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A Sample Literacy Solutions EvaluationOn this page is an actual literacy-skills evaluation performed and reported by Literacy Solutions. Identities have been changed to protect the privacy of the client. Every evaluation performed by Literacy Solutions is as thorough and informative as the report below. Our aim is to give parents and educators what they need to help students realize their full reading and writing potentials. The following report was created to supply necessary information to teaching professionals. It contains technical language and references that may be unfamiliar to the lay person. Literacy Solutions explains every part of an evaluation — in simple English, and in a relaxed and private setting — to the parent(s) or guardian of the evaluated student. Literacy Solutions™, LLC
Reason for Referral: Mr. and Mrs. Smith brought Student to The Literacy Center™ for a diagnostic evaluation of his learning strengths and weaknesses. They are concerned with his poor progress in reading and written language and with his academic frustration. The Anyfamilys are seeking information regarding an appropriate program for Student in reading and written language, and help in dealing with his learning frustration. Background History: Student is beginning his fourth grade year at Any School in Jonestown, Anystate. He currently receives Special Education services for reading and spelling. The last reference in his records regarding the amount of service he receives is in the minutes of the March 30, 1998 PET. The minutes show that Student was receiving 210 minutes weekly of special education service, no speech and language therapy, no physical or occupational therapy and that counseling was to be determined. Student was in the Reading Recovery program in grade one. According to parental report, in the referral for PET dated November 19, 1996, Student seemed to do well in this program, but lost ground after exiting the program and beginning grade two. Student's parents requested testing in November of 1996. A referral was made to the Pupil Evaluation Team on November 22, 1996. The records indicate that "Student is performing below his peers in the area of reading". An evaluation by Mr. John Doe in November, 1996 revealed that Student had a learning disability. Student's cognitive ability as measured by the WISC-III was in the superior range (Performance Score: 113, Verbal Score: 123, Full Scale IQ: 121). Student's achievement testing revealed the following scores: Broad Reading: Standard Score = 86, Basic Reading = 85, Broad Written Language = 95, Broad Math = 100, Broad Knowledge = 124. Mr. Doe noted that Student shows a particularly outstanding knowledge of science. He also noted that Student's behavior is considered significantly inappropriate by his classroom teacher. A Speech-Language Evaluation report by Ms. Betty Smith in December of 1996 found Student's speech and language functioning to be in the average range, overall. Weaknesses were noted in the areas of communicative performance specific to pragmatic language functions, and receptive skills pertaining to auditory processing of directions, word discrimination and memory. Student often misunderstood words and reproduced them incorrectly. Ms. Smith stated that it was her opinion that Student did not present with a Central Auditory Processing Disorder. There is no indication in her report that formal screening for a Central Auditory Processing Disorder was done to rule in or out the need to evaluate for a CAP-D. There is also no indication in the records that Student has ever been formally evaluated for a Central Auditory Processing Disorder. On January 3, 1997 the Pupil Evaluation Team identified Student as having a Learning Disability in reading. Although there was also a measured significant discrepancy between his math achievement and his full scale IQ (FS IQ = 121 – 100 math achievement = 21 SS points difference), Student was not identified as a student with a learning disability in math and Special Education services were not offered in math. Special Education services were also not offered to Student in written language, although there was a significant discrepancy between his written language achievement and his Verbal IQ (V IQ = 123 – 95 written language achievement = 28 SS points difference). Student’s strength in Broad Knowledge (SS=124) was noted as a strength. There was clearly an enormous gap between Student’s knowledge base and what he is able to communicate in writing and what he is able to understand in reading. It was noted that he also had difficulty controlling anger when frustrated. The records indicate that Student would receive Resource Service, which would be combined pullout and in class service. On January 23, 1997 Student was evaluated by Mr. John Smith. Mr. Smith completed a psychological evaluation of Student. He describes Student's performance on the WJ-R as being indicative of a weakness in phonetic instructional analysis skills. Mr. Smith described Student’s spelling as appearing to reflect stronger phonological awareness than his reading. Student's exceptional expressive verbal skills and verbal reasoning abilities were cited. Mr. Smith's report notes a marked discrepancy between Student's exceptional expressive vocabulary and his low average sight vocabulary. The Conner's Parent and Teacher Rating scales found some areas of clinical significance. These areas included excessive self-blame, poor academics, excessive sense of persecution, excessive resistance, excessive anxiety and withdrawal, poor ego strength, poor physical strength, poor coordination, poor attention, poor impulse controlled, poor reality contact, excessive suffering, poor anger control and excessive aggressiveness. A neuropsychological evaluation was recommended for Student. A Central Auditory Processing evaluation was suggested, along with an audiometric evaluation. The report stated that Student might benefit from a relatively structured and individualized academic setting. Minutes from the PET meeting of February 3, 1997 indicate that Student was identified as a student with a learning disability and as such, would begin to receive special education services. The amount of time for which he would receive services is not stated. Mr. Smith stated that he sees Student as truly dyslexic, but in need of a neuropsychological evaluation. This PET meeting was continued on February 11, 1997. Student's IEP was finalized at this meeting. It included reading, spelling, behavioral and pragmatic language goals. Goals in math and written language were not established. It was noted that Student has been participating in the gifted and talented program, and that he has been much happier since the last PET meeting. It was determined that Student would begin receiving one hundred fifty minutes of special education services weekly. On September 3, 1997 a goal was added to Student's IEP to improve self-esteem regarding school. Mr. Sam Jones completed a neuropsychological examination of Student in April of 1997. The results confirmed that Student was performing in the superior range of intellectual ability. Deficits were found on measures of verbal memory and learning, visuoperceptual ability, attention/concentration, and sensory perception. Achievement testing found Student to be functioning in the lower first grade level in word recognition and reading comprehension and in the upper first grade level in spelling. Math reasoning and computation skills were found to be at or about grade level. Standard scores for these tests are not cited. Based on the DSM 4, a diagnosis of Learning Disorders in Reading and Written Language was made. An additional diagnosis of Attention Deficit Hyperactivity Disorder, Predominantly Inattentive Type was made, based on DSM 4. Evidence of a mild verbal memory problem and of a mild verbal learning problem was seen. Evidence was also seen of organizational problems. Low self-esteem and depression were linked to the academic stress. One to one educational was recommended. Multimodal instruction, chunking of instructions, positive reinforcement, side front seating, hand cues, and extra time to complete testing assignments were also recommended. At the June 18, 1997 PET meeting Student's special education teacher stated that Student had done very well with the reading program. No standardized testing is cited. The minutes of this meeting state that Dr. Smith recommended counseling for Student but that, "everyone agreed that things are going well and that counseling was not needed as a support services at this time." On October 8, 1997 a PET meeting was held. A new objective was added for reading. A recommendation was made to slowly increase service time in the resource room for Student. Additional recommendations were to add a modification for Student to have time-out, and to add to the plan that the parents would be called if Student became upset enough to act out physically. A PET meeting was held on December 4, 1997 to discuss programming. The minutes state that Student's reading program "is up to an hour three times per week and that on two days he works for one half-hour." Progress was noted in Student's program. The PET planned for Student's counselor to observe Student in school. On January 22, 1998 a PET meeting was held to discuss programming. The team felt that Student's behavior had become disruptive to his academic program. Student had been reacting negatively to requests to follow directions, to perform writing tasks and other academic tasks across the curriculum, and to complete some assignments for which he was provided one-to-one assistance (with a paraprofessional). Student's behavioral program was modified as to time intervals and rewards. An annual review meeting of the PET was held on March 30, 1998 to review Student's IEP. The minutes show that Student was receiving 210 minutes weekly of special education service, no speech and language therapy, no physical or occupational therapy and that counseling was to be determined. These records indicate that Student would take the CMTs in the fall. Annual goals were written calling for an increase in Student's reading and spelling skills by one year. A goal is included for Student to increase his on task behavior at school. Student's Special Education teacher, Cathy Smith, indicates that Student has made excellent progress in the Wilson reading program and that the Woodcock Reading mastery test places him at a 2.5 reading level. No standard scores are included in the report of the minutes of the meeting. The records do not indicate when and why Student’s amount of Special Education services were decreased (12/97, 240 minutes/week; 3/98, 210 minutes/week). Test Observations: Student is a highly verbal, imaginative young man who feels that he is not successful in reading and writing tasks and who reaches frustration fairly quickly. On tasks that Student found easy, and at which he was successful, he worked quickly and steadily. When attempting tasks that were difficult for him, Student continued for a time to persevere, but when he realized that he was not successful he quickly "shut down". Auditory tasks frustrated Student more than any other task, although the motoric component of writing was also quite difficult for him. During a break in testing, Student was observed to have great difficulty tying the laces of his sneakers. The awkward grasp that he used and the difficulty that he had coordinating the movements required for tying his laces were quite discrepant with his chronological age and his verbal abilities. The same degree of difficulty with fine motor coordination was seen in Student's pencil grip and in the way he manipulated his pencil when writing. Although Student did not always correctly understand the directions that were given to him, he attempted to follow them as he perceived them. Student appeared to have difficulty activating and sustaining his attentional system. He had weak stamina for task completion and a high level of motor activity. However, even when Student was very attentive and his motor activity was not interfering with his ability to focus, he had difficulty processing auditory information. Student demonstrated significant difficulty with sensory stimuli. He displayed marked sensitivity to auditory input. When observed carefully, a gradually escalating degree of agitation could be seen as Student worked to overcome the irritation to his auditory sense. When he reached sensory overload, Student tended to jump up and bolt from the environment that was causing his overload. It is important to note that this state of sensory overload was reached irrespective of task difficulty, and was highly correlated with sounds within the environment and with his difficulty with auditory perception. Visual stimuli also seemed to bother Student as well, although to a lesser degree. Not only was Student easily distracted visually; he appeared to find certain light and patterns quite difficult to tolerate. Tests Administered: Test of Written Language-3
TEST RESULTS: Test of Written Language-3: Scores are reported with a mean of 10 and a standard deviation of 3. Spontaneous Writing Quotient is reported with a mean of 100 and a standard deviation of 15. Grade level norms were used for scoring. Spontaneous Writing Sample:
Woodcock Diagnostic Reading Battery: Scores are reported with a mean of 100 and a standard deviation of 15. Grade level norms were used for scoring.
Qualitative Reading Inventory: Scores are reported by grade level.
The Phonological Awareness Test: Scores are reported with a mean of 100 and a standard deviation of 15. Age level norms were used.
Non-Psychometric Assessment of Phonemic Blending Ability: In this test, the individual is asked to repeat phonemes after the examiner, then to blend the phonemes together and to close upon the word. Student experienced more success in this venture, most likely because it is a task that brings him from the non-sense level (phonemes) to the real word level, and he is able to draw upon his listening and speaking vocabulary to assist him. Additionally, this test suggests that Student has somewhat more difficulty with isolating and ordering phonemes than with blending phonemes. Nevertheless, Student’s performance on this assessment measure was not in the proficient range. He was able to blend and correctly close upon only 3 of 7 words, all of which contained only three individual sounds. Student was not successful with any of the blending and closing tasks with words that contained more than three sounds. With words consisting of more than three sounds, Student tended to substitute sounds, insert sounds, and incorrectly sequence sounds. These results are consistent with Student’s performance on other standardized measures of decoding, encoding and sight word reading given to him by this examiner. Boston Naming Test This subtest of the Boston Diagnostic Aphasia Examination assesses an individual’s ability to name items presented in picture format, with no cueing, or, if necessary, with a stimulus cue and/or with a phonemic cue. It also notes any latency period required by the examinee to retrieve the word. The ability to successfully engage in rapid, automatic naming has been positively correlated with reading achievement, particularly the ability to develop a sight vocabulary. Pronunciation errors were noted during this and other tasks, some of which were also seen when analyzing Student’s reading and writing errors, such as: sound insertions (flixt/fixed, gunsp/gusp), sound omissions (pet/pecked, tros/trucks), sound substitutions (thit/lish, goat, ghost/gusp), and sound sequencing errors (sinirk/snirk, besik/because) [TOWL-3; WDRB—Word Identification, Word Attack, Passage Comprehension; QRI; Boston Naming; Phonological Awareness Test]. Student also experienced a great deal of difficulty with word retrieval and word labeling. He could often retrieve a label for a similar, but incorrect, object, thus mislabeling the picture (decoration/wreath, branch/asparagus). At other times, Student would substitute a word from the same or a similar category (calculator/compass, easel/tripod). Student would sometimes name a picture with a word which sounded similar, but had an entirely different meaning or which was not even a real word (flannigan/ pelican, muzzle/mug, ice clongs/tongs). At times, Student was able to retrieve a part of the word he sought to name the presented picture, but could not retrieve the other part of the sought word correctly (horsefish/seahorse). Student also worked to describe the object or its purpose when he could not come up with the label (hang, rope/noose). There was a latency of up to eight seconds while Student worked to find a word he wanted. Almost without exception, Student was aware of his error, engaged in circumlocutions in an attempt to describe the object which he was trying to name, and was distressed and frustrated by his inability to produce the name of the pictured object with which he was clearly familiar. In one instance, when shown the picture of a wreath, Student was initially at a loss, but was clearly thinking and searching. When given a phonemic cue, he responded, "regal". When given a stimulus cue, Student first said, "decoration", then said, "Christmas". He was ultimately able to label this picture. In another example, Student demonstrated some knowledge of the pictured object even while ultimately proving unable to name the object. He was shown a picture of a noose. As Student stared at the picture, deep in thought, he squirmed around in his chair and squinted in an effort to enhance his concentration. After the phonemic cue was given, Student said, "knot", then immediately tried to self-correct and said, "No; it’s to hang with—it’s a rope.". He then angrily shook his head as he continued to struggle to retrieve the correct label. He was ultimately unsuccessful in naming the object. In other instances Student was ultimately able to correctly label the pictured object, after being given a cue. He was much more successful with phonemic cues than with stimulus cues, which is indicative of phonological processing difficulty. These errors and behaviors are indicative of significant word retrieval difficulties and may reflect inefficiencies in the correct initial labeling and storing of words in memory. These initial labeling weaknesses, and inefficiencies in moving labels from short term memory to long term memory may be due to poor auditory memory, phonological processing disorder, attentional disorder, and/or a combination of all of these difficulties. This weakness in word retrieval is in sharp contrast with Student’s Verbal IQ of 123 and is clearly a source of frustration for Student. Reading: Student needed to read out loud to afford him auditory feedback. This bi-modal processing allowed Student to focus better and it enhanced his self-monitoring ability. He also performed better when he had the reading material in front of him as he responded to questions about what he had read. Student's reading comprehension is well below the average range. Student used some good fix-up strategies to enhance his comprehension of what he read. Given the severity of his reading disability, this is somewhat surprising. Students often abandon good reading strategies when they are unable to make them work successfully. But when reading shorter cloze passages that only required him to activate prior knowledge, Student often re-read to enable him to profit from syntactic and semantic cues, made self-corrections after these re-readings, and monitored for meaning. He drew upon his background knowledge whenever possible. However, his difficulty with word retrieval sometimes made it difficult for him to come up with the word he sought for his answer (WDRB, Passage Comprehension). When reading longer passages (QRI) which required Student to gain new information from what he read, hold it in short term memory while he integrated the information with prior knowledge, and to make inferences from this process, Student’s comprehension broke down much more rapidly and significantly. He made few to no self-corrections, indicating his difficulty with monitoring for meaning in this type of reading activity. He made many more meaning changing miscues when reading longer connected text. Student's very poor performance on this particular reading test is highly significant because this type of reading test is very similar to school curricular tasks. These executive functions of tracking and self-monitoring are strongly related to attention. Since Student’s attentional system is clearly compromised at the primary level (ADD/H), this is not surprising. However, Student’s weak attentional system is further compromised by his difficulty with phonological processing and its impact upon his decoding and ability to build a sight vocabulary. When Student is able to read the words, he understands what he reads quite well. When he encounters an unknown word, however, he has little word attack strategies on board with which to help himself. His comprehension of what he reads is severely compromised by his phonological processing disorder and by his extremely weak sight vocabulary. It is really only his broad base of background knowledge and his superior thinking and reasoning abilities that enable Student to gain any understanding from what he reads, and these strengths are not enough to hold him afloat in the face of his reading disability. Student's sight vocabulary is very significantly below the average range and his word attack skills are well below average. Student’s limited sight vocabulary and his deficient phonological processing ability significantly impaired his ability to use his comprehension strategies, thereby depressing his performance on the reading comprehension tests. When an individual has a phonological processing disorder of such magnitude as Student’s, it is very difficult for that individual to develop a solid sight vocabulary. Perceptual organization of words is so weak that the individual seldom approaches and perceives a word in the same way, thus inhibiting sight storage of a word. Additionally, Student’s comprehension of what he reads is impacted by several other factors. Student understands better when he is able to read complete sentences, without having to retrieve one specific word to complete the sentence correctly, such as in a cloze procedure (WDRB). Student clearly needs the complete sentence structure presented intact to him in order to be able to utilize his comprehension strategies, so that his specific language difficulties are compensated for. Student clearly uses language to comprehend what he reads, but he needs language in a completed format, with no deletions, in order to be able to utilize it effectively. However, when there is too much connected text presented to him on a page, Student’s attentional weakness causes him to process the information from the text in a splintered manner, often resulting in incorrect assimilation of material from the text. Additionally, his deficient sight vocabulary and his phonological processing disorder also negatively impact on Student’s ability to gain new information from text. Because of his weak auditory memory, Student needs to be able to see and to hear what he reads simultaneously. In summary, when Student’s reading is not compromised by his deficient sight vocabulary, weak phonological processing, specific language and auditory deficits, and when he is able to effectively utilize his strengths in language and background knowledge, his comprehension of what he reads is quite good. However his areas of deficit will continue to impact more and more negatively on Student’s reading comprehension if not therapeutically remediated. The discrepancy between Student’s intellectual ability and his achievement in reading is immense and can be seen to be widening as he grows older. When tracking Student’s scores over time, his negative growth is readily apparent. In November of 1996, his Broad Reading score was 86. In April of 1997, he was found to be reading on a low first grade level (no standard scores are provided). In March of 1998, Student’s reading level is cited as a 2.5 grade level (no standard scores are provided and it is not clear whether this score is a Broad Reading score or a subtest score). Current testing results establish his Broad Reading score as a 54 (0.1%ile). Since grade equivalents are quite unstable, one must look to standard scores to assess Student’s reading progress over time. The drop in standard scores in Broad Reading from 86 to 54 is immense (-31 SS) and is not only indicative of lack of growth, it is indicatory of significant regression in reading achievement. The discrepancy between Student’s Verbal IQ and his reading achievement is enormous (123 SS – 54 SS = 69 SS). It is highly unusual for an individual to have a discrepancy of this magnitude. This degree of divergence suggests that Student’s learning disability is quite significant and that he is unable to benefit from his current educational program. It would seem that marked changes need to be made in Student’s program if he is to narrow the gap between his superior potential and his deficient achievement level in the language arts. Reading and writing success are key to an individual’s success in the content areas, particularly in the intermediate and upper grades. Therefore, accommodations as well as educationally therapeutic interventions will be needed for Student. Phonological Processing: Student demonstrated phonological awareness at the initial letter level, and sometimes at the final letter level. There was little to suggest that Student utilized strategies for analyzing, or even attending to, the medial parts of words when he was attempting to read words. When reading isolated phonemes, Student experienced some spotty success, but when reading phonemes imbedded in words, and words imbedded in connected text, he rarely used his familiarity with these phonemes to help him perceptually organize print. Student seemed unfamiliar with common vowel chunks, and with some consonant blends. He had difficulty hearing all of the sounds within words and ordering sounds within words. On the Phonological Awareness Test Student had the greatest difficulty with isolating and manipulating phonemes, particularly final phonemes. This task did not involve printed symbols, and was assessed with and without manipulatives. When the task demands increased from phonemic awareness (no print symbols) to phonological processing (sound/symbol), Student’s struggle increased. The visual anchor of letters can be helpful to individuals with attentional weaknesses, but it was not helpful to Student. This is consistent with the multiple facets of Student’s learning difficulties. Student also struggled with his confusion about the concepts of sounds/phonemes. This is consistent with his performance on the other measures of reading administered to him (WDRB, QRI, and Non-Psychometric Phonemic Blending). Student demonstrated confusion with sounds, particularly l, s/f, y/v (WDRB [Word Attack, Letter-Word Identification] QRI, Boston Naming). For example, he said park for part, sit for feet, yet for vent. When attempting to read lish, Student said, "thi, chi…the l gets me all confused." It was clear that Student knew the name of the letter and the sound it makes, and it was equally clear that he was struggling to help himself produce the sound that he sought. This is consistent with his phonological processing difficulties and is also indicative of his weak auditory memory. Student was somewhat more successful with phonological tasks when he was able to use colored blocks to represent the sounds that he was manipulating. This visual anchor helped to focus him and provided support for his phonological abilities. It is also likely that this visual and tactile support enhanced his weak auditory memory. This will be a good teaching medium for Student. Clearly, his phonological ability is not yet developed enough to function in words independent of these anchors. In order to assess the impact of attention upon Student’s learning difficulties, items on some subtests of the WDRB were scored with and without prompting (Word Attack, Letter-Word Identification). The difference in scores, (72/89, 57/78) is quite significant. Differences of this magnitude are rarely seen except when attentional difficulties interfere. Attentional difficulties compound Student’s primary deficits in phonological processing. Student’s spelling and reading were significant for sound omissions; that is, for words written without all of the sounds which are actually present being represented by a symbol in the child’s writing of the word. Sound substitutions; that is, hearing and representing a sound which is different than the one which is actually in the word, were also evidenced in Student’s reading and writing. Sound sequencing errors were noted in Student’s reading and writing; that is, the representation of sounds within words by symbols which are out of the correct order. Additionally, sound insertions; that is, hearing and representing a sound in a word which is not actually present in the word, were evidenced in Student’s reading and writing. These types of errors are often seen in individuals with phonological processing disorders. Student lacks the phonological ability to decode the elements in the middle of a word. The result is a guess based on the onset and sometimes the ending, or on general configuration. Unfortunately, without appropriate , what happens to individuals in this situation is that they become caught in a self-perpetuating cycle. Because they lack proficiency in coding, they guess at these word parts rather than read them, the guessing prevents them from gaining proficiency in this area of phonological awareness, which leads to more guessing, and the cycle continues to backfire on itself. Without appropriate , the negative impact on such an individual’s ability to comprehend what he reads becomes greater and greater. After a period of time, the individual’s ability to continue to acquire a sight vocabulary becomes compromised as well, since words beyond the two syllable length are much more difficult to hold in visual memory without any real phonological processing skill development. In Student’s case, his ability to develop a sight vocabulary beyond the one phoneme length is already significantly compromised, since he presently lacks the phonological skills to decode the middle of words. His ability to develop a writing vocabulary of words beyond the one phoneme length is similarly compromised, for the same reason, since encoding is simply another reflection of the phonological processing system. Typically, progress in writing lags behind progress in reading, and the individual is able to recognize more words than can be encoded. This is certainly true for Student. He sometimes used good strategies to assist him in spelling in the one-to-one setting. He whispered the word out loud slowly, attempting to listen for the individual sounds within the words. However, his efforts still did not always lead to correct responses. Student seemed to have a partial visual image in memory for some common sight words. He had difficulty remembering the middle and final parts of these words, but was able to use his oral elongation of the words to enable him to correctly produce the beginning sounds in many cases, and the ending sounds in some cases. While Student’s encoding attempts are not always correct visually, beginning and some ending sounds are often represented by appropriate alphabetic mapping symbols in short words. Because of his partial visual memory of some words, Student knew that these words had a middle part, but he was unable to use his auditory ability to correctly identify and produce this part of these words. Student’s phonological approximations in writing were sometimes more accurate than in reading. This may be facilitated by the physical act of writing. Writing slows down the process of reading, thereby permitting improved attention to the details of sound and print and facilitating one’s use of the phonological code. However, when an individual is struggling with the alphabetic code because many elements of it are unknown, and/or known elements are not accessed in a fluent, automatic manner, the attention diverted to coding depletes what is for Student an already compromised attentional system. The higher level functions of ideation and organization, and reasoning with text, are consequently deprived of the needed attention. In Student’s case, this becomes a vicious circle, with lower level perceptual tasks leeching attention from higher level tasks. With the degree of phonological processing dysfunction Student is currently experiencing, it is extremely difficult at this time for him to focus on creating a cohesive piece of writing which is commensurate with his oral language, in an unassisted writing task. There is a tremendous discrepancy between Student’s phonological processing ability and his intellectual potential, especially when a comparison is made between his verbal potential and his phonological processing achievement. Student demonstrates a symptomatic pattern of errors which is known to be associated with primary reading disorder. An error analysis reveals a preponderance of sound insertions, sound substitutions, sound sequencing errors, and sound omissions. These symptoms are consistent with symptoms demonstrated by those individuals who have the specific reading disorder known as Dysphonetic Dyslexia. Dysphonetic Dyslexics can present with any or all of the following auditory channel deficits: auditory perception and discrimination deficits, auditory sequential memory and recall deficits, difficulty with segmenting the spoken word into its component phonemes and syllables, and difficulty with blending phonemes into syllables and syllables into words. Evidence of all of these auditory channel deficits is seen in analysis of Student’s reading, writing and processing. These deficits impair phonological processing and negatively impact on decoding and encoding. Individuals with the particular form of dyslexia known as Dyseidetic Dyslexia can present with any or all of the following visual channel deficits: visual gestalt perception, memory for letters and whole words, visual discrimination, visual sequential memory and recall, and visuospatial orientation. Evidence of all of these visual channel deficits is seen in analysis of Student’s reading, writing and processing. These deficits impair the individual’s ability to develop a sight vocabulary and a fund of fluent writing words, and to master letter formation. Mixed Dysphonetic-Dyseidetic dyslexics can be expected to have a combination of component deficit functions in both the visual and auditory channels. This certainly seems to be the case for Student, and there is a strong family history of dyslexia (at least four paternal cousins have been diagnosed with dyslexia). However, this examiner believes that it would be best to reserve a definitive diagnosis of Mixed Dysphonetic-Dyseidetic Dyslexia until after a re-evaluation in approximately nine to twelve months, when Student has had some specifically geared towards remediating his phonological processing disorder, and when further investigation of his attentional difficulties has been completed, with possible pharmacological to assist attention. This re-evaluation should take place after Student has been assessed for a Central Auditory Processing Disorder, has had an Occupational Therapy evaluation and has perhaps seen a neurologist to rule out the existence of neurological syndromes. If evaluation in nine to twelve months reveals the same constellation of symptoms, consistent with Mixed Dysphonetic-Dyseidetic Dyslexia in particular and with Dyslexia in general (see section on Information Processing), it is likely that the diagnosis is appropriate. Written Language: Graphomotor: Ideation: Organization: In light of the obstacles presented by Student’s graphomotor weakness, cognitive organization difficulties, attentional difficulties, phonological deficits, and word retrieval weakness, it is not surprising that Student’s writing lacked organization. He was reluctant to put pencil to paper and was often frustrated by his difficulties with putting his thoughts down on paper. Additionally, Student seemed overwhelmed by the preponderance of thoughts in his oral composition. When prompted to write a paragraph, Student wrote down a few words and phrases. In order to assess the language portion of the writing task as an entity separate from the motor component, Student was given the TOWL-3 writing prompt and asked to respond orally. When Student struggled somewhat as well with this task, it was apparent that language organization skills are weak, both in the oral and the written mode. His other difficulties described above most likely also contribute to this difficulty with generating and organizing written expression. Shared Writing Task: With a more knowledgeable adult available to assist Student in recognizing and utilizing what he knows, Student functions more consistently in the proximal zone of his learning development, and produces better quality work that he is more consistently able to read. Much teaching can take place in this forum, particularly in the areas of phonological processing, sequential processing, delineation of ideas, and organization. However, this is not a forum in which Student can build independence in his writing, and should be reserved as a medium through which learning can take place. Writing in this setting produced more risk-taking behavior, probably because this examiner was able to use Student’s "knowns" to enable his leaps into the unknown. Technologically Assisted Writing Task: An assessment of Student’s ability to profit from technologically assisted reading and writing was done, to see if this is something that can enable Student to benefit from appropriate instruction. Student was shown how to use Co-Writer, a word prediction software program. The sound was turned on to enable Student to benefit from bi-modal presentation, and to permit Student to have words in the prediction list read to him, both of which factors are known to benefit disabled readers and writers. It was in this forum that Student produced his most successful writing. Phonological processing was enhanced, visual recognition of words was enhanced, and motor weaknesses were bypassed. Student was able to utilize his strengths and to minimize his weaknesses with the Assistive Technology. He was able to produce a significantly better writing product when he utilized this Assistive Technology. The software also helped him to activate and to sustain attention through its bi-modal feedback and instant assistance in spelling. Student was easily able to integrate the various aspects of the program and quickly became independent in its use. Initially, Student used only the middle finger of his right hand to type, and did not utilize the left side of his body at all. With prompting, he began to use both hands on the keyboard. Student became quite excited at his ability to write independently and this appeared to enable him to focus more efficiently and to tap into ideas with less struggle. Write Out Loud was another program that was tried with Student. The bi-modal feedback enhanced his attention but because no phonological assistance is built into the program, he still struggled with the phonological aspect. Inspiration is a software program that helps individuals with idea generation and with organization of ideas. It is particularly helpful to random thinkers such as Student who need to take a "think it, write it" approach and to focus on organization after idea generation. Student quickly became proficient with this program as well and was quite excited that he could generate and process ideas in a way that worked well for him and allowed him to bypass word retrieval difficulties. Student generated more specific ideas with this program than he did even in the strictly oral mode. The program clearly assists Student in overcoming his deficits in such a way that he is able to utilize his strengths. Information Processing: Information processing is discussed within the sections on reading and writing and will therefore only be briefly discussed in this section. Student has a lag in his information processing system, which may cause him to require additional processing time. Student’s attentional difficulties also clearly interfere with his ability to process information in an efficient manner. Student has phonological processing problems. The effects of these phonological processing problems on Student’s reading and writing are discussed above. Phonological processing problems also interfere with aspects of information processing. Since words are accessed through a phonological route, all mental activity, which is facilitated through the phonological/language route, is compromised. As such, phonological processing problems contribute to breakdowns in working memory and the executive functions of tracking and self-monitoring. Dyslexia does also have social implications. Dyslexic individuals often have trouble reading social cues and with being sensitive to the facial expressions of those with whom they engage in conversation. Student clearly, both historically and in current testing situations, has difficulty reading social cues and facial expressions. He fails to notice when his listener is no longer interested in his stories and monologues. Student needs training in reading social cues and in social interaction. Student has a low tolerance for frustration and does not have good self-help mechanisms on board. He has learned to act out to avoid difficult tasks. However, sometimes his acting out is due to sensory overload. Student needs to learn to be aware of when he is having difficulty with sensory overload so that he can calmly seek to remove himself from the provoking environment. Environments for Student should have as little noise as possible, soft lighting, and little intrusive touch, especially until Sensory Defensiveness is ruled in or out, and if diagnosed, treated. Additionally, Student is an "alpha" type personality; one who needs to be in charge. It is helpful in dealing with a child such as this to allow choices, any of which would be acceptable to the individual offering the choices. Student’s difficulties with auditory memory, auditory discrimination, and auditory function are very likely related to his probable diagnosis of dyslexia. It is important to note that individuals with dyslexia also often have difficulty with receptive and/or expressive language (as language processing at large is often impacted), auditory discrimination, auditory processing, word retrieval, mastery of rote memory learning, and time lags in information processing, in addition to more obvious weaknesses in phonological processing. Student certainly seems to have difficulties in all of these areas (Expressive language primarily in the written mode). While it is best to reserve a definitive diagnosis until after re-evaluation, it is very important for those who work with Student to understand that this is a potential diagnosis for several reasons. First, if such a definitive diagnosis is made, dyslexia is a disorder which requires long term and highly specific . Second, dyslexia is eminently treatable. Third, it is important to understand how all of Student’s symptoms fit together, and how they interactively impact on him both academically and socially. Fourth, it is important to understand what residual symptoms one might expect Student to exhibit after successful remediation so that possible necessary compensatory strategies and accommodations for later academic success can be understood. Fifth, it needs to be understood that with appropriate educational therapy and accommodations, Student has the ability to be successful both socially and academically, particularly in light of his superior intellectual ability. Recommendations: The following recommendations are respectfully made to the PET on Student’s behalf:
Student clearly has multiple learning difficulties which need to be appropriately and therapeutically addressed. When he was seen informally in the summer of 1997, Student appeared extremely withdrawn and depressed. He was nearly noncommunicative with people around him. The following summer, Student appeared happier, more extroverted, and engaged easily with his family and others. Since there is some concern that much of Student’s emotional difficulties stem from his academic struggles, it is extremely important that Student receive appropriate educational therapeutic so that healing may begin and so that Student may experience an improvement in his self image and in his perception of himself as an independently capable individual. Please feel free to contact me at my office if I can be of any further assistance to you in addressing Student’s needs or clarifying and/or expanding upon the matters contained within this report. Respectfully submitted by Shelley J. Lacey-Castelot, ATACP, MS Rdg Accurate evaluation is key to skills development
©1998 This report may not be
reproduced in whole or in part
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