Rethinking Learning Disabilities: Understanding Children Who Struggle in School

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Individual decisions were highly accurate if the formulae indicated no LD. However, positives for LD decisions were inaccurate because of a high false positive rate. In a series of studies summarized in Miciak, Fletcher, and Stuebing , there was poor overlap between concordance—discordance and cross-battery methods. Simply changing highly correlated achievement tests and holding the cognitive assessments constant led to low agreement in individual decisions.

Given poor reliability, it is not surprising that treatment validity evidence is also lacking.

Miciak et al. There was little evidence of incremental value relative to baseline assessments of reading skills. Burns and colleagues synthesized studies addressing the relation of cognitive and neuropsychological tests for screening, planning, intervention design, and outcomes. These findings highlight the essence of the issues involved in assessing cognitive processes, which is the value of the assessments for identification and intervention. What value is added by measuring correlates when levels of academic achievement have been assessed?

Contrary to proponents of cognitive assessments Hale et al. In fact, their status is no better than the null results for low level optometric exercises, physical exercise, colored overlays and lenses, and other questionable treatments Pennington, It is important to separate a clinician's evaluation of a comprehensive assessment that includes cognitive and achievement tests, history, and behavioral observation from the cognitive tests themselves.

It seems likely that clinicians can make more informed decisions because they can account for measurement error and have experience, and that judgement may be enhanced by observing children undergoing testing Waber, We ask what needs to be observed: The student memorizing lists of words, drawing, or connecting numbers and letters, or actually reading, writing, and completing math problems. Any evaluation of a child for LD must include a careful assessment of academic performance, especially for high stakes decision-making. This assessment, in combination with direct observation, history, and evaluation of contextual factors and other possible disorders, provides ample opportunity to develop and apply clinical judgement.

If there is a question of an intellectual disability or autism spectrum disorder, for example, IQ tests may be important for identification and treatment Munson et al. We also would not extend our arguments to children with brain injury, including congenital disorders, frank brain injury, or conditions or treatments variably associated with brain injury e. Prior to formal academic instruction, a short cognitive assessment may help identify children at risk for LD.

The utility of these cognitive assessments expires once formal academic instruction and academic achievement can be directly assessed. Evaluating adults with LD has not been adequately studied and some suggest an important role of neuropsychological testing for adults, especially given the inability to observe adults in intervention and the rules for accommodation laid out for high stakes tests Mapou, We would still argue that such assessments should include a careful review of previous assessments and especially of intervention history, with particular attention to the automaticity of academic skills.

We urge empirical evaluation of this hypothesis. For example, Fuchs et al. It may be that embedding cognitive interventions within academic instruction will prove more beneficial for some students. The issues with the reliability of individual decisions for cognitive tests are universal across alternative methods for LD identification. The hypothesized attributes of LD low achievement, cognitive discrepancy, instructional response are dimensional and normally distributed in the population. When formulae are applied that use bright thresholds with no consideration of the measurement error present in any psychometric measure, individual decisions will not show strong agreement Fletcher et al.

Some may conclude that the problem with use of cognitive tests is with the application of formulae, but we see little evidence of relations with identification or intervention at a group level when achievement is measured. We have argued that cognitive tests are not necessary for evaluating LD. At the heart of this argument was two implicit questions. First, what is the cost?

If cognitive assessment does not improve the reliability or contribute to intervention outcomes, we cannot afford them.

Rethinking Learning Disabilities : Understanding Children Who Struggle in School

Funds spent for assessment may reduce funds available for intervention, which is a higher priority. As an alternative conceptualization, we would focus on inadequate response to quality instruction. The child with LD is harder to teach—not unable to learn. These assessments should be brief, directly assess the behaviors of interest, and focused on hypotheses about why the child's learning is not adequate.

If other disabilities or comorbid disorders are suspected, the comprehensive assessment process should include assessments to evaluate this possibility e. Any assessment should lead to intervention. Because of the importance of screening and early intervention, we have advocated that the comprehensive assessment process is best conducted in the context of service delivery frameworks representing response to intervention or multi-tiered systems of support.

Although it is true that neuropsychologists may evaluate children outside school contexts, the focus should still include a review of instructional history and response, along with assessments of academic achievement and contextual factors and other disorders. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development or the National Institutes of Health. Oxford University Press is a department of the University of Oxford.

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Rethinking Learning Disabilities: understanding children who struggle at school – By Deborah Waber

Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Evidence for the Value of Cognitive Tests. Concluding Comments. Conflict of Interest. Editor's Choice. Oxford Academic. Google Scholar. Jeremy Miciak.


Cite Citation. Permissions Icon Permissions. Abstract There is considerable controversy about the necessity of cognitive assessment as part of an evaluation for learning and attention problems.

Learning disabilities , Neuropsychological assessment , Response to intervention , Cognitive processes. Google Preview. Meta-analysis of academic interventions derived from neuropsychological data.

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Search ADS. Neuropsychological profiles of written expression learning disabilities determined by concordance-discordance model criteria. Psychometric approaches to the identification of learning disabilities: IQ and achievement scores are not sufficient. Does working memory moderate the effects of fraction intervention? Login Remember me. Lost your password? Your personal data will be used to support your experience throughout this website, to manage access to your account, and for other purposes described in our privacy policy.

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