What Are LDs?

If your child is not doing well in school you should request a special interview time with his/her teacher to review in detail your child’s progress. Your child’s teacher may have valuable insights into his/her strengths and learning needs. In turn, you can share your understanding of your child and his/her needs with the teacher. Remedial help or an adapted regular class program and/or some extra help at home may be what is needed to help your child keep up with school work.

If, in spite of additional help, your child’s level of achievement does not improve, it is time to pursue a psychoeducational (psychological) assessment. A psychological assessment can be done through the school board’s psychological services department or by a psychologist or psychological associate in private practice. Some school boards do not have their own psychology staff, and use community psychologists on a contract basis. The school must obtain your written consent before a psychological assessment can be done.

In the school system there are often long waiting periods for psychological assessments. Occasionally assessments are available in a hospital setting and are covered under OHIP, or through a children’s mental health centre, if there are emotional/behavioural concerns, but there are long waiting lists in these settings as well. If you have a group medical plan through an employer, you can check to see if assessment by a psychologist is covered and to what maximum fee. You would need a referral from a medical doctor to get coverage under the group plan, but you can refer your child directly to most psychologists. If you use a private psychologist/psychological associate, make sure that they are willing to write a report in the format used by the school board. You could suggest the protocol developed through the LDAO Promoting Early Intervention Project. To read the “LDAO Recommended Practices for Assessment, Diagnosis and Documentation of Learning Disabilities” go to the LDAO website (www.LDAO.ca ) and look under About Assessments.

A good psychological assessment should provide information about overall intellectual ability, but more importantly, about strengths and weaknesses. There should be recommendations about remedial strategies and ways of using areas of strength to compensate for areas of deficit. In older children, there should be recommendations for accommodations and use of technology to bypass weak areas, in addition to remedial strategies to work on deficits.

1. Who can diagnose a learning disability?

A Psychologist or Psychological Associate who is registered with the College of Psychologists of Ontario and who does not have a restriction on his or her certificate of registration can diagnose Learning Disabilities (and a host of other psychological conditions). Because “Communicating a Diagnosis” is a Controlled Act under provincial legislation (because of the potential harm that can result from inaccurate diagnoses), there are stringent requirements that must be met before the right to diagnose is granted. Further, not all psychologists and psychological associates are certified to work with children, or to conduct assessments of learning disabilities, and therefore may not be suitably qualified to arrive at a correct diagnosis. Parents (and other consumers) need to ask specific questions about a practitioner’s qualifications and areas of competence.

2. What is a Psychological Associate?

While a Psychologist has graduate university training at the doctoral level (typically a Ph.D. in psychology), a Psychological Associate has training typically at the Master’s level. Both titles can be used only if the person using the title is registered with the College of Psychologists of Ontario. A Psychometrist or Psychoeducational Consultant typically has a Master’s degree in Psychology, but is not registered with the College, and is usually supervised by a Psychologist or Psychological Associate.

3. What is involved in a psychological assessment for a possible learning disability?

A psychological assessment involves gathering information from a number of sources, and using that information to draw conclusions. The sources of information may include parents, teachers, observations, interviews, review of records and schoolwork, formal psychometric measures, and informal testing and evaluation. It is essential to rule out other explanations for the child’s presenting difficulties, and to determine the strengths and weaknesses in the child’s functioning. The information gathered may be very helpful in facilitating decision making about academic and vocational choices, or further interventions which might be appropriate, for example. Formal psychometric assessment usually looks at reasoning and thinking ability, visual, auditory, and kinaesthetic processing, memory, attention, academic skills, social and emotional functioning, and a number of other areas in order to develop a comprehensive picture of a child’s current functioning. An assessment can take several hours, often spread over a few days.

4. Who can conduct psychological assessments?

Psychological assessments can by done only by those people who are properly trained and qualified in psychological assessment. This includes most (but not all) psychologists and psychological associates, and psychometrists who typically work under the supervision of a psychologist or psychological associate. No assessments are undertaken without the written informed consent of the parent or legal guardian.

5. How do I find a psychologist who can assess my child?

Most school boards employ psychological services staff who provide assessment, counselling, and consultation services to schools, These people are accessed through the school principal. Additionally, there are a number of psychologists in private practice who usually accept direct referrals from parents. The Ontario Psychological Association also provides a referral service. Sometimes the best way to select someone with whom you and your child are comfortable and compatible is by word-of-mouth references, or by meeting the practitioner in advance of committing to the involvement.

6. What happens after the assessment?

When all the information which has been gathered as part of the assessment is analyzed, a formal written report is prepared. This is discussed with the parents, the child if appropriate, and with school staff if the referral was generated through the school. The findings are explained, suggestions offered, and recommendations made. If a diagnosis has been made, it will be presented at this time. The parent is given a copy of the report after its contents have been thoroughly explained, in order to minimize misunderstanding of the results. When the referral has been generated through the school, the principal is also given a copy of the report. The recommendations might include specific suggestions for teachers regarding teaching approaches which complement the child’s learning style. A recommendation for further intervention such as counselling or therapy might also be made.

7. What other services do psychological services personnel provide?

Many psychologists and psychological associates are also qualified to provide counselling and / or therapy to children, adolescents, and adults. In addition, they consult to schools regarding issues of mental health, effective programming, and learning / teaching.

Dr. Ian Brown is Coordinator of Psychological Services for the Durham Catholic District School Board and a former member of the LDA Ontario Board of Directors

Reprinted with permission of the author, from the LDA of Durham Region Newsletter, Fall 2003

How can students with learning disabilities make a successful transition to post-secondary education? It’s as easy as A-R-C.

Author: Dr. Allyson G. Harrison and Dr. Alana Holmes
Source: Assessment Resource Centres of Ontario (A.R.C.)

How can students with learning disabilities make a successful transition to post-secondary education? It’s as easy as A-R-C.

by Dr. Allyson G. Harrison and Dr. Alana Holmes
of: Assessment Resource Centres of Ontario (A.R.C.)

One of the biggest identified barriers to the success of students with learning disabilities at the post-secondary level is inadequate or incomplete documentation of their disability (Bell, 2002; LOTF, 2002). This creates a problem as more and more students identified as having such disabilities are now enrolling in college and university. Indeed, there are presently more than 13,000 students in Ontario’s colleges and universities who have diagnosed learning disabilities (LD). These students are capable of being successful…if they have the supports and services they require to level the playing field and demonstrate what they know. In order to access these existing supports, however, they require an updated and comprehensive* Psychoeducational assessment.

In 1997, the Ontario government struck the Learning Opportunities Task Force (LOTF). The mandate of this task force was to investigate the status of post-secondary students with learning disabilities and to make recommendations that would enhance access and services for students with specific learning disabilities. The final report of the task force was submitted to the Ontario Ministry of Training, Colleges and Universities (MTCU) in November 2002. This report contained seven key findings and 24 recommendations. One of the key findings was that:

“A significant majority of the students arrived at (post-secondary) institutions with no, or at best inadequate, diagnostic information. As a result, students had neither appropriate documentation nor an understanding of their own learning disabilities. A comprehensive, up-to-date diagnostic assessment is essential for the provision of requisite supports, services, programs and accommodations for students with learning disabilities.”

The LOTF therefore recommended that, “The Province should establish, implement and evaluate the concept of Regional Assessment and Resource Centres” or ARC’s.

In a proactive and visionary move, the MTCU decided to accept this recommendation and fund two such assessment centres. The first of these, the Regional Assessment and Resource Centre (RARC) was established at Queen’s University in Kingston in September 2003. The second, the Northern Ontario Assessment and Resource Centre/Centre d’évaluation et de ressources du Nord de l’Ontario (NOARC/CÉRNO), began in April 2004 at Cambrian College in Sudbury. These centres and the Psychological professionals, who work with them in every part of the province, can assist high-school students in making a successful transition to college or university.

The ARC’s allow students to get appropriate, comprehensive and reasonably priced assessments that identify their strengths and make specific and relevant recommendations for accommodations and supports. The diagnosis of a learning disability has, until now, not always been available to individuals without the financial means to pay for an expensive assessment. Happily, initiatives such as the ARC’s provide students with an opportunity to undergo such an assessment at a cost that is appropriate to their financial means. To date, these centres have provided over 1,000 assessments.

RARC is a stand-alone clinic located at Queen’s University in Kingston, and serves students in all of Southern Ontario. Its Mobile Assessment Team (MAT) provides assessments in all cities within Southern Ontario to assist in the transition process. NOARC/CÉRNO is physically located over the Glenn Crombie Centre for disability services at Cambrian College in Sudbury. Its in-house team of psychological professionals provides assessments primarily to the three post-secondary institutions in Sudbury. NOARC/CÉRNO’s roster of external psychological practitioners provides service to students on all of the main campuses (and some satellite campuses) of the eight other colleges and universities in Northern Ontario.

Ideally, such assessments should occur before the student begins college or university. This enables them to start their post-secondary studies having already forged a relationship with the Disability Office, understanding their learning profile and needs, and in possession of appropriate documentation capable of securing their accommodations. In fact, it is recommended that all students in need of accommodation, and accepted into a post-secondary institution, secure an appointment with the Disability Office staff for assistance in determining if their existing documentation is adequate to garner accommodations. Helpful documentation might include: medical reports, IEPs, IRPCs, educational assessments, and professional assessment reports. Disability Office staff can review the presented documents and advise on the need for additional documentation or updated assessment.

Students and their parents may not be aware of the various methods of funding such assessments. Currently, the ARC’s provide assessments at a modest fee, with a sliding fee scale based on financial need. In addition, students with disabilities who are eligible to receive even $1.00 of OSAP may access the Bursary for Students with Disabilities (BSWD), which can in fact fund a transition assessment. As well, students denied OSAP but with proven financial need may receive an assessment funded by their home ARC.

Research from the LOTF also identified that students with LD require specialized transition planning to help them succeed at the post-secondary level. One transition initiative developed by the team at RARC is a program called On-Line to Success, available to any Ontario student planning to attend college or university anywhere in the world. This past year, the program ran in seven different school boards, and feedback from students, teachers and parents about the value of this program has been universally positive. Furthermore, the follow-up information we have on past participants would indicate that they continue to feel that this program significantly improved their first-year transition experience. Presenting information about this unique program has given us national exposure, and RARC has received requests from all over Canada to allow other schools to use this program as part of their curriculum. Students with LD should also investigate other transition programs provided at their chosen institution.

While it is true that the ARCs provide high-quality assessments, their mandate is much broader than this. They also provide training opportunities for graduate students in psychology, education and rehabilitation medicine; engage in clinical research; offer transition support and disability-specific counselling to students; and act as a resource for people seeking LD-specific information.

In any area of student service, one needs to engage in research, the results of which will improve and advance the service that is being provided. Providing service without continually validating it as well as generally endeavouring to “push back the frontiers of knowledge” would be to abandon one’s role as a professional. To this end, these two centres have begun collaborating on joint research projects that will benefit students with LD all over North America. Their combined research efforts will help to inform both our practice and the practice of other professionals in this area of service provision across Canada. It will help clinicians make more accurate diagnoses, which in turn will lead to provision of more appropriate treatment and academic support.

The ARCs are able to provide updated or initial assessments for any Ontario student accepted into or enrolled in college or university. For further information about these assessment centres please contact using the information below. A referral may be initiated through the Disability Service office where students have been accepted.

Regional Assessment and Resource Centre (RARC)
Queen’s University
186 Barrie St.
Kingston, Ont.
K7L 3N6
Phone: 613-533-6311
www.queensu-hcds.org/rarc/

The Northern Ontario Assessment & Resource Centre/Centre d’évaluation et de ressources du Nord de
l’Ontario (NOARC/CÉRNO)
1400 Barrydowne Rd.
Sudbury, Ont.
P3A 3V8
Phone: 705-524-7397
Fax: 705-524-6779
www.noarc-cerno.ca

* There is a significant difference between a psychological diagnosis of an LD and the criteria for identification of an LD in elementary or high school. In addition, at the post-secondary level, students can only access disability-related accommodations and services if they have a formal diagnosis of a disability. Sadly, most parents and students are not aware of this fact, and are surprised when the accommodations they have always received in high school are no longer offered to them based solely on an “identification.” Criteria for an appropriate and thorough assessment report may be found at www.ldao.ca.

The following are questions that you can use to see if someone may be at risk of learning disabilities. The questions should be used with individuals who show competencies in many areas, but demonstrate difficulties that cannot be explained by lack of education, low intelligence or mental health/addiction problems.

Everyone has problems with these areas some of the time, but if there are many questions answered “often”, it may be useful to look further into the possibility of 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

Estimates vary, but it is believed that up to 80 per cent of those with ADHD also have a learning disability.  In the LD population, it is estimated that 30 to 40 per cent also have ADHD, so clearly the conditions are highly related.  One of the main links between these two diagnoses is the fact that attentional deficits themselves can be one of the underlying information processing difficulties that gives rise to academic problems.  In other words, problems with attention can be so pronounced as to interfere with the acquisition of reading, writing, or mathematical skills.

Similar to LD, Attention Deficit/Hyperactivity Disorder cannot be readily diagnosed through medical technologies, despite the fact that the disorder is due to brain dysfunction.  However, even though attention and concentration are clearly a cognitive skill, and can certainly be measured, they are in fact a multifaceted set of cognitive skills in their own right.

Furthermore, the seat of attention/concentration abilities resides in the forward most part of the brain known as the “frontal lobes”.  The frontal lobes are complex and functions relating to them are extremely difficult to measure.  The reason for this difficulty is that the frontal lobes play an integrative role, coordinating and synthesizing inputs and information which is being received by other areas of the brain. Through the attentional processes, the frontal lobes are responsible for sifting out irrelevant information such as distractions in the environment.  The frontal lobes are also the part of the brain responsible for adaptation to one’s environment.  When we are involved in routine behaviours and skills, the frontal lobes are not highly activated in general.  Most cognitive/academic testing is therefore weak at testing the frontal lobes because: (1) Both the clinical interview and testing generally occur in a quiet, distraction-free environment; (2)  Testing protocols are generally highly structured, reducing demand on the frontal lobes which would otherwise have to create the “structure”.

There are some tests which are specifically geared towards AD/HD and many of these are well validated.  However, in the experience of some clinicians, many of these tests often seem to produce “false positives” and/or be more effective with children than adults, perhaps in part because over the years adults learn to manage their attentional difficulties, especially in quieter, more structured environments.

Most often, the diagnosis of ADHD is made clinically, particularly in adult populations.  “Clinically” means the examiner considers the full history of the client, considers the client’s behaviours and presenting symptoms, considers observations throughout testing (perhaps with greater emphasis than test scores themselves), and uses subjective client questionnaires. Additionally, input may be sought from significant others, friends and even co-workers and/or employers.  Other possible explanations for the attentional and/or hyperactivity symptoms are then considered and ruled out before arriving at a diagnosis of AD/HD.

By Dr. J. Douglas Salmon Jr.

From “The Role of Cognitive Assessments in the Workplace“ in Benchmarking: A Guide to Hiring and Managing Persons with Learning Disabilities, 2005, Adult Learning Disabilities Employment Resources, Toronto, ON.