specific Learning Disorders (Dyslexia, Dysgraphia and Dyscalculia)

specific learning disorder is a neuro cognitive disorder

1. Learning DisordersLearning Disorders
Psy 610APsy 610A
Gary S. Katz, Ph.D.Gary S. Katz, Ph.D.

2. Diagnostic FeaturesDiagnostic Features

NOTE: DSM-IV-TR and many state guidelines are NOT NOTE: DSM-IV-TR and many state guidelines are NOT
the same when it comes to diagnostic features of learning the same when it comes to diagnostic features of learning
disabilities/disorders.disabilities/disorders.

DSM: Learning DSM: Learning DisorderDisorder

Education law: Learning Education law: Learning DisabilityDisability

Learning Disorders are diagnosed when an individual’s Learning Disorders are diagnosed when an individual’s
achievement on an individually-administered, standardized test is achievement on an individually-administered, standardized test is
substantially below what is expected for age, schooling, and level substantially below what is expected for age, schooling, and level
of intelligence.of intelligence.

Discrepancy model.Discrepancy model.

““Substantially below” = more than 2 SD (usually 1.5SD)Substantially below” = more than 2 SD (usually 1.5SD)

That this model requires a “clean” measure of intelligence; one That this model requires a “clean” measure of intelligence; one
that is unimpacted by other comorbid conditionsthat is unimpacted by other comorbid conditions

3. Diagnostic IssuesDiagnostic Issues
The Individuals with Disabilities Education Act (IDEA 2004) defines a
Specific Learning Disability in Title 20 United States Code Section 1401(30)
[cited as 20 USC 1401(30)] as follows:
(30) Specific Learning Disability.
(A) In General. The term ‘specific learning disability’ means a disorder in 1 or more of
the basic psychological processes involved in understanding or in using language,
spoken or written, which disorder may manifest itself in the imperfect ability to listen,
think, speak, read, write, spell, or do mathematical calculations.
(B) Disorders Included. Such term includes such conditions as perceptual disabilities,
brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.
(C) Disorders Not Included. Such term does not include a learning problem that is
primarily the result of visual, hearing, or motor disabilities, of mental retardation, of
emotional disturbance, or of environmental, cultural, or economic disadvantage.

4. Diagnostic IssuesDiagnostic Issues
Aside from the discrepancy model, IDEA allowed for a
“Response to Intervention” approach:
Title 20 of Section 1414, subsection b(6), [cited as 20 USC
1414(b)(6)].
(6) Specific Learning Disabilities.
(A) In General . . . [W]hen determining whether a child has a specific
learning disability as defined in Section 1401 of this title, a local educational
agency shall not be required to take into consideration whether a child has a
severe discrepancy between achievement and intellectual ability in oral
expression, listening comprehension, written expression, basic reading skill,
reading comprehension, mathematical calculation, or mathematical reasoning.
(B) Additional Authority. In determining whether a child has a specific
learning disability, a local educational agency may use a process that
determines if the child responds to scientific, research-based intervention as a
part of the evaluation procedures described in paragraphs (2) and (3).

5. Discrepancy Model vs RTIDiscrepancy Model vs RTI

Why the shift to a RTI model?Why the shift to a RTI model?

Discrepancy model can be seen as a “wait to fail” Discrepancy model can be seen as a “wait to fail”
model.model.

Children with low IQs harder to qualify with a Children with low IQs harder to qualify with a
Learning DisabilityLearning Disability

Younger children harder to assess to find Younger children harder to assess to find
“significant discrepancy”“significant discrepancy”

Floor issues on IQ/academic testsFloor issues on IQ/academic tests

6. Associated Features & DisordersAssociated Features & Disorders

Demoralization, low self-esteem, social skill deficitsDemoralization, low self-esteem, social skill deficits

Drop-out rate for children or adolescents with LDs is nearly Drop-out rate for children or adolescents with LDs is nearly
40% (1.5x the average).40% (1.5x the average).

Adults with LDs may have employment or social difficulties.Adults with LDs may have employment or social difficulties.

10-25% of individuals with Conduct Disorder, ODD, ADHD, 10-25% of individuals with Conduct Disorder, ODD, ADHD,
Major Depressive Disorder, or Dysthmic Disorder also have Major Depressive Disorder, or Dysthmic Disorder also have
comorbid LD.comorbid LD.

May also have subtle developmental delays in language (though May also have subtle developmental delays in language (though
not meeting criteria for Communication Disorder).not meeting criteria for Communication Disorder).

Higher rates of Developmental Coordination Disorder in LD Higher rates of Developmental Coordination Disorder in LD
population as well.population as well.

7. Associated Features & DisordersAssociated Features & Disorders

May also be underlying deficits in cognitive May also be underlying deficits in cognitive
processingprocessing

Makes assessing IQ quite difficultMakes assessing IQ quite difficult

Visual perceptionVisual perception

Linguistic processesLinguistic processes

AttentionAttention

MemoryMemory

May be a history of genetic predisposition, perinatal May be a history of genetic predisposition, perinatal
injury, and other medical conditions – not specific to injury, and other medical conditions – not specific to
LDsLDs

8. Specific Cultural FeaturesSpecific Cultural Features

Most IQ/ACH tests are normed on North Most IQ/ACH tests are normed on North
American / United States samples.American / United States samples.

Makes assessing LDs in other cultures Makes assessing LDs in other cultures
difficult.difficult.

Options:Options:

Nonverbal intelligence tests (TONI, CTONI, Nonverbal intelligence tests (TONI, CTONI,
UNIT)UNIT)

Nonverbal academic tests???Nonverbal academic tests???

9. PrevalencePrevalence

Estimates between 2% and 10% of the general Estimates between 2% and 10% of the general
population have LDspopulation have LDs

Approximately 5% of the students in public Approximately 5% of the students in public
schools in the United States are identified as schools in the United States are identified as
having a Learning Disorderhaving a Learning Disorder

10. Differential DiagnosisDifferential Diagnosis

Normal variations in academic functioningNormal variations in academic functioning

Impoverished environmentImpoverished environment

Lack of opportunityLack of opportunity

Poor teaching (dyspedagogia) or no teaching (apedagogia)Poor teaching (dyspedagogia) or no teaching (apedagogia)

Cultural factorsCultural factors

Impaired vision / hearing Impaired vision / hearing

Need to have troubles learning beyond what would be Need to have troubles learning beyond what would be
expected with the sensory impairmentexpected with the sensory impairment

Mental retardation / PDD / CDMental retardation / PDD / CD

Need to have academic achievement significantly below what Need to have academic achievement significantly below what
would be expected for the extant cognitive abilitieswould be expected for the extant cognitive abilities

11. Reading Disorder (315.00)Reading Disorder (315.00)
A.A.Reading achievement as measured by individually-administered Reading achievement as measured by individually-administered
standardized tests of reading accuracy or comprehension is standardized tests of reading accuracy or comprehension is
substantially below that expected given the person’s chronological substantially below that expected given the person’s chronological
age, measured intelligence, and age-appropriate education.age, measured intelligence, and age-appropriate education.
B.B.The disturbance in (A) significantly interferes with academic The disturbance in (A) significantly interferes with academic
achievement or activities of daily living that require reading skills.achievement or activities of daily living that require reading skills.
C.C.If a sensory deficit is present, the reading difficulties are in excess If a sensory deficit is present, the reading difficulties are in excess
of those usually associated with it.of those usually associated with it.
Note: If a general medical (e.g., neurological) condition or sensory Note: If a general medical (e.g., neurological) condition or sensory
deficit is present, code the condition on Axis IIIdeficit is present, code the condition on Axis III
Generic term: dyslexiaGeneric term: dyslexia

12. Reading Disorder (315.00)Reading Disorder (315.00)

Impacts oral reading, silent reading, reading Impacts oral reading, silent reading, reading
comprehensioncomprehension

Can see distortions, substitutions, omissions in Can see distortions, substitutions, omissions in
readingreading

In some cases, directionality and/or sequencing In some cases, directionality and/or sequencing
is impactedis impacted

Losing place while reading, unaware of how to shift Losing place while reading, unaware of how to shift
to the next lineto the next line

Overlap with executive dysfunctionOverlap with executive dysfunction

13. Reading Disorder (315.00)Reading Disorder (315.00)

Very rare to have Mathematics Disorder and Disorder of Very rare to have Mathematics Disorder and Disorder of
Written Expression without a comorbid Reading Disorder.Written Expression without a comorbid Reading Disorder.

60-80% of individuals with Reading Disorder are male; 60-80% of individuals with Reading Disorder are male;
however, may be due to the fact that males are more likely however, may be due to the fact that males are more likely
to be referred for evaluationto be referred for evaluation

Gender differences in LD expressionGender differences in LD expression

When stringent dx criteria are applied, equal sex ratioWhen stringent dx criteria are applied, equal sex ratio

Prevalence: RD + (MD, DWE) accounts for nearly 80% of Prevalence: RD + (MD, DWE) accounts for nearly 80% of
all LDsall LDs

Prevalence in United States: 4% of all school-aged children.Prevalence in United States: 4% of all school-aged children.

14. Reading Disorder (315.00)Reading Disorder (315.00)

May see signs of RD as early as kindergarten; May see signs of RD as early as kindergarten;
however, not usually diagnosed until late K, however, not usually diagnosed until late K,
early 1early 1
stst
grade as formal reading instruction has grade as formal reading instruction has
not yet occurred.not yet occurred.

With high IQ, may not see RD until later grades With high IQ, may not see RD until later grades
(when curriculum shifts to reading for (when curriculum shifts to reading for
knowledge as opposed to reading for reading).knowledge as opposed to reading for reading).

With early identification and intervention, With early identification and intervention,
prognosis is good.prognosis is good.

15. Mathematics Disorder (315.1)Mathematics Disorder (315.1)
A.A.Mathematical ability, as measured by individually administered Mathematical ability, as measured by individually administered
standardized tests, is substantially below that expected given the standardized tests, is substantially below that expected given the
person’s chronological age, measured intelligence, and age-person’s chronological age, measured intelligence, and age-
appropriate education.appropriate education.
B.B.The disturbance in (A) significantly interferes with academic The disturbance in (A) significantly interferes with academic
achievement or activities of daily living that require mathematical achievement or activities of daily living that require mathematical
ability.ability.
C.C.If a sensory deficit is present, the difficulties in mathematical If a sensory deficit is present, the difficulties in mathematical
ability are in excess of those usually associated with it.ability are in excess of those usually associated with it.
Note: If a general medical (e.g., neurological) condition or sensory Note: If a general medical (e.g., neurological) condition or sensory
deficit is present, code the condition on Axis III.deficit is present, code the condition on Axis III.
Generic term: dyscalculiaGeneric term: dyscalculia

16. Mathematics Disorder (315.1)Mathematics Disorder (315.1)

Impacts:Impacts:

““linguistic” skills (e.g., naming or understanding mathematical linguistic” skills (e.g., naming or understanding mathematical
terms, operations, concepts)terms, operations, concepts)

““perceptual” skills (e.g., knowledge of mathematical symbols, perceptual” skills (e.g., knowledge of mathematical symbols,
clustering objects into groups)clustering objects into groups)

““attention” skills (e.g., copying numbers correctly, sequencing attention” skills (e.g., copying numbers correctly, sequencing
arithmetic operations correctly)arithmetic operations correctly)

About 20% of all individuals with LDs have About 20% of all individuals with LDs have
Mathematics Disorders alone.Mathematics Disorders alone.

About 1% of school-age children have Mathematics About 1% of school-age children have Mathematics
DisorderDisorder

17. Mathematics Disorder (315.1)Mathematics Disorder (315.1)

Symptoms may appear as early as K or 1Symptoms may appear as early as K or 1
stst
grade; grade;
however difficult to diagnose that early.however difficult to diagnose that early.

Peak diagnosis occurs in 2Peak diagnosis occurs in 2
ndnd
& 3 & 3
rdrd
grade, when grade, when
mathematics instruction increases in complexity.mathematics instruction increases in complexity.

Individuals with higher IQs may go undiagnosed Individuals with higher IQs may go undiagnosed
longer (5longer (5
thth
grade). grade).

18. Disorder of Written Expression (315.2)Disorder of Written Expression (315.2)
A.A.Writing skills, as measured by individually administered standardized Writing skills, as measured by individually administered standardized
tests (or functional assessments of writing skills) are substantially tests (or functional assessments of writing skills) are substantially
below that expected given the person’s chronological age, measured below that expected given the person’s chronological age, measured
intelligence, and age-appropriate education.intelligence, and age-appropriate education.
B.B.The disturbance in (A) significantly interferes with academic The disturbance in (A) significantly interferes with academic
achievement or activities of daily living that require the composition achievement or activities of daily living that require the composition
of written texts (e.g., writing grammatically correct sentences and of written texts (e.g., writing grammatically correct sentences and
organized paragraphs).organized paragraphs).
C.C.If a sensory deficit is present, the difficulties in writing skills are in If a sensory deficit is present, the difficulties in writing skills are in
excess of those usually associated with it.excess of those usually associated with it.
Note: If a general medical (e.g., neurological) condition or sensory deficit Note: If a general medical (e.g., neurological) condition or sensory deficit
is present, code the condition on Axis III.is present, code the condition on Axis III.
Generic term: dysgraphiaGeneric term: dysgraphia

19. Disorder of Written Expression (315.2)Disorder of Written Expression (315.2)

Typically see:Typically see:

Grammatical or punctuation errorsGrammatical or punctuation errors

Spelling errorsSpelling errors

Excessively poor handwritingExcessively poor handwriting

Little known about DWE as compared to the other LDsLittle known about DWE as compared to the other LDs

Standardized testing in this area is less developed than in Standardized testing in this area is less developed than in
reading / mathreading / math

WJ3 writing tests – single word (spelling), single sentences WJ3 writing tests – single word (spelling), single sentences
(writing fluency, written expression)(writing fluency, written expression)

20. Disorder of Written Expression (315.2)Disorder of Written Expression (315.2)

Features can be seen as early as K, typically Features can be seen as early as K, typically
diagnosed in 2diagnosed in 2
ndnd
grade. grade.

Little known about long-term prognosis; however, Little known about long-term prognosis; however,
with the advent of “smarter” word processers, with the advent of “smarter” word processers,
impact of poor handwriting, spelling, grammar has impact of poor handwriting, spelling, grammar has
been minimized more than years ago.been minimized more than years ago.

If poor handwriting is the only symptom, consider If poor handwriting is the only symptom, consider
Developmental Coordination Disorder (315.4)Developmental Coordination Disorder (315.4)

21. Learning Disorder NOS (315.9)Learning Disorder NOS (315.9)

NOS: Not Otherwise SpecifiedNOS: Not Otherwise Specified

Used in disorders of learning that do not meet Used in disorders of learning that do not meet
criteria for any specific LD. criteria for any specific LD.

Could include moderate problems in all three Could include moderate problems in all three
areas (reading, mathematics, written expression) areas (reading, mathematics, written expression)
that together interfere with academic that together interfere with academic
achievement.achievement.

Consider academic fluency concerns in the NOS Consider academic fluency concerns in the NOS
area.area.

22. Learning Disorders - TreatmentLearning Disorders - Treatment

Early intervention is best.Early intervention is best.

Treat comorbid emotional / attentional problems.Treat comorbid emotional / attentional problems.

School support is criticalSchool support is critical

Section 504 of the Rehabilitation Act of 1973Section 504 of the Rehabilitation Act of 1973

Provides for academic accommodations with little or no financial tiesProvides for academic accommodations with little or no financial ties

Individualized Educational ProgramIndividualized Educational Program

Mandated by the Individuals with Disabilities Education Act Mandated by the Individuals with Disabilities Education Act
(reauthorized in 2004) – IDEA 2004(reauthorized in 2004) – IDEA 2004

Provides for academic modifications/accommodations that are tied Provides for academic modifications/accommodations that are tied
to some degree of financial cost/support.to some degree of financial cost/support.