Who Diagnoses Dyslexia? Understanding the Evaluation Process

When a child struggles with reading, the question of dyslexia often arises. Many suggest “testing” for dyslexia, but a more accurate term for this process is an evaluation. This comprehensive evaluation is not just a simple test but involves identification, screening, testing, diagnosis, and gathering information collaboratively by the student, family, and a team of professionals. The goal is to understand the root of the learning difficulty and determine the best course of action.

Why is a Dyslexia Evaluation Crucial?

An evaluation is fundamental in understanding why a student is facing challenges in reading and spelling. It’s a process of collecting detailed information to pinpoint the contributing factors. Initially, insights are gathered from parents and educators to understand the child’s developmental history and educational background. Following this, specific tests are administered to identify strengths and weaknesses. This analysis leads to a diagnosis and sets the stage for a tailored intervention plan. Ultimately, the evaluation culminates in conclusions and actionable recommendations.

There are three key reasons why a dyslexia evaluation is essential when a student exhibits difficulties in reading and spelling:

Accurate Diagnosis: A thorough evaluation is designed to pinpoint the source of the reading problem. It differentiates dyslexia from other potential causes of reading difficulties and confirms if the student’s cognitive profile aligns with the characteristics of dyslexia.
Targeted Intervention Planning: A well-conducted evaluation paves the way for creating a focused and effective remedial program. Students diagnosed with dyslexia require specialized reading instruction to achieve meaningful progress. Crucially, this instruction should be tailored to the student’s current reading skill level, not just their grade level. An effective evaluation helps educators and parents identify specific skill deficits and determine the optimal starting point for reading and spelling intervention.
Formal Documentation: An evaluation serves as formal documentation of a student’s learning disability history. This documentation is vital for accessing special services, including special education support. Furthermore, it is often necessary for obtaining accommodations for standardized tests like the ACT and SAT, as well as for college and workplace accommodations.

When Should a Child Be Evaluated for Dyslexia?

Early identification is key. Reading difficulties can be detected in young children even before they lead to significant reading failure. Screening tests, such as the Predictive Assessment of Reading (PAR), Dynamic Indicators of Basic Early Literacy Skills (DIBELS), Texas Primary Reading Inventory (TPRI), and AIMSweb, are designed for early detection. These tools should be used universally in schools, starting in kindergarten, to identify students at risk of reading difficulties. If dyslexia is suspected, preventative intervention should begin immediately. The child’s response to this early support will provide valuable information to determine if more intensive special education services are necessary.

Before second grade, evaluations should focus on the foundational skills for reading. Language skills, phonological awareness, memory, and rapid naming are more indicative of dyslexia risk in younger children than reading, decoding, and spelling skills. Therefore, assessments in kindergarten and early first grade often include measures of phonological awareness, memory, and rapid naming to identify children who need targeted intervention to develop these essential pre-reading skills and meet grade-level expectations. While various tests can be used early to assess emerging reading and spelling skills, the benchmarks for “average” achievement at this stage are relatively low. A kindergarten or early first-grade student might only need to recognize a few letters and common words to score within the average range. Consequently, students with dyslexia might not initially appear to be significantly behind their peers. Moreover, even if low achievement is observed, it doesn’t explain why the child is not learning as expected, highlighting the need for a comprehensive evaluation.

By January or February of first grade, assessments of early word reading, decoding, and spelling become more informative in understanding a student’s acquired knowledge and learning gaps. This information is crucial for instructional planning and ongoing assessment.

What Components are Included in a Dyslexia Evaluation?

A comprehensive dyslexia evaluation considers several key areas to provide a complete picture of the student’s learning profile.

Background Information: Gathering information from parents and teachers is crucial to understand a student’s overall development and identify patterns of strengths and weaknesses. Dyslexia has a genetic component, so a family history of dyslexia increases the likelihood of a student having it. A history of speech or language delays is also a risk factor for reading difficulties. It’s important to document any previous interventions the student has received at school, home, or through tutoring, and their response to these interventions. School attendance history should also be considered, as poor attendance alone can explain skill development weaknesses.

Intelligence: Historically, IQ testing was a central part of learning disability evaluations, focusing on the discrepancy between IQ and reading skills. The idea was that poor reading despite average or above-average intelligence was a key indicator. However, current regulations no longer require this discrepancy for diagnosis. Research has shown that oral language skills are stronger predictors of reading and spelling development than general intelligence.

While formal IQ testing isn’t always necessary, demonstrating average intellectual ability is important. For younger children, parental reports of language development and teacher observations of oral learning ability can indicate average intelligence. For older students or adults, academic or professional history might suffice.

Oral Language Skills: Oral language encompasses the ability to understand spoken language and express thoughts verbally. It includes basic skills like sound recognition and higher-level skills like comprehension and expressive language. Students with dyslexia typically have strong higher-level oral language skills. They can generally understand age-appropriate stories and directions, participate in conversations, and use age-appropriate vocabulary. If a student demonstrates strong higher-level oral language skills but struggles significantly with written language (reading and spelling), a dyslexia evaluation is strongly recommended.

Although higher-level oral language skills are usually a strength, students with dyslexia often have deficits in lower-level phonological skills (discussed below). This phonological deficit hinders their ability to learn to read and spell by connecting sounds to letters. While young children with dyslexia might have experienced early language delays, their higher-level language skills usually catch up by school age. Difficulties with higher-level language skills might indicate a language impairment requiring evaluation by a speech-language pathologist.

Word Recognition: Word recognition, or word reading, is the ability to read individual printed words in isolation. Tests assess this by having students read words from a list, removing context clues. Assessments that measure both accuracy and reading speed (fluency) are particularly valuable. Students with dyslexia often achieve accuracy in word reading but remain slow. Both accuracy and speed impact reading comprehension.

Decoding: Decoding is the skill of reading unfamiliar words by applying letter-sound knowledge, recognizing spelling patterns, and breaking words into smaller parts like syllables. Decoding tests often use nonsense words (e.g., frut, crin) to ensure students rely on decoding skills rather than memorized words.

Spelling: Spelling tests evaluate the ability to spell words from memory, utilizing knowledge of letter-sound relationships, spelling patterns (like igh or oa), and rules like pluralization. Spelling is essentially the reverse of decoding but often more challenging. It requires segmenting spoken words into individual sounds, recalling spelling options for each sound, selecting the correct spelling, and writing the letters in sequence. Spelling heavily relies on both short-term and long-term memory and can be further complicated by handwriting difficulties. Spelling is frequently the most significant weakness for individuals with dyslexia and often the most challenging to remediate.

Phonological Processing: Phonology is a specific aspect of language related to the sound system. It involves the sounds of language – words, syllables, and individual phonemes – without considering meaning. Efficient reading and spelling require the ability to process, remember, and sequence sounds within words to connect letters and sounds. Proficient readers do this automatically. However, individuals with dyslexia struggle with identifying, pronouncing, or recalling sounds. Phonological processing tests specifically assess these skills.

Automaticity/Fluency Skills: Individuals with dyslexia often exhibit slower processing speeds for both visual and auditory information. Naming Speed, also known as Rapid Automatic Naming (RAN), tasks are used to measure this. These tasks involve rapidly naming sets of objects, colors, letters, or numbers presented in rows. Letter naming speed is a strong early predictor of reading difficulties and is often included in screening for young children. Slow naming speed contributes to reading fluency problems and difficulties with timed tests. A “double deficit” refers to the co-occurrence of both slow naming speed and phonological processing deficits, leading to more severe reading challenges.

Reading Comprehension: Typically, students with dyslexia score lower on reading comprehension tests compared to listening comprehension tests due to their difficulties with decoding and fluent word reading. However, it’s important to recognize that their strong higher-level oral language skills can enable them to grasp the main idea of a passage despite word-level challenges. Furthermore, reading comprehension tests often use short passages that students can refer back to, which can inflate scores. Therefore, students with dyslexia might achieve average scores on standardized reading comprehension tests yet still struggle significantly with the volume and complexity of reading required in grade-level textbooks.

Vocabulary Knowledge: Assessing vocabulary is crucial because vocabulary significantly impacts both listening and reading comprehension. Difficulties with early language acquisition or memory can affect vocabulary development in individuals with dyslexia. Independent reading is a vital way to expand vocabulary, and poor readers tend to read less, potentially leading to vocabulary delays. However, it’s important to note that decoding difficulties can cause students with dyslexia to score poorly on reading vocabulary tests, even if they understand the word meanings. Therefore, administering both reading and listening vocabulary assessments provides a more accurate measure of vocabulary knowledge.

The specific profile of strengths and weaknesses in dyslexia varies based on age, educational opportunities, and other factors like emotional adjustment, attention, health, and motivation. However, certain patterns are frequently observed across different age groups.

Family History and Early Development:

Reported reading/spelling difficulties across family generations.
Typical prenatal and birth history.
Speech/language acquisition delays or difficulties.

Early Childhood/Primary Grades:

Difficulty with rhyming, sound blending, alphabet learning, and letter-sound connections.
Challenges learning spelling rules – spelling words phonetically (e.g., lik for like), using letter names for sounds (e.g., lafunt for elephant).
Difficulty memorizing high-frequency “sight words” (e.g., the, of, said).
Listening comprehension often surpasses reading comprehension.

Middle and Secondary School:

Reluctance towards reading.
Slow, word-by-word reading; significant difficulty with word lists, nonsense words, and unfamiliar vocabulary.
Severe spelling weaknesses – misrepresenting sounds, omitting or adding sounds or letters/syllables.
Non-fluent writing – slow, poor quality and quantity.
Occasional mispronunciation of common words (e.g., floormat for format); difficulty with complex grammar in speech.
Listening comprehension usually stronger than timed reading comprehension.
Weaker vocabulary knowledge and usage.

Outcomes of a Dyslexia Evaluation

A dyslexia evaluation should culminate in a comprehensive written report. This report should detail the information gathered, including family literacy history, medical history, developmental milestones, and educational background. It should include a record of administered tests and their standard scores, which compare the student’s performance to peers of the same age or grade. This information forms the basis for a detailed analysis of strengths and weaknesses across assessed skill areas, aligning with the typical dyslexia profile for the student’s age. This analysis leads to a tentative diagnosis, indicating whether or not the student’s reading, writing, and spelling difficulties are likely related to dyslexia. The report must clearly explain the specific evidence supporting the diagnosis.

Diagnosis: Who is Qualified to Diagnose Dyslexia?

The diagnosis of dyslexia is a team effort, involving information from interviews, observations, and testing. The team typically includes:

Classroom Teachers: Provide valuable insights into the student’s classroom performance and learning behaviors.
Parents/Guardians: Offer crucial developmental and family history.
School Psychologists: Often play a central role in assessment and diagnosis, interpreting test results and integrating various data points.
Speech-Language Pathologists (SLPs): Assess oral language skills, phonological processing, and related language-based learning difficulties.
Educational Assessment Specialists: Administer and interpret educational and psychological tests.
Medical Personnel (if necessary): Physicians may be involved if co-occurring medical, developmental, health, or attention concerns are suspected.

The crucial task of synthesizing and interpreting this collected information to reach a diagnosis should be undertaken by a professional with in-depth knowledge of dyslexia characteristics across different literacy development stages. This professional must also understand the influence of language development and behavior on literacy acquisition. School psychologists and speech-language pathologists are frequently the professionals responsible for this diagnostic role within educational settings.

Important Caution: An initial dyslexia diagnosis should always be considered tentative, based on the available data. While a struggling reader might present a profile consistent with dyslexia, rapid improvement with appropriate intervention suggests that the reading difficulty might be more related to past educational opportunities than to underlying neurological differences associated with dyslexia. The student’s response to targeted, evidence-based instruction in foundational reading and spelling skills is vital for confirming or refuting the initial diagnosis.

Intervention Planning: What Happens After Diagnosis?

The evaluation report should recommend instructional programs tailored to address the identified skill gaps and weaknesses. Since many children will have already acquired some foundational reading skills, intervention should begin at their current skill level, not necessarily at the very beginning of a program. While some programs offer placement tests, many do not. Therefore, the evaluation report should detail specific skill needs to guide the starting point of instruction. Recommended interventions should align with research-backed methods and content proven effective for students with dyslexia and other struggling readers. The report may also recommend further assessments in areas like vision, hearing, fine motor skills (occupational therapy), attention, or emotional well-being, if warranted.

Documentation: Accessing Support and Accommodations

The evaluation report provides the necessary documentation for determining eligibility for special services, including special education, under regulations like IDEA (Individuals with Disabilities Education Act) in the US. Specific eligibility criteria and cutoff scores can vary by state.

Parents and guardians of children with dyslexia must be proactive advocates to ensure their child receives optimal educational opportunities. Understanding the diagnostic report and the child’s legal rights is crucial for effective advocacy. Resources on teaching methodologies, accommodations, and instructional modifications are available from organizations like the International Dyslexia Association (IDA).

The International Dyslexia Association (IDA) thanks Diane J. Sawyer, Ph.D., and Karen M. Jones, Ed.S., NCSP, for their assistance in the preparation of this fact sheet.