Prepared by: Anastasya Shepherd, Ph.D., Supervising Clinical Neuropsychologist, PSY 17626
In order to navigate Learning Disability evaluations, it is important to understand the basic difference between Learning Disability, Learning Disorder, actual medical disorder underlying one’s learning problems, and cognitive process underlying this disorder. These are three different things, causing no end of confusion to everyone.
I. Learning Disabilities: what are they (apart from source code 34, impairment 17)?
Learning Disability is an administrative concept, which is used to determine if the client qualifies for particular services. Because it is an administrative concept, there is no absolute definition of learning disabilities; they are defined by various aid agencies.
Since Learning Disabilities are usually diagnosed at school and we inherit our clients from California schools, their definitions are most relevant to us (school districts in different states have different definitions).
In California schools, one qualifies for special services under three categories:
1. Specific Learning Disability;
2. Other Health Impairment;
3. Emotional Disturbance;
4. Section 504.
Please, note that 2), 3) and 4)are also learning disabilities, albeit not “specific” ones.
[Enc.: Definitions of qualifying disabilities]
II. Learning Disorders.
Learning Disorder is a diagnostic category in DSM-IV designed specifically for psychologists and psychiatrists to be able to bill for school assessments. It has nothing to do with actual medical or cognitive problems underlying learning difficulties. As such, it is a formal criterion for providing a diagnosis to the payment agencies, such as insurance companies, and the service agencies, such as school district.
There are three Learning Disorder diagnoses in DSM-IV:
1. Reading Disorder;
2. Mathematics Disorder;
3. Disorder of Written Expression.
The diagnosis of a learning disorder is given if:
1. Reading/Writing/Mathematics achievement, as measured by individually administered standardized tests, is substantially below expectations given their age,intelligence, and age-appropriate education (i.e. achievement test results {WRAT, Woodcock-Johnson, WIAT} are two standard deviations or more below intelligence test results {WAIS, Raven, Cognitive Assessment System} given that they actually attended school at expected levels), dyslexia is a medical term for disturbance in reading and/or writing, dyscalculia is a medical term for disturbance in mathematics ability;
2. The disturbance significantly interferes with academic achievement (grades) or activities of daily living requiring reading/writing/mathematics;
3. If a sensory deficit (in vision or hearing) is present, the disturbance is in excess of that usually associated with it.
III. Disorders actually causing learning problems.
DSM-IV lists a number of disorders, which commonly cause learning problems.
Cognitive Disorders:
1. Mental Retardation (IQ below 70);
2. Expressive Language Disorder (scores on expressive language tests are substantially below non-verbal IQ and receptive language scores), expressive aphasia is a medical term;
3. Receptive Language Disorder (scores on receptive language tests are substantially below non-verbal IQ and expressive language scores), receptive aphasia is a medical term;
4. Mixed Receptive-Expressive Language Disorder (scores on language tests are substantially below non-verbal IQ), aphasia is a medical term;
5. Phonological Disorder (failure to use developmentally appropriate phonemes or speech sounds);
6. Autistic Disorder (impaired social interactions and communication, stereotyped behaviors and/or interests, onset before 3 y.o.);
7. Asperger’s Disorder (impaired social interactions and communication, stereotyped behaviors and/or interests, NO cognitive or language problems);
8. Pervasive Developmental Disorder (impaired social interactions and communication, but criteria for a specific disorder are not met);
9. Attention Deficit/Hyperactivity Disorder – Inattentive, Hyperactive/Impulsive, and Combined types – (inattention and/or hyperactivity in at least two settings, onset before 7 y.o.);
10. Cognitive Disorder NOS (covers everything else, including congenital disorders and results of brain injuries due to trauma or medical condition).
Behavioral Disorders:
1. Conduct Disorder (pattern of behavior where major social norms or rules or rights of others are violated);
2. Oppositional-Defiant Disorder (pattern of negativistic, hostile, or defiant behavior).
Emotional Disorders:
1. Anxiety Disorders (e.g. PTSD);
2. Mood Disorders (e.g. Depression);
3. Psychotic Disorders (e.g. Schizophrenia);
4. Adjustment Disorders (e.g. bereavement).
IV. Processes underlying disorders underlying learning problems.
Cognitive processes that cause difficulties in learning could be impaired because of:
1. A congenital problem (something a person was born with, underlie most of DSM-IV cognitive disorders, such as Down’s Syndrome causing Mental Retardation);
2. A traumatic brain injury (this includes prolonged injury due to toxic exposure or substance abuse, effect depends on the location and severity of the injury);
3. Psychiatric problems (they usually interfere with attention and concentration, though specific disorders are associated with various forms of neurotransmitter imbalance and thus cause specific patterns of deficits);
4. Medical problems (may interfere with attention and concentration or directly with brain functioning, such as Multiple Sclerosis or Wilson’s Disease).
These cognitive processes include:
1. Attention/Concentration (ability to stay on task for expected amount of time, in spite of usual distractions) – disturbance causes ADHD;
2. Visual Processing (ability to parse and manipulate visual information) – disturbances contribute to dyslexia and dyscalculia;
3. Auditory Processing (ability to parse and manipulate auditory information) – disturbances contribute to language disorders;
4. Sensory-Motor skills (ability to perceive information accurately and control one’s movement at the expected level) – disturbances may contribute to a variety of difficulties, e.g. writing problems;
5. Executive functioning (ability to organize information, plan, solve problems, categorize and abstract) – disturbances interfere with learning in all areas at a relatively complex level.
V. Technical issues – how to read scores in reports.
Grade scores are often given for achievement tests and indicate how well one is doing compared to the level of skills expected for a certain grade (e.g. 4 th Grade Level means that one has skills expected of a fourth-grader, but below those of a fifth-grader).
All other scores indicate how one is doing compared to others of similar age and background. These scores are placed on a “normal curve” – a curve depicting normal population, where most people are in the middle (they do OK) and a few people are at the extremes (they do very well or very badly). The percentages in the picture indicate how many people fall in this area. The scores are all equivalent and indicate how your client compares to others on this curve. Percentiles are easiest to conceptualize. If your Client’s score falls at the 16th percentile, it means he did better than 16% of that population, but worse than 84%.
