A learning disability affects the way a person understands information and how they communicate. This means they can have difficulty:

• understanding new or complex information
• learning new skills
• coping independently

Around 1.5 million people in the UK have a learning disability. It’s thought up to 350,000 people have a severe learning disability. This figure is increasing.

Severity of learning disability

A learning disability can be mild, moderate or severe.

Some people with a mild learning disability can talk easily and look after themselves but may need a bit longer than usual to learn new skills. Other people may not be able to communicate at all and have other disabilities as well.

Some adults with a learning disability are able to live independently, while others need help with everyday tasks, such as washing and dressing, for their whole lives. It depends on the person’s abilities and the level of care and support they receive.

Children and young people with a learning disability may also have special educational needs (SEN).

Support for learning disabilities and family carers

Some learning disabilities are diagnosed at birth, such as Down’s syndrome. Others might not be discovered until the child is old enough to talk or walk.

Once your child is diagnosed with a learning disability, your GP can refer you for any specialist support you may need.

You’ll begin to get to know the team of professionals who will be involved in your or your child’s care.

The right support from professionals – such as GPs, paediatricians (doctors who specialise in treating children), speech and language therapists, physiotherapists, educational and clinical psychologists and social care – helps people with a learning disability live as full and independent a life as possible.

What causes learning disabilities?

A learning disability happens when a person’s brain development is affected, either before they’re born, during their birth or in early childhood.

This can be caused by things such as:

• the mother becoming ill in pregnancy
• problems during the birth that stop enough oxygen getting to the brain
• the unborn baby inheriting certain genes from its parents that make having a learning disability more likely – known as inherited learning disability
• illness, such as meningitis, or injury in early childhood

Sometimes there’s no known cause for a learning disability.

Some conditions are associated with having a learning disability because people with these conditions are more likely to have one.

For example, everyone with Down’s syndrome has some kind of learning disability, and so do many people with cerebral palsy.

People with autism may also have learning disabilities, and around 30% of people with epilepsy have a learning disability.

Profound and multiple learning disability (PMLD)

A profound and multiple learning disability (PMLD) is when a person has a severe learning disability and other disabilities that significantly affect their ability to communicate and be independent.

Someone with PMLD may have severe difficulties seeing, hearing, speaking and moving. They may have complex health and social care needs due to these or other conditions.

People with PMLD need a carer or carers to help them with most areas of everyday life, such as eating, washing and going to the toilet.

With support, many people can learn to communicate in different ways, be involved in decisions about themselves, do things they enjoy and achieve more independence.

Diagnosis of Autism Spectrum Disorders

Early signs of this disorder can be noticed by parents/caregivers or pediatricians before a child reaches one year of age. However, symptoms typically become more consistently visible by the time a child is 2 or 3 years old. In some cases, the functional impairment related to autism may be mild and not apparent until the child starts school, after which their deficits may be pronounced when amongst their peers.

 Social communication deficits may include(1):

• Decreased sharing of interests with others
• Difficulty appreciating their own & others’ emotions
• Aversion to maintaining eye contact
• Lack of proficiency with use of non-verbal gestures
• Stilted or scripted speech
• Interpreting abstract ideas literally
• Difficulty making friends or keeping them

Restricted interests and repetitive behaviors may include(1):

• Inflexibility of behavior, extreme difficulty coping with change
• Being overly focused on niche subjects to the exclusion of others
• Expecting others to be equally interested in those subjects
• Difficulty tolerating changes in routine and new experiences
• Sensory hypersensitivity, e.g., aversion to loud noises
• Stereotypical movements such as hand flapping, rocking, spinning
• Arranging things, often toys, in a very particular manner

Parent/caregiver/teacher concerns about the child’s behavior should lead to a specialized evaluation by a developmental pediatrician, pediatric psychologist, child neurologist and/or a child & adolescent psychiatrist. This evaluation involves interviewing the parent/caregiver, observing, and interacting with the child in a structured manner, and sometimes conducting additional tests to rule out other disorders. In some ambiguous cases, the diagnosis of autism may be deferred, but otherwise an early diagnosis can greatly improve a child’s functioning by providing the family early access to supportive resources in the community.

The first step is seeking an evaluation. Most parents start with their pediatrician who is checking on developmental milestones. If your child is under the age of 3 years, you can obtain an evaluation through your local early intervention system.  If your child is over the age of 3, you can get an evaluation through your local school (even if your child does not go there).  Contact your local school’s preschool special education team to request an evaluation. )

Risk Factors

The current science suggests that several genetic factors may increase the risk of autism in a complex manner. Having certain specific genetic conditions such as Fragile X Syndrome and Tuberous Sclerosis has been identified as conferring a particularly increased risk for being diagnosed with autism. Certain medications, such as valproic acid and thalidomide, when taken during pregnancy, have been linked with a higher risk of autism as well.(2) Having a sibling with autism also increases the likelihood of a child being diagnosed with autism. Parents being older at the time of pregnancy is additionally linked with greater risk of autism. Vaccines on the other hand have not been shown to increase the likelihood of an autism diagnosis, and race, ethnicity or socioeconomic status does not seem to have a link either. Male children tend to be diagnosed with autism more often than those assigned female sex at birth, albeit this ratio is changing over time.

Treatment

While there is no “cure” for autism, there are several effective interventions that can improve a child’s functioning:

Applied behavioral analysis: It involves systematic study of the child’s functional challenges, which is used to create a structured behavioral plan for improving their adaptive skills and decreasing inappropriate behavior

• Social skills training: Done in group or individual settings, this intervention helps   children with autism improve their ability to navigate social situations
• Speech & language therapy: It can improve the child’s speech patterns and understanding of language
• Occupational therapy: This address adaptive skills deficits with activities of daily living, as well as problems with handwriting
• Parent management training: Parents learn effective ways of responding to problematic behavior and encouraging appropriate behavior in their child. Parent support groups help parents cope with the stressors of raising a child with autism
• Special education services: Under an Individual Education Plan provided by their school, which accommodates for their social communication deficits, restricted interests, and repetitive behaviors, children with autism can achieve their fullest potential academically. This includes special day classes for very young children to address language, social, and life skills. 
• Treating co-occurring conditions: Children with autism experience insomnia, anxiety, and depression more often than peers without autism. They also more often have ADHD. Children with autism may have intellectual disability and this needs to be addressed. The impact of these conditions can be reduced with the proper services, which include all of the above, in addition psychotherapy and/or medication treatment
• Medication: A child psychiatrist can evaluate for co-morbid depression, anxiety, and impulsivity. If appropriate medications can be helpful. For example, autism-related irritability can be reduced by medications such as aripiprazole and risperidone (the two medications approved by the Food and Drug Administration for irritability associated with autism), prescribed judiciously by a knowledgeable clinician in collaboration with the child’s parents.

Several complementary and alternative interventions involving special diets and supplements have been tried over the years by parents/caregivers seeking ways to help their child with autism function better. To date compelling evidence has not been found to clearly recommend any such specific interventions. Research into these types of interventions continues, and parents/caregivers interested in them should discuss them with their child’s treating clinician.

Additional information can be found in the Expert Q&A and Resources sections.

Tips For Parents

• Learn as much as possible about autism spectrum disorder
• Provide consistent structure and routine
• Connect with other parents of children with autism
• Seek professional help for specific concerns
• Take time for yourself and other family members

Having a child with autism affects the whole family. It can be stressful, time-consuming and expensive. Paying attention to the physical and emotional health of the whole family is important. Many national and local advocacy organizations provide information, resources and support to individuals with autism spectrum disorder and their families. A few are listed in the Resources section.

The American Psychiatric Association defines dyscalculia as a ‘mathematical disability’.  Those with the condition have a, ‘…mathematical ability, as measured by individually administered standardized tests, is substantially below thatexpected, given the person’s chronological age, measuredintelligence, and age-appropriate education, whichsignificantly interferes with academic achievement oractivities of daily living that require mathematical ability,’

The most common problem is with ‘number sense’. This is an intuitive understanding of how numbers work, and how to compare and estimate quantities on a number line. This means children with dyscalculia are unable to understand number words (one, two, twelve, twenty), numerals (1, 2, 12, 20) and therelationship between them (i.e. which quantity is greater or less than the other etc.), struggle with understanding the number line and the logic behind its sequencing. These issues further evolve into difficulties carrying out basic mental math, the application of the four concepts of addition, subtraction, multiplication and division, struggles with the ‘missing operand problems’(13+?=46), difficulties with word problems, and eventually, struggling with money and time management etc.

Studies show that even babies have a basic sense of numbers. Dr. Brian Butterworth, a leading researcher in dyscalculia, compares number sense to being color-blind. He says some people are born with number blindness. This makes it hard to tell the difference between quantities. Number blindness is one reason many kids have trouble connecting numbers to the real world. They can’t grasp the idea that ‘five cookies’ has the same number of objects as ‘five cakes’ and ‘five apples’.

Source: UNESCO MGIEP, www.understood.org

Dyscalculia is an under-studied condition with research on dyslexia outnumbering that on dyscalculia by 14:1 despite having the same prevalence as dyslexia. Thus, the exact causes for dyscalculia cannot be pointed and differ from person to person. However, following is a list of potential causes.

• Genetic: Researchers have found that a child with dyscalculia often has a parent or sibling with similar math issues. Turner’s syndrome, Fragile X syndrome, Velocardiofacial syndrome, Williams syndrome are some of the genetic disorders that have been observed in people with dyscalculia. Certain genes in the population people put members at high-risk of dyscalculia.
• Braindevelopment: Researchers are using modern brain imaging tools to study for a comparative analysis of people with and without dyscalculia. Such researches have observed a difference in the gray matter, surface area, thickness, volume of parts of the brain that are associated with learning, memory and cognitive capacities. Research in ‘special populations’ such as babies with Turner’s syndrome shows the presence of less brain cells or gray matter in those parts of the brain that are known to process mathematics.
• Environment: Dyscalculia has been linked to exposure to alcohol in the womb. Prematurity and low birth weight may also play a role in dyscalculia. All of these may cause delayed brain development.
• Braininjury: Studies show that injury to certain parts of the brain can result in what researchers call ‘acquired dyscalculia’.

            It is important to remember that trouble in math is not necessarily always caused by dyscalculia. It can also be a lack of instruction, opportunity, a side effect of anxiety, depression and other mental health issues, math anxiety, or dyslexia that is being masked by instruction in a phonetically-consistent language. An in-depth assessment of the child is important to ensure that there is no misdiagnosis.

Children with dyscalculia begin to rely heavily on physically counting everything to make sense of the calculations. This is harmful as this will disrupt their understanding beyond a certain basic level. Children struggle withautomatically recalling an answer that they have already arrived at and fall into the habit of counting up, often on their fingers, to calculate the answer over and over again. This mechanical method takes time and effort which puts an undue strain on working memory, which in turn prevents connections being made between the question and the answer.

Children with dyscalculia must be prevented from falling into this ‘Counting trap’. By teaching them innovative and compressed calculation tactics, their brains can be ‘rewired’ to perform math at a faster and less tedious pace. At a young age this can be done through games, visual aid and other toolkits that teach them to recognize quantity and associate it successfully with numeric symbols. This will take time but it is extremely important.

Parents, teachers and tutors need to ensure a child doesn’t fall into this trap.

Here is a helpful video on how to deal with the ‘counting trap’: https://www.youtube.com/watch?v=GstqJ5sEEoo

Conditions that often exist with—or are misdiagnosed as—dyscalculia are:

• Dyslexia: Children are often diagnosed with dyslexia and dyscalculia. Researchers have found that 43–65 percent of children with math disabilities also have reading disabilities.
• ADHD: Children are often diagnosed with dyscalculia and ADHD. But some math errors can be explained by inattention to detail and other characteristics of ADHD. As a result, some experts recommend reevaluating math skills after getting ADHD symptoms under control.
• Math anxiety: Children with math anxiety are so worried about the prospect of doing math that their fear and nervousness can lead to poor performance on math tests. Some children may have both math anxiety and dyscalculia. Math anxiety does not mean that the child is struggling with a conceptual understanding, but are in fact feeling pressurized to perform well, causing them to have poor math skills.
• Genetic disorders: Dyscalculia is associated with several genetic disorders including fragile X syndrome, Gerstmann’s syndrome and Turner’s syndrome.

Source: www.understood.org

Dyscalculia and Dyslexia are two separate conditions with distinct characteristics and over-lapping symptoms. While it may seem easy to confuse the two, there are several fundamental differences. Dyslexic children flip numbers, mess up places of numbers in larger quantities, and misread arithmetic symbols. Their condition affects their reading abilities. But they can gain a conceptual understanding and are, in fact, known to recognize broader patters in math that an average student may not. They donot have issues with the conceptual understanding in arithmetic calculations. Einstein and Beethoven are two examples of dyslexics with impeccable mathematical abilities. While Einstein’s success needs no reiteration, Beethoven may seem a more peculiar example. Music theory does have several mathematic concepts at its base. Beethoven, with his ability to recognize larger patterns, was able to create beautiful symphonies. Children with dyscalculia, like those with dyslexia, also have trouble with sequential memorizing but, unlike dyslexics, they struggle with conceptual arithmetic understanding – patterns, quantities, comparisons etc.

This is an important difference as dyslexia in children learning in phonetically-consistent languages may get masked but the symptoms may come out while learning math. In such situations, it is important to recognize whether the child has dyslexia or dyscalculia for an effective treatment. If it is dyslexia, it is the language and reading short-comings that need to be tackled, while dyscalculia requires an entirely different treatment.