• Diagnosing Learning Disabilities in Ann Arbor: Changes in Definition, Part 1

    Lisa Woodcock-Burroughs, Ph.D., N.C.S.P.

    The way learning disabilities are identified, and defined, has changed in recent years and educational and medical definitions remain discrepant. However, this post will discuss the change in the medical definition of learning disabilities. Watch for future posts that detail changes in how learning disabilities are educationally defined and ways these definitions do, or do not, overlap with medical definitions.

    There are three categories of Specific Learning Disorders (DSM-5; ICD-10):

    • Reading
    • Mathematics
    • Written Expression

    Skills within the entire domain may, or may not be affected, and can include the following manifestations:

    • Reading
      • Difficulties with automatically recognizing printed words (word reading accuracy)
      • Problems with how quickly and accurately a person can read written material (fluency)
      • Struggles with understanding the meaning of what is read (reading comprehension)
    • Mathematics
      • Inability to understand quantities/numbers, and the relationships between numbers (number sense)
      • Difficulty memorizing and retrieving math facts including addition, subtraction, multiplication or division
      • Problems with quickly and accurately completing math calculation items (fluency)
      • Difficulties with evaluating situations, selecting problem-solving strategies, developing and describing mathematical solutions, and recognizing how those solutions can be applied and whether or not they make sense (math reasoning)
    • Written Expression
      • Difficulties with accurately spelling words
      • Problems with applying grammar and punctuation rules correctly and effectively
      • Constructing written responses that clearly communicate ideas (written expression)

    In order to receive a diagnosis of Specific Learning Disorder, these difficulties with learning and using academic skills must have gone on for at least six months, despite intervention received at home or school and cause “significant interference” with academic, occupational or daily living activities. There must be evidence that your child received appropriate teaching and learning experiences within the classroom setting. As part of a comprehensive clinical evaluation, at least 84 to 93 percent of same-age peers should perform better at the skill in question on an individually administered test of academic achievement. Additionally, your child must exhibit age appropriate functioning in other areas, indicating that the academic skill deficit is not part of a global pattern of delay.

    Specific Learning Disorders can differ in severity and the level of intervention that is required:

    • Mild
      • Your child has difficulties in one or two academic areas but can compensate and/or function well despite these difficulties when provided with accommodations, especially during the school years
    • Moderate
      • Your child likely requires at least some intervals of intensive and specialized teaching during the school years in order to become proficient in the academic skills. Accommodations and support services are required for at least part of the day at school, work or home in order to use the skills accurately and efficiently.
    • Severe
      • Your child has severe learning difficulties, affecting three or more academic domains, which are so severe that they are unlikely to achieve those skills without ongoing intensive, individualized and specialized teaching for the majority of the school years. Even with this extensive array or appropriate accommodations and services at school, work or home, your child may not be able to perform all tasks efficiently and effectively.

    The previous medical definition of a learning disability (DSM-IV; ICD-9) was based on a mathematical calculation, or discrepancy, between academic skills and age, intelligence and educational level. No continuum of severity was indicated.

    The current medical definition recognizes that a person may be intellectually gifted and also have a learning disability. In fact, a child who is both gifted and has a learning disability may seem to have adequate academic functioning due to their use of compensatory strategies, extraordinarily high effort, or reliance on external supports. It may not be until demands change, such as by limiting the amount of time they have to complete a given task, that these difficulties become apparent.

    Specific Learning Disorders begin during childhood but may not be obvious until adolescence or later, depending on the expectations of learning and work environments that the individual encounters. While your child can learn to compensate for their academic difficulties, they will likely persist throughout development, requiring effective use of accommodations and supports to ensure a bright future.

    If you think you or someone you care about may have a learning disability, please contact our office for more information and scheduling.