Mathematics Learning Disorder


Practice Essentials

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), learning disorders are among the most frequently diagnosed developmental disorders in childhood. Children experiencing a deficit in one learning domain frequently show deficits in other domains likely due to shared genetic variance.

The definition of a mathematics learning disorder includes well below average mathematical academic performance for age that is not attributable to an intellectual disability (which is defined by IQ below 70) or a predefined discrepancy between IQ and the affected learning domain.[1]


Neurologic in origin, learning disorders impede a person's ability to store, process, and/or produce information. Learning disorders can affect the ability to read, write, speak, or compute mathematics and can impair socialization skills. The central clinical feature of a learning disorder is the lack of normal developmental skill, either cognitive or linguistic.


Mathematical learning disorder (MD) also known as dyscalculia is a term used for a wide range of disorders caused by abnormalities in one or more of the basic psychological processes involved in understanding or use of math. Several manifestations of the disorder may occur throughout the life of the individual. Mathematical learning disorder does not include children who have learning problems caused primarily by (1) visual, hearing, or motor impairments; (2) mental retardation; (3) emotional disturbance; or (4) environmental, cultural, or economic disadvantages.[2, 3, 4]

US clinicians should become familiar with the federal Individuals with Disabilities Education Act (IDEA), which defines learning disorders as "processing disorders that result in a significant discrepancy between potential and acquisition of various academic or language skills."[5, 6] Although this definition has raised several questions, it remains important in current clinical practice. Mathematical learning disorder is among the disabilities that qualify children for special education programs under IDEA.



Assessing the exact incidence of mathematical learning disorder is difficult due to paucity of studies that focus specifically on basic number and arithmetic skills.

Collectively, learning and language disorders comprise a very common set of problems. An estimated 10–20% of children and adolescents have a language disorder, a learning disorder, or both. Reading disorders (RDs) comprise a large portion of this group. An estimated 3–7% of elementary school children have been identified with mathematical disorder comparable to the percentage with reading and spelling disorder.[1] However, children often have more than one disorder; 56% of children with a reading disorder also showed poor mathematics achievement, and 43% of children with a mathematical learning disorder showed poor reading skills.

The estimated incidence may not accurately reflect the presence of the disorder. Some children may have narrow deficits in certain aspects of arithmetic (eg, counting) and perform well in all other aspects. However, standardized tests will still record a poor performance.

Mathematical learning disorder incidence among American children is higher than in Japanese, German, or French children. This higher incidence may be linked to the instructional course design.


Although children with developmental dyscalculia perform more poorly during subtraction activities, there appears to be greater activity in multiple intra-parietal sulcus (IPS) and superior parietal lobule subdivisions in the dorsal posterior parietal cortex as well as in the fusiform gyrus in the ventral occipito-temporal cortex. A study of connectivity analyses revealed hyper-connectivity, rather than reduced connectivity, between the IPS and multiple brain systems including the lateral fronto-parietal and default mode networks thus suggesting the possibility that the IPS and its functional circuits are involved with inappropriate task modulation and hyper-connectivity during addition and subtraction tasks as opposed to the theory of under-engagement and under-connectivity.[7]

Risk factors include very low birth weight due to maternal cigarette (nicotine) smoking, which can contribute to reduced gray matter volume in the intra parietal sulcus.[8]


Long-term prognosis is guarded as numerical skills have been associated with increased risk for unemployment and stress. The lack of numerical literacy skills can interfere with everyday basic living skills: e.g., not being able to make and keep appointments (due to not being able to judge or tell time), problems with paying bills (which can lead to homelessness), and trouble with the use of social media (passwords) and social interactions (not able to remember phone numbers).[8]


Children with learning disorders typically present at primary school age or later. Often, mathematical learning disorder (MD) is associated with reading disorder (RD), although mathematical learning disorder is noticed later because of language's permeating influence in everyday life. Mathematical learning disorder often goes unrecognized until the child begins schooling.


A multitude of developmental pathways converge when children strive to comprehend and apply mathematics in school.[9, 10, 11, 12, 13] Over time, the demands of the mathematics curriculum impose increasing strain on a developing and differentiating nervous system. Levine and associates' 16-subcomponent model helps clarify the causes of problems performing mathematics and helps evaluate mathematical learning disorder.[14] Subcomponents of the model include the following:[15]

Learning facts

See the list below:

Understanding details

See the list below:

Mastering procedures

See the list below:

Using manipulations

See the list below:

Recognizing patterns

See the list below:

Relating to words

See the list below:

Analyzing sentences

See the list below:

Processing images

See the list below:

Performing logical processes

See the list below:

Estimating solutions

See the list below:

Conceptualizing and linking

See the list below:

Approaching the problem systematically

See the list below:

Accumulating abilities

See the list below:

Applying knowledge

See the list below:

Fearing the subject

See the list below:

Having an affinity for the subject

See the list below:

Mathematical subcomponents and the principal neurodevelopmental function(s) each requires

See the list below:

Approach Considerations

Importance of obtaining a birth history cannot be neglected especially due to the high association of low birth weight, especially from maternal cigarette (nicotine) smokine, and mathematics learning disability.[8]


Mathematics assessments play a valuable role in identifying students' strengths and weaknesses and in developing and monitoring instructional practices. The following assessment strategies are the most popular in use today.

Approach Considerations

Early remediation of mathematical learning disorder (MD) is crucial to ensure the child's recognition of mathematics' significance not just in the classroom but also in everyday life. Based on the new information available for reading disorders (RDs), new strategies designed for educators to guide and help nonperforming students improve are available. Work is still needed to identify the basic problems with mathematical learning disorder, however there may be a verbal subtype of MD that involves problems with phonological awareness reflected in impairment of counting speed, number processing, and fact recall, however it is unknown at this time if the processing deficit is specific to symbolic magnitudes or nonsymbolic magnitudes involving conceptual processing and the recall of semantic information from memory.[8, 15]

Medical Care

Management of mathematical learning disorder

Mathematical learning disorder (MD) management should begin early in a child's educational career. Unfortunately, mathematical learning disorder is usually not recognized early enough or management is delayed until other problems (eg, language disabilities) are addressed.

Many children perceive mathematics as a subject confined strictly to mathematics class and homework. Early remediation of mathematical learning disorder is crucial to ensure the child's recognition of mathematics' significance not just in the classroom but also in everyday life. Based on the new information available for reading disorders (RDs), new strategies designed for educators to guide and help nonperforming students improve are available. Work is still needed to identify the basic problems with mathematical learning disorder, which will help create improved strategies to help children. Meanwhile, the following guidelines are indicated to help children with this pervasive disability.

Remediation demands close collaboration between regular classroom teachers and those involved in remedial support. Many children with underachievement in mathematics are eligible for legally mandated special education services in public schools. Wide differences are observed in service eligibility requirements, and the quality and intensity of services markedly vary between communities. Identifying the disability of each student and addressing it at the individual level is still important. General remediation guidelines are as follows:


Neurodevelopmental or neuropsychological testing can yield valuable information about the underlying dysfunctions that may impede mathematical learning. These dysfunctions include the following:

An education diagnostician or psychoeducational specialist should examine all areas of academic performance. Educational testing of a child with mathematics underachievement should be performed on a 1-to-1 basis. Other academic difficulties (eg, spelling, writing) often lead to mathematics underachievement.

Evaluation of a child's mathematics performance should be calibrated specifically to that child's age and grade level. Identification of specific developmental subcomponents may have significant implications for remediation efforts. Include the following parameters in a standard examination:

Medication Summary

At this time, there is no sufficient scientific evidence that supplementation with PUFAs (Omega-3 fatty acids) should be considered for youth with mathematics learning disorder.[17] Studies of mice have been suggestive that inflammation may explain the deleterious impact on spatial learning of PUFA deficiency.[17]


Originally approved by the US Congress in 1975, the Individuals with Disabilities Education Act (IDEA) is an attempt to remedy problems that contribute to the barriers faced by children with disabilities.[18]

Patient Education

The following nonprofit organizations provide information, referrals to professionals, and contacts to local groups:


Bettina E Bernstein, DO, Distinguished Fellow, American Academy of Child and Adolescent Psychiatry; Distinguished Fellow, American Psychiatric Association; Clinical Assistant Professor of Neurosciences and Psychiatry, Philadelphia College of Osteopathic Medicine; Clinical Affiliate Medical Staff, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia; Consultant to Gemma Services, Private Practice; Consultant PMHCC/CBH at Family Court, Philadelphia

Disclosure: Nothing to disclose.

Specialty Editors

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Angelo P Giardino, MD, MPH, PhD, Professor and Section Head, Academic General Pediatrics, Baylor College of Medicine; Senior Vice President and Chief Quality Officer, Texas Children’s Hospital

Disclosure: Nothing to disclose.

Vidhu V Thaker, MBBCh, MD, Attending Pediatrician, Haverstraw Pediatrics; Clinical Assistant Professor of Pediatrics, New York Medical College

Disclosure: Nothing to disclose.


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