Learning disabilities in children with hydrocephalus

Hydrocephalus is a condition that may be congenital or acquired in origin. It is the most common congenital anomaly affecting the nervous system and is known to occur in 0.3 to 2.5% per 1,000 live births.

Hydrocephalus is a descriptive term used to denote an excess of cerebrospinal fluid (CSF) under pressure in and/or around the brain. In hydrocephalic states, the normal CSF circulation pathways may be narrowed or obstructed by either developmental or acquired abnormalities.

Treatment by shunting the CSF to another area of the body generally allows patients to lead full and active lives. An overwhelming majority of newborns with hydrocephalus will have normal life span and normal or even superior intelligence. In addition, they will enjoy normal activities and be useful members of society. However, there are complications associated with hydrocephalus, with learning disabilities being one of the most prevalent.

Learning disabilities (LD) is a term that refers to a varied group of disorders that is manifested as significant difficulties in the acquisition and use of listening, speaking, reading, spelling, writing, reasoning, or mathematical abilities. These separate types of learning disabilities frequently co-occur with one another and with social skill deficits and emotional or behavioural disorders.

These disorders are intrinsic to the individual and are presumed to de due to Central Nervous System dysfunction and hydrocephalus can cause them. Children with LD have average or above average intelligence. Currently, the most accepted approach to define a learning disability is one in which there is a significant discrepancy between a child's potential for learning and his/her achievement. Children with LD have learning difficulties in the traditional way compared to the accepted rate for their age group.

Children with hydrocephalus represent a heterogeneous group with various aetiologies and disability profiles. Over the years, continuous changes in medical care have occurred and updated information is important.

Nowadays, early diagnosis is the central focus of the treatment of children with hydrocephalus and learning disabilities. Neurosurgeons should treat hydrocephalus by introducing a shunt system in the children affected.

If a child with hydrocephalus displays early signs of learning disabilities, a neuropsychological evaluation at approximately the age of 7 may be helpful. IQ tests can also give information about cognitive strengths and weaknesses and help define how well the child processes information. The cornerstone of treatment of learning disabilities is educational therapy. This must be tailored to the individual needs, and depends on the child's learning strengths and weaknesses.

Cognitive functions in children with hydrocephalus need to be carefully assessed before school age to ensure adequate support and education. It is very important to monitor the outcome consequences of the varying trends in treatment of hydrocephalus in children, in order to be able to inform parents correctly about the prognosis and to provide the child with optimal support.

The majority of children with hydrocephalus have behavioural problems, present learning disabilities and a low average IQ. Despite average or slightly below average intelligence, children with hydrocephalus had major difficulties with learning and memory and executive functions, regardless of the aetiology of the hydrocephalus. It is therefore important to assess and understand all the aspects of cognition and behaviour in these children in order to minimise disability and enhance participation for the child.

Concluding, we must underline the fact that the quality of life for children who develop hydrocephalus and learning disabilities continues to improve. In spite of major advances in management, hydrocephalus in children still has a considerable impact on the outcome.

Technology, education and research have contributed to early diagnosis and more effective treatments. Although individuals with hydrocephalus may live near normal lives, they must always depend on their care providers for vigilance and guidance over their health care needs.

Key words: Hydrocephalus in children, congenital anomalies in C.N.S, learning disabilities.