behavioral, emotional and social aspects of the learning disabled dr. kersi chavda psychiatrist,...

Behavioral, emotional and social aspects of the Learning

Disabled

Dr. Kersi Chavda

Psychiatrist,

P .D. Hinduja National Hospital

After the 1980’s there has been a change in

focus from only looking at academics of the

LD child to evaluating his social, emotional

and behavioural aspects

We know that the majority of preschoolers

with dyslexia are happy and well-adjusted.

However emotional problems seem to

begin when early reading instruction does

not match their learning styles

Frustration centres on their inability to meet

expectations of others as well as inability

to achieve their own goals

The emotions of bewilderment, shame and guilt

of being “inadequate” deals a crippling blow to

confidence and self-esteem

Early on in life starts a feeling of inadequacy and

impotence… a feeling that he would not be able

to manage things and will NEVER get them right

This feeling tends to persist in adulthood…one often avoids challenges, refuses promotions, etc.

Often the feeling…: “Am I good enough”?

A child is likely to be having BES difficulties if his behaviour

• Is not age- appropriate• Results in isolation from his peers• Negatively affects the learning environment• Places unreasonable demands on the teaching

staff• Leads to negative self-concept and a low self-

esteem• Creates dangerous situations

Pupils with BES behaviours are troubled

individuals whose emotional state leads them to

negative behaviours. They may seek attention,

even the negative kind, or “lash-out” at a world

wherein they feel that everyone is against them.

This results in a serious lack of positive feedback in a downward spiralling of self-esteem

The child becomes his worst enemy

Social Competence

This refers to the social, emotional and

cognitive skills and behaviours that

children need for successful social

adaptation

This depends on a number of factors including social skills, social awareness and self-confidence

Whereas parents are the primary source of social

and emotional support for children during the

first years of life, in later years peers play a

significant complimentary or unique role in

promoting child social-emotional development.

With increasing age, peers rather than parents

become preferred companions

Children learn to take another persons perspective

and develop an understanding of the social rules

and conventions of their culture. There is more give

and take between them than with adults.. thus

providing an opportunity for the development of

social competencies such as cooperation and

negotiation. These skills are associated with

effective interpersonal relationships in adult life,

including with co-workers and romantic partners

Social skills This is the knowledge and ability to use a

variety of social behaviours that are appropriate to a given inter-personal situation and are pleasing to others

It is the capacity to inhibit egocentric, impulsive and negative social behaviours

A child’s social effectiveness is an ability to

establish and maintain high quality and mutually

satisfying relationships and to avoid negative

treatment or victimization from others

Why are youth with LD less accepted by their peers?

# Poorly developed social-emotional skills may be responsible (Bryan 2002)

# Poor language and communication skills

# Difficulty recognizing and understanding others emotions

# Co-morbid psychiatric disorders e.g.. ADHD and depression

# Educational isolation

# Repeated failure and low self-esteem

The possibility of bidirectional pathways

between both disorders has also been

proposed (Hinshaw 1992)

Thus :

Anxiety Cognition

Failure

There appear to be five main ways in which

emotional concerns and Learning

Disabilities interact:

* LD leads to emotional distress

* LD raises or exacerbates existing emotional concerns

* Emotional issues may mask a child’s LD

* Emotional issues may exacerbate an LD

* Positive emotional health may enhance the

performance of children with LD

LD may lead to emotional stress

# There are increasing levels of depression, loneliness and low self-esteem (Livingston.1985).

# It is unclear as to whether depression worsens

LD or LD puts children to increasing risk of

depression, or whether an overreacting brain

dysfunction increases the likelihood of both

# There is often increased victimization

# There is increased anxiety {Margalit and Zak

1984} …the LD child feels more often that

events happening to them are beyond their

control

# Bender and Wall (1997) :There is an increased

co-morbidity of LD and depression

Forness and Karale (1999): Nearly I out of

every 4 depressed children seemed to

have an LD

There are attempts to cope with a difficult

learning process and the resultant failure,

frustration and feelings of incompetence

that these feelings cause

# Impulsivity and low self esteem and a cognitive

weakness in relating cause and effect may

increase suicide risk above the risk of

depression alone.

# Thus, some of the very characteristics of LD may

predispose them to suicide (Rouke 1996)

LD exacerbates existing emotional concerns:

# The disability influences the child’s ability to

develop positive interpersonal relationships

# There are more problems with social incompetence

# There is increased sadness, confusion and anxiety

The incidence of anxiety and depression

in LD children seems to cause

Oppositional Defiant Disorders , Conduct

Disorders and Adjustment Disorders of

Adolescent much more than in the normal

population

Behavioural problems in LD are not

necessarily an indication of emotional

disturbances but may be part of the neuro-

developmental delays associated with this

condition

# There is an increased vulnerability to drug and alcohol abuse

• # The is an increased likelihood of being a school drop-out

Emotional issues may mask LD

# There may be a focus on a child’s demeanor or actions with no realization that LDs are present

# There may be an increase in somatic complaints

# There may be acting –out behaviours: a turning

of hatred onto self…provoking reproach from

others

Emotional health may intensify LD

# Abrams(1986): Constant failure and frustration may lead to strong feelings of inferiority which in turn may intensify the initial LD

# Escaping school

# Trouble at home

Emotional health may enhance performance of students with LD

Bryan (1996): Positive “affective states” increase

performance of memory, computation and

discrimination

# Learning about their own LD seems to help

# Cognitive therapy : helps “can-do” attitude

There are clear indications that understanding

the different mechanisms of interaction can be

helpful in selecting priorities and strategies for

interventions

Helma Myklebust et al (Chicago, Ilinois,2005) :

394 public school children: explored the

relationship between emotional disturbance and

LD

226 III and IV graders, 170 boys/156 girls with

clearly diagnosed LD were compared to a

control group of 168 kids

Factorial analyses of variance disclosed that

children with LD exhibited greater emotional

stress on only 4 out of 14 scores of the

Children's Personality Questionnaire.

Despite marked differences in verbal learning

and cognitive functioning, they were comparable

to normal children in emotional status

It is suggested that deficits in social (non-

verbal} perception may be more critical to

the onset of autism

Another perspective:

Kids with LD often land up experiencing /exhibiting a number of characteristic features:

SHAME For some kids who are diagnosed…there

is a sense of relief. For others, this causes further stigmatization.

This often causes the individual to hide the

difficulty rather than risk being labelled.

Internalized negative labels of stupidity

and incompetence usually result in a poor

self-concept and lack of confidence

(Gerber and Ginsberg,1992)

FEAR This is often masked by anger and

anxiety Fear:….of being found out They develop coping strategies to hide

their disability Fear of failure:….. They reason that since they failed

before, they will fail again…so they perceive themselves to be failures

Fear of ridicule:

Adults internalize the negative criticisms and view themselves as dumb, lazy and incompetent

Fear of rejection:

…..if not seen as capable by others

Environmental and Emotional Sensitivity

Adults are often overwhelmed by too much

environmental stimuli e.g.. background

music, side-conversations, etc.

They are often believed to be highly sensitive…often unable to cope with the onslaught of the emotions that they feel

Emotional regulation

LD’s shift easily from one emotion to the

next. Others may experience difficulty

regulating impulses or actions

CHANGE

There is often difficulty adjusting to change

They are less prepared for the unexpected!

What can be done?

The negative behaviours often seen in a child with LD

and ADHD often seem to turn into positive attributes

in adulthood. List carefully the irritating negative

behaviours in your students and imagine which ones

may eventually contribute to adult success

What happens in childhood as a refusal to

do things the same way that others do

them is really an inability to perform the

same way. The child has to find a way to

solve the problems…in his own original

manner, an original way

Students who are rigid and work with great

intensity as children are committed and

dedicated with highly focused thinking…

e.g. researchers

Kids who are highly ego-centric and self-

absorbed…often translate into creative and

highly successful activity…the artist, the

novel thinker and the popular critic

A number of LD’s who tend to be friendless and

isolated from groups…land up working for the

homeless, elderly or ill…populations which

desperately need assistance

Harvard psychologist, Dr. Howard

Gardner, says most schools rely on

linguistic intelligence, the world of words,

or mathematical logical intelligence, the

world of numbers and logic.

Alternative learners frequently use their

visual intelligence (artists, film makers0, or

musical intelligence (musicians), or

kinesthetic intelligence (dancers and

athletes)

Gardner also describes those who have interpersonal intelligence (great leaders and entrepreneurs) or intrapersonal intelligences (psychologists and social workers). Some learn through nature (zoo keepers and explorers)….and many more.

Parents and teachers need to look for these

routes and bring them to schools

Remediation must find a way to reverse the

cycle of failure and to experience success,

build feelings of self-worth and increase

confidence

Individual therapy could be effective when

introduced in conjunction with special ed.

provisions. However, group therapy may be

more effective as peers are a better source of

support and insight, specially peers who have

the same problems. While insight is gained in

individual therapy, it can be exercised in the safe

environment of a supportive small group

Testing the negative thought, and

often realizing it is wrong.

e.g. “I’ am dyslexic – it must be

my fault again” or “I never get

anything right”.

Exercise….structured physical activity

Relaxation exercises…guided visual

imagery

Helping a child develop a sense of commitment, control

and challenge may be useful while coping with the

stressful circumstance.

Commitment

The committed find the learning situation

more meaningful…ideally they are actively

involved in building their special

educational programme.

Control

They behave and act as if they can influence the

course of events. They perceive many stressful

life events as predictable consequences of their

own activity, and thereby, as subject to their own

direction and manipulation

Challenge

This is a belief that change, rather than

stability, is normal. Stress then is

anticipated as an opportunity and incentive

for growth

Mother Theresa:

We will never know till we go to heaven how much we owe the poor for allowing us to help them. The truth she spoke lies in the basic need of human beings to do something useful and helpful to others if one is to be truly fulfilled and happy.

As the LD student acquires the skills of

helping others, they discover more of their

own resources, and feel more related to

the world because others need them. They

are empowered by giving.

Do not give up hope

There is outstanding resilience in many

unlikely students and there are numbers of

good people who help them with their

difficult journeys to adulthood.

Do not discount the impossible

Some very irritating negative behaviours that

have worn out parents and teachers and lead to

school failure, have helped youngsters with LD

demonstrate astonishing creativity and awesome

talent in adult life.

Different is not bad.

Different is the world.

Thank you