James B. Hale

Critical Issues in Response-To-Intervention, Comprehensive Evaluation, and Specific Learning Disabilities Identification and Intervention: An Expert White Paper Consensus

Developed in concert with the Learning Disabilities Association of America (LDA), this White Paper regarding specific learning disabilities identification and intervention represents the expert consensus of 58 accomplished scholars in education, psychology, medicine, and the law. Survey responses and empirical evidence suggest that five conclusions are warranted: 1) The SLD definition should be maintained and the statutory requirements in SLD identification procedures should be strengthened; 2) neither ability-achievement discrepancy analysis nor failure to respond to intervention alone is sufficient for SLD identification; 3) a “third method” approach that identifies a pattern of psychological processing strengths and weaknesses, and achievement deficits consistent with this pattern of processing weaknesses, makes the most empirical and clinical sense; 4) an empirically-validated RTI model could be used to prevent learning problems, but comprehensive evaluations should occur for SLD identification purposes, and children with SLD need individualized interventions based on specific learning needs, not merely more intense interventions; and 5) assessment of cognitive and neuropsychological processes should be used for both SLD identification and intervention purposes.

Analyzing Digit Span Components for Assessment of Attention Processes

The Digit Span (DS) subtest of the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) is thought to be a measure of attention, concentration, sequencing, number facility, and auditory short-term memory. An optional WISC-III subtest and part of the Freedom from Distractibility (FD) factor, DS assesses several cognitive constructs, yet its utility in differential diagnosis has been questioned because poor DS or FD performance has been inconsistently associated with attention processes. In this study of 195 children referred for comprehensive neuropsychological evaluations, Digits Forward (DF) and Digits Backward (DB) component scores were found to be differentially predictive of attention, executive function, and behavior rating measures. Results suggest that DB is associated with attention and executive function processes, not the short-term rote auditory memory processes tapped by DF.

Executive Impairment Determines ADHD Medication Response: Implications for Academic Achievement:

Methylphenidate (MPH) often ameliorates attention-deficit/hyperactivity disorder (ADHD) behavioral dysfunction according to indirect informant reports and rating scales. The standard of care behavioral MPH titration approach seldom includes direct neuropsychological or academic assessment data to determine treatment efficacy. Documenting “cool” executive-working memory (EWM) and “hot” self-regulation (SR) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response. In this study, children aged 6 to 16 with ADHD inattentive type (IT; n = 19) and combined type (n = 33)/hyperactive-impulsive type (n = 4) (CT) participated in double-blind placebo-controlled MPH trials with baseline and randomized placebo, low MPH dose, and high MPH dose conditions. EWM/ SR measures and behavior ratings/classroom observations were rank ordered separately across conditions, with nonparametric randomization tests conducted to determine individual MPH response. Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction. Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment, yet response was poor for those with adequate EWM/ SR baseline performance. Even for strong MPH responders, the best dose for neuropsychological functioning was typically lower than the best dose for behavior. Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized. Implications for academic achievement and medication titration practices for children with behaviorally diagnosed ADHD will be discussed.

Is the Demise of IQ Interpretation Justified? A Response to Special Issue Authors

Standardized testing of intellectual and cognitive functioning remains a critical component of psychological assessment despite widespread criticism of the practice. Although most standardized intellectual measures are some of the best tools available to practitioners, opponents of intellectual assessment argue the traditional use of global IQ-achievement discrepancy has little diagnostic utility or treatment validity. It is time to move beyond the academic rhetoric of global intelligence to make standardized intellectual assessment meaningful for individual children. In this paper, we respond to special issue authors by presenting clinical and statistical arguments that support idiographic interpretation of intellectual measures for children with disabilities and variable test profiles, and offer recommendations for practice that demonstrate the clinical utility of such approaches. If practitioners move beyond global IQ interpretation, and methods for objective idiographic interpretation are established, the practice of intellectual assessment will be once again valued and respected among those in clinical and educational practice.

Interpreting Intelligence Test Results for Children with Disabilities: Is Global Intelligence Relevant?

School psychological and neuropsychological evaluations typically include intellectual and other standardized assessment tools in the identification of children with disabilities. The clinical utility of intellectual assessment in the identification and treatment of these children has been repeatedly challenged, with alternatives such as a response to intervention or global intelligence score interpretation offered to replace the long-held tradition of idiographic interpretation of intellectual factors or subtests for the purpose of differential diagnosis and individualized intervention. Replicating previous work, this study examined the structure of intellectual functioning for children diagnosed with Learning Disability (LD; n = 128), Attention-Deficit/Hyperactivity Disorder (ADHD; n = 71), and traumatic brain injury (TBI; n = 29) using regression commonality analysis. Across groups, results provide substantial evidence for a multifactorial representation of intellectual functioning for children with LD, ADHD, or TBI, with little shared variance among factor predictors of FSIQ in each analysis. As global intellectual functioning, represented by the shared variance among all predictors, was largely absent and instead composed of several discrete elements with the requisite specificity for individual interpretation, idiographic interpretation appears to be warranted for children with disabilities.

Development and validation of an attention-deficit/hyperactivity disorder (ADHD) executive function and behavior rating screening battery

Attention problems are ubiquitous in clinical practice, commonly found in many childhood learning and behavior disorders. Practitioners need cost- and time-effective methods for determining whether children have attention problems due to attention-deficit/hyperactivity disorder (ADHD) or numerous other conditions. This study examined the utility of a 15-minute ADHD screening battery designed to differentiate ADHD (including inattentive, IT, and combined, CT, subtypes), specific learning disability (SLD), and typical child samples. Results for the 368 children (age 6 to 12 years) revealed that the Trail Making Test–Part B (Time/Errors), Hale–Denckla Cancellation Test (Time/Correct), and Child Attention Profile (Inattention/Overactivity) teacher ratings discriminated between typical and ADHD groups (87% correct classification; sensitivity = .64; specificity = .92) and differentiated between IT, CT, and SLD groups (80% correct classification; IT sensitivity = .82, and specificity = .96; CT sensitivity = .84, and specificity = .82). Discriminant function and Bonferroni post hoc results revealed different neuropsychological and behavioral patterns among groups.

Predicting Math Achievement Through Neuropsychological Interpretation of WISC-III Variance Components:

Although prevalence estimates suggest that mathematics learning disorders (MLD) are as common as reading disorders, there has been comparatively little research conducted that examines the psychological processes involved in math competency for typical children, and the characteristics, etiology, and treatment of children with MLD. Previous research in disabled populations has implicated dysfunctional right hemisphere cognitive processes as a cause of MLD and suggested that impaired visual-spatial skills lead to specific MLD error patterns. In this study of 587 unidentified children with variable intellectual test profiles, the cognitive predictors necessary for math competency were interpreted from a neuropsychological orientation. Results revealed that complex interactions between WISC-III Verbal and Performance subtests were predictive of Albert Einstein College of Medicine math word problems and computation skills, suggesting that semantic/mathematics knowledge, working memory, executive function, novel problem solving, and visual-perceptual-motor processes are necessary for mathematics performance. Contrary to the right hemisphere hypothesis of math competency, results suggest that left hemisphere crystallized abilities and frontal executive functions are most predictive of mathematics achievement for children with variable test profiles. Consistent with theoretical and empirical advances regarding lateralization of function, the numerous predictor commonalities found support a reconceptualization of the left-verbal/right-nonverbal dichotomy of the cognitive processes underlying mathematics competency.

Forest Grove School District v. T.A. Supreme Court Case: Implications for School Psychology Practice

The 2009 Forest Grove School District v. T.A. United States Supreme Court case could have significant implications for school psychology practice. The Court ruled that the parents of a student with a disability were entitled to private school tuition reimbursement even though T.A. had not been identified with a disability or previously provided with special education services. The district multidisciplinary team had not identified T.A.’s disability in part because of a limited psychoeducational evaluation that did not assess him in “all areas of suspected disability” which is a requirement of the Individuals with Disabilities Education Act (IDEA; 20 U.S.C. § 1414(b)(3)(B)). Dissatisfied with the team’s decision, the parents sought an independent comprehensive evaluation of T.A.’s psychological processes which revealed the full nature of his disability and needs. Although T.A. had been unresponsive to interventions in his home school, this comprehensive psychoeducational evaluation led to more targeted interventions in his private school placement and likely contributed to T.A.’s subsequent academic and behavioral success. This Supreme Court case highlights the need for school-based teams to conduct comprehensive evaluations in all areas of suspected disability, including psychological processes such as attention, memory, and executive function. The relevant IDEA 2004 and governing 2006 federal regulations are presented, followed by recommendations for school psychologist assessment practices to ensure compliance with IDEA statutory and regulatory requirements.

Estimating Base Rates of Impairment in Neuropsychological Test Batteries: A Comparison of Quantitative Models

Neuropsychologists frequently rely on a battery of neuropsychological tests which are normally distributed to determine impaired functioning. The statistical likelihood of Type I error in clinical decision-making is in part determined by the base rate of normative individuals obtaining atypical performance on neuropsychological tests. Base rates are most accurately obtained by co-normed measures, but this is rarely accomplished in neuropsychological testing. Several statistical methods have been proposed to estimate base rates for tests that are not co-normed. This study compared two statistical approaches (binomial and Monte Carlo models) used to estimate the base rates for flexible test batteries. The two approaches were compared against empirically derived base rates for a multitest co-normed battery of cognitive measures. Estimates were compared across a variety of conditions including age and different α levels (N =3,356). Monte Carlo R(2) estimates ranged from .980 to .997 across five different age groups, indicating a good fit. In contrast, the binomial model fit estimates ranged from 0.387 to 0.646. Results confirm that the binomial model is insufficient for estimating base rates because it does not take into account correlations among measures in a multitest battery. Although the Monte Carlo model produced more accurate results, minor biases occurred that are likely due to skewess and kurtosis of test variables. Implications for future research and applied practice are discussed.

Psychosocial and Adaptive Deficits Associated With Learning Disability Subtypes

Children with specific learning disabilities (SLD) have deficits in the basic psychological processes that interfere with learning and academic achievement, and for some SLD subtypes, these deficits can also lead to emotional and/or behavior problems. This study examined psychosocial functioning in 123 students, aged 6 to 11, who underwent comprehensive evaluations for learning and/or behavior problems in two Pacific Northwest school districts. Using concordance-discordance model (C-DM) processing strengths and weaknesses SLD identification criteria, results revealed working memory SLD (n = 20), processing speed SLD (n = 30), executive SLD (n = 32), and no disability groups (n = 41). Of the SLD subtypes, repeated measures MANOVA results revealed the processing speed SLD subtype exhibited the greatest psychosocial and adaptive impairment according to teacher behavior ratings. Findings suggest processing speed deficits may be behind the cognitive and psychosocial disturbances found in what has been termed “nonverbal” SLD. Limitations, implications, and future research needs are addressed.