Dyslexia Screening in Schools: Helping Teachers by Doing It Right!

Hey Folks:

It’s less than two weeks away until our webinar on November 20. Please register now as there is limited availability. After you’ve registered you get to send any question about implementing universal screening for dyslexia and we will answer it LIVE during the webinar.

Join me and Tie Hodack, Director of Instructional Programming, Special Populations, Tennessee Department of Education for this very “nuts and bolts” discussion about best practices for the actual implementation of a universal screener for reading problems in schools.  Tie has many years of experience and brings a great deal of wisdom and real-time know-how to this type of implementation.

You will not want to miss out.  Please note that this webinar will be recorded and available to all registrants for viewing anytime, anywhere.  

 

Click here for REGISTRATION:  http://www.doctormichaelhart.com/dyslexia-screening-in-schools-supporting-our-teachers-by-doing-it-right-optin/

What’s Next After We Teach Phonological Processing Skills? Lynn Givens Interview

What’s Next After We Teach Phonological Processing Skills?  Connect to Comprehension! 

An Interview with Lynn Givens, M.Ed.

Recently I had the honor of interviewing Lynn Givens, M.Ed.  She is currently a Visiting Professor, School of Teacher Education at Florida State University and the creator of the very detailed reading program entitled Connect to Comprehension.

Lynn has been a teacher of struggling readers and a teacher educator for over 35 years. She served as Director of Intervention at the Florida Center for Reading Research where she was involved in providing intervention training and professional development for teachers throughout Florida. Lynn is currently teaching undergraduate reading and English/language arts courses, including a practicum on teaching struggling readers, at FSU’s School of Teacher Education and acting as instructor/facilitator for online teacher endorsement courses in reading.

Ms. Givens also spent eight years at the Schenck School in Atlanta, GA, one of the top institutions for teaching dyslexic students and other struggling readers.

I was lucky to meet Lynn through Marisa Bernard, the Executive Director at the Orton Gillingham Online Academy.  Lynn and Marisa are collaborative partners and Marisa is making Lynn’s Connect to Comprehension product available through her site.

I’m particularly excited to share our interview with you because I think Lynn is focusing on closing a very critical gap in our training and teaching of children who struggle with reading.  So often we find ourselves without a map after applying the intensive, multisensory teaching approach (e.g., Orton Gillingham) to addressing the foundational issues with phonological processing.  The question becomes…”What do we do next?”

As Lynn tells her story, she clearly adds to our map of understanding how to properly support our educators’ efforts to teach our children who struggle with reading beyond the initial foundational layers.

I hope you enjoy getting to know Lynn Givens as well as I did.  Please be sure to add your thoughts in the Comments Section below.

Welcome Lynn!  What led you to create the Connect to Comprehension course?

In 2004, as Director of Intervention at the Florida Center for Reading Research, I began work with Dr. Joseph Torgesen on a year-long study of the types of intervention being provided to struggling readers in the state of Florida.  After visiting with many teachers, principals, and administrators in six Florida districts, I reported to Dr. T that most of these educators did not have a clear and effective strategy for helping these students.  Many of the interventions being implemented were just watered-down versions of the core curriculum.  With that information in hand, we began to develop an “intervention kit” to send to districts and then trained district personnel to deliver professional development in the use of the strategies and methods contained in the kit.  Several of the districts asked me if a reading program was available that incorporated the ideas in the kit, and I had to say “no.”  After my work at FCRR was completed, I began to develop such a program, which eventually became Connect to Comprehension (CtoC).

I connected with Marisa Bernard almost two years ago, as we share a common educational background in the field of dyslexia and a common passion for working with readers who struggle.  After she carefully reviewed the CtoC kit, she asked me if I could write a course for teachers, parents, and tutors to help them understand the link between the elements taught in the OG language courses and the teaching of comprehension skills to struggling readers. The development of the course, which was quite intensive, does, I believe provide this information in an easy-to-understand format.

I know it’s a 10 part course but could you give us a brief overview of the key components—what are your major takeaways?

The course is centered around the five components of reading – phonemic awareness, phonics, fluency, vocabulary and comprehension – and how these components are all interrelated and are critical to the reading process.  As participants learn about the components, they also learn about how dyslexic students and other struggling readers may have difficulty in each of these and how the CtoC program specifically addresses each of these needs.  The process of using this scripted, leveled program is also addressed in detail, from the initial assessments to determine specific weaknesses in each component through the planning and teaching of the lessons.

The issue of efficiently assessing students is a hot topic of conversation these days.  What is involved in your initial assessments? 

Yes, assessment is critical for all students but especially for students who are struggling.  In addition to possibly having deficits in foundational skills, they often have skill gaps throughout the phonological and phonetic sequences.  An effective assessment for these students must include measures of their abilities to read isolated words with targeted word patterns, to read these words in connected text, and to demonstrate understanding of what they are reading. 

The CtoC assessment is composed of two measures: the Single Word Assessment and the Passage Assessment.  Students begin with the Single Word Assessment, reading word lists that are leveled, beginning with short vowel words and concluding with multi-syllabic words that correspond to the six syllable types. Each level of the assessment corresponds to a level in the Connect to Comprehension program.  Students then read a decodable passage in the Passage Assessment and answer a series of questions based on the passage.  This second assessment provides measures of fluency (WCPM) as well as information concerning critical comprehension skills (recall, facts/details, making inferences, cause/effect, compare/contrast and author’s purpose.)  With all of this information in hand, the teacher can assemble a reliable profile of the struggling student’s skills in terms of strengths and weaknesses and can then determine at which level of CtoC to begin instruction.

While we are speaking of levels, I’d like to give you a brief explanation of the program’s structure.  There are 6 levels in the program, with explicit phonetic and comprehension instruction at each level.  Level A is composed of short vowel words; Level B incorporates reading words with v-e patterns as well as vowel digraphs.  Level C includes words with initial and final consonant blends and digraphs, and Level D targets r-controlled vowels and diphthongs.  In Level E, morphological elements of prefixes and suffixes are taught and practiced, along with variant vowels.  Level F focuses on multi-syllabic words.  Each of the six levels is supported with 6 High Noon decodable readers that are completely aligned with the skills being taught and practiced.  The most unique part of the program, I think, is that upper-level comprehension skills are taught and practiced throughout each level, beginning with Level A.  Because of this unique aspect, students do not have to learn these comprehension skills AFTER their decoding skills have developed.  Decoding and comprehension are taught simultaneously.

And there are several different types of materials provided when you enroll, yes?

Yes.  Participants receive a complete CtoC kit, including the 6 scripted teacher’s manuals (one for each level of the program) and an assessment/implementation manual.  Also included is a complete set of fluency and sequencing strips, which are used throughout the lessons.  In addition to this kit, participants receive a set of the 36 High Noon decodable readers used for teaching all of the levels of the program.  Finally, participants have unlimited access to the course information, which includes powerpoints, audio discussions, and video examples of many of the program’s elements.  As with all OGOA courses, participants receive new information as it is added to the course for an unlimited time, so that they can review, refresh, and expand their understanding.

I love that you include a discussion of written expression at the end…Talk to us about the philosophical underpinnings of that decision?

We have known for a long time about the critical connection between reading and writing.  My mentor at the Schenck School for dyslexic students in Atlanta, the late David Schenck, always told me, “Be sure to have children write about what they are reading, and always have them read back to you what they have written.”  I have followed this advice for the last 25 years, and it is incorporated into the CtoC program at every step.    More recently, the “Writing to Read” report published by the Carnegie Corporation in 2010, gave us a strong research basis for this connection.  One of the findings of the report, a meta-analysis of many research studies, was that comprehension was most improved when students were asked to write about what they were reading, through answering questions, writing summaries, and making personal connections through written statements.

At another level, we also know that dyslexic students benefit from a multisensory approach to all components of reading.  Therefore, the phonetic instruction and practice in the program consistently tie together reading and writing.

What is the ideal level of expertise needed for this course?  When should a tutor or teacher enroll in this course?

Since the course begins with the basics, a discussion of the five components of reading, it provides a foundation of understanding for anyone who is interested in working with struggling readers, whether as a parent, a teacher, or a tutor.  Although the course can stand alone, it is recommended that participants enroll in the Orton Gillingham Online Academy’s (OGOA’s) Basic Language Course and, if possible the Advanced Language Course before taking this course.  This will give a complete and well-developed understanding of all the elements involved in teaching dyslexic students and other struggling readers. The Academy now offers a “bundled” course option, which allows participants to purchase all three courses at a reduced rate.  I am really excited about this new opportunity, as I am convinced that it will give anyone who works with struggling readers the complete “tool kit” to help these students succeed

How does your program address the different types of dyslexia?  E.g., Students with poor phonological skills v. those with weak rapid automatic naming or those Double Deficit kids with both?

As noted by Maryanne Wolf, one of the leading experts in the research supporting the double deficit theory, “dyslexia does not always involve a failure to decode words.  Rather, it involves a failure to read fluently with comprehension.” (http://ase.tufts.edu/crlr/documents/2009MBE-NeuroscienceClassroom.pdf)  According to Dr. Wolf and her colleagues, practice in automatic decoding should not be an end in itself, but should lead to fluent reading.  This automaticity ensures that students are not using so much of their cognitive efforts to decode that little cognitive energy is left to understand what they are reading.  Another important aspect in an integrated approach that addresses this issue is that fluency instruction and practice should not begin after reading skills are already acquired, but that “efforts to address fluency need to begin at the start of the reading acquisition process.”  (http://ase.tufts.edu/crlr/documents/2009MBE-NeuroscienceClassroom.pdf)

So, how does the CtoC program address the needs outlined above?  Automaticity is emphasized on a daily basis through the use of the leveled skill decks.  Students practice reading these leveled decks, using the phonetic patterns that they are learning/have learned, and are encouraged to read these words as quickly as possible.  The opportunity for such games as “minute dash”, where students read and then graph the number of these patterned words read correctly in a minute, is used throughout the program.

Fluency is, as Wolf and colleagues suggest, emphasized from the very beginning of the program.  Students work on reading the fluency phrases provided, beginning in Level A, after receiving instruction and explicit modeling from the teacher.  Questions are asked that require the use of the fluency phrases to answer, thus connecting the elements of phonology, fluency, and comprehension.  In addition, students are frequently encouraged to reread sections of the text to stress elements such as dialog reading and emphasis on important words in a sentence.

How are you tying in semantics, syntax and morphology in your literacy instruction?  

These linguistic elements are all addressed through instruction and consistent opportunities for student practice.  Word meanings are taught through use of a vocabulary deck, which is reviewed on a daily basis and which forms the basis for multi-sensory activities and games.  This deck is also used for written expression activities, which help to incorporate syntax and sentence structure.  Sentence frames are used throughout the program so that students who have difficulty with syntax can be guided and thus become more accomplished in this area.  Words with multiple meanings are explored at each level of the program, using graphic organizers as visual tools.  In addition, elements of figurative language are also taught and practiced, again incorporating written and oral language as students learn about idioms, similes, etc.  Morphological elements of prefixes and suffixes are introduced in the upper levels of the program.  Meanings of these affixes are taught and practiced, using both oral and written activities.  In addition, spelling rules for adding the affixes (e dropping rule, doubling rule, rule for y) are introduced/reviewed.

The instruction in these elements becomes meaningful, as it is tied to the decodable texts that students are reading.  For example, idioms are discussed and practiced when they appear in the text.  In this way, students can connect the concepts and strategies that they are learning immediately to what they are reading.

Does the course require a student teaching practicum or observations of application?  If so, how do you test a person’s knowledge in an online setting?

For course completion, participants are required to develop and submit a series of exercises involving assessment of a struggling reader, planning a CtoC lesson based on the assessment results, etc.  The final submission is a videoed lesson with a self-reflection rubric that I use for scoring the video and providing specific feedback.  I have had extensive experience in developing and facilitating these types of online courses, and these types of submissions work well to ensure that each participant has a solid understanding of the course’s concepts, strategies, and materials.

What kind of certification are you able to provide?

A Certificate of Completion is provided by the O-G Online Academy upon completion of all of the course requirements.

Lynn Givens, I want to thank you for taking the time to chat with me about your Connect to Comprehension course!  Clearly you’re helping us make great strides in answering the key question of “What’s next?” when a struggling reader needs to move beyond the foundational phonological awareness skills and go deeper into fluency and comprehension.

Dear Readers:  I strongly urge you to take a look at Lynn’s Connect to Comprehension program and consider adding it to your tool kit.

To learn more about Connect to Comprehension, please visit Marisa Bernard’s Orton Gillingham Online Academy site. Click here:  http://www.ortongillinghamonlinetutor.com/orton-gillingham-training-ecourses-and-webinars/connect-to-comprehension-course/

Note:  No compensation was received for supporting this product. Michael Hart)

The Power of Speech to Text: A True Story

What beautiful irony that Sean is now getting daily requests to “write” something for someone after spending the first few decades of his life getting hammered for NOT reading and writing.

Meet Sean Douglas, the founder and owner of The CodPast, a “fresh, contemporary resource for students and adults with dyslexia.”  

Here’s a brief version of his story:

Then:
Had no support for his dyslexia throughout his life including his university years
From 12 years old until at least 18 years old he never read a book
Lost employment because they thought he was “dumb”
Figured out his diagnosis on his own
Supportive mom helped him find his strengths and passions outside of the world of school

Now:
Age in the mid-30’s
Founding director of his own television and video production company
Founder and chief executive of The CodPast podcast site
Former cameraman, director, producer at a global bank

…and he also…

…”Writes” quite a bit…

What?!  How?  By using technology to circumnavigate the weaknesses in his brain that make it hard for him to write in the traditional way.  By using his considerable intellectual strengths and verbal abilities to educate and communicate with others without the bottleneck of actually writing or typing.  By using digital tools like speech to text.  

Sean started The CodPast because when he went searching for useful, interesting information about dyslexia all he basically found were the traditional, “text-heavy” sites that haven’t caught up to the digital media revolution.  (Oh, man, I need more videos and podcasts!)  His audience is international and growing quickly and he’s created a great mix of videos, podcasts and blog posts that are interesting and relevant to our dyslexic folks.  

What beautiful irony that Sean is now getting daily requests to “write” something for someone after spending the first few decades of his life getting hammered for NOT reading and writing.

Sean is a shining example of what we frequently espouse:  Never give up.  For dyslexics, the technology revolution is much more powerful, much more specific.  This is not to say that there isn’t a learning curve when using speech to text.  Everyone has to learn how to “dictate” punctuation, sentences, paragraphs, etc.  But with a little perseverance and creativity, using speech to text tools creates that bridge that allows bright dyslexics to communicate in the written form consistent with their intellectual capability…often for the first time in their life.  In Sean’s case, he endured decades of perceived failure, misunderstanding and needless suffering.  

Here’s another key point.  In a recent interview, Sean explained that one of the key factors that fed his resilience was his mother’s insistence that he find places to shine other than school.  Swimming, judo, scouts…Whatever it was…Sean’s mom made sure that he experienced competence and success elsewhere in life outside school.  She made sure that Sean was not defined by his dyslexia.

As with all of our inspirational stories, please keep Sean Douglas in your mind as you navigate the waters of helping a loved one grow up with dyslexia…or as you navigate the waters for yourself.  Know it can be done.  

Remember that tools like speech to text can literally change a life.  Get started.

Thanks to Sean Douglas for allowing me to tell a small part of his story.  Please be sure to visit http://www.thecodpast.org/ and sign up for his informative newsletter.  

Executive Function (EF): Dr. Lynn Meltzer’s SMARTS Program Now Online!

Hello! And Welcome!

Today I’m going to write about something that’s sort of pushed itself to the forefront of my mind lately–but I’ve been really mulling over this issue for quite some time.  As many of you know, developing and mastering executive functioning skills is really a major challenge for many of our dyslexic kids and adults.  And just as importantly, it is also a challenge for our parents and educators to provide the necessary support for our dyslexic friends to improve their executive functioning.

Recently, I’ve had the good fortune to connect with Dr. Lynn Meltzer and her team at the Research Institute for Learning and Development (ResearchILD) and her corollary services organization The Institute for Learning and Development (ILD). (https://smarts-ef.org/about/us/)   Dr. Meltzer has long been known to be an international leader in the EF field and she has been at the forefront of the efforts to create programs and curriculum to support our teachers’ efforts to strengthen students’ EF skills.  

For the past several years, Dr. Meltzer and her colleagues have been evolving their SMARTS Executive Function program from its beginnings as a mentoring program to an in-house teacher training program to now most recently a fully online program!  

The SMARTS Online Executive Function Program is a huge step forward…and thank goodness it’s finally available anywhere and anytime.  

Let’s talk a bit about what the program entails and then I’m going to provide some of my own views about how to think about this amazing tool.  

What is SMARTS?

SMARTS is a very intensive and thorough program that provides core help with EF skills that usually just aren’t taught in school.  Developing EF skills is a struggle for many kids but when you add the issue of dyslexia, the challenge is often seemingly overwhelming.  Too many of our kids just don’t know where to start and the likelihood of them shutting down is intensified.

Let’s take a look at what the SMARTS acronym stands for.  

(Note:  The following images are screenshots from the SMARTS website.)

 

10_15_SMARTS_Executive_Functioning_Blog_Post_-_Google_Docs

The key word to describe the SMARTS program is…thorough!  There are six units with multiple lessons in each unit (Unit 4 is actually broken up into 2 parts) and the program includes Instructional Overview Videos that are key in terms of providing a foundation for teaching the curriculum.

To review the curriculum outline in detail, open a new tab in your browser and take a look here… https://smarts-ef.org/curriculum/executive-function-curriculum/

Also, keep in mind that this program is designed for a 9-month timeframe and covers the top five key executive function processes–

  • goal setting
  • thinking flexibly
  • organizing and prioritizing
  • accessing working memory
  • self-checking.

Here is a key point…which will serve as a jumping off point for my own commentary.  Dr. Meltzer and her team are quite clear that this curriculum is in-depth and should not be viewed as a quick fix. There isn’t a quick fix…but this program works.  And the reasons it works is because the educators come to realize that we teach each of these skills in three steps:

  • Each EF strategy must first be modeled by the teacher
  • THEN the students practice the skills with fun activities
  • THEN AND ONLY THEN the students begin to incorporate their EF skills in their actual schoolwork

“Building a Container”

Implicit in the above comments about teachers taking the step by step process (I do it, we do it, you do it) is a very important concept that often is not discussed.  And that is, a key component to our dyslexic students’ success is the awareness that we, as adults, must think explicitly about how we organize ourselves around our kids.  Very often we expect the students to organize around us instead of thinking about how to organize around our kids…especially those who struggle with EF or some other learning difference.

Here’s an example that happens commonly.  Most schools have a culture of demanding that the student’s organize around a specific curriculum, a certain educator mindset, a certain set of rules, etc.  If the child unable to do so, very frequently there is no cultural mechanism in place that prompts the question…”If the child is failing in school, how might we as adults organize more effectively around them, understand them, and provide the support they need to succeed.”  Instead, the child fails and suffers the consequences.  

So “building a container” refers to our process as teachers, administrators, school team members,  etc. to create a support system or “container” around our students who need extra help.  It refers to an explicit awareness that we have a responsibility to create a plan and make them feel valued, safe and successful.  

As mentioned earlier, executive functioning skills are not, by and large, included in most school curricula.  Yet, a substantial proportion of our students, by virtue of how their brain is wired, present with very significant challenges in the EF area.  This is clearly an area where we, as adults and educators, must provide the “container” for our kids.  We’ve got to close the gap.

Therein lies the beauty of Dr. Meltzer’s SMARTS EF program.  She and her team leveraged technology so that evidence-based strategies for developing the key skills in this area are available anytime, anywhere.  

Exploring the use of this program is not unlike your initial experience with intensive, multisensory approaches to dyslexia.  Honestly, it can look daunting at first blush.  However, keep this in mind…It is a triathlon, not a sprint.  This  is a program that provides intensive support in developing EF skills over a significant number of months.  One step at a time.  One step at a time.  

Dr. Meltzer and her team have created an incredible program and I urge you to consider how you might integrate it into your existing curricula.  

(Note:  I am not receiving any compensation for this post–Michael Hart)

Resources:  

About SMARTS Executive Function Online Curriculum

https://smarts-ef.org/about/smarts/

About the ResearchILD and ILD

https://smarts-ef.org/about/us/

Book:  Promoting Executive Function in the Classroom–Lynn Meltzer, Ph.D. Editor

http://www.guilford.com/books/Promoting-Executive-Function-in-the-Classroom/Lynn-Meltzer/9781606236161

Book:  Executive Function in Education–Lynn Meltzer, Ph.D. Editor

http://www.guilford.com/books/Executive-Function-in-Education/Lynn-Meltzer/9781606236468

Children with Learning Problems: Empowering Parents

A woman posted in a forum recently that, as a young graduate student, she wanted to learn more about how to better advocate and communicate with the parents of her students.  Those of us who have been in that position truly understand what a delicate dance it is to empower parents when their children present with learning problems.

Let me start with what I think is the core issue.  And that is…How can I effectively empower parents so that, over time, they become more effective in advocating for their kids?  Keep in mind that you will likely spend a small proportion of the child’s educational life as an advocate for them.  To be most effective, the focus should be on giving the parents the skills, tricks, know-how so they become the expert.

As an example, let me review the top three things I do with parents who come to me needing a diagnostic evaluation for their child.

  1. During the initial consult, not only do I listen carefully to the content I need, I also listen to what their experience has been as they’ve tried to navigate the system and get their child’s needs met.  We want to know how well they’ve mapped out their process.  I also want to make sure that, by the end of the first touch, they feel a sense of relief that someone is listening and that they’ve got someone they can lean on and learn from.
  2. Parents often don’t have a map of where they need to go and what they     need to do.  Take the time, even if it takes repetition over and over, to explain and predict what is coming next in the process—whether it’s the testing process, the IEP process, setting up other evals—whatever it is give them a sense of prediction and control.  Remember that when someone is in a highly emotional state—whether it’s fear, anger, sadness, etc.—their decision-making can be negatively impacted.  Be kind, for goodness sake, but also be competent.  Understand that the beautiful child that they brought into this world is suffering and oftentimes has been for years.
  3. Most importantly, remember that parents need to be educated about how their children’s brains are wired and how that informs their behavior and learning styles both good and not-so-good.  I almost always recommend a couple of books, articles, videos, etc.  THIS IS TRULY THE CRUX OF THE ISSUE.  Long after you are gone, these moms and dads are going to have to continue to advocate.  Just as importantly, the parents need to educated about how their OWN brains are wired!

Recommended Reading:

www.allkindsofminds.org

Educational Care:  A System for Understanding and Helping Children with Learning Problems at Home and in School.  Mel Levine, MD.  1994  Educators Publishing Service, Inc.

Note:  This book is easily available online at Amazon, Alibris, etc.

There is so much more I need to say about this topic.  Clearly, I’ll need to break this discussion up into multiple posts.  Please stay tuned.  If you have questions, reach out to me at doctormichaelhart@gmail.com.

The DSM-V, SLD and Dyslexia: A Fascinating, Frustrating Disservice

The DSM-V Update Process

In a Facebook posting about two weeks ago, Julya Johnson (nee Shane) asked me to comment on the latest Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) diagnostic criteria for Specific Learning Disability and the mysterious relegation of the word dyslexia to an “alternative term.”

It might make sense to start by explaining a bit about the process for updating the DSM-V.

Here are a few answers to questions about the development process verbatim from the American Psychiatric Association DSM Development Committee:  (italics in red are mine)

What was the process that led to the new manual?

The APA prepared for the revision of DSM for nearly a decade, with an unprecedented process of research evaluation that included a series of white papers and 13 scientific conferences supported by the National Institutes of Health. This preparation brought together almost 400 international scientists and produced a series of monographs and peer-reviewed journal articles.

The APA Board of Trustees, which approved the final criteria for DSM-5 on Dec. 1, 2014 appointed a Scientific Review Committee of mental health experts to review and provide guidance on the strength of evidence of proposed changes. The Scientific Review Committee evaluated the strength of the evidence based on a specific template of validators. In addition, a Clinical and Public Health Committee reviewed proposed revisions to address difficulties experienced with the clinical utility, consistency and public health impact of DSM-IV criteria.

Who was involved in the development process?

APA recruited more than 160 of the top researchers and clinicians from around the world to be members of our DSM-5 Task Force, Work Groups and Study Groups for this important job. These are experts in neuroscience, biology, genetics, statistics, epidemiology, social and behavioral sciences, nosology, and public health.  These members participate on a strictly voluntary basis and encompass several medical and mental health disciplines including psychiatry, psychology, pediatrics, nursing and social work.

How were decisions made about what would be included, removed, or changed?

APA’s goal in developing DSM-5 was to create an evidence-based manual that is useful to clinicians in helping them accurately diagnose mental disordersDecisions to include a diagnosis in DSM-5 were based on a careful consideration of the scientific advances in research underlying the disorder, as well as the collective clinical knowledge of experts in the field. Advances in the science of mental disorders have been dramatic in the past decades, and this new science was reviewed by task force and work group members to determine whether diagnoses needed to be removed or changed.

http://www.dsm5.org/about/pages/faq.aspx#3

My point in sharing the above information with you is this:  On the surface, it looks like the decision-making process for updating the DSM looks well-thought out and quite rigorous…and in many ways it is.

But for those of you who have participated in the academic world can you imagine using the consensus model with that many researchers and clinical professionals?

Do you think there might be some politics involved in the decision-making process?

Here’s another piece of the puzzle.  One of the stated goals for the new DSM edition, according to Dennis Charney et. al. (https://contextualscience.org/system/files/Kupfer,2002.pdf  Chapter 2)  is to work toward a more “etiologically-based diagnostic system” that would move the psychiatric world “into the mainstream of modern medicine where etiology and pathophysiology have replaced descriptive symptomatology as the fundamental basis for making diagnostic distinctions.”

For those of you who are allergic to terminology, etiology of something means the cause of something.  Pathophysiology simply refers to the idea that we can map the symptoms of a disorder to actual physical structures…like neural pathways in the brain and dyslexia.

So, in simpler terms, we want to move from just describing what we’re seeing in testing and observation of dyslexia to actually mapping the underlying issues in how a person’s brain is wired and how that impacts the development of reading, writing and spelling.

Which is what we’ve been doing for many years.

Fascination and Frustration

[Note:  In the next section, I’m going to quote heavily from Comments on Proposed DSM-5 Criteria for Specific Learning Disorder from a Legal and Medical/Scientific Perspective (http://dyslexia.yale.edu/CommentsDSM5ColkerShaywitzSimon.pdf ) If you do not have this article in your files, I couldn’t recommend it highly enough.  The authors include Ruth Colker, JD, Sally Shaywitz, MD, Bennett Shaywitz, MD and Jo Anne Simon, JD.]

As the Colker, et. al. article points out so elegantly, dyslexia is essentially the most well-described clinical phenomenon we have in the SLD category consequently the DSM committee actions are quite disturbing.

“Specifically, dyslexia is a well-described and long-standing entity that adheres to a well-specified medical model including, known neurobiology, pathophysiology, symptoms and developmental manifestations, treatment, and long term outcome. In contrast to the other domains included under SLD, dyslexia is not a feature but a well described disorder.

Further… “Given the advanced state of knowledge of its neurobiology and pathophysiology, dyslexia serves as a model for the identification of a learning disorder.” 

Nonetheless, in spite of over 100 years of discussion about dyslexia as a distinct clinical phenomenon, the criteria for Specific Learning Disorder relegates the term “dyslexia” to the following in the DSM V:

  • 00 (F81.0) With impairment in reading:
    • Word reading accuracy
    • Reading rate or fluency
    • Reading comprehension
    • Note: Dyslexia is an alternative term used to refer to a pattern of learning difficulties characterized by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities. If dyslexia is used to specify this particular pattern of difficulties, it is important also to specify any additional difficulties that are present, such as difficulties with reading comprehension or math reasoning.

It would be enough if the denial of the state of knowledge about dyslexia was the extent of the issue.  The disconnect between the stated goals of the DSM development team and the exclusion of acknowledgement of the actual scientific history of dyslexia is stunning and morbidly fascinating…much like a car wreck in the opposing lane.

Finally, one of the very last versions of the DSM V manual the diagnosis of dyslexia included a reference to requiring participation in RTI.

Herein lies the rub for those of us who already suffer needlessly by having to wait sometimes years before a proper evaluation is conducted to determine eligibility for services.

In spite of the final changes in the wording it is noteworthy that, after a 10 year process, attempts were made to insert a poorly executed intervention system into the diagnostic process.  The Colker, et. al. article played a key role in getting the language changed, in my opinion.  Again, if you haven’t read the article I strongly urge you to do so.  It is a great lesson in political manuevering. Suffice it to say, we all know that requiring RTI in lieu of a proper educational evaluation is in direct opposition to the IDEA.  It’s illegal.  But we also know that many school districts are attempting use RTI to replace the special education teams and processes in spite of the final changes in the wording of the diagnostic criteria. 

The Current Bottom Line

  • Colker, et. al. uses the word “inexplicable” to describe why the term dyslexia is subsumed in the SLD category as an alternative term. I don’t think it’s inexplicable at all.  In fact, I think it’s obviously a result of political maneuvering in the DSM update process IN SPITE of massive amounts of peer-reviewed data confirming that dyslexia research strongly reflects the presumed goal of using an “etiologically-based” system for diagnosing SLD.
  • RTI (or the concept of classroom intervention) is not evil in and of itself. The process/strategy is being misused in order to avoid proper evaluation of our kids.
  • RTI (or any other classroom intervention approach) also does not “cover the waterfront” regarding the identification of learning disabilities. As we know, intensive intervention is not offered in later grades (including college) where many of our students are first identified with dyslexia.
  • The research, as well as my own clinical anecdotal experience, clearly indicate that there is no nationally accepted standard of implementation for RTI, that the RTI process/protocol is not implemented consistently and staff training for the implementation of the program is inconsistent at best.

Ultimately, though, as our understanding of the complexities of the neurological underpinnings of dyslexia grows (Double Deficit anyone?), the idea of using a blunt instrument like RTI or any other classroom intervention in lieu of a proper evaluation to “diagnose” dyslexia is absurd.  As Martha Denckla, Sally Shaywitz, Louisa Moats, Maryanne Wolf and countless others will tell you, each of our kids’ brains are unique.  We have a responsibility as parents, specialists and educators to appreciate, understand and integrate what we’re learning in the research into our daily decision-making about our kids and their needs. 

In my opinion, the DSM V committee members blew it…and in a very ham-handed fashion.  The whole dynamic of Dyslexia Denial is fascinating, painful and ultimately sad.  And yet we need to keep working…we’ve never had the momentum we have now.  Let’s use it.

Kids need us.  Parents need us.  And teachers need us too.  Never give up.

Pounding Away at Your School: What Do You Do When Your Cup Runneth Empty?

We all have a finite cup of resources when advocating for our children.  For many of us, it’s financial, but sometimes it’s emotional…We get so intensely focused on the fact that our schools should be experts and take proper care of our children that our laser focus distracts us from the bigger picture.  And we deplete ourselves.

We’ve got to remember that we are going to build a “village” for our kids that will encompass more than just your local school.

We have to be open and honest about what the schools are really going to be able to do even if you win an IEP battle or court case.  Remember…

Three out of four elementary teacher preparation programs still are not teaching the methods of reading instruction that could substantially lower the number of children who never become proficient readers.  Virtually no secondary school preparation programs include curricula about reading and written language instruction in spite of the fact that dyslexia is a life-long issue. [Read more]

Many good people in our schools haven’t been given the proper education, training and experience to effectively support our dyslexic child’s educational needs.  That’s not their fault but it is our reality.

There are times when exhausting that cup of resources on forcing a school system to do something they can’t runs counter to your primary goal which is to give your child a safe, happy environment in which to grow.

I was working with a family today that had reached the point of complete exhaustion and exasperation in their efforts to get their daughter’s school to provide adequate academic support for her severe dyslexia.  They gave up…and I supported their position.
I did what?

They had already come to the precipice of deciding to try cobbling together a homeschooling program for her…I just helped them get over the hump on the idea.  They had tried homeschooling before but it was hard for mom to be teacher too.  It didn’t work so well and they returned her to the public schools. She’s now in 6th grade and she still can’t read beyond the second grade level.

This little girl is never going to shine in an academic environment AND she is a bright, delightful child who loves being with her family and friends.  It happens that our little friend is a tomboy and her real passion is camping and fishing.  She struggles mightily with generating two sentences about an academic topic but get her going on lake fishing and she will not stop.

Mom and dad have done a brilliant job putting together a program for her upcoming year.  They’ve got a retired language arts teacher who is trained in Orton Gillingham working with her daily…They’re using a homeschooling curriculum they found online that will give them a foundation for organizing resources for other content areas.  Most importantly, they’ve freed their daughter up to spend more time fishing and camping.  In fact, they found a mentor in the forestry department to take her under his wing for “special projects.”

Please know that I’m fully and completely committed to overhauling the public school systems in the US when it comes to treating our dyslexic kids. The school system is broken and it will be for many more years.  We’re working on it but we have a long way to go.  So, in the meantime, we have to decide whether Plan B is best for our kids.

I’m also super aware of what it means for a child to feel safe and properly nurtured.

So in the interim, what makes the most sense for your child?  Traditional education where your child is getting pummeled every day or some sort of creative plan that gives the kid a place to shine.

Not every child should be homeschooled…and the above program isn’t right for everybody.  But, I wanted to jostle you a bit and ask you to remember that we’re going to have to get creative in creating our village because the schools oftentimes can’t…yet.

Remember to use that cup of resources any way you need to so that your child knows we’re going to help them find a place to shine!

For the Kids,
Michael Hart

The Double Deficit Hypothesis: This Just In

There is a really great new article out about the neuroscience behind Double Deficit Dyslexia.  Here’s the link for the article through ScienceDirect.

 http://www.sciencedirect.com/science/article/pii/S0028393214001961

 The title of the article is Functional neuroanatomical evidence for the double-deficit hypothesis of developmental dyslexia.  Elizabeth Norton from MIT is the lead author.  I don’t know her but the writing, while not an easy cruise, is so beautifully elegant.  I aspire.  I aspire.

 I urge you to read it all yourself but here’s the short of it–with my editorial comments.

 We’re in the early stages of parsing out the neurological underpinnings for dyslexia particularly with regard to rapid automatic naming (RAN) but, with time, we’re going to be able to MAP cognitive processing to remediation.

 We’re going to MAP cognitive processing to remediation...That is truly extraordinary and will ultimately serve as a great gift to our dyslexic kids.

 My excitement is blunted somewhat by Martha Denckla’s voice in the back of my head saying “Remember…every brain is different.”  Nonetheless, there is enough commonality that I find this stuff exciting.

 Okay…Here’s the short of it:

  1.  The study suggests that “children with a double deficit have the greatest reduction in brain activation in regions important for both rapid naming skills and phonological awareness, even when compared to children who have single deficits.”
  2.  Most importantly, “these findings have implications both for the design and future neuroimaging studies and also for the design of assessment batteries, diagnostic criteria and educational interventions, as children meeting different criteria for reading impairment also show differential brain activation and behavioral profiles.
  3.  There were some limitations to the study, including sample size (too small).  But overall I’d say that this study put one more brick in the road to understanding how our kids’ brains are wired and how to best take care of them.

It heartens me the more we include RAN in the discussion about the cause of dyslexia.  It took us many decades for the general population to get up to speed regarding the role of phonological awareness and dyslexia.  We’re making progress there.

Martha Denckla has been conducting research regarding RAN and dyslexia since the 1970’s.  Maryanne Wolf has also been heating up the research in this area since the 1990’s.

Now, with access to the Internet and social media we can collapse the lapse, so to speak, in educating the general population about what we’re learning in the research.

 So, to that effort, please take the time to read this study and pass it on!

 

When the School Says No…How to Get the Yes! IEP Success w/ Vaughn Lauer

Click here to listen to the full exclusive interview with Vaughn Lauer!

From Suffering to Success: Lisa Rose’s You’ve Got Verve Jamie Ireland!

Click here to listen to the full exclusive interview with Lisa Rose!