Specific Learning Disorder DSM-5 315 (ICD-10-CM Multiple Codes)
DSM-5 Category: Neurodevelopmental Disorders
Introduction
Specific learning disorder is a biologically based, neurodevelopmental disorder that affects a person’s ability to take in, process, and/or communicate information (American Psychiatric Association, 2013). These abnormalities in the brain’s ability to accurately and efficiently perceive and process information result in difficulties in learning foundational academic skills, such as reading accuracy, fluency and comprehension; spelling and written expression; and arithmetic calculation and mathematical reasoning. As a result of deficits in keystone academic skills, difficulties arise in learning more complex subjects and cause the student’s academic achievement to lag far behind what is expected for his and her age and intellectual ability. Lagging academic achievement that results from visual or auditory problems or poor or inappropriate academic instruction is not indicative of a specific learning disorder.
Types and Degrees of Specific Learning Disorder
Specific learning disorder can affect one or more of the following academic domains: reading, as in the case of dyslexia, written expression, and/or mathematics, as in the case of dyscalculia (American Psychiatric Association, 2013). In addition, the disorder is classified by severity. The disorder is considered to be “mild” if a student has some learning difficulties, but is able to function well with minimal appropriate support services. If a student’s learning difficulties require multiple periods of intense, specialized instruction in order to obtain proficiency in academic skills, the disorder is considered to be “moderate.” When learning difficulties are so pronounced that the student is unable to obtain the necessary academic skills without continuous, intensive, specialized instruction, a designation of “severe” is appropriate.
How Common is Specific Learning Disorder
Specific learning disorder affects approximately 5%-15% of school-age children and 4% of adults (American Psychiatric Association, 2013; Margari, Buttiglione, Craig, Cristella, de Giambatista, Matera, Operto, & Simon, 2013; Katusic, Colligan, Weaver, & Barbaresi, 2009).
Specific Learning Disorder and Co-Occurring Disorders
Specific learning disorder can occur alongside other disorders. A study by Margari et al. (2013) revealed that 33% of patients with specific learning disorder also show signs of attention deficit hyperactivity disorder (ADHD), indicating that common biological mechanisms are at play in both specific learning disorder and ADHD. Additionally, this study suggested that other disorders, such as anxiety disorders, depressive disorders and developmental coordination disorder, may tend to co-occur with specific learning disorder.
What Causes Specific Learning Disorder
While the biological underpinnings of specific learning disorder are not entirely understood, progress has been made in understanding some of the mechanisms responsible for the disorder. For example, children that have been born pre-term have an increased likelihood of experiencing difficulties attaining competency in various academic subjects, especially mathematics (Simms, Cragg, Gilmore, Marlow, & Johnson, 2013). Along similar lines, low birth weight is also correlated with later academic difficulties (Taylor, Espy, & Anderson, 2009). Other biological mechanisms that trigger specific learning disability have been investigated, including epigenetic agents. For instance, chemicals – such as pesticides, dioxins, and other organic toxins – that damage hormones of the endocrine gland are associated with learning disabilities (Kajta & Wójtowicz, 2013). In addition, improperly functioning microRNAs can negatively impact neurodevelopment.
How Specific Learning Disorders Are Diagnosed
A qualified professional called a psychologist can diagnose specific learning disorder based on the presence of the following criteria. Persistent difficulty acquiring academic skills despite adequate instruction is a primary feature of the disorder. Students with specific learning disorder struggle to learn in at least one academic domain. In addition, academic performance in the affected academic domain must be confirmed by a “comprehensive clinical assessment” (including a standardized test of achievement) to be “substantially and quantifiably” lower than expected given the individual’s age and to result in “significant interference” with school, work performance, or daily living (American Psychiatric Association, 2013). Intellectual deficits, problems with sensory perception, socioeconomic adversity, lack of access to adequate instruction, and other mental disorders and neurological problems must be ruled out as likely causes of the learning difficulties. In some cases learning problems that are present during childhood may be only partly apparent until academic or occupational demands exceed the underlying capacities.
Treatment of Specific Learning Disorder
Remediation for specific learning disorder often involves specialized instruction provided by a special education teacher. Special education teachers are uniquely qualified to provide special teaching to help students overcome learning difficulties. Special education is often part of a comprehensive individualized education plan (IEP) that may include classroom or test-taking accommodations (e.g. quite learning environment, extra test taking time, etc.) to compensate for the impact of cognitive inefficiencies on academic performance.
A variety of treatment approaches are available to remediate symptoms of specific learning disability. One study described a method for improving math ability in adolescents with intellectual disabilities that involved the use of computer software called Math Garden assist teaching basic arithmetic operations (Jansen, De Lange, & Van der Molen, 2013). Similarly, the use of computer software been shown to successfully to ameliorate deficits in reading comprehension skills (Saine, Lerkkanen, Ahonen, Tolvanen, & Lyyttinen, 2011). Neurofeedback, which involves the use of electroencephalography to monitor brain activity, has been shown to significantly increase reading comprehension skills (Nazari, Mosanezhad, Hashemi, & Jahan, 2012). These finding suggest that computer-based education and neurofeedback may be of benefit to individuals with a broad range of learning problems.
Although traditional psychotherapy does not directly address specific learning disorder, it is known to effectively treat depressive disorders and anxiety disorders that frequently occur as a result of the impact that specific learning disorders can have on an individual’s life. Consequently, psychotherapy may be an important competent of comprehensive treatment.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Jansen, B.R., De Lange, E., Van der Molen, M.J. (2013). Math practice and its influence on math skills and executive functions in adolescents with mild to borderline intellectual disability. Research in Developmental Disabilities, 34(5), 1815-1824.
Kajta, M., Wójtowicz, A.K. (2013). Impact of endocrine-disrupting chemicals on neural development and the onset of neurological disorders. Pharmacological Reports, 65(6), 1632-1639.
Katusic, S.K., Colligan, R.C., Weaver, A.L., Barbaresi, W.J. (2009). The forgotten learning disability: epidemiology of written-language disorder in a population-based birth cohort (1976-1982), Rochester, Minnesota. Pediatrics, 123(5), 1306-1313.
Margari, L., Buttiglione, M., Craig, F., Cristella, A., de Giambattista, C., Matera, E., Operto, F., Simone, M., (2013). Neuropsychopathological comorbidities in learning disorders. BMC Neurology, 13(1), 198.
Nazari, M.A., Mosanezhad, E., Hashemi, T., Jahan, A. (2012). The effectiveness of neurofeedback training on EEG coherence and neuropsychological functions in children with reading disability. Clinical EEG and Neuroscience, 43(4), 315-322.
Saine, N.L., Lerkkanen, M.K., Ahonen, T., Tolvanen, A., Lyytinen, H. (2011). Computer-assisted remedial reading intervention for school beginners at risk for reading disability. Child Development, 82(3), 1013-1028.
Simms, V., Cragg, L., Gilmore, C., Marlow, N., Johnson, S. (2013). Mathematics difficulties in children born very preterm: current research and future directions. Archives of Disease in Childhood, 98(5), 457-463.
Taylor, H.G., Espy, K.A., Anderson, P.J. (2009). Mathematics deficiencies in children with very low birth weight or very preterm birth. Developmental Disabilities Research Reviews, 15(1), 52-59.
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