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 () and the International Classification of Diseases, Code Book 10 ().
• 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 that impact word reading and fluency. Poor comprehension is associated with language difficulties and executive dysfunction. Children with math disability show procedural, retrieval, and number sense deficits.
• The role of the pediatrician is to screen for LDs, advocate for a child with LD to obtain early intervention, interpret predisposing factors in child’s developmental and medical history, and offer scientific interpretation of the range of theories and interventions.

EPIDEMIOLOGY

The lifetime prevalence of LD in U.S. children is 9.7%.

RISK-FACTORS

• LD are familial and moderately heritable.
• Risk loci and genes have been identified for reading and language disorders.
• Hypothesized pathophysiology includes neuronal migration, cell adhesion, axonal guidance, neurometabolites, gray and white matter, activation, adaptation, and connectivity.
• 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, toxins, anesthesia and TBI.

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

ASSOCIATED-CONDITIONS

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