Understanding Learning and Attention Issues
Learning and attention issues are more common than many people think, affecting 1 in 5 children. With supportive policies and increased awareness among parents, educators and communities, these students can thrive academically, socially and emotionally.
https://youtu.be/m8uQAsTu6hQ“We would drill words again and again and again. After the fifth time my daughter had seen the word, it was like she was seeing it again for the first time. And I realized that working harder wasn’t necessarily better, but working smarter was what we should be focusing on.”—Dr. Travis Harker, family physician in New Hampshire
1 in 5 children in the U.S. have learning and attention issues
Children with dyslexia^, ADHD^ and other kinds of learning and attention issues are as smart as their peers. But without the right support, many fall behind academically and struggle socially. They’re more likely to repeat a grade, get in trouble at school or with the law, drop out and struggle as adults to find work. But this downward spiral can be prevented.
This data-intensive report provides insights into the challenges facing the 1 in 5 as well as specifics on how to improve outcomes in school, work and the community. We start with a snapshot of learning and attention issues—focusing on the costs to society when these issues remain unaddressed.
What are Learning and Attention Issues?
Learning and attention issues are brain-based difficulties in reading, writing, math, organization, focus, listening comprehension, social skills, motor skills or a combination of these. Learning and attention issues are not the result of low intelligence, poor vision or hearing, or lack of access to quality instruction.
Common Examples
| LEARNING DISABILITIES | OTHER DIFFICULTIES THAT AFFECT LEARNING AND BEHAVIOR |
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Risk Factors
GENETICS |
Learning and attention issues tend to run in families. Genes that can affect brain structure and chemistry get passed down from parent to child. |
TOXIN EXPOSURE |
Exposure to lead and other environmental factors have been linked to ADHD and other issues that impact learning, attention and behavior. |
ADVERSE CHILDHOOD EXPERIENCES |
Trauma, such as abuse, neglect, and other adverse childhood experiences, can increase the likelihood of being identified with learning or behavior issues. |
Barriers to Success
REPEATING A GRADE |
Children with learning and attention issues often don’t receive early or effective interventions. A third of students with SLD or OHI have been held back a year, which increases the risk of dropping out. |
SCHOOL DISCIPLINE |
Students with disabilities are more than twice as likely to be suspended as those without disabilities, and the loss of instructional time increases the risk of course failure and school aversion. |
DROPPING OUT |
Students with SLD drop out of high school at nearly three times the rate of all students. The top reason students with SLD drop out? 57% cited disliking school or having poor relationships with teachers or peers. |
JUSTICE INVOLVEMENT |
Unaddressed learning and attention issues lead to conditions that push students into the school-to-prison pipeline. A large study found that half of young adults with SLD or OHI had been involved at some point with the justice system. |
NOT FINISHING COLLEGE |
Young adults with learning disabilities enroll in four-year colleges at half the rate of the general population. Their completion rate for any type of college is 41%, compared to 52% of all students. |
UNEMPLOYMENT |
Only 46% of working-age adults with learning disabilities are employed. Compared with adults who do not have learning disabilities, adults with these issues are twice as likely to be jobless. |
Ways to Help
| RAISE AWARENESS | Learning and attention issues can look like laziness or lack of intelligence, but with the right support, children can achieve at high levels. Less stigma and high expectations are key. |
| EMPOWER PARENTS | With major changes ahead in education policy, it has never been more important to empower parents with information and help them be effective advocates for their children. |
| EQUIP TEACHERS | Most students with SLD or OHI spend 80% or more of the school day in general education classrooms, and all educators need more resources and strategies to meet the needs of diverse learners. |
| INTERVENE EARLY | If a child is struggling with academics or behavior, it’s imperative to find out why and to provide targeted, evidence-based instruction and intervention as early as possible. |
| PERSONALIZE LEARNING | Aligning learning with each student’s interests, strengths and needs—as well as rigorous standards—helps all children, especially those with learning and attention issues. |
| INCORPORATE SOCIAL AND EMOTIONAL LEARNING (SEL) | Embedding SEL instruction into the curriculum and tailoring it for students with learning and attention issues can help develop important skills such as managing emotions and persevering. |
| BUILD SELF-ADVOCACY SKILLS | Helping students understand how they learn and practicing how to ask for accommodations are essential for success and can be fostered through mentoring. |
| FOCUS EARLIER ON POSTSECONDARY TRANSITIONS | Helping high-schoolers adjust to changing expectations can promote resilience as they transition to college or the workplace. |
| ADVOCATE FOR INCREASED FUNDING | Education laws offer protections and can be powerful tools for change, but implementing them requires adequate, steady funding to provide supports and services. |
Sources listed at the bottom of this page.1
How common are different kinds of learning and attention issues?
Converging epidemiological evidence indicates at least 1 in 5 children in the U.S. have learning and attention issues. Prevalence estimates vary for conditions such as dyslexia because different studies use different definitions. There is no blood test or other quick way to tell if a child has a learning or attention issue. An accurate diagnosis involves comprehensive assessment protocols that look at many kinds of behaviors and skills.
| ISSUE | PREVALENCE | SOURCE |
| Dyslexia | 5%–17% | Pediatrics in Review |
| Dyscalculia | 5%–7% | Science |
| Dysgraphia | 7%–15% | Pediatrics |
| Dyspraxia* | 5%–6% | DSM-5 |
| ADHD | 5%–11% | DSM-5, CDC |
*Also known as developmental coordination disorder
Comorbidity is common
It’s important to keep in mind that many children have more than one learning or attention issue. For example, researchers have found that dyslexia and dyscalculia^ co-occur in 30% to 70% of children who have either disorder.2 Studies also indicate as many as 45% of children with ADHD also have a learning disability^.3
Public perceptions reveal widespread misconceptions
Despite how common learning and attention issues are, there is still widespread confusion among the public about the nature and impact of these issues. Recent surveys, detailed below, highlight the perceptions of three key groups: parents, educators and healthcare professionals who work with children between the ages of 3 and 20. These surveys are consistent with previous research on public perceptions4 and underscore the ongoing need to:
- Raise awareness and reduce stigma among parents, 43% of whom say that they wouldn’t want other parents to know if their child had a learning disability.
- Clear up misconceptions among educators—a third of whom believe that sometimes what people call learning or attention issues is really just laziness.
- Keep learning and attention issues top of mind among healthcare professionals, only a fifth of whom say they almost always ask parents and children about symptoms of learning and attention issues.
Parents
Myths About Learning and Attention Issues
| MYTH | FACT |
 48% of parents believe: Children can grow out of learning disabilities |
Learning and attention issues are lifelong conditions involving differences in brain structure and function. Symptoms may change over time, and the right support helps address weaknesses. But age doesn’t make these issues “go away.” |
 78% of parents believe: Any child can do well in school if he or she tries hard enough |
When it comes to learning and attention issues, trying harder is not the answer. Children with these issues need targeted interventions and accommodations to help them work on or work around their weaknesses. |
 18% of parents believe: Children with learning disabilities are less intelligent than other children |
Children with learning and attention issues are as smart as their typically developing peers, and many have average or above-average intelligence. There are many children who are gifted and have learning disabilities. Many schools refer to these children as “twice-exceptional.” |
Signs of Learning and Attention Issues
| SIGN | AWARENESS |
| Reads at a lower level than his/her peers |  43% of parents are aware of this possible sign |
| Has a hard time “getting” math concepts |  40% of parents are aware of this possible sign |
| Has bad handwriting |  19% of parents are aware of this possible sign |
| Always loses his/her homework |  27% of parents are aware of this possible sign |
| Can’t sit still |  63% of parents are aware of this possible sign |
| Doesn’t want to go to school |  28% of parents are aware of this possible sign |
| Has a hard time making friends |  27% of parents are aware of this possible sign |
Awareness of Issues—and Tools That Schools Can Use to Help
| ISSUE/TOOL | AWARENESS |
| Dyscalculia |  11% of parents have heard of this |
| Dysgraphia |  13% of parents have heard of this |
| Dyspraxia |  14% of parents have heard of this |
| Dyslexia |  80% of parents have heard of this |
| ADHD | 82% of parents have heard of this |
| Individualized Education Program (IEP) |  42% of parents have heard of this |
| 504 Plan |  23% of parents have heard of this |
Source: Survey commissioned by Understood.org and conducted by Lightspeed GMI in September 2016. The survey polled a random sampling of 1,000 parents who have children under the age of 18 and who are representative of the U.S. population.
Educators
| of classroom teachers and other educators believe sometimes what people call a learning or attention issue is really just laziness | |
| of classroom teachers say they are somewhat or not very confident in recommending that a child be evaluated for special education for learning issues | |
| of classroom teachers in elementary school say a significant challenge they face is lack of resources needed to provide instruction, related services and support to children with learning and attention issues |
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| of classroom teachers say they are somewhat or not too confident in their ability to implement IEP/504 plans |
Source: Survey commissioned by Understood.org and conducted by GfK in September 2014. The survey polled 300 classroom teachers (evenly represented across Pre-K/elementary, middle and high school) and 100 other kinds of educators including school psychologists, special education teachers, reading specialists, speech-language pathologists, occupational therapists, school nurses, guidance counselors, principals and vice-principals.
These surveys offer a glimpse into public perception and awareness of learning and attention issues and point to the troubling reality that not only are many people misinformed about these issues, but many educators and healthcare providers do not feel confident about their ability to address these issues. These findings warrant additional research into public perceptions and stigma and their impact on individuals with learning and attention issues.
New findings point to differences in brain structure and function
New research in the fields of neuroscience and neurogenetics is deepening our understanding of the differences in brain structure and function in children with learning and attention issues. Brain scans and other tools are also helping researchers measure the biological impact that instructional interventions have on children with dyslexia and other issues.
As studies expand how we think about and address learning and attention issues, it’s important to note that the science is still emerging and that studies need to be replicated to confirm these findings.
| NEW FINDINGS | IMPLICATIONS |
| A groundbreaking study used brain imaging to show that, when repeatedly presented with certain stimuli, the brain’s responses are different in people with dyslexia when compared to typical readers. This difference was apparent when the study’s participants heard or looked at words as well as when they were presented with pictures of objects and faces. | If neurons have trouble adapting to repeated stimuli, it may be harder to learn new information. And if weaker neural adaptation is the core difference in the brains of people with dyslexia, these findings could lead researchers to investigate the underlying mechanism and find ways to address it. |
| Another new study points to structural and functional differences between the brains of children with dyslexia and the brains of children with dysgraphia when compared to neurotypical children. Children with dyslexia or dysgraphia have less white matter (which connects different parts of the brain and relays information quickly), but more functional connections in their gray matter (where thinking and language processing take place). The study also shows there are brain-based differences between children with dyslexia and dysgraphia. | These findings indicate that brains of children with dyslexia or dysgraphia have to work harder to complete written-language tasks as compared to the brains of neurotypical children. And because the spelling problems associated with both of these learning disabilities appear to have different brain bases, they may require different kinds of interventions. (It’s also important to keep in mind that children with co-occurring issues may need several types of interventions.) |
| Functional connections within and betweencertain brain networks take longer to mature in children with ADHD. These networks are associated with paying attention, staying on task and other executive functions. | This study helps explain why children with ADHD struggle with executive functioning. Providing direct instruction and support could help nurture the formation of neural connections needed to improve performance. |
| A longitudinal study looked at the role neurochemistry plays in the process of learning to read and found that young children’s reading ability can be predicted by glutamate and choline levels in their brains. Children with higher levels of these metabolites tended to have lower scores for reading and language. | These findings point to new directions for research on dyslexia, including the possibility of one day, perhaps, developing medication that could help children who struggle to develop early reading skills. |
| A study of more than 5,000 children offers insights into the complex role genes play in dyslexia. Children who have variants of two genes associated with dyslexia (DCDC2 and KIAA0319) have a much greater risk of developing dyslexia or language impairment than if they only have variants of one gene or the other. | The more we understand how genes interact with each other or how they’re affected by environmental factors, the sooner we may be able to use this information alongside screening and progress monitoring to identify children at risk and intervene before they fall behind in school. |
| An imaging study showed how learning to read changes the way the brain’s visual system functions. Researchers compared children with dyslexia to typically developing readers who were the same age as well as to younger, less experienced readers. The findings indicate thatdifferences in processing visual stimuli is not a cause of dyslexia but instead is a consequence of less reading. The study also observed that after children with dyslexia received intensive phonological tutoring to address the core deficit of this reading disorder, they made significant gains in reading, and their brains boosted their response to certain kinds of visual stimuli. | These findings indicate that when researchers observe differences in visual processing in children with dyslexia, it may be because they are being compared to more skilled readers whose brains have undergone more of this change. The findings also further demonstrate that phonological training can improve reading and reinforce the notion that identification and treatment of dyslexia should not revolve around deficits in visual processing. |
| A study of children with dyscalculia identified changes in brain function after the children received effective tutoring. Eight weeks of one-on-one cognitive tutoring not only improved math performance, but also led to widespread changes in brain activity in networks associated with numerical problem-solving. | These findings may provide new ways to understand and measure how children respond to different kinds of math interventions. |
| New research shows that dyslexia affects brain structure in males in different ways than it affects brain structure in females. Sex-specific differences were observed in areas that process language as well as in regions of the brain that process sensory and motor information. | Because more boys than girls tend to be identified as having dyslexia, our understanding of the brain basis of dyslexia has developed primarily through the study of males. More research is needed to determine whether different approaches are needed to identify and treat dyslexia in girls. |
Clinical Caveats
In the field of learning and attention issues, brain imaging technology is still considered to be only a research tool. No brain imaging technology has been validated by the research community for clinical use in lieu of behavioral evaluations to diagnose either ADHD or dyslexia.
There is tremendous variability from one person to the next in terms of brain anatomy and brain function. (The same is also true when it comes to people’s genomes—even identical twins don’t have identical DNA!) Any differences that might serve as diagnostic markers need to be tested in large-scale studies and replicated by other researchers before brain scans can be used to reliably identify dyslexia in clinical settings.
“Perhaps one day imaging will play a role in identifying individuals with dyslexia. Until then, parents and educators need to use traditional options, such as a neuropsychological evaluation and other behavior measures proven effective in identifying struggling readers and very young children at risk for reading difficulties, even before they learn to read.”
—Guinevere Eden, Ph.D.,
Director of Georgetown University’s Center for the Study of Learning and former president of the International Dyslexia Association
Laws that guarantee supports and services are essential for improving outcomes for the 1 in 5
Several long-standing legal protections as well as some newer laws protect the rights of children and adults with disabilities, including learning disabilities and disorders such as ADHD.
Federal Laws That Protect the Rights of Children and Adults With Disabilities
| LAW | YEAR PASSED | KEY DETAILS |
| Section 504 of the Rehabilitation Act (Section 504) |
1973 |
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| Individuals with Disabilities Education Act (IDEA) | 1990 (and updated in 1997 and 2004) |
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| Americans with Disabilities Act (ADA) | 1990 |
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| Workforce Innovation and Opportunity Act (WIOA) | 2014 |
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| Every Student Succeeds Act (ESSA) | 2015 |
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| Research Excellence and Advancements for Dyslexia Act (READ) | 2016 |
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State Laws
Over the last decade, 38 states have passed laws that require schools to monitor students’ progress in reading between kindergarten and grade 3. These laws emphasize the importance of early screening to help find struggling students before they fall far behind. These laws are often referred to as third-grade reading laws or third-grade retention laws because they require students who can’t read at a certain level to repeat grade 3. Some of these laws allow exceptions for students with and IEP^ or 504 plan^.
In addition, 26 states have passed dyslexia laws to help identify and provide early intervention for students with a reading disability. These laws provide funding and require intervention and services for students who are struggling with reading. Many states with these early screening and literacy laws also provide funding for teacher professional development.
40%Percentage of the extra cost of special education that Congress promised to fund in 1975 with the passage of IDEA
16%Percentage of the extra cost of special education that Congress appropriated in 2016
The federal government has not delivered on its promise to provide full funding
Federal laws that guarantee equal access and protect the rights of students with disabilities are most effective when schools receive adequate funding to provide essential services and supports. Yet as the number of students with disabilities has increased, the federal government has made drastic cuts to education spending. And Congress has never come close to fulfilling its promise to fund 40% of the extra cost of special education.
In 2016, the federal government covered 16% of the extra cost of special education, leaving states to grapple with this multibillion-dollar shortfall.5
As schools struggle to provide the services that children with disabilities need—and that federal law requires—it is more critical than ever for parents, educators and others who care about students with learning and attention issues to advocate for increased funding.
For a full discussion of how to address the challenges and opportunities discussed in this chapter, see NCLD’s Recommended Policy Changes.
How to Help Kids With Working Memory Issues by Rae Jacobson
Parents Guide to ADHD Medications by Child Mind Institute
The Most Common Misdiagnoses in Children by Linda Spiro, PsyD
How to Spot Dyscalculia by Rae Jacobson
Post-Traumatic Stress Disorder Basics by Child Mind Institute
How to Help Anxious Kids in Social Situations by Katherine Martinelli
Anxiety in the Classroom by Rachel Ehmke
The Benefits Of Unsupervised Play Will Make You Want To Back Off Your Kids' Activities In A Big Way by Katie McPherson
How to Avoid Passing Anxiety on to Your Kids by Brigit Katz
3 Defining Features of ADHD That Everyone Overlooks by William Dodson, M.D.
Should emotions be taught in schools? by Grace Rubenstein
Why Do Kids Have Trouble With Transitions? by Katherine Martinelli