NEURODEVELOPMENTAL DISORDERS

Specific Learning Disorder (SLD)

Dyslexia, dyscalculia, and dysgraphia — we might have come across these terms from time to time.
Are they somewhat similar? Well, they do fall under an umbrella term known as specific learning disorders (SLDs).
But what exactly are their distinctions?

What is Specific Learning Disorder?

A specific learning disorder (SLD) is a neurodevelopmental condition involving difficulties learning and using academic skills. It includes difficulties with reading (Dyslexia), writing (Dysgraphia), and mathematical calculations (Dyscalculia).

Diagnosis of a SLD requires the persistence of one of the following symptoms over a period of six months, despite targeted interventions:

Ψ Inaccurate or slow and effortful word reading
E.g., reading single words aloud incorrectly, slowly or hesitantly; frequently guessing words; has difficulty sounding out words.

Ψ Difficulties understanding the meaning of what is read
E.g., reading text accurately but not understanding related sequence, relationships, inferences or deeper meanings of what’s read. 

Ψ Difficulties with spelling
E.g., adding, omitting, or substituting vowels or consonants.

Ψ Difficulties with written expression
E.g., making multiple grammatical or punctuation errors within sentences; employing poor paragraph organisation; unable to express ideas clearly by writing 

Ψ Difficulties mastering number sense, number facts, or calculation
E.g., having poor understanding of numbers, their magnitude and relationships; using fingers to add single-digit numbers (rather than recalling the fact); getting lost in arithmetic computation and switching procedures

Ψ Difficulties with mathematical reasoning
E.g., having severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems

Individuals with SLD are typically identified during school-going years. Their academic skills are significantly below those expected when compared to peers of the same age. That said, they may generally be able to cope with the rigors of learning until their capacities are pushed to the limit (like during timed tests, tight deadlines, heavy academic loads and so on). For those no longer in school (or aged 17 years and older), history of learning impairments may take the place of standardized assessments.

According to the DSM-5, the symptoms above are then classified according to the following severity levels:

Ψ Mild:
Individuals with mild SLD experience some difficulties learning skills in one or two academic domains, but are generally still able to function well with support and accommodation services, particularly if received during school-going years.

Ψ Moderate:
Individuals with moderate SLD experience more difficulties learning skills in one or more academic domains. They are unlikely to become proficient without some forms of intensive and specialized intervention during the school-going years. Support services might be required across settings, such as school/workplace and at home, to help them complete activities accurately and efficiently.

Ψ Severe:
Individuals with severe SLD experience significant difficulties learning skills across several academic domains. They are unlikely to learn without any intensive individualized and specialized intervention for most of the school-going years. They may not be able to complete all activities accurately or efficiently even with the provision of appropriate support services across settings.

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Can SLD be cured?

Currently, no. However, there are plenty of ways to support individuals with SLD to minimise its impact across settings.

Ψ Direct instruction:
This is aimed at teaching children specific skills in preparation for larger tasks in a gradual manner.
E.g., teaching to read phonemes in order to read whole words;
For Dyslexia: emphasising learning of word structure and word reading regardless of the context of the sentence/story;
For Dyscalculia: recognising numbers and their values before progressing to basic operations

Ψ Behavioural strategies:
E.g., providing with verbal rules for writing and re-application
For Dyscalculia: demonstrating problem-solving approach in a step-by-step manner (modelling)

Ψ Learning Support Programmes:
Teachers in these programmes teach students with SLD in smaller groups, with classes tailored to students’ needs. Students who are identified with Dyslexia will also undergo a 2-year remediation programme.

This is available in most MOE schools.

Prognosis

The prognosis of SLD is mixed as it really depends on a number of factors, like the age of diagnosis and comorbidity of conditions:

Ψ Generally, the earlier the diagnosis for SLD, the better the prognosis. Early diagnosis allows for early intervention. It’s been found that there is a brief window of opportunity for successful intervention, which is before the age of 8. Many who receive early intervention are actually able to do well academically and go on to pursue higher education.

Ψ The presence of comorbidity means that people can experience different symptoms and with varying degrees of severity. Predictions are hard to make. If there is comorbidity, it can be more challenging to predict the prognosis.

Besides, a supportive family environment makes a big difference. Being encouraging and learning to celebrate small successes helps these individuals build positive self-image and increase willingness to commit to learning despite challenges. Remind yourself that these difficulties are unintentional, recognise their efforts and offer whatever support possible, be it practical or emotional. It’ll go a long way in helping them on their learning journey.

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While there might be various types of SLD, one commonality among all these conditions is that the developmental trajectory of children with SLD is often associated with low-self-esteem, anxiety, low mood and school drop-out. This is more often than not due to the lack of understanding by parents, teachers, peers and the child himself/herself on the nature of SLD, criticism and shame, coercive methods of teaching and challenging behaviours and reaction. In addition, when entering new situations or attempting to engage in class activities or homework, some children might anticipate failure, hence resulting in more anxiety. Some children might feel frustrated, seeing that they have to put in extra effort to reach the same level as their peers. However, sometimes, their efforts do not pay off, hence resulting in more frustration.

Therefore, it’s also important to take care of the emotional needs of your child. Be consistent in offering ongoing support and encouragement to your child. There are various ways you can encourage your child. Try to help them learn to talk about their feelings. They might be feeling anxious, angry or depressed, but language problems make it difficult for them to express their feelings. Be patient with them, give them time to express themselves and most importantly, listen to them and validate their feelings. It’s also good to give them chances to show their strengths by exploring various other activities with them (e.g art, music) – this is useful in boosting their self-esteem!

In the process of guiding your child, help them set realistic goals about their progress. Most children with SLD set unattainable and perfectionistic goals for themselves. This would be helpful in proving to them that they can still learn and make progress even if it’s slower. In the process of doing so, learn to reward effort as well, and avoid placing too much focus on the outcome. It would also be good to teach your child ways to manage stress and negative emotions in the event that they are unhappy because they are unable to reach a goal.