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To cite this article: Melanie E. Fenwick, Hanna A. Kubas, Justin W. Witzke, Kim R. Fitzer,
Daniel C. Miller, Denise E. Maricle, Gina L. Harrison, Sarah J. Macoun & James B. Hale
(2015): Neuropsychological Profiles of Written Expression Learning Disabilities Determined
by Concordance-Discordance Model Criteria, Applied Neuropsychology: Child, DOI:
10.1080/21622965.2014.993396
Article views: 39
Download by: [Texas A & M International University] Date: 06 November 2015, At: 00:36
APPLIED NEUROPSYCHOLOGY: CHILD, 0: 114, 2015
Copyright # Taylor & Francis Group, LLC
ISSN: 2162-2965 print=2162-2973 online
DOI: 10.1080/21622965.2014.993396
School and Applied Child Psychology, University of Calgary, Calgary, Alberta, Canada
James B. Hale
School and Applied Child Psychology, University of Calgary, Calgary, Alberta, Canada
decits that often adversely impact social, emotional, RTI delays needed services for children with SLD (e.g.,
behavioral, adaptive, and occupational functioning Barth et al., 2008; Fletcher et al., 2014; Fuchs, Fuchs, &
(Backenson et al., 2013; Grigorenko et al., 2013; Silver Compton, 2004; Hale, Wycoff et al., 2010; Reynolds &
et al., 2008). Disparate cognitive or neuropsychological Shaywitz, 2009; Speece, 2005; Waesche, Schatschneider,
processing decits can lead to different learning decits Maner, Ahmed, & Wagner, 2011).
among children with SLD, even in the same academic In light of AAD irrelevance for diagnosis and inform-
domain (e.g., reading, math, writing; Johnson, ing intervention (Fletcher et al., 2006) and the fact that
Humphrey, Mellard, Woods, & Swanson, 2010; Miller, RTI is primarily benecial for the early identication
2013; Semrud-Clikeman, 2005), suggesting that clini- of learning needs and improving academic outcomes
cians need sophisticated diagnostic tools and methods (Burns, Riley-Tillman, & VanDerHeyden, 2013) for non-
for identifying and supporting children with SLD in disabled children, neither of these methods are sufcient
written expression (WE) and other areas. for SLD identication. Furthermore, neither AAD nor
RTI is supported by legal precedence (as stated by the
U.S. and Canadian Supreme Court rulings) requiring
Recognizing SLD: Why Statutory Definitions Should
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inherent in modern conceptualizations of SLD underpinning consistent with Berninger and Dunns
(Flanagan, Fiorello, & Ortiz, 2010; Hale et al., 2010; (2012) emphasis on using neuropsychological and aca-
Fletcher-Janzen & Reynolds, 2008), can thus be opera- demic data to determine what works for whom. With
tionalized in the following SLD denition: the explosion of neuroscientic evidence serving as the
impetus for an evolution in psychological practice, clin-
A specic learning disability is characterized by repeated icians can now use neuropsychological data to more
inadequate response to increasingly intense evidence-
accurately identify child disorders and provide targeted
based interventions and an inconsistent pattern of
cognitive=neuropsychological strengths and weaknesses
efcacious interventions, thereby linking brain and
that lead to insufcient achievement in one or more behavior in the real world.
academic domains.
In this denition, a child who is chronically unrespon- Operationalizing PSW Approaches for SLD
sive to intervention (i.e., a nonresponder) must also Identification and Intervention
demonstrate a cognitive and=or neuropsychological PSW methods and tools differ, but they similarly
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PSW that leads to poor academic achievement prior to emphasize: (a) cognitive-processing strengths and weak-
SLD classication. PSW can be based on a growing nesses; (b) academic decits relative to cognitive
body of empirical evidence of cognitive process strengths; and (c) a theoretical or empirical association
academic achievement relationships (e.g., McGrew & between the processing weakness and achievement de-
Wendling, 2010). Phonological, abstract visual- cit (Hale, Flanagan, & Naglieri, 2008). For example, the
symbolic, rapid automatic naming, memory-encoding, Naglieri consistency-discrepancy approach is based on
storage, retrieval, receptive=expressive language, visual- the planning-attention-sequential-simultaneous model,
spatial processing, uid reasoning, processing-speed, which has successfully been linked to academic inter-
response inhibition, executive-planning, and working- vention (see Naglieri & Otero, 2011), while the Flanagan
memory processes have been linked to academic aptitude-achievement consistency model is based on
domains and are useful in differentiating SLD from well-researched Cattell-Horn-Carroll (CHC) and cross-
other disorders, SLD subtypes, and=or low achievement battery methods (see Flanagan, Ortiz, & Alfonso,
according to many peer-reviewed research studies.1 A 2013; Keith & Reynolds, 2010; McGrew & Wendling,
PSW approach is supported by cognitive-processing 2010).
differences between children with SLD and typical The Hale and Fiorello (2004) concordance-
peers (Johnson et al., 2010) and by low intellectual discordance model (C-DM) uses a CHC classication
functioning (Cornoldi, Giofre`, Orsini, & Pezzuti, of measures for an initial interpretive framework, but
2014). Furthermore, the link between cognitive and also requires a neuropsychological approach (i.e.,
neuropsychological functioning and SLD treatment out- CHT; Hale & Fiorello, 2004) to ensure the concurrent,
come is now regularly being documented.2 This research ecological, and treatment validity of results (Fiorello,
suggests that neuromarkers and neuropsychological Hale, & Wycoff, 2012). Research investigating C-DM
functioning may predict individual differences or treat- has shown meaningful SLD subtype differences on
ment response better than academic performance or reading (decoding, uency, comprehension), mathemat-
observable behavioral measures (e.g., Insel, 2013; ics (computation, uency, word problems), neuropsy-
Reddy, Weissman, & Hale, 2013; Supekar et al., 2013; chological (learning and memory), and
Wasserman & Wasserman, 2012). psychopathology (rating scale) measures (Backenson
As a result, the PSW denition presented here is con- et al., 2013; Carmichael, Fraccaro, Miller, & Maricle,
sistent with the IDEA SLD statutory and regulatory 2014; Elliott et al., 2010; Feifer, Gerhardstein Nader,
requirements (Decker et al., 2013) and ensures that chil- Flanagan, Fitzer, & Hicks, 2014; Hain & Hale, 2010;
dren receive comprehensive evaluations that address all Hain, Hale, & Glass-Kendorski, 2009; Hale, 2010; Hale,
areas of suspected disability, thus facilitating SLD dif- Fiorello et al., 2008; Hale et al. 2013; Kubas et al., 2014).
ferential diagnosis and intervention development (Hale, In addition, children with C-DM-identied SLD are
Alfonso et al., 2010). Thus, a PSW approach has the more likely to show a positive treatment response when
potential to provide differentiated instruction for chil- these data are used to guide instruction and intervention
dren with SLD and other disabilities, a theoretical (Avtzon, 2012; Hale, Wycoff et al., 2010; Hale et al.,
2004; Mascolo, Kaufman, & Hale, 2009; Reddy & Hale,
1
The studies that support PSW utility in diagnosing SLD and SLD 2007).
subtypes and differentiating SLD from low-achievement differences Although emerging evidence documents the promise
are reported here: http://werklund.ucalgary.ca/braingain/projects.
2
The studies reviewed that support PSW utility in developing spe- of the C-DM SLD method to guide individualized
cic interventions for SLD and SLD subtypes are reported here: intervention,1, 2 this empirical work has been limited
http://werklund.ucalgary.ca/braingain/projects. because most studies did not conrm the processing
4 FENWICK ET AL.
cognitive strength score and the writing achievement ongoing PSW (also true with AAD) criticism that
score, the child was identied as having an SLD. If no children with higher cognitive functioning are more
signicant differences emerged between the cognitive likely to be identied with SLD compared with lower-
strength and the cognitive weakness or between the cog- functioning children (Fletcher, Lyon, Fuchs, & Barnes,
nitive strength and any of the academic subtests, the 2006). Thus, the nal sample included children with no
child was not identied as having an SLD. SLD in reading, math, or WE (n 66) and children with
WISC-IV factor and subtest scores used to dene WE SLD with below-average WE subtest scores
PSW were not conrmed using CHT, nor were there (n 146), thereby allowing for direct comparison of
efforts to link PSW patterns to achievement decitsa children with no SLD to those with WE SLD who also
practice that would negate C-DM use for individual had low WE in at least one area.
children (Hale & Fiorello, 2004). The WISC-IV index
scores were used for PSW unless there was signicant
within-factor variability (p < .05; Wechsler, 2003). If RESULTS
there were subtest differences, two-subtest combinations
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were created using the CHC and=or neuropsychological The groups differed in the prevalence of WJ-III Spelling,
WISC-IV interpretive approach (e.g., Flanagan, v2(5) 135.07, p < .001 (u .85, p < .001, n 181),
Alfonso, Mascolo, & Hale, 2010; McGrew & Wendling, Writing Fluency, v2(5) 69.13, p < .001 (u .69,
2010; Miller & Hale, 2008), with averaged subtest means p < .001, n 144), and Writing Samples, v2(5) 74.32,
and reliability coefcients used for C-DM calculation. p < .001 (u .59, p < .001, n 212; see Table 1). The
The standard error of the difference formula (p < .05; C-DM-determined SLD subtypes did not differ for the
Anastasi & Urbina, 1997) was used to establish PSW. Spelling analyses, with most children with WE SLD
A no-SLD group (n 66, 23.3%) and ve SLD sub- identied as having spelling difculties regardless of
types were identied, including presumed left hemi- their specic processing weakness. Of note, however,
sphere (LH-SLD; auditory-lexical-semantic-crystallized was that every child with WM-SLD was found to have
subtest weaknesses; n 18, 6.4%), presumed right hemi- a spelling decit. In contrast, for the Writing Fluency
sphere (RH-SLD; determined by visual-spatial-uid analysis, primarily the LH-SLD (89%), PS-SLD (77%),
reasoning subtest weaknesses; n 25, 8.8%), presumed and EX-SLD (87%) subtypes had decits. For the
working memory (WM-SLD; determined by auditory Writing Samples subtest, no meaningful SLD subtype
sequential-working-memory subtest weaknesses; n 46, relationships were apparent.
16.3%), presumed processing speed (PS-SLD; deter- The WISC-IV index and WJ-III WE subtest
mined by processing speed-associative-learning subtest differences across the no-SLD group and all ve SLD
weaknesses; n 81, 28.6%), and executive (EX-SLD; subtypes are presented in Table 2, with the WISC-IV
determined by Working Memory Index and Processing subtest differences displayed in Figure 1. Although all
Speed Index [PSI] subtest weaknesses; n 47, 16.6%). analyses were signicant (F range 2.8621.16,
From this sample, children with C-DM decits on the p < .01), this would be expected given the strictly
WJ-III Spelling, Writing Fluency, and=or Writing psychometric C-DM WE SLD denition in this study.
Samples subtests were further excluded if they had aver- As a result, these data should be interpreted for descrip-
age WE scores (SS 90 or greater). This ensured that tive rather than inferential purposes. Qualitatively, only
the nal sample did not include children with higher the PS-SLD subtype appeared to have an additional
cognitive functioning or gifted children with C-DM- processing weakness (PSI), with other subtype weak-
determined WE SLD. These criteria addressed an nesses consistent with their denition. The LH-SLD,
TABLE 1
Children Identified With Concordance-Discordance Written Expression SLD
C-DM Subtype
C-DM concordance-discordance model; SLD specic learning disabilities; LH left-hemisphere decit; RH right-hemisphere decit;
WM working-memory decit; PS processing-speed decit; EX WM and PS decits; WJA Woodcock Johnson Achievement.
6 FENWICK ET AL.
TABLE 2
Descriptive Statistics for WISC-IV and WJ-III Writing Subtests for the No-SLD and WE SLD Subtypes
WISC-IV Wechsler Intelligence Scale for Children-Fourth Edition; WJ-III Woodcock-Johnson Tests of Achievement-Third Edition;
WE written expression; SLD specic learning disabilities; LH left-hemisphere decit; RH right-hemisphere decit; WM working-memory
decit; PS processing-speed decit; EX WM PS decit.
a
p < .01, as expected given the concordance-discordance model denition.
RH-SLD, and EX-SLD subtypes had the lowest auditory-language long-term memory measures, the
Spelling scores, but all subtypes had low-average per- WRAML-2 Number-Letter (NL), Verbal Learning
formance. Low-average Writing Fluency scores were (VL), Verbal Learning Delayed Recall (VL-DR), Story
evident for all subtypes. The RH-SLD, WM-SLD, Memory (SM), and Story Memory Delayed Recall
and EX-SLD subtypes had low-average mean Writing (SM-DR) subtests were examined. Group differences
Samples scores. were found on all measures except VL, which
For the neuropsychological proles reported in approached signicance. Bonferroni post-hoc analyses
Table 3, several subtype differences emerged. For the for the NL subtest revealed the WM-SLD and EX-SLD
FIGURE 1 Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) subtest proles of children with and without a written expression
specic learning disability (SLD; F range 3.4320.37, p range .005 to <.001 as expected given concordance-discordance model denition). LH left
hemisphere; RH right hemisphere; WM working memory; PS processing speed; EX WM PS decit.
C-DM WRITTEN EXPRESSION SLD SUBTYPES 7
TABLE 3
No-SLD and Written Expression SLD Differences on Neuropsychological Tests
Note. All scores are scale scores (M 10, SD 3), except VMI subtests (M 100, SD 15). SLD specic learning disabilities; LH left hemi-
sphere; RH right hemisphere; WM working memory; PS processing speed; EX WM PS decit; Seq. sequencing; VMI Visual-Motor
Integration; TMT Trail-Making Test.
a
p < .05. bp < .01.
subtypes had lower performance than the PS-SLD sub- were used. For these measures, differences emerged
type. For VL-DR, the LH-SLD and PS-SLD subtypes between SLD subtypes for the TMT Vis subtest only,
performed worse than the no-SLD group. For SM, chil- with Bonferroni post-hoc analyses revealing the PS-SLD
dren with the LH-SLD subtype performed worse than subtype scoring lower than the LH-SLD and EX-SLD
those with the PS-SLD and EX-SLD subtypes. Lastly, subtypes. The FW subtest was low for all participant
for the SM-DR, the LH-SLD subtype scored lower than groups, with mean scores in the low-average range
all other subtypes, including the no-SLD group. For except for the LH-SLD group.
visual-spatial-holistic measures, the WRAML-2 Finger For the motor sequencing-constructional-psychomotor
Windows (FW) and Design Memory subtests, the speed measures, the VMI-6 total (VMI) and VMI-6
VMI-6 Visual Perception subtest, and the D-KEFS Motor Coordination subtests, as well as the D-KEFS
Trail-Making Test Visual Scanning (TMT Vis) subtests Trail-Making Test Number Sequencing (TMT NumS),
8 FENWICK ET AL.
Letter Sequencing, and Motor Speed measures were However, visual-spatial-motor processes for visuocon-
administered. Differences were noted among SLD sub- structional VMI skills may not be as relevant as
types for the TMT NumS subtest, with post-hoc analy- sequential-processing weaknesses in recognizing WE
ses revealing that the PS-SLD group performed worse SLD subtype spelling decits (Richards et al., 2009),
than the LH-SLD subtype and no-SLD group. Finally, which would be consistent with the sequential motor
the working-memory-interference control-retrieval uency decits found in this (e.g., TMT differences, low FW
executive measures consisted of the D-KEFS Verbal performance across subtypes).
Fluency Letter Fluency and Category Fluency measures, For Writing Fluency, difculty in lexical-semantic
the Design Fluency Switching, the Color-Word knowledge (LH-SLD), graphomotor speed when writing
Interference Inhibition (CW), and the Trail-Making (PS-SLD), and=or speeded sequential processing and
Test Number-Letter Switching subtests. Subtype differ- error monitoring (EX-SLD) may potentially contribute
ences emerged for the CW subtest only, with post-hoc to poor performance. Clearly, lexical-semantic and
analyses revealing the EX-SLD and RH-SLD groups expressive language processes are important for WE
performed worse than the no-SLD group. and the likely source of the LH-SLD subtype decits
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et al., 2011). In fact, WE competence requires the ability for understanding a childs unique learning difculties
to plan, organize, strategize, implement, monitor, evalu- across academic domains, or even within the same
ate, and revise the writing samplethe same dorsolat- domain. When combined with a CHT neuropsychologi-
eral processes tapped by many executive function cal approach, C-DM provides a practical and compre-
measures. The EX-SLD subtype had lower mean hensive tool to illuminate the relationship between
Writing Samples scores than any other subtype, and PSW and academic achievement, thus staying true to
their poor performance on the D-KEFS CW subtest statutory denitions that emphasize processing decits
might suggest that inhibition, response selection= as a hallmark characteristic of SLD (Dehn, 2014; Hale,
interference, and=or performance monitoring may have Alfonso et al., 2010). For example, C-DM has been
contributed to their WE decits (Berninger et al., 2008; advocated for use in neuropsychological practice
Hooper et al., 2011). In addition, Writing Samples sub- (Miller, Getz, & Leffard, 2006), has been adopted by
test difculties were also evident for the other standardized achievement tests (e.g., Wechsler, 2009),
executive-related subtypes (WM-SLD and PS-SLD), so and is supported by both diagnostic and treatment val-
executive-based subtypes displayed proles similar to idity studies,1,2 making it a potentially practical SLD
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children with ADHD who have executive and WE clinical and research tool. In addition, the PSW method
decits (Tannock, 2012; Yoshimasu et al., 2012). How- also helps differentiate SLD from low academic achieve-
ever, the other executive measures did not differentiate ment, SLD subtypes, and other disorders.
subtypes, so perhaps they were not sensitive to WE This study provides preliminary evidence for the rel-
executive requirements. Alternatively, these ndings evance of identifying and understanding neuropsycholo-
may reect the structured nature of the WJ-III Writing gical processes to best support the individual needs of
Samples task, which asks the child to write single sen- children with SLD. However, it is important to note that
tences using words and pictures provided, rather than although processes help us understand WE SLD and
writing an unstructured essay on a topic, thus limiting other disorders, their denition, operationalization,
the need for executive functions typically required in and assessment are an ongoing challenge for the eld
WE (e.g., Hooper et al., 2011). of neuropsychology. Psychology is replete with poorly
Children in the RH-SLD group deserve special atten- operationalized terminology, and yet, psychological
tion given that some WE research shows the relevance of constructs may be considered denitive in many social,
visual-spatial processes (e.g., Carlson, Rowe, & Curby, legal, and practice contexts. The frequently used generic
2013), while others show little relationship with WE in constructs of cognition and psychological processes
typical children (Floyd, McGrew, & Evans, 2008). This are umbrella terms meant to reect global concepts, but
RH-SLD subtype had the lowest mean score on all in reality, they are poorly dened. Perhaps a psychologi-
visual-spatial measures in this study, suggesting their cal process is a mental action dened by central nervous
writing difculties are not specically related to linguis- system neuronal activity (e.g., LeDoux, 2002). However,
tic competency, which was a relative strength. Perfor- this neurocellular and neurochemical activity occurs
mance on the WRAML-2 FW task was poor across all with and without thought or volition or action,
C-DM SLD subtypes, thereby highlighting the need to and some processes require integration of brain struc-
consider spatial sequential-processing decits in WE or tures and systems not under conscious control (e.g.,
disability in general, but not necessarily any WE SLD Cromwell & Panksepp, 2011; Koziol & Budding,
in particular. Some might suggest that the WE SLD def- 2009). Providing a list of brain-based psychological
icits in this group may be related to visualization of the processes (e.g., phonological awareness, visual discrimi-
topic for subsequent WE (Olive & Passerault, 2012), but nation, sequential memory, executive planning, sus-
when one considers the importance of right-hemisphere tained attention) and linking them to brain structures=
processes in uid reasoning, complex language relation- systems may facilitate interdisciplinary recognition and
ships, and ideational exibility (e.g., Bryan & Hale, foster ontological convergence (e.g., Hastings et al.,
2001; Floyd et al., 2008; Kaufman, Kaufman, Liu, & 2014). However, the measures used to evaluate these
Johnson, 2009; Takeuchi et al., 2010), this could explain processes are never specic to single brain structures
their WE problems. Visual search skills were poorer for or even systems, nor are they comparable across test
both the RH-SLD and PS-SLD groups, suggesting that batteries. This explains why similar test scores can be
sustained attention may be important to consider during found for children with very different brain-based deter-
WE for these subtypes, especially in light of research minants. As a result, the C-DM approach presented here
linking right-hemisphere function to ADHD and vigil- is inherently limited by this ontological issue, and ulti-
ance (Hale et al., 2013) and ADHD processing decits mately, practitioners can only understand the childs
that predict WE competency (e.g., DeBono et al., 2012). processing weakness as it relates to an achievement de-
In addition to cognitive and academic proles, neu- cit within the context of the measures used and out-
ropsychological test results provide critical information comes observed. Otherwise, one runs the risk of
10 FENWICK ET AL.
assuming that a processing weakness is an automatic Achievement Test (WIAT-III) or Test of Written
indicator of an SLD, which is the same illusion practi- Language (TOWL-3). The WJ-III Writing Samples
tioners entertained when discrepancy was equated with subtest may not tap executive processes necessary for a
SLD. child to compose a small essay, which would reveal
clearer information on how a child actually generates
ideas and translates them in the WE product (e.g.,
Limitations and Future Directions
Altemeier et al., 2006). This also touches on the need
Study results may have been attenuated in this clinical for more unstructured WE tasks when evaluating
sample because participants could not have intellectual children with WE SLD, as idea formulation, theme
disability but had to have below-average WE perfor- development, ideational exibility, and organization
mance, which restricted the range and limited subtype are not tapped on the WJ-III Writing Samples subtest.
sample size, thereby decreasing power. Another signi- If the task was less explicit or more creative, children
cant limitation was the use of a strictly psychometric would likely be required to recruit more right-
C-DM approach; thus, processing weaknesses could hemisphere linguistic functions to produce novel, diver-
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not be veried as the cause of WE decits. Additionally, gent, or complex prose (e.g., Bryan & Hale, 2001; Koziol
this study was limited by the specicity of study mea- et al., 2013; Takeuchi et al., 2010) or use implicit lan-
sures; because neuropsychological processes dened guage for creative writing or poetry (Faust & Mashal,
by psychometric measures cannot adequately evaluate 2007). Even with this limitation, it is important to note
the numerous brain structures, circuits, or systems the relevance of processing speed in this study, with
required for WE competency and because these mea- white-matter integrity=connectivity, right-hemisphere
sures are factorially complex and not orthogonal, they functions, and uent performance (e.g., Bryan & Hale,
may not reect the same underlying determinants for 2001; DeBono et al., 2012; Turken et al., 2008) linked
different children or different WE task requirements. to WE competency, which would be reected in the
For instance, it is possible that a poor auditory working- RH-SLD=PS-SLD WE decits found in the present
memory score may reect an underlying phonological study. Finally, it is important to note that environmental
sequencing decit (e.g., Asberg, Kopp, & Gillberg, factors such as prior experience and education continu-
2014) on a spelling test, but a low score could reect a ously interact with individual child characteristics to
working-memory problem on a writing uency task. fundamentally alter brain structure and function during
This may also be the case with the PSI Coding subtest, neurodevelopment (Koziol et al., 2013). Therefore,
often thought of as a measure of processing speed and future research should examine how environmental
graphomotor skills. However, research has conrmed inuences impact neurodevelopmental sequelae associa-
that it also measures the associative learning processes ted with SLD subtype patterns.
of the inferior parietal lobe (see Hale et al., 2012), the WE is likely the most difcult academic subject one
same region thought to be critically important in pho- must learn in school (Hale & Fiorello, 2004), yet it
nemegrapheme correspondence for spelling compe- receives the least amount of empirical attention (e.g.,
tency (Berninger et al., 2010). Because brain structures, Berninger et al., 2008). WE difculties and disorders
circuits, and systems cannot be uniformly understood occur at alarmingly high rates in children (Zins &
using single measures, a neuropsychologicalnot a Hooper, 2012), and for children with SLD, these decits
psychometricinterpretive approach is needed to persist into adulthood even when other literacy skills
understand the relationship between objective measures have improved (Harrison, 2009). WE requires multiple
and WE competence and SLD. As Luria (1980) noted, brain functions and systems to work in an integrated
WE decits can result from disruption of, or damage to, fashion, and a decit in one or more of these processes
diverse cortical and subcortical areas, with only the may result in WE SLD (Berninger & Dunn, 2012;
peculiarities of WE output highlighting where the prob- Hooper et al., 2011; Lorch, 2013). Clearly, signicant
lem is occurring within the context of the complex func- empirical work is necessary to understand the PSW
tional system that governs WE. Clearly, there is a need associated with WE spelling, writing uency, and WE
to link brain structure and function of neuropsychological decits, so affected children can receive the differen-
measures and their relationship with academic achieve- tiated instruction and targeted interventions necessary
ment using structural and functional imaging techniques. to ameliorate their WE decits.
Future research should also be conducted to verify the
relationship between the processing decit and WE SLD
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