head injuries, malnutrition, or by toxic exposure (such as heavy metals or pesticides). diagnosis iq-achievement discrepancy learning disabilities can be identified by psychiatrists, speech language pathologists, school psychologists, clinical psychologists, counseling psychologists, neuropsychologists, speech language pathologists, and other learning disability specialists through a combination of intelligence testing, academic achievement testing, classroom performance, and social interaction and aptitude. other areas of assessment may include perception, cognition, memory, attention, and language abilities. the resulting information is used to determine whether a child's academic performance is commensurate with their cognitive ability. if a child's cognitive ability is much higher than their academic performance, the student is often diagnosed with a learning disability. the dsm-iv and many school systems and government programs diagnose learning disabilities in this way (dsm-iv uses the term "disorder" rather than "disability"). although the discrepancy model has dominated the school system for many years, there has been substantial criticism of this approach among researchers. recent research has provided little evidence that a discrepancy between formally measured iq and achievement is a clear indicator of ld. furthermore, diagnosing on the basis of a discrepancy does not predict the effectiveness of treatment. low academic achievers who do not have a discrepancy with iq (i.e. their iq scores are also low) appear to benefit from treatment just as much as low academic achievers who do have a discrepancy with iq (i.e. their iq scores are higher than their academic performance would suggest). since 1998 there have been attempts to create a reference index more useful than iq to generate predicted scores on achievement tests. for example, for a student whose vocabulary and general knowledge scores matches their reading comprehension score a teacher could assume that reading comprehension can be supported through work in vocabulary and general knowledge. if the reading comprehension score is lower in the appropriate statistical sense it would be necessary to first rule out things like vision problems response to intervention much current research has focused on a treatment-oriented diagnostic process known as response to intervention (rti). researcher recommendations for implementing such a model include early screening for all students, placing those students who are having difficulty into research-based early intervention programs, rather than waiting until they meet diagnostic criteria. their performance can be closely monitored to determine whether increasingly intense intervention results in adequate progress. those who respond will not require further intervention. those who do not respond adequately to regular classroom instruction (often called "tier 1 instruction") and a more intensive intervention (often called "tier 2" intervention) are considered "non-responders." these students can then be referred for further assistance through special education, in which case they are often identified with a learning disability. some models of rti include a third tier of intervention before a child is identified as having a learning disability. a primary benefit of such a model is that it would not be necessary to wait for a child to be sufficiently far behind to qualify for assistance. this may enable more children to receive assistance before experiencing significant failure, which may, in turn, result in fewer children who need intensive and expensive special education services. in the united states, the 2004 reauthorization of the individuals with disabilities education act permitted states and school districts to use rti as a method of identifying students with learning disabilities. rti is now the primary means of identification of learning disabilities in florida. the process does not take into account children's individual neuropsychological factors such as phonological awareness and memory, that can inform design instruction. by not taking into account specific cognitive processes, rti fails to inform educators about a students' relative strengths and weaknesses second, rti by design takes considerably longer than established techniques, often many months to find an appropriate tier of intervention. third, it requires a strong intervention program before students can be identified with a learning disability. lastly, rti is considered a regular education initiative and consists of members of general education teachers, in conjunction with other qualified professionals. occupational therapists in particular can support students in the educational setting by helping children in academic and non-academic areas of school including the classroom, recess and meal time. they can provide strategies, therapeutic interventions, suggestions for adaptive equipment, and environmental modifications. occupational therapists can work closely with the child's teacher and parents to facilitate educational goals specific to each child under an rti and/or iep. latino english language learners demographers in the united states report that there has been a significant increase in immigrant children in the united states over the past two decades. this information is vital because it has been and will continue to affect both students and how educators approach teaching methods. various teaching strategies are more successful for students that are linguistic or culturally diverse versus traditional methods of teaching used for students whose first language is english. it is then also true that the proper way to diagnose a learning disability in english language learners (ell) differs. in the united states, there has been a growing need to develop the knowledge and skills necessary to provide effective school psychological services, specifically for those professionals who work with immigrant populations. currently, there are no standardized guidelines for the process of diagnosing ell with specific learning disabilities (sld). this is a problem since many students will fall through the cracks as educators are unable to clearly assess if a student's delay is due to a language barrier or true learning disability. with an unclear diagnosis, many students will suffer because they will not be provided with the tools they need to succeed in the public education school system. for example, in many occasions teachers have suggested retention or have taken no action at all when they lack experience working with english language learners. students were commonly pushed toward testing, based on an assumption that their poor academic performance or behavioral difficulties indicated a need for special education. linguistically responsive psychologist understand that second language acquisition is a process and they understand how to support ells' growth in language and academically. when ells are referred for a psychoeducational assessment, it is difficult to isolate and disentangle what are the effects of the language acquisition process, from poor quality educational services, from what may be academic difficulties that result from processing disorders, attention problems, and learning disabilities. additionally not having trained staff and faculty becomes more of an issue when staff is unaware of numerous types of psychological factors that immigrant children in the u.s dealing could be potentially dealing with. these factors that include acculturation, fear and/or worry of deportation, separation from social supports such as parents, language barriers, disruptions in learning experiences, stigmatization, economic challenge, and risk factors associated with poverty. in the united states, there are no set policies mandating that all districts employ bilingual school psychologist, nor are schools equipped with specific tools and resources to assist immigrant children and families. many school districts do not have the proper personnel that is able to communicate with this population. spanish-speaking ell a well trained bilingual school psychologist will be able to administer and interpret assessment all psychological testing tool. also, an emphasis is placed on informal assessment measures such as language samples, observations, interviews, and rating scales as well as curriculum-based measurement to complement information gathered from formal assessments. a compilation of these tests is used to assess whether an ell student has a learning disability or merely is academically delayed because of language barriers or environmental factor. many schools do not have a school psychologist with the proper training nor access to appropriate tools. also, many school districts frown upon taking the appropriate steps to diagnosing ell students. assessment many normed assessments can be used in evaluating skills in the primary academic domains: reading, including word recognition, fluency, and comprehension; mathematics, including computation and problem solving; and written expression, including handwriting, spelling and composition. the most commonly used comprehensive achievement tests include the woodcock-johnson iv (wj iv), wechsler individual achievement test ii (wiat ii), the wide range achievement test iii (wrat iii), and the stanford achievement test–10th edition. these tests include measures of many academic domains that are reliable in identifying areas of difficulty. in the reading domain, there are also specialized tests that can be used to obtain details about specific reading deficits. assessments that measure multiple domains of reading include gray's diagnostic reading tests–2nd edition (gdrt ii) and the stanford diagnostic reading assessment. assessments that measure reading subskills include the gray oral reading test iv – fourth edition (gort iv), gray silent reading test, comprehensive test of phonological processing (ctopp), tests of oral reading and comprehension skills (torcs), test of reading comprehension 3 (torc-3), test of word reading efficiency (towre), and the test of reading fluency. a more comprehensive list of reading assessments may be obtained from the southwest educational development laboratory. the purpose of assessment is to determine what is needed for intervention, which also requires consideration of contextual variables and whether there are comorbid disorders that must also be identified and treated, such as behavioral issues or language delays. these contextual variables are often assessed using parent and teacher questionnaire forms that rate the students' behaviors and compares them to standardized norms. however, caution should be made when suspecting the person with a learning disability may also have dementia, especially as people with down's syndrome may have the neuroanatomical profile but not the associated clinical signs and symptoms. examination can be carried out of executive functioning as well as social and cognitive abilities but may need adaptation of standardized tests to take account of special needs. types learning disabilities can be categorized by either the type of information processing affected by the disability or by the specific difficulties caused by a processing deficit. by stage of information processing learning disabilities fall into broad categories based on the four stages of information processing used in learning: input, integration, storage, and output. many learning disabilities are a compilation of a few types of abnormalities occurring at the same time, as well as with social difficulties and emotional or behavioral disorders. input: this is the information perceived through the senses, such as visual and auditory perception. difficulties with visual perception can cause problems with recognizing the shape, position, or size of items seen. there can be problems with sequencing, which can relate to deficits with processing time intervals or temporal perception. difficulties with auditory perception can make it difficult to screen out competing sounds in order to focus on one of them, such as the sound of the teacher's voice in a classroom setting. some children appear to be unable to process tactile input. for example, they may seem insensitive to pain or dislike being touched. integration: this is the stage during which perceived input is interpreted, categorized, placed in a sequence, or related to previous learning. students with problems in these areas may be unable to tell a story in the correct sequence, unable to memorize sequences of information such as the days of the week, able to understand a new concept but be unable to generalize it to other areas of learning, or able to learn facts but be unable to put the facts together to see the "big picture." a poor vocabulary may contribute to problems with comprehension. storage: problems with memory can occur with short-term or working memory, or with long-term memory. most memory difficulties occur with one's short-term memory, which can make it difficult to learn new material without more repetitions than usual. difficulties with visual memory can impede learning to spell. output: information comes out of the brain either through words, that is, language output, or through muscle activity, such as gesturing, writing or drawing. difficulties with language output can create problems with spoken language. such difficulties include answering a question on demand, in which one must retrieve information from storage, organize our thoughts, and put the thoughts into words before we speak. it can also cause trouble with written language for the same reasons. difficulties with motor abilities can cause problems with gross and fine motor skills. people with gross motor difficulties may be clumsy, that is, they may be prone to stumbling, falling, or bumping into things. they may also have trouble running, climbing, or learning to ride a