A comprehensive assessment by a member of the College of Psychologists is required to diagnose a learning disability. This process should involve an interview and a series of different types of tests, which may take several hours and require more than one appointment. The assessment should consist of:
1. An initial interview
2. Tests of cognitive functioning and information processing
3. Tests of academic achievement levels
4. Social and emotional evaluations
5. Feedback interview
1. INITIAL INTERVIEW
An initial interview should cover a thorough review of:
- birth history and early development
- language and cultural background;
- medical history including vision, hearing, neurological status, illnesses, allergies, medications and current health conditions;
- family and social history to determine social, behavioural or emotional factors or any hereditary patterns;
- academic and work history;
- previous psychological evaluations and relevant medical tests.
This intake interview is crucial in providing the assessor with a thorough understanding of the background against which to interpret the results of the testing. The reasons that lead the individual to seek an assessment should be discussed, as well as current problems and challenges, and expectations of what the assessment will accomplish.
2. TESTS OF COGNITIVE FUNCTIONING AND INFORMATION PROCESSING:
The Wechsler Adult Intelligence Scale–Revised, or the newer version WAIS-III, are widely used to assess cognitive functioning and determine levels of intellectual abilities. In addition, specific measures should be included in the test battery to assess: short and long term memory; receptive and expressive language; verbal and non‑verbal abstract reasoning or logic; attention span; visual perceptual abilities including various spatial tasks; sequencing, right‑left orientation and fine motor dexterity; and organizational and planning skills.
3. TESTS OF ACADEMIC ACHIEVEMENT LEVELS:
Basic skill areas of reading, spelling, written expression and mathematics should be evaluated. The profile of reading subskills should be determined (e.g.: reading vocabulary, word recognition, comprehension of paragraphs, and phonemic awareness); math computation and problem-solving; mechanical and creative aspects of writing. With this detailed information, the assessor should outline an effective plan to remediate or compensate for the academic difficulties
Study skills, organizational and workplace skills, as well as time management, are other areas that should be assessed along with the basic skills. Learning disabilities screening questionnaires may be used to assess the individual’s perception of areas of ability and difficulty, life skills, specific academic problems, and workplace issues.
4. SOCIAL AND EMOTIONAL EVALUATIONS:
This part of the assessment consists of formal instruments to determine whether social/emotional problems occur concurrently with or are secondary to learning disabilities. Anxiety, depression, poor self-esteem and attention deficit disorder are important areas to examine.
5. FEEDBACK INTERVIEW AND WRITTEN REPORT:
Once the testing is completed, a feedback interview is carried out to convey the results, along with suggestions for remediation to improve weaknesses, or compensatory strategies and accommodations to cope more effectively with problem areas. Areas of strength should be discussed as well as weaknesses. A written report is provided either at the same time or sometime following the session. There should be opportunities for the client to ask questions in the feedback interview and after receiving the written report.
The report should provide a clear statement about whether or not there are learning disabilities; the types, extent and severity of the learning disabilities; an outline of strengths and weaknesses, guidelines for remediation and compensatory strategies; and recommended accommodations in academic or employment settings.
WHO DOES THE ASSESSMENT?
The psychological assessment should be carried out by, or under the supervision of, a registered psychologist or psychological associate who specializes in learning disabilities, and has experience with adults. In Ontario, communicating a diagnosis of learning disabilities is a controlled act under the Regulated Health Professions Act, restricted to members of the College of Physicians and Surgeons, and the College of Psychologists. Registered psychologists and some registered psychological associates may diagnose learning disabilities.
COST OF ASSESSMENT
Psychologists are usually not covered under provincial health plans. Many insurance companies cover some portion of psychological testing and most require a letter of referral from a physician to the psychologist or psychological associate, if covered. Some people may be covered by the extended benefits plan of their work health insurance plan. The cost of assessment typically ranges from $2000 to $2500. Many unemployed or underemployed adults cannot afford such fees. It is sometimes possible to gain access to an assessment through an institution (college, university or hospital) or government agency (ODSP, Worker’s Compensation, Service Canada) if an individual meets their requirements and is willing to wait.
It is advisable to check cost and coverage before starting the assessment, and clients can ask about a sliding scale fee structure and/or payment over time.
BENEFITS OF AN ASSESSMENT
Many adults have grown up feeling inadequate, attributing their difficulties to a general lack of ability. Knowing that there is a specific reason for their difficulties can be a great relief. A better understanding of their strengths as well as their weaknesses can be an important first step towards building self‑esteem and developing more effective coping strategies.
AFTER DIAGNOSIS, WHAT NEXT?
All information provided to the assessor is strictly confidential, and cannot be shared with third parties without the client’s written permission. Whether or not to disclose to others is a very personal decision and some prefer to keep the information private, at least initially. However, many employers are willing to accommodate special needs in a supportive yet confidential manner, and an employee is entitled to reasonable accommodations under Human Rights legislation.
There are many excellent support programs for the student with learning disabilities in community colleges and universities, so it is useful for students to self-identify in order to access services and accommodations.
Many adults who are newly diagnosed with learning disabilities could benefit from counselling to help them understand their strengths and weaknesses. Career counselling and adult support groups may be helpful as well.
ADAPTED FROM A FACT SHEET PREPARED BY:
Learning Disabilities Association of Canada (March,1997)
323 Chapel Street, Suite 200, Ottawa, Ontario, Canada, K1N 7Z2 (613) 238‑5721
FACT SHEET ADAPTED FROM:
For You: Adults with Learning Disabilities, by C. Smith, (1991) LDAC
Tools for Transitions: A Counsellor’s Guide to Learning Disabilities, by E. Nichols (1994) LDAO
Let’s Look at the Assessment of Learning Disabilities in Adults, by Dr. C. Fiedorowicz, National, Summer 1995 pg 5, LDAC