Handwriting, of course, is a motor skill that requires the precise coordination and timing of different muscle groups. Lack of coordination of these muscles due to a cerebellar deficit would create difficulties in writing, a characteristic that many dyslexics display. Problems with spelling would arise from poor phonological awareness, trouble with word recognition, and difficulties in automating spelling rule skills. It remains to be seen whether these problems will lessen or worsen as children become more accustomed to composing text on keyboards, and as more schools abandon instruction in cursive writing.
The possibility of deficits in visual and auditory perception and memory as well as in motor coordination on various reading tasks accounts for the wide range of individual differences observed among those with reading disorders. Analyzing these differences leads to a better understanding of the multidimensional nature of reading disorders and possible treatment.
Figure 5.6 The cerebellum is located at the rear of the brain and is responsible for coordinating learned motor skills.
Attention Deficit/Hyperactivity Disorder
Attention deficit/hyperactivity disorder (ADHD) is a developmental disorder characterized by difficulty in focusing and sustaining attention. Children with ADHD are often assumed to also have developmental reading problems. But that is not necessarily the case. ADHD and developmental dyslexia are separate disorders, although some brain regions may be affected by both. Estimating the exact percentage of ADHD children who also have dyslexia is difficult because of the inconsistency of criteria used for diagnosis. The accepted range at the time of this printing is between 15 and 40 percent (Kibby et al., 2009).
Answer to Test Question #6
Question: Most children with attention deficit/hyperactivity disorder (ADHD) are also dyslexic.
Answer: False. ADHD and developmental dyslexia are separate disorders. Less than one-half of ADHD children also have dyslexia.
Is Dyslexia Present in Readers of Other Languages?
Dyslexia appears in all languages, including those that are read from right to left, such as Hebrew and Arabic. People with dyslexia who speak highly phonetic languages with shallow orthography, such as Spanish, Italian, and Finnish (see Chapter 2), are usually identified with the disorder later than those who speak deep morphological languages such as English, where the linguistic demands of the language are more challenging. English speakers experience the complex phonetic structure early on in their schooling. Readers can also encounter difficulties in logographic languages, such as Chinese, due to visual confusion of the more than 3,000 characters or problems with working memory and recall (Siok, Spinks, Jin, & Tan, 2009).
DETECTING READING PROBLEMS
In recent years, researchers have made significant progress using fMRI scans to understand how novice, skilled, and dyslexic brains read. Yet, despite these advancements, fMRI scans are not a practical tool at present for diagnosing dyslexia in a single individual. That is because the results of fMRI studies are usually reported for groups rather than for individuals. Researchers have found some variations in the activated areas of the brain among individuals within both the dyslexic and control groups. More research is needed to clarify these differences before fMRI or any other imaging techniques can be used for diagnostic purposes. Until that time, however, researchers can use the information gained from imaging studies to develop other kinds of diagnostic tests that more closely align with our new understanding of dyslexia.
For the moment, critical observation of a child’s progress in learning to speak, and eventually in learning to read, remains our most effective tool for spotting potential problems. Most difficulties associated with reading do not go away with time. Therefore, the earlier that parents and teachers can detect reading problems in children, the better. The problems often begin to reveal themselves first in spoken language and later while learning to read.
Spoken Language Difficulties
We discussed in previous chapters that learning to read is closely connected to fluency in spoken language. Both speaking and reading rely on the proper functioning of the phonologic areas of the brain where sounds are combined to form words and words are broken down into their basic sounds. Consequently, difficulties that children have with spoken language are often clues to potential reading problems. Parents and teachers should remember that it is normal for all children to make occasional language errors while speaking. But frequent language errors, stemming from any one or a combination of the following conditions, could indicate that a child may run into trouble when beginning to learn to read.
Some of the spoken language difficulties may involve any one or more of the following (Dehaene, 2009; IDA, 2003; NAEYC, 1998; Shaywitz, 2003):
• Delay in speaking. Children generally say their first words at about 12 months of age and follow with phrases when between 18 and 24 months old. Because learning to read is closely linked to a child’s phonologic skills in spoken language, delays in speaking may be an early indication of potential reading problems, especially in a family that has a history of dyslexia.
• Difficulties with pronunciation. Children should have little difficulty pronouncing words correctly by 5 or 6 years of age. Difficulties in pronouncing words (sometimes referred to as “baby talk”) may be an indication of future reading problems. Such trouble pronouncing long or complicated words could signal a snag in the parts of the brain that generate spoken language, causing a mix-up in the processing of the phonemes. Mispronunciations often involve mixing syllables within words (aminal for animal) and leaving off the beginning syllables (luminum for aluminum).
• Difficulty in learning the letters of the alphabet. Learning the names of the letters of the alphabet is an important, though not essential, step in learning to read. Marked difficulties in learning the letters could indicate a potential reading problem.
• Recalling incorrect phonemes. A child looks at a picture of a donkey and recalls the word doggie, a word similar in sound but not in meaning. This recall of incorrect phonemes may cause a child to talk about a word without actually recalling it. The child may get frustrated because of the inability to say the word. As these children get older, they may resort more to vague words in order to mask their difficulties in retrieving specific words. They use general words like things and stuff, making their conversations hard to follow. It is important to remember that the problem here is not with their thinking, but with their ability to use expressive language—that is, to recall a word on command.
• Insensitivity to rhyme. Part of a young child’s enjoyment of spoken language is playing with rhyme. Hearing and repeating rhyming sounds demonstrates how words can be separated into smaller segments of sound, and that different words may share the same sound. Children with good rhyming skills are showing their readiness for learning to read. Those with little sensitivity to rhyme, on the other hand, may have reading problems because they are unable to detect the consonant sound that changes the meaning of closely rhyming words.
• Genetics. We mentioned earlier that heredity is a key factor in dyslexia. Looking at the family tree for signs of dyslexia in close relatives is a clue because about 25 to 50 percent of the children born to a dyslexic parent will also be dyslexic. Whether the child actually displays dyslexia depends somewhat on that child’s environment. This revelation came from studies of identical twins. Because they share the same genes, if one twin has dyslexia, so should the other. But in reality, in 30 to 35 percent of the cases, one twin is dyslexic while the other is not (Fisher & DeFries, 2002). Apparently, even though these children had a genetic predisposition for dyslexia, differences in the home and school environments played important roles in determining how successful these children would be at learning to read.
Looking for Early Indicators of Reading Problems
Until the time that brain imaging becomes a standard diagnostic tool, researchers will continue to look for ways to accurately identify students with reading problems as early as possible. Multip
le research studies have sought to find indicators of reading problems that are more valid than solely the professional judgment of the evaluating team. The obvious problem here is that the application of professional judgment is only as good as the training and competence of the team members. This approach can often lead to considerable variability in identification from one school district to another, and even from state to state. Using more objective measures would reduce this variability. Research studies have found that letter fluency is a useful measure in kindergarten, while response to instruction can be a valuable measure in second grade.
Letter Fluency Tasks as Kindergarten Indicators
The earlier that children who are at risk for reading problems can be identified, the better. Trying to carry out such identification procedures in kindergarten is difficult because of the broad range of background experience these children bring to the classroom. Nonetheless, studies involving kindergarten children do seem to indicate that letter-name fluency and nonsense word fluency can be valid indicators of early reading skills, such as oral reading fluency (ORF).
One study (Speece & Mills, 2003) tested 39 kindergartners in the spring in several language skill areas, including receptive vocabulary, phonological awareness, letter-name knowledge, letter-sound knowledge, letter-name fluency, and nonsense word fluency. These same children were again tested one year later in first grade in similar skills, plus ORF. Nonsense word fluency and letter-word fluency, respectively, were the highest predictors of ORF. In fact, the fluency measures were more accurate at predicting ORF than national normed measures of reading and phonological awareness, which identified only 33 percent of the poor readers in this study. Subsequent studies have found similar results (e.g., Burke, Hagan-Burke, Kwok, & Parker, 2009).
Using Response to Intervention
Another technique for avoiding the misidentification or nonidentification of students with reading problems is to place increased emphasis on measures of school performance, especially in the primary grades. The response-to-intervention (RTI) model identifies students based on low achievement, application of certain criteria for exclusion, and their response to varying degrees of interventions. The goal is to screen all students to identify those who, despite a strong general education program in the regular classroom, are still failing. In Tier 1, they receive careful monitoring and special assistance as needed. Students who do not make adequate progress in Tier 1 move to Tier 2 where they receive targeted evidence-based interventions, usually from a team of educators. If more assistance is needed, the student moves to Tier 3, which involves more frequent and intensive interventions by a multidisciplinary team. Some schools and districts also have a fourth tier, while in others students in Tier 3 are identified as being in need of special education services. All students in an RTI model can move between tiers according to their rate of progress.
Models for RTI Identification. A survey of the research literature reveals several models that exist for using the RTI process to identify students at risk for reading difficulties. Three of the most common models proposed by researchers include the direct route models, the progress-monitoring models, and the risk index models. Here is a brief description of each:
• Direct route models: Students who are identified by screening measures as being at risk for reading difficulties are placed immediately into Tier 2 intervention. Screening is often done through the results of one reading skills measure (e.g., word identification) (Jenkins, Hudson, & Johnson, 2007). The problem with this model is that it may mistakenly identify students as being at risk.
• Progress-monitoring models: Students who are initially identified as at risk for reading difficulties are monitored for a number of weeks to see if their performance improves. This model helps to prevent students who were identified at the beginning of the school year as at risk when, in fact, their reading performance may have decreased simply due to the summer break. These students often respond positively to the first few weeks of reading instruction and will no longer be considered at risk. Progress-monitoring models have resulted in high levels of accuracy in studies examining their use, especially for students in the first grade (Compton, Fuchs, Fuchs, & Bryant, 2006). Although this model has a higher predictive value, it also postpones interventions during the monitoring phase.
• Risk index models: Identifying students at risk with this model involves looking at all variables collected on a student, including assessment results and other related factors, such as when the student is an English language learner, and the education level of the student’s parents. The probability for risk is reported as a percentage of students who have similar profiles and who later performed poorly on some measure of reading skills. Thus, the higher the risk index, the greater the likelihood that the student may encounter difficulties when learning to read. Because risk index models take into account the impact of numerous variables, they tend to be more accurate than screening processes that rely on only a single measure (Johnson, Jenkins, Petscher, & Catts, 2009).
Screening Measures. Some screening measures have a higher predictive value of future reading ability than others. A comprehensive review of research studies found the following screening tools effective for Grades 1 to 3:
• Grade 1: Word identification fluency (WIF), letter knowledge, and phonological awareness are the common measures. Studies show that WIF is one of the strongest predictors of reading ability at this grade level (e.g., Compton et al., 2006).
• Grades 2 and 3: ORF and WIF are the measures regularly used. Although there are fewer studies of screening measures for these grades, both of these tools are strong predictors, especially for second-grade students.
Studies that tested this approach provided children in primary grades with incremental periods of instruction, usually through RTI, and moved them out when they made adequate progress. One study used data from nearly 400 linguistically diverse students to examine the usefulness of RTI measures in Grades 1 and 2 for predicting reading difficulties at the start of Grade 3 (Beach & O’Connor, 2013). Reading skills measured in first grade included oral reading fluency, phoneme segmentation fluency, and nonsense word fluency. Measures in second grade included tests of word identification, word attack, and word and passage comprehension. Students at both grade levels who met the intervention criteria were placed in small groups of two to three students and received support as needed for 25 to 30 minutes, four times per week. The instruction focused on letter-sound correspondence, sight word identification, decoding, and reading of sentences and decodable books. Some of the second-grade students needed practice in word study with multisyllabic words, vocabulary, and comprehension activities. They also received support in reading and rereading books at the students’ current reading level, as well as opportunities for short spelling and sentence writing. English language learners were also included in these groups and received the same instruction.
The students were assessed at the beginning of third grade using tests of written spelling, ORF, picture vocabulary, word attack, WIF, and passage comprehension. The results showed that measures of first-grade WIF and second-grade ORF had correctly identified nearly 89 percent of students with reading difficulties (including English language learners), compared to 86 percent for average readers. Other measures, such as passage comprehension, also contributed to the identification, but to a lesser degree. This multifaceted identification process ensured that students with reading difficulties were monitored and given extra support in third grade, as needed. The study reaffirms the value in using multiple measures in the early primary grades to identify children at risk for reading difficulties.
Predictive Power of the Measures. One critical element of identifying children at risk for future reading difficulties is deciding which screening measures to use. As we mentioned earlier, many measures are commercially available, but not all have the same degree of predictive power. If an RTI model is to be effective, the screening procedures need to include measures that accurately
identify all students at risk for reading problems (true positives), while reducing the number of students who are incorrectly identified (false positives). Practitioners who perform such screening should use care in selecting these measures. Some studies have evaluated the predictive power of the more commonly used measures for assessing the students’ level of reading skills (e.g., Petscher, Kim, & Foorman, 2011).
Remember that all children make errors in spoken language and while reading. But the number of errors should decrease with time, and there should be clear evidence of growth in vocabulary and reading comprehension. Determining whether a child has consistent problems with reading requires careful and long-term observation of the child’s fluency in speaking and reading. Most children display obvious improvements in their speaking and reading skills over time. Researchers, clinicians, and educators who study dyslexia and who work with poor readers look for certain clues that will show whether a child’s reading ability is progressing normally.
The checklists that follow contain indications of reading problems commonly found in struggling readers, including those diagnosed with dyslexia. The indications have been gathered from several sources (e.g., Birsh, 2005; Brady & Moats, 1997; Clark-Edmands, 2000; IDA, 2003; Munro & Dalheim, 2008; NAEYC, 1998; Shaywitz, 2003; Stinson, 2003) and are separated into grade-level groupings. The lists are not intended to be used for final diagnosis. Diagnosis of dyslexia or any other learning disorder can be made only by experienced clinicians. However, the lists will help you to assess the degree of difficulty a child may be having in learning to read and to determine whether additional testing and consultations are required.
How the Brain Learns to Read Page 18