Presentation on theme: "Overview of Specific Learning Disability"— Presentation transcript:
1Overview of Specific Learning Disability Dr. Madhuri KulkarniSenior Consultant PediatricianMumbai Port Trust HospitalWadala MumbaiFormer Prof. of Pediatrics & Dean In-chargeLTMGH & LTMMC, Mumbai
2Learning Disability Common neuro-developmental disorder Prevalence 5% to 15 %Equal male : female distributionPersistent throughout lifeMost likely to be familial
3Contd..... Across all socio economic classes Problems in learning to read, write, spell or do mathematics and in social behaviourPresumed to be due to CNS dysfunction.
4History of LD 1877 : Kussmaul – Word blindness 1896 : Hinshelwood – Dyslexia1925 : Orton – Special training fordyslexics1962 : 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
5NJCLD DefinitionHeterogeneous 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.
6Specific 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
7What is not L.D.? Mental Retardation Borderline I.Q. Sensory deficits: Vision, HearingEmotional disturbancesAttention deficitsLate maturation
8Etiology Genetic - Sibling recurrence rate 40 % - Parent rate 25 – 50 %Chromosomes – Loci on 6 & 15- Sex chromosome anomaliesinfluencing cognitive functioningNeurofibromatosis, PKU, TourrettFragile X etc.
10Characteristics Academic problems Dyslexia Dysgraphia Dyscalculia Social interaction deficitsEmotional problems
11Dyslexia Reading difficulties Dys = difficulty Lexia = words/vocabularyReading difficulties• Reads slowly and hesitantly• Follows the word with fingers• Mispronounces words• Looses place in text
12Contd…… 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 aloudOral work better than written answers
13Dysgraphia Difficulty related to writing Writing very small or large, may be impossible to readFaulty pressure usedWrong order, ‘tiem’ for ‘time’Poor at copying from boardWritten sentences are jumbledFaulty spacing
14Dyscalculia Difficulty in mathematics calculations, tables, logic Counting numbersMental sums difficultMixes up symbols ‘+’, ‘-’, ‘=‘Difficulties in word-problems, understanding mathematical operationDrawing geometric figures
15Social skill deficits Poor social comprehension Inability to take the perspective of othersMisinterpretation of body languageBeing easily ledInattentiveImpulsiveOver-aggressive
16Presenting 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
17Presenting 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
18Presenting Features Middle school Reversing sequences Spelling difficultyLaborious readingComprehension problemsProblems on the playgroundHas trouble with word problems in mathematics
20ADHDAttention Deficit Hyperactivity Disorder: genetic, neuro bio-chemical & developmental disorderCharacterized by hyperactivity, impulsiveness and short attention20% of LD children are associated with ADHD
21Assessment Multi-disciplinary Approach School referral Medical / Neurological / Development ExaminationEducational HistoryVision, Hearing testsAnalysis of school reportsGeneral cognitive functionsEducational assessmentsPsychiatric assessmentsCase conferenceFinal diagnosis
22Why early diagnosis ? Early acceptance Early intervention Reduction in emotional problemsEffective main-streamingOptimum development
23Brain plasticity in childhood Sparse Profuse Pruned connections connections connections
24Ideal Procedure Referral Stage a) Pre-referral screening b) School committee reviewAssessment Stagea) Multidisciplinary evaluationb) Case conference, team meetingc) Writing of IEPIntervention Stagea) Implementation of IEPb) Monitoring student progress
25What is Remedial Education? A specific method of instruction/teachingBased on specific deficits in performance of childStarts after collecting relevant information about the child’s performanceDevelops on the strengthsFills in the gaps in learningEnables child to achieve academic skills
26Important Points about Remedial Education One-to-one basis in a child friendly environment.Minimum one hour duration.Two to three sessions per weekR.E. should continue all the year round and not only during vacations or schooldays. However, the sessions could be intensified during the vacation.
27Cont…. 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.
28Key message L.D.commonly present as school problems Early detection :Early interventionClinical features vary with age & with achievement of developmental skillsMulti-disciplinary approachRemedial EducationProvisionsParent Support and school supportMVK NAGPUR 2009