CHAPTER 17

The terms learning disability (LD) and learning disorder are often used interchangeably. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) uses the term Specific Learning Disorder and states that learning disorders are diagnosed when difficulties in learning and academic skills “are substantially and quantifiably below those expected for the individual’s chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment.”1 This differs from the previous (DSM-IV-TR) definition of learning disorders, which specified that academic achievement must fall “substantially below that expected given the individual’s chronological age, measured intelligence, and age-appropriate education.”² In other words, according to DSM-5, the child must demonstrate a significant discrepancy between achievement scores in reading (fluency or comprehension), writing (spelling or written expression), or math (number sense or mathematical reasoning) in comparison to his or her chronological age. The DSM-5 definition further emphasizes that specific learning problems in reading, mathematics, or written language must be distinguished from situations in which low academic achievement is better accounted for by overall lower cognitive ability as measured by an IQ test. It is important to emphasize that the shift away from an explicit statement about a discrepancy between academic achievement and IQ does not preclude the diagnosis of specific learning disorder in a child who, for example, has IQ scores in the “gifted” range (>120) with academic achievement in the “average” range (eg, standard score of 100 on an academic achievement test). Similarly, children with borderline IQ scores may manifest unexpected, severe academic underachievement in comparison to their cognitive ability. Rather, the DSM-5 encourages a broader consideration of the many factors that can influence academic achievement, such as cognitive ability, exposure to appropriate instruction, and genetic and environmental factors. The new wording in DSM-5 should not be interpreted in ways that diminish the appropriate application of the diagnosis and provision of special educational supports for children who have significant academic achievement difficulties compared to their learning potential, including children with very strong or borderline cognitive ability. The child must demonstrate an impact of these discrepant measures on academic achievement in the classroom. Furthermore, according to DSM-5, learning disorders should not be diagnosed when delays in academic achievement are primarily attributable to impaired hearing or vision, intellectual disability, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction.1 A child may meet the diagnostic criteria for a specific learning disorder in one or more academic skill sets (reading, mathematics, and/or written language).

Discrepancy Versus Low Achievement Definitions of Learning Disability

Previous federal special education laws emphasized the concept of a “significant discrepancy” between measurements of academic achievement and cognitive ability, typically defined as a 1– to 2–standard deviation or more difference in academic achievement and full-scale IQ scores.¹ However, recently there has been a trend toward LD definitions that emphasize low academic achievement among children with at least low-average cognitive skills.³ This is a particularly important concept for children who may, for example, have IQ scores in the low-average range (80–90). In order to meet a discrepancy-based definition of LD, such a child would have to have academic achievement standard scores of 50 to 60, representing delays of several grade levels or more, in comparison to peers. In contrast, a child with an IQ of 100 or more would be required to have an achievement score of 70 in order to meet a discrepancy-based LD definition. In both instances, the child would be underachieving to a degree that would significantly impact his or her ability to succeed in school, yet the child with low-average intelligence would be required to have far lower achievement scores in order to be eligible to receive special education assistance, if only discrepancy definitions of LD are employed. For this and other reasons, Kavale and Forness caution against conflating learning disorder, a distinct neurodevelopmental entity with enduring neuropsychological correlates, with “low achievement,” a remediable multidimensional phenomenon stemming from psychosocial adversity and/or lack of adequate educational resources.³

Legal Definition of Learning Disability as Per the Individuals with Disabilities Education Act

The reauthorization of the Individuals with Disabilities Education Act (IDEA), the federal legislation that governs special education services in public schools, reflects the trend away from discrepancy-based definitions of LD. In fact, the legislation states that LD criteria “must not require the use of a severe discrepancy for determining whether a child has a specific learning disability….”⁴ Further, the law states that the presence of LD may also be defined by a child’s failure to improve academic achievement “in response to scientific, research-based intervention” while also continuing to allow other “research-based procedures” to determine LD status.⁴ Thus the law continues to allow children to qualify for LD services if they manifest a discrepancy between academic achievement and intellectual ability, but it now also allows children who meet “low achievement” definitions of LD to receive special educational assistance. This should help to ensure that more children who are struggling with academic achievement will receive appropriate services. It is also possible that these new regulations will diminish the number of children who fulfill medical diagnostic criteria for LD yet who do not qualify for LD services in public schools. Most importantly, a child is deemed to have a specific LD if he or she “does not achieve adequately” for age or meet grade-level standards, assuming that appropriate instruction has been provided. Specific LDs can be reflected in problems with the following specific academic tasks: oral expression, listening comprehension, written expression, basic reading skills, reading fluency skills, reading comprehension, mathematics calculation, and mathematics problem-solving.3 It is important for primary pediatric health care professionals to be familiar with the terminology in the reauthorization of IDEA, particularly Response to Intervention (RTI). Special education services must be supported by “scientifically based research…accepted by a peer-reviewed journal or approved by a panel of independent experts through a comparably rigorous, objective, and scientific review.”⁴ Outlined in sections 34 CFR 300.35 and 20 U.S.C. 1411(e(2)(C)(xi)] [sec. 9101(37) of the Elementary and Secondary Education Act (ESEA)], a proposed intervention must meet standards for clear and replicable methodology and analytic methods, appropriate experimental/quasi-experimental study design with control subjects (eg, randomized controlled trial), and sufficient clarity of reporting to be accepted by a peer-reviewed journal or approved by a panel of independent experts.⁵ (For further information on RTI, see also Chapter 20, Interpreting Psychoeducational Testing Reports, Individualized Family Service Plans [IFSP], and Individualized Education Program [IEP] Plans.)

This higher standard for methodological rigor and replication should help to ensure that unproven, non-evidence-based practices are gradually eliminated from special educational programs. The federal law requires that each state enact special education laws that are consistent with the federal law. This leaves the states considerable latitude in special education laws, which is likely to continue the historic tendency for significant state-by-state variations in criteria required to receive special educational services, as well as the nature of the services themselves. Unfortunately, despite the fact that this legislation was passed in 2004, many states have yet to operationalize IDEA by changing relevant state laws. In 2007, states were given “report cards” on their ability to implement IDEA and offered two levels of aid (assistance and intervention) if they fell below their self-imposed requirements.⁶ It is concerning to note that, as of 2009, only 13 states and one US territory have met their own self-imposed requirements for educating children with disabilities. Twelve states met criteria for “Needs Assistance,” with an additional 13 states and 4 US territories meeting that classification for two consecutive years. One state met criteria for “Needs Intervention,” the highest level of concern, and 3 states have held this worrisome status for 2 consecutive years.⁷

Epidemiology of Learning Disability

Learning disorders are among the most common neurodevelopmental disorders in childhood, and it is therefore essential for primary pediatric health care professionals to understand the important role that they play in identification, diagnosis, intervention, and advocacy for their patients with LD. The DSM-5 includes prevalence estimates of “5–15% (across all LD types) among school-aged children across different languages and cultures.”¹ Estimates for the incidence (likelihood of developing LD during childhood) of reading disorder range from 5.3% to 11.8% and for mathematics disorder from 5.9% to 13.8%.8,9 For each type of LD, the highest incidence rates are obtained with “low achievement” definitions, while discrepancy-based definitions lead to considerably lower estimates. It is also important to recognize that epidemiological studies demonstrate that boys are 2 to 3 times more likely than girls are to manifest any type of LD.^8–10

Identifying Children With Learning Disability

Children at Risk for Learning Disability

As with other neurodevelopmental disorders, primary pediatric health care professionals play a crucial role in the early identification of children with LDs. This begins with recognition of medical, genetic, and psychosocial conditions that place children at greater risk for development of an LD. They also have a unique opportunity to contribute to early identification of children at risk for LD based on their knowledge of their patient’s family, medical, and psychosocial histories. Learning disabilities are clearly familial, with genetics contributing substantially to a child’s risk for LD.¹¹ The family history should include information about learning and other developmental disorders.

Two categories of medical risk factors for LD deserve special attention: prematurity and cyanotic congenital heart disease. Premature infants are at significantly higher risk not only for global developmental delays, but also for LD.^12,13 In particular, children born at less than 32 weeks’ gestation or who experience perinatal and postnatal complications such as prolonged ventilation, intracranial hemorrhage, sepsis, seizures, prolonged acidosis, or hypoglycemia are at higher risk for neurodevelopmental sequelae. Similarly, children now surviving previously fatal congenital cardiac anomalies are another group at high risk for LDs.^14,15 Children living in poverty and other adverse circumstances that would fall under the category of toxic stress are at risk for academic underachievement and premature dropout, while their risk for LD may be less clear.¹⁶ Nevertheless, such children certainly warrant increased vigilance for not only developmental delays but also LD.

Several genetic disorders have been linked to risks for various forms of LD. In particular, children with Klinefelter syndrome, Turner syndrome, velocardiofacial syndrome, or spina bifida with shunted hydrocephalus have all been shown to be at significant risk for LD.^17,18 Some studies have suggested that children with Turner syndrome and children with spina bifida and shunted hydrocephalus may be specifically at risk for problems with visuospatial cognitive skills and math achievement.^17,19 However, given the limitations in the available literature, it is more appropriate to view these children as being at risk for LD in general, rather than for a specific type of learning problem.

Male gender is also a risk factor for LD. While some authors have suggested that boys and girls are at equal risk for certain types of LD, epidemiological studies have consistently demonstrated that boys are at greater risk for all LDs.^8–10 Girls certainly deserve to be monitored for LD as part of routine care, but boys are at significantly higher risk for LD.

When one of these risk factors is identified, the child should be monitored more carefully, with a low threshold for referral for comprehensive assessment, either privately or through public early intervention and school-based programs.

The importance of careful developmental surveillance and screening cannot be over-estimated, not only in order to identify developmental delays that should be addressed in the toddler or preschool-aged child, but also to identify children at risk for later problems with language-based learning. In addition to formal developmental surveillance and screening, certain “red flags” suggest that a child may be at increased risk for later reading problems. These include delays in receptive and expressive language and speech articulation in toddlers and young preschoolers. Later, children may have difficulty learning simple songs or rhymes.20 Unfortunately, less is known about early indicators of risk for math LD.

– The Prekindergarten Checkup

Aside from immunizations and hearing and vision testing, primary pediatric health care professionals may question the utility of the prekindergarten preventive care visit. However, this visit provides an ideal opportunity to identify children at risk for LD. Milder delays in language development and speech articulation, which would not have been detectable using standardized developmental screens in the birth to 3 year age group, should be apparent at this age. At the prekindergarten visit, identification of at least 4 random letters that are not in alphabetical order is strongly associated with appropriate phonological processing skills needed for reading decoding. Early indicators of risk for math LD, such as difficulty learning to count or understanding the concept of one-to-one correspondence, may be detected. Children who have difficulty drawing simple shapes (a circle at 3 years, a square at 4 years, or a triangle at 5 years) at the prekindergarten checkup may be at risk for difficulties with writing. In addition, several good developmental screens that include early academic learning skills are available, including the parent-completed Ages & Stages Questionnaires (ASQ) and the directly administered Brigance Screens—II and Parents’ Evaluation of Developmental Status: Developmental Milestones (PEDS:DM). Children who appear to be at risk for LD may be scheduled for reassessment during or toward the end of the kindergarten year. At that time, if problems are noted with acquisition of basic number and letter identification or counting, or if teacher concerns are reported, it may be appropriate to refer the child for further assessment (see below).

– School Age: The Report Card Visit

While schools are mandated to evaluate children whose academic performance suggests the presence of an LD, children often “fall through the cracks” and are not assessed until their academic achievement lags far behind their same-aged peers. Alternatively, secondary behavioral and psychosocial problems may develop, and these may be the presenting concern when children are brought to their primary pediatric health care professional. During school-age well-child visits, primary pediatric health care professionals have an opportunity to assess academic progress and identify children who warrant referral for more comprehensive assessment. This requires that a few, brief questions are asked about progress in reading, math, and writing: (1) Has the first-grade child learned all of the letters and letter sounds, numbers, and beginning addition and subtraction facts? (2) Does the child have poor memory for spelling words or numbers? (3) Has the teacher expressed any concerns about academic progress? Parents should be encouraged to bring copies of their child’s report card to these visits. At times, academic concerns may be masked by behaviorally acting out in the classroom or while doing homework. LD should be considered among the leading differential diagnoses when the child’s acting out occurs around a specific academic subject (eg, only reading or math).

Comprehensive Assessment for Learning Disability

Primary pediatric health care professionals have an important role to play not only in early identification and referral but also in the evaluation of children with suspected LD. This begins with a complete medical history, physical examination (including formal hearing and vision testing, and lead and iron deficiency screening), and a thorough neurological examination. Primary pediatric health care professionals will also be familiar with the child’s family and psychosocial history. The latter is particularly relevant, as stressful or frankly neglectful home environments can lead to academic underachievement and school failure.21 A medical assessment can also identify behaviors suggestive of emotional and behavioral problems, such as depression or oppositional behavior, that can interfere with school performance. Finally, problems with attention and concentration associated with attention-deficit/hyperactivity disorder (ADHD) should be assessed as potential primary contributors to academic underachievement or as a comorbid condition with LD.²² Of course, assessment for LD requires psychometric testing, including administration of individual standardized measures of cognitive ability (intelligence tests) and academic achievement. These assessments may be completed by school psychologists as part of an assessment of eligibility for special education services or by private psychologists.

What Causes Learning Disability?

A lengthy review of the genetic, neurological, and neuropsychological factors that underlie LD is beyond the scope of this chapter. However, it is important for primary pediatric health care professionals to have some basic information on these topics.

First, and most important, is an understanding that LD is in large measure genetically determined.¹¹ This does not diminish the important contribution of environment to a child’s developmental progress, including the development of preacademic and academic skills. Nevertheless, it does highlight the importance of the family history in identifying young children at risk for LD. A thorough family history, obtained at the time of an infant or young child’s first well-child visit, is therefore an essential component of early identification of LD in primary care pediatric practice.

Recently, functional magnetic resonance imaging (fMRI) technology has helped researchers begin the process of understanding the neurological underpinnings of LD. This has been particularly true for reading LD, with studies showing clear differences in fMRI activation patterns between individuals with normal reading skills and those with reading LD.²³

These differences in central nervous system function correlate with deficits in phonological processing, a skill that has been shown to be essential for efficient reading decoding and that is impaired in individuals with classic dyslexia.²⁴ Phonological processing refers to “awareness that words can be broken down into smaller segments of sound.”^23,24 While children may have deficits in reading that are caused by a variety of other issues (eg, poor reading comprehension due to problems with receptive language deficits), impaired phonological processing seems to be the most common underlying problem for children who experience difficulty with the basic process of decoding (ie, “reading”) written words.

While reading LD (or dyslexia) tends to get the most attention in both the research literature and the classroom, it is important to recognize that many children have more than one type of LD. A recent study of math LD demonstrated that, depending on how LD is defined, 35% to 56.7% of children with math LD also had reading LD.15 The key for primary pediatric health care professionals is to recognize that children who are found to have problems in one area of academic achievement often have problems in other areas; hence, such children should be carefully assessed in all areas of academic achievement to ensure that they receive appropriate intervention. The new DSM-5 diagnostic categories of Other Specified Neurodevelopmental Disorder (formerly Cognitive Disorder—Not Otherwise Specified under DSM-IV) and Unspecified Neurodevelopmental Disorder (formerly Learning Disorder—Not Otherwise Specified)^1,2 are intended to capture learning problems that do not fit easily or neatly into discrete categories. Other Specified NDD is intended to implicate a known biomedical etiology to the learning problems, such as fetal alcohol exposure or anoxia, whereas Unspecified Neurodevelopmental Disorder is intended to capture problems in learning, such as nonverbal learning disabilities, in which the etiology is unknown or unclear.

Learning Disability and Attention-Deficit/Hyperactivity Disorder

Epidemiological studies have demonstrated that children with ADHD experience multiple school-related problems, including academic underachievement, as well as increased rates of absenteeism, grade retention, and school dropout.²² Comorbid LDs account for at least some of the observed academic underachievement in children with ADHD. This association is so common that every child with LD should be considered to be at risk for ADHD and vice versa. Primary pediatric health care professionals should at least screen for ADHD among their patients with known LD by asking about symptoms of ADHD and considering obtaining ADHD-specific rating scales from the child’s parents and teachers. Children with learning problems often exhibit secondary attention deficits or attention problems secondary to the underlying learning disorder. That is, it can be very difficult for a student to maintain focus on tasks that are difficult for him or her to understand. It is sometimes difficult to distinguish “secondary” attention deficits from primary attention deficits.

Language-based Versus Nonverbal Learning Disorders

In contrast, a smaller, though uncertain, proportion of children manifest nonverbal LD.17 Such children have nonverbal cognitive measures that are significantly lower than their verbal scores. Children with nonverbal LD experience problems with math computation, organization (particularly in middle and high school), and higher-order math and science concepts. In addition, these children often manifest significant problems with social perception and social interaction that contributes to their negative experiences in educational settings. It is important to distinguish between language-based and nonverbal LDs, both because of the differing profile of academic challenges and differences in associated problems and intervention strategies. School personnel tend to be less familiar with approaches that are successful for children with nonverbal LD, in part due to ongoing controversies about whether nonverbal LD should be considered a diagnosis in its own right or secondary to related conditions such as autism spectrum disorder and social communication disorder. (In clinical settings, nonverbal LD is acknowledged under the broad diagnostic category of Unspecified Neurodevelopmental Disorder in the DSM-5 but has yet to be formally identified as a “diagnosis under consideration” by any of the DSM Workgroups.) Hence, primary pediatric health care professionals can play an important role in advocating for these children.

Intervention and Advocacy

Understanding Special Education Laws

As described earlier, LD is defined in the federal special education law. Each state, in turn, must enact laws that are consistent with the federal statute. As a result, the precise definition of LD varies from state to state, making it important for professionals to familiarize themselves with their own state’s special education laws. Individual states’ department of education Web sites will typically provide a summary of relevant laws to enable primary pediatric health care professionals to understand the system in their state and thus to be knowledgeable advocates for their patients.

In addition to the terminology described earlier, several other important abbreviations are worth noting.⁴ The federal law stipulates that a child’s special education plan will be described in detail in an Individualized Education Program (IEP) plan. Primary pediatric health care professionals can play a critical role for families as an independent resource to review school-based psychometric testing reports and IEPs with families to ensure that the IEP provides services appropriate to meet each child’s needs.²⁵ In preparing an IEP, schools must adhere to the principle of a free and appropriate public education (FAPE). This means that children must be provided with an appropriate array of accommodations and services to meet their basic educational needs. This raises an important distinction between services provided under the federal special education law and services that may be available on a private basis. According to the FAPE principle, the child’s intervention plan must be appropriate, but it is not required to be “optimal.” States have a great deal of latitude in defining an appropriate level of service, and pediatric health care professionals can play an important role in assessing the extent to which school services are sufficient or should be supplemented by privately available educational services.

One of the greatest challenges in the LD field has been to ensure access to evidence-based interventions for children with LDs. Recently, multiple studies have clearly demonstrated that reading curricula that include explicit teaching of phonics are more effective. This is not surprising because phonological awareness has emerged as a critically important prerequisite for the development of good, basic reading skills. Functional magnetic resonance imaging has evolved as a powerful new research tool for the study of brain activation patterns during reading. This technique has revealed differences between dyslexic and nondyslexic readers.24,26 Reading skills in young children are positively correlated with activation in the left occipitotemporal area, a region of the brain that seems to be responsible for the most rapid, efficient reading skills.²⁴ Furthermore, when dyslexic children were exposed to an empirically validated educational intervention, they demonstrated increased activation of left-sided, occipitotemporal systems, making them functionally more similar to nondyslexic children.²⁶ These studies illustrate the potential application of functional imaging techniques to elucidate the underlying neurophysiology of learning disorders and to assess, in a direct manner, the impact of intervention on brain function. Unfortunately, far less is known about the most effective interventions for children with math or writing LD. It should be noted that functional imaging is not a clinically useful approach at this time.

For children who qualify for special educational services, the IEP must list specific learning goals, as well as the nature and intensity of services to be provided. Some children may require direct, individual, or small-group instruction with a special education teacher in a special education resource room. In other cases, support from the regular or special education teacher, or a paraprofessional assistant, may be provided in the regular classroom. According to federal law, interventions must be provided in the LRE (see above) while still meeting the child’s educational needs. In addition to direct instructional services, IEPs can include accommodations, such as shortened assignments, increased time to complete tests (so as not to penalize children for slower reading of questions), or oral administration of tests for children with reading problems. The key is to ensure that services and accommodations specifically match the demonstrated needs of the child based on the results of individual assessment of learning strengths and weaknesses.

Some children who lag behind their peers in math or reading may not fulfill state and federal criteria to receive formal special educational services through an IEP. For such children, another option may be Title 1 reading and math support. Title 1 is a federal program, originally enacted in 1965 and revised in the No Child Left Behind Act of 2001, designed to provide additional support in reading and math for economically disadvantaged children.27 Title 1 services are available to all students in a school building only if a sufficient percentage of students who attend that building are economically disadvantaged, based on receipt of federally subsidized free-lunch services.

Some children may have delays or deficits in academic achievement that are significant but not severe enough to qualify for any additional services in the school. In these instances, the only options are private services provided by individual teachers, tutors, or tutoring agencies. The primary pediatric health care professional can play an important role in directing families to high-quality tutoring services in the community.

Unfortunately, unproven, ineffective “interventions” and treatments for LD are available, often at significant cost in both time and money. The issue of nonstandard therapies for children with developmental and behavioral disorders is addressed in detail elsewhere in this book (see Chapter 24, Complementary Health Approaches in Developmental and Behavioral Pediatrics). However, one specific, supposed “intervention” for reading LD deserves mention. Although there is no empirical evidence to support it, “vision therapy” is available in many communities and is typically provided by optometrists. This intervention is based on the non–evidence-based belief that reading problems can be corrected by “eye exercises” aimed at somehow improving the child’s ability to process the written word. This clearly contradicts all of the research evidence that demonstrates that reading skills depend on language-based cognitive processes, such as phonological awareness. In a joint policy statement, both the American Academy of Pediatrics and the American Academy of Ophthalmology concluded that scientific evidence does not support the efficacy of eye exercises, behavioral vision therapy, or specially tinted filters or lenses for improving the long-term educational performance in children with reading LD, and thus, these vision therapies are not endorsed and should not be recommended for children with reading LD.²⁸

Consequences of Failure to Intervene

The most recent changes in the federal special education laws were intended, in part, to prevent situations in which children were “required” to fall so far behind their peers before qualifying to receive special educational services that intervention was available too late to make a meaningful difference in learning outcomes. Children who do not receive timely intervention are at risk not only of academic failure but also for school dropout and the psychosocial morbidities that accompany limited academic achievement, such as unemployment, substance abuse, and juvenile delinquency.29–31

For reading LD, research has clearly demonstrated that intervention must be provided early, at least before third grade, in order to provide an opportunity to remediate reading problems.³² Thus, early identification and timely access to evidence-based reading intervention is essential to ensure the best possible outcome. For math LD, the critical age by which problems must be identified is not yet known, although it is reasonable to assume that there may be a similarly limited window of opportunity to ensure adequate academic outcomes in math.

Historically, children who demonstrated inadequate academic achievement were often retained a grade, based on the assumption that another year at the same grade level would allow the child to “catch up” to his or her peers. For many children, repeating a grade led to a delay in assessment that would have revealed an LD and initiated appropriate remediation. We now know that grade retention is almost universally unsuccessful and is in fact associated with poorer long-term school outcomes.³³ If there is a role for grade retention, it is only for a limited number of children in the very early school years (kindergarten and first grade) and should be considered only after a thorough evaluation for specific LDs or other conditions that may account for the child’s academic underachievement.

Advocacy

Throughout this chapter, the role that the primary pediatric health care professional can play to ensure that children with LD are identified in a timely fashion, referred for appropriate assessments, and offered evidence-based intervention has been highlighted (Box 17.1)

– Starting the Assessment Process

If primary pediatric health care professionals incorporate early identification and ongoing monitoring for LD into their routine practices, they will be in a position to direct their patients to timely assessments, either through the local school or through private psychologists. This is particularly important for families who may lack the resources to monitor and understand information about their child’s academic progress.

– Reviewing Evaluation Reports and Individualized Education Programs

Similarly, the primary pediatric health care professional can assist the family by serving as an objective reviewer of assessment reports and making referrals for additional private evaluations when school assessments have not adequately addressed the child’s needs. Once the evaluation is complete, the pediatric health care professional can meet with the family to review the IEP to ensure that goals match the demonstrated learning needs of the child.

– Get to Know Local Resources

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