Dyslexia – “The D Word” Part One: Diagnosis Who Can “Diagnose” Dyslexia?
by Lancaster Reading Solutions
February 2, 2020
By Rachel Moore, MD, Certified Dyslexia Practitioner
“I was told the school doesn’t test for dyslexia.”
“Is dyslexia some kind of older term that no one uses anymore?”
“Do only physicians diagnose dyslexia?”
“How is dyslexia different from specific learning disability?”
The word “dyslexia” can bring up some questions! Words carry many shades of meaning and that meaning shifts over time. So, the first thing to know when a person says “dyslexia” is who they are and how they are using this very interesting and, at times, controversial word. One important way the word “dyslexia” has been and is being used is as a diagnosis.
Dyslexia as a clinical diagnosis. It all started with doctors. A physician came up with the word dyslexia back in 1887 – a German ophthalmologist named Rudolph Berlin. A bunch more physicians came along and further defined the word including the famous Samuel T. Orton, a neuropsychiatrist from Iowa. As curious, scientific types, these physicians viewed dyslexia as a puzzle to be worked out, maybe even… a disease? Was the problem in the eyes? The brain? The ears? What might be the “cure”?
But fascination with dyslexia did not stay within the medical community. In fact, research, evaluation and therapy for dyslexia largely shifted from the MDs of clinical medicine to the fields of psychology and education over the next century. So, today’s physicians are generally much less knowledgeable about dyslexia than their historical counterparts.
Some physicians may be returning to their roots, however. The rise of developmental-behavioral pediatrics as a subspecialty means that some pediatricians are very well-informed about dyslexia. The generalists are getting more information too. I found a great 2019 article titled “Re-Introducing Dyslexia: Early Identification and Implications for Pediatric Practice” that hopes to get general pediatricians more involved in the diagnosis of dyslexia. Another sign of change is this great video on a pilot program through the American Academy of Pediatrics for literacy screening in the well child visit. And family physicians published a 2019 review on dyslexia and other learning differences in their journal American Family Physician – though the focus is on how the physician can partner with the school to identify alternate or contributing diagnoses.
Should you visit a physician for a dyslexia diagnosis in the 21st century? It depends. A developmental-behavioral pediatrician or a regular old pediatrician or family doc who just happens to be well-informed on dyslexia could be quite helpful. Any competent physician can help you rule out hearing problems, vision problems and assess general health which are important steps in the initial evaluation. Also, many docs are pretty good with ADHD if that is a concern for you. But, in general, the diagnosis part of dyslexia has moved to psychologists – educational and neuro.
So, I should see a psychologist? Yes, a neuropsychologist or an educational psychologist is qualified to give a full evaluation for dyslexia. Psychologists may talk to you about dyslexia and discuss it in their lengthy reports. However, when it comes to diagnostic terms, they use the DSM-V (the big book of diagnostic terms for psychologists and psychiatrist) which points them to the words “Specific Learning Disorder” followed by “with impairment in” and then “reading”, “writing” or “mathematics” as appropriate. The DSM-V mentions dyslexia as a type of specific learning disorder, a nod to the original term that is used by a lot of people. Some psychologists will use both e.g. “specific learning disorder with impairment in reading (also known as dyslexia)” or speak about a learning disorder of “the dyslexic type”. So, it’s possible to see a psychologist, be told your child has dyslexia and then have the official diagnosis listed as “specific learning disorder with impairment in reading/writing/mathematics”.
The main benefit of getting a clinical diagnosis of dyslexia from a psychologist or a physician/psychologist team is getting the answers to the questions – “Why is my child struggling to read and spell?” and “What are all of my options for helping him or her?”
Dyslexia as an identifier for services. Another reason for obtaining a diagnosis of dyslexia is to provide proof of a need for educational services at school. This is also the goal of a school-based evaluation usually led by the school psychologist. It is also the area where the “d word” can become more confusing. The idea is, “if we can just get the right label, then the right services will follow”. This is an area rife with miscommunication, mistrust and unproductive arguments over the correct terminology. I’d like to make two important points here:
School psychologists are unlikely to use the word dyslexia in describing the results of a student evaluation. These professionals are influenced both by the terminology of the DSM-V and, perhaps more importantly, the complex educational law they have to follow (IDEA 2004). Both DSM-V and IDEA encourage the identification of students under the broad label of SLD (IDEA calls it Specific Learning Disability instead of Disorder). IDEA lists specifiers for the academic area in which difficulty occurs: “oral expression”, “listening comprehension”, “written expression”, “basic reading skills”, “reading fluency skills”, “reading comprehension”, “mathematics calculation” and “mathematics problem solving”. IDEA also mentions dyslexia as an example of a kind of SLD. However, a school evaluation of a dyslexic student is likely to lead to a result of “specific learning disability in the area of ___________”
Always remember that a school evaluation is about how a child’s abilities/disabilities impact their education. The school’s role is NOT to diagnose dyslexia or SLD or whatever. The school’s role is to see if your child needs assistance in learning. At the bottom of it, the school’s assessment is a practical one, much more than a diagnostic one. Fighting to have “dyslexia” vs. “specific learning disability with impairment in basic reading skills” on your child’s IEP is not a battle worth fighting. Focusing on needed services rather than labels is the way to go. Also, looking to the school as the place to provide a full explanation for your child’s learning difficulties may be less than satisfying.
Bottom Line:
Are you looking for WHY your child is struggling? An evaluation with a neuropsychologist or educational psychologist is best for clarifying and diagnosing as well as providing recommendations. A developmental-behavioral pediatrician is also a great asset. A trusted general pediatrician or family doctor can contribute needed medical work up (hearing, vision, general health).
Are you interested in getting your child assistance at their public school? This is where the school psychologist evaluation is very helpful. Don’t expect that you will get all your answers here though. Focus on practical solutions and don’t nitpick diagnostic labels if they are just a matter of terminology.
