We are testing an eighth grade girl at our school for dyslexia. She is a straight-A student, but her parents said this girl spends hours and hours trying to get homework done because of how slowly she reads. Her teachers said she hates reading aloud in class but is a stellar student. Her IQ is Average (WISC-V) in all areas including processing speed and working memory. Her naming speed for both letters and digits is average but her Symbol Translation was ‘Very Low’ (78) and her Storage and Retrieval was ‘Low Average’ (81). Her word reading, pseudoword reading, oral reading accuracy, and fluency are below average but her reading comprehension is average (WIAT). No history of delays with language or any other developmental milestones are known of. She had early intervention in 1st-4th grade for reading through which she responded to and always caught up to grade level expectations by the end of each year. I am waiting to hear back on scores for WJ and CTOPP. But does this seem to fit the Dyslexia profile?

Any direction is appreciated!

Dr. Pierson's Response: 

Given that dyslexia is defined as having a difficulty with phonological processing, it would be helpful to have the CTOPP-2 results (I'm assuming the 2nd edition is being used...). As I'm sure you know, IQ has been found to NOT be the best indicator when making a dyslexia diagnosis, and instead we use language comprehension as a benchmark. Therefore, it appears that this student is using her strong spoken language skills to make sense of text.

This is a piece that I wrote after having a number of students come into my clinical practice whom I was pretty sure were dyslexic, but had intervention before getting a diagnosis. Because intervention works (a good thing), these students no longer evidenced weaknesses in phonological awareness and their performance was subclinical for dyslexia. In that case, it really requires the diagnostician to dig deep and use qualitative data to make the argument for dyslexia.

It appears that rapid automatic naming (RAN) is not an issue -- did you administer the Test of Word Reading Efficiency - 2? This test can really get at the core issue of decoding under time constraints.

When I am making a diagnosis, I obtain receptive vocabulary (i.e., a strength) via a PPVT-4 and then use that as the benchmark for looking at whether reading, spelling, and writing skills that are not in line with what we would expect based on vocabulary understanding. One thing to be mindful of, though, is that we know that the vocabulary skills of older students can degrade over time if they do not have access to the same text as their peers, as if frequently the case for our dyslexic students. So, if she is a struggling reader and 4th grade or older, then you need to be mindful of a depressed vocabulary score.

There other pieces of important information you include are the facts that this student does not like reading (probably because it is hard for her), she spends an inordinate amount of time on homework, and she has a history of reading delay (i.e., not being successful in school). So, to answer your question -- is this a dyslexic profile? Indeed, it could be, but I'd need more data.

Good for you to inquire!