The identification of a reading disorder (dyslexia) needs to happen as soon as it is suspected by a parent, teacher or physician. Individuals need intervention so they can learn to read and go on to be skilled readers. Developmental dyslexia is a language-based disorder that is neurological in origin. It affects reading and it runs in families.

As children grow older difficulty with reading can begin to become more obvious. As the demand for good reading and related skills (spelling, writing, test taking) increases in quantity and quality a child with poorly developed reading and writing abilities begins to fall behind. Parents and teachers often don’t realize reading is the problem. When speed and accuracy are compromised because a student cannot accurately decode new vocabulary, reading slows down in a greater effort to understand or comprehend the text. Frustration can take over as the student begins to feel like they “just don’t get it”.

Skilled readers develop a large storage system of word representations having built this across years of reading instruction, practice and application. Skilled readers can digest words quickly, accurately moving through text building meaning and reflecting on what is being taken in. When it is difficult to process print accurately and quickly developing ideas from reading is labor intensive. It is difficult to generate creative thinking when the reading is slow and the volume is overwhelming.
Reading fluently (accurately and quickly) for meaning is what drives a reader through the print. Evaluation of Dyslexia or a reading disorder identifies a phonological, language- based disorder, and related deficits such as poor spelling, reading comprehension, and sometimes attentional problems. “The most identifiable and consistent characteristic of dyslexia is encapsulated in a phonologic weakness.” Dr. Sally Shaywitz, Overcoming Dyslexia

The phonological weakness can be treated successfully if the right instruction and enough of the right instruction is put into place. It is important to establish exactly what areas are giving a student difficulty and impeding achievement. A phonologic weakness makes reading difficult, slow and labor intensive. Verbal skills, such as listening and understanding complex information, are different from reading and usually not affected by the phonologic weakness. It is not uncommon for a person with a reading disorder to have an impressive knowledge base about a particular subject. These higher level verbal abilities can disguise a reading disorder.

The goal of an evaluation is to intervene as soon as possible with any individual who is struggling to achieve. Some students have been evaluated for learning differences by a professional prior to contacting our clinic. If a student has not had an evaluation to determine deficits and strengths we can recommend several excellent providers. Accurate identification of deficit areas and documentation of an individual’s strengths provides a helpful guide for effective treatment.

It is important to document where a child is currently functioning in terms of reading, spelling, writing and mathematics. Determining a baseline allows us as clinicians to clearly outline the appropriate intervention for each individual. It also gives the parents and student important information about his/her achievement potential and specific deficits which may be preventing access to that potential. Consistent progress monitoring of a student’s response to intervention is continual ensuring the student is making progress and overcoming their struggle.

If there is a need for an in-depth evaluation by a clinical psychologist to determine the presence of ADH/D or other related disorders we will provide the names of reputable and highly experienced therapists. Our clinic is not in the business of “testing to treat”. It is more common for us to “treat and test” meaning that an individual’s response to treatment provides a working knowledge of areas of concern that may be preventing adequate response. Providing an adequate opportunity to learn and knowing the integrity of the intervention provided by our clinic we can reliably determine if further testing and evaluation is indicated.

When a child is struggling to read, someone will probably suggest that he or she be tested for dyslexia. What does it mean to be tested? You might think that of a test as something you take in an afternoon. Someone scores it and tells you how you did. Evaluation is a more accurate word to describe the process of determining if someone has dyslexia. The word evaluation encompasses identification, screening, testing, diagnosis, and all the other information gathering involved when the student, his or her family, and a team of professionals work together to determine why the student is having difficulty and what can be done to help.

An evaluation is the process of gathering information to identify the factors contributing to a student’s difficulty with learning to read and spell. First, information is gathered from parents and teachers to understand development and the educational opportunities that have been provided. Then, tests are given to identify strengths and weaknesses that lead to a diagnosis and a tentative road map for intervention. Conclusions and recommendations are developed and reported. When a student is having difficulties with reading and spelling, an evaluation is important for three reasons.

1. Diagnosis An effective evaluation identifies the likely source of the problem. It rules out other common causes of reading difficulties and determines if the student profile of strengths and weaknesses fit the definition of dyslexia. Who Does Them?
   • A full psycho-educational evaluation is best done by a Licensed Clinical Psychologist who specializes in this type of testing.
   • Upon request, we can provide a short list of evaluators to you.  Our office can review the results of your testing and provide intervention for the identified deficits.
2. Intervention planning An effective evaluation develops a focused remedial program. Students who have a specific learning disability in reading (dyslexia) need a specialized approach to reading instruction to make progress. It is crucial that this specialized instruction begin at the student’s current level of reading skill development, rather than at the student’s grade level. An effective evaluation helps parents and teachers see which specific skills are weak and where reading and spelling instruction should begin.
3. Documentation An effective evaluation documents the history of a student’s learning disability. One purpose of this documentation is to determine eligibility for special services, including special education. Documentation is also important for obtaining accommodations on college entrance exams (ACT, SAT), in college, or in the workplace.

Without diagnosis, children may not receive early intervention or specialized instruction in all the relevant skills that are interfering with their learning of written language. Considering that many schools do not have systematic instructional programs in handwriting and spelling, it is important to assess whether children need explicit, systematic instruction in handwriting and spelling in addition to word reading and decoding. Many schools offer accommodations in testing and teaching to students with dysgraphia, but these students also need ongoing, explicit instruction in handwriting, spelling, and composition. It is also important to determine if a child with dysgraphia may also have dyslexia and require special help with reading or OWL LD (SLI) and need special help with oral as well as written language.

• Initially, children with impaired handwriting benefit from activities that support learning to form letters:
• playing with clay to strengthen hand muscles;
• keeping lines within mazes to develop motor control;
• connecting dots or dashes to create complete letter forms;
• tracing letters with index finger or eraser end of pencil;
• imitating the teacher modeling sequential strokes in letter formation; and
• copying letters from models.
•  Subsequently, once children learn to form legible letters, they benefit from instruction that helps them develop automatic letter writing, using the following steps to practice each of the 26 letters of the alphabet in a different order daily:

• studying numbered arrow cues that provide a consistent plan for letter formation
• covering the letter with a 3 x 5 card and imaging the letter in the mind’s eye
• writing the letter from memory after interval that increases in duration over the handwriting lessons
• writing letters from dictation (spoken name to letter form).

•  In addition, to developing handwriting speed, they benefit from writing letters during composing daily for 5 to 10 minutes on a teacher-provided topic.
•  Students benefit from explicit instruction in spelling throughout K-12:

• initially in high frequency Anglo-Saxon words;
• subsequently in coordinating the phonological, orthographic, and morphological processes relevant for the spelling of longer, more complex, less frequent words; and
• at all grade levels in the most common and important words used for the different academic domains of the curriculum.

• Throughout K -12, students benefit from strategies for composing:

• planning, generating, reviewing/evaluating, and revising
• compositions of different genre including narrative, informational, compare and contrast, and persuasive
• self-regulation strategies for managing the complex executive functions involved in composing.

Some children do make reversals (reversing direction letter faces along a vertical axis), inversions (flipping letters along a horizontal axis so that the letter is upside down), or transpositions (sequence of letters in a word is out of order). These errors are symptoms rather than causes of handwriting problems. The automatic letter writing instruction described earlier has been shown to reduce reversals, which are less likely to occur when retrieval of letters from memory and production of letters have become automatic.

If children have both handwriting and spelling problems, the kinds of handwriting instruction described earlier should be included along with the spelling instruction.

Yes. See Barnett, Henderson, Scheib, and Schulz (2007), Berninger (2007a), Milone (2007), and Slingerland assessment for assessing handwriting problems associated with dysgraphia. Also, see Berninger (2007b) and Berninger, O’Donnell, and Holdnack (2008) for using these tests and other evidence-based assessment procedures in early identification, prevention, and diagnosis for linking assessment results to evidence-based handwriting and spelling instruction (also see Troia, 2008).

 In summary, dysgraphia is a specific learning disability that can be diagnosed and treated. Children with dysgraphia usually have other problems such as difficulty with written expression. It is important that a thorough assessment of handwriting and related skill areas be carried out in order to plan specialized instruction in all deficient skills that may be interfering with a student’s learning of written language. For example, a student may need instruction in both handwriting and oral language skills to improve written expression. Although early intervention is, of course, desirable, it is never too late during the school age years to intervene to improve a student’s deficient skills and provide appropriate accommodations.

Research to date has shown orthographic coding in working memory is related to handwriting and is often impaired in dysgraphia. Orthographic coding refers to the ability to store written words in working memory while the letters in the word are analyzed or the ability to create permanent memory of written words linked to their pronunciation and meaning. Children with dysgraphia do not have primary developmental motor disorder, another cause of poor handwriting, but may have difficulty planning sequential finger movements such as the touching of the thumb to successive fingers on the same hand without visual feedback. Children with dysgraphia may have difficulty with both orthographic coding and planning sequential finger movements.

Children with impaired handwriting may also have attention-deficit disorder (ADHD)–inattentive, hyperactive, or combined inattentive and hyperactive subtypes. Children with this kind of dysgraphia may respond to a combination of explicit handwriting instruction plus stimulant medication, but appropriate diagnosis of ADHD by a qualified professional and monitoring of response to both instruction and medication are needed.

 Dysgraphia may occur alone or with dyslexia (impaired reading disability) or with oral and written language learning disability (OWL LD, also referred to as selective language impairment, SLI).

 Dyslexia is a disorder that includes poor word reading, word decoding, oral reading fluency, and spelling. Children with dyslexia may have impaired orthographic and phonological coding, rapid automatic naming and focused, switching, and/or sustained attention.

 OWL LD (SLI) is impaired language (morphology–word parts that mark meaning and grammar; syntax–structures for ordering words and understanding word functions; finding words in memory, and/or making inferences that go beyond what is stated in text). These disorders affect spoken as well as written language. Children with these language disorders may also exhibit the same writing and reading and related disorders as children with dysgraphia or dyslexia.

• Inhibition-The ability to stop one’s own behavior at the appropriate time, including stopping actions and thoughts. The flip side of inhibition is impulsivity; if you have weak ability to stoop yourself from acting on your impulses, then you are "impulsive".
• Shift-The ability to move freely from one situation to an-other and to think flexibly in order to respond appropriately to the situation.
• Emotional Control-The ability 10 modulate emotional responses by bringing rational thought to bear on feelings.
• Initiation-The ability to begin a task or activity and to independently generate ideas, responses, or problem-solving strategies.
• Working Memory-The capacity to hold information in mind for the purpose of completing a task.
• Planning/Organization-The ability to manage current and future-oriented task demands.
• Organization of Materials-The ability to impose order on work, play, and storage spaces.
• Self-Monitoring-The ability to monitor one’s own performance and to measure it against some standard of what is needed or expected.