IN THIS ARTICLE
The diagnosis of dyslexia is not a simple one and often needs input from several different professionals. While it is indeed a disorder affecting learning and considered predominantly part of the educational realm, there are neurological and medical issues at play as well, and so a cooperative effort between the school, physician, and other health care professionals is critical to serve the child and family.
The centerpiece of a diagnosis of "learning disability" in schools is the demonstration of a difference or "discrepancy" between the child's IQ and his academic performance or "achievement." This discrepancy criterion has been widely debated between the research community and the educational community, however, at the present, it remains an important consideration. This was done so that children who are exceptionally gifted may still be learning disabled, and struggle with reading and spelling, but perform on those subjects at the level of their grade peers, and be thus overlooked if one only bases the diagnosis on performance below one's classmates.
Many children with dyslexia get missed or overlooked until they are in higher elementary or middle school, when there is a noticeable decline in academic performance. They often do not "fall two grades behind their grade level," which in many systems is the cut-off for providing remedial services, and so continue to struggle without intervention.
Furthermore, there is a confounding factor in using typical school-based criteria for discrepancy in that many IQ tests rely on strong language skills which are inherently weaker in many children with dyslexia, thus narrowing the "discrepancy" and thus negating a conclusive diagnosis of dyslexia.
There is also the ongoing argument between medical and educational professionals regarding terminology around reading disorder. Many educators do not believe that "dyslexia" is a valid term; many physicians believe the term "learning disabilities" is applied too broadly to indicate the specific deficits a child has.
A community specialist like a developmental-behavioral pediatrician or neurologist might use screening tools like Wide Range Achievement Test (WRAT) or Peabody Individual Achievement Test (PIAT). These can identify domains of concern, but should not be construed as final diagnostic tests. The latter can only be done by educational specialists or psychologists skilled in administering IQ and achievement tests.
Typical IQ tests in schools include Wechsler WISC-IV test, and achievement is measured by a battery of academic tests included in the Woodcock-Johnson test or Wechsler Achievement test (WIAT) or similar tests. The choice of tests may vary depending on the school district's preference. Usually, behavioral data and speech-language testing may also be done depending on the determination of the school system's committee on special education.
Neelkamal S Soares, MD, MBBS, FAAP
Elizabeth A Finley-Belgrad, MD
Mary L Windle, PharmD
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