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Learning Disabilities and Anxiety: A Meta-Analysis

Jason M. Nelson and Hannah Harwood
J Learn Disabil 2011 44: 3 originally published online 7 April 2010
DOI: 10.1177/0022219409359939

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 Journal of Learning Disabilities

Learning Disabilities and Anxiety: 44(1) 3­–17

© Hammill Institute on Disabilities 2011
Reprints and permission:
A Meta-Analysis sagepub.com/journalsPermissions.nav
DOI: 10.1177/0022219409359939
http://journaloflearningdisabilities
.sagepub.com

Jason M. Nelson1 and Hannah Harwood2

Abstract
This article presents the results of a meta-analysis of the empirical literature on anxious symptomatology among school-
aged students with learning disabilities (LD) in comparison to their non-LD peers. Fifty-eight studies met inclusion criteria.
Results indicate that students with LD had higher mean scores on measures of anxiety than did non-LD students. The
overall effect size was statistically significant and medium in magnitude (d = .61) although substantial heterogeneity of
results was found. Moderator effects were examined for informant type, gender, grade, publication status, and identification
source. Informant type (i.e., self-, parent, or teacher report) explained a significant amount of variability in the sample
of studies, and identification source (i.e., school identified or special school and clinic/hospital identified) approached
statistical significance. Implications for assessment and intervention are discussed.

Keywords
learning disabilities, anxiety, meta-analysis, internalizing, multi-informant assessment

Learning disabilities (LD) and emotional problems have reaction theory have suggested that anxiety develops as a
been associated since the first conceptualizations of LD in result of learning difficulties, whereas primary disorder
the early 1900s. In early accounts of students with LD, theorists have argued that learning problems are caused by
emotional problems were portrayed as a normative experi- high levels of anxiety. Cerebral dysfunction theorists have
ence for this group of students (Blanchard, 1936; Gates, proposed that LD and anxiety have a common brain-based
1941; Siegel, 1954). More recently, it has been commonly etiology and, therefore, frequently co-occur. According to
assumed that students with LD experience significantly Spreen (1989), few data are available to either support or
more emotional difficulties than do their non-LD class- disconfirm any of these theories, although secondary reac-
mates (Abrams, 1986; Beitchman & Young, 1997; Bender tion theory is most commonly assumed to explain the
& Wall, 1994; Bryan & Bryan, 1977; Bryan, Burstein, & relationship between LD and emotional difficulties.
Ergul, 2004; Cohen, 1986; Elksnin & Elksnin, 2004; Rock, The intuitive appeal of secondary reaction theory is
Fessler, & Church, 1997; Spreen, 1989). Anxiety is a par- apparent. Academic achievement is a central activity of
ticular form of emotional distress thought to be frequently childhood; adequate progress in reading, writing, and math-
experienced by students with LD (Huntington & Bender, ematics represents one of the major developmental tasks to
1993). The common assumption that students with LD be accomplished during the school-age years (Walzer &
experience higher levels of anxiety than their non-LD peers Richmond, 1973). At an early age, children recognize the
do has yet to be empirically tested by application of quanti- importance placed on academic success by their teachers
tative statistical methods to the body of literature on this and parents. Therefore, those who struggle to master aca-
topic. In this study, we conducted a meta-analysis of the demic skills may develop an anxiety reaction in anticipation
extant studies on the presence of anxious symptomatology of possible academic failure (Zinkus, 1979). The experi-
among students with LD. ence of anxiety may become a greater obstacle to learning

Theoretical Explanations for 1

University of Georgia, Athens
the Relationship Between LD and Anxiety 2
University of North Carolina, Chapel Hill
A variety of theories have been developed to explain the
Corresponding Author:
possible relationship between LD and anxiety, including Jason M. Nelson, University of Georgia, Regents’ Center for Learning
secondary reaction, primary disorder, and cerebral dysfunc- Disorders, 337 Milledge Hall, Athens, GA 30602
tion theories (Spreen, 1989). Those espousing secondary Email: [email protected]

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4 Journal of Learning Disabilities 44(1)

than the student’s LD by compounding learning struggles stated that although separating students with special needs
or causing avoidance of academic work (Cohen, 1986). into distinct groups (e.g., LD vs. emotionally disabled)
serves a practical purpose by “determining which competing
professionals do what to whom under what circumstances”
Impact of Anxiety on Cognitive (p. 142), it also may cause the emotional distress purport-
and Academic Performance edly experienced by students with LD to go untreated.
A large body of research has indicated that high levels of Understanding the level of anxiety commonly experienced
anxiety have deleterious effects on performance on cognitive by students with LD would inform whether the routine
and academic tasks. High levels of anxiety introduce task- assessment of symptoms and the provision of intervention
irrelevant cognitions into the limited storage component of services to reduce anxiety are warranted. Because teachers
the information processing system. This anxiety-produced who specialize in LD likely do not receive training in these
distracting information disrupts attentional focus and con- types of interventions (Bryan & Bryan, 1977), a clearer
sumes space in working memory, resulting in inefficient understanding of students with LDs’ experience of anxiety
information processing (Eysenck, Derakshan, Santos, & could potentially inform training needs.
Calvo, 2007). Supraordinate components of the information
processing system are also negatively affected by high levels
of anxiety. In particular, individuals experiencing high levels Purpose of Study and Research Goals
of anxiety engage metacognitive skills (e.g., strategy use and Our primary purpose was to conduct a meta-analysis to
monitoring) less frequently (Fisher, Allen, & Kose, 1996; quantify the magnitude of the difference in anxious symp-
Pekrun, Goetz, Titz, & Perry, 2002; Veenman, Kerseboom, & tomatology, if any, between students with and without LD.
Imthorn, 2000). Deficits in specific cognitive abilities such as To address this purpose, we pursued two research goals.
working memory (Swanson & Sachse-Lee, 2001) and meta- First, we sought to determine whether students with LD had
cognition (Wong, 1991) are common characteristics of LD. higher mean scores than non-LD students did on measures
Additional impairment in these cognitive processes as a of anxiety and, if so, to determine the magnitude of the dif-
result of anxiety may be particularly debilitating. ference between scores. Second, we examined whether
High levels of anxiety likely have an epiphenomenal anxious symptomatology among students with LD varied
effect on academic performance via disruption of the infor- based on informant type (self-, parent-, or teacher-report),
mation processing system. For example, elevated anxiety gender, grade, identification source (school, special school,
during reading interferes with the phonological loop, caus- clinic/hospital, or researcher), and publication status (peer-
ing the need for articulatory rehearsal, which taxes working reviewed journal articles or dissertations).
memory capacity (Calvo & Eysenck, 1996). Because read-
ing involves holding information in working memory from
one sentence to the next, poor reading comprehension may Method
result when working memory is disrupted by anxiety (Eysenck Locating Studies
et al., 2007). Similarly, the negative association between
trait anxiety and math achievement has been found to be To locate relevant studies, we conducted searches using
mediated by verbal working memory (Owens, Stevenson, PsycINFO, ERIC, and Dissertation ProQuest databases.
Norgate, & Hadwin, 2008). Over time, the impact of persis- Search terms for group included learning disabilities,
tently heightened anxiety on academic achievement may learning disabled, and several variations (e.g., reading dis-
contribute to negative educational outcomes, such as failure abilities, dyslexia, math disabilities). The search included
to complete high school and failure to enter college the terms anxiety, anxious, internalizing, emotional, per-
(Kessler, Foster, Saunders, & Stang, 1995; Van Ameringen, sonality, and behavior for the dependent variable. The
Mancini, & Farvolden, 2003). terms depression and depressed were also searched because
it is common for anxiety and depression to be studied
together. Furthermore, the names of common narrow-band
Importance of Understanding the (e.g., Revised Children’s Manifest Anxiety Scale) and
Relationship Between LD and Anxiety broad-band measures that include anxiety scales (e.g.,
Understanding students with LDs’ experience of anxiety Behavior Assessment System for Children) were used as
has implications for assessment, intervention, and training. search terms. The search was limited to studies reported in
Several authors have argued that the emotional needs of and after 1977 because this was the first year that LD
students with LD are often neglected because they are often became a special education classification under the Educa-
served only for the LD itself (Bender & Wall, 1994; Rock tion for All Handicapped Children Act of 1975. All studies
et al., 1997; Sabornie, 1994). Bryan and Bryan (1977) discovered were reported between 1977 and 2007. After the

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Nelson and Harwood 5

database search was completed, we reviewed all reference of students with LD was selected because of a comorbid
lists of included studies to locate additional studies. condition (e.g., behavior disorder) or if the students were
We obtained 533 studies through the database search and selected because of any characteristic other than or in addi-
the reference list reviews. Of these studies, 277 were journal tion to LD (e.g., gifted LD). Studies were also excluded if
articles and 256 were dissertations. Seven studies (all disser- the sample had been represented in another study. When the
tations) could not be obtained through library loan because same study was reported in a dissertation and peer-reviewed
some university libraries employ a noncirculating policy for journal article, the peer-reviewed journal article was included
dissertations. When studies could not be borrowed, we con- and the dissertation was excluded. Finally, studies in which
ducted an Internet search to obtain current contact information a control group was not included were excluded if the
of the authors; however, this procedure did not lead to the manual for the instrument used could not be obtained to
acquisition of any of the seven dissertations. incorporate statistics for a comparison group. Fifty-eight
studies met all criteria and were included in this study.
Inclusion Criteria
Five inclusion criteria were used to select the studies. First, Coding Procedure
LD must have been defined according to state or federal edu- A template (available upon request from the first author)
cation guidelines, according to the criteria of the Diagnostic was developed prior to conducting the search to code the
and Statistical Manual of Mental Disorders, or according to a studies according to the inclusion criteria, exclusion crite-
method that was consistent with either of the two guidelines. ria, and moderator variables. Of the 533 studies coded, two
Additionally, studies were included if the sample of students independent raters coded 35%. The interrater agreement for
was reported to be eligible for special education services inclusion decisions was .96. When disagreements occurred,
through an LD placement in a public school but the authors coders reconsidered the study together until an agreement
did not further define the diagnostic requisites. Second, stu- was reached.
dents with LD were required to be school aged, defined as A separate rater agreement reliability index was calcu-
kindergarten to 12th grade. Third, for their studies to be lated for all moderator variables of the included studies.
included, researchers were required to report using an instru- Moderator variables included grade level, identification
ment to assess anxiety that was labeled as measuring anxiety source, gender, informant type, and publication type. To
exclusively or that was labeled as measuring anxiety and examine grade level, we categorized the studies as includ-
included an associated term (e.g., anxiety/withdrawn). We ing students in elementary school, middle and high schools,
excluded studies in which instruments were used that com- and mixed level. The elementary school category included
bined anxiety with other conditions such as anxiety/depression kindergarten through 6th grade; the middle and high school
or in which projective instruments (e.g., Rorschach) were category included 7th through 12th grades. Studies that
used to measure anxiety. Studies incorporating instruments incorporated groups that were mixed included students
that measured types of anxiety other than trait anxiety (e.g., from all grade levels or combined elementary and middle
test anxiety) or general anxiety (e.g., social anxiety) were school. If the author did not report grade level but reported
excluded. In this study, trait anxiety was defined as general age ranges, the grade level categories were imposed on
anxiety that is stable over time and across settings. Fourth, the age ranges. The elementary school category and the
authors of the studies also had to report statistics to calculate middle and high school category included students aged 5
an effect size. For studies in which a control group was not to 12 years and 13 to 18 years, respectively. The identifica-
included, the mean and standard deviation of the instrument tion source variable was categorized as school identified,
were used as the comparison statistics. The standardization special school identified, clinic/hospital identified, or
samples of the instruments were large; therefore, in line with researcher identified. Gender was coded as male or female.
other meta-analyses (e.g., Frazier, Youngstrom, Glutting, & The informant moderator variable was categorized as self-,
Watkins, 2007), a sample size of 100 was used to minimize parent, or teacher report. Publication status was either peer-
overrepresentation of these studies in the analysis. Fifth, reviewed journal article or dissertation. The interrater
studies were required to be reported in peer-reviewed journal agreement for moderator variables was .98. Again, when
articles or doctoral dissertations. disagreements occurred, coders reconsidered the study
together until they reached an agreement.
Exclusion Criteria
The sample of studies was further defined by applying the Analyses of Effect Sizes
following exclusion criteria. All single-subject and case We used the Comprehensive Meta-Analysis (Biostat, 2000)
studies were excluded. Studies were excluded if the sample computer program to conduct all analyses. Effect sizes were

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6 Journal of Learning Disabilities 44(1)

computed using the means and standard deviations of the permit moderator analyses, the number of studies for each
groups. If these statistics were not reported in the studies, potential moderator varied. When determining statistical
other data (e.g., t-test statistics) were used to estimate effect significance of the moderator effects, we attempted to
sizes. Cohen’s d was calculated for each analysis. Hedges’s reduce the risk of Type I error by using a conservative
g was also calculated because it corrects for bias of d when alpha level of .01.
small samples are used (Hedges, 1981). Because these effect
sizes were virtually identical in this study, only d is reported
because of its customary use in other meta-analyses. Results
A random-effects statistical model was used. Whereas Table 1 displays the sample sizes and effect sizes of each of
within a fixed-effect model an assumption is made that the included studies. A total of 3,336 students with LD were
one true (common) effect size underlies all the studies of included and a total of 97 effect sizes were calculated.
a meta-analysis, a random-effects model allows for the Effect sizes were interpreted in accordance with Cohen’s
possibility that the true effect size varies from study to (1988) guidelines that those ranging from .20 to .49, .50 to
study (Borenstein, Hedges, Higgins, & Rothstein, 2009). .79, and .80 and above should be regarded as small, medium,
We judged the assumptions of the fixed-effects model to and large, respectively. A positive effect size indicated that
be implausible because we could not assume that the fac- the individuals with LD experienced higher levels of anx-
tors that could influence each effect size were the same ious symptomatology than did non-LD individuals. Prior to
across studies. Rather, because of the manner in which conducting the analyses, we compared those studies in
researchers have investigated this topic (e.g., self- vs. which a non-LD control group was incorporated (n = 42) to
parent vs. teacher report) and the subjective nature of the those in which a non-LD control group was not included
phenomena under investigation, it was unlikely that each and a mean score from the norm sample of the instrument
effect size was influenced in the same way across studies. was imputed (n = 16) to determine whether combining
In such instances, the random-effects model is recom- these studies was justifiable. The result of this comparison
mended (Borenstein et al., 2009). was not statistically significant, Qb = 0.62, df = 1, p = .43,
The following procedures were incorporated to calculate indicating that it was reasonable to include these two types
the overall effect size. When more than one effect size could of studies together in our analyses.
be calculated per study, we calculated each effect size, com-
puted the mean of the effect sizes for each study, and
included the overall effect size in the analysis. For example, Analysis of Overall Effect Size
in the case that studies were longitudinal and statistics were The overall effect size was statistically significant (z = 10.95,
reported over time, we calculated an effect size at each time p < .001) and medium in magnitude (d = .61). Individuals
point and then combined them to obtain an overall effect with LD had higher mean scores on measures of anxiety
size for the study. This procedure prevented violation of the than did non-LD individuals. Table 1 shows that approxi-
assumption of independent data points. Violation of this mately 95% (55 of 58) of studies were in the direction of
assumption results in the allotment of undue weight to those students with LD having higher anxiety scores than did
studies with multiple effect sizes (Lipsey & Wilson, 2001). non-LD students. Because it is not guaranteed that we
Additionally, we examined the effect size distribution for located all the studies with relevant data for this topic, we
potential outliers by calculating standardized residuals. calculated the classic fail-safe N and found that 4,948 miss-
Values greater than three were determined to be outliers ing studies would need to be located to bring the p value to
because standardized residuals of this magnitude are rare greater than .01. To determine the number of studies that
(Hedges & Olkin, 1985). Outliers were not detected. would be needed to reduce the overall effect size to a trivial
To examine potential moderator effects, we disaggre- magnitude (designated as .19), we calculated Orwin’s fail-
gated the data from the overall effect size analysis. If safe N and found that 216 studies with a mean effect size
authors of the included studies reported data separately for of .1 would be needed to reduce the overall effect size to
a moderator variable, we combined these data to form one this magnitude.
overall effect size for the overall effect size analysis. In Table 1 displays a wide range of effect sizes (–0.21 to
contrast, for the moderator analyses, we entered the data 1.83). The null hypothesis that all studies share a common
separately for each classification of the moderator vari- effect size was rejected, Qw = 312.95, df = 57, p < .001. We
able. For example, when conducting the moderator variable calculated Tau (T) to investigate the distribution of effect
analysis for gender, if a study reported data separately for sizes surrounding the mean effect. The T was .37 and
males and females, we calculated an effect size for each equated to a 95% confidence interval of –0.12 to 1.34, indi-
gender rather than combining them into one effect size. cating that most of the true effects fell in this range.
Because not all studies reported disaggregated data to Additionally, we calculated the I2 statistic, which indicated

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Nelson and Harwood 7

Table 1. Effect Sizes of Included Studies

Study N of Learning Disabled Sample k d Lower Limit Upper Limit

Acker (1990) 48 1 0.95 0.53 1.38

Boersma (1984) 68 2 0.56 0.25 0.87
Bonner (1986) 50 1 0.56 0.18 0.94
Branch, Cohen, & Hynd (1995) 20 4 1.83 1.30 2.35
Breen & Barkley (1984) 15 1 0.93 0.38 1.49
Casey, Levy, Brown, & Brooks-Gunn (1992) 28 1 0.92 0.41 1.43
Clark (1982) 70 1 0.16 -0.14 0.47
Clark (1987) 30 2 0.27 -0.02 0.56
Cohen, DuRant, & Cook (1988) 221 1 0.55 0.23 0.88
Cohen & Hynd (1986) 40 1 1.20 0.81 1.59
Coronado (1995) 45 1 0.65 0.22 1.07
Ehly, Reimers, & Keith (1986) 23 1 0.91 0.35 1.47
Elder (1992) 28 2 0.70 0.15 1.25
Ellen (1989) 125 1 0.88 0.64 1.12
Fisher, Allen, & Kose (1996) 45 1 1.04 0.60 1.49
Goh, Cody, & Dollinger (1984) 30 1 0.48 0.07 0.89
Golden (1983) 39 1 0.75 0.29 1.21
Grewe (1993) 32 1 0.94 0.52 1.35
Grolnick & Ryan (1990) 37 1 0.78 0.31 1.25
Hale (1994) 64 2 0.89 0.60 1.18
Hiebert, Wong, & Hunter (1982) 39 1 0.85 0.39 1.30
Hildreth (1987) 68 2 0.86 0.51 1.21
LaGreca & Stone (1990) 11 1 1.07 0.16 1.99
Li (2003) 135 1 0.10 -0.16 0.35
Luettgen (1988) 18 1 0.07 -0.59 0.73
Maag & Reid (1994) 95 3 0.97 0.69 1.25
Margalit & Heiman (1983) 20 1 1.19 0.52 1.86
Margalit & Heiman (1986) 20 1 1.72 1.00 2.45
Margalit & Shulman (1986) 20 1 1.57 0.86 2.28
Margalit & Zak (1984) 108 1 0.68 0.41 0.95
Martinez & Semrud-Clikeman (2004) 90 3 0.27 -0.03 0.56
Mattison, Bagnato, Mayes, & Felix (1990) 69 1 0.38 0.07 0.69
McClain (1997) 48 6 0.97 0.73 1.22
Mercer (2004) 83 1 0.13 -0.17 0.42
Miller, Hynd, & Miller (2005) 20 1 0.56 0.04 1.07
Murphy (1984) 55 1 0.22 -0.12 0.56
Murray (1978) 104 1 0.21 -0.06 0.48
Newcomer, Barenbaum, & Pearson (1995) 85 12 –0.04 -0.20 0.12
Nussbaum & Bigler (1986) 75 3 0.98 0.71 1.25
O’Brien (2005) 24 1 1.25 0.78 1.72
Paget & Reynolds (1984) 106 1 0.47 0.19 0.75
Perez (1991) 66 2 0.18 -0.16 0.51
Reardon (1990) 30 1 0.03 -0.47 0.54
Reidy (1985) 20 1 0.21 -0.41 0.84
Rennels (1988) 106 1 0.98 0.69 1.27
Rodriguez & Routh (1989) 31 4 0.88 0.56 1.20
Schneider & Yoshida (1988) 30 1 0.62 0.11 1.14
Schnel (1982) 92 2 0.66 0.46 0.86
Short (1992) 31 1 0.19 -0.32 0.69
Sliwa (1977) 40 1 -0.10 -0.54 0.34
Stein (1990) 91 1 0.06 -0.23 0.34
Stein & Hoover (1989) 30 2 0.72 0.27 1.17
Toro, Weissberg, Guare, & Liebenstein (1990) 86 1 0.13 -0.17 0.43
Valenti (1986) 49 1 -0.21 -0.55 0.13
Vaughn, Zaragoza, Hogan, & Walker (1993) 10 4 0.39 -0.06 0.84
Weinberger (1981) 41 1 0.73 0.29 1.18
Wenner (1993) 23 1 1.09 0.43 1.75
Wilcutt & Pennington (2000) 209 1 0.29 0.09 0.48
Overall effect size (random effects) 3,336 97 0.61 0.50 0.72

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8 Journal of Learning Disabilities 44(1)

the proportion of observed variance due to real differences Table 2. Analyses of Moderator Effects
across the studies. The I2 of 81.79% indicated that a large Moderator N d Lower Limit Upper Limit
proportion of the variance was due to real differences across
the studies (Higgins, Thompson, Deeks, & Altman, 2003). Informant type
In summary, all tests of heterogeneity indicated substantial Self-report 25 0.43 0.28 0.59
variation across the results of the included studies and the Parent report 16 0.63 0.43 0.83
Teacher report 23 0.81 0.65 0.98
need for examination of potential moderator effects.
Identification source
School 44 0.56 0.44 0.68
Analysis of Moderator Variables Clinic or hospital   6 0.88 0.48 1.29
Special school   6 0.92 0.36 1.49
Table 2 displays the results of the moderator analyses. Researcher   2 0.32 0.14 0.50
Informant type was found to be a statistically significant Gender
moderator variable, Qb = 10.98, df = 2, p = .004. Post hoc Male 23 0.50 0.32 0.69
Female 11 0.45 0.18 0.72
tests indicated that anxious symptomatology among stu-
Grade
dents with LD was higher when rated with teacher reports Elementary 28 0.60 0.45 0.75
than when rated with self-reports, Qb = 10.80, df = 1, p = .001. Middle or high school 10 0.54 0.30 0.79
As shown in Table 2, the effect size based on teacher report Publication status
was large, whereas that based on self-report was small. The Journal 32 0.70 0.55 0.85
effect size was medium for results based on parent report, Dissertation 26 0.51 0.35 0.68
but the difference between parent and self-reports was not
statistically significant, Qb = 2.37, df = 1, p = .12. Differ-
ence in reports by teachers and parents was also not both elementary school and middle and high school stu-
statistically significant, Qb = 2.06, df = 1, p = .15. dents with LD were included and data were disaggregated
Table 2 displays the number of studies that incorporated according to these variables. Instead of examining how
the various identification sources (school, clinic/hospital, these groups of students with LD compared to non-LD stu-
special school, and researcher). The vast majority (n = 44) dents, we sought to examine how these groups of students
of studies were those with school-identified samples. We with LD compared to each other (i.e., female students with
judged the sample sizes of each of the other identification LD vs. male students with LD; elementary school students
sources to be inadequate for making comparison to the with LD vs. middle and high school students with LD). Ten
studies with school–identified samples. Instead, we com- studies were located in which within-study comparisons of
bined the studies with clinic/hospital–identified samples male and female students with LD could be made. The dif-
and those with special school–identified samples because ference in anxious symptomatology of female students with
they had similar results. The difference between the results LD as compared to male students with LD was not statisti-
of studies with school–identified samples and this com- cally significant, z = 1.45, p = .15, and the magnitude of the
bined group of studies approached statistical significance, nonsignificant difference between these groups was trivial
Qb = 4.49, df = 1, p = .03. The effect size was large for the (d = .09). We judged the number of studies (n = 2) in which
studies with special school– and clinic/hospital–identified both elementary school students with LD and middle and
samples and medium for the studies with school-identified high school students with LD were included and data were
samples. disaggregated by grade level to be insufficient for conduct-
Neither gender nor grade level was found to be a sta- ing this analysis.
tistically significant moderating variable. Results of studies We investigated the possible variation of results based
in which male students with LD were compared to non-LD on publication status in two ways. First, we compared the
students did not significantly differ from the results of stud- results of studies reported in peer-reviewed journals to
ies in which female students with LD were compared to those reported in dissertations. A statistically significant
non-LD students, Qb = 0.10, df = 1, p = .75. Likewise, difference based on publication status was not found,
results of studies in which elementary school students with although results were in the direction of published studies
LD were compared to non-LD students did not significantly having larger effect sizes than dissertations, Qb = 2.64,
differ from the results of studies in which middle and df = 1, p = .10. Second, we created a funnel plot using the
high school students with LD were compared to non-LD results of all published studies (see Figure 1). In the pres-
students, Qb = 0.15, df = 1, p = .70. To more directly inves- ence of publication bias, the funnel is dense and generally
tigate potential differences between students with LD by symmetrical at the top, has some gaps in the middle, and
gender and grade level, we searched the studies to find has a gap at the left side of the bottom (Borenstein et al.,
those in which both male and female students with LD or 2009). The latter aspect of the funnel is interpreted as the

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Nelson and Harwood 9

0.0 The overall effect size must be interpreted in light of the

heterogeneous results of the included studies. When such
0.1 heterogeneity exists, the overall effect size may be, and is
Standard Error

0.2
perhaps likely to be, misleading, and factors that may
explain such heterogeneous results should be explored
0.3 (Rosenthal, 1995). Our moderator analyses illustrate intri-
cacies in the research findings that must be considered to
0.4
fully understand the relationship between LD and anxiety.
0.5 The most interesting moderator variable discovered in this
–2.0 –1.5 –1.0 –0.5 0.0 0.5 1.0 1.5 2.0 study is informant type. Our analysis of this moderator indi-
Standard Difference in Means cates that the magnitude of differences between students
with and without LD on measures of anxiety significantly
Figure 1. Funnel plot of published studies
varies depending upon the person reporting the symptoms
(i.e., self-report vs. parent report vs. teacher report).
main indicator of potential publication bias because studies The extant literature on cross-informant agreement
with small sample sizes are unlikely to be published if appears pertinent to the interpretation of our findings,
effect sizes are small. Figure 1 displays a gap in the left although an important caveat should be kept in mind.
bottom section of the funnel, indicating the possibility of Researchers conducting cross-informant agreement studies
publication bias. Another noteworthy aspect of the funnel is have made within-study comparisons of parent, teacher, and
the cluster of studies at the top left outside of the funnel. self-reports, whereas we have made between-study compari-
These studies incorporated large samples that possessed sons. That is, our informant type analysis reflects comparisons
increased power to detect statistically significant differ- of parent, teacher, and self-reports across different samples
ences, despite only small effects. rather than comparisons of these reports when each infor-
mant rated the same sample. Therefore, our results do not
indicate differences in agreement among informants; rather,
Discussion they indicate different levels of anxious symptomatology
Our results confirm the common assumption that stu- among students with LD depending on whose perspective is
dents with LD experience higher anxious symptomatology considered. Despite this important difference, a cautious
than do their non-LD peers. The overall effect size found interpretation of our results within the context of the cross-
in this study is statistically significant. Perhaps more informant agreement literature appears defensible.
important is the delineation of the magnitude of students Overall cross-informant agreement tends to be low to
with LDs’ experience of higher anxious symptomatology moderate. Achenbach, McConaughy, and Howell (1987)
in comparison to their non-LD peers. The overall effect conducted a meta-analysis of this literature and found the
size of .61 is classified as medium. This finding indicates mean correlation between self-report and the reports of other
that approximately 70% of students with LD experience informants to be .22, with higher agreement for externaliz-
higher anxious symptomatology than do non-LD stu- ing problems than for internalizing problems. Researchers
dents. Unquestionably, this finding suggests cause for investigating cross-informant agreement among ratings of
concern that students with LD are at risk for potentially anxious symptomatology in particular have found generally
problematic anxiety-related distress. Although it is poor agreement (Choudhury, Pimentel, & Kendall, 2003;
highly important to acknowledge students with LDs’ Frick, Silverthorn, & Evans, 1994; Grills & Ollendick, 2003;
heightened risk for problems associated with anxiety, it Safford, Kendall, Flannery-Schroeder, Webb, & Sommer,
is also important to not exaggerate this risk. Our results 2005). Many studies have indicated that school-aged indi-
do not indicate that the LD population, on average, expe- viduals self-report more internalizing symptoms than parents
riences clinically significant anxious symptomatology. or teachers report for them (Angold et al., 1987; Bird, Gould,
In fact, in none of the studies did samples with LD have & Staghezza, 1992; Edelbrock, Costello, Dulcan, Kalas, &
mean scores in the clinically significant range, and the Conover, 1985; Epkins, 1996; Herjanic & Reich, 1997;
vast majority did not approach this level of severity. The Stanger & Lewis, 1993; Youngstrom, Loeber, & Stouthamer-
higher mean anxiety scores of students with LD suggest Loeber, 2000), although some have indicated that parents
that it is possible that they are more likely to experience report more internalizing symptoms for their children than
clinically significant anxiety than non-LD students are, the children report for themselves (Briggs-Gowan, Carter, &
but our findings are unequivocal in indicating that the Schwab-Stone, 1996; Frick et al., 1994; Krain & Kendall,
LD population, as a group, does not experience anxiety 2000). Teachers tend to report lower levels of internaliz-
at this level of severity. ing symptomatology among their students not only in

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10 Journal of Learning Disabilities 44(1)

comparison to students’ self-reports but also in comparison approach implies “no royal road or preeminent gold standard”
to parents’ reports for their children (Stanger & Lewis, 1993; (p. 228). Rather, divergent information across informants is
Youngstrom et al., 2000). This tendency may be one of the considered a valid reflection of variant behavior across set-
reasons teacher reports are regarded as less useful than are tings and situations (Achenbach et al., 1987; Stanger &
parent and self-reports for assessing children’s internalizing Lewis, 1993).
symptomatology (Loeber, Green, & Lahey, 1990). Depending on the interpretive approach to which one
Our results are similar to those of cross-informant agree- subscribes, our results could be considered as evidence that
ment studies in that the level of anxious symptomatology individuals with LD may underreport symptoms of anxiety
among school-aged students with LD appears to differ con- or that adults may overreport them. Little to no empirical
siderably depending on whose perceptions are assessed. evidence is available to support either possibility, although
The direction of these differences, however, is opposite that reasonable theoretical explanations can be provided for
of most cross-informant agreement studies. We found that both. A metacognitive explanation supports the possibility
the magnitude of anxious symptomatology differences that students with LD may underreport anxious symptom-
between students with and without LD was large when atology. The ability to reflect on emotional experience and
teachers’ perceptions were investigated, medium when par- to inform others of one’s emotions is partially dependent on
ents’ perceptions were investigated, and small when the metacognitive abilities (Safford et al., 2005). Individuals
students’ self-reports were investigated. Results from the with LDs’ metacognitive difficulties are well documented
investigation of the three informant types indicate that indi- (Wong, 1991) and may prevent them from accurately inter-
viduals with LD experience higher levels of anxious preting their emotional states. Secondary reaction theory’s
symptomatology than do non-LD individuals, but the level intuitive appeal potentially provides support for the possi-
of symptomatology differs based on the eye of the beholder. bility that adults may overreport symptoms of anxiety for
Different levels of anxious symptomatology dependent individuals with LD. Parents and teachers observe their
on informant type beg the question of which informant children or students with LD struggling to learn and perhaps
should be most relied upon in diagnostic decision making assume, albeit reasonably, that they must also experience
about internalizing problems. An easy answer to this impor- feelings of internalized distress such as embarrassment and
tant diagnostic question is unlikely because a gold standard anxiety.
does not exist for determining internalizing psychopathology Without a gold standard for validating internalizing psy-
(Safford et al., 2005). At least four approaches to interpreta- chopathology, it will be difficult for researchers and
tion have been proposed. The most liberal approach is to practitioners to determine the true level of anxious symp-
consider any positive report from any informant to indicate tomatology experienced by students with LD. Both
that the child experiences problematic internal distress. underreporting and overreporting are possible, but neither
Within this approach, all interpretive weight is attributed to is justifiable as an a priori assumption. Differences between
the informant who reports the highest level of symptoms. informants’ reports may also accurately reflect symptom
Two other approaches involve apportioning the majority of variation across specific settings and contexts. Therefore,
interpretive weight to specific informants, regardless of the all informants may contribute valid information even if
nature of the report. Within one of these approaches, chil- their reports differ. Judgments on how to weight divergent
dren are considered to be the best or most accurate sources information should be made on a case-by-case basis after
of information because the internal distress they potentially considering a complex array of information, taking into
experience may not be observable by their parents and account both personal and environmental characteristics
teachers (Angold et al., 1987; Edelbrock, Costello, Dulcan, influencing the reports of each source.
Conover, & Kalas, 1986; Herjanic & Reich, 1997). Those Another moderator that was valuable in explaining the
taking the other of these approaches rely more heavily on study’s heterogeneous results was the setting in which the
adult reports, particularly parent reports, when making students with LD were identified. The differences in anx-
diagnostic decisions about internalizing problems. Clini- ious symptomatology between students with LD identified
cians tend to take this approach; they have been found to in clinic/hospital and special school settings compared to
perceive parent reports to be more useful than children’s public school settings approached statistical significance,
self-reports (Loeber et al., 1990) and to rely most heavily with the trend in the direction of the former experiencing
on parent reports when making childhood anxiety disorder higher levels of anxiety than the latter. The effect size was
diagnoses (Grills & Ollendick, 2003; Krain & Kendall, large for those identified in special schools and clinic/
2000; Rapee, Barrett, Dadds, & Evans, 1994). The final hospital settings and medium for those identified in public
approach incorporates all viewpoints; those taking this school settings. These findings may be due to varying
approach do not assume that one informant type is better severity levels of LD. Students who are seen in clinic/
than another. According to Achenbach et al. (1987), this hospital settings are likely to be more severely disabled and

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Nelson and Harwood 11

to have a greater variety of problems than those in public non-LD samples has indicated that problems with anxiety
schools (Horn, O’Donnell, & Vitulano, 1983). This is also tend to increase with age (Costello & Angold, 1995).
likely the case for those students who are served in schools
that specialize in the treatment of LD. The results of this
analysis must be interpreted cautiously, however, because Limitations
the effect sizes generated for the clinic/hospital and special Our results should be interpreted in light of the following
school comparisons were based on only six studies each. limitations. For those studies in which information was not
Our results support the possibility of publication bias in provided on the grade level of participants, we imputed grade
the literature on anxiety and LD. Publication bias refers to levels to these samples by using the reported age ranges.
a phenomenon in which the published literature is not rep- Because age and grade level are generally well matched, we
resentative of all completed studies on a topic (Rothstein, believe this was a justifiable approach; however, we acknowl-
Sutton, & Borenstein, 2005). It generally refers to the ten- edge its imprecision and the potential for some samples to
dency for studies in which the null hypothesis has been have been slightly misclassified. Additionally, the generaliz-
rejected to be more likely to be published than studies with ability of our findings is limited by the incorporation of only
statistically insignificant findings. The funnel plot analysis one conceptualization of LD. Any generalization of our find-
of the published studies indicates missing published studies ings to groups identified by alternative approaches should be
in which small samples were used and small effect sizes done cautiously and conservatively. Finally, some of our
were found. Additionally, though not statistically signifi- moderator analyses were limited by low power to detect sta-
cant, the trend of findings was in the direction of larger tistically significant differences because of small numbers of
effect sizes in published studies (d = .70) than in disserta- studies. Although results of the studies were highly heteroge-
tions (d = .51). These results are consistent with publication neous, most data were not disaggregated in ways that
bias found in other literature bases (see Dickersin, 2005, for permitted the examination of our moderator variables. There-
a review) and illustrate the value of including unpublished fore, those moderator analyses with small numbers of studies
works in meta-analyses. According to Rothstein et al. should be interpreted cautiously.
(2005), publication bias is perhaps the greatest threat to the
validity of meta-analyses. Although some have argued
against the inclusion of unpublished studies due to poten- Implications for Research and Practice
tially inadequate quality (e.g., Weisz, Weiss, Han, Granger, Sufficient research evidence exists to conclude that students
& Morton, 1995), others have argued that a priori exclusion with LD are at greater risk for experiencing problems with
of such studies is problematic and may lead to a missed anxiety than are non-LD students. Future researchers should
opportunity for reducing threat to validity (e.g., Borenstein direct their focus to determining the mechanisms that
et al., 2009). Our inclusion of unpublished studies may underlie this increased risk rather than determining whether
have led to a reduced threat to the validity of our results. students with LD are at risk. Furthermore, protective factors
The moderator analyses for gender and grade level did that may prevent students with LD from developing prob-
not yield statistically significant findings. Additionally, the lems with anxiety should be explored. Finally, it would
results of the within-study analysis of gender indicate that likely be beneficial to investigate the effects of treatments
male and female students with LD do not experience sig- for anxiety problems on the academic achievement of stu-
nificantly different levels of anxious symptomatology. This dents with LD.
finding is different than would be predicted based on Regarding implications for practice, our results suggest
research using non-LD samples, in which females have the need for the screening of possible anxiety by those evalu-
been found to experience a higher prevalence rate of anxi- ating students with LD. The use of only self-report assessment
ety disorders than males do (Lewinsohn, Gotlib, Lewinsohn, measures is likely insufficient because individuals with LD
Seeley, & Allen, 1998). The results of our grade-level mod- may underreport their symptoms. Incorporating both parent-
erator analysis should not be interpreted as evidence that and teacher-report screeners in assessments of students with
elementary school students with LD and middle and high LD is unlikely to provide redundant information to that
school students with LD experience similar levels of anx- obtained through self-report and provides a more compre-
ious symptomatology. Rather, the magnitude of difference hensive clinical picture. Those conducting these assessments
between elementary school students with and without LD will likely encounter low cross-informant agreement. The
and the magnitude of difference between middle and high identification of anxiety will require an assessment approach
school students with and without LD are similar. Because that uses not only objective test scores but also considerable
of an insufficient number of studies, we were unable to clinical judgment to interpret cross-informant differences
directly compare elementary school students with LD and and to distinguish between normal and clinically significant
middle and high school students with LD. Research using anxious symptomatology. Practitioners may benefit from

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12 Journal of Learning Disabilities 44(1)

keeping the following in mind when determining how to difficulties but also significant emotional distress. Problems
apportion interpretive weight. First, some individuals who with anxiety should be not be regarded as inevitable, how-
are anxious may respond in a socially desirable manner ever, because the majority of students with LD who
to self-report anxiety measures because they are often experience higher anxious symptomatology than non-LD
overly concerned about self-presentation and being evalu- students do not experience these symptoms at clinically sig-
ated by others (Kendall & Flannery-Schroeder, 1998). This nificant levels.
tendency may lead to underreporting of symptoms. Second,
metacognitive difficulties may lead to inaccurate self- Declaration of Conflicting Interests
reporting in either direction. If the particular individual with The authors declared no potential conflicts of interests with respect
LD is suspected of metacognitive difficulties that negatively to the authorship and/or publication of this article.
affect accurate self-reporting, less interpretive weight should
be ascribed to this information. Third, adults’ reports of chil- Financial Disclosure/Funding
dren’s anxiety have been shown to be affected by their own The authors received no financial support for the research and/or
internal distress, which may result in overly sensitive report- authorship of this article.
ing of children’s symptoms (Frick et al., 1994). Finally, the
possibility that parents may overreport symptoms to obtain References
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Nelson and Harwood 17

Wong, B. Y. L. (1991). The relevance of metacognition to learning About the Authors

disabilities. In B. Y. L. Wong (Ed.), Learning about learning
disabilities (pp. 231–258). San Diego, CA: Academic Press. Jason M. Nelson, PhD, is Head of Research and a licensed
Youngstrom, E., Loeber, R., & Stouthamer-Loeber, M. (2000). Patterns psychologist at the Regents’ Center for Learning Disorders at the
and correlates of agreement between parent, teacher, and male University of Georgia. He is currently interested in issues related
adolescent ratings of externalizing and internalizing problems. to the assessment of learning disabilities and attention-deficit/
Jour­nal of Consulting and Clinical Psychology, 68, 1038–1050. hyperactivity disorder.
Zinkus, P. W. (1979). Behavioral and emotional sequelae
of learning disorders. In M. I. Gottlieb, P. W. Zinkus, & Hannah Harwood, MA, is a doctoral student in the School Psy-
L. J. Bradford (Eds.), Current issues in developmental pedi- chology Program at the University of North Carolina at Chapel
atrics: The learning-disabled child (pp. 183–218). New York, Hill. She is interested in the social-emotional functioning of
NY: Grune & Stratton. students with exceptionalities.

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