Assessment

“Is ADHD a Valid Disorder?”

by | Mar 21, 2025 | ,

“‘I think the current diagnosis of ADHD is a mess and has been wildly overdone.  It blames a variety of symptoms entirely on the child’s brain, and ignores the child’s environment and the interaction with it.”  (Dr. William B. Carey, pediatrician, researcher, and medical educator)

Going through a pile of articles I have saved (hoarded) for over 20 years, one caught my eye, replete with coffee stains, by Dr. William Carey, the late, renowned professor of pediatrics at the Children’s Hospital of Philadelphia.

While not knowing him personally or having the pleasure of attending his lectures, I have been a behind the scenes disciple of Dr. Carey’s

Within the article,  “Is ADHD a Valid Disorder,” Dr. Carey raises many important issues that are as relevant today as they were when it was written.

Dr. Carey emphasizes that there is no one test or objective instrument to diagnose ADHD (often referred to in more casual terms as “ADD.”)

Typically, in the process of obtaining a diagnosis of ADHD, a parent will identify some common themes on a rating scale or questionnaire.  Some of these include:

  • “He just can’t focus.”
  • “He’s easily distracted.”
  • “She won’t get started.”
  • “He hates homework and the teacher says his attention is very poor.”
  • “The teachers say that they are not doctors, but… (with the clear implication that they think the child needs medication).” 
  •  “She’s always fidgeting.”

When descriptors like these and a few others have been present for at least 6 months, the scales tilt in the ADHD direction and a diagnosis is typically obtained.

After receiving this diagnosis parents will often report a sense of comfort, feeling that they have, “finally gotten the answer.”

As is my nature, I will push back on this notion of “the answer,” emphasizing that there are many other factors that may not have been understood or addressed.

Just below the coffee stains on my saved article, Dr. Carey noted:

“The assumptions that the ADHD symptoms arise from cerebral malfunction has not been supported even after extensive investigations.  The current diagnostic system ignores the probable contributory role of the environment; the problem is supposedly all in the child.  The questionnaires most commonly used to diagnose ADHD are highly subjective and impressionistic…The label of ADHD, which is widely thought of as being beneficial, has little practical specificity and may become harmful.”

Wow!  Dr. Carey is not mincing words in his taking on the ADHD industry.

Takeaway Point

Don’t be too quick to toss things out.  They may come in handy one day.

Thank you, Dr. Carey.

Must See the Neurologist

by | Mar 14, 2025 |

Even though schools will tell parents that they need to see a neurologist to diagnose dyslexia, the following are essentials that must be considered in an assessment:

  • Reading aloud from a graded word list to determine word identification skills and how automatically the words are read.
  • Reading real and nonsense words in isolation under timed conditions.
  • Reading passages orally at specific grade levels to determine reading rate, accuracy, and fluency.
  • Spelling of real and nonsense words.
  • Writing of a paragraph.
  • Screening of phonological processing competence, including phonemic awareness and measures of rapid naming.
  • Perceptual screening, including the copying of a series of increasingly difficult geometric designs.
  • Screening of language functions.

Are you aware of any neurologists who are doing this type of assessment?

It’s simply not in their purview.

Then why do schools continue to insist upon this?

 

“Getting ‘Dissed'”

by | Mar 6, 2025 | ,

Without turning this into a confessional, when I look back on my schooling here are a few things I know:

  • Math was far my strong suit. I probably needed tutoring, particularly as I had to suffer through geometry, algebra and calculus.  So, did that make me “dyscalculic? (i.e., math disabled)”
  • My penmanship was awful. My grandmother, a very old school second grade teacher, gave me penmanship lessons.  (They obviously didn’t take, as evidenced by my persistent scrawl.)  So, along with my “dyscalculia,” was I also “dysgraphic?”
  • My reading skills were reasonably strong, so I couldn’t own that particular “dys,” as in dyslexia.
  • I don’t think I was emotionally dysregulated, but who knows. My parents are no longer around to tell that side of the story.  They might have just called me spoiled, without the “dys” attached to the regulated.
  • While I think I got along with most of the kids, I was probably “dysmissed” by some along the way.  (Ok, I am taking poetic license here with a made up word.)

Back in the day, a long time ago in a galaxy far away, there were no “dys’s.”  They were not part of our parlance.

Now the “dys’s”  are front and center, occupying a great deal of parental speculation and concern.  Are we better off now or the way it used to be?  I think arguments could be made on both sides.

Having assessed thousand of kids at this point, I often find it difficult to confidently determine where a weakness leaves off and a “dys” is there.  (e.g., It may be objective that the child is not reading well, but is it necessarily “dyslexia?”)

A weakness does not necessarily make it a disability.

it’s often shades of gray and unclear.

Welcome to my murky world.

 

Dyslexia: Not a Score

by | Feb 13, 2025 |

A number of years ago, I had the good fortune to take part on a panel during a symposium on dyslexia sponsored by the grassroots parenting group, Decoding Dyslexia: NJ.  Dr. Sally Shaywitz, the author of “Overcoming Dyslexia” was the keynote speaker.

While talking about assessing dyslexia, Dr. Shaywitz said something that really struck me, as it reminded of something I had been saying for years.

As she stated, “Dyslexia is not a score.”

That statement is right on the money.

In the assessment of dyslexia, scores are certainly involved.   Tests such as the Woodcock Reading Mastery Test, the Tests of Word Reading Efficiency and the Comprehensive Tests of Phonological Processing, among other standardized measures, yield reliable and valid standard scores, grade equivalents and percentiles.  Such scores can be helpful markers in formulating the diagnosis.

However, the scores often don’t tell the whole story, as seen in the case of Marla a 12-year-old sixth grader.

Cognitive scores found Marla in the 60th %ile of verbal intelligence, with her nonverbal scores clustering in the 75th % percentile, meaning Marla’s a pretty bright kid.  Marla’s word identification (words read in isolation) placed her in the lower portion of the average range, with similar word attack (decoding) and passage comprehensions scores.

Marla’s academic scores would not have gotten the school too excited since the sores clustered in the average range, albeit on the low end of average.

However, listening to Marla read was almost painful.  Every time she came upon a large word that was not all that common (such as, historical,  pedestrian, departure) she hesitated a number of seconds, and either stumbled finally coming up with the right word or substituted a nonsense word (e.g., “ostrich” for “orhestra”).   The substitutions completely  altered the meaning, making comprehension challenging, even though she did compensate on comprehension questions getting many of them right.

Two other areas of concern involved the way that Marla  spelled (circle/serkul, correct/crect, minute/mintue)  and her sentence/paragraph writing.  While Marla could memorize for a spelling test and get  good grades, her spelling and her open writing were very weak.

Similar to the sound of Marla’s painful oral reading, producing something in writing was a painful process for her.

Takeaway Point:

With dyslexia, you can’t just look at the scores and make a conclusion.  You need to look under the hood to see what’s going on with the engine.

“Dyslexia is not a score.”

Brief Tip: Know What You Are Targeting

by | Dec 19, 2024 | , ,

Many children referred for assessments are related to struggles with reading, spelling and writing.

Not knowing what direction to go, parents feel a sense of desperation and need guidance on appropriate next steps.

Once the issues are identified, the remediation, unfortunately, can be a bit scattershot.  This is embodied in the statement a teacher recently told a mom, “Well, we do a bit of everything…a little comprehension, some decoding, and writing stories.  We’ll touch all bases.”

For struggling children, I prefer a different mindset.

Rather than a “touch-all-bases” approach, I suggest a different direction.

To get clear on the remediation, start with the concept that there are are two fundamental types of reading problems:

  • Type I: The Type I child has trouble with reading rate, accuracy and fluency.  These children largely fit the definition of dyslexia.
  • Type II: These are children who read fluently, but have difficulty understanding what they read.  Usually, they have trouble with inferences and drawing conclusions.  For such children, confusion reigns.  Unfortunately, they are often quickly viewed as Inattentive ADHD, when there are likely other variables not readily understood.

For either type, tutoring is a great way to go, but only if the tutor is clear on what the problem is and that they are committed to a laser-focused approach.

Scattershot may work for the children who are not in the Type I or Type II categories, but for the rest, it’s important to get clear.

Know what you are targeting.

“Dyslexia is Not a Score”

by | May 17, 2024 | ,

A number of years ago, I had the good fortune to take part on a panel during a symposium on dyslexia sponsored by the grassroots parenting group, Decoding Dyslexia: NJ.  Dr. Sally Shaywitz, the author of “Overcoming Dyslexia” was the keynote speaker.  While talking about assessing dyslexia, Dr. Shaywitz said something that really struck me, as it reminded of something I had been saying for years.

As she stated, “Dyslexia is not a score.”  That statement is right on the money.

In the assessment of dyslexia, scores are certainly involved.   Tests such as the Woodcock Reading Mastery Test, the Tests of Word Reading Efficiency and the Comprehensive Tests of Phonological Processing, among other standardized measures yield reliable and valid standard scores, grade equivalents and percentiles.  Such scores can be helpful markers in the diagnosis.

However, the scores often don’t tell the whole story.  Here’s one example:

Jacob, a fifth grader, is in the 60th %ile of verbal intelligence and his nonverbal score is in the 75th % percentile, meaning Jacob’s a pretty bright kid.  Jacob’s word identification standard score on the Woodcock placed him in the lower portion of the average range, with similar word attack and passage comprehensions scores.

Jacob’s scores would not have gotten the school too excited since the sores clustered in the average range.  Yet, here’s what I told the mom.

“There’s a lot of evidence in Jacob’s assessment that suggests that he is dyslexic.  Even though his scores are fundamentally average, he was observed to be very inefficient in the way that he read.  For example, while Jacob read words like “institute,” and “mechanic” correctly, he did so with a great deal of effort.  It was hard for Jacob to figure out the words.  For those who are not dyslexic, word reading is smooth and effortless.  Those words would be a piece of cake for non-dyslexic fifth graders.  They were not for Jacob.”

“Even more to the point was the way that Jacob read passages out loud.  Listening to Jacob read was almost painful.  Every time he came upon a large word that was not all that common (such as, hysterical, pedestrian, departure) he hesitated a number of seconds and either stumbled on the right word or substituted a nonsense word.  An example was substituting the word “ostrich” for “orchestra.”  The substitutions completely changed the meaning.

“Finally, the two other areas of concern involved the way that Jacob wrote, as well as his spelling.  While Jacob could memorize for a spelling test and get  good grades, his spelling and his open ended-writing were very weak.  The amount of effort that Jacob put into writing a small informal paragraph was considerable.  There also wasn’t one sentence that was complete.”

“Even though Jacob is unlikely to be classified in special education because of his scores, I think he has a learning disability that matches the definition of dyslexia as it is known clinically (see  International Dyslexia Association website:  www.dyslexiaida.org).  The scores simply do not tell the story.”

Takeaway Point:

You need to look under the hood to see what’s going on with the engine.

With dyslexia, you can’t just look at the scores and make a conclusion.

“Dyslexia is not a score.”

Feel free to make comment below. 

To receive future blog posts, register your email: https://shutdownlearner.com.

To Contact Dr. Richard Selznick for advice, consultation or other information, email: shutdownlearner1@gmail.com. 

Copyright, Richard Selznick, Ph.D.  2023, www.shutdownlearner.com.

 

“Gradations from the Middle” (#Dyslexia #ADHD #Other Stuff)

by | May 10, 2024 | , ,

Parents commonly come in with common questions such as,  “Does their child have ADHD?” or “Is my child dyslexic?”

Difficulty  with reading and attention occur on a continuum or a spectrum from below the mid-point of average (see bell-curve picture above), to more moderate and severe.

Just because a child is struggling to a degree with reading doesn’t necessarily mean the child is “dyslexic.”  There could be a myriad of reasons why the child is delayed in reading that are not necessarily dyslexia.

The lower portion of the average range (around the 25th – 30th %ile) is what I call, “the dreaded portion of the bell-shaped curve,” meaning it is neither here nor there or clear cut whether the difficulty represents a legitimate learning disability like dyslexia or an attention disorder with questions of ADHD.

Dyslexia or ADHD are not something like COVID where you can take a test that tells you “yes” or “no” (has it – doesn’t have it). There is no one test for either of them.  (Sometimes I wish that I had the one “Dyslexia Test”.  It would certainly make my life easier.)

Adequate diagnosing i somewhat like detective work requiring a weight of the evidence in order to more confidently state the presence of a disorder.

With dyslexia and ADHD the weight of the evidence includes things like a review of the child’s history  and family factors such as whether either or both  of the parents had similar struggles in their own development.

Evidence such as this helps to tip the balance one way or the other along with other quantitative (objective) and qualitative (subjective) assessment data.

Takeaway Point

Reflect on the bell-shaped curve.  Just because a child is somewhat left of the mid-point (i.e., 50th %ile) in a given area does not mean the child has a disability or a disorder.

(Next week we will discuss how dyslexia (reading disability) is more than a score.)

Feel free to make comment below. 

To receive future blog posts, register your email: https://shutdownlearner.com.

To Contact Dr. Richard Selznick for advice, consultation or other information, email: shutdownlearner1@gmail.com. 

Copyright, Richard Selznick, Ph.D.  2023, www.shutdownlearner.com.

Podcast Interview Released

by | Feb 23, 2024 | , , ,

As a changes of pace, I am excited to share a recent interview that was conducted with me by “Beautifully Complex:  Navigating Neurodiverse Parenting.”

The interview is only about 30 minutes.  Would love to get your feedback on it.

If you enjoy it, please share it with others.

Here’s the link:     (Selznick Podcast Interview)

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Feel free to make comment below. 

To receive future blog posts, register your email: https://shutdownlearner.com.

To Contact Dr. Richard Selznick for advice, consultation or other information, email: shutdownlearner1@gmail.com. 

Copyright, Richard Selznick, Ph.D.  2023, www.shutdownlearner.com.

 

 

 

“Pictures Telling the Story”

by | Feb 2, 2024 | , ,

Largely supported by the medical model, when parents have their child assessed they are often  focused on “the diagnosis.”    Such a model embodies a, “Yes, they have it,” or “No, they don’t have it,” (whatever “it” is) perspective.

In my corner of the universe, I wish things were that straight-forward.  I am hopelessly mired in identifying a pie-chart of interacting variables.

Less important than a “diagnosis,” a good assessment should  identify major “red flags” of concern and  guide you with  “next-step thinking.”

For example if the child has a reading problem, what type is it?  Is it primarily based in decoding/fluency or is it a comprehension based problem? What are the next steps?

If the child shows inattentiveness and distractibility, can that be clarified more specifically?

Just saying a child is “ADHD” doesn’t tell us much.  What situations pull for greater inattentiveness?

If the child’s behavior can be challenging, what seems to trigger the difficulty?

More than the diagnosis, what do the snapshots in the assessment tell us about the child?

I understand that I am sadly dating myself by citing a great song by Rod Stewart, but remember, “Every Picture Tells a Story?”

What are the pictures that are telling the story?

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To receive future blog posts, register your email: https://shutdownlearner.com.

To Contact Dr. Richard Selznick for advice, consultation or other information, email: shutdownlearner1@gmail.com. 

Copyright, Richard Selznick, Ph.D.  2023, www.shutdownlearner.com.

 

 

“‘Come on, Doc. Tell It to me Straight'” (#Assessment)

by | Oct 27, 2023 |

Whenever I do an assessment I know that in many ways I am swimming against the tide in my approach and perspective.

Hopelessly mired in identifying the the “soup-pot” of variables interacting, I rarely see things as one way or another.

Parents are typically focused on “the “diagnosis,” largely supported by the medical model.   Such a model embodies a, “Yes, he has it,” or “No, he does not have it,” perspective. It is the belief held by many, that once one gets the diagnosis the treatment will logically follow.

While this may be true in real medicine, I wish things were that straightforward in my corner of the universe.

Apropos of that, a dad said to me recently,  “Come on, Doc,” tell it to me straight.  What’s he got,”  as I wriggled in my chair trying to side-step his statement.

From my perspective, assessment should identify major areas of need and what should be done next, ideally guiding you on what I refer to as “next-step thinking.”

If you are having your child assessed more than a reductionistic diagnosis, important questions to ask include:

What are the identified strengths and the the areas of greatest need?  How mild, moderate or severe are the areas of need?    How much direct instruction (i.e., tutoring)  is needed?  What is realistic to expect from the school in terms of direct instruction?  What type of accommodations would be helpful in addition to any direct instruction?  If no direct instruction is offered by school, how do we deal with that? 

Notice, the questions are focused on the practicality of the skill needs and the consideration (ratio) of direct instruction to support and accommodation.

Takeaway Point

Let me tell it to you straight.

Assessment drives “next-step thinking.”  Ask the right questions!

Feel free to make comment below.  To receive future blog posts, register your email: https://shutdownlearner.com.

To Contact Dr. Richard Selznick for advice, consultation or other information, email – rselznick615@gmail.com. 

Copyright, Richard Selznick, Ph.D.  2023, www.shutdownlearner.com.

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