Learning Disabilities (LD)
Dr Ira Shah
Learning Disabilities (LD) - Patient Education
Q. What are learning disabilities ?
Learning disabilities are a group of disorders that affect a person's ability to either interpret what they see and hear or to link information from different parts of the brain. Learning disabilities may affect a person's ability to speak, listen, read, write, spell, reason, recall, organize information or to do mathematics. These disorders are seen in people who have normal intelligence but due to some differences in the connections in the brain, they affect various speech, articulations, coordination and academic aspects of the development.

Q. What are the various types of learning disabilities ?
Learning disabilities can show up in several ways-as specific difficulties with spoken and written language, co-ordination, self-control or attention. They are divided into 3 broad categories:

These people have difficulty producing speech sounds,(Developmental Articulation Disorders) whereby they may have trouble controlling their rate of speech or may lag behind in learning to make speech sounds for e.g. "Sweep" may be pronounced as "Thweep". These articulation disorders are common and are seen in at least 10 percent of children younger than 8 years. Most of the children however outgrow their problems or are successfully treated with speech therapy.

Some children may have problems expressing themselves in speech (Developmental Expressive Language Disorders). They may call objects by wrong names or are unable to answer simple questions.

Some people may have trouble understanding certain aspects of speech (Developmental Receptive Language Disorders). They may not respond to their names or are unable to follow simple directions. Their hearing is normal but they just can't make sense of certain sounds, words or sentences that they hear and may even appear inattentive. These people may also have trouble in expressing themselves.

* Dyslexia (Developmental Reading Disorder: A person with dyslexia has trouble in any of the tasks involving reading. A significant number of people with dyslexia are unable to distinguish or separate the sounds in a spoken word for e.g. they may be unable to identify the word "Cat" if you spell out the individual letters "c-a-t." They may also reverse letters, words and numbers. They may confuse the order of letters in words or may not recognize words previously learned. They may also spell a word in several different ways without recognizing the correct version. They may not hear fine differences in words i.e. write "tin" for "ten" and may even confuse between right and left.
An older child with dyslexia may have trouble remembering what has recently been read, have difficulty concentrating while reading or writing and may also have poor spelling.

*Developmental Writing Disorder: Writing involves several areas of the brain (areas involved with vocabulary, grammar, hand movement and memory). Hence, a developmental writing disorder may develop in a person who has problems in any of these areas.

* Dyscalculia (Developmental Arithmetic Disorder: It is a mathematical disorder in which a person has a difficult time solving arithmetic problems and in grasping math concepts.

includes coordination, motor skill disorders and other specific developmental disorders. Here a person may have difficulty in doing coordinative actions, difficulty to form letters or write within a defined space (dysgraphia). Some children with learning disorders (almost 20%) have difficulty to focus their attention. Some children and adults may have attention disorder, where they may daydream excessively and tend to get distracted easily. Other children (especially boys) with attention deficit disorder may have hyperactivity. They act impulsively, are fidgety, and always losing things. These hyperactive children can't sit still, can't wait for their turn and interrupt the classroom. However, by adolescence, this physical hyperactivity usually subsides into restlessness and fidgeting.

Q. How are children with learning disabilities identified?
Parents are usually the first to notice delays in their child reaching early milestones, but the pediatrician may observe more subtle signs of minor neurological damage. However, the classroom teacher may, in fact be the first to notice the child's persistent difficulties in reading, writing or arithmetic.

There are some warning signs, which may help to pick up children with learning disabilities earlier.

Warning signs in a preschool child
- Speaks later than most children.
- Has difficulty pronouncing and finding the right word.
- Has difficulty rhyming words.
- Has trouble learning number,alphabets, ays of the week,color,Shapes etc..
- Gets easily distracted and is extremely restless.
- Has trouble interacting with peers.

Warning signs in a school going child
- Spelling errors.
- Reveres letter sequences.
- Confuses arithmetic signs (+, -, X, /, =).
- Is slow to remember facts and learn new skills
- Has an unstable pencil grip
- Has trouble learning about time
- Has poor co-ordination and is prone to accidents
- Avoids reading aloud
- Has trouble with handwriting
- Has difficulty making friends
- Has trouble with words

Warning signs in an Adolescent and Adults
- Continues to spell incorrectly.
- Avoids reading and writing tasks.
- Has weak memory skills.
- Has difficulty adjusting to new settings.
- Works slowly
- Misreads information.
- Either pays too little attention to details or focuses on them too much

It has been found that there may be variations in the brain structure called planum temporale, a language related area found on both sides of the brain. In people with dyslexia, the two structures are found to be equal in size. In people who are not dyslexic, however the left planum temporale is found to be noticeably larger.

Q. How are children with learning disabilities diagnosed ?
A child is suspected to have a learning disability, when there is inability to attain certain skills inspite of a normal intelligence. The actual diagnosis of learning disabilities is made using standardized tests that compare the child's level of ability to what is considered normal development for a person of that age and intelligence.

Each type of learning disability is diagnosed in slightly different ways:
- To diagnose speech and language disorders, a speech therapist tests the child's pronunciation, vocabulary and grammar and compares them to the developmental abilities seen in most children of that age. A psychologist tests the child's intelligence. A pediatrician checks for any ear infection and an audiologist checks the hearing
- If the problem involves articulation, a doctor examines the child's vocal cords and throat
- In the case of academic skills disorder, academic development in reading, writing and maths in evaluated using standardized tests. In addition, vision and learning are tested to be sure that the student can see words clearly and hear adequately

Q. How are children with learning disabilities treated ?
It is extremely important that learning disabilities are diagnosed early as the brain's flexibility to learn new skills is greatest in young children and may diminish somewhat after puberty. Thus, early intervention is most important (Nevertheless, the ability to learn remains throughout life).

Children with LD and their families require help on several fronts: educational, medical, emotional and practical.

In most ways, children with LD are no different from other children. They require special educational programs either in a separate all -day classroom or as a special educational class for several hours a week. If problems are severe, these children may require a special school for the learning disabled. Special educational programs begin with systematically identifying what the student can and cannot do. By using several skills and sense, the child is taught the activities for e.g. in learning to spell and recognize words, a student may be asked to see, say, write and spell each new word. The student may also write the words in sand, which engages the sense of touch (children are more likely to retain a skill if more the senses are used).

For a child with articulation problems, the child may watch the speech therapist make the sound, feel the vibration in the therapist's throat, then practice making the sounds before a mirror.

Non-standard teaching methods like using computers that talk can help teach children with language disabilities to process spoken words more quickly. The computer starts slowly, pronouncing one sound at a time. As the child gets better at recognizing the sounds and hearing them as words the sounds are gradually speeded up to a normal rate of speech.

Medications like methyl phenidate, dextroamphetamine and pemoline are available, which are used in children with attention deficit disorders. They help children control their impulsiveness and other hyperactive behaviors. These drugs are effective for 3-4 hours and the child takes the medication so that the drug is active during peak school hours.

The effects of LD may not enable a LD child to effectively communicate socially. Children with LD may have a low self-esteem and consider themselves :- 'behind, slow or different' from other children. Counseling can be very useful to people with LD and their families. Counseling can help affected children, teenagers and adults develop greater self-control and a more positive attitude towards their own abilities. Family members may also be allowed to air their feelings as well as get support and reassurance. When children have learning disabilities, parents may need to work harder at developing their children's self-esteem and relationship -building skills for self-esteem and good relationships are as worth developing as any academic skills.

Q. Can learning disabilities be cured ?
Though learning disabilities can not be cured, most people learn to adapt and live fulfilling lives. Certain learning problems reflect delayed development and many children eventually catch up. Children with articulation and expressive language disorders do not usually have a longterm problem.

Q. I have heard that megavitamins help a child with LD. Is that true ?
Megavitamins have not been proven to be effective in treating majority of children with LD. Other therapies that have been proven to be ineffective are colored lenses, special diets and body stimulation.

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