Children with “Specific Learning Disorder with Impairment in Reading” have an unusually difficult time learning how to read. They often struggle with reading new words, picking out words they have already learned, reading words and sentences at an appropriate pace, and/or comprehending the materials they read. People often use the alternative term “Dyslexia” when referring to children with reading impairments. Dyslexia is used to refer to a specific pattern of reading and writing difficulties, including difficulties with recognizing words, decoding or sounding out new words, and spelling words when writing. Children with Dyslexia may or may not also have other reading and writing difficulties, including with reading words and sentences at an appropriate pace, comprehending the materials they read, as well as recognizing punctuation, capitalization, and sentence structures when reading and writing.

Other children may struggle only with written expression impairment, such as with spelling, grammar, punctuation, sentence structure, and overall written expression. These struggles are reflective of “Specific Learning Disorder with Impairment in Written Expression.” People sometimes use the alternative term “Dysgraphia” to refer to children with written expression impairment. Unlike children with Dyslexia, children with Dysgraphia do not experience both reading and written expression impairments. However, some may also experience fine motor challenges, such as difficulties with holding a pencil or forming written letters and writing may be very tiring for them.

Children who have an unusually hard time learning and managing mathematics. They struggle to understand, learn, and utilize numbers for number-based operations and various other mathematical applications. These children may have a mathematics impairment, “Specific Learning Disorder with Impairment in Mathematics,” sometimes referred to as “Dyscalculia.”

Having Specific Learning Disorder does not mean that a child has an intellectual problem. On the contrary, some children with Specific Learning Disorder might show higher than average intelligence. Some children with learning impairments keep up in school by working much harder than their classmates, but most require specialized instruction to become proficient with reading, written expression, and/or mathematics.

What are the symptoms of Specific Learning Disorder?

Core Symptoms of Specific Learning Disorder

Associated Symptoms of Specific Learning Disorder

Symptoms of a reading impairment or Dyslexia: Reading single words incorrectly Reading single words slowly or with hesitation Guessing words frequently in lieu of reading Slowly or effortfully sounding out single words or words in sentences Difficulty understanding what is read or extracting meaning from text during or after reading Difficulty learning, recalling, and using spelling rules when writing Symptoms of a written expression impairment or Dysgraphia: Difficulties with writing mechanics, like spelling, grammar, punctuation, and sentence structure Trouble with written organization (i.e., have great ideas, but having a hard time getting them down onto paper) Symptoms of a mathematics impairment or Dyscalculia: Having a poor understanding of numbers in terms of meaning and/or magnitude Counting on fingers in lieu of remembering basic addition and subtraction facts as expected Struggling with calculations or “getting lost” in calculation steps Switching calculations during mathematical problems

These may emerge early in childhood, even before a student is taught to read or write: Early speech delays Troubles with learning simple rhymes Troubles with learning left versus right Troubles with following directions Troubles with learning or remembering the rules to games Troubles with learning letters or letter sounds Avoiding or refusing book activities Later difficulties with reading and written expression may include: Understanding a sequence of events in a story Organizing a sequence of events when writing a story Understanding relationships Making inferences or “reading between the lines” These may emerge early in childhood, even before a student is taught math: Learning to count later than other children Losing track when counting Trouble recognizing numbers Trouble telling left from right Trouble reading clocks and telling time Trouble using money to pay for things or make change

How is Specific Learning Disorder diagnosed?

Specific Learning Disorder is diagnosed by a multidisciplinary team including child psychiatrists, psychologists, special educators, and other specialists (e.g., speech-language pathologists). These professionals use standardized measures to determine if a child’s reading abilities are deficient and, if so, work to determine other risk factors for the deficit, including hearing problems, or social, environmental, or cognitive factors. A diagnosis of Specific Learning Disorder with Impairment in Reading (Dyslexia), Impairment in Written Expression (Dysgraphia), or Impairment in Mathematics (Dyscalculia) can only be made if a child's difficulties have persisted for at least six months despite appropriate instruction on how to read, write, or perform mathematics, as well as despite the provision of interventions to remediate the difficulties. Typically, children must wait until they are school-aged (or have had significant early reading instruction) to get an accurate assessment.

Specific Learning Disorder Facts
Worldwide frequency of the condition	The percentage of the world’s school-aged children and adolescents with a Specific Learning Disorder varies from study to study, ranging from 5% to 15%.
Burden of the condition in Greece	Specific Learning Disorder accounts for less than 0.01% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents.
Gender ratio	Male-female comparative data for Specific Learning Disorder varies from 2:1 to 3:1, although more of this data is based on studies examining reading than written expression or mathematics.
Peak age of onset	Although specific data for Specific Learning Disorder is unavailable, the peak age of onset for neurodevelopmental disorders, in general, is 5.5 years of age.
Proportion of the condition that emerges before age 18	Although specific data for Specific Learning Disorder is unavailable, the proportion that emerges before age 18 years for neurodevelopmental disorders, in general, is 83.2%. This means that 83.2% of individuals with a neurodevelopmental disorder will have been diagnosed by the time they are 18 years old.

What are the associated factors for Specific Learning Disorder?

Some common factors associated with Dyslexia are:

• Genetic and familial factors. There is an increased risk for children with a dyslexic first degree relative.

• Exposure to toxins. Exposure to certain toxins (e.g., lead, flame retardants) prenatally or during first years of life.

• Preterm delivery or low birth weight.

• Cognitive factors. These may include verbal deficits (e.g., poor vocabulary; difficulties with describing, grammar, and syntax errors in oral speech), phonological deficits (e.g., omissions, replacements, and transpositions of consonants), and deficits in sensory, auditory, speech, or visual processing.

Socioeconomic factors, such as poor access to appropriate academic resources, can limit a child’s reading, written expression, and/or mathematics skill acquisition. However, Specific Learning Disorder is not simply consequences of lack of opportunity of learning or inadequate instruction. While lack of instruction or educational opportunities do not result in Specific Learning Disorders, they may result in weak reading, written expression, and/or mathematics skills or symptoms that mimic those seen in Specific Learning Disorder.

What other disorders co-occur with Specific Learning Disorder?

Even though each child with a Specific Learning Disorder is different, impairment in one aspect of learning (i.e., reading, written expression, or mathematics) commonly co-occurs with another aspect of learning (e.g., a child with Dyslexia may also have Dyscalculia), as well as with other neurodevelopmental disorders, including Attention-Deficit/Hyperactivity Disorder (ADHD), communication disorders, Developmental Coordination Disorder, and Autism Spectrum Disorder (ASD). Other mental health disorders that might commonly co-occur include anxiety disorders, depressive disorders, and bipolar disorders.

How is Specific Learning Disorder managed?

Children with Specific Learning Disorder need to be taught specific skills so that they can learn to read, write, and compute problems more effectively. These skills are usually taught by special educators. Treatment can also include support to help children feel less anxious or embarrassed about their learning difficulties.

Children with Specific Learning Disorder may also need extra support to help them stay on track in their classes, manage their homework assignments, and deal with test pressures. Special educators and tutors can help students learn how to approach reading and writing assignments, and/or math problems in more effective ways.

Children with Specific Learning Disorder also benefit from direct classroom support, as well as assistive tools and technology. Some common examples include for mathematics calculators, graph paper, math apps, and time management tools like phone alarms.

Students with Specific Learning Disorder have certain rights by law after having been evaluated and diagnosed through the Centers of Multidisciplinary Assessment, Counseling, and Support (KEDASY). They may also be entitled to educational accommodations in school, for example:

• In the classroom:

• Not having to read aloud in class

• Not having to learn a foreign language

• Online access to the teacher’s book

• Outside of the classroom:

• Additional educational support through a school’s Inclusion Department

• Additional support through Remedial Teaching (i.e., Supplementary Teaching)

• During tests:

• The option to take secondary education and panhellenic exams orally or speak answers instead of writing them

• Examiner prompts to facilitate oral answers

• Writing answers first in a notebook and consulting notes when answering

• Reminders to concentrate and finish on time for students

• With approval, time extensions may be grated on National exams

• Additional time may be given on quarterly tests

Where to find more information

If you need more information on reading and mathematics skills development and reasons for concerns, you can also go to "Reading Difficulties" or “Math Difficulties”.

To learn more about the technical work conducted to develop this guide, please consult our reference list here:

References

Clinical description, symptoms, and diagnostic information

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

• Child Mind Institute. (2023, January 9). Quick guide to dyscalculia. https://childmind.org/guide/quick-guide-to-dyscalculia/

• Child Mind Institute. (2023, January 9). Quick guide to specific learning disorder. https://childmind.org/guide/quick-guide-to-specific-learning-disorder/

• Martinelli, K. (2022, December 6). Understanding dyslexia: Know the signs, and how to help kids with the most common learning disability. https://childmind.org/article/understanding-dyslexia/

• Sadusky, A., Berger, E. P., Reupert, A. E., & Freeman, N. C. (2022). Methods used by psychologists for identifying dyslexia: A systematic review. Dyslexia, 28(2), 132–148. https://doi.org/10.1002/dys.1706

• Souza, J. (2023, January 9). Understanding dysgraphia: How to help kids who struggle with learning to write. https://childmind.org/article/understanding-dysgraphia/

• World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6A03 Developmental Learning Disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f2099676649

Facts

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

• Fortes, I. S., Paula, C. S., Oliveira, M. C., Bordin, I. A., de Jesus Mari, J., & Rohde, L. A. (2016). A cross-sectional study to assess the prevalence of DSM-5 specific learning disorders in representative school samples from the second to sixth grade in Brazil. European Child & Adolescent Psychiatry, 25(2), 195–207. https://doi.org/10.1007/s00787-015-0708-2

• Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)

• Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50

• Khodeir, M. S., El-Sady, S. R., & Mohammed, H. A. E.-R. (2020). The prevalence of psychiatric comorbid disorders among children with specific learning disorders: A systematic review. The Egyptian Journal of Otolaryngology, 36(1), 57. https://doi.org/10.1186/s43163-020-00054-w

• Moll, K., Kunze, S., Neuhoff, N., Bruder, J., & Schulte-Körne, G. (2014). Specific Learning Disorder: Prevalence and Gender Differences. PLoS ONE, 9(7), e103537. https://doi.org/10.1371/journal.pone.0103537

• Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7

• Vlachos, F., Avramidis, E., Dedousis, G., Chalmpe, M., Ntalla, I., & Giannakopoulou, M. (2013). Prevalence and Gender Ratio of Dyslexia in Greek Adolescents and Its Association with Parental History and Brain Injury. American Journal of Educational Research, 1(1), 22–25. https://doi.org/10.12691/education-1-1-5

• Yang, L., Li, C., Li, X., Zhai, M., An, Q., Zhang, Y., Zhao, J., & Weng, X. (2022). Prevalence of Developmental Dyslexia in Primary School Children: A Systematic Review and Meta-Analysis. Brain Sciences, 12(2), 240. https://doi.org/10.3390/brainsci12020240

Associated factors

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

• Dulcan, M. K., Ballard, R. R., Jha, P., & Sadhu, J. M. (Eds.). (2017). Concise Guide to Child and Adolescent Psychiatry (Fifth Edition). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9781615371457

• Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50

Co-occurring disorders

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

• Donolato, E., Cardillo, R., Mammarella, I. C., & Melby‐Lervåg, M. (2022). Research Review: Language and specific learning disorders in children and their co‐occurrence with internalizing and externalizing problems: a systematic review and meta‐analysis. Journal of Child Psychology and Psychiatry, 63(5), 507–518. https://doi.org/10.1111/jcpp.13536

• Khodeir, M. S., El-Sady, S. R., & Mohammed, H. A. E.-R. (2020). The prevalence of psychiatric comorbid disorders among children with specific learning disorders: A systematic review. The Egyptian Journal of Otolaryngology, 36(1), 57. https://doi.org/10.1186/s43163-020-00054-w

Interventions

• Datchuk, S. M., Wagner, K., & Hier, B. O. (2020). Level and trend of writing sequences: A review and meta-analysis of writing interventions for students with disabilities. Exceptional Children, 86(2), 174–192. https://doi.org/10.1177/0014402919873311

• Datchuk, S. M., Rodgers, D. B., Wagner, K., Hier, B. O., & Moore, C. T. (2022). Effects of writing interventions on the level and trend of total words written: A meta-analysis. Exceptional Children, 88(2), 145–162. https://doi.org/10.1177/00144029211027537

• Galuschka, K., Görgen, R., Kalmar, J., Haberstroh, S., Schmalz, X., & Schulte-Körne, G. (2020). Effectiveness of spelling interventions for learners with dyslexia: A meta-analysis and systematic review. Educational Psychologist, 55(1), 1–20. https://doi.org/10.1080/00461520.2019.1659794

• Hall, C., Dahl‐Leonard, K., Cho, E., Solari, E. J., Capin, P., Conner, C. L., Henry, A. R., Cook, L., Hayes, L., Vargas, I., Richmond, C. L., & Kehoe, K. F. (2022). Forty years of reading intervention research for elementary students with or at risk for Dyslexia: A systematic review and meta‐analysis. Reading Research Quarterly, rrq.477. https://doi.org/10.1002/rrq.477

• Perdue, M. V., Mahaffy, K., Vlahcevic, K., Wolfman, E., Erbeli, F., Richlan, F., & Landi, N. (2022). Reading intervention and neuroplasticity: A systematic review and meta-analysis of brain changes associated with reading intervention. Neuroscience & Biobehavioral Reviews, 132, 465–494. https://doi.org/10.1016/j.neubiorev.2021.11.011

• Powell, S. R., Mason, E. N., Bos, S. E., Hirt, S., Ketterlin‐Geller, L. R., & Lembke, E. S. (2021). A Systematic review of mathematics interventions for middle‐school students experiencing mathematics difficulty. Learning Disabilities Research & Practice, 36(4), 295–329. https://doi.org/10.1111/ldrp.12263

• Simms, V., Gilmore, C., Sloan, S., & McKeaveney, C. (2018). Protocol for a systematic review: Interventions to improve mathematics achievement in primary school‐aged children: a systematic review. Campbell Systematic Reviews, 14(1), 1–26. https://doi.org/10.1002/CL2.215