Treatment or Remediation
It is particularly important that learning disabilities are identified
and treated as early as possible. Because of the frequency and importance
of reading problems, they are emphasized here. However, learning problems
can appear as well in math and writing. Instruction in math or written
language skills is not as well developed as it is for reading. However,
as in the case of reading, individualized instruction is usually the
key to effective remediation in math or written language.
Best evidence from research now suggests that direct and systematic
instruction in phonological awareness (recognition of the sounds and
patterns of language) in kindergarten or even preschool can prevent
reading failure for most children with early signs of learning disabilities.
Training teachers to use such instructional techniques is critical not
only in prevention but in setting the stage for detecting children who
do not respond to these interventions and may need more intensive intervention.
If severe phonologic deficits are left untreated, they can lead to problems,
later in kindergarten or beginning first grade, in phonemic awareness
(association of sounds with specific letters or groups of letters).
If phonemic skills are not well established, problems can develop later
in first or second grade in decoding (segmenting written words into
discrete sounds and blending specific groups of letters into sounds)
and word recognition. Problems in accuracy and fluency in these skills
can then lead to subsequent problems in effective comprehension of what
has been read.
Only a few commercial programs for reading are available that use principles
of instruction based on specific remediation of these deficits in phonological/
phonemic awareness and decoding skills. Fewer still have been widely
tested in research with children with learning disabilities. DISTAR
(Direct Instructional System for Teaching Arithmetic and Reading) and
Lindamood Bell are two examples. DISTAR can be used individually or
with groups of children in classrooms, but the Lindamood Bell program
is designed primarily for use with individual children. Commercial versions
based on the original DISTAR program are currently known as Reading
Mastery and Open Court.
There is also considerable evidence that instruction can be made more
effective by daily charting of accuracy and fluency rates for each individual
child, in order to better plan instruction based on this continuous
feedback. Several studies have also suggested strategies, such as previewing
text and anticipating content, that can enhance reading comprehension
in older children with learning disabilities, once they have begun to
master phonemic awareness and word recognition.
Although there are occasional exceptions to the above instructional
principles, parents and teachers should be cautious of most other approaches
to intervention or remediation. Evidence-based practice is the best
standard. This involves a number of independent and carefully designed
studies which demonstrate that the particular instructional approach
is effective for children with learning disabilities. Using less effective
instructional practices means that weeks or even months may be essentially
wasted during critical periods in a childs development of reading
An approach called whole-language instruction, for example, focuses
primarily on a language-rich environment in the classroom and on getting
meaning from the context of written stories. Less attention is paid
to phonological awareness, decoding, or word recognition. The research
evidence for such an approach is less than convincing, especially for
children with learning disabilities.
A recent computerized system, Fast ForWord, that does attempt to help
children better discriminate the sounds of language, is a popular commercial
program; but very little research has been published on this program
independently from its developers that would currently support its use
in learning disabilities. Reading Recovery is also a popular program,
but results have also been somewhat less predictable with children with
learning disabilities. Even less convincing are approaches such as perceptual
training or sensory integration, as a remediation for learning disabilities,
or remediation that tries to segment readers into visual or auditory
learners and then teaching only to that mode of learning. Comprehensive
reviews of research studies on children with learning disabilities do
not demonstrate that such approaches are more effective than direct
instruction in phonologic or phonemic awareness. Some studies even suggest
that perceptual training or teaching primarily by specific auditory
or visual modalities may even be harmful, since such approaches may
waste valuable instructional time.
Some evidence suggests that direct instructional approaches in number
and math concepts, with lots of opportunity for guided practice and
application of these skills is useful. Early in preschool or kindergarten,
effective instruction involves manipulation of objects that can be sorted
and counted. Associating these manipulatives with actual numbers and
sets of numbers then follows. From there, basic addition and subtraction
are taught directly, with increasing emphasis on abstract number concepts
and less reliance on sorting and counting, although manipulatives may
be reintroduced to support direct instruction in multiplication and
division. The DISTAR program (mentioned above) has excellent evidence
for its use in development of number skills and math concepts. Considerably
less evidence is available for effectiveness of "new math"
approaches, which rely less on computation and more on math concepts.
Using hand-held calculators to check work has been extremely useful
as well in math instruction.
Writing instruction usually begins with exercises in copying letters
and words and leads to writing one-word answers and composing short
sentences. Availability of instructional packages for remediation of
writing skills is quite limited, but more research on writing skills
is emerging; and use of laptop computers for children whose poor fine-motor
coordination interferes with effective handwriting is becoming a common
classroom accommodation. There are some commercially available computer
programs which address composition skills in young writers, such as
Learning disabilities is a field in which a surprising number of approaches
are widely used without sufficient evidence that they are effective.
Parents need to be wary of remedial approaches that seem logical, at
first glance, but fail to focus sufficiently on direct instruction in
phonological or phonemic awareness for reading or on direct skill instruction
in math or written expression.