Neuropsychological Evaluation of Learning Disabilities

Understanding Specific Learning Disorders

Learning disorders (also known as learning disabilities) are not due to a lack of intelligence, effort, or motivation. They are persistent difficulties in acquiring and using basic academic skills, despite adequate instruction and a stimulating environment.

The DSM-5-TR defines specific learning disorders under three main categories:

• Specific Learning Disorder with impairment in reading (DSM-5-TR 315.00) – commonly referred to as dyslexia. It affects accuracy, fluency, or reading comprehension.
• Specific Learning Disorder with impairment in written expression, particularly spelling (DSM-5-TR 315.2) – commonly referred to as dysorthographia. It manifests as difficulties writing without errors, memorizing words, and applying spelling rules.
• Specific Learning Disorder with impairment in mathematics (DSM-5-TR 315.1) – commonly referred to as dyscalculia. It involves difficulties understanding numbers, performing calculations, solving problems, or memorizing arithmetic facts.

These disorders may appear on their own or in combination. Each person presents a unique profile: two children with dyslexia, for example, may have very different strengths and challenges.

Frequent Coexistence with Other Conditions

One of the main reasons for conducting a complete neuropsychological evaluation is the high frequency of associated conditions. For example, about 50% of children with dyslexia also have ADHD. Other common co-occurring difficulties include:

• language disorders;
• anxiety or mood disorders;
• dyspraxia/dysgraphia;
• challenges in emotional regulation.

This coexistence complicates the picture. Without a comprehensive evaluation, it is easy to conclude too quickly that difficulties stem from a learning disorder alone, while in fact other conditions are present. Neuropsychological evaluation helps disentangle these factors and guides more precise interventions.

How Learning Disorders Evolve with Age

Specific learning disorders manifest differently across development:

• Early childhood: slow acquisition of letters and sounds, difficulty memorizing nursery rhymes, persistent confusion with numbers.
• Elementary school years: marked struggles in reading fluently, spelling correctly, or learning multiplication tables.
• Adolescence: slower pace, cognitive fatigue, difficulties during exams, declining motivation.
• Adulthood: impact on higher education, professional performance, and self-confidence.

This progression highlights the importance of early evaluation but also of re-evaluation at key stages, such as the transition to high school, post-secondary studies, or entry into the workforce.

Why a Neuropsychological Evaluation?

A neuropsychological evaluation does not simply measure reading, spelling, or math skills. It aims to understand all the cognitive processes that underlie learning. Several factors can mimic or worsen academic difficulties:

• attention deficit disorders;
• working memory problems;
• visuomotor or graphomotor difficulties;
• performance anxiety;
• low self-esteem.

Without a comprehensive evaluation, one may miss the true cause of the difficulties or fail to recognize that several challenges overlap.

The Evaluation Process

A neuropsychological evaluation of a learning disorder generally takes about six hours in total, spread over one or two days. This includes the initial interview, test administration, and the neuropsychologist’s analysis of results. The process includes several stages:

1. Initial Interview

The neuropsychologist meets with parents and the child (or with the adult being evaluated) to gather developmental, medical, and educational history. Concerns and everyday observations are discussed. This step helps target hypotheses and contextualize test results.

2. General Cognitive Assessment

Core intellectual abilities are measured: reasoning, verbal comprehension, information processing, and abstract thinking. This helps situate academic skills relative to the individual’s overall cognitive potential.

3. Perceptual-Motor and Visuospatial Functions

Eye-hand coordination, graphomotor skills, and visuospatial organization are assessed. These abilities influence writing, copying, geometry, and even reading strategies.

4. Attention and Executive Functions

Concentration, inhibition, planning, flexibility, and working memory are evaluated. These higher-order processes orchestrate learning and problem solving.

5. Memory

Short-term memory, working memory (often included under executive functions), and long-term memory are distinguished. Memory weaknesses can explain persistent errors in reading, spelling, or math.

6. Academic Skills

A detailed academic assessment is conducted:

• Reading: accuracy, fluency, speed, comprehension.
• Spelling: dictation, orthographic memory, phonological rules, written expression.
• Mathematics: number sense, calculation, automatization of arithmetic facts, problem solving.
  Precursors (such as phonological awareness for reading or number sense for math) are also examined to identify the origins of difficulties.

7. Psychoaffective Profile

Emotional aspects are essential. Many children with a learning disorder develop performance anxiety or low self-esteem. Addressing these factors is crucial; ignoring them can undermine the effectiveness of interventions.

Differential Diagnosis and Clinical Precision

A full evaluation helps answer key questions:

• Is this truly a specific learning disorder?
• Are the difficulties better explained by another condition, such as ADHD, a language disorder, or an anxiety disorder?
• Are both a learning disorder and another condition present?

This level of precision prevents misunderstandings, such as attributing academic difficulties solely to a learning disorder when they are aggravated by an undetected attention deficit.

Communicating Results

About three weeks after testing, a feedback session is held. The neuropsychologist presents a clear overview of:

• the child’s or adult’s strengths;
• the specific challenges identified;
• the possible emotional impacts;
• the diagnoses retained and their significance.

A detailed written report is provided. It includes:

• a summary of cognitive and academic findings;
• an individualized intervention plan;
• recommendations for the school (teaching adaptations, study strategies, exam accommodations);
• referrals to complementary services if needed (speech-language therapy, remedial teaching, psychology, occupational therapy).

What a Neuropsychological Evaluation Provides

The evaluation of learning disorders helps to:

• identify the true cause of academic difficulties;
• highlight strengths that can be leveraged for learning;
• propose targeted, effective interventions;
• support motivation and self-confidence;
• provide parents, teachers, and professionals with a clear roadmap.

It goes beyond diagnosis: it sets the stage for meaningful, tailored support that acknowledges each individual’s unique profile.

A Long-Term Perspective

An evaluation is not an endpoint but a starting point. It offers a snapshot of the individual at the time of testing and guides interventions. Development is dynamic, and follow-up may be necessary at critical stages: entering high school, choosing an academic path, or transitioning to post-secondary education.

Conclusion

Specific learning disorders are common and can significantly affect academic success and self-confidence. A neuropsychological evaluation, through its rigor and comprehensive approach, makes it possible to clarify causes, understand the unique profile of each individual, and design appropriate interventions. It is an essential step in transforming academic struggles into a more supported and fulfilling learning journey.