Dr. Ratna Bilwani*
MD, (Psych.) *
In your pediatric practice, you must have come across many parents being worried about their child's school performance. Many children suffer and parents wonder - Why a smart and active child does not perform well? These children are brought to clinics with variety of behavioral and emotional problems like - Hyperactivity, problems of discipline, behaviour like opposition or the other extreme of anxiety and other stress symptoms.

Here one example is presented - A child aged nine years studying in fourth standard was brought with:
C/o - Inattentiveness, hyperactive, disobedient and demanding at home. Gradual fall in school performance, not completing his work in time. Sensitive and becoming aggressive when demands not fulfilled.

Family: Living in joint family where grand parents pampered him. Both parents educated and concerned about child. Mother often lost patience and punished him for his misbehavior. Further enquiry revealed he could watch TV continuously and could attend to videogames for long and enjoyed.

School teacher had been repeatedly complaining to parents about. Inattentive in class, slow writing, and making lot of spelling mistakes, which was attributed to carelessness and inattentiveness.

Birth history and developmental history was reported uneventful.

On examination: A presented as alert, active, and smart child. Answered questions about personal and family life adequately. When asked to write he wads reluctant of all the mystery of his underlying problems unfolded.

Though it appeared to be an emotional and behaviour problem from history, actual problem underlying was DYSLEXIA.

What are learning Disorders?

Learning Disorders (L.D.) are problems related to child's difficulty to perform and learn at school. Difficulty in acquiring scholastic skills affecting child's reading, writing, spelling or math performance, that is lower than expected for I.Q., age and educational inputs. Some may struggle with several other problems.

These are though to be due to problems in brain affecting information processing, involved primarily in understanding and use of language and other symbolic representations. Intelligence of these children is generally normal or above average.

Type of Learning Disorders:

Dyslexia: Difficulty in using and understanding, language, problem with listening, speaking, reading and writing.

Dysgraphia: Inability to write legibly and quickly. May be associated with problem of spelling.

Dyscalculia: Problem with mathematical concept and symbols.

Mixed and non-verbal type Involving right brain. There are wide variations in types and degree of impairment in various skills for learning - mild to severe.

No two Dyslexics are alike.

What is the prevalence of L.D.?
Studies show up to 4-10% of school age children have these problems. The ratio is high in boys - 7:3.

What Dyslexia is not?
  1. Dyslexia is not a sign of poor intelligence - These children have average or superior intelligence. Many kids may be extremely creative and excel in arts, sports, mechanics and other areas in life.
  2. Dyslexia is not laziness or lack of caring. It is not due to emotional or social problems.
  3. It is not due to inadequate schooling or opportunity to learn
  4. Dyslexia is not due to vision or hearing problem.
  5. It is not a disease, it has no cure.

What are the characteristics?
Problems may be in following areas:

READING: Involves recognition of letters, associated sounds (phonetic), and understanding the text. These children have problem of inability to recognize sounds and to pronounce sounds into words correctly Slow labored reading poor comprehension of text missing words, lines while reading

WRITING: Writing involves 10-15 developmental skills. These areas include-
Lack of organization and messy writing, poor spelling even for common words. Missing letters, reversal, use of capitals. Poor sentence structure, grammar and content of writing that may not be in proper flow. Problem with use of punctuation.
Even copying may be slow and with lot of mistakes.

MATEMATICS: Poor number concept, place value problem understanding add, subtract, multiply or divide. Poor digit memory, telling time or geometry shapes.

What causes L.D?
These difficulties are thought to be due to problems of brain functioning that affects integration of processing visual, hearing and motor co-ordination that is required for effective learning.
Genetic - Dyslexia is known to occur in families. High occurrence in sibs / parents and relatives is reported. Other external factors contributing are Exposure to toxins, use of alcohol or smoking during pregnancy and trauma to brain during delivery is found in history of some children.

What are the associated features?
  1. Poor motor coordination - hand and finger control, Inability tying shoelaces, handling scissors, clumsy motor activity
  2. Poor eye hand coordination affecting focusing on fine activity and writing
  3. Poor short term memory and processing in to long term memory
  4. Confusion with directions, Rt and Lt orientation
  5. Sequencing problem - Inability to put things in sequence, e.g., - days of week, months in year and multiplication tables
  6. Organization abilities may be good or very poor
  7. Trouble paying attention - many of these children have associated problems of attention deficit hyperactivity disorders

What happens to the child?
Early identification and intervention is needed. Earlier we undertake proper remedial education (7-9 years) better are the chances of good progress in scholastic ability with minimum deficits left. With appropriate education, understanding and time many of these children learn to read, write and develop their talents and abilities.

Each child needs to be assessed for individual Educational Plan considering strengths and weaknesses. In addition, it is important to help child by providing successful experience and enhance self-esteem during therapy.
Followings are special method of teaching which improves the condition:
  • Focusing on phonological processing to make reading fluent and automatic.
  • Reading comprehension exercises.
  • Writing and language expression skill exercises.
  • Psychological and social support to help them overcome the problem.
Duration of Therapy: Depends on many factors - Intelligence of child, parent's willingness and support, and emotional stability helps. Persistent effort is required over a time for good outcome. Larger the gap between expected and actual level of performance more time is needed. It takes about four to six months to cover one academic year enhancement.

Points for remedial education of Adolescents
Those children who receive early intervention during school are better prepared for higher-level learning strategies at this stage. For normal children there is steady expansion of bank of information with the skills they acquire in earlier stages, especially a components called rapid retrieval memory, a process referred to as progressive automatization in reading and understanding. - High school children with L.D. often have trouble because of lack of automatization of one or more of these retrieval strategies.

How much does it cost to educate a person with L.D.?
It costs very little compared to the cost of not educating him at an early stage. Good professionals dedicated to careful diagnosis and quality remediation is the need of the time.
Many children do not require extra funds, extensive use of personnel or intense assistance, but may need only properly planned and timely remediation programmes fitting in child's needs. The services are to be aimed at equalized the opportunities and not to lower the academic standards.
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Bilwani R D.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=483
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