Learning Disabilities and Testing/Assessment for it

How to assess learning disabilities in school children for therapists and special educators.

1. Learning disability

2. Introduction Learning disabilities are problems that affect the brain's ability to receive, process, analyze, or store information These problems can make it difficult for a student to learn as quickly as someone who isn't affected by learning disabilities

3. INTRODUCTION Learning disability (LD) refers to a group of disorders that affect a broad range of academic and functional skills including the ability to speak, listen, read, write, spell, reason and organize information

4. Definition The definition of Learning Disability as per the Diagnostic and Statistical Manual – IV (DSM-IV) (American Psychiatric Association, 1994): Learning Disorders are diagnosed when the individual’s achievement on individually administered, standardized tests in reading, mathematics or written expression is substantially below that expected for age, schooling and level of intelligence. The learning problems significantly interfere with academic achievement or activities of daily living

5. The ICD-10 1999 Definition of LD Learning disorders (LD) refer to a significant deficit in learning due to a person’s inability to interpret what is seen and heard, or to link information from different parts of the brain (GEON, 2005).

6. Causes Heredity Learning disabilities often run in the family. Children with learning disabilities are likely to have parents or other relatives with similar difficulties.

7. Causes Problem during pregnancy and birth Learning disabilities can result from anomalies in the developing brain, illness or injury, fetal exposure to alcohol or drugs, low birth weight, oxygen deprivation, or by premature or prolonged labor

8. Causes Accidents after birth Learning disabilities can also be caused by head injuries, malnutrition, or by toxic exposure (such as heavy metals or pesticides).

9. Incidence 6 % to 8 % of school age population

10. Types of LD Learning disorders are of four types Disorders of Reading, Disorders of Mathematics, Disorders of written expression and Learning disorder not otherwise specified

11. Classification of learning disabilities Common types of LD Dyslexia : Difficulty in writing, reading and spelling Dyscalculia: Mathematic and computation problems Dysgraphia: difficulty with writing , spelling and composition Dyspraxia: problems with manual dexterity and coordination (Various terms are used to describe specific learning disabilities. A person may exhibit one or more of them)

12. Dysphasia/Aphasia Speech and language disorders Difficulty producing speech sounds (articulation disorder) Difficulty putting ideas into spoken form (expressive disorder) Difficulty perceiving or understanding what other people say (receptive disorder).

13. Dyslexia The general term for reading disability which involves difficulty in phonetic mapping, where sufferers have difficulty with matching various orthographic representations to specific sounds. Some claim that dyslexia involves a difficulty with sequential ordering such that a person can see a combination of letters but not perceive them in the correct order

14. Dysgraphia The general term for a disability in physical writing, usually linked to problems with visual-motor integration or fine motor skills.

15. Dyscalculia The general term for disability in mathematics

16. Early identification and assessment procedures LD is not curable Using compensatory mechanisms to alter functional gaps which are to be initiated early to ensure that the disability is not aggravated further The child must be able to develop and learn to the best of his/her potential

17. Early identification Early intervention presupposes early identification At present, there is no universally standardized screening procedure to guide referrals from schools

18. The Schwab Foundation for Learning has a grade specific checklist to help identify “at risk for LD” children. This list is comprehensive and usually followed by organizations working in the field of LD (Schwab Learning, 2002). The checklist for LD in the Sarva Shiksha Abhiyan Manual (SSA, 2003 ) is also a helpful tool for initial screening by teachers in the schools

19. Assessment The child must be assessed in all areas related to the suspected disability such as health, vision hearing, social and emotional status, general intelligence, academic performance, communicative status, and motor abilities Ideal assessment for LD is a long process requiring several sessions with a qualified educational psychologist

20. The assessment procedure for LD involves the following steps: Parental Consent and Parent Interview Parents’ consent must be obtained before evaluating the child. The academic, developmental and medical history along with the linguistic usage and communications patterns of the child must be obtained from the parents The parent must be involved in the planning of the intervention program such as attending a resource room, provision of accommodation and modifications to the child

21. Gathering Information from the Teachers/School Child’s performance and behavior in the class, and gain insights from the teacher. Review of previous grades will show the pattern of academic progress

22. Looking at Student Workbooks The examination papers may give a clearer picture of the specific nature of difficulty

23. Only through collecting data through a variety of approaches (observations, interviews, tests, curriculum-based assessment, etc.) and from various sources such as parents, teachers, peers, adequate picture be obtained of the child’s strengths and weaknesses

24. Interview with the Child “An Interview should be a conversation with a purpose” with questions designed to collect information that “relates to the observed or suspected disability of the child”. A careful review of the student’s school records or work samples help the assessment team identify patterns or areas of specific concern which may be focused on at the time of interview.

25. Testing There are two types of tests. Criterion-referenced tests Norm-referenced tests:

26. Criterion-referenced tests Criterion-referenced tests are scored according to a standard, or criterion decided by the teacher, the school, or the test publisher. An example of a criterion referenced test might be a teacher-made spelling test where there are 20 words to be spelled and where the teacher has defined an “acceptable level of mastery” as 16 correct (or 80%).

27. Norm-referenced tests Norm-referenced tests: Scores on these tests are not interpreted according to an absolute standard or criterion (i.e., 8 out of 10 correct, etc.) but, on how the student’s performance compares with that of the norm group (a large number of representatives of that age group). This helps evaluators determine whether the child is performing at a typical level, below, or above that expected of a given ethnicity, socio-economic status, age, or grade

28. drawback The drawback of this type of test is that the norms in different regions of a country will vary and too the norms of the same region will change over a period of time. Hence in a diverse country like India, each area would have to develop its own norms which would need to be reviewed periodically

29. Essentially, the tests for LD have two major components: Testing for Potential: Performance Discrepancy. Testing Processing Abilities A two-year discrepancy between potential and performance is an indicator of a possible LD. Validity of a significant discrepancy will be evaluated on a case by case basis

30. The recommended Psycho-educational tests are discussed below under various heads Intellectual Assessment : Weschler Adult Intelligence Scale Third Edition (WAISIII), Woodcock Johnson Tests of Cognitive Ability .

31. Cognitive Processing Abilities : Woodcock Johnson Psycho-Educational Battery- Revised (Part 1 - Tests of Cognitive Ability), Weschler Memory Scales- Revised, Benton Visual Retention Test, Nimhans Index

32. Assessments in India The National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore has developed the index to assess children with LD There are two levels of this index. They are: Level I for children 5-7 years and Level II for 8-12years.

33. The index comprises of the following tests Attention test (Number cancellation). Visuo-motor skills (the Bender Gestalt test and the developmental test of Visuo – Motor integration). Auditory and Visual Processing (discrimination and memory). Reading, writing, spelling and comprehension. Speech and Language including Auditory behaviour (Receptive Language) and Verbal expression. Arithmetic (Addition, subtraction, multiplication, division and fraction)

34. Prevention and intervention Possible Preventive Measures in Schools Prevention of the effects of LD involves early identification and intervention for language development Language development and Phonetics are important areas to focus on

35. In India, mainly the lecture and blackboard method of teaching is used. This poses difficulties for children with auditory or/and visual processing problems. For them, activities involving self, drama, music, pictorials and use of audio-visual aids are essential, for example, learning alphabets through sandpaper cutouts, tracing, movement, sounds, etc .

36. Similarly, activities that demonstrate concepts, such as, rotation and revolution in geography either through craft activities or role play will ensure understanding of the concept

37. Present accommodations and modifications, commonly called concessions , being offered by some secondary boards in India are provision of a writer, reader, extra time, exemption from second and/or third languages, etc

38. Family therapy To cope up with stress and guilt Enhance international pattern Safely express concerns Provide mutual support Help to obtain support from community organizations Individualized educational plan Following parental consent for referral and planning Encourage to attend support group