Specific Learning Disability - Impairment in Reading in Children and Adolescents

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:

  • Impairment in Reading
  • Impairment in Written Expression
  • Impairment in Mathematics
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These disorders are categorized by a persistent difficulty learning keystone academic skills 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. Difficulties learning to map letters with the sound of one's language- to read printed words- is one of the most common manifestations of specific learning disorder. Children and adolescents with specific learning disorder experience a persistent, or restricted progress in learning for at least six months despite intervention. The learning difficulties are usually readily apparent in the early school years in most children.

Children and adolescents with Specific Learning Disorders also 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 school skills that is usually indicated by school report or teacher's grades. These learning difficulties are considered "specific" for four reasons: (1) they are not attributable to an intellectual disability; (2) the difficulty 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) it cannot be attributed to a neurological or motor disorder and (4) the difficulty must 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.

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What is Specific Learning Disorder, Impairment in Reading?

Approximately 5-5% of individuals in the general population have a learning disorder. Roughly 4% of school-aged children have a diagnosable impairment in reading.

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Reading impairments are characterized by:

  • Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly, or slowly and hesitantly, frequently guesses words, has difficulty sounding out words)
  • Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read).

Impairments in reading can affect a child's word reading accuracy, reading rate or fluency, or reading comprehension. Common characteristics of children with a reading disorder are:

  • Problems identifying single words
  • Problems understanding the sounds in words, sound order, or rhymes
  • Problems with spelling
  • Transposing letters in words
  • Omitting or substituting words
  • Poor reading comprehension
  • Slow reading speed (oral or silent)
  • Confusion with directions
  • Confusion with opposites
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Understanding Impairment in Reading

Impairments in reading severity can range from mild to severe. In severe cases, reading disorders can impact several academic domains so that the individual is unlikely to learn those skills without ongoing intensive individualized and specialized teaching for most of the school years.

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It is not uncommon for children to have difficulties learning skills in one or two academic domains, such as reading and writing. Many children and adolescents 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 is different in children with reading difficulties when compared to other children.

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How is Impairment in Reading treated?

Impairments in reading are treatable using a targeted, individualized intervention. The intervention is uniquely tailored to remedy the child's weaknesses in a targeted area of reading (e.g., decoding, fluency, comprehension).

Although interventions should be individualized to take into account a child's academic strengths and weaknesses, there are recommendations of what a reading intervention should include: Best Practice Guides for Students with Learning Disabilities; Effective Reading Interventions, & Preventing and Remediating Difficulties with Reading Fluency

First Line Treatments

  • Individualized Reading Program: Systematic instruction of letter-sound correspondences and decoding strategies. An effective reading program consists of explicit and systematic instruction in:
    • Phonological and phonemic awareness
    • Concepts about print
    • The alphabetic principle
    • Decoding strategies
    • Reading fluency training
    • Reading comprehension strategies

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.

  • Adaptation to general curriculum: Teachers will differentiate instructional content and activities to ensure student is provided practice on core objectives that have already been taught
    • Common adjustments are: decreasing group size when reviewing content, making instruction visible and explicit, providing additional practice, adjusting pacing, diving tasking into smaller steps for student.

Second Line Treatments

When patients do not respond adequately to the first- and second-line treatments described above, other strategies might include:

  • Auditory Training: Speech-sound correspondence training (e.g., Earobics or Fast ForWord)

Although interventions should be individualized to take into account a child's academic strengths and weaknesses, there are recommendations of what a reading intervention should include: Best Practice Guides for Students with Learning Disabilities; Effective Reading Interventions, & Preventing and Remediating Difficulties with Reading Fluency

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: