Stupid, lazy, clumsy. These labels are not only destructive to a child's self-esteem, they also fail to recognise real neurological reasons for under-performance, a new book claims. Louise Holden reports

Many people are sceptical, if not downright opposed, to labelling children's academic and social hurdles. As neurodevelopmental research progresses, however, clinicians are discovering more about the science of certain difficulties, from poor attention to awkward motor skills. Many people are resistant to the idea of diagnosing children, giving them a medical "excuse" for what really boils down to a personality trait. What we are inclined to forget, however, is that labelling of weaknesses in nothing new. The difference is that terms such as Attention Deficit Hyperactivity Disorder (ADHD) or dyspraxia are replacing the more damaging labels of the past, such as lazy, clumsy and stupid.

In his new book, The Myth of Laziness, professor of paediatrics Dr Mel Levine addresses some of the underlying neurological gaps that can cause what he describes as "output failure" in children and adults. We are all familiar with the child who is bright, articulate, imaginative and energetic but who cannot put her thoughts on paper, complete a project or produce any evidence of her intellectual ability. These children are often described as lazy because adults cannot reconcile their apparent intellect with their poor showing at school.

Levine reminds us of the sweeping differences in our experience of life as a child and as an adult. As adults we veer towards activities that showcase our strengths and we avoid areas that we find difficult and unrewarding. We are not often tested in those areas and, as a result, we avoid the experience of failure. Children, on the other hand, are constantly tested at school in a wide range of basic skills. Of course this is for their own benefit - children with the privilege of a broad education get a real opportunity to discover themselves and the possibilities that await them. However, it can be a very stressful process for some children. If they are hampered in their efforts by what Levine calls "neurodevelopmental dysfunctions", they can experience failure on a scale that is damaging to the ego. Bright, able children who enjoy learning stumble at the point of producing their own work because of faulty wiring. The result is fear of failure and lack of productivity, Levine contends.

"As a developmental-behavioural paediatrician specialising in learning differences I have spent three decades concentrating on the varied and often subtle breakdowns within a developing brain that trip up basically bright children during their school years. In particular, I have studied a wide spectrum of dysfunctions, the very numerous discrete weaknesses that deprive so many students of success. Kids afflicted with these difficulties are the innocent victims of their own wiring. They have specific shortcomings in the areas of their minds that control essential aspects of memory, language, attention, motor function and other processes required for mastery of school subjects."

So what "neurodevelopmental dysfunctions" is the author referring to? Levine has some meaty scientific concepts to lay out for the reader, so he employs a number of case studies to illustrate various dysfunctions, their effects and therapies. He describes, for example, 11-year-old Russell Strinerg, who, despite obvious intellectual ability, never produced the goods in school. He had plenty to say for himself in class and at home, was curious, creative and enjoyed learning. However, his written work was sloppy, crude and thoughtless - it never bore out his obvious abilities. His teachers and parents assumed that he was just lazy. He had what it took, but he wasn't prepared to use it.

After a series of interviews with the child and his parents Dr Levine discovered an array of issues that were hampering Russell's output - from a weight problem to an experience with bullying. However, he also discovered that Russell had a neurological impairment that made writing an uphill struggle. Russell's "motor logic" was failing. The brain tells the muscles around the body how to complete motor tasks. The muscles in the fingers are directed to make certain shapes when writing is called for.

Russell's brain messages were not getting though to his fingers, Levine concluded. They were getting as far as his elbows and then the signal was becoming weak. It sounds absurd, until you watch a child with such a dysfunction in action. Writing becomes a "whole arm" affair with elbows clumsily directing the motion of the pen. It makes writing a tiring and awkward experience for even the most intelligent child.

Russell was concentrating so hard on getting the letters down on the page that he could not devote mental energy to formulating concepts or perfecting grammar and spelling. As a result, he could not get his sophisticated ideas on to paper. He was well able to spell when asked, but made rudimentary mistakes in writing.

Levine goes on to take the reader through a cast of seven children and their dysfunctions, which range from difficulties in planning motor tasks to recalling the skills needed to perform basic motor actions. In each case a relatively minor brain defect had wide ranging consequences in the child's life. In most cases, writing was the hurdle - the children had everything going for them, but they could not document it.

Dr Levine points out that, while children are regularly required to write all manner of texts from creative essays to mathematical equations, many adult careers require little writing. Children are daily directed to engage in one of the most demanding skills of all, which requires the co-ordination of many different neurological, physical and academic skills. It's hardly surprising, then, that one weak spot in an otherwise efficient brain is likely to become apparent when putting pen to paper. School is all about writing - imagine the trouble this causes for a child with an impairment that makes writing an insufferable endeavour.

Readers of the The Myth of Laziness may not come away convinced that no child is lazy. Some will still consider the medicalising of children's difficulties to be unhelpful and indulgent. One sinister side-effect of proscribing clinical categories to learning difficulties is overzealous medication - the number of children currently on Ritalin (a drug used in the management of ADHD) in the United States is heartbreaking and impossible to justify. At least in Levine's case there are many practical interventions suggested and medication is rarely among them.

No matter where you stand on the issue of labelling learning difficulties, one thing is certain - no child ever overcame a challenge because someone pointed out that she was stupid.