Translated by Céline BALLUAIS

Learning difficulties are different from specific troubles. Their origins vary from the most affective to the most neurological. But usually it is about the DYS diseases (dyslexia, dyspraxia, dysphasia, dyscalculia, dysgraphia, dysorthographia). Depending on the cases and the moments, their efficient treatment will be center around one of those three principals practitioner (psychologist - psychotherapist or psychomotor therapist or speech therapist), most of the time in association with the two other one. Below, definitions of learning specific troubles and, in another tab dyspraxia. The psychomotor therapist usefully steps in for most of these DYS. 

THE SPECIFICS TROUBLES OF LEARNING 

Translated by Céline Balluais 

The specifics troubles of learning interfere with success at school and daily life. It is necessary to clearly distinguish the difficulties of learning troubles. The notion of learning difficulties correlate with “obstacles to learn which are temporaries and occasional” (D. DESTREMPEZ-MARQUEZ and L. LALFEUR, 1999, p14).

However, the learning trouble is persistent. It is a real handicap. 
According to D. DESTREMPEZ-MARQUEZ and L. LAFLEUR (1999, p16), learning troubles correspond to “a heterogeneous set of troubles caused by a dysfunction obvious or not of the central nervous system. (…) They are intrinsic to the person (…) and manifest themself by a delay or by difficulties to concentrate, to memories, to communicate, to read, to write, to spell, to calculate, to be social, and on affective maturity.”

The specifics troubles of learning aren’t the result of an intellectual delay, or a sensorial or motor handicap, or unfavorable conditions of the environment but these factors have to be considerate, nevertheless. Indeed, the neurological problematic or neurodevelopmental can be exaggerated by familial and social environment difficulties. 

The fourth edition revised of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) of the American Psychiatric Association and the tenth edition of the International Classification of Diseases (CIM-10) of the World Health Organization make clear the criteria to differentiate specifics troubles and not specifics troubles: 
•  Discordance criteria: between the difficulties for tests related to troubles at stake and the good performances to other cognitive tests.
•  Exclusions criteria: troubles must not have as primary cause neither a global delay, neither a sensorial handicap, neither an unfavorable environment or mental troubles recognized.
•  The trouble is due to intrinsic children factor.

Specifics troubles of learning are most commonly called “dys”. We distinguish dyslexia, dysorthographia, dyscalculia, dyspraxia, dysgraphia, dysphasia and the syndrome of hyper-kinetic trouble with attention deficit.

World Health Organization recognized dyslexia as a development trouble of school acquisitions in 1991; they estimate that it concerns 8 to 12% of the population.
It is a specific and durable trouble, which affects the identification of writing words and can be acquired or developmental. Furthermore, dyslexia often lead to transcription and spelling difficulties (dyslexia-dysorthographia) but, otherwise, there is a good comprehension and normal skills for activities that do not require reading and writing.
The diagnostic of dyslexia is, most of the time, at the end of CE1, meaning two years after the beginning of learning to read.
Researchers of cognitive sciences often try to associate dyslexia to perturbation in these fields: 

•    Phonological conscience: capacity to pay attention and manipulate sounds that compose words.
•    Sequential analyze 
•    Visual and auditory discrimination
•    Lateralization (30 to 50% of left-handed children)
•    Memorization
•    Space and time orientations 

Dyscalculia is about a severe trouble in numerical learning without any organic injury and without mental deficient.

Dysgraphia is an anomaly of cursive movement, of the conduction of the line, which is related to difficulties of coordination, unevenness of spacing between letters and words, all kind of malformations and discordances, often with a defective quality of the line. 
We distinguish five groups of dysgraphia: 
•    Stiffs
•    Soft
•    Impulsive
•    Slow and precise
•    Clumsy

Dysgnosia is a trouble of information recognition that arrives to the brain through sense organ.

 
Dysphasia is a “specific deficient of language characterize by serious problems of comprehension and/or of speaking language expression, without auditivo, mental deficient or emotional trouble”. (BENTON, 1964). 
We distinguish: 
•    Transitional light dysphasia: underachievement of speaking language acquisition mechanism
•    Development dysphasia: trouble of speaking language persistent after 6 years old
•    Severe dysphasia: absence of language around 4-5 years old or later however with a good understanding.
We make a distinction between dysphasia and aphasia, which is an important trouble of expression and understanding of language. It isn’t related to a dementia state, neither to a sensorial disease, neither to a dysfunction of pharyngolaryngeal musculature. The various aphasia depends on the location of the lesion.
We distinguish: 
•    Wernicke's aphasia: language trouble characterized by a fluent speech, absence of articulation troubles but many perturbations of speaking language understanding.
•    Broca's aphasia: articulation language trouble making an influent speech. 
•    Pure motor aphasia

Dyspraxia is a development trouble, which is a perturbation of the initiation of praxias. 
Praxias are actions that are coordinate movement system depending on a result or an intention. They are volunteer and conscious coordination, oriented to a goal and outcome of learning.
MAZEAU defines dyspraxia as a “trouble of realization of gesture due to the impossibility or the difficulty to automatically program various sensori-motor and spatiotemporal constituents of volunteer gesture”.
Different forms of dyspraxia are: 

•    Unconstructive dyspraxia, also know as gestural: trouble of succession and sequentiality of constituents of a gesture.

We find ideomotor dyspraxia, which refer to an alteration of isolated simple gesture or some fragments of a gestural sequence realized on an imitation or on an order (symbolic gesture as “bravo”, “hello”, “come here”, “shh”, etc).
But we also can find ideational dyspraxia: alteration of complex gesture, which require several steps for the realization of the gesture, the initiation of the gesture require the evocation of the finality of the action. 

•    Constructive dyspraxia: difficulties to put together pieces to built a whole. The difficulty is in the assembly of pieces, the ones with regard to the others.

We either find constructive dyspraxia not visuospatial (the constructive dyspraxia is associate to space organization difficulties), or dyspraxia visuospatial that associate a constructive dyspraxia, a trouble of the look and a trouble of space organization.

•    Oral-facial dyspraxia.

+ about DYSPRAXIA :
The psychomotor therapist is the principal actor to help for the diagnostic and the care of the dyspraxic. Dyspraxia can cause a big suffering. It can take many forms. We discovered it recently, its diagnostic is difficult and complex because it can be confuse and complicated with others school difficulties. 
You can find here the description of the difficult journey of Theo and his parents that shows the difficulty to put a diagnostic and to find the best way to help a child. This case is developed, threw doubt on, decrypted and explained in our book “Difficultés scolaires” (school difficulties) where you can also find explanations about DYSPRAXIA. 

THEO: HELP THINGS HOLD IT AGAINST ME!

Theo, 11 and half years old, is in first year of high school. The assessment of the first school report of the year alerted his parents: “Work only if he feels like doing it”. ”I don’t understand what is going on, Theo gives all the right answers orally. In writing, one day it is very good, the day after, it doesn’t get along well anymore.” or “Lazy student”. His parents watch out closer his school bag, his notebook, his files. Everything is jumble and disorganized. Life science schemas are stick on the English book, the homework are writing on the agenda at the wrong day. When Theo, in class, writes a statement from the board, without noticing anything, he write only one part of it, and at home, he realizes that a paragraph is missing. His parents think that he has some difficulties to acquire the autonomy necessary for the first year of high school and they hire a student to help him to do his homework, specifically in math. But his results aren’t better. His mother makes an appointment with his teachers.
The teacher of Math explains that Theo has difficulties in geometry and can’t reproduce a schema; the sport teacher says that his inefficiency is scary! As he is bad in collective sports, we can offer him in rugby only a replacement post and Theo spend all the games waiting on the sideline. Nobody wants to take him in his foot team. At tennis, he runs after the ball instead of playing with his racket. In geography, he is slow every time it is about drawing a map or to built a chart. 
The French teacher? He can sees that he seems to like reading and knows many things, but he writes in transverse on the paper, not on the lines. (His writing, more or less legible in Primary school, isn’t anymore and Theo is more and more stuck in front of writing). 
We talk about repeating a year. Distress of the parents; Thinking that it is about dyslexia and dyscalculia, they consult a speech therapist that he sees two times a week but whom doesn’t find out the real problem. Theo doesn’t progress. At home, he always has been a walking disaster and a wrecker. He brings down everything around him, breaks a lot, he only closes the washing machine door and explode the hinge of the door! “But be careful!” is the sentence that he hears the most. He doesn’t stand a chance to a fastener and if he wants to unroll some toilet paper, he unrolls 3 meters or tears out the holder!
11 years old and he still doesn’t know how to use a knife and his dad is making a little fun of him. He only starts to be able to do knot with his laces but he doesn’t know how to tight them. So, they lie on the floor. When he gets on his bicycle, his balance is unstable. His mother feels like all of that isn’t normal. 
Conclusion? Here we are, more than half of the school year and Theo isn’t working at all anymore. Just like if he would rather been seen as a lazy boy than to show that he can’t do it, it is less depreciating. Sometimes, he is discouraged, sad (“Why am I like that?”), uncomfortable in his own skin, rejected by his classmate. He never wants to go to a sleepover organized by friends. As he doesn’t have the sense of direction, even in his own area, he couldn’t go and come back by himself. 

Flashback: Theo, the third child of the siblings, is a premature baby (seven months and half of pregnancy). Little, his favorite game is to hit and hit again on his garage or his crane until it breaks! He gets angry often when he can’t realize what he wants, doing his constructions games. Or he trough away of rages a puzzle unfinished. He doesn’t like to climb on the module of the square (such as the “chicken cage”). The adaptation is ok in nursery school. But during the second year, his parents consult a psychomotrician adviced by their family doctor because the teacher thinks he is immature for his age on a psychomotor level. Theo, she says, is really clumsiness for early-learning exercises that request application and for games. He can’t jump and he can do some trip to himself! The psychomotor therapist assumes that it is an old psychomotor backwardness, maybe in relation with his prematurity. He makes him work on his dexterity and progress. But a moving house interrupts this help at the end of the second year of nursery school. The psychomotor therapist advices to pursuit the reeducation to prepare graphic and writing, but the parents neglect the approach. In primary school, Theo learns quickly to read, but to write and to form his letters seem to exhaust him and he sigh of exasperation. He always has to think about the way to form a letter, and his mother spends many times with him at night to try to make him write cleanly and on the line. The teacher of third grade relates his difficulties to the fact that he is left-handed. During these 5 years of primary school, any other suspected a more important problem.
He is appreciated because smart, nice, pleasant, enjoys life, he participate well in class. During fourth and fifth grades, he likes to read and he’s got all the answers in history. His intelligence is going really fast but his gestures aren’t following. When by chance, rarely, he starts to play with others, his clumsy face makes them laugh and he answer to the taunt by fighting them. The Director of the School is complaining about it. As he still can’t button up his jeans after sport or going to toilet, at school, he only wears joggings. He has some difficulties to situate himself in time. “You come back in one hour” or “at noon” means nothing to him. In family, it is hard for him to find his place in the sibling. Society games always end badly, he gets mad against his brother and his sister.

BACK TO THE SQUARE ONE

The end of the first year of High School. His father and his mother believe in nothing and nobody anymore. All of the approach and consultation that they undertaken until now didn’t help. We have to start from zero and see a psychologist? Who can help them? Explain to them what is going on with their son?

EPILOGUE. October. He is in second year of high school. On the sidewalk of high school a Saturday morning, Theo’s mother discuss with another student mother about her son problems. This lady is psychologist. Happy chance. She asks to Theo mother “3 little silly questions”: does he know to thigh his shoes lace? Cut his meat? Play to balloon? No! Isn’t he dyspraxia? Theo mother never heard about this word. Back home, she writes it on Internet. Reading the description of this handicap, she feels like she sees exactly her son and says it to him. Both of them, paradoxically, feel a big relief. Few months later, the diagnostic is confirm by a specialize Hospital Service. Theo is 12 years old.