Specific Learning Disorder

What Is Specific Learning Disorder?

Specific learning disorder is a developmental disorder that begins by school-age, although it may not be recognized until later. It involves ongoing problems learning key academic skills, including reading, writing and math.

Specific learning disorder is not simply a result of lack of instruction or poor instruction. Key skills that may be impacted include reading of single words, reading comprehension, writing, spelling, math calculation and math problem solving. Difficulties with these skills may cause problems learning in other academic subjects, such as history, science and social studies. But those problems are attributable to difficulties learning the underlying academic skills.

Specific learning disorder, if not treated, can potentially cause problems throughout a person’s life, including lower academic achievement, lower self-esteem, higher rates of dropping out of school, higher psychological distress and poor overall mental health, as well as higher rates of unemployment/under-employment.

• Diagnosis

  Diagnosis

  To be diagnosed with specific learning disorder, a person must have difficulties in at least one of the following areas. The symptoms must have continued 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)

  Reading problems can include difficulties with reading accuracy, reading rate or fluency, and reading comprehension. Dyslexia refers to learning difficulties related to word recognition, decoding and spelling.

  Problems with written expression can include difficulties with spelling, grammar and punctuation, and with clarity or organization of written expression. Dysgraphia is a term used to describe difficulties with handwriting.

  Problems with math can include difficulties with number sense, memorizing math facts, math calculations or math reasoning/problem solving. Dyscalculia is a term used to describe difficulties learning math facts and performing math calculations.

  For a person with specific learning disorder, his/her affected academic skills are substantially below what is expected for his/her age, and cause problems in school, work or daily living activities. What is the difference between having a specific learning disorder and just poor school performance? To be diagnosed with specific learning disorder, other possible causes of learning difficulties need to be ruled out.

  To receive a diagnosis, the difficulties must not be due to:

  • intellectual disabilities
  • external factors, such as economic or environmental disadvantage or lack of instruction
  • vision or hearing problems, a neurological condition (e.g., pediatric stroke) or motor disorders

  The difficulties are also not due to limited English language proficiency.

  Children with specific learning disorder are sometimes described as having “unexpected academic underachievement,” meaning that the child’s test scores or grades are significantly below what would be expected given his/her thinking and reasoning ability (cognitive ability).

  In their preschool years, children with specific learning disorder often experience delays in attention, language or motor skills. The learning difficulties are seen by the early school years in most children. However, for some the learning difficulties may not be apparent until later, when academic demands are greater. Specific learning disorder can only be diagnosed after formal education starts.

  Kindergarten-age children with specific learning disorder may not be able to recognize and write letters, may have trouble breaking down spoken words into syllables and may have trouble recognizing words that rhyme. Children in elementary school may have difficulty connecting letters with sounds, may read slowly and inaccurately, and may have difficulty with spelling or math facts.

  Adolescents and adults may still read slowly and with much effort and may have problems with writing, understanding what they read or with mathematical problem solving. Adolescents and adults may avoid activities that demand reading or arithmetic (reading for pleasure, reading instructions). They may use alternative approaches to access print (e.g., text-to-speech/speech-to-text software, audiobooks, audiovisual media).

  A diagnosis of specific learning disorder is not based on a single source of information. It is based on a combination of individual’s medical and family history, observation, interviews, history of the learning difficulty, school reports, educational and psychological assessments, and standardized tests.

  An estimated 5 to 15 percent of school-age children (and about 4 percent of adults) experience specific learning disorders. Reading disorder (dyslexia) is the most common. An estimated 70 to 80 percent of those with a learning disorder have a reading disorder.

  Specific 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

  Specific learning disorder is more common in males. People with family members with specific learning disorder are at greater risk of developing it. An estimated one-third of people with learning disabilities also have attention-deficit/hyperactivity disorder (ADHD).

• Treatment

  Treatment

  Early intervention is key in people with learning disorders. If problems are identified early, treatment can be more effective and children can avoid going through an extended period of academic failure before getting help.

  Under federal law, the Individuals with Disabilities Education Act (IDEA), students with specific learning disabilities are eligible for special education services. The law requires that if a child is suspected of having a learning disorder, the school must provide an evaluation. Specific learning disorder is primarily treated through special education services.

  While there is no cure for learning disorders, special education services can help children with learning disorder to 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 difficulties. Education for a person with specific learning disorder often involves multimodal teaching – involving multiple senses.

  Research has shown that the most effective treatments for reading disorder are structured, targeted and use strategies that address phonological awareness, decoding skills, comprehension and fluency (rate). Treatments for writing problems are in two general areas – the process of writing and the process of composing written expression. In school, students with problems with written expression may benefit from accommodations, such as the use of computer for typing rather than writing by hand, and additional time on tests and written assignments.

  Appropriate interventions, strategies and accommodations will typically change over time as the child develops and academic expectations change.

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

Physician Review By:

Ranna Parekh, M.D., M.P.H.
March 2016