Approximately 2.6 million children in the US, aged between 6 and 11 years, are affected by some kind of learning disorder (LD). This constitutes from 5% to 10% of the students in public schools all over the country (American Academy of Pediatrics, 2009). Learning disorders refer to difficulties in learning, faced by individuals of average or above average intelligence. Such people may face difficulty in any of the seven areas related to language, reading, writing and mathematics. The learning disability may occur in one or several areas and may be associated with emotional/behavioral disorders and deficiency of social skills. Individuals with learning disorder process information differently and have trouble collecting, remembering and processing new information and acting in response to verbal and nonverbal cues. Also known as “hidden handicap”, LDs are not easily recognized or diagnosed. However, early diagnosis, evaluation and intervention help in overcoming the disability (Turkington & Harris, 2006). This paper describes learning disorder, including its classification, symptoms, causes, diagnosis and treatment. It also examines the long-term effect of learning disabilities on the psychology of the affected individual.
Terms and Definition
The term “learning disability” is used in an educational or political context, whereas the term “learning disorder” is used in a medical context, after the condition has been diagnosed. However, there is appreciable overlap between these two terms and they can be used interchangeably (Kronenberger & Dunn, 2003).
LDs have been defined in various ways over the years by many different authorities, although no single definition has been universally accepted. LDs are difficult to define as the variables they represent are unobservable and latent. Secondly, the defining traits of LDs exist as a continuum, rather than as discrete categories. Thus, LDs are often defined on the basis of certain exclusionary criteria which refer to the conditions in which low achievement is expected, like visual, hearing or motor impairment, mental retardation or economic disadvantage. According to Individuals with Disabilities Education Act (IDEA) 2004, learning disability is defined as “a disorder in written or spoken language that results in an imperfect ability to listen, think, read, write, spell or do math” (Public Law, p. 101-476). This definition refers only to those children whose problems do not stem from the above mentioned exclusionary criteria. IDEA mandates free education and special services for children with LDs (Kronenberger & Dunn, 2003).
Types of Learning Disabilities and their Symptoms
According to the Diagnostic and Statistical Manual for Mental Disorders (DSM), learning disabilities can be classified into three broad types:
1. Developmental speech and language disorders
2. Academic skills disorders
3. Others, including all learning handicaps and coordination disorders not covered in the earlier two categories.
Developmental speech and language disorders include articulation disorder, expressive language disorder and receptive language disorder. Children with articulation disorder are slow to learn speech sounds and the whole manner of speaking much later than their peers. Articulation disorder is easily treated with speech therapy. Children with expressive language disorder have trouble expressing themselves while speaking, e.g. calling objects by the wrong name or not being able to answer simple questions. Receptive language disorder refers to the condition in which children cannot understand and respond to speech. They have normal hearing skills, but they cannot process and understand certain words or sentences. Such children may have trouble following simple directions (Turkington & Harris, 2006).
Academic skills disorders include reading disorder, writing disorder and mathematics disorder. Children with these disorders generally lag far behind their classmates in class. Reading disorder is also known as dyslexia and is the most common learning disability. The process of reading involves recognizing letters and sounds, understanding words, building images and comparing ideas. A problem with any one of these can lead to a problem with reading in general. Dyslexic children often cannot distinguish between sounds in spoken language. Therefore, they have trouble with rhyming words. They may also be unable to form mental images and connect new ideas to known concepts. Hence, they have trouble understanding words, sentences and comprehending new information (Turkington & Harris, 2006).
Developmental writing disorder, also called dysgraphia, may occur because of the problems with vocabulary, grammar, memory or hand movements, all of which should be well- coordinated. Children with writing disability are unable either to craft grammatically correct and complete sentences or write inside a defined space (Turkington & Harris, 2006).
Mathematical disorder, or dyscalculia, involves failure to recognize numbers and symbols, align numbers, memorize facts and understand mathematical concepts (Turkington & Harris, 2006).
Other disabilities include motor skill disorders and specific developmental disorders which do not fall in any other category. Affected children show a delay in acquiring motor and coordination skills which may interfere with the development of writing, leading to poor spelling and memory. Attention disorder affects about 20% of all children with LDs and is characterized by excessive daydreaming and the inability to focus attention on something. It may also involve hyperactivity, especially in boys. These children have excessive energy, can’t sit still and are constantly in motion. Attention disorder can seriously impair performance in school (Turkington & Harris, 2006).
The exact cause of learning disability is not yet clear, though it is known to be a result of subtle disturbances in the structure and function of brain. Brain dysfunction may be caused by a number of factors during fetal development, birth and during infancy. In a fetus, brain develops from a few unspecialized cells into an organ of amazing complexity, with millions of neurons, all of which are interconnected with each other in a specific pattern. Nerve cells form networks which allow information to be shared between various regions of the brain. Such a complex structure is vulnerable during the development and a minor disruption in cell location, organization or connection can lead to a learning disorder. Major disruptions can cause severe mental retardation or fetal death (Turkington & Harris, 2006).
Learning disorders have been observed to run in families that points to a genetic link. However, the specific disability of the child may be different from that of the parent, e.g. the parent may have a reading disability while the child may experience an expressive language disorder. This indicates that the disability is not directly inherited. Rather, the brain dysfunction is passed on, which may lead to a learning disorder. Some researchers give an alternative explanation for why LDs run in families. Learning difficulty may be due to the family environment. For instance, parents with expressive language disorders may not talk much to their children or use distorted language. In such a case, children will not have good language skills and may come across as learning disabled (Turkington & Harris, 2006).
Use of alcohol, tobacco or other drugs during pregnancy has a damaging effect on the fetus, as many of these drugs pass directly from mother to the child via blood. If the mother smokes during pregnancy, her child tends to be underweight at birth, which makes the child vulnerable to a host of problems, including LDs. Use of alcohol during pregnancy can lead to Fetal Alcohol Syndrome, characterized by low birth weight, hyperactivity, mental impairment and many other physical defects. Drugs like cocaine disrupt the normal development of receptors of the brain, which transmit incoming signals from sensory organs. Faulty receptors may be one of the reasons for learning disorders as such children have trouble interpreting sounds, letters and speech (Turkington & Harris, 2006).
Even after birth, new brain cells continue to be formed for about a year. They are vulnerable to disruption due to head injury, ingestion of poisonous substances, nutritional deprivation or child abuse. Any of these may lead to the development of a learning disorder in a child (Turkington & Harris, 2006).
Certain environmental toxins, like cadmium and lead, can also cause disruptions in brain development, and lead to learning disorders. LDs are also prevalent in children with cancer who have undergone chemotherapy or radiotherapy at an early age, particularly in the cases of brain tumor when the skull was irradiated (Turkington & Harris, 2006).
The earlier a learning disorder is detected and treated, the better its prognosis would be. However, it is difficult to detect LDs in children before they start going to school. Besides, all learning problems in young children cannot be termed learning disabilities as some children are simply slow learners (Cavendish, 2008).
LD covers a broad range of symptoms and is suspected when there is a significant gap between an individual’s IQ and the standard skills acquired at a particular age. In primary school, a two year delay in skill development is generally considered as significant. However, a formal diagnosis of learning disorder is made only after ruling out any medical problem and using standardized tests to compare a particular child’s ability with what is normal development for that particular age and IQ. Commonly used ones are Wechsler Intelligence Scale, Woodcock- Johnson Psycho-educational Battery and Peabody Individual Achievement Test (Cavendish, 2008).
For speech and language disorders, a child’s vocabulary, pronunciation and grammar are tested by a speech therapist. They are compared to those seen in normal children at that particular age. Any ear infections, auditory problems and problems with throat and vocal cords are ruled out. The child’s intelligence is checked by a psychologist (Turkington & Harris, 2006).
For academic skills disorder, skill in reading, writing and math is evaluated by standardized tests. Vision and hearing are also evaluated to ensure that the child can see and hear clearly. Attention disorder is diagnosed by observing continuous presence of specific behavior, like constant fidgeting, inability to sit still, take turns, excessive talking, interrupting etc. In addition to a child’s actual abilities, the outcome of these tests also depends on the reliability of the test and the child’s ability to focus attention and understand the questions (Turkington & Harris, 2006).
After the condition has been diagnosed, public schools in the US are obligated to provide an appropriate special education program to such children. Special education teachers work on a child’s strengths and offer alternative methods of learning. A special education program needs to be carefully planned by systematical identification of the tasks that a child can and cannot do and the senses that are intact. Using the well developed senses and bypassing the weaknesses, a child can be made to learn the necessary skills. After the child is assessed, an Individualized Educational Program (IEP) is developed (Turkington & Harris, 2006).
IEP identifies the skills that the child needs to develop and outlines learning activities, based on the child’s strengths. These learning activities aim at making use of several senses to learn a particular skill. For example, to teach spelling and identify words the child is made to see, say, spell and write a new word in sand, which engages the sense of touch as well. The rationale for this is that the more senses children use to learn a particular skill, the more inclined they are to remember it. A speech and language therapist helps a child to produce speech sounds. This may be done by talking about toys or other areas of interest with a child who watches the therapist make movements with lips and feels the vibrations in the therapist’s throat. Then the child is encouraged to produce the same sounds. Gradually, the child gets better at hearing, recognizing and pronouncing the words (Turkington & Harris, 2006).
There are no medicines to improve speech, language and academic disorders. However, for children with attention disorder, drugs like Strattera (Atomoxetine), Ritalin (methylphenidate), Dexedrine (dextro-amphetamine) and Cylert (pemoline) have proven to be beneficial for the improvement of focus and attention span. They help to curb hyperactive and impulsive behavior. The effect of a single dose lasts for about 4 hours. The dosage and medication schedule is carefully adjusted, so that the peak effect is during school hours. These drugs are also effective in adults with attention disorders and have helped many severely affected people to keep their jobs and organize their lives (Turkington & Harris, 2006).
Effect on Child Development and Psycho-social Consequences
People with LDs are often marginalized in our society as children and later as adults. Children with learning disorder have to struggle to overcome their specific area of disability, while facing the added stress of isolation and peer rejection. In school, children with special needs may face scorn or mockery and be labeled as ‘slow’ or ‘behind’. Studies reveal that children with learning disorders tend to have lower self-esteem than their peers (Turner & Rack, 2004). Good academic skills, intelligence and social acceptance are an important part of school life and children with LD often perceive themselves as less intelligent and less competent in all these fields when comparing themselves to their peers. People with bad spelling, reading problems and poor language skill are often derided or laughed at which leads to a devastating impact on their self-esteem. In school, such children are less likely to be popular in class, have low social status among peers and are often shy and retreating and are recognized as victims of bullying. They were revealed by the researchers to have high levels of anxiety, difficulty in problem solving, difficulty in concentration, social immaturity and depression (Turner & Rack, 2004).
According to Turner & Rack (2004), “This kind of chronic disappointment can translate psychologically into a generalized sense of diminished value and potential, where children’s inner sense of adequacy is seriously compromised” (p. 253).
There is an increased prevalence of psychopathology in people with LD, as high as 30%-50%. After leaving school, children with LD have trouble making transition from school to college or finding suitable employment. Lack of information about various options after school may lead to unemployment, poverty and poor housing. This places them under enormous stress and increases risk of mental disorders development (Raghupatel & Pradip, 2008).
Learning disorder is a complex problem with no clear diagnostic tests, genetic markers or biological indicators. The physician has to rely on observation of a consistent, specific pattern of behavior in a child’s daily life. More research is being done to unveil the mysteries behind the cause of LDs and in the future, we can expect to have a clearer understanding of its etiology. Thus, taking adequate measures will presumably help in prevention of risk factors in the pre-natal and post- natal stages. Even though there are many competent therapists to manage the condition, a lot of children and adolescents with LD go undiagnosed and untreated. To prevent this, primary school teachers need to be adequately prepared to identify and address differences in academic skills. Due to the new scientific findings coming to light, public awareness about the disorder and its management has increased. The awareness of parents and teachers leads to early identification and diagnosis of the condition. The earlier the disorder is diagnosed, the sooner the treatment can be initiated, which leads to a better prognosis.