**7. Assessment of reading, writing and spelling difficulties in the author's practice**

Country contexts differ. Much of the literature reviewed has been based on work with North American children and to lesser extent British children. This chapter focuses on the fluency processes applying to children in South Africa, and for this reason this section focuses on the format used to assess reading, writing and spelling in the author's practice, which is based in the northern suburbs of Johannesburg.<sup>6</sup> This reflects similar procedures used by other educational psychologists in South Africa to provide evidence which can be used not only for diagnostic purposes against what are termed the ICD DSM IV criteria by South African medical

<sup>5</sup> As indicated by the range of deficits found empirically in children with reading difficulties. These would not only indicate associated language-based and phonological deficits as proposed by Snowling et al. [171], Snowling [172], Stanovich [173, 174] and Vellutino [175, 176], but also a range of additional deficits as indicated by Rudel [177], Eden and Zeffiro [178], Wolf and Bowers [179], Nicolson and Fawcett [118, 119, 180–182], Nicolson et al. [183], Tallal et al. [184, 185], Stein and Walsh [186], Swan and Goswami [187], Stein [188], Nicolson et al. [189], Goswami et al. [190], Facoetti et al. [191], Bosse et al. [192] and Nicolson et al. [193].

<sup>6</sup> Affluence of parents may have affected the results of the sample of children referred to in this chapter. Parents in the northern suburbs of Johannesburg have traditionally been from higher socio-economic brackets than parents in other residential areas, or the reason that as the city evolved, the eastern, western and southern suburbs were closer to the dust, pollution as well as the physical danger of underground blasting in the gold mines. As commercial gold mining has been phased out as the underlying gold-bearing reef has been exhausted, wealth distinctions affecting residential areas have become more blurred. The majority of the children in the author's practice come from affluent households in a wide catchment area, with many parents traveling from the eastern, southern and western suburbs, and some parents travelling as much as 600 km from out of town on a weekend to bring their children for assessment or for educational therapy sessions. Similarly the referral and schooling network in the practice covers a wide geographical area. This is possible with the advent of email and cellphones, and this has been enabled by the fact that our reading, writing and spelling fluency materials and manuals are electronic and can be delivered by email.

aid societies,<sup>7</sup> but also as background for the development of programmes which can be used for working with children with deficits on a functional level.

As with the repetitive methods used for developing fluency in reading, the procedures used by the author for developing automaticity in writing and spelling are based on Luria's assumption [2, 3, 11] that language mediates reading, writing and spelling and that repetition and practice increases automaticity at each level of input and integration and fluency at each level of output. The methods used in the author's practice are multisensory, repetitive and integrative, following Nicolson and Fawcett's [118] and Nicolson's [170] contention that automaticity can relate to a variety of different reading, writing and spelling skills and that therapeutic techniques need to be capable of addressing a variety of areas of deficit in children

It is important to stress that these types of fluency-based activities are not undertaken in isolation, but as an integral part of an individual programme directed at a range of difficulties identified through assessment. How this is done will be outlined in the following

Country contexts differ. Much of the literature reviewed has been based on work with North American children and to lesser extent British children. This chapter focuses on the fluency processes applying to children in South Africa, and for this reason this section focuses on the format used to assess reading, writing and spelling in the author's practice, which is based in

tional psychologists in South Africa to provide evidence which can be used not only for diagnostic purposes against what are termed the ICD DSM IV criteria by South African medical

As indicated by the range of deficits found empirically in children with reading difficulties. These would not only indicate associated language-based and phonological deficits as proposed by Snowling et al. [171], Snowling [172], Stanovich [173, 174] and Vellutino [175, 176], but also a range of additional deficits as indicated by Rudel [177], Eden and Zeffiro [178], Wolf and Bowers [179], Nicolson and Fawcett [118, 119, 180–182], Nicolson et al. [183], Tallal et al. [184, 185], Stein and Walsh [186], Swan and Goswami [187], Stein [188], Nicolson et al. [189], Goswami et al. [190], Facoetti et al. [191],

Affluence of parents may have affected the results of the sample of children referred to in this chapter. Parents in the northern suburbs of Johannesburg have traditionally been from higher socio-economic brackets than parents in other residential areas, or the reason that as the city evolved, the eastern, western and southern suburbs were closer to the dust, pollution as well as the physical danger of underground blasting in the gold mines. As commercial gold mining has been phased out as the underlying gold-bearing reef has been exhausted, wealth distinctions affecting residential areas have become more blurred. The majority of the children in the author's practice come from affluent households in a wide catchment area, with many parents traveling from the eastern, southern and western suburbs, and some parents travelling as much as 600 km from out of town on a weekend to bring their children for assessment or for educational therapy sessions. Similarly the referral and schooling network in the practice covers a wide geographical area. This is possible with the advent of email and cellphones, and this has been enabled by the fact that our reading, writing and spelling fluency materials and manuals are electronic and

This reflects similar procedures used by other educa-

**7. Assessment of reading, writing and spelling difficulties in the** 

with reading, writing and spelling difficulties.<sup>5</sup>

126 Learning Disabilities - An International Perspective

the northern suburbs of Johannesburg.<sup>6</sup>

Bosse et al. [192] and Nicolson et al. [193].

can be delivered by email.

sections.

5

6

**author's practice**

Four screening tests are used at the outset of the assessment process in the author's practice. These are designed to yield information about reading single words and reading words in sequence and writing and spelling single words and words in sequence. The results on these tests are then reported using reading, spelling and dictation ages, for the reason that the South African ICD DSM IV criteria are based on age-related expectancies, which are then used by the medical aid societies for the management of claims and benefits. 8

Besides following the guidelines of the DSM IV criteria in focusing on basic skills in reading and written expression and in reporting age levels for test results, the assessment procedures followed in the author's practice are also based on the procedures suggested by Luria [1] for clinical assessment of reading and writing. Qualitative analysis of an initial interview is combined with analysis of drawings, pragmatic writing-based tasks and observation in an initial ice-breaking session with the child, followed by a second initial session with the child during which the four screening tests are used to establish levels of basic skills in reading, writing and spelling. This information is then combined with additional evidence from a biographical inventory, parental interview and more formal psychometric testing.

The author also follows Luria's suggestion [201] that assessment should start with a preliminary conversation and then include a careful history, detailed observation of behaviour,

<sup>7</sup> The ICD-10 (International Statistical Classification of Diseases and Related Health Problems – 10th Revision) is a diagnostic coding standard owned and maintained by the World Health Organisation (WHO) [194]. The coding standard has been adopted by the National Health Information System of South Africa (NHISSA) and forms part of the health information strategy of the South African National Department of Health (NDoH). The standard serves as the diagnostic coding standard of choice in both the public and private healthcare sectors in South Africa for morbidity coding under Regulation 5(f) of the Medical Schemes Act 131 of 1998 [195, 196].

In psychology in South Africa, due to the similarity between the DSM IV and ICD classification systems, the DSM IV criteria have been used since August 2005 for the purpose of deriving ICD-10 codes by all psychology healthcare providers except pharmacists, clinical support and allied healthcare providers. The mandatory submission of ICD-10 codes by these groups was postponed until 1 January 2006. With effect from this date, the criteria have been referred to as the ICD DSM IV criteria, and ICD-10 coding using these criteria has been mandatory for all psychology health providers (including pharmacists and clinical support and allied healthcare providers) under government regulation in South Africa.

<sup>8</sup> There have been differences between the ICD and the DSM criteria historically, for the reason that the ICD is produced by a global health agency (The World Health Organisation) with a constitutional public health mission, while the DSM is produced by a national professional association (The American Psychiatric Association). Since 2005, South African medical aid societies have used both sets of criteria interchangeably in providing benefits for psychological work, for the reason that while the DSM and ICD have over time become very similar, due to collaboration between the two organizations. The coding system utilized by the DSM-IV [197] is designed to correspond with codes from the International Classification of Diseases, Ninth Revision, Clinical Modification, commonly referred to as the ICD-9-CM [198]. The coding system for the later revised DSM-IV TR [199] is designed to correspond with codes from the International Classification of Diseases, Tenth Revision, commonly referred to as ICD-10 [194]. Government regulation has been based on a national task team set up in South Africa involving representatives of the medical aid societies and of the Department of Health [200]. Based on the recommendations of the national task team, what are termed the ICD DSM-IV criteria have been adopted by all medical aid societies to cover the services provided by psychologists and other allied health workers registered with the South African Board of Healthcare Providers. This board, in turn, provides practice numbers to South African psychology and allied healthcare providers registered with the Health Professions Council of South Africa.

analysis of neurological symptoms and a series of additional objective tests. Luria suggests that the examination needs to be relatively short and involves methods of experimental psychological investigation applied to clinical practice.

The methods of examination used in the initial sessions spent working with the child also include pragmatic assessment of repetitive and spontaneous speech, writing, reading, comprehension of texts and the solution of problems, in order to establish how reading, writing and spelling are used by the child as a functional system. This informal evidence is then combined with more formal testing of reading, writing and spelling skills and interpreted, as Luria suggests, against a framework of knowledge of the types of difficulties normally associated with the functional system under investigation, based on current literature (for example [104, 170]).

Assessment leads to a functional description of deficits sufficient for diagnosis of learning disability to meet medical aid requirements,<sup>9</sup> as opposed to an attempt to link this to possible labelling of the child as dyslexic. The standpoint adopted by the author would accord with the suggestions made by Elliott and Grigorenko [204] and Elliott [205], namely that adding a label adds little of clarity to a functional description of deficits in reading, writing and spelling for purposes of intervention. Similarly, the pattern of scores on subtests of an IQ test is used functionally to indicate areas of cognitive and language strength and weakness, as well as areas in sequencing and working memory which may need to be worked with in therapy.
