INTRODUCTION:

A learning disability is a neurological condition that interferes with a person’s ability to store, process, or produce information.

Learning disabilities can affect one’s ability to read, write, speak, spell, compute math, reason and also affect a person’s attention, memory, coordination, social skills and emotional maturity.

Sheldon Horowitz, Experts aren’t exactly sure what causes learning disabilities. Some possibilities include:

· Heredity: Often, learning disabilities run in the family, so it’s not uncommon to find that people with learning disabilities have parents or other relatives with similar difficulties.

· Problems during pregnancy and birth: Learning disabilities may be caused by illness or injury during or before birth. It may also be caused by low birth weight, lack of oxygen, drug and alcohol use during pregnancy, and premature or prolonged labor.

· Incidents after birth: Head injuries, nutritional deprivation, and exposure to toxic substances (i.e. lead) can contribute to learning disabilities

· Learning disabilities are NOT caused by economic disadvantage, environmental factors, or cultural differences. In fact, there is frequently no apparent cause for learning disabilities.

David Urion, There appears to be no one cause of learning disabilities. That some appear to be hereditary — for example, dyslexia and certain other language-based learning disorders seem to pass through families. In other instances, early brain injury — such as can occur as a consequence of prematurity — is associated with learning disabilities. Certain toxic exposures, such as lead, can produce injury to the developing brain and lead to learning disabilities. Many remain obscure in their origins.

Cheryl Weinstein, The most is known about the learning disability known as dyslexia. Individuals with dyslexia do not have the typical pattern of left hemisphere brain organization for reading. Dr. Sally Shaywitz at Yale University (2003) has done remarkable research with functional magnetic resonance imaging (MRIs) showing that dyslexic adults have under-activation of the reading area of the brain and over-activation of brain regions responsible for attention and recognition of sounds. It is no wonder that the adult with a reading disorder is more fatigued after work. Their brain is literally working harder.

More generally, there are multiple factors that cause learning disabilities, including atypical brain organization. Specifically, there may be differences in cells or in the basic “hard-wiring” of the brain. One patient explained that his brain “was wired by a non-union electrician.” There also may be differences in brain development due to metabolic disorders such as maternal diabetes or thyroid disease. Parental alcohol abuse and maternal smoking are well-known agents contributing to childhood learning problems. In addition, there may be stress to the baby during birth when there is sudden lack of oxygen to the baby’s brain (anoxic events).

NEED FOR THE STUDY:

As of now, no one is certain what causes learning disabilities. It is thought that learning disabilities may be caused by hereditary, teratogenic factors (for instance, alcohol or cocaine use during pregnancy), medical factors (premature birth, diabetes, meningitis of mother or offspring), and/or environmental factors (malnutrition, poor prenatal healthcare). A leading theory among scientists is that learning disabilities stem from subtle disturbances in the way brain structures are formed. Researchers are also studying genetic links. (Gail Grodzinsky).

The investigator wants to experiment whether the learning disability among children is really associated with hereditary or not.

STATEMENT OF THE PROBLEM:

“A case control study on learning disabilities and the family history of learning disabilities among schoolers in Pallakkapalayam, Namakkal District”.

OBJECTIVES:

1. To assess the level of learning disabilities and the family history of learning disabilities among schoolers.

2. To find out the association between learning disabilities and the family history of learning disabilities among schoolers.

3. To identify the risk of learning disability among schooler with family history of learning disability and those who donot have family history of learning disability

HYPOTHESIS:

· H₁ : There is a significant level of learning disabilities and the family history of learning disabilities among schoolers

· H₂: There is a significant association between learning disabilities and the family history of learning disabilities among schoolers

· 4. H_3
:There is a significant risk of learning disability among schooler with family history of learning disability than those who do not have family history of learning disability

RESEARCH METHODOLOGY:

· The research design: The case control design was used

· Setting of the study: Conducted at Pallakkaplayam in Namakkal District

· Research variable: Learning disabilities and the family history of learning disabilities

· Population: Schoolers.

· Sample: Schoolers in Pallakkapalayam, Namakkal District.

· Sample Size: The total sample size is 30

· Sampling technique: Purposive sampling technique was used.

Table.1.Check list on learning disabilities

S. No	Signs and behaviours of children with learning difficulties	Response
		Yes	No
		0	1
1.	Difficulty following verbal instructions
2.	Repetition of the same question or asking seemingly simple questions or self-explanatory questions
3.	Repeated asking of questions about work already explained
4.	Losing their place when reading or copying
5.	Erratic spelling or no set pattern to spelling mistakes
6.	Difficulty working from written instructions
7.	Difficulty copying
8.	An awareness of a mistake, but difficulty correcting that mistake
9.	Difficulty distinguishing main ideas from details
10.	Difficulty adjusting to change in routine
11.	Difficulty making choices, identifying priorities and initiating tasks
12.	Forgetting assignments or homework
13.	Difficulty completing tasks within a given time
14.	Difficulty in putting ideas to paper even when verbal answers given are correct
15.	Difficulty remembering information from one day to the next
16.	Inconsistent performance in school work (“up and down days”)
17.	Ability to complete difficult examples of work, but difficulty with simpler examples
18.	Poor handwriting
19.	Clumsiness
20.	Difficulty sustaining attention

RESULTS:

Table.2. Frequency and percentage distribution of level of disability among schoolers

Level of learning disability	Frequency	Percentage
No disability	12	40%
Mild learning disability	13	43.30%
Severe learning disability	5	16.70%

The result shows that 43.3% schooler having mild disability and 16.7% of schooler having severe learning disability.

Exposure rates

Cases: a/a+c = 11/18 = 0.61x 100= 61%

Controls: b/b+d = 1/12 = 0.083x100 = 8.3%

Relative risk = Incidence among exposed / Incidence among non exposed = 61/8.3 = 7.35

Odds ratio = ad/bc = 11x11/ 1x7 = 17.28

The table.5. Shows that the frequency of learning disability among schooler with family history of learning disability definitely higher than schooler without family history of learning disabilities. The exposure rates among cases was 61% and 8.3% among controls. The relative risk of learning disability with family history of learning disability was 7.35.

The odds ratio shows that a risk of having the learning disability for schooler with the family history of learning disability was 17.28 times higher than those who donot having the family history of learning disability.

The table.3. Shows that the frequency and percentage distribution of schoolers according to their family history of learning disabilities

Purposively selected schoolers	With family history of learning disabilities		Without family history of learning disabilities
Purposively selected schoolers	Frequency	Percentage	Frequency	Percentage
No disability	1	3%	11	37%
Mild learning disability	7	24%	6	20%
Severe learning disability	4	13%	1	3%

Table .4. Showed that the association between the learning disabilities among schooler and their family history of learning disabilities.

Level of learning disabilities	With family history of learning disabilities	Without family history of learning disabilities	Df	Chi-square	Table Value	Level of significance
No disability	1	11	2	9.6	5.99	P < 0.05 Not significant
Mild learning disability	7	6
Severe learning disability	4	1

It reveals that there was strong association between the learning disabilities and their family history of learning disabilities.

Table.5. Contingency table applied to learning disability among schooler and family history of learning disability.

Family history of Learning disability	Cases (with learning disabilities)	Controls (with out learning disabilities)
Yes	11(a)	1(b)
No	7 (c)	11(d)
Total	18(a)+(c)	12(b)+(d)

DISCUSSION:

Objective 1: To assess the level of learning disabilities and the family history of learning disabilities among schoolers.

The result showed that the 40% of schoolers were with no disabilities, 43.3% had mild learning disabilities and 16.7% had severe learning disabilities.

Table.2. Showed that in the schooler with family history of learning disabilities 3% had no disabilities, majority (24%) had mild learning disabilities, and 13% had severe learning disabilities. In the schooler without family history of learning disabilities majority (37%) had no disabilities, 20% had mild learning disabilities, and 3% had severe learning disabilities.

So the first hypothesis (H₁) “There is a significant level of learning disabilities and the family history of learning disabilities among schoolers” was accepted.

Objective 2: To find out the association between learning disabilities and the family history of learning disabilities among schoolers

Table.3. Showed that the association between the learning disabilities among schooler and their family history of learning disabilities. The calculate Chi square value is 9.6, when compared to table value (5.99) was high at the level of significance of p< 0.005 level, that indicate the strong association between the learning disabilities and their family history of learning disabilities.

So the second hypothesis (H₂) “There is a significant association between learning disabilities and the family history of learning disabilities among schoolers” was accepted.

Objective 3: To identify the risk of learning disability among schooler with family history of learning disability and those who donot have family history of learning disability

A risk of having the learning disability for schooler with the family history of learning disability was 17.28 times higher than those who donot having the family history of learning disability.

So the third hypothesis (H₃₎“There is a significant risk of learning disability among schooler with family history of learning disability than those who do not have family history of learning disability”

IMPLICATIONS FOR NURSING:

· The nursing personnel working in hospital and community settings can reinforce the parents and care giver to take necessary measures to avoid school dropout and mental stress to their children.

· Nursing educator can educate the nursing professionals about the importance of screening for learning disabilities for protecting the child from social stress in order to make the healthy society.

· Nursing educator can influence nursing professionals and other health team members about screening procedures and treatment measures for learning disabilities.

· The nurse administrator can organize the continuing nursing education programme on learning disabilities and its influence among children.

· The study may be issued for further reference.

· Further large scale study can be done in different settings to generalize the finding.

RECOMMENDATIONS:

· This similar study can be replicated on large scale there by findings can be generalized for the target population.

· A similar study can be done by undertaking experiments with the use teaching interventions, health awareness programme.

REFERENCES:

www.pbs.org/parents/education/learning-disabilities

www.health24.com/Medical/Diseases/Learning-disabilities

Received on 22.02.2014 Modified on 02.03.2014

Int. J. Adv. Nur. Management 2(1):Jan. - Mar., 2014; Page 15-18