Specific Learning Disorder (SLD): DSM Criteria and Educational Perspectives
Specific Learning Disorders (SLDs) are neurodevelopmental disorders that impact an individual's ability to acquire and use academic skills, such as reading, writing, and mathematics. Despite being common, often misunderstood, and frequently misdiagnosed, a precise understanding of SLDs is crucial for effective intervention and support. To achieve diagnostic clarity for a Specific Learning Disorder (SLD), a comprehensive psychoeducational evaluation is essential.
This article delves into the classifications recognized by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) and contrasts them with the broader perspective of an educational learning disability.
Specific Learning Disorder (SLD) According to DSM-5-TR
The DSM-5-TR provides the clinical criteria for diagnosing Specific Learning Disorder. A diagnosis requires persistent difficulties in learning foundational academic skills that begin during the school-age years, are not better accounted for by intellectual disabilities, uncorrected vision or hearing problems, other mental or neurological disorders, psychosocial adversity, or lack of proficiency in the language of instruction.
Core Criteria and Specifiers
The umbrella diagnosis of SLD is defined by a consistent pattern of at least one of the following six symptoms persisting for at least six months, despite the provision of targeted interventions:
Inaccurate or slow and effortful word reading. (e.g., reads single words aloud incorrectly or slowly and hesitantly; frequently guesses words; has difficulty sounding out words).
Difficulty understanding the meaning of what is read. (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings).
Difficulty with written expression. (e.g., makes multiple grammatical or punctuation errors within sentences; poor paragraph organization; written expression lacks clarity).
Difficulties mastering number sense, number facts, or calculation. (e.g., poor understanding of numbers, their magnitude and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact).
Difficulties with mathematical reasoning. (e.g., severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems).
Difficulties with spelling. (e.g., may add, omit, or substitute vowels or consonants).
Once the criteria for SLD are met, the diagnosis is further specified based on the academic skill domain that is impaired:
Specifiers Based on Impairment
With impairment in Reading: This specifier covers difficulties with word reading accuracy, reading fluency, and/or reading comprehension. This aligns with what is commonly known as Dyslexia (which most accurately refers to difficulties with word recognition, decoding, and spelling).
With impairment in Written Expression: This specifier addresses difficulties with spelling accuracy, grammar and punctuation accuracy, and/or clarity or organization of written expression. The term Dysgraphia is sometimes used to refer specifically to motoric/mechanical aspects of writing, though the DSM focuses on the product of writing.
With impairment in Mathematics: This specifier includes difficulties with number sense, memorization of arithmetic facts, accurate or fluent calculation, and/or accurate mathematical reasoning. The term Dyscalculia is often used to refer to severe difficulties in math.
Common Subtypes of Dyslexia
While the DSM-5-TR uses "With impairment in Reading" as the clinical specifier, the term Dyslexia is widely used, particularly in education and research, to describe difficulties primarily affecting accurate and fluent word recognition and spelling. Researchers and clinicians often distinguish between subtypes based on the underlying processing deficits:
Phonological Dyslexia (or Dysphonetic Dyslexia): This is the most common type. Individuals have difficulty breaking words down into their elemental sounds (phonemes) and mapping those sounds to letters (decoding). This makes sounding out unfamiliar words challenging.
Surface Dyslexia (or Dyseidetic Dyslexia): Individuals with this type primarily struggle with recognizing whole words automatically (sight words) and reading irregularly spelled words (like yacht or colonel). They often rely heavily on sounding out every word, leading to slow, effortful reading.
Reading Comprehension Deficit (or Mixed Dyslexia): This may involve combined difficulties with both decoding and understanding the meaning of text. While technically falling under the broader DSM category of "Impairment in Reading," it highlights the critical difference between accurate word reading and genuine comprehension.
The Educational Perspective: Learning Disability
While the DSM-5-TR provides the clinical framework, educational systems, particularly in the United States under the Individuals with Disabilities Education Act (IDEA), use a slightly different and often broader definition known as a Learning Disability (LD) or Specific Learning Disability (SLD).
The educational definition is critical because it determines eligibility for special education services (e.g., specialized instruction, accommodations, and related services) within public schools.
Key Differences and Similarities
The educational criteria focus on a discrepancy between a student's cognitive ability (or intellectual potential) and their actual academic achievement, often referred to as the "Ability-Achievement Discrepancy Model," or increasingly, using a Response to Intervention (RTI) model. If you suspect your child may have a Specific Learning Disability, a comprehensive psychoeducational evaluation is the necessary first step to determine a diagnosis and support eligibility for services.
Contrasting Clinical and Educational Models
The clinical and educational models have distinct goals and eligibility criteria:
Primary Goal: The DSM-5-TR aims for clinical diagnosis in medical and psychological settings, while the educational (IDEA) model aims to determine eligibility for special education and related services.
Focus: The clinical focus is on the persistence of specific symptoms and difficulties despite intervention. The educational focus is on the student's need for specialized instruction due to a lack of expected progress.
Eligibility Model: The clinical diagnosis relies on assessment and symptom criteria. Educational eligibility historically used the Ability-Achievement Discrepancy model, but increasingly uses Response to Intervention (RTI) or a Pattern of Strengths and Weaknesses (PSW) model.
Response to Intervention (RTI): This model is commonly used in schools and views a child as having a learning disability if they fail to make adequate academic progress after receiving high-quality, research-based instruction and targeted interventions. It shifts the focus from an internal disorder to a need for specialized educational support.
Ability-Achievement Discrepancy Model: This model is an alternate method used to qualify students for an SLD by identifying a significant statistical gap between a student's measured intellectual ability (IQ) and their actual academic performance (achievement scores). This model established eligibility by showing that the student was not achieving at a level commensurate with their cognitive potential, suggesting a specific processing disorder was the cause of the learning difficulty.
Final Notes
Whether viewed through the lens of the DSM-5-TR or an educational framework, Specific Learning Disabilities are real, neurological differences that require targeted support. Accurate diagnosis, whether clinical or educational, is the first step toward unlocking an individual's potential. By understanding the specific nature of the impairment (in reading, writing, or math), and recognizing the nuances like different types of dyslexia, educators, clinicians, and families can collaborate to implement effective strategies, accommodations, and specialized instruction that enable individuals with SLDs to achieve academic success and thrive. To ensure your child receives the focused support they need after diagnosis, explore our academic skills workshops which provide specialized instruction.
Helpful Resources
National Center for Learning Disabilities (NCLD)
Focus: Advocacy, Education, and Support
International Dyslexia Association (IDA)
Focus: Dyslexia Research, Education, and Practice
Learning Disabilities Association of America (LDA)
Focus: Support for Individuals, Families, and Professionals
Understood.org
Focus: Practical Resources for Parents of Children with Learning and Attention Issues
National Institute of Child Health and Human Development (NICHD)
Focus: Research and Scientific Information
U.S. Department of Education, Office of Special Education Programs (OSEP)
Focus: Federal Guidance and Policy (IDEA)
https://www2.ed.gov/about/offices/list/osers/osep/index.html
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