OBJECTIVETo examine the value of neurodevelopmental examination, fragile X testing, iron studies, and other screening procedures in children with mild to moderate learning difficulties.
DESIGNA cross sectional case-control study.
SUBJECTSA 34% random sample (n = 130) of children with mild to moderate learning difficulties born between 01/07/83 and 30/06/84 and resident in North and West Belfast. Controls were 130 children without learning difficulties matched for age and geographical area.
RESULTSThe prevalence of mild to moderate learning difficulties in North and West Belfast was 16%; 115 (89%) of the learning difficulties group and 80 (58%) of the control group consented to participate. Children in the learning difficulties group scored significantly lower in neurodevelopmental testing and were more likely to fail their audiometry assessment than controls. Children in the learning difficulties group were also more likely to be anaemic and had lower serum iron and transferrin saturation than controls. No cases of fragile X were identified. Thyroid function tests and urinary amino acids were all within normal limits There were no significant differences in anthropometry, head circumference, or formal neurological examinations.
CONCLUSIONSChildren with learning difficulties are more likely to be neurodevelopmentally immature and iron depleted than controls. Iron depletion should be aggressively sought and treated. The role for routine assessment for fragile X, thyroid function tests, and amino acid chromatography is doubtful.

Keywords: neurodevelopmental screening; learning difficulties; iron; fragile X syndrome.