While there are several assessments we use as “standards” for each student, our evaluation approach is also customized to the specific challenges of your child. What may look like a problem in one area, may be a manifestation of a different source no one thought of exploring. Knowing the underlying cause of a child’s reading and/or writing performance steers the ability of our clinicians to select the proper treatment approach from the array of methods currently available. There are many reading programs utilized by our reading interventionists that only work when the specific intervention is correctly applied to the specific deficit needing remediation. Concerned parents are often left wondering, “How do I know what reading program is best for my child?”
Researchers have identified various subtypes of dyslexia. Distinguishing and understanding these dyslexia types is important in order to determine what the best treatment approach is to obtain the most successful outcomes for your child. The two most common types of dyslexia are phonological dyslexia or orthographic dyslexia. These problems can co-occur and is then termed mixed dyslexia. There are also the more uncommon surface and deep dyslexia types. Understanding the types of dyslexia a child may have, and also exploring other comorbidities (such as attention deficit-hyperactivity disorder, executive function deficit, auditory processing disorder, dysgraphia (disorder of written expression) and dyscalculia (math disorder), or other language processing disorder) allows us to work as efficiently and effectively as possible with your child.
It is our philosophy to look at a child’s entire learning system from its neurological source, and not simply confirm the symptoms of the presenting problem.
Phonemic awareness is a student’s basic understanding that words are composed of a series of sounds. Having strong phonological awareness skills means that a student is able to manipulate sounds and words, or “play” with sounds and words. For example, a teacher might ask a child to break the word “jump” into individual sounds: “j-u-m-p.” Because the phonological structure of oral language is represented in written language (for alphabetic writing systems, letters roughly correspond to phonemes) phonological awareness provides a beginning reader with an important tool for understanding relations between written and spoken language. A deficit in phonological awareness is viewed as the hallmark of reading disability or dyslexia. Poor phonological awareness is associated with poor reading skills for both individuals whose poor reading levels are discrepant from their IQs, as well as those whose are consistent with their IQs.
A core skill we evaluate is a student’s ability to decode (sound out) words quickly and accurately. Often the true test of reading is decoding nonsense words. This eliminates a child’s reliance on memorizing words and authentically assesses the student’s ability to apply phonological awareness skills. Young readers may appear to be reading at grade level when, in fact, they are not. An over reliance of memorized words instead of applying the rules of phonics can be exposed in assessing decoding skills. We are also looking at a student’s ability to recognize familiar words with automaticity. Encoding is the process of hearing a sound or word and being able to write a symbol (or sequence of symbols) to represent that sound or word.
Morphology is one of the often-overlooked building blocks for reading fluency, reading comprehension, and spelling. Morphological awareness is the recognition, understanding, and use of word parts that carry significance. By 10 years of age, knowledge about the structure of words is a better predictor of decoding ability than is phonological awareness (Mann & Singson, 2003). Students with strong morphological skills possess a distinct advantage over students who use a “whole word approach” to decode (read) words and encode (spell) words. A morpheme is different than a phoneme such that it carries meaning whether it be grammatical or lexical. For example, consider the word endings –tion, -sion, and –cian. There is a rule when to use -cian, which is used when referring to an occupation or profession: pediatrician, mathematician, electrician. Students are often confused when to use -ist vs. -est as they are pronounced the same in speech but carry different meaning.
Rapid Automatic Naming (RAN) measures the efficient retrieval of phonological information from long-term or permanent memory and executing a sequence of operations quickly and repeatedly. This is required when readers attempt to decode unfamiliar words. Students who score poorly on RAN tasks commonly have problems with reading fluency. Students who have deficits in both rapid naming and phonological awareness appear to be at greater risk for reading problems compared to students with deficits in only one of the two areas. Reading involves more than just phonological awareness. Students with problems in both RAN and phonological awareness have what’s called a “double deficit.” Students with this profile usually have more severe reading problems as there is both a phonological deficit and likely an executive functioning deficit.
If a student has a reduced vocabulary, reading comprehension can suffer. Vocabulary knowledge is believed to be the single most important factor contributing to reading comprehension. Students struggling with reading comprehension often do not possess the oral vocabulary that is a prerequisite to their understanding and retention.
Vocabulary knowledge is believed to be the single most important factor contributing to reading comprehension. Second to vocabulary, comprehension can largely be affected by a student’s attention and their level of engagement. Attention can often influence level of engagement and motivation. Comprehension can also be impacted by a lack of decoding accuracy, slow rate of reading, “reading through” punctuation, monotone reading voice or irregular reading cadence.
Accuracy is the essential foundation of reading fluency. To be considered a fluent reader, reading must be accurate, first and foremost. Fluency is more complex than rate alone. A common fallacy about rate is that “faster is better”. Speed alone does not facilitate comprehension, and a fast reader is not necessarily a fluent reader. In fact, fast readers may be reading inaccurately or simply reading too quickly to be able to think about what they are reading. We are also evaluating reading expression. Expression is a component of oral reading that includes the pitch, tone, volume, emphasis, and rhythm in speech.
Oral language consists of phonology, grammar, morphology, vocabulary, narrative storytelling, and pragmatics. Students with a history of oral language impairment are more likely to present with reading difficulties than their peers. It is important to consider that “not only are oral language skills linked to the code-related skills that help word reading to develop, but they also provide the foundation for the development of the more advanced language skills needed for comprehension” (Cain & Oakhill, 2007). Listening comprehension skills can also be predictive of reading comprehension skills and are correlated.
Here, we are measuring a student’s ability to code information phonologically for temporary storage in working or short-term memory. Specifically, it provides an assessment of the functioning part of memory called the phonological loop, which provides a brief, verbatim storage of auditory information. A deficit does not inevitably lead to poor reading of familiar material but is more likely to impair decoding of new words, particularly words that are long enough to decode bit by bit, as a means of storing intermediate sounds. A deficit may also impair both listening and reading comprehension for more complex sentences rather than simple sentences. Visual working memory may also be assessed. In particular, we assess visual sequential memory, which is the ability to remember things in a specific order. Words consist of letters in a certain sequence. In order to read, one must perceive the letters in a particular sequence and also remember what word is represented by that sequence of letters. Students with poor sequential memory may misread words by putting letters in the wrong order reading left and felt, for example.
Measuring a student’s written language skills allows us to further explore if, how, and to what extent dyslexia is adversely affecting other aspects of language. We test spelling, grammar and punctuation, sentence structure, language organization, and story composition.
Professionals who are qualified to evaluate and diagnose dyslexia include pediatric neuropsychologists, psychologists, and speech-language pathologists. Our diagnostic team is made up of qualified professionals who use their extensive clinical experience to accurately assess and diagnose, as well as make or rule out differential diagnoses.
Speech-language pathologists (SLPs) play a critical and direct role in facilitating the development of literacy in children and adolescents and in the diagnosis, assessment, and treatment of written language disorders, including dyslexia, given that:
– American Speech and Hearing Association
Our evaluation team works very closely with other professionals such as psychologists and occupational therapists in the event that other differential diagnostic expertise is warranted. We often work as part of a multi-disciplinary team when making a diagnosis related to disorders of reading and writing. Having a clear and accurate understanding of the origin of a student’s deficits is imperative when considering an appropriate intervention method or plan.
If your child’s evaluation was conducted within the past year, it is likely that your child will not have to undergo another comprehensive evaluation. However, it may be recommended that we administer one or two specific tests in the event that our team feels there are missing components in the evaluation you bring to us.