SPECIFIC LEARNING DISABILITIES Nature of Learning Disabilities • Controversies and trends in defining specific learning disabilities. • The differences in definitions can be found based on the nature of the defining source (e.g., the DSM [APA, 2000]; U.S. Federal Educational; National Joint Committee for Learning Disabilities) and on the country of origin. • In many countries of the world, the term learning disability continues to be equated with Mental Retardation ( MR) or intellectual disability. However, specific learning disability has also often become equated with developmental dyslexia (Demonet et al., 2004), which is primarily used to describe a reading disability. THE DSM DEFINITION OF LEARNING DISORDERS • Formerly called Academic Skills Disorders • the DSM-IV-TR (APA, 2000) clusters specific learning disabilities under Learning Disorders in the subsection entitled Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence • Reading Disorder, Mathematics Disorder, Disorder of Written Expression, and Learning Disorders NOS. • Discrepancies between 1 and 2 standard deviations may be acceptable. • dyslexia is diagnosed if achievement in reading (accuracy, fluency (speed), or comprehension) is significantly below the expected level. • the prevalence of Reading Disorder in US is estimated to be approximately 4% of the school-age population and is far more prevalent in males (60 to 80%). • A Mathematics Disorder may be evident in problems understanding or naming mathematical concepts, operations, and functions. • Mathematics disorders are less prevalent than reading disorders and appear in 1% of school-aged children. • A Disorder of Written Expression beyond spelling is more difficult to assess due to a lack of standardized measures and the difficult and often laborious methods of scoring instruments that are available. • Prevalence rates are also lacking for this lesser known disorder. • disorders of spelling or handwriting alone are not considered sufficient to diagnose a Disorder of Written Expression. DSM V Diagnostic Criteria 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 those difficulties: 1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words). 2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read). 3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants). 4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity). 5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures). 6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems). B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment. For individuals age 17 years and older, a documented history of impairing learning difficulties may be substituted for the standardized assessment. C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the individual’s limited capacities (e.g., as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads). D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction. Note; The four diagnostic criteria are to be met based on a clinical synthesis of the individual’s history (developmental, medical, family, educational), school reports, and psychoeducational assessment. Coding note: Specify all academic domains and subskills that are impaired. When more than one domain is impaired, each one should be coded individually according to the following specifiers. Specify if: 315.00 (F81.0) With impairment in reading: – Word reading accuracy – Reading rate or fluency – Reading comprehension Note: Dyslexia is an alternative term used to refer to a pattern of learning difficulties characterized by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities. If dyslexia is used to specify this particular pattern of difficulties, it is important also to specify any additional difficulties that are present, such as difficulties with reading comprehension or math reasoning. 315.2 (F81.81) With impairment in written expression: – Spelling accuracy – Grammar and punctuation accuracy – Clarity or organization of written expression 315.1 (F81 .2) With impairment in mathematics: – – – – Number sense Memorization of arithmetic facts Accurate or fluent calculation Accurate math reasoning Note: Dyscalculia is an alterative term used to refer to a pattern of difficulties characterized by problems processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations. If dyscalculia is used to specify this particular pattern of mathematic difficulties, it is important also to specify any additional difficulties that are present, such as difficulties with math reasoning or word reasoning accuracy. Specify current severity: • Mild: Some difficulties learning skills in one or two academic domains, but of mild enough severity that the individual may be able to compensate or function well when provided with appropriate accommodations or support services, especially during the school years. • Moderate: Marked difficulties learning skills in one or more academic domains, so that the individual is unlikely to become proficient without some intervals of intensive and specialized teaching during the school years. Some accommodations or supportive services at least part of the day at school, in the workplace, or at home may be needed to complete activities accurately and efficiently. • Severe: Severe difficulties learning skills, affecting several academic domains, so that the individual is unlikely to learn those skills without ongoing intensive individualized and specialized teaching for most of the school years. Even with an array of appropriate accommodations or services at home, at school, or in the workplace, the individual may not be able to complete all activities efficiently. THE FEDERAL DEFINITION OF LEARNING DISABILITY • Specific learning disability (SLD) means a disorder in one or more of the basic psychological processes involved in understanding or using language, spoken or written, in which the disorder may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations. • The term SLD is inclusive in subsuming other previously used terms, such as perceptual handicap, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. • it excludes children who have learning problems that are primarily a result of visual, hearing, motor handicaps, MR, emotional disturbance, or environmental or cultural disadvantage Discrepancy Criteria • IQ-achievement discrepancy model • A key defining feature in making a differential diagnosis of MR is that in MR academic achievement is low but commensurate with expected IQ, while in the learning disabled population, a significant discrepancy exists between IQ and achievement. • How a significant discrepancy is operationally defined? • Some studies have arbitrarily applied the 2-year rule to define the discrepancy (e.g., a significant discrepancy between grade attainment and present functioning occurs once there is a 2-year gap, Grade-4-age child functioning at a Grade-2 level). • However, this criteria has been criticized on two counts: – (1) it is very difficult for a child to be 2 years behind in the early grades, – (2) the model relies on a failure-based criterion. • convert academic scores to standard scores and compare these directly with IQ scores. • Using this method, discrepancies between 15 to 22 points (1 to 1.5 standard deviations) are most commonly used to determine a significant discrepancy between IQ and academic performance. • the discrepancy model is problematic when children’s IQ scores are compromised by processing problems underlying the learning disability • Although this method works well in the middle ranges, IQ scores at the upper and lower levels tend to bring criticisms. • Using this method, a student with an IQ of 140 would be considered to be significantly behind if the academic score was 125 (which is within the Superior range). However, a student with an IQ of 85 would have to have an academic score of 70 (Borderline range) to qualify as SLD. • Students with higher IQs are more likely to have a significant discrepancy between their IQ and achievement than students with lower IQs. • the IQ-achievement discrepancy is biased in favor of students with higher IQs getting assistance, while those with lower IQs do not qualify for assistance. • A learning disorder is evident if achievement in one of the above areas (reading, mathematics, writing) is substantially below what would be expected based on age and intellectual potential. • Furthermore, substantially below is defined as a discrepancy between achievement and intelligence that is in excess of 2 standard deviations. • Despite the criticisms, there continues to be strong support (Kavale, Forness, & McMillan, 1998; Sattler, 2002) for retaining the model to determine eligibility for SLD programs THE NATIONAL JOINT COMMITTEE FOR LEARNING DISABILITIES • a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical skills. • The disorders are considered to be intrinsic to the individual, due to central nervous system dysfunction, and may occur across the life span. • associated problems of handicapping conditions , self-regulatory behaviors, social perception, and social interaction often co-occur with SLD but do not themselves constitute a learning disability. CONTROVERSY AND TRENDS IN THE DEFINITION OF LEARNING DISABILITIES • The DSM-IV-TR (APA, 2000) definition has been criticized on the grounds that the definition is too narrow, considering only three academically oriented disorders, and in its exclusive orientation that implies that a learning disorder cannot exist in comorbid relationship with another disorder. • The federal definition has also been criticized for its vague references to basic psychological processes at the basis of the disability and lack of guidelines regarding how to measure the manifestation of an imperfect ability. • the NJCLD definition does not provide any guidelines regarding how to measure the significant difficulties in acquisition of academic skills that result. • Learning Disabilities Association of America (LDA, 2010) recommended that the identification procedures for SLD be strengthened to include cognitive and neuropsychological assessments necessary to identify strengths and weaknesses for the purposes of developing appropriate interventions. • The DSM-5 (APA, 2013) has altered its criteria by removing reference to the discrepancy criteria and replacing it with reference to academic skills that are “substantially and quantifiably below those expected for the individual’s chronological age…as confirmed by individually administered standardized achievement measures and clinical assessment” Response to Intervention Models • The IDEA Act provides for the use of Response to Intervention (RTI) models to identify and assess children. RTI consists of tiered instruction where children who have difficulty learning to read using typical methods of instruction are provided with small-group, intensive instruction. Those who need additional intervention may receive one-on-one special education. This approach seeks to provide each child with the appropriate level of instruction required for his or her individual needs. • First, there are no clear guidelines provided or objective means to determine what are or are not considered appropriate forms or levels of intervention. • While some mainstream teachers naturally provide appropriate interventions which may even enable LD students to succeed, other teachers will have considerable difficulty providing any level of appropriate intervention. • Some students (most notably those with lower cognitive abilities) will naturally struggle to keep up with their classmates regardless of any intervention which may be provided. As such, while some truly LD students may not be identified through RTI, many more non-LD underachievers will be found eligible for LD services. • Please visit http://www.ldinfo.com/rti.htm PREVALENCE • The prevalence of specific learning disorder across the academic domains of reading, writing, and mathematics is 5%-15% among school-age children across different languages and cultures. • In studies that have used a discrepancy criterion (standard score differences between achievement scores and IQ scores), prevalence figures for comorbid ADHD + SLD have ranged from 16 to 21% (Frick et al., 1991) in a study where a 20 point discrepancy between intelligence (IQ) and achievement was used to a prevalence of 38 to 45% in a study where a 10 point discrepancy was used between the standard reading scores and the IQ LEARNING DISABILITIES AND SOCIAL SKILLS DEFICITS • children with learning disabilities encounter more social difficulties than their non–learning disabled peers. • The Interagency Committee on Learning Disabilities (ICLD) conducted a massive evaluation of available research concerning learning disabilities and social skills and concluded that social skills deficits can represent an SLD (1987). • the ICLD suggested that the NJCLD definition be altered to include social skills among the other areas of skill acquisition deficits (e.g., listening, speaking, reading, writing, reasoning, mathematical abilities, or social skills). • children with SLD not only had significantly lower sociometric scores compared to nondisabled peers but that they also were overly represented in the rejected and neglected sociometric groupings. • three ways in which social competence can be undermined: – skill deficit (individual has not learned required skill), – performance deficit (individual has the skill but does not apply it) – Self-control deficit (individual demonstrates aversive behaviors that compete or interfere with the acquisition and performance of appropriate social skills). • In meta-analytical studies, results revealed that almost .75 of the students (74%) received negative assessments of their social skills that would clearly discriminate them from their non-SLD peers. • teachers perceived the SLD students to be less academically competent and having less social interaction than their non-SLD peers. • Teachers also rated 70% of the SLD population as demonstrating anxiety. • Peer assessments (non-SLD peers) revealed that 8 of 10 SLD students were rejected by their peers, with 7 of 10 not considered as friends by peers. • non-SLD peers rated the SLD children as less popular, competent, communicative, and cooperative than their non-SLD peers. • Self-assessment results indicated that 70% of SLD students identified social skills deficits, while 80% identified lack of academic competence as their biggest concern. • Measures of external-internal locus of control and attributions revealed that the majority of SLD students were externally driven. LEARNING DISABILITIES AND SUBTYPES • Rourke and colleagues (Harnadek & Rourke, 1994; Rourke, 1989) have described a syndrome that they call nonverbal learning disability (NLD) or developmental right-hemisphere syndrome (DRHS) and nonverbal learning disorder. • Predominant symptoms include interpersonal skill deficits, nonverbal problem-solving deficits, visual perceptual disorganization, motoric slowness, and mathematical disability. • The Predominantly Inattentive Type of ADHD is often a comorbid disorder. • long-term prognosis for NLD without intervention reveals an increased risk for internalizing disorders, depression, suicide ideation, and increased isolation as adults • Difficulties exist distinguishing NLD and Asperger’s Disorder and in establishing legitimacy for the NLD subtype within education, which tends to conform to the more traditional concept of learning disabilities as language-based disorders (Thompson, 1997). Specific Reading Disability/Developmental Dyslexia • the most prevalent (80% of learning disabilities) and well-researched disability to date. • reading disabilities afflict children who are usually at least of average intelligence, whose reading disability is not related to general cognitive limitations or other environmental factors, such as inappropriate instruction, socioeconomic disadvantage, or sensory deficits. • The disability impacts on the acquisition of basic reading skills from simple phonological processing (sound-symbol association) to word identification and passage comprehension. • The current definition differs from that derived in 1994 by specifying the disability as neurobiological in origin and conceptualizing the reading disability as a specific type of disability rather than one of several general disabilities. • The definition characterizes the disability manifested in difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities as a result of deficits in phonological awareness. • The disability is not predicted by either cognitive abilities or instructional methods. Associated features may also include problems in reading comprehension and poor vocabulary development resulting from lack of reading. • Individuals with dyslexia are compromised in several ways, since reading often provides the foundation for learning about our world. As a result, a fluid reader can obtain more information about many topics than an individual who struggles with the written word. Stanovich (1986) labeled this process the “Matthew effect” to refer to the increasing gap in knowledge that can exist between good and poor readers. According to Ferrer et al. (2010), this gap can influence the development of IQ over time, because measurement of IQ often includes an assessment of our acquisition of vocabulary and general knowledge. Etiology • Twin studies have found that dyslexia was evident in 68% of monozygotic twins, and genetic effects seem most pronounced in children with high IQs compared to those with low IQs. • Left-handedness (50% relatives) • the neurological basis of the disorder has been confirmed through the use of functional magnetic resonance brain imaging (fMRI) and magnetoencephalography (MEG). • Results have demonstrated that the left-hemisphere posterior brain system in dyslexics does not respond appropriately when reading • two different systems operate to develop reading ability, an initial more laborious system of phonetic awareness (parieto-temporal region) and a more rapid decoding system used by more skilled readers (e.g., sight vocabulary, from the occipito-temporal region). • Apparently, dyslexic readers demonstrate underactivation of both these areas with an increased activation of the frontal gyrus (letter to sound decoding), which carries the entire decoding load for the dyslexic population. • Ectopic cells (beneath the surface in dyslexics) • Smaller magno-cellular system (seeing moving images). • anatomical differences in the medial geniculate (auditory) nucleus of the thalamus—an overall reduction in the cell size. • Dyslexics have to use left as well as right hemispheres. • Cognitively, the linguistic and visual coding processes should work together to provide links between the written and spoken word. • From a cognitive perspective, both permanent memory and working memory are involved in learning to read. • Increased research effort and technological advances have also confirmed that deficits in the phonological components of language are at the basis of dyslexia. ASSESSMENT • Assessment of SLD has involved the process of exclusion; for example, assessment is driven by differential diagnosis to rule out competing hypotheses to explain why the child has a reading disability. • Ruling out other possible explanations for a specific learning disability often entails assessment of intellectual, sensory ( hearing, vision, language), familial, developmental, emotional, and school history (absenteeism, number of schools attended, interventions attempted, etc.) • Lyon & Shaywitz (2003) also include reference to effective classroom instruction. The reason for inclusion of instructional history is because the authors believe that many children with reading problems lack early pre-reading skills, and early intervention targeting these deficits can alleviate the problem in many cases. INTERVENTION • Aaron and Joshi (1992) suggest that poor readers can be grouped into one of three categories: – deficient decoding but adequate comprehension (fluency problem), – adequate decoding but poor comprehension, – poor decoding and comprehension. • It is most likely that children with dyslexia will fall into either category 1 or 3. • Early Intervention • Programs that target phonemic awareness and context in the early years (kindergarten, first grade) have been instrumental in reducing the risk of reading difficulties to less than 5% (Shaywitz et al., 2008), regardless of whether programs were embedded in the classroom, offered in a resource room, or a combination of both. • Late Intervention • Although direct instruction and practice in phonological processing can improve accuracy of decoding (Lovett, Barron, & Benson, 2003), the majority of those with dyslexia continue to be plagued by fluency issues and problems with labored reading, which impedes progress and hinders comprehension. Programs that target reading for comprehension and repeated reading approaches (student reads the same passage multiple times, trying to beat his or her earlier time) have been successful in enhancing reading fluency and critical thinking in some students Reading Fluency and Repeated Readings • Students read a selected passage (curriculum based) and use their own reading rate as a baseline for improved performance. • Reading rate (words per minute) is calculated by dividing the number of words read correctly by seconds read and multiplying by 60. Comprehension questions at the end of the reading passage provide an index of rate/comprehension. Reading Comprehension and Graphic Organizers • Graphic organizers are visual and/or spatial methods of highlighting important information to be presented by drawing on a reader’s previous knowledge base and providing a framework for facilitating and incorporating new information. • Studies have demonstrated that graphic organizers are most effective when they are created by the students, positioned after the text, and used for a longer period of time. • particularly helpful for SLD students because of their documented problems organizing and recalling verbal information and their noted strengths in spatial or visual reasoning Response to Intervention Models • The IDEA Act provides for the use of Response to Intervention (RTI) models to identify and assess children. RTI consists of tiered instruction where children who have difficulty learning to read using typical methods of instruction are provided with small-group, intensive instruction. Those who need additional intervention may receive one-on-one special education. This approach seeks to provide each child with the appropriate level of instruction required for his or her individual needs. • First, there are no clear guidelines provided or objective means to determine what are or are not considered appropriate forms or levels of intervention. • While some mainstream teachers naturally provide appropriate interventions which may even enable LD students to succeed, other teachers will have considerable difficulty providing any level of appropriate intervention. • Some students (most notably those with lower cognitive abilities) will naturally struggle to keep up with their classmates regardless of any intervention which may be provided. As such, while some truly LD students may not be identified through RTI, many more non-LD underachievers will be found eligible for LD services. Steps in Direct Behavioral Instruction 1. Review the child’s existing abilities. 2. Develop a short statement of goals at the beginning of each lesson. 3. Present new concepts and material in small steps, each followed by student practice. 4. Provide clear and detailed instructions and explanations. 5. Provide considerable practice for all students. 6. Check student understanding of concepts continually, in response to teacher questions. 7. Provide explicit guidance for each student during initial practice. 8. Provide systematic feedback and corrections. 9. Provide explicit instruction and practice for exercises completed by students at their desks.
