**8. From assessment to statement of areas of deficit**

The majority of children referred into the author's practice have had developmental difficulties at school, manifesting in problems with language, reading, writing and spelling, as well as associated difficulties with focus, attention and working memory. A number of the children have had previous assessments or have been referred by either their teachers or medical professionals. These difficulties form the focus of discussion in the preliminary interview with the child's parents, as well as preliminary conversation conducted during an initial session with the child.

Following Luria [1], the aim is to move from assessment to statement of areas of deficit and from this to specific suggestions for programmatic intervention. During the initial session with the child, evidence is collected on how the child uses a pencil for drawing and copying, how the child uses language in conversation and in writing and how the child works with integrated picture-based tasks involving comprehension and interpretation. Evidence collected during the second initial session includes indicators of one word reading ability, sentence reading ability, one word spelling ability and sequential spelling ability as tapped by two short tests of dictation.

Besides assessment of basic skills in reading, writing and spelling, the evidence collected in the two initial sessions also enables assessment to be made concerning handedness, eye movements and visual tracking, as well as the potential influences of focus, attention and fatigue on rate of work. This evidence is then interpreted against a framework of additional

<sup>9</sup> At time of writing, the ICD DSM IV criteria are being phased out by South African medical aid societies and replaced by the ICD DSM V criteria. This may affect the codings used in the author's practice [202, 203] in the future, but has not affected the codings used with the children whose results are reported in this and the next chapter.

evidence from a biographical questionnaire completed by the parents, analysis of the child's school books, a reading fluency rating form completed with parents and evidence from previous assessments conducted with the child.

The aim of the initial sessions is thus to develop a preliminary base of observational and test data, which can then be used as a basis for a diagnosis for medical aid purposes, recommendations concerning the need for additional more in-depth testing (e.g. cognitive testing, speech and language and/or visual assessment, more in-depth analysis of phonological and phonic skills) or for more in-depth neurological or paediatric investigation,<sup>10</sup> as well as to recommend specific types of programmatic activities which can be used to address the areas of deficit.

Being based on the DSM IV criteria,<sup>11</sup> the diagnosis then enables parents to be able to claim benefits from their medical aid societies. At the same time, the recommendations then enable work to commence on more in-depth testing in areas where there is evidence of language deficits, reading and writing skills deficits or evidence concerning lack of automaticity in reading, writing and spelling.
