Learning difficulties (LDs) are often linked to other conditions, and it's essential to consider these conditions while assessing impairment and planning interventions. The identification of these associated difficulties varies based on the child's age and the severity and extent of their learning problems. Although an LD may be detected when a child starts school, it could have been preceded by a language delay that increases the risk of future LDs. LDs are also linked in complex ways with other issues, including attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorders such as conduct disorder. Children with severe difficulties may experience repeated school failure, which can lead to anxiety and depression in middle childhood and adolescence. They may also be at higher risk of bullying, being bullied, or both. While learning difficulties often persist into adulthood, many individuals develop compensatory strategies and thrive as adults. see detail on https://adamt04.blogspot.com/2024/02/specific-learning-disorder-dsm-v-tr.html

1. Specific
learning
disorder

2. content
• Diagnostic criteria
• Specifiers
• Onset
• Causes
• Assessment
• Differential diagnosis
• Comorbidity
• Treatment

3. Diagnostic Criteria
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).

4. Cont.…
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.

5. Cont…
C. The learning difficulties begin during school-age years but may not become fully manifest
until the demands for those affected academic skills 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, psychological adversity, lack of
proficiency in the language of academic instruction, or inadequate educational instruction.
• Note: the four diagnostic criteria are to be met based on a clinical mixture of the individual’s
history (developmental, medical, family, educational), school reports, and psychoeducational
assessment

6. SPECIFIERS
Coding
• F81.0 With Impairment in reading:
• Word reading accuracy, Reading rate or fluency, Reading Comprehensive
• F81.81 With Impairment in written expression
• Spelling accuracy, Grammar, and punctuation accuracy, Clarity or organization of written
expression
• F81.2 With Impairment in Mathematics:
• Number sense, Memorization of arithmetic facts, Accurate or fluent calculation
• Accurate math reasoning

7. Specifiers
Severity:
Mild
experience some difficulties in learning skills in one or two academic domains.
Moderate
experience significant challenges in learning skills in one or more academic areas
Severe
face significant challenges in learning skills across multiple academic domains

8. onset
• Specific learning disorder is usually diagnosed in elementary school years

9. causes
• Environmental factors
low socioeconomic, Exposure to air pollution, nicotine, flame retardants, lead during
pregnancy or early life
• Genetic and physiological
Parents, Preterm delivery, or very low birth weight
• Course modifier
Preschool children with inattentive, internalizing, and externalizing behaviors are likely to
face difficulties in reading and math in the future. Language impairment during preschool years
may lead to impairment in reading and written expression later in life

10. Causes…
• Culture-Related Diagnostic Issues
symptoms may differ based on the type of written and spoken symbol systems and cultural and
educational practices
•Sex- and Gender-Related Diagnostic Issues
specific learning disorder is more prevalent in males than in females, with ratios ranging from
approximately 2:1 to 3:1

11. Assessment
 Academic testing
 Performance review
 Medical history
 Physical and neurological exam
 Standardized Instruments for Assessment
Weschler Intelligence Scale for Children. Woodcock-Johnson IV, Wechsler
Individual Achievement Test II, and the Wide Range Achievement Test III. Specialized
tests, such as the Comprehensive Test of Phonological Processing and the Test of Word
Reading Efficiency

12. Differential Diagnosis
• Variations in academic attainment that fall within the normal range
• Intellectual disability
• Learning difficulties due to neurological or sensory disorders
• Neurocognitive disorder
• Attention deficit hyperactive disorder
• Psychotic Disorder
• Lanuage disorder

13. Comorbidities
• attention deficit hyperactivity disorder (ADHD)
• disruptive behavior disorders
• conduct disorder
• medical conditions

14. Treatment
• Special education
• Medication
• Therapy
• Other interventions
• Support groups