What is Dyslexia or Reading Disorder and How Do Learning Disability Evaluations Work in Your Charlotte, NC Practice?
Specific learning disorder (SLD), of which dyslexia or reading disorder is one type, is a clinical diagnosis that is not necessarily the same as ‘learning disabilities’ as identified within the education system: that is, not all children with learning disabilities/difficulties identified by the school system would meet a DSM-5 clinical diagnosis of SLD.
So What is Dyslexia?
Dyslexia is the medical term for a hardwired difficulty learning to read. Children with dyslexia have normally developing intellect, but their ability to connect sounds to letters, and read fluently does not keep up with that of their classmates’. This results in considerable frustration. Most children, incorrectly, conclude that they must be “stupid” if they cannot learn to read. They may begin to act up in school to divert attention from their reading deficit. They may appear to have trouble concentrating, particularly when reading or writing.
We now know a lot about what happens in the brains of dyslexic children. fMRI scans (brain scans that take real time images of children’s brains as they read) tell us that children with dyslexia process reading differently in their brains than typically developing children. When children and adults without dyslexia read, the information is processed on the left side of their brains, moving from back to front. Children with dyslexia do not show this typical pattern. However, after intensive, scientifically based reading instruction, these brain differences can disappear. The key is intensive, EARLY intervention.
Sally Shaywitz, MD and her group at Yale, 2004 found that after a year of intensive, 50 minute per day, one on one instruction with a scientifically based reading program, not only did reading improve, but the brain activation patterns of children changed during reading tasks. These changes continued to be measured one year after the experiment.
Does My Child Have Dyslexia?
Because research indicates that early intervention produces the best outcomes, it is important to seek a comprehensive assessment early. “Wait and see” often results in a significant amount of lost instruction time and also increases frustration for children.
Scientists in the area of learning disorder have determined that problems in phonological awareness are responsible for reading disorder. Phonological awareness refers to an individual’s awareness of and access to the sound structure of his or her oral language. It includes the individual’s ability to access speech sounds and put them together to make words. The spoken word “bat” has three phonemes – “B-A-T” – each of which happens to correspond to the sound made by the three letters of the printed word BAT. Children (and adults) who are weak in phonological awareness show improvement in their word-level reading skills after being given intervention designed to improve phonological awareness. Phonological memory is also very important for reading (this refers to coding information phonologically for temporary storage in short-term or working memory). Phonological memory supports the role of working memory in comprehension. A problem with phonological memory does not have to lead to poor reading of familiar material, but is more likely to impair decoding of new words, particularly words that are long enough to sound out bit by bit. A deficit in phonological memory may not negatively impact listening or reading comprehension for simple sentences but may do so for more complex sentences. Another kind of functioning essential for phonological processing is rapid word naming.
Neuropsychological evaluation of reading can provide us with information about where the breakdown in reading is! The reading assessment begins with a measure of intellect, memory, attention, and frontal executive network function. I administer the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) in children ages 7 years, 7 months up to age 15, and the WISC-V or Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) beginning at age 16. The WAIS-IV may be administered at age 17. All of the above skills are important building blocks in your child’s ability to read. Phonological processing skills (phonological memory, awareness) are then assessed, including connections between sounds and letters, and rapid access to this stored information in the brain. To assess these skills, I use the Comprehensive Test of Phonological Processing – Second Edition (C-TOPP-2) and the Woodcock-Johnson Test of Cognitive, Achievement, and Oral Language Abilities, Fourth Edition (WJ-IV). Some of these tests also give us a picture of your child’s reading, writing, and mathematics achievement, which is essential for a learning disability evaluation. Your child is then given a series of reading tests which measure their ability to sound out nonsense words, recognize sight words, read aloud accurately and fluently, and comprehend what he or she has read. I use the Nelson Denny reading test as well as reading subtests from the WJ-IV above and the Wide Range Achievement Test (WRAT) to further assess the skills involved with reading and writing.
Because dyslexia often is accompanied by other learning difficulties, such as poor attention, expressive or receptive language problems, or other academic weaknesses, the comprehensive neuropsychological evaluation goes on to ask and answer the questions “Are there other learning disabilities present that will get in the way of successful treatment if not addressed?” and “What are my child’s strengths that we can harness to make the treatment more effective?” Thus, a reading disability evaluation also screens for other learning disabilities such as a disorder of written expression or a non-verbal learning disorder.
What is the Reading Disorder / Dyslexia Evaluation Like?
To accomplish the reading disorder/dyslexia evaluation, the first appointment you will have with Dr. Messler is a Parent Interview. This appointment is 1-2 hours long during which you will speak with Dr. Messler about your concerns. Dr. Messler will ask you questions about your child’s medical history, behavior, learning and attentional concerns, and personality. Dr. Messler’s comprehensive and compassionate approach means you will have plenty of time to ask questions and discuss your child. Please do NOT bring your child to this appointment. This will allow you to talk freely and devotee all your attention to the conversation. Dr. Messler will give you a teacher questionnaire to be given to the child’s teacher at the time of this meeting, and will seek permission to discuss your child with your child’s teacher at this time.
The second appointment is a Child Interview. Dr. Messler will spend most of this hour with your child. Dr. Messler will ask your child about their feels and experiences in order to gain a better understanding of their perspective. Then Dr. Messler will do some cognitive testing with your child, which can be done on the computer and will also be done using paper and pencil. This can look like asking your child to remember lists of words or read words or paragraphs.The length of the testing will be pre-arranged with Dr. Messler and depends on the question we are trying to answer. For the testing, children are tested alone without parents present since having parents present has been shown to impact the child’s performance. After testing is completed, a feedback session will be conducted in approximately 2 weeks to discuss the test results. I prefer to do a feedback session with the parents first, and then to arrange for a separate feedback session where the child is present, in order to discuss the results with him or her. Parents may be present for this.
Dr. Messler also assesses for ADHD as a part of all of her learning disability evaluations. Dr. Messler previously worked with Dr. Keith Conners at the Duke ADHD Program and utilizes his methodology and instruments for assessing ADHD.
The neuropsychologist (Dr. Messler) will also need to review any student study team (SST) meeting documentation plans, individual education programs (IEPs), previous psychoeducational reports, neuropsychological assessment reports, psychiatric/neurologic consultation reports, imaging results, and remediation reports. These materials are important for important background information and are necessary per standard neuropsychological testing guidelines. These help ensure accurate findings are produced.
Dr. Messler generates an evaluation report with findings regarding diagnosis, whether a disability is present, and recommendations for accommodations if a disability is found. Dr. Messler aims to identify whether there are useful cognitive and behavioral strategies that may be used in the home to aid with learning and attention problems.
Included with your evaluation fee is one feedback session for parents, typically lasting 1-2 hours, and one session for children. Additional sessions to implement interventions are not built into the evaluation process, but Dr. Messler may be able to help identify tutors, coaches, counselors, and psychologists who work with you and your family to implement treatments related to the diagnosis.