Address for
Correspondence: Dr. Beena Johnson, Developmental
Paediatrician & Senior Consultant in Child Guidance, Baby
Memorial Hospital, Kozhikode, Kerala, India. E- mail:
jiacam@gmail.com
Abstract
Learning disorders are common developmental disorders seen in
the school-age children. The intelligence quotient of these
children will be normal. But they will have significant
difficulties in using the key academic skills. The prevalence
among school-age children is 5% to 15% across different
languages and cultures. Children with specific learning
disorder can have impairment in reading, writing and
mathematics. 62.2% of the children with learning disorders
have comorbidities which include
attention-deficit/hyperactivity disorder, anxiety disorder,
developmental coordination disorder, language disorder and
mood disorder. The poor academic performance due to learning
disorders cause significant stress for children, their parents
and teachers. Hence early identification of students with
learning disorders is essential and individualized
interventions should be provided at the earliest. The
treatment for learning disorders is implementation of
individually tailored one to one remedial education program,
which will definitely help in attaining victory over learning
disorders. Comorbid problems also should be managed
scientifically. Prevention of learning disorders is a much
more efficient approach in management. Early interventions in
kindergarten-age children, focusing on learning difficulties,
will prevent the development of learning disorders.
Introduction
Children with learning disorders have significant difficulties
in using the academic skills. Fluent reading of words, reading
comprehension, spelling skills and arithmetic calculations are
the key academic skills. In specific learning disorder, the
affected academic skills are substantially below those
expected for the age of the child. These children will have
impairment in reading, impairment in writing or impairment in
mathematics. The learning difficulties become apparent
in the early school years in most of the children. The
intellectual functioning of these children will be normal. The
vision and hearing are also normal. Children with mathematics
disorder have deficits in visual-spatial memory and children
with reading disorder have deficits in phonological awareness
as well as central executive functioning [1].
Learning disorders are common developmental disorders which
negatively affect the children and finally the society in
general [2]. The poor academic performance cause significant
stress for children, their parents as well as educators. The
school dropout rate for these children is very high. Early
identification of students with learning disorders is
essential and individualized interventions should be provided
at the earliest [3].
Prevalence
About 5% to 15% of school-age children across different
cultures have learning disorder. In a study conducted in South
India, the prevalence of
specific learning disabilities was 15.17% in
children aged eight to eleven years. 12.5% of children had
dysgraphia, 11.2% had dyslexia and 10.5% had dyscalculia [4].
Several studies have reported prevalence rates of 4 to 9% for
reading disorder and 3 to 7% for mathematic disorder. Children
having a deficit in one learning domain usually experience
deficits in other learning domains also [5].
Specific Learning Disorder with Impairment in Reading
The clinical features include poor reading fluency, slow
reading speed, inadequate comprehension, impairment in
properly sequencing words, mirror reading (reversal of words
or letters), omissions, substitutions or distortions of
letters and words, inability to recall facts that have been
read, as well as inability to draw conclusions or inferences
from the material that has been read.
Specific Learning Disorder with Impairment in Writing
These children have poor handwriting, poor paragraph
organization, lots of grammatical errors, spelling errors,
punctuation errors, reluctance to do assigned written homework
and mirror writing of letters or words.
Specific Learning Disorder with Impairment in Mathematics
The clinical features include significant difficulty in
acquiring even the basic mathematical skills like addition,
subtraction, multiplication and division; severe difficulty in
mastering number sense; and defect in attention skills
required to copy numbers and figures correctly.
Comorbidity
The learning disorders not only impair the learning process of
children, but also lead to negative impacts on various aspects
of their lives. Emotional and social deficits are seen in
children with learning disorders. Children with learning
disorders have lower self-esteem, increased anxiety and
behavior problems, as well as reluctance to go to school [6].
Neuropsychopathological comorbidities are seen in 62.2% of the
children with learning disorders. The common comorbidities
include attention-deficit/hyperactivity disorder, anxiety
disorder, developmental coordination disorder, language
disorder and mood disorder [7].
Attention-deficit/hyperactivity disorder
and learning disability co-occur in children and the
mean comorbidity rate is 45.1% [8]. Children with
specific learning disorders also have self-stigma
and poor quality of life [9].
Treatment
Learning disorders should be diagnosed early and managed
scientifically to enhance the quality of life of these
children. The deficits in academic skills of each child with
learning disorder will be different. The remediation programs
should target the specific needs of each child in order to
facilitate learning [10]. The treatment of choice for learning
disorders is implementation of intensive individually tailored
one to one remedial education program lasting for months. This
will definitely help in achieving victory over learning
disorders.
The neuropsychopathological comorbidities should be promptly
managed. Specific interventions are needed to reduce
the long-range consequences of the comorbid problems.
Comprehensive intervention services are required for students
with comorbid attention-deficit/hyperactivity disorder
and learning disorder, that address
both disorders [8].
The families of children with learning disorders, experience
significant difficulty in parent-child relationships and the
caregiver burden is usually high. Parental social wellbeing
influence the child's quality of life [11]. Involving parents
of children with learning disorders in the remedial programs
help to improve the scholastic skills of these children. Hence
parental guidance is essential in the management of learning
disorders of children.
When compared to post-diagnosis remediation, prevention of
learning disorders is a much more efficient approach in
management. Early interventions in kindergarten-age children,
focusing on learning difficulties in reading, mathematics and
written expression, will help to prevent the development of
learning disorders and thus we can lead the children to
academic brilliance in future.
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