Evaluation and Intervention Strategies in Evaluation and Intervention Strategies in Children with Learning and Behaviour Disorders: Children with Learning and Behaviour Disorders:

An Experience from 333 Children from a Tertiary An Experience from 333 Children from a Tertiary Referral CenterReferral Center

Smita A. DesaiSmita A. Desai (Ph.D) (Ph.D)Sanjeev V. KothareSanjeev V. Kothare,, MD, DCH, FAAP (USA) MD, DCH, FAAP (USA)

Referral Center: Drishti, Mumbai, IndiaReferral Center: Drishti, Mumbai, India

AimsAims Part I: EvaluationPart I: Evaluation

– To study the prevalence of Learning To study the prevalence of Learning Disorders (LD), Behavior Disorders (BD), Disorders (LD), Behavior Disorders (BD), Developmental Disorders (DD), Mental Developmental Disorders (DD), Mental Retardation (MR), Emotional Disorders (ED), Retardation (MR), Emotional Disorders (ED), in 333 children aged 3-14 years.in 333 children aged 3-14 years.

Part II: InterventionPart II: Intervention

– To assess the effect of intervention in a To assess the effect of intervention in a subset of children with LD with average IQ.subset of children with LD with average IQ.

Part I - SamplingPart I - Sampling Population: Urban children with learning Population: Urban children with learning

and/or behavioural difficultiesand/or behavioural difficulties Size of sample: 333 childrenSize of sample: 333 children Age group: 3-14 yearsAge group: 3-14 years Sex Distribution:Sex Distribution:

– Males: 242Males: 242

– Females: 91Females: 91

Part I - ProcedurePart I - Procedure Individualised Assessment Plan:Individualised Assessment Plan:

– Standardised diagnostic tests for the Standardised diagnostic tests for the following areas:following areas:• Intelligence, Achievement, Information Intelligence, Achievement, Information

processing skills, Emotional and Behavioural processing skills, Emotional and Behavioural Difficulties, Developmental functioningDifficulties, Developmental functioning

– ObservationsObservations

– Parent Interview & checklistsParent Interview & checklists

– Teacher Interviews & checklistsTeacher Interviews & checklists

Part I - Measurement toolsPart I - Measurement tools Some measurement tools usedSome measurement tools used

– Intelligence: WISC, SFB.Intelligence: WISC, SFB.– Achievement: WJ-R Psycho-educational battery, Achievement: WJ-R Psycho-educational battery,

Schonell’s Diagnostic and Attainment Test, Curriculum Schonell’s Diagnostic and Attainment Test, Curriculum Based TestsBased Tests

– Information Processing: BVMGT, MVPT, TAPS, RIPA, Information Processing: BVMGT, MVPT, TAPS, RIPA, Aston IndexAston Index

– Developmental screening: DASI-II, VSMS, MDFG, EASICDevelopmental screening: DASI-II, VSMS, MDFG, EASIC– Pervasive Developmental Disorders: GARS, CARS, Pervasive Developmental Disorders: GARS, CARS,

GADSGADS– Emotional Disorders: CAT, SSCT, HSPQ, HTP, SAED, Emotional Disorders: CAT, SSCT, HSPQ, HTP, SAED,

CBRSCBRS

Results - IResults - IPrimary Diagnosis

19%

10%

24%

5%

42%LDBDDDMRED

BD includes primarily ADHDBD includes primarily ADHDDD includes Speech and Language impairments, Autism, and TBIDD includes Speech and Language impairments, Autism, and TBI

Comparing Prevalence Comparing Prevalence DataData

BD includes primarily ADHD BD includes primarily ADHD DD includes Speech and Language impairments, Autism, and TBIDD includes Speech and Language impairments, Autism, and TBIUS govt. data from Digest of Education Statistics, US govt.,2000 (age grp.6-21 yrs)US govt. data from Digest of Education Statistics, US govt.,2000 (age grp.6-21 yrs)

51%

43%

4%10%

21%23%

11%

19%

8%5%

0%

10%

20%

30%

40%

50%

60%

LD BD DD MR ED

US Govt. dataSample

Results - IIResults - II

9%

30%57%

1%1%

2%

LDBDDDMREDNA

Secondary Diagnosis

Results - IIIResults - III

0%

20%

40%

60%

80%

100%

% s

ampl

e

LD BD DD MR ED

Disability Area

Intelligence Levels

AveB. Ave

Results - IVResults - IV

55% 66%76% 73%

71%

0%

20%40%60%80%

100%

% In

cide

nce

LD BD DD MR ED

Pathological Symptom

Perinatal Encephalopathy

Results - VResults - V

35% 41%

95%82%

29%

0%

20%

40%

60%

80%

100%

% s

ampl

e

LD BD DD MR ED

Disability area

Speech Delay

Results - VIResults - VI

39%

63% 58% 52%35%

0%20%

40%60%

80%100%

% s

ampl

e

LD BD DD MR ED

Disability area

Medical History

Results - VIIResults - VII

40%

63% 64% 69%

24%

0%20%

40%60%

80%100%

% s

ampl

e

LD BD DD MR ED

Disability area

Concomitant Disabilities

Results - VIIIResults - VIII

32%25%

6%

44%

18%

0%10%

20%30%

40%50%

% s

ampl

e

LD BD DD MR ED

Disability area

Grades Repeated

Results - IXResults - IXGender Differences

72.7%

27.6%

MaleFemale

Part II - MethodologyPart II - Methodology SampleSample

– 24 children (age group: 9-14 yrs ; 24 children (age group: 9-14 yrs ; 16 males, 8 females)16 males, 8 females)

– LD with GIQ of 90 and aboveLD with GIQ of 90 and above Areas of InterventionAreas of Intervention

– Reading (word reading, comprehension)Reading (word reading, comprehension)– Written language (spellings, composition, Written language (spellings, composition,

creative expression)creative expression) EvaluationEvaluation

– Criterion referenced testsCriterion referenced tests

Part II - ResultsPart II - Results

83%

80%

78%

72%

65%

0% 20% 40% 60% 80% 100%

Word Reading

Comprehension

Spellings

Written Composition

Creative Expression

Performance (%)

Discussion & ConclusionsDiscussion & Conclusions Largest number of referrals for academic Largest number of referrals for academic

difficulties & speech delay (w\autism)difficulties & speech delay (w\autism)

Birth encephalopathy - implications for Birth encephalopathy - implications for health care in developing countrieshealth care in developing countries

Learning & Behavioral disorders under-Learning & Behavioral disorders under-recognised as pediatric difficultiesrecognised as pediatric difficulties

Limited English Proficiency (LEP) - effect Limited English Proficiency (LEP) - effect on Assessment and Interventionon Assessment and Intervention