Magazine article Clinical Psychiatry News

Social and Emotional Costs of Learning Disabilities

Magazine article Clinical Psychiatry News

Social and Emotional Costs of Learning Disabilities

Article excerpt

The notion that learning disabilities are an academic problem exclusively is not only erroneous, it's dangerous. The struggles of children with impairments in reading, writing, math, memory, and organization extend far beyond the classroom and often contribute to a heavy psychological burden.

Multiple studies demonstrate that adolescents with learning disabilities frequently exhibit co-occurring emotional and behavioral problems, including depression, anxiety, conduct disorders, and delinquency In the landmark 2001 National Longitudinal Study of Adolescent Health, a cross-sectional analysis of the in-home interview data of more than 20,000 adolescents included in the study showed that rates of emotional distress, suicide attempts, and involvement in violence were significantly increased in the 1,301 adolescents who were identified as having a learning disability, compared with their non-learning impaired peers (J. Adolesc. Health 2001;27:340-8). Similar results have been reported in a variety of community and clinical samples.

As many as 20% of people in the United States have a learning disability (including about 3 million children aged 6-21 years who receive special education services in school), and about 30% of learning-disabled children have behavioral and emotional problems, according to data presented in the Department of Education's 2005 report to Congress on the Individuals With Disabilities Education Act (www.ed.gov/about/reports/annual/osep/2005/index.html). The lesson? The societal impact of this problem is huge.

In the 2003 National Survey of Children's Health, learning disabilities were the most commonly diagnosed emotional, developmental, or behavioral problem of children aged 0-17 years. Compared with their peers without developmental problems, these children had lower self-esteem, had more depression and anxiety, and missed more school and were less involved in sports and other community activities (Pediatrics 2006;117:e1202-12).

In addition, children with learning disabilities drop out of high school at a disproportionately higher rate than their peers, and high school dropouts are 3.5 times more likely to have trouble with the law than are those who graduate, according to the National Center for Educational Statistics.

Literature on the causal direction of the co-occurrence of behavioral/emotional and learning problems is inconsistent. For example, it is unclear whether learning impairments beget mental health troubles or vice versa, whether the causation is reciprocal, or whether a shared etiologic factor underlies the overlap. It is clear, however, that "a cascade of negative psychosocial effects" occur with learning disabilities," said David Osher, Ph.D., project director for the American Institutes for Research in Washington.

Adult expectations of adolescents make them particularly vulnerable to negative sequelae, contends John McNamara, Ph.D., associate professor in the department of child and youth studies at Brock University in St. Catharines, Ont. A younger child with a learning disability who exhibits a behavioral need probably would be identified in elementary school, but a teenager at risk for emotional or behavioral problems "is operating within a setting where expectations shift to the adolescents advocating for themselves--so a kid in trouble can fall off the radar," he said.

In a large-scale study published in 2005, Dr. McNamara and his colleagues explored the relationship in adolescents between learning disabilities and risk-taking behavior. They determined that adolescents with learning disabilities (and adolescents with learning disabilities and comorbid attention-deficit hyperactivity disorder) were significantly more likely to smoke, use alcohol and marijuana, engage in acts of direct aggression, and engage in acts of minor delinquency (Learn. Disabil. Res. and Pract. 2005; 20:234-44).

In a recent follow-up to that study, which is slated for publication this summer, Dr. …

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