What Testing Can Help Diagnose Learning Disabilities?

What is a learning disability?

Learning disabilities refer to a disruption or disorder in the cognitive process that impacts learning. Learning disabilities are typically identified in a child as he or she progresses through the grades at school when they must demonstrate their ability to read, write, or perform mathematical concepts as a measure of their learning.

Learning disabilities can also impact higher-level brain functions, like organization and planning, reasoning, attention, or memory. These skills can affect one's employment status or their successful relationships with family and friends. At times, a learning disability may not be appropriately identified until high school or later. Often, adults look back on their youth, never understanding why certain academics were more difficult for them and may seek answers later in life.

Individuals with learning disabilities have average to above-average intelligence. To be diagnosed with a learning disability, there must be a documented discrepancy in capability and performance.

In school, a child may struggle with reading, writing, or math. They might have difficulty with motor coordination, focusing their attention, remembering things, staying organized or following directions.

A learning disability may or may not be attributed to genetic or neurobiological factors that change the brain's function. Sometimes a learning disability can be referred to as a "hidden disability" because the individual presents typically and appears bright and of average intelligence but may struggle to complete age-level skills.

Who diagnoses a learning disability?

Often, a team of specialists or neuro-psychologist can diagnose a student with a learning disability. To be diagnosed with a specific learning disability, an individual has to have a significant discrepancy in scores between intellectual and achievement testing scores. Typically, a student needs to go through a psycho-educational evaluation, meaning an evaluation process that involves both academic and psychological testing. Additionally, a medical exam must rule out other diseases, emotional issues, developmental disabilities, and genetic disorders.

Family history is taken, and past school performance is reviewed. In a school setting, a parent, caregiver, or teacher may refer to special education to assess a student's learning needs. If an evaluation is recommended, a multi-disciplinary team of school professionals will evaluate the student in the areas of concern. This team is often comprised of the school psychologist, school nurse, special education teacher as well as speech therapist, reading specialist, occupational therapist, and physical therapist if needed.

A school psychologist is trained in both education and psychology. He or she will meet with the student and conduct standardized testing to measure the student's intellectual ability. Cognitive tests are typically performed, as well as measures of emotional, behavioral, and adaptive skills (with input from parents or caregivers, and teachers).

Academic testing is conducted by a special education teacher and may include formal or standardized measures and some informal observation and assessment. A student's skills in reading, writing, and arithmetic are measured and compared relative to other normative scores for children in their age and grade. The results of the school psychology and academic achievement evaluations will be compared to determine consistency and identify any discrepancies. A certain score difference or spread is required to be identified as a student with a specific learning disability in some states.

Additionally, during testing and in the discussion of criteria to identify a student with a learning disability, the team must rule out learning difficulties due to motor delays, hearing or visual impairments, emotional disturbance, and disadvantages due to cultural restrictions or economic disadvantages.

Some families seek an outside professional evaluation like a neuropsychologist instead of their local school psychologist and educational team.

Independent evaluations offer families more privacy, as they may or may not want to share the results of testing with the school. Private psycho-educational evaluations should include a background intake, cognitive assessment, academic achievement, personality or emotional assessment, as well as supplemental tests for memory and attention, language, or processing skills if needed. Observation and clinical impression are common in a report as well.

How much does an evaluation cost? How long does it take?

A school evaluation is free. A parent or caregiver may refer their student to the special education team to determine if a full evaluation is warranted. The team may or may not agree to proceed. The school psychologist and special education teacher are often employed by the school and are obliged to focus on the school concerns as they impact a student's learning in an educational setting. The school is required to complete evaluations and determine eligibility within 45 school days of a signed consent form.

If a family chooses to elect for a private neuropsychological evaluation, they should expect to pay somewhere between $2000 and $5000 for testing, depending on where they live (and demand). Some types of testing and parts of an evaluation may be covered by health insurance (or reimbursable if the practitioner does not accept private insurance) if it is to diagnose psychological disorders (like anxiety, depression, or ADHD).

Typically, one's medical insurance does not cover learning disorders or educational challenges. Health insurance plans follow a "medical model" and can cover mental health or neurological conditions that are medically necessary. Learning disabilities are primarily dealt with at school, with the school team, under an educational model. The timeline for private testing may take a few weeks to a few months, depending on what types of assessment and observations are made. 

Common Types of Learning Disabilities and Disorders

Several types of specific learning disabilities may be identified or diagnosed as part of a psycho-educational evaluation. Some of the more common learning disabilities include:

• Dyslexia
• This type of specific learning disability affects reading and language-based processing skills. It involves a disconnection between letters and their sounds with recognition and spelling of words
• May struggle with identifying left or right, have poor spelling, frequent (beyond age-appropriate) reversals of letters when reading or writing
• Difficulty understanding/answering questions or following directions
• Poor reading comprehension skills, as well as word recognition
• Difficulty organizing language – both spoken and written
• Deficits in phonemic awareness (hearing and understanding sounds of spoken language)
• Dyscalculia
• This type of specific learning disability involves one's ability to understand numbers and math facts to perform math calculations. They may struggle with comprehending fractions and number lines, positive and negative numbers
• Poor ability to make change when handling money; to estimate time and sequence of events
• Difficulty with math-related word problems and organizing math work on paper
• Dysgraphia
• This specific learning disability involves visual-motor coordination and fine motor skills required for handwriting
• Individuals struggle with letter recall for formation and automaticity to write letters and numbers (which impact can impact math performance and contribute to dyscalculia)
• Aversion to writing, poor interest or stamina to get thoughts onto paper
• Can overlap with or be an indicator execute function difficulties
• Dyspraxia
• This specific learning disability refers to difficulty with motor tasks that interfere with learning
• Trouble staying organized with personal materials, difficulty manipulating school tools like scissors or using two hands together
• Struggle with balance and navigating the school environment
• Sensory processing challenges may come into play, sensitivity to sound, light, touch
• Dysphasia/Aphasia
• Difficulty with language, understanding spoken language, and poor reading comprehension
• Often is present with a speech disorder or language impairment
• Auditory Processing Disorder
• This specific learning disability involves difficulty hearing the differences between sounds
• Trouble with reading and understanding language
• Visual Processing Disorder
• This specific learning disability refers to difficulty interpreting visual information
• Trouble with maps, charts, and visual displays of information
• Nonverbal Learning Disability (NVLD)
• Individuals have difficulty with non-verbal language like facial expression or body language. Poor social, motor, and organizational abilities
• Not listed under IDEA, but growing research that NVLD coexists with other specific learning disabilities
• Executive Function Disorder (EFD)
• This specific learning disability impacts planning and organization, management of time and space, and attention.
• Individuals with ADHD often struggle with executive function

Response to Intervention

Response to Intervention, or RTI, is a school model to begin interventions in students before they are identified with a learning disability. School teams often use RTI data as part of their evaluation process, if that is the next step. Standardized testing is still usually recommended. When a student is identified as struggling with concepts in the academic setting, general education supports are put into place via a tiered model. These supports may differ from state to state and school to school. Generally, they follow the following type of sequence:

• Tier 1 – all students receive high quality, researched-based, whole-class, universal instruction and behavioral support with periodic benchmarks
• Tier 2 – targeted small group interventions for students that struggle or are considered "at-risk"
• Tier 3 – intense, individualized intervention, sometimes at the stage where evaluations at IEPs are considered

Learning Disabilities in Adults

While most learning disorders are diagnosed in children as they learn to read and write in grammar school, some adults go their whole lives without having a diagnosis of a learning disorder. It is estimated that 10% of the population experience some type of learning disorder. 

Having a learning disability go undiagnosed can impact relationships with others, job choices, and career decisions, as well as contribute to other life-long emotional difficulties like anxiety and depression. Some estimate that 1 in 6 adults have difficulty with reading. It is believed that many teenagers who drop out of high school early can have learning disabilities. Reports show a high percentage of prisoners and inmates that struggle with literacy and likely have undiagnosed learning disabilities.

In today's world, it is important for functioning individuals to have an awareness of their strengths and weaknesses, including a potential learning disability, to advocate for themselves and manage their needs. Unfortunately, there is a long history of social stigma that incorrectly associate learning disabilities like dyslexia and attention struggles with low cognitive skills.

If you are an adult questioning your learning style and are curious about a potential learning disability, it can be important to identify it. There is treatment. If diagnosed with a learning disability, you may qualify under the American Disabilities Act for accommodations that can help with success in the workplace. Some are easy to do and can make a big impact on the individual's comfort, success in the workplace, and overall improved self-esteem. Some technology-based accommodations for learning disabilities may include:

• changing the font of printed materials when reading
• utilizing voicemail over email
• adjusting the screen display
• using speech to text
• improving typing skills
• embedding word-prediction in typing programs

References

https://ldaamerica.org/types-of-learning-disabilities/

https://individualmatters.org/insurance-vs-private-pay/

https://www.readandspell.com/us/is-dyslexia-a-disability

https://ldaamerica.org/advocacy/lda-position-papers/response-to-intervention-rti/