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Abstract

Background:

Executive functions (EFs) are a set of cognitive processes required to select and monitor behaviors that facilitate the achievement of desired goals. Many studies reported that students with learning disabilities appear to have impaired EFs and difficulties in performing school-related and daily activities.

Methods:

This review attempts to focus on identifying different components of executive functioning and its relationship with specific learning disabilities from the published literature. A search using 3 databases identified 37 relevant articles that met the inclusion criteria.

Results:

Many recent studies have found a relation between EFs with specific learning disabilities including meta-analysis and non-experimental comparative studies. Most of the studies were conducted among school children with reading, learning difficulties, and writing difficulties, university students with developmental dyscalculia and adults with or without dyslexia.

Conclusion:

Working memory is the key component affecting performances in children with learning disabilities whereas emotional control and metacognition skills such as organization of material, monitoring, planning, etc have a more specific role in different skills in performing the act of reading, writing, and mathematical operations. They may play a subdued role, but their involvement cannot be segregated because of the complex interplay between them.

Keywords

Attention executive function inhibition learning disability working memory

Introduction

The wide word that covers a range of learning difficulties is “specific learning disorder” (SLD). It is classified by the DSM V as a biologically based neurodevelopmental disorder that affects academic mastery and causes learning difficulties. Intellectual disabilities, developmental disorders, neurological conditions, or motor disorders are not to blame for these challenges. It is divided into three groups: Specific Learning Disabilities with Impairment in Mathematics, Specific Learning Disabilities with Impairment in Written Expressions, and Specific Learning Disabilities with Impairment in Reading. It is further defined according to severity. (mild, moderate, severe).¹

A broad range of cognitive, behavioral, and adaptive abilities known as executive functions (EFs) aid in the completion of novel tasks, self-reflection, and the creation of plans that are frequently based on prior experiences. These skills are crucial in complex social behaviors, suppressing inappropriate actions and focusing on purposeful information.^2–4 Success in school and daily life depends upon efficient EFs.⁵

These abilities fall under the categories of behavior management and metacognition.

Shift, emotional control, and inhibition are all aspects of behavior regulation. Initiation, Working Memory, Plan/organizing, Material Organization, and Monitoring are all components of metacognition.⁶ The central executive (supervisory system), the phonological loop, and the visuospatial sketchpad are the other two divisions of working memory (WM). WM is the capacity to simultaneously store and manipulate information needed to carry out mental tasks. The EF system and phonological storage (also known as the phonological loop) are 2 important parts. The former is focused on verbal and numerical information storage and rehearsal, whereas the recent is in charge of information integration and the coordination of cognitive processes like switching, inhibition, performances related to dual tasks, and updating. The visuospatial sketchpad caters to visuospatial data, whereas the phonological loop saves verbal content.⁷

The three established subdivisions within the domain of phonological processing—phonological awareness, phonological short-term and working memory (ST/WM), and phonological lexical access, that are often lacking in dyslexic individuals. The capacity to actively access and control sublexical phonological segments (phonemes and onsets/rimes) is known as phonological awareness. The lack of semantic memory is correlated with lexical access.⁸

Children with learning disabilities have shown difficulties with various aspects of EF involving inefficiency in cognitive flexibility, sorting, organizing, and prioritizing information as well as self-regulatory activities such as monitoring, checking, and revising when learning.⁹ The strong conceptual reasoning abilities of these children do not replicate their output and productivity because due to difficulties in prioritizing and organizing plenty of details, analyzing, and altering these details in WM; adjusting between abstract and concrete concepts as well as from major themes to the details.¹⁰ According to studies, these children’s disabilities include widespread WM deficiencies brought on by the executive system’s storage limitations. Additionally, there is no difference between the subtypes’ outcomes on tests of verbal and spatial WM.¹¹

Specific learning disabilities have been diagnosed and treated from an educational perspective aiming at molding the educational resources to fit the child’s needs. Formulating a treatment approach based on the identified problem and focusing on the components will yield more positive results.¹²

The number of studies evaluating EF, particularly WM, and its relationship with academic success has increased significantly. However, there is a gap in the literature that summarizes various components of EFs for their potential involvement in different types of learning disabilities. This literature review’s objective was to ascertain the connection between specific learning disabilities and various EF components. This study also provides guidance for various educational professionals to fully comprehend the impact of these interactions on the performances of students with various learning difficulties or impairments in academic and daily activities.

Method

Search Strategy

A broad search was undertaken to identify relevant studies for this review. Databases and sites searched included PubMed, CINAHL, ERIC, and EBSCOhost. Search terms were developed by the authors based which included specific learning disabilities, learn, reading, read, write, writing, mathematics, dyslexia, dyscalculia, dysgraphia, EF, metacognition, WM, initiation, planning, organization, monitoring, inhibition, shift, attention, and emotional control (Figure 1).

Figure 1.

Source: Page et al. (2021).⁴⁷

Study Selection

The participants in the study were mainly young adults and children with diagnosed learning disabilities. Peer-reviewed journals were included if they were: published between 1993 and 2018, written in English, involving human participants, and were assessed for deficits in EFs specific to any types of learning disabilities. Quantitative studies encompassing assessment and treatment were included. Papers were excluded if the participants had any other comorbidities associated with learning disabilities. Some of the internet search engines such as Google Scholar were used to identify grey literature. Hand search strategies were also used to find some articles.

Data Extraction

The authors looked through each study’s title, abstract, and full text for any possible relevant studies that met the requirements for inclusion. The title, author(s), year of publication, aim, study population, method, assessment tools, and study types were charted. Disagreements on study selection and data extraction were done by consensus and discussions.

Results

On searching the literature, 1312 articles matched the search word criteria. 853 articles were examined as relevant after duplication. Finally, 57 articles were found to be related to this study. 37 articles appeared to have relevance and were included in the study based on inclusion criteria.

Table 2 presents a summary of the 34 articles reviewed and included: (a) title (b) authors/year (c) population/sample size (d) paper type/study design (e) aim (f) assessment tools and (g) research outcome.

Table 1.

The table represents the components of executive dysfunction in relation to specific learning disabilities.

Types of Specific Learning Disabilities		SLD with Reading Difficulties	SLD with Writing Difficulties	SLD with Mathematics Difficulties	Reading and Mathematical Deficits
Executive Dysfunction		SLD with Reading Difficulties	SLD with Writing Difficulties	SLD with Mathematics Difficulties	Reading and Mathematical Deficits
Metacognition
1	Working memory	Word recognition PR<RD<CD<SR	Not reported	Visuospatial processes for single-digit arithmetic, judging magnitude, and writing numbers, partial calculation, carrying errors, and column confusion.	Combination of problems pertaining to reading and dyscalculia separately.
1	Working memory	numerical WM deficit RDMD > MD > RD > TD Verbal WM deficit RDMD > MD = RD > TD complex reading span TD > RD = RDMD complex computation span TD = RD > RDMD
	Central executive	Memory tests	Mean pressure	Numerical stimuli and/or processing. Addition	Combination of problems pertaining to reading and dyscalculia separately.
	Phonological loop	General reading	Number writing	Multiplication	Verbal and numerical tasks
	Phonological loop	Phonological storage Word span TD = MD > MDRD Number span TD > MD = MDRD
	Visual spatial sketchpad	Word recognition	Broken & misaligned letters, or inconsistent letter spacing	Number Writing, Magnitude	Number Writing, Magnitude Word recognition
3	Plan/Organize	Comprehension	A longer amount of time is required to prepare and execute subsequent letters when there is pressure applied to the paper and/or a higher pen stroke height.	Further overwritten, erasable, and unrecognizably altered letters	Combination of problems pertaining to reading and dyscalculia separately.
4	Organization of material	Not reported	Overwriting/ Unrecognizable Letters Spatial Arrangement	Not reported	Not reported
5	Monitoring	Not reported	Pen strokes Mean pressure	Not reported	Not reported
Behavior regulation
6	Inhibition	Word recognition	Mean pressure pen stroke height	deficits in both verbal and numerical dual-tasking and numerical information	Combination of problems pertaining to reading and dyscalculia separately.
6	Inhibition	Word inhibition and number inhibition TD > RD = RDMD, RD < SR, RD = PR = CD Word inhibition (s). TD = MD > MDRD Number inhibition (s) TD > MD = MDRD
7	Shifting	Reading ability	Copying	Copying Calculations	Combination of problems pertaining to reading and dyscalculia separately.
8	Emotional control	Not reported	Mean pressure Applied pressure	Not reported	Not reported
Components of specific learning disabilities and executive dysfunction associated with performance

Table 2.

Descriptions of the Included Studies in the Present Review.

Sr. No	Title	Authors/Year	Population/Sample Size	Paper Type/Study Design	Aim	Assessment Tools	Research Outcome
1.	Executive functions in adults with developmental dyslexia	James H. Smith- Sparka, Lucy A. Henryb, David J. Messerc, Elisa Edvardsdottira, Adam P. Zi˛ecik (2016)	60 IQ-matched adults with and without dyslexia.	Non-Experimental Comparative Study	The study addressed the subjective experience of adults with dyslexia (regarding their EF- Executive Functions)	BRIEF-A; Roth, Isquith, & Gioia, 2005)	The group with dyslexia (mean = 78.13, SD = 14.17) indicated more frequent problems on the Metacognition Index than the group without dyslexia. Whilst the group with dyslexia (mean = 52.10, SD = 8.81) scored slightly higher on the Behavioral Regulation Index than the group without dyslexia (mean = 48.77, SD = 10.70), this difference was not statistically significant, F(1, 60) = 1.78, MSE = 96.002, P = .187. Group with dyslexia scored significantly lower than the group without dyslexia on three of the nine BRIEF-A clinical scales (Working Memory, Plan/Organize, and Task Monitor; all P values ≤ .004).
2.	Working memory deficits in children with reading difficulties: Memory span and dual-task coordination	Shinmin Wang A, B, Susan E. Gathercole C(2013)	45 typically developing children matched for age and nonverbal ability to 46 children with single word reading difficulties.	Non-Experimental Comparative Study	The study investigated the cause of the reported problems in working memory in children with reading difficulties	Verbal and visuospatial simple and complex span tasks, and digit span and reaction times tasks performed singly and in combination.	Children with reading difficulties scored significantly less than typical readers on all memory measures: verbal short-term memory, F(1,89) = 10.12, P = .002, verbal working memory, F(1,89) = 11.34, P = .001, visuospatial short-term memory, F(1,89) = 8.12, P = .005, and visuospatial working memory, F(1,89) = 9.01, P = .003. Typical readers had significant greater digit span than children with reading difficulties, F(1,89)= 12.82, P = .001
3.	A Subgroup Analysis of Working Memory in Children with Reading Disabilities: Domain-General or Domain-Specific Deficiency?	H. Lee Swanson and Carole Sachse-Lee (2001)	20 high executive processing (high listening span) children without RD, 20 children with RD and low executive processing (low listening span), 16 children with RD and 20 without RD matched on executive processing (moderate listening span).	Non-Experimental Comparative Study	The study explored whether changes in working memory (WM) of children with reading disabilities (RD) were related to a domain-specific or a domain-general system.	Subgroups were compared on phonological visual-spatial, and semantic. WM tasks across initial (no probes or cues), gain (cues that bring performance to an asymptotic level), and maintenance conditions (asymptotic conditions without cues).	In Responsiveness to Cues MANOVA for the subgroup effect on the number of probes for the tasks was significant, F(9,170) = 2.63, P < .05. in Sentence Span Measures test showed that the CAHigh subgroup significantly (P < .05) outperformed the other subgroups (RD-Severe < RD-Moderate = CAModerate < CA-High).
4.	Working Memory, Short-Term Memory, and Reading Disabilities. A Selective Meta-Analysis of the Literature	H. Lee Swanson Xinhua Zheng (2009)		Meta-analysis	The study was done to synthesize research that compares children with and without reading disabilities (RD) on measures of short-term memory (STM) and working memory (WM).		Across a broad age, reading, and IQ range, 578 effect sizes (ESs) were computed, yielding a mean ES across studies of –.89 (SD = 1.03). A total of 257 ESs were in the moderate range for STM measures (M = –.61, 95% confidence range of –.65 to –.58), and 320 ESs were in the moder-ate range for WM measures (M = –.67, 95% confidence range of –.68 to –.64). The results indicated that
5.	Deficits in working memory in young adults with reading disabilities	Ravit Cohen- Mimran, Shimon Sapir (2007)	32 native Hebrew-speaking young adults with and without RD	Non-Experimental Comparative Study	The study examined the extent to which reading disabilities (RD) in young adults are related to deficits in specific aspects of temporary storage of verbal information- memory span and the central executive (CE) component of working memory	Digit Span Forward and Backward tests and a new version of the Token Test (TT)	Mean digit span scores were significantly poorer in the RD group compared to that of the control group on both the DSF (t(30) = 3.47, P < .01) and the DSB (t(30) = 2.49, P < .05) tests. For the WMTT scores RD group had poorer scores (F(1,30) = 11.76, P < .01) compared to the control group. Significant main effect of level of storage (F(1,30) = 37.41, P < .001) and level of CE (F(1,32) = 6.47, P < .02) were also indicated
6.	A Meta-Analysis of Working Memory Deficits in Children With Learning Difficulties: Is There a Difference Between Verbal Domain and Numerical Domain?	Peng Peng, and Douglas Fuchs (2014)	29 studies	Meta-analysis	The study synthesized research on verbal WM and numerical WM among children with reading difficulties (RD), children with mathematics difficulties (MD), and children with reading and mathematics difficulties (RDMD).		In numerical working memory the mean effect size was medium and significant (Hedges’s g = −0.42, 95% CI [–0.64, –0.20], P = .001),. RDMD children demonstrated a significantly greater numerical WM deficit than RD children (t = 2.30, P = .036) and MD children (t = 4.77, P < .001). MD children also showed a marginally significantly greater numerical WM deficit than RD children (t = 2.12, P = .05).
7.	Specific Impairment in Developmental Reading Disabilities: A Working Memory Approach	Michelle Y. Kibby, William Marks, Sam Morgan, and Charles J. Long (2004)	20 children with RD and 20 typical readers between the ages of 9 and 13.	Non-Experimental Comparative Study	The study assessed Baddeley’s working memory model as a whole rather than focusing on particular aspects	The phonological loop, visual-spatial sketchpad, and central executive were assessed according to Baddeley’s model.	Verbal working memory, F(1, 38) = 12.61, P = .001, for group membership; F(2, 76) = 282.71, P < .001, for list length; F(2, 76) = 23.39, P < .001, for central executive (CE) load; F(1, 38) = 80.37, P < .001, for word length; and F(1, 38) = 20.45, P < .001, for phonemic similarity. Visual working memory F(2, 74) = 291.87, P < .001, for list length, and F(2, 74) = 104.21, P < .001, for CE load.
8.	Dyslexia and dyscalculia: Two learning disorders with different cognitive profiles	Karin Landerl a,*, Barbara Fussenegger b, Kristina Moll b, Edith Willburger (2009)	Four groups of 8- to 10-year-olds (42 controls, 21 Dyslexic, 20 Dyscalculic, And 26 Dyslexic/Dyscalculic).	Non-Experimental Comparative Study	The study tests the hypothesis that dyslexia and dyscalculia are associated with two largely independent cognitive deficits, namely a phonological deficit in the case of dyslexia and a deficit in the number module in the case of dyscalculia	The Phonological awareness, phonological and visual-spatial short-term and working memory, naming speed, and basic number processing skills were assessed	In Phonological awareness and lexical access both dyslexia groups (dyslexia only and dyslexia/dyscalculia) performed at a significantly lower level than both groups with age-adequate reading levels (control and dyscalculia only) (all ps < .01) dyslexia/dyscalculia group named fewer items than the control and dyscalculia-only groups (ps 6 .001). Short-term and working memory significant differences between the dyslexia/dyscalculia group, on the one hand, and the dyslexia-only and control groups, on the other (ps ≤ .01) and in Symbolic magnitude comparison the dyscalculia-only group performed significantly worse than the control group (P = .007) and the dyslexia-only group (P = .021).
9.	Working Memory Deficits in Children With Specific Learning Disorders	Kirsten Schuchardt, Claudia Maehler (2008)	17 Dyscalculic 30 Dyslexics 20 Dyslexic/Dyscalculic). 30 Control	Non-Experimental Comparative Study	The study investigated the functioning of the three subcomponents of working memory in children with learning disorders	The three subcomponents of working memory described by Baddeley: phonological loop, visual-spatial sketchpad, and central executive were assessed.	In phonological loop multivariate main effect for dyslexia, F(7, 85) = 6.91, ç² = .36, p < .001. Visual–Spatial Sketchpad. The multivariate main effect for dyscalculia, F(5, 87) = 4.31, η² = .20, P < .01. For Central executive the multivariate main effect for dyslexia, F(4, 88) = 5.79, ç² = .208, p < .000
10.	Executive functions in developmental dyslexia	Pamela Varvara, Cristiana Varuzza, Anna C.P.Sorrentino, Stefano Vicari and Deny Menghini (2014)	60 children with DD and 65 with typical reading abilities	Non-Experimental Comparative Study	The study aimed to simultaneously test different EF domains in the same group of children with DD using numerous tasks.	A neuropsychological battery tapping verbal fluency, spoonerism, attention, verbal shifting, short-term and working memory	DD children obtained significantly lower scores(p always ≤ 0.005) than TR children in phonological and categorical fluency, spoonerism abilities, visual-spatial and auditory attention, verbal and visual short-term memory, and verbal WM
11.	Inhibition and Updating, but Not Switching, Predict Developmental Dyslexia and Individual Variation in Reading Ability	Caoilainn Doyle, Alan F. Smeaton, Richard A. P. Roche and Lorraine Boran (2018)	27 children with dyslexia and 29 age-matched controls	Non-Experimental Comparative Study	The study aims to establish the core executive function profile (strengths/ impairments in inhibition, updating, and switching) associated with dyslexia and determine which core executive functions are predictive of dyslexia	Coding Task (Wechsler, 2003) Stroop Task Picture Go No-Go Task Phoneme Go No-Go Task Sustained Attention To Response Task (SART) Letter 2-Back Task Picture 2-Back Task Phoneme Switch Task Switching Composite Number-Letter Switch Task Wide Range Achievement Test 4 Phoneme 2-back task	Inhibition: composite tasks [F(1, 53) = 13.85, P = 0.000, Cohen’s d = 1.01; Updating: composite level, dyslexia is characterized by a significantly higher updating z-mean error score than control participants [F(1, 54) = 19.14, P = 0.004, Cohen’s d = 0.86, Switching: composite level, dyslexia is characterized by a significantly lower switching zmean reaction time cost score than control participants [F(1, 54) = 5.03, P = 0.029, Cohen’s d = −0.60].
12.	The deficit profile of working memory, inhibition, and updating in Chinese children with reading difficulties	Peng Peng, Tao Sha, Li Beilei (2013)	22 children with reading difficulties (RD), 24 children with reading and mathematics difficulties (RDMD), and 31 typically developing peers (TD).	Non-Experimental Comparative Study	The study investigated executive function deficits among Chinese children with reading difficulties	Complex reading span Complex computation span Word inhibition Number inhibition Word updating Number updating Character coding speed Number coding speed Rapid character naming Rapid number naming	Working memory: TD and RD groups scored significantly higher than the RDMD group (P = 0 &.02, respectively), and no significant difference was found between the TD and RD groups (P = .24). Inhibition: TD group performed significantly better than the RD and RDMD groups (P = .02 &.01, respectively), and there was no significant difference between the RD and RDMD groups (P = 1.00). Updating: There was no significant difference between the TD and RD groups (p = 1.00), and they both performed better than the RDMD group (P = 0 & .02, respectively).
13.	Poor Stroop performances in 15-year-old dyslexic teenagers	Zoï Kapoula · Thanh-Thuan Lê · Audrey Bonnet · Pauline Bourtoire · Emilie Demule · Caroline Fauvel · Catherine Quilicci · Qing Yang (2010)	.10 dyslexics teenagers and 14 controls	Non-Experimental Comparative Study	The study aims to test Stroop performances of older dyslexic versus non-dyslexic teenagers using a four-card version of the test and to examine and explored the effect of bilateral eye movements for older teenagers on the interference subtest.	Stroop with four color cards	Between group errors: dyslexics > non dyslexics P < 0.019 Between tasks errors; Reading < color < interference post saccades < flexibility < interference
14.	Shifting ability predicts math and reading performance in children: A meta-analytical study	Nihal Yeniad, Maike Malda, Judi Mesman, Marinus H. van IJzendoorn, Suzanne Pieper (2013)		2 meta- analysis	Children’s shifting ability is examined with their performance in math and reading.		Combined effect size for the relation between shifting and math was substantial and significant (r = .26, 95% CI = .15–.35, pb.01) intelligence and math: significant and large combined effect size (r = .47, 85% CI = .41–.52) in a heterogeneous set of studies (Q = 40.86, pb.01). intelligence and reading: significant and large combined effect size (r = .43, 85% CI = .37–.49, pb.01) in a heterogeneous set of studies (Q = 46.27, pb.01). combined effect size intelligence and shifting was significant and substantial (r = .30, 85% CI = .18–.41, pb.01)
15.	Pinpointing the Deficit in Executive Functions in Adolescents With Dyslexia Performing the Wisconsin Card Sorting Test: An ERP Study	Tzipi Horowitz- Kraus (2014)	27 individuals with dyslexia and aged-matched 30 skilled readers	Non-Experimental Comparative Study	The study examined the performance of adolescents with dyslexia and their age-matched skilled readers in a computerized WCST	Computerized-WCST (named the ‘Madrid- Card Sorting Test’	Error rate. A significant main effect of type of trial, F(6, 47) = 101.468, P < .001, η2 = .928, Reaction time: Results revealed a trend of longer RT for individuals with dyslexia than for skilled readers, F(1, 53) = 3.488, P = .06, η2 = .062.
16.	Do Different Components of Working Memory Underlie Different Subgroups of Reading Disabilities?	H. Lee Swanson, Crystal B. Howard, and Leilani Sáez (2006)	4 ability groups 19 children with RD in both word recognition and comprehension. 14 with comprehension deficits (CD) only; 18 children with low verbal IQ, word recognition, and comprehension (PR) 15 skilled readers (SR)	Non-Experimental Comparative Study	The purpose of this study was to determine the components of working memory (WM) that underlie less skilled readers’ comprehension and word recognition difficulties.	WRAT-3. GORT-3 WRMT-R Comprehensive Test of Phonological Processing (CTOPP; WISC-III. TOWRE RCPM	Working memory: PR < RD < CD < SR Short term memory: RD = PR < CD = SR Phonological: PR < RD < CD = SR Processing speed: PR = RD > CD > SR Inhibition: RD < SR, RD = PR = CD
17.	Inter-relationships between objective handwriting features and executive control among children with developmental dysgraphia.	Sara Rosenblum (2018)	64 children, 32 with dysgraphia, and 32 matched controls.	Non-Experimental Comparative Study	The study aimed to describe handwriting and executive control features and their inter-relationships among children with developmental dysgraphia	Computerized Penmanship Evaluation Tool (ComPET). Hebrew Handwriting Evaluation (HHE). the Behavior Rating Inventory of Executive Function (BRIEF) parent form	Between group HPSQ mean final score (TD: 1.03 ± 1.79; dysgraphic: 21.21 ± 2.90 t(62) = 33.58 P <.0001). BRIEF domains (F(8,55) = 26.28; P <.0001 η2 P = .79).
18.	Computerized Temporal Handwriting Characteristics of Proficient and Non-Proficient Handwriters	Sara Rosenblum, Shula Parush, Patrice L. Weiss (2003)	50 non-proficient handwriters and 50 proficient handwriters	Non-Experimental Comparative Study	The study used computerized temporal measures to examine and compare the writing process of proficient and non-proficient third-grade handwriters.	Computerized Digitizer System	Non-proficient handwriters required significantly more time to perform handwriting tasks [F(4,91) = 14.83, P < .0001]; their “in air” time, was especially longer as compared to the proficient handwriters [F(4,91) = 13.63, P < .0001]. Their handwriting speed was slower [F(4,91) = 5.99, P < .0002], and they wrote fewer characters per minute (F(4,91) = 14.63, P < .0001).
19.	Automatic segmentation as a tool for examining the handwriting process of children with dysgraphic and proficient handwriting	Sara Rosenblum a,, Assaf Y. Dvorkin, Patrice L. Weiss (2006)	14 children with proficient and 14 with poor handwriting.	Non-Experimental Comparative Study	The purpose of this study was to collect handwriting samples typical of those written by the child in his or her natural environment, to analyze these samples with novel segmentation algorithms, and to present them visually in ways that illuminate spatial and temporal dynamic features amongst children with dysgraphic and proficient handwriting.	An X–Y Digitizer POET software (Penmanship Objective Evaluation Tool),	Significant differences between the dysgraphic and proficient handwriting groups were found for the number of raw segments (i.e., the number of segments before the combination process) (t(26)D2.62, pD.01); the number of ‘direction reversal’ segments (t(26)D2.51, pD.01); the number of letters for the Wrst minute (t(26)D3.42, p < .001); and the number of letters per minute for the whole paragraph (t(26)D3.6, p < .001).
20.	Relationships between handwriting performance and organizational abilities among children with and without dysgraphia: A preliminary study	Sara Rosenblum, Tsipi Aloni, Naomi Josman (2010)	58 Male children, 30 with dysgraphia and 28 with proficient handwriting	Non-Experimental Comparative Study	The study explored the relationship between handwriting performance and organizational ability in school-aged children	Handwriting Proficiency Screening Questionnaire (HPSQ). Hebrew Handwriting Evaluation (HHE), Questionnaire for Assessing Students’ Organizational Abilities- for Parents (QASOA-P)	Between groups HHE: (F(5,52) = 6.60, P < .001 ES-h2 = .34). (QASOA-P): t(52) = 6.39, P < .001)
21.	Spatial Working Memory and Arithmetic Deficits in Children With Nonverbal Learning Difficulties	Irene Cristina Mammarella1, Daniela Lucangeli, and Cesare Cornoldi (2010)	Children with nonverbal learning difficulties (N = 21), Children without learning disabilities (N = 21).	Non-Experimental Comparative Study	Visuospatial working memory and its involvement in arithmetic were examined	Nine Computerized Tests, included in a VSWM test battery (I. C. Mammarella, Toso, Pazzaglia, & Cornoldi, 2008).	The two groups were found to differ on some spatial tasks but not in the visual working memory tasks. On the arithmetic tasks, the children with nonverbal learning difficulties made more errors than controls in calculation and were slower in number order. A discriminant function analysis confirmed the crucial role of spatial-sequential working memory in distinguishing between the two groups.
22.	Number magnitude processing and basic cognitive functions in children with mathematical learning disabilities	Ulf Andersson, Rickard Östergren (2012)	63 children (20 with Mathematical Learning Disability (MLD) and 43 in control group	Non-Experimental Comparative Study	The study aimed to extend knowledge regarding the origin of MLD in children by testing and contrasting different hypotheses in the same sample of children with MLD,	Working memory tasks Naming of one-digit numbers Naming of two-digit numbers Number magnitude comparison Dot magnitude discrimination Subitizing Enumeration Number line estimation task	MLD group, significant correlations, ranging from r = −.56, pb.05, to r = −.68, pb.05, and r = .76, pb.05, to r = .77, pb.05, in size, were obtained among the subitizing measure, the number line estimation task (R2) and the number naming tasks.
23.	Exploring working memory in children with low arithmetical achievement	Antonella D’Amicoa, T, Maria Guarnerab (2005)	25 children with low arithmetical achievement and 25 controls.	Non-Experimental Comparative Study	The study aimed at exploring the working memory functions in children with low arithmetical achievement and normal reading, compared to age- matched controls	Series of working memory tasks, involving the central executive functions (using both linguistic and numerical material), the phonological loop (using words, pseudo-words, and digits), and the visual sketchpad (using both static visual-spatial patterns and visual- spatial sequences).	The children with poor arithmetical skills obtained lower scores in the Listening Span task, t(26 )= _3.28, pb0.005, and in the Digit Span Backward, t(26) = _3.04, pb0.005, and took longer than the controls to complete the Making Verbal Trails, t(26) = 2.19, pb0.05, and the Making Color Trails, t(26) = 1.99, pb0.05
24.	Working memory deficits in children with low achievements in the national curriculum at 7 years of age	Susan E. Gathercole, and Susan J. Pickering (2000)	Eighty-three children aged 6 and 7 years	Descriptive Study	The study aimed to investigate whether working memory abilities are also associated with attainment levels in the national curriculum assessments at 7 years of age.	Working Memory Battery Phonological Loop Assessment Tasks Central Executive Assessment Tasks	Significant achievement group effects were found in the MANOVAs performed on the central executive measures, F(3,79) = 8.97, P < .001, and on the visuo-spatial memory scores, F(4,77) = 8.09, P < .001,
25.	Identifying Simple Numerical Stimuli: Processing InefficienciesExhibited by Arithmetic Learning Disabled Children	Kristine L. Koontz (1996)	32 children 16 with arithmetic learning disabilities (ALD) and 16 normally achieving (NA) controls	Non-Experimental Comparative Study	To examine if ALD children exhibit several processing inefficiencies with even very simple numerical stimuli,	A battery of computerized tasks, including numerical and letter matching, naming latency, and memory span.	The group main effect was marginally significant, F(1, 30) = 3.31, 0.05 < P < 0.10, suggesting that the ALD children were somewhat less accurate overall when making name identity judgements for letter stimuli as well as numerical stimuli. ALD children exhibited smaller digit spans than their NA peers, t(15) = 2.76, P < 0.05 and significantly smaller letter spans as well, t(15) = 3.47, P < 0.01.
26.	Executive Functioning and Mathematics Achievement	Rebecca Bull and Kerry Lee (2014)	NA	Descriptive study	NA	NA	The review of findings from studies that have taken different approaches to measure EF (e.g., using single versus multiple indicators), and which apply different analytical techniques to conceptualize EF structure (e.g., exploratory versus confirmatory techniques) was done. The consistent finding that emerges despite these differences is that updating is a significant, often unique, predictor of math achievement across a wide age range, whilst the findings relating to inhibition and switching are less conclusive.
27.	Working Memory Impairments in Children with Specific Arithmetic Learning Difficulties	Janet F. McLean and Graham J. Hitch (1999)	12 children with difficulties specific to arithmetic, 12 age-matched and 12 ability-matched controls.	Non-Experimental Comparative Study	Aim was to gain a more complete picture of working memory deficits in children with specific arithmetic difficulties and to consider whether working memory deficits are responsible for children’s difficulties in arithmetic	Working memory battery	Poor Arithmetic group were significantly impaired on the Missing Item task, F(1, 33) 5 9.17, partial (h2) 5 .22, but not on any of the other tasks.
28.	Developmental dyscalculia is related to visuospatial memory and inhibition impairment5	Denes Szucs, Amy Devine, Fruzsina Soltesz, Alison Nobesand Florence Gabriel (2013)	12 participants in both the DD and the Control group (DD: four girls; Control: seven girls)	Non-Experimental Comparative Study	Contrast between five alternative theories (magnitude representation, working memory, inhibition, attention and spatial processing) of developmental dyscalculia was done	Automated Working Memory Assessment Sustained attention: Stop-signal task: Symbolic magnitude comparison: Non-symbolic magnitude comparison Animal Stroop: Numerical magnitude comparison Stroop task: Physical size comparison Stroop task: Subitizing	The regression had a significant fit [R2 ¼ .583, F(20,3) ¼ 9.30, P < .0001]. Visuo-spatial WM [Standardized Beta (b) ¼ .48, t(20) ¼ 3.2, p ¼ .0045] was a significant predictor and Inhibition [b ¼ .36, t(20) ¼ 2.06, p ¼ .0522] was a marginally significant predictor. Subitizing slope was a non-significant predictor [b ¼ _.17, t(20) ¼ _1.02, p ¼ .31].
29.	Different components of working memory have different relationships with different mathematical skills.	Simmons F, Willis C, Adams A. (2012)	90 typically developing children (41 in Year 1 (5–6 years of age) and 49 in Year 3 (7–8 years of age).	Non-Experimental Comparative Study	To investigate whether different mathematical skills have different relationships with different working memory components	Automated Working Memory Assessment (AWMA) Word Recognition and Phonic Skills Test–second edition British Picture Vocabulary Scale– second edition (BPVS II) Arithmetic, symbolic magnitude judgment, and number writing	Working memory explained statistically significant variance in number writing, magnitude judgment, and single-digit arithmetic, but the different components of working memory had different relationships with the different skills. Visual-spatial sketchpad (VSSP) functioning predicted unique variance in magnitude judgments and number writing. Central executive functioning explained unique variance in the addition accuracy of Year 1 children. The results are consistent with the VSSP having a role in the development of number writing and magnitude judgments but a lesser role in early arithmetic.
30.	Working memory deficits in Math learning difficulties: a meta-analysis	Carmen V David (2012)	18 studies	Meta-analysis	Quantitative synthesis of the literature comparing children with Math learning difficulties to average-achieving, age-matched children on measures of working memory in view of Baddeley and Hitch’s multicomponent working memory model were analyzed.		One mean effect size was situated in Cohen’s large effect range (D521.29), for comparisons on CE component measures of numerical nature. A moderate effect size was obtained for comparison on PL numerical measures (D520.52). The effect size for CE nonnumerical measures is situated in the moderate range (D520.56). Corrected mean effect size for PL non-numerical is situated in the weak-to-moderate range (D520.43).
31.	Working Memory in Children With Reading Disabilities and/or Mathematical Disabilities	Frauke De Weerdt, Annemie Desoete, Herbert Roeyers (2012)	Elementary school children with reading disabilities (RD; n = 17), mathematical disabilities (MD; n = 22), or combined reading and mathematical disabilities (RD+MD; n = 28) were compared to average achieving (AA; n = 45) peers	Non-Experimental Comparative Study	The study explored differences and com-monalities in working memory performance between AA children and children with RD, MD, and RD+MD. It also investigated which working memory tasks best predict learning disabilities.	IQ, mathematics, reading, and spelling measures. Dutch Wechsler Intelligence Scale for Children–III Tempo Test Rekenen Kortrijkse Rekentest Revisie the Eén-Minuut-Test the Klepel Paedological Institute–Dictation Paedological Institute–Dictation	Children without RD performed bet-ter than children with RD on digit recall (P < .001), block recall (P = .002), backward digit recall (P < .001), backward word list recall (P = .002), backward block recall (P = .017), listening recall (P = .046), and spatial span (P = .046 MD were lower than span scores of children without MD on digit recall (P = .002), backward digit recall (P = .006), backward word list recall (P = .006), listening recall (P = .030), and spatial span (P = .031). There were no significant effects of word list recall (P = .344), block recall (P = .148), and backward block recall (P = .153).
32	Phonological storage and executive function deficits in children with mathematics difficulties	Peng Peng, Sun Congying, Li Beilei, Tao Sha (2012)	68 children, 18 with only mathematics difficulties (MD), 20 with mathematics and reading difficulties (MDRD), and 30 typically developing (TD) peers	Non-Experimental Comparative Study	The study investigated the deficit profile of phonological storage and executive functions in working memory among children with mathematics difficulties.	Measures for phonological storage, dual-task performance, inhibition, and updating of verbal and numerical materials	Group differences phonological storage: significant medium group main effect, Wilks’s k = .66, F(4,128) = 2.84, P < .001, g2 = .23. Executive functions: significant large group main effect, Wilks’s k = .33, F(12,120) = 7.42, P < .001, g2 = .79
33.	The Inhibition Capacities of Children with Mathematical Disabilities	Sandrine Censabell,Marie-Pascale Noël (2008)	40 children (20 with mathematics deficits, 20 control)	Non-Experimental Comparative Study	The present study aimed to test all three inhibition functions in one single sample of children with MD.	Color-Word Stroop Test Flanker Task. Listening Span.	Compared to typically achieving children, children with MD had significantly lower arithmetic skills, t(38) = 16.03, P < .0001, but equivalent fluency scores, t(38) = 0.73, p > .4, reading skills, t(38) = −0.23, p > .8, and estimated IQs, t(38) = 1.04, p > .3. For inhibition no significant group difference, t(38) = −0.01, p > .9, M = 30.13% for children with MD and 30.12% for control children, effect size d = 0.001.
34.	Attentional networks in developmental dyscalculia	Sarit Askenazi, Avishai Henik (2010)	14 university students with developmental dyscalculia–and 14 matched controls	Non-Experimental Comparative Study	The study examined attention abilities of participants suffering from developmental dyscalculia	Preliminary tests to measure mathematical abilities, reading, attention, and intelligence. ANT-I test	Responses were faster in congruent trials (mean RT = 566 ms) than in incongruent trials (mean RT = 656 ms) [F(1, 26) = 189.4, MSE = 3,593, P < 0.001]; in trials with a tone (mean RT = 597 ms) than trials with no tone (mean RT = 624.7 ms) [F(1, 26) = 55.6, MSE = 1,132, P < 0.01]

The results were organized and categorized based on the connection between executive dysfunction and specific learning disabilities. Certain elements of EF are found to be common in all subtypes but there is variation in the intensity of an effect in each learning disability.

Discussion

Metacognition underlies all types of learning disabilities. Impairments in metacognition skills (such as initiation, monitoring, etc) are more related to reading disabilities with emotional control having a lesser impact. In specific writing disability central executive (CE), monitoring and organization of materials tend to play a more important role. All components of WM and emotional control predominate in mathematical operations.

Specific Learning Disabilities With Impairment in Reading

While there was no evidence of executive functioning issues in reading-disabled children, it was observed that they were slower at naming letters in activities without executive demands.¹³ Nevertheless, there was a minor but substantial correlation between reading and spelling skills and EF. Word and non-word reading deficits are better explained by Spoonerism abilities.¹⁴

During specialist remediation, improvement in reading and spelling abilities could not be established with EF.¹⁵ In another study, adult individuals with dyslexia reported EF issues more frequently, with difficulties focusing on metacognitive functions (WM, planning, task monitoring, and organization) rather than emotional regulation. EF issues were discovered to persist into adulthood across a variety of assessments and to extend beyond issues solely with phonological processing.¹

These children exhibited pervasive deficits in both simple and complex span tasks and have poorer abilities in coordinating two cognitively demanding tasks. Problems with WM frequently indicate a CE deficit, and they persisted long after the applicable short-term memory (STM) domain was under control.¹⁶ Children with RD may have poor WM in part due to their domain-general system, and this system is independent of their reading difficulties.¹⁷ Domain-specific WM variation between ability groups persisted across age.¹⁸ They performed poorly on the memory tests, particularly on CE-taxing tasks, supporting the overall WM deficit hypothesis and indicating that people with RD have both memory span and CE deficits.¹⁹

The phonological store appears to have a deficit in terms of the phonological loop (PL), which is definite. Additional research supports the relationship between PL activity and phonological processing. Deficits in phonological are also seen in children with RD. Deficits in phonological ST/WM have additionally been noted in children with dyslexia.^{8, 20} Yet, the effect is no longer substantial when the PL’s performance on the CE is controlled.²¹

The visual-spatial sketchpad (VSSP) is intact in RD,²⁰ and to some degree, auditory and visual-spatial attention also played a role in the increased percentage of variation associated with reading disability.¹⁴

The verbal deficit paradigm underlies RD, however, is ineffective at utilizing both the phonological and executive systems.¹⁹ Several EF domains, including verbal categorical and phonological fluency, visual-spatial and auditory attention, spoonerism, verbal and visual STM, and verbal WM, have also been linked to impairments.¹⁴

Domain-specific STM differences persist across ages between ability groups.¹⁹

Inhibition and updating, rather than switching, play a significant role in the prediction of developmental dyslexia and individual difference in reading ability.⁸ Deficits are exhibited also in verbal WM, inhibition, and processing speed.²¹ For the oral language system, inhibition associated with focused attention predicted outcomes.¹⁴ The inhibitory and attentional processes necessary for the Stroop test were dysfunctional in adults with dyslexia. Yet, the study provides no evidence for any specific flexibility task difficulty, which would be inconsistent with issues with mental switching.²²

Shifting was found to be significantly and equally associated with reading performance²³; however, increased rate of errors and slow response times were exhibited in studies of adolescents with dyslexia. In dyslexic individuals, the disparities between the groups in the “shift” compared to the “stay” conditions demonstrated the critical role of WM in fundamental (like shifting) and higher-order (like reading) processes and implied an intact shifting mechanism and WM deficits.¹⁴

A hierarchical regression analysis revealed subgroup differences in a study comparing three subgroups of RD: poor readers (those with low verbal IQ, word recognition and comprehension deficits), reading disabilities (word recognition and comprehension deficits), and comprehension deficit only. A storage system that was not phonological skills-specific moderated WM tasks in less-skilled readers, and STM and updating significantly increased WM above and beyond the contribution made by reading group classification, indicating that between more- and less-skilled readers, certain variations in storage and executive processing arose that were not related to reading.²⁴

Children with word recognition deficit (WRD) demonstrate problems in verbal WM and inhibitory factors; it was previously believed that the core deficits associated with WRD were the cause of poor performance on EF factors. (EF impairments in this group were eliminated after phonological processing was taken into consideration).²³

When factors that are typically considered to be important for reading comprehension (such as attention, decoding abilities, fluency, and vocabulary) are taken into account, EF still significantly contributes to reading comprehension but not word comprehension.²⁵ When planning is taken into account following phonological processing, children with specific-reading comprehension deficits do significantly worse. This implies that challenges with comprehension of what is being read are related to ED; in specific, reading comprehension issues may be brought on by ineffective strategic planning or organising.²⁶ On assessments of WM, STM, phonological processing, and processing speed, children with comprehension problems outperformed those with RD.²⁴

Spoonerism, verbal categorical and phonological fluency, visual-spatial and auditory attention, verbal and visual STM, and verbal WM all demonstrated deficits.

Nonetheless, visual shifting skills and spatial STM were still present.²⁰

Specific Learning Disabilities With Impairment in Written Expressions

Executive Functioning components such as shifting, WM, planning and organization, monitoring, and material organization, are basics to effective handwriting transcription performance.

The WM as well as inhibition, emotional control, and monitoring are all highly connected with the average pressure applied to the writing surface. Applied pressure can predict emotional control in some children with dysgraphia whereas pen stroke height can be used to predict monitoring ability in this group.²⁷ Erased/overwritten and unrecognizable letters can be attributed to organizational abilities.^{28, 29} Organizational skills and handwriting spatial organization show a significant association in the dysgraphic group.³⁰ Inattention confirms with measures of written language. There is a link between sustained switching, typing the alphabet by memory on a keyboard or in a manuscript, and quickly reproducing a sentence that contains every letter of the alphabet.¹⁴

Specific Learning Disabilities With Impairment in Mathematics

Children with arithmetic disabilities are observed to name digits and quantities more slowly¹³ for activities without executive demands, & tends to make more calculation errors, and go through number order more slowly.³¹ They exhibit impaired subitizing, number-line estimation, digit comparison.²⁹

Several studies proposed that deficits in Executive Functioning^{32, 33} and WM^34–36 are associated with developmental dyscalculia. Deficits in visuospatial WM, visuospatial STM, and inhibitory function (interference suppression) impairment are seen in developmental dyscalculia. The interruption of CE memory function is associated with impairments in inhibition. Developmental dyscalculia often results from STM/WM and inhibition dysfunction, which may cause visuospatial processing and attention issues.³⁷

There is a significant role of WM in number writing, magnitude judgment, and single-digit arithmetic, however different parts of WM effects distinct skills.¹² These children demonstrate severe numerical WM deficits. There is domain-general nature of WM deficits in Mathematical Disability (MD) in which the numerical WM deficits reflect the domain-specific nature of WM deficits.³⁴

Math difficulties are attributed to a CE deficit or delay, mostly noticeable for numerical stimuli and/or processing. A strong relationship is seen between math performance and CE component, a moderate relation emerged in the case of CE and PL numerical measures, and a weak relation in non- numerical PL.³⁸ Children with MD show lower span scores on measures of the PL and the CE.³⁹ CE functioning is used to explain the difficulty in the addition accuracy of children (5–6 yrs), whereas multiplication can be explained by phonological loop functioning.¹²

Moreover, memory retrieval and visual-spatial WM are compromised.⁴⁰ The effect of visual-spatial WM deficits more visible in the younger age group. There is a strong relationship between math performance and the visual-spatial sketchpad.³⁸ Visual–spatial sketchpad functioning indicated difficulties in magnitude judgments and number writing with minor role in early arithmetic.¹²

Arithmetic-disabled children are also impaired on measures of inhibition²³ and shifting.¹³ In MD, there were deficits in dual-tasking of both verbal and numerical information as well as storage and inhibition of specific numerical information.⁴¹ According to research, updating is a very good indicator of Maths performance; however, the results for inhibition and switching were less clear-cut.³⁵

In contrast, when Stroop and the flanker tasks were used to evaluate the inhibitory capacity in MD children, the researchers discovered no evidence of low EF in those children.⁴² Another study found that performance on the test requiring the ability to suppress extraneous information was within the normal range.^{43, 46}

Reading and Mathematical Deficits (RDMD)

Children who struggle with reading and Maths exhibit a combination of EF issues that distinguish those with a single learning deficit.¹³

RDMD showed domain-general WM deficits.²¹ On both verbal and numerical tasks, these children displayed severe deficits in phonological storage and executive skills.^{21, 41} They exhibit the worst WM impairments. Dyscalculia and dyslexia do not significantly interact in terms of WM subcomponents in children who struggle with both reading and maths.⁴⁴ Children who had both dyslexia and dyscalculia displayed phonological deficits similar to those of children who had dyslexia only, as well as deficits in processing numbers compared to those of children who had dyscalculia solely.⁴⁵

Variation Among Learning Disabilities

When compared to TD children, all LD subgroups had substantial verbal and numerical WM deficits. Children with RDMD exhibited the most significant linguistic and numerical WM deficits. While both RD and MD children had comparable verbal WM deficits, the MD group had significantly severe numerical WM deficits than RD children.

There were no discernible moderating effects for the degree of LD or the type of academic screening assessment.⁴⁴

WM tests showed that RDMD children had a much worse verbal and numerical WM deficit than RD and MD children. Moreover, MD children displayed a scarcely significant higher numerical WM deficit than RD children. Similar abnormalities in verbal WM were observed in RD and MD children, in the MD, the correlations between verbal WM and numerical WM and LD were not averaged by low mathematics proficiency.

Regardless of the degree of their LD, children with RD, MD, and RDMD all had verbal and numerical WM deficits. In tasks like complex reading span (WM), word inhibition, number inhibition, verbal and numerical processing speed, the TD group outperformed the RD and RDMD groups (where RD=RDMD). TD group scored better than RD and RDMD group (where RD=RDMD) in task such as complex reading span (WM), word inhibition, number inhibition, Verbal and numerical Processing speed. TD and RD group scored better than RDMD group (where TD=RD) in advanced computation span (WM), word updating and number updating.²¹

When it came to tasks like number scan, advanced reading span (WM), advanced computation span (WM), and number inhibition, the TD group performed better than the MD and RDMD group (where MD=RDMD). TD and Mathematical Disability group scored greater than RDMD group (where TD=MD) in word span, word inhibition, word updating and number updating.⁴¹

Variations were also found in different reading ability groups. Skilled readers were comparable to comprehension deficits groups in terms of short term memory and phonological domain, whereas they were better in WM. In inhibition skilled readers have better inhibition than those with reading disabilities. Reading disability, Poor readers and those with comprehension deficits have similar inhibition skills.¹⁵

Future Implications

Future evaluation and tailored treatment will be guided by the relationship between the EF components and particular learning difficulties, which will ultimately save important time spent catering to various components. Future studies could also be conducted to find the effect of protocol designed as per the observations made for clients with specific learning disabilities.

Limitations

The fact that our review was restricted to peer-reviewed English-language material published in the listed databases and may have left out significant non-English literature in other databases and unpublished manuscripts or theses. Since EFs are the interplay of many components working together to attain a goal, evaluation of any single component individually cannot be done,

The interplay of components of EFs was not taken into consideration in this review. It cannot be concluded by the studies alone if treatment aimed at a specific deficient skill set will lead to an overall improvement in academics. Also, Functional assessments of day-to-day executive skills were not correlated with academics. And lastly, the protocol was not registered for the review in any database or registry before its conduct.

Conclusion

EFs have a much complex role as thought in children with learning disabilities with each factor affecting different domains of learning and manifesting itself in their performance. These components also affect their functioning in day-to-day functioning. WM is found to be the key component affecting performance while other components play a subdue role, but their involvement cannot be segregated because of the complex interplay between them. Having appropriate knowledge of the specific area of involvement of EF in particular disability can aid and speed up the intervention process as specific components can be directly targeted.

Footnotes

Acknowledgements

All authors contributed equally to this manuscript. Our review could not have accomplished without the assistance of Ms. Deepshikha Gupta and Dr. Sangeeta Narang. We would like to express our gratitude towards colleagues for their continued support and encouragement. Finally, to our family for their everlasting patience and motivation.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

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Executive Dysfunctions in Different Learning Disabilities: A Review

Abstract

Background:

Methods:

Results:

Conclusion:

Keywords

Introduction

Method

Search Strategy

Study Selection

Data Extraction

Results

Discussion

Specific Learning Disabilities With Impairment in Reading

Specific Learning Disabilities With Impairment in Written Expressions

Specific Learning Disabilities With Impairment in Mathematics

Reading and Mathematical Deficits (RDMD)

Variation Among Learning Disabilities

Future Implications

Limitations

Conclusion

Footnotes

Acknowledgements

Declaration of Conflicting Interests

Funding

References