1. Overview of Specific Learning Disability
Dr. Madhuri Kulkarni
Senior Consultant Pediatrician
Mumbai Port Trust Hospital
Wadala Mumbai
Former Prof. of Pediatrics & Dean In-charge
LTMGH & LTMMC, Mumbai

2. Learning Disability Common neuro-developmental disorder
Prevalence 5% to 15 %
Equal male : female distribution
Persistent throughout life
Most likely to be familial

3. 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.

4. History of LD 1877 : Kussmaul – Word blindness
1896 : Hinshelwood – Dyslexia
1925 : Orton – Special training for
dyslexics
1962 : Kirk – Learning disorder /
disability
1988 : N.J.C.L.D.
1995 : L.D. Clinic at L.T.M.G.H.
1996 : M.D.A
1996 : State Govt.of Maharashtra

5. 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.

6. 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

7. What is not L.D.? Mental Retardation Borderline I.Q.
Sensory deficits: Vision, Hearing
Emotional disturbances
Attention deficits
Late maturation

8. 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.

9. Specific Areas in the Brain

10. Characteristics Academic problems Dyslexia Dysgraphia Dyscalculia
Social interaction deficits
Emotional problems

11. Dyslexia Reading difficulties Dys = difficulty
Lexia = words/vocabulary
Reading difficulties
• Reads slowly and hesitantly
• Follows the word with fingers
• Mispronounces words
• Looses place in text

12. 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

13. 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

14. 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

15. Social skill deficits Poor social comprehension
Inability to take the perspective of others
Misinterpretation of body language
Being easily led
Inattentive
Impulsive
Over-aggressive

16. 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

17. Presenting Features - Reading single word Primary school
- 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

18. Presenting Features Middle school Reversing sequences
Spelling difficulty
Laborious reading
Comprehension problems
Problems on the playground
Has trouble with word problems in mathematics

19. Associated Conditions
Attention deficit hyperactivity disorder (ADHD)
Obsessive Compulsive Disorder
Anxiety disorders
Tic disorders and Tourette’s Syndrome
Conduct disorders, Oppositional Defiant Disorder
Depression

20. 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

21. Assessment Multi-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

22. Why early diagnosis ? Early acceptance Early intervention
Reduction in emotional problems
Effective main-streaming
Optimum development

23. Brain plasticity in childhood Sparse Profuse Pruned connections connections connections

24. 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

25. 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

26. 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.

27. 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.

28. 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

29. Thank You !