Management of Specific Developmental Disorder in Children Can you recall Ishan Avasthi of the film “Taare Jameen Par”? The poor boy who can not express what is his problem. But the more graceful thing was that his parents were unable to identify the problem. He had expressional problem i.e. reading and writing skill problem. Fortunately he got Nikumbh (Aamir Khan) as savior. But every child who suffers from this disease may not be able get somebody to rescue. As a result he has to suffer for lifelong. Report says approximately 20% children have learning disorder and 6% have difficulty in mathematics. But in true sense, from an angle of a psychiatrist I must say it is not a big deal to treat this socially vulnerable morbidity. Let us discuss about this disease.
There are numbers of diseases in same spectrum. Child Psychiatry is based on “Behavioral & Emotional disorder”. The “Specific developmental disorder (SDD)” is one of worse childhood psychiatric disorder affects normal development of a child. This is characterized by an inadequate development in usually one specific area of functioning. Where in Mental retardation there is generalized impairment in nearly all areas of functioning.
What are the types of developmental disorders? The deficit in functioning may be in scholastic skills, speech & language and motor skill. These may include reading (Developmental reading disorder), language (Developmental language disorder), arithmetic or mathematics (Developmental arithmetic or mathematics disorder), mental articulation (Developmental mental articulation or phonological disorder) and coordination disorder (Developmental coordination disorder) is present.
All the developmental disorder either causes impairment in academic functioning at school especially when language is affected or impairment in the daily activities. A large majority of these children have an underlying cerebral disorder. Boys are more affected than girls. It is important to keep remember the mental age, IQ level, socio-cultural background, schooling, impairment in vision & hearing and neurological deficit.
Specific Developmental Disorder (SDD): This is also called as Dyslexia or Developmental reading disorder. The child presents with a serious delay in learning to read, omissions, distortions or substitutions of words, long hesitations, reversal of words, slow reading and impairment of writing & spelling. Therefore the child will have educational under achievements.
Specific Arithmetic Disorder: It is also called Dyscalculia. The child presents with arithmetic abilities well below level expected for the mental age. It may include failure to understand simple mathematical concepts, failure to recognize mathematical signs or numerical symbols, difficulty in carrying out mathematical manipulations and tables.
Speech & Language Disorder: It is also called communication disorder. There are three types. Phonological disorder (Dyslexia) i.e. below per accuracy in the use of speech sounds despite normal language skill. The problem includes severe articulation errors that make it difficult for other to understand speech or phonemes are omitted, distorted or substituted (e.g. wabbit for rabbit, ca for car, bu for blue). Expressive language disorder i.e. below par ability of using the expressive speech. The other symptoms are restricted vocabulary, difficulty in selecting appropriate words, immature grammatical usage and cluttering speech. Receptive language disorder or receptive-expressive language disorder, i.e. by a below par underlying of language, failure to respond to simple instructions (provided deafness and pervasive developmental disorder are to be ruled out).
Motor Function Disorder: It is characterized by poor coordination in daily activities of life like in dressing, walking, feeding and playing. There is an inability to perform fine or gross motor tasks.
Why these diseases occur? The damage in left hemisphere produces intellectual disorder and loss of narrative dreams. Damage in the right hemisphere produces failure to connotation and normal understandings. Research in the field of cognitive neuro-science & neuro-psychology supports the hypothesis that encoding the process of working memory & attention ensure the reading & writing skill of a child. The developmental factors such as maturational, cognitive, emotional, educational and socio-economic factors are also responsible in a greater extend. One recent study found an association between Dyslexia and birth in the month of May, June and July, which suggests a maternal exposure to infections like Influenza. Another study found an association between Reading disorder & birth in winter months. The left handed persons, maternal complications may cause developmental disorder.
Management: The management is based on the learning theory principles and is behavioral in approach. It involves the use of special remedial teaching focusing on the underlying deficit like perceptual motor training. The treatment of common co-morbid emotional problems is often necessary parental education counseling is an important pre-requisite of proper management. Counseling is the main treatment. It should be done at multiple levels i.e. to the patient, to parents & other family members and to the school teachers. Although some drugs have very good roles. Among them Brahma Rasayana have shown marvelous outcome. The single drugs like Brahmi (Bacopa monnieri) and Asvagandha (Withania somniferum) are also advisable.
MD, Lecturer, Deptt. Of Basic Principles
Dayanand Ayurvedic College, Jalandhar (Pb)
Member of Indian Psychiatric Society,