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Components of Comprehensive Dyslexia Testing: Part I- Introduction and Language Testing

Image result for dyslexia lawsWith the passing of dyslexia laws in the state of New Jersey in 2014, there has been an increased focus on reading disabilities and dyslexia particularly in the area of effective assessment and remediation. More and more parents and health related professionals are looking to understand the components of effective dyslexia testing and who is qualified to perform it. So I decided to write a multi-part series regarding the components of comprehensive dyslexia testing in order to assist parents and professionals to better understand the steps of the testing process.

In this particular post I would like to accomplish two things: dispel several common myths regarding dyslexia testing as well as discuss the first step of SLP based testing which is a language assessment.

Myth 1: Dyslexia can be diagnosed based on a single test!

DYSLEXIA CANNOT BE CONFIRMED BY THE ADMINISTRATION OF ONE SPECIFIC TEST. A comprehensive battery of tests from multiple professionals including neuropsychologists, psychologists, learning specialists, speech-language pathologists and even occupational therapists needs to actually be administered in order to confirm the presence of reading based disabilities.

Myth 2: A doctor can diagnose dyslexia!

A doctor does not have adequate training to diagnose learning disabilities, the same way as a doctor cannot diagnose speech and language problems. Both lie squarely outside of their scope of practice! A doctor can listen to parental concerns and suggest an appropriate plan of action (recommend relevant assessments)  but they couldn’t possibly diagnose dyslexia which is made on the basis of team assessments.

Myth 3: Speech Pathologists cannot perform dyslexia testing!

SPEECH-LANGUAGE PATHOLOGISTS TRAINED IN IDENTIFICATION OF READING AND WRITING DISORDERS ARE FULLY QUALIFIED TO PERFORM SIGNIFICANT PORTIONS OF DYSLEXIA BATTERY.

So what are the dyslexia battery components?

Prior to initiating an actual face to face assessment with the child, we need to take down a thorough case history (example HERE) in order to determine any pre-existing risk factors. Dyslexia risk factors may include (but are not limited to):

  • History of language and learning difficulties in the family
  • History of language delay (impaired memory,  attention, grammar, syntax, sentence repetition ability, etc) as well as
  • History of impaired phonological awareness skills (difficulty remembering children’s songs, recognizing and making rhymes, confusing words that sound alike,  etc).

After that, we need to perform language testing to determine whether the child presents with any deficits in that area. Please note that while children with language impairments are at significant risk for dyslexia not all children with dyslexia present with language impairments. In other words, the child may be cleared by language testing but still present with significant reading disability, which is why comprehensive language testing is only the first step in the dyslexia assessment battery.

Image result for language testingLANGUAGE TESTING

Here we are looking to assess the child’s listening comprehension. processing skills, and verbal expression in the form of conversational and narrative competencies. Oral language is the prerequisite to reading and writing.   So a single vocabulary test, a grammar completion task, or even a sentence formulation activity is simply not going to count as a part of a comprehensive assessment.

In children without obvious linguistic deficits such as limited vocabulary, difficulty following directions, or grammatical/syntactic errors (which of course you’ll need to test) I like to use the following tasks, which are sensitive to language impairment:

Listening Comprehension (with a verbal response component)

  • Here it is important to assess the student’s ability to listen to short passages and answer a variety of story related questions vs. passively point at 1 of 4 pictures depicting a particular sentence structure (e.g., Point to the picture which shows: “The duck was following the girl”). I personally like to use the Listening Comprehension Tests for this task but any number of subtests from other tests have similar components.

Semantic Flexibility

  • Here it is important to assess the student’s vocabulary ability via manipulation of words to create synonyms, antonyms, multiple meaning words, definitions, etc. For this task I like to use the WORD Tests (3-Elementary and 2-Adolescent).

Narrative Production:

  • A hugely important part of a language assessment is an informal spontaneously produced narrative sample, which summarizes a book or a movie.  Just one few minute narrative sample can yield information on the following:
  • Sequencing Ability
  • Working MemoryRelated image
  • Grammar
  • Vocabulary
  • Pragmatics and perspective taking
  • Story grammar (Stein & Glenn, 1979)

Usually I don’t like to use any standardized testing for assessment of this skill but use the parameters from the materials I created myself based on existing narrative research (click HERE).

Social Pragmatic Language

  • Given my line of work (school in an outpatient psychiatric setting), no testing is complete without some for of social pragmatic language assessment in order to determine whether the student presents with hidden social skill deficits. It is important to note that I’ve seen time and time again students acing the general language testing only to bomb on the social pragmatic tasks which is why this should be a mandatory part of every language test in my eyes. Here, a variety of choices exists. For quick results I typically tends to use the Social Language Development Tests as well as portions of the Social Thinking Dynamic Assessment Protocol®.

Not sure what type of linguistic deficits your student is displaying? Grab a relevant checklist and ask the student’s teacher and parent fill it out (click HERE to see types of available checklists)

So there you have it! The first installment on comprehensive dyslexia testing is complete.

READ part II which discusses components of Phonological Awareness and Word Fluency testing HERE

Read part III of this series which discusses components of Reading Fluency and Reading Comprehension testing HERE.

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Review: Kindergarten Language Benchmark Assessment (KLBA)

Recently I had an opportunity to use the Kindergarten Language Benchmark Assessment published by Speech Language Literacy Lab with a classroom of kindergarten students 5-6 years of age.  The KLBA is the screening and progress monitoring tool which tracks the development of appropriate early language skills and helps support the RTI model.

KLBA+test

This tool is comprised of four sections: auditory comprehension, following directions, categories and  narrative language, which are correlated to future reading success and academic competence. It is intended for monolingual and bilingual kindergarten children 5 to 6 years of age. It yields a raw score for each skill area and requires a very short administration time (around 5-7 minutes) .

The kit was created by Naomi R. Konikoff, MS, CCC-SLP and Jennifer Preschern, MA, CCC-SLP. It includes an administration manual, testing book, and 25 protocols.  Each protocol allows for 3 administrations (Winter, Spring, Fall) to monitor language growth in kindergarten students over a period of a school year.

Subtest description:

Auditory Comprehension subtest assesses the students’ ability to respond to -wh-questions based on short stories 3-4 sentences in length

Following Directions subtest assesses the students’ ability to follow 1-2 step directions.

Categories subtest assesses the student’s ability to receptively identify the similarities between 2 out of 3 presented items and then coherently verbalize their connection

Narrative Language subtest assesses the students’s ability to produce simple stories in order to determine their use of relevant story grammar elements.

KLBA 1

While there are a number of uses for this tool (RTI, to reduce over-identification of Limited English Proficiency students, evaluation of effectiveness of early language instruction, etc.),  since I’ve had it for a fairly limited time I used it as a screening instrument in order to determine whether a full comprehensive language testing was needed for the kindergarten children who were currently not mandated language services.

To confirm its reliability I also used it with children with known language impairment on my caseload, to determine how sensitive it was to detecting already existing language impairments.

The KLBA had indeed proven to be a reliable screening tool with the children I had tested. It cleared the children with typically developing language abilities (as per teachers reports and personal observations). In contrast when used with language impaired students on my caseload, KLBA had reliably identified their areas of weaknesses.  Children with language impairments were able to do quite well on several KLBA subtests due to the fact that they had already been receiving language therapy services. However, they invariably did poorly on the following subtests: expressive categorization and narrative production, which research has identified as being most sensitive to language impairment.

KLBA 2

Given the research behind the KLBA I find it to be another useful tool in my material repertoire. For more information on KLBA check out Speech Language Literacy LabTo purchase KLBA from their site click HERE.