Maternal and Child Health Journal

, Volume 10, Issue 4, pp 329–338 | Cite as

Behavioral Problems and the Effects of Early Intervention on Eight-Year-Old Children with Learning Disabilities

  • Jennifer W. Yu
  • Stephen L. Buka
  • Marie C. McCormick
  • Garrett M. Fitzmaurice
  • Alka Indurkhya
Original Article

Objectives: 1) To investigate the comorbidity of verbal and nonverbal learning disability subtypes with several domains of behavior problems among 8-year-old children. 2) To determine whether receipt of an early intervention modified the association between childhood behavior problems and learning disabilities (LD). Methods: This is a secondary data analysis of the Infant Health and Development Program (IHDP), a randomized clinical trial of an early intervention provided between ages 0 and 3 involving 985 children born low birthweight and premature. The findings are based on a prospective follow-up of these children at 8 years of age. Results: Compared to children without verbal LD (VLD), those with VLD were twice as likely to exhibit clinical levels of total behavior problems and 89% more likely to exhibit externalizing behavior problems. Analysis of specific subscales of behavior revealed significant associations with anxious/depressed and withdrawn behaviors, as well as an increased likelihood of attention problems among children with VLD. No significant association was found between nonverbal LD (NVLD) and any type of behavior problem. Furthermore, there was a significant interaction between VLD and the intervention, in which the odds of internalizing behavior problems were greater among children with VLD. No interaction effect of the intervention occurred for any type of behavior problem among children with NVLD. Conclusions: These findings provide evidence that distinct differences exist for different learning disability subtypes with regards to behavioral outcomes and the effects of early intervention services among 8-year-old children.


learning disability behavior early intervention childhood. 



Support for this research was provided by the Maternal and Child Health Bureau (5T76 MC 00001) and by the National Institute of Health (GM 299745).


  1. 1.
    Bryan T, Burstein K, Ergul C. The social-emotional side of learning disabilities: A science-based presentation of the state of the art. Learn Disabil Q 2004;27:45–51.CrossRefGoogle Scholar
  2. 2.
    Sundheim ST, Voeller KK. Psychiatric implications of language disorders and learning disabilities: Risks and management. J Child Neural 2004;19:814–26.Google Scholar
  3. 3.
    Duncan D, Matson JL, Bamburg JW, et al. The relationship of self-injurious behavior and aggression to social skills in persons with severe and profound learning disability. Res Dev Disabil 1999;20:441–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Biederman J, Mick E, Faraone SV, et al. Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. Am J Psychiatry 2002;159:36–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Mayes SD, Calhoun SL, Crowell EW. Learning disabilities and ADHD: Overlapping spectrum disorders. J Learn Disabil 2000;33:417–24.PubMedCrossRefGoogle Scholar
  6. 6.
    Pennington BF, Groisser D, Welsh MC. Contrasting cognitive deficits in attention deficit hyperactivity disorders versus reading disability. Dev Psychol 1993;29:522–3.CrossRefGoogle Scholar
  7. 7.
    Willcutt EG, Pennington BF. Comorbidity of reading disability and attention-deficit/hyperactivity disorder: Differences by gender and subtype. J Learn Disabil 2000;33:179–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Bruck M. Social and emotional adjustments of learning disabled children: A review of the issues. In: Ceci S, editor, Handbook of Cognitive, Social and Neuropsychological Aspects of Learning Disabilities. Hillsdale, NJ: Erlbaum, 1986.Google Scholar
  9. 9.
    Maughan B, Rowe R, Loeber R, et al. Reading problems and depressed mood. J Abnorm Child Psychol 2003;31:219–29.CrossRefPubMedGoogle Scholar
  10. 10.
    Greenham SL. Learning disabilities and psychosocial adjustment: A critical review. Child Neuropsychol 1999;5:171–96.Google Scholar
  11. 11.
    Wilcutt EG, Pennington BF. Psychiatric comorbidity in children and adolescents with reading disability. J Child Psychol Psychiatry 2000;41:1039–48.CrossRefPubMedGoogle Scholar
  12. 12.
    Feagans LV, McKinney JD. Subtypes of learning disabilities: A review. In: Feagans L, Short E, Meltzer L, editors, Subtypes of Learning Disabilities: Theoretical Perspectives and Research. Hillsdale, NJ: Lawrence Erlbaum Associates, 1991.Google Scholar
  13. 13.
    Beitchman JH, Young AR. Learning disorders with a special emphasis on reading disorders: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1997;36:1020–32.CrossRefPubMedGoogle Scholar
  14. 14.
    Lyon G. Learning disabilities. Future of Children 1996;6:54–76.PubMedCrossRefGoogle Scholar
  15. 15.
    Hakeem A, Fitzgerald B. A survey of violent and threatening behaviors within an in-patient learning disability unit. Psychiatr Bull 2002;26:424–7.CrossRefGoogle Scholar
  16. 16.
    Osman B. Learning disabilities and the risk of psychiatric disorders in children and adolescents. In: Greenhill L, editor, Learning Disabilities: Implications for Psychiatric Treatment. Washington, DC: American Psychiatric Publishing Inc., 2000, pp. 33–57.Google Scholar
  17. 17.
    Robins PM. A comparison of behavioral and attentional functioning in children diagnosed as hyperactive or learning-disabled. J Abnorm Child Psychol 1992;20:65–82.CrossRefPubMedGoogle Scholar
  18. 18.
    Arnold EM, Goldston DB, Walsh AK, et al. Severity of emotional and behavioral problems among poor and typical readers. J Abnorm Child Psychol 2005;33:205–17.CrossRefPubMedGoogle Scholar
  19. 19.
    McGee R, Williams S, Share D, et al. The relationship between specific reading retardation, general reading backwardness, and behavioral problems in a large sample of Dunedin boys: A longitudinal study from five to eleven years. J Child Psychol Psychiatry 1986;27:597–610.PubMedCrossRefGoogle Scholar
  20. 20.
    Smart D, Sanson A, Prior M. Connections between reading disability and behavior problems: Testing temporal and causal hypotheses. J Abnorm Child Psychol 1996;24:363–83.CrossRefPubMedGoogle Scholar
  21. 21.
    Tomblin JB, Zhang X, Buckwalter P, et al. The association of reading disability, behavioral disorders, and language impairment among second-grade children. J Child Psychol Psychiatry 2000;41:473–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Holborow PL, Berry PS. Hyperactivity and learning disabilities. J Learn Disabil 1986;19:426–31.PubMedGoogle Scholar
  23. 23.
    Silver L. The relationship between learning disabilities, hyperactivity, distractibility, and behavioral problems. J Am Acad Child Adolesc Psychiatry 1981;28:385–97.Google Scholar
  24. 24.
    Shaywitz SE, Schnell C, Shaywitz BA, et al. Yale Children's Inventory: An instrument to assess children with attentional deficits and learning disabilities. J Abnorm Psychol 1986;14:347–64.CrossRefGoogle Scholar
  25. 25.
    Frick PJ, Kamphaus RW, Lahey BB, et al. Academic underachievement and the disruptive behavior disorders. J Consult Clin Psychol 1991;59:289–94.CrossRefPubMedGoogle Scholar
  26. 26.
    Hinshaw SP. Externalizing behavior problems and academic underachievement in childhood and adolescence: Causal relationships and underlying mechanisms. Psychol Bull 1992;111:127–55.CrossRefPubMedGoogle Scholar
  27. 27.
    Moffitt TE. The neuropsychology of conduct disorder. Dev Psychopathol 1993;5:135–51.Google Scholar
  28. 28.
    Carroll JM, Maughan B, Goodman R, et al. Literacy difficulties and psychiatric disorders: Evidence for comorbidity. J Child Psychol Psychiatry 2005;46:524–32.CrossRefPubMedGoogle Scholar
  29. 29.
    Cleaver RL, Whitman RD. Right hemisphere, white-matter learning disabilities associated with depression in an adolescent and young adult psychiatric population. J Nerv Ment Dis 1998;186:561–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Huntington DD, Bender WN. Adolescents with learning disabilities at risk? Emotional well-being, depression, suicide. J Learn Disabil 1993;26:159–66.PubMedGoogle Scholar
  31. 31.
    Svetaz MV, Ireland M, Blum R. Adolescents with learning disabilities: Risk and protective factors associated with emotional well-being: Findings from the National Longitudinal Study of Adolescent Health. J Adolesc Health 2000;27:340–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Rourke BP, Fuerst DR. Psychosocial dimensions of learning disability subtypes: Neuropsychological studies in the Windsor Laboratory. School Psych Rev 1992;21:361–74.Google Scholar
  33. 33.
    Rourke BP. Syndrome of Nonverbal Learning Disabilities: Neurodevelopmental Manifestations. New York: Guilford Press, 1995.Google Scholar
  34. 34.
    Rourke BP, Dotto JD, Rourke SB, et al. Nonverbal learning disabilities: The syndrome and a case study. J Sch Psychol 1990;28:361–85.CrossRefGoogle Scholar
  35. 35.
    Gross-Tsur V, Shalev RS, Manor O, et al. Developmental right-hemisphere syndrome: Clinical spectrum of the nonverbal learning disability. J Learn Disabil 1995;28:80–6.PubMedGoogle Scholar
  36. 36.
    Gross-Tsur V, Manor O, Shalev RS. Developmental dyscalculia: Prevalence and demographic features. Dev Med Child Neurol 1996;38:25–33.PubMedCrossRefGoogle Scholar
  37. 37.
    Levine MD, Lindsay RL, Reed MS. The wrath of math: Deficiencies of mathematical mastery in the school child. Pediatr Clin North Am 1992;39:525–36.PubMedGoogle Scholar
  38. 38.
    Burke MD, Hagan-Burke S, Sugai G. The efficacy of function-based interventions for students with learning disabilities who exhibit escape-maintained problem behaviors: Preliminary results from a single-case experiment. Learn Disabil Q 2003;26:15–25.CrossRefGoogle Scholar
  39. 39.
    Keilitz I, Dunivant N. The relationship between learning disability and juvenile delinquency: Current state of knowledge. RASE 1986;7:18–26.Google Scholar
  40. 40.
    Rourke BP, Fisk J, Strang J. Neuropsychological Assessment of Children: A Treatment-Oriented Approach. New York City: Windsor, 1986.Google Scholar
  41. 41.
    Fenichel E, Mann TL. Early head start for low-income families with infants and toddlers. Future Child 2001;11:134–41.PubMedCrossRefGoogle Scholar
  42. 42.
    McCarton CM, Brooks-Gunn J, Wallace I, et al. Results at age 8 years of early intervention for low-birth-weight premature infants: The Infant Health and Development Program. JAMA 1997;277:126–32.CrossRefPubMedGoogle Scholar
  43. 43.
    McCormick MC, McCarton CM, Brooks-Gunn J, et al. The Infant Health and Development Program: Interim summary. J Dev Behav Pediatr 1998;19:359–70.PubMedGoogle Scholar
  44. 44.
    Grunau RE, Whitfield MF, Davis C. Pattern of learning disabilities in children with extremely low birth weight and broadly average intelligence. Arch Pediatr Adolesc Med 2002;156:615–20.PubMedGoogle Scholar
  45. 45.
    Pastor PN, Reuben CA. Attention deficit disorder and learning disability: United States, 1997–1998. In: Vital and Health Statistics. Washington, DC: US Government Printing Office, 2002.Google Scholar
  46. 46.
    Ramey CT, Bryant DM, Wasik BH, et al. Infant Health and Development Program for low birth weight, premature infants: Program elements, family participation, and child intelligence. Pediatrics 1992;3:454–65.Google Scholar
  47. 47.
    Elbaum B, Vaughn S. Self-concept and students with learning disabilities. In: Swanson H, Harris K, editors, Handbook of Learning Disabilities. New York: Guilford Press, 2003, pp. 229–41.Google Scholar
  48. 48.
    Swanson H, Harris K. Handbook of Learning Disabilities. New York: Guilford Press, 2003.Google Scholar
  49. 49.
    Heiman T. Parents of children with disabilities: Resilience, coping, and future expectations. J Dev Phys Disabil 2002;14:159–71.CrossRefGoogle Scholar
  50. 50.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, 4th edn. Washington DC: American Psychiatric Association, 1994, pp. 39–40.Google Scholar
  51. 51.
    Wechsler D. Wechsler Intelligence Scale for Children. New York: The Psychological Corporation, 1991.Google Scholar
  52. 52.
    Woodcock R, Johnson M. Woodcock-Johnson Psycho-Educational Battery-Revised. Riverside Publishing, 1992.Google Scholar
  53. 53.
    Rutter M, Yule W. The concept of specific reading retardation. J Child Psychol Psychiatry 1975;16:181–97.PubMedCrossRefGoogle Scholar
  54. 54.
    Achenbach T. Integrative Guide for the 1991 CBCL/4-18, YSR, and TRF Profiles. Burlington, VT: University of Vermont, 1991.Google Scholar
  55. 55.
    Achenbach T. Empirically Based Taxonomy: How to Use Syndromes and Profile Types Derived from the CBCL/4-18, TRF, and YSR. Burlington, VT: University of Vermont, 1993.Google Scholar
  56. 56.
    Greenbaum PE, Dedrick RF. Hierarchical confirmatory factor analysis of the Child Behavior Checklist/4-18. Psychol Assess 1998;10:149–55.CrossRefGoogle Scholar
  57. 57.
    Gadeyne E, Ghesquiere P, Onghena P. Psychosocial functioning of young children with learning problems. J Child Psychol Psychiatr 2004;45:510–21.CrossRefGoogle Scholar
  58. 58.
    Stone W, Greca AL. The social status of children with learning disabilities: A reexamination. J Learn Disabil 1990;23:32–7.PubMedGoogle Scholar
  59. 59.
    Swanson HL, Deshler D. Instructing adolescents with learning disabilities: Converting a meta-analysis to practice. J Learn Disabil 2003;36:124–35.PubMedCrossRefGoogle Scholar
  60. 60.
    Cornwall A, Bawden HN. Reading disabilities and aggression: A critical review. J Learn Disabil 1992;25:281–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Mazzocco MM, Myers GF. Complexities in identifying and defining mathematics learning disability in the primary school-age years. Ann Dyslexia 2003;53:218–53.CrossRefPubMedGoogle Scholar
  62. 62.
    Padget SY. Lessons from research on dyslexia: Implications for a classification system for learning disabilities. Learn Disabil Q 1998;21:167–78.CrossRefGoogle Scholar
  63. 63.
    Yoshikawa H. Long-term effects of early childhood programs on social outcomes and delinquency. Future Child 1995;5:51–75.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Jennifer W. Yu
    • 1
    • 6
  • Stephen L. Buka
    • 2
    • 3
  • Marie C. McCormick
    • 2
  • Garrett M. Fitzmaurice
    • 4
    • 5
  • Alka Indurkhya
    • 2
  1. 1.Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoUS
  2. 2.Department of Society, Human Development and HealthHarvard School of Public HealthBostonUS
  3. 3.Department of EpidemiologyHarvard School of Public HealthBostonUS
  4. 4.Division of General Medicine, Brigham and Women's HospitalBostonUS
  5. 5.Department of BiostatisticsHarvard School of Public HealthBostonUS
  6. 6.UCSF Institute for Health Policy StudiesSan FranciscoUS

Personalised recommendations