Assessing and Differentiating Reading Disorders

Linda J. Lombardino, Ph.D.Professor of Speech-Language Pathology

School of Special Education, School Psychology and Early Childhood Studiesllombard@ufl.edu

Presentation at The Ohio State University

Department of Speech and Hearing ScienceJanuary 26, 2012

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Aims of Assessing and Differentiating Reading & Writing Disorders: Multidimensional Model

• Overview of component skills needed for skilled reading

• Developmental Schemes for core components• Identify core weaknesses that underlie the

struggling readers’ difficulties• Show sample tests for core areas• Provide diagnostic profiles with scientific support• Recommend specific treatments for case studies• Provide information on counseling parents

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Part 1 – Model/Framework

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Language Knowledge

Word retrieval

Discourse

Syntax

Morphological Knowledge

Vocabulary

Environmental Factors

Neurological Factors

Grapho-phonemic Integration

“Alphabet principle”

Word level reading

Word level

spelling

Text level writing

Text level reading

Phonological Knowledge

Print Knowledge

READING ACHIEVEMENT

Multidimensional Model for Assessing Reading and Writing (MARwR)

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Spoken Language Vocabulary Understanding of words and word meanings in both spoken and written language

Word retrieval Accessing pronunciations of words or sound patterns stored in memory

Morphological awareness

Understanding that morphemic units exist in words and contribute to the meaning of the word

Syntactic knowledge

Understanding how to use grammatical rules and to adhere to word order, morphological markers, and other syntactic constraints of one’s language

Discourse skills Understanding causal connections and inferences in texts

Print KnowledgePrint awareness Knowledge of book conventions, concept of word in print, and print mechanics

Letter knowledge Knowledge of letter names and ability to write letters that represent letter names

Word awareness Knowledge that words can be segmented into separate units that represent individual spoken words

Phonological KnowledgePhonological awareness

Awareness that the stream of speech can be broken down into smaller units

Grapho-phonemic Integration Phonics knowledge

Mapping phonemes (sounds) onto graphemes (letters)

Invented spelling Knowledge that sounds are represented by letters in some consistent way and use of this knowledge to create spellings prior to conventional instruction

Skills Targeted in MARwR [

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Word-Level Reading and Spelling

Decoding Segmenting letters in words into corresponding sounds, then blending sounds to create real words or nonsense words

Word recognition Recognizing familiar words in print (sight-word recognition) such that sight of spelling patterns results in immediate word recognition

Spelling Remembering spelling for sound units (e.g., -ight sounds

like /ai/) and knowledge of rules that determine word pronunciations (e.g., silent e dictates the pronunciation of site)

Text-Level Reading

Reading comprehension Understanding the meaning of information in print

Reading fluency Reading words and text accurately and effortlessly

Text-Level Writing

Mechanics & conventions Handwriting and punctuation

Composition Planning, translating, and reviewing written text

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Part 2- Developmental Hierarchies for Core Component

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Table 2-1. Ehri’s three-phase model of word-level reading

• Phase I: Pre-Alphabetic Stage of Word Reading• Preschool (aka visual cue stage)• Key characteristic/strategy: • Learners recognize words by connecting salient visual cues within or around the word with words’

pronunciations or meanings (aka visual cue reading)• • Primary Indicators:• Recognizes a word only when it occurs in a specific context• Does not recognize when letters in a word are replaced or letters are re-arranged (e.g., Pepsi spelled as

Zepsi)• Unable to identify letters in own the printed name even if name is recognized• • Examples:• Relies on contextual cues such as familiar logos (e.g., McDonald’s golden arches) to recognize a

McDonald’s sign• Relies on the shape and color of a stop sign to recognize the word “STOP”• Relies on a meaningful pattern such as the two eyes in the word “bee” or the circle at the end of Pogo’s

name to recognize these words in print• • “Because the visual cues forming connections are not unique to individual words, children mistake

visually similar words for one another (Ehri, 1992, p. 125).

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Stages of reading acquisition cont.• Transition from Pre-Alphabetic to Partial Alphabetic Stage• • Learners begin to use knowledge of a few letter names to form connections between letters and

corresponding sounds at the beginning or end of words ( e.g, child uses the letter “l” to represent the sounds in “ball” when attempting to spell it).

• • Phase 2: Partial Alphabetic Stage of Word Reading• Kindergarten (aka phonetic cue stage)• Key characteristic: • Learners recognize words by connecting letters with sounds• • Primary Indicators:• Knows the names of most letters in the alphabet• Shows the ability to segment the initial sound in a word from the remainder of the word• Uses knowledge of letter names and ability to partially segment words (phonemic awareness) to make systematic

connections between letters and their corresponding sounds, especially at the beginning and ends of words. Knowing letter names gives access to phonetic cues that can be used to attempt word reading

• • Examples:• Spelling flower as “FLR” by using letter names to guide spelling• Misreading simple words such as “ for” for “from” and “like” for “lake ” while indicating that that s/he is using phonetic

cues as a strategy for reading.• “It is important to note that sight word reading during the partial alphabetic phase is an imperfect process that occurs among

be)ginners who lack full knowledge of the alphabetic system and phonemic segmentation skill (Ehri, 2005, p. 145).

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Stages of reading acquisition cont.Phase 3: Full Alphabetic Stage of Word Reading

First-Second Grade (aka alphabetic coding stage)

Key characteristics: Learner can integrate knowledge of phonemic segmentation with knowledge of

letter-sound associations to decode words Learner is able to quickly identify familiar words by retrieving spellings and

pronunciations stored in memory. Primary Indicators: Segments and blends unfamiliar, phonetically regular words to arrive at accurate

pronunciations of words in print.At this level, children are “… able to form connections between all of the graphemes in spellings and the phonemes in pronunciations to remember how to read words” (Ehri, 2005, p. 148)

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Figure 2-7 (fluency )

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Figure 2-9 (reading processes for text comprehension)

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Figure 2-10 (writing processes for text composition)

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Figure 2-11(developmental scheme of reading skills for reading

achievement)

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Part 3Protocol of Component Strength and Weaknesses

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Summary Sheet for Weaknesses and Strengths

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Part 4-Diagnostic Classifications

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Profiles/ClassificationsPreschool – First Grade

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At Risk Classifications for PK – First Grade ChildrenProfile 1: Mixed Language and Emergent Literacy Deficit

Mild to severely depressed language production and/or comprehension

Difficulty in one or more phonological processes Low normal to above average nonverbal intelligence Absence of primary visual, auditory or motor disabilities

Profile 2: Emergent Literacy Deficit

Normal language with or without a history of articulation difficulties Difficulty with emergent literacy skills especially letter knowledge

and sound-letter associations Low normal to above average nonverbal intelligence Absence of primary visual, auditory or motor disabilities

Profile 3: Environmental Disadvantage Deficit

Overall depressed pre-academic skills with or without previous identification of a language delay or disorder

History of diminished opportunities for exposure to language and to literacy concepts at home and/or in school

Low normal to above average nonverbal intelligence Absence of primary visual, auditory or motor disabilities

Classifications

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Profile 1 Mild to moderate

mixed spoken language & emergent

literacy deficit

Profile 2 Emergent literacy

deficit

Profile 3 *Environmental

disadvantage deficit

Spoken languageknowledge _ + -/+

Phonological knowledge -/+ -/+ -/+

Grapheme-Phoneme knowledge

-/+ _ -/+

Early Literacy Classifications (4-7 years)

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Brittany Profile 1

Severe spoken language & emergent literacy deficit

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Amanda Profile 1

Moderate mixed language and literacy

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Carlos Profile 2

Emergent literacy Deficit

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Profiles/ClassificationsFirst Grade & Beyond

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Profile Type Spoken Language characteristics Reading and Writing Characteristics

Profile 4: Mixed

Spoken and Written

Language Disorder

Exhibits depressed oral language

abilities in one or more domains of

language (e.g., semantic, syntax,

pragmatics), however, deficits in

phonological processing

(awareness, memory, rapid) are

often mild and sometimes do not

occur

Typically has a history of early

language impairment

Often shows deficits in production

of oral language narratives and

other forms of oral discourse

Often shows deficits in use of

morphological and syntactic forms

Can exhibit relatively good word

recognition and reading fluency, and

spelling

Exhibits depressed reading comprehension

Exhibits depressed writing composition in

terms of story grammar and other structural

elements of discourse

Morpho-syntactic and semantic errors are

often observed in written composition

Classifications for End of First Grade and Beyond

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Gail (9 years)Profile 4

Mixed language and literacy

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Gail (9 years)Profile 4

Mixed language and literacy deficits

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Profile 5:

Dyslexia

Deficits in phonological and orthographic

coding along with a lack of fluency in reading

Depressed ability to remember the precise oral

pronunciations of words learned, particularly

when they consist of multisyllabic and

complex constructions.

Relatively frequent history of articulation

therapy

Low average or above language production

and comprehension skills depending on the

severity of the word reading deficit

Listening comprehension exceeds reading

comprehension although sometimes holding

lengthy oral directions in memory is difficult

Handwriting varies from good to very poor

Writing conventions, such as punctuation and

capitalization are often ignored or misused.

Depressed phonological decoding of

nonwords, word reading, spelling, and

reading fluency

Listening comprehension exceeds word

reading and reading fluency

Spelling is always impaired and retention

of word spelling is very difficult

Writing mechanics including punctuation

conventions are typically poor.

Morph-syntactic deficits may be apparent

in written language

Handwriting can range from good to

illegible but is typically of poor quality

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Evan (10 years) Profile 5Dyslexia

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Evan (10 years) Profile 5Dyslexia

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Profile 6: Reading

Comprehension

Disorder

Typically unidentified with

learning difficulties until 4th

grade and beyond.

Average to strong phonological

decoding and word recognition

Relatively weak language

comprehension skills at the word

and discourse levels

Weaknesses in telling well

structured and integrated stories

orally and in writing

Variable performance on tasks of

working memory

Word level reading, decoding

and spelling are all superior to

reading comprehension

Depressed reading

comprehension skills,

particularly beyond a 3rd-4th grade

reading level

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Harry (14 years)Profile 6

Reading Comprehension Deficit

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Harry (14 years)Profile 6

Reading Comprehension

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Profile 4: Dyslexia Profile 5 : Mixed Spoken Language and Literacy

Profile 6:Comprehension Deficit

Listening comprehension

Language concepts

+ _ -/+

Word-level reading _ -/+ +

Reading fluency_ -/+ +

Reading Comprehension + _ _

Diagnostic Classifications

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Examples of Treatment Recommendations

DyslexiaOrton-Gillingham based approach to reading.Lexercise (http://www.lexercise.com/), an advanced Web-based treatment program for children who have dyslexia or other language-based learning disabilitiesTouchmath program (http://www.epsbooks.com)Ginger software (http://www.gingersoftware.com)

Mixed Spoken Language and LiteracyLanguage intervention that targets words meanings in the context of listening comprehension activitiesReading intervention that targets strengthening her reading fluency and improving knowledge of word meaningsLanguage Tune-Up Kit at Home Reading Software.Quick Reads: A Research-Based Fluency ProgramTouchmath program (http://www.epsbooks.com)

Comprehension DeficitStrategies for achieving reading comprehension for narrative and expository textsSemantic webbing strategiesComprehension monitoring strategiesMaking Connections: Explicit Instruction for Comprehension Skills and Strategies

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In-take Forms

• Appendix 3-1. Caregiver/teacher questionnaire for preschool-early first grade children

• Appendix 3-2. Caregiver/teacher questionnaire for school age children at the end of 1st grade and beyond

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Part 5Discussing & Interpreting Diagnostic Reports

Group Activity

Interpretations Recommendations

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Sample #1Student: 6 year, 4 month old female• At risk for language and literacy deficit

• RECOMMENDATIONS• JJ should begin therapy focusing on:

– Reading for recognition and decoding– Reading in words and sentences– Spelling in words and sentences– Listening comprehension using small graded paragraphs and then discussing the

content– Accurate copying of numbers and words from a close distance and then further away– Math skills including addition and subtraction of single digits

• • It is recommended that JJ be examined to rule out Attention Deficit Disorder (ADD)• • Recommended testing location:

– Sarkis Family Psychiatry

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Sample #2Student: 5 year ,7 month old male • exhibits characteristics that are consistent with a diagnosis of developmental dyslexia

(ICD-10-CD Code 315.02.

Recommendations:• Andy is a bright child who presents with developmental dyslexia. Therefore, intervention and

academic accommodations are essential for Andy to perform at his full potential. Andy can be successful if he is provided with appropriate and adequate methods of reading instruction.

• The severity of Andy’s dyslexia creates an impairment that significantly hinders several major life activities, including reading and writing, learning, and listening. To meet Andy’s educational needs as adequately as other children his age, Andy will need the following classroom accommodations as he advances through elementary school, which can be provided through a 504 plan.

• Andy should be given more time on tests and other class work.Andy should not be required to copy notes from the board, an overhead, or a book. Instead, the teacher should provide Andy with a copy of her own notes/overheads

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Sample 2 cont.• Andy should be allowed to type all written assignments.

• Andy’s spelling tests should not be graded. Because children with dyslexia are not able to master spelling the traditional way, Andy will be taught by a tutor using a different method. Until Andy’s spelling reaches grade level, he should be allowed to take spelling tests with his class, but they should not be graded.

• Andy should be given reduced homework assignments in all of his subjects. The amount of homework required should be based on the time it would take students without the disability to complete the assignment. The number of problems or length of an assignment should be reduced, with feedback from his parents, until Andy is spending no more than 1 ½ the amount of time on homework as a student without dyslexia would spend.– These same accommodations should be provided on all standardized tests.

• Andy should be enrolled in a multi-sensory phonics and fluency-based instructional program. Examples of such programs are: a) Barton Reading and Spelling System and b) Lindamood Phoneme Sequencing (LiPS)®. The features of these approaches are listed below.

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Sample 2 cont

Recommendations: The Barton Reading and Spelling System® is a tutoring program, which parents, volunteer tutors, resource specialists, and professional tutors can use with children, teenagers, and adults who have learning difficulty. It is an adapted and simplified version of the Orton-Gillingham approach to teaching reading and spelling. It includes fully scripted lesson plans, plus all reading material, spelling lists, homework pages, and training videos.

The Lindamood Phoneme Sequencing (LiPS)® program is a multi-sensory, multifaceted program of phonemic awareness training of reading and spelling, based on a phonological foundation and rooted in the motor-articulatory feedback theory. This program facilitates perception of contrasts between speech sounds and the order of sounds in syllables in words, a critical skill needed for reading and spelling. A distinctive feature of the program is that the student is taught to self-correct rather than be given the right answers. If this program is chosen, Andy should attend therapy sessions implementing this program a minimum of three times per week. Components of the LiPS program are listed below:

Identifying and classifying speech sounds (consonants and vowels) Tracking speech sounds (isolated sounds and sounds in syllables) Associating sounds and syllables Applying this sound-symbol knowledge to spelling (encoding) and reading (decoding)

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Sample #3Student: 9-year-old 1-month female (home schooled)• profile of strengths and weaknesses consistent with a diagnosis of

Developmental Dyslexia (ICD-9 Code 315.02).

Recommendations• The instruction must start with phonemic awareness instruction, followed by

a systematic approach to phonics, both analytic and synthetic.

• It must also teach reading and spelling as related subjects with intense practice and constant weaving of the concepts taught.

• Orton-Gillingham-based systems such as the Barton Reading and Spelling Program, Wilson Reading System, and the Slingerland Approach meet these requirements.

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Sample 3 cont.

Recommendations continued• Enroll Rose in a more traditional school setting, however, it

is imperative that school personnel be made aware of Rose’s need for educational support.

• Enroll in Tier III reading instruction

• At this level of intervention the reading instruction at school is intensive (i.e., 1:1 – 1:3 ratio), systematic, and provided for ninety (90) minutes per day in addition to her regular classroom reading instruction. (For more information on the Tier Model, the reader is referred to www.fcrr.org)

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Sample 3 cont.

Accommodations • The severity of R’s reading disability creates an

impairment that substantially limits several major life activities, including reading, writing, learning, and listening. To meet her educational needs as adequately as a child without these disabilities, Rose will require classroom accommodations, which can be stipulated on a 504 Plan or an IEP.

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Sample #4Student: 10-year-old male• E’s scores from the present evaluation, along with

parent observations, educational difficulties, and family history are consistent with a diagnosis of developmental dyslexia (ICD-10-CD Code 315.02)

Recommendations• E be enrolled in a multi-sensory phonics- and fluency-

based instructional program, which provides intense one-on-one intervention

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Sample 4 cont

Some examples are:• The Orton-Gillingham Method• Barton Reading and Spelling Program• The Wilson Reading System• Specialized Program Individualizng Reading Excllence (S.P.I.R.E)• The Slingerland Multisensory Approach• The Herman approach• Alphabetic Phonics• LANGUAGE!• Lindamood-Bell

Programshttp://www.linguisystems.com/getourcatalog.php

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Sample 4 cont.• E’s parents consider a computer-based program such as the Touchmath

program (www.epsbooks.com) to assist in facilitating his math skills. This program uses a multisensory approach to teaching basic math skills.

• E’s parents read grade-level books to him or have him listen to grade-level books on tape in order to support his vocabulary growth. Some ideas for grade level books can be found on the website www.bookadventure.org. On this website BW can find a list of books that interest him on his reading level and also earn points for each book he reads that can be redeemed for awards and prizes.

• Mrs. EE have E evaluated to rule out Attention Deficit Hyperactivity Disorder (ADHD) because she is concerned about E’s difficulty sitting still and because there is a high incidence of Attention Deficit Hyperactivity Disorder (ADHD) in children who have dyslexia.

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Sample # 5Student: 16 year, 1 month old male• revealed a profile of strengths and weaknesses that is consistent

with a diagnosis of Mixed Receptive/Expressive Language Disorder (ICD-9 code 315.32) and Reading Disorder (unspecified) (ICD-9 code 315.00)

Recommendations• F receive language therapy, whether through the public school

system or privately, to work on his language processing for in both listening and reading comprehension.

• F should benefit from therapy that would give him comprehension support, such as Visualizing and Verbalizing for Language Comprehension and Thinking Program.

• Additional reading comprehension strategies would also be useful, including pre-reading, highlighting, outlining, and use of graphic organizers.

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Sample 5 cont.

Accommodations

• F be given extra time on tasks and tests that require memory and recall, especially in math class. Students with language-based disabilities have an especially difficult time memorizing rote facts such as addition and subtraction facts and the multiplication tables. Because of this, F should be allowed to use a calculator for his math assignments, math tests, and classroom work.

• F should not be required to copy from the board, an overhead, or from the book. The teacher should provide an outline and copy of the notes.

• F be given advance organizers, graphic organizers, and study guides before beginning each new content area in all subjects. He will need these to organize daily reviews at home.

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Sample 5 contAccommodations cont

• 4. F have access to a note taker for class lessons.• 5. F have the option for a foreign language requirement waiver exemption

or to take replacement requirement. A student who has a language-based disability in his native language will experience it in a foreign language as well. For a student who is struggling with English, learning a foreign language is typically extremely difficult.

• 6. F’s academic progress monitored regularly to ensure that accommodations gives are effective.

• 7. F will need to have extra time and possibility other accommodation if he takes nationally standardized tests such as the Scholastic Aptitude Test (SAT). Refer to www.ets.org

• for further information on accommodations for high-stakes testing.

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Sample #6Student: 20-year 8- month-old female attendingat a state university, majoring in biology, hoping

to attend medical school. • exhibits characteristics that are consistent with a diagnosis of

Developmental Dyslexia (ICD-10-CM Code 315.02)

Recommendations• SS register with the Student with Disabilities Office at the

University of Florida in order to receive the necessary assistance with her academic courses.

• SS be exempt from taking university/college level foreign language requirements in lieu of taking alternate courses.

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Sample 6 cont.• SS receive extended time on all tests administered, as well as

having the testing material provided verbally, if necessary.

• SS be allowed to tape record all classes.• SS be provided with a note taker, if necessary.• SS outline texts as she reads to maximize reading

comprehension. • SS should visit the website for the Florida Branch of the

International Dyslexia Association (IDA): www.Interdys.org for more information on dyslexia.

• These same accommodations must be provided on all standardized tests.

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Thank You!