LEARNING DISORDERS

Learning disorders in a child or adolescent are characterized by academic underachievement in

reading, written expression, or mathematics comparison with the overall intellectual ability of a
child. Children with learning disorders often find it difficult to keep up with their peers in certain
academic subjects, whereas they excel in others. Learning disorders result in underachievement
that is unexpected based on the childs potential as well as the opportunity to have learn more.
When academic achievement testing is administered along with a measure of intellectual
capability, this psychoeducational assessment can identify learning problems. Learning problems
in a child or adolescent that are identified in this manner can establish eligibility for academic
services through the public school system.
Reading Disorder:
Reading disorders are present in approximately 75 percent of children and adolescent with
learning disorders. Students who have learning problems in other academic areas most
commonly experience difficulties with reading as well. Reading disorder is defined as reading
achievement below the expected level for a childs age education and intelligence, with the
impairment interfering significantly with academic success or the daily activities that involve
reading. According to DSM-IV-TR, if a neurological condition or sensory disturbance is present, the
reading disability exhibited exceeds that usually associated with the other condition.
Epidemiology:
An estimated 4 percent of school-age children in the United States have reading disorder;
Prevalence studies find rates ranging between 2-8 percent. Three to four times as many boys as
girls are reported to have reading disability in clinically referred samples. Careful epidemiological
studies have found closer to equal rates of reading disorders among boys and girls. Boys with
reading disorder may be referred for evaluation more often than girls because of frequently
associated behavior problems. No clear gender differential is among adults who report reading
difficulties.
Comorbidity:
Children with reading disorder are at higher than average risk for attentional problems,
disruptive behavior disorders, and depressive disorders, particularly older children and
adolescents. Data suggest than up to 25 percent of children with reading disorders also have
ADHD. Conversely, it is estimated that between 15 and 30 percent of children diagnosed with
ADHD have learning disorders.
Etiology:
Data for cognitive, neuroimaging and genetics studies indicate that reading disorder is most
accurately describe as neurobiological disorder with the genetic origin. It is currently believed to
reflect a deficiency in processing sounds of spoken language. That is, children who struggle with
reading have a deficit in phonological processing skills. These children cannot identify effectively
the parts of words that denote specific sounds, which leads to grave difficulty in recognizing and
sounding out words. Children with reading disorders are slowing than average in naming letters
and numbers, even when controlling for IQ. thus, the core deficits for children with reading
disorders lies within the domain of language use.
Diagnosis:

Reading disorder is diagnosed when a childs reading achievement is significantly below that
expected of a child of the same age and intellectual capacity. Characteristic diagnostic features
include difficulty recalling, evoking and sequencing printed letters and words; processing
sophisticated grammatical constructions; and making inferences.
DSM-IV-TR Diagnostic Criteria for Reading Disorder:
A. Reading achievement, as measured by individually administered standardize test of
reading accuracy or comprehension, is substantially below that expected given the
persons chronological age, measured intelligence, and age appropriate education.
B. The disturbance in criterion A significantly interferes with academic achievement r
activities of daily living that required reading skills.
C. If a sensory deficit is present, the reading difficulties are in excess of those usually
associated with it.
Coding note: if a general medical(e.g. neurological) condition or sensory deficit is present, code
the condition on axis III
Treatment:
Most current remediation strategies for children with reading disorder are characterized by direct
instruction of the various components of reading that focus a childs attention to the connections
between speech sound and spelling.

Mathematics Disorder:
Children with mathematics disorder have difficulty learning and remembering numerals, cannot
remember basic facts about numbers, and slow and inaccurate in computation. Poor
achievement in four groups of skills have been identified in mathematics disorder: linguistic skills
( those related to understanding mathematical terms and converting written problems into
mathematical symbols), perceptual skills (the ability to recognize and understand symbols and
order clusters of numbers), mathematical skills (basic addition, subtraction, multiplication,
division, and following sequencing of basic operations), and attentional skills (copying figures
correctly and observing operational symbols correctly). A variety of terms over the years,
including dyscalculia, congenital arithmetic disorder, acalculia, Gerstmann syndrome, and
developmental arithmetic disorder have been used to denote the difficulties present in
mathematics disorder.
Epidemiology:
Mathematics disorder alone is estimated to occur in about 1 percent of school-age children, that
is, approximately 1 of every 5 children with learning disorder. Epidemiological studies have
indicated that up to 6 percent of school-age children have some difficulty with mathematics.
Mathematics disorder may occur with greater frequency in girls. Many studies of learning
disorders in children have grouped several disorders together rather than separating them into
individual disorders, which makes it more difficult to ascertain the precise prevalence of
mathematics disorder.
Comorbidity:
Mathematics disorder is commonly found comorbid with reading disorder and disorder of written

expression. Children with mathematics disorder may also be at higher risk for expressive
language disorder, mixed receptive-expressive language disorder, and developmental
coordination disorder.
Etiology:
Mathematics disorder, as with other learning disorders, is probably at least partly caused by
genetic factors. An early theory proposed a neurological deficit in the right cerebral hemisphere,
particularly in the occipital lobe areas. These regions are responsible for processing visual-spatial
stimuli that, in turn, are responsible for mathematical skills. This theory, however, has received
little support in subsequent neuropsychiatric studies.
DSM-IV-TR Diagnostic Criteria for Mathematics Disorder:
A. Mathematical ability, as measured by individually administered standardized tests, is
substantially below that expected given the persons chronological age, measured
intelligence, an age-appropriate education.
B. The disturbance in Criterion A significantly interferes with academic achievement or
activities of daily living that require mathematical ability.
C. If a sensory deficit is present, the difficulties in mathematical ability are in excess of those
usually associated with it.
Coding note: If a general medical (e.g., neurological) condition or sensory deficit is
present, code the condition on Axis III.
Treatment:
Mathematics difficulties for children has not been shown to be stable disorder over time, thus,
early intervention may lead to improved skills in basic computation.

Disorder of Written Expression:

Written expression is the most complex skill acquired to convey an understanding of language
and to express thoughts and ideas. Writing skills are highly correlated with reading for most
children; for some children, however, reading comprehension may far surpass their ability to
express complex thoughts. Written expression in some cases is a sensitive index of more subtle,
although impairing, deficits in language usage that typically are not detected by standardized
reading and language tests.
Epidemiology:
The prevalence of disorder of written expression alone has not been studied, but as with reading
disorder, it is estimated to occur in approximately 4 percent of school-age children. The gender
ratio in writing disorder is believed to be similar that of reading disorder, occurring in about three
times as many boys. Disorder of written expression often occurs with reading disorder but not
always.
Comorbidity:

Children with writing disorder are at higher risk for a variety of other learning and language
disorders, including reading disorder, mathematics disorder, and expressive and receptive
language disorders.
Etiology:
Causes of writing disorders are believed to be similar to those of reading disorder, that is , a
deficit in the use of the components of language related to letter sounds. It is likely that genetic
factors are significant in the development of writing disorder. Writing difficulties often accompany
language disorders in which a given child may have trouble understanding grammatical rules,
finding words, and expressing ideas clearly.

DSM-IV-TR Diagnostic Criteria for Disorder of Written Expression:

A.Writing skills, as measured by individually administered standardized tests (or functional
assessments of writing skills), are substantially below those expected given the persons
chronological age, measured intelligence, and age-appropriate education.
B.The disturbance in Criterion A significally interferes with academic achievement or activities of
daily living that require the composition of written texts (e.g., writing grammatically correct
sentences and organized paragraphs).
C.If a sensory deficit is present, the difficulties in writing skills are in excess of those usually
associated with it.
Coding note: If a general (e.g., neurological) condition of sensory deficit is present, code the
condition on Axis III.
Treatment:
Remedial treatment for writing another disorder, such as ADHD or a depressive disorder, is
preventing a child from being able to concentrate on writing task in the absence of writing
disorder itself.