Chapter 3

METHOD
This chapter indicates the outline of consolidating the procedures for gathering
the reliable data for the purpose of investigation.The research methodology has to be
robust in order to minimize errors in data collection and analysis. This chapter
introduces the research strategy, the research method, approach, pilot study, final
study, the methods of data collection, participants of the study, the research process,
and the type of data analysis, ethical considerations and data analysis procedures of
the entire study. This chapter is divided into sub-sections as follows:

3.1 Need for the study

3.2 Statement of the problem

3.3 Objectives

3.4 Hypotheses

3.5 Research design

3.6 Sample

3.7 Inclusion and exclusion criteria

3.8 Operational definition of variables

3.9 Research tools

3.10 Procedure

3.11 Ethical considerations

3.12 Statistical analysis

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3.1 Need for the study

Learning disability in children acts as an underlying cause in developing many

psychological problems. Measuring impact of disability on psychological issues is
challenging phenomena for professionals. If so what extent it is true in the case of
shyness and depression, but does it really affect child’s quality of life or not ? Shyness
has negative effect on individuals personal and emotional life, it is very much true in
disabled. The early life experience will always have an impact on individual’s later
life. If a person has had more negative, bitter early life experience it will have an
effect on person’s mental health throughout the life. If this is true, preventive step
falls at early stage among individuals who are at risk. The review of literature showed
most of earlier studies on children used professional, parents and teachers rating
scales to address child’s psychological issues though recent researches shows children
are capable in reporting their own wellbeing when measuring scale appropriate to
their age and intellectual level. The present study aimed to investigate self-reported
shyness, anxiety and depression symptoms in children with learning disability among
children in tow age groups.

Not many studies have examined whether or not children with LD exhibit
higher levels of shyness, in relation to anxiety, depression and its influence on quality
of life than their non-LD (NLD) peers. Thus, the purpose of this study is to address
this gap in research knowledge by reporting a cross sectional analysis that synthesizes
research comparing the all the variable (Shyness, anxiety, depression and quality of
life) among children with and without learning disability. Better understanding of the
factors that contribute to the development and maintenance of these problems can
help the development of culture-specific interventions and facilitate to policy makers,
and planning of community-tailored services and interventions.

Hence, limited literature available on extent of shyness among children with

learning disability in Indian context and within the available literature there is no clear
relationship established in the case of shyness, anxiety and depression compared to
children without learning disability. Keeping this in mind researcher attempts to
address this research gap to know the significance of shyness level among children
with learning disability and its relationship with anxiety, depression and quality of life
comparing with non LD Children.

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3.2 Statement of the problem

To study Shyness among Children with Learning Disability in Relation to Anxiety-

Depression dyad and Quality of Life.

3.3 Objectives of the study

1. To assess the levels of shyness, anxiety, depression and quality of life among
children with and without LD

2. To find out difference between children with and without LD in their shyness

3. To find out difference between children with and without LD in their anxiety

4. To find out difference between children with and without LD in their depression

5. To find out difference between children with and without LD in their quality of
life

6. To find out the extent of relationship between shyness and anxiety, depression,
and quality of life.

7. To find out the influence of secondary variables (age and gender) on shyness,
anxiety, depression, and quality of life.

3.4 Hypotheses
Following alternative hypotheses were formulated for the present study.

H1: Children with and without LD differ significantly in their shyness

H2: Children with and without LD differ significantly in their anxiety

H3: Children with and without LD differ significantly in their depression

H4: Children with and without LD differ significantly in their quality of life

H5: Shyness and anxiety are significantly related to each other

H6: Shyness and depression are significantly related to each other

H7: Shyness and quality of life are significantly related to each other

H8: Age and gender will have significant influence on shyness, anxietyand
depression, and QOL

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3.5 Research design

In the present study, an exploratory cross-sectional research design was

adopted.The exploratory researchis the initial research, which forms the basis formore
conclusive research. It has to be noted that it tends to tackle new problems on which
little or no earlier research has been done.

3.6 Sample

Sample size calculation and sampling

The prevalence of learning disability in school children in India has been

reported to be 3-10% among student populations (Ramaa & Gowramma, 2000;
Mogasale, Patil, Patil & Mogasale, 2011). Keeping this in mind, in the present study
we assumed that 10% of school students would have LD. With 95% confidence level
and 5% precision, Daniel's formula yielded a sample size of 138 (Daniel, 1999).
Hence, in the present study the sample size of 160 considered in each group. A 1:1
ratio of students with LD (“study cases”) and regular students (“controls”) were taken.
The controls (children without LD) were age and gender matched.

Sample was chosen using stratified random sampling method. A total sample
size of 320 children of both genders was selected.

Further, the sample was classified further division as per age criteria i.e. 9 to
12 years and 12 to 16 years by gender. The detailed sample distribution shows in
below table no.3.1.

Table 3.1 Distribution of study sample by group, gender, and age

Children
Age
Gender Without Total
With LD
LD
9-12 years 56 35 91
Boys
12-16 years 53 59 112
9-12 years 23 27 50
Girls
12-16 years 28 39 67
Total 160 160 320

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Socio demographic characteristics of the children with and without LD

Table3.2

Distribution of the selected sample of children with and without LD by age

groups, gender, area and SES
Sub Children
Variable Total
variable With LD Without LD
F 79 62 141
Age 9-12 years
groups % 49.4% 38.8% 44.1%
(in years) 13-16 F 81 98 179
years % 50.6% 61.2% 55.9%
F 109 94 203
Male
% 68.1% 58.8% 63.4%
Gender
F 51 66 117
Female
% 31.9% 41.2% 36.6%
F 31 13 44
Rural
% 19.4% 8.1% 13.8%
Area
F 129 147 276
Urban
% 80.6% 91.9% 86.2%
F 46 18 64
Low
% 28.8% 11.2% 20.0%
F 57 67 124
SES Middle
% 35.6% 41.9% 38.8%
F 57 75 132
High
% 35.6% 46.9% 41.2%
F 45 60 105
State
% 28.1% 37.5% 32.8%
F 100 93 193
CBSE
% 62.5% 58.1% 60.3%
Syllabus
F 11 7 18
ICSE
% 6.9% 4.4% 5.6%
F 4 0 4
NIOS
% 2.5% 0.0% 1.2%
F 50 36 86
Joint
Type of % 31.2% 22.5% 26.9%
family F 110 124 234
Nuclear
% 68.8% 77.5% 73.1%
F 160 160 320
Total
% 100.0% 100.0% 100.0%

Table 3.1 shows the socio demographic characteristics of the subjects in both
children with LD and without LD groups. Both the groups found to be homogeneous.
49.4% of the subjects are between the age ranges of 9-12 years old, 50.6% are 13-16
years in the LD group whereas, children without LD samples majority (61.2%) falls in

56
the age range of 13-16 years and rest (38.8%) are 9-12 years old. There are majority
of male subjects in the group LD are males and remaining (31.9%) are female
subjects. In contrast in the group without LD more (58.8%) are males remaining
(41.2%) are females.

Area wise comparison of the sample revealed that majority of them hailed
from urban area to the extent of 86.2% and remaining 13.8% of them were from rural
areas. This trend was found to be similar for sample of children with and without LD.

When socio-economic status of the sample was verified, 41.2% of the selected
samples were with high SES, 38.8% of them were with middle SES and remaining
20.0% of them were with low SES status. Again the pattern of spread of samples in
both groups in different SES status was same.

As far as the syllabi studied by the children was analysed, majority of them
were following CBSE syllabi (60.3%), followed by 32.8% of them studying state
syllabus (32.8%) and very few of them were following ICSE and NIOS syllabi (5.6%
and 1.2% respectively).

A large majority of 73.1% of them belong to nuclear family and remaining

26.9% of them hailed from joint family. This trend was found to be similar for both
children with and without LD samples.

3.7 Inclusion Criteria:

1) Child must have average or above levels of intelligence

2) Male and female children in the age range of 9-16 years

3) Children studying in 4th to 10th standard and following CBSE/ICSE/State

syllabusin English medium.

4) Children who got sufficient quality or quantity of exposure to school/academic

training.

5) Diagnosed as LD according to the ICD-10-DCR (WHO, 1993)with at least

minimum 2 and above grade discrepancy between expected and achievement
grade level.

57
 For children without LD group, criteria under serial no -5 not applicable,
instead those who were showing average and above performance consistently in their
academics were considered.

Exclusion Criteria:

1) Children with any psychiatric illness or neurological disorder or disability such as

impaired vision, impaired hearing, severe physical conditions that may interfere
with school performance, sub normal intelligence were excluded.

2) Children with history of Mental Retardation, ADHD, Conduct disorder and

Autism, Global delays in developmental milestones.

3) Those children, who are having any academic problems due to change of the
medium of instruction, change of the place, social or economic deprivation and
culture deprivation.

4) Those Children who are not studying in English medium from early educational
level.

3.8 Operational definition:

An operational definition outlines a criterion for measuring or quantifying

variables or something of research interest. For the purposes of present study, an
operational definition is one that denotes specific domains measured as per diagnostic
criteria of learning disability and in the selected research tools for other variables as
the respective authors specified.

3.8.1 Learning disability (LD):

In the present study, Learning disability (LD) is conceptualized as a disability

in which child exhibits difficulty or disability in performing any academic grade level
in which the child is expected to perform at average or above average level in spite of
average and above level of intelligence. This definition holds well, when the child
should have average and above intelligence, may able to learn other than the
academics along with the peers, without sensory deficits and emotional or mental
disorders irrespective of gender. It includes four categories of Learning disability like
Reading disability, Mathematics disability, Disability of written expression, and

58
Learning disability not otherwise specified which is deferent from scholastic delay,
academic underachievement, slow learner and mental retardation.

3.8.2 Shyness:

Shyness may be defined experientially as an excessive self-focuses

characterized by negative self-evaluation that creates discomfort and/or inhibition in
social situations and interferes with pursuing one’s interpersonal or professional
goals. Doubts about one’s own ability in effective social interaction constitute
shyness. It conceptualized as a syndrome of cognitive/affective, behavioral and
physiological components characterized by social anxiety and behavioral inhibition
resulting from the feeling that others are evaluating.

3.8.3 Anxiety:

Anxiety is an emotion characterized by feelings of tension, worried thoughts,

nervousness or unease about something with an uncertain outcome and physical
changes like increased blood pressure and other physiological changes usually noticed
as hyper-arousal.

3.8.4 Depression

A state of excessive sadness or being down, hopelessness, loss of

interest/pleasure in usual activities, irritability, difficulty in concentration, social
withdrawal, insomnia, feeling worthless, thinking of death & dying (in extreme
cases) often with physical symptoms among children aged 9-16 years.

3.8.5 Quality of life-Health related (HRQOL)

Health-related quality of life" (HRQL) is a child’s satisfaction or happiness

with domains of life since as they affect or are affected by health. Most
conceptualizations of HRQL emphasize the effects of condition or disease on
physical, social/role, psychological/emotional, and cognitive functioning of children.
It focuses on the impact of health status has on quality of life.

59
3.9 Research tools

The following research tools employed in the present study.

1. Socio Demographic Clinical Data Sheet:

The basic socio-demographic information data sheet to collect information

such as gender, age, domicile, religion, education, and family type etc about the
sampled children used. In addition parental education, occupation and socio-economic
status information was obtained. Further, clinical pro-forma was used to gather
information regarding the duration of problem, type of problem, presence of
precipitating factor, behavioral and other emotional problem, management,
undergoing intervention etc.

2. Children Shyness Assessment Test(D’Souza, 2006:CSAT)

It consists of 54 items and requires the subject to indicate his/her response by

selecting one of the option out of three options given namely Yes/No/Can’t say. The
items in the test pertain to three domains of shyness - Cognitive/Affective,
Physiological, and Action oriented. The maximum possible score is 108 for full scale.
CSAT is developed exclusively on Indian adolescents and children by D’Souza
(2006). The reliability index ascertained by split half (odd-even) method and
Cronbach’s alpha coefficient for the scale as a whole were found to be 0.73 and 0.81
respectively.

The physiological domain: Physiological manifestations of shyness may

include: excessive perspiration, blushing, increased heart and pulse rate, dry mouth,
trembling and uneasy feeling in the stomach.

The cognitive domain: At the cognitive domain, manifestations of shyness

may include, fear of negative evaluation and rejection, self-consciousness, worry,
rumination and self-blaming attributions. The affective domain: Affective symptoms
of shyness may include feelings of self-consciousness, embarrassment, insecurity and
feelings of inferiority.

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 Behavioural component: It may include reticence, speech disfluencies,
passivity, reduced eye contact, maintaining physical distance, lack of appropriate
responses and avoidance of situations.

Scoring: Responses were scored as 2 for ‘Yes’, 1 for ‘don’t know’, and ‘0’ for
‘No’. Depending on the scores the subjects were classified into three levels of
shyness- High, Medium, Low. The scores for all the statements were cumulated and if
the subject scored 80and above he/she was considered as having high levels of
shyness.

3. Revised Children's Manifest Anxiety Scale (Reynolds & Richmond, 2008:

RCMAS-2)

The RCMAS-2 is a 49-item self-report instrument designed to assess the level

and nature of anxiety in children from 6 to 19 years old. The instrument may be
administered either to an individual or to a group of respondents, as described in
chapter 2. A child responds to each statement by indicating a ‘Yes’ or ‘No’ response.
A response of Yes is given if the item is descriptive of the child’s feelings or actions,
whereas a response of No is given to items that generally are not descriptive of the
child’s perceptions of self. If the child has difficulty reading, an available Audio CD
can be used for audio presentation of RCMAS-2 items.

The RCMAS-2 yields scores for the four scales; includes a Total Anxiety
score and scores for three anxiety-related scales—Physiological Anxiety, Worry, and
Social Anxiety. This scale standardized on sample of 2,368 individuals aged 6 to 19,
representative of the U.S. population in terms of key demographic variables such as
gender, ethnicity, and socioeconomic status. The RCMAS-2 was standardized on
4,972 children between the ages of 6 and 19 years and normative data were available.
Norms are stratified into three age groups: 6 to 8 years, 9 to 14 years, and 15 to 19
years.

The psychometric properties of the RCMAS have been well documented as

reported by original author. The full anxiety scale shows good internal consistency (α
= .79-.85) and Reynolds (1981) demonstrated that scores showed reasonable stability
over a nine month period (r = .68). Additionally, Wisniewki, Mulick, Genshaft, and
Coury (1987) reported a test-retest reliability of r = .88 after one week and r = .77

61
after five weeks. The concurrent validity of the RCMAS is also well established.
Reynolds (1980) reported a correlation of .85 between the RCMAS scores and scores
obtained on the State-Trait Anxiety Inventory for Children (STAIC). More recently,
Muris and colleagues (2002) reported substantial correlations between the RCMAS
and a variety of children’s anxiety measures; including the STAIC (r = .88), the Fear
Survey Schedule for Children (r = .63), and the Multidimensional Anxiety Scale for
Children (r = .76).

Reliability and validity: author reported a test-retest correlation of .68 and,

convergent and divergent validity in a concurrent administration of the State-Trait
Anxiety Inventory for Children high significant correlation reported .85.

Administration

It is self-report instrument that requires only about 10-15 minutes. It is

administered individually or in a group setting, by having respondents mark their
answer to RCMAS II items. The items are written to be understood easily by anyone
with a second grade reading level, some younger students and students with serious
attention difficulties may require more time to complete the test or may require more
time, whereas audio CD can be used to present test items.

Scoring

It consist both positive and negative items in which ‘yes’ marked positive
items and ‘no’ marked negative items receives one mark each. Total possible raw
score is 49

Construct validity

The psychometric properties of the RCMAS have been well documented. The
full anxiety scale shows good internal consistency (α = .79-.85) and Reynolds (1981)
demonstrated that scores showed reasonable stability over a nine month period (r =
.68). Additionally, Wisniewki, Mulick, Genshaft, and Coury (1987) reported a test-
retest reliability of r = .88 after one week and r = .77 after five weeks. The concurrent
validity of the RCMAS is also well established. Reynolds (1980) reported a
correlation of .85 between the RCMAS scores and scores obtained on the State-Trait

62
Anxiety Inventory for Children (STAIC). More recently, Muris and colleagues (2002)
reported substantial correlations between the RCMAS and a variety of children’s
anxiety measures; including the STAIC (r = .88), the Fear Survey Schedule for
Children (r = .63), and the Multidimensional Anxiety Scale for Children (r = .76).

Reliability:

Cronbach’s alpha estimated for RCMS 2is .92 for total (TOT) anxiety. For the
RCMS 2 alpha reliability estimates were .75 for physiological anxiety (PHY), .86 for
worry (WOR), .80 for social anxiety (SOC), and .79 for defensiveness (DEF). in the
clinical sample an alpha reliability value of .92 was observed for TOT and values of
.70, .89, .82, and .81 was reported for the PHY, WOR, SOC, and DEF scales,
respectively (Reynolds & Richmond, 2008).

The RCMAS, which scales correlate highly with the RCMAS-2, had an
internal consistency of above 0.80 and test–retest reliability ranging from 64 to 76
across total scale and subscales (Reynolds & Richmond, 1985; Silverman &
Ollendick, 2005).

4. Children’s Depression Inventory 2nd Edition: ( Kovacs, 2009: CDI-2)

The Children’s Depression Inventory 2nd Edition: Self-Report (CDI 2: SR)

assesses the presence and severity of depressive symptoms in children aged 7–17
years. It consist of total 28 statements based on depressive symptoms, has two major
scales namely

a) Emotional Problems

b) Functional Problems.

And four subscales as below:

(i) Negative Mood

(ii) Negative Self-Esteem

(iii)Ineffectiveness

(iv) Interpersonal Problems

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Forms or versions of CDI 2:

CDI 2: Self-Report (CDI 2: SR)

The full-length CDI 2 Self-Report Form is ideal when assessors require a more robust
description of the child's depressive symptoms. The CDI 2: SR is 28-item assessment
that yields a Total Score, two scale scores (Emotional Problems and Functional
Problems), and four subscale scores.

CDI 2: Self-Report (Short) version (CDI 2:SR[S])

The CDI 2:SR(S) Form is an efficient screening measure that contains 12

items and takes about half the time of the full-length version to administer (5-10
minutes).The CDI 2:SR(S) has excellent psychometric properties and yields a Total
Score that is generally very comparable to the one produced by the full-length
version.

CDI: Teacher (CDI:T) and CDI: Parent (CDI:P)

The CDI:T and CDI:P Forms consist of items that correspond to the self-report
version and are suitably rephrased. Item selection for the parent and teacher forms
was guided to maximize validity, and thus focused on observable manifestations of
depression

The present study incorporated self-report version of CDI 2 to measure

depressive symptoms among targeted samples. This scale was standardized on 1,100
children of United States and normative data were produced. All items are scored with
a 0, 1 or 2, indicating the presence or absence of a particular symptom. Scores
between 0 and 56 are possible, with higher scores indicating more reported depressive
symptomatology. The scale had sufficiently high validity as reported.

Scoring:

Raw scores are derived by the sum of the numerical values of the items
responses that were endorsed on a particular for by a respondent. The higher score
indicate more marked or definite symptoms. Thus, for example, a CDI 2; self-report
total raw score of 28 indicates a considerably higher level of depression symptoms
than does a total raw score of 4.

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Construct validity

CDI scores have been shown to correlate with a range of theoretically related
constructs in hypnotized direction. These constructs have included depressive
attributional style and positive negative affectivity. Additionally, CDI scores stronger
related to hopelessness as well as negative self-esteem.

Reliability: Internal consistency of self-rated CDI reported as .86 in the

normative sample.

Cronbach’s alpha coefficients were calculated for each subscale and total scale
alpha score reported as .91.

5. KIDSCREEN-52: (Ravens-Sieberer et al., 2005)

The KIDSCREEN instruments assess the subjective health related quality of

life of children and adolescents. This self-report measure is applicable for healthy and
chronically ill children and adolescents, aged from 8 to 18 years. The KIDSCREEN-
52 instrument measures 10 HRQoL dimensions: Physical- (5 items), Psychological
Well-being (6 items), Moods and Emotions (7 items), Self-Perception (5 items),
Autonomy (5 items), Parent Relations and Home Life (6 items), Social Support and
Peers (6 items), School Environment (6 items), Social Acceptance (Bullying) (3
items), Financial Resources (3 items). A 5-point Likert response scale is used in all
dimensions. The 8-17 year-olds respond by indicating one point on the scale. Across
most dimensions, the highest scale (i.e. 5) receives the highest score (representing, for
example, ‘extremely’, ‘always’), indicating better quality of life.

Definitions of dimensions and interpretation guidelines for low and high

scores of the KIDSCREEN dimensions are as follows.

Physical Well-being: This dimension explores the level of the

children/adolescent's physical activity, energy and fitness. Level of physical activity is
examined with reference to the child's/adolescent’s ability to get around the home and
school, and to play or do physically demanding activities such as sports, since a
child's/adolescent's impairment does also affect physical activity. The dimension also
looks at the child's/adolescent's capacity for lively or energetic play. In addition, the

65
extent to which a child or adolescent feels unwell and complains of poor health is
examined.

Psychological Well-being: This dimension examines the psychological well-being of

the child/adolescent including positive emotions and satisfaction with life. It
specifically reveals the positive perceptions and emotions experienced by the
individual. The questions look at how much a child/adolescent experiences positive
feelings such as happiness, joy, and cheerfulness. It also reflects the person's view of
their satisfaction with life so far.

Moods & Emotions: This dimension covers how much the child/adolescent
experiences depressive moods and emotions and stressful feelings. It specifically
reveals feelings such as loneliness, sadness, sufficiency/insufficiency and resignation.
Furthermore, this dimension takes into account how distressing these feelings are
perceived to be. This dimension shows a high score in QoL if these negative feelings
are rare.

Self-Perception: This dimension explores the child's/adolescent's perception of self. It

includes whether the appearance of the body is viewed positively or negatively. Body
image is explored by questions concerning satisfaction with looks as well as with
clothes and other personal accessories. The dimension examines how secure and
satisfied the child/adolescent feels about him/herself as well as his/her appearance.
This dimension reflects the value somebody assigns to him/herself and the perception
of how positively others value him/her.

Autonomy: This dimension looks at the opportunity given to a child or adolescent to

create his/her social and leisure time. It examines the child's/adolescent's level of
autonomy, seen as an important developmental issue for creating an individual
identity. This refers to the child's/adolescent's freedom of choice, self-sufficiency and
independence. In particular, the extent to which the child/adolescent feels able to
shape his/her own life as well as being able to make decisions about day-to-day
activities is considered. The dimension also examines if the child/adolescent feels
sufficiently provided with opportunities to participate in social activities, particularly
in leisure activities and pastimes.

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Parent Relation & Home Life: This dimension examines the relationship with the
parents and the atmosphere in the child's/adolescent's home. It explores the quality of
the interaction between the child/adolescent and parent or carer, and the
child's/adolescent's feelings towards parents/carers. Particular importance is attached
to whether the child/adolescent feels loved and supported by the family, whether the
atmosphere at home is comfortable or not and also if the child/adolescent feels treated
fairly.

Financial Resources: The perceived quality of the financial resources of the

child/adolescent is assessed. The dimension explores whether the child/adolescent
feels that he/she has enough financial resources to allow him/her to live a lifestyle
which is comparable to other children/adolescents and provides the opportunity to do
things together with peers.

Social Support & Peers: This dimension examines the nature of the
child's/adolescent's relationships with other children/adolescents. Social relations with
friends and peers are considered. The dimension explores the quality of the interaction
between the child/adolescent and peers as well as their perceived support. The
questions examine the extent to which the child/adolescent feels accepted and
supported by friends and the child’s/adolescent’s ability to form and maintain
friendships. In particular, aspects concerning communication with others are
considered. It also explores the extent to which the person.

School Environment: This dimension explores a child's/adolescent's perception of

his/her cognitive capacity, learning and concentration, and his/her feelings about
school. It includes the child's/adolescent's satisfaction with his/her ability and
performance at school. General feelings about school, such as whether school is an
enjoyable place to be, are also considered. In addition, the dimension explores the
child's view of the relationship with his/her teachers. For example, questions include
whether the child/adolescent gets along well with his/her teachers and whether the
teachers are perceived as being interested in the student as a person.

Social Acceptance (Bullying): This dimension covers the aspect of feeling rejected
by peers in school. It explores both the feeling of being rejected by others as well as
the feeling of anxiety towards peers. A student is being bullied when another student

67
or a group of students say or do nasty and unpleasant things to him or her. It is also
bullying when a student is teased repeatedly in a way he or she doesn't like. But it is
not bullying when two students of about the same strength quarrel or fight.

This definition is fairly standard and has been used over a number of years in
the HBSC studies (Curie et al., 1998, 2001).

Scoring: Scores can be calculated for each of the 10 dimensions. Stratified by

age, gender and socio-economic status mean and percentages are available. The
KIDSCREEN-52 was standardized on 1,800 children of Ireland and normative data
were produced.

For both alternatives, the first step is to recode negatively formulated items.
Most of the items are formulated positively and in concordance is the scoring, which
means a higher score reflects a higher HRQoL. However, some items are formulated
negatively and as a consequence the scoring has to be recoded. Recode the negatively
formulated items to have scorings from 1 to 5with higher values indicating a higher
HRQoL. Then sum up the item scores of the respective scale (scale raw scores). Only
values from persons with complete data, with every item of the scale answered, can be
summed up.

Interpretation of KIDSCREEN Dimensions

For the interpretation of the KIDSCREEN scores, the content of the scales has
to be considered. The basic information about the scales is given by their definitions.
In addition to the scale definitions, interpretations for very low or very high scores of
every scale are provided in Table 3.3

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Table 3.3

Interpretation of scores of the KIDSCREEN-52 dimensions scales

Dimension Low score High score

Physical well- Physically exhausted, physically Physically fit, active, healthy,
being unwell, feeling unfit, having Energetic
low energy
Psychological No pleasure in life, dissatisfaction Happy, view life positively,
with life
well-being satisfied with life, pleased,
Cheerful
Moods and Feels depressed, unhappy, Feeling good, feeling in good
emotions feeling in bad mood Mood
Self-perception Negative body image, self- Self-confident, satisfied with
rejection, unhappy/dissatisfied self, positive body image,
with self, having low self-esteem,
feeling uncomfortable with happy with self, having good
appearance self-esteem, comfortable with
Appearance
Autonomy Restricted, oppressed, Dependent Feeling free to decide,
independent, autonomous
Parent relations Feeling alone, overlooked, not Feeling secure, supported and
and appreciated, perceives parents loved, feeling well
unavailable/unfair understood/well-cared, perceives
home life
parents as fair/available
Financial Feeling finances are restricting Feeling satisfied with financial
resources lifestyle, feeling financially resources, feeling well-off,
Disadvantaged enjoying financial resources
Social support Feeling excluded, not accepted by Feeling accepted, supported
and peers, not supported by peers, not and included in peer group,
relying on peers
Peers relying on peers
School Disliking school and/or teachers, Feeling happy at school and
environment negative feelings about school, not doing well, enjoying school life
doing well
Social Feeling tormented by peers, Not feeling bullied, feeling
acceptance bullied, feeling rejected by respected and accepted by
Peers Peers

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Validity

Convergent and discriminant validity were shown using information on the

children’s and adolescents' physical (Children with Special Health Care Needs
Screener for Parents, CSHCN) and mental health (Strength and Difficulties
Questionnaire, SDQ). In addition to this, in each country the relationship between
national HRQoL instruments for children and adolescents and the KIDSCREEN
versions were analysed and showed overall satisfactory results. The scale construct
validity was assessed by calculating Cohen’s effect sizes (ES; Cohen, 1988).ES of
0.2–0.5 were considered small; those between 0.51-0.8 moderate and those over0.8
were considered large. Convergent and discriminant validity were reported through
calculating correlations between dimensions it was found to be above or up to 0.55.

Reliability:

The internal consistency reliability was good-to-excellent for all the domains,
ranging from 0.77 to 0.89. The test-retest reliability at a 2 week interval varies
between .56 and .77.The Intra-class Correlation Coefficients (ICC) between scale
scores for the two assessments ranged from 0.56 to 0.77 for theKIDSCREEN-52.

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 3.10 Procedure
Figure 3.1 Schematic Representation of the Research Design

PHASE I Polite Study, n=40

(LD=20, without
LD=20)

Data collected
(n=350)

30 data sheets rejected due

to incomplete response and
integrity issues

PHASE II Main Study Finale

sample (n=320)

Children with LD Children without

(n=160) LD (n=160)

Boys (n=109) Girls (n=51) Boys (n=94) Girls (n=66)

Research tools Research tools

administration administration

Coding and analysis

of results

Reporting study
findings

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Present study was done in two phase namely pilot study and main study.

Phase-I

Pilot study: In Pilot study approximately 10% of total study sample was administered
in Socio demographic clinical data sheet, Shyness assessment test, Children’s
Depression Inventory-2, RCMAS-2, and KIDSCREEN-52 to see the feasibility of
study tool. The pilot study was done to understand the following aspects:

a. To get possible difficult areas and lacunae in the questionnaires/inventories used

before actually administering on the study sample

b. To get the familiarity with the methodology being employed, and to decide proper
method of administration.

c. To get an idea on approximate time consumption for each tool and total procedure

d. To make minor alterations if any, where subjects had difficulty in comprehending

the tool.

e. To find out the suitability of collection of data using specific technique.

f. To get a preliminary idea on possible outcome of the study.

Phase-II

Main study: In the main, the practical field problems which are rectified from pilot
study was incorporated with necessary modification in procedure on need base.

Selection of the sample:

Selection of sample of children with LD

In the group children with LD all the samples recruited from department of
Clinical Psychology, All India Institute of Speech and Hearing (AIISH), Mysore.
Being premiere institute in the field of communication and related disorders most of
the children with academic problems referred to the institute from different parts of
the state and country. The children/adolescents who referred to the institute, have to
undergo various levels of screening and assessment such as speech, audiological
screening, along with detailed psychological assessments. The researcher was also a
part of this process where a child assessed for intelligence and learning disability

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assessment. All the samples in the present study recruited in this stage where a child
diagnosed as per ICD-10 criteria in a scientific manner.

Selection of sample of children without LD

For Children without LD samples, researcher visited various schools

personally, with a request letter to permit to carry out study and once permission
granted, the children were selected as on criteria such as medium of instruction,
average and above consistent performance in school, not having any form of disability
or illness.

All the subjects were briefed about the study and expected to complete
informed consent procedure at first, followed by personal demographic information
and then answering CSAT, RCMS, CDI2 and KIDSCREN-52 questionnaire.
Considering disability in children with LD, the examiner read each item aloud and
asked to respond with their choice of response.

For Children without LD samples, researcher visited various schools with

request letter to permit to carry out study and once permission sough the children
selected as on criteria such as medium of instruction, average and above consistent
performance in school, not having any form of disability. After rapport is established,
children were allowed to fill in their demographic information and answering CSAT
questionnaire on a group administration. Participants read each item carefully and
chose one of three possible responses (‘yes’/ ‘no’ or ‘cannot say’) to show how much
each statement is true about them, how they feel or do in the described situations.

The researcher read aloud both the instruction and item choices of the research
tools, when they are found to be not able to read the items in the scales. All subjects
instructed not to leave any items unanswered and at the end of the assessment it has
been told to check and recheck for unanswered items. Before preparing master chart
missing responses were cross checked by the researcher. Responses are considered
missing or omitted if the responder skips an item, gives multiple responses to a single
item (e.g., accidentally marks more than one response), or provides non-standard
responses (e.g., instead of selecting one of the options that was provided in the
instrument the respondent wrote a text explanation, or marked in between response,
such as can’t say). Those data sheets which are considered as missing responses were
excluded for statistical analysis.

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3.11 Ethical considerations

The ethical consideration of research is done by briefing about the study and
assuring confidentiality about information shared by participants. The process of
obtaining informed consent begins by explaining to the participants about general
purpose of the assessment including reason she/he being asked to complete the test
being used in the research. The participants were also instructed that he/she has the
right to stop or withdraw their consent of participating in the study the assessment at
any time for any reason, along with the consequences of their choice and of any
alternative options.

Informed consent means that respondents has agreed to complete the

assessment without being forced to do so, and understood what the task involves(i.e.,
answering questions about one’s feeling and behaviours) and how the results will be
used.

Confidentiality is often addressed as part of informed consent discussion and

should include information about two main issues: protecting information about the
child and protecting the privacy of the respondents’ responses. Once all the research
tools answered by the participants researcher debriefed them as a part of ethical
guidelines.

Locale of the study

This present study was conducted in the Department of Clinical Psychology,

All India Institute of Speech and Hearing (AIISH), Mysore and the sample of children
without LD was drawn from the different Schools in and around Mysore.

Course of action

The entire data collection was carried out in two phases:

Phase -I: Establishment of rapport, administration of Socio-demographic clinical data

sheet, CD1-2 and SAT.

Phase -II: administration of KIDSCREEN and RCMAS-2.

74
 The selected subjects who fulfilled the inclusion criteria were briefed about
the study and expected to complete informed consent procedure at first, followed by
personal demographic information and then answering CSAT questionnaire, RCMS,
followed by interval (spread over 2 to 3 days)Children’s Depression Inventory-2 and
KIDSCREEN-52 were administered. Considering disability in children with LD the
examiner read each item aloud and asked to respond with their choice.

For Non-LD samples researcher visited various schools with request letter to
permit to carry out study. Once permission sought, the children were selected based
on criteria such as medium of instruction, average and above consistent performance
in school, not having any form of disability. After rapport was established, children
were allowed to fill their demographic information and answering CSAT
questionnaire on a group administration. Participants read each item carefully and
chose one of three possible responses (‘yes’/ ‘no’ or ‘cannot say’) to show how much
each statement is true about them, how they feel or do in the described situations. The
sequence of test administration was maintained uniformly across subjects in both
groups to minimize bias, order or fatigue effects with sufficient intervals between the
tests.

3.10 Statistical analysis

Once data were collected, each data sheet was subjected to scrutinization in
terms of incomplete response. The incomplete response data is not considered for
tabulation and analysis. The research questionnaires with complete responses were
considered, scored and a master chart was prepared for further statistical calculations.
The IBM SPSS version 20 was used for statistical analysis.

Following descriptive and inferential statistics were employed in the present study.

Descriptive statistics

a. Frequency

b. Percent

c. Mean

d. Standard Deviation

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Inferential statistics

a. Cramer’s V test:

b. Independent samples‘t’ test

c. Pearson’s Product moment correlation

d. Two-way ANOVA

a. Cramer’s V test

Several tests attempt to establish the association between two variables,

usually in categorical format, where the association between rows and columns can be
analysed. Cramer’s V test is one of the widely used tests of association. To find out
the association between groups and levels of shyness, anxiety, depression and quality
of life, Cramer’s V test was applied.

b. Independent samples ‘t’ test

Independent samples t test (also called as student t test or unpaired t test), a

parametric test of significance. Whenever there are two independent groups are to be
compared for their significance of mean difference, Independent samples ‘t’ test will
be employed. To find out the significance of mean difference between children with
and without LD, on various selected variables-shyness, anxiety, depression and
quality of life, Independent samples t test was applied.

c. Pearson’s Product moment correlation

Correlation procedures try to establish mutual relationship between two or

more variables. Pearson’s product moment correlation test is one of the robust
predictive statistics to establish the mutual relationships between the variables
employed. To find out the mutual relationship between shyness, anxiety, depression
and quality of life, Pearson’s product moment method was employed in the present
study.

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d. Two-way ANOVA

ANOVA is a procedure to establish significance of mean difference between

more than two groups. In fact, one-way ANOVA is an extension of independent
samples ‘t’ test. In one way ANOVA, one independent variable is split into more
than 2 levels against one dependent variable. In two way ANOVA, two independent
variables are treated against one dependent variable. In two way ANOVA, Along
with individual effects, even interaction effect between two variables can be obtained.
To find out the influence of gender and age (independent variables) along with groups
(Independent variable), two-way ANOVA was employed in the present study treating
shyness, anxiety, depression and quality of life as dependent variables. Along with the
influence of age and gender influence, even the interaction effects were analyzed for
the selected variables of shyness, anxiety, depression and quality of life.

Chapterization:

Chapter I: Introduction

This chapter gives an overview, which states the core nature and perspective
of the research problem. Brief discussions on various aspects of shyness and learning
disability in relation to anxiety, depression and quality of life have been presented in
this chapter.

Chapter II: Review of related Literature

This chapter deals with earlier literature in the present study context in order
to have an understanding of the existing literature available and their contributions
and implications.

Chapter III: Method

This chapter includes aspects like research approach, research design, setting
of the study, samples, criteria for sample selection, sampling technique, sample size
and calculation, description of the tool, ethical consideration, pilot study, method of
data collection, and data analysis.

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Chapter IV: Analysis of results and Interpretation

This chapter explains data related to the background information of method

adopted in the present study and respondents. This section focuses on reporting the
results by means of the analysis of results obtained. This chapter includes statistical
measures that were employed to test hypotheses framed in the study.

Chapter V: Discussion, Summary & Conclusion

In this chapter obtained results discussed with support from similar earlier
study findings and theoretical background. It also included a short summery of the
present study, limitations and implications.

References

Appendices

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