NYSED / ACCES / VR / Adult Vocational Rehabilitation Service Delivery and Coordination / Policies and Procedures / Learning Disabilities and Vocational Rehabilitation Implications

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Learning Disabilities and Vocational Rehabilitation Implications

Technical Assistance Brief (2002-01)

Contents

• Introduction
• Key Point Summaries
  • Section I Key Points
  • Section II Key Points: Implications for Vocational Rehabilitation Services for Individuals with Learning Disabilities
• Section I: Learning Disabilities and Vocational Rehabilitation Implications
  • What is a Learning Disability
  • Impact of Learning Disabilities on Employment
  • Learning Disabilities and Functional Limitations
• Section II: Implications for Vocational Rehabilitation
• Resource Links
• Other Resources
• Related Topics in VR Policy and Procedures

Introduction

This Technical Assistance Brief (TAB) is intended to provide the vocational rehabilitation counselor with a better understanding of the complex nature of this cluster of disabilities and the varying manners in which they are presented.

The Key Points are intended to be brief summaries that precede and highlight the main points of each section. The narrative sections following the key points provide a detailed discussion of the points. For issues related to ACCES-VR policy, the policy sections of the Vocational Rehabilitation (VR) Manual should be consulted. The Technical Assistance Brief is not vocational rehabilitation policy or a prescription for services.

Key Point Summaries

Section I Key Points:

1. What is a learning disability?
   Learning disabilities (LD) is an umbrella term for a group of related cognitive disorders involving the ability to acquire and use information through listening, speaking, or reading, and the related ability to use information through writing or mathematical reasoning. For adults, there is no one correct term or definition that defines learning disabilities. LD is a life-long disorder in one or more of the central nervous system process related to the input, processing and output of information.
2. Impact of Learning Disabilities on Employment
   The impact of LD on employment can be challenging for consumers and counselors. Individuals with LD often have difficulties in accurate appraisal of their abilities and limitations making rehabilitation planning and establishing an appropriate employment outcome challenging.
3. Learning Disabilities and Functional Limitations
   LD results in a diverse array of abilities and deficits in each person. The functional limitations associated with LD may not be obvious to the VR counselor and consequently this may cause difficulties in determining the significance of the disability. Functional limitations related to LD mean measurable impediments directly related to an employment outcome resulting from the person's disability in areas such as communication, interpersonal skills, cognition, mobility, self-care, self-direction, work tolerance, or work skills.

Section II Key Points: Implications for Vocational Rehabilitation Services for Individuals with Learning Disabilities

Section I: Learning Disabilities and Vocational Rehabilitation Implications

What is a Learning Disability

Generally speaking, a learning disability (LD) is a life-long disorder in one or more of the central nervous system processes related to the input, processing and output of information. In most instances an individual with a learning disability has average or above average intelligence. For the adult population with LD there is no one correct term that defines learning disabilities. There are over 13 major definitions of learning disabilities accepted throughout the United States. Most of these definitions reflect a commonality in that LD is thought to be a processing problem. The lack of a standardized definition or common vocabulary often contributes to misinterpretation of the term "learning disability".

For rehabilitation counseling purposes, the U.S. Department of Education's Rehabilitation Services Administration (RSA) defines a learning disability "as a disorder in one or more of the central nervous system processes involved in perceiving, understanding and/or using concepts through verbal (spoken or written) language or non-verbal means. This disorder manifests itself with a deficit in one or more of the following areas: attention, reasoning, processing, memory, communication, reading, writing, spelling, calculation, coordination, social competence and emotional maturity."

The term learning disability does not include learning problems that are primarily the result of visual, hearing or motor disabilities, mental retardation, emotional disturbance, or environmental, cultural or economic disadvantage. However, a diagnosis of another disability does not preclude the co-existence of LD with that disability. Learning disabilities are life long disabilities that cannot be cured or fixed. However, an individual can develop learning or performance strategies that can decrease the functional limitations of the disability. Because they cannot be seen, they often go undetected. LD can affect self-esteem, education, vocation, socialization and/or daily living activities.

Impact of Learning Disabilities on Employment

Individuals with LD are often impaired by lack of insight, i.e. inadequate awareness of their strengths and weaknesses and inability to monitor their performance. They often have an inability to detect whether their behavior is meeting the demands of the environment, and to adjust behaviors and activities if the current performance is not adequate. Inappropriate social skills can create challenges in maintaining employment for adults with LD. Most people are terminated from employment due to poor attitude, inappropriate behavior, and poor interpersonal skills. If individuals with LD have little work experience, especially those who are just coming out of high school, they may have difficulty with understanding the differences in appropriate behavior for work settings, social settings, and intimate relationship settings. The impact of these difficulties can effect the individual's participation and success in all walks of life including the person's family life, social life, employment, self-esteem, self-control and independent living skills. 

Because individuals with LD often have difficulties in the accurate appraisal of their abilities and limitations, the issues of eligibility decision making, rehabilitation planning and establishing an appropriate employment outcome can be challenging for both the rehabilitation counselor and the individual.

Learning Disabilities and Functional Limitations

Functional limitations are defined as a measurable impediment directly related to employment outcome resulting from the person's disability in areas of communication, interpersonal skills, cognition, mobility, self-care, self-direction, work tolerance or work skills.

Communication
Communication is the ability to send and/or receive information through spoken or written or other non-verbal means. Communication problems caused by LD are often manifested by serious difficulties in the acquisition and/or the mastery of language; in the understanding and/or articulation of moderately complex ideas and sentences; and in the development of appropriate grammatical constructions to express ideas in a clear and intelligible manner. Such limitations may be the result of perceptual, language and higher level conceptual deficits caused by the LD.

Problems with subtle communication, such as receptive language deficits, are not easily detected, even by a thorough psychoeducational assessment. Better assessment strategies may be standardized tests of receptive and expressive language, role-plays and interviews with the individual and persons who know the individual well, vocational evaluations and situation assessments.

Examples of communication problems in work related environments are difficulties with: 

• following oral and/or written instructions
• interpreting written materials, particularly job manuals, work orders, diagram and signs
• understanding complex sentences and/or language subtleties, including work related items such as tools
• completing job applications
• learning new tasks or procedures from written materials or verbal instructions
• remembering information, especially multi-step directions
• differentiating important information from unimportant information
• tendency to transpose words or to delete less concrete parts of language such as prepositions, articles and connectors
• illegible handwriting
• inability to prepare a written report or letter due to spelling, grammatical, or organizational difficulties
• lack of organized development and focus in describing a topic
• Inadequate ability to describe skills, work and educational experiences on a job application or during employment interviews
• difficulties in using the telephone
• inability to repeat or relay instructions to co-workers and others.

Interpersonal Skills
Interpersonal skills mean the ability to interact with others, to establish and/or maintain personal, family or community relationships as they affect job performance. For an individual with LD, interpersonal skill limitations are often key factors contributing to the degree of difficulty or lack of success in educational and/or employment situations, particularly with respect to job retention. Often, the individual with LD may not be able to correctly interpret subtle, non-verbal cues or highly nuanced verbal communications that provide feedback on work performance. Also the LD may cause the individual to make literal interpretations of events and dialogue even when the social context of the interaction would dictate otherwise. 

Interpersonal skill deficits may manifest themselves as:

• inappropriate behavior and language, 
• lack of inhibitions
• explosiveness
• withdrawal
• sudden shifts in mood and attitudes
• low frustration tolerance
• task avoidance
• unpredictability.

Frequently these types of limitations are the most devastating in their impact on successful work adjustment. In many cases an individual with LD can master the specific task requirements of a job but cannot negotiate job related interpersonal considerations such as appropriate interactions with peers and supervisors; working collaboratively with others, accepting supervisory monitoring and criticism; and understanding acceptable types and levels of personal interaction.

Cognition
Cognition means learning, reasoning, problem solving, perception and judgment. It also includes the ability to analyze, discriminate, organize, and memorize. These processes allow individuals to assimilate information and learn specific skills related to job functions. Multiple functions that require an individual to mobilize both cognitive and physical resources, including the abilities to organize, structure and plan appropriate approaches to achieve necessary tasks and to do problem solving, will pose great difficulty to many individuals with LD. 

Cognitive limitations are exemplified by an individual's inability to adapt and shift quickly, accurately and appropriately in response to changing work requirements. Individuals may have serious limitations in gathering, organizing and analyzing information and may experience cognitive disorganization and a lack of focus, often misinterpreted by others as lack of motivation or laziness.

Cognition problems are incorporated into all aspects of functioning.

Mobility
Mobility means a person's ability to move to and from work or within a work environment, including walking, climbing, coordination, accessing and using transportation, as well as use of spatial and perceptual relationships. LD would not typically cause motor disorders of the type or degree that interfere with the physical aspect of mobility such as climbing stairs or accessing public transportation. However, LD may present a variety of significant barriers regarding mobility particularly with respect to transportation to and from the worksite. 

For the LD population, mobility problems need to be examined in the way that they impact academic, spatial and perceptual, language, higher level conceptual, and motor coordination deficits. For example:

• reading problems may interfere with the ability to read a bus or train schedule, to determine how to transfer, or to read road signs and maps. 
• Calculation and number concept problems may interfere with the ability to pay for public transportation or budget for transportation. 
• Spatial orientation and perceptual problems influencing directional sense may result in frequently getting lost and an inability to navigate within the environment, be it traveling within the community or finding one's way around the inside of a building, plant or complex.
• Time sense deficits may result in chronic lateness or serious problems in reading, planning, and/or comprehending public transportation schedules. 
• Directional confusion may also pose significant safety problems because of the individual's difficulties in the integration of visual information.
• Limitations in organization, sequencing, and planning resulting from attention and higher level conceptual deficits may preclude an individual's ability to make arrangements for transportation, particularly if these involve modification of simple routines; one or more transfers; or coordination of connections. 
• Problems with comprehension or attention may result in errors such as taking the wrong bus or getting off at the wrong stop, consistently taking wrong turns while driving and/or accident proneness.
• Memory difficulties may interfere with the individual's ability to navigate due to inability to recall landmarks and direction. In addition, language deficits related to LD may interfere with the ability to understand spoken directions.

Self-Care
Self-care means the ability to perform activities of daily living, including eating, toileting, grooming, dressing, cooking, shopping, washing, housekeeping, money management and health and safety needs. Some individuals with LD may experience difficulties in the acquisition of knowledge, experience and skills needed to fulfill the basic activities of daily living.

Serious self-care limitations may be caused by LD deficits in attention, reasoning, memory, communications and coordination. Some examples of LD related self-care limitations that can impact employability are:

• Problems with reasoning, processing and cognition that may cause the individual to repeatedly make poor decisions about basic necessities of life such as health, grooming, dressing, nutrition, etc. and frequently engage in dangerous activities without considering their possible consequences;
• Academic deficits, particularly in reading, writing and arithmetic, that may severely limit an individual in the management of finances, in utilizing transportation, in the taking of medicine and in self-care activities that require following written directions
• Language deficits that may cause difficulties in carrying out basic everyday functions such as shopping and banking. 
• Memory deficits that may lead to forgetting to observe job-related safety precautions or take prescribed medications at the designated intervals.

Self-Direction
Self-direction is an individual's ability to independently plan, initiate, organize, make decisions and carry out daily life activities necessary for employment. Adequate self-direction requires that an individual be able to plan, initiate and monitor behavior with respect to an identified outcome. These executive functions are frequently seriously limited by LD related deficits in cognition and reasoning. 

Some examples of limitations in self-direction include:

• shifting from one activity to another without purpose;
• failing to follow through with and complete assignments:
• inability to set up and implement a study schedule or job search; and 
• requiring a higher degree of supervision than typically available at most worksites. 

Limitations with respect to self-direction are often manifested in problems related to time management, such as underestimating the time (and energy) needed to complete work assignments, causing other responsibilities not to be addressed, missing or being late for appointment and meetings; and making decisions impulsively without consideration given to previous plans or experiences.

Work Tolerance
Work tolerance is defined, as a person's capacity to meet the demands of the work place regardless of the work skills already possessed by the individual. Limitations may be due to physical disability, stamina/fatigue, and effects of medication or psychological factors. For the individual with LD work tolerance may be seriously impaired by attention, reasoning and cognition deficits. These deficits may manifest themselves in a variety of ways including:

• difficulties in concentrating and focusing on the task at hand; 
• frequent shifting from one uncompleted activity to another; 
• or the inability to physically remain in the same location for an extended period of time without fidgeting, feeling restless, or even fleeing the site. 

Related attention problems may be the inability to "tune out" normal back ground noise and general conversation present in most workplaces, and as a result, the individual may become distracted, even agitated, and unable to work effectively. Related motor coordination and balance deficits or problems in processing sensory stimuli may result in serous limitations with regard to the physical endurance and stamina requirements for many jobs. Deficits in processing, attention, memory, reasoning, or communication may result in a serious degree of cognitive fatigue as a result of expending additional effort and energy to compensate for these deficits. Physical and cognitive fatigue may result in a general decline in overall functioning, as demonstrated by lowered productivity, increased mistakes and an increased injury rate. Also, depending on the ability to successfully handle and compensate for the LD deficits, an individual's job performance may vary significantly from day to day.

Work Skills
Work skills means the ability to demonstrate specific tasks and work-related behaviors to carry out job functions as well as the capacity to benefit from training necessary to obtain and maintain appropriate employment. In assessing the type and degree of the work skills limitations caused by LD related deficits, it is important to determine whether the deficits impact a major or critical function of a specific job, and/or the individual's general capacity to learn and carry out any work task.

Academic deficits in reading, writing, spelling or arithmetic can seriously impair an individual's ability to perform job tasks which primarily depend on skills such as legible handwriting; accurate handling of information; filling out forms and applications.

Section II: Implications for Vocational Rehabilitation

The VR counselor may need to gather, analyze, and interpret a broad range of assessment data in order to identify the LD related deficits, and to assess their impact on the functional capacities and limitations identified in the definition. Not all consumers with LD will have all of the functional limitations noted above. Only some will apply to each particular individual.

Significance of Disability
Individuals with learning disabilities experience a broad range of abilities as well as disabilities. Employment outcomes may range from employment with supports and the use of a job coach to completion of advanced post-secondary degree to achieve the employment outcome. Identifying specific functional limitations consistent with the individual’s impediments will serve as a basis and rationale for service provisions.

To determine the level of significance the counselor needs to know the consumer's functional limitations and the degree of their severity. The counselor must then determine the types and number of services the individual needs as well as determine the duration of those services.

The case record needs to reflect documentation supporting any determination that the consumer's disabilities are most significant, significant or less significant. It is recommended that the counselor describe the learning disability related deficits and resultant functional limitations in a manner that clearly identifies the impact of disability on the individual's ability to prepare for, enter, engage in or retain gainful employment. 

Assessment for Eligibility
A critical component of the eligibility process and vocational planning is establishing not just the presence of a disability, but determining how the disability impedes employment and whether an individual requires ACCES-VR services.

Information obtained through assessments needs to focus on the impact of the individual's LD on employment. The assessment should provide specific information as to what the individual can or cannot do in a work setting. It should also define the supports an individual will need to enhance strengths and overcome or modify work limitations.

It is important that the VR counselor consider a variety of approaches to assessment such as work evaluations, standardized tests, situational assessment, functional assessment, consumer self-reports, interviews with the individual and the individual's family, teachers, employers, and a review of the individual's history.

Since some individuals with learning disabilities have little understanding of their disability and how it impacts their functioning, the assessment must extend to others with firsthand knowledge of the individual's functioning to determine their perspective on the individuals' behaviors. This can include individual's familiar with the consumer (family members, teachers, etc.).

Information for Service Planning
While gathering information during the assessment process counselors should give thought to the information they need to assist the individual with planning for employment. Referral questions need to be quite specific and detailed. In general, referral questions for assessment should specify any employment goals under consideration. Below are samples of initial referral questions. Many of these questions need to be answered in the context of an actual work environment to provide valid information. Refinement and specification of the referral questions should occur as the result of direct collaboration among the individual, the vocational rehabilitation counselor and the assessment provider.

Typical Questions That Can Be Asked When Making a Referral for an Assessment

• How well does the person learn and remember?
• What types of information does the person recall?
• How aware is the person of his/her limitations?
• Under what circumstances is information best learned and/or tasks performed?
• How well does the person concentrate? How distractible is the person?
• Can the person be expected to consistently maintain performance on work-related tasks?
• What type of work environment would be optimal?
• What environmental modifications and/or accommodations are recommended or required?
• How can the person be expected to form and manage work and social relationships?
• Is the person likely to become agitated? Under what circumstances? What types of interventions are suggested in these situations?
• How can we best assist the individual to use strategies that will improve performance on work-related tasks? What are the strategies?
• What level of support is needed to perform essential tasks?
• How well does the person respond to feedback?
• How does the person respond to assistance from others?
• What is the person's stamina or endurance on cognitive tasks?
• What is the examiner's confidence that their findings will apply to work settings?

Many of these questions need to be answered in the context of an actual work environment to provide valid information.

Psychological, Psychoeducational and Neuropsychological Assessment
When the counselor has insufficient information to determine the presence of a learning disability or insufficient information to determine the employment goal further assessment may be necessary. A psychological, neuropsychological or psycho/educational assessment may be utilized. 

Psychological tests measure abstract concepts such as intellectual capacity or personality. Psychological assessments also measure behaviors that are thought to indicate types of brain information processing. These assessments provide information about the relative strengths and weaknesses of brain processing. By measuring strengths and weaknesses, psychological assessment clarifies the nature of the learning disabilities. Psychological assessment should build upon information that has been gained from review of existing records, history, and interview. Likewise, results of psychological assessment should not be thought of as an independent, isolated service upon which definitive goals or directions are based.

Psychological assessments involve an individualized measure of intelligence and personality, perhaps with screening of academic and "organic" functions.

A neuropsychological assessment involves a comprehensive evaluation of brain functions using a standardized group of tests or subtests. Neuro-
psychological tests were developed to determine the presence or absence of brain damage. They assess specific cognitive skills such as verbal memory or divided attention. 

Psycho/educational assessment is made up of two types of testing psychological assessment and educational assessment. Psychological testing, in general, measures potential, not what has been learned. It clarifies the nature of the processing deficit. It measures developmental learning, behavioral and other personality characteristics. Areas may include: general intelligence, learning strengths and weaknesses, instructional needs, social interactions and relationships.

Educational assessment identifies a child's level of achievement, knowledge, and development in subject and skill areas such as maintaining attention, auditory and visual perception, fine and gross motor skills, and self-help skills, social interactions and learning styles.

Each of the above assessments will provide intelligence test, yielding an IQ score. While an IQ score is part of an assessment to determine a learning disability, ACCES-VR does not require an IQ score to determine eligibility or goal planning. Determining the functional limitations of the individual is most relevant to the VR process.

Depending upon the situation, individuals with LD may receive any or all of these testing approaches. However, no established battery of tests sufficiently addresses all of the cognitive, behavioral, and emotional domains required to evaluate the individual with learning disabilities comprehensively. As a result, assessment must be accomplished by combining available instrumentation to cover required areas of functioning.

When assessment is needed to confirm a diagnosis of learning disability the following professionals would generally be considered qualified to evaluate learning disabilities: psychologist including clinical or educational psychologist, school psychologist, neuropsychologist and medical doctor. For school based children the evaluation is made by a multidisciplinary team or group of persons, including at least one teacher or other specialist with certification or knowledge in the area of the suspected disability.

Identifying and Selecting the Appropriate Testing Approach; Evaluating Assessments
Assessment, and any resulting diagnosis, should consist of and be based on a comprehensive assessment battery that does not rely on any one test or subtest. Evidence of a substantial limitation to learning or other major life activity must be provided. The diagnostician's report should use direct language in the diagnosis and documentation of a learning disability avoiding the use of terms such as "suggests" or "is indicative of." 

Ideally, individual assessments for LD should include the following types of tests:

• Aptitude- a complete intellectual assessment with all subtests and standard scores reported.
• Measures of Academic Achievement - a comprehensive academic achievement battery. The battery should include current levels of academic functioning in relevant areas such as reading (decoding and comprehension), mathematics, and oral and written language.
• Measures of processing ability-specific areas of information processing (e.g. short- and long-term memory, sequential memory, auditory and visual perception/processing, processing speed, executive functioning and motor ability) should be assessed.
• A Clinical Summary-A well-written diagnostic summary based on a comprehensive evaluation process is an important component of the assessment. Assessment instruments and the data they provide do not diagnose; rather they provide important elements that must be integrated by the evaluator with background information, observations of the individual during the testing situation, and the current context. It is essential that professional judgment be utilized in the development of a clinical summary.

Community-based Situational Assessments 
Community-based situational assessments often work well and are particularly relevant for persons with LD since research has shown that assessments within the actual life context yield more valid information than "decontextualized" or standardized assessments. In addition, some individuals with LD may need to visit or try out a job or employment situation before considering other options.

LD and school referrals
Historically individuals with learning disabilities have been defined by educators for the provision of education services at the K-12 level. Information has been focused on educational problems, not functional limitations related to daily living skills or employability. Since secondary schools are the largest source of referrals of individuals with learning disabilities to ACCES-VR, it is essential that school and ACCES-VR personnel have a clear understanding that the definitions of learning disability do differ, depending upon the purpose of the classification. For school purposes, the learning disability must adversely affect educational performance; for vocational rehabilitation purposes, the disability must be a substantial impediment to employment. Not all individuals who are classified as having a learning disability for educational purposes require vocational rehabilitation services. 

A ACCES-VR counselor should review transcripts from all school and training programs the individual has attended whenever possible. These records may also contain information from standardized IQ and achievement tests. For individuals who have been involved in school or training recently, the counselor may want to collect information from key informants (with the individual's written consent) in writing or by phone or in person. These informants may include anyone in the school or training setting who had a good knowledge of the individual and their school experience. This might be a school counselor, resource room teacher, teacher, advisor, etc.

A student with a learning disability in school must have received an individual evaluation in order to receive either 504 accommodations or be eligible for special education programs and services. An individual evaluation means any procedures, tests, or assessments used selectively with an individual student as may be necessary to determine whether a student has a disability and the extent of his or her special education needs. An individual evaluation does not include basic tests administered to, or procedures used with, all students in a grade or class.

An individual evaluation must include a variety of assessment tools and strategies, including information provided by the parent, to gather:

• Functional and developmental information about the student; and
• Information related to enabling the student to participate and progress in the general education curriculum.

Components of an Initial Individual Evaluationmust include:

• A physical examination
• An individual psychological evaluation, except when a school psychologist determines that, after an assessment of a school-age student, further evaluation is unnecessary;
• A social history and observation of the student in the current educational placement; and
• Other appropriate assessments or evaluations, including a functional behavioral assessment for a student whose behavior impedes his or her learning or that of others, as necessary to ascertain the physical, mental, behavioral and emotional factors which contribute to the suspected disabilities.
• For students age 12 and those referred to special education for the first time who are age 12 and older, an assessment that includes a review of school records, teacher assessments, and parent and student interviews to determine vocational skills, aptitudes and interests.

The determination of the need to conduct an individual psychological evaluation for school-age students must be made on an individual basis using a variety of data collection methodologies and information sources (e.g., analysis of the referral, interviews, observation, rating scales completed by parents teachers and the student and a review of school records.) 

The evaluation is made by a multidisciplinary team or group of persons, including at least one teacher or other specialist with certification or knowledge in the area of the suspected disability. No determination can be made on a categorical basis, i.e., it can not be predetermined, based on the type of disability suspected, whether a psychological evaluation is needed or not.

Support Services, Compensatory Strategies and Technical Aids
Strategies to enhance an individual's skills and ability or compensate for functional limitations need to be developed on an individual basis in a particular training or work setting. ACCES-VR staff may need to include the development of compensatory strategies as part of the individual Plan for Employment.

An individual with LD often will have cognitive difficulties that interfere with participation in employment services. Compensatory strategies, environmental modifications, training or job modifications, or other accommodations can be developed to enable the individual with LD to learn new work skills or perform the essential aspects of a job at an acceptable performance level. The unique strengths and deficits of the individual in the context of his/her respective work or training environment must be carefully considered in developing any effective compensatory strategies or environmental modifications.

In addition to learning specific strategies, the goal is to help the individual to become more strategic in his/her approaches to learning and not simply have them acquire one or more compensatory behaviors.

Related Training/Supports to be considered:

• Travel training from occupational therapists, job coaches or other community resources 
• Remediation, tutoring or other instructional supports 
• Assistive technology or creative use of new technology products

The following tables are provided as examples only, but not as "prescriptions". Each strategy must be developed with an individual for the particular situation or task where a support, strategy or modification may be needed.

Chart #1 Examples of Compensatory Strategies for Behavior
LD Behavior	Vocational Impact	Compensations/accommodations/ modifications/strategies
Has difficulty following through on instructions from others	Completing job applications Job promotions Loss of job Low self-esteem	Identify learning/working styles Provide instructions in preferred learning style mode (auditory/visual/tactile) Provide feedback/supervision Provide special assistive aids, accommodations, etc. prescribed to meet individualized needs
Has difficulty sustaining attention in tasks or play activities	Difficulty following multi-step instructions Increases risk for accidents for certain jobs Increases risks for mistakes on-the-job	Break tasks into short segments Gradually extend activities into longer units Schedule breaks between tasks Arrange environment to block visual/auditory distractions Use earphones to block sound
Has difficulty working independently	Problems in jobs such as sales where you need to be a self-starter Problems in helping professions Problems in jobs requiring travel from supervised work setting	Develop a structured and clearly defined task Work close to peer or supervisor Help the consumer identify and practice his/her preferred learning/work style
Displays disorientation to time	Impact job success if consumer is frequently late Problems with professions where schedules and appointments are required	Use pocket calendar Develop written schedule for daily work or independent living routines Use watch alarm or beeper to cue
Has difficulty using public transportation	Frequents absences or tardiness increase risk of losing job	Have consumer ride the bus with counselor or peer Teach specific transportation skills required
Takes longer to do job than others	Rules out production jobs Rules out assembly jobs Irritates other co-workers who work faster Problems with jobs having deadlines	Allow extra lead time Gradually decrease practice time while maintaining or increasing job demands Use a timer to set pace and cue consumers
Has difficulty following oral instructions	Failure to complete work assignments Problems with attendance/punctuality Aggravates supervisor Safety may be a factor	Develop a list of written instructions Provide diagrammatic instructions  Provide hands on task demonstrations
Has difficulty following written instructions	May fail to complete work assignments Difficulty completing job applications Difficulty with jobs requiring interpretation of written material	Tape instructions Give oral instructions Provide hands on task demonstration

 

Chart #2 Examples of Compensatory Strategies
Cognitive Challenge	Possible Intervention
Orientation	Keep a calendar for appointments, to-do lists, checklist, phone #s, etc.
Attention/Concentration	Ask for clarification and step by step instructions when necessary. Present new information slowly.
Visual/Perceptual Process	Provide orientation to written documents or screens/fields on a computer screen.
Organization	Follow an established, set process, organized checklist or schedule for completing certain tasks. Do one thing at a time.
Memory	Use a tape recorder to remember information provided in presentations or meetings. Take notes. Summarize information. Organize notes.
Problem-Solving	Depending on the task, use a decision table or chart to solve recurring problems.
Self-Monitoring	Keep a schedule or checklist of work tasks necessary to complete. Check-off completed items.

 

Chart #3 Examples of Environmental Modifications or Accommodations
Cognitive Challenge	Possible Intervention
Orientation	Organize work materials or set up in a consistent manner. Keep a calendar with schedule and daily tasks.
Attention/Concentration	Minimize distractions through noise control or visual barriers.
Visual/ Perceptual Process	Use high contrast materials to complete certain tasks.
Organization	Use graphics, checklists or charts to outline essential job functions. Keep files.
Memory	Use a planner pad/appointment book to track meetings, goals and "to do" lists.
Problem-Solving	Identify staff as "resource" people to help solve certain problems (natural supports). Plan and structure each day.
Self-Monitoring	Keep a checklist of tasks that need to be completed daily.

Resource Links

• http://www.ldanatl.org/ - Learning Disabilities Association of America
• http://www.ldonline.org - LD Online
• http://www.seakingwdc.org/ld/index.htm - Workforce Development Council of Seattle-King County (Learning Disabilities Project)
• http://www.nifl.gov/nifl/ld/archive/resource.htm - National Resources for Adults with Learning Disabilities

Other Resources

• Learning Disabilities, Literacy, and Adult Education, Susan A. Vogel and Stephen Reder (Editors).
• Understanding and Managing Learning Disabilities in Adults. (The Professional Practices in Adult Education and Human Resource Development Series). Dale R. Jordan

Related Topics in VR Policy and Procedures

• Section 202.00 Eligibility for Service Policy
• Section 204.00 Assessment Policy
• Section 205.00 Significance of Disability
• Section 206.00 Individualized Plan for Employment Policy
• Section 1282.00 Neuropsychological Evaluation Policy
• Sections 1310.00 Supported Employment Policy
• Section 1320.00 Cognitive Remediation Policy
• Special Education Policy June 1992 Memo on Transition Planning and Services for Students with Disabilities at the Secondary Level
• Special Education Policy November 1999 Memo on Coordination of Special Education and Vocational Rehabilitation Services for Students Who are Eligible for Both Programs

Last Updated: February 9, 2011