Learning disorders

Pre-referral guidelines for primary care providers

Learning difficulties are a common presentation seen in up to 5-15% of school aged children, characterized by a child having difficulties with one or more ‘subjects’ (e.g. reading, writing, spelling, mathematics). It is distinct from, and exclusive to, intellectual disability.


A Specific Learning Disorder is diagnosed when a child falls below the 2nd percentile (a score of <70) for that learning domain. This is a clinical diagnosis made by a psychologist, not a medical doctor. We do not support the role for any routine blood tests or imaging modalities to assist with diagnosis.

The preschool age group is generally not diagnosed with learning disorders.

DSM-V criteria

The following four criteria are required:

  • A persistent difficulty in learning or academic skills for at least six months despite intervention targeting the area(s) of difficulty.
  • The affected academic skills are substantially below expectations given the individuals’ age and result in impaired functioning.
  • Apparent in early years, although not diagnosed until school years
  • Occur in the absence of:
    • Intellectual disability (full scale IQ less than 70)
    • Visual or hearing deficits
    • Mental health disorders (depression, anxiety, ADHD, etc.)
    • Neurological disorders
    • Psychosocial difficulty
    • Language differences
    • Lack of access of adequate instruction

Practice points



  • Ensure hearing and vision have been checked
  • Consider intellectual disability, ADHD, depression/anxiety and other behavioural problems.
  • Remember that children with learning disorders will often manifest as behavioural difficulties given they naturally attempt to move attention away from the fact that they are struggling with their academic work.
  • Sleep impacts significantly on childhood behaviour, thus tackling any sleep difficulties is paramount to managing learning disorders.
  • Assessment of learning difficulties can be done through a learning assessment or a neuropsychology assessment:
    • Learning assessment: generally comprised of both a cognitive assessment (WISC – Weschler Intelligence Scale for Children – or similar) and a learning assessment (WIAT – Weschler Individual Achievement Test – or similar).
    • Neuropsychology assessment: this is a more in depth process which covers a WISC & WIAT (above), but also screens for many other neuro-behavioural difficulties such as ADHD, anxiety, mood disorders and the like.


Management of specific learning disorders is primarily undertaken through the school setting (focus on specific areas of concern, remedial classes, individual learning plans, teaching methods suggested through assessment psychologists), however private tutoring or educational institutions may also be of benefit.

Referral pathways

  • Paediatrician
    • A referral for paediatric outpatient services is generally only undertaken in order to exclude other diagnoses, and is not required for a diagnosis of specific learning disorders
    • Information to bring to any appointments:
      • recent school reports
      • written reports from teachers regarding academic, behaviour and social progress
      • any testing performed (learning, cognitive, language, audiology, etc.)
      • any relevant reports from other health practitioners
      • any behavioural questionnaires (if done)