SEMINARS I N NEUROLOGY-VOI.UME
11, N O . 1 MARCH 1991
Prognosis: The Adult with a Learning Disability
John T. is a highly successful and dynamic producer, consultant, and commentator in the television industry. Invited to lead seminars throughout the country, he is bright, articulate, and thoughtful. He is, however, dependent on his wife to correct excessive grammatical and spelling errors in his written work. Because he is afraid that he will stumble over words if he reads a speech to an audience, he previews the material silently, mentally noting important points that he wants to make, and then does not refer to the written speech again. Steven R., chronically unemployed, is in a drug rehabilitation program. Prospects for employnlent are poor. He cannot read well enough to fill out a simplejob application. He grew up in a poor urban area and remembers that he never seemed to be able to learn to read. He failed first grade and left school after his third year in 7th grade. These men represent the extremes in the functioning of adults with learning disabilities. The awareness that learning disabilities in adults exists is recent, even among professionals in the field, primarily because this condition has been perceived as a problem of childhood. A growing realization that learning disabilities may not disappear when children leave school has led to an additional phrase in the definition of learning disabilities put forth by the National Joint Committee on Learning Disabilities, a panel of learning disability experts who represent the major national professional organizations in the field. T h e definition now reads, "These disorders (learning disabilities) are intrinsic to the individual . . . and may
occur across the life span" (italics are mine).' Moreover, two major national organizations serving professionals and parents of learning-disabled individuals recently changed their names to reflect this recognition. The Association for Children with Learning Disabilities become the Learning Disabilities Association of America and the Foundatiori for Children with Learning Disabilities became the National Center for Learning Disabilities. There are no widely accepted prevalence figures for adults with learning disabilities, but estimates of the number of functionally illiterate adults (reading below 8th grade level) in the United States range from 20 to 85 m i l l i ~ n . ~It- is ~ also estimated that 10 to 15% of school-aged children are learning d i ~ a b l e d . ~If- ~children do not outgrow these problems, then many of the illiterate adults may actually be learning disabled. This article will focus on three areas of concern about adults with learning disabilities: (1) the outcome of childhood learning disabilities, (2) basic skill deficiencies and other characteristics found in learning-disabled adults, and (3) challenges faced by learning-disabled adults in postsecondary and vocational settings and employment, and the kinds of support services available for them. Learning disabilities are defined in this article as serious difficulties in reading, writing, spelling, and/or mathematics well beyond what might be expected on the basis of a person's general intellectual ability. Learning disabilities occur in conjunction with underlying difficulties in language, perception, and memory and are of presumed neurologic origin.'
Department of Pediatrics, Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, New York Copyright O 1991 by Thieme Medical Publishers, Inc., 381 Park Avenue South, New York, NY 10016. All rights reserved.
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Ruth L. Gottesman, Ed.D.
Over the past 30 years at least 22 studies have been conducted to determine the outcome of childhood learning disabilities.''-" Outcomes that were investigated include the improvement of reading and other academic skills over time; attainmerit high and P ~ degrees; social and emotional adjustment; and type of employment, if any. Outcome measures include the use of standardized achievement tests, questionnaires and self-rating scales, and interviews. Ten of the most widely reviewed and comprehensive studies are summarized in Table 1. The studies differ from each other in the criteria used to select subjects, the outcome measures, and the presence or absence of control groups. Children in the studies came from lower class, middle class, and upper class backgrounds and were selected from public and private school and from clinic populations. They were seen initially in grades ranging from second through high school, and, at the time of follow-up, through middle age. In some studies the mean I Q of the subjects was in the superior range, whereas in other studies it was in the average or low-average range. Despite the differences in methodology and in study samples, the studies were consistent in their findings that childhood learning disabilities continued into adulthood and affected not only reading achievement but also vocational choices, social relationships, and emotional well-being in the individuals studied. The degree of the impairment at the time of follow-up varied considerably among the studies. The most favorable outcomes were reported in the studies of children attending private schools. The majority of persons in these studies attended college. Most earned college degrees and some went on to graduate school. After completing their education, most of them selected a career in business; few if any became physicians or lawyers. The outcomes of learning-disabled students in public school settings were less favorable. Compared with their non-learning-disabled classmates, significantly more of these students dropped out of high school, had low-paying jobs, or were chronically unemployed. Children who were referred to clinical settings had the least favorable outcomes. The differences in outcomes may be, in part, related to the differences among the private and public school and clinic populations of children. Most children attending private schools came from affluent and highly educated families, whereas most children attending public schools came from working class families whose educational and oc-
cupational expectations for their children were more modest. Children who were seen at clinics usually had problems of a more serious nature. FACTORS RELATED TO ADULT OUTCOMES
The factors most closely associated with adult and early onset of were the symptoms, the socioeconomic status (SES) of the family, intellectual ~ ability, ~ and evidence ~ of neuro~ logic impairment.ll,M,35
~
Severity and Early Onset of Symptoms In all studies, children with the most severe learning disabilities had the poorest outcomes in educational attainment, employment, and social adjustment. They also made the least progress in reading despite remediation efforts, were most likely to drop out of school, and showed the highest incidence of difficulties with the law. Often, these were the children whose learning disabilities were evident from the very beginning of school. Children who show severe reading disabilities in the early grades seem likely to remain poor readers throughout their lives.
Socioeconomic Status The data suggest that well-educated and financially successful parents played an important role in their learning-disabled child's educational and occupational outcomes. They provided their child with the best schooling (usually private), obtained remedial and ancillary services, found and were able to fund appropriate kinds of postsecondary education, and were able to locate employment possibilities. Most children from lower SES backgrounds did not have access to private schools or private tutorial help. Many more learning-disabled (and nondisabled) subjects from lower class than middle or upper class backgrounds either dropped out or did not continue their education beyond high school.
Intellectual Ability High intelligence, especially when coupled with high SES, was significantly and positively related to a high level of educational attainment, the highest reading achievement, and the most prestigious employment. (This was true for the control groups as well.) Lower IQs were associated with the poorest outcome on all parameters just mentioned.
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OUTCOME OF CHILDHOOD LEARNING DISABILITIES
Table 1. Summary of Follow-up Study
Subjects
R a ~ s o n , ~1968 O
Age at Follow-up fvr)
20 dyslexic, 16 medium Elementary achieving, and 20 grades high achieving males attending small private school. Mean IQ 131. High SES Rutter et al,311976 86 reading-disabled, 155 slow learning, and 184 normal (controls), the entire 9- to 10-year-old population of the Isle of Wight in 1964-65 G o t t e ~ m a n1979 , ~ ~ 43 learning-disabled children evaluated at a diagnostic clinic showed high incidence of positive neurologic, psychologic, and language findings. Mean IQs in lowaverage range. Low to average SES Frauenheim, 11 adults who as Hecker1,18 1983 children had been diagnosed as dyslexic in mental health facility in Michigan. From middle class families and communities in Detroit metropolitan area. Mean IQ score 94 at time of initial testing and 92 at time of follow-up. Hartzell, 114 learning disabled C o m p t ~ n 1984 ,~~ (LD) students evaluated at a diagnostic clinic; 144 siblings served as controls. Mean IQ of LD sample, 107. Highly educated families. High SES
26-40
Finucci et aI,l7 1985
Average age, 37
579 alumni of private boarding school for boys with developmental dyslexia. Mean IQ, 118. 612 alumni of private school-both groups of middle to high SES
7-12 grade
Years Between Initial Evaluation & Follow-UD 18-35
Results 100% dyslexic boys were graduated from high school and entered college; 80% were graduated from college
At follow-up both reading-disabled and slow-learning groups continued to do poorly in reading, spelling, and mathematics; half of the group were 2 SD below the mean in reading and spelling 5-7
Showed small gains in readingapproximately 4 months per year. Mean grade level scores increased from 3.3 to 4.4 on the Reading Subtest of the Wide Range Achievement Test (WRAT), and 2.6 to 6.0 on the Adult Basic Learning Evaluation (ABLE)
Made little progress. Mean grade level scores increased from 1.9 to 2.6 in reading, 1.4 to 2.1 in spelling, and 3.1 to 4.5 in arithmetic. Subjects represent severe end of continuum in learning disabilities. Despite remediation and completion of high school of 80% of sample, patterns of skill weakness and cognitive abilities remain remarkably consistent
-
9% of LD sample compared with 1% siblings dropped out of high school. 35% LD sample compared with 11% siblings who were graduated from high school did not continue education. 23% LD sample compared with 75% siblings experienced "high" academic success. 31 % of LD sample compared with 77% siblings reported high level social success. Best predictors of academic success were high IQ and effective family functioning. Predictor contributing most to negative outcome was severity of learning disability 468 respondents from 50% received B.A., 70% received graduate degree, 39% had some college or technical training beyond high school. The dyslexic alumni were overrepresented in business field and underrepresented in mathematics, engineering, and science fields. Dyslexic alumni took longer in graduating than controls. Boys with milder dyslexia did well. Boys with severe dyslexia had more difficulty in obtaining a college degree
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Studv
Age or Grade When First Evaluated
Table 1. Continued
Subjects
Zigmond and T h ~ r t o n , ~1985 '
105 students entering a 9th grade learning-disability program in large northeastern urban school district. Mean IQ, 86. 18 non-learningdisabled (NLD) controls from same 9th grade roster
Bruck,12 1987
101 boys and girls referred to LD clinic. Mean IQ, 103. 43% judged severely learning disabled, 30% moderate, and 27% mild. All children received remedial help throughout their school years. Primarily from middle class backgrounds 54 boys and 16 girls with reading disability. Mean IQ, 103. 55 boys and 20 girls as controls. Mean IQ, 116. Middle to high SES in Colorado 203 learning-disabled boys and girls referred to neuropsychology clinic in Victoria, British Columbia. Divided into 3 subgroups according to neurologic findings; group I showed hard neurologic signs, group I1 showed soft signs, and group Ill showed no signs. Mean IQ for LD subgroups were 88, 95, and 102. 52 children selected for control group, matched for SES. Mean IQ, 110. Low to middle SES
DeFries,13 1988
S ~ r e e n 1988 ,~~
Age at Follow-up fvr) Past high school
Years Between Initial Evaluation & Follow-ur,
Results
6
More than 50% LD students left before high school graduation. Drop-out rate significantly higher than for NLD students. Great difficulty finding employment. Remaining 50% showed significantly lower scores on reading tests than NLD students. Chances of both remaining LD and NLD students having a job 18 to 24 months after graduation equally good, and better than for LD and NLD drop outs 10% did not complete high school, 32% completed high school or additional vocational training, 17% attended junior college or a university, and 11% completed college. Educational achievement of LD subjects less than their normal-learning siblings, but did not differ s~gnificantlyfrom it
5
Reading disabled and control children differed substantially on measures of reading performance. Reading deficits during middle childhood are highly predictive of later reading problems
10
All LD subgroups showed greater amount of emotional maladjustment and antisocial behavior than control subjects. Oral reading grade level of all LD subgroups 3 years below controls (7th vs 10th grade level). The presence of a neurologic handicap affected all areas of long-term adjustment and outcome-social, personal, and occupational
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Studv
Age or Grade When First Evaluated
SEMINARS I N NEUROLOGY
The degree of neurologic impairment or dysfunction, as evidenced in a neurologic examination, was significantly related to outcome. Learning-disabled children with demonstrable "hard" neurologic signs had poorer outcomes than those with "soft" signs, who did not fare as well as learning disabled children with no neurologic signs. SUMMARY
The lifetime effects of a learning disability appear to be far broader than the persistence of difficulties in reading, writing, and spelling. The presence of a learning disability has a major effect on the attainment of a high school or college degree, employment options, interpersonal relationships, and emotional well-being. High SES learning-disabled children with average and aboveaverage intelligence and the mildest symptoms usually have the best outcome in all areas, whereas those of lower SES with below-average intelligence and moderate to severe manifestations of learning disabilities usually have the least favorable outcomes. Even those who have the best outcomes are not likely to find careers in professions such as law or medicine. Those with the most severe learning disabilities are likely to experience chronic unemployment, poor interpersonal relationships, and difficulty in independent living.
bored handwriting, excessive spelling errors, and an inability to produce grammatically and syntactically correct written communications are frequently r e p ~ r t e d . " . ~ ' -Difficulties ~~ in activities of daily life stemming from deficiencies in basic skills include reading a newspaper, filling out job applications, handling money, writing checks, paying bills, keeping records, following recipes, calculating tips, reading manuals, looking up telephone numbers, reading menus or street signs, and setting alarm clocks.
Language A common finding in learning-disabled individuals is a history of language delays or impairment. This often results in smaller vocabularies, less use and understanding of complex sentences, mispronunciations, incorrect word usage, poor organization of thought, and a narrower range of l - ~ ~ language is the meanings for w o r d ~ . ~ Since major vehicle for communication between people, restricted and flawed language skills can hamper interpersonal relationships. Learning-disabled persons often cannot recognize when someone is exaggerating, using figurative language, teasing, or joking.
Memory and Attention ADULT SYMPTOMS OF LEARNING DISABILITIES In general background and attributes, adults with learning disabilities are as heterogeneous a group as those without learning disabilities. Learning-disabled adults are also far from homogeneous in their symptomatology. Nevertheless, most learning-disabled adults continue to experience difficulties ranging from mild to severe in at least some of the following areas.
Basic Skills Deficiencies
Memory deficiencies interfere with learning rote material, such as days of the week, months of the year, and times tables. Learning-disabled adults frequently have difficulty with questions such as, "How many weeks in a year?" or "Where does the sun set?" They find basic facts hard to remember, and are lacking in their knowledge of general information. Many learning-disabled adults show deficits in attention that interfere with their ability to focus and concentrate on tasks.45.48.50
Auditory Processing
Learning-disabled adults report continued diffiMost learning-disabled adults have difficulties culty in decoding unfamiliar words, and they often in discriminating among similar-sounding phocomplain of slow, labored reading and poor com- nemes, blending sounds into words, and associatprehension and retention of what they read.38-45 ing sounds with their letter counterparts, all deMany report difficulty in simple mathematical op- spite adequate hearing.54-56This results in their erations such as multiplying, dividing, and solving inability to read unfamiliar words and limits their . ~ Vlao o runderstanding of reading passages. problems that contain f r a c t i ~ n s . ~ ~ . ~ ~and 68
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Neurologic Impairment
VOLUME 1 I , NUMBER 1 MARCH I991
Some learning-disabled adults have great difficulty with spatial relationships. Assembling a pencil sharpener, vacuum cleaner, or luggage rack can be major challenges. Many cannot copy a gcometric design or put a puzzle together. These adults may also have problems in interpreting common facial expressions such as frowns, grimaces, or looks of annoyance, and therefore often respond inappropriately. They often do not get to places on time because of directionality confusion and poor time concepts."-"!'
Social-Emotional Adjustment The many failures and frustrations experienced by learning-disabled persons throughout their school years and beyond often leave them with feelings of inadequacy, low self-esteem, lack of confidence, and depression. Forming and maintaining friendships with others is complicated by their deficiencies in language and social judgment, including poor perception of other people's feelings.~,% The presence of learning disabilities in youth and adults who are incarcerated or otherwise in trouble with the law is disproportionately high. Learning-disabled individuals are postulated to have a greater susceptibility for involvement in antisocial acts because of an inclination toward impulsive and aggressive behavior, difficulties in language, less ability to understand cause and effect relationships, and poor social skills. When these difficulties occur in association with conduct disorders or attentional deficit hyperactivity disorder (ADHD), the individual may be predisposed toward criminal acts."'.."' SUMMARY
The learning-disabled adult shows deficiencies in basic skills, language expression and comprehension, memory, attention, visual perception, and social-emotional adjustment. These deficiencies are similar to those reported in learning-disabled children. During school years when tasks were primarily academic, the major concerns were about children's reading, writing, and spelling disabilities. In adulthood, even though the tasks are no longer school-based, life's demands still require many of the same skills and abilities that underlie school achievement, and therefore the learningdisabled adult has continued difficulty in meeting these needs.
LEARNING-DISABLED ADULTS IN POSTSECONDARY AND VOCATIONAL SETTINGS POSTSECONDARY SETTINGS
Until recently, selective colleges and universities excluded many learning-disabled persons because they did not meet the qualifications for acceptance based on standard admission criteria. For example, they did poorly on timed tests because of slow and inefficient reading. Yet, if given unlimited time, they could demonstrate that they knew the material. In colleges and universities that were less selective, or had "open admission" policies, some learning-disabled students were initially accepted, but proved unable to meet academic demands because programs were not modified and remedial and counseling services were not readily a ~ a i l a b l e Since . ~ ~ the passage by Congress of Section 504 of the Rehabilitation Act of 1973, the number of students with learning disabilities who attend colleges and universities has grown steadily."-" Section 504 states that no otherwise qualified individual can be excluded from participation in any program that receives federal financial assistance solely because of a handicapping condition (including learning disabilities)." h a recent survey conducted by the U.S. Department of Education, 160,878 students attending postsecondary educational institutions were reported to be learning disabled, the single largest contingent of students with disabilities being served on American college camp use^."^^' Currently, approximately two thirds of learning-disabled high school students are planning to go to college.68 As might be expected, learning-disabled persons who attend college tend to show higher intellectual ability and milder learning deficits than the majority of persons with learning disabilities. Although many are extremely bright, motivated, and hard-working, their learning-disabilities still impede their academic progress and take a toll on their emotional ~ell-being.."~-~'
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Visual Perception and Directionality
Common Academic Problems For the majority of learning-disabled college students, difficulties in reading, writing, and mathematics persist throughout their college careers. Their reading and written expressions are considerably worse than those of their non-learningdisabled peers, and many students experience problems in simple mathematical computation and problem solving. They have continued difficulty in 69
SEMINAKS I N NEUKOLOGY
VOLUME I I , NUMBEK 1
MARCH I991
field of learning di~abilities.~~ As postsecondary institutions become more aware of the needs of learning-disabled students, they are responding with increased services and are allowing some modifications in academic programs. Services that colleges are providing to learning-disabled students include academic advising, diagnostic services for identifying affective and cognitive strengths and weaknesses, group and individual counseling, psychotherapy, and social skills training. Students can often obtain tape-recorded texts and are provided Social and Emotional Problems with note-takers. Often, they are allowed to take Learning-disabled college students are most their tests without time limits. Many colleges have often painfully aware of their difficulties in read- developed and made available special courses for ing and written expression, mathematics, visual their learning-disabled students in study skills, processing, and short-term memory. They report note-taking, remedial reading, writing, spelling, great concerns about their slow reading rate and and arithmetic, test-taking strategies, and word reading comprehension. The pressures of long- pro~essing.",",~' Learning-disabled students are range reading and writing assignments and exam- often permitted to use electronic aids for spelling inations can be overwhelming for them, especially such as the Franklin Spelling Ace. Some colleges because they also have difficulty in time manage- allow students to take fewer courses at a time and ment and organization, and in knowing how and to omit a foreign language requirement. There are what to study. It is not surprising that many of a number of guides that list the colleges that prothese students suffer from a diminished self-con- vide special services and the kinds of services procept, a fear of failure, and great anxiety. Often ~ i d e d . ~ ' , ~ ~ these feelings interfere with their developing good VOCATIONAL SETTINGS relationships with their peers, resulting in feelings of loneliness and isolation.72 As with non-learning-disabled adults, employability or employment is related to factors of social class, educational background, general ability, speCoping Strategies cific skills and talents, motivation, and personality, in addition to handicapping condition. Some indiCoping strategies commonly recommended for viduals who have been identified as learning dislearning-disabled college students include avoiding abled have had remarkable careers, but they have unnecessarily hard subjects, spending more time also had extraordinary talents, strong motivation, studying, taking longer to complete the college de- and drive that has helped them compensate for gree, developing listening skills rather than taking their deficiencies in basic skills. Thomas Edison, notes in a lec~ure,and using typists to prepare pa- Albert Einstein, Nelson Rockefeller, and George per~.~Vo some r students, it is better to compen- Patton are reported examples of talented and tesate for a skill deficit than to try to remediate it. nacious individuals who have been said to have had There are reports of severely learning-disabled a learning di~ability.~~,~"venadults with severe adults who earn graduate degrees through the use learning disabilities can achieve success. For exof such alternative strategies as listening to tapes of ample, Abraham G., a 42-year-old man of basically lectures and average ability, can barely read a first grade book. Despite weekly instruction in reading with a skilled therapist, he still cannot remember the sounds of vowels and confuses "on" and "no," and "was" and Postsecondary Institutions' Response "saw." His reading vocabulary remains pitifully to Learning Disabled Students small despite enormous effort on his part to learn Meeting and accommodating the educational to read new words. He has not been able to rememand psychologic needs of learning-disabled stu- ber words such as "what," "there," and "who." Yet, dents without compromising academic standards he has held a job as a security guard at a metroare major challenges for institutions of higher politan hospital for 17 years and was recently asked learning. Needless to say, these challenges are the to join the honor guard for a most distinguished subject of great debate among college administra- visitor to New York City. He is a well-adjusted and 70 tors, faculty, students, and professionals in the personable man with a fine sense of humor.
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decoding unfamiliar words and in understanding and retaining what they read. They read inaccurately and slowly, apparently because of basic deficiencies in processing phonological information. Severe written language deficits characterize most learning-disabled college students. Almost all show pervasive problems in spelling and grammar, and some students have illegible h a n d ~ r i t i n g . ~ " ~ '
ADUlll-S W I T H L,E:AKNIN(; DISABILITIE:S-GO.~.I.F.SMAN
Vocational Needs Many of the more severely learning-disabled young adults who have been in special education programs are unable to live independently and Interhave difficulty finding and keepingj~bs.'"~~ views with learning-disabled adults seeking employment reveal that academic problems are only one manifestation of learning disabilities, and other characteristics may take precedence in vocational planning and employment. Help is requested to improve their attention and memory disorders, poor social skills, and limited language and problem-solving abilities, as well as their reading.8'.n4There are few services in community agencies that address the needs of these adultss6
Vocational Rehabilitation Prior to 1980, and despite the passage of Section 504 described previously, learning disabilities were viewed by most state rehabilitation agencies as an educational problem affecting reading, writing, and arithmetic, but not as a vocational problem. Therefore learning-disabled individuals were not eligible for services provided by these agencies. In 1980 the Rehabilitation Services Administration (RSA) of the U.S. Office of Special Educational and Rehabilitation adopted a resolution stating that learning-disabled individuals are eligible for vocational rehabilitation services if their condition
is diagnosed by a physician or psychologist skilled in the diagnosis of the disorder, if the learning disability results in a substantial handicap to employment, and if it is felt that vocational rehabilitation services can facilitate e m p l ~ y a b i l i t y . ~ " ~ ~ r e s e n t l y , most state vocational rehabilitation agencies will accept adults with severe learning disabilities as clients. Although they are mandated to provide evaluative, training, counseling, and job placement services for these clients, the agency staff often lacks the necessary knowledge and experience to be effective providers of s e r ~ i c e . ' ~ , ~ ~ ADULT EDUCATION AND LITERACY PROGRAMS
Approximately two and a half million adults are enrolled in Adult Basic Education and General Educational Degree programs.83Estimates of adults with learning disabilities in these programs range from 20 to 89% of this population.83." At present, some adult literacy programs do not recognize learning disabilities as a major problem of their adult clientele. Severe reading difficulties are often attributed to environmental and educational limitations rather than to a learning disability. A common viewpoint holds that it is wrong to label adults as learning disabled, that the label is overused, and that it limits the expectations of achievement in both client and teacher. If motivated adults are not making improvement while attending the reading classes, then, most often, the teacher is believed to ~ ~ it- is ~ reported ~ that many learnbe at f a ~ l t . Yet, ing-disabled adults enroll in and then drop out of literacy programs because their reading needs are not being met.44Adult education teachers report that there are many students in their programs who cannot read and that there are not adequate materials or methods to deal with them. There is a great need for training and meaningful dialogue among teachers and administrators at the state and local levels regarding program considerations and adaptations for students with learning disabilitie^.'^.^' In addition, a working definition for "learning disabled" needs to be determined and circulated among the teaching staff in adult education programs. One teacher wrote, "I feel that there are many students in my program that have learning disabilities. I am very frustrated because the structure of the class and lack of funds does not allow them to receive the kind of help they need. I know that many of them, if in school today, would be detected and would receive Resource Room or other support services. . . . Thus, I feel that they are likely to drop out of the GED program-again because of frustration-just like what they experienced in public schools, and remain in their present situations (low paying jobs-no advance-
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The relationship of educational attainment to employment is the same for learning-disabled individuals as for those without learning disabilities. College graduates with learning disabilities usually obtain better-paying jobs than learning-disabled high school graduates or drop-outs, but their vocational choices are often limited because of reading, writing, or arithmetic limitation^.'^.'^.^^ Moreover, many report that they work at a slower rate, feel less organized, and generally feel less adequate than their coworkers, because of their learning disabilitiesn1Employers are often reluctant to hire persons with learning disabilities, even more so than persons with physical handicaps, and learning-disabled adults often agonize whether they should tell a prospective employer that they have a learning disability.= Learning-disabled students who have completed high school apparently find jobs with the same degree of frequency as their non-learningdisabled peers. These jobs, however, are often at the unskilled or semiskilled level^.^^-^^
71
ment) suffering from low-self-esteem and continued frustration at a system that once again failed the~n."'~ Other adult literacy programs recognize the need to train their teaching staff about learning disabilities in adults. They see the need to expand training in the evaluation of learning-disabled adults and educational intervention on their behalf. 'They have developed specific strategies to teach reading, depending on the degree of impairment shown by the ~ l i e n t . ~ ' . ~ ~For . ~ ! ' example, ,"~ adult non-readers are taught the simplest words needed for survival: labels, traffic words, and other essential words such as "exit" and "toilet." They are also taught to listen to recorded books and use calculators. Although a "whole word" rather than a "phonic" (learning the sounds of letters and letter combinations) approach is most often used to teach words to this population of adults, individual testing and trial teaching is used to determine the best approach to use, and the kind of material most suitable. If clients are found to be at a higher level of reading, greater emphasis is usually given to instruction in In most programs, reading for meaning is a major part of the instructional program. SUMMARY
Deficiencies in reading and writing appear to be major and lasting handicaps for learning-disabled college students. However, gains have been made in program modifications for learning-disabled students in many higher education institutions. Many adults with learning disabilities find that their handicap makes it difficult to obtain and keep jobs. Although they perceive a need for a wide range of educational and vocational services, there are few services available at most community agencies. Service providers and educators in vocational rehabilitation and adult education and literacy programs need to know more about learning disabilities in adults and how to identify such persons and provide them with more appropriate educational instruction and job counseling and training.
CONCLUSIONS
72
This article focused on the outcome of childhood learning disabilities, adult symptomatology, and the educational and vocational status of learning-disabled adults. T h e major conclusion is that learning disabilities are life disabilities. Most learning-disabled adults do not outgrow their childhood learning disabilities and show the same basic skill deficiencies as well as difficulties in language,
VOLUME I I, NUMBER 1
MARCH 1991
memory, attention, visual perception, and socialemotional adjustment. Difficulties in these areas often affect a learning-disabled individual's educational attainment, employment options, interpersonal relationships, and emotional well-being. Colleges and universities have not only opened their doors to otherwise qualified, learning-disabled students, but now provide help and program modifications that will enhance the chances of academic success for these students. Many learning-disabled students on graduation from high school or college still have the need for educational, vocational, and social skills training, counseling services, and help in finding and keeping a job. Vocational opportunities remain limited for many learning-disabled adults, especially those with the most severe learning disabilities. At the present time, there is a lack of professional knowledge about the problems of adults with learning disabilities and about useful and effective services and programs. There is a continued need to increase our knowledge about how to improve the functioning of learning-disabled adults. Future research is needed to identify the most effective compensatory strategies that learning-disabled adults can use to achieve vocational independence and social competence."" Learningdisabled adults who have themselves developed strategies to help overcome or compensate for their difficulties are primary candidates for studies.
REFERENCES 1. National Joint Committee on Learning Disabilities. Learning disabilities: issues on definition. J Learn Disabil 1987;20: 107-8 2. Harmon D. Turning illiteracy around: an agenda for national action. Working Paper No. 2. New York: Business Council for Effective Literacy, 1985 3. Kozol J. Illiterate America. Garden City, NY: Anchor Press, 1985: 10 4. Illiteracy in America: extent, causes, a n d suggested solutions. Washington DC: National Advisory Council on Adult Education, 1986 5. Venezky R. Introduction. In: Venezky KI., Wagner DA. Ciliberti BS, eds. Toward defining literacy. Newark, DE, International Reading Association 1YYO:ix-xii 6. Chall J , Heron E, Hilferty A. Adult litcracy: new and enduring problems. Phi Delta Kappan, 1987;Nov; 190-6 7. Kitz WR. Adult literacy: a review of the past and a proposal for the future. Remedial Spec Educ 1988;4: 44-50 8. Gaddes WH. Prevalence estimates a n d the need for definition of learning disabilities. In: Knights RM, Bakker DL, eds. T h e neuropsychology of learning disorders, theoretical approaches. Baltimore: University Park Press, 1976:3-24 9. Rutter M. Prevalence and types of dyslexia. In: Benton AL, Pearl D, eds. Dyslexia; an appraisal of current knowledge. New York: Oxford University Press, 1978:
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S E M I N A R S I N NE:UROI.OC;Y
10. Balow BJ, Blomquist M. Young adults 10-15 years after a severe reading disability. Elementary School J 1965; 66:44-8 11. Bowen SM, Hynd GW. Do children with learning disabilities outgrow deficits in selective auditory attention? Evidence from dichotic listening in adults with learning disabilities. J Learn Disabil 1988;2 1:623-3 1 12. Bruck M. T h e adult outcomes of children with learning disabilities. Ann Dyslexia 1987;37:252-63 13. DeFries JC. Colorado Reading Project: Longitudinal analyses. Ann Dyslexia 1988;38: 120-30 14. Dykeman RA, Peters JE, Ackerman PT. Experimental approaches to the study of minimal brain dysfunction: a follow-up study. Ann NY Acad Sci 1973;205:93-108 15. Finucci JM. Follow-up studies of developmental dyslexia and other learning disabilities. In: Smith SD, ed. Genetics and learning disabilities. San Diego, CA: College Hill Press, 1986:97-121 16. Finucci JM, Gottfredson LS, Childs B. Explaining the adult careers of dyslexic boys. Variations in critical skills for high level jobs. J Vocational Behav 1984;24: 355-73 17. Finucci JM, Gottfredson LS, Childs B. A follow-up study of dyslexic boys. Ann Dyslexia 1985;35:117-36 18. Frauenheim JG, Heckerl JR. A longitudinal study of psychological and achievement test performance in severe dyslexic adults. J Learn Disabil 1983;16:339-47 19. Gottesman RL, Belmont I, Kaminer R. Admissions and follow-up status of reading disabled children referred to a medical clinic. J Learn Disabil 1975;8:642-50 20. Gottesman RL. Follow-up of learning disabled children. Learn Disabil Q 1979;2:60-8 21. Gottfredson LS, Finucci JM, Childs B. Explaining the adult careers of dyslexic boys: variations in critical skills for high-level jobs. J Vocational Behav 1984;24: 355-73 22. Hartzell HE, Compton C. Learning disability: 10 year follow-up. Pediatrics 1984;74: 1058-64 23. Herjanic BM, Penick EC. Adult outcomes of disabled child readers. J Spec Educ 1972;6:397-410 24. Horn WF, O'Donnell JP, Vitulano LA. Long-term followu p studies of learning disabled persons. J Learn Disabil 1983; 16:542-55 25. Koppitz E. Children with learning disabilities: a five year follow-up study. New York: Grune & Stratton, 1971 26. LaBuda MC, DeFries JC. Cognitive abilities in children with reading disabilities and controls: a follow-up study. J Learn Disabil 21:562-6 27. Muehl S, Forrell E. A follow-up study of disabled readers: variables related to high school reading performance. Reading Res Q 1973;l: 110-23 28. O'Connor SC, Spreen 0 . T h e relationship between parents' socioeconomic status and education level, and adult occupational and educational achievement of children with learning disabilities. J Learn Disabil 1988;21:148-53 29. Preston RC, Yarrington DJ. Status of 50 retarded readers eight years after reading clinic diagnosis. J Reading 1967; 11: 122-9 30. Rawson M. Developmental language disability: adult accomplishments of dyslexic boys. Baltimore: Johns Hopkins University Press, 1968 31. Rutter M, Tizzard J , Yule W, et al. Research report: Isle of Wight studies 1965-1974. Psychol Med 1976;6: 3 13-32 32. Scarborough HS. Continuity between childhood dyslexia and adult reading. Br J Psychol 1984;75:329-48 33. Schonhaut S, Satz P. Prognosis for children with learning disabilities: a review of follow-up studies. In: Rutter M, ed. Developmental neuropsychiatry. New York: Guilford Press, 1983:542-63 34. Spreen 0 . Adult outcomes of reading disorders. In: Malatesha RN, Aaron PC, eds. Reading disorders, varieties and treatments. New York: Academic Press, 1982:473-98.
35. Spreen 0 . Prognosis of learning disabilities. J Consult Clin Psychol 1988;56:836-42 36. Watson BU, Watson CS, Fredd R. Follow-up studies of specific reading disability. J Am Acad Child Psychiatry 1982;21:376-82 37. Zigmond N, Thorton H. Follow-up postsecondary age learning disabled graduates and drop-outs. Learn Disabil Res 1985; 1:50-55 38. Johnson D. Reading disabilities. In: Johnson DJ, Blalock JW, eds. Adults with learning disabilities. Orlando: Grune & Strattop, 1987: 145-7 1 39. Hoffmann FJ, Sheldon KL, Minskoff EH, et al. Needs of learning disabled adults. J Learn Disabil 1987;20: 43-52 40. Gambrel1 LB, Heathington BS. Adult disabled readers' metacognitive awareness about reading tasks and strategies. J Reading Behav 1981; 13:2 15-22 41. Keefe D, Meyer V. Adult disabled readers, their perceived models of the reading process. Adult Literacy Basic Educ 1980;4: 120-4 42. Keefe D, Meyer V. Profiles of and instructional strategies for adult disabled readers. J Reading 1988;31:614-9 43. Kitz WR, Tarver SG. Comparison of dyslexic and nondyslexic adults o n decoding and phonemic awareness tasks. Ann Dyslexia 1989;39 44. Malicky G, Norman CA. T h e reading concepts a n d strategies of adult nonreaders. J Reading 1989;33:198-202 45. McCue PM, Shelly MA, Goldstein G. Intellectual, academic and neuropsychological levels in learning disabled adults. J Learn Disabil 1986;19:233-6 46. Blalock JW. Problems in mathematics. In: Johnson DJ, Blalock JW, eds. Adults with learning disabilities. O r lando: Grune & Stratton, 1987:205-17 47. Gregg N. College learning disabled writer: error patterns and instructional alternatives. J Learn Disabil 1983; 16: 334-7 48. Houck CK, Engelhard J, Geller C. Self-assessment of learning disabled and nondisabled college students: a comparative study. Learn Disabil Res 1989;5:61-7 49. Liberman IY, Rubin H, Duques W, Carlisle J . Linguistic abilities and spelling proficiency in kindergarten and adult poor spellers. In: Kavanagh J , Gray D, Pearl D, eds. Behavioral measures of dyslexia. Baltimore: York Press, 1986 50. New111 a n , tioyette C H , Fogarty TW. Diagnosis and assessment of the adult with specific learning disabilities. J Rehabil 1984;50:34-9 51. Blalock JW. Auditory language disorders. In: Johnson DJ, Blalock JW, eds. Adults with learning disabilities. Orlando: Grune & Stratton, 1987:81-105 52. Litowitz B. Problems of conceptualization and language: evidence from definitions. In: Johnson DJ, Blalock JW, eds. Adults with learning disabilities. Orlando: Grune & Stratton, 1987: 131-43 53. Wiig EH, Fleischmann N. Prepositional phrases, pronominalization, reflexivization & relativization in the language of learning disabled college students. J Learn Disabil 1980; 13:45-50 54. Byrne B, Ledez J. Phonological awareness in reading disabled adults. Aust J Psychol 1983;35: 185-97 55. Elliott LL, Bosse LA. Auditory processing by learning disabled young adults. In: Johnson D, Blalock J , eds. Adults with learning disabilities. Orlando: Grune & Stratton, 1987: 107-29 56. Hasbrouk JM. Diagnosis of auditory perceptual disorders in previously undiagnosed adults. J Learn Disabil 1983; 16:206-8 57. Johnson D. Nonverbal disorders and related learning disabilities. In: Johnson DJ, Blalock JW, eds. Adults with learning disabilities. Orlando: Grune & Stratton, 1987:219-32 58. Kopp KH, Miller J H , Mulkey SW. T h e paradox of learning disabilities: a stumbling block to rehabilitation. J Rehabil 1984;50:4-5 59. Sanchez S. Where d o we go from here: a look to the fu-
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A D U I l f S WITH LEARNING DISABILITIES-GO.~TESMAN
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ture in the rehabilitation of learning disabled persons. J Rehabil 1984;50:82-8 Lane BA. T h e relationship of' learning disabilities to juvenile delinquency: current status. J Learn Disabil 1980; 13:20-9 Brier N. T h e relationship between learning disability a n d delinquency: a review and reappraisal. J Learn Disabil 1989;22:546-53 A ~ o s t o l iBD. Makine the transition to secondarv education. Reading, Writing Learning Disabil 1986;2: 325-30 Hughes CA, Smith J 0 . Cognitive and academic performance of collegc students with learning disabilities: a synthesis of the literature. Learn Disabil Q 1990;13: 66-79 McGuire JM, Norlander KA, Shaw SF. Postsecondary education for students with learning disabilities: fhrecasting challenges for thc future. Learn Ilisabil Focus 1990;5:69-74 Vogel S. Issues and coticerns in LD college programming. In: J o h n s o n DJ, Blalock JW, e d ~ Adults . with learning disabilities. Orlando: (;rune 8c Stratton, 1987: 239-75 Illinois Program helps learning disabled graduate from college. Educ Handicapped 1990; 16:Y-10 HEATH Resource Center. Transitions fhr young adults with learning disabilities and other special needs. Washington, DC: T h e National
11, N O . 1 MARCH 1991
Prognosis: The Adult with a Learning Disability
John T. is a highly successful and dynamic producer, consultant, and commentator in the television industry. Invited to lead seminars throughout the country, he is bright, articulate, and thoughtful. He is, however, dependent on his wife to correct excessive grammatical and spelling errors in his written work. Because he is afraid that he will stumble over words if he reads a speech to an audience, he previews the material silently, mentally noting important points that he wants to make, and then does not refer to the written speech again. Steven R., chronically unemployed, is in a drug rehabilitation program. Prospects for employnlent are poor. He cannot read well enough to fill out a simplejob application. He grew up in a poor urban area and remembers that he never seemed to be able to learn to read. He failed first grade and left school after his third year in 7th grade. These men represent the extremes in the functioning of adults with learning disabilities. The awareness that learning disabilities in adults exists is recent, even among professionals in the field, primarily because this condition has been perceived as a problem of childhood. A growing realization that learning disabilities may not disappear when children leave school has led to an additional phrase in the definition of learning disabilities put forth by the National Joint Committee on Learning Disabilities, a panel of learning disability experts who represent the major national professional organizations in the field. T h e definition now reads, "These disorders (learning disabilities) are intrinsic to the individual . . . and may
occur across the life span" (italics are mine).' Moreover, two major national organizations serving professionals and parents of learning-disabled individuals recently changed their names to reflect this recognition. The Association for Children with Learning Disabilities become the Learning Disabilities Association of America and the Foundatiori for Children with Learning Disabilities became the National Center for Learning Disabilities. There are no widely accepted prevalence figures for adults with learning disabilities, but estimates of the number of functionally illiterate adults (reading below 8th grade level) in the United States range from 20 to 85 m i l l i ~ n . ~It- is ~ also estimated that 10 to 15% of school-aged children are learning d i ~ a b l e d . ~If- ~children do not outgrow these problems, then many of the illiterate adults may actually be learning disabled. This article will focus on three areas of concern about adults with learning disabilities: (1) the outcome of childhood learning disabilities, (2) basic skill deficiencies and other characteristics found in learning-disabled adults, and (3) challenges faced by learning-disabled adults in postsecondary and vocational settings and employment, and the kinds of support services available for them. Learning disabilities are defined in this article as serious difficulties in reading, writing, spelling, and/or mathematics well beyond what might be expected on the basis of a person's general intellectual ability. Learning disabilities occur in conjunction with underlying difficulties in language, perception, and memory and are of presumed neurologic origin.'
Department of Pediatrics, Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, New York Copyright O 1991 by Thieme Medical Publishers, Inc., 381 Park Avenue South, New York, NY 10016. All rights reserved.
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Ruth L. Gottesman, Ed.D.
Over the past 30 years at least 22 studies have been conducted to determine the outcome of childhood learning disabilities.''-" Outcomes that were investigated include the improvement of reading and other academic skills over time; attainmerit high and P ~ degrees; social and emotional adjustment; and type of employment, if any. Outcome measures include the use of standardized achievement tests, questionnaires and self-rating scales, and interviews. Ten of the most widely reviewed and comprehensive studies are summarized in Table 1. The studies differ from each other in the criteria used to select subjects, the outcome measures, and the presence or absence of control groups. Children in the studies came from lower class, middle class, and upper class backgrounds and were selected from public and private school and from clinic populations. They were seen initially in grades ranging from second through high school, and, at the time of follow-up, through middle age. In some studies the mean I Q of the subjects was in the superior range, whereas in other studies it was in the average or low-average range. Despite the differences in methodology and in study samples, the studies were consistent in their findings that childhood learning disabilities continued into adulthood and affected not only reading achievement but also vocational choices, social relationships, and emotional well-being in the individuals studied. The degree of the impairment at the time of follow-up varied considerably among the studies. The most favorable outcomes were reported in the studies of children attending private schools. The majority of persons in these studies attended college. Most earned college degrees and some went on to graduate school. After completing their education, most of them selected a career in business; few if any became physicians or lawyers. The outcomes of learning-disabled students in public school settings were less favorable. Compared with their non-learning-disabled classmates, significantly more of these students dropped out of high school, had low-paying jobs, or were chronically unemployed. Children who were referred to clinical settings had the least favorable outcomes. The differences in outcomes may be, in part, related to the differences among the private and public school and clinic populations of children. Most children attending private schools came from affluent and highly educated families, whereas most children attending public schools came from working class families whose educational and oc-
cupational expectations for their children were more modest. Children who were seen at clinics usually had problems of a more serious nature. FACTORS RELATED TO ADULT OUTCOMES
The factors most closely associated with adult and early onset of were the symptoms, the socioeconomic status (SES) of the family, intellectual ~ ability, ~ and evidence ~ of neuro~ logic impairment.ll,M,35
~
Severity and Early Onset of Symptoms In all studies, children with the most severe learning disabilities had the poorest outcomes in educational attainment, employment, and social adjustment. They also made the least progress in reading despite remediation efforts, were most likely to drop out of school, and showed the highest incidence of difficulties with the law. Often, these were the children whose learning disabilities were evident from the very beginning of school. Children who show severe reading disabilities in the early grades seem likely to remain poor readers throughout their lives.
Socioeconomic Status The data suggest that well-educated and financially successful parents played an important role in their learning-disabled child's educational and occupational outcomes. They provided their child with the best schooling (usually private), obtained remedial and ancillary services, found and were able to fund appropriate kinds of postsecondary education, and were able to locate employment possibilities. Most children from lower SES backgrounds did not have access to private schools or private tutorial help. Many more learning-disabled (and nondisabled) subjects from lower class than middle or upper class backgrounds either dropped out or did not continue their education beyond high school.
Intellectual Ability High intelligence, especially when coupled with high SES, was significantly and positively related to a high level of educational attainment, the highest reading achievement, and the most prestigious employment. (This was true for the control groups as well.) Lower IQs were associated with the poorest outcome on all parameters just mentioned.
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OUTCOME OF CHILDHOOD LEARNING DISABILITIES
Table 1. Summary of Follow-up Study
Subjects
R a ~ s o n , ~1968 O
Age at Follow-up fvr)
20 dyslexic, 16 medium Elementary achieving, and 20 grades high achieving males attending small private school. Mean IQ 131. High SES Rutter et al,311976 86 reading-disabled, 155 slow learning, and 184 normal (controls), the entire 9- to 10-year-old population of the Isle of Wight in 1964-65 G o t t e ~ m a n1979 , ~ ~ 43 learning-disabled children evaluated at a diagnostic clinic showed high incidence of positive neurologic, psychologic, and language findings. Mean IQs in lowaverage range. Low to average SES Frauenheim, 11 adults who as Hecker1,18 1983 children had been diagnosed as dyslexic in mental health facility in Michigan. From middle class families and communities in Detroit metropolitan area. Mean IQ score 94 at time of initial testing and 92 at time of follow-up. Hartzell, 114 learning disabled C o m p t ~ n 1984 ,~~ (LD) students evaluated at a diagnostic clinic; 144 siblings served as controls. Mean IQ of LD sample, 107. Highly educated families. High SES
26-40
Finucci et aI,l7 1985
Average age, 37
579 alumni of private boarding school for boys with developmental dyslexia. Mean IQ, 118. 612 alumni of private school-both groups of middle to high SES
7-12 grade
Years Between Initial Evaluation & Follow-UD 18-35
Results 100% dyslexic boys were graduated from high school and entered college; 80% were graduated from college
At follow-up both reading-disabled and slow-learning groups continued to do poorly in reading, spelling, and mathematics; half of the group were 2 SD below the mean in reading and spelling 5-7
Showed small gains in readingapproximately 4 months per year. Mean grade level scores increased from 3.3 to 4.4 on the Reading Subtest of the Wide Range Achievement Test (WRAT), and 2.6 to 6.0 on the Adult Basic Learning Evaluation (ABLE)
Made little progress. Mean grade level scores increased from 1.9 to 2.6 in reading, 1.4 to 2.1 in spelling, and 3.1 to 4.5 in arithmetic. Subjects represent severe end of continuum in learning disabilities. Despite remediation and completion of high school of 80% of sample, patterns of skill weakness and cognitive abilities remain remarkably consistent
-
9% of LD sample compared with 1% siblings dropped out of high school. 35% LD sample compared with 11% siblings who were graduated from high school did not continue education. 23% LD sample compared with 75% siblings experienced "high" academic success. 31 % of LD sample compared with 77% siblings reported high level social success. Best predictors of academic success were high IQ and effective family functioning. Predictor contributing most to negative outcome was severity of learning disability 468 respondents from 50% received B.A., 70% received graduate degree, 39% had some college or technical training beyond high school. The dyslexic alumni were overrepresented in business field and underrepresented in mathematics, engineering, and science fields. Dyslexic alumni took longer in graduating than controls. Boys with milder dyslexia did well. Boys with severe dyslexia had more difficulty in obtaining a college degree
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Studv
Age or Grade When First Evaluated
Table 1. Continued
Subjects
Zigmond and T h ~ r t o n , ~1985 '
105 students entering a 9th grade learning-disability program in large northeastern urban school district. Mean IQ, 86. 18 non-learningdisabled (NLD) controls from same 9th grade roster
Bruck,12 1987
101 boys and girls referred to LD clinic. Mean IQ, 103. 43% judged severely learning disabled, 30% moderate, and 27% mild. All children received remedial help throughout their school years. Primarily from middle class backgrounds 54 boys and 16 girls with reading disability. Mean IQ, 103. 55 boys and 20 girls as controls. Mean IQ, 116. Middle to high SES in Colorado 203 learning-disabled boys and girls referred to neuropsychology clinic in Victoria, British Columbia. Divided into 3 subgroups according to neurologic findings; group I showed hard neurologic signs, group I1 showed soft signs, and group Ill showed no signs. Mean IQ for LD subgroups were 88, 95, and 102. 52 children selected for control group, matched for SES. Mean IQ, 110. Low to middle SES
DeFries,13 1988
S ~ r e e n 1988 ,~~
Age at Follow-up fvr) Past high school
Years Between Initial Evaluation & Follow-ur,
Results
6
More than 50% LD students left before high school graduation. Drop-out rate significantly higher than for NLD students. Great difficulty finding employment. Remaining 50% showed significantly lower scores on reading tests than NLD students. Chances of both remaining LD and NLD students having a job 18 to 24 months after graduation equally good, and better than for LD and NLD drop outs 10% did not complete high school, 32% completed high school or additional vocational training, 17% attended junior college or a university, and 11% completed college. Educational achievement of LD subjects less than their normal-learning siblings, but did not differ s~gnificantlyfrom it
5
Reading disabled and control children differed substantially on measures of reading performance. Reading deficits during middle childhood are highly predictive of later reading problems
10
All LD subgroups showed greater amount of emotional maladjustment and antisocial behavior than control subjects. Oral reading grade level of all LD subgroups 3 years below controls (7th vs 10th grade level). The presence of a neurologic handicap affected all areas of long-term adjustment and outcome-social, personal, and occupational
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Studv
Age or Grade When First Evaluated
SEMINARS I N NEUROLOGY
The degree of neurologic impairment or dysfunction, as evidenced in a neurologic examination, was significantly related to outcome. Learning-disabled children with demonstrable "hard" neurologic signs had poorer outcomes than those with "soft" signs, who did not fare as well as learning disabled children with no neurologic signs. SUMMARY
The lifetime effects of a learning disability appear to be far broader than the persistence of difficulties in reading, writing, and spelling. The presence of a learning disability has a major effect on the attainment of a high school or college degree, employment options, interpersonal relationships, and emotional well-being. High SES learning-disabled children with average and aboveaverage intelligence and the mildest symptoms usually have the best outcome in all areas, whereas those of lower SES with below-average intelligence and moderate to severe manifestations of learning disabilities usually have the least favorable outcomes. Even those who have the best outcomes are not likely to find careers in professions such as law or medicine. Those with the most severe learning disabilities are likely to experience chronic unemployment, poor interpersonal relationships, and difficulty in independent living.
bored handwriting, excessive spelling errors, and an inability to produce grammatically and syntactically correct written communications are frequently r e p ~ r t e d . " . ~ ' -Difficulties ~~ in activities of daily life stemming from deficiencies in basic skills include reading a newspaper, filling out job applications, handling money, writing checks, paying bills, keeping records, following recipes, calculating tips, reading manuals, looking up telephone numbers, reading menus or street signs, and setting alarm clocks.
Language A common finding in learning-disabled individuals is a history of language delays or impairment. This often results in smaller vocabularies, less use and understanding of complex sentences, mispronunciations, incorrect word usage, poor organization of thought, and a narrower range of l - ~ ~ language is the meanings for w o r d ~ . ~ Since major vehicle for communication between people, restricted and flawed language skills can hamper interpersonal relationships. Learning-disabled persons often cannot recognize when someone is exaggerating, using figurative language, teasing, or joking.
Memory and Attention ADULT SYMPTOMS OF LEARNING DISABILITIES In general background and attributes, adults with learning disabilities are as heterogeneous a group as those without learning disabilities. Learning-disabled adults are also far from homogeneous in their symptomatology. Nevertheless, most learning-disabled adults continue to experience difficulties ranging from mild to severe in at least some of the following areas.
Basic Skills Deficiencies
Memory deficiencies interfere with learning rote material, such as days of the week, months of the year, and times tables. Learning-disabled adults frequently have difficulty with questions such as, "How many weeks in a year?" or "Where does the sun set?" They find basic facts hard to remember, and are lacking in their knowledge of general information. Many learning-disabled adults show deficits in attention that interfere with their ability to focus and concentrate on tasks.45.48.50
Auditory Processing
Learning-disabled adults report continued diffiMost learning-disabled adults have difficulties culty in decoding unfamiliar words, and they often in discriminating among similar-sounding phocomplain of slow, labored reading and poor com- nemes, blending sounds into words, and associatprehension and retention of what they read.38-45 ing sounds with their letter counterparts, all deMany report difficulty in simple mathematical op- spite adequate hearing.54-56This results in their erations such as multiplying, dividing, and solving inability to read unfamiliar words and limits their . ~ Vlao o runderstanding of reading passages. problems that contain f r a c t i ~ n s . ~ ~ . ~ ~and 68
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Neurologic Impairment
VOLUME 1 I , NUMBER 1 MARCH I991
Some learning-disabled adults have great difficulty with spatial relationships. Assembling a pencil sharpener, vacuum cleaner, or luggage rack can be major challenges. Many cannot copy a gcometric design or put a puzzle together. These adults may also have problems in interpreting common facial expressions such as frowns, grimaces, or looks of annoyance, and therefore often respond inappropriately. They often do not get to places on time because of directionality confusion and poor time concepts."-"!'
Social-Emotional Adjustment The many failures and frustrations experienced by learning-disabled persons throughout their school years and beyond often leave them with feelings of inadequacy, low self-esteem, lack of confidence, and depression. Forming and maintaining friendships with others is complicated by their deficiencies in language and social judgment, including poor perception of other people's feelings.~,% The presence of learning disabilities in youth and adults who are incarcerated or otherwise in trouble with the law is disproportionately high. Learning-disabled individuals are postulated to have a greater susceptibility for involvement in antisocial acts because of an inclination toward impulsive and aggressive behavior, difficulties in language, less ability to understand cause and effect relationships, and poor social skills. When these difficulties occur in association with conduct disorders or attentional deficit hyperactivity disorder (ADHD), the individual may be predisposed toward criminal acts."'.."' SUMMARY
The learning-disabled adult shows deficiencies in basic skills, language expression and comprehension, memory, attention, visual perception, and social-emotional adjustment. These deficiencies are similar to those reported in learning-disabled children. During school years when tasks were primarily academic, the major concerns were about children's reading, writing, and spelling disabilities. In adulthood, even though the tasks are no longer school-based, life's demands still require many of the same skills and abilities that underlie school achievement, and therefore the learningdisabled adult has continued difficulty in meeting these needs.
LEARNING-DISABLED ADULTS IN POSTSECONDARY AND VOCATIONAL SETTINGS POSTSECONDARY SETTINGS
Until recently, selective colleges and universities excluded many learning-disabled persons because they did not meet the qualifications for acceptance based on standard admission criteria. For example, they did poorly on timed tests because of slow and inefficient reading. Yet, if given unlimited time, they could demonstrate that they knew the material. In colleges and universities that were less selective, or had "open admission" policies, some learning-disabled students were initially accepted, but proved unable to meet academic demands because programs were not modified and remedial and counseling services were not readily a ~ a i l a b l e Since . ~ ~ the passage by Congress of Section 504 of the Rehabilitation Act of 1973, the number of students with learning disabilities who attend colleges and universities has grown steadily."-" Section 504 states that no otherwise qualified individual can be excluded from participation in any program that receives federal financial assistance solely because of a handicapping condition (including learning disabilities)." h a recent survey conducted by the U.S. Department of Education, 160,878 students attending postsecondary educational institutions were reported to be learning disabled, the single largest contingent of students with disabilities being served on American college camp use^."^^' Currently, approximately two thirds of learning-disabled high school students are planning to go to college.68 As might be expected, learning-disabled persons who attend college tend to show higher intellectual ability and milder learning deficits than the majority of persons with learning disabilities. Although many are extremely bright, motivated, and hard-working, their learning-disabilities still impede their academic progress and take a toll on their emotional ~ell-being.."~-~'
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Visual Perception and Directionality
Common Academic Problems For the majority of learning-disabled college students, difficulties in reading, writing, and mathematics persist throughout their college careers. Their reading and written expressions are considerably worse than those of their non-learningdisabled peers, and many students experience problems in simple mathematical computation and problem solving. They have continued difficulty in 69
SEMINAKS I N NEUKOLOGY
VOLUME I I , NUMBEK 1
MARCH I991
field of learning di~abilities.~~ As postsecondary institutions become more aware of the needs of learning-disabled students, they are responding with increased services and are allowing some modifications in academic programs. Services that colleges are providing to learning-disabled students include academic advising, diagnostic services for identifying affective and cognitive strengths and weaknesses, group and individual counseling, psychotherapy, and social skills training. Students can often obtain tape-recorded texts and are provided Social and Emotional Problems with note-takers. Often, they are allowed to take Learning-disabled college students are most their tests without time limits. Many colleges have often painfully aware of their difficulties in read- developed and made available special courses for ing and written expression, mathematics, visual their learning-disabled students in study skills, processing, and short-term memory. They report note-taking, remedial reading, writing, spelling, great concerns about their slow reading rate and and arithmetic, test-taking strategies, and word reading comprehension. The pressures of long- pro~essing.",",~' Learning-disabled students are range reading and writing assignments and exam- often permitted to use electronic aids for spelling inations can be overwhelming for them, especially such as the Franklin Spelling Ace. Some colleges because they also have difficulty in time manage- allow students to take fewer courses at a time and ment and organization, and in knowing how and to omit a foreign language requirement. There are what to study. It is not surprising that many of a number of guides that list the colleges that prothese students suffer from a diminished self-con- vide special services and the kinds of services procept, a fear of failure, and great anxiety. Often ~ i d e d . ~ ' , ~ ~ these feelings interfere with their developing good VOCATIONAL SETTINGS relationships with their peers, resulting in feelings of loneliness and isolation.72 As with non-learning-disabled adults, employability or employment is related to factors of social class, educational background, general ability, speCoping Strategies cific skills and talents, motivation, and personality, in addition to handicapping condition. Some indiCoping strategies commonly recommended for viduals who have been identified as learning dislearning-disabled college students include avoiding abled have had remarkable careers, but they have unnecessarily hard subjects, spending more time also had extraordinary talents, strong motivation, studying, taking longer to complete the college de- and drive that has helped them compensate for gree, developing listening skills rather than taking their deficiencies in basic skills. Thomas Edison, notes in a lec~ure,and using typists to prepare pa- Albert Einstein, Nelson Rockefeller, and George per~.~Vo some r students, it is better to compen- Patton are reported examples of talented and tesate for a skill deficit than to try to remediate it. nacious individuals who have been said to have had There are reports of severely learning-disabled a learning di~ability.~~,~"venadults with severe adults who earn graduate degrees through the use learning disabilities can achieve success. For exof such alternative strategies as listening to tapes of ample, Abraham G., a 42-year-old man of basically lectures and average ability, can barely read a first grade book. Despite weekly instruction in reading with a skilled therapist, he still cannot remember the sounds of vowels and confuses "on" and "no," and "was" and Postsecondary Institutions' Response "saw." His reading vocabulary remains pitifully to Learning Disabled Students small despite enormous effort on his part to learn Meeting and accommodating the educational to read new words. He has not been able to rememand psychologic needs of learning-disabled stu- ber words such as "what," "there," and "who." Yet, dents without compromising academic standards he has held a job as a security guard at a metroare major challenges for institutions of higher politan hospital for 17 years and was recently asked learning. Needless to say, these challenges are the to join the honor guard for a most distinguished subject of great debate among college administra- visitor to New York City. He is a well-adjusted and 70 tors, faculty, students, and professionals in the personable man with a fine sense of humor.
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decoding unfamiliar words and in understanding and retaining what they read. They read inaccurately and slowly, apparently because of basic deficiencies in processing phonological information. Severe written language deficits characterize most learning-disabled college students. Almost all show pervasive problems in spelling and grammar, and some students have illegible h a n d ~ r i t i n g . ~ " ~ '
ADUlll-S W I T H L,E:AKNIN(; DISABILITIE:S-GO.~.I.F.SMAN
Vocational Needs Many of the more severely learning-disabled young adults who have been in special education programs are unable to live independently and Interhave difficulty finding and keepingj~bs.'"~~ views with learning-disabled adults seeking employment reveal that academic problems are only one manifestation of learning disabilities, and other characteristics may take precedence in vocational planning and employment. Help is requested to improve their attention and memory disorders, poor social skills, and limited language and problem-solving abilities, as well as their reading.8'.n4There are few services in community agencies that address the needs of these adultss6
Vocational Rehabilitation Prior to 1980, and despite the passage of Section 504 described previously, learning disabilities were viewed by most state rehabilitation agencies as an educational problem affecting reading, writing, and arithmetic, but not as a vocational problem. Therefore learning-disabled individuals were not eligible for services provided by these agencies. In 1980 the Rehabilitation Services Administration (RSA) of the U.S. Office of Special Educational and Rehabilitation adopted a resolution stating that learning-disabled individuals are eligible for vocational rehabilitation services if their condition
is diagnosed by a physician or psychologist skilled in the diagnosis of the disorder, if the learning disability results in a substantial handicap to employment, and if it is felt that vocational rehabilitation services can facilitate e m p l ~ y a b i l i t y . ~ " ~ ~ r e s e n t l y , most state vocational rehabilitation agencies will accept adults with severe learning disabilities as clients. Although they are mandated to provide evaluative, training, counseling, and job placement services for these clients, the agency staff often lacks the necessary knowledge and experience to be effective providers of s e r ~ i c e . ' ~ , ~ ~ ADULT EDUCATION AND LITERACY PROGRAMS
Approximately two and a half million adults are enrolled in Adult Basic Education and General Educational Degree programs.83Estimates of adults with learning disabilities in these programs range from 20 to 89% of this population.83." At present, some adult literacy programs do not recognize learning disabilities as a major problem of their adult clientele. Severe reading difficulties are often attributed to environmental and educational limitations rather than to a learning disability. A common viewpoint holds that it is wrong to label adults as learning disabled, that the label is overused, and that it limits the expectations of achievement in both client and teacher. If motivated adults are not making improvement while attending the reading classes, then, most often, the teacher is believed to ~ ~ it- is ~ reported ~ that many learnbe at f a ~ l t . Yet, ing-disabled adults enroll in and then drop out of literacy programs because their reading needs are not being met.44Adult education teachers report that there are many students in their programs who cannot read and that there are not adequate materials or methods to deal with them. There is a great need for training and meaningful dialogue among teachers and administrators at the state and local levels regarding program considerations and adaptations for students with learning disabilitie^.'^.^' In addition, a working definition for "learning disabled" needs to be determined and circulated among the teaching staff in adult education programs. One teacher wrote, "I feel that there are many students in my program that have learning disabilities. I am very frustrated because the structure of the class and lack of funds does not allow them to receive the kind of help they need. I know that many of them, if in school today, would be detected and would receive Resource Room or other support services. . . . Thus, I feel that they are likely to drop out of the GED program-again because of frustration-just like what they experienced in public schools, and remain in their present situations (low paying jobs-no advance-
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The relationship of educational attainment to employment is the same for learning-disabled individuals as for those without learning disabilities. College graduates with learning disabilities usually obtain better-paying jobs than learning-disabled high school graduates or drop-outs, but their vocational choices are often limited because of reading, writing, or arithmetic limitation^.'^.'^.^^ Moreover, many report that they work at a slower rate, feel less organized, and generally feel less adequate than their coworkers, because of their learning disabilitiesn1Employers are often reluctant to hire persons with learning disabilities, even more so than persons with physical handicaps, and learning-disabled adults often agonize whether they should tell a prospective employer that they have a learning disability.= Learning-disabled students who have completed high school apparently find jobs with the same degree of frequency as their non-learningdisabled peers. These jobs, however, are often at the unskilled or semiskilled level^.^^-^^
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ment) suffering from low-self-esteem and continued frustration at a system that once again failed the~n."'~ Other adult literacy programs recognize the need to train their teaching staff about learning disabilities in adults. They see the need to expand training in the evaluation of learning-disabled adults and educational intervention on their behalf. 'They have developed specific strategies to teach reading, depending on the degree of impairment shown by the ~ l i e n t . ~ ' . ~ ~For . ~ ! ' example, ,"~ adult non-readers are taught the simplest words needed for survival: labels, traffic words, and other essential words such as "exit" and "toilet." They are also taught to listen to recorded books and use calculators. Although a "whole word" rather than a "phonic" (learning the sounds of letters and letter combinations) approach is most often used to teach words to this population of adults, individual testing and trial teaching is used to determine the best approach to use, and the kind of material most suitable. If clients are found to be at a higher level of reading, greater emphasis is usually given to instruction in In most programs, reading for meaning is a major part of the instructional program. SUMMARY
Deficiencies in reading and writing appear to be major and lasting handicaps for learning-disabled college students. However, gains have been made in program modifications for learning-disabled students in many higher education institutions. Many adults with learning disabilities find that their handicap makes it difficult to obtain and keep jobs. Although they perceive a need for a wide range of educational and vocational services, there are few services available at most community agencies. Service providers and educators in vocational rehabilitation and adult education and literacy programs need to know more about learning disabilities in adults and how to identify such persons and provide them with more appropriate educational instruction and job counseling and training.
CONCLUSIONS
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This article focused on the outcome of childhood learning disabilities, adult symptomatology, and the educational and vocational status of learning-disabled adults. T h e major conclusion is that learning disabilities are life disabilities. Most learning-disabled adults do not outgrow their childhood learning disabilities and show the same basic skill deficiencies as well as difficulties in language,
VOLUME I I, NUMBER 1
MARCH 1991
memory, attention, visual perception, and socialemotional adjustment. Difficulties in these areas often affect a learning-disabled individual's educational attainment, employment options, interpersonal relationships, and emotional well-being. Colleges and universities have not only opened their doors to otherwise qualified, learning-disabled students, but now provide help and program modifications that will enhance the chances of academic success for these students. Many learning-disabled students on graduation from high school or college still have the need for educational, vocational, and social skills training, counseling services, and help in finding and keeping a job. Vocational opportunities remain limited for many learning-disabled adults, especially those with the most severe learning disabilities. At the present time, there is a lack of professional knowledge about the problems of adults with learning disabilities and about useful and effective services and programs. There is a continued need to increase our knowledge about how to improve the functioning of learning-disabled adults. Future research is needed to identify the most effective compensatory strategies that learning-disabled adults can use to achieve vocational independence and social competence."" Learningdisabled adults who have themselves developed strategies to help overcome or compensate for their difficulties are primary candidates for studies.
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