What is a Learning Disorder? Understanding Specific Learning Disorders

Specific Learning Disorder (SLD), sometimes referred to as a learning disability, is a neurodevelopmental condition that affects how individuals acquire, retain, or apply specific categories of information or skills. It’s crucial to understand that learning disorders are not indicative of lower intelligence; rather, they reflect differences in brain wiring that impact learning processes. These disorders typically become apparent in early school years but can sometimes go unrecognized until adulthood when academic or professional demands increase. SLDs are characterized by persistent difficulties in at least one of three core areas: reading, writing, and/or mathematics.

It’s estimated that between 5% and 15% of school-aged children have a learning disability. A significant majority, around 80%, of these learning disorders involve reading difficulties, commonly known as dyslexia. Dyslexia is quite prevalent, affecting approximately 20% of the general population and impacting individuals across genders equally. SLDs frequently co-occur with other neurodevelopmental conditions like Attention-Deficit/Hyperactivity Disorder (ADHD) and anxiety disorders, highlighting the complex nature of these conditions.

Individuals with learning disorders may struggle with specific skills such as accurate word reading, spelling, grammar, mathematical calculations, or reading and math fluency. These challenges can significantly impact learning in subjects like history, science, and even social studies, and can also affect daily life and social interactions.

Learning disorders are classified into levels of severity: mild, moderate, and severe. The intensity of support and accommodations provided is determined by the severity level to ensure individuals can function effectively in their learning and daily lives.

If learning disorders are not identified and properly managed, they can lead to challenges that extend beyond academics. These can include increased psychological distress, poorer mental health outcomes, higher rates of unemployment or underemployment, and a greater likelihood of dropping out of school.

Terminology Note: While “specific learning disorder” is the clinical term used in medical diagnoses, “learning disability” is commonly used in educational and legal contexts. Although not perfectly synonymous, a diagnosis of SLD generally qualifies an individual for the legal status of having a learning disability, making them eligible for accommodations and support services in educational settings. The term “learning difference” is also increasingly used, particularly when discussing these challenges with children, as it avoids the potentially stigmatizing label of “disorder.”

Diagnosis of Specific Learning Disorders

Diagnosing a Specific Learning Disorder (SLD) involves a comprehensive assessment process to confirm that an individual meets specific criteria outlined in diagnostic manuals like the DSM-5. The diagnosis is not based on a single test but rather on a collection of evidence gathered over time. To receive an SLD diagnosis, an individual must meet the following four key criteria:

1. Persistent Learning Difficulties: The individual must demonstrate difficulties in at least one of the following areas for a minimum of six months, despite receiving targeted educational interventions and support:

   • Reading Difficulties: This can manifest as inaccurate or slow reading, reading with significant effort, and struggling to decode words.
   • Reading Comprehension Difficulties: Challenges in understanding the meaning of written material, even when able to read the words.
   • Spelling Difficulties: Significant problems with spelling accuracy, beyond what is typical for their age and education.
   • Written Expression Difficulties: Difficulties with expressing thoughts in writing, including issues with grammar, punctuation, organization, and clarity.
   • Number Sense and Math Facts Difficulties: Struggles with understanding numerical concepts, memorizing basic arithmetic facts, and grasping mathematical principles.
   • Mathematical Reasoning Difficulties: Problems applying mathematical concepts to solve problems or reasoning mathematically.

2. Substantially Below Expected Academic Skills: The individual’s academic skills in the affected area(s) must be demonstrably and substantially below what is expected for their age group. These deficits must cause significant difficulties in academic performance, occupational settings, or everyday activities. This criterion is typically confirmed through standardized achievement tests and a comprehensive clinical assessment conducted by qualified professionals.

3. Onset During School Age: While learning difficulties may not become fully apparent until adulthood when academic, work, or daily demands increase, the underlying difficulties must have originated during school-age years. This means the challenges are not a new development in adulthood but rather a long-standing pattern that may have been less noticeable earlier.

4. Exclusion of Other Causes: It is crucial to rule out other potential factors that could explain the learning difficulties. The learning problems should not be primarily due to intellectual disability, visual or auditory impairments, neurological conditions (such as a history of pediatric stroke), or external factors like economic disadvantage, lack of adequate instruction, or limited proficiency in the language of instruction. If these factors are present, they should not be the primary explanation for the learning difficulties.

The diagnostic process typically involves a combination of methods, including careful observation of the individual’s learning behaviors, detailed interviews with the individual and their family, a review of educational history and school reports, and sometimes neuropsychological testing. Neuropsychological assessments can be particularly helpful in identifying specific cognitive strengths and weaknesses, which can inform the development of personalized intervention strategies. For adults over 17, a documented history of learning impairment can sometimes be considered in place of standardized assessments if formal testing is not feasible or available.

Types of Specific Learning Disorders: Dyslexia, Dysgraphia, and Dyscalculia

In the DSM-5, the previous categories of reading disorder, mathematics disorder, and disorder of written expression were consolidated under the umbrella term Specific Learning Disorder (SLD). To specify the areas of difficulty, the DSM-5 uses specifiers, allowing for a more nuanced diagnosis. The three primary specifiers for SLD are:

1. With impairment in reading (Dyslexia)
2. With impairment in written expression (Dysgraphia)
3. With impairment in mathematics (Dyscalculia)

Dyslexia

The specifier “with impairment in reading,” often referred to as dyslexia, is used when an individual exhibits significant difficulties in reading. These difficulties can manifest in various reading subskills, including:

• Word Reading Accuracy: Struggles to read words correctly, often making errors or misreading words.
• Reading Rate or Fluency: Reading slowly and laboriously, lacking fluency and automaticity in reading.
• Reading Comprehension: Difficulty understanding the meaning of what is read, even if word reading is relatively accurate.

Dyslexia is more than just reversing letters; it’s fundamentally a language-based learning disability. Problems in reading can emerge even before formal reading instruction begins. For instance, preschool and kindergarten children at risk for dyslexia may have trouble with phonological awareness skills, such as breaking down spoken words into individual sounds (phonemes) or syllables, or recognizing rhyming words.

A core challenge in dyslexia is often the difficulty in establishing a strong connection between the letters seen on a page (graphemes) and the sounds they represent (phonemes). This grapheme-phoneme correspondence is crucial for decoding words. As a result of these underlying phonological processing difficulties, reading becomes a slow, effortful, and non-fluent process for individuals with dyslexia. They may also experience challenges with spelling and written expression, as these skills are closely related to reading and phonological processing.

Older students and adults with dyslexia often develop strategies to avoid reading-intensive tasks whenever possible. They may prefer alternative media formats like audiobooks, videos, or visual materials to access information. Reading for pleasure or tackling complex written instructions can become sources of frustration and avoidance.

Dysgraphia

When an individual’s primary learning difficulties are in writing, the specifier “with impairment in written expression,” often termed dysgraphia, is applied. Dysgraphia encompasses challenges with various aspects of writing, including:

• Spelling: Persistent difficulties with spelling accuracy.
• Grammar and Punctuation Accuracy: Frequent errors in grammar and punctuation when writing.
• Clarity and Organization of Written Expression: Difficulties in organizing thoughts logically and expressing them clearly in writing.

Similar to dyslexia, dysgraphia can have roots in pre-reading skills. Kindergarten-age children who will later be diagnosed with dysgraphia may struggle with pre-writing skills, such as recognizing and writing letters correctly compared to their peers. Dysgraphia is often described as difficulty translating thoughts and ideas into written form – essentially, the challenge of “putting thoughts onto paper.”

Dyscalculia

The third SLD specifier, “with impairment in mathematics,” or dyscalculia, is used for individuals who demonstrate significant difficulties in acquiring and using mathematical skills. These difficulties can affect various mathematical domains:

• Number Sense: A limited understanding of basic number concepts, quantities, and numerical relationships.
• Memorization of Arithmetic Facts: Trouble memorizing basic math facts, such as addition, subtraction, multiplication, and division tables.
• Accurate or Fluent Calculation: Difficulties performing accurate and efficient mathematical calculations, even simple ones.
• Mathematical Reasoning: Problems with applying mathematical concepts to solve word problems or reasoning mathematically to solve problems.

Dyscalculia is characterized by difficulties in learning number-related concepts, processing numerical information, mastering arithmetic facts, and using mathematical symbols and functions to perform calculations. It’s not just about being “bad at math”; dyscalculia represents a specific learning disability that impacts mathematical cognition.

Severity Levels of Specific Learning Disorders

In addition to specifying the domain of learning disorder (reading, writing, or math), the diagnosis of SLD also includes an indication of the severity level. This is important for guiding the intensity of interventions and support needed. There are three recognized levels of SLD severity:

• Mild: Individuals with mild SLD experience some difficulties in one or two academic areas. They are often able to compensate effectively and achieve adequately with appropriate accommodations and support services, such as extra time on tests or targeted tutoring.

• Moderate: Moderate SLD involves more significant learning difficulties. Individuals at this level require more specialized teaching approaches and may need more extensive accommodations and supportive services in school, at work, or at home. These supports are necessary for them to complete tasks accurately and efficiently.

• Severe: Severe SLD represents profound learning difficulties that affect multiple academic areas. Individuals with severe SLD require ongoing, intensive, specialized instruction throughout most of their school years. Even with significant accommodations and support, they may continue to struggle with academic tasks and may not achieve efficiency in these areas.

Treatment and Support for Learning Disorders

While there is no “cure” for specific learning disorders, they are highly manageable conditions. With appropriate interventions and support, individuals with SLDs can become successful learners and often develop unique strengths that can be leveraged. For example, individuals with dyslexia are frequently noted for their creativity and ability to think innovatively and “outside the box.”

Having a learning disorder does not predetermine a person’s career path or limit their potential for success. Early identification and intervention are critical. When learning disorders are recognized early in a child’s development, interventions are generally more effective. Early support can help children avoid prolonged struggles with schoolwork and prevent potential negative impacts on self-esteem and emotional well-being.

In many countries, including the United States, laws like the Individuals with Disabilities Education Act (IDEA) ensure that students with learning disorders are entitled to special education services in public schools. IDEA mandates that schools must provide evaluations if a learning disability is suspected. Students diagnosed with SLDs are eligible for special education and related services, such as specialized instruction, accommodations, and therapies. An Individualized Education Program (IEP) is developed collaboratively by a team that includes school personnel, parents, and sometimes the student, to outline specific educational goals and support strategies. Parents concerned about their child’s learning should proactively request an evaluation from the school. Educational advocates can also provide valuable support to families navigating the IEP process. These laws also guarantee a Free Appropriate Public Education (FAPE) for all students, including those with disabilities.

Special education services are designed to help children with learning disabilities improve their skills in reading, writing, and mathematics. Effective interventions typically involve systematic, intensive, and individualized instruction tailored to the specific needs of the learner. These interventions aim to remediate learning deficits and/or teach compensatory strategies to help individuals work around their challenges.

Currently, there are no medications specifically approved to treat specific learning disorders directly. However, medication may be prescribed to manage co-occurring conditions, such as ADHD or anxiety, which can often exacerbate the challenges associated with SLDs. Research consistently shows that the most effective interventions for SLD with impairment in reading (dyslexia) are structured, explicit, and targeted strategies that focus on building phonological awareness, decoding skills, reading comprehension, and fluency. Interventions for writing difficulties often address both the physical process of writing (handwriting, spelling) and the cognitive process of composing written expression (planning, organizing, revising). Treatment approaches for dyscalculia often incorporate multisensory instruction to help children understand mathematical concepts through different modalities (visual, auditory, kinesthetic). Accommodations, such as assistive technology, graphic organizers, and manipulatives, can also be highly beneficial for students with dyscalculia and other types of SLDs.

Common school accommodations for students with specific learning disorders include extended time on tests and assignments, the use of computers for writing tasks, preferential seating in the classroom, and smaller class sizes. The most effective interventions, strategies, and accommodations may evolve over time as the child develops, their academic demands change, and as we learn more about effective educational practices.

*Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision. American Psychiatric Association, 2022.

References

1. McDonough, E.M., Flanagan, D.P., Sy, M., Alfonso, V.C. (2017). Specific Learning Disorder. In: Goldstein, S., DeVries, M. (eds) Handbook of DSM-5 Disorders in Children and Adolescents. Springer, Cham. https://doi.org/10.1007/978-3-319-57196-6_4
2. Shah HR, Sagar JKV, Somaiya MP, Nagpal JK. Clinical Practice Guidelines on Assessment and Management of Specific Learning Disorders. Indian J Psychiatry. 2019 Jan;61(Suppl 2):211-225. doi: 10.4103/psychiatry.IndianJPsychiatry_564_18.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-Text Revision. (DSM-5-TR) American Psychiatric Association Publishing. 2013.
4. Shaywitz SE, Shaywitz JE, Shaywitz BA. Dyslexia in the 21st century. Current Opinion in Psychiatry. 2021;34(2):80-86.
5. 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.
6. Gabbard, GO. Gabbard’s Treatments of Psychiatric Disorder, Fifth Edition. American Psychiatric Publishing. 2014.
7. Tannock, R. DSM-5 Changes in Diagnostic Criteria for Specific Learning Disabilities (SLD): What are the Implications? International Dyslexia Association. 2014.
8. Every Student Succeeds Act: Opportunities for school psychologists. National Association of School Psychologists. Communiqué. 44(8):13, 2016.
9. Shaywitz, S. Overcoming Dyslexia, Yale Center for Dyslexia and Creativity. Random House. 2005.

Physician Review: Rubí E. Luna, M.D. UCLA Semel Institute for Neuroscience and Human Behavior Child and Adolescent Psychiatry Fellow, PGY-5 Member, APA Council on Communications, March 2024.