Learning disorders

We understand that you may have a lot of questions when your child is suspected of having or diagnosed with a learning disorder:

• What is a learning disorder? 
• What does it mean?
• How will it affect my child long term?
• What do I do next?
   

We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can further discuss your child’s evaluation.  
 

What is a learning disorder?

A learning disorder is defined as a difficulty in an area of cognitive functioning in which two conditions are met:

1. 1. The child's achievement level is below what’s expected for his age, educational level and level of intelligence (most children with learning disorders have normal intelligence).
2. 2. The difficulty is not caused by:

• a sensory disturbance, such as hearing or visual loss  
• a primary neurologic disorder
• a psychiatric disorder
• some form of social deprivation or failure to attend school
   

What’s the difference between a learning disorder and a learning disability?

Understandably, there’s often confusion between these two terms:

• A learning disorder is a medical term.
• A learning disability can be thought of as more of a legal term (used by a state’s Department of Education) that identifies the line past which a school is required to make special arrangements to help a child learn. This means that a child might have a learning disorder, but if it is not shown to sufficiently impact his school performance, the school will not consider it to be a learning disability, and will not consider him eligible for special services.
   

What are the types of learning disorders?

The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) recognizes four types of learning disorders:

1. Reading disorders

A reading disorder may be suspected when a child reads below the expected level for his age, grade in school and intelligence. Children with a reading disorder may:

• read slowly
• have difficulty with word recognition
• confuse words that look similar
• have difficulty understanding what they read
   

2. Mathematics disorders

A mathematics disorder may be present when a child has problems with skills related to numbers. These may include:

• counting
• copying numbers correctly
• adding and carrying numbers
• learning multiplication tables
• recognizing mathematical signs
• understanding mathematical operations
   

3. Disorders of written expression

A disorder of written expression is characterized by difficulty with skills related to writing, such as:

• spelling
• handwriting
• organizing paragraphs
• composing written information
• understanding grammar and punctuation
   

4. Learning disorders not otherwise specified (LD NOS)

Learning disorders not otherwise specified may affect problem solving, and mimic or exacerbate other types of learning disorders. Examples of LD NOS include problems with:

• switching between tasks
• monitoring one’s own performance
• memory
   

What is dyslexia?

While the term “dyslexia” is often used to refer to any reading disorder, classical dyslexia is a type of reading disorder in which a child’s inability to read is caused by an inability to associate letters with sounds. This prevents the child from being able to read in an efficient way.

Reading disorders other than dyslexia include problems with comprehension and problems with fluency.
 

Who is affected by learning disorders?

It’s estimated that ten to 30 percent of children have learning disorders. Reading disorders are the most common. Mathematics disorders are estimated to affect one percent of school-aged children.
 

Can learning disorders be prevented?

Currently, there’s no known way of preventing the incidence of learning disorders. But researchers at Children’s and elsewhere are working on innovative early diagnostic techniques that will allow clinicians to identify nascent LD and develop interventions to let us optimize a child’s strengths and compensate for his weaknesses as early as possible. 
 

Do learning disorders overlap?

Because of the way the brain is organized, certain types of learning disorders are likely to be seen alongside certain other issues—for example, poor handwriting (a sign of disorder of written expression) may often accompany dyslexia (a reading disorder).

Learning disorders can sometimes mimic each other, too. For example, a child may have difficulty with word problems that looks like a math disorder, but is actually a reading disorder. This is why it’s important that your child be diagnosed by an expert who can tease out the exact nature of his challenges.
 

Could a child have both a learning disorder and ADHD?

Yes. While it’s by no means assured, learning disorders and ADHD go together frequently:

• About 60 percent of kids with ADHD also have a learning disorder.
• About 25 percent of kids with a learning disorder also have ADHD.
   

Causes

What causes learning disorders?

Learning disorders are believed to occur because of an abnormality in the nervous system, either in the structure of the brain or in the functioning of brain chemicals. This causes a child with a learning disorder to receive, process or communicate information in a different way.

This difference might be caused by a variety of factors, including genetics and other factors that can affect the developing brain, such as:

• prematurity
• problems during pregnancy, birth or early infancy
• early brain injury
• other medical conditions
• exposure to toxins such as lead
   

Symptoms

What are the symptoms of a learning disorder?

Since learning is age-dependent, it’s no surprise that signs of a learning disorder are age-dependent, too.

Younger children:

It goes without saying that each child is different and may reach developmental milestones at a different age. Still, some basic benchmarks include:

• By pre-school, most kids are playing around with making sounds vocally.
• By kindergarten, kids should be picking up on common signs, such as exit signs and men’s/women’s room signs.
• By the end of kindergarten, most children know all the letters in the alphabet, and should know most of the associations between letters and sounds.
• Children should be reading single words by the middle of first grade.
   

We recommend that your child’s progress be followed closely in his early school years if he experiences one or more of the following:

• delay in language skills
• delay in motor skills
• delay in visual-spatial coordination
   

Our researchers are developing tools to help us identify risk factors for learning disorders at an increasingly early age.
 

Older children:

Once a child is in school, a parent or teacher may be able to identify a learning disorder if the child consistently has difficulty with one or more of the following:

• reading, spelling, writing or completing math problems
• understanding or following directions
• distinguishing right from left
• reversing letters or numbers (for example, confusing “b” and “d” or “12” and “21”)
   

Keep in mind that learning disorders aren’t inextricably linked to certain symptoms. Children might have the same type of learning disorder but show different symptoms.

As a parent, you know your child best. But no parent should be tasked with diagnosing his or her child—our experts have lots of experience identifying different types of learning disorders in kids of all ages.
 

FAQ

Q: What’s the long-term outlook for a child with a learning disorder?
A: The long-term outlook is often age-dependent.

If very young elementary school children with learning disorders get appropriate, evidence-based intervention, the potential for considerable improvement is high.

Older kids diagnosed with an LD are unlikely to be able to fully close the gap with their peers, although special education and tutoring can help them improve.

Q: If my child has a learning disorder, what can I do to help?
A: Your support is extremely important to your child. If your child is young, reading to him can help model language for him in the right way. You can point out words and make their sounds to help your child make the connection between the two, and ask your child to tell you what the pictures are about.  

If your child is older, emphasize that treatment is just as much about taking advantage of his strengths as it is about compensating for his challenges. Talk to your doctor about other ways that you can help.

Q: Can a learning disorder be outgrown?
A: There’s no evidence that suggests that an LD can be outgrown. But there is evidence that for certain types of LD, early, intensive evidence-based intervention can help substantially.

Q: Are learning disabilities inherited?
A: There is some evidence that learning disorders—particularly reading disorders—can be passed down. If a parent has a learning disorder, his or her child should be monitored for one as well. And if one child in a family has an LD, it’s a good idea to be on the lookout for signs in the others as well.

Parents with a learning disorder should be careful to remember to allow their children to have their own experience with their own learning disorder, and not assume that they know what the child is thinking or feeling.

Q: Could my child’s learning disability be a sign of something more serious?
A: It is possible.Here at Children’s, our thorough, multidisciplinary evaluations are targeted at making sure that we isolate the cause of your child’s struggles, keeping in mind medical conditions (e.g., epilepsy or sleep apnea), mood disorders (e.g., depression) and behavioral disorders (e.g., ADHD).

Sometimes issues such as depression, anxiety and ADHD may masquerade as a learning disorder, and sometimes a learning disorder may masquerade as one of these conditions. That’s one of the reasons why we have such a comprehensive process of evaluation.

Q: If a learning disorder is a gap between ability and performance, how can a child’s “ability” be measured without his performance being taken into account? 
A: As unlikely as it may seem, IQ tests are designed not to call on learned skills like reading. And learning disorder experts are well-versed in choosing and administering the most appropriate measures to accurately measure a child’s learning capability.

Q: Will health insurance cover my child’s evaluation?
A: Unfortunately, health insurance coverage for a learning disorder evaluation is extremely limited, and only certain components may be covered. Your child’s school system may be able to provide financial assistance, too. Your family is responsible for obtaining all necessary authorizations and referrals. Call your insurance provider, using the toll-free number on the back of your insurance card, for specific information about your child’s situation.

Q: What should parents keep in mind when talking with a child about his learning disorder?
A: As in other circumstances, parents should listen to the child, answer the questions the child has and only go further when the child requests more information. Too much information can be overwhelming. It is also important that the parent master any strong emotional reactions to the diagnosis before talking to the child.
 

Questions to ask your doctor

If your child is suspected of or has been confirmed as having a learning disorder, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you.

Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed. If your child is old enough, you may want to suggest that she write down what he wants to ask her health care provider, too.

Here are some questions to get you started:

• What will the experience be like for me?
• What will the experience be like for my child?
• How will the results be communicated to me?
• How will the results be used?
• What will the follow up be?
• Could anything else be causing my child’s symptoms?
• Can you suggest other sources of information and support?

Rethinking Learning Disabilities: Understanding Children Who Struggle in School

Children’s neuropsychologist Deborah Waber, PhD, a leading researcher and clinician in our Learning Disabilities Program, recently authored Rethinking Learning Disabilities: Understanding Children Who Struggle in School. In the book, she explains how understanding learning difficulties as a developmental problem can guide educators, clinicians and parents to better support children who struggle in school.