The document discusses using a "third method" approach to identifying specific learning disabilities (SLD) that integrates data from response to intervention (RTI) with cognitive assessment, as tier II interventions alone may not meet the needs of all students with SLD. It argues that a comprehensive evaluation including cognitive assessment is necessary for tier II nonresponders to identify cognitive strengths and weaknesses, allow for differential diagnosis, and guide targeted intervention selection. The "third method" evaluates for discrepancies between cognitive strengths and academic or cognitive weaknesses based on cognitive constructs from the Cattell-Horn-Carroll theory.

1. A Theory- and Research-based Approach to SLD Identification: Integrating RTI with Cognitive Assessment Data Dawn P. Flanagan, Ph.D. St. John’s University Yale Child Study Center, School of Medicine

2. Presentation Outline The Field of School Psychology is Polarized on What Constitutes “Comprehensive” Assessment for SLD Identification The Crux of the Debate is the Utility of Cognitive and Neuropsychological Tests for SLD Identification and for Guiding Intervention Selection and Development RTI and Cognitive Assessment are Complimentary Contemporary Cognitive Assessment Differs from Traditional Cognitive Assessment Tier II Interventions Work for Many, But Not All Students Tier II Nonresponders Should Receive a Comprehensive Evaluation That Includes Cognitive Assessment – Necessary to identify a disorder in one or more basic psychological processes and necessary for Differential Diagnosis Rather than using the traditional ability-achievement discrepancy method or an RTI-only approach to SLD identification, a “Third Method” Approach should be used Relevance of a “Pattern of Strengths and Weaknesses” for SLD Identification “Third Method” Approaches Integrate data from RTI with Other Data Sources Assessment for Intervention – Linking Cognitive Assessment Data to Intervention Conclusions and Questions

3. Cognitive Assessment for SLD Identification: The Field of School Psychology is Polarized Communiqué (2008) Why Is This The Question?

4. Cognitive Assessment Traditional Atheoretical assessment and interpretive approaches (e.g., some subtest analysis approaches) Limited to no attention paid to neuropsychology literature Ability-Achievement Discrepancy g Wechsler V-P Dichotomy VIQ PIQ

5. Traditional Cognitive Assessment Verbal Ability FSIQ Nonverbal Ability 1930s to the late 1990s

6. Cognitive Assessment Contemporary Cattell-Horn-Carroll (CHC) Theory Flexible Battery Approaches School Neuropsychology Alternative research-based methods for identifying patterns of cognitive strengths and deficits g Gf Gc Ga Gv Gsm Glr Gs

7. Cattell-Horn Gf-Gc Theory Gf Gq Gsm Gv Ga Gs CDS Grw Gc Glr Broad (Stratum II) Fluid Intelligence Quantitative Knowledge Crystallized Intelligence Short-Term Memory Long-Term Retrieval Visual Processing Auditory Processing Processing Speed Reading/ Writing Correct Decision Speed Narrow (Stratum I) 69 narrow abilities found in data sets analyzed by Carroll (1993) Figure by McGrew; originally printed in McGrew & Flanagan (1998)

8. A Landmark Event in Understanding the Structure of Intelligence Carroll, J. B. (1993). Human cognitive abilities: A survey of factor-analytic studies. New York: Cambridge University Press

9. Carroll’s (1993) Three-Stratum Theory of Cognitive Abilities G General Intelligence General (Stratum III) Gf Gc Gy Gv Gu Gr Gs Gt Processing Speed (RT Decision Speed) General Memory & Learning Broad Visual Perception Broad Auditory Perception Broad Cognitive Speediness Broad Retrieval Ability Broad (Stratum II) Fluid Intelligence Crystallized Intelligence Narrow (Stratum I) 69 narrow abilities found in data sets analyzed by Carroll Figure by McGrew; originally printed in McGrew & Flanagan (1998)

10. Carroll’s Research-based Conclusions About the Cattell-Horn Model “The Cattell-Horn model...is a true hierarchical model covering all major domains of intellectual functioning...among available models it appears to offer the most well-founded and reasonable approach to an acceptable theory of the structure of cognitive abilities” Carroll (1993)

11. An Integration of the Gf-Gc and Three-Stratum Theories of Cognitive Abilities Based largely on McGrew’s analyses in 1997-1999

12. Contemporary Cognitive Assessment Based on CHC Theory 10 Broad Abilities and Over 70 Narrow Abilities Integrated Model First Published in Flanagan, McGrew, & Ortiz (2000)

13. The WJ III(Woodcock, McGrew, & Mather, 2001) The first in a flurry of test revisions that represented advances unprecedented in assessment fields

15. KABC-II (2004) – Based on CHC theory and Luria

16. DAS-II (2007) – Based on CHC theoryg Gf Gc Ga Gv Gsm Glr Gs

18. WAIS-IV (2008) – CHC terminology and interpretive approach (Kaufman & Lichtenberger, 2009)Keith et al. (2006)

19. Summary of Relations between CHC Abilities and Specific Areas of Academic Achievement (Flanagan, Ortiz, Alfonso, & Mascolo, 2006) See McGrew and Wendling (in press) for an extension of this work

20. Comparison tables may be found in: Flanagan & Alfonso (in press). Essentials of Specific Learning Disability Identification. Hoboken, NJ: Wiley.

21. Subtypes of Reading Disability (Fiefer, in press) (1) Dysphonetic Dyslexia – difficulty sounding out words in a phonological manner (Ga-Phonetic Coding; Gsm-Memory Span, Working Memory) (2) Surface Dyslexia – difficulty with the rapid and automatic recognition of words in print (Glr-Naming Facility; Gv-Orthographic Processing; Gs-Perceptual Speed; Gc-Vocabulary Knowledge) (3) Mixed Dyslexia – multiple reading deficits characterized by impaired phonological and orthographic processing skills. It is probably the most severe form of dyslexia. (Multiple CHC abilities or processes involved; attention and executive functioning) (4) Comprehension Deficits – the mechanical side of reading is fine but difficulty persists deriving meaning from print (Gf-Induction, General Sequential Reasoning; Gc- Language Development; attention and executive functioning)

22. Correspondence Between Diagnosis and Treatment as syndromes/disorders become more discretely defined, there may be a greater correspondence between diagnoses and treatment Kratochwill and McGivern's (1996; p. 351)

23. Individual Differences ARE Important Why do some children fail to respond? Perhaps because interventions are being applied “blindly” as a one size fits all method without understanding whether or not specific cognitive deficits exist

24. Individual Differences ARE Important “A neuropsychological process that is important to reading skills development is working memory – it is a crucial process for early reading recognition and later reading comprehension. One must assess it if one is to develop the most appropriate method of intervention (Teeter et al., 1997).” “Given the findings from the neuroimaging and neruopsychological fields of deficient performance on measures of working memory, processing speed, auditory processing ability, and executive functions, evaluation of these skills is necessary to determine the most appropriate program to fit the individual child’s need.” Semrud-Clikeman (2005)

25. Individual Difference ARE Important “The danger with not paying attention to individualdifferences is that we will repeat the current practice of simple assessments in curricular materials to evaluate a complex learning process and to plan for interventions with children and adolescents with markedly different needs and learning profiles.” (Semrud-Clikeman, 2005) “Nonresponders” provide sound evidence that one size DOES NOT fit all.

26. Comprehensive Evaluations (That Include Assessment of Cognitive Functions) Are Necessary for Nonresponders Cost – Benefit Do Tier III interventions work? Would it make sense to gather more information about Tier II nonresponders prior to implementing Tier III interventions?

27. For a copy of this White Paper, contact James (Brad) Hale, Ph.D. at: jamesha@pcom.edu

28. Expert Panel Consensus For Using Intensive RTI to Meet the Needs of Children with SLD Item #8 Increasing intervention intensity in a multi-tier response to intervention model will meet the academic and psychosocial needs of all children with SLD Hale et al. 2010 Expert Panel White Paper (N = 58)

29. NAPSA Practitioner Survey Increasing intervention intensity in a multi-tier response to intervention model will meet the academic and psychosocial needs of all children with SLD McHale-Small NAPSA Survey (N=680; Administrators; Practitioners; Specialists)

30. Response at Tier II? Responder? YES, Return to Tier 1 Regular Education and Progress Monitoring NO, Tier III Intervention OR NO, Comprehensive Evaluation and Problem-solving to Redirect Intervention Flanagan, Fiorello, & Ortiz (in press); Flanagan, Ortiz, Alfonso, & Dynda (2008); Hale & Fiorello (2004)

31. Mathes and Colleagues (2005) Provided Tier I and Tier II intervention to struggling first-grade readers in six schools Severe difficulties in phonological awareness, letter-sound correspondence, and word reading Three conditions Tier I classroom instruction only (n = 92) Tier I plus Tier II intervention (consisting of Proactive Beginning Reading Instruction; Mathes et al., 1999; n = 83) Tier I plus Tier II intervention (Responsive Reading Instruction; Denton & Hocker, 2006; n = 80) Reported in Denton, Fletcher, Simos, Papanicolaou, and Anthony, 2007

32. Tier II Intervention Tier I instruction plus daily 40-minute, small group interventions for about 30 weeks in the first grade (groups of 3 students to one teacher) Six certified teachers who received about 42 hours of professional development delivered by the developers of the programs they used Responsive Reading Instruction Proactive Beginning Reading Instruction High levels of fidelity were achieved by intervention teachers Reported in Denton, Fletcher, Simos, Papanicolaou, and Anthony, 2007

33. Results of Tier I and Tier II Intervention Of the 255 students who received Tier I and II interventions, only 22 were reading below average(below benchmark) at the end of the intervention period Below 30th percentile on WJ III Basic Reading Skills 87 students did not reach a common oral reading fluency benchmark 40 WCPM by end of 1st Grade 14 students were identified for Tier III intervention based on primarily on availability (Denton, Fletcher, Anthony, & Francis, 2006; Mathes and colleagues, 2005). Reported in Denton, Fletcher, Simos, Papanicolaou, and Anthony, 2007

34. Tier III Intervention 16-week intervention provided daily in groups of two students to one teacher First 8 weeks students received the Phono-Graphix program (McGuiness et al., 1996) two hours daily Followed by 8 weeks of the Read Naturally program (Ihnot et al., 2001) one hour daily Six teachers were well trained in intervention programs Students response to Tier III intervention was highly variable Reported in Denton, Fletcher, Simos, Papanicolaou, and Anthony, 2007

35. Results of a Tier 3 Intervention Phase Benchmark 30th Percentile Key: PG = Phono-Graphic Phase; RN = Read Naturally Phase (From An evaluation of intensive intervention for students with persistent reading difficulties. Journal of Learning Disabilities, 39, 447-466. In D. Haager, J. Klingner, & S. Vaughn. [2007]. Evidence-based reading practices for response to intervention. MD: Paul H. Brookes Publishing Co., Inc.)

36. Important Consideration The education community must ask whether it is important and reasonable to expectthat even students with severe reading difficulties can be taught to read competently, closing the gap with their peers (Denton, Fletcher, Simos, Papanicolaou, & Anthony (2007). Can we help more children if we understand them better via a comprehensive evaluation?

37. Response to Intervention Responder? NO, Comprehensive Evaluation and Problem-solving for Differential Diagnosis and Intervention Selection or Modification YES, Regular Education Instruction and Progress Monitoring Criteria for SLD met? YES, Eligible for Special Education Services? Implement Modified Intervention and Progress Monitoring In LRE NO, Continued Problem Solving; Implement Modified Intervention and Progress Monitoring Flanagan, Fiorello, & Ortiz (in press); Flanagan, Ortiz, Alfonso, & Dynda (2008); Hale & Fiorello (2004)

38. A Comprehensive Evaluation , that Includes Cognitive Assessment, is Necessary for Tier II Nonresponders

39. Common Components of Third Method Approaches to SLD Identification COGNITIVE STRENGTH Average or higher abilities and processes; May also include strengths in academic skills Statistically significant difference between cognitive integrities and circumscribed cognitive ability or processing deficit(s) Cognitive deficit(s) is specific, not general or pervasive, because overall cognitive ability is at least average Statistically significant difference between cognitive integrities and academic skill deficit(s) Academic deficit(s) is unexpected, not expected, because overall cognitive ability is at least average Discrepant/Discordant Discrepant/Discordant ACADEMIC WEAKNESS/FAILURE Academic Skills/Knowledge Deficits COGNITIVE WEAKNESS/DEFICIT Cognitive Ability or Processing Disorder Consistent/Concordant No Statistically significant Performance Difference (constructs are related empirically ) Flanagan, Fiorello, and Ortiz (in press); Hale, Flanagan, and Naglieri (2008)

40. CHC Abilities and Processes Related to Basic Reading Skills and Reading Comprehension in Children Ages 6-8 Years (Cross-Battery Assessment or other Flexible Battery Approaches May be Necessary to Measure All Important Abilities and Processes) Gc Ga Gs Gsm Glr Important Broad CHC Cognitive Constructs Important Narrow CHC Cognitive Constructs LD VL PC US P MW MA NA Co-normed KABC-II Non. Wrd Dcd Timed NWD Verbal Know. Timed Wrd Rec Phon. Aware. Word Order Fluency KTEA-II Atlantis Riddles Rebus RAN WJ III WM Cluster WJ III Aud. Attent. Supplemental WJ III Gs Cluster CTOPP = Consistent significant relation = Strongest and most consistent significant relation

41. Flanagan et al. Operational Definition of SLD A “Third Method” Approach Continued on Next Slide Flanagan, Alfonso, and Mascolo (in press). In Flanagan & Alfonso (Eds.), Essentials of Specific Learning Disability Identification. Wiley

42. Flanagan et al. Operational Definition of SLD A “Third Method” Approach Flanagan, Alfonso, and Mascolo (in press). In Flanagan & Alfonso (Eds.), Essentials of Specific Learning Disability Identification. Wiley

43. Name:_____________________ Age: ____ Grade: ____ Examiner:____________________ Date: ___________ KABC-II and KTEA-II Data Pattern of generally average cognitive abilities and processes establishes basis for satisfying criterion of “an otherwise normal ability profile” Pattern of empirically or logically related cognitive and academic deficits establishes basis for satisfying criterion of “below average aptitude-achievement consistency” 40 50 60 70 80 90 100 110 120 130 140 150 160 Grw Broad/Narrow Cluster Reading Composite( ) Sound Symbol ( ) Reading Fluency__(_ _) Domain-Specific Ga Broad/Narrow Cluster Nonsense Wd Decod( ) Phonol. Awareness_( ) ________________(___) Glr/Gs Broad/Narrow Cluster Assoc. Fluency_____(___) Naming Facility____(___) WJ III Gs Cluster__ (___) Historical Concept of Intra-Individual Discrepancies Glr-MA Broad/Narrow Cluster Rebus_____________(___) Atlantis_ __________(___) __________________(___) Gsm Broad/Narrow Cluster Word Order__ ( ) Number Recall_ ( ) WJ III Working Mem. (__) Unexpected Underachievement Gf Broad/Narrow Cluster Story Comp.__ ( ) Pattern Reasoning ( _) _______________ ( ) Gv Broad/Narrow Cluster Rover_ __( ) Triangles_______ ( ) _______________( ) Gc Broad/Narrow Cluster Expressive Vocab. ( ) Verbal Knowledge ( ) _______________( ) 40 50 60 70 80 90 100 110 120 130 140 150 160

44. Name:_____________________ Age: ____ Grade: ____ Examiner:____________________ Date: ___________ KABC-II and KTEA-II Data GENERAL Learning Difficulty DOMAIN-GENERAL EXPECTED Underachievement (aka “Slow Learner”) 40 50 60 70 80 90 100 110 120 130 140 150 160 Grw Broad/Narrow Cluster Reading Composite( ) Sound Symbol ( ) Reading Fluency__(_ _) Ga Broad/Narrow Cluster Nonsense Wd Decod( ) Phonol. Awareness_( ) ________________(___) Glr/Gs Broad/Narrow Cluster Assoc. Fluency_____(___) Naming Facility____(___) _________________(___) Glr-MA Broad/Narrow Cluster Rebus_____________(___) Atlantis_ __________(___) __________________(___) Gsm Broad/Narrow Cluster Word Order__ ( ) Number Recall_ ( ) _______________(___) Gf Broad/Narrow Cluster Story Comp.__ ( ) Pattern Reasoning ( _) _______________ ( ) Gv Broad/Narrow Cluster Rover_ __( ) Triangles_______ ( ) _______________( ) Gc Broad/Narrow Cluster Expressive Vocab. ( ) Verbal Knowledge ( ) _______________( ) 40 50 60 70 80 90 100 110 120 130 140 150 160

45. On the Flanagan et al. and Kavale and Forness Operational Definitions of SLD… These operational definitions provide an inherently practical method for SLD identification that carries the potential for increased agreement about the validity of SLD classification Kavale, Holdnack, & Mostert (2005, p. 12)

46. The Importance of Assessing Cognitive Abilities and Processes and Academic Skills… By identifying specific targets for remediation, the possibilities for truly individualized intervention are increased significantly. Kavale, Holdnack, & Mostert (2005, p. 12)

47. The Value of Assessing Cognitive Abilities and Processes… Even if a student never enters the special education system, the general education teacher, the student’s parents, and the student him- or herself would receive valuable information regarding why there was such a struggle in acquiring academic content, to the point of possibly needing special education Kavale, Holdnack, & Mostert (2005, p. 12)

49. Failure to respond to scientific research-based intervention

50. May permit the use of other alternative research-based procedures for determining whether a child has a specific learning disability, as defined in §300.8(c)(10) (OSERS Final Regulations-8/06)

51. Flanagan and colleagues

52. Hale and Fiorello

53. McCloskey

54. Naglieri

55. Feifer and Della Tafano

56. Berninger

57. GearyAll value RTI approach; All consider RTI data in the diagnostic process

58. On Third Method Approaches Della Tofallo(2010; pp. 180-181) – RTRI or Response to the Right Intervention Make no mistake…integrated models [third method approaches] of identifying (and serving) students with LDs do not arrive prepackaged along with dozens of studies touting their “scientific validation.” However, they are evidence-based because they emanate from the marriage of a collective body of knowledge that has been acquired through research in the fields of neuroscience, pedagogy, assessment, and intervention.

59. “At the current state of scientific knowledge, it is only through a comprehensive evaluation of a student’s cognitive and psychological abilities and processes that insights into the underlying proximal and varied root causes of [academic] difficulties can be ascertained and then specific interventions be provided targeted to each student’s individual needs, a process long advocated” From Reynolds and Shaywitz (2009)

60. Diagnostic Impressions Following a Comprehensive Evaluation/Third Method Approach Bob’s academic difficulties in reading and writing have persisted despite being exposed to quality instruction and intervention over a prolonged period of time. These difficulties could not be explained by global cognitive impairment, social-emotional problems, cultural and linguistic differences, sensory-motor difficulties, lack of motivation, environmental disadvantage, or a health-related impairment. Rather, Bob exhibited specific and circumscribed weaknesses in cognitive areas that are known to be related to difficulties in reading and writing, namely short-term memory, retrieval ability, phonological processing, and possibly associative memory. Thus, while Bob has the ability to think and reason like most children his age, as demonstrated by his performance in the cognitive areas of Fluid Reasoning, Comprehension-Knowledge, and Visual-Spatial Thinking, he possesses specific and related cognitive and academic deficits that are consistent with a diagnosis of Specific Learning Disability (SLD). Failure To Respond to quality instruction and intervention Global Ability at least Average; Low Achievement Unexpected Exclusionary Factors ruled out as primary reason for underachievement Domain-specific weaknesses/deficits in cognitive areas that are related empirically to achievement weaknesses Meets third method criteria; “pattern of strengths and weaknesses” Flanagan, D. P., & Alfonso, V. C. (in press). RTI Data and Cognitive Assessment are Both Useful for SLD Identification and Intervention Planning. In N. Mather & L. E. Jaffe (Eds.), Expert Psychological Report Writing. New York, NY: John Wiley & Sons.

61. Learning Disability Quarterly, Volume 31, Summer 2008

62. Linking Assessment to Intervention

64. Reading Recovery Results Amy, Belinda, and Carl are making some gains in Reading Recovery No appreciable change in reading performance Tier II “nonresponders” Need for a comprehensive evaluation that includes cognitive assessment Mascolo and Flanagan (2008)

65. Individual Differences Are Important One Size Does Not Fit All

66. Instructional Planning is Complex and Requires a Team of Experts Home and Community School Environment Diagnostician Regular Ed Teacher CHILD Multiple Data Sources Knowledge of and Access to Appropriate Resources Parents and Other School Personnel Special Ed Teacher Mascolo and Flanagan (2008)

67. Linking Assessment to Intervention Requires good instruments Well trained clinicians Well trained teachers and special educators A mechanism in place for bringing data together to problem-solve in an attempt to offer the most effective instruction and interventions to children Mascolo and Flanagan (2008)

68. Intervention Types Need to differentiate between Direct Interventions (remediation) Accommodations Compensation Instructional/Curricular Modifications Intervention: any technique, product, or approach that intends to address directly an identified area of weakness through remediation Accommodations: any technique or support that intends to alleviate the symptomatology associated with an identified area of weakness (e.g., circumventing the impact of a processing speed weakness via extended time - - the symptom is not “Gs deficit” – that’s the problem; the symptom is “unfinished assignments” - - when you extend time you alleviate the symptom and assignments are completed. Compensation: strategies taught to a student that he or she is expected to apply independently to by pass weaknesses Mascolo and Flanagan (2008)

69. Different Cognitive Ability Profiles Suggest Different Interventions

70. Different Cognitive Profiles Suggest Different Interventions Amy’s cognitive testing shows a significant deficit in phonetic coding – she doesn’t know how to translate symbols into sounds Ga deficit impacts her fluency – labored reading Lack of decoding and fluency impacts comprehension Intervention should focus on Phonemic Awareness – Remediate Ga Mascolo and Flanagan (2008)

71. Different Cognitive Profiles Suggest Different Interventions Gc deficit – language deficit Comprehension is poor b/c of low Gc Poor vocabulary – needs to re-read to gain meaning, which impacts fluency Intervention should focus on vocabulary development – Remediate Gc-VL, KO Accommodation of extended time due to a global Gs deficit Mascolo and Flanagan (2008)

72. Different Cognitive Profiles Suggest Different Interventions Gsm deficit Decoding is poor – he cannot hold the complete phonemic string in mind long enough to say the word Comprehension is poor because he needs to allocate all memory space decoding words and therefore cannot focus on meaning Fluency is impaired because he must re-read the text to gain meaning Intervention should focus on developing a sight word vocabulary Carl needs to be taught compensatory strategiesto assist with poor Gsm (text previews; guided notes; one comprehension question at a time) Mascolo and Flanagan (2008)

73. Different Cognitive Ability Profiles Suggest Different Interventions All had same academic deficits (decoding, comprehension, fluency) All made slow gains with Reading Recovery All had different patterns of cognitive strengths and weaknesses Reading Recovery – allocating time to areas that do not need to be trained Not enough explicit instruction in main problem area because the intervention was not tailored Mascolo and Flanagan (2008)

74. Amy’s Intervention No need to focus on comprehension and fluency Amy needs phonemic awareness training Mascolo and Flanagan (2008)

76. Belinda’s Intervention No need to focus on decoding Belinda needs to focus on building her vocabulary She will also benefit from strategies/adaptations to build fluency Mascolo and Flanagan (2008)

78. Carl’s Intervention No need to focus on comprehension or fluency Carl needs sight word reading and memory strategies Mascolo and Flanagan (2008)

79. http://www.multilit.com.au/

80. RTI-Only Camp No evidence that your method is effective and leads to positive outcomes for children Lack of documented effectiveness is not the same as documented ineffectiveness Failure to Prove is not Proof of Failure (Braden et al., 2009) We are just beginning to do the research – using current instruments, current theory, current methods Look for upcoming special issue of JLD, Cognitive and Neuropsychological Assessment Data That Inform Educational Intervention (Guest Edited by Hale & Fuchs)

81. School Psychologists are Scientist-Practitioners Third method approaches then arrive to you “with a call to duty – the duty of the scientist- practitioner to engage simultaneously in both practice and research calculated to evaluate current practice in order to guide future practice.” Della Tofallo(2010; p. 180) – RTRI or Response to the Right Intervention

82. Conclusions

83. “To Test or Not To Test” is the Wrong Question Rather than Abandoning our Best Tools, Practitioners Need to Learn How to Integrate Assessment for Intervention into their Practice and Evaluate the Effectiveness of their Recommendations for Children with SLD

84. “In an ever-changing world, psychological testing remains the flagship of applied psychology” Embretson, S. E. (1996). The new rules of measurement. Psychological Assessment, 8 (4), 341-349.