Dr. Y. Simpson
Education is too demanding in this modern world. Poor academic performance is a serious issue for children and their parents. Parents often find their own reasons such as poor teaching by the teacher or the school. With this suspicion, they may shift the child from one school to another. The teachers may give their own reason such as the child is purposely not learning. As solution to this problem, parents and teachers may adopt various forms of solutions including punishments.
In order to find the right solutions, the first thing that must be taken into account is the cause. Very often, the cause may be either external or internal. Regardless of what the cause may be, poor academic performance is not a situation that warrants punishment. It shouldn’t be about blaming people. It should be about identifying problems and solving them.
When the child shows decline in academic performance, it is important to go for a consultation with the Psychologist for an evaluation. Prior to that, a paediatrician has to check for any sensory deficits such as vision and hearing. In the absence of medical conditions, the psychologist will try to find out the intellectual functioning of the child basedon scores of cognitive ability obtained on assessment by standardized and validated psychometric tools including adaptive functioning of the child. If the Intelligent Quotient (IQ) is below 70, the child will be considered to have Intellectual Disability (ID). When the IQ is found to be at average level (90-110), other problems such as Specific Learning Disability (SLD), Attention deficit Hyperactivity disorder(ADHD), Autism Spectrum Disorder (ASD), Psychiatric disturbances, Emotional problems and Psychosocial issues are to be investigated.
Intelligence refers to the global mental ability of a person which includes the ability to understand, to reason, to plan, to solve problems, to remember, to think abstractly, and to learn from experience. Children with deficits in social and practical skills along with IQ below 70 will have difficulty in performing academic exercises from school.
The effects of this disability vary considerably among children who have them. Such children may take longer to learn to speak, walk and take care of their personal needs such as dressing or eating, poor memory, childish behaviour and inability to understand the consequences of actions. They may struggle in learning reading, writing and doing calculations. Leading an independent life in the community will be a problem for majority of them. Lifelong limitations may be present in a small percentage of them. Some of them may exhibit behaviour problems. Comorbidities such as seizure disorder, attention deficit hyperactivity disorder and physical disabilities may be present in some of these children.
The magnitude of this problem in India has been predicted as 2 – 3 percentage based on surveys conducted in different parts of the country. The causes for this problem is multifactorial and it is difficult to pinpoint the exact cause except for certain known causes. Problems before birth such as an infection or exposure to alcohol, drugs, maternal radiation,pollution of water and air or other toxins are responsible in some cases. Conditions during birth such as premature delivery, post mature delivery, prolonged and difficult labour and oxygen deprivationat birth may result in damaging the cells of the young brain causing intellectual disability. Certain chromosomal abnormalities also can cause cognitive problems in some children. Few conditions after birth like brain injury and Meningitis (Brain fever) are also responsible for this problem in some children.
Since Intellectual Disability is not a disease, like other forms of physical disabilities, there is no medical treatment available so far to treat this condition. Yet, these children will be benefited from special schooling where trained special teachers educate these children using various special education techniques to enhance their abilitiesin various life skills, education, social skills and vocational skills. Training has to be continued for several years. They will not be benefited by regular school curriculum. School pressure can cause psychological damage in them. The parents of such children need lot of support in bringing up these children in the right way through regular parental education.
A multidisciplinary team consisting of Psychologists, Special Teachers, Speech Therapists, Occupational Therapists, Social workers, Physiotherapists, Pediatricians and other related specialists can jointly work out effective and appropriate intervention strategies by which the child with special needs can get benefited the maximum.Various forms of misconceptions such as intellectual disability is one form of mental illness, it is a punishment for our sins, medicines can cure this conditions, attack of evil spirits are existing among the minds of the public at large.
Specific Learning Disability (SLD):
Specific learning disability is a neurodevelopmental disorder that begins during school-age (After the age of 7 Years), and it may not be recognized until adulthood. It is related to ongoing problems in one of three areas: reading, writing or mathematics. Approximately about 6-7% of children in India is having this problem.
There are three types of Specific Learning Disabilities: Dyslexia (reading disability), Dysgraphia (Writing disability), and Dyscalculia (Mathematical disability).
Dyslexia is a term that refers to the difficulty with reading. People with dyslexia have Complications with reading, difficulty spelling words, letter and number reversals, problems with pronunciation, omitting or adding sounds or letters when reading, reading softly, assuming and reading, reading backward, confusion of left and right etc.
Dysgraphia is related to the difficulty in writing. The common symptoms are improper pencil grip, illegible hand writing, poor letter or word spacing, problems with punctuation marks, over writing, mixing up of capital and small letters, difficulty to maintain the margins on the paper and letter reversal.
Dyscalculia is the third type of problem seen in children with SLD in which children will have difficulty in counting backwards, remembering basic mathematical facts, understanding place value, aligning numbers, confusion with mathematical symbols, following mathematical rules, choosing appropriate sign of operation in math, understanding and doing word problems, and understanding fractions.
All these problems may co-exist in the same child or any two of the two problems or may present in isolation. Special tests are required to make a diagnosis of SLD. School psychologists are trained in both education and psychology who may do the neuropsychological assessment as well as curriculum based assessment to identify the errors in all three domains to plan out appropriate interventions. Specific Learning Disability is a disorder and not a disease and therefore no medical intervention is available.
Remedial teaching is the only available procedure to correct this problem in children. With proper intervention, these children will be benefited by mainstreaming them later. There are specially trained teachers who can help the students with SLD to correct the errors. Most often, children with SLD become victims of teasing and criticisms by class mates and others. Public education about this disability can prevent with SLD becoming victims of teasing and criticism.
Scientists do not know all of the possible causes of learning disabilities. Yet, they have identified few of the risk factors that may be present from birth and in some it run in families. Factors that affect a fetus developing in the womb such as alcohol or drug use, exposure to lead in water or in paint can put a child at higher risk for a learning disability.
Attention Deficit Hyperactivity Disorder:
ADHD is one of the common childhood neurodevelopmental disorders. It is always difficult to tell, since toddlers tend to have trouble paying attention in general.Many symptoms of ADHD can be typical childhood behaviors. Boys are more affected than girls (Twice than in Girls). About 6-7% of children in India seems to be having ADHD.
Attention deficit hyperactivity disorder (ADHD) affects children and teens and can continue into adulthood. Children with ADHD may be hyperactive and unable to control their emotions and impulses. They may have trouble paying attention to any task given. ADHD interfere with school performance and home life.
There is no single test used to diagnose ADHD. Experts diagnose ADHD after a person has shown some or all of the symptoms on a regular basis for more than six months and in more than one setting based on DSM V criteria. There are few standardized scales to assess the severity of the symptoms.
According to the diagnostic criteria, there are three types of ADHD in children; predominantly hyperactive, predominantly inattentive and combined type. It is ideal to make a proper diagnosis after the age of five. The common symptoms include making careless mistakes, often losing things, not seem to listen, getting easily distracted, lack of focus, excessive energy, impulsivity, Interrupting, trouble waiting their turn, fidgetiness, unfinished tasks, daydreaming, always being on the move, squirming and fidgeting, often talking excessively and Interrupting or intruding on others.
Studies show that pregnant women who smoke or drink alcohol may have a higher risk of having a child with ADHD. Exposure to lead, or pesticides may also have a role.ADHD runs in families, anywhere from one-third to one-half of parents with ADHD will have a child with the disorder.
Treatment plans may include special education programs, behavioural intervention, and pharmacological intervention. Studies show that a combination of medications and behavioral techniques is much better than only with medicines, or no specific treatments in managing Attention Deficit Hyperactivity Disorder. Parents and teachers need to be psycho educated regarding the disorder and its management. Medicines, behaviour therapy, parent coaching and school support are the components of treatment for ADHD. Though ADHD is a disorder and not a disability, it impairs a child’s learning if not treated by specialized professionals.
Autism Spectrum Disorder:
Autism is a neuro developmental disorder. Children with autism may demonstrate restricted, repetitive and stereotyped movements such as hand flapping, swaying of head, body rocking, and moving inside the room repeatedly in the same pattern. They may have difficulty in maintaining eye contact with people. Toe walking may be present in some children. Some of the features like staring at vacant space, crying or laughing for no apparent reasons, resistance to change in their routines, demanding to play the same music repeatedly, spinning of toy wheels, spinning to self, smelling of objects or people, aversion to sticky objects, fear of certain objects, attachments to objects, fear of dark places or closed places, and hypersensitivity to loud noises or touch may present in varying degrees.
In some children, speech may be absent after the age of two and in others it may be inadequate,including difficulties sharing emotions, sharing interests, or maintaining a bilateral conversation. Many of them will have difficulties developing and maintaining relationships and prefer to be alone and some of them often avoid crowded places.
Some children develop seizures at later part of their life. Some of them may have cognitive impairment at varying degrees. Few children show special abilities in mathematical calculations, music, or drawing.
The onset of Autism is between two to three years of age and may be even before in some children. Many of these children develop typically till the age of two years. Autism is four times more in boys than in girls. The global prevalence estimates of autism spectrum disorders found to be of 62 cases per 10,000 people.
Autism runs in families. The cause for Autism is controversial due to lack of scientific evidences. Yet, some of the predictions are exposure of pregnant mother to certain drugs, alcohol, antiseizure drugs, and chemicals.
Autism is diagnosed through various screenings, behavioural evaluation, and occupational therapy screening. Diagnoses are typically made by a team of specialists which includes child psychologists, occupational therapists, andspeech and language therapist.
Treatment for Autism is multimodal and complicated as they are not good enough to control the features of Autism completely. Yet, scientific studies prove symptom reduction using some of the intervention strategies such as behavioral therapy, play therapy, occupational therapy, physical therapy, and speech therapy. The effect of therapies differs from one child to another.
When the child’s school performance is affected in the absence of any one the above Intellectual and Developmental Disabilities, the psychologists may try to investigate other forms of factors such as emotional problems, psychiatric and psychological problems or psychosocial problems such as poor socioeconomic conditions, alcoholism in the family, divorce among parents, step mother of stepfather situation, adoption and similar kind of situations. The child has to be referred to appropriate specialist for treatment based on the type of problem.
Christian Institute of Health Sciences and Research (CIHSR) is currently equipped with a team of specialists focusing on a multidisciplinary team approach to cater to the needs of children with Intellectual and Developmental Disabilities following the scientific approaches and guidelines. Diagnostic work up is carried out following which therapy procedures are implemented by specialists in the special school which is within the premises of the institute. The children along with their parents are trained in appropriate management techniques. Through careful assessment and appropriate intervention by qualified professionals, children with IDD can be made useful citizens of this world.
(Dr. Y. Simpson is the Principal of Allied Health Sciences HOD, Developmental Paediatrics at Christian Institute of Health Sciences and Research, Dimapur, Nagaland. <firstname.lastname@example.org>)