Understanding Learning Disabilities, Part II

In my last post I discussed the definition of a learning disability and some of the factors that lead to detection and the decision to do a formal assessment. In this post I’ll talk about how such assessments are done, how I approach the task, and how my role differs from and dovetails with the role of a school psychologist.

There are four stages to a learning evaluation: preliminary data gathering, the actual testing, interpretation of the results and follow-up consultation with parents and school officials on implementing interventions. Once a child is referred to me for a learning disabilities assessment, the first thing done is to meet with parents (and sometimes with the child as well, especially if they are in late elementary school or beyond) to get a detailed history and description of the problem. The history will include a description of how the child’s development progressed, especially with regard to speech and language, but also in the domains of motor skills and other nonverbal functions. A review of the child’s medical history will shed light on whether there might be any physiological factors, such as premature birth, that might put the child at risk for learning problems. A description your child’s everyday behavior, their relationships with other children, and their ability to focus and cooperate with home and classroom routines helps determine whether attention problems or emotional and behavioral issues might be interfering with progress in school. I will usually ask parents and teachers to complete some questionnaires that further help assess those areas.

Once the decision is made to test for learning problems, there are two approaches that I might take. One is to do a brief screening battery focused on a single area of achievement, such as reading fluency. The results of such limited testing usually are not sufficient to diagnose a learning disability, but they can be useful in determining whether more comprehensive testing might be needed. Sometimes a screening evaluation can be enough to convince the school system to do further testing, which can save a family considerable out of pocket expense. In many cases, such as when a school resists assessing the child, or when the family simply prefers to seek testing through private channels, I end up doing a more comprehensive assessment.

A comprehensive assessment to diagnose or rule out a learning disorder involves a number of tests covering both the child’s cognitive ability and their level of academic achievement. Cognitive ability, or “intelligence”, is the term used for a child’s native ability to perform a wide variety of functions of which human brains are capable. Academic achievement refers to what a child has learned in school, particularly in terms of basic skills such as reading, math, writing, and oral language. The goal is to use the test results to form and test hypotheses about the relationship between the child’s cognitive ability and their performance in school. Unlike the standardized group tests that are used a regular intervals in the schools for screening purposes, the battery is individualized to assess the specific needs of the individual child. The tests are administered in a one on one setting, where I present the items to the child, and work to make sure that they maintain attention and motivation throughout the session. Observation of the child’s attitude during the testing, and their approach to solving the problems presented to them can provide crucial information that adds to the assessment. Depending on the extent of the battery, testing can take anywhere from 3 to 6 hours. In most cases the assessment is broken up into separate sessions of about 2 hours in length, though younger children sometimes require shorter sessions.

Cognitive ability is tested using any of a number of standardized test batteries, sometimes popularly known as “IQ tests”. The term IQ test has generally fallen out of favor among professionals, primarily because it promotes the notion that a single number can adequately summarize a person’s ability in a wide range of areas. For the average person, who by definition has average ability in most areas, this may be more or less true. For children with learning problems it is rarely the case. A test of cognitive ability will assess the child’s performance in several areas. The test I use most frequently produces scores for both verbal and nonverbal reasoning ability – that is, the ability to process information and solve problems both with and without the use of language. It also assesses two important areas that I think of as “support services” for the child’s reasoning ability. These are labeled Working Memory and Processing Speed. Each area is assessed by several shorter subtests. Once the scores are obtained it is my job to consider what the similarities and differences among the various areas of ability may mean, and what their implications may be for the child’s school performance.

Following the test of cognitive ability, I generally administer a broad-based battery of academic achievement tests. Such a battery will almost always include tests of reading, including both mechanics and comprehension; tests of mathematics ability, including both the ability to perform straightforward calculations and to solve applied problems; a writing portion, which assesses spelling, grammar and mechanics, and the ability to develop and express a theme; and tests of expressive and receptive oral language. Depending on the individual child’s strengths and weaknesses, and the specific concerns of teachers and parents, one or more of these areas might be targeted for more extended assessment.

Once testing is completed, the next step is score the tests using statistical norms that compare the child’s performance to the average of other children their age, compile the results, and meet with parents in an interpretive conference. My goal is to describe for parents their child’s strengths and weaknesses, the nature of any learning problems, and any influence their learning style might have on the progress of their education. I will also describe my recommendations for the most appropriate interventions for that child. In this meeting I will usually have the time to provide a much more comprehensive interpretation of the test results than busy school psychologists are usually able to do. I also have the luxury of providing a complete description of the child’s abilities and the optimal interventions for their learning problems. This differs a bit from the school psychologist’s role, as they are constrained by their obligation to determine whether or not your child meets the state’s definition of conditions which are entitled to receive special services, and which of the programs available in your district might be the best fit for your child’s needs.

Of course, the next step in this process has to be fitting my recommendations to the services available at school. I provide a detailed written report of the test results and my findings, which parents can use to seek services from the school district. I am also always happy to meet with school officials to provide further input, and to help in matching the right interventions to your child’ needs.

In a future post I’ll have more to say about specific learning problems, especially those to do with reading. More parents seek evaluations for dyslexia than for any other learning problem, and reading is the area about which we have the clearest research findings to guide clinical and educational practice.