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UNLOCKING
DYSLEXIA IDA 2007
THE PICTURE OF DYSLEXIA
ANN W ALEXANDER, M.D.
THE MORRIS CENTER
GAINESVILLE, FL
www.TheMorrisCenter.com
TIM CONWAY, Ph.D.
UNIVERSITY OF FLORIDA
GAINESVILLE, FL
IDA 2007
THE PICTURE OF DYSLEXIA
 WHAT
 WHY
 WHAT IT LOOKS LIKE
 WHERE
 WHEN
 WHAT TO DO
 WHO
THE
&
WHAT IT ISN’T
DYSLEXIA IS …
 NOT A VISUAL PROBLEM
 NOT A LACK OF INTELLIGENCE
 NOT DUE TO LACK OF EFFORT
 NOT RESPONSIVE TO STANDARD READING
INSTRUCTION
 NOT UNCOMMON – 5 – 17.5 %
OF POPULATION
 NOT A DEVELOPMENTAL LAG.
WHAT IT IS
DYS = TROUBLE
LEXIA = WORDS
TROUBLE WITH WORDS
 NEUROLOGIC IN ORIGIN - GENETIC
 LIFELONG – ENVIRONMENT MAY ALTER COURSE
 CORE DEFICIT IN PHONOLOGICAL COMPONENT OF LANGUAGE
 READING COMPREHENSION > WORD READING
 ACCOMPANYING CHALLENGES ( 50% )
ADHD
 SENSORY MOTOR DIFFICULTY
 BEHAVIORAL PROBLEMS
MORE CHALLENGING TO REMEDIATE
THE PICTURE OF DYSLEXIA
(All Symptoms Do Not Occur With Everyone)
STRENGTHS
LEADERSHIP SKILLS THINKING “OUT OF THE BOX”
JFK
CHURCHILL
POLITICAL
&
MILITARY
TED TURNER
ENTREPRENEURS
SCIENTISTS
&
INVENTORS
HANS CHRISTIAN
ANDERSEN
LEONARDO
Da VINCI
HARRISON FORD &
STEVEN SPEILBERG
THE PICTURE OF DYSLEXIA
(All Symptoms Do Not Occur With Everyone)
STRENGTHS
CREATIVITY
WRITERS ARTISTS MUSICIANS ACTORS / DIRECTORS
MOZART
THE PICTURE OF DYSLEXIA
(All Symptoms Do Not Occur With Everyone)
STRENGTHS
VISUOSPATIAL / MOTOR SKILLS
SURGEONS ATHLETES
NEUROSURGERY MOHAMMAD ALI NOLAN RYAN
COMPENSATE
PROMOTE
ACCOMMODATE
REMEDIATE
WHAT TO DO?
WHAT TO REMEDIATE?
“IF YOU DON’T KNOW THE CAUSE YOU
GET INSTRUCTIONAL PARADIGMS BUILT
ON FAULTY ASSUMPTIONS.”
G. Reid Lyon, Ph.D.
PHONOLOGICAL AWARENESS
THE CORE DEFICIT
WHAT IS PHONOLOGICAL AWARENESS?
PHONOLOGICAL AWARENESS
 THE UNDERSTANDING THAT WORDS ARE MADE UP OF
SMALL BITS OF SOUND – PHONOLOGICAL SENSITIVITY
 INNATE IN A TYPICAL BRAIN RECEIVING
APPROPRIATE LANGUAGE INPUT
Do the words cat and fat sound the same at the end?
What is the first sound in the word man?
Torgesen, www.fcrr.org
 THE ABILITY TO IDENTIFY, THINK ABOUT, AND
MANIPULATE THE INDIVIDUAL SOUNDS
(PHONEMES) INWORDS
 THE IMPLICATION OF A GROWING ABILITY TO
IDENTIFY INDIVIDUAL SOUNDS INWORDS.
PHONEMIC AWARENESS
Torgesen, www.fcrr.org
EARLY LANGUAGE DEVELOPMENT
 BRAIN IS TUNED TO PARENTS’ LANGUAGE
 NEWBORN: INTEGRATES:
ORAL-FACIAL MOVEMENTS
SPEECH SOUNDS – PHONOLOGY
SOCIAL – EMOTIONAL (NON VERBAL
TONES & GESTURES) - PRAGMATICS
LANGUAGE
(BUILDING BLOCKS)
18 MONTHS ___
1 MONTH ___
9 MONTHS ___
5 YEARS ___
9 YEARS ___
PHONOLOGY
(FORM)
PRAGMATICS
(FUNCTION)
SEMANTICS
(MEANING)
SYNTAX
(FORM)
READING
WRITING
SPELLING
METALINGUISTIC
PRINCIPLES OF LEARNING
 WHAT FIRES TOGETHER, WIRES TOGETHER
– MULTIPLE SENSES STRENGTHEN
PATHWAYS
 OPTIMAL ATTENTION
 CONSISTENT INPUT
 INTENSITY
SALIENT
FREQUENT
REPETITION, REPETITION, REPETITION
Alexander, 2003
PHONOLOGY
EXECUTIVE FUNCTION / INTENTION
WORKING MEMORY
HOLD / MANIPULATE
(PERCEPTION / PRODUCTION)
ATTENTION / AROUSAL
ACOUSTIC
STIMULUS
VISUAL
STIMULUS
MOTOR ARTICULATORY
STIMULUS
SOMATOSENSORY ARTICULATORY
STIMULUS
PHONEMIC REPRESENTATION
PROSODIC
REPRESENTATION
(WORD LEVEL)
READING
EXECUTIVE FUNCTION / INTENTION
WORKING MEMORY
HOLD / MANIPULATE
ATTENTION / AROUSAL
(PERCEPTION / PRODUCTION)
PHONICS RULES
SYNTACTIC
REPRESENTATION
SEMANTIC /LEXICAL
REPRESENTATION
ARTICULATORY
REPRESENTATION
PHONOLOGIC
REPREESENTATION
ORTHOGRAPHIC
REPRESENTATION
MORPHOSYNTACTIC
REPRESENTATION
PROSODIC
REPRESENTATION
DYSLEXIC
THE EFFECTS OF WEAKNESSES IN ORAL
LANGUAGE ON READING GROWTH
(Hirsch, 1996)
5 6 7 8 9 10 11 12 13 14 15 16
16
15
14
13
12
11
10
9
8
7
6
5
Reading
Age
Level
Chronological Age
Low Oral
Language in
Kindergarten
High Oral
Language in
Kindergarten
5.2 years difference
Torgesen, www.fcrr.org
EARLY READING DEVELOPMENT
BREAKING THE CODE
DECODING
(MECHANICS)
LANGUAGE
COMPREHENSION
READING
COMPREHENSION
+
RECIPE FOR READING
WHAT IS “PHONICS”?
IT MUST BE TAUGHT
NEED PA (SOUNDS) TO HOOK TO
ABSTRACT WRITTEN SYMBOLS
(LETTERS)
IT’S A LEARNED SKILL
PRONOUNCE THESE
WORDS…
blit frachet
GROWTH IN “PHONICS” ABILITY OF CHILDREN WHO
BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME
AWARENESS AND LETTER KNOWLEDGE (Torgesen & Mathes,
2000)
6
2
4
1 2 3 4 5
1
3
5
5.9
2.3
Low PA
K
Ave. PA
GRADE LEVEL CORRESPONDING TO AGE
READING
GRADE
LEVEL
Average
Low
GROWTH IN WORD READING ABILITY OF
CHILDREN WHO BEGIN FIRST GRADE IN THE
BOTTOM 20% IN PHONEME AWARENESS AND
LETTER KNOWLEDGE (Torgesen & Mathes, 2000)
6
Low PA
5.7
3.5
2
4
1
3
5
K
Ave. PA
GRADE LEVEL CORRESPONDING TO AGE
1 2 3 4 5
READING
GRADE
LEVEL
Average
Low
Torgesen, www.fcrr.org
GROWTH IN READING COMPREHENSION OF
CHILDREN WHO BEGIN FIRST GRADE IN THE
BOTTOM 20% IN PHONEME AWARENESS AND
LETTER KNOWLEDGE (Torgesen & Mathes, 2000)
1 2 3 4 5
Low PA
3.4
2
4
6
1
3
5
K Ave. PA
6.9
GRADE LEVEL CORRESPONDING TO AGE
READING
GRADE
LEVEL
Average
SAME VERBAL ABILITY – VERY
DIFFERENT READING
COMPREHENSION
Low
Torgesen, www.fcrr.org
AUDITORY /
SOUNDING OUT
VISUAL /
SIGHT WORDS
LANGUAGE /
VOCABULARY
GRAMMAR
COMPREHENSION
FLUENCY
3 – LEGGED
STOOL
NORMAL
READER
AUDITORY/
SOUNDINGOUT
VISUAL /
SIGHT WORDS
LANGUAGE /
VOCABULARY
GRAMMAR
COMPREHENSION
FLUENCY
3 – LEGGED
STOOL
AUDITORY/
SOUNDING
OUT
AUDITORY/
SOUNDINGOUT
AUDITORY/
SOUNDINGOUT
AUDITORY/
SOUNDINGOUT
AUDITORY/
SOUNDINGOUT
AUDITORY/
SOUNDINGOUT
DYSLEXIA
WHERE
 “SIGNATURE” BRAIN IMAGES ARE THE SAME
 DIFFERENT LANGUAGES AFFECT THE PICTURE
 ITALIAN VS ENGLISH
 ANYWHERE
WHO
 ANYONE
 ALL AGES
 ALL WALKS OF LIFE
PREPONDERANCE IN :
ARCHITECTS
ENGINEERS
SURGEONS
ENTREPRENEURS
SCHOOL DROPOUTS
PRISON INMATES
WHEN
 AS EARLY AS THE NEWBORN PERIOD
IDENTIFICATION OF A PHONOLOGIC “GLITCH”
 THE WEAKER THE PHONOLOGY,
THE EARLIER THE STRUGGLE
THE PICTURE OF DYSLEXIA
WHAT DOES IT “LOOK” LIKE?
THE PICTURE OF DYSLEXIA
(ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE)
ORALLANGUAGE
CHALLENGES
LISTENING
Memoryfor word
sequence
(phonenumbers,
directions)
Poor
PHONOLOGICAL
AWARENESS
Foreign
Language
SPEAKING
Word
Finding
Multi-
syllables
Sequencing
Ideas
Foreign
Language
THE PICTURE OF DYSLEXIA
WRITTENLANGUAGE
CHALLENGES
(ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE)
READING
Mechanics Comprehension
Speed
Mechanics
Speed
SPELLING/WRITING
Expressing
Ideas
THE PICTURE OF DYSLEXIA
(ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE)
ACCOMPANYING CHALLENGES
(SENSORIMOTOR)
Oral Motor
Messy Eating
Writing/knots Fingers
Eyes
Tired
Words
Swim
Lose
Place
SpatialAwareness
Up/Down
Left/Right
THE PICTURE OF DYSLEXIA
(ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE)
ACCOMPANYING CHALLENGES
(BEHAVIORAL)
Parents withsimilar
challenges
Brain/ Behavior
Disorders
Attention /
Executive Function
Anxiety
Depression
OCD
Oppositional
Behavior
DEVELOPMENTAL DIFFERENCES
 PRESCHOOL:
SENSORIMOTOR
ORAL LANGUAGE
ATTENTION
 EARLY ELEMENTARY:
PRINT RECOGNITION
LETTER – SOUND KNOWLEDGE
MECHANICS OF READING
HANDWRITING
ATTENTION
DEVELOPMENTAL DIFFERENCES
 HIGH SCHOOL / ADULT:
READING EFFICIENCY
COMPREHENSION
FOREIGN LANGUAGE
ATTENTION
 MID ELEMENTARY / MIDDLE SCHOOL:
COMPREHENSION
WRITTEN EXPRESSION
ATTENTION
WHAT TO DO
ASSESSMENT OF STRENGTHS
AND WEAKNESSES
 NEUROCOGNITIVE
 PSYCHOSOCIAL
ASSESSMENT DRIVES TREATMENT
BELL SHAPED CURVE
NORMAL POPULATION DISTRIBUTION
PROFILE GRAPH
BRAIN TEAM
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
ATTENTION/ INTENTION
Visual
Auditory
INTELLIGENCE/COGNITION
Fluid Reasoning
Executive Processes
Processing Speed
ORAL LANGUAGE
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
PROFILE GRAPH
BRAIN TEAM RESULTS
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
WRITTEN LANGUAGE
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
PRESCHOOL PREDICTORS
OF
FUTURE READING
SUCCESS
PHONOLOGICALAWARENESS
LETTERNAMEKNOWLEDGE
RAPIDNAMINGofOBJECTS,COLORS
ALLOFTHESEPREDICTORSAREDEPENDENT
ONASTRONGPHONOLOGICALSYSTEM
NOT IQ !!! Torgesen, www.fcrr.org
TREATMENT
EARLY IDENTIFICATION
PREVENTION OF READING DIFFICULTIES
LATER IDENTIFICATION
INTERVENTION FOR READING DIFFICULTIES
PREVENTION STUDY
 MID KG – END 2ND GRADE
 SCREENING - BOTTOM 10TH %ILE
 FREQUENCY – 20 MINUTES / 4 DAYS / WEEK
 INTENSITY – 1:1, 67 HRS.
 TEACHERS & AIDES
 4 METHODS – PASP (MULTISENSORY, “BOTTOM UP”- LiPS)
EP (TRADITIONAL RDG INSTRUCTION WITH EXPLICIT PHONICS)
RCS (SUPPORT OF CLASSROOM TEACHING)
NTC (NO TREATMENT CONTROL) Torgesen et al, 1999
NICHD
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.
A SOLUTION TO THE PROBLEM OF THE FLUENCY GAP:
PREVENTIVE INTERVENTIONS
10th 10th
70
80
90
100
Accuracy
Rate
4th
GRADE
2nd
GRADE
30th % ile
BEGINNING % ile
TREATMENT AGE 5-6 5-6
Torgesen et al, 2003
WORD READING
DYSLEXIA PREVENTION STUDY
“BOTTOM-UP” VS “TOP-DOWN”
 PASP (LiPS) USES A MORE
EXPLICIT, CONCRETE,
MULTISENSORY (“BOTTOM UP”)
APPROACH TO DEVELOP
PHONOLOGICAL AWARENESS
NTC
RCS
EP
LiPS
0
5
10
15
20
25
30
35
40
45
Percent
retained
in K or 1
Torgesen et al, 1999
30th
70th
75th
50th
25th
OCTOBER JANUARY MAY
NATIONAL
PERCENTILE
GROWTH IN WORD READING ABILITY
Torgesen, www.fcrr.org
KINDERGARTEN
FIRST GRADE
Left Right
AT RISK READER
BEFORE
INTERVENTION
AFTER
INTERVENTION
Simos et al, 2005
REMEDIATION STUDY
 2 TREATMENTS – BOTH EXPLICIT PHONICS RX
A “BOTTOM UP” (LiPS) VS A “TOP DOWN” (EP)
 SEVERE DYSLEXIA
2nd %ILE FOR WORD READING
35th %ILE IQ
 EQUAL TIME AND INTENSITY
1:1
100 MINS DAILY
8-9 WEEKS
TOTAL 67.5 HRS
 OLDER CHILDREN (8 – 10 YRS)
RESEARCH DEMONSTRATES BOTH
IMMEDIATE & LONG LASTING RESULTS IN BROAD
READING (DECODING+COMPREHENSION)
Standard
Score
75
80
85
90
95
Initial
Test
Pre-
Treatment
Test
Post-
Treatment
Test
1 Year
After
Treatment
2 years
Normal Range of Performance
9-Week
Intensive
Program
Torgesen, Alexander, Wagner et al, 2001
16 Mos.
Special Ed Class
81
*
91
93
TWO YEAR FOLLOW UP
READING RESULTS
WRMT-R
70
80
100
90
WORD
ATTACK
WORD ID PASSAGE
COMP.
69
68
82
30th percentile
N = 50
*
* p= <.05
*
Torgesen, Alexander, Wagner et al, 2001
72
96
*
91
*
91
*
TWO YEAR FOLLOW UP
READING RESULTS
GORT-R
70
80
100
90
WORD
ATTACK
WRMT-R
TEXT
READING
ACCURACY
READING
COMP.
TEXT
READING
RATE
68
74
83
71
30th percentile
* p= <.05
N = 50
SPOKEN LANGUAGE GAINS
GROWTH IN SPOKEN LANGUAGE DURING INTERVENTION &
FOLLOW-UP
60
70
80
100
Pretest Post Test 1 year 2 years
Standard
Score
90
LIPS
CELF-R-RLS
CELF-R-ELS
EP
CELF-R-RLS
CELF-R-ELS
Torgesen, Alexander, Wagner et al, 2001
EFFECT SIZE OF TREATMENT ON
LANGUAGE COMPREHENSION
LIPS EP
PRE - POST PRE - 2 YRS PRE - 2 YRS
PRE - POST
RLS
OD
WC
SR
LP
ELS
FS
RC
SA
1.05
0.75
0.61
0.61
0.62
0.85
0.60
0.24
0.75
0.97
0.75
0.44
0.93
0.58
0.71
0.70
0.54
0.49
0.49
0.31
0.50
0.37
0.03
0.70
0.44
0.20
0.76
1.05
0.46
0.84
0.43
0.38
0.67
0.60
0.16
0.78
P<= 0.05
ES of 5 – 7 moderate; 8+ large
Decreased activity
in right hemisphere Increased activity in
left hemisphere
TREATMENTS EFFECTS ON BRAIN ACTIVITY
Simos et al 2002
EXCITING RESULTS!
HOWEVER……..
LATE VS EARLY INTERVENTION (PREVENTION)
WORD READING ACCURACY AND RATE
2nd 10th 10th 10th
70
80
90
100
Accuracy
Rate
4th
grade
2nd
grade
30th % ile
BEGINNING % ile
TREATMENT AGE 8-11 5-6 5-6
8-11
PROJECTED GROWTH IN “SIGHT VOCABULARY” OF
NORMAL READERS AND DISABLED CHILDREN
BEFORE AND AFTER REMEDIATION
Normal
Intervention
Size
of
“sight
vocabulary
Grade in School
1 2 3 4 5 6 7
Dyslexic
2nd Year
follow-up
Later intervention does not close fluency gap – early intervention does
Torgesen
Torgesen, www.fcrr.org
EARLY INTERVENTION IS URGENT!
 50TH %ILE 5TH GRADE READER
600,000 WORDS A YEAR
AVERAGE STUDENTS
RECEIVE ABOUT 10
TIMES AS MUCH
PRACTICE IN A YEAR
(Anderson, Wilson, & Fielding, 1988)
 10TH %ILE 5TH GRADE READER
50,000 WORDS A YEAR
RESPONSE TO INTERVENTION MODEL
 APPLICATION OF EVIDENCE-BASED
TREATMENT TO SCHOOLS
 TIER 1: CLASSROOM
 TIER 2: PULL OUT SUPPORT
 TIER 3 :TOTAL PULL OUT
A TIERED APPROACH
TIER TWO
LITCHFIELD SCHOOL DISTRICT
PHOENIX, ARIZONA
 ID BY CLASSROOM TEACHER
SPALDING INSTRUCTION IN CLASSROOM
 READING / PA ASSESSMENT BELOW GRADE LEVEL OR,
AT GRADE LEVEL, BUT STRUGGLING
 NOT QUALIFIED FOR SLD
 EXPLICIT, MULTISENSORY PROGRAM (LiPS) 40 MINS
DAILY, 120 DAYS, 80-100 HRS
GROUPS :
6-8:1 (YOUNGER)
8-12:1 (OLDER)
LSD RESULTS 1st GRADE
101
113
96
70
80
100
90
WORD
ATTACK
WORD ID PASSAGE
COMP.
83
72
85
30th percentile
N = 63
*
* p= <.05
110
*
*
101
108
98
LSD RESULTS 2nd GRADE
70
80
100
90
WORD
ATTACK
WORD ID PASSAGE
COMP.
96
93
95
30th percentile
N = 64
*
*
* p= <.05
110
101
100
96
LSD RESULTS 3rd – 5th GRADES
70
80
100
90
WORD
ATTACK
WORD ID PASSAGE
COMP.
91
91
95
30th percentile
N = 126
* *
*
* p= <.05
PRINCIPLES OF LEARNING
 WHAT FIRES TOGETHER, WIRES TOGETHER
– MULTIPLE SENSES STRENGTHEN
PATHWAYS
 OPTIMAL ATTENTION
 CONSISTENT INPUT
 INTENSITY
SALIENT
FREQUENT
REPETITION, REPETITION, REPETITION
Alexander, 2003
TIER THREE
EINSTEIN MONTESSORI CHARTER
SCHOOL
FLORIDA
www.einsteinmontessori.com
EINSTEIN MONTESSORI SCHOOL, INC
(EMS)
 CHARTER SCHOOL (1999)
 REMEDIATE LITERACY SKILLS
 LANGUAGE-BASED LEARNING DIFFICULTIES
 2ND - 8TH GRADE
 LITERACY SKILLS FOUR CLASS PERIODS/DAY
1. PHONOLOGICAL AWARENESS (LIPS)
2. READING
3. READING
4. WRITING
 TEACHER TRAINING ACROSS ALL CLASSES
EMS GAINS 2004-2005 (GRADES 3-5)
 SIGNIFICANT IMPROVEMENT (P <0.001)
WORD ATTACK
PASSAGE COMPREHENSION
PHONOLOGICAL PROCESSING
WORD & NONWORD READING EFFICIENCY
STATE ACHIEVEMENT TESTING
 NON-SIGNIFICANT IMPROVEMENT
WORD IDENTIFICATION
EINTSTEIN MONTESSORI RESULTS
HOWEVER….MANY MEASURES, WHILE SIGNIFICANT,
DID NOT REACH 30TH%ILE BENCHMARK
THEREFORE….INSTITUTING AN INTENSIVE
FOUNDATIONAL INTERVENTION
(LiPS)
3 HOURS/DAY X 6 WEEKS
SMALL GROUP
0
50
100
150
200
250
300
350
4th 5th 6th 7th 8th
GRADE
DEVELOPMENTAL
SCALE
SCORE
FLORIDA STATE
AVERAGE
ALACHUA COUNTY
AVERAGE
EINSTEIN
MONTESSORI
FCAT 2005
AVERAGE CHANGE IN READING DEVELOPMENT
(IMPROVEMENT FROM 2004 TO 2005)
“TIER FOUR”
1:1
FOR THE TREATMENT RESISTERS
 THE RESEARCH MODEL
 THOROUGH BRAIN TEAM ASSESSMENT
TREAT OTHER FACTORS THAT MAY BE OBSTACLES
ATTENTION
BEHAVIOR
SENSORIMOTOR
81
*
91
93
RESEARCH RESULTS 3rd – 5th GRADES
70
80
100
90
WORD
ATTACK
WORD ID PASSAGE
COMP.
69
68
82
30th percentile
N = 50
*
* p= <.05
*
CONCLUSION
 TREATMENT IS MOST EFFECTIVE IF:
YOUNGER AGE
INTENSIVE
EXPLICIT PHONOLOGICAL/PHONICS
ATTENTION IS OPTIMAL
 “BOTTOM-UP” MORE EXPLICIT PHONICS APPROACH:
PREVENTION
MILD TO SEVERE DYSLEXIA
AUDITORY WORKING MEMORY WEAKNESS
 “TOP-DOWN” PHONICS APPROACH:
AFTER 3RD GRADE
MILD TO MODERATE DYSLEXIA
NEUROBIOLOGY REVIEW
WHY DOES INTERVENTION WORK?
WHY
“OUT OF LINE NEURONS” ( ECTOPIAS )
FRONT
http://www.thebrain.mcgill.ca/flash/d/d_02/d_02_cl/d_02_cl_vis/d_02_cl_vis.html#3
LAYERS OF
BRAIN CORTEX
NEURAL
MIGRATION
http://www.thebrain.mcgill.ca/flash/a/a_09/a_09_cl/a_09_cl_dev/a_09_cl_dev.htm
GENETICALLY PROGRAMMED
NEURAL
MIGRATION
GONE AWRY IN
DEVELOPMENTAL DYSLEXIA
http://www.thebrain.mcgill.ca/flash/a/a_09/a_09_cl/a_09_cl_dev/a_09_cl_dev.htm
X
ECTOPIC CELLS
Ramus, 2004
NEURONAL CONNECTIONS
“OUT OF LINE NEURONS” ( ECTOPIAS )
FRONT
TYPICAL LANGUAGE ACTIVATION AREAS
SPEECH
PRODUCTION
AREA
AUDITORY
PROCESSING
AREA
VISUAL-LANGUAGE
ASSOCIATION AREA
VISUAL /
VERBAL
AREA
LEFT HEMISPHERE
TYPICAL READING ACTIVATION AREAS
LEFT HEMISPHERE
WORD ANALYSIS
WORD ANALYSIS
AUTOMATIC
(SIGHT WORD)
Strong activation
pattern
Weak activation
pattern
BRAIN ACTIVATION WITH READING
“SIGNATURE” BRAIN, Shaywitz, 2005
Simos, Fletcher, Bergman, et al 2002
BACK
OF LEFT
BRAIN
B
A
C
K
O
F
R
I
G
H
T
B
R
A
I
N
PRINCIPLES OF LEARNING
 WHAT FIRES TOGETHER, WIRES TOGETHER
– MULTIPLE SENSES STRENGTHEN
PATHWAYS
 OPTIMAL ATTENTION
 CONSISTENT INPUT
 INTENSITY
SALIENT
FREQUENT
REPETITION, REPETITION, REPETITION
Alexander, 2003
WHAT HAVE WE LEARNED FROM
RESEARCH?
 GOOD SCIENCE BEHIND INSTRUCTION
AND MATERIALS.
INFORMED CONSUMERS OF
MATERIALS.
 FOLLOW PRINCIPLES OF LEARNING.
 PREVENTION IS THE MOST EFFECTIVE
TREATMENT APPROACH.
FUTURE DIRECTIONS
 SHOULD WE ACCEPT THE PERSISTENCE OF
A “GAP” AND ONLY FOCUS ON THE
STRENGTHS?
HAVE WE LEARNED ALL THERE IS TO KNOW
ABOUT IMPROVING LANGUAGE AND LEARNING
SKILLS?
 IS “CLOSING THE GAP” AN ACHIEVABLE
GOAL?
 PREVENTION RESEARCH CLOSED THE GAP IN
FLUENCY AND READING ACCURACY.
 REMEDIATION RESEARCH CLOSED THE GAP IN
READING ACCURACY AND IMPROVED FLUENCY.
 NCLB – THE LEGISLATURE’S RESPONSIBILITY.
 NCLB – OUR RESPONSIBILITY IS TO PREVENT
AND REMEDIATE LANGUAGE/LEARNING
DISABILITIES; GIVIVING THE TAX PAYER THEIR
MONEY’S WORTH.
AVAILABLE SCIENCE
 JOE TORGESEN, Ph.D.
WWW.FCRR.ORG
 RICHARD WAGNER, Ph.D.
NICHD – FSU LEARNING
DISABILITIES RESEARCH
CENTER
GENETICS / DYSLEXIA
REGISTRY
FOLLOW SEVERE
DYSLEXICS
WEBSITE – CLEARING
HOUSE FOR TREATMENT
RESEARCH
Acknowledgments
 National Institute of Child Health and Human
Development
 Joe Torgesen
 Carol Rashotte
 Rick Wagner
 Pat Lindamood
 Jane Lawyer
 Sally Shaywitz
THANK YOU
www.TheMorrisCenter.com
info@morriscenters.com
5930 SW Archer Rd
Gainesville, Florida 32608
(352) 332-2629

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Picture_of_Dyslexia (2).ppt

  • 2. THE PICTURE OF DYSLEXIA ANN W ALEXANDER, M.D. THE MORRIS CENTER GAINESVILLE, FL www.TheMorrisCenter.com TIM CONWAY, Ph.D. UNIVERSITY OF FLORIDA GAINESVILLE, FL IDA 2007
  • 3. THE PICTURE OF DYSLEXIA  WHAT  WHY  WHAT IT LOOKS LIKE  WHERE  WHEN  WHAT TO DO  WHO THE &
  • 4. WHAT IT ISN’T DYSLEXIA IS …  NOT A VISUAL PROBLEM  NOT A LACK OF INTELLIGENCE  NOT DUE TO LACK OF EFFORT  NOT RESPONSIVE TO STANDARD READING INSTRUCTION  NOT UNCOMMON – 5 – 17.5 % OF POPULATION  NOT A DEVELOPMENTAL LAG.
  • 5. WHAT IT IS DYS = TROUBLE LEXIA = WORDS TROUBLE WITH WORDS  NEUROLOGIC IN ORIGIN - GENETIC  LIFELONG – ENVIRONMENT MAY ALTER COURSE  CORE DEFICIT IN PHONOLOGICAL COMPONENT OF LANGUAGE  READING COMPREHENSION > WORD READING  ACCOMPANYING CHALLENGES ( 50% ) ADHD  SENSORY MOTOR DIFFICULTY  BEHAVIORAL PROBLEMS MORE CHALLENGING TO REMEDIATE
  • 6. THE PICTURE OF DYSLEXIA (All Symptoms Do Not Occur With Everyone) STRENGTHS LEADERSHIP SKILLS THINKING “OUT OF THE BOX” JFK CHURCHILL POLITICAL & MILITARY TED TURNER ENTREPRENEURS SCIENTISTS & INVENTORS
  • 7. HANS CHRISTIAN ANDERSEN LEONARDO Da VINCI HARRISON FORD & STEVEN SPEILBERG THE PICTURE OF DYSLEXIA (All Symptoms Do Not Occur With Everyone) STRENGTHS CREATIVITY WRITERS ARTISTS MUSICIANS ACTORS / DIRECTORS MOZART
  • 8. THE PICTURE OF DYSLEXIA (All Symptoms Do Not Occur With Everyone) STRENGTHS VISUOSPATIAL / MOTOR SKILLS SURGEONS ATHLETES NEUROSURGERY MOHAMMAD ALI NOLAN RYAN
  • 10. WHAT TO REMEDIATE? “IF YOU DON’T KNOW THE CAUSE YOU GET INSTRUCTIONAL PARADIGMS BUILT ON FAULTY ASSUMPTIONS.” G. Reid Lyon, Ph.D.
  • 12. WHAT IS PHONOLOGICAL AWARENESS?
  • 13. PHONOLOGICAL AWARENESS  THE UNDERSTANDING THAT WORDS ARE MADE UP OF SMALL BITS OF SOUND – PHONOLOGICAL SENSITIVITY  INNATE IN A TYPICAL BRAIN RECEIVING APPROPRIATE LANGUAGE INPUT Do the words cat and fat sound the same at the end? What is the first sound in the word man? Torgesen, www.fcrr.org
  • 14.  THE ABILITY TO IDENTIFY, THINK ABOUT, AND MANIPULATE THE INDIVIDUAL SOUNDS (PHONEMES) INWORDS  THE IMPLICATION OF A GROWING ABILITY TO IDENTIFY INDIVIDUAL SOUNDS INWORDS. PHONEMIC AWARENESS Torgesen, www.fcrr.org
  • 15. EARLY LANGUAGE DEVELOPMENT  BRAIN IS TUNED TO PARENTS’ LANGUAGE  NEWBORN: INTEGRATES: ORAL-FACIAL MOVEMENTS SPEECH SOUNDS – PHONOLOGY SOCIAL – EMOTIONAL (NON VERBAL TONES & GESTURES) - PRAGMATICS
  • 16. LANGUAGE (BUILDING BLOCKS) 18 MONTHS ___ 1 MONTH ___ 9 MONTHS ___ 5 YEARS ___ 9 YEARS ___ PHONOLOGY (FORM) PRAGMATICS (FUNCTION) SEMANTICS (MEANING) SYNTAX (FORM) READING WRITING SPELLING METALINGUISTIC
  • 17. PRINCIPLES OF LEARNING  WHAT FIRES TOGETHER, WIRES TOGETHER – MULTIPLE SENSES STRENGTHEN PATHWAYS  OPTIMAL ATTENTION  CONSISTENT INPUT  INTENSITY SALIENT FREQUENT REPETITION, REPETITION, REPETITION Alexander, 2003
  • 18. PHONOLOGY EXECUTIVE FUNCTION / INTENTION WORKING MEMORY HOLD / MANIPULATE (PERCEPTION / PRODUCTION) ATTENTION / AROUSAL ACOUSTIC STIMULUS VISUAL STIMULUS MOTOR ARTICULATORY STIMULUS SOMATOSENSORY ARTICULATORY STIMULUS PHONEMIC REPRESENTATION PROSODIC REPRESENTATION (WORD LEVEL)
  • 19. READING EXECUTIVE FUNCTION / INTENTION WORKING MEMORY HOLD / MANIPULATE ATTENTION / AROUSAL (PERCEPTION / PRODUCTION) PHONICS RULES SYNTACTIC REPRESENTATION SEMANTIC /LEXICAL REPRESENTATION ARTICULATORY REPRESENTATION PHONOLOGIC REPREESENTATION ORTHOGRAPHIC REPRESENTATION MORPHOSYNTACTIC REPRESENTATION PROSODIC REPRESENTATION DYSLEXIC
  • 20. THE EFFECTS OF WEAKNESSES IN ORAL LANGUAGE ON READING GROWTH (Hirsch, 1996) 5 6 7 8 9 10 11 12 13 14 15 16 16 15 14 13 12 11 10 9 8 7 6 5 Reading Age Level Chronological Age Low Oral Language in Kindergarten High Oral Language in Kindergarten 5.2 years difference Torgesen, www.fcrr.org
  • 23. WHAT IS “PHONICS”? IT MUST BE TAUGHT NEED PA (SOUNDS) TO HOOK TO ABSTRACT WRITTEN SYMBOLS (LETTERS) IT’S A LEARNED SKILL PRONOUNCE THESE WORDS… blit frachet
  • 24. GROWTH IN “PHONICS” ABILITY OF CHILDREN WHO BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME AWARENESS AND LETTER KNOWLEDGE (Torgesen & Mathes, 2000) 6 2 4 1 2 3 4 5 1 3 5 5.9 2.3 Low PA K Ave. PA GRADE LEVEL CORRESPONDING TO AGE READING GRADE LEVEL Average Low
  • 25. GROWTH IN WORD READING ABILITY OF CHILDREN WHO BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME AWARENESS AND LETTER KNOWLEDGE (Torgesen & Mathes, 2000) 6 Low PA 5.7 3.5 2 4 1 3 5 K Ave. PA GRADE LEVEL CORRESPONDING TO AGE 1 2 3 4 5 READING GRADE LEVEL Average Low Torgesen, www.fcrr.org
  • 26. GROWTH IN READING COMPREHENSION OF CHILDREN WHO BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME AWARENESS AND LETTER KNOWLEDGE (Torgesen & Mathes, 2000) 1 2 3 4 5 Low PA 3.4 2 4 6 1 3 5 K Ave. PA 6.9 GRADE LEVEL CORRESPONDING TO AGE READING GRADE LEVEL Average SAME VERBAL ABILITY – VERY DIFFERENT READING COMPREHENSION Low Torgesen, www.fcrr.org
  • 27. AUDITORY / SOUNDING OUT VISUAL / SIGHT WORDS LANGUAGE / VOCABULARY GRAMMAR COMPREHENSION FLUENCY 3 – LEGGED STOOL NORMAL READER
  • 28. AUDITORY/ SOUNDINGOUT VISUAL / SIGHT WORDS LANGUAGE / VOCABULARY GRAMMAR COMPREHENSION FLUENCY 3 – LEGGED STOOL AUDITORY/ SOUNDING OUT AUDITORY/ SOUNDINGOUT AUDITORY/ SOUNDINGOUT AUDITORY/ SOUNDINGOUT AUDITORY/ SOUNDINGOUT AUDITORY/ SOUNDINGOUT DYSLEXIA
  • 29. WHERE  “SIGNATURE” BRAIN IMAGES ARE THE SAME  DIFFERENT LANGUAGES AFFECT THE PICTURE  ITALIAN VS ENGLISH  ANYWHERE
  • 30. WHO  ANYONE  ALL AGES  ALL WALKS OF LIFE PREPONDERANCE IN : ARCHITECTS ENGINEERS SURGEONS ENTREPRENEURS SCHOOL DROPOUTS PRISON INMATES
  • 31. WHEN  AS EARLY AS THE NEWBORN PERIOD IDENTIFICATION OF A PHONOLOGIC “GLITCH”  THE WEAKER THE PHONOLOGY, THE EARLIER THE STRUGGLE
  • 32. THE PICTURE OF DYSLEXIA WHAT DOES IT “LOOK” LIKE?
  • 33. THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ORALLANGUAGE CHALLENGES LISTENING Memoryfor word sequence (phonenumbers, directions) Poor PHONOLOGICAL AWARENESS Foreign Language SPEAKING Word Finding Multi- syllables Sequencing Ideas Foreign Language
  • 34. THE PICTURE OF DYSLEXIA WRITTENLANGUAGE CHALLENGES (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) READING Mechanics Comprehension Speed Mechanics Speed SPELLING/WRITING Expressing Ideas
  • 35. THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ACCOMPANYING CHALLENGES (SENSORIMOTOR) Oral Motor Messy Eating Writing/knots Fingers Eyes Tired Words Swim Lose Place SpatialAwareness Up/Down Left/Right
  • 36. THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ACCOMPANYING CHALLENGES (BEHAVIORAL) Parents withsimilar challenges Brain/ Behavior Disorders Attention / Executive Function Anxiety Depression OCD Oppositional Behavior
  • 37. DEVELOPMENTAL DIFFERENCES  PRESCHOOL: SENSORIMOTOR ORAL LANGUAGE ATTENTION  EARLY ELEMENTARY: PRINT RECOGNITION LETTER – SOUND KNOWLEDGE MECHANICS OF READING HANDWRITING ATTENTION
  • 38. DEVELOPMENTAL DIFFERENCES  HIGH SCHOOL / ADULT: READING EFFICIENCY COMPREHENSION FOREIGN LANGUAGE ATTENTION  MID ELEMENTARY / MIDDLE SCHOOL: COMPREHENSION WRITTEN EXPRESSION ATTENTION
  • 39. WHAT TO DO ASSESSMENT OF STRENGTHS AND WEAKNESSES  NEUROCOGNITIVE  PSYCHOSOCIAL ASSESSMENT DRIVES TREATMENT
  • 40. BELL SHAPED CURVE NORMAL POPULATION DISTRIBUTION
  • 41. PROFILE GRAPH BRAIN TEAM 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 ATTENTION/ INTENTION Visual Auditory INTELLIGENCE/COGNITION Fluid Reasoning Executive Processes Processing Speed ORAL LANGUAGE 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
  • 42. PROFILE GRAPH BRAIN TEAM RESULTS 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 WRITTEN LANGUAGE 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
  • 44. TREATMENT EARLY IDENTIFICATION PREVENTION OF READING DIFFICULTIES LATER IDENTIFICATION INTERVENTION FOR READING DIFFICULTIES
  • 45. PREVENTION STUDY  MID KG – END 2ND GRADE  SCREENING - BOTTOM 10TH %ILE  FREQUENCY – 20 MINUTES / 4 DAYS / WEEK  INTENSITY – 1:1, 67 HRS.  TEACHERS & AIDES  4 METHODS – PASP (MULTISENSORY, “BOTTOM UP”- LiPS) EP (TRADITIONAL RDG INSTRUCTION WITH EXPLICIT PHONICS) RCS (SUPPORT OF CLASSROOM TEACHING) NTC (NO TREATMENT CONTROL) Torgesen et al, 1999 NICHD
  • 46. 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.
  • 47. A SOLUTION TO THE PROBLEM OF THE FLUENCY GAP: PREVENTIVE INTERVENTIONS 10th 10th 70 80 90 100 Accuracy Rate 4th GRADE 2nd GRADE 30th % ile BEGINNING % ile TREATMENT AGE 5-6 5-6 Torgesen et al, 2003 WORD READING
  • 48. DYSLEXIA PREVENTION STUDY “BOTTOM-UP” VS “TOP-DOWN”  PASP (LiPS) USES A MORE EXPLICIT, CONCRETE, MULTISENSORY (“BOTTOM UP”) APPROACH TO DEVELOP PHONOLOGICAL AWARENESS NTC RCS EP LiPS 0 5 10 15 20 25 30 35 40 45 Percent retained in K or 1 Torgesen et al, 1999
  • 49. 30th 70th 75th 50th 25th OCTOBER JANUARY MAY NATIONAL PERCENTILE GROWTH IN WORD READING ABILITY Torgesen, www.fcrr.org
  • 50. KINDERGARTEN FIRST GRADE Left Right AT RISK READER BEFORE INTERVENTION AFTER INTERVENTION Simos et al, 2005
  • 51. REMEDIATION STUDY  2 TREATMENTS – BOTH EXPLICIT PHONICS RX A “BOTTOM UP” (LiPS) VS A “TOP DOWN” (EP)  SEVERE DYSLEXIA 2nd %ILE FOR WORD READING 35th %ILE IQ  EQUAL TIME AND INTENSITY 1:1 100 MINS DAILY 8-9 WEEKS TOTAL 67.5 HRS  OLDER CHILDREN (8 – 10 YRS)
  • 52. RESEARCH DEMONSTRATES BOTH IMMEDIATE & LONG LASTING RESULTS IN BROAD READING (DECODING+COMPREHENSION) Standard Score 75 80 85 90 95 Initial Test Pre- Treatment Test Post- Treatment Test 1 Year After Treatment 2 years Normal Range of Performance 9-Week Intensive Program Torgesen, Alexander, Wagner et al, 2001 16 Mos. Special Ed Class
  • 53. 81 * 91 93 TWO YEAR FOLLOW UP READING RESULTS WRMT-R 70 80 100 90 WORD ATTACK WORD ID PASSAGE COMP. 69 68 82 30th percentile N = 50 * * p= <.05 * Torgesen, Alexander, Wagner et al, 2001
  • 54. 72 96 * 91 * 91 * TWO YEAR FOLLOW UP READING RESULTS GORT-R 70 80 100 90 WORD ATTACK WRMT-R TEXT READING ACCURACY READING COMP. TEXT READING RATE 68 74 83 71 30th percentile * p= <.05 N = 50
  • 56. GROWTH IN SPOKEN LANGUAGE DURING INTERVENTION & FOLLOW-UP 60 70 80 100 Pretest Post Test 1 year 2 years Standard Score 90 LIPS CELF-R-RLS CELF-R-ELS EP CELF-R-RLS CELF-R-ELS Torgesen, Alexander, Wagner et al, 2001
  • 57. EFFECT SIZE OF TREATMENT ON LANGUAGE COMPREHENSION LIPS EP PRE - POST PRE - 2 YRS PRE - 2 YRS PRE - POST RLS OD WC SR LP ELS FS RC SA 1.05 0.75 0.61 0.61 0.62 0.85 0.60 0.24 0.75 0.97 0.75 0.44 0.93 0.58 0.71 0.70 0.54 0.49 0.49 0.31 0.50 0.37 0.03 0.70 0.44 0.20 0.76 1.05 0.46 0.84 0.43 0.38 0.67 0.60 0.16 0.78 P<= 0.05 ES of 5 – 7 moderate; 8+ large
  • 58. Decreased activity in right hemisphere Increased activity in left hemisphere TREATMENTS EFFECTS ON BRAIN ACTIVITY Simos et al 2002
  • 60. LATE VS EARLY INTERVENTION (PREVENTION) WORD READING ACCURACY AND RATE 2nd 10th 10th 10th 70 80 90 100 Accuracy Rate 4th grade 2nd grade 30th % ile BEGINNING % ile TREATMENT AGE 8-11 5-6 5-6 8-11
  • 61. PROJECTED GROWTH IN “SIGHT VOCABULARY” OF NORMAL READERS AND DISABLED CHILDREN BEFORE AND AFTER REMEDIATION Normal Intervention Size of “sight vocabulary Grade in School 1 2 3 4 5 6 7 Dyslexic 2nd Year follow-up Later intervention does not close fluency gap – early intervention does Torgesen Torgesen, www.fcrr.org
  • 62. EARLY INTERVENTION IS URGENT!  50TH %ILE 5TH GRADE READER 600,000 WORDS A YEAR AVERAGE STUDENTS RECEIVE ABOUT 10 TIMES AS MUCH PRACTICE IN A YEAR (Anderson, Wilson, & Fielding, 1988)  10TH %ILE 5TH GRADE READER 50,000 WORDS A YEAR
  • 63. RESPONSE TO INTERVENTION MODEL  APPLICATION OF EVIDENCE-BASED TREATMENT TO SCHOOLS  TIER 1: CLASSROOM  TIER 2: PULL OUT SUPPORT  TIER 3 :TOTAL PULL OUT A TIERED APPROACH
  • 64. TIER TWO LITCHFIELD SCHOOL DISTRICT PHOENIX, ARIZONA  ID BY CLASSROOM TEACHER SPALDING INSTRUCTION IN CLASSROOM  READING / PA ASSESSMENT BELOW GRADE LEVEL OR, AT GRADE LEVEL, BUT STRUGGLING  NOT QUALIFIED FOR SLD  EXPLICIT, MULTISENSORY PROGRAM (LiPS) 40 MINS DAILY, 120 DAYS, 80-100 HRS GROUPS : 6-8:1 (YOUNGER) 8-12:1 (OLDER)
  • 65. LSD RESULTS 1st GRADE 101 113 96 70 80 100 90 WORD ATTACK WORD ID PASSAGE COMP. 83 72 85 30th percentile N = 63 * * p= <.05 110 * *
  • 66. 101 108 98 LSD RESULTS 2nd GRADE 70 80 100 90 WORD ATTACK WORD ID PASSAGE COMP. 96 93 95 30th percentile N = 64 * * * p= <.05 110
  • 67. 101 100 96 LSD RESULTS 3rd – 5th GRADES 70 80 100 90 WORD ATTACK WORD ID PASSAGE COMP. 91 91 95 30th percentile N = 126 * * * * p= <.05
  • 68. PRINCIPLES OF LEARNING  WHAT FIRES TOGETHER, WIRES TOGETHER – MULTIPLE SENSES STRENGTHEN PATHWAYS  OPTIMAL ATTENTION  CONSISTENT INPUT  INTENSITY SALIENT FREQUENT REPETITION, REPETITION, REPETITION Alexander, 2003
  • 69. TIER THREE EINSTEIN MONTESSORI CHARTER SCHOOL FLORIDA
  • 71. EINSTEIN MONTESSORI SCHOOL, INC (EMS)  CHARTER SCHOOL (1999)  REMEDIATE LITERACY SKILLS  LANGUAGE-BASED LEARNING DIFFICULTIES  2ND - 8TH GRADE  LITERACY SKILLS FOUR CLASS PERIODS/DAY 1. PHONOLOGICAL AWARENESS (LIPS) 2. READING 3. READING 4. WRITING  TEACHER TRAINING ACROSS ALL CLASSES
  • 72. EMS GAINS 2004-2005 (GRADES 3-5)  SIGNIFICANT IMPROVEMENT (P <0.001) WORD ATTACK PASSAGE COMPREHENSION PHONOLOGICAL PROCESSING WORD & NONWORD READING EFFICIENCY STATE ACHIEVEMENT TESTING  NON-SIGNIFICANT IMPROVEMENT WORD IDENTIFICATION
  • 73. EINTSTEIN MONTESSORI RESULTS HOWEVER….MANY MEASURES, WHILE SIGNIFICANT, DID NOT REACH 30TH%ILE BENCHMARK THEREFORE….INSTITUTING AN INTENSIVE FOUNDATIONAL INTERVENTION (LiPS) 3 HOURS/DAY X 6 WEEKS SMALL GROUP
  • 74. 0 50 100 150 200 250 300 350 4th 5th 6th 7th 8th GRADE DEVELOPMENTAL SCALE SCORE FLORIDA STATE AVERAGE ALACHUA COUNTY AVERAGE EINSTEIN MONTESSORI FCAT 2005 AVERAGE CHANGE IN READING DEVELOPMENT (IMPROVEMENT FROM 2004 TO 2005)
  • 75. “TIER FOUR” 1:1 FOR THE TREATMENT RESISTERS  THE RESEARCH MODEL  THOROUGH BRAIN TEAM ASSESSMENT TREAT OTHER FACTORS THAT MAY BE OBSTACLES ATTENTION BEHAVIOR SENSORIMOTOR
  • 76. 81 * 91 93 RESEARCH RESULTS 3rd – 5th GRADES 70 80 100 90 WORD ATTACK WORD ID PASSAGE COMP. 69 68 82 30th percentile N = 50 * * p= <.05 *
  • 77. CONCLUSION  TREATMENT IS MOST EFFECTIVE IF: YOUNGER AGE INTENSIVE EXPLICIT PHONOLOGICAL/PHONICS ATTENTION IS OPTIMAL  “BOTTOM-UP” MORE EXPLICIT PHONICS APPROACH: PREVENTION MILD TO SEVERE DYSLEXIA AUDITORY WORKING MEMORY WEAKNESS  “TOP-DOWN” PHONICS APPROACH: AFTER 3RD GRADE MILD TO MODERATE DYSLEXIA
  • 78. NEUROBIOLOGY REVIEW WHY DOES INTERVENTION WORK?
  • 79. WHY “OUT OF LINE NEURONS” ( ECTOPIAS ) FRONT
  • 82. NEURAL MIGRATION GONE AWRY IN DEVELOPMENTAL DYSLEXIA http://www.thebrain.mcgill.ca/flash/a/a_09/a_09_cl/a_09_cl_dev/a_09_cl_dev.htm X
  • 85. “OUT OF LINE NEURONS” ( ECTOPIAS ) FRONT
  • 86. TYPICAL LANGUAGE ACTIVATION AREAS SPEECH PRODUCTION AREA AUDITORY PROCESSING AREA VISUAL-LANGUAGE ASSOCIATION AREA VISUAL / VERBAL AREA LEFT HEMISPHERE
  • 87. TYPICAL READING ACTIVATION AREAS LEFT HEMISPHERE WORD ANALYSIS WORD ANALYSIS AUTOMATIC (SIGHT WORD)
  • 88. Strong activation pattern Weak activation pattern BRAIN ACTIVATION WITH READING “SIGNATURE” BRAIN, Shaywitz, 2005 Simos, Fletcher, Bergman, et al 2002 BACK OF LEFT BRAIN B A C K O F R I G H T B R A I N
  • 89. PRINCIPLES OF LEARNING  WHAT FIRES TOGETHER, WIRES TOGETHER – MULTIPLE SENSES STRENGTHEN PATHWAYS  OPTIMAL ATTENTION  CONSISTENT INPUT  INTENSITY SALIENT FREQUENT REPETITION, REPETITION, REPETITION Alexander, 2003
  • 90. WHAT HAVE WE LEARNED FROM RESEARCH?  GOOD SCIENCE BEHIND INSTRUCTION AND MATERIALS. INFORMED CONSUMERS OF MATERIALS.  FOLLOW PRINCIPLES OF LEARNING.  PREVENTION IS THE MOST EFFECTIVE TREATMENT APPROACH.
  • 91. FUTURE DIRECTIONS  SHOULD WE ACCEPT THE PERSISTENCE OF A “GAP” AND ONLY FOCUS ON THE STRENGTHS? HAVE WE LEARNED ALL THERE IS TO KNOW ABOUT IMPROVING LANGUAGE AND LEARNING SKILLS?  IS “CLOSING THE GAP” AN ACHIEVABLE GOAL?  PREVENTION RESEARCH CLOSED THE GAP IN FLUENCY AND READING ACCURACY.  REMEDIATION RESEARCH CLOSED THE GAP IN READING ACCURACY AND IMPROVED FLUENCY.
  • 92.  NCLB – THE LEGISLATURE’S RESPONSIBILITY.  NCLB – OUR RESPONSIBILITY IS TO PREVENT AND REMEDIATE LANGUAGE/LEARNING DISABILITIES; GIVIVING THE TAX PAYER THEIR MONEY’S WORTH.
  • 93. AVAILABLE SCIENCE  JOE TORGESEN, Ph.D. WWW.FCRR.ORG  RICHARD WAGNER, Ph.D. NICHD – FSU LEARNING DISABILITIES RESEARCH CENTER GENETICS / DYSLEXIA REGISTRY FOLLOW SEVERE DYSLEXICS WEBSITE – CLEARING HOUSE FOR TREATMENT RESEARCH
  • 94. Acknowledgments  National Institute of Child Health and Human Development  Joe Torgesen  Carol Rashotte  Rick Wagner  Pat Lindamood  Jane Lawyer  Sally Shaywitz
  • 95. THANK YOU www.TheMorrisCenter.com info@morriscenters.com 5930 SW Archer Rd Gainesville, Florida 32608 (352) 332-2629