Risk, Resilience, and Adjustment of Individuals with Learning Disabilities
By: Gale M. Morrison and Merith A. Cosden (1997)
This article uses the concepts of risk and resiliency to frame our understanding of how having a learning disability affects nonacademic outcomes such as emotional adjustment, family functioning, adolescent problems of school dropout, substance abuse and juvenile delinquency, and adult adaptation. The presence of a learning disability viewed as a risk factor that, in and of itself, does not predict positive negative outcomes. Rather, other risk and protective factors, as highlighted in the literature, interact with the presence of a learning disability to facilitate or impede adjustment. These risk and protective factors may be internal characteristics of -the individual or external characteristics of the family, school and community environments. Implications for the development of proactive interventions and areas for future research are discussed.
Today's children and youth are faced with many challenges, including changing family constellations, economic hardship, exposure to violence, availability of drugs and alcohol, and a general loosening of community bonds. Longterm exposure to these risk conditions may have debilitating consequences (Garmezy, 1983; Maag, Irvin, Reid, & Vasa, 1994), particularly if one must deal with them in addition to a learning disability. This article will examine how stressors, throughout the life cycle, affect the emotional and societal adjustment of individuals with learning disabilities.
It is not surprising that many studies of learning disabilities have focused on academic performance (Bender, 1994; Sabornie, 1994) or "secondary" noncognitive variables (see review by Bender & Wall, 1994). This article will address broader outcomes that are also related to the individual's ability to function effectively in society. As noted by Bender and Wall (1994), serious intra- and interpersonal problems, including loneliness, depression, suicide, and delinquency, are common among individuals with learning disabilities. These problems exacerbate those presented by the learning disability itself and may lead to serious negative outcomes in adulthood (Weller, Watteyne, Herbert, & Crelly, 1994). Recent theories of risk and resiliency, based on early work by Garmezy, Masten, and Tellegen (1984) and Rutter (1979), provide a framework for understanding the complex factors that influence the adjustment of individuals with learning disabilities.
Risk and resiliency: A review of current models
Garmezy (1983) defined risk factors as those that are associated with the increased likelihood of an individual developing an emotional or behavioral disorder in comparison with a randomly selected person from the general population. Keogh and Weisner (1993) defined risk as "a11 negative or potentially negative condition that impedes or threatens normal development" (p. 4). Ramey, Trohanis, and Hostler (1982) suggested that risk is associated with the likelihood of future development of a handicap. We note here that risk has become a catch-all term for a multitude of conditions that may lead to negative outcomes and that attention should be paid to specifying outcomes and factors associated with those outcomes.
Common risk factors in a child's developmental path include temperament (Werner, 1986); developmental delay (Ramey et al., 1982; Werner & Smith, 1982); early antisocial behavior (Patterson, Reid, & Dishion, 1992; Walker, Stieber, & O'Neill, 1990); disturbed peer relationships (Roff, Sells, & Golden, 1972); and biological/genetic factors (Garmezy, 1983). Being of the male gender has also been identified as a risk factor for developmental delay and developmental psychopathology (Rutter, 1987; Werner, 1986). This fact is especially pertinent given the predominance of boys who are identified as having a learning disability. Environmental risk factors for delay and psychopathology include chronic poverty (Garmezy et al., 1984; Rutter, 1979); lack of parenting skills (Kolvin, Miller, Fleeting, & Kolvin, 1988); parental psychopathology (Hutchings & Mednick, 1974); chronic family discord (Rutter, 1979); and lack of social support for the child and the family (Sameroff & Seifer, 1990).
Risk has also been identified in relation to school failure (Wehlage, Rutter, Smith, Lesko, & Fernandez, 1989); school dropout (Rumberger, 1987; Wehlage et al., 1989); and substance abuse (Hawkins, Catalano & Miller, 1992). For these outcomes, different factors come into play. For example, the work of J. David Hawkins and colleagues on adolescent alcohol and other drug abuse has emphasized the risks of negative peer influence, lack of normative expectations for nonuse, and alienation from or lack of bonding to school, family and community.
As indicated, in studying risk factors, it is important to specify "'at risk" for what? There is a literature that identifies risk factors for the development of learning disabilities (Keogh & Weisner, 1993; Werner, 1986). In this article, we will focus on the additional internal and external risk factors that may interact with the learning disability to create socioemotional complications or societal maladjustments.
Researchers have also identified protective factors, or variables associated with resiliency, for a variety of outcomes (Garmezy, 1983; Rutter, 1987; Werner & Smith, 1982). Garmezy and Masten (1991) defined resilience as a "process of, or capacity for, or the outcome of successful adaptation despite challenging and threatening circumstances" (p. 459). Zimmerman and Arunkumar (1994) described resiliency as the ability to spring back from adversity or "those factors and processes that interrupt the trajectory from risk to problem behavior or psychopathology and thereby result in adaptive outcomes even in the presence of challenging and threatening circumstances" (p. 4). Garmezy (1983), in turn, categorized protective factors leading to resilience as (a) child factors, such as positive temperament and social competence; (b) family factors including supportive parent(s) and consistent rule setting; and (c) community factors, including positive relationships with significant adults and supportive school environments.
While many risk and protective factors have been identified, no one factor has been directly associated with the development of later problems (Pellegrini, 1990). Rather than looking for single linear relationships, more promising explanations of the association between risk and protective factors and disorder rely on compounding multiple factors (Rutter, 1979) and interactive relationships between risk factors and environmental contexts (Garmezy et al., 1984; Sameroff, Seifer, Baldwin, & Baldwin, 1993).
One example of the impact of compounding risk factors on developmental outcomes involves premature birth. Prematurity is associated with a number of behavioral problems later in life, including learning disabilities. Prematurity tends to co-occur with complications of delivery and respiratory distress but is also more likely to occur in cases of socioeconomic disadvantage (Pellegrini, 1990). Rutter (1979) found that when four or more risk factors were present for a child born prematurely, the rate of later disturbance rose significantly. Thus, the number and combination of risk factors "potentiated" the likelihood of future problems.
The longitudinal research of Werner and Smith (1982) further demonstrates the interactive nature of physical risk and environment. In their study, infants who experienced perinatal stress and environmental disadvantage,. such as chronic poverty, family discord or poor child rearing conditions, demonstrated greater developmental deficits than those who experienced perinatal distress but in a context of fewer social stressors or in the presence of protective factors.
The compounding of environmental risk factors and the interaction of risk and protective factors occur in the schooling experiences of young children who have been exposed to early risk and disadvantage (Maughan, 1988; Rutter, 1979). Just as disorganized and unsupportive school environments compound the risks that students bring from discordant and stressful family and community situations, schools can act in a protective fashion to reduce the impact of other risks (Rutter, 1979). Specifically, the enhancement of self-efficacy and self-esteem and the provision of new opportunities for students act as protective factors (Rutter, 1987).
Learning disabilities and risk/resiliency
Although the importance of protective and risk factors for people with learning disabilities has been noted (e.g., Learning Disabilities Research & Practice: Special Issue, Winter 1993), few empirical studies have used this paradigm to explain variations in individual adaptation. The presence of a learning disability is, in itself, a risk factor; however there are wide variations in the emotional and social adaptation of individuals with learning disabilities. Thus, we must consider the impact of personal and environmental risk on the exacerbation of difficulties for those with learning disabilities. As found in the broader literature, risk factors may be internal to the individual, as a function of specific neurological characteristics that affect behavior, or external, when the structure of family, peer, and societal environments results in frustration (Spekman, Herman, & Vogel, 1993).
Protective factors, on the other hand, may ameliorate problems often associated with learning disabilities. Keogh and Weisner (1993) and Spekman et al. (1993) noted that while most studies document the deficits of individuals with learning disabilities, a significant proportion of these individuals have positive outcomes in terms of employment and overall life satisfaction. As with risk factors, protective factors may reside in the individual's other skills or temperament or in the responsiveness of the environment to the individual and the ecocultural "fit" of the individual to the environment (Feagans, Merriwether, & Haldane, 1991; Keogh & Weisner, 1993; Silver, 1989; Wilchesky & Reynolds, 1986).
The ecocultural perspective acknowledges the meaning given to a learning disability by the affected individual, his or her family, and other people in the environment. For example, individuals may see their disability as all-encompassing or discrete. Parents have different "theories" about why their child has a disability and what it will mean for the future. Similarly, social expectations and values may serve to protect the individual with learning disabilities or put him or her at risk for failure at school and in other social environments. Particularly in a society where literacy and numerical skills are highly valued, children with learning disabilities may be vulnerable to emotional problems and social failure without school and community understanding and support.
The analysis presented in this article is grounded in the following assumptions about learning disabilities: (a) a learning disability, if accurately determined, reflects internal problems in processing information that typically affect academic school performance; (b) a learning disability puts the individual at risk for subsequent nonacademic problems, at school, at home, and in the community, but the scope and severity of these problems vary; (c) protective and risk factors act in combination to affect outcomes for individuals with learning disabilities; and (d) specific protective and risk factors vary as a function of the person's age, stage of development, and the ecocultural context in which he or she is functioning (Keogh & Weisner, 1993).
The following review utilizes the risk/resiliency framework to conceptualize research findings on the personal and societal adjustment of individuals with learning disabilities. The review will begin with studies on the "internal" emotional adjustment of individuals with learning disabilities. We will then consider implications for family functioning, review problems associated with the adolescent years (dropout, juvenile delinquency, and substance abuse), and end with a look at adult adaptations. Although the selection of outcomes is not exhaustive, it does represent a sampling of significant social outcomes across the lifespan.
Each section will cover the incidence of the compounded outcomes and identification- of either potential or confirmed risk and protective factors. Most of the literature reviewed was not designed to specifically identify risk and protective factors. Thus, it has been necessary to reconceptualize the findings within the risk and resiliency framework. We consider the risk factors that are associated with negative outcomes for children and adolescents with learning disabilities and those that impede their development above and beyond their learning disability. We infer protective factors when variables or conditions work to reduce the negative trajectory established by risk factors.
Much of the relevant research is correlative in nature; that is, risk and protective factors are related to negative outcomes but are not studied in a manner that allows one to make assumptions about causation. A typical approach is to identify the "haves" and the "have nots" and study factors that discriminate between these groups. For example, one could identify two groups of adolescents (those who have a juvenile record and those who do not) and then examine factors associated with the existence of the juvenile record. Another approach is to describe differences between groups such as the higher incidence of learning disabilities among adolescents with a juvenile record. However, the concepts of risk and resilience imply chronology and causality; risk implies that one factor precedes an outcome; resilience implies that protective factors act upon risk conditions to reduce or correct the damage of risk factors. A study of dynamics would require longitudinal data. While several projects have longitudinal data available (e.g., Werner's Kauai project; Werner, 1986; and Sameroff's Rochester Longitudinal Study project; Sameroff et al., 1993), they have not focused on learning disabilities.
In summary, our intent is to identify factors in the extant literature that appear fruitful for future study of risk and resilience in learning disabilities.
Factors related to risk and resilience for individuals with learning disabilities
The co-morbidity of emotional problems and learning disabilities has been cited by a number of investigators (see San Miguel, Forness, & Kavale, 1996). Yet, the extent and nature of this relationship is far from conclusive. Children, adolescents and adults with learning disabilities tend to score higher on scales of anxiety and depression than do their counterparts who do not have known disabilities (Epstein, Bursuck, & Cullinan, 1985; Gregg, Hoy, King, Moreland, & Jagota, 1992; Hall & Haws, 1989; Huntington & Bender, 1993; Margalit & Raviv, 1984). Nevertheless, most studies reflect wide variation in depression and anxiety among individuals with learning disabilities, with fewer than half scoring as clinically anxious or depressed (Hall & Haws, 1989; Maag & Behrens, 1989; Stevenson & Romney, 1984; Wright-Strawderman & Watson, 1988). In the Stevenson and Romney (1984) study, for example, 14% of the sample (N=103) of school-aged children with learning disabilities indicated significant depression on a self-report scale. In other studies, the percentage of children with learning disabilities who also evidence significant depression ranged from 21% (Maag & Behrens, 1989) to 36% (Wright-Strawderman & Watson, 1988).
There is wide variation in the emotional adjustment of individuals with learning disabilities. Fuerst, Fuerst, Fisk, and Rourke (1989) used Q-factor analysis with the Personality Inventory for Children to identify emotional subtypes of children with learning disabilities. They established three groups: one with normal psychosocial adjustment (approximately 55% of the sample), one with significant internalizing psychopathology (20% of the sample), and one group with externalizing psychopathology (24% of the sample).
Risks for emotional complications. While many studies have assessed the levels of depression and anxiety in children with learning disabilities, there have been fewer attempts to identify factors related to variations in emotional adjustment. Two hypotheses regarding the emotional adjustment of individuals with learning disabilities are most commonly assessed in the literature.
The first hypothesis is that some subtypes of learning disabilities present higher levels of risk for depression and other emotional problems. Brumback and Staton (1983), for example, hypothesized that learning disabilities involving right hemispheric dysfunction may be neurologically linked with depression. Similarly, Rourke and his colleagues (Rourke, Young, & Leenaars, 1989; Rourke, 1988) described a "nonverbal learning disability" subtype that may put people at greater risk for anxiety and depression. These investigators postulated that the emotional risk associated with this type of learning disability is a function of behavioral manifestations, which include psychomotor clumsiness and problems in tactile sensitivity, deficits in visual-spatial organization, difficulties in dealing with novelty, and problems in intermodal integration. These neurologically based deficits seriously interfere with the individual's social functioning. It is hypothesized that this, in turn, results in higher levels of depression and suicide than is evident among individuals without learning disabilities or in individuals with other subtypes of learning disabilities. Support for this hypothesis is derived from significant correlations among clusters of behaviors and emotional outcomes.
Another hypothesis advanced in the literature is that depression and anxiety are the result of high levels of frustration and perceived lack of control and predictability, which result from having a learning disability (Cohen, 1986). This suggests that although people with learning disabilities generally face higher levels of frustration than those without disabilities, intergroup differences in the experience of frustration may be a factor in one's emotional adjustment.
Few studies have directly addressed this question, and those that do have yielded mixed results. Margalit and Shulman (1986), for example, found lower levels of perceived autonomy and higher levels of anxiety in students with learning disabilities than in those without disabilities. Other studies (e.g., Bryan, Sonnefeld. & Grabowski, 1983) reported that higher levels of anxiety were correlated with lower achievement for students with learning disabilities. More research is needed to support this hypothesis. however.
Protective factors. The major protective factors for depression and anxiety found in the literature are self-esteem and self-awareness. Wide variations in self-esteem and self-understanding have been noted among children and adults with learning disabilities (Heyman, 1990: Kloomok & Cosden, 1994). Self-esteem and perceptions of one's learning disability as being circumscribed, not global, are highly correlated (Rothman & Cosden, 1995; Wilczenski, 1992). Several investigators (e.g., Patten, 1983, Stevenson & Romney, 1984) have reported significant relationships between anxiety. self-esteem, and self-awareness, such that higher levels of self-awareness and self-esteem are correlated with lower levels of anxiety. Thus, self-esteem and self-awareness may function as protective factors in the sense that they may facilitate lower levels of anxiety, despite the difficulties associated with having a learning disability.
In sum, the majority of individuals with learning disabilities do not have significant emotional problems; nevertheless, the presence of a learning disability appears to place one at greater risk for depression and anxiety specific subtypes of learning disabilities, in which behavioral manifestations are likely to affect social relationships, are correlated with depression. Given the high risk associated with negative peer relationships and lack of adult relationships, the constellation of characteristics associated with this subtype of learning disabilities is particularly worrisome. Experiencing higher level of frustration is predicted to affect depression and anxiety, but few studies specifically address this relationship. Self-esteem and self-understanding appear to be protective factors.
One caveat is that most measures of selfesteem, depression, anxiety, and self-understanding are based on self-report; thus, studies that reflect associations between these factors may also reflect overlap in construct definition and measurement.
The family environment has been identified as a key factor that can provide both risks (e.g., discord, inconsistent discipline) and protection (e.g., a supportive adult relationship, cohesive family functioning) for the developing child. Having a child with a learning disability may add to a family's stress in several ways. Problems with information processing may be evident at home as well as at school; thus, parents may experience different types of interactions with their children who have learning disabilities than with their children who do not have learning disabilities (Kaslow & Cooper, 1978). In addition, these families are required to interact more with school personnel than are families with children. who are typical achievers. Such interactions, in many instances, appear to be stressful (Waggoner & Wilgosh, 1990). Other problems experienced by the child, whether behavioral, social or vocational, are concerns with which the family must also contend. The family's ability to absorb these stressors is critical to children with learning disabilities, who may continue to need parental assistance and support throughout adulthood (Spekman. Goldberg, & Herman, 1992).
Compared to parents of normally achieving children, parents of children with learning disabilities have higher levels of anxiety (Margalit & Heiman, 1986); perceive their families as more chaotic (Amerikaner & Omizo, 1984), and report higher levels of conflict among family members (Margalit & Almougy, 1991; Toro, Weissberg. Guare, & Liebenstein, 1990). These are group effects, however.
Significant variations in perceived stress have been noted among families with a child with a learning disability (Michaels & Lewandowski, 1990; Morrison & Zetlin, 1992). Morrison and Zetlin (1992), for example, studying families with .and without an adolescent with a learning disability, found five distinct profiles of family functioning, as measured by adaptation, cohesion, and communication patterns. With the exception of one profile, both families with and without adolescents with disabilities were represented in each profile, indicating that these family patterns are typical of families of both groups.
Protective and risk factors for families include the personal characteristics of the child(ren) and parents, the structural characteristics of the family, and the external support available to the family. To some extent, these factors may have reciprocal effects on one another. For example, child characteristics may affect family structure, while family structure may influence the child's personality development (Freund, Bradley, & Caldwell, 1979; Green, 1990, Kaslow & Cooper, 1978; Michaels & Lewandowski, 1990). However, each factor may also serve as an independent source of risk or support. For example, a cohesive and supportive family structure (a protective factor) may have an ameliorating effect on the severity of the child's academic and behavior problems (a risk factor).
Risk factors. Among child characteristics, hyperactivity has been noted as a particular risk factor for family functioning. For example, hyperactivity has been associated with less support and less control for families with and without a child with a learning disability (Margalit & Almougy, 1991). The presence of behavior problems, particularly in. boys with learning disabilities, also appears to contribute to the experience of parental stress (Konstantareas & Homatidis, 1989).
Parental expectations and disappointment with a child's academic performance also increase family stress (Kaslow & Cooper, 1978). For example, Margalit and Heiman (1986) found that mothers who had lower academic expectations for their children with learning disabilities reported higher levels of anxiety, suggesting discomfort with these lower expectations. Other studies (e.g., Tollison, Palmer, & Stowe, 1987) reported that lower expectations, which are commensurate with the student's academic capabilities, may result in lower anxiety and higher overall student achievement. Understanding the nature of the child' disability, and not generalizing that disability to the whole child, is characteristic of families who are adjusting well to having a child with a learning disability (Jain & Zimmerman, 1984, as cited by Fish & Jain, 1985; Switzer, 1985). Thus, parental acceptance of the child's academic limitations, as well as acknowledgment of the child's strengths, may mediate stress created by the learning disability.
From a systemic viewpoint, families vary along a number of dimensions, including their sense of hierarchy, cohesion, and flexibility (see Olson, Russell, & Sprenkle, 1983)., Change is an inevitable part of the family life cycle, as children grow older or other alterations in the family constellation occur. The family's ability to adapt to change is a predictor of healthy family functioning. Children with learning disabilities require special family adaptations, particularly during periods of developmental change (Vigilante, 1983). Thus, families with a child with a learning disability may be at risk if they lack the flexibility to meet their normal developmental challenges as well as the special needs of the child (Margalit, 1982).
Investigators have hypothesized that certain structural family characteristics place children with learning disabilities, and their families, at greater risk. For example, transactional patterns of enmeshment, overprotection and rigidity make it difficult for families to resolve problems in general. and result in dysfunction when the family is faced with the additional stress of having a child with a learning disability (Fish & Jain, 1985). Investigators have characterized families with these structural characteristics as "at risk" and "rigid" (Wilchesky & Reynolds, 1986), and "fragile," "disorganized," "blaming," and "split" (Ziegler & Holden, 1988). Each of these "types" of families is noted for lacking stability and strength prior to having a child with a learning disability, and as being at risk for further dysfunction as a result of having a child with special needs.
Protective factors. Protective factors are primarily inferred at this point from clinical descriptions of the "healthy" family. For example, it has been suggested that a resilient family is one in which emotional stability and strong parenting skills are available and applied to children with and without learning disabilities (Wilchesky & Reynolds, 1986; Ziegler & Holden, 1988). Families that are more effective in responding to the needs of children with learning disabilities appear to be both cohesive and flexible, to demonstrate affective support for the child with the disability, and to utilize coping skills at home and in their interactions with the schools. These conceptualizations are based on clinical reports and case studies.
Clearly, there are many variations among families who are well adjusted to having a child with a learning disability, as there are variations among families who do not adapt well to having a child with special needs. From an ecocultural perspective, the child's "goodness of fit" within the family (Feagans et al., 1991) may be the more appropriate measure of risk or protection. To ascertain -"goodness of fit" Feagans asked parents to rate behavioral characteristics that they perceived as particularly desirable and undesirable, and then rate the extent to which those characteristics were evident in their child. In so doing, the investigators were able to create "low-fit" and "high-fit" subgroups among families with and without a child with learning disabilities. Children in "low-fit" homes demonstrated poorer classroom behavior and achievement, with these effects being particularly pronounced for children with learning disabilities.
Thus, several factors related both to risk and protection for families who have a child with learning disabilities emerge from the literature, albeit based on clinical and case observations. Child characteristics, parental expectations and disappointment, and rigidity in family functioning are hypothesized to increase family stress. By contrast, parental understanding of the learning disability, and the ecocultural fit of the child within the family, may reduce stress and enhance family functioning.
Dropping out of school is a major societal problem, both in terms of the impact on the individual who has dropped out and as a general indicator of educational and economic decline.
Levin, Zigmond. and Birch (1986) found that rates of school dropout were significantly higher in youth with learning disabilities than students without disabilities. Research exploring the extent of dropout by students with learning disabilities has found that rates of 33% to 47% are common (Levin et al., 1986; Zigmond & Thornton, 1985). Individuals who have learning disabilities and who have dropped out of school are at particular risk for extended economic and social disadvantage (Blackorby, Edgar, & Kortering, 1991; Lichtenstein, 1993; Zetlin & Hossini, 1989; Zigmond & Thornton, 1985).
Risk factors. Certain student characteristics have been identified as risk factors for dropping out; these include prior school attendance, discipline problems, reading ability, socioeconomic status, and family intactness (Blackorby et al., 1991; Lichtenstein, 1993; Zetlin & Hossini, 1989; Zigmond & Thornton, 1985). School transfers and suspensions/expulsions have also been identified as risk factors for school dropout. While these are factors that may be associated with individual students, they are also the result of school policy and disciplinary philosophy, which affect the rate at which students are suspended or expelled, and which vary from school to school. School practices that lead to student alienation, disengagement and loss of commitment also contribute to the dropout problem (Lee & Burkam, 1992; Rumberger, 1987; Wehlage et al., 1989). Fine (1986) identified the disconnection between schooling structures and curriculum and the needs of students as a potent factor leading to dropout.
What do we know about the relationship of these factors to the dropout problem for students with learning disabilities? Kortering et al. (1992) studied factors that discriminated between students with learning disabilities who had dropped out of school and those who had not. Differences in ethnicity, reading ability, and family socioeconomic status did not discriminate between the two groups. The major factors that predicted dropout were district-initiated interruptions (suspensions/expulsions), school transfers, and lack of family intactness. Seidel and Vaughn (1991) found that social alienation was significantly higher in students with learning disabilities who dropped out of school than in those who completed school. Dropouts with learning disabilities stated that they disliked their classes, their teachers, and their classmates. Although academic, social, and behavioral problems could lead to this alienation, it is likely that schooling attitudes and practices can contribute to students' feelings of alienation.
Further research is needed to determine the manner in which these risk factors interact with one another. For example, it is likely that district-initiated interruptions are the result of behavior and adjustment problems that accompany the learning disability. These adjustment problems may be associated with particular subtypes of learning disabilities, an experience of school failure, peer problems or family disruptions. However, school interruptions may further exacerbate this cluster of problems.
Protective factors. Most authors have framed dropout predictions in terms of risks; specific resiliency factors, other than the implied polar opposites of the risk factors, have not been examined. Lichtenstein (1993) studied the dropout dynamics for four individuals with learning disabilities and found evidence of resiliency, albeit after they left school. The lure of success in outside employment outweighed the continual failure and discouragement these students experienced in school. These adolescents were able to successfully negotiate their work environments, make friends, and gain alternative educational credentials outside of the school environment. This pattern suggests that certain supports were absent in the school environment but available in the workplace.
Further, Blackorby et al. (1991) found that students with mild disabilities who dropped out often returned to school (74% of their sample returned). Similarly, 12% of students with mild disabilities who graduated had interrupted their schooling at some point. This pattern suggests that it is important to look at factors that affect school persistence, despite disruptions. The resiliency or "self-righting" mechanism in operation in these cases remains to be identified.
Bartnick and Parkay (1991) noted that characteristics of successful dropout prevention programs, such as small class size with low student teacher ratios, responsive educational programming, individualized attention, basic skill instruction, and parental involvement, are also associated with special education programs. These schooling characteristics could be viewed as factors contributing to the resilience of students who stay in school. Unfortunately, the Bartnick and Parkay study suggested that special education classes for students with learning disabilities had less "holding power" than general education programs, even when controlling for student characteristics. Further research is needed to understand the interaction between student characteristics, risk conditions, and schooling practices.
Berman (1974) reported that more than 50% of juvenile offenders had evidence of early learning disabilities. Similar figures were found by Podboy and Mallory (1978) and Rich, Fowler, Fogarty, and Young (1988) for the prevalence of learning disabilities among adjudicated youth. Larson (1988) stated that youth with learning disabilities were adjudicated about twice as often as those without disabilities, and that delinquents with learning disabilities had a greater likelihood of recidivism and parole failure. While these figures represent the number of already adjudicated youth who have learning disabilities, Keilitz and Dunivant (1986) reported that youth with learning disabilities who have not been adjudicated also are more involved in delinquent acts than their nondisabled peers. Maughan, Gray, and Rutter (1985) found that 67% of their sample of adolescents with learning disabilities had records of juvenile delinquency.
Waldie and Spreen (1993) characterized the relationship between learning disabilities and juvenile delinquency as a "source of widespread discussion, limited research, and little consensus" (p. 417). Despite evidence supporting the connection between learning disabilities and juvenile offenses, the causal nature of these relationship remains undetermined.
Risk factors. Several hypotheses regarding factors that place adolescents with learning disabilities at risk for juvenile delinquency have received attention (Lane, 1980; Larson, 1988). According to the school failure hypothesis, students with learning disabilities are more likely than normally achieving peers to fail in school and develop a negative self-image, which, in turn, leads to school dropout and involvement in delinquent activity (Hawkins & Lishner, 1987). Thus, the combination of having a learning disability and receiving socially negative consequences (school failure) may be seen as additive risks that increase the likelihood of maladjustment. This concept is supported by research that shows significant correlations between delinquent behavior and low academic achievement (Grande, 1988). In addition, improvement in academic skills has been found to reduce delinquent behavior in adjudicated youth with learning disabilities (Keilitz & Dunivant, 1986).
A second hypothesis suggests that children with learning disabilities possess personality characteristics (poor impulse control and problem-solving ability, social perceptions problems, lower self-esteem, and suggestibility) that make them more susceptible to delinquent activity (Brier, 1994; Murray, 1976). In support of the susceptibility hypothesis, Waldie and Spreen (1993) found poor judgment and impulsiveness to be significant indicators of recidivism among juvenile delinquents with learning disabilities. Other characteristics associated with learning disabilities and delinquency include difficulties with social skills, poor social competence, and social cognitive ineffectiveness (Larson, 1988; McConaughy & Ritter, 1986; Phihi & McLarnon, 1984).
The association between juvenile delinquency and learning disorders is strongest when hyperactivity and conduct disorders are also apparent (Dalby, Schneider, & Arboldea-Florez, 1982; Loney, Kramer, & Milich, 1981). The significance of the impulsivity/hyperactivity factor in predicting delinquent behavior poses problems in clearly relating juvenile offenses with learning disabilities, independent of the co-occurrence of hyperactivity. Further, determining a diagnosis of hyperactivity, independent from antisocial tendencies or conduct disorders, has consistently posed a challenge for clinicians and researchers (San Miguel, Forness, & Kavale, 1996).
Another hypothesis addressing the link between learning disabilities and juvenile delinquency is the differential treatment hypothesis, which suggests that youths with learning disabilities who engage in antisocial activities are more likely to be arrested and adjudicated than youths without learning disabilities. According to this hypothesis, youths with learning disabilities face additional vulnerability during the arrest and adjudication process because they lack the verbal and social finesse to escape detection or interact with law enforcement and justice personnel in a positive, productive manner (Pearl & Bryan, 1994; Spafford & Grosser, 1993). Again, further research is needed to support this hypothesis.
Protective factors. Protective factors discussed in the general literature include attachment to teachers and peers and engagement in academic tasks (Wehlage et al., 1989). However, researchers have not identified factors that would make adolescents with learning disabilities resilient to involvement in delinquent activities. Brier (1994) described an intervention program designed to reduce recidivism in adjudicated youth with learning disabilities. Positive results were associated with increases in academic skill levels and reduction of psychological distress. Brier speculated that these positive changes indirectly increased self-efficacy and prosocial aspirations. Although more controlled studies are needed, these results suggest the nature of some protective factors for individuals with learning disabilities.
The two primary research approaches exploring the relationship between LD and delinquency include (a) identification of the prevalence of LD in a sample of adjudicated youth, and (b) asking identified students with LD about their delinquent behavior. Both approaches suffer from limitations. In the first, research does not distinguish between those adjudicated youth who had a previous diagnosis of LD and those who did not. A previous diagnosis of LD would suggest either the susceptibility hypothesis or the school failure hypothesis. In the context of the risk and resiliency framework, either implies that personality characteristics or school failure are stresses that compound the LD and lead to other negative outcomes. However, without a previous diagnosis of LD. it is possible that the assessment of low achievement is a function of the delinquent behaviors. The limitation of the second approach is that the self-reports are usually of nonadjudicated offenses. These are not the same delinquent behaviors observed in youth who have been officially "caught" and adjudicated.
Most of the research cited above is based on samples who were predominantly male. Males are overrepresented in categories of learning disability and juvenile delinquency. Therefore, generalizations to females about the relationships between delinquency and learning disabilities would be inappropriate. Despite limitations in the methodology, it appears that personal factors, such as deficits in social skills, hyperactivity, and impulsiveness, may contribute to involvement in delinquent activities. School failure is a strong predictor of later delinquency. Thus, having negative school experiences may be a significant risk factor for students with learning disabilities.
Kress and Elias (1993) noted that there is a dearth of literature on prevalence rates of substance abuse among youth with disabilities. This is surprising given that many of the risk factors for substance abuse, including poor school performance, impulsivity, problems with peer relationships, and low self-esteem, are common among youths with learning disabilities (Karacostas & Fisher, 1993).
In a study comparing adolescents with and without learning disabilities on the Substance Abuse Subtle Screening Inventory, Karacostas and Fisher (1993) found that a significantly higher proportion of students with than without learning disabilities were classified as chemically dependent. Maag et al. (1994) noted that while rates of alcohol use among learning disabled and nondisabled adolescents were not significantly different, use of tobacco and marijuana was higher for adolescents with learning disabilities. However, these rates were below the national average for adolescents in general.
Risk factors. It has been proposed that low self-esteem may predispose adolescents with learning disabilities to substance abuse (Bryan, 1986). Maag et al. (1994) did not find a relationship between self-esteem and substance use; however, these authors noted that although the association between self-esteem and substance use was not significant, self- esteem may be a factor in substance abuse. Associations have been made between the presence of cognitive deficits in childhood and the onset of alcoholism in adulthood (Tarater & Edwards, 1986). This relationship has been linked to both neurological problems and a family history of alcoholism (Parsons, 1986). According to this perspective, certain neuropsychological deficits are likely to manifest as learning disabilities that persist into adulthood and precede alcoholism. In a sample of male alcoholics, Rhodes and Jasinski (1990) found that 40% of clients had received special education or remedial services and experienced repeated grade failure, concurrent with a familial history of alcoholism. It cannot be determined by this type of retrospective study, whether the primary risk for alcoholism is the presence of a learning disability, or the use of alcohol in the family.
Another personal factor related to risk for substance abuse is hyperactivity. Retrospective studies have found a high prevalence of childhood hyperactivity among adults who are alcoholics (Alterman & Tarter, 1986; - Kramer & Loney, 1982). Adolescents who were hyperactive as children have higher rates of substance abuse than their peers (Gittleman, Mannuzza, Shenker, & Bonagura, 1985). This association was found specifically for a subgroup of individuals who were hyperactive as children and displayed ineffective self-regulatory skills (Moore & Polsgrove, 1989). Further, Blackorby et al. (1991) found less drinking among students with school problems who were not hyperactive than among students with school problems who exhibited hyperactivity.
Environmental factors may also put adolescents with learning disabilities at risk for abusing substances. Hawkins, Catalano, and Miller (1992) highlighted a number of environmental risks for substance abuse, including early and persistent behavior problems, low commitment to school, peer rejection in the elementary grades, and experiences of school failure. These problems are encountered by many children and adolescents with learning disabilities.
While few studies have examined the interrelationships among internal risk factors, environmental stressors, delinquent behavior, and substance abuse, several theories have been offered. Keilitz and Dunviant (1986), for example, developed a model based on personal risk factors, including external attribution for negative events, impulsivity, and lack of anticipation of consequences; and environmental risk factors, such as school failure, association with students who have behavior problems, detachment from school rules, and economic incentives to commit crimes.
According to these investigators, because there is an association between having a learning disability and engaging in delinquent behavior and a relationship between engaging in delinquent behavior and substance abuse, youths with learning disabilities are vulnerable to substance abuse. Similarly, Fox and Forbing (1991) hypothesized that special education students may be vulnerable to substance abuse to the extent that their disability involves any of the following: (a) use of prescription drugs; (b) biochemical imbalance; (c) low achievement, low self-esteem, and impulsivity; (d) parents who abuse alcohol or drugs; and (e) prenatal exposure to drugs.
There are several weaknesses in this literature. As noted in the section on juvenile delinquency, few efforts have been made to identify protective factors other than those that are the diametric opposite (e.g., the absence of parental substance abuse) of risk factors. Further, methodological problems regarding identification of learning disabilities and substance abuse are obvious. For example, Fox and Forbing (1991) noted the overlapping symptoms of learning disorders and substance abuse, including memory loss, withdrawal, concentration or attention deficits, motor/physical extremes, poor coordination, poor academic performance, inappropriate social skills, low self-esteem, attention-getting behaviors, negative attitude, and delayed maturation. The commonality of these symptoms complicates diagnosis of the primary condition, especially when the identification is done retrospectively.
Adults with learning disabilities
Concerns in adulthood reach beyond the classroom to vocational and independent living skills; thus, outcome measures vary from college completion, to the development of adult social relationships, to the ability to obtain and maintain satisfying employment. The literature on adults with learning disabilities reflects a range of outcomes, and more directly addresses risk and protective factors than the previously reviewed literature.
Studies on adults with learning disabilities document the continuation of many academic and social problems into adulthood. For example, while this population is very heterogeneous, a disproportionate number of adults with learning disabilities experience emotional distress and social problems (Gregg et al., 1992; Harzell & Compton, 1984), as well as problems obtaining employment and gaining personal independence (Hoffman et al., 1987). One of the shared characteristics of adults with learning disabilities is a prolonged period of dependence on their families; this factor. is related to difficulties in finding satisfying employment and developing independent living skills (Spekman et al., 1992).
Risk factors. Several factors appear to place adults with learning disabilities at greater risk for poor adjustment, including weak verbal skills, dropping out of high school, and denial of their disability (Hoffman et al., 1987; Spekman et al., 1992). The first two factors relate to the type and severity of one's disability and are also likely to reflect a history of frustration and failure within the school system. Denial affects one's coping mechanisms; that is, adults who are in denial about their disability are less likely to take the necessary steps to develop effective strategies for educational and vocational success.
Protective factors. Several protective factors also emerge from the literature. Whereas poor verbal skills and dropping out of school are risk factors, higher verbal skills and graduation from high school are factors that predict positive adult outcomes (Hoffman et al., 1987; Spekman et al., 1992). Thus, individuals whose learning disabilities are less severe, particularly in the verbal domain, and who are able to achieve some success in high school, are more likely to achieve academic and vocational success as adults.
Knowledge about one's disability can reduce one I s vulnerability to it. Thus, understanding and accepting one's disability, and viewing the disability as circumscribed rather than global and encompassing, is associated with successful adult functioning, including personal satisfaction, vocational success, and college completion (Adelman & Vogel, 1990; Spekman et al., 1992; Vogel & Adelman, 1990; Vogel, Hruby, & Adelman, 1993). Self-awareness serves as a protective factor, in part, because it allows the individual to develop proactive compensatory strategies for achieving in school, as well as for finding appropriate employment. For example, adults who have greater understanding of their disability are more likely to seek assistance when needed and avail themselves of educational and employment opportunities that build on their strengths and not their weaknesses. Having a supportive, and responsive, environment also serves a protective role. That is, adults who have -good vocational assessments, supportive parents, and counselors or mentors at school more successfully adapt to the demands of adulthood.
The interrelationship of personal and environmental factors has been noted in several studies. Werner (1993), for example, conducted a longitudinal study of 22 individuals with learning disabilities and 22 matched individuals without learning disabilities. She found that the temperament of people with learning disabilities affects the support they receive from others which, in turn, affects the development of their autonomy. Thus, the individual characteristics brought by the person with learning disabilities to his or her family, school, or other community setting, will, in part, determine the level of support received and future growth and development.
Adults with learning disabilities share certain characteristics, including the continuation of academic and/or social problems and a prolonged period of dependence. Nevertheless, there is variation in the success with which individuals with learning disabilities become societally contributing adults. This literature is most closely aligned with theories of risk and resilience and identifies several factors that are related to both vulnerability and protection in this population. Specifically, verbal skills, self-awareness, and an environment that offers both practical and emotional support have emerged as factors that can either reduce risk by their presence, or increase risk through their absence.
Children and adolescents with learning disabilities are exposed to same challenges in society as other children. However, the existence of a learning disability, combined with significant stressors in the family, school and community, puts the individual with learning disabilities at greater risk for negative emotional, familial, and societal outcomes. While the majority of individuals with learning disabilities function well in society, identification of factors related to risk and resilience for this population allows us to facilitate the adjustment of those who experience more severe problems.
Risk factors may reside in the individual or in the environment, or may be created by specific individual-environment ment interactions. Internal factors that make the individual with learning disabilities more vulnerable to negative outcomes include certain types of nonverbal learning disabilities, impulsivity, hyperactivity, and denial of one's disability (Margalit & Almougy, 1991; Rourke et al., 1989; Spekman et al., 1992). According to the literature reviewed here, these risk factors can affect the individual's emotional, familial and societal adjustment.
Factors that are environmental risks for individuals with learning disabilities are, in many instances, the same as those that exist for individuals without learning disabilities. However, the potential for risk is exacerbated by the presence of a learning disability. Risks include parental disappointment, family rigidity or disorganization, school disruptions, and school failure. We consider school failure as an environmental risk, because variations in school policies support different levels of accommodation to students with special needs. The nature of these policies and the school's will to accommodate students with learning disabilities are viewed as primary risk factors. Thus, both th families and schools may augment the risk of failure ure or youths with learning disabilities.
Although the majority of individuals with learning disabilities avoid negative societal outcomes, factors related to resilience for individuals with learning disabilities have received little attention. Personal factors that serve to protect the individuals include self-esteem, high verbal skills, and a delineated understanding of one's disability. Family factors that provide resilience include good parenting skills, appropriate expectations for the child with the learning disability, and flexibility in family functioning. School may also be considered a "breaklink" (Spafford & Grosser, 1993) in the relationship between learning disabilities and later negative outcomes. That is schools can provide the supportive environment and skills necessary for positive coping strategies. Although in each instance, the protective factors identified in the literature appear malleable and accessible to intervention, relatively little research has been conducted in this area.
As specific factors related to risk and resiliency for individuals with learning disabilities are identified, interactional models need to be considered. Models developed by Ottman (1991) and Simeonsson (1994) can be used to illustrate the different ways in which both internal and external factors may combine to augment the risk of the individual with learning disabilities.
We will use as an example the documented relationships between learning disabilities, school failure, and juvenile delinquency (although other risk and outcome factors could be used interchangeably). Four interactive models are considered.
In the first model (see below) the environment (i.e., school) exacerbates the risk that is created by the presence of a learning disability, thereby increasing the chance of the youth engaging in delinquent behavior. Thus, school failure for a student with a learning disability puts him or her at greater risk for delinquent behavior than would school failure for a student without a learning disability.
In the second model, the internal risk factor (the learning disability) exacerbates the environmental risk created by a stressful school environment. According to this model, poor schooling, although presenting a risk to all students, creates a greater risk for students with learning disabilities, thereby increasing the likelihood of their engaging in delinquent activities.
A third scenario suggests that both a poor environment and a learning disability are required to raise the risk level such that students are likely to engage in delinquent activities. Documentation of students with learning disabilities who have failed in school but who are not engaging in delinquent activities weakens this model, however.
Finally, according to a fourth model, poor school environment and the presence of a learning disability act independently to enhance risk for juvenile delinquency. This is a nonadditive model, which suggests equal weight to both risk factors.
In these examples, the presence of a learning disability is considered an internal risk factor; however, as noted throughout this review, learning disabilities may be accompanied by other internal risk factors, such as impulsivity and social perception deficits. These also play a role in any predictive model. Further, the role of protective factors, and the interaction of protective and risk factors, needs to' be systematically considered. For example, how does high self-esteem or strong parental support affect an adolescent with learning disabilities who is experiencing school failure?
Identification of specific risk and protective factors and the relationship- between them requires further study. In some studies, outcomes are associated with both risk and resilience aspects of the same factor. For example, school completion is fostered by a lack of school transfers and disruptions, by successful school performance, and by the existence of intact families. Conversely, higher levels of school disruptions, unsuccessful school performance, and family separations are associated with school dropout. However, Keogh and Weisner (1993) suggested that resiliency may not be just the "flip side" of risk. Further specification of factors related to risk and resilience and the additive and interactive effects of multiple risk and protective factors should be considered in future studies.
The mechanisms by which risk and protective factors interact have been delineated in several areas in the literature. For example, several studies address the role of family perceptions of a learning disability on subsequent behavior (e.g., Spekman et al., 1992; Switzer, 1985; Vogel & Adelman, 1990; Vogel et al., 1993). These studies indicate that increased knowledge can result in actions that facilitate the adaptation of the person with learning disabilities. Understanding a child's special needs allows parents to perform support functions for the child (Switzer, 1985).
A second example can be found in the literature on adults with learning disabilities, which suggests that those with less denial and a greater understanding of their disability are more likely to seek educational and vocational mentors, and to make vocational choices that are commensurate with their skills (e.g., Spekman et al., 1992; Vogel et al., 1993). In both examples, greater awareness results in actions that affect the environment in which individuals with learning disabilities find themselves. Thus, part of the potency of knowledge as a protective factor is that it results in actions that can create a better environmental "fit" for the individual.
A final example can be found in Rourke et al.'s (1989) suggestion of a mechanism by which nonverbal learning disabilities ' create emotional and social risk. These authors posited that this neurologically based syndrome has specific effects on information processing and behavior integration, and that these problems interfere with the development of appropriate social behaviors. As a function of poor social interactions, depression and social stigmatization occur. Further study of these mechanisms, and the manner in which other risk and protective factors affect the individual, is needed.
There are also weaknesses in this area of research. Most of the studies reviewed rely on correlational methods rather than longitudinal or experimental designs. Further, most, but not all, of the data have been collected on males, or have not been analyzed for sex differences. Most of the factors identified thus far can be interpreted for males with learning disabilities, but sex differences in risk and protective factors and factors specific to females need further study.
The identification of risk and protective factors for individuals with learning disabilities may guide future intervention efforts. To date many interventions have focused on remediation of academic problems associated with a learning disability. The diagnosis of a learning disability typically sets into motion a set of academic and school structure modifications. These interventions have a heavy emphasis on the academic needs. However, what can be done to prevent complications beyond these academic needs? Further knowledge about risk and protective factors may help guide programs in these areas. For example, Kress and Elias (1993) noted that prevention programs for substance abuse and dropout, in particular, have ignored special education populations. While there is a solid literature base for social skill development with students who have learning disabilities (e.g., Walker et al., 1983), such programs should include developing relevant personal and social skills, setting appropriate expectations or norms for behavior, giving students opportunities to succeed, and providing a curriculum to enhance educational engagement, in addition to peer, family, and school attachment (Hawkins & Weiss, 1985; Wehlage et al., 1989).
The presence of a learning disability is a risk factor that, in and of itself, does not result in depression, family discord, or societal conflict. Rather, outcomes for this population reflect a combination of protective and risk factors, some of which are internal, whereas others are external to the individual. The ease with which these factors can be affected varies. For some internal factors such as the presence of hyperactivity or severe processing deficits, environmental accommodation may be key to risk reduction. In other instances, such as denial of a disability or parental disappointment and inappropriate expectations, direct interventions may result in risk reduction. Most of the environmental risks cited in this review are amenable to change; however, such changes require motivation and effort on the part of families, schools, and the workplace. Understanding the impact of these factors on the individual with learning disabilities will enable investigators to reduce many of the secondary problems associated with having a learning disability.
Correspondence concerning this article should be sent to Merith Cosden or Gale Morrison, Graduate School of Education, University of California, Santa Barbara, CA 93106. The authors contributed equally to this manuscript.
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