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Year : 2019  |  Volume : 65  |  Issue : 4  |  Page : 199-200

The enormous economic burden of slow learners: A wake up call

Department of Pediatrics, Dr. S N Medical College, Jodhpur, Rajasthan, India

Date of Web Publication14-Oct-2019

Correspondence Address:
M Parakh
Department of Pediatrics, Dr. S N Medical College, Jodhpur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpgm.JPGM_394_19

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How to cite this article:
Parakh M. The enormous economic burden of slow learners: A wake up call. J Postgrad Med 2019;65:199-200

How to cite this URL:
Parakh M. The enormous economic burden of slow learners: A wake up call. J Postgrad Med [serial online] 2019 [cited 2023 Jun 9];65:199-200. Available from:

Children with borderline intellectual functioning (“slow learners”) form a significant section of the student population and face a lot of academic difficulties. The exact prevalence of slow learners in a large country like India is not yet clearly determined. Nor has the economic burden of this underrecognized yet prevalent clinical condition been addressed adequately. In this journal issue, Karande et al[1] have evaluated the economic burden of slow learners by estimating its direct, indirect and intangible costs. Their study reveals that economic burden of slow learners is enormous (intangible > indirect > direct costs).[1] Tuitions are the most costly component of direct costs. Parental loss of earnings is the most costly component of indirect costs.[1] The results of this study should serve as an eye-opener to the authorities dealing with ensuring inclusive education in our country.

Karande et al[1] have addressed a very important and timely topic and highlighted its impact on the family and community. In the past, a few studies have tried to look into the social and academic issues of slow learners. However, no previous study has looked into the economic burden of slow learners. An extensive review of the literature revealed that this study is an unique attempt to address this important but neglected condition.

The methodology of this study conducted by Karande et al[2] is robust: an adequate sampling size and collecting all the necessary data to estimate the direct (both medical and non-medical), indirect and intangible costs. However the study is a single center study and the sampling method followed was by the nonprobability method, which could introduce a bias in the results and its interpretation. This study has documented that the economic burden of slow learners in the city of Mumbai is huge not only for the afflicted families, but also for the healthcare provider, and ultimately for society at large. “Indirect costs” far outweigh “direct costs” of slow learners (62.9% vs 37.1%) and the hypothetical “intangible costs” of slow learners is much higher than the “total costs” of slow learners. Furthermore, Karande et al[1] have reported that “longer duration of poor school performance” is an independent predictor of increased “direct costs” and “total costs.”

The authors have also highlighted that most of the slow learners continue to be diagnosed late (mean age 14.5 years), which delays or makes them miss out on their educational rehabilitation. This study [1] also highlights that slow learners need to be identified at a much younger age to ensure that they receive remedial eduction and individual attention from their teachers to learn the school curriculum. Early diagnosis and developing facilities for remedial education will definitely support parents to reduce expenditure on private tuitions which comprises the major chunk of direct costs.

Other researchers have also recently highlighted the enormous economic burden of children with chronic conditions.[2],[3] Hoefgen et al[2] from US have estimated the economic burden of children having a single minor chronic disease (asthma, attention-deficit/ hyperactivity disorder, diabetes mellitus, and depression). Miller et al[3] from US have also highlighted the enormous burden of five chronic conditions (asthma, epilepsy, hypertension, food allergies, and diabetes) in children.

Karande et al[1] have also highlighted that almost 25% of slow learners have co-morbid attention-deficit/ hyperactivity disorder and/or a chronic medical condition (namely: refractive error, epilepsy, hemiparesis, cogenital heart disease, hypothyroidism) which need treatment. One of the main challenges for India is that health spending is mostly out-of-pocket and both the urban and rural poor cannot afford private care.[4] It is very likely that parents of slow learners will be finding it very difficult to manage the medical and educational costs of their children; as both costs are chronic and substantial.

Karande et al[1] have made a very important and valid appeal to school managements to set up resource rooms to ensure that these children receive regular and affordable remedial education. Such a step would aid the concept of inclusive education and also reduce the economic burden on the afflicted parents.

Based on the results of this study, it is prudent to state that health care managers in this country need to formulate a policy for developing a focussed infrastructure having integrated educational, health care and vocational facilities. This will reduce the cost of education and health care of slow learners and will help in appropriate employment/placement of these children. This model is being tried in many western countries but requires development of a clear policy targeted for the Indian setting.[5] It can therefore be envisaged that in future rehabilitation professionals in India will work at the interface of clinical and educational settings to support slow learners/children with disabilities at school which can eventually reduce the financial burden on parents, community and healthcare system.

Development of an ideal economic model which has the best academic and health outcome for Indian children will be very complex because of high variation in demographic variables across the length and breadth of this vast country. In a study conducted in rural Sri Lanka, it was suggested that students with learning difficulties actively engage in learning when an integrated approach utilising thematic units reflecting the students' world is used along with a behavioural approach to teaching-learning.[6] In future, the economics of this approach or other similar models can be studied in the Indian setting especially for rural non-English speaking children.

It is imperative that a comprehensive national registry be developed for children with academic difficulties, which would help to set up a focused state funded financial and logistic support for these children and their families.[7],[8] This will help in obviating the limitations pointed out in the current study. The current study sets up the stage to design future studies looking further into the direct, indirect and intangible costs to tease apart every part of economics involved in the care of slow learners. The present study can help school authorities and the government plan and allocate resources which are specific in their objectives to reduce the overall financial burden and also optimize the outcome of slow learners.

 :: References Top

Karande S, Ramadoss D, Gogtay N. Economic burden of slow learners: A prevalence-based cost of illness study of its direct, indirect, and intangible costs. J Postgrad Med 2019;65:219-26.  Back to cited text no. 1
[PUBMED]  [Full text]  
Hoefgen ER, Andrews AL, Richardson T, Hall M, Neff JM, Macy ML, et al. Health care expenditures and utilization for children with noncomplex chronic disease. Pediatrics 2017;140:e20170492.  Back to cited text no. 2
Miller GF, Coffield E, Leroy Z, Wallin R. Prevalence and costs of five chronic conditions in children. J Sch Nurs 2016;32:357-64.  Back to cited text no. 3
Nair SR. Relevance of health economics to the Indian healthcare system: A perspective. Perspect Clin Res 2015;6:225-6.  Back to cited text no. 4
[PUBMED]  [Full text]  
Ng SL, Lingard L, Hibbert K, Regan S, Phelan S, Stooke R, et al. Supporting children with disabilities at school: Implications for the advocate role in professional practice and education. Disabil Rehabil 2015;37:2282-90.  Back to cited text no. 5
Wickremesooriya S. Teaching children with learning difficulties via community-based rehabilitation projects in rural Sri Lanka. Disabil CBR Inclusive Dev 2016;26:53-81.  Back to cited text no. 6
Miller B, Vaughn S, Freund L. Learning disabilities research studies: Findings from NICHD funded projects. J Res Educ Eff 2014;7:225-31.  Back to cited text no. 7
Padhy SK, Goel S, Das SS, Sarkar S, Sharma V, Panigrahi M. Prevalence and patterns of learning disabilities in school children. Indian J Pediatr 2016;83:300-6.  Back to cited text no. 8


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