Learning Disorder

Aka: Learning Disorder, Academic Skill Disorder, Learning Disability, Learning Difficulty, Academic Underachievement, School Problem Evaluation

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II. Definitions

  1. Learning Disability
    1. Discrepancy between IQ and achievement
    2. No obvious underlying neurologic Impairment or Intellectual Disability
    3. Specific learning disabilities include dyslexia, dysgraphia and dyscalculia
    4. Difficult to diagnose before second grade
  2. Academic Underachievement
    1. Unable to maintain average grades in classes and tests, performing below school grade level

III. Epidemiology

  1. Affects 2-12% of school population
    1. Special education received by 10-14%
    2. Specific Learning Disability in 4.6%
  2. Reading disorders are most common (8%)
  3. Boys affected 2-4 times more often than Girls

IV. Risk factors

  1. Medical History
    1. Prematurity
    2. Low birth weight
    3. Perinatal infections
    4. Prenatal exposure to drugs or Alcohol
    5. Postnatal lead exposure
    6. Early Speech Delay or Language Delay
    7. Traumatic Brain Injury
    8. Chronic medical conditions (e.g. Asthma)
  2. Family History
    1. Specific Learning Disability, special education or lower level of parental education
    2. Neurocutaneous disorders or other neurologic disorders
  3. Social History
    1. Family does not read for pleasure
    2. Domestic Violence or Substance Abuse in the home
    3. Poverty

V. Symptoms

  1. Delay in acquiring academic skills
  2. Dropping grades
  3. Excess time to complete work or learn new material
    1. Homework takes too long to complete
    2. Excess parental involvement
  4. Inconsistent performance
    1. Does better one-to-one
    2. Does better on homework than tests
  5. Behavior problems
    1. Disruptive behavior
    2. Homework refusal
    3. Class clown
    4. Hates school
    5. Frequent school absences
    6. Hides school work, lies about assignments

VI. Signs

  1. Subtle language difficulties
    1. Poor processing
    2. Poor phonological awareness
  2. Secondary inattention (up to 40%)
    1. Retention of information is poor
  3. Low self-esteem
  4. Depression
  5. Aggressive behaviors

VII. Differential Diagnosis

  1. Genetic Disorders
    1. Deletion at 22q11.2
    2. Klinefelter Syndrome
    3. Down Syndrome
    4. Fragile X
    5. Prader-Willi
    6. Angelman's Syndrome
    7. Rett Syndrome
    8. Neurocutaneous Disorders (e.g. Neurofibromatosis, Sturge-Weber Syndrome, Tuberous Sclerosis)
  2. Acquired Disorder
    1. History of prematurity
    2. Congenital Hydrocephalus
    3. Traumatic Brain Injury
    4. Prior cerebral infection (e.g. Encephalitis)
    5. Lead Poisoning or Mercury Poisoning
  3. Intellectual Disability (Mental Retardation) or Developmental Delay
  4. Autism Spectrum Disorder
  5. Attentional Disorders (e.g. Attention Deficit Disorder)
  6. Language or Developmental Disorder
  7. Emotional disorder
    1. Anxiety
    2. Depression
    3. Post-Traumatic Stress Disorder
    4. Psychosis
  8. Visual Impairment or Hearing Impairment
  9. Seizure Disorder
  10. Substance Abuse

VIII. Associated Conditions

  1. Mood and behavioral disorders
    1. Bullying
    2. Generalized Anxiety Disorder and other Anxiety Disorders
    3. Oppositional Defiant Disorder and other Behavioral Disorders
    4. Major Depression
  2. Other disorders impacting learning
    1. Attention Deficit Disorder
    2. Autism Spectrum Disorders and other neurodevelopmental disorders
    3. Speech Delay or Language Delay
    4. Social skill deficits
  3. Somatic Conditions
    1. Headaches
    2. Motor disorders

IX. Exam

  1. Growth Assessment
  2. Hearing Testing
  3. Visual Acuity testing
  4. Signs of other disease
    1. Cutaneous Signs of Dysraphism
    2. Dysmorphic features (e.g. Fetal Alcohol Syndrome)
    3. Chronic disease (e.g. Asthma, Seizure Disorder, recurrent Otitis Media)
    4. Neurocutaneous findings (e.g. Neurofibromatosis)

X. Diagnostics: As Indicated

  1. Intelligence Testing (IQ Testing)
  2. Mental Status Exam
  3. Developmental Evaluation
  4. Developmental Milestone
  5. Speech Exam
  6. Psychological Testing (examples)
    1. Draw a person
    2. Kinetic family drawing
    3. Sentence completion
    4. Thematic apperception test
    5. Cole's animal test

XI. Labs: As Indicated

  1. Lead Level
  2. Complete Blood Count
  3. Specific Indications
    1. Thyroid (TSH)
    2. Electroencephalogram

XII. Imaging: As Indicated

  1. Brain MRI
    1. Indicated for focal or progressive neurologic signs

XIII. Evaluation: School-Based

  1. Response to Intervention
    1. Early intervention initiated by school in response to Academic Underachievement
    2. Persistent lack of progress results in Individualized Education Program (IEP) Evaluation
  2. Individualized Education Program (IEP)
    1. Special Education Assessment to address student needs impacting academic performance
    2. Eligibility evaluation performed by multidisciplinary team
    3. Primary and secondary eligibility categories are identified
  3. Individualized Education Program Categories
    1. Medical Diagnosis and School Eligibility
      1. Cognitive Disability resulting in school academic performance
    2. Medical Diagnosis Only
      1. Correctable medical diagnosis (e.g. Visual Acuity) impacting learning
    3. School Eligibility Only
      1. Special Education Eligibility based on pure Learning Disorders (non-medical conditions)
  4. Alternative evaluations
    1. Nonschool psychology evaluations
      1. Often self-pay (not covered by insurance)
      2. Results often not accepted by the school to impact school interventions

XIV. Evaluation: Medical Provider

  1. History and exam as above
  2. Identify medical diagnoses impacting learning
  3. Medical provider may send a letter on patient behalf to school identifying medical findings andf request for school evaluation

XV. Prognosis

  1. Best outcomes for specific learning disabilities are when treatment is started by third grade

XVI. Resources: Learning Disability Screening

  1. Project Teach Rating Scales
    1. https://projectteachny.org/rating-scales/
  2. University of Washington Screening Tools
    1. https://depts.washington.edu/dbpeds/Screening%20Tools/ScreeningTools.html

XVII. Resources: Parents

  1. Child Mind Symptom Checker
    1. https://childmind.org/symptomchecker/
  2. Learning Disabilities Association of America
    1. https://ldaamerica.org/
  3. National Center of Learning Disabilities
    1. https://www.ncld.org/
  4. Response to Intervention Action Network
    1. http://www.rtinetwork.org/
  5. Understood
    1. https://www.understood.org/en

XVIII. References

  1. Bravender (2008) Clin Pediatr 47(6): 535-45 +PMID:18566352 [PubMed]
  2. Curtin (2019) Am Fam Physician 100(10): 628-35 [PubMed]

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Related Studies

Ontology: Learning Disorders (C0023186)

Definition (MEDLINEPLUS)

Learning disorders affect how a person understands, remembers and responds to new information. People with learning disorders may have problems

  • Listening or paying attention
  • Speaking
  • Reading or writing
  • Doing math

Although learning disorders occur in very young children, they are usually not recognized until the child reaches school age. About one-third of children who have learning disabilities also have ADHD, which makes it hard to focus.

Evaluation and testing by a trained professional can help identify a learning disorder. The next step is special education, which involves helping your child in the areas where he or she needs the most help. Sometimes tutors or speech or language therapists also work with the children. Learning disorders do not go away, but strategies to work around them can make them less of a problem.

NIH: National Institute of Neurological Disorders and Stroke
Definition (NCI) A group of disorders that affect a person's ability to learn or process specific types of information which is in contrast to his/her apparent level of intellect.
Definition (MSH) Conditions characterized by a significant discrepancy between an individual's perceived level of intellect and their ability to acquire new language and other cognitive skills. These disorders may result from organic or psychological conditions. Relatively common subtypes include DYSLEXIA, dyscalculia, and dysgraphia.
Definition (PSY) According to U.S. federal legislation, learning problems that are due to visual, hearing, or motor handicaps, mental retardation, emotional disturbance or environmental, cultural, or economic disadvantage. Compare LEARNING DISABILITIES.
Definition (CSP) conditions characterized by a significant discrepancy between an individual's perceived level of intellect and their ability to acquire new language and other cognitive skills; may result from organic or psychological conditions.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D007859
ICD10 F81.9
SnomedCT 1855002
DSM4 315.9
English Learning Disorders, LEARNING DISORDERS, Learning Disorder NOS, Learning disorder NOS, LEARNING DIS, academic skills disorder, Learning disorders, Learning Disorders [Disease/Finding], Disorder;learning, learning disorders, Learning Disorder, Learning differences, Learning disorder, Academic skill disorder, disorder; learning, learning; disorder, Academic skill disorder, NOS, Learning disorder, NOS, learning disorder, Disorder;academic skills
Italian Disturbo dell'apprendimento, Disturbo dell'apprendimento NAS, Disturbi dell'apprendimento
Dutch leerstoornis NAO, leervermogen; stoornis, stoornis; leervermogen, leerstoornissen, leerstoornis, Leerstoornis
French Trouble de l'apprentissage SAI, Trouble de l'apprentissage, Troubles de l'apprentissage, Troubles des apprentissages
German Lernstoerung NNB, Lernstoerungen, Lernstoerung, Lernstörungen
Portuguese Perturbação da aprendizagem NE, Transtornos de Aprendizado, Deficiências do Aprendizado, Perturbação da aprendizagem, Perturbações da aprendizagem, Transtornos de Aprendizagem
Spanish Trastorno del aprendizaje NEOM, trastorno del aprendizaje, Trastornos del aprendizaje, Trastorno del aprendizaje, Trastornos del Aprendizaje
Japanese 学習障害ＮＯＳ, ｶﾞｸｼｭｳｼｮｳｶﾞｲNOS, ｶﾞｸｼｭｳｼｮｳｶﾞｲ, 学習障害
Swedish Inlärningsstörningar
Finnish Oppimishäiriöt
Russian ZNANII PRIOBRETENIIA SPOSOBNOSTI NARUSHENIIA, ЗНАНИЙ ПРИОБРЕТЕНИЯ СПОСОБНОСТИ НАРУШЕНИЯ
Czech Porucha učení, Poruchy učení, Porucha učení NOS, poruchy učení, obtíže s učením, potíže s učením, učení - poruchy
Croatian UČENJE, SMETNJE
Polish Zaburzenia uczenia się
Hungarian Tanulási zavar k.m.n., Tanulási betegségek, Tanulási zavar
Norwegian Læringsforstyrrelser
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Learning difficulties (C0424939)

Concepts Finding (T033)
SnomedCT 161129001
English Difficulty learning, difficulty learning, difficulties learning, learning difficulties, Learning difficulties, LD - Learning difficulties, Learning difficulties (finding)
Spanish dificultades del aprendizaje (hallazgo), dificultades del aprendizaje
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Academic underachievement (C0476587)

Definition (PSY) Academic achievement less than that expected based on one's scholastic aptitude score or individual intelligence.
Concepts Finding (T033)
SnomedCT 105419003
English Academic Underachievement, Under achievement in school, Underachievement in school, underachievement in school (diagnosis), Academic underachievement (finding), lack of; achievement in school, achievement in school; lack of, underachievement in school, Academic underachievement, Underachievement (Academic)
Dutch slechte schoolprestatie, ondermaatse leerprestatie, gebrek; schoolprestaties, schoolprestaties; gebrek
French Sous-performance scolaire
German Academic underachievement (hochbegabte Schulversager), erwartungswidrige Niedrigleistung in der Schule
Italian Insuccesso accademico, Scarso rendimento scolastico
Portuguese Subaproveitamento escolar
Spanish Bajo rendimiento académico, Bajo rendimiento escolar, falta de logros en la escuela, retraso escolar (hallazgo), retraso escolar
Japanese 学校成績不良, ｶﾞｯｺｳｾｲｾｷﾌﾘｮｳ
Czech Vysokoškolské podprůměrné výsledky, Podprůměřné výsledky ve škole
Hungarian Iskolai alulteljesítés, Alulképzettség
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Learning Disabilities (C0751265)

Definition (PSY) According to U.S. federal legislation, disabilities involved in understanding or using language, manifested in impaired listening, thinking, talking, reading, writing, or arithmetic skills. Includes perceptual handicaps, brain injury, minimal brain dysfunction, and developmental aphasia. Compare LEARNING DISORDERS.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D007859
ICD10 F81.9
SnomedCT 389991004, 192531005, 154973004, 247576004, 154974005, 367332004, 1855002
Italian Difficoltà di apprendimento, Difficoltà dell'apprendimento
Japanese 学習障害者, ｶﾞｸｼｭｳｼｮｳｶﾞｲｼｬ
English Learning disabilities, learning disability, learning disability (physical finding), Disabilities, Learning, Disability, Learning, Learning Disability, Learning disability NOS, learning disabilities, disability learning, disabilities learning, Learning disability (disorder), Learning disability (finding), Learning disability, General learning disability, Learning Disabilities
Portuguese Deficiências da Aprendizagem, Dificuldade de aprendizagem
Spanish Incapacidades del Aprendizaje, Discapacidad para el aprendizaje
French Difficultés d'apprentissage, Difficulté d'apprentissage
German Lernbehinderungen, Lernunfaehigkeit
Czech Narušená schopnost učení, neschopnost učit se
Hungarian Tanulási képtelenség
Norwegian Læringsvansker
Dutch leerhandicap, Leerstoornissen
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Neurology

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