WritingWriting

Isabelle RapinIsabelle Rapin

Seminar on developmental disabilitiesSeminar on developmental disabilities

December 14, 2012December 14, 2012 No conflict of interestNo conflict of interest

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Quick Review:Quick Review:

Dysphasia and DyslexiaDysphasia and Dyslexia

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Oral & Written LanguageOral & Written Language

Oral languageOral language • develops gradually without specific develops gradually without specific

instructioninstruction• provided adequate exposure to its provided adequate exposure to its

conversational useconversational use Reading written languageReading written language

• grafted on oral language grafted on oral language • requires specific instructionrequires specific instruction

Producing written languageProducing written language • grafted on readinggrafted on reading• + requires fine motor skill+ requires fine motor skill

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One-way path in language One-way path in language processingprocessing

InputInput OutputOutput

(sensory)(sensory) (motor)(motor)

DecodingDecoding Higher order Higher order EncodingEncoding

processingprocessing

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Levels of language encodingLevels of language encoding

1.1. Phonology Phonology (articulation/intelligibility, (articulation/intelligibility, prosody)prosody)

2.2. Grammar/syntaxGrammar/syntax

3.3. Semantics: word/sentenceSemantics: word/sentence

4.4. Pragmatics: verbal/nonverbal Pragmatics: verbal/nonverbal

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Language areas in the left Language areas in the left hemispherehemisphere

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Required mechanisms for Required mechanisms for readingreading

Auditory processingAuditory processing Phonological awareness Phonological awareness (phoneme/letter relation, (phoneme/letter relation,

word segmentation)word segmentation)

Phonological decoding Phonological decoding (regular non-words)(regular non-words) Orthographic coding Orthographic coding (irregularly spelled words, (irregularly spelled words,

homonyms)homonyms) Single word reading Single word reading (accuracy, speed)(accuracy, speed) Spelling ability Spelling ability (real words, non-words, irregular words)(real words, non-words, irregular words)

Spika et al., Behav. Genet., Spika et al., Behav. Genet., 20112011

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Phonological levelPhonological level

Phoneme = smallest linguistic sound unit Phoneme = smallest linguistic sound unit in any particular languagein any particular language

Syllable = co-articulated phonemes Syllable = co-articulated phonemes processed as units (chunks)processed as units (chunks)

Lexicons (i.e., dictionaries) in our brainsLexicons (i.e., dictionaries) in our brains• PhonologicPhonologic

AuditoryAuditory Visual (letters, ideograms [complex=syllabic])Visual (letters, ideograms [complex=syllabic])

• Word meanings (semantics)Word meanings (semantics)• Word relations (grammar)Word relations (grammar)

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Phonologic/reading Phonologic/reading developmentdevelopment

> birth:> birth: can make all potential speech-sound can make all potential speech-sound discriminations discriminations

> ~ 1 year:> ~ 1 year: chunk words into whole expressionschunk words into whole expressions > ~ 2 years:> ~ 2 years: begin to segment single wordsbegin to segment single words 3-5 years:3-5 years: progressive awareness of phonemes, e.g., rhymes, progressive awareness of phonemes, e.g., rhymes,

initial consonant sounds, syllables, phonetic sequences, initial consonant sounds, syllables, phonetic sequences, cadencescadences

kindergarten:kindergarten: starting awareness of letter-sound mappingstarting awareness of letter-sound mapping 11stst grade: grade: read/spell mostly regular wordsread/spell mostly regular words 2-3 grades:2-3 grades: ↑↑ fluency, learn irregular words, fluency, learn irregular words, ↑ ↑ vocabulary, vocabulary,

beginbegin to read for meaning to read for meaning > ~ 3> ~ 3rdrd grade: grade: fluent reading by-passes phonologic decoding, fluent reading by-passes phonologic decoding,

goes goes directly to lexicon (word dictionary)directly to lexicon (word dictionary)

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Progressive reading Progressive reading competencecompetence

Word recognition (phonology)Word recognition (phonology)• Phonetically consistent (words/nonwords)Phonetically consistent (words/nonwords)• Phonetically inconsistent (e.g., yacht, blood)Phonetically inconsistent (e.g., yacht, blood)

Reading fluency (direct access to Reading fluency (direct access to lexicon)lexicon)

ComprehensionComprehension• At the word level (vocabulary)At the word level (vocabulary)• At the sentence level (+ grammar)At the sentence level (+ grammar)• At the idea level (reading now automatic) At the idea level (reading now automatic)

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Cortical activation during readingCortical activation during reading

Shaywitz et al. 2008

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Brain basis of most prevalentBrain basis of most prevalentdyslexiadyslexia

Underactivity of posterior brain regionsUnderactivity of posterior brain regions Overactivity of interior frontal cortex Overactivity of interior frontal cortex

concerned with speech articulationconcerned with speech articulation Remediation improves but does not “cure” Remediation improves but does not “cure”

dyslexiadyslexia• Tend to read slowlyTend to read slowly• Fluency improves but difficulty reading non-Fluency improves but difficulty reading non-

words persistswords persists• Poor spelling, etc. very likely Poor spelling, etc. very likely

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WRITINGWRITING

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Writing deficitsWriting deficits

Writing: hierarchically related to readingWriting: hierarchically related to reading Dysorthographia (poor spelling): the telling Dysorthographia (poor spelling): the telling

sign of compensated dyslexiasign of compensated dyslexia Spelling and writing: related to speech Spelling and writing: related to speech

articulation articulation • all 3 outputs involve translating inner language all 3 outputs involve translating inner language

into sound-based fine motor commandsinto sound-based fine motor commands• Speech requires continuous feedback monitoring Speech requires continuous feedback monitoring

of the accuracy of production (phonological loop)of the accuracy of production (phonological loop)

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Modes of language outputModes of language output

1. gestures 1. gestures 2. speech articulation2. speech articulation 3. writing3. writing

handwritinghandwriting spellingspelling

4. Sign, other symbolic codes4. Sign, other symbolic codes

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What is writing?What is writing?

““Transcription is a basic cognitive Transcription is a basic cognitive process … that enables the writer to process … that enables the writer to translate internal language into external translate internal language into external written symbols to express ideas in written symbols to express ideas in written language. … Transcription written language. … Transcription ability draws on handwriting and ability draws on handwriting and spelling.”spelling.”

Berninger et al . 2009Berninger et al . 2009

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Language outputsLanguage outputs

All are All are motormotor Skilled speakers, readers, & writers Skilled speakers, readers, & writers programprogram

motor commands to express retrieved motor commands to express retrieved chunks of inner language from the lexicon chunks of inner language from the lexicon

ExecuteExecute commands ‘on line’ commands ‘on line’ in parallelin parallel with with• retrieval of retrieval of nextnext language chunk to be expressed language chunk to be expressed• and programming of the commands for its and programming of the commands for its

productionproduction Requires a high degree of over-learning and Requires a high degree of over-learning and

automationautomation

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Relation of reading & writing to Relation of reading & writing to speech articulationspeech articulation

Children learning to read regularly Children learning to read regularly articulate articulate sotto vocesotto voce what they are decipheringwhat they are deciphering

They do as well when writingThey do as well when writing Fades as reading/writing become automatizedFades as reading/writing become automatized Many compensated dyslexics continue silent Many compensated dyslexics continue silent

articulation when reading and writingarticulation when reading and writing

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VAA: Writing vs. copyingVAA: Writing vs. copying

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Development of speech Development of speech awarenessawareness

1. At birth: ability to make any auditory 1. At birth: ability to make any auditory discrimination adopted by any language discrimination adopted by any language

2. Discriminate the stream of speech from 2. Discriminate the stream of speech from other environmental soundsother environmental sounds

2. Segment word-chunks from the stream2. Segment word-chunks from the stream 3. Segment syllables in phrases & words3. Segment syllables in phrases & words 4. Segment individual phonemes 4. Segment individual phonemes

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Auditory Processing for Auditory Processing for ReadingReading

Identifying/segmenting individual wordsIdentifying/segmenting individual words Steps toward identifying individual Steps toward identifying individual

phonemes/syllables, e.g.,phonemes/syllables, e.g.,• First phonemes/syllablesFirst phonemes/syllables• Phonemic gamesPhonemic games• RhymesRhymes

Reciting the alphabetReciting the alphabet Learning letter namesLearning letter names Relating letter names to phonemes Relating letter names to phonemes

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Prerequisites for Prerequisites for reading/writingreading/writing

Syllabication, then individual phonemesSyllabication, then individual phonemes Relate letter names/shapes to perceived Relate letter names/shapes to perceived

and produced speech and produced speech Learn to point to, tap on keyboard, Learn to point to, tap on keyboard,

reproduce reproduce

(write) letters on the basis of letter names (write) letters on the basis of letter names

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WritingWriting Orthography (letter/syllable spelling)Orthography (letter/syllable spelling)

• essential basis for learning to read and essential basis for learning to read and writewrite

Whole word knowledgeWhole word knowledge• essential for fluent reading/writingessential for fluent reading/writing

Speaking/writingSpeaking/writing• translation of inner language into motor translation of inner language into motor

commands for commands for speech articulationspeech articulation writing letters. keyboardingwriting letters. keyboarding

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Writing EngagesWriting Engages Multilevel Processes Multilevel Processes

integration of vision + auditionintegration of vision + audition phonologic discriminationphonologic discrimination several memory processesseveral memory processes attentionattention acquisition of specific fine motor skills acquisition of specific fine motor skills

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Memory requirementsMemory requirements

Short term sequential memory for Short term sequential memory for spoken/read phonemes, words, phrasesspoken/read phonemes, words, phrases

Working memory: needed to Working memory: needed to • retrieve needed material from long term retrieve needed material from long term

storagestorage• compare new input with stored materialcompare new input with stored material• evaluate on-line significance of inputevaluate on-line significance of input• prepare commands for motor outputprepare commands for motor output• Monitor outputMonitor output

Store outputStore output

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Visual perceptionVisual perception

Letter shapesLetter shapes• RoundedRounded• Angular Angular

Right/left orientationRight/left orientation Up/down awarenessUp/down awareness SizingSizing Spacing Spacing

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Auditory/visual integrationAuditory/visual integration

In response to letter names:In response to letter names:• identifying corresponding printed capsidentifying corresponding printed caps• identifying printed lower case lettersidentifying printed lower case letters• identifying cursive lettersidentifying cursive letters• eventually identifying unusual eventually identifying unusual

scripts/fonts scripts/fonts

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Letter reversalsLetter reversals

ExamplesExamples: p/q, b/d, d/p, b/q, m/w, backward f, : p/q, b/d, d/p, b/q, m/w, backward f, s, z, etc.s, z, etc.

Most in lower case printMost in lower case print Normal in preschoolers and Normal in preschoolers and up to ~ 3up to ~ 3rdrd grade grade Not predictiveNot predictive of either dyslexia or of either dyslexia or

dysgraphia dysgraphia Not due toNot due to defective visual perception defective visual perception If persistent consider If persistent consider

• inefficient working memoryinefficient working memory• Spatial, R/L confusion (incl. Gerstmann syndrome)Spatial, R/L confusion (incl. Gerstmann syndrome)

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DysgraphiaDysgraphia

Classic motor deficitClassic motor deficit Deficit in rapid fine motor control Deficit in rapid fine motor control

(timed) (timed) Deficient procedural memory Deficient procedural memory

inadequate learning of motor inadequate learning of motor sequencessequences

Inattention (ADHD)Inattention (ADHD) Lack of motivationLack of motivation

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MacrographiaMacrographia

• Frequent in ASD (e.g., DeLong, Mostofsky)Frequent in ASD (e.g., DeLong, Mostofsky)• Also frequent in ADHD (also inconsistent Also frequent in ADHD (also inconsistent

size size

and legibility) and legibility)

MicrographiaMicrographia• Frequent in OCDFrequent in OCD

• Sometimes in Asperger-type ASDSometimes in Asperger-type ASD