Download - No Slide Title - Clinical Assessment
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Steven G. Feifer, D.Ed., NCSP, ABSNP [email protected]
www.schoolneuropsychpress.com
Integrating RtI with Cognitive Neuropsychology:
A Scientific Approach to Reading
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PRESENTATION OF GOALS
1. Discuss the role of school neuropsychology, within an RtI framework, as a more viable means to both assess and
remediate reading disorders in children.
2. Discuss four universal truths with respect to reading, and the relative importance of understanding literacy from a brain-behavioral standpoint.
3. Identify four subtypes of reading disorders, and tie in appropriate remediation strategies for each reading disorders’ subtype.
4. Introduce the 90 minute reading evaluation to help practitioners better assess eight core cognitive constructs associated with reading disorders in children.
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Continued Professional Development
www.schoolneuropyschpress.com
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Currently, approximately 6.7 million children receive special education services under IDEA, which
corresponds to approximately 9 percent of all children aged 3-21 in public education.
More than 20 percent of adults read at or below a fifth- grade level - far below the level needed to earn a living
wage.
More than three out of four of those on welfare, 85% of unwed mothers and 68% of those arrested are illiterate.
About three in five of America's prison inmates are illiterate.
Literacy is one of the most important educational attributes paving the road for not only school success, but
perhaps for successful life endeavors as well.
BASIC LITERACY FACTS (National Literacy Council, 2008)
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Special Education Disability Categories
(2009)
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Specific learning disabilities are endogenous in nature and are characterized by neurologically based deficits in cognitive processes.
These deficits are specific; that is, they impact particular cognitive processes that interfere with the acquisition of academic skills.
Specific learning disabilities are heterogeneous—there are various types of learning disabilities, and there is no single defining academic or cognitive
deficit or characteristic common to all types of specific
learning disabilities.
Of children identified as having specific learning disabilities, the great majority (over 80%) have a
disability in the area of reading.
NASP 2011 LD Position Statement
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• It is best practice to look at multiple sources of data, including how students respond to scientifically based instruction, including environmental and
instructional conditions. Relying upon an ability–
achievement discrepancy as the sole means of identifying children with specific learning disabilities
is at odds with scientific research and with best
practice (Gresham & Vellutino, 2010).
It is critical for school psychologists to continually upgrade their knowledge and skills and use only those methods which have research support (National
Association of School Psychologists, 2010c).
NASP 2011 LD Position Statement
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Traditional Problems with Special Education Service Delivery Model
A deliberate separation of regular education from special education.
Undocumented benefit of special education for children with high incidence disabilities.
A disconnect between testing for eligibility purposes versus testing for what
interventions work best.
A reactive model not geared toward early intervention services.
IEP’s that rarely emphasize the “I”.
Inconsistent qualification decisions since there
is no universal agreement on what
constitutes a significant discrepancy.
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1. There is no universal agreement on what the
discrepancy should be, or developmental guidelines for discrepancy expectations.
2. It remains unclear as to which IQ score should be used to establish a discrepancy.
3. A discrepancy model of learning disabilities precludes early identification and creates a “wait and fail” policy.
4. A discrepancy model of reading assumes that IQ is the best predictor of successful reading.
What is the relationship between IQ and reading?
Discrepancies only represent unexpected underachievement!!
MAIN PITFALLS OF DISCREPANCY MODEL
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(1) Universal Screening - for all students a
minimum of three times per year. (2) Baseline Data - using curriculum-based
measurement as primary data gathering means.
(3) Measurable Terms - define problem areas numerically.
(4) Accountability Plan – monitor fidelity of
selected intervention. (5) Progress Monitoring – how, where, and when
intervention results will be measured and
recorded. (6) Data Based Decision Making – ongoing analysis
of data to drive future intervention decisions.
Six Components of an Effective RTI Model
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RESPONSE TO INTERVENTION MODEL
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Curriculum-Based Measurement
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RtI strengths: allows for earlier intervention.
non-categorical. excellent for progress monitoring.
utilizes data to make decisions.
systemic deployment of interventions.
RtI weaknesses: is not sufficient to identify a learning disability
(National Joint Commission on Learning Disabilities, June 2005)
RtI is incapable of differential diagnosis and offers
little in identifying other emotional conditions or attention factors hindering learning (Reynolds, 2008).
Run the risk of delaying assessment and denying a
student eligibility for services (OSEP memo, 2010).
RtI models often promote standard protocol
interventions and assume a “one size fits all” approach to
remediation (Feifer & Della Toffalo, 2007).
Evidence based interventions require evidence based assessments!!
RtI Strengths and Limitations
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School Neuropsychological Assessment
Reports based upon a brain-behavioral paradigm which attempts to describe how a
child learns and processes information.
Focus on why the child has not been
successful in school as opposed to IQ
scores.
Less emphasis on whether or not the
student qualifies for special education
services.
Examine the cognitive and emotional strengths and weaknesses of the child and
link to specific educational strategies and
interventions.
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1. In all word languages studied to date, children with developmental reading disorders (dyslexia) primarily
have difficulties in both recognizing and manipulating
phonological units at all linguistic levels (Goswami, 2007).
The Universal Truths of Reading
Lowest Incidence: Highest Incidence:
Slovakia 1-2% China 5-8%
Italy 1-5% United States 5-10%
Czech Republic 2-3% Russia 10%
Britain 4% Israel 10%
Poland 4% Finland 10%
Belgium 5% Nigeria 11%
Greece 5% Australia 16%
Japan 6% India 20%
(Smith, Everatt, & Salter, 2004)
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The Hierarchical Structure of Phonics
ACTIVITY AGES PURPOSE BRAIN DEVELOPMENT
(1) Response to Rhymes 3 - 4 Three and four year old The myelination of the
memorize nursery rhymes auditory cortex in the
rhyming songs, and provide temporal lobes.
(2) Classifying Phonemes 4 - 5 Children can match similar Sound discriminations
sounds together and pick in right hemisphere
the sound that does not can now be classified
belong (i.e. book, look, toy) in left hemisphere.
(3)Segmenting Words 5 – 6 Five year olds capable of Cross modal associations
isolating beginning allow for visual mapping
sounds and inventive of acoustic information
spelling of words. (parietal lobes)
(4) Phoneme Segmenting 6 – 7 By 1st grade, children can Myelination of language tap out phonemes in words zones in temporal lobes.
and represent all sounds by
inventive spelling.
(5) Phoneme Deletion 6 - 8 Children can delete or add Tertiary regions of the
the sound of one word to posterior language
create another zones myelinated.
(i.e. Say the word “sting”
without the “t”)
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2. The English language is not a purely phonological language. In fact, one letter may map to as many as five distinct
phonemes or sounds. English speaking children tend to
develop phonemic processing more slowly (Goswami, 2007).
The English language includes over 1,100 ways of representing 44 sounds (phonemes) using a series of
different letter combinations (Uhry & Clark, 2005). By
contrast, in Italian there is no such ambiguity as just 33 graphemes are sufficient to represent the 25 phonemes.
Therefore, 25% of words are phonologically irregular (i.e. “debt”, “yacht”, “onion”, etc..) or have one spelling but
multiple meanings (i.e. “tear”, “bass”, “wind”, etc..)
Summary: We need to develop orthography!!
The Universal Truths of Reading
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The six types of syllables that compose English words must be directly taught. These syllable subtypes help
to develop orthographical patterns in words and
include: a) Closed syllables (just one vowel…”cat”)
b) Open syllables (ends in long vowel…”baby”)
c) Vowel-Consonant E Syllables (silent e elongates vowel...”make”)
d) Vowel-Team Syllables (two vowels make one
sound…”caution”) e) R-Controlled Syllables (vowel followed by “r”
changes sound…”hurt”)
f) Consonant-le Syllables (end of word ending in “le”…..”turtle”)
Six Syllable Subtypes
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3. Specific neuroimaging techniques have demonstrated that
phonological processing and orthographic processing is
a by-product of the functional integrity of the temporal-
parietal junctures in the left hemisphere of the brain (Pugh et al., 2000, McCandliss & Noble, 2003; Shaywitz, 2004;
Sandak et al., 2004).
The Universal Truths of Reading
Supramarginal
Gyrus (phonics)
Heschl’s Gyrus
Superior
Temporal Gyrus
Angular Gyrus (orthography)
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4. According to the National Reading Panel (2000), and
modified by Grizzle et al. (2009), the 5 big ideas of the
reading process include:
The Universal Truths of Reading
COMPREHENSION
LANGUAGE
FLUENCY
PHONICS
PHONEMIC AWARENESS
5 Big Ideas
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Neural Circuitry of Reading Disorders (Shaywitz, 2003)
Nonimpaired readers activate primarily posterior portions of left hemisphere.
Impaired readers under-activate posterior regions and activate primarily frontal
areas.
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Question: Can brain chemistry actually become altered
as a result of practice and effective interventions???
London cab drivers showed direct correlation between number of years on the job and hippocampal
volume (Maguire et al., 2000)
Bilingual individuals have more gray matter in the left angular gyrus than monolingual students, no matter
when the second language was acquired (Green et al.,
2007)
There is a correlation between the size of Heschl’s gyrus and the amount of time practicing an instrument
(Schneider et al., 2002)
Dyslexic students fail to activate brain regions associated with phonological processing and
automaticity (Shaywitz & Shaywitz, 2005).
Our Adaptive Brain
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Dominant Characteristics of Reading
Disabled Children
Poor decoding skills.
Weak vocabulary development.
Inability to read strategically.
Poor spelling.
Few reading opportunities outside of school.
Poor motivation and confidence.
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3 PATTERNS OF WORD IDENTIFICATION
1. Phonological Code - using sound patterns to identify words.
2. Orthographic Code - using visual contour and shapes to identify words
3. Semantic Code - using meaning of text to identify words by anticipating what word
should come next.
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Four Subtypes of Reading Disorders
(1) Dysphonetic Dyslexia – difficulty sounding
out words in a phonological manner.
(2) Surface Dyslexia – difficulty with the rapid
and automatic recognition of words in print.
(3) Mixed Dyslexia – multiple reading deficits
characterized by impaired phonological and orthographic
processing skills. Most severe form of dyslexia.
(4) Comprehension Deficits – mechanical
side of reading is fine but difficulty persists deriving
meaning from print.
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UNDERSTANDING THE NOTION OF
SUBTYPING
Inferior Frontal Gyrus Supramarginal
Gyrus
Heschl’s Gyrus
Angular
Gyrus
Superior Temporal
Gyrus
Fusiform
Gyrus
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UNDERSTANDING THE NOTION OF
SUBTYPING
KEY BRAIN REGIONS IN DYSLEXIA
(1) Heschl’s Gyrus- auditory perception and
discrimination. (2) Superior Temporal Gyrus – modulates the 44
phonemes of the English Language.
(3) Angular Gyrus – cross modal association area mapping symbols to sounds.
(4) Supramarginal Gyrus – cross modal association
area underlying the spatial appreciation of sounds. (5) Fusiform Gyrus – automatic word recognition center
for reading.
(6) Inferior Frontal Gyrus – key region for passage comprehension.
* Posterior portion of the brain decodes. * Anterior portion of the brain comprehends.
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REMEDIATION STRATEGIES FOR
DYSPHONETIC DYSLEXIA Over Age 12: Wilson Reading System
SRA Corrective Reading & REACH System
(Top- Down) Read 180
HOSTS
Kaplan Spell/Read
Ages 7 - 12: Alphabetic Phonics (Orton-Gillingham)
Recipe for Reading
SRA Corrective Reading
Earobics II
SIPPS
Lindamood Seeing Stars Program
LEXIA
(Bottom-Up) Horizons
Read Well
DISTAR (Reading Mastery)
Under Age 7: Fast Forword (Tallal) Earobics I Phono-Graphix Saxon Phonics Program Success for All Ladders to Literacy Fundations Road to the Code
Scott Foresman Early Intervention Reading
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Morpheme- the smallest meaningful component of a word
that still conveys meaning. Examples include:
Research suggests that children learn to anticipate
words through a combination of phonological,
orthographic, and morphological strategies.
Knowledge about morphological awareness
contributes to individual differences in reading and
spelling that cannot be entirely attributed to orthographic
and phonological processing. The key is to teach in
combination with vocabulary, phonology, and orthography
to promote reading and spelling skills.
The Morphological Connection (“Top-Down”) (Senechal & Kearnan, 2007)
Prefixes: ante, extra, mis, para, pre, retro, super
Suffixes: able, tion, ment, ness, ship, tude, ward, ible
Latin Roots: cent, extra, hemi, meta, therm, ultra
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REMEDIATION STRATEGIES FOR SURFACE DYSLEXIA
Over Age 12: Academy of Reading
Wilson Reading System
Laubauch Reading Series
Read 180
Ages 7 - 12: Read Naturally
Great Leaps Reading
Quick Read
RAVE-O
Fast Track Reading
Under Age 7: Analytic or Embedded Phonics
Reading Recovery
Early Success
Fluency Formula
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4 REMEDIATION STRATEGIES FOR
MIXED DYSLEXIA
(1) Balanced Literacy - An eclectic and approach capitalizing
on the particular strengths of the child. Consider using a
multi-sensory type of Orton-Gillingham program, coupled
with a fluency model such as Read Naturally, and the
computerized models of Read 180.
(2) Top Down Strategies – Often atypical development
mapping individual sounds to the visual word form
association areas (Temple, 2002; Shaywitz, et al, 2003; Noble
& McCandliss, 2005).
(3) Socioeconomic Status - According to Noble and
McCandliss (2005), socioeconomic status (SES) is a very
strong predictor of reading skills due primarily to the home
literacy environment. Therefore, schools need to provide
more reading opportunities.
(4) Motivation and Confidence –Great Leaps, Read Naturally,
and Neurological Impress tend to give immediate feedback.
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1. Content Affinity - attitude and interest toward
specific material.
2. Working Memory - the ability to temporarily
suspend information while simultaneously
learning new information. The amount of memory needed to execute a cognitive task.
3. Executive Functioning - the ability to self- monitor performance and organize
information on a given problem solving task.
4. Language Foundation – most children enter
kindergarten with 3000 – 5000 words, though
graduate from high school with 60,000 words (Pinker, 1994).
4 Reasons for Poor Comprehension
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Ten Reading Comprehension Teaching Strategies
1) Review vocabulary daily, though avoid rote
memorization of terms.
2) Preferential seating closer to instructor and check on
student progress every five minutes. Have the student
paraphrase verbally what was read.
3) Make real life connections with the material to increase
motivation and interest.
4) Assign more projects than tests to assess knowledge.
5) Have student underline all topic sentences prior to
reading the text.
6) Use a tracking bar to guide reading and eliminate page
distractions.
7) Modify text to student’s basic reading level.
8) Reciprocal teaching – student’s work in small groups
and follow a protocol for predicting, questioning,
clarifying and summarizing (SOAR).
9) Visualize the reading process (Lindamood Visualizing
and Verbalizing program)
10) Structured note-taking while reading, not highlighting.
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3-Headed Monster of Reading
DECODING FLUENCY COMPREHENSION
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Intelligence tests
Phonemic/Phonological Awareness
Rapid Naming
Verbal Memory Tests
Reading Fluency
Orthographic Skills
Attention
Executive Functioning
Family History
90 Minute Dyslexia Evaluation
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Phonemic/Phonological Awareness :
NEPSY II: Phonological Processing
PAL II: Phonological Coding
WIAT III: Pseudoword Decoding, Early Reading Skills
CTOPP
KTEA II
Rapid Naming:
PAL II: RAN, NEPSY II: Speeded Naming, CTOPP, KTEA II
Verbal Memory Tests:
CVLT-C , NEPSYII: List Memory,
PAL II Verbal Working Memory
Reading Fluency: GORT 5, CBM, WIAT III ORF,
WIAT III Word Reading
Orthographic Skills: PAL II Receptive Coding,
Orthographic Spelling
Attention: NEPSY II Auditory Attn, Connors 3, TEACH
Executive Functioning: BRIEF, NEPSY II Inhibition, WIAT III Reading Comp (Inferential vs. literal)
DKEFS
Dyslexia Assessment Instruments
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1. Dysphonetic Dyslexia:
Lower Verbal IQ
Lower Phonological Processing
Lower Phonological Working Memory
Inaccurate Oral Reading
“Guessing” based upon first letter
2. Surface Dyslexia:
Lower Nonverbal IQ
Lower Orthographic Processing
Poor Rapid Naming Speed
Slower Reading Speed
Errors on Phonologically Irregular Words
90 Minute Dyslexia Evaluation:
Interpretation
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3. Mixed Dyslexia:
Lower Full Scale IQ
Lower Phonological Processing
Poor Rapid Naming Skills
Lower Orthographic Processing
Poor Verbal Working Memory
Bizarre types of errors
Multiple grade levels behind
Diagnosed after multiple interventions
4. Comprehension Deficits:
Lower Verbal IQ
Lower Verbal Working Memory
Slower Reading Speed
Poor Executive Functioning
Poor Attention
90 Minute Dyslexia Evaluation:
Interpretation
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What is a Learning Disability?
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1) There should be data documenting that a student’s
RATE of learning is substantially slower than grade
level peers.
2) There should be data documenting that a student
has not responded to evidenced-based
interventions over a protracted period of time.
3) There should be data from standardized testing
indicating the presence of a psychological
processing deficit associated with the academic
skill in question. This may include measures of
phonological or orthographic processing skills,
language skills, working memory skills, executive
functioning skills, and rapid naming and retrieval
skills.
4) There should be data ruling out environmental,
medical, emotional, and cultural factors.
Proposed 4-Factor Model Defining a Learning Disability