The Difference Between Learning Difficulties and Learning Disability

“What the difference is between the term learning difficulties and learning disability.”

This question is often asked by clients via our email advice service.  We prefer to use internationally recognised and agreed terms such as those defined in DSM-5 and ICD 10.  The most recently reviewed being DSM-5.  DSM-5 is the diagnostic manual produced by the American Psychiatric Association.  It has international acceptance.  The ICD 10 also has international acceptance and is produced by The World Health organisation (WHO) With respect to both DSM-5 and ICD 10 the terms learning difficulties and learning disability are not found. 

The term Specific Learning Disorder is found in DSM-5 and refers to difficulties with reading, reading fluency, reading comprehension, spelling accuracy, grammar and punctuation accuracy and organisation of written expression. Dyslexia is cited as an alternate term. 

DSM-5 also refer to Intellectual Disability this term is used to describe people who find learning generally difficult, there will be difficulties learning both in the academic setting and home and social settings.  IQ would generally be in the bottom 2% of the population (IQ 70 or below).

Children who are persistently given detentions at school.

I have a very varied practice seeing both quite young children all the way through to adults.  I am also trained to assess adults for attention deficit disorder (ADD).  When assessing adults for ADD a very important part of the assessment is their history of difficulties with impulse control and attention during the early developmental period, that is to say before 12 years of age and then their difficulties with the same during secondary education.   Time and time again I see clients who are polite, responsible adults from good homes who describe having been in persistent trouble at school.  During their secondary school education, they describe being given frequent detentions and it is concerning that the school does not see this pattern as being of sufficient concern to warrant further investigation.   As it is passingly rare to see a client with a simple diagnostic profile as in just one diagnosis such dyslexia or ADD it is worrying that other comorbid conditions are also being missed. In essence, it is the complex mix of specific learning difficulties that are causing the child to present with inappropriate behaviors that then lead to detentions having to be regularly served.

I would suggest that all schools review the children who are being subject to sanctions and if a child is getting more than one detention per term then at least some form of assessment should take place. My preference would be to refer the child for an educational psychologist assessment. I understand that EP time is rare and limited and so priorities have to be identified but many parents will be confused by their child being in frequent trouble at school and be prepared to fund an EP assessment if so advised by the school.  Behaviour is a symptom, it is the job of the adults to try and figure out the cause.  Humans are group animals we do not act outside the heard behavior unless something is wrong.  



Managing ADD/ADHD in the classroom

Teachers know what many professionals do not: that there is no one syndrome of ADD (Attention Deficit Disorder) but many; that ADD rarely occurs in "pure" form by itself, but rather it usually shows up entangled with several other problems such as learning disabilities or mood problems; that the face of ADD changes with the weather, inconstant and unpredictable; and that the treatment for ADD, despite what may be serenely elucidated in various texts, remains a task of hard work and devotion. There is no easy solution for the management of ADD in the classroom, or at home for that matter. after all is said and done, the effectiveness of any treatment for this disorder at school depends upon the knowledge and persistence of the school and the individual teacher.

Here are a few tips on the school management of the child with ADD. The following suggestions are intended for teachers in the classroom, teachers of children of all ages. Some suggestions will be obviously more appropriate for younger children, others for older, but the unifying themes of structure, education, and encouragement pertain to all.

First of all, make sure what you are dealing with really is ADD. It is definitely not up to the teacher to diagnose ADD, but you can and should raise questions. Specifically, make sure someone has tested the child's hearing and vision recently, and make sure other medical problems have been ruled out. Make sure an adequate evaluation has been done. Keep questioning the SENCo until you are convinced.

Second, build your support. Being a teacher in a classroom where there are two or three kids with ADD can be extremely tiring. Make sure you have the support of the school and the parents. Make sure there is a knowledgeable person with whom you can consult when you have a problem (learning specialist, child psychiatrist, social worker, educational psychologist, pediatrician - the person's degree doesn't really matter. What matters is that he or she knows lots about ADD, has seen lots of kids with ADD, knows their or her way around a classroom, and can speak plainly.) Make sure the parents are working with you. Make sure your colleagues can help you out.

Third, know your limits. Don't be afraid to ask for help. You, as a teacher, cannot be expected to be an expert on ADD. You should feel comfortable in asking for help when you feel you need it.

ASK THE CHILD WHAT WILL HELP. Children can often tell you how they can learn best if you ask them. They are often too embarrassed to volunteer the information because it can be rather eccentric. But try to sit down with the child individually and ask how he or she learns best. By far the best "expert" on the how the child learns best is the child himself or herself. It is amazing how often their opinions are ignored or not asked for. In addition, especially with older kids, make sure the child understands what ADD is. This will help both of you a lot.

Having taken the aboveinto account, try the following:

Remember that ADD kids need structure. They need their environment to structure externally what they can't structure internally on their own. Make lists. Children with ADD benefit greatly from having a table or list to refer back to when they get lost in what they're doing. They need reminders. They need previews. They need repetition. They need direction. They need limits. They need structure.

REMEMBER THE EMOTIONAL PART OF LEARNING. These children need special help in finding enjoyment in the classroom, mastery instead of failure and frustration, excitement instead of boredom or fear. It is essential to pay attention to the emotions involved in the learning process.

Post rules. Have them written down and in full view. The children will be reassured by knowing what is expected of them.

Repeat directions. Write down directions. Speak directions. Repeat directions. People with ADD need to hear things more than once.

Make frequent eye contact. You can "bring back" an ADD child with eye contact. Do it often. A glance can retrieve a child from a daydream or give permission to ask a question or just give silent reassurance.

Seat the ADD child near your desk or wherever you are most of the time. This helps stave off the drifting away that so bedevils these children.

Set limits, boundaries. This is containing and soothing, not punitive. Do it consistently, predictably, promptly, and plainly. DON'T get into complicated, lawyer-like discussions of fairness. These long discussions are just a diversion. Take charge.

Have as predictable a schedule as possible. Post it on the blackboard or the child's desk. Refer to it often. If you are going to vary it, as most interesting teachers do, give lots of warning and preparation. Transitions and unannounced changes are very difficult for these children. They become discombobulated around them. Take special care to prepare for transitions will in advance. Announce what is going to happen, then give repeat warnings as the time approaches.

Try to help the kids make their own schedules for after school in an effort to avoid one of the hallmarks of ADD: procrastination.

Eliminate or reduce frequency of timed tests. There is no great educational value to timed tests, and they definitely do not allow many children with ADD to show what they know.

Allow for escape valve outlets such as leaving class for a moment. If this can be built into the rules of the classroom, it will allow the child to leave the room rather than "lose it," and in so doing begin to learn important tools of self-observation and self-modulation.

Go for quality rather than quantity of homework. Children with ADD often need a reduced load. As long as they are learning the concepts, they should be allowed this. They will put in the same amount of study time, just not bet buried under more than they can handle.

Monitor progress often. Children with ADD benefit greatly from frequent feedback, it helps keep them on track, lets them know what is expected of them and if they are meeting their goals, and can be very encouraging

Break down large tasks into small tasks. This is one of the most crucial of all teaching techniques for children with ADD. Large tasks quickly overwhelm the child and he recoils with an emotional "I'll-NEVER-be-able-to-do-THAT" kind of response. By breaking the task down into manageable parts, each component looking small enough to be do-able, the child can sidestep the emotion of being overwhelmed. In general, these kids can do a lot more than they think they can. By breaking tasks down, the teacher can let the child prove this to himself or herself. With small children this can be extremely helpful in avoiding tantrums born of anticipatory frustration. And with older children it can help them avoid the defeatist attitude that so often gets in their way. And it helps in many other ways, too. You should do it all the time.

Let yourself be playful, have fun, be unconventional, be flamboyant. Introduce novelty into the day. People with ADD love novelty. They respond to it with enthusiasm. It helps keep attention - the kids' attention and yours as well. These children are full of life - they love to play. And above all they hate being bored. So much of their "treatment" involves boring stuff like structure, schedules, lists, and rules, you want to show them that those things do not have to go hand in hand with being a boring person, a boring teacher, or running a boring classroom. Every once in a while, if you can let yourself be a little bit silly, that will help a lot.

Still gain, watch out for overstimulation. Like a pot on the fire, ADD can boil over. You need to be able to reduce the heat in a hurry. The best way of dealing with chaos in the classroom is to prevent it in the first place.

Seek out and underscore success as much as possible. These kids live with so much failure, they need all the positive handling they can get. This point cannot be overemphasized: these children need and benefit from praise. They love encouragement. They drink it up and grow from it. And without it, they shrink and wither. Often the most devastating aspect of ADD is not the ADD itself, but the secondary damage done to self-esteem. So water these children well with encouragement and praise.

Memory is often a problem with these kids. Teach them little tricks like mnemonics, flashcards, etc. They often have problems with what Mel Levine calls "active working memory", the space available on your minds table, so to speak. Any little tricks you can devise - cues, rhymes, codes and the like- can help a great deal to enhance memory.

Use outlines. Teach outlining. Teach underlining. These techniques do not come easily to children with ADD, but once they learn the techniques it can help a great deal in that they structure and shape what is being learned as it is being learned. This helps give the child a sense of mastery DURING THE LEARNING PROCESS, when he or she needs it most, rather than the dim sense of futility that is so often the defining emotion of these kids' learning process.

Announce what you are going to say before you say it. Say it. Then say what you have said. Since many ADD children learn better visually than by voice, if you can write what you're going to say as well as say it, that can be most helpful. This kind of structuring glues the ideas in place.

Simplify instructions. Simplify choices. Simplify scheduling. The simpler the verbiage the more likely it will be comprehended. And use colourful language. Like colour coding, colourful language keeps attention.

Use feedback that helps the child become self-observant. Children with ADD tend to be poor self-observers. They often have no idea how they come across or how they have been behaving. Try to give them this information in a constructive way. Ask questions like, "Do you know what you just did?" or "How do you think you might have said that differently?" or "Why do you think that other girl looked sad when you said what you said?" Ask questions that promote self-observation.

Make expectations explicit.

A point system is a possibility as part of behavioural modification or reward system for younger children. Children with ADD respond well to rewards and incentives. Many are little entrepreneurs.

If the child seems has trouble reading social cues - body language, tone of voice, timing and the like - try discreetly to offer specific and explicit advice as a sort of social coaching. For example, say, "Before I tell your story, ask to hear the other person's first," or, "Look at the other person when he's talking." Many children with ADD are viewed as indifferent or selfish, when in fact they just haven't learned how to interact. This skill does not come naturally to all children, but it can be taught or coached.

Teach test-taking skills.

Make a game out of things. Motivation improves ADD.

Separate pairs and trios, whole clusters even, that don't do well together. You might have to try many arrangements.

Pay attention to connectedness. These kids need to feel engaged, connected. As long as they are engaged, they will feel motivated and be less likely to tune out.

Try a home-to-school home notebook. This can really help with the day-to-day parent-teacher communication and avoid the crisis meetings. It also helps with the frequent feedback these kids need.

Try to use daily progress reports.

Encourage and structure for self-reporting, self-monitoring. Brief exchanges at the end of class can help with this. Consider also timers, buzzers, etc.

Prepare for unstructured time. These kids need to know in advance what is going to happen so they can prepare for it internally. If they are suddenly given unstructured time, it can be over-stimulating.

Prepare for unstructured time. These kids need to know in advance what is going to happen so they can prepare for it internally. If they suddenly are given unstructured time, it can be over-stimulating.

Praise, stroke, approve, encourage, nourish.

With older kids, have then write little notes to themselves to remind them of their questions. In essence, they take notes not only on what is being said to them, but what they are thinking as well. This will help them listen better.

Handwriting is difficult for many of these children. Consider developing alternatives. Learn how to use a keyboard. Dictate. Give tests orally.

Be like the conductor of a symphony. Get the orchestra's attention before beginning (You may use silence, or the tapping of your baton to do this.) Keep the class "in time" , pointing to different parts of the room as you need their help.

When possible, arrange for student to have a "study buddy" in each subject, with phone number (adapted from Gary Smith).

Explain and normalize the treatment the child receives to avoid stigma.

Meet with parents often. Avoid pattern of just meeting around problems or crises.

Encourage reading aloud at home. Read aloud in class as much as possible. Use story-telling. Help the child built the skill of staying on one topic.

Repeat, repeat, repeat.

Exercise. One of the best treatments for ADD in both children and adults, is exercise, preferably vigorous exercise. Exercise helps work off excess energy, it helps focus attention, it stimulates certain hormones and neurochemicals that are beneficial, and it is fun. Make sure the exercise IS fun, so the child will continue to do it for the rest of his or her life.

With older children, stress preparation prior to coming into class. The better idea the child has of what will be discussed on any given day, the more likely the material will be mastered in class.

Always be on the lookout for sparking moments. These kids are far more talented and gifted than they often seem. They are full of creativity, play, spontaneity, and good cheer. They tend to be resilient, always bouncing back. They tend to be generous of spirit, and glad to help out. They usually have a "special something" that enhances whatever setting they're in. Remember, there is a melody inside that cacophony, a symphony yet to be written.

Short Lecture on the Assessment and Diagnosis of Dyscalculia.

I was asked to make a presentation to a group of senior decision makers from universities across London with respect to dyscalclia. To make the talk available to a wider audience I added a voice over to the PowerPoint presentation and published on YouTube.  Hope you find it interesting.

If you are interested in an assessment which would include dyscalculia, I would suggest our DSA assessment which is a through diagnostic assessment aimed at university students, but can be used as an adult diagnostic assessment, or our work related assessment, which is focused on the person in a particular job, both assessments include all specific learning difficulties.

If you would like to make an appointment please contact:

The Dyslexia Centre.
5 Wadeson Street,
E2 9DR
Telephone 0207 018 0210



ASD Links

Cerebral Palsy

The best site we have found is is a comprehensive informational website on cerebral palsy and behavioral health. The founder is someone who’s lived with cerebral palsy since infancy, he knows how critical it is for parents of a child with CP to have access to reliable and comprehensive information on this complex condition.

Site includes advice about a wide range of therapies aimed at treating and maintaining the physical and mental well being of children and adults with cerebral palsy and/or behavioral and cognitive disorders. 


Assessment via the internet

We are often asked for assessment via Skype, FaceTime etc. and we have developed a highly successful approach to meet this demand from clients who find it difficult to come to London for an office based assessment. This service may be of interest to people who live in remote parts of the UK or international clients.  For this type of assessment we would need to work with someone who would administer the tests under the direction of an educational psychologist. We make no additional charge for this service so the fee you see for clients visiting the Dyslexia Centre is the fee  you will pay for an internet assessment.  The same tests will be used.  

If interested in an educational psychologist assessment via the internet please contact the Dyslexia Centre  on:

0207 018 0210


Access arrangements for GMAT Exam.

This is an American examination and the report must be made according to the diagnostic criteria in DSM-5, which is the guide to diagnosis used in the USA.  There is a requirement that a substantial body of evidence is referred to in the report.  It is important that you have evidence form your past, such as old school reports, assessment reports, letters etc. 

It can be very difficult to find an educational psychologist to make this type of assessment in the UK.  

Difficulties at Work.

Difficulties at Work.

To experience difficulties at work can be one of the most stressful life events, particularly if you have dependents and commitments.  Our practice borders with the City of London a huge financial centre where many people live and work, consequently we have received many requests to assess employees and have developed a thorough assessment for employees experiencing difficulties at work. 

If you find you:

·         Are less productive than peers

·         Find it difficult to read fast and accurately comprehend.

·         Have poor spelling skills.

·         Find it difficult to write reports.

·         Have difficultly concentrating in meetings.

·         Make silly mistakes.

·         Have difficulties organising your thoughts.

·         Have difficulty with number related activity.

In general clients request assessment for two main reasons, firstly confusion and secondly conflict. Clients or their employer may be confused as to why a valued employee appears to perform at a lower level than peers with respect to some occupational duties. A less frequent referral route is from solicitors and trade unions as well as individual clients as there is conflict at work about levels of performance. 

We have consistently found that the assessment process is a useful way of identifying causes behind occupational inefficiency and this has many benefits. Reasonable adjustments can be suggested which allow for focused intervention and supportive practice, that leads to good outcomes. The assessment process is also a very good opportunity for an employee to evaluate themselves against the demands of their workplace duties. 

Work related assessment fee £450  

You may find this video of interest.

If you would like to arrange for an assessment connected with difficulties at work please contact The Dyslexia Centre 0207 018 0210

See also: DSA assessment for those in adult education.


Palin Parent-Child Interaction Therapy for young children (0-7) who stammer

The Michael Palin Centre is an internationally recognised centre for excellence in the field of stammering, credited with the exposition of the multifactorial model of stammering as well as Palin Parent-Child Interaction Therapy. The multifactorial model explains stammering as a phenomenon that does not have a single cause, but occurs because of several contributing factors. These include physiological, psychological, linguistic (speech and language), and environmental factors.

Comprehensive assessment of a child who stammers should explore each of these factors. The resultant formulation should aim to highlight factors contributing towards a child’s stammer that can be changed. Palin Parent-Child Interaction Therapy provides parents with the opportunity to reflect on their interaction with their child during free-play using short video recordings made during each session. Thorough discussion with the SLT parents learn to positively affect their child’s communication environment, while the young person experiences more opportunities to be fluent.

The programme involves an initial assessment, a 6 week period of direct therapy, a 6 week consolidation period where parents implement what has been learned at home, followed by a review session on the 12th week. A longitudinal study (Millard, Nicholas & Cook; 2008) has demonstrated the effectiveness of Palin Parent-Child Interaction Therapy for child who have stammered for 12 months or more.



Millard, S. K., Nicholas, A., & Cook, F. M. (2008). Is parent–child interaction therapy effective in reducing stuttering?. Journal of Speech, Language, and Hearing Research51(3), 636-650.

Taking Notes In Lectures

Possibly the simplest clue to dyslexia in a student is their answer to the question 'Can you take notes in a lecture?'. The answer is usually some variation on 'no'. Sometimes it is ‘Oh my word, not a chance’. Sometimes it is 'Yes, but I can't read them afterwards'. It all amounts to the same thing. What it means is that they don't leave a lecture much wiser than when they entered it.

Dyslexics are weak at processing language. This is not limited to the written word. They also have a weakness in absorbing and storing information in lectures. They are not so good at 'extracting value' from lecturers 'talking at them'.

Sometimes this is partly the fault of the teacher. Academics often believe that subject knowledge is the only criteria that determines their competence. Teaching skill is sometimes not considered a requirement. Some students have to endure lectures that are three hours long. No-one learns well in that situation and dyslexic students find it particularly difficult.

The issue is how much information or 'value' does the student get from the lecture? And what can they do to get more?

The first suggestion is sometimes a little intimidating for the eager-to-learn-and-remember dyslexic. Try not writing at all. 'But then I won't remember any of it!', they say. 'How much of it do you remember at the moment? is the next question. 'Very little', comes the reply.

The attempt to make notes, however futile, is often a long-practised and deep-seated habit. It's like clinging onto a flimsy piece of driftwood in a raging sea. It won't save you, but it's hard to let go. But once the student has relaxed and accepted that retaining everything is not possible – or reasonable to expect – and that relaxing, enjoying the lecture and allowing the brain to catch what it catches and miss what it misses, often more is retained than before. And more understood.

Long lectures are not good for imparting lots of detailed information. What they should be used for is giving an overview, or explaining important points, or providing direction. If the student sets out to achieve some of these objectives – rather than trying to retain great clumps of detail – they will begin to get better value from the experience.

Some students are able to audio-record their lectures. They usually find, though, that they don't have time to listen to them all the way through. Imagine having to attend all your lectures twice and you'll understand why. A strategy for dealing with this is to be alert to which sections of the lecture are particularly significant – an important theorist or significant event – and mark this on the recording, perhaps by re-starting it at that point and making it easy to find. Then these sections can be reviewed later.

Another successful technique is to spend a little time after a lecture to quietly make notes on what is immediately retained. This can be done alone or with one or two fellow students. The key is relaxation. The brain works better when it isn't trying too hard. Just sit, pen in hand, and let the lecture wash through the brain. Note what comes to mind. Don't try to actively remember, just note what the moment presents. Often most of the salient points will be 'captured'.

Reading in advance of the lecture can also be a big help. If the course is well organised, the subject of the lecture will be available in a course overview or on a VLE. Try finding the relevant chapter in a course reader or text-book and scan-read it (see Reading Tips). Read the first and last paragraph in the relevant section and anything else that grabs your attention. That's usually enough to prepare you better for the lecture and helps you follow it.

Also, you can prepare a template for the lecture. Take a single page of A4 and put headings on it from the reading. Just four or five bullet points on the main issues you'll encounter. You might then like to add to that during the lecture. Don’t try to add much, just a further four or five phrases – a date, a theorist's name, a movement or the name of a theory.

Finally, if you don't already receive them, you can ask the lecturer for notes to the lecture. Of course, if you already do, you're probably not reading this piece. Many lecturers feel, wrongly, that writing in the lecture leads to better absorption of the material for all. That's to misunderstand what it means to be a right-brained learner (of course, not having the burden of providing notes makes the lecturer's life easier). Making learning easy for everyone should be the objective and some people learn much more easily when they have notes in advance of lectures.

You can always ask..

Written by Simon Hopper

Employee making mistakes with reading and numbers.

The case below was reported in February 2016 and shows why an employer must pay attention to an employee in difficulty. 

Meseret Kumulchew v Starbucks

•    Meseret Kumulchew accused of falsifying paperwork at Clapham branch
•    She made errors when recording the temperatures of fridges and water
•    Her duties were reduced and she was told to retrain.
•    Starbucks faces a compensation claim after losing tribunal in December

A Starbucks supervisor with a diagnosis of dyslexia was demoted after making mistakes with paperwork, she took the case to a disability tribunal and won a disability discrimination claim against Starbucks because she struggled to read, write and tell the time.

Meseret Kumulchew, who struggles with reading, writing and telling the time, was accused of falsifying documents at the Clapham branch. Ms Kumulchew was given reduced duties and told to retrain after failing to correctly take the temperature of the water and fridges at regular intervals and record the results. Starbucks said the errors amounted to fraud, which she successfully claimed was a form of disability discrimination. Ms Kumulchew explained that she wasn't afforded the help needed to carry out her duties.  In a message to Starbucks she said: 'I'll struggle, but don't worry, help me and I'll get there in my own time."

Starbucks lost the tribunal in December 2015 and is now facing a compensation claim.
Starbucks was found to have victimised Ms Kumulchew and its 'equality' policies failed to support her dyslexia, they should have made 'reasonable adjustments' to her duties to help her continue in her job.

This case illustrates two core points:
1. If you are employee and you experience difficulties with reading, number or organisation and you suspect these difficulties  are linked to a specific learning difficulty such as dyslexia, dyspraxia, dyscalculia it is vital that you have a diagnostic assessment, Ms Kumulchew won her case because she had been diagnosed with dyslexia by an educational psychologist.

2. If you are employer and one of your employees is experiencing difficulties with reading, number or organisation and you suspect these difficulties  are linked to a specific learning difficulty such as dyslexia, dyspraxia, dyscalculia, then you have a duty to ask them to have a diagnostic assessment with an educational psychologist.

Many dyslexics are struggling in the work place with very high levels of anxiety, because employers do not have the training or the awareness to make adjustments for them. An educational psychologist will be able to make an assessment and identify any specific learning difficulties that may be causing mistakes at work and recommend reasonable adjustments. We offer a work related diagnostic assessment for £450, which includes a discussion and agreement with the employee as to reasonable adjustments. We welcome a representative from the employees company to observe the assessment and join the discussion as to reasonable adjustments at the conclusion of the assessment



Moderate Learning Difficulties, General Learning Difficulties, Intellectual Disability, what does this mean and are they the same?

We are often asked this question by parents.  All of the above refer to difficulties with learning across multiple contexts, so difficulties with learning academic and non-academic material.   In Wadeson Street Dyslexia Centre we prefer, when we can, to use internationally agreed and recognised terms, this is because educational psychologists reports are accepted as evidence in a variety of countries and contexts including law courts, tribunals and when claiming benefits etc. In fact we would go further and take the view that there is a professional duty to use diagnostic terms that would be internationally recognised, by professionals such as, legal, psychological and medical where possible.  There is a trend within LEA educational psychology services to use the term: moderate learning difficulties to describe children who are experiencing difficulties with accessing the school curriculum despite skilled differentiation and support.  The term moderate learning difficulties is not an internationally recognised term and does not appear in ICD 10 or DSM-5.  Whilst a psychologist or physician in a country other than UK could deduce what was meant by the term moderate learning difficulties it could cause difficulties when seeking to access support or provision because moderate learning difficulties is not a clear internationally agreed diagnostic definition. It is also entirely likely that even within the UK, because there are no clear diagnostic criteria, that a diagnosis of moderate learning difficulties could be challenged. Below you will find a description of moderate learning difficulties published on the Institute of Education web site. Then below that is a summary of the criteria for the diagnosis of intellectual disability provided by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM -5)  The DSM-5 is produced by the American Psychiatric Association and is used across the world.

Moderate learning difficulties (MLD)
Pupils with MLD will have attainments well below expected levels in all or most areas of the curriculum, despite appropriate interventions. They will have much greater difficulty than their peers in acquiring basic literacy and numeracy skills and in understanding concepts. They may also have associated speech and language delay, low self-esteem, low levels of concentration and underdeveloped social skills. 

The school environment/curriculum can present a range of barriers to participation and learning for pupils with MLD. The SEN Code of Practice says that pupils who demonstrate features of MLD, require specific programmes to aid progress in cognition and learning. In particular, pupils with MLD may need support with:

understanding instructions and the requirements of tasks " acquiring sequencing skills − for example, when following a recipe or science experiment " understanding how they affect and relate to their immediate surroundings " personal organisation over the short, medium and long term, and " visual and auditory memory for information, processes and instructions. "

Careful assessment of baselines and monitoring of progress will help ensure that their progress can be recognised and built upon.

DSM-5 Criterion for the diagnosis of intellectual disability from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, APA 2013). 

Severity is assessed across three domains, a summary of the diagnostic criteria for each domain are as follows:

1. Deficits in intellectual functioning
2. Deficits or impairments in adaptive functioning
3. Deficits in intellectual and adaptive functioning were present during the developmental period. 

Deficits in intellectual functioning
This includes various mental abilities:
•    Reasoning
•    Problem solving
•    Planning
•    Abstract thinking
•    Judgment
•    Academic learning (ability to learn in school via traditional teaching methods)
•    Experiential learning (the ability to learn through experience, trial and error, and observation)

These mental abilities are measured by IQ tests. A score of approximately two standard deviations below average represents a significant cognitive deficit.  This is typically an IQ score of 70 or below.

Deficits or impairments in adaptive functioning
This includes skills needed to live in an independent and responsible manner. Limited abilities in these life skills make it difficult to achieve age appropriate standards of behaviour. Without these skills, a person needs additional supports to succeed at school, work, or independent life. 
Various skills are needed for daily living: 
•    Communication: This refers to the ability to convey information from one person to another. Communication is conveyed through words and actions. It involves the ability to understand others, and to express oneself through words or actions.

•    Social skills: This refers to the ability to interact effectively with others. We usually take social skills for granted. However, these skills are critical for success in life. These skills include the ability to understand and comply with social rules, customs, and standards of public behaviour. This intricate function requires the ability to process figurative language and detect unspoken cues such as body language.

•    Personal independence at home or in community settings: This refers to the ability to take care of oneself. Some examples are bathing, dressing, and feeding. It also includes the ability to safely complete day-to-day tasks without guidance. Some examples are cooking, cleaning, and laundry. There e are also routine activities performed in the community. This includes shopping for groceries, and accessing public transportation.

•    School or work functioning: This refers to the ability to conform to the social standards at work or school. It includes the ability to learn new knowledge, skills, and abilities. Furthermore, people must apply this information in a practical, adaptive manner; without excessive direction or guidance.

Adaptive functioning is usually measured using a recognised test instrument such as the Vineland II.

Deficits in intellectual and adaptive functioning were present during the developmental period. 
This means problems with intellectual or adaptive functioning were evident during childhood or adolescence.  This information can come from the Vineland II, but primarily from an in-depth interview, either with the client if an adult or a parent or care giver.

You can see that there is much in common, but the identification of moderate learning difficulties as described does not require measurement using test instruments whereas it is a requirement for the diagnosis of intellectual disability.  

Typical Ages Of Elimination For Sound Errors (Phonological Processes)

Below you will find descriptions of phonological processes (a pattern of sound error(s)) a typical child will use. This includes an example, and the approximate age (years;months) at which these processes will stop being used.

  • Pre-vocalic voicing:        pig = big        3;0
  • Word-final de-voicing:       pig = pick        3;0
  • Final consonant deletion:    comb = coe        3;3
  • Fronting:       car = tar        3;6
  • Consonant harmony:       mine = mime        3;9
  • Weak syllable deletion:        elephant = efant    4;0
  • Cluster reduction:        spoon = poon        4;0
  • Gliding of liquids:        run = one        5;0
  • Stopping /f/:            fish = tish        3;0
  • Stopping /s/ :          soap = dope        3;0
  • Stopping /v/ :           very = berry        3;6
  • Stopping /z/:            zoo = doo        3;6
  • Stopping 'sh' :           shop = dop        4;6
  • Stopping 'j':            jump = dump        4;6
  • Stopping 'ch':            chair = tare        4;6
  • Stopping voiceless 'th':        thing = ting        5;0
  • Stopping voiced 'th' :       them = dem        5;0

If you are concerned about your child’s speech or language development, please email for free advice: 

Alternatively, please see our fixed fee assessment which may meet your needs


  • Bowen, C. (2011). Table 3: Elimination of Phonological Processes. Retrieved from on 16/01/2016.
  • Bowen, C. (1998). Developmental phonological disorders. A practical guide for families and teachers. Melbourne: ACER Press.
  • Grunwell, P. (1997). Natural phonology. In M. Ball & R. Kent (Eds.), The new phonologies: Developments in clinical linguistics. San Deigo, CA: Singular Publishing Group, Inc.

Phonological Processes In Typical Development

As children learn to speak, they tend to use some different sound errors or patterns as they are not yet able to use all the sounds in all the different word positions that most adults can use. These are called phonological processes. As they get older, these typically disappear as they become more able to pronounce all the words they need to use correctly. For the typical ages that phonological processes are gone by, please click here.

Below, the name of the phonological process is given, along with an example and a description of what is happening to create the process. 

  • Pre-vocalic voicing:    car = gar    A voiceless sound preceding a vowel is replaced by a voiced sound.
  • Word final devoicing:    red = ret    A final voiced consonant is replaced by a voiceless consonant
  • Final consonant deletion:    boat = bo    A final consonant is omitted (deleted) from a word.
  • Velar fronting:    car = tar    A back sound is replaced by a front sound.
  • Palatal fronting:    ship = sip    sh or zh are replaced b y s or z respectively
  • Consonant harmony:    cup = pup    The pronunciation of a word is influenced by one of the sounds it 'should' contain.
  • Weak syllable deletion:    telephone = teffone    Weak (unstressed) syllables are deleted from words of more than one syllable.
  • Cluster reduction:    try = ty    A cluster element is deleted or replaced.
  • Gliding of liquids:    ladder = wadder    Liquids are replaced by glides.
  • Stopping:    ship = tip    A stop consonant replaces a fricative or affricate.

If you are concerned about your child’s speech or language development, please email for free advice: 

Alternatively, please see our fixed fee assessment which may meet your needs


  • Bowen, C. (2011). Table 2: Phonological Processess. Retrieved from on 16/01/2016.

Typical Stages Of Language Development

January 26, 2016

Receptive Language
Receptive language development refers to how children develop listening skills and an understanding of the language they are hearing. 

Language learning starts at birth. Even new babies are aware of the sounds in the environment. They listen to the speech of those close to them, and startle or cry if there is an unexpected noise. Loud noises wake them, and they become "still" in response to new sounds.

0-3 months
Between 0-3 months babies learn to turn to you when you speak, and smile when they hear your voice. In fact, they seem to recognise your familiar voice, and will quieten at the sound of it if they are crying. Tiny babies under three months will also stop their activity and listen closely to the sound of an unfamiliar voice. They will often respond to comforting tones whether the voice is familiar or not.
4-6 months
Between 4 to 6 months babies respond to the word "no". They are also responsive to changes in your tone of voice, and to sounds other than speech. For example, they can be fascinated by toys and other objects that make sounds, enjoy music and rhythm, and look in an interested or apprehensive way for the source of all sorts of new sounds such as the toaster, birdsong and the whirr of machines.

7-12 months
During the 7 to 12 month timeframe, the baby will listen when spoken to, turns and looks at your face when called by name, and discovers the fun of games like "peep-oh" and "pat-a-cake". They will begin to recognise the names of familiar objects ("Daddy", "car", "eyes", "phone", "key") and begin to respond to requests ("Give it to Granny") and questions ("More juice?").
1-2 years
Now your child points to pictures in a book when you name them, and can point to a few body parts when asked (nose, eyes, tummy). He or she can also follow simple commands ("Push the bus!", "Don't touch; it's hot!") and understand simple questions ("Where's the toy?" "Who likes chocolate?", "What's in your bag?"). Your toddler now likes listening to simple stories and enjoys it when you sing songs or say rhymes. This is a stage in which he or she will want the same story, rhyme or game repeated many times.

2-3 years
By now your toddler will understand two stage commands ("Get your coat and put your shoes on") and understand contrasting concepts or meanings like hot / cold / stop / go / in / on and nice. He or she notices sounds like the telephone or doorbell ringing and may point or become excited, get you to answer, or attempt to answer themselves.

3-4 years
Your three or four year old understands simple "Who?", "What?" and "Where?" questions, and can hear you when you call from another room. This is an age where hearing difficulties may become evident. If you are in doubt about your child's hearing, speak to your GP who will refer you to a clinical audiologist.

4-5 years
Children in this age range enjoy stories and can answer simple questions about them. He or she hears and understands nearly everything that is said (within reason) at home or at pre-school or day care. 
Expressive Language
Expressive language refers to how children learn to speak and use Language

Newborn babies make sounds that let others know that they are experiencing pleasure or pain.

0-3 months
Your baby smiles at you when you come into view. He or she repeats the same sound a lot and "coos and goos" when content. The baby uses a different cry for different situations to help you differentiate between what they need. For example, one cry says "I'm hungry" and another says "I have a pain".

4-6 months
Gurgling sounds or "vocal play" occur while you are playing with your baby or when they are occupying themselves happily. Babbling really gets going in this age range, and your baby will sometimes sound as though he or she is talking. This speech-like babbling includes many sounds, often these are bilabial (two-lip) sounds e.g. 'p', 'b' and 'm'. They also use different pitches. Your baby can tell you, using sounds or gestures that they want something, or want you to do something. He or she can use very "urgent" noises and facial expressions to spur you into action.

7-12 months
The sound of your baby's babbling changes. This is because it now includes more consonants, as well as long and short vowels. He or she uses speech and/or sounds other than crying to get your attention and hold on to it. Your baby's first words may be spoken (they may not be very clear yet). Examples of typical first words are: "MaMa", "Doggie", "Night Night", "Bye Bye", "No")

1-2 years
Now your baby is accumulating more words as each month passes. He or she will even ask 2-word questions like "Where ball?" "What's that?" "More choc", and combine two words in other ways to make other sentence types ("Birdie go", "No doggie", "More push"). Words are becoming clearer as more initial consonants are used.

2-3 years
Your two or three year old's vocabulary is increasing quickly. He or she seems to have a word for almost everything. Utterances are usually one, two or three words long and family members can usually understand them. Your toddler may ask for, or draw your attention to something by naming it ("Dog") or one of its attributes ("Red!") or by commenting ("Wow!").
3-4 years
Sentences are becoming longer as your child can combine four or more words. He or she talks about things that have happened away from home, and is interested in talking about pre-school, friends, outings and interesting experiences. Speech is usually fluent and clear and people outside of the family can understand what your child is saying most of the time. 

4-5 years
Your child speaks clearly and fluently in an easy-to-listen-to voice. He or she can construct long and detailed sentences ("We went to the zoo but we had to come home early because Sally wasn't feeling well". He or she can tell a long, involved imaginative story sticking to the topic, and using "adult-like" grammar. Most sounds are pronounced correctly, though he or she may be lisping as a four year old, or, at five, still have difficulty with "r", "v" and "th".
Your child can communicate easily with familiar adults and with other children. Your child may tell fantastic, dramatic, inventive, "tall stories" and engage strangers in conversation when you are out together.
If you are concerned about your child’s speech or language development, please email for free advice:

Alternatively, please see our fixed fee assessment which may meet your needs


  • Bowen, C. (1998). Ages and Stages Summary: Language Development 0-5 years. Retrieved from on

The Difference Between 'Speech' And 'Language' Impairments

‘Speech’ refers to the sounds we make when we are talking. We put strings of sounds together to create words. For example, ‘Cat’ is made up of 3 sounds – C, A and T. The number of sounds in a word does not necessarily correspond to the number of letters when spelling the word. For example, ‘Fright’ is made up of the sounds F, R, I and T (the ‘I’ would be pronounced like ‘eye’).

Different sounds develop at different ages, for example, ‘m’ is typically acquired at around 3 years old, whereas ‘v’ is not typically acquired until 6 years, and ‘th’ until 8 years (Kilminster & Laird, 1978). Children initially will not be able to produce certain sounds, or produce all the sounds in a longer word and so employ phonological processes e.g. saying ‘lectic’ for ‘electric’ or always producing ‘k’ as ‘t’. For more information on phonological processes used in typical development, see here: LINK. All children employ phonological processes up to a certain age. Norms for elimination of phonological processes can be found here: LINK.

Speech Sound Disorder (SSD) is an umbrella term referring to slow development of, or a difficulty with, speech development. An SSD could include articulation disorder, phonological disorder, childhood apraxia of speech and motor-speech disorders. If a child has a speech sound disorder, they may have difficulty producing certain sounds past the age at which those sounds would typically have been acquired. They may use a pattern of sound errors (phonolocial processes) past the age at which this may be typical. A child may be unable to coordinate the sounds needed to make up words, or have a structural or neurological reason that they cannot produce all of the sounds we use when we are talking.

A child may also have difficulty processing certain sounds; this will inevitably lead to difficulty producing that sound. This could have different causes e.g. glue ear, or an Auditory Processing Disorder. 

A Speech and Language Therapist will assess your child’s ability to process and produce a full range of speech sounds to identify how to best target any difficulties in therapy. They may use a formal assessment such as the Diagnostic Evaluation of Articulation and Phonology (DEAP) (Dodd et. al., 2002). For further information on the DEAP, see here: LINK.

Language refers to the meaning of the words we use. When we talk, we string words together into sentences to convey meaning. We also listen to other people’s sentences to understand what they are telling us. Children move through language development milestones, however there will of course be some variation between them. Norms for language development can be found here: LINK

Children may have a language delay if they do not achieve language norms within the expected time-frame. Children may also be diagnosed with ‘Specific Language Impairment’; this is where language is below the expected level in relation to a child’s academic abilities in the absence of general learning difficulty, hearing impairment, autism spectrum condition or anything else that could explain their language difficulty.

A Speech and Language Therapist will assess your child for language impairment. They may use a formal assessment such as the Clinical Evaluation of Language Fundamentals (CELF) (Semel et. al., 2006), along with speaking to the child’s parents and teachers. They may also observe the child in different settings. They will use the information gained in assessment to inform their therapy plan.

If you are concerned about your child’s speech or language development, please email for free advice:

Alternatively, please see our fixed fee assessment which may meet your needs.


  • Bowen, C. (1998). Ages and Stages Summary: Language Development 0-5 years. Retrieved from on[insert the date that you retrieved the file here].
  • CELF
  • Kilminster, M.G.E., & Laird, E.M. (1978) Articulation development in children aged three to nine years. Australian Journal of Human Communication Disorders, 6, 1, 23-30.
  • Bowen, C. (2011). Table 2: Phonological Processess. Retrieved from on [insert the date that you retrieved the file here].
  • Bowen, C. (2011). Table 3: Elimination of Phonological Processes. Retrieved from on [insert the date that you retrieved the file here].
  • DEAP



Reading Tips

Reading (or 'engaging with text')

For many dyslexic students, the reading load they are given is a burden. There are very good ways to make this easier to handle. To a degree, it means making a change to your 'philosophy of reading'. However, if you would like to save time and stress with your reading-list-load, note the tips below.

Firstly, you don't have to read, cover to cover, everything your tutors tell you to. They might say otherwise, but you don’t. You may well need a familiarity with – an overview of – many texts, but you can obtain this without the grief of painfully reading every word of every sentence of every paragraph. A change to your approach can turn a painful and not very rewarding half-day into a satisfying twenty minutes. It really can make that much difference, but you have to adjust your approach and expectations.

Of course, if you want to read the whole thing, have the time and enjoy doing it, that's your choice. Good for you. This piece is written on the assumption that you don't want to or don't have the time or don't enjoy it.

Not all people learn in the same way. Some prefer to start with detail and move from that to the bigger picture. Some are better at beginning with the overview and proceeding in the other direction – to the detail. Reading is a 'detail to overview' process, but dyslexics tend to be better at 'overview to detail'. In fact, dyslexics often have a talent for understanding a subject – having a 'feel for' it – just by gaining a overview of it and, through a sort of intuitive process, 'getting it'.

Note that this is never enough if you have to write an essay on a subject. Although the ideas here are useful to begin to study an essay topic, detailed reading will always be needed (see Essay Writing). But this approach will be enough for preparing for a seminar, tutorial or lecture, or for just gaining a background understanding of a subject. And it can save huge amounts of time and energy.

So, how does a dyslexic obtain an overview of a text without reading 'every word of every sentence'? It's useful to bear in mind that information doesn't exist in the world in the way it's usually presented in academic writing. Out there 'all the things that there are to know' aren't ordered, analysed, put into chapters and expressed in formal sentences. Rather, they exist in a mish-mash of messily interconnected bits and pieces which someone then 'makes sense of' and writes in a book – according to their personal analysis and interpretation. The reader, therefore, should feel free to engage with the text in ways other than the 'start with word one, proceed to word two and so on' approach.

Before any engagement with the text, however, you should first make a mental – or written – note of what you expect/hope to learn from your session. Part of what it takes is to prepare yourself for absorbing the information. And always make notes as you engage with the text. Always write down the ideas you encounter that seem interesting or important – along with the book and page number. You don't want to have to back-track.

Then you should start at the front and the back of the text and work your way in. This is the 'Bookends' approach.

Skim over the contents and index of the book. Do you see anything interesting or relevant? Be confident of your ability to intuitively know this. You will have some familiarity with the topic, however superficial. Let this guide you. If nothing grabs your attention, perhaps you don't need to bother with this text.

If something does, go to that chapter/section. Read the first and last paragraph (or the introduction and the conclusion). Often, you won't need to do more than this to 'get' the subject. You probably don't have to know everything about it (see comment on essays, above). If you want to know more, read the first sentence of each paragraph. Or the first and last. For fun, and to see how this technique can work (and how information outside of academic texts is random and how you can engage with texts by reading them randomly) try reading the first sentence of each paragraph starting with the last paragraph and working towards the first. It really does work and can help free you from the 'tyranny of the text' – the feeling that you have to read in a conventional way.

For this approach to work, you must have faith in your ability to understand intuitively, through extrapolation (by latching on to significant aspects of a subject and more or less 'getting' the rest of it), and you must practise it. And it's OK to engage with a subject whilst knowing that you don't know everything – you don't always have to. Living with an amount of unknowns about a topic is part of this whole approach. And it's fine to do be in that position.

If texts are written well, they will usually introduce the subject of a book in the first chapter and give and overview of it in the last one. Likewise with chapters and their opening and closing paragraphs. Ditto (to a lesser but still useful extent) with paragraphs and their first and last sentences. You can use this to your advantage to help you save time and energy with your reading.

Good luck.

Essay Key Words

Key Words in Essay Titles

Account for: Explain why something happens; give reasons for it.

Analyse: Break down into its important parts and comment on. Examine in close detail; identify important points and chief features.

Comment on: Identify and write about the main issues, giving your reactions based on what you have read or heard in lectures. Avoid purely personal opinion.

Compare: Show how two or more things are similar. Indicate the relevance or consequences of these similarities.

Contrast: Show how two or more things are different. Indicate the relevance or consequences of these differences.

Critically Evaluate: Weigh arguments for and against something, assessing the strength of the evidence on both sides. Use criteria to guide your assessment of which opinions, theories, models or items are preferable.

Define: Give the exact meaning of. Where relevant, show that you understand why the definition may be significant.

Discuss: Describe the most important aspects of the topic (probably including criticism); give arguments for and against; consider the implications of.

Distinguish: Bring out the differences between two (possibly confusable) items.

Evaluate: Assess the worth, importance or usefulness of something, using evidence. There will probably be cases to be made both for and against.

Examine: Put the subject ‘under the microscope’, looking at it in detail. You may be asked to ‘critically evaluate’ as well. See 'Analyse'.

Explain: Make clear why something happens, or why something is the way it is.

Illustrate: Make something clear and explicit, giving examples or evidence.

Interpret: Give the meaning and relevance of data or other material presented.

Justify: Give evidence which supports an argument or idea; show why a conclusion or decisions were made, considering objections that others might make.

Narrate: Concentrate on saying what happened, telling it as a story.

Outline: Give only the main points, showing the main structure.

Relate: Show similarities and connections between two or more things.

State: Give the main features, in very clear English (almost like a simple list, but in sentences). 

Summarise: Draw out the main points only, omitting details or examples.

To what extent: Consider how far something is true, or contributes to a final outcome. Consider also ways in which the proposition is not true.

Trace: Follow the order of different stages in an event or process.

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