Learning Disorders

Essential Concepts

A learning disability is a significant discrepancy between assessed cognitive ability and assessed academic achievement.
Learning disorders of reading, mathematics, and written language are defined in the Diagnostic and Statistical Manual (DSM-IV-TR).
Children with learning disorders have a high prevalence of
comorbid emotional and behavioral difficulties.
Early identification and intervention are essential for optimal prevention of further learning, emotional, and behavioral problems.

Identification and intervention of learning disabilities (LDs) in children is primarily the function of the educational system. However, children with LD have many risk factors for emotional and behavioral difficulties: frustration at school, poor self-esteem, criticism by adults who don’t understand the disability, and biological vulnerabilities. It is these secondary disorders that prompt consultation to a mental health professional.

Early detection and specialized tutoring and teaching techniques may be quite helpful in improving prognosis. Additionally, it is essential that the child, his or her parents, and school personnel have a good understanding of the nature of the disability, to minimize the risk of the child “feeling stupid,” academic failure, and criticism for “not trying” or being “lazy,” which may erode self-esteem and precipitate emotional and behavioral difficulties. Because children with learning disabilities are usually bright, they are more cognizant of their difficulties than individuals with more pervasive cognitive and learning issues. It is heartbreaking to hear a child call himself “stupid” when he is quite bright but unable to read.

Basic Principles

It should not be assumed that children with special learning needs will have other psychiatric difficulties. However, children with learning disorders have a high incidence of psychiatric difficulties. An estimated 15 to 25% of children with reading disability will meet criteria for ADHD. School avoidance, depressive moods (14–32%) and anxiety disorders are also common. Overall, girls with LDs are more likely to suffer from internalizing symptoms and boys from externalizing symptoms. Additionally, learning disorders frequently co-occur. It is common for a child to demonstrate more than one learning disorder or a concomitant language disorder.

Diagnostic Criterion and Epidemiology

All learning disorders are diagnosed by the administration of an individually administered standardized measure of intelligence (such as the Wechsler Intelligence Scale for Children—WISC) and an individually administered achievement test (such as the Wechsler Individual Achievement Test—WIAT). If the academic achievement in a given area (reading, mathematics, or written language) is substantially below that expected given the person’s chronological age, education, and measured intelligence, and is functionally impairing, a learning disorder may be diagnosed. The Individuals with Disability Education Act (IDEA PL 94-142) provides for services under the classification of Specific Learning Disability. For a child to be eligible for special education services, a statistically significant difference of at least 1.5 to 2 standard deviations between assessed academic achievement and cognitive ability must exist.

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