Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Specific learning disabilities in children: Evaluation

L Erik von Hahn, MD
Section Editors
Carolyn Bridgemohan, MD
Marc C Patterson, MD, FRACP
Deputy Editor
Mary M Torchia, MD


Learning disabilities (LD) are a heterogeneous group of disorders characterized by the unexpected failure of an individual to acquire, retrieve, and use information competently. They are the most severe, pervasive, and chronic form of learning difficulty in children with average or above-average intellectual abilities [1,2].

LD have a multifactorial etiology [3]. They typically manifest as a failure to acquire reading, writing, or math skills at grade- and age-expected levels. Learning problems that are outside of these traditional core domains, such as memory problems, attention problems, and difficulty managing social interactions, are not typically considered to be LD. However, they may affect reading, writing, and math and may be a separate focus for intervention.

The evaluation of children with LD will be presented here. The clinical features, management, and prognosis of LD and the role of the primary care provider are discussed separately. (See "Specific learning disabilities in children: Clinical features" and "Specific learning disabilities in children: Educational management" and "Specific learning disabilities in children: Role of the primary care provider".)

Educational definitions for LD and a review of special education law, which describes how students can access special education services in school settings, also are provided separately. (See "Definitions of specific learning disability and laws pertaining to learning disabilities in the United States".)


In this topic review, the term "learning disability" (or "specific learning disability") refers to a heterogeneous group of disorders characterized by the unexpected failure of an individual to acquire, retrieve, and use information competently.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Apr 11, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Adelman HS. Toward solving the problems of misidentification and limited intervention efficacy. J Learn Disabil 1989; 22:608.
  2. Adelman HS. LD: the next 25 years. J Learn Disabil 1992; 25:17.
  3. American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists. Joint statement--Learning disabilities, dyslexia, and vision. Pediatrics 2009; 124:837.
  4. Lyon GR. Learning disabilities. Future Child 1996; 6:54.
  5. Keogh BK. A matrix of decision points in the measurement of learning disabilities. In: rames of Reference for the Assessment of Learning Disabilities, Lyon GR (Ed), Paul H. Brooks Publishing Co, Baltimore 1994. p.15.
  6. Definition and criteria for defining students as learning disabled. Federal Register, 42:250, US Government Printing Office; United States Office of Education, Washington, DC, 1977.
  7. National Joint Committee on Learning Disabilities (NJCLD). Operationalizing the NJCLD definition of learning disabilities for ongoing assessment in schools. American Speech-Language Hearing Association 1997. Available at: www.asha.org/docs/html/RP1998-00130.html (Accessed on February 17, 2010).
  8. American Psychiatric Association. Specific learning disorder. In: Diagnostic and Statistical Manual of Mental Disorders, 5th ed, American Psychiatric Association, Arlington, VA 2013. p.66.
  9. Shapiro BK, Gallico RP. Learning disabilities. Pediatr Clin North Am 1993; 40:491.
  10. Wood DM. Discrepancy formulas and classification and identification issues that affect diagnoses of learning disabilities. Psychol Sch 1991; 28:219.
  11. Beitchman JH, Young AR. Learning disorders with a special emphasis on reading disorders: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1997; 36:1020.
  12. Reschly DJ. Identification and assessment of students with disabilities. Future Child 1996; 6:40.
  13. Rispens J, van Yperen TA. How specific are "specific developmental disorders"? The relevance of the concept of specific developmental disorders for the classification of childhood developmental disorders. J Child Psychol Psychiatry 1997; 38:351.
  14. Mather N, Gregg N. Specific learning disabilities: Clarifying, not eliminating, a construct. Prof Psychol Res Pr 2006; 37:99.
  15. Tervo RC. Parent's reports predict their child's developmental problems. Clin Pediatr (Phila) 2005; 44:601.
  16. Glascoe FP, Dworkin PH. The role of parents in the detection of developmental and behavioral problems. Pediatrics 1995; 95:829.
  17. Burgess DB, Asher KN, Doucet HJ 3rd, et al. Parent report as a means of administering the prescreening developmental questionnaire: an evaluation study. J Dev Behav Pediatr 1984; 5:195.
  18. Kenny TJ, Hebel JR, Sexton MJ, Fox NL. Developmental screening using parent report. J Dev Behav Pediatr 1987; 8:8.
  19. Michaud LJ, American Academy of Pediatrics Committee on Children With Disabilities. Prescribing therapy services for children with motor disabilities. Pediatrics 2004; 113:1836.
  20. The pediatrician's role in development and implementation of an Individual Education Plan (IEP) and/or an Individual Family Service Plan (IFSP). American Academy of Pediatrics. Committee on Children with Disabilities. Pediatrics 1999; 104:124.
  21. Schulte EE. Learning disorders: How pediatricians can help. Cleve Clin J Med 2015; 82:S24.
  22. Waldron NL, Mcleskey J, Skiba RJ, et al. High and low referring teachers: Two types of teachers-as-tests? Sch Psychol Int 1998; 19:31.
  23. Lane K, Menzies H. Teacher-identified students with and without academic and behavioral concerns: Characteristics and responsiveness. Behav Disord 2005; 31:65.
  24. Gresham F, MacMillan D. Teachers as 'tests': Differential validity of teacher judgments in identifying students at risk. School Psych Rev 1997; 26:1.
  25. Domscheit-Chaleff C. From Assessment to Instruction: Sharing Assessment Data Effectively. Volta Rev 1996; 98.
  26. Stein MT, Lounsbury B. A child with a learning disability: navigating school-based services. J Dev Behav Pediatr 2004; 25:S33.
  27. Public Law 108-446. Individuals with Disabilities Education Improvement Act of 2004. Available at: www.copyright.gov/legislation/pl108-446.pdf (Accessed on February 08, 2010).
  28. Levine MD. Differences in learning and neurodevelopmental function in school-age children. In: Developmental-Behavioral Pediatrics, 4th ed, Carey WB, Crocker AC, Coleman WL, et al (Eds), Saunders Elsevier, Philadelphia 2009. p.535.
  29. Fletcher JM, Francis DJ, Morris RD, Lyon GR. Evidence-based assessment of learning disabilities in children and adolescents. J Clin Child Adolesc Psychol 2005; 34:506.
  30. Flanagan D, Ortiz S, Alfonso V, Dynda A. Integration of response to intervention and norm-referenced tests in learning disability identification: learning from the Tower of Babel. Psychol Sch 2006; 43:807.
  31. Meyer MS. The ability-achievement discrepancy: does it contribute to an understanding of learning disabilities? Educ Psychol Rev 2000; 12:315.
  32. Siegel LS. Issues in the definition and diagnosis of learning disabilities: a perspective on Guckenberger v. Boston University. J Learn Disabil 1999; 32:304.
  33. Cotton SM, Crewther DP, Crewther SG. Measurement error: Implications for diagnosis and discrepancy models of developmental dyslexia. Dyslexia 2005; 11:186.
  34. Francis DJ, Fletcher JM, Stuebing KK, et al. Psychometric approaches to the identification of LD: IQ and achievement scores are not sufficient. J Learn Disabil 2005; 38:98.
  35. MacMillan DL, Gresham FM, Bocian KM. Discrepancy between definitions of learning disabilities and school practices: an empirical investigation. J Learn Disabil 1998; 31:314.
  36. Waber DP, Weiler MD, Forbes PW, et al. Neurobehavioral factors associated with referral for learning problems in a community sample: evidence for an adaptational model for learning disorders. J Learn Disabil 2003; 36:467.
  37. Fletcher JM, Foorman BR, Boudousquie A, et al. Assessment of reading and learning disabilities: A research-based intervention-oriented approach. J School Psychol 2002; 40:27.
  38. Smart D, Prior M, Sanson A, Oberklaid F. Children with reading difficulties: A six-year follow-up from early primary school to secondary school. Aust J Learn Disabil 2005; 10:63.
  39. Shaywitz SE, Escobar MD, Shaywitz BA, et al. Evidence that dyslexia may represent the lower tail of a normal distribution of reading ability. N Engl J Med 1992; 326:145.
  40. Shaywitz SE, Fletcher JM, Holahan JM, et al. Persistence of dyslexia: the Connecticut Longitudinal Study at adolescence. Pediatrics 1999; 104:1351.
  41. Wilson AM, Lesaux NK. Persistence of phonological processing deficits in college students with dyslexia who have age-appropriate reading skills. J Learn Disabil 2001; 34:394.
  42. Bruck M. Persistence of phonological awareness deficits. Dev Psychol 1992; 28:874.
  43. Gresham F, MacMillan D, Bocian K. Agreement between school study team decisions and authoritative definitions in classification of students at-risk for mild disabilities. Sch Psychol Q 1998; 13:181.
  44. Bocian K, Beebe M, MacMillan D, Gresham F. Competing paradigms in learning disabilties classification by schools and the variations in the meaning of discrepant achievement. Learn Disabil Res Pract 1999; 14:1.
  45. Mellard D, Deshler D, Barth A. LD identification: It's not simply a matter of building a better mousetrap. Learn Disabil Q 2004; 27:229.