Assessment & Certification in

Specific Learning Disability - (SLD)

Arun Selvaraj
M.Sc., M.Phil. in Clin. Psych. (NIMHANS)
Consultant Clinical Psychologist
RCI CRR No A94418
Sneka Mind Care Centre
Tirunelveli
Contents

➔ SLD - Overview
➔ Research Evidence - Prevalence
➔ Symptom Manifestation
➔ Assessments - NIMHANS SLD Battery
➔ Certification process
➔ Rehabilitation Process
Specific Learning Disability (SLD)
Dyslexia | Dysgraphia | Dyscalculia | Mixed
Specific Learning Disorders

Specific learning disorder is an umbrella term for a group of neurodevelopmental disorders that
are typically diagnosed in early school-aged children, although it may not be recognized until
adulthood.

They are characterized by a persistent impairment in at least one of the following areas

➔ Reading
➔ Written expression
➔ Math &
➔ Mixed
RPWD Act 2016

SL disabilities as per RPWD Act 201 6

"Specific learning disabilities" means a heterogeneous group

of conditions wherein there is a deficit in processing language,
spoken or written, that may manifest itself as a difficulty to
comprehend, speak, read, write, spell, or to do mathematical
calculations and includes such conditions as perceptual
disabilities, dyslexia, dysgraphia, dyscalculia, dyspraxia and
developmental aphasia.
SLD vs Intellectual
Disability (ID) The psychological testing usually includes
testing for cognitive abilities (CA) and
testing for academic abilities (AA).

Discrepancy between the cognitive abilities

vs academic abilities clinches the diagnosis.

CA > AA

Specific Deficits in Scholastic activity.

Prevalence
Research Evidence
Meta-analysis of Indian Studies

● Included six studies

● Comprising N= 8133 children
● This systematic review reports an
● 8% prevalence of SLD in India
● Sub-group analysis couldn't be done
Prevalence

It is estimated to affect between 5% and 15% of school-aged children. Whereas among children's in the
USA was 9.7% - (Altarac & Saroha 2007, Pediatrics)

Prevalence among adults is unknown, but is estimated at approximately 4%.

The prevalence of SLD among specific academic areas in school-aged children is variable

➔ reading 5– 17%
➔ mathematics 6– 7%
➔ written expression 7– 15%
Prevalence

It is more common among Boys > Girls.

Boys may be more likely to be clinically referred because of greater prevalence of co-occurring attention
deficit hyperactivity disorder or problematic externalizing behaviors.

Among community samples, the gender ratio of males to females ranges from 1.5:1 to 3:1.

This ratio appears greater in clinical samples (estimated at 6:1).

(ICD-11)
Early Symptom Manifestation
Clinical Presentation
Common Reason for Consultation

Usually, parents bring them for

➔ Behavioural/ Emotional problems (Both internalizing & externalizing problems)

➔ School refusal/ ODD /CD /Depression
➔ Academic decline (lazy/ stupid/ trouble creator)

Referral from school

Academic decline / difficulties — poor scores, writing slowly, not completing homework, poor
handwriting, not completing writing tasks, spelling mistakes, reading slowly, reading word by word,
reading without punctuation, mistakes while doing arithmetic and so forth.
Process in Diagnosis of SLD

A diagnosis is made through a combination of

➔ Detailed clinical evaluation

➔ Observation
➔ Interviews
➔ Family history and
➔ School teacher's reports.
➔ Reviewing homework notebooks/ Exam Answer sheets
RPWD Act, 2016 & 2024

Guidelines for Disability

Evaluation & Certification
Diagnostic Guidelines

A diagnosis of specific learning disability will be given if all the following criteria are fulfilled

➔ IQ 85 or more
➔ No vision and /or hearing impairment which are likely to affect learning.
➔ No emotional and behavioral disorders mimicking SLD
➔ Presence of adequate opportunity for learning with proper motivation
➔ The child is functioning at 3 standard deviations below the current class on NIMHANS SLD battery
or his/ her GLAD score is below 40% for the child’s current class level.
Roopesh, B. N. (2020).
Assessment & Certification Process
RPWD Act, 2016
IQ Testing - Cognitive Abilities

Assessment of the child's level of Intelligence by measuring IQ can be done using Standardized IQ
tests

➔ Binet-Kamat Test (BKT),

➔ Malin's Intelligence Scale for Indian Children (MISIC),
➔ Wechsler's Intelligence Scale for Children-4th Edition (WISC-IV)
Grade Level
Assessment Device
- GLAD
NIMHANS SLD Battery
 NIMHANS SLD Battery

Level 1 = 5– 7 years Level 2 = 8 -12 Years

1. Attention 1. Attention Test

2. Visual Discrimination 2. Memory (Verbal & Non-verbal)
3. Visual Memory 3. Visuospatial Functioning/ Perceptual
4. Auditory Discrimination Motor Abilities
5. Auditory memory
4. Language
6. Visual Motor Screen
a. Reading
7. Speech & Language b. Comprehension
8. Alphabets c. Spelling
9. Phonic Skills d. Writing
10. Numbers 5. Arithmetic
Case Sample & Protocol
Case Vignette

Master JR, 12 year 4 months old boy, currently doing his 7th std. (Govt. Tamil Medium), 1st born out of
non-consignuous marriage, hailing from LSES, residing in Muthusamypuram, Virudhunagar District.

Presented with the complaints of episodes of forgetting & wandering behavior, academics difficulties,
school refusal, palpitations, anger-outbursts and sleep disturbances for the duration of 3–5 months. Was
taken to Neurologist & Pediatrician and later referred for psychiatrist opinion.

K/C/O - Dissociative fugue, ? SLD

Pharmacological - Anti-Anxiety Medications

Psychological - Assessment, Psychoeducation of Findings (Parents & School), PMT & Skill Building.
IQ Assessment - MISIC
Roopesh, B. N. (2020).
NIMHANS SLD Battery - Reading Subtest (Level 2)
NIMHANS SLD Battery - Comprehension Subtest (Level 2)
NIMHANS SLD Battery - Spelling Subtest Response Sheet (Level 2)
NIMHANS SLD Battery - Spelling Subtest Scoring (Level 2)
NIMHANS SLD Battery - Written Expression - Copy Subtest (Level 2)
NIMHANS SLD Battery - Written Expression - Production Subtest (Level 2)
NIMHANS SLD Battery - Arithmetic Subtest (Level 2)
NIMHANS SLD Battery - Visuospatial Functioning/ Perceptual Motor Abilities Subtest (Level 2)
El-Hattab et al. (2010)
Sample Certificate
SLD Exemption from Second Language & Third Language

Disability Benefits
Extra Time in Exam

Scribe Facilities

Provision of Reader

Use of Calculator

Condoning/ Excuses from Spelling Mistakes

Other sig. Accommodations during the exam

Neuronal Correlates - SLD
 SLD Types Brain Areas Involved/ Localization

Dyslexia Left temporoparietal cortex

Impairment in Reading Left occipitotemporal cortex (Word Recognition & Phonological Reasoning)

Dysgraphia Premotor cortex (planning and executing fine motor movements)

Impairment in Written Parietal cortex (sensorimotor integration required for handwriting)
expression

Dyscalculia Intraparietal Sulcus (numerical cognition and mathematical processing)

Impairment in Mathematics
SLD - Rehabilitation
Rehabilitation Process

➔ Assessment and Diagnosis

➔ Individualized Education Plan (IEP) - Educational Interventions
➔ Cognitive Behavioral Therapy (CBT)
➔ Skill Building
➔ Parent and Teacher Involvement - Education/ Career plans/ Transition Planning
➔ Psychosocial Support
➔ Advocacy and Rights Awareness
➔ Continued Support and Monitoring
Hope in rehabilitation

➔ The neurobiology of SLDs offers hope through the lens of neuroplasticity.

➔ Targeted interventions, such as phonics-based reading programs for dyslexia, have demonstrated
the brain’s ability to undergo structural and functional changes

Shaywitz SE, Shaywitz BA, Pugh KR, et al (2004)

Take Home/Clinic Message !

SLD can be screened from the age of eight (8) or by 3rd standard

The certification will be done for children aged eight years and above only.

The child will have to undergo repeat certification at the age of 14 years and at the age of 18 years. The certificate
issued at 18 years will be valid life-long

The Children with SLD have high risk of developing internalizing & externalizing disorders
Take Home/Clinic Message !

SLD is a potentially disabling condition that interferes with adaptation at school and in society.

Providing a legal support and availing disability benefits can provide opportunities & welfare measures to
the individual and the family.

Children with SLD, who don't receive interventions - can be a high cost to the society, family and to
themselves. Therefore, not identifying & treating SLD’s can be potential damage to society.
Movies related to SLD
Taare Zameen Par/ Like a stars on earth
For Referrals

Sneka Mind Care Centre,

Psychology Unit
South Bypass Road
Near Saravana Stores
Tirunelveli

Child & Adolescent Clinic

On Every Saturdays
Contact Details

● +91 7305221870

● arunselvarajoffi[email protected] Thankyou
● [email protected]

● inpsydout