Transcript Learning Disorder Documentation: - AHEAD

Understanding what you receive and knowing what else to ask
for.
Derek Griner, Ph.D., Michael Brooks, Ph.D., J.D.,
Edward Martinelli Jr., Ph.D.
Definition of a Learning Disorder
 According to the DSM-IV, learning disorders are diagnosed
when:
a. The individual’s achievement on individually
administered, standardized tests in reading,
mathematics, or written expression are substantially
below that expected for age, schooling and level of
intelligence.
b. The learning problems in Criterion A significantly
interfere with academic achievement or activities of
daily living.
c. If a sensory deficit is present, the difficulties in the
particular skill area (e.g., reading, writing, math) must be
in excess of those usually associated with the deficit.
LD Etiology
 Genetic predisposition
 Perinatal injury (e.g., complications during
pregnancy)
 Neurological conditions (e.g., head injuries, serious
falls, concussions, prolonged fevers, etc).
 Medical Conditions (e.g., lead poisoning, fetal alcohol
syndrome, seizures, fragile X syndrome).
Gathering Background Information
 90% of a diagnosis is based on history. It is therefore
imperative to gather specific information regarding
the reported problem (e.g., did the problems occur
early on, did the problems begin once the person
began college).
 How does this apply to the Amendments Act that Dr.
Brooks spoke about yesterday?
Gathering Background Information
(Continued)
 A thorough background interview is extremely important. Intake interviews
that occur at Brigham Young University include the following areas:
 Presenting Concern (What is the client’s most pressing concerns?)
 Personal Background (e.g., previous testing, previous diagnosis,
documentation of previous diagnosis, other languages spoken at home, current
employment, marital status, struggles in school from k-12, held back a grade,
easiest h.s. subjects, difficult h.s. subjects)
 Medical/Psychological Hx (pregnancy complications, developmental
milestones, prolonged fevers, seizures, serious fall, concussions, serious
physical illnesses, hospitalizations, current medical concerns, past emotional
concerns, current emotional concerns, diagnosis of emotional concerns,
current medications, previous substance abuse/use, toxic materials exposure)
 Family Hx (Number of brothers/sisters, which child, siblings diagnosed with
LD/emotional concerns, parents diagnosed with LD/emotional concerns,
parents educational background).
Evaluations and Behavioral
Observation
 A thorough evaluation will include a section dedicated
to behavioral observations. Such behaviors that were
observed either during testing or during the clinical
interview are recorded in this area.
 These observations can give valuable information into
the manner in which a client’s disabilities manifest
themselves.
 There are some tests that help illuminate the amount
of effort a client has put forth during LD testing (e.g.,
TOMM, Green’s Word Memory Test, CVLT, etc.)
Discrepancy Model
 There are a number of statistical approaches that can
be used to establish significant discrepancies (e.g.,
intra-individual achievement discrepancy, absolute
achievement discrepancy, relative achievement
discrepancy).
 The DSM-IV suggests that in order to be considered
substantially below, a discrepancy of more than 2
standard deviations between achievement scores and
IQ be present.
Average Person Model
 The average person model asserts that a specific
disability exists when a person has intellectual abilities
that fall no lower than the Average range and
achievement scores that fall below the Average range
when compared to others of the same age.
 Furthermore, the identified disability significantly
limits or restricts the condition, manner or duration
under which an average person in the population can
perform a major life activity (i.e. learning, listening).
Reading Disorder
 DSM-IV Criteria:
A. The essential feature of Reading Disorder is reading achievement (i.e., reading
accuracy, speed, or comprehension as measured by individually administered
standardized tests) that falls substantially below that expected given the
individual’s chronological age, measured intelligence, and age appropriate
education.
B. The disturbance in Criterion A significantly interfere with academic
achievement or activities of daily living that require reading skills.
C. If a sensory deficit is present, the reading difficulties are in excess of those
usually associated with it.
 From 60-80% of individuals diagnosed with Reading Disorder are males.
However, the disorder occurs at more equal rates between males and females.
 Reading Disorders are often not fully apparent until the fourth grade or later.
 Reading disorders are more prevalent among first-degree biological relatives of
individuals with Learning Disorders.
Mathematics Disorder
 DSM-IV Criteria:
A. Mathematic ability, as measured by individually administered
standardized tests, is substantially below that expected given the
individual’s chronological age, measured intelligence, and age
appropriate education.
B. The disturbance in Criterion A significantly interfere with academic
achievement or activities of daily living that require mathematical
ability.
C. If a sensory deficit is present, the difficulties in mathematical abilities
are in excess of those usually associated with it.
 Mathematics Disorder is commonly found in conjunction with Reading
Disorder or Disorder of Written Expression.
 Approximately one in every five cases of Learning Disorders reveals a
diagnosis of solely Mathematics Disorder.
 Mathematics Disorders are often not fully apparent until the fifth grade
or later.
Disorder of Written Expression
 DSM-IV Criteria:
A. Writing skills, as measured by individually administered standardized
tests (or functional assessments of writing skills), are substantially
below that expected given the individual’s chronological age, measured
intelligence, and age appropriate education.
B. The disturbance in Criterion A significantly interferes with academic
achievement or activities of daily living that require written texts (e.g.,
writing grammatically correct sentences and organized paragraphs).
C. If a sensory deficit is present, the difficulties in writing skills are in
excess of those usually associated with it.
 Disorder of Written Expression is rare when not associated with other
Learning Disabilities.
 A disorder in spelling or handwriting alone, in the absence of other
difficulties of written expression, generally does not qualify for a
diagnosis of Disorder of Written Expression.
Learning Disorder Not Otherwise
Specified
 DSM-IV Criteria:
 This category is for disorders in learning that do not meet
criteria for any specific Learning Disorder. This category
might include problems in all three areas (reading,
mathematics, written expression) that together
significantly interfere in academic achievement even
though performance on tests measuring each individual
skill is not substantially below that expected given the
person’s chronological age, measured intelligence, and ageappropriate education.
 LD NOS could be due to fluency or sub clinical problems
across all of the aforementioned areas.
Documentation - Achievement
 Woodcock Johnson III (WJ-III Tests of Achievement).
 Commonly used and widely accepted measure of
achievement.
 Has 22 subtests that feed into Reading, Oral Language,
Mathematics, Written Language, Academic
Knowledge and Supplemental curricular areas.
 Using the Average Person Model, achievement scores
below 90 indicate potential learning disabilities;
provided that an individual’s IQ score is in the Average
range.
Broad Reading
 The Broad Reading cluster provides a comprehensive
measure of reading achievement including reading
decoding, reading speed and the ability to
comprehend connected discourse while reading.
 Comprised of the following:
1. Basic Reading Skills
2. Reading Comprehension
Broad Math
 The Broad Math cluster provides a comprehensive
measure of math achievement including problem
solving, number facility, automaticity and reasoning.
 Comprised of the following:
1. Math Reasoning
2. Math Calculation Skills
Broad Written Language
 The Broad Written Language cluster provides a
comprehensive measure of written language
achievement including spelling of single-word
responses, fluency of production, and quality of
expression.
 Comprised of the following:
1. Basic Writing Skills
2. Reading Comprehension
Other Achievement Tests
 Wechsler Individual Achievement Test (WIAT)
 Kaufman Test of Educational Achievement (KTEA-II)
 Wide Range Achievement Test (WRAT): Should only be
used as a screening instrument.
 Nelson Denny Reading Test (ND): Should only be used
as a screening instrument.
 If unsure about the validity of a particular achievement
test, an excellent resource to help determine a test’s validity
is the Mental Measurements Yearbook.
 It is also good practice to consult with colleagues
concerning tests with which one is unfamiliar.
Documentation – Intellectual
Abilities
 Wechsler Adult Intelligence Scale III and IV




(WAIS-III WAIS-IV).
The WAIS-IV was just recently released.
The WAIS-III and WAIS-IV are commonly used and
widely accepted measures of intellectual abilities.
Has 14 subtests, seven of which feed into a Verbal IQ
(VIQ) and seven of which feed into a Performance IQ
(PIQ).
A composite or single Full Scale IQ is based on the
combined scores of the Verbal IQ and the Performance
IQ.
Documentation – Intellectual
Abilities
 In addition to the Verbal and Performance IQ’s are the following four indices
and subtests used to create them:
1.
Verbal Comprehension Index (VCI): a measure of verbal acquired
knowledge and verbal reasoning (Vocabulary, Information, Similarities)
2.
Perceptual Organization Index (POI): a measure of nonverbal, fluid
reasoning, attentiveness to detail, and visual-motor integration. These
scores are less dependent on quick responses than those of the Performance
IQ (Picture Completion, Block Design, Matrix Reasoning)
3.
Working Memory Index (WMI): a measure of one’s ability to attend to
information, to hold briefly and process the information in memory, and
then formulate a response (Arithmetic, Digit Span, Letter-Number
Sequencing).
4.
Processing Speed Index (PSI): a measure of one’s ability to process visual
information quickly. This measure is more sensitive to neuropsychological
conditions (Digit Symbol-Coding, Symbol Search)
Other Intellectual Ability Tests
 Stanford-Binet Intelligence Scales (SB-5)
 Woodcock Johnson III –Tests of Cognitive Skills (WJ-Cog)
 Kaufman Assessment Battery for Children, Second Edition





(KABC-II)
Kaufman Brief Intelligence Test- Second Edition (KBIT-2):
Should only be used as a screener.
Slosson Intelligence Test-Revised (SIT): Should only be used
as a screener.
Wonderlic: Should only be used as a screener.
There are also a number of culture-free/language free tests that
should be interpreted with caution.
Test of Nonverbal Intelligence- 3 (TONI-3)
Documentation – Other areas for
rule-outs
 Attention Deficit Hyperactivity Disorder (ADHD):
There is a need to rule out this disorder as ADHD can
affect working memory, fluency, etc.
 Some measures used to assess ADHD include:
1. Connor’s Continuous Performance Test-II (CPTII)
2. Integrated Visual and Auditory Continuous
Performance Test Advanced Edition (IVA-AE)
3. Questionnaires (e.g., Hawthorne Self-Report,
DSM Diagnostic Survey)
Documentation – Other areas for
rule-outs
 Socio-emotional functioning can also affect one’s working
memory, fluency, etc.
 Some measures used to assess for emotional interference
include:
1. Minnesota Multiphasic Personality Inventory-2
(MMPI-2)
2. The MMPI-2-RF has recently been released and is
psychometrically up-to-date and linked to current
models of psychopathology and personality. It has 338
items and reportedly takes just 25-35 minutes for
computerized administration.
3. Millon Clinical Multiaxial Inventory-III (MCMI)
4. Personality Assessment Inventory (PAI)
Prior Documentation
 Reasonable accomodations and services are based upon the current





impact of the disability in the academic setting.
Documentation should indicate that a specific disability does exist and
that the documented disability limits or restricts the individual’s ability
to perform major life activities (e.g., learning, listening).
Documentation needs to be recent.
Documentation also should be completed by a competent professional
who is able to diagnose either learning/attention disabilities or
emotional concerns.
For Learning Disabilities documentation should be within the last 3-5
years. For student’s with IEP’s, it is wise to get updated testing that
fulfills the criteria set forth by your college/university.
For emotional concerns documentation should be updated on a yearly
basis. Emotional concerns are not as stable as LD’s and can change
within a year’s time.
Documentation and IEP
 Individual Education Plans (IEP’s) should be used for
guidance. If a student has an outdated IEP, use the IEP
as a guide for provisional accomodations and have the
student begin updated testing.
Evaluating the Evaluation
 Many evaluators do not know disability law.
Therefore, some of the recommendations made may
not be supported legally (e.g., last week received a fax
requesting that a student with OCD be allowed “at
least three times the amount of time to complete
testing”).
 If we do not carefully examine the recommendations
set forth by some evaluators, we may actually inhibit a
client’s potential for success (i.e., A student with OCD
spending three to four times the amount of allotted
time on a test may actually reinforce OCD behaviors).
Collaboration
 It is good practice and necessary to obtain a signed
release of information from the client before
discussing his/her case with any other evaluator.
 Once a release of information is obtained, it is also
good practice to speak with evaluators about clients
and get answers to follow-up questions.
 The more consultation that occurs, the more likely we
are to understand a client’s recorded disability and the
more likely we are to provide appropriate and
reasonable accommodations for the individual.
Examples
 Good Documentation (Reports)
 Poor Documentation (Reports)
Conclusion
 Discussion and questions.