Sociodemographic details:

Name: Age:
Gender: Education:
UHID No.: [Link]. No.:
Referred By: Socio-economic Status:
First Contact on: Informant:
Assessed by: Assessment Conducted on:

Chief Complaints:
Informant:
● School walo ne kaha hai
● Reading difficulty hai, numbers and letters mei, jese 15 ko 51 pdhna ya fir Bus ko ub, second letter
pehle and first wala second
Patient:
● Spelling test mei hmesha zero milta hai.
Brief Developmental History:
Patient was born preterm ( 8 months 15 days) caesarian delivery at the hospital. Birth cry was immediate
and birth weight was below normal range ( 2.1 kg). History of seizures, pneumonia, jaundice, high grade fever
or head trauma is unknown to informants as patient was put in incubator for 15 days immediately after birth.
There were postnatal complications as the mother's blood pressure levelled up after giving birth. Formal
education was started at 3 years. Currently, patient studies in Kendriya Vidyalaya Sector 47. According to
informants, patient had problems with sustaining attention and used to cry while studying.

Behavioural Observations:
Patient entered the room with his father and mother. She was well kempt and dressed appropriately. Eye
contact was initiated and maintained. Attention was aroused and sustained. Working rapport was established.
She was very cooperative during intake and was able to comprehend the instructions adequately. Poor vision
was found in both eyes (L=6/9, R= 6/9)
Test Administered:
1. NIMHANS Index of Specific Learning Disabilities (SLD)
Tests Findings:

1. Attention Test – double number cancellation test was used to assess the child’s attention which
includes three functions – selection, capacity and sustained attention. The scores were as
follows:

No. of correct Number of Number of Time taken

Omissions Commissions (in sec)
240 10 2 504
Remarks: patient's performance indicates adequate attention.

2. Language: This domain covers reading, comprehension and spelling.

a) Reading and Comprehension:

The summary is presented in Table given below:
FREQUENCY
TYPE OF ERRORS
English Hindi
Reads word by word 15 10
Ignores punctuation 0 0
Adds words 0 1
Omits words 0 2
Cannot use phonetic cues 10 0
Spells out words 20 7
Guesses at words 7 3
Reversals 0 0
Others - 0 0
Total no. of errors 45 23
Time Taken 4 mins 3 mins

Comprehension Score
English 5/5
Hindi 5/5

YES/
READING AND COMPREHENSION SUMMARY NO
Omissions, substitutions, distortions or additions of words or parts
Yes
of words
Slow Reading Rate Yes
False starts, long hesitations, or loss of place in text, and inaccurate
Yes
phrasing
Reversals of words in sentences or letters within words Yes

Inability to recall facts No

Inability to draw conclusions or inferences from the material read No

Use of general knowledge as background information rather than of
information from a particular story to answer questions about a No
story read.
Remarks: the child is inadequate in reading abilities in English and in Hindi. Her listening comprehension
is adequate.

b) Writing
This domain assesses letter formation/legibility, letter spacing, spelling, fine motor coordination, rate
of writing, grammar, and composition.

TYPE OF ERRORS FREQUENCY

English Hindi
No space between words 5 0
Missed out a letter 1 0
Substituted a letter 0 0
Reversed a letter 0 0
Added a letter /word 0 0
Wrong Capitals 0 0
Others Missed words: 0 Missed sentence: 0
Punctuation: 0 Punctuation: 0
Spelling Error: 13 Missed word: 0
Missed sentence: 0 Spelling error: 11
Total no. of errors 17 11
Time taken 7 minutes 12 minutes

Remarks: Child’s performance in writing is adequate for the child’s educational level.

c) Spelling Test

LANGUAGE SCORE
English 3/15
Hindi 6/15

SPELLING SUMMARY YES/NO

The child's spelling performance should be significantly below the level Yes
expected on the basis of his or her age, general intelligence.
The difficulties in spelling should not be mainly due to grossly inadequate No
teaching or to the direct as a result of any neurological, psychiatric, or other
disorder
The child's reading skills should be within the normal range and there should be No
no history of previous significant reading difficulties.

Remarks: Spelling Test indicates that the child has inadequate spelling abilities in both English and Hindi
language.

3. Arithmetic Test
STANDARD NO. OF
CORRECT
ANSWERS
I (Addition) 5/5
II (Substraction) 1/5
 III ( Multiplication) 3/5
IV ( Division) 1/5
V ( Miscellaneous) 1/4
VI (Graded Addition) 0/5
VII ( Graded Subtraction) 1/5

ARITHMETIC SUMMARY YES/NO

The child's arithmetical performance should be significantly below the level expected based on YES
his or her age, general intelligence, and school placement.
The difficulties in arithmetic are not mainly due to grossly inadequate teaching, or to the direct YES
effects of defects of visual, hearing, or neurological function, and should not have been
acquired because of any neurological, psychiatric, or other disorder.
Remarks: Basic concepts and operations involving arithmetic are inadequate.

4. Perceptual Motor Abilities – Child performance on Bender-Gestalt test as per the Koppitz scoring
method was of inadequate performance level. 4 errors were made.
5. MEMORY
a. Visual Memory - On Benton Visual Retention Test, the child scored 4 /10 indicating
inadequate visual memory.
b. Auditory Memory: child was able to recall all words correctly on familiar pairs on 1st trial
and on unfamiliar pairs on 3rd trial. Thus, the child’s auditory memory is adequate.
c. Auditory Discrimination - child could discriminate between words and his score was 9 /20
which indicating inadequate performance.

Summary:
Child has inadequate level of functioning in reading , spelling in Hindi and English, mathematics, perceptual
motor abilities, and auditory discrimination. However she has an adequate level of functioning in attention,
writing , auditory memory and listening comprehension.

Impression:
Test findings indicate that the child has Specific Learning Disability (Mixed Learning Disorder).
Recommendations:
● Special Education for SLD including phonetic learning, supervision of academics, attention building
exercises and differential reinforcement.
● Reassessment after remedial training
Assessed by: Supervised by: