Table Of ContentLearning Disability Subtyping
Stephen R. Hooper W. Grant Willis
Learning Disability
Subtyping
Neuropsychological Foundations,
Conceptual Models, and Issues in
Clinical Differentiation
Springer-Verlag
New York Berlin Heidelberg
London Paris Tokyo
Stephen R. Hooper Ph.D.
The Clinical Center for the Study of Development and Learning
Department of Psychiatry
University of North Carolina School of Medicine
Chapel Hill, NC 27599-7255, USA
W. Grant Willis Ph.D.
Department of Psychology
University of Rhode Island
Kingston, RI 02881-0808, USA
Library of Congress Cataloging-in-Publication Data
Hooper, Stephen R.
Learning disability subtyping : neuropsychological foundations,
conceptual models, and issues in clinical differentiation / Stephen
R. Hooper, W. Grant Willis.
p. cm.
Bibliography: p.
Includes index.
ISBN (invalid) 0-387-96803-3 (alk. paper)
I. Learning disabilities. I. Willis, W. Grant. II. Title.
[DNLM: I. Learning Disorders-classification. WS 15 H788L]
RJ506.L4H66 1989
GI8.92'858-dcI9
DNLMlDLC
for Library of Congress 88-39218
Printed on acid-free paper.
© 1989 by Springer-Verlag New York Inc.
Softcover reprint of the hardcover I st edition 1989
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ISBN-13: 978-1-4613-8812-8 e-ISBN-13: 978-1-4613-8810-4
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To my family (S.R.H.)
To people with learning disabilities (W.G. W.)
Foreword
The publication of this very important volume comes at a timely juncture
in the history of learning disabilities. The focus of this volume is on
developing a multidisciplinary understanding of the complexities of the
research on learning disabilities and its various sUbtypes. It also will serve
as an important compendium of the subtyping literature, particularly with
respect to pertinent issues of nosology, specific sUbtyping models, neuro
psychological diagnosis, and treatment.
As the authors so correctly suggest, the differential diagnosis of learning
disabilities subtypes is a critical first step in developing theoretically sound
programs of psychoeducational intervention. Clearly, one must have some
idea about the general abilities of a child before realistic expectations can
be charted. Also, how can one plan a program of intervention without
some knowledge of the deficient components of achievement within a do
main? Does it not make both conceptual and practical sense to identify an
individual's relative strengths and weaknesses so that abilities or strengths
can be utilized to optimize functioning in areas of deficit? Although these
all sound like reasonable precursors to assisting individuals in need of
academic assistance, there are those who would argue otherwise. Impor
tantly, however, the Director of the National Institutes of Health, in a
recent report to Congress, advocates exactly what this volume proposes.
Indeed, there are important needs to be addressed, and the literature
reviewed herein strongly supports the conclusions drawn by these authors.
There is ample evidence of subtypes of learning disabilities, and a concur
rent need exists for a standardized nosology. There is a need for more
psychometrically· refined neuropsychological and neurodiagnostic proce
dures, both for children currently in school and for those of preschool age.
There also is an urgent need for standardized markers and variables that
should be employed in all research efforts. There are studies currently
underway that are investigating the very specific issue of whether sUbtype
by-treatment interactions occur and to what degree. Although there are
few actual data about this important issue, within the next 5 years, some
conclusions may indeed be warranted. This volume succeeds in outlining
many of the issues with respect to treatment.
viii Foreword
Thus, in my view, the authors of this volume have provided us all (e.g.,
psychologists, educators, physicians, and parents) with a comprehensive
neuropsychological perspective as to what the presumed neurological basis
is, how cognitive, academic, linguistic, and social-emotional systems are
implicated, how the subtypes can be viewed as discretely different, and
what the literature says about assessment and intervention. This book does
far more than summarize the present state of affairs in a well written man
ner; it provides a solid conceptual perspective about where we have been,
what we have done, and perhaps most important, what we need to do next
to ensure that learning-disabled individuals will profit from our most
productive research efforts.
University of Georgia George W. Hynd
Athens, Georgia
Preface
The conceptualization of learning disabilities has a long history. Case de
scriptions of children with unusual learning profiles, for example, were pre
sented in the 1800s. Although the actual term, learning disability, was not
coined until the middle 1960s, the clinical and research legacy left a trail of
findings supporting the existence of such a learning phenomenon. Many of
the findings related to this phenomenon, however, were conftictual and,
subsequently, provided little guidance to the clinician and researcher in
terested in working with these children. These concerns did not constrain
researchers' efforts to investigate this disorder but, unfortunately, these
efforts rarely occurred from a unified perspective.
From both research and clinical perspectives, the study of learning dis
abilities had become a burdensome and confusing quagmire. There were
blatant problems in the clinical components of evaluation, diagnosis, and
treatment. Problems also existed in even more fundamental aspects of this
disorder, including such basics as definitional issues and conceptual found
ations. Although clinicians and researchers continue to struggle with these
difficulties when working with this population, there have been relatively
recent advances in this field that may help to bring greater clarification and
understanding to this clinical and research area.
Over the past three decades, there has been a steady proliferation of
research investigating the neuropsychological factors contributing to learn
ing disabilities. One of the major research trends that has emerged from
these efforts is that a learning disability actually is a generic classification
that represents a heterogeneous group of neurologically based disorders.
The identification of reliable subtypes has the potential to lend assistance
to the evaluation and diagnosis of learning disorders. It also has the poten
tial to improve the specificity of treatment programs and intervention plans
for these individuals. By attempting to classify learning problems according
to more homogeneous groupings, researchers will be able to begin to bring
some clarity to the confusing mass of learning disability research that has
been conducted to date. Research efforts ultimately will become more
theoretically sound and, thus, clinically useful if a reliable and valid clas
sification model can be developed.
x Preface
Given this evolving literature on learning disability subtyping, it be
comes important for this information to be gathered from time to time in a
single resource so that it can be evaluated efficiently and effectively.
Rourke (1985) presented the first publication addressing this need, largely
focusing on his landmark efforts in the subtyping area. In a complementary
fashion, this volume also addresses this need by providing a comprehensive
compendium of the subtyping models derived to date. As such, the volume
is intended for students, practitioners, and researchers across a wide array
of fields who are interested in learning disability subtyping.
The book is divided into four major sections. The first section is con
cerned with providing a historical and conceptual framework from which to
view the sUbtyping efforts. Chapter 1 provides an overview of historical
antecedents to learning disabilities, along with a discussion of definitional
issues crucial to this field. Chapter 2 is concerned with the neurological
foundations for the study of learning disability subtyping and its proposed
classification models.
The second section is devoted exclusively to the various subtyping
models. Chapter 3 deals with an overview of all of the clinical-inferential
sub typing attempts completed to date, and Chapter 4 presents an overview
of classification models employing empirical strategies and techniques.
Specific issues directly related to subtype derivation are discussed in Chap
ter 5.
The third section deals with specific components of the sub typing pro
cess. Chapter 6 is concerned with the neuropsychological assessment of
subtypes, and Chapter 7 deals with emergent concerns pertaining to impor
tant social-emotional features of learning disability subtypes. Chapter 8
provides an overview of treatment models and issues related to interven
tion programs with children showing particular learning profiles. A particu
lar emphasis in this chapter is placed on the few studies that have been
conducted to date exploring treatment interventions for speCIfic subtypes.
Finally, the last section provides a summary of the literature published to
date, emphasizing recent advances and future directions of the subtyping
endeavor.
The classification of children with learning disabilities has extraordinary
potential to bring greater clarity to clinical and experimental efforts in this
field. We hope that our overview of the subtyping literature and related
issues contributes to this important endeavor.
Chapel Hill, NC Stephen R. Hooper
Kingston, RI W. Grant Willis
Acknowledgments
Although the time spent drafting and redrafting this volume was great, our
efforts would never have reached fruition without the help of several
"significant others." We would like to extend our sincere appreciation to
Teresa Buckner and Elizabeth Scott at the Clinical Center for the
Study of Development and Learning for their efficient clerical assistance
in preparing this volume. We also would like to thank Dr. Mary Gail
Becker at The Pennsylvania State University for her input on several of the
chapters. Finally, we would be remiss if a heart-felt "thank you" were not
given to the editorial staff at Springer-Verlag. In particular, we would like
to thank Dr. Robert Kidd for his unending patience with us during the
process of completing this volume. Despite this excellent support, how
ever, we remain responsible for any shortcomings of this volume.
