Why Do Children Struggle with Reading? Do They Have Dyslexia? Eileen C. Vautravers, M.D

Remember This: If you look for dyslexia in your students, you will find it!

Outline of Presentation 1. Facts about reading 2. Dyslexia definition and genetics 3. Common signs of risk for dyslexia 4. Neurobiology of dyslexia 5. Brain rewiring by evidence-based phonologic reading instruction 6. Treatment

U.S. Facts about Reading 1. 95% of all children can learn to read % of elementary children struggle with learning to read % of elementary children do not read fluently enough to enjoy or engage in independent reading.

U.S. Facts about Reading 4. Reading failure occurs in 60%-70% of African-American, Hispanic, ESL and poor children % of youth in juvenile justice system are functionally illiterate. 6. One-third of poor readers live in college-educated families.

U.S. Facts about Reading 7. According to American Federation of Teachers, some children never learn to read unless taught in an organized, systematic, efficient way using a well- designed instructional approach by a knowledgeable teacher % of adults lack basic literacy skills required in a typical job.

Dyslexia 1. Difficulty with reading words 2. Receptive language-based learning disability (LD) 3. Difficulty with phonological (sound) part of language 4. Manifests as difficulty with reading, writing, spelling, comprehension and/or fluency

Dyslexia (Cont) 5. 20% of children have LD 6. 80% of LD are dyslexia 7. Most common specific LD: 16% - 20% 8. “Dyslexia Spectrum Disorder” 9. # males slightly > # females 10. Children do not outgrow it

IDA Definition Dyslexia is: A specific learning disability that is neurologic in origin. It is characterized by difficulties with accurate and/or fluent word recognition, and by poor spelling and decoding abilities.

IDA Definition (Cont) These difficulties typically result from a deficit in the phonological component of language, often unexpected in relation to other cognitive abilities, and the provision of effective classroom instruction.

IDA Definition (Cont) Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede the growth of vocabulary and background knowledge. November 12, 2002

Types and Causes 1. Secondary dyslexia – lack of activation of normal brain wiring for reading a. Environmental deprivation b. Poor school reading instruction

Types and Causes (Cont) 2.Primary dyslexia – absence of brain wiring to left hemisphere posterior reading systems a. Genetically programmed error in wiring b. 40% chance a sibling, parent, child of affected person will have dyslexia c. 5%-6% chance child will have dyslexia if parent/siblings don’t

At-Risk Signs of Dyslexia in Preschoolers Predictive relationship between preschool language developmental delays and delays in emergent literacy skills with later having a reading disability

At-Risk Signs of Dyslexia in Preschoolers (Cont) 1. Late learning to talk 2. Difficulty with speech intelligibility 3. Frequent ear infections 4. Difficulty learning nursery rhymes and songs 5. Difficulty sequencing, as in counting, alphabet, days of week, months of year

At-Risk Signs of Dyslexia in Preschoolers (Cont) 6. Confusion with concepts (before, after) 7. Difficulty remembering object names 8. Difficulty rhyming words 9. Reticent 10. Less knowledge about books 11. Dislike/disinterest in reading

Oral Signs of Risk for Dyslexia in Early Elementary 1. Difficulty using age-appropriate grammar 2. Difficulty acquiring vocabulary 3. Difficulty listening and following directions 4. Substitutes sounds in words or words in sentences

Reading Signs of Risk for Dyslexia in Early Elementary 1. Difficulty distinguishing sounds in words 2. Difficulty learning sounds of letters 3. Difficulty learning and remembering alphabet letter names, shapes, sounds 4. Difficulty learning to read 5. Transposes order of letters when spelling or reading

Reading Signs of Risk for Dyslexia in Early Elementary (Cont) 6. Misreads/omits common short words 7. “Stumbles” through long words 8. Poor reading comprehension 9. Reads slowly

Writing Signs of Risk for Dyslexia in Early Elementary 1. Spelling errors in daily work 2. Difficulty proofreading 3. Difficulty putting ideas on paper 4. Poor handwriting

Characteristics of Children with Dyslexia  Difficulty with decoding and/or reading comprehension  Misshapen, laborious handwriting  Extreme spelling difficulty  Poor written composition  Difficulty in sequencing and following directions  Difficulty in recalling names of people, places and/or events  Poor oral expression  Difficulty with copying at near and/or far point  Disorganization in school and at home  Difficulty with time and space  Slowness in completing tasks  Poor performance on tests  Inconsistency in performance

Red Flags 1. Attention deficits and perceptual delays are red flags for LD 2. 25%-35% of ADHD have dyslexia 3. 15% of students with dyslexia have ADHD 4. 10%-40% of LD have ADHD 5. If either ADHD or LD exists, evaluate for the other

Red Flags (Cont) 6. Research shows ADHD must be adequately treated with meds for students to learn %-50% of those children whose families sought professional help for emotional or behavioral problems had LD. 8. If receptive and expressive language are age-appropriate, but student struggles with written word (reading, spelling), think dyslexia.

Assumptions 1. Average or above intelligence 2. Adequate instruction 3. Gifted in music, art, sports, mechanics, physics, math

Neurobiology of Reading 1. Nondyslexic Reader a. Left parieto-temporal – word analysis – slow; strong activation b. Left occipito-temporal – word form storage, fluent reading – fast; strong activation c. Left Broca’s area – Inferior frontal gyrus – slow; lesser activation

System for Reading in Young Dyslexic

Systems for Reading in Older Dyslexic Systems for Reading in Older Dyslexic

Neurobiology of Reading (Cont) 1. Dyslexic Reader a. No activation of fast left posterior reading systems b. Left Broca’s area, then bilateral, with increased activation of both to overactivation by adolescence - slow c. Gradual compensatory right brain posterior reading system - slow

Neurobiology of Dyslexia 1. Dyslexia is caused by an abnormality in the word analysis pathways of the brain that interferes with its ability to convert written words into spoken words (decoding). 2. Research supports this phonologic- coding-deficit theory of dyslexia.

Brain Rewired by Evidence-Based Phonologic Instruction 1. Functional MRI’s on young struggling readers – left Broca’s area 2. One year of sequential, explicit, multi-sensory reading instruction (Orton-Gillingham based) 3. Repeat fMRI’s - emergence of left posterior, right frontal and right posterior reading systems

Brain Rewired by Evidence-Based Phonologic Instruction (Cont) 4.Repeat fMRI’s one year after instruction ceased – right frontal and right posterior systems much less prominent, increased left posterior systems; fMRI’s essentially same as a non-impaired reader 5. Children had improved reading accuracy and speed Source: Sally Shaywitz, Overcoming Dyslexia, Alfred A. Knopf, New York, Multiple studies have confirmed results

Brain Repair after Intervention

Brain Rewired by Evidence-Based Phonologic Instruction (Cont) 7.Both primary and secondary dyslexics improve with accuracy and speed of reading with appropriate instruction. 8.Without appropriate instruction, primary dyslexics can improve accuracy, but remain slow. Secondary dyslexics remain slow and inaccurate.

Treatment 1. Early recognition of at-risk students 2. Systematic, structured, multi-sensory reading programs 3. Neural target for reading interventions

Window of Opportunity 1. When evidence-based phonologic remedial intervention was begun in first grade, the expected reading disability of 12% to 18% was reduced to 1.6% to 6%. 2. When this intervention is delayed until third grade, 74% of students continue with reading difficulties through high school.

Take Advantage of the Window of Opportunity

Other Influences on Reading Ability  Sleep requirements months 9-12 hrs./night hrs./day 2.Preschool hrs./night 3.School-age hrs./night 4.Teens 9 hrs./night 5.Adults 8-9 hrs./night

Other Influences on Reading Ability  Allergies 1.Up to 40% of youth have hay fever 2.Increasing children with food allergies 3.1/3 of children with allergies don’t sleep well 4.1/4 of children with allergies wake at night 5.Bothersome symptoms interfered with school performance in 40% of youth with allergies, compared to 10% without allergies 6.29% drop in school performance during bad allergy season