Summary

• Learning disability encompasses a wide range of learning and/or social difficulties.
• People with learning disabilities are usually of average to above average intelligence.
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LI>The effects of a learning disability may be mild, moderate or severe.
• There are different types of learning disabilities, including auditory or visual perceptual difficulties, motor difficulties, poor memory, inattention and concentration difficulties, difficulty with mathematical reasoning or with reading and writing, etc.
• Some people present with only one particular difficulty while others present with a combination of difficulties.
• It is important to distinguish learning disabilities from academic difficulties due to lack of opportunity, poor teaching, cultural factors, inadequate curriculum or family problems.
• Psychologists, remedial teachers, occupational therapists, speech and language therapists, physiotherapists and neuro-developmental paediatricians are the professionals who are mostly involved in the assessment and treatment of learning disabilities.

Description

• Understanding, remembering or producing language, i.e. difficulty with listening, speaking, reading, writing and spelling
• Reasoning, both verbally and non-verbally
• Mathematics, which includes arithmetic and mathematical reasoning
• Motor co-ordination, both gross and fine
• Noticing and remembering social information
• Processing information, which includes reading and writing speed
• Organising time and/or space

Learning disabilities are not primarily due to physical disability, such as impairment of hearing, motor abilities or sight, mental disability or retardation, emotional issues or mental illness, or environmental disadvantages such as poverty.

Many children with learning disabilities may function within the average or even above average range in their grade at school. The learning disorder may not be fully apparent until grade four or later. The manifestations of learning disabilities change with the demands at school, as the need for more independent work increases. As these demands change, the severity of the problem also changes. Without help, nearly 40 percent of children and adolescents with learning problems drop out of school. Learning difficulties can be detrimental to a person’s self-esteem.

Types of learning disabilities

• Dyslexia is difficulty in using and understanding language. Problems may occur in the areas of listening, speaking, reading, spelling and/or writing. Despite these difficulties, people with dyslexia can be extremely creative and talented. They often excel in the visual arts, drama, sport, mechanics and many other areas that require visual-spatial integration.

The following are some common signs of dyslexia:

• Difficulty with verbal expression
• Poor reading comprehension
• Poor spelling
• Difficulty identifying individual words when reading
• Difficulty expressing thoughts in written form
• Difficulty in following instructions – may hear words incorrectly
• Confusion about directions in space and time, such as distinguishing left from right, up from down, months of the year, etc.
• Letter reversals and may see words as upside down, blurred or distorted
• Difficulty with handwriting
• Difficulty with mathematics, for example using mathematical symbols or sequencing steps to solve a mathematical problem
• Dysgraphia is being unable to produce legible handwriting in an appropriate length of time.
• Dyscalculia is being unable to understand or use mathematical concepts and symbols. People with dyscalculia may have difficulty performing even the simplest mathematical calculations.
• Non-verbal learning disorder (NLD) is a neurological syndrome affecting the right hemisphere of the brain. People with NLD usually have outstanding verbal abilities and do well in subjects requiring reading, writing and speaking. They learn primarily through verbal skills such as listening and speaking.

The three major non-verbal areas affected include:

• Gross and fine motor co-ordination – severe balance problems and difficulty with handwriting
• Visual-spatial organisation
• Social skills – inability to use and understand non-verbal communication such as eye contact and body language
• Memory disabilities can be divided into four categories:
• Short-term auditory memory – difficulty in remembering orally given (spoken) information in the short term
• Long-term auditory memory – difficulty in remembering orally given information in the long term
• Short-term visual memory – difficulty in remembering visual information in the short term
• Long-term visual memory – difficulty in committing visual information to long-term memory
These memory difficulties present significant problems in academic study. You might listen attentively during a class or lecture, or study hard for a test, but soon realise that you can't remember the information. Sometimes people have an intact long-term memory, but a poor short-term memory; in other words, once the information has been ‘over-learnt’ (learnt and revised a number of times) it can be remembered in the long term.

• Auditory processing disability is difficulty in processing and/or understanding information that is orally given and perceived aurally (heard). The deficit does not involve physical hearing problems such as deafness, but does affect how the brain interprets and/or processes auditory information. This disability can affect all areas of language development including reading, spelling, speech and the ability to understand verbal instructions.

Types of auditory processing deficits:

• Auditory discrimination difficulty: difficulty in discriminating between similar sounds such as ‘th’ and ‘f’ or ‘th’ and ‘v’. People with an auditory discrimination problem may have trouble distinguishing between tones of voice such as those used when a speaker is making a joke or is being serious.
• Auditory figure-ground difficulty: difficulty in hearing sound over background noise; for instance, having trouble hearing what someone is saying to you when the television is on in the background.
• Auditory sequencing difficulty: difficulty in hearing sounds in the correct order. For example, people with auditory sequencing problems may hear "two – one" instead of "one – two".
• Visual perceptual disability involves having difficulty in processing and/or interpreting visually perceived information. This does not mean that you have visual acuity difficulty or visual impairment; it has to with how the brain interprets and makes sense of visual information.

Types of visual perception difficulties:

• Visual figure-ground problem: difficulty in distinguishing between a specific image and a competing background, locating somebody in a crowd, finding an object on a crowded desk, or picking out one line of print from a page of written information. People with this disability struggle to visually pay attention to visual detail and are unable to spot things the way others can.
• Visual sequencing problem: difficulty in seeing things in the correct order. People with this disability see words, letters and numbers in reverse or in a different order. This causes significant difficulties with reading and writing.
• Visual discrimination problem: difficulty in seeing differences between two similar objects. People with this problem may see two similar letters as alike, such as ‘u’ and ‘v’. They may also have trouble telling the difference between two shades of one colour.
• Depth perception problem: difficulty in perceiving distance. People with this disability have trouble telling how far away or how near an object is – they may misjudge the corner of a chair, for example, and walk into it.
• Speech and language disability involves difficulty in expressing verbal language. It is also known as dysnomia. People with this disability may have trouble remembering names or recalling appropriate words in a discussion. This problem may be particularly prominent if the person is asked a question to which he/she must supply an immediate answer. The person struggles to find the appropriate word(s) to adequately express what he or she wants to say. However, when the person speaks spontaneously, without prompting, his or her speech appears perfectly normal.
• Organisational disability: difficulty in organising time, tasks or space.
• People who have difficulty in organising time have trouble understanding and estimating time. They are frequently late for appointments.
• People who have difficulty in organising tasks struggle to organise their thoughts to complete a given task. They process each piece of information separately but have difficulty merging the pieces into a whole. They usually struggle with essay writing, particularly under exam conditions. Some people who struggle to organise tasks have difficulty thinking in an orderly, logical manner. They may jump to conclusions and have difficulty planning tasks. They also have difficulty in organising the tasks of daily living. Their bedroom or house is often in a mess and they often can’t find things. They frequently forget things or lose their belongings.
• People who have difficulty in organising space have trouble finding their way to different locations. They may frequently get lost and need directions. Once given directions, they may have trouble following them, confusing left and right. They may also have difficulty with learning the layout of large buildings.
• Motor disability involves having difficulty in using your body to perform a physical task. Motor disabilities generally fit into two categories:
• Gross-motor disability: difficulty co-ordinating large muscles to perform an activity. People with gross-motor difficulties may stumble when walking, have difficulty running, riding a bicycle or participating in sports activities, and are generally considered to be clumsy.
• Fine-motor disability: difficulty co-ordinating the small muscles needed for writing or drawing. Handwriting may be a slow, messy and tedious process. People with this difficulty may have trouble performing other fine-motor tasks such as typing, tying their shoelaces or buttoning a shirt. This disability is also known as dyspraxia.
• Social skills deficit involves having difficulty using and understanding social information and conversations. People with this disability may experience difficulty in the following areas:
• Understanding social conventions. Some people with learning disabilities have trouble understanding the established social conventions used in daily living. They may have trouble monitoring their own behaviour and act or speak without forethought. They may laugh inappropriately and interrupt conversations. A common problem for people with learning disabilities is difficulty in recognising language conventions. They may not understand the expected reply to many common phrases. They may take things literally.
• Visual perception of facial expression and body language. Some people with learning difficulties misinterpret messages people give and receive through body language and facial expression.
• Auditory perception of vocal cues. Difficulties with auditory perception affect a person’s ability to interpret vocal tone. They may have trouble deciding whether somebody is using an angry voice or expressing feelings of boredom or impatience. This difficulty can lead to misunderstandings and is likely to be very frustrating for all involved.
• Body awareness. Some people with learning disabilities have trouble situating their bodies at a comfortable distance away from others. They do not understand how close they are to someone with whom they are interacting and how uncomfortable this may be for that person.
• Inattention and concentration difficulties usually involve distractibility and/or hyperactivity/impulsivity. This is the inability to focus and sustain attention and concentration. You are easily distracted by extraneous stimuli, are overactive or lose focus and daydream. Some people concentrate better with auditory information and others with visual information. Concentration and inattention difficulties usually accompany learning disabilities and this does not necessarily mean that you have an attention deficit/hyperactivity disorder (ADHD).

Associated problems

Ten to 25 percent of individuals with learning disabilities have associated problems such as conduct disorder, oppositional defiant disorder, major depressive disorder, or attention deficit/hyperactivity disorder.

Cause

Although learning disabilities are assumed to be the result of variations in brain structure and function, at present these variations are not well understood. Research on the brains of brain-injured children and adults is beginning to provide some valuable information.

Children with learning disabilities process information differently. Learning disabilities are caused by a faulty brain system, either in the structure of the brain or the functioning of different chemicals. Underlying abnormalities in cognitive processing such as visual perception, linguistic processes, attention and memory often precede or are associated with learning disabilities. Genetic predisposition, perinatal injury and various neurological and other general medical conditions may be associated with learning disabilities, but the presence of such conditions does not necessarily presuppose a learning disorder. Learning disabilities are, however, frequently found in association with a variety of general medical conditions such as lead poisoning, foetal alcohol syndrome and fragile X syndrome (an inherited genetic condition associated with mental retardation).

Prevalence

Diagnosis

Co-operation among the family, the school (if the person is still at school) and the professionals involved is crucial. A complete diagnostic evaluation of skills can provide the basis for individualised treatment strategies for schools and families. A psychologist who has specialised in the field of learning disabilities usually conducts such an evaluation, also called a psycho-educational assessment. There is often a team of professionals involved in the assessment and identification of learning difficulties. These include the following:

• Occupational therapists
• Physiotherapists
• Speech and language therapists
• Remedial teachers
• Neuro-developmental paediatricians
• Psychologists

Learning difficulties can sometimes be identified as early as three years of age.

The list below contains elements that should be prevalent in order to identify certain specific learning disabilities. (This does not, however, replace the qualified professional in diagnosing learning disabilities. It merely provides a guideline for teachers and parents of children who may present with learning disabilities, and gives guidance on whether professional diagnosis should be considered.)

• Auditory perception and language difficulties.
Problems encountered:
• Loses concentration during class lectures
• Has difficulty following verbal instruction
• Cannot take notes accurately from verbal presentation
• Lacks understanding of complex words
• Often repeats the same question
• May repeatedly ask questions about work already explained
• Irritated by extraneous noise
• Difficulty remembering what is heard
• Difficulty with written expression
• Difficulty with verbal expression
• Visual perception, organisation and planning difficulties.
Problems encountered:
• Loses place when reading or copying
• Cannot visualise things mentally
• Difficulty remembering what is seen
• Confused by an abundance of visual stimuli
• Erratic spelling
• Difficulty working from written instructions
• Trouble reading from the board
• May not notice details on pictures, maps or photographs
• Misplaces items
• Becomes disorientated
• Difficulty distinguishing main ideas from details
• Difficulty adjusting to change in routine
• Difficulty making choices and identifying priorities
• Forgets assignments or schedules
• Loses track of time
• Work on paper appears disorganised
• Difficulties with memory and recall.
Problems encountered:
• Problems involve a combination of difficulties that can occur in listening and attending to information, and storing and retrieving information from memory
• Motor difficulties.
Problems encountered:
• Poor handwriting
• Difficulty in hands-on activities such as typing
• Trouble with speed and neatness
• Work appears sloppy and disorganised
• Difficulty manipulating small objects such as a screwdriver
• Difficulty connecting points, matching answers and labelling maps
• Clumsiness
• Poor copying skills
• Slowness with written work
• Inattention and concentration difficulties.
Problems encountered:
• Difficulty sustaining attention
• Difficulty completing a sequence of steps to complete a task
• Shifting from one unfinished task to another
• Difficulty following a plan
• Difficulty following instructions
• Struggles to prioritise
• Struggles to sustain effort and accuracy over time
• Difficulty completing assignments
• Poor memory
• Poor exam technique
• Confusion when distinguishing important details
• Messiness
• Poor handwriting
• Poor study skills
• Poor self-monitoring
• Inappropriate seeking of attention
• Excessive talking
• Difficulty remaining seated
• Fidgeting
• Blurting out answers in class
• Poor use of time
• Poor self-esteem

Intervention

• Individual or group remedial lessons by a trained remedial teacher
• Occupational therapy for children with NLD, motor disabilities and visual perception disabilities
• Physiotherapy for NLD and motor disabilities
• Speech and language therapy for children with specific language difficulties and auditory perception disabilities
• Social skills groups and behavioural management for children to help them to be more aware of appropriate behaviour and social expectations.
• Education for family members on the ramifications of learning disabilities and the effect on family functioning
• In South Africa, the Department of Education offers special dispensations for Learners with Special Educational Needs. These must be applied for by the school and include:
• Extra time for exams
• Spelling concession
• Handwriting dispensation
• Oral exams
• A planning aid for exam writing
• Questions on tape
• Use of a computer during exams
• A scribe during exams

The following are guidelines of recommended interventions for teachers and parents of learners with learning difficulties:

• Auditory perception and language difficulties
• Stimulate writing skills.
• Encourage writing quantity without regard for errors to stimulate output.
• Provide a checklist of features that can help learners to evaluate their own work, such as paragraphs, style, punctuation, and use of headings.
• Practise comprehension.
• Break assignments up into small tasks.
• Reduce volume of work (only essential material).
• Underline important facts in passages.
• Give specific questions to guide reading.
• Show exact paragraphs where information can be found.
• Repeat instructions.
• Give both written and oral instruction.
• Allow work to be done on a computer.
• Don’t penalise poor spelling, just correct it.
• Have the learner repeat instructions back to you.
• Be aware of using complex language when giving instructions or explaining work.
• Provide synonyms for difficult or new words.
• Paraphrase explained work.
• Use short sentences.
• Be specific about where answers can be found, e.g. "in paragraph four…"
• Provide a key with word definitions.
• Enlarge reading text.
• Provide handouts.
• Use visual aids such as charts and graphs.

• Visual perception, organisation and planning difficulties
• Provide a calendar with a weekly plan, homework, assignments and tests.
• Give detailed explanations for projects – break down the instructions into manageable chunks.
• Do periodic checks for long-tem projects.
• Show by example.
• Provide detailed explanatory steps for tasks.
• Enlarge maps and diagrams.
• Create keys that are easy to interpret.
• Do spot checks.
• Give extra time to complete tasks.
• Avoid copying from the board.
• Enlarge print.
• Teach highlighting of relevant information.
• As the learner will remember more of what he or she hears than sees, encourage verbalising of instructions.
• Check learner’s notebook regularly.
• Use concrete examples.
• Difficulties with memory and recall
• Ensure that learning occurs in a relatively distraction-free environment.
• Ensure learners are not too stressed, tired, restless or hungry.
• Repeat work to commit it to memory.
• Provide the learner with strategies such as acronyms or mnemonics to remember information.
• Summarise information.
• Repeat instructions and have the learner demonstrate that he/she knows what to do.
• Provide many practice opportunities.
• Don’t assume that he or she remembers what was learnt yesterday.
• Teach how to visualise or use imagery to recall information.
• Teach how to make lists to remember information.
• Avoid rote learning.
• Teach mind-mapping and other summarising techniques.
• Make it clear which material is essential or important and de-emphasise unimportant information.
• Motor difficulties
• Avoid long copying or written assignments.
• Allow oral evaluation.
• Allow tape-recording of assignments.
• Provide well-spaced and lined worksheets.
• Allow the use of a computer.
• Encourage keeping of a booklet of incorrectly spelt words.
• Do not pressurise for speed and accuracy e.g. in typing.
• Inattention and concentration difficulties
• Seat the student near the front of the classroom.
• Make eye contact when talking to him or her.
• Break tasks down into small, manageable parts.
• Do spot checks.
• Be available to check project work or essay writing in the planning stages.
• Alert his or her attention before explaining key points or instructions.
• Cue student by calling his or her name.
• Make positive, personal comments when there is evidence of interest.
• Give one instruction at a time.
• Check that the learner has understood instructions.
• Use positive reinforcement – be encouraging when they do something right.
• Help the learner to identify important aspects to focus on when learning work.
• Seat the learner next to someone who is organised.
• Teach ways to focus attention, e.g. "look at me when I talk".
• Avoid seating the learner near distractions such as a window or a fan.
• Make instructions clear and concise.
• Bear in mind that he or she becomes frustrated easily: pressure, fatigue and stress can build up.

Before making use of any of the above-mentioned interventions, consult with one or more of the professionals who work with learners who have special educational needs and together decide on an intervention plan. Employing some of the above suggestions in the classroom context would benefit all learners, not only those with special educational needs.

(Reviewed by Dr P. Normand, clinical psychologist)

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