I was surprised recently to read a post that made me realise even experienced and active members of our neurodiverse community are not always as fully informed as we might expect. This has prompted me to write something explaining the types of screening and assessment someone might encounter when considering investigation of possible dyslexia.
What are the signs of dyslexia?
Every individual is unique, so dyslexia can present differently. Cognitive scientists using brain imaging and genetics are beginning to understand what are termed ‘risk factors’ for learning differences, and our current understanding indicates that potential and outcomes are the behavioural product of biology and cognition in an environment (click here for links to some of those scientists and information on their presentations at the BDA International Conference 2018). This is known as the biopsychosocial model.
Because children develop at different rates, it is generally considered more appropriate to wait until age 7 before assessing for dyslexia. Some early signs might indicate a need, but may pass with time and/or support. It is vital to be aware of someone’s history before considering a learning difficulty, for example, delays can be the result of missed opportunities due to illness. Nevertheless, if one or more of these indicators coincides with other difficulties in the classroom and at home, parents may choose to seek referral for assessment and possible therapy to the services mentioned:
- Immature speech for age not school year, including sound production and/or spoken sentence structure (Speech and Language Therapist, Audiology)
- Poor aural comprehension and/or attention for age (Speech and Language Therapist, Audiology)
- Difficulties with fine motor control for age, e.g. manipulating malleable materials, construction toys, mark making/art & craft activities (Occupational Therapy)
- inconsistent memory of letters and sounds
- inconsistent memory of high frequency words
- difficulties with pencil control and remembering starting points, shape and orientation of letters
- difficulty/reluctance to record independently
Some children will struggle to get beyond the phonetic stage, despite engaging well and appearing initially to learn the basics of letter-sound correspondence. This is sometimes attributed to high quality or intensive instruction including synthetic phonics, which occasionally means potential difficulties are not apparent in the early years.
Once difficulties have been identified and support has been put in place (with or without a formal diagnosis), some will respond well to early intervention and will make good progress, with support.
Others in the same supportive circumstances will need more intensive intervention over longer periods and may benefit from assistive technology to achieve their full potential.
Another group will develop such strong coping strategies that support needs are well masked and do not become apparent until they reach an academic level where demands are too great. This could be at any stage from pre-school to post-graduate level.
The most important thing to remember is that we all are individuals with our own strengths and needs.
The following are graphical representations of some of the causal theories of dyslexia:
(More info on the interactive factors framework can be found here)
Is assessment necessary?
If learning needs are well met in class and at home, and if children are making progress and remain happy at school, there may be no need for a full assessment. I have worked with dozens of students who have reached A levels or university before feeling the need to seek diagnosis. Some people only reach this point on entering the workforce, or when they are promoted to a managerial position that puts so much load on their organisational skills that their exceptional coping mechanisms are no longer sufficient.
That’s not the same for everyone, though. There are many undiagnosed adults. Certainly when I was at school dyslexia was not well understood, and I have family members who would have benefited from the type of assessment and support that I have trained for.
For us the crunch came when my daughter reached secondary school, and her considerable coping mechanisms, honed at home and at school in relatively protective environments, were simply not sufficient. For many learners, waiting until secondary school is not an option, and specialist help is needed if self-confidence is to be protected and progress assured.
Screeners may indicates traits of dyslexia or other learning differences. Screening is not the same as diagnosis, and false positives or false negatives are not uncommon. Nevertheless, for many, screening is a good starting point. It’s a quick and inexpensive way of identifying individuals and areas for support. At my last school I was responsible for screening entire year-groups. One example of the type of tool that might be used for this is GL Assessment’s Dyslexia Screener, which can be completed in about half an hour by a whole class at a time if your school computer suite is up to the task.
There are individual screeners available, too.
Nessy offers individual screening for 5-7, 8-10 and 11-16 year olds priced just £10 at the time of writing – look out for special offers during the year, too.
Do-IT Dyslexia+ Student Profiler is for students 16 and over. It currently costs £25 and provides an in-depth profile of areas to explore further that can be downloaded for sharing with school, university, an assessor or your GP if onward referral is recommended. An individual version is also available for adults outside education.
Some school SENCos are able to conduct dyslexia screening that is not computer based, and many assessors also offer this service to adults as well as children.
Full diagnostic assessment
In the UK, dyslexia can be diagnosed by an educational psychologist or specialist teacher assessor. Both routes to diagnosis are equally valid, but EP assessment tends to cost more, for example, the British Dyslexia Association currently charge £450 (+ VAT) for assessment by a specialist teacher, or £600 (+ VAT) for assessment by an educational psychologist. Engaging an assessor or EP direct will be cheaper, but make sure you choose someone whose training and certification is current. The BDA and PATOSS have lists of qualified individuals.
So what’s the difference?
Specialist SpLD assessors are usually qualified and experienced teachers, meaning they will have completed a teaching degree, or a first degree followed by a teaching qualification such as a PGCE. They will additionally have completed a masters degree or masters level programme to train for SpLD assessment and qualify for AMBDA status (associate member of the British Dyslexia Association). Many, like me, will also hold an Assessment Practicing Certificate, and conduct assessments to stringent SpLD Assessment Committee (SASC) standard. SpLD assessors may be qualified to assess children, young people and adults for dyslexia only, dyscalculia only or both. Some of us are additionally able to assess adults for developmental coordination disorder (DCD/dyspraxia). Many are also very experienced supporting students with ADHD or autistic spectrum conditions, but these are diagnosed by a team including medical professionals.
Some specialist SpLD teachers have completed training required to tutor and support students with dyslexia, but not the additional training and qualification to become assessors. Many local authorities employ SpLD teachers and assessors, and some schools have at least one teacher with this type of qualification in their learning support team.
EPs are usually psychology graduates who have completed an additional 3 years’ training to become educational psychologists. In local authorities they might work with a team of other specialists across health as well as education to provide multi-disciplinary assessment and support recommendations for both learning and mental health. Independent psychologists may specialise in a particular area or they may generalise in the way that e.g. GPs or primary school teachers must. To be able to conduct assessments, EPs must be registered with the Health and Care Professional Council (HCPC).
What happens in an assessment?
For dyslexia to be confirmed, the following types of assessment are needed:
This will consist standardised tests of single word reading, single word spelling and reading comprehension and may include reading rate and handwriting speed, depending on the age of the student. Speed of reading and writing are factors considered for exam access arrangements.
This will look at aspects of reasoning and processing, including verbal and visual skills. Discrepancy between these can provide insight into the individual’s profile of strengths and areas for support.
These tests assess aspects of memory and processing, including assessment of processing speed, and, crucially for dyslexia, phonological processing. Phonological processing is the ability to recognise and isolate the individual sounds in words.
This will depend on the individual’s learning profile and information gathered through interviews conducted and questionnaires completed by the individual, parents and school or other educational establishment. It may include, for example, assessment of maths skills or motor skills. Sometimes, the learning differences noted may not constitute dyslexia, but could still be a specific learning difficulty, and a full report should provide a full learning profile together with recommended support strategies and accommodations.
When to assess?
In the case of children, the first thing to do is speak to school. An assessment may be possible through the local authority, or there may even be someone qualified to assess for dyslexia on the staff. If your LA can’t help, there’s is guidance available on the BDA website.
For some learners, transition to Key Stage 2 is the catalyst for assessment, as children are expected to work at greater length and more independently. For others it is the move to secondary school that prompts a decision to assess.
Once a diagnosis of dyslexia has been made, there is no need to repeat this; however, key dates to bear in mind are preparation for GCSEs and preparation for university. For GCSEs an assessment for Joint Council for Qualifications (JCQ) exam access arrangements may be made no earlier than Year 9. This does not need to be a full diagnostic assessment, but the school or exam centre must prove through assessment and/or a record of the young person’s normal way of working that for example, extra time and/or a scribe or computer with word processing software, human or computer reader, or rest/movement breaks are required. Assessments conducted to support such an application must be made in conjunction with the school or exam centre. For this reason, it is important that a private assessment is only commissioned for this if there is no school alternative available, and in consultation with the school or college SENCo.
For university students, a full assessment must be conducted after the age of 16. This is not to alter any previous diagnosis, but to provide an up to date picture of strengths and needs for application for disabled students allowances (DSAs). This report is required for the DSA needs assessment. The DSA needs assessment cost is typically refundable via DSAs, but often students have to fund the full cost of the updated SpLD assessment report. It’s worth checking with your university whether there is any possibility of them covering or subsidising the cost.
For adults in the workplace, there is something called a workplace needs assessment. This should not be dependent on a confirmed diagnosis, but it often requires an assessment to have been conducted (again, post-16), to reveal an accurate picture of needs. Check with your union and/or employer to find out how they may be able to help you. Clear Talents and Ability Net both provide workplace accessibility audit tools.