NEUROPSYCHOLOGICAL EVALUATION FOR DEVELOPMENTAL DYSLEXIA AND ADHD (ADD)        
(cost $1800)   (procedure code 96101 or 96118)



This is for the purpose of determining whether a child or adult has the reading problem that meets the criteria to receive
a formal diagnosis of a Reading Disorder (developmental dyslexia ) and attention deficit disorder ( ADD  or ADHD ).  It
involves an assessment of overall cognitive functioning, tests of attention, questionnaires, rating scales and reading
tests.  A formal diagnosis is necessary if you are seeking insurance reimbursement or are trying to obtain special
accommodations under the American with Disabilities Act in school, for standardized testing or for employment
purposes.  This evaluation results in an integrated written report.


Problems with IQ Testing:

Traditionally, the principal method of diagnosing learning disabilities, such as dyslexia, has been to compare measured
intelligence and achievement level such as reading.  It is expected that the reading score for instance,  will be
significantly below the IQ score if dyslexia is present.  Other factors are also considered, but he center piece to
diagnosis is this discrepancy in scores.  However, there are serious problems with this approach that are frequently not
considered in a diagnostic evaluation.

First, the concept of intelligence being a single ability ("g") accurately represented by a single score such as IQ has
been seriously challenged by research.  The overall functioning that is represented by IQ is actually the result of at least
four, (and possibly more) separate cognitive abilities.  The are most commonly identified as verbal reasoning, nonverbal
reasoning, working memory and processing speed.  When these are all functioning at  the same level, then a single
score such as the IQ can be regarded as validly representing a person's intelligence.  However, It is not uncommon for
people with learning disabilities to have very uneven functioning in these four areas,  perhaps ranging from very low to
very high.  Consequently, a child or adult's reasoning and learning abilities may be much higher than what is reflected in
the IQ score.   Unfortunately, it is the lower IQ score that is often used in calculating the discrepancy between ability
and achievement such as reading resulting in a discrepancy that is deemed within normal limits.  Consequently, the
learning disability that is actually present is not detected.  Failing to detect a problem that is actually present is called a
false negative.   

There are additional consequences in not properly interpreting intelligence tests.  Working memory and processing
speed are considered aspects of attention and are closely associated with some type of attention deficit disorder.  
Impairments in these areas strongly suggests that an evaluation for ADHD or ADD is in order.  Relying on the
traditional IQ score may mask actual impairments and result in failure to detect a problem, when in fact a problem is
present. Again a false negative.  This can also result in serious under measurement of actual ability or potential.  
Unfortunately many psychologists are only trained to use the traditional IQ score and ignore indications that a traditional
IQ score is invalid.    


Problems with Testing Reading:

Automaticity is acquired in the latter stage of reading acquisition when decoding of words is automatic and therefore
rapid, which allows more mental resources to be directed to the task of reading comprehension.  Automaticity is
necessary for practical reading typical non-dyslexic readers.  However, the extra steps and mental effort the dyslexic
reader must use to perform basic decoding continues to reflect the ongoing interference that their dyslexia has with
practical reading.   Most reading tests that are used to evaluate for dyslexia are untimed and do not require Automaticity
of decoding and will often fail to detect the presence of dyslexia in a person who has had substantial remediation.  
People with dyslexia who have had substantial amount of remedial reading instruction can often perform well on these
untimed tests.  Consequently, it is important to administer reading tests that require Automaticity of decoding for the
evaluation to have a reasonable chance of detecting dyslexia.  Unfortunately, such tests are often not included in an
evaluation, which may result in a false negative diagnostic conclusion.



Problems with ADHD or ADD testing:

There is considerable controversy at the present time over what are the core symptoms of ADHD or ADD.   ADD,
which is ADHD, Predominantly Inattentive Type, is particularly difficult to diagnose because hyperactivity or
impulsiveness are not the primary symptoms.  People with ADD are not disruptive and are often well behaved in
classrooms.  Their symptoms involve internal, silent problems of mental processing of information that results in poor
academic performance.  Because their symptoms are not readily noticed by observers, their condition often goes
undetected despite the suspicion that something is just not right.   Because of the controversy regarding the core
symptoms and the difficulty detecting symptoms evaluations often result in false negatives when in fact there is a
problem.  Evaluations require a care review of all tests, history, grade reports, teacher reports and parent reports.
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