Tuesday, October 11, 2011

Learning Disability - academic underachievement

learning disorder
Impaired spelling and arithmetic in Standard 3 boy with Learning Disorder

Learning Disorder (LD) is characterised by impaired acquisition of academic skills. This impairment in scholastic skills is not due to intellectual disability, physical disorders, emotional disturbances, or environmental, cultural, or economic disadvantage.

There is a gap between ability and application. The child may know what is asked, is able to explain it verbally, but is unable to put it down in writing. Learning Disorder could affect any of the three scholastic Rs – Reading, wRiting or aRithmetic.

Types of Learning Disability

  1. Dyslexia – is the commonest learning disability (80%). It is marked by impairment of the ability to recognize and understand written words.
  2. Dyscalculia – problems with doing math, understanding time, using money.
  3. Dysgraphia – problems with handwriting, spelling.
  4. Dyspraxia – problems with hand-eye coordination and balance, difficulties with fine motor skills.

Signs and Symptoms

Most children with a Learning Disability are not diagnosed until they are in Standard 2-3 or 7-8 years of age. Remarks like ‘can do better’ or ‘handwriting needs to improve’ are often the first warning signs to appear in the report card. Many of these children would have been the stars of their nursery or kindergarten class. The transition to assessment of written output in primary school is what unmasks the disorder. The aware teacher is able to help the parents understand and put the parents on the path to remedial teaching.

Parents should watch out for

  • Reading may be slow or there is repeated rereading or skipping of an entire section. In the lower classes the child learns to memorise and reproduce entire chapters. Later the child is unable to hold the increasing amounts of material in memory, grades plummet, and confused parents are left searching for answers.
  • Problems in copying from the blackboard or a book. This is a frequent complaint of the teacher. Classwork is left incomplete. The child tries to copy from their partner and is punished for distracting the class.
  • Poor handwriting or drawing – their exercise books are messy, with frequent scratching out and erasing. This is especially so when the child writes on blank paper. It is also a reason why the child performs poorly in exams – they just cannot write quickly enough. They run out of time before they reach the last few questions.
  • Other signs in more severe conditions
    • Reversing numbers and letters while reading or writing - For example, confusing ‘b’ and ‘d’
    • Mixing the order of letters or numbers. Writing ‘twon’ instead of ‘town’.
    • Skipping letters in spelling. The child says ‘grass’ but writes ‘gas’.
    • Forgetting words they know well.
    • Weakness in mathematics.

Conquering Learning Disorder

  • Approach a centre undertaking diagnosis of learning disabilities.
  • A complete history of the child’s birth, milestones, health and academic record
  • Physical exam to exclude problems related to vision and hearing
  • Psychometry - to demonstrate specific academic problems that are not associated intellectual disability
  • Psychiatric assessment - to address associated anxiety, phobias and depression that arise out of repeated academic failures.
  • Psychiatric assessment - to exclude or address Attention Deficit Hyperactivity Disorder (ADHD) a common comorbidity. 15-40% of children with ADHD also have dyslexia.
  • Remedial teaching is essential to overcome learning problems 

Drug treatment for dyslexia?

There is a growing body of research to show that at least in children who have both ADHD and dyslexia there are significant improvements in reading ability with ADHD medication. These improvements in reading ability are not related merely to improvements in attention. The brain systems responsible for therapeutic improvement in children with ADHD + dyslexia are probably different from those in children with ADHD alone. The finding that selective areas of working memory can be enhanced by these medications is important, as poor working memory function appears to be a mental constraint on academic learning.

References
  1. Schulte-K├Ârne G. The Prevention, Diagnosis, and Treatment of Dyslexia. Dtsch Arztebl Int. 2010 Oct;107(41):718-26; quiz 27. Epub 2010 Oct 15
  2. Sumner CR, Gathercole S, Greenbaum M, Rubin R, Williams D, Hollandbeck M, Wietecha L. Atomoxetine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children with ADHD and dyslexia. Child Adolesc Psychiatry Ment Health. 2009 Dec 15;3:40..