ICD-10 code: F81.0
Specific Learning Disorder, Impairment in Reading is part of a cluster of diagnoses called Specific Learning Disorders. Specific Learning Disorders are a group of psychiatric conditions that include:
These disorders are categorized by a persistent difficulty learning keystone academic sills with an onset during the years of formal schooling. Key academic skills include reading of single words accurately and fluently, reading comprehension, written expression and spelling, arithmetic calculation, and mathematical reasoning. Difficulty learning to map letters with the sound of one's languageâto read printed wordsâis one of the most common manifestations of specific learning disorder.
Learning difficulties are usually readily apparent in the early school years in most individuals. Academic skills that were not mastered during the school-age years remain difficult. They are a persisting problem that evolves throughout the developmental continuum. The academic difficulties an individual might experience as a grade-school student can be very different from what is manifested as an adult with a learning disability. Thus, learning disabilities in adulthood present different themes, challenges, and issues. Social and emotional problems are not uncommon with adults with learning disabilities. An overall feeling of lack of self-worth, low self-esteem, and a poor self-concept can be pervasive. Many adults with learning disabilities have had negative experiences since their school-age years. Consequently, it is not uncommon for them to have carried their self-attributions of feeling incompetent and unintelligent into adulthood. Adults with learning disorders also have considerable strengths that include development of compensatory strategies to bypass academic impairments and resiliency to recover and persist despite challenges.
Adults with Specific Learning Disorders perform well below average for their age, and average achievement is only attained through extraordinarily high levels of effort or support. The low academic skills cause significant interference with vocational or workplace skills. These learning difficulties are considered "specific" for four reasons: (1) they are not attributable to an intellectual disability; (2) they cannot be attributed to external factors such as economic or environmental disadvantage, chronic absenteeism, or lack of education in the individual's community context; (3) they cannot be attributed to a neurological or motor disorder and (4) the difficulties may be restricted to one academic skill or domain (i.e., reading single words, retrieving or calculating number facts).
Note that Dyslexia is an alternative term use to describe a pattern of difficulties characterized by reading and writing problems. If dyslexia is used to specify this particular pattern of difficulties, it is important to specify what and if any additional difficulties are present.
Approximately 4% of adults in the general population have a learning disorder. In the 2010 census, 4.6 million adults reported have a learning disorder.
The prevalence of a reading impairment in adults is currently unknown. Reading impairments are characterized by:
Impairments in reading can affect an adult's word reading accuracy, reading rate or fluency, or reading comprehension. Common characteristics of adults with a reading impairment are:
Impairments in reading severity can range from mild to severe. It is not uncommon for adults to have difficulties learning skills in one or two academic domains, such as reading and writing. Many adults with impairments with reading also have neurodevelopmental disabilities such as attention-deficit/hyperactivity disorder (ADHD), communication disorders, autism spectrum disorders, anxiety, depression, and bipolar disorder.
As with most learning disabilities, the exact cause of reading disabilities is unknown. However, recent studies suggest that structural or functional brain problems may cause people with reading disorders to identify and sequence phonemes less efficiently and to have a harder time making associations within the context of what they read than do normally progressing readers. The strongest finding to date is that the area of the brain responsible for phonological processing is different in children with reading difficulties when compared to other children. With adults, however, the cause-effect relationship is more tenuous. Poor readers read less (and therefore have different language experiences) than able readers, who develop vocabulary, background knowledge, and familiarity with complex syntax structures through reading material. Readers with deficient word identification and comprehension skills often find reading unrewarding, and this reduces their motivation to read. Reading volume for adults has an effect on important language abilities, and therefore people with reading impairment may have less well-developed language skills either as a cause or as a result of reading deficiencies.
Impairments in reading are treatable using a targeted, individualized intervention. The intervention is uniquely tailored to remedy the individual's weaknesses in a targeted area of reading (e.g., decoding, fluency, comprehension).
Although interventions should be individualized to take into account an adult's academic strengths and weaknesses, there are recommendations of what a reading intervention should include: Reading Instruction for Adults; Intervention Practices In Adult Literacy Education.
Under the Americans with Disabilities Act (ADA), particularly Title I, employers are required to provide workplace accommodations for individuals with learning disabilities, but only for disabilities that have been disclosed. Individuals have the right to determine whether, when, how, and to whom to disclose their disabilities, and many choose to withhold disability information. The following sources provide recommendations of workplace accommodations for adults with learning disabilities: ProLiteracy.org, LdAmerica.org.
First Line Treatments
The program should be balance and grounded in meaningful context across a variety of literary genres. Phonological awareness, the alphabetic principle, and fluency work together to create a skilled decoding that permits full access to text meaning. Daily activities to develop phonological awareness, to build concepts about print and understanding of the alphabetic principle, and to build fluent reading in narrative text represent the best of what reading research currently has to offer teachers.
Second Line Treatments
When patients do not respond adequately to the first- and second-line treatments described above, other strategies might include: