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Vol. 14, No. 2, February 1998
1. A teacher's view: Inclusion has helped everyone involved
2. A researcher's view: Learning-disabled children get lost in definitions
3. Recommended Reading

Special Issue: Learning Disabilities

A teacher's view: Inclusion has helped everyone involved
By Ann D. Lipsitt, B.A. I was particularly concerned that students placed in these self-contained classes were not expected to be successful academically, behaviorally or socially. Those of us with the power to use terms such as "deficit," "disorder" or "disability" often apply them with a lack of regard for how that labeling might affect the labeled individuals. Sometimes it feels like name calling. These words are loaded with negative connotations, and can be easily misinterpreted. As soon as we hear them, we focus on what the person can't do. While labels do indeed help us determine what teaching or therapy strategies may be most helpful, they also perpetuate the myth that people who have been "diagnosed" are inferior, based on the absence of an ability. As a special educator, I have had the opportunity to meet many unique individuals with more similarities than differences. However, most of the students I have worked with have been diagnosed with a variety of "disabilities." I say most of the students, because I have made a strong attempt over the years to help bridge the gap between special education and regular education. I have done so in a variety of ways and for several reasons. When I started teaching, it was expected that students with significant special needs would be placed in segregated special education classrooms. I noted at that time that these students didn't have access to the same opportunities as the students who participated in regular education classrooms. Their curriculum was watered down and did not provide exposure to the real world. Their school environment was isolating, and they had only each other as role models and peers. I was particularly concerned that students placed in these self-contained classes were not expected to be successful academically, behaviorally or socially. Along with many other special educators in the early 1980s, I worked toward creating a more integrated model of education and pushed for all students to participate within the mainstream. Vermont has taken the lead in the effort toward mainstreaming and has been cited for its exemplary innovations. I have had the good fortune to witness the positive changes that have occurred. As students began to be mainstreamed into a few classes, I also found myself moving out of my isolated classroom, working together with the rest of the staff. Teachers, administrators and special educators met regularly to talk about students' needs, abilities and differences. Initially this was a very challenging process. Helping others see the benefits of having children in their schools and classes who were significantly different from the students they were accustomed to teaching was the biggest hurdle. I'd like to believe that those of us involved in the early integration of students with significant learning differences were great at convincing others of the benefits of these changes. But this was not the case. While the adults were instrumental in making schools welcoming and supportive, the students themselves have been the greatest teachers. As more students began attending classes in local communities, significant changes began to take place in both their schools and their communities. Vermont schools were already providing for learning-disabled students in the form of small-group instruction taught by special education staff. The precedent had already been set for inclusion. We were now just expanding the concept of who would be included in our local schools. Over the years we have learned that inclusion is a complex process calling for a variety of solutions that include a blend of mainstreaming and individualized instruction. I believe that through exposure, experience and education, we have helped people become more accepting and tolerant of individual human differences. Especially impressive is the rapidity with which our students have developed their sensitivities to others. I recall one middle school student, Steven, who had a multitude of tics. He was diagnosed with Tourette's syndrome (TS) and written language and mathematical learning disabilities. Steven's ticking behaviors were frequent and included loud noises, throat clearing and head and eye movements. However, he was in total denial of the fact that he was different. He would not discuss with anyone that he manifested behaviors that were unusual and, interestingly, he insisted that he did not have TS. Each year, classroom teachers and special educators spoke with Steven's classmates, explaining TS, answering questions and helping to eliminate the concerns and fears of the other students. Steven never wanted to be included in these discussions. Although some teasing occurred, few incidents among students were noted by the teachers. Instead, whole classrooms of students learned to live with these noises and accepted Steven into the group, becoming oblivious to his difference. In the process of assimilating Steven, it became apparent that the adults were the ones doing the talking, and their talk tended to convey fear, annoyance and concern for themselves and their students. Through discussion, experience and personal contact, the whole school became a more accepting environment where some loud, interrupting noises and unusual physical movements became acceptable. This was Steven, a child who ticked, not the student with TS. One strategy I adopted to help bridge the gap between regular education and special education can be termed "reverse mainstreaming." I stopped teaching exclusively homogeneous classes and began teaching a few heterogeneous reading and writing classes. Thus, my classroom stopped being just a special education classroom, except in the sense that everyone there was special. Team teaching between special educators and regular educators has also significantly changed the school environment, making it more like the world found in local malls, grocery stores and libraries - an inclusive community represented by a complete spectrum of the human condition. When schools and local communities include all of their members, all individuals have the opportunity to know and feel that they belong. When we segregate some individuals through the words we use, along with other exclusionary practices, we imply that some people are not good enough to be a part of the whole community. The language we use to describe individual differences to each other can have a lasting, humanizing effect on how we treat each other. A disability - or difference - is just one part of who a person is. It's not the person's identity. A person with a disability is not a disabled person. Ann Lipsitt is a special educator in Underhill, Vt. A 1993 recipient of The Outstanding Vermont Teacher Award for excellence in teaching and devoted service to Vermont youth, she has been teaching for 18 years.

A teacher's view: Inclusion has helped everyone involved

By Ann D. Lipsitt, B.A.

I was particularly concerned that students placed in these self-contained classes were not expected to be successful academically, behaviorally or socially.

Those of us with the power to use terms such as "deficit," "disorder" or "disability" often apply them with a lack of regard for how that labeling might affect the labeled individuals. Sometimes it feels like name calling.

These words are loaded with negative connotations, and can be easily misinterpreted. As soon as we hear them, we focus on what the person can't do.

While labels do indeed help us determine what teaching or therapy strategies may be most helpful, they also perpetuate the myth that people who have been "diagnosed" are inferior, based on the absence of an ability.

As a special educator, I have had the opportunity to meet many unique individuals with more similarities than differences. However, most of the students I have worked with have been diagnosed with a variety of "disabilities." I say most of the students, because I have made a strong attempt over the years to help bridge the gap between special education and regular education. I have done so in a variety of ways and for several reasons.

When I started teaching, it was expected that students with significant special needs would be placed in segregated special education classrooms. I noted at that time that these students didn't have access to the same opportunities as the students who participated in regular education classrooms. Their curriculum was watered down and did not provide exposure to the real world. Their school environment was isolating, and they had only each other as role models and peers.

I was particularly concerned that students placed in these self-contained classes were not expected to be successful academically, behaviorally or socially. Along with many other special educators in the early 1980s, I worked toward creating a more integrated model of education and pushed for all students to participate within the mainstream.

Vermont has taken the lead in the effort toward mainstreaming and has been cited for its exemplary innovations. I have had the good fortune to witness the positive changes that have occurred. As students began to be mainstreamed into a few classes, I also found myself moving out of my isolated classroom, working together with the rest of the staff. Teachers, administrators and special educators met regularly to talk about students' needs, abilities and differences.

Initially this was a very challenging process. Helping others see the benefits of having children in their schools and classes who were significantly different from the students they were accustomed to teaching was the biggest hurdle.

I'd like to believe that those of us involved in the early integration of students with significant learning differences were great at convincing others of the benefits of these changes. But this was not the case. While the adults were instrumental in making schools welcoming and supportive, the students themselves have been the greatest teachers. As more students began attending classes in local communities, significant changes began to take place in both their schools and their communities.

Vermont schools were already providing for learning-disabled students in the form of small-group instruction taught by special education staff. The precedent had already been set for inclusion. We were now just expanding the concept of who would be included in our local schools. Over the years we have learned that inclusion is a complex process calling for a variety of solutions that include a blend of mainstreaming and individualized instruction. I believe that through exposure, experience and education, we have helped people become more accepting and tolerant of individual human differences.

Especially impressive is the rapidity with which our students have developed their sensitivities to others. I recall one middle school student, Steven, who had a multitude of tics. He was diagnosed with Tourette's syndrome (TS) and written language and mathematical learning disabilities. Steven's ticking behaviors were frequent and included loud noises, throat clearing and head and eye movements. However, he was in total denial of the fact that he was different. He would not discuss with anyone that he manifested behaviors that were unusual and, interestingly, he insisted that he did not have TS.

Each year, classroom teachers and special educators spoke with Steven's classmates, explaining TS, answering questions and helping to eliminate the concerns and fears of the other students. Steven never wanted to be included in these discussions. Although some teasing occurred, few incidents among students were noted by the teachers. Instead, whole classrooms of students learned to live with these noises and accepted Steven into the group, becoming oblivious to his difference. In the process of assimilating Steven, it became apparent that the adults were the ones doing the talking, and their talk tended to convey fear, annoyance and concern for themselves and their students.

Through discussion, experience and personal contact, the whole school became a more accepting environment where some loud, interrupting noises and unusual physical movements became acceptable. This was Steven, a child who ticked, not the student with TS.

One strategy I adopted to help bridge the gap between regular education and special education can be termed "reverse mainstreaming." I stopped teaching exclusively homogeneous classes and began teaching a few heterogeneous reading and writing classes. Thus, my classroom stopped being just a special education classroom, except in the sense that everyone there was special. Team teaching between special educators and regular educators has also significantly changed the school environment, making it more like the world found in local malls, grocery stores and libraries - an inclusive community represented by a complete spectrum of the human condition.

When schools and local communities include all of their members, all individuals have the opportunity to know and feel that they belong. When we segregate some individuals through the words we use, along with other exclusionary practices, we imply that some people are not good enough to be a part of the whole community. The language we use to describe individual differences to each other can have a lasting, humanizing effect on how we treat each other. A disability - or difference - is just one part of who a person is. It's not the person's identity. A person with a disability is not a disabled person.

Ann Lipsitt is a special educator in Underhill, Vt. A 1993 recipient of The Outstanding Vermont Teacher Award for excellence in teaching and devoted service to Vermont youth, she has been teaching for 18 years.

A researcher's view: Learning-disabled children get lost in definitions
By Stephen L. Buka, Sc.D. The reputed connection between early learning disabilities and later antisocial behavior and emotional disorders is not well-supported. A new version of the Individuals with Disabilities Education Act (IDEA) was reauthorized by Congress and signed into law by President Clinton on June 4, 1997. First implemented in 1975 as the Education for All Handicapped Children Act, the law is intended to ensure that children with disabilities have access to a free, appropriate public education, and to improve educational results for children with disabilities. The IDEA amendments of 1997 are intended to strengthen academic expectations and accountability for the nation's 5.8 million children with disabilities. A broad range of childhood disabilities is covered, including mental retardation, hearing impairments, speech or language impairments, visual impairments, serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments and specific learning disabilities. The definition of learning disability (LD) is essentially unchanged from federal regulations of the past 30 years. For purposes of this critical legislation, specific learning disability means "a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in imperfect ability to listen, think, speak, read, write, spell or do mathematical calculations." Included are conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia and developmental aphasia. 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 are not included. These, then, are the legal definitions that determine which children will and will not receive special education services in the years ahead. Contrast this broad language with definitions used in medical settings. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) states that learning disorders "are diagnosed when the individual's achievement on individually administered, standardized tests in reading, mathematics or written expression is substantially below that expected for age, schooling and level of intelligence" and when the learning problems "significantly interfere with academic achievement or activities of daily living that require reading, mathematical or writing skills." Reading disorder, alone, accounts for four of every five cases of learning disorder. Dyslexia, the most common of learning disabilities, has been defined even more narrowly as "a specific language-based disorder of constitutional origin characterized by difficulties in single word decoding, usually reflecting insufficient phonological processing abilities. These difficulties in single word decoding are often unexpected in relation to age and other cognitive and academic abilities; they are not the result of generalized developmental disability or sensory impairment. " (operational definition of the Orton Dyslexia Society Research Committee, April 18, 1994). Many recent scientific advances have resulted from such stringent definitions of dyslexia. Brain imaging studies now identify critical brain regions (primarily in the left cerebral hemisphere and planum temporale), identification of a core phonological processing deficit, evidence of genetic factors for both family history of reading disorders and phonologic deficits, and sophisticated new educational technologies. We have a mismatch here between the definition of learning disabilities under the IDEA legislation and the conditions found, treated and studied in medical and research settings. They are not the same children. In a study that I and my colleagues did of 230 adolescents seeking treatment for chemical dependence, 11 percent (26 subjects) had been diagnosed as LD by their schools. However, only six of these met formal test-based criteria. Similarly, only 13 percent of those meeting test-based criteria were diagnosed by their school systems. Sally Shaywitz, M.D., and others at Yale University followed a representative sample of Connecticut public kindergarten students into the second grade (and beyond). By second grade, the schools had identified only half as many girls as reading-disabled than did standardized test procedures, but twice as many boys. A valuable strategy for determining which children have a true disability is to conduct longitudinal studies, examining the persistence of deficits and associated difficulties of daily living over time. At UCLA, Paul Satz, Ph. D., reviewed the quality and results of 33 follow-up studies of children with LD. A few central findings from this work warrant mention. First, irrespective of how childhood learning problems are defined, these studies demonstrate that the academic outlook for children with early learning problems is poor, unless a child comes from a high-income family and/or participates in high-quality educational remediation programs. Second, children with early LD are more likely to drop out of school. Third, the reputed connection between early learning disabilities and later antisocial behavior and emotional disorders is not well-supported. Such studies can contribute greatly to current debates around the definition of LD, including potentially harmful effects of labeling and mislabeling. Is the long-term prognosis for certain forms and definitions of LD worse than for others? Are certain forms of LD more likely to persist across the life course than others? As for other forms of disorder, shouldn't we reserve the term "disability" for chronic or persistent conditions that have a poor prognosis? There are several ongoing studies worldwide that will help resolve these questions. In addition to the Connecticut study, Lewis P. Lipsitt, Ph.D.,and colleagues at Brown University are reinterviewing a sample of 500 children with test-defined LD and 500 non-LD children in adulthood, at age 35. In addition to those with early reading problems, children with problems in writing (dysgraphia), arithmetic (dyscalcula) and spelling complete a full battery of neuropsychological, educational and cognitive tests as well as detailed life history interviews. Preliminary results do indeed indicate that school systems ovrediagnose LD in boys and underdiagnose girls. This may account for the worse prognosis observed in this study for girls with early LD. Ongoing results from these studies should help bring together scientific advances with legislative mandates such as the reauthorization of IDEA, further ensuring that those children with the most severe forms of LD do indeed receive the free and appropriate education to which they are entitled.

A researcher's view: Learning-disabled children get lost in definitions

By Stephen L. Buka, Sc.D.

The reputed connection between early learning disabilities and later antisocial behavior and emotional disorders is not well-supported.

A new version of the Individuals with Disabilities Education Act (IDEA) was reauthorized by Congress and signed into law by President Clinton on June 4, 1997. First implemented in 1975 as the Education for All Handicapped Children Act, the law is intended to ensure that children with disabilities have access to a free, appropriate public education, and to improve educational results for children with disabilities.

The IDEA amendments of 1997 are intended to strengthen academic expectations and accountability for the nation's 5.8 million children with disabilities.

A broad range of childhood disabilities is covered, including mental retardation, hearing impairments, speech or language impairments, visual impairments, serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments and specific learning disabilities.

The definition of learning disability (LD) is essentially unchanged from federal regulations of the past 30 years. For purposes of this critical legislation, specific learning disability means "a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in imperfect ability to listen, think, speak, read, write, spell or do mathematical calculations."

Included are conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia and developmental aphasia. 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 are not included. These, then, are the legal definitions that determine which children will and will not receive special education services in the years ahead.

Contrast this broad language with definitions used in medical settings. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) states that learning disorders "are diagnosed when the individual's achievement on individually administered, standardized tests in reading, mathematics or written expression is substantially below that expected for age, schooling and level of intelligence" and when the learning problems "significantly interfere with academic achievement or activities of daily living that require reading, mathematical or writing skills."

Reading disorder, alone, accounts for four of every five cases of learning disorder. Dyslexia, the most common of learning disabilities, has been defined even more narrowly as "a specific language-based disorder of constitutional origin characterized by difficulties in single word decoding, usually reflecting insufficient phonological processing abilities. These difficulties in single word decoding are often unexpected in relation to age and other cognitive and academic abilities; they are not the result of generalized developmental disability or sensory impairment. " (operational definition of the Orton Dyslexia Society Research Committee, April 18, 1994).

Many recent scientific advances have resulted from such stringent definitions of dyslexia. Brain imaging studies now identify critical brain regions (primarily in the left cerebral hemisphere and planum temporale), identification of a core phonological processing deficit, evidence of genetic factors for both family history of reading disorders and phonologic deficits, and sophisticated new educational technologies.

We have a mismatch here between the definition of learning disabilities under the IDEA legislation and the conditions found, treated and studied in medical and research settings. They are not the same children.

In a study that I and my colleagues did of 230 adolescents seeking treatment for chemical dependence, 11 percent (26 subjects) had been diagnosed as LD by their schools. However, only six of these met formal test-based criteria. Similarly, only 13 percent of those meeting test-based criteria were diagnosed by their school systems.

Sally Shaywitz, M.D., and others at Yale University followed a representative sample of Connecticut public kindergarten students into the second grade (and beyond). By second grade, the schools had identified only half as many girls as reading-disabled than did standardized test procedures, but twice as many boys.

A valuable strategy for determining which children have a true disability is to conduct longitudinal studies, examining the persistence of deficits and associated difficulties of daily living over time. At UCLA, Paul Satz, Ph. D., reviewed the quality and results of 33 follow-up studies of children with LD. A few central findings from this work warrant mention.

First, irrespective of how childhood learning problems are defined, these studies demonstrate that the academic outlook for children with early learning problems is poor, unless a child comes from a high-income family and/or participates in high-quality educational remediation programs. Second, children with early LD are more likely to drop out of school. Third, the reputed connection between early learning disabilities and later antisocial behavior and emotional disorders is not well-supported.

Such studies can contribute greatly to current debates around the definition of LD, including potentially harmful effects of labeling and mislabeling. Is the long-term prognosis for certain forms and definitions of LD worse than for others? Are certain forms of LD more likely to persist across the life course than others? As for other forms of disorder, shouldn't we reserve the term "disability" for chronic or persistent conditions that have a poor prognosis? There are several ongoing studies worldwide that will help resolve these questions.

In addition to the Connecticut study, Lewis P. Lipsitt, Ph.D.,and colleagues at Brown University are reinterviewing a sample of 500 children with test-defined LD and 500 non-LD children in adulthood, at age 35. In addition to those with early reading problems, children with problems in writing (dysgraphia), arithmetic (dyscalcula) and spelling complete a full battery of neuropsychological, educational and cognitive tests as well as detailed life history interviews.

Preliminary results do indeed indicate that school systems ovrediagnose LD in boys and underdiagnose girls. This may account for the worse prognosis observed in this study for girls with early LD. Ongoing results from these studies should help bring together scientific advances with legislative mandates such as the reauthorization of IDEA, further ensuring that those children with the most severe forms of LD do indeed receive the free and appropriate education to which they are entitled.

Stephen L. Buka, Sc.D., is associate professor, Department of Maternal and Child Health, Harvard University School of Public Health, and a member of the CABL editorial board.