case study on learning disability

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LEARNING DISABILITY : A CASE STUDY

The present investigation was carried out on a girl name Harshita who has been identified with learning disability. She is presently studying at ‘Udaan’ a school for the special children in Shimla. The girl was brought to this special school from the normal school where she was studying earlier when the teachers and parents found it difficult to teach the child with other normal children. The learning disability the child faces is in executive functioning i.e. she forgets what she has memorized. When I met her I was taken away by her sweet and innocent ways. She is attentive and responsible but the only problem is that she forgets within minutes of having learnt something. Key words : learning disability, executive functioning, remedial teaching

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The Indian Journal of Pediatrics

Sunil Karande , Madhuri Kulkarni

International Journal of Scientific Research in Computer Science Applications and Management Studies

Monika Thapliyal

This paper reviews the research work on 'learning disability' in India. It studies the social and educational challenges for learning disabled, and details research in India, concerning the aspects of diagnosis, assessment, and measures for improvement. The paper critically examines the development in their teaching-learning process, over the years. It highlights the role of special educator in their education and explores the impact of technology and specific teaching-aids in the education of learners with learning disability. The later part of the paper, throws light on the government policies for learning disabled and attempts to interpolate their proposed effect in their learning. It concludes with possible solutions, learner progress, based on the recommendations from detailed analysis of the available literature.

International Journal of Contemporary Pediatrics

Shipra Singh

Background: Specific learning disability (SLD) is an important cause of academic underachievement among children, which often goes unrecognized, due to lack of awareness and resources in the community. Not much identifiable data is available such children, more so in Indian context. The objectives of the study were to study the demographic profile, risk factors, co-morbidities and referral patterns in children with specific learning disability.Methods: The study has a descriptive design. Children diagnosed with SLD over a 5 years’ period were included, total being 2015. The data was collected using a semi-structured proforma, (based on the aspects covered during child’s comprehensive assessment at the time of visit), which included socio-demographic aspects, perinatal and childhood details, scholastic and referral details, and comorbid psychiatric disorders.Results: Majority of the children were from English medium schools, in 8-12 years’ age group, with a considerable delay in seek...

Journal of Postgraduate Medicine

Sunil Karande

Fernando Raimundo Macamo

IJIP Journal

The cardinal object of the present study was to investigate the learning disability among 10 th students. The present study consisted sample of 60 students subjects (30 male students and 30 female students studying in 10th class), selected through random sampling technique from Balasore District (Odisha). Data was collected with the help of learning disability scale developed by Farzan, Asharaf and Najma Najma (university of Panjab) in 2014. For data analysis and hypothesis testing Mean, SD, and t test was applied. Results revealed that there is significant difference between learning disability of Boys and Girls students. That means boys showing more learning disability than girls. And there is no significant difference between learning disability of rural and urban students. A learning disability is a neurological disorder. In simple terms, a learning disability results from a difference in the way a person's brain is "wired." Children with learning disabilities are smarter than their peers. But they may have difficulty in reading, writing, spelling, and reasoning, recalling and/or organizing information if left to figure things out by them or if taught in conventional ways. A learning disability can't be cured or fixed; it is a lifelong issue. With the right support and intervention, children with learning disabilities can succeed in school and go on to successful, often distinguished careers later in life. Parents can help children with learning disabilities achieve such success by encouraging their strengths, knowing their weaknesses, understanding the educational system, working with professionals and learning about strategies for dealing with specific difficulties. Facts about learning disabilities Fifteen percent of the U.S. population, or one in seven Americans, has some type of learning disability, according to the National Institutes of Health.

Indian Pediatrics

Rukhshana Sholapurwala

samriti sharma

Baig M U N T A J E E B Ali

The present article deals with the important factors related to learning disability such as the academic characteristics of learning disability, how learning disability can be identified in an early stage and remedial measures for learning disability. It tries to give an insight into various aspects of learning disability in children that will be of help in designing the tools and administering them properly.

Iconic Research and Engineering Journals

IRE Journals

This article explains how learning disability affect on one's ability to know or use spoken affects on one's ability to know or use spoken or communication, do mathematical calculations, coordinate movements or direct attention learning disabilities are ignored, unnoticed and unanswered such children's needs are not met in regular classes. They needed special attention in classrooms. Learning disability is a big challenge for student in learning environment. The teacher's role is very important for identifying the learning disability. Some common causes and symptoms are there for children with learning disability. The classroom and teacher leads to main important role in identification and to overcome their disabilities.

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The following are some case studies of dyslexics with whom we have worked over the past years. In each story, we provide background information, the course of therapy that integrates the individual's strengths and interests, and the outcomes—all of which are positive.

Case Studies for using strengths and interests

Case Study One:

Grace has a diagnosis of dyslexia. She has trouble with visual scanning, processing, and working memory. She also has difficulties with spelling and sequencing for problem solving. She has strong verbal skills and is artistic abilities. She learns well with color and when her hands are occupied.

Grace struggled with note taking because of her difficulties with spelling and visual scanning (looking from the board to her paper). Furthermore, she could not keep up and got "lost" in the lecture (particularly for subjects that were already difficult for her). Grace’s teachers thought that she was not putting forth the effort, because they often saw her daydreaming in class. When the therapist asked Grace about this, she admitted that sometimes she would daydream because she did not know where they were in the lecture. She also desperately wanted to blend in with her peers, so she looked to them to see what she was supposed to be doing. However, when she was permitted to follow along with a book that she could highlight in and make her own doodles and notes in the margins during the lecture, she was able to focus her energy on the teacher and have notes that she could refer back to later with all of the main points highlighted. Using Grace's kinesthetic learning style and preference for color, she was able to participate with her peers, decrease her anxiety in class, and develop a skill that will help her to learn better across the curriculum.

Due to her difficulties with sequencing, working memory, and reading, Grace struggled with numerical operations and story problems in math. Her problem solving skills were good when she could leverage her strengths: connecting abstract ideas and thinking at the macro level. Hence, when she could connect a concept to a real life problem, she could inevitably come up with a creative solution and grasp the concept; however, her poor numerical operations skills were still holding her back. The therapist remembered Grace's interest in color and tactile learning style and introduced her to a number of "hands-on" ways of solving the problem: calculating probability with colored marbles, using her fingers for multiplication, and solving equations with objects to represent the variables. In this manner, Grace not only grasped the concept that was presented at the macro-level, but using her love of color and keeping her hands moving she could reliably solve for the answer. Employing colored pencils for numbering steps or placing hash marks in multi-step directions helped Grace stay on point and not skip steps in complex problems. These strategies were incorporated into her 504 Plan and were communicated to her math teacher.

Case Study Two:

Amy has a diagnosis of dyslexia. She enjoys creative writing, fashion, and art. She is extremely bright and has a strong memory. She benefits from rule-based instruction. If you tell her a rule once, she will be able to recite it to you the next time you see her. She delights in being able to be the teacher and teach the rules herself or correct others’ errors.

Amy’s stories often jumped around without any cohesion or plot. The clinician suggested that Amy work on her stories on a daily basis. Amy drafted her stories about glamorous people and enjoyed illustrating their wardrobes. Her clinician helped her to expand and revise her story using a multi-sensory tool to teach her the parts of story grammar. She was able to revise her own story, by adding the components of a good plot (characters, setting, initiating event, internal response, plan, and resolution). With several revisions, she produced a well-developed story and colorful illustration that was framed and displayed. The combination of using Amy’s interests, learning style, and a powerful reinforcement (framing and displaying the finished product) lead Amy to become proficient in telling stories and in revising her own work.

Case Study Three:

Ryan has a diagnosis of PDD-NOS that affects his language, social, and literacy skills. He also struggles with anxiety. He has a number of interests including: pirates and treasure, cooking, watching his favorite TV shows, and drama. Ryan has a strong memory and conveys a great deal of social knowledge when he is acting or drawing.

Due to Ryan’s anxiety associated with reading and writing, he often protested and completely shut down when presented with something to read or write. Ryan watched a number of shows that taught lessons about friendship or had a “moral to the story.” He was able to take some of those themes and stories and modify them, inserting kids from his school as the characters, and adding himself as a character and narrator. Given his interest in drawing, he illustrated his story, and made it into a short book.

The clinician wanted to incorporate his interest in writing and illustrating stories to improve his social skills. The therapist suggested that Ryan make his story into a play, and that he could be the director. Through a series of role-plays, Ryan was able to overcome his social anxiety and invite a peer to act in his play. Numerous social skills were targeted: greetings, turn-taking, active listening, problem solving, and flexibility for handling unforeseen circumstances. Ryan has now directed four plays, and has written countless others. To date, five of his peers have come and acted in his plays. (It has become a “cool” thing to do in Ryan’s social circle). He has gained a great deal of confidence in relating to his peers and in his strength of writing and directing plays.

In addition to social skills, Ryan has struggled with reading and following directions, asking for clarification, and comprehending and using abstract vocabulary. These areas were addressed using his interests in cooking and treasure hunts. Ryan participated in a number of baking projects that required him to locate the directions on the package, sequence and follow each step in a sequence, and determine the meaning of new vocabulary. Since this was in a context that he enjoyed, his attention was high and his anxiety was non-existent. Furthermore, Ryan had the opportunity to learn a new recipe and build on his strength for baking. Since his learning was in context, he was able to remember the meanings of abstract vocabulary. Ryan’s social skills were targeted when he went to the various offices in the building and offered his baked treats. He inevitably received positive social feedback.

Another motivating context for boosting Ryan’s reading for directions and vocabulary skills was participating in scavenger hunts around the building. He enjoyed the challenge of complex directions because there was an element of surprise and adventure. There was a notable consequence if he incorrectly followed the directions. This created the opportunity for Ryan to ask for directions or seek clarification. Since his learning was in context (i.e., he was looking at a fire extinguisher when he was reading the word for the first time), it was memorable. Many conjunctions (but, therefore, so, if) and sequence words (when, at the same time, before, after, next) were targeted multiple times, which led to mastery. This multi-sensory activity was enjoyable for both Ryan and the clinician. For Ryan, it resulted in greater participation, gains, and retention than traditional teaching approaches.

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Understanding, Educating, and Supporting Children with Specific Learning Disabilities: 50 Years of Science and Practice

Elena l. grigorenko.

1 University of Houston, Houston, USA

2 Baylor College of Medicine, Houston, USA

Donald Compton

3 Florida State University, Tallahassee, USA

4 Vanderbilt University, Nashville, USA

Richard Wagner

Erik willcutt.

5 University of Colorado Boulder, Boulder, USA

Jack M. Fletcher

Specific learning disabilities (SLD) are highly relevant to the science and practice of psychology, both historically and currently, exemplifying the integration of interdisciplinary approaches to human conditions. They can be manifested as primary conditions—as difficulties in acquiring specific academic skills—or as secondary conditions, comorbid to other developmental disorders such as Attention Deficit Hyperactivity Disorder. In this synthesis of historical and contemporary trends in research and practice, we mark the 50th anniversary of the recognition of SLD as a disability in the US. Specifically, we address the manifestations, occurrence, identification, comorbidity, etiology, and treatment of SLD, emphasizing the integration of information from the interdisciplinary fields of psychology, education, psychiatry, genetics, and cognitive neuroscience. SLD, exemplified here by Specific Word Reading, Reading Comprehension, Mathematics, and Written Expression Disabilities, represent spectrum disorders each occurring in approximately 5–15% of the school-aged population. In addition to risk for academic deficiencies and related functional social, emotional, and behavioral difficulties, those with SLD often have poorer long-term social and vocational outcomes. Given the high rate of occurrence of SLD and their lifelong negative impact on functioning if not treated, it is important to establish and maintain effective prevention, surveillance, and treatment systems involving professionals from various disciplines trained to minimize the risk and maximize the protective factors for SLD.

Fifty years ago, the US federal government, following an advisory committee recommendation ( United States Office of Education, 1968 ), first recognized specific learning disabilities (SLD) as a potentially disabling condition that interferes with adaptation at school and in society. Over these 50 years, a significant research base has emerged on the identification and treatment of SLD, with greater understanding of the cognitive, neurobiological, and environmental causes of these disorders. The original 1968 definition of SLD remains statutory through different reauthorizations of the 1975 special education legislation that provided free and appropriate public education for all children with disabilities, now referred to as the Individuals with Disabilities Education Act (IDEA, 2004). SLD are recognized worldwide as a heterogeneous set of academic skill disorders represented in all major diagnostic nomenclatures, including the Diagnostic and Statistical Manual-5 (DSM-5, American Psychiatric Association, 2013) and the International Statistical Classification of Diseases and Related Health Problems (ICD-11, World Health Organization, 2018).

In the US, the SLD category is the largest for individuals who receive federally legislated support through special education. Children are identified as SLD through IDEA when a child does not meet state-approved age- or grade-level standards in one or more of the following areas: oral expression, listening comprehension, written expression, basic reading skills, reading fluency, reading comprehension, mathematics calculation, and mathematics problem solving. Although children with SLD historically represented about 50% of the children aged 3–21 served under IDEA, percentages have fluctuated across reauthorizations of the special education law, with some decline over the past 10 years ( Figure 1 ).

The Individuals with Disabilities Education Act (IDEA), enacted in 1975 as Public Law 94–142, mandates that children and youth ages 3–21 with disabilities be provided a free and appropriate public school education in the least restricted environment. The percentage of children served by federally mandated special education programs, out of total public school enrollment, increased from 8.3 percent to 13.8 percent between 1976–77 and 2004–05. Much of this overall increase can be attributed to a rise in the percentage of students identified as having SLD from 1976–77 (1.8 percent) to 2004–05 (5.7 percent). The overall percentage of students being served in programs for those with disabilities decreased between 2004–05 (13.8 percent) and 2013–14 (12.9 percent). However, there were different patterns of change in the percentages served with some specific conditions between 2004–05 and 2013–14. The percentage of children identified with SLD declined from 5.7 percent to 4.5 percent of the total public school enrollment during this period. This number is highly variable by state: for example, in 2011 it ranged from 2.3% in Kentucky to 13.8% in Puerto Rico, as there is much variability in the procedures used to identify SLD, and disproportional demographic representation. Figure by Janet Croog.

This review is a consensus statement developed by researchers currently leading the National Institute of Child Health and Human Development (NICHD) supported Consortia of Learning Disabilities Research Centers and Innovation Hubs. This consensus is based on the primary studies we cite, as well as the meta-analytic reviews (*), systematic reviews (**), and first-authored books (***) that provide an overview of the science underlying research and practice in SLD (see references). The hope is that this succinct overview of the current state of knowledge on SLD will help guide an agenda of future research by identifying knowledge gaps, especially as the NICHD embarks on a new strategic plan. The research programs on SLD from which this review is derived represent the integration of diverse, interdisciplinary approaches to behavioral science and human conditions. We start with a brief description of the historical roots of the current view of SLD, then provide definitions as well as prevalence and incidence rates, discuss comorbidity between SLD themselves and SLD and other developmental disorders, comment on methods for SLD identification, present current knowledge on the etiology of SLD, and conclude with evidence-based principles for SLD intervention.

Three Historical Strands of Inquiry that Shaped the Current Field of SLD

Three strands of phenomenological inquiry culminated in the 1968 definition and have continued to shape current terminology and conventions in the field of SLD ( Figure 2 ). The first, a medical strand, originated in 1676, when Johannes Schmidt described an adult who had lost his ability to read (but with preserved ability to write and spell) because of a stroke. Interest in this strand reemerged in the 1870s with the publication of a string of adult cases who had lived through a stroke or traumatic brain injury. Subsequent cases involved children who were unable to learn to read despite success in mathematics and an absence of brain injury, which was termed “word blindness” ( W. P. Morgan, 1896 ). These case studies laid the foundation for targeted investigations into the presentation of specific unexpected difficulties related to reading printed words despite typical intelligence, motivation, and opportunity to learn.

A schematic timeline of the three stands of science and practice in the field of SLD. The colors represent the strands (blue—first, yellow—second, and green—third). Blue: provided phenomenological descriptions and generated hypotheses about the gene-brain bases of SLD (specifically, dyslexia or SRD); it also provided the first evidence that the most effective treatment approaches are skill-based and reflect cognitive models of the conditions. Yellow: differentiated SLD from other comorbid conditions. Green: stressed the importance of focusing on SLD in academic settings and developing both preventive and remediational evidence-based approaches to managing these conditions. Due to space constraints, the names of many highly influential scientists (e.g., Marilyn Adams, Joseph Torgesen, Isabelle Liberman, Keith Stanovich, among others) who shaped the field of SLD have been omitted. Figure by Janet Croog.

The second strand is directly related to the formalization of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). Rooted in the work of biologically oriented physicians, the 1952 first edition (DSM-I) referenced a category of chronic brain syndromes of unknown cause that focused largely on behavioral presentations we now recognize as hyperkinesis and Attention Deficit Hyperactivity Disorder (ADHD). The 1968 DSM-II defined “mild brain damage” in children as a chronic brain syndrome manifested by hyperactive and impulsive behavior with reference to a new category, “hyperkinetic reaction of childhood” if the origin is not considered “organic.” As these categories evolved, they expanded to encompass the academic difficulties experienced by many of these children.

After almost 30 years of research into this general category of “minimal brain dysfunction,” representing “... children of near average, average, or above average general intelligence with certain learning or behavioral disabilities ... associated with deviations of function of the central nervous system.” ( Clements, 1966 , pp. 9–10), the field acknowledged the heterogeneity of these children and the failure of general “one size fits all” interventions. As a result, the 1980 DSM-III formally separated academic skill disorders from ADHD. The 1994 DSM-IV differentiated reading, mathematics, and written expression SLD. The DSM-5 reversed that, merging these categories into one overarching category of SLD (nosologically distinct from although comorbid with ADHD), keeping the notion of specificity by stating that SLD can manifest in three major academic domains (reading, mathematics, and writing).

The third strand originated from the development of effective interventions based on cognitive and linguistic models of observed academic difficulties. This strand, endorsed in the 1960s by Samuel Kirk and associates, viewed SLD as an overarching category of spoken and written language difficulties that manifested as disabilities in reading (dyslexia), mathematics (dyscalculia), and writing (dysgraphia). Advances have been made in understanding the psychological and cognitive texture of SLD, developing interventions aimed at overcoming or managing them, and differentiating these disorders from each other, from other developmental disorders, and from other forms of disadvantage. This work became the foundation of the 1968 advisory committee definition of SLD, which linked this definition with that of minimal brain dysfunction via the same “unexpected” exclusionary criteria (i.e., not attributable primarily to intellectual difficulties, sensory disorders, emotional disturbance, or economic/cultural diversity).

Although its exclusionary criteria were well specified, the definition of SLD did not provide clear inclusionary criteria. Thus, the US Department of Education’s 1977 regulatory definition of SLD included a cognitive discrepancy between higher IQ and lower achievement as an inclusionary criterion. This discrepancy was viewed as a marker for unexpected underachievement and penetrated the policy and practice of SLD in the US and abroad. In many settings, the measurement of such a discrepancy is still considered key to identification. Yet, IDEA 2004 and the DSM-5 moved away from this requirement due to a lack of evidence that SLD varies with IQ and numerous philosophical and technical challenges to the notion of discrepancy (Fletcher, Lyon, Fuchs, & Barnes, 2019). IDEA 2004 also permitted an alternative inclusion criterion based on Response-to-Intervention (RTI), in which SLD reflects inadequate response to effective instruction, while the DSM-5 focuses on evidence of persistence of learning difficulties despite treatment efforts.

These three stands of inquiry into SLD use a variety of concepts (e.g., word blindness, strephosymbolia, dyslexia and alexia, dyscalculia and acalculia, dysgraphia and agraphia), which are sometimes differentiated and sometimes used synonymously, generating confusion in the literature. Given the heterogeneity of their manifestation and these diverse historical influences, it has been difficult to agree on the best way to identify SLD, although there is consensus that their core is unexpected underachievement. A source of active research and controversy is whether “unexpectedness” is best identified by applying solely exclusionary criteria (i.e., simple low achievement), inclusionary criteria based on uneven cognitive development (e.g., academic skills lower than IQ or another aptitude measure, such as listening comprehension), or evidence of persisting difficulties (DSM-5) despite effective instruction (IDEA 2004).

Manifestation, Definition, and Etiology

That the academic deficits in SLD relate to other cognitive skills has always been recognized, but the diagnostic and treatment relevance of this connection has remained unclear. A rich literature on cognitive models of SLD ( Elliott & Grigorenko, 2014 ; Fletcher et al., 2019) provides the basis for five central ideas. First, SLD are componential ( Melby-Lervåg, Lyster, & Hulme, 2012 ; Peng & Fuchs, 2016 ): Their academic manifestations arise on a landscape of peaks, valleys, and canyons in various cognitive processes, such that individuals with SLD have weaknesses in specific processes, rather than global intellectual disability ( Morris et al., 1998 ). Second, the cognitive components associated with SLD, just like academic skills and instructional response, are dimensional and normally distributed in the general population ( Ellis, 1984 ), such that understanding typical acquisition should provide insight into SLD and vice versa ( Rayner, Foorman, Perfetti, Pesetsky, & Seidenberg, 2001 ). Third, each academic and cognitive component may have a distinct signature in the brain ( Figure 3 ) and genome ( Figure 4 ). These signatures and etiologies likely overlap because they are correlated, but are not interchangeable, as their unique features substantiate the distinctness of various SLD ( Vandermosten, Hoeft, & Norton, 2016 ). Fourth, the overlap at least partially explains their rates of comorbidity ( Berninger & Abbott, 2010 ; Szucs, 2016 ; Willcutt et al., 2013 ). Fifth, deficiencies in these cognitive and academic processes appear to last throughout the lifespan, especially in the absence of intervention ( Klassen, Tze, & Hannok, 2013 ).

Results of meta-analyses of functional neuroimaging studies that exemplify the distribution of activation patterns in different reading- ( A ) and mathematics- ( B ) related networks, corresponding to componential models of the skills. A (Left panel, light blue): A lexical network in the basal occipito-temporal regions and in the left inferior parietal cortex. A (Middle panel, dark blue): A sublexical network, primarily involving regions of the left temporo-parietal lobe extending from the left anterior fusiform region. A (Right panel): Activation likelihood estimation map of foci from the word>pseudowords (light blue) and pseudowords>words (dark blue) contrasts. The semantic processing cluster is shown in green. B (Left panel): A number-processing network, primarily involving a region of the parietal lobe. B (Middle panel): An arithmetic-processing network, primarily involving regions of the frontal and parietal lobes. B (Right panel): Children (red) and adult (pink) meta-analyses of brain areas associated with numbers and calculations. Figure by Janet Croog.

A schematic representation of the genetic regions and gene-candidates linked to or associated with SRD and reading-related processes (shown in blue), and SMD and mathematics-related processes (shown in red). Dark blue signifies more studied loci and genes. Blue highlighted in red indicate the genes implicated in both SRD and SMD. Figure by Janet Croog.

The DSM-5 and IDEA 2004 reflect agreement that SLD can occur in word reading and spelling (Specific Word Reading Disability; SWRD) and in specific reading comprehension disability (SRCD). SWRD represents difficulties with beginning reading skills due at least in part to phonological processing deficits, while other language indicators (e.g., vocabulary) may be preserved ( Pennington, 2009 ). In contrast, SRCD ( Cutting et al., 2013 ), which is more apparent later in development, is associated with non-phonological language weaknesses ( Scarborough, 2005 ). The magnitude of SRCD is greater than that of vocabulary or language comprehension difficulties, suggesting that other problems, such as weaknesses in executive function or background knowledge, also contribute to SRCD ( Spencer, Wagner, & Petscher, 2018 ).

Math SLDs are differentiated as calculations (SMD) versus problem solving (word problems) SLD, which are associated with distinct cognitive deficits ( L. S. Fuchs et al., 2010 ) and require different forms of intervention ( L. S. Fuchs et al., 2014 ). Calculation is more linked to attention and phonological processing, while problem solving is more linked to language comprehension and reasoning; working memory has been associated with both. Specific written expression disability, SWED ( Berninger, 2004 ; Graham, Collins, & Rigby-Wills, 2017 ) occurs in the mechanical act of writing (i.e., handwriting, keyboarding, spelling), associated with fine motor-perceptual skills, or in composing text (i.e., planning and revising, understanding genre), associated with oral language skills, executive functions, and the automaticity of transcription skills. Although each domain varies in its cognitive correlates, treatment, and neurobiology, there is overlap. By carefully specifying the domain of academic impairment, considerable progress has been made in the treatment and understanding of the factors that lead to SLD.

Identification methods have searched for other markers of unexpected underachievement beyond low achievement, but always include exclusionary factors. Diagnosis solely by exclusion has been criticized due to the heterogeneity of the resultant groups ( Rutter, 1982 ); thus, the introduction of a discrepancy paradigm. One approach relies on the aptitude-achievement discrepancy, commonly operationalized as a discrepancy between measures of IQ and achievement in a specific academic domain. IQ-discrepancy was the central feature of federal regulations for identification from 1977 until 2004, although the approaches used to qualify and quantify the discrepancy varied in the 50 states. Lack of validity evidence ( Stuebing et al., 2015 ; Stuebing et al., 2002 ) resulted in its de-emphasis in IDEA 2004 and elimination from DSM-5.

A second approach focuses on identifying uneven patterns of strengths and weaknesses (PSW) profiles of cognitive functioning to explain observed unevenness in achievement across academic domains ( Flanagan, Alfonso, & Mascolo, 2011 ; Hale et al., 2008 ; Naglieri & Das, 1997 ). According to these methods, a student with SLD demonstrates a weakness in achievement (e.g., word reading), which correlates with an uneven profile of cognitive weaknesses and strengths (e.g., phonological processing deficits with advanced visual-spatial skills). Proponents suggest that understanding these patterns is informative for individualizing interventions that capitalize on student strengths (i.e., maintain and enhance academic motivation) and compensate for weaknesses (i.e., enhance the phonological processing needed for the acquisition and automatization of reading), but little supporting empirical evidence is available ( Miciak, Fletcher, Stuebing, Vaughn, & Tolar, 2014 ; Taylor, Miciak, Fletcher, & Francis, 2017 ). Meta-analytic research suggests an absence of cognitive aptitude by treatment interactions ( Burns et al., 2016 ), and limited improvement in academic skills based on training cognitive deficits such as working memory ( Melby-Lervåg, Redick, & Hulme, 2016 ).

Newer methods of SLD identification are linked to the development of the third historical strand, based on RTI. With RTI, schools screen for early indicators of academic and behavior problems and then progress monitor potentially at-risk children using brief, frequent probes of academic performance. When data indicate inadequate progress in response to adequate classroom instruction (Tier 1), the school delivers supplemental intervention (Tier 2), usually in the form of small-group instruction.

A child who continues to struggle requires more intensive, individualized intervention (Tier 3), which may include special education. An advantage of RTI is that intervention is provided prior to the determination of eligibility for special education placement. RTI juxtaposes the core concept of underachievement with the concept of inadequate response to instruction, that is, intractability to intervention. It prioritizes the presence of functional difficulty and only then considers SLD as a possible source of this difficulty ( Grigorenko, 2009 ). Still, concerns about the RTI approach to identification remain. One concern is that RTI approaches may not identify “high-potential” children who struggle to develop appropriate academic skills ( Reynolds & Shaywitz, 2009 ). Other concerns involve low agreement across different methods for defining inadequate RTI ( D. Fuchs, Compton, Fuchs, Bryant, & Davis, 2008 ; L. S. Fuchs, 2003 ) and challenges schools face in adequately implementing RTI frameworks ( Balu et al., 2015 ; D. Fuchs & Fuchs, 2017 ; Schatschneider, Wagner, Hart, & Tighe, 2016 ).

Prevalence and Incidence

Because the attributes of SLD are dimensional and depend on the thresholds used to subdivide normal distributions ( Hulme & Snowling, 2013 ), estimates of prevalence and incidence vary. SWRD’s prevalence estimates range from 5 to 17% ( Katusic, Colligan, Barbaresi, Schaid, & Jacobsen, 2001 ; Moll, Kunze, Neuhoff, Bruder, & Schulte-Körne, 2014 ). SRCD is less frequent ( Etmanskie, Partanen, & Siegel, 2016 ), but still represents about 42% of all children ever identified with SLD in reading at any grade ( Catts, Compton, Tomblin, & Bridges, 2012 ). Estimates of incidence and prevalence of SMD vary as well: from 4 to 8% ( Moll et al., 2014 ). Cumulative incidence rates by the age of 19 years range from 5.9% to 13.8%. Similar to SWRD, SMD can be differentiated in terms of lower- and higher-order skills and by time of onset. Computation-based SMD manifests earlier; problem-solving SMD later, sometimes in the absence of computation-based SMD ( L. S. Fuchs, D. Fuchs, C. L. Hamlett, et al., 2008 ). SWED is the least studied SLD. Its prevalence estimates range from 6% to 22% ( P. L. Morgan, Farkas, Hillemeier, & Maczuga, 2016 ) and cumulative incidence ranges from 6.9% to 14.7% ( Katusic, Colligan, Weaver, & Barbaresi, 2009 ).

Comorbidity and Co-Occurrence

One reason SLD can be difficult to define and identify is that different SLDs often co-occur in the same child. Comorbidity involving SWRD ranges from 30% ( National Center for Learning Disabilities, 2014 ) to 60% ( Willcutt et al., 2007 ). The most frequently observed co-occurrences are between (1) SWRD and SMD ( Moll et al., 2014 ; Willcutt et al., 2013 ), with 30–50% of children who experience a deficit in one academic domain demonstrating a deficit in the other ( Moll et al., 2014 ); (2) SWRD and early language impairments ( Dickinson, Golinkoff, & Hirsh-Pasek, 2010 ; Hulme & Snowling, 2013 ; Pennington, 2009 ) with 55% of individuals with SWRD exhibiting significant speech and language impairment ( McArthur, Hogben, Edwards, Heath, & Mengler, 2000 ); and (3) SWRD and internalizing and externalizing behavior problems, with 25–50% of children with SWRD meeting criteria for ADHD ( Pennington, 2009 ) and for generalized anxiety disorder and specific test anxiety, depression, and conduct problems ( Cederlof, Maughan, Larsson, D’Onofrio, & Plomin, 2017 ), although comorbid conduct problems are largely restricted to the subset of individuals with both SWRD and ADHD ( Willcutt et al., 2007 ).

The co-occurrence of SMD is less studied, but there are some consistently replicated observations: (1) individuals with SMD exhibit higher rates of ADHD, and math difficulties are observed in individuals with ADHD more frequently than in the general population ( Willcutt et al., 2013 ); (2) math difficulties are associated with elevated anxiety and depression even after reading difficulties are controlled ( Willcutt et al., 2013 ); and (3) SMD are associated with other developmental conditions such as epilepsy ( Fastenau, Shen, Dunn, & Austin, 2008 ) and schizophrenia ( Crow, Done, & Sacker, 1995 ).

SLD is clearly associated with difficulties in adaptation, in school and in larger spheres of life associated with work and overall adjustment. Longitudinal research reports poorer vocational outcomes, lower graduation rates, higher rates of psychiatric difficulties, and more involvement with the justice system for individuals with SWRD ( Willcutt et al., 2007 ). Importantly, there is evidence of increased comorbidity across forms of SLD with age, with accumulated cognitive burden ( Costa, Edwards, & Hooper, 2016 ). Individuals with comorbid SLDs have poorer emotional adjustment and school functioning than those identified with a single impairment ( Martinez & Semrud-Clikeman, 2004 ).

Identification (Diagnosis)

Comorbidity indicates that approaches to assessment should be broad and comprehensive. For SLD, the choice of a classification model directly influences the selection of assessments for diagnostic purposes. Although all three models are used, the literature (Fletcher et al., 2019) demonstrates that a single indicator model, based either on cut-off scores, other formulae, or assessment of instructional response, does not lead to reliable identification regardless of the method employed. SLD can be identified reliably only in the context of multiple indicators. A step in this direction is a hybrid method that includes three sets of criteria, two inclusionary and one exclusionary, recommended by a consensus group of researchers (Bradley, Danielson, & Hallahan, 2002). The two inclusionary criteria are evidence of low achievement (captured by standardized tests of academic achievement) and evidence of inadequate RTI (captured by curriculum-based progress-monitoring measures or other education records). The exclusionary criterion should demonstrate that the documented low achievement is not primarily attributable to “other” (than SLD) putative causes such as (a) other disorders (e.g., intellectual disability, sensory or motor disorders) or (b) contextual factors (e.g., disadvantaged social, religious, economic, linguistic, or family environment). In the future, it is likely that multi-indicator methods will be extended, with improved identification accuracy, by the addition of other indicators, neurobiological, genetic, or behavioral. It is also possible that assessment of specific cognitive processes beyond academic achievement will improve identification, but presently there is little evidence that such testing adds value to identification ( Elliott & Grigorenko, 2014 ; Fletcher et al., 2019). All identification methods for SLD assume that children referred for assessment are in good health or are being treated and that their physical health, including hearing and vision, is monitored. Currently, there are no laboratory tests (i.e., DNA or brain structure/activity) for SLD. There are also no tests that can be administered by an optometrist, audiologist, or physical therapist to diagnose or treat SLD.

Etiological Factors

Neural structure and function.

Since the earliest reports of reading difficulties, it has been assumed that the loss of function (i.e., acquired reading disability) or challenges in the acquisition of function (i.e., congenital reading disability) are associated with the brain. Functional patterns of activation in response to cognitive stimuli show reliable differences in degrees of activation between typically developing children and those identified with SWRD, and reveal different spatial distributions in relation to children identified with SMD and ADHD ( Dehaene, 2009 ; Seidenberg, 2017 ). In SWRD, there are reduced gray matter volumes, reduced integrity of white matter pathways, and atypical sulcal patterns/curvatures in the left-hemispheric frontal, occipito-temporal, and temporo-parietal regions that overlap with areas of reduced brain activation during reading.

These findings together indicate the presence of atypicalities in the structures (i.e., grey matter) that form the neural system for reading and their connecting pathways (i.e., white matter). These structural atypicalities challenge the emergence of the cognitive—phonological, orthographic, and semantic—representations required for the assembly and automatization of the reading system. Although some have interpreted the atypicalities as a product of reading instruction ( Krafnick, Flowers, Luetje, Napoliello, & Eden, 2014 ), there is also evidence that atypicalities can be observed in pre-reading children at risk for SWRD due to family history or speech and language difficulties ( Raschle et al., 2015 ), sometimes as early as a few days after birth with electrophysiological measures ( Molfese, 2000 ). What emerges in a beginning reader, if not properly instructed at developmentally important periods, is a suboptimal brain system that is inefficient in acquiring and practicing reading. This system is complex, representing multiple networks aligned with different reading-related processes ( Figure 3 ). The system engages cooperative and competitive brain mechanisms at the sublexical (phonological) and lexical levels, in which the phonological, orthographic, and semantic representations are utilized to rapidly form representations of a written stimulus. Proficient readers process words on sight with immediate access to meaning ( Dehaene, 2009 ). In addition to malleability in development, there is strong evidence of malleability through instruction in SWRD, such that the neural processes largely normalize if the intervention is successful ( Barquero, Davis, & Cutting, 2014 ).

The functional neural networks for SMD also vary depending on the mathematical operation being performed, just as the neural correlates of SWRD and SRCD do ( Cutting et al., 2013 ). Neuroimaging studies on the a(typical) acquisition of numeracy posit SMD ( Arsalidou, Pawliw-Levac, Sadeghi, & Pascual-Leone, 2017 ) as a brain disorder engaging multiple functional systems that together substantiate numeracy and its componential processes ( Figure 3 ). First, the intraparietal sulcus, the posterior parietal cortex, and regions in the prefrontal cortex are important for representing and processing quantitative information. Second, mnemonic regions anchored in the medial temporal lobe and hippocampus are involved in the retrieval of math facts. Third, additional relevant regions include visual areas implicated in visual form judgement and symbolic processing. Fourth, prefrontal areas are involved in higher-level processes such as error monitoring, and maintaining and manipulating information. As mathematical processes become more automatic, reliance on the parietal network decreases and reliance on the frontal network increases. All these networks, assembled in a complex functional brain system, appear necessary for the acquisition and maintenance of numeracy, and various aberrations in the functional interactions between networks have been described. Thus, SMD can arise as a result of disturbances in one or multiple relevant networks, or interactions among them ( Arsalidou et al., 2017 ; Ashkenazi, Black, Abrams, Hoeft, & Menon, 2013 ). There is also evidence of malleability and the normalization of neural networks with successful intervention in SMD ( Iuculano et al., 2015 ).

Genetic and environmental factors

Early case studies of reading difficulties identified their familial nature, which has been confirmed in numerous studies utilizing genetically-sensitive designs with various combinations of relatives—identical and fraternal twins, non-twin siblings, parent-offspring pairs and trios, and nuclear and extended families. The relative risk of having SWRD if at least one family member has SWRD is higher for relatives of individuals with the condition, compared to the risk to unrelated individuals; higher for children in families where at least one relative has SWRD; even higher for families where a first-degree relative (i.e., a parent or a sibling) has SWRD; and higher still for children in families where both parents have SWRD ( Snowling & Melby-Lervåg, 2016 ). Quantitative-genetic studies estimate that 30–80% of the variance in reading, math or spelling outcomes is explained by heritable factors ( Willcutt et al., 2010 ).

Since the 1980s, there have been systematic efforts to identify the sources of structural variation in the genome, i.e., genetic susceptibility loci that can account for the strong heritability and familiality of SWRD ( Figure 4 ). These efforts have yielded the identification of nine regions of the genome thought to harbor genes, or other genetic material, whose variation is associated with the presence of SWRD and individual differences in reading-related processes. Within these regions, a number of candidate genes have been tapped, but no single candidate has been unequivocally replicated as a causal gene for SWRD, and observed effects are small. In addition, multiple other genes located outside of the nine linked regions have been observed to be relevant to the manifestation of SWRD and related difficulties. Currently there are ongoing efforts to interrogate candidate genes for SWRD and connect their structural variation to individual differences in the brain system underlying the acquisition and practice of reading.

There are only a few molecular-genetic studies of SMD and its related processes ( Figure 4 ). Unlike SWRD, no “regions of interest” have been identified. Only one study investigated the associations between known single-nuclear polymorphisms (SNP) and a composite measure of mathematics performance derived from various assessments of SMD-related componential processes and teacher ratings. The study generated a set of SNPs that, when combined, accounted for 2.9% of the phenotypic variance ( Figure 4 shows the genes in which the three most statistically significant SNPs from this set are located). Importantly, when this SNP set was used to study whether the association between the 10-SNP set and mathematical ability differs as a function of characteristics of the home and school, the association was stronger for indicators of mathematical performance in chaotic homes and in the context of negative parenting.

Finally, studies have investigated the pleiotropic (i.e., impacting multiple phenotypes) effects of SWRD candidate genes on SMD, ADHD, and related processes. These effects are seemingly in line with the “generalist genes” hypothesis, asserting the pleiotropic influences of some genes to multiple SLD ( Plomin & Kovas, 2005 ).

Environmental factors are strong predictors of SLD. These factors penetrate all levels of a child’s ecosystem: culture, demonstrated in different literacy and numeracy rates around the world; social strata, captured by social-economic indicators across different cultures; characteristics of schooling, reflected by pedagogies and instructional practices; family literacy environments through the availability of printed materials and the importance ascribed to reading at home; and neighborhood and peer influences. Interactive effects suggest that reading difficulties are magnified when certain genetic and environmental factors co-occur, but there is evidence of neural malleability even in SWDE ( Overvelde & Hulstijn, 2011 ). Neural and genetic factors are best understood as risk factors that variably manifest depending on the home and school environment and child attributes like motivation.

Intervention

Although the content of instruction varies depending on whether reading, math, and/or writing are impaired, general principles of effective intervention apply across SLD i . First, intervention for SLD is explicit ( Seidenberg, 2017 ): Teachers formally present new knowledge and concepts with clear explanations, model skills and strategies, and teach to mastery with cumulative practice with ongoing guidance and feedback. Second, intervention is individualized: Instruction is formatively adjusted in response to systematic progress-monitoring data ( Stecker, Fuchs, & Fuchs, 2005 ). Third, intervention is comprehensive and differentiated, addressing the multiple components underlying proficient skill as well as comorbidity. Comprehensive approaches address the multifaceted nature of SLD and provide more complex interventions that are generally more effective than isolated skills training in reading ( Mathes et al., 2005 ) and math ( L. S. Fuchs et al., 2014 ). For example, children with SLD and ADHD may need educational and pharmacological interventions ( Tamm et al., 2017 ). Anxiety can develop early in children who struggle in school, and internalizing problems must be treated ( Grills, Fletcher, Vaughn, Denton, & Taylor, 2013 ). Differentiation through individualization in the context of a comprehensive intervention also permits adjustments of the focus of an intervention on specific weaknesses.

Fourth, intervention adjusts intensity as needed to ensure success, by increasing instructional time, decreasing group size, and increasing individualization ( L. S. Fuchs, Fuchs, & Malone, 2017 ). Such specialized intervention is typically necessary for students with SLD ( L. S. Fuchs et al., 2015 ). Yet, effective instruction for SLD begins with differentiated general education classroom instruction ( Connor & Morrison, 2016 ), in which intervention is coordinated with rather than supplanting core instruction ( L. S. Fuchs, D. Fuchs, C. Craddock, et al., 2008 ).

In addition, intervention is more effective when provided early in development. For example, intervention for SWRD was twice as effective if delivered in grades 1 or 2 than if started in grade 3 ( Lovett et al., 2017 ). This is underscored by neuroimaging research ( Barquero et al., 2014 ) showing that experience with words and numbers is needed to develop the neural systems that mediate reading and math proficiency. A child with or at risk for SWRD who cannot access print because of a phonological processing problem will not get the reading experience needed to develop the lexical system for whole word processing and immediate access to word meanings. This may be why remedial programs are less effective after second grade; with early intervention, the child at risk for SLD develops automaticity because they have gained the experience with print or numbers essential for fluency. Even with high quality intensive intervention, some children with SLD do not respond adequately, and students with persistent SLD may profit from assistive technology (e.g., computer programs that convert text-to-speech; Wood, Moxley, Tighe, & Wagner, 2018 ).

Finally, interventions for SLD must occur in the context of the academic skill itself. Cognitive interventions that do not involve print or numbers, such as isolated phonological awareness training or working memory training without application to mathematical operations do not improve reading or math skill ( Melby-Lervåg et al., 2016 ). Physical exercises (e.g., cerebellar training), optometric training, special lenses or overlays, and other proposed interventions that do not involve teaching reading or math are ineffective ( Pennington, 2009 ). Pharmacological interventions are effective largely due to their impact on comorbid symptoms, with little evidence of a direct effect on the academic skill ( Tamm et al., 2017 ).

No evaluations of recovery rate from SLD have been performed. Intervention success has been evaluated as closing the age-grade discrepancy, placing children with SLD at an age-appropriate grade level, and maintaining their progress at a rate commensurate with typical development. Meta-analytic studies estimate effect sizes of academic interventions at 0.49 for reading ( Scammacca, Roberts, Vaughn, & Stuebing, 2015 ), 0.53 for math ( Dennis et al., 2016 ), and 0.74 for writing ( Gillespie & Graham, 2014 ).

Implications for Practice and Research

Practitioners should recognize that the psychological and educational scientific evidence base supports specific approaches to the identification and treatment of SLD. In designing SLD evaluations, assessments must be timely to avoid delays in intervention; they must consider comorbidities as well as contextual factors, and data collected in the context of previous efforts to instruct the child. Practitioners should use the resulting assessment data to ensure that intervention programs are evidence-based and reflect explicitness, comprehensiveness, individualization, and intensity. There is little evidence that children with SLD benefit from discovery, exposure, or constructivist instructional approaches.

With respect to research, the most pressing issue is understanding individual differences in development and intervention from neurological, genetic, cognitive, and environmental perspectives. This research will ultimately lead to earlier and more precise identification of children with SLD, and to better interventions and long-term accommodations for the 2–6% of the general population who receive but do not respond to early prevention efforts. More generally, other human conditions may benefit from the examples of progress exemplified by the integrated, interdisciplinary approaches that underlie the progress of the past 50 years in the scientific understanding of SLD.

Acknowledgments

The authors are the Principal Investigators of the currently funded Learning Disabilities Research Centers ( https://www.nichd.nih.gov/research/supported/ldrc ) and Innovation Hubs ( https://www.nichd.nih.gov/research/supported/ldhubs ), the two key NICHD programs supporting research on Specific Learning Disabilities. The preparation of this articles was supported by P20 HD090103 (PI: Compton), P50 HD052117 (PI: Fletcher), P20 HD075443 (PI: Fuchs), P20 HD091005 (PI: Grigorenko), P50 HD052120 (PI: Wagner), and P50 HD27802 (PI: Willcutt). Grantees undertaking such projects are encouraged to express their professional judgment. Therefore, this article does not necessarily reflect the position or policies of the abovementioned agencies, and no official endorsement should be inferred.

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What Are Learning Disabilities?

Types, Causes, Symptoms, and Treatment

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What are learning disabilities?

Learning disabilities are a group of neurodevelopmental disorders that can significantly hamper a person’s ability to learn new things. As a result, the person may have trouble with tasks such as speaking, reading, writing, paying attention, understanding information, remembering things, performing mathematical calculations, or coordinating movements.

This article explores the types, causes, symptoms, and treatment of learning disabilities.

People with learning disabilities generally have average to superior intelligence and are often gifted in science, math, fine arts, and other creative mediums. However, there can be gaps between their potential and the skills expected from a person of their age .

Nevertheless, some of history's most accomplished, influential people had learning disabilities, including Albert Einstein, Leonardo da Vinci, Thomas Edison, and Winston Churchill.

Types of Learning Disabilities

“Learning disability” is an umbrella term that encompasses many types of specific learning disorders, including:

• Dyslexia: Dyslexia is the most common learning disability, accounting for 80% of all learning disability cases. It is a language processing disorder characterized by difficulty with speaking, reading, writing, or understanding words. This can cause the person's vocabulary to develop at a slower pace and lead to issues with grammar, reading comprehension, and other language skills.
• Dysgraphia: People with dysgraphia may have difficulty putting their thoughts into writing due to issues with vocabulary, spelling, grammar, memory, and critical thinking. This condition is characterized by poor handwriting, as the person may struggle with letter spacing, spatial awareness, and motor planning. Dysgraphia can make it hard for the person to think and write simultaneously.
• Dyscalculia: Sometimes known as “math dyslexia,” this condition includes learning disorders related to mathematics, such as difficulty with numbers, concepts, and reasoning. People with dyscalculia may struggle to count money, read clocks and tell time, perform mental math calculations, identify number patterns, and apply mathematical formulae.
• Auditory processing disorder (APD): People with APD may have difficulty processing sounds because their brain misinterprets auditory information received by the ear. As a result, they may confuse the order of sounds in certain words, or they may not be able to distinguish between sounds such as the teacher’s voice and the background noise in the classroom.
• Language processing disorder (LPD): This is a subset of APD, characterized by difficulties with processing spoken language . The person may have difficulty attaching meaning to sound groups representing words, sentences, and stories.
• Nonverbal learning disabilities (NVLD): NVLD is characterized by difficulty interpreting nonverbal cues such as facial expressions, body language, tone of voice, and other nonverbal signals.
• Visual perceptual/visual motor deficit: People with this condition may have difficulty with hand-eye coordination and motor activities. They may frequently lose their spot while reading, demonstrate unusual eye movements while reading or writing, confuse similar-looking letters, have difficulty navigating their environment, and struggle to manage items like pens, pencils, crayons, glue, and scissors.

Symptoms of Learning Disabilities

These are some of the symptoms of learning disabilities:

• Poor memory
• Difficulty focusing
• Short attention span
• Difficulty with reading or writing
• Inability to distinguish between sounds, letters, or numbers
• Difficulty sounding out words
• Tendency to put numbers or letters in the wrong sequence
• Difficulty telling time
• Confusion between right and left
• Tendency to reverse letters
• Difficulty grasping certain words and concepts
• Disconnect between words and meaning (i.e.. saying one thing but meaning another)
• Difficulty expressing thoughts and emotions
• Poor hand-eye coordination
• Delayed speech development 
• Disorganization
• Trouble with listening and following instructions
• Inappropriate responses
• Restlessness and impulsiveness
• Tendency to act out
• Difficulty with discipline
• Resistance to change 
• Inconsistent performance on a daily or weekly basis

While all children struggle with some of these things from time to time during their school years, people with learning disabilities tend to have a cluster of these symptoms that persist even as they get older.

According to the National Institute for Learning Development (NILD), frustration is a hallmark of this condition, since people with learning disabilities often excel at some things but do very poorly in other areas, and are often acutely aware of the gaps between what they can and cannot do.

The NILD notes that people with learning disabilities often find themselves failing in certain academic or professional areas due to reasons beyond their control, or having to put in tremendous amounts of effort in order to succeed. This experience can be difficult, confusing, and demotivating, often causing the person to feel sad and disappointed.

Causes of Learning Disabilities

Learning disabilities are caused by differences in the neurological functioning of the person’s brain. These differences can occur before the person is born, during their birth, or in early childhood, and may be caused by factors such as:

• Maternal illness during pregnancy
• Birth complications that block the flow of oxygen to the baby’s brain
• Certain genes that can make the person more genetically predisposed to developing a learning disability
• Injury or illness, such as meningitis, in early childhood 
• Health conditions such as cerebral palsy and Down’s syndrome often involve some extent of learning disability

However, it’s important to note that learning disabilities should not be mistaken for learning problems that arise due to other factors such as:

• Visual, hearing, verbal, or motor handicaps
• Intellectual disability
• Emotional disturbances
• Economic , cultural, or environmental disadvantages

Diagnosing Learning Disabilities

A healthcare professional can diagnose learning disabilities. The diagnostic process might involve:

• Academic testing: The healthcare provider may administer a standardized achievement test that checks the person’s reading, writing, and arithmetic skills, as well as an intelligence quotient (IQ) test . If the person performs well on the IQ test but has a lower score on the achievement test, it could indicate that they have a learning disability.
• Performance review: The healthcare provider may review and evaluate the person’s academic, professional, social, and developmental performance.
• Medical history: The healthcare provider will likely ask questions about the person’s personal and family medical history.
• Physical and neurological exam: The healthcare provider may conduct a physical and neurological exam to check for other health conditions such as brain diseases, mental health conditions, and developmental and intellectual disabilities .

Every learning disability has different symptoms, and everyone’s experience of the condition is unique. The signs, frequency, and intensity of symptoms can vary considerably. Some people may have a single, isolated learning difficulty that doesn't cause issues in day-to-day life; others have overlapping learning disabilities that make it difficult for them to function without support.

Learning disabilities typically develop at a young age and are often diagnosed during the person’s school years, since the primary focus at school is learning. An estimated 8% to 10% of American children younger than 18 have learning disabilities. However, some people are not diagnosed with learning disabilities until they attend college or get a job; others never receive an official diagnosis, so they go through life without knowing why they have trouble with academics, work, relationships, or day-to-day tasks.

Treating Learning Disabilities

Learning disabilities are lifelong conditions that cannot be fixed or cured; however, with timely diagnosis, treatment, and support, people with learning disabilities can be successful at school, work, and among their community.

Treatment for learning disabilities may involve:

• Special education: Children with learning disabilities may benefit from education by specially trained teachers who perform a comprehensive evaluation of the child’s abilities and then help the child build on their strengths while compensating for their disabilities. 
• Medication: Some people may need to take medication to improve their ability to focus and concentrate.
• Therapy: Psychotherapy can help people with learning disabilities deal with emotional issues and develop coping skills.
• Other interventions: People with learning disabilities may also benefit from other interventions such as speech and language therapy.
• Support groups: People with learning disabilities as well as parents of children with learning disabilities may benefit from support group meetings that help them connect with others who have similar experiences. Learning difficulties can often lead to tension, misunderstandings, and conflicts among the family, particularly among families where the condition is hereditary.

Every human being is equipped with a unique set of strengths and weaknesses that enable them to do some things effortlessly but struggle in other areas. Although people with learning disabilities have some challenges with learning, they are not in any way inferior to anyone else . Special education, treatment, support, kindness, and patience can help them achieve success.

Vidyadharan V, Tharayil HM. Learning disorder or learning disability: Time to rethink . Indian J Psychol Med . 2019;41(3):276-278. doi:10.4103/IJPSYM.IJPSYM_371_18

National Institute for Learning Development. What is a learning disability?

National Institute of Neurological Disorders and Stroke. Learning disabilities .

Learning Difficulties Association of America. Types of learning disabilities .

Walden University. 7 learning disabilities every psychology professional should study .

Kohli A, Sharma S, Padhy SK. Specific learning disabilities: Issues that remain unanswered . Indian J Psychol Med . 2018;40(5):399-405. doi:10.4103/IJPSYM.IJPSYM_86_18

Learning Difficulties Association of America. Symptoms of learning disabilities .

American Academy of Pediatricians. Diagnosing a learning disability .

National Health Service. Learning disabilities .

National Institute of Child Health and Human Development. How are learning disabilities diagnosed?

National Institute of Child Health and Human Development. What are some signs of learning disabilities?

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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Home > Books > Learning Disabilities - Neurological Bases, Clinical Features and Strategies of Intervention

The Child with Learning Difficulties and His Writing: A Study of Case

Submitted: 30 May 2019 Reviewed: 16 August 2019 Published: 20 November 2019

DOI: 10.5772/intechopen.89194

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The purpose of this paper is to present one child with learning difficulties writing process in multigrade rural elementary school in México. It presents Alejandro’s case. This boy lives in a rural area. He shows special educational needs about learning. He never had specialized attention because he lives in a marginalized rural area. He was integrated into regular school, but he faced some learning difficulties. He was always considered as a student who did not learn. He has coursed 2 years of preschool and 1 year of elementary school. Therefore, this text describes how child writes a list of words with and without image as support. Analysis consists to identify the child’s conceptualizations about writing, his ways of approaching, and difficulties or mistakes he makes. The results show that Alejandro identifies letters and number by using pseudo-letters and conventional letter. These letters are in an unconventional position. There is no relationship grapheme and phoneme yet, and he uses different writing rules. We consider his mistakes as indicators of the learning process.

• writing difficulties
• learning difficulties
• writing learning
• writing process
• special education

Author Information

Edgardo domitilo gerardo morales *.

• Faculty of Philosophy and Letters, National Autonomous University of Mexico, México City, México

*Address all correspondence to: [email protected]

1. Introduction

One of the purposes of Mexican education system is that students acquire conventional writing during first grades in elementary school [ 1 ]. This purpose consists of students to understand the alphabetical code, its meaning, and functionality. In this way, they can integrate into a discursive community.

The elementary school teacher teaches a heterogeneous group of children [ 1 ,  2 ]. Some students show different acquisition levels of the writing. This is due to literacy environment that the family and society provide. Thus, some children have had great opportunities to interact with reading and writing practices than others. Therefore, some students do not learn the alphabetical principle of writing at the end of the scholar year. They show characteristics of initial or intermediate acquisition level of the writing. In this way, it is difficult for children to acquire writing at the same time, at the term indicated by educational system or teachers.

In addition, there may be children with learning difficulties in the classroom. Department of Special Education teaches some children. Students with special educational needs show more difficulties to learn than their classmates [ 3 ]. They require more resources to achieve the educational objectives. These authors point out that special educational needs are relative. These needs arise between students’ personal characteristics and their environment. Therefore, any child may have special educational needs, even if he/she does not have any physical disability. However, some students with learning difficulties do not have a complete assessment about their special educational needs. On the one hand, their school is far from urban areas; on the other hand, there are not enough teachers of special education for every school. In consequence, school teachers do not know their students’ educational needs and teach in the same way. Thereby, students with learning difficulties do not have the necessary support in the classroom.

Learning difficulties of writing may be identified easily. Children with special educational needs do not learn the alphabetical principle of writing easily; that is, they do not relate phoneme with grapheme. Therefore, children show their conceptualizations about writing in different ways. Sometimes, teachers censor their students’ written productions because they do not write in a conventional way. Children with special educational needs are stigmatized in the classroom. They are considered as less favored. At the end of the scholar year, children do not pass.

Therefore, the purpose of this paper is to present one child with special educational needs writing process in a Mexican multigrade rural school. This text describes how the child writes a list of words with and without image as support. Analysis consists to identify the child’s conceptualizations about writing [ 4 ], his ways of approaching, and difficulties or mistakes he makes. These mistakes are the indicators of learning process [ 5 ].

This paper presents Alejandro’s case. This boy lives in a rural area. He shows special educational needs about learning. He never had specialized attention because he lives in a marginalized rural area. He was integrated into regular school, but he faced some learning difficulties. He was always considered as a student who does not learn. Therefore, this text describes Alejandro’s writing, what he does after 2 years of preschool and 1 year of elementary school.

2. Children with learning difficulties and their diagnosis

According to the National Institute for the Evaluation of Education [ 6 ], Mexican education system provides basic education (preschool, elementary, and secondary school) for students with special educational needs. There are two types of special attention: Center of Multiple Attention (CAM, in Spanish) and Units of Service and Support to Regular Education (USAER, in Spanish). In the first one, children with special educational needs go to this Center. These children receive attention according to basic education and their educational needs. In the second, specialized teachers on special education go to school and provide support to students. These teachers provide information to school teachers too. In this way, there is educational equity and inclusion in Mexican school [ 7 ].

Physical appearance : Teacher describes the child’s physical characteristics. These features indicate the type of food the student eats, care his or her person, the parents’ attention, among other elements.

Behavior observed during the assessment : In this section, the teacher should record the conditions in which the assessment was carried out: child’s attitude, behavior, and interest.

Child’s development history : This section presents conditions in which pregnancy developed, physical development (ages in which child held his/her head, sat, crawled, walked, etc.), language development (verbal response to sounds and voices, age in which said his/her first words and phrases, etc.), family (characteristics of their family and social environment, frequent activities, etc.), hetero-family history (vision, hearing, etc.), medical history (health conditions, diseases, etc.), and scholar history (age at which he/she started school, type of school, difficulties, etc.).

Present condition : In this, there are four aspects:

It refers to student’s general aspects: intellectual area (information processing, attention, memory, understanding, etc.), motor development area (functional skills to move, take objects, position of his/her body, etc.), communicative-linguistic area (phonological, semantic, syntactic and pragmatic levels), adaptation and social interaction area (the child’s skills to initiate or maintain relationships with others), and emotional area (the way of perceiving the world and people). In each one, it mentions the instruments he suggests, although there is not enough information about them [ 3 ].

The second aspect is the curricular competence level. Teacher identifies what the student is capable of doing in relation to established purposes and contents by official curriculum.

The third aspect is about the learning style and motivation to learn. It presents physical-environmental conditions where the child works, their interests, level attention, strategies to solve a task, and the incentives he receives.

The fourth aspect is information about the student’s environment: factors of the school, family, and social context that influence the child’s learning.

Psycho-pedagogical assessment allows to identify children’s general educational needs. In this way, the school teacher could have information about the students’ difficulties. However, it is a general assessment. It contains several aspects and does not go deeper into one.

Therefore, this paper does not propose a new assessment. It consists of presenting one child’s writing difficulties, his ways of conceptualizing writing, and some mistakes he gets to make.

3. Students with learning difficulties and their scholar integration

Since 1993, Mexican system education has tried to offer special education services to students with special educational needs in basic education [ 8 ]. The first step was to promote the integration of these children in regular education classrooms. However, only insertion of the student in the school was achieved. Therefore, the system of education searched for mechanisms to provide advice to teacher. In this way, student with learning difficulties can be attended at the same time in the classroom [ 8 ].

Educational integration has been directly associated with attention of students with learning difficulties, with or without physical disabilities [ 8 ]. However, this process implies a change in the school. For this, it is necessary to provide information and to create awareness to the educational community, permanent updating of teachers, joint work between teacher, family, and specialized teachers.

At present, Mexican education system looks at educational integration as process in which every student with learning difficulties is supported individually [ 9 ]. Adapting the curriculum to the child is the purpose of educational integration.

Curricular adequacy is one of the actions to support students with learning difficulties [ 10 , 11 ]. This is an individualized curriculum proposal. Its purpose is to attend the students’ special educational needs [ 3 ]. At present, Mexican education system indicates that there should be a curricular flexibility to promote learning processes. However, it is important to consider what the child knows about particular knowledge.

Regarding the subject of the acquisition of written language, it is necessary to know how the children build their knowledge about written. It is not possible to make a curricular adequacy if teachers do not have enough information about their students. However, children are considered as knowledge builders. Therefore, there are learning difficulties at the process.

4. Alejandro’s case

This section presents Alejandro’s personal information. We met him when we visited to his school for other research purposes. We focused on him because the boy was silent in class. He was always in a corner of the work table and did not do the activities. For this, we talked with his teacher and his mother to know more about him.

Alejandro is a student of an elementary multigrade rural school. He was 7 years old at the time of the study. He was in the second grade of the elementary school. His school is located in the region of the “Great Mountains” of the state of Veracruz, Mexico. It is a rural area, marginalized. To get to this town from the municipal head, it is necessary to take a rural taxi for half an hour. Then, you have to walk on a dirt road for approximately 50 min.

Alejandro’s family is integrated by six people. He is the third of the four sons. He lives with his parents. His house is made of wood. His father works in the field: farming of corn, beans, and raising of sheep. His mother is a housewife and also works in the field. They have a low economic income. Therefore, they receive a scholarship. One of his older brothers also showed learning difficulties at school. His mother says both children have a learning problem. But, they do not have any money for attending their sons’ learning difficulties. In addition, there are no special institutes near their house.

The boy has always shown learning difficulties. He went to preschool for 2 years. However, he did not develop the necessary skills at this level. At classes, this child was silent, without speaking. Preschool teachers believed that he was mute. Nevertheless, at scholar recess, he talked with his classmates. Alejandro was slow to communicate with words in the classroom.

When he started elementary school, Alejandro continued to show learning difficulties. At classes, he was silent too. He just watched what his classmates did. He did not do anything in the class. He took his notebook out of his backpack and just made some lines. Occasionally, he talked with his classmates. When the teacher asked him something, Alejandro did not answer. He looked down and did not answer. He just ducked his head and stayed for several minutes.

When Alejandro was in second grade, he did different activities than his classmates. His teacher drew some drawings for him and he painted these drawings. Other occasions, the teacher wrote some letters for him to paint. The child did every exercise during several hours. He did not finish his exercises quickly. Sometimes he painted some drawings during 2 h.

Although Alejandro requires specialized attention, he has not received it. He has not had a full psycho-pedagogical assessment at school by specialized teachers. His school does not have these teachers. Also, the child was not submitted to neurological structural examination or neurophysiological studies to exclude an organic origin of his learning difficulties. His parents do not have enough financial resources to do this type of study for him. In addition, one specialized institution that can do this type of study for free is in Mexico City. It is so far from child’s house. It would be expensive for the child’s parents. Therefore, he is only attended as a regular school student.

For this reason, this paper is interested in the boy’s writing process. This is because Alejandro coursed 2 years of preschool and 1 year of elementary school; however, he does not show a conventional writing yet. In this way, it is interesting to analyze his conceptualizations about writing and difficulties he experiences.

5. Methodology

The purpose of this paper is to know the child’s ways to approach writing spontaneously and his knowledge about the writing system. For this, the author used a clinical interview. He took into account the research interview guide “Analysis of Disturbances in the Learning Process of Reading and Writing” [ 12 ].

The clinical interview was conducted individually. We explored four points, but we only present two in this text: to write words and to write for image.

Interviewer took the child to the library room at school. There were no other students. First, the interviewer gave the child a sheet and asked to write his name. Alejandro wrote his name during long time. Interviewer only asked what it says there. He answered his name: “Alejandro.” Next, the interviewer asked the child to write some letters and numbers he knew. Alejandro wrote them. The interviewer asked about every letter and number. The child answered “letter” or “number,” and its name.

To write words : The interviewer asked the child to write a group of words from the same semantic field in Spanish (because Alejandro is from Mexico) and one sentence. Order of words was from highest to lowest number of syllables. In this case, interviewer used semantic field of animals. Therefore, he used following words: GATO (cat), MARIPOSA (butterfly), CABALLO (horse), PERRO (dog), and PEZ (fish). The sentence was: EL GATO BEBE LECHE (The cat drinks milk). The interviewer questioned every written word. He asked the child to show with his finger how he says in every written production.

To write for image : This task was divided into two parts. The first analyzed the size and second analyzed the number.

Interviewer used the following image cards: horse-bird and giraffe-worm ( Figure 1 ). Every pair of cards represents a large animal and a small animal.

Cards with large and small animals.

The purpose of this first task was to explore how the child writes when he looks at two images of animals with different size. The animal names have three syllables in Spanish: CA-BA-LLO (horse), PA-JA-RO (bird), etc. In this way, we can see how the child writes.

The interviewer used the following pair of cards for second task ( Figure 2 ).

Cards for singular and plural.

First card shows one animal (singular) and the second shows some animals (plural). In this way, we search to explore how the child produces his writings when he observes one or more objects, if there are similarities or differences to write.

The interviewer asked what was in every card. Next, he asked the child to write something. Alejandro wrote something in every picture. Afterward, the interviewer asked the child to read every word that he wrote. Child pointed with his finger what he wrote.

After, the interview was transcribed for analysis. We read the transcription. The author analyzed every written production. He identified the child’s conceptualizations about writing. He compared the written production and what the child said. In this way, the analysis did not only consist to identify the level of writing development. This text describes the child’s writing, the ways in which he conceptualizes the writing, the difficulties he experienced to write, and his interpretations about writing.

6. Alejandro’s writing

This section describes Alejandro’s writing process. As we already mentioned, Alejandro is 7 years old and he studies in the second grade of the elementary school. His teacher says the child should have a conventional writing, because he has already coursed 1 year of elementary school, but it is not like that. Most of his classmates write a conventional way, but he does not.

We organized this section in three parts. The first part presents how Alejandro wrote his name and how he identifies letters and numbers; the second part refers to the writing of words; and the third part is writing for picture.

6.1 Alejandro writes his name and some letters and numbers

The first part of the task consisted of Alejandro writing his name and some letters and numbers he knows. His name was requested for two reasons. The first reason is to identify the sheet, because the interviewer interviewed other children in the same school. Also, it was necessary to identify every written productions of the group of students. The second reason was to observe the way he wrote his name and how he identified letters and numbers.

The interviewer asked the child to write his name at the top of the sheet. When the interviewer said the instructions, Alejandro was thoughtful during a long time. He was not pressed or interrupted. He did not do anything for several seconds. The child looked at the sheet and looked at everywhere. After time, he took the pencil and wrote the following on the sheet ( Figure 3 ).

Alejandro’s name.

The interviewer looked at Alejandro’s writing. He asked if something was lacking. The interviewer was sure that Alejandro knew his name and his writing was not complete. However, Alejandro was thoughtful, and looked at the sheet for a long time. The interviewer asked if his name was already complete. The child answered “no.” The interviewer asked the child if he remembered his name. Alejandro denied with his head. So, they continued with another task.

Alejandro has built the notion of his name. We believe that he has had some opportunities to write his name. Perhaps, his teacher has asked him to write his name on his notebooks, as part of scholar work in the classroom. We observed that Alejandro used letters with conventional sound value. This is because he wrote three initial letters of his name: ALJ (Alejandro). The first two letters correspond to the beginning of his name. Then, he omits “E” (ALE-), and writes “J” (ALJ). However, Alejandro mentions that he does not remember the others. This may show that he has memorized his name, but at that moment he failed to remember the others, or, these letters are what he remembers.

Subsequently, the interviewer asked Alejandro to write some letters and numbers he knew. The sequence was: a letter, a number, a letter, another letter, and number. In every Alejandro’ writing, the interviewer asked the child what he wrote. In this way, Alejandro wrote the following ( Figure 4 ).

Letters and numbers written by Alejandro.

For this task, Alejandro wrote for a long time. He did not hurry to write. He looked at sheet and wrote. The child looked at the interviewer, looked at the sheet again and after a few seconds he wrote. The interviewer asked about every letter or number.

We can observe that Alejandro differentiates between letter and number. He wrote correctly in every indication. That is, when the interviewer asked him to write a letter or number, he did so, respectively. In this way, Alejandro knows what he needs to write a word and what is not, what is for reading and what is not.

Also, we can observe that the child shows a limited repertoire of letters. He did not write consonants. He used only vowels: A (capital and lower) and E (lower). It shows us that he differentiates between capital and lower letter. Also, he identifies what vowels and letters are because the child answered which they were when the interviewer asked about them.

6.2 Writing words from the same semantic field

Asking the child to write words spontaneously is a way to know what he knows or has built about the writing system [ 12 ]. Although we know Alejandro presents learning difficulties and has not consolidated a conventional writing, it is necessary to ask him to write some words. This is for observing and analyzing what he is capable of writing, what knowledge he has built, as well as the difficulties he experiences.

The next picture presents what Alejandro wrote ( Figure 5 ). We wrote the conventional form in Spanish next to every word. We wrote these words in English in the parentheses too.

List of words written by Alejandro.

At the beginning of the interview, Alejandro did not want to do the task. He was silent for several seconds. He did not write anything. He looked at the sheet and the window. The interviewer insisted several times and suspended the recording to encourage the child to write. Alejandro mentioned he could not write, because he did not know the letters and so he would not do it. However, the interviewer insisted him. After several minutes, Alejandro took the pencil and started to write.

Alejandro wrote every word for 1 or 2 min. He required more seconds or minutes sometimes. He looked at the sheet and his around. He was in silence and looking at the sheet other times. We identified that he needs time to write. This shows that he feels insecure and does not know something for writing. He feels insecure because he was afraid of being wrong and that he was punished by the interviewer for it. It may be that in class he is penalized when he makes a mistake. There is ignorance because he does not know some letters, and he has a low repertoire of the writing system. Thus, Alejandro needs to think about writing and look for representing it. Therefore, this is why the child needs more time to write.

We identified that the child does not establish a phoneme-grapheme relationship. He only shows with his finger from left to right when he read every word. He does not establish a relationship with the letters he used. In each word, there is no correspondence with the number of letters. The child also does not establish a constant because there is variation in number and variety of letters sometimes.

Alejandro used letters unrelated to the conventional writing of the words. For example, when he wrote GATO (cat), Alejandro used the following letters: inpnAS. It is possible to identify that no letter corresponds to the word. Perhaps, Alejandro wrote those letters because they are recognized or remembered by him.

Alejandro shows a limited repertoire of conventional letters. This is observed when he uses four vowels: A, E, I, O. The child used these vowels less frequently. There is one vowel in every word at least. When Alejandro wrote PEZ (fish), he used two vowels. We observed that he writes these vowels at the beginning or end of the word. However, we do not know why he places them that way. Maybe this is a differentiating principle by him.

There is qualitative and quantitative differentiation in Alejandro’s writing. That is, he did not write any words in the same way. All the words written by him are different. Every word has different number and variety of letters. When two words contain the same number of letter, they contain different letters.

When Alejandro wrote MARIPOSA (butterfly), he used five letters. The number of letters is less than what he used for GATO (cat). Maybe he wrote that because the interviewer said “butterfly is a small animal.” This is because the cat is bigger than the butterfly. Therefore, it may be possible that he used lesser letters for butterfly.

In Spanish, PERRO (dog) contains five letters. Alejandro wrote five letters. In this case, Alejandro’s writing corresponds to the necessary number of letters. However, it seems that there is no writing rules for him. This is for two reasons: first, because there is no correspondence with the animal size. Horse is larger than dog and Alejandro required lesser letters for horse than for dog. Second, CABALLO (horse) is composed by three syllables and PERRO (dog) by two. Alejandro used more letters to represent two syllables. In addition, it is observed that there is a pseudo-letter. It looks like an inverted F, as well as D and B, horizontally.

When Alejandro wrote PEZ (fish), the interviewer first asked how many letters he needed to write that word. The child did not answer. Interviewer asked for this again and student said that he did not know. Then, interviewer said to write PEZ (fish). For several minutes, Alejandro just looked the sheet and did not say anything. The interviewer questioned several times, but he did not answer. After several minutes, Alejandro wrote: E. The interviewer asked the child if he has finished. He denied with his head. After 1 min, he started to write. We observed that his writing contains six letters. Capital letters are predominated.

Alejandro used inverted letters in three words. They may be considered as pseudo-letters. However, if we observe carefully they are similar to conventional letters. The child has written them in different positions: inverted.

May be there is a writing rule by Alejandro. His words have a minimum of four letters and a maximum of six letters. This rule has been established by him. There is no relation to the length of orality or the object it represents.

We can identify that Alejandro shows a primitive writing [ 4 ]. He is still in writing system learning process. The phoneticization process is not present yet. The child has not achieved this level yet. He only uses letters without a conventional sound value. There is no correspondence to phoneme-grapheme, and he uses pseudo-letters sometimes.

6.3 To write for image

Write for image allows us to know what happens when the child writes something in front of an image [ 12 ]. It is identified if there is the same rules used by the child, number of letters, or if there is any change when he writes a new word. It may happen that the length of the words is related to the size of the image or the number of objects presented. In this way, we can identify the child’s knowledge and difficulties when he writes some words.

6.3.1 The image size variable

The first task is about observing how the child writes when he is in front of two different sized images. That is, we want to identify if the image size influences on his writings. Therefore, two pairs of cards were presented to Alejandro. Every pair of cards contained two animals, one small and one large. The interviewer asked Alejandro to write the name on each one ( Figure 6 ).

Horse and bird writing.

Based on the writing produced by Alejandro, we mentioned the following:

Alejandro delimits his space to write. When he wrote for first pair of words, the child drew a wide rectangle and he made an oval and several squares for the second pair of words. The child wrote some letters to fill those drawn spaces. It seems that Alejandro’s rule is to fill the space and not only represent the word.

When Alejandro writes the words, we identified that he presents difficulty in the conventional directionality of writing. He wrote most of words from left to right (conventional directionality), but he wrote some words from right to left (no conventional). For example, the child started to write the second word on the left. He wrote seven letters. He looked at the sheet for some seconds. After, he continued to write other letters on the right. He wrote and completed the space he had left, from right to left.

Alejandro shows two ways to write: left–right (conventional) and right–left (no conventional). When he wrote the last word, the child wrote one letter under another. There was no limited space on the sheet. Alejandro wrote it there. The child has not learned the writing directionality.

When we compared Alejandro’s writings, we identified that the number of letters used by him does not correspond to the image size. Although the images were present and he looked them when he wrote, the child took into account other rules to write. The six names of animals had three syllables in Spanish and Alejandro used nine letters for CABALLO (horse) and eleven for PÁJARO (bird). The letters used by him are similar to the conventional ones. However, these are in different positions. There are no phonetic correspondences with the words. The child shows a primitive writing. Alejandro has not started the level of relation between phoneme and grapheme yet. We can believe that the boy wrote some letters to cover the space on the sheet. Alejandro takes into account the card size instead of the image size.

After writing a list of words, the interviewer asked Alejandro to read and point out every word he wrote. The purpose of this task is to observe how the child relates his writing to the sound length of the word. When Alejandro read CABALLO (horse), he pointed out as follows ( Figure 7 ).

Alejandro reads “caballo” (horse).

Alejandro reads every word and points out what he reads. In this way, he justifies what he has written. In the previous example, Alejandro reads the first syllable and points out the first letter, second syllable with the second letter. At this moment, he gets in conflict when he tries to read the third syllable. It would correspond to the third letter. However, “there are more letters than he needs.” When he reads the word, he shows the beginning of phoneticization: relation between one syllable with one letter. This is the syllabic writing principle [ 4 ]. Nevertheless, he has written more letters. Therefore, Alejandro says “o” in the other letters. In this way, we can point out that Alejandro justifies every letters and there is a correspondence between what he reads and what he writes.

When Alejandro reads the second word, the child pointed out as follows ( Figure 8 ).

Alejandro reads “pájaro” (bird).

Alejandro makes a different correspondence syllable-letter than the first word. Although his writing was in two ways, his reading is only one direction: from left to right. The first syllable is related to first three letters he wrote. The second syllable is related to the fourth letter. But, he faces the same problem as in the previous word: “there are many letters.” So he justifies the other letters as follows. He reads the third syllable in relation to the sixth and seventh letter. And, reads “o” for the other letters.

When interviewer showed the next pair of cards, Alejandro wrote as following ( Figure 9 ).

Giraffe and worm writing by Alejandro.

When the interviewer shows the pair of cards to Alejandro, the child said “It’s a zebra.” So, the interviewer said “It’s a giraffe and it’s a worm” and pointed out every card. The interviewer asked Alejandro to write the name of every animal. First, the child draws a rectangle across the width of the sheet. Next, he started to write on the left side inside the rectangle. He said the first syllable “JI” while writing the first letter. After, he said “ra,” he wrote a hyphen. Then, he said “e” and wrote another letter. At that moment, he looked at the sheet and filled the space he left with some letters ( Figure 10 ).

Giraffe writing.

Alejandro shows different rules of writing. These rules are not the same as previous. He delimited the space to write and filled the space with some letters. The child tries to relate the syllable with one letter, but he writes others. There is a limited repertoire of letters too. In this case, it seems that he used the same letters: C capital and lower letter, A capital and lower letter, and O. We believe that he uses hyphens to separate every letter. However, when he wrote the first hyphen, it reads the second syllable. We do not know why he reads there. Alejandro had tried to use conventional letters. He uses signs without sound value. In addition, there is no relation phoneme and grapheme.

When Alejandro wrote GUSANO (worm), he drew a rectangle and divided it into three small squares. Then, he drew other squares below the previous ones. After, he began to write some letters inside the squares, as seen in the following picture ( Figure 11 ).

Worm writing.

Alejandro used other rules to write. They are different than the previous. Alejandro has written one or two letters into every box. At the end, he writes some letters under the last box. There is no correspondence between what he reads and writes. There are also no fixed rules of writing for him. Rather, it is intuited that he draws the boxes to delimit his space to write.

6.3.2 Singular and plural writing

The next task consists to write singular and plural. For this, the interviewer showed Alejandro the following images ( Figure 12 ).

Cards with one cat and four cats.

Alejandro drew an oval for first card. This oval is on the left half of the sheet. He wrote the following ( Figure 13 ).

Alejandro writes GATO (cat).

Next, the interviewer asked Alejandro to write for the second card, in plural. For this, Alejandro draws another oval from the middle of the sheet, on the right side. The child did not do anything for 1 h 30 min. After this time, he wrote some different letters inside the oval ( Figure 14 ). He wrote from right to left (unconventional direction).

Alejandro writes GATOS (cats).

Alejandro wrote in the opposite conventional direction: from right to left. He tried to cover the delimited space by him. His letters are similar to the conventional ones. Also, there are differences between the first and the second word. He used lesser letters for first word than the second. That is, there are lesser letters for singular and more letters for plural. Perhaps, the child took into account the number of objects in the card.

The writing directionality may have been influenced by the image of the animals: cats look at the left side. Alejandro could have thought he was going to write from right to left, as well as images of the cards. Therefore, it is necessary to research how he writes when objects look at the right side. In this way, we can know if this influences the directionality of Alejandro’s writing.

With the next pair of images ( Figure 15 ), the interviewer asked Alejandro to write CONEJO (rabbit) and CONEJOS (rabbits).

Cards with one rabbit and three rabbits.

Alejandro draws a rectangle in the middle of the sheet for the first card (rabbit). He said “cone” (rab-) and wrote the first letter on the left of the sheet. Then, he said “jo” (bit) and wrote the second letter. He said “jo” again and wrote the third letter. He was thoughtful for some seconds. He started to write other letters. His writing is as follows ( Figure 16 ).

Alejandro writes CONEJO (rabbit).

At the beginning, Alejandro tries to relate the syllables of the word with first two letters. However, he justifies the other letters when he read the word. There is no exact correspondence between the syllable and the letter. As well as his writing is to fill the space he delimited.

Alejandro takes into account other rules for plural writing. He drew a rectangle across the width of the sheet. Starting on the left, he said “CO” and wrote one letter. Then, he said “NE” and drew a vertical line. After, he said “JO” and wrote other letters. His writing is as follows ( Figure 17 ).

Alejandro writes CONEJOS (rabbits).

Alejandro writes both words differently. He reads CONEJO (rabbit) for first word and CONEJOS (rabbits) for the second. Both words are different from each other. But, he wrote them with different rules. This is confusing for us because there are vertical lines between every two letters in the second word. We believe that the child tried to represent every object, although he did not explain it.

In summary, Alejandro shows different writings. He used pseudo-letters and conventional letter. These letters are in unconventional positions. There is no relationship between grapheme and phoneme yet; and, he uses different writing rules.

7. Conclusions

We described Alejandro’s writing process. According to this description, we can note the following:

Alejandro is a student of an elementary regular school. He presents learning difficulties. He could not write “correctly.” However, he did not have a full assessment by specialized teachers. His school is so far from urban areas and his parents could not take him to a special institution. Therefore, he has not received special support. Also, there is not a favorable literacy environment in his home. His teacher teaches him like his classmates. Usually, he has been marginalized and stigmatized because “he does not know or work in class.”

We focused on Alejandro because he was a child who was always distracted in class. We did not want to show his writing mistakes as negative aspects, but as part of his learning process. Errors are indicators of a process [ 5 ]. They inform the person’s skills. They allow to identify the knowledge that is being used [ 13 ]. In this way, errors can be considered as elements with a didactic value.

Alejandro showed some knowledge and also some difficulties to write. The child identifies and distinguishes letters and numbers. We do not know if he conceptualizes their use in every one. When he wrote, he shows his knowledge: letters are for reading, because he did not use any number in the words.

The writing directionality is a difficulty for Alejandro. He writes from left to right and also from right to left. We do not know why he did that. We did not research his reasons. But, it is important to know if there are any factors that influence the child to write like this.

The student does not establish a phoneme-grapheme relationship yet. He is still in an initial level to writing acquisition. He uses conventional letters and pseudo-letters to write. There are no fixed rules to write: number and variety of letters. However, we observed student’s thought about writing. He justifies his writings when he reads them and invents letters to represent some words.

There is still a limited repertoire of letters. He used a few letters of the alphabet. Therefore, Alejandro needs to interact with different texts, rather than teaching him letter by letter. Even if “he does not know those letters.” In this way, he is going to appropriate other elements and resources of the writing system.

Time he takes to write is an important element for us. He refused to write for several minutes at the beginning. After, he wrote during 1 or 2 min every word. As we mentioned previously, we believe that Alejandro did not feel sure to do the task. Perhaps, he thought that the interviewer is going to penalize for his writing “incorrectly.” He felt unable to write. Therefore, it is important that children’s mistakes are not censored in the classroom. Mistakes let us to know the child’s knowledge and their learning needs.

We considered that class work was not favorable for Alejandro. He painted letters, drawings, among others. These were to keep him busy. Therefore, it is important for the child to participate in reading and writing practices. In this way, he can be integrated into the scholar activities and is not segregated by his classmates.

About children with learning difficulties, it is important that these children write as they believe. Do not censor their writings. They are not considered as people incapable. It is necessary to consider that learning is a slow process. Those children will require more time than their classmates.

Special education plays an important role in Mexico. However, rather than attending to the student with learning difficulties in isolation, it is necessary that the teacher should be provided with information and the presence of specialized teachers in the classroom. In this way, the student with learning difficulties can be integrated into class, scholar activities, and reading and writing practices.

We presented Alejandro’s writing process in this paper. Although he was considered as a child with learning difficulties, we identified he shows some difficulties, but he knows some elements of the writing system too.

Acknowledgments

I thank Alejandro, his parents, and his teacher for the information they provided to me about him.

Conflict of interest

The authors declare no conflict of interest.

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• 2. SEP. Propuesta Educativa Multigrado 2005. México: Secretaria de Educación Pública; 2005
• 3. García-Cedillo E, Escalante I, Escandón M, Fernández L, Mustre A, Puga I. La Integración Educativa en el Aula Regular. Principios, Finalidades y Estrategias. México: Secretaría de Educación Pública; 2000. ISBN: 978-607-8279-18-0
• 4. Ferreiro E, Teberosky A. Los Sistemas de Escritura en el Desarrollo del Niño. México, D.F.: Editorial Siglo XXI; 1979. ISBN 968-23-1578-6
• 5. Dolz J, Gagnon R, Vuillet Y. Production écrite et Difficultés D’apprentisage. Genève: Carnets des Sciences de L’education. Université de Genéve; 2011. ISBN: 2-940195-44-7
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John and College Studies: A Case Study in Accommodating Learning Disabilities

John has a learning disability which affects auditory processing. Like many students with invisible disabilities, such as learning and psychological impairments, he is sensitive to the attitudes and perceptions of fellow classmates and instructors regarding his need for a notetaker in class. He is reluctant to announce this need among his classmates, fearing perceptions of preferential treatment, invalid reasons, and negative stereotyping (e.g., that he is lazy or stupid).

Access Issue

John needed to obtain lecture notes as an accommodation. He was too embarrassed to make such a request of his classmates. Although the student disability resource center had provided paperwork and approval for monetary compensation for a notetaker, nearly two weeks had passed and still no classroom volunteers were identified.

Intervention from the student disability resources office included contact with the instructor who then made a general announcement in class about the need for a notetaker, noting that monetary compensation would be provided; if there were no volunteers, the disability resources office staff would recruit on campus for a paid notetaker enrolled in the class. It was also recommended that the instructor provide lecture outlines and the option for the student to tape record the lectures. Additional support was provided to the student through disability management counseling, which reinforced self-advocacy and learning skills.

This case shows how:

• The three-way coordination of the student, faculty, and office of disability services can effectively support the student who has concerns about what others might think and help him attain needed academic accommodations.
• The disability resources office may help a student develop self-advocacy and learning skills.

• A to Z Topics Index
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Learning Disabilities

Learning disabilities are differences in a person’s brain that can affect how well they read, write, speak, do math, and handle other similar tasks. Different groups may define “learning disability” differently, often depending on the focus of the organization.

Having a learning disability, or even several disabilities, isn’t related to intelligence. It just means that the person’s brain works differently from others. In many cases, there are interventions—treatments—that can help a person with learning disabilities read, write, speak, and calculate just as well or better than someone without these disabilities.

NICHD and other federal agencies are looking into what causes these disabilities, how to identify them, and ways to treat them. The institute also studies typical learning processes and the effectiveness of different treatments for learning disabilities.

About Learning Disabilities

Learning disabilities affect how a person learns to read, write, speak, and do math. They are caused by differences in the brain, most often in how it functions but also sometimes in its structure. These differences affect the way the brain processes information. 1

Learning disabilities are often discovered once a child is in school and has learning difficulties that do not improve over time. A person can have more than one learning disability. 2 Learning disabilities can last a person’s entire life, but he or she can still be successful with the right educational supports. 1

A learning disability is not an indication of a person’s intelligence. Learning disabilities are different from learning problems due to  intellectual and developmental disabilities , or emotional, vision, hearing, or motor skills problems. 1

Different groups may define “learning disability” differently, often depending on the focus of the organization. You can read more at the U.S. Department of Education , which provides statutes, regulations, and policies on the Individuals with Disabilities Education Act; the Learning Disabilities Association of America   ; and https://www.understood.org   , which is maintained by the National Center for Learning Disabilities.

Types of Learning Disabilities

Some of the most common learning disabilities are the following:

• Dyslexia.  People with dyslexia have problems with reading words accurately and with ease (sometimes called “fluency”) and may have a hard time spelling, understanding sentences, and recognizing words they already know. 3
• Dysgraphia.  People with dysgraphia have problems with their handwriting. They may have trouble forming letters, writing within a defined space, and writing down their thoughts. 4
• Dyscalculia.  People with this math learning disability may have difficulty understanding arithmetic concepts and doing addition, multiplication, and measuring. 5
• Apraxia of speech. This disorder involves problems with speaking. People with this disorder have trouble saying what they want to say. It is sometimes called verbal apraxia. 6
• Central auditory processing disorder.  People with this condition have trouble understanding and remembering language-related tasks. They have difficulty explaining things, understanding jokes, and following directions. They confuse words and are easily distracted. 7
• Nonverbal learning disorders.  People with these conditions have strong verbal skills but difficulty understanding facial expression and body language. They are clumsy and have trouble generalizing and following multistep directions. 8

Because there are many different types of learning disabilities, and some people may have more than one, it is hard to estimate how many people might have learning disabilities.

• LD Online. (n.d.).  What is a learning disability? Retrieved March 4, 2017, from  http://www.ldonline.org/ldbasics/whatisld   
• National Institute of Neurological Disorders and Stroke. (n.d.).  L earning disabilities information page . Retrieved March 6, 2017, from https://www.ninds.nih.gov/Disorders/All-Disorders/Learning-Disabilities-Information-Page
• International Dyslexia Association. (2008).  Dyslexia at a glance . Retrieved March 4, 2017, from  https://dyslexiaida.org/dyslexia-at-a-glance/  
• National Institute of Neurological Disorders and Stroke. (n.d.).  Dysgraphia information page. Retrieved March 4, 2017, from https://www.ninds.nih.gov/Disorders/All-Disorders/Dysgraphia-Information-Page
• Understood.org. (n.d.).  Understanding dyscalculia.  Retrieved August 24, 2018, from  https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/dyscalculia/understanding-dyscalculia  
• National Institute on Deafness and Other Communication Disorders. (2010).  Apraxia of speech . Retrieved March 4, 2017, from http://www.nidcd.nih.gov/health/voice/pages/apraxia.aspx  
• American Speech-Language-Hearing Association. (n.d.) Auditory Processing Disorder in Children. Retrieved June 24, 2020, from   https://www.asha.org/public/hearing/Understanding-Auditory-Processing-Disorders-in-Children/  
• Learning Disabilities Association of America. (n.d.).  Non-verbal learning disorders . Retrieved March 4, 2017, from  https://ldaamerica.org/disabilities/non-verbal-learning-disabilities/  

Video Text Alternative: Manage Your Learning Disability Be Your Own Advocate

To view the original video, please go to http://www.nichd.nih.gov/health/topics/learning/conditioninfo/treatment/mld/Pages/default.aspx

Video Text Alternative: Manage Your Learning Disability Ensure Your Surroundings Facilitate Success

Video Text Alternative: Manage Your Learning Disability Take Advantage of Assistive Technology

What are some signs of learning disabilities?

Many children have trouble reading, writing, or performing other learning-related tasks at some point. This does not mean they have learning disabilities. A child with a learning disability often has several related signs, and they don’t go away or get better over time. The signs of learning disabilities vary from person to person.

Please note that the generally common signs included here are for informational purposes only; the information is not intended to screen for learning disabilities in general or for a specific type of learning disability.

Common signs that a person may have learning disabilities include the following:

• Problems reading and/or writing
• Problems with math
• Poor memory
• Problems paying attention
• Trouble following directions
• Trouble telling time
• Problems staying organized 1

A child with a learning disability also may have one or more of the following 1 :

• Acting without really thinking about possible outcomes (impulsiveness)
• “Acting out” in school or social situations
• Difficulty staying focused; being easily distracted
• Difficulty saying a word correctly out loud or expressing thoughts
• Problems with school performance from week to week or day to day
• Speaking like a younger child; using short, simple phrases; or leaving out words in sentences
• Having a hard time listening
• Problems dealing with changes in schedule or situations
• Problems understanding words or concepts

These signs alone are not enough to determine that a person has a learning disability. Only a professional can diagnose a learning disability .

Each learning disability has its own signs. A person with a particular disability may not have all of the signs of that disability.

Children being taught in a second language may show signs of learning problems or a learning disability. The learning disability assessment must take into account whether a student is bilingual or a second language learner. In addition, for English-speaking children, the assessment should be sensitive to differences that may be due to dialect, a form of a language that is specific to a region or group.

Below are some common learning disabilities and the signs associated with them:

People with dyslexia usually have trouble making the connection between letters and sounds and with spelling and recognizing words. 2

People with dyslexia often show other signs of the condition. These may include 3 , 4 :

• Having a hard time understanding what others are saying
• Difficulty organizing written and spoken language
• Delay in being able to speak
• Difficulty expressing thoughts or feelings
• Difficulty learning new words (vocabulary), either while reading or hearing
• Trouble learning foreign languages
• Difficulty learning songs and rhymes
• Slow rate of reading, both silently and out loud
• Giving up on longer reading tasks
• Difficulty understanding questions and following directions
• Poor spelling
• Problems remembering numbers in sequence (for example, telephone numbers and addresses)
• Trouble telling left from right

A child who has trouble writing or has very poor handwriting and does not outgrow it may have dysgraphia. This disorder may cause a child to be tense and twist awkwardly when holding a pen or pencil. 5

Other signs of this condition may include 5 :

• A strong dislike of writing and/or drawing
• Problems with grammar
• Trouble writing down ideas
• Losing energy or interest as soon as they start writing
• Trouble writing down thoughts in a logical sequence
• Saying words out loud while writing
• Leaving words unfinished or omitting them when writing sentences

Dyscalculia

Signs of this disability include problems understanding basic arithmetic concepts, such as fractions, number lines, and positive and negative numbers.

Other symptoms may include 6 :

• Difficulty with math-related word problems
• Trouble making change in cash transactions
• Messiness in putting math problems on paper
• Trouble with logical sequences (for example, steps in math problems)
• Trouble understanding the time sequence of events
• Trouble describing math processes
• Learning Disabilities Association of America. (n.d.).  Symptoms of learning disabilities . Retrieved June 15, 2012, from  https://ldaamerica.org/support/new-to-ld/  
• National Institute of Neurological Disorders and Stroke. (n.d.).  Dyslexia information page. Retrieved March 6, 2017, from https://www.ninds.nih.gov/Disorders/All-Disorders/Dyslexia-Information-Page#disorders-r1
• International Dyslexia Association. (n.d.).  Dyslexia at a glance . Retrieved March 6, 2017, from https://dyslexiaida.org/dyslexia-at-a-glance/  
• American Speech-Language-Hearing Association. (n.d.).  Learning disabilities . Retrieved August 24, 2018, from  http://www.asha.org/public/speech/disorders/LBLD.htm  
• Patino, E. (n.d.).  Understanding dysgraphia.  Retrieved March 6, 2017, from  https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/dysgraphia/understanding-dysgraphia  
• Learning Disabilities Association of America. (n.d.).  Dyscalculia . Retrieved March 6, 2017, from https://ldaamerica.org/disabilities/dyscalculia/  

What causes learning disabilities?

Researchers do not know all of the possible causes of learning disabilities, but they have found a range of risk factors during their work to find potential causes. Research shows that risk factors may be present from birth and tend to run in families. 1 In fact, children who have a parent with a learning disability are more likely to develop a learning disability themselves. 2 To better understand learning disabilities, researchers are studying how children’s brains learn to read, write, and develop math skills. Researchers are working on interventions to help address the needs of those who struggle with reading the most, including those with learning disabilities, to improve learning and overall health.

Factors that affect a fetus developing in the womb, such as alcohol or drug use, can put a child at higher risk for a learning problem or disability. Other factors in an infant’s environment may play a role, too. These can include poor nutrition or exposure to lead in water or in paint. Young children who do not receive the support they need for their intellectual development may show signs of learning disabilities once they start school. 3

Sometimes a person may develop a learning disability later in life due to injury. Possible causes in such a case include dementia or a  traumatic brain injury (TBI) . 4

•   National Center for Learning Disabilities. (2017). Snapshot of learning and attention issues in the U.S. Retrieved August 7, 2018, from https://ncld.org/wp-content/uploads/2023/09/Reading-NAEP-Data-Snapshot.pdf   (PDF 743 KB)
•   Harstad, E. (n.d.). Are the learning issues in my family genetic? Retrieved August 7, 2018, from https://www.understood.org/en/family/siblings/multiple-children-learning-issues/are-the-learning-issues-in-my-family-genetic  
•   National Center for Learning Disabilities. (2014).  The state of learning disabilities: Facts, trends and emerging issues (3rd ed.).New York: National Center for Learning Disabilities. Retrieved March 8, 2017, from https://ncld.org/resources/#expander-68-3  
•   National Institute of Neurological Disorders and Stroke. (n.d.).  Dyslexia information page. Retrieved March 8, 2017, from https://www.ninds.nih.gov/Disorders/All-Disorders/Dyslexia-Information-Page  

How are learning disabilities diagnosed?

Learning disabilities are often identified once a child is in school. The school may use a process called “response to intervention” to help identify children with learning disabilities. Special tests are required to make a diagnosis.

Response to Intervention

Response to intervention usually involves the following 1 :

• Monitoring all students’ progress closely to identify possible learning problems
• Providing children who are having problems with help on different levels, or tiers
• Moving children to tiers that provide increasing support if they do not show sufficient progress

Students who are struggling in school can also have individual evaluations. An evaluation can 2 :

• Identify whether a child has a learning disability
• Determine a child’s eligibility under federal law for special education services
• Help develop an individualized education plan (IEP) that outlines help for a child who qualifies for special education services
• Establish benchmarks to measure the child’s progress

A full evaluation for a learning disability includes the following 3 :

• A medical exam, including a neurological exam, to rule out other possible causes of the child’s difficulties. These might include emotional disorders, intellectual and developmental disabilities, and brain diseases.
• Reviewing the child’s developmental, social, and school performance
• A discussion of family history
• Academic and psychological testing

Usually, several specialists work as a team to do the evaluation. The team may include a psychologist, a special education expert, and a speech-language pathologist. Many schools also have reading specialists who can help diagnose a reading disability. 4

Role of School Psychologists

School psychologists are trained in both education and psychology. They can help diagnose students with learning disabilities and help the student and his or her parents and teachers come up with plans to improve learning. 5

Role of Speech-Language Pathologists

All speech-language pathologists are trained to diagnose and treat speech and language disorders. A speech-language pathologist can do a language evaluation and assess the child’s ability to organize his or her thoughts and possessions. The speech-language pathologist may evaluate the child’s learning skills, such as understanding directions, manipulating sounds, and reading and writing. 6

• National Center for Learning Disabilities. (n.d.).  What is RTI ? Retrieved March 8, 2017, from  http://www.rtinetwork.org/learn/what/whatisrti  
• Learning Disabilities Association of America. (2001).  Assessment & e valuation.  Retrieved March 8, 2017, from https://ldaamerica.org/category/assessment-evaluation/?audience=Parents  
• National Library of Medicine. (2015).  Developmental reading disorder . Retrieved March 8, 2017, from  http://www.nlm.nih.gov/medlineplus/ency/article/001406.htm
• Learning Disabilities Association of America. (n.d.).  Eligibility: Determining whether a child is eligible for special education services . Retrieved March 8, 2017, from  https://ldaamerica.org/info/eligibility-determining-whether-a-child-is-eligible-for-special-education-services/   (PDF 86 KB)
• National Association of School Psychologists. (n.d.).  Who are school psychologists? Retrieved March 8, 2017, from  http://www.nasponline.org/about-school-psychology/who-are-school-psychologists  
• American Speech-Language-Hearing Association. (n.d.).  Learning disabilities . Retrieved August 24, 2018, from http://www.asha.org/public/speech/disorders/LBLD.htm  

What are the treatments for learning disabilities?

Learning disabilities have no cure, but early intervention can lessen their effects. People with learning disabilities can develop ways to cope with their disabilities. Getting help earlier increases the chance of success in school and later in life. If learning disabilities remain untreated, a child may begin to feel frustrated, which can lead to low self-esteem and other problems. 1

Experts can help a child learn skills by building on the child’s strengths and finding ways to compensate for the child’s weaknesses. 2  Interventions vary depending on the nature and extent of the disability.

Learn tips for managing a learning disability in adulthood.

Special Education Services

Children diagnosed with learning disabilities can receive special education services. The  Individuals with Disabilities Education Act (IDEA) requires that public schools provide free special education supports to children with disabilities. 3

In most states, each child is entitled to these services beginning at age 3 years and extending through high school or until age 21, whichever comes first. The  rules of IDEA for each state   are available from the Early Childhood Technical Assistance Center.

IDEA requires that children be taught in the least restrictive environment appropriate for them. This means the teaching environment should meet a child’s needs and skills while minimizing restrictions to typical learning experiences.

Individualized Education Programs (IEPs)

Children who qualify for special education services will receive an Individualized Education Program, or IEP. This personalized and written education plan 4 :

• Lists goals for the child
• Specifies the services the child will receive
• Lists the specialists who will work with the child

Qualifying for Special Education

To qualify for special education services, a child must be evaluated by the school system and meet federal and state guidelines. Parents and caregivers can contact their school principal or special education coordinator to find out how to have their child evaluated. Parents can also review these resources:

• The Center for Parent Information and Resources   offers information about Parent Training and Information Centers and Community Parent Resource Centers   .
• IDEA Parent Guide  

Interventions for Specific Learning Disabilities

Below are just a few of the ways schools help children with specific learning disabilities.

• Intensive teaching techniques.  These can include specific, step-by-step, and very methodical approaches to teaching reading with the goal of improving both spoken language and written language skills. These techniques are generally more intensive in terms of how often they occur and how long they last and often involve small group or one-on-one instruction. 6
• Classroom modifications.  Teachers can give students with dyslexia extra time to finish tasks and provide taped tests that allow the child to hear the questions instead of reading them.
• Use of technology.  Children with dyslexia may benefit from listening to audio books or using word-processing programs.

Dysgraphia 7

• Special tools.  Teachers can offer oral exams, provide a note-taker, or allow the child to videotape reports instead of writing them. Computer software can facilitate children being able to produce written text.
• Use of technology.  A child with dysgraphia can be taught to use word-processing programs, including those incorporating speech-to-text translation, or an audio recorder instead of writing by hand.
• Reducing the need for writing.  Teachers can provide notes, outlines, and preprinted study sheets.

Dyscalculia 7

• Visual techniques.  Teachers can draw pictures of word problems and show the student how to use colored pencils to differentiate parts of problems.
• Memory aids.  Rhymes and music can help a child remember math concepts.

Computers.  A child with dyscalculia can use a computer for drills and practice.

• Learning Disabilities Association of America. (2018).  New to LD. Retrieved August 24, 2018, from https://ldaamerica.org/support/new-to-ld/  
• National Institute of Neurological Disorders and Stroke. (n.d.).  Learning disabilities information page . Retrieved March 9, 2017, from https://www.ninds.nih.gov/Disorders/All-Disorders/Learning-Disabilities-Information-Page
• U.S. Department of Education. (2018). About IDEA . Retrieved August 24, 2018, from https://sites.ed.gov/idea/about-idea/  
• Center for Parent Information and Resources. (2017).  The short-and-sweet IEP overview. Retrieved August 24, 2018, from https://www.parentcenterhub.org/iep-overview/  
• International Dyslexia Association. (n.d.).  Dyslexia basics . Retrieved March 9, 2017, from  https://dyslexiaida.org/dyslexia-basics/  
• Understood.org. (n.d.). Treatment for kids with dyslexia. Retrieved August 7, 2018, from https://www.understood.org/en/learning-attention-issues/treatments-approaches/treatment-options/treatment-for-kids-with-dyslexia  
• Learning Disabilities Association of America. (n.d.).  Types of learning disabilities . Retrieved March 9, 2017, from  https://ldaamerica.org/types-of-learning-disabilities/  

What conditions are related to learning disabilities?

Children with learning disabilities may be at greater risk for certain conditions compared to other kids. Recognizing and treating these conditions can help a child be more successful.

Attention Deficit and Hyperactivity Disorder

Attention deficit and hyperactivity disorder (ADHD) occurs more frequently in children with learning disabilities compared to children without learning disabilities. A child with a learning disability who also has ADHD may be distracted easily and find it harder to concentrate.

An NICHD-supported study on reading disorders found that it is important to treat both the ADHD symptoms and reading problems. The findings show that although both disorders need separate treatments, these interventions can be done effectively at the same time.

Depression/Anxiety

A child with a learning disability may struggle with low self-esteem, frustration, worry, and other problems. Mental health professionals can help the child understand these feelings, learn ways to cope with them, and learn how to build healthy relationships.

3 Tips for Managing a Learning Disability in Adulthood

Support from schools can improve elementary and secondary students’ math, reading, and other language skills. But how can people with learning disabilities prepare for the demands of university or working life?

Dr. Brett Miller directs the Reading, Writing, and Related Learning Disabilities Program within NICHD’s  Child Development and Behavior Branch . In the video series below, he talks about tools, tips, and approaches that can help people manage their learning disabilities as adults.

Be Your Own Advocate

It's important to know and speak up for what you need. Understand your learning challenges, identify possible solutions, and ask for the resources that will allow you to reach your goals.

Read the Manage Your Learning Disability: Be Your Own Advocate text alternative .

Ensure That Your Surroundings Facilitate Success

Work with your school or employer to create a supportive learning environment, such as access to software that will help you succeed now and in the future.

Read the Manage Your Learning Disability: Ensure Your Surroundings Facilitate Success text alternative .

Take Advantage of Assistive Technology

Use computer tools customized to your own pace and needs that can read text aloud, help you articulate your thoughts, and provide structure to your writing.

Disability as Diversity

A Case Studies Companion Guide

• © 2021
• Leslie Neal-Boylan 0 ,
• Lisa M. Meeks   ORCID: https://orcid.org/0000-0002-3647-3657 1

Mansfield Kaseman Health Clinic, Chevy Chase, Rockville, USA

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Department of Family Medicine, University of Michigan Medical School, Ann Arbor, USA

• The information is critically needed, as this is a first-of-its kind publication
• Case studies are connected to case law and OCR decisions for health science programs
• Applicable across healthcare professions

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Healthcare Disparities for Individuals with Disability: Informing the Practice

Legibility: knowing disability in medical education inclusion

Public Health Ethics and Disability: Centering Disability Justice

• Case studies
• Disability services

Table of contents (15 chapters)

Front matter, medical student cases, the student with a learning disability: clarissa connors, a medical student with undiagnosed adhd and a learning disability.

• Kristina H. Petersen, Stacy C. Jones, Lisa M. Meeks

The Student with a Physical Disability: Tammy Thomas, a Clinical Year Medical Student with Quadriplegia

• Christopher D. Connolly, Maya M. Hammoud, Charlotte H. O’Connor

The Student with a Sensory Disability: Conrad Barker, a Rising Third-Year Medical Student with Hearing Loss

• Michael S. Argenyi, Alicia Booth, Christine Low

The Student with a Psychological Disability: Rhonda Rapp, a Fourth-Year Medical Student with Depression and PTSD

• Lisa M. Meeks, Hilit F. Mechaber, Samantha Schroth, Rahael Gupta, Joseph F. Murray

The Student with a Chronic Health Condition: Hillary Hampton, a Second-Year Medical Student with Crohn’s Disease

• Nichole L. Taylor, Charlotte H. O’Connor

The Student with Cancer: Marc Fernandez, a Fourth-Year Medical Student with Cancer

• Nichole L. Taylor, Catherine Moore, Suzanne Hawks

Nursing Student Cases

The student with a learning disability: mee sook smith, a nursing student with a learning disability in an associate degree program.

• Leslie Neal-Boylan, Patricia Lussier-Duynstee, Christine Low

The Student with a Learning Disability: Maxwell Mason, a Nursing Student with a Learning Disability in a Baccalaureate Degree Program

• Patricia Lussier-Duynstee, Charlotte H. O’Connor, Leslie Neal-Boylan

The Student with a Physical Disability: Sam Stone, a Nursing Student with a Missing Limb

• Leslie Neal-Boylan, Patricia Lussier-Duynstee, Jan Serrantino-Cox

The Student with a Sensory Disability: Anna Howard, a Deaf Nursing Student

• Stacey M. Carroll, Carrie Morgan Eaton, Marie Lusk

The Student with a Psychological Disability: Melanie Mathews, a Nursing Student with Suicidal Ideation

• Leslie Neal-Boylan, Michelle D. Miller, Jan Serrantino-Cox

The Student with a Chronic Health Condition: Susan Nacht, a Nursing Student with Narcolepsy

• Sharron E. Guillett, Elizabeth Kane

Focused Topic Cases

The student using medical marijuana.

• Leslie Neal-Boylan, Charlotte H. O’Connor

The Student Who Brings an Animal to Class

• Patricia Lussier-Duynstee, Christine Low, Elisa P. Laird, Leslie Neal-Boylan

The Student Who Fails the Medical Board Exam

• Kristina H. Petersen, Lisa M. Meeks

Back Matter

Editors and affiliations.

Leslie Neal-Boylan

Lisa M. Meeks

About the editors

Leslie Neal-Boylan, PhD, APRN, CRRN, FAAN

Solomont School of Nursing

University of Massachusetts

Lowell, MA, USA

[email protected]

Lisa M. Meeks, PhD, MA

Department of Family Medicine

The University of Michigan Medical School

Ann Arbor, Michigan, USA

[email protected]

Bibliographic Information

Book Title : Disability as Diversity

Book Subtitle : A Case Studies Companion Guide

Editors : Leslie Neal-Boylan, Lisa M. Meeks

DOI : https://doi.org/10.1007/978-3-030-55886-4

Publisher : Springer Cham

eBook Packages : Medicine , Medicine (R0)

Copyright Information : The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021

Softcover ISBN : 978-3-030-55885-7 Published: 01 November 2020

eBook ISBN : 978-3-030-55886-4 Published: 31 October 2020

Edition Number : 1

Number of Pages : XIV, 158

Number of Illustrations : 1 b/w illustrations, 1 illustrations in colour

Topics : Health Administration , General Practice / Family Medicine

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Learning Disability week: Nursing case studies

Meet 16 year old Justina (Juzzy). Juzzy loves singing, Benidorm (TV show), being sociable, dancing with whoever and riding her new trike!

Justina has complex physical health needs alongside a diagnosis of a learning disability. Justina has had several procedures throughout her life which can make her anxious about accessing hospital settings.

Justina required treatment and investigations whilst under a general anaesthetic. Justina’s primary procedure would be dental treatment and secondary treatments would include outstanding vaccinations, spinal x-ray (scoliosis monitoring), blood tests, and PEG (percutaneous endoscopic gastrostomy) feeding change/sizing.

First visit

On Justina’s first attendance for the above planned procedures, she was extremely anxious and subsequently very distressed. Justina displayed her anxiety through dropping to the floor, screaming, attempting to run away, grabbing, and pulling her PEG out. The procedure was cancelled due to the extent of Justina’s distress and staff feeling that the time was not right to proceed.

Second visit

Following the first visit, plans were made alongside the wider MDT (multidisciplinary team, including lead anaesthetist) about how to successfully administer the general anaesthetic to Justina safely, whilst supporting her anxieties. A plan was made and shared with Mum. This plan involved; a very quick transition from Mum’s car and straight into anaesthetic room  (with all appropriate checks completed with Mum outside of the hospital), a member of the team met Justina outside of the main hospital to maintain consistency of supporting staff, pictures of Benidorm characters were displayed in the anaesthetic room for staff to utilise distraction, favourite songs were played from Mum’s phone to which all staff sang/danced to which further aided distraction. We ensured there were continuous dynamic assessments taking place throughout this period – checking in with Mum throughout.

Justina had a very positive experience with limited distress and Mum felt relieved and grateful for the support given.

Justina post-procedure

Following Justina’s procedure, she had her iPad ready to watch Benidorm (as you can see!).

Justina proceeded to shout, ‘Adios Lads!’ on leaving the department – to which clinicians felt proud and relieved at a successful visit.

• ‘The team’s input has been vital to me and Juzzy.
• The team’s input has made a big difference to Juzzy and the fact that Juzzy was excited to see one particular member of the team after a very distressing recent admission, says so much!
• Can’t thank the team enough!’

What’s next for the Learning Disability and Autism Spectrum Condition Liaison team?

• Build ‘everyday, all day’ capacity within organisation due to prevalence of children and young people with a learning disability and who are autistic attending
• Support the most complex children and young people to ensure they can access their treatment
• Collaborate with teams to provide advice, guidance and support best practice
• Develop flexibility within team re skills, availability across site and liaison with families
• Continue to listen and learn from children and young people, families, carers and staff to provide the best service possible

All information and pictures provided within this case study has been consented to by Justina’s Mum.

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