LEARNING DISABILITY P. V. VARSHA

BOT 2nd YEAR

SAVEETHA COLLEGE OF OCCUPATIONAL

THERAPY.

Learning disorders are characterised by an inability to acquire, retain, or

generalize specific skills or sets of information because of deficiencies in

producing responses associated with a desired and skilled behavior.

A learning disability is a specific disorder and assumes cognitive abilities.

1. Written expression or handwriting (dysgraphia)

2. Problem in reading(dyslexia)

3. Arithmetic (dscalculia)

4. Understanding and use of verbal communication (dysphasia, dysnomia,

difficulty with expressive language)

-quick reference of occupational therapy.

INTRODUTION:

Characteristics of Learning disability :

Slow reading rate

Problem with responding and abstract concepts.

Problems Understand What is read.

Difficulty recalling arithmetic operations.

Difficulty finding important points on main ideas.

Problems remembering math facts.

Confusion of similar words.

Poor organization and management of time.

Letter reversals.

Poor note taking and outlining skills.

Difficulty with sentence structure and poor grammar.

Inability to complete assignment in time allowed.

Self esteem and peer relationships also are negatively influenced. Personal and financial strains are placed on parental resources.

Types of specific learning disorders:

DYSLEXIA (Reading disorder).

DYSGRAPHIA(writing disorder).

DYSCALCULIA(mathematical disorder).

DYSPRAXIA(Problem in motor development).

SPECIFIC LEARNING DISORDER:

Specific learning disorder in youth Nero developmental disorder produced by the interactions of veritable and environmental factors that influence the brains ability to efficiently perceive or process verbal and non verbal information.

It is characterized by persistent difficulty learning academic skills.,

Reading expression.

Written expression

Mathematics expression.

Problems in motor development.

In beginning with early childhood, that is inconsistent with the overall intellectual ability of a child.

_KAPLAN &SADDOCK.

SPECIFIC LEARNING DISORDER WITH

IMPAIRMENT IN READING ;(DYSLEXIA) Reading impairment is present in up to 75% of children and adolescents

with specific learning disorder.

Students who have learning problems in other academic areas most

commonly experience difficulties with reading as well.

Reading impairment is characterized by difficulty in recognizing words,

slow and inaccurate reading.

Poor comprehension.

Difficulties with spelling.

Reading impairment is often comorbid with other disorders in children,

particularly ADHD.

CAUSE:

Neurobiological disorder with significant genetic contribution.

Deficiency in processing sounds of sppech sounds, and spoken language.

Deficit of children with reading impairment include poor processing of

speech sound and deficit in comprehension spelling and sounding out

words.

Reading and spelling has new been linked to susceptibility locus on

multiple chromosomes including 1,2,3,6,15,and18.

Recent research study identified on locus on chromosome18.

Reading impairment are caused by visual motor problems termed as

SCOTOPIC SENSITIVITY SYNDROME.

CLINICAL FEATURES:

Children with reading disability are usually Identified by the age 7yrs.

Poor spelling.

Poor self expression.

Children with reading impairment make many errors in their oral reading.

The errors are characterized by omission, additions, and distortions of words.

Slowness in learning songs and rhymes.

Sich children have difficulty in distinguishing between printed letter characters and sizes especially those that differonly in spatial orientation and length of line.

Most children with reading disorder dislike avoid reading and writing.

Disabilityin reading have an age appropriate ability to copy from a written or printed text, but nearly all spell poorly.

Trouble in learning foreign languages.

DIFFERENTIAL DIAGNOSIS :

Reading deficits are often accompanied by comorbid disorder, such as

language disorder disability in written expression and ADHD.

Data indicate that children with reading disability consistently presend

difficulties with linguistic skills, whereas children with ADHD.

Children with reading disability, without ADHD, however may have some

overlapping deficits in cognitive inhibiton.

Deficit in expressive language and speech discrimination along with

reading disorder may lead to a comorbid diagnosis of language disorder.

Poor reading skills resulting from inadequate schooling can be detected by

comparing a given child’s achievement with classmates on reading

performance.

DYSLEXIA :

SPECIFIC LEARNING DISORDER WITH

IMPAIRMENT IN MATHEMATICS

:(DYSCALCULIA) Children with mathematic difficulties have difficulty learning and remembering

numericals, cannot remember basic facts, and numbers are slow inaccurate computation.

Poor achievement in four groups of skillshave been Identified in mathematics disorder.

Lingiustic skills, perceptual skills, mathematical skills, attentional skills.

Variety of terms include.

Dyscalculia

Congenital arithmetic disorder

Acalculia

Gerstmann syndrome

Developmental arithmetic disorder.

Care deficit in processing numbers, and good language abilities are skill needed for accurate counting, calculating and understanding mathematical disorder.

CAUSE:

Mathematics deficiency as with other areas of specific learning disorder,

has a significant genetic contribution.

High rates of comorbidity with reading deficits have been reported in range

17% to 60%.

Cause of deficit in mathematics are believed to be multifactorial, including

genetic, maturational , cognitive , emotional, educational and

socioeconomic factors.

Prematurity and very low birth weight at also a risk factor for specific

learning disorder including mathematics.

Cimparing with reading abilities, arithmetic abilities seem to depend more

on the amount and quantity of instruction.

CLINICAL FEATURES :

Common features of mathematics disorder include difficulty learning number and names.

Remembering the signs for addition and subtraction.

Learning multiplication table.

Translating word problems into computation.

Performing calculation at the expected spaces.

Difgiculty learning to count meaningfully.

Difficukty mastering cardinal and ordinal systems.

A child with poor mathematics abilities typically has problems with concepts such as counting and adding even one digit numbers compared with classmates of same age. .

Trouble making change in cash transaction.

DIFFERENTIAL DIAGNOSIS :

The diagnosis of mathematics disorder is made when a child skill in

mathematics fall in child’s age, intellectual ability and education.

Linguistic skills, conceptual skills, and computational skills.

Linguistic skills involve understand of an mathematical terms understand

word problem, translate them in mathematical process.

Conceptual skills involve recognition of mathematical symbol being signs.

Computational skills include ability line up number rules of mathematical

operation.

An pervasive developmental disorder and mental retardation should also

be ruled out before confirming diagnosis of mathematics disorder.

DYSCALCULIA

SPECIFIC LEARNING DISORDER WITH

IMPAIRMENT IN WRITING:(DYSGRAPHIA)

It is characterized by problem with writing.

This disorder may cause a child to be tense and when holding a pen or

pencil.

Disorder of written expression is characterized by writing skills significantly

below level for a child age and intellectual capacity.

Many components of writing disorder include poor spelling, errors in

grammar and punctuation, poor handwriting, spelling errors are most

common difficulties for child’s writing disorder.

CAUSE :

Cause of writing disorder are believed to be similar to those of reading

disorder, that is deficit in use of components language related to letter

sounds.

Writing disorder in which given child may have trouble understanding

grammatically rules, finding words and expressing ideas.

Children with limited attention spans and high levels of distractibility may

find writing an arduous task.

Disorder of written expression may result from the combined effects of one

or more of the following.

Expressive language disorder and mixed receptive expressive language

disorder and reading disorder.

CLINICAL FEATURES :

Children with disorder of written expression having difficulties early in grade school in spelling words and expressing their thoughts and age appropriate grammatical horns.

A strong dislike of writing and or drawing.

Problem with grammar.

A quick loss of energy and interest while writing.

Trouble writing down thoughts in a logical sequence.

Saying words out loud while writing.

Leaving words unfinished or omitting them when writing sequences.

Poor academic performance and general avoidance of school work, attention deficit and conduct disturbances.

DIFFERENTIAL DIAGNOSIS :

It is important to determine whether another disorder such as ADHD or a

depressive disorder, is preventing a child from being able to concentrate

an writing tasks in absence of writing disorder itself.

Treatment for other disorders should improve child writing performance.

Common associated disorder are an reading disorder, mixed receptive

expressive language disorder, mathematics disorder, developmental

coordination disorder and ADHD.

SPECIFIC LEARNING DISORDER WITH

IMPAIRMENT IN MOTOR DEVELOPMENT

(DYSPRAXIA) A person with DYSPRAXIA has problems with motor tasks such as hand eye coordination that can

interfere with learning.

It is a neurological disorder that impacts an individuals ability to plan and process motor tasks.

SYMPTOMS:

1. Poor balance

2. Poor posture

3. Fatigue

4. Clumsiness

5. Differences in speech

6. Perception problems

7. Breaking things.

8. Sejsitivity to touch including irritating over bothersome feeling clothing.

9. Poor hand eye coordination.

CAUSE:

Immaturity of neuron development in the brain..

Probably hereditary.

DIAGNOSIS:

Adiagnosis of dyspraia can be made by a clinical psychologist an

educational and suscept child may have an problem.

GROSS MOTOR SKILLS _ child uses large muscles that coordinate body

movement, including jumping, throwing, walking, running, and maintaining

balance.

FINE MOTOR SKILLS _ child can cause smaller muscles, including cutting out

shapes pair of scissors and writing. It will need an developmental milestone

such as walking, crawling, and speaking were reached the activities.

Motor planning:

DSM5 CRITERIA FOR LEARNING

DISORDER :

A. Difficulties learning and using academic skills as indicated by the

presence of atleast one of the following symptoms that have persisted for

atleast 6months despite probation of intervention that target has

difficulties.

1. Inaccurate or slow and effortful word reading.

2. Difficulty understanding the meaning what read.

3. Difficulty with spelling.

4. Difficulty with written expression.

5. Difficulty mastering number sense, number fact or calculation.

6. Difficulty with mathematical reasoning.

B. The affected academic skills are substantially and quantifiably below

there expected for the individual chronological age and cause significant

interference with occupational performance.

C. The learning difficulties begin during school age years but may not

become fully manifest until demands for those affect academic skills and

individual limited capacities.

D. The learning difficulties are not better and accounted for intellectual

disability un corrected visual or auditory acuity, other mental or an neuro

developed disorder, psychosocial adversity, lack of proficiency of

academic instructions or inadequate educational instructions.

WITH IMPAIRMENT IN READING:(DYSLEXIA)

1. word reading acuracy

2. Reading rate or fluency

3. Reading comprehension.

WITH IMPAIRMENT IN WRITTEN EXPRESSION :(DYSGRAPHIA)

1. Spelling accuracy

2. Grammar and punctuation accuracy.

3. Clarity or organization of written expression.

WITH IMPAIRMENT IN MATHEMATICS :(DYSCALCULIA)

1. Number sense.

2. Memorization of arithmetic facts.

3. Accurate of fluent calculation.

4. Accurate math reasoning.

SPECIFY CURRENT SEVERITY:

1. MILD : some difficulties learning skills in one or two academic domains but

of mild enoughvseverity that the individual may be able to compensate or

function well.

2. MODERATE: marked difficulties learning skills in one or more academic

domains so that the individual is unlikely to become an proficient without

some intervals of intensive and specialized teaching during 2nd years.

3. SEVERE : severe difficulties learning skills affecting severe academic

domains so that an individual is unlikely to learn those skills without going

intensive individualized as specialized teaching of school ears.

GENERAL TREATMENT FOR LEARNING

DISORDER :

TREATMENT FOR READING DISORDER :

Most current remediation strategies for children with reading disorder are characterised by direct instruction of child’s attention of concentration between speech, sounds and spelling.

The reading skills indicated that student exposed to either forgoung distortion received an classroom instructions

Reading accuracy reading comprehension , reading efficiency, reading fluency and an spelling.

The core deficit in reading disorder are related difficulty recognize and remembering between letters and sounds.

Coexting emotional and behavioral problem shouldbe treated by psycho therapeutic.

TREATMENT FOR MATHEMATIC DISORDER :

Mathematic difficulties for children has not seen in stable disorder over time

of intervention lead to basic computation.

Disorders are need for intervention include lack of mastery in knowledge of

which digit in pair of larger, counting disabilities, identification of number and

poor working memory for numbers, such as difficulty with reverse digit span.

The most effective treatment for an mathematics disorder combine

teaching of continuous math problems.

Flash cards, work books, and complete games xan be viable part of

treatment.

TREATMENT FOR WRITING DISORDER :

Remedial treatment for writing disorder includes direct practice in spelling

with sentence writing as well as a review of grammatical rules, intensive and

continuous administration of individually tailored, One an expressive writing

therapies appears.

Associated secondary emotional and behavioral problem should be given

an prompt attention with psychiatric treatment and parental counselling.

TREATMENT FOR MOTOR DEVELOPMENT :

Dyspraxia is not curable with treatment individual can improve

ofearlierchild is diagnosed and better prognosis.

OCCUPATIONAL THERAPY –it will evaluate child manage with everyday

function at home. They help child develop skills daily activities.

SPEECH AND LANGUAGE THERAPY –speech and language pathologist of

implement to communicate more effectively.

PERCEPTUAL MOTOR TRAINING : Involves improving child language, visual

movement and auditory skills.

ASSESSMENT TOOLS FOR LEARNING

DISABILITY :

IQ tests correlate with predict school achievement, a measure of academic intelligence.

IQ is a score Ina test it is descriptive, not explanatory.

TESTS FOR INTELLIGENCE : Wechsler scales (most common)

wechslers preschool and primary scale of intelligence.

WPPSI-3(2.6-7.3)yrs

Wechsler intelligence scale for children

WISC-4(6.0-16.11Yrs)

Wechsleradult intelligence scale

WAIS -3(16-89yrs)

OTHER COMMONLY USED SCALES:

Standford –binnet intelligence scale.

Kaufman assessment battery for children.

Woodcook- Johnson tests of cognitive ability... Etc.

WISC-3

Verbal IQ

Performance IQ

Full scale IQ.

WISC-4

Verbal comprehension Index.

Perceptual reasoning Index.

Working Memory Index.

Processing speed Index.

PROBLEM IDENTIFIED:

SELFCARE: The person may have difficulty perForming sone activities of daily living,tying shoe laces.

PRODUCTIVITY: The person may have poorly developed play skill.

The person does not want to participate in games and athletic activities due to

poor motor functioning.

The person is atleast two year behind age level in one or more school years,

such as reading, spelling or math.

LEISURE : The person may have few leisure activities.

SENSORIMOTOR: POSTURAL CONTROL AND AUTOMATIC POSTURAL REACTION.

The person posture is poor with landosis of upper trunk, kyphosis of lower trunk of knees.

The person may unable to rotate upper and lower segment of body’s axis.

The person may develop pattern of an compensation for knee fixing

patterns include rotated shoulder, internally rotated hip.

REFLEX MATURATION AND INTEGRATION OF PRIMITIVE POSTURAL REFLEX:

The person may Show again sign of residual primitive postural reflex in

stressful Motor performance especially a symmetrical and symmetrical tonic

neck reflex.

The oerson may have difficulty in tabke for fine motor or writing task or with

other midline such as pulling or ranging on a rope with both hands.

GROSSMOTOR SKILLS :

The person may have delay in develop gross motor skill needed for such

functions in smooth gait, running, skipping, or catch a ball.

The person may have unusual movements, such as choreiform

movement of face, arms or leg’s, especially a movement for person.

FINEMOTOR SKILLS:

The person has difficulties in fine motor dexterity and manipulate lead to

perform such as poor control of pencil and inability to cut on line or color

within lines.

The person lack still in eye motor coordinate in cluding being labeled

clumsy and an performing poor eye tasks.

ADAPTATION MOVEMENT RESPONSES, MOTOR PlANNING AND IDEATION :

The person has difficulty In motor planning motor sequencing and flexibility

responses.

The person may have dysdiadochinesia or an inability rapidly and smoothy

movement supination and probation of forearm.

SENSORY MODULATION :

The person may show tactile defensiveness.

The person may be hyper or hyporesponse to vestibular stimulation and

may have an gravitational insecurity intolerance to movement.

COGNITIVE :

the person may have short attention span and inattentive or overattentive.

The person may be easily distracted.

The person may have shoot term memory loss.

The person may preservate.

The person may have difficulty orienting to time, space or distance.

PSYCHOSOCIAL:

the person has poor self perception.

The person may show poor impulse control.

The person has non goal oriented behaviour.

The person may be withdrawn or act class clown.

TREATMENT :

The major models for treatment in occupational therapy are sensory

integration, vision therapy and an metacognition strategies with information

processing theory.

Occupational therapisttherapy are sensory integration, visual therapy,

metacognition strategies with information processing theory.

1. SELF CARE: improve daily living skills use schedule boards to list daily tasks

provide checklists of activities to perform and use of timer to signal the end

of an activity. Use the picture sequence to help the person learn tasks such

as tying shoelaces.

2. PRODUCTIVITY:improve level of play skills in exploration and imaginative

activities. Improve level of academic skills by promoting better adaptive

and organizational skills.

LEISURE : increase the person exposure to LEISURE activities of possible interest.

SENSORIMOTOR: promote effective total body management Ina wide variety of activities that require dynamic balance and agility. Promote object management including manipulation propulsion and reception. Improve gross motor skills through active participation of play ground.

Improve fine motor skills using constructive toys. Improve ability to deal with daily schedule of activities by providing a flip picture with one step photos of each activity done during the day. Increase visual reacting skills.

COGNITION:improve persons ability to organize ideas plan a sequence of actions and execute plan. Increase attention span and concentration. Teach the person compensatory techniques and metacognition Strategies. Teach the person always to check the work that has been done to see if its correct or person intended.

PSYCHOSOCIAL :increase the persons self esteem positive self concept and

self confidence. Improve coping skills and emotional control. Improve

social interaction skin pls. Increase communication skills.

ENVIRONMENTAL:adapt the environment to take advantage of the person

strength and to compensate for areas deficit.

Prvide information to teachers on sensory modulation disorder on the way in

which sensory overload affects performances. Provide session with parents to

explain management techniques and activities that can be usedat home.

PRECAUTION :

Observe child for signs of sensory overload such as flushing, blanching or

perspiring.

Observe the child for signs of over inhibiton of brain stem functions such as

depressed respiration functions.

Monitor the child for potential accidents due to lack of skills or lack of skills

or lack of judgment on part of child.

REFERENCE :

1. SYNOPSIS OF PSYCHIATRY BY KAPLAN & SADDOCK’S (10th edition)

2. QUICK REFERENCE OF OCCUPATIONAL THERAPY, KATHYLN L. REED (2nd

Edition)

3. SYNOPSIS OF PSYCHIATRY, BEHAVIOURAL SCIENCE /CLINICAL PSYCHIATRY BY

KAPLAN & SADDOCK’S(11th edition).

4. A SHORT TEXTBOOK OF PSYCHIATRY BY NIRAJ AHUJA(7th edition).

5. CREEK‘S OCCUPATIONAL THERAPY AND MENTAL HEALTH BY JENIFER

CREEK ( 2nd edition).