Access Type

Open Access Dissertation

Date of Award

January 2020

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

First Advisor

Douglas Barnett

Abstract

Specific learning disorders, also known as learning disabilities, are defined as neurodevelopmental disorders in which long-term difficulties with learning and using academic skills occur within the context of one or multiple academic areas (i.e., reading, mathematics, writing). As our understanding of learning disorders (LD) has evolved beyond a focus on childhood diagnosis, a limited body of research has emerged examining adult outcomes for individuals with learning disorders in regards to higher education, employment, psychosocial, and health outcomes. Much of the results of this research seems to indicate that individuals with LDs may have poorer outcomes in adulthood across these domains. However, there are significant methodological concerns within the limited body of literature regarding adult outcomes for individuals with LDs, including a lack of relevant control comparison groups, variability in criteria used for learning disorder diagnosis, low representation from individuals who obtained higher education, and a tendency to follow-up with parents or caregivers rather than the diagnosed adult. Thus, one of the primary purposes of this study was to gather and analyze follow-up data regarding occupational, psychosocial, and health outcomes for a diverse clinically-assessed group of adults in higher education diagnosed with specific LDs. The roles of initial assessment cognitive factors, LD subtype, specific assessment recommendations and adjustment to LD in outcomes were also examined.

Participants were 77 adults who had previously received clinic-based psychoeducational assessments due to expressed concerns regarding possible LD (47 LD; 30 No LD). The comparison group (no LD) consisted of higher education students who did not meet criteria for LD but were referred for psychoeducational assessment due to academic performance concerns. Fifteen participants completed telephone follow-up interviews (10 LD; 5 No LD) a mean of 6.03 years later (SD = 1.9 years).

Study findings regarding follow-up functioning overall indicated minimal group differences in outcomes between the comparison and LD groups in regards to education, employment, health and psychological well-being. However, evidence of possible underemployment and mental health difficulties emerged for participants in the study sample with and without LD. Specifically, unemployment rates (LD = 40%; no LD = 50%) for the total sample of participants exceeded the U.S. national average for adults of a similar education level. Annual income for the LD group (88.9% earning less than 40,000) was also found to be significantly below the national average. These findings occurred despite half of participants with LDs reporting that they did not perceive their diagnosis as impacting their employment. Additionally, within the entire study sample a relatively high reported prevalence of anxiety disorders (LD = 40%; no LD = 60%) was observed. 20% of follow-up participants diagnosed with LDs also reported being diagnosed with clinical depression. Interestingly, although the interaction effect between LD and anxiety status was not significant, a significant negative relationship was found between anxiety disorder and LD, and a positive correlation found between anxiety disorder and overall intellectual ability.

Regarding the assessment process and treatment recommendations for LD, findings of this study indicated that most participants generally viewed their assessments as helpful (87.5%) and attempted to follow recommendations provided by their clinicians, despite some barriers. Ability-achievement discrepancy was found to be the most common criteria used by assessing clinicians for determining the presence or absence of LD in this study sample, although a notable percentage (1/7th) of the assessment reports examined failed to provide a clear rationale for diagnostic decision-making.

This study highlighted a number of issues in regards to diagnosis, assessment, and psychosocial outcomes in post-secondary educated adults with learning disorders. Specifically, that ability-achievement discrepancy continues to be preferred for LD diagnostic decision-making, despite concerns in the field regarding the approach's reliability. More research also appears to be needed regarding the relationship between anxiety, LD, and cognitive variables such as achievement and ability. Additionally, outcomes for adults with learning disorders point to potential long-term issues with underemployment and relatively higher prevalence of anxiety and depression - issues which may need to be screened for and addressed more specifically at the time of assessment. Notably, individuals who did not meet criteria for LD diagnosis but did experienced education difficulties also appear to be at risk for occupational and psychological difficulties.

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