Psychologist and Evaluator
San Francisco, CA
Phone: (415) 577 - 4750

What is dyslexia really?

Dyslexia is a fundamental deficit in the ability to read efficiently.  I cannot emphasize the word efficiently enough, because some people think that dyslexia means a student basically cannot read.  I have evaluated over 500 people with dyslexia and of those only one was essentially not able to read (even though he had a very high IQ).  First, let’s clarify our terms: dyslexia is a term coming out of the educational therapy world to signify a reading deficit.  Concurrently, psychologists use the term Reading Disorder to denote dyslexia; these two conditions are usually synonymous, but not always. (more…)

California Bar Exam has highest cut-score in the nation

Case Law for High Stakes Standardized Testing

Justice Department Intervenes in Lawsuit Against Law School Admission Council on Behalf of Test Takers with Disabilities Nationwide

“A federal judge issued an order today allowing the Justice Department to intervene in a disability discrimination lawsuit against the Law School Admission Council (LSAC)………”

Defining My Dyslexia

A truly excellent article from the NY Times I’d like to share…

Defining My Dyslexia
Perhaps I’ve succeeded not despite, but because of, my disability.

Why U.S. Girls Underperform In Math, But Swedish Girls Don’t

An excellent article I thought I’d pass along…

Working Memory Exercises: Effective or Bunk?

When I provide feedback to clients that their working memory ability is weak they often ask what can be done about this. They want to know if there are ways to improve their working memory. Unfortunately, to date, there is no clear way to do this. Several companies have created and marketed computer-based programs which purportedly increase working memory ability through the use of daily exercises. Recently a team of researchers has taken an in-depth look at whether these programs are truly effective. As reported in the October 2012 edition of CHADD’s magazine: Attention, there is no clear benefit from these programs. Quoting from this article, “….several working memory ‘training programs’ have been developed and marketed. Unfortunately these programs don’t work very well (if at all). At this year’s American Psychological Association conference, Rapport and Kofler presented a meta-analytic review of twenty-three studies that found overall small or no benefits of these training programs for reducing inattention, hyperactivity, or impulsive behavior for children with ADHD. One reason for this disappointing conclusion is that most of these programs target the wrong parts of working memory: They’re training the short-term memory part, rather than the ‘working’ part of working memory.

Legal Updates on Accommodations


Working with students who have diligently and conscientiously pursued advanced education, despite a learning or physical disability, impels one to provide support and accommodations when justified.  For students who have succeeded in college and graduate school, only to fail licensing and high-stakes exams as a result of denied accommodations, is not only disheartening but unjust.  To this end, there is ‘good news’ in the area of testing accommodations, for those who are documented to be in need.

This has come as a result of a Department of Justice Title III Regulation, in combination with an update to the Americans with Disabilities Act, which recently went into effect in March 2011.  The primary changes are thus:

1) The terms ‘learning, reading, concentrating, and thinking,’ have been added as domains of major life activities. Therefore clients who have dyslexia and AD/HD are more specifically covered under these major life activity domains.

2) Testing boards are asked to ‘give considerable weight’ to documentation of past accommodations or auxiliary aids. While the statute specifically states the ‘documentation’ of past accommodations, it does not specify the form in which this documentation may be provided.  Many students report long histories of both formal and informal accommodations which are not technically documented in their academic record.  However, letters from teachers, professors, tutors, and parents, who have witnessed these accommodations firsthand, may serve as another form of documentation.   This will likely add substantially to the weight of their request for accommodations.

3) The new regulations add protections for those who experience impairment in ‘major bodily functions,’ including digestive, bowel, respiratory, and neurological challenges.  Over these years of providing Psychoeducational Evaluations I have been surprised and impressed by the number of students who struggle with concomitant physical maladies which add to their burden, particularly under standard testing conditions.  It seems fair and humane that this clause was added as well.

The key in all of this is to ensure that Psychoeducational Evaluations are extremely thorough, particularly in the narrative description of the disabilities.  No ‘assumptions’ can be left unspoken while numerous ‘rule outs’ must be overtly addressed.  There is a highly specified skill set required for evaluators who take on the burden, trust, and responsibility of aiding able students in successfully passing licensing exams, as a result of earning necessary accommodations.

Parent Talk Interview

To hear Dr. Waterworth speak about learning and attention issues in detail please click on the link below.

ParentTalk Interview / KWMR Radio

The Impact of Learning Disabilities on the Self

This article has been published in The National Psychologist, the San Francisco Psychological Association, and Internet Special Education Resources (ISER).

The Impact of Learning Disabilities on the Self

The evaluation of learning disabilities and ADD has proven to be a surprisingly satisfying and enriching focus for my clinical work.  I have conducted more than 300 evaluations over the course of 6 years and I have found this testing to be both meaningful and heartfelt.  The clarification and elimination of other potential causes for academic struggles present a central goal of learning disabilities evaluations:  Cognitive, social, and emotional factors may play a role.  My training as a general clinical psychologist enables me to examine these other factors and to offer a more comprehensive clinical perspective and evaluation than other testing professionals. I would like to share my experience and offer some guidance regarding the importance of identifying learning disabilities and attention problems in both children and adults.

As Erikson highlights, the development of mastery and competence represents one of the most important developmental stages of the self.  This occurs in the elementary school years, a critical timeframe during which children develop a sense of themselves as learners.  Children may develop a sense of competence or inadequacy.  Often, perceived intelligence is intricately but not accurately intertwined with this sense of learning competence.  Children who struggle with reading or spelling and are consequently sent to “special learning groups” will often be considered as less intelligent than their peers.    Most significantly, these children will perceive this about themselves and the damage from this incorrect perception will follow them into adulthood.  I have observed adults burst into tears when encountering an area of learning weakness during an educational evaluation.  Their sense of incompetence and shame about their learning weaknesses has undermined their confidence for years.  These adults have typically concluded that they were “stupid” and often exerted tremendous energy to avoid detection of their deficiencies.  It is during these moments of crisis and discovery that my clinical skills permit me to comfort, console, empathize, and educate the client.  The client learns that it is normal and understandable to feel sad, embarrassed, and frustrated about areas of weakness which have long been buried.  Their decision to engage in the evaluation process, to learn more about their weaknesses as well as their strengths, is framed as an empowering and potentially life-changing event.

Thus, each examinee has the opportunity to shift their perceptions of themselves and move ahead with a new understanding of his/her strengths and weaknesses.  As mentioned previously, many people have drawn erroneous and damaging conclusions about their school struggles and failures.  They are now challenged to integrate specific knowledge about their strengths and weaknesses accurately and proportionately.  Consider a person who has dyslexia:  This does not define the self but has likely had a powerful shaping influence on the landscape of the development of the self.  After testing, a person with dyslexia can accept and integrate this condition as one area of weakness while also fully acknowledge other, unrecognized or taken-for-granted areas of strength.

Further, it can be very useful and validating for persons with learning disabilities to gain the perspective that all individuals have their domains of strength and vulnerability.  Viewing themselves in a larger context rather than viewing themselves as a damaged or dysfunctional few can be profoundly unburdening and a source of tremendous relief. It can also offer untold empowerment to have a name assigned to a perplexing and distressing phenomenon experienced but not examined until adulthood.  Consider the relief offered by the realization that years of ineffective behavior stemmed from a real and diagnosable condition, not a character flaw, personal failing, laziness, or low intelligence!

Because of the detrimental impact undiagnosed learning disabilities on self-perception, many people with these disorders suffer from depression or anxiety. It has often been my observation that many individuals who have been diagnosed with anxiety or depression as a primary condition have an underlying and untreated diagnosis of ADHD.  A number of potential red flags may help illuminate undiagnosed ADHD or learning disabilities in the therapeutic setting:  embarrassment about reading, spelling, or writing skills at work, reported problems with memory, avoiding the pursuit of real vocational or academic goals due to fears of failure, rarely reading or report of being a “slow reader,” disorganization in one or several parts of life, poor time management, a general sense of incompetence or feeling like a fraud, difficulty staying on topic in conversations, and poor reported school performance despite seeming intelligence.  The presence of a few or several of these symptoms, as endorsed by a therapy client, may suggest that a more thorough screening of symptoms is warranted.
It is helpful for the referring clinician what a client might expect during an assessment appointment.  Recall that for many, such testing will provoke trepidation as they confront their weaknesses in this formal way.  It is thus comforting for the client to be prepared regarding what will unfold during their assessment experience. At the outset of such a screening, I discuss with the client what type of evaluation will meet his or her needs.  Not every assessment requires a full battery of tests and comprehensive write-up; some clients benefit from a more brief evaluation which might include IQ screening with targeted subtests detecting deficits associated with learning disabilities, with no write-up.  The shorter process can usually be completed in 3-4 hours total, including a clinical interview, 2 hours of targeted testing, and a one-hour feedback session.  The more comprehensive evaluation, formally called a Psychoeducational Evaluation, is necessary for individuals who want to use their condition as a means of obtain special accommodations and services at work or school. This is the common means to obtain extended time on standardized tests (SAT, GRE. LSAT, GMAT, CBEST) and high stakes licensing exams.
At the culmination of the testing, the client will, with hope, have a more accurate and empowered understanding of their strengths and weaknesses.  This information will cast a new light on experiences from the past, which may require exploration and processing, as well as open new ideas and avenues for personal enrichment.  In addition, the client may be equipped with the information necessary to shape his or her learning environment in such a way as to maximize success.  Traditional schooling methods do not work effectively for everyone and clear testing results can help a person create an environment that will improve their academic performance.  The broadened possibilities and alternate paths ensuing from such testing will provide many new directions for growth.

For more information please contact Allison Waterworth, Psy.D., ABPP at or 415-577-4750

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