DELHI PSYCHIATRY JOURNAL Vol. 12 No.

OCTOBER 2009

Original Article

Neuro-Cognitive Functioning in Children with

Learning 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

ABSTRACT
Learning difficulties can occur due to complex interplay of factors that may reside in the childs
own constitution, temperament and cognitive abilities and/or in the background and quality of
childs schooling and/ or in family related factors that affect interactions and emotional well
being of the child. Aims & Objectives: To study the neuro-cognitive functioning of children
with learning difficulties . Method: Forty children studying in English medium schools in Delhi
from Grade 2nd to 5th who were reported to be having learning difficulties. The children were
divided 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, scholastic
performance (on three basic subjects- Hindi, English and Mathematics)); Sustained attention;
Verbal Working Memory, Visual Learning and Memory; Verbal Learning and Memory , Verbal
Comprehension, Visuo-Constructive Ability and Visuo-Conceptual Skills. Conclusions:Both the
groups had impairment in assessed neuro-cognitive skills. Children with learning disability
had significantly poorer performance on tasks of sustained attention, visual memory and learning
, delayed recall and visuo constructive skills. There were no differences among children on
other assessed functions.
Keywords: Neurocognitive functioning, Learning difficulties, Children
Introduction
Estimates of the school and study related
problems vary considerably. In India, the estimates
of prevalence of children with scholastic
backwardness, as screened by Rutters proformas
are reported to be 17 percent.1 Learning difficulties
in children are proposed to occur due to complex
interplay of factors that may reside in the childs
own constitution, temperament and cognitive
abilities and/or in the background and quality of
childs schooling and/or in family related factors
that affect interactions and emotional well being of
the child.
The child related factors that interfere with
scholastic performance include childs limited
cognitive capacities such as limited intellectual
276

functioning., learning disabilities, 2 sensory

impairments including milder forms of hearing loss
and partial visual impairments 3,4, 5 behaviour
problems such as attention deficit disorder or
hyperactivity 6 and those that are related to
temperament and personality traits of the child. Of
the many child related factors that may produce
learning problems, learning disabilities constitute
the most prevalent as well as the most perplexing
underlying cause7 of the problems. The investigation of learning disabilities through neuropsychological studies, structural and functional
imaging as well as electrophysiological studies has
yielded evidence that deficits arise from central
nervous system dysfunction.8-13 While the Western
Literature is replete with such studies, the Indian

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DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

scenario is strikingly different. In India, the

incidence of learning disability ranges from 2-18%
14, 15
yet, most of the Indian studies have focused
largely on psychosocial concomitants of LD. 16,17
Reports on neuropsychological profile and
cognitive deficits of children with LD are few.18,19
Although these few studies provided many useful
insights, they largely compared the neuropsychological functioning among the various
groups of learning disability. There have been no
reported Indian studies that have compared the
cognitive functioning of learning disabled children
with the profile of those children who have learning
difficulties but do not have any diagnosable
neuropsychiatric/emotional/behavioural problems.
These children with learning difficulties but
without any diagnosable disorder/disability have
remained at the periphery probably because of under
reporting of this population in the clinical set-ups
to seek help. The present study, has attempted to
overcome some of these lacunas in the field of
learning difficulties in the Indian population. The
study has attempted at uncovering the neuropsychological basis of various groups of children
with learning difficulties and carries implications
for future remedial training programmes.

excluded from the study. The children belonged to

the age group of 8 to 10 years.
TOOLS

Materials and Methods

Sample: The study sample consisted of 40
children studying in English medium schools in
Delhi from Grade 2nd to 5th who were reported by
teachers to be having learning difficulties. Based
on the initial diagnostic assessments children were
divided into two groups (n = 20, each). One of the
groups had children having being diagnosed with
learning disability. The other group had children
with learning difficulties but without any
diagnosable neuropsychiatric disorder/emotional
problems/behavioral problems. All children in the
sample had average level of intellectual functioning,
were attending school regularly, without any study
breaks or school change, and were from middle
socioeconomic status. Children having any physical
disability, subnor mal level of intellectual
functioning, any sensory impairments, children
from single parent families or those having any
other developmental disorder other than learning
disability/any other neurological/psychiatric/
behavioural/or any other major medical illness were

Childrens Behaviour Questionnaire (CBQ)20

was used to screen children for having/ not
having behavioural and emotional disorders.
NIMHANS Index for Specific Learning
Disability1 comprises of Malins Intelligence
Scale for Indian Children (MISIC), Digit
Vigilance Test, Bender Gestalt Test, Test of
Visuo-Motor Integration, Auditory Memory
Test, Benton Visual Retention Test along with
tests of Academic Performance that include
reading, writing, arithmetic, spelling and
comprehension. For the present study, the Tests
for Academic Performance of this battery were
replaced by GLAD.
Grade Level Assessment Device for Children
with Learning Problems in Schools21 to assess
scholastic performance. The GLAD assesses
the level of academic performance in three basic
subjects viz. Hindi, English and Mathematics,
in primary school children while systematically
making an observation of the processing pattern
in the child.
Colour Trails Test22 was used as a measure of
focused attention.
Digit Vigilance Test 23 to assess sustained
attention.
Benton Visual Retention Test24 to assess visual
memory and visual perception.
N Back Test (Visual) was used as a measure
of visuospatial working memory. It consists of
36 cards each in the 1 back and 2 back test.
Indian Adaptation of Reys Auditory Verbal
Learning Test 25 to measure verbal memory.
Block Design Test26 for assessment of visuoconstructive abilities.
Token Test 27 is a measure of ver bal
comprehension of commands of increasing
complexity.

Procedure
Based on the initial diagnostic assessment all
children were divided into two groups (n= 20)Group 1- having children with learning disability
and Group 2- having children with learning
difficulties but without learning disability. The tests

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DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

OCTOBER 2009

were administered in the following or der:

NIMHANS SLD Index, GLAD, Digit Vigilance
Test, Benton Visual Retention Test, RAVLT, Token
Test and Block Design Test. Children were assessed
for their school performance using GLAD to
compare the scholastic performance of the two
groups. The entire battery of tools took about 6
hours to administer which was done across 3-4
sessions. The study was performed with written
informed consent of school authorities as well as
of parents.
Analysis: The data thus collected following
the above design and procedure was interpreted
using mean and standard deviation and compared
through t-test.
Results
The obtained mean, Standard Deviation and tvalues for scholastic performance of the two groups
are given in Table 1. Table 2 shows mean, SD and
t-values on assessed cognitive domains of both the
groups.
From Table 1 it is observed that, the obtained

t-values for all the three subjects are not significant

at = 0.05 level of significance . this means that,
L.D and N.L.D groups did not differ significantly
on their scholastic performance for any of the three
subjects.
From Table 2 which shows the comparative
analysis of cognitive skills between L.D and N.L.D
it is observed that the obtained t-values are
significant for attention (time taken and error score),
visual memory, delayed verbal recall, and visuo
spatial skills, at 0.05 level of significance. However,
obtained t- values are not significant for immediate
verbal memory and total recall. Thus, for all
cognitive skills (except immediate verbal recall and
total learning) and it is inferred that there is a
significant difference in cognitive skills of L.D and
N.L.D group. Further, from the mean scores of the
two groups it is observed that children in L.D group
performed poorly on all cognitive skills as their
mean scores are higher for attention and lower for
other cognitive skills, as compared to mean scores
of N.L.D group. The mean IQ of L.D group was
98.9 (3.81) and of the N.L.D group was 101.0

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

Subject

LD (n = 20)
Mean
S.D.

N. L.D (n = 20)
Mean
S.D.

t-value

English
Hindi
Mathematics

60.8
63.2
55.8

63.4
64.2
57.4

0.335
0.247
0.223

15.08
5.16
14.66

8.6
7.7
6.4

*p < 0.05, **p < 0.01

Table 2: Comparison of Cognitive Skills in L.D Vs Non L.D Group
Cognitive Skills
Sustained Attention(Time Taken)
Attention(Error Score)
Focused Attention
VisualMemory
Visual Working Memory
Immediate Verbal Memory
Delayed Verbal Recall
Total Learning
Visuospatial
Comprehension

L.D (n=20)
Mean
S.D.

N.L.D ( n = 20)
Mean
S.D.

t-Value

8.9
20.2
177.2
4.2
2.5
43.0
32.0
50.0
86.5
14.0

5.2
9.0
158.7
6.4
3.9
42.0
44.0
49.0
102
12.01

2.32*
2.45*
1.76
2.41*
1.01
1.09
2.34*
0.041
2.99**
1.97

3.7
11.5
15.7
1.3
0.81
3.4
4.8
4.5
4.40
3.91

* p < 0.05, **p < 0.01

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

1.03
5.89
18.9
2.07
1.01
37.84
36.40
4.80
5.79
2.98

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DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

(2.5) with a t value of 0.099 which is non

significant at p>0.01 indicating that the two groups
were matched for their intellectual functioning.
Discussion
As seen from results section, the two groups
of children, did not differ significantly on IQ, their
school performance on three school subjects thus
indicating that both the study groups were matched
for their intellectual functioning and academic
performance. However, the qualitative analysis
revealed that the nature of mistakes committed on
the three school subjects was different for both the
groups.
Attention as measured in this study was
sustained attention, that is, the capacity to be
vigilant and attend for a period of time; even in the
presence of distracters. It has been found from the
present results that children with learning disability
have poorer sustained attention than children
without learning disability as children with learning
disability took significantly longer time to complete
the task as compared to children in non learning
disability group. That is, their speed of processing
information was found to be significantly slow as
compared to children without learning disability.
Further, the error score on this test revealed that
children in learning disability group committed
significantly more errors than children without
learning disability. It was found during scoring of
this test that children with learning disability
committed both errors of commission (indicating
that the children had problems in r esponse
inhibition) as well as error of omission (reflecting
poor visual scanning and poor selective attention)
in approximately similar ratio. Children without
learning disability showed only error of omission.
This has implications for academic performance as
reading primarily requires accurate analysis of the
characteristics of visual pattern. Correct decoding
of written words requires detailed processing which
is made possible by sustaining attention. Since
sustained attention is found to be impaired in both
the groups with more impairment in learning
disability children, activities to improvise sustained
attention is implicate to improve reading abilities
of these children.
Focused attention was found to be relatively
intact in the learning disability group whereas

problems in focusing attention have been observed

in the Non learning disability group. Similar
findings have been reported by Agarwal 28 in their
study with children with dyslexia.
Further, although both the groups have shown
impairment in visual and verbal memory, visual
memory is poorer in children with learning
disability than in children without learning
disability. With respect to immediate recall of verbal
information, there was no significant difference in
the skills demonstrated by the two groups. Further,
there were no significant differences between the
two groups with respect to their total verbal
learning. However, it was found that whereas
children with learning disability showed both
recency and primacy effects while learning the list
of words; children without learning disability
largely showed primacy effect. From introspective
reports of children it was revealed that children with
learning disability attended to the words as they
were presented but most children in the non learning
disabled groups were putting extra efforts to
memorize whatever was being presented and so they
were more concerned and stuck with the initial
words in the list.
Also, children with learning disability have
shown significantly poorer performance on delayed
recall than children without learning disability. This
implies that either, the consolidation process itself
is poorer in children with learning disability or that,
interference processes are more at work in the
learning disability children than those children who
do not have learning disability but still have
scholastic backwardness. This aspect needs to be
taken up in further research studies. Since both
reading and writing are significantly based on
storage , processing and retrieval of information in
different modalities; these findings explain the
probable reasons for poor academic performance
of children in both the groups. Also, memory
deficits indicate inability to use strategies of
phonetic or semantic clustering, which is related to
language related impairments of children with
learning disabilities.28
From the result findings, it was further found
that children with learning disability have shown
significant deficits on visuo spatial skills as
compared to children without learning disability.
However, no significant differences were observed

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on comprehension and visual working memory.

Although there is a dearth of studies on
neuropsychological in different groups of children
having scholastic backwardness, studies with
learning disability children have reported deficits
in their attention, verbal and visual memory, and
visuospatial functioning29, 30,18, 19.Similar deficits in
children with learning disability have been found
in this study also. The present study went a step
further and found that children having learning
difficulties but etiology different from learning
disability also have neuropsychological deficits but
the deficits are more pronounced in the learning
disability group.
The sample of the present study being small,
the findings must be generalized with caution. The
findings need further validation through a study
with larger sample from wide range of sociodemographic strata. The study has implications for
planning of intervention modules for different
groups of children with learning difficulties.
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