Post by Admin on Feb 1, 2014 11:28:47 GMT -6
After reading through the DSM-5's method of diagnosing specific learning disorder, I am surprised and disappointed that it says "...assessment of cognitive processing deficits is not required for diagnostic assessment" (p. 70). Yet, the emphasis for school psychologists and school neuropsychologists diagnosing students with SLD has been, and to my knowledge, continues to be to ensure that appropriate measures of cognitive processing are included in the assessment. Apparently, the DSM-5 working group stated this because "...it remains unclear whether these cognitive [processing] abnormalities are the cause, correlate, or consequence of the learning difficulties." Perhaps the DSM-5 working group did not want professionals to think that they can simply use processing weaknesses alone as justification for diagnosis? Yet, any good psychological assessment would rule out competing explanations for poor achievement in any one area.
The DSM-5 says that a "Comprehensive assessment is required." They emphasize that SLD is a clinical diagnosis based on a synthesis of the individual's medical, developmental, educational, and family history; the history of the learning difficulty, including its previous and current manifestation, the impact of the difficulty on academic or social functioning,; previous or current school reports; portfolios of work requiring academic skills; curriculum-based assessments; and previous or current scores from individual or standardized tests of academic achievement.
Unlike DSM-IV-TR, in which each SLD was listed as a separate disorder (e.g., Reading Disorder, Mathematics Disorder), the DSM-5's diagnostic statements start with the DSM-5 numerical code (e.g., 315.00) followed by the ICD-10 code (e.g., F81.0) followed by the general term specific learning disorder followed by with impairment in a specific academic domain (e.g., reading), followed by the subskills that are affected (e.g., with impairment in word reading accuracy, with impairment in reading rate or fluency). The specific subskill pattern involving problems with accurate or fluent word recognition, poor decoding, and poor spelling may be called "dyslexia" at the clinician's discretion. Similar permission is granted for "dyscalculia." Finally, the severity specifier is given at the end of the diagnostic statement (e.g., Mild, Moderate , or Severe). The "Mild" specifier is given for difficulties in 1 or 2 academic domains, when the individual can still function well with appropriate accommodations and supports. The "Moderate" specifier is given for marked difficulties in 1 or more academic domains for individuals who require intensive and specialized teaching, in addition to accommodations and supports in order to complete activities accurately and efficiently. The "Severe" specifier is given for severe difficulties in several academic domains, when the individual may not be able to complete all activities efficiently, even with individualized and specialized teaching, accommodations, and supports.
The other interesting thing I noticed in the DSM-5's definition of SLD is that they consider normal intellectual functioning as "...an IQ score that is greater than 70 [+/- 5]. We school psychologists have typically used an IQ of 90 as the lower end of Normal or Average. Nevertheless, they allow for individuals with an Intellectual Disability (ID) to also have a diagnosis of SLD if the learning difficulties in an academic domain are in excess of those usually associated with the ID. I'm not sure if they are only referring to those individuals with an IQ range between 70 and 75, on the upper end of what would be allowed for individuals diagnosed with an ID. More importantly, they say that significantly low academic achievement should be at least 1.5 SDs below the population mean of 100, which translates to a standard score of 78. But, if Normal is at the same level (i.e., FSIQ = 78 & Achievement = 78) , where is the "unexpected academic underachievement" that was one of the original hallmarks of a learning disability? In addition, it is puzzling that the DSM-5 says that SLD may also occur in individuals identified as intellectually "gifted," yet Criteria B states that "...the individual's performance of affected academic skills is well below average for age." It does not mention "Mental Age." How do you determine normal or gifted without intelligence testing? According to DSM-5, gifted individuals would also have to have an academic deficit with a standard score of 78 or less to be considered "disabled."
What are your thoughts about the diagnosis of SLD using DSM-5?
The DSM-5 says that a "Comprehensive assessment is required." They emphasize that SLD is a clinical diagnosis based on a synthesis of the individual's medical, developmental, educational, and family history; the history of the learning difficulty, including its previous and current manifestation, the impact of the difficulty on academic or social functioning,; previous or current school reports; portfolios of work requiring academic skills; curriculum-based assessments; and previous or current scores from individual or standardized tests of academic achievement.
Unlike DSM-IV-TR, in which each SLD was listed as a separate disorder (e.g., Reading Disorder, Mathematics Disorder), the DSM-5's diagnostic statements start with the DSM-5 numerical code (e.g., 315.00) followed by the ICD-10 code (e.g., F81.0) followed by the general term specific learning disorder followed by with impairment in a specific academic domain (e.g., reading), followed by the subskills that are affected (e.g., with impairment in word reading accuracy, with impairment in reading rate or fluency). The specific subskill pattern involving problems with accurate or fluent word recognition, poor decoding, and poor spelling may be called "dyslexia" at the clinician's discretion. Similar permission is granted for "dyscalculia." Finally, the severity specifier is given at the end of the diagnostic statement (e.g., Mild, Moderate , or Severe). The "Mild" specifier is given for difficulties in 1 or 2 academic domains, when the individual can still function well with appropriate accommodations and supports. The "Moderate" specifier is given for marked difficulties in 1 or more academic domains for individuals who require intensive and specialized teaching, in addition to accommodations and supports in order to complete activities accurately and efficiently. The "Severe" specifier is given for severe difficulties in several academic domains, when the individual may not be able to complete all activities efficiently, even with individualized and specialized teaching, accommodations, and supports.
The other interesting thing I noticed in the DSM-5's definition of SLD is that they consider normal intellectual functioning as "...an IQ score that is greater than 70 [+/- 5]. We school psychologists have typically used an IQ of 90 as the lower end of Normal or Average. Nevertheless, they allow for individuals with an Intellectual Disability (ID) to also have a diagnosis of SLD if the learning difficulties in an academic domain are in excess of those usually associated with the ID. I'm not sure if they are only referring to those individuals with an IQ range between 70 and 75, on the upper end of what would be allowed for individuals diagnosed with an ID. More importantly, they say that significantly low academic achievement should be at least 1.5 SDs below the population mean of 100, which translates to a standard score of 78. But, if Normal is at the same level (i.e., FSIQ = 78 & Achievement = 78) , where is the "unexpected academic underachievement" that was one of the original hallmarks of a learning disability? In addition, it is puzzling that the DSM-5 says that SLD may also occur in individuals identified as intellectually "gifted," yet Criteria B states that "...the individual's performance of affected academic skills is well below average for age." It does not mention "Mental Age." How do you determine normal or gifted without intelligence testing? According to DSM-5, gifted individuals would also have to have an academic deficit with a standard score of 78 or less to be considered "disabled."
What are your thoughts about the diagnosis of SLD using DSM-5?