Presented at ISEC 2000

Affective Disorders and Academic Performance in Students with and without Specific Learning Difficulties: Is there a Relationship?

Dimitra Hartas - University of Derby, UK

Abstract

In the last decade there has been an accumulation of empirical evidence suggesting a link between language-and reading. In much current research reading is seen as a continuum that involves informal spoken language to formal written discourse. In the light of the transactional nature of reading and language development, it could be argued that various aspects of language (i.e., phonology, semantics, pragmatics) and reading (i.e., word recognition, reading comprehension) are so intertwined that they cannot be isolated in a meaningful way. However, some recent research efforts have focused on untangling these interactions by looking at inter-relations between domain-specific language and reading skills. The aim of the present study was to look at the relationship between language and reading in pupils with and without expressive/receptive language difficulties (E/RLD). Results from this study suggest that pupils with E/RLD performed poorly across reading comprehension tasks compared with peers who do not experience language difficulties. Evidence from this study stresses the importance of the role of speech and language therapy with pupils with language and reading difficulties, and of an on-going inter-professional collaboration between educational psychologists and speech and language therapists.

As models of affective disorders have been applied to younger populations, deficits in cognitive and academic domains have received the most attention (Cole, 1990). The co-existence of affective disorders (depression, dysthymia or other mood related difficulties) and specific learning difficulties has been a topic for study since Brumback, Weinberg, and their colleagues began investigating children referred to educational diagnostic centers two decades ago (Brumback, 1979; Brumback, Jackoway, & Weinberg, 1980). Since that time, depression or depression-related symptomatology seems to be increasingly apparent among students with specific learning disabilities. Increasing empirical evidence supports a relationship between depression or dysthymia and academic difficulties in children and youth (eg, Goldstein, Paul, & Sanfilippo-Cohen, 1983; Maag & Behrens, 1989; Maag & Reid, 1994). Specifically, 21% to 29% of children and youth with specific learning disabilities in a school setting received clinically significant scores on the Children's Depression Inventory (CDI). In other studies, as many as 76% of children with specific learning difficulties have been found to exhibit emotional problems manifested in terms of obtaining higher scores on teacher behavior rating scales and exhibiting poor concentration and negative feelings of self-worth and helplessness (Hall and Haws 1989; Hayes & Sloat, 1988; Livingston, 1995; Maag & Behrens 1989; Wright- Strawderman & Watson 1992).

When looking at the relationship between emotional and learning difficulties it is important to differentiate between children with depression or dysthymia who consequently have learning problems and those who have learning problems and subsequently develop depressive symptomatology. Children with cognitive/academic limitations are usually met with academic failure, resulting in being unmotivated, unresponsive to and/or withdrawn from school-related activities and events and, ultimately, likely to experience depression (Seligman, et all 1984). Conversely, children with depression who are likely to exhibit poor concentration, short attention span and lack of motivation are likely to experience difficulties in many cognitive domains, including language.

Although clear links between affective disorders and academic performance are yet to be established, research findings suggest that children with depression report low self-esteem, make negative self-statements and experience hopelessness and helplessness (e.g., Allen & Tarnowski, 1989; Kendall, Stark, & Adam, 1990), resulting in poor academic performance by taking less responsibility for academic outcomes (Pearl, Bryan & Donahue, 1980). Implicitly, a relationship between children's affective and academic functioning is suggested. However, current research findings cannot support this multifaceted relationship. Perhaps, affective disorders impact academic performance indirectly by affecting students' motivation and concentration which in turn result in poor academic performance.

Despite the growing interest in the social-emotional functioning of students with specific learning difficulties, there is virtually no current research investigating subject-specific academic performance in students diagnosed with affective disorders and learning difficulties. Only a couple of studies on the reading performance of students with depression have been reported, yielding inconclusive results (McGee & Williams, 1988; Vincenzi, 1987). Specifically, in a longitudinal study of some 900 children in Dunedin, New Zealand, McGee and Williams (1988) reported normal reading levels in 9-year old children identified with depression in that depression measures taken from self-reports were only weakly correlated with measures of scholastic achievement, ie, vocabulary, reading comprehension, spelling and mathematics. Despite evidence suggesting that students' school performance can suffer as a result of poor concentration, low self-esteem, and maladaptive attributions of academic success and failure (eg, Pearl, Bryan & Donahue, 1980), there were no differences found in reading skills as a function of these depression-related characteristics. On the contrary, Vincenzi (1987) found significant differences in the academic performance of students with and without depression. In the light of conflicting evidence further research is needed to look at the relationship between affective and learning difficulties and academic functioning in children and adolescents.

Recently, there is an increasing emphasis on interventions that meet both the educational and social-emotional needs of students (eg, Sabornie, 1994). Yet, there is no clear-cut research on how affective disorders impact academic performance. Also, most of the current research has focused on estimating prevalence rates of depression among students with specific learning disabilities (eg, Maag & Behrens 1989; Maag & Reid, 1994). However, there are virtually no studies looking at subject-specific academic performance in learning disabled students who present some type of depressive symptomatology. This is an important research gap because affective and cognitive domains are interrelated and influence children's and youths' overall functioning (Huntigton & Bender, 1993).

There are several reasons that may explain the relative lack of research on affective disorders, learning difficulties and academic functioning in students: First, research on affective disorders in children has been conducted mainly in the clinical and psychiatric field and, thus, direct educational implications can hardly be drawn. Secondly, the assessment procedures (eg, teacher or parent behavior rating scales, self reports, inventories) employed to diagnose childhood depression have provided inconsistent findings because (a) behavior rating subscales assess associated or co-existing conditions (eg, anxiety, withdrawal) and thus are not sensitive to measuring depression or dysthymia at clinical levels, and (b) teacher behavior rating scales are not entirely accurate in that teachers are more likely to identify children who display externalizing behavior problems (eg, aggression, hyperactivity) than those with internalizing behavior problems (eg, social withdrawal). Self-report measures, on the other hand, are not valid to assess depression in students with learning difficulties in particular given that these tests pose certain language demands and, thus, students with language-based problems may be less likely to respond accurately. Thirdly, most of the current research has examined very small samples without including a control group (ie, children without learning and/or affective difficulties) and, thus, comparisons to the social-emotional functioning of non-disabled students cannot be made. Finally, children with affective disorders present a profile that is qualitatively different from that of adults with depression or dysthymia. As a result, "depressive equivalents" among children can be hardly found. For example, children with depression are more likely to display difficulties concentrating and exhibit restlessness, irritability and helplessness towards academic failure rather than self-reproach and feelings of guilt which are more typical in adults with depression (Cole, 1990). Looking for "depressive equivalents" is particularly difficult given that depressive manifestations are broader in children than they are in adults, ranging from being disruptive and experiencing learning difficulties to engaging in self-injurious behavior.

Limited research on students' affective and academic functioning may also be explained by the lack of rigorous methodologies. Until now, measures from standardized tests that quantify the severity of depressive symptoms should identify students who meet the diagnostic criteria for depression (DSM-IV). However, research with adult samples has shown that 30% to 60% of persons who meet the diagnostic criteria for depression fail to attain cutoff scores in standardized tests (Kazdin et al, 1983). This discrepancy between DSM-IV criteria and actual performance on standardized tests points to the need for employing alternative assessment procedures to increase the diagnostic classification accuracy. Also, the academic characteristics of children with depression have been difficult to delineate because depression often co-exists with a variety of other conditions including Attention Deficit Disorders and Anxiety Disorders (Maag & Behrens, 1989). Thus, in-depth interviews and constant triangulation of information collected from different sources are more likely to construct a valid profile of affective disorders.

In the light of the existing theoretical and methodological concerns, the purpose of this study was to describe, analyze and compare subject-specific academic performance (ie, reading, writing, mathematics) in students with and without (i) dysthymia and (ii) specific learning difficulties. Specifically, reading (ie, phonology, word recognition, reading comprehension), writing (ie, spelling, written expression) and mathematics (ie, reasoning, calculation) were examined as a function of students' diagnostic classification.

Method

Participants

This study included 110 case studies initially that were conducted as a part of a multi-disciplinary evaluation of students' psycho-educational functioning at a US Diagnostic Center. Because a large number of students had multiple diagnoses (eg, ADHD, Autism, severe Learning Disabilities, Behavioral/Emotional Disorders) students with and without dysthymia and specific learning difficulties only were selected for this study (total of 61). Students' academic performance was examined by assessing their skills in reading, writing and mathematics. Most of them had already been placed in special education settings to accommodate learning problems and underachievement. All the participants were native speakers of English and came from ethnically and socio-economically diverse backgrounds; thus, their assignment into groups was matched to ensure equal representation of ethnicity, gender and SES across groups. Their ages ranged between 10 and 14 years old. The participating children and adolescents were assigned into four groups (18 with a diagnosis of dysthymia and specific learning difficulties -LD/D-; 25 with specific learning difficulties alone (non-dysthymic) -LD/ND-; 9 with dysthymia alone (non-learning disabled) -NLD/D-; and 9 without a diagnosis of specific learning difficulties and dysthymia -NLD/ND-). Age, gender and IQ distributions for the four groups are presented at the Table 1.

Table 1 - Means and SD of students Age, IQ by group

For the purpose of this study, students with learning difficulties were those who failed to achieve commensurate with their age and ability levels in one or more of the areas of oral expression, listening comprehension, mathematical calculation and reasoning, reading and spelling skills. Sensory and motor handicaps, mental retardation, and cultural or economic disadvantage were not considered to be the primary cause or etiology for classifying students under the category of learning difficulties (IDEA, 1990; Public Law 101-476).

Procedure/Instrumentation

The diagnosis of affective disorders and specific learning difficulties was carried out by a multi-disciplinary team comprising of a child psychiatrist and a special educator. The diagnosis of (a) dysthymia was based on evidence gathered through clinical observations, background history, information on family circumstances, and extensive interviews (following the criteria delineated in the Diagnostic and Statistical Manual of Mental Disorders-IV, DSM-IV) and of (b) specific learning difficulties was based on an evaluation of intellectual and academic skills via the use of standardized batteries and criterion-referenced tests.

A special educator administered achievement tests (i.e., Wechsler Individualized Achievement Test -WIAT-, Test of Early Reading Ability -TERA-, and Woodcock-Johnson Revised -WJ-R-) during one-to-one interactions with students. Scores of students' reading performance (i.e., phonological awareness, word recognition, reading comprehension) were triangulated by administering various standardized tests (e.g., WIAT, TERA) and subtests from the WJ-R (e.g., Word Attack, Vocabulary), all measuring aspects of reading. Samples of writing were assessed by administering subtests (i.e., Writing Fluency, Spelling, Written Expression) from the WIAT and WJ-R achievement batteries. Finally, mathematical skills were assessed by administering two subtests (i.e., Mathematical Reasoning and Numerical Operations) from the WIAT. Students and their parents were informed that all their responses will remain confidential. Upon completing both the educational and psychological evaluation, the diagnosis of specific learning difficulties was based on the discrepancy in the scores between IQ (WISC-III) and standardized achievement tests (WIAT-R, WJ-R, TERA).

Data Analysis

In this study, the main interest was to test the effects of group status (i.e., LD/D, LD/ND, NLD/D, NLD/ND) on students' achievement in reading, writing and mathematics. Differentiating between dysthymia and learning difficulties was not practical in this study given that dysthymic symptoms were found to co-exist with specific learning disabilities for many participants. This may be explained by the fact that almost all the students were referred for psychological and educational evaluation by their schools because of already existing learning problems and poor academic performance. Thus, groups of students with and without dysthymia and learning difficulties were formed with one group being the control (those diagnosed with neither learning difficulties nor dysthymia). An one-way analysis of variance (ANOVA) was employed to assess possible differences in reading, writing and mathematical performance as a function of group status. Analysis of variance was deemed to be appropriate given that the purpose of this study was to assess between-group differences in subject-specific academic domains separately as a function of students' assignment to specific groups. Classification of the 61 students by group status yielded four groups of unequal size. Post-hoc Tukey-Krammer tests, an adaptation of Tukey tests for unequal cell sizes (Kirk, 1982), were used to determine the significant pair-wise comparisons for all the achievement variables found to be significant at the p<.05 level.

Results

Performance in Reading, Writing and Mathematics

There were no significant main effects at the .05 level found for reading (i.e., vocabulary, word attack skills and reading comprehension) for students assigned to any of the four groups. Results suggested that, among students with dysthymia, those without learning difficulties (NLD/D) (M=89.80) performed better on reading than did their peers with learning difficulties (LD/D) (M=77.15). Similarly, among students without dysthymia, those without learning difficulties (NLD/ND) (M= 89.33) performed better than did their peers with learning problems (LD/ND) (M= 77.64). However, these group differences were significant at the .08 level and thus claims about the relationship between reading and diagnostic categories can hardly be made (Table 2).

Significant differences at the .05 and .01 level were found across the 4 groups for their performance in spelling and written expression tasks. Among students with dysthymia, those without a diagnosis of specific learning difficulties (NLD/D) performed better on spelling, F(3,55)=2.64, p<.05, than did their peers with learning difficulties (LD/D) (Table 2). Pair-wise comparisons revealed that, during a spelling task, dysthymic students without learning difficulties (NLD/D) (M=91.60) did better than those with learning difficulties (LD/D) (M=78.72). There were no significant differences in spelling for nondysthymic students with (LD/ND) or without (NLD/ND) learning difficulties, suggesting that students in both groups performed equally poorly (below average scores).

On the written expression task and among students without dysthymia, those without learning difficulties (NLD/ND) (M=83.12) performed better on a written expression task than did their peers with learning difficulties (LD/ND) (M=68.89), F(3,55)=6.77, p<.0006. Interestingly, the same pattern was found in written expression scores for students with (LD/D) (M=73.94) and without (NLD/D) (M=93.20) learning difficulties, F(3,55)= 6.77, p< .0006, who had a diagnosis of dysthymia (Table 2).

Table 2 - M (SD) and F Scores of the Achievement Variables for the Four Groups

*p<.05

** p<.01

Analysis of variance of the scores on the mathematical operation task also yielded significant main effects, F(3, 59)=3.54, p<.01. Pairwise comparisons revealed that among students without dysthymia, those without a diagnosis of specific learning disability (NLD/ND) (M= 93.22) performed better than did their peers who experience learning problems (LD/ND) (M= 75.82). There were no significant differences in mathematical scores for dysthymic students with (LD/D) and without learning difficulties (NLD/D); students in both groups performed at the below-average level.

In summary, as it was expected, students without learning difficulties performed better than their peers with learning difficulties in spelling, writing and mathematics regardless of whether or not they were diagnosed with dysthymia. It is the condition of specific learning difficulties and not that of dysthymia per se that was found to differentiate between groups in spelling, written expression and mathematical calculations.

Discussion

Although there have been a growing interest in childhood depression, little is known about how students with dysthymia and learning difficulties differ from their normally developing peers in terms of the prevalence and characteristics of their learning problems. The present study was designed to describe, analyze and compare subject-specific academic performance in students with and without dysthymia and learning difficulties. Previous research has led the way in exploring the relationship between scholastic aptitude and affective functioning, but the present study looked at the subject-specific academic attainment of children and adolescents with a diagnosis of dysthymia and learning difficulties.

Results from this study revealed that students without learning difficulties performed better in writing and mathematical operations than did their peers with learning difficulties, irrespective of a diagnosis of dysthymia. In other words, both dysthymic and non-dysthymic students without learning difficulties produced better written outputs and were more competent problem solvers than did their peers with learning difficulties.

Findings on students' writing may be explained by research on writing disabilities indicating that certain factors or constraints (ie, neurophysiological, linguistic, and cognitive) are more likely than affective factors to influence students' performance in writing (Berninger, Mizokawa, & Bragg, 1991; Berninger & Alsdorf, 1985; Perfetti & McCutchen, 1987). Specifically, difficulties with rapid, automatic, sequential retrieval of alphabet letters; immaturity of the nervous system affecting fine motor function, visual motor integration delay; difficulties with the production of words and sentences; and limited competence in planning and revising/reviewing have been found to adversely affect writing (Berninger & Alsdorf, 1985). As Berninger et al (1991) stated the level of constraints is not exhaustive; social and emotional constraints may also contribute to writing difficulties, perhaps in an indirect way. If links between affective disorders and writing difficulties were evident, then counseling may be indicated to alleviate students' lack of concentration and mitigate issues that are likely to preoccupy their attention.

A promising educational programme for remediating writing and mathematical difficulties in students with learning difficulties at the cognitive and emotional level has been developed by Englert et al (1988) focusing on the teaching of strategies for writing and math problem-solving subprocesses (planning, organizing, writing, editing, and revising) in the social context (peer sharing and collaborating). Similarly, other strategies including schema building (teacher-directed instruction on organizational structures such as comparison/contrast, problem/solution, enumeration, description and sequence) and dialogic approach (teacher models writing and problem solving through the think aloud technique to help students internalize meta-cognitive strategies such as planning, revising) seem likely to support concentration and self-confidence in students with affective, writing and mathematical difficulties.

The results from this study regarding reading (i.e., no significant differences at the .05 level) tentatively support McGee's and Williams' hypothesis stating that affective difficulties are less likely to impact directly students' performance in reading. However, they may have an indirect effect by influencing students' motivation or concentration which in turn affects reading. Theoretically, the different group profiles suggest that different factors may be contributing to the individual differences seen in the academic performance of students with and without learning difficulties and dysthymia. Together these findings suggest that dysthymia and perhaps other affective disorders are likely to have an indirect effect on students' academic performance. Future research might examine the effect of multiple factors (ie, attention, self-esteem, helplessness), via multivariate techniques, that have been found to associate with affective disorders on students' academic performance.

In recent studies on reading, there is a growing emphasis on quantitative and qualitative growth paradigms in an attempt to explain the process of meaning making and code breaking during reading (Riley, 1996). The quantitative growth or meaning making paradigm (Ehri, 1978) suggests that the reader is most successful if minimal orthographic information is used. Meaning making is thus achieved by the reader's knowledge of the language and the world (background knowledge). Thus, readers who experience social emotional difficulties manifested in terms of low self-esteem and limited peer interaction and linguistic competence are likely to display reading comprehension difficulties. Also, helpless students often fall into a self-perpetuating cycle in which they attribute failure in reading to causes for which they do not have any control, do nothing to avoid failure in subsequent situations, and consequently fall again, thus further reinforcing beliefs of inevitable failure (Riley, 1996).

According to the qualitative paradigm (code breaking), reading development is a succession of stages through which the learner becomes more knowledgeable about orthography and, thus, increasingly rapid and efficient use of maximal orthographic information leads to better reading comprehension, in that orthographic decoding skills are necessary to facilitate all aspects of reading (Ehri & Wilce, 1985; Riley, 1996). Thus, it appears that emotional problems are less likely to affect the knowledge of the conventions of orthography in terms of identifying words by making use of larger orthographic units.

In sum, the school performance of students with affective disorders is likely to suffer because of poor concentration, low self-esteem and motivational difficulties. However, the relationship among affective functioning, learning and academic achievement needs to be further delineated by taking into consideration multiple factors. Researchers need to be aware of the extent to which affective disorders are associated with other types of childhood disorders and these interrelationships may be considered in attempts to identify unique correlates of depression.

Implications and Future Research Directions

Educators face a unique challenge working with students whose diagnostic profile includes affective disorders and learning difficulties. Assessment and intervention models need to integrate educational and social-emotional goals to support academic attainment in students with depression or dysthymia; thus, coordination of goals and techniques is crucial. Recently, major attention has been focused on developing curricula and strategies to assist children with learning difficulties who also display social-emotional difficulties (see Sabornie, 1991; Schumaker & Hazel, 1984a; 1984b). This is important given that remediation efforts on academic functioning may not be effective and students may fail to improve further if difficulties in their affective functioning remain untreated. Clearly, effective assessment and intervention depends on a better understanding of the relationship between affective disorders and reading, writing and mathematical difficulties at various developmental stages with the diagnosis of affective disorders being based on multi-disciplinary case studies and well-informed reports of students emotional and educational functioning. Nevertheless, the present study highlights the feasibility of assessing affective disorders by applying more naturalistic procedures and collecting information from multiple sources (e.g., student interview, background educational and social history) than those usually employed during standardized assessment (e.g., self-reports, Child Depression Inventory).

Most studies on students' social-emotional functioning have focused on examining mean differences using univariate procedures. This approach, however, does not allow the assessment of the interrelations between measures and the degree to which measures of depression or dysthymia predict learning and academic performance. Because children diagnosed with dysthymia may also display other types of psychopathology including externalizing disorders, anxiety or withdrawal analyses need to be multivariate in order to provide the opportunity to examine the contribution of various, depression-related conditions to student's scholastic aptitude. Thus, it is important for future research to adopt methodologies that would allow analyses of the effect(s) of multiple factors on academic performance simultaneously (e.g., structural equation modeling).

A number of methodological shortcomings to this study may limit the conclusions to be made. Because of the small cell sizes a gender analysis could not be performed. It would have been of interest, however, to look at gender differences on measures of academic and affective functioning especially in adolescence, a stage in which the differences in the prevalence of affective disorders (i.e., dysthymia) becomes increasingly evident (Cole, 1990). Another factor limiting the generalization of these findings involves the matching procedure used. Because variables such as gender, SES, and ethnicity are likely to impact the results, it was necessary to match the subjects. However, with matching procedures, one never knows how many variables to control and which uncontrolled variables (e.g., SES, ethnicity) may interact with the dependent variables.

In the present study, age effects were not assessed because of the small cell sizes that such an analysis would have yielded. Evaluating age effects on students' affective and academic functioning, however, is important given empirical evidence suggesting that the social-emotional development of students with specific learning disabilities may be more severely impaired during adolescence than any other developmental stage (Huntington and Bender, 1993).

Also, because children and youth with specific learning disabilities constitute a heterogeneous population, it is important to have as much information as possible about their social-emotional and educational characteristics. Perhaps, this can be achieved by classifying these characteristics into meaningful subgroups.

Finally, future studies need to investigate if social/language and academic incompetencies have a cumulative effect on symptoms of dysthymia. That is, if social/language difficulties predict dysthymic symptoms over and above academic difficulties and vise versa. Longitudinal investigations to focus on multiple academic (i.e., reading, writing, mathematics) and academic-related (e.g., social skills, sports, peer interactions) competence domains may shed light on the relationship between affective disorders and multiple domains of students' functioning.

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Index