Understanding Students with Learning Disabilities’ Mental Health, Care Coordination and School Outcome Needs

Background/Purpose: Students with learning disabilities (LD), such as dyslexia and dysgraphia, represent a critically underserved population at the intersection of educational and mental health systems. Despite growing evidence that students with LD experience more mental health needs than students without LD, school-based interventions have largely focused on academics, leaving mental health needs substantially unaddressed. Additionally, there is minimal evidence regarding care coordination experiences of these students, but recent work suggests that students with LD have higher rates of unmet need for care coordination than students without LD. To better understand this population, we used data from the National Survey of Children’s Health to answer the questions: What needs and unmet needs do students with LD report related to mental health care, care coordination, and school outcomes? Do these rates of need and unmet need differ from students without LD or students with other types of special needs?

Methods: We conducted a secondary analysis of pooled 2023-2024 National Survey of Children's Health data (N=106,537; representing approximately 72.3 million U.S. children). Children were categorized as: no LD and no special health care needs (non-LD/non-SHCN; 77.0%), any LD with or without SHCN (6.8%), and SHCN without LD (16.2%). We examined weighted prevalence of co-occurring mental health conditions, care coordination needs, school-health communication, and school outcomes across groups using design-adjusted chi-square tests. Survey-weighted logistic regression models estimated adjusted odds of each outcome controlling for sociodemographic, insurance, and health complexity variables, with predicted marginal probabilities to aid interpretation.

Results: Children with LD had substantially elevated rates of co-occurring conditions: 52.8% currently had ADHD (vs. 2.2% non-LD/non-SHCN; 37.2% SHCN-only), 36.2% had current anxiety (vs. 3.8%; 34.4%), 40.1% had current behavioral problems (vs. 1.3%; 27.1%), and 14.4% had current depression (vs. 0.9%; 14.5%). Nearly half (46.5%) of children with LD needing care coordination reported unmet needs, compared to 17.5% of non-LD/non-SHCN children and 39.7% of SHCN-only children. In adjusted models, children with LD had over four times the odds of repeating a grade compared to non-LD/non-SHCN children (OR=4.09, p<.001; predicted probability 10.9% vs. 3.0%) and significantly higher odds of school contact about problems (OR=1.96, p=.002). Children with LD had over twice the odds of reporting unmet mental health need (OR=2.14, p<0.10) compared to non-LD/non-SHCN. These effects exceeded those observed for children with SHCN without LD. Adjusted differences in school engagement, homework completion, and unmet care coordination and mental health needs were not statistically significant for the LD group, though trends were in the expected direction.

Conclusions/Implications: Children with LD experience high rates of co-occurring mental health conditions and considerable challenges in school engagement and academic progression, even after adjusting for health complexity and sociodemographic factors. These findings underscore the need for mental health-focused interventions tailored to students with LD and enhanced coordination across healthcare and educational systems. School social workers are uniquely positioned to bridge these gaps through providing care coordination, advocating for comprehensive Individualized Education Programs, and linking students with LD to mental health services.