LEARNING DISORDER -AN OVERVIEW

Ms. SUSAN VARGHESE

Psychologist, Bethsada Hospital, Vengola

Across all ages and across all classes children master their native language by tuning their thoughts and intentions into patterns of sounds that others understand and are deep into the task of acquiring language. During the school years, if the child lacks attention, motivation, organizational skills accompanied by deficits in the acquisition and performance of reading and writing including arithmetic, non-verbal and social skills, concludes to be an academic skills are diagnosed as having Learning Disorder.

LEarn9ing Disorder is a term that denotes a single, but heterogeneous group of disorders like difficulties in the acquisition and use of basic Academic skills-skills of reading, comprehension, writing, spelling, mathematics or language. these disorders are intrinsic to the individual and are due to the dysfunction of the central nervous system. children with LD are slow in learning despite normal or above normal intelligence. the term does not include children who have learning problems which are primarily the result of visual, hearing or motor handicaps, of mental retardation or of emotional disturbances.

Reading Disorder was first described in 1878 by Dr. Kussnaul, who called this problem 'Reading Blindness'. In the year 1886, a German physician Dr. Berlin first coined term 'Dyslexia' for learning disorder. Dyslexia is a German word meaning 'Difficulty with words'. Later in the year 1895, Dr. James Hinshelwood, a British eye surgeon coined the term 'Word Blindness' for learning disability. Dr. Samuel T. Orton an American neurologist proposed the developmental origins of learning disorders and devised a number of teaching strategies.

In 1977, a law was passed in the U.S. which ensured rights of children with ensured rights of children with specific learning disorders and to obtain specific provisions in their schools. In 1981, England and Scotland also passed education Act incorporating special provisions and help according to Special Education Need (SEN). The revised Education Act in 1993, Learning Disorders was listed as Special Education Need (SEN).

In India, Person With Disability Act (PED) was passed in 1995, without any mention of the children with learning disability.

Prevalence

There are 10% of children affected by this handicap according to the current statistics in India. Learning disability is more common in mild forms than severe. As genetics play an important role, boys are affected three times more than girls. Prevalence differ across countries where learning involves different linguistics structures.

Identification of Learning Disability

Children with learning disability like any other normal child face different sets of problems which are outstanding, critical and needs to be identified.

Problem faced by preschoolers

* Lag in the development of milestones like delay in walking with absence of crawling.

* Looks clumsy with repeated bumping and triping.

* Poor language development with delayed speech.

* Poor attention and concentration.

* Left, right confusion.

* Reversing of alphabets and numbers.

* Difficulty in reciting, naming of colours and shapes

Problems Faced By School Going Children

* Reading0Dyslexia or Reading Disorder

* Difficulty in learning alphabets and members.

* Unable to associate sounds with letters in rhyming words of being confused by words that sound alike.

* Slow reading with omission or addition of words

* Difficulty in reading lengthier words.

* Omits punctuations, misses lines or even pages.

* Unable to interpret the meaning of the read portions.

Writing-Spelling Disorder

* Has slow writing speed.

* Illegibility, letter reversed, rewriting, spacing errors commonly noted.

* Poor spelling, grammar, sentence construction, paragraph writing, syntax error.

* Confusion of letters and numbers and oral and written spellings

* Omits Capitals and punctuations.

Mathematics - Dyscalculia or Arithmetic Skill Disorder

* Confusion with arithmetic signs (eg: +,_, ..., ....)

* Unable to decide over correct operations (eg: Ans. 2588 becomes 5238)

* Reversing of numbers (eg: 12 for 21)

* Difficulty in calculation (fractions, decimals, percentages), measurements (space, time, weight) and logical reasoning.

Non-Verbal

* Use of life skills and academic skills are affected.

* Difficulty in non-verbal problem solving, grapho-motor skills, and visuo-spatial organization.

* Despite these difficulties they have a good memory, reading (decoding) and spelling.

Motor Co-Ordination

* Inability to acquire and use skills which require fine motor movements.

* Simple tasks like putting shoelace, buttons, threading the needle, using scissors, scribbling, drawing, running, climbing, throwing are difficult for them.

* This difficulty leads to social embarrassment by losing self-esteem and confidence.

Perceptual Deficits

* LD children finds difficulty in selecting sounds from the environment and also to make sense of the incoming stimuli.

* Unable to interpret what is heard.

* Unable to derive meaning from touch (Tactile) and kinesthetic (Movement) systems.

Social Skills

* Poor social skills as they are unable to build affection, acceptance from their peers.

* Unable to understand facial expressions.

* Unable to pick up environmental cues.

* Misinterprets other peoples reaction.

* In- turn leads them to be a loner.

Etiology of Learning Disorder

Learning disorder, being developmental in origin is life long and cannot be prevented completely nor cured. It is important to recognise that the Childs problem is neurological, biological, genitival and environmental.

Neurological Factors

Brain being the seat of the mind which in turn is the seat of learning, plays an important role. The brain has two separate halves or hemispheres (left, right) which function in tandem to instantly produce an output. The right hemisphere controls non-verbal. Abstract functions, art and music, imagination and institution, The left hemisphere controls reasoning, logical mathematical thinking and verbal skills. The left brain is responsible for understanding (hearing or reading) and expressing (talking and writing of Language. The front of the left brain (Broca's area) is in charge of expressive language.

In most dyslexic patients the 'core' specific dysfunction involves a defect in phonological processing. In phonological  processing, words are decomposed (decoded) into their constituent units of sound (Phonomes) and then mapped on to the appropriate groups of letters (graphemes). Impairment in the accuracy and speed of reading single words is the 'gold standard' difficulty in reading disabilities and it arises specifically from the difficulty with phonological processing.

Reading disorder seems involve dysfunction of a largely 'posterior' cortical system specialized for reading. Dysfunctions also appear to be related to the  superior temporal gyrus, posterior superior temporal gyrus (Wernick's area), the angular gyrus, striate cortex, inferior frontal gyrus (Broca's area) and the inferior lateral striate cortex.

In Reading Disorders, the cerebral pattern of a larger language dominant region (Broca's area) in the left hemisphere is absent (Haslam et al 1981). Instead the Planum Temporale is symmetrical in there brain, indicating that the  usual asymmetry in this part of the brain is absent.

Finding indicates that the cerebral blood flow is more left asymmetrical (i.e. predominates the left side of the brain) during a semantic  task in the individual with RD. These anomalous brain structure along with the under developed Broca's area as well as widespread cortical anomalies are associated with a broad range of cerebral functions, including spatial and verbal abilities, motor dominance (i.e. handedness) and left and right sense.

A recent functional MRI (FMRI) study suggest that the structural changes in the anterior corpus callosum that interfere with inter hemispheric transfer or coordination of information might play a role in reading disorder.

Numerous studies also suggest that strong left handers and their relatives have more reading disability and Stuttering when compared to strong right handers.

In short, the inadequate or inappropriate functioning of the brain caused by certain damages, malformation, inadequate maturation or improper migration of concerned brain cell during the prenatal, natal or post natal period results in Learning Disability. Also prolonged birth, premature birth, maternal age, use of drugs and alcohol, Maternal foetal blood incompatibility or endocrine disorders, Rh factors and low birth weight are also factors contributing Disorders.

Genetic Factors

LD are genetically inherited as its been shown that 88% of children with LD have immediate relatives with the same disorder. Genes carried on the x-chromosomes play a greater part than the other genes. Gene linkage analysis has implicated chromosome 15 in the autosomal dominant transmission of certain cases of LD. Chromosome 6 is also involved in some cases. It is found that boys with learning disability outnumber girls with the ratio 3:1 Likewise Monozygotic twins are more vulnerable than Dizygotic twins.

Environmental Factors

Before during or after birth, changes that occur in the brain from an illness or insult like a viral fever or anoxia contributes to LD and acts as environmental factors. Also economically poor, emotionally unstable homes causes LD. Poor teaching styles also contributes.

Remediation

Learning Disorders are neurological deficits which cannot be prevented or cured. Early diagnosis and interventions can help circumvent and overcome the problem. Early educational intervention may involve one of several remedial programmes. Remediation implies the fortification of Childs learning skills. the child's strengths are used to work on his area of skill deficits. Thus helping the child to cope with the curriculum. There are different educational approaches to various types of learning problems. The use of phonologically based intervention have been found effective in Reading Disorder. Diagnoses and Remediation of Reading Disorder should take into account the degree of difficulty.

In keyword approach, exercise are given where children are to pick out the keyword from the paragraphs of lessons. This helps them to understand and remembers the content of the lesson more easily. Reading speed and inefficiency can be enhanced by enriching word attack skills. The development of Basic Site Vocabulary (words which should be read at sight without effort) will helpful to speed up the process of learning. In phonic method, the child taught the sound of letter and is encouraged to blend this into a word. With practice he learns to decode and read more complex phonemes and graphemes correspondences on his own. In phonetic method, phoneme, graphemes are taught in an organized manner. Starting with individual letter-sounds and proceeding to families of words that have same sounds.

The key to remediation is identification of skill deficit in each area of deficit in each individual child. remediation inputs for this children should be provided in the main stream school itself. the class room teacher can play a significant role in inclusive education. He/She is the most significant contributor as a manager and a therapist. Resource Room is a specific room where the child with LD. goes only for specific instruction. A special educator is available to help the child during short periods away from regular class. the Resource Room with infra structure is essential in ever is school. there must be co-operation and co-ordination among class room teachers and special educators. the school counselor also may need to know every child within the school with learning problems and must function with the school's administrator.

In addition to Remediation treatment should be directed to co-morbid disorders like ADHD, Conduct disorder, mood or anxiety disorders. Self esteem may need to be enhanced to help the child tolerate the remedial effort for the educational programme and for the Childs persistent efforts in a criticism free learning environment. It will be beneficial for parents if they listen to their children read at home daily providing proper care and emotional support help them achieve their maximum potentials.

Conclusion - Never Give Up

Together with the school administrator school counselor, staff members, parents and student body lets restore and build on the disabled child's self-esteem, strengths, Potentials and make him confident and a reliant citizen.