Assessment of Learning Disabilities
by Dr. Norman Brodie, Ph.D. Chartered Psychologist Consulting Neuropsychologist
Background information
A good diagnostic assessment for learning disabilities needs to
address several important areas. A primary need at the onset of
the diagnostic process is the taking of a good history. While the
diagnostic testing can provide excellent evaluations of the current
levels of functioning in the various areas assessed, it is also
important to have:· a detailed history of the development
of the problems (including a developmental history with attention
to issues such as delayed speech and motoric milestones)
- any family history of similar conditions amongst blood relatives
(many learning disabilities "run in families" and are
clearly related to genetic predispositions),
- and personal history for relevant events such as head injuries
or other neurological insults and emotional stressors (such as
family break - ups, exposure to domestic violence or child abuse,
reactions to changes tn the family structure from additions or
losses to the family, etc.)
- This background information is crucial to a thorough assessment,
as the professional not only has to determine if there are true
educational deficits or impairments, but also to attempt to identify
the cause of them in order to determine the correct line of intervention.
The next stage of the assessment process is to obtain some current
information regarding the child's functioning in the day - to -
day life situations such as at school and at home. Depending upon
the age and expressive verbal skills of the child, a considerable
amount of information may be obtained from a direct interview and
asking specific questions about their experiences and feelings in
different situations. This helps to identify how the child sees
him or herself, as well as providing some insight into their self-esteem
and approach to challenging situations. I also interview the parents
whenever possible and generally attempt to get some additional information
from both parents and the teacher through behavioural rating scales
that help to quantify and make more specific the descriptions of
the behavioural and emotional responses in different environments.
This is especially critical when assessing for the possible presence
of an Attention Deficit Hyperactivity Disorder (ADHD) and/or a Conduct
Disorder, as many of the defining symptoms or problems associated
with these conditions are not likely to be displayed or observed
in the one - on - one testing session in the office setting.
INTELLECTUAL FUNCTIONING
In the formal testing session, it is vital to obtain reliable measures
of the child's current intellectual functioning and academic achievement
as a basic prerequisite for making a diagnosis of learning disability.
Intellectual testing is most commonly done using the Wechsler Intelligence
Scale for Children - 3rd Edition (WlSC - Ill). This is the most
widely used intellectual battery for children in North America,
and it also now provides (since 1996) Canadian norms based on a
very large sample of children from across Canada. The Canadian norms
should generally be used as there are significant differences in
performance level seen between the norms for the USA and Canada,
largely indicating that the American norms tend to over - estimate
the child's performance by a slight extent compared to standards
in Canada.
The WISC - III is also a very useful test because it not only provides
a general estimate of learning aptitude, it also provides a breakdown
into the areas of Verbal, Performance (nonverbal) and Full Scale
I.Q. It is also possible to identify patterns of strength and weakness
across the profile that can help with determining more specific
diagnoses of subtypes of learning disability (such as the identification
of global language disorders or nonverbal learning disability subtypes)
by consideration of discrepancies between the Verbal and Performance
I.Q. scores and patterns of strength and weakness on the subtests.
ACADEMIC ACHIEVEMENT
In combination with the intellectual test results, it is also important
to obtain concurrent measures of academic achievement using standardized
tests that provide reliable estimates of performance relative to
age or grade population norms. This allows for a comparison of performance
using national standards rather than subjective ratings based on
a comparison to the rest of the child's class (with uncertainty
as to how he/she would compare to a different class of students).
It also provides an objective basis for comparing performance to
potential by contrasting standard scores from the achievement test
(which are generally expressed in I.Q. like units) with the I.Q.
scores to determine if the achievement level is significantly below
the intellectual expectancy range. This is important in that all
standard definitions of learning disability emphasize that the individual
has a deficit in learning that is not attributable to general intellectual
handicap or deficiency.
It is also important to consider the possibility that a very bright
child who functions in the well above average range on the intellectual
battery may still have a significant learning disability condition
that results in a relative deficit on academic achievement as reflected
by low to even mid - average performances on the achievement tests.
Formal assessment of academic achievement levels with standardized
tests is also important with respect to qualifying for special education
assistance in most jurisdictions in Canada. Most education departments
have set quantified criteria for identification of learning disability
based on performing below specific levels (often at below the 10th
percentile) on one or more academic test areas, using a recognized
educational achievement test.
Some of the most commonly used educational batteries include:
- the Woodcock - Johnson Psycho - Educational Battery - Revised
(WJ - R)
- the related Woodcock Reading Mastery Test - Revised (WRMT -
R)
- the Kaufman Test of Educational Achievement (K - TEA)
- the Wechsler Individual Achievement Test (WIAT)
- the Wide Range Achievement Test - 3rd Edition (WRAT - 3)
- and the Canada Quick Individual Achievement Test (C - QUIET)
Each of these tests employs a battery approach to educational testing,
employing a number of individual subtests that assess specific skill
areas, allowing for the performance to be compared across subject
or skill areas, and providing normative data that allows the individual's
scores to be compared to standards established at a national level.
All of these tests also correlate quite highly with one another,
and the results obtained on one tend to be similar to the results
obtained on another, such that selection of the specific test is
often a matter of personal preference by the specific consultant.
In my own practice, I most often employ a combination of the WRAT
- 3 and C - QUIET tests in combination with other measures as needed,
such as the use of the Canada French Immersion Achievement Test
(C - FIAT) that is produced by the authors of the C - QUIET to allow
for a direct comparison of the student's performance levels in English
and French when the child has been enrolled in a French Immersion
school programme. I also employ a variety of more selective tests
such as specific tests of reading vocabulary and reading comprehension
from the Gates - MacGinitie Reading Tests or measures of visual
spelling recognition and resistance to various forms of reading
errors with the Diagnostic Analysis of Reading Errors test or measures
of writing skills using the Test of Written Language - 3rd Edition.
The specific test battery selected is, however, of less importance
than ensuring that the areas of identified academic weakness are
systematically assessed with a reliable and valid achievement test.
The test should provide standard scores and percentile rankings
that can be contrasted to the intellectual estimates in order to
identify discrepancies indicative of learning disability, and provide
a breakdown of scores into functional areas for remedial planning
purposes.
SELF-ESTEEM & EMOTIONAL STATUS
Another area that should be included in almost all psycho - educational
assessments is a systematic evaluation of self - esteem and emotional
status. Many students with learning disabilities have developed
significant problems with self - esteem and emotional reactions
to prolonged frustration. Negative self - esteem and childhood depressive
reactions also seriously compromise the individual's ability to
apply themselves to programming in an effective fashion. Therefore,
when such emotional interferences are present (whether as a primary
problem or as a secondary reaction to the learning disability),
it is imperative that we recognize these as problems in their own
right and initiate some intervention or provide assistance to help
them begin the process of developing improved self - confidence
(e.g. encouraging the child to participate in some extracurricular
activities for self - esteem boosting success and "setting
them up for success" in some areas). In some cases, the emotional
distress and disturbance may be of sufficient severity that formal
professional counselling and/or medical treatment of depression
may be necessary. A combination approach of rebuilding self - esteem
as well as improving the educational programming at the same time
is most often necessary and critical for either aspect of the overall
plan to succeed.
SUMMARY
What is most important is for the psychologist to be able to use
the available information arising from the history, clinical interviews,
test behavioural observations and objective test data to achieve
an integrated or holistic picture of the individual and the specific
needs for each case. Only with such a well detailed picture of the
person as an individual can we begin to identify specifically what
type of educational programme, supplementary assistance and educational
modifications are appropriate for the specific situation. This places
the psychological assessment findings well above the assignment
of a simple label or diagnostic term. Through such a comprehensive
evaluation process, the individual's strengths and talents are also
highlighted and brought into focus as a basis for preserving and
enhancing self - esteem and personal development.
|
