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UNLOCKING THE CODE

UNLOCKING THE CODE. DYSLEXIA ASSESSMENT, TREATMENT & DEVELOPMENTAL THEORY. ANN W ALEXANDER,M.D. THE MORRIS CENTER GAINESVILLE, FL JANE LAWYER M.ED. WELINGTON ALEXANDER CENTER SCOTTSDALE, AZ. IDA 11 / 07. WHAT IT IS ?. DYS = TROUBLE. LEXIA = WORDS. TROUBLE WITH “ WRSD ”

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UNLOCKING THE CODE

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  1. UNLOCKING THE CODE

  2. DYSLEXIA ASSESSMENT, TREATMENT & DEVELOPMENTAL THEORY ANN W ALEXANDER,M.D. THE MORRIS CENTER GAINESVILLE, FL JANE LAWYER M.ED. WELINGTON ALEXANDER CENTER SCOTTSDALE, AZ IDA 11 / 07

  3. WHAT IT IS ? DYS= TROUBLE LEXIA= WORDS TROUBLE WITH “WRSD” (WORDS)

  4. 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

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

  6. ADHD 20-50 % CLINICAL PICTURE NONLINGUISTIC DEFICITS IN : • COGNITIVE: PHONOLOGICAL WORKING MEMORY, EF • SENSORIMOTOR • FINE MOTOR SEQUENCING • WEAK ORAL / FINGER SOMATOSENSORY MAPS • LOW TONE, POSTURAL INSTABILITY • SLOW RESPONSE TIME • IMPAIRED PROCESSING OF RAPIDLY PRESENTED SEQUENTIAL AUDITORY, VISUAL, & SOMATOSENSORY INPUT • BEHAVIOR • DEPRESSION, OCD, ANXIETY

  7. 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)

  8. 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)

  9. A B C D MORRIS CENTER FLORIDA STATE KATIE PRE - Rx KEY PPVT – VOCABULARY PIQ – PERFORMANCE IQ, WISC-3 CELF – ORAL LANGUAGE :RECEPTIVE & EXPRESSIVE WRMT-R – ORAL READING : WORD ATTACK, WORD ID, COMPREHENSION OUR CAT MIMI LIKES TO SIT ON THE ROOF. MIMI GOES UP TO THE TALL TREE BY THE HOUSE. THEN SHE JUMPS ON THE ROOF. SHE SITS AND LOOKS AT BIRDS. BUT SHE ALWAYS COMES DOWN WHEN IT IS TIME TO EAT.

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

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

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

  13. WHAT IT IS ? DYS= TROUBLE LEXIA= WORDS TROUBLE WITH “WRSD” (WORDS)

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

  15. EARLY READING DEVELOPMENT UNLOCKING THE CODE

  16. 3 – LEGGED STOOL COMPREHENSION FLUENCY VISUAL / ORTHOGRAPHY AUDITORY / PHONOLOGY LANGUAGE SEMANTICS SYNTAX

  17. 3 – LEGGED STOOL COMPREHENSION FLUENCY VISUAL / ORTHOGRAPHY AUDITORY / PHONOLOGY LANGUAGE SEMANTICS SYNTAX AUDITORY / PHONOLOGY AUDITORY / PHONOLOGY AUDITORY / PHONOLOGY AUDITORY / PHONOLOGY AUDITORY / PHONOLOGY AUDITORY / PHONOLOGY AUDITORY / PHONOLOGY AUDITORY / PHONOLOGY AUDITORY / PHONOLOGY AUDITORY / PHONOLOGY

  18. PHONOLOGICAL AWARENESS THE CORE DEFICIT

  19. WHAT IS PHONOLOGICAL AWARENESS?

  20. PHONOLOGICAL PROCESSING • A CORE INGREDIENT FOR ORAL AND WRITTEN LANGUAGE DEVELOPMENT • THREE COMPONENTS • PHONOLOGICAL AWARENESS • LEXICAL RETRIEVAL / RAPID NAMING • PHONOLOGICAL WORKING MEMORY

  21. THE “PHON” WORDS PHONOLOGICAL AWARENESS • UMBRELLA TERM THAT INVOLVES ABILITY TO APPRECIATE THAT WORDS ARE COMPRISED OF CHUNKS OF SOUNDS • PHONOLOGICAL SENSITIVITY (e.g. RHYMING)

  22. THE “PHON” WORDS PHONEMIC AWARENESS • FALLS UNDER UMBRELLA OF PHONOLOGICAL AWARENESS • ABILITY TO APPRECIATE AND MANIPULATE INDIVIDUAL SOUNDS IN WORDS (e.g.BLENDING AND SEGMENTING)

  23. THE “PHON” WORDS PHONICS • IS NOT PHONOLOGICAL AWARENESS • SKILL THAT MUST BE TAUGHT • PHONOLOGY + ORTHOGRAPHY • READ “BRUP,” “SPROIGILTY”

  24. THE “PHON” WORDS ANOTHER CORE DEFICIT PHONOLOGICAL WORKING MEMORY ESSENTIAL FOR EXECUTIVE FUNCTION • DISTINCT PHONEME REPRESENTATIONS • ATTENTION

  25. CLINICAL EVALUATION OF LANGUAGE FUNDAMENTALS -REVISED

  26. CLINICAL EVALUATION OF LANGUAGE FUNDAMENTALS -REVISED

  27. 6 5.9 5 Average Low PA Low 4 Ave. PA 3 READING GRADE LEVEL 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)

  28. 6 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 SIGHT WORD READING ABILITY OF CHILDREN WHO BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME AWARENESS AND LETTER KNOWLEDGE (Torgesen & Mathes, 2000)

  29. 6.9 6 Average Low 5 4 3.4 READING GRADE LEVEL 3 2 SAME VERBAL ABILITY – VERY DIFFERENT READING COMPREHENSION 1 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)

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

  31. BELL SHAPED CURVENORMAL POPULATION DISTRIBUTION

  32. 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 Verbal IQ 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

  33. 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 PERFORMANCE

  34. REMEDIATIONSTUDY • OLDERCHILDREN (8 – 10 YRS) • SEVERE DYSLEXIA 2nd %ILE FOR WORD READING 35th %ILE IQ (SS 92) • 2 TREATMENTS – BOTH EXPLICIT PHONICS RX • A “BOTTOM UP” (LiPS) VS. • A “TOP DOWN” (EP) Torgesen, et al, 2001, NICHD

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

  36. PRINCIPLES OF LEARNING • WHAT FIRES TOGETHER, WIRES TOGETHER – MULTIPLE SENSES • ATTENTION • CONSISTENT INPUT • INTENSITY • SALIENT • FREQUENT • REPETITION IS KEY

  37. REMEDIATIONSTUDY • EQUAL TIME AND INTENSITY 1:1 • 100 MINS DAILY • 8-9 WEEKS TOTAL 67.5 HRS

  38. 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

  39. 96 * 91 * 91 * 83 72 74 71 68 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= <.05 Torgesen, Alexander, Wagner et al, 2001

  40. REMEDIATION STUDY SPOKEN LANGUAGE GAINS

  41. CELF-R OUTCOMES: 67.5 HOURS OF INTENSIVE INTERVENTION 95.2 93.8 87.4 86.2 85 79.7 78.5 76.2 100 30th percentile 90 STANDARD SCORE 80 70 REC-L EXP-L REC-EP EXP-EP 2yr PRE 2yr PRE

  42. LIPS EP PRE - POST PRE - 2 YRS PRE - 2 YRS PRE - POST RLS 1.05 0.97 0.49 1.05 0.75 0.75 0.31 0.46 OD 0.61 0.44 0.50 0.84 WC 0.61 0.93 0.37 0.43 SR 0.03 0.62 0.58 0.38 LP ELS 0.85 0.71 0.70 0.67 0.60 0.70 0.44 0.60 FS 0.24 0.54 0.20 0.16 RS 0.75 0.49 0.76 0.78 SA EFFECT SIZE OF TREATMENT ON LANGUAGE COMPREHENSION & EXPRESSION P<= 0.05 ES of 0.5 – 0.7 moderate; 0.8 + large

  43. PRE Rx POST Rx 1 Yr 130 120 110 100 90 STANDARD SCORE 80 70 60 50 40 PPVT P IQ CELF-R CELF-E WRMT-A WRMT-I WRMT-C A B C D MORRIS CENTER FLORIDA STATE KATIE 1 Yr. KEY PPVT – VOCABULARY PIQ – PERFORMANCE IQ, WISC-3 CELF – ORAL LANGUAGE :RECEPTIVE & EXPRESSIVE WRMT-R – ORAL READING : WORD ATTACK, WORD ID, COMPREHENSION OUR CAT MIMI LIKES TO SIT ON THE ROOF. MIMI GOES UP TO THE TALL TREE BY THE HOUSE. THEN SHE JUMPS ON THE ROOF. SHE SITS AND LOOKS AT BIRDS. BUT SHE ALWAYS COMES DOWN WHEN IT IS TIME TO EAT.

  44. LONG TERM GAIN RESISTERS VARIABLES RESULTING IN POOR PROGRESS • WEAK ATTENTION • POOR RECEPTIVE LANGUAGE • LOWER SES 20 % OF SUBJECTS WHO HAD IMMEDIATE GAINS HAD NOT CONTINUED READING GAINS AT 2yr FOLLOW UP

  45. PREVENTION STUDY

  46. 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 !!!

  47. PREVENTIONSTUDY • MID KG - END 2ND GRADE • SCREENING - BOTTOM 10TH %ILE • FREQUENCY - 20 MINS/DAY - 4 DAYS / WEEK • INTENSITY - 1:1, 67 HRS. • TEACHERS & AIDES • 4 METHODS - PASP, EP, RCS, NTC Torgesen et al, 1999, NICHD

  48. 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.

  49. Accuracy Rate A SOLUTION TO THE PROBLEM OF THE FLUENCY GAP: PREVENTIVE INTERVENTIONS 2nd GRADE 4th GRADE 100 30th % ile 90 STANDARD SCORE 80 70 BEGINNING % ile 10th 10th TREATMENT AGE 5-6 5-6

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