Learning disorders

Definition

Learning disorders are academic difficulties experienced by children and adults of average to above-average intelligence . People with learning disorders have difficulty with reading, writing, mathematics, or a combination of the three. These difficulties significantly interfere with academic achievement or daily living.

Description

Children with learning disorders, or disabilities, have specific impairments in acquiring, retaining, and processing information. Standardized tests place them well below their IQ range in their area of difficulty. The five main types of learning disorders are reading disorders, mathematics disorders, disorders of written expression, disorders of fine motor skills , and information processing disorders.

Reading disorders

Reading disorders are the most common type of learning disorder. Children with reading disorders have difficulty recognizing and interpreting letters and words ( dyslexia ). They are unable to recognize and decode the sounds and syllables (phonetic structure) behind written words and language in general. This condition lowers accuracy and comprehension in reading.

Mathematics disorders

Children with mathematics disorders (dyscalculia) have problems recognizing and counting numbers correctly. They have difficulty using numbers in everyday settings. Mathematics disorders are typically diagnosed in the first few years of elementary school when formal teaching of numbers and basic math concepts begins. Children with mathematics disorders usually have a coexisting reading disorder, a disorder of written expression, or both.

Disorders of written expression

Disorders of written expression typically occur in combination with reading disorders or mathematics disorders or both. The condition is characterized by difficulty with written compositions (dysgraphia). Children with this type of learning disorder have problems with spelling, punctuation, grammar, and organizing their thoughts in writing.

Disorders of fine motor skills

Children with motor skill disorders (dyspraxia) have coordination problems and may have difficulty with handwriting tasks and speech patterns. Dyspraxia tends to affect boys more than girls.

Information processing disorders

Information processing disorders often occur along with other types of learning disorders. Children with this problem have difficulty processing the sensory input they receive, specifically sight and sound information. They can see and hear adequately, but they have difficulty distinguishing between different visual cues and auditory signals, and may have problems understanding spatial relationships and sequencing the sights and sounds they observe.

Demographics

Learning disorders affect approximately two million children between the ages of six and 17 (5 percent of public school children), although some experts think the figure may be as high as 15 percent. The male to female ratio for learning disorders is about five to one.

Causes and symptoms

Learning disorders are thought to be caused by neurological abnormalities or differences that trigger impairments in the regions of the brain that control visual and language processing and attention and planning. These traits may be genetically linked. Children from families with a history of learning disorders are more likely to develop disorders themselves. In 2003, a team of Finnish researchers reported finding a candidate gene for developmental dyslexia on human chromosome 15q21.

Learning difficulties may also be caused by such medical conditions as a traumatic brain injury or brain infections such as encephalitis or meningitis .

The defining symptom of a learning disorder is academic performance that is markedly below a child's age and grade capabilities and measured IQ. Children with a reading disorder may confuse or transpose words or letters and omit or add syllables to words. The written homework of children with disorders of written expression is filled with grammatical, spelling, punctuation, and organizational errors. The child's handwriting is often extremely poor. Children with mathematical disorders are often unable to count in the correct sequence, to name numbers, and to understand numerical concepts.

When to call the doctor

A child thought to have a learning disorder should undergo a complete medical examination to rule out an organic cause of the problem. This may include an eye exam by an ophthalmologist, a psychological exam by a psychologist, and an exam by an otolaryngologist (an ear, nose, and throat doctor, or ENT).

Diagnosis

Problems with vision or hearing, mental disorders (depression, attention-deficit/hyperactivity disorder ), mental retardation , cultural and language differences, and inadequate teaching may be mistaken for learning disorders or may complicate a diagnosis. A comprehensive medical, psychological, and educational assessment is critical to making a correct diagnosis.

A psychoeducational assessment should be performed by a psychologist, psychiatrist, neurologist, neuropsychologist, or learning specialist. A complete medical, family , social, and educational history is compiled from existing medical and school records and from interviews with the child and the child's parents and teachers. A series of written and verbal tests are then given to the child to evaluate his or her cognitive and intellectual functioning. Commonly used tests include the Wechsler Intelligence Scale for Children (WISC-III), the Woodcock-Johnson Psychoeducational Battery, the Peabody Individual Achievement Test-Revised (PIAT-R) and the California Verbal Learning Test (CVLT). Federal legislation mandates that this testing is free of charge within the public school system.

Treatment

Once a learning disorder has been diagnosed, an individual education plan (IEP) is developed for the child in question. IEPs are based on psychoeducational test findings. They provide for annual retesting to measure a child's progress. Learning-disordered students may receive special instruction within a regular general education class or they may be taught in a special education or learning center for a portion of the day.

Common strategies for the treatment of reading disorders focus first on improving a child's recognition of the sounds of letters and language through phonics training. Later strategies focus on comprehension, retention, and study skills. Students with disorders of written expression are often encouraged to keep journals and to write with a computer keyboard instead of a pencil. Instruction for students with mathematical disorders emphasizes real-world uses of arithmetic, such as balancing a checkbook or comparing prices.

Prognosis

The high school dropout rate for children with learning disabilities is almost 40 percent. Children with learning disabilities that go undiagnosed or are improperly treated may never achieve functional literacy. They often develop serious behavior problems as a result of

Common strategies for the treatment of reading disorders focus first on improving a child's recognition of the sounds of letters and language through phonics training.

their frustration with school. In addition, their learning problems are often stressful for other family members and may strain family relationships. The key to helping these students reach their fullest potential is early detection and the implementation of an appropriate individualized education plan (IEP). The prognosis is good for a large percentage of children with reading disorders that are identified and treated early. Learning disorders typically persist into adulthood, but with proper educational and vocational training, an individual can complete college and pursue a challenging career. Studies of the occupational choices of adults with dyslexia indicate that they do particularly well in people-oriented professions and occupations, such as nursing or sales.

Prevention

Some studies have indicated that one-on-one tutoring of children at risk for developing learning disorders may be effective in preventing later reading and writing problems.

Parental concerns

Parents of children with learning disorders should stay in close contact with educators and school administrators to ensure that their child's IEP undergoes a regular review and continues to provide the maximum educational benefit for their child.

KEY TERMS

Dyslexia —A type of reading disorder often characterized by reversal of letters or words.

IEP —Individualized Education Plan. Under federal law governing special education, every child in public schools who is determined through assessment to have special mental disability needs has an IEP. An IEP is typically developed by a team of professionals that may include special education teachers, physical, occupational and speech therapists, psychologists, parents or guardians, and others who may be called on to provide expertise. The team meets at least once a year to set goals for the next school year and to assess progress on already established goals. Parents who are not satisfied with school-based assessments have the right to ask for independent assessments that must be paid for by the school system.

IQ —Intelligence quotient, a measure of intellectual functioning determined by performance on standardized intelligence tests. It is usually calculated by dividing an individual's mental age (determined by testing) by his/her chronological age and multiplying that result by 100.

Phonics —A system to teach reading by teaching the speech sounds associated with single letters, letter combinations, and syllables.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revision (DSM-IV-TR). Washington, DC: American Psychiatric Press, Inc., 2000.

Marshall, Abagail. The Everything Parent's Guide To Children With Dyslexia: All You Need To Ensure Your Child's Success. Adams Media, 2004.

PERIODICALS

Gillberg, C., and H. Soderstrom. "Learning Disability." Lancet 362 (September 6, 2003): 811–821.

Taipale, M., N. Kaminen, J. Nopola-Hemmi, et al. "A Candidate Gene for Developmental Dyslexia Encodes a Nuclear Tetratricopeptide Repeat Domain Protein Dynamically Regulated in Brain." Proceedings of the National Academy of Sciences in the USA 100 (September 30, 2003): 11553–11558.

Witt, W. P., A. W. Riley, and M. J. Coiro. "Childhood Functional Status, Family Stressors, and Psychosocial Adjustment Among School-Aged Children with Disabilities in the United States." Archives of Pediatric and Adolescent Medicine 157 (July 2003): 687–695.

ORGANIZATIONS

Learning Disabilities Association of America. 4156 Library Road, Pittsburg, PA 15234. (412) 341–1515. Web site: http://www.ldanatl.org.

National Center for Learning Disabilities (NCLD). 381 Park Avenue South, Suite 1401, New York, NY 10016. (410) 296–0232. Web site: http://www.ncld.org.

WEB SITES

The Interactive Guide to Learning Disabilities for Parents, Teachers, and Children. Available online at: http://www.ldonline.org.

LD Online Page. Available online at: http://www.ldonline.org.

Paula Ford-Martin Rebecca J. Frey, PhD