Specific learning disorder

NEURODEVELOPEMENTAL
DISORDERS
3rd Disorder
(Specific Learning Disorder)
By: Muhammad Musawar Ali
MPHIL, ICAP
Psychmmusawarali@gmail.com
1

When was the term learning disability first
used?
Kirk becomes the first to use the term “learning disability” at an education
conference in 1964 and association for Children with Learning Disabilities (ACLD) is
created.
2

Different learning disabilities
 Dyslexia.
 ADHD.
 Dyscalculia. ...
 Dysgraphia. ...
 Processing Deficits.
3

Dyslexia
 Dyslexia, also known as reading disorder, is characterized by
trouble with reading despite normal intelligence.
 Problems may include difficulties in spelling words, reading
quickly, writing words, "sounding out" words in the head,
pronouncing words when reading aloud and understanding
what one reads.
 Often these difficulties are first noticed at school.
 When someone who previously could read loses their ability,
it is known as alexia.
 Dyslexia is sometimes referred to as a Language-Based
Learning Disability.
4

Changes Made to SLD in DSM-5
 Two major changes
 Category of SLD with ‘specifiers’ to characterize the specific
manifestations of learning difficulties at the time of
assessment in three major academic domains, namely
reading, writing, mathematics (e.g., SLD With impairment in
reading).
 Elimination of the IQ-achievement discrepancy requirement
and its replacement with four criteria (A – D), all of which
must be met.
5

Diagnostic Criteria for Specific Learning
Disorder
 (A) Difficulties learning and using academic skills, as
indicated by the presence of at least one of the following
symptoms that have persisted for at least six months, despite
the provision of interventions that target those difficulties:
 (1) Inaccurate or slow and effortful word reading (e.g., reads
single words aloud incorrectly or slowly and hesitantly,
frequently guesses words, has difficulty sounding out words).
 (2) Difficulty understanding the meaning of what is read (e.g.,
may read text accurately but not understand sequence,
relationships, inferences, or deeper meanings of what is
read).
6

 (3) Difficulties with spelling (e.g., may add, omit, or substitute
vowels or consonants).
 (4) Difficulties with written expression (e.g., makes multiple
grammatical or punctuation errors within sentences; employs
poor paragraph organization; written expression of ideas lacks
clarity).
 (5) Difficulties mastering number sense, number facts, or
calculation (e.g., has poor understanding of numbers, their
magnitude, and relationships; counts on fingers to add single-
digit numbers instead of recalling the math fact as peers do; gets
lost in the midst of arithmetic computation and may switch
procedures).
7

 (6) Difficulties with mathematical reasoning (e.g., has severe
difficulty applying mathematical concepts, facts, or procedures
to solve quantitative problems).
8

 B) The affected academic skills are substantially and
quantifiably below those expected for the individual’s
chronological age, and cause significant interference with
academic or occupational performance, or with activities of
daily living, as confirmed by individually administered
standardized achievement measures and comprehensive
clinical assessment.
 For individuals aged 17 years and older, a documented
history of impairing learning difficulties may be substituted
for the standardized assessment.
9

 (C) The learning difficulties begin during school-age years
but may not become fully manifest until the demands of
those affected academic skills exceed the individuals limited
capacities (e.g., as in timed tests, reading or writing lengthy
complex reports for a tight deadline, excessively heavy
academic loads).
10

Specify if:
With impairment in reading:
 Word reading accuracy.
 Reading rate or fluency.
 Reading comprehension.
11

With impairment in written expression:
 Spelling accuracy.
 Grammar and punctuation accuracy.
 Clarity or organization of written expression.
12

With impairment in mathematics:
 Number sense.
 Memorization of arithmetic facts.
 Accurate or fluent calculation.
 Accurate math reasoning.
13

Specify current severity:
 Mild: Some difficulties learning skills in one or two academic domains, but of mild
enough severity that the individual may be able to compensate or function well
when provided with appropriate accommodations or support services, especially
during the school years.
14

 Moderate: Marked difficulties learning skills in one or more
academic domains, so that the individual is unlikely to
become proficient without some intervals of intensive and
specialized teaching during the school years. Some
accommodations or supportive services at least part of the
day at school, in the workplace, or at home may be needed
to complete activities accurately and efficiently.
15

 Severe: Severe difficulties learning skills, affecting several
academic domains, so that the individual is unlikely to learn
these skills without ongoing intensive individualized and
specialized teaching for most of the school years. Even with an
array of appropriate accommodations or services at home, at
school, or in the workplace, the individual may not be able to
complete all activities efficiently.
16

Specific Learning Disorder
By: Anum Hayyat
Advance Diploma in clinical
Psychology

The term means a disorder in one or more
of the basic psychological processes
involved in understanding or in using
language, spoken or written, that may
manifest itself in an imperfect ability to
listen, think, speak, read, write, spell, or to
do mathematical calculations, including
conditions such as perceptual disabilities,
brain injury, minimal brain dysfunction,
dyslexia, and developmental aphasia.

Whether we are studying Roman history or calculus,
applying ourselves to the task of learning requires
exertion and concentration. Like physical activities,
some learning activities are more difficult than
others, especially for younger children who have
not developed a foundation of good study habits and
successful learning experiences. Parents and
teachers may notice that a child is struggling
unusually hard to master a particular skill, such as
reading, and wonder why. The problem may be
formally assessed by an IQ test and various
standardized tests that assess abilities in specific
academic areas.

 When achievement in reading, math, or writing is well below average for the
child’s age and intellectual ability, he or she may be diagnosed with a specific
learning disorder (SLD). In other words, a child write a specific learning disorder
is intellectually capable of learning key academic concepts of reading, writing, and
math, but seems unable to do so. The phrase “unexpected academic
underachievement” captures this notion that the child’s learning problems are
indeed specific and not due to intellectual disability or global developmental delay.

 James, at age 9, had problems primarily in reading and spelling.
Contrast his reading difficulties with those of Tim, who struggles with
spatial orientation and mathematical reasoning.
 James’s pattern of strengths and weaknesses shows that although he has
reading problems, other strengths compensate for this disability. He has
strong talents for figuring out how things work and for drawing ideas
on paper. Tim has several strengths, too, especially in linguistic skills
such as word recognition, sentence structure, and reading. In contrast to
James, Tim has problems primarily in the visual, spatial, and
organizational spheres, which show up as difficulties with tactile
(touch) perception, psychomotor activity (e.g., throwing and catching),
and nonverbal problem solving (e.g., figuring out math problems and
assembling things). Both boys fit the diagnostic criteria for SLD. Note
how Tim’s academic problems, in particular, were almost masked by
his frustration and low self-esteem.

 Emotional problems are often seen in children who are bright enough to recognize
that their performance is below that of others and are frustrated with their poor
performance at school. The limitations of both James and Tim can affect every
aspect of their formal education as well as their interpersonal abilities; therefore,
these disorders require comprehensive and ongoing treatment plans.

 The main diagnostic feature of SLD is that the child has difficulties learning
keystone academic skills of reading, writing, spelling, or math.
 These difficulties may appear in one or more of these skills, including inaccurate or
slow reading, difficulty understanding the meaning of what is read, difficulties with
spelling and/or written expression, or difficulties mastering num be sense,
calculation, or mathematical reasoning.

Causes
Learning disabilities. Learning
disabilities are presumed to be disorders
of the central nervous system and a
variety of factors may contribute to their
occurrence. Learning disabilities may be
due to

Heredity: Learning disabilities tend to
run in families.
Problems during pregnancy and
childbirth. Learning disabilities may be
caused by illness or injury during or
before birth. Learning disabilities may
also be caused by the use of drugs and
alcohol during pregnancy, RH
incompatibility with the mother (if
untreated), premature or prolonged labor
or lack of oxygen or low weight at birth.

Incidents after birth. Head injuries,
nutritional deprivation, poisonous substances,
(e.g., lead), and child abuse can contribute to
learning disabilities

Characteristics
Students who have learning disabilities may exhibit a wide range of traits, including:
 problems with reading comprehension
 spoken language
 writing
 reasoning ability
 Hyperactivity
 Inattention
 difficulty remembering today what was learned yesterday
 short attention span (restless, easily distracted)

Characteristics
letter and number reversals (sees "b" for "d"
or "p", "6" for "9", "pots" for "stop" or
"post")
poor reading (below age and grade level)
frequent confusion about directions and time
(right-left, up-down, yesterday-tomorrow)

trouble remembering what someone just
told him or her
poor coordination (in gross motor
activities such as walking or sports and/or
in fine motor activities such as tying a
shoelace, holding a pencil, or handwriting)

Learning Disabilities
Learning disabilities may occur in the following academic areas:
 Spoken language: Delays, disorders, or discrepancies in listening and speaking.
 Written language: Difficulties with reading, writing, and spelling.
 Arithmetic: Difficulty in performing arithmetic functions or in comprehending
basic concepts;
 Reasoning: Difficulty in organizing and integrating thoughts.

Types
 I-Dyslexia - a language-based disability in which a person has trouble
understanding words, sentences, or paragraphs.
 II-Dyscalculia - a mathematical disability in which a person has a difficult time
solving arithmetic problems and grasping math concepts.
 III-Dysgraphia - a writing disability in which a person finds it hard to form letters
or write within a defined space.

Types
 Auditory and Visual Processing Disabilities - sensory disabilities in which a person
has difficulty understanding language despite normal hearing and vision.

 When you consider everything involved in learning the basics of reading, such as
associating shapes of letters (graphemes) with sounds (phonemes), it is not
surprising that some children have difficulty and can quickly fall behind. Read the
following sentence: “I believe that abnormal child psychology is one of the most
fascinating and valuable courses I have taken.” As you read the sentence, did you
notice that you had to simultaneously:
 Focus attention on the printed marks and control your eye movements across the
page?
 Recognize the sounds associated with letters?
 Understand words and grammar?
 Build ideas and images?
 Compare new ideas with what you already know?
 Store ideas in memory?

 Many clinical signs of reading disorders are first evident only to a trained eye.
Some testing methods developed by teachers and school psychologists show how
children with reading disorders function in the classroom. They often have trouble
learning basic sight words, especially those that are phonetically irregular and must
be memorized, such as the, who, what, where, was, laugh, said, and so forth. These
children have developed their own unique and peculiar reading patterns, which
signal the need for different teaching methods. Typical errors include reversals (b/d,
p/q), transpositions (sequential errors such as was/ saw, scared/sacred), inversions
(m/w, u/n), and omissions (reading place for palace or section for selection).
However, these errors are common in many younger children who are just learning
to read and write and do not necessarily imply a reading disorder.

A child with a SLD with impairment in reading lacks the
critical language skills required for basic reading: word
reading accuracy, reading comprehension, and reading rate
or fluency. Dyslexia is an alternative term sometimes used
to describe this pattern of reading difficulties. These core
deficits stem from problems in decoding breaking a word
into parts rapidly enough to read the whole word coupled
with difficulty reading single small words (Elution et al.,
2007). When a child cannot detect the phonological
structure of language and automatically recognize simple
words, reading development will very likely be impaired
(Peterson & Pennington, 2010). The slow and labored
decoding of single words requires substantial effort and
detracts from the child’s ability to retain the meaning of a
sentence, much less a paragraph or page.

SLD with Impairment in Written
Expression
 SLD with impairment in written expression may manifest as problems in spelling accuracy,
grammar and punctuation accuracy, and/or clarity or organization of written expression.
This particular SLD is often found in combination with SLD in reading or mathematics,
which also have underlying core deficits in language and neuropsychological development.

Children with impairment in written expression often
have problems with tasks that require eye– hand
coordination, despite their normal gross motor
development. Teachers notice that, as compared with
children who have normal writing skills, children with
impairments in writing produce shorter, less
interesting, and poorly organized essays and are less
likely to review spelling, punctuation, and grammar to
increase clarity. However, spelling errors or poor
handwriting that do not significantly interfere with
daily activities or academic pursuits do not qualify a
child for this diagnosis. In addition, problems in
written expression signal the possibility of other
learning problems

SLD with Impairment in Mathematics
 During their preschool years, children are not as naturally drawn to mathematical concepts
as they are to reading. This changes rapidly as they discover that they need to count and
add to know how much money it takes to buy something or how many days remain until
vacation. As in reading, the need to know propels children to learn new and difficult
concepts, and little by little their new skills help them understand the world better.

 Children with an SLD with impairment in mathematics typically have core deficits
in arithmetic calculation and/or mathematics reasoning abilities, which include
naming amounts or numbers, enumerating, comparing, and manipulating objects,
reading and writing mathematical symbols, understanding concepts and performing
calculations mentally, and performing computational operations. These deficits
imply that the neuropsychological processes underlying mathematical reasoning
and calculation are underdeveloped or impaired

Prevalence
 As many as 1 out of every 5 people in the United States has a learning disability. Almost 3
million children (ages 6 through 21) have some form of a learning disability and receive
special education in school.
 In fact, over half of all children who receive special education have a learning disability.

Gender Differences
LD is twice as common in males as in
females, Males are significantly more
likely than females to fall within each
major disability group.

Co-morbidity
 Co-morbidity means that certain diseases and disorders tend to occur together.
 In 25% of the cases of Learning disabilities, a co-morbid condition is Attention
Deficit/Hyperactive Disorder-AD/HD.

Educational Implications
 Supports or changes in the classroom (sometimes called accommodations) help most
students with LD.

Other Facts
 Learning disabilities should not be confused with other disabilities such as mental
retardation, autism, deafness, blindness, and behavioral disorders.
 New statistics indicate that about 47.5% of the disability population are individuals with
learning disabilities.
 Approximately 85% of all individuals with learning disabilities have difficulties in the area
of reading.

44% of parents who noticed their child
exhibiting signs of problems with learning
waited a year or more before acknowledging
their child might have a serious problem.
35% of children with learning disabilities
drop out of high school.

Cultural, Class, and Gender Variations
Social and cultural factors are less relevant to
SLD than other types of cognitive and
behavioral problems, in fact, the diagnostic
criteria state that they cannot be attributed to
these factors. Nevertheless, some cultural and
ethnic factors may affect how children with
SLD are identified and treated.

Whereas attention to cultural and ethnic issues
pertaining to SLD is a recent addition to research, sex
differences have a long and contentious history. Boys
are more often referred for learning difficulties than
girls, perhaps because boys are more likely to show
associated behavior problems such as aggression or
inattention. Girls with learning problems often are
quiet and withdrawn rather than loud and attention
seeking, and they may be overlooked unless
educators and parents are well informed. Nonetheless,
when male–female ratios of SLD are derived from
epidemiological estimates rather than from referrals,
the ratio of boys to girls fall between 2:1 and 3:1.

Specific learning disorder

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