What definitions of learning disability say and don't say: a critical analysis.

In this article, we analyze critically available definitions of learning disability (LD). The general problem of definition is discussed first followed by a discussion of individual LD definitions from the earliest to the latest. We conclude that LD definitions fail to provide substantive insight into the nature of the condition. The reasons for this failure are discussed in relation to the nature of definition and the difficulties in providing operational definitions of LD that are meaningful and significant. Finally, means for resolving the problem of definition are discussed.

Comorbidity of hyperactivity-impulsivity-inattention and conduct problems: risk factors in social, affective, and academic domains.

Children showing a comorbid behavior pattern of hyperactivity-impulsivity-inattention and conduct problems (HIA + CP) were contrasted to children having only an internalizing and externalizing behavior pattern (I + E) and matched controls. Children displaying the HIA + CP behavior pattern were at greater risk on a number of outcome measures in social and academic domains beginning in Grade 3 and continuing into Grade 4. The most marked differences among the three groups were found on peer measures of rejection and friendship and teacher ratings of social skills. On average, almost two-thirds of the HIA + CP group were rejected by their peers compared to one-third of the I + E group and only 12.5% controls. Over 70% of the HIA + CP group had no reciprocated friendships from Grade 3 to Grade 4 compared to less than half of the I + E group and approximately one-fourth of controls. Contrary to much theorizing in the literature, the HIA + CP and I + E groups showed average levels of academic self-concept and did not differ from controls in on measures of social self-concept and academic self-concept and general self-esteem. These findings were interpreted in light of positive illusory biases and the established link between aggressive behavior and egotism. The current article offers partial support for Lynam's (1996) notion of the "fledgling psychopath."

Sheltered homeless children: their eligibility and unmet need for special education evaluations.

OBJECTIVES: This study described the proportion of sheltered homeless children in Los Angeles, Calif, who were eligible for special education evaluations because of a probable behavioral disorder, learning disability, or mental retardation, and to explore their level of unmet need for special education services. METHODS: This was a cross-sectional study of 118 parents and 169 children aged 6 through 12 years living in 18 emergency homeless family shelters in Los Angeles County, California. Parents and children were interviewed with standardized mental health and academic skill measures in English and Spanish. RESULTS: Almost half (45%) of the children met criteria for a special education evaluation, yet less than one quarter (22%) had ever received special education testing or placement. The main point of contact for children with behavioral disorders and learning problems was the general health care sector. CONCLUSIONS: School-aged sheltered homeless children have a high level of unmet need for special education evaluations, the first step toward accessing special education programs. Interventions for homeless children should include integration of services across special education, general health care, and housing service sectors.

Social skill deficits and learning disabilities: a meta-analysis.

Over the past 15 years, increased attention has been directed at social skills and their relationship to learning disabilities. Using the methods of meta-analysis, this investigation explores the nature of social skill deficits among students with learning disabilities. Across 152 studies, quantitative synthesis shows that, on average, about 75% of students with learning disabilities manifest social skill deficits that distinguish them from comparison samples. Approximately the same level of group differentiation is found across different raters (teachers, peers, self) and across most dimensions of social competence. Although social skill deficits appear to be an integral part of the learning disability experience, a number of questions about the relationship between learning disability and social skill deficits remain unanswered. Until these questions are answered, social skill deficits are best viewed as one among many elements of the learning disability constellation, and no significant definitional changes related to social skill deficits appear warranted.

Psychiatric consultation in severe and profound mental retardation.

OBJECTIVE: This study was designed to examine the relationship between reason for referral and subsequent DSM-III-R diagnosis in institutionalized individuals with severe to profound mental retardation. A heavy emphasis was placed on articulating how diagnostic criteria are applied in this population. METHOD: The study population consisted of 251 patients consecutively referred for initial psychiatric consultation from a large series of institutionalized patients with predominately severe to profound mental retardation. On the basis of the chief complaint, subjects could be grouped into six overlapping categories: self-injury, aggression, hyperactivity, agitation, medical questions, and miscellaneous behaviors. Psychiatric diagnoses were made according to DSM-III-R criteria on the basis of simultaneous clinical examination, staff interview, and medical review. Relevant medical conditions were noted. RESULTS: The authors demonstrate, as have others, that it is possible to make psychiatric diagnoses in this population and that psychiatric disorder is common. The most frequent diagnoses were impulse control disorders, anxiety disorders, and mood disorders. Comorbid medical conditions, particularly seizure disorders, are also common. CONCLUSIONS: These results are consistent with the reported experience of others and underscore the importance of psychiatric involvement in the multidisciplinary assessment and treatment of individuals with retardation.

Stimulant medication and reading performance: follow-up on sustained dose in ADHD boys with and without conduct disorders.

The study examined the sustained effects of methylphenidate on reading performance in a sample of 42 boys, aged 8 to 11, with attention deficit-hyperactivity disorder (ADHD). Two subgroups were formed based on the presence or absence of co-occurring conduct disorders. Subjects were selected on the basis of their positive response to methylphenidate as determined in a series of original medication trials (Forness, Cantwell, Swanson, Hanna, & Youpa, 1991). For the purpose of this study, subjects were placed on their optimal dose of medication for a 6-week period and then tested on measures of oral reading and reading comprehension equivalent to those used in the original trials, retested after a week without medication (placebo), then tested again the following week after return to medication. Only the subgroup with conduct disorders responded, and this response was limited to reading comprehension improvement in only those subjects who also demonstrated improvement in oral reading on original trials. No response differences were found between subjects with or without learning disabilities.

Differential effects of stimulant medication on reading performance of boys with hyperactivity with and without conduct disorder.

Controversy surrounding stimulant medication, particularly its effects on reading performance, continues to obscure the issue of the use of this drug in classroom situations. The present study emphasized careful differential diagnosis, double-blind and placebo approaches, and curriculum-based dependent measures to address these concerns. Methylphenidate was administered to two groups of boys, ages 8 through 11. The two groups included 27 subjects meeting criteria for attention deficit-hyperactivity disorder but not conduct disorder, known as hyperactive disorder (HD), and 28 subjects meeting criteria for both diagnostic categories, known as hyperactive-aggressive (HA). Only four subjects in each group met a discrepancy criterion for learning disabilities (LD). Methylphenidate was administered to both groups at three levels of dosage, along with baseline and placebo conditions. Dependent measures involved both reading recognition and reading comprehension, equivalent across all conditions. No significant results were found for the group with HD in either reading recognition or comprehension, due largely to unusual placebo reactions. Results were generally in the direction predicted for the group with HA, but only significantly so in reading comprehension, and no dose effect was found on this variable. Implications for reading as a dependent measure of medication effects are discussed.

Identification and diagnostic issues in special education: a status report for child psychiatrists.

Education of children with learning, behavioral, or emotional disorders in the public schools has been rather remarkably transformed over the past decade by implementation of Public Law 94-142, Education of the Handicapped Act. Although children with learning disabilities have been served in far greater numbers than before, children with other disorders, including serious emotional disturbance, have either declined in numbers served or are being served in numbers far smaller than current prevalence rates would suggest are adequate. This paper reviews these trends, along with diagnostic criteria used to determine special education eligibility for such children, and discusses selected interdisciplinary and related trends.

Behavioral disturbance in mentally retarded children in TMR and EMR classrooms.

The frequency with which disruptive behavior actually takes place in ongoing classroom settings was examined. Disruptive behavior of 646 subjects in TMR and EMR classrooms was observed over a 4-day period. Although mean disruptive behavior occurred at relatively low levels, considerable variability was evident with some differences observed in the nature of disruptive behavior between TMR and EMR subjects. This variability was further examined within a subsample of "high" and "low" disrupters.

Interdisciplinary services used by public schools.

A questionnaire to survey interagency cooperation was developed and sent to public school educational agencies throughout the country. Respondents included: special education supervisors and principals, school psychologists, and administrators at the local, regional, and state level. It was found that children with specific learning disabilities were referred more frequently than children with mental retardation and identification and assessment were the interdisciplinary services most requested in terms of evaluation and inservice training for public school staffs.