Your son or daughter is struggling in school. He is not mastering expected academic skills. She is having difficulty completing work accurately or on time. Maybe your child (or adolescent) is no longer trying in school, perhaps refusing to work or hiding work. Or, maybe he is disrupting the class or getting into trouble out of class. Your high schooler might be skipping classes. You wonder if the problem is dyslexia (learning disability (LD); specific learning disorder (SLD)) with resulting frustrations and failures. How do you find out if you are right?
First, what do you not do: don't fall into the easy trap of blaming the victim nor should you let teachers do this. "He could do better if he tried." "She just does not work hard enough." "If only he paid more attention, he would have less trouble." Children want to please their parents and teachers. They want to learn and to succeed. Before you blame them for their problems or allow teachers to do so, be sure to check if there might be a reason for their lack of success.
What is dyslexia (learning disability)?
A learning disability is a neurologically-based processing disorder resulting from "faulty" wiring in the cerebral cortex. These processing difficulties might involve understanding or using language (spoken or written) resulting in an imperfect ability to listen, speak, read, write, spell or do mathematical calculations. Children with learning disabilities are as smart as or smarter than their peers, i.e., they have average or above average IQs.
Learning disabilities might impact learning to read, write or do basic math or reading comprehension, written language or more complex math. They might also impact the student’s ability to organize materials and thoughts or to plan a task and carry out that plan. Thus, some problems are apparent in the earliest school years; some are not apparent until late elementary school; and still others show up in middle or high school. In any grade, the presenting problem is struggling with school work, possibly with failing grades. You might find that homework is a battle every night. Unfortunately, some teachers and parents blame the victim. They complain that your patient is lazy or unmotivated. But, if you know what questions to ask, you will find that there are reasons for these struggles.
How widespread is dyslexia?
About 5% of the school-going children (and adolescents) have a learning disability significant enough to meet formal diagnostic criteria. Nevertheless, many more people - perhaps as many as 10% of the population as a whole - have some of the symptoms of dyslexia, including slow or inaccurate reading, poor spelling, poor writing or mixing up similar words. Not all of these will need remedial education, but they are likely to struggle with many aspects of academic learning and are likely to benefit from systematic, explicit instruction in reading, writing and language.
Dyslexia occurs in people of all backgrounds and intellectual levels. People who are very bright can be dyslexic. They are often capable or even gifted in areas that do not require strong language skills, such as art, computer science, design, drama, electronics, math, mechanics, music, physics, sales, and sports. In addition, dyslexia tends to run in families; dyslexic parents are more likely to have children who are dyslexic. Some people are identified as dyslexic early in their lives, but for others, their dyslexia goes unidentified until they get older.
Suspecting a Learning Disability
If you suspect that your child has a problem with learning, the sooner you act on your suspicions, the easier it will be for your child. It is natural for children to have one or more of the following characteristics at times. But, if your child consistently exhibits several of these signs, you should speak to his or her teachers, and then consider a formal evaluation to answer questions you may have about the way your child learns. The following ‘systems review’, which won’t take more than ten minutes, can help you decide if professional help is needed.
Oral language: Was she late in learning to speak? Does she pronounce words properly? Does she muddle-up words (aminal for animal, or gabrage for garbage)? Does she have frequent confusion with before / after, right / left, and so on? Does she frequently have naming problems? Does she have difficulty with age-appropriate grammar?
Reading: Is reading something he likes to do or something he has / hates to do? How well does he read? Does he understand what he reads? Does he ever skip words or lines or read the same lines twice? Does he get to the end of the page or chapter and not know what he has read? Does he frequently reverse letter order in words (for eg. was / saw)? Does he confuse similar-looking words (for eg. beard / bread)? With an older child, ask yourself: When you go through his answer papers, do you find that he has misread questions or instructions? Does he have difficulty with word problems in maths?
Writing: How is her handwriting? Does she dislike / avoid writing and copying? When you look at what she has written, do you see errors in spelling, grammar, punctuation or capitalization? Can she copy material from the board fast enough? Do you find that she will answer correctly orally but finds it difficult to do so in writing? Does she frequently reverse letters (b for d) and words (was for saw)? With an older child, ask yourself: can she take notes as the teacher is talking? Can she organize her thoughts and come up with a well-written essay?
Maths: Depending on grade level, ask yourself: Does he have difficulty counting accurately? Does he know the multiplication tables? Do you find that he aligns numbers poorly, resulting in computation errors? Is there a problem with word problems? Does he have difficulty with comparisons (eg. less than, greater than)? Does he have difficulty learning strategic counting principles (eg. by 2, 5, 10, 100)?
Next, we’ll look at questions relating to the processing skills needed to learn.
Sequencing: When she speaks or writes, do you sometimes have difficulty getting everything in the right order? You might ask her to name the months of the year. Then, ask what comes after May. Does she answer easily or does she need to go back to January and count forward? Ask if she has difficulty using the dictionary and remembering the order of the alphabet.
Abstraction: Does he understand the jokes his friends tell? Does he sometimes get confused when he hears something? Do people say that he did not understand what they said?
Organization: What does her notebook look like? How about her binders and papers? Is everything falling out or in the wrong place? What about her desk? School bag? Bookshelf? Bedroom? Does she lose things or forget things? Does she do her homework, but forget to turn it in? Does she have difficulty with planning and writing essays? Does she have problems planning time so that things get done?
Memory: Does he have trouble with word recall (e.g. "You know, that thing we hold above our heads when it is raining”)? Do you find that he can learn something at night and then go to school the next day and forget what he learned? How does he learn best: by listening to people or by reading?
Making the diagnosis
The primary diagnostic approach is formal testing for dyslexia. If these tests focus primarily on educational issues, the assessment is called a "psycho–educational" evaluation. If the focus of the tests is on educational issues as well as on a broader range of brain tasks, the assessment is called a "neuro–psychological" evaluation. Either will help to clarify if the child (or adolescent) has LD. A psycho-educational evaluation is done by an educational psychologist; either a neuro-psychologist or a clinical psychologist performs a neuro-psychological test. Medical doctors (psychiatrists / developmental pediatricians) can SCREEN for dyslexia; formal DIAGNOSIS, however, requires an assessment by a qualified and experienced psychologist.
These studies consist of a battery of tests that will provide information on your child's overall abilities, particularly learning style, information processing abilities and academic skills. A significant part of this assessment is the IQ test which helps to clarify the student's strengths and weaknesses. It provides information regarding the student's ability to process verbally and visually presented information as well as his or her overall intellectual potential. Considerable additional information is derived relating to sequencing abilities, short and long–term memory issues, language functioning, and processing speed. The most widely recognized IQ test is the Wechsler Intelligence Scale for Children (WISC). There are corresponding versions for preschoolers (the Wechsler Preschool and Primary Scale of Intelligence) and for students over the age of 16 (the Wechsler Adult Intelligence Scale). Instruments have also been developed and validated in the Indian context, such as the Binet Kamat Tests of Intelligence (BKT) and the Malin’s Intelligence Scale for Indian Children (MISIC). In addition to the IQ test, the examiner might do specific tests to evaluate the student's cognitive abilities, typically tests of memory and organizational skills.
The other parts of the psycho-educational evaluation assess the student's academic skills: reading, written language, and math. There are many standardized tests that can be used to obtain this information. These studies include brief tasks and, for older students, more complex activities consistent with grade demands (e.g., reading multiple paragraphs, writing essays). Studies might include informal measures but should also involve standardized tests which provide objective scores that can be compared to grade level expectations as well as to the student's intellectual potential. Testing should also allow comparison of the student's performance under timed and untimed conditions. Standardized, syllabus-based tests such as the HELPCHILD Learning Difficulty Assessment Test and the NIMHANS Dyslexia Battery are used, depending on the geographical location and the syllabus.
In addition to test data, the evaluation includes a clinical interview as well as questionnaires and rating scales completed by parents and the student. These data help to identify whether attentional and/or emotional issues might be contributing to or resulting from the learning difficulties. Once the student completes the tests, the test findings are interpreted and an assessment report is prepared. This report forms the basis of dyslexia treatment - remedial education.
There is no “medicine” for dyslexia. However, remedial education by a qualified and experienced professional (“remedial educator”) helps most children cope with the difficulty and perform to their potential in academic settings.
Ideally, remedial education must take place in the student’s primary educational environment, i.e., his or her school. This, however, is rare in our country. The next best option is part-time remediation within school hours (“partial pullout”). Schools are increasingly receptive to this idea, wherein the student is given permission to attend remedial intervention in a specialized centre during a specified day (or specified days) of the week. In case this option is also unavailable, the child will need remedial coaching after school hours for extended periods of time (usually between a few months and a couple of years). In cases of severe dyslexia, parents may need to consider full-time remediation for a year or two, before attempting “mainstreaming”, i.e., returning to a regular school.
With early diagnosis and appropriate intervention, most children with dyslexia can go on to be regular, well-adjusted, happy adolescents and adults.
Concessions for learning disabled students
Many states now provide concessions for learning disabled students; these tend to vary from state to state. Some concessions include
- Extra time for written examinations
- Extra time for practical examinations
- Use of a calculator
- Use of Clarke’s Tables
- Use of a scribe
- Exemption from one language