Making the links
Dr Anna Smith
No task is ‘pure’
• Neuropsychological
functions operate together
rather than in isolation
• Theoretically, a pure task
would lack ecological
• We need to examine
• Certainty is not guaranteed
No single diagnostic test
• Dyslexia is heterogenous
• No different from other
developmental disorders
• eg., ADHD is diverse
with several:
 Etiological pathways
 Clinical presentations
 Levels of severity
Two cases of ADHD
Case 1: Dan (12)
• Born prematurely
• low scores on target
detection tasks
• Academically
• Easy to manage
Case 2: Sian (41)
• Talks continuously and
changes subject
• Difficulty keeping job for
very long
• Several relationships in
• Impulsive hobbies that
don’t last long
• Performance is average
on most tasks
Dyslexia is also heterogenous
• Dyslexia can be heterogenous
• We must make judgement on the
neuropsychological evidence we
have gathered
 Test scores
 Background information
 Qualitative information during
• A good assessor will make the
• Comparison of reading single words and
reading in context
 Higher scores in tests of comprehension
suggest inference when reading in context
• Comparison of timed and untimed
reading of single words with WRAT and
 poor reading fluency is more likely to be
observed in older children and adults
• Comparison with PA subtests
 Errors on phonetically plausible words
suggest phonological deficits
• Good readers can be poor spellers
 They tend to make ‘phonetic’ errors eg., spelling cough, as coff
 Poor readers and poor spellers make more ‘non-phonetic’
errors eg, spelling cough as coft
• Good spelling in DASH tests cannot rule out poor spelling
 may be attributable to word selection
 Link standard spelling test with spelling in DASH tests
• Sound based errors are associated with phonological errors
 More often observed in poor readers
• Rule based errors are associated with word structure difficulties
 More often observed in good readers
• Fine motor problems will be seen in DASH
 Note handwriting
 Link with scores from developmental coordination
disorder screening tools
 Link with performance on WRIT diamonds but
may be specific to handwriting
 Compare copy best and copy fast
 Free writing may deteriorate over time
(qualitative observations important here)
• Language difficulties will be
observed in free writing
 Compare scores with WRIT
verbal subscores
 May be consistently poor
rather than decline over
• Don’t forget to look at
spelling and word choice
Phonological awareness
• Subtests may not be equally sensitive:
 Elision subtest – involves repetition and allows for
other visual strategies
 Blending and phoneme isolation are purer
measures of PA
 Use of supplementary tests containing non-words
• eliminates the influence of vocabulary thus a purer test
• May be useful in adults
• Acceptable for APC as long as case made
Phonological awareness
• Scores may not be below average but…
 Qualitative analysis important as tests are not
 Which of the items are difficult:
• Compound words: see[saw] - see
• Syllables: ri[der] - rye
• Onset and rime: ma[n] - ma
• Phonemes: tan[k]s - tangs
Phonological awareness
 Links can be made with TOWRE 2 (sight word
subtest may be better than phonemic decoding
 Links can be made with spelling
• more on this later
 Links with reading single words
• Errors with phonetically plausible real words suggest
phonological awareness problem
Phonological memory
• Non-word repetition task (CTOPP 2)
 CTOPP 2 version does not include many established word
 task is purer
 Can be indicator of specific language impairment (Bishop
• Link with forwards letters and digits (correlated
strongly (Wijsman et al, 2000)
 These are established, familiar sounds
 If deficit here as well, then more generalised problem with
short term memory
Phonological memory
• What other clues might you be looking for?
 Teacher reports
 GORT comprehension subtest – low score may
mean less able to maintain information
 Specific to phonological information? Compare
with manual imitation (TOMAL2) – visual
information may be better held
Working memory
• TOMAL 2 is very useful as we can compare directly
backwards and forwards scores
 Manipulation of letters and numbers may be challenging
 Individuals with dyslexia make reversals of number pairs
and inversions (6 for 9)
• Make links with PA sub-tests: elision requires word
to be held and manipulated in WM
• Make links with memory for stories (TOMAL 2)
 Good for semantic memory
Speed of processing
• Typically measured by Rapid Automatic
• Not seen in all dyslexic individuals
• Possible subtype?
• Speed and quality of visual information is
• Letter identification is slowed
• Links between frequently occurring
letters are not made
Speed of processing
• May be related to orthographic skill rather than
phonemic encoding
• May mean slow access to phonological representations
rather than visual input (cancellation task) or
phonological output (articulation rate)
• Regular and irregular words are equally challenging
• Further reading: Wolf et al (2000) and Araujo et al (2010),
Georgiou et al, 2013
• Links can be made with:
 TOWRE: a good measure of reading fluency
 WIAT reading speed
 If generally slow processing - SDMT – speed of
Language difficulties
• Background may reveal information:
 parental report describes word finding difficulties ‘she
knows the answer but she can’t find the word’
 Significant delay in acquisition of first words
• Verbal subtest of WRIT may reflect account
 requires a qualitative analysis – definitions may involve
pointing and using a basic explanation
• Analogies subtest of WRIT
 a feel for the answer but a difficulty expressing it
• Link with low score on phonological memory tests (Bishop
Language difficulties
• Be aware of discrepancy between performance and verbal
ability eg., average versus 70 (Georgopoulos et al, 2003)
 strict criteria but useful
• Comprehension is often better than production
• Qualitative information can be accessed through responses
on WIAT (an advantage over WRAT)
 Syntax is often impaired
 Mean length of utterance is short
Attentional difficulties
• Parent and teacher report is crucial here
 Inability to concentrate, finish anything, disrupts games
• Qualitative observations during testing also
• Use a screening tool to gather information
• A great website is
• May not be clear indications on tests
 Cognitive Variability is hallmark of ADHD
 poor motivation, distractability during tests
Making links means comparing scores
• Where possible use confidence intervals of 95% but be
cautious with these
• If you have subtests which differ you can use confidence
intervals to be objective
• Convert scaled scores to standard or quotient scores
• Example: Comparison of digit forwards and manual imitation:
 Digit forwards 7 = 85 (SEM is 3) 95% CI is 79-91
 Manual imitation 10 = 100 (SEM is 3) 95% CI is 94-106
 No overlap thus confidence performance is markedly
 Avoid use of the word ‘significant’ as you are not
performing a statistical test
Single subtests versus composites/
• It can be misleading to focus upon one subtest
 Especially if that subtest is not reliable (less than .9
• APC preference is for composite scores where appropriate
• BUT if subtests within a composite are discrepant, it makes no
sense to ‘pool’ scores either
 Use outcomes cautiously
 Consider reliability of each test
 Use qualitative data
• If you don’t feel confident, just report composite scores CIs
Table of SEMS for CTOPP-2 and
Using your own CIs
• You may wish to use your own calculations
but worry that they differ from those
provided in the table
• Use footnotes to make it clear
*Confidence intervals were calculated
using SEMs provided in manual
* Confidence intervals were calculated
using reliability coefficients provided in
the manual
Suggested statements
The scores for Test X and Test Y result in the lack of an overlap of the
associated confidence intervals of 95%. This discrepancy suggests that
the composite score associated with these tests has less meaning than
the individual test scores themselves.
There is a marked discrepancy between Test A and Test X as
defined by the lack of an overlap of the associated confidence
intervals of 95%. This suggests that Learner has difficulties with
skill A in comparison with skill X
It is best to avoid the word ‘significant’ as this implies
a formal test of score differences which has not been
carried out for these tests.
Related flashcards

Dreams in fiction

81 cards


15 cards

Consciousness studies

16 cards

Raving Rabbids

11 cards

Create Flashcards