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Mental Disorders and Disabilities Among Low-Income Children (2015)

Chapter: 10 Clinical Characteristics of Learning Disabilities

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Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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10

Clinical Characteristics of Learning Disabilities

DIAGNOSIS AND ASSESSMENT

Learning disabilities (LDs) are diagnosed using both educational and medical perspectives (Cortiella and Horowitz, 2014). From an educational perspective, the most commonly used definition is found in the federal special education law, the Individuals with Disabilities Education Act (IDEA). The medical perspective on LDs is reflected in the Diagnostic and Statistical Manual for Mental Disorders (currently the DSM-5 and previously the DSM-IV) published by the American Psychiatric Association (APA, 2013). There is considerable overlap in the definition of LD used by professionals in educational and medical settings (Cortiella and Horowitz, 2014).

Individuals with Disabilities Education Act

IDEA defines a specific learning disability as

a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations. This term includes conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. Specific learning disabilities are not primarily the result of visual, hearing, motor disabilities, mental retardation, emotional disturbance, or of environmental, cultural, or economic disadvantage. (DOE, 1995)

Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Children are typically diagnosed using the IDEA criteria in school settings as a prerequisite to receiving educational interventions and accommodations (Cortiella and Horowitz, 2014). A challenge presented by the IDEA definition is the use of diagnostic nomenclature, such as “perceptual disabilities” and “minimal brain dysfunction,” that are no longer recognized. Among the major forms of learning disabilities, some evidence suggests that dyslexia, or difficulty with reading, may be the most common form (Ferrer et al., 2010). Other major types of specific disabilities include dyscalculia (difficulties with mathematical calculations), dysgraphia (difficulties with writing), and others. In studies where every student is examined, as many as 21.5 percent are found to be dyslexic; in contrast, schools report less than 4 to 5 percent (Ferrer et al., 2010).

Diagnostic and Statistical Manual for Mental Disorders

According to DSM-5, the diagnosis of a specific learning disorder includes the following symptoms:

  1. Persistent difficulties in reading, writing, arithmetic, or mathematical reasoning skills during formal years of schooling. Symptoms may include inaccurate or slow and effortful reading, poor written expression that lacks clarity, difficulties remembering number facts, or inaccurate mathematical reasoning.
  2. Current academic skills must be well below the average range of scores in culturally and linguistically appropriate tests of reading, writing, or mathematics. Accordingly, a person who is dyslexic must read with great effort and not in the same manner as those who are typical readers.
  3. Learning difficulties begin during the school-age years.
  4. The individual’s difficulties must not be better explained by developmental, neurological, sensory (vision or hearing), or motor disorders and must significantly interfere with academic achievement, occupational performance, or activities of daily living (APA, 2013).

Of note, the fourth edition of the DSM (i.e., DSM-IV-TR) did not use a broad category of LD; instead it included several diagnoses specific to impairments in reading, mathematics, and written expression (APA, 2000).

In DSM-IV-TR, LD is diagnosed “when the individual’s achievement on individually administered standardized tests is substantially below that expected for age, schooling, and level of intelligence” (APA, 2000). The DSM-IV-TR approach recognizes three explicitly defined diagnostic categories: reading disorders, mathematics disorders, and disorders of written expression. A residual category, learning disabilities not otherwise specified,

Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

is also provided. These terms are commonly used as equivalent, overall, to the term for learning disability in federal regulations.

The DSM-IV approach, now more than 20 years old, was based on methods that relied on discrepancy scores; that is, a learning difficulty was said to exist in a particular area such as reading when the scores in that particular area were significantly below what would be expected judging by the individual’s overall cognitive ability. The International Classification of Diseases, Ninth Revision, definition of these conditions is rather similar but includes an explicit requirement that the school environment is appropriate to the child’s ability to learn the skill. Sensory deficits can be present, although the additional learning difficulty is diagnosed only when the achievement delays are even greater than would be expected.

DSM-5 has taken a different approach to LDs by broadening the category into a single overall diagnosis. It does not limit the diagnosis to reading, math, or written expression but more generally describes problems in achieved academic skills with the potential for specification of the more traditional areas (APA, 2013). A diagnosis is made based on a clinical review of an individual’s history, teacher reports and academic records, and responses to interventions. Difficulties must be persistent, scores must be well below the range on appropriate measures, and the problems cannot be better explained by other disorders. A significant interference in achievement, occupation, or activities of daily living must be present.

Dyslexia, a term that antedates LD, refers specifically to difficulties with accurate or fluent word recognition, poor spelling, and deficits in coding abilities (International Dyslexia Association, 2015). It continues to be used in both clinical and research contexts and is included under the single DSM-5 umbrella diagnosis of LD.

Standardized Instruments for Assessment

A number of well standardized instruments are available for the assessment of LDs. A measure of cognitive ability, such as the newly developed Weschler Intelligence Scale for Children, is commonly used (Prifitera et al., 2005). Other frequently used measures include Woodcock–Johnson IV, the Wechsler Individual Achievement Test II, and the Wide Range Achievement Test III. Specialized tests are also available, such as the comprehensive test of phonological processing and assessments of fluency such as the Test of Word Reading Efficiency. Assessment results assist with diagnosis, planning for intervention, and identifying any additional comorbid conditions or problems that may interfere with treatment. Children growing up in different cultures should be assessed with different instruments, with the instruments matched to the culture.

Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Response to Treatment Intervention

An awareness of the potential problems with diagnosis led to the introduction of a new concept, response to treatment intervention (RTI), in the 2004 amendment of IDEA. The RTI approach has emerged as a possible alternative to the discrepancy-based diagnostic approach (Vaughn and Fuchs, 2003). This model combines aspects of assessment with intervention, and its approach includes an emphasis on early screening and closer follow-up to clarify the need for additional intervention. Several types of interventions are used, ranging from less to more intensive. The LD diagnosis is made only if these various attempts to modify the child’s regular classroom and program have not been successful or if problems remain with the child’s absolute performance or rate of skill gains. This diagnostic process can be prolonged.

Alternatives to the RTI approach use annual testing to identify students whose skills have not progressed as would be expected and thus who might need more intensive and directed intervention. Another approach uses normalized references to establish which child scores below a preestablished threshold. These issues continue to be widely debated in the field. School districts vary considerably in their approaches to these issues.

DEMOGRAPHIC FACTORS AND DURATION OF THE DISORDER

Age

The National Health Interview Survey (NHIS) estimates the prevalence of any parent-reported LD from 1997 to 2008 to be 5 percent among children 3 to 10 years old, and 9.3 percent for children from 11 to 17 years old (Boyle et al., 2011). LD is a lifelong condition and is unlikely to resolve after a child graduates, although many individuals learn to successfully accommodate for their LDs.

Sex

Multiple sources indicate that the rates of LD are higher among males than females. The 2010 data indicate that for children ages 6 to 17, 2.8 percent of males have an LD, while 1.6 percent of females have an LD. Similarly, IDEA data indicate that 66 percent of students identified with LD are male. The NHIS has consistently shown that males are more likely than females to be diagnosed by a school or health professional as having an LD (Pastor and Reuben, 2008). The NHIS survey estimates the prevalence of any parent-reported learning disabilities from 1997 to 2008 among boys (3–17) to be approximately 9 percent, and among girls to be 5 percent

Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

(Boyle et al., 2011). However, when the identification depends not on teacher identification and parent reports, but rather on direct cognitive assessments of the child, the prevalence of males and females is almost equivalent. Teachers may use the more active and potentially disruptive behavior of males as a factor in a student’s referral for evaluation (Shaywitz, 1990).

Race/Ethnicity

Racial disparities have been observed in the rates of LD among children in some but not other studies. According to NHIS data, the prevalence of LD among black children is generally higher than the prevalence of LD in white or Hispanic children; in 2010, for example, the prevalence of LD among school-aged children was 1.7 percent in white non-Hispanic children, 1.9 percent in black non-Hispanic children, 0.9 percent in Asian children, and 1.2 percent in Latino/Hispanic children. According to the 2011/2012 National Survey of Children’s Health (NSCH), the estimated prevalence of mild LD by race was 3.4 percent for Hispanic children, 4.4 percent for white children, 3.9 percent for black non-Hispanic children, and 3.6 percent for other non-Hispanic children. The NSCH-estimated prevalence for severe LD by race was 3.8 percent for Hispanic children, 3.9 percent for white non-Hispanic children, 5.7 percent for black non-Hispanic children, and 3.2 percent for other non-Hispanic children. Variations in the rates of LD by race must be cautiously interpreted. Even after taking into account the effect of socioeconomic status, there is some evidence that test bias and diagnostic bias contributes to disparities observed between racial or ethnic categories in the identification of children with LD (Coutinho et al., 2002; Jencks and Phillips, 1998).

Socioeconomic Status

Differences in the rates of LD by race and ethnicity must take into account the role of poverty. Studies have consistently shown that the risk of LD is higher among children in poverty. U.S. national data from 2010 indicated that for children of ages 5 to 17, the prevalence of LD was 2.6 percent among children below the federal poverty level (FPL), while the prevalence of LD was 1.5 percent among children above the poverty line. Results of the 2011/2012 NSCH show a direct relationship between poverty and the rates of severe LD. The prevalence rate of severe LD for children in households at 0 to 99 percent FPL is 6.7 percent, at 100 to 199 percent FPL is 4.2 percent, at 200 to 299 percent FPL is 3.3 percent, and at 400 percent FPL or higher is 2.6 percent.

Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

COMORBIDITIES

LDs are frequently associated with certain other conditions, and it is important to consider these conditions in assessing impairment and planning interventions. The recognition of these associated difficulties varies depending on the age of the child and the severity and extent of the learning problems. The recognition of an LD may occur as the child enters school, but the LD may have been preceded by a language delay which does increase the risk of subsequent LDs. LDs are also associated in complex ways with a range of other problems, including attention deficit hyperactivity disorder and disruptive behavior disorders such as conduct disorder. For children with more difficulty, repeated school failure may be associated with the onset of anxiety and depression in middle childhood and adolescence. There may also be an increased risk for bullying, being bullied, or both. Although learning difficulties often do persist into adulthood, many individuals are able to develop compensatory strategies and can do well as adults.

LDs are commonly associated with many medical conditions. A multitude of genetic and congenital conditions have LDs as a frequent phenotypic finding (Kodituwakku, 2007; Mazzocco, 2001; Murphy et al., 2006; Wernovsky et al., 2005). For example, children with spina bifida often have math-related learning difficulties (Barnes et al., 2006; English et al., 2009). Children born prematurely are also at increased risk for LDs, as are children with cerebral palsy (Aarnoudse-Moens et al., 2009; Beckung and Hagberg, 2002). Children with epilepsy and other neurologic conditions often have concurrent LDs which may be easily identified or overlooked because of the complexity of the primary neurologic problem (Prince and Ring, 2011). Additionally, children may manifest LDs as findings that are associated with an unrecognized or newly recognized medical condition such as sleep apnea (Lewin et al., 2002; Sadeh et al., 2002).

FUNCTIONAL IMPAIRMENT

Learning difficulties, including dyslexia, result in significant functional impairments in important life skills such as reading and learning. Recent IDEA data show that children with LD are more likely to experience challenges in academic performance and negative school outcomes, including below-average test scores, lower grades, and higher rates of course failure. The same data show that approximately one-third of children with LDs have been held back a grade in school at least once. Only about 68 percent of children with LDs graduate with a regular diploma, with 19 percent dropping out and 12 percent receiving a certificate of completion. Adults with LDs are less likely to enroll in post-secondary education than

Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

individuals without LDs, and adults with LDs are less likely to be employed than adults without LDs (Spencer et al., 2014).

At the same time, many of these individuals may have reasonably good real-life, or adaptive, skills. The presence of additional, comorbid diagnoses raises the likelihood of disruptions in multiple areas and of impaired functional skills. Even in the absence of a comorbid disorder, some learning difficulties can present challenges for the child in important functional areas, notably in the area of peer interactions. Increased family attention and participation in remedial efforts is an added burden.

In some ways the spectrum of possible early interventions has complicated the data on potential functional impairment. In addition, the largest body of research has focused on the most prevalent and clearly delineated LD, dyslexia, rather than on the outcomes of other areas of impairment.

TREATMENT AND OUTCOMES

Given the various federal mandates for service, many children with significant LDs now receive special help. Most of the available information on treatment and outcome specifically addresses dyslexia or another specific learning disorder. Even in the instances in which students who are dyslexic have received effective interventions, there are no data indicating a closure of the fluency gap; these individuals remain slow readers, although they are often very good thinkers and, with individualized accommodations, can succeed academically.

Many different intervention strategies and accommodations are now available and can help children, adolescents, and adults with LDs. The What Works Clearinghouse, sponsored by the Institute of Education Sciences of the U.S. Department of Education, offers a good source of information concerning which programs are evidence based. No matter how intelligent an affected individual is, dyslexia will impede fluency, so these individuals require extra time to complete reading and writing assignments and to work on examinations. There are also various forms of assistance that can be used to accommodate these individuals, ranging from low tech to very high tech, e.g., visual aids, schedules, organization software, and text-to-speech software.

Treatment planning should be comprehensive, addressing areas of weakness but also recognizing areas of strength. The range of services provided in school can vary from a very intensive level of support, e.g., individualized interventions or special educational classes, to less intensive support, such as additional help in the mainstream classroom or with homework and special tutoring. Support is often also provided through special lesson plans, with individuals grouped according to achievement levels, and frequent assessment and more intensive teacher involvement. Modification

Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

in the classroom setting—e.g., in the placement of the child, modifications in homework, modified test requirements, or extra time on tests—can be helpful. Electronic and other resources, such as the use of computers with spell check, text-to-speech or speech-to-text, and specialized games and learning materials, are also used. There are few data concerning the effectiveness of many of these procedures within the regular classroom.

For students who qualify, the provision of resource room support or special classes along with an individualized education plan is often the most helpful approach. It is important that the school focus on areas of strength as well as weakness, e.g., helping the child achieve in areas such as sports or music as well as in traditional academic areas (Shaywitz, 1990).

Other treatment approaches have been concerned with addressing what are presumed to be underlying problems in information processing, such as attention. LDs often present the child with challenges in other areas, including peer interaction. Support for programs in these areas, as well as the more specifically academic challenges, can be helpful.

While many individuals with learning difficulties lead active and productive lives as adults, others have learning challenges that lead to early withdrawal from school and lower levels of occupational attainment.

FINDINGS

  • LDs are diagnosed in educational and clinical settings. Standardized instruments are available as diagnostic aides.
  • The diagnosis is usually made in school-aged children.
  • Boys are more often identified as having an LD than girls.
  • Academic and employment success can be challenging for those with LDs.
  • Comorbidities are common and add to the likelihood of functional impairment.
  • Appropriate accommodations in educational settings enhance the opportunities for children with LDs to achieve academically and develop real-life skills that allow them to do well as adults.

REFERENCES

Aarnoudse-Moens, C. S., N. Weisglas-Kuperus, J. B. van Goudoever, and J. Oosterlaan. 2009. Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics 124(2):717–728.

APA (American Psychiatric Association). 2000. Diagnostic and statistical manual of mental disorders, 4th edition, text revision. Washington, DC: APA.

APA. 2013. Diagnostic and statistical manual of mental disorders. Washington, DC: APA.

Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Barnes, M. A., M. Wilkinson, E. Khemani, A. Boudesquie, M. Dennis, and J. M. Fletcher. 2006. Arithmetic processing in children with spina bifida: Calculation accuracy, strategy use, and fact retrieval fluency. Journal of Learning Disabilities 39(2):174–187.

Beckung, E., and G. Hagberg. 2002. Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Developmental Medicine & Child Neurology 44(5):309–316.

Boyle, C. A., S. Boulet, L. A. Schieve, R. A. Cohen, S. J. Blumberg, M. Yeargin-Allsopp, S. Visser, and M. D. Kogan. 2011. Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics 127:1034–1042.

Cortiella, C., and S. H. Horowitz. 2014. The state of learning disabilities: Facts, trends, and emerging issues. https://www.ncld.org/wp-content/uploads/2014/11/2014-State-of-LD.pdf (accessed August 13, 2014).

Coutinho, M. J., D. P. Oswald, and A. M. Best. 2002. The influence of sociodemographics and gender on the disproportionate identification of minority students as having learning disabilities. Remedial and Special Education 23(1):49–59.

DOE (U.S. Department of Education). 1995. Individuals with Disabilities Education Act Amendments of 1995: Reauthorization of the Individuals with Disabilities Education Act (IDEA). Washington, DC: DOE.

English, L. H., M. A. Barnes, H. B. Taylor, and S. H. Landry. 2009. Mathematical development in spina bifida. Developmental Disabilities Research Reviews 15(1):28–34.

Ferrer, E., B. A. Shaywitz, J. M. Holahan, K. Marchione, and S. E. Shaywitz. 2010. Uncoupling of reading and IQ over time: Empirical evidence for a definition of dyslexia. Psychological Science 21(1):93–101.

International Dyslexia Association. 2015. Definition of dyslexia. http://eida.org/definition%20of%20dyslexia/?gclid=Clrl-MHMqMUCFFdgUc (accessed July 6, 2015).

Jencks, C., and M. Phillips. 1998. The black-white test score gap. Washington, DC: Brookings Institution Press. http://site.ebrary.com/id/10224504 (accessed July 1, 2015).

Kodituwakku, P. W. 2007. Defining the behavioral phenotype in children with fetal alcohol spectrum disorders: A review. Neuroscience & Biobehavioral Reviews 31(2):192–201.

Lewin, D. S., R. C. Rosen, S. J. England, and R. E. Dahl. 2002. Preliminary evidence of behavioral and cognitive sequelae of obstructive sleep apnea in children. Sleep Medicine 3(1):5–13.

Mazzocco, M. M. 2001. Math learning disability and math LD subtypes: Evidence from studies of Turner syndrome, fragile X syndrome, and neurofibromatosis type 1. Journal of Learning Disabilities 34(6):520–533.

Murphy, M. M., M. M. Mazzocco, G. Gerner, and A. Henry. 2006. Mathematics learing disability in girls with Turner syndrome or fragile X syndrome. Brain and Cognition 61(2):195–210.

Pastor, P. N., and C. A. Reuben. 2008. Diagnosed attention deficit hyperactivity disorder and learning disability: United States, 2004–2006. National Center for Health Statistics. Vital and Health Statistics 10(237). http://www.cdc.gov/nchs/data/series/sr_10/sr10_237.pdf (accessed June 6, 2015).

Prifitera, A., D. H. Saklofske, and L. G. Weiss. 2005. WISC-IV clinical use and interpretation: Scientist–practitioner perspectives. New York: Academic Press.

Prince, E., and H. Ring. 2011. Causes of learning disability and epilepsy: A review. Current Opinion in Neurology 24(2):154–158.

Sadeh, A., R. Gruber, and A. Raviv. 2002. Sleep, neurobehavioral functioning, and behavior problems in school-age children. Child Development 73(2):405–417.

Shaywitz, S. E. 1990. Prevalence of reading disability in boys and girls. JAMA 264(8):998–1002.

Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Spencer, T. J., S. V. Faraone, L. Tarko, K. McDermott, and J. Biederman. 2014. Attention-deficit/hyperactivity disorder and adverse health outcomes in adults. The Journal of Nervous and Mental Disease 1.

Vaughn, S., and L. S. Fuchs. 2003. Redefining learning disabilities as inadequate response to instruction: The promise and potential problems. Learning Disabilities Research & Practice 18(3):137–146.

Wernovsky, G., A. J. Shillingford, and J. W. Gaynor. 2005. Central nervous system outcomes in children with complex congenital heart disease. Current Opinion in Cardiology 20(2):94–99.

Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
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Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
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Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
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Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 185
Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 186
Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
Page 187
Suggested Citation:"10 Clinical Characteristics of Learning Disabilities." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Children living in poverty are more likely to have mental health problems, and their conditions are more likely to be severe. Of the approximately 1.3 million children who were recipients of Supplemental Security Income (SSI) disability benefits in 2013, about 50% were disabled primarily due to a mental disorder. An increase in the number of children who are recipients of SSI benefits due to mental disorders has been observed through several decades of the program beginning in 1985 and continuing through 2010. Nevertheless, less than 1% of children in the United States are recipients of SSI disability benefits for a mental disorder.

At the request of the Social Security Administration, Mental Disorders and Disability Among Low-Income Children compares national trends in the number of children with mental disorders with the trends in the number of children receiving benefits from the SSI program, and describes the possible factors that may contribute to any differences between the two groups. This report provides an overview of the current status of the diagnosis and treatment of mental disorders, and the levels of impairment in the U.S. population under age 18. The report focuses on 6 mental disorders, chosen due to their prevalence and the severity of disability attributed to those disorders within the SSI disability program: attention-deficit/hyperactivity disorder, oppositional defiant disorder/conduct disorder, autism spectrum disorder, intellectual disability, learning disabilities, and mood disorders. While this report is not a comprehensive discussion of these disorders, Mental Disorders and Disability Among Low-Income Children provides the best currently available information regarding demographics, diagnosis, treatment, and expectations for the disorder time course - both the natural course and under treatment.

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