The Relationship between Learning Disabilities and Mental Health (LDMH)
We know individuals with learning disabilities (LDs) are two to three times more likely to experience mental health challenges [i]. When it is hard to ‘show what you know’, it is understandable that we might see higher rates of school-related stress [ii] and more school dropout. Individuals with LDs are also more likely to experience anxiety, depression and suicidal ideation [iii].
When we consider the continuum of mental health with respect to LDs, most students with LDs would experience ‘yellow zone’ levels of stress and distress, as school and social environments are an ongoing source of stress. However, a number of students may also experience significant mental health issues that interfere with day to day functioning, moving them into the ‘red zone’. These students with Learning Disabilities and Mental Health issues (LDMH) and their families may need intervention to engage in school successfully, to navigate peer relationships, and to manage intense emotions and behaviors.
Comorbidity is a medical term used to reflect the situation when a person has more than one condition at the same time.
“It is estimated that 50 per cent of children experiencing a mental health disorder have two or more disorders at the same time (Wadell et al., 2002). Co-morbidity of different emotional and behavioural problems varies with the age and developmental stage of the child or adolescent. When children and youth experience multiple problems or more than one disorder, they are more vulnerable, and treatment becomes more complicated [iv].”
Students with LDs have a higher rate of co-morbid or co-occurring disorders [v]. The most common comorbid diagnosis is Attention Deficit Hyperactivity Disorder (ADHD); one in three students who have ADHD will also meet criteria for an LD [vi]. Students with LDs are also more likely to have diagnosed mental health or psychiatric conditions [vii]. For example, a recent study by Margari et al [viii] found that 30% of individuals with LDs met criteria for diagnosed anxiety disorders, such as Generalized Anxiety Disorder and Obsessive Compulsive Disorder.
Figure 1: This Venn diagram demonstrates the relationship between the challenges associated with LDs and those associated with mental health problems.
Having mental health challenges or disorders, such as anxiety, depression, and explosive reactions, in addition to LDs, can complicate the picture for diagnosis and treatment. For example, a youth with depression and LDs might struggle with a slower rate of thinking and difficulties with concentrating, which could reflect either the depression or the LD, or both.
Evidence-based treatment for anxiety, such as cognitive behavior therapy, might include demands for reading and writing that might be difficult for a child with LDs. The pace of manualized treatments may not be tailored to meet the particular learning needs of the child or youth. Having LDs can also complicate the student’s ability to cope with stress, such as getting “stuck” in problem solving or having difficulties regulating emotions.
Educational Implications for Students with Learning Disabilities
Mental health issues can have an impact on a student’s ability to learn. For example, students may have trouble concentrating in class because they are preoccupied with their worries; they may have trouble starting and completing their work; they may have physical complaints such as stomachaches and headaches; they may be frequently absent from school; or they may drop out of school. For students with LDs who already have learning challenges, mental health issues may pose significant obstacles in the classroom, making learning even harder.
Mental health challenges can also have an impact on a student’s social functioning. A student’s ability to self-regulate and manage their emotions may make it harder to develop and maintain friendships at school. Under-regulation of affect (e.g., meltdowns, impulsivity, and a low tolerance for frustration) can adversely affect peer relations [ix], and over-regulation of affect (e.g., anxiety, avoidance, and withdrawal) may impede initiation and social risk-taking [x].
This module will explore the educational implications for students with LDMH along the continuum of mental health, starting with the Green Zone.
[i] Wilson, Deri Armstrong, Furrie, & Walcot, 2009
[ii] Sparks & Lovett, 2009
[iii] Svetaz, Ireland, & Blum, 2000; Nelson & Harwood, 2011
[iv] Ontario Ministry of Education, 2013, p. 10
[v] Zakopoulou, Mavreas, Christodoulides, Lavidas, Fili, Georgiou, Dimakopoulos, & Vergou, 2014
[vi] DuPaul, Gormley & Laracy, 2013
[vii] Esmaili, Shafaroodi, Mehraban, Parand, Qorbani, Yazdani, & Mahmoudpour, 2016
[viii] Margari, Buttiglione, Craig, Cristella, & de Giambattista, 2013
[ix] Gaub & Carlson, 1997
[x] Suveg, Sood, Comer, & Kendall, 2009