The natural history of developmental dyscalculia (DC) in 140 fourth-grade students was studied at the Shaare Zedek Medical Center, Jerusalem, Israel. In phase I of the study, IQ testing; arithmetic, reading, and writing evaluations; and ADHD assessments were conducted over a 3-year period. In phase II, three years later, 123 (88%) were retested and 57 (47%) had persistent DC, with scores in the lowest 5% for their age group (13-14 years). Persistence of DC was correlated with severity of DC and arithmetic problems in siblings of the probands. Socioeconomic status, gender, another learning disability, and educational interventions were not associated with persistence of DC. Attention problems were more severe in children with persistent DC than in those whose scores improved at follow-up. 
COMMENT. Approximately one half of children diagnosed with developmental dyscalculia in fifth grade are likely to have persistent DC in eighth grade. Division and complex subtraction were especially impaired while addition was generally mastered. Arithmetic problems in siblings were associated with persistent DC in the proband. Educational intervention, provided in 47% of children with persistent DC compared to only 17% of those with nonpersistent DC, is apparently not the only answer. The occurrence of associated neurological conditions and components of the Gerstmann syndrome, including dysgraphia, finger agnosia, and R-L disorientation, would have been of interest, and might explain persistence of DC in some cases. Visual-perceptual and spatial disturbance, problems with symbols, language and reading disorders, impaired concepts of direction and time, and memory deficits may be implicated in arithmetic difficulties. A variety of teaching strategies are required in mathematics . Developmental dyscalculia is a chronic disorder that is not outgrown, but demands the same interest of neurologists and educators as dyslexia.