Why Do Children Struggle with Why Do Children Struggle with Reading? Do They Have Reading? Do They Have

Dyslexia?Dyslexia?

Eileen C. Vautravers, M.D. Eileen C. Vautravers, M.D. www.ne-da.org

402-434-6434402-434-6434

Remember This:Remember This:

If you look for dyslexia in your students, If you look for dyslexia in your students,

you will find it!you will find it!

Outline of PresentationOutline of Presentation

1.1. Facts about readingFacts about reading

2.2. Dyslexia definition and geneticsDyslexia definition and genetics

3.3. Common signs of risk for dyslexiaCommon signs of risk for dyslexia

4.4. Neurobiology of dyslexiaNeurobiology of dyslexia

5.5. Brain rewiring by evidence-based Brain rewiring by evidence-based phonologic reading instructionphonologic reading instruction

6.6. TreatmentTreatment

U.S. Facts about ReadingU.S. Facts about Reading

1.1. 95% of all children can learn to read.95% of all children can learn to read.

2.2. 20% of elementary children struggle 20% of elementary children struggle with learning to read.with learning to read.

3.3. 20% of elementary children do not 20% of elementary children do not read fluently enough to enjoy or read fluently enough to enjoy or engage in independent reading.engage in independent reading.

U.S. Facts about Reading U.S. Facts about Reading

4.4. Reading failure occurs in 60%-70% Reading failure occurs in 60%-70% of African-American, Hispanic, ESL of African-American, Hispanic, ESL and poor children.and poor children.

5.5. 85% of youth in juvenile justice 85% of youth in juvenile justice system are functionally illiterate.system are functionally illiterate.

6.6. One-third of poor readers live in One-third of poor readers live in college-educated families.college-educated families.

U.S. Facts about ReadingU.S. Facts about Reading

7.7. According to American Federation of According to American Federation of Teachers, some children never learn to Teachers, some children never learn to read unless taught in an organized, read unless taught in an organized, systematic, efficient way using a well-systematic, efficient way using a well-designed instructional approach by a designed instructional approach by a knowledgeable teacher. knowledgeable teacher.

8.8. 25% of adults lack basic literacy skills 25% of adults lack basic literacy skills required in a typical job.required in a typical job.

DyslexiaDyslexia

1.1. Difficulty with reading wordsDifficulty with reading words

2.2. Receptive language-based learning Receptive language-based learning disability (LD)disability (LD)

3.3. Difficulty with phonological (sound) Difficulty with phonological (sound) part of languagepart of language

4.4. Manifests as difficulty with reading, Manifests as difficulty with reading, writing, spelling, comprehension writing, spelling, comprehension and/or fluencyand/or fluency

Dyslexia (Cont)Dyslexia (Cont)

5.5. 20% of children have LD20% of children have LD

6.6. 80% of LD are dyslexia80% of LD are dyslexia

7.7. Most common specific LD: 16% -Most common specific LD: 16% -20%20%

8.8. ““Dyslexia Spectrum Disorder”Dyslexia Spectrum Disorder”

9.9. # males slightly > # females# males slightly > # females

10.10.Children do Children do notnot outgrow it outgrow it

IDA DefinitionIDA Definition

Dyslexia is:Dyslexia is:

A specific learning disability that is A specific learning disability that is neurologic in origin.neurologic in origin.

It is characterized by difficulties with It is characterized by difficulties with accurate and/or fluent word accurate and/or fluent word recognition, and by poor spelling and recognition, and by poor spelling and decoding abilities.decoding abilities.

IDA Definition (Cont)IDA Definition (Cont)

These difficulties typically result from a These difficulties typically result from a deficit in the phonological component of deficit in the phonological component of language, often unexpected in relation language, often unexpected in relation to other cognitive abilities, and the to other cognitive abilities, and the provision of effective classroom provision of effective classroom instruction.instruction.

IDA Definition (Cont)IDA Definition (Cont)

Secondary consequences may include Secondary consequences may include problems in reading comprehension problems in reading comprehension and reduced reading experience that and reduced reading experience that can impede the growth of vocabulary can impede the growth of vocabulary and background knowledge.and background knowledge.

November 12, 2002November 12, 2002

Types and CausesTypes and Causes

1. 1. Secondary dyslexia – lack of Secondary dyslexia – lack of activation of normal brain wiring for activation of normal brain wiring for readingreading

a. Environmental deprivationa. Environmental deprivation

b. Poor school reading instructionb. Poor school reading instruction

Types and Causes (Cont)Types and Causes (Cont)

2.2. Primary dyslexia – absence of brain Primary dyslexia – absence of brain wiring to left hemisphere posterior wiring to left hemisphere posterior reading systems reading systems a. Genetically programmed error in a. Genetically programmed error in wiringwiringb. 40% chance a sibling, parent, child of b. 40% chance a sibling, parent, child of

affected person will have dyslexia affected person will have dyslexiac. 5%-6% chance child will have dyslexia c. 5%-6% chance child will have dyslexia

if parent/siblings don’t if parent/siblings don’t

At-Risk Signs of Dyslexia At-Risk Signs of Dyslexia in Preschoolersin Preschoolers

Predictive relationship between Predictive relationship between preschool language developmental preschool language developmental delays and delays in emergent literacy delays and delays in emergent literacy skills with later having a reading skills with later having a reading disabilitydisability

At-RiskAt-Risk Signs of Dyslexia Signs of Dyslexia in Preschoolers (Cont)in Preschoolers (Cont)

1.1. Late learning to talkLate learning to talk

2.2. Difficulty with speech intelligibilityDifficulty with speech intelligibility

3.3. Frequent ear infectionsFrequent ear infections

4.4. Difficulty learning nursery rhymes and Difficulty learning nursery rhymes and songssongs

5.5. Difficulty sequencing, as in counting, Difficulty sequencing, as in counting, alphabet, days of week, months of alphabet, days of week, months of yearyear

At-Risk Signs of Dyslexia At-Risk Signs of Dyslexia in Preschoolers (Cont)in Preschoolers (Cont)

6.6. Confusion with concepts (before, Confusion with concepts (before, after)after)

7.7. Difficulty remembering object namesDifficulty remembering object names

8.8. Difficulty rhyming wordsDifficulty rhyming words

9.9. ReticentReticent

10.10. Less knowledge about booksLess knowledge about books

11.11. Dislike/disinterest in readingDislike/disinterest in reading

Oral Signs of Risk for DyslexiaOral Signs of Risk for Dyslexiain Early Elementaryin Early Elementary

1.1. Difficulty using age-appropriate Difficulty using age-appropriate grammargrammar

2.2. Difficulty acquiring vocabulary Difficulty acquiring vocabulary

3.3. Difficulty listening and following Difficulty listening and following directionsdirections

4.4. Substitutes sounds in words or Substitutes sounds in words or words in sentenceswords in sentences

Reading Signs of Risk for Dyslexia Reading Signs of Risk for Dyslexia in Early Elementaryin Early Elementary

1.1. Difficulty distinguishing sounds in wordsDifficulty distinguishing sounds in words

2.2. Difficulty learning sounds of lettersDifficulty learning sounds of letters

3.3. Difficulty learning and remembering Difficulty learning and remembering alphabet letter names, shapes, soundsalphabet letter names, shapes, sounds

4.4. Difficulty learning to readDifficulty learning to read

5.5. Transposes order of letters when spelling Transposes order of letters when spelling or readingor reading

Reading Signs of Risk for Dyslexia Reading Signs of Risk for Dyslexia in Early Elementary (Cont)in Early Elementary (Cont)

6.6. Misreads/omits common short wordsMisreads/omits common short words

7.7. ““Stumbles” through long wordsStumbles” through long words

8.8. Poor reading comprehensionPoor reading comprehension

9.9. Reads slowlyReads slowly

Writing Signs of Risk for DyslexiaWriting Signs of Risk for Dyslexia in Early Elementary in Early Elementary

1.1. Spelling errors in daily workSpelling errors in daily work

2.2. Difficulty proofreadingDifficulty proofreading

3.3. Difficulty putting ideas on paperDifficulty putting ideas on paper

4.4. Poor handwritingPoor handwriting

Characteristics of Children Characteristics of Children with Dyslexiawith Dyslexia

Difficulty with decoding and/or reading comprehensionDifficulty with decoding and/or reading comprehension Misshapen, laborious handwritingMisshapen, laborious handwriting Extreme spelling difficultyExtreme spelling difficulty Poor written compositionPoor written composition Difficulty in sequencing and following directionsDifficulty in sequencing and following directions Difficulty in recalling names of people, places and/or eventsDifficulty in recalling names of people, places and/or events Poor oral expressionPoor oral expression Difficulty with copying at near and/or far pointDifficulty with copying at near and/or far point Disorganization in school and at homeDisorganization in school and at home Difficulty with time and spaceDifficulty with time and space Slowness in completing tasksSlowness in completing tasks Poor performance on testsPoor performance on tests Inconsistency in performanceInconsistency in performance

Red FlagsRed Flags

1.1. Attention deficits and perceptual delays Attention deficits and perceptual delays are red flags for LDare red flags for LD

2.2. 25%-35% of ADHD have dyslexia25%-35% of ADHD have dyslexia

3.3. 15% of students with dyslexia have 15% of students with dyslexia have ADHDADHD

4.4. 10%-40% of LD have ADHD10%-40% of LD have ADHD

5.5. If either ADHD or LD exists, evaluate If either ADHD or LD exists, evaluate for the otherfor the other

Red Flags (Cont)Red Flags (Cont)

6.6. Research shows ADHD must be Research shows ADHD must be adequately treated with meds for students to adequately treated with meds for students to learn.learn.

7.7. 30%-50% of those children whose families 30%-50% of those children whose families sought professional help for emotional or sought professional help for emotional or behavioral problems had LD.behavioral problems had LD.

8.8. If receptive and expressive language are age-If receptive and expressive language are age-appropriate, but student struggles with written appropriate, but student struggles with written word (reading, spelling), think dyslexia.word (reading, spelling), think dyslexia.

AssumptionsAssumptions

1.1. Average or above intelligenceAverage or above intelligence

2.2. Adequate instructionAdequate instruction

3.3. Gifted in music, art, sports, Gifted in music, art, sports, mechanics, physics, mathmechanics, physics, math

Neurobiology of ReadingNeurobiology of Reading

1.1. Nondyslexic ReaderNondyslexic Reader

a. Left parieto-temporal – word analysis a. Left parieto-temporal – word analysis – slow; strong activation– slow; strong activation

b. Left occipito-temporal – word form b. Left occipito-temporal – word form storage, fluent reading – fast; storage, fluent reading – fast;

strong strong activation activation

c. Left Broca’s area – Inferior frontal c. Left Broca’s area – Inferior frontal gyrus – slow; lesser activation gyrus – slow; lesser activation

System for Reading System for Reading in Young Dyslexic in Young Dyslexic

Systems for ReadingSystems for Readingin Older Dyslexicin Older Dyslexic

Neurobiology of Reading (Cont)Neurobiology of Reading (Cont)

1.1. Dyslexic ReaderDyslexic Reader

a. No activation of fast left posterior a. No activation of fast left posterior reading systemsreading systems

b. Left Broca’s area, then bilateral, b. Left Broca’s area, then bilateral, with increased activation of both with increased activation of both to to overactivation by adolescence overactivation by adolescence - slow - slow

c. Gradual compensatory right brain c. Gradual compensatory right brain posterior reading system - slow posterior reading system - slow

Neurobiology of DyslexiaNeurobiology of Dyslexia

1.1. Dyslexia is caused by an Dyslexia is caused by an abnormality in the word analysis abnormality in the word analysis pathways of the brain that interferes pathways of the brain that interferes with its ability to convert written with its ability to convert written words into spoken words words into spoken words (decoding).(decoding).

2.2. Research supports this phonologic-Research supports this phonologic-coding-deficit theory of dyslexia.coding-deficit theory of dyslexia.

Brain Rewired by Evidence-Based Brain Rewired by Evidence-Based Phonologic InstructionPhonologic Instruction

1.1. Functional MRI’s on young struggling Functional MRI’s on young struggling readers – left Broca’s areareaders – left Broca’s area

2.2. One year of sequential, explicit, multi-One year of sequential, explicit, multi-sensory reading instruction (Orton-sensory reading instruction (Orton-Gillingham based)Gillingham based)

3.3. Repeat fMRI’s - emergence of left Repeat fMRI’s - emergence of left posterior, right frontal and right posterior, right frontal and right posterior reading systemsposterior reading systems

Brain Rewired by Evidence-Based Brain Rewired by Evidence-Based Phonologic Instruction (Cont)Phonologic Instruction (Cont)

4.4. Repeat fMRI’s one year after instruction Repeat fMRI’s one year after instruction ceased – right frontal and right posterior ceased – right frontal and right posterior systems much less prominent, increased left systems much less prominent, increased left posterior systems; fMRI’s essentially same as posterior systems; fMRI’s essentially same as a non-impaired readera non-impaired reader

5.5. Children had improved reading accuracy and Children had improved reading accuracy and speedspeedSource: Sally Shaywitz, Source: Sally Shaywitz, Overcoming DyslexiaOvercoming Dyslexia, Alfred A. Knopf, New York, 2003, Alfred A. Knopf, New York, 2003

6.6. Multiple studies have confirmed resultsMultiple studies have confirmed results

Brain Repair after InterventionBrain Repair after Intervention

Brain Rewired by Evidence-Based Brain Rewired by Evidence-Based Phonologic Instruction (Cont)Phonologic Instruction (Cont)

7.7. Both primary and secondary dyslexics Both primary and secondary dyslexics improve with accuracy and speed of improve with accuracy and speed of reading with appropriate instruction.reading with appropriate instruction.

8.8. Without appropriate instruction, primary Without appropriate instruction, primary dyslexics can improve accuracy, but dyslexics can improve accuracy, but remain slow. Secondary dyslexics remain slow. Secondary dyslexics remain slow and inaccurate.remain slow and inaccurate.

TreatmentTreatment

1.1. Early recognition of at-risk studentsEarly recognition of at-risk students

2.2. Systematic, structured, multi-sensory Systematic, structured, multi-sensory reading programsreading programs

3.3. Neural target for reading Neural target for reading interventionsinterventions

Window of OpportunityWindow of Opportunity

1.1. When evidence-based phonologic remedial When evidence-based phonologic remedial intervention was begun in first grade, the intervention was begun in first grade, the expected reading disability of 12% to 18% expected reading disability of 12% to 18% was reduced to 1.6% to 6%.was reduced to 1.6% to 6%.

2.2. When this intervention is delayed until third When this intervention is delayed until third grade, 74% of students continue with grade, 74% of students continue with reading difficulties through high school.reading difficulties through high school.

Take Advantage of the Window Take Advantage of the Window of Opportunityof Opportunity

Other Influences on Reading AbilityOther Influences on Reading Ability

Sleep requirementsSleep requirements1.1. 2-12 months 9-12 hrs./night + 2-4 hrs./day2-12 months 9-12 hrs./night + 2-4 hrs./day

2.2. PreschoolPreschool 11-13 hrs./night 11-13 hrs./night

3.3. School-age 10-11 hrs./nightSchool-age 10-11 hrs./night

4.4. TeensTeens 9 hrs./night 9 hrs./night

5.5. AdultsAdults 8-9 hrs./night 8-9 hrs./night

Other Influences on Reading AbilityOther Influences on Reading Ability

AllergiesAllergies1.1. Up to 40% of youth have hay feverUp to 40% of youth have hay fever2.2. Increasing children with food allergiesIncreasing children with food allergies3.3. 1/3 of children with allergies don’t sleep well1/3 of children with allergies don’t sleep well4.4. 1/4 of children with allergies wake at night1/4 of children with allergies wake at night5.5. Bothersome symptoms interfered with Bothersome symptoms interfered with

school performance in 40% of youth with school performance in 40% of youth with allergies, compared to 10% without allergiesallergies, compared to 10% without allergies

6.6. 29% drop in school performance during bad 29% drop in school performance during bad allergy seasonallergy season