Dr. Anjana Thadhani's presentation at Tata Learning Disability Forum (TDLF), 2013. The Forum for Learning Disabilities centred on the theme ‘Learning Disabilities – a more inclusive perspective’. The forum this year included in its purview three additional Learning Disabilities (LD), namely Specific Learning Disability (SpLD), Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). In line with the TATA Group’s corporate sustainability endeavors, TIS initiated the Tata Learning Disability Forum (TLDF) in 2006 to ensure that students with special education needs receive the required attention as well as to spread awareness about LD which had been receiving scant attention in India. Since then, via the TLDF platform, TIS has been successful in generating an increased level of awareness and enabling progress in remediation activities for students with LD.

1. Dr Anjana Thadhani
Consultant Developmental
Pediatrician

2. Specific Learning Disabilities
 Group of developmental disorders
 Significant unexpected, specific and persistent
difficulties in the acquisition and use of
reading (dyslexia), writing (dysgraphia) or
mathematical (dyscalculia) abilities,
 despite conventional instruction, normal
intelligence, proper motivation and adequate
socio-cultural opportunity

3. Salient Features
Types: Dyslexia
Dysgraphia
Dyscalculia
Creates a significant gap between the potential
and academic performance
Prevalence - 10% of school going children
Difficulty with information processing

4. LEARNING
INPUT
PROCESSING
OUTPUT

5. INFORMATION PROCESSING
RECORDING INFORMATION (INPUT)
 Perceptual →Visual
→Auditory
INTEGRATION
 Sequencing
 Abstraction
 Organization
STORAGE (MEMORY)
 Short – term
 Long – term

6. READING
 Phonological awareness
 Letter-sound association
 Decoding & Blending
 Focus on printed words
 Control of eye movements across the page
 Processing of images and ideas
 Comparisons and associations of ideas
 Storing of the information into memory

7. CAUSES
 Neuro-developmental condition
 Multi-factorial
 Genetic predisposition
 ADHD - Strong association
 CO-MORBIDITY

8. GENETICS
• In 1950, Hallgren, an autosomal dominant
disorder
• Recent findings:
Dyslexia is a genetically heterogeneous and
complex trait that does not show classical
mendelian inheritance
Several chromosomal regions & genes
affecting reading disability (chromosome
1, 2, 3, 6, 15, 18)

9. NEUROIMAGING
 Absence of usual asymmetry of planum
temporale (portion of temporal lobe lying
posterior to Heschl’s gyrus)
 Left is usually larger than right
 Neuronal ectopias in frontal and parietal
regions

11. MANIFESTATIONS
 Varied spectrum presentation
 Mild to severe
 Academic
 Behavioral
 Co-morbidity
 Psychosocial

12. REFERRAL LETTER
 Repeated failures
 Does not write or read
 Spelling mistakes
 Oral work better than written work
 Problems in math

13. EARLY POINTERS

14. Developmental delays
 Mild gross motor delays
 Fine motor problems
 Speech delay or difficulties
 Lack of dominant handedness
 Perceptual problems

15. AUDITORY PERCEPTION
 Auditory perception
 Auditory discrimination
 Auditory memory & sequencing
 Auditory filtering
 Auditory processing

16. VISUAL PERCEPTION
 Visual perception
 Visual discrimination
 Visual memory & sequencing
 Form constancy
 Visuomotor integration
 Figure ground discrimination

17. THE RED HOUSE

18. RED HOUSE & TREE

19. RED HOUSE, TREE & SUN

20. Learning Concerns
 Difficulty in pronouncing words.
 Poor phonological awareness
 Difficulty or slowness to add words.
 Inability to rhyme by age 4 years.
 Confusion in directionality, words and space
concepts, left versus right, over versus
under, before versus after.

21.  May have trouble learning the
alphabets, numbers, day of the
week, colors, shapes.
 May have difficulty telling or retelling a story in
the correct sequence.
 Abnormal grip or refusal to write.

22. Behavioral concerns
 Hyperactivity
 Difficulty in following instructions
 Slow in ADLs
 Stubborness
 Temper tantrums

24. Dyslexia
 Avoids reading aloud
 Reads slowly
 Uses finger tracing
 Looses place or skips words
 Mispronounces or guesses words
 Has difficulty decoding or blending single words

25.  Relies heavily on memorizing without
understanding.
 Poor comprehension
 Gives stress on wrong syllables
 Reads with substitution
 While reading makes up his own stories
 Poor memory & recall

26. Dysgraphia
 Slow in writing or may avoid writing.
 Often uses an awkward pencil grip ( fist, thumb
hooked over finger, etc.)
 Writes with illegible handwriting
 Poor letter formations
 Untidy written work
 Uses inappropriate pressure
 Uneven size of letters with poor spacing

27.  Spelling mistakes
 Bizarre spelling
 Spells the same word differently
 Punctuation & capitalization errors.
 Mixes upper & lowercase letters
 Problems with copy writing

30. Typical errors
 Letters reversals -d for b as in dog for bog.
 Word reversals – tip for pit.
 Inversions – m and w, u and n.
 Transpositions – felt and left.
 Substitutions – house and home.
 Omissions
 Additions.

31. Spelling errors
 Amount – aomunt
 Awards – awords
 Consent – conset
 Recent – resent
 Domestic – domistic
 Brain – brian
 Method - matheod

32. Dyscalculia
 May transpose number sequences , 231 as 312
 Confuse arithmetic signs. (+ - * / = )
 Has trouble with word problems
 Poor in mental maths
 Difficulty in learning tables
 Counting on fingers may be seen

33.  Difficulty in carrying over or borrowing sums
 May count from left to right
 Poor in geometry
 Poor in algebra

34. Other concerns
 Appears very clumsy and untidy.
 Has difficulty making friends.
 May not understand body language and facial
expression of others.
 Has trouble with non-literal language
(idioms, jokes, proverbs, slang)

35.  Difficulty following step by step instructions
 Difficulty in telling time
 Difficulty in telling/ following directions
 Slow in ADLs
 Poor understanding of abstract
 Disorganized behavior and thoughts

36. Associated behavioral issues..
 Hyperactivity
 Day dreaming
 Poor peer relations
 Aggressive behavior
 Poor participation

37. Pyschosocial concerns
 Poor self esteem
 Poor self confidence
 Poor interpersonal relations
 Emotional lability

38. Strengths
 Sensitive & compassionate
 Good at mechanical work
 Good at sports
 Usually good dancers
 Good at cooking & eating too…

39. Key Messages
 Hidden Handicap
 Neurological Disorder
 Present since Birth
 Multi-factorial
 Essentially Normal child
 Average / above average Intelligence

40. To Summarize…
 “Every learning problem is not a Learning
Disability”
 With early intervention & provisions, they
can be mainstreamed
 Secondary behavioral problems need
effective management.