Journal Issue: Special Education for Students with Disabilities Volume 6 Number 1 Spring 1996
What Are the Educational Needs of Students with Disabilities?
Students with disabilities are an extremely heterogeneous group, varying by type and severity of disability, as well as by the many variables found in the population at large, such as income, family characteristics, temperament, and intelligence. This heterogeneity means that some students have highly specialized educational needs, such as sign language interpretation or occupational therapy. However, it is possible to make some generalizations about the most common characteristics and needs of students with disabilities as a group.Most Common Characteristics
In general, students in special education require greater than normal consistency and intensity of instruction, greater individualization of both academic content and pacing, and greater emphasis on behavior management. Here, common characteristics of children with disabilities in various categories are described. Later, options for providing special educational services in the regular classroom are also discussed.
As a group, students with disabilities are more likely to be poor and to be African American than are students in the general school population.
Poverty and disability are often found together. Wagner found that 68% of high school students with disabilities in 1986 came from households with incomes of less than $25,000, compared with about 40% of the general school population.16
Congress has established separate programs to meet the educational needs of children with disabilities (the IDEA) and children in poverty (Title 1 of the Elementary and Secondary Education Act). Congress's intent was that the IDEA's strong entitlements be reserved for children with disabilities. Indeed, the IDEA definition of learning disability specifically excludes those students whose underperformance is primarily attributable to poverty. However, this distinction is often difficult or impossible to draw. For example, as Lyon points out in this issue, no empirical data exist to support this exclusionary practice as it relates to learning disabilities in basic reading skills, the most common disability diagnosis.
Ethnicity and Disability
It has long been noted that African Americans are disproportionately represented in special education. At the same time, Hispanics are nominally underrepresented in most categories of special education. (See the article by Reschly in this journal issue.) While it is common for special educators to be accused of overidentification of minority children, attributing some identifications to cultural bias, Wagner found higher incidence among minorities of deafness, blindness, and other disabilities measured by accepted, objective criteria. In her statistical analysis of a large sample, poverty played a major role in this overrepresentation.17 The majority of the disproportionate representation of African-American students in special education is within the category of mild mental retardation. Disproportionate representation is discussed by Reschly in connection with mental retardation.Eligibility and Entitlement Processes
Students who may have a disability are identified and referred for evaluation by their classroom teachers or, more rarely, by their parents or pediatricians.18 Once referred, students are entitled to a multidisciplinary evaluation provided by specialists competent in each area of suspected disability.19 If a student is found to have a disability and to need special services, then he or she is entitled to services under the IDEA. Once eligibility is determined, the school develops an individualized education program (IEP) laying out goals for the student, proposed placement, and services to be provided by the school district. Parental consent is required before a student can be evaluated, services provided, or the student's placement changed.Disability Categories Under the IDEA
Under the IDEA, students are categorized for statistical purposes by their primary disability, although students must receive services based on their individual needs, not on their disability category. Within each category, there is a wide range of severity of disability.
Fifty-one percent of students served under the IDEA in grades K–12 in 1992–93 had learning disabilities as their primary disability. Another 22% had speech or language impairments; 11% had mental retardation; 9% had serious emotional disturbance; and 7% had hearing or visual impairments, orthopedic impairments, autism, traumatic brain injury, or multiple disabilities.20
The category of learning disabilities (LD) is examined in greater detail here because of the increase in the number of students identified as having learning disabilities and the controversies about the criteria used for this identification. A description of students with attention-deficit hyperactivity disorder (ADHD) is also included because of extensive interest in this diagnosis, although ADHD is not listed as a separate disability category under the IDEA.
Learning Disabilities (LD)
Fifty-one percent of students served under the IDEA, amounting to 5% of all students in public schools, have learning disabilities. The proportion of students identified with learning disabilities has grown steadily since 1975. This growth is caused by multiple factors including increased awareness of the existence and impact of learning disabilities, ambiguous definitions of learning disabilities, the inability of regular education to provide individual accommodations in an era of increased academic expectations and diminishing resources, and the attraction of a less stigmatizing label.
Is this growth in identification of children with learning disabilities legitimate? Research literature is not able to answer this question because of continuing debate over both theoretical and operational definitions of LD. What is clear is that the group of students identified with learning disabilities has particular, persistent educational needs that are not being met in the regular classroom.
Despite their prevalence, learning disabilities are poorly defined or understood. Learning disabilities are identified by professionals in many fields, including pediatrics, psychology, neurology, and audiology. Although a coalition of professional and parent organizations has agreed upon a broad and complex definition of LD,21 there are no universally accepted, validated tests or diagnostic criteria to determine the presence or absence of learning disabilities. Some observers argue that the IDEA's requirement of multidisciplinary evaluations increases the likelihood of an LD diagnosis because a student may meet the criteria established by one professional discipline but not another.22
Learning disabilities are most commonly diagnosed on the basis of a notable discrepancy between the student's academic achievement and ability to learn. In other words, the student has reasonable intelligence and adequate opportunity to learn but performs poorly for unknown reasons. Ability to learn is usually measured by intelligence quotient (IQ), and the discrepancy between ability and achievement must be substantial. Specific standards are set by individual states, but the American Psychiatric Association suggests a discrepancy of either two standard deviations or one standard deviation plus other factors such as motor, sensory, or language differences, which are believed to have artificially depressed the student's IQ.23
Further complicating diagnostic efforts, learning disability is not a single condition, but a collection of often co-occurring but distinct conditions that may involve difficulties with listening, speaking, reading, writing, reasoning, or mathematical abilities. Other characteristics commonly found in students with learning disabilities include pervasive weakness in general organizational skills and exceptionally poor social skills.24 This wide variation in symptoms leads to confusion because individual students with learning disabilities may look very different from one another. One student may have problems with basic reading skills, while another has problems with listening, comprehension, and social perception. Learning disorders are also frequently found in association with medical conditions such as lead poisoning, fetal alcohol syndrome, or fragile X syndrome.23
As with most disabilities, there is a range of severity with learning disabilities, and the student with severe learning disabilities is relatively easily recognized by his specific academic inabilities combined with general intelligence and competence. These unusual cases of severe learning disability have been recognized for more than a century, as with this 1896 observation of a 14-year-old boy: "I then asked him to read me a sentence out of an easy child's book without spelling the words. The result was curious. He did not read a single word correctly, with the exception of 'and,' 'the,' 'of,' 'that,' etc.; the other words seemed to be quite unknown to him, and he could not even make an attempt to pronounce them.
"I next tried his ability to read figures, and found he could do so easily. . . . He multiplied 749 by 876 quickly and easily. He says that he is fond of arithmetic and has no difficulty with it, but that printed or written words 'have no meaning for him,' and my examination of him quite convinces me that he is correct in that opinion. . . . I may add that the boy is bright and of average intelligence in conversation. . . . The school master who has taught him for some years says that he would be the smartest lad in the school if the instruction were entirely oral."25
Though the severe learning disabilities might be easily recognized, the majority of students with learning disabilities have a milder form, and there is no clear line of demarcation between students who have mild learning disabilities and those who do not have learning disabilities. As Reschly points out in this issue, the current system imposes dichotomous decisions (students are either disabled or not disabled) rather than reflecting the reality that, in learning disabilities, as in many other aspects, individuals vary by fine gradations along broad continua. The lack of agreed-upon diagnostic criteria means that states and localities create their own diagnostic criteria, leading to considerable variations from state to state in the identification rate for learning disabilities, as discussed in this journal issue by Lyon and by Lewit and Baker.
Despite difficulties in identification, the impacts of having a learning disability are real and persistent. As Wagner discusses in this issue, students with learning disabilities as a group show poor academic performance, high dropout rates, and poor employment and postsecondary education records. Hocutt in this issue concludes that students with learning disabilities who are taught in regular education without extensive support are rarely able to achieve the level of academic competence of even lowachieving, nondisabled students.
Improving outcomes for students with learning disabilities has proven to be a challenging task, generally requiring intensive interventions for even modestly improved outcomes. No model program has proven to be effective for all students with learning disabilities.
Speech and Language Disorders
Twenty-two percent of students eligible for services under the IDEA have speech or language disorders. Approximately half of these students have a speech disorder, usually involving difficulties with articulation.26 Disorders of articulation can generally be improved or resolved with speech therapy, though doing so may take months or years.
Language impairments, on the other hand, often result in substantial learning problems. Students with language impairments will have difficulty with language comprehension, expression, word-finding, and/or speech discrimination. Language impairments are often first noticed because of the student's significantly delayed speech (for example, not using two-word sentences until age four). Delayed speech may be associated with early hearing loss, which also correlates strongly with delayed or inadequate vocabulary development, reading, and general academic development.27 The major causes of language impairments are mental retardation, hearing impairment, central nervous system dysfunctions (generally in the form of learning disabilities), and environmental factors such as lack of stimulation.28 Determining causes with precision in individual cases is often not possible. Indeed, classifications based on causation have not proven useful for remediation, and so professionals are generally advised to base interventions on an assessment of the individual student's language abilities.28
Treatment by a language therapist generally leads to improvement in functional communication skills,29 although the treatment cannot usually be expected to eradicate the problem.
Mental Retardation (MR)
Eleven percent of IDEA-eligible students have mental retardation (MR).30 The severity of mental retardation is classified as mild (generally defined by an IQ test score of between 50-55 and 70, accompanied by deficits in adaptive behavior), moderate (IQ of 35-40 to 50-55), severe (IQ of 20-25 to 35-40), or profound (IQ below 20-25).31 Roughly 75% to 85% of those with mental retardation fall in the category of mild mental retardation (MMR).31,32 In this journal issue, the other three categories are referred to collectively as severe mental retardation.
From an epidemiological viewpoint, using a cutoff of 50 IQ points to divide students into different classifications is arbitrary, because students may show either mild or severe mental retardation as a result of the same diagnosis, such as Down's syndrome. As a group, however, students with severe mental retardation are more likely to also show signs of serious conditions with neurological complications, such as Down's syndrome, cerebral palsy, epilepsy, hearing impairment, visual impairment, and other structural, chromosomal, or metabolic birth defects affecting the central nervous system. In a study of 458 students with mental retardation in Atlanta,33 two-thirds of the students with severe MR, but less than 20% of the students with MMR, were known to have another neurological condition. Moreover, the students with severe mental retardation were more likely to have multiple neurological conditions.
Nationally, African-American students are more than twice as likely as whites to be diagnosed as having MMR. (See the article by Reschly in this journal issue.) Researchers have some understanding, though far from complete, of the reasons for this disproportionate representation. Causes most commonly proposed are poverty16 and cultural bias.34 Recent important research concludes that poverty is a major cause of disproportionate African-American representation within the MMR category, but that poverty does not explain the differences at the mildest levels of mental retardation. A study in Atlanta of 330 children identified as having MMR and 563 randomly selected controls35 found that African-American children were 2.5 times as likely as whites to receive a diagnosis of MMR and that approximately one-half of this difference could be eliminated by controlling for economic status. Low birth weight (defined in this study as under 2,500 grams) was found to be only a minor contributing factor to MMR, though other researchers have found that the incidence of mental retardation escalates with very low birth weight (that is, less than 750 grams).36
In the Atlanta study, ethnicity was closely related to the student's age at time of initial diagnosis. After adjusting for economic status, the researchers found no significant difference in the occurrence of MMR between African-American and white children diagnosed before age 6. However, among children first diagnosed between the ages of 8 and 10, even after controlling for economic status, African-American students were 2.5 times as likely as whites to be identified as having MMR. The median IQ among children diagnosed before age 6 (54.5 for whites, 56.5 for African Americans) was significantly lower than that for children diagnosed between the ages of 8 and 10 (68 for whites, 67 for African Americans). Thus, children with the mildest level of mental retardation, who are identified at a later age, appear to be most disproportionately African American, and the difference is strong even after controlling for poverty. The cause of this disproportionate identification, however, is unclear.
Students with MMR can usually be expected, by their late teens, to develop academic skills to approximately the sixth-grade level. During their adult years, they are often able to hold jobs and live on their own with some supportive supervision or in group homes.31 Students with severe MR can be expected to need more extensive supervision.
Serious Emotional Disturbance (SED)
Students with serious emotional disturbance (SED) account for 9% of students served under the IDEA. These students may have an inability to build or maintain relationships, inappropriate behaviors or feelings under normal circumstances, a pervasive mood of unhappiness or depression, or a tendency to develop physical symptoms or fears associated with personal or school problems.37 These problems are "severe, pervasive and chronic, not minor, situational, or transitory."38
Most students with serious emotional disturbance have been removed from the regular classroom because of their consistently disruptive behavior. As Hocutt notes in this journal issue, research consistently finds that general education teachers will not tolerate disruptive, aggressive, defiant, or dangerous behaviors. Elementary and secondary teachers are concerned that students follow classroom rules, listen to and comply with teacher directives—in short, behave in an orderly fashion. By definition, students with serious emotional disturbance have significant difficulty in these areas. They are more likely than students with any other disability to first experience disability-related problems in adolescence, although their parents report that the majority of these students began to display their emotional problems in their grade school years.15
An article describing the characteristics and outcomes of students with serious emotional disturbance appeared in a recent issue of this journal.15 The author concluded that placement decisions for these students must be made on an individual basis. The higher-functioning students with SED, when returned to regular classrooms, benefitted socially and held constant in academic achievement. However, lower-functioning students (those with more course failures and less social integration) were more likely to drop out of school altogether if moved to regular classrooms.
Hocutt in this issue notes that programs designed to return students with serious emotional disturbance to the regular classroom require extensive time on the part of both special education and regular education teachers, as much as several hours per week for several weeks to enable one or two students to make the transition. Such staff-intensive programming requires appropriate budgeting.
Physical or Sensory Disabilities
Seven percent of IDEA-eligible students have multiple disabilities, hearing or visual impairments, orthopedic impairments, autism, or traumatic brain injury. These students are likely to require both special educational services and related services. Related services include transportation and such developmental, corrective, and other supportive services as are required to assist a student to benefit from special education. Related services may also include physical therapy, occupational therapy, speech therapy, psychological services, school health services, social work services, and parent counseling and training.39 Schools are also the provider of last resort for specialized equipment needed by students.40
Because social integration is a major goal for many students with severe disabilities, social-skills training and recreation programs can be an important component of services. Students with disabilities who have strong recreational interests that can be shared with others are more likely to be integrated in a meaningful way in social settings.
Attention-Deficit Hyperactivity Disorder (ADHD)
Students with attention-deficit hyperactivity disorder are exceptionally inattentive, impulsive, and/or hyperactive.41 Although ADHD is theorized to be a neurological condition, its cause has not been firmly established, and it is not listed as a separate disability category under the IDEA.
The number of students diagnosed and treated for attention-deficit hyperactivity disorder (ADHD) has increased dramatically, by some estimates doubling between 1990 and 1995. Between 1990 and 1993 alone, the annual number of outpatient pediatric visits for ADHD increased from 1.7 million to 4.2 million.42 It has been estimated that as many as 2.4 million youngsters nationally are affected by ADHD and that 85% to 90% of them are taking stimulant medication (for example, Ritalin), to control their behavior. 43 Production of methylphenidate (Ritalin) has more than quadrupled in the past four years.43
There is considerable controversy over whether the increase in diagnosis of ADHD is valid. Some attribute the increase largely to heightened awareness of the disorder. Others worry that many children are diagnosed without undergoing the hours of observation and interviews required for a comprehensive evaluation.43 There is no simple test for ADHD; rather, diagnosis depends upon habitual and long-standing behavior patterns, beginning before the age of seven, which are maladaptive and inconsistent with the student's developmental level.41
These maladaptive or developmentally inappropriate behavior patterns may have a significant negative impact on the student's academic performance and may also cause continual disruption in the classroom. In the majority of cases, these problems can be temporarily addressed with prescriptive medication. Methylphenidate (Ritalin) and some other medications have been shown to lead to substantial short-term improvement in the behavior of most children with ADHD.44 For many children this medication, combined with appropriate behavior modification and support from parents and teachers, is sufficient. However, not all students respond well to stimulant medications.
As Lyon notes in this journal issue, children with ADHD are twice as likely as others to also have a diagnosis of LD and, therefore, to be eligible for special education. The school may also determine that a student with ADHD is eligible for services under Section 504 of the Rehabilitation Act. There is no way to know how many of the 4.6 million IDEA-eligible schoolchildren have a diagnosis of ADHD or how many of the 2.4 million students diagnosed with ADHD are receiving special education. It is clear that students with ADHD have a recognizable, medically treatable condition which affects their schooling and that, even if they are taking prescription medication, they require additional attention and support from their teachers.Appropriate, Individualized Services
What do students with disabilities need? First, they need access to education. Before passage of the IDEA, many students were denied the opportunity for a free, appropriate public education. Bringing about that access has been a major success of the IDEA.
Second, students with disabilities need an education that is appropriate to their needs. It is not enough to include students with disabilities in the regular classroom if their disabilities prevent them from obtaining an education.
Third, appropriateness must be individually determined. Differences in disabilities, severity, comorbidities, and individual strengths mean that the federal government and states cannot legislate specific services for students by category.
However, some general statements can be made about the types of instruction required by the majority of students with disabilities. As a group, they respond best to instruction which is more intense, consistent, and individualized than that required by non-disabled students. Compensating for any disability, from hearing loss to dyslexia, can be a tiring process, and students with disabilities are more prone than their non-disabled peers to fatigue and frustration. Thus, they are likely to require different pacing than other students. They may need additional time to cover the same amount of material or a modified curriculum which allows them to keep pace with the class. Fatigue and frustration, even in small amounts, increase the likelihood of behavior problems. Therefore, students with disabilities may need additional assistance with behavior management, oriented to helping the child develop positive self-management skills.
Predictions about which students will do better academically or socially in which setting are highly fallible. No interventions in either regular or special education are uniformly successful for students with special needs; students with the same disability, in roughly the same degree of severity, may vary tremendously in personality, motivation, social and family support systems, and compensating strengths. A strength of the IDEA is its requirement that placements and services be determined individually and that parents be offered the opportunity to contribute their knowledge and insight about their child as the student's individualized education program (IEP) is developed. For these reasons, some advocacy organizations and the major national teachers' unions have taken the position that schools should preserve a range of options in placements and services.45-47
- Schools must continue to recognize the special needs of students who, because of individual differences, do not respond to regular education. The IDEA's guarantees of individually determined, appropriate education should be maintained.