Identification of Learning Dis

IDENTIFICATION OF LEARNING DISABILITIES IN INDIA
A Thesis
Presented to
the Department of Psychology and Special Education

EMPORIA STATE UNIVERSITY
In Partial Fulfillment
of the Requirements for the Degree
Specialist in Education
by
Geetika Kapoor
May 2007
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UMI Number: 1446402
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Approved for the Department of
Psychology and Special Education
Dr. Paul McKnab

Committee Member
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6 Committee Member
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Approved for the Graduate Council
11
AN ABSTRACT OF THE THESIS OF
Geetika Kapoor for the Specialist in Education
in School Psychology_______presented April 5, 2007
Title: Identification of Learning Disabilities in India
Abstract approved:
This study explored the methods used by clinical psychologists to identify learning
disabilities among school-aged children in India. Participants were members of the
Indian Association of Clinical Psychologists and a few others whose participation was
solicited through personal contact. Results revealed that most clinical psychologists used
the discrepancy model for identification of learning disabilities. In order to make the
diagnostic decisions, psychologists used standardized instruments that had been normed
for the Indian population of children as well as those that were normed for some foreign
populations of children. While most psychologists reported using standardized
instruments to clarify the diagnosis, they used informal curriculum and criterion
referenced tools for intervention purposes. Most children being assessed for learning
disabilities were bilinguals and second language learners of English. The study
highlighted some dilemmas that psychologists face in India while conducting the
assessments for learning disabilities; the most prominent ones were the lack of good
standardized instruments and difficulty in addressing the language issues during the
assessment.
ACKNOWLEDGMENTS
I would like to thank Dr. Tysinger for his guidance in the writing of this thesis. His
valuable input helped me refine this project. Also, I would like to thank Dr. McKnab for
stretching his time beyond his retirement and accepting to be on the thesis committee. I
would like to thank Dr. McKnab and Dr. Persinger for their advice and suggestions while
completing the project. I deeply appreciate the emotional support that my husband and
family gave me throughout the project. I do not think I would have been able to complete
this project without their constant support and encouragement.
iii
TABLE OF CONTENTS
ACKNOWLEDGMENTS...................................................................................................... iii
TABLE OF CONTENTS........................................................................................................ iv
LIST OF TABLES...................................................................................................................vi
CHAPTER
1 INTRODUCTION..................................................................................................... 1
Definition of Learning Disabilities................................................................ 2
Importance of Operational Definitions.......................................................... 3
Operational Models of Learning Disabilities................................................ 4
Identification Criterion as Specified by the States........................................ 5
Use of IQ Scores and the Discrepancy M odel..................................6
Academic Achievement......................................................................9
Exclusion Factor................................................................................ 11
Factors Further Affecting the Implementation of the Status M odels 12
Psychological Processes and the Language Component in LD
Identification................................................................................................... 14
Multilingualism and Learning Disabilities...................................................14
Issues Related to Identification of Learning Disabilities in India.............. 16
Summary........................................................................................................ 18
Research Questions....................................................................................... 20
2 METHOD................................................................................................................ 21
Participants.....................................................................................................21
Research Design............................................................................................ 22
iv
Instrumentation .25
Procedure........................................................................................................ 26
3 RESULTS................................................................................................................ 28
Data Analysis..................................................................................................28
Demographic Profile of the Children Being Assessed for Learning
Disabilities......................................................................................................28
Identification Criteria Used to Make Diagnostic Decision......................... 29
Tools Used by Professionals.........................................................................30
Differences in Identification Practices of Clinical Psychologists..............33
Dilemmas Faced in Making Diagnostic Decisions about LD.....................34
Follow Up Procedures and Difficulties........................................................36
4 DISCUSSION......................................................................................................... 38
REFERENCES......................... 45
APPENDICES.........................................................................................................................52
Appendix A: Questionnaire....................................................................................... 53
Appendix B: Cover Letter..........................................................................................57
Appendix C: Scoring Rubric..................................................................................... 59
LIST OF TABLES
TABLE PAGE
1 Summary of the Percentage of Respondents from Different States........................23
2 Summary of Percentage of Respondents within Other Demographic
Categories...................................................................................................................24
3 Summary of the Most Frequently Used Instruments................................................31
4 Summary of Means and Standard Deviations of Use of the Two Types of Tools,
and Age and Number of Years in Profession........................................................... 35
vi
1
CHAPTER 1
INTRODUCTION
Many school-aged children are unable to show adequate achievement; given these
children’s overall ability, educators find it difficult to reason their underachievement. In
1963, Samuel Kirk articulated this condition as learning disabilities (LD), a language-
based difficulty. Since its conception in the 1960s in America, the field of LD has
undergone rapid research and has sparked professional and political controversies.
Professionals have struggled to arrive at unanimous definition of learning disabilities;
different professional orientations have offered a varied understanding of the condition of
LD. Equally difficult has been the process of choosing the optimal ways to identify this
condition among school-aged children.
In India, scholars have long held that given the transparency of Indian languages
(i.e., a consistent sound-letter association between spoken languages and the written
scripts), students in India are unlikely to experience LD (Karanth, 2003). However,
research conducted over the past two decades supports the existence of this condition
among the Indian population of school-aged children (Ramaa, 2000). Though there is
extensive research being reported on the importance of understanding the structure of
Indian languages and inclusion of specific language-based tests in assessment batteries
for LD (e.g. Prema & Karanth, 2003), little information is available about the practices
that are actually adopted by professionals involved in the identification of this condition
among children (Karanth). Clinical psychologists and special educators are the main
professionals involved in the process of identification (Karanth). This study explored the
2
methods used by clinical psychologists to identify learning disabilities among school-
aged children in India.
Literature Review
Definition o f Learning Disabilities
Traditionally, learning disabilities as a construct has addressed the unexpected
nature of a child’s underachievement and used exclusionary criteria to rule out other
causes that may be reasoned as responsible for underachievement (Lyon et al., 2001).
Learning Disabilities have been characterized as a difficulty in using language (Siegel,
1999). It may be manifested in academic difficulties to “listen, speak, read, write, spell,
or do mathematical calculations” (U.S. Office of Education, 1997, as cited in Kavale &
Fomess, 2000, p. 240). Most of the definitions of learning disabilities emphasize the
‘inability’ as intrinsic to the individual, thus paying little attention to the impact of one’s
environment/context on the expression of learning disabilities (Speece, 1993).
Defining learning disabilities has been a struggle, and many definitions have been
proposed. However, the National Joint Committee on Learning Disabilities (NJCLD) and
the federal definition listed in the Individuals with Disabilities Education Act (IDEA) are
the two definitions of LD most widely accepted in America (Kavale & Fomess, 2000).
Seventy-one percent (n = 36) of the states used the federal (IDEA) definition proposed in
1977, with 29% (« = 15) using some different definition (Mercer, Jordan, Allsopp, &
Mercer, 1996). As informed by the formal definitions, the identification practices adopted
by different state departments of education demonstrated consistency with use of certain
criteria (Mercer et al.), while still showing great amount of variations in their use of other
criteria (Kidder-Ashley, Deni, & Anderton, 2000).
3
Looking at the literature, different researchers use varying terminologies when
they refer to the formal definitions and the identification criteria in the assessment of
learning disabilities. For the purpose of this chapter, the various terms may be understood
as follows. The terms “formal definition” and “definition” (alone) are used to suggest the
theoretical definition(s) only. The term “operational definition” is readily used in research
studies to refer to the specific identification criteria and the subsequent methods being
used to determine if child has LD. “Identification methods” refer to the assessment
procedures (tests, etc.) being used in research and by professionals in the field. At the
same time, the term “identification criteria” is used to define the way in which these test
results are used to make the identification decisions. For example, using an intelligence
test and a standardized achievement test would constitute the identification method,
whereas the difference of 20 points between the standard scores of the intelligence and
achievement tests would be called the identification criteria being adopted. Finally, all the
operational definitions and the way these are implemented and used by professionals in
the field are theoretically conceptualized into operational models. For example,
identification decisions made following one-time assessment reflect the Status Model.
Importance o f Operational Definitions
While the formal definitions are important in order to clearly define the concept
of learning disability, operational definitions ascertain which students are identified as
learning disabled and, thus, are entitled to special education services (MacMillan,
Gresham, Bocian & Siperstein, 1997). The U.S. Office of Education (USOE) has
forwarded a formal definition of learning disability, along with specified methods
(criterion/operations) that should be used in order to identify the children as having LD.
4
In spite o f the mandate, evidence suggests that a significant discrepancy exists between
the prescribed operations and the ones actually used by the schools to determine
eligibility of students (MacMillan, Gresham & Bocian, 1998). This difference is also
evident in the identification criteria adopted by various research studies and the ones
adopted by the schools (MacMilllan & Siperstein, 2002). Thus, along with the
exploration of the formal definition of learning disabilities, it is important to investigate
the operational definitions (methods/ criterion) as they are implemented by the
professionals in the field.
Operational Models o f Learning Disabilities
According to the research evidence, current identification methods are divided
into two broad categories, the Status Models (Fletcher, Denton, & Francis, 2005) and the
Problem Solving Models (Reschely, Tilly, & Grimes, 1999). The “status models” are so
called because of their use o f assessment procedures at one point in time to determine if a
student has a learning disability. The status models also treat disabilities as dichotomous
categories, rather than viewing them as “continuous and normal distribution” (Fletcher et
al.). From an educational point of view, determining eligibility using one time assessment
has been seen as a flawed practice because it does not allow for a distinction between
poor performers with a true disability versus those who have not been exposed to
adequate instruction (MacMilllan & Siperstein, 2002).
The “problem solving models” involve functional analysis of the child’s learning
(Fletcher, Morris, & Lyon, 2003) and draw conclusions based upon the child’s response
to intervention and the subsequent educational outcomes (Tilly, Reschely, & Grimes,
1999). The problem solving models do not focus on eligibility determination; the
5
emphasis is on discerning the nature of a student’s difficulties and how to remediate the
situation (Shinn, Good III, & Parker, 1999). Instead of waiting for a student to fall below
a certain level of achievement, help is forwarded as soon as the child displays signs of
difficulties. In other words, this approach promises early intervention.
“Response to Intervention” is a problem-solving model that has been
recommended as a potentially useful method in identification of learning disabilities
(Fuchs, Fuchs, & Compton, 2004). When the students fail to respond to the regular
classroom instruction, their failure to learn is assessed in the context of a problem-solving
model. The students are then provided with evidence-based interventions and failure to
respond to highly structured and problem focused interventions is then labeled as
existence of disability. In other words, an attempt is made to address instructional,
environmental and student variables as probable causes of underachievement, before
deciding that the nature of difficulties experienced by the student is a sign of learning
disability (Ysseldyke & Marston, 1999).
Identification Criterion as Specified by the States
The identification criterion as prescribed by the federal regulations include the
discrepancy and the exclusion components that are deemed necessary in identification of
learning disabilities with the determination of deficiency in basic psychological processes
as an optional criterion (Mercer et al., 1996). However, the federal government does not
specify the extent of discrepancy. Thus, the states should use their own judgment in
operationalizing the discrepancy between the child’s potential and level of achievement.
In other words, the federal regulations only provide a broad frame of reference for
identification criterion. Nevertheless, as indicated earlier in this chapter, great variance
6
exists in the use of these criteria for identifying students with learning disabilities across
states and even among districts (Mercer et al.).
Mercer et al. (1996) have discussed six possible criteria that are implemented by
different states, that is, academic, exclusion, discrepancy, psychological processes,
neurological, and intelligence. Seventy-three percent (n - 37) of the states opt not to
specify the intelligence factor in their definitions; however, 26% (n = 13) of them use
intelligence test scores in their identification criterion (exclusion component). Language
component is included by 84% (n = 42) of the states in their identification criteria. Low
academic achievement is observed as central to the concept of learning disabilities with
92% (n = 47) of the states including reading factors, 88% (n = 45) specifying writing, and
90% (n = 46) indicating math in their criteria. Up to 98% (n = 50) of the states indicate
exclusion and the discrepancy criteria.
Use o f IQ scores and the Discrepancy Model. In identification of learning
disabilities, IQ scores may be used in two main ways: as the inclusion criteria to establish
the discrepancy between ability and achievement, and as the exclusion criteria to rule out
mental retardation. Use of IQ scores in eligibility determination of learning disabilities
has been questioned by many (e.g. Siegel, 1999; Stanovich, 2005; Velutino, Scanlon, &
Lyon, 2000).
Siegel (1999) argued that IQ scores do not represent a single construct, and
different tests measure different skill sets. Moreover, predictions made by IQ scores tend
to put limits on the extent that a child can achieve. If made early in one’s academic life,
such a prediction can prove detrimental to a child’s educational experience.
7
Others hold that IQ scores have not proved useful because they have not been
used appropriately to understand the students’ cognitive profile (Kavale, 2005). As
pointed out by Naglieri (2003), if educators have a sufficient understanding about the
individual differences among cognitive profiles of their students, they can be
tremendously aided in selecting appropriate interventions for them.
Establishing IQ-Achievement discrepancy is one of the most important criteria
that should be established in order to make the determination of learning disabilities. This
criterion supports the unexpected nature of the underachievement; there is a learning
failure in spite of average and above average cognitive ability (Kavale, 2005). Mercer et
al. (1996) have listed four main methods in which discrepancy has been operationalized
by different states. These methods for determining ability- achievement discrepancy
include, constant and graduated deviation from the grade level, using expectancy
formulas, regression analysis, and standard scores comparisons. Use of standard scores to
determine the inter-individual discrepancy is reportedly used by most of the states,
whereas intra-individual method (difference between “student’s highest and lowest areas
of achievement”) was reported to be used only by one state (Kider-Ashley et al., 2000, p.
68).
Though the standard score method of inter-individual discrepancy between ability
and achievement is used by most states, this method has been criticized by many. Since
many of the abilities, like linguistic coding ability and short-term verbal memory
assessed by intelligence tests, are adversely affected in presence of specific learning
disabilities, intelligence scores underestimate the true ability (Vellutino et al., 2000).
Therefore, the discrepancy model for identification likely leads to a misdiagnosis.
8
In response to this argument, Kavale (2005) has argued that the discrepancy
between IQ and achievement should be treated as an indicator o f a possibility that the
child has a learning disability. This indication should, then, set the stage for further
interventions or evaluations. At the same time, existence of the discrepancy in itself
should not be treated as diagnostic of learning disability; below average achievement
should be a required adjunct to its existence (Gordon, Lewandowski, & Keiser, 1999).
In practice, use of the discrepancy model has been explained as the one that waits
for the student to fail because identification under this model depends on a large enough
discrepancy (15-22 points) between aptitude and achievement, which may not be
obtainable until third or fourth grade (Stuebing et al. 2002). At the same time, “children
identified as RD [Reading Disability] after grade 2 rarely catch up to their peers” (Lyon
et al., 2001). Such evidence is likely to raise ethical dilemmas for educators and the
school systems, who are more concerned about providing help to these students.
Therefore, they tend to ignore the identification criteria and classify the low achieving
students as LD even in absence of the prescribed discrepancies (MacMillan et al., 1997).
In light of this evidence, MacMillan et al. have called for a revision of the identification
regulations, either to modify the criteria for LD or to create a separate category for the
low achieving students who otherwise do not classify in the existing systems.
On similar grounds, though retaining the traditional conceptualization of learning
disability, the discrepancy model along with the IQ measures has been criticized for its
lack of instructional validity (MacMillan, Gresham, Siperstein, & Bocian, 1996).
Research evidence suggests that there is no significant difference between the primary
word recognition problems of poor readers with high IQ scores when compared to those
9
with low IQ scores (Stanovich, 2005). There is also no significant relationship found
between aptitude as marked by IQ scores and response to remediation (Aaron, 1997).
Further, Flowers, Meyer, Lovato, Wood and Felton (2000) reported that all poor readers
show similar patterns of gains; both the discrepant and non-discrepant poor readers
continued to show gains from remediation, but none of the groups caught up to their
normal reading peers. In light of similar evidence, researchers have called for adoption of
criterion similar to a Reading Component Model (systematic analysis of the reading
profiles of poor readers to match with the evidence-based interventions) and to give up
use of the discrepancy model in identification of LD (Aaron).
Academic achievement. Poor academic performance is the most unanimously
agreed upon characteristic of individuals with learning disabilities. As suggested earlier
in this section, low academic achievement was included in the identification criterion of
up to 92% (n = 47) of the state departments of education (Mercer et al. 1996). Written
expression, basic reading, reading comprehension, mathematics calculation, and
mathematics reasoning were the most common academic achievement areas to be
evaluated.
Gordon et al. (1999) suggested that, conceptually, learning disability includes
students demonstrating absolute low achievement (when compared to their peers).
However, recent times have witnessed an increase in the number of students identified as
LD as determined by their relative underachievement as compared to their own ability
(IQ scores of 130 and above). According to Gordon et al., categorizing students as LD in
absence o f absolute low achievement leads to a liberal assignment of LD label, which in
turn, deprives those who actually need the remedial help. They further elaborated that
10
when a student is achieving around the same levels as most others in the classroom but
not as high as their own high ability suggests, “inadequate instruction, limited motivation,
poor study habits, ill advised course selection, psychiatric factors, or inappropriate
expectations” (Gordon et al., p. 489) may be the more viable options to be explored as a
probable cause of the relative underachievement.
Researchers and schools often find it difficult to distinguish between the low
achieving students and students with learning disabilities because the performance
variables for these two populations show considerable overlap (Fuchs, Fuchs, Mathes,
Lipsey, & Roberts, 2001). This phenomenon has led many researchers and educators to
question the existence of learning disability as a category different from low
achievement.
In a meta-analysis of 79 studies, Fuchs et al. (2001) concluded that LD can be
reliably differentiated from “garden variety” low achievement (p. 2). In contrast to
Flowers et al. (2000) where poor readers with and without discrepancy showed identical
educational gains, here LD students differed from their low achieving counterparts in
their inability to achieve adequate reading fluency, and more discrepant performance was
found at the higher grade levels. Consequently, Fuchs et al. concluded that adhering to
more objective and timed assessments, especially at higher grade levels, should lead to
proper identification practices.
Kavale and Fomess (2000) have appealed to maintain a distinction between low
achievement and learning disabilities; “they are not equivalent but are often confounded”
(p. 250). The fact that low achievers demonstrate depressed scores in all areas of
achievement as compared to LD students whose underachievement in one or two areas is
11
difficult to explain, Kavale (2002) has concluded that the “etiology of these two
conditions is really not the same, and consequently, LD and LA groups appear to possess
quantitative and qualitative differences” (p. 400).
In conclusion, LD is a valid diagnostic category (Stuebing et al., 2002), different
from other forms of low achievement (Kavale, 2002). However, more adequate
identification criteria would help distinguish low achieving students from the learning
disabled at earlier grade levels.
Exclusion factor. Exclusion criteria are an important part in the identification of
learning disabilities because they set apart the conditions that may explain the cause of
underachievement and, thus, take away the unexpected nature of underachievement. The
federal register stated that a student demonstrating the severe discrepancy between ability
and achievement cannot be categorized as learning disabled, if “visual, hearing or motor
disabilities,... mental retardation,... emotional disturbance, or environmental, cultural,
or economic disadvantage” are the primary cause of underachievement (IDEA
amendments of 1997, P.L. 105-17, June 4,1997, 1lstat 37[20 USC 1401(26)], in Kavale
& Fomess, 2000, p. 240).
Mercer et al. (1996) reported that up to 98% of states use the exclusionary criteria
in the identification process. Further, most states have expanded the federal requirements
to include lack of attendance, poor motivation, continuous inadequate instruction, stress
and change in curriculum as the exclusion criterions to be considered in their
identification processes.
12
Factors Further Affecting the Implementation o f the Status Models
Within the school systems, there are many factors that contribute to the varied
identification practices, namely, decision of the regular education teacher to refer
(Ysseldyke & Algozzine, 1983), the assessment procedures, and the considerations of the
placement committee (MacMilllan & Siperstein, 2002). Teachers are prompted to refer a
child for assessment as guided by their own judgments about the child’s level of deficient
performance, which is not always weighed against the local norms of achievement
(MacMilllan & Siperstein). Though teachers’ judgments are generally perceived as less
reliable, research has reported otherwise; teachers are largely able to differentiate
between groups of students with learning disabilities, low achievement and normal
achievement (Gresham, Macmillan, & Bocian, 1997). However, as pointed out by
Zigmond (1993), rather than being determined by the child’s level of performance, the
referral is influenced by the teachers’ realization of their own incapacities to successfully
teach the child as part of a larger group, and, thus, add a great amount of subjectivity to
the process that will ultimately decide which children will be identified as eligible to
receive services.
The assessment process then “serves to screen the referral made by the teacher”
(MacMilllan & Siperstein, 2002, p. 295). Apart from the results from the psychometric
tests, many more factors affect the conclusions drawn from this stage (MacMilllan &
Siperstein, 2002). A close examination of these factors reveal that the test results are not
used objectively, and the schools’ beliefs about who should be served through special
education tend to influence the conclusions. If the child demonstrates low achievement
and the school believes that placing the student in special education will help, despite the
13
exclusionary criteria, the students with low cognitive skills and those failing to meet the
discrepancy criterion are classified as learning disabled (Gottlieb, Alter, Gottlieb &
Wishner, 1994; Shepard, 1983). Schools tend to ignore the lack of discrepancy. A large
proportion of underachieving students who are qualified for LD services obtain the IQ
scores between 70-85. Many proponents assert that students identified with learning
disabilities should demonstrate IQ scores in the ‘average’ or ‘above average’ ranges, i.e.,
an IQ score of 90 or above (Kavale, 2005; MacMillan, Gresham, & Bocian, 1998). The
students obtaining IQ scores between 70-85 are not included in any category of disability,
but they are the group of students showing chronic low achievement. Thus, in order to
assist these children though special education services, schools classify them as having a
learning disability (Gerber, 1999-2000).
In addition, schools are often reluctant to classify students as emotionally
disturbed and/or mild mental retardation (Kavale, 2005). The diagnosis of LD is often
used “as an initial nonspecific category, appending an acceptable label because it is less
stigmatizing and pessimistic in its prognosis, to be used until the treatments provided are
deemed ineffective and inappropriate” (MacMillan & Siperstein, 2002, p. 302).
The determination of eligibility of a student as having learning disability cannot
be decided solely on the basis of the psychometric test results; rather the decision should
be based on the preponderance of data and the joint decision of the (interdisciplinary)
team members, including the child’s parents (Kansas State Department of Education,
Process Manual). The process at this stage is influenced by the competence and
individual persuasive abilities of the team members, availability and perceived
14
effectiveness of resources in helping the student, caseload of resource teachers, and the
concerns about second language learners (MacMilllan & Siperstein, 2002).
Psychological Processes and the Language Component in LD Identification
The 1977 federal definition indicated that learning disabilities is “a disorder in
one or more o f the basic psychological processes involved in understanding or using
language, spoken or written” (USOE, 1977 as cited in Kavale & Fomess, 2000). Though
language problems, like difficulties in reading and writing, are evaluated within the
context of the discrepancy model, there is consideration given to assessment of specific
skills deficit in components like listening comprehension and oral expression (Mercer et
al., 1996). It may, however, be difficult to determine the primary reason for the
difficulties because language skills and academic achievement are so closely related to
each other. At the same time, awareness of language and its use are closely related to and
invariably affect achievement in school (Karanth, 2003).
Along with determination of specific language skills, assessment of cognitive
processes like memory, attention and metacognition also provide insight into the
condition of learning disabilities (Kavale & Fomess, 2000). For example, Rourke (1993)
demonstrated that use of immature algorithms in children with dyscalculia is associated
with slow information processing and poor working memory. It is, however, important to
note that assessment of cognitive processes has been largely emphasized by researchers
but is not used by states in the identification criteria (Mercer et al., 1996).
Multilingualism and Learning Disabilities
Academic difficulties of bilingual children and their subsequent identification as
being learning disabled has raised many remarks about the relationship of social and
15
linguistic context and academic learning. The continued focus on determination of
difficulties faced by the bilingual students has reinforced the concept of deficits as
inherent in the child. Professionals often fail to take notice of the environmental and
cultural influences as powerful contributors to learning differences (Cummins, 1986).
Existence of language disorders as an indicator of learning disability has gained
wide acceptance; this is reflected in the finding that all the 50 states and the District of
Columbia include this criterion as part of their definition and/or criteria (Mercer et al.,
1996). At the same time, a large proportion of non-English speaking children are often
inaccurately diagnosed as having language disorders because most of the assessment
procedures are conducted in English or by English speaking professionals who have little
or no proficiency in the child’s native language (when conducting assessment in that
language (Ambert, 1986).
Similar overrepresentation of non-English speaking children is observed in the
category of learning disabilities (Ortiz & Maldonado-Colon, 1986). Ortiz and
Maldonado-Colon (1986) have highlighted behavioral difficulties that prompt the
teachers to refer non-English speaking children; the same behaviors are also found to be
characteristic of second language learners. Therefore, children exhibiting behavioral and
academic achievement patterns inconsistent with the expectations of the larger system are
likely to be identified as disabled. This finding raises alarm and warrants inclusion of
objective measures of socio-cultural and linguistic influences on the learning behaviors of
children.
Viera (1986) explains that, from a psycholinguistic point of view, reading is an
interaction between language and thought. The skills acquired in spoken language help
16
the young reader in making sense and predictions about the printed structures on paper.
From this point of view, children acquiring instruction in a language with which they
have little or no experience can prove to be a complex task. And, equally difficult is the
situation of identifying the reason of child’s academic difficulty; is it lack of exposure or
an inherent inability in the learner? What should be the standards of measurement? What
length of exposure may be considered optimal for the child to gain proficiency, which, in
turn, should rule out one of the crucial environmental factors affecting the academic
performance?
Issues Related to Identification o f Learning Disabilities in India
In India, identification and study of learning disabilities has been taken up in the
last two decades and is largely limited to the students attending urban schools, where the
medium of instruction is English. However, continued research in rural areas has
substantiated the prevalence of learning disabilities among children across different
populations (Karanth, 2003).
In addition to the assessment and identification issues discussed above (with
respect to the American population of school-aged children), multilingual and
multicultural backgrounds in which children learn at schools make study of learning
disabilities a more complex task in India (Ramaa, 2000). There are 18 standard languages
and each language has its own orthographic system. Though variations are observed
across different states, the typical school system uses the “three language formula”
(Ramaa, 2000, p. 269). In other words, students are expected to learn to read and write in
Hindi (the national language), English, and the regional language. At the same time,
17
depending upon the medium of instruction and the syllabus followed in the school, the
students may be expected to speak in English and/or the regional language.
Though Hindi is spoken by the majority of the Indian population, children
entering schools at pre-kindergarten and kindergarten levels come from families that may
be speaking the regional language at home. In other words, children entering school
systems may have little or no exposure to the language used as the main medium of
instruction, especially in the urban English medium schools. In fact, this multilingual
environment has led some researchers to articulate learning disabilities as inability to use
a specific language, for example “LD in English” as noted by Ramaa (2000, p. 271). This
conceptualization of LD is further substantiated by the fact that difficulty in reading in
one orthographic system does not necessarily imply inability to read in a different
orthography (Padakannaya, 2003).
In addition to the multilingual context, factors like parental illiteracy, lack of
exposure to the pre-academic skills, and lack of awareness among teachers and a high
student-teacher ratio (50:1) make identification of learning disabilities extremely difficult
(Karanth, 2003). In absence of any governmental or organizational framework for
identification, professionals from different fields work with children with learning
disabilities to varying degree in rather sporadic fashion.
Researchers have attempted to use various inclusion and exclusion criteria in
identification of learning disabilities. In a description of the studies done in India over the
last two decades, Ramaa (2000) has listed some of these criteria: “no sensory problems,
no serious emotional problems, no serious brain injuries, no intellectual retardation, eight
years of age or above, regularity in school attendance, serious academic difficulty (more
18
than 2 years of retardation), receiving help at home with school work, motivation to
achieve academically” (p. 270). Others have chosen exclusion of bilingualism and use of
different language at home and school as necessary criteria in order to identify true
conditions of learning disabilities.
Summary
Selection of appropriate criteria for identification of children as having learning
disabilities has been a struggle for researchers and practitioners. Considerable variation is
observed in the criteria adopted by different school systems in identification of learning
disabilities among school-aged children.
Identification of learning disabilities in a single assessment, done at one point in
time, has been the norm for a long time. Different inclusion and exclusion criteria are
considered in order to make the decision. Though the identification criteria forwarded by
the federal regulations provide the broad framework for reference, different states and
districts give precedence to different criteria in their identification process.
The one-time assessment methods make use of the discrepancy formulas (inter-
and intra-individual comparisons) as a chief criterion to determine the existence of
learning disabilities. The discrepancy is largely a comparison between the child’s ability
(as determined by the obtained IQ scores) and her/his achievement. Use of discrepancy
formulas and IQ scores in identification of learning disabilities has been questioned for
their lack of instructional validity and inability in early identification. Additionally,
researchers have pointed out that reliance on the discrepancy formulae in isolation leads
to skewed identification practices, that is, identifying children with high IQ scores as
learning disabled and leaving out the children with IQ scores in average and low average
19
ranges. Therefore, using discrepancy formulas for low academic achievement has been
strongly suggested by many researchers.
Recently, the one-time assessment method has been questioned because it does
not allow the distinction of true condition of learning disabilities from poor academic
performance that is due to lack of instruction. In response to this issue, the Problem
Solving Approach has been put into effect by many school systems. Through a process of
functional analysis, the child is provided with interventions as soon as the difficulty is
detected. Failure to respond to the continued and specific interventions over a longer
period of time is used as the chief criterion for identification of child as having learning
disabilities.
Students’ fluency and efficiency in using the language used as the medium of
instruction is seen as an important precursor to academic learning. Therefore, existence of
language disorders is perceived as a strong predictor of learning disabilities.
The role of language in understanding children’s lack of achievement at school
becomes a complex issue when children learn in a multilingual context. In such a context,
children often enter school systems with little or no exposure to the language used as the
medium of instruction. Therefore, in situation of a student failing to learn in spite of
having average or above average ability, there are many confounding factors that may
make identification of learning disabilities a difficult task.
Identification of school-aged children as having learning disabilities in India
poses similar difficulties. It is difficult for the professionals to isolate the influences o f a
child’s native language and the socio-cultural aspects from the intrinsic difficulty to deal
with language in the academic environment.
20
These difficulties are further complicated by the fact that learning disabilities are
not recognized by the federal system as a category in special education. Therefore, there
is no federal or organizational framework as a reference point for different professionals
involved in identification of learning disabilities. Identification of learning disabilities is,
rather, a result of awareness among professionals, concerned parents and teachers; it also
provides for some accommodations for the identified students in the state level exams
conducted by different education boards at the 10th and 12th grade levels. However,
involvement of different professionals with no framework to follow leads to the use of
random and inconsistent identification criteria.
Therefore, the present study aims to reflect upon the identification criteria of
learning disabilities used by clinical psychologists in India in order to articulate the
prevalent practices. Before aiming to create uniformity in the practices of identification
and providing help to children demonstrating unexpected underachievement, one must
first identify the currently existing criteria and/or practices.
Research Questions
1. What are the specific identification criteria used by psychologists in deciding the
existence or nonexistence of learning disabilities in school-aged children?
2. What standardized assessment tools are used in diagnosing learning disabilities?
3. What informal assessment tools are used in diagnosing learning disabilities?
4. Are there differences in identification practices and service delivery options, with
regard to the demographic characteristics of the psychologists?
21
CHAPTER 2
METHOD
Participants
Clinical psychologists listed in the ‘Professional Life’ and ‘Fellow’ membership
listings of the Indian Association of Clinical Psychologists (IACP) were included in the
survey. The members whose mailing addresses were incorrect were excluded. The
‘Professional Life’ membership category included professionals who have the minimum
educational qualification of Master of Philosophy (M. Phil.) in Clinical Psychology,
which is currently the recognized entry-level practicing criterion for clinical
psychologists in India. The ‘fellow’ membership category included professionals who
have a minimum of 10 years of experience in the field in addition to holding the
‘Professional’ membership of the association for at least two years. In addition to the
Clinical Psychologists listed in the IACP membership list, a few more (8) professionals
were included in the study through personal contact. The professionals included in this
way were the ones who held the minimum qualification of M. Phil clinical psychology,
held job title of ‘clinical psychologist’, and had been working in the field for at least 4
years, but did not hold the membership of IACP. A mailing list of 351 clinical
psychologists was thus assembled.
O f the 351 surveys mailed out, 79 were returned for a total response rate of
22.5%. However, 22 questionnaires had to be eliminated because of the inapplicability to
the professionals’ current work; these clinical psychologists did not work with children or
conduct assessments for identification purposes. Thus, a usable response rate of 16% was
achieved. The first mailing was conducted in November, 2006, and follow up mailing to
22
those who had not responded was conducted three weeks following the first mailing. A
response rate of 6% (n = 21) was achieved following the first mailing and a response rate
of 16.5% (n = 58) was achieved following the second mailing. The usable 16% responses
included respondents from 15 states in India, with the maximum number (9) of
respondents from the State of Karnataka. The representation numbers and percentages
from different States are summarized in Table 1.
The additional demographic characteristics of the respondents are summarized in
Table 2. The ages of the respondents ranged from 26 to 75 years, with the mean age of
respondents being 48.5 years (SD - 13.5); the maximum number of respondents (20) was
in the age range of 55 to 75 years. Thirty-eight percent (n = 22) respondents were males
and 59.6% (n = 34) were females. Fifty-four percent (« = 31) of the respondents reported
their highest level of professional training being the Master of Philosophy (M. Phil) in
Clinical Psychology, along with 21.1% (n = 12) holding PhD or PsyD in Clinical
Psychology as their highest qualification. The respondents had an average of 22 years
(SD = 14.1) of experience in the profession, predominantly worked in private practice
(65%), and consulted for up to 10 children in a week (66.7%).
Research Design
The purpose of this study was to explore the identification practices used for
identification of learning disabilities by clinical psychologists in India. Descriptive
research was used to describe the methods and criteria that clinical psychologists use in
order to identify school-aged children with learning disabilities. This study used the
survey research method to effectively explore the different methods and criteria used by
these professionals. In addition, the study attempted to examine if psychologists consider
23
Table 1
Summary o f the Percentage o f Respondents from Different States
State Percentage
Delhi 10.5
Uttar Pradesh 10.5
Himachal Pradesh 1.8
Gujarat 10.5
Tamil Nadu 10.5
Maharashtra 8.8
Kerala 12.3
Karnataka 15.8
Andhra Pradesh 5.3
Chandigarh 1.8
Jharkhand 5.3
West Bengal 1.8
Madhya Pradesh 1.8
Uttaranchal 1.8
Bihar 1.8
24
Table 2
Summary o f Percentage o f Respondents within Other Demographic Categories
Demographic Percentage
Gender
Male 38.6
Female 59.6
Age
25 to 34 26.3
35 to 44 15.8
45 to 54 22.8
55 to 75 35.1
Highest Qualification
M.Phil Clinical Psychology 54.4
PhD/PsyD Clinical Psychology 22.9
MPhil/PhD 15.8
MA Clinical 1.8
M.Ed. School Psychology 1.8
Diploma in Psychotherapy 3.5
25
the bilingual status of children, and the criteria/method they use for identification of
bilingual children as having learning disabilities. The questionnaire designed for this
purpose (see Appendix A) included a combination of open-ended and categorical
questions to facilitate the professionals’ listing of various practices they use in making
the decisions about existence of learning disabilities.
Instrumentation
The questionnaire designed by the researcher had 14 items. The questionnaire
consisted of questions that would elicit descriptive responses from the participants. The
questionnaire was divided into two sections. The first section (Questions 1 to 4) aimed to
gather information about the different identification criteria and tools that the
psychologists might use to diagnose children with learning disabilities. Question 1 was
designed to elicit information about the different kinds of tools that they used
(standardized and/or informal assessment procedures). Question 2 explored the method
and importance that the practitioners gave to the standardized and/ or the informal
assessment instruments in making the decision about a child as having learning
disabilities. The next question asked the participants to state their specific inclusion as
well as exclusion criteria that they might use in making the diagnoses of learning
disabilities. To sum up the first section, the respondents were asked to list some of the
difficulties or dilemmas that they encountered while doing assessments for children to
identify learning disabilities.
Section two of the questionnaire was designed to examine the process of
identification and service delivery for children identified as having learning disabilities.
Question 5 asked the participants to identify the classification system that they refer to in
26
making their evaluation decisions of presence or absence of learning disabilities.
Questions 6 and 7 were designed to examine the demographic profile of children
being identified as having learning disabilities, specifically the type of school population
that was being referred and, thus, assessed for learning disabilities, and the extent to
which bilingual children were being assessed for learning disabilities. Questions 6 and 7,
when combined with responses to questions 1 to 4, were expected to be able to give
important information about the extent to which identification practices were sensitive to
the needs and characteristics of bilingual or second language learners. Questions 8, 9 and
10 examined the sources, reasons and age of referral, respectively. These items provided
further demographic information about the probable children being identified as having
learning disabilities.
Questions 11 to 14 were designed to examine the association between the
identification practices and the subsequent help being provided to the children.
Specifically, the items aimed to examine the professionals involved in the identification
process, the communication between the identifying professional(s) and the school (in
order to plan and implement the interventions), and finally, any regulations or role played
by the education board(s) in ensuring help for the children being identified as having
learning disabilities.
Procedure
After receiving the permission from the Emporia State University Institutional
Review Board for the treatment of Human Subjects, the paper copy of the questionnaires
were mailed in a box to a contact in India. The contact person then mailed the
questionnaires to the home addresses of clinical psychologists listed in membership list of
27
the IACP and others who had been identified through personal contact. A cover letter
accompanied the questionnaire to inform the participants about the purpose of the study
and served as the informed consent document (see Appendix B). A second mailing was
conducted 21 days after the first mailing to those participants whose responses were not
received until then. The participants were informed that the questionnaires would be
coded only for the purpose of the follow-up mailing, and no identifying information
would be asked on the questionnaire.
A stamped, self-addressed return envelope was included with the questionnaire.
The participants were requested to return the questionnaire by a specific date stated in the
cover letter. A second mailing of the complete cover letter, questionnaire, and stamped
return envelope was conducted on the day after the specified date. In order to protect
confidentiality, once the second mailing was conducted, data about the coded information
about the participants was deleted. Responses received after January 2007 were not
included in the study. The contact person from India mailed the received responses (in a
box) during the first week of February 2007.
28
CHAPTER 3
RESULTS
Data Analysis
The first 20 questionnaires were analyzed and coded for the recurring themes of
responses reported under the descriptive questions. A scoring rubric was developed and
used to code the questionnaires. The scoring rubric was coded for demographic
information about the professionals. Other codes included tools, method of using the
assessment information, identification criteria, dilemmas, and use of classification
system, among other categories. A summary of scoring rubric with codes used for
respective categories is listed in Appendix C. Two other professors of school psychology
and special education coded the questionnaires and an inter-rater agreement of 95% was
achieved.
A descriptive analysis of the data was, then, conducted to address the research
questions posed in this proposal. The Statistical Package for the Social Sciences (SPSS)
was to conduct a post hoc analysis to assess the test differences between the types of tools
that clinical psychologists were using with regard to their age and number of years that
they had been in practice. Four analyses of variance (ANOVA) were conducted to make
these comparisons.
Demographic Profile o f the Children Being Assessedfor Learning Disabilities
Most children being assessed by the responding clinical psychologists were
attending private schools; 80.7% (n = 46) of the professionals reported this finding.
Seventy-seven percent (n = 44) of the psychologists assessed children who were
receiving instruction for all the subjects in English language, whereas 49% (n = 28) of the
29
professionals indicated that most children that they assessed were receiving instruction in
Hindi or the regional language. Schools and teachers along with psychiatrists were the
most commonly sources of referral (68.4% and 38.6%, respectively), who typically
referred children for poor academic performance (M= 55.43, SD = 23.3). Other reasons
of referral on average included 29% (SD = 18.2) behavioral problems, 13.2% (SD =15.7)
school refusal, and 15.4% (SD =18.2) difficulty with the medium of instruction. Eight to
10 years (i.e., in Grades 4th and 5th) is the typical age at which children are formally
assessed for learning disabilities (65%).
Identification Criteria Used to Make Diagnostic Decisions
Research Question 1. What are the specific identification criteria used by
psychologists in deciding the existence or nonexistence of learning disabilities in the
school-aged children? Having average and above average intelligence was reported by
26.3% (n = 15) of the professionals, and presence of poor academic performance was
noted by 29.8% (n = 17) of the professionals, as important inclusion criteria that are used
for diagnostic purposes. Mental retardation and neurological disorders (e.g., epilepsy)
were noted by 26.3% (n = 15) as important exclusion criteria. Seven percent (n = 4) of
the professionals reported using environmental factors (like, social/cultural disadvantage,
and being a first generation learner) and difficulty to cope with the medium of instruction
as important exclusion criteria. In addition to these exclusion criteria, changes in
curriculum (e.g., the child’s shift from one board of education to another) was also
reported by 3.5% (n = 2) of the psychologists as being included in their diagnostic
decisions about learning disabilities.
30
Up to 70% of professionals did not explicitly state the inclusion and exclusion
criteria that they use. However, they (n = 44) reported referring to the diagnostic criteria
listed in either of the two classification systems, namely the International Classification
of Diseases - Tenth Edition (ICD-10) and the Diagnostic and Statistical Manual- Fourth
Edition (DSM-IV). There were 3.5% (n = 2) professionals who indicated that they did not
use any of the classification systems.
Tools Used by Professionals
Research Questions 2 and 3. What standardized and informal instruments are
used in diagnosing learning disabilities? The results revealed that 71.9% (n = 41) of
clinical psychologists used standardized instruments normed for the Indian populations of
children. The list of the most commonly reported instruments with Indian norms and the
number of professionals who reported using them is presented in Table 3. However, most
professionals did not report the year of publication and the exact population for which the
listed instruments have been standardized. Fifty-four percent (n = 31) of the clinical
psychologists reported that they use standardized instruments that are normed in other
countries.
However, these numbers do not present two discrete groups, as 21 (36.8%)
professionals reported using a combination of both types of standardized instruments,
ones that are normed in India and those that are standardized for some foreign
populations of children. Therefore, it may be concluded that for assessments of learning
disabilities, approximately 35% (n = 20) of the clinical psychologists resort purely to the
use of tools with Indian norms where as another 17.5% (n = 10) use only those
standardized instruments that are not normed for such populations.
31
Table 3
Summary o f the Most Frequently Used Instruments
Name
Instruments with Indian norms
Binet Kamat Intelligence Scales
Bhatia’s Battery of Performance Intelligence Test
Wechsler Intelligence Scale for Children - Indian and Gujarati adaptation
NIMHANS Battery of Learning Disability
Instruments not having Indian norms
Raven’s Progressive Matrices
Stanford-Binet Intelligence test
Seguin Form Board Test
Wechsler Intelligence Scale for Children- Revised Edition
Bender Visual Motor Gestalt Test
Vineland Social Maturity Scales
Informal methods
Informal reading/writing/math tests
Observation
Parent Interview/History
Record review/ assessment of the academic work
32
When asked about the informal tools used in assessment of learning disabilities,
36.8% (n = 21) o f the clinical psychologists reported using such procedures. Out of these,
only 10.5% (n = 6) of the professionals depend solely on the information gained from the
informal instruments in order to make diagnostic decision about a child having or not
having learning disabilities. A summitry of informal methods used in assessment is
presented in Table 3. Other respondents (26.3%) use informal procedures in conjunction
to the standardized instruments in order to draw their conclusions.
There are different ways in which clinical psychologists use these various
assessment tools to draw their conclusions. The most common procedure followed by the
professionals is to use informal methods to understand the child’s difficulties and
combine this information with the results of the standardized instruments; 40.4 % (n -23)
of the clinical psychologists reported making diagnostic decisions in this way. Another
21.1% (n = 12) of the psychologists indicated that they depend only on the results
obtained from the standardized instruments to make determination about a child having
any type of learning disabilities. Other combinations of using the assessment information
included using standardized instruments to substantiate the diagnosis along with using the
informal curriculum and criterion referenced information for intervention purposes, using
standardized instruments only when specific referral demands such information otherwise
only using informal procedures, and using of informal assessment tools at the screening
stage but using standardized instruments for making the diagnosis; 15.7% of the
respondents indicated using such combinations.
33
Differences in Identification Practices o f Clinical Psychologists
Research Question 4. Are there differences in identification practices and service
delivery options with regard to the demographic characteristics of the psychologists? A
post hoc analysis that included four one-way analyses of variance (ANOVA) was used to
test differences between the types of tools that clinical psychologists were using with
regard to their age and number of years that they had been in practice. The ANOVA
yielded significance with respect to use of standardized instruments that have Indian
norms and age of clinical psychologists, F (l, 56) = 8.42,/? = .005, indicating that clinical
psychologists who do not use standardized instruments with Indian norms are older in
age (M= 56.38, SD =11.46) than the younger professionals (M= 45.51, SD =11.46)
who use such instruments. Similarly, the ANOVA yielded significance with respect to
use of standardized instruments that have Indian norms and number of years that the
clinical psychologists have been in practice, F (l, 55) = 6.55,/? = .01, indicating that
professionals who use such instruments have fewer years of experience (M = 19.18, SD =
13.96) than those professionals with more number of experience in the field (M = 29.38,
SD = 12.08). In addition, the ANOVA yielded significance with respect to the use of
informal tools in assessment and age of professionals, F (l, 56) = 5.09, p = .02, indicating
that informal tools are used by older clinical psychologists (M= 53.67, SD = 13.54) than
younger psychologists ( M - 45.58, SD = 12.74). A similar significance was yielded by
ANOVA in regards to use of informal tools and years of experience, F (l, 55) = 4.12,/? =
.04, indicating that informal tools were used more by clinical psychologists who had
more number of years in the profession (M —26.90, SD = 14.92) as compared to those
who had been in the profession for relatively fewer years (M = 19.20, SD = 13.01). A
34
summary of the means and standard deviations of the use of the two types of tools and
age and number of years in profession is presented in Table 4.
Dilemmas Faced in Making Diagnostic Decision about Learning Disabilities
Though clinical psychologists are most frequently (94.7%) responsible for making
diagnostic decisions about learning disabilities, they are faced by some dilemmas and
difficulties in arriving at such decisions. The psychometric issues, namely, not having
adequately normed standardized instruments and other difficulties in ascertaining the
presence of the condition learning disabilities, contributed to the dilemmas of 52.6% (n =
30) of the clinical psychologists. These professionals stated that presence of different
educational systems, like CBSE, Anglo-Indian schools, and ICC, make it difficult to
establish the normative group for the instruments. In addition, it was reported that many
instruments have outdated norms and lack adequate reliability. With respect to the
psychometric properties of the standardized instruments, psychologists conveyed a
persistent desire to have achievement tests that would give clear cutoffs to demarcate the
children with learning disabilities from their typically performing peers. Gauging the
effect of emotional and environmental influences as contributing factors, differentiating
between learning disabilities and difficulties (e.g., child presenting other condition like
behavioral disorders), and receiving inadequate data from school and parents were some
other difficulties that prevented clinical psychologists from arriving at a clear decision
about existence of learning disabilities.
Along with the above stated difficulties, psychologists reported that lack of
information about quality of instruction during initial academic years makes it difficult
for them to say whether lack of adequate instruction is a reason for academic
35
Table 4
Summary o f Means and Standard Deviations o f Use o f the Two Types o f Tools, and Age
and Number o f Years in Profession
Age Years in Practice
Use of Tools n M SD n M SD
Standardized Tests with
Indian Norms
Yes 41 45.51 13.12 40 19.18 13.96
No 16 56.38 11.46 16 29.38 12.08
Informal Tools
Yes 21 53.67 13.54 21 26.90 14.92
No 36 45.58 12.74 35 19.20 13.01
36
underachievement among children; 28.1 % (n = 11) professionals reported being faced
with such dilemmas during the assessment processes. This picture is further compounded
by professionals’ concerns about children’s native language being different from the
medium of instruction used in the schools. Seventy-seven percent (n = 44) of the
psychologists reported that most children that they assess for learning disabilities are
attending English medium schools (where all main subjects are taught in English). Many
professionals (19.3%) raised concerns about lack of exposure to English language before
school years and outside school and parental illiteracy as debilitating factors during the
assessment process. Some professionals (8.8%) reported that they find it hard to identify
children as having learning disability (a label that the child will carry for his/her entire
academic life) when they cannot ensure any remedial help being provided because of
insufficient services and trained special educators.
Follow-Up Procedures and Difficulties
After ascertaining the diagnosis of learning disabilities, clinical psychologists are
able to follow-up with children on average of 58.7 times (SD = 35). The most frequently
reported (28%) method o f follow up is provision of consultation or remedial education
provided by an itinerant special educator, who may be part of the psychologists’ team or
may be an independent practitioner. Other modes of follow up included holding
consultation sessions with parents, asking the parents to come back for re-evaluation after
6 to 12 months, and holding counseling sessions with individual children in regards to
their behavioral and academic problems. Only 1.8% (n = 1) of the psychologists reported
as being part of a school, whereas all other clinical psychologists reported working
outside school and rarely visiting schools as part of their work with children.
37
Psychologists also reported some difficulties that hinder follow up after initial
assessment. Such difficulties included practical struggles like families coming from far
off places and difficulty for parents to pay for the follow-up sessions. Also, unawareness
about learning disabilities was seen as a factor that prevents families from understanding
the diagnosis and needing quick remedies for the child’s underachievement. Twenty-
eight percent (n = 16) of the psychologists reported that the educational boards do not
play any role in clarifying the diagnosis of learning disabilities. The only role played by
the education boards with respect to learning disabilities is that different educational
boards provide accommodations during 10th and 12th grade examinations for students
who have been identified as having this condition.
38
CHAPTER 4
DISCUSSION
The findings o f this study aligned with Karanth’s (2003) observations that in India
clinical psychologists are the professionals who are most commonly responsible for
making diagnostic decisions about learning disabilities; 94.7% of the professionals
reported this being the prevalent practice. Clinical psychologists predominantly (77.1%)
reported using the diagnostic criteria listed in the Diagnostic and Statistical Manual of
Mental Disorders (DSM) and/or the International Classification of Diseases (ICD) as
their points of reference in ascertaining the diagnosis of learning disabilities. Both the
DSM and the ICD profess that the child’s achievement scores (on standardized
instruments) should be substantially low given the child’s chronological age and general
intelligence. The DSM does not clearly define “substantially low,” but the ICD lists a
discrepancy of 2 standard deviations between children’s scores on standardized
achievement tests and the child’s age or intelligence. In addition, ICD states attainment of
IQ scores below 70 as important exclusion criterion in diagnosis of learning disabilities.
In other words, the ability/achievement discrepancy model was the only model for
identification of learning disabilities that was reported in this study. The principal use of
this model is consistent with the predominant practices being used in the United States,
with 98% (n - 50) o f the states using the discrepancy criteria as central to the
identification of learning disabilities (Mercer et al., 1996).
IQ scores may be used in two main ways: as the inclusion criteria to establish the
discrepancy between ability and achievement or as an exclusion criterion to rule out the
existence of mental retardation. This finding was reflected in the results of this study as
39
well. Forty-five percent {n = 26) of the psychologists who explicitly indicated the
inclusion and exclusion criteria that they use; 38.5% (n = 22) of the professionals were
using IQ scores in similar ways.
Gordon, Lewandowski and Keiser (1999) have pointed out that in order to avoid
liberal assignment of the LD label, below average achievement should be a required
adjunct to the existence of ability/achievement discrepancy. The ICD requires the
discrepancy criterion with or without academic difficulties as necessary to the diagnosis
of learning disabilities. In the present study, although 54.4% {n = 31) of the psychologists
reported using ICD criteria, it is difficult to comment upon the extent to which these
professionals would include low academic achievement in making the diagnosis. In
addition, 28.1% (« = 16) of the psychologists use the DSM criteria which do not require
inclusion of low academic achievement in order to make the diagnosis. Of the 45% (n =
26) psychologists who explicitly stated the inclusion criteria that they use, only 17% (n -
10) stated using the low academic achievement criterion in conjunction with the
discrepancy criterion. Combining this information with the typical reasons of referral
(poor academic performance) that have been reported by the professionals, it is highly
probable that a large proportion of children being identified as having a learning
disability in India may be displaying relative underachievement when compared to their
own ability but not necessarily the absolute underachievement as highlighted by Gordon
et al. Also, there may be a need to systematically assess other factors such as inadequate
instruction, difficulties as a second language learner, and limited motivation as possible
reasons for low academic performance.
40
Most children being assessed by clinical psychologists attended private schools
(80.7%) and received instruction for all main subjects in English (77%). In other words,
most children being assessed for learning disabilities are second language learners of
English. Cummins (1986) has pointed out the importance of assessing the environmental
and cultural influences as important contributors of learning differences among bilingual
learners. Only 7% {n = 4) o f the psychologists in the present study explicitly indicated
that they use factors such as socio-cultural disadvantage and the child’s being a first
generation learner as significant exclusion criteria in making the diagnosis of learning
disabilities. Though used as research criteria in many studies in India (Ramaa, 2000), the
criteria of bilingualism and language differences between school and home were noted by
only 7% (n = 4) of the professionals in this study as being used in their decisions about
existence of learning disabilities; they used difficulty with medium of instruction as an
exclusion criteria. Some professionals (19.3%) raised concerns about lack of exposure to
English language outside school, but most (92.9%) psychologists did not indicate the
procedures that they use to address such dilemmas or whether they address language
related issues during the evaluation process.
Since learning disabilities have not been identified as a category of disability in
India, there is no organizational representation for learning disabilities at the national
level, along with absence of any formal definition. Similarly, referral of children for
evaluation is limited to professionals who are aware about the condition of learning
disabilities. As highlighted by this study, teachers and psychiatrists are among the chief
sources of referral. At the same time, the grade level at which most children (65%) are
41
referred is 4th and 5th grade -an age that is considered by many researchers as being too
old for children to show any significant gains (Lyon et al., 2001).
Types o f standardized and informal instruments used during the assessment
process also play an important part in making the diagnosis. Since both classification
systems that are being used by the professionals in clarifying the diagnosis require use of
standardized instruments, it is worth taking a note of this practice among professionals.
Approximately 17% (n= 10) of the psychologists use standardized instruments that are
not normed for the Indian populations of children, whereas 36.8% (n = 20) of the
professionals use such instruments in conjunction with those that have been normed for
Indian children. Use of instruments that have not been normed for Indian population
raises crucial ethical and practical issues. According to the standards that have been put
forward for appropriate use of standardized instruments, being fair and valid are two
important standards. However, when instruments that are not normed for the same
population are used, both these standards are markedly compromised; the tests are likely
to be in English (which is not the native language of children in India), and children are
being compared to their peers in a different socio-cultural setting which may bear no
resemblance to their own. In other words, validity of diagnostic decisions made on such
instruments cannot be assured.
With respect to the standardized instruments with Indian norms, the respondents
did not provide the year of publication and the specific Indian population that the tests
were normed for. Therefore, it would be difficult to comment upon the adequacy of these
instruments in drawing diagnostic conclusions about the children’s abilities as compared
to the normed groups. Approximately 52% (n = 30) of the psychologists, however, raised
42
dilemmas associated with psychometric issues where they expressed dissatisfaction with
prevalence of outdated instruments and lack of instruments with adequate reliability.
Farrell, Jimerson and Oakland (2007) have highlighted that, in many developing
countries like India, costs associated with development and standardization of tests often
are the reasons behind lack of affordable and suitable standardized instruments.
Additionally, the information provided by the professionals in this study indicated
that standardized instruments are used mainly for the purpose of establishing the
diagnosis (i.e., the discrepancy). At the same time, in order to plan interventions
psychologists use informal curriculum and criterion reference tools. This finding supports
the criticism of the discrepancy model for its lack of instructional validity that has been
pointed out by other researchers like MacMillan et al. (1996). The finding in this study
that the older professionals and those with more years of experience did not use
standardized instruments but, instead, used informal tools may be an indication of a
similar dissatisfaction. In other words, after conducting assessments according to the
prescribed methods (e.g., use of standardized instruments to establish discrepancy as
professed by the classification systems) for a number of years, these professionals may be
in a more informed position to evaluate the utility of different methods.
In the light of this information, moving away from the Discrepancy Model and
exploring different models of identification of learning disabilities (e.g., Response-to-
Intervention) that do not rely solely on standardized instruments may be worth
professionals’ consideration. As reported in the results of the present study, 10.5% (n = 6)
of the psychologists rely only on the informal assessment procedures for making their
diagnostic decisions. Examination of the actual assessment reports written by these
43
professionals may give valuable insight into operationalization of the construct of
learning disabilities amidst the debilitating issues raised by professionals in this study.
A limitation of this study is that the professionals were asked to report their
practices in generic sense, outside the context of actual assessment cases. This method of
reporting may have presented a limited scope of information. This method also does not
allow an analysis of the ways in which professionals would overcome the dilemmas and
difficulties that they come across during the assessment process; information about such
ways may provide better understanding about the process of identification. This
shortcoming may be improved in future efforts of combining the survey method with
interviews and examination of actual assessment reports prepared by the professionals.
Since the numbers of respondents from some states were as low as 1,
generalizability was a concern. Another concern that may indicate potential response bias
was that the total number of responding psychologists was less (response rate of 16%) as
compared to those listed in the LACP membership listing. In addition, there may be other
groups of professionals who may be involved in identification but did not come to the
awareness of the researcher. Two points are worth noting, however. First, even though
the number of respondents from some states was low, all the respondents held adequate
training in Clinical Psychology. They would be expected to use similar assessment
practices as professed by prominent training institutes in India. Second, in the absence of
strong regulatory organizations for Clinical Psychology and other related professions
(like special education) in India, it is difficult to estimate the exact number of adequately
qualified professionals working in any given state.
44
There is a need for additional research to compare the consequences of using
other models of identification of learning disabilities. Professionals who have expressed
their dissatisfaction with the discrepancy model will want to know the feasibility and
usefulness of alternative models for identification purposes. Since large numbers of
children in India go through the process of education in a bilingual or multilingual
context, further research is needed to understand the implications of language issues for
children with learning disabilities. Though research has been conducted about language
acquisition and possible implications in assessment for learning disabilities among
second language learners in western countries, much of this research points to the needs
o f immigrant second language learners who not only have to cope with language barriers
but also have to adapt to a new socio-cultural environment.
Although this research is important for understanding the process of language
acquisition and the nuances of separating difference from disability, further research in
India is needed to address the compounding factors of inadequate instruction, methods of
progress monitoring, and role o f other professionals in identification and service delivery
for the identified students. Also, in contrast to the literature reported in Western
countries, research in India needs to address the implications for assessment and learning
in a socio-cultural context, where multilingualism is the norm for the school-aged
children with learning disabilities.
45
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52
APPENDICES
Appendix A
Questionnaire
54
Personal information
• A ge:_________
• Gender:_________
• The State in which you Practice:______________________
• Educational qualification/training:_____________________
• Type o f practice: (a) Government, (b) Private, (c) Govt. & Private
• Location of practice:(a) Child Guidance Clinic
(b) Mental Health Department
(c) Department of Clinical psychology
(d) Department of Psychiatry
(e) Department of Pediatrics
(f) Other_________________________
• Professional title/designation you hold:_____________________

• Number of years that you have been in professional practice:
• Average number of children you assess/consult for in a week:
Kindly answer the following questions based on the learning disabilities assessments
that you may have conducted over the past one year. Some of the following
questions are purposely kept open ended; therefore provide as detailed responses as
possible. If desired you may attach extra pages to the following questionnaire.
Identification Criterion
1. What are the assessment tools (standardized and/or informal) that you typically
use in learning disabilities assessments? Please give specific names of the tools.
2. To what degree do you rely upon standardized v. informal assessment procedures

to diagnose children as having learning disabilities? In other words, how do you
use these instruments in your learning disabilities assessment battery?
55
3. During the evaluation procedure, what are the inclusion and exclusion criterion
you use to decide whether a child has learning disabilities?
4. What are some of dilemmas or difficulties do you face while diagnosing children
as having learning disabilities?
Process of identification and service delivery:

5. If you refer to any classification system(s) such as DSM and ICD, please list here.
6. What kind of schools (government or public) do majority of children that you

assess for learning disabilities, attend?
7. What is the medium of instruction for most of the children assessed by you for
learning disabilities?
8. List three primary sources, in order of significance, that refer students to you for
diagnosis.
9. Estimate the percentage for the general reason(s) for referral to you for an
assessment.
______ Poor academic performance
Behavioral problems
______ Learning disabilities
ADHD
______ School refusal
______ Difficulty with the medium of instruction
______ Neurological Disorder (e.g. Epilepsy)
Family/Parent relations
Others
56
10. What is the most typical age range/Std. level for initial/ first time formal
assessment for learning disability? Mark applicable choice(s)
• 3-5 yrs (Nursery, Kindergarten)
• 5-7 yrs (I, II, III Std.)
• 8-10yrs (IV, V Std.)
• ll-13yrs(V I, VII, VIII Std.)
• 14-17 yrs (IX, X, XI, XIII Std.)
11. In your experience, which professionals are involved in determining the

diagnosis/eligibility of Learning disability? Kindly specify their specific roles, if
multiple professional are involved.
• Clinical psychologists
• school counselors
• special educators
• psychiatrists
• others (specify)
12. In your practice, estimate the percentage of cases in which the report is handed
over directly to the parents, with no contact/ discussion with the school?
13. Is there any follow up done on the assessed cases? If yes, explain the procedure. If
no, what are the difficulties in the follow up?
14. What role does CBSE/state board of education play in identification of learning
disabilities and/or implementing the accommodations recommended by the
psychologists/educators?
57
Appendix B
Cover Letter
58
Department of Psychology and Special Education

Emporia State University
Date: November 13, 2006
Ms. Psychologist
1200 Nowhere Drive
Emporia, KS 55555
Dear Psychologist,
I am a school psychology graduate student at Emporia State University. I am doing

research on the assessment practices prevalent among psychologists, in India, with
reference to identification of learning disabilities (LD) in children. The enclosed
questionnaire is designed to elicit information about methods and procedures adopted by
you in diagnosing children as having learning disabilities.
In India, different professionals are involved in identification of learning disabilities

among the school-aged population of children. Though research has highlighted the
unique issues that professionals should consider while making these decisions, there is
little information available about the practices actually adopted by different professionals.
In light of this fact, I would like to seek your expertise to add to this crucial piece of
information.
You are my seniors in the field and as a fellow compatriot and student of psychology, I
look up to you for guidance and support for this study, so that it may help all of us get a
collective insight into LD, from an Indian perspective.
I would appreciate it if you would complete the questionnaire and return it in the
enclosed stamped, self-addressed envelope by December 10th2006. Your response will
be kept confidential and no identifying information will be asked on the questionnaire.
The questionnaires are coded for the follow-up purposes only.
By returning the questionnaire, you are agreeing to participate in this study. It will only
take a few minutes to fill out the questionnaire. Thank you for taking the time to
complete the questionnaire. If you have any questions about this questionnaire or this
research project, please feel free to contact me at gkapoor@emporia.edu or Dr. Jeff
Tysinger at itvsinge@.emporia.edu .
Sincerely,
Geetika Kapoor Jeff Tysinger, Ph.D., NCSP

School Psychology Student Assistant Professor
59
Appendix C
Scoring Rubric
60
Scoring Rubric fo r Different Categories
Category Code
Age As stated
Gender
Male 1
Female 2
State
Delhi 1
Uttar Pradesh 2
Himachal Pradesh 3
Gujarat 4
Tamil Nadu 5
Maharashtra 6
Kerala 7
Karnataka 8
Andhra Pradesh 9
Chandigarh 10
Jharkhand 11
West Bengal 12
Madhya Pradesh 13
Uttaranchal 14
Bihar 15
61
Qualification
M.Phil Clinical Psychology 1
PhD/PsyD Clinical Psychology 2
MPhil/PhD 3
MA Clinical 4
M.Ed. School Psychology 5
Diploma in Psychotherapy 6
Type of Practice
Government 1
Private 1
Government & Private 1
Location of Practice
Child Guidance Clinic 1
Mental Health Department 1
Department of Clinical Psychology 1
Department of Psychiatry 1
Department of Pediatrics 1
Titles
Retired professor 1
Professor, Head of department 2
Clinical Psychologist 3
School Counselor 4
62
Director/ Scientific 5
researcher/officer/coordinator
Special Educator 6
Year of practice As stated
Number of Children seen
1-10 1
11-20 1
21-30 1
31-40 1
41-50 1
51-60 1
Tools
Standardized instruments with Indian 1
norms
Standardized instruments norms or 1
norms not reported
Informal tools 1
Use of assessment results
Understand child’s difficulties through 1
informal methods and combine with
results from standardized instruments
Use standardized tests for diagnosis, 1
63
informal for intervention
Use standardized tools only for specific 1
referral & demand, otherwise only
informal techniques
Use informal tools for screening & 1
standardized tools for making the
diagnosis
Use only informal tools for diagnosis 1
Use only standardized instruments for 1
diagnosis
Inclusion Criteria
Average or above average IQ 1
History of academic difficulties 1
Emotional difficulties 1
Exclusion criteria
Mental retardation 1
Neurological deficits/disorders 1
Environmental/cultural/first generation 1
learner
Curriculum 1
Medium of instruction 1
Psychiatric disorders 1
64
Dilemmas
Instruction related 1
Language/ Socio-cultural issues 1
Psychometric issues 1
Lack of services 1
Poor parent compliance 1
Use of classification system
Yes 1
No 2
DSM-IV 1
ICD-10 1
School
Government 1
Private 1
Special school/NGO 1
Aided 1
Medium of instruction
English 1
Hindi 1
Regional language 1
Referral sources
Parents 1
65
General Physians 1
School/ teacher 1
Psychiatrist 1
Pediatrician 1
Others (special educators, speech 1
therapists)
Reasons of referral
Age of referral
3-5 years 1
5-7 years 1
8-10 years 1
11-13 years 1
14-17 years 1
Professionals involved
Clinical psychologists 1
Counselors 1
Special educators 1
Psychiatrists 1
Others 1
Follow-up percentage As stated
Follow-up procedure
Sessions with parents only 1
66
Coordinated with school and parents 1
Parents asked for reevaluation for 1
planning/ progress
Remedial consultation by itinerant 1
special educator/ other professional
Children counseled for behavioral/ 1
emotional difficulties
Follow up difficulties
Distance 1
Poor parental compliance 1
Lack of awareness 1
Parents have to pay for consultation 1
Lack of services 1
Role of education board
No role 1
Provide accommodations 1
Don’t know 1
Having a checklist to identify children 1
I,______ Geetika Kapoor_____ , hereby submit this thesis to Emporia State University as
partial fulfillment of the requirements for an advanced degree. I agree that the Library of
the University may make it available for use in accordance with its regulations governing
materials of this type. I further agree that quoting, photocopying, or other reproduction of
this document is allowed for private study, scholarship (including teaching) and research
purposes of a nonprofit nature. No copying which involves potential financial gain will
be allowed without written permission of the author.
eetika Kapoor
Date
Identification of Learning Disabilities in
India
Title of Thesis
NV £
V .Cro-VJU^
Signature of Graduate office Stan Member
5~ - 3 - Ol
Date Received
II

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IDENTIFICATION OF LEARNING DISABILITIES IN INDIA

the Department of Psychology and Special Education

of the Requirements for the Degree

ProQuest Information and Learning Company

Dr. Paul McKnab

Dr. James Persfnger

Approved for the Graduate Council

Geetika Kapoor for the Specialist in Education

in School Psychology_______presented April 5, 2007

Title: Identification of Learning Disabilities in India

disabilities among school-aged children in India. Participants were members of the

populations of children. While most psychologists reported using standardized

this project without their constant support and encouragement.

Definition of Learning Disabilities................................................................ 2

Importance of Operational Definitions.......................................................... 3

Operational Models of Learning Disabilities................................................ 4

Identification Criterion as Specified by the States........................................ 5

Use of IQ Scores and the Discrepancy M odel..................................6

Factors Further Affecting the Implementation of the Status M odels 12

Psychological Processes and the Language Component in LD

Multilingualism and Learning Disabilities...................................................14

Issues Related to Identification of Learning Disabilities in India.............. 16

Demographic Profile of the Children Being Assessed for Learning

Identification Criteria Used to Make Diagnostic Decision......................... 29

Tools Used by Professionals.........................................................................30

Differences in Identification Practices of Clinical Psychologists..............33

Dilemmas Faced in Making Diagnostic Decisions about LD.....................34

Follow Up Procedures and Difficulties........................................................36

Appendix B: Cover Letter..........................................................................................57

Appendix C: Scoring Rubric..................................................................................... 59

1 Summary of the Percentage of Respondents from Different States........................23

2 Summary of Percentage of Respondents within Other Demographic

3 Summary of the Most Frequently Used Instruments................................................31

and Age and Number of Years in Profession........................................................... 35

children’s overall ability, educators find it difficult to reason their underachievement. In

Professionals have struggled to arrive at unanimous definition of learning disabilities;

different professional orientations have offered a varied understanding of the condition of

condition among school-aged children.

scripts), students in India are unlikely to experience LD (Karanth, 2003). However,

extensive research being reported on the importance of understanding the structure of

Indian languages and inclusion of specific language-based tests in assessment batteries

methods used by clinical psychologists to identify learning disabilities among school-

aged children in India.

Definition o f Learning Disabilities

Traditionally, learning disabilities as a construct has addressed the unexpected

Learning Disabilities have been characterized as a difficulty in using language (Siegel,

or do mathematical calculations” (U.S. Office of Education, 1997, as cited in Kavale &

environment/context on the expression of learning disabilities (Speece, 1993).

by different state departments of education demonstrated consistency with use of certain

criteria (Kidder-Ashley, Deni, & Anderton, 2000).

Looking at the literature, different researchers use varying terminologies when

Importance o f Operational Definitions

of learning disability, operational definitions ascertain which students are identified as

forwarded a formal definition of learning disability, along with specified methods

exploration of the formal definition of learning disabilities, it is important to investigate

the operational definitions (methods/ criterion) as they are implemented by the

professionals in the field.

Operational Models o f Learning Disabilities