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Understanding Dyslexia:
Myths and Realities of Assessment and Instruction
LOUISA MOATS, ED.D.
DUBARD HONORARY LECTURE, 2014
1Myths We Have Already
Dispelled
Dyslexia means “seeing things backwards”
Dyslexia requires vision therapy
Dyslexia is far more common in
boys than girls
Dyslexia is associated with left-handedness
2
Your Turn: True or False?
Einstein was dyslexic.
Dyslexia is associated with cognitive gifts.
Low performance on phonological tasks (oral
language) is the cornerstone of a diagnosis of
dyslexia.
There are at least several types of dyslexia.
The syndrome of dyslexia is very distinct from
other language-based learning disorders.
3 4
language
writing system
(orthography)
pragmatics
morphologydiscourse structure
sentences
(syntax)
phonology
meaning (semantics)
“Reading builds on language…” (Perfetti, 2011)
5
The Many Strands that are Woven into Skilled Reading(Scarborough, 2001)
6How We Read and Spell Words
Context
Processor
Orthographic
ProcessorPhonological
Processor
Meaning Processor
spellingspeech input and output visual input
The Reading Brain7 8
How We Recognize Words
unreachable
un-reach-able
un-reach-a-ble
u-n-r-ea-ch-a-b-le
u-n-r-e-a-c-h-a-b-l-e
Units of Analysis
word
morpheme
syllable
grapheme
letter
9 Dyslexia: Definition (2003)
One of several distinct reading difficulties
Characterized by…
Poor decoding and encoding (spelling)
Unusual problems with accurate and/or fluent printed word recognition
Inconsistent with age and/or cognitive ability
Often associated with difficulty identifying, manipulating, and/or producing the speech sounds in spoken words (phonology)
A Common Conceptualization
of Dyslexia…
Text Sound-symbol
correspondence
General
Intelligence
Word
Identification
Reasoning
Concept
Formation
Vocabulary
= Meaning
A Newer Conceptualization: “Multiple
Dyslexias” (Fletcher et al., 2007; Aaron, Joshi et al., 2008;
Elliott & Grigorenko, 2014)…
12
Phonological
Awareness
/Decoding
Orthographic
Memory/
Fluency
Language
Comprehension
Is Dyslexia Associated with
Giftedness?
Claims of visual, artistic, and
entrepreneurial superiority are common
Reality: reading, in the early stages, has a
low correlation with intelligence, especially non-verbal intelligence
Reading and many aspects of intelligence are independent
13 The “Einstein” Syndrome? He was slow in learning how to talk…Whenever he
had something to say, he would try it out on himself, whispering it softly until it sounded good
enough to pronounce aloud…He had such
difficulty with language that those around him
feared he would never learn…Throughout his life,
Einstein had a mild form of echolalia, causing him to repeat phrases to himself, especially if they
amused him.
…a cheeky rebelliousness toward authority
…he generally preferred to think in pictures, most
notably in famous thought experiments
…in primary school, he was at the top of his class…
14
People with LD Can Have
Disparate Talents
Pablo Picasso (visual-spatial imagination)
Winston Churchill (oration)
Agatha Christie (literary/narrative imagination)
Philip Schultz (poetry)
Greg Louganis (sense of body position in space)
Jim Dutcher (wildlife photographer)
Simon Pierce (glass blower/designer)
Whoopi Goldberg (actress, comedienne)
15
-1.5
-1
-0.5
0
0.5
1
Problem Solving
ConceptFormation
Phonological Awareness
Rapid Naming Vocabulary Paired AssociateLearning
VisualMotor
IQ- Consistent
Ag
e A
dju
ste
d S
tan
da
rdiz
ed
Sc
ore
IQ-Discrepant
IQ Discrepancy Has Little to
Do with Specific Reading Disability
Discrepant and Non-Discrepant Have Similar Outcomes Over Time (Francis et al., 1996)
17
Aim of Assessment!
Who needs help?
(Why do they need help?)
What kind of help do they need?
Is the help helping?
If not, why not? Should I change something?
18
Five Questions to Answer
1. Has any immediate relative experienced similar
difficulty learning to read, spell, or write?
2. What have the parents observed about their child’s
early language development and early interaction with print and books?
3. Have hearing, vision, and general health been
checked? Is there any medical reason why there might be a learning impairment?
4. What did the student experience in the way of prior
instruction, and how was that documented?
5. (If student is older) – Are the reported difficulties
chronic? Is there evidence in the school record that
they have been there all along?
19 Most Important Skills to Assess
and Interpret
• Nonword reading and spelling
• Phonological awareness
• Reading accuracy, out of context
• Reading fluency and rate
• Spelling (regular and irregular words)
• Math and oral language
abilities, for comparison
20
Case Study #1, SD
Repeated kindergarten – “progressing
normally”
First grade teacher “expressed concerns
that he was falling behind”
Second grade teacher referred him to
Title 1 remedial reading program; observed difficulty with phonics, speech
sound discrimination, and verbal comprehension
Parents sought private evaluation in
summer before 3rd grade
21 SD’s Behavior During
Academic Tests
Very slow processing speed on verbal or symbolic
tasks ; yawned and tuned out.
No spontaneous conversation; didn’t initiate.
Needed high rate of reinforcement to persist and
much encouragement to respond to tasks.
Gave truncated responses to verbal questions; often
was unable to elaborate. Like “pulling molasses.”
Deliberate, methodical; attentive when a motor (hands-on) component was present.
22
SD’s Reading Evaluation -
WRMT
Subtest Standard Score
Percentile Rank
Word
Identification73 4
Word Attack 71 3
Word Comp 78 7
Passage Comp 72 3
Composite72 3
23
75th%ile
25th%ile
Verbal IQ 80Performance
IQ 105 (117)
24
Speech/Language
EvaluationNot low enough to qualify as “language disordered” but
scored at about the 10th %ile on the CELF.
Strengths: Labeling pictures; repeating sentences
verbatim.
Pronounced weakness in ability to:
Explain word meanings; recognize multiple meanings
of words; comprehend spatial and temporal word
classes and categories; and formulate complete
sentences with conjunctions.
Doesn’t know months of the year or calendar concepts.
25 Spelling Errors (TWS, 8th %ile)
Confusion of short vowels a, e
(lat/let; nast/next; spand/spend;
mysalf/myself; avreonn/everyone)
Omission of nasals before
consonants
(whet/went; ucul/uncle; nihtn/nineteen)
Omission of /r/ in “storm”
Confusion of /s/ and /ch/
(mues/much)
C-le syllable (ucul/uncle; pepule/people)
26
Questions: Case Study #1, SD
What is the nature and severity of this
student’s problem?
“Mixed” or “triple deficit” reading disability.
Why wasn’t it identified sooner?
No universal screening; no behavioral problems.
Who should be responsible for teaching a student like this?
Everyone, all day every day.
27 What Components of Instruction Should Be Emphasized for SD ?
phonological awareness
phoneme-grapheme mapping (encoding)
accurate blending and word reading (decoding)
vocabulary: multiple meanings, elaborated
definitions, spatial and temporal words;
categorization; inflectional morphemes
sentence elaboration and formulation
verbal reasoning and expressive skills
28
Phoneme Identification
Link the phoneme to a gesture, object, or picture of the word.Call attention to articulation.
Identify the sound in spoken words.
Cue the production of the sound with the gesture, object, or picture.
29
/wh/
/ŏ/
30Consonant Phonemes by Place and Manner of Articulation
lips(bilabial)
teethon lips/
labiodental
betweenteeth
(interdental)
behindteeth
(alveolar)
roof ofmouth
(palatal)
back of throat(velar)
glottis
stopsunvoiced
voiced
/p//b/
/t//d/
/k//g/
nasals /m/ /n/ /ng/
fricativesunvoiced
voiced
/f//v/
/th//th/
/s//z/
/sh//zh/
affricatesunvoiced
voiced
/ch//j/
glidesunvoiced
voiced
/y/ /wh//w/
/h/
liquids /l//r/
English Vowel Phonemes by Order of Articulation
Vowel sounds that are close to each other are easily confused.
Moats, L.C., LETRS Second Edition, Module 2 (2009)
Why Does Phoneme Awareness
Predict Reading and Spelling?
“ Children faced with the task of learning to
read in an alphabetic script cannot be
assumed to understand that letters represent phonemes because awareness of the
phoneme as a linguistic object is not part of their easily accessible mental calculus, and
because its existence is obscured by the
physical properties of the speech stream.” (A. Liberman, 1989)
32
Phoneme-Grapheme Mapping
ch o ck
sh r i ll
kn igh t
j u dge
c r ow d
Dimensions of English Orthography
Sound-Symbol Syllable Patterns
Morpheme Structure
Anglo-Saxon
Consonants
single, digraphs, trigraphs, blends
Vowels
short, long
-v-c-e, vowel team, vowel-r patterns
closed
open
vce
vowel-r
vowel team
consonant –le
(oddities)
compounds
inflections
base words
suffixes
high frequency words
Latin prefixes
roots
suffixes
Greek ph for /f/ (graph)
ch for /k/ (chorus)
y for /i/ (gym)
Combining forms
plurals
35“Deep Knowledge” of Words
(word)
Linguistic Structure
Examples in
context
SynonymsAntonyms
Connotations/
Denotations
Multiple
meanings
Categories
Vocabulary Learning is
Influenced by Phonology
Ability to repeat, remember, and recall new words depends on naming them correctly
zydeco chimera
dizygotic segue
syncope
dialogic
Similar words must be distinguished
anecdote; antidote prune, prude
departed, deported tenant, tenet
36
37
Sentence Sense, Grammar &
Syntax
exposure to “literary”
syntax
sentence coding and diagramming
multisensory grammar
sentence combining
sentence anagrams
sentence elaboration
Relationship Between Fluency and Comprehension Changes Over Time
0
10
20
30
40
50
60
3rd Grade 7th Grade 10th Grade
ORF
VC
38
Proportion of variance in FCAT explained by oral reading fluency and
verbal comprehension. (Schatschneider et al., 2004)
Goal:Mental Model
39
Surface Code
Text Base
WM
LTM
Comprehension Reading Comprehension
Depends on Active Processing
of…
figurative language
multiple meanings
academic language formalities
discourse structure
phrase structure in sentences
topic-specific terminology
40
Case Study #2, 2nd Grader
WISC Vocabulary 98th %ile
Full Scale IQ 90th %ile
Listening Comp 98th %ile
WIAT III Word Reading – 16th %ile
Gray Oral Rate & Accuracy –
16th%ile
OWLS-II (Reading Comp) 20th %ile
Woodcock RMT Word ID - 16th %ile
Spelling (TWS-4) – 12th %ile
Is accurate at decoding elements
(untimed)
Phonological Awareness
(PAT, C-TOPP) all above avg.
41 42
Do All Dyslexics Have
Phonological Deficits?
Franck Ramus (cited in Dehaene, 2009)
“A core deficit in phonological processing lies at the origin of most dyslexia..” but
“about one in four presents a pronounced visual [orthographic] deficit and no
phonological impairment.” (p. 242)
“The problem that faces us is complex and
does not have a single well-defined cause.” “A joint deficit of vision and language.”
43
More Complex Conceptualization of
Reading Disabilities (Fletcher et al., 2007;
Aaron, Joshi et al., 2008)…
44
(Phonological)
Word
Recognition
Orthographic
Processing/
Fluency
Language
Comprehension
Adjustment for Poor Orthographic
Memory
Teach the logic of English spelling, emphasizing
patterns, word origin, and morphology
Practice “sight word” memory for highest
frequency words
Constantly review and reteach as needed
Call attention to details of print through word
sorting, computer games, spelling aloud, color coding – anything that works.
45
Part 2 – The Consequences of
Misinformation and
Misunderstanding about
Reading, Language, and
Writing Instruction
46
Unsupported Conceptual
Models
47
Graphophonic/
Visual
Semantic Syntactic
“The Three Cueing Systems”
For example, using
configuration in word ID:48
Word Recognition Depends On Phoneme-Grapheme Mapping 49
O
one
once
only
out
open
on
off
E
eye
eat
end
every
even
50
The “alphabetic word wall.”
“Making Words” (Not Systematic!)
i, u, k, m, n, p, p
up, in, ink/kin, pin, pun, pup,
pump, pink, mink, pumpkin
a, i, b, b, r, s, t
at, sat, rat, bat, bar, tar,
star, stir, stair, rabbits
51 Unfortunate consequences, continued…
“Phoneme awareness” instruction that doesn’t focus on phonemes
syllable counting
rhyming
matching a first sound
Phoneme awareness that isn’t directly assessed
“running records”
52
Misuse of context for word
recognition…
Context does not drive word recognition.
Context is useful for deciphering the
meanings of unknown words, once they are named or recognized.
(Perfetti, 2011)
53Misuse of context in instruction…
“….Don’t know that word?
Well just keep reading and see what might make sense here…”
54
Part 3 – What is research-
supported best practice?
55 Structured Literacy
Linguistic concepts
Systematic
Explicit
Cumulative
Multisensory
Intensive
Applied to purposeful reading and writing
56
Implications of Current Research (Elliott & Grigorenko, 2014)
Traditional “O-G” is not the only approach
Teachers need preparation in all aspects of oral and written language
Curriculum should include direct teaching
of all strands of language PLUS
accommodations, technology supports, and compensatory strategies
Student’s strengths must be developed
57
Many “Structured Literacy” Therapies and Approaches
DuBard Association Method
Lindamood-Bell – LIPS and VV
REWARDS
Direct Instruction (e.g., Reading Mastery; ReadWell; SFA)
Wolf’s RAVE-O; Lovett’s PHAST
Hochman’s Teaching Basic Writing Skills
LANGUAGE! Curriculum
58
A Multi-component Lesson Framework
“Sound warm-up” – phoneme awareness
Direct, explicit teaching of word or language concept (phonics, etc.)
Modeling
Guided practice
Supported independent practice
Application in context
59Multi-component Lesson,
continued.
Fluency development
speed drills
repeated reading
Partner work
Vocabulary building
Oral and silent text reading for comprehension, including sentence level work
Spelling and writing
60
Reading Should Be
Meaningful
Is the vocabulary rich and evocative?
Is there thematic depth?
Are major genres well sampled?
Are the ideas engaging and worth knowing about?
Is the text worth rereading?
61Adapt for the Learner!
62
(Phonological)
Word
Recognition
Orthographic
Processing/
Fluency
Language
Comprehension
In Summary – Some
Realities
Learning to read is complex; there is no single cause
for dyslexia and related reading disabilities
Most students need a multi-component approach
Assess and treat the problem directly; use
“processing” tests to help explain the student, but not
as a gateway to services
Rely on structured literacy and language approaches
for intervention
Look for and develop compensatory student
strengths
63 64
Age 16, After
many years of
intensive
teaching.
Remember
“Every child would read [and spell] if it were in his power to do so.”
Betts, E. A. (1936). The prevention and correction of
reading difficulties. Evanston, IL: Row, Peterson and
Company. (p. 5)
65 “It Changed My Life!”
You, the teacher, are the most important agent for that change.
Thank you for the work you do!
66
References
Bahr, R.H., Silliman, E.R., Berninger, V.W., & Dow, M. (2012). Linguistic Pattern
Analysis of Misspellings of Typically Developing Writers in Grades 1-9. Journal
of Speech, Language, and Hearing Research, (55), pp. 1587-1599.
Berninger, V. & Wolf, B. (2009) Teaching students with dyslexia and
dysgraphia. Brookes Pub.
Birsh, J. (Ed.) (2010) Multisensory teaching of basic language skills, 3rd Edition.
Brookes Publishing.
Elliott, J.G. & Grigorenko, E.L. (2014) The dyslexia debate. New York, NY:
Cambridge University Press.
Farrall, M. (2012) Reading Assessment: Linking Language, Literacy, and
Cognition. John Wiley.
Grace, K. (2007) Phonics and spelling through phoneme-grapheme
mapping. Longmont, CO: Sopris/Cambium.
67 References, continued.
Hosp, M.K, Hosp, J.L., & Howell, K.W. (2007) The ABCs of CBM:A practical guide to curriculum-based measurement. New York: Guilford.
Joshi, M., Treiman, R., Carreker, S., & Moats, L.C. (2008/2009) How words cast their spell: Spelling is an integral part of learning the language, not a matter of memorization. American Educator, 32(4), 6-16, 42-43.
Moats, L. (2010) Speech to Print: Language Essentials for Teachers, 2nd Edition. Baltimore: Brookes Publishing.oats, L. (2006) How spelling supports reading. American Educator,29, 12-22, 42-3.
Moats, L.C., Dakin, K., & Joshi, M. (Eds.) (2012) Expert perspectives on interventions for reading: A collection of best-practices articles from the International Dyslexia Association. Baltimore: International Dyslexia Association.
Moats, L., & Rosow, B. (2010) The Speech to Print Workbook, 2nd
Edition. Brookes.
68