Specific Learning Disorders and ADHD Assessment in University Counseling

 
Learning Disorder and ADHD
Assessment in University
Counseling Center
 
Sara Rieder Bennett, Ph.D.
       Licensed Psychologist, Counseling & Testing Center, The University of Akron
       President, Ohio College Testing Association
1
 
Objectives
 
Provide overview of psychological assessment, diagnosis,
and interpretive reports for common academic
disabilities
Diagnostic categories and associated features
Specific Learning Disorders
ADHD
Practices in psychological assessment
Standard batteries at UA CTC
Factors affecting test performance
Recommendations and accommodations
2
 
Specific Learning Disorder Diagnoses
 
Difficulties learning and using academic skills, as indicated by the
presence of at least one symptom persisting for at least 6 months
despite provision of interventions that target those abilities
Symptoms include inaccurate or slow and effortful word reading;
reading comprehension difficulties; difficulties with spelling;
difficulties with written expression; difficulties mastering number
sense, number facts, or calculation; difficulties with mathematical
reasoning).
Identify by specific impairment and mild, moderate, or severe
severity.
Neurobiological disorder affecting information processing – input,
processing, storage, expression, output
Typically “hidden disabilities”
Prevalence across diagnoses of 5-15%, and adults around 4%.
3
 
SLD with Impairment in Reading (315.00)
 
4% prevalence in school aged kids in U.S.
Basic skill is below age norm and aptitude – decoding, fluency,
letter-word recognition, phonemic analysis, comprehension.
Processing deficits may include - speech/language delays;
auditory processing; phonological awareness; phonemic
awareness; phonics; lexical retrieval; ST auditory memory;
verbal fluency; visual memory and processing speed
Specify if Word Reading Accuracy, Reading Rate or Fluency,
Reading Comprehension.
“Dyslexia” refers specifically to problems with accurate or
fluent word recognition, poor decoding, or poor spelling
abilities.
 
SLD with Impairment in Written Expression (315.2)
 
Prevalence difficult to identify
Basic skill below age norm and aptitude – composition,
grammar, punctuation, organization, handwriting,
spelling
Processing deficits – dyspraxia; R/L confusion;
phonological processing; phoneme-grapheme
relationships; lexical retrieval; auditory working memory;
visual motor integration, sequencing, memory,
processing, and planning
Specify if Spelling Accuracy, Grammar and Punctuation
Accuracy, Clarity or Organization of Written Expression.
May be referred to as “Dysgraphia”
 
SLD with Impairment in Math (315.1)
 
1% of school age children in US
Basic skill below age and aptitude – recognizing numbers and
symbols, understanding math concepts, sequencing…not math
anxiety, self-efficacy, training
Usually present by 5-6
th
 grade due to increased complexity of
classes
Processing deficits – motor skills, VMI, visual-spatial organization,
tactile perceptual tasks, attention to visual detail, sequential
processing, mental flexibility, LT memory (storage and retrieval)
Specify if Number Sense, Memorization of Arithmetic Facts,
Accurate or Fluent Calculation, Accurate Math Reasoning.
“Dyscalculia” is alternative term referring to pattern of problems
processing numerical information, learning arithmetic facts, and
performing accurate or fluent calculations.
 
Common Characteristics across LDs
 
Developmental Delays
 
Learning to speak
Fine motor skills
Following directions or
routines
Coordination
Usually family history or
developmental trauma
like TBI as causal factors
 
Reading Problems
 
Trouble learning ABCs
Rhyming words
Connecting letters to
sounds
Errors when reading
aloud
Frequent pauses when
reading
Avoid reading aloud or
independently
 
Common Characteristics across LDs
 
Writing Problems
 
Sloppy handwriting
Hold pencils awkwardly
Persistent spelling errors
Letter reversals
Confusion of basic words
Spell same word
differently throughout
one piece of writing
 
Other Cognitive Problems
 
Work slowly/impaired
processing speed
Memory impairments
Too little or much attention
to details
Difficulty with abstract
concepts
Struggle with summarizing
information or answering
open ended questions
 
Common Social Characteristics in LD
 
Misunderstand social rules of conversation, language,
facial expressions
Frequent pauses/stammering in conversation
Trouble understanding jokes, comics, sarcasm
Seen as socially awkward or immature
Few friends, isolated, and likely experienced bullying or
ridicule
Seen as liars – poor recall of events; intentional hiding of
perceived failures
Difficulty adjusting to new settings
 
Common Emotional Characteristics
 
Low self-esteem/efficacy, insecure, thwarted
potential
Difficulty managing stress and usually under high
stress
Frustration, feel defeated, angry
Anxiety, depression
See self as lazy or unmotivated…or perfectionistic
Family discord
 
Impact of Learning Disorders
 
Affects access and performance in school, work, daily
routines, family life, social context
35% drop out of high school – 2x general population
13% attend college within 2 years of HS – ¼ that of
general population rate
Fewer attend graduate school or plan to attend
43% at or below poverty level
48% out of workforce or unemployed
 
Attention-Deficit /
Hyperactivity Disorders
 
3-7% of school age children
50-80% continue to have symptoms in adulthood and most
have comorbid conditions
Youth with ADHD underreport symptoms, while other college
students overreport
50% of variance in objective testing is due to effort and
cooperation
Assessment is not about the presence of a critical number of
symptoms, but their strength:
Chronicity
Pervasiveness
Stability
 
DSM-5 ADHD
 
A.
Persistent pattern of inattention and/or hyperactivity-impulsivity:
1.
Inattention – Six or more symptoms inconsistent with developmental level, for
at least six months, with impairments (Five symptoms if 17 or older)
2.
Hyperactivity and Impulsivity – Six or more symptoms inconsistent with
developmental level, for at least six months, with impairments (Five symptoms
if 17 or older)
B.
Symptoms were present prior to age 12
C.
Present in two or more settings
D.
Interferes with or reduces quality of social, academic, occupational functioning
E.
Rule outs
 
314.01 Combined Presentation
314.00 Predominantly Inattentive Presentation
314.01 Predominantly Hyperactive/Impulsive Presentation
-
In partial remission (less than full criteria for 6 months, still impaired)
-
Mild, Moderate, Severe
 
314.01 Other Specific Attention-Deficit/Hyperactivity Disorder
314.01 Unspecified Attention-Deficit/Hyperactivity Disorder
 
Attention or Executive Functioning
Deficit Disorder?
 
Barkley (1993, 94) and just about everyone since then:
ADHD is not a deficit in attention, but in the ability to inhibit
behavior and delay a response to immediate events.
Contingency-shaped sustained attention versus Goal-directed
persistence
ADHD is multifaceted impairments in executive functioning:
Working memory, inhibition, self-monitoring, emotional control,
organization, planning, initiating (all subtypes according to
metaanalysis in 2004)
Processing speed (C, IA; not H/I)
 
Psych Assessment Models for LD
 
Discrepancy Approach: 1-2 standard deviation
discrepancy between achievement and expectations
for age, education, and IQ
Cutoff Approach: use of normed cutoff scores
Ipsative Approach: intra-individual discrepancies
(not norm based)
Inter-Individual Ability/Cognitive Approach: skills in
normative weakness range for general population
and 
confirmed through convergent data sources
Across all, attend to rule-outs, exclusionary criteria,
and explanatory criteria
LD usually impaired WMI and PSI
 
Integrated Method of Psychological
Assessment
 
Observational Data
Background Information
Research-Based Evidence
Quantitative Data – an aid to judgment, not a substitute
No specific battery exists for LD or ADHD but ethical
assessment of either includes investigation of
cognitive, language, behavioral, affective, and
achievement performance
 
(Gregg, 2009)
 
Counseling Center Batteries
 
All batteries:  Clinical Interview and CCAPS-62, SDS, Review of
records, Assessment Screener Questionnaire, WAIS-IV
LD: WJ-IV Tests of Achievement, psych measures (e.g. PAI) and
collateral interviews as needed
ADHD:
Student:  Barkley Adult ADHD Rating Scale-IV (Current and
Childhood), Barkley Functional Impairment Scale, PAI, PRIME-MD
Patient Health Questionnaire, Semi-Structured Interview for
Adult ADHD
Parent/Guardian completes: BAARS-IV (Current and Childhood),
BFIS, Interview for Adult ADHD
If needed, WJ-IV Tests of Achievement, WMS-IV, Validity Indicator
Profile
17
 
Considerations
 
Intelligence Hereditary Indexes are around .50
Intelligence Scores influenced by:
Culture, language, opportunities, interests/curiosity
School attendance and quality of schooling
Family environment
Environmental toxins
Motivation, Persistence
Anxiety, obsessiveness, ability to tolerate ambiguity
Concentration/Attention, distractibility and distractions
Sleep, diet, medications etc.
Bias of examiner
Gender Differences tend to be minimal and specific
Race/ethnicity – African Americans, Latino(a)s, Native Americans
lower than Asian Americans and European Americans (~9 points)
18
 
Recommendations and/or Accommodations
 
Reports culminate in treatment planning and feedback session with
student, with recommendations including meeting with OA to identify
accommodations if diagnosis and impairments
Accommodations can include Adaptive Study Strategies Program,
adaptive technology, alternative media format, classroom,
equipment, internship/co-op, recording lectures, note-taker, priority
registration, sign language, testing
Recommendations:  personal, educational, career counseling;
academic support services on campus; community resources; online
resources (e.g. Pomodoro, Khan Academy); physician referral; speech
pathology; rehabilitation, occupational therapy
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This content discusses the diagnosis and assessment of Specific Learning Disorders (SLD) and ADHD in a university counseling center. It covers the symptoms, prevalence, and impact of SLD, focusing on impairments in reading and written expression. The document also highlights the assessment practices, recommendations, and accommodations for students with SLD and ADHD.

  • Learning Disorders
  • ADHD Assessment
  • University Counseling
  • Academic Disabilities
  • Psychological Assessment

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  1. Learning Disorder and ADHD Assessment in University Counseling Center Sara Rieder Bennett, Ph.D. Licensed Psychologist, Counseling & Testing Center, The University of Akron President, Ohio College Testing Association 1

  2. Objectives Provide overview of psychological assessment, diagnosis, and interpretive reports for common academic disabilities Diagnostic categories and associated features Specific Learning Disorders ADHD Practices in psychological assessment Standard batteries at UA CTC Factors affecting test performance Recommendations and accommodations 2

  3. Specific Learning Disorder Diagnoses Difficulties learning and using academic skills, as indicated by the presence of at least one symptom persisting for at least 6 months despite provision of interventions that target those abilities Symptoms include inaccurate or slow and effortful word reading; reading comprehension difficulties; difficulties with spelling; difficulties with written expression; difficulties mastering number sense, number facts, or calculation; difficulties with mathematical reasoning). Identify by specific impairment and mild, moderate, or severe severity. Neurobiological disorder affecting information processing input, processing, storage, expression, output Typically hidden disabilities Prevalence across diagnoses of 5-15%, and adults around 4%. 3

  4. SLD with Impairment in Reading (315.00) 4% prevalence in school aged kids in U.S. Basic skill is below age norm and aptitude decoding, fluency, letter-word recognition, phonemic analysis, comprehension. Processing deficits may include - speech/language delays; auditory processing; phonological awareness; phonemic awareness; phonics; lexical retrieval; ST auditory memory; verbal fluency; visual memory and processing speed Specify if Word Reading Accuracy, Reading Rate or Fluency, Reading Comprehension. Dyslexia refers specifically to problems with accurate or fluent word recognition, poor decoding, or poor spelling abilities.

  5. SLD with Impairment in Written Expression (315.2) Prevalence difficult to identify Basic skill below age norm and aptitude composition, grammar, punctuation, organization, handwriting, spelling Processing deficits dyspraxia; R/L confusion; phonological processing; phoneme-grapheme relationships; lexical retrieval; auditory working memory; visual motor integration, sequencing, memory, processing, and planning Specify if Spelling Accuracy, Grammar and Punctuation Accuracy, Clarity or Organization of Written Expression. May be referred to as Dysgraphia

  6. SLD with Impairment in Math (315.1) 1% of school age children in US Basic skill below age and aptitude recognizing numbers and symbols, understanding math concepts, sequencing not math anxiety, self-efficacy, training Usually present by 5-6th grade due to increased complexity of classes Processing deficits motor skills, VMI, visual-spatial organization, tactile perceptual tasks, attention to visual detail, sequential processing, mental flexibility, LT memory (storage and retrieval) Specify if Number Sense, Memorization of Arithmetic Facts, Accurate or Fluent Calculation, Accurate Math Reasoning. Dyscalculia is alternative term referring to pattern of problems processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations.

  7. Common Characteristics across LDs Developmental Delays Learning to speak Fine motor skills Following directions or routines Coordination Usually family history or developmental trauma like TBI as causal factors Reading Problems Trouble learning ABCs Rhyming words Connecting letters to sounds Errors when reading aloud Frequent pauses when reading Avoid reading aloud or independently

  8. Common Characteristics across LDs Writing Problems Sloppy handwriting Hold pencils awkwardly Persistent spelling errors Letter reversals Confusion of basic words Spell same word differently throughout one piece of writing Other Cognitive Problems Work slowly/impaired processing speed Memory impairments Too little or much attention to details Difficulty with abstract concepts Struggle with summarizing information or answering open ended questions

  9. Common Social Characteristics in LD Misunderstand social rules of conversation, language, facial expressions Frequent pauses/stammering in conversation Trouble understanding jokes, comics, sarcasm Seen as socially awkward or immature Few friends, isolated, and likely experienced bullying or ridicule Seen as liars poor recall of events; intentional hiding of perceived failures Difficulty adjusting to new settings

  10. Common Emotional Characteristics Low self-esteem/efficacy, insecure, thwarted potential Difficulty managing stress and usually under high stress Frustration, feel defeated, angry Anxiety, depression See self as lazy or unmotivated or perfectionistic Family discord

  11. Impact of Learning Disorders Affects access and performance in school, work, daily routines, family life, social context 35% drop out of high school 2x general population 13% attend college within 2 years of HS that of general population rate Fewer attend graduate school or plan to attend 43% at or below poverty level 48% out of workforce or unemployed

  12. Attention-Deficit / Hyperactivity Disorders 3-7% of school age children 50-80% continue to have symptoms in adulthood and most have comorbid conditions Youth with ADHD underreport symptoms, while other college students overreport 50% of variance in objective testing is due to effort and cooperation Assessment is not about the presence of a critical number of symptoms, but their strength: Chronicity Pervasiveness Stability

  13. DSM-5 ADHD A. Persistent pattern of inattention and/or hyperactivity-impulsivity: Inattention Six or more symptoms inconsistent with developmental level, for at least six months, with impairments (Five symptoms if 17 or older) Hyperactivity and Impulsivity Six or more symptoms inconsistent with developmental level, for at least six months, with impairments (Five symptoms if 17 or older) Symptoms were present prior to age 12 Present in two or more settings Interferes with or reduces quality of social, academic, occupational functioning Rule outs 1. 2. B. C. D. E. 314.01 Combined Presentation 314.00 Predominantly Inattentive Presentation 314.01 Predominantly Hyperactive/Impulsive Presentation - In partial remission (less than full criteria for 6 months, still impaired) - Mild, Moderate, Severe 314.01 Other Specific Attention-Deficit/Hyperactivity Disorder 314.01 Unspecified Attention-Deficit/Hyperactivity Disorder

  14. Attention or Executive Functioning Deficit Disorder? Barkley (1993, 94) and just about everyone since then: ADHD is not a deficit in attention, but in the ability to inhibit behavior and delay a response to immediate events. Contingency-shaped sustained attention versus Goal-directed persistence ADHD is multifaceted impairments in executive functioning: Working memory, inhibition, self-monitoring, emotional control, organization, planning, initiating (all subtypes according to metaanalysis in 2004) Processing speed (C, IA; not H/I)

  15. Psych Assessment Models for LD Discrepancy Approach: 1-2 standard deviation discrepancy between achievement and expectations for age, education, and IQ Cutoff Approach: use of normed cutoff scores Ipsative Approach: intra-individual discrepancies (not norm based) Inter-Individual Ability/Cognitive Approach: skills in normative weakness range for general population and confirmed through convergent data sources Across all, attend to rule-outs, exclusionary criteria, and explanatory criteria LD usually impaired WMI and PSI

  16. Integrated Method of Psychological Assessment Observational Data Background Information Research-Based Evidence Quantitative Data an aid to judgment, not a substitute No specific battery exists for LD or ADHD but ethical assessment of either includes investigation of cognitive, language, behavioral, affective, and achievement performance (Gregg, 2009)

  17. Counseling Center Batteries All batteries: Clinical Interview and CCAPS-62, SDS, Review of records, Assessment Screener Questionnaire, WAIS-IV LD: WJ-IV Tests of Achievement, psych measures (e.g. PAI) and collateral interviews as needed ADHD: Student: Barkley Adult ADHD Rating Scale-IV (Current and Childhood), Barkley Functional Impairment Scale, PAI, PRIME-MD Patient Health Questionnaire, Semi-Structured Interview for Adult ADHD Parent/Guardian completes: BAARS-IV (Current and Childhood), BFIS, Interview for Adult ADHD If needed, WJ-IV Tests of Achievement, WMS-IV, Validity Indicator Profile 17

  18. Considerations Intelligence Hereditary Indexes are around .50 Intelligence Scores influenced by: Culture, language, opportunities, interests/curiosity School attendance and quality of schooling Family environment Environmental toxins Motivation, Persistence Anxiety, obsessiveness, ability to tolerate ambiguity Concentration/Attention, distractibility and distractions Sleep, diet, medications etc. Bias of examiner Gender Differences tend to be minimal and specific Race/ethnicity African Americans, Latino(a)s, Native Americans lower than Asian Americans and European Americans (~9 points) 18

  19. Recommendations and/or Accommodations Reports culminate in treatment planning and feedback session with student, with recommendations including meeting with OA to identify accommodations if diagnosis and impairments Accommodations can include Adaptive Study Strategies Program, adaptive technology, alternative media format, classroom, equipment, internship/co-op, recording lectures, note-taker, priority registration, sign language, testing Recommendations: personal, educational, career counseling; academic support services on campus; community resources; online resources (e.g. Pomodoro, Khan Academy); physician referral; speech pathology; rehabilitation, occupational therapy

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