TOD Case Example: Using the Tests of Dyslexia-Comprehensive in Middle School

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 

Rebecca is a 7th grade student with long-term difficulties in reading and a family history of dyslexia diagnoses. Held back in Grade 3 out of concern about her reading abilities, Rebecca has worked with tutors in and out of school for several years. Her fluency has improved a little, but she still reads slowly.

Rebecca is a hard worker, coming into school early to take advantage of teacher support sessions and spending extra time and effort to complete her assignments. As a result of her willingness to do the extra work, she has achieved A’s and B’s in school. Still, her parents and her teacher are concerned. They are wondering whether she would benefit from the formal accommodations and supports a dyslexia diagnosis would unlock.

Our Testing Strategy

Rebecca took the online version of the TOD-Screener (TOD-S) at Homestead Middle. Two of the three tests in the TOD-S, the Letter and Word Choice test, along with the Question Reading Fluency test, gave us her dyslexia risk index (DRI) score: 71. That score is in the Well Below Average range.

By contrast, her score on the Picture Vocabulary test was 115, in the Above Average range, showing that her receptive vocabulary is strong. Rebecca’s DRI, coupled with the discrepancy between her reading ability and her listening ability, cued us to explore more fully with the TOD-C and TOD-C Parent/Caregiver, Teacher, and Self-Rating Scales.

Rebecca’s Assessment Results 

Three weeks after she took the screener, Rebecca completed the TOD-C in two separate sessions. Each session lasted about an hour and a half.   

TOD-C Index Scores 

The tests within the TOD-S and TOD-C produce three distinct index scores:   

• Reading and Spelling Index (measures these two skillsets) 
• Linguistic Processing Index (measures the language skills that underlie reading and spelling) 
• Dyslexia Diagnostic Index (indicates the probability of dyslexia) 

Reading and Spelling Index (RSI) 

Four tests make up the RSI: Letter and Word Choice and Question Reading Fluency (both from the TOD-S), plus Pseudoword Reading and Irregular Word Spelling (from the TOD-C). Rebecca’s standard score on the tests in this index was 74, in the Well Below Average range. 

Linguistic Processing Index (LPI)

Similarly, the LPI is drawn from four tests: Phonological Manipulation, Rapid Letter Naming, Word Pattern Choice, and Word Memory. On these tests, Rebecca’s standard score was 88, in the Below Average range. It’s important to note that her Word Memory score was significantly higher than the other the scores in the LPI.  

Dyslexia Diagnostic Index (DDI)

The DDI is based on the scores of eight tests: two from the TOD-S and the remaining six from the TOD-C. The DDI is an umbrella score that includes both the RSI and LPI. Rebecca’s DDI score was 78, which is in the Well Below Average Range. A DDI score in this range indicates that there is a Very High Probability that Rebecca has dyslexia.  

Composite Scores  

We used additional tests within the TOD-C to help confirm Rebecca’s diagnosis, and to give us more detailed information about exactly which skills most need support.  

Reading and Spelling Composites 

Rebecca’s reading and spelling composite scores come from tests that assess her knowledge and skill in these areas: 

Linguistic Processing Composites 

Rebecca’s language skills showed some variability, which may be owing to the intensive, explicit instruction she’s received in some of these areas.  

Vocabulary and Reasoning Composites  

The Vocabulary and Reasoning composite score is drawn from four tests: Picture Vocabulary, Picture Analogies, Listening Vocabulary, and Geometric Analogies. Together, they yielded a composite score of 125. When we compared this score to her DDI score (78), we noticed a clinically meaningful discrepancy, which does suggest Rebecca has dyslexia.

We also administered the Symbol to Sound Learning test from the TOD-C assessment. It’s a measure that checks Rebecca’s ability to match sounds to symbols that represent letters, blending them to produce real words. These associations were difficult for her—which is unsurprising since it is a characteristic of dyslexia. Rebecca’s score on this measure (87) is considered Below Average.  

TOD-C Teacher, Parent, and Self-Rating Scales

Rebecca’s teacher, Mr. Williams, described her oral language and reasoning abilities as “similar to or better than” those of other students in her grade. He has observed her difficulty with basic reading, orthographic, and spelling skills, and has noticed how slowly she reads compared to her peers. He pointed out, however, that Rebecca reads aloud with great expression and pays attention to punctuation in her writing. Overall, his responses produced a T-score of 67, which shows a High Risk of dyslexia.  

Mrs. Webber, Rebecca’s mom, completed the Parent/Caregiver rating scale. From her view, Rebecca has the most difficulty with reading fluency, even though she enjoys learning. She also noted Rebecca’s difficulty with basic reading, orthographic, and spelling skills. Owing to these difficulties, Rebecca takes a long time to finish any homework assignment that involves reading. Mrs. Webber’s responses produced a T-score of 72, which indicates a Very High Risk of dyslexia.  

Our Diagnostic Impressions 

Using the diagnostic criteria outline in the DSM-5-TR, we have determined that Rebecca has a Specific Learning Disorder with Impairment in Reading (dyslexia). Given her test results, she is eligible for an IEP, 504 plan, or the equivalent.   

Interventions & Recommendations 

After analyzing Rebecca’s performance on the TOD-S and TOD-C and consulting the Dyslexia Interventions and Recommendations: A Companion Guide to the Tests of Dyslexia (TOD), the dyslexia evaluation team feels the following supports would build on Rebecca’s many strengths and help improve her reading abilities: 

1. We recommend that Rebecca’s teachers provide her with extended time on school assignments and tests. These accommodations should be formally outlined in a 504 plan, IEP, or similar document.  
2. Rebecca needs assistive technology to make longer texts and reading materials more accessible. Speech-to-text software should also be provided to help her generate ideas and complete other early-stage processes in writing assignments. Teachers should not penalize Rebecca for spelling errors in her work.  
3. Rebecca needs access to the regular curriculum for students in her grade, but her teachers should be prepared to adjust assignments to accommodate a slower reading rate. For example, if it’s clear Rebecca has mastered a skill or concept, her teachers should shorten her assignments to prevent her from over-working. 
4. Some students with slow reading speed also work extra hard to master math facts. Rebecca may need extra time accommodations for tasks involving math fluency. 
5. Intensive, explicit instruction should focus on reading efficiency and fluency, especially repeated reading strategies to help boost her confidence and skill level.  
6. Rebecca should keep reading for pleasure because it builds her vocabulary, comprehension, and fluency. It’s important to allow her to choose her own reading material.  

Outcomes

Using the TOD-S and TOD-C, Rebecca’s dyslexia evaluation team was able to confirm a diagnosis of dyslexia following years of reading difficulties, intensive instruction, and other interventions. As the academic and organizational demands of middle school increase, it’s particularly important that Rebecca have access to the specialized interventions and supports that an IEP or 504 plan can provide. We now know much more about Rebecca’s many strengths in addition to her areas of need, so we can work with her family to co-create an educational environment that supports and encourages her.  

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. 

Related to this TOD Case Example: 

• Introduction to the Tests of Dyslexia (TOD™) 
• Assessing for Dyslexia in English Learners 
• Dyslexia Assessment Best Practice FAQs