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October 04, 2019 Friday 11:00:05 AM IST

Learning Disorders

Personal Counseling

Disability is a matter of perception. If you can do just one thing well, you’re needed by someone.” -Martina Navratilova

Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible.” - St. Francis of Assisi

My advice to other disabled people would be, concentrate on things your disability doesn’t prevent you doing well, and don’t regret the things it interferes with. Don’t be disabled in spirit as well as physically.” -Stephen Hawking

A learning disorder (LD) or disability is best understood as neurological disorder with psychological consequences. It results from a difference in the way a person's brain is ‘wired’. Children with LD are as smart or smarter than their peers. But they may have difficulty in reading, writing, spelling, reasoning, recalling and/or organizing information. Our aim is not to ‘cure’ LD, but to face it as a challenge as it can be a lifelong issue. With the right support and intervention, children with LD can succeed in school and go on to have successful, often distinguished, careers later in life.Parents can help children with LD achieve such success by encouraging their strengths, knowing their weaknesses, understanding the education system, working with professionals and learning about strategies for dealing with specific difficulties.


Learning disabilities can be seen as neurologically-based processing problems which can interfere with learning basic skills such as reading, writing and/or mathematics.  They can also interfere with higher level skills such as organization, time-planning, abstract reasoning, long or short-term memory and attention.  It is important to realize that learning disabilities can affect an individual’s life beyond academics and can impact relationships with family, friends and in the workplace.

LD and Education:  Education is a fundamental right of every child. The educationsystem in India is very vast and there are about 150 million students enrolledin various schools in India. There is an observed increase of more than 100% in the Gross Enrolment Ratio in primary education,but almost 40% of the students drop out of schools beforecompletingtheir primary education, one of the main reasons for this being the lack of a holistic education that caters to theneeds of every child. The education system is responsible for providing knowledge to the student in a way that he/she is receptive to. Unfortunately, neither teachers nor parents areunaware of the differentteaching methods and the problems that can interfere with learning. Each studenthas a different learning habit and ability. Learning style is unique to each individual.However, some students cannotlearn efficiently due to specific breakdown in the learning processinvolving listening, thinking, perceiving, memory and expression.Such difficulties are known as Specific Learning Disabilities.Learning disorders are diagnosed when, on an individually administered, standardized tests in reading, math or written expression, the individual has a substantially low score than expected in respect ofhis age, schooling, and level of intelligence. That itself should take you to the clue that this phenomenon is different from intellectual disability (mental retardation).

Learning disability describes a range of learning problems which are due to the problems with the brain getting, using, storing and sending out information. As many as 15% of children have a LD and they may have trouble with one or more of the following skills: reading, writing, listening, speaking, reasoning, and math and is not because of intellectual disability or any other disorders of mind or due to impairment in hearing or vision. The most common type of LD is a reading disorder.Studentssuffering from these conditions are termed as lazy, irresponsive, etc.,and are subjected to a lot of harassment in their school and community. They soon becomesusceptible to rejection and as a result, drop out from the schools.Having a parent or relative with any learning difficulties, low birth weight and prematurity, or an injury or illness during childhood (head injury, lead poisoning, a childhood illness like meningitis), etc. may put one at risk of developing learning disorder.

Common Learning Disorders (LD)


·        Dyslexia – a language-based disability in which a person has trouble understanding written words. It may also be referred to as reading disability or reading disorder.

·        Dyscalculia – a mathematical disability in which a person has a difficult time solving arithmetic problems and grasping math concepts.

·        Dysgraphia – a writing disability in which a person finds it hard to form letters or write within a defined space.

·        Auditory and Visual Processing Disorders - sensory disabilities in which a person has difficulty understanding language despite normal hearing and vision.


·        Non-verbal Learning Disabilities - a neurological disorder which originates in the right hemisphere of the brain, causing problems with visual-spatial, intuitive, organizational, evaluative and holistic processing functions.

Child with dyslexia or reading disorder has difficulty in remembering the names of letters and the sounds they make, understanding that words are made up of sounds and that letters stand for those sounds, sounding out words correctly and at the right speed,spelling words correctly and in understanding what they read.Child with dysgraphia or writing disorder can have difficulty in using a pen or pencil, remembering how letters are formed, copying shapes, drawing lines, or spacing things out correctly, organizing and writing their thoughts, feelings, and ideas on paper and in spelling and punctuation.Child with math disorder may have problems with recognizing and drawing shapes, math concepts such as number values, quantity, and order, understanding time, money, and measuring and in fractions, percentages, geometry, and algebra.  In addition to this, the child may also exhibit emotional problemsmainly due to poor academic performance. They are also found to have attention and concentration difficulties, socialization difficulties, low frustration tolerance, poor impulse control, poor speech and language development and hyperactivity.

Indicators of Learning Disorders (LD)

At a pre-school level:


·        Delays in language development and difficulty in speaking.

·        Trouble with learning colours, shapes, letters, words and numbers.

·        Trouble with coordination (buttoning, copying a circle, square, or triangle).

·        Short attention spans.


At school level

·        Difficulty in understanding and following instructions.

·        Trouble with remembering what someone just told him or her.

·        Fails to master reading, spelling, writing, and/or math skills, and thus fails in class.


·        Difficulty in telling right from left; difficulty in identifying words or a tendency to reverse letters, words, or numbers (for example, confusing 25 with 52, ‘b’ with ‘d’, or ‘on’ with ‘no’)

·        Lacks coordination in walking, sports, or small activities such as holding a pencil or tying a shoelace.

·        Easily loses or misplaces homework, schoolbooks, or other items.

·        Difficulty understanding the concept of time; is confused by ‘yesterday, today, tomorrow’.


Management

The cornerstone of treatment of LD is remedial (‘special’) education. Considering thecentral nervous system’s higher plasticity in earlyyears, this should begin early when in primary school itself. An Individual Educational Programme using specific teaching strategies and teaching materials reduces or eliminates the child’s deficiencies in specific learning areas of learning. The child has to undergo remedial education sessions twice or thrice weekly for a few years to achieve academic competence.

An important first step is a comprehensive evaluation by an expert to assess all the different issues affecting the child such ascommunication, self-help skills, willingness to accept discipline, impact on play, and capacity for independence. A detailed understanding of the family, reviewing the academic performance, and consulting the school are often needed. Appropriate school placement, help from special educational services or speech-language therapy are required. Parents may have a pivotal role to play -assist their child in maximizing their learning potential. Addressing other problems of the child as well as the family is also necessary.  Medication may be prescribed for hyperactivity or inattention. Most of the kids with learning disorders have depressive symptoms which also needs prompt management. It is important to strengthen the child's self-confidence and also help parents and other family members better understand and cope with the realities of living with a child with learning disorders.

The curriculum in all the teacher education programmes shouldinclude a specific course on the curriculum and instruction for children with special needsso that teachers have the necessaryskills to teach children with Specific LD. Simple interventions such as seating the childnear the teacher minimize classroom distractions and improve the behaviour and academicperformance of children. Teachers can also help the student by explaining what is expected of them with each new session and by making sure that they have learned the previous lessons.The school authorities have an important role to play by ensuring the presence of the remedial teacher. Remedial teachers may work for particular goals as mandated by anIndividualized Education Programme and remediategeneral education curriculum. They also emphasizethe development of executive skills, including homework completion and behaviour. These LD-friendly schools should maintain a proper register of these children tomonitor their academic progress and to get thebenefit of provisions in the examinations. They also ensure that the regular teachers undergo training in Specific LD.


Focus on the child’s strength: Identify the special talents as well as weaknesses. He or she might be good at math, music, or sports or could be skilled at art, working with tools, or caring for animals. Don’t forget to praise them whenever they do well or succeed at a task.

Develop social and emotional skills: The challenges of growing up,combined with the learning disability,can make your child sad, angry, or withdrawn. Acknowledging that learning is hard for them because their brain learns in a different way, is a very important step. Being into groups and participating in activities may build confidence.

Plan for the future:Many people with LDs are very bright and you can encourageyour children to consider their strengths and interests when making education and career choices. Make sure that you don’t force them to take the career of your choice.

Indian scenario


In India with its cultural, lingual and social diversity, students often learn through a medium or a language that is different from mother tongue. This makes the diagnosis of these disorders very difficult. Moreover, the emphasis on theory-oriented learning rather than application-oriented learning is ill-suited for students with SLDs. However, during the last two decades, there has been an increasing rate of awareness and identification of children with LD in India.

Advocacy for LD

The Rights of Persons with Disability Act has included the SpecificLearning Disabilities among the 19 disability conditions. The legislative approach varies from one State to another and also across various boards of examination. Maharashtra remains theonly State where children with SLD are trained to take examinations,incorporating the provisions, from primary classes onwards.

Provisions for children undergoing training under different educational boards:


ICSE:

·                    Extra time - 15 minute/per hour or 25% of total timeextra;

·                    Exemption from second language: students need not takeanother subject in lieu;

·                    Use of calculator in some cases, for mathematics;


·                    Question paper will be read out to the student;

·                    Use of a writer, if required, as per the rules.

CBSE :

·                    Use of a writer as per the rules of the board;


·                    Additional 1 hour for each paper; and

·                    One compulsorylanguage as against 2, in addition to any 4 of the following subjects:mathematics, science, social science, another language, music,painting and home science.

SSLC:  

·        Children with learning disability are not eligible for grace mark.


·        Service of Scribe or Interpreter (Any One) will be permitted.

·        Dyslexia:

i) Additional time of 10 minutes per hour per paper;

 ii) Assistance of an Interpreter, if necessary.


·        Dysgraphia:

i) Additional time of 10 minutes per hour per paper

ii) Exemption from either Malayalam or English and also Hindi if necessary. Instead, they can opt forsubjects like (a) Computer Education,(b) Horticulture,(c) Catering and (d) Drawing & Painting. Since thereare two papers in Malayalam, any two of the subjects have to be selected while exemptingMalayalam.

 iii) A scribe will be permitted, if required.


·        Dyscalculia:

i) Exemption from Mathematics and permitted to opt subjects from Computer Education, Ratoon work,Vocal music, Instrumental music

 ii) Assistance of an interpreter for mathematics only, if required

 iii) Additional time of 10 minutes per hour per paper


Conclusion:  Since difficulties with reading, writing and/or mathematics are recognizable problems during the school years, the signs and symptoms of learning disabilities are most often diagnosed during that time.  However, some individuals do not receive an evaluation until they are in post-secondary education or adults in the workforce.  Other individuals with learning disabilities may never receive an evaluation and go through life, never knowing why they have difficulties with academics and why they may be having problems in their jobs or in relationships, with family and friends. Learning disabilities should not be confused with learning problems which are primarily the result of visual, hearing, or motor handicaps; of intellectual disability; of emotional disturbance; or of environmental, cultural or economic disadvantages. Generally, people with learning disorder or disabilities (LD) are of average or above average intelligence. There often appears to be a gap between the individual’s potential and actual achievement. Hence LD is often referred to as ‘hidden disability’: The person looks perfectly ‘normal’ and seems to be a very bright and intelligent person, yet may be unable to demonstrate the skill level expected from someone of a similar age. LD is best seen as a lifelong challenge where with appropriate support and intervention, those affected can achieve success in school, at work, in relationships, and in the community. And that should be recognised at the earliest opportunity possible!


Prof Roy Abraham Kallivayalil & Dr Soumya P Thomas

*Prof. Roy Abraham Kallivayalil MD,DPM
Secretary General, World Psychiatric Association   
Professor & Head, Dept of Psychiatry

Pushpagiri Institute of Medical Sciences,  

Tiruvalla, Kerala- 689 101, India

                   &

**Dr Soumya P Thomas MD

Senior Resident

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