通过学习障碍的故事,50年的个人奥德赛:从小学到成人的学习障碍诊断。

IF 2 4区 心理学 Q3 CLINICAL NEUROLOGY
Richard L Sparks
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引用次数: 0

摘要

LD诊断的问题是一个概念的逻辑结果,这个概念在63年后从未有一个普遍接受的定义或经验验证的诊断标准。这篇文章是一篇50多年来的个人奥德赛,探讨了LD概念和LD诊断的许多问题,这些问题影响了我对儿童和成人的研究、教学和临床实践。这是一个关于LD故事的批判性、历史性和分析性的旅程,以第一人称临床经验为基础,明确参与诊断理论,对首次成人LD诊断有影响。本文以成人诊断为目标,对学习障碍概念和学习障碍诊断在整个生命周期中的演变和现状提出了几个主张:(1)个体内部和个体间的成就和认知差异是正常和预期的,但通过“意外成就不足”的构建被重新定义为异常;(2)尽管LD领域促进了意外的不良成就,但它选择性地将部分个体的不良成就视为“意外的”,造成了内部不一致;(3)依赖于假定的“潜力”(IQ)差异使诊断变得不必要地复杂,并通过排除低成就个体而引入不公平;(4)尽管有大量的经验证据质疑这些做法的有效性,但这些做法仍然存在;(5) DSM-IV保留了基于差异的方法,导致了成人诊断和正常变异性和平均表现病理化的持续问题;(6)强调相对于普通人的实质性限制的残疾标准被继续依赖差异所取代;(7)差异、潜力和意外的低成就被规范化为持久的概念和文化假设。总之,这些主张将LD重新定义为一个由故事而不是科学塑造的结构,并呼吁重新关注其理论基础和实际后果,特别是对成人诊断。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A 50-year personal odyssey through the story of learning disabilities: from primary school to adult LD diagnoses.

The problems with LD diagnosis are the logical consequence of a concept that, after 63 years, has never had a universally accepted definition or empirically validated diagnostic criteria. This essay is a personal odyssey over 50 years that explores the many problems with the LD concept and LD diagnosis that have affected my research, teaching, and clinical practice with children and adults. It is a critical, historical, and analytic journey about the LD story grounded in first-person clinical experience and explicit engagement with diagnostic theory that has implications for first-time adult LD diagnosis. The essay advances several claims about the evolution and current state of the LD concept and LD diagnosis across the lifespan with adult diagnosis as its destination: (1) intra- and inter-individual differences in achievement and cognition are normal and expected, yet were reframed as abnormal through the construct of "unexpected underachievement"; (2) even as the LD field promoted unexpected underachievement, it selectively treated only some individuals' underachievement as "unexpected," creating internal inconsistency; (3) reliance on discrepancy from presumed "potential" (IQ) made diagnosis unnecessarily complex and introduced inequities by excluding lower-achieving individuals; (4) these practices persisted despite substantial empirical evidence challenging their validity; (5) DSM-IV's retention of discrepancy-based approaches contributed to ongoing problems in adult diagnosis and pathologizing of normal variability and average performance; (6) disability standards emphasizing substantial limitation relative to the average person were overridden by continued reliance on discrepancy; and (7) discrepancy, potential, and unexpected underachievement were normalized as enduring conceptual and cultural assumptions. Together, these claims reframe LD as a construct shaped by a story, not science, and call for renewed attention to its theoretical foundations and practical consequences, especially for adult diagnosis.

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来源期刊
CiteScore
3.20
自引率
4.50%
发文量
52
审稿时长
6-12 weeks
期刊介绍: Journal of Clinical and Experimental Neuropsychology ( JCEN) publishes research on the neuropsychological consequences of brain disease, disorders, and dysfunction, and aims to promote the integration of theories, methods, and research findings in clinical and experimental neuropsychology. The primary emphasis of JCEN is to publish original empirical research pertaining to brain-behavior relationships and neuropsychological manifestations of brain disease. Theoretical and methodological papers, critical reviews of content areas, and theoretically-relevant case studies are also welcome.
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