From Parenting New Mexico October1999

ARTICLE TWO OF FOUR ARTICLES ON
LEARNING DISABILITIES

Diagnosing Learning Disabilities:
Untangling the Mystery

In last month's article describing Learning Disabilities (LD) we discussed the complexity and many forms of LD. It is the complex nature and many types which make the diagnosis a multi-dimensional task requiring the assessment of many abilities. A full LD evaluation is a complicated array of diagnostic tests designed to systematically determine whether an individual is having difficulty in one or more of the many skills which go into readin', 'ritin', and 'rithmatic.

LD evaluations are usually completed by educational diagnosticians in the public schools or by psychologists with special training in educational/school psychology or neuropsychology. Helpful ancillary testing is often obtained from speech and language pathologists and occupational therapists.

In this article we describe the many skill areas which must be assessed. In next month's article we will build on these to discuss Dyslexia (reading disorders) and Disorders of Written Expression.

Intellectual Functioning.

To determine that someone has a disability in one of the areas labeled LD relates to their general intellectual functioning. Being one grade level behind in math, for example, may be a marked disability for a very gifted child, while being two grade levels behind may be somewhat expected for a student whose overall functioning is well below average.

For this reason, an LD evaluation begins with an assessment of the individual's IQ. In school-based evaluations, an individual intelligence test taking about 90 minutes is the starting place of an assessment. The most common IQ test involves a series of subtests assessing different skills which are grouped into Verbal Subtests (those which require language for the child's response) and Performance Subtests (those not involving language). Other uses of the IQ test in school evaluations is discussed later in the article. In private evaluations short forms of the IQ test are often used when the IQ is assumed to be average, or there is previous testing.

Based on the IQ estimate, the evaluator has a baseline for comparing other skills, such as reading and mathematical abilities. The IQ estimate provides an estimate of what to expect from the child. Major deviations above this are labeled talents while major deviations below are called disabilities.

Academic Achievement.

For comparison to the expected levels based on the IQ estimate, the child's basic academic skills are assessed. Important academic skills evaluated are: word decoding (ability to read individual words), reading fluency (reading sentences and paragraphs), reading comprehension (knowing the content of what has been read), written expression (spelling and the ability to write paragraphs/stories), and knowledge and application of mathematics.

In my evaluations I measure spelling and mathematical skills both in mental functioning (spotting correctly spelled words and understanding math concepts) and with on-paper production (writing spelling words and doing math problems). I am often amazed at the difference between in-the-head abilities and what is produced on paper.

Language Abilities.

Assessing language skills is critical in an LD evaluation. The evaluator must establish the child's skill levels in: spoken language, receptive vocabulary (words recognized when others use them), expressive vocabulary (words he/she can actively use), fluency, and syntax (grammar). When there are strong concerns about a child's functioning in these areas, a separate evaluation by a speech and language pathologist is warranted. When the basics of speech are intact, the assessment moves to phonological processing - the ability to manipulate sounds (phonemes) and letter combinations representing sounds to make words (phonics). When a child is struggling with phonological processing, reading and spelling will be impaired, and remediation of these skills is needed. We will discuss phonological processing more in next month's article on Dyslexia.

Specific Information Processing Skills.

There are a number of mental data processing abilities other than language which are needed to perform school tasks. Most prominent to assess are fine motor abilities, visual-spatial skills, and memory proficiency.

Fine motor skills as related to learning disabilities involve being able to hold a pencil correctly, draw easily within small spaces like the lines on a piece of notebook paper, and, for older children, being able to learn typing and the use of a keyboard. When there are distinct weaknesses, an evaluation of coordination skills may be needed from an occupational therapist.

Visual-spatial skills involve visual perception (for example, being able to see that an N is made from two vertical lines and a diagonal while knowing that H is similar but not the same) and visual-motor integration (being able to see an N and then draw it). Major impairments here create havoc in perceiving letters correctly and writing words. Mild impairments (often seen with older children and adults) produce slowness in reading. Problems here also create trouble in doing mathematics; like the boy doing a long division problem who remarked, "I can't ever keep the columns of numbers straight. Does that matter?"

Memory problems come in about as many variations as there are ice cream flavors at Baskin Robbins. Especially important to evaluate in LD testing are forms of sequential memory, memory for the order of things. Remembering order requires neurological processes different from remembering what just happened. Many LD individuals have problems with these processes, especially auditory sequential memory (remembering step wise directions that the teacher gave, for example, or when using phonics remembering the sounds so you can put them all together to say the word) and visual sequential memory (being able to visualize a word in your mind when trying to spell it). So often when I start these testing procedures the kids blurt out, "Oh no, this is going to be hard!" And I know that I have a kid who has trouble following directions and remembering that "picnic" ends with a c not a ck.

Public School Evaluations.

Whether your child is assessed by the public schools or privately, all evaluators are looking to determine talents, average abilities, and disabilities. However, the schools have an extra burden - how to evaluate hundreds of children in many schools by different evaluators and keep the process impartial and consistent. In an attempt to maintain fairness and consistency, the New Mexico Department of Education, like most other states, has a very numerically-based definition of what is a learning disability and what isn't. In New Mexico a child's test score in one or more areas of academic achievement must be a certain number of points or more (the amount varies with grade level) lower than his/her IQ score (where both tests have 50th percentile score set at 100). Meeting this standard for a discrepancy between IQ and achievement qualifies a child for receiving special education services while scores differing by a smaller amount may certainly mark a significant problem but will not qualify a child for the official school label of LD or for special services. While most experts in LD disagree with the use of this "discrepancy formula," alternative LD definitions which can be used by schools have been difficult to craft.

In non-school evaluations we can investigate the full continuum of strengths and weaknesses including mild problems and weak skills which may be producing subtle effects on learning and performance. However, school-based evaluations will remain how most children are assessed, and the basic test battery designed by the schools, having a full IQ test compared to an achievement test, continues to be necessary for an LD child to be designated eligible for special education.

Since school-based evaluations are by far the most prevalent, I provide an outline of the process in the graphic (far right). The process begins with a referral from a parent, teacher, or other knowledgeable individual asking the school to provide extra assistance. First the School Support Team (consisting of regular classroom teachers and special education staff) reviews the options for providing help to the child. If an evaluation for special education services is warranted, a battery of tests, including the IQ and achievement tests, is given by an educational diagnostician. Finally, the diagnostician's findings and recommendations are reviewed by the Individual Educational Plan (IEP) Committee consisting of parents, teachers, school administrators, and special education staff. In the meeting a formal document is drawn up outlining the program to be provided - called the Individual Educational Plan (IEP). The IEP and all processes within special education are defined by federal law (the Individuals with Disabilities Education Act - IDEA) and state Department of Education regulations.

When to Seek an Evaluation.

There are no hard and fast rules for when a child should be evaluated. Here are some guidelines for when an assessment has the strong possibility of uncovering a true problem and leading to needed remedial help.

For Four and Five Year Olds, if the child:

• is distinctly delayed in speech and language compared to peers
• can't write his/her first name by the middle of the kindergarten year
• can't identify or write most of the letters of the alphabet correctly by late in the kindergarten year.

In Middle to Late First Grade, if the child:

• can't reliably read or spell very common words such as "the" and "with"
• can't routinely say the sounds associated with "m," "k," "ch," or "sl"
• struggles with basic arithmetic such as knowing the answer to 6 minus 3 or 5 plus 6.

For Older Children, if the child:

• functions in a skill like children three quarters of his/her age or younger
• is getting Ds and Fs yet is distinctly trying
• takes nearly double or more time to complete homework compared to peers.

At any age, an evaluation is warranted if a child puts forth a good,
sustained effort in a basic academic skill, but remains highly frustrated in either learning or using that skill. Excessive frustration is a red flag that something is wrong.

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Dr. Zieman is an Albuquerque psychologist who specializes in the evaluation of child and adolescent disorders. He also works with people having ADHD.

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Learning Disability Articles
Part 1 | Part 3 | Part 4

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Copyright by Parenting New Mexico and Gayle L Zieman PhD. This article may not be published in part or in its entirety in any medium without written permission from Gayle L Zieman PhD or Parenting New Mexico magazine. Links to this page are welcome.