Specific learning disorder - reading disorder, mathematics disorder, and disorder of written expression and learning disorder NOS . neurodevelopmental disorder produced by the interactions of genetic and environmental factors that influence the brain's ability to perceive or process verbal and nonverbal information efficiently.

1. SPECIFIC LEARNING
DISORDER
DR.R.G.ENOCH
MD Psychiatry II Yr
GMKMCH, Salem

2. • Introduction
• History
• DSM & ICD
• Epidemiology
• Specific learning disorder with impairment in reading
• Specific learning disorder with impairment in mathematics
• Specific learning disorder with impairment in written expression
• Comorbidities
• Complications
• Conclusion

3. Introduction
• Specific learning disorder in youth is a neurodevelopmental disorder
produced by the interactions of genetic and environmental factors that
influence the brain's ability to perceive or process verbal and nonverbal
information efficiently.

4. Definition
• A disorder in one or more of the basic psychological processes involved in
understanding or in using language, spoken or written, which may
manifest itself in an imperfect ability to listen, think, speak, read, write,
spell, or do mathematical calculations.

5. The 1977 federal definition of LD included three major components:
(1)severe discrepancy between achievement and intellectual ability,
(2)Heterogeneity - manifest in various academic domains (e.g., speaking,
listening, basic reading, reading comprehension, math calculation,
written expression); and
(3)Exclusion - SLD is not identified when the primary cause is mental
retardation, emotional disturbance, sensory disorder, social, or
economic disadvantage.

6. HISTORY
• 1877 Rudolph Berlin coined the term dyslexia
• 1896, British physician W. Pringle Morgan - first to describe reading difficulty in a 14-
year-old boy.
• In the 1920s, the neurologist Samuel Orton - a neurological basis for the disorder, that
delayed development of specialization of the left hemisphere for language was
potentially causal.
• The term “Learning Disability” was given by Samuel Kirk, 1962
• Gerstmann described Gerstmann syndrome in 1960s
• 1970s - pinpointed the cause as deficits in phonological processing.

8. TERMS
• Phoneme: Smallest sound units in a word that distinguishes one word from another (e.g., the
word “peach” has three phonemes: /p/ /ea/ /ch/; the phoneme /p/ distinguishes the word
“peach” from “teach”).
• Phonemic awareness: awareness that there are discrete speech sounds (phonemes) in speech.
• Phonological awareness: awareness that spoken language comprises discrete units – words,
syllables and phonemes.
• Phonological coding: Translating the letters of a written word into speech patterns to identify the
word and gain access to its meaning.
• Orthography: The representation of the sounds of a language by written or printed symbols.(EG.
Incredible - / n kr d b( )l/ )ɪ ˈ ɛ ɪ ə

9. DSM
• DSM-5 combines the DSM-IV diagnoses of reading disorder, mathematics
disorder, and disorder of written expression and learning disorder NOS
into a single diagnosis: Specific learning disorder.
• Learning deficits in reading, written expression, and mathematics in the
DSM-5 are designated using specifiers.

10. ICD 10
• F81 Specific developmental disorders of scholastic skills
F81.0 Specific reading disorder
F81.1 Specific spelling disorder
F81.2 Specific disorder of arithmetical skills
F81.3 Mixed disorder of scholastic skills
F81.8 Other developmental disorders of scholastic skills
F81.9 Developmental disorder of scholastic skills, unspecified

11. ICD 11
• 6A03 Developmental learning disorder
6A03.0 Developmental learning disorder with impairment in reading
6A03.1 Developmental learning disorder with impairment in written expression
6A03.2 Developmental learning disorder with impairment in mathematics
6A03.3 Developmental learning disorder with other specified impairment of
learning
6A03.Z Developmental learning disorder, unspecified

12. DSM-5 DIAGNOSTIC CRITERIA FOR SPECIFIC LEARNING DISORDER
A. Presence of at least one of the following for 6 months, despite interventions:
1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and
hesitantly, frequently guesses words, has difficulty sounding out words).
2. Difficulty understanding the meaning (e.g., may read text accurately but not understand the sequence, or
deeper meanings of what is read).
3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants).
4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors; poor
paragraph organization; written expression of ideas lacks clarity).
5. Difficulties mastering number sense or calculation (e.g., counts on fingers to add single-digit numbers; gets
lost in the midst of arithmetic computation and may switch procedures).
6. Difficulties with mathematical reasoning (e.g., difficulty applying mathematical concepts, facts to solve
quantitative problems).

13. B. The affected academic skills are below those expected for the individual's
chronological age, and cause significant interference with functioning.
C. The learning difficulties begin during school-age years but may not become fully
manifest until the demands exceed the individual's limited capacities (e.g., as in timed
tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy
academic loads).
D. The learning difficulties are not better accounted for by intellectual disabilities,
uncorrected visual or auditory acuity, other mental or neurological disorders,
psychosocial adversity or inadequate educational instruction.

14. Specify if:
31 5.00 (F81 .0) With impairment in reading:
31 5.2 (F81 .81) With impairment in written expression:
31 5.1 (F81 .2) With impairment in mathematics:
Specify current severity:
• Mild
• Moderate
• Severe

15. EPIDEMIOLOGY
• SLD of all types affects approximately 10 % of youth.
• SLD occurs two to three times more often in males than in females.
• Reading and written expression disorder are more common in boys and mathematics disorder is
more in girls.
• At least 75 % of all individuals identified as having SLD have reading disorder
• The prevalence of a disorder of written expression and mathematics disorder is about 6 percent
of school-aged children
• There is an increased risk of 4 to 8 times in first-degree relatives for reading deficits, and about 5
to 10 times for mathematics deficits.

16. SPECIFIC LEARNING
DISORDER WITH
IMPAIRMENT IN READING

17. • Multiple skills are involved in reading. These include the
• awareness that spoken language can be segmented into smaller units (words,
syllables, phonemes)
• mapped onto written visual symbols;
• the ability to identify letters and words rapidly (orthographic awareness); and
• the ability to extract meaning from this written language.

18. Definition
• Lyon and co-workers in 2003 specified the following:
• Dyslexia is a SLD that is neurobiological in origin. It is characterized by
difficulties with inaccurate word recognition and poor spelling and
decoding abilities. These difficulties typically result from a deficit in the
phonological component of language.
• “dyslexia” - Greek origin, with a meaning “impaired” “word.”

19. Etiology
• Neurological Factors
• Genetic Factors
• Cognitive Factors
 Phonological Theory
 Rapid Auditory Processing Theory
 Cerebellar Theory
 Visual/Magnocellular Theory

20. Neurological Factors
• fMRI - show a distinct brain activation profile during reading.
• Basic word reading activates three systems in the left side of the brain :
• (1) an anterior system in the left inferior frontal region - phoneme production (vocalizing words silently or out loud);
• (2) a left parietotemporal system - analyzing the written word
• (3) a left occipitotemporal system - automatic word recognition
• In contrast, in RD demonstrate
• underactivation in both posterior systems (left temporoparietal, left occipitotemporal) and
• increased activation in the left inferior frontal gyrus, right temporal and tempoparietal regions.
• So they rely more heavily on right-sided posterior brain systems to read via memorization rather than
by sound–symbol linkages and so continue to struggle to read unfamiliar words.

23. Imaging
• MRI studies - planum temporale in the left brain shows less asymetry
than the right brain.
• PET studies - left temporal blood flow patterns during language tasks
differ between children with and without SLD.
• Cell analysis studies - the visual magnocellular system (which normally
contains large cells) contains more disorganized and smaller cell bodies
than expected.

24. Genetic Factors
• RD is highly familial and heritable.
• Upto 50 % of children of parents with RD and 50 % of siblings of a child with RD may
have the disorder.
• Twin studies - high concordance rates for RD. Genetic factors account for 69 to 87 %
and 13 to 30 % is due to environmental factors.
• Molecular genetic studies of RD have reported several susceptibility loci on
chromosomes 1p, 2p, 3p, 6p, 11p, 15q, 18p, and Xq27.3.
• Chromosome 1p – common susceptibility locus for both reading disorder and
inattention dimension of ADHD

25. Cognitive Factors
• Diverse hypotheses exist for the underlying cognitive deficits in RD,
including
 Phonological Theory
 Rapid Auditory Processing Theory
 Cerebellar Theory
 Visual/Magnocellular Theory

26. 1. Phonological Theory
• Most widely accepted.
• According to this model, the core difficulty in RD is a specific deficit in the representation, storage,
or retrieval of speech sounds.
• At the neurological level, there is a dysfunction of lefthemisphere perisylvian brain areas that
support phonological representation.
• Double-deficit hypothesis - phonological and naming-speed deficits
• Naming-speed deficits - slow rate in the recognition and retrieval of the names of symbol. Eg:
naming colors, letter or objects. Double deficit leads to a more profound form of RD
• Triple-deficit model - The addition of an orthographic deficit to the double-deficit model.
Individuals with orthographic deficits have difficulty in recalling written words.

28. 2. Rapid Auditory Processing Theory
•Auditory deficit in the perception of short or rapidly varying sounds.
•Studies demonstrated that individuals with RD perform poorly on auditory tasks (e.g.,
frequency discrimination) and exhibit abnormal neurophysiological responses to various
auditory stimuli.
•More recently, perceptual deficits in the processing of acoustic structure at the level of
the syllable - rhythm detection is included. This involves detection of modulation of the
speech waveform.

29. 3. Cerebellar Theory
•The cerebellum plays a role in motor control and so in speech articulation deficient
phonological representations.
•Critical role in specific timing required for some aspects of speech perception (e.G., Distinguishing
“rapid” and “rabid”).
•Plays a role in the automatization of activities, such as typing and reading. A weak capacity to
automatize would impair learning and fluency.
•Brain imaging studies have revealed anatomical, metabolic, and activation differences in the
cerebellum of individuals with RD.

30. 4. Visual/Magnocellular Theory
•most ubiquitous and influential theories of dyslexia
•emphasizes a visual contribution to reading problems
•Proposed visual problems include unstable binocular fixations, poor visual tracking, abnormalities in
perception of visual motion and poor contrast sensitivity.
•mechanism - disruption of the magnocellular pathway
•deficits anywhere along the magnocellular pathway can affect the spatiotemporal gating functions that
are essential for reading a text by spotlighting the individual letters of a text in a sequential fashion.

32. Signs of Reading Disorder
Kindergarten
Lack of interest in playing games with language sounds (e.g., repetition, rhyming)
Trouble learning nursery rhymes
Failure to recognize letters in their own name
Trouble remembering names of letters, numbers, or days of the week
Unable to recognize phonemes (e.g., does not know which of the set of words “dog,” “man,” “car” starts
with same sound as “cat”)
Primary Grades (Grades 1–3)
Receives reports of “not doing well in school”
Unable to read one-syllable words, such as “mat” or “top”
problems in connecting sounds and letters (e.g., “big” for “got”)
Difficulty in sequencing numbers and letters

33. Middle Grades (Grades 4–6)
Mispronounces or skips parts of long words (e.g., says “conible” for “convertible” and “aminal” for “animal”)
Confuses words that sound alike (e.g., “tornado” for “volcano”)
Trouble remembering dates, names, telephone numbers
Gets the first part of word correct, then guesses wildly (e.g., reads “clover” as “clock”)
Poor comprehension
Trouble completing homework or tests on time
Terrible spelling
Fear of (refuses) to read aloud, avoids reading
High School, College, Work
Slow, effortful reading of single words and connected text
Trouble pronouncing multisyllable words
Frequent need to reread material to understand
Avoids activities that demand reading (reading for pleasure, reading instructions)

36. Assessment
• Psychoeducational testing, is critical in determining these deficits.
• The reading subtests useful are
• Woodcock-Johnson Psycho-Educational Battery- Revised, and
• The Peabody Individual Achievement Test-Revised
• Test of Word Reading Efficiency (TOWRE);

37. NIMHANS INDEX FOR SLD
LEVEL -1
• YOUNGER STUDENTS (5-7 YEARS)
Level II
• OLDER STUDENTS (8 to 12 years)

38. 1. ATTENTION
1. Simple Colour Cancellation test.
2. Double Colour Cancellation test.
2. VISUAL DISCRIMINATION
3. VISUAL MEMORY

39. 4. AUDITORY DISCRIMINATION
5. AUDITORY MEMORY
6. SPEECH AND LANGUAGE
a. Verbal language expression
7. VISUAL-MOTOR SKILLS

40. 8. WRITING SKILLS
a. Capital letters
b. Small letters
c. Write the letter that comes before and after
9. NUMBERS
a. Write the numbers up to 20
b. Write the number that comes before and after

41. • Level II
• OLDER STUDENTS (8 to 12 years)
1.ATTENTION
a. Number cancellation
2.LANGUAGE
a. Reading of english passages
b. Comprehension
c. Spelling test (schonell's list)
d. Copying of english passages
3.ARITHMETIC SUBTEST
4.BENDER GESTAULT TEST

42. Course and Prognosis
• RD is persistent and does not remit with age or time in the absence of effective
intervention.
• Many eventually learn to read, at basic level, using various compensatory strategies, but
they rarely read for pleasure.
• Problems in persist into adulthood, at which time the main problem is in terms of speed
rather than accuracy of decoding single words.
• Young adults rely more on memory-based rather than analytic strategies to assist in
word identification.

43. Treatment
• Typically carried out in education settings or specialized psychology clinics
• The psychiatrist’s primary role is to instigating pharmacological or psychological
treatment for coexisting mental health problems
• Remediation - focus on direct instruction that leads a child's attention to the
connections between speech sounds and spelling.
• After individual letter- sound associations have been mastered, larger components of
reading such as syllables and words are targeted.
• Positive coping strategies include small, structured reading groups that offer individual
attention and make it easier for a child to ask for help.

44. Remediation programs
•Orton Gillingham and Direct Instructional System for Teaching and Remediation (DISTAR)
approaches – begin by simple phonetic units, and then blend these units into words and sentences
•Merrill program, and the Science Research Associates, Inc. (SRA) Basic Reading Program -
introducing whole words first and then teach to break them down and recognize the sounds of the
syllables and the individual letters in the word.
•Bridge Reading Program - teaches to recognize whole words through the use of visual aids and
bypasses the sounding-out process.
•The Fernald method - teaching whole words with a tracing technique so that the child has
kinesthetic stimulation while learning to read the words

48. SPECIFIC LEARNING
DISORDER WITH
IMPAIRMENT IN
MATHEMATICS

49. Definition
• Mathematics disorder (dyscalculia) refers to impairment in the
development of arithmetic skills, including but not restricted to
computational procedures used to solve arithmetic problems and the
representation and retrieval of basic arithmetic facts from long-term
memory.

50. Problematic skills in mathematics disorder
four groups of skills are poorly achieved
linguistic skills (understanding mathematical terms and converting written problems into
mathematical symbols),
perceptual skills (the ability to recognize and understand symbols and order clusters of
numbers),
mathematical skills (basic + , - , x, ÷), and
attentional skills (copying figures correctly and observe symbols correctly).

51. Etiology
• Psychological Factors
• Neurological Factors
• Genetic Factors
• Environmental Factors
• Emotional Factors

52. Psychological Factors
Core neuropsychological factor - impairment in number sense.
The term number sense is used to refer to two distinct constructs:
• (2) an acquired verbally based ability - through enculturation and formal schooling
• (1) a biologically based nonverbal capacity to estimate
numerosity (non-symbolic representation of
numerical magnitude, such as arrays of dots) - property of the
visual system; and

53. Neurological Factors
• Inferior parietal sulcus plays a dominant role in numerical processing
• fMRI - children use frontal regions during calculation, whereas adults use in parietal
areas. children may have to use attentional and working memory resources until they
acquire adult-like levels of automaticity and functional specialization for mental
arithmetic.
• MRI studies - decreased gray matter in the left parietal lobe.
• Moreover, calculation ability was found to be related to plasma taurine level in the
neonatal period since taurine is important in neural development

55. Genetic Factors
• Family studies - 50 to 60 % of all siblings and parents of children with
mathematics disorder also have mathematics disorder.
• To date, no specific genes for mathematics disorder/dyscalculia
Environmental Factors
• Psychosocial adversity and schooling, and
• Affective factors - anxiety and motivation.
• Children from low-income households have a low level of number sense—
because of their poor experience.

56. Emotional Factors
• Math anxiety refers to increased physiological reactivity, negative
cognitions, avoidance behavior, and substandard performance when
presented with math stimuli.
• As math anxiety increases, working memory is compromised and math
achievement declines.
• Math anxiety is common, particularly in females.

57. Signs of mathematics disorder
 has difficulty with counting - may count on fingers
 difficulty with mathematic concepts and reasoning, and can’t solve quantitative
problems
• switching to use the wrong sign midway through a complex problem,
• incorrect regrouping procedures, ( 6 x 4 ) + 3
• misalignment of digits, and
• completing the arithmetic procedure in the wrong direction (e.g., left to right; top to
bottom in order to subtract a smaller from a larger number).
• and poor comprehension of fractional concepts ( ¼ )

58. • During the first 2 or 3 years of elementary school, a child with poor
mathematics skill may just do it by relying on rote memory.
• But soon, as mathematics problems require discrimination and
manipulation of spatial and numerical relations, a child with mathematics
difficulties is affected.
• In older children (i.e., third grade and above), major impairments are
evident in rapid retrieval of number facts (e.g., 6 × 7) and in solving more
complex arithmetic problems.

61. Assessment
• Standardized measurement of intellectual function is necessary to make this diagnosis.
• The Keymath Diagnostic Arithmetic Test measures several areas of mathematics
including knowledge of mathematical content, function, and computation. It is used to
assess children in grades 1 to 6.
• Woodcock–Johnson Achievement Battery-III
• Test of Early Mathematical Abilities
• Teacher Academic Attainment Scale (TAAS)

62. • Math anxiety may be assessed using child self-reported math anxiety
scales
• (e.g., Math Anxiety Questionnaire [11 items];
• Abbreviated Mathematics Anxiety Scale for Children [9 items]);
• Health numeracy in adults may be assessed using
• Subjective Numeracy Scale
• Test of Functional Health Literacy in Adults (s-TOFHLA)
• Rapid Estimate of Adult/Adolescent Literacy in Medicine [REALM])

63. Treatment
• Psychoeducation about the disorder and its longer-term implication is an
essential first step.
• Mathematics difficulties are best remediated with early interventions that lead
to improved skills in basic computation.
• The presence of specific learning disorder in reading along with mathematics
difficulties can impede progress; however, children are quite responsive to
remediation in early grade school.

64. Effective educational techniques for children with mathematics disorder are
those which incorporate
• reinforcement of acquired arithmetic skills,
• a concrete-to-abstract teaching sequence,
• think-aloud procedures (i.e., verbalization while problem solving),
• creative strategies and mnemonics for sequential problem-solving,
• Frequent monitoring of the student's progress, and teaching skills

65. • Project MATH, a multimedia self-instructional training program
• Several promising computer-based software programs (e.g., Number Worlds; Number Race)
have been developed.
• Problem-solving skills in the social arena also helps in mathematics.
• Behavioral strategies (e.g., relaxation training, systematic desensitization, visualization of
successful math performance) have been found to be effective for math anxiety.

67. SPECIFIC LEARNING DISORDER
WITH IMPAIRMENT IN WRITTEN
EXPRESSION

68. • Is a condition diagnosed in childhood characterized by poor writing skills that are
significantly below for the child's age, intelligence, and education, and
• cause problems with the child's academic success or other important areas of life.
• Components of writing disorder include poor spelling, errors in grammar and
punctuation, and poor handwriting.
• Also called dysgraphia, spelling disorder and spelling dyslexia.

69. • Spelling errors are among the most common difficulties for a child with a writing
disorder.
• Spelling mistakes are most often phonetic errors; that is, an erroneous spelling that
sounds like the correct spelling.
• Examples are: fone for phone, or beleeve for believe.
• In contrast with DSM 5, the ICD 10 has a separate category called specific spelling
disorder.

70. Etiology
• Neuropsychological Factors
• Genetic Factors
• Perinatal Factors

71. Neuropsychological Factors
• Writing skills include both transcription and composition (text generation).
• Transcription
• writers transform the words they want to use into written (orthographic) symbols;
• it involves spelling and handwriting skills.
• It is based on phonological short-term memory
• Composition (text generation) –
• the act of constructing written text.
• Ideas are generated in memory and then transcribed onto the written page.
• It is based on verbal working memory.
• Difficulties in any one area (e.g., transcription, listening or reading comprehension,
working memory) can delay skill development and efficient functioning in another.

72. Genetic Factors
• Family studies - youth with impaired written expression have first-degree relatives with
similar difficulties.
• Twin studies - the heritability of spelling deficits to be higher than the heritability of
reading deficits.
• Molecular genetic studies –
• spelling disability - chromosome 15
• orthographic skills - chromosome 6.
• Four candidate genes (DYX1C1 on 15q, KIAA0319 and DCDC2 on 6p, and ROBO1 on
3q).

73. Perinatal Factors
• Extreme prematurity (i.e., <28 weeks' gestation or birth weight of <1,000
g) - poor spelling, as well as with poor reading and mathematics.
• recent large-scale randomized trial - relationship between breastfeeding
and children's cognitive development and academic attainment at age 6
years, particularly in reading and writing.

74. Clinical Features
• Avoidance of written work
• Only a few words or sentences in the same time when other students produce several
paragraphs
• Excessive problems in generating a text (output failure)
• Excessive technical errors of punctuation, grammar, word usage, sentence structure, and
paragraph structure
• fail to capitalize the first letter of the first word in a sentence
• Frequent omission of words in sentences or incomplete sentences

75. • Poor organization of written work (e.g., poor paragraph organization; poor cohesion within
sentences)
• Disordered and illegible handwriting (e.g. admixture of printing and cursive writing; inappropriate
admixture of upper- and lower-case letters, inverted letters)
• essential written activities such as notes taking is difficult – as it involves simultaneous listening,
comprehending, retaining information, process new information, and summarizing the important
points rapidly into a legible and useful format for subsequent review.

79. Common spelling problems
• Confusion of similar letters or sounds (e.g., “jumpt” for “jumped”; “caterpault” for
“catapult”)
• Inability to select correct spelling from two plausible alternatives (e.g.,
successful/succesfull; necessary/necessery)
• Frequent use of nonpermissible letter strings (e.g., “egszakt” for “exact”; “freeeqwnt”
for “frequent”)
• Same word spelled in different ways within one piece of written work

81. Standardized Tests for Assessing Written Expression
• Wechsler Individual Achievement test (WIAT-II)
• Test of Written Language (TOWL; 3rd edition)
• Test of Early Written Language (TEWL; 2nd
edition)
• Test of Written Spelling (TOWS; 4th edition)
• Test of Written Expression (TOWE)

82. Treatment
• A preventative approach of providing instruction in handwriting, spelling, and composition in
primary grades, for children already at risk of reading delay is effective in improving these
children's subsequent spelling and reading abilities.
• Explicit instruction in handwriting - directing attention to critical features of letters and on-task
demands
• Other variables include sequence in which letters are introduced, paper position, and pencil grip

83. • Spelling can be improved by systematic spelling instruction that focuses on letter patterns
(orthography) and opportunities to practice writing.
• Writing involves teaching of three critical steps: Planning, writing the first draft, and revision of
the draft.
• The inclusion of mnemonics (e.g., P.O.W.E.R: Plan, Organize, Write, Edit, Revise; C-SOOP:
Capitalization, Sentence structure, Organization, Overall format, Punctuation) provides an
effective reminder to the sequence of processes and steps being taught.

84. COMORBIDITY
• Reading and mathematics disorder frequently occur comorbidly with language disorder. Children with
language disorder have
• poor word knowledge,
• limited abilities to form accurate sentence structure, and
• impairments in the ability to put words together to produce clear explanations and
• difficulties with grammar and syntactical knowledge.
• There are also high rates of comorbidity between reading impairment and mathematics impairment -
up to 60 percent.
• communication disorders (primarily with mixed receptive-expressive language disorder), as well as with
developmental coordination disorder.

85. • 25 % of children with SLD may have comorbid ADHD. Same genetic factors contribute to
both reading impairment and attentional syndromes. The major link appears to be
between the inattention dimension of ADHD and RD.
• high rates of depressive moods and feelings of lack of control and poor self-esteem
• Oppositional Defiant Disorder, Conduct Disorders especially in adolescents.
• Genetic deficits (e.g., velocardiofacial syndrome, fragile X syndrome, Down syndrome,
Williams' syndrome, Gerstmann's syndrome),

86. Differential Diagnosis
• A diagnosis of SLD is not usually made before the child is about 6 or 7 years old because evidence
of failure to learn to read is required.
 Intellectual disability syndromes in which most skills, are below the achievement expected for a
child's chronological age. Intellectual testing helps to differentiate.
 Inadequate schooling - can be detected by comparing a given child's achievement with classmates
on reading performance on standardized reading tests.
 Hearing and visual impairments should be ruled out with screening tests.
 Impaired motor coordination, arising from developmental coordination disorder or neurological
damage, may produce illegible handwriting, but in the absence of additional impairments in
spelling and expression of thought in writing, a disorder of written expression is ruled out.

87. • often find it difficult to keep up with their peers in certain academic subjects, whereas they may
excel in others.
• often leading to demoralization, low self-esteem, chronic frustration, and compromised peer
relationships.
• increased risk of comorbid disorders, including attention-deficit/hyperactivity disorder (ADHD),
communication disorders, conduct disorders, and depressive disorders.
• are at least 1.5 times more likely to drop out of school, approximating rates of 40 percent.
• Adults with are at increased risk for difficulties in employment and social adjustment.
COMPLICATIONS

88. • NGO found in 1992
• remedial help and support to children
• spreading awareness
• Hosts learning centres in school in tamil nadu
• Conduct training for teachers

90. Summary
• DSM-5 combines the DSM-IV diagnoses of reading disorder, mathematics disorder, and disorder
of written expression and learning disorder NOS into a single diagnosis: Specific learning disorder.
• Dyslexia is characterized by difficulties with inaccurate word recognition and poor spelling and
decoding abilities resulting from a deficit in the phonological component of language.
• Mathematics disorder refer to impairment in the development of arithmetic skills, including
computational procedures used to solve arithmetic problems and the retrieval of basic arithmetic
facts from long-term memory.
• Disorder of written expression Is characterized by poor writing skills like poor spelling, errors in
grammar and punctuation, and poor handwriting
• SLD could cause complications if not remedied earlier.

91. Conclusion
• Intense and focused instruction may in fact alter the brain activation profiles observed
in children with SLD.
• Thus, clinicians need to be aware that recommendations for placement in special
education may not alone be sufficient to improve reading or arithmetic skills.
• Rather, they need to advocate for intense and focused instruction in each of the
affected academic domains.
• Also, given the importance of literacy and numeracy skills in health, clinicians are
advised to screen for health literacy and numeracy in all children.

93. References
• Kaplan and Sadocks Comprehensive textbook of Psychiatry – 10th
edition
• Kaplan and Sadocks Synopsis of Psychiatry – 11th
edition
• Postgraduate Textbook of Psychiatry – Ahuja 3rd
edition
• Rutter’s child and adolescent psyhiatry – 6th
edition

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