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CHAPTER 37 • Mental Disorders of Childhood and Adolescence

with dyslexia have another comorbid neurodevelopmen tal disorder (Bozatli et al., 2024). Although it is clear that no single cause will pro vide a sufficient explanation for reading disability, the underlying issue appears to be a deficit in phonologic processing , which involves the discrimination and interpretation of speech sounds. A disturbance in the development of the left hemisphere is believed to cause this deficit. Both genetic and environmental factors have been implicated in the etiology of reading disabil ity. Data from family studies show that reading disability is familial and that shared environmental factors alone cannot explain the high rate of recurrence in affected families (Gialluisi et al., 2021). Another learning disorder that is frequently comorbid with dyslexia is mathematics disorder, or dyscalculia. Dyscalculia affects approximately 5% to 7% of children worldwide (Li et al., 2023). Children with mathematics disorder struggle in comprehending even basic numeric and arithmetic concepts, despite average intelligence. This poses significant challenges due to the predominant use of numbers in everyday life that may also impact an individual’s job opportunities and learning potential as an adult. An estimated 30% to 70% of children with mathematics disorder also have dyslexia, and 11% have comorbid ADHD (Hussain & Soares, 2022). COMMUNICATION DISORDERS Communication disorders involve speech or language impairments. Speech refers to the motor aspects of speaking; language consists of higher-order aspects of formulating and comprehending verbal communication. Communication disorders can affect the individual’s ability to speak, listen, read, and write. Communication disorders are fairly common, occurring in approximately 1 in 14 children in kindergarten, with the impact gener ally persisting into adulthood. Although the exact cause of communication disorders is unknown, evidence points to a strong genetic link, with 50% to 70% of children affected having at least one family member with the dis order (National Institute of Health, National Institute on Deafness and Other Communication Disorders [NIH, NIDOCD], 2023). Language difficulties are an associ ated risk factor for reading and mathematics disorders (Duff et al., 2023). A delay in speech or language development can adversely affect the child’s socialization and education. For example, peers may rebuff or tease a child with an articulation defect or stutter, contributing to withdrawal and a negative self-image. The resulting isolation could limit opportunities to negotiate rules, take turns, and learn cooperation. These same tasks could also be dif ficult for children with language delay. For school-aged children, interventions may focus on helping the child

follow directions, understand the meaning of words being used in class, organize information, and improve speaking, reading, and writing skills (NIH, NIDOCD, 2023). EVIDENCE-BASED NURSING CARE FOR CHILDREN WITH COMMUNICATION DISORDERS Nursing assessment of children with a known specific developmental disorder includes (1) evidence of interfer ence in daily life, (2) determination of the child’s ability (and limitations) to communicate during the interview, (3) assessment of the child’s perception about their dis ability, (4) observation for impaired learning and com munication, and (5) past and current interventions for the learning or communication deficit with data gathered through direct interview of the child and significant others such as parents. Several nursing diagnoses can be generated from these data, such as impaired verbal com munication and social isolation. For the child with learning disabilities, nurses can focus on building self-confidence and helping the family connect with guidance and educational resources that support the child’s development into adulthood. For the child with communication disorders, the interventions focus on fostering social and communication skills and making referrals for specific speech or language therapy. Modeling appropriate communication in spontaneous situations with the child can be a useful intervention for some children. The following is an overview of nursing interventions for the child with specific developmental difficulties: • Introduce strategies for increasing communication skills (e.g., initiating conversation, taking turns in con versation, facing the listener). • Identify and develop specific intervention strategies for issues secondary to learning communication disor ders, such as low self-esteem. • Provide parental support for coping with the disorder. • Maintain interdisciplinary medical, dental, and speech therapy, and also educational collaboration. • Refer to learning or speech specialist for evaluation and assistance. Continuum of Care Children with learning disabilities obviously require careful psychoeducational and cognitive testing to iden tify their strengths and deficits. School or clinical psy chologists usually perform this type of specialized testing. When a learning disability has been identified, the U.S. Education for All Handicapped Children Act (Public Law 94–142) mandates that public school systems provide

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