Learning Disabilities and Alphabet Soup: LD, AIS, 504, and IEP*...What’s it all about?

Heather Adams, PhD Assistant Professor, Division of Child Neurology Spring 2018

LD: Learning Disability AIS: Academic Instruction Services 504: Section 504 Plan IEP: Individualized Education Plan Objectives

Learning Disabilities ‐ Overview

Evidence –Based Assessment & Diagnosis of LD

Evidence –Based intervention for LD

LD and the educational system Learning Disabilities ‐ Overview What is a learning disability?

“an unexpected, specific, and persistent failure to acquire efficient academic skills despite conventional instruction, adequate intelligence, and sociocultural opportunity”

Lagae (2008) review DSM‐5: Specific Learning Disability A neurodevelopmental disorder of biological origin manifested in learning difficulty and problems in acquiring academic skills markedly below age level and manifested in the early school years, lasting for at least 6 months; not attributed to intellectual disabilities, developmental disorders, or neurological or motor disorders

Specify if: • With impairment in reading • With impairment in written expression • With impairment in mathematics

Specify current severity: Mild ‐ Moderate ‐ Severe LD Epidemiology • LDs in reading, writing, math: ~ 5% of children overall

• 15% of U.S. population has ever received an LD diagnosis

• Of those with LD, about 80% have a reading disability

• Nearly 2.9 million students are currently receiving special education services for learning disabilities in the U.S.

Source: National Center for Learning Disabilities (NCLD) LD Epidemiology • 50% of students receiving special education services through the public schools are identified as having learning disabilities.

• 66% of secondary students with learning disabilities are reading three or more grades levels behind. And, 20% percent are reading five or more grade levels behind.

• Compared to non‐LD, higher rates of course failure, lower GPA, higher rates of grade repetition, higher rates of school‐drop out, fewer in higher education. Educational level, employment & income Common Learning Disability terms:

Dyslexia (Reading Disability): “unexpected difficulty in reading”

Dyscalculia (Math Disability): problems w/numeracy, math calculation & math reasoning

Dysgraphia: Writing disability

Auditory processing disorder: problems processing / making sense of auditory information. Manifest as difficulty comprehending multiple tasks, multiple pieces of info, relatively better visual or procedural/hands‐on learner.

Non‐verbal learning disability: “difficulty processing information that is presented non‐verbally, such as visuospatial stimuli or nonverbal aspects of language” (Semrund‐Clikeman; see also, Byron Rourke). LD Subtypes, supported by research

1. Word Reading 2. Reading Fluency 3. Reading Comprehension 4. Mathematics Computations 5. Math Problem Solving 6. Written Expression Evidence‐Based Assessment & Diagnosis of Learning Disabilities General Principles… Tests themselves must be… • Reliable • Valid • Norm‐referenced

Assessment of LD considers… • Predictive value of diagnosis • Natural history of LD • Co‐morbidities • Exclusion and inclusion criteria for the diagnosis • Intervention • Contextualized assessment • Response to Intervention – child’s ability to respond to remediation Some Common Intelligence Tests

• Wechsler Intelligence Scale for Children-4thed (WISC-IV)

• Woodcock-Johnson Tests of Cognitive Abilities-3rd ed normative update (WJ-III NU)

• Differential Ability Scales -2nd ed (DAS-II)

• Stanford – Binet Intelligence Scales – 5th ed (SB-V)

• Wechsler Abbreviated Scales of Intelligence - 2nd ed (WASI-II)

• Kaufman Brief Intelligence Test (KBIT) Some Common Achievement Tests

• Wechsler Individual Achievement Test –2nd ed (WIAT‐III)

• Woodcock‐Johnson Tests of Achievement –3rd ed (WJ‐III)

• Kaufman Tests of Educational Achievement –3rd ed (KTEA‐3)

• Wide Range Achievement Test –4th ed (WRAT‐4) A guide to interpretation of test scores A guide to interpretation of test scores Achievement Tests ‐ Content Writing • Alphabet knowledge • Mechanics (capitalization, punctuation) • Composition / Organization of Ideas • Spelling (sentences, paragraphs, essays/reports) • Handwriting / graphomotor skills • Writing Fluency • Writing to dictation • Editing • Tense & Grammar Arithmetic / Mathematics

• Number identification • Subitizing

• Computational skills • Ordinality

• Math fluency • Counting

• Math reasoning / analytic • Estimation skills • Organizational skills • Multiple‐step operations • Mental arithmetic Reading

• Alphabet knowledge • Working Memory

• Phonics • Word Recognition

• Reading Fluency • Vocabulary

• Comprehension • Syntax

• Context cues • Spelling Dyslexia Dyslexia (Specific Reading Disability)

Does not involve ‘seeing’ letters/words backwards, up‐side down, transposed, etc; i.e., is not a primary visual processing disorder.

Is properly defined as, “an unexpected difficulty in reading”

Involves core deficits in phonemic processing, sound recognition, mapping sounds to the written code of letters and letter groups

And also impacts reading fluency, reading rate, reading comprehension Epidemiology of Dyslexia

• Dyslexia occurs in between 5‐15% of the population.

• Is familial and heritable. • Up to 50% of parents (of dyslexic child) may also have dyslexia

• Up to about 40% of siblings also have dyslexia

• When looking at parents with dyslexia, up to 65% of children also affected

• Affects males & females equally B Shaywitz & S Shaywitz When comparing to research‐based definitions of reading disability (RD) Teachers Over‐estimate RD in boys, and Under‐estimate RD in girls.

16% Prevalence of Reading Disability (Grade 2) 14% 12% 10% 8% Boys 6% Girls 4% 2% 0% Research Teachers

Shaywitz, Shaywitz, Fletcher, & Escobar (1990), JAMA Dyslexia Persists unless evidence‐based remediation is provided

Lower trajectory of reading achievement in children who are poor readers. These children did not receive remediation. Evidence Based Intervention for Learning Disabilities

http://ies.ed.gov/ncee/wwc/ General principles for reading remediation… • Small groups with high response rates • Immediate feedback • Sequential mastery of topics

• Response to Intervention as both assessment and intervention – “Monitor & Adjust”: • Application of scientific, research‐based interventions in general education • Measurement of student responses to the interventions • Use of the response data to change the intensity or type of subsequent intervention. Reading remediation approaches: state of the science

Highly/Very Effective/Moderately Promising / Needs Effective Effective Study • Explicit •Computer- • Study Aids Instruction Assisted Instruction •Hands-On • Mnemonic Learning strategies •Spatial Organizers • Classroom learning • Peer Mediation strategies

Scruggs et al. (2010). Remedial and Special Education, Volume 31, No. 6. Meta‐analysis of 70 studies Neurobiology of Dyslexia

Dyslexia  inefficient reading... • Diffuse, widespread activation through brain.

• Greater activity in left middle/superior temporal gyri (linguistic processing)

• Over activation in response to non-meaningful sentences

29 Other Characteristics of Poor Readers

• May over-rely on anterior systems for sound recognition

• May recruit posterior systems for compensatory use of visual recognition patterns (e.g., memorizing a large bank of ‘sight words’)

The good news • Brain activation patterns in dyslexics can be normalized following successful, intensive, reading interventions

30 Poor readers

Poor readers : Over-activation of right temporoparietal region and underactivation of left temporoparietal region

Good readers

Jack Fletcher’s lab: Univ Texas/Houston; MEG/MSI studies Poor readers BEFORE INTERVENTION Over‐activation of right temporoparietal region and underactivation of left temporoparietal region

Pseudoword reading task; marker for phonologic decoding

AFTER INTERVENTION Brain activation patterns are normalized: reduction in inefficient right hemisphere activity & increase in left temporoparietal region activity

Jack Fletcher’s lab: Univ Texas/Houston Dyslexia Intervention

Bottom‐up training •Phonemic processing and related skills •Reading fluency, reading rate

Top‐down training •Use of context cues •Boost reading comprehension •Strategy instruction Learning Disabilities & the Educational System How Students Can Receive Help at School Options available include • Unofficial arrangements with classroom teacher or other school personnel

• Academic Instruction Services (AIS)

• Section 504 Plan

• Individualized Education Plan (IEP)

Source: Cohen, MW. The Attention Zone: A Parents’ Guide to Attention Deficit/Hyperactivity Disorder. 1998: 105-110; Alza Corporation. Concerta Slide Kit. 2000. Academic Intervention Services (AIS) Goal: Help students achieve learning standards in English & Math (grades K‐12), and Social Studies & Science (4‐12).

AIS Involves: a) Additional general education instruction (supplemental to general curriculum) b) Student support services as needed to address barriers to improved academic performance

AIS is triggered by: Most often, by NY State test scores of 1 or 2: 1 = not meeting standards; 2 = partially meeting standards; 3 = meeting standards; 4 = exceeding standards

AISI is provided to: Students with and without disabilities. For students with 504 Plans or IEPs, it is intended to supplement, but not replace, special education services “Section 504 Plan”

“No otherwise qualified individual with a disability...shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance” Rehabilitation Act of 1973, Section 504

Civil rights law ‐ to prevent discrimination of individuals with disabilities, including (but not limited to) providing children with equal access to education. Extends to other settings that receive federal assistance.

The disability can be a “mental or physical impairment that substantially limits one or more major life activity” “Section 504 Plan”

• Includes providing children with equal access to education. • Requires a written plan to provide reasonable accommodations, supports that enable the child to access the general academic curriculum.

• In essence, a plan that “levels the playing field” so students can fully demonstrate their ability to meet educational goals at a level equal to that of non‐disabled students.

• Fewer legal / procedural protections under Section 504 vs. IDEA, but children do still have rights under a 504 Plan. “Individualized Education Plan” (IEP)

• Arises from the Individuals with Disabilities Education Act (IDEA, 1997) and the Individuals with Disabilities Education – Improvement Act (2004)

• A federal statue specifically focused on supporting children who experience an adverse educational impact of a disability. • Part A: General provisions, definitions • Part B: Assistance of Education of All Children with Disabilities • Part C: Infants & Toddlers with Disabilities • Part D: National Activities to Improve Education of Children with Disabilities (includes teacher training) IDEA: Six Core Principles

1. Free & Appropriate Education (FAPE) 2. Appropriate Evaluations 3. Individualized Education Plan: contains info on •student’s present level of ability •short & long term goals •special ed & related services for student •student participation with other students, classroom setting, extracurriculars, etc. •dates of service

4. Least Restrictive Environment (LRE) 5. Due Process

6. Parent Participation IEP –13 Disability Classifications (K‐12)

1. Autism 2. Deafness All Eligible Preschool students receive 3. Deaf‐blindness classification of, 4. Emotional disturbance “Preschool Student 5. Hearing impairment with a Disability” 6. Intellectual Disability 7. Learning Disability 8. Orthopedic impairment 9. Speech or Language Impairment 10. Traumatic Brain Injury 11. Visual Impairment (includes, but not limited to, blindness) 12. Other Health Impairment 13. Multiple Disabilities Elements of the IEP

1. Student information: Name, DOB, Disability Classification, projected date of implementation, projected date of annual review 2. Evaluation results 3. Four “Need Areas” a) Academic achievement, functional performance, learning characteristics b) Social development c) Physical development d) Management needs

4. Effect of student needs on involvement in general education curriculum 5. Student needs –special factors (behavior plan, foreign language needs, assistive device or service for communication, other assistive tech. 6. Measurable annual goals (for students >15, postsecondary goals & transition plan are also required) Elements of the IEP 7. Reporting progress to parents 8. Recommended special education programs and services a. Special education program b. Related services (occupational therapy, speech therapy, counseling, etc. c. Supplementary aids and services; program modifications d. Assistive technology devices / services e. Supports for school personnel on behalf of the student 9. 12‐month service/program (if eligible) 10. Testing accommodations & Participation in State / District‐wide Testing You can request alternate assessment if appropriate. 11. Participation with students without disabilities (mainstream activities) In the spirit of, “Least Restrictive Environment” 12. Special transportation 13. Placement recommendation “IEP” (Individualized Education Plan) • Functions as a contract between parents and the school.

• Lists the special education services the child will receive, explains why these services are educationally necessary, and how progress will be measured.

• Can be implemented, changed, or discontinued at any time, based on the needs of the child, and with consent of parents.

• IEPs are developed through a process overseen by the Committee on Special Education (CSE).

• Parents should communicate in writing with the CSE to request meetings, discuss assessment, consider modifications to IEP. “Individualized Education Plan”

• Arises from the Individuals with Disabilities Education Act (IDEA, 1997) and the Individuals with Disabilities Education – Improvement Act (2004)

• A federal statue specifically focused on supporting children who experience an adverse educational impact of a disability. • Part A: General provisions, definitions • Part B: Assistance of Education of All Children with Disabilities • Part C: Infants & Toddlers with Disabilities • Part D: National Activities to Improve Education of Children with Disabilities (includes teacher training) IDEA ~ Six Core Principles

1. Free & Appropriate Education (FAPE) 2. Appropriate Evaluations 3. Individualized Education Plan: contains info on •student’s present level of ability •short & long term goals •special ed & related services for student •student participation with other students, classroom setting, extracurriculars, etc. •dates of service

4. Least Restrictive Environment (LRE) 5. Due Process

6. Parent Participation Resources – Education law & advocacy http://www.p12.nysed.gov/specialed/publications/policy/parentguide.htm “Special Education in New York State for Children: Ages 3–2; A Parent’s Guide (May 2002)”

www.wrightslaw.com Free, online information about educational advocacy

http://www2.ed.gov/about/offices/list/osers/index.html Office of Special Education and Rehabilitative Services

http://idea.ed.gov/ Individuals with Disabilities Education Improvement Act of 2004

http://www.nichcy.org/Laws/IDEA/Pages/Default.aspx National Dissemination Center for Children with Disabilities (an easier way to find a copy of IDEA). Note that the website expired in Sept 2014 but materials are archived at: http://www.parentcenterhub.org/resources/ Resources – Learning Disabilities (general) www.ncld.org National Council on Learning Disabilities

https://ies.ed.gov/ncee/wwc/ What Works Clearinghouse. Reviews evidence base for educational curricula and interventions

http://ldaamerica.org/ Learning Disabilities Association of America

http://www.ldonline.org/ LD Online – information clearinghouse on learning disabilities & ADHD Resources – Dyslexia www.nationalreadingpanel.org National Reading Panel

http://www.rowlandreading.org/events/symposia/reid‐lyon.pdf How Children Learn to Read and Evidence‐Based Reading Instruction

Position statement on Learning Disabilities, Dyslexia, and Vision: AAP Section on Ophthalmology, Council on Children with Disabilities, Amer. Acad. Ophthalm., Amer. Assoc. Pediatr. Ophthalmology and Strabismus, and Amer. Assoc. of Certified Orthoptists. Learning Disabilities, Dyslexia, and Vision Pediatrics, Aug 2009; 124: 837‐844.

Book by Sally Shaywitz, MD, useful for families “Overcoming Dyslexia –A new and complete science‐based program for overcoming reading problems at any level” Resources – LD in Mathematics https://www.miottawa.org/Health/CMH/pdf/brains/Neuropsycholo gy%20Overview/Articles%20and%20Readings/The%20Neuropsychol ogy%20of%20Math%20Disorders.pdf The Neuropsychology of Math Disorders – Diagnosis and Intervention Steven G. Feifer, D.Ed.

http://www.nctm.org/ National Council of Teachers of Mathematics

Developmental Disabilities Research Review. (2009). Special issue: Pathways to Mathematical Learning Difficulties and Disabilities. 15(1). Thank you