Learning Disabilities Diagnosis: Understanding the Process and What It Means

Specific learning disorder (SLD), often referred to as a learning disability, is a neurodevelopmental condition affecting how individuals process information. It’s characterized by persistent difficulties in reading, writing, and/or mathematics. While diagnoses often occur during early school years, learning disabilities can remain unrecognized until adulthood when academic or professional demands increase. Understanding the Learning Disabilities Diagnosis process is crucial for accessing appropriate support and interventions.

An estimated percentage of school-aged children, ranging from 5% to 15%, grapple with a learning disability. Notably, approximately 80% of these cases involve reading impairments, commonly known as dyslexia. Dyslexia is prevalent, impacting around 20% of the general population and affecting individuals of all genders equally. Learning disabilities frequently co-occur with other neurodevelopmental disorders like ADHD and anxiety, highlighting the complexity of these conditions.

Individuals with learning disabilities may face challenges in specific skills such as accurate word reading, spelling, grammar application, or mathematical calculations. Reading and math fluency can also be affected. These difficulties can significantly hinder learning in subjects like history, science, and social studies, and can extend to everyday activities and social interactions.

Learning disorders are classified into mild, moderate, and severe levels. The intensity of required accommodations and support services is determined by the severity of the learning disability, aiming to optimize an individual’s functional abilities.

If learning disabilities remain undiagnosed and unaddressed, the repercussions can extend far beyond academic struggles. Individuals may experience heightened psychological distress, poorer mental health, unemployment or underemployment, and increased risk of dropping out of school. Early and accurate learning disabilities diagnosis is therefore essential for mitigating these potential long-term impacts.

It’s important to clarify terminology: “Specific learning disorder” is the clinical term used in medical diagnoses. “Learning disability” is often used interchangeably, particularly in educational and legal contexts, and carries legal weight for accessing accommodations in schools. “Learning difference” is a more person-centered term, often used when discussing these challenges with children, avoiding potentially stigmatizing language.

Diagnosis of Learning Disabilities

A learning disabilities diagnosis, specifically of a specific learning disorder (SLD), requires meeting four distinct criteria outlined in the DSM-5. These criteria are designed to ensure a comprehensive and accurate identification of SLD.

1. Persistent Difficulties Despite Intervention: The individual must demonstrate difficulties in at least one of six key academic areas for a minimum of six months, even after receiving targeted educational support. These areas include:

   • Reading challenges: inaccurate reading, slow reading, reading with excessive effort.
   • Reading comprehension difficulties: struggling to understand the meaning of written material.
   • Spelling difficulties.
   • Written expression difficulties: problems with grammar, punctuation, or organization in writing.
   • Number concept and calculation difficulties: struggling with understanding number concepts, recalling math facts, or performing calculations.
   • Mathematical reasoning difficulties: challenges in applying mathematical concepts or solving math problems.

2. Substantially Below Expected Academic Skills: The individual’s academic abilities in the affected area(s) must be significantly below what is expected for their age. These deficits must cause significant difficulties in academic, occupational, or everyday life activities. This criterion necessitates the use of standardized achievement tests and a comprehensive clinical assessment to objectively measure academic skill levels.

3. Onset During School Age: While the diagnosis may occur later in life, the learning difficulties must have originated during school-age years. Sometimes, the challenges become pronounced only in adulthood when academic, work-related, or daily living demands increase.

4. Exclusion of Other Conditions: The learning difficulties cannot be primarily attributed to other conditions such as intellectual disability, vision or hearing impairments, neurological conditions (like pediatric stroke), socioeconomic disadvantage, inadequate instruction, or language proficiency issues. It’s crucial to rule out these alternative explanations to ensure an accurate learning disabilities diagnosis.

The diagnostic process for learning disabilities involves a multi-faceted approach. Clinicians rely on a combination of direct observation, detailed interviews with the individual and their family, a review of family history, and examination of school records and reports. Neuropsychological testing may be employed to gain a deeper understanding of cognitive strengths and weaknesses, and to guide the development of individualized intervention strategies. For adults over 17, a documented history of learning impairments can sometimes substitute for standardized assessments.

Types of Specific Learning Disorders: Dyslexia, Dysgraphia, and Dyscalculia

The DSM-5 classification consolidated three previously separate learning disorders into the single category of Specific Learning Disorder (SLD). To specify the areas of academic weakness, the DSM-5 utilizes specifiers:

1. With impairment in reading (Dyslexia): This specifier is applied when an individual exhibits significant difficulties in reading subskills. These subskills encompass word reading accuracy, reading rate or fluency, and reading comprehension. Dyslexia is often used synonymously with reading disorder, specifically referring to challenges in word reading fluency, accuracy, decoding, and spelling.

   Reading difficulties associated with dyslexia can manifest even before formal reading instruction begins. Preschool children at risk for dyslexia might struggle with phonological awareness skills such as breaking down spoken words into syllables or recognizing rhyming words. A core challenge in dyslexia is the difficulty in establishing connections between letters and their corresponding sounds. Consequently, reading becomes a slow, effortful, and non-fluent process. Individuals with dyslexia may also experience difficulties with writing accuracy and spelling.

   Older students and adults with dyslexia often develop avoidance strategies, steering clear of reading-intensive activities whenever possible. They may prefer alternative media formats such as images, videos, or audiobooks to access information.

2. With impairment in written expression (Dysgraphia): This specifier indicates difficulties primarily in writing skills. Dysgraphia encompasses impaired spelling and writing problems that may include inaccuracies in grammar and punctuation, as well as issues with the clarity or organization of written expression. Similar to dyslexia, precursors to dysgraphia can be observed before formal writing instruction. Kindergarten-aged children with dysgraphia may struggle to recognize and write letters compared to their peers. Dysgraphia is often used to describe the fundamental difficulty in translating thoughts into written form.

3. With impairment in mathematics (Dyscalculia): This specifier is used when an individual demonstrates significantly below-average skills in mathematics. Dyscalculia encompasses difficulties in several key areas of mathematical cognition, including number sense, memorization of arithmetic facts, calculation accuracy and fluency, and mathematical reasoning. The term dyscalculia is used to describe challenges with learning number-related concepts, processing numerical information, mastering arithmetic facts, or effectively using mathematical symbols and operations for accurate and fluent calculations.

Severity Levels of Learning Disabilities

In addition to specifying the domain of learning disorder, the DSM-5 also requires indicating the severity level of the SLD diagnosis. There are three recognized severity levels:

• Mild: Characterized by some difficulties in learning in one or two academic areas. Individuals with mild SLD may often compensate effectively with appropriate accommodations and support services.
• Moderate: Involves significant learning difficulties requiring specialized teaching and accommodations. Individuals with moderate SLD typically need supportive services in school, the workplace, or at home to perform tasks accurately and efficiently.
• Severe: Represents severe learning difficulties impacting multiple academic areas. Individuals with severe SLD require ongoing, intensive specialized teaching throughout most of their school years. Even with substantial accommodations, individuals with severe SLD may still struggle to perform academic tasks efficiently.

Treatment and Support for Learning Disabilities

While there is currently no “cure” for specific learning disorders, they are highly manageable throughout an individual’s lifespan. Individuals with learning disabilities can develop into skilled learners and often leverage unique strengths often associated with their learning differences. For instance, individuals with dyslexia are frequently recognized for their creativity and ability to think innovatively.

A learning disabilities diagnosis does not impose limitations on career choices or future success. Early intervention is paramount for individuals with SLD. When learning disabilities are identified early, interventions are generally more effective, preventing prolonged academic struggles and potential negative impacts on self-esteem.

Under the Individuals with Disabilities Education Act (IDEA) in the United States, students with learning disabilities are entitled to special education services. If a learning disability is suspected, schools are legally mandated to provide an evaluation. Students diagnosed with SLD are eligible for special education services, and an Individualized Education Program (IEP) is developed collaboratively by an IEP team, including school personnel and parents. Parents have the right to request an evaluation if they have concerns. Educational advocates can provide valuable support to families navigating the IEP process. Furthermore, federal law mandates that a free appropriate public education (FAPE) be available to all students, including those requiring special education.

Special education services play a crucial role in helping children with learning disabilities improve their reading, writing, and math skills. Effective interventions are typically systematic, intensive, and individualized, aiming to remediate learning difficulties and equip individuals with compensatory strategies.

Currently, there are no FDA-approved medications specifically for learning disorders. However, medication may be prescribed to address co-occurring conditions such as ADHD and anxiety. Research consistently indicates that structured and targeted interventions focusing on phonological awareness, decoding skills, comprehension, and fluency are the most effective treatments for SLD with reading impairment (dyslexia). Interventions for writing difficulties typically address both the writing process itself and the broader process of composing written expression. Treatment for dyscalculia often incorporates multisensory instruction to enhance understanding of math concepts. Accommodations, such as using manipulatives and assistive technology, can also be beneficial for individuals with dyscalculia.

Students with learning disabilities frequently benefit from various school accommodations, such as extended time on tests and assignments, the use of computers for typing instead of handwriting, and smaller class sizes. Effective interventions, strategies, and accommodations may evolve over time as a child develops and academic demands change.

*Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision. American Psychiatric Association, 2022.

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Physician Review

Rubí E. Luna, M.D. UCLA Semel Institute for Neuroscience and Human Behavior Child and Adolescent Psychiatry Fellow, PGY-5 Member, APA Council on Communications

March 2024