Review Article

Prevalence of Specific Learning Disorders

(SLD) Among Children in India: A Systematic
Review and Meta-Analysis
Liss Maria Scaria1 , Deepa Bhaskaran1 and Babu George1

ABSTRACT
Background: Specific learning disorders
(SLD) comprise varied conditions with
ongoing problems in one of the three areas
of educational skills–reading, writing,
and arithmetic–which are essential for
the learning process. There is a dearth of
systematic reviews focused exclusively on
the prevalence of SLD in India. Hence, this
study was done to estimate the prevalence
of SLD in Indian children.
Methods: A systematic search of
electronic databases of MEDLINE, Embase,
PsycINFO, and CINAHL was conducted.
Two authors independently assessed the
eligibility of the full-text articles. The third
author reassessed all selected studies.
A standardized data extraction form
was developed and piloted. The pooled
CI = 4–11). The tools used to diagnose SLD
in the studies were the National Institute
of Mental Health and Neurosciences
(NIMHANS)-SLD index and the Grade Level
Assessment Device (GLAD).
Conclusions: Nearly 8% of children up to
19 years have SLD. There are only a few
high-quality, methodologically sound,
population-based epidemiological studies
on this topic. There is a pressing need to
have large population-based surveys in
India, using appropriate screening and
diagnostic tools. Constructing standardized
assessment tools, keeping in view the
diversity of Indian culture, is also
necessary.
Keywords: Specific learning disorders,
prevalence, India, systematic review, meta-
analysis
process.1 These difficulties, namely dys-
lexia, dysgraphia, dyscalculia, dyspraxia,
and developmental aphasia,2 can occur
alone or in different combinations rang-
ing from mild to severe difficulties.3
Dyslexia, the reading disability,
is the most common condition,
accounting for about 80% of all SLDs. 4
Dysgraphia is generally characterized
by distorted writing despite thorough
instructions. T he significant charac-
teristic of dyscalculia is the problems
in understanding or learning math-
ematical calculations. About 30% of
children with SLD have behavioral
and emotional problems, and they are
at increased risk for hyperactivity and
other comorbidities. 5
Although SLD cannot be cured, there

S
prevalence of SLDs was estimated
from the reported prevalence of eligible
studies, using the random-effects model.
Results: Six studies of the systematic
review included the diagnostic screening of
8133 children. The random-effects meta-
analysis showed that the overall pooled
prevalence of SLD in India was 8% (95%
pecific learning disorders (SLD),
often referred to as learning dis-
ability, is a neurodevelopmental
disorder (NDD) and refers to ongoing
problems in one of the three basic skills–
reading, writing, and arithmetic–which
are the essential requisites for the learning
are interventions for underlying condi-
tions so that children with SLD can adapt,
accomplish academic achievements,
and live productive and fulfilling lives.3
Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) estimates the preva-
lence of all learning disorders (including

Child Development Centre, Government Medical College, Thiruvananthapuram, Kerala, India.

1

HOW TO CITE THIS ARTICLE: Scaria LM, Bhaskaran D and George B. Prevalence of Specific Learning Disorders (SLD) Among Children in
India: A Systematic Review and Meta-Analysis. Indian J Psychol Med. 2023;45(3):213–219.

Address for correspondence: Deepa Bhaskaran, Child Development Centre, Submitted: 08 Nov. 2021
Government Medical College, Thiruvananthapuram, Kerala 695011, India. Accepted: 22 Apr. 2022
E-mails: deepa.children@hotmail.com; cdc.tvpm@kerala.gov.in Published Online: 26 Jun. 2022

Copyright © The Author(s) 2022

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative ACCESS THIS ARTICLE ONLINE
Commons Attribution- NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) Website: journals.sagepub.com/home/szj
which permits non-Commercial use, reproduction and distribution of the work without further permission
provided the original work is attributed as specified on the Sage and Open Access pages (https://
DOI:10.1177/02537176221100128
us.sagepub.com/en-us/nam/open-access-at-sage).

Indian Journal of Psychological Medicine | Volume 45 | Issue 3 | May 2023 213

 Scaria et al.
impairment in writing, reading, and
mathematics) to be about 5% to 15%
worldwide.6 The lifetime prevalence of
learning disability among children in the
USA was 9.7%.7 In India, the prevalence of
SLD is reported to vary from 3% to 10%.8
In India, although SLD is included as
one of the disabilities according to the
Rights of Persons with Disability Act of
2016, the screening and diagnosis of SLD
are complicated. Various tools are used
for the assessment, with their own merits
and demerits. Some tools like the AIIMS
SLD: comprehensive diagnostic battery9
and the National Institute of Mental
Health and Neurosciences (NIMHANS)
index for SLD10 are commonly used
for assessment, but there is a dearth
of well-established norms for the sub-
types of SLD. There is no screening tool
available for teachers to identify SLD,
and various education boards (central
and state boards) have different levels
of academic curriculum. Some tools like
the NIMHANS index for SLD can only
be administered in English-medium
schools, whereas in India, about 42% of
students are studying in Hindi-medium
schools.11 Although many tools are devel-
oped in regional languages like Tamil,
Kannada, and Marathi,12 there is no
nationwide acceptability of these tools to
certify children with SLD.
It is crucial to have a review to know
the depth and breadth of the problem
and the differences in the diagnostic
criteria used in the studies. There is a
lacuna in the evidence regarding the
prevalence of SLDs, and usually, they go
undetected.13,14 Early diagnosis and assis-
tance for a child with SLD is the need
of the hour, and thus it is also essential
to know about the diagnostic methods
used. There is a lack of systematic reviews
focused exclusively on the prevalence of
SLD in India. Estimating the prevalence
of SLD in India is valuable in planning
diagnostic and intervention services.
Information regarding the overall esti-
mate of SLDs in the country will help
develop a school-based policy for early
identification, referral, and management
of children with SLDs. Hence, this study
was designed to perform a systematic
review and meta-analysis to estimate
the prevalence of SLD in Indian children
and review the tools used for diagnosing
SLD.
214 Indian Journal of Psychological Medicine | Volume 45 | Issue 3 | May 2023
Materials and Methods Population
The protocol for the review was reg- The population of interest was school-go-
istered with PROSPERO (registration ing children residing in India aged 6 to 19
number- CRD42020154690). years who were assessed for SLD using dif-
ferent existing tools for diagnosing SLD.
Data Sources and Search
Strategy Inclusion Criteria
Observational studies, including cross-
Two investigators (LMS and DB) searched
sectional, cohort, or case-control studies,
the electronic databases of MEDLINE,
of children with SLDs, using validated
Embase, PsycINFO, and CINAHL. Data
or nonvalidated tools, published in
search was carried out between June and
the English language and conducted
August 2021. Because SLD prevalence
in community settings, were included.
studies were published since 1990, the
Where multiple publications were gen-
authors selected 30 years to review arti-
erated from the same data with the same
cles (1990–2020). Additional searches
outcome, only the most relevant study
were conducted in Google Scholar and
was included.
grey literature sources such as documents
of conferences and government web-
sites. Hand searching and retrospective
Exclusion Criteria
searching of relevant published litera- Studies that discussed therapy, manage-
ture was also done. All English-language ment, and comorbidities of SLDs were
studies containing information on SLD excluded. Studies conducted in hospitals
prevalence among children and adoles- were excluded because the children are
cents aged 6 to 19 years were retrieved. likely to be highly selected (i.e., selection
To select the upper age limit, the WHO bias), resulting in inaccurate estimations of
definition of adolescents as 10 to 19 years the true prevalence of SLDs. Studies were
was adopted.15 From the selected studies excluded if children were not screened
having information on the prevalence of for intelligence quotient (IQ). Editorials,
SLD, information on screening criteria letters, opinion articles, narrative or sys-
and tools used to diagnose SLD was iden- tematic reviews, brief communications,
tified and reviewed. A search strategy and posters were excluded.
that included the combination of subject
terms and free-text terms was employed Screening Strategy
using the operators “OR” and “AND.” The Two authors reviewed the titles and/or
Medical Subject Headings (MeSH) terms abstracts of studies identified using the
were SLD, learning disability, learning search strategy and those from additional
disorder, dyslexia, dysgraphia, dyscal- sources. They independently assessed the
culia, prevalence, and India. All MeSH eligibility of the full-text articles. The
terms were exploded where necessary third author (BG) reassessed all selected
(Table 1). studies. Any disagreement between the
TABLE 1.
Search Strategy Used in MEDLINE Database (1989–2020).
Number Search Terms
1 prevalence/or incidence/or prevalence [MeSH Terms]/or prevalence*
2 AND
3  learning disability/or learning disabilities/or learning disorder [MeSH Terms] or learn-
ing disorder*/or dyslexia [MeSH Terms]/or dysgraphia [MeSH Terms]/or dyscalculia
[MeSH Terms]
4 AND
5 children/OR child*/or child aged less than 18 years
6  AND
7 India/OR Indian/OR Indian studies

reviewers was resolved through discus-
sion with the third author.
Quality Analysis
The quality of reporting in the selected
articles was checked using Strength-
ening the Reporting of Observational
Studies in Epidemiology (STROBE). The
STROBE checklist for cross-sectional
studies was used to evaluate the rele-
vant information from each article. LMS
and DB independently assessed studies’
reporting quality. In case of any disagree-
ment on this assessment, the issue was
resolved by discussion or consensus with
the third investigator (BG).
Data Extraction
A standardized data extraction form
was developed and piloted based on the
Cochrane good practice data extraction
form template to extract data from
the selected studies. Extracted infor-
mation included study design and
methods, study settings, participant
characteristics, study outcomes, results,
conclusions, and study funding sources.
FIGURE 1.
PRISMA Flow Diagram of the Review Process and Study Selection.
The pooled prevalence of SLDs was
estimated from the reported prevalence
of eligible studies, using the random-ef-
fects model. Analyses were performed
using STATA 16 (College Station, Texas,
USA) software. Forest plots were gen-
erated displaying prevalence with the
corresponding 95% confidence intervals
(asymptotic Wald) for each study. The
I-squared (I2) test was used to assess het-
erogeneity. The tools used to diagnose
SLD were identified from the selected
articles and reviewed.
Results
Literature Search
The preferred reporting items for system-
atic reviews and meta-analyses (PRISMA)
statement flowchart16 in Figure 1
describes the literature screening, study
selection, and reasons for exclusion.
Out of 17 studies assessed for eligibil-
ity, 11 were excluded for the following
reasons: management/interventional/
risk factor studies,17,18 no diagnosis done/
only screened for different SLDs,19–22 the
prevalence of SLD was not assessed,23,24
Indian Journal of Psychological Medicine | Volume 45 | Issue 3 | May 2023
Review Article
the study did not screen for the intel-
ligence of the participant children,25
and studies assessed only dyslexia.26,27
A total of six studies met the inclu-
sion criteria for this review and were
finally included in the meta-analysis
(Table 2).28–33
Description of Included
Studies
The studies included in this review
were conducted in different states of
India, including Andhra Pradesh,
Chandigarh, Goa, Gujarat, Haryana, Him-
achal Pradesh, Karnataka, Kerala, Madhya
Pradesh, and Odisha. All were cross-sec-
tional studies done among children aged
6 to 19 years. The studies assessed chil-
dren at a younger age itself, except for
Arun et al., for which the age group was
12 to 19 years. Three studies assessed the
subcategories of SLD separately along
with the total prevalence of SLD31–33; all
other studies assessed SLD in total and
not the subtypes. The study by Arora et
al. was done in the community setting,29
and all the other studies were conducted
at schools. Of the studies conducted in
schools, the study setting of four included
both private and government schools.
Three studies were conducted in urban
areas alone.31–33 The grade in which the stu-
dents were studying ranged from Class
II to Class XII. The articles by Mogasale
et al., Sharma et al., and Shah and Buch
assessed students of Classes III to IV, III
to IV, and II to VI, respectively.31–33
SLD was diagnosed with different
diagnostic tools in different studies.
The tools used to screen and diagnose
SLD were the NIMHANS-SLD index and
Grade Level Assessment Device (GLAD34;
Table 3). All the studies except Arora
et al. used the NIMHANS-SLD index to
diagnose SLD. The tool is available for
English-medium students, and while
using this tool, the authors used local
language textbooks of lower grades for
assessments.
The highest prevalence rate of SLD
from individual studies was reported
as 16.49% by Chacko and Vidhuku-
mar,30 followed by Mogasale et al., who
reported a prevalence rate of 15.17%.31 The
least prevalence was reported as 1.58%
by Arun et al.28 Mogasale et al. reported
12.5%, 11.2%, and 10.5% prevalence of
dysgraphia, dyslexia, and dyscalculia,
215
 Scaria et al.
TABLE 2.

Characteristics of Selected Studies.

Author Year Region Study Age in Number of Children Total Number of Male SLD Studied
Setting Years with SLD Children Surveyed Female Ratio
Mogasale et al. 2012 Belgaum, School 8–11 165 1088 1.69 SLD–total
Karnataka and Dyslexia
Dysgraphia
Dyscalculia
Arun et al. 2013 Chandigarh School 12–19 38 2402 1.33 SLD–total
Arora et al. 2018 Himachal Pradesh, Community 6–9 32 1970 1.01 SLD–total
Haryana, Odisha,
Andhra Pradesh,
Goa
Sharma et al. 2018 Gwalior, Madhya School NA 23 800 0.97 SLD–total
Pradesh (third and Dyslexia
–sixth Dysgraphia
standard) Dyscalculia
Shah and Buch 2019 Jamnagar city, School 7–12 38 393 0.87 SLD–total
Gujarat and Dyslexia
Dysgraphia
Dyscalculia
Chacko and 2020 Ernakulam, School 8–12 244 1480 1.03 SLD–total
Vidhukumar Kerala
SLD, specific learning disorders.

TABLE 3.

Methodological Details of Specific Learning Disorders’ Screening and Evaluation Done.

Chacko and
Criteria Mogasale et al. Arun et al. Arora et al. Sharma et al. Shah and Buch Vidhukumar
IQ test Yes Yes Yes Yes Yes Yes
Hearing test Yes Not mentioned Yes Yes Yes Yes
Vision Yes Not mentioned Yes Yes Yes Yes
assessment
Other NDDs Yes ADHD not excluded Yes Yes Yes Locomotor impairment
excluded
Diagnostic NIMHANS index NIMHANS index GLAD NIMHANS index NIMHANS NIMHANS index
measure index

Case Screened Screening by teachers The diagnostic Initial screening Team of Screened by parents
ascertainment by pediatric based on a six-item team comprised using academic developmental or teachers using
postgraduates proforma a physician, performance pediatricians, a learning disorder
diagnosed diagnosed by audiologist/ screened for special screening tool
by a clinical psychologist speech therapist, vision and hearing educators, and diagnosed by a
psychologist and psychologist from the pediatric psychologists psychiatrist
outpatient
department
NDDs, neurodevelopmental disorders; ADHD, attention deficit hyperactivity disorder; GLAD, grade level assessment device; NIMHANS index, National Institute of Mental
Health and Neurosciences index for SLD; SLD, specific learning disorders; IQ, intelligence quotient.

respectively,31 while the prevalence of
SLD subtypes–dysgraphia, dyslexia, and
dyscalculia–reported by Shan and Buch
was 7.4%, 8.6%, and 7.1%, respectively.32
The six studies of this systematic
review have included the diagnostic
screening of 8133 children. The random-ef-
fects meta-analysis showed that the
overall pooled prevalence of SLD in India
was 8% (95% CI = 4–11, Figure 2). In this
meta-analysis, a high level of heteroge-
neity (98.72%) was observed between the
studies. The diamond in the result rep-
resents the point estimate of 7.7% from
all the individual studies together. The
horizontal point of the diamond rep-
resents the 95% confidence interval of
this combined point estimate.

216 Indian Journal of Psychological Medicine | Volume 45 | Issue 3 | May 2023


FIGURE 2.
Prevalence of Specific Learning Disorders Among Children Aged 6
to 19 Years in India (Random Effect Model).
Subgroup analysis and meta-
regression were not attempted because
the studies did not mention urban-rural
differences or gender differences. Also,
characteristics such as age group, type
of study, and the diagnostic measure did
not vary much among the studies.
In this meta-analysis, because the
outcome measure is the prevalence and
the probability that significance levels
that may have biased publications
are less, publication bias may not be
applicable. The reasons for nonpubli-
cation are more likely small studies not
using appropriate methodology. All the
selected articles satisfied the STROBE
criteria for reporting.
Discussion
This systematic review reports an 8%
prevalence of SLD in India. All the
enrolled studies were recently published
from 2012 to 2020. However, the six
studies included in this review used a
spectrum of tools for screening and diag-
nosis of SLD.
There is no single screening and diag-
nostic tool that may be considered specific
for the diagnosis of SLD. The NIMHANS
index for SLD was developed in 1991 in
the Department of Clinical Psychology,
NIMHANS, Bangalore. The NIMHANS
index for SLD is a curriculum-based
assessment that can be used to confirm
Review Article
There is a dearth of acceptable tools
that are developed and validated in
regional languages, particularly in rural
parts of the country and the Adivasi
population, where the dialects are dif-
ferent. The tools accepted for diagnosis
of SLD are developed for students of
English-medium schools, whereas in
India, only one-fourth of the students
study in English-medium schools.36 The
content used in the tools is not standard-
ized. Existing tools have not included
all the age groups for assessment, which
makes assessment difficult, especially
when the student is to be assessed in
tenth or twelfth classes to issue a certifi-
cate for availing benefits.37
In a population-based prevalence
estimate from the USA, the prevalence
of SLD reported was 9.7% in children
aged 3 to 17 years.7 Nearly 5% of the US
school-age population have learning
disabilities that have been formally
identified.38 Our study reports that
nearly one in twelve Indian children
the diagnosis of SLD.10 It includes
have SLD. In Brazil, recent estimates
tests of reading, writing, spelling, and
show that the prevalence rate was
arithmetic abilities to detect children
7.6% for global impairment, 5.4% for
with disabilities in these areas. There are
writing, 6.0% for arithmetic, and 7.5%
norms for children in Standards I to V.
for reading impairment.39 Also, an epi-
This battery can be used not only for con-
demiological study from Turkey found
firming an initial diagnosis of SLD but
the prevalence rate to be 13.6%.40 A
also for certification of SLD in India. The
recent estimate from Pakistan showed
Gazette of India (No. 61, dated January
a similar prevalence of 7.7% among
6, 2018) states that the NIMHANS-SLD
primary school children.41
index shall be used to diagnose SLD in
SLDs are challenging to diagnose
children. The tool can also be used for
and are often not well understood as
the assessment of improvement after
a group of disorders. There is a gap of
remediation. However, the different
nearly four years between the child’s age
types of SLDs cannot be picked up using
at SLD diagnosis and the mother’s first
this battery.35 Besides, since the tool is
suspicion of a problem.42 The treatment
in English and India is a multilingual
of SLD focuses on educational interven-
country, professionals find it challenging
to assess SLD in a child’s mother tongue.
tions, and early interventions are most
desirable.43 Therefore, it is crucial to iden-
The assessment using GLAD includes
tify SLD as soon as possible.
the level of functioning and process of
Lack of appropriate resources, tools,
learning. In developing this tool, the
and support and lack of awareness among
National Council of Educational Research
parents and school teachers are significant
and Training (NCERT)-prescribed
issues in the Indian context.44 The multiple
minimum levels of learning (MLL) were
curriculums at schools, varying standards,
taken as standard. English, Hindi, and
and multilingualism prevent a unifying
Mathematics textbooks from Class I to
standardized approach.45 Regional adapta-
Class IV of the Central Board of Second-
tions in protocols and universal screening
ary Education (CBSE), Indian Certificate
of children are the vital components. Pro-
of Secondary Education (ICSE), and the
spective studies (across different states and
state board in Andhra Pradesh were used
vernacular languages), multicenter collab-
to develop the tool. Items were taken
orations, and longitudinal research with a
from all the syllabi based on the MLL
large sample and a single comprehensive
fixed based on NCERT stipulations.34
test battery are needed to understand the
Indian Journal of Psychological Medicine | Volume 45 | Issue 3 | May 2023 217
 Scaria et al.
situation better and make the children
achieve their maximum potential. Also,
SLD epidemiology needs to develop into
the arenas of operational research to study
the utilization pattern of services as well,
thereby making care available to those
in need.
The high prevalence of SLD among
children in India implies the need for
awareness generation among parents
and teachers. Adopting community sen-
sitization programs will be beneficial for
early identification and improving access
to remedial education programs. Advo-
cating and strengthening the integrated
education system, management of
comorbidities, and prevention of mental
health problems will improve the quality
of life of children with SLD.
This systematic review had a few lim-
itations. There was heterogeneity in
the methodology among the applied
screening and diagnostic tools used in
the included studies, which might have
led to under‑ or over-estimation of the
prevalence data. The prevalence rate
trend analysis was not done because the
studies were published recently within
ten years. Subgroup analysis on rural
versus urban population and male and
female sex could not be done because
the articles did not mention the required
data. Prevalence in the subgroups of ages
could not be assessed because data were
not available for different age groups.
Conclusion
This review systematically analyzed data
from Indian studies to determine the
prevalence of SLD in India. This is the
only systematic review on the topic so
far, and it demonstrated that nearly 8%
of children have SLD. This may include
mild, moderate, and severe cases. The
conclusion shall be inferred taking care
of the study’s limitations. The study
also highlights that there are only a few
high-quality, population-based epide-
miological studies on this topic. This
review has contributed to explaining the
prevalence estimates of SLD in India.
The impact of factors such as urban or
rural location, age, diagnostic tools, and
medium of instructions on SLD preva-
lence needs to be further investigated.
As India is a vast country, there is a
pressing need to have extensive popu-
lation-based surveys using appropriate
218 Indian Journal of Psychological Medicine | Volume 45 | Issue 3 | May 2023
screening and diagnostic tools. Con-
structing standardized assessment tools,
keeping in view the diversity of Indian
culture, is an enormous task. Similarly,
regional-language-based screening and
diagnostic tools must be developed for
easy identification and reporting. Since
SLD is included as one of the disabili-
ties in the RPWD Act 2016, diagnosis
and certification are warranted. Early
diagnosis and disability certification are
essential requirements for providing
equal opportunities, equal rights, and
equal participation of the children in the
community.
Acknowledgement
We acknowledge the research team of the Child
Development Center for their support during this
study.
Declaration of Conflicting Interests
The authors have no potential conflicts of
interest to declare with respect to the research,
authorship, and/or publication of this article.
Funding
The authors received no financial support for the
research, authorship, and/or publication of this
article.
ORCID iD
Liss Maria Scaria https://orcid.org/0000-
0002-2892-6898
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