Yale Child Study Center, School of Medicine

Yale Child Study Center, School of Medicine
Assessment for Differential Diagnosis of Learning Problems and Intervention Dawn P. Flanagan, Ph.D. St. John’s University Yale Child Study Center, School of Medicine

Relations between cognitive constructs and academic areas

See McGrew and Wendling (2010) for an extension of this work
Summary of Relations between CHC Abilities and Specific Areas of Academic Achievement (Flanagan, Ortiz, Alfonso, & Mascolo, 2006) See McGrew and Wendling (2010) for an extension of this work

Relations between CHC Abilities and Processes and Reading Achievement
Gf – Induction (I) and general sequential reasoning (RG) play a moderate role in reading comprehension Gc – Language development (LD, lexical knowledge (VL), and listing ability (LS) are important at all ages. These abilities become increasingly more important with age Gsm – Memory span (MS) is important, especially when evaluated within the context of working memory Gv – Orthographic processing

Ga – Phonetic Coding (PC) or phonological awareness; phonological processing – very important during the elementary school years. Glr – Naming facility (NA) or “rapid automatic naming” is very important during the elementary school years. Associative memory (MA) may be important at early elementary school ages. Gs – Perceptual speed (P) abilities are important during all school years, particularly the elementary school years.

Gf – Induction (I) and general sequential reasoning (RG) play a moderate role in reading comprehension Gc – Language development (LD, lexical knowledge (VL), and listing ability (LS) are important at all ages. These abilities become increasingly more important with age Gsm – Memory span (MS) is important, especially when evaluated within the context of working memory Gv – Orthographic processing

Ga – Phonetic Coding (PC) or phonological awareness; phonological processing – very important during the elementary school years. Glr – Naming facility (NA) or “rapid automatic naming” is very important during the elementary school years. Associative memory (MA) may be important at early elementary school ages. Gs – Perceptual speed (P) abilities are important during all school years, particularly the elementary school years.

Building on the work of Flanagan and Colleagues (2006)
McGrew and Wendling (2010) Need to move from general to specific Reading -> basic reading skills; reading comprehension Math -> basic math skills; math application Need to systematically take into account developmental level Ages 6-8 years Ages 9-13 years Ages years Need to control for specification error Seems necessary primarily if interested in percentage of variance accounted for in academic outcome May pose more of a limitation (e.g., Flanagan et al. had over 100 studies in their review; McGrew and Wendling had less than 20)

Comparison tables may be found in:
Flanagan & Alfonso (2011). Essentials of Specific Learning Disability Identification. Hoboken, NJ: Wiley.

Comparison tables may be found in:
Flanagan & Alfonso (Eds.) (2011). Essentials of Specific Learning Disability Identification. Hoboken, NJ: Wiley.

Cognitive Correlates and Diagnostic Markers for SLD in Oral Language (Receptive and Expressive)
Attention Processing Speed Short-term Memory (particularly Working Memory) Word Retrieval (Glr)

Basic Reading Skills – ages 6 to 8 – WISC-IV
Broad Domain Markers Narrow Domain Markers Relevant WISC-IV tests XBA Supplemental Tests from WJ III Work Mem (MW) Digit Span (MS/MW) Letter-Number Seq. (MW) Short-Term Memory Gsm Perc. Speed (P) Coding (P/R9) Symbol Search (P) Cancellation (P) Gs Processing Speed Lang. Dev. (LD) Listen. Ability (LS) Gen. Info. (K0) Lex. Know. (VL) Vocabulary (VL) Similarities (LD/VL) Comprehension (LD) Information (K0) Word Reasoning (LD/VL) Crystallized Intelligence Gc Long-Term Retrieval Glr Assoc. Mem. (MA) Naming Fac. (NA) Vis.-Aud.-Lrng. (MA) Rapid. Pic. Nam. (NA) Retrieval Fluency (FI) (NA) Auditory Processing Ga Phonetic Coding (PC) Snd. Aware (PC/MW) Snd. Blending (PC) Basic Reading Skills – ages 6 to 8 – WISC-IV Slide Adapted from Kevin S. McGrew

We Have Knowledge of What Our Tests Measure According to CHC Theory We Have Knowledge of What Cognitive Constructs are Most Closely Related to Academic Achievement Cross-Battery Assessment Approach Classification system Joint or CB-FAs Content Validity/Expert Consensus Facilitated the use of a common nomenclature Beginning to link CHC and neuropsychological theory and research

What is the School Psychologist’s Goal When Working With Students With Significant Learning Difficulties and Skill Deficiencies? Identify targets for remediation and determine what the student needs to improve academically

RTI at Tiers I and II Students Amy Belinda Carl Tier I Screening
At-risk in Reading Decoding Fluency Comprehension Tier II Treatment Protocol Reading Recovery Students Amy Belinda Carl Mascolo and Flanagan (2010)

Reading Recovery Results
Amy, Belinda, and Carl are making some gains in Reading Recovery No appreciable change in reading performance Tier II “nonresponders” CHOICE move to Tier III or conduct a “diagnostic assessment” Mascolo and Flanagan (2010)

Individual Differences Are Important
One Size Does Not Fit All

Different Cognitive Ability Profiles Suggest Different Interventions

Different Cognitive Profiles Suggest Different Interventions
Amy’s cognitive testing shows a significant deficit in phonetic coding – she doesn’t know how to translate symbols into sounds Ga deficit impacts her fluency – labored reading Lack of decoding and fluency impacts comprehension Intervention should focus on Phonemic Awareness – Remediate Ga Mascolo and Flanagan (2010)

Gc deficit – speech-language impairment? Comprehension is poor b/c of low Gc Poor vocabulary – needs to re-read to gain meaning, which impacts fluency Intervention should focus on vocabulary development – Build Gc-VL, KO – and building fluency Accommodation of extended time may be warranted due to a Gs deficit Mascolo and Flanagan (2010)

Gsm deficit – memory span and working memory are deficient; visual memory ok Decoding is poor – he cannot hold the complete phonemic string in mind long enough to say the word Comprehension is poor because he needs to allocate all memory space decoding words and therefore cannot focus on meaning Fluency is impaired because he must re-read the text to gain meaning Intervention should focus on developing a sight word vocabulary Carl needs to be taught compensatory strategies to assist with poor Gsm (text previews; guided notes; one comprehension question at a time) Mascolo and Flanagan (2010)

Different Cognitive Ability Profiles Suggest Different Interventions
All had same academic deficits (decoding, comprehension, fluency) All made slow gains with Reading Recovery All had different patterns of cognitive strengths and weaknesses Reading Recovery – allocating time to areas that do not need to be trained Not enough explicit instruction in main problem area because the intervention was not tailored Mascolo and Flanagan (2010)

Amy’s Intervention No need to focus on comprehension and fluency
Amy needs phonemic awareness training Mascolo and Flanagan (2010)

Programs/Techniques for Ga-Phonetic Coding Deficits
When selecting a program or a technique to intervene with a student with a Ga deficit, consider one that Teaches students to manipulate sounds by using letters (i.e., phoneme-grapheme correspondence) Uses individual or small group format Focuses on reading and spelling development (again, the phoneme-grapheme connection) Explicitly teaches student how to blend sounds

Another Program for Ga-Phonetic Coding Deficit
Phonemic awareness games

Road to the Code Provides 44 lesson plans that include games to encourage phonemic awareness. The games are Say-It-and-Move-It—the child learns to recognize phonemes by moving a disk for every phoneme heard Letter Name and Sound Instruction—the child learns the name of the letter that produces the phoneme heard and what the letter looks like Phonological Awareness Practice—the child participates in a range of simple phonological awareness tasks. Here are some games

Belinda’s Intervention
No need to focus on decoding Belinda needs to focus on building her vocabulary She will also benefit from interventions designed to build fluency Mascolo and Flanagan (2010)

Recommendations for Gc Deficit
Work on vocabulary building Teach morphology Activities to build listening skills Explicitly teach listening strategies Use text talks Semantic feature analysis/Semantic maps

http://teacher. scholastic. com/products/texttalk/overview/readaloud
This is an intervention program that involves read aloud, talking about text, direct instruction in reading, and teacher supports. Leveled learning, so good for differentiating instruction. Free trial of text-talk. You are trying to build vocabulary which will support comprehension (even though it is in the context of reading, growth in vocabulary supports writing, etc.).

Choral Repeated Reading
Belinda also has a Gs Deficit – Suggest Need to Work on Building Fluency Choral Repeated Reading Students listen to the text being read and follow along by reading aloud and looking at the text (using their fingers to keep pace) 10 to 15 minutes Text can be higher than students’ instructional level Comprehension activities can be added Feedback and assistance can be provided

Carl’s Intervention No need to focus on comprehension or fluency
Carl needs sight word reading and memory strategies Mascolo and Flanagan (2010)

Build Sight Words Print Flash Cards Use folding-in technique
Go to: Print Flash Cards Use folding-in technique (builds confidence)

Increase Vocabulary

Understanding a student’s pattern of (cognitive and academic) strengths and weaknesses informs intervention

Remember: ecological validity is essential

Manifestations of Cognitive Weaknesses and Examples of Recommendations and Interventions (Flanagan, Alfonso, & Mascolo, 2011, in press) Flanagan, D. P., Alfonso, V. C., Sotelo-Dynega, M., & Mascolo, J. T. (in press). Use of Ability Tests in the Identification of Specific Learning Disabilities (SLD) within the context of an Operational Definition. In D.P. Flanagan & P.L. Harrison, Contemporary intellectual assessment: Theories, tests, and issues (3rd edition). New York: Guilford. Flanagan, D. P., Alfonso, V. C., & Mascolo, J. T. (2011). A CHC-based Operational Definition of SLD: Integrating Multiple Data Sources and Multiple Data Gathering Methods. In Flanagan, D. P., & Alfonso, V. C. (Eds.), Essentials of Specific Learning Disability Identification. New York, NY: John Wiley & Sons.

What Do You RECOMMEND When You Only Have Progress Monitoring Data?

Student: Willie Age: 11 Grade: 3 Retained: 1st and 3rd grades 20 Pages of RTI Data 2 Pages of History/Background

Student: Willie; Course of Action: “Tier 1 and Tier 2 Student Who is on his way to Tier 3”
Grade RLI LNF ISF PSF NWF DORF MISC KG (05-06) S 19 AA Age 6 13 MR 18 iii 18 HR 14 MR 2 29 MR 4 HR 15 MR PPVT 85 1st (06-07) ii 43 LR 53 AA 28 LR Age 7 76 AA 25 HR 68 AA 40 MR 10 HR 92 Stanford-10 15% 1st (07-08) 39 LR 29 LR 6 MR Age 8 36 LR 42 MR 17 MR 30 MR 89 20% 2nd (08-09) 19 HR 21 HR Age 9 22 HR 36 HR 26 HR 46 HR 94 8%

Regardless of Treatment Protocol, You Must Stay at Learning Level Until Mastery

Automaticity Process of going from explicit to implicit memory
Efficient way of managing overwhelming amounts of information Implicit memory-laying down of skills and habits that, once learned, do not have to be consciously thought about – eating, talking, walking, reading Information on this slide was presented by Elaine Fletcher-Janzen at the 3rd annual assessment conference, Fordham University. New York, NY (May, 2011).

What Does it Look Like? Pathology
Labored reading Tires easily Faltering at math facts and subsequent math problems Does Willie demonstrate any of these characteristics? Wellness Quick reader with prosody Instant math facts Takes to new math problems consistently Information on this slide was presented by Elaine Fletcher-Janzen at the 3rd annual assessment conference, Fordham University. New York, NY (May, 2011).

What do we Do? Check to see if skill deficit is more of a lack of automaticity than ability This distinction is not clear based on the information provided for Willie Break down content and slowly build up to complex skills Move from one level to another after mastery is fluid and automatic Keep instruction simple and rote Stay at learning level until mastery Information on this slide was presented by Elaine Fletcher-Janzen at the 3rd annual assessment conference, Fordham University. New York, NY (May, 2011).

OPM – at benchmark for early 3rd grade
Did Willie Stay at Learning Level Until Mastery? Assessment Grade 3: Reading Comprehension FACT Success Probability Maze Word Analysis 1 2% 5% 2 23% 1% 3 4% 15% 22% OPM within and across grades often yield inconsistent results; difficult to interpret 3rd Grade OPM – at benchmark for early 3rd grade Date Oral Reading Fluency - WCPM 97 129 115 Average WCPM 113

Willie: Problem with RTI Data Presentation
RTI data not explained; not placed in context RTI data not explained within the context of classroom performance, standardized test performance, etc. RTI/data collection continued for too long…several years before considering SLD (other conditions) and special education eligibility

Example: Not Enough Data Reported from RTI
Alan; 3rd grade; repeated 1st grade; age 10 From Report: “Response to Intervention Data” “Alan has been receiving intensive Tier 3 interventions through the School-based Intervention Team since early Fall to address reading and communication concerns. Response to intervention data indicate that Alan has not shown adequate growth.” WHAT I DON’T KNOW When intervention began Type of intervention Who delivered intervention Attendance during intervention Integrity of intervention delivery Whether or not the intervention was matched to child’s instructional level Whether or not the intervention was selected based on student’s demonstrated deficits in academic areas (vs. standard treatment protocol)

Other Issues with RTI Data in Psych Reports
Progress monitoring data not reported/explained in psychological report Inconsistencies in progress monitoring data not explained Progress monitoring data not integrated with other data sources See case of Johnny

Progress Monitoring Results for Johnny
Letter Naming Fluency – one minute probe; KS score likely spurious due to unreliability of the measure (or some other factor); he knows his letters (see KTEA-II Letter-Word Identification) and has demonstrated that he can name them quickly

KTEA-II Letter & Word Recognition
Recognizes all letters Demonstrated in K that he can say the letters quickly KS LNF score is not indicative of true performance

Progress Monitoring Results
Letter Sound Fluency – OK Phoneme Segmentation Fluency – OK (segment 3 to 4 phoneme words into individual phonemes in one minute) Nonsense Word Fluency – perhaps a different evaluator (at KS and 1F). KS performance is unlikely because Johnny cannot read (see Nonsense Word Decoding on KTEA-II)

KTEA-II Nonsense Word Decoding performance is consistent with 1F NWF
Both performances call into question the KS NWF performance

Reading - CBM Assessed Johnny’s accuracy and speed of reading grade level text Was accuracy impacted by his articulation difficulties? He substitutes “d” for “g”, “w” for “l” (wov instead of love), “bw for bl”, “fw for fl”, “gw for gl” (gwass instead of glass), “pw for kl”, “pw for pi”, “sw for sl”, “f for th”, and “d for th”.

Johnny’s R-CBM is consistent with his performance on the KTEA-II Letter & Word Recognition Test

Ehri’s Phases of Word Reading
Pre-Alphabetic (e.g., when a child says “that says stop!” when they see a red octagonal traffic sign, but cannot read the word “stop” in isolation) Partial-Alphabetic Understand that there is a relationship between letters and sounds Rely on beginning and ending sounds so they continue to make errors in reading words (e.g., reading “bank” as “book” or “bake” or “belt”)

Ehri’s Phases of Word Reading
Fully Alphabetic Phase – students are able to sound out words successfully They know the sound-symbol connections and move from guessing a word from the first or last letter to complete word decoding sound by sound. (e.g., /b/ /a/ /n/ /k/) When they see the same word more than a few times, then that word becomes automatically recognized. As more and more words become “sight” words, students move into the consolidated alphabetic phase (e.g., /b/ /ank/) There is an assumption that Johnny is AT the fully alphabetic phase. He is not. Therefore, developing this phase of reading should be the immediate goal for reading intervention.

Summary of Classroom Observation
Johnny was observed in his first grade classroom by the Speech Language Pathologist During the observation, students were working in their journals independently and participating in Calendar Math, weather review, and a movement/music activity. Johnny had a hard time getting started on his writing assignment independently. When his teacher prompted him, he said he didn’t know what to write about.

Johnny “didn’t know what to write about”
Fan, dog, he, book Can Johnny work in his journal independently? Johnny doesn’t have the skills to write in a journal

Summary of Classroom Observation
The observer also prompted him by encouraging him to draw pictures about their upcoming field trip to a dairy farm and she gave him several examples of what he might draw. When she asked him what he was going to draw, he stated that he was going to draw a “monster truck” and “hot lava.” Johnny wrote several letters on his paper and began copying another student’s name from the wall. Summary of Classroom Observation

Johnny wants to Write But he Doesn’t Have the Skills
He is at this level “I Miss Home”

He is at the partial alphabetic stage and cannot write words or sentences… It is a good idea to ask the child what he/she wrote (random letters? Or does what he said he wrote make sense within the context of the tasks?

Recommendation in report: “Johnny should work on improving his reading accuracy and reading speed”

Teach Phonological Awareness – Move from Partial Alphabetic Phase to Fully Alphabetic Phase

Go To ReadingRockets.org

Build Sight Words Print Flash Cards
Go to: Print Flash Cards

Adapt Writing Assignments
Have Johnny tell you what he wants to write about Provide structure based on instructional level. For example, Johnny wants to write about monster trucks. __onster ___rucks are bi___. I have a re__ Monste__ Truc__. Task: Fill in missing letters. Re-write first sentence. This will keep Johnny busy during journal time with a journal activity that is at his instructional level.

Student: Willie; Course of Action: “Tier 1 and Tier 2 Student Who is on his way to Tier 3”
Subject 2006 2007 2008 2009 2010 2011 Kindergarten (age 6) 1st (age 7) 1st (Retained) 2nd (age 9) 3rd (age 10) (age 11) LangDevlp N F C D Reading Handwrtn Math B Science S Social Sts Art A Music Phys Ed FCAT Reading 20% 8% FCAT Math 17% 4%

A Major Inhibiting Factor to Learning and Achievement is Retention

Retention: Just the Facts
Academic achievement of kids who are retained is poorer than that of peers who are promoted. Achievement gains associated with retention fade within two to three years after the grade repeated. Kids who are identified as most behind are the ones "most likely harmed by retention." Retention often is associated with increased behavior problems. National Association of School Psychologists

Grade retention has a negative impact on all areas of a child's achievement (reading, math, and language) and socio-emotional adjustment (peer relationships, self-esteem, problem behaviors and attendance). Students who are retained are more likely to drop out of school compared to students who were never retained. In fact, grade retention is one of the most powerful predictors of high school dropout. National Association of School Psychologists

Retained students are more likely to have poorer educational and employment outcomes during late adolescence and early adulthood. Retention is more likely to have benign or positive impact when students are not simply held back, but receive specific remediation to address skill and/or behavioral problems and promote achievement and social skills. National Association of School Psychologists

Progress Monitoring and SLD Identification (slide adapted from Dan Miller)
Multiple Reading Interventions tried with Willie Willie Remains Moderate to High Risk After Several Years of Intervention PM data alone will lead to SLD by default What about other causal factors, such as: Other disabilities (e.g., intellectual disability) Cultural or language difference Psychological factors Poor treatment fidelity Inappropriate intervention based on child’s cognitive strengths and weaknesses Significant behavioral or social-emotional issues Progress Monitoring data alone do not answer the question of why the child is significantly behind same age and grade peers

Why Is the “Why” in Cases of Suspected SLD Important?
Differential diagnosis Psychological health of the student Expectations Treatment/Intervention

Information About Willie Collected via Parent Interview
FACILITATORS TO LEARNING INHIBITORS TO LEARNING He is praised, encouraged, and rewarded for good behavior at home He is violent/aggressive (rolls up and down hall when things do not go his way; cannot control his temper; tried to kill a puppy) Mother came to the school and asked for help. She reported that “nothing seems to be working.” Parent Unemployed; Food Stamps; Low SES; parents divorced Good attendance Not toilet trained (cannot control his bowels; has accidents); Encopresis Family history of Learning Disability (Grandmother, aunts, cousins, and sister have learning disabilities) Behavioral difficulties at home (parent cannot control his behavior; constantly fighting; lacks respect; curses at grandmother; fights with siblings) Poor peer relationships; always fighting Delayed Language (first words at age 2; first phrases in 1st grade) Serious family illness (Grandmother very sick and is bed bound) Parents have H.S. education or less (mother completed 11th grade; father graduated from H.S.) Has poor self-esteem

RTI-Only (progress monitoring only) approaches

Are We On The Right Track With RTI?
“Slow reading acquisition has cognitive, behavioral, and motivational consequences that slow the development of other cognitive skills and inhibit performance on many academic tasks. For example, knowledge bases that are in reciprocal relationships with reading are inhibited from further development. The longer this developmental sequence is allowed to continue, the more generalized the deficits will become, seeping into more and more areas of cognition and behavior. Or to put it more simply and sadly—in the words of a tearful 9-year-old, already falling frustratingly behind his peers in reading progress, ‘Reading affects everything you do.’ ” (p. 390) Stanovich, K. E. (1986). Matthew effects in reading: Some consequences of individual differences in the acquisition of literacy. Reading Research Quarterly, 21,

What We Know There are many approaches and methods that aid in understanding, identifying, and treating SLD RTI Ability-Achievement Discrepancy Third Method Approaches (“Pattern of Strengths and Weaknesses”) Demand Analysis/Process Approach - School Neuropsychololgy There is no litmus test; the more well-versed you are in different approaches and methods, the more information you will gain about the child (including how to best help him or her)

Third Method Approaches Multiple Methods/Multiple Data Sources for SLD Identification

ACADEMIC WEAKNESS/FAILURE COGNITIVE WEAKNESS/DEFICIT
Common Elements of “PSW Component” of Third Method Approaches to SLD Identification COGNITIVE STRENGTH/INTEGRITY Average or higher abilities and processes; May also include strengths in academic skills Statistically significant difference between cognitive integrities and academic skill deficit(s) Academic deficit(s) is unexpected, not expected, because overall cognitive ability is at least average Statistically significant difference between cognitive integrities and circumscribed cognitive ability or processing deficit(s) Cognitive deficit(s) is specific, not general or pervasive, because overall cognitive ability is at least average Discrepant/Discordant Discrepant/Discordant ACADEMIC WEAKNESS/FAILURE Academic Skills/Knowledge Deficits COGNITIVE WEAKNESS/DEFICIT Cognitive Ability or Processing Disorder Consistent/Concordant No Statistically significant Performance Difference (constructs are related empirically ) Sotelo, Flanagan, and Alfonso (2011). Overview of SLD Identification. In D. P. Flanagan & V. C. Alfonso, Essentials of Specific Learning Disability Identification. Hoboken, NJ: Wiley. Flanagan, Fiorello, and Ortiz (2010); Hale, Flanagan, and Naglieri (2008)

Better Title: On the RELEVANCE of Intelligence……
Fuchs and Young (2006). On the irrelevance of intelligence in predicting responsiveness to reading instruction, 73(1), pp Better Title: On the RELEVANCE of Intelligence……

“Historical Perspective” Slides from Nancy Mather

KABC-II and KTEA-II Data with WJ III as Supplement
Name:_____________________ Age: ____ Grade: ____ Examiner:____________________ Date: ___________ KABC-II and KTEA-II Data with WJ III as Supplement Grw Broad/Narrow Cluster Reading Composite( ) Sound Symbol ( ) Reading Fluency__(_ _) Pattern of empirically or logically related cognitive and academic deficits establishes basis for satisfying criterion of “below average aptitude-achievement consistency” Domain-Specific Ga Broad/Narrow Cluster Nonsense Wd Decod( ) Phonol. Awareness_( ) WJ III Auditory Atten.(___) Glr/Gs Broad/Narrow Cluster Assoc. Fluency_____(___) Naming Facility____(___) WJ III Gs Cluster__ (___) Historical Concept of Intra-Individual Discrepancies Glr-MA Broad/Narrow Cluster Rebus_____________(___) Atlantis_ __________(___) __________________(___) Gsm Broad/Narrow Cluster Word Order__ ( ) Number Recall_ ( ) WJ III Working Mem. (__) Pattern of generally average cognitive abilities and processes establishes basis for satisfying criterion of “an otherwise normal ability profile” Unexpected Underachievement Gf Broad/Narrow Cluster Story Comp.__ ( ) Pattern Reasoning ( _) _______________ ( ) Gv Broad/Narrow Cluster Rover _ __( ) Triangles_______ ( ) _______________( ) Gc Broad/Narrow Cluster Expressive Vocab. ( ) Verbal Knowledge ( ) _______________( )

Is “Otherwise Average Overall Ability” Consistent with the SLD Construct?

“Historical Perspective” Slides from Nancy Mather

How Do You Determine an “Otherwise Normal Ability Profile” or Otherwise Average Ability
Clinical Judgment SLD Assistant (Flanagan, Ortiz & Alfonso, 2007) Instruments on which deficit areas do not contribute to g estimate (e.g., GAI from WISC-IV) GAI (average or better) > WMI and PSI in SLD (Prifitera, Soklofske, & Weiss, 2005) Pattern suggests Specific LD in Math (Geary et al., 2011) Academic areas not related to referral Math achievement (average or better) > reading achievement Informal observations and assessments, teacher report CONVERGENCE OF INDICATORS

CD Included with Essentials of Cross-Battery Assessment, 2nd Edition (Flanagan, Ortiz, & Alfonso, 2007)

Is performance in Broad Area WNL or Higher?
Bill Gc = 86 Glr = 80 Gv = 100 Ga = 78 Gf = 88 Gs = 87 Gsm = 79 Bob Gc = 109 Glr = 83 Gv = 100 Ga = 78 Gf = 112 Gs = 98 Gsm = 82 g value =

Is performance in Broad Area Average (> 90) or Better?
Bill Gc = 86 Glr = 80 Gv = 100 Ga = 78 Gf = 88 Gs = 87 Gsm = 79 Bob Gc = 109 Glr = 83 Gv = 100 Ga = 78 Gf = 112 Gs = 98 Gsm = 82 g value = g value =

Broad CHC Abilities and SLD Assistant
g values close to 1 (e.g., .97, .98, .99) or higher Suggest that deficient areas are likely to be domain-specific or circumscribed (vertical) Deficient areas may be amenable to remediation, depending on the developmental level of the student Deficient areas may be readily accommodated or compensated The greater the g value deviates from 1 in the negative direction, the more likely it is that the student’s learning and achievement will be constrained by ability deficits Low average functioning in many cognitive and academic areas – general learning difficulty (horizontal), not SLD Intellectual Disability Differential diagnosis requires consideration of data from multiple methods and sources

GENERAL Learning Difficulty DOMAIN-GENERAL EXPECTED Underachievement
Name:_____________________ Age: ____ Grade: ____ Examiner:____________________ Date: ___________ KABC-II and KTEA-II Data with WJ III as Supplement Grw Broad/Narrow Cluster Reading Composite( ) Sound Symbol ( ) Reading Fluency__(_ _) Ga Broad/Narrow Cluster Nonsense Wd Decod( ) Phonol. Awareness_( ) WJ III Auditory Atten.(___) Glr/Gs Broad/Narrow Cluster Assoc. Fluency_____(___) Naming Facility____(___) WJ III Gs Cluster__ (___) GENERAL Learning Difficulty DOMAIN-GENERAL EXPECTED Underachievement (aka “Slow Learner”) Glr-MA Broad/Narrow Cluster Rebus_____________(___) Atlantis_ __________(___) __________________(___) Gsm Broad/Narrow Cluster Word Order__ ( ) Number Recall_ ( ) WJ III Working Mem. (__) Gf Broad/Narrow Cluster Story Comp.__ ( ) Pattern Reasoning ( _) _______________ ( ) Gv Broad/Narrow Cluster Rover _ __( ) Triangles_______ ( ) _______________( ) Gc Broad/Narrow Cluster Expressive Vocab. ( ) Verbal Knowledge ( ) _______________( )

Differential Diagnosis is important

A diagnosis identifies the nature of a specific learning disability and has implications for its probably etiology, instructional requirements, and prognosis. Ironically, in an era when educational practitioners are encouraged to use evidence-based instructional practices, they are not encouraged to use evidence-based differential diagnoses of specific learning disabilities. Virginia Berninger (2010)

On the Flanagan et al. and Kavale and Forness Operational Definitions of SLD…
These operational definitions provide an inherently practical method for SLD identification that carries the potential for increased agreement about the validity of SLD classification Kavale, Holdnack, & Mostert (2005, p. 12)

The Importance of Assessing Cognitive Abilities and Processes and Academic Skills…
By identifying specific targets for remediation, the possibilities for truly individualized intervention are increased significantly. Kavale, Holdnack, & Mostert (2005, p. 12)

The Value of Assessing Cognitive Abilities and Processes…
Even if a student never enters the special education system, the general education teacher, the student’s parents, and the student him- or herself would receive valuable information regarding why there was such a struggle in acquiring academic content, to the point of possibly needing special education Kavale, Holdnack, & Mostert (2005, p. 12)

Conclusions

Correspondence Between Diagnosis and Treatment
as syndromes/disorders become more discretely defined, there may be a greater correspondence between diagnoses and treatment Kratochwill and McGivern's (1996; p. 351)

Subtypes of Reading Disability
Dysphonetic Dyslexia – difficulty sounding out words in a phonological manner Surface Dyslexia – difficulty with the rapid and automatic recognition of words in print Mixed Dyslexia – multiple reading deficits characterized by impaired phonological and orthographic processing skills. It is probably the most severe form of dyslexia. Comprehension Deficits – the mechanical side of reading is fine but difficulty persists deriving meaning from print (Ga-Phonetic Coding; Gsm-Memory Span, Working Memory) (Glr-Naming Facility; Gv-Orthographic Processing; Gs-Perceptual Speed; Gc-Vocabulary Knowledge) (Multiple CHC abilities or processes involved; attention and executive functioning) (Gf-Induction, General Sequential Reasoning; Gc- Language Development; attention and executive functioning) Feifer, S. (2011). How SLD Manifests in Reading Achievement. In Flanagan & Alfonso (Eds), Essentials of Specific Learning Disability Identification. Hoboken, NJ: Wiley.

Predicting the 4 Subtypes of Reading Disability
Gf Gc Gv Ga Gsm Glr Gs etc Criterion DVs Dysphonetic Dyslexia PC MW Surface Dyslexia VL VM NA OrthP Mixed Dyslexia VL VM PC MW NA OrthP Comprehension Deficits I,RG LD,MY VM MW EF, AC = most likely a strong predictor = most likely a moderate predictor = most likely non-significant Note: four subtypes from Feifer (2011); identification of IVs from Flanagan; Figure adapted from McGrew (2010)

Correspondence Between Diagnosis and Treatment
as syndromes/disorders become more discretely defined, there may be a greater correspondence between diagnoses and treatment Kratochwill and McGivern's (1996; p. 351)

Measures and Processes involved suggested by Flanagan

Includes contributions by many school neuropsychologists: Dan Miller, Brad Hale, Scott Decker, Cecil Reynolds, Cynthia Riccio, and more Nudging the Field….

Flanagad@stjohns.edu SLDidentification.com Crossbattery.com

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