Intervene early

LEARNING DISABILITIES

While parents and teachers want the best for their wards, they are confused about what to do when children exhibit signs of learning disability. Chetana Keni explains the path to take in such a situation

Sara faced difficulties even in Class 1. She couldn’t read and write as much as the others and her work was always messy. The teachers referred her to a counsellor who identified that Sara had dyslexia — a learning difficulty. The parents took Sara for remedial classes for a year where there was partial improvement. At the end of the academic year, the school assured the parents that Sara could take the open schooling route in Class 10.

They asked the parents to allow the child to enjoy what she liked and not stress on academics. Today Sara is in Class 10 under the NIOS system, an under confident child who is usually listless and has no ambitions for the future. Her reading and writing levels are around the second grade and her parents are very worried.

Anik also was diagnosed in Class 1 and taken to special educators. His mother got trained in remedial teaching and helped Anik at every step. Anik is pursuing his Class 10 through the NIOS and is doing very well. He aims to go into Hotel Management. Anik still has certain learning difficulties. For example, he needs help in organisation, planning and preparation, but he is much better than before.

Sweekrut’s parents feel that he takes a long time to study and doesn’t retain as much. He also is restless and has a low sitting tolerance. But he is very smart, is good orally, although he doesn’t score well as he resists writing tasks. His parents have asked the school’s opinion for a psychological assessment. The school feels that the parents are over-reacting, and that Sweekrut is smart and is using his intelligence to refrain from tasks that need more effort. However, the teachers feel something is amiss, but they don’t know whom to consult.

Tina teaches a group of 30 children in UKG. She is clueless about how much activity is hyperactivity, how to identify if a child has a language delay etc. About 10 per cent of her class is below average in all the tasks that are assigned to them. But she doesn’t know if she has to give them time or if she has to bring it to the Management’s notice. Many of her colleagues also tell her that they are in the same boat. The Principal feels identifying children this early is not good and is against their philosophy. 

Suma is the principal of a school which boasts a state-of-the-art resource room. With 10 per cent of the school needing some special attention or the other, around 55 children are listed in the resource room register.

The three special educators are working very hard but they are not able to meet the needs of all. The Special Educator and the Principal want to accommodate all the children but they are aware that some of them have severe learning differences and a total change in environment would benefit the children. The parents are not convinced since they feel they have put their children into a school and it’s the school’s responsibility.

There are several more incidents like these. Though, schools, teachers, caretakers and others want the best for their children, they are confused about the path they need to take when the child exhibits signs of learning deficits/differences. Going to a psychologist is still a taboo and even if we do manage to go to one, finding a remedial class and managing time become difficult.

What then should we do? When is the right time? How do we understand a right diagnosis and the remedial plan? How do we understand if it is the right time to move out to an alternative school or to continue in the mainstream with remedial support? How do we know if the child needs a tuition teacher or a special educator? And in this confusion is it ok for the child to get support after a delay of a few years.. Is there such a thing as early intervention? If yes, then what about our elders who say with age things will improve?

Let’s evaluate these questions.

First, we must understand that all children like to do well, do not like to struggle and like to be praised. They may not know how to do well, but surely they do not decide to do badly.

Second, as parents we must follow our intuition. We will be the first ones (if we spend quality time with our children) to see there is a mismatch in the child’s actual ability vs achievement.

Third, as teachers, we must be aware of the children who do not fall in the average category, both higher and lower. In case of any deviance with respect to behaviour, skills and abilities, we must put the children in an at-risk category and observe carefully. We must write down our observations and discuss them with peers, school administrators and parents.

Let us look at a few of the disabilities we find in children and their characteristics

Speech, language or hearing impairments

A child may have a speech delay, speech impairment, language delay or language impairment. Delays may be due to the child being a late bloomer, however they do require intervention. In most cases speech and language delays are indicative of other disorders. Consulting a speech pathologist and an audiologist is mandatory for every child if you suspect any deviations from the normal. 

*Speech (refers to sounds)

Articulation disorder — difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child.
Fluency disorder — disrupted rhythmic and forward flow of speech. Example: stuttering.
Voice disorder — problems with the pitch, loudness, resonance, or quality of the voice.

*Language (refers to meanings)

Impaired ability to understand and/or use works in context
Difficulty expressing ideas or needs and/or understanding what others are saying
Some characteristics of language disorders include: Improper use of words and their meanings; inability to express ideas; inappropriate grammatical patterns; reduced vocabulary, and inability to follow directions.

*Hearing

If your child has a speech delay, frequent or recurrent ear infections, a family history of hearing loss, certain infectious diseases, use of high antibiotics, poor school performance, learning deficits, autism etc. you must visit an audiologist for a hearing test.

Other impairments

*Learning difficulties/dyslexia   

Problems reading, writing, spelling, speaking
Problems doing math problems, understanding time, using money
Problems with handwriting, spelling, organising ideas
Problems with hand–eye coordination, balance, manual dexterity
Problems understanding spoken language, poor reading comprehension
Problems with reading, comprehension, language
Problems with reading, math, maps, charts, symbols, pictures

*Autism

May have trouble communicating, reading body language, learning basic skills, making friends, and making eye contact.
   
*Behavioural

ADHD/ADD

Have problems sitting still, staying focused, following instructions, staying organised, and completing homework.
Anxiety disorders like obsessive compulsive disorders, selective mutism, oppositional defiance disorder etc.

Every school must be connected to a network of specialists which include paediatricians, psychiatrists, speech pathologists, audiologists, occupational therapists, special educators and psychologists. Children must be referred, to not only rule out any problems but also for appropriate intervention. Early intervention is the first and only solution to any difficulties the child may have, to enable him to fit into mainstream life, academics and professions.

So what happens in these assessments?

First, the psychologist or the social worker will ask you relevant questions to understand your concerns, the child’s environment, his upbringing, his developmental milestones and other information that may give a complete background information.

Second, different tests will be conducted using questionnaires, puzzle like activities, interview, academic skill tests etc along with the required medical tests to determine the exact cause and extent of the problems. This is where the specialists step in.

Third, a case conference is held between all the professionals involved to reach a consensus about the problem, plan an intervention and provide guidance to the parent.
What happens after the assessment?

If your child does not have any major difficulties you may go relieved! If your child does have any difficulties then you will be relieved to have found it and can work on the suggested methods. The methods may involve speech therapy, remedial therapy, occupational therapy, medicines, admission into the school resource room etc.

How much do these assessments cost and how much time do they take?
Generally assessments cost Rs 1000 and upwards depending on the tests used, the expertise of the professionals involved and the time taken.

Assessments can last from 1 hour to even 10 hours. Usually the child is called for three sittings each lasting 2-3 hours with adequate breaks. It is best if we do not prepare the child academically in anyway so we get accurate results.

Reports can take one week to three weeks to be delivered again depending on the tests done and the professionals involved.

The following are a few centres in Bangalore that offer these services:

*Octave Speech and Hearing Centre: 753, 3rd Block, 8th Main Road, Koramangala, Bangalore 560034.  Phone: [phone]
*Spastics society of Karnataka: Spastics Society of Karnataka, No. 31, 5th Cross, Off 5th Main, Indira Nagar, Bangalore 38. Ph: 4074 5900
*Dr S R Chandrasekhar Institute of Speech & Hearing: Hennur Main Road, Lingarajapuram, Bangalore - 84. Ph:  2546 0405
*Abhaya Hospital: No 17, Dr M H Mari Gowda Road, (Hosur Road), Opposite 9th Cross bus stop, Wilson Garden, Bangalore - 27. Ph: 26563865
*Vydehi Hospital: 82, Nallurahalli, Near BMTC 18th Depot, Whitefield, Bangalore - 66. Phone: [phone]
*St Johns Hospital: Sarjapur Road, John Nagar, Koramangala Bangalore 34, India. Ph: 22065000

Early intervention doesn’t label children but enables them. Feel free and consult specialists to ensure your child achieves his full potential.

(The writer is a psychologist, special educator, and founder of Aurinko Academy.)