Dyslexia

1
Dyslexia

• Teaching students with receptive and expressive
  language impairments in the oral and written
  language modalities

2
Contents

• 1. What is Dyslexia?
• 2. Identification, diagnoses and treatment
  considerations?
• 3. What are some ways to approach treatment?
• 4. Answering questions

3
Definition

• Dyslexia is defined by the National Institution
  of Health (NIH) as a brain-based type of
  learning disability that specifically impairs a
  person's ability to read.
• In general, most individuals with dyslexia
• Typically read at levels significantly lower than
  expected despite having normal intelligence.
• Dyslexia is often referred to as a language based
  learning disability.
• Individuals with dyslexia usually have difficulty
  with either receptive oral language skills,
  expressive oral language skills, reading,
  spelling, or written expression.

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Research Based Facts

• Dyslexia is the most researched of all learning
  disabilities.
• Dyslexia affects at least 1 out of every 5
  children in the United States.
• Dyslexia affects as many boys as girls.
• Dyslexia is the leading cause of reading failure
  and school dropouts in our nation.
• Reading failure is the most commonly shared
  characteristic of juvenile justice offenders.

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Characteristics

• 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.

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Question 1 Can you be a little or a lot
dyslexic?

• Dyslexia varies in degrees of severity.
• The prognosis depends on the
• severity
• specific patterns of strengths and weaknesses
• appropriateness of the intervention
• It is not a result of lack of motivation, sensory
  impairment, inadequate instruction, environmental
  opportunities, low intelligence, or other
  limiting conditions. It is a condition which is
  neurologically based and often appears in
  families.
• Occasionally, dyslexia can be misdiagnosed when
  vision deficits are involved.

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Question 2 Is it spectrumish?

• This question leads to the discussion of
  emotional/behavioral consequences of reading
  deficits.
• Other disorders that may co-occur include
• Attention deficit disorders
• Autism spectrum disorders
• Auditory processing deficits
• Seizure disorder
• Children with Language Learning Differences
  (multilingual backgrounds) may also have dyslexia
• Others

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Question 3 Is dyslexia hereditary?

• Answer Some forms of dyslexia are highly
  heritable.
• (Excerpt of an article in the American Journal
  of Psychiatrypublished in December 2008on
  www.ajp.psychiatryonline.org)

• Dyslexia Susceptibility Gene
• The results of this study both support the
  role of K1AA0319 in the development of dyslexia
  and suggest that this gene influence reading
  ability in the general population. Moreover, the
  data implicate the three-SNP haplotype and its
  tagging SNP rs2143340 as genetic risk factors for
  poor reading performance.

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2005-2008 Research Highlights

• Dyslexic children use nearly five times the
  brain area as normal children while performing a
  simple language task (2005) (e.g., Detour to MP)
  
• Dyslexia may be caused by disorganized,
  meandering tracts of nerve fibers in the brain
  making it difficult to integrate the information
  needed for rapid, automatic reading. (2007)
• Key areas for language and working memory
  involved in reading are connected differently in
  dyslexics (2007)
• Intensive remedial instruction resulted in an
  increase in brain activity in several cortical
  regions associated with reading, and that gains
  became further solidified during the year
  following instruction (2008)
• Once the children with dyslexia received an
  intense and specialized instructional program,
  their patterns of functional brain connectivity
  normalized. (2008)

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2008-2010 Research Highlights

• Preschool predictors of reading and writing
  difficulties were identified in two contexts a
  delayed ability to detect and process voices, and
  slow naming of familiar, visually presented
  objects (2008)
• A moderate and stable relationship was found in
  phenotypes between 4-year speech and language
  scores and reading at 7, 9, and 10 years (2009)
• Results support the notion that letter-speech
  sound integration is an emergent reading skill
  that develops inadequately in dyslexic readers,
  presumably as a result of a deviant interactive
  specialization of neural systems for processing
  auditory and visual linguistic inputs. (2010)

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Conclusions

• Dyslexia is a brain-based disorder.
• Timing of connections have a significant affect
  on processing language.
• White matter in the brain can be altered. The
  earlier this happens the better.
• "Focused instruction can help underperforming
  brain areas to increase their brain
  proficiency." 
• Both genetic and environmental factors contribute
  to the relationship between early language skills
  and reading, whereas genetic factors play a
  dominant role in the relationship between early
  speech and reading.

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Early Intervention Begins in Preschool

• Individuals with dyslexia respond successfully to
  timely and appropriate intervention.
• Children as young as 4 1/2 can be diagnosed with
  dyslexia.
• Dyslexia is identifiable, with 92 accuracy, at
  ages 5 1/2 to 6 1/2.

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Red Flags

• Begins with
• Poor expressive receptive language skills
• Poor listening, processing organizational
  skills
• Lack of print knowledge
• Poor phonological awareness skills
• But, often, it is spelling that separates kids
  with dyslexia from kids who struggle with reading
  for some other reason.
• (See a list of additional red flags in the
  addendum)

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Directionality

• Most dyslexic children and adults have
  significant directionality confusion.
• Left-Right confusion
• Even adults have to use whatever tricks their
  mother or teacher taught them to tell left from
  right. It never becomes rapid and automatic.
• A common saying in household with dyslexic people
  is, "It's on the left. The other left."
• That's why they are b-d confused. One points to
  the left and one points to the right.
• They will often start math problems on the wrong
  side, or want to carry a number the wrong way.
  (e.g., Hannah)
• Up-Down confusion
• Some children with dyslexia are also up-down
  confused. They confuse b-p or d-q, n-u, and m-w.

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My kid reverses. Is he dyslexic?

• Confusion about directionality words
• First-last, before-after, next-previous,
  over-under
• Yesterday-tomorrow (directionality in time)
• North, South, East, West confusion
• Adults with dyslexia get lost a lot when driving
  around, even in cities where they've lived for
  many years
• Often have difficulty reading or understanding
  maps.

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Who can identify and diagnose?

• Anyone can identify a child with dyslexia
• Knowledgeable
• Informed
• Who can provide a diagnosis? Washington State DOH
  indicates only licensed and trained
• Physicians
• Psychologists
• Speech-language pathologists

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Why test for dyslexia?

• Why is an evaluation important?
• better understand the problem
• determine eligibility for special education
  services in various states
• also determine eligibility for programs in
  colleges and universities
• provide a basis for making educational
  recommendations
• determine the baseline from which remediation
  programs will be evaluated

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The Numbers

• Very few children with dyslexia are in the
  special education system. Only 1 in 10 will be
  eligible for an IEP (when tested in second or
  third grade) under the category of Learning
  Disability (LD).
• That means 9 out of 10 may "fall through the
  cracks." Although the parents and the teacher
  know there's something different about the child,
  the child does not qualify for special education
  services, and most will no longer get help from
  the reading specialist after first or second
  grade.
• Dyslexia is not rare. It is the most common
  reason a child will struggle first with spelling,
  then with written expression, and eventually "hit
  the wall" in reading development by third grade.

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Testing

• Individuals may be tested for dyslexia at any
  age.
• Tests which are selected will vary according to
  the age of the individual.
• Young children may be tested for phonological
  processing, receptive and expressive language
  abilities, and the ability to make sound/symbol
  associations.
• When problems are found in these areas
  remediation can begin immediately. A diagnosis of
  dyslexia need not be made in order to offer early
  intervention in reading instruction.

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Treatment Considerations

• Acquisition of letters and their sounds for
  reading and writing typically mirrors
  developmental norms for speech sound acquisition
• When youre choosing materials and what to focus
  on with an individual, keep this at the forefront
• (See normative data chart in addendum)

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Phonological Awareness

• Broader ? Narrower (top down)

1. Identify
2. Use

syllables in spoken words
onsets rimes in spoken syllables
individual phonemes in words spoken
oral rhymes
cup, sup, tup
cupcake cup cake
cup c up
cup c u p
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Phonemic Awareness

• Increases word reading ? increases reading
  comprehension
• Increases reading fluency
• -through blending
• Increases strategies for accurate spelling
• -via segmenting
• -predictable relationships

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Sound Segmentation

• Sentence segmentation nursery rhymes, famous
  songs, etc. (only if they can interpret
  information at this level)
• Word segmentation
• Syllable segmentation
• Phoneme segmentation
• Count how many sounds you hear in the word
  boat. Remember to sound them out! not, How
  many sounds are there?
• b-o-t boat
• What sound does letter B say? Or B says /b/ but
  help them distinguish between the name of the
  letter and the actual sound it makes. The answer
  is not bee, it is /b/.
• How many sounds do you hear in B? (2?, 1?) vs.
  How many sounds does letter be make/say? (1? 2?)
• Help the students identify and catalog how many
  sounds certain letters make and in what
  combinations (e.g., What letters spell /i/ or
  /ai/?)
• Continue teaching letter names vs. sounds letters
  make for CV, CVC, CVCV, CCVC, and CVCC words

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SLPs building strong phonemic awareness skills

• Identifying sounds
• Start with counting the number they hear in a CVC
  word, then contrast with CV or VC
• If they arent getting it, I often go to How
  many sounds do you hear in the letterM?
• /m/ or e-m /k/ or k-ay
• Do for first, middle and last sounds within words
  (e.g., Tell me the first sound you hear in cat)
  /k/
• Isolating sounds
• (e.g., Say cat without saying at) /k/
• Try manipulables (pompoms, colored squares, etc.)
  for support take away to increase the demand

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SLPs building strong phonemic awareness skills

• Categorization of sounds
• Choppers (ch, j), poppers (t, d, k, g), air
  sounds (s, f, v, sh, zh), lip sounds (m, p,
  b, w), tongue sounds (l, r)
• Blending sounds
• Im going to tell you some sounds that make a
  word. What word can you make with these?
• /a/-/t/ at
• Onsets/rimes
• CV, CVC, CVCe, CVCV, CCVC, CVCC, CVCVC and so on

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Deletion Addition

• Sentence level (when they are reading sentences)
• Try working with adjectives and adverbs (e.g.,
  He ran softly and quickly.)
• Phrase level (when they are reading phrases)
• Name Game Mad Libs, fill in the blank (e.g.,
  auditory closure tasks), wacky words (combine 2
  juxtaposed words in a silly phrase)
• Word level TYPICALLY, I START HERE
• Syllables
• Compound words (cowboy, cupcake, pigpen)
• Try using affixes (-er, pre-, re-)

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Deletion Addition

• Phoneme deletion (initial, medial, final
  positions and consonant clusters)
• Say cup with out saying /k/.
• Say tired without saying /d/.
• Phoneme addition
• Incorporate morphology instruction (-s, -es,
  -ing, -ed)
• Add /s/ to the beginning of top it becomes
• Add /t/ to the end of goes, it becomes

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Substitutions

• Word substitution (the name game)
• Alicen Lea Burke
• Change Lea to Fizzle
• Now change Burke to Pop
• Syllable substitution (the other Name Game)
• Phoneme substitution
• Say hat. Now, change the /h/ in hat to a /s/.
• Sentence and Phrases can be addressed later

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Building Strong Skills

• Work on only one or two targets with individuals
  at a time.
• Work through a hierarchy for each target.
• When theyve mastered all the domains, you should
  be able to have them mix 2 domains, 3, and then
  all in any order. They will not achieve
  independence until they effectively master
  multiple targets at once.
• Language use/presentation is key to helping them
  understand!

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Setting Them Up for Success Through Specific
Language Use

• The obscurity of the letter name and the sounds
  letters make
• What sound does B make? vs. What sound does
  letter B say?
• Bee or /b/?
• Letter B says, /b/.
• How many sounds are there in the word bush?
  How many sounds do you hear in the word bush?
• b-u-sh bu-sh b-u-s-h

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Common Errors

• When confusion of letter name vs. phonemes heard
  is not corrected at the sound level, it will
  continue to confound the young reader and writer
  at higher linguistic levels. (e.g., fractions)
• Compensatory strategies adopted by the student
• Using knowledge about the context of the content
  to guess
• Using reasoning skills to guess more accurately
• Searching their environment for clues
• Guessing (random or methodical)
• Consequence Students often start off behind in
  spelling and later in reading comprehension and
  fluency.

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Teach Awareness Strategies

• Start out teaching rhyming with long, familiar
  words instead of short ones (e.g., peanutbutter)
• Vowel pacing board with explicit teaching
• Provide tactile cues if needed when segmenting
• Consonants vs. vowels identification
• Chart sound families (use like a dictionary)
• Chart word families as they progress through
  levels
• Chart common letter sequences within words,
  affixes in English (e.g., ng, str)

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Hierarchical Support Systems (e.g., Words Their
Way)

• Use a hierarchy of support to ensure success.
• Explicit teaching
• Identification
• Matching
• Sorting
• Sequencing
• Fill in the blank
• Independent
• Give consistent, intermittent positive feedback!

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More

• Student to identify and chart hard words are
  there trends?
• Visualizing Does it look funny?
• Choral reading (let students lead?)
• Keep a vocabulary list of new words define them
  on 3X5s for early study habits and games (e.g.,
• Arrange by letter/sound
• Arrange by category
• Parts-of-a-whole
• Sound segmentation
• Include gross motor movement during reading and
  spelling
• Involve the cerebellum! Use jump rope, Chinese
  jump rope, Mother May I, Simon Says, word
  pop-ups, sound pop-ups, four square, hopscotch,
  Hullaballoo)

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Management and Accommodations

• Richelle to add

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Procedures for Referral at Sunnycrest

• If its speech only refer to the SLP
• If its language in any form, refer to the team
• If its highly likely the child will not qualify
  and you dont think its worth it to refer to
  the team, use your resources and talk to the
  parents about self-referral for literacy
  assessments.

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Questions you asked

• Is it hereditary?
• Is it spectrumish?
• Can you be a little or a lot dyslexic?
• What are the red flags that we should be looking
  for?
• "My kid reverses b/d or some other letters and
  numbers.  Does that mean they are dyslexic?" "My
  kid will be reading words like "was" and say
  "saw" instead.  Do they have dyslexia?"
• When are children typically diagnosed with
  dyslexia?
• Is there a window of opportunity for
  intervention, or can it be addressed at any age?
• Can it be confused with other disabilities or can
  a professional confidently diagnose it?
• Where can they be tested?
• What can teachers do to help a student with
  dyslexia that is not succeeding in the regular
  ed. classroom, but does not qualify for special
  ed. services?
• Are there research based interventions that work
  for everyone?
• What resources are available from the Lake
  Stevens School District for the classroom teacher
  to aid in the teaching of a dyslexic child? What
  can we do in the classroom to provide help?
• Are there good resources out there that we can
  let parents know about?

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Resources

• Seattle/King County
• Hearing Speech and Deafness Center (HSDC),
  Seattle Branch (Noreen Bucknum, MA, CCC-SLP)
• UW and possibly WSU run summer literacy camps 
• Commercial programs
• Snohomish
• SLPs, SPED teachers in LSSD
• Local research based programs
• Language to Literacy Program, provided at HSDC
  (BSHC)
• Julie Sewalds early intervention Tutorial
  Program

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References and Citations

• Keller Just (2009). Altering cortical
  connectivity Remediation-induced changes in the
  white matter of poor readers. Accessed from
  http//www.ncbi.nlm.nih.gov/pubmed/20005820
• Bright Solutions for Dyslexia, Inc.
  http//www.dys-add.com/symptoms.html. Accessed
  April, 2010.
• Marshall Messaoud-Galusi (2010). Disorders of
  language and literacy Special issue. Accessed
  from http//www.ncbi.nlm.nih.gov/pubmed/20306622
• Blau, V., Reithler, J., van Atteveldt, N.
  Seitz, J., et al. (2010) Deviant processing of
  letters and speech sounds as proximate cause of
  reading failure A functional magnetic resonance
  imaging study of dyslexic children Journal of
  Speech, Language, and Hearing Research Vol.53
  311-332 April 2010. doi10.1044/1092-4388(2009/07-
  0145) Accessed from http//www.ncbi.nlm.nih.gov/p
  ubmed/20061325
• Mayo Clinic dyslexia information page. Mayo
  Clinic. http//www.mayoclinic.com/health/dyslexia/
  ds00224/dsectionsymptoms. Accessed April, 2010.
• NINDS dyslexia information page. National
  Institute of Neurological Disorders and Stroke.
  http//www.ninds.nih.gov/disorders/dyslexia/dyslex
  ia.htm. Accessed April, 2010.
• What are the signs of dyslexia? International
  Dyslexia Association. http//www.interdys.org/Sign
  sofDyslexiaCombined.htm. Accessed April, 2010.
• Catts Kamhi (2005). Language and Reading
  Disabilities. (Ed. 2). Boston, MA Pearson, Inc.