Rethinking Learning Disability Definitions: Theory To Practise - Part One

Over the next few weeks I'm going to be presenting a more thorough examination of Learning Disabilities as defined by the Learning Disability Association of Canada. In my opinion, we can better understand what constructs would be helpful to evaluate in LD evaluations by examining this definition more thoroughly. The slide series will include:

(1) A breakdown of LDAC's definition
(2) Translation of this to an easy to use DSM style format
(3) An examination of potential tools to explore these domains.

Learning Disabilities Defined

View SlideShare presentation or Upload your own. (tags: disability learning)

Implementing a Useful Learning Strategies Assessment with SMALSI

Test: School Motivation and Learning Strategies Inventory (SMALSI)

Publisher: Western Psychological Services (WPS)

Publication: 2007

Age Range: 8-12 (Child Form); 13-18 (Teen Form)

Admin time: About 20 minutes

The School Motivation and Learning Strategies Inventory (SMALSI) is an instrument I was introduced to briefly on its arrival to the school psychology scene as a possible compliment or replacement to some of the older or less broad academic enabler evaluations on the market (e.g. LASSI - Learning and Study Strategies Inventory or the ACES - Academic Competency Evaluations Scales).  Due to the ease of administration (computer admin and scoring available) it soon became my standard test for evaluating these areas.  Initially I threw the SMALSI at borderline LD cases or for those who were not going in the direction of a diagnosis to determine whether motivation or learning strategy use.  In reality, I suspect most clinicians (including myself historically) have left these tests, along with many supplemental self-reports, as a small complementary paragraph at the end of the report.  I also suspect that this paragraph was often ignored in the bigger scheme of things.

Recently on a case that proved to have a complex history but resulted in no formal diagnosis I decided to take a more comprehensive look at the SMALSI and what it could offer to this particular student as a map on how to increase their academic success.  When performing an item level analysis on the SMALSI it can be quite surprising what strategies are not being used by students who even perform within the Average range on particular strategy domains.  Whether intentional or not (e.g. never trained to do so) it is likely that an increased level of success would be the result of implementing these academically.

What does SMALSI offer?

The tool provides an evaluation of several "strengths" and "liabilities" which are essentially a checklist of positive learning strategy use combined with measures of potential interpersonal risk factors.  The domains include:

Strengths

Study Strategies

Note-Taking/Listening Skills

Reading/Comprehension Strategies

Writing/Research Skills

Test-Taking Strategies

Organizational Techniques

Time Management

Liabilities

Low Academic Motivation

Test Anxiety

Concentration/Attention Difficulties

How should it be interpreted?

With many T scored scale domains you need to use caution in assuming that an average result in one area means that the student is fully capable within that context.  In the case of the SMALSI, more often than not, I've found it is more likely to be an averaging of strengths and weaknesses.  You also must be cautious in recognizing that these are the students self perception of their competency in the use of these strategies.

In my experience with using the SMALSI over the last few years is that the domain scores are less useful than the actual item reports.  Fortunately the computer report provides an easy to view narrative of item responses that allows you to quickly pinpoint those areas that the student is not implementing in their academic efforts.  These results subsequently can be used to provide a checklist or "to do" list of what the student needs to do to take the next step academically.

For example, responses may indicate the following (items are greatly paraphrased for copyright purposes):

I NEVER study differently for different types of tests (e.g. multiple choice or essay)

I SOMETIMES make notes regarding material I do not understand in order to ask my teacher at a later time

I NEVER use the review material at the end of a book chapter to prepare for tests

It is not a large leap to ascertain that these are each things a student should be doing.  Regardless of why they are not doing these strategies (with the exception of if they are incapable) it would be helpful that these are drawn to their attention and used in future settings.

Unfortunately, in my experience this can quickly become a LONG list which risks taking away from other aspects of the report.  What I have taken to doing is creating an addendum to the report (noting this in the reports body) that lists the students responses that were in the NEVER or SOMETIMES range that should be used more frequently.  This list then is reviewed with the student and allows them for some easy strategies that they can implement immediately and take personal ownership over.  This can be quite helpful in the face of many recommendations that the student does not have a great deal of personal control over.

How much does it cost?

Adding a paper and pencil self-report checklist can get quite pricey if you have several in each case.  Fortunately the SMALSI provides a unlimited use computer administration that can be found in Canada for about $450.  In the end that is less than many test kits in total and provides a very valuable addition to your test kit at no additional cost.

MHS has it for $435 Canadian HERE

PsyCan's price is a bit more prohibitive at $600 HERE

In the US check out PAR for $425 HERE  or for $400 with WPS

Some support literature:

A Review of the SMALSI is available in the Canadian Journal of School Psychology:

Review of the School Motivation and Learning Strategies Inventory (SMALSI)

J Jeary - CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY, 2007

One of the authors PhD dissertations was on the tests complete development.  A PDF of that dissertation is available here: Development of the School Motivation and Learning Strategies Inventory - PhD Dissertation by Kathryn Chatham Stroud

A not so useful powerpoint from the publisher: HERE

What else is out there?

There are several other SMALSI Like tests that you may already own that could provide a similar (though in my opinion less comprehensive) review:

BRIEF - Covers self-regulation based academic enablers to a degree (All ages)

LASSI - Learning and Study Strategies Inventory (College & High School) 

SRSI - Self Regulation Strategy Inventory (High School)

MSLQ - Motivated Strategies for Learning Questionnaire (College & High School)

STRANDS - Survey of Teenage Readiness and Neurodevelopmental Status

ACES - Academic Competence Evaluations Scales - (Grade 6+)

Stimulant Treatment Not Related to Abuse Risk

Just a brief note regarding a recently published article from the American Journal of Psychiatry on stimulant medication and future substance abuse risk. This article appears well timed as there has been recent concern (realistic or not) about both introducing a drug culture to kids through ADHD treatment and the actual abuse of stimulants in adolescents and young adults.

What we do know for sure is that ADHD kids are at increased risk of substance abuse. The AJP longitudinal study found that those who are being properly treated for their ADHD were actually at a decreased risk of future substance abuse (this is not a big surprise if you know the biology behind the disorder). The earlier they received proper medical support the less risk they were at of abuse.

You can read the press release on the article by CLICKING HERE or read the full article in:

• Title: Age of Methylphenidate Treatment Initiation in Children With ADHD and Later Substance Abuse: Prospective Follow-Up Into Adulthood
• Author: Salvatore Mannuzza, Rachel G. Klein, Nhan L. Truong, John L. Moulton III, Erica R. Roizen, Kathryn H. Howell, and Francisco X. Castellanos
• Journal: American Journal of Psychiatry May 2008 (Available online now).
• Abstract: Objective: Animal studies have shown that age at stimulant exposure is positively related to later drug sensitivity. The purpose of this study was to examine whether age at initiation of stimulant treatment in children with attention deficit hyperactivity disorder (ADHD) is related to the subsequent development of substance use disorders. Method: The authors conducted a prospective longitudinal study of 176 methylphenidate-treated Caucasian male children (ages 6 to 12) with ADHD but without conduct disorder. The participants were followed up at late adolescence (mean age=18.4 years; retention rate=94%) and adulthood (mean age=25.3; retention rate=85%). One hundred seventy-eight comparison subjects also were included. All subjects were diagnosed by blinded clinicians. The Cox proportional hazards model included the following childhood predictor variables: age at initiation of methylphenidate treatment, total cumulative dose of methylphenidate, treatment duration, IQ, severity of hyperactivity, socioeconomic status, and lifetime parental psychopathology. Separate models tested for the following four lifetime outcomes: any substance use disorder, alcohol use disorder, non-alcohol substance use disorder, and stimulant use disorder. Other outcomes included antisocial personality, mood, and anxiety disorders. Results: There was a significant positive relationship between age at treatment initiation and non-alcohol substance use disorder. None of the predictor variables accounted for this association. Post hoc analyses showed that the development of antisocial personality disorder explained the relationship between age at first methylphenidate treatment and later substance use disorder. Even when controlling for substance use disorder, age at stimulant treatment initiation was significantly and positively related to the later development of antisocial personality disorder. Age at first methylphenidate treatment was unrelated to mood and anxiety disorders. Conclusions: Early age at initiation of methylphenidate treatment in children with ADHD does not increase the risk for negative outcomes and may have beneficial long-term effects.

A Note on Net News

Quite some time ago I set up news feeds that send me all the latest news on ADHD, Autism, Asperger's, and LD's. In fact, a lot of the reports I provide on here initially come from the results of that research. What strikes me though is the amount of opinion pieces I see that are passed off as legitimate news articles. In fact many reports from reputable sources are little more than press releases.

Take THIS ARTICLE on nutrition and Autism for Medical News Today (MNT).

Let's look at the problems here:

• This is clearly a press release. When was the last time you saw an unbiased article that provides direct links to only one side of the argument?
• There is no author listed. If you wrote something professionally you usually want to take credit for it.
• It is full of loaded language .. Ms. M is presented as a nutrition expert. But the Mayo Clinic nutritionists are not.
• Not only is there a website posted that examines only one side of the argument, but Ms. M is clearly looking at a book tour and workshops. As a reader I have to ask if this is an advertisement.
• There is no sources provided other than the book which is being promoted.

I don't have a problem with press releases. I do have a problem with them being presented as news. The unfortunate truth is that I am able to view this and see it for what it is, but an everyday parent is not. I would not share my opinion on nutrition based pushes for treatment of neurological and learning difficulties (and I have opinions) without sourcing them, and that is why you won't read them here.

Now take a look at THIS ONE from Medical News Today discussing a longitudinal study that found no increased risk of substance abuse for ADHD medication users. It's still not perfect (it is also a press release without saying it is one.. perhaps that's MNT's fault) but it is sourced with references that are PEER REVIEWED and easily verified.

The difference is pretty clear. It is unfortunate that parents have to be such educated consumers in our field, but they need to know that the publishing side of treatment is big business.

Executive Functioning: Developmental Aspects

The Eide Neurolearning Blog has a great post that is about the development of neuropathways in executive functioning (though it refers to it as cognitive control).

An interesting post with good images that shows that adult like development is emerging soundly around age 9. This observation fits well with the norms of tests like D-KEFS where increased frequency in productivity tasks and a decreased rate of errors starts to appear around age 9-10. It also highlights that evaluation of executive impairment under this age (as can be done with NEPSY-II and by checklist form on BRIEF-P) should be interpreted with a caveat that this is a highly developmental characteristic and that borderline impairments my warrant revisiting after age 9.

You can read the Eide post by CLICKING HERE

Building a Searchable Psychoed Library

Do you have a few psychoed text books laying around? I bet they are full of extremely useful information. If you only had the time to search through them all. Unfortunately this can be a pretty big hassle if you've build a collection of any size. Recently I discovered a nice little option over at Google's book search that could make indexes a thing of the past.

Google Book Search is an index and archiving project that you may have heard about in the news about a year ago. Google was attempting to scan in the contents of every book written in order to allow people to find resources and texts of interest. Unfortunately the press grabbed onto the story and tweaked it just enough to terrify book publishers into thinking Google was giving books away for free. This is certainly not the case as the service allows you only to see a brief portion of a page (enough to gain your interest and encourage you to pick up the book if it has the information you need). I've used this search tool in the past to find books on certain topics that are worth ordering for reference use. What I recently noticed is that if you have a Google account (if you don't sign up for one by clicking here) you can use the database to build a search program for your own library.

All you have to do is enter the title of each of your books in the search box, find the copy that is yours, and click on "add to library". After this you can then search your own personal library for important references.

Unfortunately every book you own has likely not been scanned (some publishers were ignorant of the purpose of the project and refused permission) but it is a good start to finding resources.

For example.. lets say I was looking for a reference on story recall and ADHD. I go to "My Library" on Google Book Search and add "story recall" ADHD as a search term and poof it tells me the pages of interest in my copy of Attention Deficit Hyperactivity Disorder by Barkley.

That should save you some time... next I'll show you how to build a searchable article database and why you should always buy eBooks!

An Inspiring Autism Video

A very inspiring and encouraging video (it's short) about a autistic student who works as an assistant for a high school basketball team and the final game of the season where he suits up. Definitely worth a view.

Predicting Schizophrenia in Teens

I am a strong believer that a full psychological approach should be taken in schools. We cannot exclude the influence of mental illness on psychoeducational testing and academic success and thereby should always be cued into the full clinical picture.

A recent study examined the predictive validity of the several symptoms including (for a full list review the article):

• Spending Excessive time alone doing nothing
• Social Withdrawal
• Thinking that people are following them; Paranoid thoughts
  

Teens with one of these symptoms showed a 35 percent risk of progressing to psychosis within 2.5 years (though I suspect symptom 3 inflated this result), but more importantly students experiencing all three were at up to an 80% risk.

Unfortunately early risk identification does not lead to decreased risk. What it can do though is provide time to prepare individuals and families prior to full progression of the illness and facilitate proper referrals and monitoring.

Source: Cannon, T. D. Archives of General Psychiatry, January 2008; vol 65: pp 28-37

The Battle Over Autism's Origins

I have not thought about the Autism caused by vaccinations theories for a couple of years. After all I had read many a review articles that discounted this aged theory years ago. Yet again this week I came across a news article discussing yet another study disproving the theory and a discussion of how "activists" (which should not necessarily be read as scientists) are still not accepting the study.

These activists are quick to point out flaws in the research. The latest study postulates that since mercury has been removed from the vaccinations that were originally theorized as having an autism link and the cases of autism diagnosis has remained stable or increased that this could not be the cause. Makes sense. It is not as medically oriented as most studies but it is just another part of the picture. The activists though say that they didn't include immigration. A bizarre argument to me, and one that is only valid if they can prove that the study included an increased ratio of immigrants who had been exposed to the vaccinations.

It made me wonder why these activists are pushing such an old theory and agenda so strongly. I suspect there is a few factors:

• Money. As we saw with NLP and the recent cognitive re-training LD programs there is big money in theories related to specific schools of thought. Books; lecture tours; support materials.
• Money II. Lawyers! It is hard to sue someone for a genetic or neurodevelopmental disorder. It is a lot easier to sue over a vaccination. A class action in this area would be worth billions.
• The last option is a sad one: Blame Shifting. Though current research shows no reason at all for parents to blame themselves for their Autistic child, it is a lot easier to shift any blame one feels to anger by explaining away what appears to parents as a regressive disease as being the fault of something tangible.

The most unfortunate part of the article I read (available here) was the statement by one pharmacologist that stated, "The final answer to me will come when that paper is written that says, 'This is what causes autism'." This is a very unfortunate stance. If you look at all of the disorders we deal with (Learning, attention, mental illness) we are clearly a field that works with symptom profiles not etiology. As a result we likely have created categories that can result from multiple causes (for a concrete example look at Barkley's breakdown of ADHD into genetic/developmental/acquired causes). The "this is the cause" study that explains all cases will never come.

Updates coming again for 2008

I wanted to put together a quick little note to state that this blog will be back up and running this month. My return to private work was a bit time consuming but things are getting a bit more organized these days. So expect to see some regular updates. I am working on some original content again and some article reviews that should appear in the next day or two. See you soon!