The complex (and often frustrating) truth about testing for a learning disability
A frequent parent request for any child psychologist is to request evaluation of a child for a specific learning disability (SLD). In this blog, I want to define the complex nature of testing for learning disabilities, and why I always encourage parents to seek evaluation through the school before paying a private psychologist to do the testing. Note: this blog pertains primarily to public schools, and to any private schools who choose to follow public school rules/regulations (not all of which do).
What is a learning disability?
Ok. Most people know basically what an SLD is, but I do find that most people tend to think of SLD in reading, also known is dyslexia, when they say SLD. However, an SLD can occur in other subject areas too: namely writing (dysgraphia) and mathematics (dyscalculia). To most lay people, an SLD simply means that a child struggles more in one subject area than in others. Some people may go further and believe, for example, that dyslexia means that a child "reverses letters" or things like that, and though specific reading anomalies (such as letter reversals) can happen in dyslexia, the definition of dyslexia does not require any specific neurocognitive deficit or manifestation. Instead, the definition of SLD is usually much simpler. In most states (all that I'm aware of), an SLD is defined for practical purposes as a child who performs below peers and fails to show academic growth at the same rate as peers.
Since I work in TN, I will provide a link to the TN state definition here: https://www.tn.gov/content/dam/tn/education/special-education/eligibility/se_eligibility_sld_standards.pdf
If you follow the link, what you'll see is that the definition starts with a rather clinical definition. However, when you get down to the actual evaluation procedures, you'll see that the true definition is not clinical, per se. It is academic. Namely, it states that a student performs below and grows slower than peers in key academic areas, as evidenced by several forms of evidence - grades, state tests, norm-referenced tests, and teacher evaluations. The only part of that that clinical psychologists are trained in are norm-referenced tests.
Why does this matter?
Here is where things get really difficult. If SLD is defined by academic markers, rather than clinical markers, evaluation of SLD becomes an academic process, and not so much a clinical one. This means that no single psychologist, especially one who works outside a school, can diagnose SLD on their own. They must do so as part of a larger academic team, one that includes parents, teachers (usually both a general education and a special education teacher), and often other personnel, like Speech-Language Pathologists and Occupational Therapists (see "Evaluation Participants" section of the TN state definition linked above).
A team approach is important because a psychologist who doesn't work in and observe a child in their school setting is usually ill-equipped to rate whether the other academic markers of SLD have been reached. Most notably, the psychologist can't judge the quality of education offered or the child's receptivity to teaching inside the classroom. We need to hear from teachers and other educators to get their perspective, and this is typically most easily done within the actual school system. Hence, school systems have dedicated school psychologists hired specifically for this purpose. Those psychologist can easily talk to teachers, perform observations, and a host of other services that private psychologist rarely have the time or access to do.
So, no matter how thorough of a neurocognitive evaluation I perform as a clinical psychologist, I will never have enough information in my report to answer all parts of the "checklist" required in the evaluation procedures defining SLD in state law/regulations.
This means that even though I CAN test for SLD, my testing is only a small part of the greater evaluation. You will still need to request a full evaluation through the school, so they can complete the rest of it.
Do schools accept your evaluations and recommendations?
Yes and no. My evaluations as a psychologist are just one small part of the larger academic evaluation for SLD. I can share my findings, but the school is still bound by the law to establish whether my findings and their findings cross the threshold of SLD based on state definitions. If other data don't support my data, then the school is likely to use the other data. However, if everything comes together consistently, there's usually no problem.
So, yes, schools will accept and use my evaluations (and those of other private psychologists) and they will consider them in the greater evaluation for SLD, as defined in the link above. However, they are not required at any time to follow any of my recommendations or even to agree with my results. For example, I could test a child who has a very high IQ, let's say in the 130s, but who is getting Bs and Cs at school and is still getting around 50th %ile on state testing. A kid with a 130 IQ would be expected to be acing school and performing great on state testing, well above 50%ile, so I could say from that data that he is performing well below expectation, and, if the problem is not due to low motivation or other issues, might also argue these data suggest an SLD. However, by school definitions, Bs and Cs are average and 50th%ile is satisfactory - it doesn't meet their state definition of a learning disability. You can see this in section 4a and 4b of the link/document above. "Insufficient" progress is defined as a student's performance compared to peers, not to their ability. As long as a student is performing similarly to his peers, they would not meet state criteria for identification with a learning disability.
This can often be frustrating because you, as a parent, might know your child isn't performing to their ability, but as long as they're making progress along with their peers, the school's hands are tied by state law/regulations.
So should I pay you to test my kid or not?
You certainly can, but even if you do pursue a private evaluation with me (or any other private psychologist), you will still need to go through a formal evaluation process with the school. You'll still need to request he be evaluated for an SLD, and the school will still need to complete their process. If you already have testing and a full report from me, they will likely forego testing with their school psychologist, but the rest of the team will still need to do their part, and the school psychologist will still look at my testing and take part in the meetings to determine eligibility. Hence, no matter what you do, you should go ahead and request with the school (in writing) evaluation for an SLD. This link guides you how to do that.
You should also know that most private psychologist will have wait lists for testing, and sometimes the wait can be extensive. Mine averages around 6 months. A school system can complete testing faster than that - the law requires them to complete it within 90 days after your request (though extensions/exceptions can be offered at times, such as during COVID, for example) - and since the school evaluation would come at no cost to you, there is no harm in doing it. Let's say you go through with that process and you for some reason disagree with their results, then perhaps you could go and get a second opinion from me (or someone like me), and we could potentially repeat testing if doing so is justified by the data. Even then, though, I couldn't guarantee what the school would do with any new information. Again, my testing is only a small part of the evaluation.
Ethically, it is important to me not to "trick" you into paying me the expense of a through clinical evaluation when you can often get what you need at no cost to you from the school system. Still, you may elect to get an evaluation from me or any other private psychologist for certain reasons.
First, the reports that I write will be much more detailed than a school report. This is true for me, but not for all other child psychologists. There is a lot of variation in report detail out there, so be sure to ask what you'll get. But with me, I write extremely detailed reports. School reports are focused on one thing, mainly - determining eligibility for special education services. My reports focus on a lot, but my key initiative is to provide a detailed neurocognitive profile that explains how your child seems to think about the world - how their brain works - and what this then might mean about how they learn best or why the struggle in a certain academic area. In this way, I write my reports like a neuropsychologist would. In fact, that highlights another point. Generally speaking, if you want the strongest, most detailed testing reports, try finding a neuropsychologist. They have specific, highly specialized training in neurocogntive reports far above most "standard" psychologists, and they tend to approach testing differently. That's not to say they are "better" than "standard" psychologists, but they do approach testing differently. and if you're considering a private evaluation for SLD, honestly the only reason to choose a private eval is if you want a lot of detail, so for this, a neuropsychologist is going to be usually more detailed. If all you want is diagnosis and identification, the school system will do that, and they'll do it for free.
Another reason to seek private evaluation is to just seek an outside, second opinion. Sometimes, parents just want to get a "clean" look, outside of school settings. Maybe, for example, a child hates school, or school makes them anxious. These can be valid reasons to test outside of school, to help remove the emotional confounds of anxiety or other distaste for school. Still, even in this example, like I said above, the school will still need to participate in the greater evaluation.
Still, another thing you should be aware of is that because SLD is considered an academic diagnosis, rather than a clinical one (by insurance companies), insurance does not pay for academic testing! So, the full cost of the assessment would have to come out of pocket, and insurance is extremely unlikely to apply that to your deductible. There can be exceptions if a student has another medical diagnosis, like a chromosomal disorder, or neurological disorder, or things like that, and if an argument can be made that the evaluator would need special clinical training (which many school psychologists don't have) to integrate those medical issues into the greater evaluation, but exceptions would still require pre-approval from insurance, and insurers can still refuse to cover it, reasoning that the school will do it for free.
Private evaluations are not cheap. Mine are around $1100 at the lower tier. Sometimes, they may be $1300 if extra considerations are needed. Other psychologists can charge more. We all set our own rates. I set mine to be in an affordable range, but also to account for the amount of time I put into them, which is usually around 10-15 hours. So, to be honest, I'm probably undercharging for the amount of time I spend. But, again, I don't want to charge so much that my evals are only available to the super rich. It's a tough balance for us as clinicians who want to provide a service, but who also need to make a living. Still, this is another reason I often direct parents to get these evaluations at school. School will need to do their own eval anyway, and often that's enough to get the services a student needs. Paying me for a private eval has some advantages, but you'll need to weigh if those advantages are enough for you to justify the significant expense of funding the evaluation.
Personally, I leave that choice up to parents. If you contact me for an eval for SLD, you won't ever get any pressure to choose me. In fact, you might feel the opposite. You might even feel like I'm trying to lean you toward a school eval instead. It's not that I don't appreciate the business, and it's not even that I don't like or don't want to do these evaluations. Rather, I just strongly believe in helping you make a well-informed decision, so you know what your options are, and what you're asking for.