Transcript Lexercise Live Broadcast November

Assessing and Differentiating Reading Disorders
Linda J. Lombardino, Ph.D.
Professor of Speech-Language Pathology
School of Special Education, School Psychology and Early Childhood Studies
[email protected]
Presentation at The Ohio State University
Department of Speech and Hearing Science
January 26, 2012
Aims of Assessing and Differentiating Reading
& Writing Disorders: Multidimensional Model
• Overview of component skills needed for skilled
reading
• Developmental Schemes for core components
• Identify core weaknesses that underlie the
struggling readers’ difficulties
• Show sample tests for core areas
• Provide diagnostic profiles with scientific support
• Recommend specific treatments for case studies
• Provide information on counseling parents
2
Part 1 –
Model/Framework
3
READING ACHIEVEMENT
Language
Knowledge
Text level
reading
Text level
writing
Word retrieval
Discourse
Syntax
Word level
reading
Word level
spelling
Grapho-phonemic Integration
“Alphabet principle”
Morphological
Knowledge
Phonological
Knowledge
Print
Knowledge
Environmental
Factors
Neurological
Factors
Vocabulary
Multidimensional Model for Assessing Reading and Writing (MARwR)
4
Skills Targeted in MARwR
[
Vocabulary
Spoken Language
Understanding of words and word meanings in both spoken and written language
Word retrieval
Accessing pronunciations of words or sound patterns stored in memory
Morphological
awareness
Understanding that morphemic units exist in words and contribute to the meaning of the word
Syntactic knowledge Understanding how to use grammatical rules and to adhere to word order, morphological
markers, and other syntactic constraints of one’s language
Discourse skills
Understanding causal connections and inferences in texts
Print awareness
Print Knowledge
Knowledge of book conventions, concept of word in print, and print mechanics
Letter knowledge
Knowledge of letter names and ability to write letters that represent letter names
Word awareness
Knowledge that words can be segmented into separate units that represent individual spoken
words
Phonological Knowledge
Awareness that the stream of speech can be broken down into smaller units
Phonological
awareness
Phonics knowledge
Invented spelling
Grapho-phonemic Integration
Mapping phonemes (sounds) onto graphemes (letters)
Knowledge that sounds are represented by letters in some consistent way and use of this
knowledge to create spellings prior to conventional instruction
5
Word-Level Reading and Spelling
Decoding
Segmenting letters in words into corresponding sounds, then blending sounds to
create real words or nonsense words
Word recognition
Recognizing familiar words in print (sight-word recognition) such that sight of
spelling patterns results in immediate word recognition
Spelling
Remembering 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 Reading
Reading comprehension
Understanding the meaning of information in print
Reading fluency
Reading words and text accurately and effortlessly
Text-Level Writing
Mechanics & conventions
Handwriting and punctuation
Composition
Planning, translating, and reviewing written text
6
Part 2Developmental Hierarchies for Core Component
7
Table 2-1. Ehri’s three-phase model of word-level
reading
•
Phase I: Pre-Alphabetic Stage of Word Reading
•
•
•
Preschool (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 context
Does 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 sign
Relies 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
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 Reading
•
•
•
•
•
•
•
•
Kindergarten (aka phonetic cue stage)
Key characteristic:
Learners recognize words by connecting letters with sounds
•
•
•
•
•
Primary Indicators:
Knows the names of most letters in the alphabet
Shows the ability to segment the initial sound in a word from the remainder of the word
Uses 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 spelling
Misreading 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
Stages of reading acquisition cont.
Phase 3: Full Alphabetic Stage of Word Reading
First-Second Grade (aka alphabetic coding stage)
Key characteristics:
 Learner can integrate knowledge of phonemic segmentation with knowledge of
letter-sound associations to decode words
 Learner 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
Figure 2-7 (fluency )
11
Figure 2-9 (reading processes for text
comprehension)
12
Figure 2-10
(writing processes for text composition)
13
Figure 2-11
(developmental scheme of reading skills for reading
achievement)
14
Part 3
Protocol of Component Strength and
Weaknesses
15
Summary Sheet for Weaknesses and Strengths
16
Part 4Diagnostic Classifications
17
Profiles/Classifications
Preschool – First Grade
18
Classifications
At Risk Classifications for PK – First Grade Children
Profile 1: Mixed Language and
Emergent Literacy Deficit




Profile 2: Emergent Literacy
Deficit




Profile 3: Environmental
Disadvantage Deficit




Mild to severely depressed language production and/or
comprehension
Difficulty in one or more phonological processes
Low normal to above average nonverbal intelligence
Absence of primary visual, auditory or motor disabilities
Normal language with or without a history of articulation difficulties
Difficulty with emergent literacy skills especially letter knowledge
and sound-letter associations
Low normal to above average nonverbal intelligence
Absence of primary visual, auditory or motor disabilities
Overall depressed pre-academic skills with or without previous
identification of a language delay or disorder
History of diminished opportunities for exposure to language and to
literacy concepts at home and/or in school
Low normal to above average nonverbal intelligence
Absence of primary visual, auditory or motor disabilities
19
Early Literacy Classifications (4-7 years)
Profile 1
Mild to moderate
mixed spoken
language & emergent
literacy deficit
Profile 2
Emergent literacy
deficit
Profile 3 *
Environmental
disadvantage deficit
_
+
-/+
Phonological
knowledge
-/+
-/+
-/+
GraphemePhoneme
knowledge
-/+
_
-/+
Spoken language
knowledge
20
Brittany
Profile 1
Severe spoken language & emergent literacy deficit
21
Amanda
Profile 1
Moderate mixed language and literacy
22
Carlos
Profile 2
Emergent literacy Deficit
23
Profiles/Classifications
First Grade & Beyond
24
Classifications for End of First Grade and Beyond
Profile Type
Profile 4: Mixed
Spoken Language characteristics

Exhibits depressed oral language
Reading and Writing Characteristics

Can exhibit relatively good word
Spoken and Written
abilities in one or more domains of
recognition and reading fluency, and
Language Disorder
language (e.g., semantic, syntax,
spelling
pragmatics), however, deficits in

Exhibits depressed reading comprehension
phonological processing

Exhibits depressed writing composition in
(awareness, memory, rapid) are
terms of story grammar and other structural
often mild and sometimes do not
elements of discourse
occur

Typically has a history of early

Morpho-syntactic and semantic errors are
often observed in written composition
language impairment

Often shows deficits in production
of oral language narratives and
other forms of oral discourse

Often shows deficits in use of
morphological and syntactic forms
25
Gail (9 years)
Profile 4
Mixed language and literacy
26
Gail (9 years)
Profile 4
Mixed language and literacy deficits
27
Profile 5:

Dyslexia

Deficits in phonological and orthographic

coding along with a lack of fluency in reading
nonwords, word reading, spelling, and
Depressed ability to remember the precise oral
reading fluency
pronunciations of words learned, particularly

when they consist of multisyllabic and
complex constructions.



Listening comprehension exceeds reading
comprehension although sometimes holding
Writing mechanics including punctuation
conventions are typically poor.

severity of the word reading deficit

Spelling is always impaired and retention
of word spelling is very difficult
Low average or above language production
and comprehension skills depending on the
Listening comprehension exceeds word
reading and reading fluency
Relatively frequent history of articulation
therapy

Depressed phonological decoding of
Morph-syntactic deficits may be apparent
in written language

Handwriting can range from good to
illegible but is typically of poor quality
lengthy oral directions in memory is difficult

Handwriting varies from good to very poor

Writing conventions, such as punctuation and
capitalization are often ignored or misused.
28
Evan (10 years)
Profile 5
Dyslexia
29
Evan (10 years)
Profile 5
Dyslexia
30
Profile 6: Reading

Comprehension
Disorder


Typically unidentified with

Word level reading, decoding
learning difficulties until 4th
and spelling are all superior to
grade and beyond.
reading comprehension
Average to strong phonological

Depressed reading
decoding and word recognition
comprehension skills,
Relatively weak language
particularly beyond a 3rd-4th grade
comprehension skills at the word
reading level
and discourse levels

Weaknesses in telling well
structured and integrated stories
orally and in writing

Variable performance on tasks of
working memory
31
Harry (14 years)
Profile 6
Reading Comprehension Deficit
32
Harry (14 years)
Profile 6
Reading Comprehension
33
Diagnostic Classifications
Profile 4: Dyslexia
Listening
comprehension
Profile 5 : Mixed Spoken Profile 6:
Language and Literacy
Comprehension Deficit
+
_
-/+
_
-/+
+
_
-/+
+
+
_
_
Language concepts
Word-level reading
Reading fluency
Reading
Comprehension
34
Examples of Treatment Recommendations
Dyslexia
Orton-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 disabilities
Touchmath program (http://www.epsbooks.com)
Ginger software (http://www.gingersoftware.com)
Mixed Spoken Language and Literacy
Language intervention that targets words meanings in the context of listening
comprehension activities
Reading intervention that targets strengthening her reading fluency and improving
knowledge of word meanings
Language Tune-Up Kit at Home Reading Software.
Quick Reads: A Research-Based Fluency Program
Touchmath program (http://www.epsbooks.com)
Comprehension Deficit
Strategies for achieving reading comprehension for narrative and expository texts
Semantic webbing strategies
Comprehension monitoring strategies
Making Connections: Explicit Instruction for Comprehension Skills and Strategies
35
In-take Forms
• Appendix 3-1. Caregiver/teacher questionnaire for preschool-early first
grade children
• Appendix 3-2. Caregiver/teacher questionnaire for school age children at
the end of 1st grade and beyond
36
Part 5
Discussing & Interpreting Diagnostic Reports
Group Activity
Interpretations
Recommendations
37
Sample #1
Student: 6 year, 4 month old female
•
At risk for language and literacy deficit
•
•
RECOMMENDATIONS
JJ should begin therapy focusing on:
– Reading for recognition and decoding
– Reading in words and sentences
– Spelling in words and sentences
– Listening comprehension using small graded paragraphs and then discussing the
content
– Accurate copying of numbers and words from a close distance and then further
away
– Math 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 Psychiatry
38
Sample #2
Student: 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
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
Sample 2 cont
Recommendations:
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 syllables
Applying this sound-symbol knowledge to spelling (encoding) and reading
(decoding)
41
Sample #3
Student: 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).
Recommendations
• The 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
Sample 3 cont.
Recommendations continued
• Enroll 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
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
Sample #4
Student: 10-year-old male
• E’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)
Recommendations
• E be enrolled in a multi-sensory phonics- and fluencybased instructional program, which provides intense
one-on-one intervention
45
Sample 4 cont
Some examples are:
• The Orton-Gillingham Method
• Barton Reading and Spelling Program
• The Wilson Reading System
• Specialized Program Individualizng Reading Excllence
(S.P.I.R.E)
• The Slingerland Multisensory Approach
• The Herman approach
• Alphabetic Phonics
• LANGUAGE!
• Lindamood-Bell
Programshttp://www.linguisystems.com/getourcatalog.php
46
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
Sample # 5
Student: 16 year, 1 month old male
• revealed 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)
Recommendations
• F 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
Sample 5 cont.
Accommodations
• F be given extra time on tasks and tests that require memory
and recall, especially in math class. Students with languagebased 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
Sample 5 cont
Accommodations cont
• 4. 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
Sample #6
Student: 20-year 8- month-old female attending
at a state university, majoring in biology, hoping
to attend medical school.
• exhibits characteristics that are consistent with a diagnosis of
Developmental Dyslexia (ICD-10-CM Code 315.02)
Recommendations
• SS 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
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
Thank You!
53