|Year : 2017 | Volume
| Issue : 2 | Page : 104-109
Clinical and academic profile of children with specific learning disorder-mixed type: An Indian study
Anamika Sahu1, Rachna Bhargava1, Rajesh Sagar1, Manju Mehta2
1 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
2 Department of Clinical Psychology, Holy Family Hospital, New Delhi, India
|Date of Web Publication||2-Apr-2018|
Room No: 4089, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Background: Specific learning disorder (SLD) in the past decade has gained recognition as a disabling condition among children by parents and teachers in India. However, there are still gaps in knowledge about its clinical presentation and understanding. Therefore, the present study was planned to evaluate the clinical and academic profile of children with SLD. Methods: The sample comprised 30 children with their age range between 7 and 12 years with a diagnosis of SLD-mixed type. All children were assessed through specifically designed structured pro forma for clinical details (i.e., nature of birth, developmental milestones, and comorbidities) and academic history (i.e., history of failure, promoted in next class, repetition in the class, school change, etc.) and SLD-comprehensive battery. Results: The mean age of the participants was 9.6 years (standard deviation [SD] = 1.5). 76.7% of participants were male and their mean years of education was 4.7 (SD = 1.5). Thirty percent of children had a history of delayed developmental milestones in terms of speech (16.7%), walking (6.7%) and in speech and walking (6.7%), 23% of children had comorbid conditions of attention-deficit/hyperactivity disorder/attention-deficit disorder. Thirty percent of children repeated classes in their academic career. Conclusions: A significant number of children had delayed milestones and other problems. Moreover, it is important to understand the clinical and academic profile in the cultural context so that early identification and intervention can be planned.
Keywords: Clinical and academic profile, India, specific learning disorder
|How to cite this article:|
Sahu A, Bhargava R, Sagar R, Mehta M. Clinical and academic profile of children with specific learning disorder-mixed type: An Indian study. J Mental Health Hum Behav 2017;22:104-9
|How to cite this URL:|
Sahu A, Bhargava R, Sagar R, Mehta M. Clinical and academic profile of children with specific learning disorder-mixed type: An Indian study. J Mental Health Hum Behav [serial online] 2017 [cited 2018 Nov 20];22:104-9. Available from: http://www.jmhhb.org/text.asp?2017/22/2/104/229099
| Introduction|| |
Specific learning disorder (SLD) affects specific abilities in children with an otherwise normal academic development. SLD is defined as a heterogeneous group of neurobehavioral disorders that clinically manifested by significant unexpected, specific and persistent difficulties in the acquisition and use of efficient reading, writing, or mathematical abilities. It generally occurs despite intact senses, normal intelligence, adequate motivation, and sociocultural opportunities. Worldwide, the prevalence of SLD has been estimated to be around 5%–15%, whereas in the Indian context, it affects approximately 0.38%–15.2% children. Prevalence studies from India have found the rate of dyslexia as 3%–4%, dyscalculia as 3%–6% and learning disability in general as 3%–7.5%. However, it has been documented that majority of the cases have mixed type of errors on SLD battery and have problems in all academic area, i.e., learning difficulty in reading, writing, and arithmetic also.,
Furthermore, comorbidity has also been documented with SLD., Due to poor academic performance, many children with SLD experience low self-esteem, lack of confidence, low expectations for themselves, and poor peer relationship. In addition, SLD (with or without any comorbidity) is known to disturb the educational achievement. Thus, early recognition and intervention for SLD are required to improve learning and to prevent emotional and adjustment issues.
Of late, awareness regarding SLD in India has increased, especially among school authorities. However, parents still have insufficient knowledge about SLD and its remediation. This area is under-researched, under-detected, and hence undertreated in India. Published literature in Indian context remains sparse as culture issues such as multilingualism, poverty, teacher-student ratio makes accurate assessment difficult. For any effective remedial training program, it is important to have an in-depth understanding of clinical and academic issues among SLD children. However, only limited studies have focused on the clinical and academic profile of these children and findings are not conclusive., Therefore, this study was planned to examine the clinical and academic profile of children with SLD.
| Methods|| |
A cross-sectional sample of thirty students in the age range of 7–12 years were drawn from the outpatient department of psychiatric, All India Institute of Medical Sciences, New Delhi, India. In our clinical observation, maximum cases coming to the outpatient department of psychiatric had mixed type SLD were in the age range of 7–12 years. All children diagnosed as cases of SLD by consultant psychiatrists were recruited in the study. Further, they were assessed on SLD battery to determine the type of learning problem in all academic areas, i.e., reading, writing, and arithmetic. The organic conditions like major neurological or medical disorders, impairment in hearing, vision, or speech due to which learning difficulties could occur were excluded from the study. Parents who were willing to participate were only included in the study.
Ethical approval to conduct the study was obtained from the Institutional Ethics Committee and written informed consent/assent was obtained from parent/child with SLD.
Following tools were used
Sociodemographic profile sheets
This data sheet was developed for the present study by authors to obtain sociodemographic details of the participants that include age, education, gender, family type of child, etc.
Kuppuswamy's Socioeconomy Status Scale
This is developed by Kuppuswamy. 2014 revision of this scale was used in present study. It takes into account education, occupation, and income of the family to categorize families into upper, middle, and low socioeconomic status (SES).
Clinical profile sheet
All children were assessed on a specifically designed structured pro forma to determine the nature of birth, developmental milestones, comorbidities, etc.
Academic performance profile
Each child's academic problems as described by the parents and by the teachers or counselor's referral letter were documented. Academic history included school type, medium, board, regularity in attending classes in school, history of failure, promoted in next class, repetition in the class, school change, etc.
Specific learning disorder-comprehensive battery
It has been developed by Mehta and Sagar. It includes Bender visuomotor Gestalt test, reading, expression both verbal and written, comprehension, arithmetic, etc. Test administration needs 1–1½ h per subject. Cutoff for each scales are provided with good reliability and validity.
Participants meeting the International Classification of Diseases 10th Revision diagnosis of SLD, fulfilling the inclusion criteria were recruited for the study. Children with SLD and their parents were informed about the nature and purpose of the study. Written informed assent/consent was obtained from the child and caregivers/parents. Parents were interviewed to record the clinical and academic profile of their child and test of SLD administered.
The data were analyzed using Statistical Package for Social Sciences software, Version 21.0 (SPSS, Chicago, IL, USA). Descriptive statistics were applied to examine demographic, clinical, and academic variables. It included frequency, percentage, means, and standard deviations.
| Results|| |
Demographic characteristics of the children with SLD are presented in [Table 1]. As can be seen, the mean age of participants were 9.6 (standard deviation [SD] = 1.5) years. The classes ranged from first to the seventh standard. Mean years of education was 4.7 (SD = 1.5). Sample was primarily male (76.7%), whereas females constituted 23.3% (n = 7). Nearly 93.3% of the participants were Hindu. The equal proportion was represented in terms of family structure; 50% were nuclear and 50% were from joint families. The majority of the participants belonged to the upper middle socioeconomic strata (76.7%) followed by upper SES (13.3%) and lower middle class (10%). All the participants came from an urban background (100%). Of them, 80% of the sample was residing in Delhi and remaining 20% were from National Capital Region (adjoining area).
|Table 1: Sociodemographic characteristics of children with specific learning disorder (n=30)|
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[Table 2] shows the clinical profile of children with SLD. Of all the participants, 10% (n = 3) of children were born of cesarean section and rest of the children had normal vaginal delivery. Nearly 6.7% of children had delayed cry (n = 2). In terms of delayed milestones, approximately 30% of the participants had delayed milestones in domain of speech (16.7%), walking (6.7%) and 6.7% had delay in both, i.e., speech and walking. Further, it was seen that one child had history of asthma and remain participants did not have any major illness. 23% of children exhibited signs of attention deficit hyperactivity disorder or attention-deficit disorder (ADHD or ADD) and 20% of them were on medication to maintain their attention for a long time and to mellow down their hyperactivity. All children had average level of intelligence.
|Table 2: Clinical profile of children with specific learning disorder (n=30)|
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[Table 3] shows the academic details of children with SLD. All children started schooling between the age ranges of 2.5 and 4 years. All children were being educated in English medium. Only two children were studying from Indian Certificate of Secondary Education board. All children were regular to their school classes (mean ± SD = 90 ± 9.1). Although the participants had no history of failure, however, 13% of them reported being promoted to next primary class due to their poor academic performance. Due to slow or poor learning and poor comprehension, nine children (30%) had repeated classes in their academic career. Out of nine, eight children were repeating once, and 1 (3.3%) repeated more than two times. However, there was no history of school change. Participants were receiving help from teachers and parents (30%), tutors and parents (36.7%) and parents only (33.3%). Most of the cases were referred by their school teachers or counselor (53.3%). Some parents were referred or suggested for psychological consultation by their doctors (10%) and friends/relatives (20%) and 5 parents (16.7) were approached for diagnosis and treatment by themselves.
|Table 3: Academic details of children with specific learning disorder (n=30)|
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Errors on reading, spelling and writing
Errors made by children on reading (Hindi and English) and writing (Hindi and English) subtests of the SLD-comprehensive battery are displayed in [Figure 1], [Figure 2], [Figure 3], [Figure 4]. Participant's performance on spelling and mathematics has been shown in [Table 4] and [Table 5].
|Table 4: Performance of children with specific learning disorder (n=30) on spelling test|
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|Table 5: Performance of children with specific learning disorder (n=30) on mathematic test|
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| Discussion|| |
As we know children with SLD are similar as other children in their physical and intellectual constructs. Learning problems in academic areas are not very oblivious at early years of a child. It displays in the form clinical (e.g., delayed milestones, comorbid conditions) and academic deficits (unable to grasp prerequisite skills or comprehends basic rules). Because of this, most of the time parents and teachers and even professionals deliberately ignore the signs and symptoms of SLD. They justify child's academic problems with his/her age, problem behaviors or mistakes of teachers and parents. Moreover, they are unable to distinguish learning problem or condition with normal learning that leads to delay in identification and remediation. Thus, it is important to understand clinical and academic problems of these children to fix it timely.
Very few studies from the Indian subcontinent have examined the clinical and academic profile of children with SLD. Here, the study extends an understanding of the clinical and academic profile of children with SLD-Mixed type. This study showed that most children with SLD had developmental milestones within normal range. However, more than one-fourth of children had a history of delayed developmental milestones in term of walking and speech or both. In addition, approximately one-fourth of children were exhibiting symptoms of ADHD. These findings are in line with previous studies where SLD children showed delayed milestones and ADHD symptoms.,,, Recently, a study has examined the clinical and psychoeducational profile of children with SLD with ADHD and they found delayed developmental milestones in around 24% of the children with SLD. Reading disorder was the most common SLD type along with ADHD.
In India, there are no examinations for primary classes and the child reaches 8th standard without much evaluation. This is especially true for government formal schools where the teacher-student ratio is quite disproportionate. In addition, in public schools, it largely depends on parent's level of awareness and the thought of retaining the child in a particular class is rare. Hence, they are promoted to next class despite their poor performance in scholastic areas. In this study, only one-fourth of participants repeated their classes in their whole academic span and more than one-sixth of children were promoted to their next class with recommendation for an extra class or remedial classes. Karande et al. also found a similar pattern where 30% of children had a history of class retention. Furthermore, these cases were primarily referred by school teachers or counselor for the diagnosis of SLD and further management. They also reported that in their clinic, referral for diagnosis of SLD was made by the school principle or the classroom teacher or school counselor.
Furthermore, the findings of the study should be contextualized in terms of the strengths and limitations. The strength of the study includes assessing for the first time clinical and academic profile of SLD-mixed type. This finding will help to understand the associated factors with SLD children that should be considered at the time of diagnosis and management of SLD children. There are few limitations of the current study that need to be mentioned and addressed in future studies. First, small sample size, there is a need for still larger samples to know exact proportion of problems. Second, lack of comparison with other disorder or controls and third, cross-sectional design.
| Conclusions|| |
This study extends our understanding of clinical and academic details of children with SLD-mixed type. The results, definitely, add crucial points to the existing literature. However, much work needs to be carried out with sophisticated study design. Moreover, the main aim should not be only to find faults with the child but also to successfully identify strengths as well as weaknesses and integrate them in management plan which may then ease the process of learning.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shapiro BK, Gallico RP. Learning disabilities. Pediatr Clin North Am 1993;40:491-505.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®
). Arlington: American Psychiatric Publishing; 2013.
Bhargava R, Prakash S, Arun P. Epidemiology of specific learning disorder: Indian context. In: Sagar R, Pattanayak RD, editors. Specific Learning Disorder: Indian Scenario. New Delhi, India: Department of Science and Technology & AIIMS; 2014. p. 133-54.
Arun P, Chavan BS, Bhargava R, Sharma A, Kaur J. Prevalence of specific developmental disorder of scholastic skill in school students in Chandigarh, India. Indian J Med Res 2013;138:89-98.
] [Full text]
Gowramma IP. Development of Remedial Instruction Programme for Children with Dyscalculia in Primary School. University of Mysore, Mysore: Unpublished Ph.D Thesis; 2000.
Margari L, Buttiglione M, Craig F, Cristella A, de Giambattista C, Matera E, et al.
Neuropsychopathological comorbidities in learning disorders. BMC Neurol 2013;13:198.
Srilakshmi P, Sundararajan J. Understanding children with specific learning disability and comorbid attention deficit hyperactivity disorder: A retrospective analysis of case records. Int J Innov Res Dev 2015;4:327-30.
Cortiella C, Horowitz SH. The state of learning disabilities: Facts, trends and emerging issues. New York: National Center for Learning Disabilities; 2014.
Karande S, Satam N, Kulkarni M, Sholapurwala R, Chitre A, Shah N. Clinical and psychoeducational profile of children with specific learning disability and co-occurring attention-deficit hyperactivity disorder. Indian J Med Sci 2007;61:639-47.
] [Full text]
Karande S, Mehta V, Kulkarni M. Impact of an education program on parental knowledge of specific learning disability. Indian J Med Sci 2007;61:398-406.
] [Full text]
Kohli A, Malhotra S, Khehra N, Mohanty M. Deficits and clinical profile of the children with specific learning disability. Indian J Clin Psychol 2007;34:173-81.
Gururaj M. Kuppuswamy's socio-economic status scale – A revision of income parameter for 2014. Int J Recent Trends Sci Technol 2014;11:1-2.
Mehta M, Sagar R. Specific learning disability comprehensive diagnostic battery (SLD-CDB). New Delhi: Psychomatrix Publication; 2014.
Goker Z, Uneri OS, Guney E, Dinc G, Hekim-Bozkurt O. Clinical and sociodemographic features of children and adolescents with specific learning disorder (SLD). J Psychiatry Neurosci 2014;2:90-5.
Karande S, Venkataraman R. Impact of co-morbid attention-deficit/hyperactivity disorder on self-perceived health-related quality-of-life of children with specific learning disability. Indian J Psychiatry 2013;55:52-8.
] [Full text]
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]