It may be caused by a combination of difficulties in phonological processing, working memory, rapid naming, sequencing and the automaticity of basic skills.

Alongside these issues is the ongoing challenge for people with dyslexia navigating through life in a largely non-dyslexia friendly world.

Researchers acknowledge that there are many possible causes of dyslexia, including genetics.

There is no relationship between a person’s level of intelligence, individual effort of socio-economic position and the presence of dyslexia.

Furthermore, across Europe the diversity of languages and the multilingual demands, socio-cultural backgrounds as well as educational opportunity, have a significant influence on the life-chances for dyslexic children and adults.

What is the difference between dyslexia and learning disability?

Dyslexia, Learning Disability, Learning Difficulty, Minimal Brain Dysfunction, Specific Learning Difficulty, Learning Disorder are all the synonyms used to describe same condition. In the entire write up of Dyslexia L.D. is used as a short form of Learning Disability.

What is dyslexia?
L.D. is a term used to describe individuals who:

• can hear
• can see
• have general intelligence in average to above average range.
• shows marked difference in his ability to perform and his potentials (Potentials being higher).
• have difficulty in learning language in one or more areas such as – Reading, Writing, Mathematics,Reasoning,Spelling. (P.N:His educational abilities do not stem from inadequate educational experiences or cultural factors).

Generally speaking the above conditions overlap, and one rarely finds a classically pure case. Following symptoms Listed briefly) are manifested in a L.D. child, due to inability to acquire and use information efficiently enough. This is caused by impairment in perception, conceptualization, language, memory, attention or motor control.

Age range
6 years to adults (One cannot label a child younger than 6yrs. as L.D.).

What is a learning problem?
Many people have problems of one kind or the other. The important thing, though, is not what a problem does to you, but what you can do about that problem. One thing you can do is find out what a learning problem is, and what it is not.

What are the different types of L.D.?

L.D. is broadly manifested ‘academically’ as:

• Dyslexia: Difficulty in reading
• Dysgraphia: Difficulty in writing
• Dyscalculia: Difficulty in mathematics and reasoning.

Generally speaking the above conditions overlap, and one rarely finds a classically pure case. Following symptoms (listed briefly) are manifested in a L.D. child, due to inability to acquire and use information efficiently enough. This is caused by impairment in perception, conceptualization, language, memory, attention or motor control.

What causes learning problems?

• Organic: Soft Neurological damage.
• Biologic: Intra-uterine causes like stress, toxemia, radition, fall etc.
• Genetic: Passes on in a particular family from generation to generation.
• Environmental: Lack of stimulation

Visual Perceptual Deficits:

• Reversals: b for d.
• Turns head or paper at odd angles.
• Rereads line or skips lines.

Visual Motor Deficits

• Letters collide with each other / no space between words.
• Messy writing
• Holds pencil too tightly; often breaks pencil / crayons

Auditory Perceptual Deficits

• Auditory discrimination: does not hear differences in sounds; does not hear final consonants accurately.
• Can’t tell the direction sound is coming from.
• Does not follow direction.

Spatial Relationships And Body Awareness Deficits

• Gets lost even in familiar surroundings such as school, neighborhood.
• Directionality problems, does not always read or write left or right.
• Bumps into things; clumsy, accident prone.

Conceptual Deficits

• Classification activities are difficult.
• Laterality Problem – Handedness not established.
• Does not understand time relationships – yesterday, today, tomorrow, after etc.
• Can’t think in orderly or logical ways.

Memory Deficits

• Can’t remember what was just seen.
• Can’t remember spellings for common / frequently encountered words.
• Makes same errors again and again; does not seem to benefit from experience.

Motor Output Deficits

• Perseveration – gives same response again and again.
• Distortion in gross motor functions – can’t skip, hop, hit ball etc.
• Difficulty cutting, pasting, coloring, Writing etc.

Behavioral Components
A. Attention Deficit Disorder

• Can’t sit still.
• Impulsive; can’t consider consequences before acting.
• Disorganized; loses books, papers, lunch box, coat.

B. Failure Syndrome

• Tends to avoid group activity.
• Immature behavior; dependent.
• Class clown – acting out

Serious Emotional Overlayy

• Fearful, anxious, insecure, tense.
• Explosive, Unpredictable, Dangerous behavior.
• Withdraws; alone; Little communication.

Academic Manifestations
A. Problems in Mathematics

• Difficulty with recognition & discrimination of mathematical symbols.
• Money, measurement, time are difficult.
• Construction of figures is difficult.

B. Problems in Language

• Difficulty in acquiring second language.
• Poor articulation.
• Poor hand writing / letter formation / grip.
• Mixes / omits syllables / writes laterally inverted letters and words (letter reversals).
• Difficulty in reading, writing, spellings.
• Disregards punctuation.
• Problems in comprehension.

What are the associated problems with L.D.?
Since any of the above four disorders can be primarily there, giving rise to any other secondarily, very often we witness that LD children have:

• Associated Behaviour problems such as ADD/ADHD oppositional behavior, stubbornness, irritability, social maladjustment due to disturbed inter personal and intra personal intelligence Etc.
• Associated Mild emotional problems such as impulsiveness, moody, abusing & cursing, anxious, apprehensive, doubtful, phobic etc.
• Those who have problems in Learning may exhibit difficulty in spoken language, having articulatory disorder or stammering or problem with intonation pattern etc.
• Very often Hyper tactile sensitivity and Hyper auditory sensitivity are associated with LD – This condition can be treated well with sensory integration therapy.

How is theory of ‘Multiple Intelligence’ related to Learning Difficulty?

With +24 years of observation, out of the above mentioned intelligences, one or more intelligences are hampered (meaning the thinking and judgment underlying each of these intelligences differ than other average human beings, e.g.: why only Newton thought that, ‘Why are these apples falling on the ground? Why can’t they fly up in the sky?) in the case of each of the L.D. child. Creating social, emotional and behavioral problem arising out of deviance in that intelligence.

What is Hyper Tactile Sensivity (i.e. Tactile Defensiveness)? How do you rationalize its association with Hyper Auditory Sensivity?

• hyper = more than, hypo = less than

The way we have resistance system in our body to fight against diseases, our brain has the capacity to filter out what we need to perceive from all the sensations at any given moment, and leave the other sensations in background. For e.g.:- while you are reading (visual sensation), this you are perhaps listening to the music (auditory sensation), you are touching the chair (Touch sensation), and the floor, you are pressing the mouse ( proprioceptive sensation) etc. but your brain is concentrating only on reading, filtering it out from others in the background.Now, when this counter inhibitory system is not built, the person feels the sensations as hyper. For e.g.: Feel pain for a particular touch instead of the touch sensation – this is ‘Hyper Tactile sensitivity’. Feel pain for the sound of the chalk on the black board instead of hearing sensation for that sound. – This is ‘Hyper Auditory; sensitivity’. The following hypothesis further explains the 2nd question. Sensory Integration therapy is the remedial measure for these problems. sensory integration for which we have ideal set up at ‘Nirmitee.’

Hyper tactile sensitivity has been observed to be associated with Hyper Auditory sensitivity:

• Constant irritability
• Impulsivity and emotional problems
• Preference for solitude
• Lack of exposure
• Lack of stimulation
• Lack of vestibular (inner ear organ, which is seat for posture, gail balance as well as hearing). Maturation. Sensory integration
• Random usage of neuronal pathway
• Inconsistent use of same neuronal pathways and centres
• Lack of automation (practice makes man perfect)
• Overall co-ordination + speech and language disorders (communication disorders – receptive and expressive
• Lack of Experience (Verbal expression – further experience & lrng)
• Thus making it a vicious cycle

What are the factors on which prognosis (i.e. success of the treatment) is dependent on?
Prognosis depends on:

• The severity of the problem
• Causative factor of Learning Disorder
• Motivation of the LD child
• Understanding and acceptance of the problem by the parents.
• Cooperation of the parents
• Early intervention
• Continuity of the integrated remedial help.

What is the incidence and prevalence of L.D.?
L.D. is a hidden handicap, as on the face value the child is absolutely normal. The condition of L.D. is generally detected in the school by the teacher. A child can be labelled L.D. only after the age of 6-7 years; till then the presence of L.D. Characteristics can be looked upon as “at risk” for L.D.

Prevalence: All socio-economic strata:

• Not related to educational background of the family.
• Has been existing ever since.
• Ratio of L.D. in boys Vs girls 3:1.
• 30 times more in adopted children.
• 60% of delinquent children are learning difficult.

Who is qualified to conduct a test to detect the presence of dyslexia?

Professionals such as clinical psychologist / educational psychologist / counselling psychologist, speech & language therapist and occupational therapist. Special Educators are trained to assess L.D. as a team. Apart from the basic medical evaluation by pediatrician/ pediatric neurologist to rule out any other condition away from L.D.

What should be assessed?

• The basic medical evaluation by paediatrician/ paediatric neurologist.
• Giving a thorough eye check up.
• Complete ear check up with Audiogram.

To rule out any other condition away from L.D., the following assessment is carried out:

I. Family and individual history
Familial, educational, developmental and medical background, concerns about speech, language, motor and attention problems are noted.

II. Cognitive ability or intellectual aptitude
Individual strengths and weaknesses to be assessed in order to understand child’s aptitude for learning in verbal, logical, mathematical, visual-motor, visual-spatial, symbolic, memory and attentional domains. Generally objective tests are used supported by subjective observation.

III. Pre-skills required to learn language
Speech & Language therapist assess following areas:

• Auditory Reception
• Auditory Memory
• Visual Reception
• Visual Memory
• Auditory Association
• Grammatic closure
• Visual Association
• Visual closure
• Verbal Expression
• Auditory closure
• Manual Expression
• Sound blending

IV. Language development achievement test
Objective Screening tests and subjective tests can be used for above evaluation.

V. Specific language skills related to reading and writing success
Investigating language processing abilities – (Through objective and subjective evaluation.)

• Speech sound and syllable awareness
• Word pronounciation
• Word retrieval
• Rapid naming
• Knowledge of word meanings
• Comprehension and production of sentence structure
• Expressive verbal ability, including organization of ideas, elaboration, and clarity of expression,
• Comprehension of what is heard and read.

VI. Handwriting
Assessment I through V are generally mandatory. Assessment could also be well supported by other objective tests as and when required, depending on the individual child’s needs.

VII. Attention and memory to be tested in an informal environment

What profession caters to the needs of a L.D. (Dyslexic) child? Or whom should be contacted for remediation?

Before we talk about the team of professionals working in the area of L.D. We must principally conclude the fact that parent’s understanding and acceptance of their child’s condition will decide the future of the child. Moreover it is also very important to have an understanding (not sympathetic) and cooperative school principal, who is progressive and democratic in thinking. This is necessary as, L.D. students are always located in normal schools, since they are normal in every way having normal to above normal intelligence. They do not belong to a special school (looking after slow learners or retarded children). The concept of separate school catering only to L.D.Students have more or less failed all over the world, as the holistic personality development is at risk. while the child is studying at the school we aim for Social, emotional, physical, physiological and mental development. For L.D. child, to be with the normal peers is the healthiest environment for his normal and speedy growth. A myth prevails that only a psychologist is involved in testing a L.D. child and that only a special educator is involved in remediation of L.D. child. Issue of evaluation and assessment has been discussed early. Professionals involved in the remedial treatment of a L.D. individual (child or an adult) comprises of a team. An inevitable, healthy and sure way of treating a L.D. case would be to seek help from a speech and language therapist, occupational therapist (optional if speech language therapist is trained in the field of sensory integration therapy), a special educator, a counsellor, a school principal and a school teacher; added with parents participation. Although this multi- disciplinary approach may appear difficult ..if the parent is motivated to let the child undergo team help for at least 2 -3 years; many to most of the problems in L.D. child’s life can be overcome or compromised.

What is the role of the Language Therapist in the treatment of Dyslexia?
Or why is there a need for a speech and language therapist in the team that treats L.D.?

As we all know language is comprehended and expressed through different modalities like reading, writing, spoken language, body language, gestural language, chemical language etc. Hence although it may not be that evident, we use all 7 senses (i.e. including kinesthetic and proprioceptive sense) while practicing language. “Language” as researched has been the most difficult of learning processes. When a child is born, he has only sucking reflex, all that he learns/ acquires later….is learned. Hearing (audition) plays major role in the acquisition of a Language. It is essential to throw light on the various hierarchical levels of Language Development.

It is a language that makes us the most superior race on earth. The father of Linguistics Dr. G H. Lewes’s words. “Just as birds have wings, man has language. The wings give the birds its peculiar ability to fly, language enables man’s intelligence and passion to acquire their peculiar characters of intellect and transfer sentiment.” That is it is language which keeps us in the intellectual company of man and enables us to share our thoughts and feelings. Thus, to acquire normalcy, if not mastery, in functional language becomes an important need for any human being.

During early developmental stages child is exploring, experiencing, and practicing. Various senses enable the child to practice and learn from experiences.

All the senses are represented at the ‘Cerebral Cortex’ level, in the brain, and so is the language; making the language highest of higher functions. i.e. in order to use language as a function all the messages have to travel to and from the cortex passing through the entire route from lower brain till cortex, which is the highest level in the brain. Now, think of the individual cell at the end organ or periphery (for e.g. in the hand). It perceives and experiences the message, (for e.g.. that of touching a rough surface) which is then carried through intricate network of nerves to the brain. This channel of neuronal network (network of nerves) can be stimulated repeatedly, using the same channel i.e. same pathway of nerves (and reaching the same centres of brain in same order), in order to practise the same experiences again and again. – The phrase, “Practice makes the man perfect” holds true when the same channel of nerves is used over and over again; Perfection is reached when the reaction becomes an automatic action. This repeated use of identical pathway of nerves, taking messages to the same sequence of various centres of the brain brings about maturity in every learned process.

Further it has been researched that either of the genetic (Hereditary), organic (minimal brain damage or minimal brain dysfunction or soft neurological signs), biological(intrauterine) or environmental reasons can cause interruption, disruption, or delay during the above mentioned process (of concrete sensory experience to abstract thinking and its application) thus resulting in L. D. The first experience of the spoken language being heard builds the inner language. The following graphical representation indicates how the inner language develops into reading and writing modalities of the Language.

VERBAL SYMBOLIC BEHAVIOR
VISUAL EXPRESSIVE LANGUAGE WRITING
VISUAL RECEPTIVE LANGUAGE READING
AUDITORY EXPRESSIVE LANGUAGE SPEAKING
AUDITORY RECEPTIVE LANGUAGE COMPREHENDING SPOKEN WORD
INNER LANGUAGE AUDITORY SYMBOL & EXPERIENCE
EXPERIENCE

If any or more than one of the pre skills mentioned earlier (in article 2) are either not developed or delayed or disrupted due to any cause mentioned above the language development from concrete auditory experience to abstract thinking or writing behavior also gets disordered, thus manifesting into Learning Difficulty or Learning Disability.

Summarising the above…
Specific developmental delays in areas of language, memory, attention, perception and fine motor coordination gives rise to disordered thinking and judgement which ultimately gives rise to learning difficulty in areas of reading, writing, spelling, maths and reasoning.

Famous people who had trouble learning

It may help to know that many famous people had learning problems. Here are a few:

Thomas Edison was taken out of school because learning seemed impossible for him. His spelling and grammar were poor. Still, he went on to invent the electric light bulb, the phonograph, the Kinetoscope (the first ‘moving picture’ machine), and other useful things.

Albert Einstein had a hard time learning languages, but he was very good at maths. He failed tests to get into college the first time he took them. He later became a great thinker and physicist and figured out the theory of relativity – about motion, speed, and gravitation.

Winston Churchill spent three times longer in the lower grades than his friends, so he learned to use the English language very well. Later he used what he knew about sentences and grammar and began to write. He had a lot of energy and became a good organizer. He was knighted by the queen and won the Nobel Prize for literature. He was one of England’s greatest prime ministers. As we all understand L.D. children need integrated approach by Special Educator, Speech and Language therapist, Occupational therapist, Counselor with cooperation of parents, class room teacher, and school principal.

As we all understand L.D. children need integrated approach by Special Educator, Speech and Language therapist, Occupational therapist, Counselor with cooperation of parents, class room teacher, and school principal.

Three areas have proved to be extremely effective and fruitful for the intervention of L.D:

• Sensory Integration approach
• Feuerstein’s Instrumental Enrichment program
• Reading Enhancement program

Not only to modify their behavior, increase sociability but also to improve their reading, and writing to large extent. All these programs/approaches undoubtedly help L.D. cases enormously, giving excellent results. Brief notes on each of these approaches follows.

Sensory Integration approach

Developed by Dr. A Jean Ayres U.S.

Intensified action brings intensified intelligence. When stability becomes a habit, maturity comes and clarity follows.

Definition
The neurological process that organizes sensation from one’s own body + the environment such that it makes it possible to use the body effectively within the environment. Sensory Intergration is information processing. The brain must select, enhance, inhibit, compare and associate the sensory information in a flexible and constantly changing pattern i.e. integrate it. (PHOTO) explains the relationship between behavior of a person and neural functioning (i.e. functioning of a nerve cell in one’s body) especially Sensory processing or integration. It describes and predicts specific relationships among neural functioning, sensory motor behavior & academic learning.

The sensory system are: Tactile, Vestibular, proprioceptive, olfactory, Visual and pull of gravity (Photo).The sensory Integration theory was developed by Dr. A. Jean Ayres. But, through exercises (Pleasurable co-ordination exercises) our experts stimulate Vestibular, tactile, proprioceptive visual channels, thus trying to develop various principles of Sensory integration.

Principles Of Sensory Integration

• Time & Rhythm
• Direction & Goal
• Spatial Orientation
• Sequencing
• Laterality
• Fine Motor Control

What are the preskills required for language learning that are developed by Sensory Integration Therapy?
Amazing results have been achieved with L.D. cases, Autistic children, Behavior problem cases and Emotionally disturbed children. Very often child does not exhibit any of the above symptoms, but has communication disorder (E.g. Stuttering). It has been learnt that if any of the preskills primarily as given below remain underdeveloped, child may end up having difficulty in language, giving rise to communication disorder, emotional problem or behavioral problem secondarily.

Preskills:

• Auditory Reception
• Auditory Discrimination
• Auditory Association
• Auditory Sequencing
• Auditory Memory
• Auditory Closure
• Visual Reception
• Visual Discrimination
• Visual Association
• Visual Sequencing
• Visual Memory
• Visual Closure
• Gross / Fine Motor Coordination

Sensory integration is applicable for L.D., behaviour problems, emotional problems & communication disorders (Secondary To L.D.).

Examples where SI can be used:

• In case of visuo-motor co-ordination difficulty/problem one can have very poor handwriting (co-ordination is needed between the hand and the eye movements).
• If there is a problem at auditory memory level, then the child maybe able to understand whatever he hears but will remain unable to reproduce the same either in spoken form or in written form.
• If handedness is not established then that person may end up with problems like stuttering or may have lot of difficulty in learning vocabulary and grammar structure of the language.

Instrumental Enrichment Program

Cognitive thinking skill programme developed by Dr. Feuerstein from Jerusalem, Israel.

Instrumental Enrichment Program proposed by Dr. R. Feuerstein (after studying hundreds of cases from Concentration Camps -& World War II) is an intervention program for cognitive modifiability. It is a brilliant, successfully implemented program in more than 59 countries globally, including U.S., Japan & Australia. By using learning to learn approach Professor Feuerstein has significantly proved that the under achievement occurs because the child has never been taught how to focus his attention on. By practicing this program the special education of Learning Difficult children (Dyslexics) as well as behavior problem cases (Stubborn, inattentive, ADHD, impulsive) has taken on new dimensions. During the course potentials of individuals are identified revealing the deficits, which then can be corrected and modified by active mediation altering the course of development.

There are 14 instruments in the entire program:

• Organization of Dots – provides practice in projecting virtual relationships. It also teaches prerequisites for learning by activating a variety of cognitive functions, including perception, organization, conservation & visual transport.
• Orientation in Space – I
• Comparison
• Analytic Perception
• Categorization
• Numerical progressions
• Family Relations
• Temporal Relations
• Illustration
• Instructions
• Orientation in Space II
• Transitive Relations
• Syllogisms
• Representational Stencil Design

Reading Enhancement Program (PREP)

Reading Enhancement Program has proved to be highly fruitful for dyslexic children. This program is based on Dr. Luria’s (Neuropsychologist’s) PASS theory of cognitive processing model in human:
P = Planning
A = Attention
S = Simultaneous
S = Successive

Planning processes will be required when the individual makes some decisions about how to solve a problem ( E.g. How to write an essay). Planning is also needed to focus our attention how to use simultaneous successive processes when required. Attention – Arousal keeps us awake & alert. It is complex in nature, as things that interest us keeps us alert but things that we find boring can put us to sleep. Simultaneous processing, as the word suggests, involves recognition as a whole ( E.g. Reading a word, idea, situation etc. as a whole & not by breaking it down). Successive processing involves recognition of a thought/ idea / situation unit by unit & not as a whole ( E.g.: learning or reading a word letter by letter i.e. de/mo/cra/cy).

Behaviour problems

Speech, Language, Communication disorders are most of the time associated with mild to moderate behaviour problems. Manifesting itself into mal-social adjustments, interpersonal and intra personal problems. Since we use language all 24 hours and express our needs, feelings and thoughts through language; language is directly related to human feeling and human behavior.

Common types of behavior problems seen associated with speech and language (including dyslexia) are:

• Oppositional Behavior
• ADD / ADHD
• Irritability
• Impulsiveness
• Antisocial behavior
• Anxious behavior
• Bluffs / Lies
• Bites nails
• Destructive
• Distractive
• Stubborn
• Temper tantrums
• Avoidance behavior
• Negativism
• Rudeness
• Enuresis
• Day Dreaming
• Swearing / abusing

Incidence

Undoubtedly the number of cases for behavior problems is increasing rapidly. Perhaps the reasons could be – lack of socializing / playing / communicating with the same age group people; individual families; excess exposure to T. V. media; intake of artificial food stuff; air and noise pollution; lack of freedom of movement etc. Moreover, it must be understood that Communication Disorders, Behavior Disorders, and Emotional Problems and Learning Difficulty exist co currently (as indicated in diagram below). Any thing can exists primarily giving rise to the other problem secondarily.

Age range
From developmental stage till adulthood. More noticed during primary and middle school education level.

Evaluation & assessment
Screening test / checklist are widely used. Subjective evaluation plays an important role. As explained under dyslexia Emotional problems coexists with Dyslexia, communication disorder and behaviour disorder. This is seen mainly because these children have lot of Visuo-spatial & Visuo-motor difficulty which gives rise to phobias of movement in space. This is one of the reason why only special education fails to help them, these children also strongly requires therapeutic intervention.

Emotional problems

Language is the highest of higher function physiologically, anatomically, mentally, socially & cognitively. Thus, if hampered can create mild to severe emotional problems. The present web site has discussed almost all speech and language disorders and their associated problems. What we have witnessed in emotional problem as associated problem range from mild depression to complete withdrawal. Anxiety, anticipation, various phobias, enurism, doubting, superstition, irritability, aggression, negativism, Day Dreams, Nightmares, Shy, Loner, are seen associated with communication disorders.

Emotional problems coexists with dyslexia, communication disorder and behaviour disorder. This is seen mainly because these children have lot of Visuo-spatial & Visuo-motor difficulty that gives rise to phobias of movement in space. This is one of the reason why only special education fails to help them, these children also strongly requires therapeutic intervention.

Counselling

As a myth very often counseling is clubbed with mental illness where as on the other hand to keep pace with changing world and change in needs very often one needs to think in different way. The proposed change is not difficult but different than how an individual would have spontaneously or automatically thought about. But thinking rationally solution to every problem can be different according to different individuals. No one is right or wrong. Counseling the people concerned simply helps to enroot the channel of thinking & judgment to bring about survival of the fittest employing easy & settle way.

Language has lots to do with social & emotional life of individual hence any problem in language / communication of mild to severe form creates disturbances in social & emotional adjustments. Thus, need for counseling is created.

Prognosis
The fight between nature & nurture is an ongoing battle for human kind. Very often the fruits of counselling are achieved in no time but at the same time it is difficult to win over the “prakruti” – inborn nature of an individual by the way of expecting individual to change their thinking. We must admit that we have achieved only about 70% success through counselling.