DOI: 10.1111/cdev.

13884

EMPIRICAL ARTICLE

Subtypes of mathematical learning disability and their antecedents:

A cognitive diagnostic approach

Xiangzi Ouyang1 | Xiao Zhang1 | Pekka Räsänen2 | Tuire Koponen3 |

Marja-­Kristiina Lerkkanen3

1
Faculty of Education, The University of Abstract
Hong Kong, Hong Kong, China
2
Using cognitive diagnostic modeling (CDM), this study identified subtypes of
Faculty of Science, University of Turku,
Turku, Finland
mathematics learning disability (MLD) based on children's numerical skills and
3
Faculty of Psychology and Education,
examined the language and spatial precursors of these subtypes. Participants were
University of Jyväskylä, Jyväskylä, Finland 99 MLD children and 420 low achievers identified from 1839 Finnish children (966
boys) who were followed from preschool (age 6) to fourth grade (2007–­2011). Five
Correspondence
Xiao Zhang, Faculty of Education, The
subtypes were identified: the arithmetic fluency deficit only subtype, the counting
University of Hong Kong, Pokfulam Road, deficit subtype, the pervasive deficit subtype, the symbolic deficit subtype, and the
Hong Kong. counting and concept deficit subtype. Different subtypes depended on different
Email: xzhang1@hku.hk
constellations of language and spatial deficits. Findings highlight the effectiveness
Funding information of CDM in identifying MLD subtypes and underscore the importance of
Academy of Finland, Grant/Award understanding the specific deficits and antecedents of the subtypes.
Number: 213486, 268586 and 292466

The need for people to understand and use data is steadily
increasing with the development of modern society, yet
5%–­8% of students struggle with mathematics learning
(Geary, 2004). These students are typically referred to
as students with mathematics learning disability (MLD),
which is defined as significant mathematical under-
achievement compared with the level at which individ-
uals are supposed to be based on their intelligence, age
and education (American Psychiatric Association, 2013).
In view of the complexity of mathematics learning, MLD
students typically show significant heterogeneity in their
numerical deficits (Geary, 2004), which leads to different
subtypes. Identifying subtypes of MLD can contribute
to a better understanding of the origins of MLD and fa-
cilitate the design of specific intervention programs that
benefit students with each subtype. Using cognitive di-
agnostic modeling (CDM), this study aimed to identify
the subtypes of MLD and examine the language and spa-
tial skill precursors of these subtypes.
Why are there MLD subtypes?
Before investigating MLD, it is necessary to determine
the competencies that contribute to children's mathemat-
ics learning. Mathematics learning is a complex process
involving a variety of domain-­specific numerical com-
petencies (i.e., competencies that predict mathematical
ability only, such as counting skills) and domain-­general
cognitive-­linguistic competencies (i.e., competencies that
predict not only mathematics ability but also other abili-
ties, such as language skills; Desoete & Grégoire, 2006;
Geary, 1993, 2004; Zhang et al., 2020). Due to the com-
plexity of mathematics learning, students with MLD
show heterogeneity in their deficits, leading to different
subtypes. Geary's (2004) model of MLD provides a com-
prehensive framework and suggests that children's defi-
cits in mathematical learning are manifested as deficits
in domain-­specific numerical skills, which are further
affected by underlying cognitive-­linguistic antecedents

Abbreviations: ANS, approximate number system; CDM, cognitive diagnostic modeling; DINA, Deterministic-­Input, Noisy “And” Gate; DINO, Deterministic
Input, Noisy “Or” Gate; G-­DINA, Generalized Deterministic, Noisy “And” Gate; LA, low achievement; LR, likelihood ratio; MLD, mathematics learning
disability; PISA, Program for International Student Assessment; RAN, rapid automatized naming; RD, reading disability; RMSEA, root mean square error of
approximation.
This article is based on Chapter 3 of Xiangzi Ouyang's PhD dissertation under the supervision of Xiao Zhang.

© 2022 The Authors. Child Development © 2022 Society for Research in Child Development.

Child Development. 2022;00:1–15.  wileyonlinelibrary.com/journal/cdev | 1

2 |   
(e.g., central executive, language system, spatial system).
In contrast to previous studies that used both domain-­
general and domain-­specific skills to identify MLD sub-
types (e.g., Bartelet et al., 2014; Chan & Wong, 2020), the
present study, drawing on Geary's model, aimed to iden-
tify MLD subtypes based on domain-­specific numerical
deficits and to investigate the domain-­general anteced-
ents of these subtypes.
Early domain-­specific numerical deficits of
MLD subtypes
Preschool is critical for children in building the founda-
tion for future mathematics learning through acquiring
informal number knowledge, and deficits in number
knowledge may lead to later difficulties in mathematics
learning (Geary, 2013). Purpura et al. (2013) proposed
a theoretical model of informal number knowledge
learned in preschool, which consisted of three numeri-
cal domains: numbering, relation, and arithmetic op-
erations. Numbering refers to children's ability to count
and determine the quantity of a series of objects; relation
is defined as children's understanding of the semantic
meanings of numbers and the relation between quantities
and includes skills, such as number-­numerosity mapping
and set comparison; arithmetic operations are defined as
basic knowledge of the principles and concepts of addi-
tion and subtraction (Jordan et al., 2006).
Previous studies have found that MLD children show
deficits in early numerical skills, such as counting skills
(e.g., Desoete & Grégoire, 2006; Zhang et al., 2020),
number-­ numerosity mapping (e.g., Rousselle &
Noël, 2007; Salminen et al., 2018), and basic arithmetic
concepts (e.g., Desoete & Grégoire, 2006), each of which
corresponds to a domain of informal number knowledge
as differentiated in Purpura et al.'s (2013) framework.
Verbal counting, as a critical skill learned in preschool,
provides the basis for linking verbal codes to their mean-
ing (e.g., quantities) in long-­term memory and thus pre-
dicts the later development of arithmetic skills (Koponen
et al., 2019). Landerl et al. (2004) found that MLD chil-
dren were slow in counting objects, especially when the
number of objects was larger than four. Similarly, Geary
et al. (2000) showed that MLD children committed
more errors in counting and used less mature strategies
(e.g., using fingers) while counting than their non-­MLD
counterparts. Such deficits lead to later difficulties in
understanding cardinal concepts and remembering
mathematical facts and retrieval errors (Geary, 1993).
MLD subtypes with counting deficits have been identi-
fied in the literature. Specifically, von Aster (2000) iden-
tified a verbal deficit subtype, characterized by deficits
in counting, using counting strategies when solving cal-
culation problems, and in storing mathematical facts.
Number-­numerosity mapping, as a crucial correlate of
mathematical achievement (Purpura et al., 2013), refers
OUYANG et al.
to the ability to map symbolic numerals (e.g., Arabic
numbers) onto the quantities they represent (Schneider
et al., 2016). The access deficit hypothesis of MLD as-
sumes that deficits in number-­numerosity mapping lead
to difficulties in mathematics learning (Rousselle &
Noël, 2007). Children with this deficit view the number
sequence as meaningless random symbols, and they are
expected to perform poorly in mathematical tasks con-
taining symbolic numbers rather than non-­ symbolic
quantities (e.g., concrete objects). The access deficit
hypothesis of MLD has received empirical support.
Rousselle and Noël (2007) showed that MLD children
were slower in numerical tasks involving Arabic num-
bers, such as comparing Arabic digits, but were no dif-
ferent in non-­symbolic number comparisons to typically
achieving children. Salminen et al. (2018) also showed
that number-­numerosity mapping ability differentiated
MLD children from children with low achievement (LA)
in mathematics. Consistent with the access deficit hy-
pothesis, MLD subtypes with Arabic deficits have been
identified. For instance, von Aster (2000) identified an
Arabic subtype of MLD, which was manifested by poor
performance in number comparison and number iden-
tification. Bartelet et al. (2014) also identified an access
deficit subtype of MLD, characterized by deficits in
Arabic number comparison and mapping between ver-
bal number words and Arabic digits.
An understanding of basic arithmetic concepts (e.g.,
understanding “more,” “less,” and “equal;” Siegel, 1971)
is also an important numerical skill. A poor understand-
ing of these concepts in preschool may contribute to later
difficulties with arithmetic (Geary, 2004). Specifically,
such a poor understanding affects children's learning of
more complicated arithmetic procedures and detection of
errors when performing arithmetic tasks (Geary, 2004).
In line with this notion, Desoete and Grégoire (2006)
found that approximately 67% of MLD students showed
deficits in understanding arithmetic concepts in pre-
school years. Notably, however, MLD subtypes with
conceptual knowledge deficits were rarely identified.
The linguistic and spatial correlates of
MLD subtypes
In the literature, the antecedents underlying different
MLD subtypes often vary. According to Geary's (2013)
model, domain-­ specific numerical skills are affected
by underlying cognitive-­linguistic antecedents, such as
executive function, the language system and the spatial
system. Executive function typically serves as a general
deficit underlying MLD (Geary, 2013), but language and
spatial skills may contribute to the differences between
MLD subtypes as mathematical information can be pro-
cessed by either the language system or the spatial system
(von Aster, 2000). To illustrate, von Aster (2000) dem-
onstrated that different MLD subtypes were related to
SUBTYPES OF MATHEMATICS DISABILITY
either left or right hemisphere dysfunction based on their
deficits in language or spatial skills. Specifically, MLD
subtypes with deficits in retrieving arithmetic facts have
been found to be associated with language dysfunction,
while subtypes with deficits in spatial representation of
numbers have been found to relate to dysfunction in spa-
tial skills. Similarly, Rourke's (1993) study also supported
the differential roles of language and spatial skills in two
subtypes of MLD (a reading spelling subtype—­an MLD
subtype relating to language deficits with intact spatial
skills, and a nonverbal subtype—­an MLD subtype relat-
ing to visuo-­spatial deficits with intact language skills).
Although it is important to examine whether various
cognitive-­ linguistic factors contribute differentially to
MLD subtypes, the focus of the present study is on the
linguistic and spatial antecedents of MLD subtypes.
Previous studies have documented the relation be-
tween language skills and numerical skills; these lan-
guage skills include, but are not limited to, phonological
awareness (Simmons & Singleton, 2008), receptive vo-
cabulary (Purpura & Ganley, 2014), letter knowledge
(Zhang et al., 2014), and rapid naming (Cirino, 2011).
Phonological awareness, which enables people to de-
code the meaning of a spoken language, has been found
to be related to children's capacity to recall the phono-
logical representations of numbers (i.e., number words)
from long-­term memory (see a review in Simmons &
Singleton, 2008). Poor receptive vocabulary contributes
to children's deficits in understanding mathematical lan-
guage, such as words describing the relations between
quantities (more, less, equal; Purpura & Ganley, 2014).
Apart from spoken language skills, written language
skills such as letter knowledge, also serve as a prereq-
uisite for understanding symbolic numbers (e.g., Arabic
digits; Zhang et al., 2014). Moreover, rapid automatized
naming (RAN) has been found to be involved in object
recognition and recognizing written symbols, such as
Arabic digits (Cirino, 2011). MLD children in general
have been found to have poorer language skills than typ-
ically developing children or children with LA, including
RAN (Zhang et al., 2020), receptive vocabulary (Cowan
& Powell, 2014), and phonological awareness (Murphy
et al., 2007). Although the relations between language
skills and children's numerical skills and the contribu-
tion of language skills to general MLD have been well
established, only a few studies have investigated how
language skills contribute to MLD subtypes. Willburger
et al. (2008) showed that children with comorbid MLD
and reading disability (RD), which is similar to the se-
mantic memory subtype in Geary (1993), had poorer
RAN performance than the other MLD children and
typically developing children.
Previous studies have also documented the correla-
tion between spatial skills and numerical skills in typi-
cally developing children (Ouyang et al., 2022) and MLD
children (Rourke, 1993). Specifically, Geary et al. (2012)
demonstrated that MLD children showed poorer spatial
   | 3
working memory than typically developing children.
Murphy et al. (2007) documented that spatial-­perceptual
ability differentiated LA children from their average
achieving peers but not from MLD children. Zhang
et al. (2020) found that MLD children had poorer spa-
tial visualization skills than LA and average achieving
children. However, few studies have examined whether
spatial skills contribute to MLD subtypes. Geary (1993)
proposed that a spatial subtype of MLD, manifested by
deficits in numerical skills involving spatial information
such as place value, was due to children's poor spatial
skills.
Approaches to classifying MLD subtypes
In the few empirical studies concerning the classifi-
cation of MLD subtypes, researchers have typically
adopted cluster analysis (Bartelet et al., 2014; Chan &
Wong, 2020; von Aster, 2000). In cluster analysis, the
best fitting model determines the number of clusters,
after which the average scores of measured variables are
computed and used to define the characteristics of each
cluster. Cluster analysis can not only provide a simple
and direct report of cluster profiles but also accommo-
date multiple measures with different difficulty levels
(Leonard & Droege, 2008). However, the use of cluster
analysis for classification has a few limitations. First, in
cluster analysis there are no prior assumptions about the
number and characteristics of the subtypes, and thus it
may be difficult to interpret some subtypes from a theo-
retical perspective (Templin & Henson, 2006). Second,
the data-­driven nature of cluster analysis may contribute
to inconsistent findings about MLD subtypes even with
similar tasks (e.g., Bartelet et al., 2014; von Aster, 2000).
Third, cluster analysis does not allow for variables with
high correlations (Tabachnick et al., 2007), a condition
that is unlikely to be satisfied in empirical studies. As a
result, previous studies have often combined highly cor-
related variables into one factor (e.g., Bartelet et al., 2014).
Lastly, cluster analysis is highly sensitive to the initiali-
zation phase in data analysis and outliers because the
profile of each cluster is computed by the average scores
of the measured variables (Bhagat et al., 2016).
To address the limitations of traditional classifica-
tion approaches (i.e., cluster analysis), the current study
adopted a new classification approach, CDM, to iden-
tify MLD subtypes. CDM, as a type of confirmatory
latent class model, classifies participants based on their
mastery status (mastery or non-­mastery) of a series of
competencies (also referred to as “attributes”) measured
in a test (de la Torre, 2011). These competencies are pre-
defined by specifying a Q-­matrix, the role of which is
similar to that of the assumed latent construct in confir-
matory factor analysis. To illustrate, the Q-­matrix speci-
fies the competencies measured in each item of a test (see
Table 1 for an example, in which “1” means that the item
4 |   
TA BL E 1 The initial Q-­matrix
Item A1 A2
Item 1 1 0
Item 2 1 0
Item 3 1 0
Item 4 1 0
Item 5 0 1
Item 6 0 1
Item 7 0 1
Item 8 0 0a
Item 9 0 0
Item 10 0 0
Note: A1 represents counting sequence knowledge, A2 represents basic
arithmetic concepts, A3 represents number-­numerosity mapping. “1” = the
attribute was measured by the item, “0” = the attribute was not measured by
the item.
a
This cell was revised to “1” after Q-­m atrix verification.
measures the attribute, and “0” means that the item does
not measure the attribute) according to the assumptions
or theories about the specific skills involved when an-
swering each item (Sorrel et al., 2016). Importantly, the
assumed Q matrix can be verified based on examinee re-
sponses to the tasks, which indicates whenever a q-­vector
of an item is over-­specified (i.e., a “0” is supposed to be a
“1”) or under-­specified (i.e., a “1” is supposed to be a “0”;
de la Torre & Chiu, 2015). The main output of CDM is
the mastery status of the attributes involved in the test of
each participant (also referred to as an attribute profile).
For instance, if a test measures three competencies, the
possible attribute profiles of the participants would be
“000,” “001,” “010,” “100,” “011,” “101,” “110,” and “111,”
in which 0 represents the non-­mastery status of the attri-
bute, and 1 represents mastery. Therefore, according to
the attribute profiles, at most 8 latent classes of partici-
pants can be identified by the test.
Given the characteristics of CDM, there are a few
advantages of using the CDM approach to identify sub-
types of MLD over cluster analysis. First, CDM, unlike
data-­driven methods, considers previous theoretical as-
sumptions about the deficits of MLD subtypes by spec-
ifying the attributes and Q-­matrix in advance. Second,
the results of CDM provide the attribute pattern for each
participant, which renders the interpretation of latent
classes easy. Third, CDM allows for high correlations
between attributes. In view of the advantages of CDM,
it has been applied to identify latent classes in many re-
search areas, such as digital literacy (Liang et al., 2021)
and psychological disorder (Templin & Henson, 2006),
and these studies have shown CDM's feasibility and ad-
vantages in the classification of latent classes. Moreover,
CDM has been used in educational assessments, espe-
cially in mathematical assessments (e.g., Wu et al., 2021).
For example, Wu et al. (2021) have used CDM to identify
different cognitive profiles of children's mathematical
OUYANG et al.
performance in the Program for International Student
A3 Assessment (PISA). However, no studies, to our knowl-
0
edge, have used CDM to identify subtypes of learning
disabilities or MLD.
0
0
0 The present study
0
0 Our review of the literature revealed several limitations
0 of previous studies. First, MLD students might show
1
early signs of difficulties in mathematics learning before
formal mathematics education, but little is known about
1
whether MLD students show heterogeneity in domain-­
1 specific skills as early as in preschool. Second, the data-­
driven nature of the traditional classification approach
(i.e., cluster analysis) to identifying MLD subtypes might
lead to difficulties in determining the number of sub-
types, interpreting the identified clusters, and general-
izing the findings (Templin & Henson, 2006). Third, the
language and spatial correlates of MLD subtypes are
understudied.
In order to fill these research gaps, the present study
aimed to address the following research questions (RQs):
RQ1: What subtypes of MLD can be classified based
on children's deficits in early domain-­specific numer-
ical skills using CDM?
Hypothesis 1: Based on the findings of previous stud-
ies (Bartelet et al., 2014; von Aster, 2000), five sub-
types may be identified: a counting deficit subtype, a
number-­numerosity mapping deficit subtype, a basic
arithmetic concepts deficit subtype, a symbolic defi-
cit subtype (with deficits in both counting and map-
ping), and a pervasive deficit subtype (with deficits in
all the measured number skills).
RQ2: To what extent is CDM reliable and valid in
identifying MLD subtypes?
Hypothesis 2: CDM shows good reliability in classi-
fying MLD subtypes. Hypothesis 3: With respect to
internal validity, children with a certain MLD sub-
type perform worse in the domain-­specific numerical
skills that are identified with deficits compared with
a control group and the MLD children without such
deficits. We used LA children rather than typically
achieving children as the control group to reduce the
false-­positive error of the diagnosis and make our re-
sults more stringent. Hypothesis 4: With respect to
predictive ability, children with different MLD sub-
types differ in arithmetic reasoning in fourth grade.
Specifically, children with subtypes involving deficits
in counting and number-­numerosity mapping show
lower arithmetic reasoning ability in fourth grade
than their peers without such deficits.
RQ3: What are the language and spatial correlates of
different MLD subtypes?
Hypothesis 5a: Children with MLD subtypes involv-
ing deficits in counting, basic arithmetic concepts, and
SUBTYPES OF MATHEMATICS DISABILITY
number-­numerosity mapping have poorer language
skills than LA children (Geary, 2004). Hypothesis
5b: MLD children with subtypes involving deficits
in number-­numerosity mapping and basic arithmetic
concepts have poorer spatial visualization skills than
LA children.
M ET HOD
Participants and procedure
This study was not preregistered and was part of a lon-
gitudinal project which followed 1839 Finnish children
(966 boys, mean age at kindergarten entry = 74 months,
SD = 3.60 months) for a total of six times from kinder-
garten (April 2007; Time 1 [T1]; n = 1839) to fourth grade
(April 2011; Time 6 [T6], Grade 4; n = 1596). The par-
ticipants were recruited from four municipalities located
in Eastern, Central, and Western Finland. Written con-
sent was obtained from participants' parents. The pro-
ject received approval from the Human Research Ethics
Committee of the University of Jyväskylä.
Among the 1839 children, 99 were identified with
MLD and 420 with LA through latent class growth mod-
eling based on their development trajectory of arithme-
tic fluency from first to fourth grade in a previous study
(Zhang et al., 2020; see Supporting Information for more
details). Among the 99 students with MLD, 53 were boys
and 46 were girls. Among the 420 low achievers, 206 were
boys and 214 were girls. The average age was 74 months
for both MLD and LA children, and the SDs were 4.0
and 3.5 months for MLD and LA children respectively.
Students with MLD had substantially lower scores in
fourth grade and a slower growth rate, which indicated
that they benefited less from formal mathematics edu-
cation than their peers. In contrast, students with LA
showed a mild but persistent difficulty in mathematics
from first to fourth grade. Among the MLD and LA
children, 18 children did not participate in fourth grade
due to their school transfer or moving out of the school
district. Attrition analysis showed no significant differ-
ence in all the variables measured at T1 between children
who left the project and those who were retained.
Measures
A battery of cognitive and numerical tests was adminis-
tered to students (see Appendix S1). The measures used
to identify subtypes of MLD consisted of three numeri-
cal tasks: a counting task (e.g., “counting forward from
6 to 13”; Items 1–­4 in Table 1), a basic arithmetic con-
cepts task (e.g., “please draw one more ball than the balls
in the picture”; Items 5–­7 in Table 1), and a number-­
numerosity mapping task (e.g., “draw as many balls as
the Arabic numeral represents”; Items 8–­10 in Table 1).
   | 5
Measures of cognitive-­linguistic antecedents, which were
administered at T1 (preschool), consisted of phonologi-
cal awareness (10 initial phoneme identification tasks;
Lerkkanen et al., 2007), letter knowledge (29 Finnish
letters; Lerkkanen et al., 2006), spatial visualization (31
items; Woodcock & Johnson, 1977), receptive vocabulary
(the shortened version of Peabody Picture Vocabulary
Test—­ Revised; Dunn & Dunn, 1981), and RAN (50
object-­naming tasks; Ahonen et al., 1999). The numeri-
cal, language, and spatial tasks were administered indi-
vidually in a quiet room at T1. The Arithmetic Reasoning
Test (Räsänen, 2000) was used for validation and it was
administered in a group setting at Grade 4 (T6). Fluid in-
telligence was tested in groups using the short version of
Raven's Colored Progressive Matrices (Raven et al., 1983),
and parental education was coded from 1 = no vocational
education to 7 = Licentiate or Doctoral degree.
Data analysis
Identifying subtypes of MLD through CDM
Initial determination of the Q-­matrix
Based on the content of the numerical tasks (e.g., Koponen
et al., 2016; Zhang et al., 2020), an initial Q-­matrix was
constructed by specifying each item corresponding to
an attribute (see Table 1). A confirmatory factor analy-
sis supported the structure of the initial Q-­matrix. The
three-­factor model showed an acceptable model fit
(χ2 = 209.72, p < .01, comparative fit index = .95, Tucker–­
Lewis index = .93, root mean square error of approxima-
tion [RMSEA] = .055, standardized root mean squared
residual = .045), with factor loadings larger than .30.
Q-­matrix validation using empirical data
The validation of the Q matrix was evaluated using a dis-
crimination index (de la Torre & Chiu, 2015) computed
from examinee responses to the tasks. The discrimination
index indicates whenever a q-­vector of an item is over-­
specified (i.e., when a “0” is supposed to be a “1”) or under-­
specified (i.e., when a “1” is supposed to be an “0”). In the
present study, changes to the Q-­matrix suggested by the
model were adopted if (a) the proportion of the discrimina-
tion index of a particular q-­vector relative to the maximum
(PVAF; de la Torre & Chiu, 2015) after modification was
larger than 0.8, and (b) the modification of the q-­vector
made theoretical sense. We included all 1839 participants
tested at T1 in the Q-­matrix validation and CDM estima-
tion since the sample size required for an accurate esti-
mation in CDM is typically larger than 500 or 1000 (de la
Torre, 2011). However, follow-­up analyses were conducted
for MLD and LA children (N = 519).
Selection of the appropriate CDM
According to different assumptions about the combina-
tion of multiple skills measured in one item, different
6 |   
CDMs have been proposed. The Deterministic-­Input,
Noisy “And” Gate (DINA) model (Junker & Sijtsma, 2001)
is representative of non-­compensatory models that assume
that only if participants master all the measured attributes
of the item can they correctly answer it. The Deterministic
Input, Noisy “Or” Gate (DINO) model (Templin &
Henson, 2006) is representative of compensatory mod-
els that assume that participants can correctly answer an
item if they master at least one measured attribute of the
item. The Generalized Deterministic, Noisy “And” Gate
(G-­DINA) model (de la Torre, 2011) is a saturated model
that considers both kinds of relations (Sorrel et al., 2016)
and assumes that the probability of participants success-
fully answering an item increases if they master more at-
tributes. The three models will be the same when the item
only measures one attribute. These models were compared
to test different assumptions about items that measured
multiple attributes. The likelihood ratio (LR) was used to
compare the fitness of the reduced models and the satu-
rated G-­DINA model. RMSEA was adopted to evaluate
the absolute model fit.
Estimating attribute profiles
The main output of CDM is the { attribute profile} of each
student represented by 𝛼 i = 𝛼 i1 , 𝛼 i2 , … , 𝛼 iK , which
specifies the mastery status of each attribute, with K de-
noting the number of attributes. 𝛼 ik = 1 or 0 means that
this attribute is mastered or not been mastered by the
participant, and there are at most 2K latent classes.
Reliability evaluation in CDM
Common indicators of reliability in the CDM frame-
work are pattern-­and attribute-­level classification accu-
racy indices, which indicate the agreement between the
expected classification and the observed classification of
the participants (Wang et al., 2015). Although there are
no gold standards for the accuracy indices, simulation
studies have indicated that the pattern-­level accuracies
of a high-­quality test with 10 items and 5 attributes—­
similar to that in the present study—­are about 0.55, and
attribute-­level accuracies larger than 0.88 indicate good
reliability for the test (Wang et al., 2015).
Validation of the MLD subtype classification
Validation of the classification consisted of two steps.
First, internal validity was evaluated by examining
whether the raw scores of the three domain-­specific skills
predicted the odds of belonging to each MLD subtype
versus the control group (LA children) using logistic re-
gression. In addition, the differences in the raw scores
of the three numerical tasks between subtypes were
examined via an ANOVA. For example, we examined
whether MLD children with the counting deficit sub-
type and those with the pervasive deficit subtype (both
showed a deficit in counting) had equivalent raw scores
OUYANG et al.
in counting. Second, predictive validity was evaluated
by examining whether MLD children with different sub-
types also differed in arithmetic reasoning in Grade 4.
The scores of arithmetic reasoning were compared be-
tween the MLD subtypes using an ANOVA.
The linguistic and spatial correlates of
MLD subtypes
We investigated whether the language and spatial ante-
cedents (i.e., phonological awareness, letter knowledge,
receptive vocabulary, rapid naming, and spatial visuali-
zation) predicted the odds of belonging to each MLD
subtype versus LA children using multiple logistic re-
gression. The sex, age, parental education, and fluid in-
telligence of the children were controlled for. The data,
study materials, and data analysis codes are available
upon request.
R E SU LT S
Descriptive statistics
The descriptive statistics and correlations of measured
variables are presented in Table 2. The three numerical
tasks showed small but significant correlations between
each other (rs > .097, ps < .05). Counting was correlated
with all the domain-­general variables (|rs| > .126, ps < .01).
Basic arithmetic concepts and number-­numerosity map-
ping were associated with all the domain-­general vari-
ables (rs > .87, ps < .05) except RAN, which provided the
statistical basis for later regression analyses of the ante-
cedents. Children's arithmetic reasoning skill at T6 was
positively associated with counting (r = .252, p < .01) and
basic arithmetic concepts at T1 (r = .214, p < .01).
Cognitive diagnostic modeling results
Based on the original Q-­matrix (Table 1), the validation
results suggested that the q-­vector of Item 8 (i.e., “draw
as many balls as the number below represents”) needed
revision (PVAF = .64 < .80). The model suggested that
Item 8 measured not only number-­numerosity mapping
but also basic arithmetic concepts. Theoretically, Item 8
(“draw as many balls as the Arabic numeral represents”)
measured children's understanding of an important
arithmetic concept, namely, equivalence. After including
the attribute (basic arithmetic concepts) in the q-­vector
of Item 8, the model resulted in a better PVAF = 0.93,
which was larger than 0.8. Therefore, we modified the
q-­vector of Item 8 to “011.”
The model fit indices of the DINA, DINO and G-­DINA
models are shown in Table S1. The RMSEA indicated an
excellent model fit for all three models (RMSEA <0.03,
 SUBTYPES OF MATHEMATICS DISABILITY    | 7

Liu et al., 2016). The relative model fit showed that the

15.88
3.17
G-­DINA model fitted better than the DINA (LR = 16.84,

.120 (.007)** —­
13
p < .001) and DINO models (LR = 19.29, p < .001). This re-
sult suggested that the more parsimonious models (DINA

19.57
and DINO) reduced the model fit significantly, so we

3.25
.233 (<.001)** −.092 (.037)* —­
12

chose the G-­DINA model for further analysis. The results

demonstrated that the relation between the two attributes

−.080 (.074)
measured by Item 8 was neither compensatory (DINO)

74.70
17.40
nor non-­compensatory (DINA); instead, the probability

−.192 (<.001)** −.138 (.002)** —­

11

of correctly answering Item 8 increased when partici-

.119 (.008)**
pants had mastered more attributes (G-­DINA).

13.66
2.37
—­
10

Identified MLD subtypes

.172 (<.001)** .189 (<.001)** .229 (<.001)** .220 (<.001)**
.208 (<.001)** .210 (<.001)**

.142 (.001)**
Table 3 lists the attribute pattern of each subtype group
21.27
as well as its prevalence. We focused on the subtypes that
6.95
.163 (<.001)** .231 (<.001)** .492 (<.001)** —­

accounted for more than 5% of the MLD children in the

9

follow-­up analyses, which is a criterion typically used in

−.143 (.001)**

.153 (.001)**

latent class analyses to determine the number of classes

(He & Fan, 2018). Among the 99 MLD children, 40
8.72
1.75
—­

(40%) had no deficits in any of the three attributes (111 in

8

Table 3). However, they were identified as having MLD

.281 (<.001)** .147 (.001)**

.157 (<.001)** .087 (.048)*

−.062 (.161)

.214 (<.001)** .073 (.103)

due to their deficits in arithmetic fluency; therefore, this

subtype was labeled the arithmetic fluency deficit only
2.66
0.71
.325 (<.001)** —­

subtype, or the fluency deficit subtype for short. A total of

7

22 MLD children (22%) had a deficit in counting but not

−.085 (.054)

in the other attributes (011), so this subtype was labeled

the counting deficit subtype. Twelve MLD children (12%)
0.57
2.78
—­

had deficits in all three attributes, so this subtype was

6

−.126 (.004)**
.166 (<.001)** .144 (.001)** .464 (<.001)**
.138 (.002)** .249 (<.001)**
.113 (.010)** .221 (<.001)**

.252 (<.001)**

labeled the pervasive deficit subtype. Eight MLD chil-

.137 (.002)** .211 (<.001)**
.119 (.007)** .318 (<.001)**

.159 (<.001)**

dren (8%) were characterized by deficits in counting and

The descriptive statistic and correlations between the measured variables

number-­numerosity mapping (010), so this subtype was

2.24
1.28
—­

labeled the symbolic deficit subtype. Eight MLD children

5

(8%) had difficulties in counting and basic arithmetic

Note: N = 519. T1: preschool, T6: fourth grade. The p values are presented in parenthesis.
.097 (.027)*

.172 (<.001)** .093 (.037)*

.139 (.002)** .184 (<.001)** .108* (.014)
.011 (.795)

concepts (001), so this subtype was labeled the counting

16.89
1.03

and concept deficit subtype.

—­
4

−.120 (.010)*
.109 (.020)*
.108 (.021)*

.040 (.388)
.022 (.630)

.073 (.120)
.024 (.614)

Reliability and validity of the classification

1.45
4.11
—­
3

Reliability of the classification

−.086 (.066)

−.158 (<.001)** −.084 (.061)

−.017 (.701)
−.172 (<.001)** .104 (.018)*

.101 (.021)*
.041 (.348)

.023 (.601)
.085 (.053)
.057 (.199)
.065 (.141)

Table 3 shows that the pattern-­level accuracies of all

73.53
3.63
—­

subtypes were larger than 0.55. Moreover, the attribute

2

level classification accuracies of counting, basic arith-

.202 (<.001)**
8 T1 phonological awareness .133 (.002)**
.131 (.003)**
.141 (.001)**

−.051 (.242)
−.058 (.184)

−.022 (.621)
−.091 (.051)

−.014 (.753)

metic concepts and number-­numerosity mapping were

.021 (.630)

0.93, 0.97, and 0.99 respectively. Both the pattern-­level

0.50
0.50

and attribute-­level accuracies indicated a good level of

—­
1

reliability of the classification.

12 T1 receptive vocabulary
13 T6 arithmetic reasoning
10 T1 spatial visualization
6 T1 arithmetic concepts

9 T1 letter knowledge
3 Parental education

11 T1 rapid naming

Validation of the domain-­specific deficits of

*p < .05; **p < .01.

MLD subtypes
5 T1 counting

7 T1 mapping
TA BL E 2

4 T5 IQ

We first examined whether children with each subtype

2 Age
1 Sex

SD
M

were more likely to have lower scores in the non-­mastered

8 |    OUYANG et al.

TA BL E 3 The attribute profiles and their prevalence among mathematics learning disability

Classification
Subtype Attribute profilea N Prevalence (%) accuracy

1. Fluency deficit 111 40 40 0.97

2. Counting deficit 011 22 22 0.70
3. Pervasive deficits 000 12 12 0.81
4. Symbolic deficit 010 8 8 0.85
5. Counting and concepts deficits 001 8 8 0.72
6. Mapping deficit 110 4 4 0.81
7. Concept deficit 101 3 3 0.55
8. Concepts and mapping deficits 100 2 2 0.55
a
The attribute profile indicated the mastery status of each of the three attributes respectively: counting, basic arithmetic concepts, and number-­numerosity
mapping. 1 = the attribute was mastered, 0 = the attribute was not mastered. The subtypes that accounted for more than 5% of the MLD children were bolded.

T A B L E 4 Estimated odds ratios (OR) of each subtype and low achievement (LA) in relation to three numerical variables in logistic
regression models

LA versus 111 LA versus 011 LA versus 000 LA versus 010 LA versus 001

Variables OR p-­Value OR p-­Value OR p-­Value OR p-­Value OR p-­Value

Counting 1.55** .01 0.32*** <.001 .44* .04 0.49* .04 0.17** .01
a
Arithmetic —­ —­ 1.42 .61 .28** .01 —­ —­ 0.09*** <.001
concepts
Mapping 4.75 .09 4.79 .09 .34** .01 0.21*** <.001 5.18* .03
Note: 111 = The fluency deficit subtype, 011 = The counting deficit subtype, 000 = The pervasive deficit subtype, 010 = The symbolic deficit subtype, 001 = The
counting and concept deficit subtype.
a
The empty cells were due to that the Wald test cannot be computed as the variance of the raw scores of the variables is 0 for children with a certain subtype.
*p < .05; **p < .01; ***p < .001.

domain-­specific skills than LA children. The logistic re-
gressions are shown in Table 4, with each column rep-
resenting a regression model. We coded the LA group
as “0” and each subtype group as “1,” so an odds ratio
smaller than 1 would mean that children with a certain
subtype were more likely to have lower scores in the
predictor than the LA group, and vice versa. The first
column in Table 4 shows that children with the fluency
deficit subtype were more likely to have higher scores in
counting than the LA group (OR = 1.55, p < .01). Although
this finding was unexpected, it validated the attributes
profile of the subtype group, which did not have signifi-
cantly lower scores in the three domain-­specific skills
compared with the LA group. MLD children with the
counting deficit subtype were more likely to have lower
scores in counting than the LA group (OR = .32, p < .001),
and they did not show significantly lower scores in basic
arithmetic concepts or mapping tasks. MLD children
with the pervasive deficit subtype were more likely to have
lower scores in counting (OR = .44, p < .05), basic arithme-
tic concepts (OR = .28, p < .01), and number-­numerosity
mapping (OR = .34, p < .01) than the LA group. MLD
children with the symbolic deficit subtype were more
likely to have lower scores in counting (OR = .49, p < .05)
and number-­ numerosity mapping than the LA group
(OR = .19, p < .001). Children with this subtype had maxi-
mum scores in arithmetic concepts, which indicated that
they did not have weaker arithmetic concepts than LA
children. Children with the counting and concept deficit
subtype were more likely to show lower scores in count-
ing (OR = .17, p < .01) and arithmetic concepts (OR = .09,
p < .001), and they also showed higher scores in number-­
numerosity mapping (OR = 5.18, p < .05) than the LA
group. To recap, the results from logistic regression were
consistent with the attribute patterns of the MLD sub-
types, which validated the attribute patterns estimated
by the CDMs. The differences in the three numerical
skills among MLD children with different subtypes also
supported their attribute patterns in most cases (see
Table S2). In other words, MLD subgroups identified
with a deficit in a certain attribute showed significantly
lower scores in the corresponding task than did the sub-
groups identified as having mastered this attribute.
Differences in arithmetic reasoning between
children with different MLD subtypes
The differences in fourth-­ g rade arithmetic reasoning
between children with different subtypes were further
investigated. Results indicated significant differences
in arithmetic reasoning between children with the five
main subtypes (F[4, 81] = 4.39, p < .01). Further post hoc
analyses (Bonferroni) indicated that children with the
SUBTYPES OF MATHEMATICS DISABILITY    | 9

fluency deficit subtype showed higher scores in arithme- (1.04–­1, p < .05) when controlling for demographic and
tic reasoning than their peers with the symbolic deficit other cognitive-­linguistic factors.
subtype (mean difference = 3.68, p < .05) and the pervasive
deficit subtype (mean difference = 3.00, p < .05).
DI SC US SION

Linguistic and spatial correlates of the
MLD subtypes
Table 5 shows the logistic regression, in which the six an-
tecedents were used to predict the odds of belonging to
each MLD subtype compared with the LA group. The
results indicated that children with the counting deficit
subtype were more likely to have lower scores in spa-
tial visualization (OR = .78, p < .01) than the LA group.
Specifically, for each point increase in spatial visualiza-
tion, the odds of children being identified with the ver-
bal deficit subtype rather than the LA group decreased
by 22% (1–­0.78) when controlling for child's age, sex, IQ,
parental education, and the other cognitive-­ linguistic
antecedents. Moreover, for each point increase in the
receptive vocabulary, phonological awareness, and let-
ter knowledge scores, the odds of children being identi-
fied with the pervasive subtype rather than the LA group
decreased by 21% (1–­0.79, p < .05), 37% (1–­0.63, p < .05),
and 15% (1–­ 0.85, p < .05) respectively, after including
control variables and the other cognitive-­linguistic an-
tecedents. Additionally, for each point increase in the
letter knowledge score, the odds of children being identi-
fied with the symbolic deficit subtype rather than the LA
group decreased by 14% (1–­0.86, p < .01) when controlling
for demographic and other cognitive-­linguistic factors.
Lastly, for each second increase in RAN time, the odds
of children being identified with the verbal and concept
deficit subtype rather than the LA group increased by 4%
Regarding RQ1, five main subtypes were identified
among the 99 MlD children, which accounted for more
than 90% of the MLD children. These subtypes are the
fluency deficit subtype, the counting deficit subtype, the
pervasive deficit subtype, the symbolic deficit subtype,
and the counting and concept deficit subtype. With re-
spect to RQ2, CDM showed good reliability and validity
in the classification of the MLD subtypes. Concerning
RQ3, this study demonstrated that spatial visualization
uniquely contributed to the identification of the count-
ing deficit subtype; language skills (i.e., phonological
awareness, letter knowledge, and receptive vocabulary)
uniquely contributed to the identification of the pervasive
deficit subtype; letter knowledge uniquely contributed to
the symbolic deficit subtype; and RAN uniquely contrib-
uted to the identification of the counting and concept defi-
cit subtype after including control variables in each case.
The identification of MLD subtypes
Among the five main subtypes identified in this study, the
fluency deficit subtype accounted for 40% of MLD chil-
dren. The identification of this subtype was inconsistent
with our hypothesis, but the subtype was similar to the
no numerical deficit subtype (8.4% of the MLD children)
identified in Bartelet et al. (2014) and the mild deficit
subtype (50% of the MLD children) identified in Chan
and Wong (2020). Children with this subtype appeared

TA BL E 5 Estimated odds ratios (OR) of each subtype and low achievement (LA) in relation to predictors in logistic regression model

LA versus 111 LA versus 011 LA versus 000 LA versus 010 LA versus 001

Variables OR p-­Value OR p-­Value OR p-­Value OR p-­Value OR p-­Value

Gender 0.60 .16 2.32 .12 2.52 .29 0.81 .83 3.37 .29
Age 1.06 .21 1.02 .77 1.06 .64 0.90 .45 1.12 .37
Parental education 1.07 .60 0.99 .93 1.29 .39 0.85 .59 0.86 .68
T6 fluid intelligence 0.92 .62 0.65 .06 0.48 .07 0.51 .10 0.94 .91
T1 phonological 1.16 .34 1.13 .47 0.63* .02 1.75 .10 1.25 .52
awareness
T1 receptive 1.03 .69 1.09 .32 0.79* .03 1.18 .30 0.83 .27
vocabulary
T1 letter knowledge 1.03 .44 0.94 .09 0.85* .02 0.86* .01 0.86 .07
T1 spatial 0.92 .28 0.78** .01 0.97 .82 0.75 .09 0.93 .65
visualization
T1 RAN 1.01 .60 1.01 .45 1.00 .91 1.00 .90 1.04* .02
Note: 111 = the fluency deficit subtype, 011 = the counting deficit subtype, 000 = the pervasive deficit subtype, 010 = the symbolic deficit subtype, 001 = the counting
and concept deficit subtype.
Abbreviation: RAN, rapid automatized naming.
*p < .05.; **p < .01.
10 |    OUYANG et al.
to have the fewest difficulties in the three numerical
skills and cognitive-­ linguistic antecedents among all
subtypes of MLD children. Nevertheless, children with
the fluency deficit subtype might have deficits in other nu-
merical skills that were not measured in this study, such
as the approximate number system (ANS). Mazzocco
et al. (2011) showed that MLD children were less accu-
rate when approximately representing magnitude com-
pared with typically achieving children. Notably, despite
the importance of the ANS, it is not yet clear whether
different variants of the ANS tasks really catch some-
thing important in MLD children (Szűcs et al., 2013).
Moreover, based on De Smedt et al. (2013), the ANS
seems to differentiate between MLD and LA only after
the ages of 9–­10 but not before that. Therefore, it will be
interesting for future studies to examine whether MLD
children with the fluency deficit subtype show a deficit in
the ANS using different ANS tasks and participants of
different ages. Another possibility is that children with
the fluency deficit subtype have a deficit in the speed, but
not the accuracy, of their processing of numerical tasks
(Chan & Wong, 2020; Rousselle & Noël, 2007).
The second subtype, the counting deficit subtype, ac-
counted for 20% of the MLD children, was consistent
with our hypothesis. This subtype is similar to the “ver-
bal subtype” in von Aster's (2000) study, which was
characterized by frequent errors in counting routines.
To illustrate, the counting deficit found in children with
this subtype might result in difficulties in understand-
ing cardinal concepts, remembering mathematical facts,
and avoiding retrieval errors, thus leading to MLD
(Geary, 1993). Moreover, consistent with their attribute
pattern, children with this subtype also showed lower
scores in counting than both LA children and children
with the fluency deficit subtype.
The pervasive deficit subtype, which accounted for
12% of the MLD children, was characterized by defi-
cits in all three numerical competencies measured in
the present study. The identification of this subtype was
consistent with our hypothesis and von Aster's (2000)
and Bartelet et al.'s (2014) studies. As von Aster (2000)
suggested, children with this subtype may have deficits
in analogue magnitude representation, which is related
to the malfunction of the brain (e.g., bilateral horizontal
intraparietal sulci), or to genetic influences. Such deficits
may appear at an early age and impede children's acqui-
sition of symbolic number skills as well as basic arith-
metic concepts. Another possibility is that children with
this MLD subtype have deficits in working memory.
Deficits in working memory have been found to be com-
mon in MLD children (Geary, 2013) and to contribute to
poor performance in multiple numerical tasks, such as
number-­numerosity mapping and explicit number pro-
cessing (Geary et al., 2004).
The symbolic deficit subtype, which accounted for 8%
of the MLD children, is consistent with our hypothesis
and the access deficit subtype (characterized by poor
performance in counting and Arabic number knowl-
edge) identified in Bartelet et al. (2014) and the symbolic
deficit group identified in Chan and Wong (2020). It is
not surprising that children with this subtype have defi-
cits in verbal number processing and number-­numerosity
mapping, as the process of learning Arabic numerals
has been found to be based on the process of mapping
number words onto quantities (Lipton & Spelke, 2005).
This also explains why very few children were identified
with a deficit only in mapping (4%). The identification
of this subtype also supports the hypothesis that MLD
is at least partially caused by difficulties in processing
symbolic numbers, including number words and Arabic
digits (Bartelet et al., 2014).
Finally, the present study also identified children with
the counting and concept deficit subtype, which accounted
for about 8% of MLD children. To our knowledge, simi-
lar subtypes have not been classified in previous studies,
and it is also inconsistent with our hypothesis. However,
the identification of this subtype supports Geary's theory
(Geary, 2004) that a poor understanding of conceptual
knowledge leads to difficulties in learning mathematics.
Furthermore, very few children were identified with a
deficit only in basic arithmetic concepts (3%), indicating
that the concept deficit was likely to be accompanied
by a deficit in counting. The finding supports the mul-
tiple deficits hypothesis (Desoete & Grégoire, 2006) and
extends previous studies by indicating that the two nu-
merical deficits may co-­occur and jointly contribute to
children's MLD. This can be explained by the notion that
counting often serves as an arithmetic strategy that fa-
cilitates children's learning of basic arithmetic concepts
(Sievert et al., 2021).
Reliability and validity of the MLD subtype
classification
Consistent with the research hypotheses, the present
study demonstrated that CDM showed good reliability
and good internal and predictive validity in the classi-
fication of MLD subtypes. MLD children with differ-
ent subtypes differed in arithmetic reasoning in fourth
grade: MLD children with the symbolic deficit subtype
and the pervasive deficit subtype had poorer performance
in arithmetic reasoning than their counterparts with the
fluency deficit subtype. This finding is consistent with
previous studies indicating that counting skills (Zhang
et al., 2017) and number-­ numerosity mapping skills
(Jang & Cho, 2018) contribute to arithmetic reasoning
skills. Moreover, interestingly, a deficit only in counting
skills did not lead to lower arithmetic reasoning ability
in fourth grade compared with that of children with the
other subtypes. One explanation may be that arithmetic
reasoning is a composite and complex skill, which de-
pends on a number of cognitive skills (Zhang et al., 2017).
The influence of a verbal deficit on arithmetic reasoning
SUBTYPES OF MATHEMATICS DISABILITY
in the early years may be compensated for by other un-
impaired numerical skills in later mathematical learning.
This explanation is supported by previous findings on
the compensatory relations between cognitive skills: for
example, Fassbender and Schweitzer (2006) found that
children with attention deficit hyperactivity disorder
and difficulties in engaging in verbal strategies to solve
arithmetic problems tended to rely on spatial, visual, and
motor strategies. However, this speculation is tentative
and requires further investigation.
Linguistic and spatial correlates of
MLD subtypes
The present study found that language skills (i.e., pho-
nological awareness, receptive vocabulary, and letter
knowledge) were critical correlates of the pervasive
deficit subtype, which supports our hypothesis (H5a).
We speculate that children with this subtype may have
RD as well, and their deficits in domain-­specific nu-
merical skills may be due to their deficits in general
language competency (Geary, 1993). Previous find-
ings have shown that students with comorbid RD and
MLD display severe difficulties in multiple domain-­
specific skills, such as retrieving arithmetic facts and
understanding arithmetic concepts (Mazzocco &
Räsänen, 2013).
The results regarding the cognitive-­linguistic anteced-
ents of the symbolic deficit subtype are also consistent
with the research hypotheses (H5a). Specifically, this
study showed that letter knowledge made a unique con-
tribution to the probability of being identified with the
symbolic deficit subtype compared with the LA group
after including control variables. This finding corrobo-
rates Zhang et al.'s (2014) study regarding the predictive
role of letter knowledge in children's numerical skills.
A possible explanation is that the acquisition of letter
knowledge may facilitate understanding, decoding, and
manipulating number symbols (e.g., number words and
Arabic digits; Zhang et al., 2017).
In addition, consistent with the research hypotheses,
RAN was found to contribute uniquely to the identi-
fication of the counting and concept deficit subtype. A
possible explanation for this is that RAN, as Torgesen
et al. (1994) described, reflects how rapidly and easily
an individual retrieves phonological information from
long-­term memory. If the quality of the storage of pho-
nological information (e.g., number words) in long-­term
memory is poor, it could be difficult for children to re-
trieve and manipulate these phonological codes, thus
leading to more errors in counting or being stuck when
counting (Simmons & Singleton, 2008). Furthermore,
RAN may be associated with basic arithmetic concepts
indirectly through counting skills because counting is
an important strategy when children start to learn basic
arithmetic concepts (Geary, 1993).
   | 11
Inconsistent with our hypothesis (i.e. children with
deficits in number-­numerosity mapping and basic arith-
metic concepts would exhibit lower spatial ability com-
pared with LA children), spatial visualization was found
to contribute to the identification of the counting deficit
subtype. However, this finding is consistent with previ-
ous studies indicating that spatial visualization skills
predict counting skills in typically achieving children
(Liu & Zhang, 2022; Zhang et al., 2014). It also joins ev-
idence showing spatial representations of numbers and
time in the human mind (i.e., numbers and time are spa-
tially represented from left to right on a horizontal line;
Gibson & Maurer, 2016). A possible explanation for this
is that children typically practice their counting skills by
pointing to objects from left to right, and such a counting
practice may be connected with spatial direction (Liu &
Zhang, 2022).
CDM as a promising approach to identifying
MLD subtypes
This study explored whether the CDM approach could
be applied in the classification of MLD subtypes and
how reliable and valid the method is. There are at least
three reasons why CDM is a promising approach to
identifying MLD subtypes. First, the attribute pattern
of each participant estimated by CDM can provide finer-­
grained information about the deficits of each MLD
subtype than that obtained by cluster analysis. Cluster
analysis estimates the cognitive profiles of subtypes by
computing the average scores in the measured variables,
in which the similarity between participants is empha-
sized, but individual differences may not be precisely
captured. In contrast, using CDM to estimate the cogni-
tive profile of each participant ensures that subtypes with
cognitive profiles that are not very common (i.e., those
comprising very few participants) are not “averaged.”
Moreover, finer-­g rained information about the subtypes
renders the interpretation easier and is also helpful for
the development of interventions to target the different
deficits of children with MLD subtypes. Second, CDM
allows for the evaluation of the reliability of the classifi-
cation, which cannot be evaluated using cluster analysis.
CDM provides reliability indices of the classification
at attribute and pattern levels. If the classification ac-
curacies of certain patterns are low, researchers should
exercise caution when interpreting and generalizing the
subtypes. Furthermore, researchers can assess whether
any of the attributes were measured with low reliability
by checking the attribute-­level classification accuracies
provided by CDM. If this is the case, additional items or
tasks could be developed to improve the reliability of the
attribute. Third, compared with cluster analysis, CDM
can be used to analyze tasks and attributes that have
moderate or high correlations, which is in accord with
the reality of mathematical research (Wang et al., 2015).
12 |    OUYANG et al.
However, the costs and limitations of CDM should
be acknowledged. First, CDM assumes that the latent
variables are discrete (e.g., mastery or non-­mastery) and
thus cannot be used to analyze continuous data, such
as participants' reaction time. As previous studies have
suggested (e.g., Geary et al., 2007), some MLD children
may not show deficits in accuracy in numerical tasks
but may do so in speed. Future studies could use timed
numerical tasks or directly measure children's speed of
processing as an antecedent. Second, the fine-­g rained
cognitive profiles provided by CDM could be a “double-­
edged sword,” because as more attributes are included
in CDM, the sensitivity of CDM increases, probably re-
sulting in more subtypes being identified and an overly
complex classification. However, this does not mean that
all the possible subtypes will be identified and valid be-
cause there might be very few (less than 5%) or no partic-
ipants in some subtypes. For example, Liang et al. (2021)
used CDM to identify latent classes of digital literacy.
Although they included 5 attributes (at most 25 = 32 la-
tent classes could be identified), 14 of the latent classes
included no participants, and only three latent classes
had prevalence larger than 5%. The classification results
depend not only on how many attributes are included
but also on whether participants differ significantly on
the included variables. Therefore, all the variables in-
cluded should be empirically and theoretically justified.
Based on this notion, the initial phase of CDM analyses
(e.g., the selection of attributes and the construction of a
Q-­matrix) is important. Put differently, if the assumed
factor structure and the number of factors are not well
founded at the beginning in confirmatory factor analy-
sis, the results will not be trustworthy. Constructing a Q-­
matrix based on a theoretical model, using think-­aloud
protocols, and validating the Q-­matrix using empirical
data can be helpful in this process. Moreover, validation
is also important after MLD subtyping. Further studies
could validate the classification of MLD subtypes from
several perspectives: examining the stability of the clas-
sification over time, investigating whether there are dif-
ferences in the effectiveness of targeted interventions for
MLD children with different subtypes, and replication
studies with other samples, age groups, and different
tasks.
Limitations and directions for future research
The current study has a few limitations. First, the iden-
tified MLD subtypes were based on three numerical
skills, while other critical numerical skills, such as the
ANS, the number line, and subitizing, were not included.
Moreover, this study only measured children's under-
standing of Arabic symbols, while other symbols such
as operative symbols (e.g., “+”) may also affect children's
arithmetic performance. Therefore, we do not intend to
claim that this study identified all the possible subtypes
of MLD. Ultimately, we hope that this study can provide
a guide for applying CDM in the identification of MLD
subtypes. Future studies can include more numerical
skills to identify more possible subtypes of MLD using
CDM. Second, the MLD subtypes were identified based
on three numerical tasks, each of which was measured
by three to four items. Although CDM requires a shorter
test length than traditional psychometric models (Sorrel
et al., 2016), the small number of numerical items may
have affected the reliability of the tasks and may have
limited the generalizability of the findings. Future re-
search should involve more items for each task. Third,
a critical cognitive-­linguistic antecedent, executive func-
tioning (e.g., working memory), was not included in the
current study. For example, working memory has been
found to affect children's numerical skills such as basic
arithmetic concepts (Desoete & Grégoire, 2006), count-
ing (Geary, 1993), and number-­ numerosity mapping
(Geary, 1993, 2013). It will be worthwhile for future re-
search to examine the role of working memory in con-
tributing to MLD subtypes. Fourth, the present study
only included one mathematical outcome variable (i.e.,
arithmetic reasoning) when examining the predictive va-
lidity of the classification. More mathematical outcome
variables, such as word problem-­ solving and number
fact retrieval, should be included in future studies to val-
idate the MLD subtypes more effectively in different do-
mains of mathematics. Lastly, while there is stability in
MLD, the profiles of MLD subtypes may change due to
development and learning (Mazzocco & Räsänen, 2013).
Future studies could measure numerical skills several
times from preschool to early primary grades to investi-
gate whether the subtypes are stable over time.
Implications
The present study has made important contributions
to identifying and theorizing about MLD subtypes.
The finding that MLD children with different subtypes
showed differences in numerical deficits supports the
heterogeneity hypothesis of MLD and the proposition
that MLD children should not be treated as a homoge-
neous group. Furthermore, this study found that MLD
children with different subtypes differed in mathematical
outcomes (i.e., arithmetic reasoning), indicating that the
heterogeneity of MLD was not temporary but had a lon-
gitudinal effect on mathematical learning. The finding
underscores the necessity of identifying MLD subtypes
and their numerical deficits in early grades. In addition,
this study examined the cognitive-­linguistic antecedents
underlying MLD subtypes, namely, language and spatial
skills. The results extend previous findings and provide a
foundation for custom-­built treatment for MLD children
with different subtypes.
The present study also made important method-
ological contributions to the research field of MLD
SUBTYPES OF MATHEMATICS DISABILITY
subtypes. The study is the first of its kind to use the
CDM approach to identify the subtypes of MLD and
has filled an important research gap in this field. It
demonstrates the feasibility and advantages of this
approach compared with traditional methods and il-
lustrates how to use CDM to classify MLD subtypes,
which can inform future studies.
The present study also has practical implications for
intervening with children at risk for MLD. First, this
study demonstrated that MLD children showed early
numerical deficits. If these children receive appropri-
ate treatment in early years, it may reduce the possi-
bility of their being identified as having MLD in later
years. Second, not only should the treatment be con-
ducted at a young age, but the interventions should be
“custom-­built.” The straightforward reports provided
by CDM can help researchers to develop interventions
for different MLD subtypes. For instance, for MLD
children with the symbolic deficit subtype, teachers can
encourage children to access the meaning of symbolic
numbers in the learning process, such as illustrating
the cardinal or ordinal meanings when learning Arabic
digits. Finally, this research demonstrates the import-
ant role of underlying cognitive-­linguistic antecedents
in contributing to MLD subtypes. Interventions aimed
at improving MLD children's cognitive-­l inguistic com-
petencies may improve their mathematical ability by
addressing root causes. For example, researchers and
educators should pay more attention to the language
difficulties of children with the pervasive subtype.
Training in spatial skills may be helpful for children
with the counting deficit subtype.
F U N DI NG I N F OR M AT ION
This study was funded by three grants from the Academy
of Finland (Nos. 213486, 268586, and 292466).
ORC I D
Xiangzi Ouyang https://orcid.org/0000-0002-5399-6820
Xiao Zhang https://orcid.org/0000-0001-6572-4411
Tuire Koponen https://orcid.org/0000-0003-0039-1016
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