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Dyslexia Testing: Which Skills Are Measured in a Dyslexia Test?

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An assessment does not measure one skill in isolation. Because of the nature of a specific learning disability, many different skills can be relevant to a diagnosis. There may be a deficit in visual, auditory or memory skills. A particular child’s deficit may exist in one, two or more skill areas.

To this end, a full educational assessment incorporates a range of tests of different skills and abilities. Practitioners use these in order to measure a child’s competence in relevant areas such as:

  • Phonological awareness
  • Decoding
  • Fluency
  • Comprehension
  • Rapid naming

Together, these tests make up the backbone – and the cost – of your assessment. In this section we will look at the important skills that assessors look at. We will also consider some of the most popular tests that are used for each one.

How is phonological awareness measured?

In an assessment report, terms like phonological awareness and phonological processing usually feature prominently. This is because reading relies on the acquisition of language, including sounds. If you have normal phonological awareness, this means that you can recognize and discriminate between the sounds in your own language. For example, you can tell when two words rhyme. You can break words down into syllables, or identify groups of words according to some criterion: “which words begin with ‘m’?”

Crucially for dyslexics, phonological awareness also involves confidently and reliably linking symbols to sounds. This is something that many dyslexic children struggle to do. Identifying this is essential, because proficient reading will never take place unless the linkage between sounds and symbols becomes automatic. Below is a list of some well known tests that practitioners like to use to assess this area. In the process, we will define key terms that feature in assessment reports:

Comprehensive Test of Phonological Processing, second edition (CTOPP -2)

This is a popular test that is widely used to assess phonological processing in children as young as 4 years of age. The test takes approximately 40 minutes to complete and consists of 12 sub-tests. These 12 components contain specific tasks that reveal a child’s ability to connect sounds with text:

  • Elision is the removal of one sound from a word. For example, removing /s/ from “sold” yields “old”.
  • Blending is what a proficient reader does when forming a word out of its constituent letters and/or syllables. The test requires the child to do this with real and non-real words. The latter are sometimes called pseudowords.  This is important because if you can successfully blend a word that you have never seen before, and to which you can’t attach any meaning, this shows that you have mastered the “rules” that underlie the spelling system in your language.
  • Segmenting is the opposite of blending; you segment a word when you break it into sounds or syllables.
  • Rapid naming, as the term suggests, simply means looking at a symbol or object and calling out its name, with minimal delay. 

NEPSY-II Phonological Processing

The Neuropsychological (NePsy) Assessment is a broadly applicable instrument that seeks to describe a child’s development in various ways. An assessor might use the entire test, or just its Phonological Processing component, in order to assess this specific area. The relevant component contains two tasks:

  • Word Segment Recognition: in this task, the child hears a word and then selects the object that it represents. Then, the child must make words out of segments that the assessor reads aloud.
  • Phonological Segmentation: the child must repeat a word and then elide or substitute sounds to make new ones.

Woodcock-Johnson III (Auditory Processing Test)

The Woodcock-Johnson Test of Cognitive Abilities comprises a battery of tests developed in the 1970s. They were subsequently revised in 1989, again in 2001 and most recently in 2014. They have a wide range of applications, but several of its components can offer a reliable measure of phonological awareness:

  • Sound-blending: the child hears individual segments of a word and must synthesize the word out of these components.
  • Auditory Attention: the child must distinguish words against background noise, varying in volume.

How is decoding measured?

To be a good reader, you have to be able to decode words. You do this every time you see a word in text and successfully identify it. To do this correctly, you need to be able to connect sounds with symbols. Particularly if it’s a new word, you may need to blend individual segments together. This skill needs to be in place for proficient reading to develop, but it’s not enough. There are words that you cannot decode. For example, words whose spelling is very different to their sound, such as “enough”. To successfully read English, you need to recognize this word, in the way that you would recognize someone’s face. Words that have a high frequency (they occur often), or which must simply be learned by sight, are called sight words. Typically, tests that clinicians use to assess decoding will address both domains: decodable words and sight words.

Test of Word Reading Efficiency (TOWRE-2)

This test comprises two modules, each with a different focus. The assessor will be looking to determine if there are weaknesses in one or both. If there is a major discrepancy between a child’s performance on each of the two, that may indicate an over-reliance on one type of reading:

  • For the Sight Word Efficiency test, the child has 45 seconds in which to read aloud a list of words. These are all actual English words.
  • The next part, Phonetic Decoding Efficiency, asks the child to pronounce as many pseudowords as possible in 45 seconds. These are not actual English words, but they are possible, meaning that they can be pronounced using the normal rules of English spelling.

Woodcock-Johnson III (Word Attack)

The “word attack” module of the Woodcock-Johnson suite of tests aims to measure a child’s ability to handle unknown words. In particular, these items are pseudowords. In order to successfully complete the test, the child must recruit his or her understanding of conventional spelling rules to decode the word.

Wechsler Individual Achievement Test (WIAT): Pseudoword Decoding

Much like the Woodcock-Johnson battery of tests, WIAT is a multi-faceted test that involves a number of sub-tests targeting specific skills. The pseudoword decoding test is similar to those of other tests.

Reading fluency: What is it and how is it measured?

Another important aspect of proficient reading is fluency. In the literature on reading and cognition, fluency is treated as a synthesis of three related factors. A comprehensive dyslexia test will typically consider all three of these in order to evaluate a child’s reading fluency.¹²

Speed/Pace

Good reading must be fairly quick. If you read too slowly, the short-term memory cannot hold onto the information at the beginning of a passage to the end. This is a problem, because you need to be able to access all of the information in order to draw the conclusion the writer wants you to draw. The most common unit of measurement for reading pace is words per minute.

Accuracy

Reading that is inaccurate is useless, at best. If you are a proficient reader, you have a large repertoire of words that you can treat as sight words. These are words that you recognize without the need to decode them. At an even higher level, you are able to take in entire chunks of language at a time.

Prosody

The third factor that undergirds fluency in reading is prosody. This term refers to things such as rhythm, pitch and tone. When you ask a question, for example, you may raise your voice slightly as you approach the end. To read effectively, you need to be able to “hear” the text, and apply the corresponding features, even when you read silently.

Ways of measuring fluency

Perhaps because of its complexity, fluency is not easy to measure. There are various approaches, with different tests using different methods to assess how fluently a child reads. There are generally three factors that vary between tests: oral/silent, real/pseudowords and in context/out of context.

Oral or silent

A test might require a child to read out loud, or silently. Reading aloud is slower than silent reading, but it’s easier to measure. It’s also a more realistic reflection of a child’s reading ability, because you can hear prosodic features such as tone and rhythm. On the other hand, asking the child to read silently has the advantage of focusing strictly on the pace of the reading. Ideally, both should be measured in some way, because variances between the two can be salient in and of themselves.¹³

Real words or pseudowords

This distinction comes up quite often in dyslexia testing. At first glance, it might seem strange to ask children to read words that are not actually part of their language. But as we saw with regard to decoding, this can be very useful, because when you encounter a “nonsense” word, you can’t rely on your world knowledge or the context in order to identify it. You have to rely on your knowledge of sound/symbol relationships and spelling rules. This is exactly the knowledge that dyslexics struggle to incorporate, so it makes sense to target that directly. However, some tests opt for real words, on the basis that a child’s awareness of meaning will meaningfully impact on his or her performance on a reading assessment. A child might successfully decode a pseudoword, but hesitate because the word does not correspond to anything that he or she understands. This can yield a skewed result.

Another undesirable consequence of using pseudowords is that they can create uncertainty in the mind of the reader. A child might come to believe that a nonsense word is in fact a real one. For these and other reasons, many practitioners object to the use of pseudowords. However, they remain quite common in dyslexia tests.

In context or out of context

Many fluency tests utilize lists of words, free of any context. The reader must move vertically down the list, rather than horizontally, as with a continuous text. The logic behind this is simple: the test wants to measure the speed and accuracy of word recognition. Giving a context allows other skills to enter the picture. For example, you might correctly “guess” an unknown word by using the context around it, using clues or strong associations between words. Consider the following example:

“It’s important to have a balanced ____”.  You probably had no difficulty inserting “diet”, because this word has a strong association with “balanced”. It’s even easier if this is a topic that has occupied your mind recently. Fluency tests that give words out of context aim to eliminate the interference of these meta-linguistic skills. On the other hand, fluent reading is always contextual, in the real world. In other words, when we read, we do make use of the immediate context in order to make quick judgments.

Given all of these differences, there is an array of tests that practitioners can choose from when assessing reading fluency. Here are some of the more popular and well-established tests that might feature in your child’s assessment:

Gray Oral Reading Test (GORT-5)

Assessors use this test to gauge how accurately and fluently a child reads. It’s appropriate for people between 6 and 24 years of age. The test comes in two forms (A and B), which allows the practitioner to calibrate it to the needs of a particular child. The format of the test is simple; there are 16 stories, with questions after each one. The results are precise and the assessor can derive a score based on the following:

  • Rate: this score comes from measuring the amount of time a child takes to read the story. Reading is done out loud in order to make this possible.
  • Accuracy: the number of correctly pronounced words goes into a calculation of accuracy.
  • Fluency: from these two, the assessor can derive a fluency index, which collates the factors rate and accuracy. For many dyslexic children, rate and accuracy are in tension: fast reading is inaccurate, and accurate reading is slow. This test can provide a clear picture of the imbalance and give subsequent therapists a basis on which to develop a treatment plan.

Test of Word Reading Efficiency (TOWRE-2)

We have seen how TOWRE is useful in assessing decoding ability. But it is also informative for the clinician who wants to ascertain reading fluency. This test utilizes word lists to measure fluency. One list uses real words (Sight Words) and the other uses pseudowords (Phonemic Decoding). For both tests, the words are always out of context, and always oral. Children have 45 seconds to read as many of the words as possible. The clinician notes the number of correct pronunciations and generates a score accordingly.

Test of Silent Word Reading Fluency (TOSWRF-2)

In contrast, Silent Word Reading Fluency (TOSWRF) utilizes silent reading. This is a quick test, lasting either 3 or 6 minutes. Each form takes 3 minutes, and the assessor may use two. The test is also suitable for group or individual administration, because it does not require reading aloud. The child reads rows of words with no spacing between the words. The rows grow progressively more difficult. The task is to draw lines to mark where one word ends and another begins. The number of accurate lines the child draws in 3 minutes yields the score. The words in this test are out of context, but all real.

Wechsler Intelligence Scale for Children (WISC-V) Oral Reading Fluency Subtest

This subtest of the WISC-V battery of tests aims to assess all three aspects of fluency: accuracy, speed and prosody. To complete the test, the child reads two separate texts. Once they reach the end of each text, the examiner asks a comprehension question, but this is not evaluated. The purpose is simply for the child to read with comprehension. The score for accuracy comes from the average rate of accuracy on both texts. The score for speed is based on the amount of time the child takes to complete the task. The examiner then adds an evaluation of prosody after having observed the child read.

How do we measure comprehension?

Reading comprehension refers to a reader’s ability to successfully interpret a text. Of course, it’s not enough to simply read a passage accurately. This is necessary but not sufficient – to be a proficient reader, you have to understand what you are reading. This can only happen if you are able to decode the words and sentences. Another condition that seems to be necessary for comprehension is fluency. This makes intuitive sense. After all, it is difficult to understand someone who speaks haltingly or without natural intonation.

However, it is possible for someone to read fluently and have poor comprehension. This has its own clinical term: Specific Reading Comprehension Deficit (SRCD). This happens when a child’s decoding skills are more developed than his or her ability to understand a text. Conversely, a child with relatively poor decoding skills might be able to mask this by using contextual clues to deduce the most appropriate word in a particular sentence. A child with extensive general knowledge or sophisticated problem solving abilities might draw on this in order to achieve a high comprehension score, while lacking reading fluency.

What is the difference between literal and inferential comprehension?

Dyslexia tests that target reading comprehension are usually interested in either literal comprehension, inferential comprehension, or both. Literal comprehension is a reader’s understanding of the events and information in a text. To test it, you can ask a child questions like “what happened?” or “where did it happen?”. Answers to these questions are all available in the text itself. Inferential comprehension depends on literal comprehension, but goes further. This is the reader’s ability to form judgments that make sense (inferences) about the text, the author, or aspects of the text. For example, questions about the moral of a story, or the intentions of the writer, rely on inferential comprehension. In order to deal with a text at this level, the literal level has to be automatic and effortless.

These factors make it quite difficult to arrive at a true measure of reading comprehension. There is a wide range of tests that are commonly used in the United States by teachers and psychologists in order to assess comprehension skills.

Wechsler Intelligence Scale for Children (WISC-V) Reading Comprehension Subtest

This subtest of the WISC-V battery of tests can determine how well a child is able to comprehend texts. It has three components of increasing difficulty. The first of these involves matching pictures to words. This is a way to demonstrate basic, foundational association between symbols and objects. Then, the child reads individual sentences and answers a question about each one. These questions are literal, rather than inferential. The third and final part requires the child to read a text, which could be a story or an explanatory text. Verbal questions follow, both literal and inferential. The examiner gauges the number of correct answers to arrive at a score.

Measures of Academic Progress (MAP)

The Measure of Academic Progress is a group of tests that includes a reading test. It is frequently administered in a school setting. The test is widely used for a number of reasons. Firstly, it is done on a computer, which makes it easy to administer. This also gives the test another, even more important strength. The computer is able to assess the person taking the test while the test is happening, and adjust the difficulty of the questions based on the test taker’s performance so far. A correct answer on one question will lead to a more challenging question. An incorrect answer will cause the computer to offer a less challenging question next.

Secondly, MAP utilizes multiple genres to gauge reading comprehension, such as prose, recipes and poems. This means that it can provide a detailed picture of a child’s reading ability. After all, we live in a text-rich environment and we constantly have to switch between genres. On any given day, most of us will encounter a wide range of text types including emails, blog articles, written instructions and others.

The test procedure involves individual assessment, as the child reads the texts on screen. The test presents questions on each of the texts. These questions require the child to identify the meanings of words, or make judgments about the text’s purpose, or the intentions of the writer. Unlike many comprehension tests, there is less emphasis on details and more focus on informational content.

Passage Comprehension subtest (Woodcock Johnson III)

The Passage Comprehension component of the Woodcock Johnson Tests of Achievement is another test that utilizes silent reading to gauge reading comprehension. This test comprises a number of stages. The first one requires the child to match a pictograph to a picture. This gauges whether the child can successfully match a symbol to an object that it commonly represents. Next, the child reads a phrase and chooses a picture that represents that phrase. Then, the child reads a passage with a missing word, which must be supplied. The word must be grammatically correct but it must also make sense in the context. This final part is in the form of a cloze test. In psychology, cloze tests are those in which the task is to complete a piece of text that has gaps in it.

Gray Oral Reading Test (GORT-5)

The Gray Oral Reading Test (GORT-5) is used to measure a number of skills related to reading. These include fluency and comprehension. The procedure of the test is quite simple. The child reads a short story out loud to the assessor. During this time, the assessor can listen to the child’s reading and make any relevant observations about the pace and intonation that the child uses. After reading the text, the child answers five questions about the story. The questions aim to elicit inferences, recall details or identify main ideas.

Reading Comprehension WIAT-III

The Reading Comprehension subtest of the Wechsler Individual Achievement Test (WIAT) is a measure of both literal and inferential comprehension. It utilizes a wide range of text types, such as stories and advertisements. The child can choose to read in silence, or aloud. The questions are posed and answered verbally. This is important, because it enables the test to isolate comprehension without possible interference from poor writing skills.

What is rapid naming?

Rapid naming happens when you recognize something instantly and effortlessly, and say what it is. This can happen with anything – objects, symbols, colors at the most basic level. At a higher level, this can include words and phrases. For effective learning to take place, this must happen effortlessly and quickly, which is why it’s known as Rapid Automatic Naming (RAN).

Why does rapid naming matter for a dyslexia test?

Dyslexic readers frequently show weaknesses on tests of rapid naming ability. There is ongoing debate about whether the underlying deficit is visual or phonological in nature. In any event, the strong correlation between dyslexia and difficulties with rapid naming justifies its inclusion in dyslexia tests.¹⁴

Rapid Automatized Naming and Rapid Automatized Stimulus (RAN/RAS Test)

This test is widely used as a tool for measuring the rapid naming abilities of children 5 years of age and older. To complete the test, the child must name items as quickly as possible. The examiner times the child and comes up with a score based on how long it took the child to complete the test, as well as how accurate the answers were. The test includes a variety of stimuli: colors, objects, numbers and letters. All of the stimuli are high frequency, meaning they are things that the child will have experienced or encountered often. This test can help an assessor to either predict or diagnose a reading problem.

Speeded Naming subtest of the NEPSY Assessment

NEPSY is the name given to a battery of tests whose full title is: “A Developmental Neuropsychological Assessment”. One of the subtests, the “Speeded Naming” test, measures rapid naming speed in children. As with the RAN/RAS test, the examinee’s score comes from both the speed and accuracy of naming. An examiner may also draw conclusions about other behaviors such as impulsivity; an impulsive child might name rapidly but inaccurately. Conversely, a child might name adequately during the example at the beginning of the test, which is untimed, but fall short when speed is required. These two outcomes have different implications for the kinds of recommendations an examiner might make. It can also inform a prediction or diagnosis of a reading disorder.

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