Specific Learning Disorder

Children learn reading, writing, and math skills through both practice and school lessons. These skills grow over time, so problems might show up at different times as they learn and go to school. The term Specific Learning Disorder is a broad term for children who have trouble learning to read, write, and/or do math.

Children with Specific Learning Disorder with Impairment in Reading find it very hard to learn how to read. They often have trouble reading new words, recognizing words they already know, reading at a good speed, and understanding what they read. People often use the term Dyslexia for children with reading problems. Dyslexia means having trouble with recognizing words, sounding out new words, and spelling. Children with Dyslexia might also have trouble reading at a good speed, understanding what they read, and recognizing punctuation, capital letters, and sentence structures.

Some children may only have trouble with writing, like spelling, grammar, punctuation, sentence structure, and overall writing. These problems are called Specific Learning Disorder with Impairment in Written Expression. People sometimes use the term Dysgraphia for children with writing problems. Unlike children with Dyslexia, those with Dysgraphia do not have both reading and writing problems. However, some might also have trouble with fine motor skills, like holding a pencil or forming letters, and writing can be very tiring for them.

Children who have a very hard time learning and doing math might have a math problem called Specific Learning Disorder with Impairment in Mathematics, sometimes called Dyscalculia.

Having Specific Learning Disorder does not mean a child has an intellectual problem. In fact, some children with Specific Learning Disorder might be smarter than average. Some children with learning problems keep up in school by working much harder than their classmates, but most need special teaching to get better at reading, writing, and/or math.

What are the symptoms of Specific Learning Disorder?

Core Symptoms:

Symptoms of a reading impairment or Dyslexia:

– Reading single words incorrectly

– Reading single words slowly or with hesitation

– Guessing words instead of reading

– Slowly or with effort sounding out words

– Difficulty understanding what is read or finding meaning in text

– Trouble learning, remembering, and using spelling rules

Symptoms of a written expression impairment or Dysgraphia:

– Trouble with writing mechanics, like spelling, grammar, punctuation, and sentence structure

– Trouble organizing writing (e.g., having great ideas but struggling to write them down)

Symptoms of a mathematics impairment or Dyscalculia:

– Poor understanding of numbers and their size

– Counting on fingers instead of remembering basic math facts

– Struggling with calculations or getting lost in steps

– Mixing up calculations during math problems

Associated Symptoms:

These may show up early in childhood, even before learning to read or write:

– Early speech delays

– Trouble learning simple rhymes

– Trouble learning left from right

– Trouble following directions

– Trouble learning or remembering game rules

– Trouble learning letters or sounds

– Avoiding or refusing book activities

Later difficulties with reading and writing may include:

– Understanding a story’s sequence of events

– Organizing events when writing a story

– Understanding relationships

– Making inferences or “reading between the lines”

These may show up early in childhood, even before learning math:

– Learning to count later than others

– Losing track when counting

– Trouble recognizing numbers

– Trouble telling left from right

– Trouble reading clocks and telling time

– Trouble using money to pay or make change

How is Specific Learning Disorder diagnosed?

Specific Learning Disorder is diagnosed by a team of experts, like child psychiatrists, psychologists, special educators, and other specialists (e.g., speech-language pathologists). These experts use tests to see if a child’s reading skills are lacking and look for other reasons for the problem, like hearing issues or social, environmental, or thinking factors. A diagnosis of Specific Learning Disorder with Impairment in Reading (Dyslexia), Impairment in Written Expression (Dysgraphia), or Impairment in Mathematics (Dyscalculia) can only be made if a child’s problems have lasted for at least six months despite proper teaching and help. Usually, children need to be school-aged (or have had early reading lessons) to get a correct assessment.

Specific Learning Disorder facts

Worldwide prevalence:

The percentage of school-age children and adolescents with ASD varies from study to study, ranging from 5% to 15%.

Impact of the condition in Brazil:

A study with public school students from 2nd to 6thgrades in 4 of the 5 Brazilian regions found a prevalence of 7.6% for learning disorders with global impairment, 5.4% for impairment in written expression, 6.0% for mathematics and 7.5% for impairment in reading.

Genderratio:

The ratio of boys to girls with ASD is believed to range from 2:1 to 3:1, although most studies focus on reading difficulties.

Most common age of onset:

Although there are no specific data for pASD, the peak age for neurodevelopmental disorders in general is 5.5 years.

Proportion of cases arising before age 18:

Although data specific to pASD are limited, 83.2% of neurodevelopmental disorders in general are diagnosed before age 18.

What are the associated factors for Specific Learning Disorder?

Some common factors linked with Dyslexia are:

– Genetic and familial factors: There is a higher risk for children with a dyslexic close family member.

– Exposure to toxins: Exposure to certain toxins (e.g., lead, flame retardants) before birth or during early years.

– Preterm delivery or low birth weight.

– Cognitive factors: These may include verbal problems (e.g., poor vocabulary; trouble with describing, grammar, and syntax errors in speech), phonological problems (e.g., leaving out, replacing, and switching consonants), and problems in sensory, hearing, speech, or visual processing.

Socioeconomic factors, like poor access to good school resources, can limit a child’s reading, writing, and/or math skill learning. However, SLD is not just a result of not having learning chances or poor teaching. While lack of teaching or learning chances do not cause SLD, they may lead to weak reading, writing, and/or math skills or symptoms that look like SLD.

What other disorders co-occur with Specific Learning Disorder?

Even though each child with SLD is different, problems in one learning area (i.e., reading, writing, or math) often happen with another learning area (e.g., a child with Dyslexia may also have Dyscalculia), as well as with other neurodevelopmental disorders, including Attention-Deficit/Hyperactivity Disorder (ADHD), communication disorders, Developmental Coordination Disorder, and Autism Spectrum Disorder (ASD). Other mental health disorders that might commonly happen together include anxiety disorders, depressive disorders, and bipolar disorders.

How is Specific Learning Disorder treated?

Children with SLD need to learn specific skills to read, write, and solve math problems better. These skills are usually taught by special teachers. Treatment can also include help to make children feel less worried or embarrassed about their learning problems.

Children with SLD may also need extra help to stay on track in their classes, manage homework, and handle test pressures. Special teachers and tutors can help students learn how to do reading and writing tasks, and/or math problems in better ways.

Children with SLD also benefit from direct classroom help, as well as assistive tools and technology. Some common examples include math calculators, graph paper, math apps, and time management tools like phone alarms.

Students with SLD have certain rights by law after being evaluated and diagnosed through the Centers of Multidisciplinary Assessment, Counseling, and Support (KEDASY). They may also get educational accommodations in school, for example:

– In the classroom:

– Not having to read aloud in class

– Not having to learn a foreign language

– Online access to the teacher’s book

– Outside of the classroom:

– Extra educational help through a school’s Inclusion Department

– Extra help through Remedial Teaching (i.e., Supplementary Teaching)

– During tests:

– The option to take secondary education and panhellenic exams orally or speak answers instead of writing them

– Examiner prompts to help with oral answers

– Writing answers first in a notebook and using notes when answering

– Reminders to focus and finish on time for students

– With approval, time extensions may be granted on National exams

– Extra time may be given on quarterly tests

References

Clinical description, symptoms, and diagnostic information

– American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Fifth edition text revision DSM-5-TR. American Psychiatric Association Publishing.

– Child Mind Institute. (2023, January 9). Quick guide to dyscalculia. https://childmind.org/guide/quick-guide-to-dyscalculia/

– Child Mind Institute. (2023, January 9). Quick guide to specific learning disorder. https://childmind.org/guide/quick-guide-to-specific-learning-disorder/

– Martinelli, K. (2022, December 6). Understanding dyslexia: Know the signs, and how to help kids with the most common learning disability. https://childmind.org/article/understanding-dyslexia/

– Sadusky, A., Berger, E. P., Reupert, A. E., & Freeman, N. C. (2022). Methods used by psychologists for identifying dyslexia: A systematic review. Dyslexia, 28(2), 132–148. https://doi.org/10.1002/dys.1706

– Souza, J. (2023, January 9). Understanding dysgraphia: How to help kids who struggle with learning to write. https://childmind.org/article/understanding-dysgraphia/

– World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6A03 Developmental Learning Disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f2099676649

Facts

– American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Fifth edition text revision DSM-5-TR. American Psychiatric Association Publishing.

– Fortes, I. S., Paula, C. S., Oliveira, M. C., Bordin, I. A., de Jesus Mari, J., & Rohde, L. A. (2016). A cross-sectional study to assess the prevalence of DSM-5 specific learning disorders in representative school samples from the second to sixth grade in Brazil. European Child & Adolescent Psychiatry, 25(2), 195–207. https://doi.org/10.1007/s00787-015-0708-2

– Institute for Health Metrics and Evaluation (IHME). (2019). GBD compare data visualization. Seattle, WA: IHME, University of Washington. Available from http://vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)

– Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50

– Khodeir, M. S., El-Sady, S. R., & Mohammed, H. A. E.-R. (2020). The prevalence of psychiatric comorbid disorders among children with specific learning disorders: A systematic review. The Egyptian Journal of Otolaryngology, 36(1), 57. https://doi.org/10.1186/s43163-020-00054-w

– Moll, K., Kunze, S., Neuhoff, N., Bruder, J., & Schulte-Körne, G. (2014). Specific learning disorder: Prevalence and gender differences. PLoS ONE, 9(7), e103537. https://doi.org/10.1371/journal.pone.0103537

– Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7

– Vlachos, F., Avramidis, E., Dedousis, G., Chalmpe, M., Ntalla, I., & Giannakopoulou, M. (2013). Prevalence and gender ratio of dyslexia in Greek adolescents and its association with parental history and brain injury. American Journal of Educational Research, 1(1), 22–25. https://doi.org/10.12691/education-1-1-5

– Yang, L., Li, C., Li, X., Zhai, M., An, Q., Zhang, Y., Zhao, J., & Weng, X. (2022). Prevalence of developmental dyslexia in primary school children: A systematic review and meta-analysis. Brain Sciences, 12(2), 240. https://doi.org/10.3390/brainsci12020240

Associated factors

– American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Fifth edition text revision DSM-5-TR. American Psychiatric Association Publishing.

– Dulcan, M. K., Ballard, R. R., Jha, P., & Sadhu, J. M. (Eds.). (2017). Concise guide to child and adolescent psychiatry(Fifth Edition). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9781615371457

– Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50

Co-occurring disorders

– American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Fifth edition text revision DSM-5-TR. American Psychiatric Association Publishing.

– Donolato, E., Cardillo, R., Mammarella, I. C., & Melby‐Lervåg, M. (2022). Research review: Language and specific learning disorders in children and their co‐occurrence with internalizing and externalizing problems: A systematic review and meta‐analysis. Journal of Child Psychology and Psychiatry, 63(5), 507–518. https://doi.org/10.1111/jcpp.13536

– Khodeir, M. S., El-Sady, S. R., & Mohammed, H. A. E.-R. (2020). The prevalence of psychiatric comorbid disorders among children with specific learning disorders: A systematic review. The Egyptian Journal of Otolaryngology, 36(1), 57. https://doi.org/10.1186/s43163-020-00054-w

Interventions

– Datchuk, S. M., Wagner, K., & Hier, B. O. (2020). Level and trend of writing sequences: A review and meta-analysis of writing interventions for students with disabilities. Exceptional Children, 86(2), 174–192. https://doi.org/10.1177/0014402919873311

– Datchuk, S. M., Rodgers, D. B., Wagner, K., Hier, B. O., & Moore, C. T. (2022). Effects of writing interventions on the level and trend of total words written: A meta-analysis. Exceptional Children, 88(2), 145–162. https://doi.org/10.1177/00144029211027537

– Galuschka, K., Görgen, R., Kalmar, J., Haberstroh, S., Schmalz, X., & Schulte-Körne, G. (2020). Effectiveness of spelling interventions for learners with dyslexia: A meta-analysis and systematic review. Educational Psychologist, 55(1), 1–20. https://doi.org/10.1080/00461520.2019.1659794

– Hall, C., Dahl‐Leonard, K., Cho, E., Solari, E. J., Capin, P., Conner, C. L., Henry, A. R., Cook, L., Hayes, L., Vargas, I., Richmond, C. L., & Kehoe, K. F. (2022). Forty years of reading intervention research for elementary students with or at risk for dyslexia: A systematic review and meta‐analysis. Reading Research Quarterly, rrq.477. https://doi.org/10.1002/rrq.477

– Perdue, M. V., Mahaffy, K., Vlahcevic, K., Wolfman, E., Erbeli, F., Richlan, F., & Landi, N. (2022). Reading intervention and neuroplasticity: A systematic review and meta-analysis of brain changes associated with reading intervention. Neuroscience & Biobehavioral Reviews, 132, 465–494. https://doi.org/10.1016/j.neubiorev.2021.11.011

– Powell, S. R., Mason, E. N., Bos, S. E., Hirt, S., Ketterlin‐Geller, L. R., & Lembke, E. S. (2021). A systematic review of mathematics interventions for middle‐school students experiencing mathematics difficulty. Learning Disabilities Research & Practice, 36(4), 295–329. https://doi.org/10.1111/ldrp.12263

– Simms, V., Gilmore, C., Sloan, S., & McKeaveney, C. (2018). Protocol for a systematic review: Interventions to improve mathematics achievement in primary school‐aged children: A systematic review. Campbell Systematic Reviews, 14(1), 1–26. https://doi.org/10.1002/CL2.215