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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Odeilis Dominguez ; Paola Carugno .
Last Update: March 19, 2023 .
Learning disabilities (LDs) refer to a number of disorders that may affect the acquisition, organization, retention, comprehension, or the use of both verbal or nonverbal information. This activity describes and reviews the role of the primary care pediatricians and developmental specialists, along with other members of the interprofessional team in evaluating, managing, and improving the outcome for patients with this condition.
Identify the etiology of learning disability. Review the appropriate evaluation of children with learning disabilities. Outline the treatment and management options available for learning disability.Describe the importance of improving care coordination among interprofessional team members to improve outcomes for patients with learning disability.
Learning disabilities (LDs) refer to several disorders that may affect the acquisition, organization, retention, comprehension, or the application of verbal and/or nonverbal information.[1] An important aspect of defining this condition is by identifying its exclusions. Rephrased, individuals with LDs have specific issues with learning, but they preserve an average or above-average intelligence quotient. Further, a learning disability cannot be attributable to an emotional disturbance, cultural difference, or disadvantage.[1][2] The core tenet of LDs juxtaposes the disparity between a child's poor academic achievement and his expected intellectual potential.[2]
Leading theorists suggest the etiology of LDs to be influenced by both hereditary and environmental factors.[1] They do not precipitate as the result of a deficit in sensorimotor functioning, such as poor eyesight or hearing (e.g., corrective lenses and hearing aids do not resolve LDs). Unfortunately, the precise etiology still eludes experts.
LDs are nearly twice as prevalent in children with chronic illnesses as compared to healthy controls. Learning disabilities are present in approximately 5% of school-aged children globally. In the Us, data collected by the National Survey of Children's Health suggest a lifetime prevalence of 10%.[1] Risk factors include a family history of LD, poverty, premature delivery, prenatal alcohol exposure, TBI, and in the setting of other neurodevelopmental disorders.[3] The most common LD is dyslexia, which accounts for at least 80% of LDs.[4] LDs often exist comorbidly with other disorders such as oppositional defiant disorder, attention deficit hyperactivity disorder, anxiety, and obsessive-compulsive disorder.[4]
The application of innovative insight awarded by recent advances in neuroscience has allowed experts to propose putative pathogeneses for LDs.[5] For example, fMRI studies have revealed hypoactivity in the left hemisphere of dyslexic patients.[6] Additional hypotheses include aberrations within the corticostriatal systems responsible for language and communication.
Although presentations of patients with LDs will be individualized and protean, there are general patterns that can help the health care provider more reliably identify the underlying pathology.[7] Often children will present for evaluation after experiencing continued difficulties in school. Frequently, children with LDs will also demonstrate deficits in overall functioning, not solely isolated to the academic setting.[8] For example, hindrances at school may be related to academic difficulty, negative self-concept, behavior issues, or interpersonal relations. It is essential to inquire about the child’s past school history, diet, family history of similar concerns, and developmental milestones, including social skills.
Commonly recognized specific learning disabilities include:
Reading disability (dyslexia) - is the most common LD, representing at least 80% of all LDs, and results from deficits in phonologic processing. Skills necessary for appropriate phonologic processing involve reading decoding, phonics, ability to produce sounds, and proper auditory capabilities. The progression often originates with problems with reading decoding in the more nascent years, on to dysfluent reading, and then to difficulty with reading comprehension. These children may eventually avoid reading altogether.[9][4]
Dyscalculia - presents as a weakness in performing arithmetic operations. Patients will experience impediments organizing problems, finishing multiple-step calculations, distinguishing mathematical calculation signs. Proper math sense is incumbent on a broad range of neurodevelopmental functions including number sense, calculation and retrieval of math facts, the language of math, visual-spatial skills, and comprehension of word problems.[10]
Dysgraphia - is characterized by distorted writing despite thorough instruction and motor ability. Children with dysgraphia will produce inconsistent and illegible handwriting while rarely staying within the margins. These children might also demonstrate maladroit fine motor coordination, problems with spelling (encoding), grammar and syntax, or expressing ideas in writing.[11][12]
Nonverbal LDs (right hemisphere developmental LD) - as the name suggests, comprise hindrances with nonverbal activities, such as problem-solving, visual-spatial tasks, reading body language, and recognizing social cues.[4] Often these disorders do not manifest until the third grade as patients have difficulty with higher-order reading comprehension. There is substantial clinical overlap with autism spectrum disorder (e.g. poor social communication and pragmatics). Of note, not recognized in the DSM-V.
Individual factors (intrinsic) and environmental factors will influence the clinical presentation. Intrinsic factors include comorbid psychiatric conditions and personality traits.[13] Environmental factors encompass home, school, programs, etc. LDs do not often exist in isolation, rather, they will present comorbidly with other LDs and psychiatric conditions. The most common comorbid disorders are attention deficit hyperactivity disorder, autism, bipolar disorder, anxiety, depression, and oppositional defiant disorder. Some studies suggest the existence of LDs in 20-70% of children with psychiatric conditions. [14]
The evaluation of LDs begins with the exclusion of both organic and functional differential diagnoses. Once other disorders are ruled out, the health care provider is encouraged to follow diagnostic guidelines set out by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Evaluation should synthesize the developmental, medical, familial, and educational histories of the patient.
As per the DSM-5:
LDs are a type of neurodevelopmental disorder that impedes normal ability to learn and perform academically
