||Childrens Medical Office
of North Andover, P.C.
What are Learning Disabilities?|
The term "Learning
Disability" (LD) is a rather new addition to the medical, psychological, and
educational vocabulary of western civilization. Coined in the 1970s, this label was
meant to describe certain students who had difficulty learning one or various subjects
taught in school, despite normal intelligence and reasonably good emotional adjustment.
While just about everyone agrees on this broad definition, precise diagnostic criteria
have been hard to settle on. As a result, there remain various ways of diagnosing and
defining Learning Disabilities.
For fifteen years, I worked and taught in the multidisciplinary clinics at Children's Hospital evaluating
youngsters for school difficulties. We used a model that employs developmental
pediatricians, psychologists, and educational specialists working together as a team.
Since 1996 I was the Associate Director of the Young Adult Team - the Middle & High
School age division of those clinics. What follows reflects my
own personal opinions & positions regarding LD & related topics based on the above
experience. It does not necessarily represent the position of Children's Hospital, YAT, or
any other member of our staff.
LD's are neurologically based - they are caused by poor
"wiring" in the brain. They are usually something a child is born with for no
reason, although they can sometimes run in families or be caused/exacerbated by other
factors (see below).
LD's are not related to maturity or motivation. A child will
not simply "outgrow" an LD - it is not "developmental" in the sense
that teachers or schools often use this word. Simply waiting or retaining a child in a
repeated grade is seldom useful. Moreover, it is also not helpful to "blame the
child" for his or her disability. They cannot be expected to overcome it through
sheer effort alone. Younger LD children are usually very motivated. Older LD children who
may have lost their motivation have done so specifically because they have become
frustrated, discovering over and over again that simply trying harder does not help.
Learning Disabled children, regardless of their age, require a
change in teaching technique to make the way a problem subject is being taught more
closely match their "wiring" or "learning style". Indeed, LD's might
be better thought of as a "mismatch" between learning and teaching styles.
The child with an LD needs to be taught strategies for overcoming their area(s) of
weakness - in other words, for "translating" an unfriendly teaching style into
one which works better for them.
Neurodevelopmental Strengths & Weaknesses (aka "Cognitive Profile")|
skills are abilities which human beings have "wired" into
their brains from birth. These "develop naturally" over time, without any
"teaching" necessary. Other names sometimes used for the same thing include
"cognitive skills", "intelligence", "God-given talents",
"developmental milestones", or just-plain "abilities".
Regardless of what words
you use for them, ND skills are things nobody teaches you in school, yet you need them to
do school work! They include memory, attention,
motor coordination, visual processing, receptive & expressive language, sequencing,
organization, and logic. Other ND skills exist which are less important for academic
success in American society, such as musical aptitude, sensory integration, empathy,
intuition, and social cognition.
One of the great debates in modern psychology is whether or not
"intelligence" is anything more than the simple sum of all these ND skills. If
it is, modern IQ (cognitive) tests dont measure it. Cognitive tests measure a
number of ND skills, lumping the results together into a few numeric scores to generate an
IQ profile. Other kinds of tests may look at one or another ND area in detail (e.g.
& Language for receptive and expressive language; Occupational Therapy for
fine motor coordination & sensory integration, etc.). Neurodevelopmental
examinations are tests measuring most educationally relevant ND abilities, but rather
than lumping them together like an IQ test, an attempt is made to split them apart into
Although most of us have near-average
IQs, very few of us have near-average abilities in all ND areas across-the-board.
Most of us have significant strengths & weaknesses. Our strengths balance out our
weaknesses in a way that brings our overall IQ towards average. Moreover, most of us
utilize our strengths to overcome our weaknesses quite "naturally", without any
assistance from parents, teachers, or the "outside world". People who do this so
that their weaknesses do not impede their learning or job performance are, quite simply,
normal. LD is defined not merely by the existence of an ND weakness, but by an
to overcome that weakness without help. Only when a weakness gets in your way or
becomes an obstacle to your success does it become a "disability". Similarly,
while many of us have significant strengths in one or another area, very few of us utilize
those strengths to do anything particularly unusual or special. "Giftedness" is
not merely the existence of a strength, but the use of that strength to do something
Many factors influence whether a weakness becomes a disability
or not. (And, conversely, many of the same factors influence whether a strength becomes a
"gift".) These include not only what other particular strengths & weaknesses
coexist, but also such things as social environment, family structure, financial
resources, emotional health, and probably even just-plain-luck. School quality & the
match between teacher and a particular childs learning style/personality also play a
role. Sometimes a particular child will appear to have an LD in one school and not in
another, simply by virtue of the schools differences in teaching style.
While a weakness may or may not represent an impediment to
learning in different situations, because they are neurologically based ND weaknesses
themselves cannot be "cured" or directly remediated. Altering the teaching
environment in a way that de-emphasizes the impact of a childs weakness while
calling more consistently upon his or her strengths is therefore the foundation of
Special Education (SPED) assistance for LD children. Specialized LD teachers can
accomplish this. Regular teachers with good "instincts" can do it just as well.
It can happen in either SPED or regular classrooms.
Finally, no discussion of LD's or giftedness would be complete
without reference to two other things - Mental Retardation & Genius. Most people have
strengths that are somewhat above average, and weaknesses somewhat below average, so that
the whole thing averages out, well, near average. Mental Retardation is when even
someones strengths are below average for their age, and their weaknesses far
below, such that the whole thing averages out to be far below average. Genius is the
opposite - even a Geniuss weaknesses are above average for age, and his/her
strengths are very far above average, so that the whole thing averages out far above
<Click here for a graph illustrating what I mean>
In sum, most of us have
strengths & weaknesses that neither get in our way nor enable us to excel. Someone
whose weaknesses impede normal learning has a Learning Disability. When strengths lead to
special accomplishment, thats Giftedness. Someone with Mental Retardation has
weaknesses in all areas, while a Genius has nothing but strengths.
How Are LD's Diagnosed?|
LD diagnosis is a messy
field - lacking in standardization or agreement between experts. There are many protocols,
driven by distinct definitions, practiced by assorted professionals.
- EARLY RECOGNITION:
It's important to recognize many children with LD's were
first identified with "developmental
delays" of one sort or another during infancy, toddlerhood, or the preschool
years. While the chance of "outgrowing" a developmental delay (weakness) in this
young age group (or having it respond favorably to direct "therapy") is much
greater than it is at school age or beyond, many developmental delays in young children
evolve into LD's later in life. Thus, it can be said that many LD's are first diagnosed by
specialists who work with very young children: Early Intervention Programs, Speech
Pathologists, and Nursery School teachers.
oldest, simplest, most widely accepted way of diagnosing an LD is with an IQ test. Two
criteria are commonly used - one being a discrepancy of more than 15 points between
the Verbal and Performance IQ scores, the second being a great deal of "scatter"
or discrepancy between individual subtest scores within either the Verbal or
Performance sections. While either of these findings suggests LD, they can be found at
times in people who are functioning normally. Therefore, one must add the criteria of an
actual delay in learning to these IQ observations in order to fashion a rational
diagnostic method. This approach is the one most commonly used by school systems in states
other than Massachusetts, under the federal PL 94-142 and the Individuals with
Disabilities Education Act (IDEA).
A third, quite straightforward, way of diagnosing LD, popular in Massachusetts
public schools, dispenses with IQ/abilities testing altogether. Instead it focuses on
reading, writing and arithmetic. In this scenario, a detailed battery of Individual
Achievement Testing is carried out. Some (arbitrary) cut-off point is established for the
amount of delay in a particular subject that is considered acceptable. If a child is
delayed beyond the cut-off point, they are considered disabled and are given services. If
their delays are not that severe, they are not considered disabled. This approach is
appealing to some school systems because it's cheap to administer & easy to
understand. It seems outwardly "fair". It skirts the question of "why"
the delay exists, which could be seen as either an advantage or a disadvantage. This
approach can be criticized as avoiding making the diagnosis of LD altogether, but rather
simply giving help to those who are behind regardless of cause.
UP TO POTENTIAL?:
A slightly more sophisticated version of the previous approach compares
achievement test results not to the grade expectations or cutoff, but rather to the
subjective impression of the childs "potential" in the opinion of teachers
& parents. Thus, a 2-year delay in math might be considered more problematic in a
child who seems "bright" than in a child who seems "average". Carrying
that logic one step further, however, one wants to objectify the impression of potential
using something like an IQ or some other abilities test, which brings to the next method.
Many medical centers (and some school systems) combine the
above approaches. They use Individual Achievement Testing alongside Abilities Testing -
either an IQ test or Neurodevelopmental Examination. The latter is more often used in
medical settings for two reasons: First, it allows better "teasing apart" of the
various developmental strengths & weaknesses than an IQ test, so that one can be more
specific about what the LD is based upon. Second, a physician (Neurologist or
Developmental Pediatrician) usually administers the Neurodevelopmental, bringing valuable
medical perspective to the team. In any case, it is necessary to find weaknesses in
abilities along with concomitant delays in achievement, and to be able to reasonably
connect the two, in order to make a diagnosis of LD under this model. While the
achievement-abilities combo should be seen as a "minimal" multidisciplinary team
protocol, other tests & specialties can be and often are added - for instance,
projective psychological assessment to look for emotional problems, OT or Speech
evaluation, etc. All these things add to the depth of any evaluation, and thus lead to a
richer and more complete understanding of the child.
A final way of diagnosing LD's is the
"neuropsychological" or "neuropsychiatric" evaluation. This is a very
detailed battery that combines multiple tests administered from a neurological point of
view, often by a psychologist under the supervision of a neurologist or, alternatively, by
a psychologist with specific neurological training and background. The tests used combine
abilities tests, achievement tests, and some neurological assessment. Such evaluations are
often very helpful in painting a detailed picture of the childs strengths and
weaknesses and can be particularly useful when "normal" SPED techniques have
been tried and failed to help a particular child. For initial diagnosis, however, a full
neuropsychological evaluation can sometimes be "overkill" and yield more
information than is practically useful.
It needs to be pointed out
that ALL the above diagnostic methods are prone to error
in several important ways:
psychological problems can mimic LD's. Therefore, an evaluation
looking for emotional difficulties such as depression, anxiety disorders, and adjustment
problems should really be done alongside any LD evaluation. While almost always included
as part of a team evaluation in a medical setting, schools or private "LD
specialists" often omit this. In older children, it can often be difficult to tell
"what came first, the chicken or the egg" when evidence of both LD and an
emotional problem is found. In many ways this is a false dilemma, however, since in such
situations it is necessary to address both problems simultaneously in order to "break
the cycle & help the child".
Another factor to think about when student is having
difficulty is the
standards of the school system compared to the child's abilities. While it is nice to think
of "national norms" in terms of things like reading acquisition, the truth is
there are many communities across America that deviate from the norm considerably both in
the average academic attainment of their students and in the content of their curriculum.
This can affect students in a number of ways. First of all, when a child moves from one
community to another, trouble can arise if the curriculums are too different in either
direction. Some such children essentially skip a grade, find themselves behind, and start
having trouble where before they had none. This can be misconstrued as an LD at times.
Conversely, children who move to a "slower" district can sometimes develop
behavioral difficulties because they become bored and under-challenged. Another artifact
produced by this variability between community curriculums has to do with a bright child
who nonetheless has an LD. Such a child is far more likely in an accelerated curriculum to
be identified and given some help. Such a child in a slower curriculum setting is apt not
to be seen as having a problem. Conversely, a child of low-average intelligence who is
unfortunate enough to be living in an accelerated community may be misidentified as having
a LD when he really has none. The simple fact is that moving can be both disruptive and
helpful for different children. A good match between the child and his school system is
often times more important than all the SPED assistance in the world.
Who Should Do the Testing?|
In general, there are two
choices to be made when deciding where to have you child evaluated. One is to have
the testing done in the school vs. privately. The other
choice is whether to have it done by an individual
expert vs. a team.
The advantages of school testing are that it is
usually free, it is often a pre-requisite for receiving extra help or specialized services
from the school even if other private testing has been done, and the validity of school
testing is seldom questioned by school personnel. Disadvantages of testing by the school
are several. The background, training and, quality of evaluations provided by the school
varies greatly. Some are very good, but others may be lacking. It can be difficult for
parents to evaluate the qualifications of personnel on the school staff. Moreover,
personnel who are working for the school virtually always have a certain "conflict of
interest" when evaluating children for LD's. A person working for the school
cant simply give an objective opinion about what would hypothetically be in the
childs best interest, but has to temper his or her recommendations with knowledge of
the schools available resources as well as the needs of the students
classmates. Moreover, a second kind of conflict comes about when a child has been
receiving services from the school for some time. In this case, testing which demonstrates
a lack of progress reflects poorly on the schools interventions, services that may
sometimes have been delivered by the evaluator him/herself. The extent to which an
individual evaluator in the school system allows these conflicts of interest to influence
them varies greatly, but it can be hard for a parent to tell the extent to which it has
occurred. The results of school testing may be very valid, but they are always suspect on
PRIVATE: The advantages and disadvantages of private testing
are in many ways the converse of testing carried out by the school. Private evaluators
work for the parents and are free to give their best professional/expert opinions about
what would be best for a particular child without bias or conflict of interest. While the
quality of private evaluators also varies widely, parents have more freedom of choice in
selecting an evaluator and are usually more able to investigate a particular
evaluators background, training and credentials. The disadvantage of private
evaluations is that they are often quite expensive. This can sometimes be mitigated by
health insurance, although many health plans will not cover investigations of this sort.
It is also possible to sometimes get the school system to pay for private evaluations (see
below) although this has disadvantages in terms of the delay it entails as well as
sometimes engendering some bad feelings between the school staff and the parents. Often
times, parents end up having to pay this bill themselves.
looking for private evaluators, there are many different sorts of professionals that one
might utilize. These include Education Specialists (Reading Specialists, Tutors, LD
Specialists, etc.), Psychologists, Speech & Language Pathologists, Neurologists, and
Developmental Pediatricians. In general, no one specialty is better than any other for
these kinds of evaluations, although none of them are able on their own to "cover all
of the bases". Therefore, a team evaluation is almost always best. Ideally, the team
should include psychological, medical, and educational components. Unfortunately, team
evaluations in the private setting can be hard to find and often require a trip to a
teaching hospital to obtain. There can also be long waits for such evaluations.
Financially, they are often bargains (compared to their individual components obtained
separately), however, and the results are the most comprehensive, accurate and reliable.
SCHOOL & PRIVATE SIMULTANEOUSLY:
An ideal situation can be
for parents to obtain private testing at the same time that the school is proceeding with
their own evaluation process. This is best because it has the effect of "leveling the
playing field". When its time to meet with a school to agree on an Individual
Education Plan (IEP), parents who allow the school to do all the testing are at a
disadvantage - the school plays the role of "expert" and the parents have little
choice but to accept what they are told. On the other hand, parents who go into such a
meeting with their own testing already completed have their own idea of what is wrong and
what needs to be done which may or may not jive with the schools plans and perceptions.
The situation then turns into something more closely resembling a negotiation between
Specific Kinds of Learning Disorders|
Most LD's do not have
specific names. Indeed, due to the almost infinite variety of neurodevelopmental
weaknesses that can form the basis of an LD, it would be impossible to come up with some
system of names that covered all the potential varieties. In most cases, it is best to
describe an LD based upon its prominent neurodevelopmental features (e.g. language or
memory based, etc.) or upon the affected academic areas (e.g. Reading or Math
Certain LD's are common enough & have had enough written
about them to have acquired special names of their own, however. The two oldest names
actually pre-date the current LD literature, although we now understand them to be
examples thereof. The first of these is Attention Deficit
Disorder, which has been known and written about since the earliest years of the 20th
century (see separate article). Theoretically and intellectually, ADD (or ADHD) is no
different from any other LD except in the fact that we have medications that can help it
(by improving the functioning of the brain wiring).
Another LD with "roots" long before the current era
is Dyslexia. Dyslexia has been known and written about since
the 1800s. It was a severe Reading Disability characterized by certain distinctive
neurodevelopmental weaknesses including visual processing, sequencing, and language
issues. Not every Reading Disability is Dyslexia, however.
Other named LD's have been more recently described. These
include Dysgraphia, which is a difficulty performing any
pencil/paper types of tasks due to difficulties with fine motor control and visual motor
integration. They also include Dysarthria, which is a speech
impediment based upon difficulties with oromotor control. The term Dyscalculia
is sometimes used to describe a severe Math Disability mirroring Dyslexia in certain ways.
Finally, the term "Non-Verbal LD" (NVLD
or NLD) has been in
fashion lately to describe children who have strong skills when performing work verbally
(listening and talking) but have difficulty with all sorts of academic tasks
based upon weak visual processing, sequencing, and memory skills combined with
difficulties with executive functions and social interactions.
There are also a number of medical/neurologic conditions
defined by symptoms unrelated to learning, but which are often accompanied by an LD as
well. These include Cerebral
Palsy, Traumatic Brain Injury, Epilepsy or Seizure Disorder, Tourettes Syndrome, Narcolepsy, many Genetic Syndromes, as well as syndromes involving patients who in
the past have experienced Head Trauma, Shock, lack of Oxygen, near
Drowning, or who have undergone brain surgery or chemotherapy for cancer. Finally, anything that causes hearing loss, (mild or severe),
especially early in life, including recurrent/chronic ear infections, can pre-dispose to LD later. This can remain true even if
the hearing loss has been corrected if it was present for a significant period of time
early enough in life.
Developmental Delay in Infants, Toddlers, & Preschoolers:|
As mentioned earlier, LD's
often present initially as developmental delays in infancy, toddlerhood, or the preschool
years. A Language-Based LD may present as delayed talking or early difficulty following
directions. Non-Verbal LD may present with delayed finger feeding, scribbling, drawing, or
difficulty using scissors or learning how to hold a pencil or crayon the right way. In the
past, much was made of "handedness" in the preschool years. While LD may be
slightly more prevalent among left-handed individuals, this is a very weak association.
There are many right-handed individuals with LD and the majority of left-handed
individuals are not Learning Disabled. Attempts to change the handedness of a child
early in life do not prevent (and may even exacerbate) any LD destined to develop in that
The most important thing in this age group is to pay attention
to any delays in their development and address them with appropriate therapies and
interventions as early as possible. Neurodevelopmental weaknesses are never as
responsive to therapy as they are in infancy and the preschool years. This may be the one
time in life where it actually may be possible to reduce the severity of such a weakness
rather than just teach strategies for overcoming it. With this knowledge in mind,
"Early Intervention" has developed as both a field and as a legal mandate over
the last 25 years. Federal law requires that Early Intervention services (which may
include Speech Therapy, Physical Therapy, and other developmental interventions) be paid
for by health insurance. Children from birth until age 3y are eligible. They can qualify
either because of actual developmental delay, or because of situations (e.g. prematurity
or a particular medical diagnosis) which put them at higher risk for having developmental
delays and/or LD later. Early Intervention has been proven to reduce the degree of later
disability, and is available in most areas of the country. Children can be referred to
Early Intervention by their parents, physicians, day care providers, or teachers.
Government picks up the tab for people who lack health insurance.
Interestingly, the "conflict of interest" in the
Early Intervention world tends to run in the opposite direction as it does for Special
Education in the older age group. Public schools providing SPED services (age 3 & up)
tend to operate on a fixed budget and need to divide their resources among all the
children who need them. In contrast, Early Intervention has a guaranteed funding source
due to its federal mandate for insurance coverage. Early Intervention programs tend
to be private, non-profit corporations, at least in this part of the country. A director
simply hires more staff when they find more children with needs. Indeed, the way they grow
their program is precisely by finding more such children. Given the importance of Early
Intervention, this is probably good. It does lead to something of a rude awakening for
parents when their children reach age 3, however. Very often, children who were felt
to have significant needs by their local Early Intervention program, when "handed
off" to the public schools at age 3, experience severe cutbacks of services due to
the differing financial and political circumstances of the two programs and resulting
differences in criteria of "need".
Despite the above, perhaps the most successful SPED model ever
developed by public schools is the "Integrated Preschool" designed to serve the
3-4y age group. Nurses, Early Childhood Specialists, Speech & Occupational Therapists,
Physical Therapists, and Psychologists in addition to Teachers staff such preschools.
Generally a mixture of special needs and normal children are enrolled. They were the
original example of "inclusion models" and can boast a fantastic success record
at "turning around" many children with significant early developmental delays.
Especially around this geographic area, the public Integrated Preschools are glowing
examples of the best that Special Education has to offer.
One final note about early developmental delays. It is in this
age group that developmental delays are most likely to be indicative of an underlying
medical problem. Although the majority of developmental delays are NOT medically based,
the younger they are when they present, the more likely there is to be a medical diagnosis
underlying them. Therefore, all children who present with developmental delays in the
early years ought to have a full medical evaluation as part of their assessment.
Learning Disabilities in Early Elementary School|
The early elementary years
(K - 4th grade) are a crucial time from an educational standpoint. It is when
children are supposed to learn the "building blocks" upon which all other skill
& knowledge is based. Successful acquisition of these "basics" is not only
necessary later in school, but also for success in work and life in general. The pace of
learning in these years is intense, and if a child falls behind, it can be very hard to
Many LD children are first noticed when they start falling
behind in the early elementary years or have difficulty acquiring basic skills. Children
who did not appear developmentally delayed prior to school entry but who show problems
early-on, once they enter school, are far less likely to have medical problems, Mental
Retardation, Autism, or other diagnoses and are far more likely to have mild or subtle
learning problems. Luckily, most early elementary teachers are both alert and sympathetic
to such children. In most school districts across the country, the tendency is to
recognize these problems are not the childs fault and to offer assistance once the
need is recognized.
Another fortunate thing for the early elementary LD child is
the fact that they themselves usually do not yet realize they are different in any way. If
there are no associated underlying emotional problems, they tend to be well-motivated,
well-liked, and well-behaved - all of which helps the people helping them a great deal.
Learning Disabilities in Late Elementary & Middle School|
There is a "myth"
in schools, it seems, that children outgrow Learning Disabilities, or that they should
somehow be "cured" by this age. One of the more common scenarios we see is the
LD child who was identified in early elementary school, or even earlier, who was well
served by an appropriate IEP for many years, who seemed to be doing well and making great
progress. Then around 5th grade, people start to think SPED services can/should
be withdrawn. This is done, and surprise-surprise, their grades start to fall and they
struggle over the next few years. Often at the same time (since by now a child is socially
mature enough to realize whats going on, suffer falling self esteem, and try to
compensate by "acting out") behavior problems appear. Whats really
surprising (and a shame) is that too often schools then fail to think, "oh, that was
obviously a mistake - lets resume the SPED support". Instead, the LD
"label" disappears and is replaced by "lazy", "behavior
problem" or worse.
The fact is that things often get harder during the Middle
School years (5th - 8th grade) - for LD and non-LD students alike.
The nature of academic demands changes radically. All of a sudden, a child is reading to
learn, rather than learning to read. Also, they are expected to show what they know in
writing at great length, organize their own work, keep track of assignments, and stick
with long-term projects. These new demands call on strengths (and emphasize weaknesses)
that were less important in early elementary school. Some children with LD can even start
having difficulty for the first time at this age. In particular, children who are bright
but have Attention Deficit Disorder or organizational difficulties are particularly prone
to stumble in the middle school years. For them, it is like the structure they depended on
is suddenly removed, and they lack the internal skills to replace it. Unfortunately, such
children are less likely to be greeted with the sympathy, support and assistance that
younger children are. Too often, teachers take their prior good performance as
"proof" that they are capable, and instead tend to blame the child. Most school
districts tend to be far more reluctant to begin SPED services for a child in this age
group who has never had them before than they are in earlier years.
Another thing that happens in middle school is children become
increasingly aware of their differences. Children with LD's who are receiving assistance
often increasingly feel stigmatized by this. They become resistant to accepting the help,
their peers can tease them and their self esteem can suffer. Behavioral problems can
result. This makes school personnel even less likely to look sympathetically upon their
In sum, there is a common believe that LD's are a phenomenon of
early elementary school that, if helped appropriately, should resolve by late elementary
school. Nothing could be further from the truth. Children who require SPED assistance in
early elementary school often continue to require that assistance through middle school
and beyond, and will suffer if it is withdrawn from them. An additional group of children
first manifest their LD's in this age group are every bit as deserving of help.
Unfortunately this age group is far less likely to be given that help, and far more likely
to be "blamed" for something which is outside of their control.
Learning Disabilities in High School|
The availability of SPED
services is highly curtailed at the High School level. Those services which do exist tend
to be oriented to the more severely handicapped population and not towards LD adolescents.
Very often, teens with significant delays also manifest increasing behavioral problems due
to their frustration, poor self-esteem, and their need to demonstrate competency in other
areas. Thus, they are far more likely to be seen as "lazy",
"unmotivated", or even "delinquent", and their LD's are often ignored.
Adolescents with LD's do not do well with traditional pull-out
or inclusion services. They usually prefer to receive private tutoring and they can
benefit from certain accommodations to their difficulties such as untimed tasks and tests,
and reduced homework loads. Things actually get better at the college level. There are
many colleges across America with specialized LD programs that are quite good.
The thing to be avoided, which is all too common in the
adolescent age group, has been referred to as "developmental output failure".
This is essential a vicious cycle in which a childs LD becomes a self-fulfilling
prophecy. The child has not been given enough help in the early years and by the time he
or she reaches high school, has become convinced that success is not possible. As a
result, they indeed ARE unmotivated - due to learned frustration and expectation of
failure. People around them (parents & teachers) who tend to blame it on "poor
character" reinforce this. In order to break this cycle not only SPED assistance but
a great deal of support, encouragement, and active efforts to help the adolescent
experience success & competency are necessary.
Special Education Law - How it is & How it should be:|
Since the late 1970s, it has been law
everywhere in America that local public school districts are required to
provide "whatever a child needs in order to learn". In most of the United
States, the law that says this is a Federal one (originally PL 94-142, now IDEA-97). Certain states, including Massachusetts
(originally Ch. 766, now Ch. 71B), have their own laws which are more narrowly defined and
therefore supersede the Federal one. What I am going to say in this section, except as
otherwise noted, applies to the situation in Massachusetts at the current time, although,
much of it is also applicable to the rest of the nation.
The first thing that is important to understand about these
laws is why they were originally written. Prior to the late 1970s, many children in
this country with severe disabilities (Mental Retardation, Downs Syndrome, etc.)
were simply "warehoused" rather than educated. They were placed in separate
classrooms or in separate institutions and given custodial care, little more than
baby-sitting. Little or no attempt was made to teach them anything. At that time in our
history, LD's were not even thought about, hardly a "blip on the radar
screen" for politicians or public
The laws currently applied to Learning
Disabled students were not written for them. They were written with the much more severely
handicapped in mind. They were written to end
warehousing of the mentally retarded. They said two things
- First, that an attempt to educate these children must be made to some reasonable degree
(see below). Second, that to the extent possible, these children should be
"mainstreamed" (the legal phrase used for this was "educated in the least
restrictive setting possible"). The law in this regard has largely succeeded.
Today we have a society, not just in the public schools but throughout our culture, in
which handicapped persons of all stripes are far more integrated than they once were.
Nobody argues but that this is a good thing. However these laws, written to end the
warehousing of severely disabled individuals but subsequently applied to LD students as
well, have worked much less well for the Learning Disabled population. (See "Who
Qualifies" and "Inclusion vs. Pullout" below).
A few years ago, the regulations in Massachusetts governing
Special Education (SPED) were revised. The revisions generally favored
school districts and their budgets at the expense of families whose children
had special needs. They focused on "who qualifies",
tightening up those requirements and giving schools more control over spending. This
was justified by supporters of the changes by pointing out that Massachusetts
has one of the
highest percentages of children in SPED of any state in the country. In my opinion
this really missed the important points, however. It is very hard to
"codify" a system of SPED qualification - each situation is different, calling
for individual case-by-case judgment with lots of parental input. It would be much
better to debate WHO PAYS and
DECIDES rather than "who qualifies".
The major flaws in current SPED law, it seems to me, are:
It puts responsibility for
evaluation and deciding "who needs what" in the hands of the
very same people who are responsible
for delivering services and administering SPED budgets, creating the conflict of interest described
mixes up the two separate issues of clinical need and who
pays. Public school staff have no legal way of saying to a
parent, "Yes we think your child would benefit from that, but we
can't afford to pay for it." Thus, when a service has to be
denied for budget or staffing reasons the school is forced to make the
often dishonest case that the child doesn't need or wouldn't benefit
To solve the first problem,
I would propose establishing a procedure for state "accreditation" of private LD
evaluation centers (which would allow standardization of and state input into what sorts
of testing and diagnostic criteria are used). I would then take evaluation, needs
determination, and IEP writing out of the hands of local schools altogether, and give it
to the evaluation centers. They could evaluate the child and write up their objective
findings/recommendations in an IEP-like format that could be taken to the local school to
be "filled" much like you take a prescription to the drugstore.
In order for the above to
work, however, local schools need a guaranteed source of funding to fill these
"prescriptions" which doesnt threaten the remainder of their programs and
budget. We need to have an honest conversation about who should pay for
what. Guaranteed funding for such services already exists under age 3, in the form of
law requiring Health Insurance to cover all services (and the state to pay when children
have no insurance) determined to be necessary and delivered by certified Early
Intervention programs. We need to extend these same guarantees throughout childhood - or
find some other separate SPED funding mechanism. Many ways to do this could be proposed,
for example, requiring Health Insurance to pay for the evaluations and any OT, PT, Speech
Therapy, Communication Technology, medical or psychological care needed, while having
state reimbursement available to local schools for increased educational costs in SPED
kids. The latter might include funds for things like tutors, specialized staff or staff
training, LD teacher salaries, alternative textbooks, educational software, and other
specialized classroom equipment/supplies.
I would encourage anyone
who cares about these issues in Massachusetts to contact
their state legislator or the Mass. Dept. of Education. Tell them simply that giving schools more control and
tightening eligibility will not fix the problems, that they need to SEPARATE
NEEDS DETERMINATION FROM SERVICE DELIVERY and ESTABLISH
GUARANTEED FUNDING SEPARATE FROM REGULAR EDUCATION when they "reform"
here to read a letter on this subject written by Dr. Ansel to the Mass. Dept
of Education at the time they were considering the above regulation changes.
here to go to the web site of the best law firm in Massachusetts specializing
in SPED law.
SPED Procedures, Policies, and the Individual Education Plan (IEP) -|
All children are
"assumed" to have no needs beyond whatever regular education program is offered
in a particular school district until & unless someone alleges, in writing,
otherwise. When that happens, the schools are required to conduct an evaluation (called a
"CORE" evaluation in Massachusetts) to determine whether it is true, and if so,
what those needs are. In Massachusetts, such an allegation can be made by anybody. A
parent, a teacher, a doctor, a therapist, or even a stranger! If the school janitor states
in writing that he thinks a particular child has "Special Needs", that sets the
"process" which is required by law into motion.
In Massachusetts, the CORE evaluation process is supposed to be
completed within 90 days (although it is unclear whether this means 90 calendar days, 90
school days, or 90 business days). It is the schools prerogative to determine how
the evaluation is completed and what it consists of. It can include any testing which they
deem appropriate, and that testing can be carried out by school employees, private
professionals under contract, or anybody else whom they designate. There is no single
standard battery of tests either mandated by law or universally agreed upon by school
Once whatever testing process deemed appropriate by the school
is complete, the next step is to have a meeting. This meeting is normally attended by the
SPED director of a school, the childs parents, some of the childs teachers,
and any other interested parties (often including some of the evaluators, although this is
not required), and also often involving Guidance Counselors, Speech Therapists, or other
school staff who may be involved with a child. Doctors (Neurologists, Developmental
Pediatricians, Psychiatrists) who may have evaluated the child rarely attend such
meetings, mostly because it is difficult to get health insurance to cover the cost of such
attendance. That is unfortunate since their presence would certainly be helpful. The
purpose of the meeting (which in Massachusetts is called a "CORE meeting") is to
present to the parents and the rest of the Team members the results of the testing as well
as a proposed Individual Education Plan (IEP).
An IEP can call for almost anything. At one extreme, it could
simply say that the child has no special needs and will be returned to the regular
education setting with no SPED services. At the other extreme, it can say that a child
needs to and will be placed in a substantially separate setting outside the mainstream
designed for their particular LD. The majority of IEPs designate some level of need
and some type of service between these two extremes. These services could include
tutoring, small classrooms taking a different approach to teaching, Speech or Occupational
Therapy, counseling, or almost any other thing which might be necessary.
Parents have several options following a CORE meeting. It is
important for them to be aware of these options going into the meeting, since often times
the school staff will not fully explain them or will emphasize one and de-emphasize the
- One option is to accept the IEP in full.
This should only be done if parents are
totally satisfied that both the conclusions of the evaluation and the planned services
are appropriate. Accepting the IEP in full has the affect of "locking in" that
the next year - the school is under no obligation to change or renegotiate it sooner.
- A second option is to reject the IEP in full.
This should only be done in rare circumstances. It is the equivalent of a parent saying, "I do not feel my child has
special needs, I want no services, and I want my child returned to the regular
education classroom". At that point, parents give up all rights to their child
receiving any SPED services for another year.
- A third option amounts to a "line item veto".
Parents can choose to accept
portions of the IEP and reject others. This should be done only by
parents who know very specifically what they want and why, usually with some
outside expert advise.
- A fourth option is simply to delay a decision.
Parents have the right to take the
IEP and think about it or consult with anyone who they choose outside of the
school, and delay a decision for up to a month after the CORE meeting. This
would be a good option if, for instance, you wanted to have one of the
providers at our office review the IEP before you sign it.
- Finally, parents have a right to delay a decision pending
an independent evaluation,
and they used to** have the right to request
the independent evaluation be provided (paid for) by the
school. In this instance, the outside evaluation needed to occur at a
acceptable to both the parents and the school system. Obviously because outside
evaluations are very costly and they mean that the parents are not trusting the
results of the school testing, school officials were rarely pleased when this option
is chosen. It also must be borne in mind that, although the school
was paying for an independent evaluation, they were
under no obligation to heed its recommendations. Usually,
once an independent evaluation obtained in this way was completed, a second CORE
meeting will be held.
(** This right is one of the things
that was seriously curtailed by new regulations in Massachusetts adopted by
the DOE in 1999 - now paying for "second opinions" or outside assessments
is usually the parent's (or their health insurer's) responsibility,
unless a hearing before a DOE panel finds the school's evaluation to be
the school and the parents cannot reach agreement over an I.E.P., there are mediation
procedures in place that can be resorted to at a state level. Parents who find themselves
in this situation will usually want to have the assistance of someone familiar with the
process such as a child advocate (available privately or through the
Children With Special Needs or through the a variety of internet
sites) or perhaps even a lawyer.
If the mediation process fails, the parents can take the school
system to court. Fortunately, most families never reach this predicament. A more common
scenario is the IEP which is agreed upon by parents and the school but which either is not
fully implemented or isnt implemented to the parents satisfaction. The truth is,
what exists "on paper" in an IEP and what actually goes on in the classroom
rarely correspond exactly. These things always depend on the motivation, training,
experience and instincts of the teacher(s) involved. Another common scenario is the IEP
does not seem to be working and needs to be re-thought and re-written. When parents and
teachers agree that this is the case, usually, there is not a problem, but if the parents
think this and the school does not, a dispute can occur.
Normally, IEPs are re-written once every year. A repeat
CORE evaluation is mandated once every three years for those who continue to receive SPED
services. Evaluations sooner than three years can be conducted by the school at their own
prerogative but are not required. They can also, of course, be obtained privately at any
time by the parents. Once again, however, schools are under no obligation to pay any heed
to independent private evaluations.
A final word is in order about reading
IEPs. Generally, IEPs can be divided into three sections. The initial
section (first few pages) describes the child in question. It
is important to read this carefully as it reflects the schools understanding of what
is wrong. It is important that a parent be satisfied that a school understands their
child. Distortions or omissions from this section should be considered serious things that
ought to be corrected. The middle section of an IEP, ranging from one to more than 20
pages, consists of individual "instructional goals".
Within these pages are the specific techniques which are supposed to be used by the
teachers, their purpose, and goals for educational attainment by the child during the next
year. As the year goes on, there is often a large discrepancy between reality and what is
written in this section. That usually does not matter very much. Although the most
detailed, this is also usually the least important part of the IEP. The final section of
the IEP is a statement of services and overall level of
service. This summarizes such things as how many hours or minutes per week of tutoring, LD
assistance, Speech Therapy, etc. a child is to receive and in what location. In
Massachusetts, this service level has traditionally been "**coded" or categorized in a system of 502.x. The code is as follows:
(** This is another
feature that was done-away with by regulation changes in 1991 - supposedly to
"increase flexibility" for schools but the real impact has been to make it
harder for parents and outside professionals to judge the level of service actually being
provided. I encourage parents to ask schools what 502.x level an IEP would
have been under the old system.)
meant monitoring by the Special Education
Dept. but with no direct services.
meant some direct service but the majority of the
childs time is in the regular education setting.
meant a substantial amount of
encompassing the majority by not all of the childs time.
indicated full time placement in a special
setting (or its functional equivalent in an inclusion model).
meant an outside private
placement in an alternative
was a special temporary diagnostic placement.
This final service-delivery
specification page should be closely scrutinized for accuracy, as it matters more than any
other portion of the IEP. It constitutes the "bottom line" regarding how much
the child is to receive, where, and by whom. There are also sections here for
specifying whether any alterations to the normal disciplinary code and/or graduation
requirements apply to this particular child.
Inclusion vs. Pull-out -|
The idea of mainstreaming
or "least restrictive environment" has become something of a "holy
grail" among educators in America over the past 20 years. In the name of this
principle, schools have been moving in the direction of providing more & more SPED
services within mainstream classrooms rather than having children "pulled out"
to see tutors, reading specialists, and therapists.
There is no data showing whether learning outcomes are better
or worse with inclusion vs. pull-out. Remember the idea of "least restrictive
environment" was put into the original laws in order to end "warehousing"
of severely handicapped children. It was NOT based on any knowledge about children with
LD's. Most LD research suggests that the more intensive the services a child
receives, and the more specialized for their specific LD, the better the outcome
will be. This is probably true regardless of whether the services are delivered in
an inclusion or pull-out mode. There can be good and bad inclusion programs just as there
are good and bad pull-out programs. The good programs of either model will tend to
be the ones that have the smallest student/teacher ratio, the most highly qualified,
trained and specialized personnel, and to which the most resources (financial &
otherwise) are devoted. It is therefore not possible to state a general rule about whether
pull-out or inclusion is better.
Every child is an individual, however. For certain individuals,
one model or the other may be preferable. In general, parents are in a good position to
judge this themselves. If a child is feeling (or apt to feel) particularly stigmatized by
having to leave the classroom for SPED assistance, moving in the direction of an inclusion
model may be very beneficial. Alternatively, if a child needs structure or is highly
distractible (not doing well when other children in the room are engaged in different
activities), that child might do better with pull-out. Children whose delays involve all
academic areas, and are so severe that virtually everything going on in the classroom is
"over their heads", also are not good candidates for inclusion. They will be
made to feel inferior, and may even begin to feel a need to confabulate to cover up the
inadequacy. Such children do better when grouped with other children (same or different
age) who are functioning at a level close to where they are. In this way, instruction can
be directed at their level and they do not feel so different.
Another issue to think about in regard to pull-out vs.
inclusion involves the issue (alluded to above) of whether what is actually going on
day-to-day with the child matches what is written in the IEP. Oftentimes in an inclusion
model, especially when a single SPED teacher is having to service several students with
differing educational needs simultaneously in a mainstream classroom, the specific
methods/goals of the IEP for a particular child can get "lost". In these
situations, pull-out can sometimes be a remedy.
Finally, it must be recognized that a big part of the benefit
of "inclusion" accrues not to the disabled or special needs children, but rather
to their "normal" peers. There is no doubt that normal peers benefit from
exposure to disabled children in terms of learning tolerance and developing helping
skills. Such benefits surely have a value to society, but at whose expense? They should
not be given precedence over the educational needs of the individual child.
In an ideal world, all school systems would have the
flexibility to provide children with services in either an inclusion OR a pull-out model.
Selecting which is best would be a collaborative effort between parents & school
staff, individualized for each child. The truth, however, is that many school systems
utilize exclusively one or the other model as a matter of "philosophic belief".
This is unfortunate and something that we all should be working to change.
Obviously, parents with
financial means are always free to purchase whatever services they feel their child needs
privately at their own expense. This can be very expensive, however. The vast majority of
LD children's parents would find this to be quite a hardship. They have no choice but to
rely on services provided and paid for through the public schools in accordance with law
(see above). After a school system has conducted an evaluation, how do they determine
whether a child qualifies for services, and what services a child qualifies for?
answer to this question varies quite a bit between states and communities across the
country. It can also vary in a single community over time depending on staff and budget
fluctuations. There are two basic ways of approaching this problem, however -
"categorical" methods, and "functional" methods.
Most states in the nation use the categorical approach.
Under this approach, certain diagnoses qualify, others dont. At the most basic
level, children in these states are "coded" as either Learning Disabled,
Emotionally Disturbed, or Medically Handicapped. If the children do not have a diagnosis
that falls into one of those categories (by state or city criteria), they are not eligible
for services. In these states, political battles over eligibility tend to revolve around
which diagnoses are included in these lists. For instance, a common controversy is whether
Attention Deficit Disorder "qualifies" at all, and if it does, which category it
Until recently in Massachusetts, the
"functional" approach was used instead. Here, the specific diagnosis really does
not matter. Indeed, in their CORE evaluations Massachusetts school systems
"shy away" from applying labels or making diagnoses at all. Instead, it is
determined how far behind a child is in certain areas. If their problems are deemed to be
severe enough (by local criteria) for whatever reason, services are rendered. Since
1999 Massachusetts has begun moving towards the Categorical approach,
requiring a qualifying diagnosis. Because of the functional
tradition in the state, however, these requirements are sometimes rather
approach has the advantage of making services somewhat easier to obtain (as evidenced by
the fact that Massachusetts has one of the highest SPED delivery rates in the nation), but
it also has disadvantages. In particular, children in states where this approach is taken
often remain undiagnosed longer. Parents may feel that they dont know why their
children have the problems they have. This can be as frequent a reason for seeking
independent evaluations or second opinions in such states as disputes over what the needs
How Much is Enough? (Maximum Feasible Benefit vs. Adequate Progress)|
philosophical topic greatly affecting the issue of "who qualifies for what" has
to do with the standard of need being applied. This comes down to two opposing viewpoints:
optimal benefit vs. adequate
Optimal benefit basically holds that a child deserves to
receive whatever services would enable them to develop, grow, and learn to the fullest
extent of their potential. For example, if a child has an above-average I.Q. and ought
to be functioning several years above grade level, but isnt due to an LD, this
view would say bringing the child to grade level is not enough. He or she ought to be
brought to the level they should be at by virtue of their potential. Such a child
functioning "at grade level" would still be viewed as "delayed". Most
parents naturally fall into the optimal benefit camp, at least when discussing their own
children. What parent doesnt want the best for their child?
Most school officials, politicians, and even many parents (if
thinking about somebody elses child) adhere to the "adequate progress" is
good enough point of view. They would argue that the optimal benefit standard is too
idealistic, expensive, and even discriminatory. That if every child
received the "ideal" services to bring them to their "full" potential
society would be unable to afford the expense. It would break the budget of most school
districts. They say if one allows an "optimal benefit" standard it creates a
competition for services in which the playing field is not level. The children who actually
receive the "optimal service" end up being the ones whose parents are best able
to advocate for them - meaning parents who are educated and have financial resources.
Children with perhaps greater needs but less resourceful parents under such a system get
less. Advocates of this viewpoint believe all children should be entitled to a certain
"adequate" level of service that enables them to progress, but not necessarily
to the "optimal benefit".
The problem with "adequate progress" is how to decide
whats adequate. Very often, the standard used is functioning within one (or two)
"standard deviations" of grade level norms. In practical terms, this means being
less than a year delayed in the first few years of elementary school, less than two years
delayed in late elementary to middle school and less than 3-4 years delayed in high
school. Other ways of measuring adequacy include "slow but steady progress", or,
for children who are not felt to have the potential to work up to grade level, some
arbitrary determination of what their potential might be.
In practice, most of the country adheres to the adequate but
not optimal standard, although loosely. In cases where parents are very forceful
advocates, certain children do manage to obtain more. There was a time back in the
1980s when Massachusetts was one of the most "optimal benefit" oriented
states in the nation, although this has changed markedly in the last decade despite
language in our state law which supports that concept.