Learning disorders: types, symptoms, causes and treatments.

We review which disorders affect children's ability to learn.

Learning disorders are difficulties that some children have in learning to read, write, calculate, etc. They are usually detected at the schooling stage and are becoming more and more frequent.... They are usually detected at the schooling stage, and are becoming more and more frequent. This can be explained by the fact that the start of schooling is becoming earlier and earlier.

In this article we will know the different learning disorders proposed by the DSM-IV-TR and DSM-5 (Diagnostic Manual of Mental Disorders). We will explain what each one consists of, and we will also mention which disorders are proposed by the ICD-10 (International Classification of Diseases).

Learning disorders: what are they?

Learning disabilities involve performance in academic areas that is significantly below expectations (usually about two standard deviations below other students). This underachievement interferes with the student's learning.

The prevalence of learning disabilities ranges from 2 to 8%.. In addition, 40% of students with learning difficulties end up dropping out of school, which is an alarming figure.

Thus, very often this type of disorder is related to school failure, although the relationship is neither direct nor bidirectional. These disorders are more frequent lately, because the start of school is earlier.

DSM-IV-TR and DSM-5 classification

In the DSM-IV-TR (2002) (Diagnostic Manual of Mental Disorders), learning disorders were classified as:

• Reading Disorder
• Disorder of calculation
• Disorder of written expression
• Learning Disorder Not Otherwise Specified

With the arrival of the latest edition of the Diagnostic Manual, the DSM-5 (2013), comes an important change in relation to this type of disorders. The previous categories are deleted and a single one appears, called "Specific learning disorder", which includes the previous cases in a single category.

Having made this preliminary clarification, let us explain what each of these DSM-IV-TR disorders consists of, which, let us remember, would now all be called "Specific Learning Disorder".

1. Reading disorder

The reading disorder is the classic dyslexia. It accounts for 80% of all diagnoses of learning disorders. In addition, it affects up to 5% of school children. What does it consist of?

Basically in a decline in reading achievement; that is, the student's performance falls up to two standard deviations below the expected performance for the child's age, IQ and schooling. This is evidenced through standardized learning tests, administered individually.

Thus, the consequences of the reading disorder interfere with the student's academic performance or activities of daily living.. On the other hand, in the case of a previous sensory deficit in the student, the difficulties that appear would exceed the usual ones for him/her.

It is recommended not to make the diagnosis of reading disorder before the age of 7 years.

2. Written expression disorder

The second of the learning disorders is the disorder of written expression, which is also found in the DSM-IV-TR and in the DSM-5 as "Specific Learning Disorder".

In this case the student shows writing skills below what is expected for his age, IQ and schooling (also two standard deviations below). As in all learning disorders, there is also interference in daily life or academic performance, and in case of sensory deficit the difficulties exceed those that could be justified.

Normally a pupil with a disorder of written expression also has difficulties in organizing written material, as well as grammatical errors, and in the case of a sensory deficit the difficulties exceed those that could be justified.as well as errors in grammar, punctuation and paragraph organization.

Specifications

It should be mentioned that in the ICD (International Classification of Diseases) this specific category does not exist.. On the other hand, if there is only an alteration in writing (handwriting), this diagnosis is not made, but "Developmental Coordination Disorder" (in the DSM) or "Motor Skills Disorder" (in the ICD).

3. Calculation disorder

Calculation disorder is the classic acalculia, which leads to difficulties in performing mathematical operations. Thus, the student's ability to calculate is below normal, reducing his performance and/or interfering with his daily life. According to ICD-10, in order for this diagnosis to be made, reading and writing ability must be normal.

What is most affected, logically, are mathematical skills (e.g. counting, seriation, performing multiplication tables...). However, a person with a calculation disorder also shows impairment in visuoperceptual and visuospatial skills, as well as in skills in relation to mathematical terms. These may affect:

• Linguistic area: comprehension of mathematical terms/operators.
• Perceptual area: recognition/reading of mathematical/arithmetic symbols/grouping of objects, etc.
• Attentional area: for example when performing "carried" subtraction.

Specific learning disorder (DSM-5)

The specific learning disorder of the DSM-5, which groups the previous ones under this denomination, involves certain difficulties in learning and in the use of academic skills.

These difficulties last 6 months or more, and include at least one of the following symptoms (although there may be more), depending on the type of learning disorder (dyslexia, acalculia, etc.).

1. Reading

Reading is impaired, resulting in slow, inaccurate or inadequate intonation.

2. Comprehension

Difficulties appear in the comprehension of what is read. However, decoding (reading-pronunciation) may be adequate.

3. Spelling

Spelling is altered; the student may add, omit or substitute different letters, both vowels and consonants.

4. Written expression

In the written expression, grammatical errors appear, in punctuation or in the organization of paragraphs.

5. Calculation

Difficulties may also appear in mastering number sense, numerical data or calculation itself.

6. Mathematical Reasoning

Difficulties appear in mathematical reasoning, which is of a more abstract type, that is, in solving mathematical problems.

Considerations of the specific learning disorder

As we can see, the specific learning disorder proposed by the DSM-5 includes the learning disorders of the DSM-IV-TR, and we can make one diagnosis or another depending on whether the alterations occur in one of the above fields or in another.

The DSM-5 specific learning disorder also includes cases where the student presents difficulties in spelling (which were not in the DSM-IV), difficulties in writing (which were in the DSM-IV) and/or difficulties in calculation (the DSM-5 introduces difficulties in mathematical problems.

However, However, outside of the specific learning disorder are handwriting problems, which are not diagnosed as such..

Learning disorders in the ICD

We have seen learning disorders in the DSM. In the ICD, but, which is the Spanish version, these are classified as "Trastornos específicos del desarrollo del aprendizaje escolar", and include the following specific categories:

• Specific reading disorder
• Specific spelling disorder
• Specific calculation disorder
• Mixed developmental school learning disorder
• Other developmental school learning disorders
• Unspecified developmental school learning disorder

As we can see, these disorders are very similar to the learning disorders proposed by the latest versions of the DSM, and some more are included.

Bibliographical references:

• American Psychiatric Association (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Barcelona: Masson.

• American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.

• WHO (2000). ICD-10. International classification of diseases, tenth edition. Madrid. Panamericana.

• Ramos, F., Manga, D., González H. and Pérez, M. Learning disorders. In Belloch, A., Sandín, B. and Ramos, F. (2008): Manual de psicopatología. Revised edition. Volume II. McGraw-Hill. Madrid.