CHARACTERISTICS - SpLD

Specific Learning DisabilityDr Anjana ThadhaniConsultant Developmental PediatricianSpecific Learning DisabilitiesGroup of developmental disordersSignificant 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 opportunitySalient FeaturesTypes: Dyslexia Dysgraphia DyscalculiaCreates a significant gap between the potential and academic performance Prevalence - 10% of school going childrenDifficulty with information processingLEARNING INFORMATION PROCESSINGRECORDING INFORMATION (INPUT) PerceptualVisualAuditoryINTEGRATIONSequencingAbstractionOrganization

STORAGE (MEMORY)Short termLong term

READINGPhonological awarenessLetter-sound associationDecoding & Blending Focus on printed wordsControl of eye movements across the pageProcessing of images and ideasComparisons and associations of ideasStoring of the information into memory

CAUSES

Neuro-developmental conditionMulti-factorialGenetic predispositionADHD - Strong associationCO-MORBIDITYGENETICS In 1950, Hallgren, an autosomal dominant disorderRecent findings:Dyslexia is a genetically heterogeneous and complex trait that does not show classical mendelian inheritanceSeveral chromosomal regions & genes affecting reading disability (chromosome 1, 2, 3, 6, 15, 18)NEUROIMAGINGAbsence of usual asymmetry of planum temporale (portion of temporal lobe lying posterior to Heschls gyrus)Left is usually larger than rightNeuronal ectopias in frontal and parietal regionsCLINICAL CHARACTERISTICSMANIFESTATIONS Varied spectrum presentationMild to severeAcademic Behavioral Co-morbidity Psychosocial

REFERRAL LETTER Repeated failuresDoes not write or readSpelling mistakesOral work better than written workProblems in math

PRE-SCHOOLEARLY POINTERSDevelopmental delaysMild gross motor delaysFine motor problemsSpeech delay or difficultiesLack of dominant handednessPerceptual problems AUDITORY PERCEPTIONAuditory perceptionAuditory discriminationAuditory memory & sequencingAuditory filteringAuditory processing

VISUAL PERCEPTIONVisual perceptionVisual discriminationVisual memory & sequencingForm constancyVisuomotor integrationFigure ground discrimination

THE RED HOUSE

RED HOUSE & TREE

RED HOUSE, TREE & SUN

Learning ConcernsDifficulty in pronouncing words. Poor phonological awarenessDifficulty 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.

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.

Behavioral concernsHyperactivityDifficulty in following instructionsSlow in ADLsStubborness Temper tantrumsPRIMARY & SECONDARY SCHOOLDyslexiaAvoids reading aloudReads slowlyUses finger tracing Looses place or skips words Mispronounces or guesses wordsHas difficulty decoding or blending single words

24 Relies heavily on memorizing without understanding.Poor comprehensionGives stress on wrong syllablesReads with substitutionWhile reading makes up his own storiesPoor memory & recall DysgraphiaSlow in writing or may avoid writing.Often uses an awkward pencil grip ( fist, thumb hooked over finger, etc.)Writes with illegible handwritingPoor letter formationsUntidy written workUses inappropriate pressureUneven size of letters with poor spacing

Spelling mistakesBizarre spellingSpells the same word differently Punctuation & capitalization errors.Mixes upper & lowercase letters Problems with copy writing

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.

Spelling errorsAmount aomuntAwards awordsConsent consetRecent resentDomestic domisticBrain brianMethod - matheod DyscalculiaMay transpose number sequences , 231 as 312Confuse arithmetic signs. (+ - * / = )Has trouble with word problems Poor in mental mathsDifficulty in learning tablesCounting on fingers may be seenDifficulty in carrying over or borrowing sumsMay count from left to rightPoor in geometry Poor in algebraOther concernsAppears 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)

Difficulty following step by step instructionsDifficulty in telling timeDifficulty in telling/ following directionsSlow in ADLsPoor understanding of abstractDisorganized behavior and thoughts

Associated behavioral issues..HyperactivityDay dreamingPoor peer relationsAggressive behaviorPoor participationPyschosocial concernsPoor self esteemPoor self confidencePoor interpersonal relationsEmotional lability

Strengths Sensitive & compassionateGood at mechanical workGood at sportsUsually good dancersGood at cooking & eating too

Key Messages Hidden HandicapNeurological DisorderPresent since BirthMulti-factorialEssentially Normal childAverage / above average IntelligenceTo SummarizeEvery learning problem is not a Learning DisabilityWith early intervention & provisions, they can be mainstreamedSecondary behavioral problems need effective management.THANK YOU