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Clinical Atlas Prestige · Evidence-first

Psych MEQs / SAQsChild and adolescent psychiatry — specific learning disorder

Psych MEQs / SAQs · Child and adolescent psychiatry — specific learning disorder

Specific learning disorder — domains, identification and multiagency plan (MEQ)

FRANZCP-style MEQ on specific learning disorder: definition, domains, identification science, mechanisms and educational management.

20 marks20 min
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 9-year-old boy is referred by his school because he remains two years behind peers in reading despite two terms of small-group literacy support. Teachers report slow decoding, refusal to read aloud and incomplete written work; maths is nearer age level. Parents say his uncle 'never learned to read properly.' Hearing and vision screens are normal. Conversation is age-appropriate; he appears demoralised and calls himself 'dumb.' Parents ask whether he needs tablets to fix dyslexia and whether a low IQ is required for the diagnosis. (i) Define SLD and map domain/severity specification relevant to this presentation. (ii) Outline assessment including instructional response and key differentials. (iii) Summarise dyslexia science (phonological / multiple-deficit / language) at exam level. (iv) Construct a multiagency management plan including what you say about medication. (20 marks)

Model answer

Reveal model answer

(i) Definition and domains. SLD is a neurodevelopmental disorder of persistent academic skill deficits substantially below age expectations despite intervention, with functional impact, school-age onset, and exclusions (not better explained by ID, uncorrected sensory impairment, other mental/neurological disorder, psychosocial adversity, lack of language proficiency, or inadequate instruction). This boy's profile suggests impairment in reading (decoding/fluency; dyslexia-type) ± written expression contribution; maths relatively spared. Rate severity by support need/functional impact. Low IQ is not required; SLD can occur with average or high IQ.[1][4]

(ii) Assessment. Multi-informant history (language milestones, literacy exposure, family history, school trajectory), document nature/intensity of prior support and instructional response, work samples, hearing/vision (done), screen ADHD/anxiety/mood/language, educational psychology achievement battery (decoding, fluency, comprehension, spelling/writing, maths) ± cognitive profile. Differentials: ID, language disorder, ADHD-only performance failure, inadequate instruction, sensory, anxiety/trauma, ASD. Contemporary identification privileges skill deficit plus inadequate response to effective instruction over IQ–discrepancy alone.[1][4][5][8]

(iii) Mechanisms. Many reading disabilities involve phonological processing and phoneme–grapheme mapping vulnerability within the reading network; oral language shapes comprehension pathways. Multiple-deficit thinking: phonological, language and attention risks may combine. Family history fits heritable polygenic risk narrative — not laziness.[2][6][7]

(iv) Plan. Intensive systematic phonics-based / structured literacy intervention; classroom and exam accommodations (extra time, assistive tech); school learning support + educational psychology loop; CAMHS for demoralisation/anxiety/ADHD if criteria met. Medication does not fix dyslexia — treat comorbidity only when indicated. Psychoeducation: neurodevelopmental, strengths-based, early intensity better than wait-and-see; review progress with curriculum-based measures; safety-net school refusal/self-worth risk.[1][3][4]

References

  1. [1]American Academy of Child and Adolescent Psychiatry Practice parameters for the assessment and treatment of children and adolescents with language and learning disorders J Am Acad Child Adolesc Psychiatry, 1998.PMID 9785728
  2. [2]Peterson RL, Pennington BF Developmental dyslexia Lancet, 2012.PMID 22513218
  3. [3]Galuschka K, Ise E, Krick K, Schulte-Körne G Effectiveness of treatment approaches for children and adolescents with reading disabilities: a meta-analysis of randomized controlled trials PLoS One, 2014.PMID 24587110
  4. [4]Grigorenko EL, Compton DL, Fuchs LS, et al. Understanding, educating, and supporting children with specific learning disabilities: 50 years of science and practice Am Psychol, 2020.PMID 31081650
  5. [5]Miciak J, Fletcher JM The Critical Role of Instructional Response for Identifying Dyslexia and Other Learning Disabilities J Learn Disabil, 2020.PMID 32075514
  6. [6]Pennington BF From single to multiple deficit models of developmental disorders Cognition, 2006.PMID 16844106
  7. [7]Snowling MJ, Hulme C Annual Research Review: Reading disorders revisited - the critical importance of oral language J Child Psychol Psychiatry, 2021.PMID 32956509
  8. [8]Willcutt EG, Petrill SA Comorbidity between reading disability and ADHD in a community sample Mind Brain Educ, 2023.PMID 38898939