Specific Learning Disability

Included below is a summary of the official diagnostic criteria used in the DSM-5 for specific learning disorder to help you determine whether or not your student qualifies and could pursue specific learning disorder as a medical or  mental health diagnosis. This diagnosis is made as part of a comprehensive clinical evaluation that takes into account developmental, medical, family, and educational history; school reports; and appropriate educational and psychological testing.

According to DSM-5, a specific learning disorder diagnosis requires that all four of the following diagnostic criteria be met:

• Difficulties in learning and using at least one of the following academic skills lasting six months or more in spite of quality intervention:
  • inaccurate and slow or effortful word reading
  • difficulty understanding the meaning of what is read
  • difficulties with spelling
  • difficulties with written expression
  • difficulties mastering math facts, number sense, or calculation
  • difficulties with mathematical reasoning

• Skills in affected academic area(s) are shown to be substantially below what is expected for the student’s age on individually administered standardized tests.

• Difficulties start during school years, but the full impact is not seen until demand increases beyond what their limitation can cope with. Timed tests, quick turn-around times for longer written assignments, and heavy academic loads are examples of situations that may exceed the student’s capacity, causing learning challenges to surface in a student who was previously able to cope.

• Must rule out other things as the cause of the challenge before giving a specific learning disorder diagnosis. Cannot be due to:
  • low intelligence
  • vision or hearing problems
  • other mental or neurological disorders
  • environment
  • not being proficient in the language in which it provides instruction
  • poor-quality teaching (1)

At first glance it seems that the diagnosis of specific learning disorder is general in nature and not very helpful. However, if each academic area and sub-skill-set listed below is noted, the description can be useful for identifying types of skills in which the student is having difficulty. You never need to  accept a general diagnosis of specific learning disorder without an accompanying list of the specific natures of the struggles.

The following are the specific diagnostic codes with the specific categories that can officially be used for that diagnosis:

• 315.00 specific learning disorder with impairment in reading:
  • Word reading accuracy
  • Reading rate or fluency
  • Reading comprehension

Some clinicians say dyslexia isn’t an official diagnosis anymore. And they are right that dyslexia is not a major diagnostic category, but it is listed in the DSM-5 as an “alternative term to refer to a pattern of learning difficulties characterized by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities.” If the label dyslexia is important to you, ask the clinician to include “dyslexia” in the diagnostic report along with the official terminology.

Schools are often reluctant to use the word dyslexia as it implies more specialized reading intervention approaches than specific learning disability that often they may not be equipped to deliver.

• 315.2 specific learning disorder with impairment in written expression:
  • Spelling accuracy
  • Grammar and punctuation accuracy
  • Clarity or organization of written expression (see Writing Intervention article)

Note that  the term dysgraphia is not mentioned in the DSM-5, even as an alternate term.

Dyscalculia is listed as “an alternative term used to refer to a pattern of difficulties characterized by problems processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations.”

If it is important to you that the terms dyslexia, dysgraphia, or dyscalculia are used in the official report, it may be wise to check with your diagnostician prior to doing the official assessment. You will want to find out if they are comfortable using these terms as alternate terms for the specific learning disorder if such a diagnosis is warranted. Do make sure that any specific learning disability or specific learning disorder diagnosis does not just give the broad designation, but also spells out which of the sub-areas were found to be problematic for your student and make sure that suggestions are provided for appropriate interventions and accommodations. These sub-areas should drive intervention planning and specific IEP (Individualized Education Program) goals.