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Original Article

Neuro-Cognitive Functioning in Children with
Learning Difficulties
Shahzadi Malhotra*, Gaurav Rajender**, Vibha Sharma*, T.B. Singh*, M.S. Bhatia**
* Department of Clinical Psychology, Institute of Human Behaviour and Allied Sciences (IHBAS)
** Department of Psychiatry, UCMS & GTB Hospital, Delhi

Learning difficulties can occur due to complex interplay of factors that may reside in the child’s
own constitution, temperament and cognitive abilities and/or in the background and quality of
child’s schooling and/ or in family related factors that affect interactions and emotional well
being of the child. Aims & Objectives: To study the neuro-cognitive functioning of children
with learning difficulties . Method: Forty children studying in English medium schools in Delhi
from Grade 2nd to 5th who were reported to be having learning difficulties. The children were
divided into two groups (n=20, each.) One of the groups had children having learning disability.
The other group had children with learning difficulties but without any diagnosable psychiatric/
emotional/ behavioural problems. All children were assessed for their intelligence, scholastic
performance (on three basic subjects- Hindi, English and Mathematics)); Sustained attention;
Verbal Working Memory, Visual Learning and Memory; Verbal Learning and Memory , Verbal
Comprehension, Visuo-Constructive Ability and Visuo-Conceptual Skills. Conclusions:Both the
groups had impairment in assessed neuro-cognitive skills. Children with learning disability
had significantly poorer performance on tasks of sustained attention, visual memory and learning
, delayed recall and visuo constructive skills. There were no differences among children on
other assessed functions.
Keywords: Neurocognitive functioning, Learning difficulties, Children
Estimates of the school and study related
problems vary considerably. In India, the estimates
of prevalence of children with scholastic
backwardness, as screened by Rutters proformas
are reported to be 17 percent.1 Learning difficulties
in children are proposed to occur due to complex
interplay of factors that may reside in the child’s
own constitution, temperament and cognitive
abilities and/or in the background and quality of
child’s schooling and/or in family related factors
that affect interactions and emotional well being of
the child.
The child related factors that interfere with
scholastic performance include child’s limited
cognitive capacities such as limited intellectual

functioning., learning disabilities, 2 sensory
impairments including milder forms of hearing loss
and partial visual impairments 3,4, 5 behaviour
problems such as attention deficit disorder or
hyperactivity 6 and those that are related to
temperament and personality traits of the child. Of
the many child related factors that may produce
learning problems, learning disabilities constitute
the most prevalent as well as the most perplexing
underlying cause7 of the problems. The investigation of learning disabilities through neuropsychological studies, structural and functional
imaging as well as electrophysiological studies has
yielded evidence that deficits arise from central
nervous system dysfunction.8-13 While the Western
Literature is replete with such studies, the Indian

Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society

English and Mathematics. These children with learning difficulties but without any diagnosable disorder/disability have remained at the periphery probably because of under reporting of this population in the clinical set-ups to seek help. subnor mal level of intellectual functioning. excluded from the study. Colour Trails Test22 was used as a measure of focused attention. arithmetic. they largely compared the neuropsychological functioning among the various groups of learning disability. Auditory Memory Test.18. Digit Vigilance Test. The other group had children with learning difficulties but without any diagnosable neuropsychiatric disorder/emotional problems/behavioral problems.OCTOBER 2009 DELHI PSYCHIATRY JOURNAL Vol. Indian Adaptation of Rey’s Auditory Verbal Learning Test 25 to measure verbal memory. There have been no reported Indian studies that have compared the cognitive functioning of learning disabled children with the profile of those children who have learning difficulties but do not have any diagnosable neuropsychiatric/emotional/behavioural problems. spelling and comprehension. The study has attempted at uncovering the neuropsychological basis of various groups of children with learning difficulties and carries implications for future remedial training programmes. One of the groups had children having being diagnosed with learning disability. 12 No. and were from middle socioeconomic status. Grade Level Assessment Device for Children with Learning Problems in Schools21 to assess scholastic performance. children from single parent families or those having any other developmental disorder other than learning disability/any other neurological/psychiatric/ behavioural/or any other major medical illness were • • • • • • Children’s Behaviour Questionnaire (CBQ)20 was used to screen children for having/ not having behavioural and emotional disorders. Hindi.having children with learning disability and Group 2. were attending school regularly. The present study. the incidence of learning disability ranges from 2-18% 14. the Tests for Academic Performance of this battery were replaced by GLAD. any sensory impairments. writing. without any study breaks or school change. TOOLS • • • • Materials and Methods Sample: The study sample consisted of 40 children studying in English medium schools in Delhi from Grade 2nd to 5th who were reported by teachers to be having learning difficulties. The GLAD assesses the level of academic performance in three basic subjects viz.17 Reports on neuropsychological profile and cognitive deficits of children with LD are few. The tests Delhi Psychiatry Journal 2009. Test of Visuo-Motor Integration. N Back Test (Visual) was used as a measure of visuospatial working memory. Children having any physical disability. 15 yet. in primary school children while systematically making an observation of the processing pattern in the child. NIMHANS Index for Specific Learning Disability1 comprises of Malin’s Intelligence Scale for Indian Children (MISIC). Block Design Test26 for assessment of visuoconstructive abilities.having children with learning difficulties but without learning disability. each).19 Although these few studies provided many useful insights.2 scenario is strikingly different. Bender Gestalt Test. Benton Visual Retention Test24 to assess visual memory and visual perception. Token Test 27 is a measure of ver bal comprehension of commands of increasing complexity. The children belonged to the age group of 8 to 10 years. Digit Vigilance Test 23 to assess sustained attention. Benton Visual Retention Test along with tests of Academic Performance that include reading. In India. has attempted to overcome some of these lacunas in the field of learning difficulties in the Indian population. Procedure Based on the initial diagnostic assessment all children were divided into two groups (n= 20)Group 1. most of the Indian studies have focused largely on psychosocial concomitants of LD. 16. It consists of 36 cards each in the 1 back and 2 back test. Based on the initial diagnostic assessments children were divided into two groups (n = 20. For the present study. 12:(2) © Delhi Psychiatric Society 277 . All children in the sample had average level of intellectual functioning.

Thus.0 102 12. Table 2 shows mean. Further.5 14. **p < 0. this means that.D Group Cognitive Skills Sustained Attention(Time Taken) Attention(Error Score) Focused Attention VisualMemory Visual Working Memory Immediate Verbal Memory Delayed Verbal Recall Total Learning Visuospatial Comprehension L. L.8 63.4 4.05 level of significance.76 2. **p < 0.041 2.D group.9 (±3.97 3.L. Results The obtained mean.45* 1.L.40 3.5 43. at 0.08 5. obtained t.7 6.01 2.Comparison of Scholastic Skills For LD And Non LD Group Subject LD (n = 20) Mean S.2 9.91 * p < 0. GLAD.D (n=20) Mean S. 12 No. and visuo spatial skills. From Table 2 which shows the comparative analysis of cognitive skills between L.2 2. 12:(2) © Delhi Psychiatric Society 1.247 0. Standard Deviation and tvalues for scholastic performance of the two groups are given in Table 1.L. t-value English Hindi Mathematics 60.01 1. From Table 1 it is observed that.09 2.89 18.D.D and N.D.81 3. The study was performed with written informed consent of school authorities as well as of parents.9 20.D and N. However.66 8.0 44.05 level of significance . Digit Vigilance Test.8 63. as compared to mean scores of N.2 55.7 11.3 0.2 OCTOBER 2009 were administered in the following or der: NIMHANS SLD Index.0 5.D group.2 57. N.2 177.D groups did not differ significantly on their scholastic performance for any of the three subjects.7 1.4 *p < 0.D it is observed that the obtained t-values are significant for attention (time taken and error score).223 15.D.D group performed poorly on all cognitive skills as their mean scores are higher for attention and lower for other cognitive skills.0 Table1 .99** 1.D and N.9 42. Token Test and Block Design Test.32* 2.4 0.4 64. for all cognitive skills (except immediate verbal recall and total learning) and it is inferred that there is a significant difference in cognitive skills of L.07 1.16 14.0 50. t-Value 8.8 4. visual memory.41* 1. L.34* 0.D group was 101. The mean IQ of L.81) and of the N.6 7.40 4.80 5.L.7 6.9 2.05. delayed verbal recall.01 278 Delhi Psychiatry Journal 2009.D (n = 20) Mean S.335 0. The entire battery of tools took about 6 hours to administer which was done across 3-4 sessions.0 86. N.D Vs Non L.4 3.L.2 4. Children were assessed for their school performance using GLAD to compare the scholastic performance of the two groups.84 36.01 Table 2: Comparison of Cognitive Skills in L.DELHI PSYCHIATRY JOURNAL Vol.D.D ( n = 20) Mean S.0 49.L. the obtained t-values for all the three subjects are not significant at á = 0.values are not significant for immediate verbal memory and total recall. from the mean scores of the two groups it is observed that children in L.5 15.5 4.0 32.D group was 98.98 . Benton Visual Retention Test. Analysis: The data thus collected following the above design and procedure was interpreted using mean and standard deviation and compared through t-test.05. SD and t-values on assessed cognitive domains of both the groups. RAVLT.79 2.03 5.01 37.0 158.

the consolidation process itself is poorer in children with learning disability or that.01 indicating that the two groups were matched for their intellectual functioning. their school performance on three school subjects thus indicating that both the study groups were matched for their intellectual functioning and academic performance. Discussion As seen from results section. 12:(2) © Delhi Psychiatric Society 279 . although both the groups have shown impairment in visual and verbal memory.5) with a t value of 0. Focused attention was found to be relatively intact in the learning disability group whereas problems in focusing attention have been observed in the Non learning disability group. Similar findings have been reported by Agarwal 28 in their study with children with dyslexia. It was found during scoring of this test that children with learning disability committed both errors of commission (indicating that the children had problems in r esponse inhibition) as well as error of omission (reflecting poor visual scanning and poor selective attention) in approximately similar ratio. children with learning disability have shown significantly poorer performance on delayed recall than children without learning disability. there was no significant difference in the skills demonstrated by the two groups. Attention as measured in this study was sustained attention.OCTOBER 2009 DELHI PSYCHIATRY JOURNAL Vol.2 (±2. Also. the error score on this test revealed that children in learning disability group committed significantly more errors than children without learning disability. which is related to language related impairments of children with learning disabilities. Since sustained attention is found to be impaired in both the groups with more impairment in learning disability children. no significant differences were observed Delhi Psychiatry Journal 2009. there were no significant differences between the two groups with respect to their total verbal learning. However. Children without learning disability showed only error of omission. even in the presence of distracters. memory deficits indicate inability to use strategies of phonetic or semantic clustering. it was found that whereas children with learning disability showed both recency and primacy effects while learning the list of words. That is. that is. visual memory is poorer in children with learning disability than in children without learning disability. it was further found that children with learning disability have shown significant deficits on visuo spatial skills as compared to children without learning disability. With respect to immediate recall of verbal information. Since both reading and writing are significantly based on storage . did not differ significantly on IQ. the capacity to be vigilant and attend for a period of time. activities to improvise sustained attention is implicate to improve reading abilities of these children. This aspect needs to be taken up in further research studies. Correct decoding of written words requires detailed processing which is made possible by sustaining attention. Also. However. the two groups of children. It has been found from the present results that children with learning disability have poorer sustained attention than children without learning disability as children with learning disability took significantly longer time to complete the task as compared to children in non learning disability group. This has implications for academic performance as reading primarily requires accurate analysis of the characteristics of visual pattern.28 From the result findings. Further. Further. children without learning disability largely showed primacy effect. From introspective reports of children it was revealed that children with learning disability attended to the words as they were presented but most children in the non learning disabled groups were putting extra efforts to memorize whatever was being presented and so they were more concerned and stuck with the initial words in the list. their speed of processing information was found to be significantly slow as compared to children without learning disability. 12 No.099 which is non significant at p>0. This implies that either. interference processes are more at work in the learning disability children than those children who do not have learning disability but still have scholastic backwardness. these findings explain the probable reasons for poor academic performance of children in both the groups. the qualitative analysis revealed that the nature of mistakes committed on the three school subjects was different for both the groups. processing and retrieval of information in different modalities. However. Further.

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