Noreena Kausar  ( Department of Psychology, University of Gujrat, Pakistan. )
Nadia Farhat  ( Department of Psychology, University of Gujrat, Gujrat, Pakistan. )
Fauzia Maqsood  ( Department of Sociology, University of Gujrat, Pakistan. )
Hafsa Qurban  ( Department of Psychology, University of Gujrat, Pakistan. )

Objective: To examine the frequency of specific learning disorder among primary school children.

Methods: The cross-sectional study was conducted from January to July 2018 in Sarai Alamgir, Gujrat, Pakistan, and comprised children studying in 3rd and 4th grades of six local public and private primary schools. Data was collected using structured clinical diagnostic interviews based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Data was analysed using SPSS 16.

Results: Of the 837 subjects, 413(49.3%) were from private schools and 424(50.7%) from public schools. A total of 174(20.7%) children were found vulnerable to specific learning disorders, while 13(7.5%) of them were diagnosed as suffering from different specific learning disorders. Of these 13 subjects, 1(7.7%) child had reading impairment, 3(23.1%) had mathematics impairment, 4(30.8%) had multiple impairment in mathematics and writing, 1(7.7%) had multiple impairment in mathematics and reading, 1(7.7%) had multiple impairment in reading and writing, and 3(23.1%) had multiple impairment in mathematics, reading and writing.

Conclusion: Specific learning disorder was found to be prevailing in public and private school children.

Keywords: Specific learning disorder, Diagnostic and statistical manual of mental disorder, Screening tool. (JPMA 71: 1193; 2021)

DOI: https://doi.org/10.47391/JPMA.1092

 

Introduction

 

Mental and physical health of individuals are at stake, especially in developing countries like Pakistan where basic needs remain unmet for a large portion of population. A study¹ reported that 85% population from the developing and 50% from the developed countries have mental illness receive no treatment. Mental illness problems are high in low- and middle-income countries (LMICs).²

Children in Pakistan are also facing crisis related to their basic needs, inlcuding health services. Research on child mental health is a neglected area in Pakistan.³ This includes neuro-developmental issues, like specific learning disorder (SLD), which impedes the ability to learn specific educational abilities that are the basis for other educational learning.⁴ SLD happens not due to lack of instructions.⁵ There are different forms of SLD, such as reading, written expression, spelling and mathematical problems.⁶ The Colorado Department of Education has reported eight areas of SLD.⁷ The most common areas of SLD are written expression, reading and mathematics among schoolchildren and adolescents.^8-10 Individuals with SLD may perform well in one area while in other area they face some difficulties.¹¹ A study¹² reported that every 10th child has to face difficulties in one or more areas of school curriculum, and the most common impairment areas are spelling and reading. The American Psychiatric Association (APA) has described three SLD categories: impairment in reading called dyslexia, impairment in written expression called dysgraphia, and impairment in mathematics called dyscalculia.⁴ Its severity level can range from mild to severe. Dyslexia is very common and 70-80% of SLD students suffer in this category.⁴ On the other hand, dysgraphia prevalence is 1-6.5% across different countries.⁸ If proper attention is not given, SLD creates many problems, such as low confidence level, high proportion of school expulsion, low achievement and high psychological dysfunction.⁴ These three categories can be present separately and with other categories. Many studies have reported that these three categories also have relationship with each other.^13-15 One study¹⁶ observed the prevalence of SLD among third and fourth grade students in Germany based on criterion outlined by the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-V), and reported that the prevalence rate of arithmetic and spelling was higher than the rate of arithmetic and reading, and the association between arithmetic and reading differed from the association between arithmetic and spelling. Another study¹⁷ reported that the ratio of reading, arithmetic and spelling deficits were four to five times higher.

In Pakistan, a study¹⁸ explored the prevalence rate of SLD among 3rd, 4th and 5th grade schoolgirls, and found that from 200 girls, 75 had SLD. Another study¹⁹ identified 5.37% ratio of dyslexia in students of 6th, 7th and 8th grades, and boys had higher ratio than girls. One study²⁰ reported that there was no difference in SLD according to gender. The current study was planned to explore the frequency of SLD among primary school students and SLD's relation to gender.

 

Subjects and Methods

 

The cross-sectional study was conducted from January to July 2018 in Sarai Alamgir, Gujrat, Pakistan. After taking approval from the institutional ethics review board of University of Gujrat, the sample was raised using multistage stratified sampling technique from among children aged 8-9 years studying in 3rd and 4th grades of 6 private and government schools (Figure).

Children with any physical or mental disorder other than SLD were excluded. After getting permission from school authorities, the students were approached in their classes, and data was collected by using proportional allocation method.

The data-collection tool consisted of four parts. The first part was related to informed consent, while the second part gathered demographic information. The third part had screening questions to separate vulnerable cases of SLD, while the fourth part was about the diagnostic criterion of SLD. The screening tool had 10 items to measure vulnerability to reading, mathematics and writing disabilities. The items were scored Yes/No, with 'Yes' indicating vulnerability. The diagnostic tool was used to assess the diagnostic criteria of SLD on all the vulnerable cases. It consisted of 29 items based on DSM-V.⁴ Each SLD sub-category was assessed by applying the diagnostic criteria relevant to the disorder.

Data was analysed using SPSS 16. Descriptive data was expressed as frequencies and percentages. T-test was used to assess the gender difference in SLDs.

 

Results

 

Of the 914 students, 837(91.5%) participated; 413(49.3%) from private schools and 424(50.7%) from public schools. A total of 174(20.7%) children were found vulnerable to SLDs, and 13(7.5%) of them were clinically diagnosed as suffering from SLDs. Of these 13 subjects, 1(7.7%) child had reading impairment, 3(23.1%) had mathematics impairment, 4(30.8%) had multiple impairment in mathematics and writing, 1(7.7%) had multiple impairment in mathematics and reading, 1(7.7%) had multiple impairment in reading and writing, and 3(23.1%) had multiple impairment in mathematics, reading and writing (Table-1).

Among the diagnosed cases, there were 6(46.2 %) boys and 7(53.8%) girls (Table-2).

There was significant gender difference related to impairment in mathematics and writing (Table-3).

 

Discussion

 

There were 20.7% participants vulnerable to SLDs and of them 7.5% were diagnosed with SLD. The findings are similar to 7.6% prevalence reported by a study in Brazil.

In the current study, the prevalence ratio of participants in impairment in mathematics was also high at 23.1% compared to 5% reported earlier²² in the United Kingdom, but the UK is in the group of high-income countries (HICs). Also, the current study found high prevalence of impairment in mathematics and writing at 30% which is high compared to 10% reported by a study done in Lahore.²³ Though part of Pakistan, Lahore happens to be a major city, while Sarai Alamgir is small a town, and that may explain the difference.

In the current study, there was no difference in reading impairment related to gender. The finding is in line with a local study.²⁰ The current study reported high writing impairment prevalence among boys compared to girls, and the results are consistent with earlier findings.²⁴ Also, the finding that girls had more mathematics impairment compared to boys is supported by literature.²⁵

The current study has some limitations as it was conducted only in primary schools of a small town. Despite the limitation, however, the study, which is the first one done on the subject in Sarai Alamgir town, is helpful in evaluating the prevalence of SLD in primary schools of the area.

 

Conclusion

 

Findings suggest that schoolchildren may face some problems related to their brain functioning which directly hinder their academic learning. There is a need to understand the issue and to develop some policy which may cater to such cases.

 

Disclaimer: None.

Conflicts of Interest: None.

Source of Funding: None.

 

References

 

1.      Pescosolido BA, Lafsdottir SO. Beyond dichotomies: Confronting the complexity of how and why individuals come or do not come to mental health care. World Psychiatry. 2013; 12:269-71.

2.      Thyloth M, Singh H, Subramanian V.  Increasing burden of mental illness across the globe: Current status. [Online] 2016 [Cited 2021 Jan 26]. Available from: URL: https://www.indjsp.org/text.asp?2016/32/3/254/193208

3.      Jamali T, Tanzil S. Child mental health research in Pakistan; Major challenges and pitfalls: A systematic review.  Pak J Pub Health. 2016; 6:18-23.

4.      American Psychological Association. Diagnostic and Statistical Manual of Mental Disorders 5th ed. USA: American Psychological Association, 2013.

5.      Dyslexia-SPELD foundation literacy services. Understanding learning difficulties: A guide for parents. South Perth, Western Australia. [Online] 2017 [Cited 2019 October 12]. Available From: URL: URL:https://dsf.net.au/wpcontent/uploads/2017/02/clinical-services.pdf.

6.      Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ. Math learning disorder: Incidence in a population-based birth cohort, 1976-82, Rochester, Minn. Ambul Pediatr. 2005; 5:281-9.

7.      Connecticut State Department of Education. Guidelines for identifying students with specific learning disabilities. Colorado: [Online] 2010 [Cited 2019 September 03]. Available From:  URL: https://portal.ct.gov/-/media/SDE/SpecialEducation/2010_Learning_Disability_Guidelines_Acc.pdf.

8.      Japha AE, Landau YE, Frenkel L, Teicher M, Tsur GV, Shalev RS.  ADHD and dysgraphia: Underlying mechanisms. Cortex. 2007; 43:700-9.

9.      Becketta A, Ellisona N, Barretta S, Shaha S. Away with the fairies? Disability within primary‐age children's literature. Disabil Soc. 2010; 25:373-83.

10.    Callens M, Tops W, Brysbaert M. Cognitive profile of students who enter higher education with an indication of dyslexia. PLoS One. 2012; 7:1-14.

11.    Bhise CD, Desetty RV. Writing errors of elementary school children and their selected background variables. Indian Psychol Rev. 2004; 62:189-95.

12.    Prior M. Understanding specific learning difficulties. UK:  Psych Press Publisher, 1996.

13.    Ehri L. Learning to read and learning to spell: Two sides of a quenching program for reading, spelling, and speech. Austin, Texas: Pro-Ed; 2000.

14.    Fitzgerald J, Shanahan T. Reading and writing relations and their development. J Educ Psychol. 2000; 35:39-50.

15.    Pape SJ. Middle school children’s problem-solving behaviour: A cognitive analysis from a reading comprehension perspective. J Res Math Educ. 2004; 35:187-219.

16.    Moll K, Kunze S, Neuhoff N, Bruder J, Schulte-Keorne G. Specific learning disorder: Prevalence and gender differences. PLoS ONE. 2014; 9:e103537.

17.    Landerl K, Moll K. Comorbidity of learning disorders: Prevalence and familial transmission. J Child Psychol Psychiatry. 2010; 51:287-94.

18.    Irshad EE. Specific learning difficulties: Diagnosis and implication for social psychological functioning [Unpublished doctoral dissertation]. Peshawar: University of Peshawar. [Online] 2005 [Cited 2019 September 3]. Available from:URL:http://prr.hec.gov.pk/jspui/handle/123456789//6107. 

19.    Ashraf M, Majeed S. Prevalence of dyslexia in secondary school students in Lahore. Pak J Psychol Res. 2011; 26:73-85.

20.    Ashraf F, Najam N. Identification of learning disabilities in students: A gender perspective. Pak J Soc Clin Psychol. 2017; 15:36-41.

21.    Fortes IS, Paula CS, Oliveira MC, Bordin IA, de Jesus Mari J, Rohde LA. A cross-sectional study to assess the prevalence of DSM-5 specific learning disorders in representative school samples from the second to sixth grade in Brazil. Eur Child Adolesc Psychiatry. 2016; 25:195-207.

22.    Morsanyi K, Van Bers BMCW, McCormack T, McGourty J. The prevalence of specific learning disorder in mathematics and comorbidity with other developmental disorders in primary school-age children. Br J Psychol. 2018; 109:917-40.

23.    Ashraf F, Najam N. Validation of learning disabilities checklist in public sector schools of Pakistan. Pak J Psychol Res. 2014; 29:223-44.

24.    Naeem F, Mahmood Z, Saleem S.  Dyslexia a myth or reality: Identification of dyslexia in school children of grade fourth and fifth. Fatima Women Uni Soc Sci. 2014; 8:1-9.

25.    Dirks E, Spyer G, van Lieshout ECDM, de Sonneville L. Prevalence of combined reading and arithmetic disabilities. J Learn Disabil. 2008; 41:460-73.