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.