Models of Diagnostic Assessment of Learning Disabilities Methodological and Ethical Issues

1. Models of Diagnostic Assessment of Learning DisabilitiesMethodological and Ethical Issues Jacques Grégoire Université catholique de Louvain Belgium

2. What is at Stake? • Some children with LD are not identify and do not receive an appropriate educational assistance. • Some children with no LD are identified as having LD and are unfairly stigmatized (e.g., confusion between LD and behavioral disorders). • Some children with LD are identified as having another problem and receive inadequate educational assistance (e.g., wrong diagnosis of mental retardation or emotional disorders). • Some children with LD are correctly identified as having LD, but the diagnosis does not provide appropriate information for efficient treatment and educational assistance.

3. There is no Universal Definition of Learning Disabilities • Some countries (e.g. U.S.A., Canada…) are using an official definition of Learning Disabilities (LD). • Other countries (e.g., France, Belgium…) do not officially use such a generic term, but only narrower diagnostic categories for specific learning disabilities (e.g., dyslexia, dyscalculia…).

4. The Concept of Learning Disabilities There is no consensus among the countries that propose an official definition of Learning Disabilities (LD). • U.S.A. (Individuals with Disabilities Education Act -IDEA-, 1997): “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, speak, write, spell, or do mathematical calculation”. […] It “Does not include learning problem that is primarily the results of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage”.

5. The Concept of Learning Disabilities (continued) • Canada (Learning Disabilities Association, 2002): “A number of disorders which may affect the acquisition, organization, retention, understanding, or use of verbal or non verbal information. These disorders affect learning in individuals who otherwise demonstrate at least average abilities essential for thinking and/or reasoning. […] LD may interfere with the acquisition and use of oral language, reading, written language and mathematics. […] LD are due to genetic and/or neurobiological factors or injury that alter brain functioning in a manner which affects one or more processes related to learning.”

6. Comparing the U.S. and the Canadian Definitions These definitions agree on the following points: • Learning problems are related to disorders of one or more cognitive processes required to learn. • LD is not: (1) a primarily consequence of perceptual or motor disabilities; (2) related to intellectual disabilities; (3) due to socio-economic or cultural factors.

7. Comparing the U.S. and the Canadian Definitions (continued) These definitions disagree on the following points: • The processes involved in the learning disabilities: (U.S.) are related to the understanding and the use of spoken and written language; (Canada) refer to a wide range of cognitive abilities (language processing, visual spatial processing, processing speed, memory and attention, and executive functions). • The cause of the disabilities: (U.S.) could be neurological factors but are not clearly specified; (Canada) are explicitly genetic and/or neurobiological factors or injury that alter brain functioning.

8. Debating these Definitions • Because each definitionfocuses on different psychological processes, psychologists would assess different characteristics and reach different conclusions according to the definition they rely on. • Both definitions are typical of a medical viewpoint on LD. A lot of learning problems (perhaps a majority) are related to poor cultural and educational conditions leading to poor linguistic and cognitive skills. Why exclude these problems from the LD category? Why reserving the LD label only to problems due to genetic or neurological factors? Such a choice has several consequences for the treatment of LD and for fairness toward children experiencing learning problems.

9. Debating these Definitions (continued) • Neither definition takes into account the largely incomplete understanding of LD. Implication and causal relationship of several cognitive processes in LD is still unclear. As for the suggested genetic and neurological origin of LD, it is speculation in most cases. Arguable conclusions have been drawn from adults with neurological impairments. Child developmental disorders are not automatically equivalent to adult brain dysfunctions, even when symptoms are similar.

10. Do we Need a General Definition of LD? • Specific learning disabilities exist, which are not one of the many symptoms of severe underlying disorders related to perceptual impairment (e.g., deafness), mental retardation, pervasive mental disorders (e.g., autism) or health disorders. • Specific learning disabilities are observed among children in good health, with normal intellectual abilities. • The recognition of a general LD category is important because the commonality among these disabilities lead to common assessment procedures and similar educational decisions.

11. Towards a Fair Definition of LD A fair definition of LD should ensure the best education for all the LD children. Such a definition should lead to: • More valid assessment procedures, • Better identification of LD children, i.e. with higher specificity (few false positives) and higher sensitivity (few false negatives), • Better understanding of LD children, taking into account all facets of learning behaviors, • Better suggestions for treatment and education, not limited to an isolated child, but including his whole environment.

12. Facets of a Fair Definition of LD Four facets should be included in a fair definition of LD and taken into account when assessing children suspected of LD: (1) Functional facet, (2) Cognitive facet, (3) Emotional and motivational facet, (4) Contextual facet.

13. (1) Functional Facet of LD • What are the consequences of LD in the children’s life? • The assessment of this facet should be more criterion-oriented than norm-oriented. Relying on the discrepancy between the child’s score and the population’s mean score can be misleading because cut scores are often arbitrary and the ecological validity of normed tests can be low. • Practioner should provide evidence that test failures have clear consequences for school learning and in the every day life.

14. (2) Cognitive Facet of LD • The cognitive processes underlying a specific LD should be described in a model. • Such a model should be the road map of the cognitive assessment of LD. Without such a map, the psychologist is like a blind man in a maze looking for the way out. • The model should be empirically validated. Evidence of the relationship between LD and the cognitive processes to be assess should be provided. • The assessment should not only focus on the explanation of LD (its cause), but also on its treatment (preserved processes).

15. (2) Cognitive Facet of LD (continued) Example of a model of the word reading. Such a model is required to select the best tasks for the assessment, but also to interpret the inter-related scores.

16. (3) Emotional and Motivational Facet of LD • The cognitive processes involved in school learning are not isolated inside the child. They influence emotions and motivation related to learning, but are also influenced by these characteristics (e.g., math anxiety). • The relationships between cognitive processes and emotional and motivational components are often circular. • A comprehensive and integrated assessment of children with LD is recommanded.

17. (4) Contextual Facet of LD • Context includes socio-cultural factors and teaching methods, which can have a major impact on LD. • In some cases, these factors are the cause of LD (e.g., poor language knowledge, poor family support to school learning…). • In other cases, these factors increase the impact of the specific cognitive disabilities (e.g., inappropriate reading method, lack of reading opportunities at home…). • When contextual factors are not taken into account, LD is only seen as a child’s attribute, of which he or she is completely accountable.

18. Conclusion A fair definition of LD should provide a framework for a diagnostic assessment that lead to the best treatment and education for LD children. To reach such a goal, a definition of LD should take into account: • Effective consequences of LD on school learning and everyday life, • Empirically validated models of the cognitive processes underlying LD, • Interactions between cognitive processes, emotions and motivation, • Family and school contexts that influence learning into circular relationships.