Specific learning disorders — branching viva

Stem

A Year 3 child is referred for “possible dyslexia.” Parents want vision therapy. The teacher mentions inattention. [1] [3]

Branch 1 — Definition and classification

Examiner: What is a specific learning disorder? [3]

Strong answer: Persistent difficulty learning and using academic skills that begins during school years, is unexpected relative to age and opportunity, and is not better explained by intellectual disability, uncorrected sensory impairment, or lack of instruction alone. DSM-5 uses one SLD category with domain specifiers. [3]

Examiner: Name the domains and everyday labels. [3] [10]

Strong answer: Reading (dyslexia), written expression (dysgraphia/written language disorder), mathematics (dyscalculia). A child may have one or more. [3] [10]

Branch 2 — Differentials

Examiner: How do you distinguish SLD from intellectual developmental disorder? [3]

Strong answer: IDD shows global cognitive and adaptive impairment. SLD shows domain-specific academic weakness with relatively preserved general reasoning and adaptive skills outside academics. [3]

Examiner: How does ADHD fit? [5]

Strong answer: ADHD commonly co-occurs with SLD. ADHD alone can impair output, but if decoding/spelling/math skills remain weak when attention is supported, assess for SLD. Treat both when both are present. [5]

Branch 3 — Medical evaluation and vision therapy

Examiner: What must you check medically? [1]

Strong answer: Hearing, vision/ocular health, neurological red flags (regression, progressive features), developmental and language history, sleep/mood, school attendance and instruction quality. [1]

Examiner: Parents insist on vision therapy. Your response? [1] [2]

Strong answer: I will arrange appropriate eye care for acuity and comfort. AAP/Handler statements state learning disabilities and dyslexia are not treated by vision therapy as primary therapy. The evidence-based path is educational evaluation and structured literacy teaching. [1] [2]

Branch 4 — Management

Examiner: The child has severe word-reading disability. What helps? [7]

Strong answer: Intensive, explicit, structured literacy/phonics-based remediation; do not wait passively for months without teaching. Torgesen-type intensive programmes can improve outcomes in severe reading disability. Add accommodations and close school loops. [7] [17]

Examiner: What would make you abandon the “routine SLD” pathway today? [17] [1]

Strong answer: Skill regression, new focal neurology, acute sensory loss, suicidality, or safeguarding — convert to urgent pathways. [17]