EVIDENCE-BASED INTERVENTIONS

FOR STUDENTS WITH LEARNING AND

BEHAVIORAL CHALLENGES

This book assembles into one volume summaries of school-based intervention research
that relates to those who deal on a regular basis with the growing body of students
having high-incidence learning disabilities and/or behavior disorders: special educators,
school psychologists, and clinical child psychologists. Chapter authors begin with an
overview of their topic followed by a brief section on historical perspectives before
moving on to the main section—a critical discussion of empirically-based intervention
procedures. In those instances where evidence-based prescriptions can legitimately be
made, authors discuss best practices and the conditions (e.g., classroom environment,
teacher expertise) under which these practices are most effective. A final section deals
with policy issues.
 EVIDENCE-BASED INTERVENTIONS
FOR STUDENTS WITH LEARNING AND
BEHAVIORAL CHALLENGES

Edited by

Richard J. Morris and Nancy Mather

First published 2008
by Routledge
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Simultaneously published in the UK

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Library of Congress Cataloging-in-Publication Data

Evidence-based interventions for students with learning and behavioral challenges / edited by Richard J. Morris and
Nancy Mather.
p. cm.
Includes bibliographical references and indexes.
ISBN 978-0-415-96454-8 (hardback: alk. paper) -- ISBN 978-0-415-96455-5 (pbk. : alk. paper)
-- ISBN 978-0-203-93854-6 (e-book)
1. Learning disabled children--Education--United States. 2. Problem children--Education--United States. 3. Special edu-
cation--United States. I. Morris, Richard J. II. Mather, Nancy.
LC4705.E85 2007
371.90973--dc22
2007027715

ISBN 0-203-93854-2 Master e-book ISBN

ISBN10: 0-415-96454-7 (hbk)

ISBN10: 0-415-96455-5 (pbk)
ISBN10: 0-203-93854-2 (ebk)

ISBN13: 978-0-415-96454-8 (hbk)

ISBN13: 978-0-415-96455-5 (pbk)
ISBN13: 978-0-203-93854-6 (ebk)
 To
Stephanie and Michael Hoffman and Michael and Lindsay Morris,
and in loving memory of Jacqueline Anne Morris

And To

George and Laura Mather for their love and support

 Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

I. INTRODUCTION

1. Introduction and Historical Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Richard J. Morris and Nancy Mather

2. Why the Need for Evidence-Based Interventions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Jeffery P. Braden and Elisa Steele Shernoff

II. STUDENTS HAVING BEHAVIORAL CHALLENGES

3. Attention-Deficit/Hyperactivity Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
George J. DuPaul, Laura E. Rutherford, and Shelley J. Hosterman

4. Disruptive Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Carl J. Liaupsin and Terrance M. Scott

5. Fears and Related Anxieties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Gretchen Schoenfield and Richard J. Morris

6. Depression and Related Difficulties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Dawn H. S. Reinemann and Sarah Schnoebelen

III. STUDENTS HAVING LEARNING CHALLENGES

7. Oral Language Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

Kathleen Fahey

8. Teaching Younger Readers with Reading Difficulties . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

Nancy Mather and Annmarie Urso

9. Teaching Older Readers with Reading Difficulties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193

Jade Wexler, Meaghan S. Edmonds, and Sharon Vaughn

vii
viii CONTENTS

10. Written Language during Early and Middle Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . 215

Virginia Berninger

11. Effective Mathematics Instruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

Marjorie Montague and Delinda van Garderen

12. Cognitive Processing Deficits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258

Milton J. Dehn

13. Effective Learning Strategy Instruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288

Patricia Gildroy and Donald Deshler

14. Accommodation of Instructional and Testing Situations . . . . . . . . . . . . . . . . . . . . . . . . . . 302

Noel Gregg and Jennifer H. Lindstrom

IV. ISSUES RELATED TO TEACHING STUDENTS HAVING LEARNING

AND BEHAVIORAL CHALLENGES

15. Issues Unique to English Language Learners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321

Sam Ortiz and Agnieszka M. Dynda

16. Serving Gifted Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336

Steven I. Pfeiffer and Samara Blei

17. Effective Service Delivery Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359

James M. Kauffman, Devery R. Mock, Melody Tankersley, and Timothy J. Landrum

V. COMMENTARY ON TEACHING STUDENTS HAVING LEARNING

AND BEHAVIORAL CHALLENGES

18. Perspective and Commentary: The Power of Mindsets, Creating Classrooms

that Nurture Resilience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Robert B. Brooks and Sam Goldstein

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
 Preface

Education is helping a child realize his potentialities.

Erich Fromm

The focus of this book is on evidence-based interventions for students with learning and behav-
ioral challenges. You may wonder why we didn’t just narrow the focus to learning or behavioral
problems. The reason is that so many students with behavioral problems also have issues with
learning, with the converse being true as well. Thus, educators and psychologists must be pre-
pared to deal with a variety of overlapping conditions, such as the student with attention deficit
hyperactivity disorder (ADHD) and a reading disability, or the student being disruptive in class
and having a language disorder. You may also wonder why we used the word “challenges” in-
stead of words such as “disorders,” “problems,” “impairments,” or “disabilities.” The reason is
that most of the procedures that are described in this book can be used with many students who
are struggling with aspects of learning or behavior.
For example, a number of school-age children and adolescents have certain fears or related
anxieties, such as test anxiety, separation anxiety, or public speaking anxiety (e.g., oral recita-
tion, answering or asking questions in class, reading out-loud, etc.) that diminish their everyday
enthusiasm for learning and may even prevent them from attending school on particular days.
Although these students might not be identified as having emotional disturbances and may not be
failing in school, they are challenged on certain days to perform at a level consistent with their
academic potential. On the other hand, some students have certain fears and related anxieties
that do, in fact, prevent them from attending school and in such cases the emotional difficulties
do constitute a bona fide emotional disturbance. The intervention research literature on reducing
fears and related anxieties does not necessarily differentiate between the types of intervention
that should be conducted with each type of student. In both cases, the behaviors pose a “chal-
lenge” to the individuals, as well as to school professionals. Fortunately, the research literature
suggests the type of intervention(s) that should be implemented to help such students reduce the
frequency and intensity of their fearful and anxious behaviors.
The same is true for children and/or adolescents with learning challenges. For example, a
fourth-grade student may be reading two years below grade level, but performing acceptably in
other subjects that require minimal reading. Without further investigation, the reason for the poor
reading is unclear. The student may have a reading disability, but regardless, his reading difficul-
ties are certainly a “challenge” for himself, the teacher, and even his parents or care providers.
Here again, the intervention research literature suggests that certain evidence-based procedures
may be used to enhance reading performance, and that these procedures may be the same or quite
similar to those suggested for students who have documented reading disabilities. School profes-
sionals in practice or training, including administrators, general and special education teachers,
psychologists, speech-language pathologists, and counselors, need to understand the challenges
and also know about the numerous evidence-based educational or psychoeducational procedures
that may be implemented to assist students.

ix
x PREFACE

The reader may also ask why, in most of the chapters in the book, the discussion centers
solely on evidence-based interventions? The reason is that society is increasingly demanding that
educators, physicians, psychologists, counselors, and other educational and child health profes-
sionals be accountable for the services that they provide and that they use the “best practice” in
the delivery of such services. In many cases, this means being able to independently verify or
support the use of the “best practice” that one provides. In the fields of education and school
psychology, verification of a practice is often demonstrated by using interventions that have
objective evidence of effectiveness derived from the research literature. Thus, in the case of the
chapters in this book, the “evidence” for the use of the various interventions is based on empiri-
cal research in education, special education, school psychology, school counseling, and clinical
child and adolescent psychology. In the case of many of the learning and behavioral challenges
discussed, the interventions described have achieved a level of treatment confidence that is often
referred to as either “efficacious” or “probably efficacious.” These terms signify that experimen-
tal control conditions have been used in evaluating the effectiveness of a particular intervention,
the intervention includes an implementation manual, and that the intervention was found to be
significantly (or appreciably) more effective than the control condition. What separates “effica-
cious” from “probably efficacious” is the number of controlled intervention studies by different
researchers that have been published on students having a particular learning or behavioral chal-
lenge. In some cases, less well-controlled research may be cited in chapters—including those
studies published by only one investigator team—but the results of the intervention(s) that were
used were still found to be effective. These latter studies are often referred to as “experimental.”
Important changes have occurred over the past 10 to 15 years in general education, special
education, school psychology, school counseling, and clinical child and adolescent psychology—
with the common focus being on evidence-based practices. Recognition and implementation of
these best practices have resulted in positive benefits for school professionals and the children
and adolescents they serve. In this regard, many teachers, school psychologists, and counselors
are using interventions that have evidence to support their effectiveness, and the majority of
university preparation and training programs include methods courses that provide instruction
and practice in the implementation of evidence-based practices. School administrators, as well
as the federal government, state education agencies and local education agencies, are demanding
accountability and the use of evidence-based interventions where the relative effectiveness of the
interventions is assessed through the use of evidence-based assessment practices.
In spite of this increasing emphasis on evidence-based practices, only a few books have
addressed this topic in depth, and few attempt to address interventions in both the learning and
behavior areas. The chapters in this book cover a broad range of the most common learning and
behavioral challenges that school professionals are likely to encounter. All chapters are written
by individuals who are leading experts in the field and on the topics being addressed. Although
the chapter authors were provided with a general outline for writing their respective chapters,
they were encouraged to adapt the outline to fit their particular topic area. Case examples are also
presented, in some instances, to further illustrate the implementation of a particular interven-
tion. Some chapters also include a discussion of historical and theoretical issues, but the primary
emphasis throughout is on the use of evidence-based intervention techniques and strategies for
addressing various behavioral and learning challenges in students.
The central intent of this book is to provide a comprehensive view of the best practices for
helping these students overcome their difficulties so that they can accomplish realistic scholastic
goals and become healthy, productive citizens. The volume covers an introduction and overview
of the field; a discussion of why we need evidence-based practices; ADHD; childhood depression
and related difficulties; fears and related anxieties; disruptive behavior problems; oral language;
 PREFACE xi

strategies for younger and older readers; written language; mathematics; strategy instruction; and
cognitive processing difficulties. Other chapters address such relevant issues as implementation
and selection of appropriate accommodations, effective instruction for English language learners,
provision of effective service delivery models, and a discussion of gifted students with learning
and behavioral challenges. The final chapter serves as a commentary and reflection to remind us
never to forget the importance of the human relationships and special bonds that form between
students and practitioners, a necessary component of all evidence-based interventions.
This book is, therefore, intended to be an intervention-oriented reference volume for special
education teachers, general education teachers, school psychologists, speech-language patholo-
gists, and school counselors who work directly with students having learning and/or behavioral
challenges. It will be especially useful for graduate training courses in special education, general
education and school psychology, as well as courses in classroom management, and school con-
sultation.
One caveat, however, is in order. Research across the century has also clarified that one
instructional method or one psychological or psychoeducational intervention will not work with
all individuals. Thus, a method, strategy, program, or intervention may meet the requirements
of being “evidence-based,” but still not be the most efficacious treatment for a certain student.
Many factors affect the choice of a methodology, intervention, or program, including the age
of the student, past approaches used and how successful they were, the personal characteristics
of the person, the demands of the setting and environment, and the resources that are available.
“Evidence-based” indicates that many individuals have made progress using the procedure and
that the method is more effective than others, but it does not guarantee that a certain student will
respond adequately to the “effective” treatment. For example, much of the research on early read-
ing indicates that when evidence-based interventions are employed with intensity and fidelity, a
certain percentage of children can be described as “treatment resistors.” Even evidence-based
procedures need, at times, to be adjusted, adapted, and refined to meet the needs and unique
characteristics of a specific individual.
A number of individuals made major contributions to the completion of this book. First, we
wish to thank Lane Akers at Lawrence Erlbaum and Associates for his support and encourage-
ment in every phase of this project. In addition, we express our appreciation to Jackie Collins for
her assistance during various phases of this project. We also wish to express our special thanks to
Vinnie Morris and Michael Gerner for their support during the preparation of this book.
Richard J. Morris
Nancy Mather
 Contributors

EDITORS

Richard J. Morris, PhD, is the David and Minnie Meyerson Distinguished Professor of Dis-
ability and Rehabilitation and Professor of School Psychology in the Department of Special
Education, Rehabilitation, and School Psychology at the University of Arizona. He is a Fellow of
the American Psychological Association (APA), Charter Fellow of the American Psychological
Society, and Fellow of the American Association on Mental Retardation. He has authored or ed-
ited 13 books and more than 120 journal articles and book chapters in the areas of child behavior
disorders, child psychotherapy, and ethical and professional practice issues in psychology. Some
of his authored or edited books are: Disability Research and Policy: Current Perspectives; The
Practice of Child Therapy, fourth edition (with Thomas R. Kratochwill), Handbook of Psycho-
therapy with Children and Adolescents (with Thomas R. Kratochwill), Treating Children’s Fears
and Phobias: A Behavioral Approach (with Thomas R. Kratochwill), and Behavior Modification
with Children: A Systematic Guide. His current research interests include: managing childhood
aggressive and disruptive behaviors in the classroom, disability and juvenile delinquency, and le-
gal and ethical issues in the delivery of children’s mental health services. Dr. Morris is a licensed
psychologist, and is a past Chair and Board Member of the state of Arizona Board of Psycholo-
gist Examiners and a former member of the Ethics Committee of the American Psychological
Association. He currently serves as a member of the Board of Trustees of the American Psycho-
logical Association Insurance Trust.
Nancy Mather, PhD, is Professor of Special Education in the Department of Special Education,
Rehabilitation, and School Psychology at the University of Arizona. She specializes in the areas
of reading, writing, and learning disabilities. She has conducted numerous workshops nationally
and internationally on assessment, instruction, and issues that affect service delivery for indi-
viduals with learning disabilities. She has written numerous books, book chapters, and articles
on topical issues in the field of learning disabilities. In addition, Dr. Mather is a co-author of the
Woodcock-Johnson III with Richard W. Woodcock and Kevin S. McGrew (Woodcock, McGrew,
& Mather, 2001) and has co-authored two books on interpretation and application of the WJ III:
Woodcock-Johnson III: Reports, recommendations, and strategies (Mather & Jaffe, 2002) and
Essentials of WJ III Tests of Achievement Assessment (Mather, Wendling, & Woodcock, 2001). In
addition, she has co-authored: Essentials of Assessment Report Writing (Lichtenberger, Mather,
Kaufman, & Kaufman, 2004) and has just completed the second edition of Learning Disabilities
and Challenging Behaviors (Mather & Goldstein, 2008).

xiii
xiv CONTRIBUTORS

CONTRIBUTORS

Virginia W. Berninger, PhD Agnieszka M. Dynda, MS

Professor Doctoral Candidate
University of Washington St. John’s University
Department of Educational Psychology Department of Psychology
Seattle, Washington Jamaica, New York
Samara Blei Meaghan Edmonds
Doctoral Student University of Texas at Austin
Program in Counseling/School Psychology Vaughn Gross Center for Reading and
The Florida State University Language Arts
College of Education Austin, Texas
Tallahassee, Florida
Kathleen R. Fahey, PhD
Jeffery P. Braden, PhD Professor of Speech-Language Pathology
Professor of Psychology University of Northern Colorado
Associate Dean for Research and Graduate School of Human Sciences
Programs Audiology and Speech Language Sciences
College of Humanities and Social Sciences Programs
North Carolina State University Greeley, Colorado
Raleigh, North Carolina
Patricia G. Gildroy, PhD
Robert B. Brooks, PhD Educational Consultant
Assistant Clinical Professor of Psychology Strategic Learning Center
Harvard Medical School Seattle, Washington
Department of Psychiatry
Sam Goldstein PhD
Boston, Massachusetts
Research Professor of Psychology
Milton J. Dehn, EdD, NCSP George Mason University
Program Director Fairfax, Virginia
Schoolhouse Educational Services Clinical Assistant Professor of Psychiatry
Onalaska, Wisconsin University of Utah School of Medicine
Salt Lake City, Utah
Donald D. Deshler, PhD
Professor & Director Noel Gregg, PhD
Center for Research on Learning Distinguished Research Professor
University of Kansas University of Georgia
Department of Special Education Department of Communication Sciences &
Lawrence, Kansas Special Education
Athens, Georgia
George J. DuPaul, PhD
Professor of School Psychology Shelley J. Hosterman, MEd
Chairperson, Department of Education and Doctoral Student
Human Services Lehigh University
Lehigh University College of Education
College of Education Bethlehem, Pennsylvania
Bethlehem, Pennsylvania
 CONTRIBUTORS xv

James M. Kauffman, EdD Richard J. Morris, PhD

Professor Emeritus of Education David and Minnie Meyerson Distinguished
University of Virginia Professor of Disability and Rehabilitation
Department of Curriculum, Instruction, and Professor of School Psychology
Special Education University of Arizona
Charlottesville, Virginia Department of Special Education,
Rehabilitation, and School Psychology
Timothy J. Landrum, PhD
Tucson, Arizona
Associate Professor, General Faculty, and
Senior Scientist Samuel, O. Ortiz, PhD
University of Virginia Associate Professor of Psychology
Department of Curriculum, Instruction, and St. John’s University
Special Education Department of Psychology
Charlottesville, Virginia Jamaica, New York
Carl J. Liaupsin, PhD Steven I. Pfeiffer, PhD, ABPP
Associate Professor of Special Education Professor and Director of Clinical Training,
University of Arizona PhD Program in Counseling/School
Department of Special Education, Rehabilita- Psychology
tion, and School Psychology The Florida State University
Tucson, Arizona College of Education
Tallahassee, Florida
Jennifer Lindstrom, PhD
Assistant Professor Dawn H. S. Reinemann, PhD
University of Virginia Assistant Professor
Department of Curriculum, Instruction, and Cardinal Stritch University
Special Education Graduate Program in Clinical Psychology
University of Virginia Milwaukee, Wisconsin
Charlottesville, Virginia
Laura E. Rutherford, MEd
Nancy Mather, PhD Doctoral Student
Professor of Learning Disabilities Lehigh University
University of Arizona College of Education
Department of Special Education, Bethlehem, Pennsylvania
Rehabilitation, and School Psychology
Sarah Schnoebelen, PhD
Tucson, Arizona
Children’s Medical Center of Dallas
Devery R. Mock, PhD Department of Psychiatry
Assistant Professor of Reading Education Dallas, Texas
Appalachian State University
Gretchen Schoenfield
Department of Language, Reading, & Excep-
Doctoral Candidate, School Psychology
tionalities
Program
Boone, North Carolina
University of Arizona
Marjorie Montague, PhD Department of Special Education,
Professor of Special Education Rehabilitation, and School Psychology
University of Miami Tucson, Arizona
Department of Teaching and Learning
Coral Gables, Florida
xvi CONTRIBUTORS

Terrance M. Scott, PhD Delinda van Garderen, PhD

Professor and Director of Special Education Assistant Professor of Special Education
Department University of Missouri – Columbia
College of Education and Human Department of Special Education
Development Columbia, Missouri
University of Louisville
Sharon Vaughn, PhD
Louisville, Kentucky
H.E. Hartfelder/Southland Corps Regents
Melody Tankersley, PhD Chair
Professor of Education Professor of Special Education
Kent State University University of Texas
Department of Special Education Department of Special Education
Kent, Ohio Austin, Texas
Annmarie Urso, MSEd Jade Wexler, MS
PhD Candidate University of Texas at Austin
Department of Special Education, Rehabilita- Vaughn Gross Center for Reading and
tion & School Psychology Language Arts
College of Education, Room 409 Austin, Texas
University of Arizona
Tucson, Arizona 85721
 I
INTRODUCTION
 1
Introduction and
Historical Perspectives
Richard J. Morris and Nancy Mather

The research and related scholarly literature on learning disabilities and behavioral and emo-
tional disturbances in children and adolescents have grown at an exponential rate over the past 25
years. In addition, during this time period, the U.S. Congress passed two major revisions of the
Individuals With Disabilities Education Act (IDEA; 1997, 2004)—legislation that guarantees all
children who have a disability a free and appropriate education until they reach 22 years of age.
The Americans with Disabilities Act (1990) also guarantees individuals with disabilities equal ac-
cess and protection from discrimination in the work place and all public settings. Another federal
act, No Child Left Behind (NCLB; 2001 had a pronounced influence on the 2004 reauthorization
of IDEA. In this regard, the NCLB Act indicates that states and local school districts need to
demonstrate that federal funds are spent on programs that have a “scientifically based research”
record (Feuer, Towne, & Shavelson, 2002). Thus, the overarching implication of IDEA 2004 is
that special educators must attempt to improve services for students with disabilities by providing
meaningful educational programs that are grounded in research-based practices (Yell, Shriner, &
Katsiyannis, 2006).
Members of society and political leaders have also sent a clear message that they wish to
promote and financially support research and scholarship in the areas of learning and behavioral
problems, as well as all other areas of special education. This support is not only because of
federal legislation, but is also a result of legal mandates at state government levels and various
court decisions that have repeatedly concluded that students with disabilities are entitled to equal
access to the same educational opportunities, services, and settings as their peers who do not have
a disability. The field of special education, as well as related fields such as school psychology,
school counseling, school health, and school administration and policy, have responded to this
level of societal support by not only centering major research and policy initiatives on advanc-
ing (and understanding) the needs of children with disabilities, but also in expanding the number
of professional journals and journal pages that publish research in these areas. In addition, the
number of research presentations on students with learning and/or behavioral challenges has also
increased at the annual meetings of various professional associations.
Over the past 25 years, new concepts have been introduced into special education and school
psychology. For example, terms such as “Curriculum-Based Measurement” (CBM), “Curriculum-
Based Intervention,” “Functional Assessment,” and “Evidence-Based Intervention” (EBI) have

3
4 MORRIS AND MATHER

all emerged from empirical studies conducted by researchers in special education and psychol-
ogy. The focus of the present book is on evidence-based interventions. Since the mid-1980s, mil-
lions of dollars have been spent on EBI research that centers upon assessing, treating, and even
attempting to prevent various learning and behavioral challenges in students.
What has society and the fields of special education and psychology learned from this re-
search and the hundreds of thousands of hours that researchers have spent studying these areas
and analyzing the results of their work? Most of the scholars in the field would quickly respond
“a great deal.” Even the most extreme skeptic would have to agree that considerable progress has
indeed been made in gathering evidence regarding what works with students who have learning
and/or behavioral challenges—as well as what does not seem to work. For example, substantial
progress has been made in our understanding of how to teach reading to students who struggle.
Similarly, results from EBI research have demonstrated how to successfully identify and inter-
vene with students having attention-deficit hyperactivity disorder. In addition, a great deal has
been learned about how to identify students who have depression or fears and related anxiet-
ies and to use data-based methods to successfully reduce the frequency and intensity of these
behavioral challenges. The EBI literature is even clarifying now the most successful classroom
methods for working with students who are disruptive in the classroom.
Why does it seem that so much progress has been made in the past 25 years when, in fact,
students with learning and behavioral challenges have been enrolled in public school settings for
at least the past 100 years? In truth, progress has been made by the many dedicated, creative, and
competent researchers throughout the last century. The gains that we have seen over the past 25
years have resulted from building upon the work of earlier researchers and advancing their initial
findings even farther. One can easily think of many of the early pioneers and spokespeople in the
field of learning disabilities, including: Samuel Orton, Grace Fernald, Newell Kephart, Samuel
Kirk, Marianne Frostig, William Cruickshank, Janet Lerner, Helmer Myklebust, and Doris John-
son, to name a few.
One can reflect upon the insights and dedication of Lightner Witmer who established the
first psychological clinic in the United States in 1896 at the University of Pennsylvania. His first
case involved a 14-year-old boy who had difficulty learning and was a “chronic bad speller”
(Witmer, 1907/1996, p. 249). Similarly, James Hinshelwood (1902), a Scottish ophthalmolo-
gist, made many pertinent observations regarding children with severe reading disabilities. From
his intensive, systematic case study observations, he concluded that: (a) particular areas of the
brain appear to be involved; (b) the children often have average or above intelligence and good
memory in other respects; (c) the problem with reading is localized, not generalized to all areas of
academic performance; (d) the children do not learn to read with the same rapidity as other chil-
dren; (e) the earlier the problem is identified, the better so as not to waste valuable instructional
time; (f) the children must be taught by special methods adapted to help them overcome their
difficulties; and, (g) persistent and persevering attempts will often help these children improve
their reading.
Others attempted to establish successful remedial reading programs within the public schools.
For example, in 1937, at the request of the U.S. Congress, Monroe and Backus established reme-
dial reading programs in the Washington, D.C. Public Schools at the elementary, middle school,
and high school levels. They summarized their results in a monograph entitled Remedial Read-
ing: A Monograph in Character Education, noting the connection between the ability to read and
the development of character. They observed that many teachers were familiar with the general
techniques of teaching reading, but were inadequately prepared to diagnose and deal with the
difficulties of individual students. They recommended that programs would be most successful if
they adhered to the following general principles: (a) the remedial work was most effective when
 1. INTRODUCTION AND HISTORICAL PERSPECTIVES 5

given individually, but small group instruction was possible if attention was paid to each child;
(b) the teaching needed to be systematic with instruction provided daily; (c) interesting reading
materials were needed that matched the level of the child’s reading ability; and, (d) teachers must
receive specific training regarding the most effective ways to help these children. All of these
tenets are still applicable today.
Several decades later Samuel Kirk coined the term “learning disability” and helped us un-
derstand the various origins of this disability. In an interview, Kirk explained: “I like to define a
learning disability as a psychological or neurological impediment to the development of adequate
perceptual or communicative behavior which first, is manifested in discrepancies among specific
behaviors…” (Arena, 1978, p. 617). He further indicated on several occasions that many people
have unfortunately confused learning disabilities with nearly every type of learning problem
(Kirk, 1978; 1984). Through years of study by hundreds and hundreds of researchers, our un-
derstanding has increased regarding the prevalence and nature of learning disabilities, the most
efficacious methods for assessment and diagnosis, and the most robust procedures for addressing
and treating these problems.
Similarly, in the area of behavioral and emotional disturbances, many early psychoanalyti-
cally- and psychodynamically-oriented individuals come readily to mind—examples include
Sigmund Freud and his daughter Anna Freud, Melanie Klein, Harry Stack Sullivan, Karen Hor-
ney, and Bruno Bettleheim. These mental health professionals emphasized the critical impor-
tance of early childhood experiences on the development of later emotional disorders. They also
contributed directly or indirectly in assisting professionals in schools and clinical settings to
formulate treatment plans to reduce emotional and behavioral problems. Others to acknowledge
include Alfred Adler, Frederick Allen, and Carl Rogers whose theoretical writings and therapeu-
tic approaches had a large impact on our understanding of the etiology of children’s emotional
and behavioral disorders, as well as on the types of classroom interventions that were effective
for altering behavior. (See Morris, Li, Lizardi-Sanchez, and Morris, 2002, for a more complete
discussion of these early theorists.)
One must also acknowledge the creativity and genius of B.F. Skinner (1938) and his work
with laboratory rats and pigeons. Skinner demonstrated that behavior was predictable under cer-
tain environmental conditions and that animals could learn based on various contingencies of re-
inforcement. Skinner (1953) and his students and colleagues such as Joel Greenspoon, Frederick
Kanfer, Fred Keller, Charles Ferster, and Nathan Azrin, also showed how his work with labora-
tory animals could be applied directly to human behavior. Others, such as Bijou and Baer (1965),
applied Skinner’s concepts to understanding child development, while Lovaas and his colleagues
(e.g., Lovaas, 1977; Lovaas, Berberich, Perloff, & Schaeffer, 1966) applied Skinner’s methods
to teaching speech to children having autism and reducing severe self-injurious behaviors in
children with serious developmental disorders. Other early researchers whose work with children
and youth was influenced by Skinner included Ogden Lindsley, Lee Meyerson, Wesley Becker,
Montrose Wolf, and Todd Risley.
The work of Lovaas and his colleagues was also built in part upon the earlier writings of
Leo Kanner who, in 1943, described the symptoms of 11 cases of “autistic disturbances of affec-
tive contact.” These descriptions began to direct the attention of scholars like Lovaas to studying
children who may have previously been erroneously labeled as having schizophrenia or mental
retardation.
One also can appreciate the creativity and insights of Albert Bandura (1969). Bandura for-
mulated a theory of modeling and explained how such imitation learning contributed to the de-
velopment (and successful remediation) of a variety of behavioral challenges in children. Time
and years of laboratory research were also needed in the areas of children’s cognitive learning
6 MORRIS AND MATHER

and memory processes before researchers, such as Don Deshler and his colleagues, could begin
to develop intervention strategies for successfully addressing a variety of children’s learning and
behavioral challenges. These are just a few examples of the foundational research that has helped
establish the framework for the multitude of findings over the past 25 years regarding EBIs for
children with learning and behavioral problems.
Progress in the area of EBIs could not, however, have taken place if students with disabili-
ties were not enrolled in public schools. That is, without the early public policy research and
advocacy work by such giants in special education as Samuel Kirk (e.g., Kirk, 1984), Burton
Blatt (e.g., Blatt, 1968, 1970; Blatt & Kaplan, 1966), and Wolf Wolfensberger (1972), as well as
the thoughtful writings of the anthropologist Robert Edgerton (1964), the political lobbying of
several key U.S. senators and representatives, and the advocacy work of many professional as-
sociations and parent organizations, the U.S. Congress may have never passed the Education for
All Handicapped Children Act (PL 94-142, 1975)—the first such federal law that guaranteed all
children with disabilities an equal and free education regardless of the nature and severity of their
disability. Given this legislation, as well as the brilliant work of earlier scholars and researchers in
both special education and psychology, much progress has been made in the educational services
available to children having learning and behavioral challenges.
Some critics, however, might say that such progress is limited only to the confines of aca-
demic research journals and scholarly textbooks; that real progress has not yet been demonstrated
in classroom settings; that teachers do not use these methods because they have no supervised
training in how to implement them or do not have the time. Although this may be true in some
special education classrooms in some school districts, it is our firm belief that as more and more
teachers are educated about EBIs—and receive supervised training in the application of EBIs—
the chances of improved services for all children will increase.
The chapter authors of this book, experts all, many of whom were mentored by the leaders
of the past, have been encouraged to sample widely from the empirical research literature and to
discuss only those methods that are data-based and have been shown on a repeated basis to be
effective in successfully addressing a particular behavioral or learning challenge. For some areas,
however, the empirical literature is still not well established. When this is the case, the authors
describe the current state of empirical knowledge and suggest additional areas for future research
and scientific inquiry.
This book contains descriptions of many research-based strategies and teaching methods
that can be used to work successfully with children having learning and/or behavioral challenges.
Although the evidence-based practices described can help all teachers meet the challenges of
improving educational outcomes for all children, simple solutions do not exist; all classrooms are
complex interactive environments that also are affected by the diverse characteristics, tempera-
ments, and personalities of both the students and the teachers. People in schools are embedded
in complex and changing networks of social interaction (Berliner, 2002; Odom et al., 2005). Al-
though scientific knowledge is certainly important, we cannot forget Berliner’s (2002) point that
“We should never lose sight of the fact that children and teachers in classrooms are conscious,
sentient, and purposive human beings, so no scientific explanation of human behavior could ever
be complete” (p. 20). Because of its complexity, special education “…may be the hardest of the
hardest-to-do science” (Odom et al., 2005, p. 139).
Despite the fact that special education research is hard to do because of the complexity and
variability of the participants and settings, the chapter authors have all done an admirable job of
presenting the current status of evidence-based knowledge within their areas of expertise. Each
and every EBI discussed in this book must be implemented by competent, caring professionals.
As Kauffman (2005) states, “Effective and humane education of students with disabilities has al-
 1. INTRODUCTION AND HISTORICAL PERSPECTIVES 7

ways depended on the individual actions of competent, caring teachers and other individuals, and
this will be the case in the future regardless of legal mandates and prohibitions” (p. 446). Simi-
larly, the child psychotherapy literature has repeatedly indicated that the therapeutic relationship
is an important contributing factor to the successful implementation of child therapy procedures
(see for example, Kendall & Morris, 1991; Morris & Nicholson, 1993). Although this uniquely
human element cannot be easily measured, it is an essential component of effective instruction
and therapy.
Although much progress has been made in the past 25 years, we look forward to the next 25
years of educational research. This new research will further clarify and enhance our knowledge
about the most effective ways to intervene successfully with students. Because of the changes
in IDEA 2004, the focus has shifted to measuring and ensuring children’s Response to Interven-
tion (RTI). Perhaps, the acronym of RTI should have an additional meaning: All children have
the Right To Intervention (RTI). Currently, we know a lot about evidence-based instruction for
students who struggle with aspects of learning or behavior but the challenge remains for special
educators, school psychologists, and administrators to ensure that all children receive the best of
what we know.

REFERENCES

Arena, J. (1978). An interview with Samuel Kirk. Academic Therapy, 13, 617–620.
Bandura, A. (1969). Principles of behavior modification. New York: Holt, Rinehart and Winston.
Berliner, D. C. (2002). Educational research: The hardest science of all. Educational Researcher, 31(8),
18–20.
Bijou, S. W., & Baer, D. M (1965). Child development II: Universal stage of infancy. New York: Appelton-
Century-Crofts.
Blatt, B. (1968). The dark side of the mirror. Mental Retardation, 1, 42–44.
Blatt, B. (1970). Exodus from pandemonium: Human abuse and a reformation of public policy. Boston:
Allyn and Bacon.
Blatt, B., & Kaplan, F. (1966). Christmas in purgatory: A photographic essay on mental retardation. Bos-
ton: Allyn and Bacon.
Edgerton, R. B. (1967). The cloak of competence: Stigma in the lives of the mentally retarded. Berkeley:
University of California Press.
Feuer, M. J., Towne, L., & Shavelson, R. J. (2002). Scientific culture and educational research. Educational
Researcher, 31(8), 4–14.
Hinshelwood, J. (1902). Congenital word-blindness with reports of two cases. London: John Bale, Sons &
Danielsson, Ltd.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.
Kendall, P., & Morris, R. J. (1991). Child therapy: Issues and recommendations. Journal of Consulting and
Clinical Psychology, 59, 777–784.
Kirk, S. A. (1984). Introspection and prophecy. In B. Blatt & R.J. Morris (Eds.), Perspectives in special
education: Personal orientations (pp. 25–55). Glenview, IL: Scott Foresman.
Lovaas, I. O. (1977). The autistic child: Language development through behavior modification. Baltimore,
MD: University Park Press.
Lovaas, I. O., Berberich, J. P., Perloff, B. F., & Schaeffer, B. (1966). Acquisition of imitative speech by
schizophrenic children. Science, 151, 705-707.
Monroe, M., & Backus, B. (1937). Remedial reading: A monograph in character education. Boston:
Houghton Mifflin.
Morris, R. J., & Nicholson, J. (1993). The therapeutic relationship in child psychotherapy. In T. R.
Kratochwill & R. J. Morris (Eds.), Handbook of psychotherapy with children and adolescents (pp.
405–426). Boston: Allyn & Bacon.
8 MORRIS AND MATHER

Morris, R .J., Li, Huijun, Lizardi-Sanchez, P., & Morris, Y. P. (2002). Psychotherapy with children and
adolescents. In I. Weiner (Ed.), Comprehensive handbook of psychology: Clinical psychology (pp.
389–405). New York: Wiley.
Odom, S. L., Brantlinger, E., Gersten, R., Horner, R. H., Thompson, B., & Harris, K. R. (2005). Research
in special education: Scientific methods and evidence-based practices. Exceptional Children, 71, 137–
148.
Skinner, B. F. (1938). The behavior of organisms. New York: Appleton-Century-Crofts.
Skinner, B. F. (1953). Science and human behavior. New York: MacMillan.
Witmer, L. (1907/1996). Clinical psychology. American Psychologist, 51, 248–251.
Wolfensberger, W. (1972). The principle of normalization in human services. Toronto, Canada: National
Institute on Mental Retardation.
Yell, M. L., Shriner, J. G., & Katsiyannis, A. (2006). Individuals with Disabilities Education Improvement
Act of 2004 and IDEA Regulations of 2006: Implications for educators, administrators, and teacher
trainers. Focus on Exceptional Children, 39(1), 1–24.
 2
Why the Need for Evidence-Based
Interventions?
Jeffery P. Braden and Elisa Steele Shernoff

Given the title and content of this book, it may seem a bit odd to raise the question why evi-
dence-based interventions (EBIs) are needed. After all, if you are reading this book, it implies
that you at least have answered the question posed in the title in the affirmative. Professional
associations, scholarly articles, and even laws and regulations are encouraging or requiring
professionals to use EBIs in their efforts to serve children. Given the current demand and the
content of the other chapters in this book, what is the value of considering EBIs? The answer
is that, by understanding the historical and current context for EBIs, you will be better able to
evaluate the promises and the pitfalls of the EBI movement, and in so doing, be a better EBI
consumer and practitioner. Or, as Santayana put it, “Those who do not remember history are
condemned to repeat it.”
EBIs are an outgrowth of three broad factors: (1) the desire to align professional practices
with the current knowledge base, (2) efforts to enhance students’ welfare while holding steady
or even decreasing costs, and (3) legal and regulatory mandates intended to improve educational
outcomes. Each of these factors is considered in the following sections.

ALIGNMENT OF RESEARCH AND PRACTICE

Although dismay at the lack of alignment between research and practice has been raised many
times within education (e.g., Coalition for Evidence-Based Policy, 2002, 2003; Cook, 2001;
Shavelson & Towne, 2002), the current push toward evidence-based practice (EBP) was first ad-
vanced within the medical profession. Surveys of medical resources found that medical proce-
dures varied substantially by region in ways unrelated to patient needs, and frequently included
treatments whose effectiveness was not clearly demonstrated (see Ginzberg, 1991/1994). This
led to calls from medical associations and elected officials for physicians to use evidence rather
than customary practice, word-of-mouth, or untested treatments in treating patients.
In part in response to this movement, Congress established the Association for Health Care
Policy Research (AHCPR), which is now known as the Agency for Healthcare Research and
Quality (AHRQ). The goal of this entity was to create panels of knowledgeable physicians and

9
10 BRADEN AND SHERNOFF

researchers to review medical research regarding treatments for given diagnoses, called Patient
Outcome Research Teams, or PORT, studies. The goal of these studies was to identify, based
on scientific research, what treatments worked for the diagnosis—and by implication, identify
treatments that either did not work or for which there was insufficient evidence to make a de-
cision regarding their efficacy. The panels typically produced a report for physicians to guide
practice, and a report for patients to help them become better consumers of medial services.
The outcomes of these panel reviews are posted on the AHCRQ Web site, which is included in
Table 2.2.
The EBP movement quickly spread to psychology, in part because many psychologists
practice in medical settings, and in part because psychology has long embraced the “scientist-
practitioner” model of training and practice (Drabick & Goldfried, 2002). Divisions within the
American Psychological Association (APA) convened panels of scientists and practitioners to
set standards to identify forms of evidence to be used to evaluate the quality of the evidence sup-
porting a particular intervention. Most relevant to this book are the standards that were devel-
oped by a joint task force of the Society for the Study of School Psychology and APA’s Division
16 (School Psychology), which are reviewed in greater detail later in this chapter. Additionally,
APA altered its program accreditation guidelines in 2005 to specify that all psychology train-
ing programs include training in EBIs (Committee on Accreditation, 2005). In short, the late
1990s and early years of the 21st century saw a flurry of activity to identify, and then apply,
standards of evidence to the extant research. This was in an effort to inform both professionals
and consumers of the interventions that did (and did not) work and to improve outcomes for
medical and psychological problems. Similar efforts were made in education, including special
education, as described in an issue of Exceptional Children (2005, Vol. 71–2) and reviewed later
in this chapter.

ENHANCING STUDENT WELFARE AND EFFICIENCY

Social pressures from outside professional associations also contributed to the growth of the
EBP movement. Specifically, two forces coincided to support EBP. The first was the drive to
ensure that people were informed consumers of health and psychological services. The argu-
ment was that informed consumers would be better than uniformed consumers when consid-
ering treatment options in ways that balanced research, their own circumstances, and their
preferences and values (Ginzberg, 1991/1993). Advocates for consumers of health and psy-
chological services therefore embraced and supported the EBP movement as a step toward
empowering consumers by giving them knowledge to make choices that maximized personal
goals and values.
The second force encouraging the EBP movement came from third-party payers for ser-
vices. Because most individuals do not pay their entire health care costs out of pocket, state
and federal government programs and insurance companies subsidize the bulk of funds spent
each year on health and psychological services. These entities have a strong fiscal incentive to
reduce expenditures, particularly when funds are expended on services with unknown or de-
monstrably ineffective outcomes. By having an independent means to decide which services to
fund, and not to fund, third-party payers could hold down costs while enhancing outcomes. In
the fields of education and school psychology, evidence-based practices also have the potential
to propel research forward and eventually improve the quality of services provided by teachers,
school psychologists, school counselors, and other educational professionals.
 2. WHY THE NEED FOR EVIDENCE-BASED INTERVENTIONS? 11

LEGAL AND REGULATORY MANDATES

Congress has expanded the EBP movement through legislation and regulation, first in health
care (which includes psychology), and then in education. As previously noted, Congress boosted
EBP by creating the Association for Health Care Policy Research. The results produced by the
AHCPR, and its successor agency, the Agency for Healthcare Research and Quality, are used by
government health programs (e.g., MEDICARE, MEDICAID) and many insurers to determine
which procedures will (and will not) be funded by third party payers.
Congress also embraced principles of EBP in passing education legislation. The No Child
Left Behind Act (NCLB) of 2001 and the Individuals with Disabilities Education Improvement
Act of 2004 (IDEIA 2004) dramatically increased accountability demands for general and special
education, outlining elaborate and extensive expectations for student performance, and including
significant sanctions for failure to meet the ambitious targets in the legislation. Along with set-
ting demands, NCLB and IDEIA 2004 explicitly direct schools to adopt EBPs so that they can
improve student performance and meet their goals. For example, the IDEIA 2004 directs schools
to use “scientifically based” methods of instruction, and allows local education agencies to di-
agnose learning disabilities in part on the basis of the student’s response to “scientific, research
based interventions.”
Additionally, legislation and regulations directed resources to develop, identify, and dissemi-
nate EBPs to educators. The Coalition for Evidenced Based Policy (2002, 2003) was funded to
provide guidelines for evaluating evidence from educational research. The What Works Clearing-
house (WWC) was also created to serve a role similar to the AHRQ; that is, to develop standards
for evidence, and then review, identify, and publicly disseminate information about educational
interventions that meet those standards. These efforts, along with legal mandates for schools to
use scientifically based practices, clearly signaled the belief of the federal government that EBP
would improve educational outcomes, and largely provide the mechanism whereby schools could
meet ambitious goals for student outcomes each year.
Consequently, pressures internal to professions coupled with the interests of consumer ad-
vocacy groups, third-party payers, and legislation encouraged the development of EBP, first in
medicine, then in education. The burgeoning of interest in and response to EBP has increased
dramatically over the past decade, and has even been incorporated as a training requirement in
professional psychology programs. Therefore, EBP is a compelling framework for conceptual-
izing training and practice in psychology and education.

DEFINING EVIDENCE-BASED PRACTICE

Although the EBP movement has grown in the past several decades, the terminology related to
EBP has not always been well understood or agreed upon. The lack of consensus regarding key
terminology is due to complexities related to formalizing criteria, and the broader issues and con-
troversies related to dictating a scientific approach to practice (Chorpita, 2003; Elliott, 1998).
One of the first terms proposed for the EBP movement in psychology was “empirically
validated interventions,” first used by the American Psychological Association Division 12 Task
Force (1995) to describe interventions that were evaluated using acceptable methods of science
and proven to be effective (Kendall, 1998). The term “empirically validated” created a firestorm
of debate and criticism within psychology, because the term suggested that an intervention could
be fully validated, with no further evaluation needed. However, in principle, an intervention can
12 BRADEN AND SHERNOFF

never be fully validated because it cannot produce success under all circumstances. Moreover, the
term “validated” also suggested that the mechanisms of effectiveness and change were known,
a condition that rarely exists for child or adult interventions (Garfield, 1996; Lonigan, Elbert, &
Bennett-Johnson, 1998; Stoiber & Kratochwill, 2000).
The term “empirically validated” was quickly replaced by “empirically supported,” which
implies that practices are never fully validated, but instead have support along a continuum of
scientific credibility (Shernoff & Kratochwill, 2005). Empirically supported interventions were
identified based on methodological features of the studies evaluating the intervention, and sta-
tistical support for intervention outcomes. The term “empirically supported” also connoted that
reviewing evidence is an ongoing process that is subject to change, based on future empirical
analysis of interventions (Kendall, 2002; Kratochwill & Stoiber, 2002).
Moving beyond specific interventions or procedures, the term evidence-based practice has
been described as a “movement” within the fields of education, psychology, and mental health in
which there has been an organized effort to identify, disseminate, and promote the use of prac-
tices with demonstrated efficacy and effectiveness (Hoagwood, 2005). Evidence-based practice
is a shorthand term denoting the quality, robustness, or validity of scientific evidence as it is
brought to bear on decisions regarding the adoption, implementation, and evaluation of services
(Cournoyer & Powers, 2002; Kratochwill & Shernoff, 2003). Although evidence is an elusive
concept, it is clear that the EBP movement embraces evidence that is empirical.
Evidence-based practices are distinct from empirically validated and empirically supported
interventions in several domains. First and foremost, evidence-based practices rest on a coher-
ent body of scientific knowledge relevant to a range of educational and clinical practices. These
practices are based on prior empirical findings showing that certain actions performed by prac-
titioners with a particular individual or system are “likely to produce predictable, beneficial,
and effective results” (Cournoyer & Powers, 2002, p. 800). Second, evidence-based practice,
in contrast to empirically validated and empirically supported interventions, integrate practitio-
ner expertise and values with the best research evidence available (Sackett, Straus, Richardson,
Rosenberg, & Haynes, 2000). This distinction is important because it places responsibility on
the educator/practitioner to provide high quality intervention practices as it emphasizes inte-
grating, rather than replacing, professional expertise and judgment with best available evidence
(Frederickson, 2002). Evidence-based practices are also systematically evaluated to assess the
degree to which the predicted results were attained as a direct consequence of the educator’s or
practitioner’s behaviors (Cournoyer & Powers, 2002). This emphasis on evaluating practice is
crucial, given that many educational and mental health interventions used in schools are limited
in terms of their research base, particularly with respect to the contextual factors that influence
their application in educational settings.

KEY CONCEPTS IN EVIDENCE-BASED PRACTICE:

METHODS OF INQUIRY AND HIERARCHIES OF EVIDENCE

A critical conceptual issue within the evidence-based practice movement focuses on the methods
of inquiry and legitimate sources of knowledge used to evaluate educational interventions, pre-
vention programs, and school-based mental health services. The evidence in support of an inter-
vention is often dictated by the specific conceptual questions of interest. These include questions
related to: (a) Efficacy (i.e., Is Intervention A superior to Intervention B?); (b) Effectiveness (i.e.,
Will the intervention work across different settings?); (c) Implementation (i.e., What training and
supervision is required to implement this intervention with integrity?); (d) Acceptability (i.e., Is
 2. WHY THE NEED FOR EVIDENCE-BASED INTERVENTIONS? 13

this practice more or less acceptable than established practices?); and (e) Cost-effectiveness (i.e.,
What is the relative cost for producing outcomes using this intervention compared to existing
practice?).

Efficacy

Most of the early evidence amassed for evidence-based practices emerged in the context of effi-
cacy trials, defined as systematic evaluations directed at (1) comparing one or more interventions
with one or more control or comparison conditions, and (2) establishing whether a particular
intervention is beneficial (e.g., improves functioning, reduces symptoms). Above all, efficacy
studies are concerned with replication so that researchers can conduct similar studies to test
the impact of an intervention (Kazdin, 2004). To maximize the likelihood of detecting treat-
ment effects, efficacy trials are usually conducted under carefully controlled conditions. Factors
that may obscure treatment effects are eliminated or controlled, including the setting in which
the intervention takes place, sample selection, and how the intervention is delivered (Nathan,
Stuart, & Dolan, 2000; Weisz & Jensen, 1999). Efficacy studies are usually conducted in uni-
versity settings or clinical research facilities using well-designed and precise methodology, usu-
ally meaning randomized controlled trials (RCTs) in which participants are randomly assigned
to conditions (Fonagy, Target, Cottrell, Phillips, & Kurtz, 2002). Efficacy studies often include
research participants who are carefully screened and selected to maximize the homogeneity of
the sample, and to increase the link between specific interventions and diagnostic classifica-
tions or disabilities. Interventions are manualized, brief, and have a fixed duration to minimize
within-group variability (Westen, Novotny, & Thompson-Brenner, 2004). Manualized interven-
tions, which are discussed in greater detail later in the chapter, specify the theory and techniques
of a treatment in written form with the goal of standardizing intervention implementation and
training. Practitioners are also rigorously trained, supervision is intensive, and there is a strong
emphasis on ensuring that the intended intervention (no more, no less) is provided in efficacy
studies (Nathan et al., 2000).
These features of efficacy research help maximize the internal validity of the studies or the
extent to which the independent variable (in the context of efficacy studies, the intervention)
causes any observed differences in the dependent variable (i.e., measures of student outcomes).
The conceptual relationship between efficacy, effectiveness, and transportability research is rep-
resented in Figure 2.1. The poles represent the degree to which internal or external validity is
the focus of the study. Although most studies are not purely constructed along these dimensions,
efficacy and effectiveness research have often been regarded as being at opposite ends of the in-
ternal-external validity continuum. Typically, efficacy studies are designed to maximize internal
validity but usually sacrifice external validity (i.e., generalization of results beyond the observed
study) (see Figure 2.1).
Results from broad-based meta-analyses of efficacy trials paint an optimistic picture of the
number of interventions shown to be effective. Casey and Berman (1985) conducted one of the
first broad-based meta-analyses, in which 75 outcome studies from 1952 to 1983 were examined
with children ages 12 and younger. They found that the average treated child scored better on
outcome measures than 76% of the control group children. Meta-analytic studies specific to
school-based interventions have also established a large body of behavioral and educational in-
terventions as efficacious. Stage and Quiroz (1997), for example, conducted a meta-analysis of
interventions for decreasing disruptive classroom behavior in public schools and found that on
average, 78% of the students exposed to the interventions reviewed had reductions in disruptive
behavior when compared to learners in control groups.
14 BRADEN AND SHERNOFF

Efficacy Research Effectiveness & Transportability

Internal Validity Maximized Research
External Validity Maximized

Goal: Goal:
Replication Generalization

FIGURE 2.1 Conceptual model of the relationship between efficacy and effectiveness research.

Despite compelling evidence for the efficacy of various interventions to address common
problems that emerge in school-aged children, controversies exist regarding the hierarchy of
evidence needed to establish an intervention as effective. For example, there has been an implicit
assumption within the EBP enterprise that efficacy studies and RCTs provide the only valid
source of evidence to support an intervention (Roth & Fonagy, 1996). Although RCTs and their
logical counterparts are considered the standard for drawing causal inferences about the impact
of an intervention, RCTs have also been criticized for their limited generalizability, higher costs
associated with training and intervention delivery, and failure to attend to the real world exigen-
cies related to implementing interventions (Carroll & Rounsaville, 2003; Lonigan et al., 1998).
Given that there is compelling evidence to suggest that intervention effects previously supported
in efficacy trials do not consistently hold under conditions of actual practice, efficacy trials are
not the design of choice for all intervention outcome studies.

Effectiveness

Effectiveness studies, in contrast to efficacy studies, are conducted under conditions that reflect
typical practice settings, such as homes, schools, and community mental health agencies (Drake,
Latimer, Leff, McHugo, & Burns, 2004). Effectiveness research aims to determine whether in-
terventions are feasible and have measurable benefits across broad populations (Nathan et al.,
2000). Effectiveness studies help answer the question “Do intervention effects generalize to the
real world?” with a premium placed on external validity (see Figure 2.1). In effectiveness re-
search, participants are in need of immediate intervention regardless of the problem, families do
not always seek out services voluntarily, and referral problems are usually more severe and com-
plex (Weisz, Donenberg, Han, & Weiss, 1995).Variables such as differential attrition and lack of
random assignment to intervention conditions are common in effectiveness research (Hoagwood,
Hibbs, Brent, & Jensen, 1995; Merrill, Tolbert, & Wade, 2003), and practitioners or educators
are not always specifically trained in a research protocol or target intervention. In effectiveness
research, outcome measures are often broadly defined and often focus on socially valid outcomes,
including improvements in quality of life, functioning, or changes in disability status, rather than
the scientifically precise (but sometimes less meaningful) measures employed in efficacy research.
Effectiveness research embraces extraneous variables, or error variance, that efficacy studies at-
tempt to control. Such messy, “real world” factors are essential to understanding if implementation
of an intervention is feasible, effective, and sustainable.
Some promising early stage effectiveness studies include cognitive-behavioral therapy (CBT)
implemented in a school for adolescents struggling with depression (Lewinsohn, Clark, Hops, &
Andrews, 1990), cognitive therapy to treat depression in community mental health centers (Mer-
rill et al., 2003), and cognitive-behavioral treatment of outpatient children with ADHD (Fehlings,
Roberts, Humphries, & Dawe, 1991). An ambitious project was also recently undertaken by the
State of Hawaii with the goal of moving from identifying promising interventions in efficacy
 2. WHY THE NEED FOR EVIDENCE-BASED INTERVENTIONS? 15

trials to evaluating the likelihood that such interventions could be successfully applied in educa-
tional settings. The Hawaii Project was groundbreaking in its approach to balancing feasibility
with high quality research and including key stakeholders (e.g., clinicians, parents) in the process
of evaluating evidence-based practices (Chorpita et al., 2002). Despite the significant contribu-
tions that the Hawaii Project made to understanding effectiveness, the project also underscored
that incontrast to the evidence supporting the efficacy of child and adolescent psychosocial and
academic interventions, evidence of effectiveness is quite limited (Chorpita et al., 2002; Hogan,
2002; Weisz & Jensen, 1999).

Transportability

In addition to longstanding concerns regarding the degree to which intervention effects are rep-
licated in applied settings, researchers across many disciplines have long struggled with the
complexities involved in wide-scale dissemination of prevention and intervention programs and
the broader organizational and training issues that mitigate the movement of EBIs into practice
settings (Blakely et al., 1987; Davidson & Redner, 1988; Hoagwood, Burns, Kiser, Ringeisen,
& Schoenwald, 2001; Schoenwald & Hoagwood, 2001). Transportability research is a type of
effectiveness research (see Figure 2.1) that focuses on understanding how the intervention works
in the real world and who can (or will) conduct the intervention, under what conditions, and to
what effect (Schoenwald & Hoagwood, 2001). Transportability research takes into account the
contextual variables (e.g., time, training and supervision requirements, and institutional support
for EBIs, sustainability of an intervention after investigator support is withdrawn) that mitigate
the movement of EBIs into practice settings (Shernoff & Kratochwill, in press). These contex-
tual variables are linked to practitioners’ inability to implement EBI protocols in mental health
settings (Miller, 2001; Schmidt & Taylor, 2002; Simpson, 2002); unfortunately, well-controlled
studies examining the transportability of EBIs to schools have been more limited to date (Storch
& Crisp, 2004).
Despite limited research regarding the transportability of EBIs to practice settings, there has
been some pioneering work with Multisystemic Treatment (MST) for adolescents with conduct
disorders (Henggeler, Melton, Brondino, Scherer, & Hanley, 1997; Henggeler, Schoenwald, Liao,
Letourneau, & Edwards, 2002; Schoenwald, Henggeler, Brondino, & Rowland, 2000).The suc-
cessful transportability of MST to community settings has been attributed to several characteristics
that differentiate the model from other EBIs. These include focussing on the multiple determiants
of antisocial behavior adherance to principles for implementing the intervention rather than using
highly specified treatment manual, and using supervision as a mechanism for enhancing fidelity
and corresponding treatment outcomes.

Additional Methods of Inquiry and Hierarchies of Evidence

Even when strong evidence is available from efficacy, effectiveness, and transportability research,
other designs and strategies make important contributions to the knowledge base regarding
evidence-based practices. For example, if the goal of the study is to understand research par-
ticipants’ subjective experience with a particular intervention, or the acceptability of specific
practices, or how an intervention can be changed to maximize its usefulness, qualitative meth-
ods, including semi-structured interviews, may be the best research approach (APA Presidential
Task Force on Evidence-Based Practice, 2006; Fredrickson, 2002). Systematic case studies, often
involving intensive, longitudinal analyses of an individual, can also be useful for generating hy-
potheses for future well-controlled studies (Levin, O’Donnell, & Kratochwill, 2003). Single case
16 BRADEN AND SHERNOFF

design strategies have only recently been seriously considered to establish the scientific rigor of
educational practices. These strategies offer a high degree of scientific rigor, and also allow for
causal interferences to be made regarding behavior changes within individuals. Clearly, differ-
ent approaches provide complementary evidence regarding effectiveness, and an integral part
of the EBP movement requires educators to recognize the strengths and limitations of evidence
obtained from different types of research.

EXAMPLES OF EVIDENCE-BASED PRACTICE STANDARDS

In this section, we will review the key criteria that distinguish evidence-based practices (or in-
terventions) from practices or interventions that lack evidence. We begin by reviewing criteria
common to most definitions, and then share some selected criteria to illustrate commonalities and
differences among various definitions of EBP and EBIs.

Elements for Evaluating Evidence

Six key elements are typically applied to decide whether an intervention can be identified as evi-
dence-based. These are listed in Table 2.1 along with the questions each element addresses. An
expanded discussion is provided in the following sections. Although these elements are, in some
shape or form, common to most definitions of EBIs, they are not used the same way by different
entities defining EBP and EBIs. For example, although all definitions attempt to define a particu-
lar practice or intervention as responding to a particular problem or set of problems, different
definitions do so in different ways. Therefore, the following elements attempt to define common
dimensions used across EBI definitions, but do not imply unanimity of agreement regarding how
to apply these elements in defining EBP and EBIs.
Specificity of problem and population. Standards for identifying EBIs are conditional, in that
they are usually limited to particular problems and populations. That is, interventions are not in
and of themselves judged to be “evidence based;” rather, they are judged to be “evidence based”

TABLE 2.1
Key Criteria for Establishing Evidence-Based Interventions

Criterion Key questions to be addressed

Specificity of the intervention target What problem does the intervention target? In whom does the problem
population occur?
Specificity of the intervention What is the nature of the intervention? What are the steps and required
resources, and are these clearly explained in writing (e.g., a treatment
manual)?
Research design Does the research employ random assignment of participants to conditions
(or conditions to a single participant)? Is the intervention compared to a
previously established treatment?
Ability to detect effects or outcomes Does the study have sufficient power to detect an effect? Does the study use
reliable and valid outcome measures?
Number and independence of studies Are the intervention effects replicated? Are the replications truly independent
needed to support the intervention investigations?
The quality of evidence What classification does the reviewed evidence merit with respect to its
overall strength and quality?
 2. WHY THE NEED FOR EVIDENCE-BASED INTERVENTIONS? 17

for a particular problem and within a particular population of children and youth. The most
common approach used in medicine, psychology, and education is to define problems via diag-
nostic classifications, and define populations primarily by the age (or grade level) of the student
(although ethnicity and gender are also often used). Just as drug efficacy studies limit claims of
efficacy by problem and child’s age (e.g., a particular drug is good for a particular problem within
adults, but has not been tested in children), so too do EBP/EBI standards delimit the claims of
efficacy to the nature of the problem and the age (or grade) of the student.
Specificity of intervention. For an intervention to be considered evidence-based, it must be
defined with sufficient precision so that it can be reliably replicated. One common method for
meeting this standard is for there to be a treatment manual that clearly specifies the steps in the
intervention process, and what to do at each step. This requirement is sometimes expressed as
requiring an intervention to be “manualized.” Typical requirements for explicitness include exact
statements and directions, as well as principles of responding to unanticipated outcomes and cir-
cumstances. The criteria should be sufficiently objective and precise to allow different people to
produce the same set of behaviors by following the directions in the manual.
Research design. Most criteria specify that the intervention must be found effective in
studies using “true” experimental designs. Experimental designs are distinguished from quasi-
experimental or pseudo-experimental designs primarily on the basis of random assignment to
treatment and control groups (Cook, 2001). Standards typically demand at least two studies
using experimental group designs, or a series of single case studies using randomized applica-
tion of at least two interventions (i.e., the intervention under study and a comparison condi-
tion). Most criteria also demand that the experimental design include an alternate intervention
in the control condition. Two types of alternatives are identified: first, an intervention that is
already established as an EBI (so that the intervention under study can be demonstrated to be
equal to or better than the EBI alternative), and second, the equivalent of a psychological or
educational placebo intervention condition. Because education is offered to all children, it is
inappropriate to test whether a particular intervention is better than no intervention at all (e.g.,
finding that a particular reading intervention works better than no intervention is hardly illu-
minating). These features (i.e., random assignment and alternate treatment control condition)
apply to group designs, in which individuals are assigned to an intervention or alternate group,
and to single-case (or N = 1) designs, in which the intervention and the alternate conditions are
repeated within an individual to demonstrate the superiority of the intervention to the alternate
condition.
Ability to detect effects or outcomes. Most statistical and experimental procedures were
developed to reduce the chances of accidentally or erroneously finding a difference between the
intervention and alternate treatment conditions. However, there is a complementary problem:
failing to find a difference when one exists. The ability of a research design to detect an effect
is known as “power.” Increasing the sample size of a study is the most direct way to increase
power, although using measures with little error also increases the sensitivity of the research
to detect actual differences between conditions. Most studies with small samples (e.g., five or
ten participants), or with weak outcome measures would fail to find a difference between a new
intervention and an established EBI, simply because it lacked the power to detect existing differ-
ences. Therefore, most standards for evidence require that the study have sufficient sample size
(or more precisely, power) and use reliable, objective measures of outcomes, to detect a differ-
ence between the conditions.
Number and independence of research studies needed to support the intervention. Eviden-
tial standards require independent replication of findings before accepting an intervention as
18 BRADEN AND SHERNOFF

evidence based. The number of replications varies for single case and group designs. Standards
require a large number of N = 1 designs to establish an intervention as evidence-based, whereas
the minimum number of group designs is typically two. A second feature of replication is that at
least two of the sources of evidence be independent from each other. That is, different investiga-
tors or teams who are autonomous must report the same finding (e.g., an experimental group
study or a series of N = 1 studies) for the intervention to be accepted as evidence-based. Repli-
cations by individuals in the same lab, or replications by graduate students or employees of an
individual do not count toward the independent replication requirement.
Quality of evidence. Finally, when all of the evidence is reviewed, most standards rate the
quality of evidence into three categories. These categories typically include a designation for
evidence meeting or exceeding the standards, such as “Established,” “Empirically Validated,” or
“Evidence-Based.” Likewise, there is typically a designation for interventions that lack most or
all of the evidence required by the standards, such as “Experimental” or “Not Established.” Final-
ly, most standards provide a designation for interventions where the evidence base meets some,
but not all, of the established criteria, such as “Promising” or “Partially Validated.” Examples
of these categories might include interventions in which an independent replication is lacking,
or those interventions tested only against no treatment (rather than alternative intervention or
placebo treatment) conditions. Therefore, to declare an intervention as “Evidence-based” implies
that the evidence supporting the effectiveness of the intervention meets all of the standards for
evidence, whereas those interventions with a less complete body of evidence would be declared
as “promising” or “experimental.” We use the term “EBI” to designate interventions meeting the
standards described in this section, although we recognize that different bodies may define some-
what different criteria to such designations. Therefore, we turn our attention to various standards
for evidence relevant to educators, school psychologists, school counselors and other profession-
als providing services to school-aged populations.

Examples of Evidential Standards

A number of groups have promulgated standards for defining “what counts” as evidence that an
intervention works. These include professional entities (e.g., various practice divisions within
the American Psychological Association, The Council for Exceptional Children), governmental
agencies (e.g., the US Department of Education, the National Institutes of Health), and non-
governmental organizations (e.g., the Coalition for Evidence-based Policy). These initiatives
establish objective, precise criteria for reviewing and coding the empirical status of a range of
interventions and practices. There are some similarities across those organizations develop-
ing practice standards (e.g., the need for operational criteria and transparency of the process).
However, these organizations and initiatives differ along many important conceptual domains,
including the criteria invoked for designating interventions as evidence-based, the literature
reviewed, and the methodologies embraced (Drake et al., 2004). The various standards for EBP
reflect differences in the traditions, values, roles, settings, individuals, and nature of interven-
tions delivered by particular organizations in psychology and education. There is an inherent
appeal in developing guidelines that reflect the ideals and values of particular professions. How-
ever, divergence across various practice guidelines has created challenges to understanding the
“state” of the evidence for evidence-based practices, and complicates conclusions that can be
drawn regarding how to integrate this knowledge base into daily practice. For example, one
organization’s “effective program” can be deemed as “ineffective” by another group. Represen-
tative samples of standards from some of the most relevant entities are reviewed in the following
sections.
 2. WHY THE NEED FOR EVIDENCE-BASED INTERVENTIONS? 19

American Psychological Association. The Task Force of the American Psychological

Association’s (APA) Division 12 (Clinical Psychology) Committee on Science and Practice,
Division 53 (Society of Clinical Child and Adolescent Psychology) Committee for Empirically
Supported Practice, and Interdisciplinary Committee on Evidence-Based Youth Mental Health
Care (1998) was one of the first entities charged with establishing criteria for and designating
effective interventions to treat specific problems. The Task Force disseminated lists of
evidence-based interventions to doctoral and internship programs to influence training, and
incorporated EBP guidelines for accrediting doctoral and internship training programs (Task
Force on Promotion and Dissemination of Psychological Procedures, 1995). The Diagnostic
and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV; American Psychiatric
Association, 1994) was the overriding conceptual framework used to link interventions to
particular problems (i.e., DSM-IV diagnoses), and a high premium was placed on the use of
efficacy research and RCTs to establish interventions as evidence-based. Based on Division 12’s
review of the literature, a list of empirically validated interventions was published for fellow
psychologists and doctoral programs. Division 12 of the APA reviewed the literature further and
recommended that clinicians and students only be trained in empirically validated interventions,
rather than other forms of intervention that lacked “empirical validation” (and were therefore
considered outdated and less essential) (Calhoun, Moras, Pilkonis, & Rehm, 1998). The idea
of creating lists of empirically validated interventions was compelling at the time, spurred
in part by widely disseminated practice guidelines giving priority to pharmacotherapy over
other forms of interventions with respect to addressing children’s emotional and behavioral
problems. Such lists would function in a fashion similar to lists created by the Federal Drug
Administration to identify which drugs are effective for which conditions. Also, a strong ethical
and professional commitment existed to improve outcomes for children and families through
the use of interventions known to be superior to ineffective or inferior interventions, or those
treatments that have not been evaluated.
The Division 12 Task Force also developed one of the first manuals to guide the process
of reviewing the literature and coding intervention outcome studies for children and adoles-
cents. The coding scheme that was developed was categorical in nature, with the highest level
of classification being well-established interventions, which were considered efficacious if they
were shown to be more effective than no treatment, psychological placebo treatment conditions,
or equivalent to established treatments. Well-established interventions must include between-
group design studies replicated by different investigators, or a large series of single-case de-
signs, comparing the intervention to other interventions. In addition, the interventions needed to
be described in manuals, and the sample characteristics in supporting studies had to be clearly
specified (Lonigan et al., 1998). Probably efficacious interventions met some, but not all, of the
criteria for well-established interventions, and were therefore considered promising but in need
of additional evidence.
Although the Division 12 practice standards had a monumental impact on training standards
and practice guidelines developed by other professional organizations in psychology, operation-
alizing criteria and publishing lists of empirically validated practices was highly controversial
(Elliott, 1998; Garfield, 1996; Norcross, 2001). Aside from the concerns regarding the term “em-
pirically validated,” major criticisms were also raised regarding the systematic discounting of
certain classes of research (i.e., research other than RCTs); types of interventions (e.g., non-
behavioral strategies); and clients (e.g., ethnic minorities) (see Elliott, 1998). The dichotomous
coding scheme was seen as a crude estimate of complex interventions, and the rigid reliance
on manuals while ignoring non-specific treatment effects (e.g., therapist skill) was condemned
(Wampold, Lichtenberg, & Waehler, 2002). Because Division 12 standards relied heavily on
20 BRADEN AND SHERNOFF

efficacy (rather than effectiveness) studies, the practice standards and lists of interventions that
evolved were viewed as poorly generalizing from research to practice settings (Kratochwill &
Stoiber, 2002; Wampold, 2001).
The field of school psychology, having a vested interest in developing the knowledge base
regarding evidence-based practices in schools, created the Task Force on Evidence-Based In-
terventions in School Psychology in 1999. This Task Force, sponsored by APA’s Division 16
(School Psychology), the Society for the Study of School Psychology (SSSP), and the National
Association of School Psychologists (NASP), was charged with reviewing and coding preven-
tion and intervention studies for children, youth, and families, and identifying interventions
that have sound research support (Kratochwill & Stoiber, 2002; Stoiber & Kratochwill, 2000).
The goal of the School Psychology Task Force was twofold: first, to synthesize research on the
effectiveness of various educational and mental health programs, and second, to help educators
make informed decisions regarding interventions that can be feasibly integrated into school
settings. This agenda meant disseminating information to key stakeholders regarding the meth-
odological rigor of intervention outcome studies along with the specific contextual barriers
and constraints that make the intervention challenging to implement in schools (Kratochwill &
Shernoff, 2003).
The Division 16 Task Force differs from the Division 12 (clinical psychology) Task Force in
several fundamental ways. First, the Task Force on Evidence-Based Interventions in School Psy-
chology has invoked a dimensional approach to evaluating intervention research. Methodologi-
cal criteria were used to evaluate the type and quality of empirical evidence for intervention and
prevention programs, rather than simply declaring whether the evidence meets minimum criteria
for empirical support. In other words, empirical support was viewed as a matter of degree rather
than an absolute value, placing responsibility on the consumer of the information to weigh the
evidence in support of a particular practice (Kratochwill & Stoiber, 2000b; Levin et al., 2003).
This “consumer reports” approach, linked to a Likert-scale, was intended to help particular audi-
ences understand and apply dimensions of evidence to fit their needs. Key features of an interven-
tion study are rated on a 4-point scale to specify level of evidence (i.e., strong evidence/support,
promising evidence/support, marginal or weak evidence/support, and no evidence/support), focus
on internal and external validity criteria, and other features considered important for school and
field-based implementation. Because a major objective of the Division 16 Task Force is to narrow
the research-practice gap, the coding schema describes the overall methodological quality of the
outcome evaluation in addition to the degree to which evaluation methods correspond to features
of the school environment (Kratochwill & Shernoff, 2003). Studies are also rated descriptively,
which may be of value to practitioners who are interested in evaluating how well an intervention
matches their specific program needs and settings.
A second feature that distinguishes the School Psychology Task Force from previous evi-
dence-based efforts is the focus on a broader range of methodological strategies to establish
evidence for an intervention. A premium is placed on quantitative methodologies as the primary
basis for credible evidence (Kratochwill & Stoiber, 2000b). However, qualitative research meth-
ods are embraced as a way to understand the community and cultural contexts that contribute to
an intervention’s success (Hohmann & Shear, 2002). Mixed methods of measurement, such as
the use of rating scales along with direct observation, can identify insights into the engagement
and retention of research participants. Confirmatory program evaluation strategies, in which re-
searchers use theory-driven evaluations to determine the effectiveness of interventions, are also
embraced (Reynolds, 1998). Finally, the School Psychology Task Force has also expanded the
focus of its literature review beyond DSM-IV clinical disorders, incorporating intervention and
prevention programs that focus on a wide range of problems relevant to practice in schools. For
 2. WHY THE NEED FOR EVIDENCE-BASED INTERVENTIONS? 21

example, the Task Force reviewed academic interventions, school healthcare, school-wide inter-
ventions, and classroom-based interventions (Kratochwill & Stoiber, 2002).
APA’s Division 17 (Counseling Psychology) has taken a unique approach to the evidence-
based practice enterprise. Rather than developing a set of criteria that would lead to a list of evi-
dence-based practices, the Special Task Group (STG) on Empirically Supported Interventions
in Counseling Psychology decided to articulate a set of principles for identifying interventions
and practices as evidence-based (Wampold et al., 2002). These principles are intended to offset
some of the significant limitations to ordaining interventions as “evidence based,” and recognize
the complex relationship that exists between science and practice. In addition, APA’s Division
29 (Psychotherapy) Task Force was developed in 1999 to identify, classify, and disseminate
information on empirically supported therapy relationships, rather than interventions. This in-
cluded identifying elements of effective therapy relationships and determining methods for cus-
tomizing interventions to the unique characteristics that individuals present (Norcross, 2001).

The Council for Exceptional Children (CEC). The Council for Exceptional Children
(CEC) is an international professional organization focused on enhancing educational outcomes
for individuals with exceptionalities and disabilities. The CEC has had a strong role in advocating
for policies, standards, and training to assist teachers, administrators, paraprofessionals, and related
support service providers to engage in effective professional practice. In 2003, the CEC Division
of Research established a Task Force to articulate quality indicators for defining “acceptable” and
“high” quality research designs and studies in special education. The CEC identified four types
of research methodologies for review: group, single case, correlational, and qualitative designs.
The CEC task force places a strong emphasis on how EBPs intersect with effective instruction,
including how teachers can access information on EBPs and implement practices with fidelity.
See the Special Issue of Exceptional Children (Winter 2005) for an overview of the quality
indicators for the CEC as they apply to special education research.

US Department of Education. The US Department of Education (USDOE) has published

a document entitled “Identifying and Implementing Educational Practices Supported by
Rigorous Evidence: A User Friendly Guide” (USDOE, 2003). The document contains criteria
to classify interventions into one of three categories, from highest to lowest: “Strong Evidence
of Effectiveness,” “Possible Evidence of Effectiveness,” or “Not Supported by Meaningful
Evidence of Effectiveness.” The aforementioned criteria common to most standards drive the
distinctions between these categories, but add a few additional features regarding research design
and context. Design features include ensuring random assignment was not violated, ascertaining
that the treatment and control groups were equivalent prior to intervention, evaluating subject
mortality (i.e., ensuring group differences are not a function of who drops out during the study),
reporting both effect size and probability statistics, and reporting all study outcomes, not just those
that were significant. Context features include multi-site replications in schools or communities
similar to the consumer’s site. Distinctions between “Strong” and “Possible” evidence again
parallel other criteria, but allow for nonrandom designs in the “Possible” category, provided there
is evidence of prospective assignment to groups and evidence that the groups are matched prior
to intervention.

Agency for Healthcare Research and Quality. The AHRQ commissioned Evidence
Practice Centers (EPCs) to generate guidelines for health care quality. The AHRQ did not adopt
a single set of standards, in part because different aspects of health must be studied in different
ways (e.g., some conditions and treatments lend themselves to experimental studies, and others
22 BRADEN AND SHERNOFF

do not). A report summarizing the key approaches to EBP guidelines (Research Triangle Institute-
University of North Carolina Evidence Based Practice Center, 2002) identified standards to rate
two types of evidence: the outcomes of randomized controlled trials (RCTs), and the outcomes of
systematic reviews. Guidelines for RCTs are similar to those identified by other groups reviewed
in this chapter, whereas guidelines for reviews essentially identify the mechanisms by which
evidence should be collected, coded, and accepted with respect to the strength of conclusions
drawn. Three elements of all criteria stand out as definitive: the quality, quantity, and consistency
of outcomes within a review indicate the degree to which evidence meets, partially meets, or does
not meet standards for EBP. The AHRQ Web site (see Table 2.2) includes practice guidelines
(i.e., approaches meeting standards for EBP in medicine) for a variety of medical problems,
with a number of additional studies underway to expand the identification of EBP in medical
treatments.

What Works Clearinghouse (WWC). As stated on their Web site, “The What Works
Clearinghouse was established in 2002 by the U.S. Department of Education’s Institute of
Education Sciences to provide educators, policymakers, researchers, and the public with a central
and trusted source of scientific evidence of what works in education” (What Works Clearinghouse,
nd). The WWC has adopted between-group randomized trials for reviewing evidence and follows
procedures highly similar to other entities, in that it empanels groups of scientists to review
studies, and rates the studies according to criteria that define the study as “Meets evidence
standard,” “Meets standard with reservation,” or “Does not meet evidence screens” (WWC,
2006). The criteria used to categorize the evidence in each study are similar to standards used
by other groups, and to the criteria developed by the USDOE (2003). However, the WWC rates
and reports all of the studies that it reviews, leaving it up to the consumer to decide what mix of
studies provides sufficient evidence for a particular intervention.
Although intended in large part to provide the definitive resource for educators seeking
to enhance EBP, the WWC has suffered from delays, and currently offers limited resources in
some critical areas. For example, only one intervention (DaisyQuest; see Foster, Erickson, Fos-
ter, Brinkman, & Torgesen, 1994) for early reading was listed as of February 26, 2007, as meet-
ing standards by the WWC. Given the importance of early reading to meeting state and federal
expectations for student outcomes, the limited availability of established alternatives listed at
the WWC undermines its ability to be “a central and trusted source” for EBP in education.
Non-governmental education agencies. The Campbell Collaboration (named for Donald
Campbell, the social scientist who pioneered the experimenting society) is an international, in-
terdisciplinary organization aimed at advancing the integration of research on interventions and
enhancing the accessibility of knowledge on evidence-based practices (Schuerman et al., 2002).
The primary goal of the Campbell Collaboration is to prepare, maintain, and make accessible
systematic reviews of the effectiveness of interventions in social welfare, education, criminal jus-
tice, and public policy. Its major product includes a database of over 1,000 systematic reviews of
controlled experiments across social, educational, and criminological interventions. Systematic
reviews are defined as the use of unambiguous, transparent, exhaustive methods of tracking down
controlled experiments that test the efficacy of programs, policies, and practices. The only crite-
ria imposed on systematic reviews are methodological, including studies that used random (i.e.,
prospective allocation of individuals, schools, or communities to one or two alternative interven-
tions) or quasi-random assignment procedures (e.g., other assignment methods, such alternating
assignment). Reviews follow a protocol describing the topics covered and the methods used for
including studies in the Campbell Database of Systematic Reviews (see Campbell Collaboration
Steering Committee, 2000).
 2. WHY THE NEED FOR EVIDENCE-BASED INTERVENTIONS? 23

RESOURCES FOR IDENTIFYING EVIDENCE-BASED PRACTICE IN EDUCATION

Clearly, the intent of this book is to provide resources for EBP relevant to educational contexts. In
addition to the resources within this volume, a number of entities are working to provide reviews
of evidence to enhance EBP in education. Some of these entities, and their Universal Resource
Locators (URLs) are listed in Table 2.2. Although some URLs change without warning, online
resources have the advantage of reflecting advances in the field, additional evidence, and other
changes over time. Additionally, some illustrative resources (e.g., URLs for evidence standards,
resources describing the EBP movement) are included in Table2.2.

EVIDENCE-BASED PRACTICE: PROMISES AND PROBLEMS

The EBP movement promises enhanced outcomes for individuals and increased efficiency and
cost effectiveness for service delivery. However, in addition to these promises, EBP also en-
genders some problems for educational practitioners. These problems include issues related to
ethics, training, implementation, politics, adapting practice to unique contexts, and research. We
address each of these in the following sections.

Ethical Issues

Although EBP seeks to promote ethical practice by encouraging practitioners to select what
works for the individual (rather than what the practitioner might find interesting or familiar), the
goal of using EBP in contexts where evidence is inconsistent or incomplete creates ethical prob-
lems. In the absence of clearly defined EBIs for a particular problem, what should practitioners
do? On the one hand, following the Hippocratic dictum (First do no harm) might lead practitio-
ners to avoid intervention altogether until EBIs are available and identified. On the other hand,
practitioners who see children struggling to learn or acquire appropriate behaviors are obligated
to do what they can to alleviate the problem. In most cases, educators will intervene even in the
absence of a definitive evidence base, as “doing something” is better than “doing nothing.”
Or is it? Critical reviews of educational interventions have often shown that specialized treat-
ments, even those with appealing theoretical justifications, are worse than customary educational
treatments. Examples include perceptual motor training to correct learning disabilities and the
Feingold K-P diet for treatment of attention deficit disorder (see Kavale, 2001, for an extensive
review). Ethical mandates from professional societies, and legal mandates for identifying and
serving student needs, may push practitioners towards providing an intervention, even if it is un-
tested. Practitioners should consider carefully the lost opportunity costs (e.g., what is the student
missing, and what resources are being expended that might be expended otherwise, in providing
specialized interventions?) when deciding whether to intervene in the absence of a clearly de-
fined evidence base to support a practice.

Research Issues

There are unique elements of educational research that may limit the application of traditional
standards for evidence to educational interventions. First, it is rarely possible to randomly assign
individuals to educational treatments, as students tend to receive interventions in groups. Thus, in
many cases, the classroom (rather than the student) should be the unit of analysis—although this
distinction is rarely honored in research (Levin, 2004). Second, the paradigm of single or double
24 BRADEN AND SHERNOFF

TABLE 2.2
Professional Organizations and Resources Featuring Evidence-Based Practices

Organizations/Resources Web site

Agency for Healthcare Research and Quality http://www.ahrq.gov/
(AHRQ)
American Academy of Child and Adolescent http://www.aacap.org
Psychiatry
American Psychological Association
Statement & expanded report on evidence-based http://www.apa.org/practice/ebpreport.pdf
practice in psychological health services (American
Psychological Association)
Division 12 (Clinical Psychology) http://www.apa.org/divisions/div12/div12.html
Division 16 (School Psychology) and the National http://www.sp-ebi.org
Association of School Psychologists and Society for
the Study of School Psychology
Division 53 (Society for Clinical Child and http://www.wjh.harvard.edu/%7Enock/Div53/EST/index.htm
Adolescent Psychology)
Australian Broadcasting Corp. Health Guide for http://www.abc.net.au/health/cguides/evidencebased.htm
consumers
Blueprints for Violence Prevention http://www.colorado.edu/cspv/blueprints/index.html
Campbell Collaboration http://www.campbellcollaboration.org/index.asp
Centers for Disease Control and Prevention http://wonder.cdc.gov/
Center for Effective Collaboration and Practice http://cecp.air.org/
Center for Evidence-Based Medicine http://www.cebm.net/
Center for Evidence-Based Practice: Young Children http://challengingbehavior.fmhi.usf.edu/
with Challenging Behavior
Center for Mental Health Services of the Substance http://mentalhealth.samhsa.gov/
Abuse and Mental Health Services Administration
(SAMHSA)
Center for Promoting Research to Practice http://www.lehigh.edu/projectreach/
Center for the Study and Prevention of Violence http://www.colorado.edu/cspv/blueprints/contacts/list.html
Council for Exceptional Children Evidence-based http://www.cec.sped.org/AM/Template.
practice resources cfm?Section=Evidence_based_Practice&Template=/
TaggedPage/TaggedPageDisplay.cfm&TPLID=24&Conten
tID=4710
Evidence-Based Medicine http://www.herts.ac.uk/lis/subjects/health/ebm.htm
Institute for Education Sciences http://www.ed.gov/about/offices/list/ies/ncer/ index.html
Interagency Education Research Initiative http://drdc.uchicago.edu/about/drdc_ieri.html
Interdisciplinary Council on Developmental and http://icdl.com/ICDLguidelines/toc.htm
Learning Disorders
MacArthur Foundation Youth Mental Health http://www.macfound.org/site/c.lkLXJ8MQKrH/b.1010061/
Research Network k.FDFC/Research_Networks__Network_on_Youth_Mental_
Health_Care.htm
National Association of State Mental Health http://nri.rdmc.org/RationaleEBPCenterReview.pdf
Directors Research Institute Center of Evidence-
Based Practices, Performance Measurement, and
Quality Improvement
National Center for Special Education Research http://www.ed.gov/about/offices/list/ies/ncser/index.html
 2. WHY THE NEED FOR EVIDENCE-BASED INTERVENTIONS? 25

Organizations/Resources Web site

National Child Traumatic Stress Network http://www.ntcsnet.org
National Institute of Mental Health (NIMH) http://www.nimh.nih.gov/
National Electronic Library for Mental Health http://www.nelmh.org/page_view.asp?c=22&did=2372&fc
(Effective Interventions) =004007
National Information Center on Health Services http://www.nlm.nih.gov/nichsr/healthservicesvideo.ram
Research and Health Care Technology (NICHSR)
New York Academy of Medicine Evidence-Based http://www.ebmny.org/
Medicine Resource Center
New York State Office of Mental Health: Evidence- http://www.omh.state.ny.us/omhweb/ebp/children.htm
based Practices for Children and Families
Promising Practices Network (Rand Corp.) http://www.promisingpractices.net/
PsychDirect (McMaster University Department http://www.psychdirect.com/
of Psychiatry & Behavioural Neuroscience listing
of evidence-based mental health education &
information)
Research and Training center on Early Childhood http://www.puckett.org
Development (CED)
Safe Schools/Healthy Students Initiative http://mentalhealth.samhsa.gov/safeschools/
Social Programs That Work http://www.evidencebasedprograms.org/
Society for Prevention Research www.oslc.org/spr/apa/summaries.html
UCLA School Mental Health Project http://www.smhp.psych.ucla.edu/
US Dept. of Education: Coalition for Evidence-Based http://coexgov.securesites.net/index.php?keyword=a432fbc
Policy 34d71c7
What Works Clearinghouse http://www.w-w-c.org/

blind treatment delivery is compromised (e.g., it is not possible for either the student or the teach-
er to be unaware of whether or which intervention is being delivered). This means expectancy
effects (on the part of the person delivering the intervention, and on the recipient) may substan-
tially influence outcomes independent of the intervention quality. Third, comparative educational
research finds any intervention delivered with fidelity tends to improve outcomes, raising the
question of whether controlled studies can truly distinguish effective from ineffective treatments.
Comparing students receiving a particular intervention to students getting “general educational
supports,” which is often referred to in the psychological literature as “usual outpatient therapy”
or “customary clinical care” (e.g., Weiz, McCarty, & Valeri, 2006), is more intuitively appealing,
but it lacks precision (i.e., it begs the question of what constitutes “usual care”). Despite these
limitations, it is still clear that standards for evidence in education still adhere closely to the major
elements of research design insofar as they embrace randomized assignment to conditions and
comparison to alternative treatments; whereas there is little work to define what would constitute
an appropriate “educational placebo” as a control condition in educational experiments. These
limitations do not mean that good educational research cannot help to identify which interven-
tions have an evidence base (and which ones do not); rather, it opens the question of the degree to
which traditional scientific standards of evidence generalize to educational contexts.
Another major problem is the identification of the “active ingredients” within a particu-
lar intervention. Typically, interventions are complex and multi-faceted, engaging a variety of
psychological dimensions. The factors to which researchers attribute outcomes (i.e., the actions
26 BRADEN AND SHERNOFF

of the interventionist) may be only partly or not at all responsible for outcomes. Instead, factors
such as the strength of the clinical alliance developed between the interventionist and the person
receiving the intervention, may largely explain intervention effects. Indeed, there is little if any
evidence to suggest that the features to which research attribute effects are in fact responsible
for those effects (Wampold, 2005). It is both conceptually and financially challenging to design
research capable of identifying which portions of an intervention influence outcomes, yet it is
essential if interventions are to be adapted to specific individuals and contexts.

Intervention Integrity and Differentiation

The study of intervention integrity has received increased attention in recent years and plays a
prominent role in the evidence-based practice movement. Integrity refers to the degree to which
an intervention is delivered as intended (Yeaton & Sechrest, 1981), with significant evidence
supporting intervention failures to be the result of poor integrity versus ineffective interventions
(Rossi, Freeman, & Lipsey, 1999; Schoenwald et al., 2000). Differentiation, on the other hand,
refers to the degree to which one intervention can be distinguished from another (Schoenwald
et al., 2000). For behavioral and cognitive-behavioral interventions, integrity and differentiation
are often ensured through the use of treatment manuals that operationally define the treatment
strategies used, coupled with intensive training and ongoing supervision of intervention agents.
Several key factors are related to the integrity of interventions implemented in school settings.
For example, studies have documented the difficulties inherent in adhering to interventions that
are complex (Yeaton & Sechrest, 1981), time consuming (Gresham & Kendall, 1987), involve
multiple participants (Gresham, 1989), and require extra materials and resources (Yeaton & Se-
chrest, 1981; Wolf, 1978). Treatment integrity has been found to increase when problems are
perceived as severe and when interventions are perceived as effective (Elliott, 1998). Although
integrity is associated with stronger treatment outcomes, the exigencies of real world practice
make it challenging to implement interventions without making adaptations to meet the unique
needs and problems of individuals.
Adapting evidence-based interventions to specific individuals and contexts. Most policies re-
garding the use of EBIs encourage their application to practice, but also caution professionals to
apply them carefully. For example, the American Psychological Association (2005; see also Le-
vant, 2005) encourages psychologists to consider three things as they engage in evidence-based
practice: (1) “best research,” (2) “patient characteristics, values, and contexts,” and (3) “clinical
implications.” Although the first consideration has been discussed extensively in this chapter, the
latter two are given scant attention in the scholarly literature. This is due in part to the lack of
systematic research on which characteristics, values, or features of context merit consideration,
and how they should be considered. Likewise, “clinical implications” include considerations
such as cost, available resources, and other factors that might constrain or alter the selection of
an intervention or treatment beyond consideration of the evidence base supporting that treatment.
Unfortunately, there is little evidence to guide how educators, school psychologists, or other
school-based professionals do (and should) make decisions with respect to these standards, par-
ticularly because “adapted” interventions may be less efficacious than those that are consistently,
or even rigidly, applied. In many respects, the gap between research and practice can be framed
as a division between the nature of evidence traditionally generated in research and the type of
evidence educators, school psychologists and other school-based professionals need to make
decisions regarding practice (Kratochwill & Shernoff, 2003).
 2. WHY THE NEED FOR EVIDENCE-BASED INTERVENTIONS? 27

CONCLUSIONS

In this chapter, we have sought to outline the EBP movement, and describe how EBIs fit within
this movement. Although EBIs are currently quite popular, they are but one aspect of the broader
EBP movements in medicine, psychology, and education. In so doing, we have attempted to iden-
tify the major criteria by which professionals identify particular interventions as being evidence-
based. It is essential to note that the criteria used to discriminate evidence-based interventions
from other interventions are controversial. Furthermore, the decision to adopt certain criteria over
others in and of itself leads to diverse conclusions regarding support for particular interventions,
and even for classes of interventions. Therefore, this chapter is intended in part to alert practitio-
ners to the history and issues that lie behind current frameworks for declaring interventions as
evidence-based. As Winston Churchill said, “he [sic] who frames the terms of the debate wins.”
Therefore, consumers should be acutely aware that any decisions regarding what is and is
not an evidence-based intervention are always provisional. Such decisions are based in part on
the types of evidence that is valued, and also on the evidence that is available. Although there has
been a surge of interest in EBP in the past few years, it is important to note that the knowledge
base regarding effective interventions—especially, in the schools—is still in its infancy stage
(Jensen, Weersing, Hoagwood, & Goldman, 2005). As evidence becomes increasingly available
and the quality of that evidence corresponds to the criteria set forth for evaluating interventions,
it is likely that additional interventions will qualify as “evidence-based.” Although we concur
with professional societies that encourage school- and nonschool-based practitioners to select
interventions from a pool so identified, we also appreciate that there are many complexities and
vagaries in the application of interventions to real-life settings that may constrain, alter, or shift
the selection of interventions. We recognize that the adoption of evidence-based practices is
not a straightforward, inexpensive, or a clear endeavor and will require shifts in how scientific
knowledge is translated into practice. Nevertheless, it is difficult to argue with the assumption
that students, teachers, parents, and administrators will be better served through the adoption
and use of interventions that have strong evidence to support their use. Virtually every institution
and organization bearing an influence on the profession concur that the practices of education
and psychology should be based, in part, on knowledge derived from empirical research. This
chapter, then, should serve as a backdrop to the rest of the book, and encourage continued devel-
opment of interventions, evidence-based evaluations of interventions, and the enhancement of
evidence-based practice.

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30 BRADEN AND SHERNOFF

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 II
STUDENTS HAVING
BEHAVIORAL CHALLENGES
 3
Attention-Deficit/Hyperactivity
Disorder
George J. DuPaul, Laura E. Rutherford,
and Shelley J. Hosterman

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common disruptive behavior

disorders affecting between 3% to 10% of children and adolescents in the United States (Bark-
ley, 2006). Individuals with ADHD exhibit developmentally deviant levels of inattention and/or
hyperactivity-impulsivity (American Psychiatric Association, 2000). Boys are two to six times
more likely to be diagnosed with the disorder (Barkley, 2006). ADHD is a chronic, life-long dis-
order in the majority of cases and is associated with significant impairment in academic, social,
and occupational functioning (American Psychiatric Association, 2006; Barkley, 2006).
The purpose of this chapter is to review evidence-based interventions for ADHD that can
be used in school settings to reduce symptoms of the disorder as well as enhance academic and
social functioning. First, a brief historical perspective on ADHD is provided. Next, the core
symptoms are described as well as short- and long-term difficulties that students with ADHD
are likely to experience in school. Third, we discuss the major intervention approaches that have
been empirically investigated for treatment of ADHD including stimulant medication, behavioral
strategies (both antecedent-based and consequent-based), social relationship interventions, and
strategies to enhance academic performance. The chapter concludes with a summary and recom-
mendations for future research.

HISTORICAL PERSPECTIVES

Descriptions of children with ADHD have been evident in the medical and educational litera-
tures since the early 20th century (for review, see Barkley, 2006). Since the beginning of formal
schooling in the United States, behaviors such as inattention, impulsivity, and high activity levels
have been associated with classroom disruption and problematic school functioning. Thus, the
core characteristics of this disorder are the same as they have always been; however, the diag-
nostic nomenclature and treatment methods to address these challenging behaviors have evolved
over time. For example, prior diagnostic terms have included minimal brain dysfunction, hyper-
kinetic impulse disorder, and attention deficit disorder with or without hyperactivity (Barkley,
2006). It is possible that future iterations of diagnostic manuals will include different terms for
the disorder; however, these labels are essentially referring to the same set of behaviors. Further,
33
34 DUPAUL, RUTHERFORD, AND HOSTERMAN

until the latter half of the 20th century, children exhibiting ADHD-like behaviors were removed
from classrooms and/or were subject to high levels of punishment. Vast improvements in treat-
ment have been obtained, including the use of psychotropic medications and positive reinforce-
ment procedures. Thus, school and mental health personnel are better able to identify students
with ADHD and effectively manage their symptoms as well as academic and social impairments
associated with this disorder.

CHARACTERISTICS AND SCHOOL-RELATED DIFFICULTIES

The 18 behavioral symptoms of ADHD include 9 inattention and 9 hyperactivity-impulsivity

symptoms (American Psychiatric Association, 2000). Specific examples of inattention symptoms
include: failing to give close attention to details, difficulty sustaining attention to task or play
activities, and not following through on instructions and failing to complete work. Hyperactiv-
ity-impulsivity symptoms include: fidgeting with hands or feet, difficulty playing quietly, and
blurting out answers before questions have been completed. In order for the diagnosis of ADHD
to be made, at least 6 inattention and/or hyperactivity-impulsivity symptoms need to be present at
a significantly higher frequency than in others of the same age and sex. Further, symptoms should
be chronic (i.e., occur for at least 6 months), begin before the age of 7 years old, and be associated
with social and/or academic impairment across at least two settings (American Psychiatric As-
sociation, 2000). Thus, this diagnosis is specific to those students who are extremely inattentive
and/or hyperactive-impulsive and, as a result, are experiencing significant difficulties in one or
more major life activity.
Not surprisingly, students with ADHD frequently experience difficulties with behavior con-
trol in classroom settings. For example, children with this disorder often are inattentive and ex-
hibit significantly higher rates of off-task behavior relative to their non-ADHD classmates (e.g.,
Abikoff et al., 2002; Vile Junod, DuPaul, Jitendra, Volpe, & Cleary, 2006). Rates of on-task be-
havior are particularly low when passive classroom activities (e.g., listening to teacher instruction
and reading silently) are required (Vile Junod et al., 2006). In addition, hyperactive-impulsive
behaviors that may comprise ADHD often lead to disruptive behaviors in the classroom and other
school environments including talking without permission, leaving the assigned area, bothering
other students, and interrupting teacher instruction. Further, from 45% to 84% of children with
ADHD are diagnosed with oppositional defiant disorder (ODD) wherein students may frequently
disobey teacher commands and overtly defy school rules (Barkley, 2006). The combination of
ADHD and disruptive behavior can interfere with learning and classroom activities for students
with ADHD and their classmates.
ADHD frequently is associated with deficits in academic skills and/or performance. On av-
erage, children with ADHD score between 10 to 30 points lower than non-ADHD control chil-
dren on norm-referenced, standardized achievement tests (e.g., Barkley, DuPaul, & McMurray;
Brock & Knapp, 1996; Fischer, Barkley, Fletcher, & Smallish, 1990). Further, approximately
20% to 30% of students with ADHD also have a specific learning disability in reading, math, or
writing (DuPaul & Stoner, 2003; Semrud-Clikeman et al., 1992). Core ADHD symptoms have
been found to be significant predictors of concurrent and future academic difficulties (e.g., per-
formance on achievement tests, report card grades, and teacher ratings of educational function-
ing). The relationship between ADHD symptoms and achievement outcomes is evident for both
referred (DuPaul et al., 2004) and non-referred (Fergusson & Horwood, 1995) samples. As a
result, students with ADHD are at higher risk for grade retention, placement in special education
classrooms, and dropping out from high school (e.g., Fischer et al., 1990). Fewer students with
 3. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 35

ADHD go on to post-secondary education relative to similar achieving non-ADHD classmates

(Mannuzza, Gittelman-Klein, Bessler, Malloy, & LaPadula, 1993). Thus, poor educational func-
tioning throughout the school years is a frequent outcome for students with ADHD.
Students with ADHD typically have difficulty developing and maintaining positive rela-
tionships with peers, teachers, and other school personnel (Barkley, 2006; DuPaul, & Stoner,
2003). Difficulties with inattention and impulsivity inhibit the development of appropriate social
relationships in several ways. First, children with ADHD often don’t follow the implicit rules of
reciprocal conversation (Stroes, Alberts, & Van der Meere, 2003). Thus, a child with ADHD is
likely to interrupt during conversation, not listen closely to what others are saying, and respond
in an irrelevant fashion (i.e., talk about something that is not germane to the conversation topic).
Second, students with ADHD may enter ongoing peer activities (e.g., games and conversations)
in an abrupt, impulsive manner, thereby disrupting the activity to a significant degree (DuPaul
& Stoner, 2003). Peers may choose to exclude the child with ADHD from activities as a result.
Third, children with this disorder are more likely than their non-ADHD classmates to behave in a
verbally or physically aggressive manner, presumably due to their problems with impulse control
(Barkley, 2006). Finally, given this combination of social relationship difficulties, several studies
have indicated that children with ADHD are less popular, more often rejected, and have fewer
friends than their non-ADHD peers (e.g., Hoza et al., 2005).
Although most students with ADHD are placed in general education classrooms, they are at
higher than average risk to be identified for special education services (Barkley, 2006). Of those
children with ADHD receiving special education services, the largest numbers are identified with
specific learning disabilities (41%) and speech/language impairments (15%) (U.S. Department
of Education, 2005). It is important to note, however, that students with ADHD make up a sig-
nificant percentage of children identified with a variety of educational disabilities including other
health impairment (65.8%), emotional disturbance (57.9%), mental retardation (20.6%), learning
disabilities (20.2%), and speech/language impairment (4.5%) (Schnoes, Reid, Wagner, & Mard-
er, 2006). Thus, ADHD may be associated with one or more educational difficulties that further
compromise school functioning and may require specialized intervention services.

EMPIRICALLY-BASED INTERVENTION PROCEDURES

The most widely studied and effective treatments for ADHD in children and adolescents include
psychotropic medication (chiefly stimulant compounds, such as methylphenidate) and behavioral
strategies implemented in home and school settings (for review, see Barkley, 2006). The combi-
nation of these treatments may be necessary for many individuals with this disorder in order to
fully address their symptoms as well as areas of functioning that may be impaired. In fact, the
combination of stimulant medication and behavioral treatment may lead to greater rates of nor-
malization than either treatment in isolation (cf. Conners et al., 2001).

Monitoring of Medication Treatment

The single most effective treatment for the reduction of ADHD symptoms is carefully titrated,
stimulant medication (MTA Cooperative Group, 1999; 2004). This class of medication includes
methylphenidate (i.e., Ritalin™, Concerta™, and Metadate™), dextroamphetamine (Dexe-
drine™), and mixed amphetamine compounds (Addreal™). These medications lead to reduction
in attention difficulties and impulsive behavior as well as enhanced task engagement and rule
compliance in the majority of children and adolescents with ADHD receiving this treatment (for
36 DUPAUL, RUTHERFORD, AND HOSTERMAN

review, see Connor, 2006a). Other medications, such as atomoxetine (Strattera™) or clonidine
(Catapres™) may be used for those children who do not respond to stimulants or experience sig-
nificant adverse side-effects (e.g., insomnia and appetite reduction) (Connor, 2006b).
Although school practitioners do not prescribe medication, they can provide critical data to
physicians seeking to monitor the initial efficacy and ongoing use of a particular drug. Specifi-
cally, information about a student’s social, academic, and behavioral functioning may be used to
determine the need for medication as well as what compound and dosage are optimal for both
reducing symptoms and enhancing functioning (DuPaul & Carlson, 2005; Power, DuPaul, Sha-
piro, & Kazak, 2003). For example, teacher ratings of behavioral functioning, curriculum-based
measurement probes, and parent report of possible adverse side-effects can be gathered during
both baseline and several medication dosage conditions. These data can then be communicated
to a student’s physician who can evaluate (a) whether the medication is effective relative to no-
medication conditions and (b) what dosage leads to the most clinically significant change with
the fewest adverse side-effects. Given that stimulants typically affect behavior only during the
school day, objective classroom data are critical in making accurate treatment decisions.

Overview of School-based Interventions

A variety of school-based interventions to address the needs of students with ADHD have been
studied over the past several decades (for review, see DuPaul & Eckert, 1997; Purdie, Hattie, &
Carroll, 2002). Four major treatment strategies are reviewed in this chapter, including behavioral
interventions that involve manipulating antecedent events (see Table 3.1), behavioral interven-
tions that involve manipulating consequent events (see Table 3.2), social relationship interven-
tions (see Table 3.3), and academic remediation strategies (see Table 3.4). All of these approaches
have received empirical support in reducing disruptive behavior and/or enhancing functioning of
students with ADHD.
In considering the use of school-based interventions for this disorder, several core prin-
ciples are important when designing treatment plans for specific students (DuPaul & Stoner,
2003). First, multiple mediators for intervention should be considered. Obviously, teachers are
the primary treatment agent for any classroom intervention plan; however, other mediators (e.g.,
peers, computers, and parents) should be used whenever possible, given that teachers have many
responsibilities that may render effective strategies untenable and impractical. Second, a bal-
anced treatment plan that includes manipulation of antecedent events and academic strategies in
addition to the more typical consequence-based approach should be used. All too often, school
professionals rely solely on aversive consequences (e.g., negative reprimands, detention, and
suspension) to address student disruptive behavior. We advocate a more comprehensive approach
using positive consequences, antecedent-based strategies, academic interventions, and social re-
lationship treatments. This combination of interventions may obviate the need for or reduce the
frequency of more punitive procedures. Finally, intervention strategies should be individualized
in order to account for the unique characteristics of each child with ADHD. Functional behav-
ioral assessment and curriculum-based assessment data can be used to specifically determine
exactly which treatment components may be most effective for each student (DuPaul & Ervin,
1996; DuPaul & Stoner, 2003).

Antecedent Interventions

Antecedents are environmental events that precede behavior. Whereas consequence-based inter-
ventions are reactive to problem behaviors, antecedent approaches are both proactive and pre-
 TABLE 3.1
Antecedent Interventions for Students with ADHD

Intervention type Key features Outcomes Benefits

Task-related choices Selecting academic tasks Increased level of task engagement Easily incorporated into curriculum/
Sequencing of tasks Decreases in disruptive behavior routine
Stimulus materials Student empowerment
Pace of instruction Task compliance
Presentation of classroom Stated in a positive manner (e.g. raise Significant improvement in behavior for Preventative approach
rules and task instructions your hand before speaking) all students (classwide) Decreased need for negative
Limited in number (fewer than 5) Students understand rules and consequences
Publicly and prominently posted consequences
Clear and brief Provides continuous and positive
May include pictures examples
Actively taught through instruction Improves overall classroom
“Catch” students being good management
Reminders immediately prior to new Cost effective
activity
Attract attention of student(s) before
stating rules (e.g. eye contact,
proximity, physical prompt)
Post schedules with activity specific
rules
Asking students to repeat rules aloud
3. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
37
38 DUPAUL, RUTHERFORD, AND HOSTERMAN

ventative. Antecedent-based interventions focus on reducing the probability of problem behavior.

These approaches may also result in increased levels of appropriate behaviors, such as increased
attention to task and work completion. Therefore, antecedent strategies may reduce the possibil-
ity that punitive consequences will be used (Kern, Choutka, & Sokol, 2002). Antecedent inter-
ventions typically involve making prearranged environmental changes to prevent conditions that
provoke the problem behavior. Research has shown several of these strategies, including provid-
ing task-related choices and presentation of rules, are effective for children with ADHD.

Providing Task-Related Choices

Choice-making is a simple antecedent-based intervention that embeds self-determination in in-

struction. Applications of this strategy include offering students choice of stimulus materials,
academic tasks, pace of instruction, and order of task presentation. Choice making can be easily
incorporated into instructional and inclusive lessons and activities (Moes, 1998). In a compre-
hensive literature review, Kern et al. (1998) found that choice was an effective procedure for both
increasing the quality and quantity of desired behaviors as well as decreasing undesirable behav-
iors in students with a variety of disabilities. Several studies have investigated the use of choice
for students with ADHD. Evidence specific to this population has focused on applying choice the
areas of selecting and sequencing academic tasks.
Dunlap and colleagues (1994) provided students with an individualized menu of possible
academic tasks and allowed students to select the next classroom activity. This study involved
three students with emotional and behavioral disorders, one of whom had ADHD. During the
non-choice condition, the teacher wrote two designated assignments on the board and all stu-
dents were expected to complete those items. During the choice condition, students were first
asked if they wanted to choose their assignment and were then provided with a list of 6 to 10
task options. Results showed that students always preferred to choose assignments themselves.
They also exhibited increased levels of task engagement and decreases in disruptive classroom
behaviors during the choice condition. In a similar study, Powell and Nelson (1997) examined
effects of choice on the behavior of one student with ADHD. Results showed the student’s levels
of undesirable classroom behaviors decreased in the choice condition when he was permitted to
select from among three academic assignments.
In the above studies, students were not expected to complete all academic tasks listed. Kern,
Mantegna, Vorndran, Bailin, and Hilt (2001) investigated the use of choice when students were
asked to complete three required tasks. Three students, two of whom were identified with ADHD,
were asked to complete three tasks they found highly undesirable. These academic and classroom
routine tasks typically provoked noncompliance and other problem behaviors. Results showed
that simply providing students with the opportunity to choose the sequence of tasks led to in-
creases in engagement and decreased problem behavior to near-zero frequencies for both stu-
dents with ADHD.

Presentation of Rules

Poor rule-governed behavior, or difficulties adhering to rules and instruction, is a common deficit
associated with ADHD (Barkley, 2006). Many behaviors associated with ADHD may interfere
with a student’s ability to attend appropriately during teacher presentation of rules or instructions.
For example, off-task behaviors such as conversations with peers, staring out the window, and
fidgeting with items in their desks may prevent students with ADHD from devoting necessary
levels of attention to rules and instructions. Clearly a student who is unaware of or not attending
 3. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 39

to expectations will have extreme difficulty following them. Teachers can use several strategies
to actively teach and reinforce rules and expectations.
Establishing general classroom rules benefits all students in the classroom, particularly
those with ADHD. General classroom rules should be stated in a positive manner (e.g., “raise
your hand before speaking”), rather than as prohibitions (e.g., “don’t call out”). Thus, rules tell
students what is appropriate or expected. Instead of simply eliminating problematic behaviors,
such rules prompt use of positive alternatives. In addition, classroom rules should be limited in
number, typically fewer than five (Rhode, Jenson, & Reavis, 1993). Classroom rules should be
publicly and prominently posted. Public posting functions as a continuous reminder of expec-
tations and encourages students to make the connection between behaviors and consequences
(Kehle, Bray, Theodore, Jenson, & Clark, 2000). Barkley (2006) suggests students with ADHD
will benefit from rules that are clear, brief, and delivered through visible and external modes of
presentation. Rule prompts with pictures (e.g., and ear for listening) can be placed throughout
the classroom as reminders.
Several proactive teacher strategies are valuable during teaching of general rules, expec-
tations, and task-specific instructions and directions. Rules should be actively taught through
discussion and always stated clearly. Johnson, Stoner, and Green (1996) found actively teaching
classroom rules led to significant improvements in behavior for all students. Asking students
to repeat rules aloud is also helpful. Teachers should “catch students being good,” and point
out natural examples of appropriate behavior by referring to rules. Teachers should also remind
students of rules immediately before starting a new activity. Because students with ADHD often
have difficulty attending, teachers should ensure these students are paying attention before giv-
ing instructions. For example, strategies like making eye contact, standing near the student’s
desk, or using a discrete physical prompt offer effective and unobtrusive means to obtain student
attention. Another option for communicating classroom expectations was described by Sprick,
Borgmeier, and Nolet (2002) who suggest posting classroom schedules that feature activity-spe-
cific rules for each time block. Teachers can then refer to the appropriate rules at the start of each
activity. Following these simple strategies may increase the likelihood that students with ADHD
will follow the rules and complete steps of assigned activities.

Consequent-Based Interventions

The most common type of behavioral strategy used for treating ADHD symptoms in children
is the manipulation of consequent events (either positive or aversive) to increase appropriate
behavior or decrease disruptive, off-task activities. Included in this category are interventions
that involve token reinforcement, response cost, contingency contracting, and self-management.
Functional assessment data can optimize treatment effects by ensuring that interventions are
directly focused on replacing inappropriate behavior with appropriate behavior that achieves the
same behavioral function.

Token Reinforcement

Token reinforcement strategies involve providing students with an immediate reinforcer (e.g.,
poker chip, sticker, or points) contingent on a desired behavior in order to increase the prob-
ability that the behavior will increase in frequency. The token reinforcer is exchanged at a later
time point for a back-up reinforcer (e.g., privileges at home or at school) that presumably has a
high degree of salience for the student. Token reinforcement programs have extensive empirical
support for the reduction of disruptive, off-task behavior and/or increased task engagement in
 TABLE 3.2
40

Consequent-based Interventions for Students with ADHD

Intervention type Key features Outcomes Benefits

Token Reinforcement Identify several specific target behaviors, including both Increased on-task behavior Improved classroom management
social and academic Decreased disruptive behavior in Decreased need for aversive procedures
Identify reinforcers (tokens) that will be provided by the classroom
teacher following display of target behavior Higher rate of task completion and
Provide back-up reinforcement at school or home on accuracy
a daily or weekly basis based on number of tokens
earned
Response Cost Identify several target behaviors that will be reinforced Improved on-task behavior Improved classroom management
Identify several target behaviors to be reduced in Decreased frequency of disruptive Enhanced maintenance of treatment
frequency behavior effects
Provide immediate reinforcement (tokens) following Higher rate of task completion and
display of appropriate behavior and remove tokens accuracy
following display of inappropriate behavior
Provide back-up reinforcement at school or home daily
or weekly based on number of tokens earned
DUPAUL, RUTHERFORD, AND HOSTERMAN

Contingency Identify several academic and behavioral goals Increased frequency of appropriate Highly feasible to implement
Contracting Identify school and/or home privileges that can be behavior and decreased frequency Enhanced collaboration among school
earned on a daily or weekly basis of inappropriate behavior personnel and student
Contract signed by student, parent(s), and teacher(s)
Privileges earned on basis of goal attainment
Contract reviewed and renegotiated on a regular basis
Self-Management Identify several target behaviors Increased frequency of on-task Highly feasible to implement
Teacher ratings of behaviors for specified intervals (e.g., behavior Enhanced maintenance and generalization
by class period) Decreased frequency of disruptive of treatment effects
Students trained to rate own behavior using same rating behavior
criteria as teacher Higher rate of task completion and
Points earned for goal attainment and matching teacher accuracy
ratings
Backup reinforcers provided at school or home based
on points earned
Teacher ratings faded gradually so that eventually
reinforcement is based solely on student self-ratings
 3. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 41

students displaying ADHD symptoms (for review, see DuPaul & Eckert, 1997; Pelham, Wheeler,
& Chronis, 1998). In order to maximize the potential success of a token reinforcement program,
several strategies should be followed including: (a) selection of a few relevant goals that clearly
identify expected behaviors, (b) initial use of the program during most problematic times of the
school day, (c) immediate and consistent follow-through in providing token reinforcement, (d)
exchange of tokens for back-up reinforcement on at least a daily basis, and (e) modifying the
expectations and reinforcers over time to address additional difficulties and to maintain student
interest in the program (DuPaul & Stoner, 2003).
Classroom-based token reinforcement programs can be supplemented by the use of home-
based reinforcement for school behavior (i.e., daily school report card). Daily report cards iden-
tify several behavioral goals (e.g., complete assigned seatwork) that students must achieve in
school in order to earn reinforcement at home (Chafouleas, Riley-Tillman, & McDougal, 2002;
Kelley, 1990). Teachers provide written quantitative ratings for each goal (e.g., 1 [“did not meet
goal”] to 5 [“met goal completely”]) that serve as the immediate contingencies. These ratings
are converted to points at home and exchanged for home-based reinforcers (e.g., access to televi-
sion and/or video games). A daily report card system is one of the cornerstones of the classroom
component within the Summer Treatment program developed by Pelham and colleagues (2002).
As such, there is substantial empirical support for the use of this system, especially in combina-
tion with classroom-based behavioral interventions. Further, the potential effects of a daily report
card system are enhanced when (a) goals are few in number and stated in a positive manner; (b)
both academic and behavioral goals are included; (c) feedback is provided by subject or class
period; and (d) parents are included in the planning process (Chafouleas et al., 2002; DuPaul &
Stoner, 2003; Pfiffner, Barkley, & DuPaul, 2006).

Response Cost

Response cost is a form of token reinforcement strategy that involves removal of tokens contin-
gent on inappropriate behavior in order to reduce the probability that the behavior will happen
in the future. This treatment strategy has been found to increase on-task behavior and work pro-
ductivity in classroom settings (e.g., DuPaul, Guevremont, & Barkley, 1992; Rapport, Murphy,
& Bailey, 1982). Response cost is particularly effective when it is combined with an ongoing
positive reinforcement system (DuPaul & Stoner, 2003). In fact, some studies have shown that
behavioral changes induced by response cost are better maintained over time than are the be-
havioral effects of an all-positive approach (Pfiffner & O’Leary, 1987). Further, in some cases,
the effects of response plus token reinforcement interventions are equivalent to those found for
psychostimulant medication (e.g., Pelham, Carlson, Sams, Vallano, Dixon, & Hoza, 1993; Rap-
port, Murphy, & Bailey, 1982). Of course, care should be taken to ensure that students don’t lose
more tokens than they earn in order to maintain motivation and emphasize positive changes made
by students. For example, teachers should only take one token away for a specific behavior even
if the latter continues after token removal. In such instances, additional contingencies (e.g., time
out from positive reinforcement) may be necessary to curtail the inappropriate behavior.

Contingency Contract

Typically, formal token reinforcement and response cost systems are not feasible or developmen-
tally appropriate for middle and high school students with ADHD. One treatment alternative to
secondary school students with ADHD is contingency contracting wherein a contractual agree-
ment is negotiated between a student and teacher (DeRisi & Butz, 1975). The contract simply
42 DUPAUL, RUTHERFORD, AND HOSTERMAN

identifies the desired classroom behaviors and consequences available contingent upon their
performance. As with a token reinforcement program, specific academic and behavioral goals
are identified that the student must meet in order to gain access to preferred activities or other
rewards. Contracting usually involves a direct connection between target behaviors and primary
contingencies, rather than the use of secondary reinforcers such as tokens. As such, there may be
a longer time delay between behavior completion and reinforcement than with a token economy
program.
The choice of target behaviors, and the manner of incorporating them into an intervention
program are important determinants of a behavioral contract’s success. For example, during the
initial stages of a contracting procedure care should be exercised to avoid large numbers of goals,
extremely high standards of quality, and completion of complex (e.g., multi-step) tasks (DuPaul &
Stoner, 2003). More difficult or complex goals could be incorporated gradually into later iterations
of the contract such that terminal objectives are reached with minimal failure along the way.
Another important consideration in designing a contingency contract is the identification of
appropriate reinforcers. All too often, identified reinforcers take the form of activities or items
that are assumed by school personnel to be motivating for students. Because reinforcer prefer-
ences can be very idiosyncratic, individual reward menus should be derived for each student. This
can be accomplished most directly by including the student in negotiations regarding potential
privileges. Direct negotiation not only assures identification of salient reinforcers, but also enlists
the student’s cooperation and investment in the contractual process.

Self-Management

Several studies have indicated that self-management, particularly the combination of self-moni-
toring and self-reinforcement, is effective in improving a variety of behaviors including task-
related attention, academic accuracy, and peer interactions (e.g., Barkley, Copeland, & Sivage,
1980; Hinshaw & Simmel, 1994). In fact, Reid et al. (2005) obtained a combined effect size of
greater than 1.0 for these interventions in relation to changes in on-task behavior, disruptive ac-
tivity, and task completion.
Self-monitoring plus self-reinforcement strategies may be particularly helpful for address-
ing ADHD-related problems in two situations. First, students can be taught to monitor and rein-
force their own behavior while fading the use of a teacher-managed, contingency management
intervention (Barkley, 1989). In such cases, it is assumed that positive behavior change will be
maintained despite the reduction in teacher feedback or other forms of reinforcement. Of course,
backup reinforcers (e.g., classroom or home privileges) should continue to be used as teacher
monitoring and feedback are faded. A second situation where self-monitoring plus self-reinforce-
ment is an appropriate treatment for ADHD is at the secondary level where teachers and students
may be reluctant to use token reinforcement, contingency contracting, or response cost. Thus,
self-management may be a more acceptable intervention at the secondary level, and, therefore,
presumably more likely to be implemented on a consistent basis.
An example of self-monitoring and self-reinforcement procedures useful for ameliorating
ADHD symptoms is based on the work of Rhode, Morgan, and Young (1983). These researchers
used these strategies to facilitate the mainstreaming of six elementary students with “behav-
ioral handicaps.” Initially, a token reinforcement program is used wherein teachers rate student
behavior during specific intervals (e.g., every 5 minutes) in the classroom. Ratings of targeted
behaviors are provided using a 6-point criterion hierarchy ranging from 0 (unacceptable) to 5
(excellent). Teacher-provided points are exchanged for backup reinforcers in school or at home
as in a standard token reinforcement system.
 3. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 43

Once target behaviors improve, students are trained to evaluate their own behavior using
the same criteria. At this stage, the teacher’s ratings continue to be used to determine how many
points students have earned. In addition, students can earn a bonus point for matching teacher
ratings exactly. If the student ratings deviate by more than one point from the teacher ratings, then
no points are earned for that interval. Thus, contingencies are associated with both behavioral
improvement and rating one’s performance in a manner similar to the teacher.
Over the course of time, the teacher ratings are gradually faded such that the student rat-
ings are the primary arbiter for earning backup reinforcement. This is facilitated by (a) the use
of random “matching challenges” that occur on a periodic basis, and (b) the gradual reduction
in frequency of these matching challenges. For example, the initial cutback in teacher ratings
may involve a matching challenge that occurs every other day, on the average. Then, the teacher
matches are faded to every third day, once weekly, and once biweekly, on the average. If, at any
point in time, the student’s performance deteriorates and/or the teacher suspects inflation of stu-
dent ratings, then matching challenges are conducted more frequently.
In the program described by Rhode, Morgan, and Young (1983), the students eventually
employed self-ratings only with no backup reinforcers. This led to maintenance of significant
behavioral improvements across resource and regular classroom settings. This self-reinforcement
system has been extended to children with ADHD and related disruptive disorders in elementary
(Hoff & DuPaul, 1998), middle (Shapiro, DuPaul, & Bradley-Klug, 1998), and high (Smith,
Young, Nelson, & West, 1992) school settings. A critical variable influencing the success of these
procedures is the continued use of external reinforcers contingent on student ratings.

Assessment of Behavioral Function

When possible, consequent-based interventions should be designed using functional assessment

data (O’Neill, Horner, Albin, Sprague, Storey, & Newton, 1997). Initially, a small number of
clearly defined behavioral targets likely to have an impact on academic functioning should be
selected. Next, functional assessment data should be used to determine the contingencies main-
taining the target behaviors. In most cases, the intervention should include frequent and imme-
diate positive reinforcement and/or response cost. Ideally, the specific consequences used in an
intervention should be matched to the presumed function of the target behavior. For example, if
a student with ADHD appears to be talking out of turn and disrupting the activity of classmates
to gain peer attention, then the intervention should include the provision of peer attention contin-
gent on appropriate behavior (e.g., through the use of peer tutoring). Presumably, an intervention
that includes consequences matched to the function of behavior will be more effective than one
designed through a trial-and-error approach (i.e., that does not consider behavioral function).
Although, in general, research findings in support of this critical assumption have been equivocal
(for review see Ervin, Ehrhardt, & Poling, 2001), several single subject design studies that in-
cluded students exhibiting ADHD symptoms (e.g., Eckert, Martens, & DiGennaro, 2005; Ervin,
DuPaul, Kern, & Friman, 1998; Northup & Gulley, 2001) have highlighted the value of an assess-
ment-based approach to intervention design. Finally, data (e.g., systematic direct observations
of behavior) should be collected on a regular basis to assess the effects of interventions and to
determine modifications that might be necessary.

SOCIAL RELATIONSHIP INTERVENTIONS

According to Barkley (2006), approximately 50% of children diagnosed with ADHD have con-
siderable problems in their social relationships with other children. In fact, social difficulties are
44 DUPAUL, RUTHERFORD, AND HOSTERMAN

so prevalent that some investigators have argued that disturbed peer relations should be a defin-
ing feature of the disorder (Gentschel & McLaughlin, 2000; Landau, Milich, & Diener, 1998).
Certain characteristics of ADHD, such as having difficulty taking turns; often interrupting and
intruding on others in games, in conversations, and classroom discussions; and the frequent ten-
dency to appear not to be listening when spoken to (American Psychological Association, 2000)
contribute to social skills problems. As a result of these problems, children with ADHD often are
rejected by their peers (Hinshaw, 1992), have fewer friends (Hoza et al., 2005), show low levels
of social competence (Campbell, 1994), and often exhibit aggressive behaviors (Campbell &
Ewing, 1990).

Social Skills Training

Although social skills trainings (SST) seem a logical solution to these difficulties, many common
training strategies do not produce successful outcomes for children with ADHD. This may be due
to the fact that many SST address social skills deficits, when many children with ADHD primar-
ily have performance deficits (Barkley, 2006). That is, the student may know the appropriate rule
for interaction, but fail to follow that rule in natural settings. Therefore, interventions designed
for children with ADHD should focus on reinforcing their use of appropriate social skills and
teaching them to use existing skills in various contexts (Stormont, 2001). Although traditional
programs produce gains during SST sessions, research shows these changes rarely translate into
natural settings (Gresham, 2002). Thus, particular attention must be paid to programming for
generalization of skills.
It is also important to target and prioritize behaviors based on individualized assessment. For
example, observations and rating scales (e.g. Social Skills Rating System (SSRS); Gresham &
Elliott, 1990) from multiple informants are valuable tools for determining key areas of need for a
particular student (Colton & Sheridan, 1998; Stormont, 2001). Students with ADHD often require
assistance with the following target social skills: cooperation, problem solving, recognizing and
controlling anger, assertiveness, conversations, and accepting consequences (Antshel & Remer,
2003).
Multicomponent SST programs are most successful for students with ADHD. Key features
of such programs include modeling, behavioral rehearsal, self-monitoring, reinforcement, and
parent/teacher training. During modeling, adults demonstrate use of inappropriate behavior and
ask students to identify mistakes and positive alternatives. Next, adults perform the skill appro-
priately, incorporating suggestions from students. Behavioral rehearsal involves role-playing, in
which students attempt the desired skill while receiving positive reinforcement and construc-
tive feedback from peers and adults. Practice continues until students achieve a certain level of
proficiency with the new skill. Ang and Hughes (2002) showed outcomes are influenced by SST
group membership, with greater improvements associated with diverse peer groups (e.g., includ-
ing children with and without problem behaviors).
Inattention and impulsivity often prevent children with ADHD from considering different
behavioral options or associated consequences before they act (DuPaul & Weyandt, 2006). Self-
monitoring offers a practical method for addressing this performance deficit. After practicing the
target skill during SST sessions, students are asked to observe and track their use of this skill in
natural environments. For example, students may rate performance of the skill (whether the skill
was used, whom? the skill was used with, when it was used, and how it went). In addition, students
may assign a number rank (e.g., on a scale from 1 to 5) describing how they felt they performed in
a particular setting (recess, lunch) (Sheridan, Dee, Morgan, McCormick, & Walker, 1996).
Self-monitoring systems should be accompanied by a reinforcement system. Many students
 TABLE 3.3
Social Relationship Interventions for Students with ADHD

Intervention type Key features Outcomes Benefits

Social Skills Training Reinforce appropriate use of social skills Improvements in assertion skills Positive peer interactions
Practice existing social skills in context (e.g. lunch, recess, Gains in social entry/initiation Decreased conflict
free time) behavior
Program for generalization (e.g. discuss upcoming Positive cooperative interactions
situations) with peers
Select target behavior based on individual’s specific needs Improved ratings of overall social
Common areas of need: cooperation, problem solving, skills
recognizing and controlling anger, assertiveness,
conversation, accepting consequences
Modeling both inappropriate & inappropriate examples of
skill
Behavioral rehearsal (students attempt skill & receive
feedback/reinforcement)
Self-monitoring (students observe/track use of skill in
natural environment)
Reinforcement (home-school communication logs; earning
points; specific praise)
Include parent and teacher training (groups sessions,
videotaped modeling, role-plays)
Use diverse peer groups (e.g. students with and without
social skills concerns)
Peer Mediated Playground monitors to manage conflict resolution Reductions in playground Does not require adult presence
Interventions Peer coaches to help students select daily goals, provide violence and negative interaction Easy to use during unstructured
reminders of goals, offer feedback, and rate success Increased use of appropriate social times
Peer buddies (pairing students to encourage interaction and skills during academic and Positive peer interactions
shared time) unstructured settings
Higher quality friendships
3. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
45
 46

TABLE 3.4
Academic Interventions for Students with ADHD

Intervention type Key Features Outcomes Benefits

Peer Tutoring Steps: Improved on-task behavior Frequent and immediate feedback
DUPAUL, RUTHERFORD, AND HOSTERMAN

1. Class divided into two teams and pairs within teams Improved academic performance Increased opportunity of active
2. provide academic “scripts” (e.g. questions and correct Reduced off-task behavior responding
responses) One-to-one ratios
3. students take turns as tutor and tutee Self-paced instruction
4. praise and points for correct responses Continuous prompting for
5. errors lead to immediate correction and practice of response
correct answer Added social benefits
6. teachers provide bonus points for following appropriate Maximizes instructional time
procedures
7. team with most points “wins” and receives applause
Computer-Assisted Target specific instructional objectives Increases in academic performance Active student involvement
Instruction (CAI) Visually highlight key facts Decreases in off-task and Increased student motivation
Immediate feedback for response disruptive behavior Minimal teacher time
Provide concrete examples Increased academic engagement
Models item completion
Elaborating tasks through step-by-step instruction
Shortening of assignments
Modification of Academic Eliminate irrelevant cues (e.g. decrease visual stimuli, Increased attention Simple and cost-effective
Tasks & Instruction work in isolated locations) Greater motivation strategies
Highlighting relevant information (e.g. color, bold text, Increase alertness Benefits both behavior and
animation) academics
Global explanations on essential task elements prior to
introduction of more specific details
Match academic tasks to ability
Interperse low interest, passive tasks with active, high
interest tasks
Motoric responding
Breaks for physical exercise
Brief academics assignments presented one at a time
Frequent and active student participation
e.g. Direct instruction
Enthusiastic teaching style
Self-monitoring Teach student to accurately recognize & discriminate Increases in on-task behavior, Inexpensive
examples and non-examples of behavior engagement, academic accuracy, Requires minimal teacher time/
Student makes record of targeted behavior work quality, & assignment supervision
Have student self-monitor either on-task time (e.g. “Am I completion Unobtrusive
paying attention”) or academic productivity (e.g. “Did I
complete my work?”)
3. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
47
48 DUPAUL, RUTHERFORD, AND HOSTERMAN

with ADHD will need intense levels of reinforcement to produce the desired social behavior,
particularly in challenging settings (Barkley, 2006). Home-school communication logs offer one
method for tracking and reinforcing use of specific target behaviors in school settings. Student’s
self-monitored ratings of behavior can earn points, which are then exchanged for reinforcers at
home. Examples might include small prizes, favorite activities, and special time with friends and
family (Colton & Sheridan, 1998). Specific praise for use of appropriate social skills is also re-
inforcing. When providing specific praise, the parent or teacher should use the child’s name and
clearly describe the desired behavior.
Parent and teacher trainings provide adults with the skills they need to support lessons
learned in SST. Adults learn to guide and support the student’s efforts to resolve social chal-
lenges. Key components of parent involvement include discussing the importance of social skills
and social status, and reviewing the specific skills addressed in their child’s SST (Pfiffner, Cal-
zada, & McBurnett, 2000). This includes determining when adult intervention is needed and
when students should manage difficult social situations using recently learned skills. Parents and
teachers can also help students set goals for social performance. Including parents and teachers
in SST may support generalization of skills to everyday social situations. Parent training might
include group sessions, written materials, video-taped modeling, role-playing, and homework
assignments (Colton & Sheridan, 1998).
SST incorporating parent and teacher involvement have produced positive effects on social
skills in students with ADHD. Many research studies demonstrating the success of SST have
been conducted in clinic-based settings. Antshel and Remer (2003) found SST led to improve-
ments in parent and child-perceived assertion skills, but did not impact other domains of social
competence. Sheridan et al. (1996) showed SST lead to gains in social entry behaviors, however,
treatment effects for maintaining interactions and problem solving skills were more variable. Stu-
dents enrolled in a clinic-based study featuring a home-school communication component also
experienced improvements in the school setting (Pfiffner & McBurnett, 1997). Similarly, Colton
and Sheridan (1998) used a conjoint behavioral consultation model, which involved collabora-
tion between parents and teachers. Results showed increases in positive cooperative interactions
with peers and improvements on SSRS ratings. Although more research is needed to demonstrate
the effects of SST on school behavior, these studies suggest collaboration between parents and
teachers supports greater improvements in school.

Peer Mediated Interventions

The ultimate goal of social skills interventions is to help students with ADHD become more
accepted and well-liked among peers. Thus, including peers in intervention efforts is crucial
to ensuring appropriate generalization. Cunningham and Cunningham (1998) developed a peer
mediated strategy in which students acted as playground monitors who managed conflict reso-
lution sessions. Results showed reductions in playground violence and negative interactions.
In addition, Plumer and Stoner (2005) investigated the effects of classwide peer tutoring with
and without a peer coaching component. Classwide peer tutoring produced improvements in
positive social behavior during academic activities, however, effects did not generalize to social
situations. With the addition of peer coaching, students showed improvements during recess,
lunch, and academic activities. During peer coaching, students were matched with a coach who
generally exhibited positive social behaviors. Coaches helped students to set daily social goals,
provided reminders of the goal, offered positive feedback about student efforts, and rated success
in meeting the goal. This peer component extends intervention into social situations where adults
are typically not present.
 3. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 49

Another type of peer-mediated intervention focuses on helping students form dyadic friend-
ships (Hoza, Mrug, Pelham, Greiner, & Gnagy, 2003). In this study, students enrolled in a larger
summer treatment program were paired with a buddy. Buddy pairs received special privileges,
and parents were encouraged to support contact with buddies outside of camp. Initial results
indicated that when parents complied with the program, students experienced higher quality
friendships and greater improvement in teacher ratings of social behaviors. Although this study
occurred during a summer program, the strategy could be implemented in classroom settings
relatively easily.

Academic Interventions

Most children with ADHD tend to struggle academically, both in their work productivity and
their academic achievement (DuPaul et al., 2004). In all, up to 80% of children with ADHD
have been found to exhibit academic performance problems (Cantwell & Baker, 1991). Teachers
and parents report that children with ADHD underperform relative to their own abilities as well
as compared to their classmates (Barkley, 2006). This may be due, in part, to the low academic
engagement rates and the inconsistent work productivity evidenced by children with ADHD
(DuPaul & Stoner, 2003; Vile Junod et al., 2006). However, addressing behavioral problems
alone may not result in academic improvements without interventions directly targeting aca-
demic concerns (DuPaul & Eckert, 1997). Suggested academic interventions for students with
ADHD include peer tutoring, computer-assisted instruction, modifying tasks or instruction, and
self-monitoring.

Peer Tutoring

Peer tutoring is a strategy in which two students work together on an academic activity. Features
of peer tutoring of include frequent and immediate feedback on performance, active responding,
one-to-one student-teacher ratios, self-paced instruction, and continuous prompting for response
(Pfiffner, Barkley, & DuPaul, 2006). Although various models of peer tutoring exist, research
on students with ADHD has focused largely on ClassWide Peer Tutoring (CWPT) (Greenwood,
Delquadri, & Carta, 1988).
Research has shown CWPT improves skills in reading, mathematics, and spelling for stu-
dents at all levels of achievement (Greenwood, Maheady, & Delquadri, 2002). This peer tutoring
approach consists of several key steps and characteristics. First, the class is divided into two
teams and tutoring pairs are formed within each team. Students are then given academic scripts
(e.g., questions with correct responses) and take turns as tutor and tutee. Throughout tutoring stu-
dents deliver praise and points to their peer partner contingent on correct responses. When errors
occur, students are given immediate correction and the chance to practice correct answers. Teach-
ers monitor tutoring pairs and provide bonus points for following procedures appropriately. At
the end of each tutoring session, points are totaled and students with the most points are declared
the winner. Sessions total 25 minutes, with 5 minutes designated for recording student progress.
Instead of exchanging points for back-up reinforcers, the team with the most points is applauded
by their peers at the end of the week.
Although few empirical studies have investigated the use of CWPT with populations of
students with ADHD, evidence suggests its effectiveness. DuPaul and Henningson (1993)
found CWPT improved on task behavior and acquisition of mathematics skills in one student
with ADHD. In a larger study, DuPaul, Ervin, Hook, and McGoey (1998) investigated results
of CWPT in a sample of 18 elementary school-aged students with ADHD. A within subject,
50 DUPAUL, RUTHERFORD, AND HOSTERMAN

repeated measures design was used. Data on behavior and academic performance were collected
across two alternating baseline and CWPT conditions. Tutoring targeted either math or spelling
based on the target child’s area of concern. Target students were paired with tutors who were
performing on grade level in all academic subjects and exhibited appropriate classroom behav-
ior. Results of DuPaul et al. (1998) showed a reduction in off-task behavior for most students.
Additionally, CWPT lead to improvements in actively-engaged on-task behavior and academic
performance on typical classroom assessments. Non-ADHD comparison students also experi-
enced improvements in both academic performance and behavior. Plumer and Stoner (2005) also
showed CWPT to be effective in improving student behavior during academic activities. In sum,
research suggests CWPT is a valuable strategy for addressing not only academic concerns, but
also the off-task, disruptive behavior of students with ADHD.

Computer-Assisted Instruction

Many features of computer-assisted instruction (CAI) are well-suited to students with ADHD
and may encourage increased attention and focus on academic material (Lillie, Hannun, & Stuck,
1989; Torgesen & Young, 1983). CAI offers an easy and efficient way to use multiple sensory
modalities, divide academic content into smaller pieces of information, target specific instruc-
tional objectives, visually highlight key facts, and offer immediate feedback on each response
(DuPaul & Weyandt, 2006). Such characteristics demand active student involvement in learning
and may increase student motivation (Fitzgerald, 1994). CAI supports instructional modifica-
tions including providing concrete examples, modeling of item completion, elaborating tasks in a
step-by-step fashion, and shortening assignments, all of which may benefit students with ADHD
(Bender & Bender, 1996).
Few well-controlled experimental studies have examined the effectiveness of CAI in stu-
dents with ADHD; many investigations have limited sample sizes, insufficient outcome mea-
sures, and poor selection procedures (Xu, Reid, & Steckelberg, 2002). However, results of three
well-designed empirical studies indicate the benefits of CAI for students with ADHD. Ota and
DuPaul (2002) used a multiple baseline design to examine the effects of a game-based mathemat-
ics software package (Math BlasterTM) on three students with ADHD. Data on behavior and math
performance were collected using direct observations and curriculum based measurement. Re-
sults showed all participants exhibited increases in math performance, with two students showing
pronounced improvements. Additionally, students showed decreases in off-task and disruptive
behaviors and increases in active engagement during computer-based instruction as compared to
typical classroom lessons. Mautone, DuPaul, and Jitendra (2005) also demonstrated the effective-
ness of CAI in improving math performance and behavior in three children with ADHD. Clarfield
and Stoner (2005) investigated the benefits of a reading-based computer program (HeadsproutTM)
in three students in ADHD. Results showed the program produced increases in both oral reading
fluency and task engagement. These studies suggest CAI offers a valuable and practical tool for
increasing on-task behavior, decreasing disruptive off-task behaviors, and possibly improving
academic performance of students with ADHD.

MODIFYING ACADEMIC TASKS AND INSTRUCTION

Many characteristics of academic tasks, instruction, and curriculum can be tailored to the unique
needs of students with ADHD. Zentall (2005) reviewed evidence based interventions for increas-
ing attention to academic tasks in children with ADHD. Changes in academic tasks such as elimi-
 3. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 51

nating irrelevant cues and highlighting relevant information can benefit children with ADHD.
For example, irrelevant cues may be eliminated by decreasing visual stimuli that compete with
practice or listening tasks or allowing students to work in more isolated locations during more
complex tasks. Teachers may use color, bold text, animation, or verbal cues to focus attention to
relevant information. It is best to add non-relevant details like color and animation after students
have initial practice with main concepts, as these details may be distracting from key content
(Zentall, 2005). In addition, students with ADHD benefit from global explanations and exposure
to the essential elements of tasks and concepts prior to considering finer details.
Instructional format and style can also be altered to improve attention and performance in
students with ADHD. Academic tasks should be carefully matched to the student’s abilities and
interests. Interest and motivation improve when presentation formats and tasks materials are
varied, for example by interspersing low-interest, passive tasks with high-interest, active tasks
(Zentall, 2005). Increasing opportunities for motoric as opposed to passive responses is also
beneficial (Zentall, 1993). Similarly, planning periodic breaks for physical exercise (e.g. jumping
jacks, conga lines, movement songs) throughout instruction may increase alertness and attention
(Pfiffner & Barkley, 1998). Academic assignments should be brief and presented one at a time to
accommodate shorter attention spans. A teaching style that is enthusiastic, task-focused, includes
brief teacher-directed segments, and allows for frequent and active student participation can also
enhance learning. For example, direct instruction provides multiple opportunities for students to
acquire and practice new skills (DuPaul & Weyandt, 2006).

Self-Monitoring

The strategy of self-monitoring assigns two responsibilities to individuals receiving intervention.

First, they must accurately recognize and discriminate instances of their target behavior. Second,
they must create a record of these occurrences (Korotisch & Nelson-Gray, 1999). In this way, self-
monitoring teaches individuals to track and manage their own behavior or performance. Research
has shown self-monitoring to be effective in increasing on task behavior (Edwards et al., 1995),
task engagement (Dunlap et al., 1995), academic accuracy (Lam, Cole, Shapiro, & Bambara, 1994),
work quality (Moore, Prebble, Alexson, Waetford, & Anderson, 2001), and assignment completion
(Brooks, Todd, Tofflemoyer, & Horner, 2003). In a meta-analysis of self-regulation interventions
applied to children with ADHD, Reid and colleagues (2005) concluded that self-regulation inter-
ventions can produce significant improvements in academic productivity and accuracy.
Two approaches to self-monitoring have been shown effective in increasing academic per-
formance. Students can either monitor on-task behavior or academic productivity. Research has
indicated that self-monitoring of on-task behaviors is effective in increasing time spent engaged
in the academic task. However, studies also suggest that academic on-task time may not necessar-
ily translate to improved academic performance (DiGangi, Maag, & Rutherford, 1991). Indeed,
when Reid (1996) reviewed 17 studies examining self-monitoring and academic productivity he
concluded the effects were “equivocal.” For the purpose of intervention, practitioners should not
assume that improvements in on-task time are benefiting academic outcomes. Although it is often
appropriate to monitor on-task behavior alone to ensure that students are not missing academic
material, alternate strategies (e.g., self-monitoring of work productivity and/or accuracy) may be
needed to address academic goals. In addition, self-monitoring systems that feature either a self-
reinforcement or external reinforcement component may be more effective than those without
such a component.
Interventions directed toward students with ADHD often address behavioral concerns alone,
because these issues are most disruptive. However, improving levels of attention and reducing
52 DUPAUL, RUTHERFORD, AND HOSTERMAN

levels of off-task behaviors will not necessarily lead to increased levels of academic performance.
Therefore, direct academic and instructional modifications should be included in a comprehen-
sive treatment plan. One benefit of the instructional modifications and interventions detailed
above is that they are relatively simple to implement. In addition, these strategies produce aca-
demic benefits for all students, not only those with ADHD, and represent best practice in class-
room instruction.

CONCLUSIONS AND FUTURE DIRECTIONS

ADHD is a disorder of early onset that affects a significant percentage of school-aged children
and adolescents in the United States. As a function of the core symptoms of ADHD, students with
this disorder experience significant difficulties with academic achievement, peer relationships,
and responding appropriately to authority figures. The risks associated with this disorder are par-
ticularly relevant to important school outcomes (e.g., successfully completing high school) and
imply the need for multiple interventions over extended periods of time. Although psychotropic
medications, particularly stimulants, are effective in reducing ADHD symptoms, this treatment
approach is typically not sufficient for addressing all of the difficulties attendant to this disorder.
Over the past several decades, considerable empirical evidence has been gathered to sup-
port the use of behavioral strategies in treating students with ADHD. Effective interventions can
include the modification of antecedent and/or consequent events to increase the probability of
desired behaviors occurring. More recently, promising evidence has been gathered to support the
use of specific strategies to enhance academic and social functioning of students with ADHD.
School-based strategies are enhanced when (a) treatment decisions are made on the basis of
data (e.g., functional assessment), (b) multiple mediators of intervention (e.g., teachers, peers,
parents, and students themselves) participate in treatment planning and implementation, and (c)
a balanced treatment plan that includes both antecedent and consequent-based interventions is
used.
Significant advances in our understanding of effective school-based interventions for stu-
dents with ADHD have taken place over the past two decades. Nevertheless, several key areas
must be addressed by future empirical studies. First, larger scale studies must be conducted in
“real world” public school settings. Most of the available research has included relatively small
samples studied under very controlled conditions (e.g., summer treatment program classrooms).
Thus, the degree to which these interventions are effective and feasible in general education
classrooms (i.e., where most students with ADHD are placed) has not been established.
Second, more studies need to be conducted in secondary school settings as there is a critical
need for middle and high school personnel to know how to address the myriad difficulties faced
by students with ADHD. Currently, there are less than a dozen investigations of school-based
interventions for adolescents with this disorder.
Third, little is known about how best to support students with ADHD as they make the transi-
tion from high school to college or to the workforce. This is a critical issue given that teenagers
with this disorder are at higher than average risk for school drop-out and are less likely to go on
to college than their peers. Further, adults with ADHD tend to complete less schooling and attain
lower occupational rankings than control subjects (Mannuzza, Gittelman-Klein, Bessler, Malloy,
& LaPadula, 1993). For those high school students with ADHD that do pursue a college de-
gree, preliminary studies suggest they are at greater risk for psychological and adjustment prob-
lems, neuropsychological impairments, and problems with internal restlessness (Heiligenstein,
Guenther, Levy, Savino, & Fulwiler, 1999; Weyandt, Iwaszuk et al. 2003; Weyandt, Mitzlaff, &
 3. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER 53

Thomas, 2002). Thus, specific programs to identify and address the school-to-college or school-
to-work needs of students with ADHD need to be developed and evaluated.
Finally, although effective school-based interventions are available, little is known about
how to help teachers and other school personnel adopt these strategies on a consistent basis in
classroom and other school settings. In other words, the optimal way for school psychologists
and other related services personnel to consult with teachers in order to enhance treatment ac-
ceptability and integrity is unclear. Given that relatively low rates of treatment integrity are the
rule rather than the exception for school-based interventions (e.g., Gresham, Gansle, Noell, Co-
hen, & Rosenblum, 1993), methods to enhance the feasibility and use of effective interventions
must be developed and evaluated.

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 4
Disruptive Behavior
Carl J. Liaupsin and Terrance M. Scott

It is common for teachers and other school personnel to describe challenging student behavior as
one of the most significant issues in education. In fact, teachers report that challenging student
behavior is the most difficult and stressful aspect of their job (e.g., Furlong, Morrison, & Dear,
1994; Kuzsman & Schnall, 1987; Safran & Safran, 1988). Further, they report that the most
distracting and time-consuming problem behaviors are not necessarily the most intense, but the
most frequent (Sprague & Walker, 2000). The most frequently cited problem behaviors include
simple non-compliance and disrespectful interaction that disrupt the learning routine. Perhaps the
most difficult type of behavior that teachers are asked to deal with are those that are considered
“disruptive.” These include student acts that range in severity from mild forms such as “talking-
out” and “interrupting” to more serious forms such as “fighting,” “theft,” and “bullying.” Disrup-
tive, aggressive, and anti-social behaviors can have a range of problematic outcomes for teachers,
administrators, and students.
With increasing frequency, students with emotional and behavioral disorders (EBD) are be-
ing included in general education classrooms (e.g., Cheney & Barringer, 1995; McLeskey, Hen-
ry, & Hodges 1999; Sawka, McCurdy, & Mannella, 2002). Representing only one to five percent
of the student population, these students typically account for more than half of the school’s
discipline referrals (Sugai, Sprague, Horner, & Walker, 2000; Taylor-Greene et al., 1997) and, as
this population increases, there is an increasing demand for teachers who possess the skills and
abilities to effectively work with these students (Sawka et al., 2002). One thing is clear; simple
inclusion in a general education classroom will not, by itself, change these students’ behaviors
(Cartwright, Cartwright, & Ward, 1988; Gable, McLaughlin, Sindelar, & Kilgore, 1993).
Teachers clearly find disruptive behaviors to be among the most difficult problems to man-
age in their daily activities. In a survey of inner-city schools, teachers identified various forms of
disruptive behavior as accounting for 80% of the disciplinary and mental health problems within
their schools (Walter, Gouze, & Lim, 2006). Unfortunately, teachers often report that they do not
have the ability to keep defiant students involved in instruction or to prevent such behavior from
disrupting the instruction (Baker, 2005). Ultimately, such problems can have the effect of forcing
many teachers to leave the profession (Scheckner, Rollins, Kaiser-Ulrey, & Wagner, 2002).
Disruptive behavior can also put heavy demands on the work of school administrators.
For example, aggression has been found to be the most common reason for administrators to
recommend that students be suspended (Costenbader & Markson, 1994), while comparatively
minor forms of disruptive behavior (e.g., lack of cooperation, insubordination, verbal abuse,
and inappropriate language), tend to be the most common reason for students to be referred for
59
60 LIAUPSIN AND SCOTT

administrative discipline (Skiba, Peterson, & Williams, 1997). A recent study of office referral
rates found elementary schools averaging 567 office referrals per year, while middle and junior
high schools averaged over 1500 office referrals (Sugai et al., 2000). One study (Scott & Bar-
rett, 2004) found that the average office discipline referral usurped an average of 20 minutes of
administrator time while suspensions averaged 45 minutes. This suggests that elementary school
administrators may be expending hundreds of valuable hours each school year dealing with dis-
ruptive behavior, with middle/junior high administrators spending even larger amounts of time
dealing with challenging behavior.
The effect of disruptive behavior on the students who exhibit such behavior must also be
considered. The outcomes for students who exhibit disruptive and anti-social behavior in school
and other environments are grim. These students are likely to have negative educational and
social experiences that can lead to life-long problems. In school, they experience greater levels
of negative interactions with teachers and students (Shores et al., 1993), spend less time on
instructional activities (Carr, Taylor, & Robinson, 1991), spend more time in restrictive educa-
tional settings, and are at higher risk for leaving school before graduating (Snyder, 2001). Once
out of school, they are at high risk for a range of negative outcomes, including unemployment,
use of drugs, and high rates of criminal offending (Loeber et al., 2000).
Given the broad negative outcomes that disruptive behavior holds for students, staff, ad-
ministrators, and the school as a whole, there is a need to identify interventions that have shown
effectiveness in reducing disruptive behavior in schools. This chapter focuses on evidence-based
interventions for students who exhibit disruptive behavior. The chapter begins by describing
the range of terms and behaviors that describe and characterize children who exhibit disruptive
behavior. Next, a broad range of interventions are discussed in a format that strongly suggests a
multi-level preventive approach to dealing with issues of disruptive behavior.

DEFINITIONS AND CHARACTERISTICS

This section describes a variety of terms that are used to refer to youth who exhibit disruptive
behavior and delineates the specific behavioral characteristics of these students

Emotional Disturbance

Some children who exhibit chronic disruptive behavior in school qualify to receive special edu-
cation services under the Individuals with Disabilities Education Act or IDEA (U.S. Office of
Education, 1976). The federal term emotional disturbance (ED) is a softening of the original term
seriously emotionally disturbed that was abandoned in the 1997 reauthorization of the act. Many
states have chosen to further soften the term in ways that they generally believe are less stigma-
tizing. The most common alternative terms for the same category are emotional and behavioral
disordered (EBD) and behaviorally disordered (BD). Children in any of the 13 categories of
disability defined in IDEA may display disruptive behavior at one time or another. However, chil-
dren for whom behavior problems are determined to be the major cause of educational difficulties
are identified in the category of ED. The definition of ED that is included in federal law is based
on research originally conducted by Eli Bower in the 1950s (Bower, 1982). Other than the 1997
change in terminology, few changes have been made to the federal definition of ED since it was
first included in the law in 1975. The definition of ED states:

(i) The term means a condition exhibiting one or more of the following characteristics over
 4. DISRUPTIVE BEHAVIOR 61

a long period of time and to a marked degree that adversely affects a child’s educational
performance:
(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors
(B) An inability to build or maintain satisfactory interpersonal relationships with peers
and teachers.
(C) Inappropriate types of behavior or feelings under normal circumstances.
(D) A general pervasive mood of unhappiness or depression.
(E) A tendency to develop physical symptoms or fears associated with personal or school
problems.
(ii) The term includes schizophrenia. The term does not apply to children who are social-
ly maladjusted, unless it is determined that they have an emotional disturbance. (CFR
§300.7 (a) 9)

As can be seen, only a few of the five characteristics of this definition are directly related to
what might be considered as disruptive, aggressive, or anti-social behavior. However, it is gener-
ally accepted by researchers and school staff that disruptive, aggressive, and anti-social behaviors
are more likely to result in a label of ED than behaviors typically associated with anxiety and
withdrawal (Kauffman, 1997). While this may indeed be the case, recent research demonstrates
that children identified as ED are likely to exhibit chronic behavior associated with all of the 5
characteristics included in the definition (Joe & Flannery, 2002).
While researchers have suggested that the actual number of children who require services in
this area of special education ranges from 2% to 20% (Kauffman, 1997), children identified as
ED make up 0.73% of all youth ages 6–21 and 8.16% of all children receiving special education
services (U.S. Department of Education, 2004). Both gender and ethnicity appear to mediate the
identification of youth in the category of ED. While few studies have found reliable gender differ-
ences regarding the characteristics of ED among school-age children (Cullinan, Evans, Epstein,
& Ryser, 2003), males are more likely to be identified as ED than are females (Kauffman, 1997).
Black youth are more likely to be identified as ED than are whites (Cohen & Osher, 1994) and
white students are more likely to be identified as ED than are Hispanic students (Artiles, Rueda,
Salazar, & Higareda, 2005). Exactly how issues of gender and ethnicity interact with the defini-
tion of ED is complex, not well understood, and continues to be explored by researchers.
The federal definition of ED has been roundly criticized for a number of reasons. First, many
leaders in the field of special education have taken issue with the exclusion of children who are
socially maladjusted from this category. This term refers to children whose behaviors manifest
from a home life in which either behavioral skills have not been taught or more basic needs have
interfered with acquisition of social norms. Many argue that definitions of social maladjustment
are imprecise and that any child who would fit a definition of social maladjustment should also
satisfy the criteria for ED (Bower, 1982; Kauffman, 1997). On the other hand, Merrell and Walker
(2004) describe research suggests that it is possible to distinguish between children who are so-
cially maladjusted and those who exhibit characteristics of ED. However, these researchers con-
cluded that while it may be possible to make such a distinction, children with problem behaviors
are best served by not distinguishing between ED and social maladjustment.

Psychiatric Diagnoses

Psychiatrists, psychologists, and other licensed mental health professionals use the Diagnostic and
Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association,
1994) to diagnose the existence of mental disorders, determine effective treatment options, and
62 LIAUPSIN AND SCOTT

gather valuable public mental health statistics. Disruptive behavior could be considered as part of
the criteria in many diagnostic categories. However, youth who exhibit disruptive, aggressive, and/
or anti-social behavior are likely be diagnosed as having a conduct disorder (CD) or oppositional
defiant disorder (ODD). It has been estimated that one or both of these disorders can be found in
between 2% and 16% of all children in the United States (Eddy, Reid, & Curry, 2002)
The distinction between ODD and CD is generally related to the severity of behavior, with
ODD representing a “milder form” of CD (Conner, 2004). ODD refers to a recurrent pattern of
negativistic, defiant, disobedient, and hostile behavior toward authority figures. A youth is con-
sidered to exhibit a CD if he shows a persistent pattern of behavior that violates the basic rights
of others or major age-appropriate societal norms. The criteria in the DSM-IV include a long list
of behaviors that typify a person who exhibits a CD. These include theft, deceitfulness, physical
cruelty to animals or people, destruction of property, and serious rule violations (Loeber et al.,
2000). Diagnosis of both ODD and CD are not based on individual behavioral events, but when
the behaviors occur over time with a significant intensity.
Two to three times more boys than girls are diagnosed with CD and ODD (Kann & Hanna,
2000). The ways in which girls and boys present characteristics of disruptive behavior disorders
may be one reason for this large gender disparity (Kann & Hanna, 2000). That is, girls tend to
exhibit fewer easily identifiable externalizing characteristics, such as fighting, vandalism, and
destructiveness. In addition, boys are at a higher risk than girls of exhibiting both CD and Atten-
tion-Deficit Hyperactivity Disorder (ADHD) (Lumley, McNeil, Herschell, & Bahl, 2002). While
these differences have been described in a number of research studies, CD in girls has not, until
recently, been studied extensively and has been identified as the most common problem for clini-
cally referred girls (Keenan, Loeber, & Green, 1999).

Comorbidity of CD and ADHD

When a youth who is diagnosed with one disorder is found to meet the criteria for a second
disorder, it is referred to as comorbidity (Walker, Ramsey, & Gresham, 2004). Youth with CD
often also meet the criteria for another DSM-IV diagnosis: Attention-Deficit Hyperactivity Dis-
order (Hinshaw, 1987). In fact, these disorders occur together with such frequency that there
has been debate regarding whether they should be classified as different disorders (e.g., Loney
& Milich, 1982). Longitudinal research studies have determined that children who exhibit both
CD and ADHD characteristics are at higher risk on a wide range of problematic socio-behavioral
measures than children who are diagnosed with only CD or ADHD (Gresham, Lane, & Beebe-
Frankenberger, 2005). Children comorbid for CD and ADHD have also been described as being
particularly resistant to intervention. Lynam (1998) has suggested that youth who exhibit this
combination of disorders are at critically high risk for lifelong patterns of aggressive, antisocial,
and criminal behavior. In a comprehensive review of the research conducted from 1990 to 2000
related to ODD and CD, Loeber et al. (2004) note that there has been very little investigation of
the comorbidity of ADHD and ODD.

Juvenile Delinquency

Disruptive behaviors exhibited by youth are considered to be deliquent acts when such behaviors
cause the youth to be arrested by the police and, in turn, become involved with the juvenile jus-
tice court system. Kauffman (1997) describes two key terms that are used to refer to youth who
commit illegal acts of disruptive, aggressive, or anti-social behavior. Index crimes are acts that
are illegal regardless of a person’s age, such as assault, theft, and vandalism. Status crimes are
 4. DISRUPTIVE BEHAVIOR 63

acts that are against the law only because of the age of the person engaging in the behavior. Some
common examples of status crimes are smoking, possessing alcohol, or being truant.
The level of crime in schools is difficult to assess, with most data coming in the form of
self-reports from victims. During the 2002–2003 school year, students reported being the victim
of non-fatal crimes in school at a rate of 72 incidents per 1,000 students (U.S. Departments of
Education and Justice, 2005). Sixty-two percent of these incidents involved theft, while the re-
mainder involved more serious acts such as assault and rape. Over a 5-year period (1999–2003),
teachers reported being the victim of non-fatal crimes at a much lower, but significant rate (39
per 1,000 teachers).
A number of factors have been shown to be associated with the likelihood of youth to become
involved in delinquent acts. These include school failure, early acts of delinquency, substance
abuse, family history of criminality, poverty, and parental disciplinary style (e.g., Kauffman,
2004; Schumaker & Kurz, 2000; Walker, Colvin, & Ramsey, 1995). Youth who have a disability
are particularly likely to become involved with the juvenile justice system (Quinn, Rutherford,
Leone, Osher, & Poirier, 2005). In fact, Jay and Padilla (1987) found that approximately 70% of
youth with ED are arrested within three years of dropping out of school.
Various theories have been proposed to suggest how students with disabilities develop the
tendency to commit acts of delinquency and become involved with the juvenile justice system.
Some researchers have suggested that the student’s disability puts him or her at greater risk of
school failure, leading to a negative self-image, disruptive behavior in school, and ultimately un-
supervised time with other peers when they are suspended, expelled, or drop out of school (Post,
1981). Others have proposed that while students with disabilities commit similar numbers of
delinquent acts as peers without disabilities, the students with disabilities tend to have developed
patterns of interpersonal behavior that lead to greater levels of miscommunication with school
and legal personnel (Leone & Meisel, 1997).

Adaptive and Maladaptive Aggression

In some situations, behaviors that appear disruptive, aggressive, or anti-social are actually an ap-
propriate or, at least, a reasonable and expected response to the environment. For instance, some
people would say that fighting is a reasonable response to being attacked and cursing is a com-
mon response to accidentally hitting your hand with a hammer. To ensure proper identification
and treatment of violent problem behavior, researchers and clinical professionals find it useful
to distinguish between adaptive and maladaptive aggression (Conner, 2004). It is important for
teachers and other personnel who work with children and youth in schools to also consider this
distinction to make accurate decisions during assessment and to determine when intervention is
actually necessary.

School Violence

Perhaps the most alarming expressions of disruptive, aggressive, and anti-social behavior are
the well-publicized and tragic incidents of serious violence and crime that occur in schools.
Prior to the early 1990s, few efforts were made to collect reliable data on serious incidents of
school violence. In fact, it was the occurrence of several high profile violent school events at
that time which focused media, political, and grassroots attention on the issue of school violence
(Furlong & Morrison, 2000). The U.S. Departments of Education and Justice publish a yearly
compendium from several sources called the Indicators of School Crime and Safety (2005) that
provides comprehensive data on disruptive, aggressive, and other behaviors that are considered
64 LIAUPSIN AND SCOTT

as school violence. A review of this source and other data on school violence brings to light some
interesting issues related to disruptive behavior.
Despite the media coverage given to such events, very few incidents of disruptive behavior
result in fatalities or serious crimes at school. For example, data collected since 1992 demonstrate
that students are 70 times more likely to die from violence away from school than at school (U.S.
Departments of Education and Justice, 2005). For instance, during the 2001–2002 school year,
there were 17 homicides and 5 suicides of school-age youth on school property. This represents
less than 1 homicide or suicide per million students enrolled (Figure 4.1) during 2001–2002. In
fact, there has been a decreasing trend in deadly school incidents from across a 10-year period
from 1992–2002. Other serious disruptive, aggressive, and anti-social behaviors classified as
criminal acts have also decreased over the last 10 years.
While the events of school violence seen in the media tend to hold the attention of the gen-
eral public, surveys conducted with teachers, administrators, and students suggest that they may
define school violence in terms that involve less serious forms of disruptive behavior. These stud-
ies have found that behaviors like cursing, grabbing, and verbal threats are considered the most
prevalent forms of violence occurring on school campuses (e.g., U.S. Departments of Education
and Justice, 2005; Petersen, Pietrzak, & Speaker, 1998). These results may explain why, despite
overall decreases in serious violent events in schools, staff and students continue to report con-
stant levels of concern over personal safety (Scott, Nelson, Liaupsin, 2001). This also suggests
that efforts to intervene in milder forms of disruptive behavior may have the effect of reducing
staff and student anxiety regarding safety in school environments.

FIGURE 4.1. Homicides and suicides at home and away from school: 2001–2002.
Adapted from Indicators of School Crime and Safety, U.S. Department of Education and Justice (2005).
Washington, D.C.: NCES 2006001.
 4. DISRUPTIVE BEHAVIOR 65

RESEARCH-BASED INTERVENTIONS

Because the projected outcomes for students with behavioral disorders are so dire, there is little
room for unproven practice as every failed effort decreases the probability of future success. Still,
the adversity surrounding these persons is obvious and becomes a beacon to charlatans who pedal
a variety of gimmicks and programs that appeal to parents and teachers whose frustrations are
transparent and understandable. Despite the existence of a growing body of unproven practices,
a well-documented base of evidence-based practices for dealing with challenging behaviors does
exist. According to Horner, Carr, Halle, McGee, Odom, and Wolery (2005), an educational prac-
tice can be deemed to be evidence-based when it is clearly defined, can be applied with replicable
fidelity, and has been repeatedly documented to have positive effects across a number of studies,
researchers, and participants.
Recent federal priorities have focused on the use of evidence-based practices to improve
social outcomes for students. Although available data indicate an increased probability of life-
long adjustment problems among students with significant behavioral disorders (e.g., unem-
ployment, unwanted pregnancy, imprisonment), research has demonstrated positive outcomes
associated with school-wide prevention efforts built around systemic implementation of effective
instructional practices that include collaboration, consistent application, formative monitoring,
and data-based decision making (e.g., Leedy, Bates, & Safran, 2004; Luiselli, Putman, & Sun-
derland, 2002). In fact, evidence-based practices in the area of disruptive behavior disorders can
be organized into three categories: (1) those that are applied across a system (i.e., school, family,
community), (2) those that are applied to smaller groups of persons who have similar issues with
which to deal, and (3) individualized interventions that are designed to meet the unique needs of
the individual. Consistent with more recent special education conceptualizations and legal man-
dates regarding identification and intervention decision-making, these three categories may be
thought of as a continuum of supports that identifies students in need of more intensive interven-
tion by their lack of response to intervention at more global levels (Gresham, 2001).
Responsiveness to intervention (RTI) is a framework for guiding the use of assessment data
to evaluate the extent to which a student’s achievement meets expectations in response to an in-
tervention. The term intervention is used to refer to (1) the curriculum all students receive at the
broadest level, and (2) progressively tailored, individualized interventions a student may receive
if the student’s progress is not adequate under the general education curriculum. Taking RTI to its
root meaning, effective intervention begins with prevention via effective instructional practices.
Then, through broad assessment, students for whom such efforts are insufficient to facilitate
success are identified for more individualized and intensive instruction. In a reciprocal manner,
intervention and assessment inform one another so that instruction and measurement are dynamic
and individualized processes. While the concept of RTI is most often applied to students with
academic problems, recent research has demonstrated the benefits for students with behavioral
problems, including those who exhibit disruptive behavior. The key features of evidence-based
practice at each of the three levels are discussed below.

System-Wide Interventions

System-wide interventions are those that are applied across an entire system such as a school,
family, or community. Most schools manage to function without structured system-wide pro-
grams in place; the majority of students will be successful regardless, or even in spite of, the qual-
ity of systemic efforts. However, system-wide interventions can provide an important scaffold
for an environment that is organized to deal effectively with disruptive student behavior. In other
66 LIAUPSIN AND SCOTT

words, system-wide interventions are designed to reduce the occurrence of common behavior
problems, allowing scarce school resources (e.g., time, effort, specialized personnel, etc.) to be
directed at the provision of small-group and individualized interventions for students who do not
respond to system-wide practices. System-wide practices have been implemented effectively in
school, home, and juvenile correctional environments and are often effective for a significant
number of students who exhibit disruptive behavior. The emphasis of evidence-based practice
at the system-wide level is on identifying predictable problems, defining and teaching expected
behavior, and creating environments that effectively prompt and respond to behavior, both posi-
tive and negative (e.g., Anderson & Kincaid, 2005; Evertson & Harris, 1992; Mayer, 1995; Scott
& Eber, 2003; Sprick, Sprick, & Garrison, 1992; Sugai & Horner, 1999).

Prevention. A foundational principle of evidence-based practice is the concept that what

can be predicted can be prevented. A number of steps can be taken at the school-wide level to
predict and prevent disruptive behavior. These strategies involve the application both academic and
social interventions. For example, language deficits have long been recognized as a predictor of
academic and social failure; language programming at an early age has been demonstrated to be an
effective prevention strategy for these students (e.g., Kaiser, Xinsheng, Hancock, & Foster, 2002;
Nelson, Benner, & Cheney, 2005). Similarly, it is becoming increasingly clear that literacy deficits
exhibited as early as kindergarten can predict behavior problems well into elementary school
(McIntosh, Horner, & Chard, 2006) and set a pattern for continued failures into high school and
beyond (Fleming, Harachi, Cortes, Abbott, & Catalano, 2004; Greer-Chase, Rhodes, & Kellam,
2002). Furthermore, evidence suggests that effective reading interventions in early elementary
school may result in earlier identification of students with severe problems (e.g., Denton & Fletcher,
2003; Ikeda et al., 2002), fewer students labeled as learning disabled (e.g., O’Connor & Simic,
2002), and fewer behavior problems throughout their school career (e.g., Fleming, Harachi, Cortes,
Abbott, & Catalano, 2004; McIntosh, Horner, & Chard, 2006). Marston, Muyskens, Lau, & Cantor
(2003) also report that early intervention can reduce occurrence of inappropriate identification
of minority students for specialized programming. A growing evidence base supports the utility
of prevention strategies aimed at enhancing the social behavior of students (e.g., Biglan, 1995;
Horner, Sugai, Todd, & Lewis-Palmer, 2005; Lewis & Sugai, 1999). Further, research suggests
that monitoring student behavior using such simple measures as office discipline referral counts is
an effective means of predicting more intense disruptive behavior problems (Tobin & Sugai, 1999)
and identifying students in need of early intervention.

Instruction. The importance of instruction in dealing effectively with disruptive behavior

cannot be overestimated. Effective instruction has been described as the foundation and most
important aspect of any intervention (e.g., Heward, 2003; Scott, Nelson, & Liaupsin, 2001).
Instruction in this sense is most often considered in terms of academics but is applied to all
desired skills and routines, whether academic or social in nature (Taylor-Greene et al., 1997).
For example, schools that teach a simple set of school-wide behavioral expectations to students,
(and establish routines for acknowledging students who follow the rules), have demonstrated
reductions in the overall incidence of disruptive behavior problems (e.g., Lewis, Sugai, & Colvin,
1998; Nelson, Martella, Galand, 1998; Nelson, Martella, & Marchand-Martella, 2002).
Evidence-based instruction involves providing a clear rule relationship (e.g., “you need to do
this when . . .”), offering modeling and guided practice with feedback until acquisition, and then
conducting gradual fading of instruction with regular assessment for mastery (Kame’enui & Sim-
mons, 1990). The logic behind instruction is based on the well-established fact that the more and
better instruction students are exposed to and engaged with, the more they learn (Brophy, 1988;
Rosenshine & Berliner, 1978). In addition, when students are engaged and experiencing success,
 4. DISRUPTIVE BEHAVIOR 67

they are less likely to make errors (academic or social) and to attempt escape from instruction
(McIntosh, Horner, & Chard, 2006) and more likely to have a positive relationship with the teacher
(Carr, Taylor, & Robinson, 1991). In other words, students are less likely to engage in disruptive be-
havior problems that evolve from their inability to engage in the required academic or social task.
In summary, the evidence-base for instruction at the system-wide level describes effective
and consistent use of group instruction (e.g., Nelson, Colvin, & Smith, 1996), the use of prompts
and cues to facilitate success (e.g., Colvin, Sugai, & Patching, 1993), and the development of con-
sistent routines (e.g., Scott, 2001). The literature base suggests that there is no relevant distinction
between effective instruction for academics and social behaviors; both should be planned, consis-
tent, and facilitated in the environment. Finally, effective instruction in both academic and social
behavior can have a positive effect in reducing the occurrence of disruptive behavior in schools.

Performance Feedback. Performance feedback, in the forms of both reinforcement

and error correction, can also serve as an effective school-wide deterrent to the occurrence of
disruptive behaviors. Despite clear evidence that positive feedback is associated with increased
and sustained positive performance (e.g., Cameron, Banko, & Pierce, 2001; Walker, Colvin, &
Ramsey, 1995), studies suggest that teacher praise drops off as grade level increases (e.g., Baker
& Zigmond, 1990; Nowacek, McKinney, & Hallahan, 1990).
It is also often the case that classroom and non-classroom school environments are not con-
ducive to the use of appropriate social or academic behavior. For example, a child is unlikely
to raise a hand in class and wait to be acknowledged during discussions if the teacher regularly
calls on students who call out. From within a system-wide perspective, school staff can reduce
disruptive behavior by developing environments that “trap success” so that positive feedback is
warranted. Effective feedback and effective instruction have elements in common. Like effective
instruction, effective feedback should be proactive, not reactive. To simply sit by and wait for a
child to behave appropriately is no more effective than it would be to sit by and wait for a child to
learn to read. Finally, effective feedback should be a formative activity that begins with instruc-
tion (Scott, Nelson, & Liaupsin, 2001).
Performance feedback, however, involves more than just positive reinforcement. While en-
gineering school-wide environments for success and teaching school-wide expectations can be
expected to reduce the occurrence of disruptive behavior problems, students will continue to
exhibit errors for a number of reasons. To be certain, error-correction in the form of re-teaching
is necessary when the error involves a skill deficit, such as when a student disrupts class because
they do not know an effective skill to use to gain a teacher’s attention. However, re-teaching will
not be sufficient for errors that are not simply skill deficits and, in such cases, feedback may take
a more punitive form. Research indicates that it is illogical and ineffective to address such errors
by simply sitting by and waiting for a correct response. The goal of any negative feedback must
be not only to decrease the undesired response, but also to increase the likelihood of a desired
response. Thus, negative feedback should be instructional in nature and, above all, punitive con-
sequences that do not change behavior must be recognized as ineffective and should be discarded
(Kerr & Nelson, 2006).
Performance feedback can also take the form of extinction. Far from its common description
as “ignoring” disruptive behavior until it goes away, the use of extinction should be considered
as a carefully planned activity that is most effectively implemented in conjunction with posi-
tive performance feedback. For instance, it would be unwise and ineffective to only ignore the
disruptive behavior of students who disrupt a class. Instead, the teacher should implement a
strategy combining three elements; (a) extinction (ignoring call-outs), (b) teaching or re-teaching
of appropriate behavior for gaining teacher attention, and (c) positive performance feedback for
any and all correct attempts to gain teacher attention.
68 LIAUPSIN AND SCOTT

School-wide interventions can be effectively employed to reduce the overall occurrence of

disruptive behavior. However, despite the effective use of school-wide intervention, there will
always be a group of students, (among them many who display disruptive behavior), for whom
these efforts are insufficient to facilitate success. These non-responders will require more inten-
sive and individualized interventions.

Small Group Interventions

If a student is not making progress when the curriculum is effective for most students, supple-
mental intervention is introduced. Intervention at this level (Figure 4.2) involves small group
or simple student-based strategies that are characterized by instruction, frequent monitoring
of student progress, and the promotion of self-management. Evidence-based practices such as
Check-In, Check-Out (Hawken, 2006), social skills instructional groups (Choutka, Doloughty,
& Zirkel, 2004), and First Step to Success (Walker, Golly, McLane, & Kimmich, 2005) can be
implemented. Although differing in both content and application, each of these strategies pro-
vides small-group intervention that is individualized to meet the needs of students who have not
positively responded to school-wide strategies.

Social Skills Instruction. Instruction is perhaps the most effective intervention for students
with behavioral disorders (Scott, Nelson, & Liaupsin, 2001). The concept of instruction puts the
onus of student success squarely on the teacher and may be conceptualized by the phrase, “adult
behavior change must precede student behavior change.” For example, if a student was to provide
the response “4” when asked to solve the problem “2 – 2,” there is no reason to believe that the
response would change in the absence of further instruction. Likewise, when students exhibit
social failure it will be the teacher’s role to provide feedback and instruction to facilitate success
with the next attempt. Continued student failure should not signal teacher fault, but it does signal
responsibility to continue with instruction and to use the most logical strategies available to facilitate

5%

10%
Intensive:
Highly individualized, collaborative,
and proficient interventions

Targeted:
Small-group and other supplemental
interventions

School-wide:
80% Preventing occurrences of disruptive
behavior across all students

FIGURE 4.2. Three-tier model of intervention.

 4. DISRUPTIVE BEHAVIOR 69

success. At the second tier of intervention, prevention continues to be a priority but the focus has
changed to prevent recurrent rather than initial errors. Again, effective instruction includes clear
definition of positive behavior, modeling, and multiple opportunities to practice with feedback
and a gradual move toward independence. Due to the intensity and individualization necessary at
this level, instruction is most efficiently delivered to smaller groups. In the small group context,
individualization is only as fine as the general skills necessary across the group. However, social
interaction skills are fairly general across students and are seen as a key to facilitating success in
the larger school environment. In fact, teachers at primary and intermediate grades report that self-
control and cooperation are equally as important (Choutka, Doloughty, & Zirkel, 2004).

Monitoring. As previously noted, the prognosis for students experiencing disruptive behavior
and social failure is bleak and grows bleaker with each additional failure. As such, there is no room
for continuation of ineffective intervention strategies and teachers must monitor intervention in a
frequent and formative manner. One example of an effective monitoring procedure is Check- in,
Check-Out (Hawken, 2006). This procedure creates a system wherein students must check-in with
teachers after each class or activity and receive feedback on performance Such strategies not only
provide students with multiple opportunities to receive feedback on their performance, but also allow
teachers to monitor performance on a very regular basis and to evaluate the success of social skills
instruction. In a sense, monitoring can be conceived of as a component of effective instruction. That
is, teaching reading or any other academic skill requires curriculum-based assessment to determine
whether instruction is effective. In addition, there is a well-established research base indicating that
simply monitoring and charting behavior is associated with effective intervention programs (Fuchs
& Fuchs, 1986). Monitoring of behavior is most effective when (1) behaviors are well defined
and measured as they occur, (2) measurement takes place on a regular basis, (3) students are kept
informed of their progress or even involved in the measurement, and (4) measures are used to
evaluate the effectiveness of the intervention strategies in place (Kerr & Nelson, 2006).

Self-Management. The ideal for any intervention is to demonstrate success and to

end intervention while the student continues success without assistance. Self-management
is a term that is used to describe both an intervention strategy and a student outcome. As an
intervention strategy, self-management involves teaching the student to monitor his or her own
behavior in concert with the teacher. Gradually, the teacher fades monitoring and students
maintain management of their own behavior (Peterson, Young, Salzberg, West, & Hill, 2006).
The process consists of several steps that include: (1) teaching a new behavior, (2) providing
regular performance feedback, and (3) teaching the student to monitor his or her own behavior.
Initial stages of self-management generally are completed in small intervals with close attention
from the teacher to provide reliability and debriefing and then moving to longer intervals with
less attention. Although more effective for attention than for specific academic skills (Harris,
Friedlander, Saddler, Frizzelle, & Graham, 2005), self-managed increases in attention to task are
associated with academic success (Lan, 2005; Mooney, Ryan, Uhing, Reid, & Epstein, 2005).

Individualized Interventions

Effective instruction has been a part of each of the preceding two levels of intervention and will
continue to be the most important component when working in the third tier with students display-
ing disruptive behavior for whom all other interventions have been unsuccessful. That is, students
requiring the most individualized and specialized instruction are those who have not responded to
school-wide or small group intervention. Too often, intervention at this level is automatically con-
sidered to include a referral for special education services. However, it is important to conceive of
70 LIAUPSIN AND SCOTT

this top tier not as special education but as the “transition point for students who have not yet found
success in school” (Brown-Cidsey & Steege, 2005, p. 3). Still, regardless of how we categorize,
refer to, or see them, students at this level require intensive, individualized, and highly proficient
intervention and instruction (Fuchs, Mock, Morgan, & Young, 2003).

Collaborative Development and Implementation. One way of thinking about these

non-responders is to consider the fact that everything the school has attempted with them has been
unsuccessful. While the school will continue to be a necessary component of intervention, it must
be considered insufficient as the sole agent of change. As such, the third tier of intervention will
necessarily involve those outside of the school, including parents and a range of community-based
professionals (e.g., physicians, mental health professionals, physical therapists, etc.). In fact, for
students with oppositional defiant and conduct disorders, parent training has been found to be the
single most successful treatment approach (Taylor & Biglan, 1998). Unfortunately, improvement
at home has not necessarily been associated with improvement in school or with peers (Taylor
& Biglan, 1998) and thus strong school involvement is critical. In the milder cases at this level,
a range of stakeholders may be invited in light of the student’s specific identified needs. In more
intense cases, however, the fullest range of stakeholders likely will be invited from the beginning
to ensure an adequate voice at the table for students who have experienced the most failure (Scott
& Eber, 2003). Aside from the parents and relevant school personnel, this group may include any
professionals with whom the student is involved, such as family; social workers; psychiatrists,
psychologists or family counselors; court designated workers; rehabilitation counselors; and
advocacy specialists. Given the range of expertise and disparate roles of such a group, the best
effect can be expected when the group includes at least one member who has received training in
the coordination of collaborative intervention practices.

Function-Based Intervention. For students who exhibit disruptive behavior, despite

appropriately implemented school-wide and targeted interventions, function-based interventions
may prove to be the most effective. Function-based interventions are based on the well
documented notion that disruptive behaviors are used by students to either gain something,
escape from something, or to do both at the same time. Once the goal or goals of the student’s
disruptive behavior is identified, the task of the interventionist is to create an environment in
which the student’s goals can be met without the need to engage in disruptive behavior. Function-
based interventions have been shown to be effective with a wide variety of disruptive behaviors
and across students with a range a characteristics (Lane, Umbreit, & Beebe-Frankenberger,
1999). While the task of developing function-based interventions often falls on school personnel
with specialized training, such as school psychologists, special education teachers and general
education teachers can learn to effectively implement this process (Lane et al., 2006). Teaching
the process of function-based intervention is, however, beyond the scope of this chapter. Those
interested in implementing such interventions should seek out qualified personnel to assist them
or gain the proper level of training.
The first task in implementing a function-based intervention is to determine the goal of the
student’s behavior. This has been referred to as a functional assessment or functional analy-
sis (note: though many argue that these terms are not interchangeable, we will not distinguish
between the two for the purposes of this explanation). Data for making this determination is
generally collected via informant interviews such as the Student Assisted Functional Assessment
Interview (Kern, Dunlap, Clarke, & Childs, 1994), brief surveys or checklists like the Functional
Assessment Checklist for Teachers and Staff (March et al., 2000), and structured observations
in the natural environment. These data are then reviewed to determine the goal or goals of the
student’s disruptive behavior.
 4. DISRUPTIVE BEHAVIOR 71

Umbreit, Ferro, Liaupsin, and Lane (2007) have developed a tool called the Function Matrix
(Figure 4.3) to simplify the process of making an accurate determination of function. Using the
Function Matrix, the interventionist considers the collected data in light of six possible outcomes;
does the behavior allow the student to (1) access attention, (2) avoid attention, (3) access tangibles
or activities, (4) avoid tangibles or activities, (5) access sensory stimulation, (6) avoid sensory
stimulation. One of the benefits of using such a system is that it forces the consideration that the
disruptive behavior may be maintained by more than one outcome. For instance, a student who is
tardy to class may not only be seeking the attention that is gained by coming late to class, but also
using the behavior to avoid classroom task or activities. This becomes critically important when
developing the resulting intervention, because an intervention that provides a more acceptable
option for obtaining desired attention, but does not deal with the desire to escape the activity, is
less likely to be completely effective in reducing the disruptive behavior.
Perhaps, the most difficult task in developing a function-based intervention is in applying
the results of the functional assessment. Scott, Liaupsin, Nelson, and McIntyre, (2005) found
that while school teams were likely to be accurate in determining the function of student problem
behavior, they were less accurate in using the information to develop function-based intervention
plans. This discontinuity may be largely due to the limited experience of school personnel in
considering how to help students develop positive pro-social skills that reduce the need to engage
in disruptive behavior. Applying the outcome of a functional assessment to a function-based
intervention often involves identifying a new behavior the student can use (a replacement behav-
ior) that meets the same goals as the original disruptive behavior. However, this is not always the
case. In a situation where a student is destroying worksheets to gain teacher attention, the result-
ing intervention may focus on teaching and reinforcing a more acceptable way to gain teacher
attention. However, if the goal of destroying worksheets is to avoid the given task, it may not be
academically beneficial to the student to simply teach a new way to avoid the task. Instead, the
focus of the intervention is likely to be one that involves teaching the skills necessary to complete
the task so that there is no longer a need to use disruptive behavior to escape. In addition, the
replacement behavior may be one that is entirely new to the student, such as learning an academic
skill, or a behavior that is in the student’s repertoire, but is not used effectively or is not actively
reinforced in the environment.
Effective intervention planning involves the same set of evidence-based practices described
for tiers one and two, albeit with far more collaboration, intensity, and comprehensive support.
While instruction remains the key, intervention also must focus on context, consideration of
the role of the environment, and how both the other humans and the physical environment may
predict and maintain behavior (Lampi, Fenty, & Beaunae, 2005). A comprehensive function-
based intervention designed to deal with the occurrence of disruptive behavior should include
several elements that will ensure the success of the intervention. There are various models for
Positive Reinforcement Negative Reinforcement
(Access Something) (Avoid Something)

Attention

Tangibles / Activities

Sensory
FIGURE 4.3. Function matrix. From Functional behavioral assessment and function-based interventions:
An effective, practical approach (p. 56), by J. Umbreit, J. Ferro, C. Liaupsin, and K. Lane, 1997. Upper
Saddle River, NJ: Prentice-Hall. Reprinted with permission.
72 LIAUPSIN AND SCOTT

the development of function-based intervention plans (e.g., Chandler & Dahlquist, 2005; O’Neil,
Horner, Albin, Storey, & Sprauge 1996; Umbreit, Ferro, Liaupsin, & Lane, 2007), but most in-
clude common elements. First, the plan should consider whether the environment (antecedent
setting) in which the student is expected to perform is arranged to allow successful use of the
new behavior. If not, the plan should include adjustments to the environment that would promote
successful use of the replacement behavior. The function-based intervention plan should also
include procedures to teach and reinforce the replacement behavior. Whether these behaviors are
academic or social in nature, a direct instruction approach has demonstrated success in imple-
menting in this portion of the function-based intervention plan. Finally, the plan should include
consideration of the actions to take if the student attempts to use the problem behavior rather
than the replacement behavior. As described earlier in this chapter, such error corrections can
involve actively ignoring the problem behavior (extinction) or addressing it through negative
performance feedback that includes an instructive component.
For example, Liaupsin, Ferro, Umbreit, et al. (2006) successfully implemented these com-
mon intervention elements in the development of a function-based intervention plan for a 14-
year-old female student who engaged in defiance, cursing and off-task behavior in two school
settings. The functional assessment revealed that the student engaged in these behaviors to escape
from classroom tasks that were too difficult for her to complete due to her limited reading ability.
In other words, when the student was faced with difficult reading tasks, she exhibited disruptive
behaviors, was sent out of the classroom or suspended, and was therefore was not expected to
complete her work tasks. The function-based intervention addressed the environment (anteced-
ent setting) by altering the student’s content reading and assignments so that they were on her
reading level. She was also assigned a “peer buddy” to assist her with reading. The replacement
behaviors, which included following directions and engaging in classroom tasks, were reinforced
with teacher praise and by providing tokens that could be exchanged daily for simple items in
the school store. In one of the settings, it was necessary for the teacher to directly teach reading
skills so that the student could engage in the replacement behaviors. When the student engaged
in instances of disruptive behavior, she was given a verbal reminder to return to her work and was
not allowed to escape the task (extinction). Figure 4.4 shows how implementation of the function-
based interventions resulted in immediate increases in the use of the replacement behaviors.

CHAPTER SUMMARY

Disruptive behavior among school-age youth is a critical concern among teachers, administra-
tors, other school professionals, and parents. The negative outcomes for students who exhibit
disruptive behavior have been widely documented and include the likelihood of not only school
failure, but failure to adjust to social norms in adulthood. The disruptive behavior may also have
broader effects on schools, including higher rates of staff job dissatisfaction, and reduced percep-
tions of safety among both staff and students.
Behavior that is seen as disruptive ranges in severity from minor incidents of unruly class-
room behavior (e.g., out of seat, talking out, cursing, and refusal) to major acts (e.g., theft, threats,
and fighting). While all of these behaviors may be of concern, no single definition exists when
determining whether a student has engaged in “disruptive behavior.” School staff should have an
understanding of the differing terminology used by school psychologists, social workers, special
education personnel, juvenile justice specialists, and other professionals who work to improve
the lives of students who exhibit disruptive behavior.
A wide variety of research-based practices have been identified as effective in managing dis-
ruptive behavior. Current initiatives suggest that successfully reducing the number of disruptive
 4. DISRUPTIVE BEHAVIOR 73

FIGURE 4.4. Student on-task behavior. From “Improving academic engagement through systematic, func-
tion-based intervention,” by C. Liaupsin, J. Ferro, J. Umbreit, A. Urso, and G. Upreti (2006). Education and
Treatment of Children, 29, p. 585. Copyright 2006 by the Editorial Review Board, Education and Treatment
of Children. Adapted with permission of author.

incidents in schools should involve the systematic use of research-based practices in a three-level
preventive framework. This framework includes practices that are implemented (1) at the school-
wide level, (2) with targeted small groups, and (3) at an intensive level with individual students
who continue to exhibit disruptive behavior despite prevention efforts at the first two levels. At the
school-wide level, disruptive behavior is reduced across the entire student population through the
use of both high quality instruction that promotes student success and performance feedback that
encourages students to engage in appropriate academic and social behavior. Small group interven-
tions related to disruptive behavior also focus on the importance of high quality instruction, but
also include practices that provide frequent monitoring of student progress, and the promotion of
self-management of student behavior. Students who engage in disruptive behavior, despite the use
of effective prevention practices at the school-wide and small group levels, require individual-
ized interventions that are carefully programmed and managed. These interventions are likely to
require a collaborative effort across school personnel, family members, and community resources.
Parent training has been identified as a highly effective intervention for school-age youth with dis-
ruptive behavior disorders, but with effects that may not generalize to school environments. Func-
tion-based intervention planning (e.g., Chandler & Dahlquist, 2001; O’Neil, et al., 1996; Umbreit,
74 LIAUPSIN AND SCOTT

Ferro, Liaupsin, & Lane, 2007), has shown significant promise in dealing with disruptive behavior
by combining an understanding of the goals of student problem behavior with interventions care-
fully designed to encourage the use of more socially appropriate alternatives.
Government initiatives, such as the establishment of the Institute for Education Sciences, are
underway to support the development of new interventions and the further validation of current
effective practices for students who exhibit disruptive behavior. However, the dismal outcomes
for students who display disruptive behavior will never improve if we wait for the final word on
effective practices. In other words, research regarding effective practice, by its very nature, will
always be an on-going endeavor and never fully complete. Of even greater importance, for indi-
viduals and society at large, is the need to encourage the use of current practices that have already
been identified as beneficial in working with students who display challenging behavior.

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 5
Fears and Related
Anxieties1
Gretchen Schoenfield and Richard J. Morris

Anxiety disorders are one of the most common types of behavior disorders in children and ado-
lescents, with estimates ranging from 6% to 18% of the population (Costello, Egger, & Angold,
2004). Childhood anxiety disorders are associated with an elevated risk for anxiety, depression,
substance abuse, and social dysfunction in adulthood (Liebowitz, Gorman, Fyer, & Klein, 1985;
Wittchen, Stein, & Kessler, 1999). Anxiety disorders in children2 can also lead to significant
distress in daily functioning, resulting in considerable difficulty both academically and socially
(Last, Hanson, & Franco, 1997; McGee & Stanton, 1990). For example, children with social
anxiety disorder or separation anxiety may risk avoiding social interaction, attending school, and
may ultimately be at risk for school failure (Albano, Marten, Holt, Heimberg, & Barlow, 1995;
Beidel, Turner, & Morris, 1999). Given the challenges youth with fears and related anxieties ex-
perience during their school-age years, as well as the potentially negative consequences of such
difficulties, there is a need for the development and implementation of effective interventions
within multiple contexts, including school settings.
In this chapter, we discuss the major evidence-based psychosocial intervention approaches
for reducing fears and related anxieties in children. In addition, we briefly review medications
that have been frequently used to manage anxiety symptoms, and provide an overview of the
emerging area of anxiety prevention.

HISTORICAL PERSPECTIVES

There is a long tradition of interest in the study of childhood fears and related anxieties, dating
back to the late 1890s and early 1900s (e.g., Freud, 1909; Hall, 1897; Jersild & Holmes, 1935;
Jones, 1924; Jones & Jones, 1928; King, Hamilton, & Ollendick, 1988; Lapouse & Monk, 1959;
Morris & Kratochwill, 1983; Winker, 1949). For example, most contemporary treatment ap-
proaches for reducing fears and related anxieties have their roots in the writings of early theorists
in the areas of learning theory and behavioral psychology, such as Ivan Pavlov (1927), Edward
Thorndike (1898, 1913), John B. Watson (1913, 1919), B.F. Skinner (1938, 1953), O. Hobart
Mowrer (1939), and Clark Hull (1943). Though they differed in their respective approaches, each
of these theorists sought to demonstrate and/or explain the process by which learning occurred

79
80 SCHOENFIELD AND MORRIS

and how a stimulus became connected to a particular behavior such as a fear or anxiety re-
sponse.
Over time, researchers began to focus on the contribution of modeling or observational
learning to the acquisition of fear responses (e.g., Bandura, 1969), as well as underlying cogni-
tive factors (e.g., Beck, 1967; Ellis, 1962, 1973; Kendall, 1994; Meichenbaum, 1971). Informa-
tion processing theories further influenced our understanding of the etiology of fears and related
anxieties (e.g., Foa & Kozak, 1986; Lang, 1977). Each of these theories, as well as the psycho-
analytic theory of Sigmund Freud (e.g., Freud, 1909), the individual psychology of Alfred Adler
(e.g., Adler, 1964; Dreikurs & Soltz, 1964), and the phenomenological theory of Carl Rogers
(e.g., Rogers, 1951, 1959), contributed substantially over the past 50 to 75 years to the develop-
ment of various therapeutic approaches to treat such fears and related anxieties (e.g., Morris &
Kratochwill, 1983).
More recently, however, interest in treating such behavior difficulties has shifted toward an
emphasis on evidence-based interventions and prevention (or early intervention) programs. This
emphasis has led researchers to begin to evaluate treatment programs using methodologically
rigorous criteria (see, for example, Weisz, Hawley, & Doss, 2004 for a review). Such evidence-
based intervention studies also strive to provide practitioners with treatment manuals and proto-
cols that can be used in a variety of settings—such as the school setting—to reduce the frequency
and severity of children’s fears and related anxieties.
The recent emphasis on prevention and early intervention of fears and anxiety reflects a
growing body of research on risk factors for developing fears and related anxieties, developmen-
tal trajectories, and treatment efficacy. Researchers suggest that addressing suspected symptoms
of anxiety prior to onset of a clinical diagnosis may be a critical component to prevention of fears
and anxiety, as well as comorbid symptoms or disorders (Kendall & Kessler, 2002).

CHARACTERISTICS OF CHILDHOOD FEARS AND RELATED ANXIETIES

Most fears and related anxieties in childhood are an adaptive and integral part of normal develop-
ment, are typically transitory in nature, and rarely interfere with a child’s or adolescent’s every-
day functioning in or outside of school. However, some fears and anxieties persist over time, are
out of proportion to the demands of the particular setting(s) in which they occur, and negatively
impact the child’s or adolescent’s daily functioning (Marks, 1969; Morris & Kratochwill, 1983).
It is important for school personnel such as school psychologists, social workers, counselors, and
teachers to be able to differentiate between such “clinical” fears and anxieties versus “typical” or
“normal” developmental fears and related anxieties, particularly when considering implementing
an intervention program.
In this regard, a student’s fears or related anxieties warrant intervention when they affect
the person’s developmental functioning (Klein & Pine, 2001). Foa, Costello, Franklin, Kagan,
Kendall, Klein, et al. (2005) proposed the following heuristics for determining whether fears
and related anxieties reach the threshold for them to be considered a “clinical” problem. First, is
the child capable of recovering from experiencing the fear or anxiety and can she or he remain
asymptomatic in the absence of the anxiety-provoking situation? Second, does the severity of
the fear responses or related anxieties negatively impact the child’s daily functioning? Last, is
the fear or related anxiety developmentally appropriate for the child’s or adolescent’s age? These
questions are consistent with the criteria proposed by Marks (1969) in differentiating a fear from
a “clinical fear” or “phobia.” Specifically, she stated that a fear becomes a phobia when it:
 5. FEARS AND RELATED ANXIETIES 81

1. Is out of proportion to demands of the situation.

2. Cannot be explained or reasoned away.
3. Is beyond voluntary control.
4. Leads to avoidance of the feared situation.

Fears and related anxieties that are considered to be clinical in nature (i.e., those that merit
professional attention and possible intervention) fall into several diagnostic categories within in
the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric
Association [APA], 2000). These are described briefly below. See Table 5.1 for common charac-
teristics of children with fears and anxieties.

Separation Anxiety Disorder

Separation anxiety disorder (SAD) is characterized by excessive anxiety due to separation from
the home or from an attachment figure. The anxiety response exceeds what is expected for the
child’s developmental level, persists for a period of at least four weeks, and causes marked distress

TABLE 5.1
Common Characteristics of Children with Fears and Related Anxieties

Anxiety disorder Characteristics/symptoms

Panic disorder Intense fear in the absence of an actual threat, accompanied by at least four of
the following symptoms: palpitations, sweating, trembling, shortness of breath,
feeling of choking, chest pain, nausea, dizziness or light-headedness, fear of
losing control, fear of dying, and/or a burning or itching sensation.
Specific phobia Persistent fear of an identifiable object or situation, typically resulting in one or
more of the following anxiety responses: avoidance anticipated harm, feelings of
loss of control, or a physiological response to a feared stimulus. Characteristics in
young or elementary school-age children may include crying, tantrums, freezing,
or clinging behaviors.
Social phobia Fearful or anxious anticipation of being negatively evaluated (such as reading
aloud in class, timed tests in school, or performing math problems in front of
the class with the teacher watching) resulting in one or more of the following:
avoidance of feared situation, headaches or stomach aches; panic attacks, and
crying.
Generalized anxiety disorder Excessive anxiety and worry about several events or activities, with at least one of
the following symptoms: restlessness, fatigue, difficulty concentrating, irritability,
perfectionism, and seeking excessive approval.
School refusal Anxiety and avoidance due to the anticipation of attending school, excessive
absences, leaving school early, refusing to attend, and occasionally somatic
symptoms.
Selective mutism Failure to speak in school or when in the company of peers, communicating
through the use of gestures, head nodding, monosyllables, utterances, or a change
in vocal intonation, excessive shyness, fear of embarrassment, withdrawal,
clinging, compulsive tendencies, tantrums, and occasionally oppositional
behaviors.
Separation anxiety Excessive anxiety due to separation from the home or from an attachment figure,
social withdrawal, sadness, apathy, difficulty with concentration.

Source: Adapted from American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. text
revision).Washington, DC: Author.
82 SCHOENFIELD AND MORRIS

and disruption to the child’s daily functioning (APA, 2000). Children with SAD may exhibit so-
cial withdrawal, sadness, and apathy, and may have difficulty with concentration. Onset of SAD
may be preschool age and can occur until 18 years of age, though occurrence of the disorder in
adolescence is uncommon. Prevalence estimates of SAD are approximately 4.1% in children and
young adolescents (Shear, Jin, Muscio, Walters, & Kessler, 2006).

Selective Mutism

Selective mutism is marked by a failure to speak in specific situations, such as in school or when
in the company of peers. Children demonstrating selective mutism must manifest these charac-
teristics for at least one month and such characteristics must be a direct result of the situation in
which the child is placed. Once in these situations (such as a school setting), these children often
communicate acceptance or rejection of inquiries through the use of gestures, head nodding,
monosyllables (“Yes,” “No”), utterances (“Uh-Uh”), or a change in vocal intonation. Children
with this disorder also may present with excessive shyness, fear of embarrassment, withdrawal,
clinging, compulsive tendencies, tantrums, and, in some case, oppositional behaviors. This dis-
order is also often associated with lower academic performance and impaired social functioning.
Onset of selective mutism often occurs before five years of age, although symptoms may not
be evident until the child begins school. Prevalence of selective mutism is less than 1% of the
school-age population (Bergman, Piacentini, & McCracken, 2002).

Panic Disorder

A panic attack is characterized by a distinct period of intense fear in the absence of an actual
threat, and is accompanied by at least four of the following physiological or cognitive symptoms:
palpitations, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea,
dizziness or light-headedness, fear of losing control, fear of dying, and/or a burning or itching
sensation with no apparent cause. Panic disorder presents as recurrent panic attacks followed by
a period of at least one month of excessive worry about having another panic attack and/or the
perceived consequences, or any marked behavioral change following an attack.
Age of onset of panic disorder is typically no earlier than late adolescence. However, it
should be noted that panic attacks often occur as a symptom of another anxiety disorder. The
distinguishing characteristic of panic disorder versus other anxiety disorders is the unexpected
nature and occurrence of the panic attack. The reported prevalence of panic attack ranges from
4% to 10% in clinically referred samples (Alessi & Magen, 1988; Hayward, Killen, Hammer,
Litt, Wilson, Simmonds, et al., 1992; Last & Strauss, 1989; Masi, Favilla, Mucci, & Millepiedi,
2000), and approximately 0.6% in school-age children (Whitaker, Johnson, Shaffer, Rapoport,
Kalikow, Walsh, et al., 1990).

Specific Phobia

A specific phobia is a persistent fear of an identifiable object or situation, the exposure to which
typically results in an immediate anxiety response. The anxiety response can present as avoid-
ance of the phobic stimulus or a panic attack, and may cause considerable distress and disrup-
tion in the individual’s daily functioning. In addition, the symptoms must persist for at least six
months, and the fear could involve anticipated harm, feelings of loss of control, or a physiological
response to a feared stimulus. Moreover, in young or elementary school-age children, the pre-
senting characteristics may include crying, tantrums, freezing, or clinging behaviors. Reported
 5. FEARS AND RELATED ANXIETIES 83

prevalence of specific phobia ranges from 4% to 8.8% (see, for example, Ollendick, King, &
Muris, 2002, for a review).

Social Anxiety Disorder

Social anxiety disorder (or social phobia) is characterized by a persistent fear of embarrassment
or being judged/evaluated in social situations or during public performances or recitations (in-
cluding performances or recitals in a school or classroom setting). In addition, the child must
manifest these characteristics for at least six months. The disorder may present as fearful or
anxious anticipation of being placed in a setting where the person may be negatively evaluated
(such as reading out aloud in class, timed tests in school, or performing math problems in front
of the class with the teacher watching) or it may cause the child to avoid the situation entirely
(such as in the case of school phobia or school refusal). In each instance, the anxiety response
must interfere appreciably with the child’s daily routine, functioning, social interactions, and/
or academic functioning. Other symptoms of social anxiety disorder may include headaches
or stomach aches, panic attacks, and crying. Prevalence of this disorder among school-age
children is estimated to range from 5% to 15% of school-age children (Kashdan & Herbert,
2001).
As mentioned above, social anxiety disorder may be associated in the school setting with
a particular academic subject or academic skill, as well as with taking exams or performing in
front of a class. For example, research suggests that a link exists between reading performance
and socio-emotional difficulties in children, with an estimated 50% of children who experience
difficulties in reading also experiencing socio-emotional and related behavioral difficulties (Fer-
gusson & Lynskey, 1997). Anxiety in other aspects of a child’s life has also been found to be
highly correlated with reading anxiety (Tsovili, 2004). In this regard, until a child has a thorough
psychological evaluation, it may be difficult to determine whether the cause of the reading-as-
sociated anxiety is learning disability-based or due to other socio-emotional factors in the child’s
life. On the other hand, with regard to math anxiety, little systematic research has been conducted
in this area. Though math-related anxiety may be attributable to a child’s learning difficulties,
researchers and educators have also speculated that it may also relate to quality of instruction, a
student’s perception of her or his ability in this area, and/or parental and teacher attitudes towards
the child (e.g., Wigfield & Meece, 1988).
In terms of writing anxiety, there is also a paucity of research in this area. The research that
does exist suggests that writing anxiety may be attributable to a lack of practice and exposure
to skill-building (Pajares & Viliante, 1997). Children experiencing writing anxiety may also be
those who procrastinate, feel apprehension, tension, or suffer from low self-esteem and poor mo-
tivation (Shweiker-Marra & Marra, 2000). Test (or examination) anxiety is characterized by feel-
ings of tension and apprehension, worrisome thoughts, or autonomic nervous system responses
due to an evaluation of academic performance (Spielberger, 1995). Children with test anxiety
often have difficulty thinking clearly, understanding questions while taking an exam, or organiz-
ing thoughts even when the person has spent considerable time preparing for the test (Goonan,
2003). Reported prevalence of test anxiety is variable, ranging from 5% to 41% of all school-age
children (e.g., Ball, 1995; Beidel, 1991; Turner, Beidel, Hughes, & Turner, 1993).

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is excessive anxiety and worry about several events or ac-
tivities, occurring more days than not for at least six months. In children, the anxious response
84 SCHOENFIELD AND MORRIS

is usually associated with at least one additional symptom such as restlessness, being easily
fatigued, difficulty with concentration, irritability, and disturbed sleep patterns. The anxious re-
sponse is difficult to control and usually leads to impairment in daily functioning. The child may
be perfectionistic, uncertain of him- or herself, and may seek excessive approval about perfor-
mance. Prevalence of GAD in school-age children is an approximately 2%–4% (Anderson, Wil-
liams, McGee, & Silva, 1987; Bowen, Offord, & Boyle, 1990).

School Refusal

Children with school refusal (or school phobia) exhibit anxiety and avoidance due to the anticipa-
tion of attending school, and often experience somatic symptoms. The child may have excessive
absences, frequently ask to leave school early, or simply refuse to attend (Kearney & Silverman,
1996). School refusal is not conceptualized as a distinct anxiety disorder, but rather a set of
symptoms with variable underlying causes. Separation anxiety is a common source of school
refusal in children, particularly in younger children, whereas social anxiety is a common source
of school refusal for older children. Specific phobias are also potential causes of school refusal.
School refusal can also occur due to conditions such as learning difficulties, bullying, or family
discord (Kearney & Albano, 2004).
School refusal exists in approximately 1%–5% of all school-age children, occurring with
equal frequency in males and females (Kearney & Roblek, 1998). School refusal can occur at any
point throughout the school years. However, children between the ages of 5 and 6 and 10 and 11
are reportedly at higher risk, which is likely due to initial entry into school and transition from
elementary to middle school (King, Heyne, Tonge, Gullone, & Ollendick, 2001).

ASSESSMENT OF CHILDHOOD FEARS AND RELATED ANXIETIES

A multi-method and multi-informant approach to assessing behavior problems in children is of-

ten recommended. Teacher reports in particular are an invaluable source of information, as they
provide context-specific examples of a child’s behavioral difficulties (e.g., Fisher, Masia-Warner,
& Klein, 2004). Although teachers can be a unique source of information on a student’s behav-
ioral difficulties throughout the day, research on teachers’ awareness of, for example, student
levels of anxiety and depression is somewhat limited (e.g., Layne, Bernstein, & March, 2006).
Studies have been published evaluating teacher-reports as a source of assessment data, but these
have focused primarily on inter-rater reliability between parent and/or child reports and those of
teachers. In addition, some writers have suggested that teachers may be less aware of mild and
moderate manifestations of children’s anxieties that are not typically associated with disruptive
classroom behaviors (e.g., Loeber, Green, & Lahey, 1990; Muris & Meester, 2002). On the other
hand, one must also question whether teachers should be expected to be aware of (or familiar
with) the symptoms of fears and related anxieties, since many teacher education programs pro-
vide little exposure to childhood behavior and affective disorders. In this regard, see Table 5.2 for
a guide that teachers and other school personnel may use to determine whether a student should
be referred for evaluation by a counselor, school psychologist, or other mental health profes-
sional.
Several methods are used for identifying children experiencing clinically significant fears
and related anxieties within the school or classroom setting. Methods of assessment are ordered
along a continuum of directness, with the least direct procedure consisting of a child’s verbal rec-
ollections of clinically relevant experiences and the most direct consisting of assessment occur-
 5. FEARS AND RELATED ANXIETIES 85

TABLE 5.2
What Teachers Should Be Looking for in Deciding whether Students Should Be Referred for a
Psychological Evaluation Regarding Fears and Related Anxieties

The behaviors, thoughts, and feelings associated with children’s fears, phobias, and related anxieties typically:
• are not proportional to situation demands in or outside of the classroom
• cannot be removed or explained on the basis of discussions with the student
• are beyond the student’s voluntary control
• lead to avoidance of or escape from the anxiety-provoking situations
• are not age-appropriate
• persist of an extended period of time
• are associated with worry and related feelings whenever the student anticipates being in the anxiety-provoking
situation

Source: Morris, Kratochwill, Schoenfield, & Auster. (in press). Fears and related anxieties. In R.J. Morris & T. R. Kratochwill (Eds.),
The practice of child therapy. Mahwah, NJ: Erlbaum.

ring at the time that the fear or related anxiety is taking place. In this regard, interviews with the
child and/or her or his parents, as well as questionnaires, are considered to be indirect sources of
assessment information, whereas a child’s self-monitoring observations during the time that the
fear or anxiety response occurs—or the teacher’s direct observation when the child’s fear or anxi-
ety response take place—is considered to be a direct observation. Physiological responses—such
as heart rate and perspiration—at the time of the anxiety or fear response also represent direct
assessment measures.

Behavior Checklists and Rating Scales

Behavior checklists and rating scales offer school personnel with a means of gauging a child’s
level of subjective stress or anxiety, and can be used as a screening device to determine whether
a particular child is at risk. Given that these self-report questionnaires are limited in the breadth
and depth of information that they can provide, they are not necessarily suitable as the sole means
of establishing a diagnosis for the child. Additionally, most self-report questionnaires cannot
provide adequate insight into the degree of functional impairment that an individual may be
experiencing (Langley, Bergman, McCracken, & Piacentini, 2004). However, there is consider-
able utility within a school setting when the goal of an assessment is to implement a school-wide
screening procedure for determining which children are at risk for clinically-based fears and
related anxieties.
The advantages of self-report checklists and rating scales are that they are relatively low
in per-unit cost and are easily administered to large groups. They can be administered without
much training in test administration methods, and often include a means by which a child’s score
can be compared to normative data. In this regard, self-report questionnaires are also useful in
distinguishing between normative, developmentally appropriate fears and clinically significant
fears and anxieties. Most self-report checklists and rating scales also include versions for parents
and teachers.
Examples of self-report instruments that have been empirically validated include the
Screen for Child Anxiety and Related Emotional Disorders (SCARED; Muris, 1997), Spence
Children’s Anxiety Scale (SCAS; Spence, 1998), and the Multidimensional Anxiety Scale for
Children (MASC; March, Parker, Sullivan, Stallings, et al., 1997). These assessments identify
a range of symptoms and also include components that distinguish between types of anxiety
disorders.
86 SCHOENFIELD AND MORRIS

Direct Observation

Direct observation is useful for identifying and quantifying specific behaviors associated with
particular fears and related anxieties in school settings (e.g., Johnston & Murray, 2003; Ramirez,
Feeney-Kettler, Flores-Torres, Kratochwill, & Morris, 2006). Classroom teachers are directly
interacting with their students throughout the day, which provides them with an opportunity to
notice behavioral and affective changes over time. However, in some instances, fears and related
anxiety-based behaviors may go unnoticed by a teacher, especially when such behaviors do not
cause classroom disruption or otherwise draw atypical attention toward a particular child.

Clinical Interview

Clinical interviews are a means by which more information can be gleaned regarding the nature
of a child’s fear and related anxieties, as well as pertinent social, medical, familial, and academic
history. These interviews are typically conducted by trained mental health professionals who
have received extensive training in this method. Interviews often involve not only the child but
also his or her parents and siblings and often require considerable time; therefore, this technique
may not always be feasible in the school environment.
The questioning format for clinical interviews can be structured, semi-structured, or informal.
A commonly used structured interview technique that is based upon DSM-IV (APA, 2000) is the
Anxiety Disorders Interview Schedule for Children (ADIS; Silverman & Albano, 1996). The ADIS
includes an interview for children and parents, though little agreement is found between parent
and child information on several of the anxiety scales (Rapee, Barrett, Dadds, & Evans, 1994).

EVIDENCE-BASED PSYCHOSOCIAL INTERVENTIONS

Several evidence-based interventions are frequently used to treat fears and related anxieties in
children, most of which have origins in various theories of learning, cognitive theory, and infor-
mation processing theory (King, Muris, & Ollendick, 2005). These interventions include such
behavior therapy approaches as systematic desensitization, modeling, reinforced practice, and
cognitive behavioral therapy.
There is some debate in the literature regarding what constitutes “evidenced-based interven-
tions” (EBI; Weisz, Sandler, Durlak, & Anton, 2005), and there has been a substantial effort to
define and disseminate information regarding “what works” in child psychotherapy. Though pro-
posed criteria for EBI vary in methodological rigor, the common criteria among them are that the
intervention being discussed has demonstrated success in comparison to a control group (Chamb-
less & Ollendick, 2001) and the steps in implementing the intervention have been detailed in a
treatment manual. For the purposes of this chapter, we will use the term “evidence-based” to de-
scribe those treatments cited in the literature as either “well-established” or “probably efficacious,”
using the criteria developed by the American Psychological Association’s Division 12 Task Force
on “Promotion and Dissemination of Psychological Procedures” (Chambless, Baker, Baucom,
Beutler, Calhoun, Crits-Cristoph, et al., 1998). As such, we limit our discussion in this chapter to
those interventions that have received empirical support using the criteria described in Table 5.3.

Cognitive Behavioral Therapy

There has been a rapid proliferation of empirical investigation into the effectiveness of cognitive
behavioral treatment (CBT) approaches in ameliorating fears and related anxieties in children.
 5. FEARS AND RELATED ANXIETIES 87

TABLE 5.3
Criteria for Empirically-Validated Treatments

Well-established treatments
I. At least two good between group design experiments demonstrating efficacy in one or more of the following
ways:
A. Superior (statistically significantly so) to pill or psychological placebo or to another treatment.
B. Equivalent to an already established treatment in experiments with adequate sample sizes.
Or
II. A large series of single case design experiments (n > 9) demonstrating efficacy. These experiments must have:
A. Used good experimental designs and
B. Compared the intervention to another treatment as in I(A).
Further criteria for both I and II:
III. Experiments must be conducted with treatment manuals.
IV. Characteristics of the client samples must be clearly specified.
V. Effects must have been demonstrated by at least two different investigators or investigating teams.
Probably efficacious treatments
I. Two experiments showing the treatment is superior (statistically significantly so) to a waiting-list control group.
Or
II. One or more experiments meeting the Well-Established Treatment Criteria IA or IB, III, and IV, but not V.
Or
III. A small series of single case design experiments (n >3) otherwise meeting Well-Established Treatment

Source: Update on empirically validated therapies: II, by D. L. Chambless, M. J. Baker, D. H. Baucom, L. E. Beutler, K. S. Calhoun, P.
Crits-Christoph et al., 1998, The Clinical Psychologist, 51, p. 4.

CBT approaches combine several components of behavior therapy and ultimately seek to man-
age anxiety symptoms through the cognitive channel. CBT approaches, therefore, emphasize
the role of cognitions in the development of fears and anxieties with the goal of replacing
these cognitions with more adaptive and realistic cognitions about those settings or situations
that contribute to the fear or anxiety response. One intervention that has received considerable
empirical support is the Coping Cat program (Kendall, 2000). This approach is considered to
be a “probably efficacious” intervention for treating SAD as well as over-anxious disorder and
social phobia. The Coping Cat program has gained empirical support for a wide age range, and
can be adapted to group settings and to various cultures (e.g., Albano & Kendall, 2002; Kendall,
2000; Kendall, Hudson, Choudhury, Webb, & Pimentel, 2005). A modified version, the C.A.T.
Program (Kendall, Choudhury, Hudson, & Webb, 2002), is an empirically supported treatment
program for adolescents.
Coping Cat consists of 16 structured sessions that occur weekly, each lasting approximately
60 minutes The first eight sessions are devoted to education, during which the child is taught to
recognize his or her own symptoms of anxiety, to engage in progressive muscle relaxation, and
to identify and modify negative self-talk and cognitions. Through graduated exposure (initially
imaginal and eventually in vivo), the child habituates to anxiety-provoking situations and learns
to employ the newly acquired coping skills. The child is also given homework assignments, role-
play exercises, and education regarding his or her subjective experience of anxious symptoms
(Kendall et al., 2002; Kendall et al., 2005).
The primary objectives of the Coping Cat process are to: (1) recognize fearful/phobic feelings
and somatic reactions to fears; (2) identify cognitions in fear-provoking situations; (3) develop a
plan to cope with fear-provoking situations; (4) practice the coping plan via behavioral exposure
techniques; (5) evaluate performance; and (6) learn self-reinforcement techniques (Kendall et al.,
2005). Parental collaboration is instrumental to the treatment, and occurs in various stages of the
88 SCHOENFIELD AND MORRIS

program. Parents are encouraged to meet with the therapist throughout the program course and
are directly involved in extra-session exposure practice.

Family Anxiety Management (FAM). Parental involvement is an important factor in

many interventions for fears and related anxieties. Parents are often responsible for implementing
procedures outlined by a clinician. Additionally, children may benefit from witnessing parents
engaging in adaptive coping styles. One family-based intervention that has received some
empirical support is the Family Anxiety Management model (Dadds, Heard, & Rapee, 1992).
This approach involves gradual relinquishing of control from clinician to parents and ultimately
to the child. Self-control and self-instructional strategies are emphasized with the ultimate goal of
teaching the child how to manage his or her fear or related anxiety when faced with the anxiety
provoking or fear evoking setting or situation. Contingency management systems are also used
to ease the child’s exposure to the feared stimuli. The FAM model also addresses parental fears
and anxiety, issues within in the family dynamic, as well as parent-child communication and
problem-solving skills (Dadds et al., 1992; Ginsburg & Schlossberg, 2002).
There is some empirical support for FAM when used in conjunction with CBT in treating
SAD, overanxious disorder, and social phobia in children. For example, Barrett, Dadds, and
Rapee (1996) found significant differences between children receiving CBT+FAM treatment and
children receiving CBT intervention alone, and a wait list control group. Additionally, Barrett
(1998) found that group CBT+FAM was superior at one-year follow-up to group CBT alone,
and to the wait list condition. Interestingly, girls were found to be more likely to demonstrate
treatment gains than boys. Additionally, the family component did not seem to yield significant
treatment gains in adolescents.

Modeling

Modeling procedures have a long history in the research literature for ameliorating fears and
related anxieties in children (e.g., Bandura, 1969; Bandura, Grusec, & Menlove, 1967; Fassler,
1985; Luscre & Center, 1996; Melamed, Hawes, Heiby, & Glick, 1975; Morris & Kratochwill,
1983). Modeling is a process by which an individual learns to adopt a behavior simply by observ-
ing another person while she or he engages in that behavior (Bandura, 1969). With regard to fears
and anxieties, an intervention using modeling techniques involves the child observing a model
engage in the desired non-fearful or anxious behavior within a familiar setting or situation that
the child tends to avoid or produces anxiety. A critical component of this procedure is that child
observes the model experiencing only neutral or positive consequences as she or he approaches
the feared stimulus (Kazdin, 2000). Modeling typically occurs in a series of graduated steps rath-
er than in a single session (Bandura, 1971). Three approaches to modeling have been discussed
in the literature: live modeling, symbolic modeling, and participant modeling.

Live Modeling. Live modeling involves a live demonstration of the graduated approach
behavior of the model toward the feared or anxiety provoking stimuli. This procedure has
received empirical support in treating childhood fears and related anxieties and is considered to
be “probably efficacious” in the treatment of specific phobias (Chambless & Ollendick, 2001).
Murphy and Bootzin (1973) investigated the effectiveness of live modeling in treating children’s
fear of snakes. White and Davis (1974) studied the relative effectiveness of live modeling,
observation/exposure only, and a no-treatment control condition on the avoidance of dental
treatment in girls ranging from 4 to 8 years of age. Treatment gains were found in both the live
modeling condition and the exposure-only condition.
 5. FEARS AND RELATED ANXIETIES 89

Symbolic Modeling. Symbolic modeling differs from live modeling in that the modeling
procedure is presented through film, videotape, DVD, or the person’s own imagination. This
procedure has received empirical support and is considered to be “probably efficacious” in treating
specific phobias in childhood. Bandura and Menlove (1968) demonstrated the effectiveness of
filmed modeling in treating fear of dogs in children between the ages of 3 and 5. In one condition,
children observed a single model approaching a dog with increasing degrees of contact throughout
several film sequences. A second condition presented several models interacting with many dogs
of various sizes. Results suggested that children in both filmed modeling conditions demonstrated
treatment gains superior to the control group, which consisted of children watching movies that
did not depict models interacting with dogs. No significant differences existed between the two
filmed treatment groups initially, but significant treatment gains were found in the multiple model
condition at follow-up.
Symbolic modeling has also been used to address anxiety in children prior to undergoing
elective surgical procedures (Melamed & Siegel, 1980). Children between 4 and 12 years of age
were either assigned to a condition in which they viewed a film about a child who underwent
a surgical procedure with no negative consequences or a control group. Children in the control
group watched a film about a child taking a nature walk. Children in the experimental group
exhibited significantly less situational anxiety compared to children in the control condition. Ad-
ditionally, treatment gains were maintained at follow-up.

Participant Modeling. In participant modeling, a child approaches the feared stimulus

in a series of graduated steps, with each step first being performed by the model (typically, a
peer) followed by the child performing the step. Participant modeling has received a great deal
of empirical support and is considered to be a “well-established” approach to treating specific
phobias in children. One example is an early study by Ritter (1968) examining the relative
effectiveness of participant modeling to live modeling and a to an active treatment control group.
Children in the participant modeling condition observed and then followed the model while he
or she safely approached the harmless snake in a series of graduated steps. The live modeling
group observed while a model safely approached the snake. Results of the study suggested that
both treatment conditions were more effective in reducing avoidance behavior than a wait-list
control group. However, further analysis of the data revealed that significantly more children in
the participant modeling group successfully completed the behavior avoidance test than did those
in the live modeling group.

Reinforced Practice

Positive reinforcement is typically defined as an event or activity that immediately follows a

behavior and results in an increase in the frequency of performance of that behavior. Thus, a
positive reinforcer is something that follows a particular behavior and strengthens the number of
times that behavior occurs (Morris, 1985). A reinforcer in the context of therapeutic intervention
for fears and anxiety may be applied as the child practices approaching the feared stimulus in a
series of graduated steps. The reinforcer is then faded and eventually withdrawn once the child
has reached a point at which he or she can successfully approach the stimulus without the fear
response. This particular method is considered to be “well-established” in treating childhood
phobias (e.g., Chambless & Ollendick, 2001; King et al., 2005; Ollendick & King, 1998; see also,
special section of Journal of Clinical Child Psychology, 1998).
Reinforced practice has also been found to be superior to verbal coping skills training in treat-
ing the fear of darkness in children (Leitenberg & Callahan, 1973; Sheslow, Bondy, & Nelson,
90 SCHOENFIELD AND MORRIS

1983), and has been successfully applied within school settings to treat school refusal (Trueman,
1984; Vaal, 1973). Additionally, Menzies and Clark (1993) found that reinforced practice pro-
duced superior treatment gains when compared to a modeling approach in reducing water phobia
in children between 3 and 8 years of age.

Systematic Desensitization

Systematic desensitization, developed in the early 1950s by Joseph Wolpe, is a frequently used
procedure for reducing specific fears and phobias (e.g., King et al., 2005; Labellarte, Ginsburg,
Walkup, & Riddle, 1999; Morris & Kratochwill, 1983). The desensitization process involves de-
creasing the association between fear or anxiety provoking stimuli and the avoidance or escape
responses by having the child engage in activities that are antagonistic to this response.
Relaxation training is the first step in the desensitization procedure. An adaptation of the
deep muscle relaxation technique developed by Jacobson (1929, 1938, 1977) is used and is pre-
sented in Table 5.4. These relaxation skills will ultimately assist the child in coping with anxiety
responses associated with exposure to the feared stimuli.
Construction of the anxiety hierarchy is the second step in the desensitization procedure and
entails identifying situations or settings that are associated with the fearful response, and rank
ordering them from least to most anxiety provoking. The child and therapist (as well as parents,
in many cases) work together to construct and refine the anxiety hierarchy, which typically con-
sists of 20–25 items.
Once the anxiety hierarchy has been finalized, the next phase of the desensitization process
begins. In this phase, the child uses the newly acquired relaxation skills to cope with the feelings
of anxiety and tension that he or she experiences as the therapist gradually presents each hierar-
chy scene for the child to imagine. Once the child has successfully moved through steps of the
anxiety hierarchy, he or she will be encouraged to approach the feared stimulus in real life, with
the aid of a therapist and/or parent. Systematic desensitization has a long history in successfully
treating specific fears in children and is regarded as being “probably efficacious.” Though several
studies have reported its effectiveness (e.g., Bentler, 1962; Obler & Terwilliger, 1970; Barrios
& O’Dell, 1989; Graziano, DiGiovanni, & Garcia, 1979; see also Morris & Kratochwill, 1983;
Morris, Kratochwill, Schoenfield, & Auster, in press), there is little support for its efficacy rela-
tive to other treatment modalities. In addition, since this intervention requires that the child be
able to visually imagine each item on the hierarchy, it is recommended that prior to initiating this
intervention the therapist should be certain that the child has the ability to visually imagine each
scene in a vivid manner.
In addition to the procedures discussed in the above section, teachers can implement the
methods presented in Table 5.6. It is recommended, however, that these methods only be used in
consultation with a school psychologist, counselor, or other mental health professional.

PHARMACOLOGICAL INTERVENTIONS

Children are being prescribed psychotropic medications at an increasing rate in the United States
today compared to 5 to 10 years ago (Carlson, Demaray, & Hunter-Oehmke, 2006). Many of
these medications have been found to be effective in reducing the severity of various childhood
emotional and behavior disorders. With respect to children’s fears and related anxieties, sev-
eral psychotropic medications have been found to be clinically useful in reducing the frequency
and intensity of the behaviors, cognitions and/or physiologic responsivity associated with this
 5. FEARS AND RELATED ANXIETIES 91

TABLE 5.4
Relaxation Protocol

Steps in Relaxation
1. Take a deep breath and hold it (for about 10 seconds). Hold it. Okay, let it out.
2. Raise both of your hands about halfway above the couch (or arms of the chair) and breathe normally. Now drop
your hands to the couch (or arm).
3. Now hold your arms out and make a tight fist. Really tight. Feel the tension in your hands. I am going to count to
three and when I say “three” I want you to drop your hands. One...two...three.
4. Raise your arms again and bend your fingers back the other way (toward your body). Now drop your hands and
relax.
5. Raise your arms. Now drop them and relax.
6. Now raise your arms again, but this time “flap” your hands around. Okay, relax again.
7. Raise your arms again. Now relax.
8. Raise your arms above the couch (chair) again and tense your biceps. Breathe normally and keep your hands
loose. Relax your hands. (Notice how you have a warm feeling of relaxation.)
9. Now hold your arms out to your side and tense your triceps. Make sure that you breathe normally. Relax your
arms.
10. Now arch your shoulders back. Hold it. Make sure that your arms are relaxed. Now relax.
11. Hunch your shoulders forward. Hold it and make sure that you breathe normally and keep your arms relaxed.
Okay, relax. (Notice the feeling of relief from tensing and relaxing your muscles.)
12. Now turn your head to the right and tense your neck. Relax and bring your head back into in its natural position.
Turn your head to the left and tense your neck. Relax and bring your head back again to its normal position.
13. Turn your head to the left and tense your neck. Relax and bring your head back again to its natural position.
14. Now bend your head back slightly toward the chair. Hold it. Okay, now bring your head back slowly to its natural
position.*
15. This time bring your head down almost to your chest. Hold it. Now relax and let your head come back to its
natural resting position.
16. Now open your mouth as much as possible. A little wider, okay, relax (mouth should be partly open afterwards).
17. Now tense your lips by closing your mouth. Okay, relax.
18. Now put your tongue at the roof of your mouth. Press hard. (Pause.) Relax and allow your tongue to come to a
comfortable position in your mouth.
19. Now put your tongue at the bottom of your mouth. Press down hard. Relax and let your tongue come to a
comfortable position in your mouth.
20. Now just lie (sit) there and relax. Try not to think of anything.
21. To control self-verbalizations, I want you to go through the motions of singing a high note-not aloud. Okay, start
singing to yourself. Hold that note. Okay, relax. (You are becoming more and more relaxed.)
22. Now sing a medium tone and make your vocal cords tense again. Relax.
23. Now sing a low note and make your vocal cords tense again. Relax. (Your vocal apparatus should be relaxed now.
Relax your mouth.)
24. Now close your eyes. Squeeze them tight and breathe naturally. Notice the tension. Now relax. Notice how the
pain goes away when you relax.
25. Now let your eyes relax and keep your mouth open slightly.
26. Open your eyes as much as possible. Hold it. Now relax your eyes.
27. Now wrinkle your forehead as much as possible. Hold it. Okay, relax.
28. Now take a deep breath and hold it. Relax.
29. Now exhale. Breathe all the air out...all of it out. Relax. (Notice the wondrous feeling of breathing again.)
30. Imagine that there are weights pulling on all your muscles making them flaccid and relaxed...putting your arms
and body down into the couch.
31. Pull your stomach muscles together. Tighter. Okay, relax.
32. Now extend your muscles as if you were a prizefighter. Make your stomach hard. Relax. (You are becoming more
and more relaxed.)
33. Now tense your buttocks. Tighter. Hold it. Now relax.
34. Now search the upper part of your body and relax any part that is tense. First the facial muscles. (Pause 3 to 5
sec.) Then the vocal muscles. (Pause 3 to 5 sec.) The neck region. (Pause 3 to 5 sec.) Your shoulders...relax any
part that is tense. (Pause.) Now the arms and fingers. Relax these. Becoming very relaxed.
(continued)
92 SCHOENFIELD AND MORRIS

TABLE 5.4
(Continued)

Steps in Relaxation
35. Maintaining this relaxation, raise both your legs (about a 45% angle). Now relax. Notice how this further relaxes
you.
36. Now bend your feet back so that your toes point toward your face. Relax your mouth. Bend them hard. Relax.
37. Bend your feet the other way...away from your body. Not far. Notice the tension. Okay, relax.
38. Relax. (Pause.) Now curl your toes together as hard as you can. Tighter. Okay, relax. (Quiet- silence for about 30
seconds.)
39. This completes the formal relaxation procedure. Now explore your body from your feet up. Make sure that every
muscle is relaxed. Say slowly-first your toes, your feet, your legs, buttocks, stomach, shoulders, neck, eyes, and
finally your forehead-you should be relaxed now. (Quiet-silence for about 10 seconds.) Just lie there and feel very
relaxed, noticing the warmness of the relaxation. (Pause.) I would like you to stay this way for about 1 minute, and
then I am going to count to five. When I reach five, I want you to open your eyes feeling very calm and refreshed.
(Quiet-silence for about 1 minute.) Okay, when I count to five I want you to open your eyes feeling very calm and
relaxed.
40. One...feeling very calm; two...very calm, very refreshed; three...very refreshed; four...and five.

*The child or adolescent should not be encouraged to bend his or her neck either all the way back or forward.
Source: Adapted in part from Jacobson, 1938, Rimm (1967, personal communication), and Wolpe and Lazarus (1966). From Treating
children’s fears and phobias: A behavioral approach (p. 135) by R. J. Morris and T. R. Kratochwill, 1983, Elmsford, NY: Pergamon
Press. Copyright 1983 by Pergamon Press. Reprinted by permission.

behavior problem. In particular, selective serotonin reuptake inhibitors (SSRIs) have been found
to have the most empirical support, as well as FDA indications of effectiveness (Walkup, Label-
larte, & Ginsburg, 2002). Specifically, there is empirical evidence to support the use of fluoxetine
and fluvoxamine for effectively treating children and adolescents with separation anxiety disor-
der, social anxiety disorder, and generalized anxiety disorder (Birmaher, Axelson, Monk, Kalas,
Clark, Ehmann, et al., 2003; Clark, Birmaher, Axelson, Monk, Kalas, Ehmann, et al., 2005; Irons,
2005; RUPP Anxiety Study Group, 2001).
Other classes of medication prescribed to manage anxiety symptoms include: anxiolytics,
antidepressants, and major tranquilizers and antipsychotics (Williams & Miller, 2003). Antihis-
timines, antiepileptics, and ȕ-blockers are also prescribed to treat clinical anxiety in children.
Evidence supporting effective use of sertraline in children having generalized anxiety disorder
also exists (Compton, Grant, Chrisman, Gammon, Brown, March, et al., 2001). Other antide-
pressants that may have anxiety reducing effects include the combined norepinephrine-serotonin
reuptake inhibitors (NSRIs). Venlaflaxine, in particular, has been investigated in industry-spon-
sored trials, though the results are currently unpublished (Walkup et al., 2003). The effectiveness
of benzodiazepines in treating fears and anxieties has also been investigated, but no demonstrated
efficacy and yet been reported. Busiprone is also commonly prescribed for children with fears
and related anxieties, though there are currently no no methodologically rigorous trials support-
ing its efficacy. Table 5.5 presents a list of medications prescribed to treat childhood fears and
related anxieties, as well as the most common side effects.

PREVENTION AND EARLY INTERVENTION APPROACHES

Although several psychosocial and pharmacological interventions have been proposed for reduc-
ing children’s fears and related anxieties, several researchers have suggested that an alternative
intervention approach involving prevention may ultimately prove to be even more effective (e.g.,
Barrett & Turner, 2001; Hudson, Flannery-Schroeder, & Kendall, 2004). In this regard, anxiety
 5. FEARS AND RELATED ANXIETIES 93

TABLE 5.5
Medications Commonly Prescribed to Treat Fears and Related Anxieties in Children

Generic name (Brand) Possible side effects

Clonazapam (Klonopin) Decreased appetite, nausea, insomnia.
Fluoxetine (Prozac) Mild headaches, restlessness, insomnia, fatigue, nausea, disinhibition, decreased
appetite
Fluvoxamine (Luvox) Gastrointestinal symptoms, insomnia, headaches, dizziness, muscle weakness.
Paroxetine (Paxil) Drowsiness, headache, nausea, dizziness, dry mouth
Sertraline (Zoloft) Nausea, diarrhea, insomnia, decreased appetite, drowsiness.

prevention programs exist along a continuum defined by levels of directness and intended popu-
lation. For example, Caplan (1964) identified a three-level model, consisting of primary, second-
ary, and tertiary prevention. Primary prevention is designed to address concerns before symptoms
of a disorder actually occur. Secondary prevention refers to interventions addressing symptoms
that are identified, yet not considered to be severe. Tertiary prevention focuses on treatment of
diagnosed disorders as well as relapse prevention. Due to concerns that the secondary and tertiary
levels were more treatment- rather than prevention-oriented, an alternative classification system
based on a continuum of risk for developing psychopathology was proposed by Gordon (1987).
In this system, prevention approaches are categorized as universal, selective, and indicated. Uni-
versal programs target entire populations, irrespective of the presence of risk factors. Selective
intervention focuses on individuals of a certain group who are believed to be at higher risk for de-
veloping psychopathology. Indicated prevention approaches are designed to address mild symp-
toms of behavior disorders through early intervention. Candidates for this category of prevention
are considered to be at high risk. Gordon’s classification system is widely used among experts
in the field of prevention (e.g., Craske & Zucker, 2001; Donovan & Spence, 2000) and has been
adopted by the Institute of Medicine’s Committee on Prevention of Mental Disorders (Mrazek &
Haggerty, 1994; Munoz, Mrazek, & Haggerty, 1996). In this regard, Table 5.6 provides a list of
suggested possible procedures for reducing students’ fears and anxieties in the classroom.

TABLE 5.6
Suggested Procedures for Reducing Student Fears and Related Anxieties in the Classroom

Reducing fears and related anxieties in the classroom

• Model appropriate behavior for the student in anxiety-provoking situations and provide positive feedback for student
success in coping with anxiety
• Relaxation training
• Make expectations clear
• Wherever possible, emphasize positive written and verbal feedback
• Encourage peer support
• Give the student sequenced activities with graduated difficulty, providing positive feedback at each level.
• When negative feedback on academic performance is necessary, it should be given in a constructive manner on a 1:1
basis. Positive comments should always be included to balance the student’s perception of negative comments.
• Give extra time on timed tests when necessary
• When giving examples during instruction, incorporate desirable or familiar content
• When students express negative beliefs or expectations about themselves, teach them to say alternative, positive
statements about themselves.
• If a student would feel more comfortable, allow the student to sit among familiar or preferred classmates— assuming
that this will not lead to class disruption.
• Have the student practice positive self-talk
94 SCHOENFIELD AND MORRIS

With respect to empirical research, limited support exists for universal prevention, mainly
because of the difficulties associated with measuring its effectiveness. In addition, among those
studies that have examined the effectiveness of universal prevention programs only a few have
explicitly included fears or related anxiety symptoms as outcome measures (Hudson et al., 2004).
For example, Barrett and Turner (2001) conducted a longitudinal study examining the effec-
tiveness of school-based universal anxiety prevention program in 6th-grade children. The brief
CBT-based intervention program, called Friends for Children (Barrett, Lowry-Webster, & Hol-
mes, 1998), was implemented by teachers or psychologists in participating schools. The program
incorporated relaxation, attentional training, cognitive restructuring, guided exposure, as well
as parental and peer support. Results showed that children in the intervention conditions dem-
onstrated significantly less self-reported anxiety symptoms when compared to a control group
of children who were engaging in self-monitoring only. Despite some methodological limita-
tions (e.g., use of self-report for measured levels of anxiety and limited sample size to examine
variance between children exhibiting at-risk anxiety symptoms at pre-test versus those without
symptoms), the study offered encouraging findings.
Lowry-Webster, Barrett, and Dadds (2001) conducted a similar study with children between
10 and 13 years of age. However, results of their study were inconclusive, with significant dif-
ferences in self-reported anxiety symptoms found only on one of the two dependent measures.
Reduced symptoms of anxiety, however, were observed among children in the study regardless
of whether they reported high pretreatment levels of anxiety.
Selective prevention programs have the least empirical support. For example, Rapee (2002)
evaluated the effectiveness of a selective prevention program in preventing anxiety in children
between 3 and 4 years of age. The children were identified as being at-risk for anxiety disorders
on the basis of rating scales completed by mothers and through direct observation of behavioral
inhibition in a laboratory setting. Children were either assigned to either a treatment condition or a
monitoring-only condition. Components of the treatment included education regarding the nature
and symptoms of anxiety, modeling adaptive behaviors, parental anxiety management, develop-
ment and use of anxiety hierarchies, and exposure techniques. Results at 12-month follow-up re-
vealed significant decreases in mothers’ reports of behavioral inhibition and decreases in reported
anxiety diagnoses when compared to participants in the control condition. However, direct obser-
vation data revealed no significant differences between the treatment and the control groups.
Indicated prevention approaches are similar to individually-based treatment methods for
treating children’s fears and related anxieties, in that they target existing anxiety symptoms.. Sup-
port for the effectiveness of these approaches, however, in preventing onset of a clinical disorder
is somewhat sparse. For example, Dadds and colleagues (1997, 1999) implemented a modified
version of Kendall’s Coping Cat program (Kendall, 2000) in a study examining the long-term
effects of early intervention on children who exhibited anxiety symptoms. Results of the investi-
gation showed significant improvement in parent and teacher-rated anxiety symptoms among the
intervention groups when compared to the control condition.
In another study, La Frenière and Capuano (1997) worked with children exhibiting anxi-
ety and withdrawal symptoms, using self-report measures of maternal stress, data on children’s
anxious or withdrawn symptoms when performing a problem-solving task, and teacher ratings
of a children’s social competence. Results using the self-reported maternal stress measure and
reports of children’s anxious and inhibited behaviors suggested that the intervention was suc-
cessful, although teacher ratings revealed a decrease in social competence among the children in
the treatment condition at posttreatment and follow up. Although this study did not specifically
examine children’s fears and related anxieties, the findings certainly lend justification for further
investigation.
 5. FEARS AND RELATED ANXIETIES 95

CONCLUSIONS AND DIRECTIONS FOR FUTURE RESEARCH

In this chapter, we have reviewed empirically-supported psychosocial and pharmacologic inter-

ventions for reducing fears and related anxieties in children, and reviewed the empirical literature
on anxiety prevention. The research literature has shown that those psychosocial intervention
programs that are administered on a relatively short term basis are effective in treating children
having a variety of fears and related anxieties. Specifically, reinforced practice and participant
modeling have garnered the most empirical support in treating specific fears and phobias in chil-
dren, with systematic desensitization also showing effectiveness in older children. In addition,
CBT approaches have demonstrated effectiveness in treating separation anxiety, social phobia,
and overanxious disorder. Less empirical information, however, is available on the long-term
maintenance of treatment gains or on relapse prevention approaches. Few studies have included
sufficient sample sizes of high school, middle school, elementary age, and preschool children
to permit adequate comparisons across age categories of the relative effectiveness of these in-
tervention programs. Additionally, the majority treatment effectiveness studies have included
participants spanning a wide age range, or have focused exclusively on pre-adolescent children.
Few studies have had an adequate samples size of adolescents such that age comparisons could
be made.
Indeed, the research agenda for fears and anxiety intervention is quite extensive. More infor-
mation is also needed concerning the extent to which these interventions can be generalized to
the successful treatment of other anxieties that children may experience, such as more cognitively
oriented fears as the fear of (or anxiety concerning) loss of control, rejection by peers, or a school
shooting or school hostage situation. In addition, research is needed on the extent to which these
effective interventions apply equally across gender and racial, cultural or ethnic groups, and on
the potential contribution of comorbid behavioral problems—such as depression or ADHD—to
the relative effectiveness of these interventions.
Although more research is needed on the treatment of fears and related anxieties in chil-
dren, the majority of studies in this area have nevertheless demonstrated that the interventions
discussed in this chapter are effective when compared at least to no-treatment or wait list control
conditions. However, more school-based research is needed to firmly cement the effectiveness of
these procedures.
Psychotropic medications are becoming a common approach to treating anxiety symptoms
in children, with SSRIs having the most empirical support. Thus far, research suggests that SS-
RIs have demonstrated success in ameliorating symptoms associated with separation anxiety
disorder, social anxiety disorder, and generalized anxiety disorder in particular. However, the
effectiveness of SSRIs in treating other types of fears and related anxieties is still unknown. Sev-
eral other classes of medication are also commonly prescribed to treat anxiety symptoms, though
evidence supporting their effectiveness is somewhat sparse. Further investigation is needed to
determine their efficacy relative to SSRIs.
With respect to prevention and early intervention programs for children who are at high risk
for developing fears and related anxieties, little research literature exists that investigates the ef-
ficacy of these programs. For example, universal prevention programs require broad participation
among children and families regardless of whether there are concerns on the part of parents (or
teachers) about the presence of anxiety and/or fears. Determining effectiveness, therefore, of such
prevention programs is difficult, given the myriad variables that cannot be accounted for in such
large population research. Selective and indicated prevention programs share the same concern
regarding how to recruit high-risk candidates without subjecting them to potential peer rejection,
either real or imagined. In addition, all levels of prevention-based programs require longitudinal
96 SCHOENFIELD AND MORRIS

data to be gathered to assess relative effectiveness over time in preventing the occurrence of fears
and related anxieties and to gather information on the characteristics of those who remain diag-
nosis-free versus those who do not. The programs that have shown some empirical support are
quite promising and, if found in future research to be effective, could be readily implemented by
school psychologists, counselors, or social workers on a school-wide basis.

NOTES

1. Preparation of this chapter was supported, in part, by the “Project on Children’s Policy Studies and
Research” at the University of Arizona (Richard J. Morris, Ph.D., Project Director).
2. The term “children” or “child” will be used throughout this chapter to refer to both children and ado-
lescents. Where it appears appropriate in terms of the research or practice literature, a distinction will
be made between children and adolescents.

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 6
Depression and Related Difficulties
Dawn H. S. Reinemann and Sarah Schnoebelen

Depressive disorders are currently conceptualized as chronic, recurrent conditions that, in most
cases, have their onset during childhood or adolescence. Furthermore, research shows that the
prevalence rates of depressive disorders are increasing at the same time the age of onset of mood
disturbances is decreasing (Kessler, 2002). This development is especially disturbing, given that
depression in childhood is associated with increased risk for developing recurrent depressive
episodes in adulthood (Hammen & Rudolph, 2003). Youth who suffer from depressive disor-
ders evidence impaired social, emotional, behavioral, and academic functioning that may lead
to delays that will adversely impact their subsequent development across the lifespan. Thus, it is
imperative for schools to address childhood and adolescent depression.
The ways in which schools can assist students affected with depressive disturbances are
numerous including identifying students at risk or currently suffering from depression, offering
classroom-based prevention and intervention services, implementing treatments in individual or
small group formats, educating parents and school personnel about depressive disorders and
treatment options, and consulting with community-based mental health professionals in order
to coordinate care. However, many youth suffering from depression and/or other psychological
problems remain unidentified and underserved. The magnitude of the problem has been illustrat-
ed by a U.S. Public Health Service Report (2001), which found that although 1 in 10 youngsters
suffer from mental illness serious enough to cause functional impairment, estimates indicate that
less than 1 in 5 receives any form of treatment.
Why have children with mental health problems, and particularly those with depression, been
overlooked? Reasons vary but include the fact that depressed children rarely act out and often
present with physical complaints that may be misleading to parents and educational profession-
als. Furthermore, with the exception of mental health specialists such as school psychologists,
licensed psychologists, school social workers, or school counselors, most other school staff have
little training regarding the ways that depressive disturbances may present themselves during child-
hood, which also may contribute to underidentification (Sander, Reinemann, & Herren, 2007).
In addition, licensed psychologists and school psychologists who are trained to identify depres-
sive disorders spend a majority of their time evaluating children referred for special education
services. However, children who present with depression often are general education students
and school personnel may not account for their specific educational needs (Reinemann, Stark,
Molnar, & Simpson, 2006). While some children with severe or lengthy episodes of childhood
depression may qualify for special education services under “Severe Emotional Disturbance,”

103
104 REINEMANN AND SARAH SCHNOEBELEN

many students with depression do not demonstrate educational need sufficient to warrant such
services (Sander et al., 2007). However, with emphasis now placed on pre-referral services, chil-
dren with depression may be more likely to come to the attention of child study teams who can
consider intervention options, including the development of a possible accommodation plan, if
warranted, based on Section 504 of the Rehabilitation Act (1973).
It is important to note that even when children suffering from depressive disturbances are
identified, most do not receive evidenced-based interventions at school or in the community.
Stark and associates (2006a) point out in their review and discussion of treatments for childhood
depression that the majority of depressed youth are being treated by physicians, or by community
mental health providers who use an eclectic mix of treatments that lack any evidence base. This
type of psychotherapy has been found to be no more effective than providing no treatment (Stark
et al., 2006). In contrast, evaluations of research-based prevention and intervention programs for
childhood depression are quite promising. Most of these programs are manualized (i.e., in the
form of a treatment manual) and can be implemented in schools or community settings. Thus,
school professionals can greatly assist their students who are at risk or suffering from depressive
disturbances by gaining knowledge about and training in evidence-based interventions for child-
hood depression. The purpose of this chapter is to provide information about the state of the art in
preventing and treating depression in youth. However, we begin with an overview of depression
before turning our attention to evidence-based interventions.

OVERVIEW OF CHILDHOOD DEPRESSION

Definitions

Depression can be defined as a symptom, syndrome, or disorder. Clinical experience suggests

that depressive disturbances frequently go unrecognized for long periods of time within the class-
room due to the internalizing nature of the symptoms. This may be particularly true for those
depressed children that tend to withdraw and isolate themselves as opposed to demonstrating
significant irritability and acting out behaviors. Nonetheless, there are a number of academic,
social, behavioral, cognitive, affective, and physical indicators of depression that are likely to
manifest themselves in the classroom.
Affective symptoms in youth include sad mood, anger or irritability, anhedonia (loss of
interest or pleasure), weepiness, feeling unloved, and self-pity (Stark, 1990). Along with these
symptoms, educational professionals may notice a decline in academic performance and loss of
interest in previously enjoyed subjects, as well as failure to complete assignments or a tendency
to give up easily. Cognitive symptoms include negative self-evaluations, guilt, hopelessness, con-
centration difficulties, and suicidal ideation (Stark, 1990). In the classroom, these symptoms may
manifest themselves in the form of indecisiveness, inattentiveness, or expectations for failure.
Certainly, writing or statements that contain themes of death or suicide should be taken seriously
and risk should be assessed by appropriately trained mental health professionals in order to guide
intervention. Youngsters suffering from depression also may experience social and behavioral
symptoms that can manifest as social withdrawal from peers and adults or engagement in be-
haviors which alienate others, suicidal behaviors, agitation, aggression, hyperactivity, or other
disruptive behaviors. In addition, physical symptoms include fatigue, changes in appetite and
weight, somatic complaints, sleep disturbances, and psychomotor retardation or agitation (Stark,
1990). For example, students may complain of fatigue or may be observed falling asleep dur-
ing class. When examining these symptoms, it becomes apparent that children who suffer from
 6. DEPRESSION AND RELATED DIFFICULTIES 105

depression experience symptoms or characteristics that negatively impact their academic confi-
dence, motivation, and cognitive processing, culminating in impaired academic functioning.
A depressive disorder consists of a constellation of behaviors and emotions that co-occur for
a minimum duration and lead to functional impairment. The Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Associa-
tion, 2000) recognizes three major diagnostic categories of unipolar depressive disorders: Major
Depressive Disorder (MDD), Dysthymic Disorder (DD), and Depressive Disorder Not Otherwise
Specified (DDNOS). The primary difference between these disorders is the number, severity, and
duration of depressive symptoms. Only a trained mental health professional or physician can assign
the diagnosis of depression (usually based on the DSM-IV or a similar classification system).
The diagnostic criteria for MDD stipulate that five or more symptoms must be present over a
2-week period, including one symptom of either depressed mood, loss of interest or pleasure (an-
hedonia), or irritability. In addition to the mood disturbance, the syndrome also includes at least
four of the following symptoms: (a) changes in weight or failure to make necessary weight gains,
(b) sleep disturbance, (c) psychomotor agitation or retardation, (d) fatigue or loss of energy, (e)
excessive feelings of worthlessness or guilt, (f) lack of concentration and decision-making ability,
(g) suicidal ideation or attempts or plans of suicide (American Psychiatric Association, 2000).
Dysthymic Disorder is characterized by a chronic mood disturbance of either dysphoria or
anger and at least two other depressive symptoms. In children, these symptoms must be present
for a minimum of 1 year without more than 2 symptom-free months. Children who exhibit de-
pressive symptoms but do not meet the diagnostic criteria for either MDD or DD may receive a
diagnosis of DDNOS.
School-age youth can experience any of the three depressive disorders; however, the man-
ner in which depressive symptoms cluster may vary as a function of development. Symptoms
commonly found in children include depressed appearance, irritability, aggressive behavior, so-
matic complaints, and social withdrawal, preferring solitary play. These symptoms may often be
mistaken for simple lack of motivation, attentional problems, or defiance. Adolescents present
more often with psychomotor retardation, sleepiness or sleeping more than usual, delusions,
hopelessness, and suicide ideation and attempts (American Psychiatric Association, 2000). Thus,
proper identification of children suffering from depression involves a consideration of the child’s
development and ways in which it may affect symptom presentation.

Prevalence

A significant number of youth experience depressive disorders at some point in time and preva-
lence rates increase with age. While about 1% to 3% of children evidence a depressive disorder
at any given time (see, for example, Hammen & Rudolph, 2003, for a review), the percentage of
adolescents with a lifetime history of major depression ranges from 9% to 21% in community
samples (Hankin et al., 1998; Kessler & Walters, 1998). Fewer studies have examined the preva-
lence rates of DD. However, it is important to uncover the prevalence of DD because it is a serious,
long-lasting disturbance that places the youngster at risk for a variety of psychosocial problems
and the later development of MDD. While initial reports indicated that approximately 2.5% of
children in the general population currently evidence Dysthymic Disorder (see, for example,
Stark, 1990, for a review), a more recent study of a community sample of 17- to 19-year-olds
indicated that 4.7% had a lifetime history of dysthymia (Jonas, Brody, Roper, & Narrow, 2003).
As can be seen, youth seem to be at heightened risk for developing depressive disturbances dur-
ing adolescence. Thus, middle and high school personnel may be especially likely to encounter
students who are suffering from significant forms of depression and are in need of services.
106 REINEMANN AND SARAH SCHNOEBELEN

Gender Differences

During the elementary school years males and females are equally likely to develop depres-
sive disturbances. However, beginning with the middle school years and extending through high
school, the balance changes and females become twice as likely as males to develop a depressive
disorder (Hankin et al., 1998; Stark, 1990). Investigators have begun to explore possible biologi-
cal, psychological, and social factors that may account for the increased rates of depression in
females. Although an in-depth review of this literature is beyond the scope of this chapter, a brief
summary of the major findings reveals that there is little evidence that hormone levels or pubertal
status directly account for the observed gender differences in rates of depression (see, for exam-
ple, Nolen-Hoeksema, 2002, for a review). However, it appears that girls, especially those who
mature early, are less satisfied with their bodies and physical appearance than their peers, and
are at increased risk for developing psychopathology including depression (Graber, Lewinsohn,
Seeley, & Brooks-Gunn, 1997).
Moreover, females are believed to have a stronger biological reactivity to stress than males,
characterized by a dysregulated hypothalamic-pituitary-adrenal (HPA) axis response, in part be-
cause they are more likely to be exposed to traumatic life events which are known to impact the
HPA axis (Heim et al., 2000). For example, females are more likely to experience sexual victim-
ization which increases the risk for depression as well as Post-Traumatic Stress Disorder (PTSD;
Cutler & Nolen-Hoeksema, 1991).
In addition, exposure to negative life events of an interpersonal nature may pose a particular
risk for girls, due to their greater affiliative needs and emphasis on social relationships (Nolen-
Hoeksema, 2002; Rudolph, 2002). This exposure, combined with a cognitive style characterized
by excessive rumination, dysfunctional attitudes, and a pessimistic explanatory style, appears to
contribute to higher rates of depressive disorders in females (Nolen-Hoeksema, 2002). All of the
variables discussed above likely interact to increase the risk for depression in females.

Depression in Specific Populations

The literature on ethnicity and depression suggests that some racial groups experience more se-
vere depression, experience different symptoms, and are less likely to receive help from mental
health professionals. Minority students have been found to report higher rates of depression (e.g.,
Roberts, Roberts, & Chen, 1997; Rushton, Forcier, & Schectman, 2003). For example, a recent
meta-analysis of studies using the Children’s Depression Inventory (CDI; Kovacs, 1992) revealed
that Hispanic youth report higher levels of depressive symptoms than African American and
Caucasian youngsters (Twenge & Nolen-Hoeksema, 2002). Research also has revealed that fe-
male African American youth have higher rates of depression than European American students
(Garrison, Jackson, Marsteller, McKeown, & Addy, 1990). Other groups that may be at increased
risk for developing depressive disturbances include Native American youngsters (Petersen et al.,
1993), children from lower socio-economic backgrounds (Reinherz, Giaconia, Lefkowitz, Pakiz,
& Frost, 1993), and gay, lesbian, and bisexual youth (Anhalt & Morris, 1998). Youth with learn-
ing disabilities also may be at greater risk for developing depressive symptomatology (Arnold et
al., 2005). In addition, children who suffer from medical problems have higher rates of depres-
sion than those in the general population (see Stark, et al., 2006, for a review).
The way in which ethnic groups experience depressive symptomatology and respond to
self-report measures of depressive symptoms may differ. For example, a recent investigation that
used the Center for Epidemiologic Studies Depression Scale (CES-D) found that African Ameri-
can adolescents and adults scored high on items that inquired about somatic symptoms (Iwata,
 6. DEPRESSION AND RELATED DIFFICULTIES 107

Turner, & Lloyd, 2002). Thus, examination of specific symptom clusters may assist mental health
professionals in understanding how depression is manifested in various minority populations.
Although minority students appear to experience higher rates of depression, they are less
likely to receive mental health services. For example, Asian American and Native American
youngsters appear less likely to receive treatment (Bui & Takeuchi, 1992). African American
adolescents with psychological problems are more likely to enter the juvenile justice system than
their Caucasian adolescent counterparts (Kaplan & Busner, 1992).
Numerous explanations for the lack of service utilization by ethnic minority families have
been proposed, including the possibility that ethnic groups differ regarding what is perceived to
be a mental health problem and how severe the problem needs to be before seeking outside as-
sistance (see, for example, Cauce et al., 2002, for a review). Cauce and associates (2002) also
indicate that poor, ethnic minority families are likely under increased stress and may be less
sensitive to their child’s psychological problems. When a child’s problem is recognized, culture,
context and development are likely to influence help-seeking. There may be a stigma to seeking
treatment in some cultures such as Asian groups (Sue, 1988), while other groups such as African
Americans are more likely to turn to nonprofessional resources such as churches and extended
family (Zito, Safer, DosReis, & Riddle, 1998). Adolescents in general may be less likely to seek
out mental health services due to the emphasis placed on autonomy and privacy, as well as the
precarious nature of their self-identities during this developmental period (Cauce et al., 2002).
Of importance for school mental health professionals is the finding that the majority of youth
(70%) who evidence psychological disorders receive services in the school system rather than
from specialty treatment providers in the community (Burns et al., 1995). Schools have become
the primary providers of mental health services for youth (Hoagwood & Jensen, 1997). Thus,
given the reluctance of minority families and adolescents to seek help from formal mental health
treatment providers, schools are likely to be an important source for the identification and treat-
ment of youth suffering from depression (Cauce et al., 2002). They also can play a major role
in educating parents about their child’s psychological disturbance, addressing the family’s ques-
tions and concerns about treatment options, and connecting the family with community mental
health treatment providers.

Course and Prognosis

Childhood depressive disorders remit naturally. However, even after remission, subsyndromal
levels of symptoms often persist along with continued impairment (Kovacs & Goldston, 1991).
Children who have experienced an episode of depression are likely to develop a subsequent epi-
sode while still in their teens, suggesting that for many youth, depression represents a recurrent,
and in some instances chronic, disorder. In fact, adolescent depression is associated with recur-
rent episodes in adulthood (Lewinsohn, Rohde, Klein, & Seeley, 1999). Adolescent depression
also predicts adverse outcomes in adulthood, including early marriage, marital dissatisfaction,
impaired occupational functioning, reduced physical well-being, and potential suicide (e.g., Le-
winsohn, Rohde, Seeley, Klein, & Gotlib, 2003). Therefore, primary prevention and early inter-
vention efforts in educational settings become an important means by which school professionals
can affect the course of depression during children’s formative years and throughout their lives.

Comorbidity

Comorbidity is defined as two or more psychological disorders that co-occur more often than
would be expected by chance (Mash & Dozois, 2003). Comorbidity is common in childhood, and
108 REINEMANN AND SARAH SCHNOEBELEN

youth who suffer from depression are likely to also evidence other psychological disturbances.
For example, it has been estimated that 43% of adolescents with MDD have a lifetime comorbid
psychiatric disorder, with anxiety disorders being the most common (Lewinsohn, Rohde, & See-
ley, 1998). Depressed youth also often experience comorbid disruptive behavior disorders and
substance abuse (Lewinsohn et al., 1998). A summary of the existing data reveals that depression
co-occurs with Conduct Disorder, Oppositional Defiant Disorder, or Attention Deficit Hyperac-
tivity Disorder (ADHD) in approximately 25% of youngsters (Nottelmann & Jensen, 1995). Of
note, a diagnosis of comorbid depression plus Conduct Disorder or comorbid depression plus
substance abuse also increases the risk of suicide in youth. When comorbidity occurs, depression
seems to develop after the other condition in the majority of youth (Lewinsohn et al., 1998).
Apart from disorders, depressed youngsters also are likely to exhibit dysfunction in other
areas that may impact their functioning, especially at school. Depressed children often exhibit
social skills deficits and have been found to be less popular, less liked, and more likely to be re-
jected by peers than their non-disturbed counterparts (e.g., Rudolph & Clark, 2001). Depressed
students also have been found to have significantly lower academic achievement than their non-
depressed peers (Puig-Antich et al., 1985), and are more likely to miss school, fail to complete
homework assignments, and repeat a grade than their non-depressed counterparts (Lewinsohn et
al., 1994). Of major concern, depressed adolescents also appear to be at increased risk for drop-
ping out of high school (Kessler, Foster, Saunders, & Stang, 1995). Thus, depression is often
associated with difficulties in multiple domains and areas of functioning. Since comorbidity has
been shown to lead to greater functional impairment and a poorer long-term prognosis (Rohde,
Lewinsohn, & Seeley, 1991), proper assessment for possible co-occurring conditions in youth
suffering from depression is paramount.

Assessment of Depression

Assessing depressive disturbances requires information gathering from multiple sources, includ-
ing the youth, parent(s), and teachers. Self-report measures play a crucial role in the assessment
process of school-age youth, as key symptoms of depression (e.g., sadness, beliefs about self-
worth and competence, etc.) involve feelings and self-perceptions which are not easily observ-
able (Reynolds, 1994). However, there are concerns about how well these measures discriminate
between different disorders and whether they specifically assess depression or psychopathology
in general (Stark, 1990). As a result, self-report measures may best be used as screening devices
that are part of a more comprehensive assessment.
For more specific and accurate identification of depressive disorders in youth, either an in-
dividual assessment or a multiple-stage assessment procedure is recommended (Reynolds, 1994;
Stark, 1990). In order to screen for depressive disturbances in a large numbers of students, a
multiple-stage procedure is recommended. This procedure involves first screening the student
body using a self-report questionnaire such as the Children’s Depression Inventory (CDI; Ko-
vacs, 1992), Reynolds Child Depression Scale (RCDS; Reynolds, 1989), or the Beck Depression
Inventory for Youth (BDI-Y; Beck, Beck, & Jolly, 2001). After the initial screening, students
who scored at or above a clinical cutoff score are re-tested a short time later (1 to 2 weeks) as
there is evidence that youth may score higher on the first administration of a self-report measure
of depression than on a second testing (Reynolds, 1994). Those youth who continue to endorse
significant levels of depressive symptomatology during the second screening are then referred
for a more comprehensive assessment, which may include a diagnostic interview, such as the
Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS; Orvas-
chel & Puig-Antich, 1994), along with information from parent and teacher questionnaires and
 6. DEPRESSION AND RELATED DIFFICULTIES 109

interviews. Clinical interviews provide a more detailed examination of onset of the disturbance,
specific symptoms and their severity, and may provide information regarding problems that may
be contributing to the depression (Reynolds, 1994).
For a more complete picture of the scope of the child’s problems, parents can provide im-
portant information regarding the child’s behaviors and functioning at home that may be of con-
cern, while teachers can provide data regarding the child’s classroom behavior and academic
functioning. Parents and teachers may be asked to complete a behavioral rating scale such as the
Achenbach System of Empirically Based Assessment (ASEBA), Child Behavior Checklist (6–18
years) (Achenbach & Rescorla, 2001) or the Behavior Assessment System for Children, 2nd edi-
tion (BASC-2; Reynolds & Kamphaus, 2004), which addresses symptoms across several areas
of behavioral and emotional functioning. For example, the BASC-2 self-report measure contains
subscales that assess self-esteem, self-reliance, and interpersonal relations, while the BASC-2
parent and teacher reports contain subscales that assess the child’s social skills, study skills, and
leadership abilities. Since children with depression often present with low self-esteem, poor peer
relations and social skills problems, assessment of these areas may assist school personnel in
developing treatment goals and in intervention planning.

School Factors Related to Childhood Depression

In addition to being able to identify depression in the classroom, educators need to be aware
of the relationship between school factors and the emotional health of students. For example,
research has suggested that at the same time that middle school students report a reduction in
both teacher support and self-esteem, these students report an increase in depressive symptoms
(Reddy, Rhodes, & Mulhall, 2003). Furthermore, increased perceived teacher support was linked
to improvements in self-esteem and decreases in depression. Positive teacher-student relation-
ships appear to create positive school-related emotions, self-esteem, and a sense of belonging
(Hoge, Smith, & Hanson, 1990; Murray & Greenberg, 2000; Roeser, Midgley, & Urdan, 1996),
and those children and adolescents who do not perceive themselves to belong are at greater risk
for depression, social rejection, and school problems (Anderman, 2002). Anderman described
the relationship between depression and school belonging to be moderated by aggregated sense
of belonging across all the students in the school. In schools in which most of the students per-
ceived to belong, those students who did not report this sense of belongingness were at higher
risk for depressive symptoms, a finding which necessitates the importance of efforts to engage
isolated students.

EVIDENCE-BASED PREVENTION PROGRAMS FOR DEPRESSED YOUTH

Because of the chronicity, severity, long-term adverse effects, and high recurrence rate of de-
pressive disturbances, there has been an increased interest in, and development of, prevention
programs for reducing the initial onset of depressive disorders or to prevent relapse. These pre-
vention programs typically consist of sessions that address negative cognitions that are linked to
depression via teaching cognitive restructuring techniques and problem-solving. Prevention pro-
grams also may include sessions that provide assertiveness training, teach relaxation procedures,
and target social skills development. Most of the evidence-based programs are in the form of a
treatment manual and designed to be implemented in school settings.
Results of investigations designed to evaluate prevention programs for depressed youths
have, in general, reported positive results immediately following program completion, but mixed
110 REINEMANN AND SARAH SCHNOEBELEN

results during subsequent follow-up evaluations. For example, the Penn Resiliency Program for
Children and Adolescents (PRP-CA) is a school-based prevention program for late elementary
and middle school students that has undergone empirical investigation. Jaycox, Reivich, Gillham,
and Seligman (1994) reported that the 12-session prevention program, which emphasized train-
ing in cognitive and social problem-solving, reduced the severity of depressive symptoms and be-
havior problems in the classroom immediately following completion of the program, prevented
symptoms from recurring for 6 months, and significantly prevented depressive symptomatology
over 2 years. However, by year 3 results were no longer significant (Jaycox et al., 1994; Gillham
& Reivich, 1999). Subsequent research on the program was conducted with groups of middle
school students who were identified as being at risk for developing depressive disorders because
of the chronic stress of poverty. According to the study, the program significantly reduced depres-
sive symptoms among participants of Latino descent but not among African American partici-
pants (Muñoz, Penilla, & Urizar, 2002). These results raise important questions about the need
for, and potential benefits of, developing culturally sensitive interventions.
Given the mixed results discussed above, Gillham and associates (2006) recently developed
a parent component to the PRP-CA and collected pilot data on its effectiveness in preventing
depression in youth. The parent intervention focuses on teaching the same cognitive and prob-
lem-solving skills to the adults so that they may serve as models for their children, as well as
preventing parental depression which is a risk factor for childhood depression. In the pilot study,
children’s groups met weekly for eight, 90-minute sessions, while parents met for six 90-minute
sessions. Results showed that in comparison to a control group, children who completed the
PRP-CA with the parent component reported lower levels of depressive symptoms and anxiety
symptoms at 6-month and 12-month follow-ups. Although results appear promising, it will be
important for these researchers to conduct future studies that will help determine whether the
inclusion of the parent component to the PRP-CA leads to significantly better outcomes than
providing the program solely to the children.
Another group of researchers has developed and evaluated a series of manualized cognitive–
behavioral programs for the prevention and treatment of depressive disorders in adolescents,
titled Coping with Stress (CWS) and Coping with Depression (CWD), respectively (Clarke et
al., 1995; Clarke, Rohde, Lewinsohn, Hops, & Seeley, 1999). Components focus on experien-
tial learning and skills training, with attention to increasing pleasant activities, improving social
interaction, and coping with maladaptive thoughts. These programs have been administered in
school and clinical settings, and the materials can be downloaded at no cost for use by mental
health professionals. In an evaluation, adolescents who reported subclinical levels of depressive
symptoms, which placed them at risk for developing a depressive disorder, completed the 15-ses-
sion CWS group prevention program (Clarke et al., 1995). When compared with a “treatment as
usual” control condition, the prevention program significantly reduced the number of adolescents
who developed diagnosable depressive disorders over a 12-month period. However, because a
number of adolescents in the study still developed depressive disorders, additional research is
needed in order to identify the variables that predict those who are resilient versus those who
subsequently experience depression.
Another group of prevention programs are considered “universal” because they are imple-
mented with entire school populations and do not select students for participation based on
level of depressive symptomatology or family risk factors. These programs are typically con-
ducted with entire classrooms and may be implemented by teachers or other school mental
health personnel. Shochet and colleagues (2001) have developed an 11-session program titled
the Resourceful Adolescent Program (RAP), which has been implemented by psychologists and
 6. DEPRESSION AND RELATED DIFFICULTIES 111

evaluated in a school setting. The RAP focuses on promoting self-management, coping with
stress, building support networks, and teaching cognitive restructuring and problem-solving
skills. Similar to the recent addition of a parent component in the Penn Resiliency Program
discussed above, the RAP includes a 3-session family program for parents that focuses on stress
management, parenting adolescents, and family conflict resolution. In order to evaluate the pro-
gram’s effectiveness, students were assigned to either the adolescent program, the adolescent
program plus the family component, or a control condition. Results revealed that adolescents
who participated in either prevention program reported significantly lower levels of depressive
symptoms and hopelessness immediately following program completion and at 10-month fol-
low-up compared to adolescents in the control condition. However, there were no differences
between those receiving only the adolescent program and those who also participated in the
family program (Shochet et al., 2001).
More recently, Spence, Sheffield, and Donovan (2003, 2005) have developed a universal,
school-based cognitive-behavioral program designed to prevent the development of youth de-
pression, titled the Problem-Solving for Life program. Spence et al. specifically attempted to
create a curriculum which can easily be used by classroom teachers who implement the program
with all students in the class. The program consists of eight, 45- to 50-minute sessions that focus
on cognitive restructuring and problem-solving skills training. Youngsters are first taught to iden-
tify thoughts, feelings, and problem situations and then are provided with training in challenging
negative or irrational thoughts that contribute to the development of depression. The second part
of the program emphasizes teaching life problem-solving skills and the development of a positive
problem-solving orientation.
In a well-designed evaluation of the program, 8th-grade students (ages 12 to 14) who com-
pleted the program were compared to students in a monitoring-control condition. Results in-
dicated that students who initially reported elevated levels of depression (high risk group) and
who participated in the program showed a significant decrease in depressive symptoms and
an increase in problem-solving skills immediately following program completion compared to
control students also at high risk for depression. In addition, those students who completed the
program but did not evidence initial elevated levels of depression also reported a significant de-
crease in depressive symptoms and an increase in problem-solving skills compared to the low-
risk control students, who actually reported an increase in depressive symptomatology (Spence
et al., 2003).
Subsequent follow-up evaluations were conducted to assess the long-term impact of the
Problem-Solving for Life program. Results revealed that treatment gains were not maintained at
12-month follow-up. Specifically, Spence and colleagues (2003) reported that there were no sig-
nificant differences between the prevention group and control group in the percentage of students
who developed a depressive disorder or who exhibited elevated levels of depression. Further-
more, there were no group differences in changes from pre-intervention to 12-month follow-up
on measures of depression, cognitive style, and problem-solving, among others. Likewise, re-
evaluations showed no significant differences between those who completed the program and
those in the control condition at 2-, 3-, and 4-year follow-up (Spence et al., 2005).
Taken together, the evidence base for various childhood depression prevention programs ap-
pears somewhat equivocal at this time. Future studies are needed to address possible factors that
may influence whether prevention programs lead to long-term benefits. Examination of factors
such as program length, content, mode of delivery, training of teachers, and other implementers,
as well as which youth are best served by such preventive interventions may lead to improved
programs that demonstrate longer-term maintenance of initial treatment gains.
112 REINEMANN AND SARAH SCHNOEBELEN

EVIDENCE-BASED INTERVENTIONS FOR CHILDHOOD DEPRESSION

Issues in Implementation and Evaluation of School-Based Interventions

A number of evidence-based interventions for child and adolescent depression have been devel-
oped and are undergoing evaluation. Several of these evaluations have been conducted within
the school setting. The provision of such services within the school offers a natural vehicle for
effective service delivery. By bringing services to the place where children and adolescents spend
the majority of the day, issues such as poor therapy attendance due to transportation and schedul-
ing conflicts may be prevented. Furthermore, as Stark and colleagues (2006a) have articulated,
the goals of any intervention with depressed children and adolescents extend beyond symptom
reduction to improvement in functional capacity. Given the significant amount of time children
spend within the school setting, it is easy to understand how quality of life is inextricably linked
to a child’s performance and satisfaction in the school environment. Providing services in the
school also facilitates close consultation with the youngster’s teachers. Such communication
allows educators and therapists to collaborate to determine how to reinforce and support the
specific interventions provided as part of the therapy within the classroom setting where students
spend the majority of their days. From a purely pragmatic standpoint, group interventions, of
which many of the published protocols employ, may be easier to manage within the school set-
ting than the clinic because there are greater chances of identifying enough children at similar
ages and grades to form more developmentally homogeneous groups. Furthermore, it is hoped
that by providing services for depression within the school, the disorder is de-stigmatized and
awareness is increased.
Despite the fact that many benefits exist to providing services for depressed children within
the educational setting, some problems exist with this method of service delivery. For example,
children and adolescents may perceive some risk to confidentiality by attending therapy with
friends and classmates, even when confidentially agreements are clearly negotiated. Further-
more, efforts must be taken to avoid students feeling as though they are being clearly identified
as a student who is receiving intervention services for depression, for example, when possible,
avoiding the interruption of class to remind a student to attend a therapy session. Also, it is im-
portant to recognize scheduling constraints within a school and the need for students to avoid
missing a significant portion of time in any one academic class.
Although many of the evaluation studies comprising the childhood depression literature have
screened participants in the school and provided services there, many other issues of treatment
generalizability and transportability remain. In a recent review, Weisz , Doss, and Hawley (2005)
directly addressed the clinical representativeness of the literature base in terms of the manner in
which participants were identified and enrolled in the studies, the characteristics and training of
the service providers, and the setting in which the treatment was provided. Weisz’s group found
that very few depression treatment outcome studies reported information on all three of these
categories. Of those studies that did provide such data, 78% of the participants were not actually
seeking treatment at the time of recruitment. In terms of treatment providers, a large percentage
of depressed participants (approximately 56%) were treated by practicing mental health profes-
sionals, with the remainder of services provided by researchers or graduate students. Certainly,
the degree of time and resources that graduate students and individual researchers are able to
devote to psychotherapy protocols may be significantly greater than that of the front-line school-
based mental health provider. As Weisz and colleagues highlight, a rapid movement from initial
efficacy studies to tests of interventions in ecologically valid conditions is essential. An account
of the experience, including some of the challenges of transporting a specific therapy (Interper-
 6. DEPRESSION AND RELATED DIFFICULTIES 113

sonal Therapy for Adolescents; IPT-A) from a university-based clinic setting to school health
centers, can be found in Mufson, Dorta, Olfson, Weissman, and Hoagwood (2004).

Overview of Evidence-Based Interventions

The psychotherapeutic treatment approaches which have received the most empirical support
include cognitive-behavioral therapy (e.g., Brent et al., 1997; Butler, Miezitis, Friedman, & Cole,
1980; Kahn & Kehle, 1990; Lewisohn, Clarke, Hops, & Andrews, 1990; Reynolds & Coates,
1986; Stark, Reynolds, & Kaslow, 1987; Stark, Rouse, & Livingston, 1991; Vostanis, Feehan,
Grattan, & Bickerton, 1996a, 1996b; Weisz, Thurber, Sweeney, Proffitt, & LeGagnoux, 1997;
Wood, Harrington, & Moore, 1996) and interpersonal therapy (e.g., Mufson et al., 1994; Mufson,
Dorta, Wickramaratne, et al., 2004; Mufson & Fairbanks, 1996; Mufson, Moreau, Weissman,
& Garfinkel, 1999; Rossello & Bernal, 1999). Family interventions for various mood disorders
also have been described in the literature (e.g., Fristad, Goldberg-Arnold, & Gavazzi, 2002; Har-
rington et al., 2000; Lewinsohn et al., 1990; Miklowitz et al., 2004; Sanford et al., 2006). These
intervention efforts frequently take the form of adjunctive family psychoeducation and training
in communication and problem-solving which, in some cases, have had positive effects on family
relationships and social functioning of depressed adolescents (e.g., Sanford et al., 2006). Unfor-
tunately, literature regarding the efficacy of family involvement in interventions for depression is
sparse. Family interventions in particular will not be described in great detail here; the interested
reader is encouraged to see Sander and McCarty (2005) for a comprehensive review of the family
risk factors associated in depression, as well family involvement in treatment approaches. Before
presenting information regarding empirically-supported psychosocial treatments for depression,
the literature regarding psychopharmacological intervention will be discussed briefly as many
children receive combined treatment that includes medication and psychotherapy.

Medication

Although tricyclic antidepressants (TCAs) formerly were utilized with frequency in the treatment
of depression in youth (Stark, et al., 2006b), studies generally have not found TCAs to be effec-
tive in children (see, for example, Geller, Reising, Leonard, Riddle, & Walsh, 1999). Further-
more, these authors point out that the serious side effects, especially cardiovascular effects, must
be carefully considered when using TCAs in children. Currently, the first line of antidepressant
medication treatment for children consists of the selective serotonin reuptake inhibitors (SS-
RIs) (American Academy of Child and Adolescent Psychiatry, 1998), which include fluoxetine
(Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and
escitalopram (Lexapro). Fluoxetine has the greatest research support (e.g., Emslie et al., 1997,
2002) and is the only SSRI approved by the U.S. Food and Drug Administration (FDA) for the
treatment of depression in children and adolescents, although the other SSRIs are frequently
prescribed by psychiatrists based on their clinical experiences of safe and effective use with pa-
tients (Stark, et al., 2006). One of the most important recent studies of medication efficacy was
the Treatment for Adolescents with Depression Study (TADS), a multi-site investigation com-
paring the effectiveness of fluoxetine alone, CBT alone, fluoxetine + CBT, and placebo (Treat-
ment for Adolescents with Depression Study Team, 2004). The results suggested that rates of
response were higher for fluoxetine alone (60.6%) than CBT alone (43.2%), the latter of which
was not significantly different than pill placebo. Combined therapy resulted in a 71.0% rate of
response. Patients receiving CBT, either alone or in combination with medication, demonstrated
decreased suicidal ideation. The American Academy of Child and Adolescent Psychiatry (1998)
114 REINEMANN AND SARAH SCHNOEBELEN

has suggested that combined treatments for childhood depression are often appropriate, stating,
“Given the psychosocial context in which depression unfolds, pharmacotherapy is never suffi-
cient as the sole treatment” (p. 72S).
Other studies have provided evidence for the effectiveness of SSRIs, including sertraline
(e.g., Wagner et al., 2003), citalopram (e.g., Wagner et al., 2004), and paroxetine (Keller et al.,
2001), compared to placebo, although a study by Simeon, Dinicola, Ferguson, and Copping
(1990) reported no statistical significance in the superiority of fluoxetine over placebo. Other
medications that may be utilized to treat child and adolescent depression include bupropion
(Wellbutrin), mirtazapine (Remeron), venlafaxine (Effexor), and the monoamine oxidase inhibi-
tors (MAOIs), the latter of which are very rarely used in pediatric depression due to their signifi-
cant side-effect profile (Stark et al., 2006b).
Although the SSRIs have demonstrated efficacy for depressed adolescents, their use with
this age group is controversial as a 2003 report by the British Medicines and Healthcare Products
Regulatory Agency (MHRA) concluded that most of the SSRIs do not show benefits that exceed
their risks of suicidal ideation and thus should not be prescribed to youth (Reinemann et al.,
2006). The FDA (FDA, 2004) then reanalyzed the results of existing drug studies and found that
youths who took antidepressants were 78% more likely to exhibit suicidal behaviors relative to
children who took a placebo. The FDA recommended that paroxetine not be used to treat depres-
sion in youth under age 18 and that caution be used when administering other antidepressants to
children and adolescents. Parents should be warned of possible suicidality concerns, especially
early in treatment. However, recent results from the TADS study found that treated youth actually
reported less suicidal ideation. Thus, continued research is needed that addresses the potential
risks and benefits of psychopharmacological treatment of depression in youth (Reinemann et al.,
2006).

Psychotherapeutic Interventions

In reviewing the evidence base for psychosocial interventions in child and adolescent depres-
sion, it is important to refer readers to previous comprehensive reviews and meta-analyses of
the literature regarding intervention outcomes for a range of childhood disorders (e.g., Casey &
Berman, 1985; Durlak, Wells, Cotton, & Johnson, 1995; Kazdin, 2000; Shirk & Russell, 1996;
Weisz, Weiss, Alicke, & Klotz, 1987; Weisz, Weiss, Han, & Granger, 1995; Weisz et al., 2005).
In their most recent review of the literature spanning from 1962 to 2002, Weisz and colleagues
(2005) evaluated outcome studies addressing four major clusters of childhood disorders, includ-
ing problems related to anxiety, depression, conduct, and difficulties with inattentiveness, hyper-
activity, and impulsivity. Of these four domains, the depression treatment outcome research was
the most recent, with 89% of the studies published in the 1990s or later, compared to 43% for
anxiety outcome research, 20% for attention problems, and 33% for conduct problems. Further-
more, compared to research associated with the other disorders, Weisz and colleagues found that
those studies evaluating outcomes of treatments for depression reported more systematic sample
selection as well as a greater degree of pre-treatment training for clinicians, use of manualized
or otherwise structured treatments, and supervision or monitoring of adherence. However, as
Stark and colleagues (Stark, et al., 2006a; Stark, et al., 2006b) have noted, simple “adherence” to
treatment manuals is not sufficient. Rather, Stark stresses the need for an “artistic application” of
the treatment components in order to flexibly and individually relate the skills taught to working
hypotheses regarding the etiological and maintenance factors underlying the child’s depressive
symptoms.
The Weisz et al. (2005) results reflect the increased awareness of childhood depression as
 6. DEPRESSION AND RELATED DIFFICULTIES 115

well as its consequence. These authors suggest that the literature base evaluating the outcomes
of depression treatment has “profited from the more rigorous methodological standards of the
era,” (Weisz et al, 2005, p. 350), although the more recent foray into this realm of research also
results in a relatively limited number of studies on the topic. In addition to the small number of
studies, most of the published evaluations are composed of small sample sizes, rendering them
underpowered. Generalizability is a problem for studies of interventions for depression as well
as psychotherapy outcome research in general. For example, Kazdin (2000) has commented that,
for the most part, participants in currently published outcome research may experience less se-
vere symptoms than seen in regular clinical practice. Furthermore, participants may face less
severe contextual factors, such as parental psychopathology and economic disadvantage (Kazdin,
2000). Transportability is another problem. According to Weisz and colleagues (2005), approxi-
mately 1% of published youth psychotherapy outcome studies report representativeness to actual
clinic populations across setting, therapist, and recruitment.
With these caveats in mind, the two psychotherapeutic modalities with the greatest empirical
evidence, cognitive-behavioral therapy and interpersonal therapy, will be discussed briefly. Table
6.1 outlines the essential features and findings of the published outcome studies of outpatient
treatments for youth depression. Although a number of these treatment programs have been de-
livered in the school setting, one particular program, the ACTION program, has been developed
specifically for school-based service and will be described in greater detail.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is built upon the philosophical and theoretical tenants of
both behaviorism/learning theory and cognitive theory. In particular, the central components
of Beck’s cognitive therapy have been outlined in several sources (e.g., Alford & Beck, 1997;
Clark, Beck, & Alford, 1999). Most central to Beck’s form of CBT is the concept of schemata
or the “meaning-making structures of cognition” (Alford & Beck, 1997). Within the cognitive
paradigm, humans are active information seekers. As information is filtered through a schema,
meaning is assigned to situations, which influences behavior, emotion, attention, memory, and
physiology (Alford & Beck, 1997). The rules for processing information are referred to as “cog-
nitive operations” (Hollon & Kriss, 1984) which serve to manipulate data in order to produce
the “cognitive products” of attributions, decisions, images, and thoughts. Cognitive operations,
however, may result in distortion or bias (Alford & Beck, 1997). Schema-consistent information
processing causes an individual to selectively attend to and process information congruent with
his or her beliefs. This restricted range of information serves to reinforce the schema. If the core
schemata are negative, the resulting cognitive products, including negative automatic thoughts,
will result in unpleasant emotional experience (Beck, 1995). Important in Beck’s theoretical
model is the concept of the cognitive triad, consisting of meaning constructed about the self, the
world, and the future. Psychological difficulties stem from maladaptive meaning construction in
any of these domains (Alford & Beck, 1997).
Cognitive-behavioral therapy attempts to restructure maladaptive cognitions and foster more
balanced information processing. For example, children who possess the core belief that they
are unlovable may interpret other people’s behavior as reflecting this unlovability. Whereas a
healthy child may attribute a teacher’s short response to the teacher being busy or stressed, a
depressed child may interpret this to mean that the teacher does not like him or her, produc-
ing negative automatic thoughts such as “He must hate me” and seemingly more evidence that
the child is unlovable. The process of cognitive restructuring involves examining such negative
thoughts to determine whether they are true or helpful. When working with depressed youth,
 116

TABLE 6.1
Characteristics and Results of Published Treatment Efficacy Studies of Childhood Depression

Study Format Participants/Setting Interventions Results

Butler et al., Group 10 weekly one- 56 children 5th–6th • Role Play (combination of problem solving • Both role play and cognitive restructuring groups
1980 hour sessions grade school and social skills) showed reduction on self-report measures of
• Cognitive Restructuring (recognition of depression and self-esteem, with greater improvement
irrational automatic thoughts, relationship noted for the Role Play group
between thoughts and feelings, and • A reduction in depressive symptoms on one self-
restructuring to produce more adaptive report measure also was observed in the Control
alternatives) group, although authors noted that a subset of this
• Attention Placebo (cooperative academic group received three sessions with a “resource
problem solving) teacher” focusing upon self-esteem improvement
• Classroom Controls • Role play group also showed improvement on self-
report measures of locus of control and depressive
REINEMANN AND SARAH SCHNOEBELEN

cognitive distortions
Reynolds & Group 10 50-minute 30 adolescents • CBT (self-control, affective education, • CBT and Relaxation Training were both more
Coates, 1986 sessions over 5 weeks 9th–12th grades goal setting, self-monitoring, cognitive effective in reduction of symptoms than waitlist at
school restructuring) immediate post-treatment and 5-week follow-up (on
• Relaxation Training (psychoeducation a self-report measure, 83% of the CBT group and
regarding the relationship between stress and 75% of the Relaxation Training group scored within
depression; progressive muscle relaxation; normal range at post-treatment; whereas none of the
direct application to stressful situations) waitlist group did)
• Waitlist Control • Differences between the two treatment groups were
not significant
• Reductions in anxiety were noted in the Relaxation
Training group and improved academic self-concept
was observed in both active treatment groups
 Study Format Participants/Setting Interventions Results
Stark et al., 1987 Group 12 45-50 minute 29 children 4th–6th • Self Control (self-monitoring of behavior • Both treatment groups improved on interview and
sessions over 5 weeks grade school and thoughts, pleasant events scheduling, self- two self-report measures of depression
evaluation and reward, and appropriate setting • Waitlist group improved significantly only on one
of goals and standards) self-report measure
•Behavioral Problem Solving •Self Control group only scored significantly lower
(psychoeducation, pleasant events scheduling, than the Waitlist group on self-report questionnaire;
and interpersonal problem solving, expression Difference approached significance on another self-
of feelings) report measure
• Waitlist • Only subjects in the Self Control group reported
significantly improved self-concept at post-treatment
and follow-up
• Benefits maintained at 8-week follow-up, and
the Self-Control group was less depressed than
Behavioral Problem-Solving group based on
interview
Kahn et al., Group CBT and 68 children 6th–8th • CBT (downward extension of the • Greatest improvement in CBT group in terms of
1990 Relaxation Training; grade school adolescent version of the Coping with reduction of depressive symptoms and improvement
Individual Self-modeling; Depression course-see Lewisohn et al., of self-esteem; but other two active treatment groups
all had 12 one-hour 1990-comprehensive program including also demonstrated improvement compared to waitlist
sessions over 6-8 weeks psychoeducation, pleasant events scheduling, condition at immediate and one-month follow-up
cognitive restructuring, problem solving, • Participants in the active treatment groups were more
social skills, self reinforcement) likely to move into the nonclinical range on measures
• Relaxation Training (psychoeducation after treatment (from 59-88% depending on the group
regarding stress and anxiety, progressive and measure) compared to 12-18% of the waitlist
muscle relaxation) group, depending on measure
• Self-Modeling Treatment (use of video
recording to reinforce behaviors incompatible
with depression)
• Waitlist Control
(continued)
6. DEPRESSION AND RELATED DIFFICULTIES
117
 TABLE 6.1
(Continued)
118

Study Format Participants/Setting Interventions Results

Lewisohn et al. Group 14 two-hour 59 adolescents ages • Coping with Depression –Adolescent • Compared to wait-list condition, subjects in both
(1990) sessions over 7 weeks; 14-18 setting not course (Affective education, social skills, treatment conditions improved significantly on self-
For adolescent + parent clearly indicated conflict resolution skills, pleasant events report measures of depressive symptoms, although
group, additional 7 scheduling, relaxation techniques, goal not parent-report measures
weekly 2-hour sessions setting, cognitive restructuring) • At post-treatment, 57.1% of adolescent group and
• Coping with Depression + Parent Group 52.4% of adolescent and parent group met criteria
(Coping with Depression Adolescent program for a depressive disorder but 95.7% of waitlist group
as described above with parent group that continued to meet criteria
provided information about the same skills • Gains appeared to be maintained for up to 2 years
taught to the adolescents) follow-up
• Waitlist Control • Trend for greater improvement in Adolescent +
Parent group over Adolescent-Only; statistically
significant for only one comparison
Liddle & Spence Group 8 weekly one-hour 31 children ages • Social Competence Training (social skills • Decline in self-reported depressive symptoms across
(1990) sessions 7–11 school training, interpersonal problem solving and all three conditions immediately and at three-months;
adjustment of maladaptive cognitive coping no statistically significant difference between active
REINEMANN AND SARAH SCHNOEBELEN

styles) treatment and placebos

• Attention Placebo Control (drama program)
• No treatment control
Fine et al., 1991 Group 12 weekly 66 adolescents ages • Social Skills Training (series of skills • Statistically significant difference between the groups
sessions 13-17 clinic including recognition of feelings, on an interview measure of depressive symptoms,
assertiveness, conversation, exchange with the therapeutic support group demonstrating
of feedback, social problem solving and greater improvement; trend toward greater
conflict resolution; included role plays and improvement in the therapeutic support group on self-
videotaping) report measures of depression
• Therapeutic Support Group (addressed • Trend for more adolescents in the therapeutic support
self-concept through the identification group falling in the nonclinical range at immediate
and reinforcement of strengths, sharing of post-treatment, although this difference was not
concerns, discussions of ways to manage clinically significant
concerns, mutual support) • Greater improvement in self-concept among
*Note: A portion of both groups were adolescents in the therapeutic support group
receiving concurrent therapy. • At 9-month follow-up, there was no difference
between the two groups on depression measures,
which the authors interpreted as the social skills
group “caught up” with the therapeutic support group
 Study Format Participants/Setting Interventions Results
Stark et al., 1991 Group 24 to 26 45-50 24 children 4th–7th • Expanded CBT program (including • Although participants in both groups reported less
minute sessions (2x grade school and elements of both active treatments in the Stark depressive behavior and cognitions, those in the CBT
week for 8 weeks and 1x home (family et. al., 1987 study; self-control, assertiveness group were less depressed than participants in the
week thereafter)monthly sessions) training, social skills, relaxation training and Traditional Counseling group at post-treatment, as
individual family imagery, cognitive restructuring, problem measured by a diagnostic interview and self-report
sessions solving; in family sessions, discussion of measure of depressive cognitions
engagement in pleasant family activities and • Group differences at 7-month follow-up were
encouraging participants to apply their skills) not significant; however, a high attrition rate
• Traditional Counseling (psychoeducation was observed with only 7 CBT and 5 Traditional
and supportive psychotherapy) Counseling participants available for follow-up
assessment
Mufson et al., Individual 12 45-minute 14 adolescents 11 • Interpersonal Psychotherapy for Depressed • At post-treatment, no adolescents met criteria for
1994; Mufson & weekly sessions + phone completers clinic Adolescents (IPT-A addresses common depression on clinical interview
Fairbanks, 1996 contact when indicated developmental issues, such as separation • Significant reduction in depressive symptoms on self-
from parents and authority in relationship report and clinician rating scale
to parents, development of interpersonal • Improvement in global functioning
relationships, experience with the loss of • At one-year follow-up, 10 adolescents were assessed;
a loved one, peer pressure, single-parent of the 9 receiving a clinical interview, only 1 met
families) diagnostic criteria for depressive disorder
*Note: Initial open trial with no control group • At follow-up, overall social adjustment improved
since termination
• Worsening in clinician-rated measure of overall
functioning from termination to follow-up, although
authors suggest this may be a result of having a
different rater at pre- and post-treatment than follow-
up; no inter-rater reliability obtained
(continued)
6. DEPRESSION AND RELATED DIFFICULTIES
119
 TABLE 6.1
(Continued)
120

Study Format Participants/Setting Interventions Results

Vostanis et al., Individual 9 biweekly 57 youth ages 8-17 • CBT (recognition and labeling of emotions, • CBT resulted in slightly higher recovery from
1996ab sessions clinic social skills/problem solving, and cognitive depression (87% in CBT vs. 75% in control)
restructuring) • No significant difference between groups on any
• Nonfocused Intervention (“supportive outcome measures, including diagnostic interviews,
therapy,” review of mental state and social structured social adjustment interview, and self-
activities; unstructured with no therapist and parent-reports immediately after treatment
suggestions) (authors did indicate that only 50% of the CBT
group completed the full program and a number of
absences occurred during the cognitive restructuring
component)
• No significant difference between treatment groups at
9-month follow-up; risk of recurrence was relatively
high in both groups
Wood et al., Individual 5-8 sessions 48 completers ages • CBT (cognitive restructuring, social problem • CBT significantly better in reducing depressed mood
1996 9–17 clinic solving, alleviation of symptoms, such as and symptoms and improving remission rates, self-
sleep difficulties and inactivity) image, and global functioning although no significant
• Relaxation Training differences between groups were noted on measures
REINEMANN AND SARAH SCHNOEBELEN

of anxiety or conduct symptoms

• Differences between groups did not persist at 3- and
6-month follow-up
Brent et al., Individual or family 107 adolescents • CBT (addressed autonomy and trust, • Significantly more adolescents in CBT group met
1997; Birmaher 12-16 weekly sessions, ages 13-18 clinic affective regulation, problem solving, requirement for remission (absence of MDD and
et al., 2000 followed by 2 to 4 cognitive restructuring) three consecutive low self-report depression scores,
monthly booster sessions • Systemic Behavior Family Therapy sustained through sessions). Rates of remission were
(structural, behavioral family therapy; 60% for CBT, 37.9% for family therapy and 39.4%
identification of dysfunctional behavior for supportive therapy; CBT group also demonstrated
patterns; development of communication and a faster rate of symptom improvement
problem solving skills; alteration of family • At immediate post-treatment, there no differences
interaction patterns) between treatment groups in functional status
• Nondirective Supportive Therapy • At two-years post-treatment (Birmaher et al., 2000),
(establishment and maintenance of rapport, no significant differences on outcome measures
reflective listening, empathy, discussion of between the groups; most adolescents eventually
patient-initiated ideas to address problems) recovered from depression
*Note: In all groups, patients and families
received psychoeducation regarding
depression and the treatment of depression
 Study Format Participants/Setting Interventions Results
Weisz et al. Group 8 weekly sessions 48 children 3rd–6th • Primary and Secondary Control • At immediate post-treatment and 9-month follow-
1997 (including one individual grade school Enhancement Training (PASCET; two- up, the treatment group demonstrated significantly
session) process model of control; primary control greater reductions in depressive symptoms on a
involves active problem solving and self-report questionnaire than the control group and a
instrumental behavior and secondary control trend towards such on a clinical interview
refers to emotion-focused coping and ability • At immediate post-treatment, more treated children
to adjust oneself) moved into the normal range on the questionnaire
• Control Group (No treatment) measure; at follow-up, significantly more treated
children fell in the normal range for both the
questionnaire and interview measure
Clarke et al., Group 16 two-hour 96 adolescents ages • Coping with Depression - Adolescent • Compared to wait-list condition, subjects in both
1999 sessions over 8 weeks; 14-18 setting not course (see Lewinsohn et al., 1990) treatment conditions improved on a self-report
For adolescent + parent clearly indicated • Coping with Depression + Parent Group measure of depressive symptoms and clinical
group, 8 additional (see Lewinsohn et al., 1990) assessment of functioning (no significant difference
two-hour parent • Waitlist Control between two active treatment groups), although not
sessions; participants in • + Booster Sessions (participants in active on parent-report measures
active treatment group treatment sessions were randomly assigned • At post-treatment, 66.7% of participants in the
randomly assigned to one to booster sessions or no booster sessions; active treatment group demonstrated recovery from
of three conditions:1) however, attendance was less than 50%) depression (defined as no longer meeting criteria
booster sessions and for major depression or dysthymia as outlined in
assessments every 4 the DSM-III-R for the two weeks prior to the post-
months, 2) assessments treatment assessment) compared to 48.1% of waitlist
every 4 months with no group; no significant difference in recovery between
booster sessions, or 3) two active conditions
annual assessments only • Booster sessions did not appear to reduce relapse rate
with no booster sessions of those participants who had recovered during initial
treatment but in the first year post-treatment may have
helped those who remained depressed after treatment
Mufson et al., Individual 12 weekly 48 adolescents, 32 • Interpersonal Psychotherapy for • Compared to the control group, adolescents in IPT-A
1999 sessions + additional completers ages Depressed Adolescents (IPT-A; see Mufson treatment endorsed fewer depressive symptoms, in
phone contact during first 12–18 clinic et al., 1994) addition to improved overall social functioning and
4 weeks of treatment + • Clinical Monitoring (30-minute monthly problem solving skills, at the end of treatment
6. DEPRESSION AND RELATED DIFFICULTIES

one parent session sessions; discussion of symptoms and • Significantly more IPT-A participants met criteria for
functioning, supportive listening) recovery on clinician ratings of depression (75% vs.
46% in monitoring group)
• No significant group differences in clinical ratings of
121

global functioning
(continued)
 122

TABLE 6.1
(Continued)

Study Format Participants/Setting Interventions Results

Rossello & Individual 12 weekly 71 adolescents ages • Interpersonal Psychotherapy for • Compared to the waitlist condition, significant
Bernal, 1999 1-hour sessions 13–18 clinic Depressed Adolescents (IPT-A; see Mufson, reduction in depressive symptoms for the two active
1994) treatment groups
• Cognitive Behavioral Therapy • Compared to the waitlist group, IPT group showed
(identification and restructuring of negative improvements in self-esteem and social adjustment
thinking; pleasant events scheduling; • No significant differences between IPT and CBT
interpersonal relationships) groups at follow-up (waitlist group was provided
• Waitlist treatment prior to follow-up evaluation so no
Note: Active treatments were adapted for comparisons with the waitlist group were available);
depressed Puerto Rican adolescents to provide however, high attrition rate for follow-up assessment
for culturally sensitive treatment
REINEMANN AND SARAH SCHNOEBELEN

Mufson et al., Individual 8 weekly 35- 63 adolescents, • Interpersonal Psychotherapy for Depressed • Compared to the control group, adolescents in IPT-A
2004 minute sessions followed ages 12-18 school- Adolescents (IPT-A; see Mufson, 1994) treatment endorsed fewer depressive symptoms in
by 4 sessions over 12 based health clinic • Treatment as Usual (treatment which would addition to improved overall social functioning at the
weeks have been provided in the school-based end of treatment
setting should the study not have occurred; • More IPT-A participants met criteria for recovery
authors reported that, in general, such on clinician ratings of depression (50% vs. 34%
treatment resembled supportive counseling; in treatment as usual group) and on a self-report
mostly individual, some group, and some with measure (74% vs. 52%)
additional family or parent sessions) • Adolescents in the IPT-A group demonstrated
significantly greater improvement in clinical ratings
of global functioning
 6. DEPRESSION AND RELATED DIFFICULTIES 123

it becomes important to provide concrete examples of how thinking affects feeling, as well as
simple methods to challenge maladaptive cognition. In addition, behavioral interventions are a
key component of treatment, especially for children and adolescents. Behavioral interventions
include engagement in pleasant activities and training in coping strategies to improve mood, as
well as direct instruction in problem solving. Kendall (2006) describes that the therapist work-
ing with children and adolescents assumes the role of a “coach” by stressing the importance of
applying the skills to the real-life concerns of the children rather than merely talking about the
skills in an abstract manner.
Cognitive-behavioral therapy for children is considered “possibly efficacious” (Kazdin &
Weisz, 1998) according to the criteria outlined by Chambless and Hollon (1998). According to
Chambless and Hollon, empirically-supported treatments are ones that have been found to have
greater efficacy than no treatment, a placebo, or an alternate treatment. Furthermore, their effects
are present across multiple studies conducted by different research teams. Kazdin and Weisz
(1998) point out that the label of CBT as “possibly efficacious” for children is conservative and
has been applied because different research teams are using various manualized programs, albeit
with positive results.
An example of one such manualized CBT treatment program that has received empirical
support is Clarke et al.’s (1999) Coping with Depression Course (CWDC). The program consists
of 16 two-hour group meetings delivered over 8 weeks. Participants are educated about the nature
of depression and are provided with a cognitive–behavioral rationale for treatment. During sub-
sequent meetings, participants are taught a variety of behavioral and cognitive skills. Self-moni-
toring is used to help the participants become more aware of their moods and the strategies that
they use to try to improve mood, including pleasant events scheduling. Participants are taught
to identify and change negative thoughts. In addition to these core cognitive-behavioral treat-
ment components, CWDC teaches participants social skills, skills for improving communication
and decreasing conflict, and skills for reducing anxiety. The skills are taught through didactic
presentations, coaching, rehearsal, and feedback and are applied through structured homework
assignments. Evaluations of the CWDC have shown that recovery rates for depressed adolescents
in the program were greater than for those in a wait-list control group, and improvements were
maintained over 2 years (Clarke et al., 1995; Clarke et al., 1999).

Interpersonal Psychotherapy for Adolescents

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is an adaptation of a brief psy-

chotherapy initially developed by Klerman and colleagues (Klerman, Weissman, Rounsaville,
& Chevron, 1984) for depressed adults which has been modified for use with adolescents (Muf-
son, Moreau, Weissman, & Klerman, 1993). The primary goals of this form of therapy include
improvement in interpersonal functioning and development of a greater understanding on the
part of parents and adolescents about depression in this population, in addition to a reduction of
depressive symptoms. As Mufson, Gallagher, Dorta, and Young (2004) note, “IPT-A posits that,
regardless of etiology, depression occurs in an interpersonal context” (p. 221). Although initially
developed as an individual therapy, it was later adapted to be used in a group format (Mufson
et al., 2004). Both the individual and group forms of the treatment are divided into a number of
phases, including identifying specific problem areas (i.e., mild to moderate grief, interpersonal
role disputes, role transitions, interpersonal deficits, and living in single-parent families), devel-
oping an understanding of the problem area, attainment and application of skills specific to the
problem area, and termination.
Treatment involves two initial individual sessions with the adolescent, as well as some
124 REINEMANN AND SARAH SCHNOEBELEN

parental involvement. During these individual sessions, information about the adolescents’ in-
terpersonal functioning is gathered. Also, the specific problems that will become the areas of
focus are determined in these initial sessions. Next, there are 12 group therapy sessions, as well
as an additional session with each participant and parent during the middle of the treatment and
at the end. These individual sessions serve as a means to review progress and modify therapeutic
goals as necessary. The group therapy sessions focus upon the acquisition and application of new
interpersonal skills, which are practiced in vivo within the context of the interpersonal relation-
ships existing in the group. Termination is given particular consideration as the therapists work to
reinforce the group member’s competence and establish an adaptive and supportive termination
experience (Mufson et al., 2004). Several studies have supported the efficacy (e.g., Mufson et al.,
1994; Mufson & Fairbanks, 1996; Mufson, Weissman, Moreau, & Garfinkel, 1999; Rossello &
Bernal, 1999) and effectiveness of IPT-A in a school-based clinic setting (Mufson et al., 2004).

Treatment Designed for School-Based Delivery: The ACTION Project

Stark and colleagues have developed a comprehensive school-based depression treatment pro-
gram for children, entitled the ACTION Program (Stark et al., 2005a; Stark, et al., 2005b). This
program currently is being evaluated by Stark and his team at the University of Texas at Austin in
surrounding local schools as part of a 5-year National Institute of Mental Health (NIMH) funded
study. Given the gender difference in depression that is observed after puberty, the program is
targeted at females in the upper elementary and early middle school grades, although the gen-
eral treatment components would be appropriate for use with males and females and across age
ranges, with some modifications (e.g., Stark et al., 2006b).
The most recent version of the treatment has its roots in earlier programs developed and test-
ed by Stark and colleagues. In 1987, Stark and colleagues randomly assigned 29 moderately to
severely depressed children to a self-control training group, a behavioral problem solving group,
or a waitlist condition. Both of the groups met for 12 sessions. The intervention provided in the
self-control training group was reflective of the treatment model for adults outlined by Rehm,
Kaslow, and Rabin (1987) and included skills such self-monitoring of behavior and thoughts,
self-evaluation and reward, and appropriate attributions. The behavioral problem-solving group
focused on psychoeducation, pleasant events scheduling, and interpersonal problem-solving and
was similar in some respects to an adult model designed by Lewinsohn, Sullivan, and Grosscup
(1980). The results suggested that both active treatment groups demonstrated reductions in de-
pressive symptoms across more measures than those in the waitlist control group. These benefits
were maintained at an 8-week follow-up.
After these initial findings, Stark and colleagues (1991) tested a treatment package which
combined the skills in both of the groups described above in a comprehensive cognitive-behav-
ioral intervention. The intervention included 24 to 26 group sessions lasting approximately 3½
months. The therapy was provided in the school, and each child also participated in monthly indi-
vidual family sessions. In the control condition, students received “traditional counseling,” which
included psychoeducation and supportive therapy. Twenty-four 4th to 7th graders were enrolled.
At immediate post-treatment evaluation, greater reductions in depressive symptoms and nega-
tive cognitions were noted in the children who had received the cognitive-behavioral treatment
package versus traditional counseling. No significant group differences were noted at a 7-month
follow-up; however, only seven of the CBT participants and five of the traditional counseling
participants were evaluated at the time of the follow-up.
The current conceptualization and implementation strategies for the ACTION project have
been described in great detail in several recent sources (Stark et al., 2006a; Stark et al., 2006b),
 6. DEPRESSION AND RELATED DIFFICULTIES 125

and we refer the interested reader to these comprehensive overviews of the treatment package
for further information, as well as examples of actual materials. Although the cornerstone of the
ACTION program is a group cognitive-behavioral child intervention, parent training and teacher
consultation are also important components of the treatment package. All of these services are
provided in the school setting.
The core component of the ACTION program is the group CBT sessions for the child par-
ticipants. Groups are composed of four to six girls and, in the context of the research study, led
by one or two highly trained graduate student therapists. There are 20 group and 2 individual
meetings that occur over an approximately 11-week period. Additional individual meetings can
be scheduled if necessary. Although the core therapeutic elements are presented in a specific
order within the manual, the therapists may be flexible in their teaching and application of the
skills and strategies in order to address the concerns which the participants bring to the group
setting. As outlined by Stark and his team (Stark et al., 2006a; Stark et al., 2006b), the primary
therapeutic components include affective education, goal setting, coping skills training, training
in problem-solving and cognitive restructuring, and building a positive sense of self. Homework
assignments are given in order to help the children apply the skills they have learned. Forms that
can be utilized in the completion of the homework are included in the published workbook (Stark
et al., 2005a). In addition, the participants in the study receive “ACTION kits,” which include
colorful cards providing reminders about the skills taught during the sessions as well as forms
which allow the participants to outline their own goals for the therapy and specific plans that can
be utilized to facilitate goal attainment.
The process of conducting the therapy within the schools during school hours offers the
therapists the advantage of operating within the child’s major systems. Participants come directly
from classes and activities and can readily bring real-life problems or concerns into group. These
concerns are discussed during the meeting time, and the therapeutic skills the children learn can
be immediately applied. Being situated within the school offers the additional advantage of ac-
cess to school personnel for consultative services.
Teacher consultation is an important part of the overall treatment package. Consultation ap-
pears most successful when conducted in a collaborative, collegial manner (Caplan & Caplan,
1999). By providing services in the schools, therapists are able to meet directly with teachers to
gain their valuable observations regarding the child’s behavior within the classroom. Addition-
ally, collaborating with teachers allows for skills being discussed in group to be generalized to
the classroom. For example, depressed children often present as being socially withdrawn, often
because core beliefs such as “I’m unlovable” or “I’m unlikable” prevent them from initiating
social contact. However, many of these children or adolescents do desire social contact. Teach-
ers can help implement behavior modification programs that successively encourage increased
levels of social approach-related behaviors. This environmental support facilitates the develop-
ment of new skills and, in turn, helps provide experiences that are contradictory to negative core
beliefs. For example, the teacher and student may establish two times during the day in which
the student reports to the teacher social contacts he or she has initiated, such as smiling and say-
ing “hello,” inviting a partner to work, etc. When the teacher and child have a good relationship,
this established time together can be reinforcing in and of itself. If not, small tangible rewards
or privileges can be provided for attempts at social interaction. In addition to strengthening the
teacher-student relationship, this also serves to establish the teacher as a resource to help the
student problem-solve challenging social situations. A variety of other specific classroom-based
interventions which can be developed in collaboration with the therapist and teacher have been
outlined by Stark and colleagues (Stark et al., 2006a).
One of the specific research questions being addressed by the current investigation conducted
126 REINEMANN AND SARAH SCHNOEBELEN

by Stark and his team is whether or not the addition of an eight-session parent training element
(with two individual family sessions) improves treatment outcomes beyond the group therapy.
One of the primary objectives of the parent training is to provide parents with ways to reinforce
and support the skills the children are learning. At the same time, it is hoped that the parents will
learn the skills themselves and attempt to apply them in their own lives. It is stressed that since
children only meet as part of the group for a relatively short period of time, practice outside
the group is essential. Furthermore, tuning the parent into the child’s key negative automatic
thoughts and core beliefs allows parents to be aware of any messages they send which either
support or negate such maladaptive thinking. The ACTION program also teaches parents skills
such as empathic listening, effective communication, positive behavior management, and conflict
resolution. Half the meetings involve only parents while the other half include both the parents
and the child participants in order to provide opportunities to practice skills. Finally, many of the
activities included in the parent training component revolve around strengthening the relationship
between parent and child, including the scheduling of pleasant family events and learning to use
effective praise. Preliminary results with the first 62 participants are very promising and suggest
that more children improve through treatment than from the normal passage of time (Reinemann
et al., 2006).
Thus, a growing evidence base supports the use of various manualized cognitive-behavioral
and interpersonal intervention programs to treat depression in youth. However, school-based
professionals will likely need some additional training in order to implement these programs
with their students. Likewise, it will be important for future research to examine the effective-
ness of such programs when implemented by school mental health personnel. Factors that may
impact treatment outcomes such as age, gender, race/ethnicity, SES, etc. of participants, along
with treatment integrity, adherence, and other implementation factors also await further examina-
tion. Although much work still needs to be done, initial evidence shows that cognitive-behavioral
treatments for childhood depression are effective and can be easily implemented in the school
setting. It is hoped that knowledge of childhood depression and related interventions will lead
to the implementation of such programs by school-based professionals. Use of evidence-based
treatments will translate into more positive student outcomes in those suffering from depres-
sion and will particularly benefit those students who otherwise may remain unidentified and
untreated.

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 III
STUDENTS HAVING
LEARNING CHALLENGES
 7
Oral Language Problems
Kathleen R. Fahey

Research findings regarding efficacious speech and language intervention have been on the rise in
recent years. Efforts have been made to link science to practice across many areas of intervention
through the life span (Fey & Johnson, 1998; Hodson, 1998; Imbens-Bailey, 1998; Ingram, 1998;
Wilcox, Hadley, & Bacon, 1998). Some researchers use their empirical findings to provide details
regarding how clinicians and educators can adapt them to their work with students including
characteristics of individuals who will benefit from such research, and what methodology needs
to be utilized for implementing the interventions (Holland, 1998). Clearly, the movement for
evidence-based practice is forging new and exciting connections between researchers, clinicians,
and educators. In this regard, in 2005, the editors of Topics in Language Disorders (Butler, Nel-
son, Wallach, Fujiki, & Brinton) devoted the fall issue of the journal to a look at how researchers
have studied the nature of language and learning disabilities, and how practitioners have worked
with such students during the past 25 years. The perspective of the articles was to examine how
we have changed our views based on both research and practice, but also how we have remained
the same in many of our beliefs and practices across time.
The most remarkable changes in recent years regarding language learning problems have
occurred in our understandings of the nature of such problems in the context of the school day
and across the oral-literacy continuum, the ways in which they should be identified relative to
the school curriculum and other social and vocational settings, the collaboration of professionals
including general education teachers to make identification and intervention relevant for class-
room learning, and the participation of the students and parents as active decision-makers in
team intervention planning. These advances in our thinking and actions have led to our current
interventions that are decidedly more student and curricula-centered than they have been in the
past. Intervention must be focused on building a student’s success in academic, social and voca-
tional realms. Speech-language pathologists (SLPs), special educators, and classroom teachers
are learning to work together toward the realization of intervention goals, which is of central im-
portance in integrating language learning goals into the curriculum. In this regard, the recent ad-
dition of the Response to Intervention (RTI) model is an exciting avenue for strong collaboration
of educators with the goal of applying interventions directly in the classroom. The core principles
of RTI stress that: we can effectively teach all children; early intervention matters; a multi-tier
model of service delivery provides appropriate and effective intervention; a problem-solving
approach to decision-making is profitable; interventions and instructions are research-based and
scientifically validated; student progress informs instruction; data is used to make decisions; and

135
136 FAHEY

assessment is used for screening, diagnostics, and progress monitoring (National Association of
State Directors of Special Education, 2005). Under this model, SLPs and related service profes-
sionals must redefine their roles to become actively engage in the general education curriculum.
In addition, teachers are encouraged to take advantage of the particular and specialized education
and experience of SLPs and related service providers to maximize the shared responsibility for
the implementation of RTI.
The focus of this chapter is on what we know about oral language problems, how these
problems are manifest in academic and social situations, and the current state of interventions
available to practitioners in classrooms and through other service delivery models including col-
laboration, consultation, RTI, and traditional pull-out intervention strategies. In particular, the
focus is on students who have language-learning problems, hereafter referred to as students with
language impairment (LI). It does not include students who have speech disorders exclusively
(i.e., articulation, voice, fluency) or students who have severe motor, sensory, or cognitive chal-
lenges, even though many of the interventions described herein are effective with such students.

CHARACTERISTICS OF LANGUAGE IMPAIRMENTS

Language problems are often described according to our understanding of language as we re-
ceive it (reception) or produce it (expression) within the language skill set appropriate to the stu-
dents’ ages. In an attempt to study, discuss, teach, and assess language characteristics in students,
professionals consider several components, including language form (phonology, morphology,
syntax), language content (semantics, metalinguistics, figurative language), and language use
(pragmatics and discourse). Students with LI may have difficulty with all or some of these com-
ponents. Table 7.1 provides a detailed list of characteristics from the literature and illuminates the
numerous problems students experience within the oral-written continuum of language learning
Viewing language characteristics is helpful for understanding the variety of skills involved,
but it often results in a fragmented presentation of the aspects of the language leading to frag-
mented intervention for language problems (Wallach, 2004). Such decontextualized descriptions
of language problems, as noted in Table 7.1, make it difficult for teachers, SLPs, and related
service providers to consider how language problems directly affect the daily performance of
students in classrooms, and most importantly, how to intervene with these children (Nelson,
2005; Simon, 1991; Ukrainetz, 2006; Wallach, 2004). Thus, the goal of the following pages is to
describe language problems as they often appear in classroom contexts for children of various
ages and to present interventions within the classroom setting.
It is not uncommon for teachers to say that children with LI are considerably disadvantaged
in schools, especially those who participate in assessments, planning meetings, and intervention
programs for school-age children with such problems. Teachers describe the language difficulties
demonstrated by students in relation to their performance within the learning environment. Some
examples of what teachers say regarding student difficulties include: understanding complex oral
and written directions for projects and assignments; participating in activities, such as rhyming,
word segmentation, and spelling; recalling information; using background knowledge to predict
outcomes from discussions, debates, narratives or plays; making inferences during discussions
or readings; understanding and using multiple meanings of words in conversations; developing
new and expanded definitions for words, and explaining and understanding metaphors and other
figurative forms as encountered in readings, discussions and social interactions. Teachers often
understand how each student’s language problem directly impacts the tasks that are required
within the classroom, sometimes without knowing or recalling the specific results of language
 7. ORAL LANGUAGE PROBLEMS 137

TABLE 7.1
Characteristics of Oral Language Problems

Articulation, Phonology, and Metalinguistics

Delayed phonological acquisition
Articulation disorder
Phonological processing deficits result in speaking, listening, and reading problems
Ineffective access of phonological codes from working memory for rapid automatic naming
Difficulty making sound-symbol associations, sequencing sounds and syllables to decode words, encoding sound and
syllable patterns to spell words, and comprehending rapid, distorted speech, especially in noise
Limited perception and production of complex phonemic configurations
Reduced phonological awareness
Incomplete development of sources of knowledge regarding phonemic awareness
Morphology and Syntax
Overall immaturity in grammatical structure with less elaboration and fewer complex forms than age peers
Difficulty with sentence repetition and completion tasks
Differences in the comprehension and production of syntax
Lack of appreciation for the morphemic structure of words
Low but significant frequency of grammatical errors, particularly in written text
Lack of later developing morphological and syntactic structures
Limited variety and combinations of verb forms, especially morphemes that mark verb tense
Limited ability to generalize morphemes to new word roots
Limited use of the copula, auxiliaries, and modals along with forms such as the perfect, progressive, and passive
involving verb suffixes and auxiliaries
Fewer and more limited range of questions containing wh and auxiliary and modal elements
Fewer complex sentences
Limited use of later developing adverbial connectives for syntactic conjunction and discourse cohesion
Difficulty with left branching clauses and combinations of clauses
Limited production and complexity of noun phrase expansions
Continued use of spoken language forms in writing
Reduced ability to use grammatical rules to understand sentences produced by teachers
Reduced flexibility in understanding word order variations
Ineffective use of grammatical morphemes to predict words in academic tasks
Semantics and Figurative Language
Reduced rate and quantity of acquisition of vocabulary
Comprehension difficulties and misinterpretations of messages
Difficulty establishing new words, their definitions and their use
Limited variety and flexibility of word use
Premature decisions about a speaker’s intentions
Difficulty comprehending basic classroom vocabulary and concepts
Immaturity in the acquisition and use of figurative forms including idioms, metaphors, multi-meaning words, jokes, and
puns
Failure to interpret headings in books and newspapers
Off-target responding
Inaccurate word selection
Word-finding and recalling problems
Use of invented words and phrases (neologisms)
Rigidity in categorizing words and difficulty making rapid associations or shifts in meaning relative to context
Difficulty drawing inferences and comprehending the broader meanings of textual information
Lack of strategies for using the dictionary
Oral and Written Discourse
Quantity and quality differences in oral and written narrative development including less detail about characters and
events, omission of story segments, and failure to use cohesive ties and explicit referents
Problems in the management of narratives and expository texts
Use of starters and stereotyped phrases
(continued)
138 FAHEY

TABLE 7.1
(Continued)
Inadequate or inaccurate use of pronouns for anaphoric reference
Immaturity in the comprehension and production of school discourse
Inadequate topic closure
Disorganized sentences and events in stories
Poor advanced cognitive planning and immature command of linguistic structures
Difficulty identifying misunderstandings and lack of strategies to seek clarification
Difficulty learning and applying classroom communication rules
Poor ability to express thoughts in a connected fashion
Pragmatics
Misinterpretation of nonverbal messages
Failure to accurately interpret facial expressions and gestures that accompany spoken messages
Significantly less eye contact
Inappropriate maintenance of distance during conversational situations
Poor use of survival language
Inappropriate interaction with peers
Limited use of style shifts to fit social situations
Information processing
More time necessary to process information
Slower rate of acquisition of lexical, syntactic, and morphological structures
Short-term memory difficulties
Difficulty recalling verbal facts and details from long-term memory
Failure to take an active role in learning
Reduced comprehension monitoring and question asking
Persistence of comprehension difficulties into adolescents and adulthood
Immaturity in the interpretation of events
Inadequate selection and attention to relevant information
Difficulty remembering and following directions
Ineffective use of strategies for learning, remembering, and generalizing information
Disorganization of thoughts and reduced flexibility in thinking
Ineffective and inefficient learning strategies
Reduced language processing and reading problems
Psychiatric and social problems

assessments. The specific and relevant information that teachers give regarding the language
and learning demonstrations of students can serve as the basis for not only assessment, but also
for intervention planning. Such information should be used in conjunction with assessment data
from norm-referenced and observational data to plan intervention strategies that directly impact
the student’s performance within the classroom or other contexts determined by the planning
team (Ukrainetz, 2006).

PRINCIPLES THAT UNDERLIE LANGUAGE PROBLEMS

Some principles have been learned across decades of research about language and learning. The
first principle is that children do not outgrow language and learning problems. In fact, longitu-
dinal studies show that language problems are pervasive and change as children age (Bashir &
Scavuzzo, 1992; Bashir, Conte, & Heerde, 1998; Wallach, 2004). The difficulties that children
demonstrate in acquiring the language as toddlers and preschoolers do not resolve themselves
with time or completely, even with intervention. Rather, such problems take on different mani-
 7. ORAL LANGUAGE PROBLEMS 139

festations as the demands increase and change through the curriculum. Nelson (1998) describes
language as multifaceted, complex, and heterogeneous. That is, language users must have a solid
and flexible system that can be adapted to suit a variety of situations and levels of complexity to
meet current and future demands for learning and the application of information to familiar and
new situations.
The second principle regarding students with LI is that the context of the situation is an
important variable in how the student uses language (Nelson, 1998; Simon, 1991a). Despite
decades of research to the contrary, language-learning interventions continue to be offered in
a fragmented and decontextualized format with a focus on competence for single skills. When
we ask only about the nature of a child’s language problem, we miss the important idea that
the student performs differently depending on the nature of the task at hand. The more useful
question for assessment and intervention is: What is this child able to do and what is she or he
having difficulty with in your classroom (or with this assignment, task, subject, etc.)? Mather
and Goldstein (2001) place the learning environment among four foundational skills within their
framework for understanding classroom learning and behavior. They discuss many attributes of
effective teachers and offer concrete suggestions for creating optimal classroom environments,
noting that what works for the majority of students require flexibility and thoughtful engineering
for others. The language environment in particular is a critical component in language interven-
tion and contextual learning is vital for students to use language within classrooms. Ukrainetz
(2006) calls for “contextualized skill intervention” that emphasizes naturalistic, hybrid (blend of
child and adult-centered), systematic, and explicit interventions.
Language and learning problems in children require individualized, direct and specialized
intervention. Each student’s needs must be carefully identified within the classroom and other
settings to design a comprehensive plan for intervention with participation from the student, par-
ents, teachers, and related service providers. Such a plan requires short- and long-term objectives
that lead to academic, social, and/or vocational progress. Educators should together, in consul-
tation with parents of students with LI, direct classroom-based and consultative/collaborative
services that will provide maximum instructional and generalization opportunities. Short-term
pull out services should primarily be used to teach new strategies and skills. Student goals and
objectives should be clearly focused to improve language in all of the affected areas.
A fourth principle is that language is not only a primary avenue for interaction with others,
but it is also a primary tool for learning. Thus, students with LI have difficulty across modes.
Language competence and performance develops and is refined over many years and within
overlapping modes. Thus, language must be thought of as a continuum of abilities that include
speaking, listening, reading, and writing. Further, language interacts with the development of ex-
ecutive functions including attention, memory, critical thinking, reasoning, and problem-solving.
As students encounter difficulties with learning in classrooms, it is a complex process to discover
the nature of their problems and to plan appropriate evidence-based interventions.
Students with LI are disadvantaged. LI interferes with academic, social and vocational suc-
cess. Children, who have enriched language backgrounds, a typical rate and sequence of acquisi-
tion, and ongoing strategies for learning, continue to gain in all of these areas. Conversely, children,
who do not have adequate opportunity and show weaknesses in learning language, do not catch
up and continue to get further behind across time (Aram, Ekelman, & Nation, 1984; Aram & Hall,
1989; Hall & Tomblin, 1978; King, Jones, & Lasky, 1982). Thus, those students with impover-
ished language and learning abilities not only continue to demonstrate these problems across the
curriculum, but also show the additive effect of their depressed skills on their acquisition and use
of academic knowledge and written language. Such students do not catch up to age-matched peers
and may continue to have language problems as adults (Johnson & Blalock, 1987).
140 FAHEY

Early intervention is critical for students with LI. The identification of infants, toddlers and
preschoolers who have communication delay leads to programs and services that are important
for long-term academic and emotional health (Rossetti, 2001). Research in early childhood re-
veals that children of preschool age are prime for reaping long term benefits from early interven-
tion services (Billeaud, 2003; Rossetti, 2001).
Achievements in language development (Fahey & Reid, 2000) highlight the knowledge and
skills that students require to be successful across the school curriculum and socially in this en-
vironment. Preschoolers and early elementary school-age children must have solid foundations
in phonology, morphology, syntax, semantics, and pragmatics. By the second grade, students ad-
vance in all areas of language and learning. They also have at least one year of experience in their
home school and have learned the language and culture of the classroom and the expectations
of teachers and peers. During the middle and high school years, most students achieve a high
level of competence in oral language and learning skills and can navigate effectively in schools
and other settings. They seek independence from adults and use listening, reading and writing as
primary learning avenues. Limitations in language and learning tend to result in self-esteem and
interaction difficulties with others as well as academic performance problems.

Intervention Strategies for Increasing Language Structure

Phonological Awareness. When planning effective language interventions for students

with severe phonological delay as one aspect of their language disability, it is important to
recognize that the speech production error patterns are overt signs of a systemic and covert
problem with establishing phonological representations (Sutherland & Gillon, 2005). Thus, even
with intensive intervention on sound production, it may take considerable time for students to
fully internalize these sounds into their phonological system including the coding, storage, and
retrieval of these sounds for all purposes in oral and written language modes. Thus, as students are
learning to produce the sounds, activities to promote phonological knowledge directly improves
phonological representations necessary for decoding of words for successful reading and spelling
development.
Activities, such as rhyming games, breaking words into syllables, creating alliteration phras-
es, changing words through additions, deletions, substitutions, and rearrangement of sounds,
and learning sound-symbol association, help children understand that knowledge about sound
segments allows them to make meaning distinctions, classify words by sounds in the beginning,
middle, and end; and represent sound segments with letters. The knowledge acquired through
such activities is an important precursor to the development of proficient reading, vocabulary,
and speech perception abilities (Rvachew, 2006). Thus, it is an important ingredient to include
in language and literacy instruction, especially is the early grades (Ball, 1997; Blachman, 1989;
Blachman, Ball, Black & Tangel, 1994; Catts, 1991; 1990; Stanovich, 2000; Tummer & Cole,
1991). Although it is not too late to begin phonological awareness training in first grade, it is
more effective in preschool and kindergarten (Laing, 2006), since phonological awareness devel-
ops from infancy through 7+ years (Norris & Hoffman, 2002). However, Swanson, Hodson, and
Schommer-Aikins (2005) found phonological awareness training successful even for seventh-
grade poor readers from a bilingual community.
Once most children are using their phonological awareness to participate in phonics and
reading activities, explicit phonological awareness activities are not often embedded in the cur-
ricula beyond the second grade. In fact, reading is the best activity to promote continued develop-
ment of phonological awareness, as these skills have a reciprocal relationship (Hogan, Catts, &
Little, 2005).
 7. ORAL LANGUAGE PROBLEMS 141

Researches have determined that phonological awareness tasks exist on a continuum of lin-
guistic complexity. Ball (1997) notes students in kindergarten and first grade are successful in
sound identification and letter naming, but have difficulty with segmenting sounds in words. The
ability to employ manipulation of sounds in words to substitute, omit, add, and rearrange them
requires even greater phonological sophistication. In addition, many types of input and levels of
difficulty exist in phonemic awareness activities. Norris and Hoffman (2002) identify and dis-
cuss 10 sources of knowledge that children acquire along with the developmental progression of
each source area, such as alphabet knowledge, rhyme, sound in word position, print conventions,
word recognition, and developmental spelling. Common activities and the types of knowledge
associated with each provide a matrix that is useful for intervention planning along the develop-
mental continuum and the assessment of student progress in this area. Further, instruction should
progress along the difficulty continuum, noting that individual children vary in their performance
across tasks and difficulty level. Instruction is most effective when it is combined with instruction
in sound-symbol relationships (Blachman et al., 1994), conducted individually or in small groups
(Laing & Espeland, 2005; Gillon, 2005a), provided in classrooms where it is consistently part of
the curriculum (Hadley, Simmerman, Long, & Luna, 2002), and the focus of instruction is during
preschool and kindergarten years (Bus & Van Ijzendoorn, 1999; Gillon, 2005a).
Children who have LI, speech sound disorders, dyslexia, and specific spelling disability are
particularly vulnerable to delays in phonological awareness (Larrivee & Catts, 1999; Moats &
Lyon, 1996; Nathan, Stackhouse, Goulandreis, & Snowling, 2004; Raitano et al., 2004; Rvachew,
2006; Snowling, Bishop, & Stoddard, 2000; Webster & Plante, 1992) because they lack the ex-
plicit awareness of the phonemes in words resulting in an “incomplete and degraded template on
which to link associations to an alphabetic writing system” (Moats & Lyon, 1996, p. 74). There-
fore, language intervention must include direct and explicit teaching, intense practice, and many
experiences in using phonological awareness in authentic speaking, reading, and writing situa-
tions (Moats & Lyon, 1996). Such intervention is successful in advancing speech and literacy
outcomes for students (Bernhardt & Major, 2005; Gillon, 2000, 2005; Hesketh, Adams, Nightin-
gal, & Hall, 2000; Major & Bernhardt, 1998). Tyler (2002) advocates a four component interven-
tion model for children who have co-occurring speech and LI focusing on auditory awareness
activities for increased attention to the acoustic attributes of sounds, contrasting sounds in words,
practicing in drill and natural contexts, and engaging in phonological awareness activities. Justice
and Ezell (2004) recommend the use of print referencing strategies in storybooks to focus student
attention on the makeup of words and how printed word forms relate to meaning. The intensity
of the services is critical for students with LI to make the necessary gains required for them to
achieve the success needed for successful participation in the curriculum.

Morphology and Syntax. The complexity of oral language increases during the first
five years as children elaborate on noun and verb phrases through the addition of grammatical
morphemes and through the use of combinations of phrases and clauses (Owens, 1996). By
school age, students have a strong command of the language to participate effectively across all
modes, engage in metalinguistic analysis of oral and written forms, and manipulate language
for academic and social uses. Yet, oral language sophistication continues to develop through the
adolescent years and well into adulthood (Nippold, 1998)
Children with LI find the acquisition of grammatical forms challenging. Overall immaturity,
lack of flexibility, and reduced use or lack of forms defines the difficulties common to these
children. They are slow to acquire grammatical forms, the use of elaboration in noun and verb
phrases is weak, and they have poor conjoining techniques for the creation of complex sen-
tences. Thus, their language is immature for speaking, listening, reading, writing, thinking and
142 FAHEY

reasoning. The accumulated effects of such problems can have a major impact on the academic
success of students with LI as grammatical sophistication increases in classroom instruction, peer
dialogue, and written texts within each grade level. Intervention should focus on the expansion
of current morphology and syntactic foundation, with increased flexibility for the use of syntax
in all modes across several purposes.

Contextually-Based Approaches to Learning Grammar. Eisenberg (2006) provides

an extensive review of the intervention studies that target grammar. Her summary concludes
that most discrete skill intervention is not efficacious, however specific strategies, especially
the use of imitation involving contrasting sentences and content alterations, modeling combined
with production, and sentence combining activities, improve student performance on the targeted
grammatical forms (Gerber, 1993). Less successful are tasks that involve grammar analysis and
error detection for isolated sentences (Eisenberg, 2006). Since the efficacy of discrete skill teaching
in general, however, is not particularly strong, Eisenberg recommends that the specific strategies
noted above be used in conjunction with contextually-based communication activities.
Contextually-based approaches for grammar include writing as the mode of both the content
of the intervention and the instructional avenue, the use of literature-based units to engage stu-
dents in syntactic activities, and reading and conversational activities (Ukrainetz, 2006b). Popu-
lar interactive strategies with students include writing conferences, modeling, peer collaboration,
and classroom dialogue. In these sessions grammar is worked on during the first draft so that
students understand the importance of accuracy for conveying meaning, rather than as just an
editing function to be focused on as the written piece is being prepared for its final copy.
Ukrainetz (2006b) advocates activities that assist students with grammar during reading of
literature. They focus the student’s attention on grammatical patterns that are repeated in books
and she recommends sentence manipulation, matching, story retelling, and drawing pictographs
to represent sentences. Grammar instruction can also be approached in conversational activities.
Brinton and Fujiki offer that “conversation is the best starting point from which to approach
language impairment, regardless of whether the impairment involves structural or interactional
components of language” (1994, p. 60). Various genres, such as expository passages in textbooks,
poems, narratives, and newspapers and magazines, provide many instances of grammatical forms
appropriate to a variety of language levels. Using patterns that often appear within writings will
help teachers highlight desired structures. Conversation about these forms captures the student’s
attention to them within the context of the passage.

Mini Lessons. Five mini-lesson strategies discussed by Eisenberg (2006) reflect the
emphasis on current practice of providing RISE in intervention activities: repeated opportunities,
intensive, systematic support, with an explicit skill focus within a contextualized framework
(Ukrainetz, 2006a). The literature supports the use of observational modeling, content alterations,
contrastive modeling and imitation, sentence expanding, and sentence combining, all of which can
be used separately and collectively to enhance student learning of grammatical forms. Eisenberg’s
detailed review of each of these instructional methods includes procedural information and easy
to follow examples. Each method explicates the form for the student and then guides the student
to use the form successfully in oral and written language opportunities. The forms are gradually
assimilated in the classroom expectations for students, as they become a part of the language
system of each student. Teachers determine which structures are needed for classroom success,
the order and timing for introducing the forms, the amount and types of scaffolds each student
needs, and the instructional context that will be used to learn the forms and practice them in
meaningful exchanges (Eisenberg, 2006; Nelson, 1998).
 7. ORAL LANGUAGE PROBLEMS 143

Oral language competence and performance should be taught in tandem and as a bridge to
the development of written language. The methods suggested above integrate oral and written
language from the start, making the continuum truly operational for learning. The SLP should
work closely with teachers and parents to assist them in using newly acquired skills in phonologi-
cal awareness, morphology, and syntax to increase student mastery of decoding, reading fluency,
reading comprehension, and spelling and writing.

INTERVENTION STRATEGIES FOR INCREASING MEANING

There are many effective strategies for working with semantic knowledge that include aspects of
thinking, and reasoning skills. Not all of them will be addressed here, but the strategies described
below highlight the nature of effective language intervention for students with LI.
Students show frustration in their daily struggles in the classroom making this setting an
important one for the intervention focus. Classroom-based collaborative models have become
popular for providing learning strategies that enhance their student learning and success. Re-
searchers have confirmed that the classroom teacher has a strong influence on student learning.
In fact, studies show that the teacher is the most important factor for student learning (Sanders
& Horn, 1994; Wright, Horn, & Sanders, 1997). All team members including parents can assist
students in practicing newly acquired information, elaborating on information already learned,
and preparing for new content through reading, thinking, and discussion (Foyle, 1985; Foyle &
Bailey, 1988).

Promoting Interaction for Practice, Expansion, Refinement, and Recall of

Information. Active and interactive participation with other learners and with the information
at hand provides students opportunities to construct meanings from multiple avenues. Several
strategies help learners focus on instructional language, which facilitates the ease in which they
are able to attend to and benefit from the instruction itself (Bashir & Scavuzzo, 1992; Silliman
& Wilkinson, 1991, 1994). Nelson (1989) discusses several curricula within typical classrooms
requiring participation that students must negotiate. The “learning to do school” continuum
includes not only the material to be learned and the background knowledge required (official
and de facto curriculum), but also involves the set of implicit and explicit rules for interactions
(classroom curriculum), the world knowledge that students bring from their previous experiences
and background (cultural curriculum), teacher attitudes, beliefs, and practices (hidden
curriculum), and the rules for social interactions from the peer group (underground curriculum).
While typical students acquire knowledge about all of these curricula implicitly, as they actively
engage in school activities, students with LI require much of this information to be made explicit.
Thus, strategies that highlight meanings for students within all of these realms are effective in
teaching such students. The three strategies summarized below are examples of ways to bring
new and related background information into the spotlight. They are useful for all learners, and
are especially helpful for students who have LI, because they advocate interaction about ideas
and provide the necessary scaffolding for supportive learning.

Dialogue, Cooperative Learning, and Reciprocal Teaching. Students need to

regularly converse with their peers regarding the information they are learning in school and
daily experiences. Verbal interactions foster the growth of personal identity, enable sharing of
different discourses, and promote the learning of critical reflection (Burbules & Rice, 1991;
Nieto, 1994; Perl, 1994; Reid & Leamon, 1996) and dialogue allows negotiation to occur
144 FAHEY

as all participants determine the level and types of supports individual students need to be
successful. Short interchanges with teachers and peers after lectures, readings, and group
discussions allow students repeated exposure to main ideas. Teachers should select dialogue
partners to help students with LI to highlight ideas, report and verify their understandings, ask
questions, and use the information to share with others. Modeling and practice of dialogues in
a variety of situations assists students in learning slang from peers, comprehending and using
words in meaningful interaction, and applying words learned from content areas to real-world
contexts.
Small group cooperative learning allows students to benefit from the combined efforts of all
group members, who explore ideas through sharing their insights and problem-solving strategies.
A group of three or four members is the most effective size (Lou et al., 1996) and heterogeneous
groups with varied abilities, skills, interests, and motivations make strong cooperative learn-
ing groups (Kagan, 1994). Learning within cooperative groups often surpasses what individuals
achieve on their own (Reid & Leamon, 1996; Shachar & Sharan, 1994). The stronger students
are taught to model and scaffold information from the teacher and from each other. They expand
and refine their existing abilities and develop coaching skills under the direction of their teacher.
Students, who have weaker abilities, learn from those who are stronger. (Brinton & Fujiki, 2006;
Nelson, 1998). The purpose of the group and the group itself may change from informal to formal
to base groups depending on the nature of the work to be accomplished (Johnson & Johnson,
1999; Kagan, 1994).
Small groups use reciprocal teaching to provide systematic support to peer learning by en-
gaging members in joint problem-solving, generation of solutions, and consensus seeking through
predicting, questioning, clarifying, and summarizing about a topic (Brown et al., 1991; Palinscar,
1986). The interactive steps in reciprocal teaching build in the redundancy that students need to
acquire new information and to relate it to what they already know.

Explicit Vocabulary and Concept Instruction. The development of the lexicon requires
early and repeated exposure to words within meaningful contexts, opportunities to explore word
use with feedback that enhances the learner’s understandings, the use of a variety of words for
a variety of purposes, and specific learning of words for use with specific topics. As children
acquire vocabulary, they discover how ideas conveyed by words relate to each other in ever-
expanding levels of meanings and through complex relationships. In the early years of word
learning, children focus on words to express the daily use of objects and events or routines
within the household (Nelson, 1985). They use social words (e.g., hi, bye-bye), functional words
(e.g., up, more), names for objects, and action words within their first 50 words and then expand
their networks through the addition of more word varieties, including descriptive adjectives,
prepositions, adverbs, and pronouns (Gleason, 1997). Vocabulary is acquired as children are
exposed to concepts, literacy terms, and stories. Students use association strategies early on to
relate nouns to verbs and, by second grade, they associate words using hierarchical and categorical
knowledge. The changes in word association strategies reflect a reorganization and refinement of
the meaningful features of words, which some have related to the ability to understand and use
figurative language forms and contribute to the ability to construct definitions (Fahey & Reid,
2000; Owens, 1992).
Semantic knowledge is vital for early learning and interactions. In fact, the single strongest
predictor of social status in a preschool sample was receptive vocabulary knowledge (Gertner,
Rice, & Hadley, 1994). In addition, vocabulary development has both immediate and long-term
effects on the development of both oral and written language, as well as on academic success
(Baddeley, Gathercole, & Papagno, 1998; Sternberg, 1987).
 7. ORAL LANGUAGE PROBLEMS 145

Word learning is highly related to reading success. In fact, receptive and expressive vo-
cabulary size at 3½ years was predictive of decoding ability at end of second grade and both vo-
cabulary development and the acquisition of decoding abilities lead to increased comprehension
during reading (Snowling et al., 2000; Storch & Whitehurst, 2002). When basic reading skills
are in place by third grade, students learn most new words through reading (Nagy & Anderson,
1984), which promotes automaticity and efficiency resulting in increased vocabulary. Thus, the
reciprocal nature of vocabulary knowledge and reading ability provides continuous reinforce-
ment and development of these areas. Oral vocabulary is essential to word-and text-level reading
development.
Vocabulary deficits are evident early and preschoolers with LI have poor conceptual and
semantic structures for organizing lexical information, difficulty comprehending oral language,
and difficulty remembering and retrieving words. They often find it challenging to connect the
meanings of new words to their stored knowledge based on a few opportunities (fast-mapping;
Nelson & Van Meter, 2006), as well as gradual acquisition of deep meanings as words are used
across contexts and as they relate to other words (slow mapping or extended mapping skills;
Carey, 1978; Owens, 1996). Delay in vocabulary impacts reading speed, automaticity, compre-
hension, and overall ability to learn curriculum content. Unfortunately, vocabulary delays widen
over time and influence growth in phonological awareness, because word knowledge sets the
stage for phonological knowledge.
Incidental exposure to words through reading is not, however, the most effective strategy for
word learning, especially for young students with low ability (Nagy & Herman, 1987; Swanborn
& de Glopper, 1999). Direct instruction, even when it is minimal, increases student knowledge
of words (Stahl & Fairbanks, 1986). Research also shows that: (a) students must encounter new
words at least six times in order to acquire and remember their meanings (Jenkins, Stein, &
Wysocki, 1984); (b) prior instruction on words increases word understandings during reading
(Jenkins et al, 1984); (c) association of the word with an image increases word knowledge (Pow-
ell, 1980); and (d) content specific vocabulary instruction increases student achievement (Stahl
& Fairbanks, 1986).
Ukrainetz (2006) and others advocate for an explicit and intensive skill focus in vocabulary
intervention within the situations in which they occur, including the school curriculum. Students
with LI need time, many opportunities (greater than the six exposures for typical learners), and
resources, including teachers, peers, parents, and strategies that promote interaction and explo-
ration, to fully learn the meanings of words in a variety of situations and applications. Direct
guidance and practice in fast and slow mapping facilitates storage, organization, retrieval, and
strengthening vocabulary in relation to content areas is an appropriate focus of intervention.

Focus on Variety and Flexibility of Words. As discussed above, vocabulary expansion

is a common goal in language intervention programs due to its importance in overall language
growth and its strong relationship to academic achievement. Several developmentally appropriate
principles regarding vocabulary instruction are discussed in the literature and relate to intervention
to strengthen the lexical system.

• Teach a flexible system of semantic knowledge. Establish and stabilize an organized struc-
ture for understanding, remembering, retrieving, and expressing semantic information.
Marzano and colleagues. (2001) recommend a five-step process for teaching new terms
and phrases: (1) teacher provides brief explanation or description, (2) teacher provides
non-linguistic representation, (3) students generate own explanations or descriptions, (4)
students create own nonlinguistic representations, and (5) teacher asks students to review
146 FAHEY

the accuracy of their explanations and representations. DeKemel (2003) includes metalin-
guistic aspects in teaching word meanings.
• Use multiple and authentic situations to promote fast mapping—child creates a represen-
tation of a new word on the basis of a few incidental exposures, and slow mapping—child
retains lexical representation in memory, differentiates it from other words, and revises
and verifies word meaning based on feedback from others in a long-term process (Carey,
1978; DeKemel, 2003).
• Include both common high frequency words and rare low frequency words in vocabulary
training.
• Include specialized vocabulary taken from content area units to develop conceptual net-
works (Nelson & Van Meter, 2006).
• Focus on contextual information to teach multiple meanings in different contexts and
across various literary genres (DeKemel, 2003) and on definitional information to teach
formal categorical structures of word meanings (Anglin, 1993; DeKemel, 2003; Johnson
& Anglin, 1995).
• Focus instruction on depth of semantic knowledge because it will aid in word retrieval.
Depth across at least three levels includes verbal association strategies, the use of words
in limited contexts, and the use of words with understanding and the ability to manipulate
meaning through word relationships, such as with antonyms, compare/contrast, multiple
meanings, novel uses, and similarities and differences.
• Emphasize morphologic, orthographic, and semantic association cues to aid in under-
standings of words (Nelson & Van Meter, 2006) and word awareness in print (Justice,
2002; Justice & Ezell, 2004; Justice, Meier, & Walpole, 2005).
• Teach dictionary and other referencing skills as a strategy for learning words within the
student’s curriculum including use of the alphabetical system, the pronunciation key, pro-
totypical and alternative definitions, the origin of the word, and abbreviations (DeKemel,
2003).
• Use multidimensional approaches for vocabulary intervention including peer models.

Some factors to consider in the selection of words include: the general importance of the
words in everyday use; the importance of the words in academics; the student’s current knowl-
edge of the target words; the need and motivation for the student to use the words, and the kinds
of instructional techniques best suited to the words (Nelson, 2006).

Focusing on Word Meanings and Relationships. As the lexicon develops from event-
based learning in the early years, to a system that is organized categorically and hierarchically,
students are able to use their mental processes to relate words in a variety of ways and for several
purposes. For instance, the ability to identify similarities and differences requires mental operations
that lead to several avenues of thought that have direct application in classrooms (Gentner &
Markman, 1994; Markman & Gentner, 1993a, 1993b; Medin, Goldstone, & Markman, 1995).
Direct and explicit instruction, as well as independent practice in the identification of similarities
and differences enhances students’ understanding and ability to use knowledge (Chen, 1996;
Chen, Yanowitz, & Dachler, 1996; Flick, 1992; Gholson, Smither, Buhrman, & Duncan, 1997;
Mason & Sorzio, 1996; Newby, Ertmer, & Stepich, 1995), and the use of graphic and symbolic
representations assist students in their understanding (Chen, 1999; Cole & McLeod, 1999; Mason,
1994). Similarities and differences can be applied to activities involving comparing, classifying,
creating metaphors, and creating analogies.
Comparison tasks, where students focus on a specific number of characteristics (Chen, 1996;
 7. ORAL LANGUAGE PROBLEMS 147

Chen et al., 1996; Flick, 1992; Ross, 1987; Solomon, 1995), can be accomplished at any grade
level in oral and written activities. Word relationships are often realized through comparing
words to other words. In the case of learning opposites (antonyms), the student learns polarized
terms, such as in-out, up-down, cold-hot, big-little. Comparing also leads to the ability to use
different words to convey the same meaning (synonyms), such big-large, cold-chilly, scared-
frightened. Learners benefit from using graphic organizers as the number of characteristics and
items to be compared increases (Marzano, Pickering, & Pollock, 2001). For example, students
in an eighth grade classroom may be required to compare the characters from one story with the
characters from another story along several dimensions such as physical attributes, background
and upbringing, attitudes and beliefs, and personality traits. They may then use this information
to discuss similarities and differences relative to the story plot.
Classification tasks focus on discovering and using rules that determine category member-
ship (Chi, Feltovich, & Glaser, 1981; English, 1997; Newby et al., 1995; Ripoll, 1999). Catagori-
cal knowledge assists students in organizing information based on similarities and differences
(Marzano, Pickering, & Pollock, 2001). Graphic organizers, such as Venn diagrams, charts, and
hierachical structures are helpful for students as they interact with the information and with each
other.
The creation and comprehension of metaphors require the realization that there is an abstract
relationship between two items (Chen, 1999; Cole & McLeod, 1999; Dagher, 1995; Gottfried,
1998; Mason, 1994, 1995). Notice that metaphors also require knowledge of similarities and
differences. Metaphors are often difficult to learn, especially for students with LI. Not only does
the learner have to consider the attributes of each item, but she or he must compare them in both
literal and figurative meanings. For instance, the metaphor The sea was like a sheet of glass
requires students to consider the attributes of glass (e.g., clear, completely smooth, cool, shiny)
then relate them to the sea.
There are many types of analogies, but they all require knowledge about similarities and
differences (Alexander, 1984; Nippold, 1998; Rattermann & Gentner, 1998; Sternberg, 1977,
1979). Analogies use the comparison of two items (A is to B) to predict the nature of the relation-
ship between two additional items (as C is to D), one of which is not stated. For example, animal
is to tiger as furniture is to _____ (couch,* porch, house, doorknob) demonstrates the supraor-
dinate-subordinate relationships. Other analogous relationships include antonyms, synonyms,
part-whole, characteristic property, familial, temporal-sequential, and causal relationships (Gal-
lagher & Wright, 1979; Sternberg & Nigro, 1980). Analogic reasoning develops with age and
experience and poses challenging problems through adolescence as difficulty increases in levels
of abstraction and complexity (Crais, 1990; Nippold, 1998; Sternberg & Nigro, 1980). An 8th
grade exercise may require students to practice solving later developing analogies including ant-
onym, synonym, and sequential patterns (Nippold, 1998). For example, the analogy: surely is to
amiable as gregarious is to: (a) effervescent, (b) outgoing, (c) withdrawn,* (d) agitated is likely
to be difficult, not only because the vocabulary is abstract and unfamiliar, but also because the
relationship between the words is not a simple polar opposite or synonym. Overall vocabulary
growth should be targeted to include a full range of word relationships with students, so that
analogic reasoning develops along the continuum expected for typical students.

Using Discussion to Facilitate Word Learning. Dialogic reading techniques, also

known as communicative reading strategies (Badon, 1993, DeKemel, 2003; Norris, 1988, 1989,
1991) are authentic and effective contextual techniques that build word and world knowledge.
Rvachew (2006) recommends the use of dialogic reading to increase interactions between the
student and the adult to improve vocabulary knowledge during storybook reading, thus leading
148 FAHEY

to better literacy skills. Scaffolding is used to relate meaning from the text using all modalities
and repeated readings of short sections of text are followed with questions to assist the student’s
comprehension. When working with toddlers, preschoolers, and early elementary grade students
use storybooks with accompanying pictures to engage the learners in vivid descriptions of objects,
events, and actions on the page. Discuss the relationship of the story to each student’s own
experiences and the narrative as a whole. Scripted book-sharing discussions (van Kleech, Vander
Woude, & Hammett, 2006) increase both literal and inferential language skills in preschoolers
with LI. During this technique, students answer questions that focus on literal information, as it
is directly present within the text, as well as on information that requires students to think about
unstated meanings, such as internal states and motives of characters, similarities and differences
between text information and life experiences, predictions, and the meanings of new words and
concepts. A book club is an effective way for students to share books with peers. High-interest
reading material can be accompanied by wh-questions for new vocabulary, distancing questions
to relate the story to learner experiences, and highlighted word meanings, including synonyms,
antonyms, and comparisons of words. The word should then be integrated back into the context
in which it was encountered and generalized to new contexts.
The use of thematic units has also shown promise in working on extending word meanings
for increased text-level comprehension. DeKemel (2003) suggests the use of literature and activi-
ties, such as drama, writing, art, music, play, and food customs to help students explore a par-
ticular topic in a thorough manner. Some goals for teaching vocabulary include: analyzing word
meanings in the context; using dictionaries and glossaries; analyzing words into roots, suffixes,
and prefixes; creating semantic maps to understand relationships between words and concepts;
noting the importance of word meanings for comprehension; and recognizing multiple word
meanings. Gillam and Ukrainetz (2006) stress that thematic units help to tie language interven-
tion sessions together toward the accomplishment of the intervention goals.
Authentic writing projects also provide an avenue for increasing word learning in an in-
teractive environment. Curriculum-based writing projects provide social interaction as well as
language comprehension and formulation opportunities. Writing can be used to activate dormant
vocabulary acquisition processes by stimulating retrieval of known and new words. Nelson of-
fers that students tend to write only the words they know how to spell, thus limiting their vo-
cabulary diversity. She recommends that teachers encourage students to expand their semantic
systems through the use of specific words and phrases necessary to convey particular meanings
during writing. Her students use their own ideas and words to plan, draft, revise, edit, publish,
and present writing products for peers, parents, and teachers. Writing labs can be incorporated
in any environment, thereby offering a flexible and dynamic avenue for word learning. Students
with LI work side-by-side with peers and benefit from scaffolding from teachers to write stories,
reports, and poems. They use specific language during peer conferences and discussion of works
in progress.

Targeting Figurative Language. Within the day-to-day interactions of home, day care,
and/or preschool, young children encounter numerous instances of figurative and nonverbal
language and they experiment with these in their communications with others. Word play, name
games, and invented figures of speech are used for teasing and joking. Gradually, as students
advance through elementary, middle, and high school, they show increased understanding and
use of riddles (Horgan, 1981; Shultz, 1974), metaphors and similes (Nippold, 1998; Polanski,
1989; Pollio & Pollio, 1974), idioms, proverbs and fables (Ackerman, 1982; Nippold, 1998;
Nippold & Martin, 1989; Prinz, 1983), slang (Nelson & Rosenbaum, 1972), and awareness of
multi-meaning words (Gardner, 1974).
 7. ORAL LANGUAGE PROBLEMS 149

Nippold (1998) discusses five changes that occur within students in the early elementary
grades that lead to their increasing ability to interpret and use non-literal language forms. The
ability to read allows students multiple avenues of information leading to knowledge about a
variety of topics of their own choosing, as well as the specialized vocabulary of the curriculum.
Students advancement in their metalinguistic abilities promote their thinking about the structural
and meaningful aspects of language and to explore these in song, rhymes, and figurative forms.
Their ability to reflect on and analyze language begins a process that will continue into adoles-
cence. Students also gain in their ability to think abstractly, which in turn broadens understand-
ings of concepts and the relationships between ideas and the opportunity to interpret nonliteral
forms of language such as puns, idioms, metaphors, jokes, riddles, and linguistic ambiguity.
Lastly, students gradually are able to take the social perspective of others, so that they respond
to the thoughts and feelings expressed in daily situations. They modify the content and style of
language to fit social and academic expectations and they take responsibility for their own com-
munication behaviors.
Recall that students who have LI process figurative language like younger children. This
lag sets them apart as they attempt to take part in the ever-changing demands of the social and
academic contexts of school. The five changes noted above pose significant challenges for these
students (Nippold & Fey, 1983; Seidenberg & Bernstein, 1986). Failure to understand and use
figurative language appropriate to ones peer group may result in alienation, frustration, hurt feel-
ings, and low self-esteem (Donahue & Bryan, 1984; Larson & McKinley, 1995). Older students
with LI may demonstrate their knowledge and use of literal language and to an extent, nonliteral
language in noninteractive contexts, yet as Creaghead and Tattershall (1991) point out, “… some
children fail to use nonliteral language, because they cannot determine when it is appropriate, or
they may use expressions inappropriately, which will make them seem odd and socially inept to
their peers and to adults” (p. 118). Poor use and understanding of nonliteral language negatively
impacts interaction with others. Students may have similar difficulty interpreting and using body
language, thus making their demeanor seem awkward and uncomfortable.
Interventions for increasing figurative language should mirror the principles of effective
vocabulary instruction including relevant and useful forms that are encountered in spoken and
written language in the classroom, direct instruction that assists students with understanding the
relationships of the words and ideas within the figurative form, many opportunities for practice,
repeated occasions for their use, and teaching that provides scaffolded learning in multiple mo-
dalities (Lund & Duchan, 1993; Nelson, 1998; Nippold, 1998; Ukrainetz, 2006). Such strategies
must provide teacher and peer modeling, opportunities for discussion about the meaning of the
form and appropriate use, practice in using the form, and self-monitoring to determine the effec-
tive use of the form for the intended purpose. The use of role plays can be used to demonstrate the
meaning behind idioms, similes, metaphors, riddles, jokes, and other figurative forms. Drawing
pictures to illustrate figurative meanings, practicing idiomatic expressions, comprehending writ-
ten material with embedded figurative language using context, and practicing communicative and
classroom routines that use figurative and nonverbal language are effective in learning to use such
forms (Creaghead & Tattershall, 1991).
The visual and verbal medium of television can provide a rich source of material to show
how nonverbal language and figurative language are used to create drama, comedy, mystery,
adventure, advertisement, and the news. Bourgault (1991) used secondary school competency
guidelines, literature regarding functional communication, and surveys from secondary classroom
teachers to design a pragmatic program that focuses on Halliday’s communication functions. She
developed language units from videotaped television programs and a process for teaching, prac-
ticing and using language competencies in speaking and writing opportunities. Bourgault (1991)
150 FAHEY

provides several ideas from sitcoms, story segments, commercials, news shows, soap operas,
and game shows. Students use the lessons to engage in discussions, small group activities, and
individual exercises. These ideas seem particularly useful for high-school students with LI, as
they involve the students in watching, listening, analyzing, discussing, modeling, and critiquing
human interactions within social situations.

Providing Structure to Aid Comprehension through Literature. The use of literature

as a context for language intervention has become a popular and effective medium to support oral
and written language development. Strong (2001) provides a detailed list of outcomes that can be
realized for students in fostering meanings, structure, and purposes of language. Strong’s advice
regarding the benefits of using literature as the content for instruction is worth repeating here.

Through literature-based intervention strategies, students learn new vocabulary, concepts, and
figurative language. They also expand their world knowledge; discover, in context, the meanings
of complex sentence patterns such as cause-effect and conditional relationships; and become fa-
miliar with the structure of stories (i.e., the cohesion and story grammar) so that they can compre-
hend and recall new stories. They use language for important communicative functions to predict
events from picture clues, summarize a story’s events, identify main ideas/ themes, compare and
contrast information, share ideas, clarify subtle meanings, retell stories, or create stories. They
practice turn-taking, topic maintenance, and perspective taking. Finally, as they work with dia-
grams, maps, and charts, students acquire strategies for organizing and remembering information.
(p. 21)

Strong (2001) presents numerous suggestions for working with students to gain the most
from literature in pre-story, during-story, and post-story activities. Pre-story strategies focus on
activating the student’s prior knowledge and using prediction skills. While students read stories,
strategies are geared to promote comprehension monitoring, active thinking, and discussion of
ideas. Follow-up activities engage students to reflect on information, discuss ideas for deeper
understandings, and relate information in a variety of ways to maximize learning. The use of
a constellation of strategies will be useful for students, as they all engage the students in their
own learning, provide interaction with the teacher and other students, encourage practice, and
provided repeated and meaningful exposure to information in dynamic exchanges. Most of the
strategies can be easily modified for effective use with narratives or expository materials.

Summary Frames. Text-level information, whether provided orally or through written

text, can present challenges to students and impact their academic performance as they attempt
to recall facts, discuss ideas, and retain the main ideas from instruction. When interacting with
expository texts, students benefit from instruction that guides their learning. For instance, it is
difficult for even advanced students to summarize, especially when oral or written text is lengthy
and complex. Summarizing requires students to delete, substitute, and keep some information
(Kintsch, 1979; van Dijk, 1980) through an analysis of the text (Rosenshine & Meister, 1994;
Rosenshine, Meister, & Chapman, 1996). Teachers use summary frames to illuminate the
structure of information, thus providing a scaffold that focuses on how information relates
within the text. Some types of narrative frames include the topic-restriction-illustration frame,
the definition frame, the argumentation frame, the problem/solution frame, and the conversation
frame. Frame questions focus the student on accessing the relevant information for the summary
(Marzano, Pickering, & Pollack, 2001). This strategy for text-level comprehension can be easily
taught in classrooms, small groups and with individual students. The specific frame questions
suggestions by Marzano and his colleagues for argumentation are included here as an example.
 7. ORAL LANGUAGE PROBLEMS 151

What information is presented that leads to a claim? What is the basic statement or claim that is
the focus of the information? What examples or explanations are presented to support this claim?
What concessions are made about the claim?
Several types of strategies exist to help students to learn a structure for topically and seman-
tically related groups of words and to link new words and concepts with existing knowledge.
Graphic organizers combine linguistic information with nonlinguistic organizational strategies to
represent relationship among ideas (Hyerle, 1996; Marzano, Pickering, & Pollack, 2001). There
are many different patterns that help learners visualize description, time sequence, process/cause-
effect, episode, generalization/principal, problem-solution, compare/contrast, and concept. They
can take various forms, such as semantic webs and maps, diagrams, decision trees, text frames
(Armbruster, Anderson, & Meyer, 1987), and story graphs (Balwin & Henry, 1991; Simon,
1991a). Research indicates that the use of graphic organizers enhances understanding of content
as it engages students in active generation of mental pictures through kinesthetic activities (Au-
busson, Foswill, Barr, & Perkovic, 1997; Druyan, 1997), such as drawing and pictographs (New-
ton, 1995) and the creation of physical models (Welch, 1997). As with summary frames, graphic
organizers can assist students with conceptual understanding of how words relate to each other in
many different ways depending on the topic and its level of depth. The ability to create a graphic
representation helps students to make explicit the meaningful links between bits of information.

INTERVENTION STRATEGIES FOR METACOGNITIVE LEARNING AND

FUNCTIONAL COMMUNICATION

Self-Instruction and Self-Monitoring

It can be difficult for students with LI to keep pace with other students in their classrooms and
such students may show confusion when given oral directions for classroom activities, projects,
and assignment. Although they may listen to the directions for main ideas, the difficulty may
lie with using the information to plan and carry out the activity. Thus, students with LI often
appear to be in the dark about what to do and they look to other students for guidance. Confu-
sion and frustration about how to implement the information has been characterized by some as
having difficulty in “doing school” as discussed earlier (Cahir & Kivac, 1981a, 1981b; Nelson,
1998; Ukrainetz, 2006). Students may also experience text-level processing problems inherent
in complex directions, and may lack metacognitive, metalinguistic, and metatextual strategies for
understanding both the processes and the products of dealing with complex instructions (Nelson,
1998).
Self-instruction, also referred to as self-talk, is based on the notion that covert speech is
the way learners gain voluntary control of behavior. The technique requires verbal mediation to
increase the learner’s perception, understanding, problem-solving, and actions (Lasky, 1991).
The strategy involves a progression of steps whereby students use self-talk to guide behaviors.
First, self-talk is overt and the verbalizations consist of explicit steps necessary to accomplish
a task, with a gradual transition to whispered talk and then finally covert self-talk. This strategy
may be useful for explicating the steps in successfully entering a group (Brinton & Fijuki, 2006),
preparing for the lead role in a book discussion, facilitating a planning session for a fundraising
event, or for predictable socially embedded conversations. Once students are proficient with the
technique through modeling and practice, they need time and lots of opportunities to generalize
the technique to academic and social contexts.
The ability to self-monitor requires that we step back from ourselves to look at and then
152 FAHEY

evaluate our behaviors for accuracy, effectiveness, and appropriateness to the situation at hand.
The primary way in which learners evaluate behavior is to use self-questioning. Students ask
themselves whether their attempts at a task are successful. Once the evaluation takes place, they
must determine to persevere in the same tactics or to change an aspect of their behavior through
the use of self-correction strategies. The implementation of our decision is an outcome of self-
monitoring. This metacognitive activity is considered to be a very necessary and powerful learn-
ing strategy (Polloway & Patton, 1993; Prater et al., 1991; Swanson, 1996).
Self-monitoring should be employed during the process of completing class assignments.
Students should be encouraged to check with peers or the teacher on each step for completeness
and accuracy. The classroom teacher, with assistance from the SLP and special educator, should
also monitor student progress by checking comprehension of each facet of the project and as-
sisting the student in self-questioning and self-monitoring as appropriate to facilitate success.
Nelson (1998, p. 449) summarized Seidenberg’s (1988) systematic steps for teaching cognitive
strategies that provide necessary scaffolding: (1) Introduce the strategy and review the student’s
current performance; (2) Explain the relevance of the strategy by using real-life examples; (3)
Describe the strategy and provide a “help sheet” that lists its steps; (4) Model the strategy and re-
hearse it with students as a group; (5) Provide opportunity to practice using controlled materials,
with prompts and corrective feedback as necessary; (6) With the student, evaluate the data gath-
ered during practice with controlled materials; and (7) Provide further practice using textbook
materials drawn from the regular curriculum.

Functional Communication in a Variety of Contexts. An important goal for students

with LI is to become competent language users within the social realm of school, community
and future work. There are several models available for viewing functional communication
(Halliday, 1973; Bereiter & Engelmann, 1966; Grice, 1975). They all share the notion that
communication competence has many features that allow us to operate and cooperate effectively
with others. A systematic approach to teaching the variety of functions is an effective way to
build “functional flexibility” for students (Simon, 1991b). Simon used Halliday’s seven functions
(e.g., instrumental, regulatory, interactional, personal, heuristic, imaginative, and informative)
to detail intervention activities that address each area. Her ideas provide an excellent basis for
direct teaching of these communicative functions. They are easily adaptable to a wide range of
ages and interests.

Situated Pragmatics. It is of prime importance that functional communication is

viewed within a “situated pragmatic” approach (Duchan, Hewitt, & Sonnenmeier, 1994)
that considers the events or discourse genres within the daily experiences of students. The
situated pragmatics framework (Duchan, 1997) emphasizes the identification of “naturally
occurring goals by examining the activity contexts of the child and designing interventions
that would involve the child more meaningfully in his or her daily life” (p. 10). It is desirable
that students work closely with the SLP and a small group of students initially to: (1) gain
understanding of the function and it’s practical uses, (2) observe others’ use of the function
in several relevant contexts, (3) practice the function in a safe and positive environment, and
(4) use self-monitoring strategies to evaluate success and make appropriate modifications as
necessary. Once success is seen in small groups there should be a gradual and careful plan to
warrant their use in the classroom and at home. Time, care, and support should be taken to
make generalization activities successful and meaningful (Bricker & Cripe, 1992; Beukelman
& Mirenda, 1992; Duchan, 1994, 1997).
 7. ORAL LANGUAGE PROBLEMS 153

SUMMARY, CONCLUSIONS, AND FUTURE DIRECTIONS FOR RESEARCH

The primary goal of this chapter regarding students with LI was to discuss research-based strate-
gies for teaching and learning that result in positive results. Across many disciplines, research has
improved and expanded on the strategies, techniques, contexts, and models educators can select
and use for working directly with the students who require our assistance in effectively learn-
ing from the curriculum. Outdated and ineffective practices are being revealed and discarded,
while state-of-the-art programs are being created and refined based on efficacy studies. Further,
researchers are working more directly with practitioners to make experimental procedures ap-
plicable to classrooms and other intervention settings.
Intervention plans for students with LI must link language goals to scientifically-based inter-
ventions. Plans must utilize: strategies that facilitate language learning within the context of the
classroom; strategies that transcend language modes to provide greater links between listening,
speaking, reading, and writing; professionals who collaborate and consult with each other and
parents to provide integrated language intervention for students; practices that include partici-
pation from families and their students as a part of the intervention team; and evidence-based
interventions to assist students in learning
The large number of students who are identified as having LI in schools is a testament to
the challenges involved in successful schooling. Thus, it is incumbent on our preservice and
inservice educational programs that teachers, special educators, SLPs, related service providers,
and administrators understand the complexities of developing and using language in the learn-
ing process. All educators require a solid foundation in the development of the language system.
Courses in language development and its disorders should be integrated into the curricula for
future educators. It is advantageous to all when courses are offered in a transdisciplinary fashion
so that educators use similar terminology and have a similar perspective on language-related
development, differences, and disorders (Fahey & Reid, 2000). When educators have common
reference points, dialogue becomes more productive and purposeful. Such dialogue has become
very important in the implementation of the Response to Intervention model. This model pro-
vides hope that educators will work collaboratively to employ the use of scientifically-based
teaching practices for all students with descriptive and prescriptive outcomes for students, who
are not making adequate progress in the school curriculum. This proactive approach, through a
multi-tiered strategy of interventions, has great potential in providing evidenced-based instruc-
tion to all students, boosting students who need tailored and supplemental instruction, and iden-
tifying those students who need intensive interventions (National Association of State Directors
of Special Education, Inc, 2005). Regardless of the intervention models used in school districts,
educators need to find common ground and recognize and use each other’s strengths for the
benefit of their students. The approaches described in this chapter require that educators work
together and with families.
There is still much to do in education as we discover what methods and practices lead to
the greatest success for our students. For students with language learning problems, the matrix
of strategies is not complete. We need to continue to ask questions about the strategies we are
using now, and continue our efforts in determining those that work, for whom, and under what
circumstances. The one-size-fits-all approach does not produce favorable outcomes. Thus, re-
searchers and practitioners require continued and enhanced partnerships to refine our selections
for individual students.
Several future directions for research will expand our current knowledge and practices (But-
ler et al., 2005).
154 FAHEY

• Longitudinal research to identify effective literacy programs (Whitmire, 2005)

• Effective literacy programs for middle and high school students (Whitmire, 2005)
• Systematic and controlled studies of advantages of inclusive classrooms (Nelson, 2005)
• Effects of differentiated learning within classrooms (Nelson, 2005)
• Use of peer-to-peer communication techniques (Nelson, 2005)
• Exploration of cognitive-linguistic models that integrate components of language (Nelson,
2005)
• Identification of interventions for subgroups of individuals with language impairments
(Wallach, 2005)
• Integration and summarization of research across time and diagnostic labels (Wallach,
2005)
• Effective functional and contextually-based language interventions (Fujiki & Brinton,
2005)
• Determination of language abilities involved in academic tasks (Erhen & Lentz, 1989)
• Long-term follow up studies of particular interventions (Richardson & Wallach, 2005)
• Systematic evaluation of the effects of preservice and inservice training in language and
literacy for practitioners (Richardson & Wallach, 2005)
• Determining outcomes of the Response to Intervention model for students with and with-
out language learning disabilities (National Association of State Directors of Special Edu-
cation, 2005)

The relationships between research and practice will no doubt continue to be the emphasis
for many years to come. Thus, the practices we use across disciplines in schools will continue to
evolve and our perspectives will continue to change. Our students are our best teachers, for it is
in their progress and their struggles that we continue to search for more effective, efficient, and
engaging strategies for learning.

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Alexander, P.A. (1984). Training analogical reasoning skills in the gifted. Roeper Review, 6(4), 191–193.
Anglin, J.M. (1993). Vocabulary development: A morphological analysis. Monographs of the Society for
Research in Child Development, 58(10), 1–165.
Aram, D.M., Ekelman, B.L., & Nation, J.E. (1984). Preschoolers with language disorders: 10 years later.
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 8
Teaching Younger Readers with
Reading Difficulties
Nancy Mather and Annmarie Urso

Children who struggle with the early stages of reading, particularly the development of phono-
logical awareness and decoding, face increasing obstacles each year to their literacy development
(Adams & Bruck, 1995; Juel, 1988; Torgesen & Burgess, 1998). Because they cannot pronounce
words accurately or quickly, they struggle to comprehend and gain conceptual knowledge (Beck
& Juel, 1995; Shaywitz, Fletcher, & Shaywitz, 1994).With each year, the gap between their read-
ing skill and ability to meet the ever-increasing expectations for proficient literacy continues to
widen and a disproportionate percentage of these students end up dropping out of school (Wag-
ner, Blackorby, & Hebbeler, 1993). Effective reading instruction is, therefore, a critical issue for
students with learning disabilities (LD) of which an estimated 80% have difficulty mastering
varied aspects of reading (Wagner et al., 1993). Approximately 3.5% of children in the United
States receive services for a reading disability (Snow, Burns, & Griffin, 1998); the accurate and
early identification of these children is a critical concern (Lipka, Lesaux, & Siegel, 2006).
This problem is not new. Throughout the 21st century, reading experts and researchers tried
to resolve the issue of the many children who had difficulty learning to read (e.g., Fernald, 1943;
Hinshelwood, 1917; Monroe, 1932; Orton, 1937; Stanger & Donohue, 1937; Weisenburg & Mc-
Bride, 1935). Monroe (1932) discussed the serious educational problem of those atypical chil-
dren who did not learn to read as well as would be expected given their intellectual abilities and
accomplishments. This characteristic of “unexpected reading failure” is often what distinguishes
the child with a specific reading disability, from one who is struggling for other reasons. In many
cases, oral language abilities are intact which are also reflected in early definitions of reading dis-
ability. For example, Weisenburg and McBride (1935) described “word-blindness” as a disorder
in the perception or understanding of letter- or word-forms that exist apart from other language
disturbances. More recently, others have explained that what distinguishes individuals with a
reading disability from other poor readers is that their listening comprehension ability is higher
than their ability to decode words (Rack, Snowling, & Olson, 1992). Despite a century of interest
in this population, numerous children still struggle to learn to read.
Recently, the goal of reducing the number of students experiencing reading failure has be-
come a national priority (Al Otaiba & Fuchs, 2006). Legislation has even attempted to address
and enforce change. For example, Public Law 107-110, The No Child Left Behind Act (NCLB)
of 2001, ushered in sweeping reforms in school accountability for student performance. Because
of NCLB, all students are supposed to reach high standards, attaining a minimum proficiency or

163
164 MATHER AND URSO

better in reading by the year 2014. As a result of this increased pressure for high standards, great-
er emphasis has been placed on the implementation of effective teaching methods, also referred
to as evidence-based, scientifically-based, or research-based practices. In fact, implementation
of evidence-based practices forms an integral part of the new evaluation procedures specified for
identifying students with LD in the Individuals with Disabilities Education Act (IDEA, 2004).

WHAT IS EVIDENCE-BASED READING RESEARCH?

To ensure that most students develop an acceptable level of reading performance, teachers need
to know and use the most effective practices and procedures (Fuchs & Fuchs, 1998; Warby,
Greene, Higgins, & Lovitt, 1999). Some teachers use strategies, methods, and programs that
are not supported by scientifically-based research, whereas others select and use well validated
practices. When making decisions about what instructional strategies, approaches, programs,
and materials to adopt, educators need to have knowledge of the criteria that constitute rigorous
research. The report of the National Reading Panel: Teaching Children to Read: An Evidence-
Based Assessment of the Scientific Research Literature on Reading and Its Implications for Read-
ing Instruction (2000) summarized the empirical findings regarding the most efficacious reading
instruction.
Within this report, the term scientifically-based reading research was used to describe re-
search that met the following four criteria: (a) incorporation of rigorous, systematic, and empirical
methods; (b) use of adequate data analyses to test the stated hypotheses and justify the conclu-
sions; (c) inclusion of measurements or observational methods that demonstrate a reliance on
valid data across evaluators and observers and across multiple measurements and observations;
and (d) acceptance by a peer reviewed journal or approval by a panel of independent experts
through a comparably rigorous, objective and scientific review. Ideally, evidence of a method’s
effectiveness should be available across all four of the above criteria. In practice, however, the
quality of evidence available on each of the four criteria varies.
The criteria used to select the programs and instructional methodology included in this chap-
ter as evidence-based best practices were based primarily on the Florida Center for Reading
Research (FCRR, Florida State University, 2002) framework, as well as the results reported in
meta-analysis studies. The FCRR framework was developed to determine if a program or method
met the criteria to be determined to be a best practice. The seven criteria that constitute quality
research are presented in Table 8.1. Although a substantive body of research exists on some
aspects of early reading development (e.g., phonological awareness), limited research exists in
other areas (e.g., vocabulary).
Many programs and strategies are geared toward the provision of effective instruction in
one critical aspect of reading performance, such as helping the young reader increase phono-
logical awareness, improve decoding skills, or increase reading speed. Regardless of the skill
or skills being targeted, all strategies and programs are aligned to the goal of increasing reading
competence so that students can comprehend text and read effectively for a variety of purposes.
Although reading is a complex process that includes the integration of many skills, this review
highlights strategies and programs that integrate what is currently known about the most effective
instruction for younger readers in: (a) phonological awareness, (b) decoding, (c) fluency, (d) vo-
cabulary, and (e) reading comprehension. Findings from evidence-based research show dramatic
reductions in the incidence of reading failure when students receive explicit instruction in these
components (Foorman & Torgesen, 2001). In addition, the chapter includes a brief discussion of
generalizations regarding instruction, an overview of a few comprehensive programs and class-
 8. TEACHING YOUNGER READERS WITH READING DIFFICULTIES 165

TABLE 8.1
Research Criteria for Programs

Research Criteria Description

Experimental Design 1) True experimental design with random assignment of participants is preferred.
2) Quasi-experimental design is acceptable when any number of variables are matched
in when control group and experimental group with appropriate analysis of variance
statistical tests.
Sample Samples should be based on a normal distribution, with a large enough size to ensure
validity of statistical analyses. Unless the study designates otherwise, the sample should be
heterogeneous.
Investigators Studies conducted by third-party investigators are preferred to preserve objectivity.
Reporting of Results Peer-reviewed journal is preferred, but does not exclude consideration of other publication
sources. Question of objectivity is present in other publication sources.
Statistical Analysis Statistical procedures employed must be appropriate for research question being asked
and the data being analyzed. Foundational assumptions that underlie the statistically
procedures should be adequately addressed
Method Methodology should be described in sufficient detail for replication by other researchers.
Methodology should be sound, well-constructed and comprehensive. No questions should
arise as to how certain dimensions of the study were carried out.
Performance Measures All measurement tools must have adequate reliability and validity. Appropriate assessment
tools for the measured elements of interest should be used to evaluate growth or progress
in students’ performance.

Note. From ©Florida Center for Reading Research (2002). Research Criteria for FCRR Reports. Retrieved September 3, 2004, from the
Florida State University Center Web site: http://www.fcrr.org/FCRRReports/PDF/Reserach_Criteria.pdf. Reprinted with permission.

wide tutoring programs, as well as a discussion of the need for increased and enhanced teacher
knowledge and preparation.

PHONOLOGICAL AWARENESS

Phonological awareness is an oral language ability that refers to the ability to attend and ma-
nipulate to the various aspects of speech sounds. This metacognitive understanding involves the
realization that spoken language is composed of a series of discrete speech sounds (phonemes)
that are arranged in a particular sequence (Clark & Uhry, 1995). Although the terms phonologi-
cal awareness and phonemic awareness are sometimes used interchangeably, these terms refer
to two distinct aspects of oral language. Phonemic awareness refers to the ability to hear and
identify the individual speech sounds or phonemes, whereas phonological awareness is a broader
term that includes all types of phonological activities, such as rhyming pairs of words or counting
the number of syllables in words. As young children learn to read an alphabetic language like
English, a critical first step is awareness that speech can be divided and sequenced into a series
of words, syllables, and phonemes.
English words have three basic units for analysis: syllables, onsets and rimes, and phonemes.
Syllables are formed by single vowels or vowels with combinations of various consonants. The
English syllable can then be divided into two parts: the onset and the rime. The onset refers to the
initial part of the syllable (i.e., one or more consonants) that precedes the vowel in a monosyllabic
word. The rime refers to the ending part. Every English syllable has a rime, but not necessarily an
onset. For example, in the word “open,” the first syllable /o/ is considered to be a rime, whereas
the second syllable /pen/ contains both an onset /p/ and a rime /en/. The phoneme, a single speech
166 MATHER AND URSO

sound, is the smallest unit of analysis. English has between 40 to 44 phonemes (dialectal differ-
ences can increase or decrease the number of speech sounds used). Awareness of these discrete
speech sounds allows one to perceive and manipulate language sounds. The number of phonemes
in a word is not necessarily equal to the number of letters. For example, the word “soap” has four
letters but only three speech sounds: /s/, /ǀ/, /p/, whereas the word fox has three letters but four
speech sounds: /f/, /ǂ /, /k/, /s/.

Sequence of Development

Phonemic awareness abilities develop in a sequence that ranges from simpler to more complex
tasks (Chard & Dickson, 1999; Ehri, 1991; Smith, 1997; Stanovich, 1986; Torgesen & Mathes,
2000). As a general principle, instruction begins with easier tasks, such as rhyming words or
identifying the first sound of a word, to more complex tasks, such as blending and segmenting the
phonemes in words (Chard & Dickson, 1999: Torgesen & Mathes, 2000). Big Ideas in Beginning
Reading (2002–2004) presents a sequence of skill development in which the child recognizes that
words can: (a) rhyme, (b) be broken into syllables, (c) be broken into onsets and rimes, (d) start
and end with the same sound, (e) have the same medial sound, and (f) be broken into phonemes.
A similar sequence uses the following order of phonological awareness tasks progressing from
the easiest to the most difficult: (a) selecting pictures beginning with the first-sound of a word, (b)
blending onset-rimes into words, (c) blending phonemes into words, (d) deleting a phoneme and
pronouncing the remaining word, (e) segmenting words into phonemes, and (f) blending words
into phonemes (Schatschneider, Francis, Foorman, Fletcher, & Mehta, 1999).
Once a word has been broken into phonemes, the child can then delete sounds from words to
make new words, blend sounds together to pronounce words, and break the sounds in words apart
(segmentation). These abilities form the foundation for the acquisition of decoding (pronouncing
words) and encoding (spelling words). Thus, phonemic awareness abilities have their primary
impact on the development of children’s phonics skills, or their knowledge of the ways that letters
represent the sounds in printed words (Torgesen & Mathes, 2000), as well as on their spelling
development (Bailet, 2001).

Research Base

A substantive body of research supports the link between phonological awareness abilities and
the subsequent development of reading skill (e.g., Lyon, 1995; Perfetti, 1992; Torgesen, 1992,
1993; Wagner & Torgesen, 1987). After conducting a meta-analysis of 52 studies, the National
Reading Panel (2000) presented the following conclusions: (a) phonemic awareness can be
taught and learned; (b) instruction in phonemic awareness improves reading and spelling skills;
(c) instruction is most effective when the focus is on one or two types of activities, rather than
several types; (d) the amount of progress is enhanced when children manipulate phonemes us-
ing letters; (e) small group instruction for 30 minutes for no more than 20 hours is effective for
most children; and (f) computers can be used effectively. In addition, teachers need to be able
to pronounce individual phonemes correctly (Kroese, Mather, & Sammons, 2006; Moats, 2000;
Torgesen & Mathes, 2000).
The various phonological awareness abilities are not of equal importance to early reading and
spelling development. For example, measures of rhyme recognition (e.g., “Which word rhymes
with tree: sun or me?”) are less predictive of reading failure than tasks that require children
to attend to the individual phonemes in words (Hoien, Lundberg, Stanovich, & Bjaalid, 1995;
Torgesen & Mathes, 2000). The two most important phonological awareness abilities are blend-
 8. TEACHING YOUNGER READERS WITH READING DIFFICULTIES 167

ing (synthesizing sounds) and segmenting (analyzing sounds) (Ehri, 2006). For blending, children
are presented with a series of sounds and then asked to push the sounds together to form a word.
For segmentation, children are presented with a word and then asked to break the word apart into
the individual sounds. Segmentation and blending can be taught using a variety of manipulatives,
including plastic markers, poker chips, colored tiles, magnetic letters, and scrabble tiles. Differ-
ent colored chips can represent the consonant and vowel sounds (e.g., consonant sounds are blue
and vowel sounds are red). Using letters, the teacher can demonstrate how to pull the sounds of a
word apart and then push the sounds back together again to form a word.

Blending

The purpose of teaching blending is to help young children combine letter sounds to be able to
pronounce or decode words (Ehri, 2006). Chard and Osborn (1999) recommended a three-step
procedure for helping students learn to blend sounds to pronounce words more easily. In the
first step, students blend sounds together as quickly as possible, rather than stopping between
the sounds. In the second step, students follow the sounding out with a fast pronunciation of
the word. In the third step, students discontinue sounding out words aloud. Gradually, as skill
progresses, word reading changes from the overt activity of oral reading to a covert activity of
silent reading. At this stage, the instructor may model the process for children by mouthing the
pronunciation of words, demonstrating how words can be sounded out silently.
The difficulty level of a blending task is affected by both the length of the pause between
the sounds, as well as the number of sounds that are presented in the sequence. A word that is
sounded with a short pause between the sounds is much easier to blend than a word that is pre-
sented with a one-second interval between the sounds. Instruction then begins with words with
two sounds (/sh/oe/), then three sounds (/c/a/t), and finally four sounds (/s/a/n/d/) (Kirk, Kirk,
Minskoff, Mather, & Roberts, 2007). In addition, speech sounds that can be prolonged and sus-
tained (e.g., /s/, /f/, /m/, /l/, /n/, /r/, /v/, /z/) are easier to blend than those that cannot (e.g., /b/, /t/)
(Carnine, Silbert, Kame’enui, & Tarver, 2004). Carnine et al. described a similar procedure called
telescoping sounds where a student transforms a series of blended sounds pronounced quickly in
succession (e.g., /i/ /i/ i/ /t/ /t/ /t/) into a word (e.g., “it”) said at a normal rate.

Segmentation

Segmentation involves breaking apart the sounds of words so that children can generate more
complete spellings of words (Ehri, 2006). Kirk et al. (2007) suggested the following sequence
for teaching segmentation:

1. Begin with compound words (e.g., “baseball”). Say: When I say the word “baseball,”
how many words do you hear? If needed use pictures or hand gestures to reinforce how
to break the two words apart.
2. Progress to syllable units (e.g., “car-pen-ter”). An easy way to help children learn how to
count the number of syllables is to have them place their hand under their chins and then
say the word aloud. The number of syllables is equal to the number of times that the chin
drops. One rule of English spelling is that each syllable must have a vowel and the vowel
sound forces the mouth to open.
3. Practice with onsets and rimes (e.g., “c-at”).
4. Practice breaking words into individual phonemes (/c/ /a/ /t/).
168 MATHER AND URSO

Phonological awareness abilities do, however, form the foundation for the acquisition and ap-
plication of phonics skills. Without appropriate intervention in important phonological abilities,
such as blending and segmentation, the reading development of children with poor phonological
processing skills will be impeded (Lipka et al., 2006). Phonological awareness is a necessary fac-
tor, but not the only factor that promotes good reading ability (Ehri, 2006; Torgesen & Mathes,
2000). Other factors such as phonics skills, sight word recognition, reading rate, vocabulary, and
comprehension also contribute to skilled reading performance.

DECODING

Decoding refers to the ability to use the systematic correspondences between sounds and spell-
ings to acquire a repertoire of words that can be recognized by sight (McCardle, Scarborough,
& Catts, 2001). Decoding includes both phonics and structural analysis, as well as instant rec-
ognition of sight words. Phonics is the reading method used to teach children how to identify
words by pronouncing the sounds. Structural analysis involves breaking words into units, often
syllables, to make longer words easier to pronounce. Sight word recognition refers to the quick
pronunciation of words without analysis of word structure.

Phonics and Structural Analysis

Several programs that have been identified as being evidence-based address the development of
decoding skills, including: the Wilson Reading System® (Wilson, 1996), the Lindamood Pho-
neme Sequencing Program for Reading, Spelling and Speech (LiPS®, Lindamood & Lindamood,
1998), Read, Write & Type!™, Learning System (Herron, 2000), DaisyQuest (Erickson, Foster,
Foster, Torgesen, & Packer, 1993) and Reading Excellence: Word Attack and Rate Development
Strategies (REWARDS®, Archer, Gleason, & Vachon, 2000).
The Wilson Reading System® is a multisensory approach to teaching reading and writing, de-
signed to teach specific strategies for decoding and encoding in a step-by-step sequential manner.
This program has been part of numerous on-going empirically-based studies and is recognized
by several states in their reading initiatives (Banks, Guyer, & Guyer, 1993; Bursuck & Dickson,
1999; Clark & Uhry, 1995; Moats, 1998). Originally, the Wilson Reading System® was intended
for use with upper elementary and older students struggling with reading. More recently, Wilson
Fundations® (Wilson Reading Systems, 2002) was added for younger readers in general educa-
tion classrooms to build a foundation of skills in phonological/phonemic awareness, phonics,
and spelling. Based upon the Wilson Reading System® principles, Fundations® is a prevention
program designed to help reduce early reading and spelling failure.
Another program that has resulted in improved decoding for students with reading difficul-
ties is LiPS®. This program teaches phonemic awareness, blending, and phoneme sequencing
skills. The program is designed to stress the oral-motor characteristics of speech and is helpful
for students who have severe difficulty with speech sounds. Analyses of data gathered by the
Lindamood-Bell researchers at their licensed Learning Centers have demonstrated the effective-
ness of this method with struggling readers (Lindamood-Bell Learning Processes, 2003).
Computers can also deliver effective instruction. The Read, Write & Type!™ Learning Sys-
tem (RWT) is a software program designed for children 6 to 9 years-of-age (Herron, 2000). By
using the keyboard, children learn the 40 speech sounds and then how to build words by typing
the sounds. The sequential curriculum is organized in 40 lessons, with each lesson covering
four sounds. When RWT was compared to an earlier version of the LIPs program, at-risk first-
 8. TEACHING YOUNGER READERS WITH READING DIFFICULTIES 169

grade readers in both instructional conditions made dramatic improvements (Torgesen, Wag-
ner, Rashotte, & Herron, 2000). DaisyQuest (Erickson et al., 1993) is an inexpensive software
program developed by researchers at the University of Florida for young children 3 to 7 years-
of-age. Through a variety of engaging games, children can work independently at developing
phonological awareness and phonics skills. Research studies on DaisyQuest showed significant
improvement on phonological awareness and phonics skills when students participated in 15-32
sessions, each lasting 20-25 minutes (Barker & Torgesen, 1995; Foster, Erickson, Foster, Brink-
man, & Torgesen, 1994; Mitchell & Fox, 2001).
REWARDS®, a specialized reading program designed for upper elementary and secondary
school students, teaches students the use of a flexible strategy for decoding multi-syllabic words.
The aim is to increase comprehension by increasing oral and silent reading fluency. Using RE-
WARDS®, readers are taught an overt and a covert strategy. The overt strategy involves circling
the prefixes, circling the suffixes, and underlining the vowel sound in the root word. The teacher
then says: “What part? What part? What part?” while drawing scoops under the segments or
decodable “chunks.” Then, students are instructed to say the words quickly. Eventually, under-
lining the vowel and circling the word parts are eliminated, leaving the student with the covert
strategy of looking for the word parts and vowel sounds, and saying the parts quickly to form a
real word.

Sight Word Recognition

Children with the most severe reading difficulties have difficulty recognizing letter sequences
as decoding units and learning to read individual words by sight (Perfetti & Hogaboam, 1978;
Torgesen, 2000; Torgesen, Rashotte, & Alexander, 2001). The key to skilled reading is the ability
to read words by sight automatically (Ehri, 1998). Ehri indicates that skilled readers can identify
different words in at least five different ways: (a) blending the sounds of letters into words, (b)
pronouncing and blending spelling patterns, (c) retrieving sight words from memory, (d) mak-
ing analogies to words already known by sight, and (e) using context clues to predict words.
Although capable readers can use all of these strategies for word identification, the most skilled
reading is based on retrieving sight words rapidly and easily from memory because all of the
other cueing systems require attention and disrupt the reading process (Ehri, 1998).
Ehri (1998, 2000) also described four overlapping phases that underlie the development of a
sight vocabulary: prealphabetic, partial alphabetic, full alphabetic, and consolidated alphabetic.
During the prealphabetic stage, readers recognize words by selected visual attributes that are not
connected to grapheme–phoneme relationships. In the partial alphabetic phase, readers make
connections between some of the letters and sounds in written words. Partial-phase readers do
not store sight words in memory in sufficient letter detail to recognize how they are similar yet
different from other words. In the full alphabetic stage, students make complete connections
between letters and sounds, and they are able to pronounce phonically regular words. In the
consolidated alphabetic phase, letter patterns that occur across many words are retained. These
larger units consist of morphemes, syllables, or onsets and rimes. Operating with chunks or word
parts makes it easier to decode and encode multisyllabic words (Ehri, 2000). In regard to the
instantaneous recognition of sight words, readers are not able to retain many sight words until
they are fully alphabetic. Thus, children must know phoneme-grapheme relationships before they
can develop and acquire a substantial sight vocabulary. In general, rapid word recognition devel-
ops as phonic word recognition improves (Moats, 2000). Interventions with struggling readers,
however, have been more successful in improving accuracy than rate (Torgesen et al., 2001). The
most promising approach to increasing sight word recognition is to first develop accuracy in word
170 MATHER AND URSO

reading followed by repeated practices viewing and naming words quickly in multiple contexts.
Thus, a core problem for children with reading disabilities is their lack of ability to rapidly and
automatically read sight words, phrases, and sentences (Chard, Vaughn, & Tyler, 2002), an abil-
ity referred to as “reading fluency.” In fact, the extent of a child’s sight vocabulary is the most
important factor for explaining differences in reading fluency (Torgesen et al., 2001).

READING FLUENCY

Reading fluency encompasses both the accuracy and the speed or rate of reading, as well as the
ability to read materials with expression. Meyer and Felton (1999) defined fluency as “...the abil-
ity to read connected text rapidly, smoothly, effortlessly, and automatically with little conscious
attention to the mechanics of reading, such as decoding” (p. 284). Children are successful with
decoding when the process used to identify words is fast and nearly effortless or automatic. This
concept of “automaticity” refers to a student’s ability to recognize words rapidly with little atten-
tion required to the word’s appearance. Chard et al. (2002) reviewed the results of 24 studies that
investigated the application of reading fluency interventions for students with reading disabili-
ties. Their findings indicated that effective interventions for fluency include: (a) provision of an
explicit model of fluent reading, (b) multiple readings of text with corrective feedback on missed
words, and (c) established performance criteria to increase the difficulty level of the text. In ad-
dition, instruction and practice in processing larger orthographic units quickly seems to enhance
fluency. Although additional research is needed, a few methods have been found to be effective
for increasing reading fluency. These are described below.

Repeated Readings

Ample evidence suggests that repeatedly practicing oral reading of instructional level text with
a model and feedback supports growth in oral reading fluency (Denton, Fletcher, Anthony, &
Francis, 2006). The use of both oral and silent repeated readings has been found to be effec-
tive for increasing reading fluency and improving comprehension (e.g., Fuchs, Fuchs, Hosp, &
Jenkins, 2001; National Reading Panel, 2000; Perfetti, 1986; Shankweiler, Lundquist, Dreyer, &
Dickinson, 1996). In a review of the effectiveness of repeated reading, Meyer and Felton (1999)
concluded that this method improves reading speed for a wide variety of readers when used
within the following context: (a) have students engage in multiple readings (three to four times);
(b) use instructional level text; (c) use decodable text with struggling readers; (d) provide short,
frequent periods of fluency practice; (e) provide concrete measures of progress; and (f) base the
amount of teacher guidance on individual student characteristics. For students with poor reading
skills, modeling and practicing specific words between readings can improve performance and
reduce frustration.
Repeated reading procedures have also been used as a component of classwide peer tutor-
ing (Mathes & Fuchs, 1993). In a study of this intervention, pairs of students in one group read
continuously over a 10-minute period, whereas pairs of students in the other group read a passage
together three times before going on to the next passage. Although both experimental conditions
produced higher results than the typical reading instruction, no difference existed between the
two procedures, suggesting that the main benefit of the intervention was the repeated practice
of passages and the increased time spent reading (Mastropieri, Leinart, & Scruggs, 1999). In
general, the most effective applications of the repeated reading technique seem to include: (a)
reading and rereading selected text a specified amount of times, (b) providing more practice with
 8. TEACHING YOUNGER READERS WITH READING DIFFICULTIES 171

tutors or peers, and (c) providing some type of feedback regarding accuracy and fluency (Torge-
sen et al., 2001).

Commercial Programs

Commercially-based programs, such as the Six-Minute Solution (Adams & Brown, 2003), are
based on the repeated readings of one-minute non-fiction passages with a peer-monitoring and
feedback system. Two other commercially available fluency based reading programs that meet
the criteria for effective practices are Read Naturally© (Ihnot, Mastoff, Gavin, & Hendrickson,
2001) and Great Leaps© (Campbell, 1998, 2005; Mercer & Campbell, 1998). The Read Natural-
ly© program combines the following three evidence-based strategies to develop reading fluency:
reading from a model, repeated readings, and progress-monitoring. Passages range from pre-K to
eighth-grade levels. Research has documented the effectiveness of the Read Naturally© program
at both elementary and secondary levels (Denton et al., 2006; Hasbrouck, Ihnot, & Rogers, 1999;
National Reading Panel, 2000; Onken, 2002; Wahl, 2006).
Great Leaps© is a program developed to increase reading fluency through the development
and mastery of phonics skills, sight word reading, and passage reading. The program is a one-to-
one supplemental reading program that takes approximately 10 minutes per day and includes a
progress-monitoring component. Daily application of this program with middle school students
with LD contributed to growth in reading and an improvement in reading rate (Mercer, Campbell,
Miller, Mercer, & Lane, 2000). Great Leaps© spans reading levels K through 8 with interest levels
through adulthood. A K–2 version of this program provides a phonological awareness instruction
component (Mercer & Campbell, 1998). The Great Leaps© program meets the criteria set forth as
an effective practice (Mercer et al., 2000; Robinson, 2003; Tenenbaum & Wolking, 1989).
A new promising approach is the Retrieval, Automaticity, Vocabulary, Elaboration, Orthog-
raphy (RAVE-O) program, a multicomponential approach to increasing fluency (Wolf, Miller, &
Donnelly, 2000; Wolf et al., 2003). Although currently, the program is not being widely distribut-
ed, its availability will likely increase in coming years. With the use of computerized games and a
variety of manipulative materials, the program is designed to help develop and increase accuracy
and automaticity at both the sublexical and lexical levels by helping the young reader develop
explicit and rapid connections among the phonological, orthographic, syntactic, semantic, and
morphological systems (Wolf et al., 2003). When used as an intervention, RAVE-O is taught in
conjunction with a program that teaches phonological awareness and blending. The program was
developed from a strong research and theoretical base, and preliminary research results support
its effectiveness (Lovett, Lacerenza, & Borden, 2000). The curriculum was originally designed
to assist struggling second and third graders; however, successful results have been obtained with
fourth-grade children (Wolf et al., 2003). Although RAVE-O is described as a reading fluency in-
tervention, its goal is improvement in comprehension through use of a comprehensive, engaging,
developmental approach (Wolf et al., 2003).

Fluency and Comprehension

Fluency is often described as forming the link or the bridge between word analysis and com-
prehension (Chard et al., 2002). Numerous studies have investigated the role of reading fluency
on comprehension (e.g., Allington, 1983; Cunningham & Stanovich, 1998; Fuchs, Fuchs, Hosp,
et al., 2001; Fuchs, Fuchs, & Maxwell, 1988; Hasbrouck et al., 1999; Jenkins & Jewell, 1993;
Mastropieri et al., 1999; Sindelar, Monda, & O’Shea, 1990).The rationale for increasing reading
fluency and rate is that when students allocate too much attention to lower-level processes such as
172 MATHER AND URSO

reading words with accuracy, not enough attentional resources are left to accomplish the higher-
order linguistic processing involved in comprehension (LaBerge & Samuels, 1974; Perfetti &
Hogaboam, 1975).
Some researchers have indicated that readers cannot be considered as fluent, unless they un-
derstand what they read (Wolf & Katzir-Cohen, 2001). Research has not, however, always dem-
onstrated that interventions designed to increase fluency also enhance comprehension abilities.
More complex, interventions with multiple components appear more effective for gains in both
fluency and comprehension. Reading instruction that integrates teaching of the alphabetic princi-
ple, applying these skills in context, and reading the same words repeatedly in different contexts,
may increase reading fluency in a way that improves reading comprehension (Berninger, Abbott,
Vermeulen, & Fulton, 2006). In addition, combining the repeated reading procedures with com-
prehension activities appears to enhance both fluency and comprehension (Chard et al., 2002).

VOCABULARY

As compared to other areas of reading instruction, little research exists on the effectiveness of
instructional methods to improve vocabulary (Jitendra, Edwards, Sacks, & Jacobsen, 2004; Na-
tional Reading Panel, 2000) and, unfortunately, current school practices appear to have little
impact on vocabulary growth and development (Biemiller, 2005). One finding seems clear: for
readers at all skill levels, the relationship between reading comprehension and vocabulary appears
reciprocal. Vocabulary knowledge contributes to improved reading comprehension; and word
knowledge increases through reading experiences (Ackerman, Weir, Metzler, & Dykman, 1996;
Cunningham & Stanovich, 1991). Even the vocabulary knowledge of low readers is strongly re-
lated to the amount of reading that they do (Cunningham & Stanovich, 1998). Thus, a weakness
in oral vocabulary can compromise reading comprehension (Berninger et al., 2006). In general,
students with reading difficulties typically spend less time engaged in independent reading than
their peers and as a result, they have less familiarity with the vocabulary used in texts and their
comprehension suffers (Anderson & Roit, 1993; Bos & Anders, 1990).
Differences in the number of words that a student has learned are apparent in the first years
of school. By the end of second grade, the difference in root vocabulary knowledge between
children in the highest and in the lowest quartile differs by as many as 4,000 word meanings
(Biemiller, 2004; Biemiller, 2005). Knowing a word’s meaning, however, is not an all or nothing
proposition (Beck & McKeown, 1991). Readers may have little, partial, or complete knowledge
of a word. Also, a distinction exists between the breadth of vocabulary (or the size of the vo-
cabulary or number of lexical entities), the depth of vocabulary knowledge, and the extent and
depth of semantic knowledge (Ouellette, 2006). The breadth of vocabulary seems to be primarily
related to decoding proficiency, whereas the depth appears more related to oral language capa-
bilities (Ouellette, 2006).Thus, students with poor word recognition skills but good verbal ability
tend to increase their vocabulary knowledge more through listening than reading (Carlisle, 1993).
Effective vocabulary instruction must focus on both oral and written communications, as well
as include techniques for increasing the number of words, and the extent, detail, and depth of
processing of the words.
Several studies have specifically addressed methods and strategies for facilitating vocabulary
acquisition in students with LD. For example, Pany and Jenkins (1978) and Pany, Jenkins, and
Schreck (1982) compared several vocabulary instruction strategies to determine which methods
were most effective for increasing word knowledge and comprehension in students with LD.
Students read sentences containing target words and synonyms, read definitions of target words,
and practiced using target words in sentences. The more the meanings of words were practiced,
 8. TEACHING YOUNGER READERS WITH READING DIFFICULTIES 173

the higher was student performance on vocabulary measures and the better was their retention
of words.
Findings from a recent review of 27 studies investigating the effects of vocabulary instruc-
tion with students with LD continue to substantiate that methods employing the direct teaching
of vocabulary are effective and that systematic practice of word meanings is critical to vocabulary
acquisition and maintenance (Burns, Dean, & Foley, 2004; Jitendra et al., 2004). In addition, ex-
plicit teaching of word meanings within the context of shared storybook reading is effective for
young children with reading difficulties (Coyne, Simmons, & Kame’enui, 2004) and is the most
powerful source of new vocabulary (Stahl & Stahl, 2004). Books should be read aloud several
times to children combined with an explanation of from 8 to 10 new vocabulary words (Biemiller,
2004). In contrast, methods, such as looking up words in a dictionary and writing definitions or
using context clues to determine a word’s meaning, are ineffective for students with LD (Bryant,
Goodwin, Bryant, & Higgins, 2003).
In addition to the need for more practice, a growing consensus exists regarding other ele-
ments of effective vocabulary instruction. In a review of four effective vocabulary programs,
Foorman, Seals, Anthony, and Pollard-Durodola (2003) found that the programs were consistent
on the following instructional principles: (a) introduction of approximately three words per day,
or no more than 12 to 15 words per week; (b) selection of words that could be extended deriva-
tionally and conceptually through discussion; (c) location and discussion of words in engaging
text; and (d) provision of contextualized definitions with practice opportunities in new and mul-
tiple contexts. In addition, words are taught in a sequence with an attempt to determine which
words should be learned next. The words to target for struggling readers are usually the ones that
some children of that grade level know but others do not (Biemiller, 2005). Instruction needs to
focus on words that students will meet often and will be useful (McKeown & Beck, 2004). Thus,
the vocabulary words being taught need to be of appropriate complexity (Stahl & Stahl, 2004).
Several effective methods for teaching vocabulary incorporate visual diagrams and support.
One method is semantic mapping (Nagy, 1998) where the relationships among the words are
visually mapped. The target word is placed in the center of a word web and the web is then ex-
panded with related words and ideas that are connected to show relationships among the words
or concepts. The benefits of graphic organizers for retaining words across several content areas
(e.g., science, social studies, mathematics, Spanish as a second language), multiple grade levels
(first through senior high school), and different student populations (general education and stu-
dents with LD) have been supported in both experimental and quasi-experimental studies (e.g.,
Bos & Anders, 1992; Braselton & Decker, 1994; Bryant et al., 2003; Doyle, 1999; Meyer, 1995;
Ritchie & Volkl, 2000). In addition, the process of developing and using a graphic organizer ap-
pears to enhance students’ critical thinking or higher-order thinking skills (Boyle & Weishaar,
1997; DeWispelaere & Kossack, 1996; Doyle, 1999).
Inspiration® and Kidspiration® (Inspiration Software, Inc., © 2002a, 2002b) are examples of
two commercially produced software programs designed to incorporate the scientifically-based
research on graphic organizers. A similar strategy, semantic feature analysis, also seems to en-
hance vocabulary growth. For this technique, the student compares words by placing them in a
grid that outlines the semantic similarities and differences (Walker, 2000). Both methods appear
effective for helping students notice similarities and differences among words and ideas (Jitendra
et al., 2004).
Other methods that are designed to help students recall vocabulary focus on the creation
of visual images which can help students recall more difficult terminology, such as new words
to be learned for a math, science, or history class. The key word method (described in detail in
chapter 13 of this volume) involves tying new words to visual images to help students recall word
meanings and learn new vocabulary (Mastropieri, 1988; Mastropieri & Scruggs, 1998). Findings
174 MATHER AND URSO

indicate that the keyword mnemonic strategy can both increase vocabulary knowledge, as well
as facilitate recall of words over time (Jitendra et al., 2004). Computer-assisted instruction also
shows promise for providing independent practice opportunities for students with LD (Bryant et
al., 2003; Jitendra et al., 2004).
Research highlights the need for early intervention that offers effective vocabulary instruc-
tion that begins in the preschool years, and continues through the early grades permeating the
instructional day (Coyne et al., 2004; Foorman et al., 2003). With good instruction, several stud-
ies have demonstrated that primary-level children can acquire new vocabulary at a rate of two
or three words a day (Biemiller, 2004). Adequate time and attention must be devoted to helping
students with reading difficulties build and maintain their word knowledge through multiple ex-
posures to words and systematic and intensive instruction. Without this type of instruction, gaps
in vocabulary knowledge will continue throughout elementary school, leaving students at greater
risk for continued problems with reading comprehension as they progress through school.
As described in previous sections of this chapter, successful reading comprehension is
highly correlated with both oral reading fluency and vocabulary knowledge. Even so, research
has shown that interventions that focus on improving fluency or vocabulary do not necessarily
increase reading comprehension especially of lengthy passages (Gersten, Fuchs, Williams, &
Baker, 2001). This finding calls attention to the need for instruction in specific skills and strate-
gies that can increase the comprehension of longer text passages.

READING COMPREHENSION

Reading comprehension is a complex skill that is dependent upon many factors, including a
readers’ background knowledge of facts and concepts, depth and breadth of vocabulary, familiar-
ity with various sentence and text structures, verbal reasoning abilities, and knowledge of print
and literacy conventions (McCardle et al., 2001). Today’s comprehension demands far exceed
the traditional poststory recall questions that were typically used in basal readers. Essentially, a
student’s reading comprehension will be no stronger than their comprehension of oral language
(Fletcher, Lyon, Fuchs, & Barnes, 2007).
Recent research on comprehension instruction has focused on the importance of teaching
the use of multiple strategies for text comprehension (e.g., Fielding & Pearson, 1994; Mins-
koff, 2005; Paris, Wasik, & Turner, 1991, Pressley, 2000; Rakes, Rakes, & Smith, 1995). For
example, the National Reading Panel (2000) found that students’ text comprehension improved
when teachers demonstrated and then had students apply varied strategies, such as answering
and generating questions and summarizing what was read. Similar types of interventions have
also been shown to be effective for children with LD (Gersten et al., 2001); however, research
findings have not yet revealed conclusive procedures for how to select methods or how to use
them effectively in different types of educational environments (Dole, 2000; Vaughn, Gersten, &
Chard, 2000). Recent reviews of meta-analyses of reading research, however, have highlighted
the importance of specific instruction in text structure (Elbaum, Vaughn, Hughes, Moody, &
Schumm, 2000; Gersten et al., 2001; Mastropieri, Scruggs, Bakken, & Whedon, 1996; Swanson,
1999; Swanson, 2001).

Text Structure

Research has also addressed the different types of structure. The two most common types of
structures are narrative, texts that tell stories that may be fiction or nonfiction, and expository,
 8. TEACHING YOUNGER READERS WITH READING DIFFICULTIES 175

texts that include discussions of issues, events, and content area knowledge. Several strategies
have been found to be effective for enhancing student understanding of both types of text (e.g.,
Bakken & Whedon, 2002; Boulineau, Fore, Hagan-Burke, & Burke, 2004; Dickson, 1995; Eh-
ren, 2005; Minskoff, 2005; Williams, 2005).
Narrative text structure is the type of text that children are usually exposed to initially when
adults read stories to them. Many children develop a natural understanding of story structure after
repeated exposures to stories using this strategy. This understanding takes place in most cases
even before these children learn to read, building expectations once they read independently
regarding how stories should unfold and develop. One effective way to help students increase
understanding of narrative text is to teach them how to recognize the components of story gram-
mar, the underlying structure of a story. Story grammar instruction can be used as a prereading
or prewriting strategy or as a postreading activity. In the early grades, a teacher can introduce the
following general elements of story grammar:

1. The setting: Where and when does the story take place?
2. The main characters: Who is the story about?
3. The problem: What happens to the main character?
4. The solution: What does the main character do to solve the problem?
5. The ending: How is the story resolved? (Stein & Glenn, 1979)

As students increase their knowledge, more complex elements can be introduced using the fol-
lowing seven categories of story elements (Montague & Graves, 1993; Stein & Glenn, 1979):

1. Major setting: The main character is introduced.

2. Minor setting: The time and place of the story are described.
3. Initiating event: The atmosphere is changed and the main character responds.
4. Internal response: The characters’ thoughts, ideas, emotions, and intentions are noted.
5. Attempt: The main character’s goal-related actions are represented.
6. Direct consequence: The attainment of the goal is noted; if the goal is not attained, the
changes resulting from the attempt are noted.
7. Reaction: The main character’s thoughts and feelings in regard to the outcome are dis-
cussed along with the effect of the outcome on the character.

Instruction in story-grammar elements using story-mapping can help children with LD in-
crease their ability to identify story grammar elements when reading narrative text (Boulineau
et al., 2004). The key to increasing comprehension using narrative text lies in teaching both the
structural knowledge of stories, as well as how to apply this knowledge when analyzing stories
(e.g., Boulineau et al., 2004; Gurney, Gersten, Diminio, & Carnine, 1990; Minskoff, 2005).
Although instruction in narrative text is often an appropriate place to begin with young read-
ers, specific instruction in expository structures is needed at all levels (Englert & Mariage, 1991).
Expository text, the main type of text found in text books and non-fiction stories, also has its own
unique structure. Comprehension of expository text structures begins in the elementary grades
when students begin the process of reading to learn information, often through the use of con-
tent area text books. The organization of expository prose is unpredictable and often laden with
syntactical complexities such as passive voice, compound and complex sentences, prepositional
phrases, and embedded sentences, presenting a unique challenge for elementary students with
LD (Abrahamsen & Shelton, 1989).
The most commonly cited factors that cause students to experience difficulty with expository
176 MATHER AND URSO

text are: (a) limited knowledge of text structure; (b) low vocabulary knowledge; (c) insufficient
prior knowledge; (d) the complexity of the ideas expressed (conceptual density); and (e) a lack
of familiarity with the content. Older students with LD who have instructional reading levels
between grades 2 and 6 appear to read expository text with less fluency than narrative texts, and
comprehend expository text with less accuracy (Saenz & Fuchs, 2002). Students may also lack
the advanced word attack skills needed to decode multi-syllabic, unfamiliar words that are typi-
cally found in expository text (Bryant, Ugel, Thompson, & Hamff, 1999).
A three-phase study by Williams (2005) explored the effects of explicitly teaching a text
structure program to second-grade at-risk readers. The following components and key elements
of a successful text structure program were identified: (a) instruction in clue words; (b) trade
book reading and discussion to supplement expository sources (i.e. encyclopedias, text books);
(c) vocabulary development; (d) reading and analysis of target paragraphs focusing on com-
pare-contrast structure; (e) graphic organizer; (f) compare-contrast strategy questions; (g) written
summaries with a paragraph frame as support; and (h) review of vocabulary and the strategies
at the end of each lesson. The results suggested that when provided with highly structured and
explicit instruction that focuses on text structure, children at-risk for reading failure, show gains
in comprehension, including the ability to transfer what they have learned to novel texts.
In the upper elementary years, students must acquire several different types of expository
styles to succeed (Westby, 1994). Many of the strategies that have been designed to assist stu-
dents with expository text are based upon sound elements of effective instruction, including: (a)
teacher modeling, (b) students practicing asking and answering questions, and (c) students re-
ceiving feedback on responses. One example of a content-area textbook study strategy developed
by researchers at the University of Kansas is MULTIPASS (Schumaker, Deshler, Alley, Warner,
& Denton, 1982). The teacher explains the steps and rationale and then demonstrates the strategy
by thinking aloud. Students verbally rehearse the strategy. By using the following three steps, the
student never reads the passage in its entirety.
Survey. The student surveys by reading the chapter title, introductory paragraph, the table of
contents (in order to understand the relationship of the chapter to others in the text), subtitles, il-
lustrations, diagrams, and summary paragraphs. The student then paraphrases all the information
gained from the first pass.
Size-Up. The student sizes-up by reading the questions at the end of the chapter and check-
ing off those for which he or she already knows the answer. The student then looks through the
text for headings and parts of the text that are in italics, bold, or colored print in order to identify
cues. The student turns each of these cues into a question and skims the text for an answer. At the
end of the chapter, the student paraphrases all remembered facts and ideas.
Sort-Out. The student sorts out by reading the questions at the end of the chapter and mark-
ing those questions that he or she can answer immediately. If a question cannot be answered, the
student attempts to locate the answer by skimming the text.
Students with LD need to be taught explicitly how to analyze text and use this analysis
strategically to assist with reading comprehension (e.g., Bakken, Mastropieri, & Scruggs, 1997;
Dickson, Simmons, & Kame’enui, 1998; Dimino, Taylor, & Gersten, 1995; Minskoff, 2005).
Methods involving “self questioning,” such as Reciprocal Teaching (Palinscar & Brown, 1984)
and adaptations such as Collaborative Strategic Reading ([CSR]; Klingner & Vaughn, 1998), are
also effective methods for improving comprehension. In CSR which was designed specifically
for students the following four strategies are taught:

1. Preview—before reading, brainstorm about the topic and predict what will be learned;
2. Click and Clunk—identify parts of a passage that are hard to understand (clunk), then use
four “fix up” strategies;
 8. TEACHING YOUNGER READERS WITH READING DIFFICULTIES 177

3. Get the Gist—identify the most important information in a passage; and

4. Wrap Up—ask and answer questions that demonstrate understanding and review what
was learned.

The students form cooperative groups to participate in the roles of (a) the leader who deter-
mines next steps for the group, (b) the clunk expert who reminds the group of steps involved in
the process, (c) the gist expert who guides the group through getting the gist, (d) the announcer
who asks group members to carry out activities, and (e) the encourager who provides encourage-
ment to group members. The teacher teaches each of the strategies and the student roles to the
entire class prior to reading. The teaching process takes several days and includes identifying,
in advance, the vocabulary words from the reading materials that may prove to be too difficult.
Students with LD show gains in reading comprehension in studies of CSR’s effectiveness (Bry-
ant, Vaughn, Linan-Thompson, Ugel, & Hougen, 2000).
In general, this concept of “making known” the thoughts and processes involved in deci-
sion-making through the use of making predictions, self-questioning techniques, and “thinking
aloud” is highly related to comprehension improvement (e.g., Gersten et al., 2001; Mastropieri
et al., 1996; Swanson & Hoskyn, 1998; Swanson, Hoskyn, & Lee, 1999). Table 8.2 provides an
abbreviated summary of the effective instructional practices for the major areas identified by the
National Reading Panel.

ADDITIONAL GENERALIZATIONS

In a meta-analysis of reading research spanning 25 years, Swanson (1999) examined over 90

studies involving samples of children and adolescents with LD. The results yielded important
information regarding evidence-based effective instructional models, methods, and strategies for
teaching word recognition and reading comprehension to children with reading disabilities. For
example, direct instruction alone was found to be most effective for teaching word recognition,
and a combination of direct instruction and strategy instruction was found to be most effective for

TABLE 8.2
Examples of Effective Reading Strategies

Reading Component Strategy

Phonological Awareness Teaching students how to blend and segment speech sounds
Decoding
Phonics Teaching students directly and systematically the relationships between the speech
sounds (phonemes) and letter patterns (graphemes).
Sight Words Providing students with practice recognizing common morphemes and orthographic
units quickly
Word Analysis Teaching students how to recognize and pronounce word parts and syllables in multi-
syllabic words.
Fluency Having students engage in repeated readings of lists of words and connected text.
Vocabulary Having students connect known words to new words with multiple exposures to
words in varied, engaging contexts.
Comprehension Having students ask and answer questions, summarize, make predictions, and clarify
text.
Teaching students about the components of various types of text structures.
178 MATHER AND URSO

TABLE 8.3
Evidence-Based Components of Effective Reading Instruction for Students with Learning
Disabilities

Component Description
Direct response/questioning Teacher asks students questions, guides them in asking their own questions, or
engages them in discussion about the subject matter.
Controlling task difficulty Teacher uses short activities that move from easier to more difficult and provides
students with support and demonstration.
Elaboration Teacher provides additional information about the subject and/or the steps involved
in accomplishing the task.
Modeling Teacher demonstrates the steps required to complete the task.
Group instruction Teacher provides instructions and interaction in small groups.
Strategy cues Teacher reminds students to use strategies, explains the benefits of strategies or
specifies steps in strategies (e.g. when the teacher encourages students to “think
out loud”).

Note. From “Reading Research for Students with LD: A Meta-Analysis of Intervention Outcomes,” by H.L. Swanson, 1999, Journal of
Learning Disabilities, 32, p. 522. Adapted with permission.

teaching reading comprehension. Moreover, the following six components were found to have a
major impact on student performance: (a) direct response/questioning, (b) controlling task dif-
ficulty, (c) elaboration, (d) modeling, (e) small group instruction, and (f) strategy cues. Table 8.3
provides a description of these components.
In addition to strategies for teaching (i.e., elaborating, modeling, and providing strategy
cues), the conditions of instruction, such as the size of the instructional group, the control of task
difficulty, and the conditions and components of the interventions were found to be important for
instruction in all aspects of reading.

Instructional Group Size

From a meta-analysis of reading research, Swanson (1999) found that instruction in small, inter-
active groups of six or fewer tended to be the most conducive for comprehension gains. Similarly,
in a meta-analysis of reading research that spanned 19 years, Elbaum et al. (2000) found that
grouping children rather than teaching the whole class at once significantly improved the reading
of students with LD. In addition, groups of four or fewer students were better than larger groups.
After analyzing research on the best practices in reading instruction, Foorman and Torgesen
(2001) identified small-group or one-to-one instruction as an evidence-based critical component
for the children who are most at risk for reading failure.
Some early intervention programs, such as Reading Recovery®, have been designed to pro-
mote literacy learning for the most at-risk children using one-to-one instruction (Clay, 1993).
Several studies have demonstrated the effectiveness of this intervention (e.g., Center, Wheldall,
Freeman, Outhred, & McNaught, 1995; Pinnell, 1989; Schwartz, 2005), although some have
suggested that similar types of instructional techniques based on the Reading Recovery format
can be successfully adapted for use in pairs (Iversen, Tunmer, & Chapman, 2005) Unfortunately,
the realities of classroom constraints can make the implementation of one-to-one instruction
too expensive, and even small grouping formats a challenge, due to limitations in the number of
teachers, classroom size, and scheduling.
 8. TEACHING YOUNGER READERS WITH READING DIFFICULTIES 179

Task Difficulty

To enhance both word recognition and comprehension, control of task difficulty is another criti-
cal component of teaching reading to students who struggle (Gersten et al., 2001; Swanson &
Hoskyn, 1998). Swanson and Hoskyn identified controlling task difficulty as one of the three
most critical components of effective instruction, and Vaughn et al. (2000) identified control of
task difficulty as a critical component of instructional scaffolding. Reading concepts and skills
need to be introduced systematically, beginning with easier tasks and progressing to more dif-
ficult tasks over time. When the task difficulty is not controlled, students often exhibit behavioral
and attentional difficulties in the general education classroom (Liaupsin, Umbreit, Ferro, Urso,
& Upreti, 2006; Umbreit, Lane, & Dejud, 2004).

Conditions and Components of Interventions

The conditions and components of an intervention appear as important as the selection and use
of a specific evidence-based approach. Results from intervention studies seem to suggest that the
nature of the program is less important than its comprehensiveness and intensity (Fletcher et al.,
2007). For example, Torgesen et al. (2001) found the same positive outcomes for two different
reading programs that both provided intensive, systematic one-to-one instruction. Effective in-
structional elements included: small group instruction with high response rates, the provision of
immediate feedback, and the sequential mastery of topics, all elements of good teaching (Nation-
al Joint Committee on Learning Disabilities, 2005). In addition, several instructional principles
can help inform decisions regarding diverse learners and effective early literacy instruction: (a)
capitalize and use instructional time efficiently; (b) provide interventions early, frequently, and
strategically; (c) teach less, more thoroughly; (d) explain reading strategies in a clear, explicit
manner to students; (e) provide teacher-directed and student-centered activities; and (f) evaluate
the effectiveness of instructional materials and student progress frequently (Kame’enui, 1993).

COMPREHENSIVE READING PROGRAMS

Some comprehensive reading programs address all areas of reading instruction specified by the
National Reading Panel (NRP). For example, Carnine et al. (2004) developed a comprehensive
model of instruction, referred to as “Direct Instruction Reading,” which incorporates the five
essential reading components identified by the NRP: phonemic awareness, phonics, fluency, vo-
cabulary, and text comprehension instruction. These subcomponents are carefully sequenced to
allow for fluid progression from beginning reading skills to more advanced reading skills. The
Direct Instruction Reading model and teaching procedures incorporate effective instructional
strategies using teaching techniques and sequences that are designed to facilitate acquisition and
progression of skills.
Another example of a structured curriculum that teaches literacy explicitly is: Language!™
The Comprehensive Literacy Curriculum (Greene, 2005). This program provides sequential in-
struction in: (a) phonemic awareness and phonics, (b) word recognition and spelling, (c) vo-
cabulary and morphology, (d) grammar and usage, (e) listening and reading comprehension, and
(f) speaking and writing. The Language!™ curriculum was developed to provide differentiated
instruction through explicit and direct teaching of the major components of written language.
Language! has been shown to be effective with students who are English Language Learners
and special education students in addition to delayed readers. The program uses evidence-based
180 MATHER AND URSO

strategies to address the needs of students with low literacy through instruction in the reading and
writing skills necessary for success. Research evaluating Language! has resulted in significant
results across a variety of settings (e.g., Greene, 1996; Moats, 2003; Torgesen et al., 2001).

CLASSWIDE AND PEER TUTORING PROGRAMS

Tutoring, cooperative grouping, and other peer-assisted learning situations have received consid-
erable research attention since the 1980s. Grouping practices that allow more proficient readers
to provide feedback and guide less able readers can increase reading fluency (Chard et al., 2002).
Elbaum et al. (2000) found that being paired with another student in a reciprocal tutoring format
was beneficial for students with LD regardless of whether the student was acting as the reciprocal
tutor or as the tutee. In contrast, cross-age tutoring only had a positive impact on older students
with disabilities who tutored younger students; the younger students with disabilities did not
benefit from being tutored by older students with disabilities.
Empirical support is also available for ClassWide Peer Tutoring (CWPT), a program devel-
oped by Delquadri, Greenwood, Whorton, Carta, and Hall (1986) at the Juniper Gardens Project
at the University of Kansas (Delquadri et al., 1986; Fantuzzo, King, & Heller, 1992; Greenwood,
Delquadri, & Hall, 1989; Maheady & Harper, 1987; Maheady, Harper, & Sacca, 1988). CWPT
pairs all students in a classroom to increase the time that students spend on task receiving feedback,
immediate error correction, and appropriate pacing on academic content (Greenwood et al., 1989).
The research on CWPT is focused on increasing the academic performance of low socioeconomic
status (SES) students (Greenwood, 1991a, 1991b; Greenwood et al., 1989) and lowering the need
for special services by this population (Greenwood, Terry, Utley, Montagna, & Walker, 1993).
Fuchs, Fuchs, Mathes, and Simmons (1997) extended the research on CWPT to include
students with and without disabilities, across socio-economic status and achievement levels in
general education classrooms. Peer-Assisted Learning Strategies (PALS) was originally designed
for students in grades two through six and has since expanded to separate programs for kinder-
garten, first grade, and high school. A strong research base exists for the efficacy of PALS and
First Grade PALS, including recognition by the Florida Center for Reading Research as an evi-
dence-based program based on nearly 15 years of empirical research (e.g., Al Otaiba & Fuchs,
2006; Grek, 2002; Fuchs et al., 1997; Fuchs, Fuchs, Thompson, Al Otaiba, et al., 2001; Ginsburg-
Block, Rohrbeck, & Fantuzzo, 2006; Maheady, Mallette, & Harper, 2006; McMaster, Fuchs, &
Fuchs, 2006; Simmons, Fuchs, Fuchs, Hodge, & Mathes, 1994).
Results from two studies on Kindergarten PALS (K-PALS) found that students receiving
K-PALS training and phonological awareness activities outperformed students receiving phono-
logical awareness training alone on measures of beginning reading skills (Fuchs, Fuchs, Thomp-
son, Svenson, et al., 2001); however, some kindergartners with disabilities who participated in
the K-PALS program did not make sufficient progress (Fuchs et al., 2002).
First Grade PALS (Mathes, Howard, Allen, & Fuchs, 1998) incorporates two separate tutor-
ing routines, namely, Sounds and Words and Partner Reading. Sounds and Words focuses on
beginning decoding skills including phonological skills and word recognition skills, and Partner
Reading is a fluency component designed to increase speed and accuracy. This one-to-one tu-
toring program incorporates partner reading, paragraph summary, prediction, and other strate-
gies identified as evidence-based practices. Results from several research studies (Fuchs et al.,
1997; Mathes et al., 1998) indicated that students receiving First-Grade PALS outperformed
students who did not receive this program, and students enrolled in peer tutoring classrooms
performed better than those receiving traditional instruction regardless of the type of learner (i.e.,
low achieving, low achieving with a disability, and average achieving).
 8. TEACHING YOUNGER READERS WITH READING DIFFICULTIES 181

PALS for grades 2 through 6 also incorporates partner reading, paragraph summary, predic-
tion, and other strategies identified as evidence-based practices for improving decoding skills
and reading comprehension. In addition to proving the program’s efficacy, studies have shown
positive social outcomes in classrooms using PALS, including greater social acceptance of stu-
dents with LD and improved social and self-concept outcomes (e.g., Fuchs et al., 1997, 2002;
Ginsburg-Block et al., 2006). Although implementation of PALS has resulted in positive student
gains in decoding and comprehension skills across grade levels, McMaster et al. (2006) caution
that this supplementary reading approach may not benefit all students. PALS interventions appear
to be most effective for low-income, minority students in urban settings in grades 1 through 3
(Ginsburg-Block et al., 2006). As with all instructional techniques, teachers have to monitor stu-
dents’ progress carefully and modify activities to address the instructional needs of the children
who do not make progress.
As another example of a successful classwide intervention, Blachman, Schatschneider,
Fletcher, and Clonan (2003) used a classroom prevention model with kindergarten children, as
well as with first and second grade students, and found that it was effective in advancing both read-
ing and spelling performance as compared to control children. The 30-minute lessons replaced the
basal reading program and were built around a five-step core program that involved: (1) teaching
and review of sound-symbol associations by showing a child a letter card and asking for the name,
the sound, and the key word for the letter; (2) practice making words by manipulating the letters
using a pocket chart or scrabble tiles; (3) timed review with flash cards of the decodable words and
introduction and practice reading high frequency irregular words; (4) practice reading stories; and
(5) writing 4 to 6 words and a sentence from dictation, beginning with simple consonant-vowel-
consonant patterns, and progressing to more complex syllable patterns. Blachman et al. noted that
when teachers were provided with an understanding of scientifically based principles of reading
instruction, classroom reading instruction improved and students benefited.

TEACHER PREPARATION AND KNOWLEDGE

One major conclusion reached from the last decade of research on young children with poor
reading performance is that early systematic instruction in phonological awareness and system-
atic phonics can improve early reading and spelling skills. This type of instruction does not
completely eliminate cases of reading failure, but it does significantly reduce the number of
students who are reading below expectancy level (Torgesen, 2000). Thus, to teach reading to at-
risk students and students with reading disabilities, teachers need to have knowledge of English
language structure as well as knowledge of how to implement systematic explicit instruction
within the classroom.
Unfortunately, many elementary and special education teachers do not have the necessary
preparation or expertise to provide specific reading interventions (Brady & Moats, 1997; Moats,
1994) so a substantial gap exists between the evidence-based reading instruction literature and
teachers’ preparedness to deliver this type of instruction (Moats & Foorman, 2003). Consistent
with this view is the finding that when interventions are implemented with lower implementation
fidelity in the general education classroom, more students experience an inadequate response
to the intervention (Al Otaiba & Fuchs, 2006). Moreover, even instruction in special education
classes may not be sufficiently explicit, systematic, and intensive to result in sustained reading
growth (Denton et al., 2006). In studies examining teachers’ self-perceptions and knowledge
regarding the teaching of reading, the results showed that experienced special and general edu-
cation teachers lack knowledge about word structure (e.g., Bos, Mather, Dickson, Podhajski, &
Chard, 2001; Bos, Mather, Friedman-Narr, & Babur, 1999; Cunningham, Perry, Stanovich, &
182 MATHER AND URSO

Stanovich, 2004; McCutchen & Berninger, 1999; McCutchen, Abbott, et al., 2002; McCutchen,
Harry, et al., 2002; Moats, 1994; Spear-Swerling, Brucker, & Alfano, 2005).
Research also suggests that even when teachers believe that they are well prepared in teach-
ing certain components of reading they may, in fact, not be so prepared. For example, in one
study, kindergarten to third-grade teachers rated their knowledge of children’s literature, phone-
mic awareness, and phonics as high, but the majority demonstrated limited actual knowledge of
phonemic awareness and phonics (Cunningham et al., 2004). The potential significance of this
problem becomes even greater when one considers the number of teachers for whom knowledge
of such skills are essential, namely, all kindergarten through third-grade teachers, as well as all
special education teachers who teach children with more severe challenges such as reading dis-
abilities. Consequently, there has been a call for increased professional development through-
out the professional and educational policy literature (e.g., Brady & Moats, 1997; International
Reading Association, & National Association for the Education of Young Children, 1998; Snow
et al., 1998; Snow et al., 2005).
One conclusion is apparent: Teacher preparation and professional development programs
need to provide instruction regarding how to improve reading performance. As noted by Lyon
(1999), “Major efforts must be undertaken to ensure that colleges of education develop prepara-
tion programs to foster the necessary content and pedagogical expertise at both preservice and
inservice levels” (p. 8). Because poor readers do not catch-up and continue to struggle with read-
ing throughout school, early intervention from knowledgeable teachers is essential (Juel, 1988;
Lyon, 1999; Shaywitz et al., 1994). More than 15 years ago, Liberman, Shankweiler, and Liber-
man (1989) expressed similar sentiments:

In view of all the evidence that has accumulated in the past fifteen years to support the critical
importance of phonological sensitivity for the attainment of literacy in an alphabetic system, one
would surely expect teacher training to reflect these findings. Unfortunately, all too often it does
not. Many teachers are being trained to teach reading without themselves ever having learned
how an alphabetic orthography represents the language, why it is important for beginners to un-
derstand how the internal phonological structure of words relates to the orthography, or why it is
hard for children to achieve this understanding. (p. 23)

With proper preparation, both general and special educators can provide informed instruc-
tion that will assist all children with reading development (Torgesen, 2000). In this regard, some
research has suggested that after completion of a course followed by a year long partnership
with elementary teachers, teachers can: (a) deepen their knowledge of language structure, (b)
use that knowledge to change classroom practice, and (c) provide reading instruction that will
improve all student learning (e.g., Bos et al., 1999; Bos et al., 2001; Mather, Bos, & Babur,
2001; McCutchen, Harry, et al., 2002). The current knowledge base gives us the responsibility
to train teachers, not in how to implement one reading approach over another, but rather in how
to make informed choices about which components of reading to target for which students at
what point in time (Brady & Moats, 1997). Recent teacher training courses, such as the LETRS
program (Moats, 2004) and Mastering the Alphabetic Principle (Podhajski, Varricchio, Mather,
& Sammons, in press) may hold promise for more in-depth preservice and inservice training that
will increase teacher knowledge of language structure. Any sustained change in reading instruc-
tion will require that teachers receive: (a) instruction in empirically-based reading strategies,
(b) feedback from trained observers regarding how to implement these strategies and monitor
student progress, and (c) information on how to individualize instruction for a variety of students
(Foorman & Schatschneider, 2003). As observed by McCutchen and Berninger (1999): Those
who know, teach well.
 8. TEACHING YOUNGER READERS WITH READING DIFFICULTIES 183

CONCLUSION

Reading is a complex process that involves the development and consolidation of numerous
skills. One cannot just teach only one aspect of reading and expect that young children will
become competent readers. Phonological awareness, phonics, and fluency are all aspects of read-
ing performance with early developmental benchmarks, whereas vocabulary and comprehension
continue to improve throughout the school years. When children fail to progress in any aspect of
reading, their difficulties increase each year. Whereas some children have specific reading dis-
abilities, others struggle to learn to read because of second language issues or limited exposures
to reading and literacy opportunities in the home (Carlisle & Rice, 2002).
Despite decades of progress regarding the use and implementation of evidence-based read-
ing interventions, we are still left with the lingering problem of the treatment resisters (Al Otaiba
& Fuchs, 2006; Torgesen, 2000). Even when children receive high-quality reading instruction,
not all students make adequate progress (Denton et al., 2006; Torgesen, 2000). We do not yet
know enough about the underlying characteristics that make it so difficult for some children to
learn to read or the specific approaches that will be most effective for each child (Al Otaiba &
Fuchs, 2006). These hard-to-teach children epitomize the true meaning of learning disabilities as
“unexpected underachievement” (Denton et al., 2006) and suggest that, despite our best efforts
and implementation of evidence-based reading interventions, some children may still be left be-
hind. Stanovich (1986) aptly described the plight of the struggling reader:

Slow reading acquisition has cognitive, behavioral, and motivational consequences that slow the
development of other cognitive skills and inhibit performance on many academic tasks. In short,
as reading develops, other cognitive processes linked to it track the level of reading skill. Knowl-
edge bases that are in reciprocal relationships with reading are also inhibited from further devel-
opment. The longer this developmental sequence is allowed to continue, the more generalized the
deficits will become, seeping into more and more areas of cognition and behavior. Or to put it
more simply and sadly—in the words of a tearful 9-year-old, already failing frustratingly behind
his peers in reading progress, “Reading affects everything you do.” (p. 390)

To meet the needs of young struggling readers, we must: (a) identify their difficulties at a
young age; (b) implement targeted instruction that represents evidence-based best practices; (c)
monitor their progress frequently and adjust instruction as needed; (d) ensure that intensive in-
terventions are available and that teachers have the requisite skills and knowledge to deliver high
quality instruction; and (e) provide a language rich, safe, motivating environment for learning to
read. The most effective programs are comprehensive, provide instruction in the alphabetic prin-
ciple, teach strategies for comprehension, and provide ample opportunities for practice (Fletcher
et al., 2007).
Children who are behind in reading contend daily with the tyranny of time as the pedagogi-
cal clock continues to tick mercilessly (Kame’enui, 1993). One conclusion from research is clear:
For children with learning problems, learning is hard work; for their teachers, instruction is very
hard work and requires an enormous amount of training and support (Semrud-Clikeman, 2005).
Children with learning difficulties benefit from the teaching of the same instructional components
as peers, but the instruction needs to be more explicit, more comprehensive, and more intensive
(Foorman & Torgesen, 2001). Therefore, we must be ever vigilant, persistent, and systematic
in all of our efforts to help. We need to identify and intervene early with children who struggle
to read to avoid the substantial social and emotional consequences (Fletcher et al., 2007). Over
160 years ago, Carlyle said that it was the business of schools to teach children to read (cited in
Stanger & Donahue, 1937). It’s time we get down to business.
184 MATHER AND URSO

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 9
Teaching Older Readers
with Reading Difficulties
Jade Wexler, Meaghan S. Edmonds,
and Sharon Vaughn

Over the past 30 years, interventions that provide explicit, systematic instruction in phonological
awareness, phonics, fluency, vocabulary, and comprehension have facilitated reading instruction
for a significant number of students (National Reading Panel, 2000). Much of our knowledge
about reading instruction comes from studies conducted with students in grade 3 and younger.
Despite the large amount of knowledge regarding effective reading instruction for young, begin-
ning readers, there are still students in grades 4 through 12 who continue to struggle with read-
ing. Often, we borrow what we know regarding effective practices for younger readers and apply
that knowledge to older, struggling readers. While many elements of reading are the same for
younger and older students, our confidence about interventions improves when the practice has
been implemented with students from similar grades and with similar reading difficulties.
This chapter provides an overview of the current research and practice related to instruction
for older students with reading difficulties. Elements of reading instruction for older readers,
including advanced word study, fluency, and comprehension, will be presented.

ADVANCED WORD STUDY

Secondary students are expected to be skilled readers who can effortlessly and accurately read
text while comprehending what they read. Because of the increasing amount of complex content
and text secondary students are asked to read, they must be highly adept at all processes related to
effective reading, including reading words efficiently and knowing what they mean—as well as
being able to integrate and comprehend complex ideas and concepts (Nagy & Anderson, 1984).
A breakdown in any of these critical reading processes makes understanding and learning from
text difficult or even impossible.
One might not expect word study to be a relevant instructional element for secondary stu-
dents. However, many students are reaching the upper grades deficient in the skills necessary to
become competent readers, including the ability to decode text (Curtis, 2004). Often, these stu-
dents have learned how to compensate for their reading deficiencies and have honed other skills,
such as listening comprehension, that help them to disguise the fact that they are not effective and

193
194 WEXLER, EDMONDS, AND VAUGHN

efficient word readers. When it becomes apparent that an older student’s listening comprehen-
sion ability has surpassed his reading comprehension ability, slow decoding usually is the reason
(Shankweiler, Lundquist, Katz, Stuebing, Fletcher, & Brady, 1999).
Does it make sense to provide word study for older students with reading difficulties? Some
long-term studies show that older students who fall behind benefit considerably from specialized,
intensive instruction aimed at improving word study (Torgesen, Alexander, Wagner, Rashotte,
Voeller, & Conway, 2001). Moats (2001) states that chronological age should not be a factor in
determining who receives remediation in any of the critical skills necessary to read fluently and
comprehend text—including word study. In summary, although early intervention is preferable,
older readers with significant reading difficulties deserve remediation efforts as much as younger,
poor readers (Moats, 2001).

What is Advanced Word Study?

Word recognition and analysis involves being skilled at phonological processing (recognizing the
speech sounds in words) and having an awareness of letter-sound correspondences in words (Ehri
& McCormick, 1998). As students become more mature readers, word study includes applying
knowledge of phonology and orthography to read many novel, complex multisyllabic words.
Typically, secondary students reading between the 2.5 and 5.0 grade levels can be characterized
as those needing instruction in multisyllabic word decoding, or what we might call advanced
word study (Archer, Gleason, & Vachon, 2003). Intervention focused on addressing word study
instruction for older students with reading difficulties typically targets two main types of instruc-
tion: (1) word analysis instruction and (2) word recognition instruction (Curtis, 2004).
Word analysis instruction exposes students to information and strategies that will help them
gain access to the meaning of words. This includes instruction in morphemic analysis, such as
knowledge of prefixes, suffixes and roots, as well as instruction in vocabulary. In word analysis
instruction, students are taught to “chunk” word parts to gain access to any known word units
within the larger word, which in turn provides access to the meaning of words. For example, in
the word repossessed, students may be taught to chunk the word into the following parts: re–pos-
sess–ed. In this example, they can decode the word and get at the meaning quickly by associating
the prefix –re with something that means “to go back.” They will associate the base word, pos-
sess, with something that means “to hold onto,” and the suffix –ed tells them that it happened in
the past. Not only does this help students access the meaning of the word, but also it helps them
isolate the root word and decode the word in chunks, rather than trying to read the entire word at
once. As a result of this type of instruction, students learn strategies to read words part by part,
while associating the word with its meaning. It is important that when educators and students use
this strategy, they are flexible in their approach of dividing the word into parts.
Instruction in word recognition involves instruction in orthographic processing, or the abili-
ty to recognize the letter patterns in words and their corresponding sound units. Word recognition
instruction at the secondary level focuses on various advanced word study components. Students
might be taught how to use knowledge of the different syllable types in the English language
(consonant-vowel-consonant, consonant-vowel, vowel-consonant-e, r-controlled, double vowel,
and consonant-le) to decode words. For example, students learn that in a consonant-vowel-con-
sonant word such as cat, the vowel makes a short sound.
In the previous example, students might divide the word repossessed differently to decode
the word than they would if their goal were to access the morphemic elements in the word.
Instead, they would divide the word according to syllable types. According to syllable types, a
student might divide the word into the following parts to help with decoding: re–po–ssess–ed.
 9. TEACHING OLDER READERS WITH READING DIFFICULTIES 195

While this might not help the student access the word’s meaning, it provides a way to break down
and decode a multisyllabic word.
In this type of advanced word study instruction, students are taught rules that they can ap-
ply when trying to segment words based on the role of the vowel. This is often referred to as the
“rules of syllabication.” For example, in the word locate, students will learn first to try to read the
word by referring to the rule that a consonant usually follows a vowel in this situation and goes
with the second syllable. Therefore, the student would learn to segment and decode the word as
lo–cate, breaking it up into an open syllable followed by a vowel-consonant-e syllable word part.
Instruction in the syllable types gives students a pattern or rule to follow, as well as knowledge
about how to pronounce the vowel sound. Students can use their knowledge of the syllable types
to analyze the role of the vowels in a word which helps separate letters into chunks and under-
stand the spelling patterns (Curtis, 2004).

Should Educators Spend Time Trying to Improve Word Recognition?

At the secondary level, factors other than reading words accurately contribute to comprehen-
sion, such as background knowledge and knowledge of vocabulary and comprehension strate-
gies (Kintsch & Kintsch, 2004). However, while it is necessary to focus on instruction that will
improve students’ comprehension through enhancing background knowledge, vocabulary, and
comprehension strategies, for many older students with reading difficulties, it is still critical to
build word-level skills so the students can access more difficult text. No matter how strong a
student’s background or vocabulary knowledge on a particular text or how developed a student’s
knowledge of comprehension strategies, without being able to decode fluently, reading compre-
hension will suffer (Archer et al., 2003; Torgesen, 2005).
There is another important reason why older students benefit from improved word reading
and decoding. Students who are able to read text effortlessly are less frustrated readers and, thus,
more likely to spend time reading. When students become frustrated, they read less text, and as
a result, they usually fall further behind (Stanovich, 1986). Students who are frustrated because
they struggle to decode are also more likely to drop out of school, have trouble finding employ-
ment, or have challenges in society in general (Biancarosa & Snow, 2004; National Association
of State Boards of Education (NASBE; 2005; RAND Reading Study Group (RRSG; 2002).
Much value exists, therefore, in providing remediation for students who need help in ad-
vanced word study. Specifically, these are typically students who can decode single-syllable (e.g.,
came, time, lump) and high-frequency irregular words (e.g., was, from, about) but have difficulty
with the pronunciation of multisyllabic words (Just & Carpenter, 1987).

Results/Findings from Intervention Studies

The overall purpose of spending time on advanced word study instruction is to help students learn
to decode text fluently and, ultimately, comprehend what they are reading. The comprehension
of older, struggling readers can be improved through several types of interventions, including in-
struction that provides comprehension strategies, multicomponent interventions, and word-study
interventions (Edmonds et al., in review).
Interestingly, word-level interventions (N = 3) were associated with small to moderate ef-
fects (ES = .34) in comprehension outcomes between treatment and comparison students. Thus,
word-study interventions significantly affect comprehension. Older students who have low de-
coding skills and require extensive instruction in word-reading skills might benefit from word-
level instruction. Therefore, using a direct approach to teaching the analysis of the structure of
196 WEXLER, EDMONDS, AND VAUGHN

words (syllables and morphemes) is relatively effective for teaching struggling readers how to
decode multisyllabic words (Archer et al., 2003; Lenz & Hughes, 1990).
Furthermore, several studies have evaluated the effectiveness of word study interventions
that were designed to teach students to analyze words structurally. Bhattacharya and Ehri (2004)
reported that teaching sixth- to ninth-grade struggling readers a multisyllabic chunking structural
analysis approach yielded positive effects. Students in their study read multisyllabic words by
analyzing grapho-syllabic units in the words or by reading the words as whole parts. Students
who practiced reading the words in multisyllabic units orally divided the words’ pronunciations
into beats and then matched the pronounced form of each beat to its spelling.
In another study that applied a structural analysis approach to interventions, Abbott and Ber-
ninger (1999) studied the effect of phonics and structural analysis instruction on word reading
skills of fourth- to seventh-grade low achievers. The effect was minimal; however, the contrasted
condition was similar to the treatment, making it hard to discern the benefit of instruction versus
no instruction. Both the treatment condition (Structural Analysis Group) and the contrasted con-
dition (Study Skills Group) participated in an hour of a systematic intervention, including equal
time training in skill areas such as orthographic skills, alphabetic skills, and oral reading. The
only difference was that for 15 minutes, the students in the Structural Analysis condition were
taught to check for affixes and roots, break the word into syllables, and then apply letter-sound
correspondences, while the students in the Study Skills condition worked in a commercial work-
book that covered topics such as outlining, writing paragraphs, and taking notes.
In 1990, Lenz and Hughes taught 12 adolescents a decoding strategy. Their approach to
strategy training was based on the idea that teachers can teach students to think of word identifi-
cation as a problem-solving process in which students follow a number of steps to solve a word-
identification problem. The problem-solving steps included use of contextual clues as well as
application of common principles of structural analysis such as isolating the prefixes and suffixes
in multisyllabic words. The strategy resulted in fewer oral reading errors and increased compre-
hension for some students. Although some students improved their comprehension, the authors
cautioned that comprehension was not improved as a direct effect of the study and that to improve
comprehension, some students will need simultaneous comprehension instruction.
While the above studies examined the effects of providing a word-recognition or structural-
analysis intervention, Bhat, Griffin, and Sindelar (2003) studied the effects of a phonemic aware-
ness (PA) intervention on the PA and word-recognition skills of 40 middle school readers with
learning disabilities. Results showed that the intervention had an effect on students’ PA skills,
but these students were not able to generalize their PA skills to word identification. Teachers of
older students with reading difficulties may consider focusing their instruction on teaching letter-
sound correspondences and structural-analysis training, rather than providing explicit instruction
in phonological awareness.

Implications for Practice

Several implications for practice can be gleaned from the knowledge base regarding instruction
in advanced word study for older, struggling readers. Older students with reading difficulties
profit from word-level interventions beyond improving their word-reading skills—they also im-
prove their reading comprehension (Edmonds et al., in review). Most secondary students with
reading difficulties would benefit from improving their knowledge and use of orthographic pro-
cessing skills. Providing explicit, systematic instruction in letter-sound relationships, sight word
instruction, and multisyllabic word study instruction is associated with overall improved reading
performance (Curtis, 2004). Students can learn to decode multisyllabic words by breaking them
 9. TEACHING OLDER READERS WITH READING DIFFICULTIES 197

TABLE 9.1
Word Study Instruction for Older Students with Reading Difficulties

Recommendation Example
Teach students to look for words they In the word resubmit, students can be taught to identify the word submit.
know within larger words.
Help students divide large words into Students can be taught to divide the word contemplate into con–tem–plate
smaller segments so they can read the or dissatisfy into:
segments and, thus, the entire word. 1. Dis–sat–is–fy for word-recognition purposes using knowledge of
syllable types and the role of the vowel. This divides the word into
three closed syllable types and one open syllable type; OR
2. Dis–satisfy using a word-analysis approach. Students will use the
prefix dis- and the previously known word satisfy to make sense of
the word and decode it.
Teach students to identify affixes, what Example affixes: re-, un-, –ly, –ment.
they mean, and how to interpret the
meaning of words that use common
affixes.

into parts using their knowledge of the rules of syllabication, including the role the vowel plays
in a word, and they can learn to identify word parts such as prefixes and suffixes to help decode
multisyllabic words as well as get at the meaning of words. To help students make the connection
between decoding multisyllabic words and comprehension, students can receive instruction in
morphemic analysis, word relationships, and word origins.
In addition to providing students with various methods to decode words and use word parts
to get at meaning, continuous and extensive opportunities to read target words in connected text
are essential. Finally, students will need extensive practice applying these word-study skills so
they can read text with speed and accuracy. Therefore, students must practice reading fluently
(discussed in the next section). When they can decode multisyllabic and sight words fluently,
students can spend less energy trying to decode and allocate more energy to comprehending the
text they are reading. Table 9.1 provides recommended word study instruction for older students,
as well as examples for each recommended practice.

FLUENCY

To meet increasing accountability demands, students must be able to read and comprehend text
at a rapid pace. When students exert too much effort at the word-recognition level, difficulties
deriving meaning from text ensue (Samuels, 1979). Therefore, although fluency is generally re-
garded as a critical component of a reading intervention at the elementary level, the importance
of fluency extends into the upper grades as well (Rasinski, Padak, McKeon, Wilfong, Friedauer,
& Heim, 2005).

What is Fluency?

Fluency is the ability to read text with speed, accuracy, and prosody. Since LaBerge and Samuels
brought fluency to the forefront in 1974, it has been considered a critical element in the reading
process. They proposed that students should be able to recognize words instantly and connect
them with meaning. Chall (1983) also brought attention to the critical role of fluency as the third
of six stages of becoming an efficient reader. She describes fluency as the “ungluing from print”
198 WEXLER, EDMONDS, AND VAUGHN

stage. In this stage, students have already established their decoding ability and are therefore
applying automaticity in print as well as making use of the prosodic features in text, such as ap-
propriate stress and intonation in their reading. After mastering the “ungluing from print” stage,
Chall suggests that it should be easier for students to read for meaning. Overall, we know that
students who can decode text fluently are generally better readers because they can demonstrate
an understanding of the text they read (Shinn & Good, 1992). We also know that, unfortunately,
students who struggle with reading typically struggle with reading fluently and often fall behind
because of their slow reading speed and a lack of motivation.

Should Educators Spend Time Trying to Improve Fluency?

If we can assume that fluency affects a student’s ability to comprehend text at the older grades as
it does at the younger grades (Chard, Vaughn, & Tyler, 2002), then it becomes important for older
students to practice reading text fluently as well. Scores on brief measures of oral reading flu-
ency are highly predictive of scores on standardized tests of reading comprehension, such as the
Stanford Achievement Test for students with reading disabilities in middle and junior high school
(Fuchs, Fuchs, Hosp, & Jenkins, 2001); therefore, one might assume that interventions aimed at
improving fluency may also improve students’ comprehension. In theory, reading fluently would
allow students to spend more energy comprehending text.
Fluency instruction alone, however, is likely not enough to support increased comprehension
for students at the upper grades. Rasinski et al. (2005) examined the role fluency plays with a
large group of ninth graders in a school that historically struggled on its high school state gradu-
ation test. After assessing the decoding (word-reading accuracy) and fluency levels (i.e., reading
rate) of the students, it became apparent that the overall student word-recognition ability was
quite strong, while their fluency levels were on average below the 25th percentile for eighth grad-
ers. From these findings, it would appear that fluency is indeed a factor in comprehension among
older students; however, the relative causal role of improved fluency on increased comprehension
of older students requires further study.
A study by Allinder and colleagues (2001) indicated that increased reading rate and accuracy
did not result in improved comprehension. Kuhn and Stahl (2000) also indicated that improving
fluency alone does not always foster better comprehension ability. In addition, the correlation
between oral reading fluency and comprehension seems to decrease as students get older and text
gets more complicated (Paris, Carpenter, Paris, & Hamilton, 2005). Background knowledge and
working memory are other factors that may play a larger role in comprehending text as a student
gets older. Therefore, while fluency remains an essential component of skilled reading and in-
creases may be associated with improved comprehension, educators may want to be thoughtful
of the amount of time spent trying to improve fluency alone for older, struggling readers.
In addition, fluency remains a very difficult area to improve. Improvements in decoding and
word recognition have been far easier to obtain than improvements in fluency (Lyon & Moats,
1997). In intervention studies that have effectively focused on and increased other critical com-
ponents of reading such as phonological awareness, fluency outcomes were not significantly
affected (Lovett, Steinbach, Frijters, 2000; Torgesen, 2004).

Results/Findings from Intervention Studies on Fluency:

Elements that Affect Repeated Reading

A majority of fluency interventions can be characterized as repeated reading interventions in

which students read the same text repeatedly. In addition, several elements involved in a repeated
reading intervention can affect student outcomes.
 9. TEACHING OLDER READERS WITH READING DIFFICULTIES 199

Previewing/Modeling Procedures and Feedback. One strong influence on the success

of a repeated reading intervention is whether it incorporates a previewing/modeling procedure.
Fluency outcomes are consistently improved following interventions that include a previewing/
modeling procedure (Conte & Humphreys, 1989; Daly & Martens, 1994; Rose & Beattie, 1986;
Rose & Sherry, 1984; Skinner, Cooper, & Cole, 1997; Strong, Wehby, Falk, & Lane, 2004).
Specifically, including a previewing procedure such as having students listen to an adult, partner,
or audiotape of good reading prior to reading text generally results in positive outcomes.
Another positive outcome related to repeated reading interventions is incorporating a model
of good reading that also provides corrective feedback to a student (Freeland, Skinner, Jackson,
McDaniel, & Smith, 2000; Mercer, Campbell, Miller, Mercer, & Lane., 2004; Scott & Shearer-
Lingo, 2002; Strong et al., 2004).

Setting a Criterion vs. Set Number of Rereads. Repeated reading interventions vary
in the number of times a student rereads a passage. There seems to be a general consensus that
setting the number of rereads in a repeated reading intervention at three or four is sufficient for
students to make gains (Meyer & Felton, 1999; O’Shea, Sindelar, & O’Shea, 1987; Therrien,
2004). For example, O’Shea et al. (1987) studied the effects of having students read text one, three,
and seven times. Students demonstrated more fluency (i.e., reading rate) growth on the seventh
reading than the third reading and on the third reading than the first reading. However, the effects
were greater from three rereads to one read than from seven reads to three reads. Keeping in mind
the amount of time teachers have to dedicate to fluency practice and the potential negative effects
on students’ interest and motivation from seven rereads, it seems that three repeated readings
may be sufficient.
Another way to conduct a repeated reading intervention is to specify a criterion students
must reach before moving to the next passage or level in text difficulty. For example, a researcher
might set a criterion of reaching 100 words per minute before a teacher has a student move on.
Conte and Humphreys (1989) studied the effects of repeated reading with audiotaped material
compared to students who received an alternative reading program. They specified a criterion that
students had to read a passage without assistance of an audiotape and without hesitation at the
same speed as the tape, with no oral reading errors. Students in the repeated reading condition
showed significant gains in reading rate.

Repeated Reading versus Non-repetitive Wide Reading

Although improving rate on practiced passages is encouraging, because secondary students have
so much complex content to get through, it is important that gains from fluency interventions
have positive effects on unpracticed passages and have a positive effect for comprehension as
well. Therefore, gains from fluency interventions must be transferable and generalizable.
Unfortunately, gains from repeated reading interventions do not necessarily generalize to
unpracticed passages and do not automatically improve comprehension or word recognition abil-
ity (Steventon & Frederick, 2003; Valleley & Shriver, 2003). In fact, results from intervention
studies with older, struggling readers show that there may be no differential effects for repeated
reading and the same amount of non-repetitive reading for increasing speed, word recognition,
and comprehension (Homan, Klesius, & Hite, 1993; Rashotte & Torgesen, 1985). Reading rate
improved only slightly in the study by Rashotte and Torgesen (1985), while there were no gains
from the repeated reading groups in comprehension on either study. In addition, the wide reading
of a variety of texts provides students with exposure to different text structures, more vocabulary,
and different content areas.
200 WEXLER, EDMONDS, AND VAUGHN

Implications for Practice

Several important implications can be drawn from intervention studies that have focused on flu-
ency-building practices. While it probably goes without saying that additional research is needed,
our interpretation of the research on older, struggling readers is that our knowledge base about
effective fluency interventions is inadequate. Repeated reading interventions may have an effect
on increasing reading rate; however, the same interventions did not support the development of
comprehension skills. Based on current research on fluency interventions with older, struggling
readers, practitioners may want to consider incorporating the following suggestions into their
instructional practices:

1. While improving reading rate may be related to improved comprehension, it does not
necessarily cause improved comprehension. This may be because other factors such as
working memory or background knowledge may play a larger role in comprehending text
at the older grades. Therefore, to enhance comprehension, educators may want to com-
bine fluency instruction with word-recognition and comprehension-strategy instruction.
2. Educators may want to consider having students practice reading the same amount of text
non-repetitively (e.g., wide reading) as they would in a repeated reading intervention.
Interventions that employ a component in which students read an equal amount of text
non-repetitively compared to a repeated reading component show promise in terms of af-
fecting word accuracy and comprehension and do not differ greatly from improvements
in reading rate. In addition, reading the same amount of text repeatedly may not only
sacrifice students’ exposure to text structure, vocabulary, and different content matter, but
there might also be an element of boredom to reading the same thing several times. Be-
cause motivation at the secondary level is such an important factor (Biancarosa & Snow,
2004; National Association of State Boards of Education [NASBE], 2005), practitioners
may want to consider effects of repeated reading on students’ interest and motivation to
read.
3. It may be useful for educators to increase the duration of fluency interventions in their
classrooms. In a synthesis of 19 fluency interventions for students in grades 6–12 (Wexler,
2006), most interventions were relatively brief, with the longest intervention providing 40
sessions (Fuchs, Fuchs, & Kazdan, 1999). In general, the interventions were conducted
only a few times per week and were an average of 5–20 minutes. Interventions longer in
duration may lead to greater effects.
4. A majority of studies used only narrative text in their intervention, making it difficult to
generalize findings to expository text. This is troublesome because secondary students
tend to encounter expository text on a more regular basis. Educators may want to consider
incorporating expository text into fluency interventions so students practice reading what
they will realistically be faced with across all content areas.

Table 9.2 provides recommended fluency instruction for older students, as well as examples
for each recommended practice.

COMPREHENSION

For adolescents, success in school depends on their ability to learn content from a wide range of
domain-specific texts. Upon entering middle and high school, proficient elementary-age readers
 9. TEACHING OLDER READERS WITH READING DIFFICULTIES 201

TABLE 9.2
Fluency Instruction for Older Students with Reading Difficulties

Recommendation Example
1. Have students practice reading text repeatedly. Students should read text 3–4 times or until a specified
criterion is met (e.g., 100 words per minute).
2. Have students practice wide reading. Students should have an opportunity to read the same amount
of text as they would in a repeated reading intervention.
3. Provide models and feedback during fluency Students can listen to an adult model of good reading (on
work. audiotape or “live”) prior to reading text. They can also
receive corrective feedback from adults or partners.
4. Provide other instruction along with fluency Remember that students will need comprehension-strategy
instruction. instruction and possibly word-recognition instruction along
with fluency practice.

may experience a decline in comprehension due to the increasing demands of the text and the
complexity of the vocabulary and constructs (Chall, 1983). Many students are unprepared for the
sophisticated text structure and complex, content-specific vocabulary they encounter in the upper
grades.

What is Reading Comprehension?

Ultimately, reading comprehension is the process of constructing meaning by coordinating a

number of complex processes, including word reading, word and world knowledge, and fluency
(Anderson, Hiebert, Scott, & Wilkinson, 1985; Jenkins, Larson, & Fleischer, 1983; O’Shea et
al., 1987). For some adolescent readers, competency in word-level skills provides a stumbling
block that prevents them access to fluent reading and, thus, comprehension. In the last few years,
students with reading difficulties were identified as having inadequate phonological awareness
and decoding skills, which proved to seriously inhibit successful reading (Ball & Blachman,
1991; O’Connor & Jenkins, 1995; Vellutino & Scanlon, 1987). While there is little question that
difficulties in these foundation skills impede successful growth in reading for many students,
several students with reading difficulties have significant challenges understanding and learning
from text even when they are able to decode adequately (Williams, 1998, 2000). Explicit and
highly structured development of beginning reading skills is required along with highly struc-
tured instruction in reading comprehension (Gersten & Carnine, 1986; Gersten, Fuchs, Williams,
& Baker, 2001). For many adolescent readers, word-level reading is “necessary but insufficient
to engender better academic performance” (Biancarosa & Snow, 2004). To successfully read to
learn, these students must be able to read with deep comprehension; that is, they must be able
to go beyond simple retell and proficiently apply more complex inferential and analytical skills
(Duke & Pearson, 2002; Pressley, 2000).
Kintsch’s (1998) model of comprehension differentiates between garnering text-based in-
formation through word-level reading and learning from text by actively constructing meaning
during reading and connecting new information with prior knowledge (Deshler & Hock, 2007;
Kintsch & Kintsch, 2005). While sufficient word-level skills may engender a surface understand-
ing of text, students who struggle to comprehend at a deeper level require explicit comprehension
and vocabulary instruction as part of an effective intervention program (Deshler & Hock, 2007;
Kamil, 2003; Kintsch & Kintsch, 2005).
Table 9.3 outlines the key findings from the National Reading Panel Report (NRP, 2000) on
effective comprehension practices. Good readers continually evaluate their understanding, depict
202 WEXLER, EDMONDS, AND VAUGHN

TABLE 9.3
Summary of National Reading Panel (2000) Report on Effective Comprehension Practices
• Teaching students to monitor their understanding while reading and procedures for adjusting reading practices when
difficulties understanding are detected.
• Using cooperative learning practices that provide interaction with peers about text understanding in the context of
reading.
• Providing graphic and semantic organizers that assist students in making connections from the story.
• Teaching students to use questioning practices through asking and answering their own questions about text,
interacting and obtaining feedback from students and teachers, and analyzing and responding to questions about text
types.
• Teaching students to write and summarize ideas from their reading.
• Teaching students to integrate and apply multiple comprehension strategies before, during, and after reading.

the relationships among ideas in text (e.g., organize content in a graphic), evaluate the connec-
tion between new and prior knowledge, and summarize what they read (Pressley, 2001; Pressley,
2005). Many older, struggling readers read fluently but do not comprehend what they read for a
variety of reasons, including problems: (a) relating content to prior knowledge, (b) monitoring
understanding, and (c) applying comprehension strategies (Biancarosa & Snow, 2004; Carlisle &
Rice, 2002; Kamil, 2003; RAND Reading Study Group, 2002).

Relating Content to Prior Knowledge

Prior knowledge plays a critical role in students’ ability to draw inferences and synthesize in-
formation from text, particularly texts that require students to have previous knowledge to make
connections among concepts. Research has provided evidence that activating relevant knowledge
prior to reading enhances understanding (e.g., Anderson, Spiro, & Anderson, 1978; Hansen &
Pearson, 1983). Struggling adolescent readers often lack the necessary background knowledge
that would allow them to infer information from text and connect new learning to prior knowl-
edge. Teaching students to make connections between prior knowledge and new information in
text differs from commonly used previewing activities that solicit guesses from students about
what they will learn with little guidance or opportunities for feedback.
In a study examining comprehension through previewing short stories with struggling junior
high students, Graves and colleagues (1983) reported that previewing significantly improved
recall of information read. The previews studied differed from the “brief previewing activities
typically used” by activating related knowledge through questioning and providing students with
considerable information needed to comprehend the text (Graves, Cooke, & Laberge, 1983).

Activities Related to Improving Connections between Content and Prior Knowledge

Teachers can improve connections between what students know and are learning in many ways
but some of these practices are exceedingly time consuming and can actually take away valuable
instructional time from other practices such as reading and discussing text. For this reason, teach-
ers benefit from efficient and effective previewing practices such as the following.

1. Preview the material by identifying key words or concepts from the text prior to reading
and discussing what students know and need to know about these key words.
2. Ask students to “put their heads together” with another student and to briefly discuss what
they know about the topic.
 9. TEACHING OLDER READERS WITH READING DIFFICULTIES 203

3. Ask students to look for key words and ideas in the passage (quickly, 2–3 minutes) and to
make links between what they are going to read and previous reading.

Applying Comprehension Strategies

Results of intervention research suggest that struggling readers benefit from explicit comprehen-
sion strategy instruction (Connor, Morrison, & Petrella, 2004; Gersten et al., 2001; Kamil, 2004;
Swanson, 1999). The positive effect of explicitly teaching students to learn and use cognitive
and metacognitive strategies continues to be replicated in studies of older readers (Guthrie et al.,
1998; Guthrie et al., 2004; Mason, 2004). Effective strategies include teaching students how to
answer and generate questions as a means of monitoring understanding, summarizing, and clari-
fying when a breakdown in comprehension occurs.

Questioning. Students who are taught to ask themselves and others questions about what
they read demonstrate improved reading comprehension. However, many teachers view asking
and answering questions about text as their responsibility and provide limited time for students to
learn to ask and answer questions. Many teachers consider questions as a means for determining
whether students truly understand and make connections with text. Smart questioning can
contribute to improving teachers’ knowledge of students’ reading comprehension and can also
extend understanding of text. However, many questions teachers ask can limit responses and
critical thinking.
Students with reading difficulties benefit from instruction that teaches them how to answer
and develop questions (Gall, 1984; Walsh & Sattes, 2005). Cue cards about how to ask and an-
swer questions can be useful:

1. Listen: Ask yourself, “What was the question?”

2. Say the answer to yourself.
3. Say the answer aloud, when called upon.
4. Listen to feedback from the teacher and answers of other students and integrate with your
answer.

Raphael (1986) identifies types of questions for students through Question-Answer Rela-
tionships (QARs) to teach students strategies to answer different question types. Students learn
to consider the type of information needed to answer different question types. Students can use
question types to determine how to answer questions from others (teacher) or to develop their
own questions.

1. Right There: Answers to these literal questions are right in the text.
2. Think and Search: Answers require students to integrate information from more than one
place in the text.
3. The Author and You: Answers require students to connect information from the text to
what they know or have previously learned.
4. On Your Own: Answers require students to connect critical information from what they
read with their own experience.

Teaching students to use questioning strategies can facilitate regulating understanding and
establishing relationships among ideas in text. Features of effective questioning strategies in-
clude using text structure to assist students in answering critical questions about the passage,
204 WEXLER, EDMONDS, AND VAUGHN

providing feedback, and structuring opportunities for students to ask and answer their own ques-
tions about the text.
This form of interactive questioning has been studied extensively by Beck and colleagues in
their work on Questioning the Author (Beck, McKeown, Hamilton, & Kucan, 1997; Beck, McK-
eown, Worthy, Sandora, & Kucan, 1996), an approach that uses questioning and discussion as a
means of engaging students in text rather than as a means for eliciting correct responses. Their
research indicates that students engaged in interactive reading instruction tend to see reading as
a process for learning new information rather than as a task or a particular activity format (e.g.,
reading with a partner) (Beck & McKeown, 2001; Pressley, 2001). However, because a discus-
sion that leads to students actively constructing meaning “needs direction, focus, and movement
toward a goal” (Beck & McKeown, 2001), teachers often find the approach difficult to imple-
ment. Supporting students’ engagement in active questioning is a rather complex teaching task
that requires considerable professional development and classroom-based support.

Monitoring Understanding. Metacognitive strategies include teaching students to

monitor their understanding and procedures for adjusting their reading when difficulties in
understanding arise. The efficacy of teaching students to monitor their comprehension has been
mainly studied with expository text, particularly in science and social studies (NRP, 2000). In a
synthesis of reading comprehension practices for students with learning disabilities, Gersten and
colleagues (2001) speculated that comprehension difficulties may be a result of a breakdown in
metacognition, not adequately monitoring understanding while reading or knowing what to do
when reading progress is breaking down (e.g., monitoring understanding and determining that
there is a problem with understanding). Students with learning difficulties typically are able to
recall less about what they have read and are challenged to identify the most critical information
in stories (Roth & Speckman, 1986). Interestingly, older students with reading difficulties may
have less knowledge about story structure than younger students without reading difficulties
(Cain, 1996). Table 9.4 provides examples of monitoring practices.

Summarization. Summarization strategies include teaching students to write important ideas

about what they’ve read (i.e., main ideas) and to synthesize these ideas after longer passages are
read. Summarization and main idea practices are typically measured on high-stakes tests and are
viewed as important indicators of reading comprehension.
Summarization requires students to generate multiple main ideas from across a reading and
to then combine them to form a summary. In addition, students must be able to generalize from
specific examples and be able to identify when information is repeated (NRP, 2000). Learning to
summarize is an effective strategy for improving comprehension for students with learning dif-
ficulties (Gajria & Salvia, 1992; Nelson, Smith & Dodd, 1992). Many summarization strategies
include rules that students learn to use to write summaries. Through modeling, feedback, and
many opportunities to practice, students are taught to use the following rules (NRP, 2000): (a)
delete trivial and redundant information, (b) use fewer key words to replace lengthy descriptions,
(c) identify topic sentences, and (d) provide a topic sentence when one is not in the text.
When we teach students strategies to summarize after reading, students learn to do the fol-
lowing:

• Distinguish between important information and details.

• Use key vocabulary or concepts.
• Synthesize information.
• Use their own words.
• Write only what is needed to present the main idea(s).
 9. TEACHING OLDER READERS WITH READING DIFFICULTIES 205

TABLE 9.4
Comprehension Strategies and How to Teach Them

Name of Strategy What Students Do How to Teach the Strategy

Predicting Students predict what they think a • Have students think about what they already
selection will be about or what they know about the topic.
will learn. During reading, they can • Teach students to read the title, skim the text, and
modify their predictions if they choose. look at headings before making their predictions.
After reading, they verify whether their • Ask students what information they used to come
predications were correct. up with their predictions.
• Have students modify their predictions as they
learn new information while reading.
• Teach students to check whether their predictions
were accurate after reading.
• Ask students to think about how helpful it is to
predict.
Questioning and Students answer questions about • Teach students to identify different types of
Answering the passage. The teacher may ask questions and the strategy for finding the answer
questions about the text at key points to each.
during and after reading. Or students • “Right there” — Find the answer in one place
may generate questions, either before in the book.
reading, about what they would like to • “Think and search” — Find the answer in more
learn, or after reading, about key points. than one place in the book.
Students identify the question-answer • “Author and me” — Find the answer in the
relationships (Raphael, 1986) and answer book and in your head.
the questions. • “On my own” — Answer the question using
what you already know about the topic.
• Teach students how to generate questions using
these same question types.
Visualizing Students construct mental images • Teach students to visualize the content in a
that represent text content. Extension: passage or to imagine what is happening.
Students construct graphic • For stories, have students visualize what is
representations to represent their mental happening at the beginning, middle, and end of
images. the story.
• For informational text, have students think
about key words and visualize the content they
are learning.
• Ask students to explain their images.
• Have students compare the picture in their minds
with what they are reading.
• Extension: Have students draw diagrams or
pictures to represent their visualizations.
Seeking During reading, students monitor their • Teach students to check their understanding while
clarifications understanding. When the text does not reading. At first, frequently ask students, “Does this
make sense, the student selects a strategy make sense?” Encourage students to do the same.
to help clarify the confusing text. • Teach students to select a strategy to use to fix
comprehension when breakdowns occur. These can
include:
• Ignore and read on.
• Guess, using clues from the context.
• Reread for clarification.
• Look back in the text for clues that can help.
• Ask students to explain why they selected the
strategy and whether it helped.
(continued)
206 WEXLER, EDMONDS, AND VAUGHN

TABLE 9.4
Continued
Name of Strategy What Students Do How to Teach the Strategy
Responding to Students make connections between the • Ask students to tell how the information from the
text based on prior text and their background knowledge and passage relates to their own lives.
knowledge personal experiences. • Ask students how the information might be
important to them and how it might help them.
• Encourage students to discuss their ideas with
one another. Ask how considering different points
of view can broaden their knowledge.
Summarizing After reading, students summarize • Teach students to differentiate between
the passage. For informational text, expository and narrative text.
they restate the most important ideas. • When retelling a story, have students describe
For narrative text, they retell the the setting, characters, problem, events (in
story. Extension: For expository text, order), and the solution.
students identify the text structure (e.g., • For expository text, have students restate the
compare and contrast, sequence) and main ideas in the passage.
use this structure as a way to organize • Extension: Teach students about different text
summaries. structures (see Chapter 4) and how to use these
as organizational structures for expository text
summaries.

Note: Used with permission from: Klingner, J. K., Vaughn, S., & Boardman, A. (2007). Teaching reading comprehension to students
with learning disabilities. New York: Guilford.

Learning how to state or write a main idea and then to combine a series of main ideas into a
summarization is challenging for most students but particularly for students with reading difficul-
ties (Simmons, Kame’enui, & Darch, 1988). Students who are provided systematic and explicit
instruction in how to identify the main idea also demonstrate improved outcomes in reading
comprehension (Graves, 1986; Jenkins, Heliotis, Stein, & Haynes., 1987; Jitendra, Cole, Hoppes,
& Wilson, 1998; Jitendra, Hoppes, & Xin, 2000; Wong & Jones, 1982).
In two studies of students with reading difficulties (Jenkins et al., 1987; Malone & Mastrop-
ieri, 1991), students’ passage retelling and recall was improved by systematically teaching them
to answer questions about what they read: (a) “Who is it about?” and (b) “What’s happening?”
Students with reading difficulties often benefit from strategies that involve ways to cue recall of
information visually (McCormick, 1999). Baumann (1984) combined summarization instruction
with visual representation with sixth-grade students, yielding improvement in students’ sum-
maries.
Jitendra and colleagues (2000) combined strategy and direct instruction to improve main
idea use for students with learning disabilities. Middle school students were taught to use a main
idea strategy in eight 30-minute lessons that taught students to: (a) name the subject and catego-
rize the action, (b) model applying the strategy within a text passage, (c) demonstrate the use of
a cue card, and (d) provide opportunities for guided and independent practice. Table 9.4 provides
descriptions of summarization practices.

Multiple-Strategy Interventions. Many of the reading comprehension strategies that

have been associated with the highest effect sizes for students with reading difficulties are those
that teach students to monitor and reflect before, during, and after reading. These strategies ask
students to consider their background knowledge on the topic, to summarize key ideas, and to
self-question while they read (e.g., Gersten et al., 2001; Jenkins, Heliotis, Stein, & Haynes, 1987;
Mastropieri, Scruggs, Bakken, & Whedon, 1996; Swanson, 1999; Wong & Jones, 1982).
 9. TEACHING OLDER READERS WITH READING DIFFICULTIES 207

Multiple-strategy interventions address the many processes involved in the implementation

of multiple strategies and the conditions that influence student performance on the related tasks.
This strand of research represents a move away from examining the application of strategies in a
technical manner to studying how the use of comprehension strategies facilitates interaction and
engagement with text (Guthrie et al., 2004; Pressley, 2001). Guthrie et al. (1998) found that strat-
egy instruction alone in the absence of opportunities to use strategies to build content and concept
knowledge is insufficient. Current applications and research on multiple strategy interventions
stress the process of actively gaining meaning from text over the rote application of a procedure
(Beck & McKeown, 2001; Carlisle & Rice, 2002; Guthrie et al., 2004).
Several studies with older, struggling readers have employed reciprocal teaching (Palincsar,
Brown, & Martin, 1987), a model that includes previewing, clarifying, generating questions,
and summarizing. Reciprocal teaching has been shown to be highly effective in improving com-
prehension (see for review, Rosenshine & Meister, 1994). Research on the effects of such ap-
proaches with middle and high school students has been initially studied. Mason (2004) taught
struggling readers an integrated self-regulation strategy throughout the reading of social studies
and science texts. Students in the self-regulated, multiple-strategy condition outperformed stu-
dents in the questioning condition on oral summarization tasks, but not on written comprehension
tasks. Alfassi (1998) reported moderate effects from implementing a multiple-strategy interven-
tion modeled after reciprocal teaching in a remedial high school setting, a context not typically
examined in previous studies of reciprocal teaching. Table 9.4 provides descriptions of multiple-
strategy intervention practices.

Research on Reading Comprehension Interventions with Older Students

with Reading Difficulties

From a recent synthesis of intervention studies (N = 29) conducted between 1994 and 2004 with
older students (grades 6–12) with reading difficulties, a meta-analysis was conducted on a subset
of treatment-comparison design studies to determine the overall effect of reading interventions
on students’ reading comprehension (Edmonds et al., in review). Thirteen studies met criteria for
a meta-analysis, yielding ES = .89 for the weighted average of the difference in comprehension
outcomes between treatment and comparison students. Studies were included because they had
similar contrasts and measures of reading comprehension and examined the effects of a reading
intervention with a comparison.

VOCABULARY

Insufficient reading vocabularies present another barrier to comprehension for students who are
otherwise fluent readers. While research has demonstrated the correlation between vocabulary size
and comprehension, the premise that vocabulary instruction leads to improved comprehension has
yet to be substantiated through a converging research base (Stanovich, 2000, as cited in Kamil,
2003; Kamil, 2004). However, a growing body of literature on effective vocabulary instruction
provides educators with research-supported practices for building students’ knowledge of word
meanings. Based on existing research, we can tentatively conclude that definitional (direct) and
contextual (incidental) learning of vocabulary is associated with improved reading achievement,
including comprehension. We also know that pre-teaching vocabulary words and repeated expo-
sure to new words have been found to have a positive effect on content area learning. Instruction in
content area vocabulary may lead to improved comprehension and content area achievement.
208 WEXLER, EDMONDS, AND VAUGHN

Additional research has supported the efficacy of directly teaching individual words (Bau-
mann, Kame’enui, & Ash, 2003; Blachowicz & Fisher, 2000). Cain, Oakhill, and Lemmon (2004)
demonstrated that students with poor comprehension skills benefited from direct instruction in
new words, however students with a double deficit of weak vocabularies and poor comprehension
skills had additional difficulties learning new words.
Some research has begun to explore the effects of fostering word consciousness (Graves &
Watts-Taffe, 2002; Nagy & Scott, 2000), but the relationship of this construct to improved com-
prehension is unclear. The area that has arguably received the most attention is the effect of mor-
phemic and contextual analysis on vocabulary acquisition. Although results show positive effects
on vocabulary, the link to improved comprehension is less convincing. Specifically, two studies
of vocabulary instruction in grade 5 social studies classrooms provided evidence that morphe-
mic and contextual analysis instruction, either in combination or alone, can improve students’
vocabulary growth but not necessarily their comprehension (Baumann et al., 2002; Baumann,
Edwards, Boland, Olejnik, & Kame’enui, 2003). Recent research has also provided additional
evidence to support incidental learning of words through units of instruction and reading in the
content areas (Carlisle, Fleming, & Gudbrandsen, 2000).

Vocabulary Instruction

Several key ideas can help to facilitate growth in vocabulary knowledge:

• Provide instruction in the meanings of words and in word-learning strategies.

• Use oral and written language to actively involve students in linking concepts and new
vocabulary.
• Provide many opportunities for students to read widely (a variety of texts).
• When defining words, use examples of what they mean and do not mean.
• Connect new words to words students already know.
• Use antonyms and synonyms to improve word meaning and to extend meaning.
• When possible, show pictures and provide examples.

IMPLICATIONS

It appears that interventions that focus on or include single-component comprehension strategies

can result in students becoming more proficient in applying learned strategies and learning taught
content, but these interventions often do not result in readers who use the strategies indepen-
dently and flexibly in novel contexts. While other critical factors are associated with improved
reading comprehension for older students with reading difficulties (e.g., motivation and use of
graphic organizers), discussion of all elements related to reading comprehension are beyond the
scope of this chapter.
Despite having comprehension and vocabulary deficiencies, many older, struggling readers
lack instructional opportunities designed to foster improved comprehension primarily because
teaching students how to read is not seen as a responsibility of middle and high school teach-
ers (Biancarosa & Snow, 2004; Kamil, 2003; RAND Reading Study Group, 2002). The RAND
Reading study group (2002) highlighted upper-grade teachers’ lack of preparation for teaching
the components of reading. Thus, if effective instruction for older students with reading difficul-
ties is likely to occur, additional professional development for teachers will be required.
 9. TEACHING OLDER READERS WITH READING DIFFICULTIES 209

Determining which conditions can improve comprehension, especially for expository read-
ing, has been established as a national research priority by both the National Reading Panel
(2000) and the RAND Reading Study Group (2002). Although much work remains, a foundation
for effective adolescent literacy instruction has been established.
The sources of reading difficulties for older students are multiple and varied, requiring tar-
geted and often multi-component interventions. While mastering each component discussed in
this chapter is important for reading success, placing too much emphasis on any one, while
neglecting others, will likely not address this population’s diverse needs. Crafting a targeted in-
tervention for older, struggling readers takes skillful teaching and access to resources such as this
chapter for guidance on effective practices. While there is still a need for additional research in
this area of literacy, there is a growing knowledge base educators can access to unlock the doors
through which older, struggling readers must pass to achieve reading success.

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 10
Written Language Instruction
during Early and
Middle Childhood
Virginia W. Berninger

This chapter is organized into four parts. Part 1 begins with a brief historical overview of the field
of writing instruction. Two themes are emphasized: the changing developmental focus and the
diverse perspectives on what counts as evidence. In this chapter, evidence will be discussed that
resulted from research using paradigms considered to be scientific by mainstream cognitive, edu-
cational, and developmental psychology and neuroscience. Part 2 describes the characteristics of
writing and of writers. The characteristics of writing are described in reference to the cognitive
processes involved, comparison of the simple and not-so simple views of writing, the relation-
ship of writing to reading, listening, and speaking, and stages of writing development. Charac-
teristics of writers are discussed in reference to whether they are typically developing, at-risk, or
learning disabled. Part 3 provides an overview of a programmatic line of research that evaluated
the effectiveness of specific kinds of writing instruction for writers that met researcher-defined
criteria: (a) early intervention for at-risk writers in the primary grades and at the critical third- to
fourth- grade transition, (b) supplementary instruction to increase the number of students passing
high stakes tests in writing, and (c) specialized instruction in writing for students with dyslexia
who struggle with writing as well as reading. Part 4 explores future directions, with focus on the
need for evidence about effective writing instruction for students with specific learning disabil-
ites, importance of generalizing results of research only to the population sampled in a research
study, and the limitations of meta-analyses in fully capturing effective writing instruction for
the complexities of the writing process, the normal variation among writers, and developmental
changes in writing.

PART 1: HISTORICAL PERSPECTIVES

Recent federal initiatives call for schools to use scientifically supported reading instruction
(SSRI), science based reading instruction (SBRI), or evidence-based reading instruction (EBRI)
and provide financial incentives if schools do. Curiously missing from these initiatives that focus
on reading is a similar focus on writing.

215
216 BERNINGER

Writing neglect may be due to the myth that children first learn to read during the elementary
years and then learn to write during the secondary years. Because of this widely held myth, most
research on writing instruction focused on grades 6 and above until the process writing move-
ment in the last two decades of the 20th century (Hillocks, 1986). Clay (1982), Graves (1983),
and Calkins (1986) brought to educators’ attention the importance of including writing activity
in the primary grades—not just penmanship and spelling but written expression of ideas for au-
thentic social communication. This “process writing” movement made a major contribution in
shifting the developmental focus of writing instruction from the upper grades to the beginning of
formal schooling.
Yet, “process writing” downplayed the role of formal pedagogy in teaching writing. Rather
the goal was to engage young children in the writing process in a way that is analogous to pro-
fessional writers at work. Children learned to use graphic organizers to plan, produce multiple
drafts, and revise their writing on the basis of peer feedback and teacher feedback. Peers offered
constructive suggestions for improving the writing during author’s chair. Teachers did not grade
the first product but rather provided ideas during writers’ workshop for improving the writing
and graded only the final product after many revisions. The social nature of writing was empha-
sized—not only do writers write for an audience, but also they perform social acts (Britton, 1978)
as they create authentic communications within a social community (Englert, 1992).
Although the process writing movement exerted great influence on instructional practices
in writing, it is not an evidence-based approach to writing instruction. It is an approach based
on teacher philosophy and belief. According to Applebee (2000), 51% of teachers in a national
survey report using process writing instruction; if so, then surely this instructional practice dur-
ing early childhood and middle childhood warrants experimental evaluation of its effectiveness,
but this evaluation has not been done. However, many of the innovations introduced by process
writing teachers were incorporated by researchers who gathered evidence on the effectiveness of
specific instructional practices in writing (e.g., Englert, Raphael, Anderson, Anthony, & Stevens,
1991; Graham & Harris, 2005; Traweek and Berninger, 1997; Wong, Butler, Ficzere, & Kuperis,
1996, 1997; also studies in Table 10.1).
Another factor stimulating research on early writing was the emergence of research oriented
to preventing learning disabilities rather than treating chronic learning disabilities (e.g., Ber-
ninger & Whitaker, 1993). Early intervention for students at-risk for handwriting and spelling
difficulties prevents more serious writing disabilities later in schooling (e.g., Berninger & Amt-
mann, 2003). Beginning writers can also benefit from composing practice and explicit composi-
tion instruction (Englert et al., 1991; studies in Table 10.1).
Although research on writing instruction during the elementary school years was sparse
throughout the 20th century, spelling during the elementary grades was the focus of earliest ap-
plication of the scientific method to evaluate effective instructional methods. Rice (1913) evalu-
ated the optimal instructional time based on student response to spelling instruction in a large
scale study including samples throughout the United States. She found that children who re-
ceived 15 minutes of spelling instruction a week achieved significantly higher spelling test scores
than those who were drilled for an hour or more a week. This finding may be counter-intuitive to
many who assume that more is necessarily better—but not if students habituate due to monotony
and do not benefit from the instruction. During the middle of the 20th century educational psy-
chologists published many studies supporting the value of distributed instruction—short lessons
distributed over time—rather than massed practice—intensive instruction over a relatively short
period of time. Experimental research that tests hypotheses by gathering data (evidence) that may
confirm or disconfirm a working hypothesis is important because evidence does not always sup-
port teacher philosophy or belief or the researcher’s hypotheses.
 10. WRITTEN LANGUAGE DURING EARLY AND MIDDLE CHILDHOOD 217

Important advances in writing since that pioneering study of effective spelling instruction
during early childhood and middle childhood are best understood in reference to what writing
is and what the characteristics of the writers are in a particular research study. Characteristics of
writing and writers are considered next.

PART 2: CHARACTERISTICS OF WRITING AND WRITERS

Writing

Cognitive Processes. Hayes and Flower (1980) asked college students who were
skilled writers to think aloud while composing. Three cognitive processes were identified in
the protocols—planning, translating, and revising. These three processes did not fully explain
the writing of children during early and middle childhood (Berninger & Swanson, 1994). For
one thing, research showed that translation of beginning writers consisted of two independent
components—text generation (translating ideas into language in the mind) and transcription
(translating mental language representations in the mind into written symbols in the external
environment; Berninger, Yates, Cartwright, Rutberg, Remy, & Abbott, 1992). Also working
memory (Swanson & Berninger, 1996a) as well as short-term and long-term memory contributed
to the writing of children. Furthermore, children showed intraindividual differences in levels
of text generation—at the word, sentence, and text levels (Whitaker, Berninger, Johnston, &
Swanson, 1994). In addition, children showed evidence of two kinds of planning—planning in
advance and planning on line—and two kinds of revising—on-line and post-translating—each
of which has its own developmental trajectory (Berninger & Swanson, 1994). Like good writers,
both Hayes (1996, 2000) and the University of Washington research team (e.g., Berninger &
Winn, 2006) have revised their models of writing for adults and children, respectively, as new
studies with new evidence became available.

Simple and Not So Simple Views of Reading and Writing. Gough and Hillinger
(1980) proposed a simple view of reading that involved only word reading and listening
comprehension. Evidence from the programmatic research at the University of Washington
over the last decade indicates that this simple model is probably an oversimplification of the
developmental stepping stones in learning to read. For example, in the beginning stages, reader
profiles show interindividual and intraindividual differences (relative strengths and weaknesses)
in the following skills some of which are directly linked to each other and some of which are
not: (a) orthographic and phonological awareness, (b) knowledge of the alphabetic principle
(phonemes that correspond to graphemes [1- or 2-letter spelling units]), (c) application of
alphabetic principle to decoding unknown words, (d) automatic recognition of single words,
(e) oral reading accuracy for single words and text, (f) oral reading fluency (speed and smooth
coordination) for text, and (g) reading comprehension at the word vocabulary, sentence, and
discourse levels (e.g., Berninger, Abbott, Vermeulen, & Fulton, 2006).
Likewise, Berninger et al. (2002) initially proposed a simple view of writing in which tran-
scription skills and executive functions at the base of the writing triangle support the text genera-
tion process. However, based on accumulating research evidence, Berninger and Winn (2006)
revised this model and called it the not-so-simple view of writing. In the revised model, the
text generation process, which is supported by transcription and executive functions, occurs in a
working memory environment through which ideas flow in the cognitively engaged writer (see
Kellogg, 1994). The working memory system, which has links to incoming information from
218 BERNINGER

the external environment through short-term memory and to existing knowledge stored in long-
term memory, consists of a three word-form storage system (phonological, morphological, and
orthographic), a time-sensitive phonological loop, and a set of executive functions (Berninger,
Abbott, & Thomson, et al., 2006). These executive functions, which account for much of the
not-so-simple view of writing, regulate the writing process and include, but are not restricted
to (a) selecting, maintaining, and switching focus (supervisory attention); (b) managing levels
of consciousness (awareness, presence, and engagement); (c) setting goals; (d) generating ideas
and plans; (e) self-monitoring and updating (reviewing); (f) repairing (revising); (g) reflecting;
and (h) adapting to the audience. It is this last executive function that underlies knowledge trans-
forming that distinguishes the expert writers from the knowledge tellers who are novice writers
(Scaradamalia & Bereiter, 1983).

Levels of Language. Writing draws upon at least three separable skills that represent
different levels or units of language: handwriting (letter formation) or keyboarding (letter
selection), spelling (word formation), and composition (text formation) (Abbott & Berninger,
2003). Although they are separable at one level of analysis, at another level they function together
in a system. When the various cognitive processes and levels of language are coordinated in real
time in goal-driven working memory, the writing system is functional. Temporal coordination
is as essential to working memory as is capacity limitations related to resources or workspace
(Berninger, 1999).

Connections between Writing and Reading, Listening, and Speaking. Writing is

language by hand. It is one of four functional language systems that develop because language
has no end organs of its own and teams up with sensory and motor systems to receive and transmit
information to the environment (Liberman, 1999). The other language systems are language by
ear (listening), language by mouth (speaking), and language by eye (reading). These systems
have their own developmental trajectories, beginning during infancy and the preschool years
and continuing through the adult years, but also interact with one another throughout the life
span (Berninger, 2000a; Berninger & Richards, 2002; Berninger, Abbott, & Thomson, et al.,
2006). For example, children’s first written productions are often letter-like stimuli in imitation
of letter symbols they have seen in books read to them; and their first spellings reflect their
early understandings of how the spelling system represents speech (Traweek & Berninger, 1997).
Later in schooling they learn to write narrative structures based on stories they have listened to
and books they have read. Oral discussion during the brain storming phase of writing develops
planning skills for writing expository text, and oral feedback during author’s chair and teacher’s
workshops develops revising skills.

Stages of Writing Development. Writing, like other human behaviors, develops not in
discrete, insular stages but rather in discontinuous phases that sometimes show forward, upward
change, but sometimes show receding regression, and sometimes flatline for a period of time.
Yet patterns emerge from this developmental change that can be described, are reasonably
predictable, and have instructional implications: the early emergent writing phase in preschool
and kindergarten; the early conventional phase in the primary grades; the developing phase during
upper elementary and middle school years; and the maturing phase during high school and college
and beyond. See Berninger, Abbott, & Thomson, et al. (2006, Figures 1, 2, and 3) for stepping
stones in writing development for transcription and composition; Berninger, Fuller, and Whitaker
(1997) for Fuller’s dissertation research on the development of the compositional algorithms for
writing the next relevant sentence during the school years and Whitaker’s dissertation research
 10. WRITTEN LANGUAGE DURING EARLY AND MIDDLE CHILDHOOD 219

on the process of learning to write profession-specific genre in adult writers; Wong (1997) for the
development of discourse genre in school-age years; Wong and Berninger (2004) for instructional
approaches for each of the developmental phases; and Berninger and Richards (2002, chapters 6
and 9) for the relationship between brain development and writing development.

Writers

Typically Developing Writers. Variation in spelling (and reading) skill development

is normal when children enter first grade (Berninger, 1986). Some of this normal variation is
due to biological differences (genetic and neurological), some of it is due to cultural and home
differences, and some of it is due to differences in prior engagement in literacy activities in home
or preschool. Reading and writing skills, like other human abilities such as athletic, artistic,
musical, etc., distribute along a normal curve; only a few individuals fall outside the normal
range that is characterized by variation, that is, individual differences. Beginning writers show
normal variation in their handwriting, spelling, and composition skills and relative strengths in
their profiles across each of these three writing skills and related processes (Berninger, Abbott,
& Thomson, et al., 2006). Only recently have researchers begun to investigate the most effective
match between these patterns of normal variation and instructional approaches for written
language (e.g., Connor, Morrison, & Katch, 2004). See Wong (1989) for conceptual and practical
considerations in dealing with individual differences among writers in the general education
classroom.
Gender differences, favoring girls over boys, occur in typically developing writers, but are
related to automatic recall and writing of letters in alphabetic order rather than to motor skills per
se (Berninger & Fuller, 1992). Controlling for individual differences in automatic production of
alphabet letters from memory eliminated gender differences, favoring girls over boys, in quality
of writing in junior high writers in grades 7 to 9 (Berninger, Whitaker, Feng, Swanson, & Abbott,
1996).
The best predictors of handwriting skills of typically developing writers in the elementary
grades (Berninger et al., 1992) are (a) orthographic coding of written words into memory and an-
alyzing the letter patterns in them (Berninger, Yates, & Lester, 1991; Abbott & Berninger, 1993),
and (b) planning sequential finger movements (e.g., Berninger & Rutberg, 1992). The best pre-
dictor of composition length and quality of typically developing writers in the elementary grades
(Graham, Berninger, Abbott, Abbott, & Whitaker, 1997; Jones, 2004), middle and high school
(Jones, 2004), and college (Connelly, Campbell, MacLean, & Barnes, 2006) and of note taking in
lectures in college (Peverley, 2006) is automatic letter writing. Good writers tend to use a mix of
manuscript and cursive and to increase handwriting speed as they progress across grade levels 1
to 9 (Graham, Berninger, & Weintraub, 1998; Graham, Berninger, Weintraub, & Schafer, 1997).
Typically developing writers in grades 1 to 9 tend to reverse j and z, low frequency letters, rather
than b, d, p, q, and g (Graham, Weintraub, & Berninger, 2001). Students with dyslexia reverse
these letters as well as b, d, p, and q (Brooks, 2003). Working memory, verbal reasoning, and
language skills such as vocabulary knowledge, syntax construction, and discourse organization
also contribute to compositional quality (e.g., Berninger, Cartwright, Yates, Swanson, & Abbott,
1994). The best predictors of spelling of typically developing writers are (a) orthographic coding
(holding written words in memory while analyzing all the letters in the word or letter segments
called graphemes), (b) phonological coding (holding spoken words into memory while analyzing
the sound segments called phonemes that correspond to graphemes), and (c) vocabulary (verbal
intelligence) (Berninger et al., 1992, 1994). Reading ability of typically developing writers does
not fully explain their writing ability (Swanson & Berninger, 1996b).
220 BERNINGER

At-Risk Writers. Gough and Hillinger (1980) also proposed that reading was an unnatural
act compared to talking, which is a natural act. This claim does not mesh with the fact that many
preschoolers require individual speech and language therapy from highly trained specialists to
learn to talk intelligibly, grammatically, and fluently. Nor does this claim fit with the findings
of Connor et al. (2004) who documented that some students, who enter school with more
advanced literacy skills, learn written language as naturally as they learned oral language and
benefit from self-directed, engagement in literacy activities rather than teacher-led instruction
in decoding. Likewise, some beginning writers appear to learn to write naturally by engaging in
the writing process, but others require explicit, systematic, and sustained instruction in writing.
School practitioners can turn to the research literature on individual differences in writing to
screen children early in schooling to determine which students are most likely to benefit from
which approach to writing instruction: (a) engagement in the writing process because their
writing skills are already grade-appropriate, or (b) explicit, systematic, and sustained writing
instruction because their writing skills and related processes are not yet grade-appropriate. Most
students will probably benefit from both approaches to some extent—but the relative mix that
optimizes their writing achievement may vary. However, many students may not make adequate
progress in writing without the explicit, systematic, and sustained instruction tailored to their
individual profiles of writing, reading, listening, and speaking abilities. Gifted students may
have transcription problems that mask superb oral text generation (Yates, Berninger, & Abbott,
1994). Skills to target in early intervention for all at-risk writers include (a) handwriting (forming
letters automatically and retrieving them quickly from memory), and (b) conventional spelling
(phoneme awareness and syllable awareness; teaching alphabetic principle in phoneme-to-
grapheme direction; the six syllable types in English spelling) (Berninger & Amtmann, 2003).

Third-to-Fourth Grade Transition. Students who learn to read relatively easily and can
meet the writing requirements in the primary grade classroom, first surface as having writing
difficulties at the transition from the primary to intermediate grades. One reason for these later
emerging writing disabilities is that the writing requirements in some primary grade classrooms
(e.g., the 49% who do not teach process writing) are minimal—for example, filling in blanks in
independent work sheets, writing spelling words from dictation, and completing handwriting
assignments that require copying letters legibly. Even in those classrooms including some
process writing activities, writing products are often not graded on the basis of the conventions of
writing, which become increasingly important in the grading of writing in the upper grades and in
high-stakes writing assessment. Building-wide screenings, based on research-supported, grade-
appropriate measures for identifying at-risk writers, should be conducted not only in the early
grades (1 to 2) but also during this important third to fourth grade transition when intervention
may be needed that is geared to (a) integrating low-level transcription and high-level composition
skills (Berninger, Abbott, Whitaker, Sylvester, & Nolen, 1995), writing text of varied genre
(Berninger et al., 2002), and integrating reading and writing (Altemeier, Jones, & Berninger,
2006). Altemeier and colleagues showed that individual differences in the executive functions of
writers play an important role in integrating reading and writing to complete written assignments
during this transition in the middle of the elementary grades. Hooper, Swartz, Wakely, de Kruif,
and Montgomery (2002) showed that executive functions contribute to difficulties in written
expression of fourth- and fifth- students.

Older, Struggling Writers. If earlier problems in transcription and executive functions

are not treated effectively, they pose ongoing challenges as students are confronted with ever
more complex writing assignments that require increasingly longer stretches of time to complete.
 10. WRITTEN LANGUAGE DURING EARLY AND MIDDLE CHILDHOOD 221

For example, middle school teachers request help with teaching grade-appropriate composing
to students whose transcription skills are well below grade level (Troika & Maddox, 2004). In
middle school and high school, individual differences in time management become critically
important as students are expected to complete such complex, long-term writing assignments
(for instructional approaches for dealing with this challenge, see Wong & Berninger, 2004).
Another challenge for older students and their teachers is learning to integrate technology and
writing instruction. Wong and colleagues developed teacher-friendly, research-based models for
integrating process writing, teacher and peer feedback (Wong, Butler, Ficzere, Kuperis, & Corden,
1994; Wong, Wong, Darlington, & Jones, 1991), explicit and systematic writing instruction,
goal-setting, computer technology, and general education curriculum and long-term writing
assignments in school settings for students who struggle in writing for a variety of reasons,
including English language learning, learning disabilities, and socioeconomic differences (Wong
et al., 1996, 1997). Such comprehensive instructional models are an excellent match with the
characteristics of preadolescent and adolescent writers.

Students with Dyslexia. One of the unexpected findings of the decade-long family
genetics study of dyslexia at the University of Washington was that dyslexia is not only a reading
disorder but also a writing disorder (Berninger, Abbott, & Thomson, et al., 2006; Berninger,
Nielsen, et al., 2007a). After the children with dyslexia learned to decode and read words
reasonably well, they invariably had ongoing spelling problems; whether the spelling problems
resolved or persisted was a matter of not only instructional programs but also gender differences.
Boys with dyslexia were more likely to be impaired in all writing skills than girls with dyslexia,
and mothers who still showed markers of dyslexia (rate of real word or pseudoword reading) were
more likely to compensate in spelling than fathers with those same dyslexia markers. The genetic
pathway to spelling problems in dyslexia was pinpointed to phonological memory as assessed by
repeating aurally presented pseudowords without meaning clues (Wijsman et al., 2000). Children
with dyslexia varied as to whether they also had handwriting automaticity problems.

PART 3: EFFECTIVE TREATMENT

Design Experiments and Randomized Controlled Studies

Initially, the University of Washington research team conducted design experiments (Brown,
1992) to evaluate effectiveness of instructional protocols that provided explicit writing or read-
ing-writing instruction to bring about desired writing outcomes (e.g., Abbott, Reed, Abbott, &
Berninger, 1997). Abbott et al. found that at-risk second graders responded more quickly to ex-
plicit instruction in integrated reading-writing in their reading, handwriting, and composing than
spelling skills. Brooks, Vaughan, and Berninger (1999) found that fourth to sixth graders with
dyslexia responded more quickly to explicit instruction in handwriting, spelling, and composition
in their handwriting and composing than spelling skills and that response to spelling instruction
depended on initial reading achievement level. Spelling did not respond to treatment until it was
taught in the direction of spoken word-to-written word, instead of using written word strategies
exclusively, in the at-risk writers and students with dyslexia. These phonological strategies in-
cluded counting syllables and phonemes in spoken words and classifying syllables according to
syllable type in English (see Berninger et al., 2000).
Subsequently, large-scale, randomized controlled studies in school settings were conduct-
ed for students at risk in specific writing skills (e.g., handwriting, spelling, or compositional
222 BERNINGER

fluency). Specific theory-driven treatments were compared to each other and to a contact control
treatment. In addition, randomized, controlled instructional studies were also conducted at the
university for students with persisting learning disabilities.
Table 10.1 summarizes some of these studies for students who were at-risk for writing on
specific writing skills (first six studies) or had a specific learning disability (e.g., dyslexia with
persisting writing problems, last study). Collectively, these studies illustrate research supported
developmental principles in planning and implementing evidence-based instruction in writing, as
is discussed next. Most of these studies organized the lessons to overcome temporal limitations in
working memory by combining within the same lesson close in time instructional activities at the
subword level (initially), followed by word level (to promote transfer of subword skills to word
context), and culminating in text level (to promote transfer of word-level skills to text context).
All treatments taught strategies for self-regulating the writing process during independent com-
posing. To avoid habituation, instructional activities lasted 10 minutes or less; to capitalize on
distributive learning, lessons were spaced in time across four months on average and took place
twice a week in 20- to 30- minute sessions in groups of three or two students (first four studies in
Table 10.1). The fifth and seventh were conducted during the summer and the sixth lasted about
seven months. Each published, peer reviewed study was translated into lesson plans teachers can
use (Berninger & Abbott, 2003).

Early Intervention for At-Risk Primary Grade Writers

Handwriting and Composing. Whole classrooms were screened to find the children
lowest in writing letters legibly and automatically. Five instructional methods were compared
to each other and to a contact control (phonological awareness training): copying letters from
models with no cues; imitating the teacher’s modeling of motor movements in making letters;
copying letters from models with numbered arrow cues showing component strokes and their
order; writing letters from memory; and combined numbered arrow cues and writing letters from
memory. All treatment groups had an opportunity to compose for 5 minutes and share their
compositions with peers, that is, to engage in the writing process. The combined numbered arrow
cues + writing from memory treatment was the front runner for improving automatic legible letter
writing and for transfer to compositional fluency (timed composing) (Berninger et al., 1997); see
first study in Table 10.1. That treatment was also more effective than the phonological control
treatment in reducing letter reversals as demonstrated by Brooks in her dissertation research (see
Berninger et al., 2006). Graham, Harris, and Fink (2000) and Jones and Cristensen (1999) also
showed that early intervention in handwriting is effective and leads to improved composing.
Rutberg’ s dissertation research (Berninger, 2006, study 1) showed that motor control training
and orthographic coding training, when coupled with direct instruction in letter writing improved
legibility of writing in at-risk handwriters, but that direct instruction in letter writing including
numbered arrow cues and writing letters from memory improved automaticity of legible letter
writing.

Spelling and Composing. Whole classrooms were screened to find second-grade

children who were the lowest in spelling words from dictation. Eight methods that varied
strategy for making connections between units of written words and units of spoken words were
compared to each other and to a phonological contact control treatment: connections between
phonemes and graphemes in alphabetic principle, connections between onset-rimes in spoken
and written words, connections between naming the spoken word and naming all the letters in a
written word, each of three combinations of two of these connections, and the combination of all
 10. WRITTEN LANGUAGE DURING EARLY AND MIDDLE CHILDHOOD 223

TABLE 10.1
Research-Supported Integrated Writing Instruction Organized Developmentallya

Writing Domain and Grade Skills Taught

Handwriting and Composing Practicing each alphabet letter once by studying numbered arrow cues; covering
(grade 1)b letter and holding it in mind’s eye, and writing letter from memory after
Lesson Set 3a increasing delays in time; transfer of automatic letter writing by word writing
(3 words), and composing for 5 minutes about composition topics provided as
prompts. Compositions are shared by reading them to peers.
Spelling and Composing Alphabetic principle in isolation (phonemes to letters ); transfer of alphabetic
(grade 2)c principle to spelling monosyllabic real words; transfer of alphabetic principle to
Lesson Set 4a spelling real words during composing when given prompts and high frequency
words to include.
Spelling and Composing Alphabetic principle in isolation (phonemes to letters ); transfer of alphabetic
(grade 3)d principle to spelling polysyllabic real words and spelling dictated sentences;
Lesson Set 5a transfer of alphabetic principle to spelling real words during composing when
given phrase prompts.
Spelling and Composing Word sorts for substitutions (alternative spellings for the same phoneme);
(grade 3)e transfer to spelling structure and content words; explicit modeling of planning,
Lesson Set 7a translating, and reviewing/revising processes in composing informational and
persuasive essays.
Writers’ Workshops Automatic handwriting warm-ups; spelling strategies; explicit modeling and
transcription + composition scaffolding of planning, translating, and reviewing/revising for narrative and
(beginning grade 4 and above)f expository genre.
Lesson Set 8a
Writers’ Clubs to meet writing Humor and play with language (riddles and jokes; morphological searches; bingo
standards (grade 4)g for structure words); automatic handwriting, spelling strategies, essay writing,
Lesson Set 10a and newspaper writing
Writing in Content Areas Humor and play with language (riddles and jokes), alphabetic principle and
(grades 4-8)h Lesson Sets decoding, reading fluency, reading in content area, and integrating talking and
13–-14a writing with reading comprehension activities

Note: aRefers to Lesson Set in Berninger, V., & Abbott, S. (2003). PAL Research-supported reading and writing lessons. San Antonio,
TX: Harcourt.
b
Berninger, V., Vaughan, K., Abbott, R., Abbott, S., Brooks, A., Rogan, L., Reed, E., & Graham, S. (1997). Treatment of handwriting
fluency problems in beginning writing: Transfer from handwriting to composition. Journal of Educational Psychology, 89, 652–666.
c
Berninger, V., Vaughan, K., Abbott, R., Brooks, A., Abbott, S., Reed, E., Rogan, L., & Graham, S. (1998). Early intervention for spelling
problems: Teaching spelling units of varying size within a multiple connections framework. Journal of Educational Psychology, 90,
587–605.
d
Berninger, V., Vaughan, K., Abbott, R., Brooks, A., Begay, K., Curtin, G., Byrd, K., & Graham, S. (2000). Language-based spelling
instruction: Teaching children to make multiple connections between spoken and written words. Learning Disability Quarterly, 23,
117–135.
e
Berninger, V., Vaughan, K., Abbott, R., Begay, K., Byrd, K., Curtin, G., Minnich, J. , & Graham, S. (2002). Teaching spelling and
composition alone and together: Implications for the simple view of writing. Journal of Educational Psychology, 94, 291–304.
f
Berninger, V., Abbott, R., Whitaker, D., Sylvester, L., & Nolen, S. (1995). Integrating low-level skills and high-level skills in treatment
protocols for writing disabilities. Learning Disability Quarterly, 18, 293–309.
g
Berninger, V., Rutberg, J., Abbott, R., Garcia, N., Anderson-Youngstrom, M., Brooks, A., & Fulton, C. (2006). Tier 1 and Tier 2 early
intervention for handwriting and composing. Journal of School Psychology, 44, 3–30. Study 4.
h
Berninger, V., Abbott, R., Abbott, S., Graham, S., & Richards, T. (2002). Writing and reading: Connections between language by hand
and language by eye. Journal of Learning Disabilities, 35, 39–56. Study 3.

three connections. Each of the treatment groups was shown how to apply the taught strategy to
spelling monosyllabic words. All treatments composed for 5 minutes and read their compositions
to peers, that is, they engaged in the writing process. Results showed that (a) both the onset-
rime and the whole word treatments were the most effective in achieving transfer across word
contexts from taught to untaught words; and (b) the phoneme-to-grapheme strategy was the most
224 BERNINGER

effective in generating correctly spelled words during composing in the pretest, midtest, and
posttest (Berninger et al., 1998). However, rapid automatic naming (RAN) predicted the three
classes of responders (initially slow and slow growth; initially slow and fast growth; initially fast
but slow growth) during the 24 lessons over four months in producing correctly spelled words
during independent composing in writing lessons (Amtman, Abbott, & Berninger, in press).
Collectively, these results for the second study in Table 10.1 point to the effectiveness of teaching
students multiple spelling strategies for making connections between spoken and printed words
and also screening those at-risk for spelling for the RAN deficit that may impede transfer of
spelling knowledge to independent composing.
The evidence for multiple strategies (Berninger et al., 1998) replicated the earlier dissertation
research of Hart (Hart, Berninger, & Abbott,1997) showing that learning phonological decod-
ing benefited from multiple strategies including phoneme-grapheme relationships but also other
connections between units of written and spoken words. Graham, Harris, and Fink-Chorzempa
(2002) also showed that early intervention in spelling is effective and leads to improved compos-
ing and other literacy skills.
Another study screened whole classrooms for third graders low in spelling (third study in
Table 10.1) and evaluated the relative effectiveness of adding phonological awareness training
for syllables and syllable types in English to the kind of spelling instruction in the second study
in Table 10.1. Some evidence for the added advantage of the phonological awareness training
for syllables was found for learning to spell polysyllabic words. Daily sentence dictation was
also found to be effective for word-specific spelling; but short-term mastery required 24 repeated
dictations in different sentence contexts (see Berninger et al., 2000).
Yet another study screened whole classrooms to find the lowest spellers in third grade (fourth
study in Table 10.1). One treatment taught alphabetic principle with an emphasis on the alterna-
tions (alternative graphemes for spelling the same phoneme in English) and transfer to spelling
structure words (prepositions, conjunctions, pronouns, and articles) that have no meaning of
their own but “glue” together other words to create meaningful sentences and to spelling content
words (nouns, verbs, adjectives, and adverbs). One treatment taught planning, translating, and
reviewing/revising strategies explicitly for writing informational and persuasive essays; that is,
students not only engaged in the writing process but also they received explicit instruction in each
of the cognitive processes for different genres. One treatment received both spelling and compos-
ing instruction equated for instructional time. The contact control received only a phonological
and orthographic awareness control treatment. Results showed that the spelling instruction was
effective in improving the spelling of the structure words, to which alphabetic principle cannot al-
ways be applied to each letter in the word, and of the content words, to which alphabetic principle
can usually be applied to each letter in the word. Also, the students who received composition
instruction, whether or not it was combined with spelling instruction, improved in composition
(see Berninger et al., 2002).

The Third to Fourth Grade Writing Transition

The fifth study in Table 10.1 screened for the lowest writers at the end of the school year in all
third grades in two school systems and invited them to the university for a summer program in
the form of a three-week writers’ workshop that offered a daily one-hour individual tutorial. All
children received explicit instruction in planning, writing, reviewing, and revising (PWRR strat-
egy) in which the tutors, who were supervised by the author behind a one-way mirror, modeled
each of the processes before the children engaged in each of the processes as they composed.
In addition, the tutor scaffolded the writing process (provided teacher guidance) as the children
 10. WRITTEN LANGUAGE DURING EARLY AND MIDDLE CHILDHOOD 225

planned, wrote, and reviewed and revised their daily compositions. Children chose their favorite
composition to publish in a book with all students’ contributions at the end of the writers’ work-
shop. Half the children were randomly assigned to extra orthographic coding training (Looking
Games that encourage careful attention to and memory for letter patterns in written words; and
the Before and After game for writing letters that come before and after others in the alphabet).
Half were assigned to extra practice in composition. All participating children showed faster
growth in handwriting automaticity and composing than the untreated controls, who were only
tested at the same pretest, midtest, and posttest occasion. Only the lowest spellers showed spell-
ing improvement. Gains in handwriting, spelling, and composing were maintained at follow-up.
The children who received extra orthographic coding training improved more in spelling. The
children who received more practice in composing improved more in handwriting on a copy task
(see Berninger et al., 1995).
Strategy instruction has been shown effective in developing executive self-regulation of the
writing process (e.g., Graham & Harris, 2005; Troia, & Graham, 2002; Troia, Graham, & Harris,
1999; Wong, 1994, 1998, 2000, 2001). Metacognitive training (planning, translating, and reflect-
ing) improved spelling (Hooper, Wakely, de Kruif, & Schwartz, 2006). Chenault’s dissertation
research showed that students who received attention training rather than reading fluency training
prior to composition training improved significantly more in composing once explicit composi-
tion instruction (planning translating, and revising) was introduced (Chenault, Thomson, Abbott,
& Berninger, 2006).

Meeting Writing Standards and Passing High Stakes Tests

The sixth study in Table 10.1 used an extended school day model to offer writing clubs before or
after school to help students prepare for the states’ high stakes test in writing. All third graders
in a school district were given a screening measure designed by the same testing company that
developed the writing test for the state. Those who fell in the at-risk range as defined by the state
were invited to participate in the study. Half of the schools were randomly assigned to the club
treatment and half to an untreated control group that received only the regular program and were
tested at the same time as the club children. The clubs met twice a week for an hour before or
after school for most of the school year beginning before the winter holidays. The treatment was
designed to be a like a real club with a healthy dose of Writers’ Play (e.g., morphological aware-
ness games called Mommy Longwords with rewards given by “Dr.-Mrs. Seuss-Goose”; jokes,
puns, riddles; and bingo words for structure words) and writing for authentic purposes (published
a newspaper Kids Writing for Kids that was disseminated periodically throughout the schools).
Other instructional activities validated in the first, second, third, fourth, and fifth studies in Table
10.1 served as Writers’ Work in the clubs. Results showed that more students in the clubs met
state standards in writing and improved on a standardized measure of writing fluency than stu-
dents in the control group. (Berninger, Rutberg, et al., 2006, Study 4).

Specialized Writing Instruction for Students with Dyslexia

Effective Instructional Treatments for Students. Two writers’ workshops have also
been held at the university for students with dyslexia in grades 4 to 9 (summer 2002, Mark
Twain Writers’ Workshop, Berninger & Hidi, 2006; Berninger, Nunn, et al., 2007, Study 1)
and in grades 4 to 6 (summer 2004, John Muir Science Writing Workshop, Berninger et al., in
press, Study 2). Results of the first study showed that two orthographic strategies—photographic
leprechaun and proofreaders’ trick— along with games such as anagrams were more effective
226 BERNINGER

than morphological strategies—word building and word dissecting—along with morphological

spelling rules in improving the spelling of real words at a behavioral level and normalizing brain
activation (Richards et al., 2005, 2006). Both orthographic strategies required students to hold
the written word in their mind’s eye with their eyes closed. For the photographic leprechaun, the
teacher asked students to name one or more letters in a word-specific position in polysyllabic words
that could not be recovered solely on the basis of sound (e.g., the third letter and the seventh and
eighth letters in elevator). For the proofreaders’ trick, students spelled words forwards and then
backwards. Results of the second study showed that phonological treatment improved pseudoword
spelling (and pseudoword reading and oral repetition of aural pseudowords). Comparing the two
studies at the behavioral and brain levels of analyses showed that real word spelling improved
only if orthographic and morphological treatment were added to phonological treatment (e.g.,
Berninger, Winn, et al., 2007), consistent with triple word form theory (Berninger, Abbott, &
Thomson, et al., 2006).

Sustaining Intervention by Educating Teachers about Specialized Instruction for

Students with Dyslexia. Federal initiatives for reading improvement assume that teachers
who were not trained to be critical consumers of educational research can implement research-
informed practices without substantial training in the nature and findings of scientific research
related to learning written language (and other areas of the curriculum) at the pre-service level.
These initiatives also assume that the link between research findings in controlled settings
generalize neatly and simply to real world school settings, which is unlikely given the normal
variation in learners and complexity of school learning environments.
Teacher training workshops have been conducted for the teachers who will work with the
students with dyslexia who attended the summer programs. The goal is to sustain the intervention
by increasing teacher knowledge of specialized instruction for dyslexia. The good news is that
at pretest most teachers showed some degree of knowledge of phonological awareness. The bad
news was that they showed virtually no knowledge of morphological awareness, which is related
to literacy skills in at-risk writers in fourth grade (Nagy, Berninger, Abbott, Vaughan, & Vermeu-
len, 2003) and spelling in fourth to ninth graders (Nagy, Berninger, Abbott, 2006). For example,
they could not give examples of inflectional suffixes, which mark tense and number, or deriva-
tional suffixes, which mark part of speech. Participants in the summer 2004 workshop showed
most growth at posttest in morphological awareness, probably because they were at floor at pre-
test (unpublished data). However, they also made some progress in their phonological awareness
as a result of participation in the workshop. These results show that even the most motivated
teachers who voluntarily participate in continuing education can still benefit from professional
development in understanding linguistic awareness.

Transfer of Writing Instruction to Reading

Because the writing and reading system are separable but interrelated systems, teaching to one
may lead to generalization (transfer) to the other. First, evidence of transfer from writing in-
struction to reading is examined. In the first grade handwriting treatment study (Table 10.1, first
study), all treatment groups improved over time in accuracy of phonological decoding, perhaps
because better letter formation facilitates learning of the alphabetic principle or application of it
to the decoding process. In the second grade spelling treatment study (Table 10.1, second study)
all treatment groups improved significantly over time in accuracy of real word reading (1/5 stan-
dard score gain), although the size of the gain was greater for spelling (1/3 standard score gain)
that was directly trained. In the third grade spelling treatment study (Table 10.1, third study),
 10. WRITTEN LANGUAGE DURING EARLY AND MIDDLE CHILDHOOD 227

transfer from spelling treatment to word reading (raw scores) was also observed; only raw scores,
not standard scores, were analyzed because of the shorter duration of this third grade study than
the second grade study. In the study comparing spelling only, composition only, and combined
spelling and composing instruction (Table 10.1, fourth study), spelling instruction that empha-
sized alternative ways of spelling the same sound (e.g., c, k, or ck for /k/) transferred to improved
accuracy of phonological decoding but not real word reading. In a study that taught handwriting
with and without extra motor or orthographic training (Berninger et al., 2006, Study 2), children
improved in real word reading (1/3 standard deviation gain).
This evidence for transfer from writing instruction to improved reading must be qualified
with other null findings. The comprehensive writing instruction during the third to fourth grade
transition (Table 10.1, fifth study) did not show transfer to rate of growth in real word or pseudo-
word reading. The comprehensive writing instruction in the clubs (Table 10.1, sixth study) did
not show transfer to improved reading on the state high stakes test or an individually adminis-
tered test of reading comprehension. Also, Brooks et al. (1999) did not find transfer from writing
instruction to improved real word reading in intermediate grade students with dyslexia.

Transfer of Reading Instruction to Writing

Results for transfer from reading instruction to writing are also mixed. Students with dyslexia in
grades 4 to 6 given comprehensive reading instruction improved significantly in reading skills
but not in writing skills (handwriting, spelling, and compositional quality and fluency; Berninger,
2000b). However, Abbott’s dissertation research showed that students with dyslexia in grades
4 to 7 given comprehensive reading instruction, with either a structural analysis (syllable and
phonemes for words of different word origin) or a study skills component, showed significant
improvement in spelling on intercept and slope of growth curves for two spelling measures, but
the improvement was not related to the component that varied between groups (Abbott & Ber-
ninger, 1999).
In a study that taught reading with and without a multisensory component (pairing handwrit-
ing instruction with phonics) to first graders who were already behind in reading and had a fam-
ily history of reading and writing disabilities, the children receiving phonics instruction without
the multisensory component improved significantly more in their reading skills and two writing
skills (alphabet writing from memory and a copy task) than those given phonics instruction with
the multisensory component (Berninger, Rutberg, et al., 2006). These at-risk students may benefit
from both phonics and handwriting instruction, but the two do not necessarily have to be taught
together. For example, low achieving first graders given both handwriting and reading lessons, ei-
ther at different times of the day or sequenced in time over the school year, improved significantly
more in real word reading and orthographic coding than did those given only additional practice
in the regular code-oriented curriculum, to equate for instructional time. Both groups improved
in phonological decoding (see Berninger, Dunn, Shimada, & Lin, 2004).
In another study (Table 10.1, seventh study), students with dyslexia given comprehensive
reading instruction but no spelling instruction improved in number of correctly spelled words
in their compositions significantly more than the wait-listed control did; although one group
completed all comprehension activities with oral discussion and the other with written composi-
tion, both groups improved significantly in composition length (Berninger et al., 2002). Thus, on
balance, reading instruction does appear to transfer to some improvement in writing in students
with dyslexia, but this issue requires more research attention and researchers should give writing
as well as reading measures in instructional studies for reading.
228 BERNINGER

PART 4: CONCLUSIONS, CAVEATS, AND CALL FOR

FUTURE RESEARCH DIRECTIONS

Writing Instruction for Different Specific Learning Disabilities

In this chapter we made a clear distinction among the various student populations studied for all
of which researcher-defined inclusion criteria were used (see published studies for details) rather
than samples of convenience. One of the issues holding back development of evidence-based
practices in writing is that research samples are often not described in sufficient detail to know to
whom results can be generalized. Although the federal special education laws have one umbrella
category for learning disabilities, 25 years of research and clinical experience of this author
point to the conclusion that this approach is overly simplistic and interfering with a scientifically
grounded approach to assessment and treatment of writing disabilities (e.g., Berninger, 2004,
2006, in press; Berninger, Nagy, Richards, & Raskind, in press). Although it is widely assumed
that all students respond well to the same instruction, the fact is this working hypothesis of many
researchers and trainers has never been put to rigorous experimental test. This assumption also
flies in the face of teachers at work in classrooms who understand the reality of normal varia-
tion among learners and the results of intervention studies showing remarkable normal variation
in not only pretreatment assessment (e.g., Berninger et al., 1995) but also response to the same
instruction (e.g., Abbott et al., 1997). At the very least, studies are needed to evaluate response
to writing instruction for the following specific learning disabilities that differ as to whether only
writing or writing plus reading or writing plus reading and oral language are impaired.

Dysgraphia. Some students have specific writing problems without motor, oral language,
or reading disabilities (Berninger, 2004, in press). These students tend to be impaired most in
orthographic coding and grapho-motor planning of sequential finger movements (Berninger, in
press). They may have a deficit in the orthographic loop of working memory that coding on
the Wechsler Intelligence Scale for Children, 4th Edition (WISC IV, Psychological Corporation,
2003), which loads on the working memory factor, may assess; specifically coding assesses
ability to engage in associative learning with the orthographic loop. Effective writing instruction
for these students may require specialized instruction in orthographic coding and integration
of orthographic coding with grapho-motor planning for sequential finger movements within
the context of the instructional protocols for writing already shown to be effective in teaching
handwriting, spelling, or composing (see Table 10.1). Students who have primary motor
disabilities, acquired or of developmental origin, will undoubtedly have handwriting problems.
Nevertheless, many students with handwriting problems do not have primary motor problems.
They are more likely to have problems in orthographic coding with and without grapho-motor
control and/or planning problems (Berninger, 2004).

Dyslexia. Some students have specific reading and spelling problems without oral
language disabilities other than phonological memory and awareness (Berninger 2006, in press;
Berninger et al., 2006). These students tend to be most impaired in phonological, orthographic,
and rapid automatic naming (Berninger, Abbott, Thomson, Raskind, 2001; Berninger, Abbott,
& Thomson, et al., 2006) and have phonological core deficits within components of working
memory (Berninger, Abbott, & Thomson, et al., 2006). RAN may be an index of the time-sensitive
phonological loop in working memory. Effective instruction may require specialized instruction
in (a) phonological awareness (e.g., beginning with the spoken not written word, Berninger et al.,
2000; Berninger, Rutberg, et al., 2006, Study 3; Berninger et al., 2007, Study 2), (b) orthographic
 10. WRITTEN LANGUAGE DURING EARLY AND MIDDLE CHILDHOOD 229

awareness (e.g., Looking Games, Berninger et al., 2006, Study 3), and (c) phonological-loop
through teacher-guided oral reading with turn switching at sentence punctuation and strategic
decoding of unknown words (e.g., Berninger et al., in press, Study 2). This instruction should
take place in the context of all the instructional components research has shown to be necessary
to develop fully functional reading systems and competent readers: decoding, automatic word
reading, oral reading fluency for passages, silent reading fluency, and reading comprehension
(e.g., Abbott & Berninger, 1999). However, some additional adjustments for the working memory
inefficiency may also be necessary (e.g., the timing of the instructional components as discussed
in this chapter).

Language Learning Disability. Some students have a history of and current problems in
oral language in addition to their problems in reading and writing; they may or may not also have
motor disabilities that are often observed in populations with oral language impairments. However,
they tend to have not only decoding/word reading problems but also reading comprehension
problems, morphological and syntactic awareness problems, semantic retrieval problems, and
working memory problems (Berninger, in press). They probably need specialized instruction
directed to morphological and syntactic awareness in spoken and written language and semantic
retrieval/vocabulary within the context of instructional protocols shown to be effective for
teaching students with dyslexia (see above section). Without the added attention to morphological
and syntactic awareness and semantic retrieval/vocabulary related to reading comprehension and
written expression, however, their reading and writing progress may be stymied.

Generalization of Research Findings

The following point is repeated for the purpose of highlighting it. Participants in writing research
need to be described carefully and results should be generalized only to the population studied.
The population studied may be typically developing students or those with specific learning
disabilities. A trend in applying research to practice is that findings based on learning disabled
samples are often generalized to typically developing students or vice versa. For example, re-
search has shown that students with specific reading disabilities need more explicit and intensive
instruction in phonics than do their classmates, but this finding is often translated to mean all
students need such explicit and intensive phonics instruction, when probably they do need some
instruction in decoding but not to the same degree—unless their career goal is to become a read-
ing or writing teacher. Often research is done on samples of convenience without adequate atten-
tion to detail in describing the characteristics of the participants. The net result is that it is difficult
to know the population of students to which results may appropriately generalize.

Caveats about Meta-Analyses

Considering that there has been less research on the writing than reading, it may be premature
to conduct large scale meta-analyses of writing unless those who conduct them carefully take
into account the aspect of writing that a specific study investigated and the specific population of
writers studied (e.g., typically developing, at-risk, specific learning disability diagnosis, stage of
writing development). Only studies comparing the same aspect of writing, the same population
of writers, and the same stage of writing development should be compared in a meta-analysis.
Writing is a very complex process with many different aspects to it. Normal variation in typically
developing writers is enormous both in pretreatment assessment and response to instruction. Tar-
get skills for instruction and assessment change across writing development. If practitioners are
230 BERNINGER

to apply results of meta-analyses meaningfully to real world classrooms and individual students,
it is important not to lose sight of these issues in the quest for What Works in Writing? The quest
for a short list of What Works in Reading? may have been short-sighted. Evidence-based practice
ultimately depends on what works for individual students in real school settings and not just in
controlled laboratory research.
Another issue to be considered in conducting meta-analyses is what the working hypotheses
of the researcher were. Research results usually cannot be interpreted meaningfully apart from
the conceptually driven research hypotheses motivating the study. Meta-analyses often disregard
the scientific purpose generating the research results when they combine results in an atheoretical
fashion and the results could therefore lead to misleading conclusions.

Cutting-Edge Research

We end where writing begins—in the preschool years. The cutting edge in literacy research in
general and writing in particular is moving downward developmentally to the preschool years.
Two research studies are representative of this new trend to understand early writing and early
intervention to prevent writing problems. The first study found that letter naming and letter writ-
ing are highly related in four-year-olds, providing clues for future assessment and treatment
studies (Molfese, Beswick, Molnar, & Jacobi-Vessels, 2006). The second study showed that early
spelling ability in five-year-olds was related to their ability to analyze sound sequences in spoken
words and letter sequences in written words and fast map these sequences across written and
spoken words (Apel, Wolter, & Masterson, 2006). Writing instruction may begin when infants
and toddlers first learn that writing instruments leave marks on the external world and parents
discourage their further use until children have the cognitive and linguistic understanding of how
to use those marks to communicate with others in a prosocial way. Yet, much of that important
writing instruction during early childhood may occur in the home or the preschool before a child
begins formal schooling. Researchers are just beginning to tackle these intriguing issues.

ACKNOWLEDGMENTS

The author thanks, in alphabetic order, her former doctoral students in school psychology who
contributed greatly to the programmatic research on writing discussed in this chapter: Dr. Sylvia
Abbott for her work in the early design experiments and later randomized controlled studies in
school settings and university settings; Dr. Allison Brooks for her assistance with early interven-
tion studies in schools and specialized treatment at the university and work on letter reversals
as indicators of working memory inefficiency; Dr. Belle Chenault for her work showing that
prior attention training enhances response to composition training in students with dyslexia; Dr.
Frances Fuller for her work on gender differences in writing and algorithms developing writers
use in deciding what to write next; Dr. Terry Hart for her work on teaching multiple connections
between units of written words and units of spoken words to improve reading and spelling; Dr.
Judith Rutberg for her assistance in the cross-sectional studies, particularly related to finger func-
tion, and her dissertation research on teaching handwriting to at-risk writers; Dr. Dean Traweek
for her work on the early development of writing in classrooms and comparison of instructional
programs that did and did not integrate reading and writing; Dr. Cheryl Yates for her assistance
in the early cross-sectional studies, particularly related to orthographic coding, and research on
writing disabilities in gifted children; and Dr. Diane Whitaker for her work on levels of language
 10. WRITTEN LANGUAGE DURING EARLY AND MIDDLE CHILDHOOD 231

in translation, branching diagnosis in writing disabilities, and the process by which adult writers
learn to write psychological reports.

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 11
Effective Mathematics Instruction
Marjorie Montague and Delinda van Garderen

Students in our nation’s schools consistently perform poorly on state (e.g., Florida Compre-
hensive Assessment Test; FCAT), national (e.g., National Assessment of Educational Progress,
NAEP, 2003), and international mathematics tests (e.g., Third International Mathematics and
Science Study; Beatty, 1997). The National Council of Teachers of Mathematics (NCTM) first
responded to the poor performance of students in 1989 with the publication of Curriculum and
Evaluation NCTM Standards for School Mathematics (NCTM, 1989) and again in 2000 with the
revised Principles and NCTM Standards for School Mathematics (NCTM, 2000). NCTM called
attention to the dismal mathematics performance of students and called for a more meaningful
approach to teaching and learning mathematics. While these standards have helped educators
generally to improve many students’ mathematics learning, they have had little impact on math-
ematics instruction for students with learning and behavioral disorders, who represent a signifi-
cant challenge for teachers.
These students fare much worse than their peers in most academic areas, but particularly in
mathematics, putting them at great risk for school dropout and poor post-secondary outcomes.
There has been a persistent performance gap in mathematics between students with and without
disabilities (NAEP, 2003). For example, NAEP 2003 results indicated that 71% of students with
disabilities contrasted with 27% of students without disabilities scored below the basic level.
In keeping with the No Child Left Behind Act (NCLB, 2001), all students, including students
with disabilities, must meet high standards in mathematics as measured by state-administered
achievement tests. To meet these standards in mathematics, students with disabilities, who vary
considerably in ability, achievement, and motivation, must develop the necessary mathematical
concepts, skills, and applications needed not only to perform well on mathematics assessments
but also to apply these skills successfully in real world settings. Contributing to the problem is
that teachers often do not have the necessary content or pedagogical knowledge or understand-
ing in how to teach mathematics, especially when students have diverse learning and behavioral
needs. With the current move toward full inclusion in our schools, it is critical that teachers
become familiar with proven instructional practices and procedures for teaching students with
special learning and behavioral needs. Curricular materials and teaching methodology consistent
with the NCTM Standards need adaptation if these students are to be successful (Woodward,
2006). Typical mathematics curricula and instructional practice reflective of the Standards have
been found to be too complex, unstructured, and confusing for most students with learning and
behavioral problems (Baxter, Woodward, & Olson, 2001; Woodward & Baxter, 1997).

236
 11. EFFECTIVE MATHEMATICS INSTRUCTION 237

Fortunately, researchers have been conducting intervention research, primarily in reading,

for the past 25 years to identify the most effective instructional practices to address the myriad
characteristics of students with learning and behavioral disorders. For example, Swanson’s (1999)
meta-analysis of intervention studies in learning disabilities (LD) found direct instruction and
cognitive strategy instruction, approaches that have many commonalities, to be the most power-
ful interventions for students with LD. Both approaches can be used across domains, including
mathematics. Both approaches incorporate numerous research-based practices and procedures
such as cueing, modeling, verbal rehearsal, and feedback. Instruction is highly structured and
organized with appropriate cues and prompts built in, leading to mastery of new concepts, skills,
and applications and eventual automaticity of responses.
Direct instruction typically focuses on basic skills and utilizes scripted lessons that are
teacher-directed and fast-paced. In contrast, cognitive strategy instruction focuses on teaching
students the process of learning (e.g., Montague, 2003). The instructional method underlying
cognitive strategy instruction is explicit instruction, which is more interactive than direct instruc-
tion. In essence, students learn to think and behave like proficient learners as they apply various
cognitive processes and self-regulation strategies. To illustrate, for mathematical problem solv-
ing, students learn to read, analyze, evaluate, and verify math problems using comprehension
processes such as paraphrasing, visualization, and planning as well as self-regulation strategies
including self-instruction, self-questioning, and self-checking (Montague, 2006).
In their meta-analysis, Kroesbergen and Van Luit (2003) reviewed mathematics interven-
tions for elementary school children with special educational needs, i.e., across disabilities. Cor-
roborating Swanson’s findings, they concluded that self-instruction, a self-regulation strategy and
component of cognitive strategy instruction, is the most effective method for teaching math prob-
lem solving; direct instruction is most effective for teaching basic skills; and both are superior
to mediated/assisted instruction, i.e., peer tutoring or computer-assisted instruction, for teaching
mathematics generally. A review specifically of self-management intervention studies targeting
academic outcomes for students with emotional and behavioral disorders (EBD) included 22
studies, 11 focused on mathematics and 10 of the 11 on math calculation skills. Self-monitoring
interventions predominated in these studies. A large positive effect size was found for the math
interventions and improved performance seemed to maintain over time, indicating self-moni-
toring may be an effective intervention for learning and maintaining basic mathematics skills
(Mooney, Ryan, Uhing, Reid, & Epstein, 2005).
Another review of math interventions for students with EBD included 13 studies conducted
between 1985 and 2005 (Hodge, Riccomini, Buford, & Herbst, 2006). Of these, 10 focused on
basic math computation skills and used student-directed interventions (i.e., self-monitoring, self-
management, or self-regulated strategies such as rehearsal or mnemonics). The authors caution
that self-regulation techniques are most appropriate when students have already learned the target
skills. Teacher-directed instruction that is clear and includes corrective feedback and ample op-
portunities for practice may be necessary initially to improve students’ academic performance.
The purpose of this chapter is to review evidence-based practices for teaching mathematics
to students with learning and behavioral disorders. First, however, cognitive and behavioral char-
acteristics of children and adolescents with learning and behavioral problems that may interfere
with successful performance in mathematics will be described. Second, instructional practices
and procedures will be discussed as they relate to levels of instruction; that is, research focus-
ing on children in primary and intermediate elementary school as well as middle and secondary
school will be described. Studies will be described, explicit examples of best practice will be
provided, and conclusions will be drawn regarding “best practice.” Intervention research aimed
at improving mathematics performance of students with learning and behavioral disorders is
238 MONTAGUE AND VAN GARDEREN

very limited. The majority of the studies at the elementary level have focused on improving
computation skills of students with learning and behavioral disorders. The few studies conducted
with middle and secondary school students focus primarily on improving problem solving skills.
Despite the paucity of research, several conclusions can be drawn regarding effective instruction
in mathematics for students with learning and behavioral disorders.

COGNITIVE AND BEHAVIORAL CHARACTERISTICS THAT INTERFERE WITH

MATHEMATICS PERFORMANCE

There are a variety of cognitive characteristics that interfere with successful performance in
mathematics. Geary (1993, 2003) proposed that children with mathematical disability (MD) have
one or more of three subtypes of the disorder. The first subtype is deficient semantic memory.
These children typically have difficulty retrieving mathematical facts or answers to simple arith-
metic problems, make more errors when they do, and vary considerably on reaction time for
correct retrieval. Semantic memory deficits appear to be relatively stable over time and seem to
be associated with a developmental difference in that children with this deficit differ in cognitive
and performance features from younger, academically typical children. The second subtype is
procedural. Children with procedural deficits frequently use developmentally immature proce-
dures similar to those used by younger, academically typical children. Procedural deficits may
represent a developmental delay as they tend to improve over time. These children have difficulty
retaining information in working memory and are unable to monitor their counting processes.
The third subtype is visuospatial. Children with visuospatial problems have difficulties in spa-
tially representing numerical relationships and other types of mathematical information. They
frequently misinterpret or misunderstand spatially represented information. Typical problems are
an inability to align and rotate numbers as well as problems in measurement, place value, and
geometry.
There is consensus about the role of memory, both working memory and long-term memory,
in mathematics development (Swanson & Jerman, 2006). The inability to retrieve arithmetic facts
from long-term memory and the inability to store numbers in working memory has an impact on
the ability to calculate, do algorithmic procedures, and solve mathematical problems. Children
with MD characteristically do not show the shift from direct counting procedures to recall of the
arithmetic combinations from memory (Swanson & Rhine, 1985). They do not remember certain
combinations and that these combinations yield certain results, do not access certain arithmetic
facts from long-term memory, and, thus, have considerable difficulty calculating.
Students with MD also have considerable difficulty translating and transforming numeri-
cal and linguistic information in mathematical word problems (Montague & Applegate, 1993).
They differ significantly from nondisabled peers in their ability to represent problems, which
is a critical stage in the problem solving process. Successful problem execution depends on
successful problem representation. Many students with MD have serious perceptual, memory,
language, and/or reasoning problems that interfere with mathematical problem solving. That is,
students may have trouble reading and understanding the problem, attending to the information
in the problem, identifying important information and representing that information, developing
a plan to solve the problem, and computing. Even though students may have acquired the basic
knowledge and skills in reading and mathematics and, therefore, should be able to carry out these
cognitive activities, they often do not because of these problems. Additionally, these students
often experience significant self-regulation problems that interfere with problem solving.
Students with learning and behavioral disorders characteristically are deficient in the ability
 11. EFFECTIVE MATHEMATICS INSTRUCTION 239

to select appropriate strategies to use and to regulate themselves during academic tasks (Wong,
Harris, Graham, & Butler, 2003). That is, they have self-regulation problems that prevent suc-
cessful completion of tasks. These students are typically disorganized, do not know where or how
to begin, lack enabling strategies, and do not evaluate what they do. The ability to regulate one’s
cognitive activities underlies the executive processes associated with metacognition (Flavell,
1976). Metacognition consists of both knowledge and awareness of one’s cognitive strengths and
weaknesses and self-regulation, the ability to coordinate that awareness with appropriate action
(Wong, 1999). Metacognition develops in young children from an early age and matures during
early adolescence, sometime between the ages of 11 and 14 years. Metacognitive ability is es-
sential for successful academic performance across domains, including mathematics (Montague,
1998).
In addition to cognitive characteristics, there is a multitude of behavioral characteristics that
interfere with successful math performance. For example, the behavioral symptoms of atten-
tion deficit hyperactivity disorder (ADHD) interfere with mathematics learning even for children
who may have the skills but do not necessarily produce what is expected. The three symptoms
associated with ADHD are inattention, impulsivity, and hyperactivity. Inattention means that an
individual has difficulty sustaining attention when effort is required. Behaviors associated with
inattention include carelessness, difficulty staying on task, not listening, disorganization, failure
to finish schoolwork and chores, distractibility, losing things, and forgetfulness. Inattention may
be less or more noticeable depending on contextual factors. Impulsive individuals seem unable
to control their behaviors and appear to act without thinking. Impulsivity implies a problem with
self-regulation. Hyperactivity implies an inordinate activity level. Hyperactive and impulsive
behaviors include fidgeting and squirming, constant movement, inability to stay seated for a
reasonable time, talking excessively, difficulty waiting or taking turns, and interrupting and in-
truding on others.
Finally, there are other behavioral characteristics that impact on academic performance.
These characteristics, generally speaking, differentiate good and poor problem solvers and strate-
gic learners (Montague, 2006). Students with MD typically have a limited repertoire of strategies
for completing math tasks effectively and efficiently, are poorly motivated and indecisive, cannot
monitor their performance by detecting and self-correcting errors, and are poor at generalizing
learning across situations and settings.

PRIMARY SCHOOL MATHEMATICS INSTRUCTION

Computation, Number Concept, Math Fact Interventions

Failure to rapidly recall basic facts is a characteristic often associated with mathematics dif-
ficulties (Miller & Mercer, 1997). One approach for improving recall and automaticity of facts
is through drill and practice. The primary advantage of such an approach is that it provides an
appropriate level of challenge and time on task with plenty of opportunities for the student to
respond (Burns, 2005). This is particularly important as it has been suggested that students with
disabilities do not get enough opportunities to practice, which is a crucial aspect of academic
remediation (Fuchs & Fuchs, 2001). Various rehearsal drill models exist, one of which has been
demonstrated to work with students with disabilities at the primary level. Burns (2005) examined
the effectiveness of an Incremental Rehearsal drill approach with three students with LD in the
third grade to learn multiplication facts. This model uses a gradually increasing ratio of known
to unknown items with the final stage of implementation at 90% known to 10% unknown. In
240 MONTAGUE AND VAN GARDEREN

this approach, facts are written on index cards and presented one at a time. The first unknown
fact is presented. If the student answers this correctly, it is then considered a known fact. A new
unknown fact is then presented. This is then followed by the known fact. This procedures repeats
until all the facts, typically 10, are introduced. If the student cannot provide the correct answer
within two seconds, does not know the answer, or provides an incorrect answer, the fact continues
to be identified as unknown and is taught to the student.
One concern associated with the drill and practice approach is that students with disabilities
often do not generalize what they have learned to other facts. It has been suggested that poor
number sense, a difficulty many students with disabilities have, could be a contributing factor
(Gersten & Chard, 1999). Understanding of number is a fundamental skill needed to learn topics
like addition and subtraction (Woodward, 2006). Funkhouser (1995), before working on basic
fact knowledge, used concrete manipulatives to develop number sense specifically to recognize
the number of objects in a set without counting them. Twelve students in grades K–1 were pro-
vided a vertical display of rectangles divided into five equal squares with dots or jellybeans
placed within the squares representing the numbers 0 through 5. The students represented the
configurations using the jellybeans and verbally identified each by a numeral. This was then fol-
lowed by discussing different combinations that could be made using the configuration. Eventu-
ally, the students were introduced to the use of the “+” symbol to produce the basic addition facts
and to begin memorizing them.
Strategy instruction has also been examined as a way of teaching number concepts, basic
facts, and computation. As Tournaki (2003) found in a study comparing the effectiveness of strat-
egy instruction to drill and practice, when given a problem, even a simple basic fact, it cannot be
assumed that students with disabilities have a strategy in place in order to solve it. Neither can it
be assumed that strategies will change as a result of practice. Therefore, instruction should also
focus on teaching students strategies for problem solving. Tournaki (2003) focused on teach-
ing students with LD a minimum addend strategy. This strategy involves determining the larger
addend and counting on from that cardinal value the number of units specified by the smaller
addend; for example, in 4 + 5 =, the students starts from the 5 and adds 4 more units. Students
who were taught the strategy improved significantly compared to those who learned basic facts
through drill and practice and a control group. Furthermore, the students with LD who learned
the strategy were able to transfer what they had learned to a task that involved adding three
single-digits together. Students with disabilities often do not transfer what they have learned from
one task to another.
A substantial body of research exists that supports the use of the concrete-representation-
al-abstract (C-R-A; sometimes known as concrete-semiconcrete-abstract: C-S-A) sequence for
teaching primarily students with LD at the elementary school level place value (Peterson, Mercer,
& O’Shea, 1988), coin sums (Miller, Mercer, & Dillon, 1992), basic facts (Mercer & Miller,
1992), and multiplication (Harris, Miller, & Mercer, 1995; Miller, Harris, Strawser, Jones, &
Mercer, 1998). The first level of instruction, concrete, involves the use of three-dimensional ma-
nipulative devices to demonstrate specific mathematical concepts. When understanding of the
concept at the concrete level is demonstrated, the instruction shifts to the second level of instruc-
tion, representation. At this level, students use visual depictions to represent the mathematical
concept introduced at the concrete level. Again, the goal at this level like the first level is to
promote conceptual understanding of the concept being presented. Finally, once conceptual un-
derstanding is obtained, the instruction shifts to the abstract level of instruction. This involves
the solving of problems using number symbols without using manipulative devices or pictorial
representations. At this level, students are to memorize the facts with fluency (Hudson & Miller,
2006). The C-R-A teaching sequence is taught using a four-step lesson format. The four steps in-
 11. EFFECTIVE MATHEMATICS INSTRUCTION 241

clude providing an advance organizer (connect the lesson to a previous lesson, identify the lesson
skill, and provide a rationale for the skill being learned), demonstrating the desired skill for the
student, providing guided practice with feedback, and allowing the student time for independent
practice (Morin & Miller, 1998).
Self-regulation enhances learning by helping students to take control of their actions and
move toward independence as they learn. Various self-regulation techniques have been re-
searched at the primary level. Self-instruction was the foundation for a comprehensive program
for improving multiplication and division skills (Van Luit & Naglieri, 1999). Participants in this
study included 42 elementary school students with LD. The instruction, the MASTERS Training
Program, involves an introductory phase, group practice phase, and an individual practice phase.
Central to the instruction is discussion among the teacher and students of the possible solution
procedures and strategies that could be used to solve the problems. Time is also spent guiding
the students towards identifying various strategies and determining which will be the most effec-
tive for solving the problems. Self-instruction is built into the program throughout, for example,
by teacher modeling. Results indicated a significant improvement compared with the general
instructional program. The students with LD generalized the self-instruction procedure to more
difficult problems.
In another study, Kroesbergen and Van Luit (2002) worked on multiplication facts with 75
students, 27 with a disability, aged 7 to 13 years. Some students received the instruction using
the MASTERS Training Program or guided instruction. Others had more structured instruction
which differed from the guided instruction in that the children did not actively contribute to
the lessons but were required to use the procedures the teachers taught them. In the structured
instruction, self-instruction is promoted by means of a strategy decision sheet that contains vari-
ous questions (e.g., What is the multiplication problem? Do I know the answer if I reverse the
problem?) used by students as they learn the different strategies. Students in both instructional
programs improved compared to those who received instruction based on the regular curriculum
method. Further, students in the guided instruction group did perform better than the students in
the other groups on a task that required them to transfer what they have learned. Overall, howev-
er, the students without disabilities were found to benefit most from the guided instruction while
the students in special education programs benefited more from the structured instruction.
Three studies (Fuchs, Fuchs, Hamlett, Phillips, & Bentz, 1994; Fuchs, Fuchs, Karns, Ham-
lett, Phillips, & Dukta, 1997; Fuchs, Fuchs, Phillips, Hamlett, & Karns, 1995) examined the ef-
fectiveness of using peer assisted learning strategies (PALS) with elementary students with and
without disabilities (grades 2–5) in math computation and concept/application. PALS effective-
ness was also examined with first-grade students with LD and ADHD with respect to mathemati-
cal development in number concept and basic facts (Fuchs, Fuchs, Yazdian, & Powell, 2002).
PALS is a classwide peer-tutoring structure that involves students within a classroom working
in dyads. A PALS session consists of coaching and independent practice. During coaching, the
stronger math student coaches a lower ability student in solving problems. Roles are reversed at
some point during each session. During the coaching, the tutor assists the student through each
step of a problem, thereby providing immediate feedback and prompting when the student is hav-
ing difficulty. As the tutees are solving problems, they are required to think aloud to help the tutor
clarify as needed. Following coaching, the students solidify the new material learned through
independent practice. The teacher monitors and awards points for cooperation and for following
the verbal routines. Curriculum-based measurement (CBM) is used in conjunction with PALS.
CBM is used to assist the teacher in tracking student progress, providing concrete recommenda-
tions for instruction, matching the students in the tutor-tutee dyads, and to provide the students
feedback on their progress (Baker, Gersten, Dimino, & Griffiths, 2004).
242 MONTAGUE AND VAN GARDEREN

Another form of tutoring is cross-age peer tutoring where an older, skill-competent student
works with a younger student. Beirne-Smith (1991) investigated the effectiveness of cross-age
peer tutoring for 20 students with LD from six to ten years in age to solve single-digit addition
facts. The tutoring sessions involved presentation of a fact by the tutor which is then repeated by
the tutee. The tutor then presented all the problems without the answers and instructed the tutee
to read the problems and give the answers first in order and then in random order. The session
ended with drill and practice using flashcards. The tutors were also trained to record the number
of correct and incorrect responses during the flashcard review to determine which problems they
would work on in the next session.
Overall, these peer-tutoring formats were found to be beneficial for all students, including
students with disabilities, for increasing number sense, basic facts, math computation and math
concepts/applications ability. However, to ensure the effectiveness of the tutoring, particularly
for students with disabilities, it is recommended that the students are taught to work with each
other. Peer explanations and support have been found to be more effective when the student’s
interactions are guided and structured (e.g., structured question sheet). In addition, teachers may
need to adopt cooperative/competitive group reward structures. Finally, while students with LD
have benefited from the intervention, they have not necessarily made the same gains as their
peers without disabilities. Students with LD may benefit from supplemental activities focusing
on the concepts being taught (Fuchs, Fuchs, Hamlett, Phillips, Karns, & Dukta, 1997; Fuchs et
al., 1995).

Mathematical Word Problem Solving Interventions

Wilson and Sindelar (1991), using a direct instruction approach, taught 62 students with LD in
second to fifth grades to solve addition and subtraction word problems. The instruction was more
effective when students were taught both a sequence for solving word problems and a strategy
to determine when to add or subtract. During the strategy instruction, the students were told that
“when the big number is given, subtract” and “when the big number is not given, add.” Sequence
instruction involved the use of questions such as “What numbers are given in the problem?” or
“What are we supposed to find?” to prompt the students to see the information in the problem.
Marsh and Cooke (1996) taught three third-grade students with LD to use manipulatives
(Cuisenaire rods) to solve one-step arithmetic word problems. Initially, the students were given
a procedure to use to analyze and solve word problems. Following this, the students reviewed
the Cuisenaire rod terms such as the word “set” where the students were to show “two sets of
five.” Using a word problem, they represented any numerical value with rods. Students were then
guided to position the rods to show what the problem was asking them to do. The students then
held up a flashcard indicating which operation they had to use to solve the problem. If correct,
the student recorded the numbers on a worksheet along with the symbol for the operation to solve
it. All the students improved in their ability to solve arithmetic word problems. Interestingly, the
findings of this study suggest that it may not be necessary to use all three levels of instruction
as presented in the C-S-A/C-R-A approach. The students in this study were able to move from
concrete to abstract without requiring intermediate training with semi-concrete representations.
Cassel and Reid (1996) taught two students with LD and two students with mild mental
retardation in the third and fourth grade to solve addition and subtraction word problems using a
strategy combined with self-generated instructions presented based on principles of strategy in-
struction recommended by Harris and Graham (1993). The steps of the strategy, “FAST DRAW,”
were: (a) read the problem out loud (b) find and highlight the question and write the label, (c)
ask what are the parts of the problem and circle the numbers needed, (d) set up the problem by
 11. EFFECTIVE MATHEMATICS INSTRUCTION 243

writing and labeling the numbers; (e) re-read the problem and tie down the sign, (f) discover the
sign—recheck the operation, (g) read the number problem, (h) answer the number problem, and
(i) write the answer and check by asking if the answer makes sense. As the students used the strat-
egy, they referred to a check list of self-generated instructions: (a) problem definition, “What is
it I have to do?”; (b) planning, “How can I solve this problem?”; (c) strategy use, “FAST DRAW
will help me organize my problem solving and remember all the things I need to do”; (d) self-
monitor, “To help me remember what I have done, I can check off the steps of the strategy as they
are completed”; (e) self-evaluation, “How am I doing? Did I complete all the steps?”; and (f) self-
reinforcement, “Great, I’m half way through the strategy.” All the students were able to learn and
implement the strategy with improved performance for all students in solving word problems.
Owen and Fuchs (2002) examined the effects of a strategy to solve mathematical word prob-
lems that required third-grade students with LD in mathematics to find half of a particular num-
ber. The strategy the students were taught involved six steps which required the student to read
the problem, generate a representation (e.g., circles of the number for which you will find half),
and to use the representation to solve the problem. Instruction began in a large-group followed by
the students working with a partner (high achieving and low achieving student) on practice prob-
lems. Compared with a control group, the students who received the entire intervention improved
in both number of problems solved and accuracy of those solved.
In an attempt to move beyond typical textbook problems, Fuchs, Fuchs, Hamlett, and Apple-
ton (2002) taught 62 students with LD in mathematics how to solve story problems, transfer
story problems, and real-world math problems. Students who received an intervention got either
tutoring and/or computer assisted practice. As a part of the intervention, the students were taught
underlying concepts and rules for solving problems and given explicit instruction on transferring
skills learned. Each session began with teacher demonstration and guided practice followed by
peer-tutoring. The tutoring format involved pairing a stronger student with a weaker student. The
computer assisted practice focused on solving real-life problems. Guided feedback in the form of
tips was provided throughout to help improve their responses. Overall, improvements were noted
for the students who received the tutoring or tutoring with computer assisted practice to solve
story problems and transfer story problems. Improvements were not found in solving real-world
math problems. Interestingly, while students who received the computer practice instruction
alone did improve, overall, the computer-assisted practice added little extra value. It is possible
that the software needed further work to incorporate more and better elaborated instruction. What
the computer assisted practice may be best for, however, is reducing the amount of teacher time
required to enhance problem solving.

INTERMEDIATE ELEMENTARY MATHEMATICS INSTRUCTION

Computation and Math Fact Interventions

As with younger students, drill and practice can be used with older students. Cooke and Reichard
(1996) examined the effectiveness of the Interspersal Drill Ratio approach with six fifth-grade
students with LD or EBD to learn multiplication and division facts. This approach involves using
a predetermined ratio of known (e.g., 70%) to unknown facts (e.g., 30%). Initially, the teacher de-
termines what facts the students do and do not know. Using that information, two groups of facts
are written on flashcards and divided into two piles based on a predetermined ratio. Individually,
the facts are presented to the student who is given two seconds to respond with the answer. De-
pending on the response, corrective feedback or praise is given. When the set is completed, the
244 MONTAGUE AND VAN GARDEREN

cards are shuffled and another round begins. At the end of the session, a mastery test is given.
Each flashcard is shown to the student, again for two seconds. If the response is correct, the card
is placed in the pile of known facts. The ratio of known to unknown facts may differ for each
student; however, Cooke and Reichard did find that the majority of students were able to master
the facts at a faster rate where 70% were unknown and 30% were known. An additional element
in this study was the use of a peer tutor. Peer-tutors, prior to the tutoring sessions, were trained via
role-plays on how to present the flashcards and provide corrective feedback or praise.
Originally developed to improve spelling performance, Cover, Copy, and Compare (CCC),
a memorization technique, has also been shown to increase mathematics accuracy, fluency, and
maintenance of math facts with 12 students with EBD at the intermediate level (Skinner, Bam-
berg, Smith, & Powell, 1993; Skinner, Ford, & Yunker, 1991; Skinner, Turco, Beatty, & Rasav-
age, 1989). The basic steps of the strategy involve having students look at an item and solution,
cover the item and solution, write the item and solution, and compare their written response to
the original example. If the written response matches the sample, the student then moves on to the
next problem (Skinner et al., 1991). The written response could also be combined with a verbal
response, or could be a verbal response alone. This strategy has also been found to be effective
with students in higher grade levels (e.g., 10th grade) (Skinner et al., 1989. Mnemonic techniques
have been found to be effective for memorizing multiplication facts for students with LD in
fourth grade and up (Greene, 1999; Wood, Frank, & Wacker, 1998). These include:

1. Pegwords or pegword phrases: With this technique, numbers are connected to a pegword
such as 6 = sticks, 7 = heaven, 42 = warty two. Students are to learn a pegword for all the
corresponding numbers that will be used. Following this, math facts are then written on a
flashcard with a pegword phrase and a picture that matches the phrase (e.g., “6 × 7 = 42;
sticks in heaven with a warty shoe”) (Greene, 1999).
2. Visual mnemonic for doubles: Picture flashcards of objects are used for two-times math
facts. For example, a skateboard—two sets of two wheels; a six-pack of pop—two sets
of three cans; a toy spider—two sets of four legs. To use this mnemonic, first find the two
in the math fact and then remember the double picture related to the other number that
would provide the answer (Wood, Frank, & Wacker, 1998).
3. Mnemonic for fives: This strategy works for students who can count by fives. The stu-
dents are then given simple steps to follow: first identify the fact as a fives fact and then
count by fives to solve the problem (Wood, Frank, & Wacker, 1998).
4. Linking strategy: this strategy can be used for facts in the nines category. Students are first
shown which numbers from 1 through 8 are linked: 1-8, 2-7, 3-6, 4-5. When they have
memorized this, they are first taught to identify if the math fact presented is in the nines
category. Then they are to take the number the 9 is being multiplied by and subtract one.
This is then placed in the tens column. The number linked to that number is then placed
in the ones column. For example, for 9 × 5, subtract 1 from the 5 and write then answer in
the tens column (i.e., 4). Then, identify the linking number with the 4 (i.e., 5) and write it
in the ones column. The answer is then 45 (Wood, Frank, & Wacker, 1998).

Even though use of mnemonics can be effective, they can take time to learn and use. For
example, Wood et al. used an instructional package to teach the students the various mnemonic
techniques. This included: (a) presentation of the facts in a structured sequence (e.g., facts in-
volving zero and ones were taught first followed by doubles, and so on); (b) teaching students
how to classify the facts into one of six categories (e.g., zeros, ones, doubles, fives, nines, and the
remaining facts); (c) introduction to the mnemonic procedures, (d) learning the various steps for
 11. EFFECTIVE MATHEMATICS INSTRUCTION 245

each mnemonic, and (e) using self-instruction in selecting and executing the strategies. Unlike
the more “traditional” classroom methods, the mnemonic techniques were effective in helping
students who had difficulty with fact recall.
Several studies at the intermediate level have focused on using self-instructions to complete
addition and subtraction computation problems. Wood, Rosenberg, and Carran (1993) taught
nine students with LD, 8 to 11 years old, to use step-by-step instructions (e.g., Step 1: First, I
have to point to the problem. Step 2: Second, I have to read the problem. Step 3: Third, I have
to circle the sign). They recorded their visualizations and played them as they solved problems.
Dunlap and Dunlap (1989) gave three students with LD (1 in 5th grade and two in 6th grade)
individualized self-monitoring checklists based on errors they made when solving the problems.
The checklists contained specific reminders (e.g., I copied the problem correctly. All the num-
bers on the top are bigger than the numbers on the bottom.), which the students would reference
and check off as they complete each problem. Jolivette, Wehby, and Hirsch (1999) taught three
students with EBD in fourth grade three of six possible strategies to solve subtraction problems.
The strategies were: (1) Bottom First—a visual cue to being in the ones column with the bottom
number; (2) Permanent Model—a visual model of a correctly solved problem with regrouping;
(3) Say It Before You Do It—verbal phrase (e.g., “If the bottom number is bigger than the top
number, then regroup.”); (4) Visual Organizer—a visual prompt such as a slash mark appearing
above the column to regroup; (5) Right is Correct—visual cue to begin in the ones column and
work left; and (6) Bigger on Top—verbal prompt (e.g., “Bigger on top.”) to regroup so that the
top number is larger than the bottom for each column. Each strategy took less than five minutes
to be taught. All the students in the various studies dramatically improved in performance.
Naglieri and Gottling (1997) taught twelve 9- to 12-year-old students with LD how to use
self-reflection to aid in planning and utilization of an efficient strategy to complete subtraction
and multiplication problems. The students were encouraged to determine how to complete the
worksheets, verbalize and discuss their ideas, explain which methods that did and did not work
well to solve the problems, and be self-reflective. Students, to achieve self-reflection, were asked
questions (e.g., What could you have done to get more correct?) by an instructor, to which they
responded (e.g., I have to keep the columns straight). Not only did the students improve in their
performance, they improved in their ability to make a plan a solution to solve a problem.
Self-monitoring of behavior as an intervention offers an alternative to other often more intru-
sive procedures to improve performance particularly as it requires less direct teacher intervention
(Maag, Reid, & DiGangi, 1993). Several studies have focused on using self-monitoring applied
to either academic or attention responses with students with LD, ADHD and/or EBD at the in-
termediate level in math computation (Maag et al., 1993; McDougall & Brady, 1998).Typically,
students are taught to monitor either their levels of attention (e.g., on or off-task, Am I paying at-
tention?), productivity (e.g., Am I working quickly? or number of problems completed), or accu-
racy (number of problems completed correctly). Students are taught to note on a form or checklist
their behavior when given a cue during a math session. McDougall and Brady (1998) also taught
their students to graph how many correct and incorrect digits they had computed and determine
if their math fluency was improving. For improved fluency the students determined how many
token points they had earned which were then exchanged for reinforcers such as sugarless gum,
a blank audio cassette, or an announcement on the school intercom system about improved per-
formance. In all the studies, the students were able to effectively and independently use the self-
monitoring techniques and improved in performance to some degree. A consistent finding across
the three studies is students can learn to self-monitor their productivity and accuracy.
Some researchers have used computers to teach math facts to students with LD and EBD
in grades 3 through 5 (Koscinski & Gast, 1993; Landeen & Adams, 1988; Wilson et al., 1996).
246 MONTAGUE AND VAN GARDEREN

In all three studies, the students who received computer instruction improved in their math fact
knowledge. However, use of CAI needs further research as students who received teacher-di-
rected instruction also improved (Landeen & Adams, 1988; Wilson et al., 1996). It is possible
that “relatively simple procedures … may be more powerful when a task is less complex or when
a student’s needs are straightforward” (Harris, Graham, Reid, McElroy, & Hamby, 1994, p. 137).
This does not necessarily mean that CAI should be ruled out. Wilson et al. point out, with the
move toward inclusion in general education classrooms, teachers may have limited time to pro-
vide appropriate individualized instruction to meet their students needs. CAI instruction may be
a more feasible option when students are working individually. Another issue related to CAI that
needs further research is the efficacy of the specific programs used. It is unclear if a game-like
format (e.g., Math Blaster) is more effective than a “paper and pencil” format. Students with dis-
abilities seem to find the game-like programs more motivating.

Mathematical Word Problem Solving Interventions

Of the various word problem solving procedures available, a well-researched and documented ap-
proach is schema-based strategy instruction. Schema-based strategy instruction has been shown
to work with students with disabilities, including students with learning and emotional disorders
in grades 2 through 8 to solve arithmetic word problems (Jitendra, Griffen, McGoey, Gardill,
Bhat, & Riley, 1998; Jitendra & Hoff, 1996; Jitendra, Hoff, & Beck, 1999; Jitendra, DiPipi, &
Perron-Jones, 2000; Xin, Jitendra, & Deatline-Buchman, 2005). The goal of the instruction is to
help the student identify the schema, “a general description of a group of problems that share a
common underlying structure” (Xin & Jitendra, 2006, p. 53), and to use that information to solve
the problem.
The schema-based problem-solving model contains four separate but interrelated procedural
steps: identification, representation, planning, and solution (Xin & Jitendra, 2006). Correspond-
ing to those steps are areas of conceptual knowledge that the student will use to solve the prob-
lem: schema knowledge, elaboration knowledge, strategic knowledge, and execution knowledge.
First, the student reads the problem and uses that information to identify the problem schema
based on knowledge of problem schemas that exist. For example, the key phrase “3 times as
many as” is a “compare” problem. Second, the student generates a schematic diagram (represen-
tation) appropriate for the schema identified. Specifically, this involves elaborating on the main
features of the schema. For example, “Peter has 2 cats. Julia gave him 3 more. How many cats
does Peter have now?” represents a change problem. The student will then map out the informa-
tion: “2 cats” and “3 cats” and “? cats.” The diagram depicts the details of the problem. Third,
once the problem is represented, the student plans how to solve the problem. Planning involves
setting up the final goal (what is being solved for) and, if appropriate, the subgoals (to get the an-
swer, what else needs to be solved), selecting the appropriate operation(s), and writing the math
sentence or equation. This step draws on the student’s strategic knowledge, for example “when
the total amount is unknown, we add to find the total.” The fourth step of the model is to carry out
the plan. This involves using execution knowledge techniques such as performing a skill (e.g.,
addition) or following an algorithm (Xin & Jitendra, 2006).
Case, Harris, and Graham (1992) worked with four students with LD in fifth and sixth grade
to improve their ability to solve one-step addition and subtraction word problems. They were
taught a five-step procedure for solving word problems: (a) read the problem out loud, (b) look
for important words and circle them, (c) draw pictures to tell what is happening, (d) write down
the math sentence, and (e) write down the answer. As part of the instruction, the students self-
generated instructions to use when solving the problem to guide and direct behavior: (a) problem
 11. EFFECTIVE MATHEMATICS INSTRUCTION 247

definition (e.g., “What is it I have to do?”), (b) planning (e.g., “How can I solve this problem?”),
(c) strategy use (e.g., “The five-step strategy will help me look for important words.”), (d) self-
evaluation (e.g., “How am I doing?”), and (e) self-reinforcement (e.g., “I did a nice job.”). To
teach the students how to use the strategy and self-regulate their performance, the instructors
introduced the steps and then modeled the procedures using a think aloud strategy, had the stu-
dents rehearse the strategy until memorized, provided guided practice with corrective feedback
and reinforcement, provided independent practice, and reminded the students to use the strategy
whenever they solved word problems in other classroom situations. All students improved in
performance for both addition and subtraction problems. Further, the students generalized what
they had learned to other classroom settings.
The majority of research using computers in math with students with disabilities has focused
on basic math facts. Shiah, Mastropieri, Scruggs, and Mushiniski Fulk (1995), however, exam-
ined the effectiveness of a computer-assisted tutorial program to learn math problem-solving
with 30 students with LD in grades one to six. The computer program incorporated a seven-step
strategy for solving word problems: (a) read the problem, (b) think about the problem, (c) decide
the operation sign, (d) write the math sentence, (e) do the problem, (f) label the answer, and (g)
check every step. The tutorial program involved several parts: a demonstration how to solve a
word problem using the seven-steps, guided practice, and independent practice. The students
worked thorough the problems presented at their own pace. The program prompted the students
what to do and to make changes when and where necessary. The findings in this study supported
the use of CAI instruction for students with LD as all the students improved in their performance
to solve word problems. One concern in this study was the lack of transfer from computer to
paper and pencil tasks.

MIDDLE SCHOOL MATHEMATICS INSTRUCTION

Only eight studies with middle school students were located. Three of these used direct instruc-
tion to teach computation skills (Rivera & Smith, 1988; Scarlato & Burr, 2002; Witzel, Mercer,
& Miller, 2003), and five employed strategy instruction to improve problem solving performance
(Jitendra, DiPipi, & Perron-Jones, 2002; Jitendra et al., 1999; Xin et al., 2005, Montague, 1992;
Montague, Applegate, & Marquard, 1993). As noted previously, direct instruction and cognitive
strategy instruction were found to be the most effective interventions for students with LD across
domains (Swanson, 1999).
Rivera and Smith (1988) devised an instructional routine, termed Demonstration Plus Per-
manent Model, for teaching long division to eight students with LD. In this routine, the teacher
first demonstrated the steps in the algorithm as she solved a simple long division problem and
then used this correct solution as the permanent model. The teacher then provided corrective
feedback as students imitated the teacher demonstration with similar problems. After solving a
problem correctly, students were allowed to work additional problems independently. The same
procedure was used with more difficult long division problems until mastery was achieved on
problems with and without remainders. All students improved substantially in minimal time (2 to
9 days). Scarlato and Burr (2002) based their instructional routine on Stein, Silbert, and Carnine’s
(1997) model of direct instruction to teach four seventh-grade students with LD fraction and dec-
imal skills. Again, effective instructional practices associated with direct instruction were incor-
porated, i.e., modeling, guided and independent practice, cumulative review, multiple examples,
immediate and corrective feedback, and mastery criteria. Following 20 weeks of instruction, the
students outperformed a comparison group on both standardized and informal assessments.
248 MONTAGUE AND VAN GARDEREN

Witzel et al. (2003) used the concrete-to-representational-to-abstract (C-R-A) sequence de-

scribed earlier in the chapter to teach students with LD or at risk how to solve algebraic trans-
formation equations. Thirty-four pairs of middle school students were matched on achievement
score, age, pretest score, and class performance. Half the students received typical textbook in-
struction, while the other half received C-R-A instruction. Each lesson had four steps: introduce
the lesson, model the new procedure, guide students through procedures, and have students work
independently. These steps were followed for instruction at each level of the C-R-A model. At
the concrete level, manipulatives were used, at the representational level, pictures were used, and
at the abstract level, symbols only. Students who received C-R-A instruction significantly out-
performed peers on both the posttest and follow-up test, each requiring solutions to 27 algebraic
transformation equations.
Jitendra’s model, Schema-Based Strategy Instruction, was the intervention for two single-
subject studies and one group study to improve math problem solving for middle school students
with LD (Jitendra et al., 2002; Jitendra et al., 1999; Xin et al., 2005). Jitendra’s model, as de-
scribed in the elementary school section of this chapter, was effective in teaching young students
to solve various types of addition and subtraction problems. In her middle school studies, students
were taught the schemata for multiplication and division problems, i.e., the multiplicative com-
pare problem schema and the proportion problem schema. The following problem is an example
of a multiplicative compare problem: Juan earned $15 raking leaves. This was one-third as much
as Jennifer made. How much did Jennifer earn? Students learned that a multiplicative compare
problem always includes a referent set, a compared set, and a statement that relates the compared
set to the referent set. In this problem, the compared set is $15, one-third is the relation, and the
referent set is unknown. Prompt sheets are provided initially and then faded as students learn
to recognize the schema and apply the strategy. The first of five strategy steps asks students to
identify and underline the relational statement in the problem. The second step requires students
to identify the referent (unknown) and the compared and map the information onto the schema
diagram provided. For the third step, students must map the relation onto the diagram, and the
fourth instructs students how to transform the information in the diagram into a math equation,
e.g., 12 over ? equals one-third. Finally, students compute, write the answer, and check the ac-
curacy of the diagrammatic representation and the computation.
The students in these studies showed marked improvement in solving multiplication and
division word problems. Students maintained strategy use and performance between two and 10
weeks, and showed generalization of strategy use to novel problems.
Montague’s intervention, the Solve It! curriculum, was the foundation for a single subject
study and a group study with middle school students with LD (Montague, 1992; Montague et
al., 1993). In the single-subject study, the two sixth-grade students did not reach criterion for
mastery, indicating that younger students may need adaptations to benefit from the intervention.
The students with LD in the group study, following about three weeks of instruction, performed
at the same level as their average-achieving peers on a test of math problems. Students declined
in performance after two months. However, a booster session consisting of one day of review and
one day of practice was provided, and students met criterion on the problem solving test. Solve
It! incorporates the following cognitive processes.

1. Reading the problem (reading, rereading, identifying relevant/irrelevant information).

2. Paraphrasing (translating the linguistic information by putting the problem into one’s own
words without changing the meaning of the “story” or “situation”).
3. Visualizing (transforming the linguistic and numerical information to form internal rep-
resentations in memory through a drawing or image that shows the relationships among
the components of a problem).
 11. EFFECTIVE MATHEMATICS INSTRUCTION 249

4. Hypothesizing about problem solutions (establishing a goal, looking toward the outcome,
and setting up a plan to solve the problem by deciding on the operations that are needed,
selecting and ordering the operations, and transforming the information into correct equa-
tions and algorithms).
5. Estimating the outcome or answer (validating the process as well as the product by pre-
dicting the outcome based on the question/goal and the information presented).
6. Computing the outcome or answer (recalling the correct procedures for the basic opera-
tions needed for solution—calculator skills are taught/reinforced here).
7. Checking (students become aware of problem solving as a recursive activity and learn
how to check both process and product by checking their understanding and representa-
tion as well as the accuracy of the process, procedures, and computation).

Students are also taught to use self-regulation strategies, i.e., self-instruct or tell themselves
what to do, self-question or ask themselves questions as they solve problems, and self-monitor
or check themselves throughout the problem solving process. Self-instruction involves provid-
ing one’s own prompts and talking oneself through the problem solving routine. Self-instruction
combined with self-questioning is very effective for guiding learners through the problem solving
process. Students are taught specific questions to ask and are provided ample practice as they solve
problems. For example, after formulating a visual representation of the problem, they ask them-
selves, Did the picture fit the problem? and Did I show the relationships among the problem parts?
Self-checking helps students review and reflect on the problem and ensure that the solution path
is appropriate and correct as well as check the procedures and computations for mistakes. Each
phase and process of the problem solving routine has a corresponding self-regulation strategy (a
SAY, ASK, CHECK procedure). That is, students learn to check that they understand the problem,
check that the information selected is correct and makes sense, check that the schematic repre-
sentation reflects the problem information and shows the relationships among the problem parts,
check that the solution plan is appropriate, that they used all the important information, and check
that the operations were completed in the correct sequence, and, finally, check that the answer is
correct. To do this, the following routine (see Figure 11.1) is used. If they are unsure at any time
as they solve the problem, they tell themselves to return to the problem to recheck or ask for help.
Students are taught how to decide if they need help, whom to ask, and how to ask for help.
Scripted lessons with proven procedures associated with explicit instruction provided the
teaching/learning structure. These procedures, incorporated into the scripts, include verbal re-
hearsal, process modeling, visualization, performance feedback, mastery learning, and distribut-
ed practice. When students first learn a strategy, they must first memorize a sequence of activities
for the cognitive routine. Students are cued and prompted until they can recite the salient steps
of the strategy from memory. Acronyms can be used to remind students of the sequence. For
example, RPV-HECC (read, paraphrase, visualization, hypothesize, estimate, compute, check)
helps students remember the cognitive processes taught with Solve It! Process modeling is sim-
ply thinking aloud or saying everything one is thinking and doing while solving problems. First,
the teacher models use of the strategy solving actual problems. As students become familiar
with the routine, they can exchange roles with the teacher and model problem solving for other
students. Visualization, the basis for understanding the problem, is a problem representation pro-
cess. Students learn how to construct a schematic or relational image, either mentally or on paper,
of the problem. Positive and corrective feedback is provided by teachers and peers throughout
the acquisition and application phases of instruction. Mastery learning implies meeting a preset
performance criterion, e.g., 7 problems correct out of 10 over four consecutive tests of 10 one-,
two-, and three-step problems. Distributed practice is necessary if students are to maintain use of
the strategy and performance levels.
250 MONTAGUE AND VAN GARDEREN

READ (for understanding)

Say: Read the problem. If I don’t understand, read it again.
Ask: Have I read and understood the problem?
Check: For understanding as I solve the problem.

PARAPHRASE (your own words)

Say: Underline the important information. Put the problem in my own words.
Ask: Have I underlined the important information? What is the question? What am I looking for?
Check: That the information goes with the question.

VISUALIZE (a picture or a diagram)

Say: Make a drawing or a diagram. Show the relationships among the problem parts.
Ask: Does the picture fit the problem? Did I show the relationships?
Check: The picture against the problem information.

HYPOTHESIZE (a plan to solve the problem)

Say: Decide how many steps and operations are needed. Write the operation symbols (+, -, x, and /).
Ask: If I …, what will I get? If I …, then what do I need to do next? How many steps are needed?
Check: That the plan makes sense.

ESTIMATE (predict the answer)

Say: Round the numbers, do the problem in my head, and write the estimate.
Ask: Did I round up and down? Did I write the estimate?
Check: That I used the important information.

COMPUTE (do the arithmetic)

Say: Do the operations in the right order.
Ask: How does my answer compare with my estimate? Does my answer make sense? Are the decimals or
money signs in the right places?
Check: That all the operations were done in the right order.

CHECK (make sure everything is right)

Say: Check the plan to make sure it is right. Check the computation.
Ask: Have I checked every step? Have I checked the computation? Is my answer right?
Check: That everything is right. If not, go back. Ask for help if I need it.

FIGURE 11.1 Math problem solving processes and strategies. From Montague (2003). Copyright by Ex-
ceptional Innovations. Permission to photocopy this figure is granted for personal use only.

SECONDARY SCHOOL MATHEMATICS INSTRUCTION

Six studies conducted with students with LD are described. The first utilized manipulatives to
improve performance on area and perimeter problems (Cass, Cates, Smith, & Jackson, 2003).
Geoboards and a model house were used to teach three high school students to solve area and pe-
rimeter problems. Instruction incorporated proven practices such as modeling, prompting, guided
practice, and independent practice. Students were actively involved and showed improvement in
 11. EFFECTIVE MATHEMATICS INSTRUCTION 251

five to seven days and maintained performance levels over a two-month period. The second study
investigated the effects of peer-assisted learning strategies (PALS) and curriculum-based mea-
surement (CBM) on the mathematics performance of 92 students in grades nine through twelve
(Calhoon & Fuchs, 2003). Students in the intervention group received training in tutoring and
CBM and were paired with a classmate. Tutoring dyads changed every two weeks. Following 15
weeks of PALS/CBM twice weekly, students who received the intervention scored significantly
higher on a test of computation than the control group students. However, no significant differ-
ence between groups was found on the concepts and application math test.
Two studies used the C-R-A model to improve performance on algebra problems (Maccini
& Hughes, 2000; Maccini & Ruhl, 2000). Maccini’s model is an instructional strategy using
the C-R-A graduated teaching sequence moving from the concrete to semiconcrete to abstract
representations and solutions with problems involving addition, subtraction, multiplication, and
division of integers. Her “STAR” strategy utilizes manipulatives and a systematic sequence of
steps:

S = Search the word problem (Read; Ask yourself questions, i.e., What facts do I know?
What do I need to find?; Write down facts).
T = Translate the words into an equation in picture form (Choose a variable; Identify
the operations; Represent the problem using concrete, semi-concrete, and abstract
representations).
A = Answer the problem using cues and a work mat.
R = Review the solution (Reread the problem; Ask the question, i.e., Does the answer make
sense? Why?; Check the answer).

In both studies, students with LD improved their ability to represent algebraic problems,
were more accurate in solving simple algebraic word problems, maintained improved perfor-
mance over time, and generalized strategy use in both near- and far-transfer tasks.
The final two studies used cognitive strategy instruction to improve students’ problem solv-
ing (Hutchinson, 1993; Montague & Bos, 1986). Montague’s Solve It! model, described in the
last section, was the basis for an intervention study with six secondary school students with
LD (Montague & Bos, 1986). All students improved to criterion, maintained the strategy and

Self-Questions for Representing Algebra Word Problems

1. Have I read and understood each sentence? Are there any words whose meaning I have to ask.
2. Have I got the whole picture, a representation, for the problem?
3. Have I written down my representation on the worksheet? (goal, unknown(s), known(s), type of
problem, equation
4. What should I look for in a new problem to see it is the same kind of problem?

Self-Questions for Solving Algebra Word Problems

1. Have I written an equation?
2. Have I expanded the terms?
3. Have I written out the steps of my solution on the worksheet? (collected like terms, isolated
unknown(s), solved for unknown(s), checked my answer with the goal, highlighted my answer)
4. What should I look for in a new problem to see if it is the same kind of problem?

FIGURE 11.2 Self-question prompt card for solving algebra problems

252 MONTAGUE AND VAN GARDEREN

Goal: ___________________________________________________________________________________________________

What I don’t know: _____________________________________________________________________________________

What I know:

I can write/say this problem in my own words. Draw a picture.

Kind of problem: ________________________________________________________________________________

Equation:

Solving the equation:

Solution:

Compare to goal:

Check:

FIGURE 11.3 Structured worksheet for solving algebra problems

performance level over time, and generalized strategy use to more difficult problems. Hutchin-
son’s (1993) intervention targeted algebra problems. The strategy included a set of self-questions
on prompt cards for the problem representation and solution phases and a structured worksheet
(See Figure 11.2 and Figure 11.3).
Hutchinson taught three types of algebra problems: relational problems (e.g., Eddie walks
6 miles farther than Amelia. If the total distance walked by both is 32 miles, how far did each
walk?); proportion problems (e.g., On a map a distance of 2 inches represents 120 miles. What
distance is represented on this map by 5 inches?); and two-variable two-equation problems (e.g.,
Sam traveled 760 miles, some at 80 miles per hour and some at 60 miles per hour. The total
time taken was 8 hours. Find the distance Sam traveled at 80 miles per hour). Scripted lessons
guided instruction. Students with LD who received cognitive strategy instruction outperformed a
comparison group of peers with LD on the posttest, which consisted of 5 problems of each type.
Maintenance and transfer effects were evident.
 11. EFFECTIVE MATHEMATICS INSTRUCTION 253

CONCLUSION

There is clearly a need for research to identify more precisely what constitutes effective, scientifi-
cally-based practice in teaching mathematics to students with learning and behavioral disorders.
What we have learned is that students with these special needs fall further behind in mathematics
as they progress through school. Geary (2004) estimated the prevalence of mathematical learning
disabilities at between 5% and 8% of the school-age population, similar to the estimated preva-
lence of reading disabilities. However, unlike reading, low achievement and underachievement
in mathematics actually may increase as children progress through school due to the nature of
mathematical learning. Mathematics requires that learners acquire and apply multiple concepts
and skills to be successful across the numerous topics in mathematics (e.g., geometry, algebra).
Dietz (2006), in a study of disorders in adolescents (n = 165), found that between 10% and 13%
of the students qualified as having learning disabilities in mathematics using stringent researcher
criteria, while 40% were achieving at least one standard deviation below the mean on a standard-
ized math test. Additionally, to further exacerbate matters, some students will evidence disabili-
ties in both reading and mathematics.
As noted, the majority of intervention studies in mathematics in special education have fo-
cused on teaching basic skills, primarily math facts and algorithmic procedures, generally with-
out providing any conceptual foundation for learning these skills. If students are to be successful
in mathematics, they need to understand the concepts underlying even these seemingly simple
skills, i.e., they need to gain conceptual knowledge. Further, problem solving is the centerpiece
of mathematics instruction in most mathematics classrooms, a result of curricular recommenda-
tions in the NCTM Standards (NCTM, 2000). To be successful problem solvers, students must
also acquire and apply strategic knowledge for solving math problems and this instruction should
begin early in elementary school.
Based on findings from the intervention research in mathematics conducted so far, we can
draw some conclusions about effective instruction. First, as in other academic domains, principles
and practices associated with direct instruction and cognitive strategy instruction are components
of most of the intervention “packages” that characterize the research across grade levels. These
principles and practices include demonstration and modeling, verbal rehearsal, guided practice,
corrective and positive feedback, independent practice, mastery, and distributed practice. Many
studies have not been replicated and, thus, are limited in advancing knowledge of effective prac-
tice. Several researchers, however, have conducted a series of studies using a particular approach
or model (e.g., Jitendra’s schema-based problem solving model, which further substantiates the
effectiveness of the approach with different groups of students under different conditions). This
perhaps is the most promising avenue if we are to identify what works, with whom the interven-
tion works, and under what conditions it works. In conclusion, the limited research in mathemat-
ics interventions for students with learning and behavioral disorders does indeed provide a base
for moving to the next level. This next level of scientifically-based research will provide further
understanding of the development of mathematical learning disabilities and, most importantly,
will identify effective interventions that address and remedy the problems in mathematics that so
many students manifest.

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 12
Cognitive Processing Deficits
Milton J. Dehn

Information processing analyses of mental abilities may enable us to diagnose and eventually re-
mediate deficiencies in intellectual function at the level of process, strategies, and representations
of information. (Sternberg, 1981, p. 1186)

More than 25 years after Sternberg’s optimistic statement, we still have a long way to go. The
whole notion of attempting to remediate a cognitive processing deficit remains quite controver-
sial, and many psychologists and educators will simply not accept it. Early attempts to estab-
lish evidence-based procedures often met with failure or were at best equivocal (Kavale, 1990;
Loarer, 2003), and reliable and valid processing assessment tools were unavailable until recently
(Dehn, 2006). Nevertheless, recent advances in neuroscience and neuropsychology have expand-
ed our knowledge of how the brain functions during academic learning (Berninger & Richards,
2002), and, as a result, efficacious neuropsychological treatments (Eslinger, 2002) are emerging.
In addition, a substantial amount of educational research literature has documented a range of
effective interventions for at least some of the cognitive processes that are essential for academic
learning. Given the renewed emphasis on educational interventions designed to prevent and re-
mediate learning problems (Brown-Chidsey & Steege, 2005), processing interventions, at the
very least, deserve another look.
Many educators and psychologists have the impression that there is a dearth of evidence-
based interventions for cognitive processing problems. To the contrary, not only is the literature
replete with documentation of effective interventions but most educators frequently utilize varia-
tions of substantiated methods (often unknowingly) that reduce the deleterious effects of defi-
cient cognitive processes. To espouse the view that no effective interventions exist for processing
deficits is analogous to saying that no educational interventions exist for improving the learning
and functioning of individuals with mental retardation. Nonetheless, direct instruction is widely
recognized for its significant positive impact on the academic learning of children with mental
retardation (Gersten & Keating, 1987). The fact that direct instruction fails to raise IQ does not
diminish its acceptance or efficacy. So why do many educational professionals demand that pro-
cessing interventions directly ameliorate what are often immutable brain-based processes? Once
we acknowledge the value of compensatory strategies, as we do for most learning difficulties, we
will discover an ample selection of scientific-based interventions for several of the processes that
underlie intellectual functioning and academic learning. Gaining more knowledge about cogni-
tive processes and implementing processing interventions will benefit all students, especially
those who struggle with learning.

258
 12. COGNITIVE PROCESSING DEFICITS 259

HISTORY OF PROCESSING INTERVENTIONS

Within the field of special education, processing interventions have a long and controversial
history. Prior to 1990, recognized processing interventions were usually referred to as “process
training” and consisted mainly of modality training, perceptual-motor training, and psycholin-
guistic training. Modality training was based on the presumption that matching instructional
strategies to individual modality preferences (either auditory, visual, or kinesthetic) would en-
hance learning. Perceptual-motor training focused on the integration of visual-perceptual and
motoric functioning, using such techniques as Doman-Delacato psychomotor patterning. Psy-
cholinguistic training emphasized training in discrete language production subcomponents,
such as auditory reception, which could be assessed with subtests from the Illinois Test of
Psycholinguistic Abilities (Kirk, McCarthy, & Kirk, 1968). These three types of process train-
ing were the subject of numerous investigations (e.g., Hammill, Goodman, & Weiderholt, 1974;
Hammill & Larsen, 1974) that mostly found these methods to be ineffective (see Kavale, 1990,
for a detailed review. Vigorous attacks on process training began as early as the 1960s, and
Mann (1979) expressed frustration with process training’s resistance to extinction, despite an
overwhelming amount of empirical evidence documenting its failure. By 1990 it was clear that
modality training and perceptual-motor training did not improve processes or enhance academic
learning (Kavale, 1990). However, contradictory findings, including meta-analytic results, on
psycholinguistic training continued to fuel the controversy surrounding it. Despite the intuitive
appeal of these three early types of processing interventions, the empirical evidence was at best
equivocal.

Contemporary Approaches

Contemporary interventions for processing difficulties should not be associated with these early
failed types of process training. Recent research on processing interventions has gone beyond
modality, perceptual-motor, and psycholinguistic training. Interventions for several types of cog-
nitive processing deficits now have a scientific track record of success, or at the every least,
emerging support. Led by advances in neuroscience (Berninger & Richards, 2002) and applied
research in pediatric neuropsychology, the nature of processing interventions has changed. This
is not a case of old ideas and methods masquerading as something new, as was once suggested
by Mann (1979). To begin with, advances in neuroimaging and psychometrics allow us to better
measure, identify, and differentiate the neurological and cognitive processes and subprocesses
involved in learning (Feifer & DeFina, 2000, 2002, 2005; Schrank, 2006). Current processing
interventions are distinct from the early discredited approaches; for example, interventions for
planning deficits (Naglieri & Gottling, 1997) and memory limitations (Ritchie & Karge, 1996)
have nothing in common with obsolete process training. In general, contemporary, evidence-
based processing interventions tend to focus on higher-level cognitive processes, such as working
memory and executive functioning. Recent neuropsychological research has even discovered that
processes once considered immutable might be ameliorated through specific cognitive training
(Klingberg, Forssberg, & Westerberg, 2002; Olesen, Westerberg, & Klingberg, 2004). Despite
recent advances, neuropsychological findings can be difficult to apply in an educational environ-
ment (Work & Choi, 2005). Hopefully, the growing interest in school neuropsychology (e.g.,
D’Amato, Fletcher-Janzen, & Reynolds, 2005; Hale & Fiorello, 2004) may further develop the
bridge between beneficial interventions in related fields and those needed in the educational
environment.
260 DEHN

History of Strategy Training

Cognitive strategy training, much of it directed towards processing deficiencies, especially defi-
ciencies in memory and executive functioning, has been researched and applied in educational
settings for the past 30 years. Strategy instruction and interventions, which were full-fledged by
the 1980s, are based on the information processing model and are designed to teach individuals
to more efficiently utilize their cognitive processing resources, such as short-term and long-term
memory. Research has found strategy training to be particularly advantageous for children with
learning disabilities (Swanson, 2001; Turley-Ames & Whitfield, 2003), given that they seldom
independently learn and use strategies (Carlson & Das, 1997). Strategy training can lead to im-
proved processing performance; for example, encoding strategies that add meaning to new in-
formation have been shown to increase retention and retrieval of information (Banikowski &
Mehring, 1999). Unlike the classic process training, strategy training has not been limited to
individuals with disabilities; there is also a history of attempts to incorporate strategy training
into the general education curriculum. For example, Conway and Ashman (1989) proposed the
implementation of the Process-Based Instruction (PBI) model. Although the bulk of the research
on strategy training has been favorable, with significant improvements in targeted processes and
academic performance (Pressley & Woloshyn, 1995), lack of maintenance and generalization
remains a concern (Carlson & Das; Conway & Ashman; Deshler & Schumaker, 1993).

PROCESSING THEORIES

The construct of cognitive processing is nearly as controversial as that of intelligence (Floyd,

2005). Despite the discord, most psychologists and educators would agree that processing in-
volves the complex integration and interaction of many interrelated functions spread throughout
the brain and that cognitive processing refers to mental operations by which sensory input is per-
ceived, manipulated, transformed, stored, and retrieved. As we learn or accomplish a behavioral
task, several processes are involved; a neural network of distributed, coordinated activity is occur-
ring in many regions of the brain. Neuropsychologists often focus on the elemental and discrete
subprocesses in the brain that underlie observable behavior and cognition; for example, there are
many subprocesses involved in retrieving verbal knowledge. In contrast, a more applicable model
in the educational environment is that which emphasizes the higher level and broader cognitive
processes that are more readily observable and measurable and have known relationships with
academic learning. Examples of such theoretical models are the classic information processing
theory (Gagne, Yekovich, & Yekovich, 1993) and the PASS (Planning, Attention, Simultaneous,
and Successive) processing theory (Das, Naglieri, & Kirby, 1994).

INFORMATION PROCESSING THEORY

Information processing theory uses the computer as a metaphor for human mental processing
(Gagne et al., 1993). The model describes an input-output flow of information in which the main
components are the senses, immediate memory, working memory, long-term memory, execu-
tive control, and muscles that produce a response. The main processes are selective perception,
encoding, retrieval, response organization, and executive functioning. Working memory is a core
component in this model, as it processes most incoming and outgoing information. Working
memory is also a central process because all higher level processes interact with or are embed-
 12. COGNITIVE PROCESSING DEFICITS 261

ded in working memory (see working memory section for more details). Executive processes are
another crucial element, as they serve a governing function, controlling and regulating all other
processes.
Information processing theory has evolved along with our understanding of cognition, learn-
ing, and brain functioning, leaving the computer metaphor and the notion of information trans-
mission outdated. Human information processing is no longer viewed as static, passive, linear,
or mechanistic. Contemporary views of information processing emphasize the executive pro-
cesses because efficient processing is self-directed. A constructivist interpretation of information
processing has also gained acceptance (Mayer, 1996). In this view, processing involves an ac-
tive search for understanding in which incoming information is restructured and integrated with
stored knowledge.

PASS Theory

Luria (1970) proposed a theory of cognitive processes associated with three functional brain units:
(1) cortical arousal and attention; (2) simultaneous and successive information processes; and (3)
planning, self-monitoring, and structuring of cognitive activities (Naglieri & Gottling, 1997).
PASS theory, which stands for Planning, Attention, Simultaneous, and Successive processing, is
an adaptation of Lurian theory (Das et al., 1994). Planning, an essential component of executive
processing, encompasses mental processes by which the individual determines, selects, applies,
and evaluates solutions to problems. Attention is a mental process by which the individual se-
lectively focuses on particular stimuli while inhibiting responses to competing stimuli (Naglieri,
1999). Simultaneous processing involves the integration of separate stimuli into a single whole
or group, usually a spatial group, and being able to recognize patterns in a group, for example,
seeing patterns in numbers. Successive processing, also referred to as sequential processing, is
the integration of stimuli into a specific serial order whereby each link is related only to the next
stimulus in the chain; for example, successive processing is used when readers blend sounds to
form words (Naglieri & Pickering, 2003).

CHC Theory

In addition, several other cognitive processes have been associated with academic learning, in-
cluding auditory processing, processing speed, visual processing, phonological processing, and
linguistic processing. One theoretical model that encompasses many of these cognitive pro-
cesses—Cattell-Horn-Carroll (CHC) theory (Carroll, 1993; Horn & Blankson, 2005; McGrew,
2005)—is actually a theory of cognitive abilities. The theory is applicable to processing because
most of the theory’s cognitive abilities can be directly linked with cognitive processes. The well
known Woodcock-Johnson III (WJ III) assessment battery (Woodcock, McGrew, & Mather,
2001) operationalizes CHC theory. Schrank (2006) recently added further clarification regarding
the cognitive processes and subprocesses involved in performance on each WJ III test.

Other Processes

Evidence-based interventions currently exist for only some of the processes that are identified
in processing theories and brain-based research. Fortunately, several processes that are essential
for academic learning have well established interventions; for example, phonological processing
(necessary for reading and spelling words) programs are clearly efficacious, whereas the treat-
ment literature on visual processing has a low correlation with academic learning (Mather &
262 DEHN

Wendling, 2005; McGrew & Woodcock, 2001). Sensory and motoric processes also have weak
relationships with learning and higher cognitive processes; thus, sensory-motor interventions
will not be discussed in this chapter, although they can be beneficial for improving handwriting.
Also, the reader is referred elsewhere for processing interventions related to speech/language
production (e.g., Mitchum & Berndt, 1995; Robey, 1998).

ASSESSMENT AND DIAGNOSIS OF PROCESSING DEFICITS

Selecting an intervention that matches the needs of the learner begins with an assessment of the
learner’s cognitive processes. Processing assessment is also controversial, with part of the current
debate arising from ongoing misconceptions about what processing assessment entails. Contem-
porary processing assessment has nothing to do with modalities or learning styles. Rather, it is
based on neuropsychology and empirically supported cognitive theories, and it consists of using
recently developed standardized tests with reputable technical properties (Dehn, 2006).
Standardized testing is an essential component of processing assessment and should take
precedence over informal methods. Informal processing assessment procedures are fraught with
inherent reliability and validity problems. Informal processing assessment is particularly chal-
lenging because most cognitive processes are not directly observable and because many processes
underlie a typical educational task, such as the many processes involved in following directions.
Thus, some standardized testing of processes should be conducted whenever a student is referred
for a possible learning disability or whenever a processing intervention is being considered. For-
tunately, there are many technically adequate processing measures to select from. Even the most
traditional intellectual instrument, the Wechsler Intelligence Scale for Children-Fourth Edition
(WISC-IV), has recently added a processing supplement (Wechsler et al., 2004).
Testing of cognitive processes should be hypothesis-driven and selective, combining sub-
tests and factors in a cross-battery fashion. Examiners need not administer entire time-consuming
comprehensive batteries. Analysis and interpretation of test results should focus on significant
intra-individual strengths and weaknesses across batteries, in addition to identifying normative
strengths and weaknesses. Furthermore, the assessment data should be interpreted from an ac-
tuarial and a clinical perspective, with an eye towards convergent data that support or do not
support processing hypotheses. See Dehn (2006) for more details and recommendations on con-
ducting and interpreting a processing assessment.
When deliberating a processing deficit diagnosis, several factors need to be considered. First,
examiners should avoid using subtest scatter to identify the learner’s processing deficits. Rather,
a process score should be considered indicative of a deficit only when it is both a statistically
significant intra-individual weakness and below the average range (Dehn, 2006; Naglieri, 1999).
Second, the learner’s developmental level and the degree of process or skill automaticity will also
impact test performance. Automaticity is acquired through practicing skills to an overlearned
state, thereby reducing the cognitive processing and interval required for their execution (Farqu-
har & Surry, 1995). Awareness of the role of automaticity and knowledge of the individual’s level
of specific skill mastery is important when conducting an evaluation so as to avoid attributing
poor performance to insufficient capacity when it may actually result from lack of automaticity.
Third, what appears to be a capacity deficit might actually be a strategy deficit instead, a strategy
deficit being the undirected, inefficient use of cognitive resources. The consistent use of effective
strategies is thought to impact performance on measures of information processing; that is, indi-
viduals who strategically and efficiently allocate their processing resources will perform better
(Turley-Ames & Whitfield, 2003). Finally, effective utilization of processing potential depends
 12. COGNITIVE PROCESSING DEFICITS 263

on adequate executive functioning and metacognition, the awareness and regulation of one’s cog-
nitive resources (Pressley & Woloshyn, 1995). Processing deficits are the observable indications
of brain impairment. When these impairments disrupt or interfere with some aspect of function-
ing, the result is often the diagnosis of a disability.

COGNITIVE PROCESSES AND ACADEMIC LEARNING

A learning difficulty or a learning disability (LD) is often due to a deficiency in one or more
processes, incomplete development of processes, or inefficient (non-strategic) use of processes.
Research in a variety of fields has identified several processing impairments that are correlated
with specific learning disabilities, the most common ones being attentional, memory, linguistic,
phonological, perceptual, and executive processing deficits. At times, learning may be impaired
because of a single deficient process; at other times, the impairment may result from several weak
processes. Working memory, which plays a crucial role in all types of academic learning, is the
process most frequently implicated in the research (Gathercole, 1999; Minear & Shah, 2006;
Pickering, 2006; Swanson, 2000; Wechsler, 2003b). Students with LD are especially deficient
in the auditory component of working memory. Other processing-learning connections are also
well known; for example, hardly anyone would dispute the strong connection that phonological
processing has with basic reading skills (National Reading Panel, 2000) or argue that learning is
not highly dependent on long-term memory storage and retrieval. Research (Evans, Floyd, Mc-
Grew, & Leforgee, 2002; Floyd, Evans, & McGrew, 2003) continues to identify the relationships
various broad processes have with specific types of learning (see Table 12.1).

APPROACHES TO PROCESSING INTERVENTIONS

In the educational environment, cognitive processing interventions refer to various treatments

and interventions that involve the development of specific cognitive and metacognitive abilities
and skills, with the goal of optimizing academic learning outcomes. Interventions for cognitive
processing deficiencies have mostly been researched and developed within the fields of neuro-
psychology, cognitive psychology, educational psychology, and speech/language therapy. After
introducing the construct of information processing decades ago, cognitive psychologists (An-
derson, 1976; Gagne, 1974; Gagne et al., 1993) were instrumental in early research on compensa-
tory strategies for working memory and other processing limitations. Educational psychologists
followed with investigations into how effective teaching practices enhance encoding and retrieval
TABLE 12.1
Cognitive Processes Highly Related with Types of Academic Learning

Reading Mathematics Written Language Reading Comprehension

Working Memory Working Memory Working Memory Working Memory
Auditory Processing Fluid Reasoning Executive Processing Executive Processing
Phonological Processing Planning Planning Fluid Reasoning
Long-Term Retrieval Visual Processing Auditory Processing Long-Term Retrieval
Successive Processing Processing Speed Processing Speed
Visual Processing
264 DEHN

of information (Rosenshine & Stevens, 1986). More recently, neuroscientists have been using
neuroimaging technology to reveal the various brain processes involved in learning (Berninger &
Richards, 2002), and neuropsychologists have been developing treatments and interventions for
processing deficits resulting from acquired brain injury (Eslinger, 2002). In the educational envi-
ronment, improved academic learning and performance are the ultimate objectives of processing
interventions. Consequently, the determination of effectiveness should be based on measure-
ment of related academic skills, as well as measurement of the cognitive processes involved. For
instance, some studies have found no post-intervention improvement in cognitive processes but
have found improvement in related areas of achievement (Leasak, Hunt, & Randhawa, 1982).
Three general approaches to intervention have been used for processing problems—remedial,
compensatory, and a combination of the two. Remedial interventions have a deficit-based focus,
with the goal of improving processing weaknesses and deficiencies. Compensatory interventions
utilize the individual’s cognitive strengths and assets, in an effort to bypass the deficit, thereby
reducing its impact on learning and performance. For example, training in the use of cognitive
strategies, such as mnemonics, is a common compensatory intervention. Many interventions,
however, combine these two approaches, utilizing the individual’s strengths to remedy his or her
deficits. For example, instruction that addresses working memory limitations may be both com-
pensatory and remedial in nature, with the goal of more efficiently using the individual’s working
memory resources. Most effective interventions reported in the literature are multidimensional
in nature, and most psychologists and educators would agree that a unified approach, with the
potential of additive effects from multiple methods, has the best chance of success (Work & Choi,
2005). Consequently, the primary focus of this chapter will be on evidence-based compensatory
interventions and interventions that combine a remedial and compensatory approach.

Remedial Interventions

Past attempts to address processing deficits through a remedial approach alone have generally
been unsuccessful (Lee & Riccio, 2005). This is not surprising, given that the capacities of various
cognitive processes have traditionally been thought to be constant. Perhaps, another reason for the
failure is that an exclusive emphasis on a specific processing impairment ignores intact functions.
Recent studies suggest that some processes, and sometimes related processes, can be improved
through remedial training (Olesen et al., 2004). However, the extent of this research is limited. In-
terestingly, the brain’s response to direct remedial treatment appears to be compensatory in nature;
remedial neurological investigations have discovered that the brain may compensate for functional
loss by using other regions not normally involved in the behavior (Berninger & Richards, 2002),
thereby improving cognitive functioning that is not normally associated with these other brain
regions (Wilson, 1987). The fact that intact, associated neurological processes are able to perform
the function of a damaged or poorly developed process is testimony to the plasticity of the brain
(Shaywitz, 2003). It is also a compelling reason for attempting processing interventions.

Compensatory Interventions

Compensatory approaches entail methods that bypass the deficient processes (Glisky & Glisky,
2002) and typically involve strategy training (see later discussion) that incorporates processing
strengths. Compensatory approaches may also include external aids, accommodations, or substi-
tute methods of reaching the same goal. Given the complexity of processing and involvement of
several cognitive processes in any given academic learning task, compensatory interventions may
succeed because they tend to be broad based and focus on higher-level processes. For example, a
 12. COGNITIVE PROCESSING DEFICITS 265

performance problem on a measure of working memory may be due to an impairment in execu-

tive processing. Thus, a top-down, broad-based treatment approach is often selected instead of
focusing on a specific processing domain. Such an approach is more likely to promote general-
ization (Levine et al., 2000) and may additionally remediate unidentified processing deficits.

Combined Interventions

In contrast to the lack of empirical support for remedial interventions alone, a growing body of
scientific evidence supports combined interventions. For example, within the field of neuropsy-
chology, empirical evidence in support of cognitive training, or retraining, is increasing (Eslinger,
2002; Lee & Riccio, 2005). Most research on cognitive retraining has been with individuals who
have sustained a traumatic brain injury (TBI) but the methods also apply to other neurologically
based cognitive processing deficits, such as the developmental processing deficits possessed by
individuals with Attention Deficit Hyperactivity Disorder (ADHD) and by students with learning
disabilities (Lee & Riccio, 2005).
With the combined approach, the goal of focusing on the deficient process is not to improve
the process but rather to optimize its use (Lee & Riccio, 2005). The desired outcome of such
an approach is more efficient use of existing processing capabilities. Typically, individuals are
taught strategies that improve functioning of the targeted process. In fact, for some individuals,
poor processing performance in an area such as working memory may be due to a lack of strategy
knowledge or limited use of known strategies, rather than a lack of processing ability per se (Kar,
Dash, Das, & Carlson, 1993). Even when individuals with learning disabilities possess a reper-
toire of cognitive strategies, they seldom select and apply an effective strategy when the situation
warrants its use (Pressley & Woloshyn, 1995).

Cognitive Strategy Interventions

Cognitive strategy interventions are designed to improve performance through compensatory

procedures or through more efficient functioning of weak or deficient processes. Strategy training
can be incorporated into classroom instruction or conducted with an individual student. Mne-
monic training, which is designed to increase encoding and retrieval of information, is the most
common and most effective application, with a strong effect size of 1.6 (Lloyd, Forness, & Ka-
vale, 1998). Another major type is self-instruction training. Over the past 30 years, self-instruc-
tion training has been successfully applied to executive processing deficits and other cognitive
processing impairments, such as attention and memory (Lee & Riccio, 2005). Other types of
strategy training often involve a metacognitive element, and some strategy interventions are en-
tirely metacognitive.

GENERAL STRATEGY TRAINING PROCEDURE

Acquiring and utilizing a cognitive strategy requires more than knowledge of a skill; knowing
how to select and use the best procedures is also a critical aspect of strategy application. The suc-
cess of strategy training depends on adherence to evidence-based training procedures. In general,
strategy training should be explicit and intensive over an extended period of time until strategy
use becomes automatic. Deshler and Schumaker (1993), Mastropieri and Scruggs (1998), and
Pressley and Woloshyn (1995) all provide details on strategy training procedures. The essential
steps and caveats in the strategy training process are:
266 DEHN

1. Teach only one strategy at a time, at least until the student is familiar with the idea of
strategy use.
2. Inform the student about the purpose and rationale for the strategy. Explain the benefits
and how it will result in better performance.
3. Explain and demonstrate the strategy, with special attention to aspects of strategy use that
generally are not well understood.
4. Model all steps and components of the strategy while thinking aloud.
5. Explain to the student when, where, and why to use the strategy.
6. Provide plenty of practice with corrective feedback, first with external guidance, then
with the student thinking aloud, and finally while encouraging the student to internalize
the strategy, such as having the student whisper the steps while enacting them.
7. Give the student reinforcement for and feedback on the use of the new strategy so that the
student understands the personal efficacy of strategy use.
8. Encourage the student to monitor and evaluate strategy use and to attribute his or her suc-
cess to strategy use.
9. Encourage generalization by discussing applications of the strategy and practicing the
strategy under different situations.

The Good Information Processor

The overall goal of strategy training is not to teach just one strategy but to help the learner de-
velop into a “good” information processor. The essential characteristics of a good information
processor, according to Pressley and Woloshyn (1995), include:

1. Possessing numerous strategies for accomplishing a variety of goals.

2. Being aware of one’s cognitive strengths and weaknesses.
3. Using efficient processes to accomplish a task.
4. Knowing where and when to use a particular strategy.
5. Monitoring the use of a strategy to determine if the goal is being accomplished.
6. Being able to coordinate strategies to accomplish complex goals.
7. Having developed strategies that are efficient, automatic, and flexible.
8. Engaging in reflective thinking.

Selection and Range of Interventions

Of course, success is not guaranteed, even with well established, evidence-based interventions.
One determinant of success is how well an intervention matches the needs of the learner, the
academic task, and the environmental demands. Interventions for processing problems should be
closely tailored to the cognitive or neurodevelopmental profile of the student, thereby increasing
the likelihood of positive outcomes (Feifer & DeFina, 2000). However, selecting an intervention
that focuses on an isolated process may not be the most appropriate choice, given the interactive
nature of processing components during cognitive activity (Swanson, Hoskyn, & Lee, 1999). It
is also frequently the case that a student has impairments in several cognitive processes. Thus,
broad based, higher level processing interventions are often appropriate. Because a disability is
the product of an interaction between the individual and the environment, procedures that modify
the environment also constitute interventions, for example, effective instructional practices that
reduce the demands on learners’ processing.
 12. COGNITIVE PROCESSING DEFICITS 267

THE IMPORTANCE OF EARLY INTERVENTIONS

Education’s renewed emphasis on early interventions is consistent with the brain-based research
on the importance of early interventions. Just like academic interventions, some processing
interventions are more effective at earlier ages; for example, there are diminishing returns on
phonological processing interventions as students progress through elementary school (National
Reading Panel, 2000). Processing interventions, especially those of a remedial nature, need to
occur before the maturing of the specific brain regions where the process of concern is located.
The key to successfully educating and retraining the brain is enrichment and treatment at critical
developmental stages (Feifer & DeFina, 2000). Change is more difficult once neural structures
are established and myelination is complete. The windows of opportunity for most basic pro-
cesses are in early childhood and early elementary; however, higher-level cognitive processes, in
particular planning, reasoning, and executive processing, continue to develop into adolescence.

Providing Processing Interventions in Educational Settings

For the most part, classroom teachers, special education teachers, school psychologists, and other
educational staff can provide the interventions reviewed in this chapter. None of the practices
require the completion of a special training course. Rather, independent study of the methods
involved should suffice. When implementing the intervention, it is important to faithfully adhere
to the procedural details recommended in research literature and other sources. The interventions
reviewed in this chapter are primarily intended for those students who have learning challenges
or are already identified as LD. However, even successful students may benefit from exposure to
these interventions. Most of the interventions can be adapted for individual, group, or classroom
use.

PHONOLOGICAL PROCESSING INTERVENTIONS

Phonological processing is the manipulation of the phonemes that comprise words (Gillon, 2004).
One of the most important phonological processes is phonemic awareness—the understanding
that words, spoken and written, can be divided into discrete sounds. The importance of phonolog-
ical processing and phonemic awareness to reading decoding and spelling has been extensively
documented (Kamhi & Pollock, 2005; National Reading Panel, 2000). Children who are better
at detecting phonemes learn to decode words more easily. Research has clearly established that
a deficit in phonological processing is a common factor among individuals with early reading
problems (Mather & Wendling, 2005). In fact, some experts argue that there is enough evidence
to conclude that a phonological processing deficit is a primary cause of reading disabilities (Bus
& Van Ijzendoorn, 1999). Given the fundamental role of phonological processing, it is alarm-
ing that one-third of middle-class first graders fail to fully recognize the phonemic structure of
words, with an even higher proportion of phonemic awareness weaknesses among disadvantaged
children (Brady, Fowler, Stone, & Winbury, 1994).
Of all the evidence-based processing interventions for academic learning, phonemic aware-
ness training has the most consistent track record of success. Phonological processing deficien-
cies can be ameliorated through training (Hurford et al., 1994). Numerous studies have also
unequivocally shown that explicit phonological processing or phonemic awareness training has
significant positive transfer effects on reading, spelling, and other linguistic processes (Bus &
268 DEHN

Van Ijzendoorn, 1999). Of the phonemic awareness studies reviewed by the National Reading
Panel (2000), the overall effect sizes were .86 for phonemic awareness outcomes, .53 for reading
outcomes, and .59 for spelling outcomes.
Several commercially available scientifically-based phonological awareness training pro-
grams are intended for classroom use (e.g., Adams, Foorman, Lundberg, & Beeler, 1998), and
the teaching of phonemic awareness skills is often incorporated into effective reading curricula.
Although a variety of approaches exist, including computer delivered instruction (Moore, Rosen-
berg, & Coleman, 2004), phonemic awareness programs address varied skills, including: (1)
rhyming; (2) isolating phonemes; (3) identifying phonemes; (4) deleting phonemes; (5) catego-
rizing common phonemes; (6) segmenting phonemes that comprise words; (7) and blending pho-
nemes into words. Because the ability to segment words into phonemic units is the hallmark of
phonological awareness, it should be the focus of any phonological awareness training. A major
difference among phonological awareness programs is whether or not they include a linkage with
written letters and words. Programs that directly connect phonological processing with reading
are generally more effective (Bus & Van Ijzendoorn, 1999). Chapters 7 and 8 of this volume pro-
vide further information on teaching phonological awareness.

WORKING MEMORY INTERVENTIONS

Working memory is defined as the limited capacity to retain information while simultaneously
manipulating the same or other information for a short period of time (Swanson, 2000). Working
memory evolved from the earlier concept of short-term memory; both working and short-term
memory involve short-term preservation of information. Thus, the constructs are often viewed
as interchangeable, or one is considered a subtype of the other. Working memory is distinct from
short-term memory in that working memory involves active manipulation of information, whereas
short-term memory is more static in nature. The classic WISC-IV Digit Span subtest (Wechsler,
2003a) illustrates the difference—responding correctly to Digits Forward requires only rote short-
term memory while responding correctly to Digits Backward demands the manipulation that is
the hallmark of working memory. In this chapter, the term “working memory” includes short-term
memory; thus, interventions for working memory apply to short-term memory as well.
Working memory can be divided into four main subprocesses—auditory, visual-spatial,
executive, and the episodic buffer. The classic three-part model (which excludes the episodic
buffer) of working memory, first proposed in 1974 by Baddeley and Hitch, has withstood re-
search and controversy and is currently compatible with neuropsychological evidence (Baddeley,
2006). The executive part of working memory has the central role of controlling the other three
subsystems and regulating the cognitive processes involved in working memory performance,
such as allocating limited attentional capacity. Because of its association with the frontal lobes,
full development of the executive component occurs later than the auditory, visual-spatial, and
episodic components (Gathercole, 1999). Auditory working memory (also known as the phono-
logical loop) is divided into two subcomponents—a temporary phonological store and a subvo-
cal rehearsal process (Minear & Shah, 2006). Visual-spatial working memory (also known as
the visuo-spatial sketchpad) is divided into the same two subcomponents and involves short-
term memory for objects and their location. The episodic buffer is a temporary storage system,
consciously accessible, that interfaces with long-term memory and constructs integrated rep-
resentations based on the information from long-term memory and the other working memory
subsystems (Baddeley).
The capacity of working memory is quite restricted, even in individuals with normal working
memory capacity. The typical individual can manage only five to nine pieces of information at a
 12. COGNITIVE PROCESSING DEFICITS 269

time. Unless the information is being manipulated, it will only remain in working memory for a
short interval, typically a maximum of 20 to 30 seconds. Given the inherent limitations of work-
ing memory, efficient utilization of its resources is important for all individuals, not just those
with working memory deficits or those with learning disabilities.
Working memory plays a critical, integral role in most higher-level cognitive activities, in-
cluding reasoning, comprehension, learning, and academic performance (Dehn, 2006; McNama-
ra & Scott, 2001). The cognitive processes that are closely linked with working memory include
executive functioning, fluid reasoning, processing speed, and long-term memory encoding and
retrieval (McNamara & Scott). For example, working memory interacts with long-term memory
by manipulating incoming information and linking it with related prior knowledge and also by
retrieving and evaluating stored knowledge. Consequently, adequate working memory processes
are essential for cognitive performance and learning; working memory capacity sets limits on
related higher-level processes (Conners, Rosenquist, & Taylor, 2001). In regards to academic
learning, reading decoding, reading comprehension, math reasoning, and written expression all
depend heavily on the adequate functioning of working memory; the strong relationships be-
tween academic functioning and working memory are well established (Berninger & Richards,
2002; Swanson, 2000; Swanson & Berninger, 1996).
Research has consistently found students with learning difficulties to display poor working
memory performance, especially in auditory working memory (Swanson & Berninger, 1996).
For example, in a WISC-IV standardization study (Wechsler, 2003b), children with reading dis-
abilities obtained their lowest mean on the Working Memory Index. The differences between
skilled readers and those with a reading disability are often attributed to deficiencies in working
memory (Swanson, 2000). Adequate working memory capacity allows the reader to fluently de-
code and to complete more complex cognitive processes, such as reading comprehension (McNa-
mara & Scott, 2001). As reading decoding becomes automated, more working memory resources
become available for comprehension. Some researchers (Swanson, 2000) theorize that a working
memory deficit is not entirely a capacity deficit. For some students with learning disabilities, a
working memory problem is primarily a strategy deficit. That is, students with LD often pos-
sess sufficient working memory resources and the ability to apply effective strategies but fail to
use these strategies spontaneously. Other populations with learning challenges are also known
to have weaknesses in working memory relative to their other cognitive abilities, among them
children with Down Syndrome (Comblain, 1994) and children with a language impairment (Gill,
Klecan-Aker, Roberts, & Fredenburg, 2003). Children with ADHD are another group who typi-
cally demonstrate a deficit in working memory (Klingberg et al., 2002).
Developmentally, working memory span expands two- to three-fold between the ages of
four and 14, with more gradual improvement after age eight (Gathercole, 1999). Longer work-
ing memory spans may be due to more than increased working memory capacity. For example,
increases in processing speed, retrieval speed, and speech rate may account for some of the im-
provement (Henry & Millar, 1993). Moreover, executive processes and strategy use develop and
increase with age (Andreassen & Waters, 1989); thus, increased use of strategies, such as verbal
rehearsal and chunking, is at least partially responsible for the apparent expansion in working
memory (Minear & Shah, 2006). Also, acquiring automaticity will free up working memory re-
sources, giving the appearance of increased working memory capacity.

Evidence-Based Working Memory Interventions

Practitioners need to be mindful of the diverse functions of working memory when assessing work-
ing memory and selecting interventions. A thorough assessment might help determine whether
the learner’s working memory weakness is primarily auditory, visual, or executive (Dehn, 2006;
270 DEHN

Pickering & Gathercole, 2001). Children with learning disabilities are more likely to possess a
deficit in auditory and executive working memory than in visual working memory (Swanson,
2000). The consensus among theorists is that the main source of individual differences in work-
ing memory is usually the amount of working memory capacity (Minear & Shah, 2006), although
knowledge, experience, strategy use, and the degree of automaticity also impact performance
on specific tasks. Moreover, disorganized information in long-term memory may exacerbate an
already weak working memory. Failure to use efficient and appropriate strategies may also impair
performance in an otherwise normal working memory (McNamara & Scott, 2001).
Some recent studies suggest that working memory capacity, especially working memory
span, can be increased through training (Comblain, 1994; McNamara & Scott, 2001; Minear &
Shah, 2006) and that the improvement generalizes to untrained tasks (Klingberg et al., 2002). For
instance, Olesen et al. (2003) found that brain activity related to working memory increased after
working memory training. Thus, there are many possibilities for intervention, not all of them
strategic or compensatory.
Most interventions for working memory involve the teaching of a strategy. Research has
found that most individuals naturally employ some type of strategy, typically a subvocal rehears-
al strategy, during working memory tasks, and that strategic individuals recall more information
than individuals who are non-strategic (McNamara & Scott, 2001). Strategy use is the result of
experience and practice and is usually domain specific (Ericsson & Chase, 1982). Unless the
trainee is encouraged to apply the strategy to different situations, generalization of strategy use
seldom occurs. Some studies (Klingberg et al., 2002), however, have found generalization to
untrained working memory tasks and related cognitive processes, such as reasoning. Continued
strategy use may also depend on the individual’s awareness of the benefits of strategy use.

Rehearsal. The development of subvocal verbal rehearsal strategies is thought to be at

least partially responsible for increased working memory span as children develop (Minear &
Shah, 2006). Although children may begin using a simple rehearsal strategy as early as 5 or
6 years of age, rehearsal is not a widespread strategy until the age of 10 (Gill et al., 2003).
Rehearsal, a serial repetitive process, allows information to be maintained in working memory
for a longer period of time (Gathercole, 1999), thus facilitating long-term storage encoding.
Children with disabilities often fail to develop or use verbal rehearsal strategies. Several studies
have found explicit rehearsal training to significantly improve the working memory performance
of children, with and without disabilities (Comblain, 1994; Conners et al., 2001). Adults with
low working memory spans have also shown improvement after training in simple rote rehearsal
strategies (McNamara & Scott, 2001; Turley-Ames & Whitfield, 2003). Moreover, there is
evidence for the maintenance and durability of rehearsal training, especially when extensive
practice and overlearning are provided during the initial training phase (Broadley, MacDonald,
& Buckley, 1994). Rehearsal strategies have even been shown to be more effective than more
elaborate memory strategies (Turley-Ames & Whitfield). Perhaps, this is because their simplicity
is less demanding of already limited working memory resources or because more complicated
strategies introduce interference.
Rehearsal strategies involve repetition of verbal stimuli, such as saying over and over again
a list of words to be remembered. The teacher should instruct the learner to say the to-be-remem-
bered words aloud as many times as possible during the procedure. If one word is introduced at
a time, then that word should be repeated continually until the next is added, and then the new
word along with the previous words should be repeated (Turley-Ames & Whitfield, 2003). At
first, students should be directed to say the stimuli aloud, but as the intervention progresses they
may whisper the words or subvocalize. The difficulty level can be adjusted by increasing the
number of stimuli.
 12. COGNITIVE PROCESSING DEFICITS 271

Several other rehearsal techniques also have been shown to be effective. Elaborative rehears-
al (Banikowski & Mehring, 1999) involves associating the new information with prior knowl-
edge. The association helps keep the information active in working memory without repetition
and also facilitates moving the information into long-term memory (see the long-term memory
interventions section for more details on elaboration). Once learners engage in auditory rehearsal
with minimal cuing, they can be taught to visualize the instructions as a way of keeping the in-
formation active. For example, encourage students to rehearse instructions while they visualize
or imagine themselves carrying out the instructions. Gill and colleagues (2003) discovered that
adding a visualization component to the rehearsal strategy increased its effectiveness and long-
term application. Another approach is to simply have students repeat instructions, which can be
paraphrased, until they have completed the task (Gill et al., 2003).

Chunking. Chunking refers to the pairing or association of different items into units that
are remembered as a whole, thereby facilitating short-term retention and encoding into long-term
storage. For example, instead of separately remembering the digits “8, 6, 5” it is easier to recall
them grouped as the multidigit number 865. Chunking develops naturally as children develop
automatized reading decoding skills, e.g., the three phonemes in “cat” become one unit instead
of three, thereby freeing up working memory resources. In instances where the chunking strategy
needs to be taught, follow the steps summarized by Parente and Herrmann (1996): (1) require
the student to group single digits into a larger unit; (2) require the student to group a longer list
of digits into multiple units; (3) continue training with commonly used numbers, such as phone
numbers for practice; (4) continue practicing until the chunking is performed consistently and
automatically; and (5) convince the student that the strategy is effective by reporting baseline and
post-intervention data.

Span Tasks. A few recent investigations indicate that directed efforts to increase working
memory span may actually increase working memory capacity (Klingberg et al., 2002; Oleson
et al., 2003). Daily practice of span activities, such as a backwards digit span task or a letter
span task, over a period of several weeks may increase working memory capacity and result in
improvement of even non-trained activities (Oleson et al.). Klingberg and colleagues lengthened
span and improved working memory by using computerized software with a group of ADHD
subjects.

Interventions for Related Processes

When considering and implementing interventions for working memory, bear in mind that re-
ciprocal relationships exist among working memory and other essential cognitive processes.
Boosting capacity and performance of related processes may have a collateral affect on working
memory performance. For example, refining and solidifying the concepts in long-term memory
may reduce some of the encoding and retrieval burdens on working memory (Henry & Millar,
1993). Also, phonological awareness training is thought to lead to improvements in working
memory (Minear & Shah, 2006). Furthermore, executive processing is known to be intertwined
with working memory. Consequently, interventions designed to strengthen executive functioning
should be incorporated into working memory interventions (Swanson, 2000).

Classroom Instruction Strategies

In the educational environment, teachers can use effective instructional practices and accom-
modations to manage and reduce the working memory demands placed on learners (Mather &
272 DEHN

Wendling, 2005). These practices are designed for use with an entire classroom or for use as
individualized compensatory interventions. Instructional practices for working memory limita-
tions include: brief and linguistically simple directions; frequent repetitions of instructions and
new information; child repetition of crucial information; graphic organizers; external memory
aides; and other methods that reduce the processing load of the task (Gathercole, Lamont, &
Alloway, 2006). Helping students acquire mastery in basic skills also alleviates impositions on
limited working memory resources.
In general, effective teaching practices, such as organized presentations, guided practice,
and frequent review, also prevent frequent and extensive overloading of working memory (Far-
quhar & Surry, 1995). Many evidence-based reading, math, and written language curricula have
embedded instructional procedures and strategies for working memory limitations (Chittooran
& Tait, 2005). In fact, documented effective teaching models, such as direct instruction (Gersten
& Keating, 1987), may be successful primarily because they address learners’ working memory
shortcomings (Rosenshine & Stevens, 1986).

LONG-TERM MEMORY INTERVENTIONS

Unlike working memory, long-term memory is capable of storing a vast amount of information
for a relatively long period of time. Many different kinds of long-term memory storage systems
are distributed throughout the brain, and the same information can be stored in multiple ways
with multiple retrieval cues (Berninger & Richards, 2002). Despite this diversity and flexibility,
information is generally stored as visual images, verbal units, or both. Long-term memory is
often divided into semantic, episodic, and visual (Banikowski & Mehring, 1999). Semantic mem-
ory contains facts and general knowledge, organized into networks of connected ideas called
schemata. Episodic memory is autobiographical, like a video of experiences, and visual memory
consists of visual images.
Cognitive psychologists also divide semantic memory according to the two major classifica-
tions of learning—declarative (factual knowledge) and procedural. Procedural memory is a store
of the steps required to complete various tasks; for example, a math algorithm may be stored as
procedural memory. Academic learning requires a well organized semantic memory for declara-
tive knowledge, as well as adequate procedural memory. Learning difficulties that are attributed
to weak long-term semantic memory are more likely due to poor encoding of new information,
rather than to actual difficulties retrieving stored information. Thus, the majority of memory in-
terventions focus on properly moving information into long-term semantic storage.
Substantial literature documents the efficacy and benefits of long-term memory interven-
tions, especially with normal populations and with individuals who have mild to moderate memory
impairments (Glisky & Glisky, 2002). Because direct remedial improvement of severely impaired
memory functioning is considered unrealistic (Glisky & Glisky) and because poor memory perfor-
mance is often a strategy deficiency, the general approach is to rely on mnemonics and other types
of strategies. Mnemonics, which originated with the ancient Greeks and have been used in schools
for over 250 years, are strategies for associating relatively meaningless input with more meaning-
ful images or words already stored in long-term memory. Over the past 30 years, an abundance of
empirical evidence supports the finding that the use of mnemonic strategies improves long-term
memory performance (Eslinger; 2002; Levin, 1993; Mastropieri & Scruggs, 1991). In a meta-
analysis of 34 studies involving the use of mnemonic strategies with LD students, the overall effect
size was a very strong 1.62 (Mastropieri, Sweda, & Scruggs, 2000). For example, the effectiveness
of the mnemonic known as the keyword method (described in The Keyword Method section) has
been demonstrated across a variety of instructional settings and subject areas (Levin).
 12. COGNITIVE PROCESSING DEFICITS 273

Most memory strategies are designed to provide a more efficient and more meaningful way
of encoding information, such as associating it with existing knowledge, and to teach a way to
use cues to facilitate retrieval. Long-term memory interventions can be classified under four gen-
eral categories—rehearsal, organization, elaboration, and visualization. With long-term memory,
rehearsal includes practice techniques, such as distributed practice and frequent review, not just
immediate repetition. Organizational strategies support and align with the structure of semantic
long-term memory, which is thought to be organized into hierarchical schemata (Gagne et al.,
1993). Elaboration is a process of enhancing meaningfulness by relating the new information to
existing schemata. And, visualization involves connecting auditory or verbal input with a visual
image that will cue the correct verbal response. The choice of memory strategy should depend
on the learner’s profile and the learning requirements; for example, if a memory deficit is con-
fined to the auditory/verbal domain, then visual strategies are most likely to be effective (Glisky
& Glisky, 2002). Similarly, children with a specific language impairment are known to have
difficulty encoding and retrieving auditory/verbal information. Consequently, the use of visual
imagery may tap the strength of the child with a language impairment (Gill et al., 2003). Due to
the integral relationship between long-term memory and working memory, long-term memory
interventions may produce collateral improvement in working memory. Likewise, the success of
long-term memory interventions depends on an adequately functioning working memory.

Rehearsal

Rehearsal, commonly referred to as repetition, is the first approach most individuals will attempt
when memorization is required. Studies have shown that even children in the first grade can be
taught to use sophisticated rehearsal strategies (Rafoth, Leal, & DeFabo, 1993). Although it is a
rote strategy that does not promote meaningful processing of information, rehearsal does result
in learning information required for academics. However, there is no long-term or general benefit
in terms of improving long-term memory functioning (Glisky & Glisky, 2002). Nevertheless,
rehearsal is a crucial step because without rehearsal it would not be possible to maintain informa-
tion in working memory long enough (see discussion in working memory section) to encode it
into long-term memory (Parente & Herrmann, 1996).

Practice and Review Techniques

Distributed practice, in which several short intervals of instruction or self-study are separated by
other activities, has been found to result in greater long-term retention of skills and knowledge
than massed practice. The positive effects of distributed practice have been demonstrated with
a variety of academic subjects, settings, and tasks, as well as with various learners with special
needs (Crawford & Baine, 1992; Swanson, 2001). Spaced retrieval, a distributed practice tech-
nique in which there are gradually increasing intervals between rehearsal, has even been found to
be effective for severely memory impaired individuals (Eslinger, 2002). In the classroom, distrib-
uted practice requires a teacher to periodically review previously taught material, with a gradual
increase in the intervening intervals. Distributed practice is consistent with the literature on effec-
tive teaching, and it is incorporated into structured methodologies, such as direct instruction.

Organizational Methods

Another class of strategies involves the organization of information into natural groupings or
categories. These methods are particularly relevant for encoding information into and retrieving
information from semantic memory, such as when studying an academic subject. For instance,
274 DEHN

when learning a list of items, it is worthwhile to group the items into categories and then later
try to recall them by category (Parente & Herrmann, 1996). To teach an organizational strategy,
follow these steps: (1) present a list of about 15 items to memorize; (2) have the student separate
the list of words into structural categories; (3) require the student to recall the categories first,
then the individual items; (4) demonstrate to the student that this method works by comparing
results with a pretest completed before the strategy was taught; (4) continue practicing until the
student can generalize the strategy; and (5) for students unable to form semantic categories, try
more concrete categories, such as acoustic similarities. During classroom instruction, effective
teachers can facilitate long-term encoding and retrieval through organized presentations and by
grouping information items categorically.

Elaboration

While simple repetitive practice has long been known to be an ineffective way to ensure reten-
tion of information over the long term (Glisky & Glisky, 2002), making information meaning-
ful is more likely to be successful (Levin & Levin, 1990). The process of making information
meaningful is accomplished by relating new information to already stored information, a strategy
known as elaboration (Gagne et al., 1993). Elaboration occurs when a learner brings associated
or related knowledge from long-term semantic memory into working memory and constructs a
verbal or visual memory link between that knowledge and the information to be learned (Ritchie
& Karge, 1996). To complete the elaboration process, the learner needs to thoughtfully pause in
order to create a meaningful link, such as an inference, with prior knowledge.
If conducted correctly, elaboration actually adds to the incoming information. At the en-
coding level, elaboration improves retrieval through associating and storing related facts and
concepts together. The elaboration process can also facilitate retrieval directly—thinking about
what you know about a general topic often leads to recall of the specific information needed. In
addition to long-term storage and retrieval, elaboration improves comprehension and learning
(Levin & Levin, 1990).
General training steps for the elaboration strategy include: explain what elaboration is and
why it helps memory; teach how and when to use it; and provide plenty of practice during both
encoding and retrieval (Gagne et al., 1993). Without explicitly training the strategy, instructors
may facilitate elaboration by modeling it, by prompting students to do it, and by allowing time
for it. The general approach is to instruct students to think about what they already know about
the new material. Examples of specific prompts include directions to paraphrase, summarize,
draw inferences, or generate questions (Ritchie & Karge, 1996). In general, effective teaching
practices, such as providing advance organizers, support elaborative thinking. Teachers may also
suggest specific links between new information and prior knowledge. Because children do not
spontaneously elaborate until about 11 years of age, young children remember more when teach-
ers provide elaborations (Rafoth et al., 1993). On the other hand, adolescents may benefit more
from self-constructed associations.

Visual Imagery

Visual imagery can be used in a variety of ways; it involves more than just creating a visual image
of the item to be learned. It is especially applicable with students who have deficits in auditory or
verbal memory or have language disorders. The method creates associations between unrelated
words and objects, thereby instilling meaning into these arbitrary relationships and prompting re-
call of the verbal information. Imagery procedures are most effective when the images are created
 12. COGNITIVE PROCESSING DEFICITS 275

by the student and when parts of the image interact (Ritchie & Karge, 1996). Several approaches
can be used to teaching mental imagery. Whichever is selected, it is important to demonstrate
the power of a visual image by first having the student try to recall a list of words through rote
memorization and then directing the student to form a visual image of each word and comparing
recall with that of rote memorization. An example of a visual imagery mnemonic is the rhyming
pegword method, whereby the numbers from one to ten are associated with rhymes (e.g., “one-
bun,” “two-shoe,” etc.). The first item to be remembered is visually linked with a bun, the second
with a shoe, and so on (Wilson, 1987).

The Keyword Method

The keyword method, a mnemonic that incorporates elaboration, paired association, and visual
imagery, can be used when learning a variety of content areas but is especially effective when
learning new vocabulary words (Mastropieri & Scruggs, 1998). The keyword method, perhaps
the most researched and effective mnemonic strategy, consists of two stages. During the first
stage, the acoustical link stage, the learner selects or is given a concrete word (the keyword) that
sounds like the stimulus word. In the second stage, the learner is provided with or creates an im-
age of the keyword interacting with the appropriate definition or response word. For example,
in learning the Spanish word “pato” (duck), the learner decides that it reminds him or her of the
keyword “pot” and then creates an image, such as a duck with a pot on its head. When retrieving,
students think of the keyword, remember the association, and then retrieve the definition (Mather
& Wendling, 2005). Researchers have reported that while students with LD can generate their
own keywords and interactive images, their retrieval is better when they are provided with the
keywords and interactive mnemonic pictures (Scruggs & Mastropieri, 1990).
Different variations of the keyword approach exist, including keyword-mediated instruction,
which has been found superior to direct instruction (Pressley, Johnson, & Symons, 1987). Also,
Bulgren, Hock, Schumaker, and Deshler (1995) expanded the keyword method into a compre-
hensive strategy referred to as Paired Associates Strategy (PAS) and provided empirical evidence
for its use. In addition to keyword pairing and mental imagery, the PAS method has students put
the informational pairs on study cards, draw the visual image, and do a self-test.

Other Mnemonics

In addition to the keyword technique, there are several other evidence-based mnemonic tech-
niques, many of which are quite familiar to teachers and students. These include acrostics and
acronyms, which make use of first letter cueing, and are especially helpful when it is necessary to
recall already known material in the correct order (Wilson, 1987). For example, the colors of the
rainbow can be remembered by the acrostic “Richard Of York Gives Battle In Vain.” Other mne-
monics involve the creation of visual images or a rhyme or song (Frender, 2004). Mnemonics are
thought to work successfully because they allow previously isolated items to become integrated
with each other (Wilson).

EXECUTIVE AND METACOGNITIVE INTERVENTIONS

One reason students with learning problems seldom utilize strategies that would improve the
functioning of their cognitive processes is that they are deficient in metacognition, a prominent
aspect of executive processing (Wynn-Dancy & Gillam, 1997). Metacognition oversees cogni-
276 DEHN

tion; cognitive strategy selection, usage, and monitoring are the primary functions of metacogni-
tion. Metacognition consists of two major components—the individual’s self-awareness of his or
her cognitive processes and the self-directed control and regulation of one’s cognitive processing.
Self-regulation is the essence of executive processing (Dawson & Guare, 2004). Interventions
to improve an individual’s self-regulatory functioning through self-instruction training go back
more than 30 years (Meichenbaum & Goodman, 1971). The effectiveness of self-instruction
training, also known as verbal mediation training, has consistently been supported in the lit-
erature (Cicerone, 2002). Specific metacognitive strategies, such as self-monitoring, can also
be taught and typically result in significantly improved metacognitive functioning and cognitive
strategy use and performance (Moreno & Saldana, 2004; Swanson, 2001; Wynn-Dancy & Gil-
lam, 1997).
To encourage internalization of regulatory behavior, three stages of self-instruction training
are involved: the student first learns to verbalize or think aloud; the student then whispers to her-
self or himself while engaging in self-regulatory behavior; and finally the student talks silently
to himself or herself before and during actual task performance. Self-instruction training is often
paired with learning a problem-solving algorithm, such as goal management training (Levine et
al., 2000).
Metacognitive strategy training typically involves the teaching of strategies relating to a
specific cognitive, behavioral, or academic task (Graham & Harris, 1989; Loarer, 2003); for ex-
ample, poor readers are often taught metacognitive strategies concerning reading comprehension.
Key aspects of metacognitive interventions include teaching the individual: to become aware of
processing deficits and strengths; how to select an appropriate strategy for the task at hand; to
self-monitor progress towards an objective; to revise or change strategies when necessary; and
to self-evaluate.
Metacognitive or executive strategy training is often selected even when there is no pre-
sumption of a metacognitive or executive processing deficit. This is because high level strategic
thinking permits more effective use of underutilized or impaired processes. Educators might also
select executive strategy training when students fail to spontaneously use or maintain strategies
they have learned for other process deficits (Lawson & Rice, 1989). When executive or meta-
cognitive processing is itself the underdeveloped process, then the intervention should include
self-instruction training because self-regulation depends on internal self-talk. When considering
executive and metacognitive interventions, developmental factors need to be taken into account,
as executive processing is one of the last cognitive functions to fully develop.

INTERVENTIONS FOR PLANNING

Planning, a key component of executive processing, is a higher-level cognitive process that is es-
sential for academic learning and performance. Numerous studies have documented the efficacy
of educational interventions designed to facilitate planning (Conway & Ashman, 1989; Cormier,
Carlson, & Das, 1990; Kar et al., 1993; Naglieri & Gottling, 1997) and have reported effect sizes
as large as 1.4 (Naglieri & Johnson, 2000). Following intervention, students perform better on
planning tasks, with poor planners improving more than good planners (Naglieri & Johnson).
Teachers can provide strategy instruction designed to facilitate planning to individuals, groups, or
entire classrooms. The instruction should be explicit and include: teaching students about plans
and strategy use; discussing how planning helps students be more successful; explaining why
some methods work better than others; requiring students to verbalize their planning process,
and encouraging students to develop, use, and evaluate their own planning strategies (Naglieri
 12. COGNITIVE PROCESSING DEFICITS 277

& Pickering, 2003). The technique does not entail using teacher scripts or rigidly formatted pro-
cedures.

Planning Interventions Involving Mathematics

Planning is the foundation of problem-solving, a requisite process for mathematics; for example,
poor planning may result in selecting the wrong math operation or failure to check work. Conse-
quently, planning interventions have often involved mathematics activities. In studies involving
math, math performance improved after instruction that facilitated planning (Naglieri & Gottling,
1997; Naglieri & Johnson, 2000). The procedure begins with students spending about 10 minutes
completing a math worksheet. The teacher then engages the students in a discussion about how
they completed the problems, which methods worked well and which worked poorly, and how
they might accomplish the task more successfully in the future. For example, the teacher might
ask, “Is there a better way, or is there another way to do this?” The initial purpose of this self-re-
flection session is to facilitate the students’ understanding of the need to be planful and to utilize
an efficient strategy when completing math problems (Naglieri & Gottling, 1997). The long-term
goal is to help the children engage in self-reflective planning processes. See chapter 11, this vol-
ume, regarding other effective techniques for improving math performance.

Strategy Verbalization

Requiring students to verbalize their planned strategies can be implemented with any task, not
just math activities, and it can be done prior to completing the task. For example, the teacher
might ask the student to explain how she or he is going to proceed with each step of the task.
The teacher should require the student to explain the reason for each strategy he or she plans to
employ. Verbalization tends to be successful because of the interrelationship between verbaliza-
tion and the planning process. One function of verbalization is the formulation and generation
of sequential plans of action (Kar et al., 1993). Overt verbalization makes elements of planning
explicit and guides the problem solving activity. Thus, verbalization is a strategy that augments
the planning process.

INTERVENTIONS FOR ATTENTION DEFICITS

Attention is a fundamental process on which many higher-level processes depend (Manly, Ward,
& Robertson, 2002). For instance, attentional processes are intimately related with self-regula-
tory executive processes, such as planning. In fact, deficient executive processing, rather than
limited attentional capacity, may account for attention problems. According to Barkley (1997),
problems with sustaining attention are caused by difficulties with inhibitory control, an executive
function. Given the prevalence of diagnosed attention disorders and their detrimental impact
on academic learning and performance, treatment for attention problems should be a priority
in school systems. Pharmacological treatment is usually the treatment of choice for individuals
diagnosed with attentional deficits. Despite the prevalent use of medication, most research on
ADHD interventions concludes that a multimodal approach, a combination of medication, be-
havior modification, and school accommodations, is the most effective (Miranda, Jarque, & Tar-
raga, 2006). From a cognitive processing perspective, self-regulatory training should be another
component of treatment, as medication combined with self-regulation may be more effective than
medication alone (Reid, Trout, & Schartz, 2005). Also, many behavior modification procedures
278 DEHN

for attention problems include self-regulatory strategies (Miranda et al.). For more information,
see chapter 3 of this volume on ADHD interventions.

Self-Monitoring Training

Self-monitoring is a critical inhibitory process; thus, many interventions for attention deficits
involve training in self-monitoring strategies. Several studies have found self-monitoring of at-
tention to be effective in helping children with ADHD increase attending behaviors and academic
productivity and decrease inappropriate behavior (Reid, 1999; Shimabukuro, Prater, Jenkins, &
Edelen, 1999), with the majority of effect sizes in the moderate to large range of .6 or greater
(Reid et al., 2005). Self-monitoring training with LD students has been associated with improved
performance on measures of reading, attention, and inhibitory control (Brown & Alford, 1984).
Self-monitoring training, a subtype of cognitive self-instruction, should be implemented in the
general education classroom during common learning activities (Harris, Friedlander, Saddler,
Frizzelle, & Graham, 2005). Wearing headphones, the student listens to taped tones that occur at
random intervals, ranging from 10 to 90 seconds. The student is taught to self-assess by asking,
“Was I paying attention?” immediately upon hearing a taped tone. The student then self-records
whether he or she was on task when the tone sounded, and tally sheets are collected daily. A high
degree of accuracy is not necessary for the effects of self-monitoring to occur. Students may also
be taught to self-monitor their academic performance, such as recording the number of times
information was correctly practiced, the amount of work completed, and the accuracy of the
work (Harris et al., 2005; Shimabukuro et al., 1999). Whenever observable behaviors are being
monitored, teachers may provide an external check on the accuracy of the student’s recordings
(Reid et al., 2005). Student graphing of on-task behavior or academic performance measures is
another option (Shimabukuro et al, 1999).

Computerized Interventions

Some interventions for attentional dysfunctions have used computer technology, which makes
long periods of inexpensive, systematic training possible. Computerized programs are often de-
signed to increase the duration of sustained attention and the efficiency of selective attention,
through such tasks as the color-word Stroop task. Manly and colleagues (2002) report studies
of computerized interventions that not only improved attentional capacity but also resulted in
generalization and maintenance.

VISUAL AND AUDITORY PROCESSING INTERVENTIONS

As stated earlier in the historical review section, past and recent attempts to ameliorate what are
considered general visual or auditory processing deficits have generally met with failure (Friel-
Patti, 1999; Wood & Fussey, 1987). Whereas modality training is clearly ineffective, interventions
for specific subprocesses in the auditory domain, such as phonological processing and auditory
short-term memory, have been very successful. Regarding visual processing, only recently have
there been a few reports of successful treatment, often limited to those with acquired brain in-
jury. Perhaps the problem with the constructs of visual and auditory processing is that they are
too broad, similar to a right-brain, left-brain division; as suggested by Berninger and Richards
(2002), the focus should be on component or subprocesses. Also, poor performance on modality
measures may be due to interaction with other processes, such as working memory or attention
 12. COGNITIVE PROCESSING DEFICITS 279

(Friel-Patti). Nevertheless, the broad visual and auditory processes should not be ignored entirely
because they obviously involve critical brain functions and because one or the other can play an
important intervention role as a strength serving a compensatory function.
Studies examining compensatory interventions for visual processing deficits have some-
times been successful, especially those using computerized visual information (Dirette & Hino-
josa, 1999). Although much of the research has been done with subjects who have acquired brain
injury, positive results have been obtained with normal students as well (Dirette & Hinojosa). A
commonly used compensatory strategy for visual processing weaknesses is verbalization—orally
repeating information gathered visually so as to enhance processing and recall. However, the
positive evidence for verbalization or other forms of linguistic coding of visual information,
especially in an educational environment, is limited (Anderson, 2002; Dirette & Hinojosa). Con-
sequently, educational interventions for broad visual processing deficits are not recommended at
this time. Fortunately, recent research has indicated that there is not a strong relationship between
visual-spatial processing and academic performance (Evans et al., 2002; Floyd et al., 2003). Nev-
ertheless, when visual processing is a strength, as it often is for individuals with learning disabili-
ties, it can be incorporated into interventions; for instance, visual imaging has been successfully
employed during compensatory interventions for long-term verbal memory weaknesses.

SIMULTANEOUS AND SUCCESSIVE PROCESSING INTERVENTIONS

PREP: A PASS Remedial Program

The purpose of PREP (Process-Based Reading Enhancement Program) is to remediate successive

and simultaneous processing deficiencies, with the ultimate goal of improving reading decoding
(Carlson & Das, 1997). During twice weekly sessions for about 16 weeks, learners are trained in
global processes in a manner that encourages internalization, along with subsequent generaliza-
tion and transfer. Children become aware of the underlying cognitive processes through guided
discussion of what they are doing during and following the tasks. The tasks include procedures
such as rehearsal, categorization, monitoring of performance, and prediction. The program con-
sists of four successive and four simultaneous processing modules, with scripted instructions for
each task. The tasks are divided into three levels of difficulty. Each task has a global component
that fosters the development of successive or simultaneous processing and a bridging component
that extends the task to a particular academic area. For example, for one simultaneous global com-
ponent, the child selects which of two or three similar pictures is best described by a passage. For
the related bridging component, the child selects which of three or four sentences best describes
a single picture. PREP avoids explicit teaching of specific reading skills. Detailed descriptions
of the procedures can be found in the appendix to Das, Mishra, and Pool (1995). Several studies,
for example Das, Mishra, and Pool, have found PREP, which was first introduced in 1976, to be
effective at improving reading decoding and reading comprehension. The success of PREP may
also result from enhancement of related processes, such as planning and short-term memory.

Simultaneous Processing

Another method for improving simultaneous processing is to provide learners with practice in
forming verbal and nonverbal relationships by having them link items of information into a sur-
veyable array (such as mapping a story on the board) and making inferences from the whole
(Leasak et al., 1982). Other approaches to developing simultaneous processing are: matching and
280 DEHN

categorizing items; having the student supply missing details in a story; teaching the student how
to summarize a written passage; and having the student create and use maps, both geographical
and contextual (Naglieri & Pickering, 2003).

Processing Speed

Processing speed, the speed and efficiency with which simple cognitive tasks are executed over
a sustained period of time, is a strong correlate of basic academic skills (Fuchs et al, 2006;
Mather & Wendling, 2005). Processing speed is also closely interrelated with other key cogni-
tive processes, mainly working memory and long-term retrieval. The quick and fluent processing
of information frees up limited resources so that higher level processing can occur. To date, no
successful remedial or compensatory interventions for slow processing speed have been pub-
lished. Nevertheless, accommodations, such as extended test time, may be appropriate (Mather
& Wendling, 2005).

Fluid Reasoning

Fluid reasoning is a higher level cognitive process that involves solving novel problems using
inductive and deductive reasoning. Although most tasks used to assess fluid reasoning are of a
nonverbal nature, fluid reasoning also includes verbal reasoning. Along with executive process-
ing, it is one of the last cognitive processes to fully develop. Fluid reasoning ability is predictive
of performance in mathematical reasoning and reading comprehension (Mather & Wendling,
2005). Interventions that directly improve fluid reasoning are non-existent. However, students
with low fluid reasoning can be taught mathematical problem-solving strategies that improve
their math performance (Owen & Fuchs, 2002), and planning interventions (see previous section)
are also likely to have a collateral effect. Furthermore, many of the well documented reading
comprehension strategies, such as elaboration, identifying the main idea, and self-questioning,
are effective with learners with low fluid reasoning (Pressley & Woloshyn, 1995). Finally, effec-
tive instructional techniques also have a positive impact on the academic learning of those with
fluid reasoning weaknesses and deficits (Swanson, 2001).

RECOMMENDATIONS

Educators considering processing interventions should keep the following conclusions and rec-
ommendations in mind:

1. Educational interventions for processing deficiencies should avoid efforts that focus on
remediation only, except for those processes, such as phonological processing, where
research supports the likelihood of improvement. Until brain research clarifies the actual
outcomes of neurological interventions, a compensatory approach that includes strategy
training is the most defensible. The primary goal of interventions for processing defi-
cits should be improved memory, academic learning, and academic performance, not the
amelioration of a specific process per se.
2. Because of the interrelated functioning of cognitive processes, processing interventions
should be top-down, especially when it is unclear which processes may account for poor
performance. A top-down approach focuses on, or at least includes, executive process-
ing interventions, providing the learner with self-regulatory strategies that will allow for
 12. COGNITIVE PROCESSING DEFICITS 281

more efficient utilization of existing resources across a variety of processes.

3. What often appears as a processing deficit may actually be a performance deficit, result-
ing from a lack of strategy application. Thus, the teaching of cognitive strategies is a very
appropriate processing intervention. Students who have not developed strategies indepen-
dently will benefit the most from strategy instruction.
4. In the classroom, a variety of cognitive strategies should be taught routinely and explic-
itly, beginning in early elementary. The teaching of strategies should be embedded into
routine instruction in most content areas; for example, keyword associations and images
should be provided whenever new vocabulary is introduced or facts need to be memo-
rized.
5. Educational interventions that are directed towards developing academic skills may be
enhanced by the inclusion of a processing component. For instance, most effective ear-
ly reading programs already include phonological processing training. Academic skills
programs might also include interventions for working memory, long-term memory,
planning, and executive processing, as these are inherent weaknesses among those with
learning challenges.
6. Classroom instructional practices should support the information processing limitations
that all learners experience. First and foremost, teachers need to avoid overloading learn-
ers’ working memory. Secondly, elementary teachers should support executive processes
that are not fully developed, such as providing cues that sustain attention.
7. For maintenance and generalization to occur, especially with strategy training, the inter-
vention should include: explicit teaching of the method; student practice until there is
overlearning; practice in a variety of settings and situations; feedback that demonstrates
the self-efficacy of the method; and imparting when and where to use the method.
8. Many neuropsychological interventions that have been successful with acquired brain
injured individuals are applicable to students with developmental and learning disabili-
ties, typically with little adaptation. Hopefully, educational personnel with an interest in
school neuropsychology will help to bridge the gap from clinic to school setting.

DIRECTIONS FOR FUTURE RESEARCH

Some processing interventions, such as phonological interventions, already have more than ad-
equate substantiation, but much remains to be accomplished before processing interventions will
gain wide acceptance and implementation. Future studies should:

1. Develop and test standardized treatment protocols that consistently adhere to core aspects
of the intervention. This allows for replication studies and facilitates correct usage of the
intervention once it is validated.
2. Test how well clinic-developed treatments can be applied in an educational environment. In
these instances, teachers and other school personnel should be the experimental trainers.
3. Assess whether improved performance actually results from changes in the targeted pro-
cess. For example, when phonemic awareness improves, might it be due to improved
attention or memory?
4. Continue to identify the specific subprocesses that comprise broader processes and then
develop and test more narrowly focused interventions.
5. Investigate the learner characteristics that predict success, including such factors as age,
severity of impairment, and number of deficient processes.
282 DEHN

6. Examine more methods designed to increase maintenance and generalization once treat-
ment is terminated.
7. Continue to study the relationships between specific processes and specific types of aca-
demic learning. Also, assess response to processing interventions with academic skills
and performance measures, in addition to processing instruments.

CONCLUSION

Rejuvenated by neuroscience research on learning and neuropsychological interventions research,

processing interventions once again hold promise for struggling learners. Children with learning
problems and learning disabilities typically have one or more underlying cognitive processing
weaknesses or deficits. Some processes have strong relationships with specific areas of academic
learning, whereas other processes play a critical role in all aspects of learning. Academic in-
terventions and instructional approaches can be more successful when they address students’
processing deficiencies. Moreover, directed efforts to improve cognitive processing performance
are appropriate in an educational environment. While currently evidence-based interventions for
only a few cognitive processes exist, these effective interventions can lead to improved learning
and academic performance. As new interventions continue to emerge and become established
in the educational environment, the foundation of processing interventions—cognitive strategy
training—remains the method of choice for higher-level cognitive processing problems.

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 13
Effective Learning Strategy
Instruction

Patricia Gildroy and Donald Deshler

Give a man a fish and you feed him for a day.

Teach a man how to fish and you feed him for a lifetime.
(Chinese Proverb)

This familiar Chinese proverb speaks to the purpose of teaching cognitive strategies to students
with learning and behavioral challenges. Typical classes focus on teaching the knowledge and
skills needed to complete assignments due today and tomorrow, far fewer teach students how to
learn. While successful students develop strategies for learning, students who struggle in school
tend to have few effective strategies for learning. Teaching cognitive or learning strategies to
students with learning and behavioral disorders can help them achieve success in school and to
become life-long learners.
Simply showing or telling how to use a complex cognitive strategy is insufficient for stu-
dents with learning and behavioral challenges. Teaching cognitive strategies requires an approach
much like that of a master and his or her apprentice. In medicine, the arts, the sciences, business,
and even in manual labor fields, masters of complex skills sets have and continue to take on
apprentices. Through watching and assisting, the apprentices see and hear how the experts use
complex skills sets and strategies for analyzing, planning, adapting, implementing, monitoring,
refining, and evaluating their work. Through extensive coaching and practice, successful appren-
tices may build on and extend what they learned, also becoming masters in their fields. Helping
students with learning and behavioral disorders become master learners, requires teaching them
how to utilize a repertoire of effective learning strategies to take in, remember, and demonstrate
what they learned.
This chapter begins with a definition and an example of a cognitive strategy for learning. A
brief history of several bodies of research that greatly influenced the development and research
on cognitive strategies follows. The chapter continues with a discussion of the principles that
guide the design and the instruction of effective learning strategies sentence needs revising help
to compensate for students’ potential problems with information processing. This chapter con-
cludes with a discussion of the most effective intervention components that increase the achieve-
ment of students with learning disabilities.

288
 13. EFFECTIVE LEARNING STRATEGY INSTRUCTION 289

WHAT ARE LEARNING STRATEGIES?

Meichenbaum (1990) described human behavior from the social-cognitive theoretical perspective
as “self-regulated, where individuals anticipate, plan, and reflect on their own behavior, thoughts
and feelings” (p. 97). Being able to do this well enables people to reach their goals successfully.
Students with learning challenges, however, often have difficulty with the information processing
demands required for self-regulation in learning that would enable them to plan, select strategies
for, and reflect on the effectiveness of their learning.
In their work on cognitive strategy instruction, Deshler and Schumaker (1986) defined a
learning strategy as “how a person thinks and acts while planning for, completing, and evaluating
performance on a learning task. Learning strategy instruction teaches students how to learn and
perform specific tasks” (p. 52). Cognitive and learning strategies consist of a sequence of steps
that cue the cognitive and overt behaviors needed to access, store, and demonstrate knowledge
related to complex learning tasks. Learning strategies in particular address academic skills that
students may have difficulty with such as decoding multisyllabic words, reading comprehension,
studying, completing assignments, taking tests, solving word problems, and producing written or
other types of products that demonstrate knowledge.
For example, one important strategy for academic success and personal communication is
paraphrasing. As students progress in school, their assignments require them to paraphrase in-
creasingly complex material. Yet, paraphrasing can be difficult for students with learning chal-
lenges. The Paraphrasing Strategy (Schumaker, Denton, & Deshler, 1984) (see Figure 13.1)
has many applications for school as well as across the life span. While paraphrasing may seem
simple, it has high language demands and can be complex for students, particularly those with
limited academic language skills.
To paraphrase, students must first read a paragraph and identify the main idea. If the main
idea appears in the first sentence, identifying it is relatively easy; however, it is more difficult
when the main idea appears later, is inferred, or is missing, as is sometimes the case. After iden-
tifying the main idea, students need to distinguish important versus less important details. To do
this well, many students with learning challenges need explicit modeling and much coaching
to learn to make these distinctions. Finally, the third step requires students to make up a good
sentence that tells about the paragraph in their own words. This requires vocabulary and syntax
knowledge, as well as pragmatics to reflect the tone of the paragraph. In order to teach this and
other learning strategies to mastery, both the design of the strategy and the instructional proce-
dures need to follow the principles discussed later in this chapter.

The Paraphrasing Strategy

R ead a paragraph
A sk yourself, “What were the
main idea and details in this
paragraph?
P ut the main idea and details
into your own words.

FIGURE 13.1 The Paraphrasing Strategy. From Schumaker, Denton, & Deshler (1984).
290 GILDROY AND DESHLER

Students with learning challenges typically use the same ineffective strategies regardless of
the task. For instance, when given a reading assignment, a commonly used strategy is to start
reading the first page of the assignment and try to read to the end of the assignment. In contrast,
comprehension and recall of what is read is much more effective when a set of reading strategies
is used including previewing the assignment, reflecting on what is already known about the topic,
using formatting cues and the text structures to identify what is important to remember, and para-
phrasing mentally or for writing notes. Although teaching individual strategies can be powerful,
the goal is for students to independently select and adapt the most appropriate strategies from a
repertoire of effective strategies to meet the demands of the specific task.

A BRIEF HISTORY OF RESEARCH LEADING TO LEARNING STRATEGIES

In the early 20th century, Luria and others began moving away from the prevailing theories that
human learning was primarily associative in nature and began looking at the role of social inter-
actions in learning. Building on Chomsky’s work of examining correlations among socialization
and language development, Luria examined cognitive development in relation to socio-historical
contexts and the use of increasingly complex language structures (see Luria, 1976). The aspect of
his research most directly related to strategy research was his insight into children’s internaliza-
tion and adaptation of adult speech to regulate their own behavior.
Vygotsky also explored the relationships between language and cognitive development in-
dependently as well as in collaboration with Luria (see Vygotsky, 1978). Among other contribu-
tions to strategy research was Vygotsky’s theory of proximal development. Through his work,
he showed that children were capable of learning complex tasks just beyond their capacities
when adults provided modeling and the needed levels of support or scaffolding required for
children to complete the targeted tasks. While children were in the initial stages of learning, the
adults provided greater levels of support and guidance to complete the task. As children gained
proficiency, the adult phased out their support until the children were able to complete the tasks
independently. The rate at which the children became independent directly related to the match
among the students’ skill level, the task difficulty, and the level of the scaffolding provided.
Building on this research and other cognitive scientists, Meichenbaum’s research on cogni-
tive-behavior modification incorporated the development of inner speech to help children become
more self-regulating. As described in chapter 13 of this volume, Meichenbaum and Goodman
(1971) taught impulsive second-grade boys to use self-regulatory strategies to better control their
behavior. The five steps of the instructional sequence began with the teacher modeling the co-
vert actions of self-regulatory behavior while simultaneously thinking aloud to reveal the covert
self-regulatory thoughts that guided the behavior. During the second step, the teacher provided
the self-regulatory language as the student displayed the overt behaviors. For the third step, the
student used the self-regulatory language aloud while practicing the overt behaviors. The fourth
step began the transition of moving from speaking aloud to using internal speech as the student
whispered the self-regulatory thoughts. Finally, the child practiced self-regulatory behavior while
guiding behavior with the internal speech that he or she had developed to improve impulse con-
trol.
Building on these three lines of research, cognitive and learning strategy research began in
earnest during the mid-1970s with the recognition of a range of characteristics that made learning
difficult for a subset of low achievers, newly classified as students with learning disabilities (LD).
Previously thought to be passive learners, researchers later attributed their learning difficulties
with weaknesses in information processing (Swanson, 1991a; Torgesen, 1994). Swanson (1991a)
 13. EFFECTIVE LEARNING STRATEGY INSTRUCTION 291

described the theoretical model of information processing as “how sensory input is transformed,
reduced, elaborated, stored, retrieved, and used” (p. 132).

Matching Strategy Design and Instruction to Learner Characteristics

As discussed in other chapters in this text, students with learning and behavioral disorders often
have limited repertoires of strategies for learning, which requires recognizing important informa-
tion, organizing it, encoding it, and rehearsing it to improve long-term memory and retrieval. To
address these issues, educational researchers analyzed the types of learning tasks students are
asked to do in school and worked to develop effective strategies students could employ to not
only meet the task demands but to also become independent learners.
Because students with learning challenges tend to have weaknesses in information process-
ing, it is helpful to review the theory (see Figure 13. 2). Familiarity of these processes enables
developers, researchers, and teachers to understand the importance of the design principles and
teaching sequence of effective learning strategy instruction.
While most students without sensory impairments perceive stimuli well, the breakdown for
students with learning disabilities occurs in working memory (Swanson & Siegel, 2001). Work-
ing memory is a workspace or cognitive processing center for manipulating and temporarily stor-
ing information (Alloway, 2006). Students with learning difficulties may have challenges across
several aspects of working memory including listening comprehension (Catts & Kamhi, 1999),
making inferences (Ellis, Deshler, & Schumaker, 1989), and identifying important information
(Swanson, 1999). In a simultaneous and continuous process, learners must attend to, identify,
encode, and rehearse the codes to move information into long-term memory (Swanson, 1991a,
1991b, Swanson & Cooney, 1991). If learners miss any of these steps, the likelihood of remem-
bering new information is minimal. Therefore, the principles for the design and instruction of
learning strategies need to include the scaffolding needed to move the strategies into long-term
memory and enable fluent recall.

Long-term memory
Didactic Memory
o Episodic
o Semantic
Procedural Memory

Working Memory
Sensory
Initial processing Response
External
Stimuli Memory Elaborating & coding
Retrieving

Forgotten… Forgotten…

FIGURE 13.2 The Information Processing Model

292 GILDROY AND DESHLER

Learning Strategy Design Principles

Selecting a learning strategy to teach begins with identifying a current learning task with which
students have difficulties. The strategy should be immediately applicable and have a component
that enables students and teachers to compare performance prior to and after students apply the
strategy. Motivation to continue to use strategies relates directly to seeing socially significant
gains (e.g., improved grades and products) resulting from strategy use (Borkowski, Levers, &
Gruenenfelder, 1976).
Understanding effective learning strategy design can help in the selection of effective strat-
egies. Learning strategy design begins with a task analysis of learning tasks that are difficult
for students. A detailed sequence of the overt and cognitive behaviors required to perform the
learning task is then developed. The behaviors are sequenced and segmented into seven or fewer
major steps, as working memory’s capacity is generally five to nine items at a time (see chapter
14). Some of the major steps may involve several sub-steps or have smaller strategies embed-
ded within them. Each of the steps is then labeled (encoded) with a short phrase or sentence that
begins with an action verb to prompt the appropriate behaviors (e.g., Read the paragraph, Ask
yourself…Put it, etc.). Using the first letter of each step to form a mnemonic also adds a memory
device (e.g., RAP).
The combination of a careful task analysis, using student friendly language with action verbs
to label each of the seven or fewer steps, and adding the memory device all help to reduce the
information processing load so there is more likelihood that students will remember and recall
the steps of the strategy. This allows more cognitive effort to be devoted to the learning task (e.g.,
comprehending, writing paragraphs, learning the material).

Cautions. Even with this careful design, strategies can still be ineffective and inefficient.
Strategies must be versatile enough to apply or be adapted easily to a range of learning tasks that
students need to do on a frequent basis. The wording of the strategies must be clear, concise, and
student friendly to avoid any confusion. The wording should prompt the overt and the cognitive
behaviors. The strategies also should not contradict what students will learn in the future (e.g.,
strategies for working with positive integers should not contradict working with negative integers
in the future).
Because strategy instruction can be complex and require a significant commitment of in-
structional time, it would benefit teachers to take a course or receive high-quality professional
development in strategy instruction. Until teachers are proficient with teaching students to master
and generalize learning strategies, they should only teach research-validated strategies (Harris &
Graham, 1996; Pressley & Woloshyn, 1995). Once teachers have mastered strategy instruction,
they will be better able to design or co-construct a strategy with an individual student that needs
to refine a strategy he or she already uses.

Learning Strategy Instructional Principles

While the various researchers developing learning strategies may use slightly different instruc-
tional sequences, most are similar to the Stages of Instruction from the University of Kansas
Center for Research on Learning (CRL) Strategic Instruction Model (SIM) strategies (see Figure
13.3). This instructional sequence has eight stages that begins with assessing students’ skills
and ends with working on generalization of the strategy. A discussion of each of these stages
follows.
 13. EFFECTIVE LEARNING STRATEGY INSTRUCTION 293

Stage 1: Pretest
Yes Go to
Mastery?
another strategy
No
Stage 2:
Describe

Model
Stage 3:

Verbal Practice
Stage 4:

No
Mastery?
Yes
Yes
Stage 5: Controlled Practice

No
Mastery?
Yes
Yes
Stage 6: Advanced Practice

No
Mastery?

Yes

Stage 7: Posttest

Mastery?

Generalization
Orientation
Stage 8: Activation
Adapation
Maintenance
No

Mastery?

Yes
Go to Another Strategy
FIGURE 13.3 Stages of Instruction
294 GILDROY AND DESHLER

Stage 1: Pretest and Commitment. In the SIM model, the Pretest stage of instruction
helps determine if students need to learn the strategy and provides data and products for a
comparison with post-test data to show students how their performance improved through
strategy use. Determining if students have the pre-skills needed for the strategy allows the teacher
to pre-teach skills if needed rather than having to interrupt the flow of strategy instruction to teach
component skills (e.g., how to use the index for the “Answering Written Questions” strategy
(Archer & Gleason, 2003).
Following the pre-test, students review the results individually with the teacher to examine
specific patterns that help or hinder learning and achievement. After the individual conferences,
the teacher explains her commitment to work in partnership with students to help them achieve
their learning goals through strategy instruction (e.g., improve writing skills, reading skills, raise
grades). The teacher then solicits verbal commitments from students to learn the strategy as a
means to reach the learning goal. When older students make verbal commitments to master the
strategy, average proficiency levels are higher than when verbal commitments are not given (El-
lis, 1986).

Stage 2: Describe. The Describe stage focuses primarily on didactic knowledge, but
also continues to develop conditional knowledge. During this stage, teachers explain more about
the strategy including the purpose, the types of activities students will be involved in during
instruction, the steps of the strategy, as well as the learning and classroom behaviors expected
during strategy instruction.
Once students understand more about t the strategy, they continue to build conditional knowl-
edge through sharing ideas about how and when they could use the strategy both in and outside
of school. For instance, paraphrasing is useful for writing notes from reading or classroom in-
struction, for answering chapter questions, writing answers to essay questions, and writing let-
ters, e-mails, and reports. Paraphrasing can also be adapted for telling about movies, television
shows, or conversations. During and after strategy instruction, the teacher continues to prompt
students to use the strategy and asks them how and when they have used the strategies out side
of the class.

Stage 3: Modeling. Modeling is the heart of strategy instruction. Teachers may need to
instruct students in cognitive behaviors as well as in overt physical acts needed to perform a given
task. The model step of instruction is fundamental for teaching and demonstrating these cognitive
behaviors (Schumaker, 1990, p.1).
Bruner pointed out, the goal of modeling is not to have students imitate the modeled behav-
ior, but to internalize and adapt the language and principles of the use of the strategy to meet new
task demands (1966).
The modeling stage is the most difficult stage of strategy instruction. Learning from model-
ing can be difficult for all learners. Even experienced teachers benefit from seeing multiple mod-
els of cognitive strategy modeling and participating in coaching to help refine modeling skills.
Learning from modeling requires sustaining attention, listening comprehension, identifying
important verbal information and overt physical behaviors, encoding the important information,
rehearsing it, and then applying it to similar tasks. Learning from modeling requires the same
information processing skill sets that are most challenging for students with learning and behav-
ioral disorders. Therefore, the modeling must be precise, reiterative, and engage students as much
as possible.
Because students may not understand the purpose for modeling, clear expectations need to
be set for attending to what the teacher says and does so students can learn to do the same things
 13. EFFECTIVE LEARNING STRATEGY INSTRUCTION 295

The Slant Strategy

S it up straight
L ean forward
A ttend to the speaker
N od
T hink
FIGURE 13.4 The Slant Strategy for Attending to Classroom Instruction

they observe. Throughout the modeling, additional cueing (telling students what to pay attention
to) helps students recognize what is most important. Though attention is critical, student engage-
ment is more highly correlated to achievement (Gerber, 1986).
Spending more than a few minutes modeling at a time can erode students’ attention; engag-
ing students by asking questions for which they have prior knowledge helps them begin to think
about and use elements of the strategy. For instance, when modeling the steps in the Slant Strat-
egy (see Figure 13.4), teachers can ask; “What would attending to the speaker look like? Show
me! What does attending to the speaker feel like?”
Sometimes a quick initial model of the strategy helps give students the “big picture” of what
they will learn to do. The main emphasis of the initial model is on using the steps of the strategy
and not the content of the learning task (e.g., the steps of the Paraphrasing Strategy, not compre-
hension of the paragraph). Students should be told that the purpose of the initial model is so they
can see how all of the steps of the strategy work together, they will then learn how to do each step
before putting all of the steps together.
The complexity of the Modeled Strategy and the language used during the model impacts
the learner’s ability to benefit from the model. Increased language loads (e.g., long or complex
sentence, the number of idea units, and the level of vocabulary) can affect the ability to take in
and process new information. The integrity of the remembered information can also be affected
by how organized it is when presented (Baker Kameenui, & Simmons, 1998; Swanson, Hoskyn,
& Lee, 1999; Vaughn, Gersten, & Chard, 2000) as well as the semantic organization and mean-
ingfulness of the information (Gagné, 1985). While good learners may compensate for poor
modeling, naïve learners or students with learning difficulties may not. For these students, a poor
model can be worse than no model at all (Pearson & Dole, 1988).
For simple strategies such as SLANT, teachers can model all of the steps and have students
practice them during one lesson. Strategies that are more complex require modeling and mastery
of individual or even subcomponents of steps, prior to synthesizing the steps (Gildroy, 2001).
Below is an example of what a teacher might say to model identifying the main idea in the
Paraphrasing Strategy.

Teacher: Now that you understand a little bit about the Paraphrasing Strategy, I’m going to show
you how I use it to find the main idea in a paragraph. Listen carefully, I expect you to watch me
closely, and pay attention to what I say and do, because I expect you to learn to follow these same
steps to find the main ideas in paragraphs. I’ll be thinking out loud so that you can learn to use
this kind of thinking to find the main ideas of paragraphs on your own. Remember, watch, and
listen carefully.
First, I read over the Paraphrasing Strategy to make sure I’m familiar with the steps. Look
up here at the screen. Let’s read the first two steps together…(Step 1: Read a paragraph. Step 2:
296 GILDROY AND DESHLER

Ask yourself, “What were the main idea and details in this paragraph.) Good. I put a passage up
on the screen. Who will read it aloud for us?”

Harriet Beacher Stow has left us no record of her meeting with President Lincoln at Washington
in 1862. Her youngest son, Charley, was with her, and to him we are indebted for a report of the
momentous occasion. It was a striking picture—the tall, rawboned man and the tiny little wisp of
a woman who had undoubtedly been partly responsible for his nomination to the presidency. He
held out his hand to her, looking down at her from his great height. “So, this is the little lady who
made this big war!” (Allen, 1944, p. 182)

Thank you. Now, to continue with the Paraphrasing Strategy. We completed the first step,
Read the paragraph. We need to do the second step. I’m going to look at my cue card that tells me
questions to ask and places to look to find the main idea (see Figure 13.5).
The questions will help me think about what I need to find. Class, looking up at the screen,
what question should I ask myself? Yes, “What is this paragraph about?” When I know, I should
be able to finish this sentence (point) “This paragraph is about…”
OK, to be able to finish that statement, I need to figure out the clues that tell me what the
paragraph is about. Show me on your papers, where it tells me where to look in the paragraph.
Great! I need to look in the first sentence of the paragraph to try to find the main idea.
The first sentence says, “Harriet Beecher Stowe has left us no record of her meeting with
President Lincoln at Washington in 1862.” This sentence mentions two related things about Har-
riet Beecher Stowe, the first is that she didn’t write about meeting the president, the second is that
she met President Lincoln in Washington in 1862. I have to figure out which part could be the
main idea. After reading the rest of the paragraph I know that her son wrote about what happened
when she met President Lincoln, because he was there too. So it’s not very important that Har-
riet Beecher Stowe did not write about the meeting. I think meeting the President of the United
States is important, and the rest of the paragraph tells about the meeting, so I think that’s what

The Paraphrasing Strategy

FINDING THE MAIN IDEA

QUESTIONS TO ASK

What is this paragraph about?

o This paragraph is about .
What does it tell me about?
o It tells me

PLACES TO LOOK
1. Look in the first sentence of the
paragraph.
2. Look for repetitions of the same
word or words in the whole
paragraphs.

FIGURE 13.5 A Cue Card for the Paraphrasing Strategy

 13. EFFECTIVE LEARNING STRATEGY INSTRUCTION 297

the paragraph is about. Class, do you agree? Now I can finish this statement: “This paragraph is
about” what happened when Harriett Beecher Stowe met President Lincoln.
To review, I used the first part of the Paraphrasing Strategy. After we read the paragraph to-
gether, I looked at the cue card for finding the main idea. I read and thought about the questions I
should ask myself and I re-read the first sentence. When I wasn’t sure what information was the
main idea, I thought about what the rest of the paragraph talks about. That gave me the clues I
needed to come up with the main idea. Then I finished the statement that answers, “What is this
paragraph about?”
In a few minutes, we’ll work together to practice identifying the main ideas in more para-
graphs about Harriet Beacher Stow. Right now, we’ll practice saying the steps of the Paraphras-
ing Strategy so we all know them by memory.

Stage 4: Verbal Rehearsal. Although the design and instructional sequence all help to
compensate for weak working memory processes, this step requires students to overtly practice
saying the steps of the strategy until they can say them fluently by memory. That way, when they
are applying the strategy, little cognitive energy needs to be devoted to remember the strategy
and students can concentrate on using the strategies to learn the content of the materials they are
using.
Because the goal is to have students internalize the self-regulating behavior that is guided
by the steps of the strategies, it is important to consistently use and have students use the correct
wording for the steps. If the teacher or students use different words for the steps, the power of the
strategy may be lost when students have difficulty recalling the steps of the strategy.
During this stage, students practice saying the names of the steps—often in a game-like
activity—until they can say them with no errors. Explaining the reasons for the various instruc-
tional steps helps students remain motivated to be engaged in activities that otherwise might be
seen as incongruous with the images students try to project among their peers. Tossing a soft
ball randomly from one student to the other and requiring the catcher to say the next step helps
everyone stay engaged in trying to remember the strategy. This even works in graduate school!
The intensity and quality of rehearsal of the codes or names of the steps directly affect recall
(Swanson, 1991b). Even when students master saying the steps, there should be opportunities
to practice saying the steps over time to ensure retention. Once students master saying the steps
fluently, they move on to controlled practice.

Stage 5: Controlled Practice. During this stage, students receive coaching as they
apply the strategy to material below their instructional levels. Using easier materials reduces
the cognitive load and allows students to concentrate on the strategy rather than devoting energy
to understanding the content with which they are working. Some learning strategy instructional
materials include all of the materials needed for controlled practice and for scoring the quality
of strategy use. This gives students and the teacher a criterion for evaluating student use of the
strategy and helps students monitor their progress.
During the controlled practice stage, students receive elaborated feedback on their use of
the strategy (Kline, Schumaker, & Deshler, 1991). First, after reviewing the students’ work and
observing students using the strategy, the teacher gives individualized feedback that begins with
specific positive comments about what went well (e.g., “Terrific! You wrote down the mnemonic
for the strategy so you could remember the steps of the strategy”). Second, the teacher identifies
and gives concise and specific feedback on one or two elements that need strengthening. The
teacher may provide a mini-model of the step with which the student is having difficulty. Next,
the teacher asks the student to perform the difficult part of the strategy. Through coaching, the
298 GILDROY AND DESHLER

student is able to refine his or her performance. Finally, the student and teacher set goals for con-
tinued improvement in performance.

Stage 6: Advanced Practice. Once students master the strategy with controlled
materials, they begin to apply it to grade level materials. As the strategy may change with use
of more difficult materials, the teacher may model adapting the strategy to meet specific task
demands. Again, the teacher coaches students as needed to help them refine their performance
with the higher level of materials.

Stage 7: Post-test. The primary purpose of the post-test is to compare pre-test products
with post-test products to show students how much improvement they made from their efforts
to learn the strategy. After the post-test, students are asked to record their scores and to compare
their performance prior to and after learning the strategy. If students do not see a significant
improvement from learning the strategy, they may not remain motivated to use the strategy.

Stage 8: Generalization. During this stage, students receive assignments that require
using the new strategy; ideally assignments will be for the class in which they learned the
strategy and in others as well. However, without planning for and monitoring generalization
of the strategy, it is unlikely students will continue to use the strategy. . Occasionally scoring
the use of the strategy can help to retain mastery. A common phenomenon is that after the post-
test, students continue to increase the quality of their performance in using the strategy. Seeing
continued improvement again reinforces students for using the strategy.
If students know several strategies, the teacher can model using the different strategies
while performing a learning task, much like the Palinscar and Brown (1984) model of recipro-
cal teaching. Students learn to select the best strategies to use for different assignments and can
practice using them with other students as they collaborate to complete assignments (e.g., self-
questioning, visualization, and paraphrasing are all appropriate for increasing reading compre-
hension).

Strategy Instruction Research

Prior chapters referred to many validated strategies that can benefit students with learning and
behavioral challenges. Swanson and his colleagues conducted a meta-analysis of over 931 re-
search studies on interventions with students with learning disabilities (Swanson, 1999). Through
coding the types of instructional methods used, they found that the combination of strategy in-
struction and direct instruction produced the highest effect sizes (M = .84). Below are the nine
instructional components that produced the highest effect sizes and a discussion of how these
components are incorporated into effective cognitive strategy instruction.

1. Sequencing. This involves breaking the task into component parts, providing step-by step
prompts, and fading prompts or cues. This is the task analysis component with the naming
of the steps, as well as the instructional sequence.
2. Drill-repetition & practice-review. Distributed short practice and review sessions over
time with feedback contribute to learning and retention. In strategy instruction, students
practice to mastery and then incorporate the strategy into regular assignments as well as
to assignments in other classes. Regular reviews maintain mastery.
 13. EFFECTIVE LEARNING STRATEGY INSTRUCTION 299

3. Segmentation. This involves breaking the task (or strategy) into component parts for in-
struction and synthesizing the parts into a whole for student mastery. Teaching preskills
and difficult portions of the strategy prior to synthesization allows success at every stage
of instruction.
4. Direct questioning and responses. This addresses engaging students in answering “pro-
cess-related” and/or “content related” questions requiring discussion. This is a critical
component in strategy instruction. Students need to understand how and why the arrived
at their conclusions.
5. Controlling difficulty or processing demands of a task. By utilizing the design principles
for strategy development and instruction, the load on working memory is reduced so that
more cognitive energy can be devoted to the content to which the strategy is applied.
Having students learn how to use the strategies with easier materials and moving to grade
level materials as they master the strategy also controls task difficulty and processing
demands.
6. Technology and Visuals. This includes using structured materials including graphic or-
ganizers. Most strategy instruction provides posters and handouts for students with the
steps of the strategies and may include cue cards for remembering how to use parts of the
strategy.
7. Group instruction. This involves small group instruction. With strategy instruction, both
some small group and individualized instruction may be necessary to meet the individual
needs all learners.
8. A supplement to teacher and peer involvement. This addresses having students apply what
they learn in other contexts including homework or in other classes.
9. Strategy cues. This involves teachers’ cuing students to use the strategy, think-aloud mod-
eling with problem solving, and reflecting on the benefits of the learning.

The strategy design and instructional principles are well established in the literature.

SUMMARY

Currently, a number of powerful research-validated cognitive and learning strategies exist across
content areas that focus on helping students become more independent and successful learn-
ers. Using the design principles of effective learning strategies can help in the selection of vali-
dated strategies to meet specific students’ immediate and long-term needs. Although only a few
researchers have been able to provide the needed assessments and materials required to help
students attain mastery of the strategies, following the instructional principles can help students
achieve mastery.
The power of strategy instruction is equally beneficial to average achievers as well as low
achievers. Some school districts have adopted sets of strategies (i.e., the Strategic Instruction
Model (SIM) strategies) and developed a scope and sequence across grade levels from upper
elementary through high school. Focused strategy instruction takes place in specific classes, with
teachers in other classes reinforcing strategy use. Professional development for teachers is ongo-
ing with school coaches. Nearly all students are able to facilitate their own parent-teacher con-
ferences, and students with IEPs facilitate their own Individual Education Plans (IEP) meetings
(Lancaster, Schumaker, & Deshler, 2002). Through a concerted effort, overall achievement in
these districts has risen and their students are graduating with the strategies to develop and attain
their own learning goals. This type of success is immeasurable in the lives of students.
300 GILDROY AND DESHLER

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 14
Accommodation of Instructional and
Testing Situations
Noel Gregg and Jennifer H. Lindstrom

Shamelka, a third grader, has significant problems in the area of reading and writing. Her learning
disabilities in the areas of phonological and orthographic awareness make learning in an inclusive
classroom challenging both for her and the classroom teacher. Shamelka’s Individual Educational
Plan (IEP) documents her right to specific accommodations in the classroom and in testing situa-
tions. These accommodations include extra time on tests that require reading or writing, alterna-
tive media (e-text read-alouds), and a word processor (Alpha Smart) for content area coursework
(science, math, and history).

David, a senior in high school, was diagnosed with Aspergers in the fourth grade. Since that time,
he has received the following instructional and testing accommodations: extra time on tests, use
of a word processor for tests and assignments requiring written expression, a private testing room,
and a personal assistant during testing to help manage potential emotional meltdown(s).

The accommodation of instructional and testing situations for students like Shamelka and
David who receive special education services has led to a great deal of debate in the literature
and within professional associations in terms of various methodological, policy, and legal issues
(Sireci, Li, & Scarpati, 2003). In this regard, one of the most significant barriers facing students
qualified to receive specific accommodations is the lack of professional knowledge pertaining to
the issues surrounding such accommodations (Gregg, Morgan, Hartwig & Coleman, in press).
Cursory understanding of the complex issues influencing accommodation selection can lead to
under, over, or misuse of them. For example, research on the effects of different accommodations
on the performance of students with disabilities has changed the mindset of most professionals
in the field from the view that “one shoe fits all sizes” to the importance of “tailoring” an accom-
modation plan to the specific needs of each student.
An apprehension frequently voiced by the public is whether an accommodation is truly
fair—that is, does it level the playing field or tilt it for a select few who qualify as disabled? Un-
derstanding the issues surrounding the use of accommodations begins with each of us reflecting
upon our own perspectives as they relate to the meanings of constructs such as reading, writing,
merit, equality, or fairness, especially as they pertain to modifying standardized approaches to
accessing and demonstrating knowledge. For example, do we consider speed essential to mea-
suring high school writing competency? Or, is allowing some students to use alternative media
(electronic text/read-alouds) to access science, math, and history books fair to the other students
302
 14. ACCOMMODATION OF INSTRUCTIONAL AND TESTING SITUATIONS 303

in the classroom? Technologies such as word processing, audio books, e-text, or podcasts have
certainly influenced our traditional definitions of reading and writing. Yet, one still hears profes-
sionals protest that to read a book one “must” read with one’s eyes not ears (e.g., read-alouds)
or that only a student with visual impairments should receive access to screen readers or audio
texts. Moreover, on many high-stakes tests, students are required to write an essay using pencil-
and-paper rather than a computer, regardless of the fact that the majority of the school writing
curriculum is done on a computer. Challenging old definitions of reading and writing is a very
concrete yet necessary initial step toward equity for all students with special needs.
Greater dialogue and sharing of knowledge are needed between professionals across the dis-
ciplines who work with elementary, secondary, and postsecondary students. In fact, there exists
a great disconnect between the K–12 and postsecondary accommodation practices and what ap-
pears in the research literature (Gregg, Morgan, Hartwig, & Coleman, in press; Thurlow, 2006).
However, it is not possible within one chapter to review all of this literature. In this regard, the
purpose of this chapter is to provide professionals who work with the K–12 population informa-
tion on the research and best practices literature on accommodations associated with instructional
and testing situations for those students receiving special education services. We will not include
a discussion of the postsecondary literature or the literature on English Language Learners (ELL)
and their specific accommodation needs (see Abedi, Courtney, & Leon, 2003, for an in-depth
review of this literature).

RATIONALE FOR ACCOMMODATIONS

Accommodations adjust the manner in which instruction or testing situations are presented and/
or evaluated so that students with disabilities can either access and/or demonstrate knowledge
in a fair and equitable fashion. An accommodation should not change the content (i.e., knowl-
edge) being learned or tested nor should it provide unfair advantage to the individual using it.
Shamelka’s case illustrates the importance for students with disabilities to receive appropriate
accommodations. Her phonological and orthographic deficits significantly influence her ability
to decode and spell words. However, she demonstrates above average listening comprehension
and verbal reasoning skills. It is imperative that Shamelka be provided access to learning infor-
mation that other students receive through reading printed text so that her knowledge base is not
impacted by her poor reading decoding and spelling abilities. Using alternative media (e.g., e-text
and screen readers) to learn new content (e.g., science, social studies, and math) provides her
equal access to information. In a testing situation, if we are assessing math knowledge, the only
equitable solution is to provide Shamelka with read-alouds and other assistive technologies that
allow her to demonstrate her abilities in math. The construct being tested is math knowledge, not
her ability to read or spell.
The rights provided to students with disabilities for accessing accommodations is built upon
legislative precedence (e.g., 14th Amendment; Title VI of the Civil Rights Act of 1964; Equal
Educational Opportunities Act of 1974; Section 504 of the 1993 Rehabilitation Act; Americans
with Disabilities Act; Individuals with Disabilities Education, 1997, 2004; and No Child Left Be-
hind). The 2004 Individuals with Disabilities Education Improvement Act (IDEA; 2004) requires
that students with disabilities be provided appropriate accommodations across both instructional
and testing situations. Students who are determined eligible for special education services (under
IDEA) must have their accommodation needs specified in their Individualized Education Pro-
gram (IEP). The IEP Team (by law) includes at least one general educator, at least one special
educator, a representative of the local educational agency (LEA), and the parents. The IEP Team
304 GREGG AND LINDSTROM

determines, if appropriate, the need for reasonable accommodations that are consistent with fed-
eral and state guidelines. However, a student’s right to use an accommodation is not generalizable
throughout his or her lifespan, or across different settings or situations. The individual, context,
and accountability system requires ongoing professional decision making and re-evaluation.
The No Child Left Behind Act (NCLB) of 2001 requires states to measure student proficien-
cy in “mathematical and reading or language arts” to determine if schools are making “adequate
yearly progress” (AYP) toward academic proficiency for all students, including students with dis-
abilities. The issues surrounding the accommodation of instruction and testing for students with
disabilities are certainly not novel to the field of special education. However, as a result of the
mandatory, standards-driven reform of NCLB, this group of learners has begun “to be acknowl-
edged fully” and “schools and school districts [are being] forced to confront the conceptual and
technical issues inherent in implementing reforms” (McLaughlin, Embler, & Nagle, 2004, p. 2).
Federal legislation does caution, however, that only “appropriate accommodations, where
necessary” (IDEA), and “reasonable accommodations necessary to measure academic achieve-
ment” (NCLB) be provided to students. Identifying “reasonable” and “appropriate” accommoda-
tions requires professional judgment as these accommodations must be examined separately for
each student. The challenge rests with the provision and implementation of accommodations.
Who resolves the question of which accommodations should be provided and under what circum-
stances? Far too often a single accommodation is used across a variety of settings (e.g., extra time
is granted for instructional and testing situations in reading, mathematics, science, etc.) with little
thought given to whether this compromises the purpose of the learning task.
While accommodation rights are specified by federal legislation, the states are left with
the responsibility of determining how the rules for ensuring valid and reliable decision making
remain consistent with professional and technical standards. It is the responsibility of each state
to develop policies clearly identifying allowable accommodations (reflecting adequate reliability
and validity), decision-making criteria, and training for educators on how best to select appro-
priate accommodations. Without clear and consistent accommodation guidelines from the state,
potential problems in the decision-making process can occur at the school level. These problems
may include offering too many or too few accommodations, mismatches between instructional
and testing assessments, lack of documentation for decision making, and treating accommoda-
tions and modifications synonymously.
The Standards for Educational and Psychological Testing (Standards; American Education-
al Research Association [AERA], American Psychological Association, and National Council on
Measurement in Education, 1999), while not legally binding, are a widely respected guide to the
best practices that have evolved over several decades (Koenig & Bachman, 2004). The Standards
provide significant guidance to professionals in developing appropriate accommodation policies
and procedures, although interpretation of their specific application continues to be debated in
the courts (Phillips, 1994; Sireci & Green, 2000). The Standards encourage professionals to
make accommodation decisions based on existing research (Standards 10.2 and 10.8), and to
consistently follow clearly delineated policy describing the rationale and procedures for accom-
modation decision making, as well as possible limits on the validity of inferences that can be
made (Standards 10.4 and 10.5).
One positive outcome of the NCLB Act (2001) is an increase toward proficiency on statewide
assessments for students with disabilities (Thompson, Johnstone, Thurlow, & Altman, 2005). Ac-
cording to data that has been collected, the trend has been influenced by the following factors:
development of policy for participation in testing, alignment of students’ IEPs with curricu-
lum standards, ongoing professional development, development and provision of accommoda-
tion policies and procedures, increased access to standards-based instruction, and improved data
 14. ACCOMMODATION OF INSTRUCTIONAL AND TESTING SITUATIONS 305

collection (see, for example, Thompson, Johnstone, Thurlow, & Altman, 2005, for an in-depth
discussion). According to this report, states identified the following as emerging needs related
to providing accommodations to students with disabilities: technical assistance on appropriate
instructional and/or testing accommodations; professional development, particularly for general
education; and federal guidance on the degree of specificity required in state guidelines. After
a long and arduous battle in the courts, the state of Oregon developed a juried process (i.e., a
panel that includes researchers, administrators, classroom teachers, and experts in testing, dis-
abilities, and academic content) for identifying appropriate accommodations and/or modifica-
tions for instruction or assessment (see, for example, Almond & Karvonen, 2006, for an in-depth
discussion). Oregon appears to have translated measurement theory and federal guidelines into
sound practice. Clearly, the policy and procedures developed by states, guided by evidence-based
research, are critical for students accessing appropriate and effective accommodations for in-
struction and assessment.

MODIFICATIONS AND ALTERNATE ASSESSMENTS

The majority of students with mild/moderate learning and behavioral disorders receive accom-
modations rather than modifications or alternate assessments. Unlike an accommodation, a
modification represents significant change to the instructional method or curriculum (e.g., in-
structional level, content, or performance criteria). The IDEA (2004) discontinued the use of the
word modification as it pertains to testing because of the requirements established in the NCLB
Act (2001) to include all students in school accountability systems.
Alternate assessments are developed to measure the performance of students who are unable
to participate in general state assessments even with accommodations. Such alternate measures
involve changes in test construction, administration, response, or scoring which, in turn, alters
the nature of the constructs being measured (Hollenbeck, 2002). Many states are developing in-
novative means to preserve the construct validity of alternate assessment measures (e.g., New
Hampshire Enhanced Assessment Initiative, National Alternate Assessment Center). Approxi-
mately half of the states report alternate assessments using a portfolio framework or other bodies
of student performance evidence (Gong & Marion, 2006). As Gong and Marion note, “There
is no question that NCLB has ratcheted up the pressure on states to compare validly the scores
derived from alternate assessments to common content and achievement standards” (p. 2). Alter-
nate assessments are more often appropriate for students with significant cognitive disabilities
who demonstrate the most profound learning challenges. Table 14.1 provides definitions for the
words used in the adaptation of testing or instructional content, as well as the principle markers
differentiating each term.

DECISION MAKING LEADING TO ACCOMMODATION SELECTION

One key component to the provision of accommodations is utilization of the information dis-
cussed during the student’s eligibility meeting and/or included in the psychological report. Draw-
ing upon the student’s unique profile when selecting accommodations enhances the probability
of their effectiveness. In addition to recognizing individual differences (e.g., cognitive, affective,
and linguistic processes), it is important to consider the task format (e.g., degree of structure,
modality) and the response choices (e.g., written, oral) during the decision-making process.
Whether an accommodation is effective is dependent upon a professional’s knowledge of specific
306 GREGG AND LINDSTROM

TABLE 14.1
Definitions and Markers for Testing and Instructional Adaptations

Term Markers
Instruction Methods of teaching;
Activities used for student learners;
Activities of both teachers and students;
Assessment Means to measure learning outcome;
Means to measure the learner
Accommodations Constructs not altered;
Changes to instructional time or testing time, presentation, response, participation,
and/or level of support;
Inferences from student performance the same across accommodation/non-
accommodation situations;
Instructional Modifications Instructional standards and pedagogy significantly altered;
Validity of instructional methodology altered;
Alternate Assessment Test construction, administration, response, or scoring significantly altered;
Constructs measured significantly alter meaning;
Inferences from student performance not equal across altered/non altered assessment;
Validity of measure altered

cognitive, affective, and linguistic processes impacting different types of learning demands. For
instance, a student’s underachievement on reading measures might be more directly related to
problems with reasoning or strategic planning than with phonological awareness. Understanding
the reason(s) for the underachievement should influence the type of accommodation(s) chosen.
As with assessment, the accommodation process requires professionals to use a “reasoning from
evidence” approach (Pelligrino, Chudowksy, & Glaser, 2001). Such an approach depends on the
integration of multiple data sources, particularly: (a) the individual’s profile, (b) the task demands
(skills/content), and (c) the interpretive methodologies used to analyze the data.
Consistent and reliable professional judgment is essential to the accommodation process
(Fuchs, Fuchs, Eaton, Hamlett, Binkley, & Crouch, 2000; Hollenbeck, Tindal, & Almond, 1998).
Recently, researchers have been working on developing theory-driven guidelines for matching
individual student profiles with accommodations (Elliott, 2006; Helwig & Tindal, 2003; Kopriva,
2002; Siskind, 2004). However, the focus of this research continues to remain predominately on
the selection of testing accommodations rather than instructional accommodations.
Focusing primarily on testing accommodations is a concern if one considers the outcomes
from The Rhode Island 2002 and 2003 Assessment Accommodation Study. Ewing (2006) report-
ed findings from this study in which the accommodation-related decisions made by professionals
were investigated across instructional and assessment situations. Ewing identified five specific
testing accommodations which were most often provided to students with disabilities regardless
of the learner’s profile or information provided by the IEP Team. These accommodations includ-
ed alternate location, oral administration of directions, clarified and repeated directions, extended
time, and frequent breaks. In addition, the testing location, rather than the student’s IEP, dictated
the type of recommended accommodation. Interestingly, Ewing found that instructional accom-
modations were much more detailed and individualized than testing accommodations. Unfortu-
nately, general educators were rarely participants in the decision making for either assessment or
instructional accommodations and follow-through on assessment accommodations was almost
always the responsibility of the special educator. The relationship between the accommodations
students with disabilities received during instruction did not parallel those received during as-
 14. ACCOMMODATION OF INSTRUCTIONAL AND TESTING SITUATIONS 307

sessment; students consistently received far fewer and less individualized assessment accom-
modations compared to those received during instruction. This outcome has grave implications
when one considers the weight given to high-stakes assessment for the progress and monitoring
of student performance. It appears that more attention is given by professionals in the field to
instructional accommodations while researchers continue to focus primarily on testing accom-
modations. Instead, testing accommodations should be determined based on which instructional
accommodations have been found to be appropriate and effective for the individual student.
Accommodations relate to the changes in time, presentation, response, participation, and
level of support necessary for a student with special needs to learn and demonstrate knowledge
across instructional and/or testing situations. Unfortunately, as previously mentioned, the vast
amount of research related to accommodations focuses on testing rather than instructional ac-
commodations. As concern over high-stakes tests dominates the political, social, and educational
mindset in today’s schools, this is not surprising. While accommodations can benefit students
across both testing and learning situations, the requirements and purpose of testing and learning
are not always identical. Therefore, professional judgment is again central to the validity of using
accommodations across multiple settings.
Rather than discussing test or instructional accommodations in isolation, in this chapter
we will view both together under the rubric of the accommodation process. Since the whole is
greater than the sum of its parts, each component of the accommodation process should influ-
ence and guide the others in a bidirectional rather than a unidirectional manner. For instance, the
questions and concerns surrounding the validity of testing accommodations are equally relevant
to instructional accommodations.
Borrowing from the Pellegrino et al. (2001), discussion on the design of scientifically-based
assessment measures, as well as the ongoing instructional validity research of the National
Alternate Assessment Center (NAAC Advisory Board, 2006), we developed a Formative Ac-
commodation Process model to be used in identifying and supporting accommodation decisions
for either instructional or testing situations at the state, school, and classroom level (see Figure
14.1). Unfortunately, the accommodation policies and procedures used by states for their high-
stakes achievement testing are often not used by teachers for classroom instruction or testing
situations. This practice leads to “idiosyncratic decision-making” (Tindal & Ketterlin-Gellor,
2004).
Step One of the Formative Accommodation Process includes careful review of a student’s
profile. This requires consideration of the individual’s cognitive, behavioral/affective, and ac-
ademic strengths and weaknesses for selection of specific accommodations across settings.
Achievement performance alone should not be the sole basis for accommodation selection. For
example, a student’s low reading comprehension scores could be the result of deficits in phono-
logical and orthographic awareness influencing reading fluency and comprehension. However,
the poor reading performance might also be the result of executive processing deficits influencing
adequate comprehension monitoring. The type of accommodation(s) for these two situations is
not identical. It is imperative that professionals give equal consideration to a student’s history and
experiences along with academic content and classroom environment.
Step Two pertains to the evaluation of the content either being tested or taught. Identification
of the specific skills (e.g., fractions) being measured rather than ancillary requirements of the
task (e.g., reading) are identified. In addition, recognition of the stages of learning that are to be
measured (i.e., acquisition, proficiency, maintenance, generalization, and adaptation) should be
clearly identified by the team of professionals who work with the student.
Step Three requires careful professional evaluation of the task and setting requirements.
The degree of structure required by the task or setting, including cues/prompts, response types,
308 GREGG AND LINDSTROM

STEP ONE

Evaluation of Student STEP TWO

Cognitive
Language Evaluation of Content
Behavioral/Affect Skills
Academic Stage of learning
Experiences

STEP SIX

Evaluation of Outcomes STEP THREE

Student level
System level Evaluation of Observations
Task
Setting

STEP FIVE STEP FOUR

Interpretation
Construct Validity
Selection of Accommodation
Multiple data sources
Reliability
Evidence-Based Research
Experiences

FIGURE 14.1 Formative Accommodation Process.

and modalities for the acquisition and/or production of learning are compared at this point to the
student’s learning profile (Step One).
Step Four is the point at which specific accommodations are selected based on multiple
data sources (Steps One–Three) and available evidence-based research. The IEP Team would
then make decisions using both their observations (Steps One–Three) and available research to
determine the most appropriate instructional and test accommodation(s) for a specific student.
Step Five is the point at which the construct validity and the reliability of a chosen ac-
commodation are evaluated. For standardized testing accommodations, the literature provides
professionals with a great deal of valuable resources to help guide this process (see below; Mea-
surement Issues and Test Accommodations, page 20 ).
 14. ACCOMMODATION OF INSTRUCTIONAL AND TESTING SITUATIONS 309

Step Six (the final step) is time at which the professional develops a standardized and sys-
tematic method to record the effectiveness of specific instructional and/or test accommodations
for each student. At any given time, an outside reviewer should be able to evaluate the progress a
student is making when specific accommodations are provided.

UNIVERSAL DESIGN FOR LEARNING (UDL)

Creating universally designed learning environments is central to any discussion of accommodat-

ing testing and learning environments for students with special needs.
Universal design is commonly associated with the movement to ensure physical environ-
ments that are accessible to all individuals (e.g., curb cuts). UDL extends universal design from a
physical space to a pedagogical space. IDEA (2004) defines UDL as “a concept or philosophy for
designing and delivering products and services that are usable by people with the widest possible
range of functional capabilities, which include products and services that are directly accessible
(without requiring assistive technologies) and products and services that are interoperable with
assistive technologies” (Section 611, 16[E]). Therefore, UDL is a philosophy written into law
that supports equal access to learning for all individuals.
The philosophy behind UDL encourages professionals to provide better access to learning
opportunities for everyone, not just students with disabilities. UDL practices are inherently
flexible so as to support all learners, thereby reducing the need for modifications and accom-
modations in either testing or instructional situations. Accommodations in UDL should be
seamlessly integrated across all situations. According to Dolan and Hall (2006, March), the
goal of UDL is to “reduce accommodations as retrofits.” However, empirical-based research
documenting the effectiveness of UDL has been limited both in rigor, specificity, and quantity
of studies.

Types of Accommodations

As mentioned earlier, accommodations can be classified under one of five different categories:
presentation, response, scheduling/timing, setting, and behavioral. These categories can be ap-
plied to either testing or instructional accommodations. Since the early 1990s, the National
Center on Educational Outcomes (NCEO) has been federally funded to maintain a systematic
database on the participation of students with disabilities in large-scale testing programs. The
NCEO Web site (http://www.education.umn.edu/NCEO/) provides professionals with a wealth
of state-level data and other resources pertaining to state compliance and the accommodation of
high-stakes testing.

Presentation Accommodations. Presentation accommodations provide the student

access to academic information by alternative means (e.g., screen reader, access assistants [reader,
sign language interpreter], alternative media [e-text, audio books, Braille], language structures
(e.g., simplified language), font format (e.g., large print, type or color of font), and instructional
methodology (e.g., cooperative learning, computer-assisted). Oral presentation (read-alouds)
is one of the most frequently investigated and used testing accommodations across disabilities
(Sireci et al., 2003; Thompson, Blount, & Thurlow, 2002). The majority of the research within
this category pertains to a variety of oral presentations accommodating testing situations (Sireci
et al., 2003; Thompson et al., 2002). The types of oral presentation methods most often studied
include teacher reading, student/peer reading, and screen reading software.
310 GREGG AND LINDSTROM

The effectiveness of oral presentation of content during testing or instruction is not sup-
ported by any conclusive evidence (Calhoon, Fuchs, & Hamlett, 2000; Fuchs et al., 2000; John-
son, 2000; Kosciolek & Ysseldyke, 2000; Meloy, Deville, & Frisbee, 2002; Sireci et al., 2003;
Thompson et al., 2002; Tindal, Heath, Hollenbeck, Almond, & Harness, 1998). It is likely that
further research examining the effectiveness of oral presentation as an accommodation will re-
veal that read-aloud applications are only one of several variables directly and indirectly influ-
encing student performance. For instance, researchers identified that students with disabilities
often do better on constructed-response items than multiple choice across different read-aloud
formats—the read aloud was not the critical variable but rather the type of task format (Calhoon
et al., 2000; Sireci et al., 2003).
Read-alouds for accommodating instructional practice have primarily focused on improving
reading or spelling performance for students with disabilities (Graham, MacArthur, & Schwartz,
1995; Handley-More, Deitz, Billingsley, & Coggins, 2003; Higgins & Raskin, 2000; MacArthur,
1998, 1999, 2000; MacArthur & Cavalier, 2004; MacArthur, Graham, Haynes, & De La Paz,
1996; Raskind & Higgins, 1999). However, what is lacking in the research is evidence of the ef-
fectiveness of read-alouds for accommodating student progress within the standard curriculum.
Computer-based instruction and testing has also been advocated by many as the solution
to accommodating students with disabilities. However, Thompson, Thurlow, Quenemoen, and
Lehr (2002) present an in-depth review of the positive and negative aspects related to computer-
based testing for students with disabilities. As they note, “Often, the approach has simply been
to take the paper-and-pencil test and put it onto the computer” (p. 1). This same conclusion can
certainly be generalized to a great deal of computerized instruction. However, technologies are
contributing to the development of classroom-based monitoring of learning progress. According
to Pellegrino et al. (2001), “A possibility for the future arises from the projected growth across
curricular areas of technology-based assessment embedded in instructional settings” (p. 10). Ap-
plication of this type of systematic monitoring of instructional outcomes has great potential for
measuring the effectiveness of instructional accommodations.

Response Accommodations. Response accommodations allow for the student to

demonstrate his or her knowledge using alternative forms (e.g., writing directly on test booklets,
oral response, sign language), accessing assistants (scribes), using assistive technologies (voice-
to-text), or other tools (word processor, calculator). The most common types of response
accommodations (using technology) include word processors with spell check, proofreading
assistance, abbreviation expanders (programs that allow students to type abbreviations for
frequently used words or phrases and press the space bar/mouse to select the complete word or
phrase), and outlining software programs (Day & Edwards, 1996).
The effectiveness of word processors for accommodating the responses of students with
disabilities for either testing or instruction has been inconclusive (Cahalan-Laitusis, 2003). For
instance, MacArthur and Graham (1987) found no differences between the quality scores for
handwritten or computer written essays of middle school students with learning disabilities. In-
terestingly, Hollenbeck, Tindal, Harness, and Almond (1999) found that students with disabilities
performed worse when they used computers on high-stakes tests. One needs to be very careful,
however, when interpreting some of the research pertaining to word processing and writing com-
petence for students with disabilities. The majority of the studies failed to control for the amount
of instructional time that was provided to students on word processing skills prior to document-
ing its effectiveness for increasing writing quality.
However, research supports the use of scribes as a very effective accommodation for students
with disabilities during testing situations (Trimble, 1998). Interestingly, Raskind and Higgins
 14. ACCOMMODATION OF INSTRUCTIONAL AND TESTING SITUATIONS 311

(1999) found the use of text-to-speech as an effective means for helping students with learning
disabilities edit their own written compositions. Again, however, application of this research to
standard curriculum experiences is necessary to evaluate the effectiveness of its use as an instruc-
tional accommodation.

Scheduling/Timing Accommodations. Scheduling and timing accommodations are

adjustments to the time provided to complete learning tasks and respond to academic content
(e.g., extended time, unlimited time, frequent breaks, testing over multiple days). Researchers
have explored the accommodation of extra time in testing situations more than any other
scheduling/timing accommodation (Chi & Pearson, 1999; Sireci et al., 2003; Thompson et al.,
2002). Unfortunately, in a great deal of current research extra time and other accommodations, in
particular read-alouds, were not studied as separate variables influencing performance.
The overall conclusion of the accommodation literature points toward the effectiveness of
extra time for students with disabilities across testing and instructional settings. Sireci (2004)
concluded that flexible time limits reduced unintended speededness effects and did not alter
the construct validity of tests. However, several researchers have pointed out that extended time
alone will not improve a student’s performance. The student must first acquire, by means of
direct instruction, the knowledge being tested (Fuchs et al., 2000). Mandinach, Bridgeman, Ca-
halan-Laitusis, and Trapani (2005) investigated the interaction of extended time and a modified
schedule. They concluded that (a) lower ability students were not aided by extended time, (b)
section breaks helped all students, and (c) extended time helped the medium to higher ability
students more significantly than low ability students. These findings highlight the fact that the
accommodation should never be seen as replacing instruction, but rather facilitating access or
production of knowledge.

Setting Accommodations. Alterations to the academic environment (e.g., private room,

small group setting) as an accommodation during testing has not been empirically studied in
isolation. While it is standard practice for many students with disabilities, the effectiveness of this
accommodation consists mainly of anecdotal evidence to support its use in practice.

Behavioral Accommodations. Facilitation of appropriate behavioral responses to

academic learning (e.g., personal assistant, time-out area, breaking tasks down into smaller
units, reinforcement systems) is a common practice in special education classrooms. Again,
while the literature has supported the need for these adaptations in teaching, empirical research
documenting their use for accommodating tests and/or as a standard classroom accommodation
is limited. Support for behavioral accommodations rests mainly with professional judgment.

MEASUREMENT ISSUES AND TEST ACCOMMODATIONS

Test accommodations are designed to promote fairness in testing and lead to more accurate inter-
pretations of examinees’ tests scores (Sireci & Pitoniak, 2006). Although accommodations (e.g.,
extended time) are intended to provide equal access by removing unnecessary challenges (e.g.,
construct irrelevant variance), some types of accommodations may change the test’s construct,
thus altering the comparability of scores derived from the accommodated test. Preservation of
construct validity allows for score comparability across individuals with and without accom-
modations.
Most accommodations do not appear to alter the validity of the test, so the interpretation of
312 GREGG AND LINDSTROM

test scores is not influenced. For instance, a reading test written in large print should not change
the underlying construct the test was intended to measure because the skill of reading is still
being assessed. Several accommodations, however, are thought to change the construct of some
tests. For instance, there is some debate regarding the impact of extended time on the validity of
tests that are speeded. Extra time allows students to reach questions at the end of a speeded test
that they may not have attempted under standard timing conditions, but no general consensus
has been reached regarding the degree to which extended time changes what the test purports to
measure or its impact on the comparability of tests scores across various groups of examinees
(Camara & Schneider, 2000).
Phillips (1994) argues that measurement specialists should consider the impact of accommo-
dations on the test’s construct validity. He contends that any changes to testing conditions should
be avoided if the change would (a) alter the skill being measured, (b) preclude the comparison of
scores between examinees who received the extended time and those who did not, or (c) allow
examinees without disabilities to benefit if they were granted the same accommodation. This last
criterion is contentious and recently several researchers have argued that accommodations should
only be provided if they offer a “differential” boost to students with disabilities (Fuchs & Fuchs,
1999; & Pitoniak & Royer, 2001).
Psychometric issues in test accommodations stress the need to remove construct-irrelevant
barriers to test performance while maintaining the integrity of the construct being measured by
the test (Sireci et al., 2003). For example, a student who learned Spanish as her first language
may do worse on a math test administered in English (her second language). In this case, English
proficiency may be considered extraneous to the math construct targeted by the test, but would
certainly affect her test performance on the English language version of the test. Removing these
barriers, which is analogous to accommodating the administration, is thus seen as removing con-
struct-irrelevant variance and strengthening the validity of test scores.
Paradoxically, accommodations may also introduce construct-irrelevant variance if the ac-
commodation itself changes the construct being measured. If the construct intended to be mea-
sured by a test changes, and the new characteristics measured represent a different and unintended
construct, then construct-irrelevant variance is also present (Sireci, 2005). Furthermore, if the
accommodation removes or replaces portions of the test content, construct-under-representation
may result. Therefore, although accommodations are designed to promote fairness in testing, the
degree to which the accommodation(s) strengthens validity is directly related to the degree to
which the accommodation alters the construct being measured (Sireci, 2005).
The issue of score comparability merits a brief discussion as well. Despite its common use
in the Standards (AERA/APA/NCME, 1999; Standard 10.11) and elsewhere, the term score com-
parability is not defined anywhere in the Standards. This lack of clear definition has led many
researchers to define score comparability in the limited framework of differences in mean scores
across groups. In fact, for many years, researchers assumed that to appropriately measure these
differences one must simply administer a measure across different testing situations and/or differ-
ent groups and compute the difference between the two (or more) observed scores (Cronbach &
Furby, 1970). However, a number of potentially problematic issues in the use of difference scores
have been identified (see, for example, Cronbach, 1992; Edwards, 1994). To get an adequate as-
sessment of these differences when comparing mean scores across groups, it is essential that the
measure is perceived to be used in the same way by individuals. In other words, it is necessary
to show that the two measurements are psychometrically equivalent to make valid comparisons
across groups of respondents (Horn & McArdle, 1992).
A test fulfills measurement equivalence/invariance when it is shown to measure the same
attribute under different conditions (Meade & Lautenschlager, 2004). These different conditions
 14. ACCOMMODATION OF INSTRUCTIONAL AND TESTING SITUATIONS 313

may include the stability of measurement across different populations (e.g. individuals with and
without disabilities) and/or different methods of test administration (e.g., extended time adminis-
tration vs. standard time administration). Under such conditions, tests of equivalence/invariance
are typically conducted via confirmatory factor analysis (CFA) methods (Meade & Lauten-
schlager, 2004), thus allowing researchers to determine the extent to which test scores across
groups and/or conditions are comparable.
Another measurement issue involves the concept of speededness. The degree to which edu-
cational tests are speeded has a direct bearing on the issue of score comparability because the
accommodation of extended time changes the construct measured on a speeded test, but not on
a test that is not speeded (e.g., a power test). According to the Standards, speededness is “a test
characteristic, dictated by the test’s time limits, that results in a test taker’s score being dependent
on the rate at which work is performed as well as the correctness of the responses…Speededness
is often an undesirable characteristic” (p. 182). In general, on a pure speed test, individual differ-
ences depend entirely upon the speed of performance and the items are relatively easy; on power
tests, the differences are not contingent on speed and the items increase in difficulty (Ofiesh,
Mather, & Russell, 2005). If speed of responding plays a significant role in determining scores on
power tests, and speed is not part of the intended construct, then the validity of the assessments
is threatened (Bridgeman, Trapani, & Curley, 2003).
The validity and reliability of nonstandardized assessments and instruction provide pro-
fessionals a greater challenge. Single-subject methodology is one solution to ongoing validity
checks, particularly for curriculum-based assessments and instruction. In addition, professional
judgment can be used in determining the appropriateness of accommodations. However, on-
going accountability measures will require some of the same validity tools being designed for
alternate assessments. The importance of valid and reliable measures cannot be stressed enough;
they provide the accountability for the ongoing instructional and testing accommodations in the
classroom.

MEASUREMENT ISSUES AND INSTRUCTIONAL ACCOMMODATIONS

As one reviews the accommodation literature for students with disabilities, it is apparent that the
primary focus of research has been on investigating the accommodation of standardized assess-
ments, particularly statewide high-stakes tests. In comparison, the accommodation of the stan-
dard curriculum has received far less attention. However, if a student with disabilities is not able
to access or demonstrate knowledge using evidence-based accommodations, the individual’s per-
formance on high-stakes tests, with or without accommodations, will be below standards. There-
fore, professionals working with individuals with disabilities must begin to focus more closely
on the effectiveness of instructional accommodations for different types of learners within the
general education curriculum.
Encouragingly, the methodologies that are currently available can be used to guide profes-
sionals in selecting and monitoring the effectiveness of instructional accommodations. For in-
stance, The Learning Strategies Curriculum developed at the University of Kansas has a wealth
of evidence-based research documenting the acquisition, storage, and demonstration of learning
strategies for a student’s success in the classroom. The Learning Strategies Curriculum has been
field-tested in hundreds of schools to show its effectiveness; long-term research provides evi-
dence of its usefulness with standard curriculum when “consistent, intensive, explicit instruction
and support are key ingredients” (Lenz, Deshler, & Kissam, 2004, p. 358). Obviously, one of the
problems of strategy instruction has been lack of generalization to the regular classroom (Ellis,
314 GREGG AND LINDSTROM

1993). However, many innovative means to evaluate, maintain, and record the generalization of
learning strategies to standard curricula have been developed by the professionals who developed
the Learning Strategies Curriculum (Deshler, 2003; Deshler, Schumaker, Lenz, Bulgren, Hock,
& Knight, 2001; Ellis, 1993, 1997; & Lenz, Deshler, & Kissam, 2004). Their research has fo-
cused primarily on adolescents with learning disabilities and their acquisition or generalization
of learning strategies. However, we do not need to reinvent the wheel. The principles, knowledge,
and methodologies gained from this significant body of research can provide guidance to state
policymakers, school personnel, and teachers in better documenting the effectiveness of learning
accommodations.
Learning accommodations are not synonymous with instructional strategies or methodolo-
gies for teaching; they are the means by which professionals adapt a learning task or curriculum
to provide equal access to students with disabilities. Some learning strategies must be adapted or
individualized to a specific learner just as instructional methodologies must be adapted or indi-
vidualized to a specific teacher. This is the fundamental and guiding principle for special educa-
tion decision making. The key is to apply this principle to ensure valid and reliable practice. Due
to the lack of evidence-based research in this area, many of the decisions surrounding learning
or testing accommodations are dependent upon professional judgment. At times, using profes-
sional observation and judgment to evaluate the effectiveness of accommodations on learning is
more appropriate than empirical-based research. However, there continues to be a need for more
evidence-based research to support decision making related to testing and instructional accom-
modations.

PAST, PRESENT, AND FUTURE

The use of accommodations in both instructional and testing situations is contributing signifi-
cantly to the increased success of students with disabilities on national and state assessments
(Thompson et al., 2005). In this regard, it is most appropriate to view accommodations as simply
leveling the playing field; they do not supply the knowledge necessary to pass tests. While ac-
commodations are tools for accessing or demonstrating knowledge, they should never replace
ongoing, direct instruction. For instance, Cohen, Gregg, and Deng (2005) found that the cause
of differential performance for students with and without learning disabilities on a high-stakes
mathematics test did not appear to be due to receipt of extended time but rather the individual’s
knowledge of the content. Mathematics competency differentiated the groups of student learners
regardless of their accommodation and/or reading levels. Accommodations are not the source of
differential performance; they simply mediate learning.
Unfortunately, focusing primarily on testing rather than instructional accommodations has
diverted professional attention away from the main goal of special education: equal access to,
and demonstration of learning for all students. Accommodating the instructional environment
will provide students with special needs the knowledge necessary for success across the cur-
riculum—not just during testing situations. Instructional accommodations must receive the same
considerations as those given to testing situations. For example, the validity and reliability issues
surrounding the provision of test accommodations should be considered for instructional ac-
commodations as well. In addition, research on validating alternate instruction has the potential
to help guide instructional accommodation decision making. As Sireci et al. (2003) note, “The
literature is clear that accommodations and students are both heterogeneous” (p. 48). Success of
students with disabilities with learning the standard curriculum in the general education class-
room is dependent upon professionals making informed decisions based on evidence-based prac-
 14. ACCOMMODATION OF INSTRUCTIONAL AND TESTING SITUATIONS 315

tice and research. At times, informed professional judgment will be the most valid and reliable
source for decision making. However, this requires that professionals use a systematic method for
decision making that is both reliable and valid.
Shamelka and David, the two students with disabilities discussed at the beginning of this
chapter, require both testing and instructional accommodations. Decisions on the appropriateness
and effectiveness of their accommodations should be based upon multiple data sources. In addi-
tion, systematic monitoring of the effectiveness of Shamelka’s and David’s accommodations will
contribute to their success on high-stakes testing and proficiency across the standard curriculum.
Accommodations are not ancillary to learning for these two students; rather, they are the heart
and soul of special education.

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 IV
ISSUES RELATED TO TEACHING
STUDENTS HAVING LEARNING AND
BEHAVIORAL CHALLENGES
 15
Issues Unique to English
Language Learners
Samuel O. Ortiz and Agnieszka M. Dynda

Those who cannot remember the past are condemned to repeat it.
Santayana, 1905

INTRODUCTION

Some may wonder whether the introductory quote for this chapter was selected intentionally with
an eye toward irony. After all, Santayana was a Spanish American and the use of his ethnicity,
not just his words, to highlight the thematic element of this chapter would certainly qualify as an
additional twist to the problem of providing evidence-based interventions for English language
learners. But the quote stands on its own merit, irrespective of the author’s heritage, and truly sets
the stage for understanding the issues relevant to language minority children being served and
educated presently in U.S. public schools. These issues form a clear pattern, one that has repeated
itself continuously throughout the history of this country, and is based on assumptions that al-
though wrong, are still pervasive in the schools and society and especially in the minds of policy
makers who hold sway over the education of all children, including English language learners.
The structure and focus of this chapter are likely to appear different than others contained in
this book. The reason for this has more to do with what is known and not known about evidence-
based interventions with English language learners. The fact is, there is virtually no literature
base on this topic; providing a review of what there is would make this an exceedingly short
chapter. And what research there is suffers from flaws that render them rather useless. To provide
a discussion that is of practical significance to practitioners looking to provide effective, respon-
sive, and appropriate interventions with English language learners requires more of a “what do
we know” than a simple “what works” approach. In the final analysis, what interventions work
with English language learners must necessarily be those that are based on what we know. It has
been precisely this problem, a failure to apply the knowledge base regarding the learning needs
and patterns of English language learners, that has doomed previous efforts in developing evi-
dence-based interventions.
Because decisions regarding education and intervention attempts are often based on intui-
tive reasoning and culturally-bound beliefs rather than on empirical data, it is necessary to begin
by revealing how such ideas and attitudes developed and how they have become entrenched

321
322 ORTIZ AND DYNDA

in the educational practices of our school systems. Indeed, practitioners have little chance of
developing appropriate interventions, evidence-based or not, if they are unable to recognize the
manner in which their own personal and professional biases affect decisions regarding the nature
of an intervention as well as the anticipated progress and expected outcome. The next section will
turn to issues regarding development. This may seem unnecessary at first given that psycholo-
gists and practitioners in educationally-related fields are usually well versed in such matters.
However, when it comes to English language learners, the manner in which cultural and linguis-
tic differences affect development and how they interact with instructional practices to produce
quite different learning trajectories is not nearly as well known. The chapter will conclude with
a discussion regarding instructional and intervention practices and how they may be designed in
accordance with the developmental principles outlined in the previous section. Practical guide-
lines will be offered so that professionals may be able to design and implement interventions to
meet the needs of English language learners that are based on the best available science about
“what works.”

English Language Learners in Historical Context

Perhaps more misconceptions exist regarding the history of schooling English language learners
in the United States than in any other area. In addition, it is likely that no topic suffers more from
“euphoric recall,” which is the tendency to remember only the good or positive about the past
and not the bad. For example, a common refrain heard often in discussions about language and
education invariably sounds something like this: “my great-grand parents came to this country
and they learned English immediately and succeeded, so why can’t current immigrants just do
the same?” Many Americans hold the belief that immigrant achievement was better in the “good
old days” despite the evidence that this is far from the truth (Rothstein, 1998). When it comes to
the reality about the history of achievement of English learners in this country, what is often be-
lieved to be true, is not. The cultural and linguistic assimilation and educational attainment of our
immigrant populations have improved considerably over the last century yet it appears as if this
phenomenon has gone largely unnoticed (Rothstein, 1998). Misconceptions continue to abound
at every level of education and in the minds and gut instincts of the policy makers who determine
educational practices broadly. There are many reasons for these mistaken beliefs, some of which
will be discussed here, but the reader is admonished to consider that these misconceptions are so
common and prevalent that they persist in policies evident in education to the present day.

English Only. English has been accorded special and favored status in the United Stated for
quite some time, not necessarily because of any constitutional or legislative protections accorded
by the founding fathers, but primarily by default. The large British population who later became
American simply dominated society and English naturally became most associated with the
United States despite the presence of other popular languages (e.g., German and French). After
some time, however, public sentiment began to associate English with patriotism and national
identity and the fervor took hold in the science of the early 20th century that began to suggest
that certain immigrant populations were mentally inferior and perhaps ought to be excluded
from entry (Brigham, 1923; Gould, 1996). This worry is illustrated poignantly in the case of
a parochial school teacher in Hamilton County, Nebraska, by the name of Robert Meyer (see
Crawford, 1992 for a detailed discussion). It seems that Mr. Meyer was found guilty of violating
a 1919 statute that mandated English-only instruction in all public and private schools in the state
of Nebraska (a law not unlike many that have been passed recently by other states). Mr. Meyer
was apparently attempting to teach a bible story to a 10-year-old student using German which
 15. ISSUES UNIQUE TO ENGLISH LANGUAGE LEARNERS 323

violated the 1919 statute which also specified that foreign language instruction could begin only
after a pupil had reached and passed eighth grade. Upon appeal, the Nebraska Supreme Court
upheld the conviction and issued the following ruling in support of its decision:

The salutary purpose of the statute is clear. The Legislature had seen the baneful effects of permit-
ting foreigners, who had taken residence in this country, to rear and educate their children in the
language of their native land. The result of that condition was found to be inimical to our own
safety. To allow the children of foreigners, who had emigrated here, to be taught from early child-
hood the language of the country of their parents was…to educate them so that they must always
think in that language, and, as a consequence, naturally inculcate in them the ideas and sentiments
foreign to the best interests of this country. (262 U.S. 390)

Fortunately for Mr. Meyer, the U.S. Supreme Court disagreed with this line of reasoning and
reversed the decision upon appeal by a seven-to-two decision. The majority decision, rendered
by Justice James C. McReynolds on June 4, 1923, focused on issues of liberty, control of edu-
cation by parents, and the lack of evidence regarding harm to America from the use of foreign
languages. The court noted that:

The challenged statute forbids the teaching in school of any subject except in English; also the
teaching of any other language until the pupil has attained and successfully passed the eighth
grade, which is not usually accomplished before the age of twelve. The Supreme Court of the state
has held that “the so-called ancient or dead languages” are not “within the spirit or the purpose
of the act.” Latin, Greek, Hebrew are not proscribed; but German, French, Spanish, Italian, and
every other alien speech are within the ban. Evidently the Legislature has attempted materially to
interfere with the calling of modern language teachers, with the opportunities of pupils to acquire
knowledge, and with the power of parents to control the education of their own. (262 U.S. 390)

The decision clearly reinforced the rights of parents to decide matters regarding the education
of their children. But the justices went further to emphasize the discriminatory implications of
xenophobic attitudes, particularly when not supported by any scientific evidence. They added:

No emergency has arisen which renders knowledge by a child of some language other than Eng-
lish so clearly harmful as to justify its inhibition with the consequent infringement of rights long
freely enjoyed. We are constrained to conclude that the statute as applied is arbitrary and without
reasonable relation to any end within the competency of the state. As the statute undertakes to
interfere only with teaching which involves a modern language, leaving complete freedom as
to other matters, there seems no adequate foundation for the suggestion that the purpose was to
protect the child’s health by limiting his mental activities. It is well known that proficiency in a
foreign language seldom comes to one not instructed at an early age, and experience shows that
this is not injurious to the health, morals or understanding of the ordinary child. (262 U.S. 390)

The decision appears to strike a blow for the freedom to educate children in any language
or even more than one language, but that momentum has never truly caught on in the U.S. main-
stream. The rights of children and their parents regarding the intersection between language and
education have always been protected. Yet the reasons for that protection have been relatively
thin and conditional. Moreover, whereas we aspire to place a great deal of trust in the wisdom of
our Supreme Court justices, the fact of the matter is they are not often educators, psychologists,
or experts in the topics they must examine critically. They, like all Americans, are subject to their
own personal biases and sometimes even they are not aware of their own prejudices that stem
from mistaken beliefs that have little basis in science or pedagogy.
324 ORTIZ AND DYNDA

Consider the 1974 landmark case of Lau v. Nichols in which the Supreme Court heard the
case involving a class-action suit brought by non-English-speaking Chinese students and their
parents against San Francisco Unified School District. The children and parents sought relief
from English-only instruction (the same instruction given to all students by the district irrespec-
tive of native language) under the argument that it effectively created unequal educational op-
portunities that violate the Fourteenth Amendment.
Interestingly, the court did not apply the equal protection clause in this case and in finding
for Lau, instead relied upon Title VI of the Civil Rights Act of 1964 that prohibited discrimina-
tion by any agencies receiving government funding on the basis of race, color, or national origin.
The court delivered a unanimous opinion delivered by Justice William O. Douglas which con-
cluded in part:

Under these state-imposed standards there is no equality of treatment merely by providing stu-
dents with the same facilities, textbooks, teachers, and curriculum; for students who do not un-
derstand English are effectively foreclosed from any meaningful education. Basic English skills
are at the very core of what these public schools teach. Imposition of a requirement that, before a
child can effectively participate in the educational program, he must already have acquired those
basic skills is to make a mockery of public education. We know that those who do not understand
English are certain to find their classroom experiences wholly incomprehensible and in no way
meaningful. (414 U.S. 563)

The upshot of the decision was the creation of the “Lau Remedies,” part of which included
a short questionnaire sent home to all students who enroll in a new school for the first time. The
parent’s responses to the questions determine if the child will or will not receive some type of
special linguistic program to prevent the discriminatory effect of being instructed in a language
the child does not understand. Over the years, the type of program that has been most commonly
implemented to comply with the Lau decision has been some form of ESL (English as a Second
Language) service. Such a program has, unfortunately, fared little better than the alternative it
was intended to replace (i.e., immersion or “sink or swim”) despite the fact that it complies with
the decision (Lindholm-Leary & Borsato, 2006; Ramirez, Wolfson, Talmadge, & Merino, 1986;
Thomas & Collier, 2002).
A closer look at the decision in Lau reveals a much less sympathetic and insightful thought
process on the part of the justices. First, two esteemed members of the court, Justice Harry
Blackmun joined by Chief Justice Warren Burger, presented a caveat to clarify the reasons for
the decision. Rather than strictly an issue of protecting discrimination against an individual, they
made it clear that the case revolved around numbers. They stated:

I merely wish to make plain that when, in another case, we are confronted with a very few young-
sters, or with just a single child who speaks only German or Polish or Spanish or any language
other than English, I would not regard today’s decision…as conclusive upon the issue whether
the statute and the guidelines require the funded school district to provide special instruction. For
me, numbers are at the heart of this case and my concurrence is to be understood accordingly.
(414 U.S. 563)

Had there been fewer plaintiffs in the case, it is unlikely that the court would have viewed the
issue in the manner in which it did and the strong precedent for the educational rights of language
minority students would not exist. Second, and perhaps even more alarming, are the comments
by these two justices which reveal their thinking and expectations regarding the manner in which
immigrants should be instructed and learn English. In the decision, they state:
 15. ISSUES UNIQUE TO ENGLISH LANGUAGE LEARNERS 325

Against the possibility that the Court’s judgment may be interpreted too broadly, I stress the fact
that the children with whom we are concerned here number about 1,800. This is a very substantial
group that is being deprived of any meaningful schooling because the children cannot understand
the language of the classroom. We may only guess as to why they have had no exposure to English
in their preschool years. Earlier generations of American ethnic groups have overcome the lan-
guage barrier by earnest parental endeavor or by the hard fact of being pushed out of the family
or community nest and into the realities of broader experience. (414 U.S. 563; italics added for
emphasis)

It would seem that even those in whom we put the utmost faith in demonstrating Solomon-
like wisdom fall prey to the same misconceptions as the rest of us. It is not difficult to understand
why the justices fail to comprehend the reason that children raised by non-English speaking
parents would have little or no exposure to English in their preschool years. Such ethnocentric
thinking notwithstanding, the comment at best minimizes the impact of early language learning
in the home for language minority children. But it is the second comment that is shocking and
difficult to believe that it comes from individuals whom we expect are extremely well studied
and education. The principle of euphoric recall is again illustrated all too clearly in Justice Black-
mun’s reference to “earlier generations of American ethnic groups” and how it was simply being
pushed out of the nest that facilitated their learning of English and presumably their success. Our
ancestors did not simply overcome the language barrier by being immersed in mainstream soci-
ety. We tend to forget immigrant portal communities, such as Little Italy or Chinatown, which
provided a means for arriving families to assimilate slowly and allow the process of acculturation
to unfold in its usual manner (Rothstein, 1998). We also tend to forget the educational support
provided in these communities that invariably was in the native language as well as English and
which across four generations or so, resulted in the monolingual English-speaking, mainstream
American that forms the ideal expectation for immigrants to the United States (Rothstein, 1998;
Valdés & Figueroa, 1994).

English Language Learners and the Present Context

There is no debate that students in public schools, irrespective of their native language, should
learn and need to become English literate. There is no sense in providing children an education in
a language that will not serve them well in the very society in which they will attempt to establish
a life and career, unless instruction in another language can be used to facilitate literacy in Eng-
lish. Few argue that the basic goal in the education of language minority children is in fact Eng-
lish literacy. Consequently, the common knee-jerk reaction is to provide a sink-or-swim program
in English because “we all know the best way to learn a language is by being immersed in it.” But
such a notion reflects an inadequate understanding of the educational needs, or, more accurately,
the course of development of English learners because it presumes that simply learning to speak
a language ensures academic success in that language when this is far from the reality (Cummins,
1984; Danoff, 1978; Genesee, Lindholm-Leary, Saunders, & Christian, 2006; Lindholm-Leary &
Borsato, 2006; Ramirez, Yuen, & Ramey, 1991; Thomas & Collier, 1997, 2002).
Nevertheless, there are significant factors in the present which continue to reflect the very
same mistaken assumptions that have permeated U.S. educational policy for at least a century.
Perhaps the most visible example of the pressures facing educators to get language minority
children to succeed in school is the recent reauthorization of the Elementary and Secondary
Education Act (ESEA), now known as No Child Left Behind (NCLB). Provisions in the legisla-
tion related to English learners have been formed within the context of popular ideals related to
“high expectations” and “raising the bar” with respect to educational standards. For example, a
326 ORTIZ AND DYNDA

recent statement by the U.S. Department of Education, citing provision in NCLB, indicated that
language minority children must be tested in English on state-mandated tests after only one year
of continuous enrollment in the public school system. Whereas it appears that the intent of NCLB
is to promote the rapid acquisition of English, the legislation effectively ignores the path of de-
velopment for English learners which is quite different than that for native English speakers. The
failure to appreciate the differences in developmental paths for bilinguals versus monolinguals
invariably leads to calls to abolish native language instruction in favor of English only which
proponents believe will allow language minority students to “catch up” (Crawford, 1992).

Language and Instruction. As noted previously, there is a natural tendency to think

that learning to speak a language ensures academic success in that language. It is a thought that
seems so intuitive, so obvious, that it must be true. Of course, the veracity of the assumption
rests upon how one wishes to define academic success. If the goal is merely to have the student
conversationally proficient in the language, then some degree of academic success might ensue
solely on the basis of better comprehension. But to what degree? The answer to this question has
been examined many times and the results continue to be consistent and clear—when students
receive primary language instruction for at least 4 to 7 years, they typically succeed or fail at the
same rates as that of their monolingual English-speaking peers (Genesee et al., 2006; Lindholm-
Leary & Borsato, 2006; Ramirez et al., 1986, 1991; Thomas & Collier, 1997, 2002). When
given programs that use English-only, including those that provide ESL services, the academic
success of language minority students is considerably less than that of their monolingual English
speaking peers.
The various patterns of achievement and development are illustrated best in Figure 15.1.
This figure, using data from the 1997 longitudinal study on bilingual education by Thomas and
60

61(70)* Two-way bilingual

*Note 1 52(54)* Late-exit bilingual and

50

content ESL
Normal Curve Equivalents

40(32)* Early-exit bilingual and

40

content ESL
30

34(22)* Content-based ESL

20

24(11)* ESL pullout traditional

10
0

K 2 4 6 8 10 12
Grade Level

*Note 1: Average performance of native-English speakers making one year's progress in each grade.
Scores in parentheses are percentile ranks converted from corresponding NCEs.

FIGURE 15.1 Data from the Thomas and Collier (1997) Study on English Learner Achievement on
Standardized Tests of Reading in English
 15. ISSUES UNIQUE TO ENGLISH LANGUAGE LEARNERS 327

Collier, represents the average levels of academic achievement on standardized tests of reading
(in English) for English learners from kindergarten through 12th grade. Of particular note in the
figure is the point around 4th grade where the learning patterns of all but two programs begin to
plateau. Except for the two-way developmental bilingual education and the one-way develop-
mental bilingual education (with content ESL), all other forms of education produce results that
are below that for native English speakers, in some cases substantially below. Even programs that
provide native language instruction in the early grades, but then force students into English only
by the third grade (transitional bilingual education with content ESL) produce achievement at the
40th/35th Normal Curve Equivalent (NCE; 32nd/23rd percentile ranks) as compared to the 50th
NCE (50th percentile rank) for native English speakers. The worst outcomes occur for children
who are given ESL pullout taught traditionally (i.e., English taught without the use of curricu-
lum materials or subject content or vocabulary). This type of program is the most common one
provided to children and is the minimum allowed under the Lau Remedies, but results in reading
achievement at the 24th NCE (11th percentile rank) for English learners. This indicates that as a
group, English learners receiving ESL, achieve at a level that is about one and one-third standard
deviation below the mean of their monolingual English speaking peers. One could hardly con-
strue this as any degree of equity in education. These findings demonstrate that conversational
proficiency in English alone is entirely insufficient to ensure the kind of academic success ex-
pected for language minority children.
The instructional implications of longitudinal studies (e.g., Thomas & Collier, 1997, 2002)
are important, not only in terms of understanding what may be expected academically from a
given student, but also in terms of what type of instruction will work best. Unfortunately, because
language is a developmental process, and because it is heavily influenced by the type of educa-
tional program being received, it is not easy to remedy academic problems once they have been
solidly reinforced over the years. Figure 15.1 makes it clear that the type of education provided
has a profound and long-lasting effect on academic performance. Nevertheless, there are impor-
tant points that need to remain front and center regarding “what works” with English learners.
First, when bilingual education students are tested in English, they typically reach and sur-
pass native English speakers’ performance across all subject areas after 4 to 7 years in a quality
bilingual program. Because they have not fallen behind in cognitive and academic growth dur-
ing the 4 to 7 years that it takes to build academic proficiency in English, bilingually schooled
students typically sustain this level of academic achievement and outperform monolingually
schooled students in the upper grades (Lindholm-Leary & Borsato, 2006; Ramirez et al., 1986,
1991; Thomas & Collier, 1997, 2002).
Second, in terms of instruction, there are several key predictors of academic success. They
include: a) cognitively complex academic instruction through the student’s first language for as
long as possible, and through the second language (English) for a part of the school day; b) use
of current approaches to teaching the academic curriculum through first and second language
through active, discovery, cognitively complex learning; and c) changes in the sociocultural con-
text of schooling, such as integration with English-speaking peers, in a supporting, affirming
environment for all students, an additive bilingual context, in which bilingual education is per-
ceived as a “gifted and talented” program for all students, and the transformation of majority and
minority student relations in a school to a positive school climate for all students regardless of
language and cultural background (Thomas & Collier, 1997, 2002).
Third, at least three key instructional factors promote learning and lead to better outcomes
for English learners, including: a) teaching learning strategies, in English, needed to develop
thinking skill and problem solving activities; b) implementing approaches that emphasize prior
knowledge; and c) maintaining respect for home language and culture (Genesee et al., 2006).
328 ORTIZ AND DYNDA

In short, there can be no substitute for good teaching. No interventions can be applied post-
hoc or concomitantly with particular types of educational programs (e.g., ESL-only) that will lead
to the kind of academic success or amelioration that would be expected for children who are native
English speakers. Nothing is more important in determining whether a student is likely to dis-
play learning or behavioral challenges than the very education they are receiving. Whereas Eng-
lish-only is entirely appropriate, from a developmental perspective, for native English speaking
students, those for whom English is a second or third language are set up for eventual academic
failure through no fault of their own. It is not difficult to imagine that such will be the children at-
risk for the development of learning difficulties and behavioral problems that result not from lack
of ability, effort, or motivation, but only from dealing with the impossible task of trying to keep up
academically in a language that is not well or completely understood (Ortiz, 2006).

EVIDENCE-BASED INTERVENTION

One of the more visible trends in education, particularly in the realm of pre-referral interventions
and instructional modifications, has been the movement toward evidence-based interventions
and practices. Nowhere is this better exemplified than in the rapid and unprecedented adoption
of response-to-intervention (RTI) models that are now codified in federal legislation, notably
the Individuals with Disabilities Education Act (IDEA 2004). It seems probable that one of the
reasons for its relatively quick acceptance and institutionalization is the fact that RTI provides a
process for engaging in intervention activities that are presumably based on actual research and
that have established empirical support. Another reason for their popularity may also rest on the
notion that RTI, or more precisely the use of methods to document academic progress in an RTI
framework (e.g., Curriculum Based Measurement; CBM), have often been touted as being more
culturally and linguistically fair. For example, Kovaleski and Prasse (2004) stated that one of the
potential benefits of RTI included “increased fairness in the assessment process, particularly for
minority students” (emphasis added). Yet a close look at some of this research indicates that use
of CBM, even within the context of an RTI framework is not necessarily less discriminatory than
traditional methods of evaluation and assessment.
Baker and Good (1995) investigated the reliability, validity, and sensitivity of English CBM
passages with bilingual Hispanic students and concluded that it was as reliable and valid for them
as for native English speakers despite the presence of differential growth rates. That differential
growth rates are present suggests that some factor is affecting the performance of one or the other
group. It is likely that in this case, limited English proficiency and perhaps limited acculturation,
are changing the expected trajectory of learning for the Hispanic students. If this influence is
not identified and understood, the expectations for growth for Hispanic students may well prove
discriminatory.
Gersten and Woodward (1994) suggested that CBM could be used to develop growth rates
for English learners, but erroneously concluded that such students generally continue to make
academic progress toward grade-level norms whereas English learners with a learning disability
(LD) do not. This study was conducted prior to the release of the findings from the Thomas and
Collier (1997) investigation so it may be excused to a certain extent. It is clear that English learn-
ers do not in fact generally continue to make academic progress toward grade-level norms if they
are in English-only programs. They will plateau long before they reach grade level and do not
“catch up” as is stated here. Moreover, English learners with LD will fare even worse than those
without LD because of the “double whammy” effect of linguistic differences and the presence
of a disability.
 15. ISSUES UNIQUE TO ENGLISH LANGUAGE LEARNERS 329

Again, such research tends to mislead practitioners to believe that CBM is much more fair
than it actually is. This concern was recently espoused in a position statement by the National
Center for Culturally Responsive Educational Systems (NCCRESt), where they state:

We are concerned that if we do not engage in dialogue about how culture mediates learning, RTI
models will simply be like old wine in a new bottle, in other words, another deficit-based ap-
proach to sorting children, particularly children from marginalized communities. (2005)

Because RTI is a measurement paradigm, it is subject to some of the same potential sources of
bias that one finds in the use of other measurement paradigms (e.g., psychometrics). The very
same questions come up in both cases, such as what constitutes sufficient opportunity to learn,
what works, and with whom, what makes an intervention culturally or linguistically appropriate,
and what research guides intervention programs. These are not easy questions and in the final
analysis, practitioners must remain aware of the problems that may plague any attempts to mea-
sure the academic progress or response-to-intervention in English learners.
One problem revolves around the fact that the most common type of instruction given in
schools today, ESL, creates an artificial linguistic “handicap” that puts otherwise capable chil-
dren at levels far below their age and grade related peers in school achievement. What is “effec-
tive instruction” for the average third grader may be totally inappropriate for the average ELL
who, nonetheless, is in third grade. Another problem is that unless measurement methods used
in RTI, whether CBM or otherwise, account for the differential rates of development that are
occurring in the processes related to native language acquisition, English acquisition, and accul-
turation to the mainstream, there is no guarantee that results will be any more “fair.” Finally, all
assessments, including CBM, should be selected and administered so as not to be discriminatory
on a racial or cultural basis. The use of CBM, as with any assessment tool or procedure, should
be designed to reduce threats to the reliability and validity of inferences that may arise from lan-
guage (and cultural) differences.

Instructional Interventions: What Works?

English learners with learning challenges will respond to interventions when those interventions
are based on solid, research based pedagogy. Currently, there are no stand alone instructional pro-
grams that have been demonstrated empirically to be effective for English learners of all types.
Many attempts to create such programs group English learners by ethnicity, mistakenly assuming
such classification is sufficient to control for the variable that affects performance differentially.
As such, practitioners will need to make independent determinations regarding the appropriate-
ness of an intervention that targets instruction for English learners on the basis of what is known
about their learning needs and development.
First and foremost, it is clear that all students benefit from strong cognitive and academic
instruction conducted in their first language. The longer that English learners are provided in-
struction in their native language, the better the prognosis for their achievement (Krashen, 1985).
Building upon the development that a student brings with them (the native language, in this case)
is the only mechanism by which instruction can be viewed as effective and appropriate as well
as evidence-based. The literature is clear in that English learners benefit from on-grade-level
academic instruction in their first language. These benefits begin in the first years of schooling,
and if such instruction is sustained, the benefits are cumulative. English learners whose school-
ing develops them academically and cognitively, using their first language, are more successful
in English-based instruction by the end of their school years than those students who are not
330 ORTIZ AND DYNDA

provided such first-language instruction. These effects presume that they also receive on-grade-
level academic instruction in and through English for part of the school day, and throughout the
school year.
Four to seven years of such combined high-quality instruction appear to ensure that by the
end of high school, typical English learners will perform as well as typical native speakers of
English. The more years in which first-language-based plus English-language-based instruction
are present, the greater is the eventual English-based achievement. In short, whenever develop-
ment is allowed to continue unabated, school success will follow. When development is inter-
rupted or inhibited, academic achievement will suffer accordingly.
The design of programs for English language learners should be responsive to the needs
and strengths of local communities, student populations, and available resources. Conventional
program labels (such as first-language immersion, transitional, sheltered and content instruction
in English, or English as a Second Language) are not useful in predicting school success. How-
ever, all effective programs share crucial features including but not limited to: 1) understanding
students’ language knowledge and needs, 2) planning and delivering instruction that meets those
needs, and 3) assessing whether students have comprehended well the instruction.
For good student achievement, effective teaching methods must be employed by well-pre-
pared teachers. Effective teaching methods have been identified by research, but are not in wide-
spread use in English-mainstream or in bilingual/ESL classrooms. Effective approaches include
students and teachers working together, in discovery processes and supportive interaction across
the curriculum, developing language through dialogue, and making school meaningful by con-
necting instruction to students’ strengths and everyday experiences in their homes and communi-
ties.
An effective model for instructional intervention may be gleaned from the Five Standards
for Effective Pedagogy advanced by Tharp, Estrada, Dalton, and Yamauchi (1999). Based on
the large body of empirical evidence regarding “what works” for English learners, they propose
their standards as critical for improving learning outcomes for all students, and especially those
of diverse ethnic, cultural, linguistic, or economic backgrounds. The Standards are defined as
follows:

Standard I. Teachers and Students Producing Together. The point of this standard is to facilitate
learning through joint productive activity among teacher and students. The collaborative
nature of the process is an important component in helping students succeed by providing
sufficient scaffolding to assist with comprehension and affirmation to keep motivation
high.
Standard II. Developing Language and Literacy Across the Curriculum. The intent of this
standard is to develop competence in the language and literacy of instruction across the
curriculum. The focus is not merely on basic language “proficiency” in which the student
learns to speak, but more on advanced levels of proficiency (e.g., cognitive-academic
language proficiency) that is essential for school success. Children may learn to speak
well, and young children will have no trouble achieving accent-free pronunciation when
schooled in English but the focus for effective intervention must be geared toward the
development of all forms of literacy across all subject areas of the curriculum.
Standard III. Making Meaning; Connecting School to Students’ Lives. To ignore the language
that student’s bring in, when that language is not English, effectively undermines the
ability to rely on one’s experiences in the context of learning new material. Instructional
interventions that are effective are those that contextualize teaching and curriculum in the
experiences and skills of students’ homes and communities. Being able to access a student’s
 15. ISSUES UNIQUE TO ENGLISH LANGUAGE LEARNERS 331

prior knowledge and experiences will go a long way toward increasing the success of any
instructional intervention.
Standard IV. Teaching Complex Thinking. It is often thought that children either possess or
do not possess certain cognitive abilities as a function of inherent individual differences.
Although there is some truth to this assumption, it is also true that English learners often
do not have the types of experiences that foster and facilitate the development of cognitive
skills that are essential to school success. That is, they do not lack the ability because of
intrinsic reasons, but more because of extrinsic factors. As such, English learners should
be challenged to develop cognitive complexity and thinking strategies in formal, direct
ways. It cannot be presumed that such strategies or ways of thinking will come along as a
function of their general life experiences.
Standard V. Teaching Through Conversation. The teaching of English often takes on a de-
contextualized form. That is, English is often taught as if it bore little relationship to the
concepts being taught in the classroom. Instead, English learners can acquire English-
speaking skills through conversations that involve the very concepts, content, and vocabulary
that form the focus of instruction in the classroom. Thus, students can be engaged through
dialogue, especially conversations where the point is not simply to communicate about
anything in general, but to communicate about the content and subject matter that forms
the basis of current instruction.

Although these standards do not represent the full range of tasks and intervention activities
that are helpful in promoting the academic success of English learners, they nonetheless provide
a solid foundation for the design of effective instructional interventions. When considered care-
fully and applied thoughtfully, it is highly likely that practitioners will be able to develop inter-
ventions that have a high probability of success and are appropriate to the cultural and linguistic
needs of English learners.

Behavioral Interventions: What works?

Intervention for behavioral challenges frequently rest upon the collection of a wide variety of
data including observation, interview, behavioral scales and questionnaires, and so forth. For the
most part, the collection of data will guide the types of decisions that will be made regarding the
nature and form of intervention. It is then on the basis of the outcomes from such interventions,
that is, the student’s response to the intervention, that will determine their effectiveness. Such
feedback may then be used to guide additional forms of treatment or intervention that may prove
effective or appropriate. To ensure that this process is successful for English learners, practitio-
ners will need to understand well the cultural and linguistic implications of any information they
might obtain.
The potential influence of cultural and linguistic factors on data collection is substantial.
Figure 15.2 provides an example regarding the manner in which behaviors of English learners
might appear to be quite dysfunctional, even mimicking the characteristics of Attention-Deficit
Hyperactivity Disorder (ADHD). Because English learners may not fully comprehend the lan-
guage, they are often at a loss regarding what to do, what to pay attention to, what is being asked
of them, what the rules of the moment are, and in so doing, may engage in a host of behaviors that
are considered inappropriate, including disrupting other children, becoming easily distracted,
and failing to start or complete assignments.
It is not difficult to recognize that data are not gathered in a cultural vacuum or immune to all
sorts of bias. According to Ortiz (2006), “the very nature of the data collection process represents
 332

Characteristics and behaviors often

Common manifestations of English Language Learners (ELLs) during classroom instruction that may
associated with various learning
mimic various disorders or cognitive deficits.
problems

ELLs may have limited comprehension of the classroom language so that they are not always clear on how to
Slow to begin tasks
properly begin tasks or what must be done in order to start them or complete them correctly.

ELLs, especially those with very limited English skills, often need to translate material from English into their
native language in order to be able to work with it and then must translate it back to English in order to
Slow to finish tasks
demonstrate it. This process extends the time for completion of time-limited tasks that may be expected in the
ORTIZ AND DYNDA

classroom.
ELLs cannot always fully encode information as efficiently into memory as monolinguals because of their
Forgetful limited comprehension of the language and will often appear to be forgetful when in fact the issue relates
more to their lack of proficiency with English.

ELLs may not fully understand what is being said to them in the classroom and consequently they don’t know
Inattentive
when to pay attention or what exactly they should be paying attention to.

ELLs may appear to be hyperactive because they are unaware of situation-specific behavioral norms,
Hyperactive
classroom rules, and other rules of social behavior.

ELLs may lack the ability to fully comprehend instructions so that they display a tendency to act impulsively in
Impulsive
their work rather than following classroom instructions systematically.

ELLs may not fully comprehend the language being spoken in the classroom and therefore will move their
Distractible
attention to whatever they can comprehend appearing to be distractible in the process.

ELLs may exhibit disruptive behavior, particularly excessive talking—often with other ELLS, due to a need to
Disruptive
try and figure out what is expected of them or to frustration about not knowing what to do or how to do it.

ELLs often display strategies and work habits that appear disorganized because they don’t comprehend
Disorganized instructions on how to organize or arrange materials and may never have been taught efficient learning and
problem solving strategies.

FIGURE 15.2 Common Behavioral Manifestations of English Learners in the Classroom due to Limited English Comprehension
 15. ISSUES UNIQUE TO ENGLISH LANGUAGE LEARNERS 333

a core set of values that may affect both the manner in which information is collected but also
what information is collected and how such information is interpreted subsequently” (p. 34).
Sandoval (1998) describes the process wherein practitioners unconsciously allow their precon-
ceived notions to enter into the evaluation process and affect the type of data gathered as well as
the meaning assigned to the data. This process is known as confirmatory bias and if a practitioner
is unable to recognize it or is unaware of it, there is little chance that intervention attempts will
be fair or responsive to the individual’s cultural or linguistic needs as they pertain to instructional
or behavioral needs. This is not an easy thing to accomplish given that practitioners are trained
in a culture of assessment that does not often include or accommodate cultural factors relevant
to understanding a student’s behavior. To this end, Ortiz and Flanagan (2002) provide various
principles that are designed to help practitioners avoid errors in practice and improve the cultural
responsiveness of intervention attempts. These principles include:

1. Establish rapport and build trust. Use the knowledge bases regarding displays of respect,
and appropriate greeting behavior and exiting behavior. Help the family to feel at ease,
respected, and provide the opportunity for the family members to fully participate and
contribute to the process of service delivery. Use interpreters/translators as necessary but
make sure they are appropriately trained and consult with individuals who are familiar
with the culture and languages relevant to the purposes of service delivery.
2. Identify the presenting problem. School psychologists should listen carefully to the fam-
ily’s perception of any suspected problem and attempt to understand it from their per-
spective. They may feel there is no problem at all. It is also necessary to determine the
family’s past efforts to resolve the problem and to elicit their present understanding of
new intervention strategies and goals. Once these issues have been clarified, the school
psychologist will be in a much better position to negotiate intervention strategies.
3. Learn the family system. The structure of the family system must be assessed and de-
termined to the maximum extent possible. Particularly important to evaluate are the ar-
eas related to family composition, family members’ roles and responsibilities, family’s
interactional patterns, family’s support system, family’s childrearing practices, and the
family’s beliefs about the student’s suspected handicapping condition and its source.
Knowledge of the relevant aspects of the structure of the family system provides the basis
for interventions that are appropriate and individually tailored to the particular needs and
resources of the family (p. 354).

SUMMARY

It seems that because each of us has learned at least one language, and because that language
was learned so easily and transparently even before we were aware that we had learned it, we
fall prey to a variety of misconceptions regarding the relationship between language and educa-
tion. Perhaps the most egregious of these mistaken beliefs is the one that leads us to conclude
that immersion in English is the best way to learn the language and once the language is learned,
all things educational become equal. The research, of course, shows us that this is not correct.
As much as it may be politically or economically convenient to view the educational needs of
English learners as rectified easily by conversational proficiency, the reality is that much more is
involved if we truly desire to ensure their future academic success. English learners are different
than native speakers by the very fact that they are bilingual (sometimes even trilingual). Even
without additional instruction in the native language, there is a dual-language influence that must
334 ORTIZ AND DYNDA

be considered, and this influence is not temporary in any way: Once a bilingual, always a bilin-
gual. Simply because an individual has become English dominant does not mean that he or she
has ceased to be bilingual (Bialystok, 1991). The effects of culture and language on the design
and implementation of instructional and behavioral interventions are indelible and not erased by
efforts designed to promote English at the complete exclusion of the native language.
At this time, there is virtually no research concerning specific evidence-based interventions
to meet the instructional and behavioral needs of English learners. Rather, there is much empiri-
cal evidence about “what works” in both cases and what does not. Therefore, there is no simple
prescription for practitioners to follow and instead, it will be necessary to first learn the nature
and extent of the dynamics and complexities involved in the education of English learners and
apply that knowledge to the development of interventions that may prove effective and appropri-
ate. This chapter provided a discussion of the knowledge base that currently exists relative to
instruction and intervention with English learners. Although the issues appear complex at the
outset, they can be rather easily managed and scaled to make them applicable to individual situ-
ations and needs.
At the very least, practitioners will find that being flexible, open, and willing to implement
new ideas and engage in new behaviors that were neither demonstrated nor taught in their train-
ing programs are the keys to successful instructional and intervention attempts with English
learners and other individuals from diverse cultural, ethnic, and linguistic backgrounds. In the
end, the very success of any intervention attempt may rest more on the efforts made by practi-
tioners to be culturally responsive and linguistically appropriate which demonstrates an implicit
respect for an individual’s culture and experiences. This point has been articulated well by Ortiz
and Flanagan (2002):

Intervening effectively with students and families will come more from a genuine respect of their
native values, beliefs, and attitudes than anything else that might be said or done, especially when
their views run counter to beliefs that may be held so dearly. In such cases it must be remembered
that school psychologists are not often in positions where they are designing interventions for
themselves. Rather, the intervention is for others and they will only be successful in so far as they
are culturally relevant to the children and families for whom they are intended. (p. 353)

REFERENCES

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Hispanic students: A validation study with second-grade students. School Psychology Review, 24,
561–578.
Bialystok, E. (1991). Language processing in bilingual children. New York: Cambridge University Press.
Brigham, C. C. (1923). A study of American intelligence. Princeton, NJ: Princeton University Press.
Cummins, J. C. (1984). Bilingual and special education: Issues in assessment and pedagogy. Austin, TX:
PRO-ED.
Crawford, J. (1992). Language loyalties: A source book on the official English controversy. Chicago: Chi-
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Danoff, M. (1978). Evaluation of the impact of ESEA Title VII Spanish/English bilingual education pro-
grams: Overview of study and findings. Palo Alto, CA: American Institutes for Research (ERIC Docu-
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Genesee, F., Lindholm-Leary, K., Saunders, W. M., & Christian, D. (2006). Educating English language
learners: A synthesis of research evidence. New York: Cambridge University Press.
Gersten, R. & Woodward, J. (1994). The language minority student and special education: Issues, trends,
and paradoxes. Exceptional Children, 60, 310-322.
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Gould, S. J. (1996). The Mismeasure of Man. New York: W.W. Norton

Kovaleski, J. F., & Prasse, D. P. (2004, February). Response to instruction in the identification of learning
disabilities: A guide for school teams. NASP Communiqué, 32(5), insert.
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tion, literacy. Englewood Cliffs, NJ: Alemany Press.
Lindholm-Leary, K. & Borsato, G. (2006). Academic Achievement. In F. Genesee, K. Lindholm-Leary,
W. M. Saunders, & D. Christian, D. (Eds.), Educating English Language Learners: A Synthesis of
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www.nccrest.org
Ortiz, S. O. (2006). Multicultural Issues in Working with Children and Families: Responsive intervention in
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interventions in educational settings: A handbook for practice (pp. 21-36). New York: Brunner-Rout-
ledge Publishing.
Ortiz, S. O. & Flanagan, D. P. (2002). Best Practices in Working with Culturally Diverse Children and
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Washington, DC: National Association of School Psychologists.
Ramirez, J. D., Wolfson, R., Talmadge, G. K., & Merino, B. (1986). First year report: Longitudinal study
of immersion programs for language minority children (Submitted to U.S. Department of Education,
Washington, DC). Mountain View, CA: SRA Associates.
Ramirez, J. D., Yuen, S. D., & Ramey, D. R. (1991). Final report: Longitudinal study of structured English
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York: The Century Foundation Press.
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Thomas, W. & Collier, V. (2002). A national study of school effectiveness for language minority student’s
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Ablex.
 16
Serving Gifted Students
Steven I. Pfeiffer and Samara Blei

This chapter addresses unique challenges facing students who are gifted. Although no research
evidence suggests that the gifted, as a group, have a higher incidence or prevalence of learning
or behavioral problems (Neihart, Reis, Robinson, & Moon, 2002), the gifted are not immune to
the academic and social challenges that all children and youth face. In addition, the gifted, as a
group, face a set of unique challenges that increase their vulnerability to and risk for learning and
behavioral challenges (Pfeiffer, 2001b; Pfeiffer & Stocking, 2000). The most frequently cited
risks associated with the gifted are asynchronous development, difficulties with affect regulation
related to over-excitability, unrealistic parental and teacher expectations, peer relation problems,
and perfectionism (Mendaglio & Peterson, 2007; Robinson, 2002). In addition, an appreciable
but as yet unknown number of gifted children suffer from troubling, often undiagnosed, dis-
abilities such as Attention Deficit Hyperactivity Disorder (ADHD), Asperger’s disorder, learning
disabilities (LD), eating disorders, and mood disorders (Webb, Amend, Webb, Goerss, Beljan,
& Olenchak, 2005). In the gifted literature, these children are referred to as “twice exceptional.”
This chapter provides a brief history of the gifted field, including a concise discussion of who
are gifted students. The chapter then describes some of the types of learning and behavioral dif-
ficulties that gifted children face and concludes with a best practices guide consisting of eight
guidelines for serving gifted students.

BRIEF HISTORY OF THE GIFTED FIELD

Awareness of gifted children began with the recognition of differences amongst individuals with-
in the general population. Although Galton never offered a formal definition of giftedness, his
theory of fixed intelligence emphasized a hereditary basis of intelligence and stressed an individ-
ual’s innate sensory acuity, which was thought to have survival value (Galton, 1869). Galton first
attempted to assess intelligence by measuring physical characteristics, such as height, weight,
and head diameter, sensory acuity, motor strength, reaction time, and visual judgments (Galton,
1869, 1888; Wasserman & Tulsky, 2005). Although he did not measure mental ability or various
talent areas that are now included in many definitions of giftedness (e.g., Pfeiffer & Jarosewich,
2003, 2007), Galton established the foundation for a psychometric approach to gifted identifica-
tion, which still dominates the gifted field today.
With the emergence of Binet’s important work in Paris, identification procedures changed
from Galton’s emphasis on “measurement of the body and of the senses,” to focus on the
336
 16. SERVING GIFTED STUDENTS 337

measurement of “higher mental processes” (Binet, 1903; as cited in Wasserman & Tulsky, 2005).
Binet introduced the field to the concept of mental age. The notion that even young children may
intellectually be far ahead of their peers held profound implications for the identification of the
gifted (Binet & Simon, 1903; as cited in Colangelo & Davis, 1997). Lewis Terman extended
Binet’s work in developing the Stanford Binet Intelligence Scale, which remains one of the most
popular measures of intelligence today (Clark, 1997).
To many, Terman is considered the “father of the gifted education movement.” He coined the
term gifted child and developed one of the first tests to measure intelligence. In his momentous
and often cited longitudinal study, Terman identified 1,528 gifted children and defined anyone
scoring above 135 on the 1916 version of the Stanford Binet test as a genius (Terman, 1925).
Terman’s pioneering work played an important role in reifying the Intelligent Quotient (IQ) to
the central role that it still enjoys in defining, identifying, and even conceptualizing the construct
of giftedness. The IQ has become representative of traditional psychometric gifted identification
procedures (Pfeiffer, 2001b).

WHO ARE THE GIFTED?

One of the first federal definitions of giftedness appeared in The Education Amendment of 1969,
(US Congress, 1970) which specified that

…the term “gifted and talented children” means in accordance with objective criteria prescribed
by the Commissioner, children who have outstanding intellectual ability or creative talent, the
development of which requires special activities or services not ordinarily provided by local edu-
cation agencies.

The initial U.S. Office of Education definition expanded on the latter definition by includ-
ing six different gifted areas: general intellectual ability, specific academic aptitude, creative or
productive thinking, leadership ability, ability in the visual or performing arts, and psychomotor
ability (Marland, 1972). The Jacob K. Javits Gifted and Talented Students Education Act of 1988
(U.S. Congress, 1988) broadened the definition of giftedness to include the term capability; those
students who display evidence of high performance capability or potential in intellectual, cre-
ative, artistic, or leadership would be given the opportunity to fully develop such capabilities.
A recent definition issued by the U.S. Department of Education (1994) suggests that in iden-
tifying “children with outstanding talent,” students should be compared to others of the same age,
experience, or environment. Pfeiffer and his colleagues (Pfeiffer & Jarosewich, 2007) remind us
that society plays an important role in defining what is meant by giftedness. Different cultures
value different gifts. In the United States, for example, our present educational system values
intellectual and academic prowess, creative problem solving, and leadership ability (Pfeiffer &
Jarosewich, 2003).
Authorities in the gifted field have crafted definitions that support, modify, expand and,
in some instances, oppose, the federal definitions. Consistent among the federal definition and
recent and emerging definitions is the recognition that gifted and talented students have excep-
tional abilities and potential for outstanding performance (Pfeiffer, 2002a). Most authorities
agree that the unfolding of a child’s potential does not necessarily occur on its own; optimizing
one’s special talent requires a supportive family climate and a stimulating, challenging, and high
quality learning environment (Ericsson, Krampe, & Tesch-Römer, 1993; Johnsen, 1997; Zigler
& Heller, 2000).
338 PFEIFFER AND BLEI

THE GIFTED: VULNERABILITIES AND UNIQUE CHALLENGES

During the late 1800s, the general consensus was that giftedness increased a child’s vulnerability
to adjustment difficulties (Lombroso, 1889). This view was challenged by Terman’s longitudinal
study (1925, 1937, 1947), which found that people of high ability experienced a lower-than-ex-
pected incidence of mental illness or other psychological problems. However, the suicide of a
gifted high school student in 1981 abruptly challenged the view that gifted students, as a group,
were impervious to psychological problems. This event represented a turning point in research
on the gifted; a number of investigators (and educators and clinicians) began exploring the social
and emotional needs of the gifted and asking research questions about the social and emotional
adjustment of these children (Freeman, 1979; Lejoie & Shore, 1981; Pfeiffer & Stocking, 2000).
The field now recognizes that the gifted, as a group, do not have a higher incidence or preva-
lence of learning or psychiatric problems compared to regular education students (Neihart, Reis,
Robinson, & Moon, 2002). The gifted field also recognizes that a significant, although as yet
unknown number of gifted students are neither immune nor impervious to the many social and
emotional challenges that all children and youth face growing up. In addition, research has iden-
tified unique challenges that increase the vulnerability of the gifted to learning and behavioral
problems (Neihart et al., 2002; Pfeiffer & Stocking, 2000). As mentioned in the Introduction,
challenges facing the gifted are related to their asynchronous development, difficulties with affect
regulation related to over-excitability, unrealistic parental and teacher expectations, peer relation
problems—specifically feelings of peer rejection and alienation, and perfectionism (Mendaglio
& Peterson, 2007; Robinson, 2002). Finally, some gifted students suffer from troubling, often
undiagnosed, disabilities including ADHD, Asperger’s syndrome, learning disabilities, eating
disorders and mood disorders (Neihart, in press; Webb et al., 2005). These uniquely distinctive
gifted children are known as twice exceptional. What next follows is a brief discussion of a few
of the types of gifted children with learning and behavior challenges. Because of space limita-
tions, we are unable to discuss all of the various types of psychological and academic problems
that gifted children might face.

Gifted Children with Learning Disabilities

Gifted students with a learning disability (LD) face unique problems. The strengths of a gifted child
with LD may serve as both an enabling and crippling force within their academic environment. Due
to exceptional performance in specific academic areas, the gifted student’s learning disability is of-
ten overlooked. As a result, the gifted child is rarely identified as LD at an early age because his/her
gifts often mask a learning disability (Vialle & Baldwin, 1999). Ferri, Gregg, and Heggoy (1997)
found that approximately 41% of gifted students with learning disabilities remain undiagnosed un-
til college. This twice exceptional student with advanced academic ability and subtle learning dis-
abilities represents one of four types of gifted LD students (Baum, Owen, & Dixon, 1991; Brody
& Mills, 1997; Gunderson, Maesch, & Rees, 1987). Typically, this student participates in gifted
programs, but may experience periods of underachievement (Ferri et al., 1997).
Many of these twice exceptional students are placed in gifted programs and silently suf-
fer within a challenging environment, without appropriate resources. LD students typically de-
velop unrealistic expectations, and believe that they should excel in academic areas in spite of
their learning disability. Resulting frustration is often expressed through decreased or variable
motivation and disruptive or withdrawn behavior. A qualitative study, examining perceptions of
academically talented students with LD in relation to their elementary school years, revealed that
negative experiences revolved around social and emotional development. The dynamic interplay
 16. SERVING GIFTED STUDENTS 339

of high ability and learning disability may cause confusion and create social, emotional and/or
behavioral challenges as the student struggles to comprehend why they know an answer but are
unable to say it or write it correctly (Olenchak, 1995).
Another category of gifted LD students are those that are identified as gifted and LD. How-
ever, the prevalence of students within this category is far lower due to stringent eligibility re-
quirements of gifted LD and the tendency of educators and school psychologists to not identify
the LD, due to the child’s extraordinary gifts (Gardynik & McDonald, 2005). Even if the child’s
learning problem is identified and is classified according to the eligibility criteria (IDEA 1997,
2004), many schools do not consider or qualify gifted students as LD. Many states and counties
do not acknowledge a learning disability if the child’s IQ score is above a certain cut point (typi-
cally a 130, which would be set by the school district) (McCoach, Reis, & Moon, 2004). Clas-
sification of LD in gifted students remains a challenge for educators and school psychologists.
Regardless of the identification model used, school districts are unlikely to incorporate
enough flexibility and clinical judgment to recognize both gifts and learning disabilities. There
exists a third type of twice exceptional gifted-LD student, the child who remains unidentified as
either learning disabled or gifted. These students are often considered average by their teachers
(Baum et al., 1991; Gunderson et al., 1987). McCoach et al. (2004) proposed a comprehensive
eight-step system for identifying gifted students as gifted and learning disabled. Unfortunately,
the feasibility of a school district adopting this comprehensive system—including behavioral
classroom observations, multiple cognitive processing tests and achievement measures, is un-
likely because of the time and cost involved.
The fourth category of gifted LD represents those who are recognized for their LD as op-
posed to their giftedness. The learning disability of a student who has not yet been identified as
gifted often disguises or masks their gifts. Instead of focusing on the development of the child’s
gifts, teachers focus exclusively on remediating the LD. A focus on student deficits, as opposed
to student strengths or assets, is not unusual in today’s schools (Pfeiffer & Reddy, 1998). The
result, unfortunately, of focusing exclusively on a student’s weaknesses can adversely impact a
youngster’s self-esteem, motivation and interest in academics, and emotional vibrancy (Baum,
Emerick, Herman, & Dixon, 1989; Pfeiffer & Stocking, 2000).
Bianco (2005) investigated the effect of the disability labels of LD and emotional and behav-
ioral disorders (EBD) on public school teachers’ willingness to refer students to gifted programs.
Results indicated that both general and special education teachers were significantly influenced
by LD and EBD labels when making referrals to gifted programs. As compared to identically de-
scribed gifted students, teachers were much less willing to make referrals for gifted consideration
for those students with LD.
Gifted students and twice exceptional gifted students with LD face many similar problems.
Although a child with LD is likely to experience academic failure (Gardynik & McDonald, 2005)
and a gifted student is likely to demonstrate advanced academic or intellectual performance, both
the gifted student and the twice exceptional gifted student struggle to find a peer group to share
their unique experiences with. The sense of isolation that students with LD experience is further
compounded when twice exceptional—feeling alone and estranged because of both their gifts
and their LD. Waldron (1987) found that students who were twice exceptional gifted-LD were
more likely to develop low self-esteem and have feelings of rejection than normally achieving
gifted students.
School psychologists need to help inform teachers about the unique interaction between a
student’s abilities and disabilities. A twice exceptional child with reading or math disability may
demonstrate any of the following characteristics: high verbal aptitude, boredom with grade level
or below grade level work in their area of disability, variable scores on achievement tests in their
340 PFEIFFER AND BLEI

area of disability, improved performance with compensation strategies, low tolerance for frus-
tration with rote-drill reading or math drills, and/or possible inattention and unrealistically high
or low self-concept (Hishinuma & Tadaki, 1996). Irrespective of the child’s label, the student’s
strengths and weaknesses need to be recognized and addressed to provide appropriate services.

Gifted Children and Underachievement

LD is not the only source of academic underachievement for gifted students. Underachievement
may stem from a number of different factors (Reis & McCoach, 2000) that include, but are
not limited to environmental causes, such as chronically underchallenging, slow moving class-
room experiences (VanTassel-Baska, in press; Whitmore, 1986); unrealistic family expectations
(Rimm, 1995); peer pressure to conform; and intra-individual causes, such as depression, anxi-
ety, rebelliousness, and attention deficit hyperactivity disorder (Baum, Olenchak & Owen, 1998);
failure to set realistic goals (Van Boxtel & Monks, 1992); and social immaturity. Regardless of the
origin, gifted underachievement is recognized as a discrepancy between expected achievement
(typically measured by standardized testing) and actual achievement (measured by grades and
performance in the classroom and teacher evaluations) (Baum, Renzulli, & Hebert, 1995; Boyd,
1990; Rimm, 1997). The current section will highlight a few causes of underachievement.
Underachievement in gifted students may develop when the student lacks motivation, dem-
onstrates boredom, and does not display interest in the subject matter. By the end of seventh
grade, many gifted students report that they are bored and lack intrinsic motivation for classroom
work due to a lack of interest, enthusiasm, or excitement in the curriculum (Boyd, 1990). Based
on a sample of 92 children identified as academically talented fifth graders (top 5% of class),
over 3% of these students dropped out of school before the eleventh grade. As indicated by their
responses to a Feelings about School Life questionnaire, the students who dropped out of school
felt that school was unrewarding.
Low motivation due to boredom and a lack of interest has been identified as a cause of un-
derachievement for many gifted students (Boyd, 1990; Emerick, 1992). Thirteen percent of gifted
students who obtained grades below the top quartile for the State of New South Wales in England
indicated that they lost excitement for school learning because lessons were not applicable to
the real world. They also felt a lack of purpose in completing routine assignments. Boyd (1990)
concluded that gifted students are not typically provided with special attention, and opportuni-
ties to encourage and nurture their advanced intellectual abilities. Emerick (1992) found that
underachieving gifted students were most likely to develop achievement oriented behaviors when
stimulated in class and provided opportunities to pursue topics of high interest.
Underachievement of gifted students can also be attributed to maladaptive motivational char-
acteristics (Reis, Neu, & McGuire, 1995). Cultural beliefs and related family values, social-peer
group dynamics, and gender are factors that can adversely impact academic motivation and con-
tribute to a gifted student’s underachievement. In a longitudinal study of 35 culturally diverse,
gifted urban students, Reis et al. (1995) found that after controlling for poverty, parental divorce,
and family size, the only differences between high and low achieving students were attitude to-
ward achievement and learning and familial support and encouragement. Academically successful
gifted students received support and encouragement from each other and supportive adults, such as
teachers, guidance counselors, coaches, and mentors. In contrast, gifted underachieving students
did not demonstrate characteristics associated with resilience or coping mechanisms to overcome
negative experiences within their families, schools, and communities. Additional research sug-
gests that attending to the student’s strengths and interests demonstrates support and encourage-
ment, motivating students to reverse academic underachievement (Renzulli & Reis, 1997).
 16. SERVING GIFTED STUDENTS 341

Culturally diverse gifted students face unique challenges in achieving academically. One
reason is because of the value placed on achievement within their culture (Diaz, 1998; Fernandez,
Hirano-Nakanish, & Paulsen, 1989). For many cultures, achievement is not necessarily defined
as excelling academically in school. Students from these cultures may not receive encourage-
ment, positive reinforcement, and support from family members for academic excellence; rather,
they will be rewarded for exhibiting culturally valued behaviors—for example, cooperation and
respect for authority (Barona & Pfeiffer, 1991). High ability minority students risk rejection from
family if they assertively develop their cognitive abilities and succeed in the majority culture
(Robinson & Noble, 1991).
Peer issues oftentimes influence adolescent behavior and can lead to academic underachieve-
ment when negative peer attitudes are encountered (Brown & Clasen, 1985). According to Clasen
and Clasen (1995), 66% of underachieving gifted students reported that negative peer influence
has the strongest force impeding their achievement. Berndt Hawkins, and Jiao (1999) found that
the grades of gifted students were more likely to drop from the fall to spring term if their friends
had lower grades in the fall. In addition, gifted students typically do not spend significant time
interacting with like peers who share their unique intellectual interests and curiosities (Boyd,
1990; Pfeiffer & Stocking, 2000).
Another category of gifted underachievers includes students who possess multiple talents (in
the gifted field, these students are labeled “multi-potentiality”). Gifted students who are talented
in many areas often need help or guidance with their decision-making skills. Indecision regarding
career choice options is common among gifted students because of the pressure they feel to make
a perfect career choice, and, in turn, to please significant others. Far too many gifted students
delay decisions concerning their career path, change majors, and even drop out of college. Baker,
Bridger, and Evans (1998) found that underachieving gifted children have deficits in behavioral
control, organizational skills, strategic problem solving skills, and coping skills. These results are
also supported by other investigations of gifted underachievement (e.g., Baum et al., 1998; Gal-
lagher, 1991; Muir-Broadus, 1995). One implication is that gifted students need to be provided
with services that assist them in narrowing down, prioritizing, and identifying specific career
options (Boyd, 1990; Sampson & Chason, in press).
Unfortunately, teachers focus most often on students in their class who are significantly be-
hind academically compared to course, grade and age expectations, and tend to overlook the gifted
student who may be falling behind relative to her/his potential, but not necessarily on those fac-
tors related to the No Child Left Behind Act of 2001. Educators typically identify underachievers
by finding that the child is behind in at least one major subject area. However, the majority of
gifted underachievers are not achieving a full grade below expectancy and may go unidentified
as underachievers for years (Mandel & Marcus, 1995). Educators are required to have access to
information regarding the special needs of students with learning disabilities; however, they are
not provided with guidelines for the evaluation and planning for underachieving gifted students.
As long as curriculum and instructional methodologies are geared toward the needs and learning
styles of the average student, many gifted students will remain vulnerable to academic under-
achievement.

Gifted Children and Attention Deficit Hyperactivity Disorder

Gifted students with academic and/or behavioral problems may have clinical or sub-clinical At-
tention Deficit Hyperactivity Disorder (ADHD). Baum et al. (1998) categorize gifted students
who exhibit ADHD behaviors into the following three groups: gifted students whose learning
and/or attention problems stem from an actual neurophysiologic disorder; gifted students whose
342 PFEIFFER AND BLEI

ADHD symptoms are precipitated and reinforced by the classroom learning environment; and,
gifted students who demonstrate ADHD characteristics due to both an actual neurophysiologic
disorder and a less-than-supportive learning environment. It is important diagnostically to distin-
guish between gifted students with an actual clinical diagnosis of ADHD and those with ADHD-
like behaviors or characteristics but not clinically diagnosed ADHD. There are very different
treatment implications for these two groups of gifted students—the most obvious being the rec-
ommendation for a trial of psychostimulant medication for the twice-exceptional gifted/ADHD
student.
Gifted children may be misidentified as ADHD due to specific environmental factors that
can cause or exacerbate ADHD-like behaviors among high ability students (Baum et al., 1998;
Pfeiffer & Stocking, 2000). Some writers in the field propose that the reported increased inci-
dence of hyperactivity and attention problems among gifted students stems primarily from un-
der-challenged and unchallenging learning environments (e.g., Webb & Latimer, 1993). Gifted
students, for example, often spend a quarter to half of the school day waiting for their classmates
to catch up (Webb & Latimer, 1993). It is hard to imagine how this would not create boredom,
restlessness, and difficulty with focused or sustained attention, particularly among young chil-
dren who have not yet developed specific coping skills (Pfeiffer & Stocking, 2000). Gallagher,
Harradine, and Coleman (1997) interviewed 800 gifted students and reported that the majority of
their struggles stem from a slow instructional pace, an emphasis on facts rather than critical and
divergent thinking, and excessive repetition of already-mastered skills. The often observed inat-
tention of gifted students may, in many instances, be due to boredom resulting from an unchal-
lenging classroom environment (Gallagher, in press; Hartnett, Nelson & Rimm, 2004).
Although under-challenging academic environments can contribute to ADHD-like behaviors
in gifted children, the gifted literature suggests that gifted children—especially the creatively
gifted—display an innate characteristic that mimics ADHD, namely, “overexcitability.” Some
gifted authorities suggest that overexciteabilities (OE) are inborn propensities to respond to stim-
uli in a heightened and intensive fashion. This increased sensitivity and awareness are purported
to manifest themselves in five areas of intensity: psychomotor, sensual, intellectual, imagination-
al, and emotional. Psychomotor overexcitability among the gifted is heightened excitability of the
neuromuscular system and is often displayed as a surplus of energy, rapid speech, enthusiasm,
intense physical activity and the need for action (Piechowski, 1991). Gifted children with this OE
may talk compulsively, act impulsively, misbehave and act out, display nervous habits, and be
overly competitive (Lind, 2001). One can readily see the overlap of symptoms and the potential
for misdiagnosis as ADHD.
The gifted child with sensual overexcitability can experience heightened sensual pleasure or
displeasure from any of the five senses. Some gifted children may feel overstimulated or uncom-
fortable with sensory input (e.g., find clothing, noise, or odors excessively distracting). Others
may overeat, go on buying sprees, or inappropriately seek out physical sensation (Piechowski,
1991).
The gifted child with intellectual overexcitability often displays an unrelenting thirst for
knowledge, information, and truth. Typical characteristics of these gifted children are an intense
curiosity, avid reading, exceptionally high concentration threshold, and seeming preoccupation
with important moral and ethical issues. These gifted children often display or broadcast their
intellectual passion in inappropriate and even rude ways.
The gifted child with imaginational overexcitability seems to the uninformed observer pre-
occupied with their imagination and inner world. Gifted children typically express imagination
OE through fantasy, intense visualization, and dramatizations. These gifted children often find it
difficult to stay on task or pay attention to a teacher lecture, since their rich imaginational world
 16. SERVING GIFTED STUDENTS 343

is more interesting and pulls them away from the more mundane environment of the classroom
The gifted child with emotional overexcitability displays heightened and intense emotions
and emotional responses to events and experiences. Due to their tendency to develop strong at-
tachments to people, places, and things, children with OE have the capacity for great emotional
depth. Although these children are sometimes accused of overreacting or being melodramatic,
their genuine behavior is often manifested because of the deep concern they have for others, as
well as self-criticism and anxiety (Piechowski, 1991).
When viewing such creative giftedness, one finds, interestingly enough, characteristics often
associated with the expression of creative talent, similar to behaviors representative of ADHD.
Characteristics of the creative gifted, consistent across multiple studies, include adventuresome,
self-assertive, and nonconforming (Andreason, 1989). Although there is a paucity of research
on creativity and affective disorders in children, a handful of clinical case studies and empiri-
cal research has verified a link between creativity and affective disorders, particularly bipolar
disorder. Adolescents with bipolar disorder often display characteristics of ADHD; educators,
school psychologists, and parents need to be cognizant of this link between creativity and bipolar
disorder, which could appear to the uninformed as ADHD (Biederman, Russell, Soriano, Woz-
niak, & Faraone, 1998; Wilens, Biederman, & Spencer, 1999). Behaviors to watch out for include
poor judgment, distractibility, inattention, irritability, hyperactivity, anger, poor impulse control,
demanding behaviors, and the tendency to jump from one topic or activity to another (Geller &
Luby, 1997).
As mentioned above, many of the behavioral characteristics of ADHD displayed by gifted
children are likely to be precipitated by boredom as well as excitement and intellectual passion.
Learning environments that match well with the student’s intellectual ability and thirst for knowl-
edge enable gifted children to focus their mental resources in a goal-directed and successful
manner. Within intellectually stimulating classroom environments, the passionate and focused
high energy level of the gifted student can be rather easily diagnostically differentiated from the
random, unfocused, hyperactive behaviors seen among non-gifted students with ADHD (Clark,
1997).
Gifted children who are deprived of a rich curriculum that is commensurate with and matches
their ability level are likely to express their energy through behaviors that mimic ADHD-driven
hyperactivity. The hyperactivity observed in a student with ADHD is often expressed as random
energy, such as psychomotor agitation (Parker, 1992). A gifted student’s high activity level, on
the other hand, is generally focused and goal directed. Although the gifted student may display
poor impulse control by excitedly shouting out an answer in a classroom, the gifted student’s
answer is likely to be correct, whereas the child with ADHD tends to guess incorrectly (Lovecky,
1994).
Although gifted students who are not placed in appropriate learning environments that chal-
lenge their intellectual curiosity are at risk for developing disruptive, inattentive classroom behav-
iors, the unidentified twice exceptional gifted/ADHD student is at heightened risk for academic
and behavior problems (Moon, 2002). Even when the curriculum and instructional methodology
are geared toward the gifted learner, the presence of ADHD will render the gifted student vulner-
able (Pfeiffer & Stocking, 2000). A gifted student with ADHD can easily become discouraged
and develop a low self-concept due to an inability to control disorganized behaviors (Leroux &
Levitt-Perlman, 2000). The oppositional behaviors, daydreaming, social immaturity, and disorga-
nization displayed by gifted children with ADHD are often triggered by their frustration (Leroux
& Levitt-Perlman, 2000).
Not surprisingly, disruptiveness of the gifted student with ADHD often results from dif-
ficulty regulating emotions (Moon, Zentall, Grdkovic, Hall, & Stormont-Spurgin, 2001) and can
344 PFEIFFER AND BLEI

lead to socially inappropriate behaviors and ongoing peer rejection. Due to these behaviors that
are uncharacteristic for a gifted child, some children are diagnosed with ADHD without being
accurately identified as gifted. Even if a child with ADHD is suspected of being gifted, and is
administered an IQ test, cognitive processing inefficiencies and attentional difficulties will lead
to IQ test scores that are typically 5-10 points lower than other children of the same ability level
(Castellanos, 2000).
Since symptoms of ADHD are likely to overlap with giftedness, it is crucial for teachers,
school psychologists, school counselors, and administrators to be cognizant of ADHD-like be-
haviors that gifted children may exhibit. Developing the ability to distinguish between ADHD
and the innate behavioral characteristics a gifted child may display, or that stem from inadequate
environmental stimulation, is necessary for appropriate intervention.

Gifted Children and Peer Relation Problems

Many gifted children experience uneven or asynchronous development. Although there are many
characteristics of uneven or asynchronous development among the gifted, the most problematic
is when there is a significant disparity between intellectual, physical, and social development
(Silverman, 1993). For example, an 11-year-old with an IQ of 160 is in all probability on the
same intellectual level as a high school student, but is unlikely to have acquired an equivalent
developmental level of emotional, social, and physical development (Burks, Jensen & Terman,
1930; Pfeiffer & Stocking, 2000). For example, the first author recently worked with the family
of an exceptionally gifted young child who frustrated his parents and teachers with his “grossly
immature behaviors.” In reality, his social intelligence was, more or less, age appropriate. What
was perplexing to others was that his social skills and interpersonal savvy, although developmen-
tally normal, were absurdly incongruous with his extraordinarily stellar intellectual abilities.
Gross (1989) has poignantly written how mental age effects friendship choices among
highly gifted children. Because of their asynchronous development, gifted students have a need
for “true peers” because they are often unable to relate to peers with average abilities (Osborn,
1996). Highly gifted children prefer close, intimate relationships, but they have few peers with
whom they can share their level of understanding, awareness, and resulting feelings of isolation
and loneliness (Brody & Benbow, 1987). In many instances gifted students tend to more closely
resemble older, non-gifted students and adults rather than students of the same age.
When gifted students are not interacting with other gifted children, they are at risk for feeling
alienated and misunderstood, and for developing social deficits and low self-esteem (Pfeiffer &
Stocking, 2000). Loneliness, social isolation, and even moderate to severe levels of depression
may result when a school district is unwilling or unable to provide gifted students access to peers
of similar intellectual and psychosocial development (Schneider, Ledingham, Crombie, & Clegg,
1986).
In one study, gifted children and adolescents who were interviewed expressed their need to
be accepted, rather than rejected by other children for their talents. They also expressed a need to
socialize with other children who share similar interests and abilities (Osborn, 1996). Although
gifted children describe feeling more socially at ease, comfortable, and accepted when placed in
educational programs that include other gifted students, most schools do not cater to gifted stu-
dents’ needs by forming compatible groups of students (Rimm, 2002, in press). During the first
author’s tenure as Executive Director of Duke University’s pre-collegiate gifted program, he in-
terviewed hundreds of gifted students attending the highly competitive Duke summer residential
program. A recurring comment voiced during dozens of focus groups was that, for the great ma-
jority of these gifted children, the summer gifted program was the first time that they felt socially
 16. SERVING GIFTED STUDENTS 345

comfortable. There is growing evidence that positive peer interaction contributes to preventing
and reversing underachievement, and that negative peer attitude impedes academic achievement
(Clasen & Clasen, 1995; Weiner, 1992). Since social perceptions affect how students learn in
school, Porath (1996) suggests assessing gifted students’ perceptions of social acceptance at the
elementary school level as a form of prevention.
Dauber and Benbow (1990) found that extremely gifted students (as measured by “out-of-
level” SAT scores taken by seventh graders) were more likely to experience feelings of social
incompetence than moderately gifted students. Extremely gifted students reported that they were
more introverted, less socially adept, more inhibited, and that peers viewed them as less popular,
less socially active, and less athletic. Gifted students scoring particularly high in verbal ability
reported the lowest social status and lowest feeling of importance. Switatek (1995) also found
that verbally precocious gifted students perceived themselves as less accepted than mathemati-
cally gifted students. Social acceptance tends to be a greater problem for students with unusually
high IQ as compared to the moderately gifted. Gross (1993) found that 80% of students with IQs
greater than 160 reported that they experienced intense social isolation in the classroom, and felt
the need to conform to match the expectations of their average classmates.
In comparing two groups of high ability students, Cross, Coleman, and Stewart (1995) found
that 94 out of the 473 gifted students reported perceiving themselves as similar to their peers,
whereas 379 of the sample reported feeling different from their peers. The gifted students who
reported feeling different from their peer group acknowledged that they had experienced stigma-
tizing situations. However, regardless of the gifted adolescents’ true social standing, Coleman
and Cross (1988) asserted that gifted students often express feelings of difference or perceived
stigma that results from the gifted label (Rimm & Rimm-Kaufman, 2000).
In addition to a lack of companionship that may impede and adversely affect the gifted stu-
dent’s social-emotional functioning, gifted students are also more likely to experience frequent
and intense bullying. In the first major study of bullying of gifted students, it is reported that by
eighth grade, more than two-thirds of gifted students have been victims of bullies. Four-hundred-
thirty-two gifted eighth graders from 11 states were interviewed; 67% had experienced bullying
by the eighth grade. Name calling was the most common form of bullying, followed by teasing
about appearance, intelligence and grades, and pushing and shoving. Teasing about appearance
was reported to create the most negative emotional effect (Peterson & Ray, 2006). Thirty-seven
percent of girls and 23% of boys reported “violent thoughts” as a result of the bullying, which
ranged from kicking to bringing a gun to school.
Twice exceptional gifted children who have Asperger’s disorder (AD), which is a perva-
sive developmental disorder characteristic of a dysfunction in social interaction, are even more
likely to suffer from bullying and social isolation (Gallagher & Gallagher, 2002). There are four
diagnostic criteria indicative of individuals with AD: impaired social functioning, restricted and
stereotyped behaviors or interests, average or above average language development, and average
or above average cognitive/intellectual development. It is important to note that not all children
with AD are gifted. At the same time, a gifted child can suffer from AD. The first author has
worked with a number of twice exceptional gifted children with AD and their families. He has
also consulted on a number of cases in which children of average intellectual ability with AD
were incorrectly diagnosed as twice exceptional gifted/AD. It is easy to understand why a parent
of a child with AD might want to view their loved one as being gifted.
Since some of the behavioral characteristics of highly gifted children are similar to those
behaviors characteristic of children with AD, it can be difficult to differentially diagnose the two.
Educators and clinicians must keep in mind that an AD diagnosis is only warranted when the
behaviors are extreme, inflexible, and resistant to behavioral intervention. Distinguishing AD and
346 PFEIFFER AND BLEI

highly gifted children is often a matter of degree. Some gifted children may present as socially
inept and isolated, and tend to avoid interaction with their same age peers. However, with strong
incentives and encouragement, they can rather easily make the necessary social adjustments and
no longer appear socially incompetent. Children with AD, display awkward and inflexible social
interactions that are notoriously resistant to behavioral or environmental interventions.
Giftedness has the potential to exacerbate symptoms of AD. The heightened emotional sen-
sitivity, constant questioning, and independent thinking associated with giftedness compounds
the problems children with AD face. The twice exceptional gifted child with AD can appear so-
cially inattentive, clumsy, and yet highly verbally adroit. The twice exceptional gifted/AD child
may be aware that s/he is quite different from other children, which can fuel a deepening sense of
isolation, low self-esteem, and depression.
The heightened emotional overexcitability associated with giftedness is exacerbated when
children have a co-morbid disability (Sword & Hill, 2002). This is true not only for the twice ex-
ceptional gifted child with AD, but for many gifted students who may feel a heightened sense of
alienation and sensitivity to being different, compared to their same age non-gifted peers. Gifted
students struggle to understand and make sense of the unkindness, taunting, and derision that
they too often experience from non-gifted students. Gifted children are prone to be hypercritical
in their self-appraisals, which can create feelings of inadequacy and inferiority. Schneider et al.
(1986) found that gifted students in the fifth, eighth and tenth grades reported less favorable self-
perceptions, compared to non-gifted peers. Older gifted children reported having fewer friends
compared to younger gifted children (Roedell, 1985). One possible explanation may be that
gifted children, especially those who are older, hold more mature and sophisticated concepts of
friendship, and are disappointed when their relationships lack the depth or intimacy that they
would like.

GIFTED CHILDREN AND SPECIFIC SOCIAL-EMOTIONAL PROBLEMS

Gifted Children and Perfectionism

Although research is limited in the area of perfectionism among gifted students, studies indicate
that it is a relatively common characteristic among gifted students, and that gifted students are
more perfectionistic than their average-ability peers. However, gifted students’ personal interpre-
tation dictates whether their pursuit of perfection contributes to academic acceleration, creativ-
ity, and empowerment, or creates intense frustration and even paralysis (Burns, 1980; Schuler,
2002).
Due to experiences that gifted students encounter relating to their exceptional abilities, per-
fectionism in gifted students tends to create more anxiety than in their average ability peers.
Gifted students’ anxiety often stems from their strong need for personal excellence, which can
result in unhealthy perfectionism and intense, debilitating emotions. Twice exceptional students
are specifically vulnerable to unhealthy perfectionism because of their unrealistic expectations of
themselves in areas in which they have disabilities (Vespi & Yewchuck, 1992). A general lack of
self-confidence due to their disability is likely to interfere with their persistence in accomplish-
ing their goals. Unrealistic expectations of teachers and parents, coupled with excessive and un-
necessary praise of accomplishments, fuel unrealistically high expectations that gifted students
calibrate for themselves (Pfeiffer & Stocking, 2000).
According to Silverman (1989), perfectionistic behaviors in gifted students may stem from
standards they set that are appropriate for their mental age, and commensurate with older peers,
 16. SERVING GIFTED STUDENTS 347

but disharmonious in relation to their other abilities. In addition, gifted students tend to be fail-
ure avoidant because they have succeeded in the majority of areas within their under challenged
environments (Dweck, 2000). Willings and Arseneault (1986) used Rollo May’s existential view
to epitomize a gifted child’s perfectionist attitude which states “I am without significance unless
I am on top; unless I am the superstar…I am nothing unless I am seen to be achieving something
spectacular” (Willings & Arseneault, 1986). Therefore, unhealthy perfectionism, or an inability
to be satisfied with a product can lead to intense frustration, and result in a general lack of motiva-
tion (Silverman & Golon, in press), learned helplessness, and disruptive or withdrawn behavior
and low self-esteem.
Research suggests that perfectionism, specifically experienced during adolescence also
increases the gifted child’s vulnerability to patterns associated with eating disorders (Gardner,
1991). Dally and Gomez (1979) reported that 90% of their patients with eating disorders had an
IQ of 130 or more, and Rowland (1970) found that 30% of his patients with eating disorders had
IQs of 120 and a higher. Parent expectations of their child identified as gifted are likely to con-
tribute to perfectionist behaviors, often demonstrated through competitiveness and the need for
high performance. Although many gifted students display adaptive forms of perfectionism that
encourage and support high achievement, it is important to be aware of maladaptive perfection-
ism that is associated with clinical depression and suicide (Schuler, 2000).

Gifted Children and Suicide

Maladaptive perfectionism is one of the many vulnerabilities of gifted children that may be as-
sociated with contemplation of suicide. Negative or neurotic perfectionism has been suggested
to be a risk factor that contributes to depression (Schuler, 2000). Unrealistic negative self-evalu-
ations and exaggerated failure, on top of parental and societal pressure to excel, may lead to
depression and suicidal ideation. Farrell (1989) asserted that a gifted child’s ability to cope is
compromised by perfectionism, stressful parental societal pressures to achieve, pressures of mul-
tiple potentiality, and distorted perceptions of failure.
A wide range of associated emotional problems may precede suicide attempts. Those that
are salient to gifted children and adolescents include: inadequate social support; relationship
failure with peers; self-derogation (Dubow, Kausch, Blum, Reed, & 1989); isolation, related to
extreme introversion (Kaiser & Berndt, 2004); and unusual oversensitivity (Dixon & Scheckel,
1996).
Dixon and Scheckel (1996) asserted that overexcitabilities including psychomotor (e.g., fast
games, sports, acting out, impulsive actions), sensual (e.g., sensory pleasure, sexual overindul-
gence), intellectual (e.g., introspection, avid reading, curiosity), imaginational (e.g., fantasy, ani-
mistic and magical thinking, mixed truth fiction, and illustrations), and emotional (e.g., strong
affective memory, concern with death, depressive and suicidal moods, sensitivity in relationships,
feelings of inadequacy, and inferiority) are of special concern when considering the possibility
of suicide in gifted children.
Suicide has been linked to depression which can be identified in three stages of adolescence
(Golombek & Kutcher, 1990; Sargent, 1984). In early adolescence depression may be marked
by anger and disorganized, erratic behavior. Exaggerated, angry outbursts and autonomy may be
expressed in mid-adolescence, the typical stage of rebellion. More “typical” depression may be
observed in late adolescence, in which emotions are more self-directed in the form of sadness or
guilt.
Some warning signs of depression and suicide among gifted students are lack of friend-
ships, self-depreciation, sudden shift in school performance, total absorption in schoolwork, and
348 PFEIFFER AND BLEI

frequent mood shifts (Delisle, 1986). Social isolation, in particular, is associated with depressed
mood in gifted children and adolescence. Highly gifted children are at higher risk for social iso-
lation, especially when surrounded by average peers and unchallenging learning environments
(Gross, 1993). Depression, however, may precede the social isolation, or be associated with pre-
mature existential depression, characterized by advanced moral reasoning and heightened sensi-
tivity, which is likely to resemble isolative behavior.

PROPOSED GUIDELINES FOR SERVING THE GIFTED WITH LEARNING AND

BEHAVIORAL CHALLENGES

The preceding section provided a brief discussion of a variety of social, emotional, and academic
challenges that some gifted children may face. The next section presents a set of guidelines to
consider when working with gifted students with learning and behavioral challenges. The seven
guidelines were developed as a result of the first author’s clinical experience working with this
unique population over the past 30 years and supported, where noted, by findings from the empir-
ical research literature. Our intention, therefore, is to provide a scholarly perspective on current
practice guidelines when working with gifted students with learning and behavioral challenges.

Guideline 1: Parent Involvement

The first principle is almost too obvious to state, but nonetheless is a core principle in effectively
helping gifted students with learning or behavior problems. It is critically important to involve
the gifted student’s parents in any planned interventions. Classroom teachers, psychologists, and
counselors (and in some instances, even the principal) need to reach out to the family and nurture
a collaborative partnership. This is not always easy. There will be times when the parents have
adopted, for a myriad of reasons, an adversarial or even intimidating posture in advocating for
their gifted child. In these particularly challenging instances, the following suggestions are im-
portant to remember:

• The student’s welfare is the central issue

• Most parents are well-intentioned and have their child’s best interests at heart
• Be supportive, understanding, encouraging, and respectful, even if you disagree with the
parents
• If you disagree with the family, communicate your viewpoint in a courteous, deferential,
and non-emotional manner

Research indicates that the great majority of families of gifted children are child-centered,
close, nurturing, and supportive (Keiley, 2002). On average, parents of gifted children invest
more time and effort than do parents of non-gifted students in engaging their children in learning
activities and introducing them to potential talent areas (Robinson, 2002).
However, when things are not going well academically or behaviorally for their gifted child,
families will require assistance, guidance, encouragement, and or support. In some instances,
the parents or family may need counseling. Parents often seek psychological services to confirm
their child’s giftedness; guide them in parenting (Pfeiffer, 2002b, 2003), determine an educa-
tional path and locate available resources (VanTassel-Baska & Stambaugh, in press), obtain early
career information (Sampson & Chason, in press), and obtain assistance with specific issues,
such as underachievement, peer relation problems or sibling conflict, depression, and negative
 16. SERVING GIFTED STUDENTS 349

perfectionism (Neihart, in press; Silverman & Golon, in press). Even if the issue facing the gifted
student appears to be exclusively an academic problem, a parental partnership is important for
two reasons: One, the home is the child’s first school and can and should continue to play an
important role in the student’s learning and attitude toward academics and achievement. Two, all
meaningful learning includes an affective component. When a student is not doing well, whatever
the reason, one can and should expect an emotional reaction that is best addressed with parental
involvement.

Guideline 2: Standard of Excellence

The principle of setting a standard of excellence, like the above principle, may seem too obvious
to state. However, we have encountered many parents and teachers in gifted workshops nation-
wide who believe that gifted children should not be encouraged to work hard. There are many
underlying reasons for this belief. Some parents and educators contend that the gifted student
should benefit from learning that comes easy and that the gifted learner should not have to put
forth extra effort. Others believe that gifted children should not be “pushed” for fear of doing
irreparable harm to their gift or creativity (Pfeiffer & Blei, 2007).
Whatever the reason, we believe that this attitude is dangerous, potentially harmful and
misguided. Research has consistently shown that the development of talent and the attainment
of expertise and expert performance in one’s profession—whatever the area might be—requires
considerable effort. Irrespective of one’s innate ability, the learner must willingly, in extensive
direct instruction, receive well-timed feedback, and engage in considerable deliberate practice—
upwards of a few thousand hours of practice if they hope to attain expertise in a field (Ericsson,
1996; Sternberg, 2000). If one of the goals of the educational system is to provide all students—
gifted and non-gifted alike—with the opportunity to reach their potential and fully actualize their
gifts, then it becomes important to reinforce an attitude of the pursuit of excellence. This, in fact,
is one reason why there is a measure of student motivation included on the Gifted Rating Scales
(Pfeiffer & Jarosewich, 2003).

Guideline 3: Appropriate Academic Fit/Academic Accommodations

It is almost universally accepted by experts in the field that gifted students need an advanced cur-
riculum targeted toward their unique needs; time to develop talents and pursue in-depth interests;
to be grouped with like intellectual peers in order to develop close peer relationships with others
who are at similar developmental stages; and an enriched curriculum that excites, stimulates,
and challenges their passion for learning (e.g., Olszewski-Kubilius, Limburg-Weber, & Pfeiffer,
2003; Robinson, Shore, & Enersen, 2007; VanTassel-Baska & Stambaugh, in press).
A number of research studies have documented that when things go awry academically or
behaviorally for gifted students, the culprit, all too often, is the lack of an appropriately challeng-
ing curriculum or unsuitable instruction. An appropriate academic fit should take into account
what we know about gifted students: they learn at faster rates (Colangelo, Assouline, & Gross,
2004), solve problems more readily (Sternberg, 1981), and manipulate abstract ideas and make
creative connections more easily (VanTassel-Baska and Stambaugh, in press).
When things are not going well academically or behaviorally for the gifted child, it is impor-
tant to determine whether the curriculum and instructional plan are appropriately matched for the
student. This, in fact, is one of the first things areas that the educator or mental health professional
should explore when consulting on referral problems for underachievement, poor motivation,
inattentiveness or distractibility, unsatisfactory peer relationships, loneliness, and depression. In
350 PFEIFFER AND BLEI

the first author’s clinical experience, all too often a gifted child’s social, emotional, or behavioral
problem is the result of chronic and unrelenting boredom and frustration in a classroom environ-
ment that is poorly matched to his/her gifts.
In some instances, academic accommodations may have to be created for the gifted student
or sought outside of the child’s local school. Examples include: youth symphony orchestras,
debate teams, and service learning opportunities, Saturday and summer gifted educational pro-
grams, online and home study gifted distance learning courses, and mentorships (see below for a
more complete discussion of mentorship).
The research literature indicates that an important component in educating gifted students
with learning or social, emotional or behavioral problems is providing instruction in the student’s
areas of strength (Emerick, 1992; Baum et al.,1995; Baum & Owen, 2004; Newman, 2004;
Olenchak, 1995; Renzulli, 1977).The evidence conclusively supports interventions that focus on
the gifted child’s strengths, not his/her weaknesses. Emphasizing the gifted student’s strengths,
for example, can include praising a perfectionist child for a project that they did not believe to
be adequate or noticing the gifts of a twice exceptional gifted child with LD. Consistent with the
tenets of applied behavior analysis (Malott, Malott & Trojan, 2000), it is important to reward the
gifted student’s effort, and not focus excessively on the outcome. Teaching to a student’s abilities
increases self-concept, motivation, and task completion (Nielsen & Mortoroff-Albert, 1989).

Guideline 4: Mentorship

Mentoring as an intervention for the gifted student is highly regarded for both its psychosocial
and vocational benefits. There are no published reports of mentoring relationships leading to
negative outcomes; in fact, the extant research literature reports only positive outcomes (Johnson
& Ridley, 2004). The origins of mentoring can be traced to classical Greek mythology (Robinson,
Shore, & Enersen, 2007).
The basic elements of mentoring include a responsible and trusted adult in the community
(the mentor) with expertise in a vocational domain who is willing to spend one-on-one time with
a gifted adolescent (the protégé). Mentorship is essentially an extension of an important aspect of
the parenting role; the mentor introduces the gifted adolescent to a domain of expertise in which
they both share a passion.
Mentorship is not classroom pedagogy. Mentoring relationships often need to be established
by a parent, psychologist, or counselor outside of the purview of the school. One cautionary note
is the importance of careful recruitment, matching, and supervision to ensure ethical conduct and
congruent goals between the gifted student and mentor.

Guideline 5: Balance in the Gifted Student’s Life

Promoting balance in a gifted student’s life means that the parent (and teacher) need to protect
the child (and themselves) from getting caught up in focusing excessively on the student’s special
gifts to the neglect of other important developmental considerations. Parents of gifted children
can be tempted to provide their child with every available opportunity and resource (Pfeiffer,
2003). Of course, nurturing a child’s special gift is important—as we emphasized in guideline #2.
However, when the scales tip to place excessive emphasis—in terms of time, emotional energy,
travel, rearranged schedules, stretched financial resources, family activities—on promoting the
special talent, the gifted child can miss out on important socialization experiences, and even feel
guilty about the excessive attention. This can inadvertently create social, emotional, and behav-
ioral problems such as perfectionism and rebelliousness (Pfeiffer, 2003).
 16. SERVING GIFTED STUDENTS 351

The lesson underlying the guideline of promoting balance is that sometimes too much of
a good thing in the pursuit of excellence—tutoring, private lessons, practice that is excessive,
special classes, after-school programs, summer camps—can be detrimental to a gifted child’s
overall psychological health. Even highly gifted students need social and recreational activities
and simple down-time to relax and unwind (Pfeiffer, 2003).

Guideline 6: Social Intelligence and Intellectual Giftedness

Intellectual giftedness does not guarantee advanced or even adequate social skills. By social
skills we mean: being courteous, a good listener, likable, helpful, trustworthy, a team player, able
to get along well with others, and empathic. These important social and interpersonal skills have
been variously labeled aspects of emotional intelligence, social competence, social maturity, and
interpersonal intelligence (Gardner, 1983; Goleman, 1995, 2006; Pfeiffer, 2001a).
The publication of Emotional Intelligence (Goleman, 1995) made popular the recognition
that IQ is not enough to guarantee success. Important social skills such as being able to rein in
an emotional impulse, accurately read social cues and other people’s feelings, delay the need
for immediate gratification, tolerate frustrating situations and events, and handle interpersonal
relationships smoothly are all important for success inside and outside of the classroom (Pfeiffer,
in press).
A number of intellectually gifted children do not demonstrate equally well-developed social
intelligence. Many extraordinarily bright children are ill at ease with peers and adults, lack self-
confidence, and are unable to tolerate stressful situations (Pfeiffer, 2003). They lack the ability
to present themselves as friendly, interested, and interpersonally attractive. As you might expect,
this puts them at risk for academic, social, emotional, and behavioral problems.
Whenever one encounters a referral for a gifted student with learning or behavioral chal-
lenges, it is advisable to evaluate the adequacy of the child’s social skills. This may provide valu-
able clues to help explain the reason for the problem, as well as fruitful strategies for intervention
(Pfeiffer, 2003). As the reader is well aware, there is ample empirical evidence supporting the
efficacy of social skills intervention programs (Pfeiffer & Reddy, 2001).

Guideline 7: Counseling: Prevention and Intervention

As this chapter has emphasized, gifted children and adolescents, as a group, are different from
their non-gifted peers in important ways. These differences can create both typical and unique
stresses and challenges. When these stresses and challenges exceed the student’s ability to effec-
tively cope, the youngster and his/her parents may benefit from counseling (Peterson & Moon,
in press). A search of journal abstract search service, PsychInfo, identified over 300 published
articles using the search terms gifted and counseling. However, very few of the articles were
empirically-based; the great majority of counseling papers were anecdotal case studies. In truth,
much of what is written about counseling the gifted is based on clinical experience, pragmatic
opinion, and empirically-based research from the non-gifted guidance, counseling, and psycho-
therapy literature. A useful resource is Models of Counseling Gifted Children, Adolescents, and
Young Adults, edited by Mendaglio and Peterson (2007). This volume compares the major coun-
seling models, techniques and therapeutic processes used with gifted clients and their families.
Although there is a dearth of empirically-supported research on the efficacy of specific psy-
chotherapeutic interventions with the gifted (Emerick, 1992; Peterson & Moon, in press; Reis
& McCoach, 2002), those who work with gifted children maintain that counseling is often a
powerful intervention for these individuals. In our experience, psycho-educational curriculum,
352 PFEIFFER AND BLEI

preventive guidance, and counseling/psychotherapy are effective interventions with the follow-
ing issues: peer rejection; teasing and bullying; frustration related to ADHD, learning disabilities,
and shyness; feelings of weirdness and being different; fear of failure; social skill deficits; peer
pressure to “dummy-down”; and maladaptive motivation. We have found bibliotherapy to be a
particularly powerful adjunctive technique for the parents of gifted students. For example, Par-
enting Gifted Kids (Delisle, 2006) and Early Gifts: Recognizing and Nurturing Children’s Tal-
ents (Olszewski-Kubilius, Limburg-Weber, & Pfeiffer, 2003) are two excellent resources written
to assist with parenting issues.

CONCLUSION

This chapter has examined a number of typical and unique challenges facing the gifted student.
The majority of gifted students are well adjusted, and the great majority of gifted students enjoy
academic success and satisfactory social lives. However, a significant number of them encounter
difficulties navigating the challenges of school, peer group, and home life. In some instances,
the problem is a developmental challenge—for example, asynchronies in different domains or
deficits in social skills. In some instances, the problem is a disability that co-exists with being
gifted—the twice exceptional student who is struggling with a learning disability, ADHD, mood
disorder, Asperger’s disorder, physical disability, etc. Finally, in some instances, the problem is
the result of being gifted in today’s anti-elitist culture and results in suffering, teasing and peer
rejection, difficulty making friends, peer pressure to hide or suppress one’s gift, and painful bore-
dom in the classroom. These many factors can contribute to learning and behavioral challenges
that require well-conceived, thoughtful, and carefully monitored interventions. The goal of this
chapter has been to introduce the reader to the special needs of the gifted and identify key guide-
lines important in providing services to serving this unique population.

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 17
Effective Service Delivery Models
James M. Kauffman, Devery R. Mock, Melody Tankersley,
and Timothy J. Landrum

Among the most contentious issues of the late twentieth and early twenty-first centuries involv-
ing students with learning and behavioral difficulties is the matter of how services should be
delivered to them. Service delivery models may be described in a variety of ways (Smith & Fox,
2003). All of the following might be considered: programs, resources, policies, and services. In
our view, the various alternative models are distinguished as well by questions that are perpetual
in special and general education:

• What language should we use to designate students and interventions?

• Who should have the authority to designate which students receive services and to desig-
nate or approve the persons who provide services?
• How should we group students for service delivery?
• In what place are services best delivered to students?

Language refers to labeling students and the service(s) given to those designated. Authority
means giving power to a person or to persons to say that a student should be identified as having
difficulty, to provide special services, or to say who should provide the services and what training
or competencies they should have. Grouping students means deciding whether students should
be treated individually or congregated heterogeneously or homogeneously for services. Place is
the issue of where services should be delivered, whether in settings considered general or special.
We acknowledge that these are overlapping questions or issues, but we believe they can be most
clearly discussed separately.
We have organized our discussion of effective service delivery models around these four on-
going issues. Our assumption throughout is that the services delivered will be the evidence-based
practices discussed in previous chapters in sections II and III of this book, and that effective ser-
vice delivery will also address matters discussed in other chapters in this section. To the greatest
extent possible, we attempt to make both a logical and an evidence-based case for service deliv-
ery. We acknowledge, however, that for some issues reliable evidence is nonexistent or nearly
so. We also acknowledge that effective service delivery might vary with the age of the student
and the nature of the problem that makes special services necessary. To illustrate, following a
comprehensive review of empirical research, Smith and Fox (2003) concluded, “We found little
empirical research of the effectiveness of systems of service delivery for young children with or

359
360 KAUFFMAN, MOCK, TANKERSLEY, AND LANDRUM

at risk of challenging behavior” (p. 8). In the absence of data on which to base our case, we make
no apologies for relying on logical argument.

HISTORICAL PERSPECTIVE

All questions about how best to deliver services to students have a very long history. However,
Bateman (1994) was perhaps the first to describe certain issues in learning disabilities as perpetu-
al—existing from the beginning of special education and unlikely ever to be fully resolved. Bate-
man described them as the questions Who? How? and Where? Kauffman and Landrum (2006)
described perpetual issues and their historical roots in the education of students with emotional or
behavioral disorders, among them inclusion, a continuum of alternative placements, and person-
nel preparation. In fact, most of the issues we discuss in this chapter have been concerns for many
years and are unlikely ever to be fully resolved, simply because reliable evidence for a position
on them is extremely difficult to obtain. Furthermore, they are matters of intense belief for many
individuals regardless of any evidence presented.
The words used to describe children—labels—have been a matter of debate at least since
special education became common in public schools. Labels have been a contentious issue in all
professions dealing with deviance, but they have been a particular problem for special educators
(Burbach, 1981). At the first meeting of the Council for Exceptional Children in 1923, delegates
had an extended discussion of labels for categories and other issues of language (see Kauffman,
1981). Over the years, the term handicap turned to disability; mental retardation was changed
to intellectual or developmental disability; disorder became challenge, and so on. In the process
of changing the terminology used to designate differences that are perceived as problems, argu-
ments have been made for and against specific labels. Some have expressed distaste for all labels
in special education that are the basis for identification and grouping or that have negative conno-
tations. Some writers consider all such labels as demeaning, unnecessary impediments to school
reform (e.g., Lilly, 1992; Reynolds, 1991). Others have argued that labels for disabilities are es-
sential, that euphemisms are counterproductive, and that resistance to labeling anything consid-
ered undesirable merely stifles prevention and appropriate services to students with disabilities
(e.g., Kauffman, 1999, 2003; Kauffman & Hallahan, 2005a; Kauffman & Konold, 2007).
Controversy about whom should be given power to identify individuals as having particular
conditions—psychologists, educational specialists, psychiatrists, or other physicians, for exam-
ple—and what training they should have to designate individuals as needing particular education-
al or psychological services or to deliver those services goes back centuries (see Kauffman, 1976;
Kauffman & Landrum, 2006; Kazdin, 1978; Reisman, 1976; Rie, 1971). Ray (1852) commented
in the mid-nineteenth century on the difficulty of finding good attendants for institutions serv-
ing persons we would now say have mental illness. A century later, Stullken (1950) and Hobbs
(1966) described the difficulty of finding and training good special educators for emotionally dis-
turbed youngsters. In fact, just about everyone who has written about special education has com-
mented on the difficulty of finding and training good personnel and on the controversies about
what constitutes appropriate training and demonstrated competence in identifying and serving
students with particular characteristics (e.g., Brownell, Rosenberg, Sindelar, & Smith, 2004).
Grouping students for instruction is a contentious contemporary issue, but the homogeneous
versus heterogeneous question has been in dispute since schooling began. In the late twentieth
century, Oaks (1992) argued that homogeneous grouping (or tracking, as she referred to it) is dis-
criminatory. Others (e.g., Engelmann, 1997; Grossen, 1993) contended that homogeneous group-
ing is necessary for effective instruction and that heterogeneous grouping is a form of educational
 17. EFFECTIVE SERVICE DELIVERY MODELS 361

malpractice. Of course, the placement of students with disabilities in general education classes
increases the heterogeneity of the groups with which teachers must contend.
Place has always occupied a central position in discussions of special education, but it be-
came a matter of particularly hot debate in the 1980s (Crockett & Kauffman, 1999). Concern
for the issue known since the 1990s as inclusion was obvious at least as early as the 1930s.
However, proposals for a merger or integration of general and special education were popular-
ized in the 1980s and 1990s (e.g., Goodlad & Lovitt, 1993). The more extreme advocates of full
inclusion proposed abandoning pull-out models of service (i.e., removing the student from his
or her regular classroom) of all types, calling programs involving any separation of students for
instruction “segregated” (e.g., Stainback & Stainback, 1991). What was known first as the Regu-
lar Education Initiative (REI; see Lloyd, Repp, & Singh, 1991) in later years was called the full
inclusion movement (FIM; see Fuchs & Fuchs, 1994). The probable effects of the REI and the
FIM on teachers and students with and without disabilities became matters of great controversy.
Many special educators expressed considerable skepticism about the feasibility of the REI and
the FIM (Braaten, Kauffman, Braaten, Polsgrove, & Nelson, 1988; Fuchs & Fuchs, 1994, 1995;
Kauffman, 1989, 1991, 1995, 1999; Kauffman, Gerber, & Semmel, 1988; Kauffman & Hallahan,
1993, 2005a, 2005b; Kauffman, Lloyd, Baker, & Riedel, 1995; Mock & Kauffman, 2005; Walker
& Bullis, 1991; Warnock, 2005).
Given the concern in the late twentieth and early twenty-first centuries for inclusion, some
may be surprised to find that these concerns have long historical roots. All of the basic issues of
segregation versus integration and the relationship between general and special education were
raised many decades ago (e.g., Baker, 1934; Berry, 1936; Postel, 1937; Rautman, 1944; Tenny,
1944; Stullken, 1950). Horn’s (1924) observation that variability in the student population is
the most basic problem of special education and that special education is designed to reduce the
variability with which a teacher must contend has been echoed by Singer (1988) and Kauffman
and Hallahan (2005a). Furthermore, as Zigmond (2003) noted, where students should be taught
is, perhaps, the wrong question to ask (the better or more important question being how should
they be taught).
Advocates for students and teachers who face special challenges have thought long and hard
about all aspects of service delivery for many decades. We shall marshal what evidence we can
and use our best logical analyses to make our case on four perpetual issues in service delivery,
realizing that the case we make will not resolve these issues for all readers.

LANGUAGE

Language reveals much about how we think about things, and our thinking is reflected in our
language. The reciprocal influence of language and thinking on each other was described by
George Orwell, who wrote:

But an effect can become a cause, reinforcing the original cause and producing the same effect in
an intensified form, and so on indefinitely. A man may take a drink because he feels himself to be
a failure, and then fail all the more completely because he drinks. It is rather the same thing that
is happening to the English language. It becomes ugly and inaccurate because our thoughts are
foolish, but the slovenliness of our language makes it easier for us to have foolish thoughts. The
point is that the process is reversible. (1954, p. 163)

The idea that language and thought can be analyzed as behavioral chains and that what is
antecedent and what is consequence depends on how the chain is analyzed seems to anticipate
362 KAUFFMAN, MOCK, TANKERSLEY, AND LANDRUM

Skinner’s (1957) behavioral analysis of verbal behavior. The last sentence in our quotation of
Orwell above provides hope that a fine-grained analysis of language and thought can make both
what we say and what we think about learning and behavior better—certainly more accurate,
perhaps less ugly as well.
Orwell (1954) described how language is used for political purposes and wrote, “if thought
corrupts language, language can also corrupt thought” (p. 174). Euphemisms not only become
jokes (Carlin, 2004) but are regularly used to mislead people, to distort their thinking about many
things, including special education (Kauffman, 2003; Lakoff, 2004; Orwell, 1954). Euphemisms
and dense, confusing language are used not only to confuse voters in elections to government of-
fice but as well to fool stockholders in business reports when companies are doing poorly (Tong,
2006).
The legitimate uses of language to influence thinking and the abuse of language are difficult
to specify. However, we believe that when language is impenetrable, unnecessarily confusing,
relies on pointless words and phrases strung together in meaningless ways, or is misleading
about the true nature of an intention, event, or condition, it is abusive. Writing that cannot be de-
ciphered logically or that is not simple and straightforward is not helpful, in our opinion. Writers
and speakers who cannot be easily understood probably have either nothing worthwhile to say or
something to hide. We need clearer, less confusing, simpler, more interpretable language describ-
ing the students about whom we are concerned and about how we teach them.
Euphemism, abstraction, and generalization are among the political strategies of language
identified by Orwell (1954), but they have been used with devastating effect in education. In spe-
cial education and related professions, euphemism, abstraction, and generalization are frequently
used to hide unpleasant realities (Kauffman, 2002, 2003). The terminology some have used to
describe special education is nothing short of scathing (see paragraph two of Cook & Schirmer,
2006b, for examples). Moreover, radical reform, restructuring, transformation, and similar terms
referring to revolutionary change are often proposed without defining these terms or specify-
ing how we would know they have been achieved. Thus, someone can call for an integration of
special and general education without stating the criteria for judging whether they have been in-
tegrated. We might ask how we would know when special education and general education have
been integrated. Would integration mean that no one could identify teachers as general educators
or special educators? Would special education and general education be indistinguishable in an
integrated system? Would budgets for general and special education be seen as beside the point
if integration became a reality? Will students with disabilities be indistinguishable from those
without disabilities when integration is a reality? To us, these seem reasonable questions to ask
of the person who proposes an integration of special and general education.
Even some of those who apparently see the risks associated with integration of various en-
tities or enterprises have supported integration of general and special education. For example,
Goodlad (1990) suggested that teacher education becomes derelict when it loses its boundaries,
budget, and other indications of separateness as an enterprise. It simply cannot be fully or com-
pletely integrated into the general mission of a university without becoming lost. What, then,
we might ask, do we expect to happen to special education if it is integrated into the mission of
general education (Kauffman & Hallahan, 1993)? The answer, we feel, is obvious—it will be
derelict, lost as an enterprise. But abstraction, generalization, and euphemism are perceived as
admirable by those who are willing to sacrifice principle or reality to politically or professionally
advantageous language. His knowledge of what happens to teacher education when it is inte-
grated into the more general mission of higher education did not prevent Goodlad from proposing
that special education be integrated with general education (Goodlad & Lovitt, 1993).
The sharpest issue of language in service delivery involves labels for disabilities. We have
 17. EFFECTIVE SERVICE DELIVERY MODELS 363

frequently heard colleagues suggest that services should be provided without labels for students,
and some have written about avoiding labels in schooling (Biklen, 1992). However, we are un-
able to figure out how avoiding labels would actually be feasible. The suggestion that services
can be provided without labels seems to us an evasion of reality (Kauffman, 2002; Kauffman &
Konold, 2007).
The labels may not be those in current use for specific disabilities, but a label is necessary
to designate the matter of concern. In our view of language, avoidance of labels merely makes
the matter of concern unmentionable—or, ironically, all the more visible. Some have attempted
to avoid labels by suggesting, for example, that “We do not believe a person has an intellectual
disability; rather, the person is defined by others as having the condition” (Kliewer, Biklen, &
Kasa-Hendrickson, 2006, p. 188). This puts the onus of naming the problem on others. In our
view, such language reflects the pretense that definitions of disabilities and the words used to
describe disabilities are inappropriate constructions of realities.
Another gambit for avoiding labels for students is to suggest labeling only the special service
that they receive (e.g., positive behavioral intervention and support). However, a label for a ser-
vice necessarily attaches to those who receive it (Kauffman & Konold, 2007). Still another tactic
in attempts to avoid labels for disabilities or make them less unpleasant is using general, less
specific language. Thus, the more general term developmental disability, which lumps disabili-
ties of all kinds together, is perceived by some as more appropriate. Nevertheless, insistence on
general language seems to be antithetical to scientific advancement. As a field of study matures,
its language gets more specific, not less. Less specific language or more general terms without an
increase in more specific subterms is a reliable indication of regression, not advances, in any field
of work. Ultimately, if a term can hide the difference of an individual from the general population
altogether while still acknowledging intraindividual differences—a term such as individual with
differing abilities, which actually applies to everyone—it may be seen as achieving the goal of a
label carrying no stigma. It is, nonetheless, useless in describing disabilities. Clarity, specificity,
and efficiency in communication, not to mention appropriate responses, are sacrificed by more
general terms. Supposing that a mechanic were allowed only to request a tool or were precluded
from asking for anything more specific than a wrench, or that a farmer were not to label anything
more specifically than animal (or cow), one can see the point about the need for more specific
labels.
Organizations and individuals have struggled to overcome stigma by changing labels, as-
suming that the stigma of disability lies in a word or phrase commonly used to signify a particular
problem. Thus, the American Association on Mental Deficiency became the American Associa-
tion on Mental Retardation and, more recently, the American Association on Intellectual and De-
velopmental Disabilities. Others have pointed out that stigma has been more effectively reduced
through public education of the meaning of the words used to label conditions than in changing
words (e.g., Kauffman, 2002, 2003).
We certainly understand the concept of the epithet, and we do not defend the use of words
intended only to hurt the self-image or social status of others. However, we do think that language
should reflect our willingness to face realities, even unpleasant ones, and that euphemisms, cir-
cumlocutions, and other contrivances of language are not helpful in the long run. In fact, chang-
ing terminology makes people stop and think about the referent, and once they understand what
is being referred to they are even more likely to see the referent as an object of jest. Just where
realism turns to brutality or kindness turns to euphemism is a difficult matter of judgment. In our
view, the labels commonly used today by professionals are not brutalities, and the terms that are
the most straightforward and understandable by the general public are most appropriate. Being
identified as needing special education or as having a behavioral disorder or a learning disability
364 KAUFFMAN, MOCK, TANKERSLEY, AND LANDRUM

is shameful only to those who make it so by their derogation of these terms or their referents
(Kauffman & Hallahan, 2005a). Certainly, few people would choose to be called retarded (see
Kliewer & Biklen, 1996), but we could say the same of any social designation carrying negative
connotations (e.g., obese, frail, antisocial, or incompetent).
Changing the word we use to designate a reality does not change the reality. We do not agree
with the assertion that “Philosophers have shown that words and sentences do not represent ideas
or objects” (Smith, 1999, p. 131; see Blackburn, 2005 for refutation of Smith’s view). If we are
interested in changing the social perception of a reality, the best way to do so is to teach people
more about that reality, including the meaning of the words we use to describe it. Changing a
word alone is unlikely to have a good long-term effect, although changing a word may in fact
fool people at least temporarily into believing that the reality is something it is not, and a change
in wording may thus “frame” an issue for political advantage. If it is advisable to change words
for political advantage, such that a different “frame” is provided, then our recommendation is that
such “reframing” be described as such without the pretense that the underlying reality has some-
how been changed and with the understanding that any change in perception of the reality will be
temporary. Finally, as Dawkins (2006) notes regarding the use of language associated with femi-
nism, the use of particular words may, indeed, raise consciousness in a very good way about an
important issue. Nevertheless, he also suggests that silly changes in language are hardly justified
because they do not really change the matter about which consciousness has been raised.

AUTHORITY

We recognize that the authority to designate a student as needing special education is controver-
sial. Controversy is sparked not only about the individuals who should be involved in identifica-
tion (i.e., who should be the decision makers) but the criteria these individuals should apply in
making their decisions (e.g., discrepancy between expected and actual achievement, response to
intervention). However, in our view the most important question regarding authority is the train-
ing and qualifications of the individuals who teach students after they have been identified as hav-
ing unusual learning or behavioral difficulties. Thus, we focus our attention here on the training
of special education teachers to obtain authority for instructing students with special needs.
The Individuals with Disabilities Education Act (IDEA; 2004) mandates that students with
disabilities receive free and appropriate public educations. Local education agencies are charged
by this law with providing educational services more specialized than those offered by general
educators. Thus, the authority of special education is derived in part from law.
Nevertheless, the specialness of special education has repeatedly come under fire. Some
writers have expressed the opinion that special education is nothing more than good teaching,
that it is not truly special or even that it is counterproductive, making things worse rather than bet-
ter for students (Cook & Schirmer, 2006b). Good teaching is good teaching, regardless where or
by whom—presumably as if good teaching is all that is required to accommodate all learners, re-
gardless of any variation among students—is a mantra of which reformers are fond (see Audette
& Algozzine, 1997; Samuels, 2006). Others have noted that although special education does,
indeed, need improvement, it also is teaching that is specialized along multiple dimensions (e.g.,
Cook & Schirmer, 2006a; Heward, 2003; Kauffman & Hallahan, 2005a; Kauffman & Landrum,
2007; Zigmond, 1997). Furthermore, many of the recommendations of would-be reformers (e.g.,
Audette & Algozzine, 1997) do not actually address the problems of labels, categories, and the
unavoidably arbitrary designation of individuals as needing special education (see Kauffman &
Konold, 2007).
 17. EFFECTIVE SERVICE DELIVERY MODELS 365

The idea is sometimes advanced that “a completely new conception of teacher education is
needed… a conception that is anchored in completely new ways of preparing teachers” (Pugach,
1992, p. 266). Precisely what the completely new conception of teacher education is or what the
completely new ways of preparing teachers are and how these are different from what is now
offered have not, to our knowledge, been explained. Moreover, the argument is sometimes made
that general teacher training should be enhanced so that all teachers are trained in special educa-
tion. This is the suggestion that for most students, if not for all, collaboration and consultation of
their general and special education teachers should be sufficient (Zigmond, 2007). Special educa-
tion teachers should be given training that general educators do not have, but their services should
be delivered through collaboration and consultation with general educators, so some argue.
Sapona, Etienne, Bauer, Fordon, Johnson, Hendricks-Lee, and Vincent (2006) described
merging their university’s special and general education teacher training. They noted that this
required not only structural but philosophical changes—specifically, adoption of the notion that
“individuals with disabilities should be viewed as learners who demonstrate variations in devel-
opment” (p. 5). In explaining the rationale for this change, Sapona et al. (2006) wrote:

A major challenge for the special education faculty was how to prepare teachers and other educa-
tional personnel to meet the needs of all children in the next millennium. Our practice had been
successful with children in self-contained, isolated settings but would not meet diverse children’s
needs in settings such as general education classrooms. The faculty was charged to identify a vi-
sion within and across special education certification areas, and for services to children across the
developmental contexts. (p. 2)

The needs of all children are assumed to be addressed by this preparation, which does not ex-
plicitly target a special population. However, effective service delivery for children with unusual
learning and behavioral difficulties rests on the authority of special educators. Those who argue
for unifying the training of special and general educators (e.g., Pugach, 1996; Sapona et al., 2006;
Schrag, 1993) seem to suggest that educators can be both effective specialists and generalists.
Teachers cannot be at once special educators and general educators, for reasons that we explain
further (see also Zigmond, 2007).
The 2001 reauthorization of the federal Elementary and Secondary Education Act—also
known as No Child Left Behind (NCLB)—required that by 2006 all teachers be highly-qualified.
To be highly qualified under the law, teachers need to: (a) hold at least a bachelor’s degree, (b)
have full state certification or licensure, and (c) demonstrate that they know each subject they
teach. In short, to be in compliance with NCLB, school districts must eliminate teacher shortages
while increasing teacher standards. Although special education has faced persistent teacher short-
ages since 1975, NCLB requires the same highly qualified status for all special educators. Many
school districts cannot comply with the law for purely pragmatic reasons.
Beyond the pragmatic issues are echoes of the logic that equates the generalist with the
specialist. At first blush, highly qualified seems to distinguish the generalist from the specialist.
However, NCLB also includes provisions for entering teaching via an alternative to traditional
teacher training. NCLB allows individuals with no training in pedagogy to receive highly quali-
fied status. That is, knowledge of content, not pedagogy, can result in a teacher’s being considered
highly qualified. Thus, a highly qualified teacher by NCLB standards may actually possess no
training in instruction, merely training in the subject matter to be taught.
Data do not support the idea that someone can be highly qualified as a teacher without
training in instruction. Growing evidence indicates that teaching authority is developed via spe-
cific training (e.g., Berliner, 2000, 2004; Berliner & Laczko-Kerr, 2002; Darling-Hammond,
Holtzman, Gatlin, & Heilig, 2005; Gage, 1984; Laczko-Kerr & Berliner, 2003; Sanders, 1998;
366 KAUFFMAN, MOCK, TANKERSLEY, AND LANDRUM

Tuerk, 2005). The notion that teachers can be highly qualified without any training in peda-
gogy has stimulated considerable research regarding the factors that account for teacher efficacy
and consequent authority. Data show a positive correlation between teacher training and student
achievement. Teachers who have received specific training in both pedagogy and content effect
higher student achievement than do teachers without such training. This holds true across sub-
ject-matter domains (Laczko-Kerr & Berliner, 2002), years of service (Darling-Hammond et al.,
2005), and geographic location (Tuerk, 2005).
Darling-Hammond and colleagues (2005) used regression analyses to investigate the rela-
tionship between student achievement and teacher training (i.e., certification) over a six-year pe-
riod. They found that certified teachers consistently produced stronger student achievement gains
than uncertified teachers. Darling-Hammond et al. (2005) then controlled for teacher experience,
educational degrees, and student characteristics. They concluded that teacher effectiveness ap-
pears strongly related to teacher training.
Laczko-Kerr and Berliner (2002) conducted a similar study comparing the achievement of
students instructed by certified and uncertified primary school teachers. They found that the stu-
dents of certified teachers out-performed students of uncertified teachers across all three subtests
of the Stanford Achievement Test (SAT9). The same researchers went on to conduct another
study in which they calculated that the advantage provided to students by having a certified
teacher versus an uncertified teacher was worth about two months progress on a grade-equiva-
lent scale (Laczko-Kerr & Berliner, 2003). Thus, students taught by uncertified teachers paid a
penalty in academic growth for their teacher’s lack of training. In this study, Laczko-Kerr and
Berliner (2003) concluded that teachers without specific training in pedagogy actually “do harm”
(p. 35).
Empirical studies have suggested that teacher effects on student achievement seem to be as
strong as the effects of student characteristics such as socio-economic status (Wenglinsky, 2002).
The implication from this finding is that teaching skill can offset the potentially negative effects
of home and community environments. The flip side of this coin is that although teacher effects
appear to be cumulative, effective teachers in later grades are unlikely to undo the effects of less
skilled teachers in earlier grades (Sanders & Horn, 1998). The results of all of these studies con-
sistently document an important correlation between teacher training and student achievement.
Thus, if teaching authority is measured via student achievement, we can conclude that teaching
authority seems to be a function of teacher training. In other words, teacher training seems to
produce differences in teaching skill.
Additional studies have investigated the relationship between teacher training and teacher
attrition. Beginning teachers are at high risk for attrition (Miller, Brownell, & Smith, 1999; Na-
tional Commission on Teaching and America’s Future, 2003). Because of attrition, the teaching
force is becoming increasingly bimodal in years of service (Darling-Hammond, 2006). Henke,
Chen, Geis, and Knepper (2000) found that teachers who entered the classroom without specific
training and supervision in pedagogy left the profession at nearly twice the rate of those who had
completed such training. This relationship suggests that teacher training also plays a role in the
goodness of fit between teacher and profession. Teacher training not only affects student achieve-
ment, but seems to increase the likelihood that teachers will remain in their jobs long enough to
become something more than novices.
If teaching authority is conceptualized as the power to make and implement instructionally
effective decisions specific to students and content areas, then the data suggest that teaching au-
thority is derived from the type of training offered in teacher education. Indeed, the data suggest
that if one is to be considered a highly qualified teacher—that is, a teacher who improves student
achievement—then one must work to possess many of the qualifications provided through teacher
 17. EFFECTIVE SERVICE DELIVERY MODELS 367

training. Qualifications beget qualified status, and training begets differences in teaching author-
ity. Effective service delivery rests upon the qualifications of the teacher delivering services.
For reasons detailed by Zigmond (2003, 2007), a teacher cannot offer both special and gen-
eral education at the same time. The sine qua non of special education is “individually planned,
specialized, intensive, and goal-directed instruction” (Heward, 2003, p. 38). Without this fo-
cus, special education ceases to be special, and students with disabilities are thereby denied the
free and appropriate education guaranteed to them under IDEA (Kauffman & Hallahan, 2005a;
Kauffman & Landrum, 2007). In order to prepare teachers to deliver this type of specialized
instruction, special educators regularly proceed through university teacher education programs.
There, they gain proficiency in the core areas that constitute most teacher training programs: (a)
Knowledge of learners; (b) Understanding of curriculum content and goals; and (c) Understand-
ing of and skills for teaching (National Academy of Education Committee on Teacher Education,
2005). What makes special education training different from elementary education training or
science education training is the focus provided in each of the three core areas. The special edu-
cator will learn much about the characteristics of students who have at least one, if not more, of
the thirteen disabilities defined in IDEA.
The special educator will also learn of specialized curricula designed to raise the achieve-
ment of students with disabilities. Such curricula may include but would not be limited to func-
tional assessment (Horner & Carr, 1997), First Step to Success (Golly, Stiller, & Walker, 1998),
Peer Assisted Learning Strategies (Fuchs & Fuchs, 2005), Positive Behavior Supports (Horner,
Sugai, Todd, & Lewis-Palmer, 1999–2000), and mnemonic instruction (Scruggs & Mastropieri,
2000). It could encompass instructional issues such as the most effective class size for remedial
instruction (Vaughn, Gersten, & Chard, 2000) as well as the limited usefulness of cooperative
learning among students with disabilities (McMaster & Fuchs, 2002). It might also give specific
focus to teaching various academic content areas, as well as basic skill development, most no-
tably in reading, mathematics, and written language. Finally, special educators would learn to
develop and apply teaching skills in contexts that include: self-contained classrooms, resource
rooms, inclusive classrooms, residential schools, separate schools, and homebound instruction.
In each of these contexts, they would develop proficiency in direct teaching, paperwork, collabo-
ration, and consultation.
Berliner (2004) has argued that teaching expertise is specific to context and is developed
“over hundreds and thousands of hours” (p. 201). The training offered in teacher education pro-
grams accounts for approximately 1,000 hours of supervised experience as a student teacher or
classroom aide (Berliner, 2000). For those who would become what Berliner would call expert
special educators, Berliner estimated that such individuals have spent a minimum of 7,000 hours
in classrooms as a teacher.
Individuals such as Sapona et al. (2006) have suggested that in order to meet the needs
of students in schools, special educators need to be integrated with general educators in both
training and delivery of services. The authors reasoned that the blending of the two professions
would result in an overall increase in teacher effectiveness that would benefit all students. We are
skeptical.
In his eloquent treatise evaluating the feasibility of identifying disabilities via student re-
sponse to teacher instruction, Gerber (2005) examined teaching and learning using an economic
model. He posited that classroom instruction is an interaction in which students bring compet-
ing demands for teacher effort (i.e., supply). In this environment, similar teaching effort results
in different student outcomes according to student ability. Because teacher effort is a limited
resource, student outcomes are necessarily limited. Moreover, because students are competing
for teacher effort, there exists “a line of maximum efficiency where increasing the achievement
368 KAUFFMAN, MOCK, TANKERSLEY, AND LANDRUM

of one student results in the decreasing of achievement for another “(Gerber, 2005, p. 518). The
more varied the students’ responses to instruction, the larger the trade-off in teacher effort and
student achievement.
If Gerber is correct, and we believe that he is, then the laws of supply and demand place up-
per limits on what any teacher can hope to accomplish in any classroom. Even if the teacher were
an experienced, well-trained specialist, he or she would be unable to offer optimum intensive,
specialized instruction in a general classroom. The competing demands for teacher effort would
dramatically limit the possible range of student achievement. “Knowing what is needed to help
students is not the same thing as being able to provide it” (Kauffman et al., 1995, p. 544), and
teachers in general education classrooms may be unable to provide what they know students
need. Teacher effort is a limited resource. When it is shared by an increased number of students,
everyone receives less. Thus, as Kauffman and Hallahan (2005a) suggest, education offered in a
general education setting can at best be sort of special, but not the highly specialized, intensive
education envisioned by Heward (2003), Heward and Silvestri (2005), Kauffman and Landrum
(2007), Zigmond (1997, 2007), and others.
Teachers can work in contexts in which demands nullify the advantages of their training.
Furthermore, teachers, like students, vary in their skills. Just as students vary in reading levels,
teachers vary in instructional finesse. If all teachers are to demonstrate the same level of profi-
ciency, that level of proficiency must become the lowest common denominator. As Gerber (2005)
has cautioned, “Teachers can not be made identical unless professional standards are pegged
low” (p. 520).
In short, if special education involves nothing special—no specialized training, merely good
teacher education—then there is no need for IDEA. But special education is more than good
general education. Special educators derive their authority from training that is specific to learn-
ers, content, and context. Such teachers are qualified because they have sought out and acquired
the qualifications that make them so. To suggest that there is no important difference between an
individual who is a qualified special educator and one who is not is to discount the considerable
data demonstrating the correlation between teacher training and student achievement.
General educators should, indeed, be taught that students demonstrate variations in devel-
opment. However, pretending that general educators can accommodate all variations in devel-
opment is tantamount to suggesting that one variation is no more significant than another and
requires no more expertise than another. We do not tolerate such nonsense about variations in
gardening, law, mechanics, medicine, music, or any other line of work in which specialization
is necessary. Effective delivery of special education services rests on the specialized training of
teachers as well as the contexts that permit specialized instruction. Special education, including
the preparation of teachers to be special educators, is different from general education and should
become even more so with evidence-based practices (see Cook & Schirmer, 2006a).

GROUPING

The move toward more inclusive placements for students with disabilities in recent years has
resulted in even greater academic and social diversity in classrooms, giving decisions about in-
structional grouping greater import. Grouping students refers to decisions teachers must make
about how teaching and learning can occur most efficiently and effectively. On the surface, it is
easy to conclude that whole class or large group instruction offers the greatest efficiency. Teacher
time is saved, and evidence suggests that teachers spend more time actually teaching—dem-
onstrating, modeling, explaining, and providing corrective feedback—when they instruct large
 17. EFFECTIVE SERVICE DELIVERY MODELS 369

groups (Ellis & Worthington, 1994). But questions remain about the extent to which struggling
learners benefit from large-group or whole-class instruction.
Ample research supports the conclusion that individual instruction can be a highly effective
means of teaching struggling learners (e.g., Elbaum, Vaughn, Hughes, & Moody, 2000; Wasik
& Slavin, 1993). Moreover, individual instruction, at least for brief periods during the school
day, is a defining characteristic of special education (e.g., Lerner, 2003; Zigmond, 1997, 2007).
Indeed the concept of individualized instruction—specially designed instruction matched to an
individual child’s learning and behavioral characteristics—can be traced to special education’s
roots at least as far back as the early nineteenth century (Hallahan & Kauffman, 2006; Kauffman
& Landrum, 2006).
Note that we make a distinction between individualized instruction and individual instruc-
tion. Individualized instruction refers to the extent to which instruction (materials, assignments,
sequencing of skills to be taught, nature and level of support, etc.) is matched specifically to a
child’s identified strengths and needs. In contrast, individual instruction refers simply to one-on-
one teaching. Special education needs to be individualized, something that can be accomplished
in a variety of instructional grouping arrangements but may be substantially more feasible in
smaller than in larger groups.
The question that must be answered in the initial decision about grouping for effective ser-
vice delivery of special education is simple: Can students be taught individually, or must they be
grouped in some way to receive instruction? The finite number of teachers in a school building
and hours in a school day mean that individual instruction is simply not possible on any significant
scale for the majority of students. Zigmond (2003) contends that general educators rarely plan or
deliver individual instruction, and for good reason: It is not feasible when a teacher has responsi-
bility for twenty-five or more students. But even smaller groups and limited time for instruction
seem to preclude individualization. Vaughn, Moody, and Schumm (1998) examined the nature
of instructional grouping in resource rooms, theoretically designed to provide greater opportuni-
ties for more focused instruction with individuals or small groups. They found that one-on-one
instruction was implemented infrequently with students with learning disabilities (arguably those
who need it most), and even when implemented lasted only a few minutes. From their observa-
tional study of fourteen special education teachers across thirteen schools, Vaughn et al. (1998)
concluded that teachers in resource rooms “are struggling to provide individualized instruction to
students when they are responsible for teaching 8 or more students at a time” (p. 222).
The larger question is how instructional groups are best formed, and the key dimension to
consider in such decisions is heterogeneity versus homogeneity. It is surprising to us that instruc-
tional grouping remains the subject of controversy and disagreement. At a fundamental level,
few educators would argue against the notion that good instruction meets students where they
are—that is, few would argue that teachers need not find out through careful observation and
assessment what children know and what they need to learn next. Tailoring instruction to specifi-
cally identified needs produces obvious benefits to students, just as instruction poorly matched
to students’ ability levels offers little promise of instructional benefit. Further, a poor match is
likely to be detrimental to future success when students are bored because the task is too easy
or are frustrated because it is too difficult. As Kauffman, Landrum, Mock, Sayeski, and Sayeski
(2005) suggested, “If instruction is to be effective, good teaching requires congregating students
of comparable performance for instruction in particular skills. This is something we have known
for decades, not a new insight or finding” (p. 3).
Several alternative instructional grouping arrangements are possible (see Vaughn, Bos,
& Schumm, 2007). These include whole-class or whole-group instruction, which necessarily
means teaching a heterogeneous group (and the larger the group, the more heterogeneous it will
370 KAUFFMAN, MOCK, TANKERSLEY, AND LANDRUM

be); small group instruction, which can be same- or mixed-ability grouping (and the smaller
the group, the more homogeneous it can be); learning pairs or partners; and individual or one-
on-one instruction. Undoubtedly, each instructional arrangement provides some benefit to some
students, but even with limited research to guide teachers in grouping decisions, two elements
seem critical regardless of which arrangement is chosen: instructional match and flexibility in
grouping. Both elements of effective teaching demand that teachers attend carefully to assess-
ment data. Ensuring a proper instructional match demands that teachers preassess skill areas
before instruction so that proper materials can be chosen and the nature, structure, and pacing of
lessons can be preplanned. Frequent ongoing assessment of some type is also necessary so that
teachers can document the effects of instruction and modify methods or materials as needed.
Ongoing assessment highlights the need for grouping. When particular students are observed to
move through material more rapidly than expected, or to struggle to master concepts, the effec-
tive teacher naturally modifies his or her instruction to meet these needs. Flexible instructional
groups provide the means to do this; students are grouped according to specific skills they need to
learn, but are expected to flow into and out of different instructional groups as they master mate-
rial at different rates. It is perhaps the historic concept of rigid, inflexible instructional groups, in
which students were essentially tracked for entire school years (e.g., redbird or bluebird reading
groups, likely formed on the basis of a single, beginning-of-year assessment, and unlikely to
change throughout a school year) that has generated a negative connotation of the very concept
of same-ability grouping. Nonetheless, fluid, flexible, instructional groups are consistent with
good practice in special education and with existing research on effective teaching (e.g., Vaughn,
Hughes, Moody, & Elbaum, 2001).

PLACE

Unfortunately where students are taught tends to take priority over questions of how they are
taught, by whom, and for what purposes. Indeed, place may have been given unwarranted space
in discussions of service delivery (see Crockett & Kauffman, 1999; Zigmond, 2003; Warnock,
2005). Educational placements for students with learning and behavioral problems have histori-
cally been provided under the assumption that a variety of options are necessary to meet the stu-
dents’ diverse needs. The continuum of alternative placements (CAP) required by IDEA reflects
this array of placement options that vary in degree of restrictiveness.
One of the basic tenets of IDEA is that service delivery occurs in the least restrictive en-
vironment (LRE) possible for a particular student’s needs. As Crockett and Kauffman (2001)
argue, restrictiveness is often erroneously judged by location alone, with placement in general
education classrooms considered always the LRE. However, analysis of restrictiveness requires
consideration of students’ learning and behavioral characteristics (i.e., establishing how they
might be taught most effectively), and their curricular needs (i.e., establishing what they need to
be taught).
Too often, placement questions are answered first—or not even considered when thinking
about services. Indeed, for many students with learning and behavioral disabilities the only place-
ment option is the general education classroom. In a recent focus group interview, special educa-
tion teachers reported that their students had no alternatives—the general education classroom
was the only placement available (Tankersley, Niesz, Cook, & Woods, in press). What these
teachers saw lacking were the hallmarks of special education—specific, intense, explicit instruc-
tion that is supportive, individualized, and carefully monitored but extremely unlikely or impos-
sible in a general education classroom (Heward, 2003; Heward & Silvestri, 2005; Kauffman,
 17. EFFECTIVE SERVICE DELIVERY MODELS 371

Bantz, & McCullough, 2002; McCray, Vaughn, & Neal, 2001; Zigmond, 2003). Moreover, what
Tankersley et al. found is simply the reverse of the days in which the special self-contained class
was all that was offered—a situation antithetical to the CAP now required by IDEA.
The extent to which different placement options can provide the kind of individualized in-
struction and support that students with learning and behavior difficulties need has not been
determined. Few rigorous studies have been done to date, although researchers have been trying
to investigate the effectiveness of one type of placement over another for more than thirty years.
The cumulative results support no simple or unequivocal answers. In a review of studies assess-
ing the efficacy of placements, Zigmond (2003) reached the conclusion that investigations to date
provide “no compelling research evidence that place is the critical factor in the academic or social
progress of students with mild/moderate disabilities” (p. 195).
The majority of early studies showed that students who received instruction in the general
education classroom tended to be lower in academic achievement than those who received spe-
cial education services in resource or self-contained classrooms (e.g., Carlberg & Kavale, 1980;
Leinhardt & Pallay, 1982; Madden & Slavin, 1983; Sindelar & Deno, 1978). However, these early
studies typically compared general education placements in which no individualized approaches
or supports were provided to the students with disabilities to resource or self-contained classrooms
in which specialized services were provided by trained special educators (Zigmond, 2003). More
recently, research has compared student outcomes in general education that incorporated supports
for students with disabilities to other placement options. Still, the results are equivocal. For some
students with mild disabilities, full-time placement in general education inclusive classrooms has
resulted in some academic gains comparable to those made by their peers without disabilities
(e.g., Banerji & Dailey, 1995) or better than their peers with learning or behavioral problems in
placements outside the general education classroom (e.g., Baer & Proctor, 1990). Nevertheless,
other studies showed that many students with mild disabilities in inclusion classrooms (a) failed
to achieve at a level commensurate with that of typically developing peers (e.g., Baer & Proctor,
1990); (b) experienced social difficulties (e.g., Vaughn, Elbaum, & Boardman, 2001); and (c) did
not receive specialized instruction (e.g., Fox & Ysseldyke, 1997). In fact, Zigmond et al. (1995)
reported the combined results of longitudinal studies that supported three full inclusion programs
with tremendous amounts of financial and professional resources, showing that in relation to aca-
demic achievement, 40 percent of the students with learning disabilities in those placements “were
slipping behind at what many would consider a disturbing rate” (p. 539).
The lack of clear, positive outcomes for students with learning and behavioral difficulties in
particular placements has led researchers to conclude that no one place can fit the needs of all stu-
dents. Indeed, after reviewing the outcomes of research on inclusionary practices, Hocutt (1996),
Manset and Semmel (1997), Waldron and McLeskey (1998), Murawski and Swanson (2001),
and Zigmond and Magiera (2002) all concluded that not all students with learning or behavioral
difficulties can benefit from receiving educational services in one type of placement. Instead, as
Zigmond (2003) noted in her summary of three decades of research investigating the efficacy of
the various educational placements in which students with disabilities received their special ser-
vices, “what goes on in a place, not the location itself, is what makes a difference” (p. 198).

CONCLUSIONS

We recommend using the clearest and most efficient language possible in describing learning and
behavioral difficulties and the special services needed to address them. Neither individuals with
disabilities nor their teachers will be well served by assuming that people with disabilities are
372 KAUFFMAN, MOCK, TANKERSLEY, AND LANDRUM

indistinguishable from the general population or that their education is like that designed for the
majority of students. Kauffman and Hallahan (2005a) and Kauffman and Landrum (2007) have
noted how special education differs along several dimensions from general education: pacing or
rate, intensity, relentlessness, structure, reinforcement, pupil-teacher ratio, curriculum, and moni-
toring or assessment. These are matters of degree, not essentially different dimensions of teach-
ing, but the degree of difference is extremely important. Other chapters in this book give more
specifics about how education must be different from the typical to meet the needs of students
who experience difficulties in learning.
The authority that we ascribe to special educators is rooted in research documenting the
relationship between teacher training and student achievement. It is also based on the logical
consideration of the limited teaching resources and the demands of instructional contexts. If such
evidence and logic are not sufficient to document the necessity for specialized teacher training,
then we urge the reader to consider special education law. For over thirty-five years, the federal
government has required that schools provide specialized instruction to students with disabilities.
Of course, we could return to the era in which whatever is provided in general education by a
general education teacher (who has been taught that there are variations in human development
but has not been fully trained as a special educator) is judged sufficient and appropriate. We do
not recommend that return.
Although certainly more research is required on the effects of grouping for instruction on
student achievement, the available research suggests that, short of individual instruction, flexible
homogeneous instructional groups formed on the basis of specifically identified instructional
needs seem best suited to promoting student success. Whether the needed instruction can be pro-
vided consistently in general education classrooms for students with disabilities remains doubtful
(Zigmond, 2003).
We cannot say that one type of placement will lead to improved outcomes for students with
learning and behavioral difficulties, but we can definitely identify practices that are effective for
addressing these students’ needs. There is no doubt that the field of special education has estab-
lished educational practices and interventions that have been shown to be effective for address-
ing many of the learning and social needs of students who experience extraordinary difficulty in
school. However, not all educational placements are conducive to incorporating these approaches
into teaching and learning. Zigmond (1996), for example, found that general education environ-
ments are not supportive places in which to implement many effective teaching practices for
students who have extraordinary difficulty. The structure, intensity, precision, and relentlessness
with which teachers must deliver, monitor, and adapt instruction for many students with disabili-
ties is surely beyond that which is possible in a general education classroom (Kauffman et al.,
2002; Kauffman & Hallahan, 2005a; Zigmond, 2003).
The most effective service delivery system probably cannot be defined totally in the abstract,
for it likely depends on the characteristics of the student (e.g., age, type and severity of disabil-
ity), the qualifications of the teacher(s) who will provide instruction, other students with whom
a student will be grouped, and features of the placement. Our view is that there is probably not
a single, best delivery system, but a variety of arrangements suited to make maximum use of
the student’s abilities. Those who propose a single best solution in all cases (e.g., self-contained
special class, inclusion in general education with collaboration and consultation of all concerned
parties) are, in our opinion, misguided. In our opinion, it is incumbent on all concerned parties
to try to find the use of language, authority, grouping, and place that will produce the optimum
academic and social development of the student. This will require the use of admittedly less than
perfect human judgment of all the factors involved, giving up the notion that one best plan for all
students exists, and keeping the welfare of the student foremost.
 17. EFFECTIVE SERVICE DELIVERY MODELS 373

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 V
COMMENTARY ON TEACHING
STUDENTS HAVING LEARNING AND
BEHAVIORAL CHALLENGES
 18
Perspective and Commentary:
The Power of Mindsets, Creating
Classrooms that Nurture Resilience
Robert B. Brooks and Sam Goldstein

The transition to evidence-based teaching practices must not be constricted by a narrow perspec-
tive focusing only on academics. The study of effective teaching practices must also encompass
the social, emotional, and ethical goals of education as well. Cohen (2006) points out that we
have failed to substantially integrate these goals into our curriculum and yet we are increasingly
aware that these form the essential foundations for psychological and emotional well being (for
review see Goldstein and Brooks, 2005). Generating evidence that addressing these goals leads
to lifelong resilience will require creative, longitudinal studies. Emotional health, psychological
well being, empathy, altruism, and connections with others are after all much more difficult to
define and measure than reading and math grade levels, but yet they are equally important factors
in assessing classroom environments and the learning process.
In this chapter, we draw upon a diverse literature including ethnographic studies and case
material to provide evidence that educators must devote equal attention to social, emotional, and
ethical goals as to academics if they are to adequately prepare students for the transition to and
journey through, adulthood.

TWO DIFFERING MINDSETS

The Case of John

Parents of a high school student, John, contacted us1 several years ago. They asked that we serve
as consultants to his school program. John had been diagnosed with learning disabilities and
was experiencing difficulty academically. We met with John and his teachers and asked each to
describe him. One teacher immediately responded, “John is one of the most defiant, oppositional,
lazy, irresponsible students we have at this school!” Another teacher looked surprised at this
assessment. In a manner that was respectful of her colleague’s opinion she said, “I have a differ-
ent view. I think John is really struggling with learning and we should figure out the best ways
to teach him.” In a brief moment we heard two markedly contrasting descriptions of the same
student from two adults who were interacting with him on a daily basis in school. It seemed as

381
382 BROOKS AND GOLDSTEIN

if they were talking about two different students. After the school meeting, we interviewed John
and asked him to describe his teachers, not revealing what they had said about him. In describing
the teacher who portrayed him very harshly, John said, “She hates me, but that’s okay because
I hate her. And I won’t do any work in her class.” Before we could even ask John to elaborate
upon his obviously strained relationship with this particular teacher or to question the wisdom of
his refusal to meet her class requirements, he blurted, “And don’t tell me that I’m only hurting
myself by not doing work (we assumed he was given that advice on numerous occasions). What
you don’t understand is that in her eyes I am a failure. Whatever I do in her class is never going
to be good enough. She doesn’t expect me to pass, so why even try?” He added that from the first
day of class he experienced “angry vibes” from her.
“She just didn’t like me and soon I didn’t like her. I could tell she didn’t want me in her class
just by the way she spoke with me. Right away she seemed angry with me. I really don’t know
why she felt that way. So, after a while, I knew there was no way I could succeed in her class; so,
I just decided that I wouldn’t even try. It would just be a waste of time. She told me I was lazy,
but if she was honest she would have to admit that she doesn’t think I could ever get a good grade
in her class.”
John’s face lit up as he described the teacher who thought that the primary issue that should
be addressed was his struggle with learning. He said, “I love her. She went out of her way the first
week of school to tell me something. She said that she knew I was having trouble with learning,
but she thought I was smart and had to figure out the best way to teach me. She said that one of
the reasons she became a teacher was to help all students learn. She’s always there to help.”
After hearing John’s views of these two teachers, we could understand why he was a disci-
pline problem with the first teacher but not the second. His behavior with each of them reflected
what he believed to be their expectations for him. We recognize that it typically takes “two to
tango” and most likely at some point John was responsible for adding fuel to the “angry vibes,”
thereby confirming the first teacher’s negative perceptions of and expectations for him. How-
ever, as we will emphasize in this chapter, if we wish children and adolescents to change their
attitudes and behaviors, the adults in their lives must have the courage and insight to change
theirs first. This is important in raising or teaching all children, but perhaps more so for children
beset by learning and behavioral problems who are often burdened by feelings of failure and
defeatism.

The Case of Lisa

Lisa, a nine-year-old girl, was referred by her pediatrician when she was about two months short
of completing in her fourth-grade year. Her parents were concerned about “her moodiness, her
tendency to be demanding, and her stubbornness.” She demonstrated difficulty shifting from one
activity to another and tolerating limits that were set. An earlier evaluation had led to a diagnosis
of bi-polar disorder and attention deficit hyperactivity disorder. In school, Lisa often refused to
do her work. Lisa’s parents commented that they did not want to make excuses for her behavior,
but they felt that her teacher “dismissed” her diagnosis. Her teacher told them, “The simple truth
is Lisa is lazy. She could do the work if she wanted to. Also, she has to learn that she can’t get
her way and that you can’t give in to her.” They reported that the teacher recommended that they
work with a behavioral specialist who could help them to become more “effective disciplinar-
ians.”
Similar to John’s negative perception of one of his teachers, Lisa correctly felt her teacher
did not like her. It was obvious that Lisa was a challenging child to both her parents and her
teacher. When we first began to work with her, it was difficult for her to appreciate the ways
 18. PERSPECTIVE AND COMMENTARY 383

in which her behaviors impacted on the teacher’s negative judgments. She was prone to blame
others, often using the word “unfair” to describe her lot in life. In our initial meeting with Lisa’s
parents, we asked them to identify Lisa’s strengths. They responded that although she did like
school and could be oppositional, she enjoyed reading, especially to younger children with
whom she related more comfortably than with children her own age group. They added that,
in general, Lisa liked to “help others out.” They emphasized that if you told her to help out,
she was quick to say no, but that if you said you needed her assistance, she was more likely to
cooperate.
Given this description, we believed that if Lisa were involved in activities in which she
helped out in school, she would feel more comfortable there, more likely to do her work, and
less prone to engage in problematic behaviors. When we raised this possibility with her teacher,
we were taken aback by the teacher’s response. She angrily retorted that our “philosophy was to
spoil children.” She added that the only way she would permit Lisa to help out was if she first
proved herself by doing all of her homework, meeting all of the school requirements, and not be-
ing “oppositional.” The teacher said, “Lisa has to prove herself first, then I will let her help out.”
The remainder of the year was characterized by ongoing struggles between Lisa and her teacher
with Lisa becoming increasingly sullen and resistant.
We do not wish to infer that Lisa was an easy child. As we have noted, she was not. We knew
that she could easily anger people. We were also aware that engaging in a power struggle with
her, which unfortunately had occurred with her fourth-grade teacher, did not motivate her to be
more disciplined and cooperative, but rather prompted her to be more angry and inflexible. We
wanted to lessen the probability that the same negative dynamic would emerge with her fifth-
grade teacher. Consequently, we arranged to meet with her new teacher the week before the new
school year began.
As we began the meeting, we were quite certain Lisa’s reputation had preceded her. It had,
but we were pleasantly surprised when her teacher began the meeting with the statement, “I
know that Lisa has had difficulty in school. I also know that she is bright child. I’m curious what
suggestions you have for making this year successful.” The contrast between being told our “phi-
losophy was to spoil children” with a request for suggestions to make the fifth-grade year suc-
cessful was striking. The tension that had permeated the school meetings at the end of the fourth
grade was replaced with an atmosphere of respect and a common goal of helping Lisa to feel
more comfortable in school. We believed that a feeling of comfort would lessen her provocative
behavior and improve her learning.
Several steps were instituted. Lisa’s teacher scheduled a meeting with Lisa two days before
classes began. With knowledge of Lisa’s interests and strengths, she told Lisa that she could be
very helpful if she were willing to assist the librarian an hour a week. She also informed Lisa
that she had spoken with the kindergarten teacher who wondered if Lisa would be willing to
read to kindergarten children once or twice a week for about 15 minutes. Lisa requested more
information about these activities, which her teacher provided. Lisa enthusiastically accepted her
teacher’s requests.
The teacher then initiated a discussion that could be subsumed under the category of “cri-
sis prevention.” She said to Lisa that sometimes students don’t agree with the requests that she
makes about behavior in the classroom or the amount of homework she assigns. She added,
“There are some rules that students have to follow so we can have a classroom where everyone
feels comfortable and can learn. But if you ever feel I am being unfair or if you don’t understand
why I am asking you or the class to do something, I would like you to talk with me about it. I plan
to tell the entire class this on the first day of school, but as long as you are here today, I wanted
to mention it to you.”
384 BROOKS AND GOLDSTEIN

This very perceptive teacher then asked, “Lisa, do you know why I want students to feel
comfortable to speak with me about things they may not understand or may disagree with me
about?” Lisa shrugged, seeming a little hesitant to answer. Her teacher replied, “I’ve found that
when students understand the reasons for my requests or what I am expecting in class, they are
more cooperative and when students are more cooperative there are fewer problems. I really want
all students to feel comfortable in school and to learn. I think you and I are going to have a good
year together.” Lisa’s teacher told us that after she offered this comment, Lisa smiled and simply
said, “Me too.”
The teacher’s prediction of a good year together and Lisa’s affirmation of this prediction
were realized. Lisa’s oppositional behavior and her refusal to do work rarely appeared. Her teach-
er had masterfully provided Lisa with an opportunity to display her strengths and, as importantly,
had provided a safety net should Lisa question the demands of the classroom. Rather than resort
to an “I won’t do the work” position, Lisa (as well as all of her classmates) was invited to speak
with the teacher about the classroom requirements. This fifth-grade teacher’s expectations were
as high as those of the fourth-grade teacher, but the ways in which she communicated these ex-
pectations and the style with which she related to her students, established the foundation for Lisa
to thrive in that classroom and become more resilient.

THE POWER OF MINDSETS

The experiences of John and Lisa with their different teachers illustrate what may seem obvious
but in many ways is not, namely, that we all possess different mindsets or assumptions about
ourselves and others (Brooks, 2001a, b, 2004; Brooks & Goldstein, 2001, 2003, 2004; Goldstein
& Brooks, 2007). These assumptions, which we may not even reflect upon or be aware of, play
a significant role in determining our expectations and behavior. Even seemingly hidden assump-
tions have a way of being expressed to others. Not surprisingly, people begin to behave in accord
with the expectations we have of them and when they do, we are apt to interpret this as a sign that
our expectations are accurate. What we fail to appreciate is the extent to which our expectations
subtly or not-so-subtly shape the behavior of others. This dynamic was vividly observed with
both John and Lisa. Their teachers got what they expected.
If we examine the school environment, it should not be surprising to learn that educators pos-
sess many different assumptions about the process of education and about students with learning
and behavioral problems. These assumptions, as was evident with John and Lisa, will determine
whether at-risk students overcome adversity and are successful and resilient in school or if they
continue on a downward spiral of frustration, unhappiness, and failure.
Given the power of mindsets, an important question can be raised, namely, “What is the
mindset (or expectancies and assumptions) of educators who truly touch the minds and hearts of
students with learning and behavior challenges and reinforce their motivation, hope, and resil-
ience?” In our work with teachers, school administrators, and other school staff, we have found
many who appreciate the need to focus not only on nurturing the intellectual lives of students
but also their emotional lives, and who, through their words and actions, demonstrate a profound
commitment to creating classroom environments in which all students will thrive.
These talented educators possess a mindset that directs their teaching style and their interac-
tions with students, a mindset that strengthens a love of learning, even in those students strug-
gling in school. The more aware educators are of the tenets of this mindset, the more they can
adhere to constructive, realistic guideposts in their work with students and the more they can
create resilient, sustainable classrooms (Goldstein & Brooks, 2007).
 18. PERSPECTIVE AND COMMENTARY 385

THE ASSUMPTIONS AND MINDSET OF EFFECTIVE EDUCATORS

A number of key components comprise the mindset of educators who work effectively with
at-risk students. We begin with a basic feature of this mindset, which if absent compromises
all other features. It directs attention to the significance of the teacher-student relationship in
promoting hope and optimism in students who often feel defeated and pessimistic about their
situation improving.

Believing that Educators Have a Lifelong Impact on Students and Their Resilience

Many students with learning and behavioral difficulties are burdened with feelings of doubt and
anxiety about their future and do not envision success in the future. It is important for educators
to believe that what they say and do each day in their classrooms can have a lifelong influence on
their students (Brooks, 1991, 2002; Brooks & Goldstein, 2001). In our consultations to schools,
we have often heard, “We know that we can have an impact on students, but this student comes
from a dysfunctional family (or this student has been abused; or this student has significant be-
havioral problems). What can I possibly do?” We certainly appreciate this kind of question, but in
response we emphasize, “For some students the only moments of sanity, security, or acceptance
they will experience is in your classroom. Don’t let the opportunity go by.”
When educators take advantage of this opportunity, lives are changed. There are many adults
who as children experienced years of frustration, failure, and humiliation and are now leading
satisfying, successful lives. This prompts the question, “Why are some students with learning
and behavioral problems successful as adults while others are not?” Answering this question is
perhaps one of the most important tasks of teachers and other caregivers. If we can understand
those factors that contribute to children bouncing back, to becoming more hopeful and resilient,
then we are better equipped to design and implement interventions that will provide children a
fighting chance in life.
Fortunately, during the past two decades there has been a burgeoning literature focusing on
the concept of resilience (Brooks, 1994; Brooks & Goldstein, 2001, 2003, 2004; Goldstein &
Brooks, 2005; Katz 1994, 1997; Mather & Ofiesh, 2005; Rutter, 1985, 1987; Thomsen, 2002;
Werner, 1993; Werner & Smith, 1992). Researchers and clinicians have identified three inter-
related domains that influence the emergence of resilience, namely, the inner characteristics of
the child, the family, and the larger social environment (Hechtman, 1991). The inner resources
of the child that contribute to resilience include an “easy” temperament from birth, solid prob-
lem-solving skills, good social skills, and effective coping strategies. Very importantly, resilient
youngsters possess a high level of self-esteem, a realistic sense of personal control, a feeling of
competence, and a belief that mistakes are experiences from which to learn rather than feel de-
feated. Brooks and Goldstein (2001) describe these attributes as part of a “resilient mindset.”
Concerning the family, it is not surprising to find that resilient children are more likely to
grow up in homes characterized by warmth, affection, emotional support, and clear-cut and rea-
sonable guidelines, limits, and consequences. Supportive adults outside the immediate family
have also proven to be a major source of resilience. When resilient adults were asked what they
believed was one of the most important factors in their childhood or adolescence that assisted
them to be resilient, invariably they responded “an adult who believed in me.” Schools have been
spotlighted as environments that can provide children with experiences that enhance their self-
esteem and resilience. For example, Segal (1988) noted:

From studies conducted around the world, researchers have distilled a number of factors that
enable such children of misfortune to beat the heavy odds against them. One factor turns out to
386 BROOKS AND GOLDSTEIN

be the presence in their lives of a charismatic adult—a person with whom they can identify and
from whom they gather strength. And in a surprising number of cases, that person turns out to be
a teacher. (p. 2)

Part of the problem is that many educators do not realize they are or have been charismatic
adults in the lives of students. In our workshops for educators, we often pose two questions, the
first geared for those who have been teaching at least five years or more, the second for all educa-
tors. The questions are:

How many of you have unexpectedly received an expression of thank you via an e-mail,
letter, or phone call from a former student in which the latter acknowledges the important
role you played in his or her life?
How many of you have written such a thank you to an educator who served as a charismatic
adult in your life, but you never really conveyed your appreciation to that person?

In many of our workshops, less than 25% of those in attendance raise their hands in response
to both of these questions. The implication is that even without receiving direct feedback from
current or former students, the mindset of effective educators carries the following belief: Today
may be the day that I say or do something that will change a student’s life in a positive way and
help that student to be more hopeful and resilient.
This point is eloquently captured by Tracy Kidder in his book Among Schoolchildren
(1989):

Teachers usually have no way of knowing that they have made a difference in a child’s life, even
when they have made a dramatic one. But for children who are used to thinking of themselves
as stupid or not worth talking to or deserving rape and beatings, a good teacher can provide an
astonishing revelation. A good teacher can give a child at least a chance to feel, “She thinks I’m
worth something. Maybe I am.” Good teachers put snags in the river of children passing by, and
over the years, they redirect hundreds of lives. Many people find it easy to imagine unseen webs of
malevolent conspiracy in the world, and they are not always wrong. But there is also an innocence
that conspires to hold humanity together, and it is made up of people who can never fully know
the good that they have done. (pp. 312–313)

The Case of Nicholas

One student who communicated to his teacher the impact she had on him was 13-year-old Nicho-
las Walker. At the end of the school year he wrote a poem about Ms. Alex Scott, one of his eighth-
grade teachers. His mother, Tammy Young, is also an educator. She told us about the impact Ms.
Scott had on Nicholas, an articulate, likeable, young adolescent who struggles with learning and
attention problems. Nicholas titled the poem “The Black Sea” and he wrote a moving dedica-
tion—“Dedicated to Ms. Alex Scott, the teacher who saved me.”

Before I met you

I lay trapped beneath the black sea,
Where the ordinary was mandatory.
You pulled me up—unconscious,
And waited for me to awaken.
It took me some time,
But I did pull through.
 18. PERSPECTIVE AND COMMENTARY 387

You taught me so much,

Now I must move on.
Your job, however, is not complete,
For others lie stranded
Beneath the Black Sea.
Waiting for you,
To reach them—like me.

Educators are in an excellent position to serve as charismatic adults for their students. They
can provide angry, resistant, vulnerable, or alienated youth with experiences that enhance their
self-dignity and competence, lessen their sadness and bitterness, and strengthen their resilience.
In this regard, a report issued by the U.S. Department of Education (Dwyer, Osher, & Warger,
1998) about “safe schools” is well worth considering:

Research shows that a positive relationship with an adult who is available to provide support
when needed is one of the most critical factors in preventing student violence. Students often
look to adults in the school community for guidance, support, and direction. Some children need
help overcoming feelings of isolation and support in developing connections to others. Effective
schools make sure that opportunities exist for adults to spend quality, personal time with children
(pp. 3–4).

At several of our workshops, participants have stated, “I want to be a charismatic adult. What
do I do?” While such a comment is often uttered with some levity, it challenges us to ask, “In
addition to believing that students with learning and behavior problems can overcome adversity
and be resilient, what are the other features of the mindset of effective educators that allow us to
become charismatic adults in the lives of students?” In the next section, we examine some of the
features of the mindset of effective educators.

Addressing the Social-Emotional Needs of a Student

Is Not an Extra Curriculum Activity

At one of our workshops, we were highlighting the significant influence that educators have on
the social-emotional life of students. A high school science teacher challenged the emphasis we
placed on social-emotional factors, contending, “I am a science teacher. I know my science and
I know how to convey science facts to my students. Why should I have to spend time thinking
about the student’s emotional or social life? I don’t have time to do so and it will distract me from
teaching science.”
We are certain that there are many teachers and school administrators who would take is-
sue with the views expressed by this science teacher, who believe as we do that focusing on a
student’s social and emotional life in the classroom may be as integral as teaching specific aca-
demic skills and content (Brooks, 1999; Cohen, 1999). However, we are also aware that others
would concur with this teacher’s opinion, especially in today’s climate of high stakes testing. It
is unfortunate that a dichotomy has emerged prompting some educators to perceive that nurtur-
ing a student’s emotional and social health takes valuable time away from the task of teaching
academic skills and preparing students for high stakes testing.
Based on our experiences as well as the observations we have heard from many educators,
strengthening a student’s sense of self-esteem is not an “extra” curriculum; if anything, a student’s
perception of belonging, security, and self-confidence in a classroom provides the scaffolding
388 BROOKS AND GOLDSTEIN

that supports the foundation for enhanced learning, motivation, self-discipline, responsibility,
and the ability to deal more effectively with obstacles and mistakes (Brooks, 1991).
This focus on social-emotional factors is of special importance when working with chil-
dren and adolescents with learning disabilities. These youngsters, given their history of learning
difficulty and failure, are especially vulnerable to feelings of frustration, low self-worth, and
helplessness (Brooks, 1999b, 2001a; Canino, 1981; Deci, Hodges, Pierson, & Tomassone, 1992;
Licht, 1983). These feelings were vividly captured in interviews and therapy we conducted with
students with learning disabilities. The following are a representative sample of their comments
when describing their learning disabilities:

“I was born to quit and God made me that way.”

“It (the learning disability) makes me feel terrible. It makes me realize that there is a barrier
that stops me from having a happy and successful future.”
“I always get confused. I don’t think I’ll ever learn. I must have half a brain.”
“I have no friends. Everyone teases me. I wish I was never born.”
“Sometimes I feel unrespected, unconfident, lower than other people. I also feel I could
never do half the stuff I want to do and that makes me feel frustrated.”

The Cases of Caitlin and Matt

Caitlin was seven years old when we first met her in therapy. She had reading and attention
problems, and was referred by her parents and teacher because of her lack of confidence, her frus-
tration and disappointment about not learning to read as quickly as her peers, and her reported
headaches. In therapy we invited Caitlin to write a story about her difficulties. We informed her,
as we do with other children, that we often read stories written by our clients at our workshops so
that parents, teachers, and doctors can gain a better understanding of how children feel and can
be more helpful to them.
Caitlin was motivated to write such a story with our assistance. She decided to use as a main
character a dog named Hyper who had difficulty learning and concentrating, an obvious repre-
sentation of herself. The theme of low self-esteem and a feeling of hopelessness were apparent at
the beginning of the story when she wrote:

Hyper told herself that she would get over this problem some day, but she wondered if she really
would. She was worried that when she grew up and her own puppies asked her something, she
would not know the answer and they would wonder why their mother was not very smart. Think-
ing about this made Hyper feel very upset. She wasn’t sure what to do about it.

We met Matt when he was a young adolescent. He was diagnosed with both learning dis-
abilities and ADHD, was depressed, and entertained little hope for the future. His description of
school reminds us of the way in which many youngsters with special needs experience school and
should prompt us to become even more committed to creating school environments that truly pro-
vide accommodations for and accept students with learning and attention problems. Matt wrote:

School has been and still is something I dread profusely. Going to school has been like climbing
up a tremendous, rocky mountain with steep cliffs and jagged, slippery rocks. This mountain
is very grey and always covered in dark, murky, cold clouds. I step forth to take on this task of
climbing this huge mountain. Each step is a battle against strong, howling, icy winds. The winds
contain frigid rain that slams against my body, trying to push me down. I keep battling my way
up. Sometimes I am knocked down and sometimes I have to stop to regain my strength. My body
 18. PERSPECTIVE AND COMMENTARY 389

is numb. My hands shake like leaves in the wind as I claw myself up the mountainside. Not being
able to open my eyes, I blindly claw myself up the steep cliff. I stop because I am in such great
pain. I look up and see that my struggle has hardly begun. Sometimes I just do not want to go on
any further.

In college, Matt, feeling more self-confident, expanded on his story of “The Mountain” and
noted that the mountain could become “your grave or your greatest triumph.”
Caitlin’s words poignantly captured not only her low self-esteem, but also a fear expressed
by many children and adolescents with learning disabilities, namely, that their condition in life
will not improve. In essence, they have lost one of the most important gifts there is, the gift of
hope. As you reflect upon the words of Caitlin and Matt as well as other youngsters with learn-
ing and behavioral struggles, place yourself in their shoes as they sit in a classroom. If we do not
address their social-emotional concerns, their negative feelings about learning, and their sense
of helplessness and hopelessness, they will not benefit from our instruction. We are not advocat-
ing that teachers become therapists, but that they recognize that the psychological readiness and
emotional state of a student to learn is an integral part of the educational process.

Believing that All Students Wish to Learn and to Succeed and

If They Seem Unmotivated or Disengaged, They May Believe
They Lack the Ability to Achieve in School

We often hear teachers refer to students as lazy or unmotivated. When these accusatory labels are
used and a negative mindset emerges, educators are more likely to respond to these students with
a lack of understanding and annoyance. The mindset of an effective educator constantly echoes,
“I believe that all students come to school desiring to learn. It they are disinterested and feel de-
feated, we must figure out how best to reach and teach them.”
Subscribing to this view has a profound impact on the ways in which we respond to students,
especially those who are struggling. When students lose faith in their ability to learn and when
feelings of hopelessness pervade their psyche, they are vulnerable to engaging in counterpro-
ductive or self-defeating ways of coping. They may quit at tasks, clown around, pick on other
students, or expend little time and effort in academic requirements. When a student feels that
failure is a foregone conclusion, it is difficult to muster the energy to consider alternative ways
of mastering learning demands.
Teachers who observe such counterproductive behaviors may easily reach the conclusion
that the student is unmotivated, or lazy, or not caring about school. As negative assumptions and
mindsets dominate, teachers are less likely to consider more productive strategies for reaching
the student. Instead, thoughts turn to punitive actions (e.g., what punishments would finally get
through to the student). However, if educators subscribe to the belief that each student wishes to
succeed, negative assumptions are less likely to prevail.

Case of Sarah

A shift in perspective was obvious in a consultation we did about Sarah, a problematic high
school student. One of her teachers began by asking, “Don’t you think it’s okay for a 16 1/2-
year-old to drop out of school?” The agenda was clear. These teachers, who typically displayed a
caring and encouraging attitude, were very frustrated and angry with Sarah to the extent of wish-
ing her to leave school. The teachers elaborated that Sarah was a student who “sabotaged” all of
their efforts. “Even if Sarah agrees to do something, she doesn’t follow through. It’s obvious that
390 BROOKS AND GOLDSTEIN

she dislikes school and she’s disruptive and disrespectful. She couldn’t care less about how she
does in school.”
As we shall see, Sarah cared a great deal about wanting to achieve in school, but entertained
little hope for doing so. It was only when her teachers truly accepted that each student desperately
wants to succeed that a positive mindset emerged, which permitted them to consider new solu-
tions. A turning point occurred when we empathized with the teachers about their frustration but
then asked, “Can anyone tell us how you think Sarah feels each day when she enters the school
building?” After several moments of silence, one teacher responded, “How Sarah feels? I never
really thought about that before.”
Another teacher followed, “I never really thought about that before either, but as I’m doing
so now, only one word comes to mind, defeated. I think everyday when Sarah comes in to the
school building she feels defeated.” As this teacher shared her observation, the shift in mindset
that permeated the room was palpable, highlighted by one teacher asking us, “You’ve written a
lot about helping kids be more confident and resilient in the school setting. So what can we do to
help a student who feels defeated begin to feel less defeated?”
A lively, creative discussion ensued, filled with ideas that had not been considered previ-
ously, including having Sarah, who relished being helpful, assist in the office. The teachers also
shifted their focus from what punitive action to take to a desire to “get to know” Sarah, not via a
tense, confrontational meeting but rather by having lunch with her. This new approach prompted
Sarah to be more responsible and a positive cycle was set in motion. The catalyst for this new
cycle was when her teachers shifted their mindset, no longer viewing Sarah’s behaviors as op-
positional, but rather as a reflection of the despair and defeatism she experienced. They adopted
the assumption that students wish to succeed, but at times obstacles appear on the road to suc-
cess—obstacles that teachers working in concert with students could remove.

If Our Strategies Are Not Effective, We Must Ask, “What Is It that I Can Do
Differently?” Rather Than Continuing to Wait For the Student to Change First.

A basic underpinning of resilience is the belief of “personal control,” namely, that we are the
“authors of our own lives” and it makes little sense to continue to do the same thing repeatedly if
our actions are not leading to positive results (Brooks & Goldstein, 2004). While many educators
and others say they subscribe to this assumption, their actions frequently belie their assertion. For
example, it is not unusual to hear the following statements offered by educators at consultations
we have conducted:

“This student is unmotivated to change. She just won’t take responsibility for her
behavior.”
Or, “We’ve been using this strategy with this student for five months. He’s still not responding.
He’s resistant and oppositional.”

We believe in perseverance, but if a staff has been employing the same approach for five
months without any positive outcome, one can ask, “Who are the resistant ones here?”
As one perceptive teacher emphasized, “Asking what is it that I can do differently should
not be interpreted as blaming ourselves but rather as a source of empowerment.” She continued,
“Isn’t it better to focus on what we can do differently rather than continue to wait for someone
else to change first? We may have to wait forever and continue to be frustrated and unhappy.”
This same teacher summarized her belief with the statement, “If the horse is dead, get off.”
We have found many dead horses strewn on the grounds of a school.
 18. PERSPECTIVE AND COMMENTARY 391

Empathy Is One of the Most Vital Skills of an Effective Educator

If teachers are to become charismatic adults, they must be empathic, placing themselves inside
the shoes of their students and perceiving the world through a student’s eyes. Goleman (1995)
highlighted empathy as a major component of emotional intelligence.
Being empathic invites educators to ask, “Whenever I say or do things with students, am I
saying or doing these things in a way that my students will be most responsive to my message?
Would I want anyone to say or do to me what I am saying or doing with my students?” For ex-
ample, a teacher may desire to motivate a student with learning disabilities by exhorting the stu-
dent to “just try harder.” While the teacher may be well-intentioned, such a remark is frequently
experienced in a negative, accusatory way. When students feel accused, they are less likely to be
cooperative. Consequently, the teacher’s comments are not likely to lead to the desired results.
However, if this teacher had been empathic, he or she would have wondered, “If I were struggling
in my role as a teacher, would I want another teacher or my principal to say to me, ‘If you just
tried harder you wouldn’t have this problem?’” We believe that the teacher would answer “no”
to this question.
Instead, as noted earlier, a teacher serving as a charismatic adult would be guided by the
belief that all students want to learn and to succeed. If students are not succeeding, such a teacher
would ask, “What is it I can do differently so that this student can learn more effectively?” Guid-
ed by this mindset, the teacher might replace the accusatory words “try harder” with, “I think one
of the reasons you are having trouble learning is that I am not using the best strategies to teach
you or perhaps you are not using the best strategies to learn. We have to figure out what are the
best ways for me to teach and you to learn.” This statement is free of accusation and judgment,
inviting students with learning problems to join with us rather than resent and avoid us.
To highlight the significance of empathy, we have asked educators at our workshops to think
of a teacher they liked and one that they did not like when they were students. We next ask them
to think of words they would use to describe each of these teachers. We observe, “Just as you
have words to describe your teachers, your students have words to describe you?” We then pose
the following questions:

“What words would you hoped your students used to describe you?”
“What have you done in the past month or two so they are likely to use these words?”
“What words would they actually use to describe you?”
“How close would the words you hope they use parallel the words they would actually
use?”
“If the descriptions are not close, what do you plan to do so that the words they would
actually use become similar to the words you hope they would use?”

Another exercise that educators have found useful in reinforcing empathy is to recruit their own
memories of school when they were students. We have asked teachers and school administrators:

“Of all the memories you have as a student, what is one of your favorite ones, something
that a teacher or school administrator said or did that boosted your motivation and self-
dignity?”
“Of all the memories you have as a student, what is one of your worst ones, something
a teacher or school administrator said or did that eroded your motivation and self-
dignity?”
“As you reflect upon both your positive and negative memories of school, what did you learn
392 BROOKS AND GOLDSTEIN

from both and do you use these memories to guide what you are doing with your students
today?”

Recalling one’s own positive and negative memories of school, especially as a group exer-
cise with one’s colleagues, often proves to be very emotional, prompting educators to ask:

“What memories are my students taking from their interactions with me?”
“Are they the memories I would like them to take?”
“If not, what must I do to change so that the memories they take will be in concert with the
memories I hope they take?”

Teachers who appreciate the importance of empathy as a critical teaching skill regularly ask
these questions of themselves. We have been fortunate to meet teachers who have assumed a pro-
active stance by requesting anonymous feedback from students; they have had the courage to ask
students to draw and describe them, to list what they like about the class and what they would like
to see changed. Such an exercise communicates the message to students, “I respect your opinion.
I value your input. You are a vital participant in the learning process.” Empathic educators con-
nect more effectively and constructively with students so that learning is enhanced.

We Must Define and Create “Motivating Environments”

Educators who touch the hearts and minds of students consider what they must do to create what
we have called “motivating environments,” that is, environments in which students are eager to
participate and cooperate. While motivating environments are of benefit to all children, they hold
special value for youngsters with learning and behavioral problems who have experienced little,
if any, success in school. If anything, the main motivation of many of these students is to avoid
the learning task, a task that they perceive as leading to further frustration and failure. Given the
strength-based model to which we subscribe, we have been drawn to two frameworks that offer
a blueprint for designing such an environment.

Attribution Theory

One promising framework originally proposed by psychologist Bernard Weiner (Weiner, 1974)
and applied by many clinicians and researchers to students with special needs is called “attribu-
tion theory” (Brooks, 1991; Canino, 1981; Licht, 1983). Children encounter numerous challenges
as they grow, some of which result in success, others in failure. What attribution theory highlights
is that youngsters assume different reasons for why they succeed or fail and that these reasons,
which vary from one child to the next, are strongly tied to their self-esteem and subsequent mo-
tivation. In terms of success experiences, research indicates that children with high self-esteem
believe that their successes are determined in large part by their own efforts, resources, and abili-
ties. These youngsters assume realistic credit for their accomplishments and feel a genuine sense
of control over their lives. They are typically children who experience success early in their life
within a responsive and encouraging environment. They are likely to be very motivated to face
new challenges (Brooks & Goldstein, 2001).
In contrast, youth who have encountered many frustrations and disappointments and whose
self-esteem has suffered erosion are more likely to assume that their achievements are predicated
on luck, or chance, or fate, on variables outside of their control, thus weakening their confidence
of being able to succeed in the future. For instance, we have worked with many children with
 18. PERSPECTIVE AND COMMENTARY 393

learning problems who quickly dismiss a high grade with such comments as, “I was lucky” or
“The teacher made the test easy.” These children minimize the role that they have played in
achieving any success; unfortunately, the cumulative effect of perceived failure outweighs any
success experiences.
Self-esteem and motivation are also strongly implicated in how children comprehend their
mistakes and failure. As an example, two children in the same third-grade class have failed a
spelling test. One child thinks, “I can do better than this. Maybe I have to study more or ask the
teacher for extra help.” The second child explains the low grade by saying, “The teacher stinks.
He never told us these words would be on the test. It’s his fault I failed.” Or, to take another ex-
ample, a child who felt he was incapable of learning, constantly hit other students. As he gained
insight into his difficulties, he told us in therapy, “I’d rather hit another kid and be sent to the
principal’s office than have to be in the classroom where I felt like a dummy.”
The child who is willing to seek additional help and/or work more diligently, basically be-
lieves that mistakes are experiences from which to learn rather than feel defeated. Such children
typically attribute making mistakes to factors that are within their power to modify, such as a lack
of effort (especially if the task is realistically achievable) or ineffective strategies (e.g., poor study
habits). In marked contrast, students who resort to blaming or hitting others typically adhere to
the painful view that “I am a failure, I cannot change. I cannot do well.” Rather than believing
that mistakes are the foundation for future learning, children with low self-esteem frequently
experience each new mistake as another rock being placed around their necks, weighing them
down more and more. To such youngsters mistakes result from conditions that cannot be easily
modified, such as lack of ability or low intelligence; given this belief, their motivation suffers and
often their anger increases.
A vicious cycle is set in motion when children believe they cannot learn from mistakes.
Feeling hopeless and wishing to avoid further perceived humiliation, they are apt to quit, offer
excuses, cast blame on others, or resort to other ineffective ways of coping, such as assuming the
role of class clown or class bully. As these youngsters reach teenage years, our attempts to teach
and encourage them may be met with angry retorts such as “Leave me alone!” “I don’t care!”
“It’s my life and I’ll do what I want with it” and/or acting out behaviors. It has been our experi-
ence that these children care much more than they acknowledge, but feeling hopeless and believ-
ing they are unable to change their situation, they do not even want to entertain the notion that
things may improve—for them, any hope is false hope that eventuates in further disappointment.
While the adults in their lives may believe that such youngsters are quitters or lack perseverance
or are bullies, what we often fail to comprehend is that these behaviors are rooted in a sense of
hopelessness and a desperate attempt to avoid further humiliation (Brooks, 2004). Working with
these at-risk youth involves helping to change their negative attributions and mindsets (Brooks,
2002; Brooks & Goldstein, 2001).
Attribution theory offers significant guideposts for designing classroom climates that will
reinforce the self-confidence and motivation of angry and defiant students. The following ques-
tions stem from this theory:

1. How do we create a school environment that maximizes the probability that students will
not only succeed but that they will experience their achievements as predicated in large
measure on their own abilities and efforts? Or, stated somewhat differently, how do we
assist youngsters to assume an increasing sense of ownership and responsibility for what
occurs in their lives?
2. How do we create a school environment that reinforces the belief that mistakes are fre-
quently the foundation for learning, that mistakes are not only accepted, but expected?
394 BROOKS AND GOLDSTEIN

How do we create an environment that lessens fears of being humiliated or embarrassed,

fears that often trigger sadness and anger?

Deci’s Approach to Self-Esteem and Motivation

A second framework that we have found helpful is based on the work of psychologist Edward
Deci who has studied self-esteem and motivation through the lens of youngsters’ needs (Deci &
Chandler, 1986; Deci & Flaste, 1995; Deci, Hodges, Pierson, & Tomassone, 1992). A great deal
of Deci’s research has involved children with learning problems. His model has many similarities
to Glasser’s (1997) “choice theory” (formerly called “control theory”) and the work of Brendtro,
Brokenleg, and Van Bockern (1990). It suggests that youngsters will be more motivated to engage
and persevere at school tasks when the adults in their lives have created a school environment that
satisfies basic needs. Deci highlights the following three needs that provide direction for foster-
ing self-esteem and motivation:

1. To belong and feel connected. Youngsters are more likely to thrive when they are in en-
vironments in which they feel they belong and are comfortable, in which they feel appre-
ciated. Many adolescents join gangs to satisfy this need for connectedness and identity.
When youngsters feel alienated or detached they are more likely to act out and fail at
school (Strahan, 1989). Related to this feeling of belonging, is the importance of helping
each child to feel welcome in the school environment. When we asked students of all
ages what a teacher could do each day to help them to feel welcome in school, the two
most frequent responses we received were: (a) being greeted warmly by a teacher who
uses your name, and (b) having a teacher smile at you. Obviously, small gestures can go a
long way toward assisting at-risk children to feel welcome at school and in other environ-
ments. If students do not feel welcome, they are more prone to becoming angry.
2. To feel autonomous and have a sense of self-determination. At the core of most theories
of self-esteem and motivation, including attribution theory, is the concept of ownership
and self-determination (Brooks, 1991). Motivation is increased when people genuinely
believe that their voice is being heard and respected and they feel they have some control
over what is occurring in their lives (Dicintio & Gee, 1999). If students feel they are con-
stantly being told what to do and that their lives are being dictated by adults, they are less
likely to be enthused about engaging in learning tasks that they feel are being imposed
upon them. If anything, their main motivation may be to avoid or oppose the desires of
others. A power struggle or angry outbursts are likely to ensue. An emphasis on reinforc-
ing self-determination requires that educators use classroom experiences to teach young-
sters how to solve problems and make wise choices and decisions. In addition, we must
provide these children with ongoing opportunities to develop and refine these skills.
3. To feel competent. We all hope to be successful, to possess skills in our lives that help
us feel competent and accomplished, skills that generate satisfaction and pride. Unfor-
tunately, many children do not feel competent. As we have noted, feelings of incompe-
tence, which are often associated with anger and sadness, prompt children to retreat from
challenges and to engage in self-defeating behaviors, including aggression, that serve to
intensify an already difficult problem.

All students require positive feedback and encouragement from educators. However, a focus
on encouragement should never be confused with giving false praise or inflated grades since chil-
dren are quite perceptive in knowing when they are receiving undeserved positive evaluations.
 18. PERSPECTIVE AND COMMENTARY 395

Positive feedback must be rooted in actual accomplishment and success. This requires teachers
to provide opportunities for children to succeed in areas judged important by themselves and oth-
ers. Their accomplishments should be displayed for others to see (what good is listing a child’s
strengths on an educational plan, for example, if no one witnesses these strengths?).
In addition, a focus on competencies and positive feedback is not mutually exclusive with of-
fering feedback to correct a child’s performance or behavior. However, corrective feedback must be
undertaken in a nonaccusatory, nonjudgmental manner that does not humiliate the child. Instead,
corrective feedback is most effective when presented to the student as a problem to be solved.
To assist at-risk students to feel competent, educators must identify and reinforce what we
have termed each student’s “islands of competence” (Brooks, 1991; Brooks & Goldstein, 2001).
These islands are areas that are (or have the potential to be) sources of pride and accomplish-
ment. Researchers and clinicians have emphasized the importance of identifying and reinforcing
islands of competence in promoting self-esteem, motivation, and resilience. For instance, Rutter
(1985), in describing resilient individuals, observed, “Experience of success in one arena of life
led to enhanced self-esteem and a feeling of self-efficacy, enabling them to cope more success-
fully with subsequent life challenges and adaptation” (p. 604). Katz (1994) proposed, “Being
able to showcase our talents, and to have them valued by important people in our lives, helps us
to define our identities around that which we do best” (p. 10).

The Case of Billy

The case of a young boy who was referred to us offers a vivid illustration of the importance of
identifying a child’s islands of competence. Billy was an angry and depressed ten-year-old boy
with learning and behavior problems who dealt with his anxieties about school by bullying peers
or hiding behind the bushes of the school instead of entering the building. In our first session, we
discussed with Billy why he hid behind the bushes. He responded quickly and directly, “I like
the bushes better than I like school.” Rather than engage in a debate about the merits of bushes
versus schools, we decided to discover what he saw as his islands of competence. He responded
that he enjoyed taking care of his pet dog. With his permission, we mentioned Billy’s expertise in
taking care of animals to the school principal, suggesting that the school might benefit from the
presence of a “pet monitor.”
The following day the principal scheduled a meeting with Billy. He told Billy that there were
pets in many of the classrooms and each class took care of its own pet. However, he added, “I
want to make certain that all of the pets are well taken care of and I would like you to become the
first pet monitor the school has ever had.” He even handed Billy a pet monitor “union card” that
he had created to emphasize the position’s importance.
Billy asked about a pet monitor’s responsibilities. The principal responded that initially Billy
would be expected to come to school 10 minutes early each day to take care of a rabbit the school
had recently purchased and would soon be responsible for checking on the welfare of the other
pets as well.
Billy accepted the offer and handled his duties in a very responsible manner, in marked
contrast to his history with academic requirements. Within a short time, he began to take care of
other pets. Billy’s teacher communicated how impressed she was with his knowledge of pets and
helped him to write a manual about animal care. Billy had always been reluctant to write, but
under these circumstances his hesitancy disappeared since he felt more confident and recognized
that he had information to communicate. His manual was bound and placed in the school library.
In addition, by the end of the school year, Billy “lectured” in every classroom in the building
about taking care of pets.
396 BROOKS AND GOLDSTEIN

Billy’s aggressive outbursts and his avoidance of the school building decreased significantly
once he assumed the position of pet monitor and had opportunities to display his islands of com-
petence. Very importantly, Billy’s teacher and principal had been willing to take a risk and change
the way in which they had been approaching his avoidant behavior. Rather than seeing Billy as a
“resistant,” annoying child who had to change his behavior, they had the courage to ask what they
could do differently so that he would not feel like a failure in school.

Understanding and Implementing Strategies to Foster Motivation, Hope, and

Resilience and Incorporating an “Orientation Period”

A number of classroom strategies, predicated on resilience research, attribution theory, and De-
ci’s framework, build upon the strengths or islands of competence of students to reinforce their
level of confidence, motivation, hope, and resilience. These strategies are especially important
for students with learning and behavior difficulties. The following are a selected group of these
interventions together with some recommendations for the implementation of an “orientation”
period at the beginning of the school year.

Intervention and Recommendation #1

Developing Realistic Expectations and Goals and Making Accommodations in a

Student’s Educational Program whenIndicated. We are frequently asked at our workshops,
“What are realistic expectations and goals for students in a particular grade?” Without avoiding
the question, we typically answer, “We don’t know. First, tell us about the student and then we
can decide what are realistic expectations and goals.” While there is a great deal of overlap among
students, our response is to highlight their differences as well and the importance of respecting
and honoring the unique learning abilities and capabilities of each student.
Although a wealth of research proves that children have different temperaments from birth
(Chess & Thomas, 1987; Keogh, 2003), possess different learning styles (Levine, 1994, 2002;
Rief & Heimburge, 1996), and that multiple intelligences are distributed differently among chil-
dren (Gardner, 1983), we believe that all too often we give lip service to accepting children for
whom they are; instead we respond to students as if they were a homogeneous group. When we
fail to make appropriate accommodations based on the unique attributes of each student, chil-
dren are more likely to fail and become sad and angry and either withdraw or display aggressive
outbursts. This scenario is often seen in the school environment, especially with students with
learning and attention problems.
Even with our increasing knowledge of individual differences among students, it is not un-
usual to hear a teacher say that it would not be “fair” to offer accommodations for one child
because how would the other children feel. We can understand the teacher’s point of view, but
we also believe that if children are different, the least fair thing we can do is to treat them all
the same. If we do not teach students in the ways that they are able to learn best, then we will
continue to have many youngsters who feel mistreated, ill-at-ease, alienated, and angry in our
schools. However, the issue of fairness must be addressed lest other students begin to resent those
students who are receiving accommodations.
One suggestion we advocate is for schools to use the first couple of days of the new school
year as an “orientation” period (Brooks, 1999). During this period, teachers would not take out
any books, but instead would use the time to set the foundation for a classroom climate in which
all students would have the opportunity to thrive. Key questions and concerns would be consid-
ered and possible obstacles to learning would be confronted before they became obstacles.
 18. PERSPECTIVE AND COMMENTARY 397

As an illustration, to minimize the possibility of children feeling a teacher is unfair because

some children might be doing more reading or homework than others, on the first day of school,
the teacher can discuss with the class how each one of them is different, how some students can
read more quickly than others, that some can solve math problems more efficiently, and that some
can run a mile in less time than others. The teacher can say that in light of these differences, there
will be different expectations of the amount and kind of work that is done by each student.
Next, the teacher can say, “Since I will treat each of you somewhat differently because you
are different, one of my concerns is if you begin to feel I am not being fair it will interfere with
your learning. Thus, if at any time during the year you feel I am not being fair, I want you to tell
me so that we can discuss it.”
Feedback we have received indicates that when a teacher brings up the issue of “fairness”
before it has become an issue, it remains a non-issue and permits teachers to accommodate to
each student’s needs without negative feelings emerging. It lessens frustration and the anger and
sadness that are typically by-products of frustration. We also suggest that teachers communicate
the same message about fairness to parents, perhaps through a short, written statement of class
philosophy that is sent home. This will help teachers and parents to be on the same page.
The kinds of accommodations we typically recommend do not require major modifications
in a student’s program, nor do they demand that a teacher develop extremely different educational
plans for each student in the classroom. We believe that effective accommodations need not be
complicated. What is required is that all parties—students, teachers, therapists, parents—appre-
ciate a child’s strengths and weaknesses, share an understanding of appropriate expectations and
goals, and define what each has to do to maximize the probability of success in meeting these
goals. We must help at-risk students to understand their strengths and vulnerabilities and the ac-
commodations that will help them to succeed. Realistic expectations lessen frustration and disap-
pointment. A few examples of typical accommodations follow.
Some youngsters experience attending school as the equivalent of climbing Mt. Everest each
day. Then, they are required to do homework after school, which one student claimed was “like
climbing Mt. Everest twice each day.” If students have learning problems, they often must spend
two or three times as long to do homework than their peers. By bedtime they are frustrated and
exhausted, as are their parents. Commonsense would dictate that a time limit be established for
homework, regardless of how much work is actually finished. For example, if most students can
complete a homework assignment in an hour, then the limit should be approximately an hour for
all students even those with special needs. Some might contend that this approach will result in
some students not completing as many of the problems as other students in the class and thus,
not learning as much of the material; however, to ask these children to spend several more hours
per evening on homework will typically prove counterproductive and may intensify sadness and
defiance.
Students with learning or attention problems usually encounter more difficulty taking timed
tests than their peers. As one child with learning difficulties once asked us with tears in his eyes,
“Why did they ever invent timed tests?” We have witnessed the test scores of students increase
noticeably when taking untimed tests and yet, they only required another 10 minutes. With the
pressure of a timed test removed, the students were more relaxed.
Similarly, some students will display far more of what they know when answering questions
orally, than when having to write these same answers. We should test students under the best pos-
sible conditions for them to display their knowledge. These kinds of accommodations should not
be viewed as spoiling these youngsters, but rather as treating them with fairness and dignity. In
doing so, we lessen the probability of acting out behaviors.
We have worked with many youth who engage in ongoing battles with parents about
398 BROOKS AND GOLDSTEIN

homework. The nightly routine is filled with frustration and anger, and family harmony is almost
nonexistent. The reasons that students do not do homework are varied. Among them are difficul-
ties copying homework assignments from the blackboard. Providing the child with a monthly
“syllabus” of assignments (it is interesting to note, that professors in colleges typically distribute
a syllabus for the entire semester during the first class—we’re not certain why we cannot do the
same in our elementary, middle schools, and high schools) can be helpful as well as assigning a
“buddy” to ensure that the child has an accurate picture of what homework is required.
A number of books are lost being transported between home and school. We have found that
providing two sets of books to a student, one for home, the other for school, so that no textbooks
have to go back and forth, has served as a helpful intervention for many students. It is one less
pressure that students have to worry about, giving them more time to focus on learning the ma-
terial in the books and less time to be angry or depressed. In addition, the necessary books are
always available, rather than being left in a locker at school the night before an exam.

Intervention and Recommendation #2

Developing Responsibility by Providing Opportunities to Contribute to Others.

When children develop a sense of accomplishment and pride, they are less likely to feel sad or
angry and less likely to engage in defiant, uncooperative behaviors. It is therefore essential to
provide youth with opportunities for assuming responsibilities, especially those that help them to
feel that they are making a contribution to their home, school, or community environments. The
experience of making a positive difference in the lives of others reinforces self-respect and a sense
of hope. It serves as a powerful antidote to feelings of defeat, anger, and despair (Brooks, 1991).
Self-esteem and motivation are enhanced when youngsters believe they are making a positive
difference to others. As Werner (1993) has noted from the findings of her longitudinal study of
resilience:

Self-esteem and self-efficacy also grew when youngsters took on a responsible position com-
mensurate with their ability, whether it was part-time paid work, managing the household when a
parent was incapacitated, or, most often, caring for younger siblings. At some point in their young
lives, usually in middle childhood and adolescence, the youngsters who grew into resilient adults
were required to carry out some socially desirable task to prevent others in their family, neighbor-
hood, or community from experiencing distress or discomfort. (p. 511)

The child who was asked to become the “pet monitor” of the school is an example of a
youngster making a contribution. Other examples include an educator that we know who en-
listed adolescents with learning difficulties to create piggy banks to sell and sponsor a bake
sale and raffle, with the proceeds going to a needy family. The educator noted that the students’
self-esteem and cooperation improved as did the many academic skills that were involved in
the charitable project. Another example involved an elementary school we visited in which fifth
graders were “buddies” with kindergarten and first-grade students. They would spend time each
week with their buddies in a variety of possible activities including reading to them, helping
them with their work, or playing a sport with them. All of the students benefited from this ap-
proach and we were impressed by the atmosphere of cooperation that permeated the building.
A third example involved a school social worker who established a committee composed of five
elementary school students who were often absent from school. The committee focused on the
question of what prompted students to be absent and the five students engaged in “research” to
answer the question. Not only did they prepare a report of their findings, but they also recom-
mended keeping track of the attendance of first graders and intervening early for all first graders
 18. PERSPECTIVE AND COMMENTARY 399

who were absent a great deal. Since becoming members of this committee the attendance and
behavior of the five students improved significantly. They now had a reason to come to school.
Their input was valued.
In addition, youngsters can take care of plants in school, or paint murals on the wall, or hang
up favorite drawings. Requesting students to decorate the walls of a school is a strong antidote to
vandalism. Co-operative learning as well as tutoring younger children is also a powerful way of
increasing a sense of belonging and competence in the school setting (Brooks, 1991). We are re-
minded of the impressive results of the Valued Youth Partnership Program reported by the Carn-
egie Council on Adolescent Development (Hornbeck, 1989). This highly successful program,
which involved at-risk older students assisting younger students, was developed to address the
large percentage of youth dropping out of school before they reached high school. The Carnegie
report described:

A rise in tutors’ self-esteem is the most noticeable effect of the program. . . . As a result, only 2
percent of all tutors have dropped out of school. This is remarkable, given that all of these students
had been held back twice or more and were reading at least two grade levels below their current
grade placement. Disciplinary problems have become less severe, grades have improved, and at-
tendance of tutors has soared. (p. 47)

Intervention and Recommendation #3

Providing Opportunities for Making Choices and Decisions and Solving Problems:
Reinforcing a Sense of Ownership. Theories of self-esteem and motivation as well as
research about hope and resilience emphasize the importance of reinforcing the belief that one
has some control over one’s life (Brooks & Goldstein, 2004). A sense of powerlessness is often
one trigger for anger and a failure to meet the requirements of school. To develop a sense of
control, ownership, and autonomy, children require opportunities to learn the skills necessary
to make sound choices and decisions and to solve problems. They also need opportunities, in
keeping with their developmental level and interests, to apply and develop these skills, especially
in those situations that have an impact on their lives (Adelman & Taylor, 1983; Deci & Chandler,
1986; Deci & Flaste, 1995; Deci, Hodges, Pierson, & Tomassone, 1992; Dicintio & Gee, 1999;
Glasser, 1997; Kohn, 1993; Shure, 1994; Shure & Aberson, 2005).
If children and adolescents feel that they are always being told what to do, if they feel they
have little control over their lives, they are less likely to be cooperative. Teachers and other
professionals have many opportunities to reinforce problem-solving and decision-making skills,
which is an especially important goal when teaching students with learning and behavior prob-
lems; some examples follow.
We spoke with a group of teachers who always offered their students a choice in what home-
work problems to do. For example, if there were eight math problems on a page, the students
were told that they had to do six of the eight and it was their choice which six to do. The teachers
told us that they actually received more homework on a regular basis when permitting their stu-
dents some choice since it reinforced a sense of ownership for doing the homework. Similarly, a
resource room teacher found that students were more likely to write when he gave them several
pens each with a different color ink and asked them which color they would most like to use on
that day. When students are provided these kinds of options, they are less likely to view school as
an unbending, rigid environment.
Teachers should incorporate time in a class schedule to elicit the input of students about solv-
ing particular problems. Assisting students to articulate what the problem is, to think of possible
400 BROOKS AND GOLDSTEIN

solutions to the problems, and to consider the likely consequences of each solution, increases the
probability of children not only learning to solve problems, but also following through on the so-
lutions (especially since they have helped to formulate the solutions). For instance, when the first
author was principal of a school in the locked door unit of a psychiatric hospital, he established
a Student Council; the opportunity and structure for the student patients to discuss their concerns
and criticisms noticeably lessened hostility while increasing a more responsible attitude.
From an early age, we must involve students in providing input about their own education.
An article in Teacher Magazine (Jacobson, 1999) titled, “Three’s Company” about parent-teacher
conferences supports this belief:

When Michelle Baker first learned that her son Colin would take part in a parent-teacher confer-
ence, she was skeptical. “I thought, This is going to be a fiasco,” she recalls. Instead, the meeting
turned out to be a big success: Colin showed unusual insight into his academic strengths and
weaknesses. “He had the opportunity to hear his teacher talk about him with him sitting there,”
Baker says. “He was able to communicate and understand better what he was being judged on.”
(p. 23)

It is interesting to note that Colin was only in the first grade.

Intervention and Recommendation #4

Establishing Self-discipline by Learning to Discipline with Respect. As might be

expected, many of the questions asked at our workshops, especially about students with behavior
problems, revolve around the issue of discipline. In turn, we frequently ask the audience to reflect
upon the purpose of discipline. Not surprisingly, the first response we typically receive focuses on
the importance of establishing rules and guidelines in order to ensure that our home and school
environments are safe and that both children and caregivers feel secure. We are in total agreement
with this purpose of discipline, especially since we have seen what can occur in an environment
in which rules, limits, and consequences are vague and inconsistently followed.
However, we must not lose sight of a second very important purpose of discipline, namely, to
promote self-discipline and self-control in children and adolescents. It is difficult to conceive of
children developing high self-esteem, motivation, and resilience if they do not possess a comfort-
able sense of self-discipline, that is, a realistic ability to reflect upon their behavior and its impact
on others, and then to change the behavior if necessary (Brooks & Goldstein, 2001). In essence,
self-discipline implies ownership for one’s own discipline.
Before examining more closely strategies that nurture self-discipline without a loss of self-
esteem, we believe that one point about discipline deserves special mention. As much as possible,
parents, teachers, and other professionals should anticipate those situations that may prove very
difficult for particular youngsters, situations that are likely to result in disruptive behaviors. We
should consider ways to help children either avoid these situations, until we know that they are
better able to manage them, or to provide them with alternative behaviors. One illustration of a
preventative approach was the child who was appointed the “pet monitor.” Other examples teach-
er have implemented include: (a) having an active child take messages to the office every half
hour to provide needed physical activity, and (b) asking a disruptive child who was constantly
being sent to the assistant principal’s office for disciplinary purposes, to become the “assistant to
the assistant principal.” This position required the child to work in the assistant principal’s office
for a short time at the beginning of each day. The disruptive behavior ceased, especially as the
child formed a more positive relationship with the assistant principal and the latter’s secretary. In
addition, the child’s self-esteem and cooperation increased.
 18. PERSPECTIVE AND COMMENTARY 401

Even if we create school environments that lessen the probability of students misbehaving,
we still know that children will, at times, act in ways that invite disapproval from other peers and
adults. Many angry and resistant students require more limits and guidelines than their peers,
but they are the first to experience limits as significant impositions on their life, arguing that the
teachers are not being “fair.” We must remember that discipline stems from the word disciple and
should be understood as part of a teaching process. In helping children to develop self-discipline,
it is essential not to humiliate or intimidate them (Charney, 1991; Curwin & Mendler, 1988;
Mendler, 1992). Humiliation and intimidation are more likely to result in increased anger and
uncooperativeness, the very feelings and behaviors we wish to change.
If we want students to assume responsibility for their actions and to perceive rules as being
fair, they must understand the purpose of the rules and participate within reason in the process of
creating these rules and the consequences that follow should the rules be broken (Brooks, 1991;
Gathercoal, 1997; Marshall & Weisner, 2004; Nelsen, Lott, & Glenn, 1997). Adults often walk a
tightrope when discipline is involved, maintaining a delicate balance between rigidity and flex-
ibility, striving to blend warmth, nurturance, acceptance, and humor with realistic expectations,
clear-cut guidelines, and logical and natural consequences; several examples follow.
An assistant principal of a middle school asked students to write a brief essay while serving
detention. They were given a choice of over 30 topics including what they would do if they ran
the school, what they could do in the future to avoid detention, or what dreams they had for their
future. As we reviewed some of the themes the students had written about, we were impressed
with their ability to reflect upon their lives and their behaviors and to consider alternative ways of
behaving in the future. In addition, the exercise led to a decrease in defiant behaviors.
During the “orientation” period in the first couple of days of school, teachers may ask stu-
dents what rules they considered necessary in the classroom or school, the best ways to remember
these rules (so that adults did not have to remind or “nag” them), and the most effective conse-
quences when rules are broken. Students should also be informed about nonnegotiable rules that
are related to safety and security issues. Although some teachers have voiced reservations about
allowing students to have an input in the creation of rules and consequences (they predicted that
students would take advantage of the opportunity and eliminate all rules), we have found that the
students often create rules and consequences similar to those of the teacher. If anything, many
teachers have reported that they must help students with behavior problems to develop less rigid
and harsh rules and consequences.
The key point is that students are more likely to remember and adhere to rules that they have
helped to create since they feel a greater sense of ownership for these rules (McGinnis, Frederick,
& Edwards, 1995; Rademacher, Callahan, & Pederson-Seelye, 1998). In addition, if students
have a difficult time following their own rules, teachers can use their difficulty as an opportunity
to discuss more effective ways of remembering these rules.
One other important point about discipline is that perhaps the most powerful forms of dis-
cipline involve positive feedback and encouragement. We will include a discussion of this when
we consider ways to help students feel appreciated (point #6).

Intervention and Recommendation #5

Helping Children to Deal More Effectively with Mistakes and Failure. All children
worry about making mistakes and feeling foolish. Students with learning and behavior problems
are typically more self-conscious and/or worried about making mistakes than their peers. As
attribution theory highlights, these children often believe that mistakes cannot be modified and
are an ongoing source of embarrassment and humiliation. Many children spend more time and
402 BROOKS AND GOLDSTEIN

energy attempting to avoid a task they believe will result in failure than in seeking solutions.
This avoidance is often manifested in seemingly oppositional behaviors. Since self-esteem and
resilience are linked to a child’s response to mistakes and failure, we must convey the message to
students that mistakes are part of the learning process. We can do so in a number of ways.
Parents, teachers, and other professionals serve as models. We frequently ask youngsters to
describe how their parents or teachers handle mistakes or frustrations. We have heard a wide ar-
ray of responses including, “They scream,” “They yell,” “They don’t talk with each other,” “They
walk around with a frown on their face, “ “They blame us.” Obviously, these parents and teachers
are not modeling an effective way of dealing with frustration.
Similarly, teachers must reflect upon how they respond to a child’s mistakes. This implies
that we must have realistic expectations for children and not overreact to their mistakes or short-
comings. All of us from time to time become frustrated with the behavior of youngsters, but we
must avoid disparaging remarks such as: “You have to pay closer attention” or “Were you listen-
ing to what I had to say?” The goal is to communicate that mistakes will occur and we should
learn from them. We can also invite a child to problem solve by asking what might help to mini-
mize the mistake from occurring in the future.
Since the fear of failure has such a strong influence in classrooms, it should be addressed
directly even before any student makes a mistake. This can be accomplished during the “orienta-
tion” period. One illustration is for a teacher to ask at the beginning of the new school year, “Who
in this class feels that he or she is going to make a mistake or not understand something in class
this year?” Before any of the students can respond, the teacher raises his or her own hand and
then asks why they think this question was posed. The students’ responses can serve as a catalyst
to discuss how fears of making mistakes interfere with offering opinions, answering questions,
and learning. The teacher can then engage the class in problem solving by asking what he or she
can do as their teacher and what they can do as a class to minimize the fear of failing and looking
foolish.
To acknowledge openly the fear of failure renders it less potent and less destructive. Early
in the school year youngsters can be taught that not understanding material is to be expected and
that the teacher’s job is to help them to learn. Mistakes can be “celebrated” as part of the educa-
tional process. This intervention for dealing with mistakes is important for all students, but even
more so for those youngsters who feel insecure, vulnerable, and angry.
Adults who focus on children’s strengths and capabilities rather than on what they cannot do
lessen children’s fear of failure. For instance, the seemingly simple practice of teachers marking
tests by adding points for correct answers rather than subtracting points for incorrect answers
places the spotlight on the positive. At one school, teachers used green rather than red ink, feel-
ing that the use of red ink for indicating errors on papers had a negative impact on children. The
students we interviewed were strong supporters of this practice.

Intervention and Recommendation #6

Letting Students Know that They Are Welcome and Appreciated. In our workshops
we often ask the audience, “In the past week or two, what have you done to help another person
to feel appreciated?” We pose this question since we have found that although most of us are
thrilled to receive a note or phone call of appreciation, many well-intentioned people do not
make use of opportunities to show appreciation. We are reminded of an article about discipline
that we once read that contended that many adults have a “praise deficit.” We must make certain
that we find ways to welcome and appreciate all students and not just those who are cooperative
and well-liked.
 18. PERSPECTIVE AND COMMENTARY 403

Self-esteem, motivation, hope, and resilience are nurtured when we convey appreciation and
encouragement to students, when we become the “charismatic adults” in their lives. Words and
actions that communicate encouragement are always welcome and energizing. They are vital for
at-risk students, many of whom are burdened with anger and self-doubt, and may not at first ac-
cept the positive feedback. However, we must persevere and never forget that even a seemingly
small gesture of appreciation can generate a long lasting positive effect; examples follow.
We met a high school teacher who each year had more than 150 students in his different
classes. At the beginning of the school year, he told his students that he planned to call each of
them at least twice at home in the evening during the school year to find out how they were do-
ing. He told us that the practice took only about seven to eight minutes an evening, but had very
positive effects, including students being more respectful and more disciplined in class, and do-
ing their homework more regularly. This particular teacher was gifted in knowing how to help his
students to feel welcome and appreciated. Similarly, research indicates that when students have
at least one adult in school who they feel cares about them and is an advocate for them, they are
less likely to be violent or drop out and more likely to attend (Brooks, 1991, 2002).
Schools can hold recognition assemblies not just to acknowledge the achievements of stu-
dents with high grades, but also to spotlight the islands of competence of students whose grades do
not qualify for the honor role, but who have made other contributions to the school environment.

We Must Learn to Take Care of Ourselves, Striving to Become

Stress Hardy Rather than Stressed Out

At the conclusion of one of our workshops, a teacher said, “I love your ideas, but I’m too stressed
out to use them.” While the remark had a humorous tone, it also captured an important consid-
eration. At first glance, the remark seems paradoxical since numerous educators have informed
us that the strength-based approach and strategies we advocate, especially for working with
challenging students, do not take time away from teaching, but rather help create a classroom
environment that is more conducive to learning and less stressful. Yet, we can appreciate their
frustration that change requires additional time, a commodity that is not readily available. Some
are hesitant to leave their “comfort zone” even when this zone is filled with stress and pressure.
They would rather continue with a known situation that is less than satisfying than engage in the
task of entering a new, unexplored territory that holds promise but also uncertainty.
If educators are to become charismatic adults who apply many of the ideas described in this
chapter, they must venture from their “comfort zone” and utilize techniques for dealing with the
stress and pressure that are inherent in their work. Each teacher can discover his or her own ways
for managing stress. For instance, some can rely on exercise, others on relaxation or medita-
tion techniques, all of which can be very beneficial. In addition to these approaches, research
conducted by Kobasa and her colleagues (Holt, Fine, & Tollefson, 1987; Kobasa, Maddi, &
Kahn, 1982; Martinez, 1989) under the label of “stress hardiness” examines the characteristics
or mindset of individuals who experience less stress than their colleagues while working in the
same environment.
This mindset involves “3 C’s” (the first letter of each of the words of the mindset begins with
the letter “C”). The three components are interrelated and when we describe them at our work-
shops we encourage educators to reflect upon how they might apply this information to lessen
stress and burnout.
The first “C” represents “commitment.” Stress hardy individuals do not lose sight of why they
are doing what they are doing. They maintain a genuine passion or purpose for their work. While
we may all have “down” days, it is sad to observe educators who basically say to themselves each
404 BROOKS AND GOLDSTEIN

morning in a resigned way, “I’ve got to go to school. I’ve got to see those kids.” Once a feeling of
“I’ve got to” or “being forced to” pervades one’s mindset, a sense of commitment and purpose is
sacrificed, replaced by feelings of stress and burnout. As an antidote to burnout, a staff meeting
might be dedicated to sharing why one became a teacher, a school administrator, a counselor, a
nurse, or a school psychologist. Such an exercise helps staff to recall and invigorate their dreams
and goals.
The second “C” is for “challenge.” Educators who deal more effectively with stress have
developed a mindset that views difficult situations as opportunities for learning and growth rather
than as stress to avoid. For example, a principal of a school faced a challenging situation. Her
school was located in a neighborhood that had changed in a few short years from a middle-class
population with much parent involvement to a neighborhood with a lower socioeconomic make-
up and less parent involvement. Several key factors contributed to the decrease in parent involve-
ment, including less flexibility for many parents to leave work in order to attend a school meeting
or conference, as well as many parents feeling unwelcome and anxious in school, based upon
their own histories as children in the school environment.
Instead of bemoaning this state of affairs and becoming increasingly upset and stressed, this
particular principal and her staff realized that the education of their students would be greatly
enhanced if parents became active participants in the educational process; consequently, they
viewed the lack of involvement as a challenge to meet rather than as a stress to avoid. Among
other strategies, they scheduled several staff meetings in the late afternoon and moved the site of
the meetings from the school building to a popular community house a few blocks away. These
changes encouraged a number of the parents to attend the meetings since the new time was more
accommodating to their schedules and the new location helped them to feel more comfortable
since it was held on their “turf.” The relationship between parents and teachers was greatly en-
hanced and the children were the beneficiaries.
The third “C” is “control” or what we call “personal control” and is closely related to the
“dead horse” phenomenon we described earlier in this chapter. Control, as used in stress hardi-
ness theory, implies that individuals who successfully manage stress and pressure focus their
time and energy on factors over which they have influence rather than attempting to change
things that are beyond their sphere of control. Although many individuals believe they engage
in activities over which they have influence or control, in fact, many do not. We worked with a
group of teachers who were feeling burned out. We reviewed the basic tenets of stress hardiness
theory and asked if they focused their energies on factors within their domain of control. They
replied in the affirmative.
We then asked them to list what would help make their jobs less stressful. Their answers
included, “If the students came from less dysfunctional families, if they came to school better
prepared to learn, if they had more discipline at home.” After a few moments one of the teachers
smiled and said, “We first said that we focus on what we have control over, but everything that we
are mentioning to help us feel less stressed are things over which we have little control.”
After the teacher said this, the group engaged in a lively discussion focusing on what educa-
tors might do to create classroom climates that nurtured learning even if the students came from
home environments that were less than supportive of education. One teacher astutely noted, “We
are expecting our students to come to school excited about learning and, when they do not, we
get frustrated and annoyed. Instead, what I’m hearing is that we must ask, ‘What can we do dif-
ferently to help motivate students who are not motivated and what can we do to help students
who feel hopeless about learning to feel more hopeful.’” As the discussion continued, the teach-
ers recognized that by focusing on what they could do differently to improve the learning envi-
ronment was empowering and lessened stressful feelings. The mood of pessimism and burnout
 18. PERSPECTIVE AND COMMENTARY 405

that had pervaded the room began to change. Effective teachers appreciate that they must make
certain they take care of their own physical and emotional needs if they are to successfully meet
the needs of their students.

A CLOSING REFLECTION

In this chapter we have shared the evidence defining the characteristics of the mindset of effective
educators as well as the behaviors that accompany this mindset. These educators touch the hearts
and minds of students and assist even at-risk students to be more comfortable, secure, coopera-
tive, motivated, hopeful, and resilient in the school setting. As we have emphasized, the actions of
teachers have a lifelong impact on students. This impact is captured in the often-cited observation
of psychologist and educator Haim Ginott:

I’ve come to the frightening conclusion that I am the decisive element in the classroom. It’s
my personal approach that creates the climate. It’s my daily mood that makes the weather. As a
teacher, I possess a tremendous power to make a person’s life miserable or joyous. I can be a tool
of torture or an instrument of inspiration. I can humiliate or humor, hurt or heal. In all situations,
it is my response that decides whether a crisis will be escalated or de-escalated or a person human-
ized or de-humanized.

Ginott’s words are well worth considering as we seek to enrich the lives of students in our care.

NOTE

1. Since the case illustrations in this chapter are taken from both of our clinical and consultation practices,
we are using the plural (e.g., we and us) for each example, not only to simplify the writing style, but
also to acknowledge the contributions of material from both of our practices.

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 Index

A Americans with Disabilities Act, 3

Academic learning, cognitive processes, 263, 263 Antecedent interventions, attention-deficit/
Accommodation, 302–315, 398–400 hyperactivity disorder, 36–38, 37
alternate assessments, 305, 306 Anxiety, see Fears and related anxieties
behavioral accommodations, 311 Appreciation, 404–405
fairness, 302–303 Association for Health Care Policy Research, 9–10,
federal legislation, 304 11
Formative Accommodation Process model, Attention-deficit/hyperactivity disorder
307–309, 308 academic interventions, 49–52
Individualized Education Program, 303–304 antecedent interventions, 36–38, 37
Individuals with Disabilities Education behavioral function assessment, 43
Improvement Act, 303–304 behavioral symptoms, 34
modifications, 305, 306 characteristics, 34
presentation accommodations, 309–310 Class Wide Peer Tutoring, 49–50
rationale, 303 computer-assisted instruction, 46, 50
response accommodations, 310–311 consequent-based interventions, 39–42, 40
scheduling/timing accommodations, 311 contingency contract, 40, 41–42
selection decision makingtion selection, 305– evidence-based interventions, 35–43
309 monitoring of medication treatment, 35–36
setting accommodations, 311 gifted students, 341–344
types, 309–311 historical perspectives, 33–34
universal design for learning, 309–311 mathematics instruction, 239
Acculturation, English language learners, modifying academic tasks and instruction, 47,
322–325 50–51
ACTION Program, depression, 124 overview of school-based interventions, 36
parent training, 125–126 peer mediated interventions, 45, 48–49
teacher consultation, 125 peer tutoring, 46, 49–50
Adaptive aggression, 63 presentation of rules, 38–39
Advanced word study, reading difficulties, older relationships, 35
readers, 193–197, 197 response cost, 40, 41
intervention study results, 195–196 school-related difficulties, 34–35
practice implications, 196–197 self-management, 40, 42–43
word analysis, 194 self-monitoring, 47, 51–52
word recognition, 194–195 social relationship interventions, 43–52, 45–47
Advocacy social skills training, 44–48, 45
Education for All Handicapped Children Act, 6 special education, 35
federal legislation, 6 task-related choices, 38
Agency for Healthcare Research and Quality, 9–10, token reinforcement, 39–41, 40
11 Attention deficits, cognitive processing deficits,
standards, 21–22 277–278
Aggression, adaptive vs. maladaptive, 63 computerized interventions, 278
American Psychological Association self-monitoring, 278
evidence-based practice, 10 Auditory processing, cognitive processing deficits,
standards, 19–21 278–279

409
410 INDEX

Authority, service delivery models, 359, 364 fluid reasoning, 280

Autism, history, 5 future research directions, 281–282
history of processing interventions, 259–260
B importance of early interventions, 267
Bandura, Albert, 5–6 information processing theory, 260–262
Behavioral accommodations, 311 long-term memory interventions, 272–275
Behavioral disorders, 60 elaboration, 274
behavioral characteristics, 238–239 keyword method, 275
cognitive characteristics, 238–239 mnemonics, 275
early theorists, 5 organizational methods, 273–274
history, 5 practice and review techniques, 273
Behavior checklists, fears and related anxieties, 85 rehearsal, 273
Blending, 167 visual imagery, 274–275
metacognitive interventions, 275–276
C PASS Remedial Program, 279
Campbell Collaboration, standards, 22 PASS theory, 261
Challenge, 406 phonological processing interventions, 267–268
Change, effective educators, 392 planning
CHC theory, cognitive processing deficits, 261 interventions for, 276–277
Chunking, 271 mathematics, 277
Class Wide Peer Tutoring, attention-deficit/ strategy verbalization, 277
hyperactivity disorder, 49–50 PREP, 279
Clinical interview, fears and related anxieties, 86 processing speed, 280
Clinical psychology, standards, 19–21 processing theories, 260
Coalition for Evidence Based Policy, 11 recommendations, 280–281
Cognitive-behavioral therapy, 15 simultaneous and successive processing
depression, 115–123 interventions, 279
fears and related anxieties, 86–88 simultaneous processing, 279–280
Cognitive processes strategy training, 260
academic learning, 263, 263 history, 260
writing, 217 visual processing, 278–279
Cognitive processing deficits, 258–282 working memory interventions, 268–272
assessment, 262–263 chunking, 271
attention deficits, 277–278 classroom instruction strategies, 271–272
computerized interventions, 278 evidence-based working memory
self-monitoring, 278 interventions, 269–271
auditory processing, 278–279 interventions for related processes, 271
CHC theory, 261 rehearsal, 270–271
cognitive strategy interventions, 265–267 span tasks, 271
general strategy training procedure, 265–266 Cognitive strategy for learning, see Learning
good information processor, 266 strategy
range of interventions, 266 Cognitive strategy instruction, mathematics
selection of interventions, 266 instruction, 237
contemporary approaches, 259 Cognitive strategy interventions, cognitive
diagnosis, 262–263 processing deficits, 265–267
evidence-based interventions general strategy training procedure, 265–266
approaches to processing interventions, good information processor, 266
263–265 range of interventions, 266
combined interventions, 265 selection of interventions, 266
compensatory interventions, 264–265 Commitment, 405–406
remedial interventions, 264 Comorbidity, depression, 107–108
executive interventions, 275–276 Composing, writing instruction, 222–224
 INDEX 411

Comprehension comorbidity, 107–108

defined, 201–202 conceptualized, 103
reading difficulties course, 107
older readers, 200–207 definitions, 104–105
applying comprehension strategies, 203– diagnostic categories, 105
207, 205 ethnicity, 106–107
improving connections between content and evidence-based interventions
prior knowledge, 202–203 evaluation, 112–113
monitoring understanding, 204–206 implementation, 112–113
multiple-strategy interventions, 206–207 overview, 113, 116–122
National Reading Panel Report, 201–202, prevention, 109–111
202 gender, 106
questioning, 203–204, 205 Interpersonal Psychotherapy for Depressed
reading comprehension defined, 201–202 Adolescents, 123–124
relating content to prior knowledge, 202 lack of diagnosis, 103–104
summarization, 204–206, 205 lack of treatment, 104
younger readers, 179 magnitude of problem, 103
Computation, mathematics instruction, 239–242, medication, 113–114
243–246 minority students, 106–107
Computer-assisted instruction, attention-deficit/ overview, 104–109
hyperactivity disorder, 46, 50 prevalence, 105
Conduct disorder prognosis, 107
characterized, 62 psychotherapeutic interventions, 114–115
oppositional defiant disorder school factors, 109
comorbidity of, 62 symptoms, 104–105
distinction between, 62 Direct instruction, mathematics instruction, 237
Consequent-based interventions, 39–42, 40 Direct observation, fears and related anxieties, 86
Contingency contract, attention-deficit/ Disruptive behavior, 59–74, see also Specific type
hyperactivity disorder, 40, 41–42 characteristics, 60–64
Contribution, 400–401 collaborative development and implementation
Coping Cat program, 87–88 of interventions, 70
Coping with Depression course, 110, 123 definitions, 60–64
Coping with Stress course, 110 effect on student, 60
Council for Exceptional Children, standards, 21 evidence-based interventions
Counseling, gifted students, 351–352 individualized interventions, 68, 70–72
Counseling psychology, standards, 21 research-based interventions, 65–72, 68
responsiveness to intervention, 65
D small group interventions, 68, 68–69
Decision making, 401–402 system-wide interventions, 65–68, 68
Decoding extinction, 67–68
language impairments, 168–170 function-based intervention, 70–72
phonics, 168–169 functional assessment, 71
sight word recognition, 169–170 Function Matrix, 71, 71
structural analysis, 168–169 intervention plans, 71–72
reading difficulties, younger readers, 168–170 teach and reinforce replacement behavior, 72,
Delinquent acts, 62–63 73
Depression, 103–126 instruction in dealing effectively with, 66–67
ACTION Program, 124 performance feedback, 67–68
parent training, 125–126 prevention, 66
teacher consultation, 125 psychiatric diagnoses, 61–64
assessment, 108–109 school administrators, 59–60
cognitive-behavioral therapy, 109–111, 115–123 self-management, 69
412 INDEX

Disruptive behavior (continued) monitoring of medication treatment, 35–36

social skills instruction, 68–69 cognitive processing deficits
teachers, 59 approaches to processing interventions,
Distributed instruction, 216 263–265
Dysgraphia, writing instruction, 228 combined interventions, 265
Dyslexia compensatory interventions, 264–265
writing, 221 remedial interventions, 264
writing instruction, 225–226, 228–229 criteria for establishing, 16, 16–18
sustaining intervention by educating teachers, depression
226 evaluation, 112–113
implementation, 112–113
E overview, 113, 116–122
Education for All Handicapped Children Act, prevention, 109–111
advocacy, 6 disruptive behavior
Effective educators, see Teachers individualized interventions, 68, 70–72
Effectiveness research-based interventions, 65–72, 68
efficacy, relationship between, 14 responsiveness to intervention, 65
evidence-based practice, 14, 14–15 small group interventions, 68, 68–69
hierarchies of evidence, 14 system-wide interventions, 65–68, 68
Efficacy English language learners, 328
broad-based meta-analyses, 13–14 behavioral interventions, 331–333, 332
effectiveness, relationship between, 14 instructional interventions, 329–331
evidence-based practice, 13–14, 14 fears and related anxieties
hierarchies of evidence, 14 early intervention approaches, 92–94
Elaboration, 274 future research, 95–96
Emotional disorders, 60–61 pharmacological interventions, 90–92, 93
behavioral characteristics, 238–239 prevention, 92–94
cognitive characteristics, 238–239 psychosocial interventions, 86–90, 87
definition, 60–61 identification of “active ingredients,” 25–26
early theorists, 5 need for, 9–27
history, 5 as outgrowth of factors, 9
Empathy, effective educators, 393–394 quality of evidence, 16, 18
Empirically supported interventions, 11–12, 12 reading, 164–165, 165
Encouragement, 404–405 reading difficulties, younger readers, 177, 178
English language learners, 321–334 components, 179
acculturation, 322–325 conditions, 179
English accorded special and favored status, task difficulty, 179
322–325 research, 4–7
evidence-based interventions, 328 alignment of research and practice, 9–10
behavioral interventions, 331–333, 332 design, 16, 17
instructional interventions, 329–331 independence of studies, 16, 18
historical context, 322–326 number of studies, 16, 18
intuitive reasoning and culturally-bound beliefs, results, 4
321 specificity of intervention, 16, 17
mistaken assumptions, 322–326 specificity of problem and population, 16, 17
Equal access, 3 standards, examples, 18–22
Ethical issues, evidence-based practice, 23 writing instruction
Ethnicity, depression, 106–107 design experiments, 221–222, 223
Evidence-based interventions early intervention for at-risk primary grade
ability to detect effects, 16, 17–18 writers, 222–224
attention-deficit/hyperactivity disorder, 35–43 randomized controlled studies, 221–222,
future directions, 52–53 223
 INDEX 413

Evidence-based practice symbolic modeling, 89

American Psychological Association, 10 observational learning, 80
defining, 11–12 rating scales, 85
differentiation, 26 reinforced practice, 89–90
efficacy, 13–14, 14 relaxation techniques, 90, 91–92
elements for evaluating evidence, 16, 16–18 systematic desensitization, 90
enhancing student welfare and efficiency, 10 teachers, evaluation referral for child, 82
ethical issues, 23 Federal legislation, 3
federal legislation, 11 advocacy, 6
hierarchies of evidence, 12–16 evidence-based practice, 11
intervention integrity, 26 history, 6
key concepts, 12–16 Feedback, 199
legal mandates, 11 Figurative language, 148–150
methods of inquiry, 12–16 Five Standards for Effective Pedagogy, 330–331
problems, 23–26 Fluency
regulatory mandates, 11 defined, 197–198
research, issues, 23–26 reading difficulties, older readers, 197–200
resources for identifying, 23, 24–25 feedback, 199
standards, 16–23 fluency defined, 197–198
examples, 18–22 intervention study results, 198–199
terminology, 11–12 practice implications, 200, 201
third-party payers, 10 previewing/modeling procedures, 199
transportability, 15 repeated reading vs. non-repetitive wide
vs. empirically supported interventions, 12 reading, 199
Executive interventions, cognitive processing setting criterion vs. set number of rereads, 199
deficits, 275–276 Fluid reasoning, cognitive processing deficits, 280
Expectations, 384 Functional assessment, attention-deficit/
realistic, 398–400 hyperactivity disorder, 43
Extinction, disruptive behavior, 67–68 Functional communication
language impairments, 151–152
F variety of contexts, 152
Failure, 403–404 situated pragmatics, 152
Family Anxiety Management, 88 Function-based intervention, disruptive behavior,
Fears and related anxieties, 79–96, see also 70–72
Specific type functional assessment, 71
assessment, 84–86 Function Matrix, 71, 71
indications for, 82 intervention plans, 71–72
characteristics, 80–84, 81 teach and reinforce replacement behavior, 72, 73
clinical interview, 86
cognitive behavioral therapy, 86–88 G
direct observation, 86 Gender, depression, 106
evidence-based interventions Generalized anxiety disorder, 81, 83
early intervention approaches, 92–94 Gifted students, 336–352
future research, 95–96 appropriate academic fit/academic
pharmacological interventions, 90–92, 93 accommodations, 349–350
prevention, 92–94 attention-deficit/hyperactivity disorder, 341–344
psychosocial interventions, 86–90, 87 balance in gifted student’s life, 350–351
Family Anxiety Management, 88 counseling, 351–352
historical perspectives, 79–80 definition of, 337
modeling, 80, 88–89 guidelines, 348–352
live modeling, 88 history, 336–337
participant modeling, 89 learning disabilities, 338–340
414 INDEX

Gifted students (continued) setting accommodations, 311

mentorship, 350 types, 309–311
parents, 348–349 universal design for learning, 309–311
peer relations, 344–346 Instructional group size, reading difficulties,
perfectionism, 346–347 younger readers, 178–179
selection of, 337 Instructions, language, 326, 326–328
social intelligence, 351 Intermediate elementary school, mathematics
standard of excellence, 349 instruction, 243–247
suicide, 347–348 Interpersonal Psychotherapy for Depressed
underachievement, 340–341 Adolescents, 123–124
vulnerabilities and unique challenges, 338–346
Goals, 398–400 J
Grammar, contextually-based approaches, 142–143 Juvenile delinquency, 62–63
Grouping, service delivery models, 359, 368–370
K
H Keyword method, 275
Handwriting, writing instruction, 222 Kirk, Samuel, 5
Hierarchies of evidence
effectiveness, 14 L
efficacy, 14 Labels, service delivery models, 361–364
evidence-based practice, 12–16 Language
Hinshelwood, James, 4 instructions, 326, 326–328
Homicide, 64, 64 service delivery models, 359, 361–364
Hope, 398 writing, levels, 218
Language impairments, 135–154
I characteristics, 136–138, 137–138
IDEA 2004, Response to Intervention, 7 concept instruction, 144–145
Index crimes, 62–63 cooperative learning, 143–144
Individual instruction, 369 decoding, 168–170
Individualized instruction, 369 phonics, 168–169
Individuals with Disabilities Education sight word recognition, 169–170
Improvement Act of 2004, 3, 11 structural analysis, 168–169
Information processing theory, 291, 291 dialogue, 143–144
cognitive processing deficits, 260–262 figurative language, 148–150
Instructional accommodation, 302–315 functional communication, 151–152
alternate assessments, 305, 306 variety of contexts, 152
behavioral accommodations, 311 grammar, 142–143
fairness, 302–303 increasing language structure, 140–143
federal legislation, 304 increasing meaning, 143–151
Formative Accommodation Process model, learning disability, writing instruction, 229
307–309, 308 metacognitive learning, 151–152
Individualized Education Program, 303–304 morphology, 141–142
Individuals with Disabilities Education phonological awareness, 140–141, 165–168
Improvement Act, 303–304 blending, 167
measurement issues, 313–314 research base, 166–167
modifications, 305, 306 segmentation, 167–168
No Child Left Behind Act, 304 sequence of development, 166
presentation accommodations, 309–310 promoting interaction for information, 143
rationale, 303 providing structure to aid comprehension
response accommodations, 310–311 through literature, 150
scheduling/timing accommodations, 311 reciprocal teaching, 143–144
selection decision making, 305–309 research, 135
 INDEX 415

future directions, 153–154 Mathematical word problem solving interventions,

Response to Intervention, 135–136 242–243, 246–247
self-instruction, 151–152 Mathematics, 277
self-monitoring, 151–152 curricula and instructional practice, 236
situated pragmatics, 152 memory, 238
summary frames, 150–151 performance gap, 236
syntax, 141–142 Mathematics instruction, 236–253
teachers, 136–138 attention-deficit/hyperactivity disorder, 239
treatment principles, 138–140 cognitive strategy instruction, 237
vocabulary expansion, 145–150 computation, 239–242, 243–246
vocabulary instruction, 144–145 direct instruction, 237
Lau Remedies, 324 intermediate elementary, 243–247
Learning disabilities, see also Reading difficulties, mathematical word problem solving
older readers; Reading difficulties, younger interventions, 242–243, 246–247
readers math fact interventions, 239–242, 243–246
gifted students, 338–340 middle school, 247–249, 250
history, 5 number concept, 239–242
writing instruction, 228–229 primary school, 239–243
Learning strategy, 288–299, see also Specific type research, 237
advanced practice, 298 secondary school, 250–252, 251, 252
characterized, 289–290 Medication
commitment, 294 attention-deficit/hyperactivity disorder, 35–36
controlled practice, 297–298 depression, 113–114
describe, 294 Memory
design principles, 292, 293 cognitive processing deficits, 268–275
generalization, 298 mathematics, 238
instructional principles, 292–298 Mentorship, gifted students, 350
matching strategy design and instruction to Metacognitive learning
learner characteristics, 291 cognitive processing deficits, 275–276
modeling, 294–297 language impairments, 151–152
slant strategy, 295, 295 Middle school, mathematics instruction, 247–249,
post-test, 298 250
pretest, 294 Mindsets, 383–386
research effective educators, 387–407
history, 290–299 power of, 386
strategy instruction research, 298–299 Minority students, depression, 106–107
verbal rehearsal, 297 Mistakes, 403–404
Listening, connection with writing, 218 Mnemonics, 275
Live modeling, 88 Modeling
Long-term memory interventions, cognitive fears and related anxieties, 80, 88–89
processing deficits, 272–275 live modeling, 88
elaboration, 274 participant modeling, 89
keyword method, 275 symbolic modeling, 89
mnemonics, 275 learning strategy, 294–297
organizational methods, 273–274 slant strategy, 295, 295
practice and review techniques, 273 Monitoring, disruptive behavior, 69
rehearsal, 273 Morphology, 141–142
visual imagery, 274–275 Motivation, 396–398, 398
Multisystemic Treatment, 15
M
Maladaptive aggression, 63 N
Massed practice, 216 National Council of Teachers of Mathematics, 236
416 INDEX

National Reading Panel Report, 201–202, 202 reading difficulties, younger readers, 165–168
No Child Left Behind Act, 3, 11 blending, 167
reading difficulties, younger readers, 163–164 research base, 166–167
service delivery models, 365 segmentation, 167–168
teacher qualifications, 365–366 sequence of development, 166
Non-governmental education agencies, standards, Place, service delivery models, 359
22 Placement, service delivery models, 370–371
Number concept, mathematics instruction, 239– Planning, cognitive processing deficits
242 interventions for, 276–277
mathematics, 277
O strategy verbalization, 277
Observational learning, fears and related anxieties, PREP, cognitive processing deficits, 279
80 Presentation accommodations, 309–310
Oppositional defiant disorder Prevention
characterized, 62 depression, 109–111
conduct disorder disruptive behavior, 66
comorbidity of, 62 Previewing/modeling procedures, 199
distinction between, 62 Primary school, mathematics instruction, 239–243
Orientation period, 398 Problem solving, 401–402
Ownership, 401–402 Problem-Solving for Life program, 111
Processing speed, cognitive processing deficits,
P 280
Panic disorder, 81, 82–83 Process writing movement, 216
Paraphrasing strategy, 289, 289 Psychiatric diagnoses, disruptive behavior, 61–64
Parents, gifted students, 348–349 Psychotherapeutic interventions, depression,
Participant modeling, 89 114–115
PASS Remedial Program, cognitive processing
deficits, 279 Q
PASS theory, cognitive processing deficits, 261 Questioning, 203–204, 205
Patient Outcome Research Teams, 10
Peer mediated interventions, attention-deficit/ R
hyperactivity disorder, 45, 48–49 Rating scales, fears and related anxieties, 85
Peer relations, gifted students, 344–346 Reading, 4–5
Peer tutoring connection with writing, 218
attention-deficit/hyperactivity disorder, 46, evidence-based interventions, 164–165, 165
49–50 research, 164–165, 165
reading difficulties, younger readers, 180–181 simple views, 217–218
Penn Resiliency Program for Children and transfer of reading instruction to writing, 227
Adolescents, 110 transfer of writing instruction to reading,
Perfectionism, gifted students, 346–347 226–227
Performance feedback, disruptive behavior, 67–68 Reading difficulties
Personal control, 406 older readers, 193–209, see also Reading
Phonics, 168–169 difficulties, younger readers
Phonological interventions advanced word study, 193–197, 197
cognitive processing deficits, 267–268 intervention study results, 195–196
language impairments, 165–168 practice implications, 196–197
blending, 167 word analysis, 194
research base, 166–167 word recognition, 194–195
segmentation, 167–168 comprehension, 200–207
sequence of development, 166 applying comprehension strategies, 203–
phonological awareness, 140–141 207, 205
processing interventions, 267–268 monitoring understanding, 204–206
 INDEX 417

multiple-strategy interventions, 206–207 Rehearsal, 270–271, 273

National Reading Panel Report, 201–202, Reinforced practice, fears and related anxieties,
202 89–90
questioning, 203–204, 205 Relaxation techniques, fears and related anxieties,
reading comprehension defined, 201–202 90, 91–92
relating content to prior knowledge, Remedial reading programs, 4–5
202–203 Research
summarization, 204–206, 205 cognitive processing deficits, directions for
fluency, 197–200 future research, 281–282
feedback, 199 evidence-based interventions, 4–7
fluency defined, 197–198 alignment of research and practice, 9–10
intervention study results, 198–199 results, 4
practice implications, 200, 201 evidence-based practice, issues, 23–26
previewing/modeling procedures, 199 language impairments, 135
repeated reading vs. non-repetitive wide future directions, 153–154
reading, 199 learning strategy
setting criterion vs. set number of rereads, history, 290–299
199 strategy instruction research, 298–299
research, comprehension interventions, 207 mathematics instruction, 237
vocabulary, 207–208 reading, 164–165, 165
younger readers, 163–183, see also Reading reading difficulties, older readers,
difficulties, older readers comprehension interventions, 207
comprehension, 174–177 special education, 3–7
text structure, 174–177 writing instruction
comprehensive reading programs, 179 caveats about meta-analyses, 229–230
decoding, 168–170 cutting-edge research, 230
phonics, 168–169 generalization of research findings, 229
sight word recognition, 169–170 Resilience, 398
structural analysis, 168–169 Resourceful Adolescent Program, 110–111
evidence-based interventions, 177, 178 Respect, self-discipline, 402–403
components, 179 Response accommodations, 310–311
conditions, 179 Response cost, attention-deficit/hyperactivity
task difficulty, 179 disorder, 40, 41
fluency, 170–174 Response to Intervention
commercial programs, 171 IDEA 2004, 7
fluency and comprehension, 171–174 language impairments, 135–136
repeated readings, 170–171 Response to intervention, 65
vocabulary, 172–174 Responsibility, developing, 400–401
instructional group size, 178–179 Rules, attention-deficit/hyperactivity disorder,
literacy development, 163 38–39
No Child Left Behind Act, 163–164
peer tutoring, 180–181 S
phonological awareness, 165–168 Scheduling/timing accommodations, 311
blending, 167 School administrators, disruptive behavior, 59–60
research base, 166–167 School factors, depression, 109
segmentation, 167–168 School psychology, standards, 20
sequence of development, 166 School refusal, 81, 84
teachers, 183 School violence, 63–64, 64
knowledge, 181–182 Secondary school, mathematics instruction, 250–
preparation, 181–182 252, 251, 252
tutoring, 180–181 Segmentation, 167–168
unexpected reading failure, 163 Selective mutism, 81, 82
418 INDEX

Self-discipline, respect, 402–403 Standards

Self-efficacy, 400 Agency for Healthcare Research and Quality,
Self-esteem, 396–398, 400 21–22
Self-instruction, language impairments, 151–152 American Psychological Association, 19–21
Self-management Campbell Collaboration, 22
attention-deficit/hyperactivity disorder, 40, clinical psychology, 19–21
42–43 Council for Exceptional Children, 21
disruptive behavior, 69 counseling psychology, 21
Self-monitoring, 278 evidence-based interventions, examples, 18–22
attention-deficit/hyperactivity disorder, 47, evidence-based practice, 16–23
51–52 examples, 18–22
language impairments, 151–152 non-governmental education agencies, 22
Separation anxiety disorder, 81–82, 82 school psychology, 20
Service delivery models, 359–372 U.S. Department of Education, 21
authority, 359, 364 What Works Clearinghouse, 22
grouping, 359, 368–370 Strategy training, cognitive processing deficits, 260
history, 360–361 history, 260
labels, 361–364 Stress hardy, 405–407
language, 359, 361–364 Students, see also Gifted students
No Child Left Behind Act, 365 social-emotional needs of student, 387–390
place, 359 Suicide, 64, 64
placement, 370–371 gifted students, 347–348
Setting accommodations, 311 Summarization, 204–206, 205
Sight word recognition, 169–170 Symbolic modeling, 89
Simultaneous processing, cognitive processing Syntax, 141–142
deficits, 279–280 Systematic desensitization, fears and related
Situated pragmatics anxieties, 90
functional communication, 152
language impairments, 152 T
Skinner, B.F., 5 Task-related choices, 38
Slant strategy, 295, 295 Teachers
Social anxiety disorder, 81, 83–84 ACTION project, 125–126
Social intelligence, gifted students, 351 assumptions, 385–405
Socially maladjusted, 61 attribution theory, 392–394
Social relationship interventions, attention-deficit/ believing educators have lifelong impact,
hyperactivity disorder, 43–52, 45–47 385–387
Social skills training change, 390
attention-deficit/hyperactivity disorder, 44–48, defining and creating motivating environments,
45 392
disruptive behavior, 68–69 disruptive behavior, 59
Societal support, 3 empathy, 393–394
Span tasks, 271 fears and related anxieties, evaluation referral for
Speaking, writing, connections between, 218 child, 82
Special education, 3 language impairments, 136–138
attention-deficit/hyperactivity disorder, 35 mindsets, 387–407
complexity, 6 qualifications, No Child Left Behind Act,
historical aspects, 3–4 365–366
new concepts, 3–4 reading difficulties, younger readers, 183
research, 3–7 knowledge, 181–182
Specific phobia, 81, 82 preparation, 181–182
Speech-language pathologists, 135 social-emotional needs of student, 387–390
Spelling, writing instruction, 222–224 teacher philosophy and belief, 216
Spelling instruction, 216 training, 6, 365–368
 INDEX 419

writing instruction for students with dyslexia, flexibility, 145–146

226 meanings, 146–147
Testing accommodation, 302–315 relationships, 146–147
alternate assessments, 305, 306 variety, 145–146
behavioral accommodations, 311 Word study, see Advanced word study
decision making leading to accommodation Working memory interventions, cognitive
selection, 305–309 processing deficits, 268–272
fairness, 302–303 chunking, 271
federal legislation, 304 classroom instruction strategies, 271–272
Formative Accommodation Process model, evidence-based working memory interventions,
307–309, 308 269–271
Individualized Education Program, 303–304 interventions for related processes, 271
Individuals with Disabilities Education rehearsal, 270–271
Improvement Act, 303–304 span tasks, 271
measurement issues, 311–313 Writing
modifications, 305, 306 cognitive processes, 217
No Child Left Behind Act, 304 dyslexia, 221
presentation accommodations, 309–310 language, levels, 218
rationale, 303 listening, connections between, 218
response accommodations, 310–311 reading, connections between, 218
scheduling/timing accommodations, 311 simple views, 217–218
setting accommodations, 311 speaking, connections between, 218
types, 309–311 stages of writing development, 218–219
universal design for learning, 309–311 Writing instruction
Text structure, 174–177 at-risk writers, 219–220
Third-party payers, evidence-based practice, 10 composing, 222–224
Token reinforcement, attention-deficit/hyperactivity dysgraphia, 228
disorder, 39–41, 40 dyslexia, 225–226, 228–229
Transportability, evidence-based practice, 15 sustaining intervention by educating teachers,
Tutoring, reading difficulties, younger readers, 226
180–181 evidence-based interventions
design experiments, 221–222, 223
U early intervention for at-risk primary grade
Underachievement, gifted students, 340–341 writers, 222–224
U.S. Department of Education, standards, 21 randomized controlled studies, 221–222, 223
handwriting, 222
V historical perspectives, 215–217
Verbal rehearsal, learning strategy, 297 language learning disability, 229
Violence, 63–64, 64 learning disabilities, 228–229
Visual imagery, 274–275 meeting writing standards, 225
Visual processing, cognitive processing deficits, older struggling writers, 220–221
278–279 passing high stakes tests, 225
Vocabulary, reading difficulties, older readers, research
207–208 caveats about meta-analyses, 229–230
cutting-edge research, 230
W generalization of research findings, 229
What Works Clearinghouse, 11 spelling, 222–224
standards, 22 third-to-fourth grade writing transition, 220,
Witmer, Lightner, 4 224–225
Word analysis, 194 transfer of reading instruction to writing, 227
Word recognition, 194–195 transfer of writing instruction to reading,
Words 226–227
discussion to facilitate, 147–148 typically developing writers, 219