Learning disability grows up: rehabilitation issues for individuals with learning disabilities.

The field of learning disabilities (LD) is "growing up." As most histories reveal, the LD concept was originally conceptualized as an elementary school phenomenon (see Kavale & Forness, 1995). By the passage of Public Law 94-142 in 1975, there was increased recognition of the needs of the adolescent with LD (Zigmond, 1990). With the LD field continuing to advance, increased attention is now being directed at adults with LD. For example, Patton and Polloway (1992) demonstrated how the journal literature dealing with adults with LD has increased significantly over a 13-year period.

One theme emerging in the literature is the growing realization that adults with LD constitute a relatively distinct population; they should not be viewed simply as "children with LD grown up" (Zigmond, 1990). The characteristics of adults with LD were gleaned primarily from follow-up studies and often resulted in a comparison of the adult with their own childhood to determine whether childhood problems persisted into adulthood. Polloway, Smith, and Patton (1984) evaluated the literature from the perspective of adult models of development and suggested that the nature of the problems change with age; a focus on childhood disability models is too narrow and may ignore problems particular to adult levels (Gerber, 1994).

Consequences of Learning Disability in Adulthood

In an analysis of the longitudinal research in LD, Kavale (1988) concluded that childhood LD is associated with a high risk of lasting deficits. Even under the best of circumstances, the child is likely never to lose the feeling that reading and spelling are areas of difficulty. There is also a somewhat elevated risk for some behavior problems (particularly low self-esteem). The persistent nature of the deficits suggested that, "parents should be advised that there is a high probability for some noticeable improvement but not enough to allay totally their expressed concerns about the child's future" (Kavale, 1988, p. 338).

A number of follow-up studies (focusing on pre- or post-high school years) have also shown the persistent and deleterious effects of LD (Hasazi, Gordon, & Roe, 1985; Haring, Lovett, & Smith, 1990; Humes & Brammer, 1985; Mithaug, Horivchi, & Fanning, 1985; Okolo & Sitlington, 1988; Rogan & Hartman, 1990; Schalock, Wolzen, Ross, Elliott, Werbel, & Petersen, 1986; Sitlington & Frank, 1990; Zigmond & Thornton, 1985). Generally, findings reveal that fewer individuals with LD are employed and, even if employed, these individuals were in jobs that usually were not full time, minimal wage, unskilled or semi-skilled, and associated with less job satisfaction (Valdes, Williamson, & Wagner, 1990).

Adults with LD experience occupational and vocational difficulties (Gottfredson, Finucci, & Childs, 1984; Siegel & Gaylord-Ross, 1991; Succimarra & Speece, 1990), social/personality problems (Fafard & Haubrich, 1981; Johnson & Blalock, 1987; Vogel & Forness, 1992), and continued academic difficulties (Frauenheim & Heckerl, 1983; Johnson & Blalock, 1987; McCue, Shelley, & Goldstein, 1986). Clearly, the adult with LD faces a number of persistent and unique problems (Gajar, 1992). The consequences of these problems are significant; for example, adults with LD have been shown to be less satisfied with their employment status (Chesler, 1982; White, Deshler, Schumacker, Warner, Alley, & Clark, 1983) and employers have been shown to view the employee with LD less positively (Minskoff, Sautter, Hoffman, & Hawks, 1987; Thomas, 1981). The consequences of LD are seen in a number of interview reports demonstrating less than satisfactory perceptions about their functioning among adults with LD (Gerber & Reiff, 1991; Polloway, Schewel, & Patton, 1992). Although adult outcomes of LD in childhood are not necessarily negative and many successful transitions can be noted, the growing group of adults with LD possesses a number of unmet needs (Gerber, Ginsberg, & Reiff, 1992; Hoffman, Sheldon, Minskoff, Sautter, Steidle, Baker, Bailey, & Echols, 1987; White, 1985) accompanied by difficulties in determining what factors ultimately relate to either success or failure (Spekman, Goldberg, & Herman, 1992; Vogel, Hruby, & Adelman, 1993).

Postsecondary Considerations for Adults with Learning Disabilities

It appears evident that adults with LD possess a broad array of unmet needs and the "problem of heterogeneity" is not attenuated in adulthood. Under these circumstances, outcomes are likely to be variable, and it is important to examine the factors that contribute to successful outcomes.

Minskoff (1994) identified factors significant for the success or failure of adults with LD that include (a) severity of the problem, (b) family support, (c) socioeconomic status, (d) completion of high school, and (e) quality of elementary and secondary education. For example, it has been found that adults with LD report a greater number and more severe problems over time (Gerber, Schneiders, Paradise, Reiff, Ginsberg, & Popp, 1990; Minskoff, Sautter, Sheldon, Steidle, & Baker, 1988). Specifically, Minskoff, Hawks, Steidle, and Hoffman (1989) found that adults with LD generally had lower intellectual levels (WAIS-R IQ 90) and achievement levels at about sixth-grade level. Additionally, their psychosocial adjustment tends to be poor and appears to be related primarily to low self-concept (Ness & Price, 1990).

The adult outcomes of LD are certainly influenced by transition planning and services. Initially, it was believed that LD would disappear in adulthood. However, the 40% dropout rate for youths with LD (Wagner, 1989) suggests that many youths with LD have not developed an awareness of the nature of their disability and require assistance to develop a realistic self-awareness to chart a pragmatic life course (Aune, 1991).

Halpern (1992) suggested that transition needs to be a comprehensive process which deals with "a period of floundering that occurs for at least the first several years after leaving school as adolescents attempt to assume a variety of adult roles in their communities" (p. 203). To minimize this floundering, Individual Education Programs (IEP) must include skills addressing independent living, career exploration, employment seeking, or job maintenance, and not simply remediation of academic deficiencies (Michaels, 1994). A critical step in the IEP process is student awareness and preparation; the goal is student planning in a realistic and systematic manner (Gerber, Ginsberg, & Reiff, 1992). The multidisciplinary team should formulate goals and objectives for postsecondary education (Posthill & Roffman, 1991) or training, employment, and independent living (Wehman, 1990). Finally, the transition process needs to begin fostering independence and establishing linkages with post-school services necessary for monitoring and evaluating future progress.

Postsecondary Education

For students with mild LD, higher IQs, and developed academic competence, postsecondary education is a likely possibility as evidenced by over 34,000 full-time college freshmen reporting the presence of LD in 1991, a figure that has doubled since 1985 (Henderson, 1992). McGuire and Shaw (1987) described the important factors for college-bound students with LD to consider. They outlined ways to examine institutional differences with respect to admissions policies, curricular options (reduced course load or course waivers), nature of support programs (extent of services and number of support staff), and graduation requirements. In comparison to nondisabled peers, however, students with LD participate in postsecondary education at a much lower rate (17% vs. 56%) (Fairweather & Shaver, 1991) with most students with LD choosing a two-year college rather than a four-year college because differences between high school and a two-year college are less dramatic and greater support services are available (Miller, Rzonca, & Snider, 1991).

Success in postsecondary education begins in high school where students must be involved in college preparatory classes, enhance their study skills, select appropriate accommodations, and become self-advocates (Aune, 1991). It is also important to note that the transition to higher education involves a change in legal status from provisions of the Individuals with Disabilities Act to those of Section 504 of the Vocational Rehabilitation Act of 1973 (Scott, 1991). A number of support service models and procedures have been proposed (Brinkerhoff, Shaw, & McGuire, 1992; Rose, 1991; Strichart, 1990) with most providing three categories of support service including (a) reasonable accommodations under Section 504 of the Vocational Rehabilitation Act (e.g., tape recording of lectures, priority registration, use of a note taker) (West, Kregel, Getzel, Zhu, Ipsen, & Martin, 1993), (b) remedial services, and (c) special support services (Bursuck, Rose, Cowen, & Yahaya, 1989).

Siperstein (1988) argued that the successful inclusion of students with LD in postsecondary education requires a comprehensive and programmatic approach. He described a Three-Stage Transition Model that outlined the activities necessary for the three transitions constituting a student's postsecondary career including (a) entering college, (b) managing the academic and social changes during college, and (c) exiting college to enter employment. Although there is recognition that accommodations for college students with LD are necessary, there remains a problem of deciding which are most appropriate. Scott (1994), using case law and existing guidelines, developed recommendations for determining reasonable academic accommodations for college students with LD based upon whether or not it (a) is based on documented individual needs, (b) allows the most integrated experience possible, (c) does not compromise the essential requirements of the course, (d) does not pose a threat to personal or public safety, (e) does not impose undue financial or administrative burden, and (f) is not of a personal nature.

Although an increasing number of colleges and universities are offering support services (Mangrum & Strichart, 1988), vexing issues remain with respect to admission policies (Spillane, McGuire, & Norlander, 1992), course requirements, particularly foreign language (Gajar, 1987; Ganschow, Meyer, & Roeger, 1989), writing requirements (Collins & Price, 1986), and adjustment problems (Roffman, Herzog, & Wershba-Gershon, 1994; Price, Johnson, & Evelo, 1994; Saracoglu, Minden, & Wilchesky, 1989). In a survey of practices and attitudes among postsecondary LD service providers, Yost, Shaw, Cullen, and Bigaj (1994) found that services usually developed in a haphazard manner, and while sincere attempts to meet student needs, represent only a "menu" of options with little or no theoretical or philosophical grounding. Nevertheless, it has been found that when appropriate support services are provided to students with LD, they seem to have a more successful retention and graduation rate than many other students (American College Testing, 1988).

Vocational Training

With only about 2% of students with LD opting for a four-year college, vocational training becomes a necessary service, and the major vehicle for assistance is the provision of vocational rehabilitation (VR) (Gerber, 1981). The large LD population has been reflected clearly in the dramatic increase in the number of individuals with LD in VR programs provided under the Rehabilitation Services Administration (RSA) (Biller & White, 1989). The types of VR services needed by individuals with LD vary widely and include evaluation, counseling, job training, job placement, and job follow-up (Dowdy & McCue, 1994; Smith, 1992).

To qualify for VR services, an individual must meet specified criteria, but the long-standing definition problem in LD is reflected in efforts to provide an appropriate definition for VR programs (Reiff, Gerber, & Ginsberg, 1993). One obstacle to service has been earlier policy of RSA recognizing only mental or physical disabilities as a basis for VR services which led to assumptions that the generally average intellectual abilities, the lack of physical limitations, and the idea that an academic disability does not always limit an individual in terms of employment may not make a person with LD eligible for VR. However, LD became a medically recognized disability in 1981 (Miller, Mulkey, & Kopp, 1984) and was defined as follows:

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 (Rehabilitation Services Administration, March 5, 1985).

In practice, the definition appears to be interpreted differently across settings as demonstrated by Sheldon and Prout (1991) who found considerable variability in diagnostic practices across VR agencies. It seems imperative that a comprehensive and extensive assessment battery be provided in order to avoid debate about eligibility and for gaining insight in severity level (Dowdy, Smith, & Nowell, 1992; McCue, 1989; Vogel, 1989). It is also necessary in the VR context that LD be understood as more than intellectual ability accompanied by academic deficits. For example, the RSA definition addresses a range of characteristics (e.g., attention, reasoning, social competence) that should be explored through instruments like the Rating Scale of Functional Limitations (Dowdy, 1994). Additionally, requirements call for VR services to be provided first to those determined "the most severely disabled," but the definition of severe disability is more readily applied to persons with mental or physical disability rather than LD. To address issues related specifically to LD with respect to eligibility, comprehensiveness of assessment, and severity level, the RSA issued a program assistance circular to assist states (Rehabilitation Services Administration, September 28, 1985).

After diagnosis of LD, attention needs to be directed at planning for VR purposes with information provided by a comprehensive psychoeducational battery (Hawks, Minskoff, Sautter, Sheldon, Steidle, & Hoffman, 1990) and a comprehensive vocational assessment (McCue, 1989; National Information Center for Children and Youth with Handicaps, 1990). The focus of VR services is on employment, and this goal is reflected in the Individual Written Rehabilitation Plan (IWRP). The IWRP is a formal plan of action that considers an individual's capabilities, limitations, and interests to determine an appropriate vocational goal. According to the 1992 Amendments to the Vocational Rehabilitation Act, each IWRP shall (a) be designed to achieve the employment objective consistent with the strengths, resources, priorities, concerns, abilities, and capabilities of the individual, (b) include the long-term goals based on the assessment and to determine the individual's vocational rehabilitation needs including the career interests and the extent to which the goals shall be accomplished in integrated settings, (c) include the intermediate rehabilitation objectives related to the attainment of the long-term goals, (d) include a statement of the specific VR services to be provided and the projected date of services, (e) include a statement of rehabilitation technology services to be provided, if appropriate, (f) include a statement of specific on-the-job and related personal assistance services to be provided, if appropriate, (g) include indication of the need for post-employment services, (h) include a description of how services will be provided or arranged through cooperative agreements with other service providers, and (i) include the evaluation procedures and evaluative criteria for determining if the goals and objectives have been met. The emphasis is on individualization because the heterogeneity of the LD population with respect to needs makes it especially necessary that the IWRP be planned, coordinated, and delivered to address the rehabilitation demands of the particular individual (Gerber & Brown, 1991). The actual program usually finds counseling at its core to achieve career decisions, and to delineate clearly the skills and training necessary to perform the desired job, to analyze the individual's skills and training in relation to the job requirements, and to identify the means of attaining the requisite skills and training. Because some individuals with LD may possess unrealistic goals, a primary aim of counseling should be to introduce consideration of reality-based issues related to these goals (Dowdy, 1992).

The involvement of the individual with LD is mandatory for success. Most IEPs at the secondary level provide limited attention to life after high school and thus fail to address the life-long implications of LD (Smith, Finn, & Dowdy, 1993). This may result in parents being unrealistic and students appearing to be uninterested and unmotivated. The misperceptions may be alleviated by educating individuals with LD about their strengths and weaknesses and providing training in self-advocacy or self-determination skills (Durlak, Rose, & Bursuck, 1994; Wilson, 1994). Self-advocacy is defined as "the ability of an individual to effectively communicate, convey, negotiate, or assert one's own interest, desires, needs, and rights. It assumes the ability to make informed decisions. It also means taking responsibility for those decisions" (Van Reusen, Bos, Schumaker, & Deshler, 1995, p. 6). Gerber and Reiff (1991) found that the most successful individuals with LD manifested a desire to gain control of their lives, a desire to succeed, individual persistence, and strong goal orientation.

Vocational training may be an integral part of the IWRP. Trade and technical schools usually require a high school diploma or a general equivalency degree (GED) that may present an obstacle because of the approximate 45% dropout rate among students with LD (Adelman & Vogel, 1990; Malcolm, Polatajko, & Simons, 1990; Valdes, Williamson, & Wagner, 1990). To remedy this situation, Westberry (1994) outlined the most efficacious learning strategies for adults with LD in preparing for a high school equivalency diploma by passing the GED test. Among the most important considerations is educating instructors about the special needs of individuals with LD. Additional vocational training may be provided through the Job Training Partnership Act, designed to increase the role of private industry in training and employment. On-the-job training that enables an individual to work on a job while learning the skills and duties from somebody already in the workplace might be useful. Finally, in some cases, supported employment as defined in the 1986 Rehabilitation Act Amendments may possess relevance for individuals with more severe LD (Rusch, 1990).

Vocational education for individuals with LD appears to be generally successful. Cawley, Kahn, and Tedesco (1989), for example, found that individuals with LD truly desired a vocational education, knew what was expected from them, and performed accordingly while their school situations provided a variety of career options and the necessary direct instruction and support services. Nevertheless, vocational outcomes appear to be marked by underemployment evidenced by entry-level positions, many on a part-time basis, and with relatively low wages (Dowdy, 1992). Among the most critical issues is whether the individual with LD should disclose their disability to prospective employers. Minskoff et al. (1989) found that only about 50% of employers would hire individuals with LD. Clearly, there is risk of not being hired with disclosure or not receiving the appropriate and reasonable accommodations without disclosure, despite the Americans with Disabilities Act.

It is also likely that the individual with LD will require job follow-up. Support services over a relatively long period is usually necessary to maintain satisfactory job performance. In addition, remedial education may be required to improve and to maintain academic skills (Martin-Ross & Osgood-Smith, 1990). Finally, individuals with LD may require assistance with difficulties caused by poor psychological and social adjustment, especially feelings of inadequacy and further lowered self-esteem (Zwerlein, Smith, & Diffley, 1984).

The major challenge appears to be in how best collaborative arrangements between special educators and VR counselors in the transition process can be facilitated. It has been found that parents, special educators, and VR counselors differ significantly in their perceptions about transition. The consequences are found in individuals with LD not taking full advantage of VR services that may interfere with full participation in work and community living. To remedy this situation, Dowdy and McCue (1994) elucidated key points for fostering collaboration between special education and vocational rehabilitation. These include:

1. Special educators and VR counselors should possess complete knowledge of available transition services.

2. The VR counselor should become involved with the student with LD as early as possible.

3. The VR counselor should have access to available assessment data on each student - particularly data about functional strengths and weaknesses.

4. Special educators should include transition activities in all classes, especially the value of non-academic experiences in relation to exploring interests and obtaining knowledge of the real world.

5. Students should discuss their LD and the legal rights of individuals with LD.

6. Model and require appropriate employment behavior in the classroom (e.g., timely arrival, group decision making, development of agendas).

7. Invite students to participate in the IEP process and insure they are prepared for the VR interview by developing personal portfolios.

8. Encourage students to try part-time employment to enhance their work history.

Conclusion

The recognition of LD as a lifelong condition has not been followed with a concomitant recognition of the need for lifelong services. As the LD field continues to "grow up", expansion of services involving postsecondary education, vocational training and services to improve job skills, academic skills, and psychosocial adjustment are necessary. Significant advances have been achieved, but the task is by no means complete. Special education and vocational rehabilitation must seek greater coordination of effort to achieve maximum impact for both the education and rehabilitation process. It seems clear that this is not an "either-or" situation but one that requires the synthesis of best practices from both special education and vocational rehabilitation to insure that individuals with LD realize their full potentials.

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