Administering LADS Plus screening
Setting the scene
Often individuals are referred from other agencies or services to unfamiliar individuals for the screening process to be administered. A part of the process in such instances must provide the opportunity to build up a rapport and trust between the client and the administrator. Although LADS Plus can be used to screen large numbers of individuals simultaneously, when working with this group of clients it is usually more effective to work on a one-to-one basis. The reasons for this are:
- Individuals may well require emotional support as they might find the process very stressful.
- Individuals may be unable to operate a computer effectively. The difficulty and amounts of concentration required to undertake the mechanical operations could result in an inaccurate representation of the results being produced.
- The initial instructions given within each test of the LADS Plus may require some explanation and some support may be required in order to coach an individual through the practice examples contained within each test.
- Often individuals require positive reinforcement and encouragement throughout the process.
It should also be understood that an individual may have low levels of literacy for a variety of reasons other than dyslexia and the potential for such factors also needs to be explored. These factors could include:
Inadequate education. If an individual has had limited opportunity to access education then it would not be surprising that their literacy levels may be lower than expected.
Broken or disrupted education. If an individual has encountered frequent changes in education such as many changes of school it may also result in lower than expected literacy levels.
Disrupted social background. If there is a history of social disruption this may also have had an impact on an individual in terms of them being receptive to education due to emotional upheaval etc.
People of lower ability levels. Individuals who are of lower intelligence may well exhibit indicators that are similar to those of dyslexia, for example poor literacy/numeracy skills and difficulty with acquiring work related skills. Although this is not to say that some one of lower overall intelligence cannot also have dyslexia.
People from diverse/different communities or ethnic minorities. Individuals who are part of diverse/different communities or ethnic minorities may not have accessed formal education in the way that might be expected and within some communities literacy is not necessarily viewed as an important or valuable skill for all individuals to develop.
People who have suffered a brain injury. In some circumstances damage to the brain sustained through an injury can also present very similar to dyslexia.
People who have a history of substance abuse. A history of long-term substance abuse may affect an individual’s cognitive (thought processing) skills, and where this is suspected such an issue should be factored into the overall analysis of the results, although such a factor would not also exclude an individual from also having dyslexia. If an individual is currently using any substance that may affect performance it is worth being cautious within the screening process as such usage may well affect the results. This also includes the use of some prescription medications.
People with physical difficulties. Before continuing with any screening for dyslexia it is always advisable to rule out any other physical factors such as previously undiagnosed problems with hearing or eyesight particularly as low levels of literacy or socio/economic factors may have presented a barrier for an individual in terms of accessing health care provision.
Building a rapport
Whilst each individual administering the LADS Plus will have their own way of doing this it is worth noting some useful points. Often individuals are referred for screening without any real knowledge or understanding of what the process involves, or even what they are there for, and it is important that anyone going through this process is informed about what it will involve and more importantly that they are in control of the process, i.e. that if they do not wish either to undertake or continue with the process they can stop at any time.
It is also worth finding out information about previous screenings/assessments that have been undertaken and ruling in or out any of the factors that could influence the results such as those listed above. Usually the best approach is to have a discussion with the client as opposed to a more formal interview. Where the administrator wishes to make notes of such a discussion it is also important to explain to the client the purpose of such notes and where or how they will be used in the future. What is not unusual, though, as part of this process is that during such an initial discussion the client may give very limited information, often more information can be gathered at the feedback part of the process when the stress levels have been reduced.
Explaining the screening process
After initially ensuring that the client is comfortable physically and that the environment is suitable an overview of the process should be given. This should include information about why they are there, i.e. to undertake a screening for dyslexia using a computer-based set of activities. Again, another check should be made to ensure that they are happy to continue. It should then be established whether or not the client wishes to operate the computer or whether they would prefer the administrator to undertake this task. Once these choices have been made the administrator can progress to the registration of the client on the system. Completion of this will lead to the initial screen listing the activities to be undertaken on the screen.
It should be explained to the client that the screening process requires them to complete a set of five short activities of which all but the first are blanked out on purpose but that these are verbal reasoning, word recognition, word construction and memory. The reason for doing this is to ensure that the client feels that they will be fully informed of all aspects of the process, particularly if they are not able to read the words on the list for themselves.
Explain that they have to do the nonverbal reasoning task first followed by the verbal reasoning task, but that after this one they can choose which they would like to do or they can follow the order in which they appear. Although they can take a break after any of the activities the program should not be stopped in the middle of the activities. With each activity the computer will give them some instructions but reassure the client that you are there to give them any assistance if required, although you cannot give them the answers and that in fact you do not know the answers. This seems to really help individuals, in that they feel that if the administrator doesn’t know the answers then it doesn’t feel as if you are judging them; you are, in fact, on an equal footing.
Finally double check that the client does want to continue.
Administering the tests
Nonverbal and verbal Reasoning
Clicking on the icon will start these test and the instructions will be given. Some individuals can find the tasks in both these tests very daunting, again reassurance is vital to identify that these are not like tests that you can pass or fail. After the instructions have been completed it is helpful to go through them again verbally and using the picture on the screen to illustrate, explaining that what is required, choosing from the options on screen they have to pick which one they think is most appropriate. In the case of verbal reasoning, if the Administrator suspects that the person may not be able to read all the words, the option to hear the words spoken by the computer should be selected. Some individuals may be embarrassed or hesitant to request this so the Administrator should take the initiative. Ask them to point at the one they would like to choose if the client is not operating the computer. Also, in the nonverbal reasoning test explain that on the real task there will be a bar at the top of the screen that is the timer, reassuring them that they have plenty of time to make their choice although it will make a noise when they are running out of time. If you feel that the timer will put too much pressure on the client then turn it off, but most seem to cope with it and prefer to be able to see how much time they have.
Another aspect to identify is that the tasks will become harder/more difficult and will continue to do so until the computer feels that it has found their level then it will stop and they have completed the activity.
On occasions it may be necessary to coach the individual with the first item to build up their confidence. In the nonverbal reasoning test this could be by pointing out that looking across the grid they can see that the circles are getting bigger, and ask which one would they choose from the bottom. Once this has been completed they can continue to make their choices without further coaching. It is also well worth noting how they tackle each of the tasks, what strategies they use; quite often individuals will verbalise what they are thinking and this can provide a useful insight to the thinking strategies that they are using and that could be applied to other areas. Throughout the task give reassurance, providing this doesn’t disturb them during the task. On completion, congratulate them on how well they have done.
Note that some individuals who are anxious, unconfident or not used to being tested may take significantly longer on these tests, as they may need to ponder the possible answers for quite a while. They should be given time to do this and not rushed, as this could lead to unreliable results.
This is perhaps the most challenging of the tasks for such clients for several reasons:
- It is testing those skills that may be very weak.
- The vocabulary used within the test is quite challenging and may be unfamiliar.
- It is one where the client suspects that they are getting the answers wrong.
- As some of the words displayed look very similar it is difficult, even if they think they know the word, to pick the correct option.
- Although for an individual who is able to read at a reasonable level there is sufficient time, for those with very weak skills in this area there is not enough time for them to examine every word displayed carefully.
If the administrator knows or suspects very low levels of literacy it is worth telling the client that they might find the task more difficult, and perhaps adding that you, the administrator find it hard also, but that if they are not sure of the answer they can either simply guess, pick the one that looks most familiar or if the administrator is operating the computer say “pass”, at which point an incorrect option can be chosen to move the activity on. Throughout the activity it is sometimes helpful to encourage the client by telling them that they are doing well.
During the practice elements it is advisable to coach the client through them, if required, to ensure that they pick the correct options as the response from the program if they pick an incorrect one is a little blunt and can further diminish an individual’s confidence.
Again, additional information can be gathered about how an individual is tackling the activity, as often the client will attempt to sound out the word. Sometimes initially the client will ask the administrator what the word is, at which point it has to be explained that unfortunately you cannot tell them. Upon completion of the activity reassure the client that they did well and that this one is probably the most difficult of all the activities they will undertake.
The instructions for this activity usually require further clarification although most individuals complete the task quite easily once they understand what is required. Following the instructions from the computer, coach the individual through the practice elements. Rather than use the word ‘syllable’ it is easier to understand if the term ‘chunk’ is used, so explain that they will hear a word and then they need to build the word from the chunks in the grid, but that the words they will hear are not real words just ‘made up’ ones. Sometimes an individual will ask you to repeat the word after it has been spoken by the computer, explain that you are not allowed to do this, unless you feel that there has been an outside noise or disturbance that has actually prevented them from hearing it.
This activity can yield some very helpful information, e.g.
- An individual may pick up the first syllable but miss the middle or end one.
- They may repeatedly confuse similar sounds.
- They may be unable to ‘let go’ of the previous word when the next one is given and have a very erratic profile of performance getting alternate ones correct.
- They may frequently forget the given word or chunks of that word
- It might provide an indication of their decoding skills in terms of whether or not they can deal with/identify individual letter sounds, blends, long and short vowel sounds, etc.
All such factors give an indication of both the individual’s ability to process auditory information and the skills/strategies being used and also the level of such skills. Such information can then be used to inform programmes of support and/or intervention.
The instructions that accompany this activity can be a little confusing to some individuals so it is worth explaining what is required in simple terms and where necessary, working through a verbal example in addition to the practice item given. Many individuals find this activity very challenging and it is best to remain as unobtrusive as possible during its administration. It is, however, a relatively quick one. Here, again, it is worth noting any strategies used, for example:
- Verbally repeating the sequence.
- Using fingers to remember numbers
- The individual placing their fingers on the keys to ‘feel’ the sequence
- Pretending to key the numbers into a phone keypad.
All such strategies may give an indication of both the preferred learning style and the strategies that they use to remember information.