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Steven G. Feifer, D.Ed., NCSP, ABSNP Feifer@comcast.net
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 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.
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.
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).
NASP 2011 LD Position Statement
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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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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
(PSW Model)
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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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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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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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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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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HORIZONS FAST TRACK A-B
* 150 Lessons – 50 minutes per lesson
* Highly scripted….designed for Grades 2 and above
* Letter sounds taught in two families:
1) F,L,M,N,R,S,X,Y - last part of sound makes letter.
2) B,D,J,K,P,T,V,Z - initial sound is the letter.
* After consonants are learned, orthographic prompts color
code blends. For instance, the blue letter makes no sound
and the black letter says its name:
ay
ea * Word attack activities emphasizing decoding and critical
vocabulary prepare students for upcoming stories
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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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Wilson Reading System
Designed specifically for adolescents and adults with dyslexia. Also, very appropriate for ELL students.
Recommended 4-5 days per week…45 -90 min per day.
Emphasis is on six syllable subtypes:
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”)
Students create their own diacritical markers.
Students rely upon finger tapping to learn syllable boundaries.
Comprehension component does not rely upon
metacognitive strategies, but rather visualization.
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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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Read Naturally
A fluency based program designed to develop speed, accuracy, and proper expression.
Designed to be used 3 times per week…30 minutes, mainly for students between 2nd (51wpm) though 8th (133 wpm) grades.
Each level of the program has 24 non-fiction stories. a) Student placed in level and goal is set.
b) Cold read for one minute graphing wpm and
identifying difficult words. c) Read with tape three times consecutively.
d) Hot read is attempted.
e) Comprehension questions involve main idea, details, vocabulary, inferences, and short
answers.
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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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Read 180 (Dr. Ted Hasselburg)
A 90 minute per day balanced literacy program.
Designed for grades 4th – 12th. 1) 20 minute whole group instruction where teachers
model fluent reading skills.
2) Students then move to three-20 min stations. a) Teacher Station – small group differentiated
instruction to reinforce previous concepts.
b) Computer Station: - Reading Zone (phonics, fluency, vocab)
- Word Zone (automaticity of decoding)
- Spelling Zone - Success Zone (comprehension strategies)
c) Library Station – read silently and written
language activities.
Software adapts level of instruction to learner.
Expensive, but research based…recommended for most struggling readers.
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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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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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