Specific Learning Disabilities: Robin P. Church and M.E.B. Lewis

Specific
CHAPTER 20 Learning Disabilities

Robin P. Church and M.E.B. Lewis
Upon completion of this chapter, the reader will

■■ Know the historical context for the term learning disabilities as well as
its definition and implications
■■ Be aware of key research findings and the biological basis of specific
learning disabilities as well as other impairments associated with
learning disabilities
■■ Distinguish among intervention strategies, particularly evidence-
based practices used in the assessment and identification of learning
disabilities
■■ Identify the range of outcomes for children and adolescents with
learning disabilities
■■ Recognize the importance of executive function in the diagnosis and
treatment of learning disabilities
A great deal of learning involves 1) processing a visual U.S. Department of Education, Office of Special Educa-
representation of concepts, 2) attaching that perception tion Programs, 2016).
to language in order to communicate understanding, Some historical context is important in under-
and 3) demonstrating that understanding with oral or standing learning disabilities. In a 1963 conference
written products. When a child struggles with these organized by parents, Samuel Kirk proposed in his
subtle and complex perceptual skills, their disabilities keynote address that the term learning disabilities be
in understanding what they are encountering in the used for otherwise normally developing students who
classroom impacts their ability to build a “toolbox” for struggle with reading, writing, or math acquisition.
more and more complex learning. This chapter focuses Following the conference, the parents of students with
on those children, who represent more than one third such learning disabilities partnered with parents of
of the students identified with disabilities in the United students with developmental disabilities to mount a
States (National Center for Educational Statistics, 2017; national political effort to get educational services for
The authors would like to acknowledge the contribution of Dr. Virginia W. Berninger in the preparation of this chapter. Her insights and
research perspectives enriched our presentation of the growing body of research and practice in this most challenging area of need.
395
396 Church and Lewis
their children. Their efforts resulted in the passage of school provide daily phonological awareness instruction
the Education for All Handicapped Children Act in (to help students improve their awareness of phonemes,
1975, also known as Public Law 94-142, which guaran- the sounds that make up syllables and words) for 15 min-
teed the civil right of free appropriate public educa- utes each day during the first 4 months of first grade and
tion (FAPE) for students with learning disabilities and daily phonics instruction (teaching students to understand
developmental disabilities (Johnson & Myklebust, 1967; the correspondence between phonemes and written let-
Kirk & Kirk, 1971; Torgesen, 2004). ters and words) for 30 minutes each day during the next
The Diagnostic Statistical Manual of Mental Disor- 4 months of first grade. This is tier 1 instruction, as part of
ders, Fifth Edition (DSM-5; American Psychiatric Asso- a 3-tier response to intervention program used by Noah’s
ciation, 2013), is used by medical staff and professionals school to help children with learning problems. During the
working in other clinical settings. The DSM-5 defini- last 6 weeks of first grade, Noah and his fellow students
tion of a learning disorder (referred to in IDEA 2004 were individually assessed by the school psychologist on
as a specific learning disability, or SLD) is a condition standardized measures of phonological awareness and
that interferes with the acquisition and use of one or phonological decoding. This was done by having the stu-
more of the following academic skills: oral language, dents read pseudo words (invented words with plausible
reading, written language, or mathematics (Clay, 2011; English phonology) and then read real words aloud (oral
McDonogh, Fanagan, Sy, & Alfonso, 2017). This impair- reading). Noah and a number of his peers scored below
ment causes serious difficulties in making daily prog- the 25th percentile on these measures. As such, he was
ress through the general education curriculum at all identified as being eligible to receive tier 2 supplemen-
grade levels. These disorders affect individuals who tary instruction in second grade in addition to the regular
otherwise demonstrate at least average abilities that reading program.
are essential for thinking or reasoning. Thus, although Upon entering second grade, Noah received tier 2
intellectual disability, cerebral palsy, seizure disorders, supplementary instruction in a small group setting that
receptive and expressive language disorders, traumatic was provided by trained paraprofessionals. This instruc-
brain injury, and hearing and vision impairments all tion occurred during regular class time when his class-
can interfere with learning, they are not classified as mates were engaged in other kinds of teacher-provided
primary learning disorders. instruction in small groups. Noah’s progress was moni-
Recognizing the need for more foundational tored throughout the school year, and at the end of sec-
knowledge to implement FAPE for specific learning ond grade, Noah was again assessed by the school
disabilities, the 1989 federal Interagency Committee psychologist. His classroom teacher reported that he and
on Learning Disabilities commissioned by the U.S. several other students who had received tier 2 support
Congress recommended funding more research on were struggling with their written assignments, not just
SLDs. This chapter will highlight these findings, which with oral reading. As a result, the psychologist included
include but are not restricted to the NICHD-funded measures of orthographic awareness (the ability to pro-
multi-disciplinary learning disabilities research cen- cess and use visual representations of letters and words;
ters as well as guidelines for applying research find- e.g., printed words), comprehension, handwriting, spell-
ings to practice (Berninger, 2015). In addition, recent ing, and composition in her assessment along with mea-
research showing that there are multiple types of SLDs sures of phonology and decoding. She also reached out
is discussed. One important outcome of this research to the parents of all the students receiving supplementary
has been a redirection away from a “wait-to-fail” model reading instruction to obtain developmental, medical,
based on cognitive-achievement discrepancy toward a family, and educational histories.
multi-tiered model of intervention, commonly referred The results of the second- grade RTI assessment
to as response to intervention (RTI) or multitiered were surprising to the teachers and school psychologist.
systems of support (Vaughn & Fuchs, 2003; Fuchs & Although most of the 10 children who had received the
Vaughn, 2012; Hughs & Dexter, 2011). This chapter year of tier 2 supplemental instruction, including Noah,
describes learning disabilities not as a single disorder, met the RTI criterion for phonological awareness, most
but as a group of profiles that present differently in did not meet criterion in orthographic awareness (a skill
different children and need to be fully understood in shown in research to be related to handwriting, real word
order for intervention to be effective. decoding in reading, word encoding in spelling, and
composition; Berninger & Richards, 2010). In addition,
many of the students still did not meet the RTI criterion
■ ■ ■ CASE STUDY for phonological decoding, which requires knowledge
Noah is a first grader who has been having trouble learn- and application of correspondences between phonemes
ing to read. All of the first-grade teachers in his elementary (the sounds which compose words) and graphemes (the
Specific Learning Disabilities 397
written representation of phonemes). The students also that Noah’s reading difficulties were not due to impaired
exhibited individual differences in whether they did or intelligence, but to specific problems with decoding that
did not meet the RTI criteria in reading comprehension, made it difficult for him to decipher and remember new
handwriting, spelling, and timed composition fluency. words, and that he also had additional difficulties with writ-
Careful examination of the profiles for these stu- ing. Because of his lack of adequate response to tier 1 and
dents identified three patterns of difficulty. For the first tier 2 interventions, he qualified for tier 3 (special education
group of students, the most prominent problem was with support) under an individualized education plan (IEP; see
dysgraphia, characterized by 1) impaired legibility and Chapter 33). He would receive specialized instruction from
automaticity of letter production, 2) problems with stor- a special education teacher, and he would also work with
ing and finding ordered letters in long-term memory, and an occupational therapist who, together with his teachers,
3) impairments in executive function for planning serial would help him develop improved writing skills.
finger movements. Two students with pure dysgraphia
profiles were impaired in handwriting rather than reading,
Thought Questions:
but their illegible, slow, nonautomatic letter retrieval and
formation interfered with their ability to complete written Why do some students respond to targeted intervention
activities. Thus, a handwriting disability rather than read- whereas others do not? How can schools meet the chal-
ing disability accounted for their failure to respond to the lenge of providing adequate shared planning time in the
tier 1 or tier 2 intervention. None of their parents reported school day for true interdisciplinary collaboration?
oral language problems during the preschool years.
Noah was in the second group of students, whose
DEFINING LEARNING DISORDERS
main problem was with dyslexia, characterized by
1) impaired word decoding (reading) and encoding (writ- The Inividuals with Disabilities Education Improve-
ing and spelling), 2) difficulties with phonological coding ment Act (IDEA) of 2004 defines a specific learning
of heard and spoken words, and 3) problems with ortho- disability as “a disorder in one or more of the basic psy-
graphic coding (processing read and written words and chological processes involved in understanding or in
retaining them in working memory). These children also using language, spoken or written, which disorder may
had impairments in the integration of phonological and manifest in imperfect ability to listen, think, speak,
orthographic processing, resulting in both reading and read, write, spell, or do mathematical calculations”
writing deficits. The five students with dyslexia profiles (§602[26][a]). The term excludes learning problems that
had difficulty translating written pseudo words into oral are the result of intellectual disability, emotional dis-
pseudo words, written real words into oral real words, and turbance, environmental, cultural, or economic disad-
spoken words into written words. Two of them (including vantage, or which are a consequence of visual, hearing,
Noah) also had co-occurring dysgraphia rather than pure or motor disabilities.
dysgraphia. All of these students had difficulty storing and This definition is problematic because it fails to
processing written words in their working memory. Sev- define the core features or origins of SLD as illustrated
eral parents of children with dyslexia, including Noah’s by the case study about Noah and his classmates. The
parents, reported that their children had difficulties with definition does not identify the “basic psychological
speech articulation during the preschool years, although processes” of learning or how marked an “imperfect
their language comprehension always seemed fine. ability” to learn must be in order to constitute a dis-
The third group of students had evidence of an oral ability. It is a definition of exclusion; all other causes for
and written language learning disability (OWL LD). Their the learning problems must be eliminated. However,
difficulties were characterized by 1) impaired listening and it is clear that SLDs can coexist with other conditions,
reading comprehension and 2) problems with oral and most notably attention- deficit/hyperactivity disorder
written expression. The three students with OWL LD had (ADHD; McNamara, Vervaeke, & Willoughby, 2008; see
difficulty in syntactic coding (the ability to learn grammar Chapter 19). Other disabilities identified in IDEA, how-
and grammatical relationships), which can interfere with ever, are excluded from the definition of SLD in order
sentence processing during listening and reading com- to prevent “double dipping” from existing federal pro-
prehension as well as sentence production during oral grams that deal with and fund those issues. It is clear,
and written expression. Despite their ability to decode however, that a child with a SLD may also have other
and encode (i.e., sounding out words and spelling), they conditions that affect learning.
scored poorly on measures of reading comprehension Originally, the common approach for diagnosing
and written composition. SLD was to document a severe discrepancy between
The school psychologist met with Noah’s parents to ability and achievement by demonstrating a signifi-
review the results of these assessments. She explained cant difference between the child’s potential to learn,
often expressed as an IQ score, and his or her actual using an at-risk rather than a deficit model, 2) earlier
educational achievement (Gregg & Scott, 2000). For identification and intervention, 3) reduction of identifi-
at least a decade, other diagnostic approaches, such cation bias, and 4) a strong focus on student outcome. As
as the Component Model of Reading and RTI, have shown in the case study at the beginning of this chap-
supported evidence that this discrepancy approach ter, RTI involves the provision of intensive, systematic
has poor sensitivity, stability, and specificity in dis- instruction for a defined period of time to very small
criminating students with specific reading disability groups of students who are at risk for academic failure
(SRD) from those with low IQ scores and poor reading (see Box 20.1 for more information on RTI).
(Aaron, Joshi, Gooden & Bentum, 2008; Francis et al.,
2005; Taylor, Miciak, Fletcher, & Francis, 2017). Calcu- Three-Tier Models of Intervention The initial
lating the discrepancy between cognitive ability and step of RTI involves students receiving instruction in
reading or writing achievement may miss diagnosing their general education classroom, with their prog-
a SLD such as oral and written language learning dis- ress being carefully and regularly monitored. Those
ability (OWL LD) because the nature of the disability students who do not progress then receive additional
lowers the ability to answer questions orally posed by services from a learning or reading specialist. Again,
the examiner on verbal cognitive ability tests as well as their progress is carefully and regularly monitored.
reading comprehension and written expression. Alter- Those who still fail to progress are referred for a special
natively, the skill that is impaired, such as handwriting education evaluation (Fuchs, Mock, Morgan, & Young,
in the case of dysgraphia, may be related to processes 2003; Olitsky & Nelson, 2003).
other than cognitive abilities (Berninger, 2015; Ber- In the most commonly used approach to RTI,
ninger & Richards, 2010; Berninger & Wolf, 2016). and the one used by Noah’s school, tier 1 of the model
IDEA 2004 expands the means by which SLD can focuses on early intervention based on the National
be determined because it states that “a local education Reading Panel’s recommendation for explicit training
agency shall not be required to take into consideration in phonological awareness and phonological decod-
whether a child has a severe discrepancy between ing to prevent reading disabilities (National Institute
achievement and intellectual ability.” It further states of Child Health and Human Development, 2000). Tier 2
that “in determining whether a child has an SLD, a provides additional supplementary instruction in pho-
local educational agency may use a process that deter- nological awareness and phonological decoding for
mines if the child responds to scientific, research-based those who do not respond to tier 1 instruction; that is,
intervention” (614b, 6, B). This approach, often called to improve phonological awareness and phonological
RTI, has emerged as common practice. decoding. Tier 3 provides comprehensive assessment
Planning effective, evidence-based interventions for those who do not respond to tier 2 instruction to
requires an understanding that dyslexia, dysgraphia, determine if they are eligible for special education
dyscalculia (math disability), and OWL LD may be services (specialized instruction). Typically tier 1 and
separate or co-occurring deficits within an individual tier 2 are delivered by trained paraprofessionals (see
student’s performance profile (Geary, 2004; Kamhi & Box 20.2 for a description of the paraprofessional’s role),
Catts, 2012; Mazzocco, Feigenson, & Halberda, 2011; and tier 3 is delivered by both the school psychologist,
Silliman & Berninger, 2014). As illustrated for Noah who carries out the assessment process, and the special
and his fellow students with learning challenges, an educator, who provides specialized instruction.
examination of the origin of the learning disability In the other main model of RTI, tier 1 children are
profile can provide an evidence-based direction for screened for the skills on which they are weak, and
effective intervention, whereas the discrepancy model early intervention is then provided for those weak-
does not. nesses. The screens are based on research showing
which skills explain significant and unique variance
in not only reading achievement, but also writing
Response to Intervention achievement and listening and oral language skills
Vaughn and Fuchs (2003) advocated redefining learn- related to literacy achievement. For example, Pura-
ing disability as an inadequate response to instruction. nik, Wagner, Kim, and Lopez were instrumental in
This response to intervention (RTI) approach has proven promoting the use of phonological awareness and
to be a promising alternative to traditional testing meth- decoding instruction at tier 1 and tier 2, but they also
ods for identifying students with specific learning dis- showed the importance of orthographic awareness
abilities (Fuchs & Vaughn, 2012). Important benefits of and writing instruction (Puranik, Wagner, Kim, &
such an approach include 1) identification of students Lopez, 2012). The intervention is then tailored to an
BOX 20.1 E V I D E N C E -B A S ED P R A C T I C E
Response to Intervention
Response to intervention (RTI) is a multitiered approach to the early identification and support of students
with learning and behavioral needs and to closing the achievement gap in at-risk students. The RTI pro-
cess begins with high-quality instruction and universal screening of all children in the general education
classroom.
RTI has also been promoted as an alternative to discrepancy models for identification of students
with learning disabilities (Hughes & Dexter, 2011). RTI emphasizes high-quality, scientifically based
classroom instruction; ongoing assessment to determine a student’s rate of learning; and analysis of
these data to determine the level of monitoring and intervention the student needs. The multitiered
approach provides increasing levels and intensity of supports. These services may be provided by a
variety of personnel, including general education teachers, special educators, and specialists. Progress
is closely monitored to assess both the learning rate and level of performance of individual students.
Educational decisions about the intensity and duration of interventions are based on individual student
response to instruction. RTI is designed for use when making decisions in both general education and
special education, creating a well-integrated system of instruction and intervention guided by child out-
come data.
For RTI implementation to work well, the following essential components must be implemented
with fidelity and in a rigorous manner (Jimmerson, Burns, & VanDerhayden, 2015; McInerney &
Elledge, 2013):
■■ High-quality, scientifically based classroom instruction;
■■ Ongoing student assessment; and
■■ Tiered instruction.
BOX 20.2 I N T ER D I S C I P L I N A RY CA R E
The Paraprofessional in the Inclusion Classroom

Since the late 1990s, the structure of the classroom has changed considerably. With the growing use of
the inclusion model in general education classrooms, students with special needs with mild to moderate
impairments are included in the classrooms of most general education teachers. Some inclusive settings
also provide for students with severe disabilities. The range of abilities, disabilities, and disorders within
the classroom community can be extensive, with requirements for both physical and instructional accom-
modations and modifications. The “teacher’s aide” is not a new role, but the need for extensive training
and continued professional development has become a priority. These individuals are often among the
least trained members of the staff in a school, but when well trained and when offered opportunities for
collaboration with teachers and related service providers, they can be important partners in the planning,
implementation, and monitoring of instruction in the classroom, including the implementation of RTI.
Research indicates that these classroom assistants often work in the area of autism, but there is a need for
these partners in other settings as well (Moshe, 2017). They can provide instruction to small groups, pro-
vide training and oversight in the use of supportive technologies for students, connect with families, assist
in creating materials, and participate in some assessments. Teachers have identified the lack of such sup-
port as one of the burdens they feel when implementing an inclusion model, and when paraprofessionals
have been trained (along with their supervising teacher partners) and participate in team planning, they
feel that their skills improve and they seek continued training opportunities (Walker, Douglas, & Chung,
2017). When the partnership of the professional and paraprofessional is established as a co-teaching model,
students benefit.
individual student’s relative weakness to personalize between students with reading disabilities who receive
their early intervention delivered via “differentiated intensive summer reading instruction and those who
instruction.” RTI is evaluated on the basis of whether do not (Christodoulou et al., 2017).
individual students improve on the skills for which Despite widespread support for RTI, challenges to
they have received specialized instruction tailored implementation remain. These include reliance on an
to their weaknesses. Orthographic skills (e.g., nam- instructional environment that reflects commitment to
ing and coding letters in memory that correspond to fidelity, validity, and collaboration; staff preparation;
phonemes) are also taught at the tier 1 level because and the availability of teachers who are well trained
considerable research has documented the contribu- in all aspects of instruction. By using scientifically
tion of orthographic as well as phonological skills to derived interventions for early instructional support,
early literacy (for reviews of evidence, see Berninger & the potential for maintaining those students in the gen-
Richards, 2010; Henry, Messer, Luger-Klein, & Crane, eral education environment increases. This is in con-
2012; Wandell, & Le, 2017). In addition to oral reading trast to the discrepancy model, which is a “wait-to-fail”
(decoding) skills, handwriting and spelling (encod- model in which the student may struggle with learning
ing) skills are also screened and taught if they are activities until a discrepancy emerges.
found to be weak. At tier 2, the interdisciplinary team This tiered approach has reduced the numbers of
engages in a problem-solving consultation for those students referred to pullout (outside of the general class-
students who do not respond at tier 1. The goal is to room) or special education services (Berkeley, Bender,
modify the early intervention by introducing new Peaster, & Saunders, 2009). In research centers around
approaches and developing a plan for evaluating their the nation, studies continue to determine how to more
responses to the modified intervention (Berninger, effectively implement this model (Deshler, Mellard,
2007a, 2007b, 2015). For those students who show per- Tollefson, & Byrd, 2005; Kennedy & Deshler, 2010; Moss,
sisting struggles in response to the tier 2 interven- Lapp, & O’Shea, 2011; Pullen, Tuckwiller, Konod, May-
tion, a tier 3 comprehensive assessment is conducted nard, & Coyne, 2010; Ramaswami, 2010). Although most
with the goal of making an instructionally relevant often described as a three-tier model, some schools iden-
differential diagnosis that can then be used to design tify a fourth, or “specialized” tier, which may provide
and implement specialized instruction and evaluate intervention closer to that provided in special education
a student’s response to it. The goal of all tiers in this classes without the express referral for a determination
version of RTI is personalized education based on of eligibility for special education. Kavale and Spaulding
carefully tailored, intensive instruction and progress (2008) reviewed the policy implications for these new
monitoring that informs changes in instruction. regulations and concluded that both RTI and psycho-
Intensive instruction provided daily in a very metric evaluation are appropriate for the identification
small group setting, a key component of RTI, is fiscally of children as having learning disorders, allowing them
demanding in that it may impose a staffing burden to receive special education services under an individu-
on a classroom, especially when carried out in a man- alized education program (IEP).
ner supported by research and policy (Fuchs & Fuchs, The diagnosis of SLD is difficult in students iden-
2002; Burns, Jimerson, VanDerHeyden, & Deno 2016). tified as English language learners (ELL) or having
Children who make progress at the end of the pre- limited English proficiency. Some of these students
scribed time (usually 12–16 weeks) then return to the may be experiencing difficulty because of their lack of
general education program, reducing needless refer- familiarity with English in its academic and/or social
rals for evaluation and potential placement in sepa- use. Alternatively, some may, in fact, have disabilities
rate, special learning environments. Children who in learning in both their native language and English
do not make adequate gains receive a second round (Barrera, 2006; Blanchett, Klingner, & Harry, 2009; Liu,
of intensive intervention (Gortmaker, Daly, McCurdy, Ortiz, Wilkinson, Robertson, & Kushner, 2008). For
Persampieri, & Hergenrader, 2007; Hay, Elias, Fielding- these students, technology, including tablets and lap-
Barnsley, Homel, & Freibery, 2007). Students who do tops with appropriate applications based in their native
not benefit from an RTI’s first two tiers of instruction languages, may afford necessary supports (Jozwik &
signal a need for even more intensive forms of edu- Douglas, 2017). Although teacher preparation for serv-
cational intervention (Fuchs, Fuchs, & Vaughn, 2014) ing students with SLD has expanded, the preparation
and should be referred for comprehensive evaluation of teachers to address the needs of students who may
to determine the specific services and interventions have both a learning disorder and English language
required. There is also direct evidence that significant proficiency issues needs to be improved (Paneque &
and widening differences in reading abilities persist Barbetta, 2006).
PREVALENCE recommended for further study to examine potential

links between the two conditions (Williams, Goldstein,
The U.S. Department of Education’s National Center Kojkowski, & Minshew, 2008). Although relatively lit-
for Education Statistics (2018) reported that of the more tle further research on this has been done, one study
than 6.4 million students receiving special education (McIntyre et al., 2017) indicates that heterogeneity in
services during the 2014–2015 school year, approxi- reading profiles depends on the level of the ASD. The
mately 35%, or 2.2 million, were classified as having higher functioning the individual with ASD, the more
SLD. The size of this category has nearly tripled since aligned the profile is to that of an individual with LD.
reporting began in 1977. These statistics represent only Although this is true of reading profiles, other factors,
those students who are served in the public schools and such as reduced self-regulation of students with ASD,
not those who may be served in private, nonpublic, or also may have an effect on the independent practice of
homeschool environments. A review of a series of NIH- these skills (Chou, Wehmeyer, Palmer, & Lee, 2017).
funded epidemiological studies at the Mayo Clinic The language deficits that may appear in students
showed that one in five otherwise typically developing with SLD or ASD require careful diagnosis and charac-
school-age children and youth has an SLD in reading, terization to ensure that interventions can be beneficial
writing, or math with or without ADHD (Colligan & and long-term prognosis can be assessed. In a study by
Katusic, 2015). In addition, some forms of SLD are Hagberg, Billstedt, Nyden, and Gillberg (2015), adults
underidentified. Writing disabilities in particular have who had persistent language deficits throughout
been left behind (Katusic, Colligan, Weaver, & Barbaresi, their school career and into adulthood demonstrated
2009). Specific language impairment (SLI), which is fre- great impairments in daily skills (often with reduced
quently associated with OWL LD, falls under the eligi- employment) compared with those whose language
bility category of communication disorders rather than deficits were only seen in childhood.
learning disabilities; as a consequence, students with
SLI/OWL LD are often underidentified and not treated
for their language learning disabilities (Silliman & ETIOLOGY: BIOLOGICAL
Berninger, 2014). AND ENVIRONMENTAL FACTORS
Reporting differences among school districts and
states also affect the assessment of the prevalence of National initiatives such as the Human Genome Project
SLD. Individual school districts exercise considerable and Decade of the Brain have resulted in an explosion
autonomy in defining, describing, and coding dis- of research on the biological bases of SLDs. Although
abilities at the time services are determined. When SLDs and other neurogenetic disorders may share
families are persistent in seeking special education some of the same learning problems at the behavioral
services and actively involved in the process of attain- level, the underlying genetic and brain bases are not
ing those services, the correct and discrete identifica- the same as for SLDs such as dysgraphia, dyslexia,
tion of a child’s disability is more certain. In districts OWL LD, and dyscalculia (Berninger, 2015).
in which some disabilities are not specified completely,
or include other aspects that contribute to learning dif-
Genetics
ficulties, such as attention or behavior problems, an
overembracing term such as multiple disabilities may be One reason that not all students respond equally to
used. This inexact term camouflages the exact nature the same instructional intervention is that the genetic
of a child’s problems with learning and may distort underpinnings are different for language by ear (lis-
the design of an effective and useful education pro- tening), by mouth (oral expression), by eye (reading),
gram. However, without more precise definitions and and by hand (written expression). Since the late 1990s,
descriptors in the education law, this type of inexact substantial progress has been made in understanding
classification by school teams will continue. the genetic bases of specific reading disabilities includ-
The growing number of individuals identified ing dyslexia and other language- related SLDs (e.g.,
as being on the autism spectrum has also influenced Fisher & DeFries, 2002; Olson, Wise, Connors, Rack, &
the overall numbers of individuals identified as being Fulker, 1989; Olson et al., 2013). For example, twin stud-
in need of special education (see Chapter 18). Many ies have documented both genetic and environmental
higher functioning students with autism spectrum influences on specific reading disabilities in otherwise
disorders (ASD) were formerly classified as having typically developing individuals, and unique genetic
learning disabilities. The overlap of severe learning contributions remain even after students respond to
disorders and higher functioning autism has long been early intervention (Samuelsson et al., 2008). Linkage
studies and gene candidate studies have identified rela- (e.g., Sandak, Mencl, Frost, & Pugh, 2004; Simos et al.,
tionships between locations in the human genome and 2002; Turkeltaub, Gareau, Flowers, Zeffiro, & Eden, 2003)
specific phenotypes (i.e., behavioral markers of genetic or dyscalculia (e.g., Cohen et al., 2007; Dehaene & Cohen,
variables). Specific genes may influence response to 1995). Subsequent imaging studies have shown how the
instruction, and while results for linkage analysis and brain changes in RTI (Berninger & Dunn, 2012; Ber-
gene candidate studies have been replicated across ninger & Richards, 2010; Gabrieli, 2009) and addressed
multiple research groups, the findings indicate that the the issue of whether the brain of students with a SLD,
genetic bases for specific reading disability are hetero- such as SRD, normalized after intervention. Consider-
geneous, meaning that multiple gene candidates may able evidence across many research groups now sup-
underlie the same phenotypic expression. Thus, indi- ports the contention that the brain can normalize in
viduals may differ in the genetic basis for the same response to instruction. One imaging study in particu-
observable behavioral difficulties in language learning. lar demonstrated that the brains of students of lower
This serves to emphasize the complex nature of read- socioeconomic backgrounds are especially responsive
ing and reading disability. to reading interventions (Romeo et al., 2017). This find-
Research using genetic linkage and association ing is important because SLDs occur in all socioeco-
techniques has shown a relationship among spe- nomic groups and have a particular impact in children
cific reading disabilities such as dyslexia and loci on and youth from low-income families who are especially
chromosomes 1, 2, 3, 6, 15, and 18 (Raskind, Peter, vulnerable to the long- term consequences of SLDs.
Richards, Eckert, & Berninger, 2012; Scerri & Schulte- Understanding brain differences in students with read-
Körne, 2010). The genetic basis of math disabilities has ing disability may also help parents and educators select
also been studied (Berninger, 2015). In a twin study in the best remediation strategy (Wandell & Le, 2017).
which one twin had math disability and the other did
not, higher rates of dyscalculia were found in identi-
cal than in fraternal twins (Cohen, Kadosh, & Walsh, CLASSIFYING LEARNING DISORDERS
2007). There is also evidence that molecular markers The section that follows explains and analyzes learn-
differ across dysgraphia, dyslexia, OWL LD, and typi- ing disorders across three classifications: specific
cal language learners (Abbott, Raskind, Matsushita, reading disability, specific math disability, and spe-
Richards, Price, & Berninger, 2017). cific writing disability.
Epigenetics research (Cassiday, 2009) is underway
that shows that genetic expression at the observable,
behavioral level can respond to environmental interac- Specific Reading Disability
tion and input (see Chapter 1). Thus, although genetic SRD, also called developmental dyslexia, is by far the
anomalies may contribute to the etiology of a SLD at most commonly recognized form of learning disabil-
the biological level, the most effective treatment may ity, accounting for over one third of the special edu-
be environmental (i.e., educational programming). cation population (National Center for Educational
For example, in one study, students with dysgraphia, Statistics, 2017). Theoretically, any defect in the pro-
dyslexia, and OWL LD who completed a special curric- cessing or interpretation of written words can lead to
ulum of computerized instruction showed significant a diagnosis of SRD. Efficient reading depends on rap-
improvement on the biologic impairments associ- idly, accurately, and fluently decoding and recogniz-
ated with their diagnosed SLD (Tanimoto, Thompson, ing the phonemes of single words (Talcott et al., 2000;
Berninger, Nagy, & Abbott, 2017). Wolf, Bowers, & Biddle, 2000). Phonological awareness
includes 1) phoneme awareness (the understanding
that speech is made up of discrete sounds), 2) a meta-
Brain Imaging cognitive understanding of word boundaries within
Since the Decade of the Brain that began in 1990, there spoken sentences, 3) a recognition of syllable bound-
has been an explosion of knowledge about the brain aries within spoken words, and 4) an ability to isolate
correlates of language and math. A variety of non- these phonemes and establish their location within syl-
invasive imaging methodologies that are safe to use lables and words. Phonological awareness manifests in
with developing children and youth have been used in the ability to analyze and manipulate sounds within
research (see Chapter 8). Initially, these studies focused syllables (e.g., to count, delete, and reorder them). As
on documenting differences in brain structure and a child learns to read, specialized areas of the brain
function between typically developing language or and its structures are trained to associate text with
math learners and those with an SLD such as dyslexia the sounds of language (Wandell & Le, 2017). If a child
does not realize that syllables and words are composed and word recognition to gain meaning. Top- down,
of phonemes and that these segments can be divided or conceptual, approaches assume that the path from
according to their acoustic boundaries, reading will be text to meaning extends from prior knowledge that is
slow, labored, and inaccurate; in addition, comprehen- applied to the process of acquiring the sound–symbol
sion will be poor. A second possible mechanism may be connection of reading.
a defect in phonetic representation in working memory, Compensated poor readers recruit additional
wherein the child can understand the syntactic struc- brain areas to read. Neuroimaging studies in individu-
ture of a sentence but is unable to maintain it in work- als with dyslexia show reduced engagement of the left
ing memory long enough to comprehend the meaning temporo- parietal cortex for phonological processing
(Kamil, Pearson, Moje, & Afflerbach, 2010; Mann, 1994). of print, altered white matter connectivity, and func-
Poor reading has been linked to phonological pro- tional plasticity associated with effective intervention
cessing impairments, but these impairments alone are (Fisher & DeFries, 2002; Gabrieli, 2009). Posterior brain
not sufficient to explain SRD. Wolf and Bowers (1999) systems predominate during early reading acquisition
proposed three underlying types of specific reading (Simos et al., 2002; Turkeltaub et al., 2003). As individu-
disability: 1) phonological impairment, in which the als become older and are more skilled at reading, they
reader attempts to manage the connection of sound begin to engage parietal and superior temporal areas,
to symbol accurately; 2) disrupted orthographic pro- with frontal regions coming online last. Individuals
cessing, which results from slow naming speed and who are identified as having dyslexia do not increase
influences the acquisition of fluency in both familiar activation of the word form area (located in the left
and unfamiliar content; and 3) a combination of both occipitotemporal gyrus) even after repeated trials of
impairments. Individuals who manifest the double word exposure. As they grow older, children show the
impairment, phonological impairments and nam- opposite—activation of the anterior system. Anterior
ing speed impairments, are the poorest readers. This activation is not the sole processing difference, how-
hypothesis has not been universally accepted. Some ever, as individuals with dyslexia also activate their
researchers failed to find a phonological impairment right anterior inferior frontal gyrus as well as the right
in the absence of a naming- speed impairment and posterior occipital-temporal region (Sandak et al., 2004).
noted that the double- impairment groupings identi- In other words, individuals with dyslexia show abnor-
fied individuals with different neuropsychological pro- malities in brain processing during reading.
files (Cirino, Israelian, Morris, & Morris, 2005; Waber, Shaywitz and colleagues (2004) have underscored
Forbes, Wolff, & Weiler, 2004). Others have found the importance of dysfunction of the left hemisphere
little support for the theory that underlies the double- brain systems in SRD. They provided a year of inten-
impairment hypothesis, namely that rapid serial pro- sive reading remediation to a group of individuals with
cessing and temporal integration of letter identities are SRD. After the intervention, the individuals made gains
the primary means by which orthographic codes are in reading fluency, and neuroimaging studies showed
formed (Ritchey & Goeke, 2006; Vellutino, Fletcher, increased activation of the anterior and dorsal systems.
Snowling, & Scanlon, 2004; Vukovic & Siegel, 2006). Another study in adults with a lifetime history of SRD
They also question the independence of phonological demonstrated that reading remediation in older indi-
and rapid naming skills and the specificity of impair- viduals might be different. This study showed increases
ments in rapid naming for reading. in both left and right hemisphere activation following
successful reading intervention (Eden et al., 2004).
The Neural Substrates of Reading Reading is
a dynamic process that develops with age and expe-
Specific Math Disability
rience. It encompasses a wide variety of skills that
develops at varying times. Early instruction focuses on Specific math disability, also known as dyscalculia, is
learning to read and targets decoding. Later instruction a complex phenomenon that must be considered in the
uses reading to learn, and the focus shifts to compre- context of other learning processes and impairments.
hension. Beginning, inexperienced readers are focused Three to six percent of individuals have a performance
on decoding and employ a “bottom-up” approach that on tests of mathematical ability that is discrepant from
uses analytic and synthetic processes. They are more their IQ scores (Mazzocco, 2007; Shalev & Gross-Tsur,
focused on sounding out each word they encounter, 2001). This percentage may be higher than the true fre-
which can often hinder comprehension. Experienced quency of a learning disorder in mathematics. Poor per-
readers use a “top- down” approach that results in formance may be due to a lack of adequate instruction
faster, more efficient reading. These readers use context in areas that are covered by the assessment measures.
Another reason for discrepant performance on math disability showed persistently poor math performance
tests may relate to impairments in reading or execu- on reexamination 6 years later (Shalev et al., 2005).
tive function rather than mathematics (Dirks, Spyer, Visuospatial working memory deficits are often
van Lieshout, & de Sonnerville, 2008; Donlan, 2007; present in those identified with math disability. A broad
Jordan, 2007). view of the connection of cognitive, neurobiological,
Math disability is commonly seen in the presence and developmental components is needed, since these
of other learning and cognitive disorders. Of individu- elements change throughout development and can cre-
als with a math disability, approximately 17% have been ate a vulnerability if not recognized (Menon, 2016).
found to have coexisting SRD and 26% have ADHD
(Gersten, Jordan, & Flojo, 2005; Shalev & Gross-Tsur,
2001). In another study that focused on kindergarten- The Neurobiology of Math Neurobiological evi-
ers with developmental language disorders, 26% had dence of math disability is still evolving, and the exact
significantly impaired arithmetic skills (Manor, Shalev, mechanism remains to be delineated. Evidence derived
Joseph, & Gross-Tsur, 2001). In addition, Marshall, from clinical syndromes, neuroimaging, and genet-
Schafer, O’Donnell, Elliott, and Handwerk (1999) found ics suggests a number of brain- based impairments.
that inattention exerts a specific and deleterious effect Although the clinical syndromes point to a major role
on the acquisition of arithmetic computation skills. This of the parietal lobe in dyscalculia, the relationship is
has led some to defer the diagnosis of math disability not simple. Different types of mathematic skills require
in the presence of ADHD until the ADHD is properly coordination of different brain functions and, by exten-
managed (Shalev & Gross-Tsur, 2001). Finally, assess- sion, activation of different brain areas. Complicating
ment of mathematics encompasses a variety of skills this is the finding that people who have difficulty with
and neuropsychological processes, some of which may math will recruit other brain areas and use other psy-
be impaired whereas others are relatively spared. chological mechanisms to compensate for the impair-
Difficulty with mathematics may manifest in differ- ment in brain function.
ent ways. Counting, basic calculation, problem solving, There is a paucity of studies that focus on the
place values (base-10 concepts), equivalence, measure- genetics of math disability. Yet, familial occurrences
ment, time, relations (as in algebra), and geometry are of the disorder have been described. Shalev and Gross-
but some of the ways that mathematics is expressed. Tsur (2001) found that approximately half of siblings of
Despite the wide range of expression, math disability is individuals with math disability also had evidence of
specifically defined by deficiencies in fact mastery and math disability. In a study of twins, one of whom had
calculation fluency (Jordan, Hanich, & Kaplan, 2003). math disability, significantly higher rates of dyscalculia
Some of the difficulties that children encounter in math- were found in identical twins than in fraternal twins
ematics evolve from their earliest encounters with num- (Cohen et al., 2007).
bers; that is, their number sense and early numeracy. Several psychological mechanisms have been pro-
The intuitive understanding of numbers and related posed for math disability. In early research, Rourke
concepts such as how numbers grow and diminish and Finlayson (1978) found that individuals with math
with calculation may be viewed as having a parallel to disability alone showed poor nonverbal skills (visual-
the initial reading skill of phonemic awareness, which spatial and tactile- perceptual), whereas individu-
includes the earliest awareness of how words are made als with combined math disability and SRD showed
up of discrete sounds. Research has shown that this poorer verbal skills (verbal and auditory-perceptual).
initial “gut sense” about numbers may be significant Geary (2004) has posited three subtypes of math dis-
in identifying the origins of math disability (Mazzocco ability based on memory and cognitive impairments:
et al., 2011). 1) the procedural subtype, 2) the semantic memory
Math disability evolves over time. Early presen- subtype, and 3) the visuospatial subtype. Others have
tations exhibit difficulty with retrieval of basic math associated math disability with executive function
facts and in computing arithmetic exercises. These and working memory impairments (McLean & Hitch,
have been related to immature counting skills. Older 1999). Dehaene and Cohen (1995) advocated a “triple-
individuals have difficulty in learning arithmetic code model” wherein simple arithmetic operations are
tables and comprehending the algorithms of adding, processed by the verbal system within the left hemi-
subtracting, multiplying, and dividing. These manifest sphere and more complex arithmetic procedures that
as misuse of signs, forgetting to carry, misplacing dig- require subitization (the ability to perceive at a glance
its, or approaching problems from left to right (Shalev, the number of items presented), cardinality (the abil-
2004). In another study, 10 to 11 year olds with math ity to perceive the number of elements in a set or other
grouping), and visual representations are bilaterally the sequences for managing the orthographic “loop”—
localized in the brain. coding the units of language formation (morphemes,
phonemes, and syntax), motor control, sustaining and
focusing attention, and self-
monitoring production
Specific Writing Disability (Berninger & Wolf, 2016).
Specific writing disability, also known as dysgraphia,
is a multifaceted and complex deficiency involving The Neurobiology of Writing The angular gyrus
the effective and coherent processing of information plays a role in mediating complex language func-
and transcribing it into written form. Writing is a tions, and it connects sensory experiences like touch to
psychomotor process involving the motor and spatial spatio-visual experiences that allow recognition of sub-
processes of handwriting, the orthographic coding of tle visual distinctions (such as the differences among
letters and symbols, storing and retrieving words, and letters like g, b, d, p, and q) or punctuation. This ability
correct spelling and syntax. In most cases, this deficit to note salient features connects to the ability to sustain
occurs together with other developmental disabilities attention (Nicolson & Fawcett, 2011).
(most commonly dyslexia, attention deficits, and ASD). Attention and memory, as executive functions, call
Writing difficulties are usually discovered when on the prefrontal cortex to coordinate the process to
children are asked to produce written work that dem- allow the student to remember the task assigned, the
onstrates their progress with reading and requires par- relevant ideas related to the task, and the organization
ticipation in discussions of subjects learned. Students required to assemble the response to the task ortho-
who become frustrated with the writing process some- graphically. An area in the middle frontal gyrus (BA6),
times show fatigue, disengagement, or simply stop termed the “graphemic/motor frontal area,” supports
writing. bridging between orthography and motor programs
There are stages of writing acquisition that must specific to handwriting (Roux et al., 2009).
be understood in order to diagnose the actual origin
of the problem—linguistic or motoric. Linguistically,
an individual takes in the phonemic and visual com- IMPAIRMENTS ASSOCIATED
ponents of words and then applies remembered spell- WITH SPECIFIC LEARNING DISABILITIES
ing, grammar, and meaning to get the word on paper
in a comprehensible format. Motorically, the individual One quarter to one half of individuals with learning
must manage the instrument for writing while remem- disorders have additional impairments that interfere
bering and planning the sequence needed to represent with school functioning. These may include executive
letters and other symbols in a defined space (Prunty function impairments, ADHD, social cognition impair-
& Barnett, 2017). Although there is usually a primary ments, and emotional and behavior disorders. These
cause for the dysgraphia, a student may exhibit both behavior and emotional problems may be external-
motoric and linguistic symptoms. izing (e.g., aggression, oppositional- defiant disorder,
The subtypes of specific writing disability are or conduct disorder) or internalizing (e.g., shyness,
dyslexic dysgraphia, motor dysgraphia, and spatial depression, or anxiety). Failure to detect and treat these
dysgraphia. Dyslexic dysgraphia is most often seen as additional impairments is a common reason for failed
illegibility of spontaneously created work; however, intervention programs. As comorbid conditions may
given time and a model, copied work improves. Motor adversely affect outcome, it may be most appropriate
dysgraphia stems from poor fine motor control or lack to categorize individuals not only on the basis of their
of dexterity. Although copied or spontaneously written learning impairments, but also according to comorbid
material may start out neat and conforming to space, conditions.
it degrades in longer writing samples (Graham, Col-
lins, & Rigby-Wills, 2017). Sustaining the coordination
for the task seems to be a problem. Spatial dysgraphia
Memory Impairments
impacts drawing as well as writing due to the fact Impairments in the ability to listen, remember, and
that the individual does not perceive space accurately. repeat auditory stimuli have been associated with read-
Written products, both copied and original, are illeg- ing disability. The holding of information in immediate
ible and spread beyond the defined space provided for and working memory is essential in learning to read
the task. (Berninger & Swanson, 2017). Research shows that chil-
Essentially, specific writing disabilities stem from dren with learning disabilities have deficits in working
deficits in automatically remembering and mastering memory (Peng & Fuchs, 2016) that can affect reading
and math performance. Attention components in work- Attention-Deficit/Hyperactivity Disorder

ing memory include 1) focused attention (inhibiting
irrelevant information), 2) switching attention (mov- Approximately one half of individuals with learning
ing from one relevant stimuli to another), 3) sustaining disorders meet criteria for the diagnosis of ADHD,
attention over time (maintaining on task behavior), and making this the most common comorbid diagnosis.
4) self-monitoring (having awareness of whether or not Studies have found that the prevalence of ADHD in
you are on task). These contribute uniquely to read- individuals with learning disorders is higher than the
ing and writing achievement (Berninger & Richards, prevalence of learning disorders in individuals with
2010). A number of studies comparing individuals with ADHD (Friedman, Rapport, Orban, Eckrich, & Calub,
equivalent IQ scores but low or high reading abilities 2017; Friedman, Rapport, Raiker, Orban, & Eckrich,
have reported impairments in the poor readers on the 2017). The symptoms typically include inattention,
Digit Span subtest of the Wechsler Intelligence Scale impulsivity, and hyperactivity (see Chapter 19). Recent
for Children–Fourth Edition (D’Angiulli & Siegel, 2003; research reviews indicate that the increase in this iden-
Wechsler, 2003). Executive dysfunction coupled with tified comorbidity may be due to inclusion of students
memory impairments may adversely affect a student’s with writing disorders who were previously under
ability to choose the appropriate strategy for solving a identified relative to students with reading and math
problem. Working memory, which is based in the area disorders (DuPaul, Gormley, & Laracy, 2013).
of the prefrontal cortex concerned with short term man-
agement of memory and attention, has also been stud-
Impairments in Social Cognition
ied and found to be of particular interest (Schuchardt,
Maehler, & Hasselhorn, 2008). As a result, the student’s Impairments in social cognition are noted often in
ability to use cognitive behavioral techniques may be individuals with learning disorders (Bauminger, Edel-
limited because he or she cannot remember a sequence sztein, & Morash, 2005; Bauminger & Kimhi-Kind,
of problem-solving steps. 2008). Such individuals have difficulty understanding
complex emotions, tend to be socially isolated, may
have few close friends, and infrequently participate in
Impairments in Executive Functions social activities. In turn, they are often overlooked or
According to Pennington (1991), executive functions rejected by their peers because of their odd behavior
(see Chapter 13) involve the ability to maintain an appro- and poor school or athletic performance. Teachers tend
priate problem-solving set of procedures for attaining to rate these individuals as having social adjustment
a future goal. This includes the ability to 1) inhibit or difficulties and as being easily led. There may be many
defer a response; 2) formulate a sequential, strategic reasons for these problems, including poor social com-
plan of action; and 3) encode relevant information in prehension, inability to take the perspective of others,
memory for future use. These metacognitive abili- poor pragmatic language skills, an inability to recog-
ties are necessary for organizational skills, planning, nize facial expressions, and misinterpretation of body
future-oriented behavior, maintaining an appropriate language. This awareness of the intent or perspective
problem- solving set of procedures, impulse control, of others is called theory of mind (see Chapter 18 for a
selective attention, vigilance, inhibition, and creativ- discussion of theory of mind as it relates to ASD) and
ity in thinking. These abilities involve an awareness of sheds light on how individuals develop the means to
what skills, strategies, and resources are needed to per- understand the social cues sent by others so that they
form a task effectively. They also require the ability to may develop their own awareness of social situations
use self-regulatory mechanisms to ensure the success- and form appropriate responses (Bloom & Heath, 2010;
ful completion of a task, yet students with learning dis- Schneider, 2008). The reported prevalence of ASD
orders are often impulsive rather than reflective when has increased significantly since 2000, when the CDC
presented with a problem-solving task. This failure to reported occurance of one in 150 children, to 2014, when
consider alternative solutions often results in errors or the occurance was reported to be one in 59 children.
a poor quality solution. Executive functions become The child who has a combination of a learning disor-
essential beginning in Grade 4 in order to complete der, poor pragmatic language skills, executive function
homework and long-term projects, to sustain attention impairments, and impairments in social cognition may
during lectures, and to set future goals (Berninger, be difficult to distinguish from a child who falls on the
Abbott, & Cook, 2017). Disruption in this organization autism spectrum. It is likely that these conditions will
and control of behavior often manifests as disruption be more closely linked in the future (McIntyre et al.,
in the classroom. Executive function impairments are 2017) and may have common genetic and neurobiologic
also a key feature in ADHD. signatures.
Emotional and Behavioral Disorders chronic illness, or psychosocial problems. If these indi-
viduals are misdiagnosed as having an SLD, efforts
Although associated emotional and behavioral impair- directed solely at treating the learning problem will
ments may represent endogenous biological condi- have limited success. Instead, the underlying prob-
tions, they also may result from the child’s experiences lem must be identified and addressed. Once this prob-
of school failure. Although individuals with learning lem has been treated, the learning problem may well
disorders may exhibit conduct disorders, withdrawal, improve or disappear.
poor self-esteem, and depression, related therapeutic For example, if a child has an unidentified sensory
services to address these concomitant disorders are impairment, learning is likely to be affected. The provi-
not mandated in federal law. A secondary diagnosis sion of hearing aids to a child with hearing loss or of
of an emotional disability would have to be in evi- glasses to the child with a refractive error may lead to
dence in the student’s profile in order for services to be a significant improvement in school performance (see
provided to address both the learning disability and Chapters 25 and 26). Individuals with epilepsy (see
related social/emotional responses to the challenges Chapter 22) also may have problems in school result-
in learning. These individuals are less likely to take ing either from poorly controlled seizures or from side
pride in their successes and more likely to be over- effects of antiepileptic medication. Modifying the drug
come by their failures. More than one third of students regimen may significantly improve both attention and
with learning disorders receive a failing grade in one learning. Individuals with psychiatric disorders (see
or more courses each school year. These individuals Chapter 27) also may fail in school. The use of psycho-
often exhibit chronic frustration and anxiety (Nielsen tropic drugs and psychotherapy, including cognitive
et al., in press) as they attempt to meet the demands of behavior therapy (see Chapter 34), often leads to signif-
skill-based tasks, such as phonological decoding, com- icantly improved school performance, although some
prehension, spelling, and math. This school failure, of these drugs can have an adverse effect on attention.
combined with social skills impairments, may lead to (For specific information on medication side effects, see
peer rejection, poor self-image, and withdrawal from Appendix C.)
participation in school activities (Abbott et al., 2017; An increased incidence of learning problems also
Maag & Reid, 2006). Eventually, these individuals may has been described in individuals with chronic ill-
avoid going to school all together or act out in class nesses, such as diabetes, HIV infection, sickle cell dis-
in order to obtain the attention they do not receive ease, cancer, and chronic kidney and liver disease (see
through good grades. There is a lack of agreement Chapter 24). In these situations, a learning disability
regarding how to best serve students with coexisting may exist, but learning difficulties also may result from
emotional/behavioral disorders and SLD, with some other causes such as illness, excessive school absences,
experts pointing out that the design of inclusion may attention impairments, or depression. A secondary
exacerbate inner conflicts and frustrations, requiring learning problem rather than a learning disability is
consideration of more specialized learning settings suggested if learning improves once the medical condi-
(Eller, Fisher, Gilchrist, Rozman, & Shockney, 2015). tion is brought under control (Sexson & Madan-Swain,
In the United States, the overall dropout rate for indi- 1993).
viduals with SLD is three times that of all students. In Individuals who were born prematurely have an
the 2013–2014 school year, 18% of students with SLD increased incidence of learning disorders. Acute dis-
dropped out as compared with 6.5% of students over- orders such as meningitis, encephalitis, and traumatic
all. Although the dropout rate has decreased since the brain injury (TBI) also can result in the subsequent
late 2000s, it remains unacceptably high. During this development of learning problems. Mild TBI is the most
time period almost half a million students with SLD common of these and is an increasingly recognized
left high school without a diploma, putting them at cause of behavior and learning problems in individuals
high risk for a poor outcome in transitioning to mean- (see Chapter 23). The injury may result in either tempo-
ingful employment (National Center for Learning Dis- rary or permanent neurological impairments. Affected
abilities, 2017). individuals present special challenges in the classroom
as a result of the evolving nature of their recovery (Car-
HEALTH PROBLEMS SIMULATING ney & Porter, 2009). During the acute phase, disorders
SPECIFIC LEARNING DISABILITIES of attention and other executive functions, higher lan-
guage skills, and behavior are common. Because of
Some individuals who do not have learning disorders this, TBI has been identified as a separate category of
may demonstrate learning differences in school as a disability under IDEA 2004 (see Chapter 33) to distin-
consequence of another developmental disability, a guish it from specific learning disabilities and other
related disorders. However, when recovery is com- Christensen, 2017). This requires attention to accurate
pleted, some individuals with TBI may have a residual assessment of abilities and disabilities so that appro-
learning disorder. priate intervention to support these students can be
Finally, psychosocial influences may affect the provided (Kim & Helphinstine, 2017). This appropriate
child’s ability to learn. A child who is hungry cannot determination of need will lead to a greater number of
pay attention or learn well. A child who comes from students with cultural and linguistic diversity being
a home that does not value learning is at high risk for accurately placed within the inclusive instructional set-
underachievement in school. A home beset with fam- ting (Barrio, 2015; Driver & Powell, 2017).
ily problems or abuse is a poor setting in which to Poverty and the related factor of homelessness also
encourage the child’s school performance. Improve- complicate identifying and serving students, especially
ment in these psychosocial areas would likely result in when they have learning disabilities. The Condition
improved school performance but has proven difficult of Education 2017, a congressionally mandated annual
to achieve. Until a complete picture of why students in report summarizing the latest data on education in the
a particular school are identified as having profiles of United States, reports that nearly 20% of children under
underachievement—and until the role of factors such the age of 18 live in poverty and that 2.5% of the pub-
as poverty, prematurity, nutrition, and environmental lic school population is homeless. This includes stu-
threats (e.g., lead poisoning and other environmental dents in both urban and rural settings (Barrio, 2017).
toxins) are fully understood and addressed—educators Because homelessness is closely related to mobility,
will continue to struggle to reconcile disorders of many children in poverty are moving around so much
learning and effective instructional practices (see that accurate assessment of their needs is not possible.
Chapter 42). Others already identified as needing services often do
What is vital to the improvement of this state of not receive them due to limited access to records and/
affairs is greater attention to how school teams obtain or the availability of qualified educators and other spe-
and use information that identifies learning disabilities cialized providers.
and how resources are mobilized to treat the learning
disabilities in the school, school district, and commu-
ASSESSMENT PROCEDURES
nity. All existing information should be used in the edu-
cational process. Medical and educational assessments The assessments used to identify students with an SLD
by qualified examiners, combined with the assessment consist of individually administered tests designed to
data developed by the school, serve as the foundation reveal both strengths and challenges so that compre-
for developing an effective educational program, which hensive recommendations can be made. A school team,
optimizes the use of related services such as speech- including the parent and student (when appropriate),
language therapy or support from learning specialists reviews all assessments and determines the appro-
in a collaborative effort to serve the student within the priate level of services required to accommodate the
most inclusive setting possible (see Chapter 33). student’s learning needs. These recommendations are
written into the individual education program (IEP)
with explicit, measurable goals and objectives, as well
ADDITIONAL as the clear description of how progress will be evalu-
ated (see Chapter 33). Recommendations may include
CHALLENGES IN THE SCHOOL SETTING specific programmatic interventions in reading, writ-
There is a disproportionality of representation of stu- ing, or mathematics; grouping strategies; or even
dents from various racial and ethnic subgroups in spe- additional therapeutic interventions from specialists
cial education (see Chapter 42). This has been linked to (Fletcher, Lyon, Fuchs, & Barnes, 2007).
gaps in achievement, resulting in the overidentification The No Child Left Behind (NCLB) Act of 2001 (PL
of these students (Williams, Bryant-Mallory, Coleman, 107-110) has been replaced by the Every Student Suc-
Gottel, & Hall, 2017). Schools serving students with ceeds Act of 2015 (PL 114-95; the reauthorization of
an array of special needs must also consider two addi- the Elementary and Secondary Education Act of 1965;
tional factors that complicate effective instruction and see Chapter 33), but the continued emphasis on access
intervention—the growing number of English language to the general education curriculum and high stakes
learners and the impact of poverty in some school set- testing as a measure of mastery creates challenges for
tings. Roughly 9.4% of students in public school are students with SLD. There have been some victories for
identified as ELLs (National Center for Educational families around issues of accommodations and modifi-
Statistics, 2017), and of that group, nearly 10% are also cations used in instruction and for high stakes testing,
identified as having disabilities (Liu, Ward, Thurlow, & but these battles continue to occur.
Psychological, language, and educational tests are all students. Additionally, computer-assisted instruc-
the mainstay of assessment in school-age individuals tion (CAI), small group specialized methods, and indi-
(see Chapter 13). However, a complete medical, behav- vidual tutoring are now provided within the general
ioral, educational, and social history also should be education classroom. When available, a special educa-
taken in order to consider confounding variables that tion teacher will collaborate with the general educator
may simulate, mask, or worsen a learning disorder to recommend specific strategies or to co-teach certain
(Francis et al., 2005; Lyon, Shaywitz, & Shaywitz, 2003). lessons. The use of evidence-based practices (EBPs) in
Simply looking at the discrepancy between potential the general education classroom promise to close the
and actual achievement can lead to misclassification of achievement gap for low- performing students, but
the students’ needs. Evaluators need to use procedures while gains have been reported, they may be difficult
for assessment that provide more information than a to sustain over time (Fuchs et al., 2015).
simple statistic as an indicator of a student’s abilities The primary goal of intervention is to facilitate the
(Grigorenko, 2009). Global standardized assessment acquisition and expression of the knowledge needed
tools, such as IQ tests, are not sensitive enough to allow for effective performance in school and subsequently in
an instructional program to be tailored to ensure a the workplace. The objectives are to achieve academic
student’s academic growth. Standardized proficiency competence, treat associated impairments, and pre-
testing must be combined with authentic assessment, vent adverse mental health outcomes. This requires the
norm-referenced as well as criterion-referenced tests, cooperation of educators, health care professionals, and
informal assessment, and portfolio assessment (based families. If individuals with SRD are not provided with
on a collection of artifacts that represent the student’s an early intervention program composed of instruction
work product) to obtain the full picture of how the in phonological awareness, sound–symbol relations,
student is progressing. This permits connecting and and contextual reading skills before the third grade,
applying this information to the content the student at least three fourths of these students will show little
is learning. If this does not occur, inappropriate treat- improvement in reading throughout their later school
ment recommendations can result. Labeling a test taker years (Shaywitz & Shaywitz, 2005).
as a “low achiever” does no service to the student. In addition to treating the core learning disor-
Well-documented strengths and challenges lead to a der, intervention strategies need to focus on associ-
more serviceable IEP (Liu et al., 2016; Phipps & Beau- ated cognitive, attention, language, perceptual, and
jean, 2016). sensory impairments. Immaturity, lack of motivation,
Continued periodic assessment of progress in and poor impulse control also must be considered in
the class is also required. This periodic “snapshot” of determining the child’s needs for remediation (Bakker,
achievement allows the effectiveness of the program Van Strien, Licht, & Smit-Glaude, 2007). An interven-
to be evaluated and the instructional program to be tion must recognize the developmental changes that
adjusted. Periodic reassessment of cognitive and execu- occur as a student gets older. It must be sensitive to
tive functions is warranted if the student is failing to the changing demands of the curriculum, the typical
progress. In addition, annual assessment of academic developmental challenges faced by the child, and the
subjects is important to determine the progress the effects of maturation and intervention on the academic
child has made and the effectiveness of the program. abilities of the student. In addition, successful interven-
This aligns with the purpose of RTI as well as the man- tions must not be withdrawn prematurely because of
dates for progress monitoring. the positive impact they have on developing the self-
awareness and self-advocacy skills necessary to combat
stigma, to build self-confidence, and to access services
INTERVENTION STRATEGIES and supports in postsecondary school settings or the
The practice of inclusion has placed most students with workplace (Reschly, 2008).
learning disabilities into general education classrooms Professionals continue to debate the most effec-
where they have access to the general education cur- tive intervention strategies. A major consideration is
riculum with modifications, accommodations, and whether to teach to the child’s abilities (i.e., compen-
supports (see Chapter 33). As a result, interventions sation/circumvention strategies) or the disabilities (i.e.,
and strategies specifically designed for learning dis- remedial strategies; Liu et al., 2016; Phipps & Beaujean,
abilities are now embedded into some general edu- 2016). Little evidence supports the superiority of one
cation classroom through the Universal Design for approach over the other. It is generally agreed, how-
Learning (UDL; King-Sears, 2014). UDL provides mul- ever, that there must be a combination of instructional
tiple modes of presentation with a variety of potential and cognitive interventions (Alexander & Slinger-
responses so that teachers can modify the material for Constant, 2004).
Instructional Interventions final analysis, semantic (the meaning of words), syn-

tactic (the rules that govern the ways words combine to
The following is a review of some interventions in form phrases), and graphophonemic (using combined
reading, writing, mathematics, and other areas. letters and sounds to decode words) systems must be
united for successful reading.
Reading In 2000, the National Reading Panel Along with knowledge of phonics, efficient reading
released its report on research-based reading instruction requires a rapid sight vocabulary (words recognized on
(National Institute of Child Health and Human Devel- sight without sounding them out phonetically). Different
opment, 2000). The panel identified the following six word recognition strategies include analysis of sound
essential components to a sound reading program: 1) (phonics or phonetics), analysis for structure (visual
phonemic awareness; 2) phonics skills; 3) fluency, accu- configuration), and use of memory skills to recognize
racy, speed, and expression; 4) reading comprehension words as total entities (whole-word approach). Compre-
strategies to enhance understanding; 5) teacher educa- hension strategies center on developing the ability to
tion; and 6) computer technology. Once decoding is draw meaning from text and to read fluently. Stevens,
unlocked, students are able to use these skills to build Walker, and Vaughn (2016) have provided a synthesis of
fluency. The focus can then shift to interventions that research showing that repeated reading increases oral
support and develop the expansion of vocabulary (for reading fluency in students who are competent decod-
general communication, usage, and technical use) and ers but need practice in faster, more accurate reading.
enhance comprehension. Most states maintain a list of Multicomponent interventions and assisted reading
approved evidence-based practices that teachers may with audiobooks produced gains in fluency and com-
draw from in choosing specific interventions. These EBPs prehension and found that repeated reading is still the
are not uniform and vary not only from state to state, but most effective intervention for improving fluency in
even within different school systems within each state. students with learning disabilities.
Reading proficiency depends on phonological Many students with a reading disability need an
processing and alphabetical mapping. Phonics instruc- adjustment in the curriculum. Some methods of teach-
tion, however, is different from phonological aware- ing reading, such as Orton-Gillingham, Wilson, and
ness training (Shaywitz, 2005). Clark and Uhry (1995) Lindamood Bell, employ multisensory approaches
defined phonics as a low level of rote knowledge of (Birsh, 2011; Ritchey & Goeke, 2006) for the remedia-
the association between letters and sounds. Phono- tion of difficulties in efficient sound–symbol processing.
logical awareness, on the other hand, includes higher Other approaches include 1) whole language (reinforc-
level metacognitive understandings of word bound- ing a spectrum of language arts), 2) thematics (utilizing
aries within spoken sentences, of syllable boundaries content areas conceptually), 3) literature-based methods
in spoken words, and of how to isolate the phonemes (using trade books to build on basal program skills),
and establish their location within syllables and words. 4) individualized reading programs (using trade books
Regardless of the method chosen, the major goal of and alternative literature forms to build personal read-
reading instruction is to improve phonological aware- ing), 5) language experience (having students generate
ness (the sublexical aspect of reading) so that there their own reading material), and 6) functional skills
is effective word recognition and comprehension of (involving the use of materials involved in daily liv-
meaning (the lexical aspect of reading). Reading activi- ing, e.g., forms, notices, and directions). The increased
ties focus on helping a child gain print awareness and influence of STEM (science, technology, engineering,
become attuned to the sound characteristics of lan- and math) has broadened the application of reading and
guage (phoneme awareness) and letter–sound relation- writing skills across the content domains. Unfortunately,
ships (the alphabetic principle). teacher preparation programs may not be providing con-
Reading instruction in elementary school varies tent area teachers with a broad enough understanding
significantly and is influenced by regulation, policy, of specific learning disabilities and the tools to modify
and budget. The common thread to this instruction instruction to meet these students’ needs.
includes methods designed to increase skills in Despite this, teachers at all levels and in all types
acquiring vocabulary, using syntax, and understand- of classrooms can give students with SRD tools such
ing meaning (Alexander & Slinger-Constant, 2004; as 1) graphic organizers (a visual representation of the
Schatschneider & Torgesen, 2004). While there is no material a student is learning that assists the student in
single model of reading instruction that suffices for all brainstorming and/or organizing information to make
individuals, there are certain components that all agree it easier to understand how ideas connect), 2) anticipa-
are essential for good instruction (National Institute of tion guides (study guides that prepare students to iden-
Child Health and Human Development, 2000). In the tify the major themes and concepts of a written work,
3) question/answer strategies, 4) think-alouds (explicit approach that embeds reading and study skills into the
modeling in which teachers give an oral description content.
of the cognitive processes they go through as they In middle and high school, the reading process
read with their students), 5) charting and outlining, must connect with other skills needed for mastering
and 6) induced imagery (teacher guided mental imag- content-related matter in subjects such as social stud-
ery while reading to enhance comprehension). These ies, geography, higher level mathematics, and sciences.
schemata all help students retain the messages they get Study, organizational, and problem-solving skills must
through their reading. The intent of these strategies is blend with the processing skills involved in obtaining
to provide the reader with ways to chunk or otherwise meaning from words, sentences, charts, maps, books,
partition their reading material into segments that they poetry, and dramatic or narrative literature. Meaning
can better understand. The goal of such instructional is easier to teach in the elementary and middle grades
interventions is movement toward higher levels of criti- than in high school, when it may become buried in
cal thinking. By attaining these skills, the student can nuances of language, such as humor, sarcasm, and
compete with peers in academic tasks that connect read- metaphor.
ing to other skills, such as writing and oral discussion. The expertise of general educators in middle and
high schools is in the content they teach and not in the
Reading in Middle School and High School instructional mechanisms that help students organize,
The mandates of No Child Left Behind, as well as the retrieve, and explain text related to that content. In
requirements of school districts for the acquisition of addition, secondary school requires learning multiple
credits toward graduation, have raised the bar for the content areas in discrete settings with several differ-
attainment of a diploma. In addition, a diploma is not ent teachers. Consequently, the student with SRD may
acquired by passing courses alone. High school stu- become a “cumulative deficit” reader who makes prog-
dents must demonstrate the ability to pass statewide- ress but at a rate that is too slow to maintain adequate
standardized measures of mastery of core subjects as academic achievement. The content teacher, therefore,
well. The path toward independent adulthood, higher needs to understand not only the demands and organi-
education, and continued training in skills needed for zation of his or her content, but also how students must
employment has a distinct “turn” as students move organize that content from lessons so that they can use
into middle school and then into high school. As previ- it in the many forms that secondary school demands
ously stated, in December, 2015, NCLB was replaced by (e.g., exams, research papers, and debates).
the Every Student Succeeds Act. Although the original
provisions of NCLB remain for many aspects of assess- Writing As much as reading dominates the
ment, much of the change relates to the shift of respon- instructional day of students with SRD, students with
sibility and accountability for student performance to disorders of written expression (e.g., dysgraphia) have
the individual states. States must show that they have specific disabilities in processing and reporting infor-
adopted challenging standards in reading, math, and mation in written form. Writing is firmly connected
science and that the levels of achievement comport to reading and spelling because comprehension and
with the standards for admission to higher education exposition of these skills are demonstrated through
institutions as well as with the standards in career and production of written symbols as indicators of under-
technical education. States may develop alternative standing (Berninger & Wolf, 2009; Mason & Graham,
assessment standards for students with the most sig- 2008). Although writing is a representation of oral lan-
nificant cognitive disabilities, but the number of stu- guage, it also must convey meaning without the ben-
dents determined to qualify for this accommodation is efit of vocal intonation or stress. This makes additional
limited. In addition, states may choose to administer demands on the writer.
assessments in annual or multiple interim formats. Problems in writing may result from either an
The demands of middle school and the pressures inability to manipulate a pen and paper to produce a
of high school programs can be very trying for stu- legible representation of ideas or an inability to express
dents with learning disorders. As individuals move oneself on paper. Word processors can assist individu-
from the structure of elementary school to middle and als who have disabilities related to the manipulation
high school, the demands of content reading become an of the writing implements (Bain, Baillett, & Moats,
additional burden. The discrete skills of content read- 2001; MacArthur, 2009). Remedial and instructional
ing and the related study skills needed for success in techniques that are helpful with problems of written
secondary education are divided into two approaches. expression include the use of 1) open-ended sentences;
One is a direct instructional approach that sepa- 2) probable passages (a strategy used to draw on a stu-
rates skills from content, and the other is a functional dent’s prior knowledge of a topic while incorporating
writing into a basic reading lesson); 3) journal keeping; those operations to daily situations (Mazzocco, 2007;
4) modified writing systems, using rebuses in which Raghubar et al., 2009). Often, however, the problem is
words are represented by combinations of pictures and in understanding the abstract concepts of mathematical
individual letters or other symbols; and 5) newspapers usage (Mabbott & Bisanz, 2008). When students with
and other print media to demonstrate various writ- dyscalculia have only written math problems to solve,
ing styles and organizational models. Additionally, the concepts remain vague. When functional applica-
the ability of the student to maintain and self-regulate tions (e.g., involving money or time) and manipulatives
attention to spoken and print language sources has are used, however, the student can connect the concepts
an impact on the development of writing and its con- to their practical applications and demonstrate greater
nection to executive functions (Berninger, Abbot, & understanding. For some individuals with this disor-
Cook, 2017). der, a calculator may prove helpful. Thus, teaching
Not to be forgotten is the connection of spelling to may focus on the use of money in fast food restaurants
writing. The developmental stages of spelling need to (e.g., making change), grocery shopping (e.g., compar-
be explored as teachers approach instruction that con- ing prices per unit of weight), banking (e.g., balancing
nects what is read to the written response of students. a checkbook or calculating interest), cooking (e.g., mea-
These stages include prephonemic, phonemic, transi- surement), and transportation (e.g., reading directions
tional, and conventional spelling (Bear & Templeton, and maps and keeping to schedules).
1998). In 1998, the International Reading Association The language aspects of instructing students with
and the National Association for the Education of a math disability, especially those who also have SRD,
Young Children (1998) issued a joint position statement have been studied to determine how the reading pro-
that advocated a developmental approach to teaching cess influences performance in numeric problem solv-
writing as an outgrowth of the reading process, rec- ing (Andersson & Lyxell, 2007; Fuchs & Fuchs, 2002;
ommending that students should be moved from the Powell, Fuchs, Fuchs, Cirino, & Fletcher, 2009; Peng &
initial, prephonemic, and phonemic attempts at spell- Fuchs, 2016). In these studies, for students with both
ing toward correct, conventional spelling of English reading and math disabilities, problems requiring addi-
words. The process must reflect an understanding of tion were easier to solve than problems requiring sub-
the developmental level and needs of the individual traction or problems requiring making change. Powell
student as well. and colleagues (2009) investigated how much the for-
Content area literacy calls for connections between mat of word problems connects to numeric ability and
reading and writing and the development of study discovered that students with math disability demon-
skills and organization of written materials so that they strated an improved ability to solve word problems in
are retrievable for later use. Interventions in this area math by using diagramming as an intervention (Van
may call for students to share their writing with peers Garderen, 2007) to incorporate visuo-spatial reasoning.
and to examine the writing styles of others. Among the The importance of adequate assessment tools
research-based strategies that assist the student with in the determination of math disability has been dis-
writing disabilities is self-regulated strategy develop- cussed by Lembke and Foegen (2009), whose research
ment, a six-step cognitive strategy model designed to in early numeracy (the ability to understand and work
make the writing process complete, automatic, and with numbers) has posited the relationship of number
flexible for all subjects (Graham & Harris, 1989; H arris sense to phonemic awareness in reading. As indicators
& Pressley, 1991; Reid, 2005; Berninger, Abbott & of math performance among primary grade students,
Cook, 2017). they have identified the skills of quantity discrimi-
Writing is also a sociocultural endeavor, represent- nation, number identification, and missing number
ing a cognitive process learned through dialogic inter- identification as three strong predictors of early math-
actions, expressing the social and cultural perspectives ematical success. Assessment and determination of
of the student (Englert, 1992). The difficulties that a stu- the possibility of other disabling conditions that might
dent with a learning disorder may have with social per- affect learning has also been a concern for researchers,
ception and awareness of cultural aspects of personal especially the combined impact of reading and math
development may influence the written product as well disabilities (Dirks et al., 2008). Limited study has been
as the writing process. done on this combined disability effect, although Dirks
and colleagues have estimated that more than 7% of
Mathematics Students with a math disability students have both SRD and math disabilities.
(i.e., dyscalculia) have an impaired ability to perform Powell and colleagues (2009) have demonstrated
basic math operations (i.e., addition, subtraction, mul- the effectiveness of an approach that emphasizes prob-
tiplication, and division) or may have trouble applying lem type for solving mathematical word problems
and complex operations (e.g., multiplication). Another disorders, support groups, and their legal rights and
approach, emphasizing executive function, involves responsibilities in the education of their child. In addi-
rehearsal, practice, and mastery of math skills in tion to support for families as they get help for their
combination with corrective and positive feedback child with learning disorders, these families, especially
throughout the process of instruction. A metacogni- parents, may need help in addressing their own feel-
tive approach can give students with dyscalculia hope ings of grief or powerlessness in assisting their child
for greater success and facility in progressing to higher toward independence in adulthood, higher education,
and more complex mathematical operations (Desoete, and employment. Innovative therapeutic interventions
Roeyers, & Buysse, 2001; Keeler & Swanson, 2001). include movement and dance therapy, art therapy, and
The concepts, principles, and procedures that are music therapy (Unkovich, Butte, & Butler, 2017).
part of mathematics instruction increase in difficulty
through the grades, and so the identification of a math
Medication Although learning disorders cannot
disability may follow the student throughout his or her
be “cured” through the use of medication, certain asso-
school career. Geary and Hoard (2005) described the
ciated impairments that affect learning, such as ADHD
executive functions that are disrupted, namely regula-
(see Chapter 19) and behavior and emotional disorders
tion of attention and the ability to distinguish between
(see Chapter 27), can be improved with the use of psy-
relevant and irrelevant numeric associations in solving
choactive drugs. If such drugs are used, their effective-
problems.
ness must be monitored carefully. Medication should
For many students with mathematical disabili-
never be a substitute for sound educational program-
ties, the more abstract levels of mathematics, such as
ming (see Chapter 38 for a detailed discussion of the
algebra, geometry, and calculus, may remain mysteries
role of medications in the treatment of developmental
forever; however, these students can still gain facility
disabilities).
with basic mathematical facts used in daily life (Mercer
& Pullen, 2004). Many schools teach students how and
when to use calculators so that more complex problems Homework The home and school should be able
can be simplified or homework checked for accuracy. to function in partnership so that homework does not
In addition, computer- assisted instruction in math- lead to tension among family members or misunder-
ematics may provide opportunities for practice and standing of the teacher’s intent in providing the home
reinforcement. assignment. This may require assisting the parent in set-
ting up a workable system and schedule at home. Stu-
dents with learning disorders often feel that homework
Other Interventions is an imposition, providing no personal fulfillment or
advancement, so individualization and creative use
Training in Social Cognition The maintenance
of assignments is essential for homework to fulfill its
of self-esteem and the development of social cogni-
reinforcing purpose. Homework should supplement
tion are very important in preventing adverse men-
material that was taught during the day (Alvermann &
tal health outcomes in any child. Bandura’s (2001)
Phelps, 2005).
research on social- cognitive theory and self-
efficacy
The improvements and availability of technology
has had its impact on general education, but relatively
to support students in completing assignments have
little research has been done on at-risk groups of stu-
been shown to assist homework completion, espe-
dents, which would include those with learning dis-
cially at the middle and high school levels (King-Sears,
abilities. Social and emotional competence is impacted
Evmenova, & Johnson, 2017). Techniques to facilitate
by personal and interpersonal agency, and it influences
homework performance include the use of coaching
the outcomes of well-being in these children (Martin,
models as well as traditional models of home comple-
Cumming, O’Neil, & Strnadova, 2017).
tion. There does not seem to be one particular system
of doing homework that emerges as most effective, but
Counseling Counseling may be required to treat research does indicate that the student’s perception of
underlying mental health issues in children with a learn- the usefulness of the assignment is important (Merri-
ing disorder. This can be provided individually or in man, Codding, Tryon, & Minami, 2016). There are non-
groups. Family-centered counseling also may be appro- academic effects of homework on student perceptions
priate. Issues to be discussed may include homework, of well-being and behavior, particularly for students in
behavior management techniques, parental expecta- high-achieving school settings (Galloway, Conner, &
tions, and the child’s self-esteem. Families also should Pope, 2013). Homework should be limited to a specific
be provided a source of information about learning time allotment. Since 2006, the National Education
Association has recommended 10–20 minutes per 2017). Academic preparation of students with learn-
day for individuals in kindergarten through second ing disorders is permitting more and more students to
grade and 30–60 minutes per day for individuals in pursue postsecondary education. However, having an
Grades 3–6. Ideally, homework should be completed in average of a 10th-grade reading level (Hughes & Smith,
a specific area of the home that is quiet, organized, and 1990; Mason & Mason, 2005) confounds the student
stocked with needed supplies. Children with learning with learning disabilities as they attempt the spectrum
disabilities may also not bring homework assignments of academic challenges at the college level. These chal-
home either to avoid doing them or because they lack lenges include writing essays and research papers,
the organizational skills to remember the assignment. completing long and complex reading assignments,
Many tools are available to assist with this process, taking timed tests, and learning foreign languages
including day planners, checklists, iPads, or other tech- (Denckla, 1993; Duquette & Fullarton, 2009; Murray &
nologies. Some schools post homework assignments Wren, 2003).
on the Internet or through other electronic methods— Some colleges offer adjustments to program loads
these should assist families in knowing the schedule and schedules, tutorial and other support services, and
and content of assignments. support technologies that have permitted students with
learning disorders to complete college at an increasing
rate (Jones, Long, & Finlay, 2007). Among the problems
Periodic Reevaluations encountered by students with SLD as they enter college
The treatment programs for students with learning is the fact that only 25% identify their special needs
disabilities are complex, and many potential gaps to the college, therefore diluting the impact of accom-
exist. Furthermore, the child is continually develop- modation or support that may be available. If such
ing, with needs and abilities that change from year to accommodations are not obtained early in the postsec-
year. Therefore, ongoing monitoring of school progress ondary experience, the risk of not graduating is greatly
is essential. The goal of periodic reassessments is to increased. The completion rate for students with SLD
evaluate academic progress, psychosocial issues, and is 41%, compared with a completion rate of 52% for the
parent–child relationships. Reassessment is also an general population (National Center for Learning Dis-
opportunity to convey new information to the family abilities, 2017).
in an effort to obtain appropriate resources. Finally, it
is a time for reassessing the child and revising the edu-
cational program. These reevaluations should occur Employment
ideally on a yearly basis so that planning for the next Career direction and preparation should be an objec-
school year can occur. Parents and school providers tive of educational programming beginning in the pri-
need to be familiar with federal and state policy and mary grades. Such training for students with learning
regulation on the schedule of assessment and reassess- disabilities begins with realistic goal setting resulting
ment in order to properly serve the student with learn- from a comprehensive assessment of abilities and apti-
ing disabilities as they respond to varied interventions tudes. Without appropriately directed training, students
(Silberglitt, Parker, & Muyskens, 2016). may be unable to support themselves in an independent
manner as adults. If career preparation and training ser-
OUTCOME vices are delayed until adulthood, they are less likely to
be effective. The design of these programs becomes part
Academic preparation and interventions have allowed of the student’s IEP (see Chapter 33).
more and more students with SLDs to pursue postsec- A generation ago, the U.S. Department of Labor
ondary education and to find success in the workplace. (1992) published competencies determined to be nec-
essary for employment. This report by the Secretary’s
Commission on Achieving Necessary Skills (known as
Postsecondary Education the SCANS Report) translated into curriculum areas
The National Center for Learning Disabilities notes that deemphasized specific job-related tasks in favor
that 68% of high school students with SLD exit with of teaching general competencies that cross all job
a diploma, compared to 12% who graduate with a cer- markets.
tificate of attendance. Unfortunately, they also report Even as adults, some individuals with learning dis-
that 19% of these students drop out of school before orders have poor retention of verbal instructions and
graduating (National Center for Learning Disabilities, other problems that may interfere with effectiveness in
their jobs. They also may be hesitant to ask questions • Career and vocational education should be included
and seek assistance. Social immaturity, clumsiness, in the general educational curriculum and as an
and poor judgment may make social interactions more individualized transition plan within the IEP.
difficult. The skills taught in career education are those
• Although the individual with SLD usually carries
required to overcome these impairments and enhance
his or her learning impairment into adulthood, the
success in the work environment, be it the classroom
outcome is often good.
or the adult job market. Cooperation, respect, responsi-
bility, teamwork, organization, and ways to seek infor-
mation to solve one’s problems are all part of career ADDITIONAL RESOURCES
education (U.S. Department of Labor, 1992).
According to the National Center for Learning LD Online: http://www.ldonline.org
Disabilities report mentioned above, over 46% of stu- Learning Disabilities Association of America (LDA):
dents with learning disabilities hold jobs in competitive http://www.ldanatl.org
employment situations. This cannot be judged too criti-
cally, however, in light of national trends in employ- National Center for Learning Disabilities (NCLD):
ment that might be influenced by economic downturns http://www.ld.org
that affect all potential workers leaving high school. Additional resources can be found online in
The Bureau of Labor Statistics reports that in 2017 the Appendix D: Childhood Disabilities Resources, Ser-
unemployment rate was 4.8% nationally; however, vices, and Organizations (see About the Online Com-
the unemployment rate for those with a college degree panion Materials).
was only 2.5%, while those without a college degree was
over 7%. This figure is much increased for young adults
with learning disabilities. REFERENCES
Aaron, P. G., Joshi, R. M., Gooden, R., & Bentum, K. E. (2008).
Diagnosis and treatment of reading disabilities based on
SUMMARY the Component Model of Reading: An alternative to the
discrepancy model of LD. Journal of Learning Disabilities, 41,
• A specific learning disability is a developmental 67–84. doi:10.1177/0022219407310838
disorder in which a healthy child of average to Abbott, R., Raskind, W., Matsushita, M., Richards, T., Price, N.,
above-average intelligence fails to learn adequately & Berninger, V. (2017). Dysgraphia, dyslexia, and OWL LD
during middle childhood and early adolescence: Evidence
in one or more school subjects. for genetic effects on hallmark phenotypes. Biomarkers and
• The underlying cause of these disorders is aber- Genes, 1(1), 1–10. doi:10.15761/BG.1000103
Alexander, A. W., & Slinger-Constant, A. M. (2004). Current
rant brain function, such as impaired phonological status of treatments for dyslexia: Critical review. Journal of
decoding in specific reading disability. Neuroimag- Child Neurology, 19, 744–758.
ing, genetic, and neuropsychological studies are pro- Alvermann, D. E., & Phelps, S. F. (2005). Content reading and lit-
viding insight into how the brain guides learning. eracy: Succeeding in today’s diverse classrooms (4th ed.). Boston,
MA: Allyn & Bacon.
• Early detection of learning disorders is important American Psychiatric Association. (2013). Diagnostic and sta-
because, if untreated, the child may develop sec- tistical manual of mental disorders (5th ed.). Washington, DC:
ondary emotional and behavior problems that hin- Author.
Andersson, U., & Lyxell, R. (2007). Working memory, deficit
der progress. in children with mathematical difficulties: A general or
• If a learning disorder is suspected, a psychoeduca- specific deficit? Journal of Experimental Child Psychology, 96,
197–228. doi:10.1016/j.jecp.2006.10.001
tional evaluation should be performed to identify Bain, A., Baillet, L. L., & Moats, L. C. (2001). Written language
areas of strengths and challenge. Then the educa- disorders: Theory in to practice (2nd ed.). Austin, TX: PRO-ED.
tion team can develop an individualized education Bakker, D., Van Strien, J. W., Licht, R., & Smit-Glaude, S. W. D.
program and appropriate changes in curriculum (2007). Cognitive brain potentials in kindergarten children
and supports can be made. with subtyped risks of reading retardation. Annals of Dys-
lexia, 57(1), 99–111. doi:10.1007/s11881-007-0005-y
• No single treatment method is ideal for all individ- Bandura, A. (2001). Social cognitive theory: An agentic per-
uals, so an empiric approach may be needed to find spective. Annual Review of Psychology, 52(1), 1–26.
Barrera, M. (2006). Roles of definitional and assessment mod-
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the amount of time spent in remediation/practice is of English for special education. Journal of Learning Disabili-
very important. ties, 39, 142–156. doi:10.1177/00222194060390020301

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CHAPTER 20 Learning Disabilities

Upon completion of this chapter, the reader will

BOX 20.1 E V I D E N C E -B A S ED P R A C T I C E

BOX 20.2 I N T ER D I S C I P L I N A RY CA R E

The Paraprofessional in the Inclusion Classroom

PREVALENCE recommended for further study to examine potential

and math performance. Attention components in work- Attention-Deficit/Hyperactivity Disorder

Instructional Interventions final analysis, semantic (the meaning of words), syn-

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