Tim Conway, Ph.D. The Morris Center, Inc. and Dept. of Clinical and Health Psychology Univ. of Florida Gainesville, Flo

1. Breaking through the Barriers: How Adults with Dyslexia Made Significant Improvements in Phonological Processing, Reading, Spelling and Writing Skills. Tim Conway, Ph.D. The Morris Center, Inc. and Dept. of Clinical and Health Psychology Univ. of Florida Gainesville, Florida www.TheMorrisCenter.com

2. WHAT DYSLEXIA IS NOTDYSLEXIA… • .. is NOT A VISUAL PROBLEM • .. is NOT A LACK OF INTELLIGENCE • .. is NOT DUE TO LACK OF EFFORT • .. is NOTA DEVELOPMENTAL LAG • .. is NOT UNCOMMON: 5–17.5 % OF POPULATION • ..is NOT IMPROVED BY STANDARD READING INSTRUCTION

3. Learning Difficulty or Dyslexia • Dyslexia => Dys = difficulty & lexia = words • Poor skills in Reading • Neurological in origin • Lifelong, but environment may alter course • Core deficit = “phonological language skills” • Accompanying Challenges (~50%) • ADHD • Sensorimotor • Behavior problems = More challenging to remediate

4. “CAN WE MAKE CHANGES IN NEURAL SYNAPSES or NETWORKS?” AT WHAT AGE DO HUMAN NEURONS LOSE THE ABILITY TO MAKE NEW CONNECTIONS (SYNAPSES) WITH OTHER NEURONS?

7. VISUAL-LANGUAGE ASSOCIATIONAREA VISUAL / VERBAL AREA SPEECH PRODUCTION AREA AUDITORY PROCESSING AREA LEFT HEMISPHERE TYPICAL LANGUAGE AREAS

8. WORD ANALYSIS WORD ANALYSIS AUTOMATIC (SIGHT WORD) LEFT HEMISPHERE TYPICAL READING AREAS

9. Area Spt (left) auditory-motor interface pIFG/dPM (left) articulatory-based speech codes STG (bilateral) acoustic-phonetic speech codes pMTG (left) sound-meaning interface STSphoneme representations Hickok & Poeppel (2000), Trends in Cognitive Sciences Hickok & Poeppel (2004), Cognition

10. UNIQUE AND OVERLAPPING NETWORKS SENTENCE/SYNTACTIC,, SEMANTIC, &, PHONOLOGICAL VIGNEAU et al., 2006

11. How were these networks formed?

12. NEURONAL MIGRATION (GALABURDA, LOTURCO, RAMUS, FITCH & ROSEN, 2006) Galaburda, 2006

13. NEURONAL MIGRATION NEURAL MIGRATION has gone AWRY in Developmental Dyslexia? X www.thebrain.mcgill.ca

14. “OUT OF LINE NEURONS” (ECTOPIAS) FRONT BACK

15. From Genes to Behavior in Developmental Dyslexia. Galaburda AM, LoTurco J, Ramus F, Fitch RH, Rosen GD.Nat Neurosci. 2006 Oct;9(10):1213-7. All four genes thus far linked to developmental dyslexia participate in brain development, and abnormalities in brain development are increasingly reported in dyslexia. Comparable abnormalities induced in young rodent brains cause auditory and cognitive deficits, underscoring the potential relevance of these brain changes to dyslexia. Our perspective on dyslexia is that some of the brain changes cause phonological processing abnormalities as well as auditory processing abnormalities; the latter, we speculate, resolve in a proportion of individuals during development, but contribute early on to the phonological disorder in dyslexia. Thus, we propose a tentative pathway between a genetic effect, developmental brain changes, and perceptual and cognitive deficits associated with dyslexia.

16. (Ramus, 2004) Biology Cognition Behavior

19. Is there a Neurobiological Basis to Dyslexia?

22. Could Dyslexia Affect More Than Language Skills?

23. “OUT OF LINE NEURONS” (ECTOPIAS) FRONT BACK

25. Intellect Development Development Systems (Williams & Shellenberger, 1996)

28. Dyslexia may involve a wide range of behaviors or developmental abilities, besides reading. However, adults may “select” occupations or environments that put limited demands on their weaker skills.

29. Interdisciplinary Approach to Assessment and Treatment • Two or more disciplines combine/coordinate their knowledge to improve “weak” skills. • Degree of shared knowledge across disciplines • Common understanding of the others’ expertise • Shared theoretical model and vocabulary

31. Intellect Development Development Systems (Williams & Shellenberger, 1996)

32. Prior Research

33. Pilot Data => Future Grants • Alexander, Anderson, Heilman, Voeller, Torgesen (1991). Phonological Awareness Training and Remediation of Analytic Decoding Deficits in a Group of Severe Dyslexics. Annals of Dyslexia, 41, 193-206.

34. Preventing Reading Failure in Young Children with Phonological Processing Disabilities: Group and Individual Responses to Instruction • Joseph K. Torgesen • Richard K. Wagner • Carol Rashotte • Elaine Rose • Patricia Lindamood • Tim Conway • Cyndi Garvan • (1999). Journal of Educational Psychology 91, 579-593. • *NICHD, National Center for Learning Disabilities, Donald D. Hammill Foundation

35. Intensive Remedial Instruction for Children with Severe Reading Disabilities: Immediate and Long-term Outcomes from Two Instructional Approaches • Joseph K. Torgesen • Ann W. Alexander • Richard K. Wagner • Carol Rashotte • Kytja Voeller • Tim Conway • (2001). Journal of Learning Disabilities, 34, 33-68. • Supported by NICHD, NCLD, DDHF

36. RESEARCH DEMONSTRATES BOTH IMMEDIATE & LONG LASTING RESULTS IN BROAD READING (DECODING+COMPREHENSION) 9-Week Intensive Program Post- Treatment Test 16 Mos. Special Ed Class 95 Normal Range of Performance 90 Standard Score 85 80 75 Initial Test Pre- Treatment Test 1 Year After Treatment 2 years Torgesen, Alexander, Wagner et al, 2001

37. Interdisciplinary Team • Pediatrician/Psychiatrist • Nursing/Nurse Practitioner • Psychology/Neuropsychology • Occupational Therapy • Speech-Language Pathology • Teacher/Special Education

38. Interdisciplinary Assessment & Treatment of Learning Disabilities Overview of Services • Intake/Screening Appointment • Phase I Assessment • Phase II Assessment • Treatment • Post-treatment Assessment • Follow-up/Generalization

39. Interdisciplinary Treatment Program • Key treatment features are based on neuroscience and behavioral treatment research findings • Intensity (# of hours per day) • Frequency (# of days per week) • Specificity (clarity of treatment program) • Ongoing data collection of program effects for program self-evaluation • Selective post-treatment assessment with standardized tests to document treatment gains

40. Interdisciplinary Assessment and Treatment Goals • Identify and then improve weak skills to develop new strengths in: • Language • Sensorimotor • Cognition/attention • Behavior • Develop independent functioning in language, sensory-motor, behavior & achievement, relative to an individual’s true potential. • Provide essential “tools” for success in academic, occupational and interpersonal domains of life.

41. Training Phonological Awareness via Articulatory feedback/awareness (Lindamood & Lindamood, 2011) VO O OV TOV TAV TAVD

42. Treatment - Case Study • High school student • History of dyslexia • Years of school-based academic intervention • Years of reading tutoring • commercial centers, by private 1:1 tutors… • a family member was an ESE Reading Specialist • A first-team athlete • Weak skills in: • reading (>5 years below grade), writing & spelling • comprehension • auditory and visual memory • visual-spatial • attention

43. Treatment - Case study • Interdisciplinary Phase I & II assessments identified weaknesses in: • Language • poor phonological processing, reading, spelling and comprehension • Occupational Therapy • sensory integration deficits including poor praxis, vestibular, visual vigilance, visual tracking, and visual processing • Medical • poor attention, as exhibited by difficulty maintaining attention to relevant visual and auditory stimuli

44. Interdisciplinary Treatment Program • Individualized, interdisciplinary treatment • Speech-Language Therapy • Occupational Therapy • Clinical Psychology/Counseling • Intensive, Frequent and Explicit Treatment • 22-25 hours of language treatment per week • 5 days/week for 4-5 hours/day • 1 hour of counseling per week • 1 hour of parent education per week • 5 hours of occupational therapy per week • 12 weeks of 1:1 interdisciplinary treatment • (duration of treatment is client dependent)

45. Documented Treatment Results • Selective re-administration of pre-treatment standardized, nationally normed-tests for measurement of post-treatment gains. • Graphical representation shows pre-treatment scores as blue stars and post-treatment scores as green stars • Green arrows indicating areas of significant gain or improvement.

46. post-treatment skills

47. Group Performance (n=19, age 16 – 47)

48. Mid-20’s grad student

49. Mid-20’s grad student

50. Future Directions • Test explicit training of sight word skills and fluency training, AFTER successfully retraining phonological awareness. • However, explicit fluency training was not needed for remediated children; they needed more practice for automaticity of skills. • Test training visual memory to improve orthographic spelling skills.