Psychological intervention for specific learning disability: A case report

Psychological intervention for specific learning disability

International Archives of Integrated Medicine, Vol.

Copy right © 2014, IAIM, All Rights Reserved.

Case Report

Psychological intervention for specific

learning disability: A case report

1Clinical Psychologist

*Corresponding author email:

How to cite this article: Neelam Verma

case report. IAIM, 2014; 1(4): 86

Available online at

Received on: 20-11-2014

Abstract

Cognitive deficits resulting in poor scholastic performance are common among children with

learning disabilities. Current study was carried out to identify areas of deficits leading to poor

academic performance followed by a home based remediation

impaired skills. Single case study method was opted and assessment of academic skills was done

using NIMHANS Index for Specific Learning Disability (SLD). Assessment findings revealed significant

impairment in scholastic skills and attention

planned and weekly sittings of remediation were provided for six months. Monitoring of the

rehabilitation package was done on every visit using charting method. Improvement in academic

skills/ performance was seen in later sessions.

Key words

Specific learning disability, Cognitive Impairments, Scholastic d

cognitive retraining.

Introduction

Learning disabilities are generally a composition

of deficits in certain skills such as basic reading

skills, reading comprehension, written

expression, receptive and expressive language

i.e. listening and speaking respectively,

mathematical reasoning and

calculation. Many of these deficits are generally

present together and type of disability may vary


International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014.




Neelam Verma1*

Clinical Psychologist, Nur Manzil Psychiatric Centre, Lucknow, India

*Corresponding author email: [email protected]

Neelam Verma. Psychological intervention for specific learning disability: A

86-90.

Available online at www.iaimjournal.com

2014 Accepted on:

Cognitive deficits resulting in poor scholastic performance are common among children with

isabilities. Current study was carried out to identify areas of deficits leading to poor

academic performance followed by a home based remediation program for rehabilitation of



ls and attention processes. Management of identified deficits was



performance was seen in later sessions.

nitive Impairments, Scholastic decline, Remedial t

Learning disabilities are generally a composition

of deficits in certain skills such as basic reading

skills, reading comprehension, written

expression, receptive and expressive language

i.e. listening and speaking respectively,

mathematical reasoning and mathematical

calculation. Many of these deficits are generally

present together and type of disability may vary

as per their presence such as disorder of

reading, disorder of writing, disorder of spelling

and disorder of mathematical skills. Plenty of

literature is available on origin and controversie

involved in the diagnosis of specific learning

disabilities; however, researchers have proved

their efficacy to advocate the term adequately.

In past some time there has been a boom in

researches related to a

rehabilitation of such disabilities; however,

ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Page 86



, India

[email protected]

Psychological intervention for specific learning disability: A

Accepted on: 01-12-2014

Cognitive deficits resulting in poor scholastic performance are common among children with specific

isabilities. Current study was carried out to identify areas of deficits leading to poor

program for rehabilitation of



processes. Management of identified deficits was



Remedial training, Manualized

as per their presence such as disorder of

reading, disorder of writing, disorder of spelling

and disorder of mathematical skills. Plenty of

rature is available on origin and controversies

involved in the diagnosis of specific learning

isabilities; however, researchers have proved

their efficacy to advocate the term adequately.

In past some time there has been a boom in

researches related to assessment and

rehabilitation of such disabilities; however,




there is lot more to explore in the mentioned

condition. Rehabilitation programs for sufferers

of Specific Learning Disabilities have been found

to be effective and current research was an

attempt to prove the efficacy of available

programs/ treatment modalities.

Case report

A nine years old boy was brought by his parents

with the complaint of poor academic skills

resulting in frequent deterioration in academic

performance and failure in grade III. Owing to

the complaints psychological assessment was

planned. Basic assessment of his comprehension

and general awareness skills was done during

clinical interview. Samples of reading and

writing ability were also taken. Overall basic

assessment did not suggest any intellectual

deficit; however, learning difficulties were found

to be prominent. Formal assessment of

intellectual functioning and learning disability

was done using Malin’s Intelligence Scale for

Indian Children (MISIC) [1] and NIMHANS Index

for Specific Learning Disability (SLD)

respectively. On formal assessment, his

intellectual functioning was found to be above

average and learning disability was significant

for reading, writing and spellings. Impairment in

attention skill was also identified. Psychological

management was planned and sessions were

spread into 24 sittings; once a week.

Simultaneous home based intervention program

was also initiated. Areas of deficit identified on

SLD assessment were targeted for rehabilitation.

Weekly assessment of target behaviors i.e. poor

scholastic/academic skills and poor cogniti

skills was done using behavioral charting to see

efficacy of remedial aids and cognitive

retraining.

The therapeutic module

Therapeutic work was started with psycho

education of parents. They were explained




there is lot more to explore in the mentioned

condition. Rehabilitation programs for sufferers

of Specific Learning Disabilities have been found

to be effective and current research was an

to prove the efficacy of available

programs/ treatment modalities.

A nine years old boy was brought by his parents

with the complaint of poor academic skills

resulting in frequent deterioration in academic

performance and failure in grade III. Owing to

the complaints psychological assessment was

of his comprehension

and general awareness skills was done during

clinical interview. Samples of reading and

writing ability were also taken. Overall basic

assessment did not suggest any intellectual

deficit; however, learning difficulties were found

prominent. Formal assessment of

intellectual functioning and learning disability

was done using Malin’s Intelligence Scale for

and NIMHANS Index

for Specific Learning Disability (SLD) [2]

respectively. On formal assessment, his

intellectual functioning was found to be above

average and learning disability was significant

for reading, writing and spellings. Impairment in

attention skill was also identified. Psychological

management was planned and sessions were

tings; once a week.

Simultaneous home based intervention program

was also initiated. Areas of deficit identified on

SLD assessment were targeted for rehabilitation.

Weekly assessment of target behaviors i.e. poor

scholastic/academic skills and poor cognitive

skills was done using behavioral charting to see

efficacy of remedial aids and cognitive

Therapeutic work was started with psycho

education of parents. They were explained

about child’s clinical condition and its

association with academic difficulties leading to

deterioration in scholastic performance.

Importance of treatment adherence and

compliance toward therapeutic work was

explained to them. Areas of deficits on SLD

assessment were opted as target behaviors for

the therapy. Strategies to deal with them were

explained as well. Each strategy was practiced in

subsequent sessions and taught to the parents.

A parallel home based intervention program was

also initiated using the same strategies. Target

behaviors for the remediation involved:

1) Improving attention skills

2) Enhancing reading skills

3) Enhancing writing skills

4) Improving spelling ability

In order to improve attention skills various

methods of cognitive retraining were used like

letter/color/number cancellation ta

tasks, auditory continuous performance and

games like spot the difference between same

looking pictures. Remediation of reading skills

was done using whole word approach, working

on improving phonetic skills, using reading drills

and paired reading. Improvement in writing

skills involved improvement in hand writing,

improving writing speed, reducing punctuation

errors and improving vocabulary to use mature

words while writing. In order to do the same

strategies for improving writing abilities

used like regular one page writing with use of

timer (to control time limit while writing), proof

reading and self correction, inserting and

correcting punctuations in running paragraphs

along with regular learning of new words from

dictionary. For improving spelling skills various

spelling games were used such as scrabble, find

the hidden words, crossword puzzles etc.

Results and outcome of therapy

Improvement was noticed in child’s

performance by reviewing parent’s weekly

reports. No improvement was reported in first

ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Page 87

about child’s clinical condition and its

ociation with academic difficulties leading to

deterioration in scholastic performance.

Importance of treatment adherence and

compliance toward therapeutic work was

explained to them. Areas of deficits on SLD

assessment were opted as target behaviors for

he therapy. Strategies to deal with them were

explained as well. Each strategy was practiced in

subsequent sessions and taught to the parents.

A parallel home based intervention program was

also initiated using the same strategies. Target

e remediation involved:

Improving attention skills

Enhancing reading skills

Enhancing writing skills

Improving spelling ability

In order to improve attention skills various

methods of cognitive retraining were used like

letter/color/number cancellation tasks, coloring

tasks, auditory continuous performance and

games like spot the difference between same

looking pictures. Remediation of reading skills

was done using whole word approach, working

on improving phonetic skills, using reading drills

eading. Improvement in writing

skills involved improvement in hand writing,

improving writing speed, reducing punctuation

errors and improving vocabulary to use mature

words while writing. In order to do the same

strategies for improving writing abilities were

used like regular one page writing with use of

timer (to control time limit while writing), proof

reading and self correction, inserting and

correcting punctuations in running paragraphs

along with regular learning of new words from

proving spelling skills various

spelling games were used such as scrabble, find

the hidden words, crossword puzzles etc.

herapy

Improvement was noticed in child’s

performance by reviewing parent’s weekly

reports. No improvement was reported in first




week of therapy; however, improvement was

noticed after second week onwards. Weekly

charting of target behaviors revealed improved

attention as seen on attention tasks where child

took less time to complete the task as compared

to earlier. Improvement in reading skills was

noted from the fluency of reading and reduced

hesitation. Improvement in spelling ability could

be noted as he took less time to solve puzzles,

reduced spelling errors and also he could

identify words in a word grid more quickly.

Improvement was also noted in child’s writing

skills as neatness was seen in his hand writing,

speed of writing also improved with help of

timers and punctuation errors reduced

significantly. Weekly progress of therapy and

improvement in target skills was as per

1.

Analysis of graph

The graphical pattern clearly shows significant

decrement in time taken for writing particular

amount of text; thus shows improved writing

speed over the therapy weeks. Frequency of

hesitation (while reading) decreased significantly

in later weeks of therapy. The child took less

time to complete attention tasks over therapy

weeks that indicates improved att

concentration. Punctuation errors were noted

less in the last week of therapy that indicates

improved quality of writing. Also, spelling errors

were noted to be reduced as therapy progressed

in later weeks. Improvement can be seen in

target behaviors by comparing trends of second

week and sixth week of the shown graph that

indicates significant progress of the therapy.

Discussion

Learning disabilities are described as a group of

disorders that are characterized by inadequate

or insufficient development of specific

academic, language and speech skills

Learning disabilities are generally described




week of therapy; however, improvement was

noticed after second week onwards. Weekly

revealed improved

ention as seen on attention tasks where child

took less time to complete the task as compared

to earlier. Improvement in reading skills was

noted from the fluency of reading and reduced

hesitation. Improvement in spelling ability could

less time to solve puzzles,

reduced spelling errors and also he could

identify words in a word grid more quickly.

Improvement was also noted in child’s writing

skills as neatness was seen in his hand writing,

speed of writing also improved with help of

ers and punctuation errors reduced

significantly. Weekly progress of therapy and

was as per Graph -

The graphical pattern clearly shows significant

decrement in time taken for writing particular

f text; thus shows improved writing

speed over the therapy weeks. Frequency of

hesitation (while reading) decreased significantly

in later weeks of therapy. The child took less

time to complete attention tasks over therapy

weeks that indicates improved attention and

concentration. Punctuation errors were noted

less in the last week of therapy that indicates

improved quality of writing. Also, spelling errors

were noted to be reduced as therapy progressed

in later weeks. Improvement can be seen in

viors by comparing trends of second

week and sixth week of the shown graph that

indicates significant progress of the therapy.

Learning disabilities are described as a group of

disorders that are characterized by inadequate

elopment of specific

academic, language and speech skills [3].

Learning disabilities are generally described

under broad categories of information or

learning processes that involve input

(receiving/perceiving information through

senses), integration (inte

received stimuli), storage (repetition and

memorization of stimuli) and output (the stage

where stored information is recalled or

recollected) [4]. Deficits in any of the areas of

information processing may contribute to

different types of specific learning disabilities

and a person may have one or more than that at

the same time [5]. Individuals with such

disabilities experience significant impairment in

all areas of academics which cannot be

accounted due to low level of intellectual

functioning, visual deficit, neurological damage

or inadequate educational environment

There is plethora of researches available

displaying important findings about such

treatment modalities and shows great success of

the same. Researches also indicated

effectiveness of neuropsychological

rehabilitation for treating learning disabilities

and are well established [7]

included two types of treatment modalities i.e.

remedial training and cognitive retraining. The

aim of the case work was

cognitive and academic skills to improve his

academic performance. The child was given

intensive remedial sessions along with a parallel

home based remediation program supervised by

his parents. Weekly review of progress chart

revealed improvement in target behaviors. If we

review the literature various studies have shown

changes in brain functioning after intensive

remediation programs given to such individuals.

Studies using functional magnetic resonance

imaging (FMRI) have shown vigor

neuroplastcity [8]. This is a process by which

new connections are made among neurons by

themselves. Researches comparing two

experimental groups indicated that brain

function changes were evident in neuro imaging

of those who attended intensive remedia

ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Page 88

under broad categories of information or

learning processes that involve input

(receiving/perceiving information through

senses), integration (interpretation of the

received stimuli), storage (repetition and

memorization of stimuli) and output (the stage

where stored information is recalled or

Deficits in any of the areas of

information processing may contribute to

f specific learning disabilities

and a person may have one or more than that at

Individuals with such

disabilities experience significant impairment in

all areas of academics which cannot be

accounted due to low level of intellectual

ctioning, visual deficit, neurological damage

or inadequate educational environment [6].

There is plethora of researches available

displaying important findings about such

treatment modalities and shows great success of

the same. Researches also indicated

effectiveness of neuropsychological

rehabilitation for treating learning disabilities

[7]. Current case work

included two types of treatment modalities i.e.

remedial training and cognitive retraining. The

aim of the case work was to work on child’s

cognitive and academic skills to improve his

academic performance. The child was given

intensive remedial sessions along with a parallel

home based remediation program supervised by

his parents. Weekly review of progress chart

mprovement in target behaviors. If we

review the literature various studies have shown

changes in brain functioning after intensive

remediation programs given to such individuals.

Studies using functional magnetic resonance

imaging (FMRI) have shown vigor of

. This is a process by which

new connections are made among neurons by

themselves. Researches comparing two

experimental groups indicated that brain

function changes were evident in neuro imaging

of those who attended intensive remedial




program as compared to those who were not

given such treatment. Reduced activation in left

parieto-temporal cortex in children that has

been found to be characteristic of learning

disabilities [9] was found to be increased after

rigorous training and remediation program for

learning disabilities [10]. In recent years there

has been a boom in researches proving efficacy

of psychological management for learning

disabilities; however, there have been

purposes to conduct them. Few indicated

importance of particular treatment modality

where others advocated efficacy of results

based on type and severity of learning disability.

Some researchers showed efficacy of

computerized training for treati

disabilities [11]. On the other hand manualized

treatment gave well established results in such

conditions [12]. Plenty of literature is available

in this field; however there is lot more to find

out in future researches.

Conclusion

Combination of Manualized Cognitive Retraining

Techniques and Remedial Training can benefit

individuals with Specific Learning Disability and

give best results in improving scholastic

performance. Manualized techniques are also

important and beneficial for those who cannot

bear the cost of computerized retraining. Also, a

parallel home based intervention program gives

strength to the therapeutic process and ensures

better outcome. In current case, improvement

was noticed in the target behaviors, thus

efficacy of both treatment modes along with

parallel home based retraining program could

be proven.

References

1. Malin AJ. Malin’s Intelligence Scale for

Indian Children- Manual. Indian

Psychological Corporation




program as compared to those who were not

given such treatment. Reduced activation in left

temporal cortex in children that has

been found to be characteristic of learning

was found to be increased after

rigorous training and remediation program for

. In recent years there

has been a boom in researches proving efficacy

of psychological management for learning

disabilities; however, there have been different

purposes to conduct them. Few indicated

importance of particular treatment modality

where others advocated efficacy of results

based on type and severity of learning disability.

Some researchers showed efficacy of

computerized training for treating learning

. On the other hand manualized

treatment gave well established results in such

. Plenty of literature is available

in this field; however there is lot more to find

Combination of Manualized Cognitive Retraining

Techniques and Remedial Training can benefit

individuals with Specific Learning Disability and

give best results in improving scholastic

performance. Manualized techniques are also

those who cannot

bear the cost of computerized retraining. Also, a

parallel home based intervention program gives

strength to the therapeutic process and ensures

better outcome. In current case, improvement

was noticed in the target behaviors, thus

cy of both treatment modes along with

parallel home based retraining program could

Malin AJ. Malin’s Intelligence Scale for

Manual. Indian

Psychological Corporation, 1969.

2. Rao S, Subbakrishna DK, Gopukumar K.

NIMHANS Neuropsychology Battery

Manual. NIMHANS, Bangalore

3. Wadsworth T. Childhood Voyages in

Development; 3rd

edition

Retrieved 2012-12-19.

4. National Dissemination Center for

Children with Disabilities (NICHY), 2004.

Accessed May 11, 2007.

5. Amanda Kirby speaking on the co

occurrence of learning difficulties

dysTalk. Retrieved 2009

6. Sadock B.J., Sadock V.A.

Psychiatry; Behavioral Sciences/Clinical

Psychiatry. 10th

edition

(India) Pvt. Ltd., New Delhi

7. Malhotra S, Rajender G, Sharma V, Singh

TB. Efficacy of cognitive retraining

techniques in children with learning

disability. Delhi Psychiatry J

100-106.

8. Tom Valeo. Dyslexia

Neuroplasticity at

Foundation, New York

9. Temple, et al. Disruption of the neural

response to rapid

dyslexia: Evidence from functional

MRI. Proc Natl Acad Sci USA

13907–13912.

10. Temple, et al. Neural deficits in children

with dyslexia ameliora

remediation: Evidence from functional

MRI. Proc Natl Acad Sci USA

2860–2865.

11. Talbot F, Pépin M

Computerized cognitive training with

learning disabled students:

Psychol Rep. Dec, 1992

1347-56.

12. Malhotra S., et al. Comparative Efficacy

of Cognitive Retraining Techniques and

Remedial Training in Children with

Learning Disability, Delhi Psychiatry J

2010; 13(2): 334-338

ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Page 89

krishna DK, Gopukumar K.

NS Neuropsychology Battery

NIMHANS, Bangalore, 2004.

Childhood Voyages in

dition, 2008, p. 387.

19.

National Dissemination Center for

Children with Disabilities (NICHY), 2004.

Accessed May 11, 2007.

Amanda Kirby speaking on the co-

occurrence of learning difficulties.

. Retrieved 2009-04-22.

Sadock B.J., Sadock V.A. Synopsis of

; Behavioral Sciences/Clinical

edition, Wolters Kluwer

(India) Pvt. Ltd., New Delhi, 2007.

Malhotra S, Rajender G, Sharma V, Singh

TB. Efficacy of cognitive retraining

techniques in children with learning

disability. Delhi Psychiatry J, 2009; 12(1):

Dyslexia Studies Catch

Work, The Dana

York, 2008.

Disruption of the neural

acoustic stimuli in

vidence from functional

Proc Natl Acad Sci USA, 2000; 97:

et al. Neural deficits in children

with dyslexia ameliorated by behavioral

vidence from functional

Proc Natl Acad Sci USA, 2003; 100:

épin M, Loranger M.

Computerized cognitive training with

learning disabled students: A pilot study.

, 1992; 71(3 Pt 2):

t al. Comparative Efficacy

of Cognitive Retraining Techniques and

Remedial Training in Children with

Learning Disability, Delhi Psychiatry J,

338.




Graph – 1: Graphical presentation of weekly progress of target behaviors

Source of support: Nil

48

45

3029

23

15

26

21

16

111012

0

10

20

30

40

50

60

week2 week3 week4




Graphical presentation of weekly progress of target behaviors.

Nil Conflict of interest:

30 31

26

1513 12

19

13

7

12

9

4

8

5 4

week4 week5 week6

Writing Speed (In Mins)

Frequncy of hesitation while

reading

Attention Time (In Mins)

Frequency in punctuation

error

Frequncy in Spelling error

Linear (Writing Speed (In

Mins))

Linear (Frequncy of hesitation

while reading)

Linear (Attention Time (In

Mins))

ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Page 90

Conflict of interest: None declared.

Writing Speed (In Mins)

Frequncy of hesitation while

Attention Time (In Mins)

Frequency in punctuation

Frequncy in Spelling error

Linear (Writing Speed (In

Linear (Frequncy of hesitation

while reading)

Linear (Attention Time (In

Documents

Psychological intervention for specific learning disability: A case report