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Evaluation includes a careful review of a child's history (medical, developmental, behavioral, educational), family situation, current functioning, and appropriate testing. Information is gathered from parents, school records, school staff, medical providers, other professionals and the child. Testing for learning disabilities includes cognitive (IQ) and achievement testing with speech/language, motor skill and other evaluations as needed. Medical consultation with a primary care provider, developmental-behavioral pediatrician, child psychiatrist or neurologist is often needed, especially when attentional, medical, developmental or emotional issues are present. Rating scales are often used to assess behavior or emotional functioning.
Learning Disabilities: Looking for Processing Problems
As learning disabilities reflect the brain's difficulty in processing certain kinds of information, the evaluation process looks for historical clues and evidence of specific patterns of strengths and weaknesses. Children with learning disabilities are more likely to show:
- history of developmental delays
- family history of learning problems
- normal medical evaluation but can have motor coordination issues
- language delays that may include mixing up sounds in words (e.g., aminal for animal)
- a lot of knowledge but difficulty in expressing ideas clearly
- slowness with learning academic readiness skills (e.g., letter identification)
- difficulty applying learned skills rapidly and automatically resulting in labored reading and poor reading comprehension
- report cards and tests that show consistent pattern of difficulty in one area
- individual testing shows distinctive patterns, such as deficits in phonological processing (pulling apart sounds in words) and delays in reading words.
- behavioral issues occur when processing weakness are stressed (e.g., too many instructions given at once when deficits in language processing are present).
- social problems because language processing impacts negotiation skills or visual-spatial problems result in standing too close to others.
Attention Problems: Looking for Problems in Self-Management
Attention/behavior control problems may range from normal temperament variation to severe Attention-Deficit/Hyperactivity Disorder (AD/HD). AD/HD is the most current term for children who experience levels of inattention and/or hyperactivity and impulsivity that are excessive for their age and causes impaired functioning in more than one setting (home, school, friends, play or work). The three subtypes of AD/HD are the predominantly Inattentive type (formerly called ADD), the predominantly Hyperactive-Impulsive type, and Combined type (with both inattentive and hyperactive-impulsive symptoms).
Children with AD/HD are more likely to show:
- normal milestones although sometimes with fine motor delays
- a family history of AD/HD, attention or behavioral problems
- hyperactivity, when present, noted in preschool but decreases to restlessness as the child ages
- impulsivity such as calling out, acting without thinking or excessive talking
- difficulty with effortful attention, often more evident once in school
- problems with "budgeting" of attention and may over-focus on favored activities
- need for frequent prompts or reminders to start or complete routine tasks
- problems across multiple situations but with variable severity
- difficulty in group or independent work but does well one-on-one
- impulsive, "careless" errors and inattention to detail across subjects
- problems with listening comprehension or academic "gaps" due to inattention or "superficial grasp" of material
- written expression problems are most common
- report cards and tests show highly inconsistent grades across subjects
- difficulty with organization in and outside of school
- tendency to "fade" or drift off during sustained tasks such as reading or chores
- low frustration tolerance and lack of persistence unless highly engaged
- better scores in testing than performance in the classroom or on homework
- testing often shows deficits in "executive functions," such as poor planning or problem-solving
- social problems because of annoying behavior and conflict
