678407

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LDXXXX10.1177/0022219416678407Journal of Learning DisabilitiesMichele et al.

Article
Journal of Learning Disabilities

Cognitive Clusters in Specific

2018, Vol. 51(1) 32­–42
© Hammill Institute on Disabilities 2016
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DOI: 10.1177/0022219416678407
journaloflearningdisabilities.sagepub.com

Michele Poletti, PsyD1, Elisa Carretta, MS2,3,

Laura Bonvicini, MS2,3, and Paolo Giorgi-Rossi, PhD2,3

Abstract
The heterogeneity among children with learning disabilities still represents a barrier and a challenge in their conceptualization.
Although a dimensional approach has been gaining support, the categorical approach is still the most adopted, as in the
recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The introduction of the single overarching
diagnostic category of specific learning disorder (SLD) could underemphasize interindividual clinical differences regarding
intracategory cognitive functioning and learning proficiency, according to current models of multiple cognitive deficits at
the basis of neurodevelopmental disorders. The characterization of specific cognitive profiles associated with an already
manifest SLD could help identify possible early cognitive markers of SLD risk and distinct trajectories of atypical cognitive
development leading to SLD. In this perspective, we applied a cluster analysis to identify groups of children with a Diagnostic
and Statistical Manual–based diagnosis of SLD with similar cognitive profiles and to describe the association between
clusters and SLD subtypes. A sample of 205 children with a diagnosis of SLD were enrolled. Cluster analyses (agglomerative
hierarchical and nonhierarchical iterative clustering technique) were used successively on 10 core subtests of the Wechsler
Intelligence Scale for Children–Fourth Edition. The 4-cluster solution was adopted, and external validation found differences
in terms of SLD subtype frequencies and learning proficiency among clusters. Clinical implications of these findings are
discussed, tracing directions for further studies.

Keywords
specific learning disorder, neurodevelopmental disorders, cluster analysis, multiple cognitive deficit model, cognitive
development

The heterogeneity among children with learning disabilities
still represents a barrier and a challenge in their empirical
and clinical conceptualization (Branum-Martin, Fletcher, &
Stuebing, 2013; Fletcher, Lyon, Fuchs, & Barnes, 2007).
Although a dimensional approach has been gaining empiri-
cal support (Snowling & Hulme, 2012), the categorical
approach based on psychometric tests and cut points
remains the most adopted in this field.
The fifth edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-V; American
Psychiatric Association, 2013) still opted for a categorical
approach, introducing the single overarching diagnostic
category of specific learning disorder (SLD); this decision
was made considering that specific learning disabilities
share many features regarding genetic risk, environmental
risk factors, developmental features, comorbidity, and
cognitive weaknesses (Tannock, 2013). However, the
choice of a single overarching category may underempha-
size interindividual differences regarding profiles of cog-
nitive functions and learning proficiency (Cornoldi,
Giofrè, Orsini, & Pezzuti, 2014; Giofrè & Cornoldi, 2015;
Poletti, 2016a). Indeed, current cognitive models of neu-
rodevelopmental disorders (e.g., Pennington, 2006;
Wilcutt et al., 2010) involve multiple and additive cogni-
tive deficits. For example, impairment in reading (i.e.,
dyslexia) is associated with deficits in skills both linguis-
tic (e.g., phonological awareness: Melby-Lervag, Lyster,
& Hulme, 2012; Morris et al., 1998) and visuospatial (e.g.,
visuospatial attention: Franceschini, Gori, Ruffino,
Pedrolli, & Facoetti, 2012) and shares executive deficits
with impairment in math (Wilcutt et al., 2013).
1
Child and Adolescent Neuropsychiatry Service, AUSL of Reggio Emilia,
Italy
2
Inter-Institutional Epidemiological Unit, AUSL of Reggio Emilia, Italy
3
Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy
Corresponding Author:
Michele Poletti, Department of Mental Health and Pathological
Addiction, Child Neuropsychiatry Service, AUSL of Reggio Emilia,
Via Amendola 2, 42100, Reggio Emilia, Italy.
Email: michele.poletti2@ausl.re.it
Poletti et al. 33
The identification of specific cognitive weaknesses asso-
ciated with SLD is an important empirical and clinical pur-
pose, for two reasons: First, it could guide prevention
studies aimed at identifying possible early cognitive mark-
ers of SLD risk; second, it could guide longitudinal studies
focusing on distinct atypical trajectories of cognitive devel-
opment headed for SLD.
For example, the longitudinal association between a spe-
cific language impairment and a subsequent increased risk
of SLD is a robust empirical finding (Bishop & Snowling,
2004; Pennington & Bishop, 2009; Ramus, Marshall,
Rosen, & van der Lely, 2013), with important clinical con-
sequences regarding prediction, intervention, and preven-
tion (Thompson et al., 2015).
In this perspective, the statistical technique of cluster
analysis (Tabachnick & Fidell, 2001) can still be useful in
identifying homogeneous subgroups based on shared cogni-
tive profiles (Allen & Goldtsein, 2013; C. R. Hale, Casey, &
Ricciardi, 2014), as long as researchers are aware of its lim-
its in regard to a relationship with external variables
(Branum-Martin et al., 2013) and a possible risk of splitting
up continuous dimensions (Morris et al., 1998; Speece,
1990, 2003).
Distinct cognitive profiles characterized by specific
weaknesses (in broad-based cognitive processing, execu-
tive functioning, verbal functioning, or nonverbal-visuo-
spatial processing) were reported in previous cluster-analytic
studies on the Wechsler Intelligence Scale for Children
(WISC) among clinical and healthy samples (Bodin,
Pardini, Burns, & Stevens, 2009; Borsuk, Watkins, &
Canivez, 2006; Donders, 1996; C. R. Hale et al., 2014;
Holcomb, Hardesty, Adams, & Ponder, 1987; Konold,
Glutting, McDermott, Kush, & Watkins, 1999; Snow,
Cohen, & Holliman, 1985; Vance, Wallbrown, & Blaha,
1978; Waxman & Casey, 2006).
In this study, we applied a cluster analysis to the fourth
edition of the WISC (WISC-IV) intellectual profiles of SLD
children, with two aims: first, to identify and describe sub-
groups of SLD children with similar cognitive profiles; sec-
ond, to describe the association between clusters and SLD
subtypes.
Method
Participants
Participants were selected from among children who were
referred for neuropsychological assessment due to persis-
tent academic difficulties and who had received a diagno-
sis of SLD at the end of the clinical evaluation. All 205
children referred to the Child-Adolescent Neuropsychiatric
Unit with a diagnosis of SLD (132 boys and 73 girls;
mean age = 10.6 ± 2.8 years; mean grade = 5.5 ± 2.7)
were consecutively recruited for this study in a 2-year
period (August 2012–August 2014). Empirical data for
this study were collected during routine clinical assess-
ment for diagnostic purposes. All recruited participants
underwent a neuropsychiatric screening and a neuropsy-
chological assessment focused on intellectual functioning
and learning proficiency, according to usual diagnostic
procedures.
Materials
The Italian version of the WISC-IV (Orsini, Pezzuti, &
Picone, 2012a) was recently standardized with a group of
2,200 participants (1,100 males, 1,100 females). Its four-
factor structure was confirmed (Orsini et al., 2012b), in
agreement with the American standardization (Wechsler,
2003). Along with the Full Scale Intelligence Quotient, the
WISC-IV provides four indexes:
Verbal Comprehension Index—based on Similarities,
Vocabulary, and Comprehension subtests;
Perceptual Reasoning Index—based on Block Design,
Picture Concepts, and Matrix Reasoning subtests;
Working Memory Index—based on Digit Span and
Letter-Number Sequencing subtests; and
Processing Speed Index—based on Coding and Symbol
Search subtests.
Subtests of the Verbal Comprehension Index and Perceptual
Reasoning Index compose an index related to reasoning
abilities (General Ability Index; Raiford, Weiss, Rolfhus, &
Coalson, 2005), and subtests of the Working Memory Index
and Processing Speed Index compose an index related to
executive functioning (Cognitive Proficiency Index; Weiss
& Gabel, 2008).
Specific tasks developed in the Italian clinical context
were administered for the assessment of learning profi-
ciency regarding reading fluency and decoding, written
expression, and mathematics (see appendix).
Diagnoses
According to the DSM-V and the Italian diagnostic guide-
lines (Consensus Conference, 2007; PARCC DSA 2007,
2011) participants were diagnosed with SLD if at least one
interpretable WISC-IV index among Verbal Comprehension
Index or Perceptual Reasoning Index was ≥85 and perfor-
mances on reading, writing, and/or arithmetic skills were
under the clinical cutoff scores indicated by cited guidelines
(≤2 SD below mean performances of age-matched partici-
pants or ≤5th–10th percentile). With the aim of selecting a
homogeneous group of children with SLD without signifi-
cant comorbidities and potentially confounding factors (fre-
quently co-occurring with SLD), exclusion criteria were the
presence of significant medical and psychological problems
34 Journal of Learning Disabilities 51(1)
and comorbid disorders (e.g., attention-deficit/hyperactiv-
ity disorder, developmental coordination disorder, present
specific language impairment) and disruptive behaviors.
The following subtypes of impairment were diagnosed
among the 205 children with SLD: 106 with an isolated
impairment (56 in reading, 28 in mathematics, 22 in written
disorder) and 99 with a combined impairment (81 in read-
ing and mathematics and 18 in written expression and
mathematics).
Statistical Analyses
Cluster analysis.  Children were grouped on the basis of the
scaled scores obtained on the 10 WISC-IV core subtests,
by means of a cluster analysis. Cluster analysis is a mul-
tivariate classification technique that allows for the iden-
tification of homogeneous subgroups based on shared
characteristics (Tabachnick & Fidell, 2001). Before clus-
ter analyses were run, data were checked for multicol-
linearity and multivariate outliers through Pearson
correlations and Mahalanobis distances (Field, 2009;
Tabachnick & Fidell, 2001).
In the first step, Ward’s linkage was used to combine
children into clusters through euclidean distance as a mea-
sure of similarity. With this procedure, each participant
begins as his or her own cluster. The two closest clusters are
then combined, and this process repeats until all children
are combined into one large cluster. The best cluster solu-
tion was selected per visual inspection of the agglomeration
coefficients and dendrogram figure. Moreover, the variance
ratio criterion was calculated for each selected cluster solu-
tion. In the second step, k-means clustering was used to
maximize cluster homogeneity. In k-means analysis, the
number of clusters to be extracted is specified in advance.
In this study, cluster means from the hierarchical procedure
were used as starting point for the k-means analysis. Cluster
solutions characterized by clinically interpretable profiles
were forwarded for reliability analyses.
The stability of the final cluster solutions were assessed,
comparing results from Ward’s and k-means methods by
Cohen’s kappa (k) and intraclass correlation coefficient
(ICC). Likewise, membership agreement was verified
between the original two-step cluster procedure (Ward’s
followed by k-means) and additional cluster analysis per-
formed with a different clustering algorithm (complete link-
age, average linkage between groups, average linkage
within groups). Overall, a k < .2 reflected poor agreement;
.21–.4, fair; .41–.6, moderate; .61–.8, good; and k > .81,
very good.
External validation. External validity of a cluster solution
addresses the degree to which empirically derived sub-
groups can be distinguished on the basis of theoretically
important variables not used in the cluster analysis (Fletcher,
1985); in this study, external validity was assessed by com-
paring the derived WISC-IV subgroups on the basis of
mean standard score performances in reading and math
tasks (performances in tasks of written expression were not
considered for external validation, because they did not pro-
vide comparable parameters across school grades). Valida-
tion of clusters with academic scores may permit searching
for possible distinct profiles of academic proficiency, given
that they could be clinically underemphasized by the DSM-
V single overarching SLD category.
An analysis of variance, followed by a Bonferroni post
hoc test, was used to compare mean scaled scores provided
by math tasks. An analysis of covariance was used to com-
pare mean raw scores on six reading parameters (reading
speed regarding words, nonwords, and text; reading accu-
racy for words and nonwords; text comprehension), adjust-
ing for age because the Bonferroni post hoc test was
calculated to evaluate differences between each pair of clus-
ters in reading tasks.
Continuous variables were summarized as mean ± SD
and categorical variables as percentage frequencies. The
percentage of diagnoses was compared among the clusters
with a chi-square test. All analyses were carried out with
SPSS 20.
Ethics
Parents signed informed written consent forms regarding
diagnostic procedure and potential subsequent use of anon-
ymous clinical data for empirical purposes. Because all
empirical data were collected during routine clinical assess-
ment, this study did not required an ad hoc ethical commit-
tee approval by the Institutional Review Board.
Results
Means and standard deviations for WISC-IV subtests are
reported in Table 1. Correlations between scaled scores on
subtests ranged from –.13 to .63. None of the correlation
coefficients exceeded .8, suggesting the absence of multi-
collinearity. Multivariate outliers were not identified on the
study sample with the critical value of Mahalanobis dis-
tance, χ2(10) > 29.59, p < .001.
Cluster Analysis
Initial hierarchical cluster analysis based on Ward’s method
provided support for two-, three-, four-, and five-cluster
solutions. In particular, the percentage of change in the
agglomeration coefficient was high up to the five-cluster
solution (>5%). As well, the dendrogram showed that there
would be from two to five potential occurring clusters in the
sample. Variance ratio criterion registered the lower score
for four- and five-cluster solutions.
Poletti et al. 35

Table 1.  Demographics Characteristics and WISC-IV k = .64, ICC = .84, vs. k = .29, ICC = .60). Based on these
Performances for Full Sample. findings, the four-cluster solution was considered appropri-
Measure M ± SD Range ate for the study sample and was chosen as the final cluster
solution.
Descriptive characteristics  
  Age, years 10.63 ± 2.80 6–17
 Grade 5.49 ± 2.71 1–12 Description of Clusters
WISC-IV subtests   The mean WISC-IV scaled scores are reported in Table 2
 Similarity 8.73 ± 2.32 5–14 and plotted in Figure 1. Clusters were clinically character-
 Vocabulary 9.30 ± 2.61 3–16
ized according to Sattler and Dumont (2004)—that is,
 Comprehension 10.34 ± 3.07 3–18
scaled subtest scores between 8 and 12 were considered
  Block Design 9.64 ± 2.61 3–17
average; scores between 1 and 7, below average; and scores
  Picture Concept 10.45 ± 2.85 2–18
between 13 and 19, above average.
  Matrix Reasoning 10.24 ± 2.49 4–17
  Digit Span 8.05 ± 2.44 2–15
Cluster 1 (n = 65) was labeled low verbal (LV) to reflect
  Letter Number Sequencing 7.73 ± 2.62 1–14 below-average scores on verbal subtests (Similarities,
 Coding 7.63 ± 2.66 1–16 Vocabulary, Letter-Number Sequencing). Cluster 2 (n = 61)
  Symbol Search 9.92 ± 2.51 4–17 was labeled low coding (LC) to reflect a below-average
WISC-IV indexes   scores only on Coding. Cluster 3 (n = 38) was labeled low
  Verbal Comprehension Index 96.81 ± 13.26 64–130 executive functioning (LEF) to reflect below-average
  Perceptual Reasoning Index 100.57 ± 12.65 69–132 scores on executive tasks (Digit Span, Letter-Number
  Working Memory Index 87.31 ± 13.05 64–124 Sequencing, Coding). Cluster 4 (n = 41) was labeled low
  Processing Speed Index 92.65 ± 13.07 59–129 reasoning and executive functioning (LREF) to reflect
  Full Scale Intelligence Quotient 93.45 ± 11.34 67–121 below-average scores on reasoning (Similarities,
  General Ability Index 98.44 ± 12.05 74–133 Comprehension, Picture Concepts) and executive function-
  Cognitive Proficiency Index 87.43 ± 12.59 55–117 ing (Digit Span, Letter-Number Sequencing, Coding,
Symbol Search). There were no statistically significant dif-
Note. Children with specific learning disorder, N = 205 (male: n = 132,
64.39%; female: n = 73, 35.21%). WISC-IV = Wechsler Intelligence Scale for ferences in mean age among clusters (Kruskal-Wallis test =
Children, fourth edition. 3.42, p = .33).

The cluster solutions were used as initial cluster cen- External Validation of Clusters
troids in the k-means partitioning method. Reestimating the
Mean global math scores for Number Sense and Calculation
clusters through the k-means analysis led to the reallocation
were statistically different among clusters (F = 5.75, p =
of between 11% and 19% of children across cluster solu-
.0010, and F = 4.92, p = .0028, respectively). Post hoc com-
tions. Following the inspection of the mean cluster profiles,
parisons showed that Cluster 1 (LV) and Cluster 2 (LC)
it was determined that four- and five-cluster solutions had
achieved significantly higher scores as compared with
the most interpretable and clinically informative profiles.
Cluster 4 (LREF; p < .05; see Table 3).
The two-cluster solution was excluded because it did not
Significant mean score differences among clusters were
clearly reveal differences in the subtests but only an overall
found in reading speed of text (F = 3.14, p = .03) and non-
assessment of high or low performance. Moreover, in the
words (F = 3.40, p = .02) and in reading comprehension (F
three-cluster solution, the third cluster looked like a residual
= 6.43, p = .0004). Cluster 1 (LV) showed a significantly
compound of the first two clusters, which identifies cases
higher score in reading speed of text in comparison with
with deficits most widespread.
Cluster 4 (LREF) and in reading speed of nonwords in com-
parison with Cluster 2 (LC) in post hoc analysis (p < .05).
Reliability Analysis Post hoc analysis also showed that the text comprehension
score was significantly higher in Cluster 2 (LC) in compari-
Good agreement (k > .7) and high profile similarity (ICC >
son with Clusters 1 (LV) and 4 (LREF; p < .05).
.8) were obtained comparing initial Ward’s analysis with
k-means analysis for both four- and five-cluster solutions.
However, the four-cluster solutions showed better stability Cluster Membership and Diagnoses in
as compared with the five-cluster solution when a different Reading, Written Expression, and Mathematics
clustering algorithm was used in the hierarchical cluster
analysis (complete linkage: k = .52, ICC = .70, vs. k = .32,
Impairments
ICC = .34; average linkage between groups: k = .45, ICC = Impairment in reading was significantly lower in children
.61, vs. k = .32, ICC = –.46; average linkage within groups: assigned to Cluster 1 (LV) than in those assigned to the
36 Journal of Learning Disabilities 51(1)

Table 2.  Mean WISC-IV Performance According to Cluster Membership.

Cluster, M ± SD

1: Low 2: Low 3: Low executive 4: Low reasoning and

Measure verbala codingb functioningc executive functioningd
Intelligence Quotient 92.37 ± 6.48 106.43 ± 6.10 90.16 ± 4.16 78.90 ± 5.52
General Ability Index 92.77 ± 7.28 112.11 ± 7.77 99.53 ± 6.10 86.10 ± 5.99
Cognitive Proficiency Index 93.88 ± 9.74 94.98 ± 8.92 79.11 ± 7.38 73.68 ± 8.54
Similarity 7.55 ± 1.78 10.87 ± 1.72 9.11 ± 1.66 7.07 ± 1.82
Vocabulary 7.91 ± 1.85 11.85 ± 1.82 9.03 ± 2.06 7.98 ± 2.33
Comprehension 8.46 ± 2.04 13.05 ± 2.34 11.82 ± 2.24 7.93 ± 1.92
Verbal Comprehension Index 88.03 ± 7.94 111.54 ± 7.44 99.89 ± 7.53 85.95 ± 8.63
Block Design 9.40 ± 2.30 11.30 ± 2.28 8.18 ± 2.35 8.93 ± 2.58
Picture Concept 10.77 ± 2.55 11.70 ± 2.47 11.39 ± 1.78 7.20 ± 2.14
Matrix Reasoning 9.77 ± 2.10 11.66 ± 2.61 9.92 ± 2.40 9.17 ± 2.07
Perceptual Reasoning Index 99.78 ± 10.69 110.02 ± 11.07 98.63 ± 9.35 89.54 ± 10.17
Digit Span 8.00 ± 2.53 9.41 ± 2.25 7.71 ± 1.74 6.44 ± 2.05
Letter Number Sequencing 7.71 ± 2.63 9.38 ± 2.37 7.34 ± 2.23 5.66 ± 1.49
Working Memory Index 87.08 ± 13.05 96.36 ± 11.62 85.16 ± 9.17 76.22 ± 7.75
Coding 9.66 ± 1.81 7.87 ± 2.30 5.53 ± 2.21 6.00 ± 2.17
Symbol Search 11.42 ± 2.05 10.75 ± 2.08 8.26 ± 1.77 7.85 ± 2.09
Processing Speed Index 103.08 ± 7.92 95.89 ± 10.04 81.34 ± 9.20 81.80 ± 10.35

Note. WISC-IV = Wechsler Intelligence Scale for Children, fourth edition.

a
n = 65. bn = 61. cn = 38. dn = 41.

Figure 1.  Mean profiles for the fourth edition of the Wechsler Intelligence Scale for Children: Cluster 1, low verbal; Cluster 2, low
coding; Cluster 3, low executive functioning; Cluster 4, low reasoning and executive functioning. Note. VCI = Verbal Comprehension
Index; PRI = Perceptual Reasoning Index; WMI = Working Memory Index; PSI = Processing Speed Index.

other clusters (χ2 = 11.31, p = .0102), and the percentage of impairment in written expression made up <10% of Cluster
impairment in mathematics was significantly higher in 3 (LEF) and Cluster 4 (LREF) but were significantly higher
Cluster 4 (LREF; χ2 = 30.82, p < .0001). Children with an in Cluster 1 (LV) and Cluster 2 (LC; χ2 = 11.12, p = .0111).
Poletti et al. 37

Table 3.  External Validation: Mean Performances on Learning Proficiency Tasks by Specific Learning Disorder Children According to
Cluster Attribution.
Cluster, M ± SD

1: Low 2: Low 3: Low executive 4: Low reasoning and Post hoc significant
Learning proficiency task verbala codingb functioningc executive functioningd comparison

BDE  
  Number Quotient 42.72 ± 1.55 42.44 ± 1.68 39 ± 2.06 33.40 ± 1.92 2 > 4, 1 > 4
  Calculation Quotient 40.17 ± 1.65 41.18 ± 1.79 37.54 ± 2.19 31.87 ± 2.04 2 > 4, 1 > 4
Reading speed, syllable/second  
 Text 2.80 ± 0.10 2.51 ± 0.11 2.51 ± 0.14 2.29 ± 0.14 1>4
 Words 2.45 ± 0.12 2.13 ± 0.12 2.22 ± 0.15 1.98 ± 0.15 —
   Errors in reading words 6.95 ± 1.15 8.95 ± 1.18 7.32 ± 1.46 7.13 ± 1.43 —
 Nonwords 1.63 ± 0.07 1.32 ± 0.07 1.38 ± 0.09 1.39 ± 0.09 1>2
   Errors in reading nonwords 6.97 ± 0.91 9.34 ± 1.17 9.67 ± 1.18 8.45 ± 1.15 —
Reading comprehension: correct answers, % 50.95 ± 2.43 61.64 ± 2.57 54.23 ± 3.29 44.07 ± 3.32 2 > 1, 2 > 4

Note: BDE = Batteria per la Discalculia Evolutiva (Developmental Dyscalculia Battery).

a
n = 65. bn = 61. cn = 38. dn = 41.

Discussion increased risk of SLD (Bishop & Snowling, 2004;

This study aimed to (a) identify groups of children with
SLD who had similar cognitive profiles and (b) investigate
the association between clusters and SLD subtypes. The
four-cluster solution of the cluster analysis based on
WISC-IV core subtests was chosen as best agreement
between statistical analyses and clinical judgement.
Cognitive Clusters
The four-cluster solution partially replicated findings of
previous cluster analyses on WISC scales (reviewed in C.
R. Hale et al., 2014) regarding clusters characterized by
specific weaknesses in broad-based cognitive processing
(LREF cluster in this study), verbal abilities (LV cluster this
study), and executive functioning (LEF cluster this study).
Children in the LV cluster presented weaknesses in ver-
bal comprehension (Similarities and Vocabulary subtests)
and verbal working memory (Letter-Number Sequencing);
this pattern was reported in other cluster analyses based on
previous WISC versions but not in the unique other cluster
analysis performed on the WISC-IV (C. R. Hale et al.,
2014). This study reported a cluster with specific weakness
in verbal comprehension (Similarities, Vocabulary, and
Comprehension subtests) but not in working memory tasks.
The cross-sectional nature of the present study did not allow
us to establish which altered trajectory of cognitive devel-
opment could have produced the cognitive profile of verbal
weakness. This investigation would be possible only
through longitudinal studies.
However, we speculatively hypothesize that the cogni-
tive profile of children in the LV cluster could mainly be the
longitudinal result of early linguistic difficulties; this
hypothesis is suggested by empirical evidence that specific
language impairment is longitudinally associated with an
Pennington & Bishop, 2009; Ramus et al., 2013) and with
cognitive profiles of individual verbal weakness in com-
parison with relative individual nonverbal strength (Botting,
2005; Gallinat & Spaulding, 2014).
The current study replicated previous findings regard-
ing specific weaknesses in executive functioning (verbal
working memory and processing speed: the LEF cluster).
Different from all previous cluster analyses, we found a
cluster with specific weakness only in the Coding subtest
(the LC cluster), which has been associated with impair-
ment in reading since previous WISC versions (Kaufman,
1981, 1994; Poletti, 2016a; Whitehouse, 1983). The spe-
cific impairment in Coding, in the face of preserved per-
formance in Symbol Search, could be due to its more
demanding components of visual search, memory, and
copying.
As reported before, the present study did not permit us
to establish which altered trajectories of cognitive devel-
opment could have produced cognitive profiles of execu-
tive weaknesses. Furthermore, it is more difficult to
formulate speculative causal hypotheses on these clusters
in comparison with the cluster of verbal weakness. Indeed,
early weaknesses in information processing/executive
functioning—as assessed, for example, by rapid automa-
tized naming tasks (Norton & Wolf, 2012) and spatial
attention tasks (Franceschini et al., 2012)—have been
shown to be predictive of subsequent risk of SLD
(Thompson et al., 2015), but their longitudinal impact on
cognitive profiles has been less investigated and did not
provide robustly replicated findings (e.g., Moll, Gobel,
Gooch, Landerl, & Snowling, 2016).
In agreement with the unique previous cluster analysis
on the WISC-IV (C. R. Hale et al., 2014), the current
study did not find any cluster with a specific nonverbal/
38 Journal of Learning Disabilities 51(1)
visuospatial weakness. This finding may be explained such
that the index tapping visuospatial abilities underwent the
greatest change in the WISC-IV in comparison with previ-
ous WISC versions, with reduction in speed and motor
demands—“The construct measured by this index has
changed from primarily perceptual organization with some
fluid reasoning to primarily fluid reasoning with some
perceptual organization in WISC-IV” (Weiss, Saklofske,
Prifitera, & Holdnack, 2006)—reducing its sensitivity to
detect nonverbal/visuospatial difficulties shown by some
children with learning disabilities (Mammarella & Cornoldi,
2014; Poletti, 2016b) and other neurodevelopmental disor-
ders, such as high functioning autism (Mayes & Calhoun,
2008) and ADHD (Mayes & Calhoun, 2006).
Overall, some overlaps (clusters characterized by spe-
cific weaknesses in broad-based cognitive processing, in
verbal abilities, or in executive functioning; absence of a
WISC-IV cluster characterized by visuospatial weakness)
and some differences (presence of a specific weakness in
Coding) emerged in comparison with previous cluster
analyses. This general finding is probably due both to the
different structures of previous WISC versions and to
heterogeneous samples. For example, the WISC-IV study
by C. R. Hale et al. (2014) used less restrictive diagnostic
criteria on academic difficulties in comparison with the
SLD diagnostic criteria used in the current study.
External Validation and SLD Subtypes Among
Clusters
Math performance differed among clusters: Children in the
LREF cluster presented more difficulties in Number Sense
tasks and Calculation tasks in comparison with children in
the LV and LC clusters; indeed, the percentage of impair-
ment in mathematics was significantly higher in the LREF
cluster in comparison with other clusters. These findings
are in agreement with those from previous studies in which
researchers reported that impairment in mathematics was
associated with a more general cognitive deficit in compari-
son with other subtypes of impairment (as impairment in
reading and impairment in written expression); this cogni-
tive impairment involves crystallized intelligence, fluid
intelligence, visual processing working memory, and pro-
cessing speed (Chen, Keith, Chen, & Chang, 2009; J. B.
Hale et al., 2008; Poletti, 2016a; Proctor, 2012; Taub, Floyd,
Keith, & McGrew, 2008).
Clusters also differed in reading speed: The LV cluster
outperformed the LREF cluster in reading a text (speed in
syllables/second: 2.80 ± 0.10 vs. 2.29 ± 0.14) and the LC
cluster in reading lists of nonwords (speed in syllables/sec-
ond: 1.63 ± 0.07 vs. 1.32 ± 0.07). Indeed, percentage of
impairment in reading was significantly lower in children
assigned to Cluster 1 (LV) than in those assigned to the
other clusters. Therefore, it is interesting to note the higher
reading speed of the cluster characterized by verbal weak-
ness in comparison with clusters characterized by weak-
nesses in the Coding subtest (the LC cluster) or in reasoning
and processing speed (the LREF cluster). The higher speed
in reading lists of nonwords, a task that principally activates
phonological skills (Griffiths & Snowling, 2002; Hermann,
Matyas, & Pratt, 2006), was unexpected and needs further
empirical confirmation. This pattern of results suggested
that executive functioning, especially visuospatial attention
(e.g., Bosse, Tainturier, & Valdois, 2007; Franceschini,
et al., 2012; Menghini et al., 2010), also is involved in read-
ing, in addition to phonological skills (Melby-Lervag et al.,
2012; Morris et al., 1998). This conclusion is in agreement
with the double-deficit model (Norton et al., 2014; Wolf &
Bowers, 1999) and models of multiple cognitive deficits as
the basis of neurodevelopmental disorders (Pennington,
2006; Wilcutt et al., 2013).
Moreover, reading comprehension differed among clus-
ters: The LV cluster and the LREF cluster presented more
difficulties in comparison with the LC cluster. The LV clus-
ter had more difficulties in reading comprehension in com-
parison with the LC cluster in spite of better reading speed
(statistically significant in nonword reading, higher without
statistical significance in text reading and word reading).
This finding confirmed the role of verbal abilities in reading
comprehension (Hulme & Snowling, 2014; Ricketts, 2011),
including oral language comprehension regarding vocabu-
lary and verbal reasoning (Catts, Adlof, & Ellis Weismer,
2006; Clarke, Snowling, Truelove, & Hulme, 2010; Nation,
Clarke, Marshall, & Durand, 2004; Nation, Cocksey, Taylor,
& Bishop, 2010; Richter, Isberner, Naumann, & Neeb,
2013; Tighe & Schatschneider, 2014), and working memory
(Cain, Oakhill, & Bryant, 2004; Goff, Pratt, & Ong, 2005).
Study Limits
The current study presents some limitations that have to be
kept in mind when interpreting its results. First, we used a
small sample of children for a cluster analysis. Second, this
study lacked an external assessment of diagnosis. A third
limit is inherent in the cluster analytic methodology itself:
Although aimed at ensuring reliability and validity of clus-
ter solutions, it is a relatively subjective research tool (C. R.
Hale et al., 2014; Lange, Iverson, Senior, & Chelune, 2002)
in which a somewhat high degree of subjective decision
making is required by the researchers. Moreover, forcing
participants into clusters on the basis of relative similarity
to other participants means that clusters may include some
individuals who bear only a minimal similarity to the mean
profile derived for that cluster (Hair & Black, 2000; C. R.
Hale et al., 2014).
In addition, some specificities of the current study have
to be underlined. First, restrictive cutoff points were used to
Poletti et al. 39
identify impaired performances suggestive of SLD, accord-
ing to cited diagnostic guidelines and DSM-V criteria; oth-
erwise, the use of less restrictive criteria for SLD as 1 or 1.5
SD below mean performance (e.g., in the SLD prevalence
study of Moll, Kunze, Neuthoff, Bruder, & Schulte-Korne,
2014) could have provided different results for cluster solu-
tions. Second, the current study was performed in a linguis-
tic context (Italian) characterized by a transparent
orthography, and this feature has to be considered when
evaluating the applicability of cluster solutions to distinct
linguistic contexts. Overall, specific diagnostic and linguis-
tic features associated with the cultural context of the cur-
rent study have to be kept in mind when interpreting the
results and their applicability to other contexts.
Finally, a new version of the Wechsler scale (i.e., the
WISC-V) is now available in a few countries, and how the clus-
ter solutions chosen in the current study based on the
WISC-IV may apply to it deserves empirical investigation.
Conclusions
To our knowledge, this is the first study to apply a cluster
analysis to the DSM-V-based diagnosis of SLD: Within the
single overarching diagnosis of SLD, distinct clinical pro-
files of cognitive strengths and weaknesses are associated
with different profiles in academic proficiency regarding
subtypes of impairment and severity. Impairments in learn-
ing proficiency profiles resulted relatively more promi-
nently in math and text reading speed and comprehension
for the LREF cluster, in text comprehension for the LV clus-
ter, and in nonword reading speed for the LC cluster; any
prominent learning proficiency impairment resulted as
regards the LEF cluster in comparison with other clusters.
Findings of the current study have clinical implications.
First, clinicians should be aware that within the DSM-V
single category of SLD, distinct cognitive profiles associ-
ated with distinct learning proficiency profiles may be
detected, and their careful investigation is still needed to
plan intervention programs and to specify special educa-
tional needs and strategies of compensation.
Second, further studies are needed to investigate if the
same impairment in learning proficiency has different
responses to treatment on the basis of associated cognitive
profiles of strengths and weaknesses.
Third, further studies are needed to better characterize
trajectories of atypical cognitive development leading to
SLD and their respective associated profiles of cognitive
strengths and weaknesses. As reported in the discussion, the
longitudinal trajectory starting from early language impair-
ment in early childhood to subsequent cognitive profiles of
verbal weakness and to SLD (especially in reading) is the
most investigated and supported by empirical evidence.
Other trajectories starting from an early executive impair-
ment have been less longitudinally characterized regarding
subsequent associated cognitive profiles and SLD risk;
these strongly deserve empirical investigation, especially
considering that rehabilitative interventions for executive
impairments are increasingly available (e.g., Mackey, Hill,
Stone, & Bunge, 2011).
Appendix
Methods
Learning proficiency tasks.  Word and nonword reading, writ-
ing, and sentence writing were assessed with the Batteria
per la valutazione della Dislessia e della Disortografia
Evolutiva–2 (Sartori, Job, & Tressoldi, 2007); text reading,
text comprehension, and writing (dictation) were assessed
with the MT Series (for primary schools: Cornoldi & Colpo,
2011; for secondary schools of first grade: Cornoldi &
Colpo, 2012; for secondary schools of second grade:
Cornoldi et al., 2010). Mathematical abilities involving
number sense (forward and backward counting, number
reading, writing and repetition, number semantics) and
calculation (multiplication tables, arithmetic facts, oral and
written calculation) were assessed with the Batteria per la
Discalculia Evolutiva (Bachmann, Mengheri, & Biancardi,
2014; Biancardi & Nicoletti, 2004), which provides a
Number Quotient, a Calculation Quotient, and a general
Number and Calculation Quotient.
Diagnostic criteria for SLD subtypes.  Impairment in reading
was diagnosed if at least two parameters were under cutoff
scores (≤2 SD below mean for decoding speed, ≤5th per-
centile for accuracy) in the three administered tasks: word
reading, nonword reading, and text reading. Reading com-
prehension was not considered in diagnosing impairment in
reading.
Impairment in written expression was diagnosed if at
least two parameters were under cutoff scores for accuracy
(≤5 percentile) in the administered tasks (word and non-
word writing and text writing for children attending primary
school; sentence writing and text writing for older chil-
dren); isolated difficulties in handwriting were not included
in the diagnosis of impairment in written expression.
Impairment in mathematics was diagnosed if at least
one quotient provided by the Batteria per la Discalculia
Evolutiva was under cutoff score (≤2 SD below mean).
According to guidelines, impairments in reading and written
expression could not be diagnosed before the end of the sec-
ond primary grade, and impairment in mathematics could
not be diagnosed before the end of the third primary grade.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
40 Journal of Learning Disabilities 51(1)
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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