Learning Disorder and ADHD Assessment in University

Counseling CenterSara Rieder Bennett, Ph.D. Licensed Psychologist, Counseling & Testing Center, The University of Akron President, Ohio College Testing Association

1

Objectives

• Provide overview of psychological assessment, diagnosis, and interpretive reports for common academic disabilities• Diagnostic categories and associated features• Specific Learning Disorders• ADHD

• Practices in psychological assessment• Standard batteries at UA CTC• Factors affecting test performance• Recommendations and accommodations

2

Specific Learning Disorder Diagnoses

• Difficulties learning and using academic skills, as indicated by the presence of at least one symptom persisting for at least 6 months despite provision of interventions that target those abilities

• Symptoms include inaccurate or slow and effortful word reading; reading comprehension difficulties; difficulties with spelling; difficulties with written expression; difficulties mastering number sense, number facts, or calculation; difficulties with mathematical reasoning).

• Identify by specific impairment and mild, moderate, or severe severity.

• Neurobiological disorder affecting information processing – input, processing, storage, expression, output

• Typically “hidden disabilities”• Prevalence across diagnoses of 5-15%, and adults around 4%. 3

SLD with Impairment in Reading (315.00)

• 4% prevalence in school aged kids in U.S.• Basic skill is below age norm and aptitude – decoding,

fluency, letter-word recognition, phonemic analysis, comprehension.

• Processing deficits may include - speech/language delays; auditory processing; phonological awareness; phonemic awareness; phonics; lexical retrieval; ST auditory memory; verbal fluency; visual memory and processing speed

• Specify if Word Reading Accuracy, Reading Rate or Fluency, Reading Comprehension.

• “Dyslexia” refers specifically to problems with accurate or fluent word recognition, poor decoding, or poor spelling abilities.

SLD with Impairment in Written Expression (315.2)

• Prevalence difficult to identify• Basic skill below age norm and aptitude – composition,

grammar, punctuation, organization, handwriting, spelling• Processing deficits – dyspraxia; R/L confusion;

phonological processing; phoneme-grapheme relationships; lexical retrieval; auditory working memory; visual motor integration, sequencing, memory, processing, and planning • Specify if Spelling Accuracy, Grammar and Punctuation

Accuracy, Clarity or Organization of Written Expression. • May be referred to as “Dysgraphia”

SLD with Impairment in Math (315.1)

• 1% of school age children in US• Basic skill below age and aptitude – recognizing numbers and

symbols, understanding math concepts, sequencing…not math anxiety, self-efficacy, training

• Usually present by 5-6th grade due to increased complexity of classes

• Processing deficits – motor skills, VMI, visual-spatial organization, tactile perceptual tasks, attention to visual detail, sequential processing, mental flexibility, LT memory (storage and retrieval)

• Specify if Number Sense, Memorization of Arithmetic Facts, Accurate or Fluent Calculation, Accurate Math Reasoning.

• “Dyscalculia” is alternative term referring to pattern of problems processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations.

Common Characteristics across LDs

Developmental Delays

• Learning to speak• Fine motor skills• Following directions or

routines• Coordination• Usually family history or

developmental trauma like TBI as causal factors

Reading Problems

• Trouble learning ABCs• Rhyming words• Connecting letters to

sounds• Errors when reading

aloud• Frequent pauses when

reading• Avoid reading aloud or

independently

Common Characteristics across LDs

Writing Problems

• Sloppy handwriting• Hold pencils awkwardly• Persistent spelling errors• Letter reversals• Confusion of basic words• Spell same word

differently throughout one piece of writing

Other Cognitive Problems

• Work slowly/impaired processing speed

• Memory impairments• Too little or much

attention to details• Difficulty with abstract

concepts• Struggle with summarizing

information or answering open ended questions

Common Social Characteristics in LD

• Misunderstand social rules of conversation, language, facial expressions• Frequent pauses/stammering in conversation• Trouble understanding jokes, comics, sarcasm• Seen as socially awkward or immature• Few friends, isolated, and likely experienced bullying or

ridicule• Seen as liars – poor recall of events; intentional hiding of

perceived failures• Difficulty adjusting to new settings

Common Emotional Characteristics

• Low self-esteem/efficacy, insecure, thwarted potential• Difficulty managing stress and usually under high

stress• Frustration, feel defeated, angry• Anxiety, depression• See self as lazy or unmotivated…or perfectionistic• Family discord

Impact of Learning Disorders

• Affects access and performance in school, work, daily routines, family life, social context• 35% drop out of high school – 2x general population• 13% attend college within 2 years of HS – ¼ that of

general population rate• Fewer attend graduate school or plan to attend• 43% at or below poverty level• 48% out of workforce or unemployed

Attention-Deficit / Hyperactivity Disorders• 3-7% of school age children• 50-80% continue to have symptoms in adulthood and most

have comorbid conditions• Youth with ADHD underreport symptoms, while other college

students overreport• 50% of variance in objective testing is due to effort and

cooperation• Assessment is not about the presence of a critical number of

symptoms, but their strength:• Chronicity• Pervasiveness• Stability

DSM-5 ADHDA. Persistent pattern of inattention and/or hyperactivity-impulsivity:

1. Inattention – Six or more symptoms inconsistent with developmental level, for at least six months, with impairments (Five symptoms if 17 or older)

2. Hyperactivity and Impulsivity – Six or more symptoms inconsistent with developmental level, for at least six months, with impairments (Five symptoms if 17 or older)

B. Symptoms were present prior to age 12C. Present in two or more settingsD. Interferes with or reduces quality of social, academic, occupational functioningE. Rule outs

314.01 Combined Presentation314.00 Predominantly Inattentive Presentation314.01 Predominantly Hyperactive/Impulsive Presentation- In partial remission (less than full criteria for 6 months, still impaired)- Mild, Moderate, Severe314.01 Other Specific Attention-Deficit/Hyperactivity Disorder 314.01 Unspecified Attention-Deficit/Hyperactivity Disorder

Attention or Executive Functioning Deficit Disorder?• Barkley (1993, 94) and just about everyone since then:• ADHD is not a deficit in attention, but in the ability to inhibit

behavior and delay a response to immediate events.• Contingency-shaped sustained attention versus Goal-directed

persistence• ADHD is multifaceted impairments in executive functioning:• Working memory, inhibition, self-monitoring, emotional control,

organization, planning, initiating (all subtypes according to metaanalysis in 2004)

• Processing speed (C, IA; not H/I)

Psych Assessment Models for LD

• Discrepancy Approach: 1-2 standard deviation discrepancy between achievement and expectations for age, education, and IQ• Cutoff Approach: use of normed cutoff scores • Ipsative Approach: intra-individual discrepancies (not

norm based)• Inter-Individual Ability/Cognitive Approach: skills in

normative weakness range for general population and confirmed through convergent data sources• Across all, attend to rule-outs, exclusionary criteria, and

explanatory criteria• LD usually impaired WMI and PSI

Integrated Method of Psychological Assessment• Observational Data• Background Information• Research-Based Evidence• Quantitative Data – an aid to judgment, not a substitute• No specific battery exists for LD or ADHD but ethical

assessment of either includes investigation of cognitive, language, behavioral, affective, and achievement performance

(Gregg, 2009)

Counseling Center Batteries• All batteries: Clinical Interview and CCAPS-62, SDS, Review of

records, Assessment Screener Questionnaire, WAIS-IV• LD: WJ-IV Tests of Achievement, psych measures (e.g. PAI) and

collateral interviews as needed• ADHD:• Student: Barkley Adult ADHD Rating Scale-IV (Current and

Childhood), Barkley Functional Impairment Scale, PAI, PRIME-MD Patient Health Questionnaire, Semi-Structured Interview for Adult ADHD

• Parent/Guardian completes: BAARS-IV (Current and Childhood), BFIS, Interview for Adult ADHD

• If needed, WJ-IV Tests of Achievement, WMS-IV, Validity Indicator Profile 17

Considerations• Intelligence Hereditary Indexes are around .50• Intelligence Scores influenced by:• Culture, language, opportunities, interests/curiosity• School attendance and quality of schooling• Family environment• Environmental toxins• Motivation, Persistence• Anxiety, obsessiveness, ability to tolerate ambiguity• Concentration/Attention, distractibility and distractions• Sleep, diet, medications etc.• Bias of examiner

• Gender Differences tend to be minimal and specific • Race/ethnicity – African Americans, Latino(a)s, Native Americans

lower than Asian Americans and European Americans (~9 points) 18

Recommendations and/or Accommodations

• Reports culminate in treatment planning and feedback session with student, with recommendations including meeting with OA to identify accommodations if diagnosis and impairments

• Accommodations can include Adaptive Study Strategies Program, adaptive technology, alternative media format, classroom, equipment, internship/co-op, recording lectures, note-taker, priority registration, sign language, testing

• Recommendations: personal, educational, career counseling; academic support services on campus; community resources; online resources (e.g. Pomodoro, Khan Academy); physician referral; speech pathology; rehabilitation, occupational therapy