Struggling to read, write or count is a common problem for many children, but how do you know when that struggle is actually a learning difficulty or disability? SASHA GONZALES asked three experts to tell us what signs to look out for and when to know to get help.
Struggling to read, write or count is a common problem for many children, but how do you know when that struggle is actually a learning difficulty or disability? SASHA GONZALES asked three experts to tell us what signs to look out for and when to know to get help.
Amy* knew something was very wrong when her daughter, Letitia*, refused to go to school in the mornings.
The seven-year-old would throw tantrums, refuse to put on her uniform, and scream that she hated reading and writing because she didn’t understand certain words.
“She felt that her classmates were smarter than her because she couldn’t read and write as well as them,” Amy explains.
“When she was four or five, she did struggle somewhat with reading, writing and spelling, but I assumed it was normal and that she’d grow out of it by age six or seven.”
Letitia complained that she couldn’t make out most of the words that she came across in books. She was also still reversing letters and numbers when she wrote them.
Worried, Amy sent her daughter to an educational psychologist. She was shocked when told that Letitia had dyslexia and would likely continue to have problems recognising words and learning to read.
Since the diagnosis, Amy has been trying to get appropriate support from her daughter’s school as well as adjust her – and her daughter’s – expectations.
“My husband and I worry about her future,” Amy continues.
“Letitia is actually a smart, inquisitive and chatty girl. It pains me to think that she may continue to have problems making sense of words and expressing herself in writing, long after she’s left school.”
Dyslexia is a common learning difficulty among kids in Singapore, but it’s not the only one.
When your child has been diagnosed with such a problem, it can be frustrating getting him the help he needs, not to mention, distressing watching him struggle through what many of his peers find effortless.
Learning difficulties aren’t the same as learning disabilities. The latter is an intellectual disability, whereas the former, such as dyslexia, is not necessarily a sign of a child’s intellectual development or capabilities.
There is no medicine or medical treatment to treat or improve learning difficulties.
And while learning difficulties are lifelong conditions, it doesn’t mean that children with these problems cannot and will not succeed, says Dr Sanveen Kang-Sadhnani, clinical psychologist and centre manager at Thomson Paediatric Centre – The Child Development Centre.
“Early intervention can minimise the impact of a learning difficulty or disability. People with these problems can develop ways to cope with them,” Dr Kang-Sadhnani adds.
“Getting help earlier increases the chance of success in school and later in life. If the problem remains untreated, a child may begin to feel frustrated, which can lead to low self-esteem and other issues.”
But how do you know if your little one has a learning difficulty or disability to begin with? We asked three experts to tell us how to spot the signs of the most prevalent ones in Singapore as well as share some advice for getting help.
Dyslexia
WHAT IS IT?
This is a specific learning difficulty that affects a child’s fluency in reading, writing and spelling, says Sara Kayla Yeow, principal occupational therapist at Mindchamps Allied Care @ East Coast
Dyslexia affects three to five per cent of school- going kids in Singapore, says Dr Chitra Ramalingam, specialist in paediatric medicine at Raffles Children Centre.
SPOT THE SIGNS
• Letter reversals in reading and/or writing. For example, your child may write “p” as “b”, “d” as “q”, or “5” as “2”.
• Reversals in letter and number sequences. For instance, writing “on” as “no”, “bad” as “dab”, or “81” as “18”.
• Presence of transposition errors (when the positions of two or more digits are switched).
• Compromised differentiation in letters with the same beginnings. For instance, “sew”, “saw”, “sow”).
• Presence of omission or addition of words in reading and/or writing.
• Compromised ability to put thoughts down in writing, although the child is good with verbal responses.
• Compromised phonemic awareness. Phonemic awareness is recognising and differentiating the various letter sounds. When a kid has compromised phonemic awareness, he may confuse the “b” and “d” sounds, for example, because they do sound similar.
• Absence of punctuation in reading and/or writing.
• Complains that words are moving on a page (omitting any eye condition).
• Compromised handwriting.
• Disorganised in work and everyday tasks.
• Mixes up upper- and lower- case letters in a word.
• Compromised working memory.
• Compromised sequencing abilities.
• Compromised visual processing ability.
WHEN TO SEEK HELP
Children typically start learning to read between five and six years; this is when symptoms of dyslexia start to be more evident, Sara says.
She suggests getting help when any of the signs continues past the age of five to six.
HOW IT’S TREATED
Children with dyslexia often work with experts from other disciplines – behavioural psychologists, speech and language therapists, occupational therapists and/or educational therapists.
Sara says that occupational therapists work on improving a dyslexic child’s visual processing and sequencing abilities.
“Visual processing is the ability of our brain to make sense of the visual information as seen by our eyes. For instance, if the eyes see a circle, someone with visual processing difficulty would probably perceive it as an oval or octagon – these shapes are similar to a circle, she explains.
“Sequencing is the part of motor planning that has steps required to perform a task, in a logical manner. For instance, when writing a letter, we have to sequence the steps to writing the strokes – starting from which point, stopping at which point, continuation of which stroke, and so on.
“With writing a sentence, we have random ideas of words in our heads, but sequencing occurs when we put these random words into a logical sentence.”
Occupational therapists use a multi-sensory approach to come up with strategies for kids to learn more optimally, and also help with their understanding of directions in a sensory-integration approach and play- based environment.
Says Sara: “In our occupational therapy sessions, I sometimes blindfold the kids before creating an obstacle for them, with an item they have to retrieve that I have hidden.
“While they are blindfolded, I will give them directions, like ‘turn left, walk two steps forward’, until they get to the item. Being blindfolded does away with their sense of sight, but as a result, the other sensory systems work harder to achieve the goal.
“When they go through the obstacles, they are receiving quite a bit of sensory input – for example, there are tactile parts that make use of their sense of touch – in addition to their sense of hearing when they receive my verbal instructions.”
“Early intervention can minimise the impact of a learning difficulty or disability. People with these problems can develop ways to cope with them.”
Dysgraphia
WHAT IS IT?
“Dysgraphia is a specific learning difficulty that affects one’s handwriting ability and fine motor skills,” says Dr Kang-Sadhnani.
Problems may include illegible handwriting, inconsistent spacing, poor spatial planning on paper, poor spelling, and difficulty composing and writing as well as thinking and writing at the same time.
Dr Ramalingam believes that dysgraphia affects between five and 20 per cent of kids in Singapore, about the same as dyslexia rates around the world. She adds that it is under-recognised.
SPOT THE SIGNS
• May have illegible printing and cursive writing, despite appropriate time and attention given to the task.
• Writing shows inconsistencies: mixtures of print and cursive and uppercase and lowercase letters, or irregular sizes, shapes or slant of letters.
• Has unfinished words or letters, omitted words.
• Inconsistent spacing between words and letters.
• Exhibits strange wrist, body or paper position.
• Has difficulty pre-visualising letter formation.
• Copying or writing is slow or laboured.
• Shows poor spatial planning on paper.
• Has a cramped or unusual grip, may complain of sore hand.
• Has great difficulty thinking and writing at the same time (taking notes, creative writing).
WHEN TO SEEK HELP
Dysgraphia usually shows up when the child is school- aged, when he has had some experience with writing, says Dr Ramalingam.
HOW IT’S TREATED
Children with dysgraphia usually work with occupational therapists. These professionals try to improve hand strength and fine motor coordination skills, as well as teach your child the right arm position and body posture for writing.
Dyscalculia
WHAT IS IT?
This is a specific learning difficulty that affects a child’s ability to understand numbers and learn math facts, says Dr Kang-Sadhnani.
Kids with this type of learning difficulty may also have poor comprehension of math symbols, may struggle with memorising and organising numbers, have difficulty telling time, or have trouble with counting.
Dyscalculia tends to be underreported, but Dr Ramalingam believes it affects about five per cent of kids in Singapore.
SPOT THE SIGNS
• Shows difficulty understanding concepts of place value, quantity, number lines, positive and negative value, carrying and borrowing.
• Has difficulty understanding and doing word problems.
• Has difficulty sequencing information or events.
• Exhibits difficulty using steps involved in math operations.
• Shows difficulty understanding fractions.
• Is challenged making change and handling money.
• Displays difficulty recognising patterns when adding, subtracting, multiplying, or dividing.
• Has difficulty putting language to math processes.
• Has difficulty understanding concepts related to time such as days, weeks, months, seasons, quarters, and so on.
• Exhibits difficulty organising problems on the page, keeping numbers lined up, following through on long division problems.
WHEN TO SEEK HELP
Dr Kang-Sadhnani suggests getting professional help as soon as you recognise that your child is having difficulty with learning and/or keeping up with the demands of his classroom.
Like dysgraphia, dyscalculia manifests at school-going age. This is when your child is just starting to learn and apply simple mathematical concepts.
HOW IT’S TREATED
Dr Ramalingam says that an educational psychologist can help evaluate what the child needs and recommend the most appropriate treatments.
“Like kids with dysgraphia, most children with dyscalculia will continue on to mainstream schools as long as they have the right support,” she adds.
Dyspraxia
WHAT IS IT?
This condition, also known as developmental coordination disorder, affects fine and/or gross motor skills. A child with dyspraxia finds it difficult to carry out smooth and coordinated movements and may have problems with verbal and oral skills, information processing, and other cognitive abilities.
Sara says that dyspraxia is fairly common in Singapore, affecting one in 10 to 15 children.
SPOT THE SIGNS
• Compromised hand-eye coordination.
• Poor balance, often looks clumsy; trips over things or self easily.
• Takes a long time to learn a new task.
• Lacks rhythm and timing.
• Compromised sequencing ability.
• Poor sense of direction.
• Poor coordination between the two sides of the body.
• Exaggerated or “unnecessary” movements when performing gross motor tasks (for example, running, while swinging arms excessively).
• Compromised ability to remember multi-stepped instructions.
• Compromised social relationships.
• Lacks imagination in play.
• Challenges with handwriting.
WHEN TO SEEK HELP
If your kid has problems with motor planning and coordination, it might be a good idea to get him assessed for dyspraxia.
Motor planning consists of ideation (having an idea of what the task is), planning and sequencing (having ideas about how to perform the task, and organising these ideas into a logical sequential manner), and execution (literally, performing the task).
HOW IT’S TREATED
In occupational therapy, Sara says that they work on improving your child’s ideation (for instance, creating and demonstrating different play themes – initially, with him imitating – and later with him coming up with his own ideas) and sequencing (such as allowing him to try a task in his own way, and if it fails, to work through another plan that could lead to a better outcome the next time around).
They do this through play (like creating and climbing obstacle courses, or imaginary play like doctor or a chef in the kitchen).
Since coordination is another area of concern in dyspraxia, they do a lot of left-right coordination (like catching a beach ball with both hands), upper and lower body coordination (for example, jumping jacks), and they also have activities that help the child work on crossing the midline (such as getting him to touch his right hand to his left knee).
Of course, she adds, these are also conducted through play instead of boring or routine “workout exercises”.
“With these play-based activities, we are also targeting the kids’ balance, core control and strength, as well as midline organisation (we help him understand where the ‘middle’ of his body is, so that he can react accordingly when he is ‘off balance’).
“Once their ‘bigger muscles’ – for instance, their core muscles – are deemed ready, they can then move on to handwriting activities, starting with pre-writing activities like cutting, tearing of scrap paper, colouring and so on, before moving on to writing proper,” Sara adds.
*Names have been changed.
Why autism is not a learning disability
Autism spectrum disorder is actually a neurological condition, says Sara Kayla Yeow, principal occupational therapist at Mindchamps Allied Care @ East Coast.
It can significantly impair the development of a child’s motor skills, language and communication skills and social interaction.
So, while autism is not a learning disability or difficulty, it certainly does affect learning.
Learning difficulties vs learning disabilities
Learning disabilities are intellectual disabilities – that is, they are linked to an overall cognitive impairment.
People with learning disabilities have difficulty with everyday activities; they also tend to have an IQ of lower than 70. Learning disabilities can be mild, moderate, severe or profound.
Learning difficulties are conditions such as dyslexia, dyscalculia and dyspraxia, and kids with these conditions may have normal intellectual development or capabilities. There is no medicine or medical treatment to treat or improve learning difficulties.
PHOTOS 123RF & MASTERFILE
