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UNLOCKING

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Title: UNLOCKING


1
UNLOCKING DYSLEXIA
IDA 2007
2
THE PICTURE OF DYSLEXIA
ANN W ALEXANDER, M.D. THE MORRIS
CENTER GAINESVILLE, FL www.TheMorrisCenter.com T
IM 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 ISNT DYSLEXIA IS
  • NOT A VISUAL PROBLEM
  • NOT A LACK OF INTELLIGENCE
  • NOT DUE TO LACK OF EFFORT
  • NOT A DEVELOPMENTAL LAG.
  • NOT UNCOMMON 5 17.5
  • OF POPULATION
  • NOT RESPONSIVE 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 gt 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
JFK
CHURCHILL
SCIENTISTS INVENTORS
ENTREPRENEURS
POLITICAL MILITARY
PATTON
7
THE PICTURE OF DYSLEXIA
(All Symptoms Do Not Occur With Everyone)
STRENGTHS
HANS CHRISTIAN ANDERSEN
LEONARDO Da VINCI
HARRISON FORD STEVEN SPEILBERG
8
(No Transcript)
9
COMPENSATE
WHAT TO DO?
REMEDIATE
ACCOMMODATE
PROMOTE
10
WHAT TO REMEDIATE?
  • IF YOU DONT 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
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
PHONOLOGY
(PERCEPTION / PRODUCTION)
EXECUTIVE FUNCTION / INTENTION
WORKING MEMORY HOLD / MANIPULATE
PROSODIC REPRESENTATION (WORD LEVEL)
PHONEMIC
REPRESENTATION
ACOUSTIC STIMULUS
VISUAL STIMULUS
MOTOR ARTICULATORY STIMULUS
SOMATOSENSORY ARTICULATORY STIMULUS
ATTENTION / AROUSAL
19
(No Transcript)
20
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
21
EARLY READING DEVELOPMENT
BREAKING THE CODE
22
RECIPE FOR READING
23
WHAT IS PHONICS?
ITS A LEARNED SKILL
IT MUST BE TAUGHT
NEED PA (SOUNDS) TO HOOK TO ABSTRACT WRITTEN
SYMBOLS (LETTERS)
24
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

25
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
26
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
27
3 LEGGED STOOL
NORMAL READER
28
3 LEGGED STOOL
AUDITORY / SOUNDING OUT
AUDITORY / SOUNDING OUT
AUDITORY / SOUNDING OUT
AUDITORY / SOUNDING OUT
AUDITORY / SOUNDING OUT
AUDITORY / SOUNDING OUT
DYSLEXIA
29
WHERE
  • SIGNATURE BRAIN IMAGES ARE THE SAME
  • DIFFERENT LANGUAGES AFFECT THE PICTURE
  • ITALIAN VS ENGLISH

30
WHO
  • ANYONE
  • PREPONDERANCE IN

31
WHEN
  • AS EARLY AS THE NEWBORN PERIOD
  • IDENTIFICATION OF A PHONOLOGIC GLITCH
  • THE WEAKER THE PHONOLOGY,
  • THE EARLIER THE STRUGGLE

32
THE PICTURE OF DYSLEXIA WHAT DOES IT LOOK
LIKE?
33
THE PICTURE OF DYSLEXIA
(ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE)
ORAL LANGUAGE CHALLENGES
34
THE PICTURE OF DYSLEXIA
(ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE)
WRITTEN LANGUAGE CHALLENGES
35
THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT
OCCUR WITH EVERYONE)
ACCOMPANYING CHALLENGES (SENSORIMOTOR)
36
THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT
OCCUR WITH EVERYONE)
ACCOMPANYING CHALLENGES (BEHAVIORAL)
37
DEVELOPMENTAL DIFFERENCES
  • PRESCHOOL
  • SENSORIMOTOR
  • ORAL LANGUAGE
  • ATTENTION
  • EARLY ELEMENTARY
  • PRINT RECOGNITION
  • LETTER SOUND KNOWLEDGE
  • MECHANICS OF READING
  • HANDWRITING
  • ATTENTION

38
DEVELOPMENTAL DIFFERENCES
  • MID ELEMENTARY / MIDDLE SCHOOL
  • COMPREHENSION
  • WRITTEN EXPRESSION
  • ATTENTION
  • HIGH SCHOOL / ADULT
  • READING EFFICIENCY
  • COMPREHENSION
  • FOREIGN LANGUAGE
  • ATTENTION

39
WHAT TO DO
ASSESSMENT OF STRENGTHS AND WEAKNESSES
  • NEUROCOGNITIVE
  • PSYCHOSOCIAL

ASSESSMENT DRIVES TREATMENT
40
BELL SHAPED CURVE NORMAL POPULATION DISTRIBUTION
41
PROFILE GRAPH BRAIN TEAM
42
PROFILE GRAPH BRAIN TEAM RESULTS
43
  • 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

44
TREATMENT
  • EARLY IDENTIFICATION
  • PREVENTION OF READING DIFFICULTIES
  • LATER IDENTIFICATION
  • INTERVENTION FOR READING DIFFICULTIES

45
PREVENTION STUDY
  • MID KG END 2ND GRADE
  • SCREENING - BOTTOM 10TH ILE
  • FREQUENCY 20 MINUTES / 4 DAYS / WEEK
  • INTENSITY 11, 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

46
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.

47
A SOLUTION TO THE PROBLEM OF THE FLUENCY GAP
PREVENTIVE INTERVENTIONS
4th GRADE
2nd GRADE
100
30th ile
90
STANDARD SCORE
WORD READING
80
70
BEGINNING ile
10th 10th
Torgesen et al, 2003
TREATMENT AGE
5-6
5-6
48
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

49
GROWTH IN WORD READING ABILITY
75th 50th 25th
70th
NATIONAL PERCENTILE
30th
OCTOBER JANUARY MAY
Torgesen, www.fcrr.org
50
AT RISK READER
Left Right
KINDERGARTEN FIRST GRADE
Simos et al, 2005
51
REMEDIATION STUDY
  • OLDER CHILDREN (8 10 YRS)
  • SEVERE DYSLEXIA
  • 2nd ILE FOR WORD READING
  • 35th ILE IQ
  • 2 TREATMENTS BOTH EXPLICIT PHONICS RX
  • A BOTTOM UP (LiPS) VS A TOP DOWN (EP)
  • EQUAL TIME AND INTENSITY
  • 11
  • 100 MINS DAILY
  • 8-9 WEEKS
  • TOTAL 67.5 HRS

Torgesen et al, 2001, NICHD
52
RESEARCH DEMONSTRATES BOTH IMMEDIATE LONG
LASTING RESULTS IN BROAD READING
(DECODINGCOMPREHENSION)
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
53
TWO YEAR FOLLOW UP READING RESULTS WRMT-R
100
30th percentile
90


STANDARD SCORE
80
70
WORD ATTACK
WORD ID
PASSAGE COMP.
N 50
p lt.05
Torgesen, Alexander, Wagner et al, 2001
54
TWO YEAR FOLLOW UP READING RESULTS GORT-R
100
30th percentile
90
STANDARD SCORE
80
70
WORD ATTACKWRMT-R
TEXT READING ACCURACY
READING COMP.
TEXT READING RATE
N 50
p lt.05
Torgesen, Alexander, Wagner et al, 2001
55
SPOKEN LANGUAGE GAINS
56
GROWTH IN SPOKEN LANGUAGE DURING INTERVENTION
57
EFFECT SIZE OF TREATMENT ON LANGUAGE
COMPREHENSION
ES of 5 7 moderate 8 large
Plt 0.05
58
TREATMENTS EFFECTS ON BRAIN ACTIVITY
Simos et al 2002
59
EXCITING RESULTS! HOWEVER..
60
LATE VS EARLY INTERVENTION (PREVENTION)
WORD READING ACCURACY AND RATE
4th grade
2nd grade
100
30th ile
90
STANDARD SCORE
80
70
2nd 10th
10th 10th
BEGINNING ile
TREATMENT AGE
8-11
5-6
5-6
8-11
61
PROJECTED GROWTH IN SIGHT VOCABULARY OF NORMAL
READERS AND DISABLED CHILDREN BEFORE AND AFTER
REMEDIATION
Torgesen
Size of sight vocabulary
1 2 3 4 5
6 7
Torgesen, www.fcrr.org
Grade in School
Later intervention does not close fluency gap
early intervention does
62
EARLY INTERVENTION IS URGENT!
  • 10TH ILE 5TH GRADE READER 50,000 WORDS A YEAR
  • 50TH ILE 5TH GRADE READER 600,000 WORDS A YEAR

AVERAGE STUDENTS RECEIVE ABOUT 10 TIMES AS MUCH
PRACTICE IN A YEAR
(Anderson, Wilson, Fielding, 1988)
63
RESPONSE TO INTERVENTION MODEL
  • APPLICATION OF EVIDENCE-BASED
  • TREATMENT TO SCHOOLS
  • A TIERED APPROACH
  • TIER 1 CLASSROOM
  • TIER 2 PULL OUT SUPPORT
  • TIER 3 TOTAL PULL OUT

64
TIER TWO LITCHFIELD SCHOOL DISTRICT PHOENIX,
ARIZONA
  • ID BY CLASSROOM TEACHER
  • SPALDING INSTRUCTION IN CLASSROOM
  • READING / PA ASSESSMENT BELOW GRADE LEVEL OR,
  • AT GRADE LEVEL, BUT STRUGGLING
  • NOT QUALIFIED FOR SLD
  • EXPLICIT, MULTISENSORY PROGRAM (LiPS) 40 MINS
  • DAILY, 120 DAYS, 80-100 HRS
  • GROUPS
  • 6-81 (YOUNGER)
  • 8-121 (OLDER)

65
LSD RESULTS 1st GRADE

110
100

30th percentile

90
STANDARD SCORE
80
70
WORD ATTACK
WORD ID
PASSAGE COMP.
N 63
p lt.05
66
LSD RESULTS 2nd GRADE
110


100
30th percentile
90
STANDARD SCORE
80
70
WORD ATTACK
WORD ID
PASSAGE COMP.
N 64
p lt.05
67
LSD RESULTS 3rd 5th GRADES
100


30th percentile

90
STANDARD SCORE
80
70
WORD ATTACK
WORD ID
PASSAGE COMP.
N 126
p lt.05
68
PRINCIPLES OF LEARNING
  • WHAT FIRES TOGETHER, WIRES TOGETHER MULTIPLE
    SENSES STRENGTHEN PATHWAYS
  • OPTIMAL ATTENTION
  • CONSISTENT INPUT
  • INTENSITY
  • SALIENT
  • FREQUENT
  • REPETITION, REPETITION, REPETITION
    Alexander, 2003

69
TIER THREE EINSTEIN MONTESSORI CHARTER
SCHOOL FLORIDA
70
www.einsteinmontessori.com
71
EINSTEIN MONTESSORI SCHOOL, INC (EMS)
  • CHARTER SCHOOL (1999)
  • REMEDIATE LITERACY SKILLS
  • LANGUAGE-BASED LEARNING DIFFICULTIES
  • 2ND - 8TH GRADE
  • LITERACY SKILLS FOUR CLASS PERIODS/DAY
  • 1. PHONOLOGICAL AWARENESS (LIPS)
  • 2. READING
  • 3. READING
  • 4. WRITING
  • TEACHER TRAINING ACROSS ALL CLASSES

72
EMS GAINS 2004-2005 (GRADES 3-5)
  • SIGNIFICANT IMPROVEMENT (P lt0.001)
  • WORD ATTACK
  • PASSAGE COMPREHENSION
  • PHONOLOGICAL PROCESSING
  • WORD NONWORD READING EFFICIENCY
  • STATE ACHIEVEMENT TESTING
  • NON-SIGNIFICANT IMPROVEMENT
  • WORD IDENTIFICATION

73
EINTSTEIN MONTESSORI RESULTS
HOWEVER.MANY MEASURES, WHILE SIGNIFICANT, DID
NOT REACH 30THILE BENCHMARK
  • THEREFORE.INSTITUTING AN INTENSIVE
    FOUNDATIONAL INTERVENTION (LiPS)
  • 3 HOURS/DAY X 6 WEEKS
  • SMALL GROUP

74
FCAT 2005 AVERAGE CHANGE IN READING
DEVELOPMENT (IMPROVEMENT FROM 2004 TO 2005)
75
TIER FOUR 11
FOR THE TREATMENT RESISTERS
  • THE RESEARCH MODEL
  • THOROUGH BRAIN TEAM ASSESSMENT
  • TREAT OTHER FACTORS THAT MAY BE OBSTACLES
  • ATTENTION
  • BEHAVIOR
  • SENSORIMOTOR

76
RESEARCH RESULTS 3rd 5th GRADES
100
30th percentile
90


STANDARD SCORE
80
70
WORD ATTACK
WORD ID
PASSAGE COMP.
N 50
p lt.05
77
CONCLUSION
  • TREATMENT IS MOST EFFECTIVE IF
  • YOUNGER AGE
  • INTENSIVE
  • EXPLICIT PHONOLOGICAL/PHONICS
  • ATTENTION IS OPTIMAL
  • BOTTOM-UP MORE EXPLICIT PHONICS APPROACH
    PREVENTION
  • MILD TO SEVERE DYSLEXIA
  • AUDITORY WORKING MEMORY WEAKNESS
  • TOP-DOWN PHONICS APPROACH
  • AFTER 3RD GRADE
  • MILD TO MODERATE DYSLEXIA

78
NEUROBIOLOGY REVIEW WHY DOES INTERVENTION WORK?
79
WHY OUT OF LINE NEURONS ( ECTOPIAS )
FRONT
80
LAYERS OF BRAIN CORTEX
http//www.thebrain.mcgill.ca/flash/d/d_02/d_02_cl
/d_02_cl_vis/d_02_cl_vis.html3
81
NEURAL MIGRATION
GENETICALLY PROGRAMMED
http//www.thebrain.mcgill.ca/flash/a/a_09/a_09_cl
/a_09_cl_dev/a_09_cl_dev.htm
82
NEURAL MIGRATION GONE AWRY IN DEVELOPMENTAL
DYSLEXIA
X
http//www.thebrain.mcgill.ca/flash/a/a_09/a_09_cl
/a_09_cl_dev/a_09_cl_dev.htm
83
ECTOPIC CELLS
Ramus, 2004
84
NEURONAL CONNECTIONS
85
OUT OF LINE NEURONS ( ECTOPIAS )
FRONT
86
TYPICAL LANGUAGE ACTIVATION AREAS
87
TYPICAL READING ACTIVATION AREAS
88
BRAIN ACTIVATION WITH READING
B A C K O F R I G H T B R A I N
BACK OF LEFT BRAIN
Simos, Fletcher, Bergman, et al 2002
89
PRINCIPLES OF LEARNING
  • WHAT FIRES TOGETHER, WIRES TOGETHER MULTIPLE
    SENSES STRENGTHEN PATHWAYS
  • OPTIMAL ATTENTION
  • CONSISTENT INPUT
  • INTENSITY
  • SALIENT
  • FREQUENT
  • REPETITION, REPETITION, REPETITION
    Alexander, 2003

90
WHAT HAVE WE LEARNED FROM RESEARCH?
  • GOOD SCIENCE BEHIND INSTRUCTION AND MATERIALS.
  • INFORMED CONSUMERS OF MATERIALS.
  • FOLLOW PRINCIPLES OF LEARNING.
  • PREVENTION IS THE MOST EFFECTIVE TREATMENT
    APPROACH.

91
FUTURE DIRECTIONS
  • SHOULD WE ACCEPT THE PERSISTENCE OF A GAP AND
    ONLY FOCUS ON THE STRENGTHS?
  • HAVE WE LEARNED ALL THERE IS TO KNOW ABOUT
    IMPROVING LANGUAGE AND LEARNING SKILLS?
  • IS CLOSING THE GAP AN ACHIEVABLE GOAL?
  • PREVENTION RESEARCH CLOSED THE GAP IN FLUENCY
    AND READING ACCURACY.
  • REMEDIATION RESEARCH CLOSED THE GAP IN READING
    ACCURACY AND IMPROVED FLUENCY.

92
  • NCLB THE LEGISLATURES RESPONSIBILITY.
  • NCLB OUR RESPONSIBILITY IS TO PREVENT AND
    REMEDIATE LANGUAGE/LEARNING DISABILITIES
    GIVIVING THE TAX PAYER THEIR MONEYS WORTH.

93
AVAILABLE SCIENCE
  • JOE TORGESEN, Ph.D. WWW.FCRR.ORG
  • RICHARD WAGNER, Ph.D. NICHD FSU LEARNING
    DISABILITIES RESEARCH CENTER
  • GENETICS / DYSLEXIA REGISTRY
  • FOLLOW SEVERE DYSLEXICS
  • WEBSITE CLEARING HOUSE FOR TREATMENT RESEARCH

94
Acknowledgments
  • National Institute of Child Health and Human
    Development
  • Joe Torgesen
  • Carol Rashotte
  • Rick Wagner
  • Pat Lindamood
  • Jane Lawyer
  • Sally Shaywitz

95
THANK YOU www.TheMorrisCenter.com info_at_morriscen
ters.com 5930 SW Archer Rd Gainesville, Florida
32608 (352) 332-2629
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