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UNLOCKING DYSLEXIA

UNLOCKING DYSLEXIA. IDA 2007. THE PICTURE OF DYSLEXIA. ANN W ALEXANDER, M.D. THE MORRIS CENTER GAINESVILLE, FL www.TheMorrisCenter.com TIM CONWAY, Ph.D. UNIVERSITY OF FLORIDA GAINESVILLE, FL. IDA 2007. THE PICTURE OF DYSLEXIA. THE. WHO. WHAT. WHEN. WHERE. WHY. &.

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UNLOCKING DYSLEXIA

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  1. UNLOCKING DYSLEXIA IDA 2007

  2. THE PICTURE OF DYSLEXIA ANN W ALEXANDER, M.D. THE MORRIS CENTER GAINESVILLE, FL www.TheMorrisCenter.com TIM CONWAY, Ph.D. UNIVERSITY OF FLORIDA GAINESVILLE, FL IDA 2007

  3. THE PICTURE OF DYSLEXIA THE • WHO • WHAT • WHEN • WHERE • WHY & • WHAT IT LOOKS LIKE • WHAT TO DO

  4. WHAT IT ISN’TDYSLEXIA IS … • NOTA VISUAL PROBLEM • NOTA LACK OF INTELLIGENCE • NOTDUE TO LACK OF EFFORT • NOTA DEVELOPMENTAL LAG. • NOTUNCOMMON – 5 – 17.5 % OF POPULATION • NOTRESPONSIVE TO STANDARD READING INSTRUCTION

  5. WHAT IT IS DYS= TROUBLE LEXIA= WORDS TROUBLE WITH WORDS • NEUROLOGIC IN ORIGIN - GENETIC • LIFELONG – ENVIRONMENT MAY ALTER COURSE • CORE DEFICIT IN PHONOLOGICAL COMPONENT OF LANGUAGE • READING COMPREHENSION > WORD READING • ACCOMPANYING CHALLENGES ( 50% ) • ADHD • SENSORY MOTOR DIFFICULTY • BEHAVIORAL PROBLEMS • MORE CHALLENGING TO REMEDIATE

  6. THE PICTURE OF DYSLEXIA (All Symptoms Do Not Occur With Everyone) STRENGTHS LEADERSHIP SKILLS THINKING “OUT OF THE BOX” THOMAS EDISON (PHONOGRAPH) TED TURNER CHURCHILL JFK SCIENTISTS & INVENTORS ENTREPRENEURS POLITICAL & MILITARY PATTON

  7. THE PICTURE OF DYSLEXIA CREATIVITY ACTORS / DIRECTORS WRITERS ARTISTS MUSICIANS MOZART (All Symptoms Do Not Occur With Everyone) STRENGTHS HANS CHRISTIAN ANDERSEN LEONARDO Da VINCI HARRISON FORD & STEVEN SPEILBERG

  8. THE PICTURE OF DYSLEXIA (All Symptoms Do Not Occur With Everyone) STRENGTHS VISUOSPATIAL / MOTOR SKILLS SURGEONS ATHLETES NEUROSURGERY MOHAMMAD ALI NOLAN RYAN

  9. WHAT TO DO? COMPENSATE REMEDIATE ACCOMMODATE PROMOTE

  10. WHAT TO REMEDIATE? “IF YOU DON’T KNOW THE CAUSE YOU GET INSTRUCTIONAL PARADIGMS BUILT ON FAULTY ASSUMPTIONS.” G. Reid Lyon, Ph.D.

  11. PHONOLOGICAL AWARENESS THE CORE DEFICIT

  12. WHAT IS PHONOLOGICAL AWARENESS?

  13. PHONOLOGICAL AWARENESS • THE UNDERSTANDING THAT WORDS ARE MADE UP OF SMALL BITS OF SOUND – PHONOLOGICAL SENSITIVITY Do the words cat and fat sound the same at the end? What is the first sound in the word man? • INNATE IN A TYPICAL BRAIN RECEIVING APPROPRIATE LANGUAGE INPUT Torgesen, www.fcrr.org

  14. PHONEMIC AWARENESS • THE ABILITY TO IDENTIFY, THINK ABOUT, AND MANIPULATE THE INDIVIDUAL SOUNDS (PHONEMES) IN WORDS • THE IMPLICATION OF A GROWING ABILITY TO IDENTIFY INDIVIDUAL SOUNDS IN WORDS. Torgesen, www.fcrr.org

  15. EARLY LANGUAGE DEVELOPMENT • BRAIN IS TUNED TO PARENTS’ LANGUAGE • NEWBORN: INTEGRATES: • ORAL-FACIAL MOVEMENTS • SPEECH SOUNDS – PHONOLOGY • SOCIAL – EMOTIONAL (NON VERBAL TONES & GESTURES) - PRAGMATICS

  16. METALINGUISTIC WRITING SPELLING READING SYNTAX (FORM) SEMANTICS (MEANING) PHONOLOGY PRAGMATICS (FORM) (FUNCTION) LANGUAGE (BUILDING BLOCKS) 9 YEARS ___ 5 YEARS ___ 18 MONTHS ___ 9 MONTHS ___ 1 MONTH ___

  17. PRINCIPLES OF LEARNING • WHAT FIRES TOGETHER, WIRES TOGETHER – MULTIPLE SENSES STRENGTHEN PATHWAYS • OPTIMAL ATTENTION • CONSISTENT INPUT • INTENSITY • SALIENT • FREQUENT • REPETITION, REPETITION, REPETITION Alexander, 2003

  18. (PERCEPTION / PRODUCTION) PHONOLOGY EXECUTIVE FUNCTION / INTENTION WORKING MEMORY HOLD / MANIPULATE PROSODIC REPRESENTATION (WORD LEVEL) PHONEMIC REPRESENTATION MOTOR ARTICULATORY STIMULUS SOMATOSENSORY ARTICULATORY STIMULUS ACOUSTIC STIMULUS VISUAL STIMULUS ATTENTION / AROUSAL

  19. THE EFFECTS OF WEAKNESSES IN ORAL LANGUAGE ON READING GROWTH (Hirsch, 1996) 16 15 14 13 12 11 10 9 8 7 6 5 High Oral Language in Kindergarten 5.2 years difference Reading Age Level Low Oral Language in Kindergarten 5 6 7 8 9 10 11 12 13 14 15 16 Chronological Age Torgesen, www.fcrr.org

  20. EARLY READING DEVELOPMENT BREAKING THE CODE

  21. DECODING (MECHANICS) READING COMPREHENSION + LANGUAGE COMPREHENSION RECIPE FOR READING

  22. PRONOUNCE THESE WORDS… blit frachet WHAT IS “PHONICS”? IT’S A LEARNED SKILL IT MUST BE TAUGHT NEED PA (SOUNDS) TO HOOK TO ABSTRACT WRITTEN SYMBOLS (LETTERS)

  23. 6 5.9 5 Average Low PA Low 4 Ave. PA READING GRADE LEVEL 3 2.3 2 1 K 1 2 3 4 5 GRADE LEVEL CORRESPONDING TO AGE GROWTH IN “PHONICS” ABILITY OF CHILDREN WHO BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME AWARENESS AND LETTER KNOWLEDGE(Torgesen & Mathes, 2000) Torgesen, www.fcrr.org `

  24. 5.7 Low PA Average 5 Low Ave. PA 4 3.5 3 READING GRADE LEVEL 2 1 K 1 2 3 4 5 GRADE LEVEL CORRESPONDING TO AGE GROWTH IN WORD READING ABILITY OF CHILDREN WHO BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME AWARENESS AND LETTER KNOWLEDGE(Torgesen & Mathes, 2000) 6 Torgesen, www.fcrr.org

  25. 6.9 6 Average Low 5 4 3.4 READING GRADE LEVEL 3 2 SAME VERBAL ABILITY – VERY DIFFERENT READING COMPREHENSION 1 Low PA Ave. PA K 1 2 3 4 5 GRADE LEVEL CORRESPONDING TO AGE GROWTH IN READING COMPREHENSION OF CHILDREN WHO BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME AWARENESS AND LETTER KNOWLEDGE(Torgesen & Mathes, 2000) Torgesen, www.fcrr.org

  26. 3 – LEGGED STOOL COMPREHENSION FLUENCY AUDITORY / SOUNDING OUT VISUAL / SIGHT WORDS LANGUAGE / VOCABULARY GRAMMAR NORMAL READER

  27. 3 – LEGGED STOOL COMPREHENSION FLUENCY VISUAL / SIGHT WORDS AUDITORY / SOUNDING OUT LANGUAGE / VOCABULARY GRAMMAR AUDITORY / SOUNDING OUT AUDITORY / SOUNDING OUT AUDITORY / SOUNDING OUT AUDITORY / SOUNDING OUT AUDITORY / SOUNDING OUT AUDITORY / SOUNDING OUT DYSLEXIA

  28. ANYWHERE WHERE • “SIGNATURE” BRAIN IMAGES ARE THE SAME • DIFFERENT LANGUAGES AFFECT THE PICTURE • ITALIAN VS ENGLISH

  29. ALL AGES • ALL WALKS OF LIFE • ARCHITECTS • ENGINEERS • SURGEONS • ENTREPRENEURS • SCHOOL DROPOUTS • PRISON INMATES WHO • ANYONE • PREPONDERANCE IN :

  30. WHEN • AS EARLY AS THE NEWBORN PERIOD • IDENTIFICATION OF A PHONOLOGIC “GLITCH” • THE WEAKER THE PHONOLOGY, THE EARLIER THE STRUGGLE

  31. THE PICTURE OF DYSLEXIA WHAT DOES IT “LOOK” LIKE?

  32. THE PICTURE OF DYSLEXIA LISTENING SPEAKING Poor PHONOLOGICALAWARENESS Word Finding Multi- syllables Memory for word sequence (phone numbers, directions) Sequencing Ideas Foreign Language Foreign Language (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ORAL LANGUAGE CHALLENGES

  33. READING SPELLING/WRITING Mechanics Comprehension Mechanics Expressing Ideas Speed Speed THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) WRITTEN LANGUAGE CHALLENGES

  34. Messy Eating Oral Motor Writing/knots Fingers Lose Place Words Swim Eyes Tired Left/Right Spatial Awareness Up/Down THE PICTURE OF DYSLEXIA(ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ACCOMPANYING CHALLENGES (SENSORIMOTOR)

  35. Brain / Behavior Disorders Attention / Executive Function Anxiety OCD Oppositional Behavior Depression Parents with similar challenges THE PICTURE OF DYSLEXIA(ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ACCOMPANYING CHALLENGES (BEHAVIORAL)

  36. DEVELOPMENTAL DIFFERENCES • PRESCHOOL: SENSORIMOTOR ORAL LANGUAGE ATTENTION • EARLY ELEMENTARY: PRINT RECOGNITION LETTER – SOUND KNOWLEDGE MECHANICS OF READING HANDWRITING ATTENTION

  37. DEVELOPMENTAL DIFFERENCES • MID ELEMENTARY / MIDDLE SCHOOL: COMPREHENSION WRITTEN EXPRESSION ATTENTION • HIGH SCHOOL / ADULT: READING EFFICIENCY COMPREHENSION FOREIGN LANGUAGE ATTENTION

  38. WHAT TO DO ASSESSMENT OF STRENGTHS AND WEAKNESSES • NEUROCOGNITIVE • PSYCHOSOCIAL ASSESSMENT DRIVES TREATMENT

  39. BELL SHAPED CURVENORMAL POPULATION DISTRIBUTION

  40. PROFILE GRAPH BRAIN TEAM SEVERE AT RISK AVERAGE SUPERIOR GIFTED RANGE WEAKNESS STRENGTH Standard Scores 65 70 75 80 85 90 95 100 105 110 115 120 125 130 135 Percentiles 1st 2nd 5th 9th 16th 25th 37th 50th 63rd 75th 84th 91st 95th 98th 99th ATTENTION/ INTENTION Visual Auditory INTELLIGENCE/COGNITION Fluid Reasoning Executive Processes Processing Speed ORALLANGUAGE Phonological Awareness (Morpho)Syntactic Awareness Receptive (Listening) Expressive (Speaking) Word Retrieval (Naming) MEMORY Aud. Working Memory Vis. Working Memory SENSORIMOTOR Visual Processing Visuo/Motor Ability

  41. SEVERE AT RISK AVERAGE SUPERIOR GIFTED WEAKNESS RANGE STRENGTH Standard Scores 65 70 75 80 85 90 95 100 105 110 115 120 125 130 135 Percentiles 1st 2nd 5th 9th 16th 25th 37th 50th 63rd 75th 84th 91st 95th 98th 99th WRITTENLANGUAGE Word Reading (Real) Word Reading (Rate) Word Reading (Nonsense) Word Reading (Rate) Passage Comprehension Passage Fluency Writing/Written Expression Writing Fluency Spelling ARITHMETIC Concepts Operations Applications Fluency PROFILE GRAPH BRAIN TEAM RESULTS

  42. PRESCHOOL PREDICTORS • OF • FUTURE READING • SUCCESS PHONOLOGICAL AWARENESS • LETTER NAME KNOWLEDGE • RAPID NAMING of OBJECTS, COLORS • ALL OF THESE PREDICTORS ARE DEPENDENT • ON A STRONG PHONOLOGICAL SYSTEM • NOT IQ !!! Torgesen, www.fcrr.org

  43. TREATMENT • EARLY IDENTIFICATION • PREVENTION OF READING DIFFICULTIES • LATER IDENTIFICATION • INTERVENTION FOR READING DIFFICULTIES

  44. PREVENTIONSTUDY • MID KG – END 2ND GRADE • SCREENING - BOTTOM 10TH %ILE • FREQUENCY – 20 MINUTES / 4 DAYS / WEEK • INTENSITY – 1:1, 67 HRS. • TEACHERS & AIDES • 4 METHODS – PASP (MULTISENSORY, “BOTTOM UP”- LiPS) EP (TRADITIONAL RDG INSTRUCTION WITH EXPLICIT PHONICS) RCS (SUPPORT OF CLASSROOM TEACHING) NTC (NO TREATMENT CONTROL)Torgesen et al, 1999 NICHD

  45. PREVENTION STUDY OUTCOME • ONLY PASP YIELDED SIGNIFICANT PHONOLOGICAL AWARENESS AND WORD READING GAINS • END OF 2ND GRADE: 50TH %ILE WORD READING SKILLS (ACCURACY AND FLUENCY). • OTHERS NO BETTER THAN NO TREATMENT CONTROL • BEST PREDICTORS OF GROWTH IN READING: ATTENTION/BEHAVIOR, HOME BACKGROUND, AND P/A.

  46. Accuracy Rate A SOLUTION TO THE PROBLEM OF THE FLUENCY GAP: PREVENTIVE INTERVENTIONS 2nd GRADE 4th GRADE 100 30th % ile 90 WORD READING STANDARD SCORE 80 70 BEGINNING % ile 10th 10th Torgesen et al, 2003 TREATMENT AGE 5-6 5-6

  47. Percent 45 retained NTC in K or 1 40 35 RCS 30 EP 25 20 15 LiPS 10 5 0 DYSLEXIA PREVENTION STUDY“BOTTOM-UP” VS “TOP-DOWN” • PASP (LiPS) USES A MORE EXPLICIT, CONCRETE, MULTISENSORY (“BOTTOM UP”) APPROACH TO DEVELOP PHONOLOGICAL AWARENESS Torgesen et al, 1999

  48. GROWTH IN WORD READING ABILITY 75th 50th 25th 70th NATIONAL PERCENTILE 30th OCTOBER JANUARY MAY Torgesen, www.fcrr.org

  49. AT RISK READER BEFORE INTERVENTION AFTER INTERVENTION LeftRight KINDERGARTEN FIRST GRADE Simos et al, 2005

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