SPECIFIC LEARNING

DISABILITY

Dr Yogendra
 Definition
The term means
• a disorder in one or more of the basic psychological
processes
• involved in understanding or in using language, spoken or
written,
• that may manifest itself in an imperfect ability to listen,
think, speak, read, write, spell, or to do mathematical
calculations
It Includes—
• perceptual disabilities,

• brain injury,

• minimal brain dysfunction,

• dyslexia, and

• developmental aphasia
 It does not include
learning problems that are primarily the result of
• visual,

• hearing,

• motor disabilities,

• mental retardation,

• emotional disturbance,

• environmental, cultural, or economic disadvantage.

 A BRIEF HISTORY
• 1878: Dr. Kussmaul (Germany) described a man with normal
intelligence but unable to read in spite of an 'adequate'
education. He called this condition “reading blindness”

• 1896: Dr. Pringle Morton (UK) described 14- year-old boy with
reading difficulty:
The teacher:- “he would be the smartest lad in the school if
instruction were entirely oral”
• 1925: Dr Samuel Orton (USA) proposed the theory of
“specific learning difficulty”

• 1936: Anna Gillingham and Bessie Stillman published

"Remedial Training for Children with Specific Disability in
Reading, Spelling and Penmanship"

• 1963: Dr. Samuel Kirk (USA) first used term “learning

disabilities”
• 1969: “The Children with Specific Learning Disabilities Act
(USA)” passed

• 1977: Public law fine tuned ensuring rights of American

children with SpLD to 'appropriate evaluation' and
'management' of their problem

• It said “every SpLD child will participate in same curriculum

and have same academic objectives”
 The Individuals with Disabilities
Education Act (IDEA)
• First came in 1990, latest amendment in 2004
• is a United States federal law
• that governs how states and public agencies
 provide early intervention,
 special education, and
 related services to children with disabilities.
• addresses the educational needs of children with disabilities
from birth to age 18 or 21
• in cases that involve 14 specified categories of disability
 Who Qualify??
• Children between the ages of 3 and 21,

• who meet the eligibility criteria in one of thirteen qualifying

disabilities

• who require special education services because of the disability

• The categories of disabilities are; autism, deaf/blind, deafness,

hearing impaired, mental retardation, multiple disabilities,
orthopedic impairment, serious emotional disturbance,
specific learning disabilities, speech or language
impairment, traumatic brain injury, visual impairment including
blindness, and other health impairment.
 History of SpLD in India
• 1987: SNDT College starts B.Ed. (Special Education) course:
Special Educators for remediation available

• 1992: Parent group start “lobbying” for recognition of SpLD so

that these children continue education in regular schools

• 1995: Maharashtra Dyslexia Association formed by parents of

SpLD children
• 1996: L.D. clinic at LTMG (Sion) Hospital started by Prof.
Madhuri Kulkarni
• 1996: Govt. of Maharashtra issues grants provisions for
first time in India; but for standards IX and X only
• 1999: ICSE and CBSE boards also grant provisions
• 2000: Provisions extended from standard I to XII
• 2003: Provisions extended to college courses; Seats
“reserved” for SpLD in physically handicapped category in
colleges, including professional courses
 The Disability Act, India
• The existing Persons with Disabilities (PWD) Act 1995 recognizes
only the standard seven disabilities

(I) Blindness;

(ii) Low vision;

(iii) Leprosy-cured;

(iv) Hearing impairment;

(v) Loco motor disability;

(vi) Mental retardation;

(vii) Mental illness;

 The Draft Rights of Persons with
Disabilities Bill 2012
• was unveiled by the ministry in September
• the definitional change is in keeping with India's ratification of
the UN Convention on the Rights of Persons with Disabilities
• Has a widened its definition of disability to give legal
recognition to include those living with
 blood disorders (haemophilia and thalassaemia),

 speech and language disability and

 specific learning disabilities such as dyslexia

 PREVELANCE
• in India prevalance in school children has been reported to be
3-10 per cent among students population

• As many as 1 out of every 5 people in the United States has a

learning disability.

• Almost 3 million children (ages 6 through 21) have some form

of a learning disability and receive special education in school.
 PREVELANCE
• In fact, over half of all children who receive special education
have a learning disability

• LD is twice as common in males as in females,

• Males are significantly more likely than females to fall within

each major disability group.
 COMORBIDITY
• Largest body of studies supports a comorbid with Attention
deficit disorder (with or without hyperactivity),estimated as
high as 70%, by Riccio, Gonzalez & Hynd (1994) and Maynard, Tyler & Arnold (1999)

• comorbidity with social, emotional, and/or behavioural

difficulties such as conduct disorder, oppositional/defiant
disorder, and social adjustment disorder, estimated 24% to
52% (Rock, Fessler & Church, 1997).
Research provides significant evidence supporting the co-
morbidity of the following disorders with learning disabilities:

• Depressive or dysthymic disorders (San Miguel, Forness & Kavale, 1996) .

• Tourette’s Syndrome (Burd, Kauffman & Kerbeshian, 1992; Shady, Rulton & Champion,
1988; Chase, Friedhoff & Cohen, 1992; Walter & Carter, 1997)

• Schizophrenia (James, Mukherjee & Smith, 1996; Gillian, Johnstone, Sanderson, Cunningham &
Muir, 1998);

• Epilepsy (Kerr & Espie, 1997; Espie, Kerr, Paul, O’Brien, Betts, Clark, Jacoby, & Baker, 1997;);
• Language/communication disorders (Riccio & Hynd, 1993);
• Hearing impairment (Bunch & Melnyk, 1989);
• Visual disabilities (low vision, blindness) (Erin & Koenig, 1997); and
• Developmental co-ordination disorder (Missiuna, 1996; Fletcher-Finn, Elmes, &
Strugnell, 1997; Martin, Heath & Missiuna, 1999)
 Causes
Heredity.
• Learning disabilities tend to run in families.

• The Colorado twin study reported concordance rates of 68%

for monozygotic twins and of 40% for dizygotic twins (DeFries et al.,
1997; DeFries & Gillis Light, 1996)

• Despite the certainty of the existence of a genetic basis, the

mode of inheritance has not yet been proven
 Causes
Problems during pregnancy and childbirth like
• the use of drugs and alcohol during
pregnancy,
• RH incompatibility with the mother (if
untreated),
• premature or prolonged labor or
• lack of oxygen or
• low weight at birth.
 Causes
Incidents after birth like
• Head injuries,
• nutritional deprivation,
• poisonous substances, (e.g., lead), and
• abuse can contribute to learning disabilities
Neuroanatomical Studies
 Autopsy Findings

• provided strong evidence that there are differences in the

brains of individuals with dyslexia (or reading disability) versus
those without problems in reading (normal controls)

• found areas of symmetry and asymmetry in normal brains

that differ in individuals with reading disabilities
 MRI Findings
• have substantiated the findings of autopsy studies

• Pennington (1999) and his colleagues investigated 75

individuals with dyslexia and 22 controls involving twin pairs.
• Summarized that :
 The insula was significantly smaller,
 the posterior portion of the corpus callosum (isthmus and
splenium) was marginally smaller, and
 the callosal thickness was smaller
 Functional Neuroimaging Techniques
• including PET , rCBF (regional cerebral blood flow), fMRI , and
SPECT.
• “in vivo” studies of the brain.
• atypical brain activity in specific areas has been identified and
directly correlated with developmental language disorders
and reading sub skill functions
• eg: PET studies by Logan (1996) indicated that individuals with
dyslexia had significantly higher glucose metabolism in the
medial left temporal lobe and a failure of activation of the left
temparo-parietal cortex.
• study was made to study the brain,
dyslexia, and the metabolism of
lactate in the brain.
• involved the use of an MR imaging
and Proton Echo-Planar
Spectroscopic Imaging (PEPSI).
• demonstrated that the students
with dyslexia have more lactate
production and the production was
located in different areas of the
brain.
• BUT the significance of the findings
is still unclear because we do not
know how lactate clearly affects the
brain and learning.
 EEG studies
• EEG abnormalities in 50% but no specific pattern

• Above minor changes which are no longer considered valid or

of any value

• No role in the evaluation of LD

 Types of Learning Disabilities
 Dyslexia  Central Auditory Processing
A language and reading disability Disorder
Difficulty processing and remembering
 Dyscalculia language-related tasks
Problems with arithmetic and math
 Non-Verbal Learning Disorders
concepts
Trouble with nonverbal cues, e.g., body
 Dysgraphia language; poor coordination, clumsy
A writing disorder resulting in  Visual Perceptual/Visual Motor
illegibility Deficit
 Dyspraxia (Sensory Integration Reverses letters; cannot copy
Disorder) accurately;
Problems with motor coordination  Language Disorders
(Aphasia/Dysphasia)
Trouble understanding spoken
language; poor reading comprehension
POSSIBLE REFERRAL CHARACTERISTICS
• Almost any student may display some of these characteristics.
• However, the student identified as having a specific learning
disability is distinguished by the magnitude and/or severity of
his/her presenting characteristics.

A. Intellectual
 Appears to possess average or above average intelligence
based on standardized intelligence tests
 but does not perform at expected achievement levels when
exposed to conventional teaching strategies
B. Academic (In general)

1. Scores indicate inconsistency and great variability between

expectancy and performance

2. Short attention span; unable to concentrate on any one task

for very long

3. Easily distracted by irrelevant stimuli

4. Disorganized in the use of books and materials

5. Unable to follow and understand class discussion; appears to

be inattentive or daydreaming
C. Reading

1. Visual processing

a. Visual discrimination difficulties; confusion of similar letters

and words
b. Letter and word reversals and inversions
c. Difficulty in following and retaining visual sequences
d. Word substitutions
e. Distracted reading; skipping and jumping over words
f. Omission of words, phrases and sentences
g. Slow recognition of words
2. Auditory processing

a. Difficulty in separating words into their component

phonemes and syllables or in blending them into whole
words

b. Difficulty in spontaneous recall of sounds associated with

letters and words

c. Disturbances in auditory sequencing

D. Writing and Drawing

1. Inability to form letters or digits correctly

2. Difficulty in staying on or between the lines

3. Difficulty in judging length and width of letters

4. Difficulty in spatial organization, identification or matching of

shapes, and/or rotation or distortion of drawings of geometric designs

5. Reversal of letters and/or digits

6. Difficulty in discriminating left from right

E. Arithmetic
1. Difficulty in analyzing and solving math problems of various
complexity (one or multiple step), including those involving probability

2. Difficulty in associating the spoken form with the correct printed

material

3. Difficulty in learning the cardinal and ordinal system of counting

4. Difficulty in understanding the meaning of the process sign

5. Difficulty in understanding the arrangement of numbers on a page

6. Inability to follow and remember the sequence of steps used in

various mathematical operations

7. Difficulty with concepts of space, time, size, distance, quantity

and/or linear measurement
F. Behavior
1. Hyperactivity, attentional deficits: constant motion, inability to attend
to a specific task for a required period of time

2. Emotional lability: easily upset, anxious, low frustration threshold, may

exhibit rapid change from one mood to another

3. Impulsivity: uninhibited, acts without thinking

4. Distractibility: difficulty in attending to dominate stimuli, may

abnormally fixate on unimportant details

5. Perseveration: attention becomes fixed upon a single task, which is

repeated over and over

6. May frequently demonstrate an inability to assimilate, store or recall

visual and/or auditory stimuli; inability to identify or discriminate
between visual and auditory stimuli
7. May be confused in his/her relationship to the physical environment
and become disoriented in a familiar setting such as school, playground
and neighborhood

8. May frequently disrupt the classroom, demand attention to an

inappropriate degree, speak out of turn or exhibit an inability to control
responses

9. May disregard or fail to understand the feelings of others

10. May demonstrate a low tolerance for change, may react

inappropriately to stimuli

11. May lack self-sufficiency, seldom initiates appropriate activities, may

have limited knowledge or acceptance of age role and may compensate
by acting foolish or making fun of others

12. Has difficulty interpreting emotions, attitudes and intentions others

communicate through nonverbal aspects of communication (facial
expressions and body language)
G. Communicative Abilities

1. Fails to grasp simple word meanings

2. Comprehends words in isolation but fails to comprehend in connected speech

3. Frequently uses incomplete sentences and has numerous grammatical errors

as evidenced by poor use of pronouns and verb tenses

4. Unable to organize and express ideas even when adequate information is

provided, relates minor or irrelevant details

5. Cannot give clear and appropriate directions

6. Does not recognize and understand figurative language such as alliteration,

similes, metaphors, personification, and idioms

7. Uses gestures extensively while talking or in place of speech

8. Cannot predict outcomes, make judgments, draw conclusions or generate

alternatives after appropriate discussion
9. Has problems interpreting and/or using vocal pitch, intensity and
timing for purposes of communicating subtle distinctions in emotions
and intention

10. Asks questions and/or responds to questions inappropriately

(especially "wh" and "how" question forms)

11. Has difficulty comprehending and using linguistically complex

sentences

12. Has problems acquiring and using grammatical rules and patterns
for word and sentence formation

13. Has difficulty interpreting or formulating compound or complex

sentences (oral and written), sentences which compare and contrast
ideas or show cause-effect relationships

14. Cannot write an organized paragraph using related sentences of

varying length and grammatical complexity
H. Physical

1. General coordination poor; awkwardness evident in skipping,

climbing, running, walking, jumping, hopping, etc.

2. May fall or stumble frequently or maintain equilibrium by

touching tables, chairs or desks when moving about the room

3. May exhibit difficulty with fine motor coordination tasks

4. May have difficulty differentiating between right and left; may

exhibit directional confusion, mirror-writing, reversals,
inversions
or rotations of letters and/or numerals
 ASSESSMENTS
Advantages of assessment:
 The diagnosis based on assessment would indicate a student
with a specific difficulty to other teachers.
 Assessment would profile the difficulties and the strengths of
the student
 Would give information regarding learning styles of the
student
 Enable form an Individualised Education Plan.
 Areas to be assessed in the child with SLD

INTELLIGENCE
 Needs to be assessed as intelligence disability can mimic SLD,
although both the disabilities can co-exist.
 The instructional style and the outcome of the special
education are influenced by Intelligence of student.
LANGUAGE
 It provides the foundation upon which communication
,problem solving and expanding ,integrating, analyzing and
synthesizing knowledge takes place.
 Deficient can have profound impact on the ability of an
individual to learn and function competently and confidently
PERCEPTUAL ABILITIES
 Determine how individuals perceive information and how
they respond
 Assessment determine the strengths and weakness in
information and sensory processing

1.Visual-perceptual ability
Includes the ability to discriminate between two or more visual
stimuli, located a particular figure within a larger seen, and
understand position in space.
Reading requires the ability to detect the visual features of a
letter or word
2.Auditory-perception ability

Includes the ability to detect certain auditory features such as

changes in the volume, discrimination of vowel or consonant
sounds

3.Perceptual motor ability

Needs to be assessed as often associated with learning problems

4.Attention

The ability to focus on a given activity for extended periods

ACADEMIC ACHIEVEMENT
• Refers to how well the child is performing in core skill areas
such as reading, mathematics, and writing.
• It is important for of all the planning and evaluation of
instructions
BEHAVIOR AND EMOTIONAL AND SOCIAL DEVELOPMENT
• Inappropriate behavior can effects the students learning
ability.
• Different reasons like, ADHD, mental illness ,and
environmental factors need to be looked into
ADAPTIVE DEVELOPMENT
• Tells the students ability in self care skills and home living
skills.
 Learning Modalities
Visual Preference
♦ want the teacher to provide demonstrations
♦ find it easy to learn through descriptions
♦ often use lists to keep up and organize thoughts
♦ often recognize words by sight
♦ often remember faces but forget names
♦ often have well developed imaginations
♦ are easily distracted by movement or action in the classroom
♦ tend to be unaware of noise
♦ Roughly 60% of students are visual learners.
Auditory Preference
♦ want the teacher to provide verbal instructions
♦ find it easy to learn by listening
♦ enjoy dialogues, discussions, and plays
♦ often remember names but forget faces
♦ often do well working out solutions or problems by talking
them out
♦ are easily distracted by noise and often need to work where it
is relatively quiet
♦ often do best using recorded books
Tactile Preference
♦ do best when they take notes either during a lecture or when
reading something new or difficult
♦ often like to draw or doodle to remember
♦ do well with hands-on activities such as projects,
demonstrations, or labs

Kinesthetic Preference
♦ do best when they are involved or active
♦ often have high energy levels
♦ think and learn best while moving
♦ often lose much of what is said during lecture
♦ have problems concentrating when asked to sit and read
♦ prefer to do rather than watch or listen
♦ Most children are kinesthetic and become more tactile in the
first grade
 COUNCELLING
3 steps:
1.Pre Test councelling
• Prepare student and parents for test
• Explain the need
• Discussing the various test available
• Nature of tests
2.Selecting a test: Test should be-
• reliable or valid
• Appropriate for student
• Student and parents are comfortable
• Similar to class room tasks
• Examiner should be trained in it.

3.Post test councelling:

• To interpret the results
• Clarify doubts in interpretation
• Recommend the intervention
• Give the copy of result to parents
• Explain the further plan
 Categories of Assessments:
Formal versus Informal Assessment
• Formal Ass is Norm referenced and Criterion referenced tests
• Informal/natural ass:Includes observation , play based, check
lists and rating scales, and parent interviews

Screening versus Comprehensive Assessment

Screening tests are used on large number of population, to
narrow down on small group of children who might need a more
thorough tests
Comp test look at the whole child and examine the root cause of
LD
 Ecological vs Dynamic vs Task analysis vs
Outcome vs Direct assessment

• Eco ass involves directly observing and assessing the child in

the many environment in which he or she operates
• Dyn ass refers to exploring nature of learning
• Task analysis is very detailed, involving breaking down a
particular task into the basic sequential steps, component
parts, or skills necesssary to accomplish the task.
• Outcome based ass is darectly related to what educators and
parents want the child to have gained in the end.
Direct (Curriculum based approach)

• Recently gained popularity

• Type of direct assessment

• Test of performance come directly from the curriculum

Psychometric Approach

• For a second opinion to confirm the diagnosis of SLD in the

student referred.
 Important points….
• If a child has multiple errors in the curriculum based checklist
and is performing 1 ½ class below the rest of class, SLD is
diagnosed
• If there is a scatter of more than 15 points in a full scale IQ
test or 2 standard deviations below the rest of class a SLD is
diagnosed in psychometric approach.
• The SLD profile acquired with the assessment should help
form IEP
MANAGEMENT
 INDIVIDUAL EDUCATION
PLAN
• A child who qualifies for special education services should
receive his or her own IEP.

• This personalized and written education plan:

 Lists individualized goals for the child

 Specifies the plan for services the youngster will receive

 Lists the specialists who will work with the child

 DETERMINING APPROPRIATE
EDUCATION SETTING
• Students need should be met in the “least restrictive”
environment.

• Following are ranked from least to most restrictive environment:

1. Regular class

2. Regular class with resource specialist support , upto ½ of the

student’s school day

3. Special day class, for at least 51% percent of the time up to

100% of the school day.(most restrictive)
Summary of Interventions for
Specific Learning Disabilities
Dyslexia
1.Phonemic awareness tasks in kindergarten include

 rhyming,

 making discriminations between similar but different words,

 blending sounds into words,

 isolating sounds from words,

 and segmenting words.

prepare the child for reading, and have shown some

effectiveness in research settings.
Dyslexia
• Explicitly teaching children about segmenting and blending
words has proven to be effective in teaching reading

• In first grade, explicit instruction in how the most common

sounds are spelled enhances both reading and spelling skills.

• Showing children how to sound out words and providing texts

they can decode helps in practicing and retaining learned
sound-spelling relationships.
Dyslexia
Special teaching techniques.
These can include helping a child learn through multisensory
experiences and by providing immediate feedback to strengthen a
child’s ability to recognize words.

Classroom modifications.
For example, teachers can give students with dyslexia extra
time to finish tasks and provide taped tests that allow the child to
hear the questions instead of reading them.

Use of technology.
Children with dyslexia may benefit from listening to books on
tape or using word-processing programs with spell-check features.
Dysgraphia
Special tools.
Teachers can offer oral exams, provide a note-taker, and/or allow
the child to videotape reports instead of writing them.

Use of technology.
A child with dysgraphia can be taught to use word-processing
programs or an audio recorder instead of writing by hand.

Other ways of reducing the need for writing.

Teachers can provide notes, outlines, and preprinted study
sheets.
Dyscalculia
Visual techniques.
For example, teachers can draw pictures of word problems and
show the student how to use colored pencils to differentiate
parts of problems.

Use of memory aids.

Rhymes and music are among the techniques that can be used to
help a child remember math concepts.

Use of computers.
A child with dyscalculia can use a computer for drills and practice
Dyspraxia
Quiet learning environment.
To help a child deal with sensitivity to noise and distractions,
educators can provide the youngster with a quiet place for tests,
silent reading, and other tasks that require concentration.

Alerting the child in advance.

For example, a child who is sensitive to noise may benefit from
knowing in advance about such events as fire drills and
assemblies.

Occupational therapy.
Exercises that focus on the tasks of daily living can help a child
with poor coordination.
 REMEDIAL TEACHING
• It is also known as compensatory or corrective teaching.

• The teacher :
 teaches the lesson in order to help slow learners make up for
what they lost in the course of learning
 uses extra hours after school, weekends or holidays.
 uses more resources and varies teaching methods.
 help the children to master, retain or remember what they
have learned
PROCEDURES FOR REMEDIAL TEACHING
1. Corrective teaching:

• Divided the content in to smaller units or step

• Supervise study sessions

• Individualized tutoring

• Re-teach the lesson

2. Consistently give quizzes as you teach to find out if children are

learning as expected and undertake to correct immediately.
 CAP UNIT Conducts Workshop on
Remedial Teaching Methods
• To create awareness
• Traine them to diagnose
SLD students
• To teach them the
remedial methods for
SLD
 PROGNOSIS
• Although some results are contradictory or inconclusive there is
agreement that LDs persist into adulthood to some degree.

• Outcome is dependent on the severity of the LD at school age, on

intelligence, on the socioeconomic status of parents, and on the
presence or absence of neurological impairment.

• Intervention has not been clearly related to improved outcome.

• Some evidence has suggested that a language-deficit subtype of LD

may show poorer outcome.
 PROGNOSIS
Yale longitudinal study showed:
• persistently poor readers continued to read more poorly than
their nondisabled peers.
• Although they did learn to read, they continued to lag
significantly behind peers throughout high school in decoding,
reading rate, and accuracy.
• Despite poor scores , their overall reading comprehension
scores were only mildly delayed.
• With persistent intervention and considerable personal effort,
can achieve an adequate literacy level to function in society
 References
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767262/
• http://www.ldao.ca/introduction-to-ldsadhd/ldsadhs-in-
depth/articles/about-lds/considering-coexisting-conditions-or-
comorbidity-2/
• http://www.pacfold.ca/download/Supplementary/Neurobiological.
pdf
• Child and Adolescent Psychiatry by Robert Goodman and Stephen
Scott
• Complete Learning Disabilities Handbook by Joan M.Harwell
THANK YOU