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ECXXXX10.1177/0014402917737467Exceptional ChildrenJitendra et al.

Exceptional Children
2018, Vol. 84(2) 177­–196
Mathematical Interventions for © The Author(s) 2017
DOI: 10.1177/0014402917737467
Secondary Students With Learning journals.sagepub.com/home/ecx

Disabilities and Mathematics

Difficulties: A Meta-Analysis

Asha K. Jitendra1, Amy E. Lein2, Soo-hyun Im1,

Ahmed A. Alghamdi1, Scott B. Hefte1,
and John Mouanoutoua1

This meta-analysis is the first to provide a quantitative synthesis of empirical evaluations of
mathematical intervention programs implemented in secondary schools for students with
learning disabilities and mathematics difficulties. Included studies used a treatment-control group
design. A total of 19 experimental and quasi-experimental studies containing 20 independent
samples met study inclusion criteria. Results of a random effects model analysis indicated that
mathematical interventions influence mathematics outcomes (g = 0.37, 95% confidence interval
[0.18, 0.56]) for students with learning disabilities and mathematics difficulties. In addition,
instructional time moderated the relation between mathematics interventions and student
learning. Limitations of the study, future directions for research, and implications for practice
are discussed.

In an increasingly competitive job market, Progress data indicated that the goal of the No
where the demand for mathematics-intensive Child Left Behind legislation to eradicate
science and engineering jobs is outpacing achievement differences among student sub-
overall job growth three to one (National groups had not yet been met (Dossey,
Mathematics Advisory Panel, 2008), the abil- McCrone, & Halvorsen, 2016). For example,
ity to think mathematically is a crucial skill. 45% of fourth graders with disabilities scored
Although the percentage of students reaching below the basic level on the 2015 National
proficient levels in mathematics has increased Assessment of Educational Progress, com-
over the past decade, it is disconcerting that, as pared with 14% without disabilities; further,
children progress from the elementary grades 68% of eighth graders with disabilities scored
into secondary grades, the mathematical gains below the basic level versus 23% without dis-
made in elementary school are, on average, not abilities. In addition, the National Longitudi-
matched in later years (National Mathematics nal Transition Study-2 (Wagner, Newman,
Advisory Panel, 2008). For example, on the
2015 National Assessment of Educational 1
University of Minnesota
Progress, only 33% of U.S. eighth-grade stu- 2
Bellarmine University
dents, compared with 40% of fourth-grade stu-
dents, were proficient or advanced in their Corresponding Author:
Asha K. Jitendra, University of Minnesota, 245 Education
knowledge of mathematics (National Center Sciences Building, 56 E. River Road, Minneapolis, MN
for Education Statistics, 2015). Further, the 55455.
2015 National Assessment of Educational E-mail: jiten001@umn.edu
178 Exceptional Children 84(2)

Cameto, Levine, & Garza, 2006) found that Several meta-analyses and narrative
secondary students with learning disabilities reviews already exist regarding the effective-
(LD) perform worse than their peers without ness of mathematics interventions for students
disabilities on mathematics subtests. with LD or MD. However, these reviews tar-
There is evidence that secondary students geted elementary students with MD (Dennis
with disabilities score significantly below et al., 2016; Kroesbergen & Van Luit, 2003)
grade level in mathematics and that their and K–12 students with LD or MD (Baker,
growth rate in mathematics slows consider- Gersten, & Lee, 2002; Gersten et al., 2009;
ably in secondary schools (Cortiella, 2011; Swanson & Hoskyn, 1998), or they focused on
Wei, Lenz, & Blackorby, 2013). The mathe- specific mathematical content instruction,
matics underachievement of these students as such as word problem solving (Xin & Jitendra,
they enter middle and high school grades may 1999; Zhang & Xin, 2012; Zheng, Flynn, &
be due to several reasons, such as increasingly Swanson, 2013), fractions (Misquitta, 2011;
difficult mathematics content as the mathe- Shin & Bryant, 2015), and algebra (Hughes,
matical ideas become more abstract (Witzel, Witzel, Riccomini, Fries, & Kanyongo, 2014;
2016) or limited access to higher-level math- Maccini, McNaughton, & Ruhl, 1999; Watt,
ematics instruction given the focus on lower- Watkins, & Abbitt, 2016). The previous meta-
level skills, including fact recall and mastery analyses for K–12 students with LD or MD
of procedures (Miller & Hudson, 2007). Many reported positive effects on test scores for stu-
secondary students with disabilities continue dents with LD (Gersten et al., 2009; Swanson
to experience difficulty with early numeracy & Hoskyn, 1998) or MD (Baker et al., 2002)
concepts, which are crucial for more advanced with regard to several components of mathe-
mathematics (National Mathematics Advisory matics instruction. Baker and colleagues
Panel, 2008). Further, difficulties in acquiring (2002) found support for peer-assisted learn-
higher-order thinking skills such as reasoning ing, explicit instruction, and providing stu-
(e.g., Hunt & Vasquez, 2014) are major dents with data and feedback. Gersten et al.
impediments and inhibit opportunities to pur- (2009) examined four components of mathe-
sue mathematics-related careers. matics instruction and found strong effects for
approaches to instruction (e.g., explicit instruc-
tion, providing visual models, heuristics), cur-
There is evidence that secondary
riculum design, and providing feedback to
students with disabilities score teachers based on formative assessment data.
significantly below grade level in Swanson and Hoskyn (1998) reported that
mathematics. cognitive strategies and direct instruction were
effective instructional models in mathematics
If the goal is to help secondary students and other domains. However, these reviews
with disabilities meet the high expectations did not examine grade level as a factor that
of, for example, the Common Core State Stan- might influence the direction and magnitude
dards (National Governors Association Center of intervention effects.
for Best Practices & Council of Chief State Previous reviews have included students
School Officers, 2010) and Every Student with LD, MD, or both. However, the authors
Succeeds Act of 2015, effective interventions did not operationalize the terms LD (Maccini
need to be identified. Much research on the et al., 1999) or MD (Baker et al., 2002;
effectiveness of mathematics interventions for Kroesbergen & Van Luit, 2003), or they used
secondary students with disabilities or those different criteria for inclusion of students with
identified as having mathematics difficulties MD. For example, students with MD were
(MD) has accumulated over the last three identified as those scoring <25th percentile on
decades to justify a meta-analysis of the effec- a mathematics test (Dennis et al., 2016; Shin &
tiveness of such interventions on students’ Bryant, 2015; Zheng et al., 2013), were con-
mathematics learning. sidered low achieving or referred by classroom
Jitendra et al. 179

teachers as being at risk for failure in mathe- lem solving and found that the efficacy of
matics (Zhang & Xin, 2012), were receiving intervention approaches (heuristic, semantic,
remedial mathematics instruction (Shin & or authentic) varied and that these interven-
Bryant, 2015; Xin & Jitendra, 1999), or were tions differed with regard to real-world con-
classified as struggling learners (Hughes et al., nections. Marita and Hord (2017) focused on
2014; Misquitta, 2011). interventions directed to students with LD and
Another limitation of the previous reviews is found that a variety of interventions, such as
the inconsistencies in calculating effect sizes systematic instruction, problem-based learn-
that impede directly comparing effect sizes ing, and visual representations, can improve
among reviews. For example, in two meta-anal- the problem-solving skills of students with
yses (Xin & Jitendra, 1999; Zhang & Xin, 2012), LD. Finally, Myers and colleagues (2015)
the authors included several single-group pre- detailed several instructional approaches and
test-posttest design studies and measured noted the benefits of cognitive and metacogni-
changes in scores from pre- to postintervention. tive strategies and enhanced anchored instruc-
There are concerns with the use of change scores tion for secondary students with LD.
and the lack of a control group because matura- The question of whether and to what extent
tion effects cannot be detected and standardized mathematics interventions are effective for sec-
mean change effects would be inflated (Borman, ondary students with LD and MD has not been
Hewes, Overman, & Brown, 2003). considered in the previous reviews. As such,
Our main objective was to conduct a meta- there is a need to integrate the empirical research
analysis of the effects of mathematics inter- on mathematics interventions for secondary
ventions aimed at improving the mathematics students with LD and MD and answer questions
performance of secondary students with LD regarding their effectiveness. This can be
and MD. Given the difficulties that secondary addressed by a meta-analysis, as it can estimate
students with LD and MD experience with the average effectiveness of mathematics inter-
mathematics, there is a need to improve the ventions on students’ mathematical learning. In
understanding of research related to mathe- addition, a meta-analysis can explore the types
matics interventions across mathematical con- of settings or student populations for which the
tent areas for this group of students. Although intervention works best. The present review
evidence suggests that students with mathe- sought to answer the following questions:
matics LD and those with MD (i.e., scored
below average to low average on tests of math •• What is the average effect of mathe-
achievement) are characteristically different matical interventions for secondary
(Mazzocco, 2007), they often encounter simi- students with LD and MD?
lar challenges with mathematics that justify •• Does it vary by student status (LD vs.
the need for high-quality instruction (Fuchs, MD)?
Fuchs, & Compton, 2013). We found three •• What instructional characteristics (e.g.,
recent narrative reviews (Hwang & Riccomini, setting, instructional time) or method-
2016; Marita & Hord, 2017; Myers, Wang, ological characteristics (e.g., research
Brownell, & Gagnon, 2015) of mathematics design, implementer, fidelity of imple-
intervention research for secondary students mentation [FOI]) of mathematical inter-
with or at risk for LD, but we did not find a ventions moderate student outcomes?
meta-analysis to date on this topic. These nar-
rative reviews provide a summary of existing
research (group and single-case studies) by Method
taking a qualitative rather than quantitative Literature Search and Criteria for
approach. The three reviews extended the ear-
lier review of the topic by Maccini, Mulcahy,
and Wilson (2007). Hwang and Riccomini We conducted a literature search of mathemat-
(2016) reviewed studies of mathematical prob- ics intervention studies ending in May 2017.
180 Exceptional Children 84(2)

First, we included the online databases ERIC, be identified with a learning disability (school
PsycINFO, and ProQuest Dissertation and or researcher identified) or mathematics diffi-
Theses. We searched abstracts for key popula- culty. We operationally defined students as
tion search terms and roots (learning dis- having MD when they scored ≤35th percen-
abilit*, learning difficult*, at-risk, struggling, tile on a standardized mathematics test. This
learning problem, underperforming, below criterion was selected to ensure broad repre-
average, underachieving, disadvantaged) in sentation of students who may be at low to
conjunction with mathematics search terms high risk of developing MD (see Fuchs et al.,
and roots (math, mathematic*, intervention, 2014; Mazzocco, 2007). We included studies
instruction, treatment, training, teaching when >50% of the participants were students
method*) and grade search terms (middle with LD or MD or disaggregated data were
school, high school, secondary, adolescent*) provided for students identified as such.
in various combinations. Second, we scanned Second, the studies had to involve students
the reference sections of each study to locate with LD or MD in Grades 6 to 12. The third cri-
other possible studies, as well as the reference terion was that studies were based on a random-
sections of existing meta-analyses and review ized controlled trial (RCT) or quasi-experimental
studies on this topic. Third, we hand-searched design and that they compared students in treat-
key journals in special education from 2016 to ment groups taught via a specific mathematics
2017: Exceptional Children, Journal of Learn- intervention with those in control groups who
ing Disabilities, The Journal of Special Educa- were taught via standard methods or an alterna-
tion, Learning Disability Quarterly, Learning tive intervention. Fourth, studies could have
Disabilities Research & Practice, and Reme- been conducted in any country, but the report
dial and Special Education. had to be available in English. Fifth, to be
The primary literature search yielded 3,355 included, studies had to evaluate the effects of
abstracts for screening, and after removal of mathematics interventions or programs on learn-
duplicate abstracts, 3,175 abstracts remained. ing of mathematical subjects. The sixth criterion
Of these, 2,970 were not considered per title is based on studies providing the necessary
and abstract review. The remaining 205 stud- quantitative information to estimate effect sizes.
ies retrieved in the primary search appeared to Last, the dependent measures had to include
match the selection criteria based on their titles quantitative measures of mathematics perfor-
and abstracts. However, most of the selected mance. Studies were excluded if they examined
studies were removed after retrieval of their only measures of student attitudes toward math-
full-text versions, either because studies were ematics or strategy use.
outside the age/grade range of this meta-analy-
sis (n = 46) or did not have a suitable research Coding Procedure and Intercoder
design (no control group, correlational studies;
n = 83). Moreover, 12 reports were reviews,
editorials, or commentaries, and 19 studies Two authors developed a coding form to
included all students but did not contain a suf- extract and record relevant information from
ficient sample of students identified as having each study. We evaluated the form multiple
LD or did not identify students as MD based times in repetitive cycles in consultation with
on standardized test scores. For 26 studies, the coders. Then we coded studies for instruc-
there were other reasons for exclusion, such as tional and methodological characteristics.
dissertations that were published and studies
that did not focus on mathematical interven-
Instructional Characteristics
tions or did not provide sufficient information
to compute effect sizes. The primary search Participants.  We coded how students with LD
resulted in a total of 19 relevant studies. or MD were identified, using open-ended
We applied seven criteria for inclusion in items (LD or MD as described in text, criteria
this meta-analysis. First, participants had to for classifying students with MD). We also
Jitendra et al. 181

coded participants’ grade as middle school concepts, such as operations and algebraic
(Grades 6–8), high school (Grades 9–12), or thinking (e.g., arithmetic word problem solv-
combined. ing) and number system (e.g., fractions, deci-
mals), and (b) higher-level mathematics topics
Intervention approaches.  We examined written (i.e., ratio and proportional relationships,
descriptions of interventions used in the stud- expressions and equations). The higher-level
ies. Interventions varied in their approaches mathematics category also included studies
and sometimes included a combination of that encompassed several mathematical topics
approaches; however, most studies included or a combination of foundational and higher-
explicit and systematic instruction. We coded level topics (e.g., number system, ratio and
intervention approaches as a categorical vari- proportional relationships, measurement and
able: (a) visual models only (e.g., fraction data).
circles or squares, manipulative objects, dia-
grams, mental representations); (b) visual
models combined with other strategies, such
Methodological Characteristics
as priming the underlying problem structure, We coded the type of report or publication
cognitive strategy, or contextualized instruc- source as a dichotomous variable (journal
tion (problems used real-world scenarios); (c) article, unpublished report). We coded the
computer-based modules (e.g., videos) com- year of publication as either 2000 and before
bined with visual models or contextualized or 2001 and later. We created a dichotomous
instruction; and (d) other (i.e., problem-based variable to code research design as RCT ver-
learning, peer-assisted learning strategies and sus quasi-experimental. RCTs referred to
curriculum-based instruction, question-and- studies in which students, teachers or class-
answer strategy). rooms, or schools were randomly assigned to
conditions and the level of random assign-
Intervention features.  We gathered information ment determined the unit of analysis. In con-
on intervention features using three open- trast, quasi-experiments may also have used
ended items (i.e., setting, implementation of random assignment at the teacher or class-
the intervention, instructional time). We coded room and school levels, but the analysis was
instructional setting as general education done at the student level because of limited
classroom, special education classroom, or samples of classrooms or schools. We coded
combined. We coded implementation of the studies to identify who delivered the interven-
intervention as a dichotomous variable, with tion to students: researcher or school person-
instruction conducted in small groups (<10 nel. In addition, we created a dichotomous
students) or large groups (≥10 students). We variable to code FOI as either reported (yes)
coded the time of treatment implementation in or not reported (no). We coded FOI when
hours and then categorized it as ≤10 hr or >10 studies reported this information, and we
hr. Specifically, we calculated instructional recorded the percentage of FOI. We catego-
time as the hours of intervention across the rized the types of measures as being researcher
duration of the intervention (i.e., number of developed or standardized. We examined the
sessions multiplied by the length of each type of control group as a proxy variable for
session). the strength of the control condition or the
counterfactual with regard to its effect on
Mathematical topic.  We coded the mathemati- observed treatment effects. We coded this
cal topic of instruction as a categorical variable variable as either business as usual (BAU; tra-
with the following categories, based on the ditional textbook method) or an alternative
Common Core State Standards for mathemat- intervention.
ics (National Governors Association Center for Four coders received training from a
Best Practices & Council of Chief State School researcher with experience in coding on the use
Officers, 2010): (a) foundational skills and and interpretation of each item, with several
182 Exceptional Children 84(2)

examples provided. Coders practiced by inde- each based on a different sample. In addition, we
pendently coding the same article, and they dis- extracted effect sizes for each outcome, and
cussed discrepancies and checked reliability by when studies included more than one outcome
comparing their ratings with that of the measure that qualified for inclusion in the meta-
researcher. The training continued until ≥90% analysis, we calculated separate effect sizes for
agreement was reached. The four coders inde- each outcome. However, when estimating the
pendently coded the studies; all studies and overall effect of mathematics interventions, we
effect sizes were double-coded by two coders. averaged the effect sizes from all measures so
The coders discussed any discrepancies in cod- that the sample contributed only one effect size
ing and resolved differences by either reexam- to the analysis.
ining the studies to settle on the most
appropriate coding or consulting with the first
author when the disagreement could not be
Data Analysis
resolved. The intercoder agreement was 88% We used Comprehensive Meta-Analysis soft-
for all studies and 98% for all effect sizes. ware (Borenstein, Hedges, Higgins, & Rothstein,
2011) for data analysis. We selected a random
effects model to analyze the effect sizes and com-
Effect-Size Calculation pute estimates of mean effects and standard
We used Hedges’s g, a measure of effect size, errors, as this model allows for generalizations to
for each study in this meta-analysis because be made beyond the studies included in the anal-
the samples in many of the studies were small ysis to the population of studies from which they
and Hedges’s g correction was used to reduce come (Card, 2012).
this small sample size bias. We first calculated We also conducted an analysis of publica-
effect sizes as the difference between treat- tion bias, especially given that our unpub-
ment and control groups’ posttests after adjust- lished studies were primarily dissertations,
ments for pretests and other covariates, divided meaning that we cannot rule out the possibil-
by the pooled standard deviation; then, we ity that other studies with nonsignificant
applied the Hedges’s g correction to all effect findings may have been excluded. Therefore,
sizes to adjust for the small sample size we first conducted an analysis of publication
(Borenstein, Hedges, Higgins, & Rothstein, bias by visually inspecting a funnel plot
2009). We extracted adjusted effect sizes, illustrating the relation between effect size
which were either based on means of gain and study size or precision (standard error of
scores (i.e., posttests – pretests) and standard the effect estimate). This approach would
deviations of pretest scores or based on covari- suggest a possible presence of publication
ance-adjusted means and unadjusted standard bias if there is a gap indicating missing stud-
deviations (see What Works Clearinghouse, ies on the left side of the distribution. Sec-
2014). For three studies that reported only the ond, to further assess for publication bias, we
treatment and comparison groups’ mean post- used Duval and Tweedie’s (2000) trim-and-
test scores, standard deviation, and sample fill procedure, which is available as part of
sizes, we calculated unadjusted effect sizes, the Comprehensive Meta-Analysis software.
which do not take into account other variables We evaluated heterogeneity of variance
that might have had an influence on the out- using the Q statistic and conducted testing for
comes. In one case (Ives, 2007), no means and moderators only when statistically significant
standard deviations were available, and we variance was found under the mixed effects
estimated g from the F statistics (Lipsey & model (Lipsey & Wilson, 2001). When stud-
Wilson, 2001). ies failed to provide sufficient data to code all
We used independent samples as the unit of moderator variables, we dropped those stud-
analysis to address effect size dependency ies from the moderator analysis for the vari-
issues. For example, we coded Manalo, Bunnell, ables but included them in the overall estimate
and Stillman (2000) as two independent studies, of the mean effect size. In addition, we
Jitendra et al. 183

included levels of each moderator in the mod- effect sizes was significant, Qb(19) = 58.7, p <
erator analysis only if the sample was ade- .001, suggesting that between-study variation
quately powered (five or more effect sizes; in effect sizes is larger than what can be
Borenstein et al., 2009). As such, our conclu- explained by sampling error alone. The mean
sions based on the moderator analyses are ten- effect size estimate for students with LD was
tative because of low power. 0.50, suggesting that the average student in
the treatment group performed at about the
69th percentile of the control group; the mean
Results effect size of 0.14 for students with MD sug-
Characteristics of the Selected gests that the average student in the treatment
Studies group performed at about the 55th percentile
of the control group. However, the moderator
Table 1 summarizes the key features of each analysis comparing students with LD and
study. The literature search located 19 reports those with MD was not statistically signifi-
that met our study inclusion criteria, with the cant, Qb(1) = 2.98, p = .08; therefore, student
19 reports providing 20 effect sizes. These status (LD or MD) did not moderate effect
studies spanned 27 years (1990–2017). The size. Thus, in what follows, we describe the
sample sizes in the reported studies ranged aggregated results for students with LD and
from 17 to 806, with a total sample size of MD with regard to the effects of interventions
1,959. Of those with available ethnicity data on mathematics outcomes.
(n = 1,416), 65% were White, and 35% were
minorities (i.e., Black, Hispanic, Asian,
American Indian, multiracial). Nine studies Examining Publication Bias
included middle school students; six involved We first conducted a visual inspection of the
high school students; and four included both. funnel plot (Rothstein, Sutton, & Borenstein,
Fourteen studies (74%) involved students 2005) to determine initial evidence of publi-
with LD. There were important differences cation bias based on asymmetrical distribu-
among the studies that examined the efficacy tion of studies around the mean effect sizes
of mathematics interventions for secondary (Kepes, Banks, & Oh, 2014). Our funnel plot
school students with LD and MD: 79% were showed a symmetrical inverted funnel with
published in a peer-reviewed journal; 68% larger studies toward the top and smaller stud-
were RCTs; 63% were conducted after the ies scattered at the bottom, suggesting the
articulation of the National Council of Teach- absence of bias. Next, we examined whether
ers of Mathematics (2000) standards; in our meta-analytic effect size point estimate
68%, school personnel implemented the differed much from Duval and Tweedie’s
intervention; 63% included BAU as the con- (2000) trim-and-fill imputed effect size point
trol group; 68% reported FOI; 63% were estimate. Results showed no difference
conducted in special education classrooms; between the trim-and-fill imputed point esti-
and 63% addressed higher-level mathemati- mate (0.37) and the random effects model
cal content. point estimate (0.37). This suggests that there
was an absence of publication bias, providing
Overall Effects validity for our results.

Of the 20 overall effect sizes, 16 were in a Testing for Moderators on the

positive direction, three in a negative direc-
tion, and one exactly 0. The mean effect size,
Overall Effect Sizes
g = 0.37, was statistically significant (p < Table 2 summarizes the findings from the
.001, 95% confidence interval [0.18, 0.56]), analysis of the moderator variables. Here we
with the 20 effect sizes ranging from −1.10 to summarize the findings by key instructional
1.83. In addition, the homogeneity test for and methodology characteristics and discuss
Table 1.  Study Characteristics Included in the Meta-Analysis.

Research Sample,
Studya design grade Setting IOI (n) Intervention (n) Instruction time, hr Implementer Math topic FOI, % ES

Bottge & RCT MD, 9 Spec ed Small group T (15): Contextualized 3.3 (5 sessions, 40 Teacher Fractions Yes (98.0) 0.14
Hasselbring (7–8) problem instruction via min)
(1993) videodisc presentation
C (14): BAU (keyword
Bottge et al. (2015) RCT MD, 6–8 Gen ed Large group T (62): Enhanced anchored 49.5~82.5 (66 Teacher Ratio and Yes (87.0) 0.35
(M = 20) instruction (computer- sessions, 45–75 proportional
based, video-based, and min) relationships,
hands-on activities) number system,
C (72): BAU statistics and
Butler, Miller, QEX LD, 6–8 Spec ed Large group T (26): Concrete- 7.5 (10 sessions, Teacher Fractions Yes (100) 0.22
Crehan, Babbitt, (12–13) representational-abstract 45 min)
& Pierce (2003) C (24): Representational-
Calhoon & Fuchs QEX LD, 9–12 Spec ed Small group T (45): PALS and CBM 15.0 (30 sessions, Teacher Operations and Yes (90.0– 0.04
(2003) (M = 9.2) 30 min) algebraic thinking, 96.2)
C (47): BAU
Hutchinson (1993) RCT LD, 8–10 Spec ed Small group T (12): Cognitive strategy 26.7 (40 sessions, Researcher Algebra No 1.22
(one-to-one) instruction and visuals 40 min)
C (8): BAU
Ives (2007) RCT LD, 7–12 Spec ed Large group T (14): Graphic organizers 3.3 (4 sessions, 50 Researcher Algebra No 0.58
(~10) and strategy instruction min)
C (16): Strategy instruction
Jitendra, Dupuis, RCT MD, 7 Gen ed Large group T (149): Schema-based 24.2 (30 sessions, Teacher Ratio and Yes (87.0– 0.40
Star, & Rodriguez (M = 27.6) instruction 45–50 min) proportional 97.0)
(2016) C (111): BAU relationships
Jitendra, Harwell, RCT MD, 7 Gen ed Large group T (399): Schema-based 24.2 (30 sessions, Teacher Ratio and Yes (68.0) 0.26
Dupuis, & Karl (M = 24.0) instruction 45–50 min) proportional
(2017) C (407): BAU relationships

Table 1. (continued)
Research Sample,
Studya design grade Setting IOI (n) Intervention (n) Instruction time, hr Implementer Math topic FOI, % ES

Kelly, Gersten, & RCT LD, 9–11 Spec ed Small group T (12): Direct instruction 7.5 (10 sessions, Researcher Fractions Yes (93.0– 0.88
Carnine (1990) (7–8) with Mastering Decimals and 45 min) 94.0)
Percents videodisc program
C (16): BAU
Konold (2004)b RCT LD, 6–12 Gen ed Large group T (37): Concrete- 5.5 (11 sessions, Teacher Expressions and Yes (97.0) 0.02
+ spec representational-abstract 30 min) equations
ed and cognitive strategy
C (24): BAU
Lambert (1996)b RCT LD, 9–12 Spec ed Small group T (38): Cognitive strategy 7.3 (8 sessions, 55 Teacher Whole number No 0.11
(M = 9) instruction and visuals min) operations,
fractions, decimals,
C (38): BAU
Manalo, Bunnell, & RCT LD, 8 NA Small group T (9): Process mnemonics 4.2 (10 sessions, Researcher Whole number No − 0.03
Stillman (2000) (3–5) 25 min) computations
C (8): Demonstration
(1) involving all four
Manalo et al. RCT LD, 8 NA Small group T (9): Process mnemonics 4.2 (10 sessions, Researcher Whole number No −0.22
(2000) (2) (3–5) 25 min) computations
C (8): Demonstration
involving all four
Muoneke (2001)b QEX LD, 9–12 Spec ed Small group T (26): Question-and-answer 24.0~36.0 (16–24 Teacher Whole number Yes (85.0) 1.35
(M = 8) strategy sessions, 90 min) one-step additive
word problems;
C (21): BAU
two-step word
problems involving
all four operations
Rodgers (2011)b QEX MD, 11 Spec ed Small group T (18): Problem-based 3.0 (4 sessions, 45 NA Geometry— No −1.10
(8–10) learning and traditional min) perimeter, area,
math surface area,
C (17): BAU

Table 1. (continued)

Research Sample,
Studya design grade Setting IOI (n) Intervention (n) Instruction time, hr Implementer Math topic FOI, % ES

Walker & Poteet QEX LD, 6–8 Spec ed Small group T (33): Diagrammatic 8.5 (17 sessions, Teacher One-step additive Yes (100) 0.31
(1989–1990) (M = 8) 30 min) word problems
C (37): BAU (keyword
Witzel, Mercer, & RCT LD, 6–7 Gen ed Large group T (34): Concrete- 15.8 (19 sessions, Teacher Expressions and Yes (100) 0.69
Miller (2003) (M = 30) representational-abstract 50 min) equations
C (34): Representational-
Woodward, QEX LD, 8–9 Spec ed Large group T (21): Mathematics in the 16.7 (20 sessions, Teacher Decimals No 0.00
Baxter, & (21–23) Mind’s Eye: Modeling 50 min)
Robinson (1999) Rationals
C (23): Mastering Decimals
and Percents videodisc
Woodward & QEX LD, 6 Gen ed Large group T (25): Transitional One school year Teacher Operations and Yes (NA) 1.13
Brown (2006) (NA) mathematics (55 min daily) algebraic thinking,
number system,
C (28): Connected
measurement and
mathematics program
data, statistics
and probability,
Xin, Jitendra, RCT LD, 6–8 Spec ed Small group T (11): Schema-based 12.0 (12 sessions, Researcher Ratio and proportion Yes (94.0) 1.83
& Deatline- (4–7) instruction 60 min) word problems
Buchman (2005) C (11): General strategy

Note. IOI = implementation of intervention; FOI = fidelity of implementation; ES = effect size; RCT = randomized controlled trial; MD = mathematics difficulties; spec ed = special
education classroom; T = treatment; C = control; BAU = business as usual; gen ed = general education classroom; QEX = quasi-experimental; LD = learning disability; PALS and
CBM = peer-assisted learning strategies and curriculum-based measurement; NA = not available.
Independent sample. bDissertation.
Jitendra et al. 187

Table 2.  Testing for Moderators of Effect Sizes Based on Random Effects Model.

Variable k g SE 95% CI Qb p
Instructional characteristics
Grade level 0.49 .48
  Middle school 10 0.44 0.11 [0.23, 0.66]  
  High school 6 0.23 0.29 [–0.34, 0.79]  
 Combined 4 0.36 0.25 [–0.13, 0.85]  
Intervention approach 1.53 .22
  Visuals only 6 0.28 0.13 [0.04, 0.53]  
  Visuals + other strategies 8 0.52 0.14 [0.24, 0.80]  
  CBM + other strategies 3 0.39 0.16 [0.09, 0.70]  
 Other 3 0.10 0.61 [–1.09, 1.28]  
Instructional setting 0.07 .79
  General education 5 0.46 0.12 [0.24, 0.69]  
  Special education 12 0.41 0.18 [0.05, 0.77]  
  General and special education 1 0.02 0.26 [–0.49, 0.53]  
  Not specified 2 –0.13 0.34 [–0.79, 0.53]  
Implementation of intervention 0.00 .99
  Large group 9 0.37 0.09 [0.20, 0.55]  
  Small group 11 0.38 0.21 [–0.04, 0.79]  
Instructional time 5.74* .02
  ≤10 hr 10 0.11 0.15 [–0.18, 0.39]  
  >10 hr 10 0.58 0.13 [0.32, 0.84]  
Mathematics topic 0.01 .92
  Foundational content 8 0.36 0.17 [0.02, 0.70]  
  Higher-level content 12 0.38 0.12 [0.13, 0.62]  
Methodological characteristics
Year of publication 0.64 .43
 1990–2000 8 0.27 0.14 [0.00, 0.54]  
 2001–2017 12 0.42 0.13 [0.16, 0.67]  
Research design 0.15 .70
 RCT 13 0.39 0.09 [0.20, 0.57]  
 QEX 7 0.28 0.26 [–0.23, 0.79]  
Implementer 1.37 .24
 Researcher 6 0.70 0.29 [0.14, 1.27]  
  School personnel 13 0.35 0.08 [0.19, 0.52]  
Fidelity of implementation 2.43 .12
 Yes 13 0.47 0.10 [0.27, 0.68]  
 No 7 0.06 0.25 [–0.43, 0.54]  
Type of measure 0.12 .73
  Researcher developed 19 0.39 0.11 [0.18, 0.59]  
 Standardized 6 0.48 0.24 [0.01, 0.94]  
Type of control group 1.05 .30
  Business as usual 12 0.29 0.11 [0.07, 0.50]  
  Alternative intervention 8 0.53 0.21 [0.12, 0.93]  

Note. k = number of effect sizes; CI = confidence interval; CBM = computer-based modules; RCT = randomized
controlled trial; QEX = quasi-experimental.
*p < .05. **p < .01. ***p < .001.
188 Exceptional Children 84(2)

outcomes that are based on five or more out- 1990 and 2000; this difference between means
comes. was not statistically significant (p = .43). In
addition, the study design variable was not
Instructional characteristics.  We examined six statistically significant (p = .70): The mean
key instructional characteristics: grade level, effect size estimate for RCT studies was 0.39,
instructional approach, instructional setting, and that for quasi-experimental studies was
implementation of intervention, instructional 0.28. Researcher-implemented interventions
time, and mathematical topic. The results by yielded a large effect size, 0.70, whereas the
grade level showed no statistically significant mean effect size estimate for interventions
difference (p = .48) between the mean effect implemented by school personnel was 0.35,
size estimate for middle school studies (g = indicating a small to moderate effect. How-
0.44) and that for high school studies (g = ever, the contrast between means was not sta-
0.23). With regard to instructional approaches, tistically significant (p = .24), suggesting that
the eight studies of visual models combined treatment implementer did not moderate
with other strategies (e.g., priming the under- effect size. Results indicated a moderate effect
lying problem structure, cognitive strategy) size, 0.47, for studies reporting fidelity of
produced the largest effect size, 0.52, and the intervention. In contrast, the mean effect size
effect size for studies of only visual models estimate for studies not reporting fidelity of
was 0.28; however, the difference was not intervention was 0.06, a small to negligible
statistically significant (p = .22). The advan- effect. However, the difference between
tage of using these approaches, as compared means for the instructional variable of FOI
with regular classroom instruction or alterna- was not significant.
tive approaches, was significant for both Similarly, the type of measure was not sig-
approaches, indicated by the fact that the con- nificant (p = .73): Researcher-developed
fidence intervals of the effect sizes did not assessments and standardized assessments
contain 0. yielded small to moderate effect sizes (g =
Effect sizes were similar for studies con- 0.39 and 0.48, respectively). With regard to
ducted in general education (g = 0.46) or spe- type of control group, studies using BAU
cial education settings (g = 0.41), and the instruction yielded a small effect size, 0.29,
difference was not statistically significant (p = whereas studies using alternative interven-
.79). We also found no significant differences tions indicated a moderate effect size, 0.53;
(p = .99) between large group (g = 0.37) and however, the contrast between means was not
small group (g = 0.38) implementation of statistically significant (p = .30).
intervention. The effect of instructional time
was found to be significant, Qb(1) = 5.74, p =
.02. The mean effect size for instruction pro-
vided for >10 hr (g = 0.58) was greater than The purpose of this meta-analytic review was
that for instructional time ≤10 hr (g = 0.11). to extend prior evaluations of mathematical
The effect of mathematical topic was not sig- interventions for secondary students with LD
nificant (p = .92), with similar effect sizes for and MD by quantifying intervention effec-
studies addressing foundational content (g = tiveness in terms of effect sizes. The finding
0.36) and higher-level content (g = 0.38). from this review indicates a small to moder-
ate effect size (g = 0.37). An effect size of
Methodology characteristics.  We examined six 0.37 can be interpreted as approximately 65%
key methodology characteristics: year of pub- of students in the treatment group performing
lication, research design, implementer, FOI, above the mean of students in the control
type of measure, and type of control group. group (Lipsey et al., 2012). Our finding that
By year of publication, the mean effect size the interventions in these studies were effec-
estimate for studies conducted after 2000 was tive is largely congruent with the conclusion
0.42 and 0.27 for studies conducted between of prior reviews of mathematics interventions
Jitendra et al. 189

for K–12 students with or at risk for MD 2008). Thus, one could argue that interven-
(Baker et al., 2002; Dennis et al., 2016; Ger- tions would be expected to produce stronger
sten et al., 2009; Kroesbergen & Van Luit, effects for middle school than high school stu-
2003; Swanson & Hoskyn, 1998). In addition dents. Although average effects for the two
to the overall findings, this review examined grade levels were aligned with this expecta-
the differential effects of mathematics inter- tion (i.e., middle school, g = 0.44, vs. high
ventions on student mathematics outcomes school, g = 0.23) and the advantage for middle
by various instructional and methodological school was significant (i.e., the confidence
features. interval of the effect sizes did not contain 0),
this contrast was not statistically significant.
The most likely explanation for this finding
Instructional Characteristics
has to do with the inability to include all stud-
The effect sizes for the following instructional ies in these two levels of the variable for this
characteristics were nearly identical: (a) gen- moderator analysis, which could have
eral education and special education settings decreased the statistical power of the meta-
(g = 0.46 and 0.41, respectively), (b) large and analysis.
small group implementation (g = 0.37 and In terms of intervention approaches, there
0.38, respectively), and (c) foundational con- are contrasting hypotheses to consider in exam-
tent and higher-level mathematical content (g ining the results of the meta-analysis. On one
= 0.36 and 0.38, respectively). These findings hand, single-component interventions (visuals
for setting, grouping, and mathematical topic only) may by parsimonious and work best for
are somewhat surprising given the different students with LD and MD because of limited
profiles of students with LD and MD served cognitive, behavioral, and attentional capaci-
in general education and special education ties (e.g., Compton, Fuchs, Fuchs, Lambert, &
classrooms (Wagner, Marder, Blackorby, & Hamlett, 2011; Fuchs et al., 2014; Geary,
Cardoso, 2002) and the different kinds of Hoard, Byrd-Craven, Nugent, & Numtee,
structures and mathematical topics covered in 2007). On the other, multicomponent interven-
the two environments. However, the compa- tions (i.e., visual models combined with other
rable findings would be expected if research- strategies) may produce stronger effects; meta-
ers took these differences (e.g., large group analysis of reading interventions support this
instruction in general education classrooms, expectation (see Wanzek, Wexler, Vaughn, &
adding prerequisite knowledge to be learned) Ciullo, 2010). The results revealed a tendency
into account and designed appropriate inter- toward this latter hypothesis (i.e., visuals only,
ventions. g = 0.28, vs. visuals combined with other strat-
With respect to the grade-level feature egies, g = 0.52), but the contrast was not statis-
examined in this meta-analysis, research indi- tically significant. However, it is encouraging
cates that the mathematical skills of children that the effect size for visuals combined with
with LD progress about 1 year for every 2 strategies is somewhat higher than the effect
years in school but plateau by age 10 or 12 size (g = 0.47) found in Gersten et al. (2009).
(Cawley, Parmar, Yan, & Miller, 1998; Wei A key finding of this meta-analysis was that
et al., 2013). Further, the mathematics content the effect of these interventions appeared to be
targeted in high schools is more complex and greater when the intervention lasted >10 hr than
advanced than the content in middle school. when it was ≤10 hr. This finding is consistent
Note also that the average annual growth with research regarding the length of instruc-
effect sizes for typically achieving students tional time provided to students being an essen-
ranged from 0.30 in Grades 6 and 7 to 0.01 in tial variable to learning (Rosenshine & Berliner,
Grades 11 and 12 on nationally normed mea- 1978). Further, within the context of a multi-
sures of mathematics achievement, indicating tiered system of support model, a framework
a decrease in effect sizes as grade level for providing high-quality mathematical con-
increases (see Bloom, Hill, Black, & Lipsey, tent and instruction to all students (core or Tier
190 Exceptional Children 84(2)

1 instruction) and additional intervention sup- studies and was generally high when reported
port for some students (secondary and intensive (see Table 1), which might have accounted for the
levels of intervention), the length of instruc- lack of differences in implementation by research-
tional time is one of the features for intensifying ers and school personnel. Our finding that inter-
instruction for students who do not adequately ventions appeared to be feasibly implemented by
respond to Tier 1 instruction. Results from the researchers and school personnel is consistent
moderator analysis of the present study support with recent research on reading interventions in
the need for engaging students in learning for an the early elementary grades (Wanzek et al., 2016).
extended period, especially when learning
higher-level mathematical content. A key finding of this meta-analysis
was that the effect of these
Methodological Characteristics interventions appeared to be
With regard to year of publication, it is not greater when the intervention lasted
clear whether the overall effectiveness of >10 hr than when it was ≤10 hr.
mathematical interventions would be higher
for studies published on or before 2000 or Research suggests that measuring treat-
published after 2000, when the National ment fidelity is crucial to assessing internal
Council of Teachers of Mathematics stan- validity—that is, the extent to which “observ-
dards were in effect. The finding of no sig- able differences in outcomes—or lack
nificant difference between studies published thereof—were due to the intervention and not
on or before 2000 (g = 0.27) and those pub- extraneous factors” (Woolley, Rose, Mercado,
lished after 2000 (g = 0.42) is probably due & Orthner, 2013, p. 59). Failure to consider or
to low power for the moderator analysis. check the FOI of the treatment has been iden-
One possible source of variation may tified as a potential deterrent to reaching accu-
relate to research design of the studies. In rate conclusions about the effectiveness of the
this review, 65% of the studies were RCTs. treatment (Bellg et al., 2004). We hypothe-
Because quasi-experimental studies gener- sized that studies that reported and assessed
ally have larger variances, we expected FOI would yield larger effect sizes than stud-
these studies to produce larger effects than ies that did not report and, presumably, did not
RCTs, even though such results could be assess treatment fidelity. However, the con-
misleading (Hedges, 1982). However, the trast was not significant (p = .12) between
evidence does not support this expectation. studies assessing treatment fidelity (g = 0.47)
The results in this review revealed similar and those that did not assess it (g = 0.06).
effects for RCTs (g = 0.39) and quasi-exper- Contrary to expectation, researcher-
iments (g = 0.28). developed measures designed to match the
With respect to the implementer variable, content of the interventions produced a some-
there are several possible reasons to expect that what smaller effect size (g = 0.39) than stan-
researchers as implementers would produce dardized measures (g = 0.48). However, the
stronger effects than school personnel as imple- contrast was not significant, possibly because
menters. One explanation is that researchers tend of the small number of studies (n = 6) using
to implement interventions as planned more so standardized measures. To evaluate the rela-
than teachers. Previous meta-analyses have indi- tive effectiveness of their interventions con-
cated implementer effects (e.g., Berkeley, sistently, it would be useful for researchers to
Scruggs, & Mastropieri, 2010; Dennis et al., utilize common measures.
2016; Wanzek et al., 2010). Our results revealed a Finally, research suggests that the use of dif-
tendency toward this hypothesis (i.e., researchers, ferent types of control groups yields different
g = 0.70, vs. school personnel, g = 0.35), but this effect size estimates (Karlsson & Bergmark,
difference was not statistically significant. It is 2015). Research methods textbooks make a
worth noting that FOI was reported in 65% of the distinction between inactive control groups
Jitendra et al. 191

(e.g., no treatment, BAU or standard treatment, with LD and MD to develop the necessary
or a waiting-list control) and active control mathematics skills to enter or advance in
groups (e.g., an alternative intervention), which STEM-related careers (see Hughes et al., 2014),
produce absolute and relative effect estimates, we urge researchers to continue to conduct stud-
respectively. An additional distinction is that, ies that will provide evidence about effective
compared with no-treatment controls, BAU interventions in mathematics for these students.
often includes “some potentially effective com- A second limitation is that we found only
ponents that may be absent in no-treatment five studies of students with MD that met our
controls” (p. 422). Therefore, and as expected, inclusion criteria. Further, how students were
the more effective the comparison group com- identified as LD may account for the variabil-
ponents, the smaller the effect size estimates. ity in effect sizes because most authors studied
However, we found no significant difference school-identified students, and, although they
between studies using BAU controls (g = 0.29) provided some description of the identification
and alternative intervention controls (g = 0.53). process, most did not provide sufficient infor-
A possible explanation is that the BAU control mation about these students’ MD. It is clear
condition in the included studies taught the that in order to identify how to better meets the
same content and for the same duration as the needs of students with LD and MD and
treatment group. improve intervention outcomes, more studies
need to be conducted with these populations.
Another limitation is posed by the lack of
Limitations and Future Directions availability of sufficient studies to inform the
Similar to other meta-analyses and primary field about what intervention approaches are
studies, there are at least three limitations that most effective. We found that the most com-
are relevant to the current meta-analysis. First, monly used method in the studies included in
there is the possible limitation of generalizing this meta-analysis was visual representa-
results from the small set of RCT and quasi- tions. Although not statistically significant,
experimental studies. Despite our exhaustive visuals combined with other strategies
search process, including published and unpub- resulted in the largest effect size (g = 0.52),
lished studies, we found only 19 studies in the which is practically significant and can be
past 27 years that focused on the outcome of interpreted as showing that approximately
secondary mathematics interventions for stu- 70% of students in the treatment group per-
dents with LD and MD. This number is rela- formed above the mean of students in the
tively small compared to intervention studies of control group (Lipsey et al., 2012). However,
reading and other content areas. For example, the strategies were varied (i.e., priming the
prior meta-analyses identified 43 reading inter- underlying structure, cognitive strategy, or
vention studies and 28 science intervention contextualized instruction), with few in each
studies for secondary students with disabilities category. Additional testing of these inter-
(Scammacca, Roberts, Vaughn, & Stuebing, ventions needs to be addressed in future
2015; Scruggs, Mastropieri, Berkeley, & research.
Graetz, 2010). Further, the effect of the small
number of studies influenced results of the
Implications for Practice
moderator analyses, which are lower powered
than the main effect analysis (Hedges & Pigott, The results of this meta-analysis demonstrate
2004). Future studies may reveal that our find- that secondary students with LD and MD ben-
ing of no significant difference between the MD efit from well-designed mathematics interven-
and LD groups is a product of having too few tions. Although the majority of interventions in
studies with too few participants. Given the this meta-analysis lasted for less than a school
increasing growth in jobs related to STEM (sci- year, the mean effect size reflected an average
ence, technology, engineering, and mathemat- gain of a little more than one third a standard
ics) and how crucial it is for secondary students deviation, which on average was about a year’s
192 Exceptional Children 84(2)

growth when compared with annual growth majority of studies in this meta-analysis that
rates for typically achieving students in second- provided >10 hr of instruction focused on
ary grades. Further, the studies in this review advanced mathematics (e.g., ratios and propor-
compared treatment to a BAU or alternative tional relationships, algebra) and resulted in
treatment comparison group receiving interven- enhanced mathematics performance. In sum, if
tion, which implies the added benefits of treat- the achievement gap between students with
ment over another intervention rather than the LD and MD and their peers without MD is to
benefit of treatment over no intervention. Based be reduced, it is important to continue to eval-
on this information, one implication that we can uate the effect of interventions to understand
draw from our finding is that practitioners can how to support these students effectively.
support the learning of struggling students in
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