TOD Case Example: Using the Tests of Dyslexia-Early to Identify Dyslexia

Thursday, October 12, 2023

The Tests of Dyslexia-Early (TOD™-E) easel and record form

The summary below is based on an actual case example from the TOD authors Nancy Mather, PhD, Sherry Bell, PhD, Steve McCallum, PhD, and Barbara Wendling, MA. We’ve changed the personally identifiable information to protect the privacy of the student and his family.

Background

Ryan Garcia is six years old. He’s curious, funny, active, and social. He’s had abundant exposure to all sorts of activities and experiences: summer camps, Sunday school, parks & recreation programs, and library story hours. He’s also had ample explicit instruction in phonemic awareness and phonics in preschool programs he’s attended since the age of two. That’s why his parents referred him for dyslexia evaluation: Despite good instruction and a love of stories read aloud to him, Ryan struggles to read and write. Whether he’s reading in class or at home, he fatigues and becomes frustrated easily. What he writes is hard to understand.

Our Testing Strategy

Based on his background and TOD-Screener results, we administered these assessments in two separate sessions, each one lasting around an hour.

Tests of Dyslexia-Early (TOD-E)
TOD Parent/Caregiver and Teacher Rating Scales
Written Language and Math tests from the Woodcock Johnson IV Tests of Achievement (WJ IV ACH)

We chose this approach because we wanted a clear picture of his linguistic abilities and his reading and writing skills, in addition to his dyslexia risk. We also wanted to be able to compare them to his abilities in other areas.

Ryan’s Index Scores

In the TOD-E, all tests except Picture Vocabulary contribute to the Early Dyslexia Diagnostic Index (EDDI). When we analyzed Ryan’s performance, we saw significant differences in scores from test to test. For example, Ryan had an Average score on segmentation and rhyming tests but had a Well Below Average score on the rapid naming test. Because of the discrepancy, we took extra care with interpreting his performance. Overall, Ryan’s EDDI score was 75, which is in the Well Below Average range, telling us that he has a Very High Probability of dyslexia.

When we reviewed Ryan’s scores on the five tests that make up the Early Reading and Spelling Index (ERSI), we noted a total score of 74, in the Well Below Average range. Again, we saw some variability in how he performed from one test to another within that index.

Ryan’s scores on the three tests included in the Early Linguistic Processing Index (ELPI) were in the Below Average range. He had higher scores in rhyming and early segmenting (Average) and lower scores on early rapid number and letter naming (Well Below Average).

When we compare Ryan’s scores on the tests most sensitive to dyslexia (EDDI) to his results on the Picture Vocabulary test, which measures his receptive vocabulary, we were struck by the difference. It clearly indicated dyslexia.

Ryan’s Composite Scores

The TOD-E gave us insights into four sets of skills and abilities: Early Sight Word Acquisition, Early Phonics, Early Basic Reading Skills, and Early Phonological Awareness. On tests that involved Early Sight Word Acquisition, his combined score of 67 indicated he was Significantly Below Average on both tests. The combined score for two Early Phonics Knowledge tests was 86—that’s considered Below Average—but scores differed between the two tests.

On the two tests that measure Early Basic Reading Skills, Ryan’s standard score was 79, in the Well Below Average range. Once again, there was a notable difference between his ability to recognize sight words and his knowledge of letters and sounds. Finally, on the two tests that track Early Phonological Awareness, Ryan’s total score was 92, in the Average range. His rhyming and early segmenting abilities were about equally developed.

Ryan’s Written Language and Math Abilities

To get a different perspective on Ryan’s writing and spelling skills, we used the WJ IV ACH spelling and writing samples. His standard score on this measure was 89—Below Average. On two math measures, Calculation and Applied Problems, however, his scores were Above Average. He understood basic math facts and could solve problems—even though he sometimes reversed or transposed numbers.

TOD-E Teacher and Parent/Caregiver Rating Scales

Ms. Eston, Ryan’s teacher, reported that his oral language and reasoning were more advanced than many of his classmates. She considered his rhyming, blending, and segmenting abilities typical for a first grader. And she pointed out that he has a hard time telling the difference between some look-alike letters, as well as difficulty with spelling some high-frequency words.

Her other observation was that Ryan never chooses to read on his own, even though he likes listening to other people read stories. Taken together, her responses gave a T-score of 71—which correlates to a Very High Risk of dyslexia.

Ryan’s parents reported that his father had trouble with reading. They also said Ryan had speech and language services when he was in pre-K and kindergarten. They see his current oral language and reasoning abilities as more advanced than his peers’. Even so, they said, he has trouble with spelling and with learning the names of letters. He sometimes mixes up look-alike letters. Like Ryan’s teacher, the Garcias noticed that Ryan avoids reading and writing. In fact, he has to work extra hard to carry out the fine motor aspects of writing, tracing, and cutting.

The Garcias’ rating scale responses produced a T-score of 77, which is characterized as a Very High Risk of dyslexia.

Recommended Interventions

Based on his background, his TOD and WJ IV ACH assessment response patterns, and what our team has observed, our diagnostic impression is that Ryan has a specific learning disability in reading (dyslexia) and in written language (dysgraphia).

Using the TOD Interventions companion guide and our clinical experience, we recommend the following interventions:

At School

His school team should consider Ryan’s eligibility for SLD services, especially systematic interventions to address his difficulty with reading and spelling.
While his reading and writing skills are improving, Ryan’s teachers will need to adjust the level of difficulty in his classwork and homework.
We recommend allowing Ryan to use the digital program Read, Write, and Type as an alternative to regular homework. Learning opportunities such as oral reports and project-based learning are a preferable way for Ryan to show what he knows. It’s also a good idea to build on areas where he’s already strong, such as vocabulary and math learning opportunities.

At Home

To grow, Ryan needs specialized instruction from a teacher trained to work with attention and reading difficulties. One option might be intensive private tutoring, especially during the summer. We’d recommend one hour, three times a week.
To minimize frustration, Ryan’s homework time should be broken into short periods of around 10-15 minutes, followed by a rewarding activity break. For homework periods that last longer, periodic tokens or rewards will help him stay motivated.
Keep reading books to Ryan—especially on topics he loves. That will grow his vocabulary and his interest in reading.

First Steps

Ryan needs an intensive synthetic phonics program to teach him letter-sound relationships. He needs immediate instruction to build his recognition of common letter patterns and spelling rules, as well as his ability to break words into syllables.
To develop his early literacy skill, try a program such as Road to the Code.
Ryan also needs a systematic spelling program. We’ve used Scholastic Success with Spelling (Grade 1) with success.
One-minute speed drills will help Ryan get faster and more accurate pronouncing sight words and irregular words. It’s important to use the drills and track his performance daily.
Decodable texts will help develop Ryan’s phonics skills.
Don’t penalize Ryan when he reverses or transposes numbers in math. Remind him to check larger numbers using place value.

Outcomes

The TOD-S and TOD-E gave us the information we needed to identify the probability that Ryan has dyslexia. The indexes and composites were useful as diagnostic indicators, but perhaps just as important, they showed us where to focus our instruction and intervention recommendations.

The rating scales provided us with much needed context and helped us identify risk factors in Ryan’s background. Using the interventions guide, we were able to provide specific guidance to his teachers and family. Later in the school year, we’ll be able to work with his teachers to monitor progress with growth scores.

This case example provides information based on the Tests of Dyslexia (TOD), published by WPS. The original case example appears in Chapter 3 of the TOD Manual.