Neurodevelopmental and psychiatric comorbidities of children and adolescents with specific learning disorders: associations with gender and educational level.

backgroundSpecific Learning Disorders (SLDs) are among the most common neurodevelopmental conditions, affecting not only academic performance but also a child's daily functioning and overall well-being. Alongside their learning difficulties, many young people with SLDs show a greater vulnerability to emotional and behavioural problems. Although these issues are increasingly recognised, much of the available research still relies on screening questionnaires rather than structured diagnostic assessments, focuses mainly on SLDs with impairment in reading, or is based on small samples. In addition, more than a decade has passed since the last epidemiological study, resulting in a lack of updated evidence on neurodevelopmental and psychiatric comorbidities in SLDs. As SLDs diagnoses increase and mental health needs intensify, robust updated data are necessary. This study offers clinically based estimates of comorbid neurodevelopmental and psychiatric disorders in a large SLDs cohort and examines the association between gender and educational level.

methodsThis retrospective cross-sectional study included 952 children and adolescents (7-19 years) diagnosed with SLDs and evaluated at the Child and Adolescent Neuropsychiatry Unit of the Bambino Gesù Children's Hospital. Neurodevelopmental and psychiatric comorbidities were assessed through multidisciplinary clinical evaluation, including developmental history, clinical observation, and a semi-structured diagnostic interview (K-SADS-PL DSM-5), and were diagnosed according to DSM-5/DSM-5-TR criteria.

resultsOverall, 53.9% of participants presented at least one neurodevelopmental or psychiatric comorbidity. ADHD was the most frequent diagnosis (32.1%), followed by anxiety disorders (15.9%), mood disorders (3.3%), and oppositional defiant disorder (ODD, 1.9%). Gender and educational level were associated with comorbidity patterns. Specifically, males showed higher rates of ADHD (M/F: 65.7% vs 49.5%) and ODD (M/F: 9.4% vs 4.2%), whereas females exhibited higher rates of anxiety (M/F: 30.8% vs 50.5%). Moreover, primary school students were more likely to receive an ADHD diagnosis (Primary/Secondary: 69.1% vs 47.6%), while secondary school students showed higher rates of anxiety and mood disorders (respectively, Primary/Secondary: 28.1% vs 51.1%; Primary/Secondary: 4.9% vs 11.6%). Finally, stratified descriptive analyses suggested increase prevalence of mood disorders among female participants attending secondary school.

conclusionsSLDs frequently co-occur with clinically significant neurodevelopmental and psychiatric diagnosis. ADHD and anxiety disorders are the most common comorbidities, displaying associations with gender and age. Our findings may be interpreted within the Research Domain Criteria (RDoC) framework, which conceptualizes neurodevelopmental and psychiatric comorbidity as the expression of partially overlapping symptom dimensions arising from shared risk factors and, potentially, common underlying pathophysiological mechanisms. Moreover, these findings support the need for comprehensive assessments and early identification to guide targeted interventions.