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Assessing Learning Disorders

Ellen Boiselle, PhD

Associate Director

Learning Disabilities Program

Department of Neurology

Boston Children’s Hospital

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BCH LD Program Process & Philosophy
Dyslexia

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BCH LD Program Assessment Model

What we do:

Children grade 2 – 8
Integrated, team-based approach assessing cognitive, academic and psychosocial functioning

Prior To Eval

Data from teachers, parents, previous testing, etc.
Medical, psychosocial, & academic hx

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BCH LD Program Evaluation

Neuropsychology

Neurology

Oral and Written Language

Mathematics

Psychology Screening

THE LEARNING DISABILITIES PROGRAM BRINGS TOGETHER AN INTERDISCIPLINARY TEAM OF EVALUATORS WITH EXPERTISE IN NEUROLOGY, NEUROPSYCHOLOGY, SPEECH–LANGUAGE PATHOLOGY (ORAL LANGUAGE), READING AND WRITING (WRITTEN LANGUAGE), MATHEMATICS, AND CLINICAL PSYCHOLOGY.

THE COMPREHENSIVE INTERDISCIPLINARY EVALUATION IS GUIDED BY DEVELOPMENTAL NEUROPSYCHOLOGICAL THEORY.

EACH CHILD IS EVALUATED IN THE COURSE OF A DAY , ROTATING AMONG ALL THE SPECIALISTS.

THAT TEAM THEN MEETS TO SHARE FINDINGS . EVALUATORS CAN USE FINDINGS FROM OTHER DISCIPLINES TO INFORM THEIR FINDINGS AND TO REFINE THEIR CONCLUSIONS. Goal of that meetin is TO CRAFT A FORMULATIOM OF THE CHILD’S LEARNIG PROFILE – SKILLS BUT ALSO HOW THE CHILD LEARNS

THE INTEGRATED FORMULATION THEN DIRECTS DEVELOPMENT OF THE INTERVENTION PLAN.

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Neuro-psychology

Neurology

Oral

Language

Reading

& �Writing

Mathematics

Psychology

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Traditional Approach to Diagnosis & Treatment of LD

Learning Disorder is a specific disability diagnosed by psychometric testing of academic skills.

Once LD has been diagnosed, provide remediation for specific skill deficit using evidence-based approaches.

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“Specific” skills are necessary but not sufficient for academic performance …..

Consider a basketball analogy….

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Traditional Approach to Identification & Treatment of LD

Deficit lies within the child (Waber, 2010)

Purpose of special education is to identify & fix the broken component (i.e., skill).

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CHILD – WORLD MODEL

(Bernstein & Waber, 1990):

Brain-behavior relationships mediated by developmental and contextual factors.

Child

World

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Neuro-developmental Model of Assessment

“Talents & Un-talents” (Denckla)

A neurodevelopmental model of assessment holds that each of us has a profile of strengths and weaknesses – or what I like to call talents and untalents

Y axis is a measure of competence

X axis is all the various skils that one has to do in one’s life –reading, writing, social skils, getting along with mother in law, cooking, appreciating nuance, etc.

Everyone’s profile would look loke this graph – a collection of peaks and valleys so to speak

AND with development and learning and experience, those peaks and valleys may shift over time….

But think of this graph of one person’s talents and untalents and then consider the context in which that person operates

Are their talents well aligned with what is expected of them in their day to day life?

During the school age period – lot going on in the noggin

Pruning of neurons (decrease in grey matter) PRUNING OF REDUNDANT NEURONS)

Increase in mylineation – connectivity (white matter)

THROUGH EXTERNAL STIMULATION AND NEED TO ACCOMPLISH GOAL DIRECTED BEHAVIOR, NETWORKS BECOME ESTABLISHED AND ULTIMATELY “ENTRENCHED”. Piaget. Karmiloff Smith

Development of functional networks –

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Neuro-developmental Model of Assessment

“Talents & Un-talents” (Denckla)

What constitutes a Learning Disorder?

When the child’s constellation of “un-talents” match the demands of school.

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Implications of Neurodevelopmental Model

Problem lies in the interaction; not within the child

Multiple vs singular etiologies

Goal is not to “fix” deficits per se but to improve interaction – to reduce risk, improve functioning & enhance resilience

Child’s profile and educational needs change over time

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So What about Dyslexia?

Dyslexia involves:

difficulties with accurate and/or fluent word recognition

poor spelling & decoding abilities

Comorbidities include ADHD, language disorders, & other LDs

Neurobiological disorder that affects individuals across the life span

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Dyslexia

Disorder with multiple etiologies

Phonology
Naming Speed / Automaticity
Orthography
Symbolism

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Treatment

Evidenced-based therapy to address specific type of problem

Fidelity & Intensity

Frequent Progress Monitoring

Adjust interventions as necessary

Accommodations

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Reading of materials at instructional level

Listen to books at grade level / interest level

Writing postcards / graphic novels

Access content via alternate methods

Talk about books; model reading at home

Alignment of tutoring with school interventions

Balance

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