Among adults who have not graduated from high school there may be an unusually high rate of undiagnosed learning disabilities and/or AD/HD. Adult students, teachers and other professionals who work with adults should consider the possibility that learning disabilities and/or AD/HD may underlie the difficulties faced in school, employment and everyday social relationships.
Understanding an individual’s learning styles is very important. This helps a teacher know how to help a student learn. It also helps a person make better career choices. If we know what kinds of thinking we are very good at, we can work in jobs that use those abilities. Sometimes a person’s relative pattern of cognitive strengths and weaknesses is also indicative of a learning disability and/or AD/HD. Understanding these learning differences is part of a diagnosis. People with diagnosed LD and/or AD/HD can request accommodations in the work or educational setting.
Accommodations are changes in a “standard” employment or educational practice that help an otherwise qualified person show what s/he can do. For example, a person who has a reading disability may be very slow when reading a passage. This does not mean the person cannot understand the passage. If a test were timed, the person who reads slowly would be unsuccessful because time would run out before a test was completed. With extended time, the person could demonstrate knowledge of the subject. Extended time is an accommodation. Thus, accommodations “level the playing field.” They do not make a test or job easier.
Diagnosis, then, is critical to employment choices and to accommodations in both work and school for individuals with LD and/or AD/HD.
Four questions are critical to diagnosis. Knowing the answer to these questions before seeking professional help can save time and assure you that you are getting the information you need. These questions are:
- Who diagnoses?
- What is involved in the process?
- How can I afford cost of diagnosis?
- What information do I need after diagnosis is complete?
Some answers to these questions are provided below.
Who diagnoses a learning disability?
Many professionals are involved in the diagnosis of LD. They include psychologists, educational specialists, and other professionals who work in specialized fields such as speech and language. Each has a different role. When accommodations are being requested in educational, “gateway testing,” such as GED or SAT, or employment settings it is important that diagnosis is made by specialist licensed to diagnose LD and/or AD/HD. Table 1, below, explains the role of some of the professionals who provide services. Recall that many of these professionals can suspect LD and/or AD/HD but all are not licensed to diagnose the disorders.
Table 1: Who Can Diagnose LD and/or AD/HD?
| Professional | Role of Professional | Licensure | Can they diagnose LD and/or AD/HD? |
|---|---|---|---|
|
Clinical Psychologist |
Provides assessment of intellectual and emotional functioning. Provides therapy for emotional and behavioral problems for individuals and groups. In general, does not do educational testing needed to diagnose LD. |
PH.D. and licensure required in most states for private practice. |
LD. Yes, either by doing complete psycho/educational assessment or by including educational assessment of educational specialist. AD/HD- Yes. Cannot prescribe medication for AD/HD. |
|
School Psychologist |
Provides assessment of learning and school related problems. Provides therapy that relates to emotional and behavioral problems evolving from school distress. Trained primarily to do both intellectual and educational testing. Can also assess emotional functioning. Usually practice in public school systems. Increasingly in private practice as well. |
Ph.D. or MA Licensure in most states if in private practice. School certification within school systems. |
LD-Yes. AD/HD- No, in general, in schools. This is a medical condition. -Yes with training if private practice. Cannot prescribe medication for AD/HD. |
|
Educational Psychologist |
Provides educational testing. Some trained to provide assessment of cognitive, intellectual functioning as well. Important question since test companies define a Level C test which is to be administered by a PhD. Trained psychologist or a professional whose training has been approved by the company who produces the test. Many test of intellectual functioning are Level C tests. Not, in general, trained to assess emotional functioning. |
Ph.D. or MA Licensure if in private practice. |
LD- Yes if qualified to do assessment of intellectual functioning or if uses results of assessment done by PhD level psychologist or trained school psychologist. AD/HD- Can offer guidance. Depends of level of training. Cannot prescribe medication |
|
Neuro– |
Ph.D. level psychologist who assesses brain processing and functioning. May not be skilled in administering educational tests. In general does not assess emotional functioning. |
Licensure required if in private practice in most states. |
LD-Yes but may need to obtain educational from educational specialist. AD/HD- Yes. |
|
Psychometrist |
Assessment specialist. Often found in school systems, forensic settings, or mental health centers. |
Most states do not license for private practice. |
LD- Yes. AD/HD- In general no unless special training |
|
Educational Specialist |
Assessment of learning and behavioral problems. |
Not licensed |
LD-No AD/HD-No |
|
School Counselor |
Counseling and help with school problems. |
Not licensed for private practice |
LD-No AD/HD-No |
|
Vocational Counselor |
Employment counseling, assessment for employment. |
Not licensed for private practice |
LD-No AD/HD-No |
|
Social Worker |
Therapy and counseling for emotional and behavioral problem. Help in finding resources. |
Licensed in most states for private practice. |
LD-No AD/HD- No |
|
Speech and Language Specialist |
Specialist diagnosing speech and language problems. These can be a component of a learning disability. Part of a diagnostic team. |
MA. Private practice and schools. Licensure and certification may be required. |
LD-No AD/HD-No |
|
Occupational Therapist |
Specialist working with motor and visual-motor problems. These can be a component of a learning disability. Part of a diagnostic team. |
MA. Private practice and in schools. Licensure and certification required in some states. |
LD-No AD/HD-No |
|
Psychiatrist |
Medical doctor who specializes in the functioning of the mind. Does therapy for emotional and behavioral problems. |
State medical board certification required. |
LD-No AD/HD-Yes Can prescribe medication |
|
Physician |
Medical doctor |
State medical board certification required. |
LD-No AD/HD-Yes Can prescribe medication |
What does testing involve?
Learning disabilities
Testing for learning disabilities usually involves three primary types of assessment:
- Testing of intellectual or cognitive potential;
- Testing of information processing or sensory motor abilities that are indicative of a learning disability;
- Assessment of current educational achievement.
Most agencies that grant accommodations have a specific policy on the documentation needed to attest to the presence of a learning disability. It is important to check with an agency before requesting accommodations to assure that you have the needed documentation. Applying without the required documentation slows your application process. This applies to both employment and educational settings.
Assessment for a learning disability usually takes six to eight hours. Often testing is done over two or three testing sessions.
Attention Deficit Hyperactivity Disorder (AD/HD)
Testing for AD/HD usually includes:
- Extensive developmental history to determine if the symptoms are present across many facets of a person’s life;
- A questionnaire that may be given to the student, a partner, a teacher or other who works with the student;
- A computerized test that requires the person to maintain attention while responding to stimuli presented on a computer screen;
- Testing of cognitive functioning and educational achievement.
How can I afford testing?
Adults who have not graduated from high school, or who are underemployed due to a learning disability and/or AD/HD, often cannot afford the cost of a private psycho/educational evaluation.1 This presents a problem of urgent concern. Assessment is a key that can open doors. It provides needed documentation. More importantly it helps people know what type of work may be best for them.
Many alternatives can help to reduce the cost of assessment.
- Check with your health insurance company first. Most will not pay for assessment for a “learning disability” but they will pay part of the cost of assessment if the need is the result of emotional problems or AD/HD. Thus, if a person is depressed and having difficulty at work and the psychologist suspects a learning disability may be an underlying component, assessment can be requested for the depression. Such an assessment would also need to look at cognitive functioning. In this case, if the referral question comes under the DSM-IV Code2 of depression, an insurance company will often help defray costs.
- Check with your HMO. Many have psychologists on staff who can do assessments.
- Vocational Rehabilitation Services have funds to do assessment. It is important in this case that the request for assessment clearly link the possible severity of a learning disability and/or AD/HD to employment. A person, who calls and says, “I need to be tested for learning disabilities.” is likely to be told there are no funds. If the same person says “I am unable to obtain employment and my counselor said I may have a learning disability,” it is far more likely that funds for testing will be made available.
- University programs that provide graduate training in psychology or school psychology often have clinics that will do low cost assessments. In these clinics graduate students do the testing but their work is supervised by faculty who are trained to diagnose learning disabilities and/or AD/HD.
- Neighborhood mental health clinics may also have psychologists who can do assessments. They also often work on a fee sliding scale.
- An advocate who specializes in helping adults with LD and/or AD/HD may know of private practitioners who will do low cost, or pro bono, assessment.
- Check with psychologists and psychiatrists in your area. If you call and explain your financial situation some may provide low cost assessment. This is the decision of the individual professional.
- Check with your state special education or GED center to see if they have a list of professionals who will provide low cost assessments.
- Educational specialists can often help reduce costs by doing the educational assessment. This can be done in the adult education setting.
What information do I need?
After the psychologist or professional has completed the diagnostic process it is important to schedule an appointment to discuss the results of the assessment with them. Ask questions and make certain you understand what the professional is telling you. If you do not know what is meant, for example, by a “visual-motor” problem, ask the professional if s/he can draw it out to show you or give you examples of how this impacts learning. You need to understand the disability so that you can advocate on your behalf.
You also want to make certain you obtain a report. The psychologist cannot give you the test materials you completed but you must have a written report. This report must contain a list of the tests used in the assessment process, the results of the assessment, diagnosis and recommendations. If a learning disability and/or AD/HD are identified the recommendations given must relate to the disability identified. For example, a psychologist might state that extended time is needed because a person has a visual-motor problem that limits reading speed. The psychologist could not simply give a diagnosis of dyslexia and request the use of a calculator. There must be a link in the report stating why the accommodation is needed in light of the disability identified.
Make certain the written report is signed by the professional who did the testing and who made the diagnosis. Also make certain the professional has indicated his or her level of education, (MA, Ph.D.) and has included his or her state license number on the report. The report should also be written on the letterhead stationery of the agency where diagnosis took place.
Finally, make certain you make a folder that you will keep of file. In this folder you should keep copies of all of the reports given to you. You may have separate reports from a psychologist, a speech and language diagnostician and a psychiatrist. Later you may need these reports to request accommodations for work or for college.