Overview of Specific Learning Disability

Dr. Madhuri KulkarniSenior Consultant Pediatrician

Mumbai Port Trust HospitalWadala Mumbai

Former Prof. of Pediatrics & Dean In-chargeLTMGH & LTMMC, Mumbai

Learning Disability

• Common neuro-developmental disorder

• Prevalence 5% to 15 %

• Equal male : female distribution

• Persistent throughout life

• Most likely to be familial

Contd.....

• Across all socio economic classes

• Problems in learning to read, write, spell or do mathematics and in social behaviour

• Presumed to be due to CNS dysfunction.

History of LD

1877 : Kussmaul – Word blindness1896 : Hinshelwood – Dyslexia1925 : Orton – Special training for dyslexics1962 : Kirk – Learning disorder / disability1988 : N.J.C.L.D.1995 : L.D. Clinic at L.T.M.G.H.1996 : M.D.A1996 : State Govt.of Maharashtra

NJCLD Definition

Heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of reading, writing, listening, speaking, reasoning and mathematical abilities.

These disorders are intrinsic to the individuals, presumed to be due to CNS dysfunction, and may occur across the life span.

Specific Learning Disability

Generic term that refers to a heterogeneous group of disorders manifested by significant unexpected, specific and persistent difficulties in the acquisition and use of reading (dyslexia), writing (dysgraphia) or mathematical (dyscalculia) abilities despite conventional instruction, normal intelligence, proper motivation and adequate socio-cultural opportunity.

*Shapiro BK-1993

What is not L.D.?

• Mental Retardation• Borderline I.Q.• Sensory deficits: Vision, Hearing• Emotional disturbances• Attention deficits• Late maturation

Etiology

• Genetic

- Sibling recurrence rate 40 %- Parent rate 25 – 50 %

• Chromosomes – Loci on 6 & 15

- Sex chromosome anomalies influencing cognitive functioning

• Neurofibromatosis, PKU, Tourrett Fragile X etc.

Specific Areas in the Brain

Characteristics

• Academic problems• Dyslexia• Dysgraphia• Dyscalculia• Social interaction deficits• Emotional problems

Dyslexia

Dys = difficulty

Lexia = words/vocabulary

Reading difficulties

• Reads slowly and hesitantly

• Follows the word with fingers

• Mispronounces words

• Looses place in text

Contd……

• Confusion of letters – ‘bog’ for ‘dog’, inverts ‘n’ for ‘u’

• Guessing word from first letter reads ‘farm’ for ‘front’

• Skips or adds words when reading aloud

Oral work better than written answers

Dysgraphia

Difficulty related to writing

• Writing very small or large, may be impossible to read

• Faulty pressure used• Wrong order, ‘tiem’ for ‘time’• Poor at copying from board• Written sentences are jumbled• Faulty spacing

Dyscalculia

Difficulty in mathematics calculations, tables, logic

• Counting numbers

• Mental sums difficult

• Mixes up symbols ‘+’, ‘-’, ‘=‘

• Difficulties in word-problems, understanding mathematical operation

• Drawing geometric figures

Social skill deficits

• Poor social comprehension• Inability to take the perspective of

others• Misinterpretation of body language• Being easily led• Inattentive• Impulsive• Over-aggressive

Presenting Features

Pre-school - Delayed speech - Difficulties in pronouncing/blending

letters - Rhyming difficulties - Delay in development of fine motor

skills - Trouble learning the alphabet,

numbers, days of the week, colours, shapes

Presenting Features

Primary school - Reading single word - Spelling errors - May confuse small words: at,to,it,

said ,and - May have trouble learning to tell

time. - Awkward pencil grip - May have poor fine motor co-

ordination

Presenting Features

Middle school

• Reversing sequences• Spelling difficulty• Laborious reading• Comprehension problems• Problems on the playground• Has trouble with word problems in mathematics

Associated Conditions

• Attention deficit hyperactivity disorder (ADHD)

• Obsessive Compulsive Disorder• Anxiety disorders• Tic disorders and Tourette’s

Syndrome• Conduct disorders,

Oppositional Defiant Disorder• Depression

ADHD

• Attention Deficit Hyperactivity Disorder: genetic, neuro bio-chemical & developmental disorder

• Characterized by hyperactivity, impulsiveness and short attention

• 20% of LD children are associated with ADHD

AssessmentMulti-disciplinary Approach• School referral• Medical / Neurological /

Development Examination • Educational History• Vision, Hearing tests• Analysis of school reports• General cognitive functions• Educational assessments• Psychiatric assessments• Case conference• Final diagnosis

Why early diagnosis ?

• Early acceptance• Early intervention• Reduction in emotional problems• Effective main-streaming• Optimum development

Brain plasticity in childhood Sparse Profuse Pruned connections connections connections

Ideal Procedure

• Referral Stage a) Pre-referral screening b) School committee review• Assessment Stage a) Multidisciplinary evaluation b) Case conference, team meeting c) Writing of IEP• Intervention Stage a) Implementation of IEP b) Monitoring student progress

What is Remedial Education?

• A specific method of instruction/teaching

• Based on specific deficits in performance of child

• Starts after collecting relevant information about the child’s performance

• Develops on the strengths• Fills in the gaps in learning• Enables child to achieve academic

skills

Important Points about Remedial Education

• One-to-one basis in a child friendly environment.

• Minimum one hour duration.• Two to three sessions per week • R.E. should continue all the year

round and not only during vacations or schooldays. However, the sessions could be intensified during the vacation.

Cont….

• Should be started as early as six to eight years of age.

• R.E. is not equivalent to giving tuitions but done by special educators or by the teachers specially trained in remedial education.

• R.E. has to be given in addition to regular school work.

• R.E. should be continued throughout school life.

Key message

• L.D.commonly present as school problems

• Early detection :Early intervention • Clinical features vary with age &

with achievement of developmental skills

• Multi-disciplinary approach • Remedial Education• Provisions• Parent Support and school support

MVK NAGPUR 2009

Thank You !