Neuropsychological Perspectives on Learning Disabilities in the Era of RTI

Recommendations for Diagnosis and Intervention

Elaine Fletcher-Janzen, Cecil R. Reynolds, Elaine Fletcher-Janzen, Cecil R. Reynolds

• Publisher: Wiley
• Year: 2010
• Print ISBN: 9780470225271
• eBook ISBN: 9780470893456
• Edition: 1
• Topic: Psychology
• Subtopic: Neuropsychology
• Index: Psychology

An insightful look at the role of neuroscience and neuropsychology as it relates to Response to Intervention (RTI) in learning disability diagnosis, treatment, and policy reform Neuropsychological Perspectives on Learning Disabilities in the Era of RTI is a revolutionary new volume presenting the latest research—in question-and-answer format—from leading scholars about the contributions of neuroscience and neuropsychology as it relates to Response to Intervention (RTI) in learning disability identification, diagnosis, and recommended interventions. This collective work includes contributions from more than thirty neuroscientists, neuropsychologists, clinical psychologists, and school psychologists with training in brain-behavior relationships, who explore the answers to questions including:

• How do you reconcile RTI as a means of diagnosis of learning disability with knowledge from the clinical neurosciences??
• What do you think neuroscience has to offer laws and policies associated with learning disability determination?
• What do you think neuroscience has to offer the assessment and identification of learning disabilities?
• What role does neurocognitive science play in designing interventions in the context of RTI?
• What role does neuropsychology have to play in the diagnosis of learning disability?

Featuring contributions from leaders in the field of neuropsychology and school psychology, and with a Foreword from Sally Shaywitz, Neuropsychological Perspectives on Learning Disabilities in the Era of RTI illuminates the contributions of neuro-science and neuropsychology to learning disability identification and current educational reform.

1

Neuropsychology and Specific Learning Disabilities: Lessons from the Past As a Guide to Present Controversies and Future Clinical Practice

Alan S. Kaufman

Learning disabilities and neuropsychology have always been intertwined, even before Ralph Reitan put neuropsychology on the map in the 1950s or Sam Kirk coined the term learning disabilities in 1963. The history of specific learning disabilities (SLDs) is steeped in the tradition of brain damage and brain dysfunction, whether one traces the roots of SLD to the perceptual processing disorder approach of Kurt Goldstein and Alfred Strauss or to the developmental language disorder conceptualization of Samuel Orton and James Hinshelwood (Shepherd, 2001). And if the past endorses the strong relationship between SLDs and neuropsychology, that endorsement is no less powerful than the impact of present research or future applications of technology on the essential role of neuropsychology on the assessment of SLD.

The history of SLD is not a linear or chronological one but rather an uneasy amalgam of two traditions that are conceptually distinct and seemingly resistant to integration. The Goldstein-Strauss-Werner history—based initially on Kurt Goldstein’s (1942) studies of the perceptual, cognitive, attentional, and mood disorders of soldiers who sustained head injuries—emphasizes disorders of perception, especially visual perception. Indeed, it is the deficit in perceptual processing that is considered the specific learning disability (there is no room in this model for specific learning disabilities). However, a different history of SLD that predates Goldstein first began appearing in Europe in the 1890s with accounts of an adult patient who lost the ability to read following a stroke, though he could speak and write fluently, remember details, and understand easily (Dejerine, 1892); and accounts of a 14-year-old nonreader, Percy F.: “I might add that the boy is bright and of average intelligence in conversation. . . . The schoolmaster who has taught him for some years says that he would be the smartest lad in school if the instruction were entirely oral” (Morgan, 1896, p. 1,378). This tradition, popularized by Orton and Hinshelwood, produced an impressive literature following Dr. Pringle Morgan’s 1896 account of Percy, which depicted clear-cut cases of individuals with learning disabilities specific to reading and writing (e.g., Kerr, 1897; Morgan, 1914) and later on specific to arithmetic (Schmitt, 1921). Hinshelwood (1917) believed the problem to be a congenital lesion in the left angular gyrus, which impaired the ability to store and remember visual memory for letters and words; Orton (1937) hypothesized a functional brain disorder associated with the inability of one hemisphere to become dominant over the other for handling language, but he nonetheless “accepted the notion of the origin of dyslexia in the angular gyrus region” (Spreen, 2001, p. 285). Both agreed that SLD was a function of a developmental disorder of written language.

Occasionally, neuropsychologists who write about the history of SLD blend the Goldstein-Strauss-Werner tradition with the Hinshelwood-Orton approach: “Orton’s theory remained a theory until, in 1947, Strauss and Lehtinen called attention to the frequent appearance of neurological signs in learning-disabled children” (Spreen, 2001, p. 286). But usually the two traditions are treated separately.

Indeed, the two historical roots of SLD could not be more different in conception, origination, or research methodology. Yet they converge in their basic premise that neurology and neuropsychology are the keys for understanding learning problems and ultimately treating them. Even the founding fathers of the developmental language disorder approach, while relying on a field of neuroscience that was in its infancy, did not agree on the neurological causation of the problem. Yet the fact remains that, regardless of the orientation of the early SLD pioneers, and regardless of whether one’s intuitive understanding of SLD is more aligned with a specific perceptual disorder or an array of specific disorders in language development, all paths to the present field of SLD come through the fields of neurology and neuropsychology.

THE GOLDSTEIN-STRAUSS-WERNER VISUAL PERCEPTUAL APPROACH TO SLD

The Goldstein-Strauss-Werner theory posited that a disorder of visual perception, along with the concomitant attentional problems, impairs learning on tasks that depend on perception and attention. Fix the perceptual disorder of these brain-damaged individuals (in a learning environment that reduces distraction and inattention), and you have fixed the learning problem (even Mental Retardation). Goldstein’s student, Alfred Strauss, extended his mentor’s work to mentally retarded adolescents and observed the same kinds of perceptual, mood, and learning disorders in this low-IQ population that Goldstein had found with head-injured soldiers (Strauss & Werner, 1943). These researchers attributed the disorders to brain damage and concluded that (a) there was a difference between Mental Retardation caused by brain injury and Mental Retardation that was familial, (b) brain injury produced specific perceptual and behavioral deficits, and (c) special education aimed at treating the observed perceptual and behavioral problems would be effective with Mental Retardation due to brain injury but not due to inheritance from parents. Strauss worked with an educator, Laura Lehtinen, to implement the perceptual training (Strauss & Lehtinen, 1947), emphasizing the point that remediation of learning and behavior problems worked hand-in-hand with identification of learning and behavior problems from the inception of the perceptual disorder movement.

The next logical step to extend the theory was to study children, not just adolescents and adults, and to investigate children with normal or near-normal intelligence. These studies included children with known brain damage, such as cerebral palsy (Cruickshank, Bice, & Wallen, 1957), and, intriguingly, samples of children who evidenced learning and behavior problems but did not show clinical signs of brain damage (Strauss & Kephart, 1955)—that moved the field forward in a dramatic way. Goldstein, Strauss, Werner, Cruickshank, and Kephart were the pioneers who established the concept of a learning and behavior disability caused by minimal brain dysfunction (i.e., not detectable through standard clinical procedures, but brain injury nonetheless) that was distinct from Mental Retardation.

Lehtinen’s early work suggested that remediation of the perceptual disorders was feasible, and a plethora of visual-perceptual-motor training programs began to predominate in the 1960s, with names like Frostig, Ayres, Getman, Kephart, and Barsch associated with different methodologies on the same theme. However, subsequent systematic reviews of 81 research studies, encompassing more than 500 different statistical comparisons, concluded that “none of the treatments was particularly effective in stimulating cognitive, linguistic, academic, or school readiness abilities and that there was a serious question as to whether the training activities even have value for enhancing visual perception and/or motor skills in children indicated” (Hammill & Bartel, 1978, p. 371). Yet, this lack of research support did not stop the visual training in the schools and it did not slow down the movement that endorsed learning disabilities (usually known then as minimal brain dysfunction or perceptual disorder) as problems with perception (usually visual but sometimes auditory). In fact, several influential special educators who have studied SLD history (e.g., Kavale & Forness, 1995; Torgesen, 1998) believe that the Goldstein-Strauss-Werner “view influenced the definition of ‘specific learning disability’ in federal laws and also influenced U.S. public school practices” (Shepherd, 2001, p. 5).

THE ORTON-HINSHELWOOD DEVELOPMENTAL WRITTEN LANGUAGE APPROACH TO SLD

Like the Goldstein-Strauss-Werner approach, the Orton-Hinshelwood view of SLD had its roots in the learning problems and behaviors of adults with brain damage. Rather than focusing on war-injured soldiers, the developmental language pioneers were impressed by late- nineteenth century accounts of adults in Great Britain, France, and Germany who suffered known brain damage to specific regions of the brain and lost the ability to read—despite retaining writing and spelling skills (Shepherd, 2001). In the early part of the twentieth century, the accounts began to include children who were seemingly normal with no overt signs of brain damage, but (like the brain-damaged adults) had a specific disability in reading, writing, or arithmetic despite normal abilities in other areas of cognition and achievement. Though Hinshelwood (1895), an ophthalmologist, initially focused on acquired word blindness based on an adult patient who could not read subsequent to injury to the angular gyrus, he was impressed by Morgan’s (1896) first reporting of congenital word blindness in children. He became intrigued by subsequent accounts published by physicians (including himself) of 14 cases in Europe and North America of children and adolescents with reading disorders that were apparently congenital and not due to any known brain injury (Spreen, 2001).

This accumulation of clinical cases impelled Hinshelwood (1917) to publish a widely read monograph, Congenital Word Blindness, that included detailed descriptions of these children, such as a boy of 12 who was brought by his mother to have his eyesight checked: “He could barely read by sight more than two or three words, but came to a standstill every second or third word. . . . [But he] read all combinations of figures with the greatest of fluency up to millions” (p. 21). And just as Sally Shaywitz (2003) insists that the diagnosis of dyslexia is no less accurate or science-based than nearly any other medical diagnosis, Hinshelwood (1917) said virtually the same thing about a century earlier—that it’s fairly easy to diagnose congenital word blindness because the condition is as clear-cut and distinct as any other medical pathology.

Orton (1937) coined the term strephosymbolia (twisted symbols) to describe what later came to be known as dyslexia. He provided excellent clinical descriptions of children with reading disorders who, he observed, had special difficulty with letter and word reversals—the kinds of transpositions that suggested to Orton that these children read from right to left. He was a firm believer in thorough assessment, including the recording of extensive family and school histories and the administration of IQ and achievement tests. He was especially interested in children’s performances on different areas of academic achievement to confirm his belief that children with a reading disability would score lower on reading and spelling tests than on arithmetic tests; and that children with writing disabilities would score lower on tests of spelling than on arithmetic tests. Orton did not feature disorders of mood or attention as aspects of the learning disability (as did the perceptual theorists), but he noted that many of his patients with reading disorders also had speech and motor disorders; they were predominantly male; they tended to have life-long difficulties with academic skills; and he often treated several members of the same family.

Hinshelwood (1917) limited the diagnosis of congenital word blindness to those who demonstrated the gravity of the defect and evidenced a purity of symptoms, but he excluded children who were just a bit slow in acquiring reading skills. Orton’s definition was not as stringent: “Our experience in studying and retraining several hundred such cases has convinced us that they form a graded series including all degrees of severity of the handicap” (Spreen, 2001, p. 285).

Hinshelwood advocated assessment methods that were remarkably similar to Orton’s and they both strongly favored remediation that was targeted directly at the academic problem. For example, they both emphasized a phonics approach to teaching reading, differing only in Hinshelwood’s preference for teaching sound to letter correspondence versus Orton’s method of teaching letter to sound correspondence (Shepherd, 2001). As with the perceptual disorder theorists, neurology was believed to be at the root of the learning problem (brain damage to Hinshelwood and failure to establish dominance to Orton). However, the brain damage or dysfunction was tied directly to the specific language disorders that the children displayed—not to a single process such as visual perception. And contrary to the Goldstein-Strauss-Werner theorists, remediation was aimed at improving the specific area of learning deficit (such as spelling or reading), not at strengthening a supposed underlying process. Both theories of the historical roots of SLD emphasized developmental disorders, but these brain-related disorders were either perceptual in nature (Goldstein-Strauss-Werner) or associated with written language (Hinshelwood-Orton)—the distinction between minimal brain dysfunction and developmental dyslexia, respectively.

SAM KIRK’S INTEGRATION OF THE TWO MODELS

Kirk (1963) coined the term learning disabilities when he delivered a speech to a large group of parents whose children were having school difficulties and to a smaller group of professionals with a keen interest in the topic. All were seeking a label for these children that Kirk referred to as having developmental deficits of one kind or another (which encompasses developmental disorders of both perception and written language). Kirk’s label had a decided educational flavor, focusing on the nature of the problem rather than the hypothesized cause, and it was the precursor for the federal definitions and laws of the late 1960s and 1970s that proclaimed specific learning disabilities as a disorder that entitled special education services to anyone with an SLD diagnosis. When reading the text of Kirk’s (1963) speech, it is clear that his notion of learning disabilities was more aligned with Hinshelwood-Orton than Goldstein-Strauss-Werner as he referred to “a group of children who have disorders in development in language, speech, reading and associated communication skills needed for social interaction” (p. 3). However, like the perceptual theorists, Kirk stressed that the disorder involved a processing disorder. But, unlike those theorists, he believed the processing disorders to be psycholinguistic in nature, not visual perceptual. He believed that these psycholinguistic disorders led directly to disorders in reading, language, and so forth—an approach that is consistent with the Hinshelwood-Orton belief that brain damage or brain organization is related specifically to written language disabilities. Kirk, however, was more consistent with the perceptual theorists regarding his model of remediation: He believed that a child’s weak psycholinguistic processes (as measured by his Illinois Test of Psycholinguistic Abilities, described in his 1963 speech, but not published until 1968) needed direct remediation in order to treat a child’s learning disability. Unfortunately, subsequent research on the effectiveness of psycholinguistic training yielded the same dismal conclusions that were reached for perceptual training (Newcomer & Hammill, 1976).

THE FEDERAL DEFINITION OF SLD

The definition of SLDs that was inaugurated in the Children with Specific Learning Disabilities Act of 1969 was retained in the Right to Education for All Handicapped Children’s Act of 1975 and has remained intact for IDEA 1997 and IDEA 2004. The first part of this definition is as follows:

The term “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.

This definition is clearly a derivative of Kirk’s approach to the disorder, but when it is related to the two separate historical roots of SLD it is unquestionably the voice of Goldstein-Strauss-Werner, not Orton or Hinshelwood. Processing disorders had no role in the notion of developmental disorders of written language.

The second part of the definition is an amalgam of the two historical traditions:

DISORDERS INCLUDED—Such term includes such conditions as perceptual disabi...

Table of contents

• Title Page
• Copyright Page
• Dedication
• Foreword
• Preface
• About the Contributors
• Chapter 1 - Neuropsychology and Specific Learning Disabilities: Lessons from ...
• Chapter 2 - RTI, Neuroscience, and Sense: Chaos in the Diagnosis and Treatment ...
• Chapter 3 - Neuroscience and RTI: A Complementary Role
• Chapter 4 - The Education Empire Strikes Back: Will RTI Displace ...
• Chapter 5 - Nature-Nurture Perspectives in Diagnosing and Treating Learning ...
• Chapter 6 - Compatibility of Neuropsychology and RTI in the Diagnosis and ...
• Chapter 7 - Assessment Versus Testing and Its Importance in Learning Disability Diagnosis
• Chapter 8 - Comprehensive Assessment Must Play a Role in RTI
• Chapter 9 - The Need to Integrate Cognitive Neuroscience and Neuropsychology ...
• Chapter 10 - Neuropsychological Assessment and RTI in the Assessment of ...
• Chapter 11 - Learning Disabilities: Complementary Views from Neuroscience, ...
• Chapter 12 - Integrating Science and Practice in Education
• Chapter 13 - Perspectives on RTI from Neuropsychology
• Chapter 14 - Neuropsychological Aspects of Learning Disabilities Determination: ...
• Chapter 15 - Identifying a Learning Disability: Not Just Product, but Process
• Chapter 16 - Integrating RTI with Cognitive Neuroscience in the Assessment of ...
• Chapter 17 - Neuropsychology and RTI: LD Policy, Diagnosis, and Interventions
• Chapter 18 - Neuroscience, Neuropsychology, and Education: Learning to Work and ...
• Chapter 19 - Diagnosing Learning Disabilities in Nonmajority Groups: The ...
• Chapter 20 - The Role of Neuroscience and Neuropsychology in the Diagnosis of ...
• Chapter 21 - Q & A about the Role of Neuroscience and Neuropsychology in the ...
• Chapter 22 - RTI and Neuropsychology: Antithesis or Synthesis
• Chapter 23 - Utilizing RTI As an Opportunity to Identify and Plan More ...
• Chapter 24 - Neuropsychology, Neuroscience, and Learning Disabilities: ...
• Chapter 25 - Knowing Is Not Enough—We Must Apply. Willing Is Not Enough—We Must ...