What happens in an adult diagnostic assessment for dyslexia?

After my previous posts about pre16 assessment I was asked about the difference between a pre and a post 16 report.

Is a full diagnostic assessment always needed for an adult?

It isn’t always needed for an adult who may not need this for their own particular needs. For adults a full diagnostic assessment is only needed?

• To claim Disabled Students Allowance through Student Finance England to support students at Higher Education.
• ?For someone doing Professional exams eg Accountancy,??who has never been tested before, or whose report is over 5 years of age.

For anyone else a screener such as the?Do it Profiler?(www.doitprofiler.com?) will be just as good and will allow for the adult to claim Access to Work support through?www.gov.uk?.

A full??Diagnostic Assessment doesn’t just rule out other reasons the adult may have challenges that indicate dyslexia, the range of tests and the experience of an expert , mean you can get a full picture of the specific ways it manifests, their underlying cognitive abilities any co-occurring conditions , and specific support strategies that might help them.?

Whilst an intense experience for the adult, half a day of testing and questions can be very worthwhile in order for them to get the support they need in their course , their exams and in their employment.

What is the difference between an assessment with an Educational Psychologist and an assessment with a Specialist Dyslexia Assessor?

The first decision you have to make about a Diagnostic Assessment is whether it is carried out by an Educational Psychologist (EP) or a Specialist Dyslexia Assessor.

Both are able to diagnosis dyslexia and the assessment they carry out is the same , and their report has the same legal standing. In practice, either will do an excellent job and there is little to choose between them. However, there are a few factors to consider.?

Educational psychologists have access to a different types of tests that Specialist Dyslexia Assessor are not able to use. Although they may be a specialist in dyslexia, they are likely to have experience across a range of learning differences and developmental challenges.

A Specialist Dyslexia Assessor will likely have more experience of classroom or supporting students at University. This means they may have more??practical experience of delivering the support strategies they are recommending, which can make the report more practical and helpful for the adult.

Another factor to consider is cost. An EP is likely to charge ￡750 to ￡1000 for a Diagnostic Assessment but a Specialist Dyslexia Teacher Assessor will charge between aroound ￡400 to ￡600.?

Things to check before the assessment takes place

Diagnostic assessments should always be conducted by a certified person, qualified to assess.

• A?Chartered Psychologist specialising in Specific Learning Difficulties registered with the Health Care Practitioners Council (HCPC)
• Specialist Teacher/Assessor with an Assessment Practising Certificate (APC) issued by one of the three providers i.e. British Dyslexia Association, Dyslexia Action or PATOSS. These need to be renewed every three years.

Data privacy

Before the assessment the adult will sign a privacy notice that means that they understand where the report will be stored, for how long, and who will have access to it. This may be a tick to consent on a website or a paper copy signed to comply with GDPR.?

Both EP’s and Specialist assessors should have Indemnity Insurance and professional membership in place of a body such as the British Dyslexia Association.

Before the Diagnostic Assessment takes place

The assessor will spend time collating information about the adult before the Diagnostic Assessment.?

The assessor will be sensitive about what information is recorded and make sure that it is used only for the purposes of the assessment itself.?

Information the assessor will need from you

The assessor will need some background information from you. Questions may be asked your developmental history and typically, questions about developmental milestones associated with language and physical development will be asked. You may need to go back to family members to find out this information! They will also check for any history of hearing or visual difficulties, as well as information about fine motor skills such as handwriting.

A recent hearing and eye test will be required before the assessment and a visual difficulties questionnaire will be circulated, as the assessor may advise an Optometrist appointment. If the adult wears glasses or uses a specific colour overlay as their normal way of working , they should bring them to the assessment.??If they are on any relevant medication this should be noted in advance and it should be taken as normal.?

The assessor will ask for information about the adult’s language development and the ease or difficulty with which they acquired literacy skills. There may have been previous speech and language (or Occupational Therapy) and information on this will need to be passed on.?

They will ask about the adult’s experience of school and their exam results . Have they had any additional learning support ior exam access arrangements n the past and, if so, what did this entail and how useful was it??

They will also want to know if English is the only language spoken at home .?

The assessor will ask if there are any literacy challenges in the rest of the family and these will be noted, but confidentially.

They will want to gather about their memory, communication skills and social interaction, as well as what they have interests in, and how they might spend their leisure time. What do they perceive to be their strengths?? We do try to discuss strengths as well as challenges as many adults have spent years believing that they only have weaknesses.

What a Diagnostic Assessment involves?

A Diagnostic Assessment will involve a series of tests that will give a profile of the individual’s strengths and limitations in a number of key areas of cognitive ability:?

• ?Verbal and non-verbal (visual) ability?
• ?Short-term and working memory – the ability to retain and use information held in memory?
• ?Phonological awareness – the ability to understand and apply knowledge of sounds i.e. to generate rhyming words or ‘sound out’ unknown words when reading
• ?Speed of processing – being able to quickly and accurately ‘pull’ information from long-term memory, such as the meanings of words?

The assessment will also involve age-appropriate tests that measure attainment in reading, spelling and writing. A piece of timed academic writing will be obtained to look at how they structure something associated with their study, the vocabulary used and the accuracy of the grammar and punctuation .

Normally, an assessment will take around three hours but the assessor will go at the adult’s speed and allow plenty of breaks.?

The assessor is trying to find out what discrepancy there is between the adult’s underlying ability and the rest of the tests carried out. Most dyslexic adults have average or above average verbal or visual abilities, but show a difference between these??and the rest of the tests. It is worth noting that according to the Rose Review (2009) dyslexia can occur at any level of intellectual ability.

Underlying ability

The adult will be given a battery of both verbal and non verbal/visual tasks and many adults with Dyslexia show a discrepancy between and within these sub tests. They will be asked questions to check their level of vocabulary and also timed construction tasks to show visual skills. Adults with dyspraxia often find these latter tasks difficult as they have weak abilities in spatial awareness.

Memory and processing

An adult with dyslexia will often have challenges with short-term and working memory.?

Their speed of processing verbal or visual information may also be impaired.?

In a test of repeating increasing digits and letters , the assessor will assess short-term auditory memory.?

Holding those numbers and letters in their head and manipulating them to repeat them backwards will assess working memory.?

These skills are important in the classroom where children will have difficulty remembering oral instructions or remembering things like their times tables.?

The ability to process information efficiently is often measured by the rapid verbal naming of items presented visually, such as a series of random letters or numbers. Children who find such tasks difficult, may find it hard to work at the same speed as their peers.?

Reading

This will assess a variety of skills required for full fluency.?

At the very least, single word reading, non-word reading and reading comprehension will be explored.?

The assessment will also involve a timed silent reading comprehension. Reading speed or rate may also be recorded. The adult will also read a suitable oral passage and qualitative observations made by the assessor.

Observations will be made for example if the adult uses their finger to help them track the text, and if they miss out words or letters.

Spelling

This will be in the form of an age-appropriate single word test but, throughout the assessment, there will be other chances for the assessor to look at spellings, such as in the academic writing task.

Writing

For post 16 a more academic extended piece of writing is required around their area of study eg around their degree course . I have learnt a lot about Corporation Tax recently!

The assessor will observe their pen grip, which hand they use, their ability to put down their ideas on paper, the quality of content in the writing, the level of vocabulary used, as well as fluency of expression.?

Many individuals with dyslexic traits have vivid and innovative ideas, but find it difficult to express these in written form. Is there a discrepancy, for instance, between their written and spoken skills??

This exercise also provides a chance to examine how the individual executes the writing. Do they, for example, produce letters that are neatly formed, or is the writing messy and difficult to read? Do they use a pen with relative ease and dexterity, or do they hold their pen in an unusual or awkward way??

The writing element will be completed within a time-limit so that speed of handwriting is also assessed, although it is also usual for a separate speed of copying test to accompany the writing exercise.

Other areas

In addition to the core tests, the assessor might also explore other areas, such as motor-coordination, or record any evidence of visual difficulties. They may also test mathematical skills and give questionnaires to investigate possible ADHD or ASD. The assessor cannot diagnose these last two co-occurring difficulties but can signpost and make recommendations. We are able to diagnose Dyspraxia in adults however .

After the Diagnostic Assessment

You may be offered some verbal feedback immediately after the assessment, but sometimes the assessor needs to go away and think about all the test scores before coming to a conclusion. You should be offered the opportunity to discuss the report when you receive it. The report will be sent to you password protected ,??to comply with Data Protection Regulations.

Diagnostic Assessment report

For adults,??two reports will be sent – one the full report the other a summary report which can be passed onto the employer without any of the scores.

The outcome and results will be different for every person and the assessment will produce a unique profile, in the form of a written report, which should be available within two to three weeks of the assessment.?

The report should be clearly written with accessible language that makes transparent the areas in which the individual has strengths as well as limitations in a holistic and accessible format.?

It should also contain very clear guidelines and suggestions for structured and well-tested interventions so that teachers, parents and the individual themselves have a very clear understanding of the way forward.?

The recommendations should be clearly set out under targeted headings, like the ones suggested below:

·??????Specialist teaching and support

·??????Assistive technology or resources that might help such as a Reading Pen

·??????Exam Access Arrangements such as extra time , quiet room for the exam

·??????Strategies that might help at work or suggest awareness training for staff

·??????Any further referrals eg a Work Place Needs Assessment

What might a further referral be?

This might be to a behavioural optometrists if visual difficulties are present. They may also be referred to the??GP for possible attention deficit disorder or autistic difficulties as these can co-occur with Dyslexia.

Interpreting the report

Your report may show the tests results using a graph and you will be able to see the ‘spiky profile’ normally associated with a specific learning difficulty. Here there will be peaks and troughs where the adult has strengths as well as limitations.?

The results will be reported in Standard Scores, which are?calculated by taking the raw?score?and transforming it to a common scale. A standard score between 90 and 110 is within the mid-average range.?

You may see a discrepancy between some scores and for the dyslexic child this is normal where they have strengths in some areas such as vocabulary, but relative weaknesses in other areas assessed including attainment and attainment.

You may also see percentile scores discussed, These compare the adult’s score with a hundred children of the same age where the 50th?percentile is the mid-point score and is within the average range. This is equivalent to a Standard Score of 100 which is the mid-point of the Standard Score range.

How the report is structured

The report you receive will have a detachable summary at the beginning of the report which will give a diagnostic decision about the adult.?

At the back of the report will be a list of recommendations and a summary table of results.?

You will be encouraged to show the summary report to the Line Manager and/or HR but the adult is under no obligation to do so.

What kind of recommendations might be made?

Recommendations might be for certain resources such as Claroread or the use of an immersive reader. Other suggestions may be around reasonable adustments in the workplace such as being given copies of training handouts in advance, or not being expected to take notes in meetings.

Explaining the diagnosis to the adult

Many adults have an emotional response to being assessed for the first time. This is normal as they think about ‘what might have been’ or ‘what could have been’,??if they had been assessed earlier. Many organisations such as Grooops ,?www.grooops.org?can help with counselling and the Adult Dyslexia Centre (www.adc.org.uk?)have a free adult support group that meets weekly, and can help.

How to book a Diagnostic Assessment

Positive Dyslexia can help with carrying out assessments for adults and work place needs assessments. The Adult Dyslexia Centre also have a bank of specialist assessors and a Helpline at ?www.adc.org.uk?. If you just need the Work Place Needs Assessment an Employer and Employee Questionnaire is sent out in advance and these can take place ( as can the Diagnostic Assessment) online from anywhere in the UK. The British Dyslexia Association (www.bdadyslexia.org.uk) also provide assessments and have a Helpline and a Bursary Fund.

Disabled Students Allowance

In time the adult may go to University and the report will be able to be used to apply for??Disabled Students Allowance (DSA) through Student Finance (?www.gov.uk) if the assessor had a current APC ( or were HCPC registered) at time of writing the report. You can check if an APC is current by going to?www.sasc.org.uk?.

I do hope this helps any adult thinking of going through an assessment or will support any Line Manager with a Dyslexic Employee. Always happy to answer any queries at [email protected] .

Katrina Cochrane, MA PGCE, PGDip(Dyslexia), APC, AMBDA, FRSA

www.positivedyslexia.co.uk