Reading DisabilitiesReading Disabilities

Thomas B. King, M. Ed.

Educational Consultant

Division of Child Neurology

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

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

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.

Historical termsHistorical terms

Word blindness (Orton)Dyslexia (Orton-Gillingham)Minimal Brain Dysfunction (MBD)Learning Disabilities (P.L. 94-142)Developmental Learning Disorders (DSM-

IV)

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

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)

One ObservationOne Observation

“I would rather have a root canal than be asked to read.”

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

What are the processing What are the processing challengeschallenges

Phonological awarenessWorking memory (esp. of phonemes)Rapid automated naming (RAN) aka Rapid

Confrontational Naming

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)

Phoneme/grapheme Phoneme/grapheme knowledgeknowledge

CAT

Phonological awarenessPhonological awareness

FOXF – O – K – S

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.

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

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

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

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

Processing testsProcessing tests

Comprehensive Test of Phonological Processing (CTOPP)– Phonological awareness– Phonological working memory– Rapid naming

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)

WJ-III (continued)WJ-III (continued)

Short term memory– Auditory working memory– Numbers reversed– Memory for words

WJ-IIIWJ-III

Rapid naming and visual scanning or processing speed– Visual matching– Cross out– Rapid picture naming

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)

Test of Phonological AwarenessTest of Phonological Awareness

Kindergarten and an early elementary versions

Tests for sound matching– Initial sounds– Ending sounds

The Phonological Awareness The Phonological Awareness TestTest

RhymingSegmentationIsolationDeletionSubstitutionNormed for ages 5-0 to 9-11

Lindamood Auditory Lindamood Auditory Conceptualization Test Conceptualization Test

Criterion referenced assessment toolFirst published in 1971Excellent tool for assessment of

phonological manipulation

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

Rapid NamingRapid Naming

If you don’t ride a bike fast enough, you will fall off.

Visual-motor integrationVisual-motor integration

Bender GestaltDevelopmental Test of Visual-motor

Integration (VMI)– Visual-motor integration– Visual processing– Motor coordination

Phonemic performancePhonemic performance

PALS – Phonological Awareness Literacy Screener

Word attack test from the WJ-IIISpelling of sounds test from the WJ-III

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)

……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.