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Differential Diagnosis and Treatment  for Dysgraphia, Dyslexia, OWL LD, and Dyscalculia

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  1. Differential Diagnosis and Treatment  for Dysgraphia, Dyslexia, OWL LD, and Dyscalculia Virginia W. Berninger RTI Webinar September 30, 2009 vwb@u.washington.edu This presentation includes 1. Part 1: Differential Diagnosis and Treatment of Dysgraphia, Dyslexia, and OWL LD 2. Part 2: Diagnosing and Treating Dyscalculia and PAL II Resources 3. Diagnostic Flow Charts 4. Decoder for Using the PAL II User Guide on CD: Table of Contents with Chapter Titles and Address Locations on the CD will be posted on website following presentation. NOTES: Figures 1, 2, and 3 are from Berninger & Holdnack (2008) Wiley. PAL II User Guide CD has 1) glossary, which defines terminology used in this presentation from the research literature supporting evidence-based practices; 2) information on subtest administration, scoring, and interpretation; 3) differential diagnosis flow sheets; and 4) instructional interventions which can be downloaded. See Decoder for address for accessing these resources on CD. Also see diagnostic profiles on the Student Record Forms.

  2. Modeling Phonological Core Deficit within Working MemoryBerninger et al. (2006) Scientific Studies in Reading, Berninger, Rutberg et al. (2008) Word Form Storage (phonological*, orthographic*, morphological*) Phonological Loop (time-sensitive coordination of orthographic and phonological codes) [RAN]* Orthographic Loop and orthographic and finger sequencing (finger succession) Executive Functions for phonological processes (Inhibition [D-KEFS] and Supervisory Attention* [RAS switching attention]) * PAL II, which is grounded in conceptual model validated in research, has measure.

  3. PAL II User GuideWorking Memory Model Assessment and Instruction For dysgraphia, orthographic codingand sequential hand movements—the orthographic loop— are critical. Give PAL II Receptive and Expressive Coding and FingerSuccession. Also all PAL II handwriting measures (Alph 15, Copy A, Copy B) and narrative fluency.

  4. PAL II User Guide Working Memory Assessment-Instruction Model For dyslexia, assess 3 word forms, phonological loop, and executive functions (EF). Give PAL II phonological coding, orthographic coding, and morphological coding (3 word forms), RAN letters and RAN words (phonological loop), and RAS letters and words (for EF switching attention). Also PAL II phonological decoding, word choice, and sentence sense (silent reading fluency), WIAT III spelling + WISC 4 Verbal Comp Index.

  5. PALII Working Memory Assessment-Instruction Model For OWL LD, assess syntactic and morphological awareness, word finding- retrieval strategies + all working memory components. Give all PAL II subtests for dyslexia (working memory components + reading/spelling) + sentence structure, CELF 4 Sentence Formulation, and word fluency and sentence combining on WIAT III Written Expression. Also, PAL II Narrative Fluency and Expository Note Taking and Report Writing + WISC 4 Perceptual Reasoning Index.

  6. Ortho- graphic Dysgraphia Phonological, Orthographic Dyslexia Morphological/Syntax Phonological, Orthographic • Oral and Written Language Learning • Disability (OWL LD) Relationship between Word Form Deficit in Working Memory and DiagnosisPAL II User Guide

  7. Dysgraphia • Problem in handwriting automaticity—retrieving and producing legible lower case letters in alphabetic order effortlessly and fast (PAL II Alph 15), • Problem in spelling with or without indicators of dyslexia (PAL II Word Choice—receptive without handwriting requirements), • Problem in finger motor planning (PAL II Finger Succession), and/or • Problems in executive functions (PAL II RAS, D-KEFS Inhibition on Color Word Form) for self-regulating the composing process (fluency and quality) (PAL II Narrative Fluency). Note: Handwriting problems may not show Verbal IQ-achievement discrepancy but spelling and composing do. Typically those with dysgraphia do not qualify for occupational therapy services. Those who do have severe motor problems have handwriting problems for other reasons and also require treatment specialized for specific motor problems. (see Berninger, 2004)

  8. phonological ORTHOGRAPHIC Phonological & ORTHOGRAPHIC LOOP and Executive Functions in Working Memory morphological Teach Phonological and Working Memory Skills Explicitly Specialized Instruction for Dysgraphia

  9. Instruction for Dysgraphia PAL Handwriting Lessons based on Berninger et al. (2007). Download PAL Reading and Writing Lessons Set 3 from PAL II User Guide 1. Teach plan for letter formation (study numbered component strokes in model letter form) --overcomes sequential finger movement problem. 2. Teach orthographic coding: Cover letter and hold letter form in mind’s eye (in working memory) for increasing duration 3. Teach self-monitoring (compare written letter to model letter)

  10. Instruction for Dysgraphia 4. Teach transfer to word writing and composing Handwriting is taught in context of higher order writing skills and authentic communication (share with peers). 5. Avoids mindless drill: Only practice each of 26 letters once in session “writers’ warm-up (avoid habituation, all letters equal opportunity to become automatic). 6. Always name letter for each handwriting activity to facilitate retrieval fluency.

  11. Orthographic Lessons (Looking Games) PAL Guides 1998 (pp. 192) can download from PAL II User Guide • Show written word (on chalk board, overhead, or written list at student’s desk) from the reading or spelling curriculum briefly (about 1 second) with this instruction while sweeping finger under the word in left to right direction: “Look carefully at each letter in this word.” • Then cover the word with a card and ask the children to spell the word or write a designated letter or letter group (orally taking turns or everyone writing independently). • Then uncover the word and play looking games in which children reproduce all the letters in a word or a single letter in a designated word position (e.g., first or third) or a letter group in a designated word position (e.g. second and third) .

  12. Alphabet Retrieval Game for Improving Automatic Retrieval PAL Guides (pp. 193)* can download from PAL II User Guide • Name or Write the letter that comes after these letters: a, s, w, g, m. • Name or Write the letter that comes before these letters: u, r, t, l, i.24 sets of five after and five before items to use in the context of a writing lesson aimed at all levels of language.

  13. Response to Instruction for Handwriting by Pen or Pencil ASSESS BEFORE AND AFTER INSTRUCTION FOR STUDENTS WITH DYSGRAPHIA: PAL II Alphabet Writing*: Print the lower case letters of the alphabet in order as accurately and quickly as you can without making a mistake. Use manuscript not cursive writing. PAL II Copy A*: Copy sentence with all the lower case letters in the alphabet from a model (no memory requirements). PAL II Copy B: Copy paragraph—sustain handwriting over time in three 30 second intervals. Scores: *Automatic legible letter writing (first 15 seconds) Legible letter writing. Legible letter writing speed (total time) Handwriting composite PAL II Narrative Fluency (number of words, number of correctly spelled words, number of complete sentences) For grade 3 and above, the expository note taking and report writing and cross-genre composite.

  14. Dyslexia • Problems in accuracy and rate of oral reading of real words (PAL II morphological decoding and WIAT III word reading) and text (GORT 4) and pseudowords (PAL II pseudowords—acc and time) and/or spelling (PAL II word choice acc and time) • Skills above discrepant from WISC 4 Verbal Comprehension Index (Verbal IQ) and below population mean. • Language (except for phonology) is a relative strength that can mask severe problems in working memory that are invisible without assessment.

  15. Dyslexia • Processing deficits in working memory architecture: 3 word forms [orthographic (give PAL II receptive and expressive orthographic coding) , phonological (give PAL II phonological coding), morphological (give PAL II morphological coding)], phonological loop (RAN letters and RAN words), and executive functions (D-KEF Inhibition on Color Word Form and PAL II RAS letters and words). • Writing as well as reading disability because spelling problems (give WIAT III spelling and assess PAL II narrative fluency—spelling accuracy), which tend to persist beyond the reading problems. Spelling ability is related to written composition (give PAL II narrative fluency and expository note taking and report writing). • Reading problems may resolve in elementary grades, but writing problems persist and these students need explicit instruction in writing and reading-writing integration K -12 (and not just accommodations).

  16. phonological orthographic Phonological & Orthographic Loops and Executive Functions in Working Memory morphological Teach Phonological and Working Memory Skills Explicitly Specialized Instruction for Dyslexics

  17. 24 Phonological Lesson PAL Guides1998 (pp. 196-219) Download from PAL II User Guides Four games played to develop syllable segmentation skills: • Find the Hidden Is ant hidden in can’t? in Andy? • Say the Missing Say carelessly. Now say lessly. What is missing? • Say the Word Without Say friendliness. Now say it without ness. • Substitute Say garden. Now don’t say it with den, say it with ter.

  18. Phonological Lessons PAL Guides 1998 (pp. 196-219)Download from PAL II User Guides Four games played to develop phoneme segmentation skills: • Find the Hidden Does the word begin with /m/ as in mother? make? time? • Say the Missing Sat mice. Now say ice. What is missing? • Say the Word Without Say wave. Now say it without /w/. • Substitute Say sad. Now say it with /h/ instead of /s/.

  19. Awareness of Orthographic and Morphological Word Form and Parts PAL Reading and Writing Lessons Sets 11, 12, and 15. Download from PAL II User Guides. Also, lesson plans for four readers’ workshop, writers’ workshop, reading-writers workshop, and writing-readers workshop: Berninger, V., & Wolf, B. (2009b). Helping students with dyslexia and dysgraphia make connections: Differentiated instruction lesson plans in reading and writing. Baltimore: Paul H. Brookes. Spiral book with teaching plans from University of Washington Research Program.

  20. Instruction for Dyslexia*In Berninger and Abbott (2003) and PAL II User Guide. *Teach PAL Lesson Set 11 (phonological, orthographic, and morphological awareness, word decoding, fluency, comprehension) *Teach PAL Lesson Set 12 (phonological, orthographic, and morphological awareness, word decoding, fluency, and comprehension) *Teach PAL Lesson Set 15 ( phonological, orthographic, and morphological awareness, decoding words of Anglo-Saxon and Latinate or Greek origin, fluency, and comprehension) Science Experiments Note: To overcome working memory problems teach procedural knowledge rather than declarative knowledge (rules) and teach to all levels of language close in time.

  21. PAL Lesson Set 11(Berninger et al., Journal of School Psychology, 2006) Subword: Phonological (Sound Games with Jabberwocky words), Orthographic (Looking Games with Jabberwocky words), and Morphological (Inflectional Suffixes) Awareness + Alphabetic Principle (Talking Letters, reading direction) and Word Families (learned best as multi-letter units of more than 2 letters each) + Word: Applying Talking Letters to reading Jabberwocky words and Fry’s Instant Words (high frequency) + Text:Guided reading of chapter book and cold/hot rereadings of graded material for fluency (Read Naturally) Progress Monitoring: List 12b letter and word probes; text rate probes

  22. Intervention for Dyslexia (Berninger, 2000 LDQ;;S. Abbott & Berninger, 1999; Carlisle & Rice, 2004) Henry, M.K., & Redding, N.C. (1996). Patterns for success in reading and spelling. A multisensory approach to teaching phonics and word analysis. Baltimore: Paul S. Brookes Publishing. Decoding for words of different Word Origin Carlisle (1996) Reasoning with Reading (Vocabulary Meaning, Sentence Interpretation, and Paragraph Understanding). Educators’ Publishing Service, Cambridge, MA. Berninger, V., & Wolf, B. (2009a). Teaching students with dyslexia and dysgraphia: Lessons from teaching and science. Baltimore: Paul H. Brookes. Berninger, V., & Wolf, B. (2009b). Helping students with dyslexia and dysgraphia make connections: Differentiated instruction lesson plans in reading and writing. Baltimore: Paul H. Brookes. Spiral book with teaching plans from University of Washington Research Program.

  23. Response to Instruction for Dyslexia ASSESS BEFORE AND AFTER INSTRUCTION: • accuracy and rate of oral reading of pseudowords (PAL II) • accuracy and rate of oral reading of real words on lists (PAL II morphological decoding accuracy and time, WIAT III word reading [accuracy]) and passages (GORT-4 accuracy, rate, fluency) • spelling real words (WIAT III Spelling, PAL II Word Choice and spelling during composing) • phonological, orthographic, or morphological coding if weakness identified in any of these before instructional intervention

  24. OWL LD • Who are the children who are low in oral reading and spelling but do not show IQ achievement discrepancy? • Extremely impaired in morphological awareness (Give PAL II Morphological Coding) and syntactic awareness (Give PAL II Sentence Structure and CELF 4 Sentence Formulation) and often word retrieval • Also impaired in all the working memory components that children with dyslexia are

  25. Oral Language + Written Language Disability (OWL LD) • Problems in decoding pseudowords (PAL II pseudoword reading), reading real words (PAL II morphological decoding and WIAT III real word reading), oral reading fluency (PAL II Sentence Sense), and/or reading comprehension (WIAT III Reading Comprehension) • Problems in writing: spelling + syntax + word retrieval (PAL II word choice, sentence structure, complete sentences on Narrative Fluency and Expository Report Writing and WIAT III Word Frequency, Sentence Combining, and Paragraph Writing) • Typically no IQ-achievement discrepancy based on Full Scale (or Verbal IQ) but nonverbal IQ within the normal range • Substantial oral language problems in phonological, morphological, and syntactic awareness and often word retrieval that require treatment. • Struggle in learning oral language and then in using oral language to (a) learn from teacher talk and (b) learn written language.

  26. phonological orthographic Phonological & Orthographic Loops and Executive Functions in Working Memory morphological Teach Phonological and Working Memory Skills Explicitly syntax Specialized Instruction for OWL LD

  27. Treatment of OWL LD Teach Morphological and Syntactic Awareness, Word Retrieval Strategies, and Inferential Comprehension • See Chapter 3 on Oral Language Instruction in Berninger, V., & Wolf, B. (2009a). Teaching students with dyslexia and dysgraphia: Lessons from teaching and science. Baltimore: Paul H. Brookes. • See Silliman, E., & Scott, C. (2009). Research-based oral language intervention routes to the academic language of literacy: Finding the right road. In Rosenfield, S., & Berninger, V. (Eds.), Handbook on implementing evidence based academic interventions (pp. 107-145). Oxford University Press. • Consult with the speech and language specialist in the school or clinic.

  28. Response to OWL LD Treatment ASSESS BEFORE AND AFTER INSTRUCTION FOR STUDENTS WITH OWL LD: PAL II phonological, orthographic, and morphological coding and syntactic coding (awareness), pseudoword reading, morphological decoding of real words with affixes, word-specific orthographic spellings among phonologically equivalent word choices, spelling from dictation and during composing, and written composition (narrative and expository writing and complete sentences on these) WIAT III real word reading, reading comprehension, spelling, written expression (word fluency, sentence combining, and paragraph writing) ***Students with OWL LD tend to be fast responders to phonics, but may be the non-responders to intervention who have persisting real word reading and reading comprehension problems unless given oral language treatment beyond phonological skills alone.

  29. Dyscalculia Webinar for Dyscalculia.ppt