Mixed Learning Disorder Case Study Using Malin’s Intelligence Scale for Indian children

Name: ……………………. Age: …. Sex: Female
Education: Elementary school Handedness: Right DOB: …..
Informants: Mother Father and Self

Referred by: ………..

Reason for Referral: For the assessment of current level of pathology

Chief Complaints:

• Poor academic performance
• Difficulty in recalling answers during exams
• Difficulty in reading and writing

History of Present Illness:

Family history

The client lives in a joint family with her grandmother, grandfather, parents, younger sister (5th standard), her father’s elder and younger brother and their family’s respectively. Her father has well-functioning business. Since past few months various family issues have cropped up due to this. The sisters-in-law often get into quarrels which sometimes directly affects the client and sometimes indirectly in ways her mother interacts with her because of that. She feels less loved and neglected at times. Client is more attached to her father and cousin elder brother. There is no history of mental illness in the family. The current family atmosphere is non congenial.

Family genogram

family genogram

Personal history

Birth and Early Development

Client was born of full term normal delivery in hospital. No pre, peri and post natal problems were faced by the client’s mother. Birth cry was present and developmental milestones were age appropriate. She has no history of seizures, head trauma, fever etc. Until 5 years of age she suffered from seasonal cold. The client started walking at the age of 9 months and talking at the age of 1 year.

Childhood history

The client has always been very social and friendly and faced no trouble in making friends. She has always been very helpful and never got into trouble for her behavior. She can be little stubborn at times and knows how to get things her way. She has always been highly sensitive and cried very easily. She was not very persistent in studies and if unable to do a task she would give up easily rather than trying for it. There is no history of stealing, sleep disorders, somatization, eating disorders, enuresis, encopresis, tics and unusual habits

Scholastic History

The client started formal schooling at the age of 2.5years in .,….. She studied in …… till 1st standard and then joined her current school.Her parents thought she would get better personal attention there, but her grades have remained constant between ‘C’ to ‘D’ across both the schools. She has reported to have high exam anxiety, which further worsens her performance during exams.

Mental Status Examination

The client was well kempt, well dressed and groomed. During the test administration she was cooperative towards the examiner. Eye contact was present. Rapport was easily established and maintained. She spoke in a clear audible voice. She was well oriented to time place and person. Her attention was easily aroused and sustained. Her immediate, recent and remote memories were intact. Her personal, social and test judgment was intact. On the basis of MSE it was found to have an average level of intellectual functioning.

Tests administered:

• Malin’s Intelligence Scale for Indian Children.
• NIMHANS Battery for Learning Disability

Test Findings:

Malin’s Intelligence Scale for Indian children

On MISIC, the Full Scale I.Q was found to be 98 which indicate an average level of intellectual functioning.

The verbal scales reflect the child’s ability to work with abstract symbols, the amount and degree of benefit she has received from her educational background, verbal memory abilities and verbal fluency.

The verbal I.Q was found to be 97 indicating an average level of verbal intelligence. On the verbal subtests, the raw scores and the corresponding IQ were as follows:

Information: (17, 93) which indicates an average level of performance in verbal ability, intellectual curiosity and long-term memory.

Comprehension: (21, 116) indicating a bright normal level of performance in social judgment, reality awareness and understanding. He can grasp the social rules and regulations very well and has knowledge about moral codes.

Arithmetic: (7, 73) indicating a borderline level of performance in numerical reasoning and speed of numerical manipulation.

Similarities and Analogies: (11, 91) indicating an average level of performance in abstract intelligence and verbal reasoning and in categorizing meaningful relationships.

Vocabulary: (17, 105) indicating an average level of performance in language usage, word knowledge and verbal fluency.

The performance scales reflect the child’s degree and quality of nonverbal contact with the environment, the ability to integrate perceptual stimuli with relevant motor responses, the ability to work quickly and the capacity to work in concrete situations.

The performance I.Q was found to be 99, which indicates an average level of functioning on the performance domain of intelligence. On subtests of performance I.Q the raw scores and the corresponding TQ were as follows:

Picture completion: (10, 90) which indicates an average level of performance in the area of reasoning, attention to visual acuity (awareness about environmental details), visual discrimination and organization and long term visual memory.

Block design: (26, 99) indicating a normal level of performance in nonverbal concept formation, capacity for sustained effort, visual-motor- spatial coordination and manipulative and perceptual speed and abstract visual problem solving.

Object assembly: (19, 89) indicating a dull normal level of performance in her visual organizational ability, visual motor coordination with motor activity guided by visual perception and sensory motor feedback.

Coding: (71, 140) indicates a very superior level of performance in visuo-motor coordination, attention, short term memory, visual scanning and tracking.

Mazes: (11, 75) indicating a dull normal level of performance in visuo-motor planning, attention, concentration and vigilance and problem solving skills.

NIMHANS assessment battery for Specific Learning Disability

On NIMHANS Assessment Battery for Specific Learning Disability, she had been tested for Reading, Comprehension, Writing, Mathematics, Spellings.

Assessment of reading ability was done by asking the child to read out a given passage. There were substitutions for e.g. ‘want’ instead of ‘went’, ‘men’ instead of ‘man’, ‘hide’ instead of ‘hid’, ‘come’ instead of ‘came’, ‘lives’ instead of ‘lived’, disappeared’ instead of ‘dispersed’. A lot of words, mostly proper names were mispronounced and word once spelled out could not correctly pronounce again, e.g.- Shylock, Portia, Venice, suit, penalty, heaps, quenching, locking, attacked, yell, deafening, terror. There were problems in punctuations as well. Her reading ability was found out to be at grade five

Skills for comprehension were assessed by asking questions about the read passage. Her reading comprehension was not grade appropriate and she could answer IV grade questions adequately. She gave inadequate answers to the questions at standard V, VI and VII. She could not answer few questions and left some questions blank and the other answered questions lacked sentence formation. She read the passage but did not understand the formation of conceptual relationships between the question and the answer. After reading the questions she failed to make inferences in regard to the paragraph.

Her spelling ability was found to be at grade four level. Omissions of letters ‘sem’ for ‘seem’, ‘gound’ for ‘ground’ ‘entred’ for ‘entered’ ‘spar’ for ‘spare’, ‘ager’ for ‘anger’. Error of substitution such as ‘het’ for ‘hit’ , ‘pat’ for ‘pet’ , ‘tolk’ for ‘talk’ , ‘noice’ for ‘noise’ , ‘alse’ for ‘else’ , ‘willfear’ for ‘welfare’. Errors of addition ‘lound’ for ‘loud’ , ‘writte’ for ‘write’ , ‘amounte’ for ‘amounte’ and mixed errors like ‘domastek’ for ‘domestic’, ‘discrptions’ for ‘descriptions’ .
In written expression she was told to write an essay on ‘My life as actresses’ where she used information to formulate ideas and organise the essay in a chronological way. She has made correct simple sentences but not many complex sentences, grammatical faults were present and the flow of the essay was not 8th grade appropriate, in copying a paragraph she did not make any errors. Her ability for written expression was found at grade five.

In Arithmetic, her level of performance was at grade four. She has a well formed concept of addition and subtraction but makes simple mistakes while calculating. In multiplication of double digits with double or more than double digits, she made errors in calculations and the resultant answers were completely wrong. She has a similar difficulty in division, where she was able to divide double digits by a single digit and not any further. She is yet to develop working concept of fractions and thus has not been able to add or subtract.

Summary of Findings:

The subject’s IQ on Malin’s Intelligence Scale for Indian Children was found out to be 98 which indicate an average intellectual level of functioning.

In NIMHANS Index for Specific Learning Disability, the client was found to have disability in the areas of Reading, Spelling, Writing and Mathematics.

Impression:

Mixed learning disorder (Reading, Spelling, Writing and Mathematics)

Suggestions:

Child is eligible for Exemption Certificate and other benefits given by Government as per the rule for learning disability.
• Parental counseling
• Assisted learning with the help of teachers/parents
• Exercises that increase phonological awareness, to help her to learn and understand sound patterns associated with words
• Using audio-visual modalities to enhance learning of spellings
• Using cued-spelling techniques
• Use of mnemonics to memorize spellings
• Remedial teachings in comprehension
• Pre-teaching vocabulary using analogies , synonyms or visual aids
• Create own sentences and then look up the key words in the dictionary to confirm they have used correctly
• Helping her to relate to the passage to an experience, another book, or other fact, helping to make connections to personal experience, knowledge and previous reading.
• Remedial teaching in Mathematics.
• Acquiring competency and confidence in number concepts
• Understanding number system , symbols and operation
• Recalling basic facts and formulae
• Reading understanding instructions and word problems
• making meaningful connections within and across mathematical expressions

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