Education

“Specific Learning Disorder": The Case Against Labeling

How a learning disorder diagnosis could become a self-fulfilling prophesy.

Posted Mar 18, 2021 | Reviewed by Matt Huston

Randen Pederson, Creative Commons
Source: Randen Pederson, Creative Commons

Many years ago, Robert Rosenthal and Lenore Jacobson (1968) performed a fascinating experiment in elementary school classrooms. They led teachers to believe that a special test had revealed that certain students would show a spurt in intellectual growth during the next few months. Only the teachers were told of the supposed test results, not the students. In reality, the students labeled as “spurters” had been selected not on the basis of a test score but purely at random. Yet, when all the students were tested eight months later, the selected students showed significantly greater gains in IQ and academic performance than did their classmates! These were real gains, measured by objective tests, not just perceived gains. Somehow, the teachers’ expectation that certain children would show more intellectual development than other children seemed to have created its own reality.

Effects such as this are often referred to as self-fulfilling prophesies. You give someone a label that seems to hold certain expectations of them, and, lo and behold, they live up to those expectations. In this case, that occurred even though the labeled students were uninformed about the label. Subsequent research, involving elaborations on Rosenthal and Jacobson’s original study, revealed that teachers behaved differently toward the “spurters” than toward other students—in ways that may very well have caused the spurts. They were warmer toward them, gave them more challenging work, gave them more time to answer difficult questions, and noticed and reinforced more often their self-initiated efforts (Cooper & Good, 1983; Rosenthal, 1994). In short, either consciously or unconsciously, they created a better learning environment for the selected students. In these experiments, the students developed better self-concepts because of how they were treated (Cole, 1991; Jussim, 1991). They began to see themselves as more capable academically than they had before, which led them to work harder to live up to that self-perception.

Today we live in a schooling world where many children are labeled not as spurters, but as people with learning disorders. It is generally not just teachers who know who has what label, but the kids themselves and also their parents. Hmmm. If a positive label can improve academic performance, I wonder what a negative label might do? In this essay my focus is on the disorder referred to, by DSM-5, the official diagnostic manual of the American Psychiatric Association, as specific learning disorder (SLD).

How is SLD defined and how is the label assigned?

According to DSM-5, “Specific learning disorder is a neurodevelopmental disorder with a biological origin that is the basis for abnormalities at the cognitive level that are associated with the behavioral signs of the disorder.” That’s a direct quote. The manual goes on to explain that the behavioral signs are manifested as difficulty learning some basic academic skill. Subtypes correspond with difficulties in reading, writing, and arithmetic, commonly referred to, respectively, as dyslexiadysgraphia, and dyscalculia. To receive such a diagnosis, according to the manual, it is necessary to show that the academic learning difficulty is quite severe (the person should rank in the bottom 7 percent on test scores of the specific ability for their age) and is not the result of low general intelligence, nor of some brain injury occurring after birth, nor of lack of conventional instruction. For the complete DSM-5 description, see here.

Although specific leaning disorder is regularly described as a biological disorder with its basis in some defect in the brain, the truth of the matter is that there is little evidence supporting that description. Brain imaging studies are reported by some to show brain differences associated with types of specific learning disorder, but there is little consistency from study to study and no consensus on what brain areas might be involved. In a review, Peters and Ansari (2019) conclude that there is no good evidence for localized neural deficits associated with learning disorders, that “all the estimates [from brain studies] are weak and noisy.” The claim that any SLD is the result of some brain difference is simply a hypothesis. Nobody has ever been diagnosed with such a disorder by looking at the brain.

Claims that some quite specific cognitive deficit underlies any given category of SLD are also undermined by research. Again, regarding dyslexia, a common claim is that the core problem lies in the ability to perceive the differences among basic language sounds, or to keep track of a sequence of such sounds, but research provides no consistent evidence for this claim (Benson et alˆ., 2020: Peters & Ansari, 2019; Ziegler & others, 2020). The only real behavioral link among people diagnosed with dyslexia is that they don’t read well.

How a learning disability label may hinder learning

Identifying and labeling people as having specific learning disorder might be worthwhile if some of the claims about the disorder were true. If we really knew that everyone with the label had the same underlying neural-cognitive deficit, and if we had a reliable treatment for the deficit, then labeling might be beneficial. It would tell us to whom to provide the treatment. As it is, however, the evidence is not strong that labeling leads to beneficial treatments, and there are good reasons to think that the label may hinder learning more often than it helps (see Cainelli & Bisiacchi, 2019; Coon, 2014; Peters & Ansari, 2019). Here are some of the possible harmful consequences of the label:

The label may lead to a sense of helplessness in the labeled person.

The assumption conveyed in most of the writings about diagnosed learning disorders is that they result from defects in the brain. This assumption is not well founded, but it gets conveyed, nevertheless, not just to the teachers and parents but also to the labeled person. It would seem quite reasonable that this could promote a sense of helplessness in the labeled person, a sense that there is not much they can do to remedy the problem. They may submit to a special education program imposed on them by the school but fail to make the individual effort required to find their own best ways of learning, independent of that program or even consistent with that program. In line with this possibility, research studies have shown that students labeled with a learning disorder have significantly lower beliefs in their own abilities to learn than do other students (e.g. Chan et al., 2017; Tabassam & Grainger, 2002). They also tend to have what clinicians call a negative attributional style, which means that they attribute their failures to their own inadequacies and their successes to luck or to other factors outside of themselves (Tabassam & Grainger, 2002). This attributional style is well known to lead to reduced effort and can also lead to both anxiety and depression.

The label may stigmatize the labeled person, thereby reducing learning opportunities and lowering the quality of life.

A large-scale study revealed that parents and, even more so, teachers have lower academic expectations of students who have been labeled as having a learning disorder than they do of students who perform equally poorly but have not been given a label (Shifrer, 2013). Just as higher expectations can lead teachers and parents to provide extra opportunities and encouragement for learning, lower expectations can do the opposite. There is evidence that teachers believe that those with a learning disorder aren’t going to show much improvement no matter what the teacher does, so they are more likely to put their effort into helping those low achievers who haven’t been labeled with a supposed brain abnormality (Shifrer, 2013).

The label may lead to treatment programs that interfere with real learning. 

Edwin Ellis (2002) has described ways by which attempts to help students diagnosed as learning disordered can backfire. He points out that often such students are presented with boring, watered-down instruction that focuses on memorizing loosely related facts or practicing low-level academic skills at the expense of focusing on meaningful content. Our brains are designed to become engaged with interesting content, and when so engaged we may pick up, as a byproduct, the lower-level skills. When the curriculum is watered down, such learning opportunities are much reduced. As I have discussed previously, many homeschooling parents have discovered that their children learn best by becoming fully engaged in content that challenges rather than insults their intellects. Students with a specific learning disorder label are, by definition, not stupid (they must have an IQ in the normal range or above to receive the label), but often they are treated as if they are, and this may lead them to begin to think that they are.

The label may provide schools with an excuse for their failures and thereby work against reform.

Perhaps you will think I’m overly cynical, but I suspect that learning disorder labels serve the needs of schools more than students. Our standard schools operate on the assumption that all normal children are ready to learn the same things, at the same time, in the same way. This assumption is blatantly false, but if educational policy makers were to recognize it as false, they would have to dramatically change the ways that schools operate. So, schools keep pushing and squeezing to get all the kids through the same square holes, and they find that no matter how hard they push there are some who just don’t fit through. So, instead of concluding that there is something wrong with the school, they may conclude that there is something wrong with the kid. It’s not the school’s failure; the problem lies in the biology of that kid’s brain. We also have systems by which schools get extra funding for children labeled with a learning disorder, which adds further to the motive for labeling. And many parents push for labels, in the belief that the special education program the child will receive will increase the likelihood of the child’s eventually going to college, where the label may continue to lead to special help.

I’ll conclude with a little story. I remember, back when I was teaching undergraduate courses, a period when more and more students were coming to me with paperwork, signed by the Dean, showing that they had a learning disorder and needed special accommodations of one sort or another. I recall a young lady showing me a document that claimed she had a “logic disorder.” The document explained that she was perfectly well qualified for academic work but had difficulty thinking logically, so she should be tested only in ways that are not logically challenging. I puzzled over it and then asked her, “What does this mean? What’s a logic disorder?” She responded, “I think it means I’m stupid,” and then she began to cry. I said something like, “Wow, that’s a very logical conclusion; if you did have a logic disorder, that’s what it would mean. So, maybe you don’t actually have a logic disorder!” We both laughed. Then we worked out a deal by which she would take the first test without any sort of accommodation, just to see how she would do. She did fine, and then fine through the rest of the course, despite the fact that there were lots of questions that required logic. We had a couple of more good laughs, as the course went on, about that stupid diagnosis.

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And now, what are your thoughts on this? What have been your experiences, positive or negative, with learning disorder diagnoses?  Psychology Today is discontinuing the practice of allowing comments here, and will remove all comments by the end of this month, but you can comment, and see others' comments, by going to the link to this post on my Facebook timeline, here. If you don't see the link at the top of my timeline, just click on the search icon (little magnifying glass) and type in the title of this post.  You can join the discussions of all of my blog posts by following me on Facebook.

References

Benson et al (2020). A national survey of school psychologists’ practices in identifying specific learning disabilities. School Psychology, 35, 146-157.

Cainelli & Bisiacchi (2019). Diagnosis and treatment of developmental dyslexia and specific learning disabilities: Primum Non Nocere. Journal of Developmental & Behavioral Pediatrics, 40, 558-562.

Chan, Y., et al. (2017) Investigating quality of life and self-stigma in Hong Kong children with specific learning disabilities.  Research in Developmental Disabilities, 68, 131-139.

Cole, D. A. (1991).  Change in self-perceived competence as a function of peer and teacher evaluation. Developmental Psychology, 27, 682-688. 

Coon, E.R., et al. (2014). Overdiagnosis: How our compulsion for diagnosis may be harming children. Pediatrics, 134, 1013-1023.

Cooper, H. M., & Good, T. L. (1983). Pygmalion grows up: Studies in the expectation communication process. Longman.

Ellis, E., (2002). Watering up the curriculum for adolescents with learning diabilities, Part I: Goals of the knowledge dimension. LD Online.

Jussim, L. (1991). Social perception and social reality: A reflection-construction model. Psychological Review, 98, 54-73.

Peters, L., & Ansasri, D. (2019). Are specific learning disorders truly specific, and are they disorders?  Trends in Neuroscience and Education, 17, 1-8.

Rosenthal, R. (1994). Interpersonal expectancy effects: A 30-year perspective. Current Directions in Psychological Science, 3, 176-179. 

Rosenthal, R., & Jacobson, L. (1968). Pygmalion in the classroom.  Holt, Rinehart & Winston.

Shifrer, D., (2013) Stigma of a label: Educational expectations for high-school students labeled with learning disabilities.  Journal of Health and Social Behavior, 54, 462-480.

Tabassam, W., & Grainger, J. (2002).  Self-concept, attributional style and self-efficacy beliefs of students with learning disabilities with and without attention deficit hyperactivity disorder. Learning Disability Quarterly, 25, 141-151.