Specific learning disorders are neurodevelopmental disorders that are typically diagnosed in early school-aged children, although may not be recognized until adulthood. They are characterized by a persistent impairment in at least one of three major areas: reading, written expression, and/or math.

An estimated five to 15% of school-age children struggle with a learning disability.¹ An estimated 80% of those with learning disorders have an impairment in reading in particular (commonly referred to as dyslexia). Dyslexia is highly prevalent affecting 20% of the population.² Dyslexia affects male and females equally. There is a high comorbidity of specific learning disorder with other neurodevelopmental disorders (such as ADHD) as well as anxiety.¹

Specific skills that may be affected include word reading accuracy, spelling, grammar, or calculation. In addition, fluency in reading and mathematics may be noted. Difficulties with these skills often cause problems in learning subjects such as history, math, science and social studies and may impact everyday activities and social interactions.

Learning disorders are categorized as mild, moderate and severe. Accommodation and support services align with the severity to facilitate a person’s most effective functioning.

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, underemployment 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.&rdquo

Diagnosis

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:
   • Difficulty reading (e.g., inaccurate, slow and only with much effort).
   • Difficulty understanding the meaning of what is read.
   • Difficulty with spelling.
   • Difficulty with written expression (e.g., problems with grammar, punctuation or organization).
   • Difficulty understanding number concepts, number facts or calculation.
   • 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 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 difficulty in acquiring and processing language that is typically manifested by the lack or proficiency in reading, spelling and writing. People with dyslexia have difficulty connecting letters they see on a page with the sounds they make. As a result, reading becomes slow and effortful and is not a fluent process for them.

Problems in reading begin even before learning to read. For example, children may 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.

Severity Levels

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: Getting Help

Though there is no “cure,” specific learning disorder can be successfully managed throughout one’s life. People with specific learning disorders 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 specific 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 specific learning disability, the school must provide an evaluation. Those found to have specific learning disorders 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 an evaluation if they are concerned. Educational advocates may be helpful to families in the IEP process. 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 – using multiple senses.

There are no FDA approved medications for specific learning disorders. However, medications may be indicated for comorbid disorders such as ADHD and anxiety. 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. Treatment for dyscalculia often includes multisensory instruction to help kids understand math concepts. Accommodations, like using manipulative and assistive technology, can also help kids with dyscalculia.

Students with specific learning disorder often 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.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. (DSM-5) American Psychiatric Association Publishing. 2013.
2. Shaywitz SE, Shaywitz JE, Shaywitz BA. Dyslexia in the 21st century. Current Opinion in Psychiatry. 2021;34(2):80-86.
3. 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.
4. Gabbard, GO. Gabbard’s Treatments of Psychiatric Disorder, Fifth Edition. American Psychiatric Publishing. 2014.
5. Tannock, R. DSM-5 Changes in Diagnostic Criteria for Specific Learning Disabilities (SLD): What are the Implications? International Dyslexia Association. 2014.
6. Every Student Succeeds Act: Opportunities for school psychologists. National Association of School Psychologists. Communiqué. 44(8):13, 2016.
7. Shaywitz, S. Overcoming Dyslexia, Yale Center for Dyslexia and Creativity. Random House. 2005.

Physician Review

Latoya Frolov, M.D., M.P.H.

Mary Ann Schaepper, M.D., M.Ed, DFAPA

August 2021