Diagnostic Considerations

Similar to the DSM5 criteria, special education committees' determinations do not define a student as having a specific learning disorder (with impairment in written expression) until excluding other potential causes. As with all learning disorders, differentiating situations in which children who have difficulty writing have other medical, developmental, physical, or sensory impairments, deficient educational opportunities, environmental deprivation, or cultural differences (including English as a second language), which may contribute to the poor achievement in written expression, is necessary.

A diagnosis of mental retardation usually rules out any learning disorder, as the general deficit in intellectual skills is equivalent to a picture of overall low academic performance. In some cases of mild mental retardation, a specific learning disorder such as disorder of written expression could occur if the skills in writing are lower than would be expected given the potential intellectual functioning of the child.

Careful attention to the neurological history and examination should rule out other factors that can cause symptoms of dysgraphia or phonological agraphia, such as injury to or vascular abnormalities in the posterior corpus callosum or superior temporal gyrus or epilepsy (a cause of acquired epileptic dysgraphia).

Symptoms of anxiety or frustration (breaking pencils, crumpling or tearing up homework papers, avoidance of academic work) should not be ignored because, for many children, these symptoms correlate with an untreated learning disorder and should not be regarded as only reflecting the presence of a comorbid disorder.

Taking a careful history for comorbid disorders is important because some children present with comorbid attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, features of obsessive-compulsive disorder (OCD), and/or seizure disorders.^[12]

Workup

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Author

Bettina E Bernstein, DO, DFAACAP, DFAPA Distinguished Fellow, American Academy of Child and Adolescent Psychiatry; Distinguished Fellow, American Psychiatric Association; Clinical Assistant Professor of Neurosciences and Psychiatry, Department of Psychiatry/Psychiatric Medicine, Philadelphia College of Osteopathic Medicine; Clinical Affiliate Medical Staff, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia; Consultant to Gemma Services, Private Practice; Consultant PMHCC/CBH at Family Court, Philadelphia

Bettina E Bernstein, DO, DFAACAP, DFAPA is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Chief Editor

Additional Contributors

Angelo P Giardino, MD, PhD, MPH, FAAP Wilma T Gibson Presidential Professor and Chair, Department of Pediatrics, University of Utah School of Medicine; Chief Medical Officer, Intermountain Primary Children's Hospital

Angelo P Giardino, MD, PhD, MPH, FAAP is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, International Society for the Prevention of Child Abuse and Neglect, Ray E Helfer Society

Disclosure: Nothing to disclose.

Sections Written Expression Learning Disorder
Overview
Presentation
- History
- Causes
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DDx
Workup
Treatment
References

Written Expression Learning Disorder Differential Diagnoses

Diagnostic Considerations

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