Moll Kristina, Kunze Sarah, Neuhoff Nina, Bruder Jennifer, Schulte-Körne Gerd
Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
PLoS One. 2014 Jul 29;9(7):e103537. doi: 10.1371/journal.pone.0103537. eCollection 2014.
Comprehensive models of learning disorders have to consider both isolated learning disorders that affect one learning domain only, as well as comorbidity between learning disorders. However, empirical evidence on comorbidity rates including all three learning disorders as defined by DSM-5 (deficits in reading, writing, and mathematics) is scarce. The current study assessed prevalence rates and gender ratios for isolated as well as comorbid learning disorders in a representative sample of 1633 German speaking children in 3rd and 4th Grade. Prevalence rates were analysed for isolated as well as combined learning disorders and for different deficit criteria, including a criterion for normal performance. Comorbid learning disorders occurred as frequently as isolated learning disorders, even when stricter cutoff criteria were applied. The relative proportion of isolated and combined disorders did not change when including a criterion for normal performance. Reading and spelling deficits differed with respect to their association with arithmetic problems: Deficits in arithmetic co-occurred more often with deficits in spelling than with deficits in reading. In addition, comorbidity rates for arithmetic and reading decreased when applying stricter deficit criteria, but stayed high for arithmetic and spelling irrespective of the chosen deficit criterion. These findings suggest that the processes underlying the relationship between arithmetic and reading might differ from those underlying the relationship between arithmetic and spelling. With respect to gender ratios, more boys than girls showed spelling deficits, while more girls were impaired in arithmetic. No gender differences were observed for isolated reading problems and for the combination of all three learning disorders. Implications of these findings for assessment and intervention of learning disorders are discussed.
学习障碍的综合模型必须既要考虑仅影响一个学习领域的孤立性学习障碍,也要考虑学习障碍之间的共病情况。然而,关于包括《精神疾病诊断与统计手册》第5版所定义的所有三种学习障碍(阅读、写作和数学缺陷)的共病率的实证证据却很匮乏。本研究评估了1633名三、四年级讲德语儿童的代表性样本中孤立性以及共病性学习障碍的患病率和性别比例。分析了孤立性以及合并性学习障碍的患病率,以及不同的缺陷标准,包括正常表现标准。即使采用更严格的临界标准,共病性学习障碍的发生频率与孤立性学习障碍一样高。纳入正常表现标准后,孤立性和合并性障碍的相对比例并未改变。阅读和拼写缺陷与算术问题的关联有所不同:算术缺陷与拼写缺陷同时出现的频率高于与阅读缺陷同时出现的频率。此外,采用更严格的缺陷标准时,算术和阅读的共病率会降低,但无论选择何种缺陷标准,算术和拼写的共病率都居高不下。这些发现表明,算术与阅读之间关系的潜在过程可能与算术与拼写之间关系的潜在过程不同。在性别比例方面,拼写缺陷的男孩比女孩多,而算术受损的女孩更多。在孤立性阅读问题以及所有三种学习障碍合并出现的情况中未观察到性别差异。本文讨论了这些发现对学习障碍评估和干预的意义。