Psychological intervention for specific learning disability ISSN: 2394-0026 (P)Case Report ISSN: 2394-0034 (O)Psychological intervention for specific learning disability: A case report Neelam Verma1* 1Clinical Psychologist, Nur Manzil Psychiatric Centre, Lucknow, India *Corresponding author email: [email protected] to cite this article: Neelam Verma. Psychological intervention for specific learning disability: Acase report. IAIM, 2014; 1(4): 86-90. Available online at www.iaimjournal.comReceived on: 20-11-2014 Accepted on: 01-12-2014AbstractCognitive deficits resulting in poor scholastic performance are common among children with specificlearning disabilities. Current study was carried out to identify areas of deficits leading to pooracademic performance followed by a home based remediation program for rehabilitation ofimpaired skills. Single case study method was opted and assessment of academic skills was doneusing NIMHANS Index for Specific Learning Disability (SLD). Assessment findings revealed significantimpairment in scholastic skills and attention processes. Management of identified deficits wasplanned and weekly sittings of remediation were provided for six months. Monitoring of therehabilitation package was done on every visit using charting method. Improvement in academicskills/ performance was seen in later sessions.Key wordsSpecific learning disability, Cognitive Impairments, Scholastic decline, Remedial training, Manualizedcognitive retraining.Introduction as per their presence such as disorder of reading, disorder of writing, disorder of spellingLearning disabilities are generally a composition and disorder of mathematical skills. Plenty ofof deficits in certain skills such as basic reading literature is available on origin and controversiesskills, reading comprehension, written involved in the diagnosis of specific learningexpression, receptive and expressive language disabilities; however, researchers have provedi.e. listening and speaking respectively, their efficacy to advocate the term adequately.mathematical reasoning and mathematical In past some time there has been a boom incalculation. Many of these deficits are generally researches related to assessment andpresent together and type of disability may vary rehabilitation of such disabilities; however,International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014. Page 86Copy right © 2014, IAIM, All Rights Reserved.
Psychological intervention for specific learning disability ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)there is lot more to explore in the mentioned about child’s clinical condition and itscondition. Rehabilitation programs for sufferers association with academic difficulties leading toof Specific Learning Disabilities have been found deterioration in scholastic performance.to be effective and current research was an Importance of treatment adherence andattempt to prove the efficacy of available compliance toward therapeutic work wasprograms/ treatment modalities. explained to them. Areas of deficits on SLD assessment were opted as target behaviors forCase report the therapy. Strategies to deal with them were explained as well. Each strategy was practiced inA nine years old boy was brought by his parents subsequent sessions and taught to the parents.with the complaint of poor academic skills A parallel home based intervention program wasresulting in frequent deterioration in academic also initiated using the same strategies. Targetperformance and failure in grade III. Owing to behaviors for the remediation involved:the complaints psychological assessment wasplanned. Basic assessment of his comprehension 1) Improving attention skillsand general awareness skills was done during 2) Enhancing reading skillsclinical interview. Samples of reading and 3) Enhancing writing skillswriting ability were also taken. Overall basic 4) Improving spelling abilityassessment did not suggest any intellectual In order to improve attention skills variousdeficit; however, learning difficulties were found methods of cognitive retraining were used liketo be prominent. Formal assessment of letter/color/number cancellation tasks, coloringintellectual functioning and learning disability tasks, auditory continuous performance andwas done using Malin’s Intelligence Scale for games like spot the difference between sameIndian Children (MISIC) [1] and NIMHANS Index looking pictures. Remediation of reading skillsfor Specific Learning Disability (SLD) [2] was done using whole word approach, workingrespectively. On formal assessment, his on improving phonetic skills, using reading drillsintellectual functioning was found to be above and paired reading. Improvement in writingaverage and learning disability was significant skills involved improvement in hand writing,for reading, writing and spellings. Impairment in improving writing speed, reducing punctuationattention skill was also identified. Psychological errors and improving vocabulary to use maturemanagement was planned and sessions were words while writing. In order to do the samespread into 24 sittings; once a week. strategies for improving writing abilities wereSimultaneous home based intervention program used like regular one page writing with use ofwas also initiated. Areas of deficit identified on timer (to control time limit while writing), proofSLD assessment were targeted for rehabilitation. reading and self correction, inserting andWeekly assessment of target behaviors i.e. poor correcting punctuations in running paragraphsscholastic/academic skills and poor cognitive along with regular learning of new words fromskills was done using behavioral charting to see dictionary. For improving spelling skills variousefficacy of remedial aids and cognitive spelling games were used such as scrabble, find the hidden words, crossword puzzles etc.retraining. Results and outcome of therapyThe therapeutic module Improvement was noticed in child’sTherapeutic work was started with psycho performance by reviewing parent’s weeklyeducation of parents. They were explained reports. No improvement was reported in firstInternational Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014. Page 87Copy right © 2014, IAIM, All Rights Reserved.
Psychological intervention for specific learning disability ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)week of therapy; however, improvement was under broad categories of information ornoticed after second week onwards. Weekly learning processes that involve inputcharting of target behaviors revealed improved (receiving/perceiving information throughattention as seen on attention tasks where child senses), integration (interpretation of thetook less time to complete the task as compared received stimuli), storage (repetition andto earlier. Improvement in reading skills was memorization of stimuli) and output (the stagenoted from the fluency of reading and reduced where stored information is recalled orhesitation. Improvement in spelling ability could recollected) [4]. Deficits in any of the areas ofbe noted as he took less time to solve puzzles, information processing may contribute toreduced spelling errors and also he could different types of specific learning disabilitiesidentify words in a word grid more quickly. and a person may have one or more than that atImprovement was also noted in child’s writing the same time [5]. Individuals with suchskills as neatness was seen in his hand writing, disabilities experience significant impairment inspeed of writing also improved with help of all areas of academics which cannot betimers and punctuation errors reduced accounted due to low level of intellectualsignificantly. Weekly progress of therapy and functioning, visual deficit, neurological damageimprovement in target skills was as per Graph - or inadequate educational environment [6].1. There is plethora of researches available displaying important findings about suchAnalysis of graph treatment modalities and shows great success ofThe graphical pattern clearly shows significant the same. Researches also indicateddecrement in time taken for writing particular effectiveness of neuropsychologicalamount of text; thus shows improved writing rehabilitation for treating learning disabilitiesspeed over the therapy weeks. Frequency of and are well established [7]. Current case workhesitation (while reading) decreased significantly included two types of treatment modalities i.e.in later weeks of therapy. The child took less remedial training and cognitive retraining. Thetime to complete attention tasks over therapy aim of the case work was to work on child’sweeks that indicates improved attention and cognitive and academic skills to improve hisconcentration. Punctuation errors were noted academic performance. The child was givenless in the last week of therapy that indicates intensive remedial sessions along with a parallelimproved quality of writing. Also, spelling errors home based remediation program supervised bywere noted to be reduced as therapy progressed his parents. Weekly review of progress chartin later weeks. Improvement can be seen in revealed improvement in target behaviors. If wetarget behaviors by comparing trends of second review the literature various studies have shownweek and sixth week of the shown graph that changes in brain functioning after intensiveindicates significant progress of the therapy. remediation programs given to such individuals. Studies using functional magnetic resonanceDiscussion imaging (FMRI) have shown vigor of neuroplastcity [8]. This is a process by whichLearning disabilities are described as a group of new connections are made among neurons bydisorders that are characterized by inadequate themselves. Researches comparing twoor insufficient development of specific experimental groups indicated that brainacademic, language and speech skills [3]. function changes were evident in neuro imagingLearning disabilities are generally described of those who attended intensive remedialInternational Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014. Page 88Copy right © 2014, IAIM, All Rights Reserved.
Psychological intervention for specific learning disability ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)program as compared to those who were not 2. Rao S, Subbakrishna DK, Gopukumar K.given such treatment. Reduced activation in left NIMHANS Neuropsychology Batteryparieto-temporal cortex in children that has Manual. NIMHANS, Bangalore, 2004.been found to be characteristic of learning 3. Wadsworth T. Childhood Voyages indisabilities [9] was found to be increased after Development; 3rd edition, 2008, p. 387.rigorous training and remediation program for Retrieved 2012-12-19.learning disabilities [10]. In recent years there 4. National Dissemination Center forhas been a boom in researches proving efficacy Children with Disabilities (NICHY), 2004.of psychological management for learning Accessed May 11, 2007.disabilities; however, there have been different 5. Amanda Kirby speaking on the co-purposes to conduct them. Few indicated occurrence of learning difficulties.importance of particular treatment modality dysTalk. Retrieved 2009-04-22.where others advocated efficacy of results 6. Sadock B.J., Sadock V.A. Synopsis ofbased on type and severity of learning disability. Psychiatry; Behavioral Sciences/ClinicalSome researchers showed efficacy of Psychiatry. 10th edition, Wolters Kluwercomputerized training for treating learning (India) Pvt. Ltd., New Delhi, 2007.disabilities [11]. On the other hand manualized 7. Malhotra S, Rajender G, Sharma V, Singhtreatment gave well established results in such TB. Efficacy of cognitive retrainingconditions [12]. Plenty of literature is available techniques in children with learningin this field; however there is lot more to find disability. Delhi Psychiatry J, 2009; 12(1):out in future researches. 100-106. 8. Tom Valeo. Dyslexia Studies CatchConclusion Neuroplasticity at Work, The Dana Foundation, New York, 2008.Combination of Manualized Cognitive Retraining 9. Temple, et al. Disruption of the neuralTechniques and Remedial Training can benefit response to rapid acoustic stimuli inindividuals with Specific Learning Disability and dyslexia: Evidence from functionalgive best results in improving scholastic MRI. Proc Natl Acad Sci USA, 2000; 97:performance. Manualized techniques are also 13907–13912.important and beneficial for those who cannotbear the cost of computerized retraining. Also, a 10. Temple, et al. Neural deficits in childrenparallel home based intervention program gives with dyslexia ameliorated by behavioralstrength to the therapeutic process and ensures remediation: Evidence from functionalbetter outcome. In current case, improvement MRI. Proc Natl Acad Sci USA, 2003; 100:was noticed in the target behaviors, thus 2860–2865.efficacy of both treatment modes along withparallel home based retraining program could 11. Talbot F, Pépin M, Loranger M.be proven. Computerized cognitive training withReferences learning disabled students: A pilot study. Psychol Rep. Dec, 1992; 71(3 Pt 2): 1347-56. 12. Malhotra S., et al. Comparative Efficacy1. Malin AJ. Malin’s Intelligence Scale for of Cognitive Retraining Techniques and Indian Children- Manual. Indian Remedial Training in Children with Psychological Corporation, 1969. Learning Disability, Delhi Psychiatry J, 2010; 13(2): 334-338.International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014. Page 89Copy right © 2014, IAIM, All Rights Reserved.
Psychological intervention for specific learning disability ISSN: 2394-0026 (P)Graph – 1: Graphical presentation of weekly progress of target behaviors. ISSN: 2394-0034 (O)6050 48 Writing Speed (In Mins) 45 Frequncy of hesitation while reading40 Attention Time (In Mins)30 29 30 31 Frequency in punctuation 26 26 error Frequncy in Spelling error 23 21 Linear (Writing Speed (In 19 Mins))20 15 Linear (Frequncy of hesitation 16 while reading) Linear (Attention Time (In 10 1112 12 1313 12 Mins)) 89 710 5 440 week3 week4 week5 week6 week2Source of support: Nil Conflict of interest: None declared.International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014. Page 90Copy right © 2014, IAIM, All Rights Reserved.
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