Reading Disabilities for Medical Professionals


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Brief overview of reading disabilities for medical professionals

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Reading Disabilities for Medical Professionals

  1. 1. Reading Disabilities Thomas B. King, M. Ed. Educational Consultant Division of Child Neurology
  2. 2. Gaps in Education = Gaps in Health <ul><li>Reading disabilities are the most common of all learning disorders </li></ul><ul><li>Children with reading disabilities often develop behavioral and/or emotional problems </li></ul><ul><li>Children with untreated reading disabilities may appear anxious, or seem to have poor attention and concentration </li></ul><ul><li>Reading disabilities may be tied to stomach aches and headaches that may be considered idiopathic when the connection isn’t appreciated </li></ul>
  3. 3. Gaps in Health = Gaps in Education <ul><li>Children with neurological problems often have reading disabilities </li></ul><ul><li>Children with low birth weight and/or premature delivery may have reading disabilities </li></ul><ul><li>Children with other chronic health conditions may be at risk for reading disabilities </li></ul>
  4. 4. Reading Disability in the medical model <ul><li>Reading disabilities may be thought of as an interlocking set of cognitive anomalies that interfere with the appropriate development of auditory, visual, visual-motor, and linguistic skills that are necessary to the acquisition of reading performance in the setting of otherwise normally developing general intelligence. </li></ul>
  5. 5. Historical terms <ul><li>Word blindness (Orton) </li></ul><ul><li>Dyslexia (Orton-Gillingham) </li></ul><ul><li>Minimal Brain Dysfunction (MBD) </li></ul><ul><li>Learning Disabilities (P.L. 94-142) </li></ul><ul><li>Developmental Learning Disorders (DSM-IV) </li></ul>
  6. 6. NIH Studies <ul><li>Began in 1965 but in earnest in the mid 1980’s </li></ul><ul><li>Involved multiple sites including Bowman-Gray, University of Houston, Yale, University of Florida, among others </li></ul><ul><li>Longitudinal results were made public in 1997 </li></ul><ul><li>Subjects had been followed since K were 21 when the results were made public </li></ul>
  7. 7. NIH Results Highlights <ul><li>50% of the population can learn to read using any program </li></ul><ul><li>50% of the population have challenges in learning to read </li></ul><ul><li>20% to 30% find learning to read a very significant challenge and a great many of those will require highly specialized instructional intervention (R Lyon, chief investigator – NIH) </li></ul>
  8. 8. One Observation “I would rather have a root canal than be asked to read.”
  9. 9. National Assessment of Reading Progress 1994 <ul><li>Percent of children in the fourth grade, not reading at a fourth grade level: </li></ul><ul><li>32% white </li></ul><ul><li>72% African-American </li></ul><ul><li>67% Hispanics </li></ul><ul><li>23% Asians </li></ul><ul><li>36% Pacific Islanders </li></ul><ul><li>55% Native Americans </li></ul><ul><li>32% had parents with college degrees </li></ul>
  10. 10. What are the processing challenges <ul><li>Phonological awareness </li></ul><ul><li>Working memory (esp. of phonemes) </li></ul><ul><li>Rapid automated naming (RAN) aka Rapid Confrontational Naming </li></ul>
  11. 11. Phonological Awareness <ul><li>Word awareness </li></ul><ul><li>Word rhyming or “hearing” rhymes </li></ul><ul><li>Sound matching </li></ul><ul><li>Sound isolation </li></ul><ul><li>Phoneme blending </li></ul><ul><li>Syllable splitting </li></ul><ul><li>Sound segmentation </li></ul><ul><li>Phoneme manipulation </li></ul><ul><li>(Hallie Yopp, 1992) </li></ul>
  12. 12. Phoneme/grapheme knowledge <ul><li>C </li></ul><ul><li>A </li></ul><ul><li>T </li></ul>
  13. 13. Phonological awareness <ul><li>F </li></ul><ul><li>O </li></ul><ul><li>X </li></ul><ul><li>F – O – K – S </li></ul>
  14. 14. Phonemic awareness and Phonics <ul><li>They are NOT the same thing </li></ul><ul><li>Phonics = visual symbols with assigned sounds </li></ul><ul><li>Phonemic awareness = sound driven learning activities </li></ul><ul><li>Good phonemic awareness ability is necessary for phonics instruction and phonics instruction is necessary for adequate reading instruction. </li></ul>
  15. 15. Phonological inefficiency <ul><li>Difficulties in phonological awareness does not imply brain damage, but does imply a less than efficient system for processing in the temporal lobes </li></ul><ul><li>Conversely, youngsters with damage or disease in the temporal lobes will be at extreme risk for phonological inefficiency </li></ul>
  16. 16. Phonics vs. Phonological Awareness <ul><li>Letter names </li></ul><ul><li>Letter sounds </li></ul><ul><li>How common groups of letters work together </li></ul><ul><li>Visual Emphasis </li></ul><ul><li>Letter sounds </li></ul><ul><li>Segmentation activities </li></ul><ul><li>Sound deletion (say fixed…now say fixed, don’t say “k”) </li></ul><ul><li>Auditory-kinesthetic emphasis </li></ul>
  17. 17. Auditory processing checklist <ul><li>Confusion in sound/words heard </li></ul><ul><li>Requests for a speaker to repeat information </li></ul><ul><li>Difficulty in following oral directions </li></ul><ul><li>Easily distracted by extraneous sounds or noises </li></ul><ul><li>Difficulty in recognizing a word when given one part at a time (auditory closure) </li></ul><ul><li>Often displays avoidance behavior during reading and writing activities </li></ul>
  18. 18. Formal assessment tools <ul><li>Intelligence tests do very little or nothing to assist with reading disability diagnostics </li></ul><ul><li>We may need to know if the child has reasonable intelligence </li></ul><ul><li>The WISC IV digit span test is a good measure for working memory </li></ul><ul><li>School psychological evaluations are designed to meet regulatory mandates, but are frequently clinically irrelevant because they are not designed to appropriately assess potential processing challenges </li></ul>
  19. 19. Processing tests <ul><li>Comprehensive Test of Phonological Processing (CTOPP) </li></ul><ul><ul><li>Phonological awareness </li></ul></ul><ul><ul><li>Phonological working memory </li></ul></ul><ul><ul><li>Rapid naming </li></ul></ul>
  20. 20. Woodcock-Johnson Psychoeducational Batteries <ul><li>A series of several interlocking and independently co-normed tests </li></ul><ul><li>Auditory processing </li></ul><ul><ul><li>Auditory synthesis (sound blending) </li></ul></ul><ul><ul><li>Auditory analysis (closure) </li></ul></ul>
  21. 21. WJ-III (continued) <ul><li>Short term memory </li></ul><ul><ul><li>Auditory working memory </li></ul></ul><ul><ul><li>Numbers reversed </li></ul></ul><ul><ul><li>Memory for words </li></ul></ul>
  22. 22. WJ-III <ul><li>Rapid naming and visual scanning or processing speed </li></ul><ul><ul><li>Visual matching </li></ul></ul><ul><ul><li>Cross out </li></ul></ul><ul><ul><li>Rapid picture naming </li></ul></ul>
  23. 23. WJ-III <ul><li>General or ‘g’ loads based on the Horn-Carroll-Cattell theories </li></ul><ul><li>Glr or long term retrieval </li></ul><ul><li>Gsm or short term memory (auditory) </li></ul><ul><li>Gs or processing speed </li></ul><ul><li>Gv or visual processing </li></ul><ul><li>Ga or auditory processing </li></ul><ul><li>Gc or comprehension-knowledge </li></ul><ul><li>Gf or fluid reasoning (with executive functioning) </li></ul><ul><li>(Gq or quantitative reasoning) </li></ul>
  24. 24. Test of Phonological Awareness <ul><li>Kindergarten and an early elementary versions </li></ul><ul><li>Tests for sound matching </li></ul><ul><ul><li>Initial sounds </li></ul></ul><ul><ul><li>Ending sounds </li></ul></ul>
  25. 25. The Phonological Awareness Test <ul><li>Rhyming </li></ul><ul><li>Segmentation </li></ul><ul><li>Isolation </li></ul><ul><li>Deletion </li></ul><ul><li>Substitution </li></ul><ul><li>Normed for ages 5-0 to 9-11 </li></ul>
  26. 26. Lindamood Auditory Conceptualization Test <ul><li>Criterion referenced assessment tool </li></ul><ul><li>First published in 1971 </li></ul><ul><li>Excellent tool for assessment of phonological manipulation </li></ul>
  27. 27. Common audiology tests <ul><li>SCAN – takes about 20 minutes to administer </li></ul><ul><li>Auditory figure ground </li></ul><ul><li>Filtered words </li></ul><ul><li>Competing words </li></ul><ul><li>Good screener for the potential for Central Auditory Processing Disorder (CAP) </li></ul><ul><li>Phonemic synthesis test </li></ul>
  28. 28. Rapid Naming If you don’t ride a bike fast enough, you will fall off.
  29. 29. Visual-motor integration <ul><li>Bender Gestalt </li></ul><ul><li>Developmental Test of Visual-motor Integration (VMI) </li></ul><ul><ul><li>Visual-motor integration </li></ul></ul><ul><ul><li>Visual processing </li></ul></ul><ul><ul><li>Motor coordination </li></ul></ul>
  30. 30. Phonemic performance <ul><li>PALS – Phonological Awareness Literacy Screener </li></ul><ul><li>Word attack test from the WJ-III </li></ul><ul><li>Spelling of sounds test from the WJ-III </li></ul>
  31. 31. prevalence <ul><li>The prevalence of ADHD has been estimated at between 3% and 7% of the general population (DSM-IV-TR) </li></ul><ul><li>The prevalence of reading disorders was found to be at or near 20% of the children followed by NIH for 20 + years </li></ul><ul><li>One known associated feature of ADHD is learning disorders (DSM-IV-TR) </li></ul>
  32. 32. … and so…. You can look for reading disabilities in a pediatric practice near you disguised as stomach ache, head ache, ADHD, generalized anxiety, vague complaints of poor school performance, among many other things.