Tennessee Center for the Study and Treatment of Dyslexia

DIFFERENTIAL DIAGNOSIS for DYSLEXIA (DDD) FORM

Student NameGrade Age

TEST RESULTS / CLINICAL INTERPRETATIONS
This form was designed to provide a framework for considering whether a student who meets state criteria to be classified as learning disabled in reading or written expression demonstrates the diagnostic profile associated with dyslexia and would therefore require intervention appropriate for this type of reading disorder. / Clinical interpretations of YES in this column suggest that dyslexia cannot be ruled out. Additional information is needed to determine this student'’ specific reading problem. / Clinical interpretations of YES for all summary statement in this column suggest this student has a specific reading disability consistent with the diagnosis of dyslexia.
General Intelligence
Most recent IQ test results; date administered ______:
Test: WISC-IV Other test: ______
Full Scale Composite: ______
Verbal Comprehension Composite: ______(VC Composite 90 or above?) NO YES
Perceptual Reasoning Composite: ______(PR Composite 90 or above?) NO YES
Working Memory: ______
Processing Speed: ______/ General intelligence tests within the average range or higher?
NO YES / General intelligence tests within the average range or higher?
NO YES
Oral Language (Listening) Comprehension
Most recent test results; date ______:
Listening Comprehension: ______WIAT-III ______WJ-III
Other test: ______Score: ______
Standard score 90 or above? NO YES
Other data regarding language abilities: ______
Estimates of oral language comprehension:
WJ-III Oral Language Cluster score: ______
Cluster score 90 or above? NO YES
WISC-IV Verbal Comp. Index scores: Vocabulary ______Similarities ______Comprehension ______
All subtest scores 8 or above? NO YES / Listening comprehension skills and oral language comprehension skills have not been formally tested but are estimated to be within the average range or higher?
NO YES / Listening comprehension skills and oral language comprehension skills have been tested and are within the average range or higher?
NO YES
Reading and Spelling
Most recent test results; date ______:
Reading comprehension: ______WIAT-III ______WJ-III
Other test: ______Score: ______
Reading Comprehension 8 or more SS points below Listening Comprehension? NO YES
Word Recognition: ______WIAT-III ______WJ-III
Other test: ______Score: ______
Word Recognition 15+ points lower than Listening Comp. and I.Q.? NO YES
Spelling: ______WIAT-III
Other test: ______Score: ______
Spelling 15+ points lower than Listening Comp. and I.Q.? NO YES
Word Attack/ Pseudoword Decoding: WIAT-III ______WJ-III ______WRMT-R______
Other test: ______Score: ______
Word Attack 15+ points < Listening Comprehension and I.Q.? NO YES / Test results in reading and spelling are incomplete but the data collected thus far is consistent with the profile of dyslexia and suggests that further assessment of reading skills is needed?
NO YES / Test results in reading and spelling are complete and are consistent with the diagnostic profile of dyslexia: Listening Comprehension and I.Q. 15+ points > Word Recognition; Word Analysis and Spelling
NO YES
Phonological Awareness
PAT Segmenting Sentences______
PAT Segmenting Syllables______
CTOPP Phonological Awareness Composite______
CTOPP Alternate Phonological Awareness Composite ______
LAC-3 Phoneme Identification_____
LAC-3 Manipulating Phonemes_____
Other test of phonological awareness: ______Score: ______/ Phonological skills are well below age and grade level?
NO YES
Naming Speed Affects reading rate and word reading accuracy.
CTOPP Rapid Naming ______CTOPP Alternate Rapid Naming / Naming Speed is slower than average?
NO YES / Naming Speed is slower than average?
NO YES

 Middle Tennessee State UniversityMTSU – Center for Dyslexia

May be copied for use in schools.Box 397 – 200 N. Baird Lane

9/01-djsrev. 8/10 eeaMurfreesboro, TN