Learning Disabilities in Adults: Implications for Rehabilitation Intervention in Work Settings.

Deficiencies in learning ability specific to basic areas of psychological functioning (e.g., reading, calculation, attending), despite apparent learning potential, are widely acknowledged in both school and work settings (Chan, Reid, Kaskel, Roldan, Rahimi, & Mpofu, 1997; Geist & McGrath, 1983; Gerber & Brown, 1997; Szymanski, Dunn, & Parker, 1989). In adults, LDs can adversely affect both work competence and social participation (Chadsey-Rusch, 1985; Chan et al., 1997; Gerber & Brown, 1997). For example, people with LDs may be underemployed; their work-related strengths, limitations, and preferences can go unrecognized by themselves, employers, or supervisors, undermining their productivity, job-tenure, and satisfaction (Gerber, 1997). Moreover, persons with disabilities and poor insight into their work-related functional abilities and limitations may be less able to self-advocate for work accommodations [(e.g. assistive device; job restructuring; adaptations in job training)] that could enhance their job competitiveness, satisfaction, and tenure. Only 5% of college graduates with LDs disclosed their disability to employers or requested accommodations, and they were more dissatisfied with their compensation, promotion opportunities, and work in general as compared to colleagues without LDs (Witte, Philips, & Kakela, 1998).

Relatively few studies have considered the implications of LDs for life adjustment (Gerber & Brown, 1997), although the importance of work to life adjustment is widely acknowledged (Neff, 1995; Szymanski & Parker, 1996). Persons with LDs have lower rates of job entry and retention than nondisabled peers (Koller, 1997; Levine & Nourse, 1998; White, 1992), thus reducing the contribution of work to overall quality of life. Consideration of characteristics of LDs that impact work by employers and persons with disabilities may result in higher levels of job entry, retention and satisfaction of persons with disabilities. Moreover, unlike most physical disabilities, LDs are invisible and abstract in nature, heightening the risk of rejection (Gerber, 1997). Some employers and colleagues may regard LDs as mental retardation, which may foreclose work opportunities for persons with LDs. The possibility that LDs may be misconstrued for mental retardation could explain in part the low rate of self-identification of persons with LDs in work-settings (e.g., Witte et al., 1998). Low self-identification of persons with LDs could also be due to a lack of awareness by persons with disabilities of possible work-related accommodations.

The quality of work life for persons with LDs could be enhanced by a greater awareness by rehabilitation professionals, employers, work supervisors, colleagues, significant others, and the persons with disabilities themselves, of how LDs relate to successful work performance. Works and studies on the successful work adjustment of persons with LDs could encourage higher levels of self-disclosure of persons with LDs, resulting in more requests and use of appropriate accommodations, higher quality of work life, and organizational productivity. This paper provides a brief historical background of LDs as a diagnostic category in adults, and its etiology, assessment, characteristics, and implications for rehabilitation intervention in work settings. It specifically focuses on personal and job factors related to the work adjustment of persons with LDs and how these are the basis for rehabilitation interventions with this clientele.

Historical Background

Recognition that LDs are a distinct diagnostic category is relatively recent. The recognition is commonly associated with the passage of the United States (US) Learning Disabilities Act of 1969, and its amendments (Little, 1995; Szymanski et al., 1989). The Act adopted the National Advisory Committee on Handicapped Children's (NACHC) definition of LDs as referring to children with average or above-average ability who have significant deficits in basic psychological processes involved in understanding or using written or spoken language in the absence of sensory, emotional, or environmental disadvantage.

For nearly two decades after the passage of the US Learning Disabilities Act of 1969, specific LDs were primarily associated with school-age children. Little regard was given to the psychosocial and vocational needs of children with LDs as they transitioned into the adulthood (Geist & McGrath, 1983; Koller, 1997; White et al., 1983). Eligibility for vocational rehabilitation (VR) was hampered by regulations that required diagnosis of a physical or mental condition, neither of which could be unequivocally shown for persons with LDs (Witten, 1983). Consideration of the work adjustment of persons with LD was uncommon or nonexistent.

In 1981, LDs were finally recognized as disabling conditions by the US state-federal vocational rehabilitation program (Geist & McGrath, 1983; Rehabilitation Services Administration, 1981; Witten, 1983). Among the leading proponents for the diagnosis and remediation of LDs in adults was the US National Joint Committee on Learning Disabilities (NJCLD) (1985, 1994) which defined LDs as:

   ... a general term that refers to a heterogeneous group of disorders
   manifested by significant difficulties in the acquisition and use of
   listening, speaking, reading, writing, or mathematical abilities. These
   disorders are intrinsic to the individual, presumed to be due to central
   nervous system dysfunction, and may occur across the life span (italics
   added). Although learning disabilities may occur concomitantly with other
   handicapping conditions (for example, sensory impairments, emotional
   disturbance) or with extrinsic influences, such as cultural differences
   and/or insufficient or inappropriate instruction, they are not the result
   of those conditions or influences (1994, p. 65).

Unlike the NACHC definition, the NJCLD definition recognizes LDs as a lifelong phenomenon; therefore as present in adults. In addition, the NJCLD definition considers LDs as heterogeneous in manifestation and as comorbid with a number of other disabling conditions. By adulthood, individuals usually develop compensatory strategies for coping with LDs so that their manifestation in adults is more diverse than in children (Goldstein, 1997; Reiff, Gerber, & Ginsberg, 1993). A diagnosis of a specific LD in adulthood, therefore, does not necessarily communicate the particular behaviors that will be displayed, nor the associated vocational limitations (Szymanski, Dunn, & Parker, 1989).

An implication of the NJCLD definition is that individuals will not show the same mix of LD-related behaviors in any particular work context. The work adaptation of persons with LD depends on the interaction between the salience of the particular LD related behavioral limitation, the demand characteristics of the work situation (e.g., task structure and pacing), and the individual's success history in similar work settings. For instance, one individual with an LD involving reading may prefer to take work instructions orally (e.g., via tape recording) rather than in written form or tasks with more auditory input (e.g., intercom operator), whereas another may perform satisfactorily with appropriate modifications in the presentation of the written instructions (e.g., bold, capitalized, or colored lettering of critical words or phrases). The severity of the reading-related LD, the extent of work components requiring reading, the availability of alternative non-reading ways of meeting the task demands and prior training (e.g., in compensatory strategies for deficits in reading ability) and experience (e.g., in a similar job) contribute to the heterogeneity of LDs characteristics in work settings. Moreover, the diagnosis of a specific LD (e.g., reading) does not preclude a concurrent deficit in any of the basic psychological processing areas (e.g., auditory processing; visual processing; memory), which compounds differences in work-related functional limitations in persons with similar LD diagnosis. The wider range of individual differences in coping with LDs among adults necessitates individualized approaches to rehabilitation interventions for work adaptation.

The US Rehabilitation Services Administration (RSA) (1981) definition of persons with LDs links LDs to the world of work much more directly than do alternative definitions. The RSA defined persons with LDs as:

   Individuals who have a disorder in one or more of the psychological
   processes involved in understanding, perceiving, or expressing language or
   concepts (spoken or written) - which may manifest itself in problems
   related to listening, thinking, speaking, reading, writing, spelling, or
   doing mathematical calculations-would be eligible to receive vocational
   rehabilitation services if they satisfy the following criteria: (a) their
   psychological processing disorder is diagnosed by a licenced physician
   and/or a certified psychologist who is skilled in the diagnosis and
   treatment of such disorders; and (b) their disorder results in a
   substantial handicap to employment; and there is a reasonable expectation
   that vocational rehabilitation may benefit the individual in terms of
   employability. (p. 3).

The RSA definition for LDs referred to "individuals" rather than "children" with learning disabilities, thereby including adults (Szymanski et al., 1989; Witten, 1983). It also explicitly recognized that LDs can significantly limit vocational preparation or' work adjustment and that vocational related rehabilitation interventions can make a positive contribution to the occupational success of persons with learning disabilities. For instance, vocational preparation programs on compensatory strategies for known LD related functional limitations in an individual (e.g., use of a work cycle chart for a person with memory problems) could enhance job retention and productivity.

However, studies that document a very low rate of self-identification of persons with disabilities in work settings (e.g., Witte et al., 1998) suggest that recognition of LDs in adults by the RSA in 1981 has not had a significant effect in the world of work in more than two decades. This situation reflects the historical preoccupation with LDs in children rather than adults by federal and state governments, and a relative paucity of information on effective strategies for LD intervention in work settings (Levine & Nourse, 1998). Nonetheless, as persons with disabilities become more knowledgeable about their legal rights (e.g., the Americans with Disabilities Act of 1990), they are likely to self-identify as having a disability and to self-advocate for disability-related accommodations at the work place in greater numbers than hitherto.

Etiology of Learning Disabilities

There is no general consensus of the prevalence of LDs in the US population (Behrens-Blake & Bryant, 1996; Frankenberger & Fronzaglio, 1991) although "most" agree LDs make-up a large portion of the total disability group in the US (Berkeley Planning Associates, 1989; Interagency Committee on Learning Disabilities, 1987; Goldstein, 1997). School-age children are estimated at between one and twenty percent (Interagency Committee on Learning Disabilities, 1987; Hallahan & Kaufman, 1988). The prevalence of LDs in adults and children is probably similar (Goldstein, 1997). The heterogeneity between cases and diagnostic criteria has been an impediment to determining reliable prevalence figures (Frankenberger & Fronzaglio, 1991; Shepard, Smith, & Vojir, 1983; Swanson, 1991). Moreover, there continues to be considerable uncertainty on appropriate methods for assessing LDs in adults (Anderson, 1993; Koller, 1997; Gerber & Reiff, 1994). What appears more clear is the wide array of factors that potentially lead to LDs.

Environmental and genetic factors have been suggested as causes (Hallahan & Kaufman, 1988; Torgensen, 1988), along with recent theoretical perspectives proposing deficits in cognitive-behavioral strategies essential for self-regulation (Kolligian & Sternberg, 1987) and dysfunctional response abilities in specific ecological settings (Higgins, 1992; Snow, 1994; Szymanski et al., 1989). Each of these perspectives on the etiology of LDs is briefly outlined below and related to the world of work.

Environmental Causes

Prenatal traumas like infections and substance abuse during pregnancy have been associated with LDs in children (Mercer, 1987). Birth complications such as extended labor, forceps delivery, induced birth, and anoxia have also been related to LD pathogenesis (Little, 1995). Malnourished children and children who experience head injuries, often have debilitating fevers, have allergic or toxic reactions to certain foods or poisons are at higher risk for developing LDs (Hallahan & Kaufman, 1988). Being raised in a large family, having a mother with a poor educational background, and coming from lower social class status are also significant risk factors for LDs (Badian, 1984; Melekian, 1990). Environmental causes of learning disability for any individual are difficult to discern, however. Research has been mostly correlational in nature and retrospective in design, rendering unclear causation.

The higher rate of learning disabilities in the lower social classes who ordinarily have lower levels of education and occupy the greater proportion of unskilled, semi-skilled or dead-end jobs means that the greater proportion of persons with LDs go undiagnosed and are less likely to seek rehabilitation services. Lower rates of rehabilitation service utilization have been reported for members of a number of lower social status groups in the US (Szymanski & Parker, 1996). In addition, changes in the American economy toward information technologies (Rifkin, 1995) are also likely to further constrain the employment opportunities of persons with lower levels of education who have a disability (Levine & Nourse, 1998). Nonetheless, work place interventions for individuals who acquired LDs through social disadvantagement and occupy low level jobs may emphasize job simplification (e.g., through automation) and structured or predictable work cycles. Rehabilitation service community outreach or education activities aimed at creating a greater awareness of the nature and impact of LDs on work adjustment may encourage self-referrals for LDs assessment and vocational counseling of members of the lower social classes. Rehabilitation professionals could also initiate employment creation and job development activities in liaison with local business leaders, which activities could enhance the work participation of the majority of members of the lower social classes who may have LDs but not self-refer for rehabilitation services.

Genetic Factors

LDs may be heritable. Data show that about 40% of first degree relatives (including monozygotic twins) of people with LDs have similar learning problems (Kirby, 1991; Torgensen, 1988). Such studies have however not successfully ruled out environmental explanations (e.g., poverty) nor accounted for the heterogeneity of learning capabilities among monozygotic twins (Hynd et al., 1991). The widely acknowledged definitions of LDs presume a genetic basis (e.g., NJCLD, 1994; RSA, 1981), although the specific biological mechanisms that are involved are not yet fully understood (Ingersoll & Goldstein, 1993). Lack of specification of the biochemical processes involved in LDs hampers the design of psychopharmacological treatments for enhancing adaptation in work settings. Furthermore, ascribing LDs to non-manipulatable factors such as genes may have the unintended effect of suggesting to potential employers that very little can be done to assist the work adaptation of persons with LDs, which in turn could contribute to a lower willingness by employers to hire such individuals. Persons with LDs who subscribed to a strict genetic etiological perspective may believe that immutable biological forces (i.e., genes) set them up for failure in work and other adult roles. Therefore, they may have a lower self-efficacy in their ability to proactively manage the disability for occupational success (e.g., through seeking compatible job positions; self-identification, and requesting for accommodations; training in compensatory strategies).

Cognitive-Behavioral Perspectives

The inactive learner hypothesis (Flavell, 1979; Kolligian & Sternberg, 1987; Torgensen, 1988) proposes that individuals with LDs lack either ability, strategy, or volition. For instance, persons with LDs may have significant deficits in essential job-related abilities such as self-questioning (e.g., What is my task? What specific actions will enhance successful performance of this task?), self-monitoring (e.g., Am I still performing requisite activities for success on this task? How shall I know when I have performed the task successfully?), and self-evaluation (How well have I achieved the task objectives? How can I maintain or improve on my current performance?). These problem solving abilities have been referred to as metacognitive strategies, or one's knowledge about knowing (Kolligian & Sternberg, 1987), and are linked to a sense of personal causality in obtaining desired consequences. Persons with LDs may have a poor sense of self-efficacy due to deficits in self-regulation strategies essential for successful work performance. They may also be less able to match appropriate work strategy (e.g., matching column and row totals) to the requirements of specific tasks (e.g., compiling a simple balance sheet). Finally, persons with LDs may have the repertoire of skills required for success in specific jobs but may be unmotivated to use them (e.g., due to poor self-efficacy; low self-esteem, incompatible job structure).

From a cognitive-behavioral perspective, successful rehabilitation intervention with persons with LDs in work settings will depend on an accurate assessment of the particular deficits in self-regulation constraining work performance. For instance, deficits in essential abilities for work-related self-regulation (e.g., self-questioning about the means and ends of a task) may require training in the design and use of job check-lists and work inventories. Persons with intact self-regulation abilities, but with apparent failures in appropriate work strategy selection or application, may need work strategy priming cues (e.g., visual, auditory) built into the job structure for efficient work performance. The work-related self-efficacy of such persons may also be enhanced by training in self-cuing strategy selection, implementation, and monitoring. Depending on the peculiarities of the job and the individual's profile of strengths, preferences and limitations, some persons with LDs may prefer kinesthetic-vestibular (touch-movement) oriented cues, auditory cues, visual-spatial cues, et cetera. Persons with LDs that present as an unwillingness to apply well learned and accessible work strategies may benefit from: (a) cognitive - behavioral counseling aimed at developing perceptions of successful work performance as linked to use of work strategies already in the individual's repertoire; (b) work performance modeling by a colleague with whom the individual identifies; (c) assessment, training, or sensitization of the work place (e.g., colleagues, supervisors, employers) to disabilities and their management; or (d) alternative job placement within the same or a different organization.

Ecological Perspectives

Ecological perspectives view LDs as rooted in complex interactions between individual, contextual, mediating, performance, and outcome factors (Szymanski et al., 1989). For example, prior learning experiences (mediating factors) may interact with learning potential (individual factor) and current task demands (performance factors) in specific situations (or contexts), leading to failure (outcome). Repeated lack of success in particular performance contexts (e.g., social interaction), could lead to a specific learning disability (poor social skills). Individuals with significant psychological processing challenges (individual factors) may be limited in response abilities (performance factors) required in particular work settings (contextual factors), leading to underemployment, underproductivity, and high job turn-over (outcomes). For instance, a person with deficits in visual-spatial skills (individual factor) may experience difficulties with a job requiring accurate depth perception and estimation (performance factor) in fast-paced work environments (contextual factor), which could negatively impact on individual productivity and job tenure (outcome factors). However, the same individual may be more successful in jobs with a lower level of visual-spatial abilities, slower pacing, or appropriate assistive devices.

Work settings have been regarded as complex sociotechnical systems in which compatible human-human, human-machine, and human-organization interfaces are essential for both productivity and the perceived quality of the work environment (Passmore, 1988). In that regard, the sociotechnical design of some work environments may be less accommodating of diversity in human abilities and create LDs in certain individuals. For instance, individual differences in preference for social involvement (human-human factor) may show as social skills deficits in work-settings demanding of a high level of social interaction and sensitivity (e.g., salesperson). Deficits in the work-flow design or work unit coupling may hamper essential input for one's job (human-organizational factor) and be (mis)construed as a deficit in an individual's information processing abilities. Similarly, machine characteristics (e.g., type and location of control panels; application requirements) that are incompatible with the person's profile of abilities (human-machine factors) could be regarded as indicating LDs in a person.

A major goal of comprehensive rehabilitation services at the work place should be to address both the personal and work environmental factors that hamper work adjustment. Ecological views of learning disability offer several possibilities for rehabilitation intervention by linking LD effects to manipulatable personal and environmental factors. For instance, the identification of individual factors (e.g., deficits in a basic psychological process; lack of opportunity or experience with a similar job) enables the formulation and testing of clinical hypotheses about work performance abilities that are likely to be impaired in specific work contexts. A knowledge of a client's work-related response abilities assists the rehabilitation professional to explore with the client, work supervisor and employer likely work accommodations or compensatory training. Similarly, the identification of work environment factors (e.g., job structure; work pacing; work equipment) that are likely to be barriers to successful work performance' by a client with a known profile of abilities could support organizational interventions (e.g., job analysis for essential functions; ergonomic modifications of equipment or work procedures) aimed at enhancing individual productivity and work satisfaction. Possible individual and work-contextual interventions for persons with specific LDs are considered in greater detail in a subsequent section.

Successful rehabilitation interventions for people with LDs presume accurate diagnosis and active client participation. The assessment process should include the person with LDs, the employing organization (or likely employer), and significant others (Szymanski et al., 1989). For example, the assessment should establish the client's strengths, preferences and limitations, organizational factors related to successful work-adjustment, and how these are likely to impact on the work performance of the individual with LDs, and the nature and level of social support (e.g., family; community) that the persons with LDs has in a work role. Participation in the assessment and diagnosis of LDs is consistent with client ownership of the assessment outcomes and willingness to participate in the planning and implementation of rehabilitation interventions, which in turn is positively related to successful work adjustment (Chan et al., 1997; Szymanski et al., 1989).

The Importance of Accurate LDs Assessment to Successful Work-Related Rehabilitation Intervention

Since LDs are heterogeneous in etiology and manifestation (NJCLD, 1994; Torgensen, 1988; Hallahan 8,: Kaufman, 1988), accurate assessment is key to planning interventions tailored to the individual client's unique needs and abilities. By definition, assessment for LDs seeks to establish the presence of a significant discrepancy between ability and achievement on individually administered cognitive ability and achievement tests, and a concurrent deficit in a basic psychological process (e.g., memory, auditory-processing, visual-processing, processing speed). There is no consensus on the tests that are used to assess for LDs (Anderson, 1993), although co-normed ability and achievement tests (e.g., the Woodcock-Johnson Psychoeducational Battery-Revised) may be better prospects in terms of meeting the psychometric requirements for discrepancy analysis. The reliability of difference scores for tests that were not co-normed is lower than for tests that were conormed (Salvia & Ysseldyke, 1991). Use of ability and achievement tests that were not co-normed is, therefore, likely to introduce considerable error in LDs diagnosis.

Most existing psychoeducational batteries have the limitation that they may not provide sufficient redundancy of measurement to reveal a deficit in a basic psychological process. In addition, the achievement tests may have ceiling and floor limitations with some populations (e.g., college graduates with LDs). These limitations of standard psychometric batteries suggest a need for comprehensive neuropsychological evaluations in LD diagnosis. Comprehensive neuropsychological batteries (e.g., the Halstead-Reitan) have more tests per ability or achievement area (Goldstein, 1990), and are likely to yield more reliable LDs diagnosis. Research suggests that performance of adults with LDs on the WAIS-R (a component of most neuropsychological batteries) is reliably predictive of employment success (Fass, 1990). However, a comprehensive neuropsychological evaluation requires a time commitment of about 14 hours per client and may not be viable for most LD assessment situations. In addition, few of the tests on current neuropsychological batteries were conormed, which raises questions about the reliability of discrepancy analysis with neuropsychological batteries.

None of the currently available psychoeducational or neuropsychological batteries was normed with a sufficient representation of ethnic minorities and persons from the lower social classes (Olivarez, Palmer, & Guillemard, 1992; Salvia & Ysseldyke, 1991), although LDs tend to be higher among minority social groups (Melekian, 1990; United States Department of Labor, Employment, & Training Administration, 1991). Tests currently in use for LD diagnosis may therefore not be reliable or valid measures for certain minority populations. Assessment of persons with LDs must also include applied aspects such as work samples, activities of daily living, and on-the-job observations (Gregg & Hoy, 1990; RSA, 1990).

Client and significant other (e.g., family) involvement in the entire assessment and rehabilitation planning process is important (Szymanski & Hanley- Maxwell, 1995). Client and family preferences for particular rehabilitation options and goals must be accommodated because the client and significant others have a more complete picture of the client's coping resources in various life roles. Family and other social networks provide invaluable job leads that often result in successful job placements and retention by both persons with disabilities and without disabilities (Hagner, Fesko, Cadigan, Kiernan, & Butterworth, 1996). Minority persons with disabilities were also more willing to take up jobs in the same locality as their families of origin (Szymanski & Hanley-Maxwell, 1995). The central role of significant others in assessment for work participation of individuals with LDs (or other disability) cannot be overemphasized.

The previous discussion has highlighted how an accurate assessment of LD-related work challenges must also account for organizational factors such as sensitivity to disability issues and work ecological and sociotechnical factors that impact on the work adjustment of persons with LDs. The impact of a specific LDs on work performance is mediated by characteristics of the work environment (Brown & Gerber, 1994; Dowdy et al., 1992; Szymanski et al., 1989), therefore, person-environment assessment techniques (Lofquist & Dawis, 1991; Passmore, 1988) should be part of any LDs assessment. Rehabilitation interventions that focus only on the person with LDs in the context where such disabilities are manifested are unlikely to lead to successful vocational and work adjustment.

Characteristics of Persons with Learning Disabilities that Impact Work and Implications for Rehabilitation Intervention

People with LDs have been characterized as facing significant challenges in the visual-spatial, cognitive, auditory, and kinesthetic-vestibular perceptual areas of functioning (American Psychiatric Association, 1994; Hallahan & Kaufman, 1988; Kirby, 1991; Witten, 1983). Reactions to persistent failure to effectively interact with the environment secondary to deficiencies in basic psychological processes lead to a variety of personal and occupational adjustment problems (e.g., low self-efficacy; shorter job tenure) with significant implications for vocational and work adjustment (Brown & Gerber, 1994; Szymanski et al., 1989; Walmsley, 1991; Witten, 1983; Witte et al., 1998). Rehabilitation professionals and employers need to take into account clients' LD-related limitations that impact adjustment in the work-place. Although this discussion will focus on personal and task specific challenges that individuals with LDs may experience in work settings, organizational and job design factors are also important considerations for successful work adjustment (Thompson, Mpofu, & Thomas, 1998).

Visual-Spatial Challenges

People with LDs may have significant difficulties in accurately perceiving or working with numbers (dyscalculia), reading (dyslexia) or writing (dysgraphia) (Anderson, 1994; Witten, 1983). Numbers may be taken out of sequence and operational signs substituted. Inability to decode letters or words, and word substitutions and omissions are also common problems. Letter reversals and omissions are also associated with dysgraphia. Poor visual discrimination is characterized by problems focusing on specific visual stimuli (e.g., a figure) that is embedded in a larger context (e.g., a financial statement). Visual-spatial difficulties may also manifest in the directional problems (e.g., right/left orientation, distance estimation) (Dowdy, Smith, & Nowell, 1992).

Persons with LDs who are challenged in visual-spatial capabilities may have difficulties learning through graphic or pictorial media (Dowdy et al., 1992) and should use alternative modalities of learning (e.g., auditory) to learn new functional behaviors. In occupational settings, individuals with visual-spatial difficulties may be less successful at tasks requiring them to visually manipulate numbers (as in calculations), shapes (e.g., space utilization, reading of diagrams), and written text. Clerical jobs involving significant computations, storage facility management, and copy editing may not be suitable for individuals with visual-spatial problems. Such individuals could also have problems managing their personal financial budgets, correspondence, and in completing job applications. Assistive devices such as simple calculators and computers with optical scanning and voice facilities could enable individuals with visual-spatial problems to successfully perform clerical tasks.

Limitations in performing work requiring depth perception or three - dimensional visual discrimination also may affect individuals with visual-spatial perceptual challenges (Anderson, 1994). Structured assembly production line work with predictable work cycles is suitable for such persons. Auditory cues that mark the various stages of a work cycle could enhance the accuracy and productivity of persons with visual-spatial problems by helping them self-monitor. Individuals who compensate for visual-spatial limitations with auditory skills could do well in jobs where these capabilities are more important for success (tour-guide, receptionist, information clerk).

Auditory-Perceptual Challenges

Witten (1983) identified three areas of auditory dysfunction which characterize persons with learning disability: auditory discrimination: figure-ground perception; and auditory sequencing. Auditory discrimination problems include an inability to distinguish between similar sounds and poor identification of tones or auditory cues. Figure-ground perception challenges pertain to difficulties in isolating and attending to particular auditory input (e.g., telephone message), against background noise (e.g., production line activity). Auditory sequencing difficulties occur when messages are taken out order or reversed.

Auditory-perceptual LD lead to challenges in noisy work environments. Jobs with high auditory input such as sales or receptionist are problematic for individuals with these types of problems. Such limitations may also hamper job interview performance due to difficulty decoding oral questions.

Simultaneous automated conversion of auditory input into visual signals (e.g., light with buzzer) helps persons with auditory perceptual problems adapt to activities of daily living or to occupations with strong auditory input. Furthermore, employers could more effectively communicate with these individuals by using shorter sentences and written notes. Metacognitive strategy training which involves self-monitoring of one's own attending behavior (Flavell, 1979) is helpful to individuals with auditory perceptual challenges. For example, training in the rehearsal and breaking down of lengthy auditory messages may help both retention and application of work-related skills.

Proprioceptive-Vestibular Perceptual Challenges

Persons with LDs may experience significant challenges in orienting their bodies in space and in coordinating gross and fine motor movements, and may tend to check their body positions for orientation (Witten, 1983). Some persons with LDs may, therefore, be less able to execute tasks requiring complex body and equipment movement.

Clumsy movements associated with proprioceptive-vestibular movements suggest limitations in jobs requiring delicate body balance or climbing (e.g., tree trimming; roofing; fire-fighting). Combined with deficiencies in visual-spatial perception, proprioceptive-vestibular perceptual problems may impose limitations in occupational tasks that involve driving or automated navigation. Jobs with ambulation at ground level and wider work spaces are more appropriate.

Tactile-perceptual problems are associated with functional limitations in performing tasks in low lighting conditions where the compensatory advantage of sight is precluded (Witten, 1983). Equipment with controls outside of the visual field is difficult to operate for persons with perceptual-motor problems. Work in well-lighted places might enable individuals with tactual perceptual problems to enhance accuracy in task performance by compensating with sight. Ergonomic modifications to equipment such as repositioning controls allows other senses to aid task performance. Jobs requiring delicate application of pressure (e.g., finger pressing) could be facilitated by using light or sound emitting devices that cue individuals when the required pressure is exerted. Biofeedback training also enhances the performance of physical tasks requiring tactile perception by engaging proprioceptive sensation in task related self-regulation.

Cognitive Challenges

Cognitive problems include difficulties in abstraction and generalization. Learning tends to be rather concrete and isolated to particular contexts. Significant problems are also evident in logical sequencing of ideas (Dowdy et al., 1992) or efficient processing from the environment. For example, persons with LDs may have significant difficulties applying, analyzing, and synthesizing information. They may be less capable of changing mental set in response to changes in task demands. Persons with LDs may also be challenged in the ability to appraise their own abilities and limitations and therefore may be less able to match their abilities to appropriate demand situations.

Nonetheless, having LDs does not contraindicate superior intelligence or necessarily lead to failure in significant aspects of life (Gerber & Reiff, 1991; Reiff et al., 1993). The impact of an LD on any individual depends on the interaction between the specific functional area in which an individual is challenged and the person's adaptive capabilities at a particular stage. For example, persons with LDs in work environments that are compatible with their abilities may not differ from colleagues without LDs in occupational success (Witte, Philips, & Kakela, 1998).

Problems in concept formation and generalization cause difficulties in social relationships where sensitivity to non-verbal cues and implied messages are important for successful social behavior (Chadsey-Rusch, 1985). Colleagues, work supervisors, and significant others might be easily misunderstood, resulting in social isolation or low job retention and satisfaction. Discretionary jobs that require momentary decision making in response to rapidly changing demands may not be suitable for persons with these types of cognitive problems. Training in self-monitoring might enhance social behavior and decision making abilities of such individuals. Assigning tasks that require less complex cognitive discrimination and transfer is also a reasonable accommodation, as is providing structured jobs with clear beginnings, sequential steps, and end points. Successes achieved as a result of harnessing functional abilities and accommodating functional limitations could result in higher self-esteem, an improved sense of self-efficacy, and perceived quality of life.

Personal and Vocational Adjustment Challenges

Challenges in basic psychological processes may result in failure to achieve beneficial interactions with the environment in personal and vocational areas. Personal adjustment challenges include poor self-esteem and learned helplessness (Little, 1995). Repeated failures may lead to lack of self-confidence, low frustration tolerance, and poor social competence. Associated vocational adjustment challenges include poor job preparation, occupancy, and tenure (Brown & Gerber, 1994; Geist & McGrath, 1983). Persons with LDs may be challenged in the communication and interpretation of own and others' socio-emotional content or experiences (Chadsey-Rusch, 1985). Deficits in social skills are associated with poor job tenure, lower job satisfaction, and poor networking skills (Chadsey-Rusch, 1985; Hinkebein, Koller, & Kunce, 1992). Superior social skills are more predictive of occupational success than level of academic or vocational preparation (Chan et al., 1997).

Summary and Conclusion

The recognition of LDs in adults and their impact on work adjustment is a recent phenomenon. Historically, LDs have been associated with children and schools. Alternative definitions of LDs in adults have been proposed which contributes to unreliability in prevalence figures. Nonetheless, persons with LDs comprise the largest disability category in the US and are also the most overlooked or misunderstood disability category at the work place. Persons with LDs experience significant challenges with work adjustment that can be ameliorated through rehabilitation interventions aimed at developing the individual's work competencies and enhancing the work environment capacity to accommodate a wider range of human abilities, preferences and limitations. A knowledge of the etiology, assessment and characteristics of LDs in adults is important for the design of effective rehabilitation interventions in work settings.

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Elias Mpofu University of Zimbabwe

Elizabeth Watson Shih-Yi Chan University of Wisconsin-Madison

Elias Mpofu, Department of Educational Foundations, University of Zimbabwe, P.O. Box MP 167, Mt. Pleasant, Harare, Zimbabwe.3