Learning Disorders

Type of psychology: Psychopathology

Field of study: Childhood and adolescent disorders

Learning disorders (LD) comprise the disorders usually first diagnosed in infancy, childhood, or adolescence. Because the condition affects the academic progress of approximately 5 percent of all public school students in the United States, it has attracted the attention of clinicians, educators, and researchers from varied disciplines. Substantial progress has been made in the assessment and diagnosis oflearning disorders but questions regarding etiology, course, and treatment of the disorder continue to challenge investigators.

Key concepts

• disorder of written expression

• learning disabilities

• learning disorder not otherwise specified

• mathematics disorder

• phonological processing

• reading disorder

Learning disorders (LD) is a general term for clinical conditions that meet three diagnostic criteria: An individual's achievement in an academic domain (such as reading) is substantially below that expected given his or her age, schooling, and level of intelligence; the learning disturbance interferes significantly with academic achievement or activities of daily living that require specific academic skills; and if a sensory deficit (such as blindness or deafness) is present, the learning difficulties are in excess of those usually associated with it. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR (rev. 4th ed., 2000) specifies four subcategories of learning disorders: Reading Disorder, Mathematics Disorder, Disorder of Written Expression, and Learning Disorder Not Otherwise Specified (NOS). The criteria for the first three specific learning disorders are the same except for the academic domain affected by the disorder. The fourth subcategory is reserved for disorders involving learning the academic skills that do not meet the criteria for any specific learning disorder. Included are problems in all three academic domains (reading, mathematics, written expression) that together significantly interfere with academic achievement even though academic achievement as measured on standardized tests does not fall substantially below what is expected given the individual's chronological age, intelligence quotient (IQ), or age-appropriate education.

A variety of statistical approaches are used to produce an operational definition of "substantially below" academic achievement. Despite some controversy about its appropriateness, the most frequently used approach de fines "substantially below" as a discrepancy between achievement and IQ of more than two standard deviations (SD). In cases where an individual's performance on an IQ test may have been compromised by an associated disorder in linguistic or information processing, an associated mental disorder, a general medical condition, or the individual's ethnic or cultural background, a smaller discrepancy (between one and two SDs) may be acceptable.

Differential diagnosis involves differentiating learning disorders from normal variations in academic achievement, scholastic difficulties due to lack of opportunity, poor teaching, or cultural factors, and learning difficulties associated with a sensory deficit. In cases of pervasive developmental disorder or mild mental retardation, an additional diagnosis of learning disorder is given if the individual's academic achievement is substantially below the expected level given the individual's schooling and intelligence.

The term "learning disorders" was first applied to a clinical condition meeting these three criteria in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV), published in 1994. Earlier editions of the DSM used other labels such as "learning disturbance," a subcategory within special symptom reactions in DSM-II (1968). In DSM-III (1980) and DSM-III-R (1987), the condition was labeled "Academic Skills Disorders" and listed under "Specific Developmental Disorders"; furthermore, the diagnosis was based only on "substantially below" academic achievement, and the disorder was classified as an Axis II rather than an Axis I or clinical condition. The LD condition is also known by names other than those used in the psychiatric nomenclature, most frequently as "learning disabilities," which is defined as a disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations in children whose learning problems are not primarily the result of visual, hearing, or motor handicaps, mental retardation, emotional disturbance, or environmental, cultural, or economic disadvantage. Learning disabilities is the term used in P.L. 94-142, the Education for All Handicapped Children Act of 1975, and in P.L. 101476, the Individuals with Disabilities Education Act. Specific learning disorders are also referred to by other names, such as dyslexia (Reading Disorder), dyscalculia (Mathematics Disorder), or dysgraphia (Disorder of Written Expression). Empirical evidence about prevalence, etiology, course of the disorder, and intervention comes mainly from subjects identified as having dyslexia or learning disabilities.

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