Assessing and Differentiating Reading Disorders - PowerPoint Presentation

1. Assessing and Differentiating Reading Disorders Linda J. Lombardino, Ph.D.Professor of Speech-Language PathologySchool of Special Education, School Psychology and Early Childhood Studiesllombard@ufl.edu Presentation at The Ohio State UniversityDepartment of Speech and Hearing ScienceJanuary 26, 2012

2. Aims of Assessing and Differentiating Reading & Writing Disorders: Multidimensional ModelOverview of component skills needed for skilled readingDevelopmental Schemes for core componentsIdentify core weaknesses that underlie the struggling readers’ difficultiesShow sample tests for core areasProvide diagnostic profiles with scientific supportRecommend specific treatments for case studiesProvide information on counseling parents2

3. Part 1 – Model/Framework3

4. Language KnowledgeWord retrievalDiscourseSyntax Morphological KnowledgeVocabulary Environmental FactorsNeurological FactorsGrapho-phonemic Integration“Alphabet principle”Word level reading Word level spelling Text level writing Text level reading Phonological KnowledgePrint Knowledge READING ACHIEVEMENT4Multidimensional Model for Assessing Reading and Writing (MARwR)

5. Spoken Language Vocabulary Understanding of words and word meanings in both spoken and written languageWord retrievalAccessing pronunciations of words or sound patterns stored in memoryMorphological awarenessUnderstanding that morphemic units exist in words and contribute to the meaning of the wordSyntactic knowledgeUnderstanding how to use grammatical rules and to adhere to word order, morphological markers, and other syntactic constraints of one’s languageDiscourse skillsUnderstanding causal connections and inferences in textsPrint KnowledgePrint awarenessKnowledge of book conventions, concept of word in print, and print mechanicsLetter knowledgeKnowledge of letter names and ability to write letters that represent letter namesWord awarenessKnowledge that words can be segmented into separate units that represent individual spoken wordsPhonological KnowledgePhonological awarenessAwareness that the stream of speech can be broken down into smaller unitsGrapho-phonemic Integration Phonics knowledgeMapping phonemes (sounds) onto graphemes (letters)Invented spellingKnowledge that sounds are represented by letters in some consistent way and use of this knowledge to create spellings prior to conventional instructionSkills Targeted in MARwR [5

6. Word-Level Reading and SpellingDecodingSegmenting letters in words into corresponding sounds, then blending sounds to create real words or nonsense wordsWord recognitionRecognizing familiar words in print (sight-word recognition) such that sight of spelling patterns results in immediate word recognitionSpellingRemembering spelling for sound units (e.g., -ight sounds like /ai/) and knowledge of rules that determine word pronunciations (e.g., silent e dictates the pronunciation of site)Text-Level ReadingReading comprehensionUnderstanding the meaning of information in printReading fluencyReading words and text accurately and effortlesslyText-Level WritingMechanics & conventionsHandwriting and punctuationCompositionPlanning, translating, and reviewing written text6

7. Part 2- Developmental Hierarchies for Core Component7

8. Table 2-1. Ehri’s three-phase model of word-level readingPhase I: Pre-Alphabetic Stage of Word ReadingPreschool (aka visual cue stage)Key characteristic/strategy: Learners recognize words by connecting salient visual cues within or around the word with words’ pronunciations or meanings (aka visual cue reading) Primary Indicators:Recognizes a word only when it occurs in a specific contextDoes not recognize when letters in a word are replaced or letters are re-arranged (e.g., Pepsi spelled as Zepsi)Unable to identify letters in own the printed name even if name is recognized Examples:Relies on contextual cues such as familiar logos (e.g., McDonald’s golden arches) to recognize a McDonald’s signRelies on the shape and color of a stop sign to recognize the word “STOP”Relies on a meaningful pattern such as the two eyes in the word “bee” or the circle at the end of Pogo’s name to recognize these words in print “Because the visual cues forming connections are not unique to individual words, children mistake visually similar words for one another (Ehri, 1992, p. 125).8

9. Stages of reading acquisition cont.Transition from Pre-Alphabetic to Partial Alphabetic Stage Learners begin to use knowledge of a few letter names to form connections between letters and corresponding sounds at the beginning or end of words ( e.g, child uses the letter “l” to represent the sounds in “ball” when attempting to spell it). Phase 2: Partial Alphabetic Stage of Word ReadingKindergarten (aka phonetic cue stage)Key characteristic: Learners recognize words by connecting letters with sounds Primary Indicators:Knows the names of most letters in the alphabetShows the ability to segment the initial sound in a word from the remainder of the wordUses knowledge of letter names and ability to partially segment words (phonemic awareness) to make systematic connections between letters and their corresponding sounds, especially at the beginning and ends of words. Knowing letter names gives access to phonetic cues that can be used to attempt word reading Examples:Spelling flower as “FLR” by using letter names to guide spellingMisreading simple words such as “ for” for “from” and “like” for “lake ” while indicating that that s/he is using phonetic cues as a strategy for reading.“It is important to note that sight word reading during the partial alphabetic phase is an imperfect process that occurs among be)ginners who lack full knowledge of the alphabetic system and phonemic segmentation skill (Ehri, 2005, p. 145).9

10. Stages of reading acquisition cont.Phase 3: Full Alphabetic Stage of Word ReadingFirst-Second Grade (aka alphabetic coding stage)Key characteristics: Learner can integrate knowledge of phonemic segmentation with knowledge of letter-sound associations to decode wordsLearner is able to quickly identify familiar words by retrieving spellings and pronunciations stored in memory. Primary Indicators:Segments and blends unfamiliar, phonetically regular words to arrive at accurate pronunciations of words in print.At this level, children are “… able to form connections between all of the graphemes in spellings and the phonemes in pronunciations to remember how to read words” (Ehri, 2005, p. 148)10

11. Figure 2-7 (fluency )11

12. Figure 2-9 (reading processes for text comprehension)12

13. Figure 2-10 (writing processes for text composition)13

14. Figure 2-11(developmental scheme of reading skills for readingachievement)14

15. Part 3Protocol of Component Strength and Weaknesses15

16. Summary Sheet for Weaknesses and Strengths16

17. Part 4-Diagnostic Classifications17

18. Profiles/ClassificationsPreschool – First Grade18

19. 19At Risk Classifications for PK – First Grade ChildrenProfile 1: Mixed Language and Emergent Literacy DeficitMild to severely depressed language production and/or comprehensionDifficulty in one or more phonological processesLow normal to above average nonverbal intelligenceAbsence of primary visual, auditory or motor disabilitiesProfile 2: Emergent Literacy DeficitNormal language with or without a history of articulation difficultiesDifficulty with emergent literacy skills especially letter knowledge and sound-letter associationsLow normal to above average nonverbal intelligenceAbsence of primary visual, auditory or motor disabilitiesProfile 3: Environmental Disadvantage DeficitOverall depressed pre-academic skills with or without previous identification of a language delay or disorderHistory of diminished opportunities for exposure to language and to literacy concepts at home and/or in schoolLow normal to above average nonverbal intelligenceAbsence of primary visual, auditory or motor disabilitiesClassifications

20. 20Profile 1 Mild to moderate mixed spoken language & emergent literacy deficitProfile 2 Emergent literacy deficitProfile 3 *Environmental disadvantage deficitSpoken languageknowledge _+-/+Phonological knowledge-/+-/+-/+Grapheme-Phoneme knowledge-/+_-/+Early Literacy Classifications (4-7 years)

21. Brittany Profile 1 Severe spoken language & emergent literacy deficit21

22. Amanda Profile 1Moderate mixed language and literacy22

23. Carlos Profile 2Emergent literacy Deficit23

24. Profiles/ClassificationsFirst Grade & Beyond24

25. 25Profile TypeSpoken Language characteristicsReading and Writing CharacteristicsProfile 4: Mixed Spoken and Written Language DisorderExhibits depressed oral language abilities in one or more domains of language (e.g., semantic, syntax, pragmatics), however, deficits in phonological processing (awareness, memory, rapid) are often mild and sometimes do not occurTypically has a history of early language impairmentOften shows deficits in production of oral language narratives and other forms of oral discourseOften shows deficits in use of morphological and syntactic formsCan exhibit relatively good word recognition and reading fluency, and spellingExhibits depressed reading comprehensionExhibits depressed writing composition in terms of story grammar and other structural elements of discourseMorpho-syntactic and semantic errors are often observed in written compositionClassifications for End of First Grade and Beyond

26. Gail (9 years)Profile 4Mixed language and literacy26

27. Gail (9 years)Profile 4 Mixed language and literacy deficits27

28. 28Profile 5: Dyslexia Deficits in phonological and orthographic coding along with a lack of fluency in readingDepressed ability to remember the precise oral pronunciations of words learned, particularly when they consist of multisyllabic and complex constructions.Relatively frequent history of articulation therapyLow average or above language production and comprehension skills depending on the severity of the word reading deficitListening comprehension exceeds reading comprehension although sometimes holding lengthy oral directions in memory is difficultHandwriting varies from good to very poorWriting conventions, such as punctuation and capitalization are often ignored or misused.Depressed phonological decoding of nonwords, word reading, spelling, and reading fluencyListening comprehension exceeds word reading and reading fluencySpelling is always impaired and retention of word spelling is very difficultWriting mechanics including punctuation conventions are typically poor.Morph-syntactic deficits may be apparent in written languageHandwriting can range from good to illegible but is typically of poor quality

29. Evan (10 years) Profile 5Dyslexia29

30. Evan (10 years) Profile 5Dyslexia30

31. 31Profile 6: Reading Comprehension DisorderTypically unidentified with learning difficulties until 4th grade and beyond.Average to strong phonological decoding and word recognitionRelatively weak language comprehension skills at the word and discourse levelsWeaknesses in telling well structured and integrated stories orally and in writingVariable performance on tasks of working memory Word level reading, decoding and spelling are all superior to reading comprehensionDepressed reading comprehension skills, particularly beyond a 3rd-4th grade reading level

32. Harry (14 years)Profile 6Reading Comprehension Deficit32

33. Harry (14 years)Profile 6Reading Comprehension33

34. 34Profile 4: DyslexiaProfile 5 : Mixed Spoken Language and LiteracyProfile 6:Comprehension DeficitListening comprehension Language concepts+_-/+Word-level reading_-/++Reading fluency_-/++Reading Comprehension+__Diagnostic Classifications

35. Examples of Treatment RecommendationsDyslexiaOrton-Gillingham based approach to reading.Lexercise (http://www.lexercise.com/), an advanced Web-based treatment program for children who have dyslexia or other language-based learning disabilitiesTouchmath program (http://www.epsbooks.com)Ginger software (http://www.gingersoftware.com)Mixed Spoken Language and LiteracyLanguage intervention that targets words meanings in the context of listening comprehension activitiesReading intervention that targets strengthening her reading fluency and improving knowledge of word meaningsLanguage Tune-Up Kit at Home Reading Software.Quick Reads: A Research-Based Fluency ProgramTouchmath program (http://www.epsbooks.com)Comprehension DeficitStrategies for achieving reading comprehension for narrative and expository textsSemantic webbing strategiesComprehension monitoring strategiesMaking Connections: Explicit Instruction for Comprehension Skills and Strategies35

36. In-take FormsAppendix 3-1. Caregiver/teacher questionnaire for preschool-early first grade childrenAppendix 3-2. Caregiver/teacher questionnaire for school age children at the end of 1st grade and beyond36

37. Part 5Discussing & Interpreting Diagnostic ReportsGroup ActivityInterpretationsRecommendations37

38. Sample #1Student: 6 year, 4 month old femaleAt risk for language and literacy deficitRECOMMENDATIONSJJ should begin therapy focusing on:Reading for recognition and decodingReading in words and sentencesSpelling in words and sentencesListening comprehension using small graded paragraphs and then discussing the contentAccurate copying of numbers and words from a close distance and then further awayMath skills including addition and subtraction of single digits It is recommended that JJ be examined to rule out Attention Deficit Disorder (ADD) Recommended testing location:Sarkis Family Psychiatry38

39. Sample #2Student: 5 year ,7 month old male  exhibits characteristics that are consistent with a diagnosis of developmental dyslexia (ICD-10-CD Code 315.02.Recommendations:Andy is a bright child who presents with developmental dyslexia. Therefore, intervention and academic accommodations are essential for Andy to perform at his full potential. Andy can be successful if he is provided with appropriate and adequate methods of reading instruction.The severity of Andy’s dyslexia creates an impairment that significantly hinders several major life activities, including reading and writing, learning, and listening. To meet Andy’s educational needs as adequately as other children his age, Andy will need the following classroom accommodations as he advances through elementary school, which can be provided through a 504 plan.Andy should be given more time on tests and other class work.Andy should not be required to copy notes from the board, an overhead, or a book. Instead, the teacher should provide Andy with a copy of her own notes/overheads 39

40. Sample 2 cont.Andy should be allowed to type all written assignments.Andy’s spelling tests should not be graded. Because children with dyslexia are not able to master spelling the traditional way, Andy will be taught by a tutor using a different method. Until Andy’s spelling reaches grade level, he should be allowed to take spelling tests with his class, but they should not be graded.Andy should be given reduced homework assignments in all of his subjects. The amount of homework required should be based on the time it would take students without the disability to complete the assignment. The number of problems or length of an assignment should be reduced, with feedback from his parents, until Andy is spending no more than 1 ½ the amount of time on homework as a student without dyslexia would spend.These same accommodations should be provided on all standardized tests.Andy should be enrolled in a multi-sensory phonics and fluency-based instructional program. Examples of such programs are: a) Barton Reading and Spelling System and b) Lindamood Phoneme Sequencing (LiPS)®. The features of these approaches are listed below.40

41. Sample 2 contRecommendations:  The Barton Reading and Spelling System® is a tutoring program, which parents, volunteer tutors, resource specialists, and professional tutors can use with children, teenagers, and adults who have learning difficulty. It is an adapted and simplified version of the Orton-Gillingham approach to teaching reading and spelling. It includes fully scripted lesson plans, plus all reading material, spelling lists, homework pages, and training videos. The Lindamood Phoneme Sequencing (LiPS)® program is a multi-sensory, multifaceted program of phonemic awareness training of reading and spelling, based on a phonological foundation and rooted in the motor-articulatory feedback theory. This program facilitates perception of contrasts between speech sounds and the order of sounds in syllables in words, a critical skill needed for reading and spelling. A distinctive feature of the program is that the student is taught to self-correct rather than be given the right answers. If this program is chosen, Andy should attend therapy sessions implementing this program a minimum of three times per week. Components of the LiPS program are listed below:Identifying and classifying speech sounds (consonants and vowels)Tracking speech sounds (isolated sounds and sounds in syllables)Associating sounds and syllablesApplying this sound-symbol knowledge to spelling (encoding) and reading (decoding) 41

42. Sample #3Student: 9-year-old 1-month female (home schooled)profile of strengths and weaknesses consistent with a diagnosis of Developmental Dyslexia (ICD-9 Code 315.02).RecommendationsThe instruction must start with phonemic awareness instruction, followed by a systematic approach to phonics, both analytic and synthetic. It must also teach reading and spelling as related subjects with intense practice and constant weaving of the concepts taught. Orton-Gillingham-based systems such as the Barton Reading and Spelling Program, Wilson Reading System, and the Slingerland Approach meet these requirements. 42

43. Sample 3 cont.Recommendations continuedEnroll Rose in a more traditional school setting, however, it is imperative that school personnel be made aware of Rose’s need for educational support. Enroll in Tier III reading instruction At this level of intervention the reading instruction at school is intensive (i.e., 1:1 – 1:3 ratio), systematic, and provided for ninety (90) minutes per day in addition to her regular classroom reading instruction. (For more information on the Tier Model, the reader is referred to www.fcrr.org) 43

44. Sample 3 cont.Accommodations The severity of R’s reading disability creates an impairment that substantially limits several major life activities, including reading, writing, learning, and listening. To meet her educational needs as adequately as a child without these disabilities, Rose will require classroom accommodations, which can be stipulated on a 504 Plan or an IEP. 44

45. Sample #4Student: 10-year-old maleE’s scores from the present evaluation, along with parent observations, educational difficulties, and family history are consistent with a diagnosis of developmental dyslexia (ICD-10-CD Code 315.02)RecommendationsE be enrolled in a multi-sensory phonics- and fluency-based instructional program, which provides intense one-on-one intervention45

46. Sample 4 contSome examples are:The Orton-Gillingham MethodBarton Reading and Spelling ProgramThe Wilson Reading SystemSpecialized Program Individualizng Reading Excllence (S.P.I.R.E)The Slingerland Multisensory ApproachThe Herman approachAlphabetic PhonicsLANGUAGE!Lindamood-Bell Programshttp://www.linguisystems.com/getourcatalog.php46

47. Sample 4 cont.E’s parents consider a computer-based program such as the Touchmath program (www.epsbooks.com) to assist in facilitating his math skills. This program uses a multisensory approach to teaching basic math skills.E’s parents read grade-level books to him or have him listen to grade-level books on tape in order to support his vocabulary growth. Some ideas for grade level books can be found on the website www.bookadventure.org. On this website BW can find a list of books that interest him on his reading level and also earn points for each book he reads that can be redeemed for awards and prizes.Mrs. EE have E evaluated to rule out Attention Deficit Hyperactivity Disorder (ADHD) because she is concerned about E’s difficulty sitting still and because there is a high incidence of Attention Deficit Hyperactivity Disorder (ADHD) in children who have dyslexia.47

48. Sample # 5Student: 16 year, 1 month old malerevealed a profile of strengths and weaknesses that is consistent with a diagnosis of Mixed Receptive/Expressive Language Disorder (ICD-9 code 315.32) and Reading Disorder (unspecified) (ICD-9 code 315.00)RecommendationsF receive language therapy, whether through the public school system or privately, to work on his language processing for in both listening and reading comprehension. F should benefit from therapy that would give him comprehension support, such as Visualizing and Verbalizing for Language Comprehension and Thinking Program.Additional reading comprehension strategies would also be useful, including pre-reading, highlighting, outlining, and use of graphic organizers. 48

49. Sample 5 cont.Accommodations F be given extra time on tasks and tests that require memory and recall, especially in math class. Students with language-based disabilities have an especially difficult time memorizing rote facts such as addition and subtraction facts and the multiplication tables. Because of this, F should be allowed to use a calculator for his math assignments, math tests, and classroom work.F should not be required to copy from the board, an overhead, or from the book. The teacher should provide an outline and copy of the notes. F be given advance organizers, graphic organizers, and study guides before beginning each new content area in all subjects. He will need these to organize daily reviews at home.49

50. Sample 5 contAccommodations cont4. F have access to a note taker for class lessons.5. F have the option for a foreign language requirement waiver exemption or to take replacement requirement. A student who has a language-based disability in his native language will experience it in a foreign language as well. For a student who is struggling with English, learning a foreign language is typically extremely difficult.6. F’s academic progress monitored regularly to ensure that accommodations gives are effective. 7. F will need to have extra time and possibility other accommodation if he takes nationally standardized tests such as the Scholastic Aptitude Test (SAT). Refer to www.ets.org for further information on accommodations for high-stakes testing. 50

51. Sample #6Student: 20-year 8- month-old female attendingat a state university, majoring in biology, hopingto attend medical school. exhibits characteristics that are consistent with a diagnosis of Developmental Dyslexia (ICD-10-CM Code 315.02)RecommendationsSS register with the Student with Disabilities Office at the University of Florida in order to receive the necessary assistance with her academic courses. SS be exempt from taking university/college level foreign language requirements in lieu of taking alternate courses.  51

52. Sample 6 cont.SS receive extended time on all tests administered, as well as having the testing material provided verbally, if necessary.SS be allowed to tape record all classes.SS be provided with a note taker, if necessary.SS outline texts as she reads to maximize reading comprehension. SS should visit the website for the Florida Branch of the International Dyslexia Association (IDA): www.Interdys.org for more information on dyslexia.These same accommodations must be provided on all standardized tests. 52

53. Thank You!53