Reading Learning Disorder Workup

Updated: Oct 15, 2021
  • Author: Eric R Crouch, MD; Chief Editor: Caroly Pataki, MD  more...
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Children with normal reading processes spontaneously begin to decode and segment words at age 4-6 years. The most reliable indicator of a reading difficulty is the inability to decode single words. The 3 components of phonological processing that predict reading ability are (1) awareness of different phonemes (eg, ability to follow instructions such as pronouncing cup without the /k/ sound), (2) ability to name objects, letters, or numbers quickly, and (3) working memory (ie, ability to accurately repeat sentences, words, or strings of numbers). Although assessment of intellectual ability, IQ, and achievement level is included in a standard school assessment of reading, these data are unreliable predictors of overall reading ability. Phonological processing ability is the best predictor of reading.

In most public schools, an educational diagnostician, an educator trained as a reading specialist, and a school psychologist are the professionals charged with evaluation. Outside public schools, a child psychologist, an educational diagnostic specialist, or a child neuropsychologist is usually best able to examine a child with a reading disability.

Under the 2004 IDEA, greater emphasis is placed on "response to intervention" than is placed on testing. Thus, most schools now initially provide a more intense level of instruction when a child in kindergarten or first grade falls behind in reading. If the child does not respond to this intervention, formal testing is performed. However, under the 2004 IDEA, the parent may request (in writing) testing at any time, and the school must comply within the specific state rules and time frame. In other words, parents can insist on testing.