I have written about “going with your gut” [1] when parents have concerns about their child’s literacy learning, particularly reading and spelling.
Recently, I assessed a third grader, whom I diagnosed with dyslexia. Two years earlier, though, when she was in first grade, this student’s parents sought an assessment for their daughter, “Jo” (i.e., they went with their gut [1]). But there was a problem. Although the data from that initial assessment supported the need for reading and writing intervention, no such recommendation was made by the professional who assessed Jo. The diagnostician concluded that there was still a need to “rule out” a reading disorder and a disorder of written expression. And so, this student went for two years with no additional help, missed precious time to learn new concepts, and just got further behind her peers. This missed opportunity obviously took a toll on learning, but also on the student’s self-esteem and self-concept of herself as a learner.
We know that the earlier we begin intervention, the better the outcomes. Lovett et al. (2017) found that students who received intervention in 1st and 2nd grades made gains almost twice that of those who did not receive intervention until 3rd grade. Moreover, upon follow-up, 1st graders who received intervention grew at faster rates than 2nd graders on a number of outcomes. It is imperative that students who are struggling with reading and spelling receive intervention as early as possible.
So, why was Jo missed? Why did the diagnostician fail to refer her for intervention immediately? As I mentioned, the data points were there – strong IQ and verbal skills (85th percentile) with reading scores at the 10th percentile and writing scores at the 8th percentile. Clearly, these scores represent a profile of strengths (i.e., IQ and verbal skills) and weaknesses (i.e., reading and writing skills). Moreover, a score below the 10th percentile is considered to fall within the clinically disordered range, and Jo’s performance on the reading and writing measures met that criterion at the time of the initial testing.
There are a number of factors (i.e., challenges) that come into play when making a diagnosis of reading disorder/dyslexia, particularly in this post-COVID time. Jo was in the cohort of students who began school at the height of the COVID-19 pandemic, either virtually or wearing masks during their first years of schooling. Undoubtedly, this had negative ramifications on Jo’s (and other students’) education in regard to learning foundational literacy skills. When making a diagnosis, we want to make sure that the student has had instruction in those foundational literacy skills (i.e., an opportunity to learn). Admittedly, trying to learn letter-sound combinations from a teacher who was either on screen or who had their mouth covered by a mask was not ideal. But delaying intervention in the hopes a struggling student will catch up is never a good idea. If we consider the data about the positive outcomes of early intervention, we should never wait.
Historically, when diagnosing learning disorders, particularly in the schools, the team must check a box suggesting that the student has had adequate instruction but continues to fail. Some may interpret the on-screen and masked instruction as inadequate instruction and decide to “wait” another year or two so that the student has exposure to in-person instruction. But, as we see in Jo’s case, this thinking is detrimental to the student, both academically and emotionally. There were students in Jo’s cohort who were learning to read and spell despite virtual and masked learning situations, and yet, she struggled. We have standardized measures of phonological processing, the skills that underlie learning to read and spell, that can be administered to children beginning at age four to help us identify those students who may be at risk for learning to read and spell. And we can intervene early.
I find that parents have a good idea when their children are not achieving as would be expected. Parents know or at least question why their children are not learning to read on par with their peers. Sometimes there is knowledge of a family member who has dyslexia or who had challenges learning to read and write that raises concerns. A positive family history for reading disorders is a red flag. According to the National Institutes of Health, inherited factors involved in the development of dyslexia are between 40% to 80%. We need to take parents’ concerns seriously.
I have assessed a number of students who were like Jo. When a student with solid (i.e., average) spoken language comprehension skills performs below the 10th percentile in phonological processing and has weaknesses in orthographic knowledge, reading, spelling, and/or writing, I tend to diagnose dyslexia. There are other students with scores that do not meet the criteria for a clinical disorder (i.e., scores that fall below the 10th percentile), but whose scores are not in line with their solid verbal comprehension skills. In other words, these students’ scores demonstrate a profile of strengths and weaknesses. Some of those students might receive a “subclinical” diagnosis of dyslexia; for others, I may defer making the diagnosis. And, if I defer making a diagnosis, I will recommend that the student return for assessment in one year. This then requires an understanding of how to make a diagnosis of dyslexia after a student has received intervention because we know that intervention works. Regardless, I would recommend intervention. The intervention that these students need is termed structured literacy [2]
The bottom line for those of us in this line of work is that when a student is struggling, the sooner we can get that student intervention, the better. We should never wait.
Joanne Marttila Pierson, Ph.D., CCC-SLP
As always, Dr. Pierson is grateful to her co-founder of 3LI, Dr. Lauren Katz, for her insightful review of and contributions to this article.
