The diagnosis, Specific Learning Disorders, is technically still pretty new, but it does not mean it is a new disorder. In reality, it is the rebranding of Specific Learning Disabilities to reflect how it is perceived in the medical field and includes two significant changes to the diagnostic criteria based on the latest research in the field of Special Education and Educational Psychology.
Why did the change the name of the of Specific Learning Disability to Specific Learning Disorder?
In 2013, the term Specific Learning Disorder (SLD) replaced the term of Specific Learning Disability. This change was made by the American Psychiatric Association when they published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-5).
If you think of the following medical diagnoses: Autism Spectrum Disorder, Thyroid Disorder, Bipolar Disorder, Generalized Anxiety Disorder or Attention Deficit/Hyperactive Disorder; all of these terms use the word disorder instead of disability. In medicine, a disorder is considered to be an abnormality of function, whereas the term disability typically refers to someone’s physical body.
The change from ‘disability’ to ‘disorder’ in 2013, allows the term SLD to be more in line with other terminology for recognized medical conditions. It also highlights the neurodevelopmental nature of an SLD, meaning the brain of an individual with an SLD interprets information in a different manner than someone without an SLD.
Isn’t it wonderful that the medical world recognizes the existence of neurologically-based learning problems. Don’t get upset if they call these problems a learning disorder rather a learning disability.
Larry B. Silver M.D.
Changes in Diagnostic Criteria
The change in terminology also brought two significant changes to the diagnostic criteria. These changes were made, so the diagnostic criteria reflected the advances in research on SLD since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Text Revision).
In the DSM-5, SLD became an overarching category with specifiers relating to the three major academic areas (reading, writing, and mathematics). This means that at the time of assessment, the report can categorize the areas that are affected by the SLD. An individual with an SLD can have an impairment in one, two or all three of these areas.
The second significant change was the removal of the need for an individual to have an IQ-achievement discrepancy. Instead, individuals must meet all four of the following criteria:
- Their symptoms must have occurred for a minimum of 6 months even after receiving extra help or targeted interventions
- This means that an individual is not just experiencing the symptoms because they did not receive proper instruction for the area of difficulty.
- They must be performing below the expected age level based on a standardized test of achievement and through a clinical assessment.
- This means while they do not have to have a discrepancy between their IQ and their achievement, they do have to be performing below what is expected for their age.
- These difficulties must have started during the individual’s school years.
- There has to be a history of difficulty throughout the individual’s childhood and adolescent years. This does not mean someone cannot be diagnosed with an SLD as an adult. It just means they must provide evidence that they had these difficulties during their formal education.
- Other causes such as disorders or adverse conditions must be ruled out before a diagnosis of SLD is given.
- This does not rule out the possibility for comorbid or co-occurring conditions, it just means that professionals have to take extra care in the diagnostic process.
- If there is another medical disorder that better explains why an individual is showing these symptoms, the clinician must decide if the diagnosis of an SLD is still appropriate.
- If the individual is experiencing the symptoms because they have not provided with appropriate educational opportunities, the individual should not be provided with an SLD.
What do these changes mean?
The abandonment of the IQ-Achievement discrepancy requirement for a diagnosis of an SLD was a significant step forward for diagnostic and intervention purposes. This means that children can be identified after six months of showing struggles with reading, writing or mathematics, instead of waiting for the gap between their IQ and their achievement on a standardized test to be big enough to meet the diagnostic criteria for an SLD.
This means that children can be identified as having an SLD during the first few years of school when interventions are most efficient and effective. Early identification means the gap between the achievement of these individuals and their peers will not be as large which means there is less material that needs to be covered in order to ‘catch up’ to their peers.
Early identification allows students to access any accommodations and assistive technology they need to succeed from early on in their educational career.
The changes to the diagnostic criteria in the DSM-5 allow for a collaborative approach during the diagnostic process. It requires educators, educational psychologist and parents to create a portfolio that includes both formal and informal school records, samples of the individual’s work, information regarding the individual’s instructional history in addition to the formal psychoeducational or clinical assessment.
An SLD is still considered a medical disorder and does have strict diagnostic criteria and does still require a formal psychoeducational assessment. However, the assessment no longer requires the same focus on cognitive processing. This means that the psychoeducational assessment can move its focus from being an assessment for diagnosis to more of an assessment for interventions. This means the report from the psychoeducational assessment can focus more on the best interventions for the individual instead of just highlighting their areas of weakness.
The term Specific Learning Disorder is a clinical diagnosis and not a label, this means in order for someone to be diagnosed with an SLD they have to meet the diagnostic criteria that are set out in the DSM-5.
SLD is not necessarily a synonymous term for ‘learning disability’ which is commonly used in the education system. Just because an individual is considered to have a learning disability in the school system, it does not guarantee that they will meet the diagnostic criteria for an SLD. However, any individual who has been clinically diagnosed with an SLD should be considered to have a learning disability.
If someone was diagnosed with a Specific Learning Disability, they should also meet the diagnostic criteria of a Specific Learning Disorder. If someone did not quite meet the diagnostic criteria for a Specific Learning Disability, they might now reach the diagnostic criteria for a Specific Learning Disorder.