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About learning disorders and disabilities

The terms “learning disorder” (used by the medical community) and “specific learning disability” (used by the schools) refer to a neurodevelopmental problem in which a child of normal intellectual potential (that is, a child does not have an Intellectual Disability) is encountering unusual difficulty with their academic functioning that cannot be explained by inadequate educational opportunity or emotional or sensory disabilities. These problems can become apparent at any point in a child’s development and may have different symptoms at different ages.

Although most people think about learning disabilities in terms of deficits in specific academic skills (reading, mathematics), children with these learning problems often experience difficulties in a variety of aspects of their functioning (language, communication, social-emotional, behavior) and these will vary from child to child and depend on many factors. They may also affect different aspects of an academic skill. For example, some children may have difficulty learning to decode words, whereas others may be able to decode words but have difficulty understanding what they read. Developing a good treatment plan, therefore, requires a detailed appreciation of each child’s individual needs.

Learning Disorders and Disabilities | Symptoms & Causes

What causes a learning disorder/disability?

No one really knows what causes a learning disability. Often, learning problems can run in families (genetic), but environmental factors can play a role too. Mostly, learning disabilities occur because there is an enormous range of variation that occurs normally in people’s cognitive strengths and weaknesses. If we think about our physical development, nearly everyone has two eyes, a nose and a mouth, yet each of our faces has its own distinctive features. The same is true of brain development. Whereas most children’s cognitive profiles are adequate to the tasks we expect children to accomplish in school, there are many children for whom that is not true. Those children encounter difficulty meeting age and grade level expectations, and the problem can become identified as a “learning disability.”

Who is affected by a learning disorder/disability?

Learning disabilities can occur in any child. They are most often detected by third grade or so, but for some children they may become apparent quite early, before formal schooling, whereas for others they may not become apparent until middle school. Children with a family history of learning problems are more likely to have learning problems, and some people think that boys are more likely to develop learning problems. Children with other neurological conditions, such as epilepsy, are more likely to have learning problems; and children with serious medical conditions may develop learning problems as a result of the condition or its treatment.

What are the symptoms of a learning disorder/disability?

Children with learning disabilities struggle with school work more than their peers. This can take many forms. They may struggle to read, be confused by math, or have trouble with formulating their thoughts and communicating them. Overall, they need to work harder than peers for their accomplishments in school. Parents often say that homework is a “battle” or they find themselves working with the child every night to try to keep up. The child may appear inattentive, especially in school, because they cannot process information like other students. Most parents say that they sense that something is “wrong” and teachers often will confirm or bring to the parent’s attention.

How common is a learning disability?

It is hard to know how many children have a learning disability since the diagnostic criteria are so variable from place to place. About 10% of students in the United States have been classified at some time in their lives as having a learning disability.

How can I tell if my child has a learning disability or if the problem is just typical ups and downs?

A child with a learning disability will have struggles that don’t get better with standard teaching or extra help. The DSM-5 (the manual that psychiatrists use to diagnose disorders) has four criteria for a diagnosis of “specific learning disorder”: (1) symptoms persist for at least 6 months despite extra help or targeted instruction; (2) affected skills are below age expectations and cause impairment in academic, occupational or everyday activities, as confirmed by testing and comprehensive clinical assessment; (3) problem starts during the school-age years; and (4) problem not due to other conditions (such as Intellectual Disability, vision or hearing impairment).

What is the long-term outlook for children with learning disabilities?

The outlook depends on many factors. In most cases, if the child receives good educational and family support and can be directed to occupations and pursuits that call upon their strengths, they do very well as adults. Long-term outcomes do not depend only on academic achievement, but also on personal qualities, supportive adults and community factors.

Learning Disorders and Disabilities | Diagnosis & Treatments

How is a learning disability diagnosed?

Typically, learning disabilities are diagnosed by school testing. If you are concerned that your child may have a learning disability, you can request testing from your school. The school will carry out testing (usually IQ, academic achievement, speech and language, and sometimes occupational therapy). Once testing is complete, the special staff and classroom teacher (s) will convene a team and the team will review the testing and determine whether the results of their testing meet the criteria for a “Specific Learning Disability”

After this process, if you continue to have concerns or disagree with the determination, you can seek an independent evaluation by a private provider, such as Boston Children’s Hospital. This independent evaluation can provide further diagnostic information and recommendations. Although the diagnostic findings and recommendations are not legally binding, you can ask to reconvene the team to discuss the findings of the independent evaluation if they are not in agreement with the school determination. Apart from the legal issues, teachers can often find these evaluations useful to help them to refine their understanding of the child’s needs and provide instructional approaches that could are compatible to your child’s cognitive profile and be effective.

If my child is diagnosed with a learning disability, what happens next?

If the school finds that your child meets criteria for a learning disability, they will develop an Individualized Education Plan, a legally enforceable document that details the services they will provide to address your child’s disability. The school will issue regular progress reports and review the IEP annually, with testing every three years.

Hopefully, with this plan in place, your child will make “effective progress” [progress in the general education curriculum that can be formally documented]. Many parents will seek an independent evaluation because the child continues to struggle despite provision of an IEP, and they seek further guidance about how well the child’s needs are being met and what other interventions could help.

Treating learning disabilities

Unlike most conditions that are diagnosed at Boston Children’s Hospital, the hospital cannot provide treatment for learning disabilities. Such treatment will be provided primarily by schools, and at times by private tutors, psychologists, or speech and language pathologists.

The Boston Children’s Hospital does provide state of the art diagnostic services, however. These are “team” evaluations, with specialists in different disciplines who collaborate on the evaluation. These programs provide detailed information that can guide the school and other professional providers in their efforts. BCH programs are as follows:

Learning Disabilities Program (Department of Neurology)

  • Neurologist
  • Neuropsychologist
  • Speech and Language Pathologist
  • Reading and Writing Specialist
  • Mathematics Specialist
  • Psychologist

School Age Team (Division of Developmental Medicine)

  • Developmental Behavioral Pediatrician
  • Psychologist
  • Educational Specialist

Learning Disorders and Disabilities | Research & Clinical Trials

Learning Disabilities Program (Deborah Waber, PhD)
Dr. Waber leads research on clinical outcomes after evaluations for suspected learning disabilities. Parents often seek evaluations for their children who struggle in school, yet remarkably little is known about benefits of such evaluations, how children fare after such evaluations and so forth. This research follows up on children who are evaluated to find out whether and how the evaluation helped.

Laboratories of Cognitive Neuroscience (Nadine Gaab, PhD)
Dr. Gaab leads research on brain bases of dyslexia and language disorders using functional magnetic resonance imaging techniques. Often, a child needs to fail before they come to attention and receive intervention. A primary focus of this research is early identification of dyslexia, which would hopefully lead to earlier intervention.

Learning Disorders and Disabilities | Programs & Services