Understanding Learning Disabilities, Part I

One of the most common reasons for families to consult with me is because of problems with schoolwork. Sometimes a child’s performance in school suffers because of poor attention, the inability to sit still or concentrate. Sometimes behavioral or emotional issues take time away from getting work done, or cause behavior that is disruptive in the classroom. However, the most common reason for poor school performance is a learning disability. In this post I’m going to talk about what that means, and how learning problems are defined and identified. In a later post I will discuss the specifics of how we test for LD, and how that leads to recommendations for the best way to help children with learning problems.

Specific learning disabilities are the most common disorder affecting children and adolescents. In 2010 over 2.4 million children in the United States were receiving services for SLD under the Individuals with Disabilities Education Act (IDEA). The first indication of a possible learning problem is poor performance early in elementary school. Usually when difficulty is spotted early in school, teachers and other staff will try to intervene with the problem. Sometimes a little extra help is all that’s needed to get a student “over the hump”, and catch them up with their peers. However, a small group of children will fail to progress, even when offered high quality intervention. In this case, a learning disability must be considered. Research has shown that the sooner a child with SLD is identified and receives help, the better that child’s chance of avoiding school failure and secondary negative effects such as low self-efficacy, frustration, anxiety, and even depression. SLD is associated with an increased chance of dropping out of high school. Because they persist into adulthood, learning disabilities often affect employment and the subsequent quality of life.

IDEA defines a learning disability as a disorder in which one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations. These conditions may include perceptual disabilities, brain injury, dyslexia, or developmental dysphasias (impairment of speech mechanisms). A learning disability does not include problems primarily due to visual, motor, or hearing disabilities, or to mental retardation, emotional disturbance, or environmental, cultural or economic disadvantage.

The proper way to identify a learning disability is still sometimes a matter of dispute. Historically, the most common approach has been to define SLD as a discrepancy between ability and a specific area of achievement. For example, if a child with average or above intelligence fails to make progress in reading consistent with that ability, that would be a reading disability. In many cases, state law defined the size of the difference that was required to qualify for special services. However, significant discrepancies between ability and achievement typically cannot be detected until several years into elementary school, so that identification of SLD does not occur until the best time to intervene has already passed. This promotes a so-called “wait to fail” approach.

A relatively recent approach to identifying LD is the response-to-intervention approach, or RTI. RTI is based on the premise that students with early problems can be identified as having a learning disorder when their response to academic intervention is drastically inferior to that of their peers. RTI is based on a tiered approach, moving from the regular curriculum to “a little extra help” to special educational intervention. The RTI approach tends to result in earlier intervention, earlier identification of children who fail to respond to that intervention and require more intensive assessment, and in continuous monitoring of progress. However, concerns remain that methods of assessment and intervention are not standardized, and it can be unclear when a child has moved or needs to move from one tier to another, or when a child has “failed” to respond to intervention and should be considered to have SLD.

IDEA, the federal law governing special education, states that no single method is sufficient for determining the presence of a learning disorder, and that school district procedures must not require the use of discrepancy, and must permit consideration of response to intervention. LD assessment usually includes multiple professionals working as a team. A clinical or school psychologist will assess the child’s ability and achievement. A physician should generally be consulted to rule out medical causes for the child’s failure to progress. Professionals who specialize in assessing communication and motor skills, such as speech pathologists, audiologists and physical or occupational therapists, are also a key component of the team, as are special education teachers and other educational professionals.

“Learning disability” is not a single disorder, but is an umbrella term that covers a number of more specific disorders including:

• Listening Comprehension or Oral Expression Disorders

• Dyslexia (reading disorder)

• Dyscalculia (math disorder)

• Dysgraphia (writing disorder)

• Nonverbal Learning Disorders

The labels above are clinical terms that describe the specific learning disorder exhibited by a child. In order to qualify for special education services, however, a child must be demonstrated to suffer deficits in specific areas of achievement, including one or more of the following:

• Oral Expression

• Listening Comprehension

• Written Expression

• Basic Reading Skills

• Reading Fluency

• Reading Comprehension

• Math Calculation

• Math Problem Solving

The twin goals of identifying the specific learning disability and determining a student’s profile of academic strengths and weaknesses are what dictate the specific assessment procedures used in assessing any particular child. In my next post I will discuss how an assessment for LD is done, and how that leads to recommendations for intervention. If you have questions about my work with learning problems, or would like to discuss an assessment, feel free to contact me at thomaspackardphd@gmail.com or call (937) 436-5361.

Note: Much of this material is based on an excellent workshop given in June of 2012 by the Academic Team of the Cincinnati Children’s Hospital Medical Center’s Division of Developmental and Behavioral Pediatrics.