Inside an Evaluation for Learning Disorders

When a child is struggling in school, the first step to finding help is figuring out what’s getting in his way. As a starting point, you need an evaluation of your child’s learning profile, to identify strengths and weaknesses, and suggest what kind of support he might need to thrive. But the process of getting a child evaluated can be daunting. How do these evaluations work? Who does them? And what kind of information can you get from them?

To help parents understand the process, Matthew Cruger, PhD, the senior director of the Learning and Development Center at the Child Mind Institute, teamed up with Understood.org to walk us through the process. In this video he shares clips from a real evaluation, and explains what’s going on at each step.

In a follow-up webinar, Dr. Cruger answers questions from parents. (Check out video of the webinar at the end of this article.)

They’re typically referred because parents, the child themselves or the teacher have concerns that the student’s not performing at a level that they think they should or could be performing, based on their intellectual capacity.

The people who do the evaluations can vary. They might be a learning specialist, an educational therapist, or a speech and language therapist. But often a psychologist is involved, because psychologists are also trained to measure intellectual capacity and think carefully about emotional difficulties that might also interfere with classroom adjustment.

Many children who have learning issues also have other conditions like anxiety, they can feel demoralized, or even be experiencing childhood depression, which leads them to have trouble managing academic demands. A neuropsychologist may also be involved in an evaluation, which is typically helpful in elucidating how aspects of cognitive functioning, like attention or executive functioning, are affecting classroom learning.

We start by gathering data from a family about early developmental issues, what they have seen in their child’s adjustment to school, how well the child is doing and where the child seems to be struggling. We also gather information from observing the child in the classroom and seeing how the child struggles to meet classroom expectations. Then we use standardized tests and measures to evaluate how a child is performing in the areas of reading capacity, of reading work and in terms of mathematics, skillsets and capacity.

Sometimes, we are able to do an evaluation that includes intellectual functioning, academic functioning and some aspects of emotional functioning in about three hours, to give us a good handle on how a student is performing. But if we have concerns about speech and language, and we want to do additional tests to look at those skillsets, or if we do neuropsychological evaluations like the ones that I complete, sometimes we’re spending six to nine hours, over several sessions.

Some children have meaningful weaknesses in learning but do not seem to have intellectual limitations or specific academic weaknesses. Those could be related to attention, memory, abstract thinking, or social cognition. These kids typically benefit from a neuropsychological evaluation. In addition, a neuropsychological evaluation may be required for those children who perform adequately on an evaluation provide by the school district, but the teachers or parents feel certain that some other cognitive problem is limiting them.

Yes, because if kids are fatigued or worn out, we’re actually not measuring their capacity or abilities. Most kids who are six years and older can sit for an evaluation for about three hours with a good break in the middle. Some children under six perform better in two-hour spurts of time and some children can’t manage it for that long. Teenagers can sometimes perform for a longer period of time — four or five hours is not unusual. But we keep in mind that teenagers do better in the afternoon. Children do better in the morning. And we try to avoid after school hours or when children are stressed because of their schedule.

Duration can matter but in the time I’m seeing the kids, they’re taking a lot of different tests. I try to pace the tests so they are not fatigued. And all the tests tend to be very short, from a couple of minutes to 15 minutes. So I tell kids that if they don’t like a test, it will be over very quickly. And if one test is not very appealing to them, I do something that is more interesting next.

Kids like to use their brains to solve problems and to handle challenges. They like to show that they’re learning. So most get something enjoyable out of the experience. But kids who have struggled in school often already know that they’re not performing as well as their friends. So they may get demoralized by a test. When that happens we need to give them some positive feedback. Sometimes we tell them quite honestly, “Yes, that was hard for you, but I’m going to try to figure out how to make it be easier for you.”

There are many kinds of learning, but the kinds we look at to diagnose a learning disability tend to be reading capacity, writing capacity and mathematics. I’m looking for differences in their ability to perform on either of the mechanical tests or applied tests compared to their intellectual capacity.

The vast majority of students I see when we’re evaluating for learning disabilities struggle with reading. For reading, the mechanical skills are being able to recognize words by sight, being able to sound out words that are unfamiliar to you, being able to read words in sentences and then being able to derive meaning from what you’ve read. That’s the process of developing from decoding to fluency and eventually comprehension, really understanding them.

With mathematics, I want to look at their basic math fact knowledge and how quickly they can apply math facts. I want to see what computation skills they have, like solving paper and pencil math tests. Then I want to see how they answer functional word problems.

The role of a school district is trying to help identify kids who have learning needs. If they do an evaluation, it’s not to make a formal diagnosis, but to see if a child is eligible for specialized educational support. So they might classify a child into the category of a learning disability, but not be any more specific.

The kinds of intervention that might help a child with ADHD at school aren’t necessarily academic support. And medication might be recommended, which is a family’s decision to make with a medical professional.

One of the best ways to find out about good evaluators is through talking to other parents. If someone else has gone through the experience and they trust an evaluator, that’s a meaningful sign. Did their child feel comfortable after having done all the tests? Did they feel the evaluator was thorough and thoughtful in how the evaluation was done? Sometimes clinicians will give out examples of reports that they’ve written that are deidentified so that the family can see what they are going to get from the process and know what experience the child is going to have.

If you don’t have word-of-mouth recommendations, you want to make sure that this is something that the person has been doing for some time and that they have a high level of training. Not every therapist does evaluations. In fact, most either do testing or they do treatment. So you want to make sure that the person’s had enough experience to be credible. A great therapist might not be a very strong evaluator.

Watch the whole webinar below: