Neurodevelopmental: Reading Disorders – Flashcards
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Neurodevelopmental Disorder
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Genetic or acquired biological brain disorder. Some define it as an impairment of the growth and development of the brain or central nervous system
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At what age are you diagnosed with an ND?
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Disorders occur before a child enters grade school except learning disabilities -- by definition you have to go through school and start to fail in order to figure out that you are learning disabled. ADHD might also be an exception to the rule
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Variance in degree of impairment
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Huge variance. They can vary from very specific limitations of learning or control of executive functions to global impairments of social skills or intelligence. Minor example: ADHD and learning disabilities Major example: Autism
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Common ND's
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Autism Fetal Alcoholism Motor Disorders: Tics; Tourettes Traumatic Brain Injury Cerebral Palsy Communication, Speech and Language Disorder Genetic Disorders Down Syndrome ADHD Learning Disabilities
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Prevalence of ND
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Affect 1 in 6 children in the industrialized countries
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What is NOT a ND
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Schizophrenia Bipolar Anxiety OCD Anything that can be treated with psychotherapy/ psychodynamic
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ND co-occurance
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Learning disorders and ADHD #1 co-occuring disorder = ADHD
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Executive Functioning
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the conductor of the orchestra (all the little parts working together) -organization -planning -lack cognitive flexibility -have difficulty shifting
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Differential Diagnosis
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Systematic method of diagnosis whereby multiple alternatives are ruled out
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Comorbidity
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Currently in the DSM there is recognition that symptoms overlap and yet a child with autism and ADHD is distinctly different from a child with autism alone; thus, may require different intervention services
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Behavioral Phenotypes
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Things that are specific indicators of that behavior -are stereotypic patterns of behavior that are reliably identified in groups of individuals with mown ND disorders and are "not learned" -acquired disorders, may also have behavior phenotypes like fetal alcohol syndrome -example: autism: behavioral phenotype is inability to maintain eye contact, tip-toe walking
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Behavioral Phenotype facts
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A. Has an increased probability of occurring, but does not occur in all cases B. They are not fully expressed in all affected individuals C. The genetic background of the individual may affect the phenotypic expression D. The behavioral presentation may be modified by the extent of intellectual deficiency in the disorder E. The possibility exists that environmental factors will affect its expression
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Acquired Causes of ND
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-Prenatal: Congenital Rubella Syndrome -Perinatal: Brain injury, Prematurity, Low birth weight -Post natal: Lead Encephalopathy -Toxic and Environmental factors: lead, tobacco, mercury, pesticides, PC -Low SES -Having a mother who has symptoms of depression, low education or is an immigrant -Familial Disruption: trauma, nurturance, emotional availability
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Risk Factors for ND
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Preterm birth Small for gestational age Low birth weight Neonatal encephalopathy
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Learning Disabilities
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Most prevalent group of neurobehavioral disorders served in the public schools. LD population is thought to be escalating at epidemic proportions
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Learning Disability Definition
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Manifest an educationally significant discrepancy between their estimated potential (measured by IQ) and actual level of performance (achievement) related to basic disorders in the learning process which may or may not be accompanied by demonstrable CNS dysfunction, and which are not secondary to generalized mental retardation, educational or cultural deprivation, severe emotional disturbance or sensory loss
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Discrepancy Model
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Inextricably tied LD to the notion of an achievement-aptitude discrepancy which persisted for the next 50 years -IQ had to be in the "normal range" -Achievement had to be "significantly lower" -According to ICD-10, the discrepancy should be at least 2 standard deviations. (15) -- 70 from an average IQ
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4 options for computing Discrepancy Model
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Grade level deviation (you don't get grade level from IQ) Expectancy Formula (based on IQ we expect that your academic performance would be x) Standard score difference Regression Formula
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Response to Intervention (RTI)
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In RTI the discrepancy is between your performance as one individual student versus your peers -Primarily a behavioral approach to L.D. -Criterion-referenced or curriculum based assessment of skills and then intervention based on an analysis of skill deficits -Test everyone and identify the lower performers -Give lowest group of performers an extra intervention and see how they respond -If they don't respond, give them more help
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Problem with RTI
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Problem: you are pulling in children that are underachieving for different reasons. You could also miss kids who aren't achieving to their potential. If all you do is compare me to main stream and I keep up with main stream I won't get an intervention. RTI is bad at that and therefore the discrepancy model is better because I look at you as an individual
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2 RTI approaches
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Problem solving approach: individualized with tailor made interventions to address the specific problems of a specific child Standard protocol approach: uses evidenced based interventions and applies them to a group of children who present with certain learning problems
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RTI Tiered Approach
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First Tier- is often broad scale assessment using standardized assessments Second tier - low performers receive a certain interventional strategy for a period of time Children who do not progress may receive a third tier of intervention Eventually those who don't respond will be classified as having L.D
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IDEA 2004 RTI criteria
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The current criteria no longer require an achievement ability discrepancy RTI can be used as part of the diagnostic process... meaning their response or lack of response to intervention can be used to make the diagnosis.
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Advantages of RTI
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-can be individualized for children (problem solving approach) -uses a different type of discrepancy model (still captures it), in a more progressive way -tier system keeps children in the least restrictive environments; doesn't keep them stuck in special education classroom -reduces the number of students receiving special education services (financially positive) -identifies children earlier (don't need the IQ score, can identify children before they enter grade school) -target children who don't have a learning disability, but may need extra help (rebuttal-poor financial decision) -doesn't have a SD cutoff (cutoff is determined by below the mean of your peers)
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Disadvantages of Discrepancy Model
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-if the students' IQ is very high but they aren't achieving well, it is possible that the instruction is faulty -IQ tests are not reliable as measures of cognitive functioning; likely overlaps with achievement measures (if you are looking at a difference between the two, achievement is moderately correlated with IQ) -IQ is not a great measure of potential -wait-to-fail....students must perform poorly for years before they are noticed and qualify for services (also if the discrepancy isn't wide enough) -has dropped from 96% - 67% in terms of usage across the US -school psychologists in RTI schools had higher levels of satisfaction (felt that they were actually doing what they were supposed to be doing)
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DSM V Learning Disorder
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Learning disorders interfere with the acquisition and use of one or more of the following academic skills: oral language, reading, written language, mathematics. But there is no option for an oral language learning disability
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Specific Learning Disorder Diagnostic Criteria
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A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties: The individual must have at least one of the following 6 criteria
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Diagnostic Criteria A: Reading
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1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words). 2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read).
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Diagnostic Criteria A: Writing
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3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants). 4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity).
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Diagnostic Criteria A: Math
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5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures). 6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems).
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Diagnostic Criteria B
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The affected academic skills are substantially and quantifiably below those expected for the individual's chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment.
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Diagnostic Criteria C
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The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the individual's limited capacities Core feature is that the difficulties are readily apparent in the early school years in most individuals. However, in others, the learning difficulties may not manifest until later school years...
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Current Severity
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Mild: some difficulty in one or two academic domains, but individual can compensate or function well Moderate: Marked difficulties learning skills in one or more academic domains, so that the individual is unlikely to become proficient without some intervals of intensive and specialized teaching during the school years. Some accommodations Severe: Severe difficulties learning skills, affecting several academic domains, so that the individual is unlikely to learn those skills without ongoing intensive individualized and specialized teaching for most of the school years
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Dyslexia
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A specific learning disability that is neurobiological in origin A deficit that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction They are not the result of a generalized developmental disability or sensory impairment
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Reading Disorder Definition
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Difficulties with accurate and/or fluent word recognition AND By poor spelling (encoding) and reading (decoding) abilities This new definition expands to include accurate word recognition (identifying real words) and to decoding abilities (pseudowords or nonsense words). It also recognizes poor spelling as a characteristic of dyslexia Site word list: one could've just memorized it. So introduced nonsense words to test decoding
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Fluency
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Is the ability to read text quickly, accurately and with good understanding. Fluency has nothing to do with comprehension but when you are measuring it, you are just measuring rate and accuracy Fluid reading is just being able to effortlessly decode, but it doesn't't mean you have any awareness of what you are reading- you can have any of these skills in isolation. Fluency has to influence comprehension - you have to be accurate to understand what it is Data indicates that readers who are dyslexic can improve in reading words more accurately, but continue to lack fluency and often continue to undertake reading as a slow and effortful process
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Spelling and Dyslexia relationship
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Why is spelling intimately related to reading? -If you cant distinguish the phoneme, you cant distinguish the letters to spell -Not merely because sounds are linked to letters but because words are being encoded which many may argue is more challenging that words being deciphered or decoded. Why might spelling not be related to reading? -It's possible I may be able to encode but not decode -If you have seen the word before you can rely on your visual memory to get you through most of your spelling needs
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Dyslexia Comorbidity
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May have deficits in: ADHD, Math, Spelling, Written Expression Secondary consequences may include problems in: Reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.
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All Dyslexics have deficits in:
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The core deficit is in word reading skills and therefore we will assume that all have deficits in Phonological processing Working Memory Short term memory Syntactic awareness Orthographic awareness
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Phonological Processing
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Phonological processing refers to the association of sounds with letters Understanding the grapheme-phoneme conversion rules and the exceptions to these rules It is the basis of decoding print 44 phonemes in the English language
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Phonological Processing continued
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The reading and spelling of pseudo words is one way to distinguish poor phonological processors. Children with RD also are slower to decide whether two aurally presented words rhymed. Poor readers also have deficits in phonological production tasks ( naming/repeating multisyllable words). Differ in their ability to segment words into phonemes and delete sounds from words.
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Syntactic Awareness
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Grammatical sensitivity The ability to understand the syntax of language Critical for fluent and efficient reading of text Enables one to make predictions about what might come next in the sequence Function words, prepositions, auxiliary verbs. Syntactical awareness allows you to pause between words, know about periods and commas-- syntax tells us a lot of things Kids who gloss over syntax tend to keep going without pausing at punctuation
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Working Memory
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Refers to the retention of information in short-term storage while processing incoming information and retrieving information from long term storage Relevant to reading because the reader must decode and/or recognize words while remembering what has been read and retrieving information such as grapheme-phoneme conversion rules Multisyllabic words would hold the greatest challenge English language rules-- the complexity of the particular rule will influence the ease of word recognition, depending on the number of possible alternate pronunciations
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Semantic Processing
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Refers to the understanding of meaning Meaning helps us process, code and store information We believe that word meanings are coded in networks and are retrieved through these networks In general, the semantic processing skills of poor readers are relatively intact --some argue that children with reading disabilities may even be superior to normal readers in their use of semantic context
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Orthographic Processing
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Visual process of reading Refers to the understanding of writing conventions of the language Knowledge of correct and incorrect spelling of words Alphabetic systems and the probable sequence of letters Fluent readers use knowledge of these sequences to quickly move through the text Involves awareness of the structure of the words in a language
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Orthographic vs. Phonological example
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In the visual task the child is shown a real word and a pseudo-word (rain and rane or boal and bowl) and the child has to select the correct spelling. Only reason you get this right is because of visual memory or orthography of the word In the phonological task, the child has to specify which of two psuedo-words, presented visually, sounds like a real word (e.g. kake-dake and joap and joak). It fits into our sound repertoire of what we know the sound is
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Orthographic vs. Phonological
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Each task is designed so that only one process can operate. In the Visual task both choices sound exactly the same, so the visual memory for the orthography of a word must be used; phonological processes are not helpful in this case For the phonological task, recall of the visual pattern would not be useful because neither alternate is correct orthographically. *Disabled readers perform more poorly on the phonological task-- phonological route is impaired
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Phonological Awareness
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To be a successful reader, one must be able to connect the letters to the phonologic segments they represent. Making that connection requires an awareness that all words can be decomposed into phonologic segments and that the letters in words represent such sounds. Readers must connect the letter strings ( which is the orthography) to the corresponding units of speech ( which is the phonology) that they represent. The general consensus in the literature is that such phonological awareness is missing or deficient in dyslexic children and adults. Phonological awareness is typically assessed by phoneme deletion measures aka Auditory Analysis. Example: Say ...block without the "buh" sound
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Dual Route Theory
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Direct Lexical Access versus Phonological Access 1. Lexical Access Route: visually read a word without any intermediate phonological processing. Relies on mental-orthographic- lexicon where representations of words are stored 2. Phonological route: use grapheme-phoneme conversion rules to gain lexical access to a print stimulus. The phonological code is accessed serially, letter-by-letter. The route is referred to as NONLEXICAL because the application of the rule does not rely on word-specific pronunciations. Instead grapheme-phoneme conversion rules are presumed to be stored explicitly and used to determine a word's pronunciation.
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Pseudo-Words
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Best measure of phonological processing. Those with reading disabilities can become reasonably fluent readers but have problems with pseudo-words
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Phonemic Rules
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One relatively simple rule of English, with a few exceptions is that the final e in a one syllable word makes the vowel long. Disabled readers could read: like, cute and nose, but not: rike, fute and mose Other findings: Disabled readers have a much more difficult time with words that are irregular or exception words As one's reading skills develop, one becomes increasingly reliant on visual/orthographic route.
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Sound Symbol Associations
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Children with reading disabilities had more difficulties than normal readers in a task that required learning or associating a symbol with words or symbols with other symbols, particularly when the rule varies.
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Vowels and Consonants
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English vowels tend to have more complex and irregular pronunciations than consonants-- consequently misreadings of vowels occur more frequently. Unlike consonants which are more likely to be misread depending on its position, the position of a vowel has no effect on it's being misread Vowels are "context dependent" - rules that children generally master with increasing age
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Vowels
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Most errors involving the shortening or lengthening of the vowel. More severely disabled readers may substitute a completely different vowel sound Long vowel sounds are learned later than short vowel sounds Vowels with the most orthographic representations are the most challenging such as /u? which is represented by u, o, oo, ou, oe, ew and ie
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Consonants
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Consonants in english are more regular than vowels, meaning few phonemic representations. Shankweiler, Liberman and Fowler found that consonants in the initial position were more likely to be read correctly than consonants in the final position. Consonant errors were closely related to their target sound-- b and p are more likely to be substituted The errors do not appear to be related to visual difficulties. Word and letter reversals account for only a small portion of the errors made.
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Hierarchical structure of language
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At the upper levels of the hierarchy are components involved with semantics ( vocabulary or word meaning), syntax and discourse. At the lower level of the hierarchy is the phonological model, which is dedicated to processing the distinctive sound elements that constitute language. Assuming the deficit is in phonological processing, which is a lower order language function, it will block access to higher order language processes and to gain meaning from text. Thus, although comprehension and meaning are essentially intact, they can be impaired because of the deficit in fluent reading.
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Role of Attention
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Theory of Automatic Information Processing Reader progresses through a series of stages in which he learns each subskill component for reading Beginning with an attention demanding the slow process of learning to read each word accurately And progressing to an automatic process where the word is now read fluently and automatically They posit that once lower level skills become automatic, attention is then freed up and can be allocated for higher level functions.
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Logan "Instance Theory" of Attention
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Summarized the properties of automatic processes as fast, effortless, autonomous and unconscious. In this view automaticity is a continuum Three assumptions: Obligatory encoding Obligatory retrieval Instance representation Attention is critical to encoding and retrieval...It is now believed that attentional mechanisms may play a causal role in dyslexia and that attentional mechanisms are essential to the development of age appropriate reading skills
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Neurobiological in Origin
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Data indicates that there are a number of interrelated neural systems used in reading Potentially two posterior reading systems: Reading of real words and pseudo words One anterior region
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Gordon ; Logan 2 systems to the automatic processing necessary for reading
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1) Word Analysis - Phonology critical for mapping the print into the phonological structure of language-- individual units of words such as phonemes which requires attentional resources and requires relatively slow processing. *This reportedly occurs within the parieto-temporal region 2) Whole word/ Word form processes words as a whole =with rapidity and does not require intense attention Rapid automatic fluent identification of words This reportedly occurs within the occipito-temporal area-Serves as a visual-word form area
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VWFA predominates
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It is this occipito-temporal system, also known as the VWFA (visual word form area) that appears to predominate once a reader becomes skilled and has bound together the Orthographic Phonological Semantic features of a word
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Shaywitz third area
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Anterior system in the inferior frontal gyrus (Broca's area) a system that is associated with: articulation silent reading naming Gender differences may exist Men - phonological processing in left inferior frontal Women - both left and right.
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Impaired vs. Non-impaired readers neurobiology
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Results indicate that during phonologic analysis, nonimpaired readers evidence greater activation in the left hemisphere sites: Representing the anterior reading system in the inferior frontal region And two posterior sites ( parietotemperoal and occipotemporal) Dysfunction in left hemisphere posterior reading circuits is evidenced in dyslexic children Overall, it is believed that the posterior systems are underactivated while the anterior system may be overactivated.
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Dyslexic Readers neurobiology
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Dyslexic readers demonstrate ; A disruption of posterior reading systems In the Left parietotemporal Left occipitotemporal areas But appear to develop compensatory systems in left anterior And right anterior areas.
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Theory of Automaticity
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You have so much cognitive energy. If you have to use all of your cognitive abilities to decipher this code, you will not have much left in you. Once you practice and learn how to do it, it becomes automatic. When you learn a new skill, all your attention is there. The dyslexic reader uses all of their effort in decoding the text. Therefore, if you believe that you only have so many cognitive resources, and if you use all of your effort, you wont have that effort available to comprehension
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What contributes to reading comprehension?
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Strong lexicon (quality of meanings of words), phonological awareness, oral language (consisting of syntax, listening comprehension and vocab), listening comprehension, and reading fluency
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RAM
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Reading disorders are primarily phonological in nature but there are still several groups that believe that the phonological theory is not sufficient to explain all reading disorders. Another big element of reading disorders is this concept of RAM (rapid automatic naming) How do we distinguish between those that have RAM problems vs. phonological problems vs. both potentially? RAM is nothing other than the ability to quickly call up the name of an object but very essential to reading because you just slide through the letters effortlessly
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What might RAN relate to in intellectual testing?
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Processing speed (symbol search, cancelation, coding)... but very different because processing speed on the WISC is primarily visual and it doesn't require any retrieval of language WISC-V- has naming speed literacy (importance of rapid automatic naming) There are 2 new supplementary tests (naming speed literacy and simple translation) --the reason they are adding them is in recognition that this ability to rapidly call up language is very important to reading and writing and learning quickly
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RAN vs. Phonological Disorder
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2 kinds of disorders: you can have a phonological and you can have a RAN disorder. I could be slow in my ability to call names, but be proficient in phonemic awareness How would the kid who is slow in RAM but proficient in phonemic awareness look in terms of test data? You would do well on word attack, where you read words in a row after the others and there is no time limit (no speeded element, just isolated words)- even better if they are nonsense words because they are the preferred for phonemic awareness. The RAN kid would not do well on reading fluency measure because all of a sudden the child has to do it with speed The measure of fluency is rate and accuracy (NOT comprehension) -RAN kid: slow rate, high accuracy -Phonemic awareness deficit kid: fast rate, poor accuracy -You can have any combination, or both (known as the double deficit)
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Primary test of RAN
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Primary tests of RAN: colors, objects, numbers and letters -of those 4, numbers and letters are the best predictors of reading disorders Why would we do colors? For younger kids who haven't been exposed or you want to get an early assessment of their ability to retrieve (more diagnostic value). It has less diagnostic value as the kid ages
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Neuro-developmental theory of RAN's influence on reading acquisition
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The thinking is that rapid object naming relates to the integrity of left midfusiform neural circuits which mediates oral responses to visual stimuli. This is consistent with the theory that our brains were not evolved for reading but reading is possible because of the neural flexibility of our circuits. Left Midfusiform: helps information travel from the visual field to the oral field which is what is essential in reading. Fusiform bridges gap between temporal and occipital lobe
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More RAN
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Therefore, we can transform the visual object recognition area of our brain into one that recognizes symbols and later letters and words. Given that the language circuits are nearby in the human brain, we can integrate visual perception with language responses. They believe this furthers their thinking that we are not born wired to be able to read, we are born wired to be able to speak. The flexibility of the circuits is something that develops with age where we are able to integrate vision with language They also found that phonological awareness predicted reading independently from RAN tasks.
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Double Deficit Hypothesis (DDH)
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Wolf and Bowers proposed that there are two core processes, PA and RAN that are causally related to variations in reading acquisition. Average PA ; RAN - then you will have no deficit in learning to read Single Deficit in either PA or RAN - Phonological Deficit - PD Naming Speed Deficit - NSD Then you will have some difficulty with reading The Double Deficit children are those with both poor PA and poor RAN. They, according to prediction, will have the most difficulty learning to read.
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RAN and other languages
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In English, reading is usually measured by reading accuracy because we expect English readers to take a longer time to achieve proficiency because our language is so complex and so many exceptions to the rules in ourreading skills. More focused on grasping accuracy than speed In other more regular languages ( European language) it is often measured by speed or fluency because accuracy reaches a very high level in the earliest years of instruction. PA only predicts during first and second grades while RAN predicts during third and fourth -- makes more sense because how can you identify words before you know how to match sounds/ what the letters mean. As a beginning reader you have to learn the sound associations. Once you do that, you can start to focus on achieving speed
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RAN ; PA
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Although RAN and PA are moderately correlated, the thinking is that they contribute separately to variance in reading acquisition Another issue that is controversial is how to measure RAN and which approach is a better predictor of reading development =letter naming
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How to test RAN
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Letter Word Identification- measure of sight vocabulary Word Attack- nonsense words Passage Comprehension- they leave one word out of 2 sentences and you have to fill in the missing word The growth trajectory of the DD group was lower with a) pseudoword b) real words and the gap increased with development.
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RAN and Reading Disabilities
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Some argue, that after controlling for oral vocabulary skills, both phonemic awareness and rapid naming each play a role in word recognition, with phonemic awareness playing a larger role. Rapid naming's however plays a unique contribution in the LATENCY (how long it takes you to pull up the correct word) of correct identification of words Also naming speed has a unique contribution to reading comprehension because it relates to the latency of word recognition Therefore, we know that word recognition speed is essential for reading fluency and fluency is essential for comprehension
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RAN and Reading Comprehension
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If your working memory is working hard on trying to retrieve words, it will have less energy available to focus on retrieving memory
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Is RAN orthographic or phonological?
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Reflecting a profile opposite to that of phonemic awareness, RAN is more related to recognition of exception words and to knowledge of orthographic patterns than to phonological decoding. Why is RAN orthographic? Because you are pulling on visual stimuli. In RAN you don't have time, it's not about miscalculation, it is visual memory
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RAN and word recognition accuracy
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Research indicates that not only is there a connection between reading speed and RAN, but there is a connection between word recognition accuracy and RAN (if I give you a list of words, your accuracy also relates to RAN, not only how quickly you pull up the names but how many will you recognize accurately)
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RAN contribution
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RAN is important diagnostically when you are trying to tease out a disabled reader But if you are competent levels of RAM skill don't really distinguish or have any diagnostic meaning/ not relevant
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RAN and math fluency
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Difficulty with math fluency: if you believe there is this slowness of retrieval and of pulling information in certain kids (otherwise known as slow processing kids, with auditory processing disorder, kids that take a while to formulate responses) then it wont only affect your reading, but it can affect many areas academically. Many measure of fluency might be problematic and on the WJ, we might see it in math fluency. They want to know if your facts are automatic, if you can retrieve them quickly. This will allow you to use more mental energy to solve more complex word problems. In writing, RAN would show itself in writing fluency. Writing fluency (you give three words and you generate a sentence as quickly as you can)
