Journal of Nursing Education

Nursing Students with Learning Disabilities: Appropriate Accommodations

Michele J Eliason, PhD, RN

Abstract

Several pieces of legislation in the past 20 years (section 504 of the Rehabilitation Act in 1973, Public Law 94-142 in 1975, and the Americans with Disabilities Act in 1989) have allowed more individuals with disabilities access to higher education. The barriers, both physical and academic, are systematically being reduced in posteecondary education. However, it has been easier to remove the physical barriers than the academic barriers.

Students with learning disabilities generally do not need changes in the physical structure to succeed, but are often severely inhibited by academic barriers. Learning disabilities (LD) are the most common form of disability found in the college-age population, but often are unrecognized. Educational programs for LD students were mandated in 1975; therefore, many of today's college-age students benefited from these programs in their primary and secondary schools. Although they may have the intellectual ability to succeed in college, their cognitive and/or academic deficits may necessitate some accommodations in their programs in college.

Nurse educators will see increasingly greater numbers of students with LD applying for and being admitted to their programs. It is imperative that educators have some information about the characteristics of learning disabilities and some general forms of accommodations that may increase chances of success.

Definition

There are a number of different definitions for LD. One of the most widely used comes from the Association for Children and Adults with Learning Disabilities (now known as the Learning Disabilities Association):

Specific learning disabilities is a chronic condition of presumed neurological origin which selectively interferes with the development, integration, and/or demonstration of verbal and nonverbal abilities. Specific learning disabilities exists as a distinct handicapping condition in the presence of average to superior intelligence, adequate sensory and motor systems, and adequate learning opportunities. The condition varies in its manifestations and in degree of severity. Throughout life the condition can affect self-esteem, education, vocation, socialization, and daily living activities.

The federal definition (PL 94-142, 1975) identified three components of LD: average or above average intellectual abilities, academic achievement significantly below that expected by the individual's intelligence, and a deficit in one or more of the cognitive processes underlying learning. In most states, the diagnosis of LD depends only on the first two and LD is defined as a discrepancy between ability and achievement. However, the law does not state how large the discrepancy must be for it to be considered significant. Each state or region sets its own criterion.

Frequency of LD

Because of the diversity of definitions and the vagueness of diagnostic criteria, the prevalence of LD has been difficult to determine. Estimates range from 3% to 15% of the population (Yule & Rutter, 1976). Most of the prevalence studies have been done with children, but there is ample evidence that the vast majority of individuals do not "outgrow" LD, although their needs and problems may change (Blalock, 1982; Polloway, Smith, & Patton, 1988X Therefore, the rates of LD in adults should be similar to the rates in children. Astin, Green, Korn, Schalit, and Berg (1988) found that 6% of all college freshman in 1988 reported having at least one disability, twice the rate reported 10 years previously.

Most definitions include only "primary* LD, where the LD is the only form of disability. However, the number of individuals with "secondary" LD adds to the incidence figures. LDs often accompany convulsive disorders, diabetes, head trauma, and many types of birth defects and chronic illnesses (including sex chromosome anomalies, spina bifida, and cleft palate).

Characteristics and Accommodations

Many studies have documented the heterogeneity of LD (Boder, 1973; Mattis, French, & Rapin, 1975; Pirozzolo, 1979; Rourke, 1985).…

Several pieces of legislation in the past 20 years (section 504 of the Rehabilitation Act in 1973, Public Law 94-142 in 1975, and the Americans with Disabilities Act in 1989) have allowed more individuals with disabilities access to higher education. The barriers, both physical and academic, are systematically being reduced in posteecondary education. However, it has been easier to remove the physical barriers than the academic barriers.

Students with learning disabilities generally do not need changes in the physical structure to succeed, but are often severely inhibited by academic barriers. Learning disabilities (LD) are the most common form of disability found in the college-age population, but often are unrecognized. Educational programs for LD students were mandated in 1975; therefore, many of today's college-age students benefited from these programs in their primary and secondary schools. Although they may have the intellectual ability to succeed in college, their cognitive and/or academic deficits may necessitate some accommodations in their programs in college.

Nurse educators will see increasingly greater numbers of students with LD applying for and being admitted to their programs. It is imperative that educators have some information about the characteristics of learning disabilities and some general forms of accommodations that may increase chances of success.

Definition

There are a number of different definitions for LD. One of the most widely used comes from the Association for Children and Adults with Learning Disabilities (now known as the Learning Disabilities Association):

Specific learning disabilities is a chronic condition of presumed neurological origin which selectively interferes with the development, integration, and/or demonstration of verbal and nonverbal abilities. Specific learning disabilities exists as a distinct handicapping condition in the presence of average to superior intelligence, adequate sensory and motor systems, and adequate learning opportunities. The condition varies in its manifestations and in degree of severity. Throughout life the condition can affect self-esteem, education, vocation, socialization, and daily living activities.

The federal definition (PL 94-142, 1975) identified three components of LD: average or above average intellectual abilities, academic achievement significantly below that expected by the individual's intelligence, and a deficit in one or more of the cognitive processes underlying learning. In most states, the diagnosis of LD depends only on the first two and LD is defined as a discrepancy between ability and achievement. However, the law does not state how large the discrepancy must be for it to be considered significant. Each state or region sets its own criterion.

Frequency of LD

Because of the diversity of definitions and the vagueness of diagnostic criteria, the prevalence of LD has been difficult to determine. Estimates range from 3% to 15% of the population (Yule & Rutter, 1976). Most of the prevalence studies have been done with children, but there is ample evidence that the vast majority of individuals do not "outgrow" LD, although their needs and problems may change (Blalock, 1982; Polloway, Smith, & Patton, 1988X Therefore, the rates of LD in adults should be similar to the rates in children. Astin, Green, Korn, Schalit, and Berg (1988) found that 6% of all college freshman in 1988 reported having at least one disability, twice the rate reported 10 years previously.

Most definitions include only "primary* LD, where the LD is the only form of disability. However, the number of individuals with "secondary" LD adds to the incidence figures. LDs often accompany convulsive disorders, diabetes, head trauma, and many types of birth defects and chronic illnesses (including sex chromosome anomalies, spina bifida, and cleft palate).

Characteristics and Accommodations

Many studies have documented the heterogeneity of LD (Boder, 1973; Mattis, French, & Rapin, 1975; Pirozzolo, 1979; Rourke, 1985). Most experts believe that LD represents a group of related disorders with different characteristics, requiring different types of treatments and/or accommodations.

Some of these studies have examined differences in academic problems such as students with reading/spelling disabilities (often called dyslexia) versus students with math disabilities (McKinney, 1984; Rourke, 1985). Others studied underlying cognitive patterns and found that while most LD students have difficulty with language and memory processes, others have nonverbal processing problems (Thompson, 1985). Because 80% to 90% of students with LD have language and/or memory deficits, this article focuses on these problems. For a detailed discussion of nonverbal processing LD, see Rourke ( 1989).

Short-term memory deficits can affect many aspects of a person's life, from following verbal directions on a quiz to finding one's car keys. Most students with LD have difficulty encoding information in short-term memory. If the information is not properly encoded, it is more difficult to retrieve from the long-term store. The academic consequences can be poor reading and/or slow rate of reading, better memory f°r concepts than details, poor memory for sequences (order) important in math and spelling, and greater fatigue associated with learning. Many students with this type of LD report that they learn best by hands-on experience or by observing others.

The reading problems often create the most significant academic barriers. Students with LD are often slow readers. The heavy reading load associated with many courses is often daunting. However, simple accommodations such as providing textbooks on tape, providing the reading list early so the student can begin reading before the course begins, and/or highlighting the most important sections can make the reading load more manageable.

Note-taking can be difficult for a number of reasons. First, one must remember the material in order to write it down. Often the student with LD records the first part of an idea, but misses important information. Difficulty with spelling also hinders note-taking and makes later interpretation of the notes more worrisome.

Written language problems may also be present, such as poor grammar, poor spelling, and difficulty organizing ideas in a coherent fashion. Some of the written problems of LD students have decreased because of word processors with spell-check programs. Some instructors allow students to revise all written papers. They hand in a first draft to which a tentative grade is assigned, separated for content and form. Giving very precise instructions about how to prepare a paper also helps.

Many LD students have difficulty with math, and instruction on calculating drug dosages and IV drip rates may be challenging. They should be encouraged to use a calculator and to check their answers with someone before proceeding. Carrying a metric conversion chart in a pocket may be helpful as well. Some students have difficulty estimating how long a procedure or care activity may take and may not use their time most efficiently. It has been beneficial for some students to time themselves while practicing procedures and to make out time management charts.

Many LD students have difficulty with exams, especially if they are timed. They are penalized by their slow reading and slow writing. Multiple-choice tests at the college level, especially those with more than one correct answer, tax the memory system. Many LD students need accommodations for test-taking: e.g., increasing the time, allowing them to take the test in a quiet room, or having someone read the exam to them. Another option is changing the format. Many LD students prefer shortanswer or essay tests (but again, remember it may take them longer to complete the test than nondisabled students). Instructors need to be careful about the wording of items. Questions with double negatives or complex grammatical forms are testing the students' English grammar rather than their knowledge of the content. These items penalize students with English as a second language as well as those with LD.

Learning disabilities often affect a student's self-esteem, confidence, and motivation. Years of feeling "different" and struggling with academic work may damage self-esteem. Failure experiences can be devastating. It is important to avoid pointing out the students' learning problems by asking them to read aloud in class, produce an answer quickly, or display written work where others can see it.

Some students with LD are reluctant to tell anyone, even their instructors. In the not-so-distant past, many college instructors still believed that LD students did not belong in college and refused to make any accommodations for their needs. Also, most students with LD do not want special favors or to be singled out; they only want to succeed. At the beginning of every semester, instructors can announce that accommodations for disabled students are available and ask that any student who needs accommodations call or come in during office hours early in the semester.

The method of instruction may also affect a student's ability to succeed. Pure lecture may provide information, but use of films, discussions, or demonstrations allows students to apply the information.

Students with LD often lack efficient study skills. Many universities/colleges have study skills classes, but often they are not geared toward the LD student. Institutions with services for LD students may provide individualized guidance on learning strategies. Useful topics for many LD students include active reading strategies (such as SQ3R [skim, question, read, rehearse, review]), time management, and organizational tips. There are a number of books on study skills, such as Pauk's How to Study in College ( 1989) and Unlocking Potential ( 1987) by Scheiber and Talpers.

In conclusion, more and more students with learning disabilities are attending college. Many of them select human serviceoriented careers because of their own childhood experiences with feeling "different." They may become more sensitized to others' suffering and select majors such as education, social work, or nursing.

Educators are obligated by law to provide accommodations for disabled students. Although they may challenge some longestablished methods of teaching or testing, working with learning disabled students can be extremely rewarding.

References

  • Astin, A., Green, K., Korn, W., Schaut, M., & Berg, E. (1988). The American freshman: National norms for 1988. Los Angeles: University of California.
  • Blalock, J. W. (1982). Persistent auditory language disorders in adults with learning disabilities. Journal of Learning Disabilities, 15, 604-609.
  • Boder, E. (1973). Developmental dyslexia: A diagnostic approach based on three atypical reading patterns. Developmental Medicine and Child Neurology 15, 663-687.
  • Mattis, S., French, J.H., & Rapin, I. (1975). Dyslexia in children and young adults: Three independent neuropsychological syndromes. Developmental Medicine and Child Neurology, 17, 150-163.
  • McKinney, J.D. ( 1984). The search for subtypes of specific learning disabilities. Journal of Learning Disabilities, 1 7, 43-50.
  • Pauk, W. (1989). How to study in college. (4th ed.). Boston: Houghton-Mifflin.
  • Pirozzolo, F. (1979). The neuropsychology of developmental reading disorders. New York: Praeger.
  • Polloway, E.A., Smith, J.D., & Patton, J.R. (1988). Learning disabilities: An adult developmental perspective. Learning Disabilities Quarterly, 11,265-272.
  • Rourke, B.P. (1985). Neuropsychology of learning disabilities: Essentials of subtype analysis. New York: Guilford.
  • Rourke, B.P. (1989). Nonverbal learning disabilities: The syndrome and the model. New York: Guilford.
  • Scheiber, B., & Talpers, J. (1987). Unlocking potential: College and other choices for learning disabled people. Bethesda, MD: Adler & Adler.
  • Thompson, D.M. (1985). The nonverbal dilemma. Journal of Learning Disabilities, 18, 400402.
  • Yule, R.. & Rutter, M. (1976). Epidemiology and social implications of specific reading retardation. In R. Knight & D. Bakker (Eds.), The Neuropsychology of learning disorders: Theoretical approaches. Baltimore: University Park Press.

10.3928/0148-4834-19921001-12

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