Where to Start

Typically you are at this point because your child’s school has expressed concern regarding his/her academic achievement in the classroom.  Sometimes parents are not surprised because they have watched their child struggle developmentally in the past, but for others this may be the first mention of concern. Sometimes the biggest hurdle is just getting started.  The questions start.  Does he/she have dyslexia, learning disability, ADD/ADHD, auditory processing, visual impairment, etc? The thought of seeing this many professionals for testing is daunting. It does take a united team to develop an appropriate intervention plan, but all of this testing may not be necessary right away.  It is best to consult with a professional to help you navigate the process. If you child is enrolled in a public school system, the special education department will guide you through this process which may involve a comprehensive evaluation including intelligence, academic achievement, reading fluency, spelling, reading comprehension, and language development. If your child is enrolled in a private school you will likely be referred to outside professionals for guidance. A team evaluation consisting of input from a Educational Psychologist and Speech-Language Pathologist would be an appropriate start.  These two professionals can evaluate the fundamental aspects of reading development and screen additional areas which may be contributing to challenges in the classroom.

The following information was taken from the International Dyslexia Association at http://www.ida-umb.org/pages/Testing-Diagnosis.cfm.

Testing & Diagnosis

Testing & Diagnosis

Generally, no one individual has all the common “characteristics/symptoms” of dyslexia, but if he/she has quite a few, then they should be properly evaluated.

If you suspect dyslexia or other language-based learning disability, a good place to start the diagnosis process is by talking with your child’s teacher about your concerns. Teachers may be able to offer valuable insight into how your child learns and areas of deficit. Next, request a formal educational evaluation through your public school by submitting a written request to your principal. Be aware that, in Minnesota, most school districts do not use the term “dyslexia,” so you should request to have your child evaluated for a Specific Learning Disability (SLD) in the areas of language skills—reading, spelling and writing. Include a list of the characteristics you see as symptomatic for your child and any other observations or concerns you may have.

“The single-most important factor in planning for a child with a learning disability is an intensive diagnostic study. Without a comprehensive evaluation of his deficits and assets, the educational program may be too general, or even inappropriate.”
– Dr. Marianne Frostig

Keep in mind that many districts are not equipped to make formal diagnoses of language-based learning disabilities; and diagnosis and testing are particularly important as they paint a detailed picture of your child’s areas of weakness and help to determine best methods of remediation. If you suspect your school cannot provide adequate testing or diagnosis, ask your pediatrician for a referral to a qualified specialist to get your child evaluated.

Evaluation is a more accurate term to describe the process of diagnosing dyslexia. The word encompasses identification, screening, testing, diagnosis and all the other information gathering involved when the learner, his or her family and a team of professionals work together to make a formal assessment.

What should be included in the evaluation?

Background information
Information from parents and teachers tells us a lot about a student’s overall development and pattern of strengths and weaknesses. Because dyslexia is genetically linked, a family history of dyslexia indicates that a student is more likely to have dyslexia. A history of delayed speech or language also puts a child at-risk for reading difficulties. It is important to know the types and length of time of any interventions the student has received at school, home or through tutoring, as well as the student’s response to the intervention. School attendance problems should be ruled out. A history of poor attendance, alone, can explain an identified weakness in skill development.

Until recently, an intelligence test was considered to be a necessary part of the evaluation because the diagnosis of a learning disability was based on finding a significant difference between IQ and reading skill. Poor achievement despite average or better intelligence was considered a key indicator. Current regulations no longer require that such a discrepancy be present when making a diagnosis. This change in the regulations came about because many studies have shown that intelligence is not the best predictor of how easily a student will develop written language (reading and spelling) skills. Instead, oral language abilities (listening and speaking) are considered the best predictors of reading and spelling.

A formal measure of intelligence is not always needed to document average intellectual abilities. For younger children, parent information about language development and teacher information about the child’s ability to learn orally may indicate average intellectual abilities. For older students or adults, past achievement in school or work may indicate at least average intelligence.

Oral language skills
Oral language, simply stated, refers to our ability to listen to and understand speech as well as to express our thoughts through speech. Oral language is made up of low-level skills, such as recognizing and making the sounds within our speech, and higher-level skills, such as getting meaning by listening to someone speak or creating sentences to express thoughts. Students with dyslexia typically have adequate higher- level language skills. Indicators of higher-level oral language skills include being able to understand an age-appropriate story and spoken directions, to carry on a conversation, and understand and use words that are age appropriate. If a student has average higher-level oral language skills but much difficulty developing written language (reading and spelling) skills, the need for evaluation for dyslexia is recommended.

Although students with dyslexia usually have strong higher-level language skills, they typically have problems (a deficit) in low-level language skills (see following section “Phonological processing”). This deficit limits the ability to learn to read and spell using the sounds of the language. Young children with dyslexia often have delays in language development, but their higher-level language skills are usually age- appropriate by the time they enter school. Difficulties with higher-level language skills suggest a need for a language evaluation by a speech-language pathologist to rule out language impairment.

Word recognition
Word recognition is the ability to read single printed words. It is also called word reading or word identification. Tests of word recognition require that students read individual words printed in a list. The student is not able to use cues, such as the meaning of a sentence, to help them figure out the word. Tests of word recognition that score both accuracy and the time it takes for the student to read the words (fluency) are particularly useful. Students with dyslexia often become accurate but are still very slow when reading words. Both accuracy and the speed of word reading can affect understanding what is read.

Decoding is the ability to read unfamiliar words by using letter-sound knowledge, spelling patterns and chunking the word into smaller parts, such as syllables. Decoding is also called “word attack”. Decoding tests should use nonsense words (words that look like real words but have no meaning, such as frut or crin) to force the student to rely on these decoding skills rather than on memory for a word already learned.

Tests of spelling measure the student’s ability to spell individual words from memory using their knowledge of, for example, letter-sound pairings, patterns of letters that cluster together to spell one sound (igh in high; oa in boat), the way plurals may be spelled (s, es, ies) and so on. Spelling is the opposite of word attack but is even more difficult. It requires separating out the individual sounds in a spoken word, remembering the different ways each sound might be spelled, choosing one way, writing the letter(s) for that sound and doing the same, again, for the next sound in the word. Spelling stresses a child’s short and long-term memory and is complicated by the ease or difficulty the child has in writing the letters, legibly and in the proper order. Spelling is usually the most severe weakness among students with dyslexia and the most difficult to remedy.

Phonological processing
Phonology is one small part of overall language ability. It is a low-level language skill in that it does not involve meaning. Phonology is the “sound system” of our language. Our spoken language is made up of words, word parts (such as syllables), and individual sounds (phonemes). We must be able to think about, remember, and correctly sequence the sounds in words in order to learn to link letters to sounds for reading and spelling. Good readers do this automatically without conscious effort. However, students with dyslexia have difficulty with identifying, pronouncing, or recalling sounds. Tests of phonological processing focus on these skills.

Automaticity/fluency skills
Students with dyslexia often have a slow speed of processing information (visual or auditory). Tasks measure Naming Speed (also called Rapid Automatic Naming). Sets of objects, colors, letters, and numbers are often used. These items are presented in rows on a card, and the student is asked to name each as quickly as possible. Naming speed, particularly letter naming, is one of the best early predictors of reading difficulties. Therefore, it is often used as part of screening measures for young children. Slow naming speed results in problems with developing reading fluency. It also makes it difficult for students to do well on timed tests. Students with both the naming speed deficit and the phonological processing deficit are considered to have a “double deficit.” Students with the double deficit have more severe difficulties than those with only one of the two.

Reading comprehension
Typically, students with dyslexia score lower on tests of reading comprehension than on listening comprehension because they have difficulty with decoding and accurately or fluently reading words. It is important, however, to be aware that students with dyslexia often have strong higher- level oral language skills and are able to get the main idea of a passage despite difficulty with the words. Further, reading comprehension tasks usually require the student to read only a short passage to which they may refer when finding the answers to questions. For these reasons, students with dyslexia may earn an average score on reading comprehension tests but still have much difficulty reading and understanding long reading assignments in their grade-level textbooks.

Vocabulary knowledge
It is important to test vocabulary knowledge, because vocabulary greatly affects understanding when listening or reading. Difficulties students with dyslexia might have had in learning language or with memory can affect the ability to learn the meanings of words (vocabulary). Independent reading is also an important means for developing new vocabulary. Poor readers, who usually read less, are likely to have delays in vocabulary development. It is important to note, however, that students with dyslexia may perform poorly on reading vocabulary tests because of their decoding problems and not because they don’t know the meaning of some words. For this reason, it is best to administer both a reading and listening vocabulary task to get a true measure of vocabulary knowledge.
The profile of strengths and weaknesses of an individual with dyslexia varies with age, educational opportunity and the influence of co- occurring factors such as emotional adjustment, ability to pay attention in learning situations, difficulties with health or motivation. Nevertheless, clusters of distinguishing characteristics are frequently noted.

Family History and Early Development

  • Reports of reading/spelling difficulties across generations in the family
  • Normal prenatal and birth history
  • Delays/difficulties acquiring speech/language
  • Difficulty with rhyming, blending sounds, learning the alphabet, linking letters with sounds
  • Difficulty learning rules for spelling— spell words the way they sound (e.g., lik for like); use the letter name to code a sound (lafunt for elephant)
  • Difficulty remembering “little” words— the, of, said—that cannot be “sounded out”
  • Listening comprehension is usually better than reading comprehension—may understand a story when read to him but struggles when reading the story independently.
  • Reluctant readers
  • Slow, word-by-word readers; great difficulty with words in lists, nonsense words and words not in their listening vocabulary
  • Very poor spellers—miscode sounds, leave out sounds, add or leave out letters or whole syllables
  • Non-fluent writers—slow, poor quality and quantity of the product
  • When speaking, may have a tendency to mispronounce common words (floormat for format); difficulty using or comprehending more complex grammatical structures
  • Listening comprehension is usually superior to performance on timed measures of reading comprehension (may be equivalent when reading comprehension measures are untimed)
  • Weak vocabulary knowledge and use

Outcomes of an evaluation
An evaluation should result in a written report. This report should detail the kinds of information collected. This includes information related to the family literacy history, any significant medical issues the child may have, prenatal and birth conditions, and preschool development, including language learning. The education history should include information on school attendance, tests administered and test scores. These scores should be stated as standard scores. Standard scores compare the learner to others of the same age or grade. This material should provide the framework for the detailed evaluation of relative strengths and weaknesses across the various skill areas assessed as well as the overall fit of all information with the typical profile of dyslexia for the child’s age. This should lead to a tentative diagnosis that states that the child’s ability to learn to read, write and spell does or does not appear to be related to dyslexia. The specific evidence that supports the diagnosis should be explained in the report.

A diagnosis of dyslexia begins with the gathering of information gained from interviews, observations and testing. This information may be is collected by various members of a team that includes the classroom teacher(s), speech/language pathologist, educational assessment specialist(s), and medical personnel (if co-occurring difficulties related to development, health or attention are suspected).

The task of relating and interpreting the information collected should be the responsibility of a professional who is thoroughly familiar with the important characteristics of dyslexia at different stages in the development of literacy skills. This professional should also have knowledge of the influence of language development and behavior on literacy learning. Often, school psychologists and/or speech- language pathologists are responsible for this task.

CAUTION: An initial diagnosis of dyslexia should be offered only as a tentative conclusion based on the data available. A poor reader may appear to “fit the profile” of dyslexia. However, if the learner responds quickly to appropriate intervention, the source of the reading problem is more likely related to earlier educational opportunity than to problems in the child’s physical makeup that limit the ability to learn from the instruction provided. The ability of the learner to benefit from instruction that is focused on the basic skills that support reading and spelling provides valuable information necessary to support or reject the initial diagnosis.

Intervention planning
Finally, the report should identify instructional programs that appear to be appropriate in meeting the specific skill(s) gaps and weaknesses identified through the evaluation process. Many children have already mastered some beginning reading skills. Thus, it is not always necessary or reasonable for a child to be placed in the very beginning lessons of a program. Although some programs have a placement test which helps the teacher to know where instruction should begin, many do not. For this reason, information about the child’s specific skill needs should be detailed in the report to assist in identifying the starting point for instruction. Recommended programs or intervention strategies should be consistent with the types of content and methods that research has shown to be effective for students with dyslexia and other poor readers. If warranted, a recommendation for further testing—vision, hearing, fine motor control (occupational therapy), attention, emotional adjustment—might also be included.

The evaluation report should provide the documentation necessary to determine eligibility for special services, including special education. The specific guidelines for determining eligibility are based on federal regulations set forth by IDEA. It is important to note, however, that the specific criteria, such as cutoff scores for eligibility vary from state to state. The parent or guardian of a child with dyslexia must advocate for the best possible educational opportunities for that child. Effective advocacy requires understanding the diagnostic report and knowing the child’s rights under the law.

Source: http://www.ida-umb.org/pages/Testing-Diagnosis.cfm.


Kandi McMahan M.A., CCC-SLP
Knoxville Based ~ Speech-Language Pathologist

For more information you may contact me at info@kandimcmahan.com

KANDI MCMAHAN, M.A. CCC-SLP IS A KNOXVILLE, TN BASED SPEECH-LANGUAGE PATHOLOGIST SPECIALIZING IN ACADEMIC-BASED INSTRUCTION IN LANGUAGE, READING, AND WRITTEN EXPRESSION. Kandi holds both state certification, and national recognition by the American Speech-Language-Hearing Association. She graduated from the University of Tennessee with a masters degree in Speech-Language Pathology and a concentration in Aural Rehabilitation. She has had extensive experience working with a wide variety of academically challenged students including those with ADD/ADHD, Dyslexia, Auditory Processing Disorder, Learning Disability, Disorder of Written Expression, Speech-Language Disorder, Autism Spectrum Disorder, and many others. She has a passion for helping “gray area” students achieve academic and college success on par with their intellectual potential. She shares her spare time with her artistic husband and energetic young daughter. Kandi is also an avid photographer and lover of all things art and design inspired.

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