DIAGNOSING A LEARNING DISABILITY: PIECING TOGETHER THE PUZZLE

You may suspect that your child has a learning disability, but you want to have it confirmed by an expert. Or maybe you already have a diagnosis and want a second opinion. But first, what exactly is a learning disability?
 
The Individuals with Disabilities Education Act (IDEA), the federal law that governs special education, designates 13 categories of disability. Presented alphabetically, they are: Autism, Deaf-blindness, Deafness, Emotional Disturbance, Hearing Impairment, Intellectual Disability, Multiple Disabilities, Orthopedic Impairment, Other Health Impairment, Specific Learning Disability, Speech or Language Impairment, Traumatic Brain Injury, and Visual Impairment.
 
Specific Learning Disability, the focus of this blog post, is defined as a “disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language.” This may interfere with:

• Listening;
• Thinking;
• Speaking;
• Reading;
• Writing;
• Spelling; or
• Mathematical calculations

Note that to be covered by special education, school performance must be “adversely affected.” In other words, it is not sufficient to merely match behaviors to a category’s descriptors; it must be shown that these have a negative impact on school performance, and to what extent. Moreover, there are exclusionary factors; according to the law, a learning problem is not considered a disability if it results primarily from a visual, hearing, or motor disability; mental retardation; emotional disturbance; or environmental, cultural, or economic disadvantage. For instance, a child who is having difficulty reading primarily because of an inability to see the print does not have a learning disability. Similarly, if a student hasn’t been exposed to appropriate instruction, his or her difficulty is not considered to be a learning disability.
 
Specific learning disability occurs more often than the other 12 categories. In the 2020-2021 school year—the most recent year for which there are data available—some 7.2 million children received special education services overall. Of these, 33 percent were for specific learning disabilities.
 
How is it determined that a child has a specific learning disability? Each state must adopt criteria that are consistent with IDEA. Evaluators need to use more than a single assessment measure, and all instruments must be technically sound and administered by trained and knowledgeable personnel. The evaluation has to be “sufficiently comprehensive to identify all the child’s special education and related services needs.”
 
In school districts, most educational evaluations are conducted by special educators and most psychological evaluations—generally comprising intelligence testing—are conducted by school or clinical psychologists. Depending on student needs, the evaluation team may also include other professionals, such as speech-language pathologists or occupational therapists.
 
Independent evaluations are usually conducted by clinical psychologists, neuropsychologists, and/or educational specialists. Independent evaluators must be qualified, using the same or similar criteria as the school district, and they cannot be employed by the same district that the student attends. Although a psychologist can conduct a psycho-educational evaluation, in many cases the educational portion--and the resulting educational recommendations--tend to be sparse. In my opinion, students benefit from in-depth evaluations from a psychologist as well as an educational specialist who can then coordinate their findings to provide expertise from both their fields.
 
It is important to be aware that a learning disability cannot appropriately be diagnosed without assessing learning. As stated earlier, to diagnose a learning disability the evaluator/s need to show that school performance is “adversely affected.” This may sound obvious, but unfortunately some professionals merely summarize what school personnel report and base their conclusions on what is at best second-hand data and at worst basically hearsay.
 
Parents may wonder what evaluators look for to make this determination. First, the psychologist needs to rule out exclusionary causes of learning difficulties. For example, is there mental retardation? Serious emotional disturbance? The educational specialist needs to ascertain that the student has been exposed to appropriate instruction. She will also want to find out what services have already been provided in or out of school, and their duration, so that recommendations can build on these. There is no point in continuing to recommend services that have not helped. Next, the evaluators review the student’s educational history via verbal and written interviews with parents and teachers, obtaining information about the child from birth to the present to ascertain if any conditions or situations may bear on the current learning difficulties. Finally, the evaluators administer a set of statistically valid and reliable tests.
 
Parents sometimes think that there is one test for dyslexia or any learning disability, but there is not. Instead, the evaluator pieces together many components to fully understand the student. For example, students with reading difficulty serious enough to be diagnosed as dyslexia also had difficulty learning letter names or sounds, or both, when they were younger, so the evaluator needs to find out when the learning issues began. A battery of tests, both standardized and informal, will help to provide a full picture about a child’s current levels of performance, areas of strength and difficulty, behaviors when presented with challenging tasks, and strategies that are used to meet those challenges. I like to think of all this as a puzzle that is pieced together until clarity emerges about how best to serve the student going forward.