Technology and Learning Disabilities

December 1983

NTIS order #PB84-184043
HEALTH TECHNOLOGY CASE STUDY 25:

Technology and

Learning Disabilities

DECEMBER 1983

This case study was performed as a part of OTA’s Assessment of

Technology and Handicapped People

Prepared under contract for OTA by:

Candis Cousins, M. S., Doctoral Candidate, Wright Institute, Berkeley, Calif.

and

Leonard Duhl, M. D., Professor of Public Health and City Planning

University of California, Berkeley, Calif.

OTA Case Studies are documents containing information on a specific medical

technology or area of application that supplements formal OTA assessments. The

material is not normally of as immediate policy interest as that in an OTA Report,

nor does it present options for Congress to consider.
Recommended Citation:

Health Technology Case Study 25: Technology and Learning Disabilities (Washington,

D, C.: U.S. Congress, Office of Technology Assessment, OTA-HCS25, December 1983).

This case study was performed as part of OTA’s assessment of Technology and EZandicapp,ed People.

Library of Congress Catalog Card Number 83-600546
Preface

Technology and Learning Disabilities is Case

Study 25 in OTA’s Health Technology Case Study

Series. It was prepared in response to a request

by the Senate Finance Committee, Subcommittee on Health, and is part of OTA’s project on

Technology and Handicapped People, requested

by the House Committee on Energy and Commerce and its Subcommittee on Health and the

Environment and the Senate Finance Committee,

Subcommittee on Health. A listing of other case

studies in the series is included at the end of this

preface.

OTA case studies are designed to fulfill two

functions. The primary purpose is to provide

OTA with specific information that can be used

in forming general conclusions regarding broader

policy issues. The first 19 cases in the Health Technology Case Study Series, for example, were conducted in conjunction with OTA’s overall project

on The Implications of Cost-Effectiveness Analysis of Medical Technology. By examining the 19

cases as a group and looking for common problems or strengths in the techniques of cost-effectiveness or cost-benefit analysis, OTA was able

to better analyze the potential contribution that

those techniques might make to the management

of medical technology and health care costs and

quality.

The second function of the case studies is to

provide useful information on the specific technologies covered. The design and the funding levels of most of the case studies are such that they

should be read primarily in the context of the associated overall OTA projects. Nevertheless, in

many instances, the case studies do represent extensive reviews of the literature on the efficacy,

safety, and costs of the specific technologies and

as such can stand on their own as a useful contribution to the field.

Case studies are prepared in some instances because they have been specifically requested by

congressional committees and in others because

they have been selected through an extensive review process involving OTA staff and consultations with the congressional staffs, advisory panel

to the associated overall project, the Health Program Advisory Committee, and other experts in

various fields. Selection criteria were developed

to ensure that case studies provide the following:

examples of types of technologies by function (preventive, diagnostic, therapeutic, and

rehabilitative);

examples of types of technologies by physical

nature (drugs, devices, and procedures);

examples of technologies in different stages

of development and diffusion (new, emerging, and established);

examples from different areas of medicine

(e.g., general medical practice, pediatrics,

radiology, and surgery);

examples addressing medical problems that

are important because of their high frequency or significant impacts (e. g., cost);

examples of technologies with associated high

costs either because of high volume (for lowcost technologies) or high individual costs;

examples that could provide information material relating to the broader policy and methodological issues being examined in the particular overall project; and

examples with sufficient scientific literature.

Case studies are either prepared by OTA staff,

commissioned by OTA and performed under contract by experts (generally in academia), or written by OTA staff on the basis of contractors’ papers.

OTA subjects each case study to an extensive

review process. Initial drafts of cases are reviewed

by OTA staff and by members of the advisory

panel to the associated project. For commissioned

cases, comments are provided to authors, along

with OTA’s suggestions for revisions. Subsequent

drafts are sent by OTA to numerous experts for

review and comment. Each case is seen by at least

30, and sometimes by 80 or more outside reviewers. These reviewers may be from relevant Government agencies, professional societies, consumer

and public interest groups, medical practice, and

academic medicine. Academicians such as economists, sociologists, decision analysts, biologists,

and so forth, as appropriate, also review the cases.

Although cases are not statements of official

OTA position, the review process is designed to

1;1
satisfy OTA’s concern of each case study’s scien- fore, OTA encourages, and to the extent possitific quality and objectivity. During the various ble requires, authors to present balanced inforstages of the review and revision process, there- mation and recognize divergent points of view.

Health Technology Case Study Seriesa

———-.——

Case Study Case Study

Series Case study title; author(s); Series Case study title; author(s);

number OTA publication numberb

number OTA publication numberb

1

2

3

4

5

6

7

8

9

10

11

12

Formal Analysis, Policy Formulation, and End-Stage

Renal Disease;

Richard A. Rettig (OTA-BP-H-9 (1))C

The Feasibility of Economic Evaluation of

Diagnostic Procedures: The Case of CT Scanning;

Judith L. Wagner (OTA-BP-H-9(2))

Screening for Colon Cancer: A Technology

Assessment;

David M. Eddy (OTA-BP-H-9(3))

Cost Effectiveness of Automated Multichannel

Chemistry Analyzers;

Milton C. Weinstein and Laurie A. Pearlman

(OTA-BP-H-9(4))

Periodontal Disease: Assessing the Effectiveness and

Costs of the Keyes Technique;

Richard M. Scheffler and Sheldon Rovin

(OTA-BP-H-9(5))

The Cost Effectiveness of Bone Marrow Transplant

Therapy and Its Policy Implications;

Stuart O. Schweitzer and C. C. Scalzi

(OTA-BP-H-9(6)}

Allocating Costs and Benefits in Disease Prevention

Programs: An .Application to Cervical Cancer

Screening;

Bryan R. Luc’e (Office of Technology Assessment)

(OTA-BP-H-9(7})

The Cost Effectiveness of Upper Gastrointestinal

Endoscopy;

Jonathan A. Showstack and Steven A. Schroeder

(OTA-BP-H-9(8))

The Artificial Heart: Cost, Risks, and Benefits;

Deborah P. Lubeck and John P. Bunker

(OTA-BP-H-9(9))

The Costs and Effectiveness of Neonatal Intensive

Care;

Peter Budetti, Peggy McManus, Nancy Barrand,

and Lu Ann Heinen (OTA-BP-H-9 (1 O))

Benefit and Co!jt Analysis of Medical Interventions:

The Case of Cimetidine and Peptic Ulcer Disease;

Harvey V. Fineberg and Laurie A. Pearlman

(OTA-Bp-H-’~(ll))

Assessing Selected Respiratory Therapy Modalities:

Trends and Relative Costs in the Washington, D.C.

Area;

Richard M. Scheffler and Morgan Delaney

(OTA-BP-H-9(12))

.——

13

14

15

16

17

18

19

20

21

22

23

24

25

Cardiac Radionuclide Imaging and Cost

Effectiveness;

William B. Stason and Eric Fortess

(OTA-BP-H-9(13))

Cost Benefit/Cost Effectiveness of Medical

Technologies: A Case Study of Orthopedic Joint

Implants;

Judith D. Bentkover and Philip G. Drew

(OTA-BP-H-9(14))

Elective Hysterectomy: Costs, Risks, and Benefits;

Carol Korenbrot, Ann B. Flood, Michael Higgins,

Noralou Roos, and John P. Bunker

(OTA-BP-H-9(15))

The Costs and Effectiveness of Nurse Practitioners;

Lauren LeRoy and Sharon Solkowitz

(OTA-Bp-H-9(16))

Surgery for Breast Cancer;

Karen Schachter Weingrod and Duncan Neuhauser

(OTA-BP-H-9(17))

The Efficacy and Cost Effectiveness of

Psychotherapy;

Leonard Saxe (Office of Technology Assessment)

(OTA-BP-H-9 (18))d

Assessment of Four Common X-Ray Procedures;

Judith L. Wagner (OTA-BP-H-9 (19))e

Mandatory Passive Restraint Systems in

Automobiles: Issues and Evidence;

Kenneth E. Warner (OTA-BP-H-15 (20))f

Selected Telecommunications Devices for HearingImpaired Persons;

Virginia W. Stern and Martha Ross Redden

(OTA-BP-H-16 (21))g

The Effectiveness and Costs of Alcoholism

Treatment;

Leonard Saxe, Denise Dougherty, Katharine Esty,

and Michelle Fine (OTA-HC2-22)

The Safety, Efficacy, and Cost Effectiveness of

Therapeutic Apheresis;

John C. Langenbrunner (Office of Technology

Assessment) (OTA-HCS-23)

Variation in Length of Hospital Stay: Their

Relationship to Health Outcomes;

Mark R. Chassin (OTA-HCS-24)

Technology and Learning Disabilities;

Candis Cousins and Leonard Duhl (OTA-HCS-25)

available for sale by the Superintendent of Documents, U.S. Government dBackground paper #3 to The Implications of Cost-Effectiveness Anal.ws of

Printtng Office, Washington, D. C., 20402, and by the National Technical Medical Technology.

Information Service, 5285 Port Royal Road, Springfield, Va., 22161. Call ‘Background Paper #S to The lmplicat]ons oi Cost-Effectiveness Analysis of

OTA’s Publlshlng Of ficr (224-8996) for availability and ordering ]nfor- Medical Technology,

mation. IBackground paper #l to OTA’s May 1982 report Technology and Hdncflboriginal Pubhcation numbers appear In Parentheses. capped People.

‘The first 17 cases in the wries were 17 separately Issued cases in Background gBackground Paper #2 to Technology and Handicapped People.

Paper u.? Case Studies of Medical Technologies. prepared m conjunction

with OTA’s August 1980 report The implications of Cost-Effectiveness Anafvsis of Medical Technolclgy.

iv
OTA Staff for Case Study #25

H, David Banta, Assistant Director, OTA

Health and Life Sciences Division *

Clyde J. Behney, Health Program Manager

Clyde J. Behney, Project Director

Anne Kesselman Burns, Analyst

Kerry Britten Kemp, Editor

Ann Covalt, Contractor’*

Virginia Cwalina, Administrative Assistant

Mary E. Harvey, Secretary

Jennifer Nelson, Secretary

OTA Publishing Staff

John C. Holmes, Publishing Officer

John Bergling Kathie S. Boss Debra M. Datcher Joe Henson

Glenda Lawing Linda A. Leahy Cheryl J. Manning

● Until August 1983.

v
Advisory Panel on Technology and Handicapped People

Daisy Tagliacozzo, Panel Chair

Department of Sociology, University of Massachusetts, Harbor Campus

Miriam K. Bazelon

Washington, D.C.

Tom Beauchamp

Kennedy Institute-Center for Bioethics

Georgetown University

Monroe Berkowitz

Bureau of Economic Research

Rutgers University

Henrik Blum

University of California, Berkeley

Frank Bowe

Woodmere, N. Y.

Jim Gallagher

Martha Porter Graham Center

University of North Carolina, Chapel Hill

Melvin Glasser

Committee for National Health Insurance

Robert Leopold

Department of Psychiatry

Hospital of the University of Pennsylvania

LeRoy Levitt

Mount Sinai Hospitai

A. Malachi Mixon, III

lnvacare Corp.

Jacquelin Perry

Rancho Los Amigos Hospital

Barbara W. Sklar

Mount Zion Hospital

William Stason

Veterans Administration and Harvard School of

Public Health

Gregg Vanderheiden

Trace Research and Development Center

University of Wisconsin-Madison

Ralf Hotchkiss Michael Zullo

Oakland, Calif. Corporate Partnership Program

John Kimberly

U.S. Council for International Year 0f

Disabled Persons

The Wharton School

University of Pennsylvania

vi
Contents

[’age

SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

PART ONE: THE FIELD OF LEARNING DISABILITIES . . . . . 7

Overview of the Field . . . . . . . . . . . . . . 7

Definition of ’’Learning Disabilities” . . . . . . . . . . . . . . . 7

History of the Field: Theories, Terms, and Treatments . . . . . . . . . . 8

Prevalence of Learning Disabilities. ,. . . . . . . . . . . . . . . . . . . . . 12

Characteristics of Learning-Disabled Individuals ...,..,. 13

Identification of Learning Disabilities . . . . . . . . . . . . 14

Intervention ., . . . . . . . . . . . . . . . . . . 16

Hard and Soft Technologies of learning Disabilities . . . . 18

Hard Technologies . . . . . . . . . . . . . . . . 18

Soft Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Current Issues in the Field of Learning Disabilities . . . . . . . . . . . . . . . . . . 24

Issues of Definition . . . . . . . . . . . . . . . . 25

Issues of Identification . . . . . . . . . 27

Issues of Treatment. . . . . . . . . . . . . . . . . . 28

Issues of Research . . . . . . . 30

Labeling . . . . . . . . . . . . . . . . . 30

Some Issues in Implementing Public Law 94-142, . . . . . . . . . . 31

Some Issues Concerning Learning-Disabled Adults. . . . . 33

Directions . . . . . . . 34

Hard Technology. . . . . . . . . . . 34

Soft Technology . . . . . . . . . . . . . . . . . . . . . 36

PART TWO: A BROADER PERSPECTIVE UNLEARNING DISABILITIES . . . . . 4 1

Overview . . . . . . . . . . . . . . . . . . 41

Integrating the Approaches to Learning Disabilities . . . . . . . . . . . . . . . . 41

The Social Context . . . . . . . . . . . . . . . . . . . . . 44

Redefining Learning Disabilities . . . . . . . . . . . . . . . 45

Disabling Settings: School Services for the Learning-Disabled Population . 46

Treatment and Intervention: Systems With Learning Problems . . 48

Lack of Communication and Support Within the Treatment

and Intervention System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Directions: Technological Possibilities to “Mainstream” the System . . . . . . 50

Develop Complementary Hard and Soft Technologies for Those

With the ’’Indistinct Handicap” . . . . . . . . . . . 50

“Mainstream” Classroom Teachers, . . . . . . . . 50

“,Mainstream” School Systems . . . . . . . . . 51

Integrate Various Services for the”learning Disabled . . . . . . . . . . . . . . 52

Consider Developing New Organizing Principles for the Schools . . . . 53

REFERENCES . . . . . . . . . . . . . . . . . . . . 57

vii
OTA Note

These case studies are authored works commissioned by OTA. Each author

is responsible for the conclusions of specific case studies. These cases are not statements of official OTA position. OTA does not make recommendations or endorse

particular technologies. During the various stages of review and revision, therefore,

OTA encouraged the authors to present balanced information and to recognize

divergent points of view. Since the research writing of this case study in early 1981,

there has been a technological revolution—in the form of the microcomputer—in

the field of learning disabilities. This study covers technological advances up to

the microcomputer and, therefore, was completed too early to include it.

.,, Vlll
Summary
Summary

Current definitions of learning disabilities refer

to a set of disorders that affect reading, handwriting, spelling, mathematics, listening, expressive

language, and social skills. By definition, learning disabilities are not caused by a lack of intelligence, sensory impairment (like deafness), primary emotional disturbance, or environmental,

cultural, or economic disadvantage. This definition thus excludes all commonly accepted impediments to learning except neurological impairment.

The theories, treatments, and investigations of the

learning disabilities field frequently reflect the

exclusionary approach of the definition. Learning disabilities are recognized primarily as schoolrelated problems.

In the last decade, however, a growing number

of experts in the field have come to see learning

disabilities as arising from an interaction of neurophysiological with psychological, educational,

and social factors. The neurophysiological factors

are seen as necessary but perhaps not sufficient

to explain the nature and prevalence of learning

disabilities. Although the precise nature of these

neurophysiological factors is yet elusive, the concept of learning disabilities seems to require a

neurophysiological component as a sine qua non,

setting learning disabilities apart as a group of disorders that merit legislative attention and support.

A systems approach is applied here to learning

disabilities. This approach is a comprehensive

rather than an exclusionary approach. Thus, .3

learning disability is seen not simply as a problem in academic learning but as a particular style

of thought, performance, and expression that can

affect one’s entire life. A learning disability is seen

not as specific to school settings but as involving

the family, the community, the immediate environment, and progressively farther-reaching environments. Rather than being seen as having a single cause, a learning disability is seen as the outcome of a network of forces that include the

neurophysiological, emotional, familial, organizational, political, social, historical, and technological. Options for research and development are

based on this integrative view.

In this case study, both “hard” and “soft” technologies relevant to the learning disabled are discussed. “Hard” technology refers to concrete discoveries and inventions such as facts about the

brain and microcomputers. “Hard” technology is

the what. “Soft” technology refers to how the

technology is used and who uses it. The complex

of legislation, private and public organizations,

programs, theories, and research are all “soft”

technologies. These “soft” inventions provide the

social context for “hard” technologies. This case

study argues that unless this social context is

addressed, the promise that advanced “hard” technology holds for Iearning-handicapped people

might be seriously compromised.
Part One

The Field of Learning Disabilities

“There was something wrong with my brain, What had previously been a shadow of suspicion that hovered on the edge of consciousness became certain knowledge the year that I was

nine and entered the fourth grade. I seemed to be like other children but I was not like them:

I could not learn to read or spell. Throughout my childhood and youth the nature of my disorder remained mysterious. . . When I was twenty-two it was diagnosed. . . . I was dyslexic. ”

—Ellen Simpson, psychotherapist and poet, in her Autobiography} Reversals

“Having made a strenuous effort to understand the symbols he could make nothing of, he

[Gustave Flaubert] wept giant tears. . . For a long time he could not understand the elementary

connection that made of two letters one syllable, of several syllables a word. ”

—Caroline Commanville in Souvenirs ln times describing the French novelist Gustave Flaubert

“I remember vividly the pain and mortification I felt as a boy of eight, when I was assigned

to read a short passage of scripture at a community vesper service during summer vacation in

Maine– and did a thoroughly miserable job of it. ”

—Nelson Rockefeller in TV Guide, October 16, I976

“I missed [my nurse] terribly. Every day I wrote her—a short, badly written ill-spelled note:

writing and spelling were always terribly difficult for me. . . . I was always recognized, though

quite kindly, as the “slow one” of the family. . . . It was quite true, and I knew it and accepted it. ”

—Agatha Christie in An Autobiography

“For years I had hidden from parents, sisters, teachers, friends, even my husband, the fact

that I can read on] y a few minutes at a time before becoming confused and exhausted. My problems extend beyond the inability to read well. Although I managed to earn a bachelor’s degree

and attend graduate school, I can neither recite the alphabet straight through nor do I know

the multiplication and division tables. . . I have difficulty writing down the simplest note. . . “

—Roa Lynn in Learning Disabilities
Part One

The Field of Learning Disabilities

OVERVIEW OF THE FIELD

A large number of competing theories concerning the nature of learning disabilities has left the

field with no universally accepted definition. The

present legal definition, accepted by most school

practitioners, as stated in the Education for All

Handicapped Children Act of ]975 (Public Law

94-142), rules out all known causes of learning

disorders except neurological impairment. The

historical roots of the field can be found in the

areas of language dysfunction, mental retardation,

and perceptual disorder. Recent estimates state

that between 4 and 20 percent of the U.S. school

age population is learning disabled. Identification

and treatment have traditionally been interdisciplinary.

Definition of “Learning Disabilities”

Despite the lack of a universal definition of

“learning disabilities, ” the definition exists in the

law. In Public Law 94-142, a learning disability

is defined as “a disorder in one or more of the

basic psychological processes involved in understanding or in using language, spoken or written,

which may manifest itself in an imperfect ability

to 1isten, think, speak, read, write, spell or do

mathematical calculations” (167).

Problems of taxonomy and semantics have impeded defining “learning disabilities” a precise,

comprehensive way. In 1968, the National Advisory Committee on Handicapped Children offered

a definition of the term that is now widely used.

This definition significantly influenced the one

that the U.S. Congress used in 1969 in Title VI

of Public Law 91-230 and in Public Law 94-142.

Congress further defined the term to exclude

“children who have learning problems which are

primarily the result of visual, hearing or motor

handicaps, of mental retardation, or of environmental, cultural or economic disadvantage. ” It is

not surprising that this definition was greatly criticized by some in the learning disabilities field,

a field that boasts scores of different professional

and special interest groups.

Whether the Federal definition has helped to

standardize the use of the term is questionable.

mercer r Forgone, and Wolking ( ]37) found that

the definitions of learning disabilities used by 42

State departments of education were not consisten t. Among the terms frequently used interchangeably with “learning disabilities” are the

following: dyslexia, hyperactivity, hyperkinetic

syndrome, brain dysfunction, brain damage, perceptual-motor dysfunction, visual-motor dysfunction, dyscalculia, aphasia, alexia, developmental

learning disability, and others.

The lack of agreement in defining learning disabilities reflects the variety of theories about the

nature, and especial] y about the cause, of such

disabilities. Over the years, the explanation of

learning disabilities in terms of underlying brain

dysfunction has been cautiously replaced with behavioral descriptions. Perhaps defining learning

disabilities is difficult because learning disabilities are not a single disorder but a set of disorders.

This set 01 disorders may or may not have a common origin. All of them, however, interfere with

learning in the nonretarded population.

Two aspects of the present legal definition that

appear problematic are the exclusionary structure

of the definition and what is called the “discrepancy ” formulation. The definition of learning disabilities as not one of a number of other known

impediments to learning ( 125) has been criticized

( 174, 17.5). The definition of learning disabilities

as discrepancies between actual school performance and intellectual potential (19) has also been

criticized (174, 177).

Thus, the definition of learning disabilities in

Public Law 94-142 is far from definitive or universally accepted. Whether such disabilities are essentially behavioral or physiological is a question not

addressed by the legislation. The definition in
8 ● Health Technology Case Study 25: Technology and Learning Disabilities

Public Law 94-142 functions primarily as legal

groundwork for demanding appropriate schooling

for learning-handicapped individuals.

History of the Field: Theories, Terms,

and Treatments

“Learning disabilities” is a relatively new term.

Coined by Samuel Kirk in 1963, the term has

come to function as a label for individuals of normal intelligence, physical intactness, emotional

health, adequate instruction, and sufficient motivation who are somehow unable to master basic

skills related to school success. Discovery of the

learning-disabled population began in the late 19th

and early 20th centuries with studies of adults with

documented brain injuries who had speech and

language difficulties. In the first half of the 20th

century, related literature appeared in the areas

of vision abnormalities, hyperactivity, postencephalitic behavior, and perceptual abnormalities

of children with cerebral palsy. Parallel to this,

researchers began differentiating among the formerly uncategorized group of “retarded” students.

From efforts at differentiating among the retarded

came remedial programs for the learning disabled.

Early Observations of Language

and Reading Disorders

Although the term “learning disabilities” is not

even two decades old, related phenomena have

been observed since the late 1800’s. The earliest

record of what is now characterized as a learning

or reading disorder can be found in the literature

on aphasia in adults. Autopsies of adults who suffered the sudden loss of speech and capability to

attach meaning to written symbols revealed lesions in these persons left hemispheres.

According to British neurologist MacDonald

Critchley, the term “word blindness” was introduced by Kussmaul in 1887 to describe the loss

of reading ability. The term “dyslexia” was introduced 10 years later (25) and became that used

by the medical community to refer to neurologically based reading disorders.

In 1885, the Scottish ophthalmologist Hinshelwood reported cases of visual memory disorders

and word blindness in adults. One year later a

case was reported of a 14-year-old boy in Britain

with “congenital word blindness, ” described by

his schoolmaster as “the smartest lad in school if

instruction were entirely oral” (141).

Interest in the causes of reading disorders in individuals of normal intelligence grew in the first

quarter of the 20th century. Some, including

Fisher (7o), proposed that the neuropathological

lesions found in the brains of aphasic adults could

account for “congenital reading disorders. ” For

others, such as Pipert writing in 1924 (53), the

underlying psychological disorders were functional neuromaturational delays rather than anatomical abnormalities.

In the 1930’s, Samuel Orton developed a theory

that was to become highly influential in shaping

the field. Orton (153) proposed that certain reading difficulties were the outcome of the incomplete dominance of one hemisphere of the brain

over the other. His theories were based on the observations of children with learning difficulties

who wrote or read written symbols in a backwards manner. His term “strephosymbolia, ”

meaning “twisted symbols, ” referred to the misperceptions of written symbols. Ann Gillingham

(84), a student of Orton, based a remedial system

on his neurological theories. Although Orton’s

theories still remain to be definitively proved or

disproved, Gillingham’s teaching system has been

successful in a large number of cases, at least

according to anecdotal evidence from practitioners.

Gillingham’s application of neurological theories to education was among the first of such attempts in the field. As in later efforts, the links

between the theory and the treatment were tenuous. It is quite common in the learning disabilities field for a certain treatment to work with a

given child without practitioners’ knowing why.

Is the successful treatment “proof” that the neurological theory is correct? Or, has the child improved because of other unrecognized factors?

These questions, difficult to answer in any field

of treatment, have been met with few outcome

studies in the field of learning disabilities.

An interest in the role of vision in learning disorders developed in the early part of the 20th century. Over the years, an extensive literature has
Part One: The Field of Learning Disabilities ● 9

suggested that problems of vision do not play a

primary role in learning disabilities (65,153). In

the last two decades, a substantial literature has

developed on binocularity and its association to

learning disabilities. Eye problems appear to exacerbate existent learning difficulties as well as

complicate the process of compensating for them

(213).

Early Observations of Hyperactivity

G. F. Still, an English pediatrician, observed

two different groups of hyperactive children, One

group was described as being hyperactive because

of “defects in moral control, ” the other Still

presumed to have brain damage or brain lesions

(195).

The connection between behavioral abnormalities and cerebral damage was given further support by clinical studies in 1918 of individuals who

had survived the major epidemic of von Economo’s encephalitis. These adults showed hyperactivity, distractibility and attention disorders, irritability, and impulsivity. In 1911, a group of

children who had also survived the epidemic had

also been found to have similar symptoms (123).

Kurt Goldstein’s studies of World War I soldiers

who had survived serious head injuries gave additional support to the hypothesized connection between hyperactive behavior and brain dysfunction. These men showed perseverative behavior,

perceptual confusions, and significant disorganization (89,90).

In 1937, Benzedrine@ was reported to have a

positive effect on the behavior of emotionally disturbed children in a residential treatment center

(30). Their interest in school work increased, their

work habits improved, and their disruptive behavior declined. This early report of drug treatment did not have great influence. At that time,

it was the custom to dismiss seriously disruptive

students rather than to medicate them. It was not

until the 1960’s, when medical journals reported

the effects of stimulant drugs on hyperactive children, that such treatment became widespread in

this country.

Observations of Learning and Behavior

Disorders in the 1940’s and 1950’s

In the early 20th century, much of the theorizing about brain-behavior relationships was based

on autopsies and on the behavior of individuals

with well-documented cerebral injuries. It is interesting to note that theories about the handicap called “learning disabilities” were not based

on such concrete, empirical evidence. Brain damage or dysfunction was characteristically inferred

in those with learning disabilities because of their

behavioral similarities to those with documented

brain insults or because no other known impediment to learning could be invoked. Gesell and

Amatruda (81) were among the first to postulate

the existence of brain lesions that couldn’t be

documented. In 1951, Lilienfeld and Parkhurst

wrote of significant, but undocumented, brain injury in early life that could result in learning or

behavior disorders. In the 1970’s, some of the relevant literature implied that early brain damage

might explain certain behavior and learning problems, A more comprehensive explanation was also

advanced about the interaction between biologically vulnerable constitutions and social-environmental factors (176,179,207).

General Trends in the Study

of Child Development: Behaviorism,

Psychoanalysis, and Piaget

In 1928, John Watson wrote that, as far as

human development was concerned, “there is

nothing from within to develop. ” This statement

was typical of the original behaviorist stand,

which portrayed the child as passively molded by

the environment. This extreme stand on the lack

of inborn predispositions contents with the contributions of psychoanalytic literature. Beginning

in the 1920’s, psychoanalytic writings emphasized

not neurological constitution but rather the impact of emotional conflict on the ability to learn

information and on the ability to separate from

the parent to go to school (74,97,159).

Both psychodynamic thinking and behaviorism

influenced the pediatricians of the day (126).

Pediatric textbooks and journals tended to give
10 . Health Technology case Study 25:: Technology and Learning Disabilities

far more weight to social-environmental and emotional factors as causes of learning disorders than

did the literature of education. For example, in

1954, Nelson’s Textbook of Pediatrics portrayed

the breakdown of causes for reading problems as

75 percent personality disturbances, 10 percent

poor instruction, 2 to 3 percent neurogenic causes,

and the remainder a mixture of causes.

The concept of abnormality, of course, is

derived from the concept of what is normal. The

Swiss epistemologist Jean Piaget had an immeasurable impact on what educators and psychologists considered normal in the conceptual development of children. Piaget wrote that the way

children acquire knowledge evolves systematically

in predictable stages. His ideas of conceptual development in children have been met in this country with growing enthusiasm since the early

1960’s. Despite the stern and elegant disclaimers

from Piaget himself that his theories are not intended as the basis for either teaching programs

or assessment plans, special education practitioners joined practitioners in regular education

in diagnosing and planning for children in accordance with Piaget’s observations and theory of normative development.

The Study of Mental Retardation as Ancestor

to the Learning Disabilities Field

Until the 1960’s, the education of mentally retarded people was almost synonymous with the

term “special education. ” The number of mentally

retarded children identified and treated between

the 1920’s and the 1970’s grew rapidly. Similar

growth has been seen in the identification and

treatment of the learning disabled between the

1960’s and the present. Furthermore, concern for

the learning disabled and other handicapped

learners has, at least for the present, far surpassed

concern for the mentally retarded. Sarason (181)

states that “In the case of Public Law 94-142, the

problems in our schools that seemed to need correction did not primarily center around mental

retardation. ” Sarason suggests that it is not that

legislators and the public are not concerned with

the mentally retarded, “but rather in the process

of implementing the law, schools would tend to

give greater attention to other kinds of children. ”

Thus, the concept of being a special education

student while not being mentally retarded, blind,

or deaf is not even two decades old. “Learning

disabilities” were of course never considered by

Binet and Simon when they began in the early

1900’s to develop an instrument to differentiate

between children who were “poorly motivated”

and “mentally retarded” or “inadequately taught. ”

Distinguishing the various degrees and types of

mental retardation was at that time far from sophisticated. In addressing the National Education

Association in 1910, Henry Goddard stated that

the “subnormal” population could be divided into

two groups: the “temporarily subnormal whose

backwardness is due to sickness, physical impairment or unfavorable environment” and the “permanently” subnormal whose development was

arrested before the age of 3 (86).

The Professional Evaluation of Learning

Disabilities as Rooted in Complex Kinds

of “Brain Damage”

It was not until the important work of Werner

and Strauss in the 1930’s and 1940’s that a more

systematic analysis of the learning strengths and

weaknesses of “backward” children was offered.

Werner and Strauss (208) studied a group of adults

of normal intelligence with head traumas, who

were earlier studied by Kurt Goldstein, and found

that common patterns of behavior were frequently

correlated to histories indicating brain injury.

Thus, they introduced the category of “braininjured children. ” Strauss and Lehtinen (196) speculated that “organic impairment, ” from brain injury or disease before, during, or after birth,

caused disturbances in “perception, thinking or

emotional behavior. ” The study of learning disabilities in the United States is often traced to this

publication. The suggestions of Strauss and Lehtinen for classroom instruction, based on the analysis of learning strengths and weaknesses, greatly influenced the field of special education. .

The work of Werner and Strauss was further

developed by Dolphin and William Cruikshank

in the 1950’s. Cruikshank attempted to apply their

findings to children with normal intelligence and

to children with cerebral palsy. In these populations Cruikshank also found evidence of percep-
Part One The Field of l.earning Disabilities ● 11

tual, conceptual, and visual-motor abnormalities

(61 ). Educational strategies for the “brain-injured

child” were further modified. This work was important in establishing the idea of learning disabilities as a problem in learning that can be modified by systematic diagnosis and teaching. The

impairment was thus judged “exogenous, ” one not

owing to an inherited pattern or to genetically

determined features of the brain but rather to injury or disease occurring outside the genetic structure (125).

Remediation Models Based on Theories

of Neurological Impairment

The predominant models of remediation in the

field have been based on theories of neurological

impairment. In the 1960’s, Kephart (110) introduced the “perceptual motor theory, ” Getman (83)

the “visuomotor theory, ” and Barsch (18) the

“movigenic theory. ” All were concerned with

what is called “perceptual-motor” and “sensorymotor” development.

In the 1960’s and 1970’s, Ayres developed the

“sensory integrative therapy, ” which suggested

that higher cortical tasks, such as reading, may

be impeded by dysfunctions or incomplete development in the lower brain. The therapy consists

of stimulating the lower brain by spinning, rubbing, swinging, and making other movements

(12,13).

In the 1960’s, Frostig developed systematic

methods of diagnosis and remediation of visualperceptual skills (75,76) as one part of a comprehensive psychoeducational approach.

Yet another kind of remediation takes a language approach. Among the more important leaders in this part of the field are deHirsch (55,56),

Myklebust (107,144), and Kirk (114). Kirk has

particular historical importance: he coined the

term “learning disabilities” in a speech to a group

of parents whose children had been labeled “perceptually impaired, ” “hyperkinetic, ” and “brain

injured. ” Kirk introduced the term in April 1963,

and by February of the following year the group

of parents he had addressed went on to organize

the Association for Children with Learning Disabilities (ACLD). Kirk also developed the Illinois

Test of Psycholinguistic Abilities (ITPA), one of

the most widely used instruments to diagnose

learning disabilities in the 1970’s.

Controversial Treatments

No treatment in the field has been met with universal acceptance. Those that have inspired the

greatest controversy have tended to be those involving the medical community. Doman and Delacato (57,62) developed a “patterning” theory of

neurological development. The corresponding

treatment, widely publicized in its early days as

a sort of miracle cure, was designed to enhance

normal neurological development in the brain injured, the mentally retarded, and the reading disabled. Certain motor activities were prescribed

to remediate neurological organization and thereby to prevent or cure learning disorders. The lack

of supportive research for this treatment and the

questionable neurological theory behind it drew

harsh criticism from the American Academy of

Pediatrics (5) and the American Academy of

Cerebral Palsy (4).

The controversy over the use of drugs for hyperactivity that took place in the 1960’s was

followed by more controversy in the 1970’s, this

time over Feingold’s association of hyperactivity

with food additives (69). The Feingold approach

concerning food additives was adopted by many

parents, who thought that learning disabilities and

hyperactivity were synonymous. Although the

populations overlap, not all hyperactive children

are learning-disabled and not all learning-disabled

children are hyperactive.

Theories of Remediation:

Compensation or Cure?

In a field where no intervention has proved effective for all children, yet where dramatic cures

are not infrequently reported in the mass media,

outcome studies are particularly important to objectively choose among many treatments. One of

the most important issues concerning remediation

is whether learning disabilities are conditions that

can only be compensated for or whether they are

conditions that can actually be cured. Those who

argue that they can be cured, such as Ayres or

Delacato, frequently advocate some form of motor therapy. Those who argue that they can only
12 Health Technology case Study 25: Technology and Learning Disabilities

be compensated for believe that intervention

should focus on the development of basic skills,

learning styles, and cognitive abilities related to

academic success. Rather than attempting to

modify underlying neurological weaknesses, the

latter approach attempts to organize learning

strengths to compensate for learning weaknesses.

Most practitioners adopt this approach, believing that learning disabilities can be effectively

ameliorated but net “cured. ” There are many parents who, quite understandably, hope that they

can be “cured. ” Future research may clarify the

issue.

Prevalence of Learning Disabilities

Methodological problems characterize surveys

of the incidence of learning disabilities in this

country. Recent estimates state that between 4 and

20 percent of the school population is learning

disabled. Initial studies indicate an extremely high

number of juvenile delinquents are learning disabled. Clinical experience as well as recent genetic research indicated a strong genetic component

in learning disabilities. Although the prevalence

is far higher in males, the disorder does not appear to be specific to race or socioeconomic class.

High prevalence has been correlated to use of prenatal drugs and to living in urban areas.

Estimates of the prevalence of learning disabilities in the United States vary widely. This variation is not surprising, given the lack of consensus in the field aboutcmt the nature of learning disabilities. The lack of agreement of course makes

identification and sampling problematic. Most

estimates of the prevalence of learning disabilities

fall between 3 and 15 percent, although some go

as high as 35 percent of the school age population (130).

Among formulators of public policy, learning

disorders are often referred to as “high-incidence/

low-severity” handicaps of children (126). Such

disorders have been estimated to occur in 4 to 20

percent of the school age population. Learning disorders occur in males far more often than in females, Some say that the ratio of males to females

is 6 and (or) 8 to 1 (139), others that the occurrence in males is 3 to 10 times that in females (40).

Learning disorders are contrasted to “lowincidence/high-severity” handicaps, which include

multiple or major handicapping conditions like

blindness, mental retardation, and severe hearing impairment (126).

Learning Disabilities and Juvenile

Delinquency

A 1976 report of the Office of Juvenile Justice

and Delinquency Prevention recommended that

vigorous incidence studies be conducted to clarify

the connection between learning disabilities and

juvenile delinquency. By 1978, studies to be conducted by the Law Enforcement Assistance Administration were proposed in Phoenix, Baltimore, and Indianapolis. Grants for this research

were awarded to Creighton University in Omaha

and to ACLD,

In 1977, the U.S. General Accounting Office

commissioned a survey of juvenile delinquents in

Connecticut and Virginia and found that 26 percent of those delinquents had “primary learning

disorders” or learning disabilities. The report concluded that the figures supported results in Colorado (where 90 percent of adjudicated delinquents were found to have learning disabilities)

and in Rhode Island (where 70 percent were)

(130).

Hypotheses About the Epidemiology

of Learning Disabilities

Learning disabilities tend to cluster in families.

It is not uncommon, for example, to uncover visual-motor difficulties in three generations of a

given family. Diagnosticians specialized in learning disabilities routinely ask if there is a history

of learning difficulties in the family. Anecdotal

reports by clinicians indicate that the parents of

learning-disabled children receiving remediation

“turn themselves in” to receive help in reading or

writing along with their children.

Medical World News recently reported that individuals with dyslexia appear to have some abnormality of genes on chromosome 15. This study

by geneticists at the University of Miami corroborated a 1979 report of abnormal cell structures

in the language function areas of dyslexics (77).
Part One: The Field of Learning Disabilities ● 13

Studies of families and twins have not yet exploited the recent advances in chromosome analysls.

Some postulate that the increasing incidence of

learning disabilities can be attributed in part to

the drugs administered to pregnant women. A

Collaborative Perinatal Project has found evidence suggesting that commonly used obstetric

medications may have long-lasting, harmful effects on children born to medicated mothers. This

study of 50,000 children was overseen by the National Institutes of Health in the 1950’s, The

behavior and attention span of the children of

medicated mothers were affected until the children

were 7 years of age. The children who appeared

to have pronounced defects in the areas of cognitive function and gross motor ability were born

to mothers who had received the largest doses of

the strongest drugs, Particularly dangerous effects

were attributed to inhalant anesthetics (116).

Learning disabilities may be more common in

children of low socioeconomic status, perhaps because of poor nutrition, birth trauma, or poor perinatal health care. It may be that learning disabilities are culturally transmitted: certain learned

skills may serve well only in nonacademic areas.

Another possible explanation of learning disabilities is that subtle abnormalities of brain functioning, which may never result in learning difficulties in children with supportive environments,

block learning in children with stress-ridden lives.

The reports of famous—and sometimes quite

wealthy—people who realize that they were dyslexic children are now familiar to all of us. Among

these people are Nelson Rockefeller (and other

members of his family), W. B. Yeats, and Gustave

Flaubert. Reversals (190) is the autobiography of

a woman poet who is dyslexic. Such accounts contribute to the understanding that dyslexia or learning disabilities can occur in individuals of talent,

intelligence, and privilege,

Prevalence of Reading Disabilities

in Other Countries

One of the most highly respected studies of

reading disabilities was conducted in Britain in

1975. It compared children in London and on the

Isle of Wight (24). This study, found that the incidence of such disabilities was higher in males,

by a ratio of 3.5 to 1. It also found a higher incidence in urban areas. Specific reading retardation

occurred in about 10 percent of London schoolboys and in only 4 percent of schoolboys on the

rural Isle of Wight. The investigators concluded

that the study supports the belief that reading disabilities are determined to an appreciable extent

by environmental factors.

Despite methodological problems, studies of the

prevalence of reading disabilities in several European countries are quite consistent. In Canada,

France, Denmark, and Britain, estimates of reading disabilities are about 8 percent (183).

Characteristics of Learning= Disabled

Individuals

Characteristic of the learning disabled most often mentioned in the literature include the following: 1) inability to sustain attention, 2) low self-

-esteem, and 3) low academic performance. Perceptual deficit is the characteristic most commonly

mentioned by practitioners. Although the perceptual deficit hypothesis has been repeatedly challenged over the years, it remains a widespread notion underlying both diagnostic and remedial

work,

It is generally agreed that learning-handicapped

people appear to be healthy individuals with average or higher intelligence. Learning-disabled individuals are not identifiable by clear-cut neurological signs like paralysis, tissue pathology, or

abnormal blood chemistry. Rather, such individuals are characterized by difficulties in performing certain learned tasks involving reading, speaking, listening, writing, calculating, spatial orientation, or task performance. Learning disabilities

have been associated with signs suggestive of

neurological dysfunction: clumsiness, abnormal

distractibility, and increased frequency of seizure

disorders. The connection of these “suggestive

signs” to underlying organic disorders is poorly

understood (130,174).

Learning disabilities encompass many characteristics, no single one of which is found in all

identified individuals. Such disabilities are recognized as problems in performance, attitude, and

behavior, It has been said that if 100 children with
14 ● Health Technology Case Study 25: Technology and Learning Disabilities

learning disabilities were tested, 30 to 40 different

profiles might result. Learning disabilities can take

many forms, for such disabilities relate to receiving, processing, and producing information (189).

A growing number of researchers in the field

state that the one characteristic common to the

learning-disabled population is difficulty in focusing and maintaining attention (163, 174). Learning disabilities have been associated with certain

emotional attributes. Low self-esteem, for example, is commonly observed by practitioners and

described in the literature. Dyslexic children from

families who have some understanding of the disorder seem to have higher self-esteem than dyslexic children from uninformed families (173). Immaturity and emotional problems are also common in the learning-disabled population. A recent

survey has indicated that only 4 percent of the

children referred for treatment of learning disabilities displayed average or better emotional

adjustment (88, 163). Significant differences have

been found in the effectiveness of communication

in families with disabled learners (160).

Perceptual deficit is perhaps the characteristic

of the learning disabled most frequently mentioned by practitioners. Research conducted over

the past 10 years, however, has challenged this

characterization. The predominant instructional

model in special education, which is based on the

idea of perceptual deficit, is “differential diagnosis/prescriptive teaching” (11 ). The assumptions

of this model have been criticized, the test instruments for measuring perceptual attributes have

been shown unreliable and invalid in many cases

(11,47), and the relation between perceptual skills

and academic achievement has been found to be

tenuous (94).

Other characteristics cited in the literature include problems in motor coordination (12), irregular eye movements (64,82), short memory (204),

certain cognitive processes (72), and linguistic impairment (149,201,209).

Identification of Learning Disabilities

The most common method of identifying learning disabilities in school settings has been interdisciplinary, but has relied on some of the assumptions and language of medicine. The medical model has been recently challenged. The regulations

for the Education to All Handicapped Children

Act of 1975 state that a multidisciplinary team

must evaluate a child suspected of a specific learning disability.

The Interdisciplinary Model

Most Used in School Settings

The most common method of identifying learning disabilities in school settings has been interdisciplinary, involving professionals from education, psychology, speech, and language. Despite

this fact, until recently the model itself has relied

on the assumptions and language of the disease

model of medicine (52). Professionals from medicine, psychology, and education have recently

suggested that a departure should be made from

this model. They proposed to analyze learning

strengths and weaknesses and the supportive features of settings and to modify any medical jargon

used when communicating across interdisciplinary

lines or with parents (126).

The regulations of the Education for All Handicapped Children Act of 1975 (Public Law 94-142)

state that a multidisciplinary team must evaluate

a child suspected of having a specific learning

disability. The team should include these members: 1) the child’s regular teacher, 2) at least one

person other than the child’s regular teacher who

is qualified to conduct diagnostic examinations

of children, and 3) one person other than the regular teacher to observe the child’s academic performance in the regular classroom. The regulations specify that identification of learning disabilities should be based on whether children show

a severe discrepancy between their achievement

and their ability. The report of the evaluation is

also supposed to mention any environmental, cultural, or economic disadvantage.

The Concept of “Dysfunction”

Rather Than Disease

Levine, et al. (126), recently proposed that

learning disabilities be considered “a clinical phenomenon in which performance is impaired on

the basis of characteristics that do not fit the traditional model of organic or emotional factors. ”

Rather, the individual is thought to have devel-
-— —

oped a particular learning style that is maladaptive to a particular educational setting.

The Process of Identification

In the school setting, the sequence of events

leading to the evaluation of a student for learning disabilities is usually the following:

1.

2.

3.

4.

5.

The

the student is not performing as expected in

one or more areas of school learning;

the low academic performance continues and

does not seem to respond to the teaching provided in the classroom;

possible causes for the academic problem

(primary emotional disturbance, physical

disability, sensory impairment such as poor

vision or hearing, mental retardation, economic or cultural disadvantage) are evaluated and eliminated;

a specialist (e. g., a school psychologist or

learning disabilities specialist) conducts diagnostic tests using standardized measures

of general intelligence and cognitive abilities

required for academic work; and

if the child is identified as learning disabled,

a remediation strategy is prescribed.

Utility of the Neurological

Examination

There is widespread misunderstanding about

the function of the neurological exam in action.

Professionals, parents, and school personnel commonly believe that this examination provides a

definitive diagnosis. Actually, no single medical

sign or symptom is a reliable diagnostic sign for

learning disabilities. Even the use of sophisticated

medical procedures like the electroencephalogram

and the dichotic listening exam cannot deliver a

definitive diagnosis. The neurological examination may clarify the status of an individual suspected of having learning disabilities, but it cannot definitively answer whether the observed

problem in learning is “organic” or “functional .“

The routine neurological exam can uncover abnormalities of the central nervous system. In most

cases, however, it reveals no precise pathology.

The examination for “suggestive signs” or minor

neurological dysfunctions may indicate developmental delays (126). The relationship of these

Part One: The Field ot Learning Disabilities ● 15

————

signs to learning disabilities, however, has still not

been established. Very few children referred for

evaluation of learning disabilities are actually

neurologically examined.

Standardized Tests, Informal Testing,

and Observations

The assessment process usually includes an informal classroom observation of the student, an

interview with the parents, and administering tests

for hearing and vision and those for general intelligence such as the Stanford-Binet Intelligence

Test or the Wechsler Intelligence Scale for Children (WISC-R). If the student scores below 80 on

an intelligence test, academic difficulties may be

attributed to mental retardation. Usually students

are not identified as learning disabled if their IQ

scores are outside the normal range (8).

Diagnostic testing is usually believed to determine the precise area of difficulty along with patterns of cognitive strengths and weaknesses. The

reading process is broken into underlying components by such commonly used tests as the

Spache Diagnostic Reading Scales (193) and the

Gates McKillop Reading Diagnostic Test (79).

During the 1970’s, the Illinois Test of Psycholinguistic Abilities (115) was commonly used to

assess underlying linguistic skills.

Recently, alternatives to standardized testing

have been proposed, e.g., the daily monitoring

of classroom work (140). Interviews with parents

are commonly regarded as useful for learning

about the student’s school and developmental

history.

The Legislative Mandate To Identify

Children With Handicaps

Profound changes in identification procedures

began with the passage of Public Law 94-142.

Public Law 94-142 specifies that States applying

for grants cannot identify over 12 percent of all

children (between ages 5 to 17) in the State as

handicapped, It is not yet clear how realistic this

ceiling is and whether it might increase or diminish

the number of handicapped children identified.

The regulations specify that all children with

handicaps are entitled to an interdisciplinary
16 ● Health Technology Case Study 25: Technology and Learning Disabilities

evaluation. An independent evaluation or second

opinion may be obtained. Parents must be notified

and involved in the evaluation process. There are

provisions for identification programs for individuals from 3 to 21, except where State law limits

the maximum age to 18. All testing is supposed

to be nondiscriminatory of the individual’s linguistic or cultural background and must be administered in the child’s native tongue. There is

often disagreement, however, over what constitutes “nondiscriminatory” testing.

Evaluation has always been an expensive process and is also a labor-intensive one. Specialists

must be paid not only to evaluate the individual

but also to meet with each other. These costs must

now be borne by the local education districts.

Physicians and other health professionals have

been wary of the effect of Public Law 94-142. The

law does not specify the inclusion of physicians

on the interdisciplinary teams, but instead leaves

it up to local education agencies to seek medical

assistance if they desire. Health professionals are

apparently concerned that the law does not assign

a central role to the medical aspect of identification. There is also the concern that physicians will

be called on by parents and schools for definitive

diagnoses that they cannot provide through diagnostic tools of adequate precision and predictive

value. Satisfactory communication between medicine and education is assumed by the law, which

provides no guidelines or support for such communication.

School personnel are also concerned about the

lack of role definition. A number of articles, written with thinly disguised disciplinary chauvinism,

decry either the underuse or the overlapping functions of school professionals. Reading specialists

and learning disabilities specialists have been

noted to show territorial conflicts (95). Other concerns of school personnel include the demands

made on them to evaluate children and write reports rather than to actually teach. Some see the

interdisciplinary identification process as one taking funds that might instead be used for teacher

salaries or educational materials (130).

Thus, the time and effort spent to comply with

Public Law 94-142 may compete with functioning in accordance with the highest professional

standards. Furthermore, it may lead school professionals to be increasingly concerned with job

boundaries rather than with providing excellent

service.

Early Identification of Learning Disabilities

(in Children 2 to 6 Years of Age)

The recent increase in use of screening tests for

learning disabilities has been attributed to the

legislative mandate to identify children with handicaps, the biomedical research on “high-risk”

children, the government-supported programs for

young children, and the increasing concern over

children’s failure in school (180). Because young

children have had limited or no exposure to reading or writing, the identification of those with

learning disabilities is quite problematic.

Some of the more commonly used early screening tests are the Anton Brenner Developmental

Gestalt Test of School Readiness, the Boehm Test

of Basic Concepts, the Denver Developmental

Screening Test, and the Jansky Screening Index.

The potential for misuse of these and other early

screening tests has been noted. Rather than being used as tools for systematic observation, they

are frequently used to isolate disabilities erroneously, to define IQs falsely, and to assign

diagnostic labels. In addition, these screening tests

have been described as having limited value in

training professionals. The use of these tests has

been said to be no substitute for the observations

of experienced, sensitive teachers who are routinely able to identify children at risk (180). A vast

number of early screening tests in local schools

are observational tools developed by teachers.

Intervention

Intervention on the part of the public schools

was profoundly changed with the passage of Public Law 94-142, which determined that all handicapped children were legally entitled to a “free appropriate” education. Private schools and clinics

also serve learning-disabled individuals, sometimes with tuition support from the public school

districts. The adult learning disabled are just now

being identified in appreciable numbers. State/

Federal Vocational Rehabilitation as well as the

community and junior college system are exist-
———

ing publicly funded structures that serve the learning-disabled adult.

Intervention by the Public Schools

by Legislative Mandate

With the passage of Public Law 94-142, responsibility for treatment was shifted from the private

to the public sector. In the 8 years since the passage of the bill, public schools across the country have developed a range of programs to identify and treat learning-disabled children. Previously, private clinics and private remedial teachers

had provided the lion’s share of treatment. Much

of this treatment could only be had by the wellto-do.

Public Law 94-142 mandates that the best educational setting for the handicapped is one “least

restrictive. ” The law’s concern about integrating

the handicapped into the “mainstream” of school

life (although the word “mainstream” is not used

in the legislation itself) can be understood in the

context of a history of litigation for the rights of

the mentally retarded. Landmark cases established

that a lack of financial resources is not a sufficient reason for a school district or agency to deny

a handicapped individual a “free appropriate education” (The Pennsylvania Association for Retarded Children v. Pennsylvania; Mills v. Board

of Education).

In theory, integrating handicapped children

with other groups provides them with the quality of life that is inherent in taking part rather than

living in relative isolation. In school situations,

such integration would consist of the children

spending as much time as possible in the regular

classroom without sacrificing the fulfillment of

any social or educational need.

An individualized education program (IEP) is

required for all children identified as in need of

special education. Public Law 94-142 stipulates

that the basic requirements of the IEP are statements of plans for the following: 1) assessment,

2) goals and objectives of the child’s education,

and 3) evaluation and review procedures. The IEP

process is designed to facilitate communication

between parents and school personnel so that they

cooperatively design the child’s program. The

law’s delineation of due process provides means

Part One: The Field of Learning Disabilities ● 17

for resolving any differences concerning the child’s

needs. Parents have the right to request a hearing.

The written IEP also serves as a commitment

of the resources necessary for the handicapped

child to benefit from special education and related

services. The IEP is to serve also as a “management tool . . . to ensure special education and

related services, ” a “compliance, ’monitoring document” for Public Law 94-142, and an “evaluation

device” (68).

Private Schools

Although small private schools, unless especially designed for the special education population,

at first turned away learning-disabled children,

they have now emerged as an alternative to public

schools for these children (3). The number of private special education schools for learning-disabled children has increased. Paradoxically, the

need for the alternative of private education was

expressed by parents with increased urgency after

the passage of the law for handicapped children.

The turn to private schooling for children with

learning disabilities has not yet been extensively

studied, but may be explained either by the dissatisfaction of parents with the quality of instruction in mainstreamed classrooms compared to that

in special education classrooms or by the legal

stipulation that school districts must pay for

private schooling if the parents and school personnel have agreed that the school district cannot provide an “appropriate” education.

Some school districts now pay the tuition for

learning-disabled children at private schools. The

law has perhaps been beneficial for the private

sector although it was designed to increase the effectiveness of the public sector. In the last 2 or

3 years, however, the reduction of Federal and

State funds to schools has meant less financial support for the private sector to serve the learning

disabled.

Learning-Disabled Adults

Learning-disabled adults are offered very few

government-supported interventions. Recommendations to ameliorate this situation have recently been submitted by the Task Force on Learning

Disabilities, based in the Rehabilitation Services

IF, — 1 , — .< ‘, — .;
18 ● Health Technology Case Study 25: Technology and Learning Disabilities

—.- . . . —- — — —

Administration (168). The purpose of the Rehabilitation Services Administration 1980 task force

is to reexamine issues associated with the learning disabled in terms of program eligibility, diagnostic procedures, and the provision of rehabilitation services by the State/Federal Vocational Rehabilitation program.

The task force found a wide range of policies

and practices for the learning disabled in different

State vocational rehabilitation programs. Until recently, to qualify [or vocational rehabilitation

services an individual had to provide evidence that

his or her learning disability had a physiological

cause. Since 1980, however, learning disabilities

have been considered a “specific developmental

disorder” in the Diagnostic and Statistical Manual

of Mental Disorders (DSM III). Thus, a learningdisabled individual meets eligibility requirements

by having a “medically recognizable physical or

mental disability” (168).

The task force also reported that, although no

well-developed literature describes the vocational

implications of learning disabilities, there appears

to be a considerable amount of practical wisdom

about the topic among vocational rehabilitation

practitioners who have worked with the learningdisabled adult population. The task force reported

that large numbers of potentially eligible citizens

HARD AND SOFT TECHNOLOGIES

OF LEARNING DISABILITIES

The technology of brain and biochemical research has seen considerable development in the

last decade, particularly with regard to localizing brain function.

The most important recent development in soft

technology is legislation for the handicapped. The

delivery of services promised in the new legislation is problematic. Financial problems are reported by school districts attempting to meet compliance regulations.

are not receiving vocational rehabilitation services.

Community and Junior Colleges

The adult identified as learning disabled is relatively new for those in the field of postsecondary education. The demand for college instruction for learning-disabled adults has stimulated

a reevaluation of programs and services in all aspects of postsecondary education (155).

The system of junior and community colleges

has been described as an educational structure

highly appropriate for the learning-disabled adult,

offering counseling and guidance as well as

coursework (130).

Although there are few special postsecondary

programs for learning-disabled adults across the

country (5o), the California community colleges

seem to provide an exception. A recent survey of

these 106 community colleges found that 75 percent operate formal programs for learning-disabled adult students. In addition, another 12 percent provide informal services for such students.

Under the label of LDA (learning-disabled average), these students can pursue an Associate of

Arts degree, a vocational certificate, or training.

These educational programs are free to California residents (155).

Hard Technologies*

The technologies of brain research and biochemical research have developed fast in the last

decade and have present suggestive findings about

the possible physiological bases of learning dis-

*The use of computers and electronics has greatly increased in

the field’s research and remediation since this report was written

in 1981. The journal of Learning Disabilities, beginning with the

june/july issue in 1982, is an excellent source of information about

computers and learning disabilities.
—

—

abilities. Biochemical studies, such as those on environmental contaminants, the effects of drugs

and food additives on hyperactivity, and the effects of massive doses of vitamins have also been

reported recently in the literature. The use of computers has been proposed for gathering data on

brain function in “neurometrics, ” for storage and

retrieval of educational and clinical data in treatment settings, and for teaching systems. The technology of intervention includes microcomputer

programs especially designed for the learning

styles and needs of the learning-disabled student.

Hand-held calculators are now available to consumers, as well as data-processing systems, which

could supplement learning disabilities programs.

Electronic technology presents the potential of

providing different auditory and visual information. It may even someday replace written symbols as a means of communication.

Neurophysiological Research

Identification and treatment of learning disabilities has traditionally been based on neurophysiological research. This research focuses on

how the brain processes information. A number

of hypotheses based on neurophysiological research have been advanced; none are universally accepted. Geschwind (80) has observed that

only within the last 25 years have the problems

of neurophysiological research begun to be clarified and that researchers have begun to realize that

a definitive delineation of the issues is still not in

sight.

As indicated above, one longstanding explanation of learning disabilities, put forth by Orton

(153), is abnormal cerebral dominance or asymmetry of the cerebral hemispheres. Testing this

hypothesis has become possible only in the last

13 or 14 years with the development of a number

of experimental techniques. Using visual, auditory, or tactile stimulation, researchers have attempted to uncover the connection between reading and the hemispheres of the brain (112,212).

The results of these studies, however, have shown

no systematic differences between normal readers

and dyslexics in terms of hemispheric functioning—both groups appear to use the left hemisphere for reading. The differences between normal readers and dyslexics might lie in the way the

right hemisphere is coordinated with the left in

reading. In dyslexic individuals, reading and other

verbal tasks involve the left hemisphere; in normal readers, the same is true. Reading also involves spatial skills, however, which in normal

individuals are associated with the right hemisphere, but which in dyslexics may be associated

with both hemispheres. In a dyslexic person, the

involvement of both hemispheres in processing

spatial information may interfere with the left

hemisphere’s processing of verbal information.

That is, the problem may be one of coordination

rather than of location of brain function (211 ).

Differences in hemispheric functioning might

also be associated with gender. Witelson (212)

suggests that the right hemispheres of girls are

specialized for specific functions considerably later

than are those of boys. This suggests that the

brains of girls may remain more flexible in the

functions they can perform. Thus, “language functions may transfer more readily to the right hemisphere in females than in males following early

damage to the left hemisphere. ”

The idea that each human behavior originates

in a specific area of the brain, called “localization

of cerebral functioning, ” is an idea older than

Plato. One of its proponents in the 19th century

was the French surgeon Broca. He observed that

a number of his patients had exhibited speech defects following injury to or disease in the left

hemisphere, more specifically, after injuries to the

area above and in front of the left ear (130).

Wada much later developed a technique for localizing brain function that has been used extensively by the researcher Milner. Amobarbital ”,

a fast-acting anesthetic, is injected into one of the

carotid arteries to disable certain parts of the

brain. Milner (138) found that most people,

whether left or right handed, could speak when

the right side of the brain is anesthetized. However, 7 pm-cent of his right-handed subjects and
20 ● Health Technology Case Study 25: Technology and Learning Disabilities

—

13 percent of his left-handed subjects could not.

A small percentage of the subjects (1 percent of

those right handed and 10 percent of those left

handed) could speak with either half of the brain

anesthetized.

“Neurometrics,” a new research methodology

for the organization of data on brain function,

was introduced in ]977. Data from brainwave recordings and sensory-evoked electrical responses

are gathered and analyzed by computer. These

methods yield insights into brain function that are

not apparent from looking at an EEG (electroencephalogram) alone. Neurometrics uses mathematical techniques known as “numerical taxonomy” and requires “a new automated, computer-centered technology” (106). This new technology was used in a research project to discriminate between a group of normal children and

children identified as learning disabled. The researchers concluded the following: “Neurometric

EEG measures not only discriminated between

normal and learning-disabled children better . . , than the psychometric measures, but reflected processes more intimately related to brain

function” (106).

Physiological research in the field also includes

the brain autopsies of diagnosed dyslexics. As

there is great variability in normal brains, the investigation of a large number of dyslexic brains

will be required to achieve significant results.

Witelson and Pallie at McMaster University in

Canada are attempting to obtain the consent of

terminally ill individuals with learning disabilities

to donate their brains for research and to take a

large number of psychometric tests while they are

still alive (130). The Orton Society is planning a

similar project. The society is also attempting to

standardize methocls of brain dissection to expedite the comparison of findings (130). The state

of the art, however, is such that in these autopsies researchers don’t know quite what to look for.

Biochemical Studies

Some investigators have proposed to identify

learning-disabled children by chemical analyses

of their hair (177). Those studied clearly differed

from normal children with regard to the amounts

of lead and cadmium in their hair. This study was

conducted using atomic absorption spectroscopy,

which is quick, inexpensive, and unobtrusive to

the subject,

The behavioral effects of toxic levels of lead

have been documented in scientific journals (37).

There is increasing evidence that even low levels

of lead can have negative effects on children’s

behavior, Hyperactivity in children has been studied as a possible outcome of exposure to toxic levels of lead although methodological questions

have been raised about the control of socioeconomic factors in such studies. This kind of analysis

might lead to early intervention and provide

insights on etiology.

The results of blood tests for monoamine oxidase in dyslexic children are reported to differ

significantly from those of control groups. This

enzyme is critical in the metabolism of dopamine,

norepinephrine, and other monoamine. These

chemical substances perform special roles in the

brain. Some hypothesize that hyperactivity is the

outcome of disrupting the dopamine economy of

the brain (105).

Biochemical Studies of Drug Treatment

for Hyperactivity

Although the physiological or structural basis

of hyperactivity is not agreed on in medical and

scientific circles, several reports in the 1960’s converged on the observation that stimulant drugs

have the “paradoxical” quality of calming many

hyperactive children. In the 1970’s, there was

much controversy about the abuse of these drugs

by physicians and educators.

Opinions about the wisdom or effectiveness of

treating hyperactivity by drugs are in conflict.

Despite the lack of conclusive data, psychostimulant drugs became popular in the 1960’s and

1970’s. Krager and Safer (121) conducted a study

in Baltimore County, Md., in which they found

a 62 percent increase in the use of drugs in public

schools between 1971 and 1973. The corresponding increase in the use of drugs in parochial

schools was 77 percent.

Stimulant drugs have been among the most frequently used and most extensively studied of

pediatric drugs (126). Some research indicates that
hyperactive children respond to such drugs as Ritalins and Tofranil@ with reduced hyperactivity

and distractibility (182). Harmful side effects of

the drugs include nausea, vomiting, insomnia,

bedwetting, abdominal pains, and even psychosis

(38).

The Orthomolecular Approach

Also controversial has been the treatment of

learning disabilities with large doses of vitamin

and mineral supplements along with improving

the child’s diet. Cott (51) reports that this “orthomolecular” intervention has helped more than 50

percent of hyperactive children in his practice.

Cott reports that Vitamin B6 has been used effectively to improve sleep patterns of learning-disabled children, while large doses of Vitamin Bb

have a calming effect. An agent called “cupramine” is prescribed to counteract the effects of toxins like lead in the body.

Despite Linus Pauling’s support of orthomolecular therapy in the late 1960’s (158), the medical

community has far from accepted megavitamin

treatment, The American Psychiatric Association

in 1973 and the American Academy of Pediatrics

in 1976 made formal statements that such treatment was without sound theoretical or empirical

basis.

Identification Techniques

Swanson and Kinsborne (198) proposed one of

the most controversial means of diagnosing hyperactivity, namely, in light of the child’s response

to stimulant medications. Most professionals have

continued to try to predict which hyperactive

children will respond favorably to stimulant medications (17).

Technologies for Instruction

When a teacher is working with a student individually much flexibility is possible. Programs

can be tailored and spontaneously modified to suit

a child’s learning style. If the present estimates of

the number of learning-disabled children in this

country are even roughly accurate, the cost of

providing individual instruction to these students

would double or triple the present cost of education (130). Schools are increasingly buying microPart One: The FieId of Learning Disabilities ● 21

computers. Computer programs could be designed

to fit a broad range of learning styles and would

thus be appropriate for integrated classrooms.

Despite the growing number of microcomputers

in the schools, appropriate curriculum software

for special education students is not necessarily

available. The software available is frequently

unable to make computers cost effective and instructionally sound.

In addition, the design of the available instructional software that is available is often educationally unsound. If the microcomputer is to fulfill

its potential in the schools, a considerable amount

of time and thought must be devoted to developing educationally valid software (184).

The advantages of microcomputers have been

described recently in a leading learning disabilities

journal (184):

1.

2.

3.

4.

5.

6.

Microcomputers are “user friendly” and can

talk with the student—actually calling the

student by name. Learning is less threatening to the extent that the computer doesn’t

chastise the learner for incorrect responses.

The learner has the computer’s undivided attention; it is not necessary to wait long periods to respond or be responded to.

The student with learning differences may

work more slowly and the computer can

wait indefinitely.

Computers can provide immediate feedback

and frequent praise, appropriate for the

learning-disabled student, who often has an

injured sense of self-esteem.

Drill and practice—perhaps more necessary

for learning-disabled students than others—

can become exciting with the use of animation, sound effects, and games.

Programs are available that enhance thinking skills. Software like “LOGO” can simulate real-life situations, involving students in

the decisions and consequences of problemsolving.

Programs that provide multisensory instruction

(requiring the student to see, to listen, and to

move) have been judged a particularly effective

use of the microcomputer. Video tapes, video

disks, and voice synthesizers can further enhance

multisensory teaching. Video tape recorders pro-
22 ● Health Technology Case Study 25: Technology and Learning Disabilities

vide the opportunity for frame-by-frame editing

of written work. Graphics tablets and equipment

like “Versa Writer”@ make it possible for the student to write as well as type into the computer

(184).

Calculator devices that give instant feedback

in spelling and mathematics are now available to

consumers. Texas Instruments has recently developed Speak and Spell@, a teaching calculator that

boasts some features of larger, computer-based

systems. A recorded voice asks for the spelling

of a word, The user “keys” in the spelling, which

appears on an illuminated display. The recorded

voice then says whether the spelling is correct. An

incorrect spelling is met with the word correctly

spelled out on the display as the voice correctly

pronounces it. This device might be particularly

valuable for those who have visual-motor difficulties and who find writing words laborious and

confusing.

The “Talking Books” program for the blind and

physically disabled is part of the Library of Congress and supported with Federal funds. Learningdisabled individuals who want to qualify as program users must furnish evidence of being physically disabled. This requirement is met by providing a letter from a physician affirming neurological impairment. Frank Clyke, Chief of the

Division for the Blind and the Physically Handicapped of the Library of Congress, states that

learning-disabled individuals are neither aware of

this requirement nor able to meet it. Advertising

the program to the learning-disabled population,

then, according to Clyke, is like “waving a red

flag” (130).

Technologies for Evaluation and Research

Data-processing systems are now being developed to support service systems for the learning

disabled. In San Diego, an interdisciplinary learning disabilities diagnostic clinic has begun to feed

clinical information to computers (2). The system,

described as inexpensive, simple, and efficient,

would make cross-sectional and longitudinal studies of treatment outcomes possible,

Helmer Myklebust, one of the founders of the

learning disabilities field, has suggested a computer-based evaluation system for special education.

An evaluation center would conduct experimental studies in learning to determine the effects of

various handicaps. Data collected with a battery

of educational and psychological tests would be

fed into an average-sized computer. The computer

would provide researchers with sufficient data to

observe significant relationships (111). Computerized technology would allow the evaluation of

remedial programs. Weekly and monthly evaluation of children’s progress would also be facilitated.

Computer-controlled physiological and psychological measures of brain responses while an individual performs learning tasks make it possible to isolate certain cognitive processes. Such

tests of visual-perceptual and symbolic processes

have already been used with electroencephalographic measurements (106).

Using Technologies Originally Designed

for Other Handicaps

Braille has been suggested as a technology that

severe dyslexics can use (135), as have other materials originally designed for the physically handicapped. Sign language has been suggested for

those with language disabilities. Other potentially

useful technologies from different fields include

video, biofeedback, computer simulation studies,

and industrial arts curricula.

Periodicals on Educational Computing

Journals on computer use in the schools are few

despite the explosion of periodicals on all types

of computer expertise and interest. The following periodicals treat educational computing:

Classroom Computer News, Closing the Gap, The

Computing Teacher, Electronic Learning, Educational Technology, and Turtle News.

Soft Technologies

The most important recent contribution to soft

technology in the learning disabilities field was

the passage of Public Law 94-142. The cornerstone

of the law is the individualized educational plan

(IEP), which requires that the school and parents

agree on a program for any children identified as

special education students. The IEP procedures
Part One: The Field of Learning Disabilities ● 23

———.—

also include due process delineations. Placement

in the “least restrictive environment, ” the legal

mandate to integrate handicapped with nonhandicapped students, has met with the criticism that

is supported neither by theory nor by facts.

Others see it as a reasonable alternative to small

classes with special education personnel.

The History of Legislation

Pubic Law 94-142, the history-making legislation for handicapped children passed by the 94th

Congress, can be seen as part of a social movement to guarantee for handicapped people those

opportunities accorded nonhandicapped citizens.

The movement began to gather force in the 1950’s

and 1960’s, as the silent sibling of the far more

dramatic, widely publicized civil rights movement. Both movements pressured for integration

into the mainstream of American life.

In 1950, the National Association for Retarded

Children was established. It was the first of a

number of parent action groups. In 1958, the idea

that mentally retarded children have the right to

be placed in the best available educational environment was presented in a debate sponsored

by the National Education Association. This view

was echoed by the International League of Societies for the Mentally Handicapped. A number

of court cases in the 1970’s established education

for the handicapped as a civil rights issue: children

could not be discriminated against on the basis

of their handicaps.

The court cases of the 1970’s established the following principles:

1.

2.

3.

4.

every handicapped child, despite the severity

of his or her handicap, had a right to a free

appropriate education;

equal education opportunities must be provided by the schools to handicapped children, meaning that one of the schools’ goals

would be for these children to fulfill their

potential despite any handicap;

to the greatest extent possible, handicapped

children must be educated together with the

nonhandicapped; and

parents, guardians, surrogate caretakers, and

the child must be notified of special education placement with the possibility of influencing that placement (130).

Most of these ideas became part of the Elementary and Secondary Education Amendments, Public Law 93-380. Grants to States were increased

for the purpose of identifying, locating, and evaluating all handicapped children to establish a policy of providing full educational opportunities.

In response to reports that States and local

education agencies were moving slowly and reports from the Bureau of Education for the Handicapped that only 3.9 million out of 8 million

handicapped children were receiving appropriate

education, the Education for All Handicapped

Children Act (Public Law 94-142) was passed in

1975.

central Features of Public Law 94-142

The purpose of Public Law 94-142 was “to establish a comprehensive mechanism which will

insure that those provisions enacted by the 93rd

Congress (Public Law 93-380) are expanded and

will result in the maximum benefits to handicapped children and their families. ”

The cornerstone of Public Law 94-142 is the individualized education plan (IEP) (see the earlier

section Intervention). According to Federal regulations, beginning on October 1, 1977, and at “the

beginning of each school year thereafter, each

public agency shall have in effect an Individualized Education Plan for each handicapped child

who is receiving special education from that agency” (68). The IEP document serves as a written

record of the decisions concerning the child’s

educational program, reached jointly by parents

and school personnel at the IEP meeting. If agreement over the IEP is not reached, the parents or

the agency may initiate a hearing. The content

of an IEP meeting includes statements regarding

the following:

1.

2.

3.

4.

5.

In

the child’s present educational status;

educational goals for the child;

special education and related services the

child requires (transportation, speech therapy, medical and counseling services, recreation) and the child’s extent of involvement

in reguIar education programs;

projected dates for initiating services; and

evaluation criteria,

order for the handicapped child to participate

in regular education programs, the IEP must spec-
24 ● Health Technology Case Study 25: Technology and Learning Disabilities

—

ify any modifications the child requires in regular

educational settings. If the public agency cannot

offer the child appropriate education, it must finance the child’s education in a private setting.

The program in the private setting shall be developed in accordance with an IEP developed by

the public agency.

What may not always be understood by school

personnel, particularly teachers, is that the IEP

is not a performance contract; the agency neither

defaults nor fulfills a contract depending on the

failure or success of the child.

If the estimate of the Bureau of Education for

the Handicapped that there are 8 million children

with handicapping conditions (between birth and

age 21) is even roughly accurate, thousands of

thousands of IEPs ‘will be written for any given

school year and the writing will involve several

professionals for each handicapped child.

The mandate for the “least restrictive environment” in Public Law 94-142 is in practice considered “mainstreaming. ” Handicapped children

are placed in regular classrooms along with nonhandicapped children. Some special education

students spend part of the day in special classes

and part in regular classes, depending on the subjects taught and what the child needs as specified

by the IEP. “Resource rooms” are provided with

special education personnel and curricula for

handicapped children. The severity of the handicap greatly determines what amount of time the

child will spend in a special program and what

amount in the regular classroom. The wealth of

special education classes, services, and regulations

developed to implement Public Law 94-142 have

closely followed the design of Deno’s (58) “cascade. ” The intent of this model is to provide flexibility in the services for exceptional students.

Some argue that there are neither theoretical

nor empirical reasons to believe that mainstreaming helps handicapped children learn more (145).

Others see mainstreaming as the alternative to

labeling and consequent social isolation and lowered self-esteem. It is also frequently less expensive to teach children in standard classrooms than

in special education settings.

Implementing Public Law 94-142

Local school districts are pressed for sufficien

funds to meet the requirements of the new law

Paradoxically, school districts feel the financia

strain of remaining compliant, which means that

the costs of receiving Federal funds are high—perhaps too high.

In October 1980, Federal agencies began to

cooperate to avoid duplication of efforts in implementing and enforcing of the law. The Office

of Special Education and Rehabilitative Services

and the Office of Civil Rights agreed to share data

and duties relating to enforcement and investigation. The two agencies also monitor implementing the regulations of Section 504 of the 1973

Rehabilitation Act. A decision was also made to

publish notices in the Federal Register, notifying

the public of policy interpretations and upcoming policy statements. For example, in January

1981, extensive clarification of the IEP was published. This basic explanation of what is considered to be landmark legislation comes many years

after its passage (68).

CURRENT ISSUES IN THE FIELD OF LEARNING DISABILITIES

Problems of definition, identification, and treatment are in part rooted in the social movement

toward integrating services for handicapped people with the nonhandicapped. This social movement has not awaited on scientific evidence about

the cause of learning; disabilities, for the development of valid identification instruments, nor for

a well-developed set of outcome studies on the

effectiveness of the most commonly used treatments. Research in learning disabilities is characterized as lacking agreed-on methods of defining

its subject and subject population. It is also

described as lacking scientific rigor.

Labeling, apparently required to provide appropriate services for the learning-disabled population, has been criticized for resulting in social

isolation and emotional wounds. Alternatives to
labeling include noncategorical teacher education

and special education programs. These alternatives have been criticized as resulting in programs

unable to meet the range of students’ needs in special education.

Issues of Definition

The current definition of learning disabilities

assumes that learning-disabled individuals are of

normal intelligence and have adequate educational

and social backgrounds. This definition may reflect social pressure rather than scientific fact.

There is still no definitive scientific evidence that

learning disabilities are biological disorders. The

method identifying them is based on the purported

discrepancy between present performance and

“potential. ” IQ tests, the most common method

of measuring potential, have been judged as invalid for the learning-disabled population.

The Lack of Agreement About the Nature

of Learning Disabilities

As discussed above, a major point of disagreement is the question of whether learning disabilities are physiologically based. Since by definition

learning disabilities are problems in learning not

attributable to any other well-known impediment

to learning (lack of intelligence or proper education, an impoverished environment, physical

impairment, or serious emotional disturbance),

many reason that such disabilities are likely to

have a physiological basis. Many experts in the

field see learning disabilities as based in the interaction of several factors, some that have “neurological” implications and others that do not.

Such factors include experience with schools and

teaching approaches, the expectations of others,

and learning style.

Learning-disabled individuals are regarded as

normal in many respects although they perform

surprisingly poorly on certain learned tasks like

reading, writing, math calculations, speaking, or

listening. These are frequently taken as indications

of some sort of irregularity in brain function, complicated to varying degrees by psychosocial factors. Some literature indicates, however, that

learning-disabled people have deficits more pervasive than difficulties in school-related tasks.

Kronick (122) has argued that difficulties in social

development are not uncommon in such persons.

The Lack of Scientific Evidence for a PhysioIogical

Basis of Learning Disabilities

The definition of learning disabilities, then, may

be interpreted to imply that they result from some

sort of organic brain problem. The lack of scientific evidence for this interpretation is discussed

in the literature (174,175). Although there is a

growing body of neurophysiological research on

brain functioning, it has not yet yielded definitive

evidence that learning disabilities represent dysfunctions of the brain.

Debate over the definition of learning disabilities has centered on just this point: What is the

cause (or causes) of such disabilities? What sort

of handicaps are they? Can individuals with such

disabilities be cured or must they simply learn to

accommodate? Is “learning disability” merely a

label invented by our social system (93)? At one

extreme, Mann (132) stated that such characteristics of learning disabilities as “process deficits, ”

“visual-auditory configurations, ” and “visualspatial disorders” are not really characteristics of

the brain but rather “make-believe fantasy. ”

Without definitive scientific ev-idence to support the claim of brain dysfunction, specialists in

the field have understandably been criticized for

passing off myth as science (124,186). In answer

to the criticism of ambiguities and contradictions

of the field, there have been rejoinders for greater

clarity (152). Methods and philosophies of identification have been marked for criticism: Are identified children actually learning disabled or are

they simply casualties of the educational system,

or both? Or are there two separate groups of

learning-disabled individuals—one neurologically

impaired and the other not?

The Legal Definition of Learning Disabilities:

Scientific Fact or Social Consensus?

With the passing of Public Law 91-230, title VI,

part G, in 1969, Congress legally recognized a

handicap whose nature and cause are in contention. The study of learning disabilities has been

described as a field having “more momentum than

direction” (130). Thus, at that time it fell to the
Bureau of Education for the Handicapped to establish criteria for identifying learning-disabled

children. The purpose of constructing a definition

was to establish a criterion for State and local

education agencies to identify learning-disabled

individuals and to develop programs for them.

Frank King, a psychologist in the Office of

Special Education and Rehabilitative Services who

had a central role in authoring the procedures,

has described the process as a frustrating effort

to reach consensus: the definition called for providing “information that was beyond science at

this stage” (130). The legal definition, then, might

be said to be a better reflection of social than of

scientific fact. Louise Bates Ames of the Gesell Institute has said that “the term learning disabilities

caught on and swept the country before we had

really reached a satisfactory definition of what it

meant, and certainly before we knew what to do

about it!”

Even those who wrote the definition have been

described as not expecting that children with

learning disabilities could actually be identified

or diagnosed on the basis of Public Law 94-142

alone. The definition, after all, was recognized for

what it was—a definition of a condition in terms

of what the condition is not (130).

The Issue of Assuming Normal Intelligence

Before the the term “learning disabilities” was

coined in the 1960’s, an inability to learn in school

was most often seen as mental retardation, cultural disadvantage, emotional disturbance, physical impairment, blindness, or deafness. The particular contribution of the concept of a learning

disability was the recognition that some people

were unable to learn although they had normal

intelligence, health, adequate education, sufficient

motivation, and normal participation in the cultural mainstream.

general population (91). A survey of 3,000 children diagnosed as learning disabled corroborates

this finding (113). This second study found that

the median IQ of the surveyed population was

93 (90 to 110 is average) and 35 percent had IQ

scores under 90.

The Issue of the Discrepancy

Between Potential and Achievement

Some in the field have proposed a functional

definition of learning disability. Bateman (19) has

stated that a learning disability is defined by a

large discrepancy between what a child has

achieved and what the child is capable of achieving. In the early grades, a lag of 6 months in

academic performance is considered a notable

discrepancy, while in grades three and higher, a

notable discrepancy would consist of 1 1/2 years

(35).

It is far more problematic to determine what

a child is capable of than to measure what the

child has already done. Usually, the child’s “potential” is measured by intelligence tests. These

tests, however, are not without their problems.

The very skills required to score well on many

subsections of intelligence tests are those often affected by a learning disability. Thus, the individual’s score on such tests may be just another indicator of a learning disability rather than a valid

measure of “potential. ”

Questions about the validity of IQ tests are not

uncommon in the field. Performance is quite variable for children who might be affected by stress,

the nature of the testing setting, or the tester’s personality (134). For the most part, intelligence tests

correlate very well with school achievement. They

have been questioned as predictors of school

achievement for those with learning disabilities

(35,103).

Intelligence tests were applied to identify this The Issue of Assuming That Environmental

population, with the exception that those with Disadvantage Is Not the Problem

learning disabilities would score within the nor- The legal definition of a learning disability is mal range. considered to ensure that children provided servThere is evidence, however, that although the

.

ices for the handicapped have a disorder most likeIQ scores of children labeled as learning disabled Iy attributable to a subtle organic dysfunction

by their school districts are not in the retarded rather than to an inadequate environment. To

range, a good number are below the mean of the make this distinction in practice, however, is
——

problematic. Do children with environmental

learning problems actually look different from

those with learning disabilities?

There appears to be no definitive research

indicating different neurological or behavioral

mechanisms in middle and lower class retarded

readers. One study has indicated that similar patterns of performance are seen in middle and lower

class children with reading problems (27).

Blank (28) points out that excluding “environmental disadvantage” as a possible reason for a

learning disorder excludes a large group of retarded readers. Children from poor socioeconomic backgrounds, he states, are the largest single

group of retarded readers in this country. Poor

children who are poor readers are not necessarily learning disabled. On the other hand, children

from low socioeconomic backgrounds might be

more “at risk” for neurological damage and, once

i t occurs, less able to compensate for it.

A not infrequent observation among school

practitioners is that most of the children in classes

for the “mentally retarded” are from lower socioeconomic groups and most of the children in

learning disabilities classes are from middle and

upper socioeconomic groups.

Issues of Identification

The standardized testing instruments used to

identify learning-disabled individuals have been

criticized as invalid by researchers. Some practitioners ignore the results of this research and continue to use these instruments. These tests assume

the existence of underlying abilities that are prerequisites for academic success, but the existence

of these abilities is questionable. Performance on

these tests doesn’t consistently correlate with

school performance. Public Law 94-142 does not

delineate job roles relating to identification procedures in educational agencies.

Issues About the Instruments That Identify

Learning Disabilities

Some of the most commonly used tests for

learning disabilities have been criticized for lacking validity (47 ). The Illinois Test of Psycholinguistic Abilities ( 115), once widely respected and

Part One The Field of Learning Disabilities ● 27

— . . . .—

used, has been criticized for poor technical inadequacy as well as for its poor validity (94). Another

commonly used instrument is the Bender VisualMotor Gestalt Test (20), designed to measure the

ability to integrate visual information relating to

the proper hand movement (“motor”) for copying designs. Performance on this test is regarded

as an indication of neurological development (20 ).

A study by Ackerman, Peters, and Dykman ( 1 )

indicates that there is little correlation between

scores on the Bender test and the results of neurological examinations. Some studies report that

the Bender test is a good instrument to identify

reading problems (98, 119), while other studies

have found it to be a poor diagnostic instrument

for academic performance (96,171 ).

The Variation in Operational Definitions

of Learning Disabilities

Most States have adopted the Federal clefinition of a learning disability in Public Law 94-142.

Even so, apparently unimportant variations of the

Federal definition have led to a range of interpretations. Some States, facing financial limitations,

have made an attempt to identify a minimum

number of learning-disabled students by using a

psychometric measurement of the difference between IQ and present school performance. This

approach is similar to that proposed by the

Federal Government (66). Another State has attempted to accomplish the same end by requiring evidence of neurological impairment. Given

decreased Federal and State support for services

for the learning disabled, the vagueness of the Federal definition has led States to adopt procedures

that limit the number of children served (188).

Assumptions Underlying Assessment Procedures

“Differential diagnosis” and “prescriptive teaching” are the predominant models for assessment

and instruction in special education (1 I ). “Differential” refers to discriminating among the possible causes of the learning disorder and to identifying the different learning strengths and weaknesses of the individual. What is purported to be

“diagnosed” are the abilities presumably required

for academic achievement. According to this model, learning problems are the expressions of im-
28 . Health Technology Case Study 25: Technology and Learning Disabilities

pairments in abilities that lie below the surface.

These abilities often are referred to as “psycholinguistic abilities” and “perceptual-motor abilities. ” The existence and measurability of these unseen abilities has been criticized as nothing more

than a presumption (132). The model, however,

is still used despite this criticism (11).

Some Organizational Issues in Assessment

Federal regulations specify that the handicapped

child’s assessment should be carried out by an “interdisciplinary team. ” However, the regulations

do not spell out the role that each profession

should take in assessment and treatment, A recent survey of 114 educators indicates that there

may be some correlation between this lack of job

specificity and job stress (21). The study suggested

that two significant predictors of job stress were

lack of role clarity and a discrepancy between the

professionals’ own views of their roles and the

views of others about those roles. Diagnostic tasks

requiring the cooperation of professionals from

different disciplines were cited as particularly

stressful.

The responsibility for evaluating children with

learning problems often falls to specialists rather

than to classroom teachers. It has been suggested

that those who are assessing and planning for the

handicapped child are not necessarily those who

know the child best (202).

The procedure delineated by the law presupposes that the specialists administering the tests

are familiar with the remedial options available

to the child. The law seems to assume open communication among departments and disciplines.

The lack of communication between specialists

is often cited as a problem in the literature. This

point is particularly important given the mandate

for interdisciplinary evaluations. It has been noted

that school psycholcjgists tend to see their jobs as

finished when the testing results are written up.

It is not always possible for the outside specialists

to see that testing results are consistently applied

if at all (114).

It is not surprising that decision making in identification procedures has been characterized as inconsistent (199). With regard to administrative

questions as well there appears to be a lack of

agreement about the procedures of assessment as

well as the uses of testing

Issues of Treatment

results (164),

With the increased accountability of schools as

delineated by Public Law 94-142, educators feel

pressured to develop new programs. Commercial

companies have flooded the market with educational materials advertised as appropriate for

meeting the law’s requirements. Results of research on the effectiveness of educational, pharmacological, or dietary treatments are far from

definitive. School personnel and parents frequently feel at a loss for any reliable basis on which

to decide treatment plans.

The Pressure for New Programs

School districts are described as investing heavily in new programs without having evidence of

their effectiveness. New assessment and treatment

materials appear on the market daily—publishers

of educational materials have discovered special

education is a lucrative market. Feeling the pressure of increased accountability, schools may well

be vulnerable to commercial advertising (47).

There is pressure within the field of education

to deal with the staggering financial, psychological, and social costs of school failures. The cost

of retaining children because of school failure is

nearly $2 billion per year. The cost increases when

one considers the well-established relationship between illiteracy and delinquency, imprisonment,

and unemployment. In this country, half the unemployed between ages 16 and 21 are illiterate

(109).

Large heterogeneous groups of children working at different instructional levels within the same

room, taught by one teacher, are often thought

to require “individualized” programed materials.

The demand for programs designed to instruct

highly heterogeneous classrooms has understandably increased in recent years.
The Lack of Satisfactory Studies of Treatments

for Learning Disabilities

Treatment strategies are frequently based on

theories of what might cause learning disabilities.

Because neither the theories nor the treatments

have been sufficiently substantiated, efforts continue in the field to conduct methodologically rigorous outcome studies of a range of interventions.

Hallahan and Cruikshank (92) reviewed several

dozen studies of perceptual-motor training and

found that nearly all were methodologically unsound. Two methodological problems common

to all outcome studies in this field are their lack

of control for the so-called “Hawthorne effect”

and their inconsistent and incomplete definitions

of their experimental subjects. The Hawthorne effect refers to a phenomenon commonly observed

in research: any new treatment can lead to improved performance independent of the treatment

itself because of the special attention provided the

subjects, With regard to defining the learning-disabled population, some studies consider those students 2 years behind their classmates as learning

disabled, while others use students who happen

to be assigned to learning-disabled classes by their

school districts. Thus, what might be shown in

one study may not apply to another group of socalled learning-disabled students, and the usefulness of the research is compromised.

Outcome Studies of Dietary Treatments

for Learning Disabilities

Benjamin Feingold, a California physician,

states that 50 percent of the hyperactive children

he treated responded positively to a diet devoid

of artificial flavorings and colorings (69). Naturally occurring salicylates were also excluded from

the diet. Decrease in both hyperactivity and impulsivity were the reported outcomes of the diet.

In the same year that Feingo]d’s results were reported, the Nutrition Foundation, supported by

commercial food companies in the United States,

established a National Advisory Committee on

Hyperkinesis and Food Additives. The Committee found that Feingold’s work was not sufficiently

supported by empirical evidence (147).

A recent study of the Feingold diet (49), however, was judged methodologically sound. This

Part One: The Field of learning disabilities ● 29

——.—.— .

study found that between 5 and 10 percent of the

subjects became more hyperactive after the addition of food colorings to their food.

Some Issues Concerning Drug Treatments

Reported problems of treating learning and

school-related difficulties with drugs are the following:

1. these difficulties do not justify the drug’s use;

2. the drugs have short-term side effects, such

3

as nausea, vomiting, insomnia, bed wetting,

abdominal pains, and psychosis; and

the drugs may have long-term effects, such

as changes in growth rate and heart functioning (38).

Evidence for the effectiveness of Ritalin’L’ and

similar drugs is far from definitive, yet some estimate that up to 600,000 children (mostly boys

from kindergarten through eighth grade) are now

receiving medication for “hyperactivity. ” Such

estimates go as high as 20 percent of the school

age population (39).

Teachers are often expected to monitor medications, but are not given sufficient information

about drugs’ effects (102). A recent survey of 82

teachers indicates that, although on the average

at least one student in every class takes medications, only 36 percent of classroom teachers know

of any school policy either condoning or prohibiting the administration or taking of drugs (143).

This study also reported that the system for monitoring medications was too loose and that there

was not enough communication between teachers

and physicians.

Issues Concerning Sensory Integrative Therapy

Sensory integrative therapy is a system of assessment and treatment used by occupational

therapists for learning-handicapped children. The

theory, based on neuroanatomical and neurophysiological concepts, holds that learning disabilities are caused by disorders of the vestibular

system, which is the part of the brain controlling

balance, posture, and consciously controlled

movements.

A physician recently wrote to the Journal of

Learning Disabilities protesting the prescription
30 ● Health Technology case study 25: Technology and learning Disabilities

— — ——————-— —

of sensory integrative therapy by occupational

therapists (124). The treatment, described as expensive and time-consuming, is based on a theory

for which there is no “valid, convincing proof. ”

After running an extensive literature search, the

physician reported that there is little evidence to

show that this type of treatment has directly

helped learning disabled-individuals. He found existing research methodologically unsound, supported only anecclotally.

Issues Concerning Remedial Education Therapies

Remedial education therapies treat learning disabilities more straightforwardly than do therapies

that attempt to address presumed underlying

causes. Remediation attempts to modify the learning behavior itself. Children are taught basic academic skills, often with attention to their individual learning styles. Like other treatment methods,

remedial ones seem to be evaluated little by sound

outcome studies.

Pihl (163) reports that evaluation of remedial

strategies has been “pessimistic. ” In the long run,

retarded readers tend to remain retarded readers.

John Richards, director of the Kaiser-Permanente

Learning Disability Clinic in San Diego states that

it is not uncommon to find children of 11 or 12

who have received high-quality educational intervention and remediation and who have not made

significant improvement (170). These children,

Richards states, tend to come from families who

have histories of learning problems. After a period

of remediation, many children tend to reach a

point beyond which they don’t progress; in junior

high school, they are still reading at the level of

third or fourth grade. Richards describes reading

as “not an efficient and effective way for them

to get information. ” Both Pihl (163) and Richards

(170) criticize the schools for organizing all learning around reading, Children who are unable to

read are often intelligent, capable people who

learn at an average or higher rate in other areas

of their lives.

Issues of Research

Common criticisms of research in the field are

that learning disabilities are inconsistently defined

and that different measures are used in studies.

This strongly suggests that the central purpose of

the research—to generalize the findings to larger

numbers of people—is seriously compromised.

One of the most commonly cited problems of

research in the field is the lack of a satisfactory

definition, and more specifically, the lack of agreement about the characteristics of individuals with

learning disabilities. How is the population to be

defined? If researchers identify learning-disabled

subjects in an arbitrary manner, how can the

results be generalized?

Criteria for selecting subjects differ widely. A

review of research in the field over the last 3 years

indicates that 50 percent of the studies used the

criterion of discrepancy between “expected grade

level” achievement and actual achievement (200).

Actual achievement was defined narrowly as reading level. In 9 percent of the studies, psychological

rather than academic tests were used to identify

the learning disabled. A good percentage of the

studies used samples of “learning-disabled” children who were not identified as learning disabled

by their school systems.

The same review of the research found that over

50 percent of the research surveyed had used experimental measures or tests that had not been

employed in previous research. This finding

strongly suggests that a central problem of the

studies would be to establish the validity of their

measuring instruments. Only 2 studies in 10, however, addressed the question of the validity of the

measures they used.

Labeling

Arguments in favor of labeling point out its necessity for the delivery of appropriate services and

its function of educating the public about policies

for an underserved population. Attempts to address the well-documented social and emotional

costs of labeling include noncategorical special

education programs in educational agencies and

noncategorical special education training for

teachers.

Social and Emotional Responses to Labeling

There is, of course, a good reason for labeling:

to ensure that educational organizations provide
—.

children with appropriate services. Public organizations are often compensated on the basis of

how many handicapped individuals have been

identified or labeled. Labeling and providing services, at least in public agencies, go hand in hand

(174). Some have commented that labeling has the

positive effect of bringing to the public’s attention a problem that should be addressed by public

policies (78, 117).

Labeling has been extensively criticized. One

two-volume classic delineates the dangers inherent

in any classification or labeling system (101).

Others claim that labeling offers no solutions and

obscures important distinctions (180). The person labeled “learning disabled” tends to be perceived by others as more like the retarded person

than “normal” people. In addition, the person

tends to be seen as having weaknesses in moral

standards and personality (192).

Some studies have found that the label is sufficient to produce negative evaluations from

teachers (73 ). Other studies contradict this claim,

finding that labels are little used by teachers, who

actually rely instead on their cumulative evaluations of children over long periods of time

(46, 169).

The social use of labeling and the social response to it are unresolved issues. Those educational systems trying to operate without labeling

find themselves facing the risks of inappropriate

placements and teaching strategies.

Attempted Alternatives to Labeling

In response to the social outcry against labeling, many State and local educational agencies

have established guidelines to provide noncategorical services, that is, to describe the manner

in which the child learns rather than to stigmatize the child with the name of the presumed cause

of the learning problem.

In 1972, the Bureau of Education of the Handicapped changed the categories used in funding

university teacher training from those of training

in “mental retardation, “ “emotional disturbance, ”

etc., to “noncategorical” grants. In response, universities were pressured to make the shift from

that instruction focused on specific handicapping

Part One: The Field of Learning Disabilities ● 31

.—.—. . —

conditions to general educational strategies for all

problems in learning, whatever their nature or

cause may be. Recent legislation, such as California’s Master Plan, has moved toward replacing

specialists in particular handicaps with special

education generalists called “resource specialists. ”

Distinguishing students according to deficit areas

has been described as encouraging a sterile, fragmented view (180). The social reaction against the

isolation and stigma associated with labeling can

be seen as an argument both for more heterogeneous special education classrooms and more heterogeneous regular classrooms.

Some say that noncategorical special education

is doomed to fail. Special education teachers find

themselves with only cursory knowledge when

confronted with the medical, social, and psychological complexities of many different handicapping conditions. Furthermore, “while lip service

is being given to individualized programing and

evaluating the strengths and weaknesses of each

child, that child may in fact be grouped in such

a way as to negate teaching to his known attributes” (127).

Retrospective life histories of adults who have

experienced learning problems in school suggest

that children feel the stigma of being different even

without a label (190,194). The experience of failure, the belief in other students’ disdain, or the

realization that parents and teachers are disappointed seem to have far more debilitating effects

than the label itself.

Some Issues in Implementing

Public Law 94-142

State noncompliance with Public Law 94-142

has included using inadequate methods to monitor

programs in private and public educational agencies, Interest groups for learning-disabled people

have pressured for additional legislative insurance

for proper compliance. Mainstreaming has been

challenged by learning disabilities researchers as

social and political invention rather than wellfounded educational intervention.

The passage of Public Law 94-142 was an important event in a period when increasing funds

were devoted to compensatory education. Imple-
32 . Health Technology/ Case study 25: Technology and Learning Disabilities

— . —— —.—

menting the law however, has been problematic.

The Federal Office of Special Education informed

the California Department of Education in late

1980 that California had failed to comply with

the law by failing to adopt and use a proper method of monitoring agencies, including private

schools. California’s monitoring of supplementary

services like counseling, physical therapy, and occupational therapy was also judged deficient. The

problem of implermentation has been addressed

by additional legislation, In California, regulations for implementing Public Law 94-142 (Senate

bill 1870 and Assembly bill 3075) are now in the

process of draft legislation and public input.

The duplication of effort by agencies and the

lack of communication between agencies and departments have been documented on both the

Federal and State levels. Those personnel in the

schools who deliver services to learning-disabled

children and their parents have been described as

under particular stress. Professional literature advises administrators to attend to the psychological

well-being of their personnel who must implement

the new law (59). Special education personnel in

“resource” rooms and in self-contained classrooms

have been described as experiencing stress directly

related to complying with Public Law 94-142 (21).

Meanwhile, to ensure compliance, legislation

has increased the accountability of school districts.

For example, Senate bill 1870 of California says

that all State provisions to comply with Public

Law 94-142 must be implemented by June 30,

1982. Assembly bill 2286 in California modifies

the use of attorneys by school districts in hearings on issues contested between parents and local

education agencies. An agency is not permitted

to use an attorney to present its case at the hearing unless the parents of the handicapped child

are given written notice. In addition, the parents

are given the option of having an attorney paid

for by the school district,

Learning disabilities interest groups are beginning to organize in opposition to recently proposed “block grant” funding. President Reagan

has also recommended that Public Law 94-142 be

repealed. Another issue of great concern to these

interest groups is the possible reduction of mandated services to those only for the severely handicapped. Such a reduction could eliminate special

services now available to many of the learning

disabled (39).

Mainstreaming

The Education for All Handicapped Children

Act states that each handicapped child should be

educated in the “least restrictive setting. ” States

must ensure that, “to the maximum extent appropriate, handicapped children, including children

in private or public institutions . . . are educated

with children who are not handicapped, and that

special classes, separate schooling, or other removal of handicapped children from the regular

educational environment occurs only when the

nature of severity of the handicap is such that education in regular classes and with the use of supplementary aid and services cannot be achieved

satisfactorily y.”

Mainstreaming is no small challenge, Ideally,

it means nothing less than attempting to set up

an environment for learning that is stimulating,

but not overly so, to provide individual instruction while inspiring cooperation, and to challenge

advanced students while fulfilling the potential of

the average and the handicapped as well. This

seemingly impossible situation is seen as “least

restrictive” simpIy in the sense that the handicapped child would not be restricted to full-day

special education placement.

The rationale of mainstreaming is that the social

and emotional growth and thus the learning potential of handicapped youngsters will be enhanced when they are educated together with

“normal” children. Often, however, this is not the

outcome. The effectiveness of mainstreaming is

unclear (36). Ronnie Gordon, professor of rehabilitative medicine at New York University, in a

recent study of mainstreaming, concluded that

handicapped children are often placed in situations that are more than they can handle. Gordon says that, at best, mainstreaming has increased social contact between handicapped and

normal children and that, at worst, it has deprived

handicapped youngsters the individual attention

they need for intellectual growth (108). A frequently overlooked component of mainstreamed

programs is the evaluation and support of the
Part One: The Field of Learning Disabilities ● 33

handicapped learner’s transfer of skills learned in

the special classroom to use in the “least restrictive setting” (172).

The policy of mainstreaming has been criticized

severely as a “policy mandated for political and

social reasons, without any basis in a scientific

frame of reference or in scientific evidence. Its

primary rationale was expediency, and then later

it became a fad” (145). Cruikshank, one of the

founders of the learning disabilities field and one

of the first to design educational interventions for

learning-disabled people, has said that the least

restrictive placement “will not, in and of itself,

solve a single problem for a single child” (216).

Some Issues Concerning

Learning-Disabled Adults

There are fewer identification and treatment

programs for learning-disabled adults than for

children. Public Law 94-142 only mandates services for individuals up to age 21. Recognizing

learning disabilities in adults is one of the more

recent developments of the field. An extremely

high percentage of adults in prison are said to be

learning disabled. Unemployment in the learningdisabled adult population is very high. Prejudices

interfere with learning-disabled adults getting

hired; their handicaps may make many aspects

of their jobs difficult.

The Identification of Learning

Disabilities in Adults

Because the field of learning disabilities is new

and because less than a decade has passed since

schools were mandated to identify learning-disabled children, it is not surprising that the great

majority of learning-disabled adults have not been

helped. Problems in identifying learning-disabled

adults include the fact that many tests commonly used for children are not designed for use with

adults, and that by adulthood, many aspects of

a handicap may have been obscured by both creativity and intelligence and by problems in social

and emotional development.

Although “symptoms” of learning disabilities

in adulthood are not as clearly identifiable as they

are in childhood, there is general recognition in

the field that learning disabilities are not necessarily a transient problem of development. Acknowledging this point, the President’s Committee on

Employment of the Handicapped entitled its pamphlet on learning-disabled adults “Learning Disability: Not Just a Problem Children Outgrow”

(34).

Learning Disabilities, Unemployment,

and Imprisonment

Unemployment among the learning-disabled

adult population is very high (9). Potential employers, not understanding the nature of the handicap, often turn down learning-disabled adults.

Certain learning disabilities can affect the speed

and quality of performance on certain tasks.

Learning-disabled adults have been known to

work on their own time in order to complete their

jobs (157),

Difficulties in areas other than reading or writing can interfere with job success. Those tasks associated with leaving home and entering into the

mainstream of life—finding an apartment, reading

maps, dialing a telephone, correctly processing

information heard over the phone or seen on television—are experienced by some as insurmountable hurdles (130).

Some estimate that 80 to 90 percent of the current prison population is learning disabled. Recent studies by the General Accounting Office and

the Law Enforcement Assistance Administration

indicate that as many as 32 percent of incarcerated

juvenile delinquents may have learning disabilities

(130),

Treatment for Learning-Disabled Adults

The Education for All Handicapped Children

Act is, exactly as named, one for children. The

law covers learning-disabled individuals only up

to age 21. The Office of Special Education and

Rehabilitative Services recently formed a task

force on learning disabilities and concluded that

learning-disabled adults were eligible for government-supported services. This suggests that the

landmark legislation, the Rehabilitation Act of

1973, would apply to the learning-disabled adult.

Programs for the learning-disabled adult, however, are still rare.
34 ● Health Technology Case Study 25: Technology and Learning Disabilities

—— -- — ——

DIRECTIONS

The issues discussed above suggest various possibilities regarding the use of hard and soft technologies to serve the learning-disabled population.

The possibilities discussed below are based on

the current literature in the field of learning

disabilities. Some are taken directly from this

literature, others are deduced from the current

work of theorists and researchers. None are recommendations. Instead, they are designed to illustrate the range of possible directions in regard

to the use of technologies. All these possibilities,

grouped as those treating either hard or soft technologies, are, of course, informed by the particular nature of learning disabilities.

Most individuals with learning disabilities take

part in the mainstream of public and private life,

looking and acting like others. Many learningdisabled individuals are distinguished only by

their performance on certain tasks. Often they

hide their inabilities for and failures on these tasks.

Their failures also may be misinterpreted as a lack

of motivation. The untutored eye may either see

these individuals as “normal” or not recognize

them as individuals with learning strengths as well

as learning weaknesses.

Paradoxically, only in societies as technologically advanced as that of the United States are

those with learning disabilities identified as handicapped, that is, by development of technologies

like those developed for brain research and psychoeducational assessment.

Hard Technology

Public Law 94-142 specifically mentions the use

of “telecommunications, sensory and other technological aids and devices” as relevant to “instructional materials” for the handicapped. Tape recorders, video tapes, and typewriters are not uncommonly used to) compensate for a range of

learning disabilities. Possibilities for research and

development in hard technology include the following: conducting research in brain functioning

and the biochemical bases of learning disabilities,

establishing a national consultancy for research

on brain functioning and the biochemistry of

learning disorders, developing computers and

other systems for legislation and implementation,

and encouraging groups

the handicapped.

Support Brain Research

Further brain research

its potential contribution

to share technology

could be supported

for

for

to uncovering the physiological, biochemical, and possibly environmental etiologies of learning disabilities. The refinement of brain research techniques could lead to

efficient, valid, and nonintrusive means of prevention and early identification. Brain researchers

might find that learning disabilities are not one

kind of learning disorder but rather a set of them.

The classifying of learning disabilities into more

precise types would in turn clarify definitions for

studies of epidemiology and treatment. Finally,

by specifying the physiological and biochemical

bases of learning disabilities, the way environmental, social, or psychological factors contribute to

learning disabilities might be clarified.

A promising and active area of brain research

in the field is “neurometrics. ” As was discussed

earlier, neurometrics is a new method of gathering and analyzing data on the activity of various

regions of the brain. Connors (49) suggests that

more promising and accurate results might be

found with “evoked potential used to measure differential processing of verbal and non-verbal information.” Rather than simply comparing the recorded brainwaves of learning-disabled subjects

with the records of control subjects—which has

shown no significant difference between the two

groups —all subjects are given verbal or nonverbal tasks while the recording takes place.

Other promising brain research is that attempting to specify the functions and integrative processes of the right and left hemispheres. Investigation of gender differences in brain development

is also important given the estimates that the

learning-disabled population contains anywhere

between 3 to 10 times as many males as females.

Other promising research is that carried out

through autopsies of the brains of those diagnosed

as learning disabled before death. All these research areas are active and worthy of support.
— —

Part One: The Field of Learning Disabilities 35

—

Support Biochemical Research

The possible effects of environmental toxins like

lead and of certain drugs could be the subject of

continued research (see the discussion of biochemical research in Issues of Research above).

Hyperactivity could be further investigated to determine whether it can be decreased in some by

eliminating from their diets food additives and

salicylates. Such investigations could lead to inexpensive, less dangerous treatments.

Pharmacological research might continue despite public objections about drug misuse. Pihl

(163) writes that “one can readily envision daily

use of drugs that affect the transmission of specific

kinds of nerve impulses in localized regions of the

cerebral cortex, counteract junk-food diets and

contaminant laden environments. ”

Develop Computer-Based Teaching Systems

Development of computers for use by schools

and individuals might lead to reduced treatment

costs. Individualized computer programs can be

designed for a range of learning styles and academic levels. Classroom microcomputers could

support the heterogeneous student populations of

mainstreamed educational settings.

Develop Computer-Based Information

Retrieval Systems

Data collected on learning-disabled individuals

could include those on developmental histories,

school histories, histories of intervention, academic progress, learning styles, test results, and

teacher observations. Through the use of computers, learning-disabled students would be able to

change schools, including from public to private

ones, and yet enjoy program continuity.

Develop Technology To Serve

a Range of Learning Styles

Practical wisdom as well as research indicates

that those who have learning disabilities have particular cognitive or perceptual styles. These individuals are frequently intelligent and capable,

but have less flexible ways of learning. Most “normal” children are able to receive information in

classrooms in any manner the teacher happens to

communicate it. Many learning-disabled children

need information presented in a particular way.

For example, a learning-disabled person with

weak visual skills may need information that is

spoken.

Electronics and computer developments in education promise to provide a range of ways to

get information across. Development in these

areas might shortly bring a time when the written symbol is not the sole conveyance of information, and visual learning disorders might then

functionally disappear.

Word processors, electronic typewriters, and

hand-held calculators and computers all have the

potential to provide learning-disabled individuals

with ways of circumventing problems in perception, language, memory, and skills required for

written productions. Development of these technologically advanced methods could be supported.

Establish a National Brain and Biochemical

Research Consultancy

Despite the fact that brain and biochemical research are in their infancies, a number of experienced researchers have made important contributions to these fields. A national consultancy for

all those receiving grants for research from the

government or major foundations in these fields

could lead to standardizing methods of identifying learning-disabled people for research, delineate

areas in need of investigation, and support methodological rigor,

Establish a Data Access System

on Legislation for Handicapped People

A national system of computer-based information on the implementation of legislation for handicapped people could help remedy widespread

confusion and ignorance. A national call-in number could provide access to data.

Establish a Clearinghouse and Data Access System

on Mainstreaming and Individualized

Education Plans (IEPs)

A national system of computer-based information serving school personnel could aid in mainstreaming and in developing IEPs.
36 ● Health Technology Case Study 25: Technology and Learning Disabilities

Pool Technology for Handicapped People

School districts and agencies could receive

grants from the State or Federal Government to

support the sharing of technology for handicapped people.

Soft Technology

Possibilities for soft technology include the

following: developing various support and training systems for the learning disabled, parents,

teachers, and administrators to implement legislation; supporting pilot and outcome studies to support legislative action, supporting the five learning disabilities research institutes; providing incentives for industry to implement affirmative action programs for learning-disabled adults; and

services for the learning-disabled population.

Develop Support Systems for Implementing

Public Law 94-142

Those administering and managing school systems and individual schools could be involved in

continuing programs of information and support

to implement Public Law 94-142, for example, elementary school principals in a given school district

could meet month] y to exchange ideas about implementation as it relates to staff management and

community relations. There is a wealth of information available from community advocacy

groups for the handicapped, Individuals in these

groups have become reliable experts on the law.

(One such group is California’s Bay Area Coalition for the Handicapped [BACH], which conducts workshops on legislation. )

Establish Training Internships

Training internships for students of law, public

policy, public health, and organizational psychology could be offered through the coordination of

local and State educational agencies. Students

could provide information on the law while gaining experience in the area of implementing legislation and related organizational functioning.

Support Pilot Studies on Legislative Action

for Handicapped People

New legislation might be informed better by

pilot studies. For example, small rural school districts could be compared with large ones, perhaps

two of each type, in pilot studies for proposed

legislative programs.

Support Outcome Studies of Legislative Action

for Handicapped People

Outcome studies of how legislation for the

handicapped has been implemented statewide, in

counties, and locally are all essential. The topics

of such studies might include the validity of the

notion of mainstreaming as well as the success in

implementing it. Some preliminary studies have

been done of nine local education agencies in

suburban, rural, and urban settings. The activities

and consequences of implementation were analyzed for themes both common and unique to the

range of settings (63).

Continue Federal Support for the Five Research

Institutes for Learning Disabilities

These institutes, in their sixth year of work,

have been highly productive. Their research has

an educational focus, striving to develop more effective methods for administrators and teachers

to work with learning-disabled children. These

five institutes are located at the following universities: Teachers College, Columbia University;

University of Illinois at Chicago Circle; University of Kansas; University of Minnesota; and University of Virginia.

Survey the Knowledge of Public Law 94-142

Regulations Among School Administrators and

Personnel, Parents, and Learning-Handicapped

Adults

Compliance regulations for local education

agencies could include a program of assessment

of legislative knowledge among school personnel,

parents, and learning-disabled adults. Determining how well the law is known is essential for implementing and using it, Such an assessment could

serve as the basis for inservice programs and

community education. Commercial organizations

could be given tax incentives for supporting such

survey research in their communities. Those conducting the research could provide training opportunities for students of social science research

in local colleges and universities, including for

learning-disabled college students and other learning-disabled adults.
—.

Develop Incentives for Industry To Implement

Affirmative Action Programs Required by

the Rehabilitation Act of 1973 Along With

the 1976 Regulations

Private industry could be encouraged to employ

learning-disabled adults. National organizations

with local affiliates such as the Association for

Children with Learning Disabilities (ACLD) could

be made eligible for grants to educate departments

in industrial training and personnel in employing

the learning-disabled adult. In the great majority

of these cases, employing the learning handicapped does not require any additional hard technology, but only matching the requirements of

a given job to the particular talents of a learningdisabled worker. A “Vocational Kit” on employment information has been made available by

the California Association for Neurologically

Handicapped Children, a local affiliate of ACLD.

ACLD couId be awarded grants to train counselors in vocational rehabilitation to work with

learning-disabled adults.

Develop Support Systems for Special Education

Personnel in the Public Sector

Because special education personnel have been

reported to be under stress specially related to

compliance with Public Law 94-142, support systems could be set up to enhance their work satisfaction and working effectiveness. School administrators, essential in such support systems, could

work with organizational consultants on areas like

the following:

1.

2.

3.

4.

5.

ensuring communication at school, city, and

county levels;

creating adequate planning time for special

education staff;

providing recognition for good teaching and

for extra time and work;

providing support for career advancement;

and

using school-based computers to relieve special education personnel of some paperwork

related to IEPs as well as some daily programing.

Part One: The Field of Learning Disabilities ● 37

Encourage Parent Involvement in P1anning

and Evaluating Programs

Despite the legal mandate for increased cooperation between parents and school personnel in

planning and evaluating special education programs for children, there is increasing evidence

that parents are not deeply involved. In California, Project TECH (Training in Education Cooperation for the Handicapped) has been set up by

the Special Education Resource Network, California Office of Special Education (39). Project TECH is a training program for parents and

school personnel to encourage cooperation in

writing IEPs. Teams of parents and school personnel are trained to return to their communities

to train others. Programs like these could be encouraged and supported.

Support Self-Help Groups

Dale Brown, an adult with multiple learning

disabilities, founded the Association of Learning

Disabled Adults (ALDA). The purpose of the organization is to provide support groups for learning-disabled adults and to educate the public. A

similar group is the Chicago-based Time Out To

Enjoy (TOTE). Within the well-established ACLD

is the Adult Committee made up of learning-disabled adults. A learning-disabled adult group

called the Puzzle People in Marin County, Calif.,

provides courses on social skills, financial management, sex education, and vocational skills.

Such groups could be encouraged and supported.

Provide State and Federal Support for Programs

for Learning-Disabled Adults

Vocational rehabilitation agencies and community colleges are already serving learning-disabled

adults and deserve additional support, particularly to train these adults in computer programing

and word processing. The “Talking Books” program of the U.S. Library of Congress could be

made readily available to learning-disabled individuals and the organizations who provide them

services. Use of the program now requires evidence of neurological impairment. Instead, this
38 ● Health Technology Case study 25: Technology and learning Disabilities

— —— . — .

program could be available to anyone with a vis- to perform several tasks: 1) to buy or develop softually based reading difficulty. The evidence for ware for special education curricula that are chalthis difficulty could take the form of a letter from lenging and appropriate, and 2) to buy or develop

a physician, teacher, vocational rehabilitation programs for computer-based curriculum plancounselor, or health professional. ning and the development of IEPs (see “Develop

Support Systems for Special Education PersonProvide Federal and State Grants for Consultants nel in the Public Sector” above).

To Serve Schools by Providing Computer

Hardware and Software

Although school districts are buying microcomputers by the thousands, consultants are needed
Part Two

A Broader Perspective

on Learning Disabilities

Here are the very people of the streets whom he passes every day, here they are coming

to him . . . telling him all about it, how it happened, what it feels like, why they did it: Looking

to him, right away, for advice and psychic. They are no two of them alike: And their records

laid before him range through every intermediate shade . . . . He begins to see that he has more

to learn than the use of the stethoscope: He must learn lives.

—Confessio Medici
Part Two

A Broader Perspective

on Learning Disabilities

OVERVIEW

An alternative view of learning disabilities is

provided by the systems approach. This approach

negates none of the findings and theories described

in Part One of this case study. Rather, the systems

approach presents a comprehensive framework

for analyzing the dynamic interaction of biological, psychological, social, environmental, and

technological factors.

The systems approach is appropriate for describing the complex system that constitutes the

field of learning disabilities research, training, and

services, and the larger system of which the field

is a part.

Integrating the Approaches

to Learning Disabilities

The systems approach presents an integrated

view of the context in which learning disabilities

exist. Rather than any single factor, the relationship of factors is the unit of observation. The

systems view is used as a technology for understanding the existence, prevalence, and nature of

learning disabilities.

The Integrative Approach as an Alternative

to the Traditional View of Learning Disabilities

The traditional view of learning disabilities is

that some unfortunate individuals have them as

they might have a cold or a headache (52). The

assumption of this approach to handicaps, and

to a host of other human problems, is that the

disorder resides in the individual, who will carry

it until cured (31). Identification, diagnosis, and

treatment reflect this assumption. We identify

learning disabilities by administering a battery of

tests, by taking school and developmental histories, and by observing the child’s behavior in the

school setting.

In addition, the increasingly sophisticated hard

technologies of brain and biochemical research are

investigating the physiological nature of learning

disabilities. The physiological disorders thought

to underlie learning disabilities appear far more

subtle than nerve damage, tissue pathology, or

abnormal blood measures; they are invisible except possibly to yet more sophisticated research.

The assumption of and search for underlying

physiological dysfunctions owes much to the

medical model of treatment, Even in school settings, practitioners in the field speak of “diagnosis”

rather than “identification” and of “symptom”

rather than “difficulty. ” One of the problems with

using the disease model is that students are often

referred to psychologists for possible learning disorders when: “The origins of the problem were

in the interaction of the school system with the

particular needs of the child” (52).

Viewing learning disabilities as medical problems has also been criticized as an attempt to

“biologize” what might well be social problems.

Theorists have “posited organic casualties for

poverty, aggression, and violence as well as for

educational underachievement” (47).

The systems or integrative approach does not

deny that learning disabilities have a physiological

basis. Nor does this approach challenge the possible efficacy of a range of treatments corresponding to the variety of learning deficits. The approach negates none of the specific studies in the

current field but rather sets these findings in context. Such an integrative approach considers the

relationships of all the component parts—biological, social, environmental, and technological.

These relationships are considered to determine

the effects of learning disabilities on the lives of

individuals, their families, their schools, and their

nations,

41
42 ● Health Technology case Study 25: Technology and Learning

— - —

The concept of the dynamic relation of many

factors is central to the systems approach. Rather

than any single factor, it is the relations among

factors that are observed.

The systems approach, long ago introduced

into biology and physics, made its way into the

social sciences. The social sciences attempt to use

the approach to understand the existence, prevalence, and nature of learning disabilities.

The Systems Approach to Data: Looking

at Relationships Rather Than at Single Factors

Scientific method dictates that researchers attempt to “control” as many confounding factors

as possible to observe the relationship between

two chosen variables. The systems approach,

rather than trying to control or isolate factors,

attempts to see how factors fit together. Not surprisingly, the systems researcher is more likely to

analyze certain kinds of data along with other

kinds.

The causes of learning disabilities are presumed

to be not exclusively biological, emotional, or

social. The approach helps to explain how so

subtle a disorder-–so subtle that it was long

unrecognized in millions of people now identified—is one that can shape entire lives. It also

helps explain why learning disabilities are common in educational settings in this country.

The following relations ought to be considered

when using a systems approach to learning disabilities:

the relation of the left hemisphere of the brain

to the right hemisphere,

the relation between an individual’s learning

strengths and learning weaknesses,

the relation between an individual’s dysfunction and the gifts the individual has to compensate,

the relation between the individual and the

family,

the relation between the individual and

school personnel,

the relation of the family to the school,

the relation of the school to the immediate

community,

the relation of the school district to the State

department of education,

Disabilities —. — —

● the relation of Federal legislation and Federal

agencies to the State department of education, and

 the relation of mandates, such as Proposition

13 in California and Proposition 21,’2 in Massachusetts, to school function and school personnel.

Even this list is far from complete, since other

relations are also potentially significant.

Using the Systems Map: Getting Around

Without All the Data

There are many important questions left unanswered. Is there a physiological basis of learning disabilities? Do food additives contribute to

hyperactivity? Is mainstreaming helping or hurting those who are learning disabled?

It is not possible to answer these questions before making decisions about identifying and treating learning disabilities. The booming field of

study has provided a great number of kinds of

quantitative data, many of them contradictory or

incomplete.

Quantitative data are important but not sufficient, Important nonquantitative factors to consider are some features of the environment where

the handicap occurs. These features provide the

map to locate facts and to get a sense of their

meaning.

Looking at Lives Rather Than at Single Factors:

A Case Study

Describing the life of one with a learning disability is an example of a systems approach to gathering data and interpreting them.

“John” is an intelligent 12-year-old who lives

in a medium-sized American city. He is the oldest

of two children. His parents are divorced. His

mother has remarried and is living in a small

town, hours from the urban area where John lives

with his father and younger sister. A custody fight

between the parents has temporarily been quieted

by a court decision that John should spend I year

with his mother in the rural school district and

the following year with his father in an urban

school district. The rural school district employs

many teachers who grew up in the area and who

attended the very schools where they now work.
Part Two: A Broader Perspective on Learning Disabilities ● 43

— — — — —.——. - —.—

The principal of the school was a classmate of

many of John’s teachers. The school district is attempting to comply with the new Federal regulations of Public Law 94-142. Specialists are not attracted to the rural school district, but, despite

the small number of specialists, the small setting

makes it possible to serve the needs of special education students comfortably. Communication

among the employees of the school is relaxed, taking place in and beyond the school setting. The

school population is relatively homogeneous.

John attended the rural school district last year.

When he entered the district, he had already been

identified as learning disabled by the urban school

district. His special education teacher knew John

as a student by the time John was assigned to

work with her 2 hours a day. John’s special education teacher and classroom teacher had known

each other for years and exchanged information

and support almost daily, The classroom teacher

didn’t hesitate to ask the principal, her old friend,

to cover her class when she had to leave for a

meeting with other school personnel about John’s

program.

In the urban school district, John had the advantage of a greater number of specialists. He not

only went to a special education teacher, he also

had a speech teacher and “adaptive physical education. ” However, the teachers found it hard to

speak with each other. Although the teachers

wanted to work closely for John’s benefit, i t was

only during the biannual meetings to prepare his

IEP, that they could exchange information. The

psychologist who had tested John didn’t have time

to meet with the classroom teacher or the special

education teacher because of district demands to

serve several schools. The classroom teacher

hadn’t been able to attend the IEP meeting because

no one was available to cover her class. She never

received a copy of the IEP and never modified curricul urn requirements for John. In addition, the

classroom teacher had the herculean task of teaching a class with non-English-speaking children,

from Vietnam and Iran, a physically handicapped

child, some with “behavior problems, ” John, and

what are called the “normal” children. In the

group of “normal” children were several “gifted”

students with parents employed by the local university. When it came time for the parent conference, the classroom teacher was at a loss: she was

unfamiliar with the psychologist’s testing results

and had not integrated them into John’s curricu

lure. John’s parents, hardly on speaking terms

with one another, both expressed disappointment

with John’s school progress. After the meeting,

John’s mother made the decision to have a parent

advocate to represent John’s interests to the school

district.

While attending the rural school and living with

his mother, stepfather, and stepbrothers, John

would visit his father and his father’s new wife

on holidays. When he returned from these visits,

school personnel noted that he was disruptive

in class, was abusive to other children on the

playground, and had a shorter attention span.

Hearing of this behavior, John’s father was convinced that the rural school district could not meet

John’s needs. John was tested intensively and frequently over a 4-year period by the school districts and by private psychologists. Testing often

took place just as John was returning to one

parent, at the times school personnel had observed were particularly disturbing. The testing

results, not surprisingly, were inconsistent and

contradictory.

The court handling the parents’ custody dispute

assigned a school specialist to determine the ability of each school district to meet john’s needs. On

the basis of the specialist’s recommendations, the

court decided that John should remain with his

mother and attend the rural school district.

John’s story is presented to illustrate that learning disabilities can be so dependent on the dynamics of school organization and the family that they

can be nearly impossible to evaluate properly and

to program effectively. School personnel, for example, were well intentioned, well trained, and

hard working, but were not always able to teach

John properly given the difficulties of the school

setting. Their social and organizational context

profoundly limited the full use of their expertise.

Yet, as the situation became more complex, fragmented, and adversarial, more and more experts

were called in. The rural school district lacked the

expertise of special education personnel, but was

seen by the court as meeting John’s needs more

fully, perhaps in part because the context in which

the school personnel worked was a relatively integrated, smaller community.

Given the confusing, discontinuous, and stressful aspects of ]ohn’s family and school lives, it

stands to reason that he would have a difficult

time learning. Perhaps another child with the

same learning strengths and weaknesses might

have met with far more school success if the
44 . Health Technology Case Study 25: Technology and Learning Dsabilities

school and family contexts in which the difficulties

appeared were less stressful and more supportive.

The Social Context

The breakdown of social cohesion is seen in the

fragmenting American family as well as in the

withdrawal of Federal and State support from the

public domain.

Isolation as a Handicapping Disorder

The modern social context is, to a great extent,

the context of stress. Although we are accustomed

to descriptions of our plight, we continue as

creators and victims of environmental hazards,

dangerous social settings, the shrinking family

unit, drug abuse, alcoholism, and divorce. The

media, the arts, and the social and biological

sciences all in their own way provide daily chronicles of these phenomena in our culture.

Dependable and meaningful social connections—probably the most important technology

available—are becoming increasingly rare. As one

of myriad examples, the family breakfast, once

a sociological given, is now fast becoming a period

piece. The lives of children are often speedy and

discontinuous. Moreover, those attempting to

support, teach, or cure children suffer from the

same social pressures that the children do.

The breakdown of the extended family (210)

means the parents of a handicapped child cannot

rely on continual support from relatives (120). Instead, they must often face problems alone or with

anyone who might be seen as sympathetic or

trustworthy.

Within the family, when family roles are rigid—

what anthropologist Jules Henry has called “role

segregated” (99)—the wife’s activity and investment might consist only of housekeeping and

childcare and the husband’s only of breadwinning.

This domestic specialization has been described

as sometimes so strict that neither wife nor husband can emotionally support each other.

The well-being of family members may also be

seriously threatened by work that is emotionally

exhausting, financially insecure, or less than

stimulating. Being harmed by the workplace

makes it less likely that one can return home to

make contributions of energy and good spirits to

the rest of the family (215).

Isolation may occur in many regions of modern

life. The families of handicapped children might

suffer some isolation, possibly compounded by

feelings of shame. Not only may the child who

has learning problems be viewed with less esteem,

the parents’ capabilities as caretakers may also be

brought into question (120). Parents themselves

may also question their own competence.

The isolation of families of the handicapped

often leads to emotional strain and exhaustion,

less effective relationships with the handicapped

child as the strain continues, maintaining the child

close to home, and being seen as outsiders by

others (120).

The Shifting Federal Stance on Education

Providing equal opportunity for the poor, racial

and cultural minorities, and the handicapped has

been the stance of the Federal Government from

the mid-1960’s to the present. Efforts for equal opportunity have focused on the creation and support of programs for the disadvantaged, the handicapped, and the needy to receive fair treatment

from educational agencies and on the enforcement

of laws and rulings of the Supreme Court about

discrimination based on sex, race, and national

origin. Continuing Federal commitment for equal

opportunity, however, is now questioned daily

in the media.

Harold Howell II, a former vice president of

the Carnegie Foundation, recently wrote that two

important features of Federal funding for the

disadvantaged will soon be seriously compromised. Title 1 of the Elementary and Secondary

Education Act will soon be “unrecognizable.”

Block grants for education, earmarked for no

groups in particular, will result in the “use of

Federal education funds primarily to relieve State

and local taxpayers. ” Also changing is the system

of student aid programs for colleges and universities (104).

The U.S. Department of Education, formed

only a few years ago, might be discontinued. The

Secretary of Education, Terrel Bell, at one time
Part Two: A Broader Perspective on Learning Disabilities ● 45

announced that he will preside over the dismantling of the department.

The shift to the private sector for education can

be seen clearly in California where the voucher

system is on the horizon. This system would

award tuition grants to pay for schooling in the

private sector. Debate over the voucher system

has understandably involved concern over the

demise of the public school system, regarded by

many as central to a democracy.

Learning Disabilities as Diagnostic Signs

for the Health of Society

What can be said about the health of support

systems, formal and informal, if “invisible” handicaps, which many learning disabilities are, can

profoundly affect self-image, school success, and

employment? For those in the middle and uppermiddle strata, a learning disability may mean low

self-image, a sense of isolation, and some difficulties related to school and career. For those

in the lower socioeconomic strata, a learning disability may have far more handicapping power

and may contribute to delinquency, unemployment, and imprisonment. Many of the people

with learning disabilities, regardless of their social

or economic status, live in the cracks in some

sense, hoping that their “stupidity” will not be

revealed.

Given all this, can one say that the disability

lies solely within the individual? Perhaps this interpretation itself represents a disability. If the

social response to learning disabilities is somehow

imperfect, how? Do we simply lack adequate technology? It is interesting to note that learning

disabilities are only recognized in cultures of high

technological development. Preindustrialized or

low-technology cultures don’t seem to “have”

learning disabilities. One legitimate question is

thus: Is there something about highly technological cultures that provides fertile ground for learning disabilities to develop?

Redefining Learning Disabilities

Learning disabilities are redefined here as a social construct as well as a possible physiological

fact.

Social and Emotional Aspects

of Defining Learning Disabilities

Learning disabilities are handicaps that, as their

name indicates, take more than one form. Individuals identified as learning disabled have a wide

variety of profiles. Some of these disabilities might

be primarily neurological, others primarily “ecological. ” The quality of family, school, and community life often determines to what extent a

learning disability will have a disabling effect.

A young girl of 7 is having trouble learning to

read. She confuses the letter b with d, the letter

p with q, and the letter p with g. She is a bright

child and converses with a good vocabulary and

much expressive detail. Identified at an early age,

she is receiving help from an experienced learning disabilities specialist. The prognosis is excellent, not only because she is receiving appropriate help early, but also because of integrated

social supports: the parents are both present and

agree about the nature of the difficulty, the school

is small, and the teachers are specialists. The family has lived in the same neighborhood for years

and relatives are nearby and willing to help out.

Another 7-year-old girl has no visual confusions

but has trouble at times understanding what her

teacher says or understanding the content of what

she reads. It seems that her problems in learning

language are entwined with a good deal of anxiety. This child’s parents are recently divorced. The

father believes that it is just a matter of the child

realizing that she must do things for herself; she

must try harder. The mother is concerned that the

father pressures the child. The teachers at school

agree that the child needs not only a program for

her learning disability, but psychotherapy as well.

The parents can’t agree to provide for either. Her

prognosis, understandably, is not as optimistic as

that for the first girl.

The descriptions of learning disabilities vary in

part because of such different social contexts. The

definition of learning disabilities is a social construct as well as a biological and educational one.

In speaking of mental retardation, Sarason and

Doris write (181): “As a social or scientific concept, mental retardation has undergone dramatic

change and there is every reason to believe that

the process will continue. ” Sarason’s social history
46 . Health Technology Case Study 25: Technology and Learning Disabilities

of mental retardation suggests that the definition

has “varied as a function of time, place and societ y.”

The function of defining a handicap is not only

to recognize a group of people who are different

from the majority, but to justify social action with

regard to them (181). Over time, our view changes

of what social action is appropriate. The definition of learning disabilities as a handicap based

on neurological dysfunctions may, in turn, shape

our response to them. One may well be less frustrated or angry with a student, for example, if one

believes he is not learning because of a problem

he has no control over. If, on the other hand, one

believes that it is a problem of “motivation,” one

might attempt to change the child’s behavior rather than accommodate to it.

Clinicians and teachers have long noted, although it is not commonly discussed in the literature, that parents are often relieved that their

child has a learning disability. Knowing a physical

problem may relieve them of the worry of being

the cause. School personnel might also feel the

weight of accountability lifted. Medicalizing an

educational problem in this way also can be seen

as imparting to learning disabilities specialists the

status of working in a medically related field.

Thus, there are social reinforcements for viewing

learning disabilities as neurological phenomena

rather than as a reflection of our time, place, and

culture.

Edwin Schur in The Politics of Deviance (187)

notes that “collective definitions” of deviant states

have a developmental cycle of their own. Part of

this “developmental process” is the discovery or

invention of a new deviance category. “This is not

to say, ” he states, “that such a new definition has

literally created the problematic behavior itself, ”

but rather that the new “collective characterization has extremely important consequences. ” As

an example of this process, Schur notes the “discovery of hyperkinesis. ”

The redefining of learning disabilities recognizes

that part of what we are describing, along with

problems in learning, is our social view,

Disabling Settings: School Services for

the Learning”Disabled Population

The legal fiat to mainstream the handicapped

has placed a considerable burden on classroom

teachers who are faced with highly heterogeneous

student groups without appropriate training or

ongoing support from special education personnel.

The population of the mainstream is changing:

two decades of social action and legislation have

provided access to the mainstream for racial and

cultural minorities as well as for the handicapped.

The definition of the mainstream must change,

and with it, the understanding of what it is that

the diverse population can share.

Disabling Settings

The nature of some learning disabilities is such

that symptoms can seemingly appear and disappear in different situations. In situations of high

stress, it is not uncommon for profound regressions in reading and writing to occur. Supportive

settings tend to enable learning-disabled individuals to use their learning strengths to compensate.

Some initial research, reported in Part One of

this case study, indicates that mainstreaming

might overwhelm some handicapped students.

Other studies indicate that the legal guidelines for

complying with Public Law 94-142, with regard

to mainstreaming, identification, and program implementation, have resulted in considerable stress

among school personnel.

The demands of teaching a highly heterogeneous population in an integrated classroom may

well be a disabling setting for teachers. The “least

restrictive setting” for the handicapped student,

as defined by the school district, may be the most

restrictive setting for good teaching.

The word “mainstreaming” does not appear in

Public Law 94-142. The word used is “integration. ” Although these words are commonly interpreted interchangeably in practice, mainstreaming does not necessarily integrate the learning
——.

Part Two. A Broader I’erspective on I.earning Disabilities ● 47

disabled into the current classroom life. Although

such students are physically included in regular

classrooms, as long as these classrooms are organized around reading and writing these students

may not be truly “main streamed.”

In addition, school services are organized

around the learning weaknesses of the learning

disabled, problems in reading or spelling or

whatever is elevated to provide definitional power

over the entire person. Learning-disabled students,

by definition “normal” in all other respects, might

also be gifted, Thus, recognizing their learning

handicaps might mask the recognition and development of a broad range of talents, skills, and

sensitivities.

Out of the Mainstream: Handicapped Teachers

Along with stressful work situations, school

personnel often have to deal with isolation.

Studies of the implementation of Public Law

94-142 indicate that classroom teachers have frequently not received the training necessary to

teach handicapped children in the regular classroom. Some school psychologists have been described as seeing their jobs as finished when the

testing report on a handicapped child is written.

Their expertise is needed to train and support the

classroom teacher, who has now become, in many

cases, the person primarily responsible for teaching the handicapped. The school psychologist,

however, is also often handicapped by too many

referrals.

One factor that could be said to contribute to

students’ learning disabilities is the handicapping

of those who work with them. Stressful work situations for teachers can undermine effective programs for students. Without considering how the

workplace can handicap teachers, one might make

the common error of believing that the problem

can be adequately addressed with more teacher

training, more new materials, more specialists,

and more hard technology.

Fragmentation of the Interdisciplinary IEP Team

The requirements for an interdisciplinary assessment team as outlined by Public Law 94-142

assume that administrators, special education specialists, classroom teachers, and psychologists will

be able to coordinate their efforts to evaluate and

program for the learning disabled. The literature

of the field describes the “overlapping jurisdictions” of specialists (95) and teachers confusions

about their roles.

There might be sufficient expertise in the

schools to identify and teach the handicapped.

Nevertheless, this expertise in and of itself may

not be sufficient to teach the handicapped successfully. The relations among those working in the

schools have not been addressed by the legislation and not accorded sufficient importance in the

literature.

A recent unpublished study is thus of note: an

investigation of IEPs for learning-disabled children

indicates that the effectiveness of these plans depends on the “harmoniousness” of the working

relations among the professionals on the IEP team.

In addition, effective IEPs took into account the

teacher’s needs as we]] as the student ’s. Three t.

four hours seemed necessary for the team to come

up with a plan for the learning-disabled child

(129).

Just as physical placement in the regular classroom presents only potential rather than certain

integration, the fiat for “interdisciplinary” teams

for evaluation and planning doesn’t ensure that

disciplinary boundaries allow exchanging information and offer support. In addition, legislation

cannot ensure the cooperation of the family.

Unfortunately, one cannot legislate for harmonious working relationships. Nor can one legislate

for the amount of time or quality of thought required for transforming a set of test scores into

an appropriate plan for learning. No amount of

funds will ensure quality of thought, performance,

or willingness to cooperate.

The Changing Nature of the Mainstream

A growing number of students are not having

their needs met by the public schools (71). This

unfortunate situation appears related to the fact

that the population of public schools is increasingly heterogeneous. The Bureau of Education for

the Handicapped estimates that there are 8 million

handicapped school children in this country. In

addition, 35 percent of the black population and
48 ● Health Technology Case Study 25: Technology and Learning Disabilities

47 percent of the Hispanic population is below

the age of 18, while only 27 percent of the white

population are. There is a movement toward the

private sector providing education—a movement

that the Reagan administration appears to support.

One can no longer assume that the great majority of public school students have racial or even

cultural similarities. The movement for universal access to public education supported by both

Democratic and Republican administrations since

the 1960’s has changed the public school community. Who is the mainstream and what are the

common needs of this increasingly diverse population? It is not surprising that a recent article on

American high schools in The New York Times

reports that there is a growing sense that the

organizing principles of high schools must be

changed (71).

Public Schools Out of the Mainstream

The New York Times article on high schools

also states that high school students are isolated

from other institutions of the community (71).

The National Commission on Resources for Youth

is quoted in a 1974 report as claiming that “in

earlier periods, the home, the local community,

and the place of employment furnished a variety

of opportunities for youth to work, to make helpful contributions to family and community and

to associate in other ways with adults. This situation has changed” (71).

Schools are being pushed out of the American

mainstream in yet another sense. The effect of the

baby boom was seen in the public schools in the

1940’s through 1960’s. Throughout, communities

prided themselves on their commitment to highquality public education. These babies grew up,

married late, divorced, or didn’t marry at all. The

birth rate dropped and, with it, the tax base to

support public education. Antitax measures along

with a diminished birth rate have led, according

to the National Center for Educational Statistics,

to the closing of 9,868 schools between 1968 and

1977. In the last 12 years, the public school population dropped 9.8 percent, and it is projected

to drop further before reaching a plateau in the

middle of the 1980’s (33).

Treatment and Intervention: Systems

With Learning Problems

One of the longstanding theories in the field

states that learning disabilities stem from a lack

of integration between the hemispheres of the

brain. This lack of integration also seems to

describe the system of treatment and intervention

for learning-disabled individuals in this country.

The outcome is that the system—not in communication or supportive relation with itself— cannot learn effectively.

Lack of Communication and Support

Within the Treatment and Intervention

System

The current literature on learning disabilities

abounds with examples of components of the system not working in concert. Parents of handicapped children are described as isolated (120),

the social movement for services for the learning

disabled is described as out of step with scientific

investigation (8), researchers identify certain children as learning disabled while school districts do

not (200), handicapped children are described as

socially isolated (108), researchers are described

as out of touch with practitioners (130), professional organizations are described as divided and

adversarial (130), the specialists evaluating and

prescribing for a given learning-handicapped child

fail to communicate (114), and decision making

in model programs for the learning disabled is

variable and inconsistent (199). These are only

some examples.

The failure to integrate Federal legislation and

State propositions has severely compromised services for the handicapped. The accountability of

the public schools to serve the handicapped has

been dramatically increased by Public Law 94-

142, while, at the same time, financial support for

the schools has been severely cut. Massachusetts

and California voted to cut property taxes, traditionally the financial basis of public education.

Proposition 21/2 in Massachusetts, in addition to

cutting local property taxes by 2,5 percent of the

market value, eliminates a local school board’s

ability to determine its own budget. Massachusetts

provides an excellent example of the lack of in-
——.

Part Two:. A Broader perspective on learning Disabilities 49

tegration in approaching the handicapped: while

on the one hand the State undercut the financial

bases of the schools with Proposition 2 1/2, it also

pioneered a model of special education services

in 1972 with the enactment of Chapter 766. Many

important aspects of Public Law 94-142 were patterned after Chapter 766 (131 ).

Many school districts face rising accountability and diminishing budgets. In addition, future

legislation requiring increased accountability is

likely. Assembly bill 2286 in California, for example, establishes that local education agencies

must pay for the attorney of the party representing the handicapped child if the local education

agency also employs an attorney to present its

own case.

It could be said, then, that the system does not

function as a well-coordinated unit. The great

numbers of well-trained, well-intentioned people

do not add up to a well-working whole. There

seems to be no shared method toward accomplishing this end. The system consists of a tangle of

institutions, dogmas, regulations, legislation,

disciplines, professionals, and parents as well as

the learning disabled themselves. Fragmentation

not only characterizes the system, but also each

of its parts. The identification, treatment, and intervention processes all share this attribute.

One could safely guess that, given fragmentation is great, communication within the system

is far less than what it could be. Another way of

saying this is that the system is not in communication with itself. Schon (18.5) offers this comment

on services for the blind:

The system will not learn what to do unless it

becomes more capable of learning; it will not act

on the basis of its learning unless it is made to do

so with forces which are commensurate with its

own resistance to change.

The “problem” and the “solution” are, in the

words of Schur, “. . . little more than two ways

of describing a single interwoven set of facts’”

(187).

For these reasons, the system of schools, researchers, professionals, and agencies can be seen

as a “learning disordered” system.

Official, Indirect, and Informal Intervention

Systems

In a classic study of a social service system

Schon (185) describes the “of ficial,” “indirect, ” and

“informal” systems of services for the blind. Using

Schon’s analysis, the official service system for

learning disabilities would encompass the followareas:

education (Federal, State, and local, both

public and private);

mental health (same);

vocational rehabilitation (mostly Federal and

State);

training of professionals (Federal, State, or

private);

research (Supported by public and private

funds); and

interest groups of professionals and parents

(private).

The “indirect” service system for learning disabilities includes the security and benefits of agencies dealing with social security, we] fare, health,

etc. The “informal” service system consists of the

benefits and services provided by families, friends,

and community members. As in Schon’s analysis

of the “system for the blind, ” one could probably

state with confidence that the informal system,

although impossible to describe in terms of financial cost, may be the largest system of all. practical wisdom also suggests that the effectiveness

of services provided by the official and indirect

systems may depend on the integrity of the informal system. For example, a child from a disintegrating family, without social supports, might

be treated for a learning disability without being

able to take advantage of that treament.
50 ● Health Technology Case Study 25: Technology and Learning Disabilities

DIRECTIONS: TECHNOLOGICAL POSSIBILITIES

To “MAINSTREAM” THE SYSTEM

The development and use of technologies

should be informed by the distinct nature of learning disabilities. Hard technology can be seen as

speaking to certain aspects of a learning handicap;

for example, a learning-disabled student might

learn best with electronic multisensory instruction.

Soft technology refers to aspects of the complex

social context in which the hard technology exists. A possibility concerning soft technology

might be the creation of programs for teacher

training and support that enhance the effective use

of school-based microcomputers (hard technology). The fragmented service system can be seen

as seriously compromising the potential contribution of hard technology. Thus, the possibilities

below include possible soft technological approaches that may determine the effective use of

hard technology.

Develop Complementary Hard and Soft

Technologies for Those With the

“Indistinct Handicap”

Because learning disabilities are most often

identified in individuals who are physically, emotionally, and intellectually within the “normal”

range, the learning disabled are excellent candidates for self-help programs, The understanding

many have developed of how to compensate with

social and other skills can be used in developing

soft technologies to support others with silent

handicaps,

The “symptoms” of learning disabilities appear

or disappear depending on the setting. A mismatch of setting and learning style is often interpreted as a learning disability, as well it may be.

It is important to note that teaching approaches

can be modified to enable the learning-handicapped student to learn much more effectively.

Other modifications that can be made to match

learning styles include choice of appropriate

materials, shortened work periods, small student

groups, and regular checking-in periods with the

teacher during the day. Restructuring settings—

both their requirements and their supports—can

mean that a learning disability is far less of a learning problem.

Because the learning profiles of the learning disabled show both strengths and weaknesses, hard

technologies can be used to supplement native

strengths insofar as they can exploit this range of

abilities, talents, and interests. Those with visualmotor difficulties might use typewriters, tape recorders, or voice-activated word processors. Electronic advances, providing a wealth of alternatives to the written word, might not only make

it easier for those with visual-perceptual problems,

but may eventually make certain learning disabilities far less handicapping. They could be used

to tailor information input and output to individual learning styles.

Task analysis, a method used in the field of

learning disabilities for evaluation and program

design, is a highly valuable soft technology. It is

a tool for determining learning styles, One observes the learner in a series of systematically sequenced tasks to determine learning strengths and

weaknesses and their interrelations. The idea is

that learning strengths can be used to compensate for learning weaknesses. One learning style

might be described as follows: visual-perceptual

confusion tends to be compensated for by using

strong verbal language skills and by saying the

letters of confusing words aloud.

With the knowledge of a person’s learning style,

one can make informed choices about the use of

both hard and soft technologies. Because everyone

has learning strengths and weaknesses, task analysis is a soft technology appropriate for the heterogeneous classroom. Students could be grouped

according to learning styles and academic needs.

A program using task analysis integrated with a

systems approach to educational setting, personality, and community was attempted in California (29),

“Mainstream” Classroom Teachers

With the radical change in the population of

the “regular” classroom, classroom teachers find

themselves in stressful situations every day. Their
training has been primarily for “regular” education, based on the assumption that only certain

types of “normative” problems might appear. Previously, children with problems had been referred

“out , “ and specialists outside the classroom had

often been responsible for them.

As Sarason (181) points out, classroom teachers

and special education teachers traditionally were

separated in training as well as in educational

agencies. It had been assumed that the two student populations they serve were so different that

integrating special and regular education was inappropriate.

With the passage of Public Law 94-142, the regular classroom teacher faces children requiring

special education. Often, the classroom teachers

are the central “deliverers” of the program delineated by the IEP. Yet they are still not centrally

involved in diagnosis and planning, even though

they are often the ones who have the most information about students and that gathered in a

range of situations over a long time.

The generalist—the classroom teacher—is now

required to be the specialist. The accountability

of the job has increased immeasurably, just as the

accountability of the school districts has increased.

And, like the school districts, the classroom teacher often does not have the proper support or preparation to do the job.

The stress, the fatigue, and possibly the guilt

of attempting a demanding job without adequate

support or preparation appears to have had an

isolating effect on classroom teachers. They are

less likely to share information, more likely to feel

that, because they are failing, they must hide the

nature of their performance (not unlike learningdisabled students). Clinical experience tells us that

being in situations in which one continually experiences failure weakens ties to others who might

be of help.

Soft technologies in the schools could focus in

part on “mainstreaming” the classroom teacher.

The isolation of the classroom teacher can be

ameliorated by taking actions like the following:

1 ) ensuring that the classroom teacher is present

at IEP meetings, 2 ) setting up specific and regular

times for specialists and classroom teachers to discuss the programs of children, 3 ) providing inservice training for the highly heterogeneous classroom, and 4 ) delineating job boundaries clearly.

In addition, hard technologies like microcomputers can be used to help the classroom teacher individualize programs for a range of learning needs

as well as reduce the time spent in paperwork.

“Mainstream” School Systems

One can make an educated guess that classroom

teachers are not the only isolated people in the

system that provides services for the learning-disabled population. The school system itself is also

fragmented. Administrators—the personnel who

are central to creating soft technologies for “mainstreaming” classroom teachers—must also be

“mainstreamed. ” They also are overwhelmed,

overaccountable, and possibly plagued by selfdoubt. Parents, observing overworked teachers —

or feeling disappointed by the unmet promise of

the new legislation, often feel alienated from

schools .

The effectiveness of hard technologies, new programs, and professional expertise are often seriously compromised by aspects of organizational

life. Cowan (52) describes a case in which a school

administration’s failure to communicate with

school principals first affected the commitment

of the principals to a “new math” program and

eventually the success of both a teacher and a student in the new program. The new math program

was introduced by the principals to their schools

with little investment. Teachers, feeling compelled

to cooperate, agreed to spend 6 weeks of their

summer in a new math training program. One of

the teachers who least wanted to take part in the

program was later faced with a number of students who needed more direction than the new

teaching method provided. One of these students

began to misbehave after weeks of not being able

to grasp the new material. The child was referred

to the school psychologist for a possible learn in~

deficit and a recommendation was made that the

child enter therapy to “remove the emotional

block to his learning. ”

This example illustrates not only that a learning problem might be based in the interaction be-
52 ● Health Technology case Study 25: Technology and Learning Disabilities

tween child and educational setting, but also that

expertise can be misapplied in certain contexts,

and that an educational innovation can be rendered ineffective by administrative mismanagement. It is common for experts to be disabled by

certain forms of administrative leadership and

decision making. The quality of organizational life

is often the most hidden and pernicious handicapping force on schools and service agencies and

should inform the choices for technology development and use.

The isolation of the system’s constituents is

especially clear in IEP meetings. In these, parents

often disagree with school personnel and with

each other. The interdisciplinary evaluation teams

are better described as multidisciplinary: each

specialist gives a report, and the results of the

reports remain unintegrated. The opinion of the

classroom teacher may not be given sufficient

weight. Often, with no one available to cover the

class, the classroom teacher is not even present.

Yet the IEP meeting is the only time that all the

people planning the educational program of the

learning-disabled child have a chance to meet.

School personnel with the same jobs could meet

in small groups. Consultants with training in

group processes could participate in the formation of these groups. The consultants could not

routinely attend the groups, but serve as consultants to any given group when asked. The

groups would of course not be therapy groups,

but rather support groups in the work setting.

After some time, horizontal connections could be

made by forming groups of administrators, teachers, and special personnel. The purpose of these

groups is not training, but to provide support and

a meaningful context to the workplace.

Not a support group primarily, Project TECH

(Training in Education Cooperation for the Handicapped) is a program of school personnel and parents to encourage cooperation in program evaluation and planning. Project TECH is part of the

Special Education Resource Network, California

Office of Special Education. Teams of parents and

personnel from local school districts are trained

in 3-day workshops and return to their communities to train others. This is a good example of

community-based soft technology that addresses

the relationships of people and interests in the

system for the handicapped (38).

Integrate Various Services

for the Learning Disabled

The learning disabled suffer problems not only

in school learning. The anecdotes about learningdisabled adults provide powerful testimony of the

range of these difficulties. If such adults manage

to circumvent the prejudice of potential employers, as workers they may be plagued by “accident

proneness, ” difficulties in reading charts and

maps, mishearing directions, or slowness in completing tasks. Often these adults maintain patterns

of dependency begun with parents and peers, Not

being able to read makes one far more dependent,

and not only in completing school tasks. Other

tasks, such as finding a job, navigating through

large buildings with titles on walls and doors, finding an apartment, or taking information over the

phone, can also be overwhelming.

Case managers are needed to coordinate and

integrate the contributions of specialists like

remedial tutors, vocational rehabilitation counselors, and psychotherapists. Just as important,

case managers can help the learning disabled to

enter into community activities by using services

and programs for the general population. Activities that recognize and develop the talents and

interests of the learning disabled are as important

or more important than services that speak only

to their limitations.

The abilities of these individuals can be combined with the abilities of others through team

structures, using the group to compensate for the

weaknesses of individual members. In the novel

More Than Human, Theodore Sturgeon describes

a group of disabled children who find each other

and create a working group by using their complementary strengths and weaknesses (197) This

is also a kind of mix-and-match soft technology:

matching person and person, person and setting,

and person and task.

In his analysis of the service system for blind

people, Schon (185) suggests “new models of integrated service” that would coordinate services

relating directly to the handicap itself and those
_ —

relating to health, employment, recreation, or

financial support.

Different forms of integrated services are necessary for different learning-disabled people, for

their range of profiles is wide. Some learning

problems may be primarily neurological, others

primarily emotional. These different profiles mean

that there must be separate, but similar and often

overlapping, service systems.

Schon suggests that “all forms of integration

would require the establishment and management

of networks of service— that is, linked arrays of

agencies. ” Greater attention would be given to activities that mark the crossing of boundaries, such

as those related to admissions, screening, and referral. “Tracking” individuals through the system,

ideally with the help of coordinated computer use

throughout the agencies, would show what agencies were meeting what needs. The leadership in

this system would largely provide feedback about

the states of the system, which would help the system self-regulate.

Establish Communication Between

Researchers and Practitioners

One of the characteristics of the system for the

learning disabled is that what is considered of

dubious value by researchers is often considered

best practice by practitioners. An example, school

practitioners’ apparent unawareness of a decade

of research seriously questioning the “perceptual

hypothesis. ” This hypothesis, which assumes the

existence of underlying perceptual abilities, is the

basis of much diagnosis and planning for learningdisabled students. Additional training may be necessary but not sufficient to close this gap between

researchers and practitioners. It is more likely that

ongoing work groups of researchers and practitioners supported by State and Federal agencies

or private foundations would establish effective

channels of communication.

Consider Developing New Organizing

Principles for the Schools

As long as “mainstreamed” classrooms are organized around the written word, “mainstreamed”

students will not be truly integrated. This is very

likely true, regardless of whether these students

are the learning disabled or non-English-speakin~

Chicanos, Chinese, or Vietnamese. As a greater

percentage of students in the “mainstream” can’t

read, one must question the wisdom of using reading as the focal point of classrooms. The idea behind “mainstreaming” is harmonious with democratic principles: minorities and the handicapped

should learn in the same social communities as

“regular” children. Because social development is

central to “main streaming,” the basis for “mainstreamed” classrooms should be something the

children do actually share—whatever that may

be. Academic instruction should take place in

small groups, organized by learning levels, styles,

and needs.

Consider the Contributions of

Learning-Disabled People

When we want to see the future, we often go

to experts. An alternative method is to go to those

who represent more marginal regions of the culture. Their perspectives are sometimes those of

the mainstream to come. The learning disabled,

many of whom have learned to survive successfully, to establish their own networks, and to have

full lives without knowing how to decode the written word, may well be the source of ideas for future developments.

Rapid advances in technology often dictate policy rather than the reverse. Yet, if we look to the

life experiences of learning-disabled people in

schools and beyond, they may provide guides for

using technologies that are both effective and

humane.
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