Written Expression Learning Disorder Differential Diagnoses

Updated: Sep 22, 2016
  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
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DDx

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]