Learning Disabilities (LD) – Assessment and Diagnosis

Assessment

How do I know if my child or I need an assessment?

You or your child may benefit from an assessment if you struggle with:

Reading, writing, math or language skills
Understanding and remembering things
Paying attention so they can be present for learning
Getting along with their peers, teachers and family members
Worrying, nervousness and/or irritable mood

What is a psychoeducational assessment?

If you or your child have difficulty with learning, remembering or understanding things, you may benefit from a psychoeducational assessment. This type of assessment looks at how a person learns and what kinds of things may be getting in the way of their learning. The information that is gathered through a psychoeducational assessment helps make decisions about how to help the individual.

Who is qualified to conduct psychoeducational assessments?

Registered psychologists who have specific training in psychoeducational assessments can provide these types of assessments. Training refers to the type of schooling they received as well as practical experience they have had working with clients under supervision by another psychologist.

Here are some questions that you can ask a psychologist to determine if you feel comfortable working with them.

What kind of training have you had in psychoeducational assessments?
Ideally, the psychologist will have attended graduate school in either a clinical psychology or school psychology program that specifically focused on psychoeducational assessments, learning disabilities and related challenges. They should also have had practical experience using their skills with clients under the supervision of another psychologist who has this training. Sometimes, psychologists trained in other areas of psychology such as counselling, will learn how to do assessments outside of a structured graduate school program.

In these cases, it will be important to discuss what kind of training they participated in and whether they were supervised. Attending a workshop about using a particular intelligence test is not sufficient training to be conducting psychoeducational assessments.

What types of information do you gather for the assessment?
A psychologist who is qualified to conduct psychoeducational assessments should be gathering multiple types of information (e.g., interview, questionnaire, standardized testing) from multiple sources (e.g., the child, the parents and the teacher). Ask them how they make decisions and draw their conclusions. Diagnoses should never be made based on one test or questionnaire.

What is a learning disability? How is it diagnosed?
A qualified psychologist will be able to answer these questions, as they would have studied learning disabilities and learned how to diagnose them during their training.

To understand what a learning disability is go to LDs – Definitions & Terminology

Where can I find someone to do a psychoeducational assessment?

Schools: Parents should always check with their child’s school first to see if the school psychologist can conduct a psychoeducational assessment. There is no cost for this service, but schools often have long waiting lists, and your child is not guaranteed to be assessed.

The health care system: In some cases, there may be a special program or clinic within the health care system that can offer psychoeducational assessments, however, the eligibility criteria are often very specific and require a referral from a physician. It is worth enquiring about this option, as it would be covered by Alberta Health Services (AHS).

Non-profit organizations/agencies: Registered psychologists will often work within non-profit agencies, and are qualified to provide psychoeducational assessments. There is often a cost, but many run on a sliding scale. Alternatively, funding assistance may be available.

Private practice psychologists: In Alberta, there are many psychologists who work in private practice who are also qualified to provide psychoeducational assessments. You will have to pay out of pocket for this option. However, some insurance plans may cover some of these services. You can search for psychologists here: https://psychologistsassociation.ab.ca/referrals/

Things to keep in mind when considering a psychoeducational assessment:

Be open. You may have an idea of what the problem is or perhaps you may even think that you or your child has a particular disorder or meets criteria for a specific diagnosis. It is fine to have hunches about these things, but keep in mind that the end results of the assessment may point to something different. A good psychologist should have an open mind as well.

Be planful. Engage in the assessment process at a time that is not too busy or stressful for you or your child. The psychologist will want to get the best “snap-shot” of what you or your child is capable of and what you/they are typically like in everyday life. For example, it would not be best to start the assessment process after a death in the family, as you/your child may be behaving differently as a result of grieving.

Be prepared. Gather ahead of time all of relevant information (ie., report cards and any previous assessment reports or other medical or educational documentation). This will save time and make the process go more smoothly. It will also help the psychologist in forming conclusions, as it gives them a better sense of the bigger picture.

Be careful and thoughtful. Not every problem requires a psycho-educational assessment. Not every problem requires a psychoeducational assessment as the first solution to a problem. Counselling, academic support such as tutoring, or other strategies may be tried first. Ask the psychologist and other options and the pros and cons of waiting.

Be realistic. It is helpful to understand that a psychoeducational assessment will provide you with information about how you or your child learns, but it will not provide solutions to every problem or quick fixes. Many of the recommendations that are made involve hard work and dedication to a new way of working. Start with recommendations that are manageable and meaningful and move forward from there. Be patient.

Be active and interested. When the assessment is complete and you meet with the psychologist to get the results, actively listen, take notes and ask any and all questions that you might have. You want to leave that appointment feeling confident about your next steps. If you don’t understand something, ask the psychologist to explain it further.

What information is gathered during a psychoeducational assessment?

A psychoeducational assessment is conducted by a registered psychologist who has training in this particular type of assessment. The types of information gathered include:

Personal background information through interviews with parents, teachers and/or the individual. Examples of information gathered include birth and developmental history, education history, medical and health information, and family relationships.
Questionnaires that may look at the person’s behavior, daily living skills, attention, mood and social skills.
School records, which include report cards, teachers’ letters, and other assessments.
Sometimes observing the child in their classroom setting can be helpful for understanding their behavior and learning challenges.
Standardized testing which looks at things like a person’s intelligence, academic skills, memory, and language abilities. These are typically standardized, norm-referenced tests. Standardized means that when they created the test, they made very specific instructions that everyone giving the test must follow, and they gave it to lots of people who are a representative sample of the population. Norm-referenced means that they have statistical information that allows the psychology to compare your child’s performance with other students her age and/or grade.
Standard Scores: These are typically scores that give a number based on several smaller tasks. On these tests 100 is the middle score. Percentile Ranks are easier to understand though.
Percentile Rank: This score tells you how well your child performed compared with children his age or in his grade. These are numbers that range from less than one to just under 100, representing 100 children’s performance who are the same age. If your child’s score is at the 10th percentile, that means that she performed better than or equal 10 out of 100 children her age. If your child’s score is at the 75th percentile, that means that he performed better than or equal to 75 out of 100 children his age.

What types of tests, questionnaires and observations will be done will depend on what you and the psychologist decide will be the primary focus of the assessment. This is often called the “referral question”. Referral questions help to give the assessment a purpose. Common referral questions include:

Why am I or my child struggling to learn to read?
Why am I or my child struggling in all academic areas?
My teenager works very hard, but doesn’t seem to be getting grades that reflect this effort. Why?
Do I or my child have a learning disability?
What can help with my or my child’s learning?

Diagnosis

What happens after the psycho-educational assessment is finished?

After the psychologist has gathered all the information that they need to answer the referral question, they can start to make conclusions about the individual’s learning.

It is important to understand that conclusions are not made simply on the basis of tests scores. Conclusions are based on the combination of test scores, background information, education history, observations and other relevant information. This is why a psychoeducational assessment is not a quick process and involves making sure that all relevant information is available for the psychologist to consider before they draw their conclusions.

Once all information is gathered, the psychologist will meet with you to discuss the results of the assessment, any diagnoses that were made and what may help. This information should be explained in a way that makes sense to you. If something doesn’t make sense, ask about it. It’s your right as a parent to understand the results of your child’s assessment. It’s also your right to understand your own assessment.

If a diagnosis is made, the psychologist will discuss with you the importance of sharing the assessment results. You should receive a report that you can share with others.

Reading the Report

You should have a meeting where the psychologist explains the results to you.

During the meeting and after you receive the report, you should ask the psychologist for more information. Here are a few questions to ask yourself about the report:

Did the report capture the question I was asking about myself or my child?
Did the report answer the question I was asking about myself or my child?
Did the report explain how the data was used to come to the conclusions and diagnoses?
Did I understand my or my child’s functioning in each of the areas measured?
Are there usable recommendations included?
Are the recommendations connected to the individual’s strengths and weaknesses?

What kinds of diagnoses can be made with a psychoeducational assessment?

Learning Disabilities

Learning disabilities, as defined by the Learning Disabilities Association of Canada (LDAC, 2015) require three things:

At least average or above intelligence;
Academic challenges that are significantly lower, given the person’s intelligence;
An information processing problem that relates to the academic challenges. These include memory, language, processing speed, visual-spatial processing and/or phonological processing.

Educational psychologists in Canada may also diagnose learning disabilities, or specific learning disorders, using the Diagnostic and Statistical Manuel for Mental Disorders (DSM-5).

Whichever diagnostic assessment the psychologist uses, it should be explained clearly in the report and during your meeting.

You can learn more about learning disabilities definitions and associated terminology here:

Intellectual Disabilities

Intellectual disabilities, as defined by the DSM-5, require three things:

Significant challenges in reasoning, problem solving, abstract thinking, and planning, which is measured using an intelligence test. Intelligence test scores would be lower in a person with an Intellectual Disability as compared to someone with a learning disability.
Significant challenges in daily living skills, which include things like communication skills, self-care, managing money, being independent in the community and at home.
Evidence that the challenges in number 1 and 2 started when the person was a child.
For more information about Intellectual Disabilities click here. https://aaidd.org/intellectual-disability/definition/faqs-on-intellectual-disability

Giftedness

Technically, giftedness isn’t a diagnosis because it isn’t considered a disability. However, some parents may want a psychoeducational assessment for their child if they wonder about giftedness. Different school boards and organizations define giftedness in different ways. Within the context of a psychoeducational assessment, giftedness usually requires intelligence test scores that are in the top 2% of the population. Knowing whether a child is gifted can be helpful in determining what kinds of educational programming may be beneficial for them.

Other Diagnoses

While learning disabilities, intellectual disabilities and giftedness can be identified with a psychoeducational assessment, other diagnoses may be made, with additional information. For example, a diagnosis of Autism usually requires extensive interviewing with the parents and play-based testing with the child. It may also include a psychoeducational assessment to understand the child’s learning needs in order to provide appropriate support and interventions.

What about ADHD?

As ADHD is a condition that can be medically managed, it is often diagnosed by physicians (family physicians, pediatricians, psychiatrists).

ADHD may also be diagnosed within the context of a psychoeducational assessment.

It is important to understand that technically, a psycho-educational assessment is not necessary to diagnose ADHD, as the diagnostic criteria for ADHD are behavioral (e.g., loses things). A thorough interview with the family, questionnaires and observations are often used to diagnose ADHD.

However, it may be necessary to also do a psychoeducational assessment, particularly when there may be concerns about underlying learning difficulties. This would be important to fully understand all of the challenges that the child is facing including ADHD.

Keep in mind that there are no “tests” for assessing ADHD. There are tests out there that measure attention in different ways (e.g. being able to focus for long periods or being able to stop yourself from doing something), however, these are mostly used in research settings and are not considered appropriate for diagnosing ADHD.

If a professional wants to solely use a test to assess for ADHD and does not conduct a comprehensive interview to learn about possible ADHD symptoms in everyday life, consider working with someone else.