DYSLEXIA OR LD IN READING: WHAT IS THE DIFFERENCE?

Anise Flowers & Donna Black, Pearson Dyslexia or LD in Reading? TCASE 2017

Image by Photographer’s Name (Credit in black type) or Image by Photographer’s Name (Credit in white type) International Dyslexia Association

Dyslexia is a specific learning disability that is neurological in origin. It is characterized by Dyslexia or LD in Reading: What difficulties with accurate and/or fluent word is the Difference? recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of Presented by effective classroom instruction. Secondary Anise Flowers, Ph.D. Donna Black, LSSP consequences may include problems in reading comprehension and reduced reading experience TCASE that can impede growth of vocabulary and January 2017 background knowledge.

Presentation Title Arial Bold 7 pt 1 2

Dyslexia Identification and Services in Texas Dyslexia Definition (in Texas)

Texas Education Code (TEC)§38.003 defines Texas Education Code (TEC)§38.003 definition: dyslexia and mandates testing and the provision of 1. “Dyslexia” means a disorder of constitutional instruction origin manifested by a difficulty in learning to State Board of Education (SBOE) adopts rules and read, write, or spell, despite conventional standards for administering testing and instruction instruction, adequate intelligence, and TEC §7.028(b) relegates responsibility for school sociocultural opportunity. compliance to the local school board 2. “Related disorders” include disorders similar to or 19 (TAC)§74.28 outlines responsibilities of districts related to dyslexia such as developmental auditory and charter schools in the delivery of services to imperceptions, dysphasia, specific developmental students with dyslexia dyslexia, developmental dysgraphia, and The Rehabilitation Act of 1973, §504, establishes developmental spelling disability. assessment and evaluation standards and procedures for students (34 C.F.R. Part 104)

3 4

Dyslexia Guidelines (in Texas) TX Handbook: Dyslexia Difficulties . Students identified as having dyslexia typically experience primary difficulties in phonological awareness, including phonemic awareness and manipulation, single-word reading, reading fluency, and spelling. . Consequences may include difficulties in reading comprehension and/or written expression. . These difficulties in phonological awareness are unexpected for the student’s age and educational level and are not primarily the result of language difference factors. . Additionally, there is often a family history of similar difficulties. 5 6

Flowers & Black Pearson Clinical Assessment 1 Dyslexia or LD in Reading? TCASE 2017

TX Handbook: Primary Dyslexia TX Handbook: Associated Academic Characteristics Difficulties . Difficulty reading words in isolation . May also have problems in written expression, reading comprehension, and . Difficulty accurately decoding unfamiliar mathematics words . Most common co-occurring disorders are ADHD & specific developmental language . Difficulty with oral reading (slow, inaccurate, disorders or labored) . May also experience symptoms such as anxiety, anger, depression, lack of motivation, . Difficulty spelling or low self-esteem

7 8

TX Handbook: Common Risk Factors Assessing Common Associated with Dyslexia Risk Factors  Difficulty pronouncing words (e.g., “pusgetti” for “spaghetti,” “mawn lower” for “lawn mower”) Shaywitz DyslexiaScreen offers two teacher  Trouble learning and naming letters and numbers and remembering the letters in his/her name questionnaire forms:  Aversion to print (e.g., doesn’t enjoy following along if book is read . Form 1 aloud) . Ages 5:0 through 6:11 in Kindergarten  Difficulty remembering the names of letters and recalling their corresponding sounds . 10 items  Difficulty decoding single words (reading single words in isolation) . Form 2  Difficulty spelling words the way they sound (phonetically) or . Ages 6:0 through 7:11 in Grade 1 remembering letter sequences in very common words seen often in print ( e.g., “sed” for “said”) . 12 items  Difficulty with written expression . Results: At Risk for Dyslexia or Not At Risk for  AND MORE… Dyslexia

9 10

TX Dyslexia Handbook TX Dyslexia Handbook Areas for Assessment Areas for Assessment Academic Skills Possible Additional Areas  Letter knowledge (name and associated sound)  Vocabulary  Reading words in isolation  Listening comprehension  Decoding unfamiliar words accurately  Verbal expression  Reading fluency (both rate and accuracy are assessed)  Written expression  Reading comprehension  Handwriting  Spelling  Memory for letter or symbol sequences (orthographic processing) Cognitive Processes  Mathematical calculation/reasoning  Phonological/phonemic awareness  Phonological memory  Rapid naming of symbols or objects  Verbal working memory  Processing speed

11 12

Flowers & Black Pearson Clinical Assessment 2 Dyslexia or LD in Reading? TCASE 2017

TX Dyslexia Handbook: Special Ed? Depends upon

• Where you live Special education and the assessment through • How the terms are defined IDEA 2004 may occur when dyslexia is associated with factors complicating dyslexia, thus requiring more support than what is available through the general education dyslexia program.

14 13

History of Dyslexia Despite claims to the contrary, it is incontrovertible that there are many people •Dates back to 19th century as “word who struggle to learn to read (decode) for blindness” reasons other than poor teaching. While • “Dyslexia” first used in 1887 by an this condition is widely known as dyslexia, ophthalmologist achieving a clear, scientific, and consensual • Professionals now see dyslexia as understanding of this term has proven Language-based elusive. – But public still defines as a Visual The Dyslexia Debate problem Elliot & Grigorenko, 2014

15 16

Dyslexia and Reversals in Writing PROBLEMS • Myth: Dyslexia is a visual problem – dyslexics see words backwards and letters • Wide ranging incidence rates from 3% to reversed. 20% Fact: This was proven inaccurate by a study by Vellutino. He asked dyslexic and non-dyslexic students to reproduce a • Researchers don’t agree on the nature and series of Hebrew letters that none of them had ever seen features of “dyslexia.” before. The dyslexic students were able to perform the task just as accurately as the non-dyslexic students, showing that – Definitions for research different from defining their dyslexia did not affect their eyesight. for educational resources • Myth: Any child who reverses letters or • Research is not clear on the cause of early numbers has dyslexia. reading difficulties Fact: Up to a certain point, it is considered normal for children to reverse their letters and numbers, and is actually – Deficits are Phonological? Visual & auditory? quite common. However, if this does not stop after two Rapid naming? Working memory? years of handwriting instruction, it becomes a red flag for dyslexia

18

Copyright © 2014 Pearson Education, Inc. or its affiliates. All rights reserved.

Flowers & Black Pearson Clinical Assessment 3 Dyslexia or LD in Reading? TCASE 2017

PROBLEMS Dyslexia Symptoms

• Dyslexia is supposed to be brain based • Difficulty with decoding single words (not environment/poor teaching) but – All poor decoders or just a subset?? difficult to tease out the difference • May also have problems with • Lack of agreement about role of IQ comprehension, fluency, motivation • Label of dyslexia doesn’t suggest – Fletcher calls this “Decoding bottleneck” intervention different from those for other • Symptoms have included poor poor decoders phonological awareness, working verbal memory, weak spelling, slow processing, impaired verbal fluency, frequent letter reversals, and more…

19 20

UNEXPECTED? Only Smart Kids ??

• Definitions often include “unexpected poor performance” Special difficulties processing the – Difficult to define unexpected phonological features of language, – Based on intelligence testing? Or failure to respond to intervention? that can co-exist with above • Shaywitz says within a “sea of strengths” average, average, or below – But some poor readers have flat cognitive average general intellectual ability. profiles – Certainly not everyone with dyslexia is gifted… • IQ does not appear to predict which poor readers will be successfully remediated Arkansas Dyslexia Resource Guide 2014

21 22

Who has Dyslexia? • Struggles with accurate single-word decoding The belief that those with dyslexia are high- • Struggles with accurate and/or fluent decoding functioning poor readers, rather than those • Scores at lower end on a test of reading accuracy or fluency who represent the full continuum of • Decoding difficulties cannot be explained in alternative ways • Significant discrepancy between decoding performance & IQ intellectual ability, has continued to persist • Decoding difficulty is unexpected despite all evidence to the contrary. • Decoding skills contrast with strengths in other domains • Decoding problems are biologically determined • Decoding problems marked by associated cognitive The Dyslexia Debate difficulties (phonological, rapid naming, working memory Elliot & Grigorenko, 2014 deficits) • History of very poor spelling • Discrepancy between decoding and listening comprehension • Fail to make progress in decoding with high-quality, evidence-based intervention

23 24

Flowers & Black Pearson Clinical Assessment 4 Dyslexia or LD in Reading? TCASE 2017

General Agreement on Cognitive Deficits in Dyslexia

• Importance of phonological awareness, • Primary: Phonological deficit especially in the early years • Also have been researched: • Importance of early intervention for reading difficulties –Rapid Naming – Working Memory • Instruction should be structured, comprehensive, and individualized – Auditory processing – Visual processing – Lack of evidence for visual/auditory training, visual-motor activities, vision therapy, tinted lenses, biofeedback, fatty acids

25 26

Although the phonological deficit theory Dylexia is often synonymous with continues to dominate, the notion of a single • Reading Disability homogeneous deficit is now recognized as inadequate. Phonological weakness, • Reading Disorder seemingly the most influential cognitive • Learning Disability in Reading component, cannot account for the • Specific Reading Disability difficulties of all those with reading • Specific Reading Difficulty disability. The Dyslexia Debate Sometimes used to refer to a more specific Elliot & Grigorenko, 2014 group of poor decoders

27 28

US DOE Oct 2015 US DOE Oct 2015 Under the IDEA and its implementing regulations https://www2.ed.gov/policy/speced/guid/idea/memo “specific learning disability” is defined, in part, as “a sdcltrs/guidance-on-dyslexia-10-2015.pdf disorder in one or more of the basic psychological processes involved in understanding or in using The purpose of this letter is to clarify that there is language, spoken or written, that may manifest itself nothing in the IDEA that would prohibit the use in the imperfect ability to listen, think, speak, read, of the terms dyslexia, dyscalculia, and dysgraphia write, spell, or to do mathematical calculations, in IDEA evaluation, eligibility determinations, or IEP including conditions such as perceptual documents. disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.” See 20 U.S.C. §1401(30) and 34 CFR §300.8(c)(10) (emphasis added).

29 30

Flowers & Black Pearson Clinical Assessment 5 Dyslexia or LD in Reading? TCASE 2017

8 Areas of Specific Learning Disability Specific Learning Disorder (SLD) in IDEIA: (with specifiers; DSM-5) 1.Specific learning disorder with impairment in • Basic Reading Skills (BRS) reading includes possible deficits in: • Reading Comprehension (RC) • Reading Fluency (RF) Word reading accuracy (BRS) Math Calculation (MC) Reading rate or fluency (RF) • Reading comprehension (RC) • Math Problem Solving (MPS) DSM-5 diagnostic code 315.00. • Written Expression (WE) • Oral Expression (OE) Note: Dyslexia is an alternative term used to refer Listening Comprehension (LC) to a pattern of learning difficulties characterized by • problems with accurate or fluent word recognition, poor decoding and poor spelling abilities.

31 32

Other Diagnostic Labels for Mascolo says….. Specific Learning Disabilities “Overall, it can be useful to adopt a “shared language” when speaking of SLD - - a group of Learning Disability Association of America (LDA) terms that we can filter other diagnostic labels through so that we can readily understand what is being talked about” LD Categories: Mascolo, J. (2015). Learning disability identification: Linking assessment to intervention. Webinar series: Cause and effect: Why your students are struggling and what to do about it. Downloaded March 12, 2015 from http://www.pearsonclinical.com/events/webinars/topicallisting/cause-and- – Auditory Processing Disorder (LC) effect.html – Dyscalculia (MC, MPS) – Dysgraphia (WE) The importance of a shared language… – Dyslexia (BRS, RF, RC)* – Language Processing Disorder (OE, WE, LC) – Nonverbal Learning Disabilities (MC, MPS) – Visual Perceptual/Visual Motor Deficit (WE)

33

Why is it more desirable to have dyslexia National Reading Panel, 2000 than a reading disability?

• Dyslexia is a meme Of the 100,000 articles on reading published since – Unit of cultural transmission 1966, 98% were discarded by the panel – Meme survives because it’s easy to Five “pillars” to reading success: understand, communicate & remember 1. Phonemic Awareness . Not because it is true, useful, or potentially harmful 2. Phonics 3. Vocabulary 4. Fluency »The Dyslexia Debate 5. Comprehension

35

Flowers & Black Pearson Clinical Assessment 6 Dyslexia or LD in Reading? TCASE 2017

Not all Reading Problems are Dyslexia Not all Reading Problems are Dyslexia (Berninger, 2006) (Berninger, 2006) OWL LD: In oral and written language learning disability, oral Dyslexia: language skills, including comprehension, are impaired A specific type of reading disability affecting accuracy in addition to the same skills that are impaired in and rate of reading real words, phonological decoding, dyslexia. oral reading of passages, and written spelling.

Phonological core deficit in storage, phonological loop, Dysgraphia: and executive functions. A specific learning disability that impairs legibility and automaticity of handwriting and/or written spelling. Except for phonological processing, oral language skills are spared and comprehension is good.

Beringer’s Reading Disabilities Why define subtypes?

• Purpose is not diagnostic but to link to the appropriate interventions

Ortho-  Dysgraphia graphic

Phonological  Orthographic Dyslexia

Morphological/Syntax Oral and Written Phonological Language Learning Orthographic Disability (OWL LD)

40 39

LD Reading Subtypes 1. LD Reading Subtype: Phonological • Phonological is the core deficit 1. Phonological • Have difficulty mentally representing the 2. Orthographic sound patterns of the words in their 3. Mixed Phonological-Orthographic language 4. Language – Causes great difficulty in using the phonological route to reading and spelling 5. Comprehension deficit • Over-rely on visual and orthographic cues 6. Fluency subtype while reading 7. Global • May memorize whole words as a strategy Dysgraphia (often a co-occurring condition with one for word recognition of the other listed subtypes) • Sometimes referred to as dysphonetic or phonological dyslexia.

41 42

Flowers & Black Pearson Clinical Assessment 7 Dyslexia or LD in Reading? TCASE 2017

LD Reading Subtype: Phonological 2. LD Reading Subtype: Orthographic

These students • Strong phonemic processing skills • Rarely use letter-to-sound conversion • Strong listening comprehension skills • Have marked difficulty reading nonsense – They know the answer to teachers’ questions. words – They glean a lot of information from the • Typically show a relative strength in reading classroom experience. exception (irregular) words, which they have memorized • Weak word recognition skills • Weak orthographic coding A phonological core deficit may be accompanied by deficits in cognitive processing and may – ability to hold word in memory and access the whole word pattern impact functioning in other academic skills such as writing and spelling.

43 44

LD Reading Subtype: Orthographic LD Reading Subtype: Orthographic

• Have difficulty in using the visual-lexical • Depend on sounding out words, but rarely route to reading and writing words. hold the words in their sight word list • Instead, the phonological route to lexicon (lexicon). is used • Struggle with spelling new words. • Tend to sound words out letter by letter, • Generally writing is also a deficit for these over relying on sound-symbol children. relationships. • Sometimes referred to as surface dyslexia, • Pseudoword reading is typically better visual form dyslexia or dyseidetic dyslexia. than real word or exception word reading • Impacts learning to read and decode because non-words are usually words, thus, impacting overall reading phonetically decodable fluency

45 46

3. LD Reading Subtype: Mixed LD Reading Subtype: Mixed Phonological and Orthographic Phonological and Orthographic • Strong in Listening Comprehension • More frequently occurring than either Phonological or Orthographic – Learn better with direct instruction and • Causes great difficulty in using the phonological experiential learning route to reading and spelling, as well as difficulty • Mixed LD reading is manifested in in using the visual-lexical route to reading and weaknesses in: writing words – Phonological Processing • Causes severe impairment in learning to read –Decoding – They have no usable key to the reading and –Word Reading spelling code, and seemingly arbitrary error patterns are often observed. – Reading Fluency, and • Difficulty mentally representing sound patterns of – Spelling words in language

47 48

Flowers & Black Pearson Clinical Assessment 8 Dyslexia or LD in Reading? TCASE 2017

4. LD Reading Subtype: Language LD Reading Subtype: Language

• Students with a language impairment, • Weaknesses sometimes referred to as Oral and Written – Reading comprehension Language Learning Disability (OWL-LD), – Listening comprehension (Grammatical) Specific Language Impairment (SLI or G-SLI), or Language – Orthographic coding, and Learning Disability (LLD), have problems in – Oral grammar both oral and written language •Strengths • Students with OWL-LD show particular – Word recognition difficulty processing grammar and syntax. – Decoding/ nonsense word reading • Adequate nonverbal cognitive ability is observed.

49 50

LD Reading Subtype: Language 5. LD Reading Subtype: Comprehension

• Some children respond well to a • A specific comprehension deficit is sometimes multisensory or VAKT (verbal-auditory- referred to as hyperlexia. kinesthetic-tactile) approach • Hyperlexia can refer to – Need input from more than one modality to – Students who exhibit poor language help them perceive or retain information. comprehension skills and exceptional word recognition and decoding skills OR • Other children are overloaded by – Students with poor language comprehension multisensory inputs and become confused and relatively good basic reading skills by having to assimilate information • Have difficulty with listening comprehension and through multiple systems at the same time reading comprehension – Read accurately and fluently, but fail to grasp the meaning of what they have read

51 52

LD Reading Subtype: Comprehension 6. LD Reading Subtype: Reading Fluency

• Specific comprehension difficulties include • Students with poor reading fluency due to a naming speed deficit typically have – making inferences adequate phonological processing skills – monitoring understanding • Able to read and decode words accurately, – using strategies to resolve ambiguity but they read connected text very slowly – inhibiting irrelevant information • Reading fluency deficits cannot be identified until word-reading skills are acquired; • Relative strengths however, naming speed deficits may be – phonological processing identified earlier. – naming speed • Specific deficits in naming speed have been shown to impede reading fluency.

53 54

Flowers & Black Pearson Clinical Assessment 9 Dyslexia or LD in Reading? TCASE 2017

LD Reading Subtype: Reading Fluency 7. LD Reading Subtype: Global

• According to the Double-Deficit Hypothesis, • A global reading impairment is sometimes most students with reading disorders can be associated with the term nonspecific language classified as one of two single-deficit subtypes impairment or, as a group, “garden variety that are relatively independent of each other poor readers” (phonological or rate deficit) or as one combined double-deficit subtype. • Students with global reading impairment are • Weaknesses in reading fluency due to a remarkably similar to younger children naming speed deficit is sometimes referred reading at the same grade level. to as a rate deficit or specific reading fluency • Probably the most common profile of reading deficit. difficulty but not SLD (they don’t qualify). • Reading fluency is considered the bridge to comprehension; hence, slow reading fluency typically impedes comprehension.

55 56

LD Reading Subtype: Global LD Reading Subtype: Global

• Difficulty with all reading-related skills, • Given that these students have learning including: word recognition, decoding, reading problems that are consistent with estimates fluency, reading comprehension, and listening of their cognitive ability (in other words, their comprehension. learning difficulties are not unexpected), this • A subset of students with a global reading subtype does not meet contemporary impairment also show phonological processing operational definitions of a specific learning deficits due to difficulty mentally representing disability. the sound patterns of the words in their • Research suggests that students with global language. reading impairment can benefit from • These students have low average verbal and intervention in a comparable manner to nonverbal cognitive processing abilities (IQ students with higher IQs and more specific standard scores between 70 and 90), but they areas of weakness do not exhibit deficits in adaptive functioning.

57 58

Intervention Guide for LD Subtypes Intervention Guide for LD Subtypes on Q-Global

10 hallmark indicators: skills/abilities that define or differentiate between subtypes

• Evaluates patterns of performance that are Cognitive ability Phonological processing consistent with research-supported LD RAN Non‐word reading subtypes Orthographic coding Word recognition • Summarizes how a child fits each subtype Spelling Reading comprehension • Provides a description of intervention Listening comprehension Reading fluency characteristics & recommendations of research-supported instructional programs **Areas for Assessment in Texas Dyslexia Handbook

Flowers & Black Pearson Clinical Assessment 10 Dyslexia or LD in Reading? TCASE 2017

Intervention Guide for LD Subtypes When to Refer to Special Education? Texas Dyslexia Handbook • If a student exhibits evidence of severe 5 ancillary indicators: skills/abilities that are difficulties with academic skills and a disability used to tailor recommendations. is suspected, further assessment should be considered. Handwriting legibility Auditory verbal WM • If, while in dyslexia intervention, the student is & speed {dysgraphia} not making sufficient progress, further Processing speed assessment should be considered. Verbal comprehension Perceptual reasoning • If a student is not enrolled in public school & reasoning (i.e., private school or a home-school setting) and a learning disability is suspected, further assessment should be considered under Child **Areas for Assessment in Texas Dyslexia Handbook Find. 62

When to Refer to Special Education? When to Refer to Special Education? Guidance from the Trenches Guidance from the Trenches

1. Parent request or suggestion by Doctor 3. Student has been tested for dyslexia, brought forward by Parent determined to have dyslexia, but it is evident to the committee that the student is going to need 2. Follow RtI process established by District more support than the kind of support that is  Rate of skill acquisition or the level of available under general education dyslexia understanding is lower than expected intervention.  There are more cognitive factors contributing to  Child is not making a sufficient rate of the reading delays (more than just phonological progress processing)  Factors may include attention difficulties, short- term and or long-term memory issues, processing speed significantly below their peers, poor language and/or reasoning impacting.

63 64

QUESTIONS?

Anise Flowers, Ph.D. Assessment Consultant 936‐321‐7663 [email protected] South Texas

Donna Black, LSSP Assessment Consultant [email protected] North Texas

65

Flowers & Black Pearson Clinical Assessment 11