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Reading Assessment or Dyslexia Evaluation?

Where should you start if you suspect your child has a reading disorder or possibly even dyslexia? A reading assessment is a shorter assessment that tests all aspects of reading and phonological processing skills, and may result in a diagnosis of reading disorder. A dyslexia evaluation is a more comprehensive process consisting of client background/history review, a battery of tests, a one hour parent verbal feedback conference, and a 10-15 page report. It is lengthier and costlier than a reading assessment. If you suspect dyslexia but are unsure whether to embark upon the process for a comprehensive dyslexia evaluation, a reading assessment can give you the information you need to decide how to go forward.

With a reading assessment, tests of spelling, written expression, vocabulary/verbal intelligence, auditory memory, and language are not administered. However, all of the same reading and phonological processing tests that are used in a dyslexia evaluation are administered. These tests include: oral reading fluency, reading comprehension, reading of nonsense words, reading of sight words, phonological awareness, phonological memory, and rapid naming (a measure of the speed of visual-linguistic information retrieval - which is highly correlated with reading speed). Once these tests are scored, you will be given a strong opinion as to whether your child's reading and phonological processing skills match a profile of dyslexia. You can then decide whether to schedule the further testing needed for a dyslexia diagnosis. If you elect to continue with a dyslexia evaluation, the reading assessment fees will be applied to the dyslexia evaluation fee. Otherwise, you can stop and receive a reading assessment report with any applicable dignostic code. A reading assessment without a full dyslexia evaluation may result in a diagnosis of Reading Disorder, which may be helpful in obtaining school services and accommodations for reading. A dyslexia diagnosis is a federally protected learning disability and is recognized by the schools.

 

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What is Dyslexia?

Definition of Dyslexia (from International Dyslexia Association)

Dyslexia Basics (Fact sheet from International Dyslexia Association)

 

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Dyslexia Testing - Process and Tests

Process

A dyslexia evaluation is a comprehensive process, not a single test. The first step is a phone consultation, to determine whether a dyslexia evaluation is appropriate. The next step is the gathering and review of client background and family history information. This includes intake forms, any school records provided, IEP records, and any previous evaluation reports. Once this information is reviewed, additional tests may be added to the core battery of tests typically administered for dyslexia.

Dyslexia testing typically takes 3-4 hours. It is scheduled in the morning, so that the student is fresh and not tired from school. For families from out of the area, scheduling for a Saturday is an option. Short breaks are taken throughout the testing, with one longer break midway. The order of tests is varied - tests of reading, writing, listening, and speaking are interspersed so that the student is not performing one type of task for a lengthy period of time.

A one-hour verbal parent feedback conference is scheduled for a week after the testing. For families out of the area, there is an option to conduct this using Skype, Facetime, or phone instead of in-person. The diagnosis and scores are reviewed in detail during this conference. Recommendations and next steps are also discussed. Resources and referrals are provided at that time as well.

A comprehensive written report is the final product of the dyslexia evaluation. This report is typically 10-15 pages in length. It contains background/history, clinical observations, detailed discussion of scores and performance on each test administered, diagnostic summary, a lengthy section of recommendations for home and school, and accommodations recommended for use in a 504 plan at school.

Tests Administered

All tests administered in a dyslexia evaluation are standardized norm-referenced tests. They include tests of the following:

  • Oral reading fluency for passages (both reading accuracy and reading speed)
  • Reading of nonsense words in isolation (decoding/word attack skills)
  • Reading of sight words in isolation
  • Reading Comprehension for passages
  • Phonological Awareness (sound awareness)
  • Phonological Memory (working memory for sounds)
  • Rapid Naming (tests of visual-linguistic retrieval/processing speed)
  • Spelling
  • Written Expression (sentences and a paragraph or essay)
  • Auditory Memory (word lists, sentences, and/or paragraphs)
  • Working Memory
  • Sequencing
  • Vocabulary or Verbal Intelligence Screening (to confirm average verbal intelligence)
  • Any other tests added after background/history review

  • These tests assess the areas recommended by the International Dyslexia Association in their Dyslexia Testing and Evaluation Fact Sheet.

    For adults, different tests may be substituted for some of the phonological processing or auditory memory tests. Please see the section on Dyslexia Testing for Adults later on this page.

     

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    Who is Qualified to Diagnose Dyslexia?

    Dyslexia testing may be performed by a qualified individual or a team of specialists. Individuals qualified to diagnosis dyslexia are qualified professionals with extensive clinical training in diagnosis and assessment in a graduate level program. Degrees may be masters or doctorate degrees in Education, Psychology, Speech Language Pathology, or Educational Psychology. Evaluation by a neuropsychologist is not needed for a diagnosis of dyslexia.

    Typically, psychologists and speech-language pathologists are the professionals qualified to diagnose dyslexia. Speech-language pathologists who perform this testing should have specialized supervised training and experience in the diagnosis of dyslexia. Psychologists with a Ph.D. will use the DSM-V (Diagnosis and Statistical Manual of Mental Disorders, 5th edition) for the dyslexia diagnostic code. Speech-language pathologists belong to the medical field and use the ICD-10 (International Classification of Diseases) for diagnostic codes. This is the same manual of diagnostic codes used by others in the medical profession, including physicians. A diagnostic code from a qualified professional is necessary for a diagnosis of dyslexia.

    The credentials needed to diagnose dyslexia are further detailed in the International Dyslexia Association's Dyslexia Testing and Evaluation Fact Sheet.

    Click here to review the qualifications of Linda Balsiger, MS, CCC-SLP.

    If there is possible ADD/ADHD, that diagnosis can usually be made by a family physician or psychologist, using questionnaires completed by the family and school. If there are behavioral concerns, an evaluation by a licensed psychologist is recommended.

     

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    Is Cognitive/Intelligence Testing needed for a Diagnosis of Dyslexia?

    No. It used to be that a "cognitive discrepancy" or a difference between intelligence scores and scores on educational achievement tests was needed to diagnose dyslexia or other learning disabilities. However, that is no longer the case. In the 1990s, the reauthorization of the Federal Individuals with Disabilities Education Act (IDEA) eliminated this requirement. The new DSM-5 Manual used by psychologists has also explicitly eliminated the IQ-achievement discrepancy requirement. Therefore, complete and costly cognitive or intelligence testing is no longer needed to diagnose dyslexia. A dyslexia evaluation will also uncover weaknesses in processing speed or working memory. For further reading on this topic, click here.

    A typical dyslexia evaluation will include some measures to "screen" or confirm that intelligence is in the normal range. This may be a standardized vocabulary test or a high-level screener of verbal intelligence. This is because dyslexia is an "unexpected" difficulty in acquiring skills in reading and written language. Students with learning delays caused by cognitive impairments do not have "unexpected difficulties" and do not meet criteria for dyslexia or a specific learning disability. For that reason, a vocabulary test or verbal intelligence screening measure is needed as part of a dyslexia evaluation to confirm verbal intelligence in the normal range.

    The changes eliminating the need for cognitive/intelligence testing have not yet trickled down to the arena of college admissions testing. Cognitive testing by a licensed psychologist is still needed to qualify for accommodations on high stakes tests such as the SAT or GRE. It is also often required for accommodations at 4-year universities (but not at most community colleges). If the purpose of testing is to gain accommodations on admissions testing (SAT, GRE, ACT) or to get accommodations at a 4-year university, then dyslexia testing is best performed by a licensed psychologist who can administer comprehensive intelligence testing. Most 4-year universities have an Office of Disability Services that provides the exact requirements needed for accommodations at that school, including specific diagnostic tests that are mandatory. Testing for college admissions or accommodations testing must usually occur within the past 3-4 years, so students with an older diagnosis of dyslexia will likely need to undergo re-testing. However, any previous diagnosis can be helpful as part of the background and history in re-confirming that diagnosis.

     

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    Learning Disability Testing in the Schools

    Educational psychologists (M.Ed) in public schools conduct evaluations to assess whether a student has a learning disability that renders him/her eligible for an IEP (Individualized Education Plan) or a 504 Accommodations Plan. They do not diagnose dyslexia and do not provide any kind of diagnostic code as a result of the evaluation. The educational psychologist performs the testing, identifies the presence or absence of a learning disability, and writes a report that is then provided to the school IEP team to make a decision about eligibility for an IEP and/or accommodations.

    Before a school evaluation is scheduled, schools typically first try to provide intervention services and monitor response to intervention (RTI). If a student fails to respond to targeted interventions (such as a specialized reading group) over a period of time, then the student may be referred for a school educational evaluation. This process can take several months, and some parents elect to pursue a learning disability diagnosis outside the school system so that they can speed up the process of obtaining an IEP and/or accommodations.

    New Oregon state legislation regarding screening for dyslexia is discussed below in Dyslexia Legislation and the Public Schools. This legislation is an important step forward, but it is important to note that the new dyslexia screening requirements only target K-1 students, and this screening does not provide a diagnosis of dyslexia or result in an IEP plan or 504 plan for accommodations.

     

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    Dyslexia Legislation and the Public Schools

    The word dyslexia has always been recognized as a learning disability in Federal special education law (IDEA 2004, 20 U.S.C 1401 (30)), but states have been slower to recognize this diagnosis. In 2015, Oregon passed 2 important laws related to recognizing dyslexia in the public school system. The first of these, House Bill 2412, requires the Oregon Teacher Standards and Practices Commission (TSPC) to require educator preparation programs to include instruction regarding dyslexia that is consistent with the knowledge and practice standards of an international organization on dyslexia (such as the International Dyslexia Association's Knowledge and Practice Standards.

    The second, Senate Bill 612, requires schools to develop a plan for screening for dyslexia screening in kindergarten and first-grade students. Parents must be notified if screening indicates that their child exhibits signs of dyslexia. It also requires schools to develop in-service general education training regarding what dyslexia is and how to best teach and support students with dyslexia. Districts are required to have at least one teacher in each K-5 school with training about dyslexia by January 2018. Funding for a Dyslexia Specialist position in the Oregon Department of Education was provided as part of this bill. The Oregon Department of Education has as summary of these requirements and the status of their implementation of the law at this web page.

    Detailed information about these laws is available at Decoding Dyslexia Oregon.

    These laws are exciting progress in the recognition of dyslexia in the Oregon public schools. Oregon now joins at least 28 states with statewide dyslexia laws.

    At the Federal level, the Bipartisan Congressional Caucus on Dyslexia was established in 2012 so that legislators across party lines could work together in educating the public about dyslexia and developing policies to support individuals with dyslexia. Information about new federal legislation or resolutions regarding dyslexia is often available at their website.

    The International Dyslexia Association also maintains a web page on current dyslexia legislation.

     

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    Dyslexia Testing for Adults

    Dyslexia testing for an adult may be different than testing for a child, because some tests have upper age limits of 21 or 24. An adult dyslexia evaluation will include many of the same measures of reading , writing, and spelling, but may not include the same measures of phonological processing. Additional tests of memory and learning are typically administered when testing adults for dyslexia.

    Adults seeking testing should have a clear idea of what they hope to gain from the testing. For 4-year university accommodations, specific test requirements are often needed and a licensed psychologist may be needed (see Is Cognitive/Intelligence Testing needed for a Diagnosis of Dyslexia? earlier on this page). Adults seeking accommodations at their jobs or seeking redress from job discrimination for learning disabilities are also better served by seeking testing from a licensed psychologist.

    Insurance rarely covers dyslexia testing in adults. Because such testing is expensive, some 2-year community college programs accept less lengthy reports from qualified professionals for individuals seeking accommodations. This can lower the cost of the dyslexia evaluation. This may be a possibility on a case-by-case basis and should be discussed when scheduling an evaluation. Adults seeking a dyslexia diagnosis for the first time should have a scholastic background and history consistent with a diagnosis of dyslexia.

     

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    Other Learning Disability Evaluations

    There are many other learning disabilities apart from dyslexia. Many students have no difficulties with reading, but have disorders that include written expression, spelling, and/or handwriting (dysgraphia). Other students may have dyscalculia, or disorders of math. A dyslexia evaluation may sometimes result in a diagnosis of a disorder of written expression or spelling, instead of dyslexia, but math testing is not included in a standard dyslexia evaluation. Evaluations for other learning disabilities, including math, can be tailored to the specific difficulties the student is experiencing.

     

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