Screening for learning disabilities in preadolescents using psychosocial disability markers-a pilot study.
PURPOSE: Learning disabilities (LD) are among the most common developmental and psychiatric disorders encountered by pediatricians, yet many children are not adequately diagnosed or treated in elementary school when intervention is most effective. Because of the well-known co-morbidity between psychosocial problems and LD, this pilot study sought to utilize psychosocial "markers" to screen for unidentified LD among all fifth graders in three urban/suburb Connecticut elementary schools.METHODS: 115 fifth graders, representing a 71% response rate, agreed to participate in the study and were screened using standardized psychosocial questionnaires administered to parents (Child Behavior Checklist), students (Youth Self Report), and teachers (Teacher Report Form). Psychosocial symptom scores and associated t-scores were obtained for three types of problems; "internalizing," "attention" and "externalizing." 28 students with high levels (t > 60) of internalizing or attention problems, were selected along with a sample of 22 "normal" students with no evidence of psychosocial impairment. These 50 students were given an individually administered battery of ability, performance and cognitive processing tests to determine the presence of unidentified LD. Performance tests included standardized tests of reading, writing and mathematics. All test scores were normed with a mean of 100 and a SD of 15. LD was determined to be present if the student had a 1.5 SD or greater discrepancy between ability and performance in any of the three academic areas, and evidence of a cognitive processing deficit.RESULTS: The results indicated that 14 of the 50 students tested (28%) had evidence of undiagnosed LD. No significant difference was found in the proportion of undiagnosed LD among psychosocially impaired versus normal students. However regression analysis suggested that this finding was misleading. Controlling for ability, attention problems reported by the parent, were found to be significant (p < 0.05) predictors of lowered test scores, whereas internalizing problems were found to be predictive of increased test scores. Students with both internalizing and attention problems did not differ significantly from psychologically unimpaired students.CONCLUSIONS: This pilot study indicates that better screening methods are needed to identify the likely high proportion of elementary school children with undiagnosed learning difficulties and co-morbid psychosocial problems.