This article reviews the nature of learning difficulties in mathematics and, in particular, the nature and prevalence of dyscalculia, a condition that affects the acquisition of arithmetical skills. The evidence reviewed suggests that younger children (under the age of 10) often display a combination of problems, including minor physical difficulties, that can create a downward spiral in their confidence with mathematics. The article then considers the range of recommendations for teaching children with mathematics difficulties, focusing in particular on an approach developed over time at Emerson House (EH), an independent centre for children aged 6 to 11 with dyslexia, dyspraxia and dyscalculia. The conclusion is that the EH approach might be effective for children with varied difficulties.