The child neurologists’ approach to the mental status examination of children with learning problems was examined by questionnaires randomly submitted to 163 attendees at the 16th Annual Child Neurology Society Meeting in 1987 and the results are reported from the Division of Neurology, Department of Pediatrics, Newington Children’s Hospital and Biostatistics Research Center, Farmington, Connecticut. The child neurologists were asked to score on a five point scale (0=never, 5=always) the frequency with which they test for 30 mental status items when examining school age children who present with learning problems. The 30 items were divided into six categories of mental status function in ascending order of complexity: 1) fundamental processes including level of responsiveness, attention and/or vigilance; 2) Language including handedness, spontaneous speech, comprehension, reading, writing, spelling; 3) Memory including orientation, immediate recall, remote memory; 4) Constructional ability with reproduction drawings, drawings to command and block designs; 5) Higher cortical function for fund of information, proverb interpretation, similarities, calculations; 6) Related cortical function including ideomotor apraxia, ideational apraxia, right/left disorientation, finger agnosia, childhood Gerstmann, visual agnosia, and geographic orientation. The responders’ frequency of testing in the six major categories of mental status function was independent of their age, sex, board certified/eligible status, type of practice and years elapsed since completion of training. The results of the entire group and comparisons among demographic subgroups demonstrated a progressive decline in testing frequency with increasing complexity of mental status function. Higher and related cortical functions were tested significantly less often in children with learning problems than were the more elementary categories of mental status function. The diagnosis ascribed to a child with learning problems appeared to be based on findings other than those provided by the mental status examination. 
COMMENT. Pediatric neurologists are often consulted for the assessment of children with learning disabilities since many childhood learning disorders appear to have a primary neurologic basis. Sensory impairment, epilepsy, or progressive neurologic disease may require exclusion. The use of stimulant medication may need to be justified or its safety determined. The neurologist will use the all important history, the physical and neurological examination, an EEG and sometimes a neuro-imaging test. He will also rely on teacher evaluations and psychological testing by the school or privately. The results of this survey indicate that although the elementary aspects of mental status function (e.g. attention, vigilance, language) are almost always assessed in these children, higher and related cortical functions are relatively ignored or may not be practical in an office setting. However, it is relatively simple to test for Gerstmann syndrome and for defects in the fund of information and calculations. The Draw A Man test and parts of the Stanford-Binet may also be included in a routine pediatric neurology examination. Clinical-neuroanatomic correlations in LD children are not uncommon, particularly when the neurological exam is supplemented with the EEG, evoked potentials, and magnetic resonance imaging. In the future perhaps the mental status examination will play a larger role in the diagnosis of children with learning problems in the child neurologist’s office setting.