Anticipatory Guidance

Learning Disabilities


  • Definition of Learning Disabilities (LD) the first is the most common working definition used.
  • The Individuals with Disabilities Education Act (IDEA) defines “specific learning disability” as “a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations”.
    • This definition includes conditions such as:
      • Perceptual disabilities
      • Brain injury
      • Minimal brain dysfunction
      • Dyslexia
      • Developmental aphasia.
    • This definiation term does not include a learning problem that is primarily the result of visual, hearing, or motor disabilities, of intellectual disability, of emotional disturbance, or of environmental, cultural, or economic disadvantage.”
  • DSM-V has 4 diagnostic criteria that must be met for diagnosis of LD
    • A persistent difficulty learning academic skills for at least 6 months despite intervention targeting the area(s) of difficulty.
      • Many schools use a Response to Intervention (RTI) model of academic skill assessment and progress monitoring to determine the effectiveness of interventions.
    • Affected academic skills are significantly below expectations given the individual’s age and result in impaired functioning in school, work or activities of daily living
    • Individuals cannot be diagnosed till onset of symptoms during school years, even if symptoms are present in the early years
    • Academic and learning difficulties occur in the absence of:
      • Intellectual disabilities
      • Visual/hearing impairment
      • Mental disorders
      • Neurological disorders
      • Psycho-social difficulty
      • Language differences
      • Lack of access to adequate instruction

Epidemiology of LD

  • The lifetime prevalence of LD in US children in 2003 was 9.7% or ~6 million children.
  • LD were more prevalent amongst children who were African American, or from homes with either a lower socioeconomic status, or a non-traditional family structure.

Specific Learning Disabilities

Traditionally subdivided into 3 areas of impact: reading, writing, and math.

  • Dyslexia: difficulty with phonemic awareness, phonological processing, and word decoding.
  • Dyscalculia: difficulty with counting, number facts, and mental math/problem-solving strategies
  • Dysgraphia: difficulty with the physical act of writing (ex. writing/drawing within lines, trouble forming letter shapes and consistent spacing) or quality of written expression (tiring quickly while writing, trouble organizing thoughts on paper, or keeping tack of thoughts already written).

Federal Law that provides the bare minimum of expectations and rights for those with a LD

  • IDEA is the most comprehensive law that mandates, funds, and provides rights to children with LD and their guardian to ensure an adequate education and support. The 4 major points are listed below
  • Individual with Disabilities Education Act:
  1. Provides the funds for special education and related services to youth 3-21 years old.
  2. Guarantees child free appropriate public education tailored to individual need and delivered in the least restrictive (most typical/standard) classroom environment appropriate to the individual’s needs.
  3. Timely evaluation (response by 60 days of parent/guardian request) and access to all meetings, paperwork, and transition planning documents.
  4. Provides ways for addressing disputes between schools and parents.

Diagnosing LD

While schools are required to respond to a parent request regarding an evaluation for LD in 60 days, 64% of parents in 2012 said that “their child’s school doesn’t provide information on learning disabilities.”

  • There are specific standardized assessments that evaluate and access the various components of student’s ability in different areas.
  • These tests are typically provided by psychologist, speech-language pathologist, social worker, or other school staff with the credentials to administer standardized tests designed for evaluation of LD.
  • Encourage parents to speak to the principal of their child’s school for more specific information.
  • You can also have an independent person or assessment group do the evaluation.
  • If interested, parents should also inquire as to whether their insurance might cover an independent evaluation.
    • One example of an independent assessment group is the University of Illinois at Chicago (UIC) assessment clinic
    • Parents can search online to find other sites and call to compare availability and pricing.

Physician’s role

  • While most LD are not diagnosed medically, physicians are able to assist in the process by testing and ruling out other causes for a patient’s academic difficulties.
  • These tests can range from hearing and vision to ADHD to serum lead levels.
  • Physicians can also be advocates in encouraging and supporting parents in their pursuit of an educational evaluation.
  • Education has been studied and shows a positive correlation to improved health outcomes and positive lifestyle behaviors.
  • Physicians can help ensure the child’s development of a positive and healthy self-identity, as well as, assist parents in understanding how to access resources to best support their child.
  • Resource that parents can go to get more information regarding learning disabilities, testing and their rights/services available are:


  1. Altarac M, Saroha E. Lifetime prevalence of Learning Disability among US children. Pediatrics. 2007. (119) pS77-S83
  2. Cortiella, Candace and Horowitz, Sheldon H. The State of Learning Disabilities: Facts, Trends and Emerging Issues. New York: National Center for Learning Disabilities, 2014.
  3. Pierce JP, Fiore MC, Novotny TE, Hatziandreu EJ, Davis RM. Trends in Cigarette Smoking in the United States: Educational Differences Are Increasing. JAMA. 1989;261(1):56-60. doi:10.1001/jama.1989.03420010066034.


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