A learning disability (LD) is a neurological disorder presenting as difficulty in the acquisition and use of language, reading, mathematical abilities, or social skills in a patient with otherwise normal intelligence, that has persisted for at least 6 months, despite the provision of interventions that target those difficulties. The prevalence of LD is 5% to 15% among school-age children across different languages and cultures. Prevalence in adults is unknown but has been estimated as 4%.

Learning disabilities can also interfere with higher-level skills such as organization, time planning, abstract reasoning, long or short memory, and attention. It is important to realize that learning disabilities can affect an individual’s life beyond academics and can impact relationships with family, friends, and in the workplace. Approximately 50% of children with LD have associated attention deficit hyperactivity disorder (predictive of worse mental health outcome), conduct disorder, anxiety disorders, and mood disorders. School dropout and co-occurring depressive symptoms increase the risk for poor mental health outcomes, including suicidality, whereas high levels of social or emotional support predict better mental health outcomes.

Dyslexia is the most common LD (80%). Dyslexia is a chronic condition in which there is impaired ability to break down words into their basic phonologic parts, resulting in difficulties in decoding and identifying the words. This will often present in a child having difficulty learning to read, and often persists into adulthood.

In pre-schoolers, LD usually becomes evident as language delay. A child who has no meaningful words by age 18 months, no meaningful phrases by age 24 months, or speech unintelligible to strangers by age 3 years should be evaluated for hearing loss and referred for speech therapy evaluation. In school-age children, LD usually becomes evident as unexpected school difficulty or failure. Manifestations may be behavioral (e.g., a reluctance to engage in learning; oppositional behavior); adults may avoid activities that demand arithmetic or reading. There is often a family history of learning problems. Prematurity or very low birth weight increase the risk for specific learning disorders, as does prenatal exposure to nicotine. Psychometric evaluation should be administered to children with school performance difficulties to verify normal intelligence and failure to achieve the expected level of performance. LD may not manifest fully until later school years, by which time learning demands have increased and exceed the individual’s limited capacities.

In the United States, the clinician should assure parents that, under the Individuals with Disabilities Education Act, public schools are mandated to meet the educational needs of all developmentally disabled children. This act further mandates the proper assessment of educational needs (including psychometric testing) and enactment of an individual education plan (IEP). All of this assessment should be performed in a timely fashion.

Counseling for associated social, behavioral, and psychiatric symptoms should be tailored to the child’s specific deficit. Parent support and consultation can help the family develop a supportive home environment and a behavioral reinforcement program.