Learning Disorders and Disabilities

  • All parents want the best for their kids, and may go through a range of emotions—including shock, disbelief, confusion and frustration—when it is suspected that their child may have a learning disorder. But many parents also experience relief once the diagnosis is made—it’s empowering to know what the issues are, and there are lots of resources in place to help your child reach his goals and plenty of sources of support along the way. 

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

    • reading disorders
    • mathematics disorders
    • disorders of written expression
    • learning disorders not otherwise specified (LD NOS)

    Most children with learning disorders have normal intelligence, and they all have strengths and weaknesses, just like everyone else. Treatment consists of modifying your child’s immediate educational environment so that it plays to his strengths and helps compensate for his challenges.

    How Boston Children’s Hospital approaches learning disorders

    Children with known or suspected learning disorders may be seen in our Learning Disabilities Program or Developmental Medicine Center (DMC).  In each of these programs, our unique interdisciplinary approach brings together experts from different fields to provide an integrated understanding of the "whole child." Depending on the program in which your child is seen (along with his particular situation), his evaluation may include meetings with experts in:

    We care for children and families who are seeking diagnosis, looking for a second opinion or have been diagnosed and are looking for intervention strategies. We answer questions including:

    • What is the nature of the child's problem?
    • Is there a medical basis for the child's problems?
    • Are emotional or social factors impeding the child’s learning progress?
    • Is the learning problem causing emotional or social problems?
    • What are the best ways to address learning and development in terms of programs and specific interventions?

    All of our clinicians benefit from our latest in-house research, targeted at gaining a better understanding of early signs of learning disorders, advanced diagnostic techniques and specific protocols around various genetic syndromes.

    Learning Disabilities Program

    Children’s Learning Disabilities Program offers comprehensive evaluations to give parents, teachers and physicians a well-rounded understanding of school-aged (7-15) children who face challenges in cognitive, academic and social development in the absence of intellectual disability or significant motor or sensory impairments.

    Developmental Medicine Center

    The Developmental Medicine Center at Children’s offers evaluation and treatment services for infants, children and adolescents with developmental, behavioral and learning difficulties. We treat children with a wide variety of conditions, from learning disorders, ADHD and autism to more specific issues, like bedwetting and school refusal. Our specialists also have expertise in evaluating and caring for complex neurodevelopmental conditions including Down syndrome, Williams syndrome and Fragile X.

  • 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:

    • learning disorder is a medical term.

    • 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 learningdisability, 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

    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

    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, classicaldyslexia 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.


    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


    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.


    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.

  • The first step in treating a learning disorder is forming a complete and accurate diagnosis. Here at Children’s Hospital Boston, whether your child is seen in theLearning Disorders Program or the Developmental Medicine Center, he’ll be evaluated by a range of specialists and sub-specialists who will work together to determine his complete cognitive profile and how he learns best.

    While each child is different, our evaluations are often aimed at addressing the following questions:

    • What is the nature of the child's problem?
    • Is there a medical basis for the child's problems?
    • Are emotional or social factors impeding the learning progress?
    • Is the learning problem causing emotional or social problems?
    • What are the best ways to address learning and development in terms of programs and specific interventions?

    Most of what we do in the course of an evaluation falls under one of three categories: make or clarify a diagnosisassess current functioning and make recommendations based on the child’s strengths and weaknesses.

    1. Make or clarify a diagnosis

    If a child is having difficulty in school, it’s not always clear why. For example, if he doesn’t seem to be paying attention, the cause could be:

    • medical, e.g., if a child has sleep apnea, he could be too tired in class to pay attention.
    • behavioral or psychological, e.g.the child may have difficulty concentrating because of ADHD or a similar condition.
    • a learning disorder, e.g. the child may have stopped paying attention to a lesson because it’s moving too quickly or being delivered in a way that he has challenges with.

    Our interdisciplinary evaluation allows us to not only understand the nature of your child’s challenges, but also to tease out the specifics and identify any underlying problems—resulting in a custom-tailored plan for academic/social/behavioral success, depending on your child’s needs.

    Components of your child’s evaluation may include:  

    • a thorough medical exam, including vision and hearing tests
    • a complete medical history
    • a social history
    • a developmental exam
    • a motor exam
    • a neurological exam
    • a psychological exam

    2. Assess current functioning

    Depending on your child’s age, we’ll also play with him or ask him to complete tests aimed at gaining a deep cognitive/intellectual assessment of his current abilities. Are they at the level at which we might expect him to perform?

    Again, depending on age and circumstance, we may look at his:

    • social and emotional functioning
    • verbal language skills
    • executive functioning, including memory skills
    • mathematics skills
    • reading skills (word-decoding, comprehension, vocabulary)

    For younger children, we look for risk factors and precursors to learning disorders.

    3. Recommendations in light of child’s strengths and weaknesses.

    After our experts have met with your child, they convene for a team conference to discuss all of the results. Within a couple of weeks, we invite you back to Children’s for a feedback session, in which we review our findings and share our medical, psychological and educational recommendations (as your child’s situation warrants). We provide you with a comprehensive report detailing these findings and recommendations, and we can also direct you to other sources of support.

    If your child is older, and has had some academic experience, we’ll recommend concrete measures that can help him succeed. If your child is younger, we’ll form a hypothesis around what his vulnerable areas may be, and what types of support may be helpful going forward.

    Q: Does my child need to have all components of the evaluation? 
    A: One strength of our programs is the deep and nuanced understanding our multidisciplinary approach provides—that’s why all children must participate in all components of the evaluation.

    Q: What should I tell my child about the evaluation process? 
    A: This also depends on age. If your child is in pre-school, you can say that you’re coming to Children’s Hospital Boston to meet some nice people who will talk to him and ask him some questions. There will be no shots, and nothing will hurt.

    Kids in pre-school might be told that they’re coming here so we can figure out how they learn best. You might add that they’ll be doing some simple tests.

    Older children are generally aware of why they’re coming, and for them it’s important to stress that the visit isn’t about “what’s wrong with them” but “how can we help?”

  • At Children’s, we know how difficult a diagnosis of a learning disorder can be, both for your child and for your whole family. That’s why our physicians are focused on family-centered care: From your first visit, you’ll work with a team of professionals who are committed to supporting all of your family’s physical and psychosocial needs. We’ll work with you to create an interventional plan that’s best for your child.

    Based on the results of your child’s multidisciplinary evaluation, our specialists will make recommendations geared towards determining:

    • educational needs

    • the best school placement

    • any possible need for medication to help with distractibility or hyperactivity

    • any possible benefit of additional therapies, such as speech therapy or family psychotherapy, to maximize your child’s learning potential and quality of life 

    Our experts can specify areas that warrant attention and describe approaches that should help your child, but by state law, it’s the responsibility of your child’s school system to decide how the recommendations will be carried out. 

    Depending on your child’s situation, recommendations might include:

    • books on tape
    • modified testing
    • special seating assignments
    • special classes
    • talking calculators
    • classroom assistants
    • text-to-speech and speech-to-text programs
    • word processors with spell checkers and dictionaries
    • other resources

    The most important thing is that your child continues to learn while his learning disorder is addressed. For example, if he’s having challenges with reading, he should be taught using other and/or supporting modalities.

    Follow up

    After your child’s evaluation, our team is available to you for follow-up to make sure that your child is reaching his goals, from elementary through high school. We can:

    • help monitor his academic and learning progress
    • offer impartial assessments of the Individualized Education Program (IEP) that the school has put in place for your child
    • modify recommendations as he reaches new stages of development

    During follow-up appointments, your child will most likely not go through the full evaluation again, but see whichever specialists are appropriate for him. Rest assured that your child’s doctors will build up a vast store of knowledge about your child and remain dedicated to his overall well-being. 

  • Boston Children’s Hospital is the world’s largest research program at a pediatric institution, and we’re known for pioneering new approaches. A large part of our success comes from our commitment to research—and to advancing the frontiers of what’s possible through our discoveries.  

    Nadine Gaab, PhD, of the Developmental Medicine Center’s Laboratories of Cognitive Neuroscience, leads research focused on:

    •  the influence of musical training on language and reading development
    • the development and evaluation of intervention programs for language and reading impairments
    • the neural correlates of reading and reading development (e.g., does learning to read change your brain?)
    • the relationship between auditory processing disorders and reading impairments
    • the neural correlates of auditory and language processing in developmental  and specific language impairments
    • the development of auditory and music processing and its relation to language development in typical readers

    Learn more about the Gaab Lab.

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