Evaluation of school performance: dyslexia and attention deficit disorder.

The primary focus of the diagnostic evaluation is to determine whether the child's problems fit the criteria for a diagnostic entity. In the case of school problems, the two most common disorders to be considered are learning disability and attention deficit disorder. Historical information from parents and teachers together with psychometric data are at the core of the assessment process. Helpful insights may be gathered from the neuromaturational examination while specific laboratory measures including electrophysiological, neurochemical, neuroradiological and psychophysiological have not been shown to be helpful in distinguishing either learning disability or attention deficit disorder. The physician is urged to take a more active role in the psychometric component of the examination. Inquiry should be made about the reliability and validity of instruments used before accepting any recommendations based on a particular test. Care should also be taken to insure that the tests used in the formulation have been individually administered and that the child's performance is noted in untimed as well as timed circumstances. While a comprehensive evaluation should inquire into social, familial and medical etiologies, this should be accomplished with the knowledge that except for family history, there may be no other contributing factors that emerge. Learning disability and attention deficit disorder are high prevalence disorders. Time and energy should not be expended in searching for rare events to invoke as an explanation for these frequent occurrences.