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Title: 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.

4
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.

5
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.

6
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.

7
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

8
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.

9
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)

10
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)

11
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.

12
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.

13
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)

14
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.

15
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.

16
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

17
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

18
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.

19
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.

20
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)

21
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
22
Phonemic Awareness
  • Increases word reading ? increases reading
    comprehension
  • Increases reading fluency
  • -through blending
  • Increases strategies for accurate spelling
  • -via segmenting
  • -predictable relationships

23
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

24
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

25
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

26
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-)

27
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

28
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

29
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!

30
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

31
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.

32
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)

33
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!

34
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)

35
Management and Accommodations
  • Richelle to add

36
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.

37
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?

38
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

39
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.
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