cholastic achievement has become an index of child’s future
in this highly competitive world. Unrecognized and unresolved,
scholastic backwardness has a lifelong impact on the child and
adolescent, affecting school completion, higher education,
interpersonal relationships, prospects for employment, marriage etc.
Awareness of the varying causes, methods of presentation and the
principles of management are essential to be known by all physicians
dealing with children.
During the last decade, the learning disability
movement has definitely picked up momentum in India, and more and
more children with this ‘invisible handicap’ are being identified.
There is paucity of epidemiological studies in India to determine
the exact prevalence of scholastic backwardness. Studies confirm
that a large percentage of school dropouts in India are due to
unsatisfactory academic performance . The prevalence may be the
same or slightly more than the western figure of 20% of the child
and adolescent population .
Scholastic backwardness has a multifactorial
1. Neurodevelopmental disorders Specific
learning disability: Specific learning disabilities (SpLD) viz.
dyslexia, dysgraphia and dyscalculia is a generic term that refers
to a heterogeneous group of disorders manifested by significant
unexpected, specific and persistent difficulties in the acquisition
and use of reading (dyslexia), writing (dysgraphia) or mathematical
(dyscalculia) abilities despite conventional instruction, average or
above average intelligence, proper motivation and adequate
socio-cultural opportunity. SpLD, an invisible handicap, constitute
an important cause of poor school performance in children and are
presumed to be due to central nervous system dysfunction.
ADHD: ADHD may be accompanied by
learning disabilities, depression, anxiety, conduct disorder, and
oppositional defiant disorder. ADHD makes the individuals less
available for learning because of the activity level, inattention,
Slow learners: Children with an IQ
range of 70-89 are classified as slow learners. Slow learners are
those with below average cognitive abilities who are not disabled,
but who struggle to cope with the traditional academic demands of
the regular classroom.
Mental retardation: Children with
mental retardation, with IQ below 70 have a generalized learning
deficit differing from specific learning disability such as
dyslexia, which is significant in severity. The common genetic
causes of MR include Down’s syndrome, Fragile X, and Klinefelter’s
Language disorders: From 1% to 13% of
the population have either a developmental expressive or receptive
language disorder. As most learning takes place in schools through
the medium of language, children with language disorders struggle in
Autism spectrum disorder:
Autism exists with any level of intelligence, but many individuals
with autism suffer also from learning disability. The core features
of autism - social, emotional, communication and language deficits
interfere at all levels learning and psychosocial functioning.
2. Emotional disorders
Emotional disorders such as anxiety,
obsessive-compulsive, mood disorders, depression, and psychosomatic
disorders are common in children. Conduct disorders, oppositional
defiant disorders are also seen in children frequently and may occur
as comorbid with ADHD.
3. Environmental factors
Poor school performance may also be due to
environmental factors especially at home, school and friends [3,4].
4. Medical factors
This may the direct effect of the condition
itself, or due to effects leading to recurrent school absenteeism,
adverse effects of medication, poor self-esteem affecting motivation
and performance. Common chronic conditions such as asthma,
allergies, repeated otitis media, lead poisoning, cancer, epilepsy,
cerebral palsy type 1 diabetes mellitus, hypothyroidism, hearing
loss - even unilateral  and visual impairment, are known to be
associated with poor academic performance.
There are warning signs that teachers and parents
can look out for. Avoidance of reading and writing, tendency to
misread information, difficulty in summarising text, reading /
comprehension problems, trouble with open ended problems, continued
difficulty with spelling, poor grasp of abstract concepts,
difficulty in learning the languages and poor ability to apply
mathematical skills are some of the signals that could be closely
Formal assessment for diagnosis of a specific
learning disability includes Wechsler intelligence tests (WAIS – III
or WAPIS –Indian Adaptation) or Stanford Binet-IV. Academic skills
may be assessed using Graded Word Lists and Reading Comprehension
List compiled by Wima H Miller, NIMHANS Index of Specific Learning
Disabilities, Mann-Suiter Written Language Expression Screen,
Developmental Word Vocabulary Lists etc.
Remediation, life skills training and management
of co-morbid conditions need to go hand-in-hand with development of
appropriate support systems to ensure that the learning disabled
develop to his potential.
Role of Indian Academy of Pediatrics
The Indian Academy of Pediatrics is committed to
support all programs for the child and adolescent and this year has
taken an important step in helping children with learning disorders
by reinforcing the IAP Action Plan 2011 – Poor Scholastic
Performance Program (PSPP) – which envisages creating an awareness
about this problem among the public, school teachers,
administrators, school boards and among paediatricians. Advocacy in
this field also finds a place of importance in this program. We hope
that with a combined effort of IAP workforce, there would be some
relief for the large number of children and adolescents in our
country who are suffering as a result of this invisible handicap.
Acknowledgments: I would like to thank Dr
MKC Nair, National Chairperson and Dr Jeeson C Unni, the National
Convenor for implementing this program throughout the country. I
acknowledge the help of Dr Seany T Varghese, Assistant Professor of
Pediatrics, PIMS, Thiruvalla for preparing this article.
1. Pratinidhi AK, Kurulkar PV, Garad SG, Dalal M.
Epidemiological aspects of school dropouts in children between 7 – 5
years in rural Maharashtra. Indian J Pediatr. 1992;59:423-7.
2. Zill N, Schoenborn CA. Developmental,
learning, and emotional problems. Health of our nation’s children,
United States, 1988. Adv Data. 1990;16:1-18.
3. Lawrence S, Neinstein MD. Adolescent Health
Care – A Practical Guide, 3rded. Baltimore USA; Lippincott, Williams
and Wilkins; 2003. p. 1124 -41.
4. Nair MKC, Paul MK, Padmamohan J. Scholastic
performance of adolescents. Indian J Pediatr. 2003;70:629-31.
5. Ruben RJ. Effectiveness and efficacy of early
detection of hearing impairment in children.ActaOtolaryngol. 1991;