The Fuse & Confuse
between
Early Screening
and
Early Diagnosis
This post discusses the risks involved in the confusion between
early screening of academic strengths and challenges &
early diagnosis of learning disabilities.
There is confusion in the field of education regarding the significant difference between the processes of early screening of students’ strengths and challenges and diagnosing learning disabilities early based on psycho-educational testing. The key to supporting students is identifying early their learning needs and then teaching accordingly.
Although early academic screening is distinctly different from a diagnosis of a learning disability through a psycho-educational assessment, many times I hear people talk about these two assessments as if they are one and the same. For example they may say: “early diagnosis is important.”
Parents intuitively know that it is important to identify their child’s learning needs early but conflate this process with diagnosing learning disabilities.
I agree about the early aspect but disagree about the diagnosis prior to any teaching intervention based on academic screening.
The importance of noticing and identifying academic learning needs before students are referred to a lengthy and expansive process of diagnosis through psycho-educational assessment is widely agreed upon in the literature and supported by research. Therefore, distinguishing the two assessments is critical so we understand which assessment students may need at different phases of their learning.
Early Screening for Identification of Strengths and Challenges
Early screening is, as it literally means, an early evaluation of students’ performance on early academic skills. Early screening results can reveal what students can do with ease and what they need support with from teachers or parents to optimize their learning and development without anxiety. The purpose of early screening, individually or class-wide, is to inform classroom teaching by identifying students’ ability level on those early academic skills.
An outcome of class-wide early identification may be, for example, proactively integrating teaching tools into classroom practice that enable supporting all students’ performance as well as continuing to identify strengths and needs. Early screening tests evaluate academic skills that teachers teach in the classroom so they can follow up with more targeted pedagogy. When assessment and teachings are combined, classroom pedagogy and assessment can work together in a more seamless way.
In that sense, early screening is integral to teaching and allows individualized instruction. Early screening for identification of learning strengths and challenges may be conducted by teachers as early as in Kindergarten or Grade 1 and ideally follows with instruction.
Examples of Foundational Academic Skills Revealed in Screening
Early screening may be revealing that Lisa, a kindergarten student, is having difficulties holding a pencil so she would be referred to learning strategist from the field of occupational therapy. Or, Daniel in Kindergarten may have difficulties with visual spatial orientation when printing on the page producing printing that is above and below the line. Daniel needs to develop awareness of the space on the page. He may know all the letters and corresponding sounds but his visual spatial orientation is in need of improvement. Jenna may have difficulty pronouncing specific sounds of letters so she will need strategies from the field of speech and language pathology/development. Other students, could be slow when asked to copy letters or a whole word from the board indicating difficulties in visual short term memory or fine motor skills. And others may have difficulties segmenting and blending sounds within words.
Classroom teachers can monitor periodically students’ progress on these very foundational skills so their intervention of teaching is informed by screening results.
Testing for Diagnosis of Learning Disabilities
Testing for a diagnosis of learning disabilities is a process of testing individual students through administering standardized measures of cognitive, academic, and adaptive behaviour abilities. Typically, a diagnosis requires psycho-educational assessment conducted by a certified psychologist within the school or a registered psychologist paid privately by parents outside of the school.
The Critical Differences Between Diagnosis and Screening
1) Teachers can make practical use of academic screening results, but find little practical meaning in the cognitive abilities results of the psycho-educational assessment.
2) Academic screening is focused on evaluation of foundational academic performance and testing for diagnosis based on standardized measures includes cognitive abilities.
3) Progress Monitoring is possible based on screening results and is done by teachers who are available in the classroom to follow up on academic screening results. Testing of psycho-educational – is done by a psychologists with no intention to follow up with students’ progress.
4) Testing for diagnosis can take place at any age, unlike early screening that must be done in early grades for preventative purposes.
The Fuse and Confusion in Schools
Unfortunately, parents (who participated in the study that this writing is based on) noticed that something was not quite right with the literacy development of their child. Being devoted parents, they asked teachers to pay attention to their child’s progress. They requested teachers to notice their child’s learning needs so they can provide the needed teaching intervention. However, the use of the term early diagnosis instead of early screening created disappointing gaps between what was needed for the child and what teachers and parents thought they needed.
During these early years, all participants’ stories revealed that there was a gap between parents’ and teachers’ understanding of what could be done to support young struggling students.
When parents really meant to ask for help, teaching intervention, attention, and advice, teachers and administrators heard a request for a psycho-educational testing for a diagnosis.
The more school administration apologized for their inability to provide testing early (as required by the BC Ministry of Education) the more parents advocated for this testing to be done privately.
To use an analogy, it sounded like as if parents initially were asking for a simple remedy such as Tylenol and the school administration response was: “we cannot afford a bed in a surgery room … it is too early for such treatment … we only have 4-5 beds per year per school.”
The dialogue between parents and school was around the question of whether to test to diagnose the young learners, even though in most cases there was no early academic screening and intervention in the classroom.
Miriam, Elizabeth’s mother, noted that they asked for academic help, rather than a diagnosis, similar to the specialized academic help that supported her older daughter’s learning and development in Manitoba. Likewise, Kate indicated that she noticed delays in her daughter’s reading, which she thought could have been identified and remediated in Kindergarten. However, the principal said to her, “we don’t test until Grade 3 or Grade 4. Even at that we don’t really do anything.” At this early age, Kate argued, specialized teaching could have helped Alexandra. Kate noted that she realized that the only way she could ensure that Alexandra’s learning needs would be noticed in school early was by obtaining privately a diagnosis of learning disabilities through testing.
As noted above, the purpose of early screening for identification is to notice students’ learning needs and then provide the needed support. Early identification does not require psycho-educational assessment or a diagnosis of learning disabilities.
The Price Of This Confusion Is Paid by Students
Identifying early students’ strengths and challenges to inform classroom teaching was replaced with referring students to a long waiting list for the standardized testing, that was done usually at least after two years of students struggling academically and emotionally.
Early identification and testing for diagnosis were not clearly distinguished by parents and teachers. One reason for this confusion may be that participants reported that according to Special Education Policy accessing special services was conditional to having a diagnose of learning disabilities through psycho-educational testing.
Although researchers recommend early screening, policies guiding schools do not clearly include mandatory early academic screening for identification, but they do include guidelines for testing to diagnose a disability. Therefore, schools follow the Ministry Special Education Policies although it is not aligned with research recommendations for early screening for identification.
The norm is to refer students to waiting lists for testing for diagnosis although they had not been though early screening and academic intervention. Some of the students on the waiting list for diagnosing learning disabilities waited until Grade 8. Needless to describe the emotional damage of feeling inadequate that was experienced by a students who had not been recognized for their learning needs or provided with teaching they deserved.
Schools Requesting Diagnosis without Early Identification
The paradox discussed here is the focus on testing for diagnosis that is done was prior to, and in the absence of, early academic screening and adequate pedagogy. Information generated from early screening could have been used to inform instruction and mediate students’ learning and development prior to diagnosing them. Especially because the diagnosis is based on students’ abilities as reflected in a one-time testing, rather than based on their abilities to progress with targeted instruction. At a student’s early age, when parents expressed their worries about their child’s difference in learning, neither early identification nor testing for diagnosis was offered to participants in their schools. Furthermore, it appeared in interviews that parents’ requests for help from teachers were understood by the schools’ personnel as requests for testing for diagnosis through a psycho-educational assessment.
From the interviews, it appeared that the lack of systemized early screening for identification practices in schools together with the policy of requiring a diagnosis of learning disabilities in order to access services in school or have an IEP, may have left parents and school personnel with no alternative but to seek testing for diagnosis to ensure services for students.
For private consultation about your children’s learning and development
please contact
Dr. Hadas Av-Gay hadasavgay@gmail.com
