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Ecological Neuropsychology: An Alternative to

the Deficit Model for Conceptualizing and
Serving Students with Learning Disabilities

Article in Neuropsychology Review · July 2005

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Neuropsychology Review, Vol. 15, No. 2, June 2005 (

C 2005)

DOI: 10.1007/s11065-005-7092-5

Ecological Neuropsychology: An Alternative to the Deficit

Model for Conceptualizing and Serving Students
with Learning Disabilities

Rik Carl D’Amato,1,3 Franci Crepeau-Hobson,1 Leesa V. Huang,2 and Molly Geil1

The present paper contends that children with learning disabilities are better served when assessment
and intervention are conceptualized within an ecological neuropsychology perspective than within the
traditional deficit model perspective, which is the predominant approach to intervention in medical
and educational settings. The deficit method conceptualizes problems as within the child, and the
major consequence of this approach is that little time is spent analyzing the learning environment or
other systems that might impact the child’s ability to be successful in an academic setting. Therefore,
rehabilitation efforts have had limited success. In contrast, ecological neuropsychology is a strength-
based approach that considers the child, as well as the systems within which he/she interacts, when
assessing, diagnosing, and intervening with students who are experiencing learning difficulties.
KEY WORDS: ecological neuropsychology; medical model; learning disabilities; special education; strength-
based models; rehabilitation.

Based on the premise that a neuropsychological
model is more comprehensive than the traditional
deficit model approach to serving students with learning
disabilities (LD), this review analyzes the problems with
the deficit or medical model approach to diagnosis and
treatment of students with LD. Rationale is provided
for developing and utilizing an ecological neuropsy-
chological approach in the assessment and intervention
of children experiencing learning difficulties in the
classroom. Moreover, it will be obvious that educational
personnel, especially school neuropsychologists, school
psychologists, and pediatric neuropsychologists, must
utilize an ecological approach to assessment and interven-
tion with those students who have a specific LD in order
for all students to be successful in the educational setting.
A specific LD was originally defined by the
Public Law 94–142 (1975). Now, the Individuals with
1 University of Northern Colorado, Greeley, Colorado.
2 California State University, Chico.
3 To whom correspondence should be addressed at the Center for
Collaborative for Research in Education, Neuropsychology Labora-
tory, College of Education and Behavioural Science, Office of the
Dean, University of Northern Colorado, Greeley, CO 80639; e-mail:
rik.damato@unco.edu.
Disabilities Education Improvement Act (IDEIA; Federal
Register, 2004) defines it as:
a disorder in one or more of the basic psychological
processes involved in understanding or in using language,
spoken or written, which may manifest in an imperfect
ability to listen, think, speak, read, write, spell, or to do
mathematical calculations . . .
The definition goes on to specify disorders (e.g.,
dyslexia) included within the rubric of LD, as well as
exclusionary criteria (as cited in Gutkin and Reynolds,
1999). According to the U.S. Department of Education
(2000), children with LD comprise approximately 51%
of all disabilities covered by IDEIA or about 5% of
the school-age population. Referrals and placements
of students with LD increased by over 100% from
1979 to 1999. Also noteworthy is the disproportionate
representation of ethnic minority youth identified as LD
and in special education (Donovan and Cross, 2002).
This is also true of boys: They are referred significantly
more often than girls for LD (Banks and Banks, 2001).
The discipline of special education developed from
Lightner Witmer’s model for treating children with
difficulties that interfered with learning (D’Amato and
Dean, 1989; Reynolds et al., 1984). Additionally, as

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C 2005 Springer Science+Business Media, Inc.
98
conceptualized by Witmer in his child guidance clinic,
the model for delivery of psychological services has
become the scientist–practitioner model (D’Amato and
Dean, 1987). Neuropsychological assessment should be
an approach to problem-solving in which the goal is to
provide both direct and indirect services to children to
improve their rehabilitation, mental health, and educa-
tional development (D’Amato et al., 1999). Thus, the role
of neuropsychologists, as well as school neuropsychol-
ogists, and special educators in the schools should be
to make observations, formulate theories, generate and
test hypotheses, evaluate data, and draw conclusions from
empirical-evidence about ways to intervene with children
who are unsuccessful in their current educational system
(Long and Ross, 1992; Rothlisberg et al., 2003; Stoner
and Green, 1992). While special educators have been pri-
marily responsible for remediating skills and developing
compensatory strategies for students with LD (Hallahan
and Kauffman, 1991), psychologists in the schools have
been limited to their role as gatekeepers of special edu-
cation (Ysseldyke et al., 1984). As gatekeepers, school
psychologists test, diagnose, and place children in special
education programs. The focus has not been on individ-
ual differences, unique styles of processing, individual
data, evidence-based practices, nor on providing services
based on student needs (Rothlisberg et al., 2003; Sattler
and D’Amato, 2002).
Nowhere has the gatekeeper role been better
demonstrated than in the diagnosis of students with LD.
The traditional, or discrepancy model, is the current
model of psychological assessment and special education
service delivery for students with LD and other mental
problems. This model focuses at the micro-level (i.e., at
the level of intra-individual characteristics) on deficits
and intrinsic flaws such as inability or lack of motivation
of the student (Condeluci, 1994; D’Amato et al., 1988;
Kavale et al., 1987; Phares, 1992; Rothlisberg et al.,
2003). The assessment process that is currently in place
within the public education system attempts to define
what the child cannot do (Sheridan and Gutkin, 2000),
and the tools that are utilized by many psychologists are
efficient in the identification of areas of weakness within
the child. The use of the data obtained from the tools
continues to perpetuate the deficit-oriented model by
providing special education services with an intervention
focus on remediation of intra-individual deficits in place
of the use of strengths to develop compensatory activities.
Several problems with the use of the deficit model in
the diagnosis and treatment of students with LD have been
noted. The primary problem with this model approach
is that it suggests that LD is a disease entity meeting
the following criteria for diagnosis: (a) reliable diagno-
sis, (b) known cause, (c) known course with and without
D’Amato, Crepeau-Hobson, Huang, and Geil
treatment, and (d) known treatment (Long and Ross, 1992;
Sheridan and Gutkin, 2000). Moreover, the identification
of the problem suggests that we are able to offer appro-
priate interventions based on the data collected (D’Amato
et al., in press; Sattler, 2002).
The significant variability between states regarding
the number of students identified as LD, as well as the
lack of distinction between students with LD and low
achieving populations, suggests that such a diagnosis is
unreliable (Kavale et al., 1987; MacMann and Barnett,
1999; Ysseldyke, 1987). In fact, establishing acceptable
criteria for the identification of children with LD has been
one of the most controversial issues in this area (Vaughn
and Fuchs, 2003). At the center of this controversy is the
use of the IQ-achievement discrepancy. This diagnostic
approach, consistent with the most recent version of the
Diagnostic and Statistical Manual of Mental Disorders
(American Psychological Association, 2000), is fraught
with measurement and conceptual problems (Vaughn and
Fuchs, 2003). Further, individual state departments of ed-
ucation have varying definitions of such a discrepancy in
terms of size and specific tests used in its determination
(Fuchs et al., 2003). Due in part to the inconsistency in
diagnosis, several authors have suggested that students
classified as LD have included those with poor motiva-
tion, emotional disturbance, and limited ability, as well as
those who demonstrate difficulties due to central nervous
dysfunction (Bricklin and Gallico, 1984; Dwyer, 1987;
Ysseldyke et al., 1989). It has also been argued that the
decision to give students a label of LD has been more a
result of “teacher squeak” (i.e., the extent to which the
teacher wanted a child out of the classroom) and program
availability than sound assessment practices and hypothe-
ses regarding intervention (Ysseldyke, 1987; Kavale et al.,
1987). The current model also forces students to fail be-
fore they can receive the help they need to succeed. Thus,
with respect to the diagnosis and treatment of LD, school
psychologists and neuropsychologists have been very in-
consistent both in diagnosis and in developing interven-
tions based on assessment evidence, although some exhil-
arating progress has quite recently been noted (Shaywitz,
2003). In general, the greatest problem with the current
procedures may relate to the fact that we conceptualize
the problem as being within each child as opposed to sys-
temic issues and then conceptualize our jobs as being to
help students (after they fail) in place of systems (Sattler,
2002). It appears that major role changes will be needed
for neuropsychologists and school psychologists to suc-
ceed in today’s schools (Sheridan and D’Amato, 2003).
For most students with LD, the disability generally
has no known cause (Gaddes and Edgell, 1994; Kavale
et al., 1987). LD appear to result from the interaction of
genetic and environmental factors (for a review, see Gilger
Ecological Neuropsychology
and Kaplan, 2001) and have a variable course either with
or without treatment (i.e., some students are successful
and some are not) (Epps and Tindal, 1987; Safran et al.,
1991). Treatment programs focusing on specific subtype
rehabilitation have shown mixed results (e.g., D’Amato
et al., 1998; Rourke, 1985) and special education pro-
grams targeting specific children with LD have not been
demonstrated to be effective (Dwyer, 1987; Epps and
Tindal, 1987; Kavale et al., 1987; Riccio et al., 1993).
Another quandary with the deficit approach to serv-
ing students with LD is that it dismisses psychosocial
factors (e.g., supportive family, exposure to violence, peer
relationships) in favor of biochemical causes of learning
problems (D’Amato et al., 1999; Huebner and Gilman,
2003; Phares, 1992). As a result, biological symptoms are
sometimes treated with psychopharmacological interven-
tions. Used in isolation, interventions of this nature may
have limited effectiveness and harmful long-term conse-
quences (Kavale, 1990; Phelps et al., 2002).
Some have argued against the use of the deficit model
since it is an expert model, which identifies the physician
or neuropsychologist as the expert with the solutions to
each individual’s problems (Conoley and Gutkin, 1995).
As a consequence, a dependent relationship may result
which disempowers the client (Phares, 1992). In addition,
the expert model of diagnosis and treatment creates labels
that can be stigmatizing and are usually unproductive,
possibly creating a self-fulfilling prophecy for the client
(Condeluci, 1994; Kavale et al., 1987; Phares, 1992;
Sheridan and D’Amato, 2003). A final criticism of the
deficit model approach to conceptualizing students with
LD is that the model, much like psychology in general,
emphasizes the negative. In this model, practitioners tend
to focus on the deficits and weaknesses of the student,
obscuring the presence of skills and coping strategies
that may be used to help the student succeed (Condeluci,
1994; Conoley and Gutkin, 1995; Phares, 1992). A deficit
approach not only fails to recognize an individual’s
strengths, but it also fails to recognize the interaction
between students with LD and the systems in which they
function (Traughber and D’Amato, 2005).
THE ECOLOGICAL NEUROPSYCHOLOGY
ALTERNATIVE
The traditional neuropsychological model has been
criticized as a model that stressed pathology and label-
ing, as well as chronicity and permanence, while ignoring
psychosocial factors and potential for change in children
identified with specific LD (Gaddes and Edgell, 1994).
In addition, it has been suggested that traditional neu-
ropsychology focused primarily on assessment with lit-
tle emphasis on intervention (Riccio et al., 1993). While
99
a neuropsychological approach does view the brain and
central nervous system as a mediator of all behaviors, a
neuropsychologist uses what is known about the brain–
behavior relationship to help understand how children
learn and process information (D’Amato, 1990; D’Amato
et al., 2005). Moreover, knowledge about brain–behavior
relationship is used to develop hypotheses and psychoe-
ducational interventions rather than to identify pathology
within the child (Rothlisberg et al., 2003).
Although neuropsychology frequently is viewed as
synonymous with the medical model approach to diag-
nosis and treatment of LD (Nell and Boer, 1988), it has
evolved over the last several decades into using an ecolog-
ical approach to examine the interaction between person
variables (i.e., brain function) and environmental vari-
ables (i.e., how the environment supports or hinders a
child’s educational development) both in diagnosing and
developing interventions for children with LD (D’Amato
et al., 1997; Gaddes and Edgell, 1994; Hynd and Willis,
1988; Parks et al., 1998; Puente and McCaffrey, 1992;
Reynolds and Fletcher-Janzen, 1997; Rothlisberg et al.,
2003). Figure 1 represents the interactional framework of
a neuropsychological approach. Consistent with an eco-
logical model of assessment for intervention, not only are
intra-individual differences in behavior observed, but also
the reciprocal nature of contextual factors to behavioral
outcomes is considered.
Figure 2 demonstrates how intra-individual charac-
teristics interact with other aspects of the learning envi-
ronment (i.e., the instructional context, content, task, and
method) to produce a more ecologically oriented picture
of the student and his or her learning difficulties.
A student’s learning “disability” may be attributed
not only to intra-individual characteristics, but also to
Fig. 1. Graphic display of the interactional framework of ecological
neuropsychology. Adapted from D’Amato et al., 1999.
100
Fig. 2. Demonstration of individual characteristics that interact with the
learner and his or her environment. Adapted from Hess and D’Amato,
1998.
the subject area, content, the student’s prior knowledge
of the content, task, the instructional approach, method,
or the classroom learning environment (i.e., instructional
context). Furthermore, each of these areas represents a
possible point of intervention for the neuropsychologist
to consider in conjunction with their efforts to remedi-
ate and/or compensate for the student’s intra-individual
characteristics. Thus, the ecological neuropsychological
model views students as dynamic with great potential for
change rather than hindered by the chronicity and perma-
nence of their learning problems (Luria, 1973; Work and
Hee-Sook, in press).
Neuropsychology does pursue what Martens (1992)
referred to as high-inference attributions (i.e., why ques-
tions) about the relationship between atypical brain de-
velopment and LD. These questions are referred to as
high inference because of the functional relationship
between brain dysfunction and LD. A pediatric neu-
ropsychologist should combine knowledge about brain–
behavior relationships with knowledge gleaned from in-
formal sources (i.e., student, peers, teachers, and parents)
in order to develop a complete picture of both organic
and psychosocial-environmental factors (D’Amato et al.,
1999; Dwyer, 1987; Gaddes et al., 1994). Thus, ecological
neuropsychology should ask why questions in addition to
what and how questions. By examining both high and
low inference causes of behavior, the neuropsychologist
is able to accurately diagnose LD as well as develop more
effective interventions (Dwyer, 1987; Martens, 1992). In
summary, ecological neuropsychology seeks to provide an
assessment for intervention link rather than an assessment
to placement link.
D’Amato, Crepeau-Hobson, Huang, and Geil
In 2002, the international “Future of School Psy-
chology Conference,” or Futures Conference, was held in
Indiana (Sheridan and D’Amato, 2003). This was the first
major conference in 25 years to reflect on the profession
and to develop an agenda for the future of the profession.
The conference resulted in the development of 54 goals
grouped under five priority categories. Each priority area
included an emphasis on linking assessment to interven-
tion, and on ecological and systems theories in which
students are viewed as part of family and school systems
within the context of community and culture (Meyers,
2002). The ecological neuropsychology model is con-
sistent with the mission of the Futures conference and
provides all psychologists with a framework to utilize in
practice (Sheridan and D’Amato, 2003).
BRIDGING THE GAP BETWEEN
NEUROPSYCHOLOGY, SCHOOLING,
AND SPECIAL EDUCATION
Despite the similarities from which the disciplines of
neuropsychology and school psychology developed, there
has been a gap between the two in the practice of assisting
children with learning problems, and particularly in de-
veloping interventions for students with LD. Historically,
the educational system has sought to confirm diagnostic
hypotheses about children rather than to focus on the
appropriate rehabilitation of children (D’Amato et al.,
1999; Epps and Tindal, 1987; Ysseldyke, 1987). Within
this framework, an attempt to individualize education and
seek effective treatment of children’s learning problems
has not been efficaciously pursued. As a result, often the
fields of school psychology, neuropsychology, and special
education search for pathology within children consistent
with the deficit model of psychological services (Huebner
and Gilman, 2003; Ysseldyke, 1987). This continues to
be surprising since school psychologists have become one
of the largest, if not the largest providers of rehabilitation
services for children and adolescents. Moreover,
practitioners from school-related specialties are further
perplexed when national and state standards are applied
to children in special education from individuals seeking
to report outcomes to the general public.
IDEIA is reauthorized about every 5 years and it is
only during this review period that changes to the law
can be made. The reauthorization of IDEIA has been
completed (Federal/Register, December 2004). Both the
President’s Commission on Excellence in Special Edu-
cation and the Secretary of the U.S. Department of Ed-
ucation eliminationed the LD discrepancy model from
federal regulations (Cortiella, 2003). While a discrepancy
model could still be used, it is much more likely that alter-
native approaches like Curriculum Based Assessment or
Ecological Neuropsychology
Response To Intervention models will be employed. Yet,
in more severe cases of students with learning disabilities,
neuropsychological evaluations will still be needed.
Assessment of all students with disabilities, consis-
tent with both legal and ethical practice, should include
multiple methods, sources, and settings (D’Amato et al.,
1999). An ecological neuropsychological approach to as-
sessment for treatment of learning problems attempts to
address the inherent weaknesses in using a medical model
approach to students identified as LD and is consistent
with both the goals of the Future of School Psychology
Conference and with the reauthorization of IDEIA. Com-
prehensive assessment of a student with learning prob-
lems should include both formal and informal measures
including:
• perceptual/sensory functions
• motor functions
• intellectual/cognitive ability
• attention/learning/processing capacity
• communication/language skills
Fig. 3. Components of a comprehensive ecological neuropsychological evaluation.
101
• academic achievement
• personality/behavior functioning
• education/classroom environment.
Information gathered should include data about when the
problem(s) do and do not occur. Given these parameters,
contemporary neuropsychological assessment should be
designed to be ecologically oriented (Leu and D’Amato,
1994). Additionally, parents, teachers, and students
should be consulted to determine for whom the behavior
causes concern, what the desired changes are, and how
individuals in the environment might facilitate change.
Indeed, exploration of how the setting may have to change
to accommodate student needs should be considered.
In summary, a comprehensive neuropsychological
evaluation includes data about home, school, peer groups,
and the community in which the child functions, leading
to successful interventions.
Figure 3 refers to the evaluation for intervention pro-
cess used within an ecological neuropsychological model.
In evaluating each of these domains and integrating data
102
gathered, the neuropsychologist can focus on the individ-
ual needs of the student with LD and design interventions
that are ecologically valid and evidence-based.
When an evaluation of the interaction between a
child’s characteristics and the instructional environment
is complete, then an individualized education plan is de-
veloped based on the child’s strengths as well as needs.
Unlike the deficit model, the ecological neuropsychologi-
cal approach to LD focuses on what the child can do rather
than what he/she cannot do (Hartlage and Telzrow, 1983).
Such an approach to learning and educational interven-
tion in general is strength-based (Hartlage and Telzrow,
1983; Riccio et al., 1993). Intervention focuses not only
on remediation and compensation skills for the child, but
also on the match between the child and his/her instruc-
tional environment (D’Amato and Rothlisberg, 1996; Leu
and D’Amato, 1994). Thus, intervention involves working
with the student and significant others in the student’s nat-
ural setting and emphasizes the contribution of the child’s
total ecology to his/her behavior.
Interventions for students with LD may be directed
toward any one area or a combination of the following
areas: (a) changing the child (e.g., teaching compensatory
or remedial skills), (b) changing the environment (e.g.,
the type of instruction and teaching to student strengths),
(c) changing the perceptions, attitudes, and expectations
of significant others toward the child (e.g., the teacher
views the child’s abilities rather than his/her disabilities),
or (d) changing the child’s perceptions, attitudes, and ex-
pectations toward him/herself (e.g., the child recognizes
he/she is not incapable, but able, when learning is ap-
proached differently).
CONCLUSIONS
Ecological neuropsychological evaluation for
intervention should replace traditional deficit model
approaches in the school setting by providing more
comprehensive services to students with LD. An
ecological neuropsychology model offers an alternative
to traditional test and places models for evaluating and
effectively intervening with students with LD. Ecological
neuropsychology encourages neuropsychologists, school
psychologists, and special educators to join together to
develop interventions based on assessment data. Consis-
tent with the goals of the Future of School Psychology
Conference and with the recent reauthorization of IDEIA,
the ecological neuropsychology model links assessment
to intervention and provides an alternative approach
to identifying students with LD. Within this model,
practitioners from all of these disciplines are responsible
for formative evaluation of student progress and revision
D’Amato, Crepeau-Hobson, Huang, and Geil
of educational goals. The advantage of this approach to
LD over the deficit or medical model is the attention given
to the reciprocal nature of all systems affecting the child.
This approach provides potential to enhance the work of
educational personnel because it includes consideration
of a biological base of behavior without precluding con-
sideration of alternative views of cognitive, emotional,
and social development. Thus, students with LD are
recognized and assisted based on their strengths as well
as their needs, increasing their opportunities for success.
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