Figure 3 is a graphic display of the brain-based systems which should be evaluated. This represents the main foundation of our model. It is appropriate for the differential diagnosis of men who may be at risk for LD or ADHD. Initially, all brain-based systems should be evaluated. This includes Systems, focusing on language, personality/behavior, sensory/perception, environmental fit, academic ability, motor functions, and cognitive ability. Be aware that motor functions, which are often not evaluated in traditional school psychology examinations, may play an important role for offering appropriate interventions for boys and men who may have LD and/or ADHD. Contexts must also be evaluated and this area, which similarly is often neglected, offers a wealth of information including family relationships, community support, peer relationships, and then with a focus on the individual, considers information such as the individual’s motivation and interests. All evaluations must also consider the variety of Settings in which individuals interact. This includes the community, hospital, school, home, clinic, and any work settings where the individual may be employed. Men may have significant relationships in unique settings like in health clubs, work, churches, lodges, or professional organizations. In some cases, if a man is incarcerated, or in the court system, information from prison or the courts would also be required (Mok, D’Amato, & Witsken, 2010). Sadly, many ineffective intervention efforts have not worked well enough to keep men out of prison. Authors have advocated in ecological neuropsychology that we use multiple Methods in collecting information (D’Amato, Crepeau-Hobson et al., 2005; D’Amato, Fletcher-Janzen et al., 2005). This should include interviews, self-report data, direct observations, objective procedures such as adaptive rating scales and intelligence tests, projective measures (which we believe are critical in all of these situations with men), and behavior rating scales. Finally, a variety of Sources must be considered. Sources should include the individual under study, peers, family members, teachers or work supervisors, community members, and other school personnel if the individual is currently in the educational enterprise. If the individual is a college student, it is important to consider information from the university setting and other school personnel, and if the individual is currently employed, comprehensive information must be collected from the employer. Depending on the referral question, some of these sources of information may or may not be appropriate to contact.

Ecological clinical neuropsychological assessment should be an approach to problem-solving in which the goal is to provide both direct and indirect services to boys and men to improve their mental health, and human development (D’Amato et al., 1999). For students in a classroom, data should be collected by the teacher and used to modify individualized instruction and behavioral programming. This would be seen as providing Level I or Level II RTI services. If intervention at Level I or Level II does not solve the problem under study, a clinical neuropsychological evaluation will be needed to look more intensely at the ability of an individual to process and learn information. This could be called a Level III assessment for intervention. Tasks and tests used to evaluate Levels I, Levels II, and Levels III will be discussed later in this chapter.

Evaluation of Brain-Based Areas. Table 1 presents a list of all the brain-based systems that should be comprehensively evaluated. It does not matter if you are doing an evaluation for a male or female, or an examination for a male with a potential ADHD or LD. The same brain-related areas should be evaluated. The only difference would be that clinicians should have a focus on the gender differences as shown in clinical practice, theoretical papers, and research (Bauermeister et al., 2007; Jackson & King, 2004; Mok et al., 2010; Rhee & Waldman, 2004; Semrud-Clikeman & Teeter Ellison, 2009).

The assessment should begin with an evaluation of Perceptual Skills followed by Sensory Skills—evaluation of each of these skills individually should take place as well as each skill when it is woven together with the other skills. Motor Functions should be evaluated remembering to consider that we are contralaterally wired. Lateral preference can be evaluated both formally and informally. While lateral preference is a commonly reported difficulty, it is often over emphasized with younger children. Lateral preference should not become an area of concern until a student has completed grade three. Hopefully, we have outgrown the old idea of attempting to force students to use a right or left hand.

The Intelligence/Cognitive Abilities domain should be evaluated next, with special focus placed on verbal functions including how they relate to language, concepts, and numerical abilities. Nonverbal functions must be evaluated in a similar fashion focusing on receptive and expressive abilities equally. Researchers have stressed the critical nature of completing a comprehensive nonverbal evaluation to aid in the identification of individuals who may have a Nonverbal LD (Semrud-Clikeman, Goldenring Fine, & Harder, 2005; Semrud-Clikeman & Teeter Ellison, 2009). Executive Functioning/Attention is an area that is often left out of traditional evaluations unless an individual is referred specifically for ADHD. Even when evaluating an individual for potential LD, this area is critical. Some individuals with Reading Disabilities have Executive Functioning Disorders which interfere with their ability to learn. It also is critical to evaluate Memory, with an emphasis on short-term, long-term, working memory, and retrieval fluency.

Communication/Languages Skills is one of the most important areas to evaluate. Seminal research has shown the importance of phonological processing and this should be an important component of any evaluation (D’Amato, Fletcher-Janzen et al., 2005). Listening comprehension also is sometimes left out of an evaluation. Depending on the age of the child, pre-academic skills or Academic Achievement should be evaluated. The differentiation between individuals who are LD or ADHD is not always easy to determine and a review of academic achievement data will help in understanding the major difficulties the student is experiencing. All traditional academic subjects should be evaluated depending on the age of the individual. If the examination takes place in a public school, typically a special education teacher will complete a comprehensive academic evaluation. If this is not the case, the clinical neuropsychologist will need to evaluate this area in order to understand the ability of the individual to learn and process different types of academic information. For example, an individual with a reading disability presents very differently than one with a written language disability (Chittooran & Tait, 2005; Joseph, 2005; Semrud-Clikeman et al., 2005). Once attention is controlled for, many individuals with ADHD are found to not have significant problems learning (Semrud-Clikeman & Teeter Ellison, 2009; Tetter Ellison, 2005). However, it is noteworthy that many individuals with ADHD also meet diagnostic criteria for those with an LD. As previously discussed, in the US, many individuals with ADHD receive services in public schools classified as an individual with OHI. The diagnostic categories of LD and ADHD often overlap in that clients and individuals who are diagnosed with one disability often are also diagnosed with the other.

The final area considered is the area of Educational/Classroom Environment/Employment. This is, perhaps, the most important area considered for school-age individuals who are potentially diagnosed as LD or ADHD. We initially consider the individual’s Learning Environment and how they fit within it, and evaluate Peer Reactions, Community Reactions, Teacher/Staff Knowledge, Learner Competencies, Teachers/Staff Reactions, and Classroom Dispositions. How the individual fits within the classroom environment or work setting as well as the family environment is imperative if we are to make an appropriate diagnosis and offer the correct evidence-based interventions (D’Amato et al., 1999; Witsken et al., 2008). For older individuals, the work setting can be a primary area of consideration and must be evaluated.

Previously, the main focus of this chapter has been on understanding the unique characteristics of male individuals who may be diagnosed as LD or ADHD. Throughout the chapter, we have argued for the importance of early intervention in the classroom, and advocated that initially, classroom teachers should intervene with students, and this intervention should be followed by specially trained teacher interventionists who work individually with students. As we have previously detailed, some students will not make progress even when provided with sustained individual instruction including curriculum modifications. When this happens, we have argued for the use of an ecologically based clinical neuropsychological examination. The most critical step when working with a child is to know which areas are strengths and which are weaknesses, and then to provide evidence-based interventions in the areas in which the student has displayed difficulties. We also can use strengths to work around or compensate for weaknesses.

To aid in this enormous undertaking, D’Amato and his colleagues have assembled a comprehensive brain-based table (Table 2) which lists the areas which must be evaluated to understand and intervene with an individual (D’Amato et al., 1999; D’Amato, Crepeau-Hobson et al., 2005; D’Amato, Fletcher-Janzen et al., 2005; Mok et al., 2010; Witsken et al., 2008). After the student is informally and/or formally evaluated by the teacher, special service provider, or clinical neuropsychologist, these individuals must offer evidence-based interventions in the area(s) of concern. All assessments, completed by individuals at any level, should include an evaluation of the following areas: READING: Phonemic Awareness, Phonics, Vocabulary, Reading Fluency, Reading Comprehension, Phonologic Access (or Rapid Automatic Naming), Oral Language/Listening Comprehension, Short-/Long- Term and Working Memory, Language Reception, Expression, Attention/Executive Functions, Visual Motor Skills. MATH: Math Computation, Math Problem Solving. WRITING-WRITTEN LANGUAGE: Handwriting, Spelling, and Written Comprehension. Each of these areas is followed by a reference which provides additional information about why the area is important and how it could be used when offering an evidence-based intervention. Obviously, it is impossible to list all tests that fall within these important areas. Clearly, measures could be added in each of our vital areas. The importance is to have a measure used in each area to evaluate if it is a strength or need of the individual. Worth mentioning is that under each of these areas, techniques or tests are offered which can be completed by teachers or other school or mental health professionals. Some of the listed tests can only be used by a school psychologist or clinical neuropsychologist. Each test is marked according to who may administer it. Remember, the area should be evaluated using whatever tests or informal measures are available. In addition, the goal should be not just to understand the individual, but to find an appropriate intervention using the individuals’ strengths and needs to help them achieve in life.