Demystifying Dyslexia Robin L Billings Ph D for
Demystifying Dyslexia Robin L. Billings, Ph. D for Rochester Public Schools
DYSLEXIA a general term for disorders that involve difficulty in learning to read or interpret words, letters, and other symbols, that do not affect general intelligence. dys = Latin for “difficult” legion = Greek for “to speak” legere = Latin for “to read” Late 19 th century: coined in German from dys- ‘difficult’ + Greek lexis ‘speech’ (apparently by confusion of Greek legien ‘to speak’ from Latin legere ‘to read’).
Historical Perspectives • 1676: Dr. Johann Schmidt Described a man who lost ability to read following a stroke. • 1877: Adolf Kussmaul “a complete text-blindness may exist although the power of sight, the intellect, and the power of speech are intact”. Coined the term wortblindheit. • 1887: Rudolf Berlin Used the terms alexia to describe a complete loss of ability to read (usually due to a lesion) and dyslexia to describe difficulty with print.
Percy F. 14 yo (British Medical Journal) “ He has always been a bright and intelligent boy, quick at games and in no way inferior to others his age. His great difficulty has been-and is now- his inability to read. He has been at school or under tutors since he was 7 years old, and the greatest efforts have been made to teach him to read, but in spite of this laborious and persistent training, he can only with difficulty spell out words of one syllable. He says he is fond of arithmetic and finds no difficulty with it, but that printed or written words ‘have no meaning to him’ … I might add that the boy is bright and of average intelligence in conversation. His eyes are normal… and his eyesight is good. The schoolmaster who has taught him for some years says that he would be the smartest lad in school if the instruction were entirely oral…He is what Kussmaul has termed ‘word blind’. ”
Samuel T. Orton, M. D. 1879 -1948 • Neuropathologist from the State University of Iowa, presented his first paper on wordblindness to the 1925 annual meeting of the American Neurological Association in Washington, DC. He disputed the premise that the roots of reading disability could be located in the angular gyrus and advanced his own theory that attributed reading disorders to a lack of cerebral dominance. ’
Anna Gillingham 1878 -1963 • • • Educator and psychologist who compiled and published materials in the 1930 s which provided the foundation for the Orton. Gillingham method. One-on-one teacher-student instruction utilizing a systematic sequential method for teaching phonological decoding skills. Wrote remedial manual with Bessie Stillman.
What it’s been called in the past word amblyopia word-blindness congenital word-blindness reading disability developmental dyslexia amnesia visualis verbalis analphabetia partialis strephosymbolia (twisted words) dyssymbolia alexia
International Dyslexia Association, August 2002 “Dyslexia is a specific learning disability that is neurobiologic in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge. ”
Developmental dyslexia occurs when there is a neurological deficit/inefficiency in language areas of the brain resulting in a language-based learning disability compromising progress in reading and spelling.
• • • Reading is more difficult than speaking The reader-to-be must convert the bunches of lines and circles into the phonetic code, otherwise print/symbols lose their phonetic meaning. Many school-aged children learn to transform the printed symbols into code without much difficulty.
Basic Terms Phonemic awareness – the awareness of individual sounds in words • • • A specific term that refers to the ability to notice, identify and manipulate sounds (phonemes) in spoken words. A phoneme is the smallest part of sound in a word that makes a difference in the word’s meaning Budding dyslexic individuals are less skilled in identifying phonemes, detecting them and segmenting words into phonemes Can be taught and learned with activities such as phoneme identity, phoneme blending, and phoneme segmentation It is NOT phonics Weak phonemic awareness is the basis for poor decoding and word recognition
Basic Terms Phonological awareness – a term that describes the awareness of the sound structure of words at all levels. Includes: rhyming identifying/working with syllables identifying/working with phonemes
Family History • • • Family history of reading delay or illiteracy 1/4 - 1/2 of children with a dyslexic parent will be dyslexic If a child is dyslexic, 1/2 of his/her siblings are likely to be dyslexic 65 -70% of cases involving dyslexia in identical twins- both twins are affected
So, ultimate expression of dyslexia depends on interaction between genetics and environment Likely several genes involved
Prevalence • 3 -5% of school-age children in the US; accounts for about 80% of all individuals diagnosed with a learning disability. • 7% of Americans • Science 2001: dyslexia manifests itself in different ways, depending on the regularity of the language’s writing system (orthography) • Although universality of dyslexia is appreciated, the detected incidence/prevalence varies across different language systems.
English and French have irregular orthography English= 1, 120 ways of representing 40 -44 letter sounds using different letter combinations. cough/bough mint/pint clove/love Italian= 33 letter combinations representing 25 sounds (the same letter groups in Italian almost always represent the same unique sound).
Risk signs of Dyslexia in Early Childhood
Risk Signs in the Preschool Years • • • Language delays Difficulties learning to rhyme or perceiving rhyming sounds/words Difficulties identifying beginning and ending sounds in words Mispronouning words (“baby talk”) Difficulties learning letters in his/her name Difficulties learning letters From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
Signs in Kindergarten and 1 st Grade • • • Failure to understand that words come apart. Difficulties learning to associate letters with sounds. Appreciation of sound-symbol relationships and the ease of application of these skills. Reading errors that show no connection to the sounds to the letters. Difficulties reading common sight words and sounding out simple words. From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
“She was not like poor little Davy, who was still stuck on saw and was. If the book said saw, Davy read was. If the book said dog, Davy read god. Ramona felt so sorry for Davy that whenever she could she tried to help him circle the right pictures in his workbook. ” From Ramona The Brave by Beverly Cleary 1975
Risk signs of Dyslexia from 2 nd grade on
Problems with verbal expression • • • Mispronunciation of words Decreased organization of ideas with wordfinding problems and verbal latency The use of imprecise language, such as vague references to stuff or things Decreased vocabulary knowledge Broader language skill weaknesses are frequently seen and present along a continuum From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
Problems with reading • • • Very slow progress in acquiring reading skills Inability to read small “function” words such as that, an, in Stumbling on reading multisyllable words Weak memory for words Possible symbol reversals (b/d, was/saw, he did/did he) From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
Problems with reading, cont’d • • • Omitting parts of words when reading Oral reading filled with substitutions, omissions, and mispronunciations Oral reading that is choppy and labored, not smooth or fluent; slow and tiring From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
Problems with reading, cont’d • • • Oral reading that lacks inflection A reliance on context to discern the meaning of what is read A better ability to understand words in context than to read isolated single words More difficulty with multiple choice tests Difficulty (sometimes extreme) learning a foreign language From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
Problems with reading, cont’d • • • Difficulty finishing tests on time A lack of enjoyment in reading, and the avoidance of reading books or even a sentence The avoidance of reading for pleasure, which seems too exhausting Recruiting parents as readers Reading whose accuracy improves over time, though it continues to lack fluency and is laborious From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
Associated problems with math • • Frequent finding in association with dyslexia In the early years, difficulty with place value/regrouping Trouble with math story/word problems Weak memory for basic math facts; difficulty memorizing multiplication tables Weak extended time concepts Many have difficulty learning time on analog clocks Difficulties recalling the months of the year in order and associating months with seasons
Signs in Adolescents and Adults
Signs in Adolescents and Adults • • Persistence of earlier oral language difficulties Mispronunciation and “tripping” over parts of words; may be hesitant to say aloud words that may be mispronounced Word retrieval problems Spoken vocabulary smaller than listening vocabulary From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
Adolescents and Adults, cont’d • • • History of reading/spelling difficulties Persistent reading problems Word reading becomes more accurate over time but continues to require effort Lack of fluency Trouble reading and pronouncing uncommon, strange or unique words Slow reading/fatigue from reading From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
Adolescents and Adults, cont’d • • • Not as likely to read for pleasure Preference for books with many graphs, tables, graphics Preference for books with fewer words, larger font, “lots of white” on a page Poor/weak spelling Penalized by multiple-choice tests From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
Severity continuum «--------------------» Mild Adults with functional reading at 10 th-11 th grade level; specific residual problems with spelling, oral reading comprehension Severe Reading and spelling remain compromised; 3 rd-4 th grade level even after extensive tutoring Moderators: efficiency of the neurological/language system intellectual potential available interventions
Strengths to look for: • • • Good imagination, creative, curious Ability to “figure things out”; think outside the box Puzzles, building models Better in areas not dependent on reading; hands-on The ability to read and to understand at a high level over-learned words in a special area of interest From Shaywitz, S (2003) Overcoming Dyslexia, Chapter 10
Myths, misconceptions & misunderstandings • • • Seeing and writing letters and words backwards Left handedness; mixed dominance Horrible handwriting Clumsiness/neurological “soft signs” Skipped crawling stage in infancy
Diagnosis • • • At all ages, the diagnosis is clinical Unexpected difficulties in reading Associated problems at the level of phonological processing No one single test is definitive Medical vs. Educational
Office Assessment • • • Physical and neurological examinations are usually normal. Rule out sensory impairments. Lab/imaging studies if there are specific clinical indications. Oral reading is a very sensitive measure of reading accuracy and reading fluency May be helpful to keep a set of graded readers from kindergarten through grade 4 in the office.
Pediatric Annals April 2005
Pediatric Annals April 2005
Assessment tools Phonological Skills and Reading Readiness: • Preschool Inventory of Phonological Awareness (PIPA) • Test of Phonological Awareness (TOPA) • Comprehensive Test of Phonological Processing (CTOPP) • Clinical Evaluation of Language Fundamentals (CELF-4) • Test of Early Reading Ability (TERA-3) • Woodcock-Johnson Tests of Achievement – Fourth Edition (WJ-IV) • Test of Word Reading Efficiency-2 (TOWRE-2) • Wechsler Individual Achievement Test - Third Edition (WIAT-III)
PIPA
Assessment tools, cont’d Reading Skills: • • • Gray Oral Reading Tests – Fifth Edition (GORT 5) Test of Word Reading Efficiency - Second Edition (TOWRE-2) - a test of speeded reading of individual words Weschler Individual Achievement Tests – Third Edition (WIAT-II) Woodcock-Johnson Tests of Achievement – Fourth Edition (WJ-IV) Nelson-Denny Reading Test (standard and extended time conditions - normative date for grades 9 through 16).
Examples (eg. WIAT -III) Word reading: in to my they cow when bear don’t shop other stone sky … demagogue quincuncial vicissitude vitiate
Examples (eg. WIAT -III) Pseudoword Decoding: ik ab fip rix seb zad sluck rith dreep snay droy joom clurt plid … unfrodding … ostique … heffle tuffle … tufle hefle … psibertarian apturarial diminecial millemignalian preembutryic diphthalbarbidinyl
Assessment tools, cont’d Written Language/Expression and Spelling: • • Diagnostic Achievement Test for Adolescents (DATA-2) OWLS Written Expression Scale (WES) Test of Early Written Language – Second Edition (TEWL-2) Test of Language Development Primary Third Edition (TOLD-P: 3)
Assessment tools cont’d • • Test of Phonological Awareness (TOPA) Test of Written Language – Third Edition (TOWL-3) Weschler Individual Achievement Tests – Second Edition (WIAT-II) Woodcock-Johnson Tests of Achievement – Fourth Edition (WJ-IV) Writing Process Test Phonemic Awareness: LAC Spelling Achievement Level (WIAT-III, WJ-IV)
Intervention/Treatment • Tailor the intervention based on age and current profile of strengths and weaknesses • For young children: Draw the child’s attention to the sounds of language (Chapter 15 Shaywitz’s book) Intense, repetitive exposure to phonemic awareness The goal of effective intervention is: 1. ) remediate the weaknesses of phonemic awareness 2. ) systematic, explicit instruction in linking letter/letter combos to sounds, including spelling patterns/spelling rules • For adolescents/young adults: Focus is less on remediation and more on accommodations, though for higher functioning students, comprehension strategies are helpful
Other Treatment/Management Considerations 1. Educational planning • Represents a learning disability according to Federal law. • Certification with a Specific Learning Disability under IDEIA or • Section 504 of the Rehabilitation Act of 1973) • Younger children may need speech and language support
Other Treatments etc. • Other classroom accommodations: Oral administration of tests/readers for tests Use of a calculator/number aids Waiving a foreign language requirement Oral presentations, projects, displays Avoid demands for oral reading in the classroom Provide additional reading time (extended time for tests) Allow for inventive spelling Apelling apps Dictation software Scanning software (Kurzweil 3000)
Other Treatments, etc. 2. Assistive Technology • • • Learning Ally (www. learningally. com) Bookshare (www. bookshare. org) Both Learning Ally and Bookshare require professional certification Audible (www. audible. com) Voice Dream (www. voicedream. com) Kurzweil 3000 -firefly (www. kurzweiledu. com) Smart Pen (www. livescribe. com) Inspiration (www. inspiration. com) Index Card 4 (www. denvog. com) Dragon Anywhere (www. nuance. com) Notes App on the i. Pad (has Dragon dictation software free)
Other treatments cont’d 2. Assistive Technology: Learning Ally • Provides educational materials, books and related library services to people with print disability • Extensive library of textbooks and books • Beginning of the second grade level and extend through college/post-graduate level • Requires a certifying professional • Tel # 1 -800 -221 -4792
ID card
Other Treatment/Management Considerations 3. Tutorial support using a systematic sequential/linguistic approach: Orton-Gillingham Lindamood-Bell F. A. S. T. (Foundations of Analysis, Synthesis and Translation)
Treatment cont’d 4. Emotional/Social concerns • May vary considerably • • • Not necessarily related to level of disability Many keep their disability “hidden” A frequent comment: “other kids are smarter than me”
Other “Treatments” Vision therapy Tinted/colored lenses Prism Lenses Vitamin therapies Sensory-motor integration therapy • Based on unproven (and improbable) theories of the underlying processing deficit in dyslexia • No evidence to support their use
One of the most important: The child with dyslexia needs a champion, an advocate, a cheerleader
Resources - Websites • • International Dyslexia Association (www. interdys. org) LD Online (www. ldonline. com) Learning Disabilities Association of Michigan (www. ldaofmichigan. org) The Dyslexia Foundation (www. yesread. org) National Center for Learning Disabilities (www. ld. org) University of Michigan Dyslexia website (www. dyslexiahelp. umich. edu) Yale Dyslexia Institute (www. dyslexia. yale. edu) Professor Garfield (www. professorgarfield. org)
Resources - Books • Shaywitz, Sally. Overcoming Dyslexia: A New and Complete Science-Based Program for Overcoming Reading Problems at Any Level. ISBN-13: 9780679781592. • Foss, Ben. EThe Dyslexia Empoerment Plan: A Blueprint for Renewing Your Child’s Confidence and Love of Learning. ISBN-13: 978 -0345541253.
Books, con’t • Silver, L. The Misunderstood Child: Understanding and Coping with Your Child’s Learning Disabilities, Third Edition. ISBN: 08129 -2987. • Hall, S and Moats, L. Parenting a Struggling Reader: A Guide to Diagnosing and Finding Help for Your Child’s Reading Difficulties. Broadway Books; New York, NY; 2002. ISBN: 0 -7679 -0776 -0. • Put Reading First: The Research Building Blocks of Reading Instruction. Second Edition June 2003. Can be downloaded at the National Institute for Literacy website at www. nifl. gov/partnershipforreading. • Thank You Mr. Falker by Patricia Polacco. Philomel Books. ISBN 13: 978 -0399257629.
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