Magazine article Clinical Psychiatry News

Social and Emotional Costs of Learning Disabilities

Magazine article Clinical Psychiatry News

Social and Emotional Costs of Learning Disabilities

Article excerpt

The notion that learning disabilities are an academic problem exclusively is not only erroneous, it's dangerous. The struggles of children with impairments in reading, writing, math, memory, and organization extend far beyond the classroom and often contribute to a heavy psychological burden.

Multiple studies demonstrate that adolescents with learning disabilities frequently exhibit co-occurring emotional and behavioral problems, including depression, anxiety, conduct disorders, and delinquency In the landmark 2001 National Longitudinal Study of Adolescent Health, a cross-sectional analysis of the in-home interview data of more than 20,000 adolescents included in the study showed that rates of emotional distress, suicide attempts, and involvement in violence were significantly increased in the 1,301 adolescents who were identified as having a learning disability, compared with their non-learning impaired peers (J. Adolesc. Health 2001;27:340-8). Similar results have been reported in a variety of community and clinical samples.

As many as 20% of people in the United States have a learning disability (including about 3 million children aged 6-21 years who receive special education services in school), and about 30% of learning-disabled children have behavioral and emotional problems, according to data presented in the Department of Education's 2005 report to Congress on the Individuals With Disabilities Education Act (www.ed.gov/about/reports/annual/osep/2005/index.html). The lesson? The societal impact of this problem is huge.

In the 2003 National Survey of Children's Health, learning disabilities were the most commonly diagnosed emotional, developmental, or behavioral problem of children aged 0-17 years. Compared with their peers without developmental problems, these children had lower self-esteem, had more depression and anxiety, and missed more school and were less involved in sports and other community activities (Pediatrics 2006;117:e1202-12).

In addition, children with learning disabilities drop out of high school at a disproportionately higher rate than their peers, and high school dropouts are 3.5 times more likely to have trouble with the law than are those who graduate, according to the National Center for Educational Statistics.

Literature on the causal direction of the co-occurrence of behavioral/emotional and learning problems is inconsistent. For example, it is unclear whether learning impairments beget mental health troubles or vice versa, whether the causation is reciprocal, or whether a shared etiologic factor underlies the overlap. It is clear, however, that "a cascade of negative psychosocial effects" occur with learning disabilities," said David Osher, Ph.D., project director for the American Institutes for Research in Washington.

Adult expectations of adolescents make them particularly vulnerable to negative sequelae, contends John McNamara, Ph.D., associate professor in the department of child and youth studies at Brock University in St. Catharines, Ont. A younger child with a learning disability who exhibits a behavioral need probably would be identified in elementary school, but a teenager at risk for emotional or behavioral problems "is operating within a setting where expectations shift to the adolescents advocating for themselves--so a kid in trouble can fall off the radar," he said.

In a large-scale study published in 2005, Dr. McNamara and his colleagues explored the relationship in adolescents between learning disabilities and risk-taking behavior. They determined that adolescents with learning disabilities (and adolescents with learning disabilities and comorbid attention-deficit hyperactivity disorder) were significantly more likely to smoke, use alcohol and marijuana, engage in acts of direct aggression, and engage in acts of minor delinquency (Learn. Disabil. Res. and Pract. 2005; 20:234-44).

In a recent follow-up to that study, which is slated for publication this summer, Dr. McNamara said he and his colleagues asked why adolescents with learning disabilities engage in these risk-taking activities to a greater extent than their non-learning disabled peers. The investigators found support for their hypothesis that psychosocial factors partly mediate the link.

Among the mediating psychosocial covariates were adolescents' familial relationships, engagement in school and extracurricular activities, and feelings of well-being and of being victimized. "To us, these findings support the idea that it is a combination of the learning disability, per se, and the secondary psychosocial characteristics associated with adolescents with learning disabilities that explains the more frequent engagement in risk taking," he said.

The findings also show that "these kids require someone to step into their space to ensure they're thriving."

These adolescents can thrive, Dr. McNamara stressed. "It is evident in the research that successful adolescents with learning disabilities are self-aware and have accepted their learning disability. They have learned to seek support when they need it, and they have learned to seek out and operate in environments where they have the tools to succeed," he said. "The ability to do these things comes from someone teaching them how to do so through well-designed interventions."

The key components to effective intervention for these adolescents, according to Dr. McNamara, include "intensive intervention during the early school years; ongoing one-on-one, or close to it, tutoring; consistent academic and life skill-based counseling; and consistent ongoing parental support and understanding."

Feeling a sense of connectedness to and support from school also serves as an important protective factor, according to the findings of the adolescent health survey. Adolescents who receive such support "often have higher self-esteem, feel more in control of their own academic achievement, and understand how to advocate for themselves," Dr. McNamara said.

To best serve not only the academic needs of adolescents with learning disabilities but also the social and emotional ones, educators and mental health providers first must understand "that the co-occurrence of behavioral and emotional problems with learning disabilities is common and leads to poorer outcomes," according to Dr. Osher. Next, they must work together to create emotionally safe and supportive school environments.

Also, "the interventions should be culturally and linguistically competent, strengths based, capacity building, and as child and family driven as possible," Dr. Osher said. "Wherever possible, labeling and pullout approaches and special classes should be avoided."

But multiple barriers impede the development of such emotionally safe and supportive learning environments. Problematic are disinterest, lack of information about what to do and how to do it, and the pressures faced by school administrators to produce "short-term gains on high-stakes tests," Dr. Osher said. "What gets assessed gets addressed," he said, so if schools are to become a protective factor in the lives of at-risk kids, social and emotional considerations must be assessed.

Toward this end, Dr. Osher and colleagues at the American Institutes for Research, together with the Collaborative for Academic, Social, and Emotional Learning and the Learning First Alliance, developed a strategy for overcoming barriers. The three-component intervention, which has been implemented by the Chicago Public Schools, includes a psychometrically robust 57-item survey of the social and emotional conditions for learning, the results of which are incorporated into school, district, or state score cards; a customized report informing administrators on the significance of specific subgroup responses to the survey; and an online tool kit linked to individual school reports that provides strategies and programs that have proven effective in similar contexts.

In Chicago, the results of the survey reports have begun to change discourse in the district, Dr. Osher reported.

Still, several barriers to widespread implementation and efficacy of such strategies have yet to be overcome. For example, Dr. Osher said, the ongoing "marginalization of social [and] emotional factors" makes it difficult to generate financial resources for comprehensive assessments and intervention design.

And even when financial support exists, "another barrier is making sure that interventions enter the classroom, affect the learning process, and reach the individual child. This is a struggle in all systems change, including education."

By Diana Mahoney, New England Bureau. Share your thoughts and suggestions at cpnews@elsevier.com.

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