Learning Disorders and Psychology: A Treatment Gap

Learning disorders are common, and despite their name, are complex problems with broad psychological impact. They require multifaceted interventions spanning both psychological and academic skills challenges. These issues are implicitly intertwined, and so need to be treated together.

Understanding Learning Disability Terminology

Two terms, “learning disorder” (used by the medical community), and “specific learning disability” (used by schools), both refer to a situation in which a child of normal intellectual potential is experiencing unusual difficulty with their academic functioning that cannot be otherwise explained. The two terms have similar meanings and are often used interchangeably; both refer to what are called “neurodevelopmental” problems. These problems can become apparent at any point in a child’s development and may have different symptoms at different ages.

There are, however, important technical differences between them. “Learning disorder” is a diagnostic term. A licensed professional — usually, a psychologist — diagnoses a person with a learning disorder based on a list of symptoms of processing issues that can create difficulties and stressors for a child. The Diagnostic and Statistical Manual of Mental Orders (DSM), the handbook used by licensed professionals like medical doctors and psychologists to diagnose conditions, recognizes three learning disorders:

• Specific learning disorder in reading
• Specific learning disorder in writing
• Specific learning disorder in math

On the other hand, “learning disability” is a legal term. A public school identifies a student with a learning disability. This may result in legal rights, like the right to special education. Learning disability is also used when cognitive processing differences cause a functional disadvantage to a person affected by that condition. These are often a bit more severe and do meet eligibility criteria for learning disabilities in a particular state. Eligibility criteria differ from state to state although there is a fair amount of overlap. So, a diagnosis by a psychologist or medical doctor may or may not meet eligibility criteria for special education in every state.

As stated on the Learning Disabilities Association of America website, learning disabilities (and learning disorders) are due to genetic and/or neurobiological and environmental factors that alter brain functioning in a manner that affects one or more cognitive processes related to learning. These processing problems can interfere with learning basic skills such as reading, writing, and/or math. They can also interfere with higher level skills such as organization, time planning, abstract reasoning, long or short-term memory and attention. Research estimates suggest that a range from 8-15% of the population have a form of learning disorder, and up to one in five, or 20%, with attentional issues.

Psychological Implications of Learning Disabilities

Learning disorder/disabilities can affect an individual’s life beyond academics, including relationships with family, friends, and in the workplace. Learning disorders and disabilities are complex problems that require multifaceted interventions spanning both psychological and academic skills issues in one or more areas of learning, even when overall intelligence or motivation is not affected. The psychological challenges are implicitly intertwined with and not separable from the learning challenges and need to be treated together. However, current practices often do not take the indivisible nature of the condition into account. Unfortunately, few researchers and/or practitioners address these issues together, resulting in negative consequences.

Although LDs are included in the DSM (as “Specific Learning Disorders” or SLDs) and are considered neurodevelopmental disorders, alongside others such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), they are nonetheless most often treated in educational arenas, and patients often do not receive the psychological help they need (Margolis and Broitman, 2023).

Research clearly establishes that the health needs of people with learning disabilities are typically greater than those of the rest of the population (Health, 2004) and that they are two to three times more likely to experience mental health challenges and psychological distress (Lindsey, 2002; Vedi & Bernard, 2012; Wilson et al., 2009). Individuals with LDs are also reported as more likely to experience anxiety, depression, and suicidal ideation (Svetaz et al., 2000).

Child and adolescent psychopathology can take many forms, and the same symptoms can often occur across diagnostic categories. While there is considerable variability in the extent to which young people with LD experience mental health difficulties, estimates suggest that more than 70% of young people with a language disorder have a psychiatric disorder. This is consistent with what we observe clinically in people with LD: They often have repeated experiences of failing, being accused of letting themselves and other people down, and/or feeling bad about themselves.

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People with LD can and do lead successful and fulfilling lives, but the process can be complicated by their environment. When it is hard to “show what you know,” it is understandable that we might see higher rates of school-related stress (Sparks & Lovett, 2009, Margolis and Broitman, 2023). Practitioners need expertise in both psychological and educational theory, assessment, and treatment to serve their clients well.

Sources of the Problematic Divide

The professional division between special education, clinical psychology, school psychology, and child psychiatry contributes to the fractured current state of LD treatment. As discussed in Learning Disorders Across the Lifespan: Mental Health Framework (2023) (Margolis and Broitman) there are five basic reasons for the professional divides:

1. While early programs of study for pediatric clinicians were focused on understanding psychological factors that influenced children in the context of their development and learning, that changed with a new specialization focus on cognitive, emotional psychological and neuropsychological issues. Two paths emerged beginning the divide: One focused on cognition and one focused on emotion.
2. Social reforms in the late 19th and early 20th centuries including compulsory schooling, resulted in mass education of individuals from diverse backgrounds with a wide range of individual differences in learning processes. The discipline of school psychology arose to identify and treat children with normal development apart from deficits acquiring an academic skill. As special educators have become primary in addressing individual differences in learning in school settings, school psychologists have become experts in assessing children's learning, particularly as needed for access to these special education services.
3. In 1975, Congress passed the landmark legislation of Education for All Handicapped Children Act, (Public Law 94- 142) requiring public schools to provide students with a broad range of disabilities — including “physical handicaps, mental retardation, speech, vision and language problems, emotional and behavioral problems, and other learning disorders” — with a "free appropriate public education." However, following its implementation, interventions for LD only developed in the educational domain and encouraged the further separation of psychological treatment from LD treatment.
4. Because LD is addressed in schools, it has been largely removed from the medical arena and from coverage under health insurance. Most other neurodevelopmental disorders, for example ADHD or ASD, are also addressed in schools but are eligible for psychotherapy. Lack of coverage results in fewer families of children with LD seeking psychological treatment.
5. This failure to reimburse for the costs of psychotherapy conducted with individuals with LD also reduced the likelihood of the development of psychological treatments designed for individuals with SLD. Because research is not generally focused on developing treatment for non-reimbursable events, studies of psychological treatments for LD are infrequently done.

Although each discipline has its unique vantage point and areas of specialty, thinking together about areas of overlap in assessment and treatment would yield better outcomes for individuals with LD. Such integrative approaches will require interdisciplinary efforts across professional training programs that can influence research and practice.

Next up: Labels aren’t all bad – How diagnostic labels can be useful tools when used correctly to identify potential learning and psychological issues.

Useful resources:

1. https://nces.ed.gov/programs/coe/indicator/cgg/students-with-disabilities
2. https://www.healthyplace.com/parenting/learning-disabilities/learning-disabilities-statistics-and-prevalence
3. https://www.crossrivertherapy.com/learning-disabilities-statistics
4. https://ldaamerica.org/lda_today/the-state-of-learning-disabilities-today/
5. https://www.understood.org/en/articles/learning-disabilities-by-the-numbers