The Link Between Learning Disabilities and Behavior
G. Emerson Dickman, J.D.
- Subtypes of LD
- Nonverbal Learning Disability
- Attention Deficit/Hyperactivity Disorder
- Executive Function Deficit
- Extrinsic Influences
- Prosocial Development
- Interim Conclusions
- Table 1
- Systemic Weaknesses
- What Will Help?
This article examines the link between learning disabilities (LD) and antisocial behavior. A hypothesis is offered that suggests that subtypes of LD vary significantly in the severity of risk or predisposition to the development of antisocial behavior and that such risk is enhanced in the presence of comorbidity and environmental factors such as school failure, low socioeconomic status, and adopted child status. It is argued herein that such risk is not properly addressed, because of fundamental weaknesses in the system of special education that preclude effective intervention.
LINK BETWEEN LEARNING DISABILITIES AND DELINQUENT BEHAVIOR
Yes, no, maybe–these are the answers to be found in the research seeking to establish the existence of a link between LD and behavior. There are studies that support a strong correlation (Wilgosh & Paitich, 1982), others that support a modest correlation (Lane, 1980), and still others that indicate that there is no correlation (Broder, Dunivant, Smith & Sutton, 1981; Cornwell & Bawden, 1992; Spreen, 1981). Other studies indicate that people react differently to a child with LD than they do to a child without LD. Such studies indicate that individuals with LD receive differential treatment because of their inability to communicate effectively and are therefore more likely to be taken into custody by police (Thompson, 1985), to be found delinquent by a juvenile court (Broder et al., 1981), or to receive more severe penalties (Spreen, 1981). When individuals with LD get in trouble, the same difficulties with language and pragmatics that lead to academic difficulty interfere with their ability to explain themselves and present a sympathetic posture. Many children with LD, in the face of an accusation, look guilty, act guilty, and cannot articulate satisfactory explanations.
The inconsistency found in these studies is more a result of a lack of comparable cohorts across studies than it is of poor methodologies within studies. To get consistent generalizable outcomes, research must be done with a similar population across studies. If research attempts to determine the link between balls and broken windows, it matters whether the study is limited to golf balls, basketballs, or baseballs. Rourke (1988) referred to such studies as addressing undifferentiated groups of learning disabilities. For example, studies that identified the LD population by indices of reading proficiency (Cornwell & Bawden), 1992) or by proficiency in content curriculum requiring reading proficiency (Rhodes & Reiss, 1969) identified an LD population that is psycholinguistically involved in terms of left hemisphere weaknesses (Pennington, 1991). Such an individual, with relative strength in visuospatial skills and the ability to envisage different perspectives from a single vantage point (Masland, 1975; West 1991), is not at significant risk for delinquent behavior (Rourke, 1988). Because of weak auditory processing skills (Harnadek & Rourke, 1994), however, such an individual may very well have difficulty meeting the communications demands of an apprehending officer or judge, which may help explain the differential treatment hypothesis of Broder et al. (1981), Spreen (1981), and Thompson (1985).
Studies of adjudicated youth who are identified as having LD by relying on evidence of previously recorded diagnosis (Broder et al., 1981) or that ruled out emotional disturbance (ED) (Broder et al.,, 1981) fail to recognize that the individual with a nonverbal learning disability (NLD) does not experience early academic failure sufficient for identification as being eligible for special education services (Semrud-Clikeman & Hynd, 1991). In other words, because of strengths in psycholinguistic and rote verbal learning skills (Rourke, 1993), the young NLD pupil’s academic achievement is not sufficiently discrepant from potential to demand the attention of school personnel. By the time the NLD child’s deficits in visual-spatial-organizational and problem-solving skills (Rourke, 1993) begin to interfere sufficiently with academic achievement in the fourth or fifth grade, it is often too late to prevent the social and emotional consequences of a negative peer environment burdened with unintelligible nonverbal language.
Emotional problems often develop as a result of the failure to identify the underlying LD. Studies that rely on previous school diagnosis or rule out ED also over identify the LD population with left hemisphere, language-based disorders. Furthermore, studies that evaluate adjudicated individuals without reference to historical diagnosis rely primarily on the existence of a significant discrepancy in aptitude and achievement (Wilgosh & Paitich, 1982). The aptitude versus achievement formula for identification and diagnosis of LD has been universally discredited (Mather & Healy, 1990; Shaywitz, Fletcher, & Shaywitz, 1994). Any formula that utilizes a comparison of performance or achievement to a standardized norm identifies a result, not a cause. Using such a discrepancy to identify a cohort compounds the bias inherent in retrospective studies.
Commenting on the inconsistent results of studies addressing the co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and LD, S.E. Shaywitz et al. (1994, p. 14) stated that
Examination of both the methods and results of these studies are instructive. . . . [I]n fact each used a somewhat different definition — a methodological inconsistency that speaks to the current lack of a single universally accepted criterion for the diagnosis of either LD or ADD.
Consistent results are not obtainable across studies if one observes baseballs and another observes basketballs. Furthermore, such research cannot accurately predict how a golf ball will behave by studying baseballs and basketballs.
SUBTYPES OF LD
The inconsistency observed in studies addressing the link between LD and delinquent behavior is of heuristic value in that it supports the existence of subtypes of LD, each of which has a different risk factor for delinquent behavior. In other words, if the inconsistent results are due to differences between the studies in the characteristics of the LD cohorts being researched, the conclusion is not that the studies are invalid, but that the characteristics of the particular cohorts being researched are a significant determinant in evaluating the link between LD and delinquent behavior. Thus, if nothing else, these studies prove that among the “ball” population there are different types, each with a unique set of characteristics. It is not surprising, therefore, that a study of the link between balls and broken windows finds no link when studying basketballs and a significant link when studying baseballs.
For the purpose of illustrating the hypothesis offered in this chapter, four possible subtypes of LD are briefly addressed: 1) nonverbal learning disability, 2) dyslexia, 3) attention-deficit/hyperactivity disorder, and 4) executive function deficit.
Nonverbal Learning Disability
As early as 1968, Myklebust (1968, 1975) suggested the possibility of a nonverbal LD subtype with deficits in interpersonal relationships or the ability to judge the emotion being expressed by other people.
Other researchers suggested that “the NLD syndrome leads to a distinct pattern of difficulty in socio-emotional functioning” (Little, 1993, p. 653; Rourke, Young, & Leenaars, 1989). Furthermore,
Children who are unable to acquire these skills because of difficulty in evaluating facial expressions, gestures, or prosody would be at high risk for the development of significant learning difficulties in, at the very least, the socioemotional arena of competence. (Semrud-Clikeman & Hynd, 1990, p. 198)
Although there appears to be a consensus among the many researchers and authors addressing the phenotype, there is no consensus regarding a name for the syndrome. The most authoritative work in this field is that by Harnadek and Rourke (1994), which presents a comprehensive model of an NLD subtype. This research indicates that the NLD subtype evidences socioemotional and adaptive deficits, including compromised social competence and emotional stability.
Harnadek and Rourke (1994) convincingly distinguished the NLD subtype from the reading-spelling (R-S) subtype, which closely matches the LD construct often referred to as dyslexia. Pennington (1991) indicated that the primary symptoms in dyslexia include problems in reading, spelling, and the phonological coding of written language. Harnadek and Rourke (1994, p. 144) described the Group R-S as having “very poor reading and spelling skills” and “relatively poor psycholinguistic skills.” It is interesting to note that the literature is replete with indications that the learner with dyslexia may also exhibit unexpected strengths (Masland, 1975; West, 1991). Harnadek and Rourke (1994, p. 144) credited the Group R-S with “very well-developed abilities in visual-spatial-organizational, tactile-perceptual, psychomotor, and nonverbal problem solving areas.”
The criteria for diagnosing ADHD have been revised and are presented in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) (American Psychiatric Association, 1994). Such criteria, all of which are observations of negative behavioral characteristics, may obviously impede the development of normal social relationships. Someone who fidgets, forgets, does not listen, is distractible, talks too much, does not wait his or her turn, and interrupts is clearly unlikely to have a large circle of good friends. S.E. Shaywitz et al. (1994) authoritatively challenged the predictive and communicative power of current methods for diagnosing ADHD. They convincingly argued that there is evidence for “at least two subtypes: (1) behavioral and (2) a cognitive type” (p. 7). The significance of this argument lies in the fact that each subtype presents a different socioemotional risk profile. The inability to identify “the diverse populations now diagnosed as ADD represents a central problem in our ability to understand, to assess, and to treat affected individuals” (S.E. Shaywitz et al., 1994, p. 22).
Executive Function Deficit
Bruce Pennington (1991) was most parsimonious in his description of executive function (EF), which he broadly defined “as the ability to maintain an appropriate problems-solving set for attainment of a future goal” (p. 13). Executive functions may include “organizational skills, planning, future-oriented behavior, set-maintenance, self-regulation, selective attention, maintenance of attention, vigilance, inhibition, and even creativity (Pennington, 1991, p. 13). Denckla (1994), a leader in exploring executive function, summed up the list of EF components by indicating simply “that executive function refers to attention not only to the present but also to the future, as well as intention (preparedness to act)” (p. 118).
Torgesen (1994) relates the term executive function, which reflects a neuropsychological perspective, to the term metacognition, which reflects an information processing, perspective. Torgesen’s description of metacognition helps to clarify the extent of the difficulties that may be faced by an individual with a deficit in executive function:
Metacognitive knowledge includes information about one’s own abilities, knowledge of what makes some tasks hard and others easy, and insights about what cognitive strategies are useful in achieving various goals. The more dynamic, behavioral side of metacognition includes the processes involving planning, organizing, coordinating, monitoring, and adapting various knowledge and strategic resources which a task is being performed. (p. 145)
Factors that may be loosely referred to as environmental have also been shown by various studies to have a negative correlation to socioemotional development. Such factors, unrelated to neurobiological profiles, include low socioeconomic status (Grande, 1988), school failure (Grande, 1988; Rhodes & Reiss, 1969), and adopted child status (Brodzinsky & Steiger, 1991; Dickman, 1992). Many studies have hypothesized that school maladjustment and academic failure are causes of the disaffection that results in delinquent behavior (Bruck, 1985; Dunivant, 1982; Healy, 1933). In fact, LD can be a factor with a significant impact on academic and psychosocial development (Myklebust, 1968; Rourke, 1988; Rourke, Young, & Leenaars, 1989).
The hypothesis presented in this chapter would anticipate that future empirical research will support the finding that a neurobiological etiology is the primary precursor to the antisocial behavior exhibited by individuals with LD and that extrinsic influences such as socioeconomic status, adopted child status, and academic failure are secondary and not altogether necessary factors compounding the risk profile.
Denckla (1979) provided convincing evidence that the presence of various codiagnoses, including types of language disorder or ADD with hyperactivity, is meaningfully related to subtypes of childhood learning disabilities. More recent studies have provided further support for the idea that learning disabilities frequently co-occur with other psychiatric disorders. (Semrud-Clikeman & Hynd, 1990, p. 199)
Clearly, one or more the intrinsic and extrinsic conditions heretofore discussed may co-occur, creating the specter of complicated diagnostic profiles unique to the individuals, such as a child who has dyslexia, ADHD cognitive subtype, is adopted, and suffers school failure. The fashion of sorting children into separate and distinct diagnostic pigeonholes is a bureaucratic convenience with no scientific pedagogic merit.
Researchers interested in the mechanics of normal psychosocial development have determined that prosocial behavior is intimately involved with cognitive growth and the development of perspective-taking and role-taking abilities (Moore & Underwood, 1981).
Although the ability to anticipate the cognition of another may be a more complex cognitive feat than the ability to recognize different visual perspectives, they are usually assumed to generate from a common basis.
This basic construct was examined in a study (Underwood, Froming, & Guarijuata, 1980) using the “three-mountain task.” In this task, a child is placed before a model of a mountain scene and is asked to imagine what he or she would see if placed in some other position. The child is asked to choose which of several photographs accurately represents the view from an alternative position.
The children were given 25 pennies when they entered the experimental room, ostensibly for helping the experimenters with their work. Following completion of the three-mountain task, the children were given an opportunity to donate some of their pennies anonymously to a fund for children who wouldn’t get a change to earn pennies. Perspective-taking scores were significantly correlated with the number of pennies donated. (Moore & Underwood, 1981, p. 78)
Although this study was intended to investigate the correlation between the development of altruism and perspective taking in typical children, the following conclusions can be related to individuals in whom perspective-taking and role-taking skills do not develop, owing to neurobiological deficits. “Empathetic reaction is an internal response to cues about the effective states of someone else; the empathetic reaction must depend heavily on the actor’s cognitive sense of the other as distinct from himself” (Moore & Underwood, 1981, p. 86).
Using the NLD model (Harnadek & Rourke, 1994) discussed earlier as an example, the individual with NLD who has difficulty with visual attention, visual memory, prosody, semantics, and pragmatics has a significantly impaired ability to interpret the paralinguistic cues (e.g., body language, expression, tone of voice) necessary to develop a “cognitive sense of others” (Hoffman, 1975, p. 610). Therefore, the individual with NLD has an impairment of neurobiological etiology in both perspective taking and role taking, both of which have been found to have a significant correlation to the development of normal prosocial behavior.
There appears to be robust support for the following conclusions:
- LD consists of various subtypes.
- Each LD subtype poses a unique and variable risk of predisposing a child to anomalous development of prosocial behavior.
- Co-occurrence of LD subtypes enhances the risk of evidencing anomalous development of prosocial behavior.
- Environmental factors such as school failure, low socioeconomic status, and adopted child status also enhance the risk of evidencing anomalous development of prosocial behavior.
Table 1 demonstrates the possible relationship of various LD subtypes and codiagnoses to a hypothetical risk factor predisposing a child to experiencing anomalous development of prosocial behavior. This table is intended only as a visual representation of an example of what this author would expect if consistent and generalizable studies were to be conducted addressing the link between intrinsic and extrinsic influences to a predisposition for the anomalous development of prosocial behavior.
Table 1 anticipates that each LD subtype predisposes a child to a quantitatively different risk for the development of behavior problems. For example, the research surveyed supports the finding that dyslexia (R-S) poses a very low risk, EF deficits present a slightly higher risk, ADHD poses an even higher risk, and NLD poses the greatest risk of all for the development of behavior problems.
If children with NLD display relative proficiencies in reading and spelling (Harnadek & Rourke, 1994) as compared with children with dyslexia who have problems with reading and spelling (B.A. Shaywitz, Fletcher, & Shaywitz, 1994), it is logical that prospective studies of individuals with dyslexia find little or no link to delinquent behavior and that retrospective studies of delinquent populations find a significant link between delinquent behavior and LD. Obviously, the prospective
study observed individuals with one LD subtype and the retrospective study observed individuals with a different LD subtype. Rourke’s research involving 750 children with LD supported his conclusion that “the better the reading the more serious the psychopathology” (Rourke, 1993). The inference is clear: A significant risk for anomalous prosocial development is not common to all LD subtypes. Rourke (1993) also described children with NLD as having a “Modality specific attention deficit” in that they do not pay attention to visual and tactile stimulation, whereas dyslexics do not pay attention to auditory stimulation.
The individual with NLD responds best to auditory stimulation and worst to visual and tactile stimulation, whereas the person with dyslexia is the reverse, responding best to visual and tactile stimulation as compared to auditory stimulation. Nevertheless, both are often labeled simply as LD and receive a generic approach to intervention that does not recognize their differences.
Could there be a better argument for the need to subtype individuals with learning disabilities and individualize intervention and remediation?
One wonders if the real progress will not come from disentangling groups of children from this huge conglomerate mass, rigorously specifying the nature of their difficulties, and systematically exploring appropriate educational interventions for these subgroups. (Doris, 1993, p. 112)
If we know so much about risk for LD individuals developing antisocial behavior, why is more not being done to avoid the process of risk becoming reality? In large measure, the fault appears to lie in the system of education, which evidences intrinsic weaknesses that interfere with the appropriate delivery of services. Three of these intrinsic weaknesses require specific mention.
First, schools are required to quantify or establish concrete, measurable growth in pupil achievement. Pretesting and post-testing is applied to virtually every increment of the educational experience to quantify measurable growth. this quantitative accountability causes administrators and teachers to de-emphasize efforts promoting skills that are not readily quantifiable (e.g., morality, ethics, problem solving, decision making) as well as strategies for the acquisition of social competencies and nonverbal literacy.
Second, a related weakness is the slice of time perspective adopted by educational evaluators. Current procedures of multidisciplinary evaluations focus on what is, with no concern for prognosis. Such evaluations are motivated by a desire to establish concrete baselines to quantify the success of remediation. Possible interventions are overlooked because prognosis is ignored.
Third, the aptitude-achievement discrepancy formula used to determine eligibility for special education services is predicated on school failure. This threshold of failure must be crossed before services can be delivered (Mather & Roberts, 1994).
This combination of weaknesses has established a dynamic that ignores the evaluation of risk. A problem must exist, not merely be possible for even probable, before resources can be devoted to intervention or remediation. Our system of education has greater regard for those who cure than for those who prevent, reversing Franklin’s axiom that an ounce of prevention is worth a pound of cure. Our educational system is a hostage to accountability and a slave to outmoded paradigms.
WHAT WILL HELP?
An 11-year-old child died while being restrained. A review of this child’s records indicated a profile that placed him among those with the highest risk of developing anomalous prosocial behavior (NLD/EF/ADHD). He was not properly diagnosed, and his needs were not properly evaluated. Care providers in his environment overlooked the neurobiological etiology of his behavior, thereby missing opportunities for intervention, and instead implemented a punitive as well as self-protective response. Society can better protect itself by delivering efficacious intervention. Society must understand the character of the threat. For many children with LD who lack the ability to interact and communicate effectively with others, the classroom, the hall, the playground, the candy store, and even their own homes are arenas for misunderstanding and conflict. Without appropriate intervention, this relatively innocuous constitutional disorder can cause the child with LD to experience an alien and hostile environment that results in anger and disaffection.
This particular example is used to indicate the seriousness of the issues involved. An educational system that does not respond to the needs of our children does not merely compromise their potential to benefit themselves, their families, and society, but risks making them burdens to their families and society and even risks their lives. What can be done?
First, in the area of research, studies are needed to identify and define learning disabilities subtypes. Second, teachers need preserve and in-service instruction to recognize children at risk and to appropriately respond to their needs. Third, parents should be provided with or directed to instruction and education that will enable them to effectively respond to their child’s needs. parents must meaningfully participate in development of their child’s individualized education program (IEP) and must be part of a comprehensive home-school service delivery package. Fourth, the IEP should address risk and prognosis as well as diagnosis and current status. The IEP should also address the need for intervention strategies and should evaluate household and peer relationships in terms of service delivery potential. Fifth, successful educational policies require the commitment of administrative personnel. Top-down support is necessary for successful implementation of innovative service delivery strategies. Sixth, interventions must redirect dysfunctional patterns in the home and in peer groups and avoid problematic social situations. Interventions should model, in the home and at school, ethics, problem solving, decision making, conflict resolution, social skills, and nonverbal competency. Seventh, the legal community of attorneys, courts, police, and correctional facilities must be educated and enlightened about the reasons behind the behaviors they observe. Law enforcement personnel must take steps to overcome the inadvertent bias that results in individuals with LD being more likely to be taken into custody, to be found guilty, and to get more severe penalties than their peers without LD. It must also be recognized that a key to modifying behavior is understanding the causes for the behavior.
Our children suffer from the isolationist perspective of school systems that define their responsibility within the parameters of a wall that they build between themselves and the communities they serve. the failure to recognize and respond to the social and emotional needs of individuals with particular LD subtypes is an example of this head-in-the-sand attitude, which encourages schools to avoid addressing a cause when they do not have to address the effect.
There are factors both intrinsic (e.g., dyslexia, NLD, ADHD, EF) and extrinsic (e.g., school failure, socioeconomic status, adopted child status) that predispose an individual to anomalous prosocial development. For this observation to have meaning, LD subtypes must be appropriately defined, and the research inconsistency that has been discussed must be addressed. S.E. Shaywitz et al. (1994) put it best: “the development of a unitary, empirically derived nosology . . . should increase the consistency and generalizability of findings across investigations and across disciplines” (p. 22).
To accomplish such consistency, S.E. Shaywitz et al. (1994) proposed a “systematic classification study” (p. 22). Such a study is essential if we are to understand the unique needs of individuals with LD subtypes, the comorbidities involved, and the complex correlation of subtypes with social and emotional development. This call to arms is perhaps the single most important movement occurring in the field of LD. We must “disentangle this huge conglomerate mass” (Doris, 1993, p. 112) if we are to develop truly efficacious methodology and service delivery. The system of education must recognize the false promise of quantitative evaluation of pedagogy and curriculum and embrace a less Newtonian and more holistic paradigm (Dickman, 1990; Heshusius, 1989) aimed at identifying risk and preventing failure.
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