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DELHI PSYCHIATRY JOURNAL Vol. 12 No.2 OCTOBER 2009

Original Article

Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society276

IntroductionEstimates of the school and study related

problems vary considerably. In India, the estimatesof prevalence of children with scholasticbackwardness, as screened by Rutters proformasare reported to be 17 percent.1 Learning difficultiesin children are proposed to occur due to complexinterplay of factors that may reside in the child’sown constitution, temperament and cognitiveabilities and/or in the background and quality ofchild’s schooling and/or in family related factorsthat affect interactions and emotional well being ofthe child.

The child related factors that interfere withscholastic performance include child’s limitedcognitive capacities such as limited intellectual

functioning., learning disabilities, 2 sensoryimpairments including milder forms of hearing lossand partial visual impairments3,4, 5 behaviourproblems such as attention deficit disorder orhyperactivity6 and those that are related totemperament and personality traits of the child. Ofthe many child related factors that may producelearning problems, learning disabilities constitutethe most prevalent as well as the most perplexingunderlying cause7 of the problems. The investi-gation of learning disabilities through neuro-psychological studies, structural and functionalimaging as well as electrophysiological studies hasyielded evidence that deficits arise from centralnervous system dysfunction.8-13 While the WesternLiterature is replete with such studies, the Indian

Neuro-Cognitive Functioning in Children withLearning Difficulties

Shahzadi Malhotra*, Gaurav Rajender**, Vibha Sharma*, T.B. Singh*, M.S. Bhatia*** Department of Clinical Psychology, Institute of Human Behaviour and Allied Sciences (IHBAS)

** Department of Psychiatry, UCMS & GTB Hospital, Delhi

ABSTRACTLearning difficulties can occur due to complex interplay of factors that may reside in the child’sown constitution, temperament and cognitive abilities and/or in the background and quality ofchild’s schooling and/ or in family related factors that affect interactions and emotional wellbeing of the child. Aims & Objectives: To study the neuro-cognitive functioning of childrenwith learning difficulties . Method: Forty children studying in English medium schools in Delhifrom Grade 2nd to 5th who were reported to be having learning difficulties. The children weredivided into two groups (n=20, each.) One of the groups had children having learning disability.The other group had children with learning difficulties but without any diagnosable psychiatric/emotional/ behavioural problems. All children were assessed for their intelligence, scholasticperformance (on three basic subjects- Hindi, English and Mathematics)); Sustained attention;Verbal Working Memory, Visual Learning and Memory; Verbal Learning and Memory , VerbalComprehension, Visuo-Constructive Ability and Visuo-Conceptual Skills. Conclusions:Both thegroups had impairment in assessed neuro-cognitive skills. Children with learning disabilityhad significantly poorer performance on tasks of sustained attention, visual memory and learning, delayed recall and visuo constructive skills. There were no differences among children onother assessed functions.Keywords: Neurocognitive functioning, Learning difficulties, Children

OCTOBER 2009 DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society

scenario is strikingly different. In India, theincidence of learning disability ranges from 2-18%14, 15 yet, most of the Indian studies have focusedlargely on psychosocial concomitants of LD.16,17

Reports on neuropsychological profile andcognitive deficits of children with LD are few.18,19

Although these few studies provided many usefulinsights, they largely compared the neuro-psychological functioning among the variousgroups of learning disability. There have been noreported Indian studies that have compared thecognitive functioning of learning disabled childrenwith the profile of those children who have learningdifficulties but do not have any diagnosableneuropsychiatric/emotional/behavioural problems.

These children with learning difficulties butwithout any diagnosable disorder/disability haveremained at the periphery probably because of underreporting of this population in the clinical set-upsto seek help. The present study, has attempted toovercome some of these lacunas in the field oflearning difficulties in the Indian population. Thestudy has attempted at uncovering the neuro-psychological basis of various groups of childrenwith learning difficulties and carries implicationsfor future remedial training programmes.

Materials and MethodsSample: The study sample consisted of 40

children studying in English medium schools inDelhi from Grade 2nd to 5th who were reported byteachers to be having learning difficulties. Basedon the initial diagnostic assessments children weredivided into two groups (n = 20, each). One of thegroups had children having being diagnosed withlearning disability. The other group had childrenwith learning difficulties but without anydiagnosable neuropsychiatric disorder/emotionalproblems/behavioral problems. All children in thesample had average level of intellectual functioning,were attending school regularly, without any studybreaks or school change, and were from middlesocioeconomic status. Children having any physicaldisability, subnormal level of intellectualfunctioning, any sensory impairments, childrenfrom single parent families or those having anyother developmental disorder other than learningdisability/any other neurological/psychiatric/behavioural/or any other major medical illness were

excluded from the study. The children belonged tothe age group of 8 to 10 years.

TOOLS• Children’s Behaviour Questionnaire (CBQ)20

was used to screen children for having/ nothaving behavioural and emotional disorders.

• NIMHANS Index for Specific LearningDisability1 comprises of Malin’s IntelligenceScale for Indian Children (MISIC), DigitVigilance Test, Bender Gestalt Test, Test ofVisuo-Motor Integration, Auditory MemoryTest, Benton Visual Retention Test along withtests of Academic Performance that includereading, writing, arithmetic, spelling andcomprehension. For the present study, the Testsfor Academic Performance of this battery werereplaced by GLAD.

• Grade Level Assessment Device for Childrenwith Learning Problems in Schools21 to assessscholastic performance. The GLAD assessesthe level of academic performance in three basicsubjects viz. Hindi, English and Mathematics,in primary school children while systematicallymaking an observation of the processing patternin the child.

• Colour Trails Test22 was used as a measure offocused attention.

• Digit Vigilance Test 23to assess sustainedattention.

• Benton Visual Retention Test24 to assess visualmemory and visual perception.

• N Back Test (Visual) was used as a measureof visuospatial working memory. It consists of36 cards each in the 1 back and 2 back test.

• Indian Adaptation of Rey’s Auditory VerbalLearning Test 25 to measure verbal memory.

• Block Design Test26 for assessment of visuo-constructive abilities.

• Token Test27 is a measure of verbalcomprehension of commands of increasingcomplexity.

ProcedureBased on the initial diagnostic assessment all

children were divided into two groups (n= 20)-Group 1- having children with learning disabilityand Group 2- having children with learningdifficulties but without learning disability. The tests

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were administered in the following order:NIMHANS SLD Index, GLAD, Digit VigilanceTest, Benton Visual Retention Test, RAVLT, TokenTest and Block Design Test. Children were assessedfor their school performance using GLAD tocompare the scholastic performance of the twogroups. The entire battery of tools took about 6hours to administer which was done across 3-4sessions. The study was performed with writteninformed consent of school authorities as well asof parents.

Analysis: The data thus collected followingthe above design and procedure was interpretedusing mean and standard deviation and comparedthrough t-test.

ResultsThe obtained mean, Standard Deviation and t-

values for scholastic performance of the two groupsare given in Table 1. Table 2 shows mean, SD andt-values on assessed cognitive domains of both thegroups.

From Table 1 it is observed that, the obtained



Table1 - Comparison of Scholastic Skills For LD And Non LD Group

Subject LD (n = 20) N. L.D (n = 20) t-valueMean S.D. Mean S.D.

English 60.8 15.08 63.4 8.6 0.335Hindi 63.2 5.16 64.2 7.7 0.247Mathematics 55.8 14.66 57.4 6.4 0.223

*p < 0.05, **p < 0.01

Table 2: Comparison of Cognitive Skills in L.D Vs Non L.D Group

Cognitive Skills L.D (n=20) N.L.D ( n = 20)Mean S.D. Mean S.D. t-Value

Sustained Attention(Time Taken) 8.9 3.7 5.2 1.03 2.32*Attention(Error Score) 20.2 11.5 9.0 5.89 2.45*Focused Attention 177.2 15.7 158.7 18.9 1.76VisualMemory 4.2 1.3 6.4 2.07 2.41*Visual Working Memory 2.5 0.81 3.9 1.01 1.01Immediate Verbal Memory 43.0 3.4 42.0 37.84 1.09Delayed Verbal Recall 32.0 4.8 44.0 36.40 2.34*Total Learning 50.0 4.5 49.0 4.80 0.041Visuospatial 86.5 4.40 102 5.79 2.99**Comprehension 14.0 3.91 12.01 2.98 1.97

* p < 0.05, **p < 0.01

t-values for all the three subjects are not significantat á = 0.05 level of significance . this means that,L.D and N.L.D groups did not differ significantlyon their scholastic performance for any of the threesubjects.

From Table 2 which shows the comparativeanalysis of cognitive skills between L.D and N.L.Dit is observed that the obtained t-values aresignificant for attention (time taken and error score),visual memory, delayed verbal recall, and visuospatial skills, at 0.05 level of significance. However,obtained t- values are not significant for immediateverbal memory and total recall. Thus, for allcognitive skills (except immediate verbal recall andtotal learning) and it is inferred that there is asignificant difference in cognitive skills of L.D andN.L.D group. Further, from the mean scores of thetwo groups it is observed that children in L.D groupperformed poorly on all cognitive skills as theirmean scores are higher for attention and lower forother cognitive skills, as compared to mean scoresof N.L.D group. The mean IQ of L.D group was98.9 (±3.81) and of the N.L.D group was 101.0


Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society 279

(±2.5) with a t value of 0.099 which is nonsignificant at p>0.01 indicating that the two groupswere matched for their intellectual functioning.

DiscussionAs seen from results section, the two groups

of children, did not differ significantly on IQ, theirschool performance on three school subjects thusindicating that both the study groups were matchedfor their intellectual functioning and academicperformance. However, the qualitative analysisrevealed that the nature of mistakes committed onthe three school subjects was different for both thegroups.

Attention as measured in this study wassustained attention, that is, the capacity to bevigilant and attend for a period of time; even in thepresence of distracters. It has been found from thepresent results that children with learning disabilityhave poorer sustained attention than childrenwithout learning disability as children with learningdisability took significantly longer time to completethe task as compared to children in non learningdisability group. That is, their speed of processinginformation was found to be significantly slow ascompared to children without learning disability.Further, the error score on this test revealed thatchildren in learning disability group committedsignificantly more errors than children withoutlearning disability. It was found during scoring ofthis test that children with learning disabilitycommitted both errors of commission (indicatingthat the children had problems in responseinhibition) as well as error of omission (reflectingpoor visual scanning and poor selective attention)in approximately similar ratio. Children withoutlearning disability showed only error of omission.This has implications for academic performance asreading primarily requires accurate analysis of thecharacteristics of visual pattern. Correct decodingof written words requires detailed processing whichis made possible by sustaining attention. Sincesustained attention is found to be impaired in boththe groups with more impairment in learningdisability children, activities to improvise sustainedattention is implicate to improve reading abilitiesof these children.

Focused attention was found to be relativelyintact in the learning disability group whereas

problems in focusing attention have been observedin the Non learning disability group. Similarfindings have been reported by Agarwal 28 in theirstudy with children with dyslexia.

Further, although both the groups have shownimpairment in visual and verbal memory, visualmemory is poorer in children with learningdisability than in children without learningdisability. With respect to immediate recall of verbalinformation, there was no significant difference inthe skills demonstrated by the two groups. Further,there were no significant differences between thetwo groups with respect to their total verballearning. However, it was found that whereaschildren with learning disability showed bothrecency and primacy effects while learning the listof words; children without learning disabilitylargely showed primacy effect. From introspectivereports of children it was revealed that children withlearning disability attended to the words as theywere presented but most children in the non learningdisabled groups were putting extra efforts tomemorize whatever was being presented and so theywere more concerned and stuck with the initialwords in the list.

Also, children with learning disability haveshown significantly poorer performance on delayedrecall than children without learning disability. Thisimplies that either, the consolidation process itselfis poorer in children with learning disability or that,interference processes are more at work in thelearning disability children than those children whodo not have learning disability but still havescholastic backwardness. This aspect needs to betaken up in further research studies. Since bothreading and writing are significantly based onstorage , processing and retrieval of information indifferent modalities; these findings explain theprobable reasons for poor academic performanceof children in both the groups. Also, memorydeficits indicate inability to use strategies ofphonetic or semantic clustering, which is related tolanguage related impairments of children withlearning disabilities.28

From the result findings, it was further foundthat children with learning disability have shownsignificant deficits on visuo spatial skills ascompared to children without learning disability.However, no significant differences were observed



on comprehension and visual working memory.Although there is a dearth of studies on

neuropsychological in different groups of childrenhaving scholastic backwardness, studies withlearning disability children have reported deficitsin their attention, verbal and visual memory, andvisuospatial functioning29, 30,18, 19.Similar deficits inchildren with learning disability have been foundin this study also. The present study went a stepfurther and found that children having learningdifficulties but etiology different from learningdisability also have neuropsychological deficits butthe deficits are more pronounced in the learningdisability group.

The sample of the present study being small,the findings must be generalized with caution. Thefindings need further validation through a studywith larger sample from wide range of socio-demographic strata. The study has implications forplanning of intervention modules for differentgroups of children with learning difficulties.

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