Specific Learning Disorders
Contributors:
Amy Milsom, Clemson University
In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association (2013) categorizes specific learning disorder (SLD) as a neurodevelopmental disorder. Combining the DSM-IV-TR diagnoses of reading disorder, mathematics disorder, disorder of written expression, and learning disorder not otherwise specified, SLD is a broad diagnosis that acknowledges deficits that impact academic achievement. SLD specifiers include:
- reading (fluency, accuracy, and comprehension);
- written expression (spelling, grammar, punctuation, organization, clarity); and
- mathematics (memorizing, calculating, reasoning).
The term learning disability is frequently used in reference to individuals who have received a DSM-5 diagnosis of specific learning disorder, but not all people who have SLD qualify as having a learning disability. Learning disability is a term typically used when referring to a category of school-age students who are eligible for special educational services under the Individuals with Disabilities Education Act (IDEA).
Resource: http://www.ncld.org/wp-content/uploads/2014/11/2014-State-of-LD.pdf
Adults with specific learning disorders might experience functional limitations related to communication, interpersonal skills, cognition, work skills, and other areas that impact employment outcomes. For detailed information about the impact of specific learning disorders on employment see: http://www.acces.nysed.gov/common/acces/files/vr/learningdisabilities.pdf
Prevalence
According to the DSM-5, specific learning disorders are typically found in 5%-15% of all school-age students.
Adult prevalence rates of specific learning disorders are estimated to be 4%. Males are more frequently diagnosed, at rates 2–3 times that of females.
Identification/Assessment Strategies
The initial diagnosis of specific learning disorder typically occurs in school-aged children. Diagnosis requires a comprehensive evaluation (i.e., family, educational, medical, and developmental history) as well as teacher observations, responses to academic interventions, and standardized test scores.
Resource: http://www.dsm5.org/Documents/Specific%20Learning%20Disorder%20Fact%20Sheet.pdf
No one assessment is used to assess specific learning disorders, and individual counselors have discretion to choose which assessments they want to use. The National Center for Learning Disabilities provides a sampling of common assessments used in diagnosing specific learning disorders.
Resource: https://www.understood.org/en/school-learning/evaluations/types-of-tests
For adults with specific learning disorders, situational assessments are often used by counselors to identify cognitive or behavioral factors that might affect job performance.
For a list of individuals who are qualified to diagnose specific learning disorders as well as the types of services different counselors can provide for individuals with specific learning disorders, see http://www.ldonline.org/ article/6027/
Intervention Strategies
Intervention strategies for individuals diagnosed with specific learning disorders address psychosocial (e.g., social skills, self-esteem) and vocational-related concerns (e.g., communication, interpersonal skills, cognition). Few evidence-based counseling practices exist, and most research has been conducted with students in school and college settings. What follows are suggested modalities of intervention that may be used to address the myriad of struggles that individuals with specific learning disorder experience.
Group Counseling.
Group counseling interventions are effective because they provide opportunities for individuals with diagnosed specific learning disorders to receive peer support as well as an enhanced understanding that others struggle with similar issues. Opportunities to practice new behaviors and gain self-awareness are also possible through group counseling interventions. Research has suggested the effectiveness of group counseling interventions for students with SLD in relation to improving self-concept and increasing their beliefs that they could be successful in college (Elbaum & Vaughn; Leichtentritt & Shechtma, 2001; Milsom et al., 2004).
Peer-Based Interventions.
In their review of empirical research studies, Elbaum and Vaughn (2001) found numerous peer-based interventions to be effective in improving the self-perceptions of students with SLD. They believed that factors including not being singled-out as different from peers and having opportunities to experience success in activities led to positive outcomes for elementary students in the interventions they reviewed. For example, students with SLD working in collaborative academic groups where they jointly completed class projects with non-disabled peers showed increases in academic self-concept. Also, students with SLD who were afforded opportunities to teach academic concepts to their non-disabled peers showed increases in self-esteem.
To help students develop vocational skills, Westerlund et al. (2006) found that interventions involving peers were effective. Specifically, when peers demonstrated work-related tasks and provided both corrective feedback and praise, high school students with SLD improved their performance on cosmetology work skills (e.g., correctly rolling hair). With peer modeling and support, the students also demonstrated the ability to ask appropriate questions of potential hair customers to ensure their needs were met (e.g., How much length are you looking to cut today?). The authors reported that the intervention was effective in part because the high school students felt more comfortable getting help from a peer than from an instructor.
Individual Counseling.
Individuals with SLD may experience difficulties in counseling because of the nature of their struggles. For example, some clients may have difficulty understanding their counselor, expressing their thoughts, paying attention, or remembering to complete homework or show up to counseling on time (Cosden et al., 2009). Counselors can accommodate SLD via techniques such as: (a) writing things down or using visuals, or providing supplies so their clients can write things down; (b) restating and clarifying more often to help clients express themselves and let them know what their statements are clear; (c) providing objects for clients (including adult clients) to manipulate (e.g., squeeze balls, toys) so that they might more easily focus; and, (d) being understanding of and patient with memory problems while helping clients develop strategies to overcome their challenges.
Cognitive and behavioral interventions, including the use of direct instruction, modeling, feedback, role play, and rehearsal have been found effective in helping individuals with SLD develop skills. For example, Milsom et al. (2004) helped high school students with SLD develop assertiveness and self-advocacy skills through interventions that incorporated modeling, role play, and feedback. Milsom et al. (2004) also successfully taught students how to locate and navigate college disability services websites through guided instruction, practice, and feedback.
Other counseling theories have been discussed as helpful for conceptualizing and working with students with SLD. Thompson and Littrell (1998) found that 2-session brief therapy interventions following a structured 4-step model was effective in helping high school students with SLD develop and make progress toward self-identified goals. The steps used in their intervention included (1) developing rapport and defining the problem, (2) exploring solutions and exceptions to the problem, (3) generating a goal, and (4) generating a task to help the student reach his/her goal. Lambie and Milsom (2010) discussed the benefits of narrative therapy in addressing psychosocial concerns in individuals diagnosed with SLD and helping this population define who they are, given the stigma they often feel in association with having a SLD label.
Professional Organizations
LD OnLine: http://www.ldonline.org/
Learning Disabilities Association of America: https://ldaamerica.org/
National Center for Learning Disabilities: http://www.ncld.org/
National Joint Committee on Learning Disabilities: http://www.ldonline.org/about/partners/njcld
REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Cosden, M., Patz, S., & Smith, S. (2009). Do problems with information processing affect the process of psychotherapy for adults with learning disabilities or attention deficit/hyperactivity disorder? Learning Disabilities Research & Practice, 24, 165-173.
Elbaum, B., & Vaughn, S. (2001). School-based interventions to enhance the self-concept of students with learning disabilities: A meta-analysis. The Elementary School Journal, 101, 303-329.
Lambie, G., & Milsom, A. (2010). A narrative approach to supporting students diagnosed with learning disabilities. Journal of Counseling & Development, 88, 196-203.
Leichtentritt, J., & Shechtman, Z. (2010). Children with and without learning disabilities: A comparison of processes and outcomes following group counseling. Journal of Learning Disabilities, 43, 169-179.
Milsom, A., Akos, P, & Thompson, M. (2004). A psychoeducational group approach to postsecondary transition planning for students with learning disabilities. Journal for Specialists in Group Work, 29, 395-411
Rodis, P., Garrod, A., & Boscardin, M. L. (Eds.). (2001). Learning disabilities & life stories. Boston, MA: Allyn & Bacon.
Thompson, R., & Littrell, J. M. (1998). Brief counseling for students with learning disabilities. Professional School Counseling, 2, 60-67.
Westerlund, D. Granucci, E. A. Gramache, P., & Clark, H. B. (2006). Effects of peer mentors on work-related performance of adolescents with behavioral or/or learning disabilities. Journal of Positive Behavior Interventions, 8, 244-251.
Published: December 2014
Updated: August 2016
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