Assessment

Assessment refers to the gathering of information in order to attain a goal. Assessment tools vary with the goal. If the goal is to establish the diagnosis, assessment involves the individualized administration of standardized tests of academic achievement and intelligence that have norms for the child's age and, preferably, social class and ethnicity. To verify that the learning disturbance is interfering with a child's academic achievement or social functioning, information is collected from parents and teachers through interviews and standardized measures such as rating scales. Behavioral observations of the child may be used to supplement parent-teacher reports. If there is visual, hearing, or other sensory impairment, it must be determined that the learning deficit is in excess of that usually associated with it. The child's developmental, medical, and educational histories and the family history are also obtained and used in establishing the differential diagnosis and clarifying etiology.

If LD is present, the next goal is a detailed description of the learning disorder to guide treatment. Tools will depend upon the specific type of learning disorder. For example, in the case of dyslexia, E. Wilcutt and Pennington suggest that the achievement test given to establish the achievement-intelligence discrepancy be supplemented by others such as the Gray Oral Reading Test (GORT-III), a timed measure of reading fluency as well as reading comprehension. Still another assessment goal is to identify the neuropsychological, linguistic, emotional, and behavioral correlates of the learning disorder and any associated disorders. A variety of measures exist for this purpose. Instrument selection should be guided by the clinician's hypotheses, based on what has been learned about the child and the disorder. Information about correlates and associated disorders is relevant to setting targets for intervention, understanding the etiology, and estimating the child's potential response to intervention and prognosis.

In schools, identification of LD involves a multidisciplinary evaluation team including the classroom teacher, a psychologist, and a special education teacher or specialist in the child's academic skill deficit (such as reading). As needed, input may be sought from the child's pediatrician, a speech therapist, an audiologist, a language specialist, or a psychiatrist. A thorough assessment should provide a good description of the child's strengths as well as weaknesses that will be the basis of effective and comprehensive treat-

DSM-IV-TR Criteria for Learning Disorders

Mathematics Disorder (DSM code 315.1)

Mathematical ability, as measured by individually administered standardized tests, substantially below that expected given chronological age, measured intelligence, and age-appropriate education

Disorder interferes significantly with academic achievement or activities of daily living requiring mathematical ability

If a sensory deficit is present, mathematical difficulties exceed those usually associated with it

Reading Disorder (DSM code 315.00)

Reading achievement, as measured by individually administered standardized tests of reading accuracy or comprehension, substantially below that expected given chronological age, measured intelligence, and age-appropriate education

Disorder interferes significantly with academic achievement or activities of daily living requiring reading skills

If a sensory deficit is present, reading difficulties exceed those usually associated with it

Disorder of Written Expression (DSM code 315.2)

Writing skills, as measured by individually administered standardized tests or functional assessments of writing skills, substantially below those expected given chronological age, measured intelligence, and age-appropriate education

Disorder interferes significantly with academic achievement or activities of daily living requiring the composition of written texts (such as writing grammatically correct sentences and organized paragraphs)

If a sensory deficit is present, writing difficulties exceed those usually associated with it

Learning Disorder Not Otherwise Specified (DSM code 315.9)

ment plans for both the child and the family. In school settings, these are called, respectively, an Individual Educational Plan (IEP) an d an Individual Family Service Plan (IFSP).

Treatment

Most children with LD require special education. Depending upon the disorder's severity, they may learn best in a one-on-one setting, small group, special class, or regular classroom plus resource room tutoring.

Treatment of LD should address both the disorder and associated conditions or correlates. Furthermore, it should include assisting the family and school in becoming more facilitative contexts for development of the child with LD. Using neuropsychological training, psychoeducational methods, behavioral or cognitive-behavioral therapies, or cognitive instruction, singly or in combination, specific interventions have targeted the psychological process dysfunction or deficit assumed to underlie the specific learning disorder; a specific academic skill such as word attack; or an associated feature or correlate such as social skills. Process-oriented approaches that rose to prominence in the 1990's are linguistic models aimed at remediating deficits in phonological awareness and phonological memory, and cognitive models which teach specific cognitive strategies that enable the child to become a more efficient learner. Overall, treatment or intervention studies during the last two decades of the twentieth century and at the beginning of the twenty-first century are more theory-driven, built on prior research, and rigorous in methodology. Many studies have shown significant gains in target behaviors. Transfer of training, however, remains elusive. Generalization of learned skills and strategies is still the major challenge for future treatment research. As the twenty-first century begins, LD remains a persistent or chronic disorder.

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