Dyslexia and allied problems

Dr. Darshana Naik, MD

Honorary Pediatric neurologist, VS hospital, Ahmedabad Fellow pediatric neurology, Mumbai. Fellow Pediatric neurophysiology, London, UK Diploma Dev. Neurology, CDC Kerala

 How do you come across patients with dyslexia???

My Experience
90% presents with mirror writing q instead of p 5% presents with poor result bcoz of lacking in one subject 3% presents with poor marks in writing and excellent result in oral 2% positive screening for dyslexia

Learning Disabilities
It means deficits in acquiring expected skills in reading (dyslexia), writing (dyagraphia), maths (dyscalculia) It accounts 4-5% of normal school population Not lack of intelligence

Etiology
Biological- Prob with brain arrangement Cognitive- Thinking process Behavioral- how child takes learning Social- environment of learning Biosocial Emotional Acquired- Following brain injury

Presentation
13+ gene identified More then 50% F/H positive Boy>Girls Mild to severe Not till 8ys Part of other disease- Autism, ADHD, Asperger

General scenario
Infants: Motor/general intelligence-WNL FM/Speech/Coordination-Del Toddlers: 50% left handed Recurrent fall Preschool: Poor in sports, poor catching ball

General scenario
School: Confusion- poor in only one subject Dumb/Failure Inattentive/disruptive-ADHD Withdrawn/silent- Autism (Asperger syndrome) Adolescence: Dropout- 35% (business leaders) <4% gets bachelor degree

General scenario
Adult: Left-Right, Off-ON Criminal/hacker Poor relationship Anxiety/depression/suicide Obesity/ Anorexia

How to diagnose in OPD?

Lagging in one particular subject Better marks in oral then written Problems in speakingmispronunciation, non fluent speech (pausing) Problems in reading- taking too much time, confusion in similar words, messy hand writing, non sense grammar Dyslexia screening test

 Screening test

Diagnosis
1) 2) 3) 4) Screening test: Diagnostic tests: Dyslexia test: Junior/Senior Sensory integration Neurological assessment EQ/SQ

Definitive diagnosis
Neurologist Occupational therapist Child psychologist Counselor Government authority

Management
1. 2. 3. Medical management Non medical management Emotional Sensory integration Educational

Management- Medical
Piracetam: Nootropic agent means smart drug or cognitive/neuro/intelligence enhancer drug Adult: Alzheimer, post stroke cognitive improvement Ped: Breath holding spells, Down, Dyslexia

Piracetam-Mechanism of action
Dyslexia- poor coordination of both hemispheres NMDA glutamate receptor stabilization contributes to learning and memory function Effects: Improves activation of corpus callosm fibers which facilitates active communication of both hemisphere hence improve reasoning (RT) and creative thinking (LT)

Supportive studies
J. clinical pharmacology, J. child neurology, J. psychology 225kids from 6-12yrs having dyslexia given for 36weeks Effect started from 12weeks and lasted for 36week Memory improved- WISC score

Side effects
Mild- Headache, Nausea, insomnia Young kids- Sedation Dose: 10mg/kg/day

Non medical
Emotional Sensory integration Educational

Emotional problems
Lack of confidence Back log of failure Frustration Insensitivity, Bullying, Fatigue Behavior therapy and counseling by trained therapist

Sensory integration
Occupational therapist Tactile Visual Auditory Kinesthetic

SI-Video

Educational Management
Neuro-linguistic system: 1) Visual- 80% Clerical jobs, Artists, visionary, scientist, doctors 2) Auditory/Acoustic- 10% Call centre, RJ, secretary 3) Kinesthetic- 10% Sports, actor

Classroom Mx
Giving more time Listening books Software for dyslexia One to one tuition Sensory and motor skills therapy Reading aloud Phonation/ decoding Relation of letters, words, sounds Each child needs tailor made program

Tasks to avoid in Education

Avoid dictation Avoid board copying Avoid too much written home work Avoid fancy fonts

Legal Aspects
Special time in all exams Certification from educational board- Neurologist, Occupational therapist, Child psychologist, Counselor Maharastra dyslexia association Special jobs

Naughty child vs ADHD

More then 500 research papers done on prisoners had ADHD and other related psychological disorders in childhood

ADHD or Naughty???

ADHD
Response to punishment and reward is poor No difference with environment Child will say I tried but I cant control

NAUGHTY
Response to punishment and reward is good More hyperactive in presence of person who pamper child Child can control willing fully

How to pick up in OPD?

Will not sit at one place Will not play with single toy for more then 1 minute Ignore your instruction in spite of listening Forget things in school Messy in nature Restless all the time Lake of sleep

ADHD screening tests

Conners teacher rating scale Conners parent rating scale

ADHD post treatment

Autism

Triad
1) No social development 2) No speech development 3) Repetitive movements Barfi- Low functioning My Name is Khan- High functioning autism

Spot diagnosis
1) Does your child remains in his/her own world? 2) No response to name 3) No separation anxiety M-CHAT screening test

Take home messages

Children are like flowers, we should be gentle and patience to them Not diagnosed before 8years and requires team to diagnose NLP is basic fundamental learning system gaining popularity

Take home messages

75% are parental related problem Screening tests are available Diagnosis is always probable and must be confirmed by clinical psychologist DSM IV and ICD 10 are internationally acceptable criteria used worldwide and available for all behavior problems Correct diagnosis at correct age and proper intervention cures 90%

With best compliments from: ASIAN CHILD NEURO CLINIC & CEREBRAL PALSY CENTRE

2nd Floor, Park Avenue Building, Opp. Parimal Garden, Ellisbridge, Ahmedabad. Phone: 079-26400640, 9924181291 E-Mail: darshanaben@gmail.com