An outline of learning disabilities

Learning disabilities (LD) are estimated to occur in between 5 - 8% of schoolage children^1,3,5,6 and are defined as the presence of a significant learning problem in one or more of the three learning areas of reading, writing and mathematics, with academic achievement in these areas falling below that of the average expected of the child’s particular age and intellectual capacity.^1,3 Beyond the general diagnosis of LD are the specific disorders of learning in the areas of reading (dyslexia), maths (dyscalculia), writing (dysgraphia) and motor problems (dyspraxia).⁷ Future outcomes for children diagnosed with LD largely concern academic and employment underachievement but can also include an increased likelihood of developing emotional and behavioural problems, brushes with the law, and exhibiting anti-social behaviour, although these are largely thought to be more a result of potential co-occurring disorders such as ADHD.^{4,8,9,10,11,12,13,14} However, the definiton of learning disabiities is still one of the most hotly debated issues surrounding the topic itself, stemming from the way in which diagnosis of LD is made.^1,2,3,5,15

Traditionally, and still officially, the main method of diagnosis is the IQdiscrepancy model, where a diagnosis of LD is made when the academic achievement of the child is below the average expected for a child with the same intelligence quotient score (IQ).^3,6,7 However, this method alone involves a ‘wait-to-fail’ approach, in that the problem is often identified late on, when difficulties have started to accumulate.^1,5 Given these problems, the current trend of assessment, diagnosis and treatment of LD is moving toward a Response-to-Intervention model (RTI).^{1,5,6,16,17,18,19} Through this model, children with difficulties are identified and treated early, with only the most persistent of problems, leading to a diagnosis of LD.^{1,5,16,17,18,19,20,21}

Assessment and diagnosis of LD can, therefore, involve a number of professionals, depending on the suspected problem of the child. For example, it could be that poor eye movement is the cause of a deficit in reading skills and thus, would require the necessary consultation with an eye specialist to assess the child’s occulomotor functioning.1 However, such assessments are carried out to aid the overall diagnosis, rather than diagnose per se, with diagnosis typically being performed by an educational psychologist.⁶

Theories and causes

Theories as to why LD occur can be divided into two main areas: neurological theories and psychological theories.

Neurological theories of LD have their origin in the observation that those disorders with a definite genetic or neurological causal factor also present LD, such as the genetic-based Down’s syndrome and Fragile X syndrome, or Fetal Alcohol Syndrome, where the mother’s consumption of alcohol during pregnancy causes neurological damage to the child.^{22,23,24,25,26} However, although the search for a genetic cause of LD in milder cases outside of these specific disorders has implicated some genetic and neurological mechanisms, researchers have yet to find a definite neurological cause. Much of the reason for this is attributed to the heterogeneity of the disorder, taken form the seven more specific symptom areas where reading, writing and maths deficits can occur (see box 1).

Psychological theories, on other hand, take a more direct approach toward the causes of LD by focusing on the underlying cognitive processes that are taken to give rise to the problems faced by children with LD.^28,29,30 Some of the cognitive processes involved here include phonological awareness and working memory (see box 2).^31,32,33 However, although some interesting work has broadened the understanding of the psychological causes of LD, again, the heterogeneity of LD means that the relationship between specific underlying cognitive deficits and the variety of problems experienced is not yet fully understood.^1,3

Although the search for underlying and neurological causes has not et provided a full understanding as to how and why LD develop, an encouraging recent trend has developed toward a RTI approach, not only for diagnosis, but also for treatment.^{5,6,16,17,18,19,20,21}

Treatment, support and management, and the Response-to Intervention (RTI) framework

Treatment, support and management for LD typically centre on a RTI approach. Developed under a framework aimed at ensuring the effectiveness of both the general and special educational settings in providing children with the necessary opportunities to learn, the RTI model focuses on early identification and treatment for children experiencing learning problems.^5,16,17,19

The first stage of the RTI model involves identification. This may take the form of the more traditional approach to the field, namely where academic achievement falls significantly below the average for a child’s age and IQ. However, the emphasis here is on a much earlier assessment and identification of difficulties across the whole classroom.^5,6,19

The second stage of the RTI model then makes provisions for those children experiencing some learning problems. These provisions commonly take the form of small tutorial groups that use specific techniques for further assessment.^5,6,19

The third stage of the RTI model can then operate in one of two ways; children who respond to the provisions made and whose difficulties improveare then deemed “disability free” and returned to the general educational setting, whilst those with more persistent problems are referred for further assessment and considered for special education.^5,6,19

Support for LD may come in a variety of formats, given the multiple ways in which a LD can manifest.^6,34 For example, some children may benefit from small teaching groups that utilise rigid and highly structured lesson plans with a focus on their specific needs. In addition, the provision of classroom aids may be required, such as computer software designed to provide reading, writing and maths learning assistance. Beyond the education setting however, there are also a number of support groups and resources available to children with LD and their families.^{35,36,37,38,39,40}

Advantages of the RTI model are the avoidance of a ‘wait-to-fail’ situation, where diagnosis and treatment only occur when a problem becomes explicit,usually around 8 or 9 years old, and treatment at this stage and beyond is less effective.^1,6 The pre-school intervention however, indicates the effectiveness and dedication of the RTI model toward early identification and treatment.

Another encouraging approach toward the topic of LD is that of risk and resiliency (RR),^{42,43,44,45,46,47,48} whereby research attempts to identify those risk factors that may lead to a child with LD developing more significant problems as they get older, such as substance abuse, and the resiliency factors that may steer children away from such outcomes.^{42,43,44,45,46,47,48}

Conclusions

Although the very definition, diagnosis and existence of LD are still widely ebated topic areas^1,2,3, there is no doubt that there are a significant proportion of children who experience a very real problem in one of more of the areas of reading, writing and maths. Moreover, in the absence of early identification and treatment of LD, the outcome for children with a LD diagnosis can be disappointing, with an increased likelihood toward poor academic achievement, employment status and emotional or behavioural problems.⁴ Causal theories of LD have also failed to provide a clear and definite underlying cause however,1 although some neurological and psychological theories have been put forward.

However, the current stance in this field is far from a negative one, with a focus on the early identification and intervention, a thriving approach.^5,6 As a result, there is a wide variety of support available for children at risk, or diagnosed with, a LD and their families. Similarly, research, governmental policies, professional protocols, and RTI treatment approaches, all converge to provide a focus on overcoming the difficulties that a LD diagnosis may bring, and seek to improve the services and long-term outcomes for children that develop LD

Although there are still some issues that require some attention, such as the nature of diagnosis, the current status of the LD field is an encouraging one, with a continued positive approach to early identification, treatment, and further understanding of these areas, and LD in general, forthcoming.

References

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