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 DataDawn P. Flanagan, Ph.D.St. John’s UniversityYale Child Study Center, School of Medicine

2. Presentation OutlineThe Field of School Psychology is Polarized on What Constitutes “Comprehensive” Assessment for SLD IdentificationThe Crux of the Debate is the Utility of Cognitive and Neuropsychological Tests for SLD Identification and for Guiding Intervention Selection and DevelopmentRTI and Cognitive Assessment are ComplimentaryContemporary Cognitive Assessment Differs from Traditional Cognitive AssessmentTier II Interventions Work for Many, But Not All StudentsTier 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 DiagnosisRather 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 SourcesAssessment for Intervention – Linking Cognitive Assessment Data to InterventionConclusions and Questions

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

4. Cognitive AssessmentTraditionalAtheoretical assessment and interpretive approaches (e.g., some subtest analysis approaches)Limited to no attention paid to neuropsychology literatureAbility-Achievement DiscrepancygWechsler V-P DichotomyVIQPIQ

5. Traditional Cognitive AssessmentVerbalAbilityFSIQNonverbalAbility1930s to the late 1990s

6. Cognitive AssessmentContemporaryCattell-Horn-Carroll (CHC) TheoryFlexible Battery ApproachesSchool NeuropsychologyAlternative research-based methods for identifying patterns of cognitive strengths and deficitsgGfGcGaGvGsmGlrGs

7. Cattell-Horn Gf-Gc TheoryGfGqGsmGvGaGsCDSGrwGcGlr Broad(Stratum II)Fluid IntelligenceQuantitativeKnowledgeCrystallized IntelligenceShort-TermMemoryLong-TermRetrievalVisual ProcessingAuditoryProcessingProcessingSpeedReading/WritingCorrectDecision 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 IntelligenceCarroll, 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 AbilitiesGGeneralIntelligence General(Stratum III)GfGcGyGvGuGrGsGtProcessingSpeed (RTDecisionSpeed)GeneralMemory &LearningBroadVisualPerceptionBroadAuditoryPerceptionBroadCognitiveSpeedinessBroadRetrievalAbility Broad(Stratum II)FluidIntelligenceCrystallizedIntelligence Narrow(Stratum I)69 narrow abilities found in data sets analyzed by CarrollFigure 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 AbilitiesBased largely on McGrew’s analyses in 1997-1999

12. Contemporary Cognitive Assessment Based on CHC Theory10 Broad Abilities and Over 70 Narrow AbilitiesIntegrated 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

14. Contemporary Cognitive AssessmentSB5 (2003) – Based on CHC theory

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

16. DAS-II (2007) – Based on CHC theorygGfGcGaGvGsmGlrGs

17. Contemporary Cognitive AssessmentWISC-IV (2003) – CHC terminology (e.g., Fluid Reasoning, Working Memory) and CHC approach to interpretation (Flanagan & Kaufman, 2004, 2009)

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 Treatmentas syndromes/disorders become more discretely defined, there may be a greater correspondence between diagnoses and treatmentKratochwill and McGivern's (1996; p. 351)

23. Individual Differences ARE ImportantWhy 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 thatone size DOES NOT fit all.

26. Comprehensive Evaluations (That Include Assessment of Cognitive Functions) Are Necessary for NonrespondersCost – BenefitDo 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 1Regular Education and Progress MonitoringNO, Tier III InterventionORNO, ComprehensiveEvaluation and Problem-solvingto Redirect InterventionFlanagan, 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 schoolsSevere difficulties in phonological awareness, letter-sound correspondence, and word readingThree conditionsTier 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 InterventionTier 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 usedResponsive Reading InstructionProactive Beginning Reading InstructionHigh levels of fidelity were achieved by intervention teachersReported in Denton, Fletcher, Simos, Papanicolaou, and Anthony, 2007

33. Results of Tier I and Tier II InterventionOf the 255 students who received Tier I and II interventions, only 22 were reading below average(below benchmark) at the end of the intervention periodBelow 30th percentile on WJ III Basic Reading Skills87 students did not reach a common oral reading fluency benchmark40 WCPM by end of 1st Grade14 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 Intervention16-week intervention provided daily in groups of two students to one teacherFirst 8 weeks students received the Phono-Graphix program (McGuiness et al., 1996) two hours dailyFollowed by 8 weeks of the Read Naturally program (Ihnot et al., 2001) one hour dailySix teachers were well trained in intervention programsStudents response to Tier III intervention was highly variableReported in Denton, Fletcher, Simos, Papanicolaou, and Anthony, 2007

35. Results of a Tier 3 Intervention PhaseBenchmark30th PercentileKey: 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 ConsiderationThe 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 InterventionResponder?NO, ComprehensiveEvaluation and Problem-solving for Differential Diagnosis and Intervention Selection or ModificationYES, Regular EducationInstruction and Progress MonitoringCriteria for SLD met?YES, Eligible forSpecial Education Services? Implement ModifiedIntervention and Progress MonitoringIn LRENO, Continued Problem Solving; Implement Modified Intervention and Progress MonitoringFlanagan, 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 STRENGTHAverage or higher abilities and processes; May also include strengths in academic skillsStatistically 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 averageStatistically significant difference between cognitive integrities and academic skill deficit(s)Academic deficit(s) is unexpected, not expected, because overall cognitive ability is at least averageDiscrepant/DiscordantDiscrepant/DiscordantACADEMIC WEAKNESS/FAILUREAcademic Skills/Knowledge DeficitsCOGNITIVE WEAKNESS/DEFICITCognitive Ability or Processing DisorderConsistent/ConcordantNo 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)GcGa GsGsmGlrImportant BroadCHC CognitiveConstructsImportant Narrow CHC CognitiveConstructsLDVLPCUSPMWMANACo-normedKABC-II Non. Wrd DcdTimed NWDVerbal Know.Timed Wrd RecPhon. Aware.Word OrderFluencyKTEA-IIAtlantisRiddlesRebusRANWJ III WM ClusterWJ III Aud. Attent.SupplementalWJ III Gs ClusterCTOPP= Consistent significant relation= Strongest and most consistent significant relation

41. Flanagan et al. Operational Definition of SLD A “Third Method” ApproachContinued on Next SlideFlanagan, 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” ApproachFlanagan, 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 DataPattern 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 160Grw Broad/Narrow ClusterReading Composite( )Sound Symbol ( ) Reading Fluency__(_ _)Domain-SpecificGa Broad/Narrow ClusterNonsense Wd Decod( )Phonol. Awareness_( )________________(___)Glr/Gs Broad/Narrow ClusterAssoc. Fluency_____(___)Naming Facility____(___)WJ III Gs Cluster__ (___)Historical Concept of Intra-Individual DiscrepanciesGlr-MA Broad/Narrow ClusterRebus_____________(___)Atlantis_ __________(___)__________________(___)Gsm Broad/Narrow ClusterWord Order__ ( )Number Recall_ ( )WJ III Working Mem. (__)Unexpected UnderachievementGf Broad/Narrow ClusterStory Comp.__ ( )Pattern Reasoning ( _)_______________ ( )Gv Broad/Narrow ClusterRover_ __( )Triangles_______ ( )_______________( )Gc Broad/Narrow ClusterExpressive 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 DataGENERAL Learning DifficultyDOMAIN-GENERALEXPECTED Underachievement(aka “Slow Learner”) 40 50 60 70 80 90 100 110 120 130 140 150 160Grw Broad/Narrow ClusterReading Composite( )Sound Symbol ( ) Reading Fluency__(_ _)Ga Broad/Narrow ClusterNonsense Wd Decod( )Phonol. Awareness_( )________________(___)Glr/Gs Broad/Narrow ClusterAssoc. Fluency_____(___)Naming Facility____(___)_________________(___)Glr-MA Broad/Narrow ClusterRebus_____________(___)Atlantis_ __________(___)__________________(___)Gsm Broad/Narrow ClusterWord Order__ ( )Number Recall_ ( )_______________(___)Gf Broad/Narrow ClusterStory Comp.__ ( )Pattern Reasoning ( _)_______________ ( )Gv Broad/Narrow ClusterRover_ __( )Triangles_______ ( )_______________( )Gc Broad/Narrow ClusterExpressive 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 classificationKavale, 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 educationKavale, Holdnack, & Mostert (2005, p. 12)

48. What is a Specific Learning Disability?IDEA Definitions and PracticesDetermining Specific Learning DisabilityDiscrepancy between “ability” and “achievement” (typically using cut-off points and global IQ)

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 ApproachesDella Tofallo(2010; pp. 180-181) – RTRI or Response to the Right InterventionMake 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 ApproachBob’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 interventionGlobal Ability at least Average; Low Achievement UnexpectedExclusionary Factors ruled out as primary reason for underachievementDomain-specific weaknesses/deficits in cognitive areas that are related empirically to achievement weaknessesMeets 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

63. RTI at Tiers I and IITier I ScreeningAt-risk in ReadingDecodingFluencyComprehensionTier II Treatment ProtocolReading RecoveryStudentsAmyBelindaCarlMascolo and Flanagan (2008)

64. Reading Recovery ResultsAmy, Belinda, and Carl are making some gains in Reading RecoveryNo appreciable change in reading performanceTier II “nonresponders”Need for a comprehensive evaluation that includes cognitive assessmentMascolo and Flanagan (2008)

65. Individual Differences Are ImportantOne Size Does Not Fit All

66. Instructional Planning is Complex and Requires a Team of ExpertsHome and CommunitySchool EnvironmentDiagnosticianRegular Ed TeacherCHILDMultiple Data SourcesKnowledge of and Access to Appropriate ResourcesParents and Other School PersonnelSpecial Ed TeacherMascolo and Flanagan (2008)

67. Linking Assessment to InterventionRequires good instrumentsWell trained cliniciansWell trained teachers and special educatorsA mechanism in place for bringing data together to problem-solve in an attempt to offer the most effective instruction and interventions to childrenMascolo and Flanagan (2008)

68. Intervention TypesNeed to differentiate betweenDirect Interventions (remediation)AccommodationsCompensationInstructional/Curricular ModificationsIntervention: any technique, product, or approach that intends to address directly an identified area of weakness through remediationAccommodations: 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 weaknessesMascolo and Flanagan (2008)

69. Different Cognitive Ability Profiles Suggest Different Interventions

70. Different Cognitive Profiles Suggest Different InterventionsAmy’s cognitive testing shows a significant deficit in phonetic coding – she doesn’t know how to translate symbols into soundsGa deficit impacts her fluency – labored readingLack of decoding and fluency impacts comprehensionIntervention should focus on Phonemic Awareness – Remediate GaMascolo and Flanagan (2008)

71. Different Cognitive Profiles Suggest Different InterventionsGc deficit – language deficitComprehension is poor b/c of low GcPoor vocabulary – needs to re-read to gain meaning, which impacts fluencyIntervention should focus on vocabulary development – Remediate Gc-VL, KOAccommodation of extended time due to a global Gs deficitMascolo and Flanagan (2008)

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