Mixed (expressive-receptive) Language Disorder Identification
The difficulties may occur in communication involving both verbal language and sign language. The language difficulties interfere with academic or occupational achievement or with social communication. A child having this disorder has the difficulties associated with expressive language disorder e.g. markedly limited vocabulary, errors, intense difficulty recalling words or producing sentences with developmentally appropriate length or complexity, and general difficulty in expressing ideas. The child also has impairment in receptive language development. Mixed receptive expressive language disorder may be either acquired or developmental.

Academic Skills Disorder
Many aspects of speaking, listening, reading, writing, and arithmetic, overlap and build on the same brain capabilities. So it is not surprising that people can be diagnosed as having more than one area of learning disability. Therefore, any disorder that hinders the ability to understand language will also interfere with the development of speech, which in turn hinders the ability to read and write. A single gap in the brain operation can disrupt many types of activity.

• Developmental Reading Disorder (Dyslexia) :
  This disability affects 2-8% of elementary school children worldwide. Dyslexia is not a disease, but describes a mind that learns in a different way from other people. Each person with dyslexia has different strengths and weaknesses, although many have unusual talents in art, athletics, architecture, graphics, drama, music or engineering. All these tasks require a rich, intact network of nerve cells that connect the brain centres of vision, language, and memory. If the brain is unable to form images or relate new ideas to those stored in memory, the child cannot understand or remember the concepts. The disturbance in reading significantly interferes with academic achievement or with activities of daily living that requires reading skills.
• Developmental Writing Disorder (Dysgraphia)
  Also referred to as dysgraphia, learning differences in writing skills involve difficulty with fine motor skills such as motor memory, muscle coordination, and movement in writing. Evidence suggests it may be hereditary. Disabilities in basic writing affect the learner’s ability to write words with correct spelling, appropriate word choice, and basic mechanics such as letter formation, grammar, and punctuation. People with learning differences in basic writing may not understand the relationship between letters and the sounds they represent and often can not distinguish the correct written word from the incorrect word.
• Arithmetic Disability (Dyscalculia):
  Arithmetic is a complex process and it refers to the inability to perform operation in mathematics or arithmetic. It could be described as an extreme difficulty with numbers. A number of different skills may be impaired in mathematics disorder, including linguistic skills e.g. understanding and clustering objects into groups, etc. Child may feel frequent difficulties with arithmetic, confusing the signs; s(he) may also feel difficulty conceptualizing time and often have poor sense of direction. The child may feel problem in measurement of distance and in understanding and doing word problem.

Motor Skills Disorder:
These disorders include delays in acquiring language and academic skills that can affect the ability to learn, but do not meet the specific criteria for diagnosis of learning disability. In this disorder the child may show poor balance, can easily bump into things and can be clumsy e.g. trip over easily and often spill or drop things. S(he) may have poor hand-eye coordination and may also feel inability to coordinate both sides of the body simultaneously. For the children with motor skills disorder practical tasks prove very hard e.g. riding a bike, using keyboard and mouse. Children may be extra sensitive to noise, touch, light and taste and find difficulty in concentrating for a period of time. Often fine motor task (e.g. coloring) are also impaired.

Stuttering:
In stuttering, speech is characterized by marked repetition of some sounds or words and disturbance in verbal fluency i.e. the speaker finds difficulty in stopping a sound. It is originally contrasted with stammering, but both terms are now used to describe speech which is not fluent. It also includes the symptoms of prolongations of sounds, long pauses between words, substituting easy words for those that present difficulty in articulating (like words beginning with certain consonants) and repeating whole words (like saying go, go, go, go instead of just a single “go”).

Speech and Language Disorder Identification
To diagnose speech and language disorders a speech therapist tests the child’s pronunciation, vocabulary, and grammar and compares them to the developmental abilities since in most children of that age. Psychologist tests the child’s intelligence, physician checks for any ear infections, and an audiologist may be consulted to rule out auditory problem. If the problem involves articulation, a doctor examines the child’s vocal cord and throat.


Impact Of Learning Differences On Children & Role Of Caregivers
For children with learning differences, learning and school is a nightmare and the future seems filled with endless struggling and failure. Demoralization, low self-esteem and deficits in social skills may also be associated with learning disorders. Social indicators of children with learning differences may include impulsiveness, frustration, poor sportsmanship, and difficulties with creating friendships, accepting changes in routine, interpreting subtle or nonverbal cues, and working with others. The lack of self esteem experienced by students with learning differences might create feelings of inadequacy or inferiority, which could be impediment to establishing social relationships. The school drop-out rate for children or adolescents with learning disorders is reported at nearly 40% or approximately 1.5 times the average.

With learning difficulties, children have trouble expressing their feelings, calming themselves down, and reading nonverbal cues, which can lead to difficulty in the classroom and with their peer group.

Social and emotional skills are an area where children can have a huge impact. For all children, especially for the children with learning differences, social and emotional skills are the most consistent indicators of success, outweighing everything else, including academic factors. Academic challenges may lead to low self-esteem, withdrawal, and behaviour problems, but a caregiver can counter these things by creating a string of support system for the child and helping her/him learn to express her/himself, deal with frustration and work through challenges, Caregivers can:

• Make the child understand his/her condition, so that (s)he can feel better about him/herself. It is best for the child to know that s(he) is bright and able but has a specific difficulty rather than being told nothing at all and left to feel stupid and a failure.
  
• Boost the confidence and self esteem whenever possible.
  
• Encourage independence: Give her/him some responsibility in the home especially in areas where s(he) is more capable than her/his siblings and other peers in school.
  
• Ensure that everybody at home and in the school understands the child’s condition, so that they can also help.
  
• Always emphasize the positive and play down the negative (e.g. encourage and give reward only on the correct work done i.e. you got two spelling correct).
  
• Find more and more information on learning differences to empower themselves only then they will be able to help their children in a better way.

All a caregivers needs to remember is that their children can do much better and can learn but (s)he cannot do this alone. Your support is vital to allow children to make a difference in their lives.

References:
Gerald.C.Davison. and John.M. Neale. Abnormal Psychology. 7th edition
Diagnostic and Statistical Manual of Mental Disorders (DSMIV)
Web: http///www.kidsource.com/kidsource/content/learningdis.html
Milan, Anne. Hou.Fong. and Wong. Irene.” Learning Disabilities and Child Altruism, Anxiety, and Aggression.
Kavale, K.A., and S.R. Forness. 1996. “Social skills deficits and learning disabilities: A meta_analysis.” Journal of learning Disabilities, 29 (3):226 to 237.

About the Writers:
Ms. Arisha Qayyum is a clinical psychologist working in the capacity of Research Officer in AKU’s Human Development Programme.
Ms. Ayesha Zahid Khan is presently working as a Senior Research Officer-Nutrition at AKU’s Human Development Programme.