Screening, identification, diagnosis and eligibility are four terms often used as if they were synonyms, yet they are in fact four distinct steps, each with its own question, its own tools and its own responsible party. In this chapter we sketch the conceptual map on which all the chapters of the book are organized, and we place it within its regulatory framework in Saudi Arabia.
At the start of the school year, Munira, a teacher, received the files of the students in her third-grade class. In Abdullah's file was a hospital report stating that he had been “diagnosed with autism spectrum disorder.” Sultan's file held the result of a reading screening the school had conducted the previous month, marked “needs follow-up.” Reem's file was empty, but last year's teacher had left Munira a note: “Keep an eye on Reem. I think she's gifted.”
Munira wonders: Is Abdullah entitled to special education services because he has a diagnosis? Does Sultan have a learning disability because the screening flagged him? And is one teacher's opinion enough to consider Reem gifted?
The answer to all three questions is the same: “Not necessarily.” Why this is so becomes clear only once we draw careful distinctions between steps that are frequently confused in practice. That is the work of this chapter, and we will return to the three students at its close.
After studying this chapter, the reader should be able to:
Every school year, teachers and assessment and diagnosis teams make decisions that bear directly on the paths of particular students: who is referred for assessment, who meets the criteria for a given category, and who needs special education services or a gifted program. Many of the errors in these decisions stem less from the limitations of the tools than from confusing distinct steps that go by similar names. A screening result is treated as a diagnosis, a medical diagnosis is taken as an educational eligibility decision, and a single teacher's opinion is deemed sufficient to judge a student gifted, just as Munira finds in the opening scene. For this reason we open the book by pinning down concepts before turning to tools and categories, since it is the question each step asks that determines the kind of evidence required, who is responsible for it, and how much of it is enough to move on to the next step.
We begin the chapter with the purposes of assessment, starting from the premise that assessment is a means of making decisions (Section 1.1). We then distinguish among screening, identification, diagnosis and eligibility determination (Section 1.2), and among measurement, testing and assessment (Section 1.3). Next we present the models of disability and the question toward which each points (Section 1.4), followed by medical and educational classification systems and the regulatory framework in Saudi Arabia (Section 1.5). We then turn to the principles of fair assessment (Section 1.6), the RIOT/ICEL framework for organizing sources of evidence (Section 1.7), and the roles of the team and the family (Section 1.8), and we close with the general assessment pathway and its common errors (Section 1.9).
Assessment is a means of making a decision. The first question an assessor asks, therefore, is “What decision do I need to make?” Only after that comes the question “Which test should I give?” A tool that is excellent for one decision may be useless for another. Specialists in educational measurement identify several purposes of assessment, each with its own question (Salvia et al., 2017):
| Purpose | Question it answers | Example of a tool |
|---|---|---|
| Screening | Who needs a closer look? | A short screening checklist given to all kindergarten children |
| Diagnosis and classification | Does the student have a disability, a disorder or giftedness? Of what kind? | A comprehensive battery: intelligence, achievement, adaptive behavior and observation |
| Eligibility determination and placement | Is the student entitled to special services? In what setting should they be provided? | A team decision based on the diagnosis and its impact on learning |
| Instructional planning | What should we teach? Where should we start? | Criterion-referenced tests (which compare a student's performance with a defined level of mastery rather than with the performance of peers), and error analysis |
| Progress monitoring | Is the student learning? Is the plan working? | Brief, repeated measures such as curriculum-based measurement (Curriculum-Based Measurement, CBM) |
| Program evaluation | Is the program meeting its goals for its students as a whole? | Aggregated data on the program's students across years |
In this book we focus on the first two purposes, with some attention to the third. The teacher, however, is present in all of them, because diagnostic information must ultimately feed into instructional planning; otherwise it loses its value.
Picture these four steps as a funnel: at the top are all students, and at the bottom are those who receive special services. The funnel narrows at each layer, because each step asks a more precise question than the one before it and requires stronger evidence.
Screening is applied to an entire group, such as all first graders, using a short tool that does not require a specialist. Its aim is to ensure that no child who needs a closer look slips past us. Screening tools are therefore preferably high in sensitivity (Sensitivity), that is, able to capture the largest possible proportion of those who actually have the problem, even if they also flag some who do not, because the cost of missing a child is greater than the cost of examining a child who turns out not to need it.
Sensitivity alone, however, is not enough to judge a screening tool. The tool also needs acceptable specificity (Specificity), meaning the ability to rule out those who do not have the problem; otherwise it will swamp the team with unnecessary referrals. A school principal will care about a third question as well: if a student's result is negative, how likely is it that the student truly does not have the problem? This is the negative predictive value (Negative predictive value), the most important question to ask of a screening, because it measures how confident we can be that we have not missed anyone. Its magnitude, like that of the positive predictive value, depends jointly on the properties of the tool and on the prevalence of the problem in the group screened (Chapter 2 works through these concepts with numbers in Section 2.6).
A positive screening result is an invitation to look more closely; diagnosis is a later stage that requires broader evidence. Screening tools are deliberately designed to catch more than they should, and when a problem is rare in a group, many of those flagged by the screening may in fact be free of it. The reverse holds as well: a negative result is no certificate of health. If the teacher's or the family's concern persists, a documented observation is reason enough to move on to the identification stage.
After screening, or after a teacher's observation, the identification stage (Identification) begins: the stage of gathering initial evidence. At this stage the teacher and the school try to provide support within the classroom, whether by adjusting the method of instruction or by offering additional small-group teaching, while monitoring the student's response. If the difficulty persists despite this support, the student is referred for a comprehensive assessment. Referral is a significant decision, because it signals that the school has tried what it can and that this has not been enough.
In the field of giftedness, this stage is usually called nomination. Teachers and families nominate students in whom they see indicators of giftedness, and those students are then assessed. Relying on nomination alone, however, misses many gifted students, because nominators tend to notice those who display their excellence clearly in achievement and behavior, and overlook those whose giftedness is hidden behind a second language, a disability or a quiet disposition (Chapter 12 addresses nomination in detail).
In this book we restrict “identification” to the stage that precedes referral, a terminological choice that gives each step of the pathway a name of its own. In the literature, however, the term Identification usually denotes the entire process of determination, up to and including the decision, and in the Arabic literature it overlaps with “al-kashf” (detection), as in the name of the “National Program for Gifted Identification,” which encompasses both testing and classification. Yet this broad sense does not carry the same content in the two fields. In the field of giftedness, identification is the complete process of determining who needs gifted services, and it is an educational process; the term “diagnosis” is avoided here because giftedness is neither a disorder nor a deficit whose cause must be sought. The process starts from the program's definition and goals, draws on multiple criteria and on local norms that compare students with peers in their own setting, and links the tool to the type of service offered: a measure of mathematical reasoning suits an enrichment program in mathematics but is not, on its own, appropriate for a program in creative writing. Its outcome is a decision to place a student in a program or to provide a service, one that is tied to the student's educational need and open to revision whenever the evidence or the program changes (National Association for Gifted Children [NAGC], 2019).
In the field of disabilities, by contrast, “identification” usually means determining eligibility for special education services under the categories recognized by the education system, as in the US Individuals with Disabilities Education Act and its implementing regulations published in the Code of Federal Regulations (IDEA, 2004; 34 C.F.R. §300.8). For some categories, such as autism spectrum disorder and attention-deficit/hyperactivity disorder, this educational decision is paralleled or preceded by a clinical diagnosis under the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2022) or the International Classification of Diseases (ICD-11). The educational decision thus meets the medical one without either replacing the other, as Section 1.5 explains in detail.
The two pathways converge in twice-exceptional learners: the same student may need a clinical diagnosis of a disability and an educational identification of giftedness, and each pathway may obscure what the other reveals if the team pursues one without the other (Chapter 13 examines this overlap in detail). So when you encounter either term in another source, infer its meaning from the context and the field, and do not assume that it refers to the narrow stage we intend here.
Diagnosis answers the question: Does the student meet the criteria for a particular category? It requires a comprehensive team assessment using multiple tools and multiple sources. A diagnosis may be medical, issued by a physician or a qualified psychologist according to a diagnostic manual, or educational, issued by a school team according to education regulations.
Here we arrive at the distinction that puzzled Munira. Diagnosis answers the question “What does the student have?”, whereas eligibility answers the question “Does the student need special services in order to learn?” A student may have a medical diagnosis yet learn successfully in the general classroom without needing special services, and so not be eligible for them. Conversely, a student may need services without yet having a medical diagnosis, in which case the student is assessed educationally.
In most education systems, eligibility for special education services requires two conditions together: the student must meet the criteria for one of the disability categories, and the disability must affect the student's learning to the point that he or she needs specially designed instruction. If either condition is absent, the student is not eligible, even if the other is met. Saudi regulations phrase the second condition in their own words: an impairment “to the extent that it necessitates the provision of special education services” (Ministry of Education [Al-Ma'arif], 1422 AH [Arabic]).
These words overlap in everyday use, but each has a specific meaning in the literature, and knowing the difference helps in reading reports and sources accurately:
| Term | Meaning | Example |
|---|---|---|
| Test | An organized set of tasks or questions administered in a specified way | An intelligence test, or a 20-word spelling test |
| Measurement | Expressing a characteristic in numbers according to rules | Scored 14 out of 20, or has a standard score of 85 |
| Assessment | The complete process of gathering information from multiple sources in order to make a decision | Tests, interviews, observation and records, ending in a decision |
| Evaluation | Making a judgment about the worth or adequacy of something; in some systems also used to mean the comprehensive assessment of a student | Evaluating a program's effectiveness, or the comprehensive evaluation of a student's eligibility |
The key point here is that testing is a small part of assessment. Sound assessment combines tests with observations, interviews and a review of records and work samples, as we will see in the evidence-gathering framework in Section 1.7.
Before we diagnose a disability, we must ask: What is disability in the first place? Where does the problem lie? How we answer these two questions is a stance with consequences, for it determines what we measure and where we look for solutions. There are three main models:
Disability is a defect in the individual's body or functions, to be diagnosed and treated or compensated for. The focus is on the impairment and its causes.
Disability arises from the barriers society places in front of those who differ: buildings a wheelchair cannot reach, curricula that ignore individual differences. The focus is on removing barriers (Oliver, 1990).
Disability results from an interaction between the individual's health condition and the environmental and personal factors surrounding him or her (Engel, 1977). This model is the foundation of the International Classification of Functioning, Disability and Health issued by the World Health Organization (World Health Organization [WHO], 2001).
It is often said that modern diagnosis follows the third model, but this claim is a generalization that needs qualifying. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR), remains at its core a categorical classification belonging to the medical model: the criteria are either met or not met, even though the manual adds severity specifiers and levels of support that move it closer to graded description (American Psychiatric Association, 2022). The biopsychosocial model, by contrast, underlies the International Classification of Functioning specifically, a descriptive classification that addresses functioning, participation and environmental factors and leaves the diagnosis of conditions to the medical systems. There is also growing discussion in the literature of dimensional models that describe psychological difficulties along graded continua rather than in discrete categories, one of the best known being the Hierarchical Taxonomy of Psychopathology (HiTOP).
Good practice comes closest to combining the two logics: the assessor judges whether criteria are met using a categorical logic when the system requires it, and then describes the impact of the condition and its relationship to the environment using a biopsychosocial logic. When we say that a student with autism spectrum disorder “requires substantial support,” we are describing the student's relationship to the environment as well as what the student has. The same student may need less support in a calm, structured classroom and more in a crowded, changeable one.
Diagnosis rests on classification systems that define categories and their criteria. The most important thing for a teacher to know is that there are two kinds of systems, medical and educational, and that each serves a different purpose.
| System | Issuing body | Purpose | Who uses it |
|---|---|---|---|
| Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) | American Psychiatric Association, 2022 | Diagnosing mental and developmental disorders using detailed criteria | Psychiatrists and psychologists |
| International Classification of Diseases, Eleventh Revision (ICD-11) | World Health Organization; adopted in 2019 and in force since January 1, 2022; its clinical descriptions and diagnostic requirements for mental and developmental disorders were published in 2024 | Classifying all diseases and health conditions, including developmental ones, for diagnostic and statistical purposes | Health systems around the world |
| International Classification of Functioning, Disability and Health (ICF) | World Health Organization, 2001 | Describing what a person can do and participate in, and the environmental factors at play, rather than diagnosing the condition | Rehabilitation and service-planning teams |
| Educational categories | Each country's education legislation and regulations | Determining who is entitled to special education services | School teams and education departments |
Clinical diagnosis relies on one of the first two manuals (American Psychiatric Association, 2022; WHO, 2019, 2024). The two converge for most developmental categories, though they differ in naming and detail, differences taken up in the category chapters of Part Three.
The US Individuals with Disabilities Education Act (Individuals with Disabilities Education Act, IDEA) was reauthorized in 2004 as the Individuals with Disabilities Education Improvement Act (IDEIA), though it is still known by its original acronym. The law specifies thirteen categories eligible for services: autism, deaf-blindness, deafness, emotional disturbance, hearing impairment, intellectual disability, multiple disabilities, orthopedic impairment, other health impairment, specific learning disability, speech or language impairment, traumatic brain injury (resulting from a blow or impact), and visual impairment including blindness. The law also permits a developmental delay category for children aged 3 to 9 (IDEA, 2004).
Note three important points about this list:
In this section we present the Saudi education system in the same detail as the US example, since it is the framework within which the assessment procedures discussed in this book are carried out. Special education in Saudi Arabia is organized at two levels: general laws that establish the rights of persons with disabilities, and regulatory documents issued by the Ministry of Education that define the categories, eligibility criteria and assessment and diagnosis procedures. The identification of gifted students is organized along a pathway separate from both. Table 1.4 summarizes the principal documents.
| Document or body | Issuance | What matters to the assessor |
|---|---|---|
| Regulations for Special Education Institutes and Programs | Ministry of Education [Al-Ma'arif] (the former name of the Ministry of Education), Decision No. 1674 of 5/4/1422 AH (Ministry of Education [Al-Ma'arif], 1422 AH [Arabic]) | Definitions of the categories and admission requirements for each; a section on assessment and diagnosis (Articles 78–82) setting out its rules, its team and its seven steps; the components of the individualized education program (Articles 83–85); and the obligations of the institute or program toward the family (Article 76) |
| Special Education Organizational Guide and Special Education Procedural Guide | Ministry of Education, first edition for the 1436–1437 AH school year, which counts the Regulations among its foundations (Ministry of Education, 1436 AH-a, 1436 AH-b [Arabic]) | The recognized categories and the eligibility criteria for each, the composition of the assessment and diagnosis team, parental consent, timelines for reevaluation, and eligibility for early intervention |
| Law on the Rights of Persons with Disabilities | Royal Decree No. (M/27) of 11/2/1445 AH (2023), in 33 articles; it replaced the Disability Welfare Law issued by Royal Decree No. (M/37) of 23/9/1421 AH | The right of persons with disabilities to “modern assessment and diagnostic tools” and to early intervention programs (Article 8), and to screening and diagnostic services and the “early detection of disability” (Article 9) |
| Authority for the Care of Persons with Disabilities | Its organizational statute was approved by the Council of Ministers in 1439 AH (2018) (Al-Jazirah, 2018 [Arabic]) | A financially and administratively independent body whose board is chaired by the Minister of Human Resources and Social Development; it works to safeguard the rights of persons with disabilities, develop policies, programs and services, and support research (Saudipedia, n.d. [Arabic]) |
| National Program for Gifted Identification, and the regulations for gifted programs at the Ministry of Education | The program was launched in 2011 as a partnership among Mawhiba, the Ministry of Education and the National Center for Assessment (King Abdulaziz and His Companions Foundation for Giftedness and Creativity [Mawhiba], n.d. [Arabic]); the General Administration for the Gifted organizes gifted classes under a dedicated guide (Ministry of Education, n.d. [Arabic]) | The Mawhiba Multiple Mental Abilities Test, the nomination criteria for gifted classes, and the rule for combining them |
Note that the two education documents use the term ʿawq (impairment) where this book uses iʿāqa (disability). The Regulations use “mental retardation,” dividing it into “educable” and “trainable” according to ranges of IQ scores, whereas the Organizational Guide uses “mental impairment” and additionally requires deficits in at least two adaptive domains. In both cases the condition meant is what this book calls “intellectual disability.”
The Organizational Guide recognizes eleven categories. Table 1.5 maps them onto the categories of US law, together with the main eligibility criteria the Guide specifies.
| US legal category | Counterpart in the Organizational Guide | Main eligibility criteria in Saudi regulations |
|---|---|---|
| Intellectual disability | Mental impairment | IQ no higher than 75 on the Wechsler scale or 69 on the Stanford-Binet Fifth Edition, or the equivalent of either, together with deficits in at least two adaptive skill domains. US law sets no numerical cut-off score |
| Specific learning disabilities | Learning disabilities | A marked discrepancy between ability and achievement in one academic area, or a disorder in one of the basic psychological processes; with intellectual and sensory impairments and behavioral disorder ruled out; and evidence that general education services are inappropriate or of limited effectiveness. The text specifies no numerical size for the discrepancy and makes no mention of the response to intervention model. US law, by contrast, prohibits states from requiring a discrepancy and obliges them to permit the response to intervention model (34 C.F.R. §300.307) |
| Deafness; hearing impairment | Hearing impairment (deaf and hard of hearing) | A hearing loss of 70 decibels or more for deafness, and between 35 and 69 decibels for hard of hearing, in the better ear with hearing aids. The US definition is functional, with no numerical threshold |
| Visual impairment including blindness | Visual impairment (blind and low vision) | Low vision: acuity between 6/24 and 6/60 meters. Blindness in the Regulations: acuity below 6/60 in the better eye after correction, or a visual field of less than 20 degrees |
| Deaf-blindness | Deaf-blind | A separate category in both systems |
| Multiple disabilities | Multiple impairments | A separate category in both systems |
| Orthopedic impairment; other health impairment | Physical and health impairment | A single category in the Guide corresponding to two categories in US law |
| Autism | Autism spectrum disorder | The Guide defines it by persistent deficits in social communication and social interaction across multiple contexts, in wording that matches the first criterion of the diagnostic manual |
| Speech or language impairment | Language and speech disorders | A separate category in both systems |
| Emotional disturbance | Behavioral and emotional disorders | A separate category in both systems; the Saudi label is broader in its wording |
| Not a separate category (usually served under “other health impairment”) | Attention-deficit and hyperactivity disorders | “Hyperactivity, attention deficit or both, requiring intervention according to an accredited report” |
| Traumatic brain injury | No separate category in the Guide | We found no separate category for it in the Organizational Guide |
| Developmental delay (ages 3–9) | Early intervention: developmentally delayed children and children at risk (up to age 6) | A delay of two standard deviations below the mean in two or more domains, or of 25%; or exposure to at least three environmental risk factors |
| Giftedness: outside the law | Giftedness: outside the Special Education Organizational Guide | Organized along a separate pathway (the National Program for Gifted Identification and the programs of the General Administration for the Gifted) |
Sources: Ministry of Education (1436 AH-a [Arabic]); Ministry of Education [Al-Ma'arif] (1422 AH [Arabic]) for the definition of blindness; and US law and its implementing regulations (IDEA, 2004; 34 C.F.R. §300.8). The Guide also sets general eligibility requirements, among them the statutory age for admission to first grade, with special education students permitted an exception of no more than three years.
The identification of gifted students in Saudi Arabia rests on two complementary pathways. The first is the “National Program for Gifted Identification,” which targets students from third grade through the first year of secondary school at three levels. Students may sit the test once at each level, and the program administers the “Mawhiba Multiple Mental Abilities Test” upon registration by the family (Mawhiba, n.d. [Arabic]). The second consists of the Ministry of Education's gifted classes, which draw their students from those classified as gifted by the national program. If places remain unfilled, the classes complete their numbers using four criteria: a mental abilities test, personal traits, academic achievement and creative products. A student must satisfy two or more criteria, one of which must be the mental abilities test with a score of at least 120 (Ministry of Education, n.d. [Arabic]). For a recent overview of gifted education in Saudi Arabia, see Alfaiz and colleagues (Alfaiz et al., 2022).
The documents cited in this section were consulted in September 2026, and we found no published edition of the Organizational and Procedural Guides more recent than their first edition; readers should consult whichever edition is in force at the time of reading. Question for reflection: If you were invited to join a committee updating the Organizational Guide, which of these three gaps would you address first, and why?
An assessment that ends in a diagnosis changes the course of a student's life: the school the student attends, the curriculum the student learns, how others see the student, and how the student sees himself or herself. For this reason, legislation and professional standards have set out principles that protect students from error and injustice. Among the clearest formulations are those in the implementing regulations of US law governing evaluation procedures (34 C.F.R. §300.304). The Standards for Educational and Psychological Testing treat fairness as a third foundation of testing alongside validity and reliability, devoting their third chapter to it (American Educational Research Association [AERA] et al., 2014). Table 1.6 sets these principles against the provisions of Saudi regulations.
| Principle | What it means in practice | Counterpart in Saudi regulations |
|---|---|---|
| Multiple tools and strategies | No single measure is used as the sole basis for any decision; a single score, however precise, is not enough on its own to support a judgment. | “Not relying solely on the results of a single measure when determining a pupil's eligibility,” and using formal and informal methods (Rules, Article 80; Organizational Guide) |
| Assessing all areas of suspected need | If there is doubt about hearing, language or attention, each is assessed, rather than only the area for which the student was referred. | A multidisciplinary team and information gathered from varied sources (Rules, Article 80) |
| Appropriate language and mode | The student is assessed in his or her native language or mode of communication; a deaf student is assessed in sign language if that is the student's language. | We found no explicit provision in either document specifying the language or mode of assessment |
| Freedom from bias | Tools are chosen so that they do not disadvantage the student because of culture or background. | Standardized tests that are “valid, reliable and suited to the child's environment” (Rules, Article 80) |
| Measuring what is intended to be measured | If a student has a motor disability, his or her intelligence is not measured with a test that depends on motor speed, lest the score fall because of the student's hand rather than ability. | “Appropriate measures and clear instructions” (Rules, Article 80), with no detail on adapting administration for students with sensory and motor disabilities |
| Validity of the tool and qualifications of the examiner | The tool is used for the purpose for which its validity has been established, and it is administered by a trained person according to its instructions. | Using “tools and measures approved by the Ministry of Education,” administered and interpreted “by qualified specialists” (Organizational Guide). We found no published text specifying the qualification levels required for each class of standardized psychological test |
| Informed family consent | The family knows what will happen and why, and consents in writing before the process begins. | Written consent from the parent or guardian after formal notification; if no reply is received within fourteen days, this is deemed consent (Organizational Guide; the Regulations specify two weeks) |
| Confidentiality | Only those entitled to access the information may see it, and it is stored in a way that protects it. | “Maintaining the confidentiality of all information” (Rules, Articles 76 and 80); the Personal Data Protection Law (1443 AH) classifies health data as sensitive data |
Sources: implementing regulations of US law (34 C.F.R. §300.304), Standards for Educational and Psychological Testing (AERA et al., 2014), Ministry of Education [Al-Ma'arif] (1422 AH [Arabic]), and Ministry of Education (1436 AH-a [Arabic]).
The comparison reveals the strength of Saudi regulations on the principles of multiple tools and examiner qualifications, and their silence on the language and mode of assessment, a silence with real consequences for the assessment of deaf students and of students whose native language is not Arabic. The consent rule deserves particular attention. In the professional literature, informed consent is an affirmative act that the family performs after it understands, and silence does not count as consent under the US definition (34 C.F.R. §300.9). Treating a lack of response as consent may streamline procedures, but it does not ensure that the family understood what it agreed to. The team would therefore do well, even when the rule allows it to proceed, to seek explicit consent and to arrange a meeting in which it explains what will take place.
These principles do not take the place of the ethical codes of the professions in which assessors work, such as the principles of the US National Association of School Psychologists (National Association of School Psychologists, 2020). Technical standards set out how a test is built and used; ethical codes set out what the assessor owes the student and the family (Chapter 2 discusses the difference between the two in detail).
How can we be sure that the evidence we have gathered is sufficient and varied? School psychology offers a simple, practical framework for this purpose, known by its acronym (RIOT/ICEL; Christ, 2008). The acronym is formed from the initial letters of its words: the first part (RIOT) covers the methods of gathering information (Review, Interview, Observe, Test), and the second part (ICEL) covers the domains (Instruction, Curriculum, Environment, Learner). The framework is a two-dimensional matrix: four methods of gathering information, applied across four domains in which the problem may lie.
The central idea of the framework is that the problem may lie outside the student: in the way he is taught, in a curriculum pitched above his level, or in a noisy environment. An assessment that looks at the student alone may diagnose a disability that does not exist. Table 1.7 presents the matrix with examples in each cell.
| Review Review | Interview Interview | Observation Observe | Testing Test | |
|---|---|---|---|---|
| Instruction Instruction | Lesson plans and the teaching methods used so far | Asking the teacher how the skill was presented | Observing the clarity of explanation and the pace of teaching | Trying a different teaching method and measuring the response to it |
| Curriculum Curriculum | Difficulty level of the textbook and the sequence of skills | Asking the teacher about the prerequisites for the skill | Observing whether the task matches the student's level | Measuring text readability, or assessing prerequisite skills |
| Environment Environment | Attendance records, and changes of school and teacher | Asking the family about circumstances at home | Observing noise, lighting and where the student sits | Classroom environment scales |
| Learner Learner | Medical reports, previous results and samples of the student's work | Asking the student what he finds difficult | Observing his behavior across different situations | Ability and achievement tests and diagnostic scales |
Most of the cells in this matrix are in your hands before they are in the specialist's. You are the one who knows how the student is taught, the level of the curriculum and the classroom environment, and you hold the student's daily work. When you attach this information to the referral, you give the team half the picture before it begins.
No single specialist has all the knowledge needed to understand a student fully. Diagnosis is therefore the work of a team, which, depending on the case, may include the psychologist, the special education teacher, the classroom teacher, the speech-language pathologist, the physician, the occupational therapist, the audiologist, the social worker and the family. Teams differ in how they work together:
The Regulations assign assessment and diagnosis to a team made up of the relevant special education teacher, the behavioral training teacher (the psychologist), the child's guardian, and anyone whose participation the case requires (Article 81). Among the psychologist's duties they list “conducting assessment and diagnosis” using formal tools, such as standardized intelligence scales and adaptive behavior scales, and informal tools, such as interviews, observation and checklists (Articles 48 and 49) (Ministry of Education [Al-Ma'arif], 1422 AH [Arabic]). The Organizational Guide widens the team to include the school principal, the vice principal for student affairs, the special education teacher, the general education teacher, the student counselor or social worker, specialists according to the disability category, the physician or nurse where available, and the student's guardian “if possible” (Ministry of Education, 1436 AH-a [Arabic]). The phrase “if possible” is weaker than what the Regulations themselves establish when they make the guardian a member of the team, and weaker than what this book holds in the next section.
The family has known the student since birth, and in situations no one else sees. Its role in assessment goes well beyond answering questions:
The Regulations grant the family explicit rights in this regard: the guardian's permission must be obtained for diagnosis, for preparing the program and for approving any modification; the family is to be invited to take part in diagnosis, program planning and evaluation; their child's condition is to be explained to them “in understandable language”; and the student is to be rediagnosed at the family's request if they believe he has not been placed in the appropriate program (Article 76). The Regulations also require the family's participation in preparing, implementing, evaluating and monitoring the individualized education program (Ministry of Education [Al-Ma'arif], 1422 AH [Arabic]).
Detailed procedures vary across countries and categories, but most systems follow a broadly similar pathway:
Some systems set binding timelines for these steps. In the US system, for example, the initial evaluation must be completed within sixty days of parental consent, unless the state sets a different timeline (IDEA, 2004). The purpose of such timelines is to ensure that a student does not wait for months without services or a decision. Table 1.8 sets each step against the provisions of the two systems.
| Step | In the US system (as an example) | Counterpart in the Saudi system |
|---|---|---|
| 1. Observation and screening | The state is obliged to locate, identify and evaluate children with disabilities (Child find; 34 C.F.R. §300.111) | A right to the “early detection of disability” (Law on the Rights of Persons with Disabilities, Article 9); for giftedness: the National Program for Gifted Identification, upon registration |
| 2. Classroom support and documentation | For learning disabilities, evidence of appropriate instruction and repeated measurement of progress is required, and the response to intervention model may be used (34 C.F.R. §300.307, §300.309) | For learning disabilities, it must be established that general education services are inappropriate or of limited effectiveness, without specifying how this is to be established; the student may be placed under observation “for a full semester” where needed (Regulations, Article 80) |
| 3. Referral and consent | Informed written parental consent before the initial evaluation (34 C.F.R. §300.300) | Written consent from the guardian after formal notification; no response within 14 days is treated as consent (Organizational Guide) |
| 4. Comprehensive assessment | Completed within sixty days of consent, unless the state sets a different timeline | Carried out by the assessment team using tools approved by the Ministry, in seven steps that begin with notifying the guardian and end with the final report (Regulations, Article 82). We found no timeline in either document for completing the initial evaluation that corresponds to the sixty-day limit |
| 5. Decision meeting | A team that includes the parents determines eligibility, and the family receives a copy of the evaluation report (34 C.F.R. §300.306) | The assessment team issues the final report; the guardian is a member of the team under the Regulations, and “if possible” under the Guide |
| 6. Plan and reevaluation | An individualized education program with specified components (34 C.F.R. §300.320); reevaluation at least once every three years, and not more than once a year unless the family and the agency agree (34 C.F.R. §300.303) | An individualized education program covering present levels of performance, long-term and short-term goals written in measurable behavioral terms, services, and performance criteria and dates for evaluating the plan (Regulations, Articles 83–85); rediagnosis no sooner than six months and no later than eighteen months after the initial diagnosis, and thereafter as needed (Organizational Guide); the family may request rediagnosis (Regulations, Article 76) |
Sources: Ministry of Education [Al-Ma'arif] (1422 AH [Arabic]), Ministry of Education (1436 AH-a [Arabic]), the Law on the Rights of Persons with Disabilities (1445 AH [Arabic]), and the implementing regulations of US law (34 C.F.R. Part 300).
| Error | How it occurs | How to avoid it |
|---|---|---|
| Diagnostic overshadowing | New symptoms are attributed to a disability the student is already known to have, so that another disorder is missed; for example, anxiety in a student with an intellectual disability is explained away as “part of his disability” (Reiss et al., 1982). | Asking every time: Does the known disability really explain this symptom? |
| Confirmation bias | The assessor starts from a hypothesis, sees the evidence that supports it and overlooks the evidence against it. A teacher convinced that a very active student has attention-deficit/hyperactivity disorder, for example, records every moment of distraction but fails to notice his sustained attention when a task captures his interest. | Deliberately seeking alternative explanations and attending to discrepancies among sources. |
| Reliance on a single score | A decision is made because the score fell above or below the cut-off score (the threshold that the scale or the system sets for the decision), without regard to the confidence interval, the range within which the student's true score is likely to fall, or to other evidence. | The principle of multiple tools, and reading the score within its surrounding confidence interval (Chapter 2 explains both concepts in detail). |
| Overdiagnosis or underdiagnosis | A group of students is represented among those diagnosed at a higher or lower rate than expected because of language, sex or social and cultural background. | Fair tools, local norms and periodic review of referral data. |
| Overlooking the effect of labeling | The team forgets that a diagnosis can change what people expect of the student, so that less is asked of him. | Having the report describe strengths and focus on the support the student needs. |
Sultan's file can serve as a running exercise, with each chapter of Parts One and Two adding what is relevant to it: scores and confidence intervals, results from formal tools, repeated measurement data, and then the application of an identification model. Here is what the file contains now, organized by the RIOT/ICEL framework:
| Cell | What we have | What is missing |
|---|---|---|
| Review / Learner | Reading screening result: “Needs monitoring” | Detailed screening scores, results from previous years, and samples of his writing and reading |
| Review / Environment | Nothing | Attendance record, and whether he has moved between schools or teachers |
| Interview / Environment | Nothing | Asking the family about reading at home, and about hearing, vision and developmental history |
| Observation / Instruction and curriculum | Nothing | Observing the reading lesson: Are the texts at his level? Is decoding taught explicitly? |
| Testing / Learner | Nothing yet | Brief, repeated measures of reading fluency during the weeks of support |
The question that remains open is this: Is his weakness in reading a response to instruction that did not suit him, or a difficulty that persists despite appropriate instruction? It can only be answered after weeks of documented support.
The argument we have developed in this chapter holds that assessment begins with the decision to be made and then selects its tool, and that each step in the pathway has its own question: screening sorts, identification gathers initial evidence and refers, diagnosis matches criteria, and eligibility determines the need for services. It follows that no step should be asked for what it cannot provide. A screening result does not establish a disability, a medical diagnosis does not automatically confer educational eligibility, and a teacher's opinion is the beginning of identification. It follows, too, that evidence should be gathered from multiple tools and sources, that instruction, curriculum and environment should be examined before a shortfall is attributed to the student, and that the family should be a partner in the decision as well as a source of information.
Some of what this chapter has presented, however, is a matter of terminology or of judgment. Using “identification” for the stage before referral is a terminological choice we have adopted for this book; the meaning of the term differs between the field of giftedness and the field of disabilities; medical and educational categories do not always coincide; and combining criterion-based judgment with a description of functioning in context calls for professional judgment that no ready-made rule can supply. Deciding whether the evidence is sufficient to move from one step to the next remains a professional judgment, one that must be reasoned and that weighs the numbers, the documents and all the other evidence.
| Objective | Assessed by |
|---|---|
| 1. Identify the purpose of assessment and the type of tool | Question 1 |
| 2. Distinguish among the four steps of the pathway | Questions 2, 3 and 4 |
| 3. Compare models of understanding disability | Question 5 |
| 4. Map Saudi categories onto US and medical categories | Question 6 and Activity 1 |
| 5. Identify which principle of fair assessment has been violated | Questions 7 and 8 |
| 6. Build a RIOT/ICEL matrix | Question 9 and Activity 2 |
| 7. Frame the conversation with the family | Activity 3 |
| 8. Detect common errors | Question 10 and part (d) of Question 11 |
| 9. Judge the sufficiency of evidence | Question 11 (Case for application) |
General caution: Any activity involving real students or families is carried out with the consent of the family and the school administration, without any data that could identify the student, and under the supervision of a specialist if it involves administering a tool. Nothing gathered for training purposes may serve as the basis for a decision, and its results are communicated only through official channels.