Summary and Conclusions

Educational practice is at an exciting time in development. Not only have we evidence that children with dyslexia (and possibly other learning disabilities) have brain differences compared to control children, emerging data indicates that they respond relatively quickly to brain-based and comprehensive teaching approaches that have empirical support (Berninger, 2003). Additional findings indicate that the most effective interventions are those that involve systematic instruction that is explicit and continues throughout their school experience (Shaywitz, 2003). Moreover, the ability to predict response to intervention is best completed by neuropsychological measures of language and attention rather than the use of a discrepancy model (Stage et al., 2003). These findings support the use of a multi-method evaluation of skills required for successful reading. Strassner, Semrud-Clikeman, and Gerrard-Morris (2003) found that teachers have lower expectations of academic performance from children that have ADHD or learning problems. These expectations may, in turn, lead to less attention in the classroom and fewer appropriate interventions.

One of the most important conclusions from research is that for children with learning problems, learning is hard work. A corollary to this finding is that for their teachers, instruction is very hard work and requires an enormous amount of training and support. Prior to this point, much of the emphasis has been on a specific type of educational placement (resource and/or inclusion). However, it appears from the data from neuroimaging studies that we need to incorporate methods that are developed from scientifically supported instructional strategies and that we need to understand whether different types of interventions are interchangeable or work as efficiently for most children. Work on this aspect of learning disabilities has not been completed.

The definitional struggle that has characterized the field of learning disabilities is continuing. The important piece of this puzzle that has been missing in the debate is how do children respond to various interventions and can we match the intervention to the difficulty. We have several years of experience showing that the "usual" method of teaching reading works for most children with an adjustment (going from phonics to look-say, etc.) works for many children who cannot profit from a single method. What we have not fully discovered and what is now developing, is the ability to work with those children who have been defined as "treatment resistant;" that is, those children who do not seem to profit from either general approach. It is also not fully understood how these children may differ early on so that our intervention can occur before significant failure sets in.

We also need to improve our teacher training programs throughout the country. The pendulum in education appears to swing from one extreme to the next. We began instruction for special education in the 1970s with pull out programs. Then when these programs did not show as much improvement for these children, the field moved to putting the children back in the classroom and charging the regular education teacher with their education. When inclusion was first introduced, there was a great deal of angst in the regular education field as many teachers were not prepared to deal with children with various learning and emotional difficulties.

The three-tier approach to intervention has much promise but again we need to prepare our teachers so that they are best able to identify the children that need a fuller evaluation of their abilities. Given the findings from the neuroimaging and neuropsychological fields of deficient performance on measures of working memory, processing speed, auditory processing ability, and executive functions, evaluation of these skills are necessary to determine the most appropriate program to fit the individual child's need. The danger with not paying attention to individual differences is that we will repeat the current practice of simple assessments to evaluate a very complex learning process.

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