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