Rehabilitation of Adolescents with Learning Disorders
Possibilities and Limitations
Child and Adolescent Unit, Community Mental Health Center Byron-Kesariani, Psychiatric Department, University of Athens

Introduction: In recent years,a significant increase in the number of adolescents attending the child psychiatry Service of the Psychiatric Department of the University of Athens has been observed. The cognitive competend expands during adolescence with a gradual acquisition of the capacity for abstract thought and correlations. Abstract and concrete thought alternate, especially in early adolescence. Symbolic use shifts away from prompts to communication symbols. The adolescent's greater capacity for hypothetical thought can enhance his awareness of the variety of emotions for the object itself and the difference between the quality of the object and the existing emotion for it. The development of the associative and reasoning ability, the increasing capacity for hypothesising and theoretical pursuits enhances social and scholastic intergration, as well as his self-appreciation in his relation with the “rival” adults. It also increases the capability for introspection and the ability to reflect on emotions.

These novel cognitive capacities of the adolescent allow him to meet the increased school requirements. Nevertheless, in various situations it is possible that the adolescent will not be able either to make use of or even to acquire them. Due to the increased school requirements, pre-existing learning disorders of either the developmental type or of mental retardation may eventually surface and make it difficult for the adolescent to meet school requirements adequately. Moreover, emotional reasons, which can sometimes pertain to temporary mental disturbances inherent in adolescence and at other times to genuine mental disturbances, can affect adversely the adolescent's performance. it has been found that children who exhibit learning disorders of the developmental type present in adolescance with a high incidence of major mental disturbances, mainly depression.

The parents' attitude plays a significant role that can occasionally aggravate the adolescent's learning difficulties when it is characterised by excessive and unrealistic demands and ignores his emotional needs. this is often further reinforced by the social reality, which requires that the pupil relinguish his adolescent identity in order to conform to the school system.

With respect to the above, the diagnostic and therapeutic approach of adolescents who present with learning difficulties should take into account not only biological, individual and developmental learning capacities but also their mental, emotional reality, as determined by the particularity of each developmental stage of adolescence.

The aim of the present study is to record the school learning disorders of the adolescents who attended the Pedopsychiatric Service during the years 1996-2000 and to assess the proposed method of their rehabilitation.

Method: From a total of 290 adolescents, aged 12-18, who were examined in our Unit during the aforementioned period of time, 53 presented with school learning disorders. From the history of the attending adolescents, the following features were recorded: sex, age, school attendance, way of referral, demand, diagnosis, method of treatment, compliance with the proposed treatment. The diagnosis was made according to the classification of Mental Disturbances and Behavioural Disorders of the World Health Organisation. For the statistical analysis Univariate Logistic Regression was used.

Results: It has been shown that learning disorders is the most prevalent diagnosis made in adolescents who attend our Unit: 53/290(18,6%). this frequency corresponds to the frequency of the “problem” because of which they attend. With respect to age, the distribution curve is normal (mean 14.7+1.7). The distribution with respect to sex has revealed a prevalence of boys (56%), while with regard to the school level Gymnasium (secondary compulsory education) students were prevalent (56%). The highest rate of referrals was by school (31,8%), immediately followed (28,4%) by self-referral, that is, by the adolescent's family.

Conclusions: It appears that the school record is related to the adolescent's personal progress and the acquisition for a title of studies, especially that of the completion of compulsory education (Gymnasium). This might be the cause of the higher rate (56%) of diagnosis of school learning disorders in adolescent students in Gymnasium compared to that of adolescent students in Lyceum (44%). While there has been recorded an increase in the attendance of adolescents with disorders of scholastic abilities, their treatment has been shown to be insufficient. A demand originating from the adolescent himself is relatively rare (8%). The adolescent usually finds himself in a passive position. Sometimes he repeats the adult's demand “I am a bad student”, at other times he has a different demand, and more often he has no demand. The expression of the adolescent's demand can be the most important step for therapeutic treatment.

It is well known that the possibility of rehabilitation for these disorders after entering adolescence is limited. It has been established that the main course of treatment is limited to diagnostic evaluation and issuing assessments that will be used for lenient marking at school. Psychotherapeutic and psychopedagogical treatment has been the way to address individual cases.

Key words: Learning disorders, adolescent, rehabilitation.