# 25 Oct What’s the best treatment for children with dyscalculia?

Considering that academic achievement is highly valued in our society, we often compare the performance of our schoolchildren. On a personal level, because parents often invest a great deal of time, resources, and emotional energy to ensure their children’s academic success, it can be extremely upsetting when a child with no obvious intellectual deficits does not achieve as expected. That is the reason to ensue for the early academic disability evaluation, so these children are not to suffer the scars of many painful school-related episodes of failure.

Dyscalculia, also known as “math dyslexia,” includes learning disorders related to mathematics, such as difficulty with numbers, concepts, and reasoning. The term “dyscalculia” (from the Greek dys and Latin calculia) was used by Cohn (1968) to refer to a “failure to recognize numbers or manipulate them in an advanced culture,” and later by Kosc (1974), a Bratislavian, as “a disorder of the special abilities for mathematics without a simultaneous defect in general mental abilities.” People with dyscalculia may struggle to count money, read clocks and tell time, perform mental math calculations, identify number patterns, and apply mathematical formulae.

## Causes of Dyscalculia

Researchers do not yet know what causes developmental dyscalculia for sure. But as with other learning disabilities, a combination of genetics and environmental factors are thought to play a role, and are considered during academic disability evaluation. Experts continue to try to work out the differences between those whose problems with math stem from deficits in brain processing and those whose are related to factors such as poor instruction, poverty, or coexisting conditions.

- It is also possible, though rare, for someone to acquire dyscalculia as the result of a brain injury or stroke. This form of the disorder typically stems from damage to the parietal lobe of the brain and may be referred to as “acalculia.” A sign of dementia, may also be the sudden problems with math.
- Genetics- Dyscalculia, like other learning disabilities, is thought to be strongly influenced by genetics. Individuals with dyscalculia are significantly more likely than the general population to have family members with dyscalculia, research finds.
- Anxiety- Dyscalculia is sometimes called “math anxiety,” though the nickname isn’t quite accurate. Someone can feel persistently anxious at the thought of doing math but not have dyscalculia; on the other hand, for some individuals with diagnosable dyscalculia, anxiety may worsen the difficulties they experience. And regardless of dyscalculia, math anxiety can be serious and lead to long-term math avoidance; some research has found that for some people who struggle with math anxiety, the anticipation of having to do math activates the same centers in the brain that register visceral threats and physical pain.
- Poor math instruction- cannot cause brain-based developmental disorders such as dyscalculia, however, poor math instruction can lead some children to struggle with common math concepts or do worse in math than they otherwise would. Determining whether a child’s difficulties with math are due to dyscalculia or to another cause, including poor instruction, is a key component of an academic disability evaluation.

However, during academic disability evaluation it’s important to note that dyscalculia, along with other learning disabilities, should not be mistaken for learning problems that arise due to other factors such as:

- Visual, hearing, verbal, or motor handicaps
- Intellectual disability
- Emotional disturbances
- Economic, cultural, or environmental disadvantages

### Signs and the behaviour profile of children with Dyscalculia

The pattern of problems with arithmetic seen in such children will vary as a function of age. Children with arithmetic difficulties initially experience problems learning to count. Once the formal teaching of arithmetic begins, these children show delays in mastering addition and subtraction, and they may tend to rely on the “count-on” strategy when solving simple addition problems for longer than typically developing children (Geary, 2004). With more complex addition problems, children with mathematics disorder tend to guess more often and less accurately than their peers (Geary et al., 2004). Although they use the same strategies as age-matched controls, they differ in the speed and skill of strategy execution, can retrieve fewer number facts from memory, are poor at monitoring their counting, and poor at detecting computational errors (Geary, 2004).

One common sign that persists across the lifespan is the sole reliance on finger counting, that which children typically start to switch from to more efficient calculation strategies, such as retrieval of math facts from memory, by about age 8 or 9.

Other common features include:

- a poor sense of numbers in terms of their magnitude and relationship
- inaccurate counting and calculation
- failure to attend to key mathematical symbols (e.g., symbols for addition, subtraction, multiplication, division)
- difficulty with identifying the previous or next item in a sequence (e.g., difficulty identifying the name of previous or next day, month, or number, despite being able to rote list those items)
- difficulty understanding the concept and use of “zero” or decimal points; and “gets lost” in the middle of multidigit calculation and may switch procedures or apply them incorrectly (e.g., in the problem 57 – 38, may start to subtract 7 from 8 instead of 8 from 7, then either subtracts 3 from 5 without considering the trading procedure, or may switch to adding 5 and 3)
- Many struggle with understanding the “language” of mathematics, especially in word problems, that are emphasized in current curricula across all grade levels
- Word problems consist of two layers: A narrative about some event or sequence of events in the real world, and a latent web of mathematical relations typically expressed in words, and related by a question involving concepts of quantity such as “more,” “more than,” “less than,” “altogether”
- Moreover, older children, adolescents, and adults manifest difficulty understanding and using money, telling the time, using calculators, and remembering numerical PIN codes

- Math anxiety is another common feature that persists across the lifespan and it is to be considered during academic disability evaluation. Often described as “a feeling of tension, apprehension, or fear that interferes with math performance,” it may manifest as sweaty palms, a racing pulse, breaking out in a cold sweat, or choking feeling in the back of the throat, when required to perform mathematics in everyday life (e.g., answer math questions in class; complete math homework, counting out money to buy something, splitting a restaurant bill or calculating the tip, entering specific numbers for cash withdrawal or deposit at an ATM machine)

#### Criteria for Diagnosis

There are no biomarkers to date for SLD. Thus, SLD is a clinical diagnosis, which is best made by an experienced clinician, based on a comprehensive academic disability evaluation with careful clinical synthesis of information from multiple sources, including:

- developmental, medical, educational, and family history
- school reports; teacher observations, including response to classroom instruction and other intervention provided at school
- direct standardized psychometric assessment of the individual’s academic skills— including reading, spelling, written expression, and arithmetic (number sense, counting, algorithmic computation)

#### Treatment

Treatment focuses almost exclusively on academic intervention and rarely includes mental health services despite the fact that students with learning disabilities experience higher levels of inattention (and ADHD), anxiety, and depression than their peers without these disabilities. Moreover, treatment of SLD is typically carried out in education settings or specialized psychology clinics, and so is not the primary responsibility of psychiatrists or primary care providers.

The primary role of medical health care providers is that of coordinator, which, as a first step, includes the provision of psychoeducation about the disorder and its longer-term implications.

A second critical step is to establish a monitoring plan with the patient and family, to permit early detection and management of commonly associated mental health problems, such as ADHDs, anxiety, and depression, as well as to ascertain whether recommended accommodations have been put in place along with intensive, individualized, explicit instruction.