DSM-5 Diagnostic Criteria for Specific Learning Disorder
Specific Learning Disorder involves persistent difficulties in learning key academic skills.
Criterion A: Difficulties in Learning Academic Skills
Requirements: At least ONE of the following symptoms persisting for at least 6 months, despite targeted interventions:
1. Reading Difficulties:
- Inaccurate or slow word reading: Reads words incorrectly, slowly, or hesitatingly
- Difficulty understanding reading: Poor comprehension despite accurate reading
- Poor reading fluency: Choppy, laborious reading
- Problems with decoding: Difficulty sounding out words
- Letter-sound correspondence: Trouble connecting letters to sounds
2. Written Expression Difficulties:
- Spelling difficulties: Inconsistent or inaccurate spelling
- Grammar and punctuation errors: Incorrect usage despite instruction
- Poor written organization: Difficulty organizing thoughts in writing
- Clarity issues: Unclear or imprecise written expression
- Handwriting problems: Slow, effortful, or illegible writing
3. Mathematics Difficulties:
- Poor number sense: Difficulty understanding quantity, magnitude, relationships
- Trouble memorizing math facts: Can’t recall addition, multiplication tables
- Inaccurate calculation: Makes frequent errors in computation
- Difficulty with reasoning: Struggles with word problems, mathematical concepts
- Slow math processing: Takes longer to solve problems
Criterion B: Below Expected Academic Performance
Requirements:
- Affected academic skills are substantially and quantifiably below those expected for age
- Causes significant interference with:
- Academic performance
- Occupational performance
- Activities of daily living requiring these skills
Assessment:
- Standardized achievement tests: Scores typically 1.5-2 standard deviations below expected
- Clinical synthesis: Professional judgment considering:
- Test scores
- Teacher reports
- Academic history
- Work samples
Criterion C: School-Age Onset
Requirements:
- Difficulties begin during school-age years
- May not fully manifest until later when academic demands exceed abilities
- Not apparent until reading, writing, or math requirements exceed capacity
Note: Some individuals compensate in early grades; problems emerge later (middle school, high school, college)
Criterion D: Exclusion Criteria
Difficulties are NOT better explained by:
1. Intellectual Disability:
- Learning difficulties are beyond what expected for intellectual level
- If ID present, learning problems exceed those typically associated with it
2. Uncorrected Visual or Auditory Problems:
- Vision or hearing impairments must be ruled out or corrected
- Learning problems persist even with glasses, hearing aids
3. Other Neurological or Mental Disorders:
- Not due to neurological conditions (stroke, brain injury)
- Not due to mental disorders (anxiety, depression) as primary cause
4. Psychosocial Adversity:
- Not primarily due to poverty, trauma, abuse
- Though these may be risk factors
5. Lack of Proficiency in Language of Academic Instruction:
- Not simply due to being English language learner
- Learning problems present in native language too
6. Inadequate Educational Instruction:
- Has received adequate, appropriate instruction
- Problems persist despite quality teaching
- Intervention has been provided but insufficient progress
Specify Type and Severity
Specify Area(s) of Impairment:
With Impairment in Reading:
- Word reading accuracy
- Reading rate or fluency
- Reading comprehension
Note: Often called Dyslexia, an alternative term for pattern of learning difficulties characterized by problems with accurate or fluent word recognition, poor decoding, and spelling. If used, specify the learning difficulties.
With Impairment in Written Expression:
- Spelling accuracy
- Grammar and punctuation accuracy
- Clarity or organization of written expression
Note: Often called Dysgraphia, an alternative term for pattern of difficulties with written expression, particularly handwriting and spelling.
With Impairment in Mathematics:
- Number sense
- Memorization of arithmetic facts
- Accurate or fluent calculation
- Accurate math reasoning
Note: Often called Dyscalculia, an alternative term for pattern of difficulties characterized by problems processing numerical information, learning arithmetic facts, performing accurate calculations.
Multiple Areas: Can specify if more than one domain is affected
Specify Current Severity:
Mild:
- Some difficulties in one or two academic domains
- May be able to compensate with appropriate accommodations
- Can achieve adequately with support during school years
Moderate:
- Marked difficulties in one or more academic domains
- Unlikely to become proficient without intensive specialized instruction
- May require extended time, accommodations, or assistive technology
Severe:
- Severe difficulties across multiple academic domains
- Unlikely to learn academic skills without ongoing intensive specialized instruction
- Even with supports, may not achieve proficiency
- May require extensive accommodations and support services
Common Presentations by Type
Reading Impairment (Dyslexia)
Typical Signs:
- Confusing similar letters (b/d, p/q)
- Reversing letter sequences (“saw” for “was”)
- Omitting or adding words when reading
- Difficulty learning letter-sound rules
- Slow reading pace
- Avoiding reading activities
- Poor spelling
- Reading comprehension problems despite adequate intelligence
Most Common: Affects approximately 80% of individuals with learning disorders
Written Expression Impairment (Dysgraphia)
Typical Signs:
- Illegible handwriting
- Inconsistent spacing between letters/words
- Difficulty organizing thoughts on paper
- Frequent spelling errors
- Poor grammar despite knowing rules
- Avoidance of writing tasks
- Very slow writing
- Discrepancy between oral and written expression
Mathematics Impairment (Dyscalculia)
Typical Signs:
- Difficulty understanding number concepts
- Trouble with mental math
- Can’t memorize math facts
- Difficulty with word problems
- Confusion with mathematical symbols
- Poor spatial sense affecting geometry
- Trouble telling time, counting money
- Difficulty estimating
Associated Features
Academic Impact:
- Frustration with schoolwork
- School avoidance or refusal
- Falling behind grade level
- Need for special education services
- Taking longer to complete assignments
Psychological Impact:
- Low self-esteem
- Anxiety about school performance
- Behavioral problems
- Depression
- Somatic complaints (headaches, stomachaches)
Social Impact:
- Peer relationship difficulties
- Being teased or bullied
- Social withdrawal
- Feeling “stupid” despite normal intelligence
Differential Diagnosis
Must Distinguish From:
Normal Variation: Some children are slower learners but don’t meet criteria for disorder
Intellectual Disability: Global impairment vs. specific academic deficit
Language Disorders: Language problems may affect reading but are more pervasive
ADHD: Attention problems can affect academic performance but are different from learning disorder
Lack of Opportunity: Inadequate schooling vs. true learning disability
Visual/Hearing Problems: Must be corrected; if problems persist, may be learning disorder
Comorbidity
Commonly Co-occurs With:
- ADHD (30-50% comorbidity)
- Developmental coordination disorder
- Communication disorders
- Anxiety disorders
- Depressive disorders
- Behavioral disorders
Assessment Requirements
Comprehensive Evaluation Includes:
- Standardized Achievement Tests: Reading, writing, math assessment
- Intelligence Testing: To confirm normal cognitive ability
- Processing Assessment: Phonological processing, working memory, processing speed
- Educational History: Report cards, teacher input, work samples
- Developmental History: Early milestones, family history
- Medical Examination: Rule out vision, hearing, neurological problems
- Behavioral/Emotional Assessment: Screen for comorbid conditions
- Response to Intervention (RTI): Document that appropriate instruction was provided
Key Diagnostic Points for Exams
- Duration: Symptoms must persist for at least 6 months despite interventions
- Three types: Reading, Writing, Mathematics (can have more than one)
- Normal intelligence: Key distinction from intellectual disability
- Significantly below expected: Must cause substantial academic difficulty
- School-age onset: Begins when formal education starts
- Multiple exclusions: Must rule out sensory problems, inadequate instruction, language barriers, etc.
- Severity levels: Mild, Moderate, Severe
- Alternative terms: Dyslexia (reading), Dysgraphia (writing), Dyscalculia (math)
- High comorbidity with ADHD: Often occur together
- Comprehensive assessment required: Can’t diagnose without thorough evaluation