Dr Anjana Thadhani Consultant Developmental Pediatrician

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, despite conventional instruction, normal intelligence, proper motivation and adequate socio-cultural opportunity

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

LEARNING INPUTPROCESSINGOUTPUT

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

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

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

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)

NEUROIMAGING Absence of usual asymmetry of planum temporale (portion of temporal lobe lying posterior to Heschl’s gyrus) Left is usually larger than right Neuronal ectopias in frontal and parietal regions

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

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

EARLY POINTERS

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

AUDITORY PERCEPTION Auditory perception Auditory discrimination Auditory memory & sequencing Auditory filtering Auditory processing

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

THE RED HOUSE

RED HOUSE & TREE

RED HOUSE, TREE & SUN

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.

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.

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

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

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

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

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

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.

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

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

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

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)

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

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

Pyschosocial concerns Poor self esteem Poor self confidence Poor interpersonal relations Emotional lability

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

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

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