737467

research-article2017
ECXXXX10.1177/0014402917737467Exceptional ChildrenJitendra et al.

Article
Exceptional Children
2018, Vol. 84(2) 177­–196
Mathematical Interventions for © The Author(s) 2017
DOI: 10.1177/0014402917737467
https://doi.org/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

Abstract
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,
where the demand for mathematics-intensive
science and engineering jobs is outpacing
overall job growth three to one (National
Mathematics Advisory Panel, 2008), the abil-
ity to think mathematically is a crucial skill.
Although the percentage of students reaching
proficient levels in mathematics has increased
over the past decade, it is disconcerting that, as
children progress from the elementary grades
into secondary grades, the mathematical gains
made in elementary school are, on average, not
matched in later years (National Mathematics
Advisory Panel, 2008). For example, on the
2015 National Assessment of Educational
Progress, only 33% of U.S. eighth-grade stu-
dents, compared with 40% of fourth-grade stu-
dents, were proficient or advanced in their
knowledge of mathematics (National Center
for Education Statistics, 2015). Further, the
2015 National Assessment of Educational
Progress data indicated that the goal of the No
Child Left Behind legislation to eradicate
achievement differences among student sub-
groups had not yet been met (Dossey,
McCrone, & Halvorsen, 2016). For example,
45% of fourth graders with disabilities scored
below the basic level on the 2015 National
Assessment of Educational Progress, com-
pared with 14% without disabilities; further,
68% of eighth graders with disabilities scored
below the basic level versus 23% without dis-
abilities. In addition, the National Longitudi-
nal Transition Study-2 (Wagner, Newman,
1
University of Minnesota
2
Bellarmine University
Corresponding Author:
Asha K. Jitendra, University of Minnesota, 245 Education
Sciences Building, 56 E. River Road, Minneapolis, MN
55455.
E-mail: jiten001@umn.edu
178 Exceptional Children 84(2)
Cameto, Levine, & Garza, 2006) found that
secondary students with learning disabilities
(LD) perform worse than their peers without
disabilities on mathematics subtests.
There is evidence that secondary students
with disabilities score significantly below
grade level in mathematics and that their
growth rate in mathematics slows consider-
ably in secondary schools (Cortiella, 2011;
Wei, Lenz, & Blackorby, 2013). The mathe-
matics underachievement of these students as
they enter middle and high school grades may
be due to several reasons, such as increasingly
difficult mathematics content as the mathe-
matical ideas become more abstract (Witzel,
2016) or limited access to higher-level math-
ematics instruction given the focus on lower-
level skills, including fact recall and mastery
of procedures (Miller & Hudson, 2007). Many
secondary students with disabilities continue
to experience difficulty with early numeracy
concepts, which are crucial for more advanced
mathematics (National Mathematics Advisory
Panel, 2008). Further, difficulties in acquiring
higher-order thinking skills such as reasoning
(e.g., Hunt & Vasquez, 2014) are major
impediments and inhibit opportunities to pur-
sue mathematics-related careers.
There is evidence that secondary
students with disabilities score
significantly below grade level in
mathematics.
If the goal is to help secondary students
with disabilities meet the high expectations
of, for example, the Common Core State Stan-
dards (National Governors Association Center
for Best Practices & Council of Chief State
School Officers, 2010) and Every Student
Succeeds Act of 2015, effective interventions
need to be identified. Much research on the
effectiveness of mathematics interventions for
secondary students with disabilities or those
identified as having mathematics difficulties
(MD) has accumulated over the last three
decades to justify a meta-analysis of the effec-
tiveness of such interventions on students’
mathematics learning.
Several meta-analyses and narrative
reviews already exist regarding the effective-
ness of mathematics interventions for students
with LD or MD. However, these reviews tar-
geted elementary students with MD (Dennis
et al., 2016; Kroesbergen & Van Luit, 2003)
and K–12 students with LD or MD (Baker,
Gersten, & Lee, 2002; Gersten et al., 2009;
Swanson & Hoskyn, 1998), or they focused on
specific mathematical content instruction,
such as word problem solving (Xin & Jitendra,
1999; Zhang & Xin, 2012; Zheng, Flynn, &
Swanson, 2013), fractions (Misquitta, 2011;
Shin & Bryant, 2015), and algebra (Hughes,
Witzel, Riccomini, Fries, & Kanyongo, 2014;
Maccini, McNaughton, & Ruhl, 1999; Watt,
Watkins, & Abbitt, 2016). The previous meta-
analyses for K–12 students with LD or MD
reported positive effects on test scores for stu-
dents with LD (Gersten et al., 2009; Swanson
& Hoskyn, 1998) or MD (Baker et al., 2002)
with regard to several components of mathe-
matics instruction. Baker and colleagues
(2002) found support for peer-assisted learn-
ing, explicit instruction, and providing stu-
dents with data and feedback. Gersten et al.
(2009) examined four components of mathe-
matics instruction and found strong effects for
approaches to instruction (e.g., explicit instruc-
tion, providing visual models, heuristics), cur-
riculum design, and providing feedback to
teachers based on formative assessment data.
Swanson and Hoskyn (1998) reported that
cognitive strategies and direct instruction were
effective instructional models in mathematics
and other domains. However, these reviews
did not examine grade level as a factor that
might influence the direction and magnitude
of intervention effects.
Previous reviews have included students
with LD, MD, or both. However, the authors
did not operationalize the terms LD (Maccini
et al., 1999) or MD (Baker et al., 2002;
Kroesbergen & Van Luit, 2003), or they used
different criteria for inclusion of students with
MD. For example, students with MD were
identified as those scoring <25th percentile on
a mathematics test (Dennis et al., 2016; Shin &
Bryant, 2015; Zheng et al., 2013), were con-
sidered low achieving or referred by classroom
Jitendra et al. 179
teachers as being at risk for failure in mathe-
matics (Zhang & Xin, 2012), were receiving
remedial mathematics instruction (Shin &
Bryant, 2015; Xin & Jitendra, 1999), or were
classified as struggling learners (Hughes et al.,
2014; Misquitta, 2011).
Another limitation of the previous reviews is
the inconsistencies in calculating effect sizes
that impede directly comparing effect sizes
among reviews. For example, in two meta-anal-
yses (Xin & Jitendra, 1999; Zhang & Xin, 2012),
the authors included several single-group pre-
test-posttest design studies and measured
changes in scores from pre- to postintervention.
There are concerns with the use of change scores
and the lack of a control group because matura-
tion effects cannot be detected and standardized
mean change effects would be inflated (Borman,
Hewes, Overman, & Brown, 2003).
Our main objective was to conduct a meta-
analysis of the effects of mathematics inter-
ventions aimed at improving the mathematics
performance of secondary students with LD
and MD. Given the difficulties that secondary
students with LD and MD experience with
mathematics, there is a need to improve the
understanding of research related to mathe-
matics interventions across mathematical con-
tent areas for this group of students. Although
evidence suggests that students with mathe-
matics LD and those with MD (i.e., scored
below average to low average on tests of math
achievement) are characteristically different
(Mazzocco, 2007), they often encounter simi-
lar challenges with mathematics that justify
the need for high-quality instruction (Fuchs,
Fuchs, & Compton, 2013). We found three
recent narrative reviews (Hwang & Riccomini,
2016; Marita & Hord, 2017; Myers, Wang,
Brownell, & Gagnon, 2015) of mathematics
intervention research for secondary students
with or at risk for LD, but we did not find a
meta-analysis to date on this topic. These nar-
rative reviews provide a summary of existing
research (group and single-case studies) by
taking a qualitative rather than quantitative
approach. The three reviews extended the ear-
lier review of the topic by Maccini, Mulcahy,
and Wilson (2007). Hwang and Riccomini
(2016) reviewed studies of mathematical prob-
lem solving and found that the efficacy of
intervention approaches (heuristic, semantic,
or authentic) varied and that these interven-
tions differed with regard to real-world con-
nections. Marita and Hord (2017) focused on
interventions directed to students with LD and
found that a variety of interventions, such as
systematic instruction, problem-based learn-
ing, and visual representations, can improve
the problem-solving skills of students with
LD. Finally, Myers and colleagues (2015)
detailed several instructional approaches and
noted the benefits of cognitive and metacogni-
tive strategies and enhanced anchored instruc-
tion for secondary students with LD.
The question of whether and to what extent
mathematics interventions are effective for sec-
ondary students with LD and MD has not been
considered in the previous reviews. As such,
there is a need to integrate the empirical research
on mathematics interventions for secondary
students with LD and MD and answer questions
regarding their effectiveness. This can be
addressed by a meta-analysis, as it can estimate
the average effectiveness of mathematics inter-
ventions on students’ mathematical learning. In
addition, a meta-analysis can explore the types
of settings or student populations for which the
intervention works best. The present review
sought to answer the following questions:
•• What is the average effect of mathe-
matical interventions for secondary
students with LD and MD?
•• Does it vary by student status (LD vs.
MD)?
•• What instructional characteristics (e.g.,
setting, instructional time) or method-
ological characteristics (e.g., research
design, implementer, fidelity of imple-
mentation [FOI]) of mathematical inter-
ventions moderate student outcomes?
Method
Literature Search and Criteria for
Inclusion
We conducted a literature search of mathemat-
ics intervention studies ending in May 2017.
180 Exceptional Children 84(2)
First, we included the online databases ERIC,
PsycINFO, and ProQuest Dissertation and
Theses. We searched abstracts for key popula-
tion search terms and roots (learning dis-
abilit*, learning difficult*, at-risk, struggling,
learning problem, underperforming, below
average, underachieving, disadvantaged) in
conjunction with mathematics search terms
and roots (math, mathematic*, intervention,
instruction, treatment, training, teaching
method*) and grade search terms (middle
school, high school, secondary, adolescent*)
in various combinations. Second, we scanned
the reference sections of each study to locate
other possible studies, as well as the reference
sections of existing meta-analyses and review
studies on this topic. Third, we hand-searched
key journals in special education from 2016 to
2017: Exceptional Children, Journal of Learn-
ing Disabilities, The Journal of Special Educa-
tion, Learning Disability Quarterly, Learning
Disabilities Research & Practice, and Reme-
dial and Special Education.
The primary literature search yielded 3,355
abstracts for screening, and after removal of
duplicate abstracts, 3,175 abstracts remained.
Of these, 2,970 were not considered per title
and abstract review. The remaining 205 stud-
ies retrieved in the primary search appeared to
match the selection criteria based on their titles
and abstracts. However, most of the selected
studies were removed after retrieval of their
full-text versions, either because studies were
outside the age/grade range of this meta-analy-
sis (n = 46) or did not have a suitable research
design (no control group, correlational studies;
n = 83). Moreover, 12 reports were reviews,
editorials, or commentaries, and 19 studies
included all students but did not contain a suf-
ficient sample of students identified as having
LD or did not identify students as MD based
on standardized test scores. For 26 studies,
there were other reasons for exclusion, such as
dissertations that were published and studies
that did not focus on mathematical interven-
tions or did not provide sufficient information
to compute effect sizes. The primary search
resulted in a total of 19 relevant studies.
We applied seven criteria for inclusion in
this meta-analysis. First, participants had to
be identified with a learning disability (school
or researcher identified) or mathematics diffi-
culty. We operationally defined students as
having MD when they scored ≤35th percen-
tile on a standardized mathematics test. This
criterion was selected to ensure broad repre-
sentation of students who may be at low to
high risk of developing MD (see Fuchs et al.,
2014; Mazzocco, 2007). We included studies
when >50% of the participants were students
with LD or MD or disaggregated data were
provided for students identified as such.
Second, the studies had to involve students
with LD or MD in Grades 6 to 12. The third cri-
terion was that studies were based on a random-
ized controlled trial (RCT) or quasi-experimental
design and that they compared students in treat-
ment groups taught via a specific mathematics
intervention with those in control groups who
were taught via standard methods or an alterna-
tive intervention. Fourth, studies could have
been conducted in any country, but the report
had to be available in English. Fifth, to be
included, studies had to evaluate the effects of
mathematics interventions or programs on learn-
ing of mathematical subjects. The sixth criterion
is based on studies providing the necessary
quantitative information to estimate effect sizes.
Last, the dependent measures had to include
quantitative measures of mathematics perfor-
mance. Studies were excluded if they examined
only measures of student attitudes toward math-
ematics or strategy use.
Coding Procedure and Intercoder
Agreement
Two authors developed a coding form to
extract and record relevant information from
each study. We evaluated the form multiple
times in repetitive cycles in consultation with
the coders. Then we coded studies for instruc-
tional and methodological characteristics.
Instructional Characteristics
Participants.  We coded how students with LD
or MD were identified, using open-ended
items (LD or MD as described in text, criteria
for classifying students with MD). We also
Jitendra et al. 181
coded participants’ grade as middle school
(Grades 6–8), high school (Grades 9–12), or
combined.
Intervention approaches.  We examined written
descriptions of interventions used in the stud-
ies. Interventions varied in their approaches
and sometimes included a combination of
approaches; however, most studies included
explicit and systematic instruction. We coded
intervention approaches as a categorical vari-
able: (a) visual models only (e.g., fraction
circles or squares, manipulative objects, dia-
grams, mental representations); (b) visual
models combined with other strategies, such
as priming the underlying problem structure,
cognitive strategy, or contextualized instruc-
tion (problems used real-world scenarios); (c)
computer-based modules (e.g., videos) com-
bined with visual models or contextualized
instruction; and (d) other (i.e., problem-based
learning, peer-assisted learning strategies and
curriculum-based instruction, question-and-
answer strategy).
Intervention features.  We gathered information
on intervention features using three open-
ended items (i.e., setting, implementation of
the intervention, instructional time). We coded
instructional setting as general education
classroom, special education classroom, or
combined. We coded implementation of the
intervention as a dichotomous variable, with
instruction conducted in small groups (<10
students) or large groups (≥10 students). We
coded the time of treatment implementation in
hours and then categorized it as ≤10 hr or >10
hr. Specifically, we calculated instructional
time as the hours of intervention across the
duration of the intervention (i.e., number of
sessions multiplied by the length of each
session).
Mathematical topic.  We coded the mathemati-
cal topic of instruction as a categorical variable
with the following categories, based on the
Common Core State Standards for mathemat-
ics (National Governors Association Center for
Best Practices & Council of Chief State School
Officers, 2010): (a) foundational skills and
concepts, such as operations and algebraic
thinking (e.g., arithmetic word problem solv-
ing) and number system (e.g., fractions, deci-
mals), and (b) higher-level mathematics topics
(i.e., ratio and proportional relationships,
expressions and equations). The higher-level
mathematics category also included studies
that encompassed several mathematical topics
or a combination of foundational and higher-
level topics (e.g., number system, ratio and
proportional relationships, measurement and
data).
Methodological Characteristics
We coded the type of report or publication
source as a dichotomous variable (journal
article, unpublished report). We coded the
year of publication as either 2000 and before
or 2001 and later. We created a dichotomous
variable to code research design as RCT ver-
sus quasi-experimental. RCTs referred to
studies in which students, teachers or class-
rooms, or schools were randomly assigned to
conditions and the level of random assign-
ment determined the unit of analysis. In con-
trast, quasi-experiments may also have used
random assignment at the teacher or class-
room and school levels, but the analysis was
done at the student level because of limited
samples of classrooms or schools. We coded
studies to identify who delivered the interven-
tion to students: researcher or school person-
nel. In addition, we created a dichotomous
variable to code FOI as either reported (yes)
or not reported (no). We coded FOI when
studies reported this information, and we
recorded the percentage of FOI. We catego-
rized the types of measures as being researcher
developed or standardized. We examined the
type of control group as a proxy variable for
the strength of the control condition or the
counterfactual with regard to its effect on
observed treatment effects. We coded this
variable as either business as usual (BAU; tra-
ditional textbook method) or an alternative
intervention.
Four coders received training from a
researcher with experience in coding on the use
and interpretation of each item, with several
182 Exceptional Children 84(2)
examples provided. Coders practiced by inde-
pendently coding the same article, and they dis-
cussed discrepancies and checked reliability by
comparing their ratings with that of the
researcher. The training continued until ≥90%
agreement was reached. The four coders inde-
pendently coded the studies; all studies and
effect sizes were double-coded by two coders.
The coders discussed any discrepancies in cod-
ing and resolved differences by either reexam-
ining the studies to settle on the most
appropriate coding or consulting with the first
author when the disagreement could not be
resolved. The intercoder agreement was 88%
for all studies and 98% for all effect sizes.
Effect-Size Calculation
We used Hedges’s g, a measure of effect size,
for each study in this meta-analysis because
the samples in many of the studies were small
and Hedges’s g correction was used to reduce
this small sample size bias. We first calculated
effect sizes as the difference between treat-
ment and control groups’ posttests after adjust-
ments for pretests and other covariates, divided
by the pooled standard deviation; then, we
applied the Hedges’s g correction to all effect
sizes to adjust for the small sample size
(Borenstein, Hedges, Higgins, & Rothstein,
2009). We extracted adjusted effect sizes,
which were either based on means of gain
scores (i.e., posttests – pretests) and standard
deviations of pretest scores or based on covari-
ance-adjusted means and unadjusted standard
deviations (see What Works Clearinghouse,
2014). For three studies that reported only the
treatment and comparison groups’ mean post-
test scores, standard deviation, and sample
sizes, we calculated unadjusted effect sizes,
which do not take into account other variables
that might have had an influence on the out-
comes. In one case (Ives, 2007), no means and
standard deviations were available, and we
estimated g from the F statistics (Lipsey &
Wilson, 2001).
We used independent samples as the unit of
analysis to address effect size dependency
issues. For example, we coded Manalo, Bunnell,
and Stillman (2000) as two independent studies,
each based on a different sample. In addition, we
extracted effect sizes for each outcome, and
when studies included more than one outcome
measure that qualified for inclusion in the meta-
analysis, we calculated separate effect sizes for
each outcome. However, when estimating the
overall effect of mathematics interventions, we
averaged the effect sizes from all measures so
that the sample contributed only one effect size
to the analysis.
Data Analysis
We used Comprehensive Meta-Analysis soft-
ware (Borenstein, Hedges, Higgins, & Rothstein,
2011) for data analysis. We selected a random
effects model to analyze the effect sizes and com-
pute estimates of mean effects and standard
errors, as this model allows for generalizations to
be made beyond the studies included in the anal-
ysis to the population of studies from which they
come (Card, 2012).
We also conducted an analysis of publica-
tion bias, especially given that our unpub-
lished studies were primarily dissertations,
meaning that we cannot rule out the possibil-
ity that other studies with nonsignificant
findings may have been excluded. Therefore,
we first conducted an analysis of publication
bias by visually inspecting a funnel plot
illustrating the relation between effect size
and study size or precision (standard error of
the effect estimate). This approach would
suggest a possible presence of publication
bias if there is a gap indicating missing stud-
ies on the left side of the distribution. Sec-
ond, to further assess for publication bias, we
used Duval and Tweedie’s (2000) trim-and-
fill procedure, which is available as part of
the Comprehensive Meta-Analysis software.
We evaluated heterogeneity of variance
using the Q statistic and conducted testing for
moderators only when statistically significant
variance was found under the mixed effects
model (Lipsey & Wilson, 2001). When stud-
ies failed to provide sufficient data to code all
moderator variables, we dropped those stud-
ies from the moderator analysis for the vari-
ables but included them in the overall estimate
of the mean effect size. In addition, we
Jitendra et al. 183
included levels of each moderator in the mod-
erator analysis only if the sample was ade-
quately powered (five or more effect sizes;
Borenstein et al., 2009). As such, our conclu-
sions based on the moderator analyses are ten-
tative because of low power.
Results
Characteristics of the Selected
Studies
Table 1 summarizes the key features of each
study. The literature search located 19 reports
that met our study inclusion criteria, with the
19 reports providing 20 effect sizes. These
studies spanned 27 years (1990–2017). The
sample sizes in the reported studies ranged
from 17 to 806, with a total sample size of
1,959. Of those with available ethnicity data
(n = 1,416), 65% were White, and 35% were
minorities (i.e., Black, Hispanic, Asian,
American Indian, multiracial). Nine studies
included middle school students; six involved
high school students; and four included both.
Fourteen studies (74%) involved students
with LD. There were important differences
among the studies that examined the efficacy
of mathematics interventions for secondary
school students with LD and MD: 79% were
published in a peer-reviewed journal; 68%
were RCTs; 63% were conducted after the
articulation of the National Council of Teach-
ers of Mathematics (2000) standards; in
68%, school personnel implemented the
intervention; 63% included BAU as the con-
trol group; 68% reported FOI; 63% were
conducted in special education classrooms;
and 63% addressed higher-level mathemati-
cal content.
Overall Effects
Of the 20 overall effect sizes, 16 were in a
positive direction, three in a negative direc-
tion, and one exactly 0. The mean effect size,
g = 0.37, was statistically significant (p <
.001, 95% confidence interval [0.18, 0.56]),
with the 20 effect sizes ranging from −1.10 to
1.83. In addition, the homogeneity test for
effect sizes was significant, Qb(19) = 58.7, p <
.001, suggesting that between-study variation
in effect sizes is larger than what can be
explained by sampling error alone. The mean
effect size estimate for students with LD was
0.50, suggesting that the average student in
the treatment group performed at about the
69th percentile of the control group; the mean
effect size of 0.14 for students with MD sug-
gests that the average student in the treatment
group performed at about the 55th percentile
of the control group. However, the moderator
analysis comparing students with LD and
those with MD was not statistically signifi-
cant, Qb(1) = 2.98, p = .08; therefore, student
status (LD or MD) did not moderate effect
size. Thus, in what follows, we describe the
aggregated results for students with LD and
MD with regard to the effects of interventions
on mathematics outcomes.
Examining Publication Bias
We first conducted a visual inspection of the
funnel plot (Rothstein, Sutton, & Borenstein,
2005) to determine initial evidence of publi-
cation bias based on asymmetrical distribu-
tion of studies around the mean effect sizes
(Kepes, Banks, & Oh, 2014). Our funnel plot
showed a symmetrical inverted funnel with
larger studies toward the top and smaller stud-
ies scattered at the bottom, suggesting the
absence of bias. Next, we examined whether
our meta-analytic effect size point estimate
differed much from Duval and Tweedie’s
(2000) trim-and-fill imputed effect size point
estimate. Results showed no difference
between the trim-and-fill imputed point esti-
mate (0.37) and the random effects model
point estimate (0.37). This suggests that there
was an absence of publication bias, providing
validity for our results.
Testing for Moderators on the
Overall Effect Sizes
Table 2 summarizes the findings from the
analysis of the moderator variables. Here we
summarize the findings by key instructional
and methodology characteristics and discuss
 Table 1.  Study Characteristics Included in the Meta-Analysis.

184
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
method)
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
probability,
geometry
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-
abstract
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
measurement,
geometry
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

(continued)
 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
instruction
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
percent
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
imitation
operations
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
imitation
operations
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,
volume
C (17): BAU
(continued)

185
186
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
method)
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-
abstract
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
program
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,
geometry
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
instruction

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.
a
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-
comes.
Instructional characteristics.  We examined six
key instructional characteristics: grade level,
instructional approach, instructional setting,
implementation of intervention, instructional
time, and mathematical topic. The results by
grade level showed no statistically significant
difference (p = .48) between the mean effect
size estimate for middle school studies (g =
0.44) and that for high school studies (g =
0.23). With regard to instructional approaches,
the eight studies of visual models combined
with other strategies (e.g., priming the under-
lying problem structure, cognitive strategy)
produced the largest effect size, 0.52, and the
effect size for studies of only visual models
was 0.28; however, the difference was not
statistically significant (p = .22). The advan-
tage of using these approaches, as compared
with regular classroom instruction or alterna-
tive approaches, was significant for both
approaches, indicated by the fact that the con-
fidence intervals of the effect sizes did not
contain 0.
Effect sizes were similar for studies con-
ducted in general education (g = 0.46) or spe-
cial education settings (g = 0.41), and the
difference was not statistically significant (p =
.79). We also found no significant differences
(p = .99) between large group (g = 0.37) and
small group (g = 0.38) implementation of
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
that for instructional time ≤10 hr (g = 0.11).
The effect of mathematical topic was not sig-
nificant (p = .92), with similar effect sizes for
studies addressing foundational content (g =
0.36) and higher-level content (g = 0.38).
Methodology characteristics.  We examined six
key methodology characteristics: year of pub-
lication, research design, implementer, FOI,
type of measure, and type of control group.
By year of publication, the mean effect size
estimate for studies conducted after 2000 was
0.42 and 0.27 for studies conducted between
1990 and 2000; this difference between means
was not statistically significant (p = .43). In
addition, the study design variable was not
statistically significant (p = .70): The mean
effect size estimate for RCT studies was 0.39,
and that for quasi-experimental studies was
0.28. Researcher-implemented interventions
yielded a large effect size, 0.70, whereas the
mean effect size estimate for interventions
implemented by school personnel was 0.35,
indicating a small to moderate effect. How-
ever, the contrast between means was not sta-
tistically significant (p = .24), suggesting that
treatment implementer did not moderate
effect size. Results indicated a moderate effect
size, 0.47, for studies reporting fidelity of
intervention. In contrast, the mean effect size
estimate for studies not reporting fidelity of
intervention was 0.06, a small to negligible
effect. However, the difference between
means for the instructional variable of FOI
was not significant.
Similarly, the type of measure was not sig-
nificant (p = .73): Researcher-developed
assessments and standardized assessments
yielded small to moderate effect sizes (g =
0.39 and 0.48, respectively). With regard to
type of control group, studies using BAU
instruction yielded a small effect size, 0.29,
whereas studies using alternative interven-
tions indicated a moderate effect size, 0.53;
however, the contrast between means was not
statistically significant (p = .30).
Discussion
The purpose of this meta-analytic review was
to extend prior evaluations of mathematical
interventions for secondary students with LD
and MD by quantifying intervention effec-
tiveness in terms of effect sizes. The finding
from this review indicates a small to moder-
ate effect size (g = 0.37). An effect size of
0.37 can be interpreted as approximately 65%
of students in the treatment group performing
above the mean of students in the control
group (Lipsey et al., 2012). Our finding that
the interventions in these studies were effec-
tive is largely congruent with the conclusion
of prior reviews of mathematics interventions
Jitendra et al. 189
for K–12 students with or at risk for MD
(Baker et al., 2002; Dennis et al., 2016; Ger-
sten et al., 2009; Kroesbergen & Van Luit,
2003; Swanson & Hoskyn, 1998). In addition
to the overall findings, this review examined
the differential effects of mathematics inter-
ventions on student mathematics outcomes
by various instructional and methodological
features.
Instructional Characteristics
The effect sizes for the following instructional
characteristics were nearly identical: (a) gen-
eral education and special education settings
(g = 0.46 and 0.41, respectively), (b) large and
small group implementation (g = 0.37 and
0.38, respectively), and (c) foundational con-
tent and higher-level mathematical content (g
= 0.36 and 0.38, respectively). These findings
for setting, grouping, and mathematical topic
are somewhat surprising given the different
profiles of students with LD and MD served
in general education and special education
classrooms (Wagner, Marder, Blackorby, &
Cardoso, 2002) and the different kinds of
structures and mathematical topics covered in
the two environments. However, the compa-
rable findings would be expected if research-
ers took these differences (e.g., large group
instruction in general education classrooms,
adding prerequisite knowledge to be learned)
into account and designed appropriate inter-
ventions.
With respect to the grade-level feature
examined in this meta-analysis, research indi-
cates that the mathematical skills of children
with LD progress about 1 year for every 2
years in school but plateau by age 10 or 12
(Cawley, Parmar, Yan, & Miller, 1998; Wei
et al., 2013). Further, the mathematics content
targeted in high schools is more complex and
advanced than the content in middle school.
Note also that the average annual growth
effect sizes for typically achieving students
ranged from 0.30 in Grades 6 and 7 to 0.01 in
Grades 11 and 12 on nationally normed mea-
sures of mathematics achievement, indicating
a decrease in effect sizes as grade level
increases (see Bloom, Hill, Black, & Lipsey,
2008). Thus, one could argue that interven-
tions would be expected to produce stronger
effects for middle school than high school stu-
dents. Although average effects for the two
grade levels were aligned with this expecta-
tion (i.e., middle school, g = 0.44, vs. high
school, g = 0.23) and the advantage for middle
school was significant (i.e., the confidence
interval of the effect sizes did not contain 0),
this contrast was not statistically significant.
The most likely explanation for this finding
has to do with the inability to include all stud-
ies in these two levels of the variable for this
moderator analysis, which could have
decreased the statistical power of the meta-
analysis.
In terms of intervention approaches, there
are contrasting hypotheses to consider in exam-
ining the results of the meta-analysis. On one
hand, single-component interventions (visuals
only) may by parsimonious and work best for
students with LD and MD because of limited
cognitive, behavioral, and attentional capaci-
ties (e.g., Compton, Fuchs, Fuchs, Lambert, &
Hamlett, 2011; Fuchs et al., 2014; Geary,
Hoard, Byrd-Craven, Nugent, & Numtee,
2007). On the other, multicomponent interven-
tions (i.e., visual models combined with other
strategies) may produce stronger effects; meta-
analysis of reading interventions support this
expectation (see Wanzek, Wexler, Vaughn, &
Ciullo, 2010). The results revealed a tendency
toward this latter hypothesis (i.e., visuals only,
g = 0.28, vs. visuals combined with other strat-
egies, g = 0.52), but the contrast was not statis-
tically significant. However, it is encouraging
that the effect size for visuals combined with
strategies is somewhat higher than the effect
size (g = 0.47) found in Gersten et al. (2009).
A key finding of this meta-analysis was that
the effect of these interventions appeared to be
greater when the intervention lasted >10 hr than
when it was ≤10 hr. This finding is consistent
with research regarding the length of instruc-
tional time provided to students being an essen-
tial variable to learning (Rosenshine & Berliner,
1978). Further, within the context of a multi-
tiered system of support model, a framework
for providing high-quality mathematical con-
tent and instruction to all students (core or Tier
190 Exceptional Children 84(2)
1 instruction) and additional intervention sup-
port for some students (secondary and intensive
levels of intervention), the length of instruc-
tional time is one of the features for intensifying
instruction for students who do not adequately
respond to Tier 1 instruction. Results from the
moderator analysis of the present study support
the need for engaging students in learning for an
extended period, especially when learning
higher-level mathematical content.
Methodological Characteristics
With regard to year of publication, it is not
clear whether the overall effectiveness of
mathematical interventions would be higher
for studies published on or before 2000 or
published after 2000, when the National
Council of Teachers of Mathematics stan-
dards were in effect. The finding of no sig-
nificant difference between studies published
on or before 2000 (g = 0.27) and those pub-
lished after 2000 (g = 0.42) is probably due
to low power for the moderator analysis.
One possible source of variation may
relate to research design of the studies. In
this review, 65% of the studies were RCTs.
Because quasi-experimental studies gener-
ally have larger variances, we expected
these studies to produce larger effects than
RCTs, even though such results could be
misleading (Hedges, 1982). However, the
evidence does not support this expectation.
The results in this review revealed similar
effects for RCTs (g = 0.39) and quasi-exper-
iments (g = 0.28).
With respect to the implementer variable,
there are several possible reasons to expect that
researchers as implementers would produce
stronger effects than school personnel as imple-
menters. One explanation is that researchers tend
to implement interventions as planned more so
than teachers. Previous meta-analyses have indi-
cated implementer effects (e.g., Berkeley,
Scruggs, & Mastropieri, 2010; Dennis et al.,
2016; Wanzek et al., 2010). Our results revealed a
tendency toward this hypothesis (i.e., researchers,
g = 0.70, vs. school personnel, g = 0.35), but this
difference was not statistically significant. It is
worth noting that FOI was reported in 65% of the
studies and was generally high when reported
(see Table 1), which might have accounted for the
lack of differences in implementation by research-
ers and school personnel. Our finding that inter-
ventions appeared to be feasibly implemented by
researchers and school personnel is consistent
with recent research on reading interventions in
the early elementary grades (Wanzek et al., 2016).
A key finding of this meta-analysis
was that the effect of these
interventions appeared to be
greater when the intervention lasted
>10 hr than when it was ≤10 hr.
Research suggests that measuring treat-
ment fidelity is crucial to assessing internal
validity—that is, the extent to which “observ-
able differences in outcomes—or lack
thereof—were due to the intervention and not
extraneous factors” (Woolley, Rose, Mercado,
& Orthner, 2013, p. 59). Failure to consider or
check the FOI of the treatment has been iden-
tified as a potential deterrent to reaching accu-
rate conclusions about the effectiveness of the
treatment (Bellg et al., 2004). We hypothe-
sized that studies that reported and assessed
FOI would yield larger effect sizes than stud-
ies that did not report and, presumably, did not
assess treatment fidelity. However, the con-
trast was not significant (p = .12) between
studies assessing treatment fidelity (g = 0.47)
and those that did not assess it (g = 0.06).
Contrary to expectation, researcher-
developed measures designed to match the
content of the interventions produced a some-
what smaller effect size (g = 0.39) than stan-
dardized measures (g = 0.48). However, the
contrast was not significant, possibly because
of the small number of studies (n = 6) using
standardized measures. To evaluate the rela-
tive effectiveness of their interventions con-
sistently, it would be useful for researchers to
utilize common measures.
Finally, research suggests that the use of dif-
ferent types of control groups yields different
effect size estimates (Karlsson & Bergmark,
2015). Research methods textbooks make a
distinction between inactive control groups
Jitendra et al. 191
(e.g., no treatment, BAU or standard treatment,
or a waiting-list control) and active control
groups (e.g., an alternative intervention), which
produce absolute and relative effect estimates,
respectively. An additional distinction is that,
compared with no-treatment controls, BAU
often includes “some potentially effective com-
ponents that may be absent in no-treatment
controls” (p. 422). Therefore, and as expected,
the more effective the comparison group com-
ponents, the smaller the effect size estimates.
However, we found no significant difference
between studies using BAU controls (g = 0.29)
and alternative intervention controls (g = 0.53).
A possible explanation is that the BAU control
condition in the included studies taught the
same content and for the same duration as the
treatment group.
Limitations and Future Directions
Similar to other meta-analyses and primary
studies, there are at least three limitations that
are relevant to the current meta-analysis. First,
there is the possible limitation of generalizing
results from the small set of RCT and quasi-
experimental studies. Despite our exhaustive
search process, including published and unpub-
lished studies, we found only 19 studies in the
past 27 years that focused on the outcome of
secondary mathematics interventions for stu-
dents with LD and MD. This number is rela-
tively small compared to intervention studies of
reading and other content areas. For example,
prior meta-analyses identified 43 reading inter-
vention studies and 28 science intervention
studies for secondary students with disabilities
(Scammacca, Roberts, Vaughn, & Stuebing,
2015; Scruggs, Mastropieri, Berkeley, &
Graetz, 2010). Further, the effect of the small
number of studies influenced results of the
moderator analyses, which are lower powered
than the main effect analysis (Hedges & Pigott,
2004). Future studies may reveal that our find-
ing of no significant difference between the MD
and LD groups is a product of having too few
studies with too few participants. Given the
increasing growth in jobs related to STEM (sci-
ence, technology, engineering, and mathemat-
ics) and how crucial it is for secondary students
with LD and MD to develop the necessary
mathematics skills to enter or advance in
STEM-related careers (see Hughes et al., 2014),
we urge researchers to continue to conduct stud-
ies that will provide evidence about effective
interventions in mathematics for these students.
A second limitation is that we found only
five studies of students with MD that met our
inclusion criteria. Further, how students were
identified as LD may account for the variabil-
ity in effect sizes because most authors studied
school-identified students, and, although they
provided some description of the identification
process, most did not provide sufficient infor-
mation about these students’ MD. It is clear
that in order to identify how to better meets the
needs of students with LD and MD and
improve intervention outcomes, more studies
need to be conducted with these populations.
Another limitation is posed by the lack of
availability of sufficient studies to inform the
field about what intervention approaches are
most effective. We found that the most com-
monly used method in the studies included in
this meta-analysis was visual representa-
tions. Although not statistically significant,
visuals combined with other strategies
resulted in the largest effect size (g = 0.52),
which is practically significant and can be
interpreted as showing that approximately
70% of students in the treatment group per-
formed above the mean of students in the
control group (Lipsey et al., 2012). However,
the strategies were varied (i.e., priming the
underlying structure, cognitive strategy, or
contextualized instruction), with few in each
category. Additional testing of these inter-
ventions needs to be addressed in future
research.
Implications for Practice
The results of this meta-analysis demonstrate
that secondary students with LD and MD ben-
efit from well-designed mathematics interven-
tions. Although the majority of interventions in
this meta-analysis lasted for less than a school
year, the mean effect size reflected an average
gain of a little more than one third a standard
deviation, which on average was about a year’s
192 Exceptional Children 84(2)
growth when compared with annual growth
rates for typically achieving students in second-
ary grades. Further, the studies in this review
compared treatment to a BAU or alternative
treatment comparison group receiving interven-
tion, which implies the added benefits of treat-
ment over another intervention rather than the
benefit of treatment over no intervention. Based
on this information, one implication that we can
draw from our finding is that practitioners can
support the learning of struggling students in
Grades 6 to 12 by using well-designed mathe-
matics interventions (e.g., visual models com-
bined with other strategies). Given that two
thirds of eighth graders with disabilities per-
form below the basic level on national assess-
ments (National Center for Education Statistics,
2015), it is crucial that students with LD and
MD receive mathematics instruction that
addresses their needs and improves mathemat-
ics performance.
Although the majority of
interventions in this meta-analysis
lasted for less than a school year,
the mean effect size reflected an
average gain of a little more than
one third a standard deviation,
which on average was about a
year’s growth.
The findings from this review also high-
light the importance of optimizing instruc-
tional time if students with LD and MD are to
become proficient in mathematics. For exam-
ple, our results show that when students with
LD and MD receive >10 hr of well-designed
mathematics instruction, one can expect an
increase of 22 percentile points, compared
with a gain of only 4 percentile points when
instruction occurs for ≤10 hr. As such, it is
vital that students with LD and MD receive
sufficient instructional time that addresses
their specific needs. Many students with LD
and MD often receive very little focused
instructional time on higher-level mathematics
despite its educational and occupational
importance (Miller & Hudson, 2007). The
majority of studies in this meta-analysis that
provided >10 hr of instruction focused on
advanced mathematics (e.g., ratios and propor-
tional relationships, algebra) and resulted in
enhanced mathematics performance. In sum, if
the achievement gap between students with
LD and MD and their peers without MD is to
be reduced, it is important to continue to eval-
uate the effect of interventions to understand
how to support these students effectively.
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