Specific Learning Disorder

What Is Specific Learning Disorder?

Specific learning disorder (often referred to as learning disorder or learning disability, see note on terminology) is a neurodevelopmental disorder that begins during school-age, although may not be recognized until adulthood. Learning disabilities refers to ongoing problems in one of three areas, reading, writing and math, which are foundational to one’s ability to learn.

An estimated 5 to 15 percent of school-age children struggle with a learning disability. An estimated 80 percent of those with learning disorders have reading disorder in particular (commonly referred to as dyslexia). One-third of people with learning disabilities are estimated to also have attention-deficit hyperactivity disorder (ADHD).

Other specific skills that may be impacted include the ability to put thoughts into written words, spelling, reading comprehension, math calculation and math problem solving. Difficulties with these skills may cause problems in learning subjects such as history, math, science and social studies and may impact everyday activities.

Learning disorders, if not recognized and managed, can cause problems throughout a person’s life beyond having lower academic achievement. These problems include increased risk of greater psychological distress, poorer overall mental health, unemployment/under-employment and dropping out of school.

A note on terminology: Specific learning disorder is a medical term used for diagnosis. It is often referred to as “learning disorder.” “Learning disability” is a term used by both the educational and legal systems. Though learning disability is not exactly synonymous with specific learning disorder, someone with a diagnosis of specific learning disorder can expect to meet criteria for a learning disability and have the legal status of a federally recognized disability to qualify for accommodations and services in school. The term “learning difference” is a term that has gained popularity, especially when speaking with children about their difficulties, as it does not label them as “disordered.” 

• Diagnosis

  Diagnosis

  Learning disorder can only be diagnosed after formal education starts. To be diagnosed with a specific learning disorder, a person must meet four criteria.

  1) Have difficulties in at least one of the following areas for at least six months despite targeted help:

  1. Difficulty reading (e.g., inaccurate, slow and only with much effort)
  2. Difficulty understanding the meaning of what is read
  3. Difficulty with spelling
  4. Difficulty with written expression (e.g., problems with grammar, punctuation or organization)
  5. Difficulty understanding number concepts, number facts or calculation
  6. Difficulty with mathematical reasoning (e.g., applying math concepts or solving math problems)

  2) Have academic skills that are substantially below what is expected for the child’s age and cause problems in school, work or everyday activities.

  3) The difficulties start during school-age even if in some people don’t experience significant problems until adulthood (when academic, work and day-to-day demands are greater).

  4) Learning difficulties are not due to other conditions, such as intellectual disability, vision or hearing problems, a neurological condition (e.g., pediatric stroke), adverse conditions such as economic or environmental disadvantage, lack of instruction, or difficulties speaking/understanding the language.

  A diagnosis is made through a combination of observation, interviews, family history and school reports. Neuropsychological testing may be used to help find the best way to help the individual with specific learning disorder.

  Types of Learning Disorders: Dyslexia, Dysgraphia, and Dyscalculia

  Dyslexia is a term that refers to the difficulty with reading. People with dyslexia have difficulty connecting letters they see on a page with the sounds they make. As a result, reading becomes a slow, effortful and not a fluent process for them.

  Problems in reading begin even before learning to read, for example when children have trouble breaking down spoken words into syllables and recognizing words that rhyme. Kindergarten-age children may not be able to recognize and write letters as well as their peers. People with dyslexia may have difficulty with accuracy and spelling as well. It’s a common misconception that all children with dyslexia write letters backwards or those who write letters backwards all have dyslexia.

  People with dyslexia, including adolescents and adults, often try to avoid activities involving reading when they can (reading for pleasure, reading instructions). They often gravitate to other mediums such as pictures, video, or audio.

  Dysgraphia is a term used to describe difficulties with putting one’s thoughts on to paper. Problems with writing can include difficulties with spelling, grammar, punctuation, and handwriting.

  Dyscalculia is a term used to describe difficulties learning number related concepts or using the symbols and functions to perform math calculations. Problems with math can include difficulties with number sense, memorizing math facts, math calculations, math reasoning and math problem solving.

  Learning disorder can vary in severity:

  • Mild: Some difficulties with learning in one or two academic areas, but may be able to compensate
  • Moderate: Significant difficulties with learning, requiring some specialized teaching and some accommodations or supportive services
  • Severe: Severe difficulties with learning, affecting several academic areas and requiring ongoing intensive specialized teaching
• Treatment

  Treatment: Getting Help

  Though there is no “cure,” specific learning disorder can be successfully managed throughout one’s life. People with specific learning disorder can go on to become skilled learners and may be able to build on strengths that often are associated with their learning differences. People with dyslexia, for example, are often particularly creative and able to think outside-of-the-box. Having a learning disorder does not mean a person is limited in their choice of career or the opportunities for success.

  Early intervention is key for people with learning disorder. If problems are identified early, intervention can be more effective, and children can avoid going through extended problems with schoolwork and related low self-esteem.

  Under federal law, the Individuals with Disabilities Education Act (IDEA), students with learning disorders are eligible for special education services. The law requires that if a child is suspected of having a learning disability, the school must provide an evaluation. Those found to have learning disorder are eligible for special education services. A team, including school personnel and parents, will develop an Individualized Education Plan (IEP) for the student. Parents should specifically ask for evaluation if they are concerned. The federal law also requires that free appropriate public education (FAPE) be offered to all students, including those requiring special education.

  Special education services can help children with learning disabilities improve reading, writing and math. Effective interventions involve systematic, intensive, individualized instruction that may improve the learning difficulties and/or help the individual use strategies to compensate for their disorder. Education for a person with learning disabilities often involves multimodal teaching – involving multiple senses.

  Research has shown that the most effective treatments for reading disorder are structured, targeted strategies that address phonological awareness, decoding skills, comprehension and fluency. Treatments for writing problems are in two general areas: the process of writing and the process of composing written expression.

  Students with learning disorders also benefit from accommodations, such as additional time on tests and written assignments, using computers for typing rather than writing by hand and smaller class size. Successful interventions, strategies and accommodations for a child may change over time as the child develops and academic expectations change.

More information

• Understood: For Learning and Attention Issues
  • Parent resources
  • Online simulations of learning difficulties
• Learning Disabilities Association of America: Parent Resources
• Center for Parent Information and Resources
• International Dyslexia Association

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. (DSM-5) American Psychiatric Association. American Psychiatric Association Publishing. 2013.

Gerber PJ: The impact of learning disabilities on adulthood: a review of the evidenced-based literature for research and practice in adult education. J Learn Disabil 45(1):31–46, 201

Gabbard, GO. Gabbard’s Treatments of Psychiatric Disorder, Fifth Edition. American Psychiatric Publishing. 2014

Tannock, R. DSM-5 Changes in Diagnostic Criteria for Specific Learning Disabilities (SLD): What are the Implications? International Dyslexia Association. 2014.

Every Student Succeeds Act: Opportunities for school psychologists. National Association of School Psychologists. Communiqué. 44(8):13, 2016.

Shaywitz, S. Overcoming Dyslexia, Yale Center for Dyslexia and Creativity. Random House. 2005

Physician Review By:

Deepak Penesetti, M.D.
November 2018