DSM-5 Perspective on Specific Learning Disorder

The DSM-5 takes a dimensional and integrative approach toward learning disorders. Rather than having
separate disorders for reading, writing, and mathematics, it consolidates them under a single diagnostic
category called Specific Learning Disorder (SLD).
This diagnosis applies when individuals have persistent difficulties in learning and using academic skills,
which are significantly below what is expected for their age, and which interfere with academic or
occupational performance.

The DSM-5 outlines the following:

 Core symptoms must have persisted for at least 6 months, despite the provision of interventions.
 The difficulties must begin during school-age years, though they may not become fully evident until
academic demands exceed individual capacities.
 It is a lifelong condition, although severity may vary over time.

Specifiers are added to indicate the affected academic area:

 With impairment in reading (also referred to as dyslexia)
 With impairment in written expression (also referred to as dysgraphia)
 With impairment in mathematics (also referred to as dyscalculia)

Each of these specifiers can be further detailed based on the particular sub-skills affected, such as:
 Reading accuracy
 Reading fluency
 Spelling
 Grammar and punctuation accuracy
 Number sense
 Mathematical reasoning

Severity levels are also identified as:

 Mild
 Moderate
 Severe
This categorical and specifier-based model helps clinicians develop targeted intervention plans.

Comparison Between DSM-5 and ICD-10/ICD-11

The ICD and DSM systems differ in how they classify learning disorders:
 DSM-5 uses a single diagnosis with specifiers.
 ICD-10 and ICD-11 separate learning disorders into distinct categories such as:
o Developmental disorder of reading (ICD: dyslexia)
o Developmental disorder of written expression
o Developmental disorder of mathematics (dyscalculia)
o Mixed developmental learning disorder

This separation can be helpful in educational settings for resource allocation, but the DSM model
emphasizes shared underlying cognitive deficits and overlapping features.
Including this comparison in your module will demonstrate an advanced understanding of nosological
frameworks used internationally.

Etiology and Neurobiological Factors

Specific Learning Disorders are not caused by lack of motivation, poor teaching, or environmental
disadvantage alone. They are neurodevelopmental in origin and involve complex interactions between
genetic, neurological, and environmental factors.
 Genetic influences: SLDs tend to run in families, particularly dyslexia. Studies have shown heritability
estimates of up to 60% in reading disorders.
 Brain imaging studies: Functional MRI scans in individuals with dyslexia show differences in brain
activation patterns, particularly in areas associated with phonological processing such as:
o The left temporo-parietal region
o The left occipito-temporal region
o The inferior frontal gyrus
 Language and auditory processing deficits: Children with dyslexia often exhibit weaknesses in
phonological awareness—the ability to recognize and manipulate the sounds in language. This impairs
decoding skills necessary for reading.
 Cognitive deficits: In SLD-math (dyscalculia), impairments may be observed in working memory,
number sense, and visuospatial processing.
 Environmental contributions: Although biological in origin, environmental factors like poor
instruction or inconsistent schooling may exacerbate symptoms.

Understanding the neurobiological foundation of SLD emphasizes that it is not a matter of effort or
intelligence but of specific neurological wiring that affects skill acquisition.

Psychosocial and Emotional Impact

Specific Learning Disorders can lead to profound emotional and social consequences if not addressed early.
 Self-esteem issues: Children struggling with academics while their peers progress normally often
develop feelings of inadequacy and inferiority. This can contribute to long-term self-esteem issues.
 School-related anxiety: Persistent failures may lead to anxiety related to specific academic subjects.
Children may begin to avoid school altogether or feign illness.
 Social withdrawal and isolation: Because of repeated failures, some children with SLD avoid peer
interactions, leading to poor social development.
 Behavioral issues: Frustration over academic tasks may lead to oppositional behavior, irritability, or
even aggression in some cases.
 Family stress: Misunderstanding or stigma around the disorder may cause family conflict,
disappointment, or neglect if the child is unfairly labeled as “lazy” or “disobedient.”

Addressing these psychosocial components is as important as academic remediation. Multidisciplinary

interventions including counseling, family therapy, and social skills training may be necessary alongside
academic help.

Legal Rights and Accommodations in India

In recent years, India has taken steps to protect and support children with learning disabilities.
Understanding the legal and educational provisions will add depth to your module.
 RPWD Act, 2016 (Rights of Persons with Disabilities Act): Recognizes Specific Learning Disability
as a form of disability, entitling children to accommodations and special educational support.
 CBSE Guidelines:
o Extra time during exams
o Use of a scribe
o Exemption from third language
o Flexibility in subject choices
o Assistive technology support
 National Institute for the Empowerment of Persons with Intellectual Disabilities (NIEPID) and
Rehabilitation Council of India (RCI) provide training programs for professionals to identify and
assist children with SLD.
 Certificate of Disability: Issued by authorized medical boards, allowing children to avail benefits and
accommodations.
These accommodations are crucial for leveling the academic playing field and preventing dropouts and
failure among children with SLD.

Assessment Tools and Diagnosis

A complete diagnosis of SLD requires a multi-method and multidisciplinary approach.
 Clinical interviews with parents, teachers, and the child
 Academic achievement testing to determine discrepancies
 Cognitive assessments such as:
o WISC-V (Wechsler Intelligence Scale for Children)
o DAS-II (Differential Ability Scales)
 Achievement tests:
o Woodcock-Johnson Tests of Achievement
o NIMHANS-SLD Index (used in India)
 Behavioral checklists and rating scales for ADHD and emotional concerns to rule out
comorbidities
Early identification through comprehensive assessments ensures timely intervention, which significantly
improves outcomes.

Response to Intervention (RTI) Model

RTI is an alternative to the traditional IQ-achievement discrepancy model. It focuses on early identification
and support for students struggling with learning before they fall significantly behind.
The RTI model is typically implemented in three tiers:
 Tier 1: Universal instruction for all students.
 Tier 2: Targeted small-group interventions for those not making adequate progress.
 Tier 3: Intensive individualized interventions.
Students who do not respond to Tier 3 may be referred for special education assessment. This model is
proactive, research-driven, and emphasizes continuous monitoring.