Overview of Specific

Learning Disabilities (SpLD)

Dr. Sunil Karande MD (Pediatrics), DCH

Associate Professor of Pediatrics

Learning Disability Clinic
Department of Pediatrics
LTM Medical College & General Hospital
Mumbai
 Specific Learning Disabilities
(SpLD)
 Group of developmental disorders
 Significant 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 opportunity
 The child with SpLD is one who does not meet
expectations for academic performance in school
but has intelligence in the normal range
 “a severe discrepancy between achievement and
intellectual ability in one or more of the following
areas:
 Oral expression

 Listening comprehension

 Written expression

 Basic reading skill

 Reading comprehension

 Mathematical calculations

 Mathematical reasoning”
 Facts about SpLD
 5-15% school population
 Intrinsic to the individual
 Invisible Handicap
 ? Genetic in origin
 Due to CNS dysfunction
 Chronic life-long conditions
 What happens in dyslexia?
 Deficits in “phonologic awareness”
 Phoneme: smallest discernible segment of speech
 "bat" consists of three phonemes:
/b/ /ae/ /t/ (buh, aah, tuh)
 Poor awareness that words, both written and spoken,
can be broken down into smaller units of sound
and; letters constituting printed word represent
sounds heard in spoken word
 How does SpLD present?
 Failure to achieve school grades
commensurate with intelligence
 Repeated spelling mistakes, untidy / illegible
handwriting, poor sequencing, inability to
perform simple mathematical calculations
 School failure / under-achievement
 Adverse impact on self-image, relationships
 If undetected: school drop-outs and even anti-
social elements
 General Philosophy
 Children irrespective of their physical,
sensory, or neurobehavioral deficits, must be
educated in regular mainstream schools
(“inclusive education”)
 Children with SpLD should continue
education in regular mainstream schools
 What is not SpLD !!!!
 “Slow learners” (IQ 71 to 84)
 Mental retardation (IQ ≤ 70)
 Visual handicap (> 40% disability)
 Hearing handicap (> 40% disability)
 Physical handicap (e.g. cerebral palsy)
 Language barrier
 Emotional problems / Chronic medical
problems
 Psychiatric disorders (e.g. depression)
 Brief History of SpLD
 1878: Dr. Kussmaul (Germany) described a
man with normal intelligence but unable to
read in spite of an 'adequate' education. He
called this condition “reading blindness”

 1896: Dr. Pringle Morton (UK) described 14-

year-old boy with reading difficulty:
The teacher:- “he would be the smartest lad in
the school if instruction were entirely oral”
 1925: Dr Samuel Orton (USA) proposed the
theory of “specific learning difficulty”

 1936: Anna Gillingham and Bessie Stillman

published "Remedial Training for Children with
Specific Disability in Reading, Spelling and
Penmanship"

 1963: Dr. Samuel Kirk (USA) first used term

“learning disabilities”

 1969: “The Children with Specific Learning

Disabilities Act (USA)” passed
 1977: Public law fine tuned ensuring rights
of American children with SpLD to
'appropriate evaluation' and 'management' of
their problem

 “every SpLD child will participate in same

curriculum and have same academic
objectives”
 History of SpLD in India
 1987: SNDT College starts B.Ed. (Special
Education) course: Special Educators for
remediation available
 1992: Parent group start “lobbying” for
recognition of SpLD so that these children
continue education in regular schools
 1995: Maharashtra Dyslexia Association
formed by parents of SpLD children
 1996: L.D. clinic at LTMG (Sion) Hospital
started by Prof. Madhuri Kulkarni
 1996: Govt. of Maharashtra issues G.R.

which grants provisions for first time in India;

but for standards IX and X only

 1999: ICSE and CBSE boards also grant

provisions
 2000: Provisions extended from standard I
to XII

 2003: Provisions extended to college

courses; Seats “reserved” for SpLD in
physically handicapped category in
colleges, including professional courses
 Genetics Of Dyslexia
 In 1950, Hallgren suggested that dyslexia was
an autosomal dominant disorder
 Recent findings:
 Dyslexia is a genetically heterogeneous and

complex trait that does not show classical

mendelian inheritance
 Several chromosomal regions have been

reported to contain genes affecting reading

disability (chromosome 1, 2, 3, 6, 15, 18)
 Genetic Disorders Associated with
SpLD

 Sex chromosome anomalies:

 XXY, XYY, fragile X syndrome, XO
(Turner’s)
 Syndrome NF1 and other neurocutaneous
disorders
 PKU
 Perinatal Risk Factors

 Low birth weight

 Obstetrical complications:
 Birth asphyxia
 Intraventricular hemorrhage
 EEG studies
 EEG abnormalities in 50% but no specific
pattern
 Above minor changes no longer considered
valid or of any value
 No role in the evaluation of LD
 Neuroimaging
 Absence of usual asymmetry of planum
temporale (portion of temporal lobe lying
posterior to Heschl’s gyrus)
 Left is usually larger than right
 Perhaps right being larger than normal is due
to failure of neuronal pruning
 Not certain if brain changes localized to
specific areas, or if interaction between
different areas important in causing SpLD

 CT / MRI scans not useful

 New research tools: fMRI, PET / SPECT

scans
 Functional Imaging in Dyslexia
 13 studies: no consistent pattern of hypo- or
hyper activation
 Abnormalities found in multiple areas,
sometimes both hemispheres
 Most common: hypo activation in left
temporal lobe during reading tasks
 Some studies: activation increased after
remedial therapy for dyslexia
 Attention deficit hyperactivity
disorder (ADHD)
 Affects 8-12% of children
 3 sub-types:
 ADHD-I: inattention
 ADHD-HI: impulsivity and hyperactivity
 ADHD-C: have both
 At risk for poor school performance
 20-25% ADHD children have SpLD and vice
versa
 Multidisciplinary approach
 Pediatrician
 Ophthalmologist
 Otolaryngologist
 Clinical Psychologist
 Special Educator
 Child Psychiatrist
 Counselor
 Evaluation Procedure
 Letter from School Principal describing child’s academic
difficulties: reading, writing, spellings, maths, behavior in
class room
 Multi-disciplinary approach:
 Medical / Neurological examination
 Vision, Hearing tests
 Analysis of school reports
 IQ testing (WISC test)
 Educational assessment
 Psychiatric assessment, if required
 Case conference / Final diagnosis
 Counseling before Certificate issued
 Takes 2-3 wks to complete
 At time of diagnosis:
Each child’s parents counseled:
 SpLD: its meaning, treatment, prognosis

 Importance of remedial education

 Provisions at school examinations and at board

examinations in future
 Child and parents to choose whether to avail all

available provisions or only some of them

 Choice to be made in consultation with school

teachers / remedial teacher

 About ADHD if co-morbidity
 Remedial Education
 Cornerstone of treatment of SpLD
 Should ideally begin early, when child in
primary school
 Special Educator formulates Individual
Education Program (IEP)
 Hourly sessions twice / thrice wkly for few yrs
 Expensive (Rs. 150-800/ session)
 Most schools do not employ special
educators as staff members
 Children have to necessarily take remedial
education from “private” special educators
 Parents not adequately knowledgeable
about remedial education
 Role of Provisions
 SpLD distorts scores causing them to be too low

 Provisions formulated to help SpLD children

continue in regular mainstream school

 Provisions function as ‘corrective lens’: distorted

array of observed scores back to where they ought to
be

 Provisions serve to "level the play field“: academic

performance now commensurate with intellectual
ability
Provisions at SSC board examination
 Extra time of 30 mins for written tests, spelling mistakes overlooked

 Employing writer for children with dysgraphia

 Exemption of 2nd language, substituting with work experience subject

 Exemption of standard X mathematics (algebra and geometry), substituting

with standard VII mathematics and work experience subject

 Choice is to be made from a range of 39 work experience subjects

[e.g. Typewriting (English), Introduction to Computer, Book Binding,
Hand Embroidery, Drawing & Painting]
 Impact of Provisions
 60 children at SSC examn with provisions compared
with performance at last annual school examn before
diagnosis of SpLD
 Improvement in mean % total marks (63.48 ± 7.86 vs.
40.95 ± 7.23 )
[mean % difference = 22.53, P < 0.0001]
 Children who availed exemption of 2nd language or
opted for lower grade mathematics scored better
marks
(P < 0.0001 and P = 0.0009, respectively)
 Experiences with Parents
 Just do not accept diagnosis
 Do not begin remedial education
 Instead private tuitions
 Omit remedial education early
 Refuse provisions as it restricts future career
options (e.g., child who has opted for lower
grade of mathematics cannot later have career
in engineering)
 Experiences with Schools
 Regular Awareness Workshops conducted
 School Principals targeted first
 School Teachers sensitized to suspect SpLD
 Initially, many schools uncooperative
 Implementation of Govt. rules mandatory
 Cannot detain child if provisions not given
 Recent High Court Judgment
 Two PIL’s filed in 2005 by parents whose
children were denied provisions
 Vincy D’Silva vs. St. Mary’s High School
(ICSE school at Mazgaon)
 Robin Machado vs. Atomic Energy Central
School (CBSE school at Anushakti Nagar)
 All schools (SSC, ICSE, CBSE) will now be
held in contempt of court for non-compliance
Salient Features of High Court Judgment
 Schools should keep record book for each SpLD
student
 Stds. I to X: 25% extra time during exams
 Final results on average of written & oral tests
 Writer or typewriter facility
 Exemption from: spelling errors, long descriptive
answers in home work, drawing figures, diagrams,
charts, maps, graphs
 Grace marks of 20, instead of 15
 Use of tape recorder in class during lessons
 Not to enforce cursive writing
 For dyscalculia: mathematics a grade or two
lower; pardon number reversals and errors in
mathematical symbols
 Nearest exam center of choice for Board exams
 Expert panel to devise standardized check list for
screening SpLD in students not doing well in
school work
 However, expenses for testing and remediation to
be borne by parents
 Use of computer for typing or calculator not
permitted
 Wish List
 Better awareness amongst parents, school authorities,
doctors
 Remediation Center in every school
 Standardized psychological and educational tests in
all languages
 Provisions made available to all SpLD children
 Tests to identify children “at risk for SpLD” early
 Identification of genetic markers for risk of SpLD
 Neuroimaging studies (fMRI and PET) to unravel
etiology
THANK YOU