In my previous blog post I shared information about Dyslexia so that readers could have a better understanding about what it is, what causes it, and spot the possible red flags for identifying it. At the conclusion of that blog post, I recommended that if you suspected your child or yourself has Dyslexia that you would want to seek out a comprehensive psychoeducational assessment. Therefore in this second blog post of my three part series on Dyslexia, I will share information about psychoeducational assessments. The goal of this post is to demystify the process, explain the components, and ultimately help the reader better advocate for themselves or their child(ren) and discriminate high quality from low quality evaluations.
What is a Psychoeducational Assessment?
Psychoeducational assessments provide information about a person’s cognitive or intellectual ability and their educational achievement. The primary purpose of this type of assessment, in addition to diagnosing a possible disability, is to yield recommendations for educational planning and targeted interventions. Additionally, although the focus is on learning, quality psychoeducational assessments provide information about possible behavior/emotional and medical issues that may also need to be addressed.
In the case of Dyslexia, an evaluation should include a comprehensive case history related to their identified concern, an observation of their reading and/or speaking during the testing process, and a specific battery of assessments targeting language and reading.
Gathering information for the assessment
An experienced assessor understands the importance of gathering data prior to the assessment. A comprehensive intake history is vital for selecting the battery that will be best suited for the examinee and determining if the evaluation is even necessary or whether another service is needed prior to testing (hearing, vision, etc). During that initial appointment the examiner will gather information about possible birth complications, language history, medical history, and educational history and interventions. The examiner may review report cards, previous testing and classroom work samples that best illustrate the examinees current skill level. During my initial appointment with clients, I also inquire about whether there is a family history of learning difficulties or other related factors. Additionally, I gather information about current or previous individualized education plans (IEPs) or accommodation plans and I review any previous testing from psychologists, physicians, speech therapists, academic interventionists, and/or audiologists and I inquire about any possible hearing or vision difficulties.
During that initial session, most assessors will also talk to the client prior to testing. In my office, for children with suspected Dyslexia I am listening and watching for how the child or adult communicates so that I can have informal data about speech, language and social language that may possibly impact their reading ability. At the end of that initial appointment, the client will receive information about the testing process --- such as how many sessions, preparing for testing, and the examiner will give time for additional client questions.
Components of a Psychoeducational Assessment for Dyslexia
As I mentioned in the earlier paragraph, a psychoeducational assessment should include a measure of cognitive ability. It is imperative that the examiner rule out that the child’s learning difficulties are not related to delays in their cognitive ability. Some examples of cognitive/intellectual assessments are:
Stanford-Binet Intelligence Scales (SB5)
Wechsler Adult Intelligence Scale (WAIS)
Wechsler Intelligence Scale for Children (WISC)
Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
Differential Ability Scales (DAS)
Woodcock-Johnson Tests of Cognitive Abilities (WJ-Cognitive)
Comprehensive Test of Nonverbal Intelligence (CTONI)
Primary Test of Nonverbal Intelligence (PTONI)
The cognitive assessment is often selected based on the specific areas that need to be examined for the examinee. Additionally, a client may be given one of the above tests as a supplementary measure to look at one of the many areas of processing that underlie Dyslexia such as: auditory processing, visual processing, long term memory, short-term memory, processing speed, verbal reasoning, fluid reasoning, quantitative ability, or general information and knowledge. Finally, for some clients that have severe language disorders they may also be assessed using a nonverbal measure such as the CTONI or PTONI to determine their cognitive ability when the demands of language are reduced.
In addition to a measure of cognitive ability, a quality evaluation should assess educational functioning that includes a “broadband educational measure” that first looks at all academic areas. For children with Dyslexia it is important to determine how those learning differences impact their academic performance across a variety of academic subjects and to discover their individual strengths that can be built upon in the classroom and at home.
Most academic assessments are designed for preschool through college and they cover the basic academic areas of reading, math and writing and, possibly, oral language. There are several areas that an assessor is typically examining when conducting a psychoeducational assessment and this includes:
Basic reading (phonemic and sight word reading)
Reading Comprehension
Mathematics Calculation
Mathematics Reasoning/Problem Solving
Written Expression (spelling, basic writing, and essay composition)
Oral Language
Listening Comprehension
There are a few commonly used academic assessments that most assessors trained in psychoeducational testing administer and they include:
Wechsler Individual Achievement Test (WIAT)
Kaufman Test of Educational Achievement (KTEA)
Woodcock-Johnson Tests of Achievement (WJ-Achievement)
It is important that the evaluation also rule out any social emotional or behavioral concerns that are co-occuring with Dyslexia or are the result of a person’s ongoing struggles with Dyslexia. For example, when ruling out attention deficit hyperactivity disorder (ADHD) there are several rating scales and computerized assessments. I have provided the following list of commonly used behavioral and emotional assessments:
Conners ADHD rating scales
Brown Attention-Deficit Disorder Scales
Conners Continuous Performance Test
Tests of Variable Attention (TOVA)
Integrated Visual and Auditory Continuous Performance Test (IVA-CPT)
Behavior Assessment Scales for Children (BASC)
Beck Youth Inventories (BYI)
Beck Anxiety Inventory (BAI)
Beck Depression Inventory (BDI)
Child Behavior Checklist (CBCL)
In order to recommend targeted interventions for a child with Dyslexia then it is also necessary to conduct assessments that will examine the core areas, which may be deficient for an individual with Dyslexia. The core areas include:
Language - An examiner will want to assess receptive and expressive language abilities and they may also need to assess language processing and pragmatic language skills. Individuals with Dyslexia may or may not have a co-occurring language disability; however, their difficulty with reading and writing may impact vocabulary development and their ability to use language at a higher level.
Phonological awareness - Poor phonological awareness is one of the common traits of Dyslexia. This means that the person is having difficulty identifying and blending individuals sounds that they hear to make a word. Additionally, weaknesses in this area may mean that individuals have difficulty with rhyming or recognizing words that rhyme, they may struggle to know how many sounds are in a word, or delete, add or move sounds around to change a word. Phonological awareness is the awareness of sound only! It does not involve print.
Phonics – People often confuse phonological awareness and phonics and use them interchangeably. It is important that a person is explicitly taught skills in phonological awareness (the ability to discriminate sounds heard) so that there is a strong foundation for teaching phonics later on. Phonics is the idea that letters represent the sounds of spoken language. The goal of phonics is to help readers connect the sounds of spoken language with letters or a group of letters and also blend the sounds of letters together to read printed real and nonsense (fake) words.
Rapid naming/word fluency– Children/adults with reading difficulties also may struggle with rapid naming fluency, which is the ability to name words, pictures or symbols quickly. For some people they may be accurate in their ability to name various objects, symbols or words but the speed at which they do this task is much slower than others. It is important that good readers are not only accurate but they are able to name words and symbols (letters) that may be in words quickly. This is an important foundational skill for reading fluency.
Reading fluency – Reading fluency is the ability to be an accurate reader and read the words quickly. The reading fluency of a person is calculated by the number of words they can read in a minute. People with poor phonological awareness (decoding, segmenting, blending skills) are likely also going to struggle with reading fluency. The struggle with reading fluency can impact reading comprehension because by the time the person has finished the passage, they have struggled so much to get through the passage they have not retained anything that they previously read.
Reading comprehension – This area is assessing if an individual understands what they read in printed form. I have been conducting psychoeducational assessments for over a decade now and I have often seen children with Dsylexia understand just enough printed content to comprehend basic reading comprehension questions (who, what, when, where). They have learned the art of compensating and masking their disorder! However, for complex passages, questions that are inferential (why, how, what-if) or questions that require an in-depth understanding, these same children score very poorly.
Spelling – Spelling is an important area of assessment because it can reveal weaknesses in phonological awareness and language. It can also reveal if a person struggles with knowing letters and letter combinations (orthographic knowledge), whether they have a weakness in vocabulary or word meanings (semantic knowledge) or if they struggle with morphemes such as -ed for past tense, -s for plural, or –‘s for noun possessive (morphological knowledge). Identifying this area of weakness can also assist in selecting specific interventions for spelling.
Writing – Children and adults with Dyslexia often show deficits in their writing, as it is the most complex form of language. These weaknesses may include spelling errors, word meaning or vocabulary errors, errors in morpheme use (past tense, present tense, possessives, etc), and/or possibly letters insertions in commonly known words that violate the rules of phonics.
As you can see, a high-quality psychoeducational assessment for Dyslexia is comprehensive and will assess multiple areas. In addition to the broadband academic assessment that assesses some of these areas, an examiner may also follow-up with more specific measures to further analyze the type of Dyslexia a person has so that they can better inform their recommendations for intervention and treatment. Examples of commonly used “narrow band assessments” include:
Comprehensive Test of Phonological Processing (CTOPP)
Test of Word Reading Efficiency (TOWRE)
Grey Oral Reading Test (GORT)
Woodcock Reading Mastery Test (WRMT)
Feifer Assessment of Reading (FAR)
Selecting the best professional to administer the psychoeducational assessment
It is important to select an expert in psychoeducational assessment instead of a person who is not proficiently trained in this specific type of assessment. There are many examiners that advertise this service; however, there are not as many clinicians that have an expertise in the area. It is important that when you are calling potential examiners that they can explain to you what is Dyslexia and that they have some professional experience that supports their knowledge, such as formal training in education and psychology and disabilities that are neurologically based, such as Dyslexia, Dyscalculia, and/or Dysgraphia. Even if an examiner is trained to give the WIAT, it is important that they have a deep understanding of Dyslexia so that they can interpret the various pieces of data and integrate it together to help you understand how your child or yourself compares to other children with Dyslexia. That requires a specialized knowledge that is beyond the technical knowledge of how to administer a test. At the completion of the testing the examiner should also be able to give recommendations for activities that specifically target specific language deficits that will improve the client’s reading, writing, and/or spelling skills at home and school. Finally, they should stay current with the research on Dyslexia and related disabilities through their involvement in professional organizations that support this type of research.
Remember, this is your child’s future in your hands or if you are seeking testing for yourself remember that correct identification can change the course of your future. I encourage you to be selective in choosing an examiner for a psychoeducational evaluation and do your research so that you can be an advocate for your child or yourself throughout the entire testing process. In my final post of the three-part series on Dyslexia I will share about effective instruction for people with Dyslexia. In the meantime, if you have additional questions, which have not been covered in this blog post please contact The Parent Child Practice to have a 15 minute consultation or schedule an appointment.
