Learning Disabilities
(2-3-15)
A most controversial subject
Questions to consider:
What is a learning disability?
How shall we identify a learning disability?
How do we best remediate/educate a learning disability?
What are the causes of learning disabilities?
Are there different types of learning disabilities?
The current picture
The concept of a learning disability
A difficulty in learning that cannot be accounted for by any of the well understood limitations on academic achievement: general intelligence, sensory or motor disability, emotional or behavior disorder, environmental or educational deficiency
problems with negative definitions
Definitions of LD
There is no universally accepted definition of learning disability
Questions and disagreements surround the issue of exclusionary criteria, relationship to intelligence, hypothesized basic psychological deficits, gender distribution, etiology, determination of a "significant discrepancy", and the nature of the frequent association with comorbid problems
Common elements in definitions of learning disorders
Academic problems with intra-individual variation in underachievement
Ability/Achievement discrepancy
Heterogeneous population
Possible CNS dysfunction
Persistent problems affecting adjustment at all ages
Association with language problems, especially in early history
Association with perceptual problems, especially in early history
Significant potential for multiple handicaps (comorbidity with other disorders is high)
Individuals with Disabilities Act (IDEA)
Reauthorized Definition of Learning Disabilities (1997)
In 1997 a reauthorization of IDEA (Public Law 105-15) was signed into law by the federal government. The definition of learning disability included was essentially the same as the previous USOE definition (1977) used in P.L. 94-142 and read:
A. In General--The term “specific learning disability” means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in imperfect ability to listen, think, read, write, spell, or do mathematical calculations.
B. Disorders Included--Such term includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.
C. Disorders Not Included--Such term does not include a learning problem that is primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage. (Individuals with Disabilities Education Act Amendments of 1997, Sec. 602(26), p. 13)2004 reauthorization of IDEA
"Specific learning disability" means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, think, speak, read, wriet, spell, or to do mathematical calculations."
"does not include chidlren who have learning challenges which are primarily the result of visual, hearning, or motor difficulties, of [intellectual difficulty], of emotional disturbance, or of environmental, cultural, or economic disadvantage."
2006 Rules and Regulations expanded exclusionary criteria to include "lack of instruction"
DSM-IV definition of Learning Disorder
"Learning Disorders are diagnosed when the individual's achievement on individually administered, standardized tests in reading, mathematics, or written expression is substantially below that expected for age, schooling, and level of intelligence." (DSM-IV-TR, 2000, p. 49)
"Substantially below is defined as a discrepancy of more than 2 standard deviations between achievement and IQ." (DSM-IV-TR, 2000, p. 49)
"If a sensory deficit is present, the learning difficulties must be in excess of those usually associated with the deficit." (DSM-IV-TR, 2000, pp. 49-50)
DSM 5 definition of Specific Learning Disorder
A. "Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target these difficulties:" (p.66)
inaccurate/slow/effortful word reaqding
difficulty understanding meaning of what is read
difficulties with spelling
difficulties with written expression
difficulites mastering number sense, number facts, calculation
difficulties with mathematical reasoning
B. "skills substantially and quantifiably below those expected for the individuals's chronological age, and cause significant interference with academic or occupational performance" (p. 67)
C. "begin during school-age years" (p. 67)
D. "not better accounted for by intelletual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders, psychological adversity, lack of proficiency in the language of academic instruction, or inadequate education instruction" (p. 67)
Characteristics of children with LD
Method of identification significantly affects population identified:
Placement/performance discrepancy
years below grade level is probably an inadequate standard but may not be extinct
minimal testing requirement would be an achievement measure (and some basis upon which to judge intelligence to be normal--this might be observation and clinical judgment)
Ability discrepancy: predict achievement level based on tested IQ and compare with measured achievement
minimal testing requirement would include and individually administered IQ test and an achievement measure
Statistical discrepancy after correction for correlation between measure (ability and achievement measures are typically positively correlated) and regression effects (regression toward the mean)
a regression equation compensates for statistical effects--this is the most conservative (stringent) approach to establishing an ability/achievement discrepancy
As increasing restrictive standards are used, 3 clear effects can be seen in the population identified as "learning disabled":
1. a small number of children are identified: population of "affected" children shrinks
2. the average severity of the identified cases increases (you have progressively excluded the milder cases)
3. the homogeneity of the identified population increases
The current struggle: Federal criteria for LD designation are changing. After decades of a definition based on the "discrepancy model" alternative formulations are being actively debated and are finding their way into law.
The Discrepancy Model
ability-achievement differences
Problems with the discrepancy model
1. it has not lead to effective instruction or remediation
2. it ignores children who are struggling academically but do not show a discrepancy between tested intelligence and achievement
3. it is difficult to use with children in the early grades
The search for an alternative:
The Comprehensive Assessment/Clinical Judgment Model/Diagnostic Approach
1. Eliminate discrepancy criteria
2. Base identification of LD on a comprehensive individualized assessment of abilities; using multiple methods, measures, sources of information, and clinical judgment
3. Decisions on eligibility made by an interdisciplinary team
The Response to Intervention/Response to Treatment Model (RTI)
Curriculum Based Instruction methodology: a testing strategy that uses to student's curriculum as the basis to plan learning needs and intervention. "test, teach, test"
1. Eliminate discrepancy criteria
2. Diagnose LD if the child fails to respond to efforts at academic remediation
Prevalence: approximately 5% of school aged children is a common estimate
50% of children in special education
Sex Ratio: M > F identified in most reports
Shaywitz & the Connecticut Longitudinal Study (1990): referral bias
Rutter et al., (2004) findings: reading disability significantly higher in males
Course: Varies most clearly with severity
Mild cases may “disappear”
Shaywitz suggests that LD may be more like hypertension (people differ in degrees) than like an infection (people have or don't have)
Moderate to severe cases usually appear stable
Associated Problems/Outcome
Risk for dropping out of school (near 40%) approximately 1.5 national average (APA, 2000)
Comorbid behavior problems approximately 3 times high than norm by 8 years of age
behavior problems in general population
age 4 ........................................ age 8
2% ............................................ 9%
behavior problems in youth with learning disorders
age 4 ..........................................age 8
11% ........................................... 27%
A review of publications by Kavale & Forness (1996) suggested that approximately 75% of students with learning disabilities have social skill deficits.
These children tend to be more isolated and less popular with peers (Vallance, Cummings, & Humphries, 1998).
Gadeyne, Ghespuiere, & Onghena (2004) found children with learning difficulties more likely to have deficits in attention, social behavior, and behavior problems; but noted found variations defending on subpatterns of learning problems: low achievement students were more likely experiencing poor academic self-concept versus students with specific learning disabilities, who were more likely to experience social problems.
Areas of disability/functional limitations associated with learning disorders:
Academic achievement: reading, written expression, arithmetic skills
Attention and concentration: even without diagnosed ADD/ADHD, there may be problems with cognitive focus, distractibility, and vigilance relative to age peers
Memory: learning and recall, incidental learning, and general fund of knowledge may be poor relative to age peers
Executive functions: planning, judgment, abstract reasoning, problem solving, generalization and discrimination based on feedback may be poor relative to age peers
Social skills: deficits in communication, nonverbal social perception, awareness of social conventions, and specific social skills (appropriate eye contact, posture, voice loudness, assertiveness) may limit adjustment and achievement. The adaptive behavior of children with LD's was found by Leigh (1987) to be poorer than typical children but better than children with mental retardation.
Poor self-esteem, limited self-confidence, performance anxiety, self-defeating behaviors, and limit goal directed behavior may further limit success. Children with LD's have been found to have more anxiety (Stein & Hoover, 1989) and higher levels of depression (Hall & Haws, 1989) than typical learners.
Subclassification: Intensely debated
May be as common as reading disorders but have received less attention
Some investigators have argued arithmetic learning disability is unique (Rourke, 1993), while others have argued that these problems are part of more generalized learning disability (Fleischner, 1994). Math and reading disabilities may share common underlying processing difficulties; they are frequently comorbid: co-occurrence estimates as high as 40% are reported (Hale & Fiorello, 2004).
Disorders of Written Expression
reportedly rarely occur in isolation, usually comorbid with other learning and language disabilities
handwriting problems
spelling
"There are only 26 letters in the alphabet, but over 500 spellings used in representing the 44 phonemes in the English language (Tompkins, 1998)." (Hale & Fiorello, 2004, p. 227)
"benign spelling dyspraxia"
composition
Comorbidity
Other emotional, behavioral, and cognitive problems are often found in association with learning disorders
Frequently report comorbid problem areas:
Attention-Deficit/Hyperactivity Disorder (ADHD)
Disruptive Behavior Disorders--Oppositional-Defiant Disorder (ODD) and Conduct Disorder
Mood Disorders and Anxiety Disorders (often latter: adolescence or adulthood)
Substance Abuse/Substance Dependence (this observed relationship may not be functional [e.g., "real"], but rather mediated by the association with ADHD and Disruptive Behavior Disorders (which do have functional links to substance use problem)
Treatment/Education: No primary intervention to date has proved successful (This may be changing in the case of some reading disabilities).
Most significant factor in remediation has been amount of instruction in skill deficit area ("time on task").
Individualized instructional approaches are often helpful (single case study approaches, response to intervention models)
Learning characteristics reported in students identified with LD have included:
perceptual problems
language problems
attention and concentration problems
memory problems
cognitive/information processing problemsinformation processing--the way a person acquires, retains, and manipulates ideas
executive function problems
executive functions: planning a task, carrying this plan out, checking progress and using feedback, verifying that results meet goal
Treatment of comorbid conditions can reduce interference with education
Most individuals with learning disorders will show some improvement of academic skills over time, almost all benefit from continuing efforts at education/self-learning; some will gain skills to the point where they no longer "qualify" for an LD classification but may nevertheless have continuing problems with academic skills that affect their occupational success and self-image