Framing Learning Disabilities and Disproportionality: Medicalization as an Obstacle of Progress

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an image of a brain, a hand with cash and two figures (one in all black and the other in all white) with two arrows (one going from the hand and the other going from the figure) to the brain

Illustration by Katie Gu

Article by Olivia First

Black students have been overrepresented in learning disability diagnoses for almost two decades. This places a disproportionate population in restrictive, stigmatized learning environments that teach derivative curricula, produce higher dropout rates, and can affect individuals across their life course. The educational community has attempted to address this disproportionality for years, but overrepresentation persists. This paper shows how an enduring psychopathological framing of learning disabilities has misguided interventions intended to address disproportionality. The medicalized conceptualization premises the narrative of overrepresentation as a product of misidentification and demands interventions that better distinguish between those with cognitive learning disabilities and those who are casualties of extrinsic circumstances. Despite these attempts to isolate a biological condition, academic achievement and socioeconomics are the best predictors of learning disabilities. As a result, a revised, social framing of learning disabilities would prompt more effective interventions that address the socio-demographic variables correlating with diagnoses and ultimately producing disproportionality. Through a historically rooted analysis, this paper attempts to highlight the inadequacy of the current response while also suggesting the expansive and intersectional causes and effects of educational inequity.

 

Introduction

Black students are overrepresented in learning disability diagnoses and have been since the Organization for Special Education Programs began recording race demographics in 2004.1,2 The educational community, however, has been concerned about this pattern since 1982.3 A disconnect between the cognitive, psychopathological conceptualization of learning disabilities and their social reality has maintained this disproportional representation. Socioeconomics and academic achievement are the best predictors of learning disabilities, indicating that a diagnosis reflects social difference rather than biology.4,5 Nonetheless, interventions attempting to address this disproportionality have focused on narrowing the diagnostic population to an objective group of learning disabled rather than addressing the responsible socio-demographics. As with any disease or disability, the treatment strategy is not random but instead reflects the historic and contextual framing of the condition.6 In the case of learning disabilities, neurological genesis and resulting cognitive conceptualizations premised a concern for minority overrepresentation. As a result, the legislative and diagnostic action to address this inequality both reflected and reinforced this physiological understanding. Deconstructing the history of learning disabilities and disparity reveals how their medicalized context and framing produced the ineffective intervention profile that maintains overrepresentation today.

 

Disproportionate Representation

While special education provides resources that are not available in general classrooms, it also teaches derivative curricula that can hinder students’ academic achievement.7,8 Across the country, students in special education graduate at a significantly lower rate than those in general education.9 Furthermore, the stigma of a learning disability diagnosis lowers teacher and parental expectations and contributes to lower academic achievement.10,11 Educators have paid particular attention to the representation of marginalized groups in learning disability diagnoses with the understanding that inappropriate representation can compound existing disparity.12 In 1975, The Center for the Study of Families and Children produced a report for the US Department of Health, Education, and Welfare; its opening lines read, “Classification, or inappropriate classification, or failure to get needed classification–and the consequences that ensure–can blight the life of a child, reduce opportunity, diminish his competence, and self-esteem, alienate him, from others, nurture a meanness of spirit, and make him less a person then he could become.”13 That same year, Congress enacted The Education of All Handicapped Children Act, which formalized a data collection and reporting process for the demographics of special education. Its language acknowledges the complexities highlighted in the US Department of Health, Education, and Welfare report, stating that this practice intended to both ensure that “handicapped children receive[d] special education and handicapped services” and to identify patterns of “erroneous classification.”14 More recent studies have reinforced fears of misidentification, revealing associations between a history of special education instruction and poor mental health, substance use disorders, reports of emotional or sexual abuse, and risk of contracting sexually transmitted infections (STIs).15,16,17 Determining the standard of appropriate representation, however, is complex and subjective. Deconstructing the historical and contextual framing of learning disabilities reveals how medicalized conceptualizations of the conditions have shaped this understanding and generated regulatory action that has failed to address the primary concern of compounded disparity for minority populations.

 

Foundations of Learning Disabilities

Doctors and psychiatrists were the first to study learning disabilities, establishing the condition’s conceptual foundation in ophthalmology and neurology. In 1877, German physician Adolph Kassamual coined the phrase “word blindness” to describe “complete text blindness…although the power of sight, the intellect and the powers of speech are intact.”18 Shortly after, two other doctors defined the term “dyslexia” to characterize a milder case of “word blindness” that created a “very great difficulty in interpreting written or printed symbols.”15 In both instances, the physicians cited ophthalmological pathology.19 In the early twentieth century, neurologist Alfred A. Strauss introduced a generalized psychopathological understanding of learning disorders, contesting that they were the product of some “minimal-brain injury” rather than optical impairment specifically.20* Finally, in 1963, psychiatrist Samuel A. Kirk coined the term “learning disability” to describe children with “disorders in development in language, speech, reading, and associated communication skills needed for social interaction.”21 Kirk remained a major contributor to the field of learning disabilities, serving as the leader of the National Advisory Committee of Special Education and continuing to produce literature on the condition. Throughout his writing, he consistently argued that learning disabilities were “intrinsic, cognitive or perceptual difficulties interfering with a child’s learning”, and attempted to distinguish them from general underachievement due to external factors.22** In 1968, Kirk and the National Advisory Committee of Special Education produced the first official definition of learning disabilities.23† Congress closely replicated this definition in the 1969 Specific Learning Disability Act and the 1975 Education of All Handicapped Children Act, which were the first federal documents responsible for regulating this condition.14,24 Their legislative language reflects and reinforces an intrinsic understanding of learning disability, stating that they are “psychological” and not a product of “environmental disadvantage”. Ultimately, the medical history of learning disabilities laid the groundwork for a biological understanding of the conditions.

 

Learning Disabilities as Intrinsic, Cognitive Conditions

These psychopathological conceptualizations shaped the interpretation of disproportionality in learning disability diagnoses. Demographic studies employed analytical techniques which assumed that appropriate diagnoses should reflect equivalent biologies rather than diverse socio-demographics. In 1982, The National Research Council published a foundational report on minority representation in special education.3 Summarizing 12 years of national surveys by the Office of Civil Rights, it found “an overrepresentation of minority children and males in special education.” Within the category of learning disabilities, however, it reported “proportional” representation among ethnic groups. To distinguish between proportionality and disproportionality, researchers employed bivariate analysis to compare the diagnostic rates of learning disabilities between ethnic groups. They defined disproportionality as an inconsistency in the frequencies of diagnosis between different ethnic groups and quantified this inequality using log odd indexes with white students as the reference population. Using newer data but the same methodology, recent reports have found an overrepresentation of black students within the learning-disabled population.25, 26 In each case, the allegation that proportionate means equal representation reflects a medicalized understanding of learning disabilities: if these conditions are biological, then diagnostic rates should be equally distributed across ethnic groups. In contrast, a social conceptualization might suggest that these rates are proportional to the socio-demographics of the different populations. Accordingly, psychopathological conceptualizations of learning disabilities premise the narrative of disproportionality.

Bivariate reports not only reflected cognitive conceptualizations of learning disabilities, but they also reproduced them. Their findings demanded techniques and strategies to better distinguish between those with intrinsic learning disabilities and those who were victims of referral racism or sociodemographic disparities.27,22 They framed the diagnostic and legislative action intended to address the apparent disproportionality. As a result, the interventions reflected and reinforced the idea that learning disabilities are intrinsic.

In response to reports of minority overrepresentation, Congress enacted numerous legislative amendments to create a narrower definition of learning disabilities that excluded social variables. Between when Congress provided the first definition of learning disabilities in 1969 and their authorization of the Education for All Handicapped Children Act in 1975, officials redefined the exclusion criteria for diagnosis. The 1969 definition stated that the term learning disability “does not include children who have learning problems which are primarily the result of visual, hearing, or motor handicaps, of mental retardation, of emotional disturbance, or of environmental disadvantage.”21 The 1975 Act, however, added cultural and economic disadvantage to the exclusion criteria.14 In the 2004 reauthorization of this law, which was renamed the Individuals with Disabilities Act, Congress added a disproportionality clause. This amendment required states to record and report rates of disability diagnoses by race.28 Similar to the statistical reports, this legislation implies that one can determine disproportionality using a single variable. It does not request any other socio-demographic information, reinforcing that “proportionate” diagnoses are equivalent diagnoses and should not reflect social conditions. In 2016, the Obama administration introduced the Equity in IDEA (Individuals with Disabilities Education Act) regulations, which provided guidelines for identifying significant disproportionality.29 According to the US Department of Education’s summary of the legislation’s goals and implications, the disproportionate representation of minority students in special education provoked these new guidelines intended to ensure that “overrepresentation was not the result of misidentification.”30 In every case, the amendments to disability legislation have attempted to narrow the diagnostic population and pursue sociodemographic-blind equality as a remedy for alleged minority overrepresentation.

The other major intervention, a shift in diagnostic techniques, also intended to address disproportionality through an improved identification process. In 1965, Barbara Batemen, Samuel Kirk’s research partner, reintroduced Marion Monroe’s discrepancy model to diagnose learning disabilities.31 It quickly emerged as the dominant diagnostic tool and framed learning disabilities as “educationally significant discrepancy between apparent capacity for language or cognitive behavior and actual level of language or cognitive performance.” To determine this “discrepancy,” evaluators compared IQ tests to academic performance, intending to differentiate between students with generalized intellectual disabilities and those with learning disabilities. In 2002, the President’s Commission on Excellence in Special Education produced a report with recommendations for addressing the overrepresentation of Black students in special education.24 They concluded that almost half of children diagnosed with a learning disability were casualties of poor teaching rather than actual disabilities. Furthermore, they emphasized that cultural biases in the IQ tests employed by the discrepancy model can misdiagnose students. To address this, they introduced the Response to Intervention (RTI) method. RTI emphasizes early intervention in the general classroom, with gradual increases in support if the child does not respond, and ultimately leads to psychological assessment and learning disorder diagnosis. It attempts to eliminate cultural IQ bias while distinguishing between students who have learning disabilities and those who are victims of poor generalized education. Congress officially recommended RTI as the diagnostic technique in the 2004 amendments to the Individuals with Disabilities Act, and it made financial resources available for early intervention practices.25 While recognizing that extrinsic variables currently contribute to learning disability diagnoses, RTI once again attempts to remove them: it seeks to distinguish the intrinsically disabled from those who are the victims of their circumstances.

 

Reconceptualizing Learning Disabilities and Disproportionality

Recent studies have found that socioeconomics and academic achievement are the best predictors for learning disability diagnosis.4,5 While neurological impairment may underlie some conditions, these findings indicate that learning disabilities currently function as measures of social difference rather than biology.32 Reconceptualizing learning disabilities as (principally) social conditions will encourage more productive strategies for addressing unequal minority representation in special education. It challenges the narrative of disproportionality, suggesting that diagnoses are proportionate to the sociodemographic disparities between races. This does not imply that the overrepresentation of black students in special education is unproblematic, but it reframes this gap as symptomatic of larger inequality in the United States rather than a separate phenomenon of racism. As a result, it encourages wider-scale interventions that centralize the role of social conditions, rather than education-specific ones that actively exclude them: if learning disabilities reflect students’ academic achievements and socioeconomics, then correcting diagnostic disproportionality requires addressing the factors that contribute to the racialized disparities within these demographics. This reframing demonstrates a distinct public health-minded approach to disability whereby we move away from simplistic, neurological understandings and instead consider the impact of social variables on disability conceptualization and identification. Adopting an intervention strategy that addresses academic achievement gaps, however, requires deconstructing the sources of knowledge production that reinforce and permeate the medicalized conceptualization of learning disabilities.

 

Notes:

* At this conference, Samuel A Kirk stated, “Recently, I have used the term ‘learning disabilities’ to describe a group of children who have disorders in development in language, speech, reading, and associated communication skills needed for social interaction. In this group I do not include children who have sensory handicaps such as blindness or deafness because we have developed methods of training the deaf and the blind. I also excluded from this group children who have generalized mental retardation.”

** In his writing, Samuel A. Kirk highlights the confusion surrounding the definition of learning disorders, which he says lead to “underachieving becoming synonymous with learning disabilities.”

† The report provides the following definition of learning disabilities, “Children with special learning disabilities exhibit a disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written languages. These may be manifested in disorders of listening, thinking, talking, reading, writing, spelling or arithmetic. They include conditions which have been referred to as perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia, developmental phasia, etc. They do not include learning problems which are due primarily to visual, hearing, or motor handicaps, to mental retardation, emotional disturbance, or to environmental disadvantage.”

 

References

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Katie Gu Olivia First