Hard to learn

Although dyslexia is considered a learning disorder, there is no relationship between dyslexia and intelligence.

SOME people have a learning disability that leads to difficulty in learning and using certain skills. The skills that are usually affected are reading, writing, listening, speaking, reasoning, and doing mathematics.

The terms used for these disabilities are dyslexia, which refers to difficulties in reading and spelling; dysgraphia, which refers to difficulties in writing; and dyscalculia, which refer to difficulties in doing mathematics.

This article is about dyslexia, which is derived from the Greek works, dys (difficulty), and lexia (use of words). The symptoms range from the very mild to the very severe. People with dyslexia have difficulties with phonemic awareness, verbal memory and verbal memory speed.

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Phonemic (or phonological) awareness is the ability to learn how speech sounds make up words, connecting the sounds to alphabet letters, and learning how to blend the sounds into words. Changes in the sounds lead to different words with different meaning. This ability is believed to be crucial in early reading and spelling development.

Verbal memory is the ability to remember a sequence of verbal information for a short time. Verbal processing speed is the time taken to recognise and process familiar verbal information, e.g. this speed is the time taken to recognise the letters, A, S, E, A and N, process it, and then realise that it refers to the Association of South East Asian Nations. Although dyslexia is considered a learning disorder, there is no relationship between dyslexia and intelligence. Dyslexia has been defined well by Shaywitz, who stated that, “Dyslexia is a reading difficulty in a child or adult who otherwise has good intelligence, strong motivation and adequate schooling … Dyslexia reflects a problem within the language system in the brain.”

Dyslexia is reported to affect about 10% of schoolchildren, with about 4% having severe difficulties that affect their learning ability in school. The incidence in males is estimated to be 1.5 to three times more than that in females. It affects all ethnic groups.

Roots of dyslexia

Dyslexia is a genetic condition. However, there are various theories about the causes.

It occurs in certain families. It is estimated that a child of a dyslexic has a 40% to 60% chance of developing the condition. If an identical twin has the condition, it is very likely that the other twin would also have the condition.

Scientists have detected genes that may lead to dyslexia, but their effects on the brain have yet to be elucidated.

The phonological processing impairment theory is believed by many to explain how dyslexia affects reading and writing. The ability to understand spoken language is an innate capacity of the brain, which recognises a word as a whole and does not register it by the units of sound that constitute a word (phonemes).

However, reading and writing requires the ability to recognise the letters in a word, identify from the letters the phonemes, and then bring them together to form a word. This process, which is termed phonological processing, is believed to be impaired in dyslexics.

There is evidence from magnetic resonance imaging (MRI) that the part of the brain (left hemisphere) involved in producing, analysing and identifying written words demonstrate less activity in dyslexics when they read. This may impact upon phonological processing.

MRI has also shown that the activity in the cerebellum of dyslexics is different from those without the condition. The cerebellum, which is found at the lower back of the brain, is believed to be crucial to the processing of language, coordination and assessment of time. This may explain why dyslexics have difficulties with coordination and time management.

Distinctive features

There is individual variation in the features of dyslexia. Each affected person would have distinctive features.

The features in a pre-school child include delayed speech development when compared to children of the same age; speech problems, like an inability to pronounce long words; problems expressing spoken language, like an inability to remember the right word to use; lack of understanding or appreciation of words that rhyme; or lack of interest in learning the letters of the alphabet.

It is not always possible to detect dyslexia in a pre-school child.

The features in the early school years include problems learning the names and sounds of letters, erratic spelling, problems copying written language, and poor phonological awareness, i.e. the ability to recognise that words are comprised of smaller sound units (phonemes) and new words can be created by altering the phonemes.

The child may also have difficulty in making sense of unfamiliar words by considering smaller words or collection of letters.

The features in the later primary school years include problems with spelling, problems understanding and recognising new words, and slow reading speed.

The features in secondary school include problems with reading fluency, slow writing speed, and problems expressing knowledge in writing.

Some dyslexics reach adulthood without the diagnosis ever being made. Their features include avoidance of reading and writing and hiding these difficulties from others, reliance on memory and verbal skills instead of reading and writing, poor spelling, and poor time management.

Dyslexia is associated with poor numerical skills, poor short term memory, poor concentration, poor time and organisational management as well as problems with physical co-ordination.

The earlier dyslexia is diagnosed, the more likely its management will be effective.

If a child has difficulties with reading and writing, a discussion with the teaching staff and a consultation with the family doctor would be helpful. The latter would exclude health problems which affect the child’s ability to read and write, e.g. vision problems, poor hearing, and other conditions like attention deficit hyperactivity disorder. The former would help in a review of the teaching methodology and provide alternative approaches and support, which is helpful for many children, including those with mild or moderate dyslexia.

If the problem persists despite the above, an assessment by an educational psychologist would be advisable. The latter is a specialist who assists children with problems in their educational progress because of emotional, psychological, cognitive (learning), or behavioural factors. This can be challenging as there are not many educational psychologists available in the country.

Alternatively, assistance can be sought from the Dyslexia Association of Malaysia, which has centres in Peninsular Malaysia. Its contact details are 6, Persiaran Kuantan, Off Jalan Setapak, 53200 Kuala Lumpur (Tel: 03-4025-5109).

The assessment includes an evaluation of the child’s reading and writing abilities as well as other skills like vocabulary, memory, reasoning, language development, processing speed of visual and sound information, organisational skills, and approaches to learning.

A diagnosis of dyslexia is made if the child’s reading and writing skills are poor despite appropriate teaching methodology and the child’s logic and verbal skills are unaffected.

Adults can also have similar assessments done.

Treating dyslexia

There is currently no cure for dyslexia. However, there are many interventions that can assist dyslexics. The degree and type of intervention is determined by the severity of the problems.

Interventions before a child goes to school are effective in achieving long term improvements in the condition. There is evidence that interventions which improve the ability to identify and process sounds (phonological skills) are effective.

These interventions, which are called phonics, concentrate on recognition and identification of sounds in spoken words (phonemic awareness) and instruction on phonics, spelling, writing, vocabulary, comprehension, and fluency.

There is evidence that effective methods of teaching phonics to dyslexics have certain features:

● Teaching is structured, with gradual increase based on what has been learnt previously.

● Use of different senses.

● Reinforcement with regular practice.

● Development of other useful skills.

● Recognition that there are different learning methods and approaches and then selecting the appropriate one for different situations.

● Breaking down the dyslexic’s emotional barriers, like anxiety and frustration, with empathy, encouragement, and promotion of the dyslexic’s self-esteem.

Many older children find the use of educational software applications useful rather than text or exercise books.

Similar approaches are useful in adult dyslexics.

In a nutshell

It is useful to remember that about 95% of dyslexic children respond well to educational interventions, with reasonable to good progress in reading and writing. About 5% continue to experience difficulties and would need more rigorous and long-term support.

It must be emphasised that although dyslexic children encounter daily challenges, even those with severe dyslexia can go on to have full and productive lives.


 

Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organization the writer is associated with.

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Constipation in Children

Constipation is often a parent’s nightmare.

Constipation in children can cause mild to severe stomach pain. Most of the time, constipation happens due to the child’s eating and bowel habit. Children tend to eat “junk food” or fast food with insufficient vegetables, fruits and water in their diet. As it prolongs, their stools becomes hard and painful to discharge. They may try to avoid

going to the toilet due to pain and discomfort. This only results in the stool becoming harder and larger and eventually leads to constipation. The pain from constipation normally goes away after a bowel movement. However, if severe pain persists, it may be caused any another condition such as appendicitis. You should also check for other symptoms such as fever or vomiting.

If your child suffers from chronic constipation or stomach pain, you should take them to seek medical attention. The doctor will normally ask about the child’s eating habits and may perform several procedures such as ultrasound or X-ray. If constipation is diagnosed, an enema would be recommended to loosen the bowels. The doctor will also prescribe pain medication along with some dietary changes.


For your information, our Paediatrician clinic hours as follows:

Dr. Lam Shih Kwong

Monday, Tuesday & Wednesday; 6 pm till 8:15 pm @ Suite No: 2 – 3a

Thursday & Friday; 3 pm till 5:30 pm @ Suite No: 2 – 3a

Saturday; 9 am till 1 pm @ Suite No: 2 – 3a

Datin Dr. Yap Lay Meng

Monday, Tuesday & Thursday; 9 am till 12:30 pm @ Suite No: 2 – 3a

Wednesday; 6 pm till 9 pm @ Suite 2 – 3

Coil to Prevent Pregnancy

An ectopic pregnancy occurs when an embryo implants somewhere other than the uterus, such as in one of the fallopian tubes.

The intra-uterine contraceptive device is made of plastic and/or copper, and is inserted into the uterus to help prevent pregnancy.

AN intra-uterine contraceptive device (IUCD) is a small contraceptive device that is inserted into the uterus. It is made of plastic and/or copper, and is called a “coil” or “loop” by many. It has threads, at one end, which protrude from the opening at the neck of the uterus (cervix) into the upper part of the vagina.

The IUCD prevents pregnancy by releasing copper, which induces a body response that changes the composition of the fluids in the uterus and fallopian tubes, thereby preventing the egg from meeting a sperm. The accepted legal and medical view is that an IUCD is a contraceptive method, and not a method of abortion, as it is extremely unlikely that it interferes with implantation.

The IUCD is an effective and reversible contraceptive method. There are 0.6 pregnancies in 100 women in one year of use.

Advantages

Most women can use an IUCD, including women who have never been pregnant. It is effective immediately after insertion by a doctor. One does not have to worry about contraception as long as it is in place. It does not interfere with sex, and is effective for three to 10 years or until it is removed. It can be used with breastfeeding.

Fertility is restored when it is removed, and there is no interaction with other medicines.

There is no evidence that IUCDs increase the risk of cancers of the cervix, endometrium and ovaries. A very small number of users may complain of changes in mood and libido.

Disadvantages
Complications after having an IUCD fitted are rare, and if they do occur, this will happen within the first year after insertion.

The periods may be heavier and last longer, especially in women who have always had heavy periods. This usually occurs in the first few cycles after insertion, which may then improve.

Sometimes, there is spotting or bleeding in between periods. The periods may also be painful. A small percentage (5-15%) of users will have the IUCD removed because of pain and bleeding.

If the problems persist, an intrauterine system may be considered. This will be discussed later.

An IUCD does not protect against sexually transmitted infections (STIs). As such, those at risk of STIs, ie those who have more than one partner or if the partner has more than one partner(s), have to use condoms as well.

There is a small increase in the chances of getting a pelvic infection in the 21 days following insertion, especially in women who have risk factors for STIs. The risk of pelvic infection at any time is increased in those at increased risk of STIs.

If an IUCD user gets an STI when it is inserted, it may lead to a pelvic infection if untreated.

The risk of pelvic infection from an IUCD itself is rare. Less than one in 100 women whose risk of STI is low will get such an infection.

Most doctors recommend screening for possible existing STI before inserting an IUCD. This includes an internal examination.

The IUCD may be expelled or displaced. The expulsion rates vary in the first year of use. The majority of expulsions occur within three months of insertion and the user may be unaware of its occurrence. That is the reason why the user is taught how to check the IUCD threads regularly.

The IUCD may, very rarely (about one in 1,000 insertions), go through (perforate) the uterus. Perforation is more likely to occur if the insertion is done after childbirth. This leads to lower abdominal pain that may require surgery to remove the IUCD.

If the pain is severe, immediate medical attention should be sought.

If an IUCD user gets pregnant, there is a risk that the pregnancy will develop outside the uterus, usually in the fallopian tube (ectopic pregnancy). Such an event is potentially life threatening. As less than 1% of IUCD users have an unintended pregnancy, the absolute risk of an ectopic pregnancy is lower in women using an IUCD when compared to sexually active women using no contraception.

If a pregnancy occurs despite the IUCD, it is removed as soon as possible in a continuing pregnancy.

Who can use an IUCD?

Most women can use an IUCD. However, women with any of the following conditions should not use an IUCD: those who may be pregnant; have an untreated STI or is at increased risk of getting an STI; now have or previously had an ectopic pregnancy; have heavy and painful menstrual periods; have any problems with the uterus or cervix; have bleeding in between periods or after sex; or have an artificial heart valve.

Because of one or more of the above reasons, the IUCD is not usually recommended for teenagers, unless they have given birth. The doctor will advise whether an IUCD is suitable for an individual, depending on her medical history.

Insertion

The IUCD is usually inserted towards the end of a menstrual period or a few days after, before the estimated time of ovulation. It can also be inserted four to six weeks after childbirth, or immediately after a miscarriage below 24 weeks gestation. If the miscarriage occurs above 24 weeks gestation, the IUCD can be inserted a few weeks after the miscarriage.

It can also be inserted within five days of unprotected sexual intercourse as emergency contraception. It is safe to use sanitary towels or tampons with an IUCD in place.

Before an IUCD is inserted, the doctor will check that there is no pregnancy or existing pelvic infection, which, if present, would be treated. An internal examination is done to determine the size and position of the uterus.

A speculum is inserted into the vagina to keep it open, just like when a cervical smear is taken. The IUCD is inserted through the cervix into the uterine cavity. The process may be uncomfortable and occasionally painful, with lower abdominal cramps after the insertion.

Some women may require painkillers before an IUCD insertion, although many do not. The insertion process usually takes about 10 to 15 minutes.

After an IUCD insertion

It is advisable to consult the doctor after an IUCD has been inserted if one feels unwell, or has lower abdominal pain, a smelly vaginal discharge or fever, which are features of pelvic infection.

Users will be taught how to feel the IUCD threads to make sure that it is in place. This should be done a few times in the first month after insertion, and then after menstruation at regular intervals after that.

It is very unlikely that the IUCD will come out. However, if the threads cannot be felt, or the IUCD itself is felt, the doctor should be consulted and another contraceptive method used (until the IUCD has been located).

On rare occasions, the partner may feel the threads during sexual intercourse. A consultation with the doctor will lead to the threads being moved out of the way or shortened.

The IUCD will need to be checked by your doctor about three to six weeks after insertion, and then at least once a year after that. If there are any problems at any time, especially if the user or partner is at increased risk of STI, the doctor should be consulted as STIs can lead to pelvic infections.

An IUCD can be removed at any time. If one does not want another IUCD inserted and does not want to become pregnant, alternative contraceptive methods have to be used.

Pregnancy with an IUCD in place

It is very rare for a woman to become pregnant with an IUCD. The doctor should be consulted immediately if the periods are delayed or light, or if there is sudden or unusual lower abdominal pain, as these may be warning signs of an ectopic pregnancy.

If one is pregnant, and it is not an ectopic pregnancy, the doctor will remove the IUCD, as this reduces the chances of a miscarriage.

On the very rare occasions that the IUCD cannot be removed and the pregnancy proceeds, the risk of premature delivery is increased four times.

There is no evidence of increased risk of the IUCD causing congenital malformation if the pregnancy goes to term.

Levonorgestrel-releasing intra-uterine system

This is an IUCD containing 52 milligrams of levonorgestrel. It releases 20 micrograms of levonorgestrel every 24 hours. It is used as a contraceptive and in the treatment of heavy periods (menorrhagia) and endometrial protection for women on oestrogen replacement therapy.

It is effective for five years, and less than one in 100 women will get pregnant in a year of use. It is, however, ineffective as emergency contraception.

It is different from other IUCDs in that it reduces menstrual blood loss and painful periods. There is also a possible reduction of pelvic infection, as compared to the copper IUCDs, because it thickens the cervical mucous.

Menstrual irregularities are not uncommon in the first few months after insertion. After three months, the menstrual blood loss is reduced by 75%.

After twelve months, most women bleed lightly for one day and many have no periods. This is not medically harmful.

However, the commonest reason for its removal is unacceptable bleeding.

IUCDs are an effective contraceptive method. However, it is not usually recommended for teenagers or women who are at risk of sexually transmitted infections.

Dr Milton Lum is available every Wednesday and Saturday morning for consultations. For more information, please call 03 – 6141 8533. 

 

Dr Milton Lum – is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Disclaimer: Nothing on this blog should be considered or used as a substitute for medical advice, diagnosis or treatment. Blog visitors with personal health or medical questions should consult their health care provider.