Identification of characteristics of specific learning disabilities as a critical component in the vocational rehabilitation process.

This paper discusses an identification process which vocational rehabilitation counselors can use to justify eligibility and determine severe handicap for persons with specific learning disabilities (SLD). Various aspects of identification are presented including definition, eligibility, characteristics, observation, and severe handicap determination. The definition proposed by Rehabilitation Services Administration (1985) and the criteria established in the Diagnostic and Statistical Manual of Mental Disorders - Revised (1987) are explored to determine their implications for the identification process. The common SLD characteristics identified in the definition are discussed in relation to identifying functional limitations, justifying eligibility, and severe handicap determination. A screening device and a more comprehensive behavior checklist, the SLD Characteristic Checklist (Dowdy, 1990), are described. These resources can be used by counselors during the intake interview or completed by parents or other professionals familiar with the client. Suggestions for future research and study are also included.

Vocational Rehabilitation (VR) Services became available to eligible persons with primary disabilities of specific learning disabilities (SLD) in 1981. Since that time learning disabilities has become the fastest growing disability group in the federal agency, Rehabilitation Services Administration (RSA), increasing from 1.3% of the total clients rehabilitated in 1983 to 4.9% of those rehabilitated in 1988 (L.I. Mars, Personal Communication, April 9, 1990; Mars, 1986). According to data from RSA, cases of 29,035 persons with SLD were closed in 1988 and of these 10,733 were closed in status 26, rehabilitated. Cases which were closed and not rehabilitated amounted to 6,176 (21.3%); 11,749 were not accepted after they applied (40.5%) and an additional 377 (1.3%) were not accepted for services after receiving extended evaluation.

A total of 63.1% of those who applied either failed to be accepted as a client or were not effectively rehabilitated. Although this data is similar to all VR applicants and clients, the percentage of persons with specific learning disabilities served by VR is significantly smaller than those receiving special education services. The 12th Annual Report to Congress (U.S. Dept of Ed., 1990) stated that in 1988-89, 47.7% of the handicapped students receiving special education services were learning disabled (LD). While all special education students with LD are not expected to become VR clients, the implementation of improved techniques for identification of the functional limitations of persons with specific learning disabilities could significantly effect the quantity and effectiveness of VR services to this population. This article will address identification procedures which VR counselors may use to improve services for persons with a learning disability.

Identification Variables

The process for identification of specific learning disabilities and the associated functional capacities and limitations is determined by several variables. Following is a discussion of the significant variables including the SLD definition, eligibility factors, characteristics of SLD, assessment, and determination of severe handicap.

Definition

A definition of any disability provides parameters for discussing the condition and should offer a basis for the identification process. While many definitions of LD have been suggested, it seems prudent to study the operational definition distributed to the State Vocational Rehabilitation Agencies by the Rehabilitation Services Administration in the RSA Program Policy Directive, RSA-PPD-85-7/ dated March 5, 1985.

A specific learning disability is a disorder in one or more of the central nervous system processes involved in perceiving, understanding, and/or using concepts through verbal (spoken or written) language or nonverbal means. This disorder manifests itself with a deficit in one or more of the following areas: attention, reasoning, processing, memory, communication, reading, writing, spelling, calculation, coordination, social competence, and emotional maturity.

The first sentence of this definition refers to the "...central nervous system processes involved in perceiving, understanding, and/or using concepts ...". An understanding of this system is critical to the understanding of LD (Biller & White, 1989). The central nervous system (CNS) processes information in much the same way as a computer (Chalfant & Schefflin, 1969). The CNS receives input primarily through auditory, visual, or haptic stimuli, enabling a person to learn primarily through listening, seeing, and/or touch or body movement.

Incoming stimuli are transmitted to the brain for analysis, integration, and storage (Chalfant & Schefflin, 1969). This is a critical part of efficient learning because new information (input) is processed. This component involves the interpretation of data and requires paying attention to the relevant details, organizing the information, relating new concepts appropriately to old ones, storing the information effectively (memory), and generalizing the information to be able to use it in new situations (reasoning/problem solving/thinking).

Finally, the output or response to the information acts as input for evaluation to make desired changes in future behavior (Chalfant & Schefflin, 1969). The output responses can be in academic or nonacademic modes. The academic areas are oral language and written language. Nonacademic modes include social interaction, nonverbal messages or body language, and motoric responses or coordination.

The complexity or comprehensive nature of the various processes involved in "...perceiving, understanding, and/or using concepts..." account for many of the difficulties in understanding LD. A person with a learning disorder may have an inefficient operating system in a combination of these processes. For example, one individual might have difficulty reading, sequencing, and attending while another might have primary deficits in written language, memory, organization, and social skills. Any number of combinations or clusters is possible. This complexity is repeatedly described in the literature as the significant heterogeneity of the LD population (Johnson & Blalock, 1987; McCue & Goldstein, 1991; National Joint Committee on LD, 1985; Newill, Goyette, & Fogarty, 1984; Vogel, 1989).

Without appropriate training, VR counselors may tend to think of SLD as simply an academic disability, which is not necessarily a vocational handicap. Documentation of a learning disability, which is limited to the level of intellectual function and deficits in academics, creates difficulties for VR counselors as they attempt to determine eligibility, justify a severe handicap code, and prioritize services. For example, only a minority, of persons with SLD rehabilitated in 1983 (39.5%) were coded severely handicapped as compared to 59.0% of the total clients who were rehabilitated. Similarly, 52% of the clients with SLD rehabilitated in 1988 were coded severely handicapped as compared to 68.5% of the total rehabilitated clients (L.I. Mars, Personal Communication, April 9, 1990). This reservation to code SLD clients as severely handicapped may create a barrier to future VR services as the emphasis on serving persons with severe handicaps grows stronger. With adequate training, VR counselors can see that academic problems are just the tip of the iceberg. Academic deficits are the most important characteristics to school personnel and they are more easily observed and measured; however, even in the school setting, characteristics of SLD such as inattention and memory deficits interfere with the acquisition of academic skills; similarly these characteristics will impede vocational success.

The VR counselor is faced with the challenge of screening for these heterogeneous manifestations of learning disorders. Often this must be accomplished in a relatively brief intake interview with the client or through additional interviews with teachers and/or parents. Specific guidelines are needed to structure the intake process to obtain the most relevant data and to identify the functional limitations of the specific learning disability. This process is complicated by the hidden nature of the handicap. For example, poor organization and time management deficits can easily be interpreted as an unmotivated, uncooperative prospective client.

Characteristics

According to the RSA definition of SLD (1985), the primary characteristics or manifestations of SLD include specific behaviors involved in "...attention, reasoning, processing, memory, communication, reading, writing, spelling, calculation, coordination, social competence, and emotional maturity." These characteristics are generally consistent with those cited most frequently in the adult SLD literature (Johnson & Blalock, 1987; McCue & Goldstein, 1991; Newill, Goyette, & Fogarty, 1984; Patton & Palloway, 1982; Zwerlein, Smith, & Diffley, 1984).

Manifestations of disorders in reading, writing, and mathematics are easily measured through available standardized tests. Scores from these tests are generally accessible to VR counselors through school records. However, the constructs such as attention, reasoning, processing, and memory are more typically tested through sophisticated neuropsychological batteries administered by licensed professionals and may not be automatically available during the intake process (McCue & Goldstein, 1991). These variables or characteristics such as attention, memory, and social interactions, are cited as having "...greater implications for vocational planning and employment than those associated with poor academic performance" (RSA, 1985). VR counselors and other VR personnel cannot ignore the characteristics during the identification process because of the difficulty in assessing them. Assessment procedures must be identified to provide counselors with the documentation of the characteristics of SLD that will limit success in the work environment.

Assessment

One approach to identification of functional limitations proposed by the University of Alabama at Birmingham SLD Project is based on the identification of specific characteristics of learning disabilities, which may be observed in the natural environment. An SLD Characteristics Checklist, (Dowdy, 1990), has been developed that may be used to structure the observation process and provide documentation of the characteristics. The checklist takes each of the 12 areas described in the RSA definition (1985) of learning disabilities and restates them as observable behaviors. The behaviors for Attention-deficit Hyperactivity Disorder were included as cited in DSMIII-R (1987). Behaviors representing the remaining areas were generated by a review of the literature describing the characteristics of persons with SLD.

The list was revised in 1990 after an extensive analysis of data obtained from parents and teachers of persons with SLD. An additional revision was made based on data from seventy-eight VR transition caseload counselors in which each behavior on the checklist was evaluated as critical, important, or unimportant to positive vocational outcome. Any item most often listed as unimportant to the VR process by these counselors was omitted from the checklist. The checklist format is exemplified in Figure 1, which contains the section assessing memory deficits. A total of 76 behaviors remained after the final revision.

Since this is a comprehensive, though not exhaustive checklist, a separate list, which includes only those characteristics that might be observed in the initial intake interview was developed for VR counselors (Dowdy, 1987). Following is a representative list of those behaviors; the characteristic which they represent is noted in parentheses.

1. Does not seem to listen to what is being said (Attention) 2. Interrupts inappropriately (Attention) 3. Has difficulty remaining seated/fidgets - feels restless (Attention) 4. Has delayed verbal responses (Reasoning/Processing) 5. Has time management difficulties (Reasoning/processing) 6. Has difficulty answering questions regarding personal history (Memory) 7. Uses eye contact ineffectively (Interpersonal Skills/Emotional Maturity) 8. Exhibits signs of poor self-confidence (Interpersonal Skills/Emotional Maturity) 9. Has difficulty explaining things coherently (Communication)

Severe Handicap Determination

Until recently RSA has offered minimal guidance to VR counselors in determining severe handicap (Sh) for persons with SLD. THE system for determining SH for reporting purposes was based on the Rehabilitation Act of 1973 and was issued in December 1973. It was intended to operationalize the not very specific definition of severe handicap found in the Act and was designed essentially to express the severity of the medical impairment. The 1986 Amendments to the Act redefined severe handicap to the point where it and the definition of severe disability were at sufficient odds with one another to cause problems within state agencies with regard to reporting and order of selection (L.I. Mars, Personal Communication, April 1990). The 1986 definition reads as follows:

the term "individual with severe handicaps" means an individual with handicaps (as defined in paragraph 8) -

(a) who has a severe physical or mental disability which seriously limits one or more functional capacities (such as mobility, communication, self-care, self-direction, work tolerance, work skills, or interpersonal skills) in terms of employability;

(b) whose vocational rehabilitation can be expected to require multiple vocational rehabilitation services over an extended period of time; and

(c) who has one or more physical or mental disabilities resulting from ... specific learning disability...

The definition of severe handicap includes limitations in buttoning buttons, climbing one flight of stairs, and sustaining work activities for at least six hours; they are suggestive of the physically disabled population and have been difficult to apply to the SLD population.

In 1990, RSA appointed a task force to study various issues relative to applying the VR process to clients with SLD, including determination of severe handicap. The result was a comprehensive guide which focuses on each of the seven areas of functional capacities and identifies common characteristics of SLD which might limit functioning in each area (RSA-program Assistance Circular, September 28, 1990). The SLD Characteristic Checklist (1990) was one of the resources cited in the document.

To aid the VR counselor in appropriately applying the severe handicap classification, each item of the SLD Characteristics Checklist can be cross-referenced to the appropriate functional capacities recommended by Congress to document severe handicap (Amendments of the Rehabilitation Act, 1986). For example, characteristics identified through the SLD Characteristic Checklist that can be used to substantiate a functional limitation in the area of mobility include difficulty: (a) with time management, (b) remaining seated when required, (c) repeating information recently heard or read, (d) performing tasks in correct sequence, (e) performing gross motor tasks, and (f) reading signs in the environment.

To date, no criteria have been established to indicate the profile on the SLD Characteristics Checklist which would justify the severe handicap determination. This is, in part, due to the heterogeneity of the population and the varying degree of impact of certain characteristics to specific jobs. It is also felt that until adequate research is completed, the decision is best left to counselor discretion. Additional study in this area is critically needed.

Summary

The initial reaction from VR counselors to the mandate to serve persons with SLD was somewhat negative. This was due to their inadequate knowledge and, in some cases, misinformation regarding the disability. However, this negative attitude is being replaced with a more enthusiastic interest. Requests for specialized training in SLD from VR counselors, VR facility staff, and other rehabilitation personnel are increasing. With the increased emphasis on adult needs and RSA's recent priority for funding programs for rehabilitating adolescents and adults with SLD, the future looks brighter for these persons. However, the momentum must not be lost if significant improvements are to be made. While it is not expected that every SLD referral will become a VR client or be successfully employed through VR, the identification and diagnostic procedures can be improved through the use of these strategies for identifying functional limitations in order to justify eligibility and severe handicap. This will become critical as more states are forced to prioritize services for the severely handicapped.

References

Amendments to the Rehabilitation Act. (1986). American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders - Revised. (3rd ed.). Washington, D.C.: Author. Biller, E.F., & White, W.J. (1989). Comparing special education and vocational rehabilitation in serving persons with specific learning disabilities. Rehabilitation Counseling Bulletin, 33, 4-17. Chalfant, J.D., & Schefflin, M.A. (1969). Central processing dysfunctions in children: A review of research. (NINDS Monograph No. 9). Washington, D.C.: U.S. Government Printing Office. Dowdy, C.A. (1987). Development of a model for vocational rehabilitation of adults with specific learning disabilities. (Final Report, RSA Project Number 128AYH30049). Submitted to Rehabilitation Services Administration. Dowdy, C.A. (1990). Specific learning disabilities characteristics checklist. Assessment instrument submitted for publication. Johnson, D.J., & Blalock, J.W. (1987). Adults with learning disabilities: Clinical studies. Orlando, FL: Grune & Stratton. Mars, L.I. (1986). Profile of learning disabled persons in the rehabilitation program. American Rehabilitation, 12, 10-13. McCue, M., & Goldstein, G. (1991). Neuropsychological aspects of LD in adults. In B.P. Rourke (Ed.) Neuropsychological Validation of LD Subtypes. New York: Guildford. National Joint Committee on LD. (1985). Journal of Learning Disabilities, 20, 172-175. Newill, B.H., Goyette, C.H., & Fogarty, T.W. (1984). Diagnosis and assessment of the adult with specific learning disabilities. Journal of Rehabilitation, 34-39. Patton, J.R., & Polloway, E.A. (1982). The learning disabled: The adult years. Topics in Learning Disabilities. 79-88. Rehabilitation Services Administration. (1983). Program Information Memorandum, RSA-PI-83-3. Rehabilitation Services Administration (1985). Program Policy Directive. RSA-PPD-85-7, March 5. Rehabilitation Services Administration (1990). Program Assistance Circular 90-7, September 28. United States Department of Education (1990). 12th Annual Report to Congress on the implementation of the Education of the Handicapped Act. Washington, D.C. U.S. Office of Special Education and Rehabilitation Services. Vogel, S.A. (1989). Adults with language learning disorders: Definition, diagnosis, and determination of eligibility for post-secondary and vocational rehabilitation services. Rehabilitation Education, 3, 77-90. Zwerlein, R.A., Smith, M., & Diffley, J. (1984). Vocational rehabilitation for learning disabled adults: A handbook for rehabilitation professionals. Albertson, NY: Human Resources Center.