Psycho-Educational Assessment Process
The following information provides an overview of the Australian context for diagnosis of a specific learning disability. The summary includes information on how the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) defines specific learning disability and what is involved in the assessment and diagnosis of a specific learning disability.
Guidelines for Provision of Support Services for students with a Specific Learning Disability
The provision of additional support in the way of personalised reasonable adjustments for students with a disability is a responsibility of every education provider under Australian Disability Discrimination Legislation and Education Standards. Within the same legislation and standards are the responsibilities of students. To ensure the education provider can and does provide appropriate reasonable adjustments, the student must in turn, provide evidence of their disability through a report developed by a relevant health professional. The health professional report must clearly define the disability, and the defined disability must meet one or more of the criteria of disability as outlined within the Disability Discrimination Act. The criteria for classification of disability according to the DDA are:
- total or partial loss of the person’s bodily or mental functions; or
- total or partial loss of a part of the body; or
- the presence in the body of organisms causing disease or illness; or
- the presence in the body of organisms capable of causing disease or illness; or
- the malfunction, malformation or disfigurement of a part of the person’s body; or
- a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction; or
- a disorder, illness or disease that affects a person’s thought processes, perception of reality, emotions or judgement or that results in disturbed behaviour.
1Specific Learning Disability is recognised as a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction and is formally recognised as a neurological disability. The appropriate health professional is a psychologist who specialises in specific learning disabilities. The psychologist may be a generalist with experience in diagnosing specific learning disabilities or a specialist psychologist such as a neuro-psychologist or educational psychologist.
Where there is no formal assessment the Screening for indicators of a specific learning disability tool can be utilised to determine whether referral for formal assessment is required or whether alternate academic skills support / reasonable adjustments are necessary based on a barrier within the educational context that is not related to a specific learning disability.
When there is a prior assessment presented the report must be reviewed to ensure that the report and the recommendations are current. 2As every person with dyslexia has a different constellation of strengths and weaknesses, is affected to a different degree, and has developed more – or less – effective coping strategies in the course of their education the assessment must provide the student and the further education provider with a detailed cognitive profile and a basis for deciding what measures will be needed to enable the individual to study without disadvantage in their current studies.
A current assessment
There are different expectations across education providers on the point of currency. When determining currency it is important to understand that once a learning disability is diagnosed (at any age) further assessment to re-establish the presence of a specific learning disability should not be required. However revisiting the assessment is recommended and often required at points of significant transition such as across the education sectors from secondary education to post-secondary education, especially when the assessment is more than 3 to 5 years old. There is also one other exception, and that is if the assessment occurred prior to the person being 16 years of age (and this was at least two years ago). This is essential because young people with Dyslexia grow through the same cognitive developmental milestones as other young people and there is significant brain development occurring in late childhood and the early years of adolescence.
The need to revisit the assessment due to change in education environment and academic expectations specific to the student’s course of study or life stage development since a previous assessment, must be clearly outlined to the student and in the referral letter. The psychologists report needs to focus on the students SLD profile in context of the new academic demands associated with their current studies. This includes an overview of how the students learning strengths can be maximised, how their learning difficulties can be minimised and the recommended reasonable adjustments and technological solutions, including a rationale for these recommendations. Knowledge of the ‘specific’ area that academic difficulties are experienced is critical as this information guides how we will plan for and implement meaningful interventions.
The DSM-V Classification of Specific Learning Disability / Disorder
3The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) identifies specific learning disabilities (disorders) as a disruption to the normal pattern of learning academic skills that is neurodevelopmental and biological in origin. Diagnosis of SLD can only occur if academic skills are substantially and quantifiably below levels expected for the person’s age and when the academic difficulties have persisted since the individual’s early years. It is also imperative that the academic difficulties cannot be attributed to intellectual disability, visual or auditory difficulties, language proficiency, inadequate education instruction or psychosocial adversity.
The changes between the DSM-4 and DSM-5 are significant with the DSM-5 broadening the category of specific learning disabilities to increase diagnostic accuracy and to provide responses specific to the experienced learning disability. The DSM-V requires diagnostic approaches that explore and specify the specific learning disability in one or more of the following:
Classification 315.00 Specific Learning disorder with Impairment in reading (includes word reading accuracy, reading rate or fluency, reading comprehension).
Classification 315.1 Specific Learning Disorder with Impaired mathematics skills (includes deficits in number sense, memorisation of arithmetic facts, accurate or fluent calculation and accurate math reasoning).
Classification 315.2 Specific Learning disability with impaired written expression (includes spelling accuracy, grammar and punctuation accuracy and clarity or organisation of written expression).
The DSM-V recognises and accepts the term Dyslexia on formal assessment documentation, as an acceptable and equivalent name for learning disorder that impacts word recognition, decoding and spelling abilities (classification 315.00 and / or classification 315.2).
Categorisation of Severity of a Specific Learning Disability / Disorder
The DSM-V categorises a Specific Learning Disability / Disorder as Mild, Moderate or Severe. It is expected that a formal assessment will identify the level of severity of the specific learning disability / disorder. The categorisations as outlined in the DSM-V are provided below.
Mild There is some difficulty experienced in one or two academic domains but is mild enough that the individual will be able to compensate or function well when provided appropriate adjustments or support services.
Moderate There are marked difficulties in one or more academic domains that will require specialised and intensive interventions and teaching with adjustments required to complete activities accurately and efficiently.
Severe There are severe difficulties in learning skills affecting several academic domains. These difficulties indicate that the student will require individualised and specialised interventions and teaching. Even with these adjustments difficulties may persist and can impact on the individual being able to complete activities efficiently.
The Australian context for assessment of Specific Learning Disability
Diagnosis of a Specific Learning Disability has until recently relied on identifying significant discrepancies between a person's cognitive abilities (intelligence) and their actual academic achievement in specific areas of learning. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) no longer recognises discrepancy between cognitive ability (IQ) and academic achievement as a diagnostic characteristic of a specific learning disability. Instead the focus has moved to the demonstrated persistent academic difficulties despite the provision of appropriate and evidence based interventions within the academic environment when assessing for a SLD.
However 4recent research into the views and practices of Australian psychologists when investigating for Specific Learning Disability has highlighted that discrepancy between intelligence quotient (IQ) and academic achievement continues to be recognised within the Australian context as an important factor in determining Specific Learning Disabilities. More than 80% of Australian psychologists continue to align with the discrepancy theory and measure IQ against academic achievement. Australian psychologists also incorporate IQ assessment as a strategy to rule out intellectual disability or to identify cognitive indicators that can guide further assessment. Maintaining discrepancy between achievement and aptitude as a component of the assessment is an important factor within the Australian context. It is important because the now preferenced approach of gauging Response to Intervention (RTI) that determines whether improvement in specific academic areas occurs when intensive evidence based instruction is applied (where there is improvement there is unlikely to be a specific learning disability), is very difficult to assess in 5Australia where there is no national and universal evidence based approach to the teaching of literacy skills and reading. It is also very difficult to assess adults through a response to intervention model. In contrast exploring for discrepancy alongside persistence of the academic difficulties (life-long difficulties) and ranking against the level of severity (mild, moderate, severe) continues to be the practice.
From the disability practitioner and student perspectives6 including the assessment for intelligence is recognised as an empowering and often life changing factor. Students have identified that after receiving diagnosis that included their IQ score, the personal shift from the label of slow or dumb to the label of learning disability with at least average intelligence has opened them up to the possibilities of achieving success within education.
What is involved in the assessment?
There are several parts to a comprehensive psycho-educational assessment for adults. These parts include assessing cognitive functioning, academic achievement and cognitive and information processing. The psychologist is required to use a comprehensive battery of tests that does not rely on any single test or subtest across each of these domains to determine diagnosis of a specific learning disability. The assessments used must also be appropriately normed for the age of the applicant and must be administered in a standardised manner. Informal aspects of the assessment also includes personal developmental information gathered through interview and through reviewing records of both medical and academic history.
Assessing Cognitive Functioning
The cognitive functioning assessment provides information about the student’s intellectual strengths and difficulties as well as insight into their overall cognitive potential (how well they can learn). The cognitive assessment incorporates assessing intelligence quotient (IQ). Intelligence testing in Australia is usually undertaken using the Wechsler Adult Intelligence Scale (WAIS-1V). This assessment is designed to measure intelligence in adolescents and adults aged between 16 and 90 years. The WAIS 1V is preferenced by Australian based psychologists as it has been normed to the Australian population. The WAIS-1V determines four individual scores which combined derive the full scale IQ. The four individual scores are related to:
• Verbal comprehension The ability to understand oral language and express ideas in words.
• Working memory The ability to hold information in the short term memory while simultaneously processing it.
• Perceptual reasoning The ability to organise and classify, draw inferences and problem solve.
• Processing speed The ability to automatically and fluently perform already learned cognitive tasks.
7The distribution of IQ scores are arranged along a bell curve with 100 (average score) positioned in the middle of the curve. Scores that are;
- above 130 are ‘superior’
- between 120-129 are ‘very high’,
- between 110-119 are ‘high average’, ’
- between 90-109’ are ‘average’,
- between 80-89 are ‘low average’,
- between 70-79 are ‘borderline mental functioning, and
- below 70 are ‘extremely low mental functioning’.
Assessing Cognitive and Information Processing
This component of the assessment explores for processing deficits. Aspects of this assessment can also be found within the cognitive functioning and achievement suite of assessments. When the IQ result is average or above and one or more of the information processing domains is scored lower than the IQ score it can indicate a discrepancy that is associated with a specific learning disability. This must be assessed in the context of a battery of tests and can only be determined by a qualified psychologist. The processing areas generally included in this part of the assessment are outlined below:
Visual Processing Relates to how well we use visual information, especially something complex, is it easily understood and is information seen remembered easily? People who have difficulty with visual processing may have difficulties in writing, spelling (recalling whole words) maths, reading and difficulty learning by demonstration.
Auditory Processing Relates to how well we understand auditory information. Hearing differences between sounds, remembering sound patterns, blending sounds to make words and words to make sentences. People who have difficulty with auditory processing may have difficulty with general reading, writing, spelling (decoding) and language including expression and receptive language.
Sequential Processing How well we use short term memory for details and long term memory for retrieval of details. How well we organise our thoughts and find the words we need. People who have difficulty with sequential processing will have difficulties in reading fluency (sounding out words), math computation, expressive language and writing mechanics including planning out assessment tasks.
Conceptual Processing How well we remember general ideas, reasoning, general knowledge, spatial awareness, inferential thinking and our creativity and inventiveness. People who have difficulties with conceptual processing will demonstrate difficulties with reading comprehension, math reasoning and creative writing and can miss the big picture by focussing attention to only one detail.
Processing Speed How fast information travels through the brain. Deficits in processing speed can impact short term memory, long term memory retrieval, time required to capture the right word, writing and reading speed, reasoning in a timed environment and general response speed. Processing speed deficits will impact skills required for reading, math, written language, problem solving, communication, maintaining attention.
Executive Functioning Our overall ability to manage the range of cognitive and emotional processes. This includes, initiation, planning, organising, execution of tasks and regulating emotional responses. Difficulties with executive functioning can impact our ability to maintain motivation, remember details, to see the relevance, to plan, recall details, pay attention, complete tasks and follow specific directions.
Assessing Academic Achievement
Academic achievement assessments measure specific academic skills and make comparison against what is the expected (normed) achievement for the age of the individual. Academic achievement assessments focus on broad reading, writing, math, and oral language skills and also different aspects of these broad areas. Within the reading domain, there will typically be tasks measuring comprehension, reading fluency, site word recognition, and decoding. Math is typically broken down into computations, fluency, and mathematical reasoning. Within the writing domain, there will be tasks measuring spelling, writing fluency, and the ability to express oneself through writing.
Typically, a student’s academic achievement scores will be quite similar to their cognitive ability scores. When there is a significant discrepancy between cognitive ability and one or more specific areas of functioning, further exploration occurs to determine whether a specific learning disability is prevalent. This exploration will include developing an understanding of the persistence of the specific difficulty – for example has this area of functioning always been difficult for the student and measuring the impact of the specific difficulty, mild, moderate or severe.
Understanding the Assessment Results
The report will provide an overview of the battery of tests used within the assessment process. Alongside each of the tests will be a results section that will contain a raw score for each of the tests. The raw score is often calculated and presented as a percentile rank or result. Percentile ranking compares the person being assessed against 100 other people who have completed the same assessment.
For example: If a student received 10/20 for a particular assessment. It is difficult to determine what this means and how this compares to others of the same age and education level. From an academic perspective this result could be perceived as a bare pass. By providing a percentile score the psychologist can inform how the 10/20 result compares across a normed group of students who completed the assessment under the same testing conditions.
- In this situation the 10/20 result equates to a percentile score of 75%.
- This means that 75% of people perform below this person with a particular task.
- This can be also be understood as 75% of people score less than 10/20 on this test, or
- This person performed in the top 25th percentile on this test.
A good report will clarify what each of the raw scores and percentile rankings mean. With a diagnosis of specific learning disability we expect to see at least average range for intelligence (cognitive) and similar scores across academic and processing functions – however there will be an unexpected and significant drop in score against one or more areas of function. When the scores in a particular area are well below measured cognitive potential an unexplained deficit is highlighted. Further exploration of this area will determine whether the student has a specific learning disability.
Understanding what each of the assessments are exploring for, assists practitioners to target meaningful support interventions (reasonable adjustments) to the specific learning profile of each individual.
What an assessment must include.
To receive adjustments through the Disability Support Program of further education provider, students with a specific learning disability must present or obtain a current diagnostic report that has been prepared by a qualified professional. An acceptable report includes a neuropsychological, psychological or psychoeducational assessment. The report must be dated and signed by the professional that completed the diagnostic assessment. The report must also:
- Provide clear evidence that a specific learning disability exists. This involves listing the battery of tests undertaken and a synthesis of the results with particular emphasis to how the area of concern was identified.
- Evidence the persistent nature of the learning difficulties and provide a specific classification and categorisation (mild, moderate, severe), including an overview of what this means for the student in the learning environment.
- Include a summary of the comprehensive diagnostic interview and include background information to support diagnosis.
- Ensure that the psychometric assessments used are appropriately normed with age based standard scores provided for all normed measures. These must be detailed.
- Include cognitive, information processing and academic achievement assessment results.
- Include a well written and easy to understand interpretation of the findings that includes a specific diagnosis and its impact on the individual within the teaching and learning environment.
- Ensure areas of strength are highlighted along with areas the student will experience difficulty.
- Validate the need for adjustments and provide specific recommendations with a detailed explanation supporting the need for each requested adjustment..
- Show evidence of the qualifications of the person assessing for specific learning disability.
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