Sandbox/Specific learning disorder

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Diagnostic Criteria

DSM-V Diagnostic Criteria for Specific learning disorder

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A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties: 1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words). 2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read). 3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants). 4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity). 5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures). 6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems). B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment. For individuals age 17 years and older, a documented history of impairing learning difficulties may be substituted for the standardized assessment. C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic sl<ills exceed the individual’s limited capacities (e.g., as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads). D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction.

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Note:The four diagnostic criteria are to be met based on a clinical synthesis of the individual’s history (developmental, medical, family, educational), school reports, and psychoeducational assessment .

References

Epidemiology and Demographics Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [4]

Epidemiology and Demographics

Prevalence

• The prevalence of specific learning disorder in school-age childhren is 5000-15,000 per 100,000 (5-15%) of the overall population.

• The prevalence of specific learning disorder in adults is 4000 per 100,000 (4%) of the overall population.

Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [6]

Overview

Risk factors for specific learning disorder includes prematurity,dyslexia, heritability, and very low birth weight among others.

Risk Factors

• Delay or disorders in speech or language in preschool
• First-degree relatives of individuals with these learning difficulties.
• Family history of dyslexia
• Heritability
• Inattentive behavior in preschool years
• Impaired cognitive processing (e.g., phonological awareness,working memory, rapid serial naming) in preschool years
• Prematurity
• Prenatal exposure to nicotine
• Parental literacy skills
• Very low birth weight

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [7]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [8]

Overview

Specific learning disorder must be differentiated from other diseases such as ADHD, intellectual disability, neurocognitive disorders and psychotic disorders.

Differential Diagnosis

• Attention-deficit/hyperactivity disorder
• Intellectual disability (intellectual developmental disorder)
• Learning difficulties due to neurological or sensory disorders.
• Normal variations in academic attainment

• Neurocognitive disorders.

• Psychotic disorders