Specific learning disorders — formative SAQs

SAQ 1 — Domain diagnosis and vision therapy (10 marks)

A 7-year-old boy in Year 2 is “bright but cannot read.” Oral language is good. He avoids reading aloud. Parents ask for a referral for vision therapy after an online search. Hearing has never been formally tested. The teacher reports adequate phonics teaching this year with little progress. [1] [3]

Questions

1. Define specific learning disorder and name the three DSM-5-style academic domains. (2 marks) [3]
2. List four discriminating features that favour reading SLD (dyslexia phenotype) over intellectual developmental disorder. (2 marks) [3]
3. What is your immediate medical evaluation plan before or alongside educational testing? (3 marks) [1]
4. How do you counsel the family about vision therapy, citing the AAP/Handler position? (3 marks) [1] [2]

Model answer

1. Definition/domains (2): SLD is persistent difficulty learning/using academic skills despite opportunity, not better explained by intellectual disability or sensory/neurological exclusion alone. Domains: reading, written expression, mathematics. [3]

2. Vs IDD (2): relatively preserved general reasoning/adaptive function outside academics; domain-specific pattern; conversational language may be age-appropriate; academic underachievement is unexpected relative to overall ability. [3]

3. Medical plan (3): formal hearing assessment; vision/ocular health assessment; neurological/red-flag screen for regression or progressive disease; developmental/ADHD/language history; school work samples and teaching intensity history. [1]

4. Vision therapy counselling (3): learning disabilities/dyslexia are language-based; vision problems can interfere with comfort but do not cause dyslexia as claimed by vision-therapy marketing; eye exercises are not recommended as treatment for SLD; comprehensive educational evaluation and structured literacy teaching are required. [1] [2]

SAQ 2 — Comorbidity and stepwise management (10 marks)

An 9-year-old girl has slow reading fluency, very limited written output, and classroom “daydreaming.” Parents were told “it is just ADHD.” No psychoeducational testing has been done. She is increasingly anxious about school. [5] [7]

Questions

1. Why is “ADHD alone” an incomplete formulation here? (2 marks) [5]
2. Outline a stepwise paediatric management pathway from today to 6 months. (4 marks) [7] [17]
3. Give four classroom accommodations that support access while skills are remediable. (2 marks)
4. List two complications of delayed accurate recognition. (2 marks) [3]

Model answer

1. Incomplete ADHD label (2): ADHD and SLD commonly co-occur; attention treatment does not create decoding/spelling skills; academic skill assessment is still required when domain weaknesses persist. [5]

2. Pathway (4): clarify domains and red flags → hearing/vision → start/intensify structured literacy and writing supports now → comprehensive psychoeducational ± speech/OT/ADHD evaluation → treat confirmed comorbidity → school–health plan with closed-loop review of RTI response. [7] [17]

3. Accommodations (2): extra time; text-to-speech; reduced copy load/scribe or speech-to-text; accessible worksheets/quiet testing (any four reasonable). [6] [11]

4. Complications (2): secondary anxiety/school avoidance; entrenched skill gaps and damaged self-concept; missed dual diagnosis; family pursuit of unproven therapies (any two). [3]