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ORIGINAL ARTICLE |
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| Ahead of print
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| Prevalence of specific learning disorders in school children in a South Indian city |
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Shailaja Bandla1, NR Nappinnai2, Srinivasagopalan Gopalasamy3, Vijay Chandra Reddy Avula4
1 Professor of Psychiatry, Department of Psychiatry, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India
2 Department of Psychiatry, Clinical Psychologist, Meenakshi Medical College and Research Institute, Kancheepuram, Tamil Nadu, India
3 Professor and HOD, Meenakshi Medical College and Research Institute, kancheepuram, India
4 Professor and HOD, Department of Psychiatry, AIIMS, Mangalagiri, Andhra Pradesh, India
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| Date of Submission | 26-Oct-2022 |
| Date of Acceptance | 26-Nov-2022 |
| Date of Web Publication | 28-Feb-2023 |
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Background: Specific learning disorders (SLDs) are an important cause of academic problems in school children mandating assessment and remediation.
Aim: To document the psychosocial profile and prevalence of SLDs in school children.
Materials and Methods: A total of 981 children studying in 3rd to 5th standard were screened for the presence of SLDs in a stepwise approach after taking permission from school authorities and consent from parents. Raven's Progressive Matrices, Malins Intelligence Scale, and NIMHANS SLD Index were used for assessment. Statistical analysis was performed using Epi info software.
Results: The prevalence of SLDs was found to be 6.1% (n = 60). Dyslexia was the most common SLD (n = 38; 63%) followed by combined type (n = 28; 46%). A significant association was found between consanguinity (P = 0.02) and delayed milestones (P = 0.02).
Conclusion: There is a need for creating the awareness among parents and teachers regarding SLDs and to screen children for the early identification and remediation.
Keywords: Dyscalculia, dysgraphia, dyslexia, NIMHANS specific learning disorder index, school children, specific learning disorders
How to cite this URL:
Bandla S, Nappinnai N R, Gopalasamy S, Reddy Avula VC. Prevalence of specific learning disorders in school children in a South Indian city. Arch Ment Health [Epub ahead of print] [cited 2023 Mar 24]. Available from: https://www.amhonline.org/preprintarticle.asp?id=370760 |
| Introduction | |  |
“If I can't learn the way you teach, why don't you teach the way I learn.”
This simple quote describes the condition of a child with a learning disorder.
Richardson quoted that for over 100 years it has been recognized that seemingly normal children can have impairment in learning to read and write (1992). In 1917, Hinshelwood described a 10-year-old boy who was bright and intelligent but had great difficulty reading. However, it was not until 1962 that Kirk first used the term learning disabilities.[1]
Specific learning disorder (SLD) is a generic term that refers to a heterogeneous group of neurobehavioral disorders manifested by significant unexpected, specific and persistent difficulties in the acquisition and use of efficient reading (dyslexia), writing (dysgraphia) or mathematical (dyscalculia) abilities despite conventional instruction, intact senses, normal intelligence, proper motivation, and adequate sociocultural opportunity.[2] However, as per the Diagnostic and Statistical Manual of Mental disorders-5[3] and International Classification of Diseases-10,[4] the term SLD does not include children who have learning problems which are primarily the result of a visual, hearing, or motor handicap, of subnormal intelligence, of emotional disturbance, or socio-cultural disadvantage.
The prevalence of SLDs in India varies from 6% to 16.9% across various studies.[5],[6],[7]
Dyslexia (or specific reading disorder) is the most common SLDs. The prevalence of dyslexia, dysgraphia, and dyscalculia was found to be 11.2%, 12.5%, and 10.5% and that of combined learning disorder was 7.5% in school children in studies done in South India.[5],[6]
Awareness about SLDs is increasing as it is an important cause of academic underachievement. Since the early 1990s, the National Educational Boards which conduct the Indian Certificate of Secondary Education and the Central Board of Secondary Education examinations; and the State Governments of some states have formally granted children with SLDs the benefit of availing the necessary provisions from Standard I to XII. The school authorities must provide these provisions to a child with SLDs. However, these provisions are not yet available to many children with SLDs in our country; especially to those who are studying in vernacular medium schools, for the nonavailability of standardized psychological and educational tests.[8]
Recently, the government has amended the disability assessment guidelines and under the changed norms anyone who is assessed positive by the NIMHANS SLD battery would be considered to have a “SLDs” of more than 40%.[9] The Rights of Persons with Disabilities Act 2016 recommend the NIMHANS index for the diagnosis of SLD.
However, the lack of awareness among parents and school teachers continues to pose a significant issue. Multiple curriculums at schools, varying standards and multilingualism preclude a unifying standardized approach. Given the above, a study is designed to estimate the prevalence of SLDs among school children and assess the level of understanding regarding SLD among teachers and address the needs of children with SLDs.
| Materials and Methods | | |
Materials
1. A semi-structured pro forma for the collection of sociodemographic data, birth, and developmental history.
2. Check List to Identify Learning Disabilities.[10]
A checklist consisting of significant features for identifying learning disorders (Department of Psychiatry, B. Y. L. Nair Hospital and T. N. Medical College) was given to the class teacher to identify children with academic problems. The checklist has been divided into four headings namely, general, reading, writing, and mathematics, respectively.
3. Intelligence tests
(a) Ravens progressive matrices.[11]
Standard progressive matrices
These were the original form of the matrices, first published in 1938. The booklet comprises five sets (A to E) of 12 items each (e.g., A1 through A12), with items within a set becoming increasingly difficult, requiring the ever greater cognitive capacity to encode and analyze information. All items are presented in black ink on a white background. Children between 11 and 12 years were administered SPM in the study.
Colored progressive matrices (CPM) designed for younger children (up to 11 years), the elderly, and people with moderate or severe learning difficulties, this test contains sets A and B from the standard matrices, with a further set of 12 items inserted between the two, as set Ab. Most items are presented on a colored background to make the test visually stimulating for participants. However, the very last few items in set B are presented in black and white.
b) Malin's Intelligence Scale for Indian Children (MISIC)[12] is the Indian adaptation of the Wechsler Intelligence Scale for Children. It has 11 subsets, classified into verbal and performance subsets. The test-reset reliability is 0.91; concurrent as well as congruent validity has also been established. This tool has been widely used in the Indian context for assessing intellectual abilities in children. It was used to identify children with intellectual disabilities and borderline intelligence.
4. NIMHANS Index for SLD[13] was developed in the Department of Clinical Psychology, NIMHANS, Bangalore. It consists of tests of reading, writing, spelling, and arithmetic abilities, to identify children with disabilities in these areas. It consists of two levels. A performance of two standards below the child's present standard is considered a diagnostic feature of SLD.
Inclusion criteria
Children studying in the 3rd to 5th standard.
Exclusion criteria
Children with visual, hearing, or locomotor impairments that interfere with the assessment, intelligence quotient (IQ) <90 and students from whose parents valid consent could not be obtained.
Methodology
This is a cross-sectional study. After taking clearance from the Institutional Ethics Committee, two private schools in the catchment area of a private medical college and hospital were approached.
After taking permission from school authorities, students in classes 3–5 were screened for the presence of SLDs in a stepwise manner as below.
Step 1: An awareness program for teachers regarding SLDs was conducted by a psychiatrist and clinical psychologist. This includes information about the screening tool.
Step 2: Students with problems in the scholastic performance were identified by the teachers using the screening tool.
Step 3: Assent was obtained from students. Written informed consent and the details of sociodemographic data, birth, and developmental history were obtained from parents.
Step 4: Then students were screened for problems with vision and hearing.
Step 5: Students who are through step 4 were subjected to IQ screening by SPM/CPM by a psychiatrist or clinical psychologist.
Step 6: Children who scored above the 25 percentile on SPM/CPM were subjected to full-scale IQ by MISIC and assessed for SLDs by NIMHANS SLD Index.
In the cases wherein there was a doubt whether the language problem in the child was due to the English language used in NIMHANS Index, the child was reassessed with a Tamil textbook from the same school, and if the child was not able to read or write up to two standards below his/her standard, then the child was considered as having SLD.
Those children who were found to have SLDs were referred for further evaluation and remediation training to the psychiatry department.
Statistical methods
The data collected were subjected to the statistical analysis using means and standard deviation for continuous variables, frequencies and percentages for discrete data. For the comparison of frequencies, the Chi-square test was used. Statistics were done using Epi Info software Epi: A Package for Statistical Analysis in Epidemiology. R package version 2.47, https://CRAN.R-roject.org/package=Epi.
| Results | | |
The overall prevalence of SLDs was found to be 6.1%, i.e., 60 children were found to be having SLD among 981 students screened [Table 1].
[Table 2] shows the sociodemographic, birth and developmental details of the children. Male children were found to be more with male-to-female ratio of 1.4:1. About 42 (70%) belonged to low socioeconomic status, most of them were right-handed 57 (95%), consanguinity was seen in 13 (21.7%), and low birth weight (<2.5 kg) in 17 (28%). The age of the children ranged from 83 to 136 months with a mean age of 101 months. Consanguinity (P = 0.02), cesarean section (P = 0.003), and delayed milestones (P = 0.02) are found to be related to SLD children. | Table 2: Sociodemographic, birth and developmental details of the children
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[Table 3] shows the various presentations of learning disorders, reading problems found in 38 (63.3%), writing problems in 17 (28.3%), problems in comprehension in 38 (63.3%), arithmetic problems in 14 (23.3%), and problems in spelling in 29 (48.3%). Dyslexia (reading disability) is found to be the most common type of SLD 38 (63.3%) followed by combined learning disorder 28 (46.7%), as evident by [Table 4] and [Figure 1]. | Table 3: Breakup of learning disabilities (NIMHANS Specific Learning Disorders Index)
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 | Figure 1: Bar chart showing the presentation of SLDs. SLDs: Specific learning disorders
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The individual prevalence of dyslexia was 3.8%, dysgraphia 1.7%, dyscalculia 1.4%, and combined learning disability 2.8%, respectively.
Children with SLD committed significant errors on the Bender Gestalt test (P = 0.001) as well as on the number cancellation test (P = 0.001).
The mean IQ scores of children on the Malins Intelligence Scale were information (92.27), comprehension (96.9), arithmetic (95.31), similarities (107.15), vocabulary (76.36), digit span (93.06), verbal quotient (93.6), picture completion (86.20), block design (99.21), object assembly (83), coding (111.2), mazes (116.3), picture completion (99.11), and IQ (96.73).
Only about 70% of the teachers were aware of SLDs. Most of them acknowledged that they didn't hear about any such thing until the awareness program was conducted.
| Discussion | | |
The prevalence of SLDs is found to be 6.1%. SLD has a variable prevalence (5%–15%).[3] It is low when compared to other studies[6],[7] where a higher prevalence is reported. The reason could be that a rigorous screening for IQ was done in our study so that other causes of secondary SLDs are ruled out. Another reason could be due to the difference in various instruments used for screening and differences in the populations studied.
Male children were found to be more with male-to-female ratio of 1.4:1. This result is on par with other studies where SLDs were found to be more in male children.[5] This difference in gender ratio could be because boys have more problems with reading than that is girls due to inherent differences in cognitive correlates that emerge before schooling.[14]
Children in the 3rd and 4th standards with SLD (n = 45) were more in numbers than those of the 5th standard (n = 15). This finding was seen in other studies.[15]
The majority of children with SLD belonged to low socioeconomic status (70%) in this study. This was similar to another study which found that SLD was more common in low socioeconomic groups than middle- and high-income groups.[16] Poor nutritional status and lack of adequate instruction could be the reasons for SLD in the low socioeconomic group. Children belonging to upper and middle socioeconomic status have better access to the early identification and also remedial education when compared to their counterparts of low socioeconomic status.
Consanguinity (P = 0.02), cesarean section (P = 0.003), and delayed milestones (P = 0.02) were found to be related to SLD children. This was similar to other studies which found SLDs to be significantly associated with the same,[5] the reason could be because SLDs are developmental disorders with a genetic component.
Furthermore, the study shows that most teachers are not aware of SLDs (about 70%) until the awareness program. It was similar to other studies where awareness among teachers was found to be low.[17] This point highlights the need to increase the awareness among school teachers so that they can identify the children early and help them with remedial training. Furthermore, teachers are not aware of the provisions provided by the state government for SLD children.
| Conclusion | | |
The prevalence of SLDs is found to be 6.1% with reading disorder being the most common SLD. A significant association was found between consanguinity (P = 0.02) and delayed milestones (P = 0.02). There is a need for creating the awareness among parents and teachers regarding SLDs and to screen children for the early identification and remediation.
Limitations
Only children studying in private English medium schools were taken into the study. Comorbidities were not assessed as it was difficult to directly contact the parents, which could have had affected the assessment.
Acknowledgment
We thank the teachers, students, and parents who have participated in the study.
Financial support and sponsorship
This study was funded by Meenakshi Academy of Higher Education and Research.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 4. | World Health Organization. The International Classification of Diseases: Classification of Mental and Behavioral Disorders. Vol. 10. Geneva: World Health Organization; 1993. |
| 5. | Bandla S, Mandadi GD, Bhogaraju A. Specific learning disabilities and psychiatric comorbidities in school children in South India. Indian J Psychol Med 2017;39:76-82. [ PUBMED] [Full text] |
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| 12. | Malins AJ. Manual for Malin's Intelligence Scale for Indian Children (MISIC). Lucknow: Indian Psychological Corporation; 1969. |
| 13. | Hirisave U, Oommen A, Kapur M. Psychological Assessment of Children in the Clinical Setting. NIMHANS Index of Specific Learning Disabilities. Bangalore: Samudra Offset Printers; 2006. |
| 14. | Arnett AB, Pennington BF, Peterson RL, Willcutt EG, DeFries JC, Olson RK. Explaining the sex difference in dyslexia. J Child Psychol Psychiatry 2017;58:719-27. |
| 15. | Siddiqui S, Tripathi N. Identification and assessment of children with dyslexia in Allahabad city. Univers J Psychol 2014;2:205-11. |
| 16. | Stanton-Chapman TL, Chapman DA, Scott KG. Identification of early risk factors for learning disabilities. J Early Interv 2001;24:193-206. |
| 17. | Shukla P, Agrawal G. Awareness of learning disabilities among teachers of primary schools. Online J Multidiscip Res 2015;1:33-8. |
Correspondence Address:
Shailaja Bandla,
14-195, Mahadevapuram Colony, Vijayawada, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/amh.amh_168_22
[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4] |
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