Dyslexia laws in the USA

Dyslexia laws in the USA Martha Youman & Nancy Mather Annals of Dyslexia An Interdisciplinary Journal of The International Dyslexia Association ISSN 0736-9387 Ann. of Dyslexia DOI 10.1007/s11881-012-0076-2 1 23 Your article is protected by copyright and all rights are held exclusively by The International Dyslexia Association. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your work, please use the accepted author’s version for posting to your own website or your institution’s repository. You may further deposit the accepted author’s version on a funder’s repository at a funder’s request, provided it is not made publicly available until 12 months after publication. 1 23 Author's personal copy Ann. of Dyslexia DOI 10.1007/s11881-012-0076-2 Dyslexia laws in the USA Martha Youman & Nancy Mather Received: 6 February 2012 / Accepted: 28 June 2012 # The International Dyslexia Association 2012 Abstract Throughout the various states of the USA, the appropriate identification of dyslexia and the timely provision of interventions are characterized by variability and inconsistency. Several states have recognized the existence of this disorder and the wellestablished need for services. These states have taken proactive steps to implement laws and regulations for both identification and treatment, and the provision of equal access to students who are diagnosed with dyslexia. The majority of states, however, have not developed such laws and guidelines. The purposes of this article are to review the present status and content of these dyslexia laws, highlight some differences among the laws and regulations across states, and suggest strategies for initiating such laws. Keywords Dyslexia eligibility . Dyslexia identification . Dyslexia laws . Dyslexia legislation . Dyslexia treatments Dyslexia is the most common neurobiological disorder that affects the development of decoding (written word pronunciation) and encoding (spelling) skills and hinders the literacy development of both children and adults (Lyon, Shaywitz, & Shaywitz, 2003; Shaywitz, 2003). Historically, prevalence rates have been estimated to be between 10 and 15 % of all school children in the USA (Fletcher, Lyon, Fuchs, & Barnes, 2007). Although it is well established that consistent and targeted early interventions can help mitigate the effects of dyslexia and improve individual outcomes (Foorman, Francis, Shaywitz, Shaywitz, & Fletcher, 1997), the majority of states have not developed guidelines regarding how to identify, help, and accommodate students with dyslexia within the requirements of federal law, including the Individuals with Disabilities Educational Act 2004 (IDEA 2004) and § 504 of the Rehabilitation Act of 1973. Several states, however, have recognized the need for M. Youman : N. Mather (*) Department of Psychoeducational and Disability Studies, College of Education, University of Arizona, Tucson, AZ 85721, USA e-mail: nmather@email.arizona.edu M. Youman e-mail: myouman@email.arizona.edu Author's personal copy M. Youman, N. Mather early services and have taken proactive steps to implement rules and regulations for identification, treatment, and the provision of legal protections. Through the creation of laws and regulations, these states have attempted to create a standardized process for both identification and service delivery. As of July of 2012, 22 states had statewide dyslexia laws, three of which provide a dyslexia handbook to inform parents and educators about the proper procedures for students in public and private educational settings. An additional three states have drafted a dyslexia handbook to provide resources and guide school personnel and parents in both identification and intervention for children with dyslexia. Of the remaining states, six have laws making their way through the legislature, and two have tried to increase dyslexia awareness through creation of a dyslexia week and dyslexia month. Table 1 provides a summary of existing laws and initiatives across all of the states. The laws focus primarily upon: (a) definitions and terminology, (b) early screening, (c) identification, (d) provision of interventions and accommodations, and (e) eligibility for services. The purposes of this article are to review the present status and content of these dyslexia laws, highlight some differences among the laws and regulations across states, and suggest strategies for initiating such laws. Definitions and terminology Even though researchers have been studying dyslexia for over 100 years and numerous professional organizations around the world have attempted to develop such a definition, a strong consensus regarding a clear, useful definition still does not exist (TǾnnessen, 1997). In 2002, the International Dyslexia Association (IDA) Research Committee and the National Institute of Child Health and Human Development (IDA, 2002; Lyon et al., 2003) proposed a revised definition that describes dyslexia as a specific learning disability that is neurological in origin and characterized by difficulties with accurate and/or fluent word recognition and poor spelling. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relationship to an individual’s other cognitive abilities. Although the IDA definition places emphasis on phonological processing as the proximal cause of dyslexia, the definitions from other countries (e.g., Australia, England, and Ireland) include other cognitive and linguistic factors in addition to phonology awareness, such as rapid automatized naming, processing speed, working memory, and automaticity. Despite this lack of agreement regarding definition and the exact causes of dyslexia, researchers and scientists from around the world have reached a consensus regarding the characteristics and symptoms of this disorder, as well as how dyslexia affects reading and spelling development (Babayiğit & Stainthorp, 2011; Bekebrede, van der Leij, Plakas, Share, & Morfidi, 2010; Ho & Bryant, 1997; Jimenez & Ramirez, 2002; Paizi, Zoccolotti, & Burani, 2010; Porpodas, 1999; Seki, Kassai, Uchiyama, & Koeda, 2008). Dyslexia is consistently described as a language-based disorder with the primary symptoms being inaccurate and/or slow printed word recognition (lack of automaticity) and poor spelling—problems that in turn affect the development of reading fluency and have a secondary impact on reading comprehension and written expression (Moats, Carreker, Davis, Meisel, Spear-Swerling, & Wilson, 2010). Thus, dyslexia is characterized as a neurobiological disorder that results in poor reading (word accuracy and reading rate) and spelling that are unexpected in relationship to an individual’s other cognitive and academic abilities (Peterson & Pennington, 2012). In many school settings, the term “dyslexia” is not used to describe students who fit the criteria for this disorder. Instead, school teams and clinical personnel use the terms “specific learning disability (SLD),” which is specified within the Individuals with Disabilities Act Author's personal copy Dyslexia laws in the USA Table 1 US dyslexia laws, proposed bills, and initiatives State Law/purpose Status Handbook Other AL None None Dyslexia Month AK None None None AZ None None None AR SB 749 (2011): Proposes K–12 screening, training, and intervention None None CA Education Code Section 56333–56338: Students with In CA law dyslexia who do not qualify for SLD receive services in the classroom None None Education Code Section 56240–56245: Encourages education of teachers Failed In CA law Family Code Section 8733: Adoption agencies to report In CA law to adoptive parents if biological parents had disabilities, including dyslexia Education Code Section 52853: Schools to develop programs for training in dyslexia intervention In CA law Education Code Section 44227.7: Higher education encouraged to provide teacher training for dyslexia and related disorders In CA law CO SB 245 (2011): Provides funds for in-school dyslexia training, identification, and higher education programs to train on dyslexia Passed None None CT HB 115 (2000): Books on tape for classrooms with students with dyslexia Passed None None DE None None None FL HB 1329 (2011): Scholarships for students with disabilities, including dyslexia Passed FCRR Technical Report #8 None HB 1249 (2011): Waives certain requirements for high Failed school diploma for students with disabilities, including dyslexia GA SB 69 “ABC Initiative” (2001): Determine risk for dyslexia in K–2 Pending None None HI SB 2217 (2010): Promotes awareness of dyslexia, assessment and identification, remedial curriculum, progress monitoring, interventions, and training Passed None None None None None Dyslexia Week SCR 110–HCR 129 (2010): Establishment of a working Passed group to develop a comprehensive plan to improve awareness of and strengthen support for persons with dyslexia ID None IL HB 4084 (2011): Pilot project for early screening Pending HB 5344 (2009–2010): School recordings for blind and dyslexic students Failed Dyslexia Month IN None None IA None None None None KS SB 75 (2011): Screening, instruction, intervention, and development of pilot programs Pending None None HB 5015 (2008): Early screening; review level and pace of implementation of best practices of instruction; review teacher preparation Passed Author's personal copy M. Youman, N. Mather Table 1 (continued) State Law/purpose Status Handbook Other courses; submit a progress report by December 31, 2009 KY SB 410 (2012): Schools to implement “best practices” of instruction for students with dyslexia Pending SB278 (2000): Dyslexia resource center Failed Passed HB 69 (2012): Early Education Assessment and Intervention; create a new section of KRS Chapter 158 to define “aphasia,” dyscalculia,” “dysgraphia,” “dyslexia,” “phonemic awareness,” and “scientifically based research”; require the Kentucky Board of Education to promulgate administrative regulations to implement district-wide use of K–3 response-to-intervention system in reading LA R.S. 17:7(11): Identification and services within the regular education program for students demonstrating characteristics of dyslexia; assessment, intervention, and accommodations In LA law SCR 62 (2010): Dyslexia regulations; requests study and review of the clarity of board regulations and guidelines relative to the education of dyslexic students and the effectiveness of procedures for monitoring the compliance of public schools and school districts when implementing such regulations and related state law Passed HR 185 (2010): Dyslexia pilot study Passed Part XXXV. Regulations and Guidelines for Implementation of the Louisiana Law for the Education of Dyslexic Students ME None None None MD None None None MA HB 3680 (2011): Requires teachers to get training in disorders including dyslexia In MA Law Mass. Gen. Laws ch. 15A, § 30, 1983: Waiver of college exams to students with dyslexia In MA Law MI None None None MN None Informational Paper # 1: Dyslexia None MS Amendment to 37-23-15, Mississippi Code Of 1972 (1997): Pilot programs for testing certain students for dyslexia Passed HB 1494: Funds for educator training, including dyslexia Passed HB 1031 (2012): Allows students enrolled in schools that do not have dyslexia programs to transfer to a different school or district universal K-1 screening required Passed Mississippi Dyslexia Handbook MO None None None MT None None None NE None None None NV Section 1–Chapter 388 of NRS (1984): School districts to establish reading programs NH None NJ AB 811 (2010): Provides for instruction in dyslexia awareness and methods of teaching students with In Law Study of Dyslexia and Other Learning Disabilities None None Pending None None Author's personal copy Dyslexia laws in the USA Table 1 (continued) State Law/purpose Status Handbook Other dyslexia for candidates for teaching certificates and current teachers and paraprofessionals AB 880/SB 2400 (2008–2009): New Jersey Reading Disabilities Task Force Passed NM HB 230 (2010): Interventions for students with signs of dyslexia required Passed NY None None None NC None None None ND None None None OH HB 96 (2011–2012): Pilot program for dyslexia screening None Dyslexia Month None None None None None Dyslexia Month Passed None HB 157 (2011): Educational service centers to provide Passed teacher professional development on dyslexia; "dyslexia specialist" to provide training for K–4 teachers in school districts and other public schools OK HB 1997 (2011): Dyslexia screening Passed HB 3073 (2012): Dyslexia training pilot program Pending OR None PA HB 322 (1985–1986): Waives college entrance exams In PA Law Dyslexia Week HB 7541 (2012): Rhode Island Dyslexia Act, defines dyslexia and the research-based interventions appropriate for students with dyslexia Pending HB 7542 (2012): To form commission for educational recommendations for students with dyslexia Pending SC SB 241 (2011): Create the South Carolina dyslexia taskforce Passed SD None TN None TX SB 867 (2011): Adult testing accommodations for a person with dyslexia taking a licensing examination administered by a state agency RI None None None None None The Dyslexia Handbook for Teachers And Parents in South Dakota None Passed Passed SB 866 (2011): Education of public school students with dyslexia, the education and training of educators who teach students with dyslexia, and the assessment of students with dyslexia attending an institution of higher education Texas Education Code (TEC) § 38.003: Screening and In TX Law treatment Texas Education Code § 28.006: Diagnose reading in K–2 In TX Law Texas Education Code § 7.028(b): Compliance with dyslexia law In TX Law Texas Administrative Code § 74.28: Districts to provide procedures for identification; adherence to dyslexia handbook; purchase program for students w/dyslexia In TX Law None Texas Dyslexia Handbook Dyslexia Day Author's personal copy M. Youman, N. Mather Table 1 (continued) State Law/purpose Texas Occupations Code Chapter 403: Licensed dyslexia practitioners and therapists Status Handbook Other In TX Law UT None None None VT None None None VA SJR 87 (2010): Pilot study for screening in kinder None None None None Passed HB 558 (2010): Early reading intervention services for Failed students in grades K–3 who demonstrate deficiencies WA SB 6016 (2009–2010): Funds pilot projects to develop Passed educator training programs and develop a handbook SB 6318 (2011–2012): Revise teacher and principal evaluation through professional development and training, dyslexia included Pending WV SB 662 (2012): Pilot project for dyslexia screening and Pending institutions of higher education to include course work on dyslexia WI AB 584 (2009–2010): Screening deficits in phonemic awareness or rapid naming Failed WY SB 39 (2012): Dyslexia screening and intervention as early as possible in K–3 Passed Adapted from the Legislative Commission of the Legislative Counsel Bureau, State of Nevada (1984); Louisiana Administrative Code, Title 28, Education, Part XXXV (2002); Minnesota Specific Learning Disability Committee, & Division of Special Education (2002); Mississippi Department of Education, Office of Reading/Early Childhood/Language Arts (2002); South Dakota Department of Education (2009); and Texas Education Agency (2007). (IDEA 2004), and “reading disability,” which is used within the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000). Unfortunately, the inconsistency in terminology and the lack of a clear definition of dyslexia as a distinct type of SLD have caused confusion regarding the distinction of dyslexia from other language and learning disorders. Thus, in most school districts in the USA, educators place students with dyslexia under the large umbrella of SLD; as a result, the suggested general intervention strategies and accommodations may or may not fit the needs of students with dyslexia. Some states, however, have implemented methods for separating dyslexia from other learning disabilities while still adhering to federal law. For example, although still using the term SLD for identification and intervention, a few states (e.g., Texas) separate the identification and service delivery for dyslexia from SLD and provide guidelines for parents and educators through published dyslexia handbooks and other informational documents (Texas Education Agency, 2007). Early screening Most US school districts maintain records of students’ reading progress during early grades in order to comply with No Child Left Behind (No Child Left Behind (NCLB), 2002). Thus, most children in public schools who struggle with reading are being monitored and receive some sort of intervention, but the causes and characteristics of their reading difficulties may remain unknown. A few states, however, have mandated universal screening for dyslexia and other reading disorders as part of reading progress monitoring in grades K–2. For example, Texas Education Code § 38.003 specifies that all students be tested for dyslexia Author's personal copy Dyslexia laws in the USA using a program that is approved by the State Board of Education. The most common screening procedures include the major linguistic and academic areas associated with dyslexia, such as phonological awareness, single word decoding, reading fluency, and spelling. Students who show this pattern of difficulties receive more comprehensive evaluations that are then followed by well-targeted reading interventions. Other states, including Louisiana, Washington, Mississippi, South Carolina, Virginia, and Ohio, have laws that require pilot programs and allocation of funds to establish universal screening for dyslexia during the early school years. Additional states, including Kansas and Oklahoma, have pending legislation on universal screening for dyslexia in public schools. A few remaining states, including Arkansas, Kentucky, Kansas, Wisconsin, Colorado, and Louisiana, have drafted universal screening legislature that failed to pass, but revisions and modifications to current proposals are likely to be forthcoming. The early screening initiative in these states is crucial for students with dyslexia, as research shows that the most effective interventions are ones that are implemented early, during the beginning stages of literacy instruction (National Reading Panel; National Institute of Child Health and Human Development, 2000). Along with the initiative to screen early, although not mandatory, a number of states provide guidelines for early screening of children with dyslexia. For example, The Dyslexia Handbook for Teachers and Parents in South Dakota (South Dakota Department of Education, 2009) highlights characteristics of students with dyslexia in grades K–3, such as difficulty remembering names and shapes of letters, confusion of letters with similar sounds (e.g., d/t, b/p, f/v), and spelling errors that involve difficulties with sequencing and monitoring sound/symbol correspondence (e.g., past/pats). In Louisiana, the Regulations and Guidelines for Implementation of the Louisiana Law for the Education of Dyslexic Students (Louisiana Administrative Code, Title 28, Education, Part XXXV, 2002) provide a list of factors that may contribute to the characteristics of dyslexia. Among others, these factors include delayed speech development, a family history of similar problems, low expressive language skills, cramped or illegible handwriting, difficulty learning sound-letter correspondences, and difficulty identifying, blending, segmenting, and manipulating phonemes. In another reference handbook, the Florida Center for Reading Research (FCRR) technical report no. 8, Dyslexia: A Brief for Educators, Parents, and Legislators (Torgesen, Foorman, & Wagner, 2010), specifies that the clearest indicators of dyslexia in kindergarten are difficulties acquiring phonemic awareness, learning letter/sound correspondences, and learning to decode using phonics. Of the remaining states, some refer educators and parents to the provisions of IDEA 2004 under the SLD category, and others to the specific state IDA chapter. Identification At the federal level, under IDEA 2004, students who have been given appropriate access to education, but continue to struggle academically, and whose difficulties cannot be explained by cultural and environmental factors must be evaluated for SLD, with dyslexia fitting under this umbrella term. Currently, IDEA 2004 specifies that three procedures may be used as a part of the evaluation for SLD: (a) an ability–achievement discrepancy formula; (b) a failure to respond to research-based methods, which is often referred to as a response-to-intervention (RTI); and (c) alternative research-based models, such as a pattern of strengths and weaknesses (PSW) approach. If the discrepancy model is used as the sole method for identification of SLD, it must be supplemented by other documentation, including classroom observations, parent and teacher reports, and intervention history. As with the ability–achievement discrepancy model, IDEA 2004 specifies that the application of research-based methodologies can be used as only part of the evaluation process. Because most school districts adhere to the diagnostic categories of Author's personal copy M. Youman, N. Mather IDEA 2004, they do not recognize dyslexia as a separate disability. Many school districts still use a numerical discrepancy formula for SLD or are attempting to build a model based upon systematic application of RTI. A few states are now moving toward the implementation of a third alternative research-based approach, typically through the documentation of a pattern of strengths and weaknesses (e.g., Idaho, Oregon). Educators working in districts without specific dyslexia laws should become familiar with the established procedure for the identification of students with dyslexia under SLD in their school district. States with clearly defined dyslexia laws or with dyslexia reference handbooks take a different approach when identifying students with dyslexia. Districts within these states are mandated or encouraged to find symptoms of dyslexia in young children, so that interventions can be implemented early, when they are likely to yield the best outcomes. It may be determined later that the student also qualifies for SLD under IDEA 2004, but at the time of identification, interventions are already in place. The process of dyslexia identification across these states is similar, beginning with K–2 screening that includes assessment of basic reading skills related to dyslexia, followed by formal assessment. In Texas, for example, the identification process begins with initial detection of the symptoms of dyslexia during K–2 mandatory periodic screenings. If a child’s reading development begins to lag behind, and deficiencies are noted in areas consistent with dyslexia, districts notify parents and begin a formal assessment process for dyslexia identification. This process includes data gathering, review of educational records and the results of benchmark reading assessments, and samples of student work. Following the review of data, students are formally assessed in a number of domains, including academic skills (e.g., letter knowledge and written spelling), cognitive processes (e.g., phonological/phonemic awareness and rapid naming), and other additional areas, such as vocabulary and listening comprehension. The results of this comprehensive assessment process are used to determine educational needs (Texas Education Agency, 2007). Similarly, in South Dakota, the department of education suggests that students suspected of having dyslexia be evaluated in oral language skills, word recognition, decoding, spelling, phonological processing, automaticity/fluency skills, and reading comprehension (South Dakota Department of Education, 2009). In Mississippi, the formal evaluation components include auditory perception, oral expression, letter identification, word attack, oral reading comprehension, silent reading comprehension, spelling, written expression, handwriting, math calculation, and math reasoning (Mississippi Department of Education, Office of Reading/Early Childhood/Language Arts, 2002). In states that acknowledge dyslexia, students that cannot be identified with dyslexia under IDEA 2004 are identified under § 504 of the Rehabilitation Act of 1973. Section 504 defines a disability as a limitation in one or more of nine major life activities, one of which is reading [34 C.F.R. 104.3 (j)]. Thus, a student with dyslexia, who has a limitation in reading, can still be considered to have a disability under § 504, even if the reading limitation does not reach the criteria for SLD. Districts aware of dyslexia develop 504 teams to evaluate students under this criterion, making sure that interventions continue for students with similar reading challenges who do not qualify for special education. Whether through IDEA or § 504, early identification of dyslexia as a separate disorder ensures that students receive the critical early interventions they need: explicit instruction in phonological awareness and letter–sound relationships (Hulme, Bower-Crane, Carroll, Duff, & Snowling, 2012; Uhry, 2005). In some instances, the identification of dyslexia occurs outside of school. If a student is given a diagnosis of dyslexia from a private provider, parents can request an evaluation for SLD in the school to determine eligibility for services. In most states, only after a school team determines that a student meets criteria for SLD can the student receive specific accommodations and reading instruction. Thus, a child may have clear signs of dyslexia and may have undergone an Author's personal copy Dyslexia laws in the USA extensive private evaluation for dyslexia outside of the school, but may not meet a school district’s requirements. Even though they may have dyslexia, some students may be judged as ineligible for services under the state or school district policy and, therefore, will not receive specialized instruction and cannot request classroom accommodations. English language learners As with the diagnosis of SLD in monolingual English speaking children, IDEA 2004 mandates the procedures for evaluation and identification of individuals with limited English proficiency. Communications with parents must be done in the parents’ first language, assessment must be conducted in the language in which the child is most proficient, and access to services must not be denied based on language proficiency. In order to comply with the federal mandates of IDEA 2004 and to reduce overidentification and underidentification of English language learners (ELLs) with SLD, most school districts form task forces and multicultural teams who have experience and knowledge in assessment of culturally and linguistically diverse children. These task forces and multicultural teams follow the same procedures for identification under the SLD category in IDEA 2004, but keep in mind the expected difficulties that explain academic difficulties in ELLs. The initiative of forming task forces that are familiar with the cultural and language characteristics of the population they serve is supported by research. Ortiz (2011), for example, explains that evaluations of students from diverse backgrounds are more accurate when the evaluation team includes at least one member who is familiar with the unique linguistic and cultural makeup of the child being evaluated. Like their monolingual peers, ELLs are not explicitly identified as having dyslexia in most school districts; they instead are identified as students with SLD. For those in school districts using the stipulations of §504 to serve students with dyslexia, identification will take a similar course as that of monolingual children with dyslexia, but with special considerations for language limitations. Few guidelines exist for the identification of ELLs with dyslexia across districts. Only Texas provides explicit regulations of data gathering and assessment to identify ELLs with dyslexia. The additional data gathering requirements include a survey of home language, assessment of English proficiency through oral language, norm-referenced tests and state-wide tests, evidence of second language acquisition development, previous schooling in and outside of the US, and the language of instruction. The additional assessment requirements include comprehensive oral language proficiency testing of the native language and in English and assessment in both languages of the cognitive and academic domains assessed in English monolingual students (when the student has received academic instruction in both languages) (Texas Education Agency, 2007). Interventions and accommodations The policies regarding the provision of interventions and accommodations also vary from state to state. In some states, children with dyslexia receive specific interventions and accommodations within the public school setting; in other states, children may not receive any additional classroom instruction or supports because they do not qualify for services under IDEA 2004. Author's personal copy M. Youman, N. Mather Interventions To learn to read and spell, children with dyslexia require intensive instruction by highly trained teachers (Moats, 2009). As Richardson (1992, p. 46) noted over two decades ago: “It is incumbent on the educational system to recognize dyslexia and to provide the appropriate alternative instructional approaches to beginning reading for children with developmental dyslexia.” This type of instruction typically involves phonological awareness training followed by systematic instruction in phonics and then fluency (Mather & Wendling, 2012; Shaywitz, 2003; Snowling & Hulme, 2012). Although NCLB requires districts and charter schools to implement scientifically based reading programs, the selected programs may not be ones that are most appropriate for the treatment of dyslexia. In some cases, a student with dyslexia, who is receiving special education services (under the category of SLD), will have appropriate interventions in his or her Individualized Education Program (IEP). These interventions are usually delivered in the least restrictive environment, which is the general classroom or a “pull-out” resource room for reading intervention sessions. In the states that recognize dyslexia, however, the methodologies in the IEP or intervention plan for a student with dyslexia are consistent with empirically proven interventions for this disorder. States that have explicit intervention programs for students with dyslexia include New Mexico, Louisiana, Texas, Minnesota, Colorado, and South Dakota. Common intervention strategies and programs for dyslexia target instruction in areas such as phonemic awareness, phonics, spelling, fluency, and vocabulary, all of which have ample research of effectiveness with students with dyslexia (National Reading Panel; National Institute of Child Health and Human Development, 2000; Snow, Burns, & Griffin, 1998; Torgesen et al., 2010). Most states with dyslexia handbooks or reference documents provide a list of approved programs that schools may implement. Table 2 provides a list of approved programs listed in various dyslexia handbooks and reference documents. Although some of the programs have more recent versions and/or additional updated materials (e.g., Auditory Discrimination in Depth, the Herman Method, and Wilson Reading System), Table 2 lists programs and publishers (not always correct) as they currently appear in dyslexia handbooks. Following the initiative from states that already have established dyslexia intervention laws, some states are beginning to implement pilot projects to document the effectiveness of dyslexia intervention programs. The state of Washington, for example, under the Lorraine Wojahn Dyslexia Pilot Reading Program, provided funds to five schools to test the effectiveness of intervention programs for students with dyslexia. In the project report, Young (2008) reported an increase from 17 to 40 % passing grades in the reading portion of Washington State exams for students who participated in the intervention programs. In addition to programs that are selected for intervention, some states emphasize the modality and setting of instruction for students with dyslexia. Table 3 provides an example of instructional methodology recommended for students with dyslexia adapted from the Regulations and Guidelines for Implementation of the Louisiana Law for the Education of Dyslexic Students. Similar recommendations are also seen in other handbooks, including the Texas Dyslexia Handbook, which recommends explicit, direct, structured, sequential, and cumulative instruction with no assumption of prior skills. The use of multisensory instruction (MSL) is also recommended by various dyslexia reference documents including the Mississippi Dyslexia Handbook (Mississippi Department of Education, Office of Reading/Early Childhood/Language Arts, 2002), which specifies that classrooms serving students with dyslexia must incorporate a MSL program, which combines auditory, visual, and tactile elements into learning tasks. The handbook provides a “Multisensory Program Review Form” for educators who are evaluating possible commercial programs Author's personal copy Dyslexia laws in the USA Table 2 Intervention programs listed in dyslexia handbooks Program Grades/age ACADEMY OF ORTON–GILLINGHAM PRACTIONERS AND EDUCATORS K–12 PUBLISHER OF ALPHABETIC PHONICS K–12 Educators Publishing Service ASSOCIATION METHOD Pre-K–Middle School Maureen K. Martin, Ph.D. AUDITORY DISCRIMINATION IN DEPTH K–Adult Lindamood–Bell Publisher CLASSROOM PHONICS/SAXON PHONICS K–2 Saxon Publisher Inc. DISTAR/CORRECTIVE READING Association for Direct Instruction Publisher, etc. K–12 HERMAN METHOD 8 year–Adult Romar Publications ESSENTIAL LANGUAGE STRUCTURES PROGRAM 5–12 KURZWEIL 3000 2–College Assistive Learning Technology LANGUAGE! 1–12 Sopris West LANGUAGE CIRCLE Project Read Strand 2 Grades 1–4 Grades 4–8 Linguistics Grades 4–8 Project Read Strand 3 Grades 1–adult Comprehension Project Read Strand 4 Written expression LAUNCHING LITERACY WITH LANGUAGE! K–3 Sopris West LEAD PROGRAM LEAD Educational Resources MULTISENSORY TEACHING APPROACH Educators Publishing Service MULTISENSORY TEACHING TECHNIQUES Developmentally K–3 Remedial 1–6 Ungraded 1–12 and college Menninger Center for Learning Disabilities PROJECT READ Language Circles Enterprises K–6 Author's personal copy M. Youman, N. Mather Table 2 (continued) Program Grades/age READING PLUS K–12 Taylor and Associates/Communications RECIPE FOR READING 1–3 Educators Publishing Service SLINGERLAND APPROACH K–12 Educators Publishing Service SRA CORRECTIVE READING SYSTEMS 4–12 TEXAS SCOTTISH RITE DYSLEXIA TRAINING PROGRAM 2–12 Texas Scottish Rite Hospital TEXAS SCOTTISH RITE DYSLEXIA LITERACY PROGRAM Secondary Texas Scottish Rite Hospital TEACHERS AND TOOLS (TNT) K–Adults VISUALIZING AND VERBALIZING FOR LANGUAGE TRAINING PROGRAM Various Lindamood–Bell WILSON READING SYSTEM 5–Adult Wilson Language System THE WRITING ROAD TO READING Pre-K–12 Spalding Foundation WRITING TO READ (IBM) K–2 Instructional Business to be used with students with dyslexia. Table 4 lists some of the evaluating criteria included in the Mississippi Multisensory Program Review Form. At the general education classroom level, some of the existing dyslexia handbooks provide suggested interventions by subject area. These interventions include techniques such as books on CD and color overlays for reading, spell check and spelling charts for spelling, copying procedures and letter-form charts for writing, and vocabulary decks and the use of highlighters for content areas. Although handbooks that list these strategies recognize that some of these techniques are controversial and not always research-based, they encourage teachers to adapt any or a combination of these methods if they help students with dyslexia in the general education classroom. Accommodations Depending upon a state’s definition and perception of dyslexia, students with this disability may be granted accommodations for classroom and homework assignments and assessment. In dyslexia handbooks across states, the most commonly suggested accommodations include Author's personal copy Dyslexia laws in the USA Table 3 Summary of recommended instructional methodology for students with dyslexia Instruction for students with dyslexia should include: 1. Direct instruction with student-teacher interaction and diagnostic teaching 2. Simultaneous and multisensory instruction: an instructional approach that uses a simultaneous combination of visual, auditory, kinesthetic, and tactile pathways, to achieve proficiency in language processing 3. Synthetic to analytic phonics: teaches students the sounds of the letters first and then combines or blends these sounds to create words. Analytic phonics uses prior knowledge of letters and their corresponding sounds to decode and form new words (e.g., using -at to form bat) 4. Systematic: Material is organized and taught in a way that is logical and fits the nature of our language. It refers to the way sounds combine to form words and words combine to form sentences to represent knowledge. The ways are determined by a system of rules 5. Sequential: The learner moves step-by-step, in order, from simple, well-learned material to that which is more complex, as he or she masters the necessary language skills 6. Cumulative: Each step is incremental and based on those skills already learned 7. Individualized: Teaching is planned to meet the differing needs of learners who are similar to each other, but no two are exactly alike 8. Allows for automaticity of performance: Fluent processing of information that requires little effort or attention as sight word recognition. Adequate practice with decodable text is to be provided for mastery of skills and applications of concepts 9. Multisensory Structured Language (MSL) programs with a minimum of 150 min/week • Regular class placement with a MSL program • Out-of-class placement in a MSL program • Individual or small group instruction in a MSL program • A combination of these options or any additional arrangements that may be developed by the committee 10. Instruction in recognition and identification of the number of syllables in a word providing training in • Sound blending of phonemes (sounds) in words and syllables • Phoneme segmentation of real words and syllables • Phoneme Manipulation 11. Syllable instruction: instruction in the six kinds of syllables and their application to reading 12. Meaning-based: instruction provided in words and sentences to extract meaning in addition to teaching isolated letter-sound correspondences (a) Instruction in morphology which includes identification of morphemes and their functional use in written and spoken words (b) Instruction of syntax to include sentence construction, combining, and expansion in both narrative and expository text (c) Instruction of semantics to include vocabulary acquisition, idioms, figurative language (d) Instruction in comprehension of narrative and expository text 13. Instruction in reading fluency: the accuracy; appropriate use of pitch, juncture and stress; text phrasing; and rate at which one reads (a) Provides for substantial practice and continual application of decoding and word recognition to work toward automaticity (b) Provides opportunities for reading large amounts of text i. At the student's independent reading level (with 95 percent accuracy) ii. Which provides specific practice in skills being learned Adapted from: Title 28 Education, Part XXXV. Bulletin 1903—Regulations and Guidelines for Implementation of the Louisiana Law for the Education of Dyslexic Students, p. 7. extended time for reading tasks, not penalizing students for spelling mistakes, additional time for statewide assessments, and oral reading of questions during assessment. These accommodations may be implemented in everyday curricular activities in the classroom and/or during statewide assessment periods. Ultimately, classroom accommodations are left to the discretion Author's personal copy M. Youman, N. Mather Table 4 Summary of components of multisensory program review form in Mississippi Dyslexia Handbook Reading specialists, general and special education teachers, principals, or literacy teams review possible multisensory programs for school wide implementation. The following characteristics of the program are evaluated in order to assess potential programs: 1. Name of program 2. Author(s) of program 3. Date of publication 4. Areas covered by program (a) Reading (b) Writing penmanship (c) Spelling (d) Writing composition (e) Other language 5. Program characteristics (a) Age/grade range of program design (b) Suggested group size (c) Length of program for students (d) Intended outcome for students (e) Support services offered or needed 6. Program Rating (as compared to other programs). Comparisons given a numerical number [(4) for Excellent (1) for Poor] in the following areas (a) The program is specifically designed for students with dyslexia (b) The program was developed by a person with extensive training and experience in teaching students with dyslexia at all age levels and with varying degrees of severity (c) The program provides criteria for evaluating student progress (d) The program provides for multisensory learning (e) The program provides spelling and writing components (f) The program provides ample opportunity for review of previous learning (g) The program provides curricula coherence between grade levels and between the remedial classroom and the regular classroom (h) The program provides for individualization to meet the needs of various students in various settings 7. Teacher/general education commitment required 8. Training needed 9. Training provided 10. Cost 11. Type of materials needed (consumable, provided, part of program, etc.) 12. Class setting recommended for service 13. Teacher/student ratio 14. Support studies, data or reports from current program users 15. Short- and long-term advantages and disadvantages of the teacher and his/her adherence to the IEP or 504 plan, while statewide assessment accommodations are left to each school district’s policy for identified students with dyslexia. Statewide assessment policies become very important for students with dyslexia, as their advancement to higher grades will depend on their performance as it compares to their peers. Unfortunately, as with policies regarding eligibility for services for students with dyslexia, policies for accommodations during statewide assessment vary greatly among states and Author's personal copy Dyslexia laws in the USA school districts. The majority of states do not provide explicit accommodations for students with dyslexia during statewide testing. For students with dyslexia identified under IDEA 2004, testing accommodations will be provided according to the specifications of their IEP. However, if the state does not explicitly recognize dyslexia, these testing accommodations may not be appropriately matched to the student’s needs. In contrast, school districts that acknowledge the limitations of students with dyslexia during high stakes statewide testing provide accommodations that allow these students the same opportunity for success. In Texas, for example, students with dyslexia are provided with “Dyslexia Bundled Accommodations” during the Texas Assessment of Knowledge and Skills, a statewide assessment of Texas education standards in reading, writing, math, science, and social studies (Texas Education Agency, 2007). These accommodations are sensitive to the students’ limitations due to dyslexia, as well as their native language. The bundled accommodations include options such as oral/signed partial or total administration, extended time, and administration in the student’s native language. All students identified with dyslexia, whether they have an IEP or a 504 plan, are considered for the bundled accommodations. A team of professionals knowledgeable about dyslexia makes decisions about the appropriate accommodations based upon each student’s unique needs. Teacher training Inadequate teacher preparation remains a significant concern across the nation (Moats, 2009). In public academic settings, students with dyslexia receive intervention services from a variety of school personnel, including general education teachers, special education teachers, reading specialists, resource room teachers, and even dyslexia specialists. Recognizing that general education teachers will spend the most time with a student with dyslexia, some states have taken proactive steps to educate teachers on effective interventions for dyslexia. For example, § 503 of the Regulations and Guidelines for Implementation of the Louisiana Law for the Education of Dyslexic Students mandates school districts to provide training to general education teachers on the interventions and strategies that are most effective for students with dyslexia in the general education classroom. Similar stipulations are stated in current laws and proposed bills in California, Arkansas, Hawaii, Washington, Colorado, and Wisconsin. Texas has even adopted training and practice standards for teachers of students with dyslexia. These standards include knowledge and skills of the psychology of reading and reading development, knowledge of language structure (e.g., phonology, phonetics, syntax, etc.), practical skills of instruction, and knowledge of assessment of classroom reading and writing skills. Each school district is responsible for training teachers to meet the state standards and provides monitoring to ensure adherence to validated instructional practice. In states without laws for in-class intervention for dyslexia, both special and general education teachers are often not trained on the implementation of crucial dyslexia intervention strategies, such as structured phonics methods and MSL approaches to reading and spelling. If students with dyslexia in general and special education classrooms continue to show lack of progress in reading performance, schools often do include extra time with a reading specialist or resource room teacher as part of the intervention program. Reading specialists in states that recognize dyslexia as a separate disorder must be knowledgeable about dyslexia intervention strategies and provide focused instruction in small groups. In states where dyslexia falls under the umbrella of SLD, however, reading specialists may or may not be knowledgeable about reading strategies that help students with dyslexia or may just use a general strategy or methodology for all struggling readers. Thus, students with dyslexia who are not separated from other SLD students Author's personal copy M. Youman, N. Mather often receive reading instruction with other struggling readers who may not need the same type of instruction (e.g., English language learners, who mostly need vocabulary building activities; students with attention deficit hyperactivity disorder, who have fallen behind their peers). Although general reading strategies provided to a heterogeneous group of struggling readers is not harmful for students with dyslexia, they are not targeted to the specific needs of students with dyslexia. The FCRR Dyslexia report (Torgesen et al., 2010) recognizes the need to separate the intervention strategies for students with dyslexia from other struggling readers, who are only “one subgroup” of students at school with reading difficulties. Many students with dyslexia, the report explains, have well-developed vocabularies, strong reasoning skills, and excellent language comprehension abilities. Thus, their primary instructional needs for reading are in: phonemic awareness, phonemic decoding, sight word development, and fluency. A few states have dyslexia “specialists” or “therapists” who provide instruction solely to students with dyslexia. In Texas, for example, a teacher or other school professional may obtain a license to work with students with dyslexia. This “Dyslexia Practitioner License” requires a bachelor’s degree, 45 hours of course work in MSL education, and 60 hours of supervised clinical experience in MSL instruction. A “Dyslexia Therapist License” requires a bachelor’s degree, 200 hours of course work in MSL education, and 700 hours of supervised clinical experience in MSL instruction. Teachers with either of these licenses are considered first for assignment to teach students with dyslexia. A few higher education programs across states also provide dyslexia intervention certification for educators who wish to work helping students with dyslexia. One program at Fairleigh Dickinson University in New Jersey, for example, offers the Dyslexia Specialist (Orton–Gillingham) FDU Certificate, which requires 30 graduate credits, including theory and practica based on the Orton–Gillingham approach, an approach often used in interventions for students with dyslexia. Unfortunately, in many states, teachers still have to seek out and pay for any specialized training they receive. A common knowledge gap still exists between the vital instructional components for students with dyslexia and the actual classroom instructional practices (Budin, Mather, & Cheesman, 2010; Moats, 2009). To address this gap, the IDA developed Knowledge and Practice Standards that were designed to inform the preparation of reading teachers (Moats et al., 2010). Eligibility for services—contrast between K–12 and postsecondary education Although IDEA 2004 and § 504 provide protections for elementary and secondary students with SLD, the responsibilities of postsecondary institutions vary significantly from those of public K–12 school districts. In K–12 settings, the district has a responsibility to provide a Free Appropriate Public Education (FAPE), whereas colleges are not required to provide FAPE. Thus, school districts focus on finding, classifying, and providing services, modifications, and accommodations to students with disabilities and, in some states, dyslexia. In contrast, higher education institutions are only concerned with providing academic adjustments that ensure that students are not being discriminated against because of a disability. Services in K–12 settings For the most part, eligibility for services for dyslexia will depend on a state’s and district’s interpretation of federal and state legislature. Following federal and state law, some school districts place dyslexia under IDEA 2004 as part of the SLD category; others consider dyslexia to be a part Author's personal copy Dyslexia laws in the USA of § 504 of the Rehabilitation Act of 1973. Unfortunately, the use of these categories, as well as a state’s particular position on dyslexia, will determine the specific services a student receives. Whereas a student with dyslexia in one state may be entitled to multiple services, a student with dyslexia in another state may have no opportunity to request or receive the same services. Students with dyslexia who have met a state’s criteria for SLD under IDEA 2004, through one of the three approaches (ability–achievement discrepancy, limited response to intervention, or a PSW approach), will be provided with interventions and instructional accommodations. These instructional procedures and accommodations will be prepared by a multidisciplinary team, including parents, and will be listed on the student’s IEP. If, however, a student fails to meet a school district’s criteria for SLD, services will not be rendered, regardless of whether or not the student shows the characteristics of dyslexia or has a diagnosis of dyslexia from a private practitioner. As an example, consider that a student shows signs of dyslexia and is evaluated for SLD by a multidisciplinary team. The multidisciplinary team follows the district’s guidelines that include evidence of delayed academic performance (classroom observations, academic work samples, interviews with the teacher, etc.) and the use of a discrepancy formula (intellectual functioning vs. expected academic performance). In addition to academic performance data, the guidelines require a discrepancy of 22 points between intellectual functioning and academic performance to qualify for SLD. The evaluated student shows academic difficulties, but after formal academic and intellectual assessment, the discrepancy is only 15 points. In this case, the criteria for SLD under the district’s guidelines are not met and the student does not qualify for services or accommodations. This student will not receive academic accommodations, even if the teacher and/or parents believe that the student has dyslexia. Unfortunately, many states and school districts still adhere to this type of approach to determine eligibility of services for students with dyslexia and, as a result, some students who actually have dyslexia are not provided with the needed accommodations and interventions that would help them keep pace with their peers. Some states use the specifications of § 504 of the Rehabilitation Act of 1973 to provide services to students with dyslexia who do not meet the criteria for SLD under IDEA 2004. The Mississippi Dyslexia Handbook (Mississippi Department of Education, Office of Reading/Early Childhood/Language Arts, 2002), for example, advocates for implementation of accommodations for students with dyslexia and indicates that under § 504 “…non-discrimination requires the provision of special services or modifications of a program to enable the student to benefit from the education that is offered to him or her” (p. 77). Other states that justify services for students with dyslexia under § 504 include Texas, South Dakota, Louisiana, Washington, Arkansas, and Minnesota. Postsecondary education Although students with dyslexia may have been identified and received services for their disability in their K–12 education, their diagnosis and services do not continue into their postsecondary education because colleges and universities are not required to provide a free, appropriate public education. Upon entering a college or university, it is the student’s responsibility to inform the higher education institution of an existing disability and the necessary accommodations that are needed for equal access to academic material. In most states, this means that students with dyslexia must pay for an evaluation to be completed by an approved provider since the documents that determined their diagnosis of dyslexia in K–12 settings may be too old or incomplete. After completion of a comprehensive evaluation, students must also ensure that results are submitted and that accommodations are granted for each class in which Author's personal copy M. Youman, N. Mather Table 5 Proposing dyslexia state laws and initiatives Law/initiative Screening for Dyslexia Suggestions 1. Form committee or task force of professionals knowledgeable about dyslexia 2. Propose a pilot program to determine cost, time, and procedure for dyslexia screening in public K–12 schools. Example: OH HB 96 (2011-2012) 3. Determine timeline for pilot program and indicate date of final report 4. Present findings of pilot program in report and draft bill for universal screening for dyslexia 5. Include specifications for special populations (e.g., ELLs, students with multiple disabilities, etc.) Dyslexia Training for Professionals 1. Draft bill requesting funds for in-school dyslexia training and dyslexia training in higher education programs. Example: CO SB 245 (2011) 2. Determine appropriate allocation of funds for dyslexia training 3. Develop training standards 4. Specify criteria for professionals working with students with dyslexia. Example: Texas Occupations Code Chapter 403 Eligibility for Accommodations and Services for Students with Dyslexia 1. Promote awareness of dyslexia under IDEA-SLD or § 504 or Rehabilitation Act 2. Develop district or school policy for eligibility of services and accommodations under IDEA or § 504 for students with dyslexia. Example: CA Education Code Section 56333–56338 Classroom Instruction for Students 1. Draft bill requesting instruction for students with dyslexia using researchwith Dyslexia based programs. Example: LA R.S. 17:7(11) 2. Provide a list of approved programs for implementation in the instruction of students with dyslexia. Example: Mississippi Dyslexia Handbook 3. Develop education programs for students with dyslexia. Example: Part XXXV. Regulations and Guidelines for Implementation of the Louisiana Law for the Education of Dyslexic Students Interventions for Students with Dyslexia 1. Draft bill requesting interventions for students with signs of dyslexia. Example: NM HB 230 (2010) 2. Provide list of approved intervention programs to districts. Example: Intervention programs listed in dyslexia handbooks 3. Update list every 3 years Dyslexia Handbook 1. Form committee or task force of professionals knowledgeable about dyslexia 2. Develop dyslexia handbook 3. Draft bill proposing adherence to dyslexia handbook (when state has specific dyslexia laws). Example: LA SCR 62 (2010) 4. Distribute dyslexia handbook to districts or require districts to develop a dyslexia handbook. Example: Texas Administration Code § 74.28 Students with Dyslexia in Higher Education Institutions 1. Draft bill proposing exclusion of standardized college entrance exams for students with dyslexia. Example: MA Gen. Laws ch. 15A, § 30 (1983) 2. Develop informational documents for students transitioning from K–12 education to institutions of higher education. Example: TX Dyslexia Handbook, Appendix K Dyslexia Awareness 1. Draft bill proposing declaration of dyslexia day, week, or month 2. Provide dyslexia professional development for educators 3. Develop dyslexia “Frequently Asked Questions—FAQs” for parents, teachers, and the community Author's personal copy Dyslexia laws in the USA they enroll. To help students with this transition, some dyslexia handbooks provide information for students with dyslexia who are transitioning to postsecondary institutions. Another factor affecting students with dyslexia who are transitioning into postsecondary education is the requirement of standardized college entrance aptitude tests. In most states, students with dyslexia who are not in special education are required to provide scores on standardized college aptitude tests as part of their application materials. These scores may significantly affect the higher institution’s decision on admitting a student with dyslexia. In the state of Massachusetts, however, the term dyslexia is listed as one of the disabilities taken into consideration when waiving the requirement of standardized aptitude scores for admission to higher education institutions. Specifically, the law states that “No resident of the commonwealth who has been diagnosed as being developmentally disabled, including but not limited to, having dyslexia or other specific language disabilities, by any evaluation procedure prescribed by Chapter 71 B, or equivalent testing, shall be required to take any standardized college entrance aptitude test to gain admittance to any public institution of higher education in the commonwealth” (Massachusetts General Laws, 1983, Chap. 15A, § 30). Most private and public colleges and universities in Massachusetts include the above statement in their admission documents. Universities and colleges in other states, however, do not provide this type of protection for individuals with dyslexia and thus, most admission offices in postsecondary institutions are unlikely to consider the impact of dyslexia on these types of high stakes tests. Conclusion State laws must include at least the same rights and protections as federal laws; they can provide more protections, but not less. Clearly, advocates in many states are paving the way for increased understanding and support of individuals with dyslexia. This growing support for dyslexia laws is encouraging. For example, on May 24, 2011, Ohio HB 96 was passed by a resounding vote of 94 to 1. This law includes dyslexia in its definition of SLD and will allow for students with dyslexia to be included in the list of students who are provided with special instruction at school. State Representative Ted Celeste, who cosponsored the bill with State Representative Andrew Brenner, commented that: “Many times the proper diagnosis of dyslexia is what holds students back from receiving the kind of educational instruction most appropriate for their individual situations. Often times a student may fall through the cracks in which he or she is not ‘behind far enough’ to qualify for special educational services.” In addition to securing services for children, another major milestone is simply getting the word “dyslexia” to be recognized by personnel within the public school systems. Table 5 provides suggestions for beginning the process of enacting dyslexia laws and promoting dyslexia awareness. Two years ago, the governor of Alabama, Bob Riley, declared October “Dyslexia Awareness Month.” In this proclamation, Riley stated: “Alabamians will benefit from increased awareness of the nature of dyslexia, the early warning signs of dyslexia, and the value of multisensory structured language interventions for students with dyslexia. Greater recognition and understanding are necessary to ensure that individuals with dyslexia living in Alabama and all other Americans with dyslexia are accurately identified and provided with appropriate services so that they might lead maximally productive lives.” As of 2011, there is still no policy or state law addressing dyslexia in Alabama. In fact, many Alabama schools refuse to acknowledge that dyslexia even exists” (retrieved from http://community.brightstar-learning.com/2011/dyslexiainalabama/). Although progress has been made regarding the creation and passing of state dyslexia laws, much remains to be accomplished. Clearly, the passing of laws does not fully Author's personal copy M. Youman, N. Mather guarantee that individuals with dyslexia will be identified and provided with appropriate accommodations and instruction. In discussing his own realization that he had dyslexia, Schultz (2011, p. 64), a Pulitzer prize winning poet, reflected: “My ignorance of my dyslexia only intensified my sense of isolation and hopelessness. Ignorance is perhaps the most painful aspect of a learning disability.” These state laws help reduce ignorance; they increase public awareness and the likelihood that students with dyslexia in our schools will receive empathetic treatment and the necessary instruction and supports. References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington: American Psychiatric Association. Babayiğit, S., & Stainthorp, R. (2011). 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