Miyuru Chandradasa

MBBS (C’bo) MD Psych (C’bo)

Child Psych AdvCert (Australia) MRCPsych (UK)

Consultant Child & Adolescent Psychiatrist

CNTH Ragama
Senior Lecturer
University of Kelaniya
A score sheet: Why?
Ordinary level
Sinhala A
Buddhism A
Music B
Science A
Mathematics C
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Probable MCQ for Final MBBS
True or False Common in boys than girls
regarding
Specific Dyslexia is the diagnostic term
Learning
Disorder
Diagnosed usually in preschool age

Not seen among adults

Pharmacotherapy is the mainstay treatment

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What is SLD/SDDSS?
A neurodevelopmental disorder

• DSM 5: Specific Learning Disorder

• ICD 10: Specific Developmental Disorders of Scholastic Skills
• Early onset, detected after commencing formal schooling
• Frequently undiagnosed and unrecognized

Types

• Reading, Writing, Mathematics

• Academic capabilities below the standard for age (SD – 1.5)

Epidemiology

• 5 – 15% of all children, 4% of all adults

• Male : Female = 2 : 1

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ICD 10

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ICD 10:
Specific Developmental
Disorders of Scholastic Skills
• Normal patterns of skill acquisition are
disrupted from the early stages of
development
• Not simply a consequence of a lack of
opportunity to learn
• Not due to any form of acquired brain trauma
or disease
• Abnormalities in cognitive processing from a
biological dysfunction
ICD 10:
Specific Reading Disorder
• Disorder
• A specific and significant impairment in
the development of reading skills
• Not due to,
• Mental age, visual acuity problems, or
inadequate schooling
• Impaired reading skills
• Comprehension
• Word recognition
• Oral reading
• Spellings (even as adults)

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ICD 10: • Omissions, substitutions, distortions, or additions
• Slow reading rate
Specific Reading • False starts, long hesitations or "loss of place" in text
Disorder • Reversals of words in sentences or of letters within words

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Associations
• Speech and Language Delay
• Auditory processing difficulties
• Visual processing difficulties
• Inattention
• Hyperactivity
• Impulsivity
• Behaviour dysregulation
• Emotional stress

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DSM 5
DSM 5

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 DSM 5: SLD
specification
DSM 5: Specific Learning Disorder
Presence of at least one of the following during the preceding 6/12

Inaccurate or Difficulty Difficulty with

Slow reading understanding spellings

Poor
Difficulties in Calculations
mathematic
writing difficult
reasoning

Below
Declining Not due to
standards for
functioning other disorder
age
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Dyslexia

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SLD: Presentations
• A lack of interest in games with language use
Preschool • Baby talk, Mispronounce
• Difficulty in learning nursery rhymes

• Reading aloud is slow, inaccurate, and effortful, Fear in reading

Primary school • Skip parts of long multi-syllable words
• Unable to read common one-syllable words and irregularly spelled words

Adolescents • Spelling mistakes

• Difficulty in solving math problems

Adults • Ongoing spelling problems, slow and effortful reading

• Problems making important inferences from numerical information

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SLD: Differential Diagnosis
• Lack of educational opportunity
Normal variant • Secondary language

Intellectual Disability • IQ low

Neurological or • Cerebral palsy, CVA, TBI

Sensory issues • Hearing and Vision impairment

ADHD • Could be a comorbidity

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SLD: Complications

Academic
limitations
Adults

Occupational Low self

failure SLD Esteem
& Low income & Depression

School dropouts
Social risks

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SLD: Mechanism

Affect the brain's ability to process verbal or nonverbal

information efficiently

Disrupts the normal pattern of learning academic skills

Not simply a consequence of lack of opportunity of learning

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Specific Reading Disorder: Neurobiology

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SLD: Comorbidities

Attentional Deficit
Communication disorder
Hyperactivity disorder

Autism spectrum disorder Anxiety Disorder

Depressive disorder Bipolar disorder

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SLD: Aetiology

• Genetic & Epigenetic factors

Genetics • Family history increases the risk 10 times

• Low birth weight & Prematurity

Environmental • Maternal nicotine exposure

• Parental educational capabilities

Social • Use of non-phonetic languages

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Management

• Provide details to parents, child and

Information teacher

Non- • Education Therapy

pharmacological • Multi sensory approach (Orton Gillingham)

Pharmacological • For comorbidities

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Multisensory approach:
Kinaesthetic, Visual, Auditory

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Multisensory approach:
Kinaesthetic, Visual, Auditory

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Phonemes

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Multisensory approach: Maths concepts

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Interventions for Specific
language disorder with
impairment in reading
• Special teaching techniques
• Helping a child learn through multisensory experiences
• Providing immediate feedback
• Strengthen a child's ability to recognize words
• Classroom modifications
• Extra time to finish tasks
• Recorded tests
• Tell the questions instead of reading them
• Use of technology
• Audio books
• Word-processing App
• Spell-check software
Interventions for Specific
Learning Disabilities
• Specific language disorder with impairment in written expression:
• Special tools
• Oral exams, note-taker, videotape reports
• Word-processing programs, Audio recorder instead of writing
by hand
• Teachers can provide notes, outlines, and pre-printed study sheets
• Specific language disorder with impairment in mathematics:
• Visual techniques
• Draw pictures of word problems, Use coloured pencils to
differentiate parts
• Use of memory aids
• Rhymes and music
• Computer for math drills and practice
Letter to the teacher

Through the
Frequent Repeated
principal with Sit in front
reminders instructions
appreciation

Inclusive: Praise for Use colour,

Avoid
Assistance in small rhythm and
punishments
normal class achievements games

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Probable MCQ for Final MBBS
True or False Common in boys than girls
regarding
Specific Dyslexia is the diagnostic term
Learning
Disorder
Diagnosed usually in preschool age

Not seen among adults

Pharmacotherapy is the mainstay treatment

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Taare Zameen Par by Aamir Khan

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Thank you!
Miyuru Chandradasa - Child & Adolescent Psychiatrist

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