NEUROPSYCHOLOGICAL EVALUATION FOR DEVELOPMENTAL DYSLEXIA AND ADHD (ADD)         (cost $2030) (procedure codes 96132, 96133, 96136, 96137 ) This   is   for   the   purpose   of   determining   whether   a   child   or   adult   has   the   reading   problem   that   meets   the   criteria   to   receive   a formal   diagnosis   of   a   Reading   Disorder   (developmental   dyslexia   )   and   attention   deficit   disorder   (   ADD   or   ADHD   ).   It   involves   an assessment   of   overall   cognitive   functioning,   tests   of   attention,   questionnaires,   rating   scales   and   reading   tests.   A   formal diagnosis   is   necessary   if   you   are   seeking   insurance   reimbursement   or   are   trying   to   obtain   special   accommodations   under   the American   with   Disabilities   Act   in   school,   for   standardized   testing   or   for   employment   purposes.   This   evaluation   results   in   an integrated written report. Problems with IQ Testing: Traditionally,   the   principal   method   of   diagnosing   learning   disabilities,   such   as   dyslexia,   has   been   to   compare   measured intelligence   and   achievement   level   such   as   reading.   It   is   expected   that   the   reading   score   for   instance,   will   be   significantly   below the   IQ   score   if   dyslexia   is   present.   Other   factors   are   also   considered,   but   he   center   piece   to   diagnosis   is   this   discrepancy   in scores. However, there are serious problems with this approach that are frequently not considered in a diagnostic evaluation. First,   the   concept   of   intelligence   being   a   single   ability   accurately   represented   by   a   single   score   such   as   IQ   has   been   seriously challenged   by   research.   The   overall   functioning   that   is   represented   by   IQ   is   actually   the   result   of   at   least   four,   (and   possibly more)   separate   cognitive   abilities.   The   are   most   commonly   identified   as   verbal   reasoning,   nonverbal   reasoning,   working memory   and   processing   speed.   When   these   are   all   functioning   at   the   same   level,   then   a   single   score   such   as   the   IQ   can   be regarded   as   validly   representing   a   person's   intelligence.   However,   It   is   not   uncommon   for   people   with   learning   disabilities   to have   very   uneven   functioning   in   these   four   areas,   perhaps   ranging   from   very   low   to   very   high.   Consequently,   a   child   or   adult's reasoning   and   learning   abilities   may   be   much   higher   than   what   is   reflected   in   the   IQ   score.   Unfortunately,   it   is   the   lower   IQ score   that   is   often   used   in   calculating   the   discrepancy   between   ability   and   achievement   such   as   reading   resulting   in   a discrepancy   that   is   deemed   within   normal   limits.   Consequently,   the   learning   disability   that   is   actually   present   is   not   detected. Failing to detect a problem that is actually present is called a false negative. There   are   additional   consequences   in   not   properly   interpreting   intelligence   tests.   Working   memory   and   processing   speed   are considered   aspects   of   attention   and   are   closely   associated   with   some   type   of   attention   deficit   disorder.   Impairments   in   these areas   strongly   suggests   that   an   evaluation   for   ADHD   or   ADD   is   in   order.   Relying   on   the   traditional   IQ   score   may   mask   actual impairments   and   result   in   failure   to   detect   a   problem,   when   in   fact   a   problem   is   present.   Again   a   false   negative.   This   can   also result   in   serious   under   measurement   of   actual   ability   or   potential.   Unfortunately   many   psychologists   are   only   trained   to   use   the traditional IQ score and ignore indications that a traditional IQ score is invalid. Problems with Testing Reading: Automaticity   is   acquired   in   the   latter   stage   of   reading   acquisition   when   decoding   of   words   is   automatic   and   therefore   rapid, which   allows   more   mental   resources   to   be   directed   to   the   task   of   reading   comprehension.   Automaticity   is   necessary   for practical   reading   typical   non-dyslexic   readers.   However,   the   extra   steps   and   mental   effort   the   dyslexic   reader   must   use   to perform   basic   decoding   continues   to   reflect   the   ongoing   interference   that   their   dyslexia   has   with   practical   reading.   Most reading   tests   that   are   used   to   evaluate   for   dyslexia   are   untimed   and   do   not   require   Automaticity   of   decoding   and   will   often   fail to   detect   the   presence   of   dyslexia   in   a   person   who   has   had   substantial   remediation.   People   with   dyslexia   who   have   had substantial   amount   of   remedial   reading   instruction   can   often   perform   well   on   these   untimed   tests.   Consequently,   it   is   important to   administer   reading   tests   that   require   Automaticity   of   decoding   for   the   evaluation   to   have   a   reasonable   chance   of   detecting dyslexia.   Unfortunately,   such   tests   are   often   not   included   in   an   evaluation,   which   may   result   in   a   false   negative   diagnostic conclusion. Problems with ADHD or ADD testing: There   is   considerable   controversy   at   the   present   time   over   what   are   the   core   symptoms   of   ADHD   or   ADD.   ADD,   which   is   ADHD, Predominantly   Inattentive   Type,   is   particularly   difficult   to   diagnose   because   hyperactivity   or   impulsiveness   are   not   the   primary symptoms.   People   with   ADD   are   not   disruptive   and   are   often   well   behaved   in   classrooms.   Their   symptoms   involve   internal, silent   problems   of   mental   processing   of   information   that   results   in   poor   academic   performance.   Because   their   symptoms   are not   readily   noticed   by   observers,   their   condition   often   goes   undetected   despite   the   suspicion   that   something   is   just   not   right. Because   of   the   controversy   regarding   the   core   symptoms   and   the   difficulty   detecting   symptoms   evaluations   often   result   in   false negatives   when   in   fact   there   is   a   problem.   Evaluations   require   a   care   review   of   all   tests,   history,   grade   reports,   teacher   reports and parent reports.
© Robert D. Smith, PhD
Robert D. Smith, PhD Diagnosis & Treatment for Dyslexia, ADD & Learning Disorders IQ Optimization Children & Adults