Dr Anjana Thadhani Consultant Developmental Pediatrician
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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
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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
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LEARNING INPUTPROCESSINGOUTPUT
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INFORMATION PROCESSING RECORDING INFORMATION (INPUT) Perceptual
Visual Auditory INTEGRATION Sequencing Abstraction Organization
STORAGE (MEMORY) Short term Long term
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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
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)
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NEUROIMAGING Absence of usual asymmetry of planum temporale
(portion of temporal lobe lying posterior to Heschls gyrus) Left is
usually larger than right Neuronal ectopias in frontal and parietal
regions
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MANIFESTATIONS Varied spectrum presentation Mild to severe
Academic Behavioral Co-morbidity Psychosocial
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REFERRAL LETTER Repeated failures Does not write or read
Spelling mistakes Oral work better than written work Problems in
math
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EARLY POINTERS
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Developmental delays Mild gross motor delays Fine motor
problems Speech delay or difficulties Lack of dominant handedness
Perceptual problems
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.
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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.
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Behavioral concerns Hyperactivity Difficulty in following
instructions Slow in ADLs Stubborness Temper tantrums
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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
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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
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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
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Spelling mistakes Bizarre spelling Spells the same word
differently Punctuation & capitalization errors. Mixes upper
& lowercase letters Problems with copy writing
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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.
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
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Difficulty in carrying over or borrowing sums May count from
left to right Poor in geometry Poor in algebra
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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)
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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
Strengths Sensitive & compassionate Good at mechanical work
Good at sports Usually good dancers Good at cooking & eating
too
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Key Messages Hidden Handicap Neurological Disorder Present
since Birth Multi-factorial Essentially Normal child Average /
above average Intelligence
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To Summarize Every learning problem is not a Learning
Disability With early intervention & provisions, they can be
mainstreamed Secondary behavioral problems need effective
management.