Learning Disabilities

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ARTICLE:  Developmental Dyscalculia and Medical Assessment ...

Ruth S. Shalev and Varda Gross-Tsur, POB 3235 Jerusalem, Israel  91031

SOURCE:  Journal of Learning Disabilities, February  1995, Vol. 28, No. 2, 96-106.

A review by Claude H. A. Simpson, Nova Southeastern University, Fl, U.S.A.


The authors defined Developmental Dyscalculia (DC) as a primary cognitive disorder of childhood manifested by disturbance of arithmetic ability. The authors rightly claimed that DC is an isolated learning disability (LD) which is usually treated by remedial education and not referred for further medical evaluation.          

In a stringent research survey, the authors observed and examined a group of seven (7) third-grade children with DC attending a mainstream school who had not progressed academically in spite of specific special education intervention. These were neurological conditions that had direct bearing on the children's cognitive disabilities and remedial programs. A breakdown showed that: one child had PETIT MAL SEIZURES, one had DEVELOPMENTAL GERSTMANN SYNDROME, another had DYSLEXIA for numbers, and four children had ATTENTION DEFICIT DISORDERS without hyperactivity. From the survey and results, the authors agreed and strongly suggested that the indications for medical or neurological assessment be broadened to include children who are allowed appropriate professional intervention but are not improving academically.

The authors cited O'Hare, Brown & Aitken 1991,who argued that achievement in  mathematics  is  very  sensitive  to  a  variety  of  factors  such  as  neurological conditions.  The authors also cited Rapin, 1988 who claimed that children with one
neurodevelopmental dysfunction are likely to have a second.

The method utilized by the authors to arrive at the breakdown aforementioned, showed that the seven (7) index children attended learning disabilities class in a regular neighborhood school in Israel. From a total of 185 third- graders, twenty (20) were enrolled in two special education classes specifically geared for children with arithmetic disorders. All children in the two classes of ten (10) were of normal intelligence with no known physical impediments. Nine (9) of the twenty (20) children who had participated did not improve significantly. These children fulfilled the criteria for developmental dyscalculia per DSM-III-R. They were referred for neurological assessment because they had not progressed as expected. Two families declined to participate whilst the other seven (7) children underwent an assessment that included a neurological examination. 

The more severe cases were summarized as follows:

CASE #1  8.5 year old girl who was born following a normal pregnancy. She was diagnosed as having a specific problem in arithmetic when she was in first grade. There was no family history of learning disabilities. The child was diagnosed as having attention deficit disorder without hyperactivity and treatment with Ritalin was initiated.  She responded with slow but constant progress in arithmetic skills.

CASE #2  8.9 year old boy was born to healthy parents after a normal pregnancy and delivery. There was no family history of LD. At age 3 he was diagnosed as hypotonic with mild incoordination for which he was treated with occupational therapy. He had no difficulty reading or writing numbers, but was unable to do arithmetic calculations under 10. He was diagnosed as having Developmental Gerstmann Syndrome and ADHD. He was recommended for a temporary shift of emphasis from arithmetic to other school subjects.

CASE #3  8.5 year old girl born after a normal pregnancy and delivery. No family history of LD. In first grade her parents were informed of severe difficulties in arithmetic and minor problems in reading and writing. She was diagnosed with petit mal (true absences). After intervention her academic skills rapidly improved and she was graduated into the regular class.

CASE #4    8.5 year old boy was born after a normal pregnancy and delivery. He had relatives who had LD. He was placed in special class for arithmetic disorders in second grade. He had no grasp of subtraction and was unable to perform many of the addition problems.  He had dyslexia for numbers.

One of the strengths of the article is that the authors highlighted Developmental Dyscalculia (DC) which is an isolated learning disability, which unfortunately affects the ability of otherwise intelligent and healthy children to learn ARI1HMETIC. The authors presented various definitions  so as to give the reader a rounded knowledge and a more accurate view-perspective of the disorder.  Another strong point is that the authors cited various references to support and validate the claim for recommendations, educational interventions and medical evaluations.

Although this survey was done in Israel with the children in their school system; the findings, recommendations  and key suggestion - "indications for medical or neurological assessment be broadened to include children who are not improving academically" may be directly applicable to children all around the world.

One of the underlying weaknesses however, is that of the assessment tools, that is, unavailability of standardized reading, writing, and arithmetic evaluations in Israel. The alternative used was the age-appropriate material provided by the Ministry of Education and this may only be suitable for Israeli children. A resulting problem is that the standard(s) may differ significantly for other countries and other nationals  and  may  be rendered  inappropriate  as  a  measurement  tool, to assess adequately. The population was also very limited, in age as well as national origin.

As I seek to conclude, I wish to commend the authors for presenting such a thorough investigation and well prepared and referenced paper on Developmental Dyscalculia. I also do applaud their suggestion of medical input where necessary when assessing children with LD who are not improving academically in spite of intensive professional intervention. This article is a rather informative one and those who are directly involved in research in Special Education - LD would find it not only informative but also useful in providing models of effective Special Education Research.