2. What makes it difficult to do physical activity? (Probed for: intrapersonal, interpersonal, social, contextual factors e.g., “How might other people make physical activity difficult”)
3. What helps/would help you to participate in physical activity? (Probed for: intrapersonal, interpersonal, social, contextual factors e.g., “What is it about where physical activity is done that could make it easier to do?”)
4. If we wanted to have a physical activity program for female university students here, what would you suggest?
5. Are there any other points you would like to go back on or talk about?
The online demographic questionnaire included items about age (years), height and weight (used to derive body mass index (BMI)), general health (excellent, very good, good, fair, poor), ability to manage on available income (easy, not too bad, difficult some of the time, difficult most of the time, difficult all of the time), and life satisfaction (rated from 1–10; 10 being high). Some data were categorized for descriptive purposes, e.g., age was categorised as 18–20, 21–24, 25+ years; life satisfaction was categorised as 1–3 = low, 4–6 = moderate, 7–10 = high.
Data from the audiotape were transcribed verbatim and entered into Nvivo. The data transcripts were read and analysed by the separate member of the research team. The data were coded and organized into major and minor themes, according to frequency, which were then discussed with the senior author (NWB) to reach consensus. Emergent themes were labelled using constructs from the Theoretical Domains Framework [ 27 ], and are presented using the headings: intrapersonal, interpersonal, and contextual (academic, cultural/environmental).
After the fifth FGD, it was decided that a saturation point had been reached as no new themes had emerged. A total of 25 female university students completed the FGDs. The mean age of participants was 20.4 years (SD 2.6) and 40% were categorised as overweight/obese (BMI > 30). The majority of the participants reported high life satisfaction and excellent/very good health. Additional characteristics of the participants are presented in Table 2 .
Summary characteristics of participants ( n = 25).
Characteristics | % | |
---|---|---|
Total | 25 | 100 |
Age group (years) | ||
18–20 | 15 | 60 |
21–24 | 9 | 36 |
25+ | 1 | 4 |
Body mass index (kg/m ) | ||
Healthy weight (<25) | 15 | 60 |
Overweight (25–30) | 2 | 8 |
Obese (>30) | 8 | 32 |
General health | ||
Excellent or very good | 15 | 60 |
Good | 7 | 28 |
Fair or poor | 3 | 12 |
Ability to manage on available income | ||
It is easy or not too bad | 14 | 56 |
Difficult some of the time | 11 | 44 |
Life satisfaction | ||
High | 19 | 76 |
Moderate | 5 | 20 |
Low | 1 | 4 |
Notes. BMI was based on self-reported height and weight.
Major themes identified for benefits of physical activity participation were improved mood, improved health, weight management, disease prevention, and stress reduction. Minor themes identified were disease management, reducing “negative energy” and improving self-confidence, meeting new people, social interactions, improving focus and concentration for academic work, and reducing academic related stress.
All the identified barrier themes, with example participant statements, are summarised in Table 3 . Strong interpersonal and contextual themes emerged. Commonly reported factors were low support from family, and competing time demands from household/family responsibilities. Contextual barriers included lack of time because of a busy academic schedule, lack of suitable accessible facilities and hot weather.
Barriers to physical activity among female Emirati university student participants ( n = 25).
Major Themes | Minor Themes |
---|---|
Intrapersonal | |
Intentions “A lot of them would just sit and use their laptops instead of going outside and doing exercises” | Emotions Positive/negative affect “If you have good mood you will do anything. If you are sad you will not do sports” “Some ladies get bored quickly. If they get bored at the activity today they will not go tomorrow” “Some ladies don’t like to go to the gym—they only think for shopping and going out” Beliefs about Capabilities Self-efficacy “People don’t have enough courage to go and do exercise—they are not confident” Reinforcement Punishment- “If they make any exercise they will get tired and their body will hurt” Knowledge “People don’t know about the benefits of physical activities |
Interpersonal | |
Social Influences Low social support (family)—“Maybe they don’t have the support from their parents” “Parents don’t like the girls to go out and do exercise” Social norms “Home responsibilities—taking care of the children, and for other family like our mothers” | Social Influences Social pressure (friends) “Sometimes my friends will stop me from doing activities” |
Contextual: Academic | |
Environmental Context and Resources Environmental stressors “The schedule is really busy for us and it’s not convenient” “We have more exams and a lot of projects in the course—all the time we are busy” | |
Contextual: Cultural/Environmental | |
Environmental Context and Resources | Social Influences |
Material resources “There is no gyms here near us to exercise” | Group norms “In other cultures, they accept this muscle for women. In Emirati female, it is not so acceptable” |
“Most of the places are mixed for ladies and men so we can’t go there” | Environmental Context and Resources |
Environmental stressors “In the summer we cannot do exercise as it is very hot” | Resources “We are only students—for the majority the cost is the problem” |
At the intrapersonal level, participants described that some women preferred more passive leisure activities, in particular using social media.
“A lot of them would just sit and use their laptops instead of going outside and doing exercises”
At the interpersonal level, low support from family members was one of the most commonly cited barriers to physical activity. It was said that parents and other family members may not encourage women to do physical activity if physical activity was perceived as primarily for weight loss.
“Families think differently to us and maybe sometimes when you are slim they ask why are you going to exercise—they don’t want you to be more slim so they prevent you from doing anything. Like my friend is not allowed to do exercise because she is slim—her family will not allow her”.
Another reason for low family support was related to sociocultural norms regarding appropriate lifestyle activities for women. Participants described needing family permission to engage in activities, or support to enable participation (e.g., transport, money).
“Some people have a culture where the family don’t let them go to gyms and do exercise. Like in UAE, the family - we are more private in our life and they don’t like the girls to go out and do exercise. Parents don’t like it”.
“Doing exercise disagrees with the Emirati culture—the parents are not used to letting the girls go out at 6pm and 8pm to do walking. And there is no time in the day to do exercise”.
“Some parents think that you are a girl and you should learn the kitchen work and you don’t do exercise—this is from the culture”.
Many women described that family and domestic duties created a competing time demand against physical activity. The women would attend university in the day and then return home to care for the household, which resulted in little discretionary time.
“Because most Emirati women are working mothers they don’t have time from their work and they have to take responsibility for their children so they don’t have time for exercise”.
“Not enough time, home responsibilities—taking care of the children, responsibility for other family like our mothers”.
At the contextual level, many of the students described that the intense academic study and assessment schedule left little time for physical activities. Additionally, it was noted that many of the physical activities held at the campus sports complex were at times that clashed with classes, and therefore prevented participation.
“We have many college work and exams and projects, and we don’t have time for gym and exercise”.
“The schedule is really busy for us and it’s not convenient with the schedule of the sports complex. We can’t manage it with our studies”.
Lack of suitable, accessible and affordable physical activity facilities was commonly identified as a barrier. Because of sociocultural reasons, women-only physical activity facilities were required, but it was reported that many of these were expensive to join and located far away from the home.
“And as we are women, we don’t have places to do exercises. Maybe two or three places we have—we don’t have enough clubs for ladies only, and even if there is, it is expensive. Before was cheaper but now double the price. We have ladies’ clubs but it’s expensive”.
“It is not only the gym that we want to go to—there are also parks and there are some for ladies but there are not enough of them and they are a long distance away. Maybe I live in Sharjah but the place is in Abu Dhabi and I have no way to get there”.
The climate of the UAE was also identified as a significant barrier to physical activity. Many of the women said they would like to do outdoor activities, but the hot weather made this uncomfortable. Some women wore traditional clothing in public, and this heightened the discomfort for specific activities such as walking.
“Because it is too hot, we cannot go outside and do exercise especially because we are wearing abaya and shayla, it is very hot for all weather. It is a very big problem to us because sometimes when we go to a walk they tell us that you have to wear the sport dress and come and walk so we can’t walk in these areas as we have to wear our abaya and shayla”
All enablers themes are presented in Table 4 . Strong interpersonal, contextual and academic themes emerged, which often mirrored the barriers reported previously. Commonly reported enablers were low-cost activities, accessible women-only facilities, friend and family support (including via social media) and physical activity classes integrated with the academic schedule.
Enablers of physical activity among female Emirati university student participants ( n = 25).
Major Themes | Minor Themes |
---|---|
Intrapersonal | |
Behavioural regulation “The solution is to organise our schedule—it’s just one hour for we will do the activities so we can manage it” Knowledge “The knowledge of the importance of sports” | |
Interpersonal | |
Social Influences Social support (friends) “They need motivation and to go with groups of friends. They will encourage” Social support (family) “The parents can give them money to join centers” Social modelling “I watch videos on health care and that will motivate me” | Social Influences Social support “More coaches or trainers coming to our homes because many parents don’t allow us to go to the gym” |
Contextual: Academic | |
Environmental Context and Resources Resources “They should make time in our schedule to allow us to do exercise” | Social Influences “Maybe they can do workshops in the school and invite the parents to help the children to do exercise” Reinforcement “The college to give course credit to people who participate in the gym programs” |
Contextual: Cultural/Environmental | |
Environmental Context and Resources Resources—“I think make the clubs near to the home so that people can walk to them and then transport won’t be a problem” “More private places for girls will help but not just gym—like parks for girls” “Make the sports complex nearer to the college to make the student go” Reinforcement “Making offers will help—if they do many exercise then they have to pay less to use the gym” | Environmental Context and Resources Resources “Having the equipment will help. I have a small gym in my house and that makes me excited to do some exercise” “The gym should provide kindergarten so the lady will feel comfortable” |
At the interpersonal level, social support was commonly reported as a key enabler of physical activity. Social support sources included friends, family, and from social media (e.g., Instagram influencers, etc.). Friends were reported as a preferred source of support, primarily for providing motivation.
“First of all, I think its support from friends—if we go to the sport together and encourage each other to exercise it will help for me especially”.
Family was also an important source of emotional and material support, including encouragement, transport, and costs for membership fees.
“Encouragement from parents is important when the parents give their children help to be more healthy and do activities and sometimes it’s about cost—the parents can give them money to join centres”.
Social media was identified as a source of knowledge and modelling.
“Social media maybe—for awareness and when you see some videos that advise you how to do the activities and what’s the benefits for it. Some applications like Instagram when you see the posts—there are some people who post about the health and the fitness. They put daily tips about the fitness and how you will be a fit person”.
At the contextual level, exercise classes as part of the college curriculum was identified as enabling students to engage in physical activity.
“Before last year there was one subject where the girls go to the gym but now they have cancelled. If this came back it would be good for the girls to take this subject and go to the gym because some girls do not have enough time but if it is in the schedule then it is easier”.
Also at the contextual level, one of the most commonly cited enablers was women-only facilities which were close to the residential area (i.e., within walking distance) and low cost.
“Now they say in each urban area there must be a club close. Now in our area they do it for each area for ladies only. From government, they approve it and each area must have a closed club to go and do exercise and also have activities”.
Participants identified the importance of engaging with female students to understand their physical activity interests.
“Ask the females what they prefer to do and ask their opinions on what they like”
Suggested types of physical activity for Emirati female university students included jogging, cardio/aerobic classes, cycling, swimming, and Zumba/dance classes. Participants described that activities should be fun and led by an instructor, who should have both fun, motivational, and educational qualities.
“The program should be fun—not only this is activity and do it”
“I think the people (the instructors) have to show that they care about us—they are friendly and funny and confident and motivate us. And tell us the benefit that we can get from each exercise”.
Structured activities were also important, with participants interested in physical activities that were well planned.
“Not just take the ball and go play basketball—it needs more structure—not just trying to show that we are doing sport”.
The majority of participants preferred that physical activities be held at the university sports complex or at classrooms on the campus, and many agreed that this would encourage them to participate during breaks in their academic schedule.
“On the campus—not outside—like they can allocate some classrooms (for activities) on the campus and we can start. If it is closer to the campus then we can come in the break in our schedule”.
This study offers insight into the barriers and enablers of physical activity among female Emirati university students. Commonly cited barriers reflected sociocultural norms for women and included low family support, competing time demands due to domestic responsibilities, and lack of women-only facilities near to home. Other common barriers were competing time demands from academic schedules and discomfort associated with the hot weather. Commonly cited enablers were social support from friends and family, the availability of low-cost women-only facilities and opportunities in close proximity to home, and organised physical activity sessions integrated with the academic schedule. Participants described a preference for activities that were fun, structured, led by a coach, and held on campus. Jogging and cardio/aerobics were commonly cited as preferred types of activity.
Distinct sociocultural factors were described as influencing physical activity participation. In particular, lack of convenient access to women-only facilities was constantly highlighted. This is consistent with a previous review which indicated the paucity of gender-segregated fitness facilities contributed to low levels of activity among women in Arab countries [ 26 ]. Accordingly, having women-only physical activity facilities and clubs in local residential areas was identified as enabling participation. The cost of these facilities is important, with comments that clubs need to be more affordable. However, providing free or subsidized women-only facilities in each residential area would be costly. It may be beneficial to conduct environmental analyses to identify underserved areas that could benefit from cost-reduced physical activity facilities—past research has shown that provision of free access to leisure facilities can increase participation in underrepresented groups [ 28 , 29 ]. There could also be opportunities to provide facilities and activity sessions in group residential buildings. This is important as other participants, noted that they were able to do physical activity within, but not outside, the home. This is consistent with previous research with Qatari women who commented on restrictions in participating in activities outside of the home [ 30 ]. Home-based resources, such as instructional materials, equipment and digital applications, may enable physical activity participation for these young women.
Some participants indicated that within their culture, there was a lack of awareness of the range of benefits of physical activity participation for women, other than weight loss. Weight loss as a motivation for exercise is more commonly identified among women than men [ 31 ]. However, weight loss may not be salient to all women, and an understanding of the broader range of benefits may motivate participation. The main benefits of physical activity identified by the young women in this study were improved mood, improved health, disease prevention, and stress reduction. Other benefits were improving self-confidence, meeting new people, social interactions, improving focus and concentration for academic work, and reducing academic-related stress. More research is needed to identify what physical activity benefits align with cultural and family values, so that participation is seen as advantageous for those young women for whom weight loss is not a concern. Previous research has demonstrated that health literacy is a consistent predictor of physical activity participation [ 32 ], including among female university students in the United Arab Emirates [ 33 ], and it may also impact on family support for physical activity.
As in previous studies with university students [ 16 , 17 , 18 ], lack of time was a commonly identified physical activity barrier. Competing time demands included academic work and family responsibilities, as well as social media use. Academic and family commitments have been commonly identified in previous research [ 10 , 19 ], and our study participants suggested on-campus activities, and physical activity sessions incorporated into the academic schedule, as potential enablers of participation. Time spent using social media may reflect the high availability, accessibility and affordability of smart devices and internet use, as well as the range of popular social media applications, such as Facebook, Instagram and Twitter. Digital media statistics estimate that 99% of the population of the United Arab Emirates are active social media users (UAE Social Media Statistics, 2020). Previous quantitative research with American college students has, however, indicated no association between social media use and physical activity [ 34 ]. It may be, therefore, that it is not the time spent on social media, but rather the preference for this as a leisure activity, that constrains physical activity. It is interesting to note that in the current study, use of social media, as a source of education and modelling, was also identified as a potential enabler of physical activity participation. Research on physical activity interventions using social media for these purposes among American university students has shown mixed results. One study reported that a social media intervention did not produce greater awareness of physical activity than an education intervention [ 35 ]. Another study found that social comparisons via social media were more effective for increasing physical activity than social support [ 36 ]. Other research with women provides some promising results when social media is combined with other intervention components. One study with female college freshmen showed a Facebook social support group improved results from a walking and pedometer self-monitoring intervention [ 37 ]. Another study with African American women demonstrated that a Facebook and text message intervention decreased sedentary behaviour and increased self-regulation for activity and light-to-moderate activity [ 38 ]. Therefore, more research is needed to understand how social media could be used among Arabic-speaking women to support physical activity participation.
As with other studies [ 10 , 39 ], the hot climate was commonly cited as a barrier to participation, and this was particularly salient for outdoor physical activity such as walking, and for women who wore traditional clothing. The temperature in the UAE can reach upwards of 40 degrees Celsius (104 Fahrenheit) in the summer. Past research with women in Qatari demonstrated a significant decrease in physical activity participation (measured by pedometers) in the summer months [ 40 ]. However, some participants in the current study expressed an interest in participating in activities that were outdoors. This interest could be considered during planning activity opportunities, for example, having indoor activities in the hotter months and scheduling outdoor activities for early morning or in cooler months of the year.
Participants reported that physical activities should be fun. Given the stressful nature of university life [ 41 , 42 ], students may prefer physical activities that are not evaluative or results-oriented. This may be particularly salient if there is low confidence/competence for physical activity, which is a key (inverse) predictor of participation among women [ 43 ]. Fun activities may also be seen as less effortful, competitive, aggressive, and skills-based—characteristics which are often linked to the traditional male stereotype. Activities perceived as inconsistent with feminine stereotypes can risk negative judgements among young women [ 44 ]. The reported preference for scheduled activities may reflect time constraints associated with academic demands and family responsibilities. Participants also preferred instructor-led activities, which was consistent with the preferred types of physical activity identified (e.g., Zumba, cardio).
A limitation of the current study is that participants were recruited through convenience sampling and the summary demographics indicate that a high proportion of the participants had excellent/very good health and high life satisfaction, and 60% were categorised within the healthy weight range. Results may have differed if the sample comprised more women with poor health, low life satisfaction/mood, or high body mass index (BMI), as these concerns are associated with specific barriers to physical activity [ 45 , 46 , 47 ]. We did not assess the physical activity levels of participants, so we cannot make comments about their experience with physical activity. We used self-reported weight and height data, which is often associated with underestimation of BMI, in particular among those with high body weight [ 48 ]; however, BMI was not a focus of this study. Focus groups were conducted in the English language, and even though the students attended an English-speaking university, this may have led to constrained communication as English was not the native language of the participants. Focus groups were led by a male researcher, which may have constrained the female participants’ disclosure of more sensitive information.
The main strength of this study is that is provides a descriptive insight into factors which can constrain or enable physical activity among female university students in an Arab-speaking country. It builds on previous research with university students which has also identified enablers and barriers related to social support, convenient facilities, costs, academic time pressures, competing time demands from family/domestic responsibilities, and hot weather. Our research contextualises these factors for this specific demographic group, and highlights the importance of sociocultural processes. This evidence can be used to generate hypotheses about behaviour and inform other studies. One imperative for future research is assessment with families to understand how physical activity among young adult women can be valued in the culture. A recent review of published physical activity interventions in the Arabic-speaking region concluded that culture is critical to success [ 49 ], and our research suggests some key sociocultural components such as aligning physical activity benefits and participation with cultural norms and values; use of social media for education and modelling; providing support for home-based exercise; and creating local, affordable, gender-segregated opportunities for physical activity.
The findings of this qualitative study suggest that there are specific sociocultural factors associated with physical activity participation among female Emirati university students. It is important to note that the potential impact of such factors may be moderated by the strength of sociocultural norms, which will differ across people. This evidence can be used to understand patterns of behaviour and inform the development of culturally sensitive interventions to promote physical activity participation. Family support for young women to engage in physical activities will be important across a range of intervention strategies. At the university level, integrating instructor-led physical activity classes, which include social and fun aspects, into the academic curriculum could be considered. Upstream approaches could focus on providing low-cost women-only physical activity opportunities in local residential areas and support for home-based activities. If successful, such strategies could make a significant contribution to the physical and mental health of Emirati women.
This study was part of an overall research program, which commenced when N.W.B. was based at The University of Queensland. This research was conducted as part of a (since completed) PhD candidate’s research program. A PhD candidate led the data collection, analysis, and original write-up as part of a research thesis This manuscript was prepared and submitted after the degree was awarded, with the person’s written permission, which we gratefully acknowledge.
Authors N.W.B. and A.K. had oversight of the study conceptualisation, data collection, and analysis.. N.W.B., B.L.B. and A.K. all contributed to the interpretation of results, drafting of manuscript, and critical review of intellectual content. All authors have read and agreed to the published version of the manuscript.
This research received no external funding.
The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Human Ethics Research Committee at The University of Queensland (2017000013, 30/01/2017).
Informed consent was obtained from all participants involved in the study.
Conflicts of interest.
The authors declare no conflict of interest.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Empirical Studies
Keywords for Empirical Studies:
empirical, experiment, methodology, observation, outcomes, sample size, statistical analysis, study
Types of Empirical Studies:
There are several types of empirical research, and three common types are quantitative , qualitative , and mixed methods research , which are all explained below. Many empirical studies in the social science use mixed methods to examine complex phenomena.
Quantitative Research
Purpose | Supports a hypothesis through a review of the literature | |
Aim | Provides a statistical model of what the literature presents | |
Previous Knowledge | Researcher already knows what has been discovered | |
Phase in Process | Generally occurs later in the research process | |
Research Design | Designed before research begins | |
Data-Gathering | Data is gathered using tools like surveys or computer programs | |
Form of Data | Data is numerical | |
Objectivity of Research | More objective; researcher measures and analyzes data | |
Keywords | Quantitative, survey, literature review, hypothesis |
Four Main Types of Quantitative Research Design:
Qualitative Research
Purpose | Used for exploration, generates a hypothesis | |
Aim | Provides an in-depth description of the research methods to be used | |
Previous Knowledge | Researcher has a general idea of what will be discovered | |
Phase in Process | Usually occurs early in the research process | |
Research Design | Design is developed during research | |
Data-Gathering | Researcher gathers data from interviews, etc. | |
Form of Data | Data takes the form of interviews, videos, artifacts | |
Objectivity of Research | More subjective; researcher interprets events | |
Keywords | Qualitative, methods, results, interviews |
Five Main Types of Qualitative Research
Mixed Methods Research
Mixed methods research uses strategies from both qualitative and quantitative research processes to provide a greater understanding of the subject matter.
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This study aims to uncover the preliminary developmental challenges experienced by children from infancy to their primary school years, who are subsequently diagnosed with specific learning disabilities during their primary education. The ultimate goal is to develop an item pool to identify early symptoms of specific learning disabilities. This qualitative descriptive design study employed semi-structured interviews with 20 participants, comprising both parents and teachers of 10 children aged 8–11. The interviews lasted between 45 and 60 min. To ensure the research's quality and reliability, we applied evaluation criteria and performed six-stage thematic analysis framework. The results indicate that children experienced developmental difficulties from infancy to preschool period that impacted their social-emotional development, language and communication, motor and self-care skills, as well as their perception, memory, attention, and self-regulation capabilities. These challenges were exacerbated during the school years by motivation-related issues. Parental observations primarily highlighted difficulties in language and communication, such as pronunciation, initiating conversations, and speech, during the first three years of life. Significant issues in social-emotional development included introversion, a need for physical contact, challenges in maintaining relationships, and adherence to rules. These challenges emerged during the first three years of children and progressively worsened across all developmental domains. This study contributes valuable insights into the literature by providing past observations from parents and teachers, thus enhancing understanding of the preliminary developmental challenges faced by children at risk of specific learning disabilities.
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SLD is classified as a neurodevelopmental disorder characterized by significant disparities between intelligence scores, which are within the normal or above-normal range, and performance in key academic areas such as reading, mathematics, and written expression (American Psychiatric Association [APA], 2013 ; Melekoğlu, 2020 ). SLD encompasses three primary types: dyslexia, dyscalculia, and dysgraphia. Diagnostic criteria are drawn from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the International Classification of Diseases (ICD-10), and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (APA, 2013 ; World Health Organization, 2019 ).
Originating from neurobiological factors, SLD's management focuses on early educational interventions rather than pharmacological treatments, highlighting the importance of early assessment and intervention (Thapar et al., 2017 ). The reason for this is that if children are not intervened in the early period, the difficulties they experience will increase (Sullivan et al., 2017 ; Zhang et al., 2020 ). Therefore, intervention services provided in the early period can also contribute to reducing the negative effects (Lange & Thompson, 2006 ). The importance of the situation is further underscored by the prevalence of SLD.
SLD was identified as the most common disability among students aged 6 through 21 in the U.S., with 37.1% of those receiving special education services diagnosed with SLD (U.S. Department of Education, 2021 ). Additionally, 15% of the European population is affected by SLD (Institute of Entrepreneurship Development, 2019 ). Despite these striking rates, Turkey reports a notably lower prevalence rate of approximately 3%, highlighting a significant discrepancy in the identification and diagnosis of SLD, and pointing to a need for improved diagnostic tools and data collection methodologies (Melekoğlu, 2020 ). The fact that children at risk of SLD show similar characteristics to normally developing children makes early diagnosis even more difficult (Steele, 2004 ).
Research is advancing in early diagnosis by concentrating on identifying children at risk of SLD and preventing issues before they arise. Researches underscore the importance of early indicators in predicting future SLD, focusing on areas such as early literacy, rapid naming, phonological awareness, and working memory (Ozernov-Palchik et al., 2017 ; Snowling et al., 2019 ). Moreover, early quantitative challenges, such as deficiencies in understanding number relations, might lead to future difficulties in mathematics for children (Bull et al., 2021 ; Zhang et al., 2020 ). When viewed within the framework of developmental domains, early challenges in language, social-emotional development, psychomotor skills, cognitive development, and self-care skills are identified as predictors of SLD (Firat & Bildiren, 2024 ; İzoğlu-Tok & Doğan, 2022 ). International researches also focus on intervention programs (Almulla et al., 2021 ; Aunio et al., 2021 ; Sakellariou et al., 2020 ), development of identification tools (Flores et al., 2022 ; Hellstrand et al., 2020 ; Navarro Soria et al., 2020 ), and profiles of children at risk (Bonti et al., 2021 ; Quiroga Bernardos et al., 2022 ). These studies emphasize the critical role of early detection and intervention.
In Turkey, the pathway to diagnosing SLD and providing special education services involves a multi-step process that engages both educators and medical professionals. Within the Turkish education system, primary education spans a four-year period following preschool, during which children undergo initial assessments. Notably, when special needs are suspected, classroom teachers play a pivotal role by referring children to medical or guidance and research centers for further evaluation. This diagnostic journey emphasizes the significance of teachers' insights into the children's academic and developmental profiles.
Specialized educational support requires obtaining a Special Needs Report for Children (SNRC), which is contingent upon a formal medical diagnosis. Importantly, the evaluation of a child's academic progress over a minimum span of six months forms a critical component of this diagnostic framework. Considering that the diagnosis process takes an average of one year, it is obvious that we cannot provide support to children in the early stages. However, both national and international research always emphasizes the importance of early detection (Chordia et al., 2020 ; Firat & Bildiren, 2024 ; Kaya-Döşlü & Bağlama, 2022 ; Roama-Alves et al., 2020 ; Thapar et al., 2017 ). Therefore, research on the characteristics of at-risk children is essential to inform the development of intervention programs, evaluation tools, and understanding children's profiles.
While existing literature underscores the significance of early identification of children at risk of SLD, there remains a noticeable knowledge gap regarding the characteristics of children in Turkey. This gap about which areas and what difficulties children experience is evidenced by the limited availability of early assessment tools (Melekoğlu, 2020 ). Therefore, the primary sources of information crucial for fill this knowledge gap are the child's parents and teachers. who possess invaluable insights into early indicators of SLD due to their extensive interactions with the child during the preschool and early school years. With this regard, this study aims to identify the difficulties experienced by children diagnosed with SLD in the preschool and school periods, with the ultimate goal of creating an item pool for identifying early symptoms of SLD. The quality of the relationship that professionals establish with parents and school personnel can affect the quality of the children's assessment process (Lange & Thompson, 2006 ). Engaging with families and teachers for their insights is deemed crucial for a comprehensive understanding of children at risk for SLD, informing strategies for health and education professionals to enhance early intervention services. By addressing these challenges, we expect that this study will enhance the comprehension of the challenges faced by children at risk of SLD, and facilitate the development of assessment tools and intervention strategies. This study offers comprehensive insights into the challenges faced by children, addressing the roles of adults both in school and at home. The research question regarding the challenges experienced by children with SLD in pre-school (0–3 years and 3–6 years) and school periods guided the study.
This qualitative study employed a qualitative descriptive design aimed at offering descriptions of experiences and perceptions, especially in areas with limited understanding (Sandelowski, 2010 ). This qualitative study utilized semi-structured interviews and thematic analysis to delve into the experiences and perspectives of parents and teachers regarding children’s developmental challenges from infancy up to the present. The reporting guidelines of “Standards for Reporting Qualitative Research- SRQR” (O’Brien et al., 2014 ) and “Consolidated Criteria for Reporting Qualitative Research- COREQ” (Tong et al., 2007 ) were followed. The study was adhered to a postpositivist paradigm. In the postpositivist paradigm, researchers integrate the diverse perspectives of participants rather than relying on a singular viewpoint and employ various validity approaches (Creswell & Creswell, 2017 ). Consequently, in this study, we brought together the perspectives of both parents and teachers and applied validity approaches.
Participants were selected through typical case sampling, a targeted method aimed at obtaining a representative cross-section of cases. For parents, the criteria were: (1) having a child diagnosed with SLD in primary school, and (2) no additional diagnoses besides ADHD, given its frequent co-occurrence with SLD (Araz Altay & Gorker, 2017 ). For teachers, we included those who taught the children of the interviewed parents.
The first author conducted interviews with 20 participants: parents and teachers of 10 children who are currently attending primary school. All participants, including the children, were monolingual Turkish speakers, hence the interviews were conducted in Turkish. Prior to conducting the interviews, arrangements were made to meet primarily with one parent-typically the mother due to their predominant role in care and education involvement. This selection was made acknowledging that recalling past experiences might be affected by the passage of time. Therefore, our focus was on the primary school period, during which the children were first medically diagnosed.
All educators involved were classroom teachers, with the duration of their acquaintance with the children varying due to school changes or different grade levels. Typically, classroom teachers remain with the same group of students from the first to fourth grade unless their assignment changes.
The size of the sample was determined based on data saturation and representativeness (Guest et al., 2006 ). Coding commenced concurrently with the interviews and persisted until the parents and teachers of the 10th child were interviewed. The decision to conclude the interviews was made when no new codes emerged, indicating that the data had reached saturation. Details on the participating parents (P) and teachers (T) are provided in Table 1 .
Approval was obtained from the [Blinded] University Clinical Research Ethics Committee (KA-19141), along with administrative permissions from the Turkish Ministry of National Education (MoNE). The first author contacted school administrators to introduce the study to parents and teachers, focusing on children diagnosed with SLD.
Interviews were initiated following verbal confirmations from parents and subsequent confirmations from teachers regarding the children's diagnosis and inclusive education status.
Written informed consent was then collected via Google Forms. Due to COVID-19 pandemic restrictions, interviews were conducted by phone from September to November 2020, with durations ranging from 45 to 60 min.
We developed two semi-structured interview schedules, distinct for teachers and parents, informed by a comprehensive literature review on developmental stages. These schedules were then refined based on feedback from three faculty members specializing in special needs education. The interview for parents comprised eleven main questions across three categories: general information, past experiences, and current status. Parents were prompted with questions designed to elicit their insights and reflections on their children's development from infancy up to the present, including the diagnostic journey and aspects of school life (detailed in Appendix A). Similarly, the teachers' interview schedule featured six main questions, organized into the same three categories. Teachers, were questioned about the developmental traits, diagnostic procedures, school experiences, and peer interactions they've noted from the commencement of the children's primary education to the present (outlined in Appendix B).
To ensure the integrity and reliability of our research, we adhered to Lincoln and Guba ( 1985 ) criteria. The interviews were conducted with 20 participants, with the first author allowing flexibility in timing to enhance the credibility and internal validity. She probed further when responses were unclear, ensuring comprehensive understanding. The diverse perspectives from both teachers and parents enriched the internal validity. Data saturation was confirmed when no new information emerged from the interviews.
For external validity criterion, transferability , we meticulously outlined the inclusion and exclusion criteria, aiming to ascertain that our findings could be applicable in various contexts (Lincoln & Guba, 2013 , p. 103). Our methodical approach, from participant recruitment to the detailed explanation of our analysis process, supports the study's transferability. The coding process and its rationale are elaborated under the findings section, with clear definitions and descriptions to facilitate understanding.
Dependability was achieved through a rigorous and transparent process, defining key concepts like social-emotional and language development, motor skills, self-care, perception, memory, attention, and motivation based on prior literature. Each participant's experiences were deductively analyzed within these frameworks. An external researcher with expertise in early intervention and qualitative methods reviewed the themes, further validating the study's reliability by assessing code accuracy and researcher impartiality (Lincoln & Guba, 1985 ).
Confirmability and objectivity were reinforced through data triangulation, collecting data from multiple sources—teachers and parents—to verify consistency across different perspectives (Lincoln & Guba, 2013 , p. 106). The first author meticulously transcribed interviews, with all data securely stored in MAXQDA qualitative research software (version 20.4.1), ensuring a robust framework for our qualitative analysis.
In qualitative research, the experience of researchers is pivotal for knowledge generation (Creswell & Creswell, 2017 ). Our team, composed of academic staff, undertakes clinical studies to assess and support children and offers family counseling services focused on child development. Acknowledging the influence of our backgrounds and experiences, we endeavored to mitigate potential biases. We documented our initial assumptions, insights from the literature, and our theoretical and practical expertise. Engaging in continuous reflection and dialogue throughout the study (Watt, 2015 ), we maintained a postpositivist perspective, anticipating a variety of developmental challenges. For instance, we defined the possible areas we expected to emerge by keeping in mind that there may be different areas of development where difficulties may arise.
Following Braun and Clarke ( 2021 ) six-stage thematic analysis framework, our approach facilitated both inductive and deductive analysis. To prevent data loss, the first author meticulously transcribed the interviews, resulting in a comprehensive document of 231 pages. This document was analyzed using MAXQDA qualitative research software, starting with a thorough reading to gain an overall understanding of the data.
In the first procedure, familiarizing with the data , we read transcripts to look at the data holistically. In the second procedure, systematic data coding , we read and coded the transcriptions line by line. We outlined the distinct early developmental characteristics observed by teachers and parents in children diagnosed with SLD compared to peers. For example, one parent commented: “ He was having too many accidents compared to his peers. He was constantly getting injured. We never missed a visit to the hospital anyway. He still has a scar on his eyebrow. He burned his arm. So, he was always clumsy. He loses his balance and falls on the straight road.” . We coded this comment as ‘difficulty with balance skills.’
In the third procedure, generating initial themes from coded and collated data , we organized the codes into potential themes and sub-themes, ensuring all related codes were considered. In the fourth procedure, developing and reviewing themes , we checked coded quotations, potential categories, and themes to see if they were related. We made additions or substructions during this control process. A thematic map was created by establishing a relationship between quotation, code, category, and theme. In the fifth procedure, refining, defining, and naming themes , we named each theme so that it could create a related story for the research. In the sixth procedure, writing the report , we determined compelling quotations for inclusion in the report. After compiling the study into a report in Turkish, we translated the text into English with an expert support.
Our analysis, presented through thematic maps, adopted a developmental lens, offering a comprehensive view of the children's developmental indicators for SLD from infancy to the school years. This approach, grounded in a developmental model (Kass & Maddux, 2005 ), aimed to present a holistic understanding of the identified early symptoms of SLD.
While composing this work, the authors used Scholar Chat-GPT by Open-AI in order to improve the readability and use of existing language. It is crucial to emphasize that Scholar Chat-GPT was solely employed to enhance the quality of the writing and facilitate better communication of ideas, and not to generate new content. Following the application of this tool, the authors reviewed and edited the content as needed and takes full responsibility for the content of the publication.
Four maps were created regarding the early symptoms after the data analysis of the interviews. In these maps, categories or periods are indicated by different symbols.
In Map 1 , the early developmental symptoms of SLD in the preschool period fall under nine categories: social-emotional development, language and communication development, motor development, self-care skills, perception, memory, attention, self-regulation, and other difficulties.
From ages 0–3, parents frequently noticed issues with their children's language and communication development. Problems with speaking, pronunciation, and starting conversations were common in this age group. After turning three, kids started showing difficulty in expressing their feelings and thoughts, often relying on fillers like "err" and "umm." One parent (P9) shared about their child's struggle to initiate conversation:
“When he wanted to be friends and get closer, but he did not get a reaction, he gave up. So, he was very eager to have friends, but he had difficulty establishing that friendship. He was not a child who communicated a lot with his friends, nor was he social.”
For social-emotional development, parents noticed early symptoms such as a need for physical contact and introverted behavior from ages 0–3. Between the ages of three and six, parents reported their children facing challenges with following rules, sustaining peer relationships, making friends, experiencing low self-esteem, becoming victims of bullying, displaying emotional overreactions, and preferring to play alone.
In the motor development category, parents reported that their children, between the ages of 0–3, encountered difficulties with activities requiring coordination, speed, or strength. They described these challenges as clumsiness during running or an inability to participate in games like football. Between the ages of 3–6, the difficulties shifted towards activities that demand balance, drawing skills, and holding a pen properly.
In the perception category, parents identified issues related to visual and auditory perception, including difficulties in perceiving auditory stimuli, recognizing colors, writing and learning numbers, interpreting visual or auditory inputs, and slow perception speed. These difficulties became apparent to the parents after their children reached the age of three. Additionally, in other areas, parents observed challenges with direction skills.
Parents also highlighted that their children experienced difficulties with memory, attention, and self-regulation. They observed issues with memory, particularly in recalling information. Furthermore, there were struggles with maintaining attention during games or tasks that required concentration. Both parents and teachers shared the belief that the children could accomplish any task if they managed to focus. Challenges in self-regulation were noted as well, especially in terms of being tidy at home and in school settings. One parent (P1), who has twins, with one diagnosed with SLD, discussed memory difficulties by drawing comparisons in the developmental process between her twins:
“… about describing the picture she saw.... Whenever I asked her, she had a blank stare on her face. Later, when we read stories together, I used to realize she did not remember anything about the story.”
In general, the challenges identified between the ages of 0–3, with the exception of speaking difficulties, continue into the ages of 3–6. This means that issues such as pronunciation, initiating communication, introverted behavior, and difficulties with tasks requiring coordination, speed, or strength that begin to emerge from ages 0–3 tend to persist through to ages 3–6.
In Map 2 , which focuses on the school period, the early developmental symptoms of SLD are categorized into ten areas: social-emotional development, language and communication development, motor development, self-care skills, perception, memory, attention, self-regulation, motivation, and other difficulties. Within the language and communication development category, difficulties were reported in initiating communication, expressing feelings and thoughts, overusing fillers, and speaking in context.
Difficulties in social-emotional development emerged as a category in which parents and teachers predominantly share their observations. The frequency of codes in this field has increased in school age. Parents have observed challenges in engaging in casual conversations and difficulty in defense own rights, while teachers have identified reluctance, choosing to play individual games, and difficulty maintaining communication. Both participant groups have highlighted a range of early symptoms including low self-esteem, bully victimization, exclusion, introversion, emotional overreactive state, willingness to be invisible, and difficulty in following the rules. One child’s parent (P6) and teacher (T6) expressed low self-esteem as follows:
“She constructs barriers in unfamiliar situations, quickly abandoning tasks and expressing self-doubt. She often declares, ‘I cannot do this. Why do you insist? That is enough; it is not working; give up.” (P6) “There was a situation like this where her self-esteem was low and quite challenging. She frequently began sentences by stating, ‘I cannot do it.’ While many students experience this to some degree, she struggled with it more than most.” (T6)
Parents and teachers used the phrase “vulnerable, sensitive, and combative” to describe the emotionally overreactive state of the children. One child’s parent (P8) and teacher (T8) expressed bullying victimization as follows:
“I did not know if he was beaten so much. He suffered a lot from a friend. He was a quiet kid. He was not a kid who defended his rights.” (P8) “He was an oppressed child. One child in the classroom put him under the pressure. He could not defend himself. When he wanted to protect himself, he was doing it wrong.” (T8)
In the perception category, difficulties with matching letters to sounds were commonly reported by both parents and teachers. Furthermore, teachers noted challenges in interpreting stimuli and understanding instructions. Both parents and teachers reported difficulties in the self-regulation category such as external audit, disorganized notebook, and difficulty in planning. Difficulties in the field of attention, memory, motivation, and self-care skills were expressed by both parents and teachers during the school period as well. They expressed difficulty paying attention to a game/task, difficulty recalling information, reluctance, and low self-motivation about a game/task in the field of attention, memory, and motivation. Considering other difficulties, the teachers emphasized that children made more effort to learn, were reluctant to go to school, and could only learn until a certain difficulty level.
In Map 3 , the early academic symptoms of SLD in the school period appeared under three categories: reading, writing, and mathematics.
In the reading category, reading comprehension was the most emphasized difficulty. Mixing letters, reading slowly, making reading mistakes, and reluctance to read were expressed by both parents and teachers. One child’s parent (P1) and teacher (T1) expressed the mixing of letters as follows:
“I turned the house into a map. Because I thought she could not forget letters if she saw them all the time. But she would do a lot of constant b-d shuffling.” (P1) “When I realized she was confusing the letters b-d, I thought this was not a problem. Because my four or five students made the same mistake as her… There was an application in the curriculum that I found very wrong. When I taught the letter groups b-d in the first grade, there was only one letter (s) between them. In other words, children are more confused because these letters are given one after the other… When these two letters are taught in proximity, students often experience confusion. Therefore, there is a need for change in this regard.” (T1)
Most of the difficulties in the writing category were expressed by both parents and teachers. Difficulties holding the pencil, writing numbers in the correct direction, leaving appropriate spaces between words, legible writing, the proportionality of letters, and making spelling mistakes emerged in this area. In the mathematics category, both parents and teachers expressed difficulty solving problems.
We created Map 4 by considering the chronological and developmental processes. Firstly, the parents observed differences in their children’s language and communication development. In particular, they emphasized difficulties in speaking, pronunciation, and limited vocabulary. In the following process, difficulties in social-emotional development were remarkably noted by the parents. This development area was that what both parents and teachers most expressed. Afterward, they started to mention motor development difficulties. Although parents believed their children had difficulties in motor development in preschool, they determined this to be an issue during school years.
Developmental symptoms pyramid of children at risk for SLD
This situation proceeded similarly for self-care, perception, attention, and memory. While self-care skills were tolerated in preschool, the child was expected to become independent in the first grade. All the difficulties above started to show their effects more clearly in the academic field during school years.
When we look at the developmental process holistically, social-emotional development and motivation challenges become more pronounced in school life. Parents and teachers have reported that children exhibit a notable lack of motivation in addition to other difficulties. They tend to be invisible, become introverted, show reluctance in both their social and academic lives, and strive to be unnoticed.
We also saw the process progress increasingly in the seven steps. For instance, language difficulties emerged in the 0–3 age period and continued to increase and intensify during the school period. The frequency of codes in socioemotional development has increased in school age. While the difficulties that appeared on the pyramid's base were expanded, new difficulties accrued on top of them. That was why we visualized this process as a pyramid . One child’s parent (P2) expressed the increase in difficulties experienced as follows:
“He began speaking later than his peers and entered kindergarten at five. During that time, his speech development lagged, causing communication challenges with his teacher and impacting his ability to form friendships. Even now, he faces difficulties in making friends. When my son started first grade, I became suspicious of his learning difficulties as he struggled with reading words composed of two letters, often reading them backward. I shared my concerns with his teacher, who insisted on waiting. Despite waiting patiently, the difficulties persisted and even worsened. At this point, the formal reporting process was initiated.” (P2)
When examining the pyramid, it is evident that there is an increase in the child's symptoms, coupled with a reluctance to understand, difficulty in motivation, and lack of self-esteem. Parents describe this situation as “ He has potential, but he believes he cannot do it, ” “ He gives up quickly, ” or “ It is tough to break his prejudice that he cannot do it .” Consequently, researchers believe that all the difficulties experienced by children point to a theme linked to challenges in their perception of themselves. Hence, we have labeled the final step of the pyramid “ negative self-concept .” Self-concept encompasses an individual's perceptions of themselves across various aspects, including physical appearance, achievements in sports and academics, behavior, social acceptance, and interpersonal relationships (Butler & Gasson, 2005 ). We referred to the negative self-concept when children held negative perceptions of themselves in these areas.
In general, the findings reveal difficulties across 13 areas. Only parents or teachers reported some of these difficulties. Both parents and teachers expressed some of the other difficulties. Table 2 presents all the difficulties mentioned above, categorized by developmental areas, period, and the individual expressing the difficulty.
This study aimed to explore early developmental challenges of children diagnosed with SLD and to contribute to the creation of an item pool for early symptom identification. Through qualitative interviews with parents and teachers, we identified a broad range of developmental symptoms from infancy to primary school, including difficulties in language and communication, social-emotional and motor development, self-care skills, perception, memory, attention, self-regulation, and academic challenges. These findings underscore the multifaceted nature of SLD and the importance of early identification and intervention.
According to the findings, parents and teachers highlighted difficulties in 13 distinct areas. We categorized these difficulties to create an item pool for early symptoms. We created an item pool at the end of the study and organized it by age groups (0–3, 3–6 and school age, outlined in Appendix C).
Our results showed that, according to parent observations, children primarily experienced language and communication difficulties—such as challenges with pronunciation, initiating communication, and speaking—during the first three years of their lives. After age three, they also struggled to express their feelings and thoughts and tended to overuse fillers in their speech. Previous studies have consistently identified these difficulties in language and communication development as early symptoms (Aunio et al., 2021 ; İzoğlu-Tok & Doğan, 2022 ; Price et al., 2022 ; Quiroga Bernardos et al., 2022 ). Longitudinal research emphasizes that children diagnosed with SLD face challenges in both receptive and expressive language skills during early developmental stages. Consistent with our findings, these challenges persist into later years (Carroll et al., 2014 ; Thompson et al., 2015 ; van Viersen et al., 2017 , 2018 ). Van Viersen et al. ( 2017 ) reported that children diagnosed with SLD begin to lag behind their peers in receptive language skills around the 17th month and in expressive language skills around the 23rd month. Unlike this study, our participants did not report any challenges related to receptive language skills. Parents in Turkey apparently prioritize their children's speech over their receptive language skills. Thus, it is plausible that parents primarily focus on expressive language skills when considering language development. Consequently, assessing language and communication development skills should be central to identifying risk groups. The literature supports the inclusion of these difficulties in the item pool. However, difficulty in speaking was not reported between the ages of 3 and 6. Lyytinen et al. ( 2005 ) found that late-talking toddlers with expressive delays caught up to their peers in language proficiency by the age of 3.5 years. Therefore, we suggest including this difficulty as a topic in preliminary interviews rather than incorporating it into assessment tools.
The most pronounced difficulties identified in our study relate to social-emotional development. Parental observations indicated that children exhibited symptoms such as introversion and a need for physical contact within the first three years of life. After the age of three, challenges in maintaining relationships and adhering to rules became apparent. Both parents and teachers noted an increase in introversion upon the children's entry into first grade, describing them as feeling excluded and invisible. Previous research has highlighted the importance of recognizing difficulties in social-emotional development as early indicators of potential issues (İzoğlu-Tok & Doğan, 2022 ; Sakellariou et al., 2020 ; Tercan & Yıldız-Bıçakçı, 2018 ). In particular, a qualitative study by İzoğlu-Tok et al. ( 2021 ) found that children with SLD felt marginalized and invisible due to experiences of bullying, with participation in mainstreaming services often equating to feelings of "rejection" and "not belonging." Reflecting on both our findings and those of previous studies, children were frequently described as "silent," "vulnerable," "sensitive," and "introverted." Thus, it is essential that these characteristics be considered as potential risk factors and integrated into the item pool for developing assessment tools.
Another significant observation was that children showed challenges in motor skills that require coordination, speed, application of strength, balance, and drawing abilities. Parents often described these challenges as clumsiness during physical activities, such as running or playing basketball. These issues were noted to persist throughout the school years. Similar challenges have been highlighted as early indicators of SLD in prior studies (Flores et al., 2022 ). Westendorp et al. ( 2011 ) determined that a greater learning lag in children correlates with poorer motor skill scores. Firat and Bildiren ( 2024 ) observed that children with SLD often began walking later than typical in the 0–2 age range and faced challenges in both fine and gross motor skills as they grew older. Although our study provides additional insights from parents regarding motor development issues, there is a general agreement that difficulties in motor skills are critical for identifying children at risk. Hence, it's essential to include these challenges in the item pool for early identification of SLD.
Parents reported that children faced difficulties with self-care skills after the age of three, a concern that aligns with findings from previous studies (İzoğlu-Tok & Doğan, 2022 ; Tercan & Yıldız-Bıçakçı, 2018 ). In Tercan and Yıldız-Bıçakçı ( 2018 ) qualitative study, parents emphasized the challenges their children encountered during toilet routines and the dressing process. It was also observed that close relatives often described the child as “unskillful” during early childhood. Consequently, challenges associated with self-care skills should be considered when developing the item pool for an assessment tool.
Our study revealed that children encountered difficulties with perception after age three. According to parents, these challenges were related to visual and auditory stimuli. Previous research on children at risk for or diagnosed with SLD has also underscored the significance of perception skills. Some studies have focused on difficulties in color and shape perception, while others have addressed challenges with numbers (Aunio et al., 2021 ; Hellstrand et al., 2020 ; Quiroga Bernardos et al., 2022 ). Additional research has highlighted challenges in letter knowledge, speech perception, and following instructions (Quiroga Bernardos et al., 2022 ; Snowling et al., 2019 ). In our study, parents did not report difficulties with letter knowledge. This may be influenced by the prevailing belief in Turkey that children should not learn letters before formal education begins. However, in the literature, visual perception is connected with reading difficulties and phonological awareness (Baluoti et al., 2012 ; Frostig, 1972 ). The phonological approach posits that children diagnosed with learning disabilities have trouble recognizing and manipulating phonemes in speech and making letter-sound matches during early phases (Wolf, 2017 , p. 173). Therefore, perception skills play a crucial role in the learning process. Thus, we suggest that challenges related to perception should be included in any assessment tool developed on this topic.
Our results also showed that children had significant escalation in self-regulation difficulties during the school period. Parents and teachers reported that children struggled with planning and maintaining the organization of their notebooks, which often required external audits. This finding aligns with findings from other studies in the literature (Tercan & Yıldız-Bıçakçı, 2018 ; Thompson et al., 2015 ). A thorough review makes it clear that challenges in this particular area are crucial and, therefore, should be included in the item pool for early identification of SLD.
Moreover, our study has demonstrated that children face challenges with paying attention to games or tasks from preschool onwards, as reported by both parents and teachers. This observation aligns with findings from previous research, where children exhibited difficulties in initiating, maintaining, or completing activities or tasks (Firat & Bildiren, 2024 ; Squarza et al., 2016 ; Tercan & Yıldız-Bıçakçı, 2018 ). Our findings indicate that parents and teachers believe that children could achieve any task if they were able to focus their attention. Consequently, problems related to attention could be mistakenly conflated with other difficulties. A common dilemma faced by parents is discerning whether the challenges with attention are a result of learning difficulties or if the inability to complete tasks stems from inherent attention issues. As such, our analysis suggests that difficulties in various domains are often attributed to an overarching issue of attention deficit by both parents and teachers.
In the context of diagnoses accompanying SLD, attention deficiency is commonly identified (Araz Altay & Gorker, 2017 ; Squarza et al., 2016 ). Thus, while attention is a necessary condition for any learning activity, it is not sufficient for diagnosing the early symptoms of SLD (Learning Disabilities Association, 2001 ). Assessing learning disabilities based solely on attention can risk misidentification as Attention Deficit and Hyperactivity Disorder (ADHD), another neurodevelopmental disorder (APA, 2013 ). Therefore, challenges related to attention should be considered alongside other difficulties when developing an assessment tool.
Our results also indicated that children have faced difficulties with memory recall since preschool, a symptom corroborated by previous research (Bonti et al., 2021 ). Studies have demonstrated a significant correlation between memory deficits and learning challenges, particularly in reading and mathematics (Mammarella et al., 2018 ; Moll et al., 2016 ; Peng et al., 2018 ). For instance, Moll et al. ( 2016 ) found that verbal memory deficits are linked to disorders in reading and mathematics, while visuospatial memory impairments are specifically associated with mathematics disorders. Although our study primarily relied on reports from parents and teachers, thus lacking detailed data on memory, the recurring theme of memory challenges emphasizes its importance. According to the information processing approach, memory plays a crucial role in learning, further highlighting memory as a key symptom to consider when identifying children at risk for SLD (Baddeley & Hitch, 1974 ). This underscores the necessity of including memory-related difficulties in the item pool for an assessment tool aimed at early detection of SLD.
Our findings showed that children have shown difficulty with location-orientation skills after age three, a challenge highlighted in previous studies (Açıkgöz, 2019 ; İzoğlu-Tok & Doğan, 2022 ). Research into the causes of SLD points to communication issues between the brain hemispheres, particularly noting that problems in the right hemisphere can impede the acquisition of directional concepts (Silver, 1989 ; Vellutino, 1987 ). Therefore, this skill is essential for inclusion in the item pool.
After preschool, parents reported that their children exerted more effort to learn, exhibited reluctance to attend school, and could only advance to a certain level of difficulty in other areas. We interpreted these behaviors as outcomes of the cumulative difficulties experienced across all areas. For example, an increased effort to learn may stem from perception challenges (Karakoç, 2020 ). The DSM-5 also points out a decline in academic performance as a distinguishing feature of SLD from other neurodevelopmental disorders (APA, 2013 ), suggesting that children may need to work harder to achieve the same performance level as their peers in early stages. These indicators should, therefore, enhance the comprehensibility of the item pool.
Our findings underscore that motivation is a critical early symptom in the developmental process, especially post-preschool. Previous research has identified a lack of motivation as an early indicator of SLD (Firat & Bildiren, 2024 ; Pesova et al., 2014 ). The decrease in motivation during the school period may be attributed to ongoing difficulties. Since strong motivation and a positive self-image are essential for learning, challenges in this domain can significantly obstruct educational progress (Aro & Ahonen, 2011 ). Pesova et al. ( 2014 ) observed that many students with SLD often remain unnoticed for extended periods, further complicating their learning, motivation, and confidence. Thus, early detection is vital. Accordingly, challenges related to motivation should be included in the item pool of any assessment tool designed to identify children within the risk group.
According to our research, difficulties in reading, writing, and mathematics become evident during the school period, as specified in the DSM-5 (APA, 2013 ). Additionally, similar challenges have been recognized as early symptoms in previous literature (Hellstrand et al., 2020 ; Navarro Soria et al., 2020 ; Quiroga Bernardos et al., 2022 ).
Reading has been the most extensively studied area (Ozernov-Palchik et al., 2017 ; Quiroga Bernardos et al., 2022 ; Snowling et al., 2019 ) as it represents the most common difficulty associated with SLD (APA, 2013 ). Parents and teachers in our study reported that children faced challenges with reading comprehension, letter mixing, slow reading, frequent reading errors, and reluctance to read. Partanen and Siegel ( 2014 ) found that children at risk of reading difficulties in kindergarten scored lower in word and letter recognition, phonological processing, and rapid naming compared to their peers not at risk. Unlike other studies, our research did not identify challenges in early literacy skills, such as phonological awareness and letter knowledge, among preschool children. This discrepancy may be attributed to the Turkish curriculum, which discourages the teaching of reading and writing, including letter introduction, before formal education begins (Ministry of National Education, 2013 ). Hence, it's likely that parents did not recognize their children’s difficulties in this area as notable challenges during the preschool period. Apart from reluctance to read, all other difficulties align with the DSM-5 diagnostic criteria (APA, 2013 ), suggesting that reluctance to read may stem from underlying challenges.
One teacher we interviewed suggested revising the curriculum, especially regarding the teaching of certain letters, such as'b' and'd'. In Turkish, each sound corresponds to a letter, and when teaching reading, letters are introduced in groups. For example, the third group includes six letters ('ö','r','ı','d','s','b'), taught consecutively, placing'b' and'd' close together, which can confuse many children. This curricular approach may influence teachers' perceptions of these issues as early symptoms of SLD in Turkey.
Challenges in writing and mathematics are consistent with DSM-5 diagnostic criteria and existing literature (APA, 2013 ; Fırat & Erdem, 2020 ; Zhang et al., 2020 ). Fırat and Erdem ( 2020 ) found that a significant portion of students who struggled with mathematics in the 1st grade continued to face challenges in the 4th grade, including issues with rhythmic counting, concept comprehension, problem-solving, number knowledge, and making comparisons. Mathematics skills are often less emphasized compared to literacy skills in early education. Thus, difficulties in reading, writing, and mathematics should be integral to the item pool for early SLD detection.
A significant finding from our study is the progressive increase in difficulties experienced by children at risk for SLD, which closely follows the critical stages of their development. Initially, parents noted early symptoms in language and communication skills, identifying developmental language disorders and language skill difficulties as potential indicators of future SLD (Quiroga Bernardos et al., 2022 ; Thompson et al., 2015 ; van Viersen et al., 2017 , 2018 ).
We observed that language development difficulties became evident in social settings, potentially impacting children's social development (Sakellariou et al., 2020 ). Consequently, social-emotional development challenges may arise following difficulties in language and communication. Socialization introduces environments where motor skills are actively utilized, making differences in motor development noticeable as children engage with their surroundings. Similarly, parents did not perceive challenges in perception, attention, and memory as significant until entering the first grade. These early developmental symptoms can influence academic performance later on.
Our study uncovered developmental symptoms across multiple areas at early life stages, suggesting that accumulating difficulties prevent children from realizing their full potential. This accumulation leads to diminished motivation and self-esteem, driving children towards invisibility-a phenomenon we described as a negative self-concept.
Parents and teachers reported developmental difficulties early on, noting that foundational challenges expanded as new difficulties emerged. We depicted this progression as a pyramid, illustrating the Matthew effect—where initial disadvantages lead to compounded challenges, echoing the adage "the rich get richer, and the poor get poorer" (Gladwell, 2008 ). This effect, evident in both reading and mathematics, highlights the escalating nature of difficulties in development (Flores et al., 2022 ; Ozernov-Palchik et al., 2017 ; Zhang et al., 2020 ).
Analyzing these challenges, we noted the influence of the developmental model, which suggests a complex interplay of factors in a child's development. Before facing academic challenges, children experience difficulties in multiple developmental areas, underlining the potential long-term impact on learning behaviors (Kass & Maddux, 2005 ).
Theories from Piaget, Vygotsky, and others highlight critical periods in development. Observations from parents and teachers suggest that learning difficulties are often perceived as delays in achieving expected milestones. For instance, a delay in language development can affect social interactions, emphasizing the importance of recognizing and addressing challenges early. In Turkey, regulations emphasize early intervention for children with diverse needs (Decree-Law No. 573, 1997). However, SLD diagnoses typically occur after the first grade, underscoring the need for earlier assessment and intervention tools.
This study has provided researchers with a crucial item pool sample, facilitating the development of comprehensive screening tools tailored to various age groups (0–3, 3–6, and school age). Collaboration with families, educators, and health professionals ensures the validity and reliability of these tools across different populations. Moreover, the research contributes to expert and educator training, offering sessions on early sign recognition across multiple developmental domains. By identifying specific areas of concern like language, communication and social-emotional skills, the study informs the creation of early intervention programs. Advocating for the integration of screening and intervention protocols into educational systems, including kindergartens and primary schools, underscores the importance of early support for children at risk of SLD. This research sheds light on the needs of children from infancy, informing policymakers and education officials. Longitudinal tracking of children with difficulties ensures ongoing assessment and progress monitoring, empowering families and educators to intervene early and improve developmental outcomes and educational success for affected children.
The exploration of early developmental challenges among children diagnosed with SLD presented in this study illuminates the multifaceted nature of this condition and underscores the critical importance of early identification and intervention. Through qualitative interviews with parents and teachers, a comprehensive item pool was established, delineating difficulties across various developmental domains from infancy through primary school. The findings highlight that challenges in language and communication emerge as early as infancy, followed by social-emotional, motor, perceptual, attentional, self-regulatory, memory, and academic difficulties during subsequent developmental stages. The study's thorough examination not only contributes to the existing literature on early symptoms of SLD but also emphasizes the necessity of integrating these findings into assessment tools for timely identification and intervention. By elucidating the progression of challenges experienced by children at risk for SLD, this research underscores the cumulative impact of developmental difficulties and advocates for proactive measures to support affected children's holistic development. Moreover, the study's insights hold significant implications for practitioners and policymakers, emphasizing the imperative of early intervention strategies aligned with the developmental needs of children with SLD, ultimately fostering their optimal growth and learning outcomes.
This study primarily examined the past observations of teachers and parents. Additionally, it was confined to the research questions formulated by the researchers, which encompass information about the children's preschool and pre-diagnosis school period. A notable limitation of this research is the potential variance in the levels of perception and expression skills among participants in the study group.
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
The code conducted from the findings of this study is available on request from the corresponding author. The code is not publicly available due to privacy or ethical restrictions.
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We would like to express our gratitude to the children, parents, and teachers who generously shared their experiences and time with us. Additionally, a heartfelt thank you to our colleagues for their valuable contributions.
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Aslı İzoğlu-Tok
Department of Child Development, Faculty of Health Sciences, Hacettepe University, Ankara, Türkiye
Aslı İzoğlu-Tok & Özcan Doğan
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Correspondence to Aslı İzoğlu-Tok .
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İzoğlu-Tok, A., Doğan, Ö. Preliminary developmental challenges of children at risk for specific learning disabilities: Insights from parents and teachers—a qualitative study. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-06231-x
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Objectives To explore pupils' and teachers' experiences of physical education (PE). Study design A qualitative investigation employing semistructured interviews. Self Determination Theory was used as a guiding theory and Template Analysis was used to analyse the data. Setting A secondary school in the North East of England. Participants 14 pupils (aged 13 and 14, boys and girls) with a ...
In the case of physical education (PE), the subject addressed in the present systematic review, there are two very different assessment models. ... A similar amount of works adopted a qualitative research approach, i.e., four articles [32,34,36,38]. In all these works, the instrument was a structured questionnaire. These quantitative studies ...
This is the first systematic qualitative review to examine and organise the current body of research that addresses the practical application of critical pedagogy within Physical Education and Sport for Development. Following a rigorous systematic review process, this paper analyses critical pedagogy, social justice and social transformation ...
Objectives To explore pupils' and teachers' experiences of physical education (PE). Study design A qualitative investigation employing semistructured interviews. Self Determination Theory was ...
Physical Education and Research Quarterly for Exercise and Sport in which one or more qualitative data collection techniques are employed (1988 to 1997). teacher-student interaction. For example, in his review of research paradigms and programs in the Handbook of Research on Teaching, Shulman (1986) stated that
Despite both heuristic power and great promise for application in sport and physical education, however, unresolved questions and troublesome concerns remain. Active scholars, editors, reviewers, and research consumers will control the future for qualitative research and all must stretch to accommodate an unfamiliar way of knowing.
Focusing on the unique nature of qualitative methods within kinesiology settings, Qualitative Research and Evaluation in Physical Education and Sport Pedagogy guides graduate students and early career researchers through designing, conducting, and reporting of qualitative research studies with specific references to the challenges and possibilities of the field.
Conclusion And Recommendations In this study, which is designed according to the qualitative research method, it was aimed to evaluate the opinions of the administrator and the educator personnel responsible for the implementation in the practice schools in Batman province center regarding the teaching practice course that physical education ...
Purpose: This study aimed to investigate the student's experiences of social and emotional learning in a community-based youth soccer program grounded in the hybridization of the teaching personal and social responsibility model and the cooperative learning model. Methods: This research was guided by a case study design. Qualitative data were collected over 28 weeks. Twenty-three children (n ...
It is interesting to note that in the current study, use of social media, as a source of education and modelling, was also identified as a potential enabler of physical activity participation. Research on physical activity interventions using social media for these purposes among American university students has shown mixed results.
Summary: "A practically-focused introductory qualitative methods text specific to physical education and activity to guide graduate students and early career researchers through the design, conduct, and reporting of qualitative research studies with specific references to the challenges and possibilities of the field"-- [Provided by publisher]
In pursuit of equity and inclusion: Populism, politics and the future of educational research in physical education, health and sport. Sport, Education and Society, 22 ... Analysing exceptions within qualitative data: Promoting analytical diversity to advance knowledge of ageing and physical activity. Qualitative Research in Sport ...
Qualitative Methods in PER: A Critical Examination. Qualitative research in PER has been a foundational part of the field since its inception. This research approach is characterized by methods that draw upon non-numeric data; researchers often see qualitative research as a means of gaining a rich understanding of an area.
There are several types of empirical research, and three common types are quantitative, qualitative, and mixed methods research, which are all explained below. Many empirical studies in the social science use mixed methods to examine complex phenomena.
A Qualitative Investigation of Teachers' Experiences of Life Skills Development in Physical Education Lorcan Cronin a, Rebecca Greenfieldb and Anthony Maher c a Department of Psychology, Mary Immaculate College, Limerick, Ireland; b Sport & Physical Activity, Edge Hill University, Ormskirk, UK; cCarnegie School of Education, Leeds Beckett University, Leeds, UK
This study aims to uncover the preliminary developmental challenges experienced by children from infancy to their primary school years, who are subsequently diagnosed with specific learning disabilities during their primary education. The ultimate goal is to develop an item pool to identify early symptoms of specific learning disabilities. This qualitative descriptive design study employed ...