Specific Learning Difficulties and Mental Health

Dr. Gilda Palti   

The nature of the relationship between specific learning difficulties such as dyslexia and various social and mental health problems has been researched extensively during the last decade. A survey (Cummings et al., 1992) looking at various emotional difficulties such as depression, anxiety, low self-esteem and low self-concept revealed increased risk for mental health associated with specific learning difficulties in youths. 
Demands to achieve academically put significant pressure on all students, but those with specific learning difficulties may be at particular risk for experiencing higher levels of stress. This may be due to several reasons, including the commonly noted remarks by significant others, such as parents and teachers, that the pupils do not put effort into school work, when in fact they try hard but cannot perform at their ability level. In addition, being tutored in a separate group with additional assistance and being dependent on others for academic success increases stress.
The gap between their ability and their performance in relation to others in class lead to the self-concept confusion. For example, they may perform well in class discussion but find it difficult to express their ideas in writing. This is accompanied by additional shame and embarrassment for writing at a less academic level than others in class. These difficulties cause enormous stress, as observed in a very bright nine years old boy who performed and worked well in various tasks which he found challenging and interesting, but when asked to produce a written task, the stress levels increased visibly and he asked to stop saying that: “I am desperate to leave the room now”, even when it was clear that the session has not ended.  
As a result of school failure, parents, teachers and peers express disapproval or disappointment toward the pupils with specific learning difficulties, leading to feelings of inferiority, helpless  (Bruck, 1986),  lower self-concept and self-esteem  (Kavale and Fomess, 1996), and stress among these pupils.
 The stress experienced by the pupils with specific learning difficulties, can be exhibited in various forms such as a sudden dramatic increase (overwork) or decrease (carelessness, lack of enthusiasm) in effort put into school work. Some show fluctuating moods and increased frustration and irritability. In more severe cases, fatigue, sleeping problems, psychosomatic symptoms, school phobia, and delinquent behavior may be observed.
 Alexander-Passe (2007) in the School Situation Survey, investigate both the sources and manifestations of stress amongst dyslexic pupils and non-dyslexic sibling controls. Results suggest significant differences between the groups, with dyslexic  pupils experiencing the highest stress levels, specifically in interactions with teachers, worries over academic examinations, and performance testing, causing emotional (fear, shyness and loneliness) and physiological (nausea, tremors or rapid heart beat) manifestations.
Higher levels of anxiety, though not clinically significant, have also been  found among pupils with specific learning difficulties (Fisher, Allen and Kose, 1996). Anxiety leads to inability to relax, often having trouble falling or staying asleep. Worries may be accompanied by physical symptoms such as headaches, irritability, muscle tension, fatigue and problems with concentration. 
Consistent and painful failures at school, and developed feelings of helplessness, were found to be associated with depression among pupils with specific learning difficulties. Depressed pupils may exhibit irritability, poor concentration, sleep disturbance, intense feeling of sadness, lack of interest, fatigue, social withdrawal and suicidal thoughts. In a case of a twelve years old boy recently diagnosed with dyslexia, the mother reported that she has caught him watching u-tube on how to commit suicide. The boy’s comment was: “I am not worth living because I am not good at anything”, expressing a generalised feeling of worthlessness as a consequence of poor academic achievement. These feelings can create barriers to academic success consequently increasing the anxiety and lowering the self-concept, thus entering into a vicious circle which may with time magnify the symptoms.
Anxiety and depression are highly related, and high levels of anxiety have been shown to predispose depression (Hirschfeld et al., 1989). However, it is important for professionals to be aware that the presentation of depression may be obscured by the symptoms of the specific learning difficulties, such as slow processing speed, memory and concentration problems.
Depression scales completed by parents and teachers were found to show a relatively higher depression mean score, though not clinically significant, for pupils with specific learning difficulties (McConaughy and Ritter, 1985) compared with pupils not experiencing specific learning difficulties.  Depression manifests differently in children than it does in adults. Symptoms of depression in children include hyperactivity, conduct problems, somatic complaints, or irritability, which make accurate diagnosis difficult (Stevenson & Romney, 1984).
There is a higher frequency rate for pupils with specific learning difficulties to be socially rejected than for those with no specific learning difficulties. Research indicates that social skills deficits are common in students with specific learning difficulties and that these deficits have a negative effect on these pupils’ relationships with adults and peers, as well as on their ability to function in the regular classroom environment (Pearl et al., 1986).
Attribution to success and failure
One of the reasons for the increased levels of emotional maladjustment is the attribution to success and failure made by pupils with specific learning difficulties. The importance of locus of control in education lies in the effect that it has on pupils’ attitudes toward school-related tasks. Those with internal locus of control are found to exhibit high levels of perseverance on difficult tasks, to delay gratification, and to seek and retain information (Dweck, 1975). Conversely, children who possess an external locus of control generally feel that they have little impact on the outcome of tasks and that task difficulty, luck or fate control their success or failure. These pupils respond to difficult tasks with withdrawn behaviour, lowered task completion, and negative self-concept (Dweck and Repucci, 1973).  Several studies have shown that individuals with specific learning difficulties attribute failure to internal factors, such as lack of ability and effort, and success to external factors, such as luck (Kavale and Fomess, 1996) . This pattern of attribution leads to feelings of learned helplessness, placing these pupils at a higher level of risk for emotional maladjustment (Brooks, 1994).  Pupils that manage to deal effectively with stress demonstrate an internal locus of control (Luthar, 1991), i.e. they believe in their ability to control the environment, rather than believing that the circumstances are determinative. Also, internal locus of control suggests that the individuals accept the responsibility for their own performance, and as a result take an active part in dealing with stressful situations. They use their internal resources in the process of coping with stress.    
Higher self-esteem and internal locus of control have been found to protect the student from both internalizing and externalizing problems. Their protective effect is more significant against depression when students experience academic failure (Roeser, 1998).  The study provides evidence that self-esteem and locus of control are related to certain types of mental health that students tend to experience, such as those with higher self-esteem tend to have externalised problems (delinquent behaviour),  than internalised problems (depression, anxiety). 
Sometimes locus of control is seen as a stable, underlying personality construct, but this may be misleading, since the theory and research indicates that locus of control is largely learned.  Some psychological and educational interventions have been found to produce shifts towards internal locus of control (e.g., outdoor education programs; Hans, 2000; Hattie, Marsh, Neill & Richards, 1997).
The more the pupils with learned helplessness put effort into problem solving without reaching any valid conclusion, the more the chances are that their cognitive system will opt to disengage from the uncomfortable situation, and protect self-concept. Failing to solve the problem (which may raise negative emotions), compounded with the cognitive effort being used, deprives energy, or 'processing capacity' (Sigmund and Tobias 1965, in Covington 1992) from the cognitive resources focused at the problem, decreasing the probability that the problem will ever be solved. As a result, it is most probable that the individual will stop the process which he considers to be worthless and tiring and may become disengaged from the problem, thus reaching a state similar to cognitive demobilization (Sedek and Kofta 1990) or cognitive exhaustion.
The suggestion here is that the learned helplessness is an informational processing phenomenon in which the individual is unable to reduce uncertainty, therefore, the cognitive resources are directed away from the task towards intruding thoughts and negative emotional arousal (such as anxiety) which may in turn interfere with future task performance.
Intervention programmes
Individuals with specific learning difficulties are at risk of failure not only academically but also socially and emotionally. Continuous experiences of academic failure lead to various emotional maladjustments such as anxiety, stress and depression. It was also found that (Palti, 1998) being educationally better off for dyslexic pupils has an emotional and social cost. This may mean that their coping strategies with the prolonged stressful educational circumstances are ineffective or even generate new problems. Therefore, an intervention programme should consist not only of specific educational provision but also of specific emotional support or retraining of attributions to education. Having realistic expectations provide the pupils with a sense of control. The development of self-control goes hand-in-glove with self-esteem and success. Having realistic information provides a feeling that things can be done to help the situation.
Children are less defensive when the problem is cast as strategies that must be changed rather than as something deficient with their motivation. For example, a comment made by teachers or parents can be reframed, such that instead of saying: "try harder or put in more effort" when many of them do try hard and still have difficulty, a comment like: "we should find a better way to help you learn" may be more effective.
Individual therapy or counselling for attribution retraining could also be effective when introduced in conjunction with special educational provision. However, group therapy may sometimes be much more effective than individual therapy, because peers may be a better source of support and insight, especially peers with the same problem. Group and individual therapy may often be recommended to complement each other. When insight is gained in individual therapy, it can be exercised in the safe environment of a supportive small group. This is recommended because pupils with specific learning difficulties do not often have a chance to air the problems they experience without being judged or criticised, not only literacy problems, but also problems about making friends, feelings of isolation, shame or frustration. Because of the nature of their difficulties, many of these pupils have problems articulating their feelings, and thoughts often get confused because they do not have the skills to verbalise them effectively. They may also have difficulties pointing to the source of their anger or frustration. Therefore, individual or group counselling or the combination of both may clear some of these uncertainties.
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