Identification of Dyslexia

Evaluating for Dyslexia

Early screening and intervention are essential in helping children who show characteristics of dyslexia or other word recognition problems. A full dyslexia evaluation or diagnosis is not required for a school to provide interventions to address characteristics of dyslexia. Screening sorts students into at-risk and no-risk groups, and can indicate which skill areas need attention. A quick skills survey for the at-risk group can help determine specific individual needs so that intervention can begin. A more complete evaluation is required in order to diagnose dyslexia or identify a specific learning disability. 

The evaluation of dyslexia is not limited to any specific age or time interval. School-aged students, or adults of any age, can be evaluated for dyslexia. This type of evaluation is frequently referred to as a diagnostic evaluation but is sometimes referred to as a multidisciplinary evaluation, psychoeducational evaluation, educational evaluation, or comprehensive education evaluation. Regardless of the name, the purpose of this type of evaluation is to determine whether the individual demonstrates the characteristics of dyslexia and to rule out other causes of the identified reading/writing concerns. 

Testing for dyslexia can verify the presence of a specific learning disability/dyslexia, aid in determining the severity of the dyslexia, and provide the needed documentation for eligibility for specially designed instruction (special education) and/or accommodations throughout an individual’s educational career from elementary school through college and postgraduate education.

A comprehensive diagnostic evaluation for dyslexia may be completed as part of the determination of eligibility for special education in a public school, or it may be administered in a hospital, clinic, or private setting. Evaluations of this type may be completed by a team of professionals or by a single clinician, depending on the setting. A primary care physician or pediatrician may refer an individual to a dyslexia specialist, psychologist, or neuropsychologist for assessment. A public school assessment team is likely to include an educational psychologist; a learning specialist or special education teacher; a speech-language pathologist; and a school social worker. Additional specialists such as an occupational therapist and/or a physical therapist might be involved in the evaluation process depending on the individual’s needs. 

If a parent chooses to seek an evaluation for dyslexia outside the school system and shares the results of the evaluation obtained at private expense with the school district, the school district must consider the results of the evaluation in any decision made with respect to the provision of a free appropriate public education (FAPE).

School Identification Versus Clinical Diagnosis

There is frequent confusion regarding the difference between the school-based identification of dyslexia as a specific learning disability and the clinical diagnosis of dyslexia. The diagnostic term “dyslexia” can be used by clinicians working in a private clinical setting and by evaluation teams found within a public school setting. The use of dyslexia as a descriptor of a specific type of reading disorder (and a specific type of learning disability) is not limited to those working in a medical setting. Rather, its use is only limited by the training and assessment experience of those who would use the term. 

In Wisconsin, there is no statute or regulation that would prohibit the use of the word dyslexia in a school setting or within school-generated documents. Likewise, there are no federal rules that prohibit the use of the term “dyslexia” when identifying a phonological-based, word-level reading disorder in a school-based setting. 

• Dear Colleague: Dyslexia Guidance - United States Department of Education (October 2015)

• Dyslexia and Specific Learning Disabilities - Wisconsin Department of Instruction (February 2016)

In using the descriptor “dyslexia,” the person or persons using the term have a responsibility to thoroughly understand typical reading development, what dyslexia is and is not, the key features of dyslexia, how it is assessed, and their obligation to use valid and reliable measurement tools and sound diagnostic judgment when making such a diagnosis.

In both the school and clinical settings, the purpose of an evaluation is the identification of the student’s specific profile, leading to the implementation of an appropriate remediation plan (Colorado's Dyslexia Handbook).

WI Statue 115.777,  Special education referrals

Who is required to refer a child suspected of a learning disability to the local education agency?

• Physician

• Nurse

• Psychologist

• Any employee required to be licensed by the local education agency (teachers)

• Any person not specifically listed

Referrals:

• Must be in writing

• Person making the referral must notify parents of referral

LEA:

• Must have written procedures to accept referrals

• Must notify parents within 15 days

• Must have parent consent to conduct a special education evaluation 

Overview of a Dyslexia Evaluation

A number of diagnostic measures will be administered during a one-on-one session or series of sessions. The assessment instruments utilized need to meet professional standards for reliability and validity, and are most commonly norm-referenced measures.

The evaluator should use assessment tools (tests) that are designed to measure specific skills that align to the student’s age, grade, and developmental needs. The following essential areas should be assessed during this phase of the diagnostic or educational/psycho-educational evaluation:

• Expressive and Receptive Vocabulary — words the student uses when speaking and words the student understands when listening;

• Listening Comprehension — what the student understands when listening to oral language at the sentence and passage level. Listening comprehension is often used as a gauge of the student’s potential for reading comprehension, when limited/inaccurate decoding does not impair comprehension of print;

• Phonological/Phonemic Awareness — the student’s awareness of and access to the sound structure of his/her oral language;

• Rapid Automatized Naming — speed of naming common objects, letters, colors and/or digits;

• Verbal Memory Skills — including phonological memory and the ability to recall sounds, syllables and words;

• Alphabetic Principle and Phonics Skills — understanding that letter symbols represent specific sounds, and appreciating combinations and patterns of letters and their relationship to speech sounds; 

• Decoding and Word Recognition — ability to use sound-symbol association to identify words and pseudo-words (nonsense words); 

• Oral Reading Fluency — the student’s ability to read single words and passages accurately, with appropriate phrasing and at a pace that supports comprehension;

• Reading Comprehension — the ability to make meaning from print, including both oral and silent reading passages;

• Spelling — the student’s ability to accurately encode words from dictation; and

• Written Expression — the student’s ability to formulate sentences and passages using basic conventions of English (e.g., capitalization, punctuation, and grammar).

Most comprehensive diagnostic evaluations also include:

• Math Calculation Skills — accuracy and automaticity of basic computational processes;

• Math Fluency — the ability to quickly recall basic math facts;

• Mathematical Problem-Solving — the ability for math reasoning and the completion of word problems;

• Processing Speed — the student’s ability to complete simple tasks quickly; and

• General Information — the student’s store of factual information, often related to content areas of science, social studies and basic literature.

Some comprehensive diagnostic evaluations include:

• Cognitive (Intelligence) Assessment — Cognitive testing is no longer required as part of the specific learning disabilities identification process. However, this type of assessment is often included to identify twice exceptional students (most commonly gifted students with dyslexia) or during the assessment of older students when their eligibility for accommodations at the college/postgraduate level or during high-stakes testing requires this type of assessment (e.g., college entrance exams, medical school entrance exams, the bar exam).

Evaluation Findings

Once all the testing is completed, the clinician or assessment team will score and analyze the assessment results. After this review and analysis, a written report is completed. The report should summarize important developmental and historical information, specifically highlight prior and pertinent assessment results, discuss current assessment data, and provide a clear interpretation and/or diagnosis of the assessment findings. A comprehensive report should draw specific recommendations from the assessment findings and highlight necessary accommodations. 

In some instances, the report will serve as a statement of eligibility for specially designed instruction (special education); in other instances, it may specifically serve to differentiate the identification/diagnosis of dyslexia from other causes of poor reading or literacy. 

In all cases, assessment data should be reported as standard scores and percentiles, thus allowing for accurate comparison of growth over time and comparisons to others of the same age. The summary report should be shared with parents and professionals working with the child. It is also helpful for the child to receive an age-appropriate explanation of the evaluation outcomes.

Evaluation Support Resources

The most common assessments used by professionals in school and private clinical settings to identify the pattern of strengths and weakness exhibited by individuals with dyslexia are the and the Wechsler Individual Achievement Test (WIAT-4) and the Woodcock Johnson Tests of Achievement (WJ IV).

Wechsler Individual Achievement Test (WIAT-4):

• Pearson Clinical Assessment Solutions: A Dyslexia Toolkit

Resources About the Woodcock Johnson IV:

• Introducing the Woodcock-Johnson® IV

• Use of the Woodcock Johnson IV for Dyslexia Evaluation

• Assessment Service Bulletin Number 6: Use of the Woodcock-Johnson® IV for the Assessment of Dyslexia

• For WJ IV WIIIP Users - Woodcock-Johnson® IV Interpretation and Instructional Interventions Program: Dyslexia Report Guide

Dyslexia, Specific Learning Disability, Specific Learning Disorder, or Reading Disability

People are often confused by the use of different terms to describe the same or overlapping conditions. 

As mentioned above, “Specific Learning Disability” (SLD) is a category of disability in special education law. Dyslexia is listed as one type of SLD in 20 U.S.C. §1401(30), 34 CFR §300.8(c)(10), and Wis. Admin. Code § PI 11.36 (6) (a). The U.S. Office of Special Education and Rehabilitative Services (OSERS) issued guidance in 2015 clarifying that there is nothing in the Individuals with Disabilities Education Act (IDEA) that prevents schools from using the term “dyslexia” in special education documents. If a parent requests an evaluation for dyslexia, a school should respond, even if it doesn’t normally use that term. “Dyslexia” is not a term reserved for medical practitioners. 

Parents should be aware, however, that Wisconsin’s process for identifying a student with SLD consists of looking at eight different areas of possible impairment: oral expression, listening comprehension, written expression, basic reading skill, reading fluency, reading comprehension, mathematics calculation, and mathematics problem-solving. Of these, only basic reading skill and reading fluency are incorporated in the most common definitions of dyslexia. Reading comprehension is merely a possible secondary consequence, and the other areas are separate impairments. Because dyslexia is often found in the company of math, language, and written expression impairments, it would be not be prudent to unintentionally limit an evaluation to basic reading skill and reading fluency by insisting on using only the term “dyslexia.” It may be helpful to refer to “dyslexia” in an IEP document to point out the nature and brain-based origin of the reading disability and suggest certain interventions for basic reading skills and fluency. However, it will not address any co-occurring disabilities.

“Specific Learning Disorder” is a term found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), used by medical practitioners to diagnose neurodevelopmental disorders in the domains of reading, written expression, and mathematics. Subskills under the domain of Specific Learning Disorder with impairment in reading (315.00; F81.0) include word reading accuracy, reading rate or fluency, and reading comprehension. Subskills under the domain of Specific Learning Disorder with impairment in written expression (315.2; F81.81) include spelling accuracy, grammar, and punctuation accuracy, and clarity or organization of written expression. The DSM-5 refers to dyslexia as “an alternative term used to refer to a pattern of learning difficulties characterized by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities.”

The DSM-5 definition of dyslexia covers two of the three reading impairments, one of the three written expression impairments, and none of the mathematics impairments. Some outside evaluators (normally psychologists) will provide a diagnosis of dyslexia, while others will specify a specific learning disorder with impairments in one or more areas. If outside evaluators use “dyslexia” as a diagnosis, the DSM cautions that they must also be careful to include any other reading, written expression, or mathematics weaknesses that are not included in the DSM-5 definition of dyslexia.

A “Reading Disability” is a general term that covers disabilities in basic reading skills, reading fluency, and reading comprehension. If this term is used in an evaluation, it is important to clarify exactly which aspects of reading are deficient, and to what extent language comprehension deficits are involved.

Dyslexia Identification Versus SLD Determination (Not All Will Qualify)

A diagnosis of dyslexia does not guarantee eligibility for special education. Eligibility for special education in Wisconsin is a two-part process. 

1. The school must document that a student has a Specific Learning Disability. This is done through a comprehensive evaluation process that, among other things, involves showing that a student, after two intensive interventions, demonstrates both inadequate achievement and insufficient progress in the area(s) of weakness, and that the inadequate achievement is not due to certain exclusionary factors. 

2. Then, if the student is determined to have an SLD, the IEP team must determine if special education is necessary (Wisconsin DPI PI 11.35 and 11.36). An outside diagnosis of dyslexia may be helpful to the school in evaluating a student, but is not determinative of whether they have a SLD or need special education. 

References

Colorado Department of Education. (2020, February) Colorado dyslexia handbook. (28-32). https://www.cde.state.co.us/cdesped/codyslexiahandbook

Kilpatrick, D. A. (2015). Essentials of assessing, preventing, and overcoming reading difficulties (essentials of psychological assessment). John Wiley & Sons.

Sawyer, D. J., Jones, K. M. (2009). Testing and evaluation. International Dyslexia Association. https://dyslexiaida.org/testing-and-evaluation/