TOD Case Example: How the Tests of Dyslexia-Comprehensive Can Help You Assess for Adult Dyslexia

Monday, October 16, 2023

The Tests of Dyslexia-Comprehensive (TOD™-C) easels, response sheets, and response booklet.

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

David Ruben is an adult with a long history of reading and spelling difficulties. His preschool teachers initially misread these difficulties as an intellectual disability or behavioral condition. By the 4th grade, however, David was transferred to a general education class. There, he continued to have trouble with reading aloud and spelling but excelled in math and music.

Two of David’s sisters, his father, and his grandfather have a similar academic history, including one sister who was diagnosed with a specific learning disability. David received informal academic support sporadically throughout school, and succeeded in college and graduate school largely because he is highly motivated, and his business courses didn’t require much writing. He also used technology to help him overcome some of the limitations he has in reading and spelling. As an adult, David also received an ADHD diagnosis.

David trained as a stockbroker, a career that capitalized on his considerable math, finance, and social skills. Later, he became a Certified Financial Planner. He’s asked for this evaluation to determine whether he has dyslexia and might be eligible for accommodations on an upcoming retake of the Chartered Financial Analyst (CFA) exam, which he’s failed once and which involves intensive reading and writing.

Test Strategy

Having learned about David’s experiences in school, we were not surprised to find that there were large discrepancies between David’s reading and spelling skills and the skills he’s developed in math.

Reading and Spelling Tests

David’s scores on all the reading and spelling tests in the TOD-C were low. His Reading and Spelling Index (RSI) score was 72, which is in the Well Below Average range. Here are a few takeaways from his assessment:

David used coping strategies to help him as he read. For example, he sometimes whispered the words as he read or held his place in the text by placing his finger on the line.

David had difficulty reading pseudowords and multisyllabic words. This told us he has to work extra hard to apply the rules of phonics when pronouncing unfamiliar words—which slows him down.

David tended to spell words as they sound instead of how they look. One example from the test: Croquet was spelled “crokay.” Spelling errors were common in words of more than two syllables.

Vocabulary and Reasoning Tests

David’s assessment included two measures of vocabulary, both of which fell in the Below Average range. These scores may reflect his avoidance of reading. By contrast, his scores on measures of reasoning ability are considered Above Average. It’s our view that these high reasoning scores make sense, given his math skills, postsecondary academic achievements, and work experience.

Woodcock-Johnson IV Tests of Achievement (WJ IV ACH)

David scored in the 83rd percentile on the Applied Problems test, which is unsurprising given his achievements in math and finance. Similarly, he scored in the 74th percentile on the Calculation test.

TOD-C Self-Rating Scale

David reported that he has ongoing difficulty with basic reading skills, especially longer words. He noted that his reading isn’t particularly fluent or efficient. Those difficulties carry over into his spelling and speaking abilities. David said he would rather listen to reading or involve himself in activities that don’t require reading at all.

Based on these responses, David’s T-score on the rating scale was 71, which indicates a Very High Risk of dyslexia.

Diagnostic Impressions

Based on our observations, David’s self-report, and his test scores, these diagnoses are appropriate:

F81.0. Specific Learning Disorder with Impairment in Reading (Difficulties with reading rate or fluency), Moderate, Current.
F90.1 Attention Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation, Moderate, Past.

Recommendations for Accommodation

Given David’s phonics knowledge, spelling skills and reading rate, David meets the diagnostic criteria for a learning disability (dyslexia), and he should be allowed extended time (double time, or 100% increase) for any licensing exams that involve prolonged reading. This accommodation includes the upcoming CFA exam.

On exams that are in a multiple-choice only format, David should be allowed time and one-half (a 50% increase) to complete the exam. Without the extra time, these exams would be measuring his reading rate rather than his subject knowledge. Furthermore, if an exam requires essay-writing, David should not be penalized for spelling errors. Examiners should only evaluate his content knowledge, not his writing skills.

Recommendations to David

We think it’s important for you to keep building your reading and spelling skills. One good option might be the MindPlay Virtual Reading Coach program. Thirty minutes day, five days a week should be effective in helping you develop phonics skills, improve your spelling, and boost your reading rate. You’ve successfully used so many coping strategies over the years, and we’re optimistic that using an online program like this will provide you with the explicit, systematic instruction you need.

You may find that you need extra time to complete work-related projects that are reading- or writing-intensive. If that’s the case, consider whether disclosing this diagnosis might be a good idea for you. Dyslexia isn’t something that you need to hide.

Outcomes

The TOD-C helped us identify dyslexia in an adult patient who, after a lifetime of reading, writing, and spelling difficulties, needed to access accommodations to pass a career-advancing professional test. The TOD-C’s vocabulary and reasoning tests, combined with math tests from the Woodcock-Johnson IV Achievement test, helped us form a complete picture of David’s academic strengths. We were so pleased to be able to help David achieve his career goals and plan for additional learning in the future.

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.