Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2019  |  Volume : 32  |  Issue : 4  |  Page : 1466-1471

Screening for learning difficulties among primary school children

1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Ministry of Health, Qalyubia Governorate, Toukh City, Egypt

Date of Submission15-Aug-2019
Date of Decision07-Sep-2019
Date of Acceptance15-Sep-2019
Date of Web Publication31-Dec-2019

Correspondence Address:
Safa H Alkalash
Shebin El-Kom, Menoufia
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mmj.mmj_255_19

Rights and Permissions

Learning difficulties (LDs) are associated with increased comorbidity, especially depression and anxiety; it constitutes one of the major health problems that affect the educational process.
The aim was to assess frequency, types, and risk factors of LDs among primary school children in Toukh city.
Patients and methods
A cross-sectional study was conducted on 273 students who were randomly selected from two primary schools in Toukh city. Data were collected by using a questionnaire which included questions about sociodemographic criteria of the participants, diagnosis, and risk factors of LDs.
Prevalence of LDs among primary school children was 31.9%. The most prevalent types were dyslexia, dyspraxia, perceptual difficulties, social difficulties, and auditory difficulties, representing 31, 29, 27, 27, and 25%, respectively. Predictive factors for LDs were low socioeconomic state, [odds ratio (OR) 5.4], female sex (OR: 3.7), nonworking mothers (OR: 0.25), and finally age upto10 years (OR: 0.35); other predictive factors were failure in school achievement (OR: 21.97), noncooperation between home and school (OR: 14.26), neglect of the student (OR: 9.64), and increased course content (OR: 1.21).
Prevalence of LDs was 31.9% among the studied group. Dyslexia was the most prevalent type. Low socioeconomic state, female children who were more than 10 years old with nonworking mothers, failure in school achievement, noncooperation between home and school, neglect of student, and increased course content were other predictive factors of LDs.

Keywords: dyslexia, learning difficulties, primary school, students

How to cite this article:
Moselhey HM, Mostafa SG, Alkalash SH. Screening for learning difficulties among primary school children. Menoufia Med J 2019;32:1466-71

How to cite this URL:
Moselhey HM, Mostafa SG, Alkalash SH. Screening for learning difficulties among primary school children. Menoufia Med J [serial online] 2019 [cited 2020 Jun 6];32:1466-71. Available from: http://www.mmj.eg.net/text.asp?2019/32/4/1466/274248

  Introduction Top

Learning difficulties (LDs) are problems that affect the brain's ability to receive, formulate, analyze, or store information; these problems cause difficulty for children to learn as quickly as someone who is not affected by LDs, and these children do not fall under other categories of handicap [1].

Although actual causes of LDs can never be known, the problem become evident when the child join the primary grades. The causes or influencing factors can be biomedical, developmental, behavioral, emotional, social, environmental, and family issues [2].

In Egypt, the prevalence of LDs was 54.2%, which represented a major problem among this age group [3].

There are five broad subgroups of LDs: dyslexia, dyspraxia, auditory difficulty, perceptual difficulty, and social problem. Reading disorders were further subcategorized into disorders of word recognition, comprehension, and fluency subtypes [4].

Possible outcomes for individuals with LDs who have not received appropriate intervention or help are emotional and behavioral problems which include low self-esteem, suicide, family instability, substance abuse, depression, psychiatric problems, and unemployment [5]. LDs are diagnosed using both educational and medical perspectives [6].

Screening assessments are brief assessments designed to identify students who may be at risk for LDs or require supplemental intervention. These brief assessments always have some degree of error; they overidentify students who do not actually need supplemental intervention (i.e., false positives) and/or fail to identify some students who do need additional intervention (false negatives) [7].

This study aimed to assess the prevalence of LDs, its types, and risk factors among primary schools in Toukh city in Qalyubia Governorate.

  Participants and Methods Top

The study was an analytical cross-sectional study, which was approved by Ethical Committee in Faculty of Medicine Menoufia University. An official permission letter was obtained and directed to the General Director of Education in Toukh city, Qalyubia Governorate. Written consents were sent to headmasters of selected schools. After illustration of the study objectives, the parents were encouraged to give fully informed consent and allow their children to participate, and parents were invited to complete a sociodemographic questionnaire.

The current study was conducted in the context of time frame of 20 months from November 1, 2017 to June 2019.

The sample size was calculated using EPIINFO version 7 (Centers for Disease Control and Prevention (CDC), Clifton Rd. Atlanta, GA 30329-4027, USA) based on the total number of primary school students in Toukh city, which was 58 726 students, referring to Ahmed et al. [8], where the prevalence of LDs was seen in 15.7%. A total of 273 apparently healthy students were included in the study.

Two primary schools of 13 schools in Toukh city were selected by simple random sampling technique. Then children were chosen by the same technique from different grades with age range from 7 to 12 years and proportionally allocated according to the total number of children in each school. The total number of primary school students in Toukh city was ∼58 726 students; of them, 87 students were chosen from El-Gala Primary School (total number 1266) and 186 students out of 4356 from El-Saad El-Aly Primary Schools in Toukh city.

All students who participated in the study were evaluated by using a validated predesigned questionnaire through directed interview with them and their parents. This questionnaire included questions about sociodemographic and socioeconomic data, which included age, sex, mother and father education, mother and father work, family size, and crowding index for assessment of socioeconomic status (SES). It involved 10 questions.

Parents were invited to complete a sociodemographic questionnaire, which formed of 10 domains, with a total score of 48, according to Fahmy et al. [9]: score less than 19.2 was classified as low socioeconomic level, score 19.2 to less than 33.6 was classified as middle socioeconomic level, and score 33.6–48 was classified as high socioeconomic level.

Another questionnaire was applied to each student with the help of their class teachers; there were ∼12 teachers. This questionnaire involved questions for diagnosis of LDs among primary school children in Toukh city. It was formed of 120 questions that assessed the following five characteristics:

  1. Dyslexia (reading difficulty)
  2. Dyspraxia (motor difficulty)
  3. Auditory difficulty
  4. Perceptual (orientation difficulty)
  5. Personal and social behavior difficulty.

Each of them consists of 24 questions, and each group consists of five selections and must put one signal in front of each statement; scores 1 and 2 were considered less than average, score 3 was considered average, and scores 4 and 5 were considered above average.

A student was considered having LDs when the score was less than 65 from total score 120 [10].

Moreover, the children were subjected to a questionnaire to detect the possible risk factors of LDs. The questionnaire was divided into 48 questions, which formed of 12 statements for each risk; four risk factors of the questionnaire included failure in school achievement, lack of cooperation between home and school, neglect of student, and finally, increased course content [11].

Validity of the questionnaires was tested by through submission to a panel of three experts to test its validity. The experts were professors in family medicine, psychiatric medicine, and education. The preliminary items were revised by the experts to determine whether the items were relevant for assessment. The experts were asked to evaluate individual items in relation to its relevance and appropriateness, and then rate the items on a four-point scale as follows: 4 = adequate (simple, relevant, and clear), 3 = adequate but needs minor revision, 2 = needs major modification, and 1 = not so adequate (could be omitted).

Content validity index was based on percentage of total item rated by experts as either 3 or 4. The score of greater than or equal to 80% is generally considered to have a good validity [12].

Content validity index of the designed questionnaire was calculated, and it was 95%.

Reliability of the questionnaire was calculated by SPSS version 20 (SPSS Inc., Chicago, Illinois, USA) using Cronbach's α, which was r = 0.8. Hence, the questionnaire is reliable.

Time needed for filling each questionnaire was ∼30 min, so we attended the selected schools in 3–4 days/week to collect data from students during their free time. Moreover, the duration of data collection was extended to 4 months.

Detection of the effect of LDs on scholastic achievement of the affected children was through revision of their school records of the first and second semesters. It was described as follows from school records: fair 50–60%, good 60–70%, very good 75–85%, and excellent if more than 85%.

Statistical design and analysis

Data were collected, tabulated, and analyzed with the statistical package for the social sciences (SPSS) version 22.0 on IBM compatible computer (SPSS Inc.). It was conducted in two steps: descriptive part, where frequency and percentage were used for qualitative date, and analytical part, where qualitative data were expressed and analyzed by applying χ2-test (for comparison between two independent variables normally distributed) and Fischer's exact (for comparison between two independent variables not normally distributed). P value less than 0.05 was considered statistically significant and less than 0.001 was considered highly statistical significant.

Study limitations

Some limitation of this study should be addressed:

  1. Some parents refused to attend the school for completing questions of sociodemographic data
  2. Owing to the large sample size (students), the applied questionnaires needed too much time, efforts, and patience to collect data
  3. Schools schedule did not allow much time with the children.

All these difficulties were overcome by the following:

  1. Parents who could not come to school were interviewed by telephone to complete sociodemographic data of the participants
  2. We attended schools for 3–4 days/week to collect data from the students
  3. Application of the questionnaires was performed during break time and any free time.

  Results Top

The prevalence of LDs among primary school students was 31.9% [Figure 1]. More than half of the participants were of female sex (54%), with highly educated mothers (41%). Approximately 53% of them had high crowding index (4–2), and more than half of the families had low SES (58%). Nonworking mothers represented 79% of them, and one-third of the participants had family size of six or more (33%) [Table 1]. Regarding school achievement, ∼24% of the participants who had LDs had history of dropout for 1–2 years [Table 2]. Types of LDS among participants were dyslexia (31%), dyspraxia (29%), perceptual difficulties (27%), social difficulties (27%), and finally auditory difficulties (25%) [Figure 2].
Figure 1: Prevalence of learning difficulties among primary school children.

Click here to view
Table 1: Comparison between both groups regarding socio-demographic characteristics as a risk factor for learning difficulties

Click here to view
Table 2: Comparison between both groups regarding school achievement

Click here to view
Figure 2: Types of learning difficulties among primary school children.

Click here to view

Predictive factors for LDs were low SES [odds ratio (OR): 5.4], female sex (OR: 3.7), nonworking mothers (OR: 0.25), and finally age upto 10 years (OR: 0.35) [Table 3].
Table 3: Logistic regression of factors affecting learning difficulties

Click here to view

Risk factors of LDS among participants were failure in school achievement (OR: 21.97), noncooperation between home and school (OR: 14.26), neglect of the student (OR: 9.64), and increased course content (OR: 1.21) [Table 4].
Table 4: Logistic regression of factors affecting learning difficulties

Click here to view

  Discussion Top

The current study was conducted for apparently healthy children who did not have any psychological problem. The prevalence of LDs among primary school children in Toukh city was 31.9%. This result is in agreement with a study was conducted among primary school students in Tunisia by Missaoui et al. [13] and in Iran by Mahin et al. [14], which concluded that 32 and 40% of the studied children, respectively, had LDs. Similarity of both results may be owing to the same culture and most nearer in location.

This result was in contrary with the studies done in Italy by Cappa et al. [15] and the USA by Boyle et al. [16], which concluded that prevalence of LDS was 6.1 and 7.7%, respectively. This was owing to their care about education and learning, cooperation between family and school, and high SES.

In the present study, LDs were more among female children, children of highly educated mothers, children of nonworking mothers, family size more than five persons and crowding inde × 4–2, and also among children of low SES. This result is in parallel to the result of a Chinees study performed by Chen et al. [17], who reported relationships between learning achievement and low SES and family size of more than 4. This result was in contrary to the studies performed in Iran by Mahin et al. [14] and in Spanish by Cortiella and Horowitz [6]. These studies showed that prevalence of learning disorder in boys significantly was more than girls.

Regarding scholastic achievement, the current study showed that school achievement was lower among children who had LDs, and this finding is in agreement with the study done in South Sudan by Minnesota [18], which concluded that ' the higher education performance is depending upon the pupil's performance in primary school, and also it is in parallel to the results of a study done in California by Robert and Byrd [19], in which ∼10–15% of school-age children repeated or failed a grade in school. Grade failure was more likely among males.

However, the present study was not in agreement with the study in Mexico by Reddy and Talcott [20], which concluded that future academic gains are resolute by preceding performance of pupils in primary school. In their research on the relationship between previous academic performance and subsequent achievement at primary level, they found that pupils learning or studying at primary level and the score secured did not predict any academic achievement at primary level.

In this study, there were different types of LDs. Dyslexia was more prominent (31%), and then dyspraxia (29%), perceptual difficulties (27%), social difficulties (27%), and finally, auditory difficulties (25%). This result was in line with a study was done in Iran by Mahin et al. [14], which reported that dyslexia (reading difficulties) was more common than other types of LDs.

However, this result is not in agreement with the results of a study one in primary school children in Turkey by Görker et al. [21], which showed that the reading difficulties were seen in 3.6%. Moreover, an Egyptian study by Gad-Allah et al. [22] found the prevalence of communication complaints (social difficulties) in the studied sample children was 56.1%.

On the contrary, another Egyptian study by Aboul-Oyoun [23] found that the overall prevalence of communication disorders (social difficulties) was 7.9% in a performed epidemiological study. Moreover, Gharib et al. [24] reported that the prevalence of delayed language complaints was 6.1%, prevalence of speech complaints was 26.4%, prevalence of combined language and speech complaints was 22.1%, and the prevalence of voice complaints was 1.4% in the studied sample.

Regarding predictive factors of LDS among participants were failure in school achievement (OR: 21.97), noncooperation between home and school (OR: 14.26), neglect of the student (OR: 9.64), and increased course content (OR: 1.21). This result agrees with a study done in the University of Luxembourg by Klapproth [25], which revealed that school achievement was the strongest predictive factor for school failure. Students obtaining low marks and test scores in primary school failed more in secondary school than students with high achievement. Students' school-related behaviors, such as a lack of engagement and acquiescence, have been shown to significantly predict school failure. However, in contrast to the hypothesis stated, neither students' sex nor their ethnicity played a role in predicting school failure, although correlation analysis indicated significant coefficients.

Results of the current study agrees with the study done in Morocco by Hafiane et al. [26], which examined the associations between home, individual, and school-related factors, and individual characteristics such as sex, motivation, positive attitude towards school, and work statues were significantly associated with low school achievement, in addition to some family-related aspects like the parents' educational level, perceptions about relationship with parents, and surrounding circumstances at home. Moreover, this study was in agreement with the study conducted in India by Kohli et al. [27] who found that dropping out from the school can be attributed to factors such as low SES, behavioral issues, LDs, or intellectual disability.

  Conclusion Top

The prevalence of LDs was 31.9% among primary school in Toukh city. Most common types of LDs were dyslexia, dyspraxia, perceptual difficulties, social difficulties, and auditory difficulties, respectively. LDs were more frequent among children who had non-working mothers, large family size, high crowding index, and families with low SES. Predictive factors of LDs among primary school children were failure in school achievement, noncooperation between home and school, neglect of the student, and increased course content.

  Recommendations Top

From this study we can recommend the following:

  1. Application of training programs for family physicians and general practitioners to promote their skills in recognizing LDs and consequently facilitating referrals, thus accelerating access.
  2. A periodic screening test should be provided for early detection of LDs within the school children where early identification and accessible services may reduce later complications.
  3. Care of pre-school education through creation of teachers and providing them with information on the natural evolution of the child's behavior and the factors leading to learning disturbances and how to avoid them.


The authors owe great and deep thanks to the children, parents, and teachers who participated in this work and from whom he learned so much.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Lyness D. Depression among students with learning disabilities. Assessing the risk. J Learn Disabil 2010; 39:3–10.  Back to cited text no. 1
Nag S, Snowling M. School underachievement and specific learning difficulties (Chapter. 3). In: Rey JM, (editor). IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: Internationa angl Association for Child and Adolescent Psychiatry and Allied Professions; 2012. 226–237.  Back to cited text no. 2
Sorour A, Mohamed N, Abdel Maksoud M Emotional and behavioural problems of primary school students with and without learning disabilities: a comparative study. J Educ Pract 2014; 5: 66–74.  Back to cited text no. 3
Lyon G, Shaywitz S, Shaywitz B. A definition of dyslexia, comorbidity, teachers' knowledge of language and reading;: a definition of dyslexia. Ann Dyslexia 2003; 53:14.  Back to cited text no. 4
Ibrahim J. Learning disabilities prevalence and its impact on primary school children. Egypt J Commun Med 2000; 21:31–52.  Back to cited text no. 5
Cortiella C, Horowitz S. The state of learning disabilities: facts, trends, and emerging issues. 3rd ed. New York, NY: National Center for Learning Disabilities; 2014. 16:201.  Back to cited text no. 6
Jenkins J, Hudson R, Johnson E. Screening for at-risk readers in a response to intervention framework. School Psychol 2007; 36:582–600.  Back to cited text no. 7
Ahmed H, Radwan S, Saber A, Shoeib R, El Shoubary A. Learning disabilities: prevalence and its impact on primary school children. Egypt J Commun Med 2003; 21:31–52.  Back to cited text no. 8
Fahmy S, Nofal L, Shehata SH, Elkady H, Ibrahim H. Updating indicators for scaling the socioeconomic level of families for health research. J Egypt Public Health Assoc 2015; 90:1–7.  Back to cited text no. 9
Kamal M. Relationship of the cognitive style and level of activity with learning difficulties in primary school. J Contemp Educ Issue 1988; 17:212–250.  Back to cited text no. 10
El Sharkawy A. Scale of risk factors of learning difficulties in primary school (ISBN 80/797/97). Egypt: Anglo Liberary; 2015, 5th ed. pp. 15–17.  Back to cited text no. 11
Schilling LS, Diaxon JK, Knafl KA, Grey M, Ives B, et al. Determining content validity of a self-report instrument for adolescents using a heterogonous expert panel. Nurs Res 2007; 56:361–366.  Back to cited text no. 12
Missaoui S, Gaddour N, Gaha L. Prevalence of specific learning disorders in a cohort of children with school failure. In La Tunisie médicale 2014; 92:570–573.  Back to cited text no. 13
Mahin E, Haghdoost A, Afsaneh N, Hamideh R. Prevalence of learning disability in primary school students in Kerman City. Eur Online J Nat Soc Sci 2014; 3:534–540.  Back to cited text no. 14
Cappa C, Giulivi S, Schilirò A, Bastiani L, Muzio C, Meloni F. A screening on Specific Learning Disorders in an Italian speaking high genetic homogeneity area. Res Dev Disabil 2015; 45:329–342.  Back to cited text no. 15
Boyle C, Boulet S, Schieve L, Cohen R, Blumberg S, Yeargin-Allsopp M, et al. Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics 2011; 127:1034–1042.  Back to cited text no. 16
Chen Q, Kong Y, Gao W, Mo L Guangdong key laboratory of mental health and cognitive science, center for studies of psychological application, school of psychology. South China Normal University, Guangzhou, China Front Psychol 2018; 25:1297.  Back to cited text no. 17
Minnesota Measures. Report on higher education performance. A case study of Islamia University Sub-Campus. Am J Educ Res 2013; 1:283–289.  Back to cited text no. 18
Robert S, Byrd R. School failure: assessment, intervention, and prevention in primary pediatric care. Pediatr Rev 2005; 26:227–237.  Back to cited text no. 19
Reddy P, Talcott J. Predicting university success in psychology: are subject-specific skills important? 2008. Available at:. http://www.aston.ac.uk/downloads/ihs/peelea/huw2006p.pdf. [Last retrieved on 2008 June].  Back to cited text no. 20
Görker I, Bozatli L, Korkmazlar Ü, Yücel Karadaǧ M, Ceylan C, et al. The probable prevalence and socio-demographic characteristics of specific learning disorder in primary school children in Edirne. Noro Psikiyatr Ars 2017; 54:343–349.  Back to cited text no. 21
Gad-Allah H, Abd-Elraouf S, Abou-Elsaad T. Identification of communication disorders among Egyptian Arabic-speaking nursery schools' children, Mansoura University, Mansoura. Egypt J Ear Nose Throat Allied Sci 2012; 13:83–90.  Back to cited text no. 22
Aboul-Oyoun A. Epidemiological study of communicative disorders in Upper Egypt [MD thesis]. Cairo, Egypt: Faculty of Medicine, Ain Shams University; 2000  Back to cited text no. 23
Gharib A, El Banna M, Khalil M, Abou Heikal M. Prevalence and etiology of communication disorders in children attending Alexandria University Children Hospital, Egypt. Alex J pediatric 2017; 30:17–25.  Back to cited text no. 24
Klapproth F, Glock S, Krolak-Schwerdt S, Martin R, Böhmer M. Predictors of recommendations for secondary school type in Luxembourg – Results of a large-scale study. Zeitschrift für Erziehungswissenschaft 2013; 16:355–379.  Back to cited text no. 25
Hafiane S, kaddari F, Elachqar A, Elaissaoui K, Tahraoui A. Major factors that influence school failure in the north region of Morocco. Procedia Soc Behav Sci 2015; 197:2164–2173.  Back to cited text no. 26
Kohli A, Sharma S, Padhy S. Specific learning disabilities: issues that remain unanswered. Indian J Psychol Med 2018; 40:399–405.  Back to cited text no. 27


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Participants and...
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded60    
    Comments [Add]    

Recommend this journal