Table of contents:
- How does a dyslexia test work?
- Which skills are measured in a dyslexia test?
- After dyslexia testing
- How much does dyslexia testing cost?
How does a dyslexia test work?
If your child has gone through a screening and there are signs of a learning difficulty, the next step is usually a full educational assessment. These are known as educational assessments, psychoeducational assessments or evaluations. Before you book one, it’s important to know what is likely to happen before, during and after the assessment.
Does my child need a dyslexia test?
These evaluations can be expensive and time-consuming, so you should consult with all the relevant stakeholders in your child’s education before you pursue one. This includes any educators or therapists who play a role in your child’s life. Most often, the recommendation to seek out an assessment comes from the child’s primary teacher. Most school districts have rules governing the procedure for dyslexia assessment. These cover the process from identification of problems, to the implementation of measures to accommodate and support students who receive diagnoses. These rules vary from state to state, so you should check with your local school district. Generally, though, the steps go in this order:
- Teacher advises the school about a child’s learning difficulties (as yet undiagnosed) through results, observations and general impressions
- School advises the parent of the need for screening and/or testing
- Permission is granted to assess (if this is done internally)
As a parent, you have certain rights and responsibilities when it comes to your child’s educational journey. In particular, you are entitled to an Individualized Educational Plan (IEP) if assessment shows your child needs this kind of support.
How to prepare for dyslexia testing
A full assessment involves a large number of different tests. These tests address different skills and competencies. This is not only time-intensive, but it can also be very taxing for your child. Practitioners should make every possible effort to minimize this, by ordering and structuring the tasks in a coherent way. To add complexity, a child who is undergoing assessment may well be aware of what is happening. Anxiety can arise as a result. Once you have an appointment, here are some practical tips:
- Put your child’s mind at ease: Many children have heard of dyslexia, dyslexia testing, and learning difficulties. Approaching an assessment can evoke stress and feelings of inadequacy, or a sense that something is wrong. This may impede your child’s performance on the tasks, so it’s important that you help your child to feel comfortable. You should also inform the assessor of any significant anxiety, because this may be relevant information.
- Provide all the information the assessor requests: Assessors often ask parents to complete questionnaires, or submit documents relating to a child’s medical, educational and psychological history. Ensure that you supply all of this timeously and in detail. You want the final report to be as thorough and informative as possible, in the event that you have to use it to get services for your child. You can help the process by being organized and efficient.
- Ensure your child has had adequate food and rest: A tired or hungry child will not be able to complete tasks. This matters, because you want the assessment to give a truthful indication of your child’s abilities. Your child should be cooperative and relaxed throughout the session.
What to expect on the day of the assessment
Usually, the assessment proceeds between the assessor and child alone. However, depending on a child’s needs and history, the assessor may permit parents to be present. In all cases, the practitioner will use a comfortable room with few distractions. The assessor will take the child through a battery of tests and assessments over the course of a few hours. The tests chosen may be influenced by the nature of the referral. If the teacher or parent has specified the nature of the problems they have observed, then the practitioner can choose appropriate instruments.
Which skills are measured in a dyslexia test?
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
- Rapid naming
Below we will look at these important skills.
Why 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’?”
What is decoding and why is is 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.
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.
- 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.
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.
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.
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.
What is rapid naming? Why does it matter for a dyslexia test?
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).
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.
After dyslexia testing
Once the assessor has completed the tests, you will have a feedback session to discuss the results. This point in the assessment is crucial. You should ask for clarification of anything you do not understand. You should also not be intimidated by the use of jargon or dense vocabulary; most of the concepts can be expressed in a straightforward manner.
The structure of a report
Once the assessment is over, you will have the report. You should think of this document as a tool. You can use it as a way of opening opportunities for your child. The structure of a report will vary from one practitioner to the next, but it should contain the following elements:
- The reason for referral: The clinician should outline the reasons for the assessment. This will draw on any reports that the teacher or parent submit. This section may also contain an overview of the child’s history, with relevant observations from any other professionals who have had a stake in his or her education.
- Clinical observations: This section is usually written in full prose, not check lists or tables. A good assessor will describe the impression that a child makes over the course of an assessment. These observations are salient for you and for any other party who has a say in your child’s education. An assessor might note things that tests do not capture, but which will be important in decision-making, such as social and emotional responsiveness, or practical things like pencil grip. Information like this can help to make any subsequent treatment plan more effective.
- List of tests used: There is a bewildering array of tests that measure different skills. For any given aspect of learning, a clinician will often have dozens of well-established tests to choose from. Ideally, practitioners should be able to explain and justify their choices to clients. If you are uncertain about any of this, you should ask. The relevant information may feature in the body of the report, or as an appendix.
- Results and interpretation: The report should provide the score that the child achieved on each test, along with an interpretation of that result. The interpretation usually unpacks what the result means, and compares the score to the standard score, or the one that is expected for a child of comparable age.
Interpreting the report
Testing for dyslexia involves assessing a wide range of skills. Measuring these requires a variety of educational, psychometric and psychological tests. This is why it is important for an assessor to be conversant with technical terms and broader developments in the field. There are some common terms you may encounter in an assessment report.
- Standard score: This is a score that rates a particular child against the peer group. Tests that are regarded as comprehensive and trustworthy by practitioners have standard scores based on a large number of samples. With many tests, the standard score is supplied next to your child’s. The difference between these two numbers (if any) is important; all the more so if it is large.
- Percentile: Many scales categorize scores in percentiles. Similar to a standard score, this gives us a way to understand how a child is doing relative to other children of similar age. If you are in the 50th percentile, this means that your score was equal to or higher than 50 percent of the people in the group. The higher the percentile, the better.
- Diagnosis: If necessary, the assessor may offer a diagnosis of a specific learning disability. Because most psychoeducational assessments involve such a broad range of data, more than one diagnosis can emerge. For example, the assessor might determine that a specific learning disability like dyslexia exists, alongside an emotional or psychological disorder. There also might be no diagnosis at all, but only recommendations.
- Recommendations and resources: The practitioner should recommend a course of action to deal with any problems that come up. In addition, a report may include appendices with tools and strategies that a parent can begin to implement at home, prior to any official or institutional intervention.
Receiving the results of a dyslexia assessment represents the end of one process, and the beginning of another. You now have a tool that adds some clarity to the problems in your child’s life. You also have a basis for acquiring any accommodations or services that your child will thrive in school.
How much does dyslexia testing cost?
There is no single diagnostic dyslexia test. In order to obtain a dyslexia diagnosis, it is necessary to get a full educational or neuropsychological assessment. These assessments are complex, involving a large number of interrelated tests and tasks administered by a professional.
The cost varies from provider to provider, and from state to state. Providers of this service often require supplementary tests to rule out physiological difficulties such as poor eyesight or hearing. Depending on where you live, the entire process can cost between $500 and $2000.
Most insurers do not classify dyslexia as a medical condition, which means that parents need to shoulder the cost. However, there are some important factors to consider:
- Free screening and testing from school districts
- The role of insurers
- Alternative options for funding
Can my school district conduct dyslexia tests?
In the United States, public school districts have a mandate to screen for dyslexia and address the needs of dyslexic children. This is defined by federal law, by the Individuals with Disabilities Education Act (IDEA). The relevant part of the statute defines the term “specific learning disability” and includes dyslexia explicitly among them. It reads as follows:
(26) SPECIFIC LEARNING DISABILITY-
(A) IN GENERAL- The term ‘specific learning disability’ means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations.
(B) DISORDERS INCLUDED- Such term includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.
(C) DISORDERS NOT INCLUDED- Such term does not include a learning problem that is primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage.
For a variety of reasons, not all school districts offer screening services. If you suspect that your child might require dyslexia testing, your first step should be to check with the school district and find out whether it offers screening, testing or treatment services. Then, you should request an evaluation. This is straightforward if your child attends a public school. You can simply communicate your request to the principal and any other relevant stakeholders in the school district, such as a head of special education. However, you can do this even if your child is not in the public school system:
- If your child is in a private or home-school, contact the public school district for which you are zoned and find out who can handle your request for dyslexia testing
- If your child attends a charter school, contact the charter school principal as well as your state’s Office of Special Education Program (OSEP) representative
Do insurers cover the cost of dyslexia tests?
Currently, dyslexia is not considered a medical condition, unlike other conditions such as ADHD and autism. Therefore, specific testing for dyslexia is not covered by most insurers. Neither are the costs of treatment for dyslexia. However, many insurers do offer coverage for neuropsychological assessments, which is the type of assessment you will want to get in order to obtain an authoritative diagnosis. The difficulty here is that neuropsychological assessments comprise educational and neuropsychological tests, and insurers that cover the latter, are often reluctant to cover the former. Your insurer might be unwilling to authorize an assessment for any conditions that it deems non-medical.
If a medical professional deems it medically necessary for your child to undergo the entire battery of tests in a neuropsychological assessment, this may help you to obtain authorization or reimbursement from your insurer. You should also check with your insurer to find out if your insurer reimburses for the codes covering psychological and neuropsychological testing and assessment. These codes are:
Can I use an FSA or HSA to cover dyslexia testing?
A Flexible Spending Account (FSA) is a savings account that your employer administers. The account can reimburse costs associated with medical treatments. Dyslexia testing can be covered by an FSA, with a Letter of Medical Necessity (LMN). This is a letter issued by a suitably authorized medical professional. Your FSA can also cover subsequent costs of treatment such as speech therapy and occupational therapy, if the assessment recommends these as fruitful avenues of treatment.
Health Savings Accounts (HSA) are savings accounts that you or your employer can fund. Like the FSA, this account can reimburse medical costs that are suitably qualified and authorized.
Edublox offers live online tutoring to students with dyslexia. Our students are in the United States, Canada, Australia, New Zealand, and elsewhere. Book a free consultation to discuss your child’s learning needs.
Authored by Susan du Plessis (B.A. Hons Psychology; B.D.), an educational specialist with 30+ years’ experience in the field of learning disabilities, and Dylan Arslanian (B.A. Hons Linguistics, Cambridge DELTA).