Specific Learning Disabilities: The Family Physician's Role

 

Am Fam Physician. 2019 Nov 15;100(10):628-635.

Author disclosure: No relevant financial affiliations.

Academic underachievement, such as failing a class and the threat of being held back because of academic issues, is common. Family physicians can provide support and guidance for families as they approach their child's unique academic challenges. Specific learning disabilities are a group of learning disorders (e.g., dyscalculia, dysgraphia, dyslexia) that impede a child's ability to learn. Understanding standard educational terms; looking for medical, family, and social risk factors associated with academic underachievement; and investigating the medical differential for academic underachievement can help direct the family to appropriate care. The physician can provide medical documentation to support an individualized education program evaluation and address risk factors that schools may not be aware of or cannot assess. The family physician can support children and families by understanding the connection between risk factors, medical and educational evaluations, and educational resources.

Many school-aged children experience academic underachievement by not being able to maintain average grades, failing a single class, performing below their grade level in one or more subjects, or receiving below-average scores on state or classroom tests. The number of public school students in the United States who receive special education support increased from 8.3% in 1976 to 1977 to 13.8% in 2004 to 2005. A large portion of the overall increase is attributed to the number of students who are now eligible for services because of a specific learning disability (currently 4.6% or 2.3 million persons).1 This article outlines an approach to the evaluation of academic underachievement with a focus on specific learning disabilities.

 Enlarge     Print

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Consider the medical, family history, and social risk factors associated with academic underachievement to share with the family.3,13,34

C

Expert opinion and observational studies in the absence of clinical trials

When indicated perform a detailed physical examination (e.g., skin findings, neurologic differences) and administer an age-appropriate developmental-behavioral screening tool to evaluate for academic underachievement.3,9,13,14,16,23,25

C

Expert opinion and review articles in the absence of clinical trials

A child receiving an evaluation from a school for a specific learning disability should also receive a medical evaluation for possible comorbidities that can impact learning, attention, and other academic skills.3,13,17,23,25,27,28

C

Surveys and studies on specific comorbidities found in children with specific learning disabilities

Communication between the physician and the school can help families advocate for their child's needs in the school setting.22,30,35

C

Special education law that requires medical input for several eligibilities


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Consider the medical, family history, and social risk factors associated with academic underachievement to share with the family.3,13,34

C

Expert opinion and observational studies in the absence of clinical trials

When indicated perform a detailed physical examination (e.g., skin findings, neurologic differences) and administer an age-appropriate developmental-behavioral screening tool to evaluate for academic underachievement.3,9,13,14,16,23,25

C

Expert opinion and review articles in the absence of clinical trials

A child receiving an evaluation from a school for a specific learning disability should also receive a medical evaluation for possible comorbidities that can impact learning, attention, and other academic skills.3,13,17,23,25,27,28

C

Surveys and studies on specific comorbidities found in children with specific learning disabilities

Communication between the physician and the school can help families advocate for their child's needs in the school setting.22,30,35

C

Special education law that requires medical input for several eligibilities


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

Specific Learning Disabilities

Specific learning disabilities are a group of disorders that impede a child's

The Authors

show all author info

MICHELLE J. CURTIN, DO, FAAP, is the director of the School Success Clinic and an assistant professor of clinical pediatrics in the Department of Pediatrics at Indiana University Riley Children's Hospital in Indianapolis....

DEANNA R. WILLIS, MD, MBA, FAAFP, is an Otis R. Brown endowed professor in the Department of Family Medicine at Indiana University School of Medicine.

BRETT ENNEKING, PsyD, is an assistant professor of clinical pediatrics in the Department of Pediatrics at Indiana University School of Medicine.

Address correspondence to Michelle J. Curtin, DO, FAAP, Indiana University, 1002 Wishard Blvd., Ste. 3120, Indianapolis, IN 46202 (email: mjcurtin@iu.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. U.S. Department of Education, National Center for Education Statistics. Digest of Education Statistics, 2018, Table 204.30. 2019. Children 3 to 21 years old served under Individuals with Disabilities Education Act (IDEA), Part B, by type of disability: selected years, 1976–77 through 2017–18. Accessed August 15, 2019. https://nces.ed.gov/fastfacts/display.asp?id=64...

2. Landerl K, Moll K. Comorbidity of learning disorders: prevalence and familial transmission. J Child Psychol Psychiatry. 2010;51(3):287–294.

3. Schieve LA, Gonzalez V, Boulet SL, et al. Concurrent medical conditions and health care use and needs among children with learning and behavioral developmental disabilities, National Health Interview Survey, 2006–2010. Res Dev Disabil. 2012;33(2):467–476.

4. Haworth CM, Kovas Y, Harlaar N, et al. Generalist genes and learning disabilities: a multivariate genetic analysis of low performance in reading, mathematics, language and general cognitive ability in a sample of 8000 12-year-old twins. J Child Psychol Psychiatry. 2009;50(10):1318–1325.

5. Samango-Sprouse CA, Stapleton EJ, Mitchell FL, et al. Expanding the phenotypic profile of boys with 47, XXY: the impact of familial learning disabilities. Am J Med Genet A. 2014;164A(6):1464–1469.

6. Friend A, DeFries JC, Olson RK. Parental education moderates genetic influences on reading disability. Psychol Sci. 2008;19(11):1124–1130.

7. Rosenberg J, Pennington BF, Willcutt EG, et al. Gene by environment interactions influencing reading disability and the inattentive symptom dimension of attention deficit/hyperactivity disorder. J Child Psychol Psychiatry. 2012;53(3):243–251.

8. Dilnot J, Hamilton L, Maughan B, et al. Child and environmental risk factors predicting readiness for learning in children at high risk of dyslexia. Dev Psychopathol. 2017;29(1):235–244.

9. Coutinho V, Kemlin I, Dorison N, et al. Neuropsychological evaluation and parental assessment of behavioral and motor difficulties in children with neurofibromatosis type 1. Res Dev Disabil. 2016;48:220–230.

10. Johnson S, Strauss V, Gilmore C, et al. Learning disabilities among extremely preterm children without neurosensory impairment: comorbidity, neuropsychological profiles and scholastic outcomes. Early Hum Dev. 2016;103:69–75.

11. Reinke WM, Herman KC, Petras H, et al. Empirically derived subtypes of child academic and behavior problems: co-occurrence and distal outcomes. J Abnorm Child Psychol. 2008;36(5):759–770.

12. Cho K, Frijters JC, Zhang H, et al. Prenatal exposure to nicotine and impaired reading performance. J Pediatr. 2013;162(4):713–718.e2.

13. O'Callaghan FV, Al Mamun A, O'Callaghan M, et al. Is smoking in pregnancy an independent predictor of academic difficulties at 14 years of age? A birth cohort study. Early Hum Dev. 2010;86(2):71–76.

14. Oei JL, Melhuish E, Uebel H, et al. Neonatal abstinence syndrome and high school performance. Pediatrics. 2017;139(2):e20162651.

15. Ekström AB, Hakenäs-Plate L, Tulinius M, et al. Cognition and adaptive skills in myotonic dystrophy type 1: a study of 55 individuals with congenital and childhood forms. Dev Med Child Neurol. 2009;51(12):982–990.

16. Brankaer C, Ghesquière P, De Wel A, et al. Numerical magnitude processing impairments in genetic syndromes: a cross-syndrome comparison of Turner and 22q11.2 deletion syndromes. Dev Sci. 2017;20(6):e12458.

17. Elbro C, Dalby M, Maarbjerg S. Language-learning impairments: a 30-year follow-up of language-impaired children with and without psychiatric, neurological and cognitive difficulties. Int J Lang Commun Disord. 2011;46(4):437–448.

18. Fantuzzo J, LeBoeuf W, Rouse H, et al. Academic achievement of African American boys: a city-wide, community-based investigation of risk and resilience. J Sch Psychol. 2012;50(5):559–579.

19. Shonkoff JP, Garner AS; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012;129(1):e232–e246.

20. Kovaleski JF, VanDerHeyden AM, Shapiro ES. The RTI Approach to Evaluating Learning Disabilities. The Guilford Press; 2013.

21. Fletcher JM, Lyon RG, Barnes M, et al. Classification of learning disabilities: an evidence based evaluation. In: Bradley R, Danielson LC, Hallahan DP, eds. Identification of Learning Disabilities: Research to Practice. Erlbaum. 2002:185–250.

22. U.S. Department of Education. Individuals with Disabilities Education Act, 20 U.S.C. § 1400. 2004. Accessed January 29, 2019. https://sites.ed.gov/idea/statute-chapter-33

23. Khairi Md Daud M, Noor RM, Rahman NA, et al. The effect of mild hearing loss on academic performance in primary school children. Int J Pediatr Otorhinolaryngol. 2010;74(1):67–70.

24. Genizi J, Khourieh Matar A, Schertz M, et al. Pediatric mixed headache - the relationship between migraine, tension-type headache and learning disabilities - in a clinic-based sample. J Headache Pain. 2016;17:42.

25. Creavin AL, Lingam R, Steer C, et al. Ophthalmic abnormalities and reading impairment. Pediatrics. 2015;135(6):1057–1065.

26. Schulte-Körne G. Mental health problems in a school setting in children and adolescents. Dtsch Arztebl Int. 2016;113(11):183–190.

27. Mishna F. Learning disabilities and bullying: double jeopardy. J Learn Disabil. 2003;36(4):336–347.

28. Fakier N, Wild LG. Associations among sleep problems, learning difficulties and substance use in adolescence. J Adolesc. 2011;34(4):717–726.

29. Horowitz SH, Rawe J, Whittaker MC. The State of Learning Disabilities: Understanding the 1 in 5. National Center for Learning Disabilities; 2017.

30. U.S. Department of Education. Office for Civil Rights. Protecting students with disabilities. Updated September 25, 2018. Accessed January 29, 2019. https://www2.ed.gov/about/offices/list/ocr/504faq.html#interrelationship

31. Catts HW, Nielsen DC, Bridges MS, et al. Early identification of reading disabilities within an RTI framework. J Learn Disabil. 2015;48(3):281–297.

32. Fuchs D, Fuchs LS. Introduction to response to intervention: what, why, and how valid is it? Read Res Q. 2006;41(1):93–99.

33. Yudin MK. Dyslexia guidance. October 23, 2015. Accessed January 29, 2019. https://www2.ed.gov/policy/speced/guid/idea/memosdcltrs/guidance-on-dyslexia-10-2015.pdf

34. Musgrove M. OSEP Memo: 11-07 Response to Intervention (RTI). January 21, 2011. Accessed February 21, 2019. https://sites.ed.gov/idea/idea-files/osep-memo-11-07-response-to-intervention-rti-memo/

35. Bravender T. School performance: the pediatrician's role. Clin Pediatr (Phila). 2008;47(6):535–545.

36. Hamilton SS, Glascoe FP. Evaluation of children with reading difficulties. Am Fam Physician. 2006;74(12):2079–2084. Accessed September 17, 2018. https://www.aafp.org/afp/2006/1215/p2079.html

37. Committee on Practice and Ambulatory Medicine; Bright Futures Periodicity Schedule Workgroup. 2017 recommendations for preventive pediatric health care. Pediatrics. 2017;139(4):e20170254.

38. Summaries for patients. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(5).

 

 

Copyright © 2019 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

More in Pubmed

MOST RECENT ISSUE


Dec 1, 2019

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article