The Specific Learning Disorder Diagnosis

By Lockwood, Adam | National Association of School Psychologists. Communique, December 2015 | Go to article overview

The Specific Learning Disorder Diagnosis


Lockwood, Adam, National Association of School Psychologists. Communique


Specific learning disorders are characterized by difficulty learning key academic skills. These skill acquisition difficulties are the result of an interaction between environmental, genetic, and epigenetic factors that negatively impact the brain's ability to process or perceive information (American Psychiatric Association [APA], 2013]. In the field of school psychology, we are acutely familiar with the IDEA classification of specific learning disability due to the large number of students with this classification represented in the special education population and the negative outcomes associated with this label, including reduced academic performance and increased rates of retention, discipline referrals, and school dropout (Cortiella & Horowitz, 2014).

While there are some differences between the construct of specific learning disability and disorder, there are many similarities. Also, due to the number of clinical evaluations school psychologists review in practice, it is necessary to be familiar with the construct of specific learning disorder in order to incorporate outside diagnostic information into intervention planning and special education determination evaluations. While most experienced school psychologists are familiar with the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR; APA, 2000) diagnosis of learning disorder, several important changes have been made with the DSM-5 (APA, 2013) and will be discussed in this article.

CHANGES FROM DSM-IV-TR

There are three substantial changes that occurred with the revision of the DSM-5. First, the DSM-5 eliminates the use of the substantial discrepancy requirement. According to the DSMIV-TR, the primary diagnostic feature of a learning disorder is learning problems that significantly interfere with activities that require reading, writing, or mathematical skills. Additionally, these academic skills must be substantially below what is expected for age, level of education, and cognitive functioning. The DSM-IV-TR further defined substantially below as being indicated by a discrepancy of two or more standard deviations between academic achievement and intellectual functioning. While the DSM-5 still defines a learning disorder as academic difficulties that are well below average for age, and not better accounted for as an intellectual disability, it does not require the use of intelligence testing, but instead focuses on determining difficulties in academic areas.

Another key diagnostic feature that represents a change between the two editions is the acknowledgement that learning disorders are specific instances of a single, overarching diagnosis (see Table 1). While the DSM-IV-TR included four separate disorders, the current DSM-5 utilizes a single diagnosis of specific learning disorder with specifiers that indicate the academic domain and specific skills that are impacted (See Table 2). Additionally, as learning disorders are now defined as "specific" there is no longer a criteria of "Not Otherwise Specified," because this diagnosis was essentially a catch all for individuals who did not meet the diagnostic criteria for the other three learning disorders (Fauman, 2002), including having general learning problems in all three academic areas (i.e., reading, written expression, and mathematics).

The last major change to the construct of learning disorder is the addition of severity specifiers, which provide information on the amount of support needed for a student to be successful in the classroom (see Table 3). This change represents the reality that learning disorders present across a spectrum and impact students to varying degrees, therefore requiring different levels of intervention. This addition of severity specifiers also brings specific learning disorder in line with other neurodevelopmental disorders, such as intellectual disability and autism spectrum disorder, in which level of support is included in a given diagnosis (Scanlon, 2013). …

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