The Elusive Diagnosis of Dyslexia

Obtaining a diagnosis of dyslexia can be difficult. The challenge stems in part from differing terminologies used to describe the condition by professionals in differing fields. What’s more, dyslexia was not specifically listed in the Diagnostic and Statistical Manual of MentalDisorders until that volume’s latest edition (DSM-5) was issued in 2013. Even after a diagnosis is made, methods to address these shortfalls may continue to be elusive.

“Dyslexia is considered a medical diagnosis, but it’s uncommon for physicians to be trained in the psychological testing required to make the diagnosis,” says Katherine Lamparyk, PsyD, a psychologist in Cleveland Clinic Children’s Center for Pediatric Behavioral Health. “The educational system is equipped to complete the testing but is not focused on diagnostic classifications.”

Defining terms

Dyslexia refers to a pattern of learning difficulties characterized by problems with accurate or fluent word recognition, and poor decoding and spelling abilities. Despite these difficulties, the child has intact oral language abilities in other areas, such as vocabulary and oral comprehension. Reading comprehension may also be intact, unless the decoding difficulties prevent the child from deriving meaning from the words he or she is attempting to pronounce.

Schools may bring differing standards into play

The educational system tends to focus on qualifying students for special education services based on requirements under the Individuals with Disabilities Education Act and state standards. Upon parent or school request, a student is evaluated for participation in an individualized education program (IEP) and may be eligible under many potential categories, including “specific learning disability,” a broad category describing students who struggle to meet the state’s grade-level standards in one or more of many academic areas.

“While testing offered by the school system is often the same that would be done by a psychologist, the child with dyslexia may not receive a diagnosis any more specific than ‘specific learning disability,’” explains Dr. Lamparyk. “This leaves the family confused about what the test results mean — and what interventions and other recommendations will be effective.”

Straight talk for confused families

Cleveland Clinic Children’s Learning Evaluation and Consultation Clinic staff do not shy away from the specific diagnosis of dyslexia. The clinic, located at Cleveland Clinic Children’s Hospital for Rehabilitation, is designed to provide families with the help they need to obtain a diagnosis and, more important, to start the child on a path to overcoming learning difficulties.

The clinic offers a comprehensive but targeted evaluation using tests that measure intellectual ability, including verbal and nonverbal reasoning, as well as various academic skills. Evaluators pay particular attention to:

• The discrepancy between phonological processing skills and other oral language skills

• How reading fluency and reading comprehension skills compare with oral fluency and comprehension

If recent testing has been completed through the child’s school system, it can be reviewed in place of repeating similar tests.

Each family is provided a specific diagnosis and tailored treatment recommendations, which are discussed in depth. “This enables the family to better advocate for their child, seek appropriate resources and develop a specific action plan,” says Dr. Lamparyk.