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Specific learning disorders in children: Educational management

Specific learning disorders in children: Educational management
Literature review current through: Jan 2024.
This topic last updated: Feb 17, 2023.

INTRODUCTION — Learning disorders (LD) are a heterogeneous group of disorders characterized by difficulties mastering academic skills. Academic skills are substantially and measurably below those expected for chronologic age and interfere with academic or occupational performance [1]. LDs are the most common form of learning difficulty in children.

LD have a multifactorial etiology [2]. They typically manifest as a failure to acquire reading, writing, or math skills at grade- and age-expected levels. Learning problems that are outside of these traditional core domains, such as memory problems, attention problems, processing speed deficits, and difficulty managing social interactions, are not typically considered to be LDs. However, they may affect reading, writing, and math and may also require intervention.

The educational management and prognosis of LD in children will be presented here. Educational definitions for LD, epidemiology, clinical features, evaluation, and role of the primary care provider are discussed separately:

(See "Definitions of specific learning disorder and laws pertaining to learning disorders in the United States".)

(See "Specific learning disorders in children: Clinical features".)

(See "Specific learning disorders in children: Evaluation".)

(See "Specific learning disorders in children: Role of the primary care provider".)

PREVENTIVE MEASURES — The management of the student with a learning disorder (LD) begins with quality instruction, even before the student is identified as having an LD. Inadequate exposure to quality instruction may account for the student's learning failure as early as kindergarten or first grade. Early intervention with quality instruction improves outcomes for all students with learning failure (including those with LD). It is more difficult to remediate the impact of LD when the student is older [3]. Thus, quality instruction should be provided early and before attempts are made to identify an LD. This is the rationale behind legislation introduced under general education law (No Child Left Behind Act, 2001) and its subsequent re-authorization, Every Student Succeeds Act (2015), which requires schools to provide "highly qualified" teachers and the use of "scientifically based practices."

"Response to Intervention" (RTI) services consist of the delivery of quality instruction to select students with learning difficulty before their identification with LD. RTI services are required by the Individuals with Disabilities Education Act and are an additional preventive measure before children are identified as having LD. (See 'Quality instruction' below and 'Response to intervention services' below and "Definitions of specific learning disorder and laws pertaining to learning disorders in the United States", section on 'Every Student Succeeds Act' and 'Mandated school based services' below.)

QUALITY INSTRUCTION — In the United States, federal general and special education laws require that school districts provide students with evidence-based practices, as outlined below.

In general education classrooms — A consensus definition for "quality instruction" is lacking. Quality instruction in general education classrooms includes multiple components. A full description is beyond the scope of this review. The United States Department of Education provides resources that schools can use to deliver quality education to diverse learners. A series of practice guides that describe quality instructional practices for a variety of learners and curricular goals is available from the Institute of Education Sciences [4]. State boards of education also provide valuable resources and information.

The scope, sequence, and pace of the lesson are critical variables that need to be individualized to the context and student. Some examples of additional teacher practices included in the definition of quality instruction in general education that apply to a range of content and learners include [5]:

Well-structured lesson plans

Carefully selected examples to illustrate key teaching points

Carefully selected sequencing from less difficult to more difficult or concrete to more abstract concepts

Spacing learning over time (ie, provide repetition of the same learning concept over time) [6]

Combining graphics with verbal descriptions

Using preworked sample solutions with problem-solving exercises

Quizzing to promote learning

Helping students to allocate their time efficiently

Connecting and integrating abstract and concrete representations of concepts

Asking deep explanatory questions to develop greater awareness of the material being taught

Student groupings and environmental features of the classroom are additional considerations.

Evidence-based practices are used inconsistently across the United States [7]. Even where there is consensus about what constitutes quality instruction, delivery of quality instruction is variable. The variability is related to multiple factors including inconsistent teacher training programs, lack of resources, and classroom and environmental factors, among others. Not all teachers have the knowledge or instructional expertise required to teach reading successfully, for example, even teachers who specialize in reading instruction [8,9].

Quality instruction for learning disorders — Quality instruction is required for children with learning disorders (LD), just as it is for general education students. A consensus definition of quality instruction for children with LD is also lacking.

When making decisions about quality instruction for a student with LD, the initial step is to identify the specific components of reading, writing, or math that are causing the student's learning difficulty (evaluation). These components commonly determine the educational skills that the student needs to master (ie, the content and the scope of instruction or the goals and objectives of the instruction). The next step is to determine what type of instruction is most likely to benefit the student, including factors such as the sequence and pace of instruction and relevant evidence-based practices. The final step is to address practical considerations such as access to the right services and supports.

Local school practices and resources influence the quality of instruction for students with LD. Evidence-based practices are used inconsistently [10]. High attrition rates and poor teacher preparation for teaching students with LD can inhibit access to the right services and supports [11]. Competing legal mandates can result in allocation of resources towards or away from certain needs at school, including the needs of children with LD [12].

Identification of students who may have LD and who may need specialized instruction is discussed separately. (See "Specific learning disorders in children: Clinical features" and "Specific learning disorders in children: Evaluation".)

General recommendations — The following general guidelines for instruction of students with diverse types of LD are provided by the Council for Exceptional Children [13].

Sufficient duration and intensity of instruction to allow the student to make progress

Appropriately trained teacher/professional development for the teacher to provide the intervention

Small group size to maximize learning, to provide feedback to the student, and to allow for individualized instruction

Appropriate progress monitoring based on the student's performance to allow adjustments to the intervention as needed

Instruction based on the best available evidence

Consideration of factors other than the student's LD (eg, second language status, behavioral self-regulation skills)

Specific examples of how to apply these practices to students with specific LDs are provided below. (See "Reading difficulty in children: Interventions" and 'Writing disability' below and 'Math disability' below.)

Limitations of the evidence base – Although the examples of quality instruction for LD that are described in this topic review are considered to be "researched" and even "evidence-based," educational research and the ways in which educational research is translated into everyday teacher practices have limitations, including:

Developmental readiness (ie, which skills and what type of content the student is developmentally ready to learn) is inconsistently addressed

Teacher behaviors and quality instructional practices are not defined consistently across studies and settings, which makes it difficult to compare outcomes

Improvement in student outcomes is likely related to a variety of teacher behaviors or practices acting together, given that teachers use multiple behaviors and teaching strategies

Types of instruction — Two important types of instruction for students with LD are explicit (also called direct or "drill and practice") instruction and strategy instruction. These two methods consist of a collection of teacher practices. They are particularly important for students with LD but are also beneficial for students without LD. They do not interfere with the learning of average- or high-achieving students being educated in the same classroom setting. Teachers have different opinions about the relative merits of explicit and strategy instruction, and how to best engage students when these methods are used. In research studies, the effect size increases when both are used together [14].

Explicit or direct instruction — In its most basic form, explicit or direct instruction refers to instruction that is dedicated to the acquisition of basic academic skills, largely through repetition and by memorization. Although criticized for being a dull form of learning and for not addressing the higher-order thinking that is the ultimate goal of education, there is broad consensus among educational researchers that direct instruction is an important component of special education instruction. In research studies, explicit instruction is associated with strong effect sizes [15].

Direct instruction typically entails frequent and direct measurement of clearly observable behaviors and responses, such as acquiring sound-symbol relationships in reading and spelling; printing and handwriting; or memorizing basic calculations in math. Progress must be measured frequently.

The specific skills taught during direct instruction should be taught in a logical sequence, with rational transitions from one set of basic skills to the next, until mastery is achieved [16]. Although direct instruction traditionally refers to instruction in basic academic skills, any form of instruction that insists upon rote learning of a skill can be referred to as direct or explicit instruction.

A detailed discussion of explicit instruction is provided in reference [17].

Strategy instruction — Strategy instruction refers to instruction in a process or a procedure that the student can use to approach learning systematically. Strategy instruction can be used to help the student memorize what they need to learn; detect and correct errors encountered during learning or task completion; monitor and revise tasks when needed; and reflect upon what was learned.

A strategy can be as simple as prompting oneself to check one's spelling errors, using mnemonics to memorize information, or underlining the topic sentences in written text to improve reading comprehension. Strategies can also be more complex, such as the strategy or set of strategies used to write an essay or the strategy used to develop a deeper understanding of the material being learned. For example, in reading-strategy instruction, the student is taught to stop while reading to use a set of steps designed to enhance comprehension. The steps can include checking vocabulary comprehension; asking questions, such as, "What does this remind me of?"; making links with prior knowledge; etc.

Students with LD often fail to approach learning strategically and do not monitor their own comprehension and/or success. Failure to approach learning strategically may be a manifestation of the executive dysfunctions that are a common comorbid condition in students with LD. However, students with LD are unlikely to approach learning strategically, regardless of any impairment in executive skills. They use excessive cognitive resources to perform basic academic skills (eg, reading decoding, spelling, calculation) and therefore have insufficient remaining cognitive resources to approach learning strategically or develop metacognitive awareness of what was learned. Provision of strategy instruction can help to circumvent these limitations.

Additional information about strategy instruction, with examples, is provided in references [17-19].

Other methods — Other methods of quality instruction for students with LD include teacher behaviors, such as stating the learning objectives clearly, having a clearly organized lesson plan, teaching in a recursive manner (concepts and learning objectives are reviewed multiple times over the course of the lesson or of the unit), providing examples, and proceeding through the material in appropriately small steps, etc.

Successful LD programs provide teachers with professional development focused on specific teaching methods. The effective teacher imparts a positive attitude to the student(s); has a variety of texts, strategies, and teaching methods to provide both direct and strategy instruction; and uses ongoing assessment to continually tailor instruction to the student's ability level [20]. Teacher behaviors that are associated with positive effect sizes include [21]:

Presenting smaller amounts of material at a time

Using small interactive groups [22,23]

Spacing [24]

Using directed questioning

Peer tutoring is also considered to be an evidence-based practice and can have positive outcomes on student learning [22,23,25,26]. Peer instruction is discussed in more detail below. (See 'Specialized instruction in writing' below and 'Specialized instruction in math' below.)

MANDATED SCHOOL BASED SERVICES — In the United States, federal special education and disability rights laws require schools to provide the services described below; access to these services is highly variable.

Response to intervention services — In the United States, federal special education and disability rights laws require schools to provide "response to intervention" (RTI) services.

RTI refers to the delivery of specialized educational or therapeutic services to students before they are identified as having a learning disorder (LD) and before providing special education services in an Individualized Education Program (IEP). The student's response to intervention can help distinguish learning failure related to inadequate instruction from learning failure related to a specific LD (or another disability). RTI is a legal term that was introduced into the Individuals with Disabilities Education Act (IDEA) in 2004. For students who are not succeeding academically, an RTI model is favored over an evaluation to identify an LD. RTI services may be warranted for any student who is not performing successfully at school. (See "Definitions of specific learning disorder and laws pertaining to learning disorders in the United States", section on 'Individuals with Disabilities Education Act'.)

RTI services are provided before the student is tested for an LD or for another disability. These services are intended to prevent the inappropriate placement of a student into a special education program. RTI should be used only temporarily; it does not replace the delivery of special education services. The criteria for eligibility for RTI services vary by school district. (See "Specific learning disorders in children: Evaluation", section on 'Diagnostic process'.)

The delivery of RTI is the responsibility of the general education teacher but can include other school professionals as well. Although it is implemented widely across the nation, implementation is inconsistent. Barriers to the successful implementation of RTI include lack of knowledge and training, lack of time, and increased documentation requirements [27-31]. The widespread use of RTI may have the unintended consequence of reducing access to quality special education services [12].

A common model for RTI services consists of three tiers.

Tier one instruction is equivalent to general education instruction, possibly with some differentiation to address the needs of diverse learners.

Tier two instruction occurs for a select group of students, often those who are performing below the 25th percentile in the general education classroom. These students receive intensive instruction. "Intensive" is defined differently by different authors but generally refers to quality instruction that is provided in a small group setting (six students or less) with a focus on remediation of deficits to help the students achieve grade-level performance. This instruction is provided for 30 to 60 minutes per day, three to five times per week, for 6 to 24 weeks. Progress is measured frequently, and an estimate of the rate of improvement is made. Based on the student's rate of progress, they may be returned to the general education setting or may undergo an evaluation to determine eligibility for special education services [32].

"Tier three" instruction is equivalent to special education instruction.

Other RTI models are discussed in greater detail in references [33,34].

One of the reasons for the shift to an RTI model is that providing preventive services is considered to be better than waiting for students to fail. Support for this position is based on results of intensive, high-quality reading instruction, which shows greater effect sizes when the interventions are provided early (eg, in kindergarten or first grade, before LDs are typically diagnosable) as opposed to later.

The long-term merits of RTI remain unclear. The impact of RTI is difficult to measure, partly because of the great variability in RTI practices across school districts and states [31,32,35]. At a minimum, RTI practices have been associated with improved screening and monitoring of students' progress since their implementation in 2004 [31]. They also appear to have reduced referrals to and placements in special education [36-38]. However, the role of RTI in preventing learning difficulty remains unclear. The reduced identification of students with LD may simply reflect a failure to identify students in need of special education programs [31]. The majority of RTI services continue to be dedicated to reading instruction for young students, though there is no legal or educational reason to limit RTI services to reading instruction alone.

Evaluation for specialized instruction — In the United States, federal special education and disability rights laws require schools to provide specialized instruction or special education.

Under IDEA, parents/caregivers, teachers, and other professionals inside and outside of the school system can refer a child who is not succeeding academically for an evaluation to determine whether the child is eligible for special education services (specialized instruction). RTI services do not have to be provided before an evaluation takes place, though the period of RTI services can provide valuable information about the student's learning abilities and learning needs, including the type of testing that may be required during a subsequent evaluation. (See "Specific learning disorders in children: Evaluation", section on 'Evaluation and identification of learning disorder in school settings'.)

When the request for an evaluation is made in writing, schools have to respond with a proposal to conduct an evaluation (or to decline to conduct the evaluation) within five business days. The school can decline to conduct the evaluation if an evaluation was done within the previous year or if they have data to show that the evaluation is not needed. If no evaluation has been completed recently, schools typically agree to the request for an evaluation. Once the caregivers have provided written permission to the school for the evaluation to begin, the school is obliged to complete the evaluation within 60 calendar days (some states count holidays in the 60 days; others to not) [39]. Specialized instruction for an LD begins after the school has created an IEP and after the student's parents/caregivers have agreed to and signed the IEP. (See "Definitions of specific learning disorder and laws pertaining to learning disorders in the United States".)

Accommodations and modifications for students with learning disorder in the general education classroom — In the United States, federal special education and disability rights laws require the provision of accommodations and/or modifications in the general classroom.

Examples of accommodations and modifications that may be appropriate for students with LD are provided in the table (table 1). Accommodations and specialized instruction can look similar. They can be provided as part of an IEP or as part of an Accommodation Plan. The legal criteria for an Accommodation Plan are discussed separately. (See "Definitions of specific learning disorder and laws pertaining to learning disorders in the United States", section on 'Section 504 of the Rehabilitation Act'.)

Accommodations are provided with the intention of simplifying or reducing performance demands on the student. They are not necessarily designed to remediate performance deficits. In contrast, "specialized instruction" is provided to a student with the goal of remediation. However, the accommodations or modifications provided by a special education teacher or in a special education classroom can look the same as the instructional strategies (specialized instruction) described below. (See 'Specialized instruction in writing' below and 'Specialized instruction in math' below.)

Presenting smaller amounts of material at a time, using small interactive groups, providing more individualized direct questioning, and using peer group discussion can serve as accommodations or modifications and do not need to be considered as "specialized instruction." Strategy instruction and advance organizers (providing key information to the student in advance of a lesson) may also be used as accommodations or modifications. A more classic type of accommodation occurs when, for example, a student with a reading disability is allowed to have test instructions provided orally and to provide responses orally, thereby reducing demands on reading decoding [40]. Dictation or scribing, or the use of preprinted lecture notes, reduce demands on handwriting and may be used for students with writing disability. For all types of LD, the amount of time allowed to complete work (including a test) can be increased [41] or the number of items that the student is expected to complete can be reduced. These accommodations do not have the goal of remediating deficits.

Another type of accommodation or modification is to deliver the curriculum in a variety of ways. This is known as Universal Design and is most easily accomplished through the use of digital media [42,43]. Information can be presented using text, voice, or images. Text can be presented in varying sizes or can be presented as speech and/or in the context of images. Text can be presented with hyperlinks to associated glossaries, to related background information, to queries that support strategic thinking, and to tools that allow the student to express and organize text, recorded voice, or images [44,45]. Curricular materials that offer these options allow easier access to the general education curriculum for all students, and perhaps especially to students with disabilities.

READING DISABILITY — Specialized instruction for children with reading disability is discussed separately. (See "Reading difficulty in children: Interventions", section on 'Remediation' and "Reading difficulty in children: Interventions", section on 'Accommodation'.)

WRITING DISABILITY

Specialized instruction in writing — A teacher who knows that a student has writing difficulty needs to consider all of the components of writing and create an intervention plan to address the components that are the most affected. Writing consists of lower-order and higher-order skills.

Lower-order writing skills consist of printing/handwriting (transcription skills) and spelling skills (a phonics-based skill that requires sound-symbol relationships). Ultimately, the student has to have memorized a certain number of high-frequency words and spell them automatically (writing fluency), without which higher-order skills are more difficult to master.

Higher-order writing skills require the ability to write sentences (eg, understand and use language conventions related to punctuation, understand grammar) and to produce a composition (write a properly structured paragraph or text).

Writing instruction involves drill and practice (explicit or direct instruction) of lower-order skills (transcription, spelling, and writing fluency) in the service of higher-order skills (writing sentences and compositions). Direct instruction is required for the student to achieve accurate letter formation and fluency in writing, spelling, and language conventions (punctuation and grammar). Improvements in these lower-order skills can improve higher-order performance. However, there are also specific types of instruction (eg, strategy instruction) that can be used to improve performance in higher-order writing skills [46].

The content of writing instruction for students with LD is not different from the content of writing instruction for general education students. "Specialized instruction" in writing thus consists of providing writing instruction in smaller groups, with more frequent repetition and practice, more gradual transition from one skill to the next, and over a longer period of time.

Although consensus about quality instruction for writing disability (WD) and national guidelines are lacking, based upon the educational literature and research in writing instruction, writing instruction should consist of the following components [47,48]:

Transcription skills – Automatic letter formation and handwriting skills are the first step to writing successfully. Handwriting/transcription is taught by direct or explicit instruction, through significant drilling and practice. Learning to write letters follows a logical sequence. Visually similar letters ("b" and "d"; "v" and "u"); letters with directional shifts ("z" and "s"); and less frequent letters ("q" and "w") are typically learned later than other letters. Printing and cursive are typically taught sequentially, but it is not clear that one should follow the other, nor that one leads to faster writing output than the other.

Handwriting (transcription) instruction is typically conducted by teachers, but occupational therapists, who focus on the motor components of writing instruction, also play a role. No one handwriting program is clearly superior to another, and the role of the occupational therapist in teaching handwriting skills varies within and between school districts [49].

In a 2011 systematic review of interventions to improve handwriting, twice weekly handwriting practice sessions for at least 20 sessions were found to be "effective," and recommended as the focus of intervention [50]. A 2016 meta-analysis of handwriting instruction corroborates the importance of handwriting instruction for improving higher-order writing skills (eg, writing sentences and writing compositions) [51]. Other motor or sensory therapies (eg, sensory-based training, relaxation) should not be the focus of the intervention. Once letter production skills are mastered, students can develop their personal handwriting style [52,53]. Learning to type may be preferred for older students or for students with motor impairments, especially when the focus is on writing compositions. (See 'Accommodations' below.)

Spelling: Phonics skills – Phonologic awareness and phonics instruction are important components in spelling instruction. The value of phonologic awareness and phonics instruction in students with WD has not been studied specifically. However, they have been shown to help typically developing students improve their spelling skills. A small number of studies suggest that spelling improves as a part of reading instruction [54]. Teaching writing includes direct and explicit instruction in these language and reading skills [53,55].

Writing fluency – When students become fluent writers, they no longer rely on phonics to spell. They have memorized the spelling of a certain number of words and transcribe them quickly from memory. Spelling improves with direct or explicit instruction in spelling that includes multiple practice opportunities and immediate corrective feedback when words are misspelled. Spelling instruction should include words that the student already knows how to spell, along with words that the student has not yet mastered. Spelling lists based on an individual student's spelling competence are a favored means of spelling instruction. Monitoring the student's progress and showing the student how many words they have mastered can enhance motivation.

Direct or explicit spelling instruction can only help students learn a small fraction of the total number of words that they will ultimately need to use in writing [55]. Thus, instruction in spelling as a part of text composition is recommended; this makes spelling more relevant and assures that it is an ongoing learning process. Spelling improves when the student is taught error correction strategies. Error correction strategies include having the student analyze their spelling and check for what is plausible; read (decode) the words aloud; have a peer read the word; read the text backward; or use a dictionary and/or computerized spell checker [54,55]. For older struggling writers, handwriting, spelling, and English language conventions can be taught in the context of composition skills.

Writing compositions (text generation) – Writing compositions is the ultimate goal of mastery in the lower-level skills discussed above. Writing compositions is complex because of the higher-order cognitive skills required for producing compositions successfully. Composition instruction requires significant strategy instruction. The specific strategies used by the student will vary according to the type of text that has to be produced and according to student preferences and needs (table 2). Some of the approaches for composition instruction (also referred to as text generation) are listed below:

Writing strategy instruction – Strategies exist for writing at both the sentence and paragraph level [56]. The strategy should teach the basics of planning, writing, revising, and editing. The specific steps in the strategy can vary from teacher to teacher. What is important is that the teacher provides a strategy for writing and uses a consistent vocabulary to describe each of the steps (table 2). This facilitates the student's learning because it allows the teacher and the peers to analyze the steps of the writing process together. It also provides a mechanism for feedback and correction from the teacher and/or peers at each of the steps. Students with LD may learn the steps of writing strategy through direct and explicit instruction or in small groups. Students with LD can be taught to use the same strategies as students in regular education. (See 'Effective writing programs' below.)

Composition instruction requires teaching how to write different genres of compositions (eg, newspaper article, business letter, advertisement, personal essay, etc). Developing a shared vocabulary for the types of writing genres facilitates teacher-peer and peer-peer discussion and feedback.

Provision of feedback – Composition instruction requires feedback. Feedback gives the student additional opportunities for planning, writing, and revising. Feedback from peers may be as valuable as feedback from the teacher and is important for the revising process, as well as to induce greater self-monitoring.

Provision of accommodations – (See 'Accommodations' below.)

Enhanced motivation – Students with WD may also need increased motivation (eg, by allowing them to choose their own topic) and more frequent and more structured opportunities to share their writing in a supportive environment [57,58].

Accommodations — Children with WD may benefit from accommodations, including:

Extra time to master lower-order skills

Extra time to understand, memorize, and apply writing strategies

Small group instruction in writing steps

For older children, use of a keyboard for lower-order weaknesses (eg, handwriting, spelling), allowing them to devote their mental energy to the ideas and organization of writing; this sometimes allows them to perform at a higher level of conceptual awareness than would otherwise be predicted and to write longer and better text [22,53]

Accommodations for writing compositions for children who have not mastered handwriting or spelling skills include:

Use of pictures

Dictation to a teacher

Use of technology (eg, word processors, spell checkers, etc)

All of the accommodations that may be required by a writer can potentially be provided by a computer, which reduces the fine motor and physical demands of handwriting. Using a computer with word recognition, voice recognition, or dictation applications helps to reduce the number of strokes required to produce a word. Technology reduces the amount of work involved in correcting errors and reduces the problem of frequent erasures. In addition, computers help students with WD manage spelling errors and generate sentences and may help with grammatic and stylistic errors. However, the effectiveness of technology to improve writing skills is uncertain. Lack of appropriately designed studies is one reason why the role of technology remains unclear [59].

Computerized writing programs also can help with planning, by providing outlines for specific kinds of text structures, or by prompting the writer with questions that help assure that certain kinds of content are included. For writers early in their writing development, computers can generate pictures and a variety of other media, which can be used to scaffold writing.

Finally, word processing and computers linked with one another can create a collaborative forum for writing to be shared, reviewed, and revised/edited by peers and teachers. Many of the accommodations listed here are used in writing instruction in the general education classroom and thus may not be accommodations in all circumstances [60,61].

Effective writing programs — Components of effective writing programs for general education students are the same as those for quality instruction for WD. The Common Core Standards [62], which are adopted by most states, describe the specific writing skills and writing knowledge that students need to master.

Successful writing instruction includes teacher professional development in writing, an effective teacher, instruction in the components of writing, and maximum student participation. The use of peer-mediated instruction appears to be an especially favored instructional technique for teaching students how to write text because it provides a mechanism for obtaining feedback. (See 'Types of instruction' above and 'Specialized instruction in writing' above.)

Few effective writing programs are recognized in the educational literature. Two researched writing (composition) programs include the Self-Regulated Strategy Development (SRSD) writing program and Cognitive Strategy Instruction in Writing (CSIW), designed for general education students but also used for students with WD [19,63-65]. Both programs teach composition skills or text generation skills by using a writing strategy. Students can work through the writing strategy over the course of several days. The strategy includes steps such as learning about different kinds of text structures, planning, writing an initial draft, revising the draft, obtaining feedback from peers and teacher, writing a final draft, etc. These programs can be used in conjunction with instruction in handwriting, spelling, and punctuation skills and can be used for students of all ages.

The general idea in SRSD, for example, is that the teacher presents information about a genre of writing (story, persuasive essay, news article) and about the specific steps for writing in that genre [64]. The steps of the strategy are identified by vocabulary chosen by the teacher and as dictated by the genre. The students learn about the type of writing they will do by analyzing examples and learning the vocabulary needed to discuss that genre of writing; they then learn the vocabulary for the strategy that is used to write in that genre (table 2). This step in the strategy is an example of direct instruction, because students are asked to memorize the steps in the strategy.

The students are then asked to work through each of the steps and to practice using the strategy in writing a composition. This is called guided practice: the teacher guides the student through each of the steps. Interactive dialogue is emphasized in this model, between teacher and student, between peers, and by using self-statements (thinking aloud with oneself as one writes). Dialogue with others and with oneself is used to monitor one's own use of the steps in the strategy but also to identify and overcome frustration during the task of writing. Over time, the dialogic component transfers the teacher's guidance to the student.

The multiple components of this example of strategy instruction include labeling and memorizing the steps in the strategy; memorizing a mnemonic for the strategy (table 3); having specific examples for how to complete each of the steps of the strategy; guided practice (the teacher monitors the student's use of the strategy); self-guidance (self-monitoring) using dialogue; and self-regulation (changing one's behavior to overcome barriers along the way). Dialogue is used to help the student monitor whether they complete each of the steps, and to identify and address obstacles (including frustration) along the way. The emphasis of this model is not simply giving the student a list of steps to follow but helping the student "own" the strategy by seeing it in action, seeing for themself how it gets completed, and even how the strategy can be modified by the student to meet their personal needs. Over time as the student matures, self-dialogue is internalized.

The instruction described above is appropriate for students with WD, as well as for general education students. The literature is not clear about the intensiveness of instruction required by students with WD. Students with WD may need intensive instruction in handwriting accuracy and fluency, spelling (including phonics instruction), and English language conventions. For students who are still mastering lower-order skills, writing compositions can be taught by teaching (oral) narrative skills and by use of dictation and/or pictures. Overemphasis on handwriting, spelling, text composition, or text meaning in isolation is likely to hamper the student's writing progress. All of the writing skills should be taught simultaneously as well as sequentially [53,54].

When all of the components of writing instruction are addressed, writing outcomes in students in both regular and special education improve. However, not all states include a writing component in state-mandated examinations. Consequently, not all states or school districts address writing skills as a formal part of the general education curriculum, let alone as part of the curriculum for students with LD [66,67]. The consistency with which writing instruction strategies are offered is highly variable across school districts and states.

MATH DISABILITY

Specialized instruction in math — Competence in math depends upon mastery of lower-order skills which are then used in the service of higher-order skills. In math disability (MD), primary deficits occur in number sense and in math facts (arithmetic calculations). These two lower-order skills are necessary to develop competence in higher-order skills [68-70]. Performance in higher-order math skills also depends upon math fluency, ie, the fluent application of number sense and math facts. Students with MD also have difficulty solving word problems. This can be due to problems in number sense and calculation skills, or to a coexistent reading or language disability. Finally, visual-spatial and organizational problems can interfere with success in math. The clinical manifestations of MD are discussed separately. (See "Specific learning disorders in children: Clinical features", section on 'Math learning disorder'.)

For a more detailed description of the difficulties faced by students with MD, see references [68,69,71-73].

Components of instruction — Understanding the components of math skills is critical to understanding how to teach math. Each component skill may be affected separately from the next and may require its own specialized instruction [71]. The framework provided below serves as a starting point for discussing the content or the components that should be addressed for students with difficulty learning math. The content of math instruction for students with math LD is not different from the content of math instruction for general education students. "Specialized instruction" in math consists of providing instruction in smaller groups, frequent repetition and practice, more gradual transition from one skill to the next, and instruction over a longer period of time.

Expert opinion and meta-analytic review suggest that effective math instruction must address difficulties in the following areas [56,68,69]:

Number sense – Number sense refers to having mental representation of quantity (ie, the ability to estimate and judge magnitude). It is an early-emerging skill that can fail to develop in students with MD.

Number sense is a prerequisite for math and is a teachable skill. It can be compared to phonemic awareness, which is a prerequisite for reading decoding and is also a teachable skill. Number sense can be taught by identifying or estimating quantity (less and more); learning about 1:1 correspondence (eg, correlating the number of coins being dropped into a box with the sound each of the coins makes as it drops); serial ordering (numbers are always counted in the same order); "counting on" (ie, identifying changes in quantity by adding up from a smaller quantity to create a larger quantity); showing the link between addition and subtraction while using objects; using more than one type of visual representation for numbers (eg, a number line both horizontal and vertical); and other visual representations that show differences in size, volume, etc [72,73].

Math facts or calculation skills – Number sense is required to understand how to add, subtract, multiply, and divide numbers, but also improves as children learn about performing calculations. Students master calculation skills when they are taught the procedures for addition, subtraction, multiplication, and division.

Efficient and effective counting-strategy use – For students with MD, counting strategies need to be taught explicitly alongside number facts [68,69,74]. Students with MD may not develop their own strategic learning. For example, they may not learn that "counting upward" from the larger addend can save time when doing addition problems. Counting strategies can help develop both number sense and arithmetic combination skills [56,68,69]. As they become more proficient in counting strategies, students of math gradually develop memory-based retrieval of answers, which increases their overall efficiency.

Math fluency – Automatic retrieval of answers to basic addition, subtraction, multiplication, and division of numbers is a prerequisite to solving higher-order math problems efficiently. Students with MD have difficulty completing higher-order math problems when they have not yet developed automaticity in basic arithmetic combinations and cannot retrieve memorized answers to basic arithmetic combinations quickly. Remediation is crucial for students who continue to have deficiencies in math facts at the beginning of third grade. Strategy instruction can help the student identify errors in their calculations and/or in their retrieved answers (eg, by using known number combinations, using associations between number combinations, etc). Drilling and memorization alone are not as effective as the combination of drilling with strategy instruction.

Math vocabulary – Students with MD have difficulty with the language of math. They may reverse numbers or make errors when reading numbers aloud. Confusion about number symbols and signs (eg, "+," "-," "×," "÷," "=," etc) is a distinguishing characteristic of MD. In math, there are no context clues to help students decipher terms that they may not understand. The language of math must be taught directly and explicitly, not incidentally.

Word problems – Reading difficulties can aggravate difficulty acquiring math skills. Students with a reading disability and MD have greater difficulty with word problems than students with isolated MD. They also have greater difficulty understanding the meaning of the sentences describing the problem, understanding what the problem is asking, and identifying extraneous or irrelevant information. (See "Reading difficulty in children: Clinical features and evaluation", section on 'Clinical features'.)

General strategy instruction may be helpful in solving word problems (eg, "Read the problem; highlight the key words; solve the problems; check your work").

Visual-spatial skills in math – Students with MD may have difficulty organizing math problems on the page. They may copy numbers incorrectly, write numbers illegibly, misalign numbers, have left-right disorientation of numbers, misplace digits in multidigit numbers, skip rows or columns during calculations, fail to carry numbers (eg, regrouping when appropriate), reverse number problems, start a calculation in the wrong place, or may not recognize operator signs. The use of lined or graph paper or specific strategy instruction to prevent errors such as these can help improve the student's performance. Visual spatial weaknesses can also affect the student's understanding of volume and math problems in geometry.

Organization and planning in math – Students with MD have difficulty planning and organizing their approach to math problems. They have difficulty with multistep problems; they may fail to verify answers and may settle for the first answer they reach for a given problem. Teaching can include strategy instruction that requires the student to follow a prescribed sequence when solving math problems, to check solutions to basic math facts using a computer, or to prompt the student to ask if the answer is a reasonable one.

General teaching strategies — General teaching strategies that are important components of math instruction include [70,75-79]:

Explicit instruction (drill and practice) – Instruction in specific step-by-step sequences or strategies that solve specific types of math problems

Heuristics – A method or strategy for use across different types of math problem, such as: "Read the problem; highlight key words; solve the problem; check your work"

Verbalizing the steps (think-aloud strategy)

Cumulative review

Small group instruction

Adequate practice opportunities

Motivators

Instructional design to minimize the learning challenge (eg, breaking math problems down into component steps)

Frequent assessment, error detection, error correction, and the provision of feedback to the student and the teacher alike

Peer-assisted instruction, especially across grades

Engage students by using their prior understanding to introduce new topics

Scaffold instruction (providing a scheme for teaching one skill; applying that scheme for teaching another skill; reducing the use of the scheme as new skills are taught)

Range and sequence of examples – Choose examples that proceed from easier to more difficult, concrete to abstract, etc

Use of visual representations

Effective math programs — Guidance about the components that make up a quality math program are available from the National Mathematics Advisory Panel (NMAP 2008) [80].

The Common Core Standards [81], which are adopted by most states, describe the specific math skills and math knowledge that students need to master. Students with LD need to master the same skills. The Institute of Educational Sciences practice guide provides recommendations for teaching math to children in kindergarten and younger using developmental progression in teaching, repetition, and integrating math across school activities [82].

GRADE RETENTION AND SOCIAL PROMOTION — Grade retention is defined as the practice of having a student repeat a grade because of academic failure and is a common intervention for students who experience academic failure. The philosophy behind grade retention is that, if given another year to "catch up," the student's academic progress can improve over time. Proponents of grade retention may also say that students use the (undesirable) possibility of grade retention as a motivator to perform better. Social promotion is defined as advancing a student to the next grade even if they are not functioning at grade level.

The educational literature generally concludes that grade retention should be avoided [83]. Neither grade retention nor social promotion on its own is an effective educational intervention. Without classroom modifications and individualized instruction, students with learning problems, and especially students with learning disorders (LDs), will continue to experience learning difficulties, even after grade retention. Alternatives to grade retention and social promotion are discussed below. (See 'Alternatives to grade retention' below.)

Which students are retained? — There is no uniform practice for deciding how a student who shows academic failure is promoted versus retained. Many factors are associated with grade retention, including poor academic performance, behavioral regulation problems, poor attendance, and lower socioeconomic status. A disproportionate number of African American and Hispanic students are retained [84]. Another important factor that contributes to the practice of grade retention is the degree to which the school staff believes in grade retention as a useful intervention. A positive attitude among school staff toward grade retention increases the likelihood of grade retention [85]. Grade retention may be more common as a result of "high-stakes" testing that requires students to achieve a minimum score on statewide testing before being promoted. State-to-state variations in school expenditure and special education enrollment figures do not account for differences in grade retention between school districts. Grade retention is thus more dependent on individual, family, and neighborhood characteristics than on state-wide characteristics [86]. Grade retention that occurs early (eg, in kindergarten or grade one) does not appear to be more beneficial or more harmful than grade retention that occurs later [87].

Prevalence of grade retention — The data available to measure changes in the prevalence of grade retention are limited. A proxy for grade retention is the prevalence of students "below modal grade for age." Using this proxy, and correcting for late entry into school, the prevalence of grade retention is estimated to be between 10 and 20 percent in any given grade [88].

Is grade retention beneficial? — Most researchers do not believe that grade retention is effective for improving long-term outcomes [83]. Several outcome measures in grade retention research support this conclusion.

The outcomes measured in grade retention research include subsequent academic achievement, socioemotional status, and high school drop-out rates. When compared with same-age promoted peers, retained students show temporary gains in academic achievement and socioemotional status (behavioral regulation, emotional status, and peer acceptance), but these gains are not sustained over time [85,89,90]. An oft-quoted meta-analysis concludes that the majority of studies (95 percent) show that grade retention is associated with either no difference in effect (48 percent) or is associated with harm (47 percent) and should therefore be avoided [83].

Of specific concern is the association of grade retention with high school drop-out. Grade retention is considered to be the single most powerful predictor of high school drop-out, and students who drop out of high school are likely to have poor outcomes following high school, including lower wages and a lower likelihood of participating in postsecondary education, and to have poor employment competence ratings [91,92].

Although grade retention is associated with negative long-term outcomes, it remains unclear whether it is grade retention or characteristics intrinsic to the student or the student's environment, that cause the negative outcomes. Most studies of grade retention do not control for variables such as absenteeism, the extent to which instruction is individualized to the student with learning difficulty before or after retention, and/or the characteristics of the control group used for comparison. A randomized, controlled study is not possible. A more detailed discussion of grade retention research is available in references [93,94].

Considering the multiple factors associated with retaining a student, including undiagnosed LD, socioemotional factors, poverty, lower caregiver participation in school, and poor attendance [92,95], it is not surprising that an intervention as nonspecific as grade retention does not, on its own, significantly improve student outcomes. Furthermore, grade retention is an expensive intervention, since the school district takes on the cost of educating the student for at least one additional year of schooling [96]. The cost of grade retention in comparison to the cost of providing remedial and/or special education services is not certain.

Alternatives to grade retention — On their own, grade retention and social promotion are generally considered to be unfavorable strategies for students who are not succeeding academically [83,84,92,97].

Given the multiple factors associated with school difficulty (eg, undiagnosed LD, low self-concept, poor peer relations, poverty, poor attendance, etc) [92,95], the placement of the student (eg, general versus special education, retained versus promoted) should be determined only after identifying appropriate remediation goals and appropriate services, interventions, and accommodations that may help the student succeed over the short and long term.

For many students, especially those who start school with fewer academic advantages than their peers, preventive intensive intervention, even before kindergarten, may be the best path to success. For students who are frequently absent, understanding and addressing the reasons for their absence should be considered. Retention usually duplicates an entire year of schooling. Other options, such as summer school, before- or after-school programs, or extra help during the school day, could provide the equivalent extra time that the student requires and could be instructionally more effective. Students who are not succeeding academically might benefit from multi-age classrooms, school-based mental health programs, and/or behavioral modification and social-skills training [84,92,98-100].

Teacher attitude and school culture may be just as important to address when considering grade retention as an intervention. In some cases, retention may be recommended as an educational intervention, even when the local school district offers other, more valid options to address learning failure [101].

SPECIALIZED EDUCATION PLACEMENTS — Educational remediation is a critical component of treatment of learning disorders (LDs), and can be provided by the public school system through special education services, by special education private schools, or by private individual special education teaching services [102,103]. The eligibility requirements for special education within the public school system are defined by the Individuals with Disabilities Education Act (IDEA). However, there is wide variation in how students are selected for special education services by school district, county, state, and region. Some schools may also provide specialized educational supports under the Americans with Disabilities Act or through Section 504 planning (504 Accommodation Plan) instead of under the IDEA. (See "Definitions of specific learning disorder and laws pertaining to learning disorders in the United States", section on 'Section 504 of the Rehabilitation Act'.)

Not every child who may ultimately prove to have an LD will initially qualify to receive special education services under the umbrella of IDEA, according to the guidelines in their school district. Even when the student is found eligible, the quality of services remains variable. (See 'Quality instruction' above.)

When children with an LD are not eligible for special education services, it may be necessary for caregivers to provide specialized educational services privately. In seeking specialized education services for their child in school, caregivers may find it helpful to maintain a file of relevant documents. A list of important documents for caregivers to retain, as well as resources and information regarding state LD organizations, caregiver support groups, and advocates, are provided in the table (table 4), which may be printed and provided to caregivers.

Services offered under Section 504 and Every Student Succeeds Act – Schools offer many specialized services and accommodations to students, with and without LD. Services offered under general education regulations (Every Student Succeeds Act) and services provided under Section 504 of the Rehabilitation Act are typically offered in a regular education setting and can include an array of individualized academic supports, paraprofessional supports, and nursing and behavioral supports, among others. (See "Definitions of specific learning disorder and laws pertaining to learning disorders in the United States", section on 'Every Student Succeeds Act' and "Definitions of specific learning disorder and laws pertaining to learning disorders in the United States", section on 'Section 504 of the Rehabilitation Act'.)

Services under the IDEA – Under the IDEA, the full range of academic and other supports, as well as a continuum of placements, is offered to qualifying students. Services can be provided in the regular classroom, special classrooms, special schools, and in home, hospital, or other institutional settings. Schools are obliged to provide services in the "least restrictive environment" (often abbreviated LRE). The legal definition of "least restrictive" means that, to the maximum extent appropriate, children with disabilities are educated with children who are not disabled [104]. Examples of the continuum are listed below:

Primarily general education classroom – Children with LD who receive services in the regular classroom are "included" (or "mainstreamed") with non-LD students for at least 80 percent of the day. The remainder of the day is spent in the resource room or special education classroom. The general education teacher typically does not have training in special education but receives consultative support from the special education teacher who provides indirect services (consultation to the teacher) and direct services (individualized instruction) to the student [105].

Nationally, the percentage of LD students educated in mainstream settings (80 percent time in general education classrooms) has steadily increased from approximately 23 percent in 1990 to approximately 69 percent in 2015 [106]. This trend is less marked but also true for other disability categories and reflects federal and state policies that promote inclusion [107].

Resource room or special education classroom placement with partial mainstreaming – Many elementary school children with LD receive instruction in the resource room or separate classroom for between 21 to 60 percent of their school days. In the resource room, remedial instruction is provided to small groups of four to eight children [105,108]. The resource room teacher usually has advanced training in the techniques of instruction and in the modifications required to individualize instruction for children with LD. Instruction in the resource room can focus on basic skills or learning strategies [109]. Remediation should be coordinated with the regular classroom teacher so that the student uses the skills acquired in the resource room to participate and learn successfully in the general education classroom [102].

Self-contained classroom with minimal mainstreaming – Children with moderate or severe LD are usually served in a self-contained classroom, with 10 to 15 students, for more than 60 percent of the school day [110]. This setting enables more intensive individualized instruction, and students are able to receive more opportunities to practice required skills.

Substantially separate placement – The student's education can be provided exclusively in a resource room or special education classroom, a private special education school, a residential facility, or a hospital setting. However, these settings often do not meet the criterion of LRE and would typically not be used for a student with a sole diagnosis of LD.

Although placement questions often are a first point of discussion for caregivers and even some school personnel, more important aspects of the discussion include the educational goals for the student, the skills that the student needs to master, the professional training and qualifications of the staff needed to deliver the student's program, the curriculum required, and/or the intensity of instruction required.

Intensity of instruction refers to the number of opportunities that the student has to practice and master a new skill, and the number of opportunities offered for corrective feedback from teachers or peers. The number of these practice opportunities increases when instruction is offered for more time per day and more sessions per week. Practice opportunities also increase when the size of the instructional group allows for increased interactions with teachers and peers.

The amount of time per day and days per week that the teacher may need to deliver to the student is affected by the use and type of quality teaching practices necessary for a given student.

Placement questions can be addressed only once the student's curricular and therapeutic needs have been determined. The type of instruction needed by the student is not determined by the placement [105,108,110,111].

This issue is especially important for the adolescent with LD, as the curriculum provided has to address transition planning and may thus require service delivery outside a traditional school setting [112]. (See 'Transition planning' below.)

MANAGEMENT OF LEARNING DISORDER IN HIGH SCHOOL — As students enter secondary school, the focus of general education becomes more content driven; basic skills are no longer emphasized. Students with learning disorders (LDs) who are still mastering basic language, reading, writing, and math skills would be expected to have difficulty understanding higher-level classroom activities that are focused on content.

Lack of special education training among general education staff is more pronounced at the secondary school level. Inclusion in the general education classroom thus requires special attention to the student's capacity to identify, understand, and recall the information that is presented. If the student's education is to be meaningful, there may need to be greater emphasis upon accommodations. For example, information may need to be presented at a slower pace, using alternative types of presentation (visual representations, such as pictures or movies, or more small-group, peer-mediated, or discussion-based presentation) (table 1) [113]. The student may also need to be permitted to use alternative means to demonstrate their knowledge (eg, writing by dictation, using word processors to help with word retrieval and spell checking, etc) [109,113]. It is also important to focus on strategy instruction, so that the student with LD learns how to elaborate upon ideas and construct knowledge independently (ie, as opposed to rote memorization of skills or information) [113-116]. (See 'Strategy instruction' above.)

Students with LD can complete a high school curriculum and can also attend college, despite their LD. That said, a significant portion of students with LD have difficulty accessing a general education curriculum at the secondary level. They may need to shift the focus of their education to acquiring life skills [117]. Specialized vocational-technical training or work-study programs should be considered [118-121] in conjunction with individual tutoring, instructional modifications such as reducing the school workload while insisting on a higher number of correct responses, and strategy instruction [118-122]. Transition planning is an important component in determining the content of the student's curriculum and preparing the student for adult life, and it is discussed in the following section.

Transition planning — The high school curriculum should prepare students to cope successfully with the requirements of the postsecondary school or of employment [123]. To be successful, adolescents with LD require planning for the transition to their postsecondary life. Transition planning has traditionally focused on students with severe disabilities. However, students with LD also have significant limitations that affect their postschool success. Over one-third (35 percent) of students with LD drop out of school after the age of 14 years [124], which may indicate that a significant number of students with LD do not find their school experience to provide valuable knowledge or skills [125]. Although this statistic is concerning, there are also many students with LD who make the transition to postsecondary education. Appropriate and specific transition planning is thus needed by the adolescent with LD [126-128].

The Individuals with Disability Education Act (IDEA) requires secondary schools to initiate a plan for the transition from secondary school to postsecondary school (college degree programs, college certificate programs, or vocational training) or, depending on the student's interests and abilities, to employment [129]. This planning has to be initiated by the age of 15 years and continued throughout the rest of the student's public school career. School counselors are expected to participate in transition planning and to help to ensure that the skills needed for postsecondary education or employment are incorporated into the student's educational program, and to help choose appropriate postsecondary programs [130].

The IDEA lists the following components for transition plans [129,131]:

Student invitation

Measurable post-secondary goals

Age-appropriate transition assessments

Coordinated set of activities

Outside agency invitation

Annual individualized education program goals

Transfer of rights at age of majority

Effective transition practices include the following components:

Student invitation and student-focused planning – The student is actively involved in their own transition planning. This means that the student learns how to identify their own vocational interests and sets goals, and jointly monitors whether those goals are being reached. The student is expected to attend and participate in relevant planning meetings.

Student personal development – The student learns about their own disability, learns how to address the limitations of the disability, and learns how to advocate for themself to ensure maximum success. For example, the student is taught how to use strategies to help organize information, study effectively, and circumvent limitations in reading, writing, and/or math. In addition, the student is taught how to communicate about their disability with others (eg, administrators, employers, educators) and to advocate for their own needs. Finally, the student is taught about interpersonal communication in general, so that they can interact successfully with peers, accept feedback and criticism from educators or employers, and function successfully in a postsecondary school or work environment.

Student vocational opportunities – In developing the skills listed above, the student is provided with vocational or work-site opportunities to acquire vocational skills and/or to generate educational goals to develop a vocation or trade. Enrollment in a regional vocational-technical school in the student's district or in a nearby district should be offered if desired [119].

Student training in independent living – Systematic instruction in the basic concepts of maintaining a home, developing satisfactory personal and social relations, and participating in the community is just as important a component of transition planning to individuals with LD as it is to students with other disabilities. A variety of curricular models to achieve this goal, as well as the above goals, are listed in reference [132].

Family involvement – Family involvement improves school attendance, increases higher-education attendance and assessment scores, improves student self-esteem and confidence, and reduces drop-out rates. Direct routine communication strategies, such as face-to-face conferences, telephone contact, open-house events, teacher notes, and classroom visits, improve educator and family interactions [128]. An important component of involving the family and the student is to help both make connections with community agencies, services, employers, etc.

Interagency collaboration – In addition to the student- and family-focused aspects of transition described above, effective transition practices require the school to develop collaborative relationships with community agencies that offer work or vocational training opportunities and to develop a knowledge base of the colleges and postsecondary institutions and their services for students with LD. A variety of off-the-shelf curricular models for transition are available [133]. However, the school administration must be supportive of transition practices in general and provide the necessary leadership and vision for successful transition planning. This includes professional development in transition planning, creating collaborative relationships with community agencies and employers, etc [126-128]. The types of services described here are not available in a consistent manner across school districts or states [134].

SERVICES FOR LEARNING DISORDER IN COLLEGE — Students with learning disorders (LDs) are able to graduate from high school with a high school diploma. However, graduation requirements for students with LD may differ from those for general education students [135,136].

In the United States, approximately 6 percent of all undergraduates report having a disability; among these, 29 percent have an LD. This means that nearly 2 percent of all postsecondary students have an LD. Among undergraduate students, the average age of students with disabilities (type not specified) was 30 years, compared with 26 years among students without a disability [137].

Unlike public schools, colleges and universities are not required to identify or evaluate students for a disability, nor are they required to provide individualized special instruction. They are only required to provide "reasonable accommodations" to students with a documented disability. College students with disabilities must self-disclose their disability, must furnish documentation of their disability at personal expense, and must self-advocate to access those reasonable accommodations that may be available [138]. A detailed summary of the documentation requirement for college students is found in text of reference [139].

There are many services available for students with LD at the college level. Adolescents who are interested in pursuing a postsecondary education will need guidance in selecting appropriate college preparatory courses and will need information regarding the admissions policies of colleges, the special nonstandard conditions available for college entrance examinations, and the types of college programs available for students with LD [130]. Additional skills that are necessary for the transition to the postsecondary educational setting are listed in the table (table 5).

Services for students with LD at the college level can include program accommodations, such as a part-time schedule or modified course requirements, longer time to complete a program, ability to repeat classes without penalty, waiver of language requirements, and course substitution. Support services can include an individualized academic plan; tutoring; personal counseling; specific instructional learning strategies, such as training to improve memory and study skills; and training in the use of and access to adaptive technology, such as assistive listening devices or talking computers [140]. Students may also have access to alternative examination formats, readers and classroom note-takers, or textbooks on tape [137,141]. These accommodations and services are offered in a highly variable manner across colleges and universities.

OUTCOMES — Outcomes for individuals with learning disorders (LDs) are not clearly defined in the research literature. Several questions need clarification before overall adult status of students identified with LD will become clear. Most research addresses outcomes in terms of work performance and functionality. Outcomes research should focus on the employment status of individuals with LD, as well as their capacity to have friendships, create intimate relationships, and raise children, if this is their choice. Only a limited number of studies address all of these outcomes. In addition, many outcomes studies do not separate adults with LD from adults with other kinds of disabilities and only evaluate outcomes for the first few years following graduation from high school.

Reading, spelling, and math problems in individuals with LD persist into adulthood [142,143]. However, not all individuals with LD have difficulty in the larger task of living an adult life. After their high school education, individuals with LD are employed at the same rate as their nondisabled peers [144] but are less likely to have left home to live independently [145]; more likely to earn lower wages [146]; and more likely to have lower job satisfaction [147]. Adults with LD are less likely to obtain postsecondary education. Approximately 30 percent of individuals with LD pursue a postsecondary education, which is less than half of the population as a whole [144]. However, of those who pursue college training, wages and job satisfaction appear to be just as good as for their nondisabled peers [148,149].

Reframing of the meaning of their LD is an important predictor of success in adults with LD. Reframing involves recognizing, understanding, and accepting the LD. It also involves having a plan of action that includes the ability to answer employer questions about the impact of the LD on productivity and the individual's capacity for team work, as well as a consideration of non-work-related factors, such as the capacity to build friendships and intimacy, and the capacity to have a family [150].

INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or email these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword[s] of interest.)

Basics topic (see "Patient education: Learning disabilities (The Basics)")

SUMMARY AND RECOMMENDATIONS

Preventive measures – The management of the student with learning disorder (LD) begins with quality instruction, even before the student is identified as having an LD. Quality instruction includes identifiable quality teacher practices such as having a well-organized lesson plan, spacing learning over time (ie, repetition of the same learning concept over time), combining verbal descriptions with graphics, connecting and integrating abstract and concrete representations of concepts, quizzing students to promote learning, helping students with time allocation, asking questions to develop greater awareness of the subject matter, and using preworked solutions for problem-solving exercises. (See 'Preventive measures' above.)

Response to intervention services – For students who are not succeeding academically, "response to intervention" (RTI) services often are provided before the student is formally evaluated for LD. RTI is a legal term that applies to specialized academic and therapeutic services that are provided to a general education student to improve the student's success at school. The student's response to intervention can help distinguish learning failure related to inadequate instruction from learning failure related to specific LD (or another disability). The services provided are the same types of services that might be provided in a Section 504 Accommodation plan or in an Individualized Education Program. (See "Specific learning disorders in children: Evaluation", section on 'Diagnostic process' and 'Response to intervention services' above.)

Types of instruction – Components of quality instruction for children with LD include: explicit or direct instruction (ie, drill and practice) and strategy instruction (ie, instruction in the procedure or process used to approach learning). Quality instruction also applies to teacher behaviors, such as stating the learning objectives, having a clearly organized lesson plan, reviewing concepts multiple times, providing examples, and proceeding through material in small steps. (See 'Types of instruction' above.)

The provision of quality services, interventions, and accommodations is preferable to simple grade retention or social promotion for children with specific LD. (See 'Accommodations and modifications for students with learning disorder in the general education classroom' above and 'Grade retention and social promotion' above.)

Interventions for reading disability – Interventions for children with reading disability are discussed separately. (See "Reading difficulty in children: Interventions".)

Interventions for writing disability – Instruction for children with writing disability should include explicit instruction in handwriting (transcription) accuracy, handwriting fluency, phonologic awareness and phonics (to help with spelling), writing fluency (the fluent production of correctly spelled words), and strategy instruction in language conventions (punctuation and grammar) and in writing text or compositions. (See 'Writing disability' above.)

Interventions for math disability – Instruction for children with math disability should include explicit and strategy instruction in number sense, math facts or math calculations, math fluency, math vocabulary, word problems, visual-spatial relationships, and organizing and planning. (See 'Specialized instruction in math' above.)

Transition planning – Planning for the transition to postsecondary school or employment is an important aspect of the management of LD during high school. (See 'Transition planning' above.)

Outcomes – Reading, spelling, and math problems in individuals with LD persist into adulthood. After high school, individuals with LD are employed at the same rate as their nondisabled peers. Among those who attend college, wages and job satisfaction appear to be similar to those of their nondisabled peers. Those who do not attend college are less likely to have left home to live independently, more likely to earn lower wages, and more likely to have lower job satisfaction than their nondisabled peers. (See 'Outcomes' above.)

  1. American Psychiatric Association. Specific Learning Disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, American Psychiatric Association, Washington, DC 2022. p.76.
  2. American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists. Joint statement--Learning disabilities, dyslexia, and vision. Pediatrics 2009; 124:837.
  3. Heward WL. Ten faulty notions about teaching and learning that hinder the effectiveness of special education. J Spec Educ 2003; 36:186.
  4. Institute of Education Sciences. What works clearinghouse. http://ies.ed.gov/ncee/wwc/default.aspx (Accessed on August 26, 2013).
  5. Pashler H, Bain P, Bottge B, et al. Organizing Instruction and study to improve student learning. IES Practice Guide. US Department of Education and the Institute of Education Sciences, September 2007. http://ies.ed.gov/ncee/wwc/pdf/practice_guides/20072004.pdf (Accessed on August 21, 2013).
  6. Thalheimer W. Spacing Learning Events Over Time: What the Research Says. February 2006. www.work-learning.com (Accessed on August 21, 2013).
  7. Kretlow AG, Helf SS. Teacher implementation of evidence-based practices in tier 1: A national survey. Teach Educ Spec Educ 2013; 36:167.
  8. Reid Lyon G, Weiser B. Teacher knowledge, instructional expertise, and the development of reading proficiency. J Learn Disabil 2009; 42:475.
  9. Washburn EK, Joshi RM, Binks-Cantrell ES. Teacher knowledge of basic language concepts and dyslexia. Dyslexia 2011; 17:165.
  10. McKenna JW, Shin M, Ciullo S. Evaluating reading and mathematics instruction for students with learning disabilities: A synthesis of observation research. Learn Disabil Q 2015; 38:195.
  11. Billingsley B, Bettini E. Special education teacher attrition and retention: A review of the literature. Rev Educ Res 2019; 89:1.
  12. Calhoun MC, Berkley S, Scanlon D. The erosion of FAPE for students with LD. Learn Disabil Res Pract 2018; 34:1.
  13. Vaugh S, Zumeta R, Wanzek J, et al. Intensive interventions for students with learning disabilities. DLD Position Statement 1. February 2014. http://ec.ncpublicschools.gov/disability-resources/specific-learning-disabilities/intensive-interventions.pdf (Accessed on June 12, 2015).
  14. Therrien W, Zaman M, Banda DR. How can meta-analyses guide practice? A review of the learning disability research base. Remedial Spec Educ 2011; 32:206.
  15. Stockard J, Wood TW, Coughlin C, Khoury CR. The effectiveness of direct instruction curricula: A meta-analysis of a half-century of research. Rev Educ Res 2018; 88:479.
  16. William L, Heward W. Ten Faulty Notions About Teaching and Learning That Hinder the Effectiveness of Special Education. J Spec Educ 2003; 36:186.
  17. Swanson HL, Deshler D. Instructing adolescents with learning disabilities: converting a meta-analysis to practice. J Learn Disabil 2003; 36:124.
  18. Ellis E. Integrative Strategy Instruction: A potential Model for Teaching Content Area subjects to adolescents with Learning disabilities. J Learn Disabil 1996; 26:358.
  19. Harris K, Graham S. Programmatic Intervention research: illustrations from the evolution of self-regulated strategy development. Learn Disabil Q 1999; 22:251.
  20. Blair T, Rupley W, Nichols W. The Effective teacher of reading: considering the “what” and “how" of instruction. Read Teach 2007; 60:432.
  21. Rosenshine B. Advances in research on Instruction. J Educ Res 1995; 88:262.
  22. Vaughn S, Gersten R, Chard D. The underlying message in LD intervention research: Findings from research syntheses. Except Child 2000; 67:99.
  23. Slavin R, Lake C, Chambers B, et al. Effective Reading programs for the elementary grads: A best-evidence synthesis. Rev Educ Res 2009; 79:1391.
  24. Carpenter SK, Cepeda NJ, Rohrer D, et al. Using spacing to enhance diverse forms of learning: Review of recent research and implications for instruction. Educ Psychol Rev 2012; 24:369.
  25. Scruggs TE, Mastropieri MA, Okolo CM. Science and social studies for students with disabilities. Focus Except Child 2008; 41:24.
  26. Stenhoff DM, Lignagaris B. A Review of the Effects of Peer Tutoring on Students with Mild Disabilities in Secondary Settings. Except Child 2007; 74:8.
  27. Barrio BL, Combes BH. General education pre-service teachers’ levels of concern on Response to Intervention (RTI) implementation. Teach Educ Spec Educ 2015; 38:121.
  28. National Center For Education Statistics. Teacher Preparation and Professional Development: 2000. http://nces.ed.gov/pubs2001/2001088.pdf (Accessed on August 21, 2013).
  29. Regan KS, Berkley SL, Hughes M, Brady KK. Understanding practitioner perceptions of responsiveness to intervention. Learn Disabil Q 2015; 38:234.
  30. Castro-Villarreal F, Rodriguez BJ, Moore S. Teachers' perceptions and attitudes about Response to Intervention (RTI) in their schools: A qualitative analysis. Teach Teach Educ 2014; 40:104.
  31. Fuchs LS, Vaughn S. Responsiveness-to-intervention: a decade later. J Learn Disabil 2012; 45:195.
  32. Fuchs D, Compton D, Fuchs L, et al. Making "secondary intervention" work in a three-tier responsiveness-to-intervention model: findings from the first grade longitudinal reading study of the National Research Center on Learning disabilities. Read Writ 2008; 21:413.
  33. Reutebuch CK. Succeed with a Response-to-Intervention model. Interv Sch Clin 2008; 44:126.
  34. Gartland D, Strosnider R. NJCLD Position Paper: Responsiveness to Intervention and Learning Disabilities. Learn Disabil Q 2005; 28:249.
  35. Vaughn S, Denton CA, Fletcher JM. WHY INTENSIVE INTERVENTIONS ARE NECESSARY FOR STUDENTS WITH SEVERE READING DIFFICULTIES. Psychol Sch 2010; 47:432.
  36. Torgesen JK. The response to intervention instructional model: Some outcomes from a large-scale implementation in Reading First schools. Child Dev Perspect 2009; 3:38.
  37. VanDerHeyden AM, Witt JC, Gilbertson D. A multi-year evaluation of the effects of a response to intervention (RTI) model on identification of children for special education. J Sch Psychol 2007; 45:225.
  38. Wanzek J, Vaughn S. Is a three-tier reading intervention model associated with reduced placement in special education? Remedial Spec Educ 2010; 32:167.
  39. IDEA 2004. CFR 34 CFR 300.500. Procedural safeguards. Authority: (20 U.S.C. 1415[a]). Downloaded from: idea.ed.gov (Accessed on January 29, 2010).
  40. Fletcher J, Francis D, O'Malley K. Effects of bundled accommodations package on high stakes testing for middle school students with learning disabilities. Except Child 2009; 75:447.
  41. Fuchs L, Fuchs D, Capizzi A. Identifying appropriate test accommodations for students with learning disabilities. Focus Except Child 2005; 37.
  42. National Center on Universal Design for Learning. http://www.udlcenter.org/aboutudl/whatisudl (Accessed on December 06, 2010).
  43. CAST. http://www.cast.org/about (Accessed on December 06, 2010).
  44. Pisha B, Stahl S. The promise of new learning environments for students with learning disabilities. Interv Sch Clin 2005; 41:67.
  45. Hitchcock C, Meyer A, Rose D, Jackson R. Providing new access to the general curriculum. Universal Design for Learning. Teach Except Child 2002; 35:8.
  46. Olinghouse NG. Student- and instruction-level predictors of narrative writing in third-grade students. Read Writ 2008; 21:3.
  47. Troia G, Graham S. Effective writing instruction across the grades: what every educational consultant should know. J Educ Psychol Consult 2003; 14:75.
  48. McMaster KL, Kunkel A, Shin J, et al. Early Writing Intervention: A Best Evidence Synthesis. J Learn Disabil 2018; 51:363.
  49. Asher AV. Handwriting instruction in elementary schools. Am J Occup Ther 2006; 60:461.
  50. Hoy MM, Egan MY, Feder KP. A systematic review of interventions to improve handwriting. Can J Occup Ther 2011; 78:13.
  51. Santangelo T, Graham S. A comprehensive meta-analysis of handwriting instruction. Educ Psychol Rev 2015; 28:225.
  52. Ritchey K. The building blocks of writing: Learning to write letters and spell words. Read Writ 2008; 21:27.
  53. Graham S. Handwriting and spelling instruction for students with LD: A Review. Learn Disabil Q 1999; 22:78.
  54. Wanzek J, Vaughn S, Wexler J, et al. A synthesis of spelling and reading interventions and their effects on the spelling outcomes of students with LD. J Learn Disabil 2006; 39:528.
  55. Scott CM. Principles and methods of spelling instruction: Applications for poor spellers. Top Lang Disord 2000; 20:66.
  56. Gersten R, Chard D, Jaynathi M, et al. Mathematics Instruction for Students with Learning Disabilities: A meta-analysis of instructional components. Rev Educ Res 2009; 79:1202.
  57. Troia G, Graham S, Harris K. Teaching students with Learning disabilities to mindfully plan when writing. Except Child 1999; 65:235.
  58. Gibson SA. An Effective Framework for primary-grade guided writing instruction. Read Teach 2008; 62:324.
  59. Batorowicz B, Missiuna CA, Pollock NA. Technology supporting written productivity in children with learning disabilities: a critical review. Can J Occup Ther 2012; 79:211.
  60. MacArthur CA. Using technology to enhance the writing processes of students with learning disabilities. J Learn Disabil 1996; 29:344.
  61. MacArthur C. New tools for writing: Assistive technology for students with writing difficulties. Top Lang Disord 2000; 20:85.
  62. The Common Core State Standards for English Language Arts and Literacy in History/Social Studies, Science, and Technical Subjects. Available at: https://learning.ccsso.org/wp-content/uploads/2022/11/ELA_Standards1.pdf (Accessed on October 11, 2023).
  63. Englert CS, Mariage TV. Shared understandings: structuring the writing experience through dialogue. J Learn Disabil 1991; 24:330.
  64. Harris K, Graham S, Mason L. Self-regulated strategy development in the classroom: Part of a balanced approach to writing instruction for students with disabilities. Focus Except Child 2003; 35.
  65. Englert RS, Raphael TE, Anderson LM, et al. Making strategies and self-talk visible: Writing instruction in regular and special education classrooms. Am Educ Res J 1991; 28:337.
  66. Gersten R, Baker S. Teaching expressive writing to students with Learning Disabilities: A meta-analysis. Elem Sch J 2001; 97:475.
  67. Harris, Learning Differences Conference, Harvard University Graduate School of Education, 2009, personal communication.
  68. Gersten R, Chard D. Rethinking mathematics instruction for students with Math Disabilities. J Spec Educ 1999; 33:19.
  69. Gersten R, Jordan NC, Flojo JR. Early identification and interventions for students with mathematics difficulties. J Learn Disabil 2005; 38:293.
  70. Geary DC. Consequences, characteristics, and causes of mathematical learning disabilities and persistent low achievement in mathematics. J Dev Behav Pediatr 2011; 32:250.
  71. Dowker A. Early identification and intervention for students with mathematics difficulties. J Learn Disabil 2005; 38:324.
  72. Bryant B, Bryant D, Kathley C, et al. Preventing mathematics difficulties in the primary grades: The critical features of instruction in textbooks as part of the equation. Learn Disabil Q 2008; 31:21.
  73. Bryant B, Bryant D. Introduction to the special series. Mathematics Learning Disabilities. Learn Disabil Q 2008; 31:3.
  74. Kroesbergen EH, Johannes EH, Van Luit C, Maas JM. Effectiveness of explicit and constructivist mathematics instruction for low-achieving students in the Netherlands. Elem Sch J 2004; 104:233.
  75. Fuchs LS, Fuchs D, Powell SR, et al. Intensive Intervention for Students with Mathematics Disabilities: Seven Principles of Effective Practice. Learn Disabil Q 2008; 31:79.
  76. Soares N, Evans T, Patel DR. Specific learning disability in mathematics: a comprehensive review. Transl Pediatr 2018; 7:48.
  77. Gersten R, Chard DJ, Javanthi M, et al. Mathematics instruction for students with learning disabilities: A meta-analysis of instructional components. Rev Educ Res 2009; 79:1202.
  78. National Research Council. How Students learn: History, mathematics and science in the classroom, Donovan MS Bransford JD (Ed), National Academies Press, Washington DC 2005.
  79. Coyne MD, Carnine DW, Kame'enui EJ. Effective Teaching Strategies that Accommodate Diverse Learners, 4th ed, Prentice Hall, Upper Saddle River, NJ 2011.
  80. US Department of Education. Foundations for success: The final report of the National Mathematics Advisory Panel, 2008. Available at: https://eric.ed.gov/?id=ED500486 (Accessed on February 17, 2023).
  81. Common Core State Standards for Mathematics. Available at: https://corestandards.org/mathematics-standards/ (Accessed on October 11, 2023).
  82. Institute of Educational Sciences. Practice Guide: Teaching Math to Young Children. Available at: https://ies.ed.gov/ncee/wwc/PracticeGuide/18.
  83. Jimerson S. Meta-analysis of grade retention research: Implications for practice in the 21st century. School Psych Rev 2001; 30:420.
  84. Jimerson SR, Fletcher SM, Graydon K. Beyond grade retention and social promotion: Promoting the social and academic competence of students. Psychol Sch 2006; 43:85.
  85. Bonvin P, Bless G, Schuepback M. Grade retention: decision-making and effects on learning as well as social and emotional development. Sch Eff Sch Improv 2008; 19:1.
  86. Corman H. The effects of state policies, individual characteristics, family characteristics, and neighborhood characteristics on grade repletion in the United States. Econ Educ Rev 2003; 22:409.
  87. Silberglitt B, Jimeson S, Burns M, Appleton J. Does the timing of grade retention make a difference? Examining the effects of early versus later retention. School Psych Rev 2006; 35:134.
  88. Frederick CB, Hauser RM. Have we put an end to social promotion? Changes in school progress among children aged 6 to 17 from 1972 to 2005. Demography 2008; 45:719.
  89. Wu W, West SG, Hughes JN. Effect of Retention in First Grade on Children's Achievement Trajectories Over 4 Years: A Piecewise Growth Analysis Using Propensity Score Matching. J Educ Psychol 2008; 100:727.
  90. Wu W, West SG, Hughes JN. Effect of Grade Retention in First Grade on Psychosocial Outcomes. J Educ Psychol 2010; 102:135.
  91. Jimerson S, Anderson G, Whipple A. Winning the Battle and losing the war: Examining the relation between grade retention and dropping out of high school. Psychol Sch 2002; 39:441.
  92. Stearns E, Moller S, Blau J, Potochnick S. Staying back and Dropping out: the relationship between grade retention and school dropout. Sociol Educ 2007; 80:210.
  93. Allen CS, Chen Q, Willson VL, Hughes JN. Quality of Research Design Moderates Effects of Grade Retention on Achievement: A Meta-analytic, Multi-level Analysis. Educ Eval Policy Anal 2009; 31:480.
  94. Alexander K, Entwisle D, Dauber S. On the Success of Failure: A Reassessment of the Effects of Retention in the Primary School Grades, 2nd ed, Cambridge University Press, Cambridge, UK 2003.
  95. McCoy AR, Reynolds AJ. Grade retention and school performance: An extended investigation. J Sch Psychol 1999; 37:273.
  96. Eide E, Showalter M. The effect of grade retention on educational and labor market outcomes. Econ Educ Rev 2001; 20:563.
  97. Jimerson S, Woehr S, Kaufman A, Anderson G. Grade retention and promotion: Information and strategies for educators. Position paper: National Association of School Psychologists 2004. Available at: www.nasponline.org (Accessed on July 29, 2010).
  98. David JL. What the research says about grade retention. Educational Leader 2008; 65:83.
  99. Jimerson S, Kaufman A. Reading, writing, and retention: A primer on grade retention research. Read Teach 2003; 56:622.
  100. US DOE practice guide: Dropout Prevention. NCEE 2008-4025. National Center for Education Evaluation and Regional Assistance. Institute of Education Sciences
  101. Picklo DM, Christenson SL. Alternatives to Retention and Social Promotion: The Availability of Instructional Options. Remedial Spec Educ 2005; 26:258.
  102. Lerner J. Learning Disabilities: Theories, Diagnosis, and Teaching Strategies, Houghton Mifflin Company, Boston 2000.
  103. Fleischner JE. Educational management of students with learning disabilities. J Child Neurol 1995; 10 Suppl 1:S81.
  104. IDEA 2004. 34 CFR 300.115(b). Authority: (20 U.S.C. 1412[a][5]). 34 CFR 300.114 (a)(2)(i) and (ii). Authority: (20 U.S.C. 1412[a][5]). Available at: idea.ed.gov (Accessed on January 29, 2010).
  105. Lerner JW. Educational interventions in learning disabilities. J Am Acad Child Adolesc Psychiatry 1989; 28:326.
  106. National Center for Education Statistics. Fast Facts: Students with disabilities, inclusion of. Institute of Education Sciences, 2019. Available at: https://nces.ed.gov/fastfacts/display.asp?id=59.
  107. McLeskey J, Landers E, Williamson P, Hoppey D. Are We Moving Toward Educating Students With Disabilities in Less Restrictive Settings? J Spec Educ 2012; 46:131.
  108. McInerny TK. Children who have difficulty in school: a primary pediatrician's approach. Pediatr Rev 1995; 16:325.
  109. Baker JM, Zigmond N. The meaning and practice of inclusion for students with learning disabilities: Themes and implications from the five cases. J Spec Educ 1995; 29:163.
  110. Zigmond N. Models for delivery of special education services to students with learning disabilities in public schools. J Child Neurol 1995; 10 Suppl 1:S86.
  111. Whinnery KW, King M. Perceptions of students with learning disabilities. Prev Sch Fail 1995; 40:5.
  112. Edgar E, Polloway E. Education for Adolescents with disabilities: Curriculum and placement issues. J Spec Educ 1994; 27:438.
  113. Deshler DD, Schumaker JB, Lenz BK, et al. Ensuring content-area learning by secondary students with learning disabilities. Learn Disabil Res Pract 2001; 16:96.
  114. Ellis ES, Deshler DD, Schumaker JB. Teaching adolescents with learning disabilities to generate and use task-specific strategies. J Learn Disabil 1989; 22:108.
  115. Ellis ES. Watering up the curriculum for adolescents with learning disabilities - Goals of the knowledge dimension. Remedial Spec Educ 1997; 18:326.
  116. Casareno A, Ellis E. Ed Ellis: Working to improve education for adolescents with learning disabilities. Interv Sch Clin 2002; 37:292.
  117. Lieberman LM. The LD adolescent.... When do you stop? J Learn Disabil 1981; 14:425.
  118. Whinnery KW. College preparation for students with learning disabilities: A curriculum approach. Prev Sch Fail 2003; 37:31.
  119. Cawley JF, Kahn H, Tedesco A. Vocational education and students with learning disabilities. J Learn Disabil 1989; 22:630.
  120. Janiga SJ, Costenbader V. The transition from high school to postsecondary education for students with learning disabilities: a survey of college service coordinators. J Learn Disabil 2002; 35:462.
  121. Brinckerhoff LC. Making the transition to higher education: opportunities for student empowerment. J Learn Disabil 1996; 29:118.
  122. Hock MF, Deshler DD, Schumaker JB. Learning strategy instruction for at-risk and learning-disabled adults: The development of strategic learners through apprenticeship. Prev Sch Fail 1993; 38:43.
  123. Skinner ME, Lindstrom BD. Bridging the gap between high school and college: Strategies for the successful transition of students with learning disabilities. Prev Sch Fail 2003; 47:132.
  124. Office of Special Education and Rehabilitative Services, Office of Special Education Programs. 26th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, 2004, Vol. 1. US Department of Education, Washington, DC 2006.
  125. Patton JR, Cronin ME, Jairrels V. Curricular implications of transition. Remedial Spec Educ 1997; 18:294.
  126. Cummings R, Maddux C, Casey J. Individualized transition planning for students with learning disabilities. Career Dev Q 2000; 49:60.
  127. DuFur S. IEP transition Planning- from compliance to quality. Exceptionality 2003; 11:115.
  128. Kohler P, Field S. Transition-focused education: foundation for the future. J Spec Educ 2003; 37:174.
  129. IDEA 2004. Definition of transition planning. 34 CFR 300.43(a). Authority: (20 U.S.C. 1401[34]). Age requirement for start of transition planning. 34 CFR 300.320(b) and (c) Authority: (20 U.S.C. 1414 [d][1][A][I][VIII]). Available at: https://sites.ed.gov/idea/ (Accessed on February 17, 2023).
  130. Hildreth BL, Dixon ME. College readiness for students with learning disabilities: The role of the school counselor. Sch Couns 1994; 41:343.
  131. Kohler PD, Field S. Transition-Focues Education: Foundation for the Future. J Spec Educ 2003; 37:174.
  132. Sitlington PL. Transition to living: the neglected component of transition programming for individuals with learning disabilities. J Learn Disabil 1996; 29:31.
  133. Bouck E. Functional curriculum models for secondary students with mild mental impairment. Educ Train Dev Disabil 2009; 44:435.
  134. Zhang D, Ivester J, Katsiyannis A. Teachers’ view of transition services: results from a statewide survey in South Carolina. Educ Train Dev Disabil 2005; 40:360.
  135. McGee A. Skills, standards, and disabilities: How youth with learning disabilities fare in high school and beyond. Econ Educ Rev 2011; 30:109.
  136. Thurlow ML, Ysseldyke JE, Reid CL. High school graduation requirements for students with disabilities. J Learn Disabil 1997; 30:608.
  137. National Center for Education Statistics. Post secondary students with disabilities: enrollment, services, and persistence. June 2000. Downloaded from: http://nces.ed.gov/pubsearch/pubsinfo.
  138. Shaw S. Transition to postsecondary education. Focus on Except Child 2009; 42:2.
  139. National Joint Committee on Learning Disabilitites. The documentation disconnect for students with learning disabilities. Learn Disabil Q 2007; 30.
  140. Mull C, Sitlington P, Alper S. Postsecondary education for students with learning disabilities. Except Child 2001; 68:97.
  141. Rath K, Royer J. The nature and effectiveness of learning disability services for college students. Educ Psychol Rev 2002; 14:353.
  142. Undheim AM. A thirteen-year follow-up study of young Norwegian adults with dyslexia in childhood: reading development and educational levels. Dyslexia 2009; 15:291.
  143. Morris MA, Schraufnagel CD, Chudnow RS, Weinberg WA. Learning disabilities do not go away: 20- to 25-year study of cognition, academic achievement, and affective illness. J Child Neurol 2009; 24:323.
  144. Wagner MM, Blackorby J. Transition from high school to work or college: how special education students fare. Future Child 1996; 6:103.
  145. Janus AL. Disability and the transition to adulthood. Soc Forces 2009; 88:99.
  146. Dickinson DL, Verbeek RL. Wage differentials between college graduates with and without learning disabilities. J Learn Disabil 2002; 35:175.
  147. Kavale K, Forness S. Learning disability grows up: Rehabilitation issues for individuals with learning disabilities. J Rehabil 1996; 62:34.
  148. Seo Y, Abbott RD, Hawkins JD. Outcome status of students with learning disabilities at ages 21 and 24. J Learn Disabil 2008; 41:300.
  149. Madaus JW. Employment outcomes of university graduates with learning disabilities. Learn Disabil Q 2006; 29:19.
  150. Gerber PJ, Reiff HB, Ginsberg R. Reframing the learning disabilities experience. J Learn Disabil 1996; 29:98.
Topic 614 Version 26.0

References

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