Deciphering Diagnostic Testing Reports for Learning Disabilities Attention

Deciphering Diagnostic Testing Reports for Learning Disabilities & Attention Disabilities Finding, Excavating & Utilizing Important Information

Learning Disabilities

Learning Disabilities There is no singular definition of what constitutes a learning disability in adults…there is an “agreed upon” joint definition

Learning Disabilities (National Joint Committee on Learning Disabilities) "Learning Disabilities is a generic term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. These disorders are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and occur across the life span. Problems in self-regulatory behaviors, social perception, and social interaction may exist with learning disabilities but do not by themselves constitute a learning disability. Although a learning disability may occur concomitantly with other handicapping conditions (for example, sensory impairment, mental retardation, serious emotional disturbance) or with extrinsic factors (such as cultural differences, insufficient or inappropriate instruction), they are not the result of those conditions or influences. "

What a Learning Disability is Not • Below average cognitive abilities • A homogeneous group of disorders • The result of: o Poor or intermittent academic background o Emotional disturbance o Lack of motivation o Socio-economic deprivation o Visual-hearing acuity o English as a second language o Physical disability

What a Learning Disability is • Only present if the individual has average to above average cognitive abilities (but not necessarily average to above average “measured” cognitive abilities) • Inconsistent • Permanent • A pattern of uneven abilities

Incidence • 5 -20% of general population • 16+ million to 65+ million • Variance due to misidentification • African Americans, Hispanics, and Native Americans often inappropriately diagnosed • 2/3 of school-aged students identified as having a learning disability are male • Research shows that equal numbers of males and females share the most common characteristic of a learning disability…difficulty with reading

Many Types of Learning Disabilities – Only 5 Main Issues • Input - Take information in through one or more of the senses • Process - Figure out what information means • Store - File information into memory • Retrieve - Pull information out of memory • Output - Use what was learned

Attention Disabilities

Attention Disabilities • An attention disability is a neurobiological disorder characterized by a pattern of “fractured” attention, present in multiple settings (i. e. , school, home, work, etc. ) that can result in performance issues in social, educational, or other situations. • 3 Types • Predominately inattentive • Predominately impulsive • Combined type

Incidence • Approximately 5% (American Psychological Association) -10% (CDC) of the general population has a diagnosable attention disability • Average at diagnosis = 7 years old • 13% of males have a diagnosable attention disability; 4. 2% of females • 42% increase in diagnoses in the past 8 years

Diagnostic Testing

Diagnostic Testing: Questions • What is the purpose of administering a series of test batteries to diagnose a learning disability/attention disability? • What information is typically included in a learning or attention disability diagnostic work-up? • Are the test scores where the important information is in a testing report? Or is the important information somewhere else? • Does the age of the testing matter? • And what about the 3 -year mantra?

Diagnostic Testing: Time-Line of Related Events 1905 Paris Minister commissions a method for sorting students; Theodore Simon & Alfred Binet create the Simon-Binet Scale 1908 Simon-Binet Scale revision is published 1911 2 nd Simon-Binet Scale revision is published Alfred Binet dies just after revision is published 1916 Lewis Terman at Stanford University publishes the American/English revision of the Simon-Binet Scale; it becomes the Stanford-Binet Test 1919 Piaget meets Simon and begins intelligence testing research 19251931 Piaget’s children are born

Diagnostic Testing: Time-Line of Related Events (Continued) 1929 Leiter Non-Verbal Test of Intelligence is published 1939 Wechsler-Bellevue is published & the Stanford-Binet is revised 1949 Wechsler Intelligence Scale for Children (WISC) is published 1955 Wechsler Adult Intelligence Scale (WAIS) is published 1960 Stanford-Binet revision is published 1971 Woodcock-Johnson Test of Cognitive Abilities is published 1975 PL 94 -142 is passed; this is the special education mandate for K-12; now known as IDEA

Public Law 94 -142 This is a funding mandate; not a civil rights mandate “Schools must use nonbiased, multifactor methods of evaluation to determine whether a child has a disability and, if so, whether special education services are needed. A nondiscriminatory evaluation: (a) tests specific areas of educational need rather than only general intelligence; (b) places students in an appropriate educational setting on the basis of 2 or more tests; (c) considers other information, (i. e. , physical development, race, culture, language, and adaptive behavior) in conjunction with test scores; and, (d) sets up a team to evaluate and appropriately place a student NOTE: Discrepancy model between potential (cognitive abilities) and achievement (academics) is part of the PL 94 -142 mandates

Diagnostic Testing: Time-Line of Related Events (Continued) 1977 Woodcock-Johnson Achievement Test is published 1977 First testing for special education, as well as testing for gifted & talented begins 1981 current Wechsler, Stanford-Binet, Woodcock-Johnson, WRAT, WIAT, even the Leiter battery have all undergone of more revisions and new test batteries continue to enter the market every year 2004 Latest reauthorization of IDEA

IDEA 2004 Psycho-educational assessment is the process of gathering and interpreting information about individual students for the purpose of educational decision -making. The assessment process must be guided by a consideration of the strengths which the student brings to the educational environment as well as a consideration of the cultural, linguistic, and family experiences of the student outside the school setting. It should be a comprehensive appraisal of the student within the context of the school, home and community. Note: Discrepancy model no longer part of the IDEA mandates

Diagnostic Testing Reports

Diagnostic Testing: Components • Generally speaking, diagnostic testing reports (documentation) for Learning & Attention Disabilities, will all contain the same type of information. • Information usually found in a testing report/documentation will include (but, may be labeled by a different name): o Tests Administered o Referral o Background Information o Behavioral Observation o Test Results & Discussion o Summary of Findings & Recommendations

Diagnostic Testing: Tests Administered • This section contains a list of all batteries completed during the assessment (example below) o Clinical Interview o Behavioral Observations o Conners’ Continuous Performance Test-3 (CPT-3) o Conners’ Continuous Auditory Test of Attention (CATA) o Nelson-Denny Reading Test, Regular and Extended Time Versions o Wechsler Adult Intelligence Scale – IV (WAIS-IV) o Woodcock-Johnson IV – Tests of Achievement (WJ-IV-ACH)

Diagnostic Testing: Referral • This section usually contains information about who referred the individual for assessment and why (example below) Miguel is a second-year law student who self-referred to the Student Psychological and Testing Center. He presented with concerns about a slow reading rate that is affecting his ability to keep up with course work and to complete exams within the allotted time.

Diagnostic Testing: Background Information • In the Background Information section, medical information (including developmental information), biographical information, educational information, social information, and information about the individual’s family, is found (example below and on next slide) Patsy, a twenty-nine year old, Caucasian, female, is a micro-computer specialist major… Patsy recalls participating in resource classes from the third grade through high school…she claims she got bored very quickly in high school and that she spent most of her time daydreaming in class.

Diagnostic Testing: Background Information (Continued) At the beginning of the 2006 spring semester, Patsy was enrolled in nine hours of classes. However, she has since dropped one of her courses (Painting I). She is still attending her Intro to Computers and Information Systems class and her Intro to DOS class. Patsy explained that she enjoys these classes very much. While the DOS class is the most challenging one for her, she’s still making progress in the class. She explained that she learns best by simply experimenting with the computer and asking questions. She stated that she has not actually read the textbook yet, but has managed to stay ahead of the class with her hands-on activities. When asked why she hadn’t attempted to read the book, she explained that she can’t learn that way. She further stated that the book didn’t make sense to her, that reading was boring, and that she needs to manipulate the keyboard to see the effects on the screen to learn.

Diagnostic Testing: Behavioral Observation • The purpose of the Behavioral Observation section is to clearly and concretely delineate exactly how the individual being evaluated, performs each of the steps in the learning process (example on next two slides)

Diagnostic Testing: Behavioral Observation (Continued) …The first session began with the administration of the Bender-Gestalt Test and the Benton Revised Visual Retention Test. Alfred was able to reproduce the figures with great accuracy. However, it took him almost two hours to complete what typically takes less than thirty minutes to complete. He also kept a running commentary going throughout the tests. He told jokes and stories and made various unrelated comments as he worked to reproduce the designs… …During the second assessment session, Alfred completed both the Woodcock. Johnson Test of Cognitive Abilities and Tests of Achievement. He began strong on the beginning subtests but became slower and talked almost continuously during the math calculation subtest.

Diagnostic Testing: Behavioral Observation (Continued) …He also utilized a series of unsophisticated methods to work the math problems (i. e. , he used his fingers to add and subtract and used “hash marks” on paper to multiply)… …Alfred scored much higher on the applied math subtest items during the third assessment session, than he did on the calculation subtest items. This time he seemed to understand the problems better because they were not presented in a void, but rather with the background details one finds in applied (word) problems. However, he still talked his way through the subtests. In fact the only time Alfred wasn’t talking, telling jokes, or telling stories was during the Dictation and Writing Samples subtests. On both of these subtests he was noticeably silent and if he made comments at all, it was between stimulus items and not during his response to the items.

Diagnostic Testing: Testing Results and Findings • The obtained test scores and a brief discussion of the findings from the various batteries administered will be in this section of the testing report/documentation (example on next two slides) NOTE: What Tests, Assess handout, explains exactly what sub-tests within frequently used test batteries assess

Diagnostic Testing: Testing Results and Findings (Woodcock-Johnson: Tests of Achievement)

Diagnostic Testing: Testing Results and Findings (Continued) …Most significant are Ashley’s fluency scores. Her fluency scores (Reading Fluency, Math Fluency & Writing Fluency) range from a low of 63 to a high of 75 - all of which fall more than a standard deviation below her Verbal Comprehension Index score of 98. In fact, her Academic Fluency (an aggregate of her reading, math and writing fluency) score is almost two standard deviations lower than her Verbal Comprehension Index score; her Math Fluency score is also over two standard deviations lower.

Diagnostic Testing: Summary of Findings and Recommendations • This section begins with a brief summary of the assessment results (standardized tests). This is followed by a statement of whether or not the individual has a disability. Finally, accommodation recommendations are made (example below and on next slide). . Blake has a long history of Attention Deficit Disorder. Overall, many of his cognitive abilities are well within the average range, with a few significant strengths and weaknesses. Blake’s performance on the WAIS-IV indicates that he has highly variable abilities in the areas of Processing Speed and Perceptual Reasoning, both areas that are negatively impacted by time constraint…

Diagnostic Testing: Summary of Findings and Recommendations (Continued) Academically, Blake shows relative strengths in the areas of formulating and writing meaningful sentences (Written Expression, Writing Samples), decoding and reading comprehension (Letter-Word Identification, Passage Comprehension), and in the automaticity of reading, writing, and math skills (Academic Fluency). Relative weaknesses were noted in attending to directions and sequencing responses (Understanding Directions) and in mathematical computation, reasoning, and abstract reasoning abilities/skills (Applied Problems). Blake has Attention Deficit Hyperactivity Disorder (ADHD)

Diagnostic Testing Case Studies

Diagnostic Testing: Case Study-Marilyn • Thoughts? • College student? • Can the playing field be leveled? • What accommodations?

Diagnostic Testing: Case Study-Laurence Reason for Testing (pg. 1) …Laurence referred himself for testing because his dyslexia affects all areas of his life that require reading and writing, especially school-related tasks.

Diagnostic Testing: Case Study-Laurence Background Information (pg. 1) …He was diagnosed with dyslexia in elementary school and changed elementary schools five times before his parents found a teacher and special education program that provided him with “the best chance of success. ” He remembers being enrolled in content mastery classes throughout his schoolage years and received accommodations such as oral examinations, written instructions, extended test time, and private testing rooms… …His mother was a schoolteacher for several years who went back to school for her special education/diagnostician license when she found out Laurence had dyslexia. His father was also a schoolteacher, but ended up interested in the administrative aspect of education…

Diagnostic Testing: Case Study-Laurence Behavioral Observation (pg. 2) …For subtests that required explanations or definitions, Laurence tended to give long, descriptive answers. When his answers required further querying, he tended to rephrase his previous response. For subtests that required manipulation of objects, he tended to use trial and error as noted by him readily rearranging items to complete the task. On the Spelling subtest for the Woodcock-Johnson III, he requested that the examiner begin at a level much lower than the protocol suggested…

Diagnostic Testing: Case Study-Laurence Results of Evaluation: Wechsler Adult Intelligence Scale – IV (pg. 3) …Laurence is significantly better at tasks of verbal intelligence versus tasks of visual discrimination… …Laurence’s strengths are focused around verbal intelligence… …Laurence has a pronounced weakness in his Processing Speed Index … …Laurence worked slowly and methodically while completing the Coding subtest and afterwards said the task was “not [his] idea of fun. ”

Diagnostic Testing: Case Study-Laurence Results of Evaluation: Woodcock-Johnson III: Achievement Tests (Reading, pg. 3; Written Language, pg. 4) Select Test Scores Reading Broad Reading Basic Reading Skills Written Language Broad Written Language Written Expression 79 79 Reading Fluency 77 Work Attack 73 65 78 Spelling 72 Writing Fluency 76

Diagnostic Testing: Case Study-Laurence Results of Evaluation: Woodcock-Johnson III: Achievement Tests (Math, pg. 3; Other, pg. 4) Select Test Scores Math Fluency Other Academic Skills Academic Fluency Handwriting 89 65 76 69

Diagnostic Testing: Case Study-Laurence Results of Evaluation: Woodcock-Johnson III: Achievement Tests (pg. 4) …Laurence appeared to encounter difficulty with completing tasks that required spelling, writing simple sentences, and expressing ideas (thoughts to paper). …Laurence told the examiner that he had “horrible penmanship” and made an active effort to write slowly and clearly. Despite this, his handwriting still had the look of being rushed and difficult to read…

Diagnostic Testing: Case Study-Laurence Results of Evaluation: Woodcock-Johnson III: Achievement Tests (pg. 5) …The examiner noted that during the Spelling subtest (SS=72), Laurence expressed his answers orally; often following a consistent pattern. He began by repeating the word and then systematically proceeded to sound the word out, write it down, and check the finished product to make sure it “looked right. ” For example with the word beautiful, he first repeated it, “beautiful. ” Next, he sounded it out phonetically, “bee-yoo-ti-ful. ” Finally, Laurence would look at his response and nod, indicating he was finished spelling the presented word. Before beginning the Spelling subtest, Laurence requested that he start at a “seventh grade spelling level. ” Laurence continued to experience difficulty with this subtest despite being administered words intended for school-age children. The examiner noted that Laurence demonstrated elements of basic phonics, blending, and orthographic skills. However, he appears to have difficulty consistently applying these skills…

Diagnostic Testing: Case Study-Laurence Results of Evaluation: Nelson Denny Reading Test (pg. 5) Vocabulary Comprehension Reading Rate Standard Time SS PR 227 86 205 50 165 4 …Laurence has a below average reading rate (SS=165) and is at the 4 th percentile for his academic level, indicating that he reads slower than 96 % of other college students.

Diagnostic Testing: Case Study-Laurence Results of Evaluation: Conner’s Continuous Performance Test (pg. 5) …his response times were inconsistent and variable. The inconsistency in reaction times can most likely be attributed to his dyslexia.

Diagnostic Testing: Case Study-Laurence Summary of Findings and Recommendations (pg. 6) Diagnostic Impressions Axis I: 315. 00 Reading Disorder Axis II: V 71. 09 No Diagnosis Axis III: None reported Axis IV: Academic difficulties Axis V: GAF=70 Wh at’ s Mi ssi n g? NOTE: The DSM (and it’s “axes”) is a coding book for the insurance companies

Diagnostic Testing: Case Study-Laurence Summary of Findings and Recommendations 1) Extended Test Time (1½ times) 2) Because of his present difficulties with reading and writing skills, Laurence might require oral testing or oral clarifications on exams requiring extensive reading or writing 3) Based upon poor word identification abilities and a slow reading rate, Laurence would benefit from electronic textbooks… 4) Laurence should not be penalized for misspellings…

Case Study Revisiting Marilyn

Case Studies Devin Michael Stacy