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Early Identification of Learning Disabilities
Tammy L. Wilgenbusch, PhD |
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Rather than waiting for indications of trouble to become major problems, the field of learning disabilities today focuses on early identification and prevention. In the 1970s and 1980s, learning disabilities (LD) were defined by the discrepancy between achievement and intellectual ability. This led to a stringent use of test scores, with arbitrary cutoff points determining diagnoses. Focusing only on a discrepancy often results in delayed treatment as these discrepancies often don’t show up until middle elementary school, past the optimal time for adequate development of skills required for reading and math. Recently, the focus has shifted to identifying and providing early treatment and prevention in younger children who may be at risk for LD. In younger children, neurocognitive skills and learning patterns are still developing, leading to great variability in skills. This makes testing somewhat difficult. For children younger than 6 or 7 years old, screening for risk of learning difficulties and global delays is most reliable. Therefore, evaluation of LD at this age should focus on specific prerequisite skills and not necessarily a full neuropsychological evaluation.
Most research on LD in children in early
elementary school has been on reading. New
research indicates that the best time to
screen and start treatment to prevent
reading LD is in kindergarten or early 1st
grade. In addition to screening at
school, it is helpful when primary care
physicians also screen these children for
learning difficulties, enabling parents
to use early intervention resources.
Specific skills in kindergarten and first grade that are predictive of later reading skills include:
Tasks that can help assess these skills include a child's ability:
In addition, basic alphabet identification and rapid naming of letters can be a good screen for these difficulties. Children with difficulties in the prerequisite skills of reading are at risk for developing reading disabilities as they progress through school, and need additional, specific instruction in kindergarten and first grade.
For these younger children with LD, school is the best referral source. Parents seeking additional support may wish to obtain private testing and screening by a psychologist. In addition to achievement based LD, children may have difficulties not related to a cognitive delay that interfere with their overall classroom learning and performance. For example, children with attention or memory problems may have difficulty following directions at school, leading to more global academic concerns.
When determining whether middle elementary to
high school students are dealing with
learning difficulties, physicians can ask
questions regarding problems with work
completion, not turning in assignments,
inability to do well on timed tests,
difficulty following directions, poor
reading fluency, and difficulty with
comprehension or test performance. If
children are having these types of
difficulties, regardless of achievement
scores, further neuropsychological testing
can be helpful to identify underlying
strengths and weakness that can help in
the development of intervention and
strategies to help improve overall
academic success.
While not all children need
neuropsychological testing to determine
whether there is an underlying
neurocognitively based learning difficulty, testing is
warranted when children do not respond to
early prevention or basic instruction. This testing should focus on a
variety of cognitive skills and identify
patterns of strength and weakness.
In the
Division of Pediatric Psychology at the
University of Iowa Children’s Hospital,
neuropsychological testing focuses on the
skills of verbal comprehension, expressive
language, visual-spatial-motor skills,
memory, attention, and processing speed.
The goal is to gain an understanding of
the child’s strengths and weaknesses so
that specific accommodations can be
recommended to parents and teachers. Neuropsychological
testing is valuable because it goes
beyond academic performance, providing
providing specific information that can
guide intervention, rather than focusing
strictly on overall scores.
In summary, it is important to screen
young children, starting in kindergarten,
for specific prerequisite skills that lead
to adequate development of academic
skills, particularly reading.
Neuropsychological testing at this age
can be helpful for identifying skills that
should be monitored or for global delays,
but specific neurocognitive learning
disabilities are
difficult to identify due to the wide
variability of children’s behavior and
skills. After a child reaches 6 or 7 years
of age, or if more global or broad
learning concerns are noted, referral for
neuropsychological testing may be
warranted to assist with the development
of specific interventions and school
accommodations for the child.
Resources
Fletcher, JM et al. (2002). Assessment of
reading and learning disabilities: A research-based intervention oriented
approach. J School Psychol, 40,
2763. doi: 10.1016/S00224405(01)000930.
Torgesen, JK (2002). The prevention of
reading difficulties. J School Psychol,
40, 726.
doi:10.1016/S00224405(01)000929. |
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