Case presentation on Learning disability

According to DSM IV “Learning disorders are diagnosed when achievement on standardized tests in reading, mathematics or written expression is substantially below that expected for age, schooling and level of intelligence”.

National Joint Committee on Learning Disabilities (NJCLD) A heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning or mathematical abilities. These disorders are intrinsic to the individual and presumed to be due to Central Nervous System Dysfunction.

Conti…. Even though a learning disability may occur concomitantly with other handicapping conditions (e.g. sensory impairment, mental retardation, social and emotional disturbance) or environmental influences (e.g. cultural differences, insufficient/inappropriate instruction, psychogenic factors) it is not the direct result of those conditions or influences.

Information processing deficits Input Integration Storage output

Reading Disorder (ICD-10 and DSM-IV codes: F81.0/315.00) most common learning disability. 70%-80% have deficits in reading. The term "dyslexia" is often used as a synonym. it can affect any part of the reading process, including difficulty with accurate and/or fluent word recognition, word decoding, reading rate, prosody (oral reading with expression), and reading comprehension. Before it was known as "word blindness."

Writing Disorder (ICD-10 and DSM-IV codes F81.1/315.2) It includes impairment in handwriting, spelling, organization of ideas, and composition. The term "dysgraphia" is often used as an overarching term for all disorders of written expression. The International Dyslexia Association, use the term "dysgraphia" exclusively to refer to difficulties with handwriting.

Speech and language disorders can also be called Dysphasia/Aphasia (coded F80.0-F80.2/315.31 in ICD-10 and DSM-IV).

Math Disorder (ICD-10 and DSM-IV codes F81.2-3/315.1) Sometimes called dyscalculia, difficulties is seen in learning math concepts (such as quantity, place value, and time), difficulty memorizing math facts, difficulty organizing numbers, and understanding how problems are organized on the page. Dyscalculics are often referred to as having poor "number sense".

Nonverbal learning disability [this disorder is not listed in the ICD-10] Nonverbal learning disabilities often manifest in motor clumsiness, poor visual-spatial skills, problematic social relationships, difficulty with math, and poor organizational skills. These individuals often have specific strengths in the verbal domains, including early speech, large vocabulary, early reading and spelling skills, excellent rote-memory and auditory retention, and self-expression.

Dyspraxia Refers to a variety of difficulties with motor skills. Dyspraxia can cause difficulty with single step tasks such as combing hair or waving goodbye, multi-step tasks like brushing teeth or getting dressed, or with establishing spatial relationships such as being able to accurately position one object in relation to another.

Disorders of speaking and listening Difficulties that often co-occur with learning disabilities include difficulty with memory, social skills and executive functions (such as organizational skills and time management). Auditory processing disorder Difficulties processing auditory information include difficulty comprehending more than one task at a time and a relatively stronger ability to learn visually

ETIOLOGY Genetic predisposition Perinatal injury Neurological or medical conditions Pathology in encoding and working process. Abnormal symmetries in parietal and temporal lobe. Lesions in occipital lobe and corpus collosum

Visual or verbal deficits Lead poisoning Fetal alcohol syndrome Cerebral palsy Epileptic children Malnourishment

DSM IV Reading disorder “Is defined as reading achievement that is below the expected level for a child’s age, education and intelligence; the impairment significantly interferes with academic success or the daily activities that involve reading”

Mathematics disorder Is defined as impairment in four group of skills have been identified: Linguistic skills Perceptual skills Mathematical skills Attentional skills

Clinical manifestations

MODELS : Respond to intervention Student performance is monitored to determine whether increasingly intense intervention results in adequate progress. Those who respond will not require further intervention. Those who do not respond adequately to regular classroom instruction (often called "Tier 1 instruction") and a more intensive intervention (often called "Tier 2" intervention) are considered "nonresponders." These students can then be referred for further assistance through special education, in which case they are often identified with a learning disability.

In the United States, the 2004 reauthorization of the Individuals with Disabilities Education Act permitted states and school districts to use RTI as a method of identifying students with learning disabilities. RTI is now the primary means of identification of LD in Florida.

Assessment tests Gray Oral Reading Test IV – Fourth Edition (GORT IV), Gray Silent Reading Test, Comprehensive Test of Phonological Processing (CTOPP), Tests of Oral Reading and Comprehension Skills (TORCS), Test of Reading Comprehension 3 (TORC-3), Test of Word Reading Efficiency (TOWRE), Test of Reading Fluency.

Tests to identify the Woodcock-Johnson III (WJ III), Weschler Individual Achievement Test II (WIAT II), the Wide Range Achievement Test III (WRAT III), the Stanford Achievement Test–10th edition.

Interventions include: Mastery model: Learners work at their own level of mastery. Practice Gain fundamental skills before moving onto the next level Note: this approach is most likely to be used with adult learners or outside the mainstream school system.

Direct Instruction Highly structured, intensive instruction Emphasizes carefully planned lessons for small learning increments Scripted lesson plans Rapid-paced interaction between teacher and students Correcting mistakes immediately Achievement-based grouping Frequent progress assessments

Classroom adjustments: Special seating assignments Alternative or modified assignments Modified testing procedures Quiet environment

Special equipment: Electronic spellers and dictionaries Word processors Talking calculators Books on tape computer dictation programs

Classroom assistants: Note-takers Readers Proofreaders scribes

Special Education: Prescribed hours in a resource room Placement in a resource room Enrollment in a special school for learning disabled students individual education plan (IEP)

for patience listening