Psychopathology Part 3

Internalizing Disorders • 487
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for clinical practice (Stark et al., 2000). Other questionnaires and self-report measures can
be administered efficiently and used in community or clinic populations, such as the depres-
sion scale of the Behavior Assessment Scale for Children, second edition (BASC-2; Reynolds &
Kamphaus, 2004), the Beck Youth Inventory–Depression Scales (BDI-Y; Beck, Beck, & Jolly,
2001), or the Children’s Depression Inventory (CDI; Kovacs, 1992), but these are recommended
only when used in conjunction with a clinician’s interview and other sources of information to
determine accurate diagnosis.
Assessment of suicide risk and behavior is important. In adolescents, there may be a pre-
cipitating stressor that has compromised developmental tasks such as establishing autonomy,
acceptance by their desired peer group, or conflict with important peers or with family mem-
bers. The clinician must remain attuned to those potential events in relation to increased risk
for suicide in youths (Rudd & Joiner, 1998), as well as assess for substance use and antisocial
behavior, as discussed previously (Wannan & Fombonne, 1998). Several self-report measures
listed above include items and clusters of items that address suicidal risk and should be reviewed
immediately following administration.
Interventions
Treatment of depression in youth is a somewhat daunting undertaking, and relapse rates are
typically high (40 to 50%) for clinically depressed youths (Asarnow, Jaycox, & Tompson, 2001).
There have been several large-scale studies within the past 10 years, as well as a few thorough
research synthesis studies on the topic, that are instrumental in advancing treatment for child
and adolescent depression (Ollendick & Jarrett, 2009). Even so, the results and conclusions are
not decisively clear, and practice guidelines and widespread use of empirically supported inter-
ventions remain sparse. There are three main approaches in the treatment of child and adoles-
cent depression: pharmacologic interventions, family or interpersonal psychosocial treatment,
and cognitive-behavioral interventions.
Pharmacologic Interventions As with the anxiety disorders, there have been a limited number
of controlled, randomized clinical trials of treatment of depression in children and adolescents,
either pharmacologic or psychosocial. Pharmacologically, the most promising results have been
obtained with use of SSRIs (e.g., fluoxetine, marketed as Prozac) to reduce depressive symptoms.
However, rates of improvement have been from 40% (Wagner & Ambrosini, 2001) to 60% at
posttreatment (Reinecke, Curry, & March, 2009). As a class of medications, the SSRIs are most
likely to quickly reduce depressive symptoms and have fewer and less detrimental side effects
than other antidepressants (Emslie & Mayes, 2001).
In the most extensive multisite medication and psychosocial intervention study with adoles-
cents to date, which included 439 adolescents from 2000 to 2003, the Treatment of Adolescent
Depression Study (TADS) team (2004) reported that fluoxetine medication plus cognitive-
behavioral treatment was the most effective intervention to alleviate depression in adolescents,
with improvement rates at 81% at 3 months posttreatment. Fluoxetine was superior to cognitive-
behavioral treatment alone in terms of providing earlier response to treatment and reduction
of symptoms (TADS, 2004). Although the cognitive-behavioral interventions incorporated for
the TADS study were criticized for being less rigorous than those used in cognitive-behavioral
treatment studies (Hollon, Garber, & Shelton, 2005; Stark, Streusand, Arora, & Patel, 2010),
the conclusions from the large study do offer cautiously positive indications that medication,
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for some children and adolescents with depression, may be useful as a treatment component
(Reinecke et al., 2009). It should be noted that even when medication was effective, particularly
early on, in follow-up studies the relapse rate for medication alone was higher than that of the
cognitive-behavioral approach (McCarty & Weisz, 2007).
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488 • Psychopathology
Psychosocial Interventions In a synthesis of psychosocial interventions for depressed chil-

dren and adolescents, Weisz et al. (2006) included 35 studies from 1980 to 2004 to examine
efficacy of psychosocial treatment of childhood and adolescent depression. The research syn-
thesis is a helpful approach to consolidate many smaller-scale studies and help interpret how
well interventions work when using a similar measure of effect size. An effect size calcula-
tion takes into account the means and standard deviations of the treatment and comparison
groups, as well as sample size. The overall fi nding from the synthesis of all psychosocial inter-
ventions for depression that were available is a cautiously positive endorsement. Psychosocial
interventions as a group certainly seem helpful in the short term (posttreatment). Long-term
outcomes are not as positive, as shown below. Taking a closer look at the effective interven-
tions at posttreatment, defi ned as a moderate effect size of 0.5 or greater in the meta-analysis,
McCarty and Weisz (2007) identified nine studies that stood out. They provided a table of each
of the nine studies, along with specific components within each treatment approach, since all
of them had multiple components and several components in common across interventions.
The approaches to treatment in these successful interventions included cognitive-behavioral
therapy, interpersonal therapy, cognitive therapy, and family therapy. One point to note is
that these were all clinical trials, and the studies with the best treatment outcomes were those
with a wait-list condition, rather than a comparison treatment condition. It would be helpful
to have data comparing one intervention to another, but that information is not yet available.
Nonetheless, these specific studies reflect the most current and efficacious psychosocial treat-
ments that are available.
Cognitive-Behavioral Therapy Cognitive-behavioral therapy has received the most empiri-

cal support among the psychosocial treatments (Curry, 2001). Components of CBT include
affective education, planning positive activities, proactive problem solving, social skills train-
ing, coping strategies, and cognitive restructuring. Family and interpersonal components may
also be included. Cognitive-behavioral therapy has been implemented with children as young as
8 to 9 years of age. Among 15 CBT studies reviewed by Curry (2001), treatment duration ranged
from 5 to 16 weeks. Some therapy protocols involved twice weekly sessions, with an average
of 11 sessions total. New treatment investigations include an emphasis on family components,
combined with cognitive-behavioral approaches (Asarnow et al., 2001; Curry, 2001; Ollendick &
Jarrett, 2009).
There are two controlled clinical trials of high scientific rigor that address depression in
youth from a cognitive-behavioral perspective. In addition, these studies included samples
that are typical of real-world practice with complex, multiple diagnoses and clinical symp-
toms: the Coping with Depression for Adolescents group treatment (CWD-A; Clarke, Rohde,
Lewinsohn, Hops, & Seeley, 1999, Lewinsohn, Clarke, Hops, & Andrews, 1990) and the
ACTION program (Stark et al., 2010). The CWD-A group treatment, which was included in
the Weisz et al. (2006) research synthesis, is based on cognitive-behavioral principles and has
been effective in reducing depressive symptoms in youths with a primary diagnosis of depres-
sion (Clarke et al., 1999; Lewinsohn et al., 1990). The most recent empirical investigation of
CWD-A is with a sample of 93 girls and boys (age 13 to 17 years) who had comorbid depres-
sion and conduct disorder (Rohde, Clarke, Mace, Jorgensen, & Seeley, 2004). Components of
treatment included altering cognitions and behaviors, use of a structured intervention ses-
sion, teaching mood monitoring, social skills, and pleasant activity scheduling. The CWD-A
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treatment did not appear to address the comorbid conduct disorder symptoms, but it did
reduce depressive symptoms in this highly challenging and distressed group of youths at post-
treatment (Rohde et al., 2004). The comparison condition was a life-skills training, which
included job-seeking and -related skills, for example, and was provided in equal proportion
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to the CBT components. Both conditions included 16 2-hr sessions over an 8-week period.
Attendance was somewhat low in terms of the length of treatment the participants received
but was acceptable for the population in the study. At posttreatment, the CBT group had a
39% recovery rate for depression, compared to 19% in the life-skills condition. The differ-
ence between conditions was not maintained over time, but the life-skills and CBT groups all
had reduced symptoms of depression over a 1-year follow-up. Given the overall challenges of
working with this complex clinical picture, these results are notable at posttreatment in terms
of some psychosocial interventions that reduced depression.
Another CBT approach is the ACTION program. The ACTION program (Stark et al., 2010) is
a cognitive-behavioral group treatment for young adolescent girls (age 9 to 13 years). It has not
been included in a research synthesis, but it is nonetheless a well-designed study with two active
treatment groups and one wait-list condition. The ACTION program included 158 girls who had
a primary diagnosis of depression to qualify to receive treatment as part of the study, but the
majority (60%) had dual diagnoses, most often an anxiety disorder (Sander, 2004). The ACTION
program is delivered over 11 weeks, with a total of 20 group meetings and 2 individual meetings
with the girls. There is a child’s workbook and a therapist manual. An individual case concep-
tualization is created for each girl in treatment so that the therapist incorporates the girl’s indi-
vidual needs throughout the group intervention. There is also a manualized parent component
to treatment in the ACTION program, with focus on parental support for the skills and tools
the girls learn during the group treatment (Stark et al., 2010). Based on posttreatment diagnostic
interviews, 84% and 81% of girls who received CBT or CBT plus parent training, respectively,
no longer met diagnostic criteria for any depressive disorder. This was compared to 46% of girls
in a minimal contact control condition. One of the key elements of treatment for girls at this
particular age, as emphasized by Stark et al. (2010), is the behavioral activation component of
CBT. This component includes active problem solving, coping strategies, and pleasant activity
scheduling. Although the outcomes have not yet been included in another research synthesis or
in terms of treatment effects that would allow for examination of effect sizes, the overall clinical
findings are promising.
Interpersonal Therapy Interpersonal therapy for adolescents (IPT-A) has also received
promising empirical support. In IPT-A, focus is on resolving confl icts in current, important,
interpersonal relationships and improving communication and relationship skills (Mufson,
Moreau, Weissman, & Klerman, 1993). The goals of IPT-A are to reduce depressive symptoms
via improving interpersonal functioning. The main areas to consider for improvement in inter-
personal areas are grief, role disputes, role transitions, and interpersonal deficits (Mufson et al.,
2004). The empirical support for this intervention from one major clinical trial was included in
McCarty and Weisz’s (2007) summary. In a more recent study, IPT-A was delivered in school
clinics located within urban, low-income neighborhoods to a sample (n = 57) of predominantly
Hispanic children, 12 to 18 years of age. Results indicated IPT-A was beneficial and feasible
within these school-based clinics as well as in more controlled settings from earlier clinical tri-
als (Mufson et al., 2004).
Family Therapy The most promising family therapy approach for youth depression is cur-
rently attachment-based family therapy (ABFT; Diamond, Reis, Diamond, Siqueland, & Isaacs,
2002). This intervention was included in the McCarty and Weisz (2007) synthesis of the nine
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most effective interventions. The treatment objectives of ABFT are not solely to reduce depres-
sive symptoms, but to improve relationships, repair relationally based wounds such as aban-
donment, and increase empathy among family members. The reduction of family conflict and
discord is also important, as is fostering trust among family members.
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Suicidality Managing suicidal risk is very important to include early in treatment.

Integrating appropriate intervention to reduce suicidality is a necessary skill when working with
depressed youngsters, particularly as outpatients. Managing this risk involves several straight-
forward strategies (Rudd & Joiner, 1998). The first is to have a proactive stance and a plan for
potential hospitalization to be revised or revisited frequently during suicide risk periods. In
addition, treatment progress and goals should be revisited and updated often, particularly not-
ing the changes that co-occur with decreased suicidal ideation. Sessions may need to occur
more frequently, and the family’s involvement and a phone contact list, as well as availability of
emergency 24-hour support, is necessary. Furthermore, full consideration of medication assess-
ment and monitoring, as well as consultation with medical professionals to manage this aspect
of treatment, is recommended. In the large-scale TADS (2004) study, the combination of CBT
and medication was found to be the most effective in reducing suicidality. The specific addition
of CBT with the medication seemed particularly helpful in attaining a quicker reduction in sui-
cidal thoughts (Reinecke et al., 2009).
In summary, although the available treatments for depressed and suicidal children and ado-
lescents show promise, several important caveats should be kept in mind. Overall, recovery
rates across broadly defined interventions are generally at or below 50% (Asarnow et al., 2001;
Curry, 2001; Ollendick & Jarrett, 2009). The most successful interventions, mainly clinical tri-
als, achieve recovery rates at 80% or better at posttreatment, but long-term follow-up rates are
rarely available. Moreover, relapse rates are high. Also, comorbidity has been rarely addressed
in treatment efficacy studies, and it remains an important factor to consider in day-to-day clini-
cal practice as well as in major clinical outcome trials (Curry, 2001). Recent studies are includ-
ing comorbidity as part of the design, rather than focusing on single-diagnosis participants.
Psychosocial interventions, particularly the CBT-based approaches, are moving in new direc-
tions to reflect a more integrative treatment, incorporating individual, cognitive, relational, and
interpersonal factors.
Summary
The research on child and adolescent depression offers a number of exciting and promising
findings. Treatment research is ongoing, including new directions involving biological and
interpersonal factors. Although efficacious treatments exist, both pharmacologic and psycho-
social (primarily CBT, IPT-A, and ABFT), not all youth are being helped by these interventions.
Furthermore, the issue of comorbidity has not been adequately addressed nor has the role of
culture and ethnicity. The protective factors and risk factors associated with different cultural
and ethnic practices have yet to be examined in standard research and clinical practice. These
could be pivotal factors in understanding and treating childhood depression in our increasingly
diverse society.
Future Directions
The internalizing disorders of children and adolescents represent a major challenge to practicing
clinicians and researchers alike. As we have seen, the anxiety and affective disorders are highly
prevalent in childhood and adolescence. Their effects are distressing in the short run and can
be long lasting.
Although we have attempted to use a developmental psychopathology perspective (see
Zeman & Suveg, this volume) on these disorders, it is evident that the field has not yet fully
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embraced this way of thinking about these problems. As a result, many studies continue to look
at single causal pathways and direct, linear outcomes. As we have suggested, it may be more pro-
ductive to posit that several very different pathways can lead to any one outcome such as depres-
sion or anxiety (i.e., the developmental principle of equifinality) and that any one pathway can
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lead to diverse outcomes (i.e., the principle of multifinality). Thus, a risk factor such as child
sexual abuse can and frequently does lead to multiple outcomes, whether they are an internal-
izing disorder or one of the externalizing disorders (reviewed in Kimonis & Frick, this volume).
Tracking this developmental process is undoubtedly a complex and challenging undertaking,
but a necessary one. This effort will benefit greatly from carefully planned, multisite, longitudi-
nal studies (Ollendick & King, 1994).
Moreover, the effects of these risk factors may not be direct, and we need to consider condi-
tions that moderate these relations. Direct effects are oftentimes captured by what are referred
to as “main effect” models, which imply that a risk factor is directly related to the outcome
in a linear fashion. Yet any one risk factor does not invariably result in any one pathological
outcome. For example, it is well known that not all sexually abused children have negative
outcomes, such as the development of internalizing or externalizing disorders, or at least not
the same negative outcomes. Often a significant minority of abused children do not develop
any disorders at all, implying a profound interaction between the experience of abuse and some
other internal or external moderating conditions (Kazdin & Kagan, 1994). What does seem
most important is the context in which the abuse occurs and the interrelated risk factors that
are present. As noted by Kazdin and Kagan, “when one begins with the multiplicity of variables
that operate, one might better consider nonlinearity to be the better point of departure in our
work” (1994, p. 38).
These same issues have important implications for the treatment and prevention of internaliz-
ing disorders. Our treatment and prevention programs must move away from a “one-size-fits-all”
mentality. Children and adolescents become depressed or anxious through a variety of path-
ways, and they express these disorders in a variety of ways. We need to take this complexity into
consideration in designing, implementing, and evaluating our interventions. Although current
empirically supported or evidence-based interventions work with most (50 to 70%) of the chil-
dren and adolescents and families who come into our practices and research clinics, we must
do better. An approach that is individualized and prescriptive, and one that is based in develop-
mental theory and grounded in established principles of behavior change (e.g., exposure, cogni-
tive change, interpersonal relationships), is likely to be most effective, although this remains to
be carefully documented.
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19
Language, Learning, and Cognitive Disorders
REBECCA S. MARTÍNEZ, STACY E. WHITE, and MICHELLE L. JOCHIM
Indiana University
Bloomington, Indiana
LEAH M. NELLIS
Indiana State University
Terre Haute, Indiana
Learning disorders represent an assorted category of generalized neurodevelopmental chal-

lenges that interfere with the ability to learn academic or social skills (Pennington, 2009).
Broadly, learning disorders originate from a combination of congenital, acquired, or envi-
ronmental conditions or circumstances. Congenital learning disorders include specific learn-
ing disabilities (e.g., dyslexia and dyscalculia), communication disorders (e.g., stuttering), and
developmental disabilities (e.g., intellectual disabilities and autism). They are present at birth
and manifest throughout the lifespan as children and adolescents engage in increasingly chal-
lenging cognitive and academic tasks. Learning disorders also can be acquired at any point in
the lifespan following acute health conditions or severe injury (e.g., traumatic brain injury).
Despite their organic etiology, risk and protective factors shape the developmental trajectory of
both congenital and acquired learning disorders. Poor environmental conditions (e.g., not read-
ing aloud to young children and implementing teaching methods that are not evidence based)
can bring about and exacerbate learning difficulties and disorders, even when there is not a
biological predisposition for them.
This chapter focuses on the three most ubiquitous learning disorders: specific learning dis-
abilities (SLD), speech or language impairments (SLI), and intellectual disabilities (ID). Based
on special education eligibility criteria, approximately 6 million (13.4%) of the total school-age
population have an identified disability and receive public school special education services
(U.S. Department of Education [USDOE], 2010). Roughly 2.6 million children and adolescents
(5.2% of the school-age population) are identified by special education legal standards as having
specific learning disabilities, representing almost half of all students who receive special educa-
tion services. After SLD, the most frequently occurring learning disorders are SLIs (1.5 mil-
lion or 3% of the school-age population) followed by IDs (i.e., mental retardation or cognitive
impairments), representing (500,000 or 1% of the population). Although true learning disorders
are present at birth, this chapter will mainly discuss malleable environmental conditions (e.g.,
importance of implementing excellent, research-based teaching methods) that can alter the tra-
jectory of organic learning disorders. Protective factors that foster student resilience (e.g., teach-
ing basic academic skills until students achieve fluency or mastery) can also prevent acquired
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learning disorders from manifesting in the first place. Although endogenous learning disorders
have a biological origin, children and adolescents exposed to environmental risk factors (e.g.,
teachers who fail to teach phonics to struggling readers) may “learn to be learning disabled”
EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 2/16/2015 10:25 AM via UNIVERSITY OF PORTSMOUTH 499
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(Clay, 1987, cited in Gresham, VanDerHeyden, & Witt, 2005, p.17) and struggle academically in
ways that are indistinguishable from students with endogenous learning disorders.
The first section of this chapter provides an in-depth discussion of SLD, including a descrip-
tion of the definition and changing identification criteria for SLD. Next, we describe a relatively
recent educational paradigm applied to the prevention and early intervention of learning disor-
ders that is rooted in the public health model commonly applied to the prevention and interven-
tion of sickness and disease. This model, Response to Intervention (RTI), has been dubbed one
of the most revolutionary manifestations in education. Response to Intervention approaches all
learning disorders, regardless of their etiology or severity, from a solution-focused perspective
of prevention and intervention. Proponents of RTI are less likely to focus on learning disorders
as a within-student problem (i.e., nonmalleable condition) and more likely to concentrate on the
instructional and environmental conditions that fail to support student learning and the ways
they can be altered to help students learn (i.e., learning disorders as malleable conditions).
Next, we describe the assessment, etiology, and prevalence of communication disorders,
focusing on speech and language impairments. Specifically, we provide information on the more
common speech and language impairments: phonological disorders and stuttering. In the third
section, we introduce intellectual disabilities (i.e., mental retardation), a less common condition
but nonetheless pervasive developmental disorder that results in difficulties with learning.
This chapter concludes with specific strategies the reader can use to help students with learn-
ing disorders and their families navigate the school system, particularly within special edu-
cation. We also provide suggestions for clinical psychologists and social workers who desire
to work closely with staff at their clients’ schools. Specifically, we recommend ways clinicians
can (a) promote prevention of learning failure, (b) participate in school-wide efforts to support
children and adolescents with learning disorders, and (c) partner effectively with parents and
schools to improve the schooling experience of students with learning disorders.
Specific Learning Disabilities

A disability classification, such as SLD, provides a mechanism to organize a heterogeneous
group of people into smaller subgroups of individuals with similar attributes who differ from
other subgroups in important and observable ways. Ideally, disability classifications facilitate
communication among professionals and the individuals themselves. Classification systems
help inform programming and treatment efforts.
Valid disability classifications and appropriate diagnoses require clear operational defini-
tions and identification criteria. Historically, there has been a lack of agreement about the best
way to identify specific learning disabilities.1 Despite being the most prevalent of the learning
disorders, SLDs are among the least understood and most passionately debated disability cat-
egories (Bradley, Danielson, & Hallahan, 2002). Inconsistent application of identification crite-
ria in school and clinical practice has contributed to contradictory and unstable classification,
identification, and remediation procedures. Understanding the current state of the field requires
a brief historical overview of the field, which is presented in the next section.
Historical Overview and Evolving Definition

Scientific, social, and political changes since the 1900s have shaped the field of learning dis-
abilities (see Turnbull, 2009, for a recent analysis). The desire and need to identify individual
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1 The term learning disability is a broad designation for a variety of learning disorders. We use the term specific
learning disability throughout this chapter to be consistent with legal language and practical consideration
because learning disabilities generally manifest in specific areas, such as reading, decoding, math computa-
tion, and so forth.
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Language, Learning, and Cognitive Disorders • 501
differences in learning and performance have dominated scientific and clinical efforts aimed
at understanding SLDs. Observations and reports of individuals with learning disabilities in
one area (e.g., reading) while having otherwise average or typical performance in other areas
(e.g., mathematics) first emerged in the early 19th century (Fletcher, Lyon, Fuchs, & Barnes,
2007). A hallmark of the earliest definition of learning disabilities is that it defined what learn-
ing disabilities were not rather than what they were. For example, Kirk (1963) first coined the
term learning disabilities to describe a “group of children who have disorders in the development
of language, speech, reading, and associated communication skills needed for social interac-
tion … not includ[ing] children who have sensory handicaps such as blindness … [or] who have
generalized mental retardation” (pp. 2–3). Specific exclusionary or “rule out” considerations
remain in the most recent (USDOE, 2004) federal definition of a specific learning disability.
Research conducted up to and through the early 1960s had a significant impact on our mod-
ern conceptualization of learning disabilities. Collectively, evidence about individual learning
disorders contributed the following to our understanding: (a) learning differences could be
understood by observing how children approach tasks and process information, (b) instruction
and programming should be designed in recognition of a child’s specific strengths and weak-
nesses, (c) specific learning disabilities are associated with neurological functioning but are not a
primary result of sensory impairments, and (d) specific learning disabilities occur in the context
of overall average cognitive functioning (Kavale & Forness, 1985; Torgesen, 1991). Also in the
1960s, researchers, educators, and policymakers began advocating fervently and effectively for
adequate educational conditions on behalf of all children with disabilities. In response, the U.S.
Department of Education began the process of operationally defining the condition, specific
learning disability, for legislative purposes. In 1968, the following definition, which included
exclusionary factors, was adopted:
The term “specific learning disability” means a disorder in one or more of the basic psy-
chological processes involved in understand or in using language, spoken or written,
which may manifest itself in an imperfect ability to listen, speak, read, write, spell, or to
do mathematical calculations. The term includes such conditions as perceptual handicaps,
brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. The term
does not include children who have learning disabilities, which are primarily the result of
visual, hearing, or motor handicaps, or mental retardation, or emotional disturbance, or
of environmental, culturally, or economic disadvantage. (USDOE, 1968, p. 34)
This definition drew from the field’s collective understanding of learning disabilities in terms
of its biological etiology (Orton, 1937) and in relation to exclusionary factors (Kirk, 1963). The
1968 definition also marked the first time the term “specific learning disabilities” was used.
Consequently, the 1968 definition was included in the Learning Disabilities Act of 1969 and
as the statutory definition of specific learning disabilities in the landmark Education for All
Handicapped Children Act of 1975 (PL 94-142), which guaranteed, for the first time in history, a
free, appropriate public education to all children with disabilities, including those identified with
learning disorders. The 1968 definition continues to be, with a few minor wording adjustments,
the definition of SLD in the most recent federal special education regulations (Individuals With
Disabilities Education Improvement Act [IDEA], 2004) that today guide school-based evalua-
tion and eligibility decisions.
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Although the federal definition and accompanying regulations were somewhat helpful in
evaluation, identification, and special education program development, significant concerns
remained regarding the procedures for identifying learning disabilities. Indeed, researchers,
practitioners, and advocates continually criticize the definition for emphasizing what learning
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disabilities are not but omitting a clear description and criteria of what learning disabilities are
(Fletcher et al., 2007) and how to identify students who have specific learning disabilities. An
ongoing debate that seeks clarity regarding the definition of SLD and identification practices
continues within the field and will likely continue into the foreseeable future. Although a full
account of this debate is beyond the scope of this chapter, interested readers are directed to writ-
ings by Fuchs and Fuchs (2006), Kavale and Forness (2000), and Kavale and Spaulding (2008)
for more information.
One of the factors contributing to the lack of shared consensus about defi nition and iden-
tification procedures for SLDs lies in the various defi nitions of SLD that have been formal-
ized by the American Psychiatric Association (i.e., in the Diagnostic and Statistical Manual
of Mental Disorders, DSM, 2000) and various advocacy groups such as the National Joint
Committee on Learning Disabilities, and the World Health Organization (i.e., International
Classification of Diseases, 1992). Professionals in clinical and medical practices favor the DSM
classification system and use it to diagnose clients with a specific learning disability. In con-
trast, school personnel use the federal special education defi nition and identification criteria
to identify a learning disorders (including SLD, SLI, and ID) for the purpose of providing
special education services in schools. It is imperative to note that eligibility for special educa-
tion services in the schools does not require a medical or clinical diagnosis of a learning dis-
order; likewise, a medical or clinical diagnosis of a learning disorder does not ensure special
education eligibility. Th is may be confusing for parents and even for professionals who do not
work in a school system. Legally, the purpose of special education eligibility procedures is to
determine educational need and, therefore, eligibility for special education services. Federal
law requires a multidisciplinary team consisting of qualified professionals to identify whether
a student has a disability that requires special support services. The multidisciplinary team
must determine whether the disorder prevents the student from learning in the general edu-
cation system and if the student would benefit from specialized services offered through the
local special education program.
In addition to the lack of universal consensus about the definition of a specific learning dis-
ability, an equally contentious predicament in the history of SLDs concerns identification proce-
dures. Although PL 94-142 provided an operational definition for specific learning disabilities,
as noted above, the omission of clear inclusionary criteria to help identify students with SLD
immediately became problematic for multidisciplinary teams responsible for making special
education eligibility decisions for children with significant learning problems.
In 1977, the USDOE published guidelines designed to facilitate the identification of stu-
dents with specific learning disabilities. The guidelines included the identification criterion of
a “severe discrepancy” between intelligence and academic achievement. School professionals
interpreted the criterion literally to mean a significant discrepancy or difference between ability,
as measured by a standardized IQ score, and academic achievement, as measured by a standard-
ized achievement test score. Despite the widespread acceptance of the discrepancy criterion,
there was limited evidence of its validity (Fletcher et al., 2002). Nevertheless school-based pro-
fessionals in the fields of special education and school psychology came to consider this IQ–
achievement discrepancy as the diagnostic criterion for the presence (or absence) of a specific
learning disability.
Concerns About the IQ–Achievement Discrepancy

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Since the passage of the All Handicapped Children Act of 1975, educators have expressed con-
cern about the lack of emphasis on prevention for students with SLDs (National Association
of State Directors of Special Education [NASDSE], 2005). Reschly (2003) criticized the dis-
crepancy approach to identifying SLD as being (a) unreliable and unstable, (b) invalid (e.g.,
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poor readers with high IQs do not substantially differ from poor readers with lower IQs), (c)
neglectful of providing the necessary focus on exclusionary criteria such as mental retarda-
tion, and environmental, cultural, or linguistic diversity, and (d) harmful because it represents
a “wait-to-fail” approach that delays identification and services. Gresham (2002) similarly
criticized the discrepancy approach because it relied on assessment information that had
restricted utility in designing, implementing, or evaluating the impact of classroom instruc-
tion and intervention. In other words, the assessment data did not drive decisions about which
instructional practices or interventions would be most beneficial for the student.
In the early part of the 21st century, alternate methods for addressing learning problems
at the first sign of difficulty in school and identifying SLDs began to emerge in the litera-
ture. Chief among these methods was RTI. RTI is a data-driven model for identifying and
responding to the needs of students who demonstrate academic and behavioral difficulties.
RTI includes school-wide universal screening, a continuum of interventions and supports,
and ongoing monitoring of student growth and learning (Brown-Chidsey & Steege, 2005;
Martínez & Nellis, 2008). Although RTI is relatively new to education, its conceptual origins lie
in the public health model of preventing disease across a population. Response to Intervention
will be discussed in greater detail later when we discuss effective ways to prevent and remediate
learning disorders.
The Problem With Special Education

In the 25 years spanning 1975 to 2000, a spike in the number of students identified as hav-
ing specific learning disabilities prompted great concern at the federal level. Consequently, in
2001, President George W. Bush appointed the Commission on Excellence in Special Education
to report on the condition of special education broadly and propose policy for improving the
educational performance and school experience of all students with disabilities. The resulting
report, A New Era: Revitalizing Special Education for Children and Their Families, (USDOE,
2002) documented the condition of special education and shed light on fundamental systemic
flaws that, at best, contributed to the overrepresentation of students identified with SLDs relative
to the other disability categories and, at worst, outright failed children.
The authors of the report acknowledged that emphasis on the process (e.g., excessive paper-
work) of providing special education services in the schools resulted too frequently in simply
identifying students as eligible for special education, rather than promoting teaching practices
in both general and special education that ensured effective instruction for all struggling stu-
dents (regardless of an identified disability). The authors of the report did not mince words when
underscoring that the education system often failed struggling learners and students with learn-
ing disorders largely because educators did not readily embrace or implement evidence-based
educational and intervention practices. Indeed the authors conceded that “special education
should be for those who do not respond to strong and appropriate instruction and methods
provided in general education” (USDOE, 2002, p. 7). Lyon (2002) poignantly referred to stu-
dents who were failed by the general education system as instructional casualties whose learn-
ing disorders manifested as a direct result of not being taught by teachers who used effective
educational practices. The 2002 report concluded that the special education system had become
obsolete because the system inadvertently facilitated a process of literally waiting for students
to fail before they received help, instead of promoting prevention, early identification and hard-
line, evidence-based intervention approaches to help struggling learners. Finally, methods of
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identifying children with disabilities, particularly with respect to the category of SLDs, were
sharply criticized in the 2002 federal report cited above and by Gresham (2002) as lacking valid-
ity and misidentifying, overidentifying, and, at times, underidentifying certain students for
special education services.
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Special Education Today

The December 2004 reauthorization of the Individuals with Disabilities Education Act of
1997 (IDEA), the United States’ special education law (originally PL 94-142), was released in
August 2006, and it included RTI as an alternative method (to the IQ-achievement discrepancy
approach) for identifying an SLD in the schools. The regulations included language specify-
ing that, in the identification of specific learning disabilities, state educational agencies must
not require that local education agencies use a severe discrepancy between intellectual ability
and achievement and must permit school districts to incorporate the use of a process based on
the child’s response to scientific research-based intervention or other alternative research-based
procedures for determining the existence of an SLD (e.g., absolute low academic functioning
irrespective of IQ) (§300.307).2 The IDEA 2004 definition of SLD was a slightly modified version
of the definition included in the first iteration of special education legislation in 1975 (PL 94-142)
and reads as follows:
§300.8(c)(10) … 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 the
imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calcula-
tions, including conditions such as perceptual disabilities, brain injury, minimal brain
dysfunction, dyslexia, and developmental aphasia. (ii) Disorders not included. Specific
learning disability does not include learning problems that are primarily the result of
visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or
of environmental, cultural, or economic disadvantage.
The eight areas in which a specific learning disability can be identified are: (1) oral expression,
(2) listening comprehension, (3) written expression, (4) basic reading skill, (5) reading fluency skills,
(6) reading comprehension, (7) mathematics calculation, and (8) mathematics problem solving.
Response to Intervention
Regulations in IDEA 2004 required state educational agencies to determine whether RTI would
be mandated or simply permitted as a component to identify the presence of SLDs. Zirkel and
Thomas (2010a) reported that 12 states require RTI, but the majority of states in the United States
continue to allow schools to use the discrepancy criterion to determine presence of an SLD.
Approximately 20 states also permit schools to use other research-based models that were not
explicitly defined but permitted in the IDEA 2004. Zirkel and Thomas noted that while such
state regulations allow for flexibility at the district and school levels, they also create the potential
for confusion and foster inconsistent practice, similar to what the discrepancy model originally
engendered. Zirkel and Thomas (2010b) examined state guidelines for using RTI and described
and found that all elements of RTI implementation were not equally addressed across the docu-
ments. Further, the lack of explicit state or federal criteria to guide schools in determining when
a student crosses the line from being a struggling student to one with a true learning disability
makes it very difficult for multidisciplinary teams to make special education eligibility decisions.
What Is Response to Intervention?

RTI is a continuum of services that are available to all students based on individual needs,
regardless of whether a student has been identified as eligible for special education services. The
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2 Under the new law, schools are still permitted to use the discrepancy approach, if their state allows it, to iden-
tifying specific learning disabilities; however, clear research evidence does not support this method to identify
SLD (see Gresham, 2002; Reschly, 2003).
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core RTI philosophy mirrors the public health model of prevention and early intervention in the
case of disease. RTI is the application of public health in the public schools. Th is RTI continuum
includes universal interventions, sometimes referred to as “primary prevention,” which are in
place for all students, including general education students, to support positive academic, behav-
ioral, and mental health outcomes. Tier 1 (i.e., primary prevention) in an RTI model involves
high-quality school and classroom environments, scientifically sound core curriculum and
instruction, and intentional instructional practices. Tier 2, or secondary prevention, consists of
targeted academic and behavioral services for those students who demonstrate risk for failure
and for whom universal interventions are not resulting in their success. Services at Tier 2 are
more intense and are focused on the specific needs of a student or group of students. Examples
of educational services at Tier 2 might include small group instruction for either academic or
behavioral needs, additional tutoring support, or involvement in remediation programs such
as Title I. Despite the educational services at Tiers 1 and 2, some students need more intensive
intervention at the tertiary or intensive level. Tier 3 services are available for those students for
whom Tiers 1 and 2 services have not been sufficient. In theory, the needs of approximately 80 to
90% of all students in any given school can be met with universal educational services at Tier 1.
Beyond Tier 1, 5 to 15% of the student body population may require Tier 2 intervention and
1 to 5% Tier 3 intervention (Walker & Shinn, 2002).
Response to Intervention for Identifying the Presence of a Specific Learning Disability

Eligibility for special education services for students with SLDs (as described above) are made
by a multidisciplinary team, as described in §300.308. The team includes a child’s parents and a
team of qualified professionals, including a teacher and at least one member trained to diagnos-
tically evaluate the student’s learning (such as a school psychologist or speech-language patholo-
gist [See Appendix A for descriptions of these roles]). As stated earlier, eligibility for special
education services is not determined by a clinical (i.e., DSM) diagnosis of a disability. Thus,
although a child or adolescent may have been diagnosed by a clinical practitioner with a specific
learning disability, if the individual’s impairment does not adversely affect his or her academic
or functional performance, as determined by the school’s multidisciplinary team, the individual
may not be identified as a student with a specific learning disability and deemed eligible for spe-
cial education services. For this reason, it is in a client’s best interest for psychologists and social
workers to work collaboratively with staff and administrators at their clients’ schools to ensure
that optimal educational services are provided. We provide practical suggestions for working
with schools in greater detail in a later section.
As part of special education eligibility determination for an SLD, as outlined in IDEA 2004,
the school-based multidisciplinary team must consider evidence that the child has not made
sufficient progress in response to scientific, research-based intervention (e.g., RTI) or exhibits a
pattern of strengths and weaknesses that is determined to be relevant to the identification of a
SLD. Addressing longstanding concerns about the rigor and appropriateness of instruction in
reading and math, the regulations also require the team to consider data that demonstrate that
appropriate instruction in general education was provided prior to, or during, the referral pro-
cess (§300.309 [b]). Such data might include assessments that all students in a school are taking
(e.g., universal screening of core skills), tests that teachers are using in their classrooms (e.g.,
teacher-made assessments), and targeted assessments (e.g., progress monitoring tests) given fre-
quently to students who are receiving additional intervention.
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Despite considerable research, debate, and legislative activity regarding SLDs, and more
recently the role of RTI in eligibility decisions, researchers and practitioners still cast doubt on
the validity of RTI procedures for identifying SLDs (Fletcher, Morris, & Lyon, 2003; Kavale &
Spaulding, 2008; McKenzie, 2009). In addition, Johnson, Humphrey, Mellard, Woods, and
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Swanson (2010) cautioned that RTI, even when implemented with fidelity, may provide restricted
information about why a student has failed to make progress over time. Thus, an explanation or
hypothesis about why the student struggles is sometimes missing, which limits future education
programming and planning efforts.
Speech or Language Impairment

Approximately 1.5 million school-age students in the United States have speech or language
disorders. Generally, children with SLIs are identified in preschool, although some children
may not be identified until early elementary school (Schuele, 2004). IDEA 2004 defines an SLI as
[§300.8(c)(11)] “a communication disorder, such as stuttering, impaired articulation, a language
impairment, or a voice impairment, that adversely affects a child’s educational performance.”
Under the broad umbrella “communication disorder,” there are three varieties of impairments:
speech, language, and hearing (Justice, 2006); this chapter focuses on speech and language
disorders or impairments. The fundamental elements of spoken communication are essential
to learning, and difficulties in these areas usually negatively impact a student’s educational
achievement well before the student is identified as eligible for special education services. A
breakdown in speech, language, or hearing can manifest as a communication disorder. As with
SLDs, the earlier communication difficulties are identified, the greater the chance of improving
and remediating symptoms of the disorder. The RTI model, described previously, is also appli-
cable to the prevention, identification, and remediation of speech and language impairments,
especially in the first few years of formal schooling.
Speech Disorders
A speech disorder is an impairment in the presentation of spoken language (Worster-Drought,
1968). Speech disorders are characterized by a breakdown in speech production (e.g., articula-
tion) and include disorders of the voice. Common speech problems include stuttering or dys-
fluency, articulation disorders, and unusual voice quality (U.S. Preventive Services Task Force,
2006). Stuttering (i.e., stammering) is characterized by repetitions, prolongations, and long
pauses in the production of speech. Stuttering affects approximately 5% of the population, and
the incidence is double in boys compared to girls (Andrews, 1984). Most children recover natu-
rally, without intervention, within 3 years of initial identification, although approximately 1% of
the adult population stutters (Zebrowski, 2003).
Language Disorders
Language involves the understanding, processing, and the production of communication (U.S.
Preventive Services Task Force, 2006). A language disorder is a breakdown in the linguistic sys-
tem that can impact at least one of the following linguistic domains: syntax, semantics, phonol-
ogy, morphology, and pragmatics (Justice, 2006). Specific language impairments encompass the
largest group of children with language disorders and affect approximately 7% of all children
(Ziegler, Pech-Georgel, George, Alario, & Lorenzi, 2005). Speech or language impairments are
often followed by associated problems such as difficulties in reading and spelling and may gen-
eralize to include abnormalities in interpersonal relationships and emotional and behavioral
disorders (Arkkila, Rasanen, Roine, & Vilkman, 2008).
Phonological disorders are considered a variety of language disorders and among the most
prevalent communication disorders present in preschool and school-age children. A phono-
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logical disorder reflects an inability to articulate speech sounds (Gierut, 1998). Phonological
awareness is essential to learning how to read (Adams, 1990), and deficits in phonological aware-
ness are inextricably linked to reading disabilities (Lyon, Shaywitz, & Shaywitz, 2003). Thus,
for speech-language pathologists employed in the school system, children with phonological
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disorders may represent as much as 91% of their average caseloads (American Speech-Language-
Hearing Association, 2006).
Assessment of Speech or Language Impairments

For both articulation and phonology disorders, methods of assessment usually include a hearing
screening and informal and formal procedures. Informal procedures may consist of a review of
existing data, examination of the structure and function of the oral mechanism, speech sam-
pling, and direct observation. Psychometric tests administered by licensed speech and language
pathologists play a significant role in the process of identifying children with SLIs. These stan-
dardized tests allow professionals to observe different aspects of language function and to relate
a child’s performance to normative data (Bishop & McDonald, 2009). Generally, methods of
assessing language disorders include: hearing screening, review of existing data, questionnaires,
teacher/parent/student interviews, direction observation and language sampling, student work
examples, and standardized tests (Sunderland, 2004).
Intellectual Disability
The third most common learning disorder is a direct result of biological, cognitive impairments
present at birth. Traditionally, individuals with ID are grouped into one of four degrees of sever-
ity, based on cognitive functioning, and all levels of ID negatively impact a student’s educational
achievement, which is evident even before the student is identified as a special education stu-
dent. As measured by most standardized assessments of cognitive ability, a standard IQ score
falling within one standard deviation of the mean (85–100; mean = 100) is considered in the
average range. Likewise, a score of 70, or two standard deviations below the mean, is consid-
ered the upper limit of mild ID. As of the fourth text revision edition of the DSM (American
Psychological Association, 2000), 3 the ranges of severity of ID are: mild (55–70), moderate (40–
54), severe (25–39), and profound (below 25). An IQ score as high as 75 is often considered at
the borderline level of intellectual functioning. However, the DSM–5 neurodevelopmental work
group (American Psychiatric Association, 2011) has recommended that the DSM–5 include only
one diagnosis for ID, with severity based not only on IQ, but also on the degree of impairment
in adaptive behavior. Similarly, IDEA 2004 defines intellectual disability, or mental retarda-
tion as [§300.8(c)(6)] “significantly subaverage general intellectual functioning, existing concur-
rently with deficits in adaptive behavior and manifested during the developmental period, that
adversely affects a child’s educational performance.”
In 2007, the American Association on Mental Retardation officially changed its name
to the American Association on Intellectual and Developmental Disabilities and has since
advocated for the use of the diagnostic term intellectual disability. Though the term mental
retardation remains in use in the most recent version of the DSM, as well as in federal edu-
cational law (IDEA, 2004), as illustrated above, it has been recommended that the upcoming
publication of the DSM incorporate the term intellectual developmental disorder (American
Psychiatric Association, 2011).
Assessment and Identification

Intellectual disability is characterized by three core traits: (1) significantly below average cog-
nitive functioning, (2) limited functioning in adaptive behavior, and (3) onset prior to the age
of 18. Comprehensive assessment of cognitive functioning and adaptive behavior is vital to an
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accurate diagnosis of ID and should take into account cultural and environmental factors that
may influence performance in these areas.
3 The fi ft h edition of the DSM is scheduled for publication in May 2013.
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Cognitive Functioning
Several norm-referenced instruments are used to assess cognitive functioning, or intel-
ligence. Among the most commonly used, particularly with children, are the Wechsler
Intelligence Scale for Children, fourth edition (WISC-IV; Wechsler, 2003) and the Stanford-
Binet Intelligence Scales, fi ft h edition (SB5; Roid, 2003). These instruments were created
based on the theory that intelligence is a multifaceted construct that encompasses perfor-
mance and ability in domains such as verbal reasoning, memory, abstract problem solving,
and visual-spatial perception.
The WISC-IV is an individually administered test that consists of 10 core subtests and
five supplemental subtests. The test yields a full-scale IQ, as well as four index scores: verbal
comprehension, which measures verbal abilities in reasoning, comprehension, and concep-
tualization; perceptual reasoning, which measures perceptual reasoning and organiza-
tion; working memory, which measures attention, concentration, and working memory;
and processing speed, which measures the speed of mental and psychomotor processing.
Similarly, the SB5 consists of 10 subtests and also yields a full-scale IQ. Each subtest in the
verbal domain has a corresponding subtest in the nonverbal domain. The five domains are:
fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing, and working
memory.
The full-scale IQ score yielded by tests such as the WISC-IV and SB5 is used as the basis for
determining impaired cognitive ability. However, as both tests yield scores in verbal and nonver-
bal domains, if there is a significant discrepancy in an individual’s performance in these areas,
clinicians should closely examine the individual’s pattern of strengths and weaknesses, rather
than simply relying on averaging these scores to derive a full-scale IQ (American Psychiatric
Association, 2000).
Adaptive Behavior
Adaptive behavior can be defined as “how effectively individuals cope with common life
demands and how well they meet the standards of personal independence expected of someone
in their particular age group, sociocultural background, and community setting” (American
Psychiatric Association, 2000, p. 42). According to the American Association on Intellectual
and Developmental Disabilities (AAIDD, 2010), adaptive behavior encompasses three types
of skills: social skills (including interpersonal skills, social responsibility, social problem solv-
ing, and the ability to follow rules and avoid victimization), conceptual skills (money, time,
and numerical concepts; language and literacy; self-regulation), and practical skills (including
self-care and activities of daily living, occupational skills, healthcare, travel and transportation,
adhering to schedules and routines, and safety). Assessment of adaptive behavior is not only a
key component of the diagnostic profi le of ID, but it also forms the basis from which interven-
tion and remediation plans are typically developed.
Assessment of adaptive behavior typically consists of multi-informant rating scales,
completed by parents, educators, community mental health providers, and the individual
him- or herself. The most frequently used measures of adaptive behavior are the Adaptive
Behavior Assessment System, second edition (ABAS-II; Harrison & Oakland, 2003) and
the Vineland Adaptive Behavior Scales, second edition (VABS-II; Sparrow, Cicchetti, &
Balla, 2005).
Assessments of appropriate adaptive functioning are highly subjective and heavily based on
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social, cultural, and other environmental norms. When selecting assessment instruments and
interpreting results, therefore, the evaluator should pay attention to the suitability of the assess-
ment tool for the individual as well as external factors that may impact his or her performance
(American Psychiatric Association, 2000).
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School Identification and Special Education Eligibility

In addition to community agencies, schools serve as one of the primary environments in which
children with IDs are identified and receive support. Recent statistics show that students iden-
tified using special education criteria for an ID represented 9% of all students served under
the IDEA, Part B (U.S. Department of Education, 2004). Educational professionals, including
school psychologists, counselors, and social workers, are traditionally charged with the task of
conducting valid assessments and designing educational interventions for this group of stu-
dents. Though standardized assessments of cognitive ability and adaptive behavior may provide
a sufficient basis for an identification of ID or for determining eligibility for special education
services, results from these assessments offer little to inform the process of intervention plan-
ning in educational contexts. To help fi ll this void, it is recommended that school teams con-
duct multidisciplinary, functional, and ecologically valid assessments to inform educational
planning for children with IDs (Powell-Smith, Stoner, Bilter, & Sansosti, 2008). As a starting
point, detailed information on the child’s developmental, medical, and social history provides
important clues regarding the onset of the child’s delay and possible etiologies of the condition,
allowing the team to rule out other potential causes for the child’s academic and behavioral
difficulties (i.e., SLD). Further, information on student performance should be gathered from
multiple sources in various environments, including the home, school, and community settings.
Particularly important are data on functional life skills and “cues and correction procedures”
that occur naturally and without planned intervention and effectively assist the individual in
completing daily life tasks.
Finally, the focus of assessment and intervention should be on functional life skills that will
allow for successful transition to postschool settings. Central to working with students with ID
is the provision of supports that increase the individual’s ability to function as independently as
possible. We strongly encourage clinical professionals serving clients with ID (or specific learn-
ing disability) outside of the school system to work collaboratively with school-based identifica-
tion teams and educational professionals to ensure optimal and appropriate educational and
intervention supports for clients with IDs.
Working With Children Who Have Learning Disorders and Their Families
This section will provide psychologists and social workers specific suggestions for working with
clients who have SLD, SLI, or ID. We contend that these and other practitioners provide opti-
mum clinical services when they collaborate with teachers, administrators, and school person-
nel at their clients’ schools to ensure that the full spectrum of services is provided to their clients.
We believe that psychologists and social workers can be effective partners in the schooling of
their clients when they (a) promote prevention and early intervention, (b) partner with school
personnel to optimize the educational supports and services being provided, and (c) assist par-
ents and families in supporting clients with learning disorders. We describe each recommenda-
tion in detail next.
Promote Prevention and Early Intervention and Encourage
Family to Become Children’s First Teachers
Psychologists and other clinicians may be most helpful to their clients who have learning dis-
orders when they promote prevention strategies at home and at school. As noted previously,
environmental conditions may predispose a child without an organic learning deficit to “learn
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to be learning disabled” (Clay, 1987, cited in Gresham, VanDerHeyden, & Witt, 2005) such that
organic and acquired learning disorders are indistinguishable. One way clinicians can promote
prevention is by conducting parent education seminars, community workshops, or parent coun-
seling sessions that emphasize the critical early role parents play in ensuring their children’s
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subsequent academic success. In Helping Your Child Become a Reader (USDOE, 2005), a pam-
phlet available free of charge on the USDOE website, parents of young children (birth to age 6)
are encouraged to (a) talk and listen to their young children even as babies, (b) spend at least
30 minutes daily reading aloud to their children, (c) bring attention to the letters and words in
books and help them understand that they have meaning, and (d) foster children’s innate curios-
ity to write, because reading and writing go hand in hand.
As consultants, psychologists can urge their clients’ teachers to focus on direct, explicit
instructional strategies (Carnine, Silbert, & Kame’enui, 1997). Struggling students need intense
instruction in small groups for longer duration with greater frequency compared to the instruc-
tion provided to typically achieving students (Deshler, 2005). One of the best tools for being an
effective consultant and recommending best practices in academic interventions is to be knowl-
edgeable about available evidence-based academic and behavioral interventions. Appendix B
lists links to helpful websites. Additionally, attending national professional conferences, such as
the National Association of School Psychologist’s and the American Speech-Language-Hearing
Association annual conventions, can provide psychologists and other clinicians the opportunity
to gain valuable knowledge about the most effective, cutting-edge instructional strategies cur-
rently available.
Participate in School Efforts to Support Clients With Learning Disorders

Another way psychologists and other clinicians can help clients who have learning disorders
is by their willingness to work collaboratively with school personnel to advocate on behalf of
their clients so they receive the best educational services in general and special education set-
tings. Federal law requires that students with disabilities be educated in the least restrictive
environment with typically achieving peers to the maximum extent that is deemed appropriate.
Therefore, practitioners want to ensure that schools are providing their clients special education
services in inclusive environments with typically achieving peers and that their clients have
equal access to the curriculum and extracurricular activities. Additionally, clinicians working
with children who are in special education or being considered for special education eligibility
can be effective as collaborative, contributing members of the school multidisciplinary team
that weighs the available evidence to make decisions about children’s placement and the reme-
dial services they receive. Collaborating with school personnel, such as school psychologists and
speech-language pathologists, provides an opportunity both to give input into school program-
ming and services and to plan direct services that seek to reinforce and generalize the school-
based efforts. For students with more severe learning disabilities (i.e., ID), practitioners can also
play a vital part in ensuring their clients receive the school-based services and supports they
need to successfully transition into employment, supported or independent living, or further
education after exiting the school system.
Assist Parents and Families to Support Clients With Learning Disorders

Psychologists can help their clients and their clients’ families develop the skills and supports
needed to successfully advocate in the school system. For example, they may work directly with
clients on self-monitoring study strategies and on developing the social skills for asking for
help when they need it. Psychologists can work with parents on skills and strategies to advocate
for their children and communicate their needs and desires to school personnel successfully.
Parents sometimes experience guilt or denial when their child is identified with one of the
copyright law.
learning disorders described in this chapter. Helping parents understand the importance of
consistency and routine in the home as well as following through with school recommenda-
tions for the home can help parents more effectively support their child who has a learning
disorder.
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Account: s4319836
Summary
Th is chapter has considered three specific types of learning disorders: specific learning dis-
abilities, speech or language impairments, and intellectual disabilities. We described issues
surrounding their defi nitions, history, identification, and intervention. Specific learning dis-
abilities are the most prevalent of the learning disorders, occurring in 5.2% of the school-age
population. Specific learning disability was fi rst defi ned in 1968 and recognized in federal law
in 1975. Inconsistencies in identification procedures for SLD since the disorder fi rst appeared
in federal education law have resulted in a lack of consensus about how to appropriately iden-
tify students with SLD for special education services in schools. The most promising model
to date for identifying students with specific learning disabilities is Response to Intervention
(RTI), which is rooted in the public health model of prevention and early intervention at the
fi rst sign of difficulty. Response to Intervention is permitted by federal law as a method for
screening populations of students so that those who are not meeting important educational
benchmarks can be provided intense educational interventions to remediate or reduce aca-
demic risk.
We also described SLIs, which are the second most prevalent learning disorders, occurring
in 3% of all school-age children, which includes impairments in speech, language, and hearing,
essential to learning in school. Finally, we described ID, the third most common learning disor-
der, characterized by significantly below average cognitive functioning, limited functioning in
adaptive behavior, and onset before age 18.
This chapter concluded by providing the reader with specific strategies for helping clients
with learning disorders and their families navigate schools generally and the special education
system specifically. Specifically, we recommend strategies that psychologists in clinical practice
can implement in their private practice to more effectively: (a) promote prevention of learning
failure, (b) participate in school-wide efforts to support children and adolescents with learning
disorders, and (c) partner effectively with parents and schools.
Appendix A: Description of School Psychologists and Speech Language Pathologists

School Psychologists
School psychologists are professionals with extensive training in both psychology and education
(National Association of School Psychologists, n.d.). The main goal of the school psychologist
is to help children and youth succeed academically, behaviorally, emotionally, and socially. To
best achieve this goal, school psychologists collaborate with teachers, parents, administrators,
and other professionals to develop healthy, safe, and supportive academic environments that
emphasize and strengthen connections between school, home, and the community for all chil-
dren (National Association of School Psychologists, n.d.). Some of the unique functions of the
school psychologist in the schools include identifying and addressing behavior and learning
problems that interfere with school success, working within a multidisciplinary team to deter-
mine student eligibility for special education services, helping teachers create positive classroom
environments, and implementing school-wide prevention programs that help maintain positive
school climates (National Association of School Psychologists, n.d.).
The implementation of the Response to Intervention (RTI) process creates new opportunities
and a greater need for school psychologists. The training the school psychologist receives in con-
sultation, behavior and academic interventions, research, counseling, and evaluation is called
copyright law.
upon as districts implement new RTI procedures (National Association of School Psychologists,
2006). The roles of the school psychologist in an RTI model expand to include duties such as
working with administration to obtain “buy-in” and facilitate system change, planning and
conducting necessary staff training to implement RTI, developing local academic achievement
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Account: s4319836
norms, and consulting with both teachers and parents regarding early intervention tools for in
the classroom and at home (National Association of School Psychologists, n.d.).
Speech-Language Pathologists
Speech-language pathologists (SLPs) are specialists who receive intensive training in both atypi-
cal and typical communication development and pathology (Sunderland, 2004). SLPs are often
the lead service providers for individuals with speech and language disorders (Justice, 2006). An
SLP has a degree or certification in speech and language pathology and is qualified to diagnose
speech and language disorders and to prescribe and implement therapeutic measures for these
disorders (Nicolosi, Harryman, & Kresheck, 2004). Under IDEA 2004, speech-language pathol-
ogy services include the identification of children with speech or language impairments, the
diagnosis and assessment of specific speech or language impairments, the referral of individuals
for medical or other professional attention necessary for the treatment of speech or language
impairments, the provision of speech and language services for the habilitation or prevention of
communication impairments, and the counseling and guidance of children, parents, and teach-
ers concerning speech or language impairments [§300.34(c)(15)]. The SLP plays a critical role in
the identification and treatment of individuals with speech or language impairments.
SLPs working in districts where RTI procedures are being implemented are able to contribute
to assessment and intervention through systemwide program design and collaboration, as well
as individual work with students. SLPS are able to offer expertise in the language basis of learn-
ing and literacy, an understanding of the utilization of student outcome data in making instruc-
tional decisions, and experience with collaborative instruction and intervention approaches
(Ehren, Montgomery, Rudebusch, & Whitmire, 2007). A few of the ways SLPs contribute in
the RTI model include assisting in identifying systemic patterns of student need pertaining to
language skills, explaining the interconnection between spoken and written language to other
school professionals, and identifying, utilizing, and disseminating evidence-based practices for
RTI interventions or speech and language services (Ehren et al., 2007).
Appendix B: Recommended Internet Resources

For Children
Professor Garfield: Comprehensive free website for children offering lively, interactive, and free
“edutainment” games and activities that help to motivate and empower kids while addressing
fundamental reading skill sets. http://www.professorgarfield.org/pgf_home.html
For Parents
Colorín Colorado: A bilingual site for families and educators. http://www.colorincolorado.org/
Star Fall: A free public service to motivate children to read with phonics. http://www.starfall.
com/
Reading Rockets: Teaching kids to read and helping those who struggle. http://www.reading
rockets.org/
For Professionals
Evidence Based Intervention Network. http://ebi.missouri.edu

copyright law.
Florida Center for Reading Research. http://fcrr.org/

Intervention Central. http://www.interventioncentral.org/
Vaughn-Gross Center for Reading and Language Arts. http://www.meadowscenter.org/vgc/
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Account: s4319836
Advocacy Groups and Organizations
Centers for Disease Control and Prevention: Intellectual Disability. http://www.cdc.gov/ncbddd/

dd/ddmr.htm
The International Dyslexia Association. http://www.interdys.org/
LD OnLine. http://www.ldonline.org/
National Center for Learning Disabilities. http://www.ncld.org/
National Dissemination Center for Children With Disabilities. http://www.nichcy.org
The National Research Center on Learning Disabilities (NRCLD). http://www.nrcld.org
Professional Associations
American Association on Intellectual and Developmental Disabilities. http://www.aaidd.org/

American Speech-Language-Hearing Association. http://www.asha.org/
National Association of School Psychologists. http://www.nasponline.org/
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Internalizing Disorders • 487

Psychosocial Interventions In a synthesis of psychosocial interventions for depressed chil-

Cognitive-Behavioral Therapy Cognitive-behavioral therapy has received the most empiri-

Suicidality Managing suicidal risk is very important to include early in treatment.

Practice, 12(2), 149–155.

tional/conduct disorders. Clinical Psychology Review, 28, 1447–1471.

Gender and psychopathology. London: American Psychiatric Press, 89–111.

Learning disorders represent an assorted category of generalized neurodevelopmental chal-

Specific Learning Disabilities

Historical Overview and Evolving Definition

Concerns About the IQ–Achievement Discrepancy

The Problem With Special Education

Special Education Today

§300.8(c)(10) … A disorder in one or more of the basic psychological processes involved

What Is Response to Intervention?

Response to Intervention for Identifying the Presence of a Specific Learning Disability

Speech or Language Impairment

Assessment of Speech or Language Impairments

Assessment and Identification

3 The fi ft h edition of the DSM is scheduled for publication in May 2013.

School Identification and Special Education Eligibility

Participate in School Efforts to Support Clients With Learning Disorders

Assist Parents and Families to Support Clients With Learning Disorders

Appendix A: Description of School Psychologists and Speech Language Pathologists

Appendix B: Recommended Internet Resources

Evidence Based Intervention Network. http://ebi.missouri.edu

Florida Center for Reading Research. http://fcrr.org/

Advocacy Groups and Organizations

Centers for Disease Control and Prevention: Intellectual Disability. http://www.cdc.gov/ncbddd/

American Association on Intellectual and Developmental Disabilities. http://www.aaidd.org/

Classification of learning disabilities: An evidence-based evaluation. In R. Bradley, L. Danielson, &

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