In 2013, the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-V)* replaced the diagnostic labels of Dyslexia, Dyscalculia and Disorders of Written Expression with the diagnostic category Specific Learning Disorder. Read more about Specific Learning Disorder in this article.

*  The DSM-V is a handbook used by mental health professionals to classify and diagnose mental disorders. It contains a list of descriptions, symptoms and criteria for each condition.

Q. What is a Specific Learning Disorder ?

According to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-V)*, a Specific Learning Disorder is diagnosed when differences in the way a child’s brain is organized in the course of maturation impedes his or her ability to learn and use specific academic skills and this affects his or her ability to cope with other activities of daily living.

*  The DSM-V is a handbook used by mental health professionals to classify and diagnose mental disorders. It contains a list of descriptions, symptoms and criteria for each condition.

Q. What are some signs that my child may have Specific Learning Disorder ?

Children with Specific Learning Disorder may show the following symptoms:

  • difficulty sounding out words, read words incorrectly or slowly, tend to guess words.
  • difficulty understanding the meaning of what is read.
  • difficulty with spelling.
  • difficulty with written expression (eg. many grammatical or punctuation errors, poor paragraph organization, ideas are not clear).
  • poor arithmetic skills (eg. difficulty with calculation, unclear about magnitude or directionality).
  • poor mathematical reasoning (eg. difficulty solving math problems).

Q. What are the different types of Specific Learning Disorder ?

According to the DSM-V, there are 3 subtypes of Specific Learning Disorders:

  1. Specific Learning Disorder with impairment in reading, which includes possible deficits in word reading accuracy, reading rate or fluency, and reading comprehension.
  2. Specific Learning Disorder with impairment in written expression, which includes possible deficits in spelling accuracy, grammar and punctuation accuracy, and clarity or organization of written expression
  3. Specific Learning Disorder with impairment in mathematics, which includes possible deficits in number sense, memorization of arithmetic facts, accurate or fluent calculation, and accurate math reasoning.

Some children may have more than one subtype of learning disorder.

Q. What are the causes of Specific Learning Disorder ?

  1. Genes. Children who have immediate family members with learning difficulties are at higher risk of having a Specific Learning Disorder compared to those without.
  2. Environment. Prematurity, very low birth weight, poor foetal growth, exposure to drugs or alcohol in the womb, or head injury are some factors that increase the risk of having a Specific Learning Disorder .

Q. Is it because I did not teach my child enough?

Children with a Specific Learning Disorder are not able to learn academic skills the same way as other children because of differences in the way their brains are organised for learning these skills. It is not because they lack adequate educational instruction or opportunity to learn. They need to be taught in a different way using specialized techniques that target their area of difficulty.

Q. How do I know if my child has a Specific Learning Disorder ?

The following steps are helpful in determining if your child has a Specific Learning Disorder :

  1. Speak to your child’s teacher. Your child’s teacher is in a good position to inform you how your child compares to other children in terms of their academic ability and learning progress. Some teachers are trained to pick up signs of Specific Learning Disorder .
  2. Rule out vision or hearing problems, as well as other medical conditions. You may want to consult your family doctor or child’s paediatrician.
  3. Get an assessment from a psychologist in Singapore trained to work with children. The psychologist will interview you and your child to obtain information about your child’s developmental history, family environment, educational history and social and occupational functioning. The psychologist will use standardised tests to determine your child’s cognitive processing strengths and challenges, as well as to assess your child’s level in academic skills such as oral language, reading, writing and mathematics, in comparison to other children in his or her age group. Depending on the psychologist’s assessment, you and your child’s teacher may also be required to fill in rating forms to provide further information about your child’s learning and behaviour.

Q. What are the criteria used to diagnose Specific Learning Disorder ?

The following diagnostic criteria are indicated in the DSM-V:

  1. The child’s difficulties in reading, writing or mathematics must have persisted for at least 6 months, even though remedial help or educational support were provided.
  2. The child’s reading, writing or mathematics skills must be far below the levels expected of his or her age (at least 1.5 standard deviations below the norm) and significantly affect his or her academic performance or activities of daily living. This must be verified using standardized tests and comprehensive clinical assessment.
  3. The difficulties begin to show after the child starts formal schooling. In some children, the difficulties may not be obvious until the later school years when academic demands exceed the child’s capacity to cope.
  4. The learning difficulties are not due to intellectual disability, problems with vision or hearing, lack of familiarity with the language of instruction (eg. if the child has little or no exposure to English), lack of educational opportunities (eg. the child was not taught or did not attend school), very difficult growing up experiences (eg. abuse or deprivation) or other neurological, motor or mental disorders.

Q. Can my child have a Specific Learning Disorder if he or she only starts having difficulties with learning in the later school years?

Some higher functioning children who have an undiagnosed Specific Learning Disorder may have found their own ways of coping with their learning difficulties in the early school years. Thus, their learning impediments only become obvious in the later school years when academic demands become too complex and exceed the child’s ability to cope.

Q. What is the difference between Intellectual Disability and Specific Learning Disorder ?

Children with Intellectual Disability are very poorly developed in their overall ability to process, retain and manipulate information, which affects learning and daily functioning in all areas. However, children with a Specific Learning Disorder struggle greatly with a particular academic area (eg. reading, writing and/or mathematics) but cope well in daily life and can achieve good progress in other academic domains as well as non-academic areas such as social functioning and community living.

Q. What is the difference between Specific Learning Disorder and Attention Deficit Hyperactivity Disorder (ADHD)?

A child with Specific Learning Disorder has difficulty acquiring specific academic skills while a child with ADHD has difficulty paying attention and controlling impulses. Although both can affect learning (for a child with ADHD, it is hard to absorb information if he or she cannot pay attention), the underlying mechanism is different. There are differences in the way the brain is organized for each of these conditions and the intervention is different. A child with ADHD can learn effectively with appropriate treatment (such as medication and behavioural management), while a child with Specific Learning Disorder would require long-term learning support in terms of specialized instruction and accommodations. It is common for a child to have both of these conditions and a comprehensive assessment is needed to ensure an accurate diagnosis.

Q. Why are there different definitions of learning disabilities?

Specific Learning Disorder is a condition diagnosed by clinicians or medical professionals using the DSM-V criteria for diagnosis. Educational systems may have different definitions of learning disabilities based on a different understanding of how best to identify the learning strengths and weaknesses of the student so as to meet the needs of the child in terms of interventions or accommodations.

There is no one definition of learning disabilities that is accepted across all countries and systems. Different professions may differ in their opinion about the criteria used to identify learning disabilities, the degree of impairment required, the underlying mechanisms and so on. New research information may also lead to changes in the way learning disabilities are assessed and diagnosed.

Q. What can be done to help?

The following can be done to support the child with a Specific Learning Disorder :

  1. School support and accommodations. Schools in Singapore have learning support programs, educational specialists and special needs teachers who can be engaged to help your child. Many teachers are aware of and supportive of children with Specific Learning Disorders and may be willing to explore ways to help your child such as providing printed notes or instructions, getting a friend to help your child, giving your child extra time to complete work and moderating workload where necessary.
  2. Examination accommodations. Children with Specific Learning Disorders can apply to MOE for examination accommodations such as extra time, being allowed to take exams in a separate room or having larger text on the exam paper. Some children with Specific Learning Disorders have been exempted from taking mother tongue as an examinable subject. Such accommodations are subject to MOE’s discretion in determining if the Specific Learning Disorder has significantly impaired the child’s achievement and if the accommodations are helpful in optimising the child’s performance.
  3. Specialist intervention. Trained professionals can teach your child strategies to target his or her Specific Learning Disorder . Children with impairments in reading will benefit from interventions offered at the Dyslexia Association of Singapore where they will be given direct, explicit and systematic instruction in the structure of language using multisensory approaches. Speech therapy can help children who have difficulties with language and occupational therapists can help children who have problems with handwriting and visual-motor coordination. Early intervention can often lead to significant improvements and remediate much of the problem.
  4. Therapy. Children with Specific Learning Disorders often experience anxiety, mood issues, a lack of self-confidence and problems with self-esteem. A psychologist can help the child to understand his or her feelings better, develop helpful and healthy ways of thinking and work towards changing behaviour for the better. Because the family and community is key to creating a supportive, accepting and nurturing environment for the child, the psychologist will often work with families and teachers to build positive relationships and experiences for the child.
  5. Medication. Specific Learning Disorders cannot be treated with medication. However, children with Specific Learning Disorders often experience anxiety, mood and emotional issues that may be related to their learning difficulties. If such issues are severe and affect your child’s ability to function well, you may want to consult a psychiatrist in Singapore to discuss how medical treatment may be helpful for your child.

Written by Ms Carolyn Kee
Consultant Principal Psychologist