Vocational Rehabilitation Outcomes of Adults with Co-Morbid Borderline IQ and Specific Learning Disabilities.

The passage of Public Law 94-142 in 1975 signaled an increase in the recognition of the educational, socio-emotional, and vocational needs of children with disabilities. Consequently, special education programs were implemented to provide interventions to accommodate students with identified special needs. Among the 13 disabilities currently addressed by these programs, specific learning disabilities (SLD) constitute the largest and fastest growing population of exceptional learners in the public schools (U.S. Department of Education, 1994). Although several definitions of SLD exist, it is generally viewed as a psychological processing disorder involving the use or comprehension of written or spoken language. It manifests itself with problems in listening, thinking, speaking, reading, writing, spelling, or performing mathematical calculations and cannot be better accounted for by another disorder (e.g., mental retardation, emotional disorder, visual or motor impairments) or condition (e.g., cultural differences, lack of educational experiences, economic disadvantage). Most definitions require the existence of a severe discrepancy between intellectual ability and academic achievement (Diagnostic and Statistical Manual-Fourth Edition [American Psychiatric Association], 1994; Public Law 94-142, 1977).

Since 1975, numerous studies have documented that SLD is a lifelong condition, continuing and sometimes intensifying in adulthood (Haring, Lovett, & Smith, 1990; Rogan & Hartman, 1990; Sitlington & Frank, 1990). Similarly, adults with SLD should not be viewed simply as children with SLD who have grown into adulthood because the problems associated with SLD change with age. For example, adults with SLD are less likely to graduate from high school (Adelman & Vogel, 1990; Malcolm, Polatajko, & Simons, 1990), exhibit problems finding and retaining employment (Shapiro & Lentz, 1991; Smith, 1992), and are commonly employed in unskilled, entry-level occupations (Haring et al., 1990; Sitlington, Frank, & Carson, 1992; Spekman, Goldberg, & Herman, 1992). As a result, many adults with SLD are financially dependent (Gajar, 1992; Spekman et al., 1992). Lastly, adults with SLD commonly exhibit higher rates of emotional maladjustment and co-morbid psychiatric conditions than the general population (Dunham, Multon, & Koller, 1999).

Based upon the findings that adults with SLD continue to demonstrate significant vocational problems after they leave school, the Rehabilitation Services Administration (RSA) and the state-federal Division of Vocational Rehabilitation (DVR) began public funding of services to this population of consumers in 1981 (Defur & Reiff, 1994). Typical DVR services for adults with SLD include testing/evaluation, guidance and counseling, job training, job placement, and job follow-up (Dowdy & McCue, 1994; Smith, 1992). Studies have shown that DVR consumers with SLD are successfully employed following service provision at rates similar to other populations served by DVR (Berkeley Planning Associates [BPA], 1989; Dowdy & Smith, 1994). Despite these interventions and outcomes, however, few consumer or service variables predict successful vocational outcomes. For example, Berkeley Planning Associates found that only Hispanic ethnicity, on-the-job training, job referral, and job placement services were associated with successful closure. Similarly, Dunham, Koller, and McIntosh (1996) found that persons whose cases were closed as unsuccessful had higher rates of mood disorders and attention problems, and were more likely to have obtained DVR assistance in attending college.

DVR also serves persons with borderline intellectual functioning-those with measured IQs from 70 to 84-when they have concurrent maladaptive problems, such as finding and maintaining employment. Prior to changes in the definition of mental retardation in 1973, children whose measured IQs were within this range received special education (MacMillan, Gresham, Bocian, & Lambros, 1998). Currently, public schools do not provide special programming for persons with borderline intellectual functioning under the Individuals with Disabilities Education Act (IDEA). However, they may provide assistance through a Section 504 plan or under another diagnostic label.

Despite differences in how or if services are provided, adults with borderline IQ exhibit characteristics that are similar to those with SLD and mental retardation. The available research suggests that persons with borderline IQ have significant academic, socio-behavioral, and vocational problems (Wittmann, Strohmer, & Prout, 1989; Zetlin & Murtaugh, 1990) and, as children, demonstrate functional limitations similar to those with mental retardation (MacMillan et al., 1998). Although many similarities exist between these two groups, most of the community support services available target those individuals diagnosed with mental retardation. For example, when students with mental retardation leave school they have available a number of options to support their continued personal and vocational development. These include independent living skills programs, supportive work programs, sheltered workshops, and adult training centers (Parmenter, 1986). Fewer options are available for students with borderline intellectual functioning when they leave school.

Another population of persons with disabilities that has received little attention in the literature is individuals with both borderline IQ and SLD (B/SLD). In addition to having borderline intellectual ability (approximately 12% of the general population), these individuals also have significant academic skill deficits that are in excess of what is expected given their measured intellectual functioning. Like the definition of SLD, those with B/SLD also demonstrate a severe discrepancy between measured intellectual functioning and academic achievement.

Although past research has focused on the vocational outcomes of individuals with SLD or mental retardation and, to a lesser extent, those with borderline intellectual functioning, no studies have investigated the vocational outcome of adults with B/SLD. It can be reasoned that persons with both conditions have significant vocational adjustment difficulties because of the concomitant subaverage cognitive functioning and severe academic skill deficits. Together, the functional limitations in the cognitive and academic sphere may significantly limit training options and job opportunities. Relatedly, although those with SLD are subject to the training and employment protections under the Americans with Disabilities Act (1990) and Section 504 of the Rehabilitation Act of 1973 (1973), their occupational success may be hindered by their limitations in cognitive ability which are not necessarily protected by legislation. In other words, accommodating the SLD alone may be insufficient to maintain employment.

The primary purpose of the present study was to investigate the vocational outcomes of persons with co-morbid borderline intellectual functioning and specific learning disabilities. A second purpose was to compare the VR training and psychoeducational functioning of those persons successfully employed to those unemployed following DVR intervention.

Method

Participants

Ninety-eight former Missouri Division of Vocational Rehabilitation (DVR) adult clients with B/SLD were included in this study. The data was collected from two consecutive fiscal years and represented all of the closed cases within that time frame meeting the B/SLD criteria. Using the service, demographic, and psychoeducational data compiled from DVR archives, those clients who had measured WAIS-R IQ scores 70 to 84, had no significant difference between Verbal and Performance IQ, and who demonstrated a significant discrepancy between IQ and reading, mathematics, and/or written language were included in the study. These 98 individuals qualified for and received DVR services as consumers with a SLD-not B/SLD. Their primary diagnosis was SLD as defined by the Rehabilitation Services Administration (RSA, 1985). For purposes of this study, a significant discrepancy between measured IQ and academic achievement was determined by the regression analysis formula used by the Missouri Department of Elementary and Secondary Education (Missouri DESE, 1994). Although a number of regression formulas exist (Berk, 1984; Forness, Sinclair, & Guthrie, 1983), the Missouri DESE formula is used in the State's public schools and by the State's psychological consultants. At the time data was collected, a successful closure was defined by Missouri DVR as at least 30 hours per week of employment for at least two months.

The mean age of the 68 males and 30 females was 22.3 (SD = 7.8). There were 72 (74%) Caucasians, 25 (25%) African Americans, and one Hispanic in the sample. As a group, the average grade achievement was 11 and the average time receiving DVR services was two years. The average number of previous jobs for the sample was approximately two, and the average length of the longest job was 16 months. Selected demographic and psychometric data of the sample are shown in Table 1.

Table 1

Demographic and Psychometric Data for the Sample

Variable                  Mean       SD      Range

Age                       22.30     7.83    16 - 51
Grade                     11.01     1.21     8 - 14
Months in DVR             24.14    14.89     5 - 91
Longest Job in Months     16.84    30.88     0 - 192
Number of Jobs            1.90      2.02     0 - 10
Full Scale IQ             78.25     3.88    70 - 84
Verbal IQ                 77.46     5.19    66 - 88
Performance IQ            82.06     5.65    61 - 90
Reading Score             71.56    10.11    40 - 93
Mathematics Score         68.32     9.97    43 - 92
Written Language Score    68.94     9.70    45 - 95

n = 98.

Results

The cases of 55 individuals (56%) were closed as successful and the remaining 43 cases (44%) were closed as unsuccessful. This difference was not statistically significant [[[Chi].sup.2] (1, N = 98) = 1.47, 12 = .225]. Table 2 describes the occupational placements for those whose cases were closed as successful and indicate that most (47.2%) were employed in service occupations.

Table 2

Occupational Category of Successful Closures using the Dictionary of Occupational Titles

First Digit

Occupational Category       n    Percent

Professional, Technical     2      3.7
 and Managerial
Clerical and Sales          4      7.5
Service                    25     47.2
Agricultural, Fishery       2      3.7
 and Forestry
Processing                  5      9.4
Machine Trades              5      9.4
Benchwork                   3      5.7
Structural Work             6     11.3
Miscellaneous               1      1.9

n = 53. There were two cases missing this variable.

Tables 3 and 4 present the psychometric, demographic, and DVR service data comparisons between those individuals whose cases were closed as successful and those closed as unsuccessful. Chi-square and t-test comparisons revealed that the two groups had similar psychometric, demographic, and DVR intervention profiles and that only the number of months in DVR (12 = .018) and race (12 = .048) distinguished the groups. A clear majority of persons in both groups received on-the-job training or job coaching (Table 5).

Table 3

Comparisons of Closure Types using Selected Demographic Variables

Variable             Successful    Unsuccessful    [Chi.sup.2]
                      (n = 55)       (n = 43)

Closure                  55             43             1.4
Number Males             37             31              .26
Race:
 Number Caucasian        45             27
 Number African           9             16
  American
 Number Hispanic          1              0             6.08
Vocational School
 in High School          18             15              .05

Variable             df      p

Closure               1    .225
Number Males          1    .607
Race:
 Number Caucasian
 Number African
  American
 Number Hispanic      2    .048(*)
Vocational School
 in High School       1    .83

Note: Figures in cells are number of actual cases.

(*) p < .05.

Table 4

Comparisons of Closure Types using Demographic and Psychometric Variables

Variable          Successful    Unsuccessful
                   (n = 55)       (n = 43)

Age at appl.        22.44          22.12
                    (8.06)         (7.6)

Grade               10.93          11.12
                    (1.18)         (1.24)

Longest Job         16.83          16.86
 in Months         (30.42)        (31.78)

Number of Jobs       1.80           1.90
                    (1.81)         (2.27)

Months in DVR       21.02          28.14
                   (13.24)        (16.03)

Full Scale IQ       78.66          77.72
                    (3.99)         (3.72)

Verbal IQ           77.31          77.65
                    (5.46)         (4.87)

Performance IQ      83.02          80.84
                    (4.70)         (6.53)

Reading Score       72.46          70.42
                   (10.78)         (9.17)

Math Score          68.64          67.91
                    (9.94)        (10.10)

Writing Score       70.62          66.79
                    (9.80)         (9.25)

Variable             t     df      p

Age at appl.       .200    96    .842
Grade              .769    96    .444
Longest Job        .005    93    .996
 in Months
Number of Jobs     .232    90    .817
Months in DVR     2.41     96    .018(*)
Full Scale IQ     1.18     96    .239
Verbal IQ          .322    96    .748
Performance IQ    1.92     96    .058
Reading Score      .989    96    .325
Math Score         .358    96    .721
Writing Score     1.97     96    .052

Note: Numbers in parentheses are standard deviations.

(*) p < .05.

Table 5

Summary of Vocational Rehabilitation Services for the Closures Types

Service(a)                      Successful    Unsuccessful
                                 (n = 55)       (n = 43)

College Training                     6              3
Vo-Tech School                       2              2
Proprietary School                   1              3
On-the-Job Training                 20             13
Work Adjustment/Job-coaching        17             10
Specific Skill Training
 (e.g., apprenticeship)              3              3
Vocational Counseling                6              9

Note. Figures in cells are number of actual cases.

(a) Null hypothesis was retained [[Chi.sup.2] (6, N = 98) = 4.50, p = .610].

Discussion

Two variables, length of time in DVR and race, were associated with unsuccessful closure. The significant difference in length of time receiving DVR services is a logical finding - counselors continued to provide services in an effort to secure successful employment for their individual clients. Although the over-representation of African Americans in the unsuccessful group is consistent with previous findings (Danek & Lawrence, 1982; Feist-Price, 1995; Herbert & Martinez, 1992; RSA, 1992), the available data does not lend itself to hypotheses testing, particularly when considering the low numbers of African Americans in the study. Some researchers (e.g., Sue & Sue, 1990) have reported that African American clients tend to drop out of counseling at a higher rate than Caucasians, while others (Ayers, 1977; Feist-Price & Ford-Harris, 1994) have hypothesized that African Americans may regard the referral process negatively and choose other means of finding employment. Still others have suggested that African Americans experience frustration in the steps and delays in the rehabilitation process (Dziekan & Okocha, 1993), significant differences in expenditures for services (Feist-Price, 1995), and inequitable treatment due to counselor bias (Rosenthal & Kosciulek, 1996). Any of these factors, singly or in combination, may account for differences in rehabilitation rates between Caucasian and African Americans.

Despite significant functional limitations in cognitive functioning and academic achievement, persons with B/SLD were employed (56%) at rates comparable to those with SLD only (59%) in the same system during the same time period. Thus, it appears that the functional limitations associated with both borderline intellectual functioning and specific learning disabilities do not disproportionately influence vocational outcomes (compared to either condition alone). Reasons for this are unclear. It could be hypothesized that B/SLD does not represent a distinct category DVR of consumers -- that, in fact, "borderline IQ" is an arbitrary psychometric profile that has no practical value and that the learning disability itself accounts for differences in vocational adjustment. Alternatively, these individuals may represent a substantially more impaired population of DVR consumers but the vocational effects are being "masked" because they are reliably employed in readily available service occupations and there is little documentation of long-term outcomes (e.g., salary, advancement, stability). Consistent with this hypothesis is the finding that those persons successfully employed were primarily placed in service occupations, which is consistent with earlier studies (Sitlington et al., 1992). The type of training received may have been a contributing factor to this placement category, as a large majority (nearly 70%) of the individuals in this study received on-the-job training or job coaching, which naturally lends itself to service occupations. However, it can be argued that most young adults without disabilities begin their careers in service occupations. Also, the job placements may reflect local vocational options and not the disability per se.

With the exception of race and length of longest job, a comparison of the demographic, psychometric, and DVR service variables revealed no significant differences between those persons whose cases were closed as successful (i.e., employed) and those whose cases were closed as unsuccessful (i.e., unemployed). These findings suggest that predicting a successful outcome for persons with SLD continues to be elusive (BPA, 1989; Dunham et al., 1996). Other variables, such as client-counselor relationship, family support, social skills, motivation, and availability of other resources of employment, which are more difficult to measure (and not available for the present study), may have contributed to a successful outcome. It is also important to consider that the restricted range in IQ scores and sample size may have contributed to the lack of statistical differences. A larger sample size thus increased power) may increase the probability of finding psychometric differences between the two groups. Lastly, it was unknown if psychiatric or adjustment variables may account for the differences between the groups. In fact, many have suggested that socio-behavioral problems and psychiatric problems contribute to vocational failure (Arns & Linney, 1995; Blalock, 1982; Dunham et al., 1996; Smith, 1988), although others have failed to demonstrate a relationship between psychiatric problems and vocational outcome (Cierdiello, Klein, & Solkowski, 1988).

It can be argued that borderline IQ/SLD is nothing more than an arbitrary description of a set of test scores -- that "borderline" does not represent a functional limitation beyond what is expected given the SLD. Indeed, this study failed to support the contention that B/SLD is distinct from SLD in placement success. However, like any study, not all potential outcome variables were examined. Additional investigation of outcome variables could help determine if persons diagnosed with both borderline IQ and SLD represent a distinct, more impaired population of DVR consumers. Specifically, future research should be conducted to determine if persons with both conditions were more likely than those with SLD only to drop out of DVR services, be fired from a job, earn lower wages, or to have a co-morbid psychiatric condition.

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Mardis D. Dunham Michael P. Schrader Murray State University

Karen S. Dunham Marshall County (KY) Public Schools

Mardis D. Dunham, Ph.D., Dept. ELC, Murray State University, 434 Wells Hall, Murray, KY 42071-3318 Email: [e-mail]