Skip to main content
SpringerLink
Log in

Learning Disabilities

Classification, Clinical Features and Treatment

  • Disease Management
  • Learning Disabilities
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

Summary

Learning disabilities are a group of conditions diagnosed when the individual’s achievement in reading, mathematics or written expression is substantially below that expected for his/her age, schooling and level of intelligence. Learning disability does not include learning abnormality resulting primarily from communication disorders, impaired vision or hearing, social or emotional disturbances or cultural differences.

A number of classification systems of learning disabilities have been proposed. A clinical-neuropsychological system recognises 5 types of learning disorders based on abnormalities of: (i) phonological processing; (ii) spatial cognition; (iii) executive function; (iv) social recognition; and (v) long term memory.

Underlying abnormalities of cognitive processes, mostly auditory and language processing but also visual-perceptual abnormalities, are frequently present in individuals with learning disabilities. Comorbid conditions include attention deficit hyperactivity disorder, conduct disorder and social skills abnormalities.

Learning disabilities can be a result of a number of conditions affecting the CNS, but the disorder is predominantly genetically transmitted. Chromosome 6 has recently been implicated in reading difficulties. A number of biological abnormalities have been found in patients with learning disabilities. Anatomical abnormalities include reversal of normally present brain asymmetries and the presence of foci of cerebral microdysgenesis and ectopias. Abnormal regional brain glucose metabolism has been demonstrated in patients with reading difficulties. Neurophysiological abnormalities include abnormal cognitive eventrelated potentials and possible abnormalities of the magnocellular visual pathway.

Treatment modalities for learning disabilities include cognitive-educational psychological and pharmacological measures. Although there are no medications directly affecting the learning ability of these patients, central stimulants, clonidine or antidepressants may enhance learning ability through an effect on frequently present comorbid conditions.

The prognosis of a patient with learning disabilities depends on the severity of the disability, intelligence level, the presence or absence of comorbid conditions, and environmental support.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Shapiro BK, Gallico RP. Learning disabilities. Pediatr Clin North Am 1993; 40: 490–505

    Google Scholar 

  2. Penington BF. Diagnosing learning disorders. A neuropsychological framework. New York: The Guilford Press, 1991

    Google Scholar 

  3. Shaywitz BA, Shaywitz SE. Learning disabilities and attention disorders. In: Swaiman KF, editor. Pediatric neurology, principles and practice. St Louis: The CV Mosby Company, 1993: 1119–51

    Google Scholar 

  4. Silver LB, editor. Learning disabilities. Child Adolesc Psychiatr Clin North Am 1993; 2

    Google Scholar 

  5. Duane DD. Learning disabilities. In: Frank Y, editor. Pediatric behavioral neurology. Boca Raton (FI): Care. In press

  6. Sandler AD, Watson TE, Footo M, et al. Neurodevelopmental study of writing disorders in middle childhood. J Dev Behav Pediatr 1992; 13: 17–23

    PubMed  CAS  Google Scholar 

  7. Critchly M. The dyslexic child. Springfield (II): Charles e. Thomas, 1970

    Google Scholar 

  8. Orton ST. ‘Word-blindedness’ in school children. Arch Neurol Psychiatry 1925; 14: 581–615

    Google Scholar 

  9. Strauss AA, Lehtinen LE. Psychopathology and education in the brain-injured child. New York: Grune & Stratton, 1947

    Google Scholar 

  10. National Advisory Committee on Handicapped Children. Special education for handicapped children. Washington (DC): Department of Health, Education and Welfare, 1968

    Google Scholar 

  11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994

    Google Scholar 

  12. Hynd GW, Cohen M. Dyslexia: neuropsychological theory, research, and clinical differentiation. New York: Grune & Stratton, 1983

    Google Scholar 

  13. Rutter M. Prevalence and types of dyslexia. In: Benton AL, Pearl D, editors. Dyslexia, an appraisal of current knowledge. New York: Oxford University Press, 1978: 3–28

    Google Scholar 

  14. Rutter M, Yule W. The concept of specific reading retardation. J Child Psychol Psychiatry 1975; 16: 181–97

    PubMed  CAS  Google Scholar 

  15. Shaywitz SE, Shaywitz BA, Fletcher JM, et al. Prevalence of reading disability in boys and girls: results of the Connecticut longitudinal study. JAMA 1990; 264: 998–1002

    PubMed  CAS  Google Scholar 

  16. DeFries JC. Gender ratios in reading-disabled children and their affected relatives: a commentary. J Learn Disabil 1989; 22: 544–55

    Google Scholar 

  17. Strang JD, Rourke BP. Arithmetic disability subtypes: the neuropsychological significance of specific arithmetic impairment in childhood. In: Rourke BP, editor. Neuropsychology of learning disabilities: essentials of SUbtype analysis. New York: Guilford Press, 1985: 167–83

    Google Scholar 

  18. Bruck M. Persistance of dyslexics’ phonological awareness deficits. Dev Psychol 1992; 28: 874–86

    Google Scholar 

  19. Stiles-Davis J. Spatial dysfunctions in young children with right hemisphere injury. In: Stiles-Davis J, Kritchevsky M, editors. Spatial cognition brain bases and development. Hillsdale (NJ): Lawrence Erlbaum, 1988: 251–72

    Google Scholar 

  20. Rourke BP. Nonverbal learning disabilities. The syndrome and the model. New York: Guilford Press, 1989

    Google Scholar 

  21. Stuss DT, Benson DF. The frontal lobes. New York: Raven Press, 1986

    Google Scholar 

  22. Goldman-Rakic PS. Circuitry of primate prefrontal cortex and regulation of behavior by representational knowledge. In: Plum F, editor. Handbook of physiology. Section 1: The nervous system. Vol. 5. Higher functions of the brain. New York: Oxford University Press, 1987: 373–417

    Google Scholar 

  23. Eliason MJ. Neurofibromatosis: implications for learning and behavior. Dev Behav Pediatr 1986; 7: 175–9

    CAS  Google Scholar 

  24. Welsh MC, Penington BF, Ozonoff S, et al. Neuropsychology of early-treated phenylketonuria: specific executive function deficits. Child Dev 1990; 61: 1697–713

    PubMed  CAS  Google Scholar 

  25. Bellinger DC, Needleman HL. Lead and the relationship between maternal and child intelligence. J Pediatr 1983; 102: 523–7

    PubMed  CAS  Google Scholar 

  26. Needleman HL, Bellinger D, Leviton A. Does lead at low dose affect intelligence in children? Pediatrics 1981; 68: 894–6

    PubMed  CAS  Google Scholar 

  27. Bender BH, Puch M, Salenblatt J, et al. Cognitive development of children with sex chromosome abnormalities. In: Smith S, editor. Genetics and learning disabilities. San Diego: College Hill Press, 1987: 175–201

    Google Scholar 

  28. Galaburda AM. The testosterone hypothesis: reassessment since Geschwind and Benan. Ann Dyslex 1990; 40: 18–38

    Google Scholar 

  29. Galaburda AM. Neurology of developmental dyslexia. Curr Opin Neurol Neurosurg 1992; 5: 71–6

    PubMed  CAS  Google Scholar 

  30. Scarborough H. Prediction of reading disability from familial and individual differences. lEduc Psychol 1989; 81: 101–8

    Google Scholar 

  31. Thomas W. Congenital ‘word blindness’ and its treatment. Ophthalmoscope 1905; 3: 380–3

    Google Scholar 

  32. Hinshelwood I. Four cases of congenital word-blindness occurring in the same family. BMJ 1907; 2: 1229–32

    Google Scholar 

  33. Finucci JM, Guthrie JT, Childs AL, et al. The genetics of specific reading disability. Ann Hum Genet 1976; 40: 1–23

    PubMed  CAS  Google Scholar 

  34. Penington BF, Gilger JW, Pauls D, et al. Evidence for major gene transmission of developmental dyslexia. JAMA 1991; 266: 1527–34

    Google Scholar 

  35. Smith SD, Pennington BF, Kimberling WI, et al. Familial dyslexia: use of genetic linkage data to define subtypes. I Am Acad Child Adolesc Psychiatry 1990; 29: 204–13

    PubMed  CAS  Google Scholar 

  36. Olson R, Wise B, Conners F, et al. Specific deficits in component reading and language skills: genetic and environmental influences. J Learn Disabil 1989; 22: 339–48

    PubMed  CAS  Google Scholar 

  37. Smith SD, Kimberling WI, Penington BF, et al. Specific reading disability. Identification of an inherited form through linkage analysis. Science 1983; 219: 1345–7

    PubMed  CAS  Google Scholar 

  38. Cardon LR, Smith SD, Fulker DW, et al. Quantitative trait locus for reading disability on chromosome 6. Science 1994; 266: 276–9

    PubMed  CAS  Google Scholar 

  39. Lambert NM, Sandoval J. The prevalence of learning disabilities in a sample of children considered hyperactive. J Abnorm Child Psychol 1980; 8: 33–50

    PubMed  CAS  Google Scholar 

  40. Silver L. The relationship between learning disabilities, hyperactivity, distractibility, and behavioral problems. J Am Acad Child Psychiatry 1981; 20: 385–97

    PubMed  CAS  Google Scholar 

  41. Anderson IC, Williams S, McGee R, et al. DSM-III disorders in preadolescent children. Arch Gen Psychiatry 1987; 44: 69–76

    PubMed  CAS  Google Scholar 

  42. Denckla MB. Academic and extracurricular aspects of nonverballearning disabilities. Psychiatr Ann 1991; 21: 717–24

    Google Scholar 

  43. Geschwind N, Levitsky W. Human brain: left-right asymmetries in the temporal speech region. Science 1968; 161: 186–7

    PubMed  CAS  Google Scholar 

  44. Wittelson SF, Pallie W. Left hemisphere specialization for language in the newborn: neuroanatomical evidence of asymmetry. Brain 1993; 96: 641–6

    Google Scholar 

  45. Chi IG, Dooling EC, Gilles FH. Left-right asymmetry of the temporal speech areas of the human fetus. Arch Neurol 1977; 34: 346–8

    PubMed  CAS  Google Scholar 

  46. Galaburda AM. Dyslexia: a neurologic update. Neurol Chron 1993; 2: 1–5

    Google Scholar 

  47. Sherman GF, Galaburda AM, Geschwind N. Cortical anomalies in brains of New Zealand mice: a neuropathologic model of dyslexia? Proc Natl Acad Sci USA 1985; 82: 8072–4

    PubMed  CAS  Google Scholar 

  48. Humphreys P, Rosen GD, Press DM, et al. Freezing lesions of the developing rat brain. A model for cerebrocortical microgyria. J Neuropathol Exp Neurol 1991; 50: 145–60

    PubMed  CAS  Google Scholar 

  49. Denckla MB, LeMay M, Chapman CA. Few CT scan abnormalities found even in neurologically impaired learning disabled children. J Learn Disabil 1985; 18: 132–5

    PubMed  CAS  Google Scholar 

  50. Hynd GW, Serrnrud-Clikeman M, Lorys AR, et al. Brain morphology in developmental dyslexia and attention deficit disorderlhyperactivity. Arch Neurol 1990; 47: 919–26

    PubMed  CAS  Google Scholar 

  51. Duara R, Kushch A, Gross-Glen K, et al. Neuroanatomic differences between dyslexic and normal readers on magnetic resonance imaging scans. Arch Neurol 1991; 48: 410–6

    PubMed  CAS  Google Scholar 

  52. Leonard CM, Voeller KS, Lombardino LJ, et al. Anomalous cerebral morphology in dyslexia revealed with magnetic resonance imaging. Arch Neurol 1993; 50: 461–9

    PubMed  CAS  Google Scholar 

  53. Gross-Glenn K, Duara R, Barker WW, et al. Positron emission tomographic studies during serial word-reading by normal and dyslexic adults. J Clin Exp Neuropsychol 1991; 13 (4): 531–44

    PubMed  CAS  Google Scholar 

  54. Hagman JO, Wood F, Buchsbaum MS, et al. Cerebral brain metabolism in adult dyslexic subjects assessed with positron emission tomography during performance of an auditory task. Arch Neurol 1992; 42: 734–9

    Google Scholar 

  55. Duffy FH, Denckla MB, Bartels PH, et al. Dyslexia: regional differences in brain electrical activity by topographic mapping. Ann Neurol 1980; 7: 412–20

    PubMed  CAS  Google Scholar 

  56. Landwehrmeyer B, Gerling I, Wallesch Cw. Patterns of taskrelated slow brain potentials in dyslexia. Arch Neurol 1990; 47: 791–7

    PubMed  CAS  Google Scholar 

  57. Kingsbourne M. Learning disabilities. In: Vinken PI, Brayn GW, Klawans HL, editors. Handbook of clinical neurology. Rev. series 2. Vol. 46. Neurobehavioral disorders. Amsterdam: Elsevier Science Publishers, 1985: 123–37

    Google Scholar 

  58. Frank Y, Seiden lA, Napolitano B. Event related potentials to an ‘oddball’ auditory paradigm in children with learning disabilities with or without attention deficit hyperactivity disorder. Clin Electroencephalogr 1994; 25: 136–41

    PubMed  CAS  Google Scholar 

  59. Livingstone MS, Rosen GD, Drislane FW, et al. Physiological and anatomical evidence for a magnocellular defect in developmental dyslexia. Proc Natl Acad Sci USA 1991; 88: 7943–7

    PubMed  CAS  Google Scholar 

  60. Galaburda AM, Corsiglia I, Rosen GD, et al. Planum temporale asymmetry. Reappraisal since Geschwind and Levitsky. Neuropsychologia 1987; 25: 853–68

    Google Scholar 

  61. Galaburda AM, Aboitiz F, Rosen GD, et al. Histological asymmetry in the primary visual cortex of the rat: implications for mechanisms of cerebral asymmetry. Cortex 1986; 22: 151–60

    PubMed  CAS  Google Scholar 

  62. Duane DD. The medical and neurological diagnostic process in learning disabilities. Child Adolesc Psychiatr Clin North Am 1993; 2: 283–93

    Google Scholar 

  63. Denckla MB. Revised neurological examination for subtle signs. Psychopharmacology 1985; 21: 773–99

    CAS  Google Scholar 

  64. Lovett MW. Developmental dyslexia. In: Segalowitz SJ, Rapin I, editors. Handbook of neuropsychology. Vol 7: child neuropsychology. Amsterdam: Elsevier Science Publishers, 1992: 163–85

    Google Scholar 

  65. Scarborough H. Very early language deficits in dyslexic children. Child Dev 1990; 61: 1728–43

    PubMed  CAS  Google Scholar 

  66. Pennington BF, Van Orden G, Smith SD, et al. Phonological processing skills and deficits in adult dyslexics. Child Dev 1990; 61: 1753–78

    PubMed  CAS  Google Scholar 

  67. Mattis S, French IH, Rapin I. Dyslexia in children and young adults: three independent neuropsychological syndromes. Dev Med Child Neurol 1975; 17: 150–63

    PubMed  CAS  Google Scholar 

  68. Kovacs M, Goldston D. Cognitive and social cognitive development of depressed children and adolescents. J Am Acad Child Adolesc Psychiatry 1991; 30: 388–92

    PubMed  CAS  Google Scholar 

  69. Silver L. Psychological and family problems associated with learning disabilities: assessment and intervention. J Am Acad Child Adolesc Psychiatry 1989; 3: 319–25

    Google Scholar 

  70. Wise B, Olson RK. Remediating reading disabilities. In: Obrzut JE, Hynd GW, editors. Advances in the neuropsychology of learning disabilities: issues, methods, and practice. New York: Academic Press, 1991

    Google Scholar 

  71. Lerner IW. Educational interventions in learning disabilities. J Am Acad Child Adolesc Psychiatry 1989; 28: 326–30

    PubMed  CAS  Google Scholar 

  72. Runyan MK. The effect of extra time on reading comprehension scores for university students with and without disabilities. In: Shaywitz SE, Shaywitz BA, editors. Attention deficit disorder comes of age: towards the twenty-first century. Austin (TX): PRO-ED, 1992: 185–95

    Google Scholar 

  73. Hagin R, Silver A. Learning disorders in childhood. New York: Wiley, 1990

    Google Scholar 

  74. Wolkowitz OM, Tinkelburg JR, Weingartner H. A psychobiological perspective of cognitive functions. Neuropsychobiology 1985; 14: 88–96

    PubMed  CAS  Google Scholar 

  75. Schneider LS, Olin JT. Overview of clinical trials of hydergine in dementia. Arch Neurol 1994; 51: 787–98

    PubMed  CAS  Google Scholar 

  76. Rozzini R, Zanetti O, Bianchetti A. Treatment of cognitive impairment secondary to degenerative dementia. Effectiveness of oxiracetam therapy. Acta Neurol (Napoli) 1993; 15 (1): 44–52

    CAS  Google Scholar 

  77. Gallai V, Mazzotta G, Del Gatto F. A clinical and neurophysiological trial on nootropic drugs in patients with mental decline. Acta Neurol (Napoli) 1991; 13 (1): 1–12

    CAS  Google Scholar 

  78. Di Janni M, Wilsher CR, Blank MS. The effects of piracetam in children with dyslexia. J Clin Psychopharmacol 1985; 5: 272–8

    Google Scholar 

  79. Wilsher CR, Bennett D, Chase CH. Piracetam and dyslexia: effects on reading tests. J Clin Psychopharmacol 1987; 7: 230–7

    PubMed  CAS  Google Scholar 

  80. Ackerman PT, Dykman RA, Holloway C, et al. A trial of pirace tam in two subgroups of students with dyslexia enrolled in summer tutoring. J Learn Disabil 1991; 24 (9): 542–9

    PubMed  CAS  Google Scholar 

  81. Rapoport JL, Buchsbaum MS, Weingartner H, et al. Dextroamphetamine: cognitive and behavioral effects in normal and hyperactive boys and normal men. Arch Gen Psychiatry 1980; 37: 933–43

    PubMed  CAS  Google Scholar 

  82. Abikoff H, Gittelman R. The normalizing effects of methylphenidate on the classroom behavior of ADHD children. J Abnorm Child Psychol 1985; 13: 33–4

    PubMed  CAS  Google Scholar 

  83. Greenhill LL. Attention deficit hyperactivity disorder. The stimulants. Child Adolesc Psychiatr North Am 1995; 4: 123–68

    Google Scholar 

  84. Wilens TE, Biederman J. The stimulants. Psychiatr Clin North Am 1992; 15: 191–222

    PubMed  CAS  Google Scholar 

  85. Dulcan M. Using psychostimulants to treat behavior disorders of children and adolescents. J Child Adolesc Psychopharmacol 1990; 1: 7–20

    PubMed  CAS  Google Scholar 

  86. Birmaher BB, Greenhill LL, Cooper MA. Sustained release methylphenidate: pharmacokinetic studies in ADHD males. JAm Acad Child Adolesc Psychiatry 1989; 28: 768–72

    CAS  Google Scholar 

  87. Carlson CL, Thomeer ML. Effects of ritalin on arithmetic tasks. In: Greenhill LL, Osman B, editors. Ritalin: theory and patient management. New York: Mary Ann Liebert, 1991: 195–202

    Google Scholar 

  88. Sprague RL, Sleator EK. Methylphenidate in hyperkinetic children: differences in dose effects on learning and social behavior. Science 1977; 198: 1274–6

    PubMed  CAS  Google Scholar 

  89. Sallee F, Stiller R, Perel J. Pharmacodynamics of pemoline in attention deficit disorder with hyperactivity. J Am Acad Child Adolesc Psychiatry 1992; 31: 244–51

    PubMed  CAS  Google Scholar 

  90. Hunt RD, Capper L, O’Connell P. Clonidine in child and adolescent psychiatry. J Child Adolesc Psychopharmacol 1990; 1: 87–102

    PubMed  CAS  Google Scholar 

  91. Biederman J, Gastfriend DR, Jellinek MS. Desipramine in the treatment of children with attention deficit disorder. J Clin Psychopharmacol 1986; 6: 359–63

    PubMed  CAS  Google Scholar 

  92. Biederman J, Baldessarini RJ, Wright V, et al. A double-blind placebo controlled study of desipramine in the treatment of ADD. II: Serum drug levels and cardiovascular findings. J Am Acad Child Adolesc Psychiatry 1989; 28: 903–11

    PubMed  CAS  Google Scholar 

  93. Biederman J, Baldessarini RJ, Wright V, et al. A double-blind placebo controlled study of desipramine in the treatment of ADD. I: Efficacy. J Am Acad Child Adolesc Psychiatry 1989; 28: 777–84

    PubMed  CAS  Google Scholar 

  94. Gualtieri CT, Keenan PA, Chandler M. Clinical and neuropsychological effect on desipramine in children with attention deficit hyperactivity disorder. J Clin Psychopharmacol 1991; 11: 155–9

    PubMed  CAS  Google Scholar 

  95. Satz P, Taylor G, Friel J, et al. Some developmental and predictive precursors of reading disabilities: a six-year follow-up. In: Benton AL, Pearl D, editors. Dyslexia: an appraisal of current knowledge. New York: Oxford University Press, 1978: 315–47

    Google Scholar 

  96. Rourke BP, Orr RR. Prediction of the reading and spelling performances of normal and retarded readers: a four-year followup. J Abnorm Child PsychoI 1977; 5: 9–20

    CAS  Google Scholar 

  97. Schonhaut S, Satz P. Prognosis for children with learning disabilities. A review of follow-up studies. In: Rutter M, editor. Developmental neuropsychiatry. New York: Guilford Press, 1983: 542–63

    Google Scholar 

  98. Apree O. Prognosis of learning disability. J Consult Clin Psychol 1988; 56: 836–41

    Google Scholar 

  99. Baker L, Cantwell DP. A prospective psychiatric follow-up of children with speech/language disorders. J Am Acad Child Adolesc Psychiatry 1987; 26: 546–53

    PubMed  CAS  Google Scholar 

  100. Bender WN. Secondary personality and behavioral problems in adolescents with learning disabilities. J Learn Disabil 1987; 20: 280–5

    PubMed  CAS  Google Scholar 

  101. Silver LB. The misunderstood child: a guide for parents of children with learning disabilities. 2nd ed. New York: McGrawHill, 1992

    Google Scholar 

  102. What happens next? Trends in postschool outcomes of youth with disabilities. The second comprehensive report from the National Longitudinal Transition Study of Special Education Students. Office of Special Education Programs. US Department of Education. SRI International, 1992 Dec: 6-32-6-36

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Neurology, Departments of Neurology and Pediatrics, North Shore University Hospital, Cornell University Medical College, 300 Community Drive, Manhasset, New York, 11030, USA

    Yitzchak Frank

Authors
  1. Yitzchak Frank
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Frank, Y. Learning Disabilities. CNS Drugs 5, 24–36 (1996). https://doi.org/10.2165/00023210-199605010-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00023210-199605010-00003

Keywords

Search

Navigation