Learning disability

For general learning disability, see intellectual disability.

Learning disability
People at a Learning Disabilities Month event
Classification and external resources
Specialty
ICD-10	F81.9
ICD-9-CM	315.0-315.3
DiseasesDB	4509
eMedicine	article/1835801 article/1835883 article/915176
Patient UK	Learning disability
MeSH	D007859

Learning disability is a classification that includes several areas of functioning in which a person has difficulty learning in a typical manner, usually caused by an unknown factor or factors. Given the "difficulty learning in a typical manner", this does not exclude the ability to learn in a different manner. Therefore, some people can be more accurately described as having a "Learning Difference", thus avoiding any misconception of being disabled with a lack of ability to learn and possible negative stereotyping.

While learning disability, learning disorder and learning difficulty are often used interchangeably, they differ in many ways. Disorder refers to significant learning problems in an academic area. These problems, however, are not enough to warrant an official diagnosis. Learning disability on the other hand, is an official clinical diagnosis, whereby the individual meets certain criteria, as determined by a professional (psychologist, pediatrician, etc.). The difference is in degree, frequency, and intensity of reported symptoms and problems, and thus the two should not be confused. When the term "learning disorder" is used, it describes a group of disorders characterized by inadequate development of specific academic, language, and speech skills. Types of learning disorders include reading (dyslexia), mathematics (dyscalculia) and writing (dysgraphia).

The unknown factor is the disorder that affects the brain's ability to receive and process information. This disorder can make it problematic for a person to learn as quickly or in the same way as someone who is not affected by a learning disability. People with a learning disability have trouble performing specific types of skills or completing tasks if left to figure things out by themselves or if taught in conventional ways.

Individuals with learning disabilities can face unique challenges that are often pervasive throughout the lifespan. Depending on the type and severity of the disability, interventions and current technologies may be used to help the individual learn strategies that will foster future success. Some interventions can be quite simplistic, while others are intricate and complex. Current technologies may require student training to be effective classroom supports. Teachers, parents and schools can create plans together that tailor intervention and accommodations to aid the individuals in successfully becoming independent learners. School psychologists and other qualified professionals quite often help design the intervention and coordinate the execution of the intervention with teachers and parents. Social support may improve the learning for students with learning disabilities.

Definitions

Representatives of organizations committed to the education and welfare of individuals with learning disabilities are known as National Joint Committee on Learning Disabilities (NJCLD.) The NJCLD used the term 'learning disability' to indicate a discrepancy between a child’s apparent capacity to learn and his or her level of achievement. Several difficulties existed, however, with the NJCLD standard of defining learning disability. One such difficulty was its belief of central nervous system dysfunction as a basis of understanding and diagnosing learning disability. This conflicted with the fact that many individuals who experienced central nervous system dysfunction, such as those with cerebral palsy, did not experience disabilities in learning. On the other hand, those individuals who experienced multiple handicapping conditions along with learning disability frequently received inappropriate assessment, planning, and instruction. The NJCLD notes that it is possible for learning disability to occur simultaneously with other handicapping conditions, however, the two should not be directly linked together or confused.

In the 1980s, NJCLD therefore defined the term learning disability as:

a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning or mathematical abilities. These disorders are intrinsic to the individual and presumed to be due to Central Nervous System Dysfunction. Even though a learning disability may occur concomitantly with other handicapping conditions (e.g. sensory impairment, intellectual disability, social and emotional disturbance) or environmental influences (e.g. cultural differences, insufficient/inappropriate instruction, psychogenic factors) it is not the direct result of those conditions or influences.

The 2002 LD Roundtable produced the following definition:

"Concept of LD: Strong converging evidence supports the validity of the concept of specific learning disabilities (SLD). This evidence is particularly impressive because it converges across different indicators and methodologies. The central concept of SLD involves disorders of learning and cognition that are intrinsic to the individual. SLD are specific in the sense that these disorders each significantly affect a relatively narrow range of academic and performance outcomes. SLD may occur in combination with other disabling conditions, but they are not due primarily to other conditions, such as intellectual disability, behavioral disturbance, lack of opportunities to learn, or primary sensory deficits."

The issue of defining learning disabilities has generated significant and ongoing controversy. The term "learning disability" does not exist in DSM-IV, but it has been added to DSM-5. The DSM-5 does not limit learning disorders to a particular diagnosis such as reading, mathematics and written expression. Instead, it is a single diagnosis criteria describing drawbacks in general academic skills and includes detailed specifiers for the areas of reading, mathematics, and written expression.

Types

Learning disabilities can be categorized by either the type of information processing affected by the disability or by the specific difficulties caused by a processing deficit.

By stage of information processing

Learning disabilities fall into broad categories based on the four stages of information processing used in learning: input, integration, storage, and output. Many learning disabilities are a compilation of a few types of abnormalities occurring at the same time, as well as with social difficulties and emotional or behavioral disorders

• Input: This is the information perceived through the senses, such as visual and auditory perception. Difficulties with visual perception can cause problems with recognizing the shape, position, or size of items seen. There can be problems with sequencing, which can relate to deficits with processing time intervals or temporal perception. Difficulties with auditory perception can make it difficult to screen out competing sounds in order to focus on one of them, such as the sound of the teacher's voice in a classroom setting. Some children appear to be unable to process tactile input. For example, they may seem insensitive to pain or dislike being touched.
• Integration: This is the stage during which perceived input is interpreted, categorized, placed in a sequence, or related to previous learning. Students with problems in these areas may be unable to tell a story in the correct sequence, unable to memorize sequences of information such as the days of the week, able to understand a new concept but be unable to generalize it to other areas of learning, or able to learn facts but be unable to put the facts together to see the "big picture." A poor vocabulary may contribute to problems with comprehension.
• Storage: Problems with memory can occur with short-term or working memory, or with long-term memory. Most memory difficulties occur with one's short-term memory, which can make it difficult to learn new material without more repetitions than usual. Difficulties with visual memory can impede learning to spell.
• Output: Information comes out of the brain either through words, that is, language output, or through muscle activity, such as gesturing, writing or drawing. Difficulties with language output can create problems with spoken language. Such difficulties include answering a question on demand, in which one must retrieve information from storage, organize our thoughts, and put the thoughts into words before we speak. It can also cause trouble with written language for the same reasons. Difficulties with motor abilities can cause problems with gross and fine motor skills. People with gross motor difficulties may be clumsy, that is, they may be prone to stumbling, falling, or bumping into things. They may also have trouble running, climbing, or learning to ride a bicycle. People with fine motor difficulties may have trouble with handwriting, buttoning shirts, or tying shoelaces.

By function impaired

Deficits in any area of information processing can manifest in a variety of specific learning disabilities. It is possible for an individual to have more than one of these difficulties. This is referred to as comorbidity or co-occurrence of learning disabilities. In the UK, the term dual diagnosis is often used to refer to co-occurrence of learning difficulties.

Reading disorder (ICD-10 and DSM-IV codes: F81.0/315.00)

Reading disorder is the most common learning disability. Of all students with specific learning disabilities, 70–80% have deficits in reading. The term "Developmental Dyslexia" is often used as a synonym for reading disability; however, many researchers assert that there are different types of reading disabilities, of which dyslexia is one. A reading disability can affect any part of the reading process, including difficulty with accurate or fluent word recognition, or both, word decoding, reading rate, prosody (oral reading with expression), and reading comprehension. Before the term "dyslexia" came to prominence, this learning disability used to be known as "word blindness."

Common indicators of reading disability include difficulty with phonemic awareness—the ability to break up words into their component sounds, and difficulty with matching letter combinations to specific sounds (sound-symbol correspondence).

Reading disorders can be helped and there are a lot of ways to help a student suffering with dyslexia. Teachers need to focus on giving students extra time to read silently in class, and to never force them to do it out loud in front of the whole class. This can discourage the student from wanting to read. Silent reading time is good for all students, however, will give the student dealing with dyslexia more time to practice on their own, and if they need help they can always ask their teacher. Another aspect to pay attention to is to create a quiet area of the classroom. Doing so will give the student a space to concentrate and not be bothered by the noise of the other students.

Disorder of Written Expression (ICD-10 and DSM-IV-TR codes 315.2)

The DSM-IV-TR criteria for a Disorder of Written Expression is writing skills (as measured by standardized test or functional assessment) that fall substantially below those expected based on the individual's chronological age, measured intelligence, and age appropriate education, (Criterion A). This difficulty must also cause significant impairment to academic achievement and tasks that require composition of written text (Criterion B), and if a sensory deficit is present, the difficulties with writing skills must exceed those typically associated with the sensory deficit, (Criterion C).

Individuals with a diagnosis of a Disorder of Written Expression typically have a combination of difficulties in their abilities with written expression as evidenced by grammatical and punctuation errors within sentences, poor paragraph organization, multiple spelling errors, and excessively poor penmanship. A disorder in spelling or handwriting without other difficulties of written expression do not generally qualify for this diagnosis. If poor handwriting is due to an impairment in the individuals' motor coordination, a diagnosis of Developmental coordination disorder should be considered.

By a number of organizations, the term "dysgraphia" has been used as an overarching term for all disorders of written expression.

Math disability (ICD-10 and DSM-IV codes F81.2-3/315.1)

Sometimes called dyscalculia, a math disability involves difficulties such as learning math concepts (such as quantity, place value, and time), difficulty memorizing math facts, difficulty organizing numbers, and understanding how problems are organized on the page. Dyscalculics are often referred to as having poor "number sense".

Non ICD-10/DSM

• Nonverbal learning disability: Nonverbal learning disabilities often manifest in motor clumsiness, poor visual-spatial skills, problematic social relationships, difficulty with mathematics, and poor organizational skills. These individuals often have specific strengths in the verbal domains, including early speech, large vocabulary, early reading and spelling skills, excellent rote-memory and auditory retention, and eloquent self-expression.
• Disorders of speaking and listening: Difficulties that often co-occur with learning disabilities include difficulty with memory, social skills and executive functions (such as organizational skills and time management).

Diagnosis

IQ-Achievement Discrepancy

Learning disabilities can be identified by psychiatrists, school psychologists, clinical psychologists, counseling psychologists, neuropsychologists and other learning disability specialists through a combination of intelligence testing, academic achievement testing, classroom performance, and social interaction and aptitude. Other areas of assessment may include perception, cognition, memory, attention, and language abilities. The resulting information is used to determine whether a child's academic performance is commensurate with his or her cognitive ability. If a child's cognitive ability is much higher than his or her academic performance, the student is often diagnosed with a learning disability. The DSM-IV and many school systems and government programs diagnose learning disabilities in this way (DSM-IV uses the term "disorder" rather than "disability".)

Although the discrepancy model has dominated the school system for many years, there has been substantial criticism of this approach among researchers. Recent research has provided little evidence that a discrepancy between formally measured IQ and achievement is a clear indicator of LD. Furthermore, diagnosing on the basis of a discrepancy does not predict the effectiveness of treatment. Low academic achievers who do not have a discrepancy with IQ (i.e. their IQ scores are also low) appear to benefit from treatment just as much as low academic achievers who do have a discrepancy with IQ (i.e. their IQ scores are higher than their academic performance would suggest).

Response to Intervention (RTI)

Much current research has focused on a treatment-oriented diagnostic process known as response to intervention (RTI). Researcher recommendations for implementing such a model include early screening for all students, placing those students who are having difficulty into research-based early intervention programs, rather than waiting until they meet diagnostic criteria. Their performance can be closely monitored to determine whether increasingly intense intervention results in adequate progress. Those who respond will not require further intervention. Those who do not respond adequately to regular classroom instruction (often called "Tier 1 instruction") and a more intensive intervention (often called "Tier 2" intervention) are considered "nonresponders." These students can then be referred for further assistance through special education, in which case they are often identified with a learning disability. Some models of RTI include a third tier of intervention before a child is identified as having a learning disability.

A primary benefit of such a model is that it would not be necessary to wait for a child to be sufficiently far behind to qualify for assistance. This may enable more children to receive assistance before experiencing significant failure, which may in turn result in fewer children who need intensive and expensive special education services. In the United States, the 2004 reauthorization of the Individuals with Disabilities Education Act permitted states and school districts to use RTI as a method of identifying students with learning disabilities. RTI is now the primary means of identification of learning disabilities in Florida.

The process does not take into account children's individual neuropsychological factors such as phonological awareness and memory, that can inform design instruction. By not taking into account specific cognitive processes, RTI fails to inform educators about a students' relative strengths and weaknesses Second, RTI by design takes considerably longer than established techniques, often many months to find an appropriate tier of intervention. Third, it requires a strong intervention program before students can be identified with a learning disability. Lastly, RTI is considered a regular education initiative and is not driven by psychologists, reading specialists, or special educators.

Assessment

Many normed assessments can be used in evaluating skills in the primary academic domains: reading, including word recognition, fluency, and comprehension; mathematics, including computation and problem solving; and written expression, including handwriting, spelling and composition.

The most commonly used comprehensive achievement tests include the Woodcock-Johnson IV (WJ IV), Wechsler Individual Achievement Test II (WIAT II), the Wide Range Achievement Test III (WRAT III), and the Stanford Achievement Test–10th edition. These tests include measures of many academic domains that are reliable in identifying areas of difficulty.

In the reading domain, there are also specialized tests that can be used to obtain details about specific reading deficits. Assessments that measure multiple domains of reading include Gray's Diagnostic Reading Tests–2nd edition (GDRT II) and the Stanford Diagnostic Reading Assessment. Assessments that measure reading subskills include the Gray Oral Reading Test IV – Fourth Edition (GORT IV), Gray Silent Reading Test, Comprehensive Test of Phonological Processing (CTOPP), Tests of Oral Reading and Comprehension Skills (TORCS), Test of Reading Comprehension 3 (TORC-3), Test of Word Reading Efficiency (TOWRE), and the Test of Reading Fluency. A more comprehensive list of reading assessments may be obtained from the Southwest Educational Development Laboratory.

The purpose of assessment is to determine what is needed for intervention, which also requires consideration of contextual variables and whether there are comorbid disorders that must also be identified and treated, such as behavioural issues or language delays. These contextual variables are often assessed using parent and teacher questionnaire forms that rate the students behaviours and compares them to standardized norms.

However, caution should be made when suspecting the person with a learning disability may also have dementia, especially as people with Down's syndrome may have the neuroanatomical profile but not the associated clinical signs and symptoms. Examination can be carried out of executive functioning as well as social and cognitive abilities but may need adaptation of standardised tests to take account of special needs.

Management

Spell checkers are one tool for managing learning disabilities.

Interventions include:

• Mastery model:
  • Learners work at their own level of mastery.
  • Practice
  • Gain fundamental skills before moving onto the next level
    • Note: this approach is most likely to be used with adult learners or outside the mainstream school system.
• Direct Instruction:
  • Emphasizes carefully planned lessons for small learning increments
  • Scripted lesson plans
  • Rapid-paced interaction between teacher and students
  • Correcting mistakes immediately
  • Achievement-based grouping
  • Frequent progress assessments
• Classroom adjustments:
  • Special seating assignments
  • Alternative or modified assignments
  • Modified testing procedures
  • Quiet environment
• Special equipment:
  • Word processors with spell checkers and dictionaries
  • Text-to-speech and speech-to-text programs
  • Talking calculators
  • Books on tape
  • Computer-based activities
• Classroom assistants:
  • Note-takers
  • Readers
  • Proofreaders
  • Scribes
• Special Education:
  • Prescribed hours in a resource room
  • Placement in a resource room
  • Enrollment in a special school for learning disabled students
  • Individual Education Plan (IEP)
  • Educational therapy

Sternberg has argued that early remediation can greatly reduce the number of children meeting diagnostic criteria for learning disabilities. He has also suggested that the focus on learning disabilities and the provision of accommodations in school fails to acknowledge that people have a range of strengths and weaknesses, and places undue emphasis on academic success by insisting that people should receive additional support in this arena but not in music or sports. Other research has pinpointed the use of resource rooms as an important—yet often politicized component of educating students with learning disabilities.

Causes

The causes for learning disabilities are not well understood, and sometimes there is no apparent cause for a learning disability. However, some causes of neurological impairments include:

• Heredity – Learning disabilities often run in the family. Children with learning disabilities are likely to have parents or other relatives with similar difficulties.
• Problems during pregnancy and birth – Learning disabilities can result from anomalies in the developing brain, illness or injury, fetal exposure to alcohol or drugs, low birth weight, oxygen deprivation, or by premature or prolonged labor.
• Accidents after birth – Learning disabilities can also be caused by head injuries, malnutrition, or by toxic exposure (such as heavy metals or pesticides).

Impact on affected individuals

The effects of having a learning disability or learning difference are not limited to educational outcomes: individuals with learning disabilities may experience social problems as well. Neuropsychological differences can impact the accurate perception of social cues with peers. Researchers argue persons with learning disabilities not only experience negative effects as a result of their learning distinctions, but also as a result of carrying a stigmatizing label. It has generally been difficult to determine the efficacy of special education services because of data and methodological limitations. Emerging research suggests adolescents with learning disabilities experience poorer academic outcomes even compared to peers who began high school with similar levels of achievement and comparable behaviors. It seems their poorer outcomes may be at least partially due to the lower expectations of their teachers; national data show teachers hold expectations for students labeled with learning disabilities that are inconsistent with their academic potential (as evidenced by test scores and learning behaviors).

Many studies have been done to assess the correlation between learning disability and self-esteem. These studies have shown that an individual‘s self-esteem is indeed affected by his or her awareness of their learning disability. Students with a positive perception of their academic abilities generally tend to have higher self-esteem than those who do not, regardless of their actual academic achievement. However, studies have also shown that several other factors can influence self-esteem. Skills in non-academic areas, such as athletics and arts, positively impact self-esteem. Also, a positive perception of one’s physical appearance has also been shown to have positive effects of self-esteem. Another important finding is that students with learning disabilities are able to distinguish between academic skill and intellectual capacity. This demonstrates that students who acknowledge their academic limitations but are also aware of their potential to succeed in other intellectual tasks see themselves as intellectually competent individuals, which increases their self-esteem.

Social correlates

Critique of the medical model

Learning disability theory is founded in the medical model of disability, in that disability is perceived as an individual deficit that is biological in origin. Researchers working within a social model of disability assert that there are social or structural causes of disability or the assignation of the label of disability, and even that disability is entirely socially constructed. Since the turn of the 19th century, education in the United States has been geared toward producing citizens who can effectively contribute to a capitalistic society, with a cultural premium on efficiency and science. More agrarian cultures, for example, do not even use learning ability as a measure of adult adequacy, whereas the diagnosis of learning disabilities is prevalent in Western capitalistic societies because of the high value placed on speed, literacy, and numeracy in both the labor force and school system. In the bigger picture, these points demonstrate how the label of disability is socially constructed and represents a lack of fit between Western conceptions of educational institutions and proper students.

Culture

There are three patterns that are well known in regards to mainstream students and minority labels in the US:

• "A higher percentage of minority children than of white children are assigned to special education;"
• "within special education, white children are assigned to less restrictive programs than are their minority counterparts;"
• "the data — driven by inconsistent methods of diagnosis, treatment, and funding — make the overall system difficult to describe or change”.

In present day, it has been reported that white districts have more children from minority backgrounds enrolled in special education than they do majority students. “It was also suggested that districts with a higher percentage of minority faculty had fewer minority students placed in special education suggesting that "minority students are treated differently in predominantly white districts than in predominantly minority districts""

Educators have only recently started to look into the effects of culture on learning disabilities. If a teacher ignores a student’s culturally diverse background, the student will suffer in the class. “The cultural repertoires of students from cultural learning disorder backgrounds have an impact on their learning, school progress, and behavior in the classroom”. These students may then act out and not excel in the classroom and will therefore be misdiagnosed: “Overall, the data indicates that there is a persistent concern regarding the misdiagnosis and inappropriate placement of students from diverse backgrounds in special education classes since the 1975”.

Social roots of learning disabilities in the U.S.

One of the clearest indications of the social roots of learning disabilities is the disproportionate identification of racial and ethnic minorities and students who have low socioeconomic status (SES). While some attribute the disproportionate identification of racial/ethnic minorities to racist practices or cultural misunderstanding, others have argued that racial/ethnic minorities are overidentified because of their lower status. Similarities were noted between the behaviors of “brain-injured” and lower class students as early as the 1960s. The distinction between race/ethnicity and SES is important to the extent that these considerations contribute to the provision of services to children in need. While many studies have considered only one characteristic of the student at a time, or used district- or school-level data to examine this issue, more recent studies have used large national student-level datasets and sophisticated methodology to find that the disproportionate identification of African American students with learning disabilities can be attributed to their average lower SES, while the disproportionate identification of Latino youth seems to be attributable to difficulties in distinguishing between linguistic proficiency and learning ability. Although the contributing factors are complicated and interrelated, it is possible to discern which factors really drive disproportionate identification by considering a multitude of student characteristics simultaneously. For instance, if high SES minorities have rates of identification that are similar to the rates among high SES Whites, and low SES minorities have rates of identification that are similar to the rates among low SES Whites, we can know that the seemingly higher rates of identification among minorities result from their greater likelihood to have low SES. Summarily, because the risk of identification for White students who have low SES is similar to that of Black students who have low SES, future research and policy reform should focus on identifying the shared qualities or experiences of low SES youth that lead to their disproportionate identification, rather than focusing exclusively on racial/ethnic minorities. It remains to be determined why lower SES youth are at higher risk of incidence, or possibly just of identification, with learning disabilities.

Contrast with other conditions

People with an IQ lower than 70 are usually characterized as having an intellectual disability and are not included under most definitions of learning disabilities, because their difficulty in learning are considered to be related directly to their overall low intelligence.

Attention-deficit hyperactivity disorder (ADHD) is often studied in connection with learning disabilities, but it is not actually included in the standard definitions of learning disabilities. An individual with ADHD may struggle with learning, but he or she can often learn adequately once successfully treated for the ADHD. A person can have ADHD but not learning disabilities or have learning disabilities without having ADHD. The conditions can co-occur.

People diagnosed with ADHD sometimes have impaired learning. Some of the struggles people with ADHD might have include lack of motivation, high levels of anxiety, and the inability to process information. There are studies that suggest people with ADHD generally have a positive attitude toward academics and, with developed study skills, can perform just as well as individuals without learning disabilities. Also, using alternate sources of gathering information, such as websites, study groups, and learning centers, can help a person with ADHD be academically successful.

Some research is beginning to make a case for ADHD being included in the definition of LDs, since it is being shown to have a strong impact on "executive functions" required for learning. This has not as yet affected any official definitions. Though, historically, ADHD was not clearly distinguished from other disabilities related to learning. Scientific research continues to explore the traits, struggles, and learning styles of those with ADHD.

In different countries

United States and Canada

In the United States and Canada, the terms learning disability and learning disorder (LD) refer to a group of disorders that affect a broad range of academic and functional skills including the ability to speak, listen, read, write, spell, reason, organize information, and do math. A person's IQ must be average or above to have a learning disability or learning disorder.

USA legislation

The Section 504 of the Rehabilitation Act 1973 was taken in effect in May 1977, this American legislation guarantees certain rights to people with disabilities, especially in the cases of education and work, such being in schools, colleges and university settings.

The Individuals with Disabilities Education Act, formerly known as the Education for All Handicapped Children Act, is a United States federal law that governs how states and public agencies provide early intervention, special education and related services to children with disabilities. It addresses the educational needs of children with disabilities from birth to the age of 21. Considered as a civil rights law, states are not required to participate.

United Kingdom

In the UK, terms such as specific learning difficulty (SpLD), developmental dyslexia, developmental coordination disorder and dyscalculia are used to cover the range of learning difficulties referred to in the United States as "learning disabilities". In the UK, the term "learning disability" refers to a range of developmental disabilities or conditions that are almost invariably associated with more severe generalized cognitive impairment. The Lancet defines 'learning disability' as a "significant general impairment in intellectual functioning acquired during childhood," and states that roughly one in 50 British adults have one.

Japan

In Japan, acknowledgement and support for students with learning disabilities has been a fairly recent development, and has improved drastically in the last decade. The first definition for learning disability was coined in 1999, and in 2001, the Enrichment Project for the Support System for Students with Learning Disabilities was established. Since then, significant efforts have been to screen children for learning disabilities, provide follow-up support, and provide networking between schools and specialists.

See also

• Functional disconnection
• Future planning
• Language-based learning disability
• Learning problems in childhood cancer

External links

• The National Center for Learning Disabilities
• SEN Rights (Hong Kong)

• Learning disability at DMOZ