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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?