Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Math and Writing Disabilities
Math Disabilities
Keywords
-
dyscalculia
-
math disability
-
Individual with Disabilities Education Act
-
IDEA
-
individualized education plan
-
IEP
-
response to intervention
-
specific learning disorder with impairment in mathematics
Data from the U.S. National Center for Educational Statistics for 2009 showed that 69% of U.S. high school graduates had taken algebra 1, 88% geometry, 76% algebra 2/trigonometry, and 35% precalculus. These percentages are considerably higher than those for 20 years earlier. However, concerns remain about the limited literacy level in mathematics for children, adolescents, and those entering the workforce; poor math skills predict numerous social, employment, and emotional challenges. The need for number and math literacy extends beyond the workplace and into daily lives, and weaknesses in this area can negatively impact daily functioning. Research into the etiology and treatment of math disabilities falls far behind the study of reading disabilities (see Chapter 50 ). Therefore the knowledge needed to identify, treat, and minimize the impact of math challenges on daily functioning and education is limited.
Math Learning Disability Defined
Understanding learning challenges associated with mathematics requires a basic appreciation of domain-specific terminology and operations. The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) has published diagnostic criteria for learning disorders. Specific types of learning challenges are subsumed under the broad term of specific learning disorder (SLD) . The DSM identifies the following features of a SLD with an impairment in math: difficulties mastering number sense, number facts, or fluent calculation and difficulties with math reasoning. Symptoms must be present for a minimum of 6 mo and persist despite interventions to address the learning challenges. Number sense refers to a basic understanding of quantity, number, and operations and is represented as nonverbal and symbolic. Examples of number sense include an understanding that each number is 1 more or 1 less than the previous or following number; knowledge of number words and symbols; and the ability to compare the relative magnitude of numbers and perform simple arithmetic calculations.
The DSM-5 definition can be contrasted with an education-defined learning disability in mathematics . Two math-related areas are identified as part of the Individuals with Disabilities Education Act (IDEA): mathematics calculation and mathematics problem solving. Operationally, this is reflected in age-level competency in arithmetic and math calculation, word problems, interpreting graphs, understanding money and time concepts, and applying math concepts to solve quantitative problems. The federal government allows states to choose the way a learning disability (LD) is identified if the procedure is “research based.” Referred to specifically in IDEA as methods for identifying an LD are a discrepancy model and “use of a process based on the child's response to scientific, research-based intervention.” The former refers to identifying a LD based on a pronounced discrepancy between intellectual functioning and academic achievement. The latter, referred to as a response to intervention (RtI) model, requires school systems to screen for a disability, intervene using empirically supported treatments for the identified disability, closely monitor progress, and make necessary adjustments to the intervention as needed. If a child is not responding adequately, a multidisciplinary team evaluation is used to develop an individualized educational plan (IEP) .
It is important that primary care providers understand the RtI process because many states require or encourage this approach to identifying LDs. Confusion can be avoided by helping concerned parents understand that a school may review their child's records, screen the skills of concern, and provide intervention with close progress monitoring, before initiating the process for an IEP. Traditional psychoeducation testing (IQ and achievement) may only be completed if a child has not responded well to specific interventions. The RtI approach is a valuable, empirically supported way to approach and identify a potential learning disability, but very different from a medical approach to diagnosis and treatment.
Terminology
The term dyscalculia , often used in medicine and research but seldom used by educators, is reserved for children with a SLD in math when there is a pattern of deficits in learning arithmetic facts and accurate, fluent calculations. The term math learning disability (MLD ) is used generically here, with dyscalculia used when limiting the discussion to children with deficient math calculation skills. A distinction is also made between children with a MLD and those who are low achieving (LA) in math; both groups have received considerable research focus. Although not included in either definition above, research into math deficits typically requires that individuals identified with MLD have math achievement scores below the 10th percentile across multiple grade levels. These children start out poorly in math and continue poor performance across grades, despite interventions. LA math students consistently score below the 25th percentile on math achievement tests across grades, but show more typical entry-level math skills.
Epidemiology
Prevalence
Depending on how MLD is defined and assessed, the prevalence varies. Based on findings from multiple studies, approximately 7% of children will show a MLD profile before high school graduation. An additional 10% of students will be identified as LA. Because research in the area typically requires that individuals show deficits for consecutive years, the respective prevalence estimates are lower than the 10th percentile cutoff for being identified as MLD or the 25th percentile cutoff for being identified as LA. It is not unusual for children to score below the criterion one year and above the criterion in subsequent years. These children do not show the same cognitive deficits associated with a MLD. Unlike dyslexia, boys are at greater risk to experience MLD. This is found in epidemiologic research in the United States (risk ratio, 1.6-2.2 : 1) and various European countries.
Risk Factors
Genetics
The heritability of math skills is estimated to be approximately 0.50. The heritability or genetic influence on math skills is consistent across the continuum from high to low math skills. This research emphasizes that although math skills are learned across time, the stability of math performance is the result of genetic influences. Math heritability appears to be the product of multiple genetic markers, each having a small effect.
Medical/Genetic Conditions
Numerous genetic syndromes are associated with math problems. Although most children with fragile X syndrome have an intellectual disability (ID), approximately 50% of girls with the condition do not. Of those without an ID, ≥75% have a math disability by the end of 3rd grade and are already scoring below average in mathematics in kindergarten and 1st grade. For girls with fragile X MLD, weak working memory seems to play an important role. The frequency of MLD in girls with Turner syndrome (TS) is the same as found in girls with fragile X syndrome. A consistent finding is girls with TS complete math calculations at significantly slower speed than typically developing students. Although girls with TS have weak calculation skills, their ability to complete math problems not requiring explicit calculation is similar to that of their peers. The percentage of children with the 22q11.2 deletion syndrome (22q11.2ds) with MLD is not clear. Younger children with this genetic condition (6-10 yr old) showed similar number sense and calculation skills as typically developing children but weaker math problem solving. Older children with 22q11.2ds showed slower speed in their general number sense and calculations, but accuracy was maintained. Weak counting skills and magnitude comparison have been found in this group of children, suggesting weak visual-spatial processing. Children with myelomeningocele are at greater risk for math difficulties than their unaffected peers. Almost 30% of these children have MLD without an additional diagnosed learning disorder, and >50% have both math and reading learning disorders. While broad, deficits are most pronounced in speed of math calculation and written computation.
Comorbidities
It is estimated that 30–70% of those with MLD will also have reading disability. This is especially important because children with MLD are less likely to be referred for additional educational assistance and intervention than students with reading problems. Unfortunately, children identified with both learning challenges perform poorer across psychosocial and academic measures than children with MLD alone. Having a MLD places a child at greater risk for not only other learning challenges but also psychiatric disorders, including attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, generalized anxiety disorder, and major depressive disorder. Individuals with MLD have been found to have increased social isolation and difficulties developing social relationships in general.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here