Specific Learning Disability

1. Specific Learning Disability Dr AnjanaThadhani Consultant Developmental Pediatrician

2. Specific Learning Disabilities • Group of developmental disorders • Significant unexpected, specific and persistent difficulties in the acquisition and use of reading (dyslexia), writing (dysgraphia) or mathematical (dyscalculia) abilities, • despiteconventional instruction, normal intelligence, proper motivation and adequate socio-cultural opportunity

3. Salient Features Types: Dyslexia Dysgraphia Dyscalculia Creates a significant gap between the potential and academic performance Prevalence - 10% of school going children Difficulty with information processing

4. LEARNING

5. INFORMATION PROCESSING RECORDING INFORMATION (INPUT) • Perceptual →Visual →Auditory INTEGRATION • Sequencing • Abstraction • Organization STORAGE (MEMORY) • Short – term • Long – term

6. READING • Phonological awareness • Letter-sound association • Decoding & Blending • Focus on printed words • Control of eye movements across the page • Processing of images and ideas • Comparisons and associations of ideas • Storing of the information into memory

7. CAUSES • Neuro-developmental condition • Multi-factorial • Genetic predisposition • ADHD - Strong association • CO-MORBIDITY

8. GENETICS • In 1950, Hallgren, an autosomal dominant disorder • Recent findings: • Dyslexia is a genetically heterogeneous and complex trait that does not show classical mendelian inheritance • Several chromosomal regions & genes affecting reading disability (chromosome 1, 2, 3, 6, 15, 18)

9. NEUROIMAGING • Absence of usual asymmetry of planumtemporale (portion of temporal lobe lying posterior to Heschl’sgyrus) • Left is usually larger than right • Neuronal ectopias in frontal and parietal regions

10. CLINICAL CHARACTERISTICS

11. MANIFESTATIONS • Varied spectrum presentation • Mild to severe • Academic • Behavioral • Co-morbidity • Psychosocial

12. REFERRAL LETTER • Repeated failures • Does not write or read • Spelling mistakes • Oral work better than written work • Problems in math

13. PRE-SCHOOL EARLY POINTERS

14. Developmental delays • Mild gross motor delays • Fine motor problems • Speech delay or difficulties • Lack of dominant handedness • Perceptual problems

15. AUDITORY PERCEPTION • Auditory perception • Auditory discrimination • Auditory memory & sequencing • Auditory filtering • Auditory processing

16. VISUAL PERCEPTION • Visual perception • Visual discrimination • Visual memory & sequencing • Form constancy • Visuomotor integration • Figure ground discrimination

17. THE RED HOUSE

18. RED HOUSE & TREE

19. RED HOUSE, TREE & SUN

20. Learning Concerns • Difficulty in pronouncing words. • Poor phonological awareness • Difficulty or slowness to add words. • Inability to rhyme by age 4 years. • Confusion in directionality, words and space concepts, left versus right, over versus under, before versus after.

21. May have trouble learning the alphabets, numbers, day of the week, colors, shapes. • May have difficulty telling or retelling a story in the correct sequence. • Abnormal grip or refusal to write.

22. Behavioral concerns • Hyperactivity • Difficulty in following instructions • Slow in ADLs • Stubborness • Temper tantrums

23. PRIMARY & SECONDARY SCHOOL

24. Dyslexia • Avoids reading aloud • Reads slowly • Uses finger tracing • Looses place or skips words • Mispronounces or guesses words • Has difficulty decoding or blending single words

25. Relies heavily on memorizing without understanding. • Poor comprehension • Gives stress on wrong syllables • Reads with substitution • While reading makes up his own stories • Poor memory & recall

26. Dysgraphia • Slow in writing or may avoid writing. • Often uses an awkward pencil grip ( fist, thumb hooked over finger, etc.) • Writes with illegible handwriting • Poor letter formations • Untidy written work • Uses inappropriate pressure • Uneven size of letters with poor spacing

27. Spelling mistakes • Bizarre spelling • Spells the same word differently • Punctuation & capitalization errors. • Mixes upper & lowercase letters • Problems with copy writing

30. Typical errors • Letters reversals -d for b as in dog for bog. • Word reversals – tip for pit. • Inversions – m and w, u and n. • Transpositions – felt and left. • Substitutions – house and home. • Omissions • Additions.

31. Spelling errors • Amount – aomunt • Awards – awords • Consent – conset • Recent – resent • Domestic – domistic • Brain – brian • Method - matheod

32. Dyscalculia • May transpose number sequences , 231 as 312 • Confuse arithmetic signs. (+ - * / = ) • Has trouble with word problems • Poor in mental maths • Difficulty in learning tables • Counting on fingers may be seen

33. Difficulty in carrying over or borrowing sums • May count from left to right • Poor in geometry • Poor in algebra

34. Other concerns • Appears very clumsy and untidy. • Has difficulty making friends. • May not understand body language and facial expression of others. • Has trouble with non-literal language (idioms, jokes, proverbs, slang)

35. Difficulty following step by step instructions • Difficulty in telling time • Difficulty in telling/ following directions • Slow in ADLs • Poor understanding of abstract • Disorganized behavior and thoughts

36. Associated behavioral issues.. • Hyperactivity • Day dreaming • Poor peer relations • Aggressive behavior • Poor participation

37. Pyschosocial concerns • Poor self esteem • Poor self confidence • Poor interpersonal relations • Emotional lability

38. Strengths • Sensitive & compassionate • Good at mechanical work • Good at sports • Usually good dancers • Good at cooking & eating too…

39. Key Messages • Hidden Handicap • Neurological Disorder • Present since Birth • Multi-factorial • Essentially Normal child • Average / above average Intelligence

40. To Summarize… • “Every learning problem is not a Learning Disability” • With early intervention & provisions, they can be mainstreamed • Secondary behavioral problems need effective management.

41. THANK YOU