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The Research Study into Possible Interventions for Children with Dyslexia

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According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V) a certain criteria should be fulfilled by the individual, to be able to be diagnosed with a specific learning disorder. The difficulties in learning and academic skills, as indicated and by the presence of the symptoms that persist for at least 6 months, despite the provisions of interventions that target those difficulties. In the given case study, the following symptoms can be accounted for the learning disorder:

  1. Cathy a 10-year-old girl is in 5th grade of primary education. She has problems with learning from the beginning of her primary school. She has problems specifically with reading.
  2. From 4th grade Cathy received additional help with reading at the school (2 hours per week). After that, she showed signs of improvement in her reading abilities, the improvement was not enough to get her to begin reading at her grade-level.
  3. She still makes many mistakes when reading and her reading speed is slow.

Her reading problem persisted for a very long time in her developing years, therefore because of her troubles with reading she is now also struggling with other subjects (e.g., mathematical word problems). Her self-confidence has deteriorated because of her reading/learning problem.

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Environmental factors: Her mother is low educated and a single parent, who works long shifts to support her family financially, therefore cathy also does not have a strong financial background.Her mother can not provide enough time to read with Cathy and does not know how to support her reading properly. Another factor is that Cathy also does not have a sufficient amount of books and material to practice with.Finally her mother ignored the advice from the school in the early years of Cathy’s education to read with Cathy, and to take her for a proper diagnosis to help cathy.

She does not show any social or behavioural problem judged from the fact that she is well accepted and has many friends, therefore She does not have any comorbidity.

Cathy’s case study shows the direct symptoms of the learning disability called “dyslexia”, which effects the part of the brain that is responsible for word formation. This is one of the most common manifestations of specific learning disorder in which some individual face difficulties learning to map letters with the sounds of one’s language-to read printed words, thus children like cathy can not read at the speed that people without dyslexia can. Cathy although shows signs of a specific dyslexia, known as Double deficit dyslexia as stated by Norton, E. S., Black, J. M., Stanley, L. M., Tanaka, H., Gabrieli, J. D., Sawyer, C., & Hoeft, F (2014) who say that “[T]his dyslexia posits that both rapid naming and phonological impairments can cause reading difficulties, and that individuals who have both of these deficits show greater reading impairments compared to those with a single deficit”. One can also denote that the impairment she faces are in her motor skills which can be seen in her inability to successfully perform math word problems and her self-esteem is affected alongside. On the basis of all the above symptoms and impairments we would like to test for dyslexia as a specific learning disorder.

The prove of learning to read consists of creating mappings between orthography and phonology via semantics (Hulme & Snowling, p.49). According to the triangle model, which was developed by Seidenberg and McClelland, learning to read is a process of creating mappings between orthography and phonology – the phonological pathway, and from orthography to phonology via semantics – the semantic pathway. (Hulme & Snowling, p.50). Clearly, the phonological skills are crucial for learning to read, and if a child has a problem in the representation of phonology, the phonological pathway is impaired. Additionally, the development of the semantic pathway may be delayed as well. So, a child learning to read creates associations between spelling and sound, spelling and meaning. Indeed, Vellutino and Scanlon in 1991 observed that the majority of dyslexic children have difficulties with phonological decoding. The phonological awareness is important in reading, it means to be aware that words consist of combinations of speech sounds and includes the ability to manipulate them.

There is also not just one type of problem in dyslexia. An influential approach to sub-type dyslexia started from analysing reading and spelling errors by Boder. She gave children some words to read aloud and noted those that were read automatically and assumed that these words were part of a child´s sight vocabulary. Afterwards, she gave a spelling test that included words that were read correctly and those that were not. She described 60% of the children as having “dysphonetic” dyslexia. Those were the ones who had a limited sight vocabulary and had difficulties with phonic analysis and synthesis. 10% of the children had difficulties in building up sight vocabulary, they were unable to memorize visual shapes of words to read as whole, their misspellings were phonetic. This group she called: “dyseidetic”. Over 20% showed errors typical of both groups, they were the most severely handicapped. This study offered clinicians to create remedial programmes to suit the individual needs of children with reading difficulties. However, it is important to keep in mind that it is difficult to clearly identify the sub-types of dyslexia, though there are individual differences among dyslexic children. They differ in extent to which they can use phonological reading skills and reading strategies.

Cathy should undertake an assessment of reading carried out by a professional. When she was in a second grade, her remedial teacher recommended to have her examined by the CLB – Pupil Guidance Centre. However, her mother ignored this suggestion, which is a great pity. It is important to have Cathy officially diagnosed with dyslexia, as only then she can be given a reasonable accommodation (for example, she can have longer time to finish math word problems or other tests and be using a reading software on computer).

The tests for assessing dyslexia evaluate these four skills: phonological awareness, decoding, rapid naming, and reading fluency and comprehension. By having Cathy evaluated on all of these skills, we would see in which one she has the greatest deficit. This would be helpful in choosing right interventions. To treat a problem, the first most step towards treatment is the understanding of the problem. When approaching dyslexia as a learning disability, one must first understand the brain’s function and role in dyslexia. Since dyslexia is known to be caused by a disruption in the left side of the brain that deals with language processing (phonological system), the left hemisphere language area(temporo-parietal cortex) do not function normally in dyslexia (Price & McCrory, 2005). Dyslexia can vary when it comes to the effect of impairments in the cognitive level, and some individuals can have a specific deficit in speech processing mechanisms or in broader oral language difficulties, therefore in this scenario the patient, a young girl named Cathy shows symptoms that are towards specific deficit in speech processing mechanisms. By learning Cathy’s impairment type, it leads to the next part, the specific intervention needed to help aid Cathy with her dyslexia, which is required to be evidence based. Through various researches done in the past, it has been concluded that dyslexia can improve through continuous regular reading therapy, and does rely on IQ (Snowling. 2013) as well, therefore to be more specific intervention would be required with respect to the IQ and nonverbal IQ(Snowling.3013) of the patient. Effectiveness of computer-based treatment for dyslexia in a clinical care setting: outcomes and moderators

The study conducted by Jurgen tijms in 2011 was designed to explain the clinical effectiveness of a Dutch computer-based treatment for children with severe dyslexia. Dutch is a language of intermediate orthographic consistency and the treatment programme focuses on systematic learning of letter–speech sound mappings and on the instrumental use of these mappings in reading and spelling.

Goals of the Study

  1. Effectiveness: According to Jacobson and Truax (1991), a treatment’s aim should be to change a dysfunctional ability into a functional level to a clinical significance. In line with this the goal of this study was to strengthen the evidence base for the effectiveness of phonologically based treatment by obtaining insight into the clinical significance of the treatment effects. The significant effects in the case of dyslexia can be tested by bringing reading and spelling skills at such a level that the treated children with dyslexia can function normally at school or in the society. The focus of evaluation was on general reading and spelling skills as required at school or in society.
  2. Moderators: The second goal of the study was to examine the baseline characteristics that are candidate moderators of treatment responsiveness. The plausible moderators are those related to the phonological deficit in dyslexia. Ample evidence from literature suggests other language skills might also be related to difficulties in reading acquisition. Another moderator could be socio-economic status (SES) which plays an important role in the development of reading skills.

Methods

Children were recruited from the IWAL Institute a nationwide specialised centre for dyslexia in The Netherlands. The selection criteria for severe dyslexia was set by the Dutch health care system (Blomert, 2006). The participants were 9-12 years old attending grades 3-6 of primary education. 75 subjects were present in the treatment group and the waiting list group consisted of 21 subjects. Both groups had about equal numbers of boys and girls coming from mostly middle class and majority of them lived in average to highly urbanised areas (Statistics Netherlands,2006). Before entering the programme the children had received on average more than a year of remedial teaching at school.The treatment group received a computer- based treatment and during this period they did not received any remedial teaching at school or another reading training elsewhere. Whereas, the waiting list control group received special remedial teaching at school during the trial period, which consisted of repeated training (cf. Meyer & Felton, 1999).

Procedure

The study consisted of a quasi-experimental, pre-test-intervention-post-test design. Subjects received an extensive differential diagnostic baseline assessment, followed by the intervention programme, and a post-test was conducted after finishing the treatment. LEXY a Dutch computer- based programme for dyslexia was used for the treatment which focused on the phonological structure that are productive for the writing system in an integrated training of reading and spelling skills. Once a week 45 min one -to-one sessions were provided by speech therapists and psychologists. Apart from these sessions at the institute, participants were required to practice at home three times a week for 15 min. Each session consisted of several parts starting with going through the homework for about 5 min, then by instruction and training parts. A new element was introduced in the instruction part and the rules for translation were explained using a graphic algorithm. Training consisted of spelling and reading modules. Exercises were given for the homework to expand training with the elements that had been subject of the session.

Results

Treatment group acquired significant greater gains than the control group which was visible in the improvements in their standard scores(SSs) showing that there was a significant effect of treatment on all four outcome variables i.e. word reading rate, spelling, text reading accuracy and text reading rate. Overall the treatment had a widespread and positive effect. It was proved by this study that one integrated intervention programme can attack both the reading and spelling disabilities of children with dyslexia. The study also revealed that neither semantic nor morphological capacities were associated with someone’s amenability to treatment. Socio-economic status did not predict treatment response. Reading rate continued to develop after termination of the intervention.

Intervention 2

Cathy should be given a sufficient and intensive reading instruction. Hatcher, Hulme, and Ellis compared effectiveness of three experimental teaching conditions on a sample of 128 seven-year-old poor readers schooled in Cumbria, northern England. These children were given tests measuring general intelligence, memory, reading, spelling, arithmetic, and phonological skills before the intervention – in September 1989, and again tested after it had ended – April 1990. They were divided into four groups closely matched for sex (18 boys and 14 girls in each group), age, IQ, and reading age. All children were reassessed nine months after the interventions ended, except three who moved out. Each program involved the children being taught individually for 40 half-hour sessions spread over twenty weeks (Hatcher, Hulme, & Ellis, 1994). The teaching methods were based on the teaching format developed by Clay in 1985. The intervention in the three groups focused either solely on reading, phonology, or both reading combined with phonology. The fourth group was a control one.

The Reading group received lessons with an emphasis on the use of context and meaning. Additionally, these children did some exercises in reading and writing individual words. The teachers could not refer to the letter-sound relationships. The Phonology group got intensive training in phonological skills but did not get any reading exercises. The Reading with Phonology group combined the two. The Phonology group received twice as much training in phonological skills compared to the Reading with Phonology group, and their improvements in these skills were visible, however, their reading did not improve much. The Reading with Phonology group achieved the highest progress – they increased their reading age of about a year and improved their spelling the most of all the groups as well. This teaching was so effective because it helped to improve phonological representations of spoken words and thanks to the reading practice, trained connections between phonological and orthographic representation of words. (Hulme & Snowling, 86).

The differences between groups were still visible even nine months after the teaching ended, although neither the Phonology nor the Reading group differed significantly from the control one, a noticeable improvement was only in the Reading with Phonology group. The conclusion is that the children with reading difficulties can make a progress if they are given highly structured teaching, suitable for their individual needs.

Intervention 3

In this respect an intervention that will suit cathy’s treatment is known as Lindamood Phoneme Sequencing (LIPS) programme.It is an evidence based effective intervention which has been used clinically and inside class room settings, and has been made for specifically targeting students development of the phonological awareness abilities who are not at the normal level of phonological development, with the assistance in thorough training to overcome their reading, writing and speaking problems according to their grade-level. LiPS has been created and tested as an approach for the students and learners.

In LiPS a feedback system comprising of oral-motor, visual, and auditory senses is used, where students explore the physical movements involved in producing sounds and learn to hear, see, and feel the physical characteristics of sounds and to notice the contrasts between them which enhances the student’s ability to distinguish phonemes in spoken patterns.What is distinct about this intervention is that LiPS tactic builds on prior knowledge within the students to introduce them to obtain new skills,furthermore this pattern frequently repeats itself until the goal of mastering the art of language is reached.

The pattern of learning in LiPS is aimed at teaching students to grasp the understanding of the ability to identify and verify sounds independently then in the next step they produce, hear, and eventually read those sounds. Once students have been introduced to the consonant and vowel sounds, they are taught to “track” sounds within a speech stream, which stimulates awareness of the identity, number, and order of phonemes in a syllable. It develops the right use of phonemes.colored magnetic squares are used to represent phonemes which aids in memory. incases where a student makes a mistake the teachers are guided by a manual to provide corrective feedback using the Socratic method of questioning. The student is questioned, with attention drawn primarily to the articulatory-motor features.

In the LiPS Program, letters are introduced after the student has a firm understanding of phonology. In teaching sound–symbol associations, the LiPS tasks progress from articulatory movements to sounds to letters. Students who can track phonemes successfully in spoken syllables are then led to discover the connection between this process and decoding and spelling. This occurs in a sequenced fashion that moves from the simple to the complex to the multi syllable level. Remedial work uses both pseudowords (to minimize the effect of memorization) and real words. Overlap to contextual reading occurs, and reading material is included in the form of the Phonological Awareness and Sequencing (PAS) Stories, chosen to be on essentially the same level that the student can track. Spelling exceptions and irregularities are introduced in a systematic fashion.

The study of McIntyre, Protz, and McQuarrie (2008) showed results of the effect of Lips on phonological awareness skills of typically achieving students and students classified as at risk for reading failure between kindergarten and Grade 1. The Students then demonstrated gains in phonological awareness and sound–letter correspondence in classrooms where teachers used the LiPS Program. For Reading deficit prevention LiPS instruction method was shown to have a positive impact in terms of cost-effectiveness and promptly meeting students’ needs.

To further see the effects of LiPS, Pokorni, Worthington and Jamison (2004) conducted a comparison study of the LiPS, Earobics (Cognitive Concepts, Inc., 1998), and Fast ForWord (Scientific Learning Corporation, 1999) programs.All three instructional methods that claimed to improve phonological awareness, language, and reading-related skills. Sixty students, age 7 to 9 years, with language and reading deficits were randomly assigned to one of the three interventions. Students received three 1-hour daily intervention sessions during a 20-day summer program conducted by a large school district. Results showed that “the LiPS intervention did a significantly better job than the other two interventions to improve students’ ability to blend phonemes” (Pokorni et al., 2004, p. 155).

This was also proved by Togesen et al., (2001) in an experiment where the children between 8-10 years were grouped into two for 8 weeks of intensive teaching. At the end of the experiment, the children’s reading accuracy was increased.( will be further elaborated )

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