How to choose a psychologist, or a learning need assessor, for a dyslexia assessment in New Zealand.

Understanding the Options

Realising that your child (or you) may need a dyslexia assessment can feel confusing and overwhelming, particularly when you google ‘dyslexia assessment options’ and discover that different professionals offer dyslexia assessments (i.e., psychologists and Learning Needs Assessors/LNA’s) and that these professionals can differ in how they assess for dyslexia. While dyslexia assessments can legitimately vary across professionals it begs the question, what do you want in a dyslexia assessment (and what do you not want), and how does this relate to professional groupings. In addition, when people are seeking dyslexia assessment, they also often have practical concerns: Who is accessible? Who is affordable?

1) Ecological assessment with cognitive assessment kept to a minimum

Ecological assessment looks to understand the factors outside of the individual that have influenced the development of a ‘problem’, and then looks to adjust these environmental levers to positively affect change. Ecological assessment is grounded in relationships, activities and routines, and it is these key levers of change that provide a framework for positive and sustainable change.

Cognitive assessment is best kept to a minimum for a number of reasons: 1) It is the most intrusive form of assessment for children and best practice guidelines (from New Zealand Psychologist Board and Ministry of Education) stipulate that it should only done within an ecological framework and on a hypothesis-testing basis. This means best practice guidelines argue against practitioners completing extensive cognitive assessment and cognitive profiling when doing dyslexia assessments; 2) there are no technical requirements for the assessment of ‘intellectual skills’/cognitive profiling when completing a dyslexia assessment here in New Zealand (unless intellectual disability is suspected).

The argument against ‘comprehensive cognitive profiling’ in dyslexia assessment is further substantiated by the Matthew’s effect, which describes the phenomenon of the ‘rich get richer and the poor get poorer’ for those with literacy difficulties. Dyslexia is a language-based difficulty and it can therefore impact both language-based learning ability over time and performance measures on language-based tasks, resulting in a cognitive profile of depressed scores that is not useful and positive for anyone to read. You want to protect you child from this outcome.

So, while some practitioners (psychologists and LNA’s) still choose to complete thorough cognitive assessments for dyslexia, others choose to only assess particular aspects of language and specific cognitive skills to inform diagnosis and intervention. There is also however a significant amount of practitioners that choose not to complete cognitive assessment at all when assessing literacy difficulties. Therefore, when enquiring about dyslexia assessment for your child, you want to understand whether the assessment is ecological in its framing, and whether and to what extent cognitive assessment is used.

2) Regulation and insurance

Dyslexia is a life-long health disability. Psychologists are registered health practitioners under the Health Practitioners Competence Assurance (HPCA) Act, and are further regulated by the New Zealand Psychologists Board in order to assure the public that they are competent to complete this diagnostic work.

A dyslexia assessment, much like any other diagnostic assessment (using the Diagnostic Manual of Mental Disorders) is an extensive process, that must be comprehensive, reliable and defensible. Assessment is an art form and because of this, alongside human error, it is essential that practitioners working in a diagnostic space hold professional indemnity insurance. If a diagnosis was ever challenged in the future or professional advice was seen as flawed, resulting in the validity of diagnosis being legally challenged, then insurance provides financial support for this process, providing safety for both the client and the practitioner.

While psychologists are expected to carry professional indemnity insurance, and organisations such as SPELD carry professional insurance for all it’s practitioners, you would need to check whether individual LNA’s do.

3) Comprehensive Assessment

One reason comprehensive assessment matters in dyslexia assessment is that learning difficulties often do not occur in isolation. Research consistently finds high rates of co-occurring challenges in students with dyslexia.

Typical estimates include:

• ADHD: approximately 25–40% overlap with dyslexia

• Anxiety difficulties: around 20%

• Depression: around 20–28%

• Behaviour difficulties: approximately 22%

• Sensory processing differences: estimated in up to 50% of students with dyslexia

These co-occurring challenges can hugely influence learning behaviour at home and in the classroom. A thorough assessment, when need indicates, must include screening/assessment for co-occurring difficulties, otherwise the assessment is incomplete and doesn’t create an effective and complete understanding of the learner’s needs, what learning supports and accommodations are needed, and how to best to build their skills.

While psychologists can be trained in differential diagnosis, LNA’s may be trained only in the assessment of dyslexia, dyscalculia and dysgraphia so are unable to recognise and assess the ‘bigger picture’.

Accessibility and Affordability

Historically, access to educational psychologists has been limited by both; 1) the low number of educational psychologists available to do dyslexia assessments; and 2) by the rural nature of a country like New Zealand which means clients may have had to travel extensively to find an appropriate educational psychologist. In addition, psychologist-led services are typically more expensive so, to help meet demand for an accessible and low-cost dyslexia assessment service, the role of Learning Needs Assessors were developed by charitable organisations such as SPELD.

Nowdays however, access to psychologists across the country has increased due to telehealth (i.e., online service delivery). Families no longer need to live close to an appropriate educational psychologist in order to access a comprehensive assessment. For some psychologists, such as myself, who want to provide equity-based service, the provision of online services which increases work flow also allows for the option of reduced fees and increased affordability. This means that individuals increasingly have a choice across differing practitioners offering dyslexia assessment.

Different Training Pathways for psychologists and LNA’s.

Psychologists have a undergraduate degree followed by a minimum of three years of postgraduate training in psychology, including around 1,500 hours of supervised practice. Ongoing skill development is then planned and tracked in a Continuing Competence Plan (CCP), which is supported by monthly supervision meetings with another psychologist and periodic reviews by the New Zealand Psychologist Board. Monthly supervision also allows for structured reflection of case work.

Within and across psychologists our areas of competence differ relative to what we have studied, and the work and training we have engaged in post registration. For a dyslexia assessment, you likely want a psychologist who trained in the educational scope, and importantly someone who has studied language, literacy development and abnormal development within their undergraduate and/or postgraduate studies.

To the best of my understanding, Learning Needs Assessors (LNA’s) must have completed a related undergraduate degree plus two undergraduate papers in psychometric assessment, alongside having attended a ‘short’ training course in the Woodcock-Johnson cognitive and achievement battery. After having completed a number of supervised reports, they can then work as LNS’s, through organisations such as SPELD, and can diagnose dyslexia, dyscalculia and dysgraphia.

Questions to Ask when Choosing a Practitioner for a Dyslexia Assessment

When seeking out a practitioner for a dyslexia assessment, parents may find it helpful to ask the following questions:

• Tell me about your training and how this relates to assessment for dyslexia?

• Do you use an ecological/environmental framework for assessment and do you explore cognitive skills (and if so, which skills and why)?

• Are you insured to provide diagnostic assessments?

• Can you assess or screen for co-occurring difficulties like ADHD, anxiety, or sensory processing differences?

• Do you offer a feedback meeting after the assessment to explain the findings, and do you offer support for intervention implementation?

A good assessment provides more than a diagnosis. It offers a pathway to create positive change, built from ecological strengths, addressing underpinning needs, research-based techniques/programmes for skill development, plus support strategies and accomodations. This can enable someone with dyslexia to understand themselves better and engage in learning more successfully.

If you are considering a dyslexia assessment for you, your child or a student at your school, taking time to understand the assessment process can help ensure the best outcome. If you want to talk more about assessment processes, please contact me via the website.