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Learning Disorders

By

Stephen Brian Sulkes

, MD, Golisano Children’s Hospital at Strong, University of Rochester School of Medicine and Dentistry

Last full review/revision May 2020| Content last modified May 2020
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Learning disorders involve an inability to acquire, retain, or broadly use specific skills or information, resulting from deficiencies in attention, memory, or reasoning and affecting academic performance.

  • Affected children may be slow to learn names of colors or letters, to count, or to learn to read or write.

  • Children take a series of academic and intelligence tests given by learning specialists, and doctors may apply established criteria to make the diagnosis.

  • Treatment involves a learning plan tailored to the child’s skills.

Learning disorders are neurodevelopmental disorders.

Learning disorders are quite different from intellectual disability (previously called mental retardation) and occur in children with normal or even high intellectual function. Learning disorders affect only certain functions, whereas in children with intellectual disability, difficulties affect cognitive functions broadly.

Three common types of learning disorders are

  • Reading disorders

  • Disorders of written expression

  • Mathematics disorders

Thus, children with learning disorders may have significant difficulty understanding and learning math, but have no difficulty reading, writing, and doing well in other subjects. Dyslexia is the best known of the learning disorders. Learning disorders do not include learning problems that are due primarily to problems of vision, hearing, coordination, or emotional disturbance, although these problems can also occur in children with learning disorders.

Children may be born with a learning disorder or develop one as they grow. Although the causes of learning disorders are not fully understood, they include abnormalities in the basic processes involved in understanding or in using spoken or written language or numerical and spatial reasoning. Possible causes include illness in the mother or the mother's use of toxic drugs during pregnancy, complications during pregnancy or delivery (for example, preeclampsia or prolonged labor), and problems with the newborn at the time of delivery (for example, prematurity, low birth weight, severe jaundice, or postmaturity). After birth, possible factors include exposure to environmental toxins such as lead, central nervous system infections, cancers and their treatments, undernutrition, and severe social isolation or emotional neglect or abuse.

Although the total number of children in the US with learning disorders is unknown, in the 2017–2018 school year, 7 million students (or 14% of all public school students) ages 3 to 21 in the United States received special education services under the Individuals with Disabilities Education Act (IDEA). Among students receiving these special education services, 34% (or about 5% of all students) had specific learning disabilities. Boys with learning disorders may outnumber girls five to one, although girls are often not recognized or diagnosed as having learning disorders.

Many children, particularly those with behavioral problems, do poorly in school and are tested by educational psychologists for learning disorders. However, some children with certain types of learning disorders hide their deficits well, avoiding diagnosis and therefore treatment, for a long time.

Did You Know...

  • Learning disorders can occur in children with normal and high intellectual function.

Symptoms

Young children may be slow to learn the names of colors or letters, to assign words to familiar objects, to count, and to progress in other early learning skills. Learning to read and write may be delayed. Other symptoms may be a short attention span and distractibility (mimicking attention-deficit/hyperactivity disorder [ADHD]), speech/language problems, difficulty understanding spoken information, and a short memory span. Affected children may have difficulty with activities that require fine motor coordination, such as printing and copying, and may have very messy handwriting or hold a pencil awkwardly. Children who have a learning disorder may have trouble organizing or beginning tasks or retelling a story in sequential order, or confuse math symbols and misread numbers.

Children with learning disorders may have difficulty communicating. Some children initially become frustrated and later develop behavioral problems, such as being easily distracted, hyperactive, withdrawn, shy, or aggressive. Learning disorders and attention-deficit/hyperactivity disorder (ADHD) often occur together.

Diagnosis

  • Educational, medical, and psychologic evaluations

  • Established criteria

Children who are not reading or learning at the level expected for their age should be evaluated. Doctors examine children for any physical disorders that could interfere with learning, including doing hearing and vision tests. Hearing and vision disorders should not be mistaken for a learning disorder.

Children take a series of intelligence tests, both verbal and nonverbal, and academic tests of reading, writing, and math skills. Often these tests can be done by specialists at the child’s school, at the parents’ request. In the United States and other nations, schools are required by law to provide testing and appropriate accommodations.

A psychologic evaluation is done to determine whether the child has emotional problems, such as anxiety or depression, or a developmental disorder, such as ADHD, because these disorders often coexist with a learning disability and can make the disability worse. Psychologists ask about the child's attitude toward school and relationships and assess the child's self-esteem and self-confidence.

The following areas are evaluated, and these criteria are used to help determine whether a child has a learning disorder:

  • Reading

  • Understanding the meaning of written material

  • Spelling

  • Writing (for example, using proper grammar and punctuation, expressing ideas clearly)

  • Understanding what numbers mean and their relationship to one another (in older children, doing simple calculations)

  • Mathematical reasoning (for example, using mathematical concepts to solve problems)

Children who are significantly below the level expected for their age in at least one of these areas for 6 months or longer despite treatment may have a learning disorder. Doctors also do tests to make sure the difficulties are not caused by intellectual disability or other neurodevelopmental disorders.

Treatment

  • Educational management

  • Sometimes psychostimulant drugs

The most useful treatment for a learning disorder is education that is carefully tailored to the individual child.

The federal Individuals with Disabilities Education Act (IDEA) requires public schools to provide free and appropriate education to children and adolescents with learning disorders. Education must be provided in the least restrictive, most inclusive setting possible—that is, a setting where the children have every opportunity to interact with nondisabled peers and have equal access to community resources. The Americans with Disability Act and Section 504 of the Rehabilitation Act also provide for accommodations in schools and other public settings.

No drug treatment has much effect on academic achievement, intelligence, and general learning ability, but, because some children with a learning disorder also have ADHD, certain psychostimulant drugs, such as methylphenidate, may improve attention and concentration, enhancing their ability to learn.

Measures such as eliminating food additives, taking large doses of vitamins, and analyzing the child’s system for trace minerals are often tried but unproved.

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