Welcome to WBR: Week 1! If you haven't already, please read the Intro post explaining what WBR is all about. This post is meant to build off this early post where I talk in general about report readability, before providing an example of a summary I'd pared down to the ninth grade reading level.
Here, I want to provide additional examples to better illustrate the idea of report readability.
If you're anything like me, you learned to write reports in grad school, on internship, and/or on post-doc, mostly from copying examples your supervisors gave you, or stealing ideas from the few sample reports published in the small collection of books on report writing.
The problem is, our way of writing - the one almost all of us learned - results in reports that are unreadable. I don't mean they are bad reports, I mean that the intended reader of the report literally cannot read it. The average readability of most child assessment reports is at the mid-college level, while only about 30% of Americans have a college degree.
I'm incredibly guilty of writing unreadable reports. Before I started doing research on this topic, I had never even thought about the readability of my reports. When I started running the Readability Stats on the summary section of my reports, I was shocked - I averaged somewhere around the 15th grade level, with something like 15% passive sentences.
I've been working on it, and my natural writing style is now at about the 13th to 14th grade level, with about 7-8% passive sentences. Which is... better. And yet still unreadable.
Getting my reports down to something the average American can read takes me a lot of work. Usually, when I need to make a report more readable, I write the report in my usual manner, and then pare it down. This post shows that "more readable" version of a report summary. I originally worked on the readability of this report because the parents speak English as a second language, and I felt they needed something that was written in readable English. I chose this [de-idenfitied] example because it is a very straightforward case, so hopefully the case conceptualization is not a distraction to the main point about readability. As a reminder, the "more readable" version is at about the 9th grade reading level, with a reading ease of 61.
Well. Below is what the "original" looked like [de-identified in the same way the more readable version was de-identified]. This original has a 13th grade reading level and a reading ease of 38. While it felt "understandable" to me while I was writing it, a reading ease of 38 is simply inaccessible to most readers, even if it's only 2 pages long and contains some bullet points. Here goes:
SUMMARY AND IMPRESSIONS
Jane is 8 year-old bilingual (English/Hindi) girl who is experiencing difficulties in reading that are impacting her ability to make effective academic progress and her emotional well-being. The results of this evaluation show Jane has above average cognitive and language development and many other areas of strength. However, she is demonstrating weaknesses in language-based learning skills and processing speed, and she is at risk for developing anxiety and/or depression secondary to these challenges. The diagnoses below are provided based on Jane’s profile of strengths and weaknesses, as described in more detail in the following paragraphs.
· ICD 10 Code F81.0: Dyslexia
· At risk for anxiety/depression secondary to learning challenges
What Are Jane’s Strengths?
Jane’s test results indicate that she has the resources to solve a wide variety of problems both within and outside of the school setting. Jane’s cognitive skills are developing nicely, and currently fall in the high average range overall (WISC-V General Abilities Index = 117, 87th percentile). She demonstrated solid and generally even development on verbal problem-solving tasks, visual-spatial problem-solving tasks, and abstract nonverbal problem-solving tasks, with her skills in all of these areas falling between the 81st and 88th percentile for her age. Jane’s verbal problem-solving skills will help her take in new information, compare and contrast ideas, and express what she knows using words. Her visual-spatial problem-solving skills will help her solve puzzles, build, design, and navigate her environment. Jane’s abstract nonverbal problem-solving skills will help her grasp patterns and think about sequences and quantities. These are also nice areas of strength that will support Jane in learning new skills.
Jane also show strengths in her language and memory skills when tested in English. Her overall language development in English is in the high average range (CELF-5 Core Language = 111, 77th percentile). Like many bilingual children, her language proficiency is very strong in the language she speaks at school. Jane demonstrated a slight advantage for her receptive language skills, or ability to understand others, over her expressive language skills, or ability to communicate her wants, needs, and ideas. However, both her receptive and expressive language skills are in the average range or above. Jane’s memory for verbal material such as a story is also strong, and at the 63rd percentile for her age. Jane’s learning difficulties are clearly not related to being bilingual or to limited English proficiency.
Jane also shows solid sensorimotor skills. Her fine-motor speed and dexterity is average to well above average for her age, meaning she can easily and efficiently complete tasks that require fine-motor skills, like handwriting and drawing. Her visual perception skills are age-appropriate, which will help support her in accurately interpreting what she sees. Jane also has average visual-motor integration, or hand-eye coordination, for her age. This will help support her in completing hands-on tasks both within and outside of the school setting.
Jane also shows nicely-developed executive functioning skills. For example, she can pay attention as well as other students her age. She also showed age-appropriate short-term memory for verbal and visual information (WISC-V Working Memory Index = 107, 68th percentile). This means she can effectively “hold on” to information while she is following directions or performing a task with that information. Jane was also able to break a large task down into steps, and work through those steps. This means her organizational and planning skills are at expected levels of her age. Consistent with her scores on direct testing, her parents rated her everyday executive functioning skills as average for her age. These information processing skills will help Jane focus, keep ideas in mind while working, and plan and organize her thoughts, feelings, and behaviors as needed in order to set and reach goals.
In addition to these neurocognitive strengths, Jane presents with many interpersonal strengths and interests. Jane is friendly, hard-working, and eager to please. She is also well-behaved at home and at school, and well-liked by adults and peers. Jane also has a wide range of interests and especially enjoys active play and sports. Jane participates in soccer, gymnastics (tumbling), and parkour. She also loves art.
What Are Jane’s Vulnerabilities?
While she has many strengths, Jane demonstrates some challenges with the basic language-based learning processes that support efficient reading and writing. More specifically, during this evaluation, she demonstrated weaknesses in her:
Sophisticated phonological awareness: Understanding how sounds combine to form words (CTOPP-2 Phonological Awareness = 90, 25th percentile, a score which is 23 points below her verbal problem-solving skills)
Rapid Naming Speed: Quick, effortless recall of information learned through rote memory, such as letter and number names, color names, and basic math facts (CTOPP-2 Rapid Naming = 82, 12th percentile).
These difficulties with processing, understanding, and combining sounds and rapid naming are significantly impacting Jane’s progress in learning to read, spell, and write. Her academic achievement test results show her academic achievement in these language-based subjects is much lower than expected given her above average verbal and language abilities. Her single-word reading skills, decoding, and reading fluency all fell at the early first grade level, or a full year behind her actual grade level. Jane’s single-word spelling skills fell at the mid-first grade level, and notably she often omitted sounds in words she was trying to spell. Her scores on all of these tests fell in the well below average to low average ranges. Her overall Dyslexia Index score on a standardized achievement test fell in the “moderate” range (WIAT-III Dyslexia Index = 80, 9th percentile). This score is 37 points (about 2.5 standard deviations) below her cognitive abilities as estimated by her WISC-V General Abilities Index. This means that there is a clear and substantial ‘gap’ between Jane’s cognitive development and her academic achievement in reading. She will need specially designed instruction that is tailored to her learning profile in order to make effective academic progress in reading.
Most children with learning differences also demonstrate challenges with at least some aspects of executive functioning, and this is true for Jane as well. In general, Jane’s executive functioning skills are developing nicely, and she does not meet criteria for any additional attention or processing disorders. However, she demonstrated a relative weakness in her processing speed, which fell in the low average range (WISC-V Processing Speed = 89, 23rd percentile). This means there is a large discrepancy between how deeply Jane can think, and how quickly she can produce work that matches her potential. Jane will clearly benefit from extended time in order to complete tasks at a level consistent with her potential.
Jane is also presenting with some emotional vulnerabilities. Based on her own self-report and her parents’ ratings, she is experiencing some symptoms of anxiety and depression. This is likely related to her learning challenges, as she appears acutely aware that she is struggling with some aspects of learning that her peers seem more easily able to grasp. It will be important to support Jane’s emotional development while she receives support for her learning needs. This will ensure she can feel calm, comfortable, and confident, so that she can have the positive, growth-oriented mindset she needs in order to take risks, try new things, and learn new skills.
What Diagnoses Best Fits Jane’s Profile?
Jane’s test results meet criteria for the diagnosis of a mild to moderate Dyslexia. This diagnosis is provided when students demonstrate difficulties processing, understanding, and combining sounds and effectively discriminating printed symbols. These difficulties impacting the ease and efficiency with which the student is able to learn to read, spell, and write. Students with dyslexia often demonstrate two specific deficits: (1) a weakness in phonological awareness, and (2) a weakness in rapid naming.
As students learn how to read and spell, they rely on their phonological awareness to decode unfamiliar words or to guess at the spelling of new words. Fluent readers and spellers also effortlessly recognize high-frequency words that they encounter, which relies on their rapid naming speed. Students who struggle with their phonological skills and their rapid naming speed are doubly-disadvantaged when it comes to ‘mastering the code’ involved in learning how to read and write. These students are described as having the double deficit that is associated with dyslexia and other language-based learning disorders. Jane is also at risk for anxiety and depression, due to a heightened level of generalized stress, worry, and lowered self-esteem, possibly secondary to her learning challenges.
How Can Jane Best Be Supported?
Given her learning profile, Jane requires support for her language-based learning disability in the school setting, supplemented with formal and informal supports outside of the classroom, as described in the recommendations section below. In particular, Jane will benefit from specialized instruction in reading and writing delivered in a small-group or one-on-one setting, using a research-based, multisensory reading program. Additional targeted instruction in math may also be helpful as she progresses through school, because students with dyslexia are at such high risk of struggling with math fluency and math word problems.
Jane will also benefit from extended time to complete tasks and/or shortened assignments, to accommodate her relative weakness in processing speed. She will also benefit from a from strategies that help her demonstrate her nonverbal and social strengths both within and outside the school setting, such as encouraging her to share her ideas with the class or with younger students, and being given opportunities to complete assignments using multisensory methods. Nurturing her strengths in this way will help foster Jane’s academic engagement while she receives support for her language-based learning skills.
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So, hopefully comparing the 13th grade-level version and the 9th grade-level version helps illustrate how the same information can be presented at different levels of readability. Recently, I've been thinking about getting the reading level down even further, to something approaching what most guidelines recommend for health or health care information, which is the 5th to 6th grade reading level.
To that end, I recently revised that same summary to reflect a 5th grade reading level. This one has a reading ease of 79, which is readable by almost all adults. This is probably not where I want most of my reports to be, as I feel like writing at this level can sound a little simplistic instead of just simple. But sometimes, writing at the 5th grade level is probably exactly what a family needs. And, hopefully this will illustrate how the same information can be presented at another level of readability.
Here we go:
Jane is 8 years old and in third grade. She is having a hard time learning to read. Her parents brought her in figure out “why it’s so hard and what to do to help her.” Jane’s test results show she has lots of strengths. She is outgoing. She speaks fluent English and Hindi. She is good at solving problems, talking, and listening to others. However, Jane has a learning disability. She also works slowly. These problems affect Jane’s grades. These problems also make her anxious and sad. Jane needs special instruction in school. She also needs to see a therapist.
· ICD 10 Code F81.0: Dyslexia
· At risk for anxiety/depression due to learning challenges
Jane is good at solving problems. She can solve problems more easily than most girls her age. She is equally good at solving problems that use words or that use pictures. She is also good at solving hands-on problems. She can also solve abstract problems like patterns. Clearly, Jane is a bright girl who can often figure things out. Her learning problems are not due to low IQ.
Jane easily understands others in English and in Hindi. She can also tell others her wants, needs, and ideas in both languages. Jane’s language skills are especially strong in English, the language she speaks at school. Jane can also remember things, like stories she hears in English. Her learning problems are not due to being bilingual.
Jane has good hand-eye coordination. She can use the small muscles in her hands to do things like write or button a button. She sees visual things accurately. She can do hands-on arts projects. She has good athletic skills. Her learning problems are not due to a visual or sensory problem.
Jane can focus and come up with a plan. She can “hold on” to information in her mind while she is doing something. Jane can break a large task down into steps. She can stay organized. Her learning problems are not due to an attention or organization problem.
Jane is friendly, hard-working, and eager to please. She behaves well at home and school. Her classmates and teachers like spending time with her. She has lots interests and loves sports. She is in soccer, tumbling, and parkour. She also loves art. Jane’s learning problems are not due to a behavior or social problem.
Jane is having trouble learning to read, spell, and write. Her test scores show she is below grade level in all areas of reading and writing. She has an especially hard time spelling. When she spells, she often leaves out sounds in the words. She also makes a lot of mistakes when she is reading. She does not like to read and feels sad and anxious about reading.
I gave Jane many tests to understand why she is having so much difficulty learning to read. One thing that stands out from her test results is the big ‘gap’ between how bright Jane is and how well she can read. This is a clue she has dyslexia. Another test result that stands out is her Dyslexia Index score. This score also shows there is a good chance she has dyslexia.
I also gave tests to see if Jane has the processing problems we see in students with dyslexia. Those tests show Jane has trouble with phonological awareness. This means it is hard for her to understand how sounds combine. Jane needs this skill to sound out or spell words. Right now, Jane is a little behind in this skill. She has to put in a lot of time and effort to sound out a word or guess how it is spelled.
Jane also has trouble with rapid naming. This means it is hard for her to quickly and easily recall things has learned. Jane needs this skill to quickly “pull up” things she knows. Because of this problem, when she is reading, Jane has trouble quickly remembering sight words. Those are words that are hard to sound out, like ‘of’ or ‘friend.’ Jane also has trouble remembering high frequency words. Those are words she sees over and over, like ‘the’ or ‘and’. Jane also has trouble remembering math facts. Jane is very behind in rapid naming.
Jane’s test results show she has Dyslexia. Dyslexia means a student has trouble easily learning how to read, spell, and write. Students with dyslexia usually have two specific problems. (1) They have a deficit in phonological awareness. (2) They have a deficit in rapid naming. These students have the double deficit of dyslexia. Students who have both these problems have a lot of trouble ‘mastering the code’ to learn how to read and write.
Jane also has a few other problems right now. First, Jane works at a slow pace. It takes her a long time to 'show what she knows.' Second, Jane is at risk for anxiety and depression. She has a high level of stress and worry. She also has low self-esteem. I think this is mainly due to her dyslexia. Jane seems very aware of her learning problems. She may feel like her classmates learn more easily than she does. She may feel sad and anxious because she feels like she is not good at learning.
Jane needs support for her dyslexia at school. This would look like specialized instruction in reading and writing. She should get this support in a small-group or 1-on-1. Jane may also need special help in math, especially in later grades. This is because students with dyslexia are at high risk of struggling with math fluency and word problems.
Jane also needs support in the classroom. She should have extra time to complete tasks or shorter assignments. Jane also needs chances to show her strengths at school. For example, teachers can encourage her to share her ideas with the class or with younger students. They can also give Jane the chance to complete assignments using multisensory methods, like doing a drawing or project to show what she has learned.
Jane also needs emotional support. We want to make sure she feels calm, comfortable, and confident. We want her to know she is bright and capable, even though reading is hard for her. We want her to have the positive mindset she needs to try new things and learn new skills. I think Jane should see a therapist who is warm, caring, and can help her learn lots of great coping skills.
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So there you have it - 3 versions of the same report summary.
In a future post, I'll outline specific steps we can take to revise the readability of text. For now, it's your turn. Does it help to see concrete examples like this? What is the average readability of your reports? What do you do to try to write reports that are readable by the families you work with?