The frequency of specific leaning disabilities (SLD) in neurofibromatosis type 1 (NF1) was determined in a cohort of 81 patients (43 males, 38 females; mean age 11 years 6 months; age range 8-16) followed at Children's Hospital, Westmead, NSW, Australia. Academic underachievement occurred in 42 (52%) of NF1 children, 3.5-fold more frequently than in a control group. One or more SLDs was present in 16 (20%); 7 had reading disability, 7 spelling, and 8 a math disability. Of the 52% with academic difficulties, one third had a general learning disability (GLD) associated with IQ deficit. Only males with NF1 were at significant risk for SLD; Verbal IQ < Performance IQ discrepancy was predictive of SLD. NF1 patients with no SLD or GLD had normal IQ scores and average academic achievement but minor difficulties in sustained attention and visuospatial skills. ADHD was present in 31 (38%) NF1 children in the total group compared to 12% of 49 controls without NFL The increase in frequency of ADHD was similar in those with comorbid SLD or GLD and lower but still significant in NF1 patients with no LD. 
COMMENT. Children with NF1 have a 52% incidence of academic underachievement, and 20% have a SLD. One third of patients with LD have a GLD associated with a lowered IQ. Comorbid SLD and NF1 occur almost always in males, and in the above study, their verbal IQ was lower than performance IQ. The authors are examining VIQ < PIQ discrepancies in male preschool children as early predictors of risk of SLD. These findings are different from those of Eliason MJ  who reported a preponderance of nonverbal learning problems (visual perceptual deficits) in children with NF1.