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

Learning disorders, or disabilities, affect approximately 2 million children between the ages of six and 17 (5% of public school children), although some experts think the figure may be as high as 15%. These children have specific impairments in acquiring, retaining, and processing information. Standardized tests place them well below their IQ range in their area of difficulty. The three main types of learning disorders are reading disorders, mathematics disorders, and disorders of written expression. The male: female ratio for learning disorders is about 5: 1.

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 not able 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.

Mathematic 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.

Causes & symptoms

Learning disorders are thought to be caused by neurological abnormalities 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, 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.

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 complicate a diagnosis. A comprehensive medical, psychological, and educational assessment is critical to making a clear and correct diagnosis.

A child thought to have a learning disorder should undergo a complete medical examination to rule out an organic cause. If one is not found, 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 testing to measure a child's progress. Students with learning disorders 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 math, such as balancing a checkbook or comparing prices.

Ensuring that the child has proper nutrition can help in the treatment of learning disorders. Those who do not receive the proper doses that they need may require changes in their diets , or supplements are taken. Supplements that may help with learning disorders are fish oil , flax oil, primrose oil, and omega-3 fatty acids . Eliminating food additives, like colors and preservatives, as well decreasing the child's consumption of refined sugars, can also be helpful.

Meditation is also beneficial. It helps to slow the mind down and take in the surroundings while focusing on the task at hand.

Herbal remedies may also help to focus the mind. St. John's wort and Ginkgo biloba are used to treat attention-deficit hyperactivity disorder (ADHD). Ginkgo is a blood thinner and those considering taking it should consult a doctor beforehand.

Expected results

The high school dropout rate for children with learning disabilities is almost 40%. 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 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. The prognosis is good for a large percentage of children with reading disorders that are identified and treated early. Learning disorders continue 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.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association, 2000.

Church, Robin P., M.E.B. Lewis, and Mark L. Batshaw. "Learning Disabilities." Children with Disabilities. edited by Mark L. Batshaw. 4th ed. Baltimore: Paul H. Brookes, 1997.

"Learning Disorders. " Section 19, Chapter 262 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Mars, Laura. The Complete Learning Disabilities Directory, 1999/2000. Grey House Publishing, 1999.

Osman, Betty B. Learning Disabilities and ADHD: A Family Guide to Living and Learning Together. New York: John Wiley & Sons, 1997.

PERIODICALS

Baringa, Marcia. "Learning Defect Identified in Brain." Science. 273 (August 1996): 867–868.

Galaburda, D. M., and B. C. Duchaine. "Developmental Disorders of Vision." Neurologic Clinics 21 (August 2003): 687–707.

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

Stage, Frances K. and Nancy V. Milne. "Invisible Scholars: Students With Learning Disabilities." Journal of Higher Education. 67 (July–August 1996): 426–45.

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.

Taylor, K. E., and J. Walter. "Occupation Choices of Adults With and Without Symptoms of Dyslexia." Dyslexia 9 (August 2003): 177–185.

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

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

The Learning Disabilities Association of America (LDA). 4156 Library Road, Pittsburgh, PA 15234–1349. (412) 341–1515. http://www.ldanatl.org.

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

Paula Ford-Martin

Rebecca J. Frey, PhD

Learning disorders

Definition

Learning disorders (LD) refer to a significant deficit in learning due to a person's inability to interpret what is seen and heard, or to link information from different parts of the brain.

Description

Academic deficiency is frequently associated with neurologic and psychological disorders. Severe academic problems may occur as a primary disorder of learning. Learning disorders can be classified in three major types: disorder of written expression (DWE); reading disorder (RD); and mathematics disorder (MD). The description of learning disorders corresponds to the educational legal designation of learning disabilities. Learning disabilities are legally defined by Public Law in a law called the Individuals with Disabilities Education Act, or IDEA. The IDEA defines a learning disability as a disorder in written or spoken language that results in an imperfect ability to listen, think, read, spell, write, or do mathematics. The act excludes persons who have learning impairments that are solely due to hearing problems, visual problems, motor problems, mental retardation , or due to environmental deprivation. The rules and related laws of IDEA stipulate that children with LD are entitled to free education and special services. A fourth category of LD has also been established for an LD that does not fulfill all the criteria (called an LD not otherwise specified.) Age of onset of LD is closely related to clinical presentation. Most cases of LD can be detected between preschool and second grade. Typically, onset of LD before first grade, often demonstrates developmental delay in learning new concepts at home, or as a delay in performance in school (delay is observed relative to other children and is observed by school officials). If the onset of LD occurs in early grade school (first or second grade), then observations typically include slow learning and difficulty completing and mastering schoolwork which often results in poor grades.

Demographics

LD occurs in approximately 5% to 10% of the population of which about 50% are classified as reading disorder. The remaining 50% of LD falls under the categories of disorder of written expression, mathematics disorder or atypical LD. LD is more common in males than females by 2:1 or 4:1 ratio. Children with LD have an increased risk for emotional behavioral problems and comorbidity (50% of the 1.6 million children with attention-deficit hyperactivity disorder [ADHD] have an LD). Approximately 2% to 8% of elementary school children have reading disorder (dyslexia). Speech disorder occurs in approximately 10% of children younger than 8 years of age. ADHD is a comorbid condition that occurs in approximately four million school-aged children (20% of them are unable to focus their attention to required tasks in school and at home).

Causes and symptoms

Reading Disorder

The cause of reading disorder is underactivity in the left superior posterior temporal lobe (planum temporale). Research using functional and structural neuroimaging techniques, demonstrates that this underactivity is evident during reading tasks. It is believed that the planum temporale is a region that is important for phonologic processing. Genetic studies reveal that there is a higher concordance rate for RD in identical (71%) than fraternal (49%) twins. Additionally, heritability of RD may be more than 50% especially in a disorder with a focal deficit in phonologic processing (phonologic dyslexia). Some genetic investigations have identified possible genes for RD, located on chromosome six and 15. Modern research techniques have demonstrated that RD is the result of brain deficits in processing sound units and sound-symbol relationships.

Most of the persons diagnosed with reading disorder (RD) have average or higher intelligence. RD is considered synonymous with dyslexia , since spelling and reading are related. Persons with RD often have deficits with spelling. Affected individuals have difficulty with phonologic processing. This means that affected persons have deficits in the process of identifying and manipulating individual sounds (phonemes) within larger sound units (morphemes and words.) Symptoms usually appear before early grade school. Patients cannot translate a visual stimulus (letters) into a meaningful blend of sounds (i.e. they have deficits in phonics). Reading is slower and more mechanical even with treatment. Typically, reading takes more effort in affected patients, often requiring intense concentration, especially on the pronunciation and identification of individual words. The increased concentration required during reading can impair the person's attention ability, causing mental fatigue, attention problems (less attention available for comprehension and memory). Sometimes, but not often, children may have visualization-comprehension or memory deficits causing RD. Persons with visualization-comprehension weakness often exhibit difficulty visualizing what is being read. The cause of visualization-comprehension weakness occurs because of deficits in visual organization (nonverbal skills.) This is a vital deficit since reading comprehension is based on some visualization (nonverbal skills.) However, in the majority of affected children with RD it is the deficits in phonologic processing (processing phonemes within morphemes and words) that are responsible for difficulty with comprehension or memory.

Mathematics Disorder

The cause of mathematics disorder (MD) is thought to be due to a nonverbal weakness. MD could take various forms and therefore the causes also change. There may be deficits visualizing and visually organizing mathematical concepts and manipulations. Some patients may have short-term or working memory deficits which can interfere with processing mathematical calculations. The cause of MD can be linked to a larger atypical LD.

The symptoms of MD can vary. Patients can exhibit dyscalculia or acalculia (deficits in mathematical calculation). Dyscalculia patients may over-rely on memory and tangible aids, because they have deficits to mentally calculate arithmetic manipulations. Symptoms in some patients can include deficits in memory (short term and working memory or deficits in visual organization or mathematical concepts).

Disorder of Written Expression

The cause of the disorder of written expression in some persons may be due to deficits in visual-motor integration and motor coordination. Most causes of DWE occur because there are deficits in the brain concerning information translation from auditory-oral modality to visual-written modality. The cause of this deficit is unknown.

Patients often exhibit spelling deficits that include problems with punctuation, grammar, and development of ideas during writing. Writing samples from persons with DWE are typically brief, simple, or may be difficult to comprehend because of grammar and punctuation errors. Patients with visual-motor deficits write with so much care that they often lose track of ideas and thoughts. If motor coordination is the only cause then symptoms may be classified more appropriately as a motor skills disorder not a DWE. Typically symptoms are not apparent until the third or fourth grade, when academic exercises demand development of ideas.

Diagnosis

The diagnosis of LD can be made if there is significant discrepancy between intelligence test scores (raw ability to learn) and achievement test score (actual learning achievement). However, the diagnosis can be a complex process since there is no universal agreement concerning the magnitude of discrepancy between test scores, nor is there a consensus concerning which test scores should be analyzed to obtain a statistical analysis of discrepancy. Tests should be administered to establish that low intelligence alone is not the cause of underachievement (i.e. children with mental retardation are not diagnosed with LDs.) There are several psychological tests that separately measure intelligence (i.e. Wechsler Intelligence Scale for Children) and achievement (Kaufman Test of Educational Achievement, K-TEA).

Treatment Team

The treatment team typically includes school counselors, education specialists, specialists in learning disorders, school psychologists or clinical psychologists (with advanced clinical training in administration and interpretation of psychological tests (psychometrics). Tests for achievement and intelligence should be administered and interpreted by a clinical psychologist or a school psychologist. Only a duly licensed or certified clinical or school psychologist can administer the recommended psychological tests. A full written report of results and interpretation of results is typically prepared and submitted to concerned persons.

Treatment

Before treatment is initiated, a very comprehensive evaluation is necessary with standardized achievement and intelligence tests.

Treatment for RD-affected persons involves a plan that provides intensive tutoring to develop phonologic processing and fluent word reading with treatment objectives that emphasize comprehension. There are several treatment approaches (Gillingham-Stillman Approach, Fernald-Keller Approach or Lindamood-Bell Reading Program) that provide intensive phonic practice and phonic associations with sensory integration or mnemonic strategies to remember letter-sound blends and relationships.

Treatment for MD can vary widely since MD can have a variety of causes and presentations. The treatment program is typically highly individualized and specific to enhance and expand upon strengths to improve weaknesses and math errors. Sometimes analogies are utilized to demonstrate abstract concepts and to build upon concepts (concrete learning) until the concept becomes understood or mastered. Flash cards and practice drills can help to memorize simple mathematical operations such as multiplication tables. MD due to visual-organization deficits can be treated with visualization techniques to improve math errors.

Treatment for DWE can involve interventions that help to improve written expression caused by a deficit in the expressive task of writing. There are several treatment plans that include writing in more "natural environments" (i.e. encourages keeping a diary or making "lists"), writing notes and outlines before attempting writing prose, and talking-to-writing progression. The talking-to-writing progression approach initially involves the affected child taking the role of dictating while another person writes for the child. As the treatments progress, the roles are gradually reversed until the child is able to dictate and write without assistance. Treatment continues with dictation until the child is independently thinking and writing. Treatment interventions for atypical LDs involve objectives to expand on the child's strengths (i.e. verbal and rote learning strengths) and to provide additional experience and practice in nonverbal weakness areas. Atypical LDs are complex disorders and treatment interventions are detailed and typically include teaching social and nonverbal material with extensive practice and concrete examples; teaching the affected person in rote in a predictable fashion; and the utilization and application of known algorithms to new situations. Additionally, treatment can include practicing organizational skills at home; practicing attention to visual and auditory (verbal information); and to encourage supervised and highly structured and inter-active peer experiences.

Clinical trials

There are many clinical trials (http://www.nlm.nih.gov) currently in progress. The studies currently sponsored by governmental agencies focus on topics that include coping, diagnosis, symptoms specific aspects of disorders, and law and public policy.

Prognosis

It is rare for persons with LD to completely improve their academic deficiencies. However, performance in the area of weakness can significantly improve with appropriate treatment interventions.

Recovery

Recovery is slow and patients are often in specialized intervention programs (MD, DWE) or are part of programs that offer specific treatments (RD).

Other Atypical LDs

There are two common patterns of working memory deficits. Nonverbal learning disability (NVLD) is a neuropsychological syndrome characterized by deficits in comprehension, motor skills, visual-perception organization, tactile perception and novel problem solving, comprehension, visual memory, concept formation, and integration/organization of information. However, NVLD patients exhibit strengths in simple verbal skills, rote learning, memory, and knowledge of facts. In addition to weakness in mathematical achievement most persons affected by NVLD also tend to have problems with written expression, reading comprehension and social skills. Persons affected with working memory deficits tend to lose track of information as they are mentally processing that information or other information. Patients with working memory deficits often have problems with mathematical manipulations (which requires working memory), and the disorder is often accompanied by ADHD. Working memory is defined as the ability to remember information while executing another cognitive task.

Resources

BOOKS

Behrman, Richard, E., et al., eds. Nelson Textbook of Pediatrics, 17th ed. Philadelphia: Saunders, 2004.

Goetz, Christopher G., et al, eds. Textbook of Clinical Neurology, 1st ed. Philadelphia: W. B. Saunders Company, 1999.

PERIODICALS

Frank, Y., and Steven G. Pavlakis. "Brain Imaging in Neurobehavioral Disorders." Pediatric Neurology 25, no. 4 (October 2001).

Kronenberger, William G., and David Dunn. "Learning Disorders." Neurologic Clinics 21, no. 4 (November 2003).

Toppelberg, Claudio O., and Theodore Shapiro. "Language Disorders: A 10-Year Research Update Review." Journal of the American Academy of Child & Adolescent Psychiatry 39, no.2 (February 2000).

WEBSITES

National Center for Learning Disabilities. <http://www.ld.org>.

National Institute on Deafness and Other Communication Disorders. <http://www.nidcd.nih.gov>.

ORGANIZATIONS

National Institute of Mental Health, Office of Communications. 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513 or 1-866-615-6464; Fax: (301) 443-4279.

Laith Farid Gulli, MD

Nicole Mallory

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 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: <www.ldanatl.org>.

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

WEB SITES

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

LD Online Page. Available online at: <www.ldonline.org>.

Paula Ford-Martin Rebecca J. Frey, PhD

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

Learning disorders, or disabilities, affect approximately 2 million children between the ages of six and 17 (5% of public school children), although some experts think the figure may be as high as 15%. These children have specific impairments in acquiring, retaining, and processing information. Standardized tests place them well below their IQ range in their area of difficulty. The three main types of learning disorders are reading disorders, mathematics disorders, and disorders of written expression. The male: female ratio for learning disorders is about 5:1.

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 aren't able 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 co-existing 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.

Causes and symptoms

Learning disorders are thought to be caused by neurological abnormalities 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.

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 complicate a diagnosis. A comprehensive medical, psychological, and educational assessment is critical to making a clear and correct diagnosis.

A child thought to have a learning disorder should undergo a complete medical examination to rule out an organic cause. If none is found, 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.

KEY TERMS

Dyslexia— An inability to read, write, or spell words in spite of the ability to see and recognize letters. Dyslexia is an autosomal dominant disorder thst occurs more frequently in males.

IQ— Intelligence quotient; a measure of intellectual functioning determined by performance on standardized intelligence tests.

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

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

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., revised. Washington, DC: American Psychiatric Association, 2000.

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Learning Disorders." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Galaburda, D. M., and B. C. Duchaine. "Developmental Disorders of Vision." Neurologic Clinics 21 (August 2003): 687-707.

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.

Taylor, K. E., and J. Walter. "Occupation Choices of Adults With and Without Symptoms of Dyslexia." Dyslexia 9 (August 2003): 177-185.

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

The Interactive Guide to Learning Disabilities for Parents, Teachers, and Children. 〈http://www.ldonline.org〉.

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

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

OTHER

LD Online Page. 〈http://www.ldonline.org〉.

Learning Disorders

Definition

Description

Resources

Definition

Learning disorders, or learning disabilities, are disorders that cause problems in speaking, listening, reading, writing, or mathematical ability.

Description

A learning disability, or specific developmental disorder, is a disorder that inhibits or interferes with the skills of learning, the ability to store, process, or produce information. Under federal law, public schools consider a child to be learning disabled if his or her level of academic achievement is two or more years below the standard for age and IQ level. The fourth edition, text revision, of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, a handbook that mental health professionals use to diagnose mental disorders) uses the term learning disorder and defines this as cognitive difficulties arising from brain dysfunction.

It is estimated that 15% of the U.S. population, or one in seven Americans, has some kind of learning disability. About six percent of school-age children,

or almost three million children, receive some kind of special education services in school as a result of learning disabilities, and this number does not include children in private or home schools. Often, learning disabilities appear together with other disorders, such as attention-deficit hyperactivity disorder (ADHD). Irregularities in the functioning of certain parts of the brain that can result in information processing problems are thought to cause learning disorders. Evidence suggests that these irregularities are often inherited (i.e., a person is more likely to develop a learning disability if other family members have them). Learning disabilities are also associated with certain conditions occurring during fetal development, birth, or infancy, including maternal use of alcohol, drugs, and tobacco; exposure to infection; injury during birth; low birth weight; and sensory deprivation, in addition to some socioeconomic factors.

The socioeconomic link to the development of learning disabilities manifests as a greater rate in certain ethnic groups. In 2001, 2.5 times as many non-Hispanic black children were receiving special education services related to a learning disability. This skewed incidence is attributable to increased risk of developmental exposure to substances known to cause neurological harm among people living in low-income communities.

The signs of the presence of a learning disorder can vary based on the type of disorder and a person’s age. The factor of age can be important because what is normal in a preschool child can be a sign of a problem in a child of elementary school age. In addition to underachievement, signs can include overall lack of organization, forgetfulness, and taking unusually long amounts of time to complete assignments. In the classroom, the child’s teacher may observe one or more of the following characteristics: difficulty paying attention, unusual sloppiness and disorganization, social withdrawal, difficulty working independently, and trouble switching from one activity to another. In addition to the preceding signs, which relate directly to school and schoolwork, certain general behavioral and emotional features often accompany learning disabilities. These include impulsiveness, restlessness, distractibility, poor physical coordination, low tolerance for frustration, low self-esteem, daydreaming, inattentiveness, and anger, or sadness. These signs also can be symptomatic of other disorders that are not learning

disorders, and only a professional evaluation can distinguish them.

Types of learning disabilities

Learning disabilities are associated with brain dysfunctions that affect a number of basic skills. Perhaps the most fundamental is sensory-perceptual ability—the capacity to take in and process information through the senses. Difficulties involving vision, hearing, and touch will have an adverse effect on learning. Although learning is usually considered a mental rather than a physical pursuit, it involves motor skills, and it can also be impaired by problems with motor development. Other basic skills fundamental to learning include memory, attention, and language abilities.

The three most common academic skill areas affected by learning disabilities are reading, writing, and arithmetic. Some sources estimate that between 60% and 80% of children diagnosed with learning disabilities have reading as their only or main problem area. Learning disabilities involving reading have traditionally been known as dyslexia; currently, the preferred term is “reading disorder.” A wide array of problems is associated with reading disorder , including difficulty identifying groups of letters, problems relating letters to sounds, reversals and other errors involving letter position, chaotic spelling, trouble with syllabication (breaking words into syllables), failure to recognize words, hesitant oral reading, and word-byword rather than contextual reading.

Writing disabilities, known as dysgraphia or disorder of written expression , include problems with letter formation and writing layout on the page, repetitions and omissions, punctuation and capitalization errors, “mirror writing” (writing right to left), and a variety of spelling problems. Children with dysgraphia typically labor at written work much longer than their classmates, only to produce large, uneven writing that would be appropriate for a much younger child.

KEY TERMS

CAPD —Central auditory processing disorder, the inability to differentiate, recognize, or understand sounds; hearing and intelligence are normal.

IQ —Intelligence quotient, or a measure of the intelligence of an individual based on the results of a written test.

Learning abilities involving math skills, generally referred to as dyscalcula (or dyscalculia) or mathematics disorder , usually become apparent later than reading and writing problems—often at about the age of eight. Children with dyscalcula may have trouble counting, reading and writing numbers, understanding basic math concepts, mastering calculations, and measuring. This type of disability may also involve problems with nonverbal learning, including spatial organization.

In order to meet the criteria established by the American Psychiatric Association (APA) for these various diagnoses, the child’s skills in these areas must be significantly below that of their peers on standardized tests (taking age, schooling, and level of intelligence into account), and the disorders must significantly interfere with academic achievement and/or daily living.

Treatment for a learning disorder can depend on the specific disorder, the age of the person at diagnosis , the disorder severity, and the assumed underlying cause. For example, people with central auditory processing disorder (CAPD), a common underlying cause of some learning disorders that is centered on a person’s inability to process heard language correctly, may undergo therapy with a speech-language pathologist and other experts may use different kinds of auditory therapies to improve the person’s ability to process heard language.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text rev. Washington D.C.: American Psychiatric Association, 2000.

Bowman-Kruhm, Mary, and Claudine G. Wirths. Everything You Need to Know about Learning Disabilities. New York: Rosen Publishing Group, 1999.

Tuttle, Cheryl Gerson, and Gerald A. Tuttle, eds. Challenging Voices: Writings By, For, and About People with Learning Disabilities. Los Angeles: Lowell House, 1995.

Wong, Bernice, ed. Learning About Learning Disabilities. San Francisco: Morgan Kauffman Publishers, 1998.

ORGANIZATIONS

Learning Disabilities Association of America (formerly ACLD, the Association for Children and Adults with Learning Disabilities). 4156 Library Road, Pittsburgh, PA 15234-1349. Telephone: (412) 341-1515. Web site: <http://www.ldanatl.org>.

National Center for Learning Disabilities. 381 Park Avenue South Suite 1401, New York, NY 10016. Telephone: (212) 545-7510, or (888) 575-7373. Web site: <http://www.ncld.org>.

National Institute of Child Health and Human Development (NICHD), National Institutes of Health, DHHS, 31 Center Drive, Rm. 2A32 MSC 2425, Bethesda, MD 20892-2425 Telephone: (301) 496-5133, Fax: (301) 496-7101. Web site: <http://www.nichd.nih.gov>

WEB SITES

American Speech-Language-Hearing Association. <http://www.asha.org/public/speech/disorders/Language-Based-Learning-Disabilities.htm>

“Developmental reading disorder.” National Library of Medicine. <http://www.nlm.nih.gov/medlineplus/ency/article/001406.htm>

National Library of Medicine. Resources for learning disorder. <http://www.nlm.nih.gov/medlineplus/learningdisorders.html>

National Institute on Deafness and Other Communication Disorders. <http://www.nidcd.nih.gov/health/voice/auditory.asp>

Emily Jane Willingham, Ph.D.