In this post, I’m going to discuss what a dyslexia assessment for adults should look like in general. In a following post, I will address dyslexia assessment specifically for college-aged students who may be seeking a formal evaluation to qualify for academic accommodations.
There are a few differences between an evaluation for children versus adults (general assessment–not for college accommodations).
We’re going to breakdown the assessment process into three sections:
- The interview process
- The actual testing
- The follow up recommendations
Each section is very important but I really feel strongly about how the recommendations are handled. I don’t mean to sound excessively hysterical but what we do with the information from the evaluation can be life-changing.
Part One: Observations, Interview and Checklists
The first part of the adult dyslexia assessment is different from an assessment of a child just by virtue of the fact that an adult is going to play a more active role in the evaluation. First, their OWN observations will likely drive the selection of the specific tests that will be conducted. Likewise with the interview. The checklists may only be collected from the individual being evaluated and perhaps their spouse.
I like to recommend that an adult start with an online screening. The National Center for Learning Disabilities has a useful Interactive LD Checklist that works well although there are several others. The checklist does cover issues beyond just dyslexia and it can be helpful to collect data in other areas of cognitive functioning and literacy skills just to be thorough. Most importantly, the checklist can provide specific language that the person being assessed can use to accurately describe their experience. Oftentimes, we may not know the right terms to use that can really help us hone in on the issues with which we’re struggling.
The interview should also include any information known about prenatal history and birth history (family lore?), developmental milestones, medical history (e.g., recurrent ear infections? Visual problems?) and family history. This all provides context and creates the opportunity for the person being assessed to weave a story that is meaningful and valid for them (more on this later).
The information from the screening and interview should serve us well then as we proceed to the actual assessment.
Part Two: The Actual Testing
The actual tests chosen are really predicated on the information collected in the first phase of the assessment as well as the intent of the evaluation. Of course, the overall goal is to provide you with a clear and understandable profile of cognitive processing strengths and weaknesses. From this profile, we are able to figure out specifically how to follow up with treatment.
Intellectual Testing? In the process of testing a child for dyslexia we usually automatically include an assessment of intellectual capability (IQ testing). It is often helpful to have an overall sense for their verbal and nonverbal reasoning abilities. For an adult, this is a judgment call. (Remember I am not talking about testing to qualify for college accommodations.) Formal IQ testing takes between 60 to 90 minutes to administer and it is expensive (administration, scoring and interpretation and write up could be several hundred dollars. I’m not convinced it’s always necessary for adults. The ultimate decision should be made after a frank discussion about the potential value of the testing.
Academic Achievement? Yes. As an example, both the Woodcock Johnson Tests of Achievement and the Woodcock Reading Mastery Test are normed for adults. In other words, we can compare your score to a group of people your age all the way up to 90 on the Tests of Achievement and 75+ on the Reading Mastery Test.
Cognitive Processing? Yes. This is the key to remediation. If you’ve started to read other posts on this site, you’ll see that I frequently state three things that are key in dyslexia assessment. First, the vast majority of learning problems, including dyslexia, involve weaknesses in language processing in the brain. Two, there are basic building blocks in language processing that build on each other and directly impact where a person struggles with the acquisition of literacy skills. And, three, the majority of adults with weak language processing skills and the attendant literacy issues often never received adequate training in mastering the most basic building blocks of language processing while they were children in school. It is critical to recognize that those weaknesses in the most basic building blocks do not just go away. We frequently find adults continuing to struggle with the most basic aspects of reading, writing and spelling acquisition just as they did as children.
So, accurate assessment of these underlying processes is the key to heaven and potentially a release from a life of great pain and confusion.
Part Three: Recommendations
This is where the rubber meets the road. First and foremost we clinicians need to verbally educate the person being tested about the results of the evaluation and we need to do so in a way that describes where the breakdowns are in cognitive processing as well as the strengths the person possesses. This is a key opportunity to de-pathologize whatever developmental variations there are in their brain wiring and provide language that does not rely on negative diagnostic labels.
Next, we need to provide a bibliography of things to read to further help them 1) understand how their brain is wired and 2) continue to develop the language they need to weave a positive, non-pathological story about how they process information and where they need work. To be clear, this is not about diminishing the impact their cognitive weaknesses have caused. This is about re-framing the issues so that a person’s total strengths and weaknesses can be seen in a clear light and the focus can be positive.
To paraphrase an old adage: It is important to recognize that you are dealing with dyslexia, but do not allow yourself to be defined by it.
Thirdly, we need to make sure that we clearly outline what sort of treatment is indicated. Frequency, intensity, type of intervention, specific referrals to trusted colleagues, etc.
Also, we need to recognize and explain that our involvement is not just a one-off assessment. We need to make sure that we continue to serve as an anchor point for the person being evaluated on an as-needed basis. Very frequently, people get a quick and dirty review of the assessment never to be seen by the consultant again. Not good. We need to make sure the person assessed (and their family, if appropriate) has the language and understanding needed to effectively advocate for themselves and follow through on getting proper treatment support.
Finally, we need to be careful not to underestimate the potential emotional impact of the evaluation. Not necessarily in all cases, but often we will find that giving someone a clear understanding why they’ve been struggling in spite so many other strengths in their lives can have a profound impact on how they feel about themselves. It can be extremely cathartic and a source of huge relief. As I mentioned, many of us go through life thinking we are damaged or a fraud. Or broken. That often takes time to work through, and we need to honor that.