Internalizing Problems in Children with Learning Difficulties

Abstract

Research has shown that students with learning difficulties (LD) are more prone to internalizing problems compared to their peers without LD. However, most previous studies have either not specified the type of LD examined or have focused on children with reading difficulties (RD) or mathematics difficulties (MD) alone, leaving it unclear whether children with comorbid RDMD experience higher levels of internalizing problems. To our knowledge, only four studies have included a comorbid group (Aro et al., 2022; Martínez & Semrud-Clikeman, 2004; White et al., 1992; Willcutt et al., 2013), and none of them controlled for attention, which is an important factor underlying both learning difficulties and internalizing problems. Additionally, none of these studies examined domain-specific forms of anxiety. Thus, to address these gaps, we conducted three studies. In the first study, we conducted a systematic review and meta-analysis to examine if individuals with LD RD, MD, or unspecified learning difficulties (ULD) experience internalizing problems to the same extent, and if the effect sizes are influenced by different factors (age, internalizing problems type, anxiety type, rater type, selection criteria, and attention control). We reviewed 2,806 studies published in English between January 2000 and April 2023. Our final sample consisted of 96 studies that reported effect sizes or data to calculate them. A random-effects model analysis revealed a significant and moderate overall effect size (Hedge’s g = -.54), indicating that individuals with RD, MD or ULD experience more internalizing problems than their chronological-age (CA) controls. Follow-up analyses showed that neither learning difficulties type nor age of participants were significant moderators, but selection criteria (diagnosis versus screening) and internalizing problems type were. In the second study, we examined whether children with comorbid RDMD experience more internalizing problems (anxiety, depression, somatic complaints, and social withdrawal) than children with RD only, MD only and controls. In addition, we examined whether any significant group differences are due to differences between groups in attention. Thirty-three children with RD, 35 with MD, 37 with comorbid RDMD, and 42 chronological-age (CA) controls were assessed on reading, mathematics, general cognitive ability and attention tasks. Their teachers also rated their anxiety, depression, somatic complaints, and social withdrawal. Results of analyses of variance showed that children with comorbid RDMD exhibited significantly higher levels of anxiety and depression compared only to the CA controls. However, after controlling for attention, these group differences were no longer significant. In light of the significant differences in anxiety between the RDMD group and the CA group (at least when attention is not covaried), in the third study, we examined whether the RDMD children experience more school, reading and/or mathematics anxiety than children with difficulty in either reading or mathematics difficulties or children with no learning difficulties. Further, we examined whether any significant group differences are due to between group differences in attention. Thirty-three children with RD, 35 with MD, 37 with comorbid RDMD and 42 CA controls were assessed on measures of reading, mathematics, general cognitive ability, and attention. The participants also completed three anxiety scales (school, reading, and mathematics anxiety). Results of analyses of variance showed that children with RDMD exhibited significantly higher levels of reading and mathematics anxiety (but not of school anxiety) compared to their CA controls. The RDMD group also exhibited higher levels in reading anxiety compared to the MD group and mathematics anxiety compared to the RD group. The group differences remained significant even after controlling for differences in attention. Overall, our findings suggest that children with LD, more specifically, with comorbid RDMD, are at greater risk for internalizing problems than children without LD. This highlights the importance of carefully distinguishing between single and comorbid learning difficulties when examining mental health problems. Additionally, domain-specific anxieties remained significant even after accounting for attention differences, with children in the RDMD group reporting elevated reading and mathematics anxiety compared to controls. Children with RD also reported higher reading anxiety, and those with MD showed increased mathematics anxiety, relative to the control group. These findings suggest that reading and mathematics anxiety are more directly linked to their respective learning difficulty than general internalizing problems are. This underscores the need for targeted, domain-specific interventions to support children with LD.