The document defines and discusses several types of learning disorders: reading disorder, mathematics disorder, and disorder of written expression. It provides details on the diagnostic criteria, epidemiology, etiology, clinical features, comorbidities, diagnosis, differential diagnosis, and treatment of each disorder based on the DSM-IV-TR. It also discusses a category of learning disorder not otherwise specified for problems that do not meet the criteria for a specific learning disorder but still significantly interfere with academic achievement.

1. Chapter- 39
Learning Disorders

2. Introduction
• Define learning disorders
• Learning disorders in a child or
adolescent are characterized by
academic underachievement in
reading, written expression, or
mathematics in comparison with the
overall intellectual ability of the
child.
• 5% of school-age children

3. The most recent revised version of
the DSM-IV (DSM-IV-TR) includes
four diagnostic categories
• reading disorder,
• mathematics disorder,
• disorder of written expression,
• learning disorder not otherwise
specified.

4. Reading Disorder
• 75 percent of children and adolescents
with learning disorders
• Defined as reading achievement below the
expected level for a child's age, education,
and intelligence, with the impairment
interfering significantly with academic
success or the daily activities that involve
reading.

5. characterized by
• an impaired ability to recognize
words,
• slow and inaccurate reading,
• poor comprehension
• children with ADHD are at high risk
for reading disorder

6. • The term Developmental alexia was
accepted and defined as a
developmental deficit in the
recognition of printed symbols.
• Dyslexia was used extensively for
many years to describe a reading
disability syndrome that often
included speech and language deficits
and right-left confusion.

7. Epidemiology
• 4 percent of school-age children in
the United States have reading
disorder
• Three to four times as many boys as
girls are reported to have reading
disability

8. Comorbidity
• 25 percent of children with reading
disorder also have ADHD.
• Family studies indicate, ADHD and reading
disorder may be genetically transmitted
together.
• Children with reading disorders have higher
than average rates of depression on self-
report measures and experience higher
levels of anxiety symptoms than children
without learning disorders.

9. Etiology
• most accurately described as a
neurobiological disorder with a genetic
origin.
• Children with reading disorders are slower
than average in naming letters and
numbers, even when controlling for IQ.
• Given that reading disorder is essentially a
language deficit, the left brain has been
hypothesized to be the anatomical site of
the dysfunction.

10. Etiology
• Positron emission tomographic (PET) studies have led some
researchers to conclude that left temporal blood flow
patterns during language tasks differ between children
with and without learning disorders.
• The hypothesis that genetic factors play a major role in
the presence of reading disorders.
• recent studies have suggested that phonological awareness
(i.e., the ability to decode sounds and sound out words) is
linked to chromosome 6.

11. Etiology
• the ability to identify single words has been
linked to chromosome 15.
• Impairment in reading spelling has now been
linked to chromosomes 1, 2, 3, 6, 15, and 18.
• The first myth is that reading disorders are
primarily caused by visual-motor problems, or
what has been termed scotopic sensitivity
syndrome.

12. Etiology
• Complications during pregnancy and prenatal
and perinatal difficulties are common in the
histories of children with reading disorder.
• Extremely low birthweight and severely
premature children are at higher risk.
• Recent evidence suggests that certain
peptides, such as those derived from
activity-dependent neurotrophic factor-12,
may mitigate alcohol-induced fetal death
and developmental learning disabilities.

13. Diagnosis
DSM-IV-TR Diagnostic Criteria for Reading
Disorder
A.Reading achievement, as measured by individually administered
standardized tests of reading accuracy or comprehension, is substantially
below that expected given the person's chronological age, measured
intelligence, and age-appropriate education.
B.The disturbance in Criterion A significantly interferes with academic
achievement or activities of daily living that require reading skills.
C.If a sensory deficit is present, the reading difficulties are in excess of
those usually associated with it.
Coding note: If a general medical (e.g., neurological) condition or
sensory deficit is present, code the condition on Axis III.

14. Clinical Features
• identified by the age of 7 years (second
grade).
• Children with reading disorder make many
errors in their oral reading.
• The errors are characterized by omissions,
additions, and distortions of words.
• Children have difficulty in distinguishing
between printed letter characters and sizes,
especially those that differ only in spatial
orientation and length of line.

15. Clinical Features
• Associated problems include language
difficulties, exhibited often as
impaired sound discrimination and
difficulty in sequencing words
properly.
• Older children tend to be angry and
depressed and exhibit poor self-
esteem.

17. Pathology and Laboratory
Examination
• Psychoeducational testing is critical in
determining this diagnosis
• standardized intelligence test
• an educational assessment of achievement.
• diagnostic battery generally includes a
standardized spelling test, written
composition, processing and using oral
language, design copying, and judgment of
the adequacy of pencil use.

18. Differential Diagnosis
• often accompanied by comorbid disorders:
• expressive language disorder,
• disorder of written
• expression, and ADHD.
• expressive language disorder or
• mixed receptive-expressive language
disorder
• Hearing and visual impairments should be
ruled out with screening tests.

19. Treatment
• focus a child's attention to the connections between
speech sounds and spelling.
• Improvements were noted on measures of reading
accuracy, reading comprehension, reading efficiency,
passage reading fluency, and spelling.
• After individual letter-sound associations have been
mastered, remediation can target larger components
of reading such as syllables and words.
• individual education program (IEP)

20. Treatment
• Reading instruction programs such as
the Orton Gillingham and Direct
Instructional System for Teaching
and Remediation (DISTAR).
• As in psychotherapy, the therapist
patient relationship is important to a
successful treatment outcome in
remedial educational therapy.

21. Mathematics Disorder
• have difficulty learning and remembering
numerals, cannot remember basic facts about
numbers, and are slow and inaccurate in
computation.
• Poor achievement in four groups of skills have
been identified in mathematics disorder:
1) linguistic skills
2) perceptual skills
3) mathematical skills
4) attentional skills

22. • A variety of terms over the years,
including dyscalculia, congenital
arithmetic disorder, acalculia,
Gerstmann syndrome, and
developmental arithmetic disorder
have been used to denote the
difficulties present in mathematics
disorder.

23. Epidemiology
• 1 of every 5 children with learning
disorder
• 6 percent of school-age children have
some difficulty with mathematics
• Mathematics disorder may occur with
greater frequency in girls

24. Comorbidity
• commonly found comorbid with
reading disorder and disorder of
written expression.
• mathematics disorder may also be at
higher risk for expressive language
disorder, mixed receptive-expressive
language disorder, and developmental
coordination disorder.

25. Etiology
• partly caused by genetic factors.
• neurological deficit in the right
cerebral hemisphere, particularly in
the occipital lobe areas.
• the cause is thought to be
• multifactorial,
• maturational,
• cognitive,
• emotional,
• educational, and
• socioeconomic factors

26. Diagnosis
• a child's skills in mathematics fall
significantly below what is expected.
• a child's skills in mathematics fall
significantly below what is expected.
• Conceptual skills involve recognition of
mathematical symbols and being able to
use mathematical signs correctly.

27. • Computational skills include the
ability to line up numbers correctly
• A definitive diagnosis can be made
only after a child takes an individually
administered standardized
arithmetic test and scores markedly
below the level expected

28. Clinical Features
DSM-IV-TR Diagnostic Criteria for Mathematics Disorder
A.Mathematical ability, as measured by individually administered
standardized tests, is substantially below that expected given the person's
chronological age, measured intelligence, and age-appropriate education.
B.The disturbance in Criterion A significantly interferes with academic
achievement or activities of daily living that require mathematical ability.
C.If a sensory deficit is present, the difficulties in mathematical ability
are in excess of those usually associated with it.
Coding note: If a general medical (e.g., neurological) condition or sensory
deficit is present, code the condition on Axis III.

30. Pathology and Laboratory
Examination
• educational testing.
• standardized measurement of
intellectual function.
• Keymath Diagnostic Arithmetic Test

31. Differential Diagnosis
• must be differentiated from global causes
of impaired functioning such as mental
retardation syndromes.
• accompanied by generalized impairment in
overall intellectual functioning.
• Inadequate schooling can often affect a
child's poor arithmetic performance.
• Conduct disorder or ADHD can occur with
mathematics disorder and, in these cases,
both diagnoses should be made.

32. Treatment
• teaching mathematics concepts with
continuous practice in solving math
problems.
• Flash cards, workbooks, and
computer games can be a viable part
of this treatment.
• Project MATH, a multimedia self-
instructional or group-instructional
in-service training program, has been
successful

33. Disorder of Written
Expression
• the most complex skill acquired to
convey an understanding of language
and to express thoughts and ideas.
• the most complex skill acquired to
convey an understanding of language
and to express thoughts and ideas.
• Spelling mistakes are most often
phonetic errors

34. Disorder of Written
Expression
• Historically, dysgraphia (i.e., poor
writing skills) was considered to be a
form of reading disorder.
• Evidence indicates that disorder of
written expression can occur.

35. Comorbidity
• Children with writing disorder are at
higher risk.
• mathematics disorder, and
expressive and receptive language
disorders can occur.
• ADHD occurs with greater frequency
in children with writing disorders
than in the general population.

36. Etiology
• a deficit in the use of the
components of language related to
letter sounds.
• the combined effects of one or more
of the following:
• expressive language disorder,
• mixed receptive-expressive language
disorder,
• reading disorder.

37. Diagnosis
• based on a child's poor performance on
composing written text
• addition to spelling mistakes, a child with
writing disorder may have serious
grammatical mistakes, such as using
incorrect tenses, forgetting words in
sentences, and placing words in the wrong
order.
• child may have poor ability to remember
which words begin with capital letters.

38. Clinical Features
DSM-IV-TR Diagnostic Criteria for Disorder of Written Expression
A.Writing skills, as measured by individually administered standardized
tests (or functional assessments of writing skills), are substantially
below those expected given the person's chronological age, measured
intelligence, and age-appropriate education.
B.The disturbance in Criterion A significantly interferes with academic
achievement or activities of daily living that require the composition of
written texts (e.g., writing grammatically correct sentences and
organized paragraphs).
C.If a sensory deficit is present, the difficulties in writing skills are in
excess of those usually associated with it.
Coding note: If a general medical (e.g., neurological) condition or sensory
deficit is present, code the condition on Axis III.

39. Pathology and Laboratory
Examination
• educational testing
• Currently available tests of written language include
• Test of Written Language (TOWL),
• DEWS,
• Test of Early Written Language (TEWL).
• A child suspected of having disorder of written
expression should first be given a standardized
intelligence test, such as WISC-III or the revised
Wechsler Adult Intelligence Scale (WAIS-R) to
determine the child's overall intellectual capacity.

40. Differential Diagnosis
• such as ADHD or a depressive disorder.
• Common associated disorders are
• reading disorder,
• mixed receptive-expressive language
disorder,
• expressive language disorder,
• mathematics disorder,
• developmental coordination disorder,
• disruptive behavior disorder and ADHD.

41. Treatment
• direct practice in spelling and
sentence writing.
• review of grammatical rules.
• Intensive and continuous
administration of individually
tailored.
• one-on-one expressive and creative
writing therapy.

42. Learning Disorder Not Otherwise
Specified
Diagnostic Criteria for Learning Disorder Not Otherwise Specified
This category is for disorders in learning that do not meet criteria
for any specific learning disorder.
This category might include problems in all three areas (reading,
mathematics, written expression) that together significantly
interfere with academic achievement even though performance on
tests measuring each individual skill is not substantially below that
expected given the person's chronological age, measured
intelligence, and age-appropriate education.

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