The Clinical Guide to Assessment and Treatment of Childhood Learning and Attention Problems

Michelle M. Martel

• Publisher: Academic Press
• Year: 2020
• ISBN:
  9780128162583
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

The Clinical Guide to Assessment and Treatment of Childhood Learning and Attention Problems provides assessment and treatment recommendations for learning disorders (LD) and attention-deficit/hyperactivity disorder (ADHD). Brimming with case studies and other practical guidance, the book reviews etiology of LD and ADHD, outlines the diagnostic criteria per DSM-5, and includes clinical insights for assessment and intervention. Evidence-based assessment and intervention strategies are emphasized, linking assessment to treatment selection and evaluation. Techniques for improving treatment outcomes and supplemental intervention planning are presented, including common modifications and accommodations for learning disorders and attention problems.

In addition, tutoring techniques, strategies for specific types of learning problems, and recommendations for Individualized Education Plans are all explored.

• Provides an integrated approach to LD/ADHD assessment and treatment
• Explores treatment implications for ADHD/LD comorbidity
• Guides readers on how to select the best intervention strategy from evidence-based treatments
• Reviews behavioral-based treatment
• Includes supplemental intervention strategies, tutoring techniques, and IEPs
• Features a broad array of clinical case studies

Section 1

Assessment guidelines

Outline

• Chapter 1 Assessment and identification of learning disabilities
• Chapter 2 Assessment and diagnosis of attention-deficit/hyperactivity disorder
• Chapter 3 Assessment of attention-deficit/hyperactivity disorder and comorbid reading disorder with consideration of executive functioning

Chapter 1

Assessment and identification of learning disabilities

Emily A. Farris¹, Erin E. Alexander¹ and Timothy N. Odegard¹,², ¹Tennessee Center for the Study and Treatment of Dyslexia, Middle Tennessee State University, Murfreesboro, TN, United States, ²Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, United States

Abstract

This chapter reviews the processes involved in the assessment and identification of learning disabilities (LDs). A brief comparison of school-based and clinical settings and a discussion of theoretical models used to define and understand the construct of LDs are provided. A variation of a hybrid model that requires three types of information to be gathered and synthesized to make recommendations for instructional plans is described. Examples of measures that may be used to document inadequate response to appropriate instruction and poor achievement within specified academic domains are included. The chapter concludes by urging individuals to use a hybrid model in the identification process and integrate any assessment results with the planning of instructional targets.

Keywords

Learning disabilities; models of identification; school-based and clinical settings; hybrid model; assessment; response to intervention

It is not uncommon for children to struggle academically at one time or another. However, some children experience severe and persistent learning difficulties that are confined to specific academic areas. For example, there are children who struggle with mathematics but read without difficulty, whereas other children struggle profoundly with reading but not with mathematics. These children are capable of learning in spite of experiencing severe difficulties in doing so. Their rate of learning, however, is much slower than their peers, and there are no obvious explanations as to why. When such observations were starting to be made in the middle of the last century, efforts to identify and categorize children as learning disabled began to emerge in hopes of guaranteeing them access to educational opportunities that would allow them to reach their potential, which at that time were not guaranteed (Kirk & Gallagher, 1979).

Often, but not always, these educational opportunities come through special education services in the child’s school under the eligibility category of specific learning disability (SLD). As of the fall of 2015, of all US students ages 6 through 21 years receiving special education services, 38.8% were identified under the eligibility category of SLD, representing the largest group of students receiving special education services out of 13 disability categories (Office of Special Education & Rehabilitative Services, 2017). Furthermore, a summary provided by the National Center for Learning Disabilities notes that individuals with learning disabilities (LDs) have higher rates of failure based on course grades and high stakes tests, higher rates of high school dropout, are more likely to have some type of involvement with the criminal justice system and live in poverty (Cortiella & Horowitz, 2014). Thus there is a great need to continue to identify and support these children.

A determination of an LD can be made based on different models and specific procedures in compliance with guidelines set forth by government agencies and diagnostic manuals. However, who is said to have an LD is determined by which of these identification procedures are adopted (Fletcher & Miciak, 2017; Siegel, 1999; Stanovich, 1999), and efforts to categorize children as learning disabled have been further complicated by there not being a single causal factor to explain the learning difficulties of these children. The construct of LDs is based on the premise that children labeled as learning disabled struggle to learn as the result of intrinsic factors. Their learning struggles are not the result of obvious differences inherent to the child (e.g., vision impairment, hearing impairment) or lack of instruction due to other factors such as poor attendance or the child not having access to instructional opportunities. Without an obvious set of factors to account for the learning difficulties, the basis of these learning struggles was thought to be neurobiological. Support for this position was provided by appealing to older concepts, such as minimal brain dysfunction and neurobiological causes offered for other conditions such as dyslexia (Hinshelwood, 1917; McCandliss & Noble, 2003; Orton, 1928; Pugh et al., 2000; Richardson, 1992; Turkeltaub, Gareau, Flowers, Zeffiro, & Eden, 2003; Wender, 1975).

Yet it was not possible at the time when LD was first conceptualized to demonstrate a neurobiological difference at the individual level to drive identification efforts, and it is still not possible to do so. Thus there was a need for guiding principles to operationalize who does and does not qualify as learning disabled, and from this need arose the notion that children with LDs were unified by their “developmental discrepancies in abilities and achievement” (Kirk & Gallagher, 1979, p. 281). This idea came to be conceptualized as “unexpected underachievement” in policies and procedures used to guide the identification and classification of children based on the presence of an LD (Education of All Handicapped Children Act, 1975; U.S. Department of Education, 2006). Variations of these initial policies and procedures continue to determine how resources are allocated and who receives additional educational opportunities through special education (U.S. Department of Education, 2004).

Models of learning disability identification

There are similarities as well as differences in identification procedures used in the schools versus clinics or private practice settings. Whereas within the schools, SLD is the required terminology as outlined by the Individuals with Disabilities Education Act (IDEA; U.S. Department of Education, 2006), outside of the school setting, LDs are currently encompassed under the term “Specific Learning Disorder” in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013). (See Table 1.1 for a comparison of the criteria specified in these documents guiding the identification processes, which are outlined in the following sections.)

Table 1.1

Comparison of identification procedures in clinic (DSM-5) or school (IDEA) settings.

	DSM-5	IDEA
Umbrella term
	Specific Learning Disorder	Specific Learning Disability
Additional specifications
	With impairment in ______ with specified area(s) as indicated below.	Name area(s) as indicated below
Achievement areas (can be identified in one or more of these areas)
Reading	Reading. Specify area(s): word reading accuracy; reading rate or fluency; reading comprehension	Basic reading skill; reading fluency skills; reading comprehension
Written expression	Written expression. Specify area(s): spelling accuracy; grammar and punctuation accuracy; clarity or organization of written expression	Written expression
Mathematics	Mathematics. Specify area(s): number sense; memorization of arithmetic facts; accurate or fluent calculation; accurate math reasoning	Math calculation skills; math problem-solving
Other	N/A (included under language disorder)	Oral expression; listening comprehension (also included under language impairment)
Exclusionary criteria
Capability	Intellectual disabilities	Intellectual disability
Sensory modalities	Uncorrected vision or auditory acuity	Vision, hearing, or motor disabilities
Mental/emotional	Other mental or neurological disorders	Emotional disturbance
Environment/social	Psychosocial adversity	Environmental, cultural, or economic disadvantage
Language	Lack of proficiency in the language of academic instruction
Exposure to instruction	Inadequate educational instruction	Inadequate educational instruction (considered but not listed under exclusionary criteria)
How instructional response is acknowledged
Duration	Symptoms persist for at least 6 months, despite targeted interventions	N/A
Evidence may include	School reports; work samples; rating scales	Direct observations in classroom
	Curriculum-based measures	Curriculum-based measures and curriculum-embedded measures
	Clinical interview; rating scales	Parent and teacher interviews
	Previous psychological or educational assessments
		Progress monitoring data is used to show if student’s rate of improvement will close the gap between student and grade-level peers

School-based identification

The IDEA is a federal law whose purpose is to ensure that students with disabilities receive a free appropriate public education (i.e., FAPE) through the provision of special education and related services (U.S. Department of Education, 2006). The current federal regulations needed to implement IDEA provide the following definition of SLD in 34 CFR 300.8(c)(10):

1. 1. General. Specific learning disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.
2. 2. Disorders not included. Specific learning disability does not include learning problems that are primarily the result of visual, hearing, or motor disabilities, of intellectual disability, of emotional disturbance, or of environmental, cultural, or economic disadvantage (U.S. Department of Education, 2006, p. 46757).

Federal regulations guide the decision-making process schools must use when determining the presence of an SLD. As stated in 34 CFR 300.309(a)(1), first, school teams must determine that the child

does not achieve adequately for the child’s age or to meet State-approved grade-level standards in one or more of the following areas, when provided with learning experiences and instruction appropriate for the child’s age or State-approved grade-level standards: oral expression, listening comprehension, written expression, basic reading skill, reading fluency skills, reading comprehension, mathematics calculation, and mathematics problem solving (U.S. Department of Education, 2006, p. 46786).

Therefore a student could have an SLD in more than one academic area. Interestingly, under the IDEA, the first two areas are also encompassed under speech or language impairment. In the DSM-5, which is used for evaluations outside the schools, these two areas are encompassed under language disorder and are not listed under areas of LD (American Psychiatric Association, 2013).

Although the IDEA definition of SLD has changed very little since the statute’s inception in 1975, the guidance regarding how to identify it has evolved. For example, the 1997 reauthorization of IDE...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• List of contributors
• Preface
• Section 1: Assessment guidelines
• Section 2: Recommendations for intervention and treatment
• Index