Description

Learning disabilities (LD) are a group of disorders characterized by unexpected and sustained difficulties acquiring and applying academic skills, including reading accuracy, reading fluency, reading comprehension, written expression, mathematic calculations, and mathematic problem-solving.

• LD comprise one category within the classification of Neurodevelopmental Disorders (NDDs) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V, 2013) and the International Classification of Diseases, Code Book 10 (ICD-10, 2013).
• Academic achievement must be substantially below the level expected for age and not attributable to intellectual disability (ID), neurologic or motor disorders, lack of schooling, psychosocial factors, economic disadvantage, or major sensory problems.
• LD have neurobiologic and genetic roots.
• Reading disability is the most frequently diagnosed type of LD and is typically characterized by impairments in phonologic processing and/or orthographic coding skills. Children with math disability show procedural, retrieval, and number sense deficits.
• The role of the pediatrician is to advocate for a child with LD, interpret predisposing factors in child’s developmental and medical history, and offer scientific interpretation of the range of theories and interventions.
• Early intervention improves outcomes.

Epidemiology

• In 2009–2010, 2.4 million or 5% of total public school enrollees (ages 3–21 years) identified with LD as eligible for special education based on U.S. Department of Education National Center for Education Statistics, 2012.
• The National Institutes of Health (NIH) estimates that as many as 15–20% of Americans are affected by LD.

Risk Factors

• LD are familial and moderately heritable.
• Risk loci and genes have been identified for reading and language disorders.
• Aberrant neuronal migration hypothesized as principal pathophysiology
• Genetic contribution increases with a high level of parent education (a bioecologic gene by environment interaction).
• Environmental factors include prematurity, low birth weight, prenatal nicotine or alcohol exposure, infections, and traumatic brain injury.

Commonly Associated Conditions

• Language disorders
• Speech sound disorders
• Auditory processing disorders
• Developmental coordination disorder
• ADHD/executive function deficits

General Prevention

• High-quality developmentally appropriate preschool experiences
• Early literacy initiatives (e.g., Reach Out and Read)
• Early intervention for speech, language, motor difficulties
• Evidence-based reading curricula and ongoing academic progress monitoring beginning in kindergarten
• Supplemental instruction for children who show early signs of learning problems