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,