- Word reading accuracy
- Reading rate or fluency
- Reading comprehension


Specific Learning Disorder: Specified impairment in Reading

- Spelling accuracy
- Grammar and punctuation accuracy
- Clarity or organization of written expression


Specific Learning Disorder: Specified Impairment in Written Expression 

- Number sense
- Memorization of arithmetic facts
- Accurate or fluent calculation
- Accurate math reasoning


Specific Learning Disorder: Specified Impairment in Mathematics

Some difficulties learning skills in one or two academic domains, but of mild enough severity that the individual may be able to compensate or function well when provided with appropriate accommodations or support services,especially during the school years.


Specific Learning Disorder: Specify Current Severity - Mild

 Marked difficulties learning skills in one or more academic domains, so that the individual is unlikely to become proficient without some intervals of intensive and specialized teaching during the school years. Some accommodations or supportive services at least part of the day at school, in the workplace, or at home may be needed to complete activities accurately and efficiently.

Specific Learning Disorder: Specify Current Severity - Moderate

Severe difficulties learning skills, affecting several academic domains, so that the individual is unlikely to learn those skills without ongoing intensive individualized and specialized teaching for most of the school years. Even with an array of appropriate accommodations or services at home, at school, or in the workplace, the individual may not be able to complete all activities efficiently.


Specific Learning Disorder: Specify Current Severity - Severe

The DSM-5-TR outlines a few specifiers to help specify the condition of Specific Learning Disorder according to the different foundational academic skills, or progress of the individual. These specifiers are as followed:

Specify if:
- With Impairment in Reading
- With Impairment in Written Expression
- With Impairment in Mathematics

Specify current severity:
- Mild
- Moderate
- Severe


State University of New York at Buffalo

A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties: 

1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words).
2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read)
3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants). 
4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity). 
5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures).
6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems). 

B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment. For individuals age 17 years and older, a documented history of impairing learning difficulties may be substituted for the standardized assessment. 

C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the individual’s limited capacities (e.g., as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads). 

D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction. 


[DSM-5-TR] Diagnostic Criteria of Specific Learning Disorder

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

DSM-5-TR

[DSM-5-TR] Diagnostic Features of Specific Learning Disorder

[DSM-5-TR] Specifiers for Specific Learning Disorder

Each impaired academic domain and subskill of specific  learning disorder should be recorded. Because of ICD coding requirements, impairments in reading, impairments in written expression, and impairments in mathematics, with their corresponding impairments in subskills, must be coded and recorded separately.


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