A study of reasonable accommodations provided in classrooms to children with specific learning disorders.
Specific learning disorders (SLD) are a group of neurodevelopmental disorders that present with significant difficulty and underachievement in areas of reading, writing and mathematics not in keeping with the child's overall achievement level.  This is despite conventional instruction, intact senses, normal intelligence, proper motivation and adequate sociocultural opportunity. The term 'learning disability' was first coined in 1963 by Dr. Samuel Kirk, referring to children who reversed their letters and made other errors in their spellings. 
The cornerstone of treatment of SLD is remedial education, which should ideally begin early, as the central nervous system plasticity is more in the early years. [3,4]
As the child grows older, accommodations are also provided along with remediation. The aim of these provisions is to help the students match their academic performance with their intellectual abilities and be on par with peers. Reasonable accommodation is defined as necessary and appropriate modification and adjustments not imposing a disproportionate or undue burden, to ensure people with disabilities the enjoyment or exercise on an equal basis with others all human rights and fundamental freedom.  As there is no uniform policy with regards to provision of accommodations for SLD in classrooms in India, it is dependent on state policy, policy of the concerned educational board and individual school policy. These policies focus more on providing accommodations during examinations. SLD is a chronic lifelong condition and everyday learning is also a struggle for the child. Therefore, reasonable accommodations should be provided in classrooms as well. Children who availed the benefits of reasonable accommodation showed a significant improvement in their academic performance.  The International Dyslexia Association has provided a list of reasonable accommodations to be provided to children in classrooms. With this background in mind, we aimed to study the reasonable accommodations provided to children with SLD in schools in Hyderabad. Hyderabad has more than 668 registered schools. 
To study the reasonable accommodations provided in classrooms to children with specific learning disorders.
1. To study the school policy with regard to provision of reasonable accommodations to children with specific learning disorders.
2. To study the reasonable accommodations provided in classrooms during the course of instructions.
MATERIALS AND METHODS
All private schools of Hyderabad formed the universe of the study. The sampling method was convenience sampling and the study design was descriptive. The total sample size was 30. To be included in the study, the following inclusion criteria were used- the school was registered, medium of instruction was English, having classes up to tenth and willing to give informed consent. The list of registered schools was obtained and the heads of institutions contacted consecutively. All schools willing to give informed consent were taken up for the study till a total of 30 was reached. The questionnaire was administered to the head of the school or the person so assigned by the head who could give information on school policy. The questionnaire used in the study was specially designed for the same as there were no prior questionnaires to assess the same. The questionnaire had two parts. The first included general policy of the school with regards to children with specific learning disorders and the second with the accommodations provided in the classrooms during the course of instructions and the questions were based on the provisions mentioned by the International Dyslexia Association. The data so obtained was analysed.
A total of 30 privately funded, registered, English medium schools were taken up for the study. 53.33% of the schools followed the CBSE curriculum, followed by SSC 33.33%. Total number of children in the classrooms ranged from 30-40. Only one school of the 30 said they did not have any children with SLD. The remaining 29 schools had children with SLD. Most of the children were detected in the primary school, which is class 1 to 5. The age group of detection ranges from 5-10 years. 76% of the schools had policy regarding the management of such children. Out of schools who had policy, 68% of schools had the policy of providing remedial education and 20% provided extra classes by the class teacher at the end of school hours. Majority of the schools were conducting regular workshops to raise awareness among teachers regarding learning disability. Approximately, 68% of schools had a resource room. Most schools (63%) had the policy for continuous effort for children who did not improve. (Table 1).
Various accommodations were given to children in the classrooms. 80% of the schools have accommodation during class work in presentation of material by the teacher. Repetition of material, reading aloud and using of audio-visual aids were some of the methods commonly followed. Only 50% of the schools provided accommodations to the student while responding. Allowing oral answers instead of written work was the most common accommodation used. 80% of the schools provided accommodations in timing to complete work. Extended time to finish class work was the most commonly used method. Accommodations in seating was provided by 87% of schools. Seats nearer to teacher and seating in places in the class with minimum distractions were used. (Table 2).
SLD is the major cause of poor school performance with studies reporting 72% of poor school performers due to SLD.  Its prevalence was reported from 3-15% in school children in India. [9,10]
A conclusive diagnosis of SLD cannot be made until the child is about 7-8 years old, as some children are "normal late developers" and they outgrow their learning problems, unlike LD, which is a life-long disorder.  However, signs of SLD can be detected in "at risk "children even earlier. In our study, most children were identified by the school between the ages of 5-10 years. The school curriculums followed were CBSE, ICSE and SSC. [12,13,14] All three boards provide for accommodations to be provided during examinations. However, with no guidelines to provide during classroom teaching, it is mostly left to school policy. Interestingly, in our study, 76% of the schools had policy in place in dealing with children suffering from SLD. 68% of these schools provided remedial education and majority had a resource room.
The "resource room" is a place provided in the school where students with SLD receive direct, specialised instruction individually or in small groups. Remedial teachers in a resource room focus on particular goals as mandated by an Individualised Education Program and remediate general education curriculum. They also emphasise the development of executive skills, including homework completion and behaviour. Resource rooms have proven to be successful in significantly improving academic skills of children with LD. [15,16]
The classroom teacher and the school authorities all play a pivotal role in this direction. When perception of teachers regarding children with SLD was studied, 43.8% endorsed educating such children in special schools, while 36.3% endorsed integration to regular schools. Three fifth of teachers were willing to undergo special training for SLD intervention.  Another study showed that knowledge among people training to be teachers was very low (exposure).  Training of teachers will better equip them to detect and help children with SLD early. In our study, 77% of the schools were conducting regular teacher training workshops to raise awareness of teachers regarding SLD.
The International Dyslexia Association has recommended a number of accommodations that can be provided during classroom instructions. It has categorised the accommodations as accommodations involving material, accommodations involving interactive instructions, accommodations involving student performance.in accommodations involving material it has recommended simplified written instructions, repetition of material, blocking extraneous stimulation among others. In interactions, it has recommended providing lecture notes to students, using visual and auditory instructions simultaneously, writing key points on blackboard etc. Accommodations in student performance include peer mediated learning, encouraging note sharing, flexible work timings and additional practice.  Many of the accommodations mentioned are easily applicable even in low income, overcrowded schools. Simple instructions to teachers such as seating the child near the teacher to minimise classroom distractions as some children with dyslexia also have comorbid impulsivity and attention deficits are workable solutions.
In our study, accommodations were mostly provided in interactive instructions and presentation of materials (80%). reading aloud, repetition and presentation of material with the help of audio-visual aids were some of the commonly followed methods. Accommodation in responses were provided in only 54% of the schools. Allowing oral answers instead of written work, use of computers while answering and extended time to complete work were some of the accommodations given in response. Accommodations in seating was a commonly provided accommodation provided by 87% of schools. Seating nearer to teacher and seating in places in the class with minimum distractions were used.
The specific learning disorders are chronic lifelong conditions. They often go undetected due to low awareness. Longterm effects of these not only take a toll on the child academically but also lead to various emotional problems. Untreated learning disability leads to poor school performance which in turn causes detention or school dropout. Detention causes severe emotional stress, loss of self-esteem, withdrawn behaviour or aggression.  The lack of achievement also adversely effects their quality of life like self-image, peer and family relationships and family interactions.  Therefore, it is necessary not only to view SLD only from an academic perspective but an overall development of the child.
The new 'Persons with Disabilities Bill 2014', which is formulated according to the provisions in the UNCRPD has included the learning disorders in the list of disabilities and made it mandatory for education to be inclusive.  This in turn reinforces the child's right to receive accommodations from the school.
Limitations and Future Directions
Small sample size and inclusion of privately funded schools only may limit the generalisation of the findings to other schools. Making accommodations mandatory, holding regular awareness workshops for class teachers and empowering parents with information to help them advocate for the rights of their child will go a long way in helping children having SLD.
Questionnaire used in the Study
1. Curriculum followed in school-ICSE/CBSE/SSC
2. Average number of children in each class
3. Are there any with SLD in your school?
4. Which classes are they most often detected.
5. Do they have any school policy regarding these children?
6. If yes--what is it?
7. Are there regular workshops conducted for teachers to raise their awareness
8. Is there a resource room provided in the school?
9. What happens to children who do not improve?
Accommodations Provided in Classrooms while
* Reading aloud.
* Larger print.
* Less number of lines per page.
* Reduce copying tasks from the board.
* Use of audio-visual aids.
* Breaking question in part.
* Any other.
* Marking responses in question paper.
* Use of computers.
* Oral answers.
* Any other.
* Extended time for work.
* Frequent breaks.
* Untimed tests.
* Any other.
* Nearer to teacher.
* Minimum distraction.
* Special lighting.
* Any other.
We wish to acknowledge the constant support and guidance of Dr. Soumitra Pathare throughout the preparation of this article.
 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edn. Arlington, VA: American Psychiatric Publishing 2013.
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Srilakshmi Pingali (1), Jayanti Sundararajan (2)
(1) Assistant Professor, Department of Psychiatry, Institute of Mental Health, Hyderabad, Consultant Psychiatrist, Roshni Counselling Center.
(2) Psychologist, Department of Psychiatry, Roshni Counselling Center.
Financial or Other, Competing Interest: None.
Submission 19-06-2017, Peer Review 14-07-2017, Acceptance 19-07-2017, Published 11 -09-2017.
Corresponding Author: Dr. Srilakshmi Pingali, Flat No. 403, Elegant Cove Apartment, Sai Sagar Enclave, Hasmathpet, Secunderabad-500009, Telangana. E-mail: drpingali1 @gmail.com
Table 1 Curriculum followed N (%) CBSE 53.33% ICSE 13.33 SSC 33.33% Number of children per class <20 1 (3%) 20-<30 4 (13%) 30-40 15 (50%) >40 10 (33.3%) Are there any children with SLD in schools Yes 29 (97%) No 1 (3%) Which classes are they often detected 1-5 25 (86.2%) 6-8 3 (10.34%) 9-10 1 (3.4%) Uniform school policy for children with specific learning disorder Yes 23 (76.67%) No 7 (23.33%) What is the policy Extra classes 6 (20%) Remedial Education 20 (68%) Any other 4(12%) (Extra-curricular activities, No detention, training of class teachers in special education) Workshop for Teachers Yes 23 (76.67%) No 7 (23.33%) Provision of Resource room Yes 20 (67.67%) No 10 (33.33%) What happens to children who do not improve Detained 6 (20%) Removed 4 (13.33%) Continuous effort 19 (63.33%) Promoted till 10th 3 (10%) Table 2. Showing Accommodations in Classrooms Modification in Presentations Reading aloud 15 (50%) Repetition 18 (60%) AV aids 14 (46.67%) Larger print 2 (6%) Lesser lines per page 7 (23.33%) Reduce copying from board 5 (16.67%) Breaking question in parts 6 (20%) None 6 (20%) Modification in responses Marking in question paper 5(16.67%) Use of computers 7(23.33%) Oral answers 13(43.33%) Any other 2 (play activity, simplified answers) None 14(46.67%) Timing Extended time for work 22 (73.33%) Frequent breaks 3(10%) Untimed tests 3(10%) None 6 (20%) Seating Nearer to teacher 26(86.67%) Minimum distraction 11(36.67%) Special lighting 0 None 4(13.33%)
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|Title Annotation:||Original Research Article|
|Author:||Pingali, Srilakshmi; Sundararajan, Jayanti|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Sep 11, 2017|
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