LD Diagnosis
From LiteracyTentWiki
What would a comprehensive evaluation process be for an LD diagnosis?
The components of a comprehensive evaluation for Learning Disabilities Diagnosis for adults should have the following:
Intensive interview and observations, comprehensive assessment of cognitive and academic skills, authentic assessment of applied skills, team approach to recommendations and accommodations, and a strong evaluation and follow up component.
(okay, you can stop here or go on for my thoughts and descriptions)
1. Intensive interview At the very least one that focuses on past history and present experience involving health and medications; prior accidents/injuries; elementary, secondary and postsecondary education and training experiences; basic socio-emotional and psychological elements such as self-esteem, depressive conditions, and emotional/stress related situations; co-existing disorders or disabilities; substance abuse; and I have probably forgotten something, but you get the picture. The interview should also have a strong amount of questioning about limitations that are typically connected to the behaviors and characteristics of Leading Disabilities (example: details about reading difficulties, math difficulties, misunderstanding oral directions, study habits, and so forth). There should be enough questions about what the individual does well to get an idea of the differences between strengths and possible limitations (hobbies, interests, tasks done well, classes and jobs liked, etc.). Finally, there are some questions that directly relate to things we know may foster the development of Learning Disabilities such as birth trauma, mother’s health during pregnancy, adopted, twin/multiple birth, etc.). I also think it critical to know the goal or possible goals even if broad so that recommendations can be more focused. I probably forgot something, but I am sure you all get the intention.
2. Assessment Tools Assessment tools must be appropriate for the individual. This means using tools that are standardized on adults from a variety of geographical areas and environments, socio-economic backgrounds, age ranges, cultures/ethnicities and other variables. STILL, biases are most definitely present in assessment tools and the evaluator must be aware of and control for them. The types of tools are important also. Abbreviated, short tools may not be the best for an adult who really needs a comprehensive assessment which is what a Learning Disabilities assessment should be.
Here are some of the areas a comprehensive assessment should contain: a. Sensory and perceptual covering discrimination and perception in auditory, visual, tactile/kinesthetic b. Motor functions such as auditory-motor, visual-motor, etc. c. Higher order executive functions such as memory processing, speed of processing, reasoning, abstract/concrete concepts, problem solving, attention and concentration, insight, etc. d. Knowledge e. Expression of ideas/language use f. Nonverbal thinking and reasoning g. Visual spatial thinking and skills h. Academic achievement (reading, math, writing, general knowledge, and oral skills) i. Psychosocial I am sure I missed some areas, but this gives an idea of the depth and focus. The point is that the evaluator should be working on an information processing model that comprehensively addresses input, integration, storage, and output. Simple to say, but certainly complex and is not something that happens in a two hour session. Oh, and by the way, newer test forms are, as they say, new and improved and should be the preferred form.
It may seem obvious, but another critical element is observations. Not only the evaluator, but your observations that you may be able to share (with the person’s permission of course) are extremely informative in the comprehensive process. Observations include things that happen in the classroom, during breaks, mannerisms, time orientation and spatial orientation, etc.
If I were to design the evaluation process I would add some things that are not usually present. The first is an authentic environment factor. Each person who has a Learning Disability performs differently on a test in a quiet room with an evaluator versus in a classroom, training or work situation. So I would want an opportunity to either have information from another professional who observed and interacted or would want to see for myself. Second, the process of comprehensive evaluation for adults should be done with a team approach. Frequently the evaluator is not familiar with the types of accommodations that are allowable and reasonable within the setting and thus does an injustice to the individual by framing the recommendations in broad terms and not specifics. Equally, each system (postsecondary, training, work, etc.) is different and has different offerings and opportunities both under the laws and by choice. Using a team approach gets those who are knowledgeable in specific areas working in tandem for the individual.
I know this is a long post, but this is not a question that can be answered by a short, easy answer, so thanks for hanging in there… one more thing, which is a pet peeve of mine.
After the assessment has been completed and diagnosis specified, evaluators should present the information to the individual, not send it to the referring agency (if there is one) for the referring agency to share with the individual. Secondly evaluators should pay attention to what they are diagnosing and recommending. My point is this: if an individual is diagnosed with a visual disability/reading disorder is a printed report the best mode of communication? If a person has low reading and vocabulary levels, why would we present the report in lengthy paragraph form with vocabulary that is unfamiliar? Now some will read/go over the report orally and feel that method covers the bases. But what if the individual has a memory processing problem or concentration difficulty, or auditory processing problem? The list could go on for days. Okay, the real point is that we cannot continue to evaluate adults for Learning Disabilities, using any model, and not provide consistent follow-up services so that the information is usable, meaningful and makes a difference in the person’s life. If all we are doing is referring for LD evaluation to jump through a hoop of documentation but the individual doesn’t understand the information, the diagnosis, etc. and how it affects life and as well never understands how to transfer and generalize that information then we have failed and failed miserably.
I am assuming I am singing to the choir here and hope you understand my comments are out of frustration with a system that I will openly admit I have contributed to…but as I have worked more and more with adults over long periods of time realize the errors of my earlier ways. Okay, first I am not a clinical or educational psychologist so I should stop sometime soon and let those who are professionals in that area help continue this dialogue before I get the entire community up in arms with me. Just one final comments…
Anytime an evaluation occurs we have changed someone’s life for a lifetime. I, for one, want it to be a positive change and I know that’s the same feeling from all of you out there. Thanks.
Nancie Payne
Posted August 9th, 2006 to the Learning Disabilities Discussion List http://www.nifl.gov/pipermail/learningdisabilities/2006/000576.html
