Learning Disability Certification in India: Quo Vadis

Learning disorder (LD), one of the most common neurodevelopmental disorders, affects 3% to 10% of children. It is characterized by poor academic skills that are quantifiably below those expected for an individual’s chronological age (at least 1.5 standard deviation below the age-wise population mean). Significant interference with academic and/or occupational performance or with activities of daily living is observed. LD is confirmed with standardized achievement measures and comprehensive clinical assessments. Learning difficulties are usually noticed during school years; however, they may not manifest till later, whenever demands in academics exceed an individual’s capacity.

Battling Conceptualization of the Construct and its Estimation

LD is a relatively naïve field in India. In fact, its recognition as a disability came only as late as 2016, with the Revised Persons with Disabilities (RPwD) Act.

The RPWD Act defines specific learning disability (SLD) as a heterogeneous group of conditions wherein there is a deficit in processing language, spoken or written, that may manifest itself as a difficulty to comprehend, speak, read, write, spell, or to do mathematical calculations and includes such conditions as perceptual disabilities, dyslexia, dysgraphia, dyscalculia, dyspraxia and developmental aphasia. ¹

As can be seen, the RPwD definition uses the terms LD and SLD, synonymously, but it does not incorporate prerequisites such as normal intellectual functioning and intact sensory- motor/neurological functioning. (It will be pertinent to mention to the readers here that we have used the terms LD and SLD interchangeably for purpose of ease in this write-up.)

It needs to be kept in perspective that as per assessment guidelines, the child’s motivation, parental involvement in child’s academics, sensory-motor impairments, neurological problems, intellectual ability, and educational ability must be assessed prior to conducting an assessment for LD which can be termed as “reliable.”

In India, the applicability of these constructs, especially child’s motivation and parental involvement, may have clinical and ethical ramifications, as several children at risk for LD may also be first-generation learners. ² There are no official nation-wide prevalence estimates of LD. Interestingly, even the National Mental Health Survey of India, 2015–2016, did not include this entity. In the absence of reliable literature and procedures, ³ estimates by studies conducted at local level range widely between 2% and 19% depending on the tools employed. ⁴ The factor of usage of different/multiple languages in India further confounds attempts to determine the exact prevalence. ⁵ Most prevalence studies refer to a population studying in English medium schools, ⁶ which constitutes a meagre percentage of the population.

Issues with Assessment Procedure

It is pertinent to mention that the tools advised for assessment of IQ as mentioned in the RPwD Act have some inherent limitations. Malin’s Intelligence Scale for Indian Children (MISIC; Malin) has not been updated/revised since 1969 and Wechsler’s Intelligence Scale for Children—III (WISC III; Wechsler) has not been adapted for Indian Children. Moreover, research studies have shown, from time to time, that these tools have limited construct validity and questionable predictive validity. Additionally, these tools are not applicable when children come for reassessment at the age of 18 years, the final point of certification as per the RPwD Act. This may lead to a practically piquant situation, where a child has a clinical diagnosis of LD but fails to get a disability certificate because of either unavailability of appropriate tools or shortcomings in the suggested assessment tools, often resulting in the nonconsideration of clinically evident individual differences in learning ability, which may not be amenable to structured assessment. This hinders clinically and culturally competent practice, creating difficulties for the clinicians and other stakeholders from a nonmaleficence and beneficence point of view. ⁷

Team Approach for Screening, Diagnosis, and Management: Do We Have Enough Liaison and Motivation?

The Ideal Approach

Screening must start as early as class 3 or 8 years of age, whichever is earlier. The process of screening is to be initiated by the teachers (in both public and private schools who should approach the screening committee (mandatorily headed by the principal) in the school. The school would then interview the parents to assess their involvement and motivation in their child’s education. If the parents are motivated and the screening questionnaire suggests LD, then the child is to be referred for further assessment. The child would have to be referred to a pediatrician for an LD assessment by the principal of the school following the recommendations of the screening committee. Further procedures involve close liaison among pediatricians, mental health professionals, and clinical/rehabilitation psychologists.

The Reality

These procedures are better envisaged than implemented on the ground. The entire documented process requires a close association of several different stakeholders, along with a vivid, in-depth, and basic conceptual understanding of the LD construct. All these factors may lead to inadvertent delays and, sometimes, may even be missed in the process of certification. ⁸ Ultimately, they may preclude the use of the Act for the purpose of certification. ⁷

Today, schools are result-oriented and focus on producing “toppers.” They are not interested in keeping the child with LD (ie the so-called slow child) in their classrooms. This attitude hinders the learning progress of the child with a resultant worsening of the problem. Teaching authorities tend to be demanding by nature and lack patience for such “slow learners.” The teacher certification programs in India lack emphasis on special education (and focus on children with LD) to prepare such “general teachers” for inclusive classrooms/teaching. Owing to the lack of proper training in this area and lack of familiarity with the developmental process of reading/writing, the aspects of creativity and trial and error often guide the course of remediation. ⁹

Limitations in Utility of Certification: Heterogeneity of Language and Educational Boards

A certificate assumes importance only when exemptions and concessions in schooling are required. Each educational board provides a range of supports, such as exemption of second and third languages, extra time, scribe support for writing, provision of calculator, and so on. However, there is no uniformity in the assessment and certification processes across the boards, let alone any alignment with the RPwD guidelines. ¹⁰ The Council for Indian School Certificate Examination board grants provisional support to candidates with LD, only upon recommendation sent by the head of the school, upon submission of supporting documents from a qualified counselor registered with the Rehabilitation Council of India, and, finally, certified by a competent State or Central Government authority acceptable to the Council. A lack of uniformity across boards further precludes the process of SLD certification. ⁹

If individual states have to implement the RPwD Act guidelines, they will have an additional challenge of arranging for assessment and certification of disability in vernacular languages. However, there are no measures and methods under the RPWD Act to assess learning disabilities in vernacular languages. This is a huge disadvantage for children who study in a vernacular language as a medium of instruction, or those who study in an English medium school but have difficulties in an Indian vernacular language. ¹⁰

Other Factors

The label of LD is burdensome, especially when dropping out of school could be attributable to several factors, such as low socioeconomic status, behavioral issues, intellectual disability, etc. The Sarva Shiksha Abhiyaan (SSA) is aimed at universalization of elementary education in a time-bound manner. It mandated free and compulsory education as a fundamental right to children between the ages of 6 and 14 years. It was decided under this scheme that all students must be mandatorily promoted to the next class. ¹¹ While a well-intentioned initiative, the flipside of SSA was that LD would remain undiagnosed and untreated for longer period.

Way Forward

Assessment and certification of LD in India is still dominated by the IQ-achievement discrepancy model. Unfortunately, developmental skills may be more nuanced and hetero- geneously able, a fact that most structured assessment measures are not able to tap.

There is a need to recognize that all children with learning issues and low average performance do not have LD. Contextual aspects like the child’s psychological well-being, family background of literacy, teaching methods and quality of teaching may all be playing a part. Strengthening children’s learning environments can play a big role in overcoming these contextual variables.

Key stakeholders, particularly teachers and the school system, need to be better sensitized in the identification of, and interventions available for, LD. Although India has committed to providing inclusive education through policy, the current teacher education programs do not equip teachers with requisite skills to teach students with learning problems of different kinds, including LD.

LD assessment procedures need to be made more flexible, in terms of allowing clinicians to adequately consider salient factors such as quality of school systems, lack of uniform curricula, psychosocial factors, etc. There is a need for greater freedom for clinicians to select appropriate clinical observations (eg school notebooks, teacher’s observation report, etc.) and having standardized tools for both IQ and LD assessment; but the assessment, though following the Act and guidelines so laid down along with adhering to the principles of sound clinical governance, is being individualized based on the child’s needs.

There is an imminent need for upgrading existing tools to suit the requirement of children, especially from secondary classes and higher levels. Also, there is a need for consensus guidelines on how to determine LD at the secondary level and above; and especially develop uniform, standardized, “culture-free” methods to measure and arrive at benchmark disability. Although periodic reviews and updates have been carried out, there is an immense gap yet to be plugged. Hence, regular periodic review of the assessment procedures with appropriate changes in the clinical practice guidelines for diagnosis and management (and certification thereof) of SLD is recommended.