Improving the Self-Esteem and Social Skills of Students with Learning Disabilities

Improving the Self-Esteem and Social Skills of Students with

Learning Disabilities
James C. Raines, Department Chair of Health, Human Services and Public Policy at California
State University Monterey Bay

https://doi.org/10.1093/acrefore/9780199975839.013.1218
Published online: 09 June 2016

Summary
Learning disabilities (LD) are the most common disability in public schools. Since 1975, students with learning
disabilities have been eligible for a free appropriate public education, including special services such as school
social work. Students with LD may be diagnosed via standardized achievement measures and clinical assessment.
Despite 40 years of progress, the evidence suggests that students with LD still feel stigmatized and finish college
and enter the workplace at a rate much lower than their nondisabled peers. School social workers can assist
students with learning disabilities by assessing their self-esteem and social skills and then providing appropriate
intervention. Self-esteem interventions should target students with LD, their parents, and their peers in the least
restrictive environment. Social skills interventions may target students with LD as a separate group or provide
those skills as part of universal inclusive education aimed at all children in the classroom.

Keywords: free appropriate public education, inclusive education, learning disabilities, least restrictive environment,
school social work, self-esteem, social skills

Subjects: Children and Adolescents, Disabilities, Populations and Practice Settings

Definition

Until the Education for All Handicapped Children’s Act of 1975 (P.L. 94–142), students with
learning disabilities (LD) were routinely misidentified (treated as “mentally retarded”) or
unidentified (treated as “slow learners”). Every social worker should be familiar with the federal
definition of the term, which still relies on Samuel Kirk’s (1962) original conceptualization.
“Specific learning disability” means:

a disorder in one or more of the basic psychological processes involved in understanding

or in using language, spoken or written, that may manifest itself in an imperfect ability to
listen, think, speak, read, write, spell, or to do mathematical calculations, including
conditions such as perceptual handicaps, brain injury, minimal brain dysfunction,
dyslexia, and developmental aphasia . . . The term does not include children who have
learning problems that are primarily the result of visual, hearing, or motor handicaps, or
mental retardation, or emotional disturbance, or of environmental, cultural, or economic
disadvantage.

(Assistance to the States, 1999, 34 C.F.R. §300.7(b)(10))

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Improving the Self-Esteem and Social Skills of Students with Learning Disabilities

Thus, students with LD are a very diverse group (Kavale & Forness, 1996) with the most common
subgroups exhibiting difficulties with reading, math, or written expression (Cortiella & Horowitz,
2014).

Diagnosis

The new Diagnostic & Statistical Manual of Mental Disorders (DSM-5; American Psychiatric
Association, 2013) designed to correlate with the International Classification of Diseases (10th
ed.) provides four main criteria:

A. Difficulties learning and using academic skills, as indicated by the presence of at least one
of the following symptoms (reading, comprehension, spelling, number sense, or
mathematical reasoning) that have persisted for at least 6 months, despite provision of
interventions that target those difficulties.

B. The affected academic skills are substantially and quantifiably below those expected for the
individual’s chronological age, and cause significant interference with academic or
occupational performance, or with activities of daily living, as confirmed by individually
administered standardized achievement measures and comprehensive clinical assessment.
For individuals age 17 and older, a documented history of impairing learning difficulties
may be substituted for the standardized assessment.

C. The learning difficulties begin during school-age years but may not become fully manifest
until the demands for those affected academic skills exceed the individual’s limited
capacities.

D. The learning difficulties are not better accounted for by intellectual disabilities,
uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial
adversity, lack of proficiency in the language of academic instruction, or inadequate
educational instruction. (pp. 66–67)

The DSM-5 allows specifiers to clarify the subtype of specific learning disability (reading, written
expression, or math) and allows users to code the current severity (mild, moderate, or severe).
Finally, the DSM-5 also acknowledges that a specific learning disability may manifest differently
across cultures. For example, English-speaking students often exhibit inaccurate and slow
reading of individual words, but students from cultures that possess a more direct
correspondence between letters and sounds (e.g., Spanish) or students from cultures that use
ideograms (e.g., Chinese) often exhibit slow but accurate reading.

Prevalence and Trends

Since the passage of P.L. 94-142, reauthorized as the Individuals with Disabilities Education Act
(IDEA) in 1990, the number of youth found to have learning disabilities grew from 800,000
students in 1976–1977 to nearly 2.9 million students in 2000–2001. Since 2001, however, the
percentage of students diagnosed with LD has steadily declined from 6.1% to 4.7% in 2011–2012,

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Improving the Self-Esteem and Social Skills of Students with Learning Disabilities

a decrease of 500,000 students (U.S. Department of Education, 2015a). Students with LD

accounted for 50% of all students receiving special education services in 2000–2001 and
represent the most common disability across all racial/ethnic groups even though they now
account for about 40% of all students in special education (Zirkel, 2013). Students with LD are
disproportionately (2/3) male, but female students may be underidentified (Cortiella & Horowitz,
2014). Students with LD are also disproportionately poor, twice as likely to be in foster care, and
twice as likely to be homeless. Over two-thirds (68%) of students with LD complete high school
on time compared to 81% of their peers (U.S. Department of Education, 2015b). Nearly a fifth
(19%) drop out of school compared to just 7% of their peers (U.S. Department of Education,
2015c). Finally, less than half (46%) of working-age adults with LD report being employed
compared to 71% of their peers. This trend is also true for adults with LD in other developed
nations (Carroll, 2015).

There are some signs of improvement. More states are adhering to the principle of educating
students with LD in the least restrictive environment so 66% of students with LD spend 80% or
more of their school day in general education, up 19% since 2002. The number of students
completing high school is up 11%, and the dropout rate has fallen 16% during the same time
period. Students with LD report enrollment in postsecondary education within eight years of
leaving high school at the same rate (67%) as their peers. Most Americans (79%) believe that
students learn in different ways, and virtually all educators (99%) agree (Cortiella & Horowitz,
2014).

Unfortunately, only 17% of students with LD receive academic accommodations in postsecondary

institutions. Thus the 4-year college completion rate for students with LD is 11% below their
peers. There is continuing evidence that there is a stigma attached to having a learning disability.
Only 2.2% of parents report that their children have LD compared to the 5% of students provided
special education for LD. Likewise, only 2.7% of adults, ages 18–24, acknowledge having a
learning disability despite the fact that P.L. 94-142 was passed over 40 years ago. Clearly, it is
difficult to ask for academic accommodations if one is trying to deny having a disability. Finally,
there was a 9% decline in employment among working-age adults with LD from 2005 to 2010.
Only 5% of young adults report receiving vocational accommodations at their workplace
(Cortiella & Horowitz, 2014).

Self-Esteem

The concept of self-esteem has evolved from focusing primarily on global measures to more
nuanced approaches that recognize that self-esteem is multidimensional, including academic,
emotional, physical, social, and other characteristics (Harter, 1999; Hymel, LeMare, Ditner, &
Woody, 1999). School social workers should be cautious about assuming that all students with LD
have self-esteem issues. While a number of multi-national studies have shown that students with
LD may have mildly lower global self-esteem (Alesi, Rappo, & Pepi, 2012; Al Zyoudi, 2010; Krull,
Wilbert, & Hennemann, 2014; Ntshangase, Mdikana, & Cronk, 2008), there is great variability
among individuals. In general, they are more likely to have moderately lower academic self-
esteem (Bear, Minke, & Manning, 2002; Zeleke, 2004), but even on this dimension scores can

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Improving the Self-Esteem and Social Skills of Students with Learning Disabilities

vary widely. Social workers are well advised to do a thorough assessment. Not all measurement
instruments for self-concept are multi-dimensional. Recommended instruments include the
Piers-Harris Children’s Self-Concept Scale (2d ed., PHCSCS-2; Piers, Harris, & Herzberg, 2002),
the Self-Description Questionnaire (SDQ) instruments (Marsh, 1990a, b), the Self-Esteem
Inventory (Coopersmith, 1986), and the Self-Perception Profile for Children (SPPC; Harter, 1982).

This difference is important for intervention. Not surprisingly, domains that are rated lowest are
the ones that demonstrate the greatest response to intervention (Elbaum & Vaughn, 2003;
O’Mara, Green, & Marsh, 2006). Elementary students’ self-esteem will benefit most from
academic interventions rather than counseling. Strategy instruction and small group instruction
are helpful. Middle school and high school students’ self-esteem will benefit most from
counseling interventions (Elbaum & Vaughn, 2003). The most effective interventions are ones
aimed at the children and their nurturing environment. While there are more recent interventions
with an emerging evidence base, the interventions mentioned here have the advantage of being
tested within a school system and having used follow-up studies to ensure that the effects are
lasting.

Interventions with Parents

Interventions with parents are important because research has found that parents of students
with LD actually hold lower expectations for their children’s educational attainment than the
students themselves (Cortiella & Horowitz, 2014). Kuzell, Brassington, and Mahoney (1988)
found that a 10-week parenting course was effective in improving the self-esteem of middle
school children with LD both at the end of the course as well as a year later. The goals of the
course include: (1) teaching general parenting skills; (2) exploring how to adapt these skills for
children with LD; (3) providing current information on how parents can improve their child’s
social and daily living skills; and (4) giving parents the chance to share their experiences in a
supportive environment. Materials include both a leader’s manual and parents’ manual (Kuzell &
Brassington, 1985). Raines (2013) recommended using two co-leaders with the following
qualifications: motivation to lead, an understanding of learning disabilities, teaching skills, and
knowledge of basic parenting techniques. He also recommended that leaders present the proposal
to the following constituencies before implementation: school administrators, supplemental
instructional service personnel (i.e., school social workers, psychologists, and special educators),
and the parent association to elicit suggestions before beginning the group. Participation by 8–10
families is optimal, so that the larger group can be broken into two subgroups for skills practice.

The course is designed to last 2.5 hours one night a week for 10 consecutive weeks. Ideal seasons
to offer the group include September to November or January to March because of the lack of
holiday interruptions. Ideal nights are Mondays or Tuesdays so that routine weekdays follow
during which the skills learned in the course can be practiced. A flier should contain information
about the goals, leaders, time, place, cost, and registration procedures. Each week the course
includes multisensory teaching about learning disabilities, some practical parenting concepts,
and opportunities for parents to practice these skills in small groups. Because Kuzell &

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Improving the Self-Esteem and Social Skills of Students with Learning Disabilities

Brassington’s (1985) book is now out of print, the Learning Disabilities Council’s parent
workbook (Trusdell & Horowitz, 2002) is recommended. Silver’s (2006) book for parents of
students with LD may also be a helpful supplement.

Interventions with Students with LD

Lenkowsky et al. (1987) found that bibliotherapy in classroom groups was effective for middle
school children (ages 12–14) with LD. Bibliotherapy involves students reading a story, identifying
with a character, experiencing catharsis, and gaining new insight into their problem (Pardeck,
1998). This approach is especially appealing because it connects an academic means (reading) to
a therapeutic end (self-esteem). The students read age-appropriate books (e.g., Albert, 1976;
Swarthout & Swarthout, 1975) about other children with learning difficulties in a “literature”
class that meets three times per week. They also participate in a weekly discussion group that
addresses the feelings, mutual experiences, and school-related problems reflected in the books.
This intervention involves collaboration between teachers, practitioners, and the school librarian
to create a high fidelity program (Lynn, McKay, & Atkins, 2003). Language arts teachers should
ensure that state reading standards are met, practitioners can facilitate the group discussions,
and librarians can help determine which books are currently in print and available at a group
discount. For students with reading difficulties, it may be best to choose a story that is also
available on audiotape. It is important to select books that reflect developmental problems
similar to the ones faced by the students.

Sridhar and Vaughn (2002) provide a list of sample questions to be asked before, during, and after
reading Polacco’s (1998) story. Before reading the book, students are given a brief introduction
(from the book’s preface) and asked to make hypotheses about the book and the outcome of the
story. During the story, students are asked to paraphrase the plot and identify the emotions of the
lead characters. After reading the book, students retell the story, recount similar personal
experiences, and generate alternative solutions to problems shared.

Interventions with Nondisabled Peers

Fuchs et al. (2002) found that Peer-Assisted Learning Strategies (PALS), a form of peer academic
tutoring, improved the social acceptance and social standing of students with LD. Other authors
have also linked small group reading with social skills improvement (Miller, Fenty, Scott, & Park,
2011; Womack, Marchant, & Borders, 2011). Fuchs and colleagues’ finding is especially interesting
in light of Mastropieri et al.’s (2000) meta-analysis, which found that tutors generally gained
more from tutoring by students with disabilities than the tutees. PALS creates 12–15 pairs of
students in a classroom who work collaboratively on different learning activities, such as reading
or math. It may be beneficial for the teachers to be careful not to pair students with similar
learning disabilities. The class is also divided into two teams. Students earn points for their team
by correct performance and good collaboration. Thus PALS uses both competition and
cooperation to motivate students. Teachers establish four classroom rules at the beginning: (1)
talk only to your partner and only about PALS; (2) keep your voice low; (3) help your partner; and

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(4) try your best. The teacher gives direct instruction and clarifies understanding of each concept
through a choral response. Each member of the pair takes turns being either the Coach (tutor) or
the Player (reader). The teacher first gives direct instructions to the Players (e.g., “K sounds like
kkk . . .”). The instructor then gives strategy hints to the Coaches (e.g., “Point to the letter and
say, ‘What sound?’”) as well as appropriate praise statements (e.g., “You could say, ‘Awesome
job!’”).

There are four PALS reading activities. The first activity is Partner Reading, during which the
higher-performing student reads for 5 minutes and then the lower-performing student rereads
the same material. As the Player works on the material, the Coach provides strategy hints. After
both have read, the lower-performing student gets two minutes to retell what has happened.
Students earn 1 point for each correctly read sentence and 10 points for the comprehension
rehearsal. The second PALS activity is Paragraph Shrinking, during which the Player reads one
paragraph at a time and tries to summarize the paragraph in 10 words or less. Students earn 1
point for correctly identifying the most important idea and 1 point for stating it in 10 words or
less. The third PALS activity is Prediction Relay, during which the Player makes a guess about what
will be found in the next half page. Students earn 1 point for each reasonable prediction, 1 point
for accurately confirming or contradicting the guess, and 1 point for summarization (Fuchs,
Fuchs, & Burish, 2000).The final step is Story Mapping, where each pair combines with another
pair. Each of the four students takes a turn being the leader, who identifies one part of the story
(lead character, setting, problem, and result) and one major event in the story. Each leader must
follow a pattern of (1) telling their answer, (2) asking group members their ideas, (3) leading
discussion toward a consensus, (4) recording the group’s answer on a story map, and (5)
reporting the answer to the teacher. Finally, the teacher debriefs the group answers with the
entire class. Each pair earns 10 points for collaborating, 2 points for each correct story part, and 1
point for each reasonable but incorrect story part (Fuchs, Fuchs, Mathes, & Martinez, 2002).
During each of these steps, the teacher roams around the class giving extra points for cooperative
behavior and good tutoring.

Social Skills

There are two kinds of social behavior problems that may need intervention. Skills deficits refer
to a lack of learned behaviors. Performance deficits refer to a lack of motivation to employ skills
already learned (Gresham, Van, & Cook, 2006; Kavale & Mostert, 2004). For skills deficits,
intervention should be aimed at the students. For performance deficits, intervention should be
aimed at parents and teachers who have the ability to cue, shape, and reinforce the execution of
social skills. Thus, interventions for social skills can be done with both the students with LD and
their nondisabled peers. Like self-esteem, multinational studies show that most students with
learning disabilities have problems with social skills (Carman, & Chapparo, 2012; Schmidt, Prah,
& Čagran, 2014; Yüksel, 2013), but there is wide individual variability (Nowicki, 2003). In general,
students with nonverbal learning difficulties will have more social skills problems (Bloom &
Heath, 2010; Glass, Guli, & Semrud-Clikeman, 2000; Palombo, 2006), but even these students
can demonstrate great unevenness. Recommended instruments for assessing social skills include

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the List of Social Situation Problems (LSSP; Spence, 1980), the Matson Evaluation of Social Skills
with Youngsters (MESSY; Matson, 1988), and the Social Skills Improvement System (SSIS;
Gresham & Elliott, 2008).

Pull-out Interventions with Students with LD

Utay and Lampe (1995) found that the Social Skills Game by Berg (1989) was effective in
improving the peer-related social skills of students with LD. They used the game with two groups
of children in grades 3–4 and grades 5–6 for 50-minute sessions over 8 weeks. The game is
designed to be used for children ages 8 and up. For younger children, a Social Thinking Skills
Puppet DVD illustrates each skill. For older children (ages 10–16), the Social Skills Skits DVD
features real kids. It includes three inventories to identify the students’ specific skill deficits,
including a parent-teacher evaluation of social skills, a children’s self-report social behavior
inventory, and a children’s self-report social cognition inventory. The inventories enable the
group therapist to preselect game cards to address the specific problems. The game also teaches
six cognitive skills that improve social interactions, including self-reinforcement, causal
attribution, managing anxiety, learning from mistakes, building confidence, and positive
expectations. The game cards address four social skill areas: (1) making friends; (2) responding
positively to peers; (3) cooperating with peers; and (4) communicating needs. While the game can
be played one-on-one, part of the effectiveness of the game is the group process itself. A newer
resource is Plummer’s (2008) Social Skills Games for Children. Because students with LD should
spend the least amount of time possible away from core academic subjects, clinicians should
consider running such groups before school, during recess or lunch, or after school. Use of a
“game” may also help these students from feeling like they are missing out on the “fun” if the
group is held during nonacademic times.

A newer group intervention for children with nonverbal learning disabilities and children with
autism spectrum disorder targets social perception (Guli, Semrud-Clikeman, Lerner, & Britton,
2013). The Social Competence Intervention Program (SCIP) is a 16-session manualized
intervention program that uses creative drama activities (Guli, Wilkinson, & Semrud-Clikeman,
2008). Sessions 1 through 7 help students with the input stage of social perception through the
following topics: group engagement, emotional knowledge, focusing attention, facial expressions
and body language, vocal cues, and integrating multiple cues. Sessions 8 through 12 assist
students with the interpretation of nonverbal cues through activities that focus on taking others’
points of view and interpreting conflicting cues. Students engage in several improvisations
through which they practice perspective taking and cognitive flexibility. Sessions 13 through 16
aid students with the output stage of social perception and effective ways to respond to others.

Elksnin (1996), however, points out that while pull-out social skills instruction may be the norm,
there are distinct advantages to inclusive social skills instruction. First, students with LD can be
co-taught by a special education teacher and a general education teacher. Since students with LD
spend the majority of the school day in general education, that teacher can provide prompts,
reinforce appropriate social skills, and identify special problems that may require more intensive
intervention. Second, coincidental instruction can enable both teachers and parents to address
naturally occurring situations as opportunities for teachable moments. Finally, teachers and
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parents may be able to conduct social skills autopsies (Lavoie, 1994) to analyze social errors and
help the student identify prosocial alternative actions for similar situations in the future.
Hutchinson, Freeman, and Berg (2004) identify five principles for contextualized social
competence education. First, the developmental interests, needs, and strengths of the students
must inform the design of interventions. Next, building friendship between students with LD and
their nondisabled peers should be an essential component of any program. Third, any program
must be cognizant of the school context in which curriculum is delivered. Fourth, in schools
where students change classes (e.g., middle or high schools), all teachers should be oriented to
the social skills curriculum so that consistent expectations exist. Finally, interventions should
focus on both how and when skills should be employed.

Inclusive Interventions with Students with LD

Embry (2002) found excellent results from the Good Behavior Game (Barrish, Saunders, & Wolf,
1969). It was created as a classroom management tool in which two to five intraclass teams
compete to earn rewards for prosocial behavior (e.g., “Raise your hand to speak”). The game
works by harnessing the positive peer pressure of the classroom teams, who work together
reduce behaviors that interfere with learning and success. A strengths-based approach to the
game in which positive rather than negative behaviors are monitored and rewarded is preferred
(Tanol, Johnson, McComas, & Cote, 2010). It also appears to work effectively across diverse
cultures (Nolan, Houlihan, Wanzek, & Jenson, 2014).

There is also a wide variety of whole classroom curriculums to teach social skills. These curricula
are organized below by the amount of evidence supporting their effectiveness in schools and with
follow-up studies that demonstrate lasting effects (Kelly, Raines, Stone, & Frey, 2010).

I Can Problem Solve (Shure, 2000) is an effective interpersonal cognitive program for young
children through adolescents (Yekta, Davaei, Zamani, Poorkarimi, & Sharifi, 2013). The program
has four components: structured lessons, classroom dialogues, curricular integration, and family
exercises. The preschool version contains 59 lessons, the K-3 version has 83 lessons, and the
4th- to 6th-grade version provides 77 lessons. Unfortunately, the two versions for older children
omit the family exercises provided in the preschool version. The program is available in both
English and Spanish.

The Incredible Years (Webster-Stratton, 2011) is a set of three multifaceted and developmentally
appropriate curricula for children (3–8 years old), teachers, and parents. The parent, teacher, and
child programs can be used separately or in combination. The classroom program is typically
offered two to three times per week for 20–30 weeks. There are also prevention and treatment
versions of the parent and child programs for high-risk populations. The basic parent training
program targets three different age groups: parents of babies and toddlers (ages 0–2.6), parents
of preschoolers (ages 3–5), and parents of school-age children (ages 6–12). In randomized
control trials (Baker-Henningham, Scott, Jones, & Walker, 2012; Webster-Stratton & Reid, 2010),

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the program has been shown to increase children’s social skills, feelings literacy, and problem-
solving skills. The program is available in multiple languages including English, Spanish,
Chinese, French, and Russian.

Second Step (Committee for Children, 2008) has developmentally focused programs for children
in three academic groups: preschool/kindergarten (ages 3–5), elementary (grades 1–5), and
middle school (grades 6–8). The preschool program focuses on executive-function skills and
self-regulation in preparation for formal schooling. It covers skills for learning, empathy,
emotional regulation, friendship skills, and transitioning to kindergarten. The middle school
program focuses on communication, coping, and decision-making skills in preparation for the
dangers of adolescence (e.g., bullying, peer pressure, and substance abuse). Each lesson includes
introduction of a weekly concept, presentation of a story using videos, puppets, or story cards,
and sample discussion questions (Brown, Jimerson, Dowdy, Gonzalez, & Stewart, 2012). The
Second Step program has been used effectively in over 26,000 schools in 70 countries (Committee
for Children, 2014; Schick & Cierpka, 2013).

Conclusion

Students with LD represent a vulnerable population that needs social work advocacy,
intervention, and research. Despite 40 years of being eligible for academic and vocational
accommodations, too few adults with LD are completing a four-year college degree and finding
gainful employment. These achievements can be furthered through self-esteem and social skills
interventions at an early age by school social workers. We also need systemic changes. First, we
need to reduce stigma by focusing on learning “differences” more than learning disabilities.
Second, we need to take a strengths perspective to this population and find their other multiple
intelligences (Raines, 2003). No individualized education program team meeting should be
complete without identifying how the identified student learns best and harnessing this strength
to empower him or her to be successful in both school and life.

Digital Resources

Council for Learning Disabilities <http://www.council-for-learning-disabilities.org/>. The Council

for Learning Disabilities, an international organization composed of professionals who represent
diverse disciplines, is committed to enhancing the education and quality of life for individuals
with learning disabilities across the life span.

LD Online <http://www.ldonline.org/>. LD OnLine seeks to help children and adults reach their full
potential by providing accurate and up-to-date information and advice about learning
disabilities and ADHD. It is a national educational service of WETA-TV, the PBS station in
Washington, D.C.

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Learning Disabilities Association of America <http://ldaamerica.org/>. Since 1963, LDA has

provided support to people with learning disabilities, their parents, teachers, and other
professionals with cutting-edge information on learning disabilities, practical solutions, and a
comprehensive network of resources.

RTI Action Network <http://www.rtinetwork.org/>. The RTI Action Network is dedicated to the
effective implementation of Response to Intervention (RTI) in school districts nationwide. Their
goal is to guide educators and families in the large-scale implementation of RTI so that each child
has access to quality instruction and that struggling students are identified early and receive the
necessary supports to be successful.

National Center for Learning Disabilities <http://www.ncld.org/>. The mission of NCLD is to

improve the lives of the one in five children and adults nationwide with learning and attention
issues—by empowering parents and young adults, transforming schools and advocating for equal
rights and opportunities.

Smart Kids with LD <http://www.smartkidswithld.org/>. The mission is to educate, guide, and

inspire parents of children with learning disabilities or ADHD. Their aim is to help parents realize
their children’s significant gifts and talents and to show that with their love, guidance, and the
right support, their children can live happy and productive lives.

Teaching LD <http://teachingld.org/>. The Division for Learning Disabilities of the Council for
Exceptional Children is an international professional organization that aims to promote the
education and general welfare of persons with learning disabilities.

Understood <https://www.understood.org/en>. Their goal is to help the millions of parents whose

children, ages 3–20, are struggling with learning and attention issues. They want to empower
parents to understand their children’s issues and relate to their experiences.

References
Albert, L. (1976). But I’m ready to go. Scarsdale, NY: Bradbury.

Alesi, M., Rappo, G., & Pepi, A. M. (2012). Self-esteem at school and self-handicapping in childhood: Comparison of
groups with learning disabilities <http://dx.doi.org./10.2466/15.10.PR0.111.6.952-962>. Psychological Reports, 111(3),
952–962.

Al Zyoudi, M. (2010). Differences in self-concept among students with and without learning disabilities in Al Karak
district in Jordan. International Journal of Special Education, 25(2), 72–77.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington,
DC: American Psychiatric Association.

Assistance to the States. 34 C.F.R. §300.7(b)(10). (1999).

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