I am a pediatric PA. I have a 7 year old patient who was diagnosed with a visual perception disorder by the OT at school. Neuropsychological testing resulted in a diagnosis of learning disorder NOS with a high risk for development of dyslexia. At a recent visit with me, she wrote out the numbers from 1 to 20 and she consistently wrote the numbers 7 and 9 backwards. Her parents would like to know just how dyslexic she is. Is there a test to quantify the severity? They are in the process of setting up an IEP for her. Is there anything else that be helpful? As with most things, cost is an issue.
Dr. Pierson's Response: 
There is no one test for dyslexia. Diagnosis requires assessing oral vocabulary, verbal comprehension, phonological processing (including awareness, memory, and rapid naming), decoding, reading comprehension, spelling, and writing at a minimum. Naming skills & oral expression should be assessed if there is a problem indicated. I've got information here [1].

Relative to determining severity, while we can look at the different areas that may be affected and how significantly the child scores on the assessments (anything under the 10th percentile has historically been considered "clinically disordered"), these data are not really predictive of what the child will be able to achieve as a reader and writer. Many quite-impaired dyslexics have achieved great things. For that reason, I typically do not put a severity level on assessments that I do. It is better to determine one’s pattern of strengths and weaknesses and then design an individual intervention program and administer that program on as intensive a therapy schedule as possible.

You should know that reversals are not an indicator of dyslexia. That is a myth. I've got the current definition of dyslexia here http://dyslexiahelp.umich.edu/parents/learn-about-dyslexia/what-is-dyslexia Dyslexia is a language-based learning disability. That said, of course, acuity and visual issues should be addressed, but that will not teach her how to perceive, manipulate, and blend the sounds of our language to learn to read and spell. She needs direct instruction to do that.

There is a lot of information about treatment on the website, as well as helpful apps [2] and software programs [3]. I think the best advice I can give is that she will need systematic direction instruction as intensively as possible. You can read more here [4]. You may also want to read more on phonological awareness (if that is a problem) here [5] and learning to map the sounds of our language onto their orthographic representations (i.e., spelling). She needs direct instruction about spelling rules. For spelling, please visit this page. [6] And then these skills should be targeted with text and practiced through writing. All of this should be undergirded in good language instruction.

Vocabulary (word knowledge) contributes to one's ability to learn to read, so her parents will want to read to her and expose her to rich experiences to increase her "world" knowledge. Please read more here [7]. Having a word in her vocabulary will increase her ability to decode it. And, last, fostering her interests and strengths will be very important [8].

You mention that cost is an issue, as it is for so many of our parents of dyslexic kids. I recently wrote a blog with some suggestions as to how to design an intensive therapy program for your child, without necessarily breaking the bank. They might find some suggestions helpful. http://dyslexiahelp.umich.edu/answers/adp-reflections

So many of our parents feel at sea alone; this family is lucky to have you in their court! (I’m mixing metaphors….) Thank you for reaching out on their behalf.