The State of LD: Understanding Learning and Attention Issues

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Understanding Learning and Attention Issues

Learning and attention issues are more common than many people think, affecting 1 in 5 children. With supportive policies and increased awareness among parents, educators and communities, these students can thrive academically, socially and emotionally.

1 in 5 children in the U.S. have learning and attention issues

Children with dyslexia^, ADHD^ and other kinds of learning and attention issues are as smart as their peers. But without the right support, many fall behind academically and struggle socially. They’re more likely to repeat a grade, get in trouble at school or with the law, drop out and struggle as adults to find work. But this downward spiral can be prevented.

This data-intensive report provides insights into the challenges facing the 1 in 5 as well as specifics on how to improve outcomes in school, work and the community. We start with a snapshot of learning and attention issues—focusing on the costs to society when these issues remain unaddressed.

What are Learning and Attention Issues?

Learning and attention issues are brain-based difficulties in reading, writing, math, organization, focus, listening comprehension, social skills, motor skills or a combination of these. Learning and attention issues are not the result of low intelligence, poor vision or hearing, or lack of access to quality instruction.

Common Examples
LEARNING DISABILITIESOTHER DIFFICULTIES THAT AFFECT LEARNING AND BEHAVIOR
  • Dyslexia
  • Dyscalculia
  • Dysgraphia
  • ADHD
  • Executive function deficits
  • Dyspraxia
  • Nonverbal learning disabilities

Risk Factors
GENETICS
Learning and attention issues tend to run in families. Genes that can affect brain structure and chemistry get passed down from parent to child.
TOXIN EXPOSURE
Exposure to lead and other environmental factors have been linked to ADHD and other issues that impact learning, attention and behavior.
ADVERSE CHILDHOOD EXPERIENCES
Trauma, such as abuse, neglect, and other adverse childhood experiences, can increase the likelihood of being identified with learning or behavior issues.

Barriers to Success
REPEATING A GRADE
Children with learning and attention issues often don’t receive early or effective interventions. A third of students with SLD or OHI have been held back a year, which increases the risk of dropping out.
SCHOOL DISCIPLINE
Students with disabilities are more than twice as likely to be suspended as those without disabilities, and the loss of instructional time increases the risk of course failure and school aversion.
DROPPING OUT
Students with SLD drop out of high school at nearly three times the rate of all students. The top reason students with SLD drop out? 57% cited disliking school or having poor relationships with teachers or peers.
JUSTICE INVOLVEMENT
Unaddressed learning and attention issues lead to conditions that push students into the school-to-prison pipeline. A large study found that half of young adults with SLD or OHI had been involved at some point with the justice system.
NOT FINISHING COLLEGE
Young adults with learning disabilities enroll in four-year colleges at half the rate of the general population. Their completion rate for any type of college is 41%, compared to 52% of all students.
UNEMPLOYMENT
Only 46% of working-age adults with learning disabilities are employed. Compared with adults who do not have learning disabilities, adults with these issues are twice as likely to be jobless.

Ways to Help
RAISE AWARENESSLearning and attention issues can look like laziness or lack of intelligence, but with the right support, children can achieve at high levels. Less stigma and high expectations are key.
EMPOWER PARENTSWith major changes ahead in education policy, it has never been more important to empower parents with information and help them be effective advocates for their children.
EQUIP TEACHERSMost students with SLD or OHI spend 80% or more of the school day in general education classrooms, and all educators need more resources and strategies to meet the needs of diverse learners.
INTERVENE EARLYIf a child is struggling with academics or behavior, it’s imperative to find out why and to provide targeted, evidence-based instruction and intervention as early as possible.
PERSONALIZE LEARNINGAligning learning with each student’s interests, strengths and needs—as well as rigorous standards—helps all children, especially those with learning and attention issues.
INCORPORATE SOCIAL AND EMOTIONAL LEARNING (SEL)Embedding SEL instruction into the curriculum and tailoring it for students with learning and attention issues can help develop important skills such as managing emotions and persevering.
BUILD SELF-ADVOCACY SKILLSHelping students understand how they learn and practicing how to ask for accommodations are essential for success and can be fostered through mentoring.
FOCUS EARLIER ON POSTSECONDARY TRANSITIONSHelping high-schoolers adjust to changing expectations can promote resilience as they transition to college or the workplace.
ADVOCATE FOR INCREASED FUNDINGEducation laws offer protections and can be powerful tools for change, but implementing them requires adequate, steady funding to provide supports and services.

Sources listed at the bottom of this page.1

How common are different kinds of learning and attention issues?

Converging epidemiological evidence indicates at least 1 in 5 children in the U.S. have learning and attention issues. Prevalence estimates vary for conditions such as dyslexia because different studies use different definitions. There is no blood test or other quick way to tell if a child has a learning or attention issue. An accurate diagnosis involves comprehensive assessment protocols that look at many kinds of behaviors and skills.

ISSUEPREVALENCESOURCE
Dyslexia5%–17%Pediatrics in Review
Dyscalculia5%–7%Science
Dysgraphia7%–15%Pediatrics
Dyspraxia*5%–6%DSM-5
ADHD5%–11%DSM-5, CDC

*Also known as developmental coordination disorder

Comorbidity is common

It’s important to keep in mind that many children have more than one learning or attention issue. For example, researchers have found that dyslexia and dyscalculia^ co-occur in 30% to 70% of children who have either disorder.2 Studies also indicate as many as 45% of children with ADHD also have a learning disability^.3

Public perceptions reveal widespread misconceptions

Despite how common learning and attention issues are, there is still widespread confusion among the public about the nature and impact of these issues. Recent surveys, detailed below, highlight the perceptions of three key groups: parents, educators and healthcare professionals who work with children between the ages of 3 and 20. These surveys are consistent with previous research on public perceptions4 and underscore the ongoing need to:

  • Raise awareness and reduce stigma among parents, 43% of whom say that they wouldn’t want other parents to know if their child had a learning disability.
  • Clear up misconceptions among educators—a third of whom believe that sometimes what people call learning or attention issues is really just laziness.
  • Keep learning and attention issues top of mind among healthcare professionals, only a fifth of whom say they almost always ask parents and children about symptoms of learning and attention issues.

Parents

Myths About Learning and Attention Issues
MYTHFACT

48% of parents believe:
Children can grow out of learning disabilities
Learning and attention issues are lifelong conditions involving differences in brain structure and function. Symptoms may change over time, and the right support helps address weaknesses. But age doesn’t make these issues “go away.”

78% of parents believe:
Any child can do well in school if he or she tries hard enough
When it comes to learning and attention issues, trying harder is not the answer. Children with these issues need targeted interventions and accommodations to help them work on or work around their weaknesses.

18% of parents believe:
Children with learning disabilities are less intelligent than other children
Children with learning and attention issues are as smart as their typically developing peers, and many have average or above-average intelligence. There are many children who are gifted and have learning disabilities. Many schools refer to these children as “twice-exceptional.”

Signs of Learning and Attention Issues
SIGNAWARENESS
Reads at a lower level than his/her peers
43% of parents are aware of this possible sign
Has a hard time “getting” math concepts
40% of parents are aware of this possible sign
Has bad handwriting
19% of parents are aware of this possible sign
Always loses his/her homework
27% of parents are aware of this possible sign
Can’t sit still
63% of parents are aware of this possible sign
Doesn’t want to go to school
28% of parents are aware of this possible sign
Has a hard time making friends
27% of parents are aware of this possible sign

Awareness of Issues—and Tools That Schools Can Use to Help
ISSUE/TOOLAWARENESS
Dyscalculia
11% of parents have heard of this
Dysgraphia
13% of parents have heard of this
Dyspraxia
14% of parents have heard of this
Dyslexia
80% of parents have heard of this
ADHD
82% of parents have heard of this
Individualized Education Program (IEP)
42% of parents have heard of this
504 Plan
23% of parents have heard of this

Source: Survey commissioned by Understood.org and conducted by Lightspeed GMI in September 2016. The survey polled a random sampling of 1,000 parents who have children under the age of 18 and who are representative of the U.S. population.


Educators

of classroom teachers and other educators believe sometimes what people call a learning or attention issue is really just laziness
of classroom teachers say they are somewhat or not very confident in recommending that a child be evaluated for special education for learning issues
of classroom teachers in elementary school say a significant challenge they face is lack of resources needed to provide instruction, related services and support to children with learning and attention issues
of classroom teachers say they are somewhat or not too confident in their ability to implement IEP/504 plans

Source: Survey commissioned by Understood.org and conducted by GfK in September 2014. The survey polled 300 classroom teachers (evenly represented across Pre-K/elementary, middle and high school) and 100 other kinds of educators including school psychologists, special education teachers, reading specialists, speech-language pathologists, occupational therapists, school nurses, guidance counselors, principals and vice-principals.


Healthcare Professionals

66%of healthcare professionals say they are somewhat or not too confident about recommending evaluations for learning issues
20%of physicians say they almost always ask about symptoms of learning and attention issues
52%of healthcare professionals say they feel confident about identifying attention issues
54%Doctors who recommend having a child evaluated for learning and attention issues say parents follow their recommendation only 54% of the time

Source: Survey commissioned by Understood.org and conducted by GfK in September 2014. The survey polled 200 healthcare professionals comprising physicians (pediatricians, general and family practice as well as internal medicine) and nurse practitioners. All respondents worked with children ages 3–20 and had some experience working with children with learning or attention issues.


These surveys offer a glimpse into public perception and awareness of learning and attention issues and point to the troubling reality that not only are many people misinformed about these issues, but many educators and healthcare providers do not feel confident about their ability to address these issues. These findings warrant additional research into public perceptions and stigma and their impact on individuals with learning and attention issues.

New findings point to differences in brain structure and function

New research in the fields of neuroscience and neurogenetics is deepening our understanding of the differences in brain structure and function in children with learning and attention issues. Brain scans and other tools are also helping researchers measure the biological impact that instructional interventions have on children with dyslexia and other issues.

As studies expand how we think about and address learning and attention issues, it’s important to note that the science is still emerging and that studies need to be replicated to confirm these findings.

NEW FINDINGSIMPLICATIONS
A groundbreaking study used brain imaging to show that, when repeatedly presented with certain stimuli, the brain’s responses are different in people with dyslexia when compared to typical readers. This difference was apparent when the study’s participants heard or looked at words as well as when they were presented with pictures of objects and faces.If neurons have trouble adapting to repeated stimuli, it may be harder to learn new information. And if weaker neural adaptation is the core difference in the brains of people with dyslexia, these findings could lead researchers to investigate the underlying mechanism and find ways to address it.
Another new study points to structural and functional differences between the brains of children with dyslexia and the brains of children with dysgraphia when compared to neurotypical children. Children with dyslexia or dysgraphia have less white matter (which connects different parts of the brain and relays information quickly), but more functional connections in their gray matter (where thinking and language processing take place). The study also shows there are brain-based differences between children with dyslexia and dysgraphia.These findings indicate that brains of children with dyslexia or dysgraphia have to work harder to complete written-language tasks as compared to the brains of neurotypical children. And because the spelling problems associated with both of these learning disabilities appear to have different brain bases, they may require different kinds of interventions. (It’s also important to keep in mind that children with co-occurring issues may need several types of interventions.)
Functional connections within and between certain brain networks take longer to mature in children with ADHD. These networks are associated with paying attention, staying on task and other executive functions.This study helps explain why children with ADHD struggle with executive functioning. Providing direct instruction and support could help nurture the formation of neural connections needed to improve performance.
A longitudinal study looked at the role neurochemistry plays in the process of learning to read and found that young children’s reading ability can be predicted by glutamate and choline levels in their brains. Children with higher levels of these metabolites tended to have lower scores for reading and language.These findings point to new directions for research on dyslexia, including the possibility of one day, perhaps, developing medication that could help children who struggle to develop early reading skills.
A study of more than 5,000 children offers insights into the complex role genes play in dyslexia. Children who have variants of two genes associated with dyslexia (DCDC2 and KIAA0319) have a much greater risk of developing dyslexia or language impairment than if they only have variants of one gene or the other.The more we understand how genes interact with each other or how they’re affected by environmental factors, the sooner we may be able to use this information alongside screening and progress monitoring to identify children at risk and intervene before they fall behind in school.
An imaging study showed how learning to read changes the way the brain’s visual system functions. Researchers compared children with dyslexia to typically developing readers who were the same age as well as to younger, less experienced readers. The findings indicate that differences in processing visual stimuli is not a cause of dyslexia but instead is a consequence of less reading. The study also observed that after children with dyslexia received intensive phonological tutoring to address the core deficit of this reading disorder, they made significant gains in reading, and their brains boosted their response to certain kinds of visual stimuli.These findings indicate that when researchers observe differences in visual processing in children with dyslexia, it may be because they are being compared to more skilled readers whose brains have undergone more of this change. The findings also further demonstrate that phonological training can improve reading and reinforce the notion that identification and treatment of dyslexia should not revolve around deficits in visual processing.
A study of children with dyscalculia identified changes in brain function after the children received effective tutoring. Eight weeks of one-on-one cognitive tutoring not only improved math performance, but also led to widespread changes in brain activity in networks associated with numerical problem-solving.These findings may provide new ways to understand and measure how children respond to different kinds of math interventions.
New research shows that dyslexia affects brain structure in males in different ways than it affects brain structure in females. Sex-specific differences were observed in areas that process language as well as in regions of the brain that process sensory and motor information.Because more boys than girls tend to be identified as having dyslexia, our understanding of the brain basis of dyslexia has developed primarily through the study of males. More research is needed to determine whether different approaches are needed to identify and treat dyslexia in girls.

Clinical Caveats

In the field of learning and attention issues, brain imaging technology is still considered to be only a research tool. No brain imaging technology has been validated by the research community for clinical use in lieu of behavioral evaluations to diagnose either ADHD or dyslexia.

There is tremendous variability from one person to the next in terms of brain anatomy and brain function. (The same is also true when it comes to people’s genomes—even identical twins don’t have identical DNA!) Any differences that might serve as diagnostic markers need to be tested in large-scale studies and replicated by other researchers before brain scans can be used to reliably identify dyslexia in clinical settings.

“Perhaps one day imaging will play a role in identifying individuals with dyslexia. Until then, parents and educators need to use traditional options, such as a neuropsychological evaluation and other behavior measures proven effective in identifying struggling readers and very young children at risk for reading difficulties, even before they learn to read.”

 

—Guinevere Eden, Ph.D.,
Director of Georgetown University’s Center for the Study of Learning and former president of the International Dyslexia Association

“Perhaps one day imaging will play a role in identifying individuals with dyslexia. Until then, parents and educators need to use traditional options, such as a neuropsychological evaluation and other behavior measures proven effective in identifying struggling readers and very young children at risk for reading difficulties, even before they learn to read.”

 

—Guinevere Eden, Ph.D.,
Director of Georgetown University’s Center for the Study of Learning and former president of the International Dyslexia Association

Laws that guarantee supports and services are essential for improving outcomes for the 1 in 5

Several long-standing legal protections as well as some newer laws protect the rights of children and adults with disabilities, including learning disabilities and disorders such as ADHD.

Federal Laws That Protect the Rights of Children and Adults With Disabilities
LAWYEAR PASSEDKEY DETAILS
Section 504 of the Rehabilitation Act
(Section 504)
1973
  • Prohibits discrimination against students with disabilities in programs or activities that receive federal funding
  • Requires school districts to provide accommodations, supports and services to remove barriers and “level the playing field” for general education students with disabilities
  • Includes some procedural safeguards to ensure that children with 504 plans receive a free and appropriate public education
  • Protects college students with disabilities from discrimination and offers accommodations
  • Does not give schools additional funding for eligible students
Individuals with Disabilities Education Act (IDEA)1990 (and updated in 1997 and 2004)
  • Replaced the Education for All Handicapped Children Act, which was signed into law in 1975
  • Requires school districts to find and evaluate—at no cost to parents—children suspected of having disabilities
  • Provides special education, accommodations, modifications and related services (such as speech therapy and counseling) through Individualized Education Programs (IEPs) that are tailored to meet the needs of each child with a qualifying disability to enable the child to be involved in and make progress in the general education curriculum
  • Provides early intervention from birth up to age 3 and special education from age 3 to 21
  • Includes many procedural safeguards to ensure that children with disabilities receive a free and appropriate public education
  • Gives schools additional funding for eligible students
Americans with Disabilities Act (ADA)1990
  • Protects individuals with disabilities from discrimination in any public place, including schools and the workplace
  • Protects students with disabilities from discrimination at private schools (including colleges and universities)
  • Ensures that individuals with disabilities have equal access to compete for educational and workplace opportunities and receive necessary accommodations on standardized testing, licensing and other types of assessments
  • Requires workplaces with 15 or more employees to provide reasonable accommodations to employees with disabilities
Workforce Innovation and Opportunity Act (WIOA)2014
  • Improves access to job training, education and employment services for young adults with learning disabilities and other people who have traditionally faced barriers to employment
  • Expands some services to high school dropouts ages 14 to 24 who are eligible under IDEA or Section 504
  • Requires states to coordinate services, including those for youth transitioning from high school to postsecondary education
Every Student Succeeds Act (ESSA)2015
  • Replaced No Child Left Behind as the main federal law for K–12 general education
  • Requires states to establish standards from kindergarten through grade 12 to help ensure that students graduate from high school prepared for college or career
  • Requires states to establish assessments aligned to the standards in English and math for grades 3 through 8 and at least once in high school; also requires assessments in science at least once in high school
  • Requires states to evaluate schools using academic factors including reading and math scores, English language proficiency test scores and high school graduation rates and another factor related to school quality or student success—to be chosen by states—such as chronic absenteeism or access to advanced coursework
  • Requires schools to set ambitious goals for all groups of students, such as those in special education, and to use evidence-based methods to help close achievement gaps
  • Encourages states to use Universal Design for Learning (UDL), a multi-tier system of supports (MTSS) and personalized learning to help meet the needs of all students
  • Calls for the creation of a national center focused on reading issues for children with disabilities such as dyslexia that will serve as an information clearinghouse for teachers and parents
Research Excellence and Advancements for Dyslexia Act (READ)2016
  • Requires the National Science Foundation (NSF) to provide $5 million every year for research on the science of learning disabilities, of which at least $2.5 million per year shall support research focusing specifically on dyslexia
  • May cover research topics such as:
    • Early identification of children with learning disabilities
    • Professional development for teachers
    • Curricula and tools to help children with learning disabilities
    • Implementation of successful interventions

State Laws

Over the last decade, 38 states have passed laws that require schools to monitor students’ progress in reading between kindergarten and grade 3. These laws emphasize the importance of early screening to help find struggling students before they fall far behind. These laws are often referred to as third-grade reading laws or third-grade retention laws because they require students who can’t read at a certain level to repeat grade 3. Some of these laws allow exceptions for students with an IEP^ or 504 plan^.

In addition, 26 states have passed dyslexia laws to help identify and provide early intervention for students with a reading disability. These laws provide funding and require intervention and services for students who are struggling with reading. Many states with these early screening and literacy laws also provide funding for teacher professional development.

40%Percentage of the extra cost of special education that Congress promised to fund in 1975 with the passage of IDEA

 

16%Percentage of the extra cost of special education that Congress appropriated in 2016

The federal government has not delivered on its promise to provide full funding

Federal laws that guarantee equal access and protect the rights of students with disabilities are most effective when schools receive adequate funding to provide essential services and supports. Yet as the number of students with disabilities has increased, the federal government has made drastic cuts to education spending. And Congress has never come close to fulfilling its promise to fund 40% of the extra cost of special education.

In 2016, the federal government covered 16% of the extra cost of special education, leaving states to grapple with this multibillion-dollar shortfall.5

As schools struggle to provide the services that children with disabilities need—and that federal law requires—it is more critical than ever for parents, educators and others who care about students with learning and attention issues to advocate for increased funding.

 

For a full discussion of how to address the challenges and opportunities discussed in this chapter, see NCLD’s Recommended Policy Changes.

40%Percentage of the extra cost of special education that Congress promised to fund in 1975 with the passage of IDEA

 

16%Percentage of the extra cost of special education that Congress appropriated in 2016

SPOTLIGHT

Understood Helps Inform and Empower Parents of the 1 in 5

Since Understood.org launched in the fall of 2014, more than 25 million unique visitors have accessed this free resource for parents of children with learning and attention issues. NCLD and 14 other founding nonprofit organizations came together to create a comprehensive online resource—available in English and Spanish as well as in read-aloud mode—that provides clear explanations, practical tips, tools and daily access to experts.

Understood also includes a secure online community where parents can connect with each other as well as with experts so they can help their children get the support they need to thrive.

“After spending all day on this site in preparation, I was able to communicate my concerns very well and I felt that I was heard,” one community member said recently about a meeting with her son’s teachers. “They also got to meet the kid that I see and see his strengths. I think we are off to a good start—my kid knows I have his back and I am one relieved mama!”

To help raise awareness about learning and attention issues and reduce stigma, Understood has partnered with the Ad Council to develop public service announcements that focus on how parents and other adults often overlook or misinterpret signs that their children may have learning and attention issues: “When you can see it from their side, you can be on their side. Go from misunderstanding to Understood.org.”

1. U.S. Department of Education (2017, January 06). IDEA Section 618 Data Products: Static Tables; U.S. Department of Education, Office for Civil Rights (2016, October 28). 2013-2014 Civil Rights Data Collection: A First Look; Institute for Education Sciences, National Center for Special Education Research (2011). National Longitudinal Transition Study-2; American Psychiatric Association (2016, October 01). Diagnostic and Statistical Manual of Mental Disorders (DSM–5); Shaywitz, S. E., Shaywitz, B. A. (2003). Dyslexia (Specific Reading Disability), Pediatrics in Review, 24(5). doi:10.1542/pir.24-5-147; Butterworth, B., Sashank, V., & Laurillard, D. (2011). Dyscalculia: From Brain to Education, Science, 332(6033), 1049-1053. doi:10.1126/science.1201536; Katusic, S. K., Colligan, R. C., Weaver, A. L., & Barbaresi, W. J. (2009). The Forgotten Learning Disability: Epidemiology of Written-Language Disorder in a Population-Based Birth Cohort (1976–1982), Rochester, Minnesota, Pediatrics, 123(5); Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J.R., Kogan, M. D., Ghandour, R. M., …Blumberg, S. J. (2014). Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011, Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34-46e2. doi: 10.1016/j.jaac.2013.09.001; Kaye, H.S. (2013). Unpublished data analysis of 2010 data from the U.S. Census Bureau Survey of Income and Program Participation. Data retrieved August 2013.
2. Willcutt, E. G., Petrill, S. A., Wu, S., Boada, R., DeFries, J. C., Olson, R. K., & Pennington, B. F. (2013). Comorbidity between reading disability and math disability: Concurrent psychopathology, functional impairment, and neuropsychological functioning, Journal of Learning Disabilities, 46(6), 500-516. doi: 10.1177/0022219413477476.
3. DuPaul, G. J., Gormley, M. J. & Laracy, S.D. (2013). Comorbidity of LD and ADHD: implications of DSM-5 for assessment and treatment, Journal of Learning Disabilities, 46(1)1, 43-51. doi: 10.1177/0022219412464351.
4. Tremaine Foundation (2010). Measuring Progress in Public & Parental Understanding of Learning Disabilities.
5. Committee for Education Funding (2016). Education Matters: Investing in America’s Future: Fiscal Year 2017 Budget Analysis (pp. 171-180). Washington, DC.

Programs: