Video summary

2018 Annual ALTA® Conference - Evaluation of Learning Differences and Related Disorders

Main summary

Key takeaways

Educational

Main ideas, concepts, and lessons

1) Speaker introduction, background, and motivation

  • The presenter is Dr. Laura “Laurie” Eames (spelling corrected during the event by another emcee), a psychologist with extensive clinical experience and leadership in learning-differences services.
  • Her motivation is both professional and personal:
    • She is a mother of a child with dyslexia who struggled for years in a North Texas school district.
    • She describes learning that she (and other families) had to become advocates because earlier identification and remediation were inadequate.

2) What the evaluation center does (Shelton/Evaluation Center overview)

  • The evaluation center was established in 1976 and serves internationally (motto: “from Dallas to Dubai”).
  • It provides multiple evaluation types:
    • Psycho-educational evaluations (primary focus of this talk)
    • Autism spectrum disorder evaluations
    • ADHD evaluations
    • Psychological evaluations addressing emotional/behavioral problems

3) Big picture: Learning differences and related disorders covered

The talk frames several “common learning disabilities/related disorders,” noting overlap (e.g., dyslexia can co-occur with ADHD or autism).

Learning-related conditions mentioned

  • Oral language disorder / Language disorder
  • Developmental coordination disorder / Dysgraphia
    • She distinguishes handwriting/fine-motor-based dysgraphia from DSM “disorder of written expression.”
  • Specific learning disorder with impairment in reading (dyslexia)
  • ADHD (three presentations)
  • Autism spectrum disorder
  • Also referenced conceptually:
    • developmental coordination issues
    • pragmatic/social communication difficulties

4) Diagnostic criteria emphasis (DSM-based, but with clinical interpretation)

She uses DSM-linked diagnostic concepts (without fully listing every criterion), stressing:

  • Diagnosis is not just test scores; it requires professional judgment and qualitative error patterns.
  • Autism is not a learning disability, but autistic students can also have dyslexia and/or ADHD.

Oral language disorder: what to assess

Focus on language in multiple dimensions:

  • Expressive language (word-finding and expressing ideas)
  • Receptive language (understanding meaning)
  • Higher-order language (idioms, inference, sarcasm/humor; not literal interpretation)
  • Pragmatic/social language (how language functions socially)

DSM-related emphasis:

  • Social/pragmatic communication disorder exists.
  • She stresses the need to rule out autism first, because autism can produce similar communication difficulties.

Dysgraphia vs “disorder of written expression” (her distinction)

She argues many schools conflate categories:

  • Dysgraphia (as she uses it) = handwriting difficulty rooted in fine-motor problems
  • Disorder of written expression (DSM) = difficulty expressing ideas in writing (e.g., spelling, written expression fluency)

Practical implications she mentions:

  • For younger students with fine-motor issues, she often recommends occupational therapy.
  • She believes OT is less successful after about age 10–11; for older students she favors accommodations.

Dyslexia: how she characterizes it and how she diagnoses it

She defines dyslexia (via DSM terminology) as:

  • Specific learning disorder with impairment in reading (often essentially equivalent in practice)
  • Characterized by inaccurate, slow, effortful word reading, and may include poor comprehension

Key diagnostic approach she emphasizes:

  • Look for the types of qualitative errors that sound like dyslexia, not just index scores.

Examples she mentions:

  • Substitutions of similarly shaped words/letters (“like-shaped words”)
  • Reversals in younger children (e.g., B/D, p/q)
  • Substituting/misreading words during passage reading
  • Choppy, halting, slow reading
  • Spelling errors and written expression problems consistent with dyslexia

ADHD: what to assess and presentations

She presents ADHD as an umbrella with three subtypes:

  • Inattentive
  • Hyperactive-impulsive
  • Combined

Diagnostic criteria emphasis:

  • Requires a set of symptoms (she mentions “at least six”), such as:
    • inattentiveness to tasks
    • forgetfulness
    • disorganization
    • losing items
    • hyperactivity/impulsivity

Treatment stance she describes:

  • Medication can be important when indicated.
  • She also advocates for academic coaching/executive functioning supports.
  • She notes potential overdiagnosis/misunderstanding, but argues that when medication is appropriate it can be “life-changing.”

Autism spectrum disorder: assessment approach

She summarizes DSM framing as requiring:

  • Social communication/interaction deficits
  • Plus restricted/repetitive patterns of behavior

Assessment approach she describes:

  • She can often confirm via history/intake, then follow with further testing at the evaluation center.

Examples she sees:

  • Trouble with give-and-take social communication
  • Nonverbal communication issues (eye contact, proximity)
  • Restricted/repetitive behaviors (motor patterns, insistence on sameness, fixated interests)
  • Sensory reactivity differences (e.g., sensory sensitivities like clothing/food)

5) Testing: why, what, when, and how (core methodology)

Why test

To:

  • Determine why a child is struggling
  • Ensure legally required supports are justified
  • Plan appropriate remediation and accommodations
  • Document needs for services/testing accommodations

When to test

She argues for testing as early as possible, aligned with screening mandates and laws (Texas context emphasized).

What to test

Evaluations serve multiple purposes:

  • Diagnose learning/related disorders
  • Plan intervention
  • Document eligibility/needs (e.g., accommodations, standardized testing access)

Screening vs evaluation (process model)

A typical pipeline she describes:

  • Universal screening (for dyslexia risk)
  • If at risk: intervention tiers (Tier 2 / Tier 3 depending on response)
  • If not responding: move toward full evaluation
    • public school evaluation or private evaluation

Qualifying for special education services (IDEA framework)

She briefly outlines common qualifying methods discussed across states (Texas included):

  • IQ–achievement discrepancy:
    • Example: discrepancy of about 1 standard deviation (often represented as 15 points) between cognitive ability and academic performance.
  • RTI models (response to intervention)
  • Another research-based approach:
    • CHC/Cattell-Horn-Carroll theory, plus an associated processing/psychological process approach

Screening limitations and teacher training

She repeatedly argues screening fails if teachers aren’t trained on dyslexia and what to look for.

  • She mentions a screening approach where teachers answer questions (example: a “Dyslexia Screener”), noting teacher knowledge limits accuracy.

6) Dyslexia handbook and legal/advocacy emphasis

She highlights:

  • Dyslexia is widespread and should be treated as such (she cites research-like estimates and emphasizes it crosses demographics).
  • The Texas Dyslexia Handbook is used as a key resource for parents/schools.
  • “Enough is enough”: research funding has advanced; the bigger issue is service delivery.

7) Her “evaluation battery” approach (what she typically includes)

She explains a comprehensive battery, often adjusted based on the child and prior tests.

Core components she states she evaluates for

  • Clinical interview/history
  • Cognitive/intelligence (e.g., WISC, Woodcock-Johnson cognitive abilities)
  • Oral language
  • Phonological awareness (and often rapid naming to predict reading fluency)
  • Fine motor / handwriting mechanics (especially if relevant)
  • Visual-motor integration/perception
  • Attention/executive functioning
  • Academics (reading, writing, math)
  • Social-emotional / anxiety
  • For autism:
    • autism-specific measures
    • possibility of diagnosis by history followed by confirmatory testing
  • Sometimes additional personality/testing tools if differential diagnosis requires it

Standard test interpretation concepts she teaches

  • She explains score types:
    • Standard scores (often centered at 100)
    • Percentiles
  • Most scores fall in a “bell curve” range (about 85–115 covering the majority).
  • She emphasizes integrating raw/standard scores with qualitative error patterns.

8) Case example: “Connor” (how she integrates data into diagnoses and planning)

She presents a practical example of how test results and observations lead to a multi-factor diagnostic picture.

Connor’s presenting concerns

  • First grade in North Texas
  • Behind in reading and math
  • Struggles forming sentences; writing errors (described as “eight sideways,” etc.)
  • Family reports strong learning challenges and mental health history:
    • ADHD in mother (with stimulant treatment)
    • Depression history; possible OCD/hoarding noted in grandmother
    • Dyslexia history in extended family
    • Speech therapy in childhood for father
    • Anxiety/PTSD background for father

School testing result she critiques

  • School says “average phonological awareness,” implying no dyslexia services.
  • She disputes the conclusion by pointing to other weak areas and qualitative issues.

Key test findings she uses to build her interpretation

  • Reading far below grade expectations
    • GORT-based measures described show low accuracy/rate/fluency/comprehension
  • Low-average IQ overall, with variability:
    • some index areas around average
    • verbal comprehension lower (suggesting oral language weakness)
  • Fine motor/visual-motor deficits
    • risk for dysgraphia or handwriting-related problems
  • Oral language weaknesses
    • receptive language especially weak in her description
  • Reading errors matching dyslexic patterns:
    • substitutions (like-shaped words)
    • halting/choppy reading
    • comprehension difficulty
  • Teacher rating scales and classroom behavior:
    • attention problems and learning problems
    • little/no anxiety/depression noted by teacher
  • Continuous performance test:
    • attention instability (attentive/impulsive/distracted patterns over time)

Diagnoses she ultimately identifies

  • Predominantly inattentive ADHD presentation
  • Oral language disorder
  • Specific learning disorder in reading
  • Learning disorder in math
  • Possible dysgraphia risk (fine motor weaknesses)

Outcome/lesson from the case

  • He wasn’t identified as qualifying earlier, so he didn’t receive services.
  • After evaluation and placement into her program:
    • he moved to Shelton
    • he received intensive language/intervention and supports

9) Remediation vs accommodation: how she frames treatment priorities

She describes a shift in priorities:

  • Early on: focus primarily on remediation (therapy/instruction targeted to the underlying deficit)
  • Later: emphasis shifts more to accommodation (supports under legal frameworks)

Examples of remediation mentioned

  • Speech-language therapy for oral language disorder
  • Academic language therapy / structured multi-sensory approaches for dyslexia
  • Occupational therapy for fine motor when appropriate (younger ages emphasized)
  • Medication as effective for ADHD when appropriate
  • For autism:
    • ABA
    • language therapy
    • social thinking/social skills approaches
    • plus other needs-based services

Examples of accommodations mentioned

  • copies of teacher notes
  • reduced copying from board
  • seating supports (with caution that “front of class” may not be feasible for all ADHD students)
  • testing accommodations to “level the playing field”

Methodology / instruction lists (structured bullet points)

A) Steps she recommends in an overall identification pipeline

  • Universal screening for dyslexia risk (K1/K2 per Texas context in her talk)
  • If risk flags:
    • provide early structured intervention (e.g., evidence-based dyslexia-focused instruction)
    • use RTI/tiers to match intensity (Tier 2/Tier 3)
  • Monitor response to intervention
  • If still not responding or if red flags exist:
    • refer for full evaluation
    • consider whether the evaluation should cover:
      • dyslexia and related reading processes
      • oral language
      • attention/executive function
      • fine motor/handwriting mechanics
      • autism/other related disorders if indicated

B) Core elements of her “full psychoeducational battery” approach

  • Clinical interview/history
    • family history of dyslexia/ADHD/anxiety/depression
    • prior interventions and response
    • developmental/language/health history (e.g., ear infections, speech delays)
  • Cognitive assessment
    • identify strength/weakness patterns
  • Oral language assessment
    • expressive/receptive
    • higher-order and pragmatic/social aspects when relevant
  • Phonological processing & language-based reading predictors
    • phonological awareness
    • rapid naming (for fluency prediction)
  • Fine motor and visual-motor integration
    • especially if handwriting is problematic or dysgraphia is suspected
  • Academic achievement testing
    • reading accuracy/rate/fluency/comprehension
    • writing output/spelling and written expression
    • math basics as needed
  • Attention and executive functioning measures
    • teacher/parent questionnaires
    • continuous performance tests
  • Social-emotional screening
    • especially anxiety
  • Autism measures (if indicated)
    • often confirmatory tools beyond history
  • Qualitative interpretation
    • prioritize dyslexia “error types” during reading tasks
    • interpret patterns of variability, not just mean scores

C) Dyslexia-specific diagnostic logic (as she applies it)

  • Look for DSM-aligned indicators of specific learning disorder in reading
  • Confirm by integrating:
    • quantitative reading measures (accuracy/rate/fluency/comprehension)
    • qualitative error patterns, such as:
      • like-shaped word substitutions
      • reversals in young children
      • omissions/insertions/repetitions during oral reading
      • choppy/halting reading behavior
    • family history and oral language history when present
  • Avoid relying solely on one phonological awareness screener or a narrow score pattern

Speakers / sources featured (explicitly mentioned)

People (speakers/primary sources)

  • Dr. Laura Eames (also referred to as “Laurie” during the introduction; spelling corrected)
  • Joyce Pickering
  • Kurt McIntyre
  • Dr. Stephanie (mentioned as a prior conference speaker; only a first name given in subtitles)
  • Stephanie (likely the same speaker; her RTI talk is praised)
  • Melissa Farrell
  • Eleanor Asbury (credited for dyslexia training; presented as “slingerland” method)
  • Luisa Moats
  • Jack Fletcher
  • Sally Shaywitz
  • Dr. Fuchs
  • Sharon Vaughn
  • Christa Norwood
  • Donald/Don Flanagan
  • Milton Dean
  • Geena Mitchell
  • William (student in a training class; later speaking again)
  • President Bush (quoted anecdote)
  • Annie and William (mentioned in anecdotes/case narratives)
  • Connor (case study child)
  • Conner/Connor’s teacher (referenced; not named)

Organizations / references / frameworks (sources)

  • DSM (Diagnostic and Statistical Manual) — American Psychiatric Association
  • IDEA (Individuals with Disabilities Education Act)
  • Section 504 of the Rehabilitation Act (1973)
  • Americans with Disabilities Act (ADA)
  • RTI (Response to Intervention)
  • National Reading Panel
  • CDC (statistics on autism prevalence; general reference)
  • Texas Dyslexia Handbook
  • International Dyslexia Association (referenced)
  • ID A website
  • ASHA (American Speech-Language-Hearing Association)
  • C-Top / CTOP (phonological awareness measure)
  • GORT (Gray Oral Reading Tests)
  • WISC / WISC-IV or WISC-like test
  • Woodcock-Johnson
  • KBIT (referenced as not ideal for IQ)
  • Clinical Evaluation of Language Fundamentals (CELF)
  • CASL (referred to as “Castle/CASL” in subtitles)
  • TOVA / QbTest / Quotient ADHD system / Conners
  • ASRs / A-TOS (autism-related rating instruments mentioned)
  • Slingerland method
  • Structured Literacy / multi-sensory structured language education
  • Social Thinking curriculum (and associated training)

Audio/video “speaker structure”

  • The emcee/introducer includes another person who corrects the spelling and pronounces her name; that person is not otherwise clearly identified.

Original video