Emotional Problems in Adults with Learning Disabilities

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Emotional Problems in Adults with Learning Disabilities:
An Often Unseen But Not Insignificant Problem

Sam Goldstein, Ph.D.
This is a SamGoldstein.com Monthly Article - July, 2000
Copyright ? 2000 Dr. Sam Goldstein - All Rights Reserved

The path to success in life is not easy. It requires focus, opportunity, commitment and most important, ability. Even when commitment, focus and opportunity are present, weak skills or specific learning disabilities can and do create stress and consequent emotional problems. As we come to recognize and accept that learning disabilities represent a life time phenomenon, our interest in the role emotional problems and emotional stability plays in successful and rewarding adult life, also grows. This article will review the relationship between learning disabilities and emotional problems beginning with a brief discussion of these issues in childhood, then discuss this issue in the adult years.

The daily demands and forces that affect adults, though different from those affecting children, are nonetheless significant. As Virginia Douglas and colleagues have pointed out, it is possible that a specific childhood problem, such as learning disabilities, may present identically during the adult years. However, it is also possible that a learning disability may change, diminish, be eliminated or in fact, take on greater significance reflecting greater vulnerability to other problems in the adult years. From the perspective of learning disabilities we all agree that learning disabled children grow up and continue to be learning disabled adults. The consequences of their learning disability, however, changes. The arena shifts from school to work and community. The implications become more significant. The learning disabled child may rely upon family and school for support. The learning disabled adult, however, often struggles to find a support system. This phenomenon argues that learning disabled adults may be at increased risk to develop emotional problems and specific psychiatric disorders as a consequence of their learning disability in the adult years. Esther Minskoff and colleagues have proposed that emotional adjustment is but one of six critical factors (intelligence, cognitive processing deficits, language deficiencies, academic achievement and vocational employability) that best determine the severity of problems adults with learning disabilities may experience.

The childhood data suggests:

  • The rate of psychiatric disorders in childhood among children with language impairments (often present in those with learning disabilities), ranges from 25% to 97%.
  • The overlap of learning disabilities with disruptive childhood disorders (ADHD, Oppositional Defiance and Conduct Disorder) has been rated between 10% and 50% for children with learning disabilities.
  • A 1991 review by Byron Rourke and colleagues of over 700 articles published over two decades concerning the psychosocial and emotional functioning of children with learning disabilities, suggests a causal link between learning disabilities and emotional functioning. Specifically, it was suggested that learning disabilities produce emotional or behavioral problems. However, it was concluded that the majority of these studies were confused, contradictory, poorly done and generally unreplicable.
  • In 1991 these same authors evaluated the psychosocial functioning over three different ages of more than 700 learning disabled children. These authors reported that the psychosocial functioning of children with learning disability was stable between the ages of seven and thirteen years. There was no evidence in this group of children that learning disability in and of itself led to increased vulnerability for psychiatrically defined, emotional problems.

While the cumulative, negative experiences resulting from learning disability certainly affect children, these data argue contradictory to the idea that most learning disabled children experience significantly more symptoms of psychiatric disturbance, especially emotional distress, than others. If in fact learning disabilities in and of themselves represent a significant risk factor for the development of serious psychiatric problems, we would expect to see an increase in these problems in children with learning disabilities as they grow. This does not appear to be the case. However, this should not lead one to conclude that the psychiatric problems identified in some learning disabled children do not continue into their later adolescent and adult lives. In fact, research suggests that they do. Thus, those learning disabled children presenting with co-occurring emotional problems, continue to experience those problems as they mature and transition into their adolescent and adult years. Thus, as with all children, learning disabled children demonstrating emotional or behavioral problems at young ages independent of other factors are likely to continue demonstrating these problems at later ages.

A series of studies by Spreen and colleagues in the early 1980's repeatedly demonstrated that children with learning disabilities were more likely than others to drop out of school and attain lower occupational achievement. It was reported that they were also more likely to experience life adjustment problems. A small study by Feldman and colleagues in 1993 of thirty-six adults with third generation familial dyslexia found those with familial dyslexia demonstrated greater symptoms of depression and anxiety than a control group. They also had a higher incidence of ADHD, yet they did not experience greater marital or vocational problems than the control group.

It is important to note that these few adult outcome studies evaluating emotional problems have focused on males with limited data available for females. As Adelman and Vogel pointed out in the early 1990's, the methodological short comings of many of the adult learning disability studies make it difficult to draw cause and effect conclusions. Nonetheless, recent studies as well as clinical observations suggest that learning disabled individuals appear more vulnerable to shadow syndrome or subthreshold psychiatric problems related to worry and depression. Thus, when symptoms are counted they may not be sufficient to provide a specific diagnosis, yet it is clear the learning disabled adult experiences greater symptoms of worry and unhappiness than others. It is also clear that many individuals with histories of learning disability perceive themselves as less competent in performance situations. This should not be surprising as this represents the logical, long-term consequence of struggling day in and day out at school. Soon to be published research concerning personality style in individuals with histories of ADHD, reflects this pessimistic, negative world view in a significant group. At least one recent study mirrors this finding in college students with learning disabilities. In the absence of a large volume of research data, professionals need to recognize the logical consequence of increased feelings of helplessness, hopelessness, lower self-esteem and lack of assertive skills that arise as the result of living day in and day out with a handicapping disability. Particularly one that for many adults with learning disability, was either inadequately or not identified and even less likely to have been treated. Given recent research data, I urge my fellow mental health clinicians, counselors and advocates to do the following:

  • Recognize and accept that children with a learning disability grow up to become adults with a learning disability.
  • Listen carefully to what our clients and patients say.
  • Obtain careful childhood histories as those individuals with learning disability and psychiatric problems in childhood likely continue to have both problems in adulthood.
  • Do not assume that all individuals with histories of learning disability will experience emotional problems but recognize that all will be affected to some extent.
  • Reasonably assume that most individuals with learning disability have had a much more difficult life course emotionally and are more likely to experience feelings of low self-esteem.
  • Offer our support and empathy, recognizing, as Dr. Larry Silver has pointed out, that to feel, function and relate as an adult is critical for successful adult life. These factors are contributed to intimately by academic and vocational success and peer acceptance, areas in which individuals with learning disability often struggle.
  • Adults with learning disability can and do experience more life and vocational problems than others. For some, these problems are invasive and intrusive. For others, they are fairly subtle.
  • Many individuals with learning disability use other strengths to compensate for their disabilities and develop a variety of coping strategies, allowing them to function in every day life.
  • Listen carefully when taking a history. An undiagnosed learning disability may, in some individuals, represent a significant variable to explain the course of reported emotional problems.

With increased community acceptance and recognition that learning disability represents a life time phenomenon, medical, mental health and educational professionals are going to find themselves supporting and treating more and more of these individuals. As adult learning disability becomes popular, these individuals are also excellent targets for the marketing of all kinds of fads, mythical treatments and unproven remedies. Knowledgeable professionals can offer their patients and clients a powerful sense of hope by being available and providing accurate information, understanding and support. Although much of the science in adult learning disability remains in the future, common sense and clinical judgment can offer great help today.