DIAGNOSING LANGUAGE PROCESSING DISORDERS:
When a person of any age has difficulty reading and spelling individual words and that difficulty is unexpected in relationship to their other abilities and the amount and quality of instruction they have had, the problem is almost always due to some type of language processing disorder.
A word processing disorder (sometimes lumped under the much more general and non-specific term, auditory processing disorder) can occur in people of all ages and all backgrounds. Word processing disorders are neurobiological in origin. They are often genetically linked and not caused by bad speech models or bad teaching. People with language processing disorders have a physiologically limited capacity to process some types of linguistic information.
Fortunately, there are treatments that can improve language processing differences, as well as technologies that can help manage them. Naturally, selecting an effective treatment depends on clarity about what is causing the difficulty. Vague diagnostic labels like auditory processing disorder and expressive-receptive language disorder don't provide adequate specificity for treatment planning.
DIAGNOSIS in HEALTH CARE: Language processing disorders may be diagnosed by a professional with training in language science. This clinician may be a speech-language pathologist, psychologist or an educational therapist. If the formal test data support it, the clinician will generally make a diagnosis and assign one or more diagnostic code(s), following using one of the two major diagnostic classification systems:
The International Classification of Diseases (ICD) / The World Health Organization
The Diagnostic and Statistical Manual (DSM) / The American Psychiatric Association
While both the ICD and the DSM coding systems can accommodate a diagnosis of dyslexia, the examiner must still understand how to make that diagnosis. Many examiners, including those in private practice, are more familiar with public school funding classifications (see below) than they are with neurobiological diagnoses. (See below* for the coding system used in Lexercise evaluations.)
Here are two articles that explain more about the diagnostic process:
QUALIFICATION by CLASSIFICATION in USA PUBLIC SCHOOLS: For students to qualify for extra help (i.e., special education) through a public school in the USA, a formal procedure must be followed. This procedure is specified in the federal law and administered through the school's Exceptional Children’s Services. This procedure does not result in a diagnosis; Rather, it may result in classifying the child in one or more of 13 categories set up under the federal law to qualify children for special education services. (The funding category for a child with a reading and/or writing disorder is typically specific learning disabilities, a term that was coined for purposes of funding categorization in public schools. (For more about the term learning disabilities see Professor Ruth Colker's Live Broadcast ans article, The Learning Disabilities Mess.)
The procedures used to qualify children for special education services differ from state to state and district to district. Some districts require the child to have a "significant discrepancy" (difference) between his/her aptitude ("IQ") and his/her academic achievement. Others have moved to a system of qualification called "Response-to-Intervention" (R-t-I) that does not involve comparing IQ and achievement but instead looks at the child's response to specialized teaching methods. A public school child with a language processing disorder will usually be classified, along with children with a variety of other learning problems, as “Learning Disabled” (LD). LD is not a diagnosis; rather, it a service-delivery category. By definition, school involves mostly group learning, so the Individual Education Plan (IEP) goals are generally carried out as part of group learning.
For purposes of determining eligibility for a publicly funded IEP, a public school's Exceptional Children's Services team is not required to accept the recommendations from a privately obtained evaluation, but they must at least consider those findings.
School (an especially group learning) typically involves extended periods of listening, reading and writing. Children with language processing problems typically become fatigued and stressed when they have to listen, read and/or write for long periods. Fatigue and stress are know to cause inattention. Children with language processing difficulties can easily be mis-diagnosed as having a primary inattentive disorder (i.e., Attention Deficit Hyperactivity Disorder or ADHD).
At present, all classification systems rely on describing symptom and behavior patterns based on direct assessment and history. As neuroscience research advances there is the hope and the expectation that diagnosis will more and more be based on neurobiological measures (rather than conventional symptom patterns), increasingly integrating the conception of brain and mind in terms of brain function.
THERAPY for LANGUAGE PROCESSING DISORDERS:
Nails and screws look a lot alike, especially to a novice carpenter. But if you try to drive a screw with a hammer the result is sure to be unsatisfactory. This analogy helps us understand the importance of diagnosis for treatment decisions. A knowledgeable practitioner will be able to differentiate nails from screws without formal testing, but a clear and specific diagnosis may be important for students who will be learning in group settings, with teachers who may not necessarily be able to differentiate dyslexia from other difficulties that cause disruptions in literacy.
Meeting each individual's unique learning needs and providing individualized instruction and enough successful practice can be difficult, even in a group of children with very similar learning patterns. But when groups include children with divergent processing patterns the instructional strategies are often too general to address any of them very efficiently.
Research-backed treatment for dyslexia is very different from treatment for other learning disabilities, such as difficulty with listening comprehension. When children with all sorts of learning disabilities are grouped together for intervention the treatment tends to be non-specific ("tutoring"), often using the same methods used in general education.
Children with language processing disorders can attain functional and even upper-level literacy skills if they have research-backed intervention that is intensive and linguistically informed (Torgensen, et al., 1997). This is the type of intervention that is supported by the American Academy of Pediatrics. However, this type of intervention is increasingly not available in public schools (Moats, 2014).
WHAT DOES INTENSIVE, LINGUISTICALLY-INFORMED THERAPY LOOK LIKE?:
Intensive has typically been defined in terms of an amount of "seat time" spent practicing (e.g., 60 – 90 min.) each day (e.g., 5 days a week). A more direct measure of intensity is the number of response opportunities the child gets in a day. It is not uncommon for children in group special education to get no more than 5 to 10 teacher-monitored practice responses a day. The number of daily practice opportunities needed for significant progress is likely to be more than 10 times that (i.e. 100 response opportunities a day). Of course, practice won't make much difference unless it is designed to address the child's individual processing difficulties. So, the the next element is also essential....
Linguistically informed intervention is typically defined as an approach with these elements:
1) Individualized: A child with a language processing disorder needs a program that addresses their unique needs as opposed to "standard" curricula. This is difficult to do in a group. Look for intervention that involves not just individualized goals but also individual teaching methods and time (1:1 teaching).
2) Explicit: This means that each linguistic element is clearly and unambiguously defined. (e.g., What is a vowel sound? What is a vowel digraph?) Practice is designed to make the child conscious of each linguistic element and with attention to both accuracy and fluency. This means that the clinician must know a lot about English word structure (e.g., consonants, vowels, onsets, rimes, syllables, grammatical endings, meaning parts and how context impacts the use of sound-letter symbols).
3) Systematic & Sequential: All the linguistic elements and concepts needed for reading and spelling words are introduced, beginning with the most basic building blocks (e.g., syllables, vowel and consonant sounds, specific sound-letter symbols) to the most complex, context-related elements (e.g., syllable types, morphemes, bases, suffixes).
4) Cumulative: Word structure is taught in a cumulative manner so the child can read and spell more and more complex words as more and more word structure elements are mastered.
The cost of linguistically informed therapy through a clinician (e.g., a speech-language pathologist, psychologist or clinical educator) is generally paid privately by the client/family and/or their Health Savings Account or Flex Account.
Technologies and blended learning platforms like Lexercise help make effective, individual therapy affordable.
* Lexercise uses the World Health Organization's ICD coding system for two reasons:
1) We work with children worldwide, and the World Health Organization's coding system is applicable worldwide;
2) We find the World Health Organization's ICD system to be more appropriate for describing the neuro-biological nature of reading and written language disorders.