O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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How is a neuropsychological assessment different from an assessment done by the school district?

How is a neuropsychological assessment different from an assessment done by the school district?

I have been contracted by nearby school districts to conduct independent assessments of students, and I have provided training and consultation to many local school psychologists and counselors, so I have a solid understanding of how the special education process works.   School districts are required by law to evaluate children for special education services if a child’s academic progress is significantly below grade level.  The school psychologist may administer intelligence tests (IQ), and tests of other cognitive skills.  A speech therapist might assess the child’s speech fluency as well as other aspects of language expression and comprehension. A learning specialist administers standardized tests of academic skills—reading, written language, and math.

The neuropsychological assessment is similar to the school assessment, but more detailed.  Typically, it covers everything the school assessment does (except speech articulation), but it goes into greater depth in examining various aspects of cognitive processing.  It is more “brain oriented,” in the sense that it starts with a fundamental understanding of how children’s brains work when they are learning and processing information.  The neuropsychological assessment aims to create a picture of how the child learns best and identify the specific areas of weakness that lead to problems in learning. We closely examine many different kinds of thinking skills, from very simple, elementary skills to very complex, high-level skills.

For example, the assessment will evaluate the child’s abilities in auditory attention, visual-spatial processing, visual-motor integration, phonemic processing, memory, attention span, and executive functioning (planning, organization and inhibition).  The results of this evaluation are then applied to an analysis of the child’s skills in reading (and other academic skills).  This way, a comprehensive set of recommendations can be made to help the child succeed in school.

Some other differences:

  • The neuropsychological assessment is usually more extensive and detailed than the school assessment.  The neuropsychologist can diagnose ADHD and related mental health conditions; the school psychologist cannot make these diagnoses.
  • The neuropsychologist can evaluate any child with learning problems—mild or severe—but the school often refuses to evaluate the student unless the student has already fallen significantly behind typical classmates.  So, the neuropsychologist is able to catch learning problems earlier.
  • The neuropsychologist works independently of the school district and is free of budgetary considerations.  The neuropsychologist can also make recommendations for services or treatment not offered by the school, or even recommend a private school placement, but the school psychologist is limited to recommending services offered by the school.  For these reasons, some parents feel that the neuropsychological assessment offers a more independent opinion about the child’s learning needs.
  • The school district assessment is done at no cost to the parents.  The neuropsychological assessment is paid for by the parents. It is sometimes covered by insurance if there is a suspicion of an underlying medical disorder, but health insurance usually does not cover “learning disability” assessments.

Parents can submit the results of an independent neuropsychological assessment to the school district as part of an IEP process to determine whether a child is eligible to receive special education services.  The school can rely upon the neuropsychologist’s findings to make decisions about the child’s placement and instruction.

Continue to my next post to learn about the interventions that can help dyslexic students learn to read.

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How is dyslexia diagnosed?

A diagnosis of dyslexia is best made by an experienced psychologist who has carefully reviewed the child’s developmental, educational and medical history.  Assessment must comprehensively evaluate the child’s health and development. Causes of reading problems other than dyslexia must be ruled out. For example, emotional disorders, mental retardation, diseases of the brain, ADHD and certain cultural and education factors can cause learning problems, but they are not dyslexia.

Neuropsychological and educational testing can provide a detailed understanding of how the child processes information and create a picture of the child’s strengths and weakness.  It can objectively measure the child’s skills in reading accuracy, reading fluency and reading comprehension and compare the child to typical children of the same age and grade level.  Moreover, the assessment can pinpoint the child’s skills in those particular cognitive processes that underlie reading—phonemic awareness, verbal fluency, verbal memory, oral comprehension and auditory attention, for example.  To place these skills in context, it is also important to understand the child’s broader abilities in reasoning and conceptual thinking, so intelligence testing (IQ) is part of the assessment.

I have made many changes over the years in my method of assessment to keep up with new discoveries in the field, and I keep refining my approach as I learn more about the things that matter most to parents, kids and teachers. Always, my goal is to understand as best I can what the main problems are—from everyone’s perspective—and then to answer questions clearly and directly so everyone has a better idea of what is going on and what specific actions will result in real improvement.

I begin with an interview of the parents (without the child). The goals here are to define the main concerns, review the child’s developmental history, review educational history, and learn about the family.  We discuss what has been tried so far, with what results.  I carefully examine all school records, including report cards and previous assessments, and I ask current teachers to complete questionnaires. Then, I usually meet with the child for two sessions of one-to-one testing, each session lasting 2-3 hours.  Finally, I meet with the parents again to discuss all the results and recommendations.  Typically, this whole assessment takes place over two weeks or so.

What do we achieve through this process?  We know if the child has dyslexia or some different kind of learning disorder. We have a good fix on the child’s current skills in reading fluency, reading accuracy, and reading comprehension, as well as writing and math.  We are able to rule in or rule out ADHD and other conditions that might affect reading. And we know about the child’s abilities in important areas of cognitive development—how well the child is able to focus, remember new information, express ideas in words, grasp new concepts, plan and stay organized.  We also have a good sense of how the child is feeling about school and his or her own learning experience.  All of this information is useful for designing the best program of instruction to meet the child’s educational needs.

Continue to my next post to learn about how a neuropsychological assessment is different from a school district assessment.

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Understanding Dyslexia

What exactly is dyslexia?  How is dyslexia diagnosed?  Is it something your child’s teacher can recognize?  Does it require some kind of special evaluation?  What is the school supposed to do to assess the problem?

If your child is struggling to read, it’s going to make you worry.  You see all of his classmates making progress, reading chapter books, glowing with excitement at their newest discovery, while your child lags behind.  He strains to sound out the most basic words, laboring, every sentence like plodding through mud.  Progress comes only by inches.  Meanwhile, frustration­––­for both of you–grows bigger every day.

Maybe you’ve heard some things about dyslexia but you’re not sure what to believe. Maybe you’ve heard that it means kids reverse letters, like d and b, or write backwards.  Maybe you feel sure your child is bright, so it doesn’t make sense that reading should be such a struggle. Or, maybe you struggled to learn to read yourself, and you wonder what a family history of reading problems might mean for your child.  Maybe your child is already receiving special education services, but you still feel confused about what exactly the problem is, and what needs to be done to help.

Dyslexia Defined.  Dyslexia is a reading disability that occurs when the brain does not properly recognize and process the symbols of written language. The disorder occurs when the brain has trouble making links, or associations, between what letters look like and what spoken words sound like.  The result is that the child does not learn the skills of reading at a rate expected for the child’s age.  Dyslexia occurs in children who are of average intelligence, in children who are of superior intelligence, and in children who are slow learners.

What causes dyslexia?  The disorder is a specific information processing problem that does not interfere with one’s ability to think or to understand complex ideas. The disorder affects how the brain processes the sounds of language, such as separating out the sounds that make up words, or properly sequencing sounds in order.  Very often, the child has related problems that involve weakness in verbal fluency, listening attentiveness, verbal memory, and vocabulary.  Commonly, there is also weakness in the “mental scratchpad” referred to as working memory—what we use when we hold information in mind briefly, long enough to complete a mental operation or very short task. Sometimes the child only shows delays in reading and all other aspects of cognitive development are normal, but sometimes the child has problems affecting many kinds of learning.

Research shows that the particular problem of dyslexia arises as a result of problems in language processing.  It is not primarily a visual problem or a kinesthetic problem.  In other words, the problem is not how the child sees or moves.  And it is much more complicated than just reversing letters like d and b.

How common is dyslexia?  Reading difficulties are very common. Exactly how common depends on the particular definition of dyslexia. For example, results of the 2005 National Assessment of Educational Progress indicate 27% of high school seniors are reading below the most basic levels (minimum level at which a student can demonstrate an understanding of what he or she has read). Primary grade students are even more frequently affected—36% of fourth grade children are reading below basic levels.

What happens as children get older?  Unfortunately, reading difficulties are persistent and do not get better just with age.  Children don’t simply outgrow the problem or catch up on their own.  A student who fails to read adequately in 1st grade has a 90% probability of reading poorly in 4th grade and a 75% probability of reading poorly in high school. Moreover, as students get older, they must shift from learning to read to reading to learn, and so poor readers remain at a big disadvantage in their education.

Brain basis of dyslexia. In the past 20 years, neuroscience has created an explosion in our understanding of dyslexia. Scientists now speak of the neural signature of dyslexia, making a previously a hidden disability now visible. Research indicates that a particular part of the brain is usually involved in the problem (the left temporo-parietal cortex), but several other networks also play a role.  Very recent research has studied dyslexia in languages other than English. One fascinating finding is that the phonological deficit—not being able to break up words into their separate components—and the lack of ability to automatize (reading quickly and effortlessly), appears to be universal among those with reading disability, regardless of the specific language. And neuroimaging studies have revealed actual brain changes after effective intervention for dyslexia.

Is dyslexia inherited?  The short answer is that genetics plays a big role. Dyslexia is strongly heritable, occurring in up to 68% of identical twins and 50% of individuals who have a parent or sibling with dyslexia. The latest research has even identified specific genes linked with reading disabilities. Dyslexia also is associated with various medical conditions that affect brain development but are not inherited, such as premature birth, epilepsy, and drug exposure during pregnancy.

But dyslexia can also occur in children who have no family history of learning disorder, and no history of medical problems.  In fact, in most cases, no specific cause is ever identified.  But one implication of this research is that if a child has a parent or sibling who is dyslexic, that child should be considered at risk and be observed carefully for signs of a reading difficulty so extra help can be offered earlier. One good reason to hope is that accurate diagnosis, especially when the child is young, can lead to early intervention that gets the child on the path to reading.

Continue to my next post to learn how dyslexia is diagnosed.