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The Proposed Changes for DSM-5 for SLD and ADHD: International
Perspectives-Australia, Germany, Greece, India, Israel, Italy, Spain, Taiwan,
United Kingdom, and United States

Article  in  Journal of Learning Disabilities · January 2013

DOI: 10.1177/0022219412464353 · Source: PubMed

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464353
ournal of Learning DisabilitiesAl-Yagon et al.
LDXXXX10.1177/0022219412464353J

Journal of Learning Disabilities

The Proposed Changes for DSM-5 for SLD 46(1) 58­–72

© Hammill Institute on Disabilities 2013
Reprints and permission:
and ADHD:  International Perspectives— sagepub.com/journalsPermissions.nav
DOI: 10.1177/0022219412464353

Australia, Germany, Greece, India, Israel,

http://journaloflearningdisabilities
.sagepub.com

Italy, Spain,Taiwan, United Kingdom, and

United States

Michal Al-Yagon, PhD1, Wendy Cavendish, PhD2 , Cesare Cornoldi, PhD3,

Angela J. Fawcett, PhD4, Matthias Grünke, PhD5, Li-Yu Hung, PhD6,
Juan E. Jiménez, PhD7, Sunil Karande, MD8, Christina E. van Kraayenoord, PhD9,
Daniela Lucangeli, PhD3, Malka Margalit, PhD1,10, Marjorie Montague, PhD2†,
Rukhshana Sholapurwala, PhD8, Georgios Sideridis, PhD11,
Patrizio E. Tressoldi, PhD3, and Claudio Vio, PhD12

Abstract
This article presents an international perspective of the proposed changes to the DSM-5 for learning disabilities (LD) and
attention-deficit/hyperactivity disorders (ADHD) across ten countries: Australia, Germany, Greece, India, Israel, Italy, Spain,
Taiwan, the United Kingdom, and the United States. We provide perspectives of the present situation for youth with LD
and youth with ADHD and describe the legislation, prevalence rates, and educational systems that serve students with
disabilities in the respective countries. We also present a discussion of the expected impact of the proposed changes for
the diagnosis of LD and ADHD in each country.

Keywords
international, DSM-5, learning disabilities, policy, legislation, prevalence

DSM-IV’s definition has a critical importance to research In the first section, reports from each researcher provide a
and practice in many countries. The diagnosis of individu- brief description of the present situation for individuals with
als with learning disabilities (LD) and with attention-deficit LD and those with ADHD in their countries, focusing atten-
disorders (ADD and ADHD) has been the meeting point of tion on the legislation, prevalence, and education. However,
professionals from education, medicine, and mental health. we do not provide details of specific diagnosis procedures in
In view of the current DSM-IV wide international use of the
DSM, the proposed changes in the DSM-5 may have an 1
Tel Aviv University, Tel Aviv, Israel
2
impact on clinical, research, and educational practices of University of Miami, Miami, FL, USA
3
the interdisciplinary professional communities in many Università di Padova, Padua, Italy
4
University of Sheffield, Sheffield, UK
parts of the world. The goals of this article are to present the 5
University of Cologne, Cologne, Germany
expected impacts of these changes for the diagnosis and 6
National Taiwan Normal University, Taipei, Taiwan
support of children with LD and with ADHD in 10 coun- 7
University of La Laguna, Canary Islands, Spain
8
tries (Australia, Germany, Greece, India, Israel, Italy, Spain, Seth Gordhandas Sunderdas Medical College and King Edward VII
Taiwan, the United Kingdom, and the United States). Memorial Hospital, Mumbai, India
9
University of Queensland, Brisbane, Australia
Expecting that these changes will bear differential impacts 10
Peres Academic Center, Rehovot, Israel
in different educational systems and different cultures, we 11
University of Crete, Rethymno, Greece
invited leading researchers to provide a short outline of the 12
U.O. NPI, ASL San Donà di Piave,Venice, Italy
†
current procedures in their countries as a background for a This author is deceased
focused discussion on the expected impact of the DSM-5
Corresponding Author:
changes. This article does not list the proposed DSM-5 Malka Margalit, Tel Aviv University, School of Education, Tel Aviv, 69978,
changes since Tannock’s (2013) article in this special issue Israel
describes them in detail. Email: Malka@post.tau.ac.il
Al-Yagon et al. 59
the different counties because of space limitations. Yet the
contextual background information provides an overview
of the local meaning of the expected changes.
Australia (by Christina
E. van Kraayenoord)
Legislation
According to the Disability Discrimination Act, 1992
(Australian Government, 1992), a “disability” includes physi-
cal, intellectual, psychiatric, sensory, neurological, and learn-
ing disabilities, as well as physical disfigurement, and the
presence in the body of disease-causing organisms. The act
protects people with LD against discrimination in the area of
education. However, in the school system, the term learning
difficulties, rather than learning disabilities, is more often
used to refer to students who have difficulties in literacy and
numeracy and who do not respond to classroom instruction
(van Kraayenoord, 2002; van Kraayenoord & Elkins, 2004).
Typically, the term LD is used to refer to a subgroup of stu-
dents who have ongoing and persistent literacy and numer-
acy difficulties (Elkins, 2002). The terms also vary from state
to state, from educational sector to sector (i.e., state, indepen-
dent, and Catholic) and from school to school.
In the school system, terms such as dyslexia and dyscal-
culia are not commonly used, although there are groups that
want to have these terms recognized in government legisla-
tion and in schools (Dyslexia Working Party, 2010). Dyslexia
and dyscalculia are recognized under the Disability
Discrimination Act, 1992 and by various states’ education
systems. The Australian Psychological Society (APS) refers
to the term specific LD, which it defines as “problems peo-
ple encounter in learning that affect achievement and daily
life skills” (APS, 2012b).
ADD and ADHD are not officially recognized in schools,
although these two terms may be used within a school com-
munity and are often regarded as being associated with or
comorbid with LD (Houghton, Carroll, Taylor, &
O’Donoghue, 2006; van Kraayenoord et al., 2001; Wright,
Shelton, & Wright, 2009). Professional associations such as
the APS (2012a) make use of the term ADHD. Furthermore,
if a particular learning problem such as ADD or ADHD has
been shown to be the result of an identifiable disability, then
it will be covered under the Disability Discrimination Act,
1992 (Australian Human Rights Commission, 2000).
Identification
The diagnosis and identification of students with LD in
Australia occurs both inside and outside the school system,
with practices of diagnosis and identification varying from
state to state. For example, in the state school system of
Victoria, the assessment and identification of students with
LD is typically undertaken by psychologists who are officers
of the state department of education. They conduct individ-
ual assessments and provide assessment reports and advice
(State Government Victoria, Department of Education and
Early Childhood Development, 2011). In contrast, in
Queensland, staff of the state department of education does
not diagnose students (S. Innes, personal communication,
January 5, 2012). Thus, parents of students must seek a
diagnosis and identification of their child’s LD outside the
system.
It is common for educational psychologists involved in
the assessment of a LD to use standardized tests of aca-
demic achievement (e.g., a reading test), and in some cases
a test of intellectual abilities may also be used. The APS
(2012b) argues that during the identification process, a stan-
dardized test of ability should be used to rule out the pres-
ence of an intellectual disability. In some cases, the
“discrepancy model” may be applied. However, many par-
ents are against the use of intelligence tests, and therefore
often an intelligence score is seen as an unnecessary ele-
ment in the assessment process.
With respect to the assessment of ADHD, the APS refers
to the use of various tools—including observations of behav-
ior, cognitive tests of attention, intelligence tests, and tests of
academic achievement (APS, 2012a). Similarly, Wright et al.
(2009) has argued for the use of a range of measures (e.g.,
interviews with parents or caregivers, teacher reports, educa-
tional assessment), as well as the application of the DSM-IV
diagnostic criteria for the identification of ADHD.
Prevalence
There is a lack of uniformity across Australia in the way in
which students with disabilities are identified. The defini-
tion of disability contained in the Disability Discrimination
Act, 1992 includes students with LD, and this group is esti-
mated to be 10% to 15% of school students (Support for
Students with Disabilities Working Group, 2010). Other
researchers, Louden et al. (2000) have reported between
10% and 20% of students with LD. The prevalence of ADD
and ADHD as reported in Australian studies ranges from
6.8% and 9.9%, whereas the National Health and Medical
Research Council has reported prevalence rates of between
2.3% and 6.0% (see Wright et al., 2009).
Support for Students
The Disability Standards for Education, 2005 (Australian
Government, 2005) spell out the obligations of education
providers for those with disabilities, including those with
LD, dyslexia, dyscalculia, ADD, and ADHD. The standards
refer to the need for education authorities to make “reason-
able adjustments” so that students can participate in educa-
tion on an equal basis with their peers. Currently, with most
education systems in Australia using an inclusive education
approach, there is an emphasis on supporting students by
60 Journal of Learning Disabilities 46(1)
identifying the barriers to learning and responding to stu-
dents’ individual learning needs. Students with ADD and
ADHD may be supported by a schoolwide continuum of
positive behavior support as well as through the provision
of instructional support in literacy and numeracy.
The Expected Impact of
Proposed DSM Changes
There appears to be no clear position in Australia about the
use of the classifications and the diagnostic criteria as
found in the proposed DSM-5. It might be expected, how-
ever, that those professionals in this country who have in
the past used earlier versions of the DSM will move to
using the DSM-5. The proposed DSM-5 is likely to have
little influence on education systems and how they support
the learning of students with difficulties and disabilities.
Germany (by Matthias Grünke)
Prevalence
About 3% to 7% of all school-aged children and youth are
diagnosed as having ADHD, 4% to 8% are identified as
students with a reading disorder, 4% to 6% meet the criteria
of dyscalculia, and up to 10% show signs of a general LD
(Lauth, Linderkamp, Schneider, & Brack, 2008). The cur-
rent basis for defining boys and girls with special needs in
epidemiological studies and in everyday practice is the
ICD-10 and not the DSM-IV. The classification system is
certainly well known among professionals in Germany, but
in connection with routine procedures of health care institu-
tions or individual therapists with health insurance compa-
nies, the DSM-IV is not used.
Terminology
Some confusion exists concerning the translation of the
American term learning disability into the German term
Lernbehinderung because they do not mean exactly the same.
The widely used expression Lernbehinderung was first intro-
duced in the 1960s during a restructuring of the national
education system by the Standing Conference of the Ministers
of Education and Cultural Affairs (Kultusministerkonferenz)
to describe the population of students who fail in all core
school subjects, regardless of the reasons. Thus, children and
youth labeled with this diagnosis include students who show
low intellectual abilities but do not meet the criteria for intel-
lectual disabilities. Around 5% of all elementary and high
school students are included in the Lernbehinderung group
(Lauth, Grünke, & Brunstein, 2012).
There is a tendency in the German scientific community
to emphasize socioeconomic basis for ADHD and learning
problems or to attribute respective difficulties to a mismatch
of teaching style and learning needs of children and youth
with diverse cultural or ethnic backgrounds (Eberwein,
1996). The poorly defined and at times overused term
Lernbehinderung certainly contributes to the uneasiness felt
by many researchers and practitioners as they struggle with
the classification systems and the perils of negatively label-
ing children and youth, and thus affecting the way society
perceives them.
However, there are legal necessities to identify and to
diagnose children and youth with difficulties to systemati-
cally provide them with available resources. Private and
national health insurance companies require institutions and
therapists to conduct thorough assessments and to assign a
diagnostic code before agreeing to refund any expenses. In
the case of learning difficulties, health insurance usually
does not cover outlays. Depending on the state and the cur-
rent budgetary situation of a given community, youth wel-
fare offices sometimes step in and meet these costs.
The assessment process conducted by medical health
professionals, psychotherapists, or social workers is usually
guided by the directives proposed by different professional
associations, like the ADHD Consortium of Pediatricians
(Arbeitsgemeinschaft ADHS der Kinder- und Jugendärzte,
2012). These organizations recommend the use of a variety
of different categorical and dimensional approaches, as well
as different methods (e.g., standardized tests, interviews,
and observations).
Education
A very large percentage of children and youth with ADHD
(and other behavioral problems) or with LD still attend
special schools for students with emotional or intellectual
challenges. In some German states, this proportion exceeds
90%. The process of inclusion is an ongoing one, but it is
probably slower than in many other countries. The system
of special schools in Germany has been more accepted by
the educational communities than in many other countries,
thus making it harder to change the status quo. Yet some
children are offered adjustments and special support in their
classroom. Nevertheless, in many instances, the students
with behavioral or learning problems are referred to special
schools. During university education of prospective special
education teachers, the problems associated with diagno-
sis are often overemphasized in classes at the expense
of imparting the theoretical knowledge and the practical
skills necessary to select, use, and interpret adequate
instruments.
The Expected Impact
of Proposed DSM Changes
Even though the new version of the DSM will not replace
the ICD, it will certainly be recognized and will have an
Al-Yagon et al. 61
impact on the way ADHD and LD are viewed and diag-
nosed by researchers and practitioners.
LD changes. Indeed LD was previously viewed as a
superordinate category for reading, mathematics, and writ-
ten expression. These three different subgroups will now be
aggregated into a single group, called “specific learning disor-
der,” thus taking into account the developmental continuities
among speech, oral language, reading, spelling, expressive
writing, and calculating. In addition, the perpetuated but often
challenged discrepancy criterion will be eliminated. Intellec-
tual disability is now used as a rule-out criterion. Last, certain
descriptive feature and severity specifiers will be added, thus
recognizing developmental changes in the manifestation of
learning problems, and acknowledging the importance of
accounting for the level and the support that will be needed
for the child or youth to function in everyday life.
ADHD changes. The diagnosis of ADHD will require sev-
eral changes: (a) more specific descriptions of relevant
behaviors within different age groups, thus enhancing reli-
ability, (b) additional impulsivity items and the changes in
the diagnostic threshold for adults (from six to three symp-
toms), and (c) the need for an attitude change regarding the
ADHD. Even though there is a risk that a number of Ger-
man experts will reject the proposed classification that con-
siders ADHD to be a neurological disorder, the new edition
of the manual will most likely win more acceptance than the
current one. Its apparent advancements concerning reliable
descriptions and a stronger focus on the needed support for
a child or youth will certainly have appeal. The innovative
concept of specific LD might be able to stimulate further
and constructive discussions in Germany about the appro-
priateness of the diagnosis Lernbehinderung. Because of
the strong focus on empirical research and clinical experi-
ence rather than on certain theoretical models, the new ver-
sion of the DSM will contribute to overcoming reservations
concerning standardized diagnostic procedures in special
education and will further improve the quality of assess-
ments of these children and youth in Germany.
Greece (by Georgios Sideridis)
Legislation
Under the current special education law in Greece (Law
3699, 2/10/2008), students with disabilities are educated in
the least restrictive environment. Among changes to previ-
ous laws, the terminology was changed from children with
disabilities to handicapped (παιδιά με αναπηρία)—a term
with less negative connotations with regard to the disability
category and the severity status. The law emphasizes that
all diagnostic services have to take place under the auspices
of the multidisciplinary team. These teams are composed of
experts (psychologists, special education teachers, speech
therapists, etc.) who primarily use the discrepancy model
for the identification of students with LD. The identifica-
tion of students with LD follows the National Joint
Committee on Learning Disabilities (1990) definition. No
formal definition exists with regard to ADD and ADHD. In
fact, these students belong to a general category—those
with “neurological impairments.” Thus, the members of the
multidisciplinary teams use criteria that reflect their theo-
retical orientation and operational definition.
Prevalence and Diagnosis
Prevalence rates for LD ranged between 1.2% in 2004 and
1.6% in 2005 based on epidemiological studies and govern-
mental reports. These were the only data available. The
respective estimate for the category of neurological disor-
ders (including ADD and ADHD) is very low (0.015%) and
available only for elementary school students in 2004.
Until 2007, there were only a few standardized tests for the
Greek population. The identification of LD requires an IQ
assessment (for evaluating the discrepancy between ability
and achievement), yet the only standardized IQ test (Wechsler
Intelligence Scale for Children–III) is already 15 years old. In
2007, 12 tests were standardized by various scientific teams
with state and European funds. These tests measure skills and
competences such as early reading ability, teacher ratings of
LD, attention, cognition, later reading, memory, and psycho-
social attributes. Anecdotal evidence suggests that they have
not been widely embraced by members of the multidisci-
plinary teams. Many members of these teams have diverse
philosophies and use different tests, various operational defi-
nitions, and various criteria for the identification of LD. The
use of the newly developed DSM criteria will promote changes
only if members of the teams are asked to adopt them. In addi-
tion, under the recently planned 2012 legislation (not yet a
law), the responsiveness to intervention (RTI) model has been
recommended (Fuchs & Deshler, 2007).
The Expected Impact
of Proposed DSM Changes
LD changes. The proposed changes suggested by the
upcoming DSM-5 criteria have both pros and cons. For LD,
the specific deficits will consist of distinct categories of spe-
cific learning disabilities (SLD; e.g., reading accuracy prob-
lems). However, the proposed adoption of the RTI model for
identification purposes has to consider the limitations
described by research (e.g., Fuchs & Deshler, 2007; Mastrop-
ieri & Scruggs, 2005; Sideridis, Padeliadu, & Antoniou,
2010). The proposed changes will be challenging for educa-
tional contexts where currently only psychometric classifi-
cation criteria for the identification of LD are employed.
ADD/ADHD changes. For ADD/ADHD, the proposed
DSM acknowledges the biological nature of the disorder.
However, the validity of the proposed subtypes may be
62 Journal of Learning Disabilities 46(1)
questioned in the absence of a large number of validation
studies.
In conclusion, there are pros and cons to the proposed
DSM criteria for the identification of LD and ADD/ADHD.
These are thoughtful changes and additions, yet only future
accumulated research evidence will allow their outcomes to
be judged.
India (by Sunil Karande
and Rukhshana Sholapurwala)
Legislation
India is a federal union comprising of 28 states. In India,
school education is largely the responsibility of the state
governments, and most children attend schools affiliated
with state education boards. Currently, the category of SLD
is not yet recognized as a disability by the national govern-
ment of India. Only six state governments (Maharashtra,
Karnataka, Tamil Nadu, Kerala, Goa, and Gujarat) have
recognized SLD as a disability and provided these students
with provisions and accommodations to enable their educa-
tion in regular mainstream schools (Karande, 2008). The
ADHD category is not recognized as a disability by the
national government of India or by the state governments.
On April 2010, the government of India implemented the
Right of Children to Free and Compulsory Education Act,
2009 (RTE Act). This RTE Act makes education free and
compulsory to all children of India (including those with
disabilities) in the age group of 6–14 years (Karande &
Gogtay, 2010).
The Expected Impact
of Proposed DSM Changes
SLD Changes
1. Recognition of SLD as a disability at the national level. The
fact that the proposed DSM-5, for the first time, will recog-
nize SLD as a distinct group of disorders will empower pro-
fessionals and advocacy groups in their negotiations with
the national government of India and the remaining 22 state
governments for the recognition of SLD as a disability cat-
egory. Under the RTE Act, adequate funds will become
available to set up assessment centers to diagnose SLD and
remedial centers to provide intervention and therapy all
over the country (Karande & Gogtay, 2010).
2. Development of local curriculum-based tests for diagnos-
ing SLD in all Indian languages. English is one of 22 official
languages of India. The majority of Indian children study in
non-English (vernacular) schools, such as those instructing in
Hindi, Marathi, Tamil, Kannada, Telugu, Urdu, and Bengali
(Karande & Gogtay, 2010). The standard educational tests
used in Western countries (e.g., Wide Range Achievement
Test, Woodcock–Johnson Tests of Achievement, etc.) are not
available in non-English Indian languages (Karande & Gog-
tay, 2010). In addition, the existing tests are not standardized
for use even for the English-speaking Indian population,
raising questions regarding their cultural appropriateness for
Indian children. Therefore, at the present, it is not possible
to diagnose children with SLD among the majority of chil-
dren who study in non-English (vernacular) schools
(Karande & Gogtay, 2010).
The proposed DSM-5 has recommended using standard-
ized educational tests that are culturally, educationally, and
age appropriate. In India, at present, only two standardized
curriculum-based tests are available for diagnosing SLD in
children (Narayan, 1997; Sholapurwala, 2010). The CBT
developed by Sholapurwala (2010) is used for diagnosing
SLD in students in Grades I–X at English-speaking medium
schools. The Grade Level Assessment Device (GLAD)
developed by the Department of Special Education is used
for diagnosing children in Grades I–IV in English and Hindi
medium schools (Narayan, 1997). The proposed DSM-5
recommendations would encourage special educators to
develop standardized curriculum-based educational tests in
all Indian languages. Thus, diagnosing SLD in the vernacu-
lar medium schools will become possible.
3. Ensured benefits in college courses for adolescents with
SLD. Under the “disability quota,” up to 3% of seats are
reserved in state colleges and in government employment
for individuals with disabilities. To benefit from this legisla-
tion, the person with a disability needs to be certified by a
medical authority (Office of the Chief Commissioner for
Persons with Disabilities, Ministry of Social Justice and
Empowerment, Government of India, 2012) as diagnosed
with at least 40% of the disability. There are clear-cut guide-
lines for certifying individuals with vision, hearing, and
locomotor impairments. Currently, there are no guidelines to
quantify the severity of individuals with SLD, and they are
often unable to get these reserved seats and jobs. Since the
proposed DSM-5 has suggested the SLD severity specifiers,
individuals diagnosed at Level 2 or Level 3 will now have
access to college studies and to governmental occupations.
4. Slow learners category will be included with SLD category.
Currently in India, only children with an average intelligence
quotient (IQ; 85 or greater) on a standard intelligence test
such as the WISC (Wechsler Intelligence Scale for Children–
Indian Adaptation) qualify for a diagnosis of SLD (Karande,
Kanchan, & Kulkarni, 2008). Children with borderline intel-
lectual functioning (i.e., an IQ score in the range of 71 to 84)
are labeled as slow learners. Unlike children diagnosed with
SLD, the majority of the slow learners group are currently
unable to continue their education in regular mainstream
schools beyond Grade VII, since they are not entitled to provi-
sions support and/or accommodations. Most parents are reluc-
tant to consider the option of special education for their
children (Karande et al., 2008). In line with the proposed
DSM-5 recommendation to adopt intellectual disability as a
Al-Yagon et al. 63
rule-out criterion, rather than using average IQ as a rule-in
criterion for diagnosing SLD, slow learners will now be diag-
nosed as having SLD and get the same provisions and/or
accommodations. This change will greatly benefit the slow
learner group of children, who will now be able to continue
their education in regular mainstream schools (Kulkarni,
Karande, Thadhani, Maru, & Sholapurwala, 2006).
ADD/ADHD Changes
5. Diagnosis of children with predominantly inattentive form
of ADHD. Often children with ADHD are referred for clini-
cal assessment only when their behavior adversely affects
their academic achievements (Karande, 2005). This situa-
tion is more pronounced at the secondary school level
(about 11 to 12 years old; Karande et al., 2007). The pro-
posed age changes for the identification of ADHD (from
7 to 12 years old) will result in more children being diag-
nosed with predominantly inattentive form of ADHD, espe-
cially when they also have comorbid SLD.
6. Challenging the ADHD stigmatization. In India, parents of
children with ADHD are often reluctant to follow the medication
recommended for their children (Karande, 2005; Sitholey,
Agarwal, & Chamoli, 2011) since ADHD is perceived to be a
result of poor parenting or a mental illness. In addition, they
fear that treatment drugs (methylphenidate and atomoxetine)
could harm the brain of their children (Sitholey et al., 2011).
Thus, parents prefer to give their child homeopathic or alter-
native medications, whose impacts have not been scientifi-
cally proven (Karande, 2005; Sitholey et al., 2011).
The DSM-5 has proposed classifying ADHD as a neuro-
developmental disorder and to separate it from disruptive
behavior disorders. This will empower professionals and
advocacy groups in their negotiations with the national gov-
ernment of India and state governments to recognize ADHD
as a disability category. Under the RTE Act, adequate funds
will become available to train school teachers to provide psy-
choeducational interventions in the classroom and free medi-
cation to these children when indicated. This proposal will
also help pediatricians to change the negative attitudes among
parents and school authorities and convince them that ADHD
requires not only educational interventions but also medica-
tion, when indicated. In addition, once specifiers for the
severity of ADHD are formulated, pediatricians and psychia-
trists will have clarification on determining when to start
medication. Thus, children with ADHD will get the recom-
mended psychoeducational interventions and medications to
improve their social life and academic performance.
Israel (by Michal Al-Yagon
and Malka Margalit)
Legislation
The Special Education Law of 1988 (Alon-Reshef,
1994) has emphasized a national commitment to placing
students in the least restrictive educational environ-
ment. Thus, most Israeli students with LD and with
ADHD are in inclusive regular educational settings
(Al-Yagon & Margalit, 2001). The current formal proce-
dure for assessing LD comprises psychoeducational
evaluation. The LD diagnosis uses the DSM-IV-TR
(American Psychiatric Association, 2000) discrepancy
criteria. Although the Ministry of Education has recog-
nized LD as a disability, parental initiation and resources
are needed to perform diagnosis since in most cases this
assessment is not provided by schools (Sharabi &
Margalit, 2009). Thus, the assessment is implemented by
private psychoeducational professionals or through
health maintenance organizations and has to be con-
firmed by the educational committees.
Prevalence
There is no official prevalence rate of LD and ADHD in
Israel. However, the Ministry of Health reported that about
5% of children were identified as children with ADD and
ADHD (http://cms.education.gov.il/NR/rdonlyres/
C194DAF7-F610-4111-A9B8-9491C806ECC8/131831/
gilion104.pdf). The severity of the LD is rated by three
levels of learning and testing accommodations and the stu-
dents’ supportive needs. In 2011, 5.29% of students who
participated in the national examinations at the end of high
school (Bagruth) were identified as students with LD,
entitled to major accommodations (Levels 2–3). The
national controller reported a higher percentage (about
15%) of children received various levels of accommoda-
tions (Sharabi & Margalit, 2009). Most of the children in
the higher prevalence report experienced mild difficulties
and received low levels of accommodations (Level 1), such
as extended testing time during academic tests. In the
Israeli Ministry of Education, the department of LD is not
a part of the special education department, and there is a
growing recognition that students with LD are entitled to
testing accommodations almost without stigmatization
(Ayalon & Margalit, 2004).
Research and Interventions
The study of LD and ADHD in Israel has grown in recent
decades, bringing major developments in understanding the
etiology, diagnosis, and interventional needs, without
neglecting the socioemotional and familial aspects (e.g.,
Al-Yagon, 2011; Tsal, Shalev, & Mevorach, 2005;
Zoccolotti & Friedmann, 2010). In addition, a variety of
intervention programs have been developed to enhance
children’s academic and socioemotional adjustment (e.g.,
Freilich & Schechtman, 2010). These studies represent but
a few of the collaboration efforts among the educational
systems, families, advocacy groups, and medical and men-
tal health service providers
64 Journal of Learning Disabilities 46(1)
The Expected Impact
of Proposed DSM Changes
LD Changes
1. The discrepancy model. There is an ongoing debate
between the existing mandatory request (based on DSM-IV)
for a substantial discrepancy model and the adoption of the
RTI diagnostic approach. The DSM-5’s proposed deletion
of the discrepancy requirement may result in a prevalence
increase. This change also demands educational systems to
use valid intervention procedures to empower RTI decision
making.
2. The superordinate categorization. The DSM-5 proposed
that the classification of LD would replace the four distinct
disorders with one superordinate disorder. Indeed, clinical
experience in Israel has demonstrated that individuals with
LD manifest high rates of co-occurrence of different learn-
ing difficulties across various academic domains. Thus, the
upcoming change may support renewed demands of advo-
cacy and parents’ groups to provide assessment of LD by
the state as an integral part of the educational law’s imple-
mentation or through the national health law coverage. It
may also initiate changes in the acceptance of the LD as a
disability category recognized by the national insurance.
3. A new group that cannot be ignored. The recommenda-
tion to use intellectual disability (and not average IQ) as a
rule-out criterion will focus interest on a neglected group,
whose intellectual functioning is lower than the average, and
yet they are not included in the intellectual disability group.
4. The severity specifiers. The severity specifiers, which
comprise the level and duration of the support required for
effective learning, are already in use in the current educational
policy. Such evaluations may promote important collabora-
tions between professionals and settings (e.g., educators, cli-
nicians) and may sensitize the multidisciplinary teams to the
educational implications of their recommendations.
ADHD Changes
5. The separation of ADD/ADHD from externalizing disor-
ders. For the first time ADHD is proposed to be located in
the neurodevelopmental disorders category. As suggested by
Tannock (2013), this change may help to attenuate the myth
regarding ADHD as synonymous with “bad behavior”
caused by lax parental and teacher discipline. Furthermore,
this change may promote greater understanding of the neu-
rodevelopmental features of this disorder, highlighting the
need for more comprehensive assessments across multiple
dimensions of dysfunction and impairment.
6. Lifelong consideration. We welcome the proposed
changes emphasizing the life span features of ADHD. Such
changes may contribute to developing appropriate compre-
hensive services for this population.
7. Age of onset. The shift in the proposed DSM-5’s “age of
onset” criterion from 7 to 12 supports the current clinical
trends in Israel, especially for individuals in the inattention
group.
Conclusions
Taken together, the implications of the proposed changes in
the DSM-5 emphasize the need for future research to inves-
tigate the possible effects of the proposed changes and their
validity among individuals with LD and ADHD. In addi-
tion, the changes will lead to national recognition that
resources are required to meet students’ needs for diagnosis
and support and that, as an outcome of the current legisla-
tion, they must be provided for by the school and mental
health systems and not by families.
Italy (by Patrizio E.Tressoldi,
Claudio Vio, Cesare Cornoldi,
and Daniela Lucangeli)
Legislation
In the past 4 years, to individuate the clinical and educa-
tional best practices related to LD, two Consensus
Conferences have been organized in Italy by national pro-
fessional and advocacy associations involved in LD and by
the Health Governmental Department. Furthermore, the
Education Governmental Department has promulgated a
specific law related to LD (Law 170, October 2010) to guar-
antee access to all the educational opportunities for students
with LD.
For ADHD, the Health Governmental Department has
regulated the procedures on how to assess this disability in
particular when a pharmacological intervention is pre-
scribed. Furthermore, all clinical data of all children under
pharmacological treatment must be stored on a national reg-
istry under the control of the Istituto Superiore di Sanità, the
leading technical and scientific public body of the Italian
National Health Service. This same institution has esti-
mated the prevalence of this disability within the range of
0.43% to 3.6%. The Education Governmental Department
has promulgated a document with recommendations to be
adopted by all teachers in their classroom if a child is diag-
nosed with ADHD.
If the recommendations included in the above-mentioned
documents are implemented by all clinical and educational
professionals involved in LD and are developed synergi-
cally with parents, the quality of Italian private and public
services for LD and ADHD will reach very high levels.
The Expected Impact
of Proposed DSM Changes
LD changes. The proposed changes for LD will support
most of the points already included in the national documents,
Al-Yagon et al. 65
that is, reduced importance of the discrepancy criteria, dif-
ferences between dyslexia and comprehension disorders,
differences between dyscalculia and mathematical reason-
ing in problem solving, and differences between spelling
and writing skills. However, the DSM-5 proposed approach
will raise problems for the differentiation of LD into the
four main categories of recent Italian law, that is, dislessia
(dyslexia), disortografia (spelling disorder), disgrafia
(handwriting disorder), and discalculia (dyscalculia).
The proposed inclusion of “severity specifiers” is wel-
come and had been expected for a long time, given the cur-
rent criteria difficulties. Similarly, the arbitrary cutoffs
divide the distributions of levels of competence. In addi-
tion, the observation of different adaptive consequences for
children with the same diagnosis of LD should highlight the
importance of finding different criteria for the diagnosis of
the disorders, which refer to the severity of the problems.
ADD and ADHD changes. The criteria for the diagnosis of
ADHD are still very heterogeneous in Italy. Intense debates
exist regarding the most effective diagnostic procedures
and the best tests to use for the diagnosis of the different
expressions of this syndrome. In particular, there are differ-
ent approaches that take into account the prevalence of vari-
ous symptoms in relationship to chronological age (with a
predominant presence of a combined symptomatology in
the 7- to 11-year-old range, followed by a predominantly
inattentive symptomatology in the following years). The
proposed elimination of the specifications into three sub-
types, in favor of the introduction of a more detailed expres-
sion of symptoms, and the use of specific developmental
pathways over time may facilitate understanding of the
manifestation of symptoms and their prognosis.
The recognition of the new symptoms in adulthood crite-
rions would also improve the knowledge of the criteria
established during development. However, in addition, it
could be useful to both diagnosis and classification to con-
sider the psychological profile and the different intensity of
symptoms (and not only the number of symptoms). The dis-
tinction between different levels of the disorder severity,
similar to the LD proposal, may be helpful. In particular, a
differentiation based on underlying neuropsychological pat-
terns among children with ADHD should also be consid-
ered. Another related issue that should be addressed is the
need to gather more evidence focused on the validity of the
tests to support a diagnosis that otherwise would be based
only on a symptomology approach (e.g., the role of execu-
tive functions in ADHD).
Spain (by Juan E. Jiménez)
Legislation
The law of education in Spain (Ley Orgánica de
Educación [LOE] 2/2006, May 3) defines students with
specific educational support needs (SESN) as those who
require additional educational support because of special
educational needs (i.e., those who require support and spe-
cific educational attention because of disabilities or severe
behavior disorders, either for a period or throughout the
whole of their schooling), SLD, high ability, late entry to the
education system (i.e., students who arrive from other coun-
tries or who enter the education system late for any reason),
or personal conditions or past school records. In this law,
there is no specific reference to ADHD. Traditionally,
Spanish legislation has not contemplated LD and ADHD as
a diagnostic category, and no guidelines have been offered
for the identification of students with LD or ADHD. SLD
has been mentioned in the recent LOE, but no definition has
been proposed for this category. However, the law specifies
clearly that it is the responsibility of the education adminis-
tration to establish procedures, resources, and measures to
identify students with SESN and to assess their needs as
early as possible. Spain is organized as a central govern-
ment with 17 autonomous communities. These regional
governments are responsible for the schools’ administra-
tion, universities, health care, social services, culture, urban
and rural development, and laws.
To our knowledge, the community of the Canary Islands
is the first autonomous community in Spain that has recently
published specific laws including definitions, procedures,
and measures to identify students with LD, dyslexia, dyscal-
culia, disorder of written expression, and ADHD (BOC 250,
December 22, 2010; BOC 40, February 24, 2011). These
research-based regulations emerged through the collabora-
tion between Canaries universities and the Department of
Education of the Canaries government. Students are consid-
ered at risk for developing SLD when they demonstrate a
gap in the curriculum or subject area and, specifically, in
aspects related to language: reading, spelling, or numeracy
in standardized assessments. The requirement for a substan-
tial discrepancy between measured academic achievement
and intellectual ability is not included as a criterion for the
identification of SLD, and the adoption of the RTI approach
is being considered (Jiménez et al., 2010). The IQ–
achievement discrepancy criterion was not used in Spain
for the identification of LD, and it also has not received
empirical support in Spanish research (Jiménez, Siegel,
O’Shanahan, & Ford, 2009).
ADHD is diagnosed when students display persistent
inattention or hyperactivity and impulsivity in their overt
behavior pattern that have a negative effect on life in school,
family, and society. These symptoms must be present at
school and in the family, and some of them must appear
before 7 years old. These indicators will initiate the identi-
fication process that will be confirmed by health services
(supported by public funds), corresponding to the Equipos
de Orientación Educativa y Psicopedagógica psychoeduca-
tional assessment and with the educational system in an
66 Journal of Learning Disabilities 46(1)
attempt to find the most appropriate educational response
for the student.
Prevalence
To our knowledge, there are no studies in Spain that have
reported the prevalence of LD except those carried out in
the Canary Islands (e.g., González et al., 2010; Jiménez,
Guzmán, Rodríguez, & Artiles, 2009). In these studies,
researchers used the same operational definition of dyslexia
included in the specific law for the Canary Islands (BOC
250, December 22, 2010). For elementary grades, Jiménez,
Guzmán, et al. (2009) selected a random sample of 1,050
children to identify students with LD. They compared the
information provided by teachers, based on a standard cur-
riculum, with specific diagnostic criteria based on psycho-
linguistic research. From a sample that was identified by
teachers with LD (n = 293), only 91 students were identi-
fied as LD by a psychometric criteria (8.6%). This repre-
sents 8.6% from the total study sample (N = 1,050), 3.2%
had dyslexia and 5.4% had difficulties in spelling according
to teachers’ reports. González et al. (2010) examined sec-
ondary schools and their sample consisted of 945 students.
Teachers identified 291 students with LD and 55% (n =
160) of these students had LD determined by psychometric
criteria. Thus, 16.9% of the students were identified as stu-
dents with LD, of which only 3.2% (n = 30) were students
with dyslexia and 7.6% (n = 72) also had problems associ-
ated with spelling.
In most studies of developmental dyslexia carried out in
opaque orthographies (i.e., English), only accuracy has been
assessed, not processing speed (for a review, see Sprenger-
Charolles, Siegel, Jiménez, & Ziegler, 2011). The incidence
rate of phonological dyslexia in Spanish has been lower than
that found in English studies because of the transparency of
orthography in the Spanish language (Jiménez, Rodríguez,
& Ramírez, 2009). Therefore, the law in the Canary Islands
region includes not only accuracy measures but also speed
measures for the identification process. Another study of the
prevalence of ADHD also conducted in the Canary Islands,
by Jiménez, Camacho, Rodríguez, Afonso, and Artiles (in
press), found an overall prevalence rate of 4.9%, divided
into three groups: 3.1% were included in the subtype inatten-
tive, 1.1% were hyperactive, and 0.7% were combined.
These findings were also found on Mallorca Island in Spain
(Cardo & Servera-Barceló, 2005).
The Expected Impact
of Proposed DSM Changes
LD changes. SLD is recognized as a distinct group of dis-
orders and without the demand for the discrepancy criteria
as specified within the proposed changes. Nowadays the
tests are culturally, educationally, and age appropriate in the
region for the identification of SLD. Terms such as dyslexia
and dyscalculia are used and recognized by the government
legislation and in schools. However, there are no guidelines
to quantify the severity of individuals with SLD.
ADD/ADHD changes. The proposed inclusion of ADHD
as a neurodevelopmental disorder and its separation from
the disruptive behavior disorder will be very important if
indeed these changes are adopted.
Taiwan (by Li-Yu Hung)
Legislation, Identification, and Prevalence
The diagnosis of ADHD and LD mainly follows the
DSM-IV definitions. The assessment and the accommoda-
tions for students with LD have been legislated in Taiwan.
Although Chinese is not an alphabetic language, and acqui-
sition of word recognition is different from that in the most
alphabetic languages, the evidence-based effective reme-
diation for Chinese dyslexia was found. The assessment
and identification system for reading disabilities is more
comprehensive than the assessments for mathematic dis-
abilities. A diagnostic battery for Chinese reading dis-
abilities developed by Ker (2007) is based on the simple
view of reading model and includes assessment for diffi-
culties in word reading (dyslexia), comprehension (hyper-
lexia), and both word reading and comprehension. Slightly
more than 10% of students were diagnosed as students
with reading disabilities under these three subtypes (Hung
et al., 2008).
Because of the need for services, psychiatrists and clini-
cal psychologists in medical teams are responsible for the
diagnosis of ADHD. However, educational diagnosticians
working with the multidisciplinary teams are responsible
for diagnosing children with LD for special education ser-
vices, whereas psychiatrists diagnose learning disorders to
meet medical needs. The prevalence of ADHD ranges
between 6.3% and 12.04% depending on the scales and
sampling used (Huang, 2008). Multiple sources of informa-
tion and psychological assessments were used to study the
prevalence. Of the children in Grades 1–9, 4.9% were iden-
tified as students with ADHD (Hung, Chiu, Chang, Meng,
& Tsai, 2001a). During the past decade, the ADHD criteria
of DSM-IV and the Swanson, Nolan, and Pelham Version
IV (SNAP-IV) were standardized in Chinese with local
norms, and they have been used widely in the clinical and
school settings (Hung, Chiu, Chang, Meng, & Tsai, 2001b;
Liu et al., 2006). The proposed changes in the DSM-5 will
help in the identification of inattentive subtypes. Under the
local parent association advocacy, the legislation for educa-
tional services and medical care for the individuals with
ADHD has increased in the past two decades. However,
because of ADHD stigmatization and the fear of pharmaco-
therapy, ADHD remains underdiagnosed in Taiwan.
Al-Yagon et al. 67
The Expected Impact
of Proposed DSM Changes
LD changes. The diagnosis of LD performed by special
educators is different from that of psychiatrists and clinical
psychologists. The psychologists follow the DSM-IV, whereas
special educators follow the neuropsychological trends more
closely than the DSM-IV. Furthermore, most individuals with
LD need special education services more than medical care.
Thus, the education profession has the major responsibility
for the diagnosis of LD in Taiwan. As a result, the proposed
changes of DSM-5 will not have a major impact on the preva-
lence and education, although professionals such as psychol-
ogists, psychiatrists, and speech pathologists might have to
make adjustments based on these new changes.
The new term dyslexia in the proposed DSM-5 is defined
as a difficulty in reading accuracy and fluency, which is dif-
ferent from the definition proposed by International Dyslexia
Association (Lyon, 2003), and it confuses word reading with
passage reading. The new definition excludes the difficulty in
comprehension and removes this subtype into oral language
problem (communication disorders). This proposed change
may result in underidentification of this subgroup because of
the sensitivity of the assessment of oral language. We found
that half of students with average IQ and poor reading com-
prehension (formally identified as reading disabled; RD)
failed to show any difficulties in word reading or oral com-
prehension. About one third of students with RD showed oral
comprehension difficulties in standardized tests, but some of
them failed to show language problems (Hung et al., 2008).
According to these findings, the change of definition of read-
ing in the DSM-5 may not represent the majority of the RD
group, which was identified as RD in the DSM-IV.
Future research will have to focus on the issues initiated
by these changes, such as what is the difference between
reading comprehension and reading accuracy and fluency
and the relationship between reading comprehension and
oral language.
ADHD changes. Two proposed changes of the DSM-5
might influence the practice in Taiwan. The addition of the
restrictive inattentive subtype will help to develop aware-
ness and support the identifying of inattentive subtypes. The
deletion of the exclusion of pervasive developmental disor-
der (PDD) might change the population and characteristics
of ADHD in Taiwan since more parents with mild PDD pre-
fer their children to be identified as children with ADHD.
The United Kingdom
(by Angela J. Fawcett)
Legislation and Identification
The DSM classification learning disorder is not currently in
use in the United Kingdom, with the term LD representing
children with intellectual difficulties, and this represents a
clear-cut difference between the United States and the
United Kingdom. The use of dyslexia in the proposed
DSM-5 in preference to reading disorder reflects common
usage within the United Kingdom, although some authori-
ties prefer to use the term SLD because the term dyslexia
has remained controversial within education. Nevertheless,
the Rose Review (2009) reinforced the use of the term dys-
lexia, recognizing the issues of comorbidity that are
acknowledged in the proposed DSM-5 and including the
following major recommendations.
• Training 4,000 specialist teachers in dyslexia over
the next 2 years
• Boosting early identification (e.g., from Year 1,
age 6) and effective intervention
• Providing dyslexia awareness training for existing
teachers
• Including more special educational needs training
into initial teacher training
• Acknowledging the need for specialist teachers
and one-on-one interventions for severely dyslexic
pupils
Traditionally, the United Kingdom has adopted state-
ments of special needs for dyslexia, but the emphasis since
1994 has been on early identification and support, which in
many areas has meant that statementing is no longer used.
ADHD Identification
The current situation in the United Kingdom in terms of
ADHD is that an incidence of between 3% and 5% is
reported, but only around 1% have a received a formal diag-
nosis. Although this means there are 100,000 children eli-
gible for treatment with medication, currently only around
70,000 receive this because there are some concerns about
prescribing medication for children. The method of diagno-
sis in the United Kingdom depends on the involvement of
the medical profession, and a psychiatrist or pediatrician,
and unlike the other learning disorders, a psychologist can-
not diagnose ADHD. Diagnosis is currently based on a
combination of DSM-IV and ICD-10 criteria, accompanied
by checklists from parents and schools, following referral
by parents, based on symptoms evident from the age of 5.
The Expected Impact
of Proposed DSM Changes
Dyslexia. The proposed removal of the discrepancy crite-
ria in the proposed DSM-5 is also in line with current think-
ing in the United Kingdom and means that children are no
longer identified as dyslexic if they are reading at their
chronological age but show a discrepancy with their high
68 Journal of Learning Disabilities 46(1)
IQ (but see Nicolson, 1996, on the significance of IQ in dys-
lexia). The proposed removal of comprehension from the
DSM-5 classification also reflects research from the United
Kingdom that identifies comprehension difficulties in poor
readers with semantic difficulties (Nation & Snowling,
1998) by contrast with dyslexic children, who rely on their
semantic skills to compensate their reading. Inclusion of flu-
ency is a clear step forward because reading speed remains a
problem for dyslexic children throughout the life span.
ADHD. The preferred approach to treatment among spe-
cialists is a mixture of therapy and medication, with 98% rec-
ommending this, but in practice only 34% receive this type of
therapy. Although 54% of psychiatrists and pediatricians
indicated in the NICE report (NICE Clinical Guidelines,
2008) that ADHD was underdiagnosed, the recommenda-
tions of the proposed DSM-5 have been criticized by the Brit-
ish Psychological Society, noting, “We are very concerned at
the increasing use of this diagnosis and of the increasing use
of medication for children, and would be very concerned to
see these increase further” (British Psychological Society,
2011). The issue of overmedicalization was raised by the
British Psychological Society in the U.K. parliament in
October 2011. One particularly disturbing aspect for spe-
cialists in terms of dyslexia is the potential confusion
between the enhanced classification of ADD inattentive,
which seems to be largely based on difficulty and reluc-
tance to complete schoolwork, which might easily reflect
problems in learning rather than attitude and attention. This
is more likely given that the proposed DSM-5 plans to rec-
ognize ADHD as a difficulty evident before the age of 12,
thus including a new group whose problems have become
apparent only in school, and with the introduction of levels
of severity.
The United States (by Marjorie
Montague and Wendy Cavendish)
Legislation, Identification, and Prevalence
The Education for All Handicapped Children Act of 1975
mandated a free, appropriate public education in the least
restrictive environment for all children with disabilities and
ensured due process rights. As such, it has been the core of
federal funding for special education. Currently, the defini-
tion for LD (along with the 12 other disability categories
recognized and defined by the U.S. Department of Education)
is provided in the most recent reauthorization of the
Individuals with Disabilities Education Improvement Act
(IDEA). The federal definition of LD in IDEA is a disorder
in one or more of the basic psychological processes
involved in understanding or using language, spoken or
written, which disorder may manifest itself in an imperfect
ability to listen, speak, read, write, spell, or do mathemati-
cal calculations. Under IDEA (2004), approximately 5% of
all school-age youth are identified as having an LD (National
Center for Learning Disabilities, 2009). Diagnosis of LD in
most states requires youth to demonstrate an IQ–achievement
discrepancy evidenced on standardized achievement tests,
and most are conducted by school district personnel. Recent
changes in IDEA (2004) regulations have noted that each
state’s criteria for determining whether a child has a LD may
include an RTI process. The U.S. Department of Education
currently recommends but does not require that schools use
an RTI model that uses a process based on systematic assess-
ment of the student’s response to research-based general
education instruction and intervention.
ADHD is diagnosed using the DSM-IV criteria. Generally,
the assessment is conducted by a clinical professional, usu-
ally a developmental pediatrician, child psychologist, or
pediatric neurologist, with observational data provided by
families and school personnel. Prevalence estimates range
from 5% (Council for Exceptional Children, 2012) to 9%
(Centers for Disease Control and Prevention, 2007) of the
school-aged population. Youth diagnosed with ADHD can
receive special education services in school under two laws:
Section 504 of the Vocational Rehabilitation Act of 1973 or
the IDEA disability category of other health impaired.
The Expected Impact
of Proposed DSM Changes
The proposed DSM-5 change to diagnostic criteria for iden-
tification of LD that includes the consideration of youths’
response to evidence based intervention aligns with the
IDEA (2004) changes. However, as school-based assess-
ment rather than clinical assessment is most frequently used
for LD identification, the proposed DSM-5 change may
have limited impact on school based practice in the United
States. Also, the limited large-scale implementation of RTI
and the considerable variability across states in regard to
the RTI processes currently used (Berkeley, Bender, Peaster,
& Saunders, 2009) make unclear the possible impact of RTI
on identifications practices or prevalence rates in the future.
The implications of the proposed DSM-5 changes for
ADHD are primarily related to the proposal to increase the
age-of-onset criteria to 12 years from 7 years. It is possible
that this shift may have an impact on greater identification
of students with ADHD.
Conclusions and Future Directions
Our goals were to examine the international significance of
the DSM-5 proposed changes to the identification, diagno-
sis, and support of individuals with LD and/or ADD/ADHD.
To start the discussion on these changes, leading researchers
from 10 countries provided descriptions of the current situ-
ation of these groups in their countries and provided their
insights by describing how these changes may initiate
Al-Yagon et al. 69
important changes. Indeed, the survey of legislation, preva-
lence, and service provisions presents a wide range of
practices, and several reports indicated that the heterogene-
ity is pronounced not only among countries but also among
different states and different regions within the same coun-
try. The prevalence ranged from very low to a very high
percentage (1.2% to 20.0%), reflecting the diverse criteria
for identification. Another source of contextual diversity
has been the differences among languages’ characteristics
in these countries and the legislative backgrounds. They
range from general disability legislation and human rights
to specific legislation regarding individuals with LD. The
educational policies differed from placing many of these
children in special schools to a full inclusion approach.
Several researchers indicated that in their countries the
usage of the DSM is quite limited. Others pointed at the
limited impact because of the differences between mental
health professionals who use the DSM-IV and the profes-
sionals in the school systems who identify and assess chil-
dren using different approaches. However, regardless of
these differences, the following common conclusions
emerged from the reports.
1. The proposed LD severity specifiers present a
new approach by focusing attention on the levels
and duration of the requested support to overcome
barriers to learning. This proposal introduces
a conceptual change from using pathology and
causation terminology to applying performance
and participation ratings. This focus on barri-
ers to learning participation defines the severity
of the disability by the levels of the needed sup-
port. Combining this proposal with the RTI diag-
nostic approach emphasizes the importance of
age-appropriate academic functioning. In line
with the conceptual model offered by the Interna-
tional Classification of Functioning, Disability and
Health, presented by the World Health Organiza-
tion’s framework for health and disability (http://
www.who.int/classifications/icf/en/), this trend
needs further research to examine its validity.
2. The acceptance of an educational terminol-
ogy (learning disabilities/disorders) in a mental
health manual—the proposed DSM-5—indicates
the advantages of interdisciplinary partnerships
between education and mental health profession-
als for the identification of the individuals. This
trend already exists in several countries and has a
special significance in educational systems where
educational communities sustain the diagnosis
and identification responsibilities. We also pro-
pose that the term dyslexia will be included in the
new DSM version, side by side with the learning
disabilities/disorders terminology, considering its
widespread usage in educational systems in differ-
ent countries.
3. The proposed changes to ADHD may challenge
the ADHD stigmatization. Special importance
has been attributed to the proposed differentia-
tion between ADHD and disruptive behavior. The
proposed DSM-5 suggested classifying ADHD
as a neurodevelopmental disorder, a separate
category from the disruptive behavior disorders
categorization. This proposal may change nega-
tive educational and parental attitudes and prevent
considering ADHD as an outcome of emotional
and familial dysfunctional factors. This change
may help more children to get the needed therapy.
4. The construct changes may provide support for
parental advocacy and assist in addressing par-
ents’ struggles. In several countries, the proposed
emphasis of the DSM-5 on LD as a global compre-
hensive clinical category, recognized by medical
authorities, may provide additional support to local
groups, such as advocacy and parents’ associations.
Instead of presenting the needs of several small dif-
ferent groups of individuals in proposed DSM-IV,
they can portray the needs and demand the rights
of a large group who experience lifelong difficul-
ties. With the support of academia, they may renew
their negotiations for additional resources to meet
children’s needs for overcoming barriers to partici-
pation in inclusive education systems. The recogni-
tion of LD by the medical community may provide
additional strength and validity to the claims for
additional education and health resources.
5. Prevalence dilemmas were expressed by several
authors, who raised concerns regarding the pos-
sible growth in the prevalence of children with LD
and with ADHD because of the changes in ages
and criteria. Future studies should examine these
trends and their outcomes.
6. Comprehensive studies were strongly recom-
mended to examine the implications of the pro-
posed changes in different cultures. Future research
evidence is needed and may provide foundations
for reexamining current priorities, for defining
strategies to introduce change, and for evaluating
results.
In conclusion, we hope that through this article we have
starting an international dialogue among scholars. We hope
that this collaboration will promote partnerships and coop-
eration among researchers and professionals to advance
knowledge and develop effective procedures to identify,
support, and empower individuals with LD and with ADHD
in their struggles to gain full access to educational opportu-
nities in different countries.
70 Journal of Learning Disabilities 46(1)
Authors’ Note
The authors played equal roles in the contribution to this publica-
tion, and the names are presented in alphabetical order. Contact
information for each author is as follows: Christina E. van
Kraayenoord from Australia, c.vankraayenoord@uq.edu.au;
Matthias Grünke from Germany, matthias.gruenke@uni-koeln.de;
Georgios Sideridis from Greece, sideridis@psy.soc.uoc.gr; Sunil
Karande and Rukhshana Sholapurwala from India, karandesunil@
yahoo.com; Michal Al-Yagon and Malka Margalit from Israel,
malka@post.tau.ac.il; Patrizio E. Tressoldi, Claudio Vio, Cesare
Cornoldi, and Daniela Lucangeli from Italy, patrizio.tressoldi@
unipd.it; Juan E. Jiménez from Spain, ejimenez@ull.es; Li-Yu
Hung from Taiwan, hung.liyu@gmail.com; Angela J. Fawcett
from the United Kingdom, A.J.Fawcett@swansea.ac.uk; and
Marjorie Montague and Wendy Cavendish from the United States,
wcavendish@miami.edu.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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