Transcript Occupational therapy for reading and writing

OCCUPATIONAL THERAPY
FOR READING AND WRITING
Catherine Candler, OTR, PhD, BCP
Lenin Grajo, OTR/L, EdM
Karen Nall, MOTS
Abbey Mulder, MOTS
November 2, 2012
Texas Occupational Therapy Association
Mountain Central Conference
Short Course Objectives
At the end of this presentation, the participant should be
able to:
• Describe the role of occupational therapy in reading and
writing intervention.
• Describe the possible application of the Occupation of
Reading Practice Model in the intervention of reading
difficulties in clinical and school settings.
• Cite evidence-based strategies for handwriting
intervention with reading.
Reading and Writing Connections
• LANGUAGE by
• ear – listening
• mouth – speaking
• eye – reading
• hand – writing
• Language
• No organ of it’s own, teams up with the sensory and motor
systems.
• Draws on common and unique brain processes to achieve
different goals.
• Are separable skills.
• Skill in one mode does not necessarily mean skill in
another
• Each has its own developmental trajectory
• Each interacts with other language systems to some
degree at different stages of that development
LANGUAGE BY HAND
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Crayons leave marks!
Scribbles
Imitate strokes
Begin making shapes
Infants and Toddlers
Integration of perceptual and motor skills
Name alphabet letters
Connecting dots
Beginning alphabet forms
Preschoolers
Coordinating language (naming letters) with act of writing
Accurate alphabet copy
Knows letter names
Writes dictated letters
Writes alphabet from memory
First grade
Integration of language by eye - orthographic codes (letter forms),
language by ear - phonological codes (letter names), language by hand - graphomotor codes (output)
Language by Eye and Hand
• Does reading drive writing?
• Does writing drive reading?
• What are the relationships between the two?
Berninger, V. W., Abbott, R., Abbot, S. P., Graham, S. & Richards, T. (2002).
Writing and reading: Connections between language by hand and
language by eye. Journal of Learning Disabilities, 35 (1), 39-56.
Examining prediction models
• 600 typically developing children
• Half girls half boys
• Grades 1-6
• Measures of:
• Handwriting – print alphabet from memory, copy text
• Spelling
• Word recognition
• Composition (essays) scored for spelling, length, quality
At the level of the WORD
• Does word recognition predict
handwriting and spelling?
At the level of the WORD
• Does handwriting and spelling predict
word recognition?
At the level of the WORD
• SO, the paths from word recognition
to handwriting are stronger than those
from handwriting to word recognition.
At the level of the TEXT
• Does reading ability predict writing ability?
• Specifically, does reading comprehension
predict spelling, length, and quality of
composition?
At the level of the TEXT
• Does reading ability predict writing ability?
• Specifically, does reading comprehension
predict spelling, length, and quality of
composition?
At the level of the TEXT
• Does writing ability predict reading ability ?
• Specifically, does spelling, length, and quality of
composition predict reading comprehension?
Language by Eye and Hand
• Writing’s influence on Reading
• Word level writing has links to word level reading
throughout elementary grades. But text level writing does
not appear to influence text level reading until upper
elementary grades.
• So working with children to write words might influence
their reading skills at all grades. But working with children
to write essays may have its strongest influence on
reading in the upper elementary years.
Language by Eye and Hand
• Reading’s influence on Writing
• Word level reading does have links to word level writing
throughout the elementary grades. And text level reading
does have links to text level writing.
• So working with children to read will influence their writing
skills at all levels.
Course Outline
• How is reading and writing addressed by OTs?
1. Reading Difficulties
• What is a reading difficulty?
• Why is reading difficulty an OT concern?
• How can reading difficulties addressed by OTs
2. Handwriting Instruction
• How can handwriting instruction be incorporated into a literacy
curriculum?
• How can OT apply evidence-based strategies for handwriting?
• Why should Pre-K children receive handwriting instruction?
Audience Survey
• Who among you work with children with handwriting
difficulties?
• Who among you work with children with reading
difficulties?
• Who among you work with children formally diagnosed
with dyslexia?
• Who among you work with children with dyslexia with
handwriting difficulties?
Reading and Writing Intervention
• Reading and writing are components of literacy that help
fulfill student and various life roles.
• Reading is addressed from a skills-based approach by
reading interventionists, SLPs and special education
teachers.
• Handwriting is addressed from a mechanical and sensory-
based approach separate from reading.
• What is the role of an OT in addressing literacy skills?
Dyslexia and Reading Difficulties
• Dyslexia is characterized by an unexpected difficulty in
children and adults who otherwise possess the
intelligence, motivation, and schooling considered
necessary for accurate and fluent reading (Shaywitz et al.,
2001).
• Typical intervention focuses on phonological processing
and fluency.
• 30% of children with dyslexia do not have expected
phonological deficits or do not respond to phonologybased remediation (Laycock & Crewther, 2008; Ramus,
2003; Wolf, 1999; Wright & Conlon, 2009).
The Case of Matt
Matt is an 8 year-old, male, client diagnosed with
Developmental Dyslexia (DD). He was referred for private
OT for sensory processing challenges that affect reading
performance and handwriting. The DD diagnosis was first
made by the school district. He currently receives reading
intervention at school but no OT services.
The Occupation of Reading
• A practice model currently being developed by Grajo,
Candler and Schultz of Texas Woman’s University through
a Reading Research Lab at Saint Louis University.
• Reframes reading as a meaningful activity to fulfill student
and various life roles.
• Guided by the Theory of Occupational Adaptation
(Schkade & Schultz, 1992).
Premise of the Model
• Contexts of performance contribute to challenges that
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facilitate or hinder successful performance (demand for
mastery).
Sensorimotor, Cognitive and Psychosocial systems of the
person are involved.
Children with reading difficulties avoid and dislike
structured reading tasks.
Anxiety overrides successful performance.
Avoidance leads to inability to transfer learned reading
skills.
Matt’s Occupational Profile
• Developmental Reading Assessment (DRA) level at that time
was 4 standard points below expected development. His
handwriting was very slow, poorly aligned, and letters poorly
formed. He had difficulty absorbing materials from class
because of increased anxiety.
• Matt was directly referred to this occupational therapist by a
child neurologist for dyslexia and dysgraphia management.
• During the interview, parents indicated that Matt dislikes going
to school. They mentioned that the school environment was
stressful for him, but they like the school district because of its
excellent teaching and service provision for children with
various challenges. They mentioned that they would read to
Matt when he was younger but that he never initiated the
activity and never seemed to demonstrate enjoyment when
doing so. He prefers video games and rough gross motor play.
The Role of the OT
• Enabler of the occupational environment.
• Facilitates an internal adaptive mechanism that leads to
self-mastery and feeling of competence.
• Support skills-based approach by the Reading
Intervention Team.
Assessments
• Multi-contextual
• Move from performance skills to performance areas –
Top-down approach
• The emphasis is NOT on reading skills but participation
and engagement in meaningful reading tasks.
• How do you feel about reading vs How well do you read
Matt’s IE
Initial interview with Matt and his mother using the Canadian
Occupational Performance Measure reveal that he wants to be
able to read and write without much difficulties, stress and
embarrassment from peers in the class. This was rated with
utmost importance (10). He currently rates his performance in
reading as a 3, parents gave him a 4; and his writing
performance a 6, parents gave him a score of 4. Satisfaction
with this level of performance was low (Reading - 3 from patient,
4 from parent; Writing - 4 from patient, 3 from parent). He wants
to be comfortable in his second grade classroom environment.
This means that he wants to be able to participate in reading
tasks successfully and efficiently, finish written tasks on time and
copy from the board without much difficulty.
Matt’s IE
• The therapist used the Dynamic Performance Analysis framework to
identify sources of performance breakdown during reading and writing
tasks.
• Matt was asked to read a 3 simple sentence passage, second grade
level, posted on the board.
• His face immediately showed signs of anxiety. He struggled with
several words that could not be easily decoded, persisted on
attempting to decode the words, paused for a long time and would
lose his mark (next word or next line) with the text. He would show a
lot of facial grimacing, knee and ankle shaking, would tap the table
lightly when he encounters a challenging word.
• He stopped midway through the 2nd sentence and said it’s too hard
(hyperstable behavior). He was then asked to copy this passage on a
ruled pad. He immediately asked “That’s too many. Can I just do 1
sentence instead?” Mom signaled that this is his usual reaction to
writing tasks - avoiding (existing response mode).
Entry-Point of Intervention
• Through the psychosocial system.
• Providing opportunities for success and feelings of
competence in the student role.
Proposed Phases of Intervention
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Occupational Readiness Training
Introducing chunks of reading and writing
Strategy Development
Strategy applications with increasing amounts of
reading and writing
Participation in highly-structured reading and writing
tasks
I. Occupational Readiness
• Shortest phase of intervention
• Performance components
• Visual Processing, Visual Motor, Sensory Processing,
Executive Functions
• Handwriting
Matt’s Occupational Readiness Training
• Typing Tutorial and Visual Processing training using iPad
games and online activities.
• Handwriting training for correct letter formation.
II. Chunks of Reading and Writing
• Embedded in preferred tasks
• Coupling of less-preferred with much-preferred tasks
• Clues in treasure hunt game
• Word/phrase station in obstacle course tasks
• Read a key ingredient in a recipe during cooking
• Fish for words while on a swing
• The key is to shunt the “primary energy” from stressful
reading tasks to “secondary energy” using fun activities.
Strategy Development
• Cognitive Orientation to Daily Occupations approach
(Polatajko & Mandich, 2004).
• Self-initiated, individualized strategies based on sources
of performance breakdown.
• Where is the source of performance breakdown?
• What does the child need to be able to do?
• How can the child do it?
• How can I enable the child to do it?
CO-OP: Global Strategies
• Global Strategy: GOAL – PLAN – DO – CHECK
• GOAL – What do I want to do?
• PLAN – How am I going to do it?
• DO – Do it.
• CHECK – Did I do my plan, Did it work?
• Guided Discovery – Ask, Don’t Teach!
(Polatajko & Mandich, 2004)
Matt’s Goal-Plan-Do-Check
T: So Matt, what is your goal?
M: I will read the clue for the treasure hunt without
mistakes.
T: What is the plan?
M: I will cross the balance beam, pick up the clue. Scan the
line, follow it with my fingers, and read the words slowly.
T: Alright, let’s do it.
M: Jump three times and c-c—call under the s—stall to get
the next clue.
T: Let’s check that line….
CO-OP: Domain Specific Strategies
Verbal Guidance:
• Body Position
• Attention to task
• Task Specification/Modification
• Supplementing Task Knowledge
• Feeling the Movement
• Verbal Motor Mnemonic
• Verbal Rote Script
Matt using Specific Strategies
T: Matt, you said “Jump three times and call under the stall…”
There were 2 words that were incorrect. What did you say
you could do when you are not sure of a word?
M: Cover the word with my finger, slowly show the letters and
make the sounds.
T: Okay let’s try that again. What do you think is your goal?
M: Read the clue without mistakes.
T: What will be your plan?
M: Read the clue slowly, cover the words I am unsure with my
finger and make out the sounds.
T: Let’s do it!
M: Jump three times and c-cr-awwwww-craw---crawwww-l, crawl
under the s-t---oooooo-st---stoooo-l, stool to get the next clue.
T: You got it!
Strategy Applications
• Practice using strategies
• Increasing amounts of reading
• Key is feeling of competence
• Feedback and monitoring systems: audio-recording
Sample Strategies for Handwriting
Participation in highly-structured tasks
• As self-mastery and competence increases, increase the
amount of structure to tasks.
• The goal is to simulate actual reading tasks in various
forms.
• Create self-monitoring aids: level of anxiety, time logs,
variety
Signs of Increasing Adaptiveness
• Child recognizes mistakes.
• Child remembers strategies.
• Child creates additional strategies.
• Child begins self-correction.
Evidence-Based Strategies for
Handwriting
• Video Modeling with Handwriting at a Montessori
Preschool: A Quasi-Experimental Study Using The TV
Teacher
• Purpose: Is VBM an effective way to teach handwriting?
• Intervention: The TV Teacher DVD
• Effects on legibility, sequencing, and phonics
Occupation-Based Approach
• Montessori method (Montessori, 1967a, 1967b)
• Self-discovery approach
• Facilitation rather than direct instruction
Montessori Handwriting Instruction
• Indirect Preparation
• Practical life activities
• Direct Preparation
• Metal insets
• Sandpaper letters
• Moveable alphabet
Phonics Program
• Readiness
• Beginning Phonics
• Phonics Boxes
Readiness
Letter matching task
Sandpaper letters
Moveable alphabet
Beginning Phonics
Letter matching matrix
Sorting Sticks
Sandpaper letters
Beginning sound matching
Phonics Boxes
• 75 color-coded boxes
• Progress in difficulty
Video Based Modeling (VBM)
• Definition (Mason, Ganz, Parker, Burke, & Camargo, 2012)
• 3 Variations
• Video modeling with other
• Video self-modeling
• Point-of-view video modeling
VBM Continued
• Evidence-based intervention (Bellini & Akullian, 2007; Delano,
2007; Mason et al., 2012)
• Advantages
• Educational television
• VBM for handwriting instruction
• The TV Teacher (2011)
• Steps4Kids (2012)
• Pencil Pete (2012)
The TV Teacher
• The TV Teacher’s Alphabet Beats: Lowercase DVD
• Video modeling with other and point-of-view modeling
• Targeted skill of handwriting
• Children with typical or atypical development from 3-5 yrs old
• 5 minute chapters for each letter of the alphabet
• A model demonstrates lowercase block letter sequencing
• Auditory instruction on letter formation
• Principles of phonics and vocabulary words introduced
(The TV Teacher, 2011)
• Video Clip
Method
• Pre-test data collected
• Post-test data collected 15 weeks later
• Students in one classroom had access to The TV Teacher
DVD
• DVD requested during daily 90-minute work time
Results
• Students were interested in watching The TV Teacher
intervention
• 584 total viewings
• 17 average viewings per student (range of 7-25)
• Viewed on 50 of the 76 school days during intervention
• Mean differences for pre-test and post-test data
Results Continued
• Sequencing, legibility, and
phonics levels increased
for both classrooms.
• The group of students who
viewed The TV Teacher
had higher legibility scores.
Application
• Where can this intervention be used?
• How can this tool be implemented?
• Who can benefit from this strategy?
References
Bellini, S. & Akullian J.(2007). A meta-analysis of video modeling and video self-modeling
interventions for children and adolescents with autism spectrum disorders. Council for
Exceptional Children, 73, 264-287.
Laycock, R., & Crewther, S. G. (2008). Towards an understanding of the role of the
‘magnocellular advantage’ in fluent reading. Neuroscience & Biobehavioral Reviews,
32(8), 1494-1506. doi:10.1016/j.neubiorev.2008.06.002
Mason, R. A., Ganz, J. B., Parker, R. I., Burke, M. D., & Camargo, S. P. (2012). Moderating
factors of videomodeling with other as model: A meta-analysis of single case
studies. Research in Developmental Disabilities, 33, 1076-1086.
Montessori, M. (1967a). The Montessori method. New York: Schoken.
Montessori, M. (1967b). The discovery of the child. Notre Dame, IN: Fides.
Pencil Pete. (2012). Pencil Pete’s Educational Software and Worksheets. Retrieved from:
http://www.jjmdesigns.com/
Polatajko, H. & Mandich, A. (2004). Enabling occupation in children: The Cognitive Orientation
to daily Occupational Performance (Co-Op) approach. Ottawa, Ontario: CAOT
Publications ACE.
Ramus, F. (2003). Developmental dyslexia: Specific phonological deficit or general
sensorimotor dysfunction? Current Opinion in Neurobiology, 13(2), 212-218. doi:
10.1016/S0959-4388(03)00035-7
References
Schkade, J. K. & Schultz, S. (1992). Occupational adaptation: Toward a holistic approach to
contemporary practice, Part 1. American Journal of Occupational Therapy, 46, 829-837.
Schultz, S., & Schkade, J. K. (1993). Occupational adaptation: Toward a holistic approach to
contemporary practice, Part 2. American Journal of Occupational Therapy, 46, 917-926.
Schkade, J. K., & McClung, M. (2001). Occupational adaptation in practice: Concepts and cases.
Thorofare, NJ: Slack.
Shaywitz, B. A., Shaywitz, S. E., Pugh, K. R., Fulbright, R. K., Mencl, W. E., Constable, R. T., . . .
Gore, J. C. (2001). The neurobiology of dyslexia. Clinical Neuroscience Research, 1(4), 291299. doi:10.1016/S1566-2772(01)00015-9
Steps4Kids. (2012). Steps4Kids ABCs: traditional printing. Retrieved from:
http://www.steps4kids.com
The TV Teacher (2011). The TV Teacher’s alphabet beats: lowercase. Retrieved from:
http://www.tvteachervideos.com/index.html
Wolf, M., & Bowers, P. G. (1999). The double-deficit hypothesis for the developmental dyslexias.
Journal of Educational Psychology, 91(3), 415.
Wright, C. M., & Conlon, E. G. (2009). Auditory and visual processing in children with dyslexia.
Developmental Neuropsychology, 34(3), 330-355. doi:10.1080/87565640902801882
At the level of the WORD
• Does word recognition predict
handwriting and spelling?
• YES. Having good word recognition has an influence
beyond a simple relationship with better handwriting and
spelling performance
• Working with children on recognizing words should help
them with their handwriting and spelling.
At the level of the WORD
• Does handwriting and spelling predict
word recognition?
• SPELLING does. Having good spelling has an influence
beyond a simple relationship with better word recognition
performance.
• Handwriting doesn’t. Having good handwriting has less
influence with better word recognition performance.
At the level of the WORD
• SO, the paths from word recognition
to handwriting are stronger than those
from handwriting to word recognition.
If you want the child to do better in handwriting, incorporate
word recognition.
If you want your kid to do better in word recognition, better
handwriting is not the way to go. Spelling will work better.
At the level of the TEXT
• Does reading ability predict writing ability?
• Specifically, does reading comprehension
predict spelling, length, and quality of
composition?
• Reading comprehension does predict spelling in text. Better
reading comprehension meant better spelling in essays.
• Reading comprehension does predict quality of composition.
Better reading means more in depth ideas shared in essays.
• Reading comprehension was a little less predictive of length of
composition. Being able to read better didn’t necessarily mean
kids would write more.
At the level of the TEXT
• Does reading ability predict writing ability?
• Specifically, does reading comprehension
predict spelling, length, and quality of
composition?
• Reading comprehension does predict spelling in text. Better
reading comprehension meant better spelling in essays.
• Reading comprehension does predict quality of composition.
Better reading means more in depth ideas shared in essays.
• Reading comprehension was a little less predictive of length of
composition. Being able to read better didn’t necessarily mean
kids would write more.
At the level of the TEXT
• Does writing ability predict reading ability ?
• Specifically, does spelling, length, and quality of
composition predict reading comprehension?
• Spelling does. Spelling has an influence beyond a simple relationship
on reading comprehension throughout elementary grades. Working on
spelling at most grade levels may positively influence reading skills.
• But length and quality of composition only predicts reading
comprehension levels in the upper grades (4-6). Text level writing does
not appear to influence text level reading until upper elementary grades.
So working with 1-3rd graders to compose essays may not have a
strong an influence on their ability to read, but working with 4-6th
graders to compose well may have a positive influence their reading.