Evidence-based diagnosis and treatment for specific learning disabilities involving impairments in written and/or oral language

Programmatic, multidisciplinary research provided converging brain, genetic, and developmental support for evidence-based diagnoses of three specific learning disabilities based on hallmark phenotypes (behavioral expression of underlying genotypes) with treatment relevance: dysgraphia (impaired legible automatic letter writing, orthographic coding, and finger sequencing), dyslexia (impaired pseudoword reading, spelling, phonological and orthographic coding, rapid automatic naming, and executive functions; inhibition and rapid automatic switching), and oral and written language learning disability (same impairments as dyslexia plus morphological and syntactic coding and comprehension). Two case studies illustrate how these differential diagnoses can be made within a conceptual framework of a working memory architecture and generate treatment plans that transformed treatment nonresponders into treatment responders. Findings are discussed in reference to the importance of (a) considering individual differences (diagnosis of impaired hallmark phenotypes) in planning and evaluating response to instruction and modifying instruction when a student is not responding; (b) recognizing that teaching may change epigenetic gene expression at one stage of schooling, but not the underlying gene sequences that render individuals still vulnerable as curriculum requirements increase in nature, complexity, and volume in the upper grades; and (c) using evidence-based diagnoses of specific learning disabilities that are consistent across states for free and appropriate education K to 12 and for accommodations throughout higher education and professional credentialing.     

Teaching children with dyslexia to spell in a reading-writers’ workshop

To identify effective treatment for both the spelling and word decoding problems in dyslexia, 24 students with dyslexia in grades 4 to 9 were randomly assigned to treatments A (n?=?12) or B (n?=?12) in an after-school reading-writers’ workshop at the university (thirty 1-h sessions twice a week over 5 months). First, both groups received step 1 treatment of grapheme–phoneme correspondences (gpc) for oral reading. At step 2, treatment A received gpc training for both oral reading and spelling, and treatment B received gpc training for oral reading and phonological awareness. At step 3, treatment A received orthographic spelling strategy and rapid accelerated reading program (RAP) training, and treatment B continued step 2 training. At step 4, treatment A received morphological strategies and RAP training, and treatment B received orthographic spelling strategy training. Each treatment also had the same integrated reading–writing activities, which many school assignments require. Both groups improved significantly in automatic letter writing, spelling real words, compositional fluency, and oral reading (decoding) rate. Treatment A significantly outperformed treatment B in decoding rate after step 3 orthographic training, which in turn uniquely predicted spelling real words. Letter processing rate increased during step 3 RAP training and correlated significantly with two silent reading fluency measures. Adding orthographic strategies with “working memory in mind” to phonics helps students with dyslexia spell and read English words.     

Is phonology bypassed in normal or dyslexic development?

A pervasive assumption in most accounts of normal reading and spelling development is that phonological coding is important early in development but is subsequently superseded by faster, orthographic coding which bypasses phonology. We call this assumption, which derives from dual process theory, the developmental bypass hypothesis. The present study tests four specific predictions of the developmental bypass hypothesis by comparing dyslexics and nondyslexics from the same families in a cross-sectional design. The four predictions are: 1) That phonological coding skill develops early in normal readers and soon reaches asymptote, whereas orthographic coding skill has a protracted course of development; 2) that the correlation of adult reading or spelling performance with phonological coding skill is considerably less than the correlation with orthographic coding skill; 3) that dyslexics who are mainly deficient in phonological coding skill should be able to bypass this deficit and eventually close the gap in reading and spelling performance; and 4) that the greatest differences between dyslexics and developmental controls on measures of phonological coding skill should be observed early rather than late in development. None of the four predictions of the developmental bypass hypothesis were upheld. Phonological coding skill continued to develop in nondyslexics until adulthood. It accounted for a substantial (32–53 percent) portion of the variance in reading and spelling performance in adult nondyslexics, whereas orthographic coding skill did not account for a statistically reliable portion of this variance. The dyslexics differed little across age in phonological coding skill, but made linear progress in orthographic coding skill, surpassing spelling-age (SA) controls by adulthood. Nonetheless, they didnot close the gap in reading and spelling performance. Finally, dyslexics were significantly worse than SA (and Reading Age [RA]) controls in phonological coding skill only in adulthood. This research was supported by the following grants to the first author: A NIMH RSDA (MH00419-05) and project grants from NIMH (MH38820-04), NICHD (HD19423-02) and the March of Dimes (12-135). Author Smith’s work was supported by a project grant from NICHD (HD 19423-02).     

Does sensitivity to orthographic regularities influence reading and spelling acquisition? A 1-year prospective study

Recent studies focused on the influence of orthographic processing on reading and spelling performance. It was found that orthographic processing is an independent predictor of reading and spelling performance in different languages and children of different ages. This study investigated sensitivity to orthographic regularities in German-speaking children (N = 31) prior and during formal reading and spelling instruction. In addition, the relationship between sensitivity to orthographic regularities and reading and spelling performance was explored. Two aspects of children’s sensitivity to orthographic regularities (sensitivity to frequent double consonants and sensitivity to legal positions of double consonants) were measured with a nonword forced choice task. The results show that sensitivity to orthographic regularities improved significantly from kindergarten to first grade. Moreover, children’s sensitivity to orthographic regularities at the end of first grade accounted for a significant amount of unique variance in their reading and spelling performance. These results suggest that orthographic sensitivity on a sublexical level is important for the development of reading and spelling skills.     

Spelling instruction in Spanish: a comparison of self‐correction,visual imagery and copying

Two randomised control experiments examined spelling outcomes in a repeated measures design (pre‐test, post‐tests; 1‐day, 1‐month follow‐up, 5‐month follow‐up), where students learned Spanish irregular words through (1) immediate feedback using self‐correction, (2) visual imagery where children imagine and represent words using movement, and (3) copying words. The two control groups engaged in reading and dictation. We expected that methods with kinesthetic components and segmentation of stimuli would yield better orthographic representations in memory. Results showed that orthographic errors on Spanish irregular words diminish when children receive self‐correction instruction. Imagery and copy instruction also reduce these errors, but less consistently. Five months later, self‐correction group maintained their advantage in spelling compared with students who read or performed dictation. Experiment 2 replicated the spelling instruction effects and showed large effects on children who had hardly received any spelling instruction in Spanish. Results indicate that research‐based practices can significantly improve spelling outcomes in primary children.     

Establishing word representations through reading and spelling: comparing degree of orthographic learning

Skilled reading involves rapid and automatic word recognition. Through a self‐teaching process, phonological decoding during reading is thought to establish the word‐specific representations in memory that support efficient word reading. Much is known about orthographic learning during reading; less is understood about this process during spelling. Here, we compared the degree of orthographic learning that occurs during reading and spelling. Forty‐eight children in Grade 2 practised reading or spelling nonwords within stories. Orthographic learning was measured using spelling recognition, spelling production and word naming tasks. Both readers and spellers showed evidence of orthographic learning; however, spellers outperformed readers on all tasks. Overall, results suggest that spelling sets up a higher quality representation in memory and highlight the importance of spelling in the development of word reading efficiency.     

Cross-language transfer of phonological and orthographic processing skills from Spanish L1 to English L2

Previous cross-language research has focused on L1 phonological processing and its relation to L2 reading. Less extensive is the research on the effect that L1 orthographic processing skill has on L2 reading and spelling. This study was designed to investigate how reading and spelling acquisition in English (L2) is influenced by phonological and orthographic processing skills in Spanish (L1) in 89 Spanish-English bilingual children in grades 2 and 3. Comparable measures in English and Spanish tapping phonological and orthographic processing were administered to the bilingual children. We found that cross-language phonological and orthographic transfer occurs from Spanish to English. Specifically, the Spanish phoneme deletion task contributed a significant amount of unique variance to English word reading and spelling, for both real words and pseudowords. The Spanish homophone choice task predicted English reading, but not spelling. Taken together, these results suggest that there are shared phonological and orthographic processes in bilingual reading; however, orthographic patterns may be language specific, thereby not likely to transfer to spelling performance.     

Spelling errors of normal and disabled students on achievement levels one through four: Instructional implications

The errors of 72 disabled and 90 normal spellers were compared on the first through fourth levels of achievement using a featural system based on developmental spelling research. The mean age of the disabled subjects was two to three years higher on all levels (the differences were significant) but, of 24 error features on the four levels, F-tests showed that the groups differed only on Front Vowels (/a/, /e/, /i/), particularly the combination of in as in chin, with the normal group making more errors. Discriminant function analysis showed that the error features which significantly discriminated between the two groups at Level 1 were Consonant Digraphs, Affricates, and Front Vowels. On Level 2, the dominant variables contributing to the significant discriminant function were Front Vowels, consonant doubling and “e-drop” errors, and suffix errors. The normal group made more errors on all but the last. There were no significant differences on Levels 3 and 4. Discriminant analysis among the four levels for the normal group showed that the incidence of lower-level spelling features declined steadily as spelling achievement level increased. A similar trend but less significant variability was found among the disabled group levels. These results suggest that the strict phonetics-based instruction used with the disabled group contributes to their relative proficiency on the lower level spelling features but that the meaning, orthographic, and derivational conventions of more advanced spelling should be emphasized when designing instruction at achievement Level 2 and above.     

Examining Word Factors and Child Factors for Acquisition of Conditional Sound-Spelling Consistencies: A Longitudinal Study

It has been suggested that children acquire spelling by picking up conditional sound-spelling consistencies. To examine this hypothesis, we investigated how variation in word characteristics (words that vary systematically in terms of phoneme-grapheme correspondences) and child factors (individual differences in the ability to extract phonological, morphological, and orthographic information) simultaneously relates to spelling accuracy. A total of 143 Korean-speaking children were assessed on spelling 4 times from prekindergarten to kindergarten. Words in the spelling task systematically varied in orthographic transparency stemming from phonological shifts. At Time 1 they were also assessed on emergent literacy or linguistic awareness skills (e.g., phonological awareness, morphological awareness, letter-name knowledge). Explanatory item response model revealed that (a) growth trajectories of spelling differed as a function of orthographic transparency, and (b) the effect of emergent literacy skills on words of varying transparency differed as a function of children’s emergent literacy skill levels and time.     

The role of orthographic and phonological processing skills in the reading and spelling of monolingual Persian children

The main objective of the present study was to examine the contribution of phonological and orthographic skills to Persian reading and spelling. The Persian language is of interest because it has very consistent grapheme-to-phoneme correspondences, but somewhat inconsistent phoneme-to-grapheme correspondences. Reading, spelling, phonological, and orthographic skills were tested in a sample of 109 monolingual Persian students (mean age = 8;1, SD = 4 mo) attending Grade 2 in Iran. The results showed that although monolingual Persian children relied both on phonological and orthographic skills, phonological skills were a strong predictor for both reading and spelling. Another objective of the study was to compare children’s spelling performance in terms of phoneme-to-grapheme (PG) consistencies. As expected, children spelled PG-consistent words more accurately than PG-inconsistent words. Moreover, they relied more on orthographic skills for spelling PG-inconsistent words than for spelling PG-consistent words. The results are discussed in terms of the differential effect of orthographic consistency on reading and spelling.     

The relationship between rapid naming and word spelling in English

A study of the concurrent relationships between naming speed, phonological awareness and spelling ability in 146 children in Years 3 and 4 of state‐funded schools in South‐East England (equivalent to US Grades 2 and 3) is reported. Seventy‐two children identified as having normal phonological awareness but reduced rapid automatised naming (RAN) performance (1 standard deviation below the mean) participated in the study. A group of 74 children was further identified. These children were matched on phonological awareness, verbal and nonverbal IQ and visual acuity, but all members of this group showed normal RAN performance. RAN made a significant unique contribution to spelling performance. Further analyses showed that participants with low naming performance were significantly poorer spellers overall and had a specific difficulty in spelling irregular words. The findings support the view that RAN may be indexing processes that are implicated in the establishment of fully specified orthographic representations.     

Longitudinal predictors of reading and spelling across languages varying in orthographic consistency

We examined the longitudinal predictors of nonword decoding, reading fluency, and spelling in three languages that vary in orthographic depth: Finnish, Greek, and English. Eighty-two English-speaking, 70 Greek, and 88 Finnish children were followed from the age of 5.5 years old until Grade 2. Prior to any reading instruction, they were administered measures of phonological awareness, letter knowledge, and rapid naming speed. In Grade 2, they were administered measures of nonword decoding, text-reading fluency, and spelling. The results showed that the model for nonword decoding in Greek was similar to that of Finnish (both have consistent grapheme-to-phoneme mappings) while the model for spelling in Greek was similar to that of English (both have some inconsistent phoneme-to-grapheme mappings). In addition, the models for nonword decoding and spelling in Finnish were similar, because Finnish is consistent in both directions. Letter knowledge dominated the prediction in each language. The predictable role of orthographic consistency on literacy acquisition is discussed.     

Components of Reading Ability: Multivariate Evidence for a Convergent Skills Model of Reading Development

The objectives of this series of 3 studies were (a) to evaluate whether French-speaking children mainly use phonological mediation in the first stage of reading acquisition in a silent-reading task and (b) to examine the role of phonological processing in the construction of the orthographic lexicon. Forty-eight French children were followed from kindergarten to the end of Grade 2. Their phonological skills were assessed using a semantic categorization task with homophone and visual foils (Study 1); their orthographic skills were assessed using a choice task involving a correct exemplar, a homophone, and a visual foil (Study 2). In the semantic categorization task, the differences between the visual and homophone foils increased with time, as the homophone foils were more and more likely to be chosen. In the orthographic choice task, performance improved with time, but errors were more likely to involve homophone foils. The results obtained by two subgroups of children who differed in their level of orthographic expertise at the end of Grade 2 (Study 3) indicated that, 1 year earlier (at the end of Grade I), the future "expert" spellers were more likely than the future "poor" spellers to use phonological processing in silent reading (semantic categorization task). Moreover, in Grade 1, future expert spellers' phonological skills in reading aloud and in spelling from dictation (pseudoword tasks) were better than those of future poor spellers, and future expert spellers also had better phonological awareness skills at the beginning of the last year of kindergarten. These results suggest that French-speaking children use phonological mediation in silent-reading tasks and that phonological processing contributes to the construction of the orthographic lexicon.     

English as a foreign language spelling: comparisons between good and poor spellers

This study examined English as a foreign language (EFL) spelling development amongst 233 fifth‐grade, eighth‐grade and 10th‐grade Hebrew first‐language speakers to examine effects of English orthographic exposure on spelling. Good and poor speller differences were examined regarding the acquisition of novel phonemes (/æ/, /Λ/ and //) and orthographic conventions (/ð/, /θ/, // and silent ‘e’). Hebrew measures included standardised spelling and orthographic and phonological tasks. Experimental English measures included real‐word and pseudoword spellings, orthographic tasks and standardised spellings. Results showed significant differences in spelling accuracy between good and poor spellers at all grades. Spelling accuracy for most conventions did not improve after the eighth grade. Spellings of consonantal clusters, initial h and /ð/ differed between good and poor spellers in the fifth grade only. Hebrew spelling was one of the strongest predictors of EFL real‐word and pseudoword spellings in both fifth and eighth grades. Implications for teaching practice are discussed.     

The role of stroke knowledge in reading and spelling in Chinese

The present study examined the types of orthographic knowledge that are important in learning to read and spell Chinese words in a 2‐year longitudinal study following 289 Hong Kong Chinese children from Grade 1 to Grade 2. Multiple regression results showed that radical knowledge significantly predicted children's word reading and spelling performance across the years. Stroke knowledge contributed both concurrently (Grade 1) and longitudinally (Grade 2) to children's spelling performance after controlling for rapid naming, phonological awareness, morphological awareness and radical knowledge. These findings support the significance of radical knowledge in Chinese reading and spelling and the specific role of stroke order knowledge in Chinese spelling. The findings have implications for the design of an effective curriculum for teaching children to spell Chinese characters.     

Tier 3 specialized writing instruction for students with dyslexia

Two instructional experiments used randomized, controlled designs to evaluate the effectiveness of writing instruction for students with carefully diagnosed dyslexia, which is both an oral reading and writing disorder, characterized by impaired word decoding, reading, and spelling. In Study 1 (4th to 6th grade sample and 7th to 9th grade sample), students were randomly assigned to orthographic or morphological spelling treatment but all students were taught strategies for planning, writing, and reviewing/revising narrative and expository texts. Both treatments resulted in improvement on three measures of spelling and one measure of composition. Morphological treatment resulted in better improvement in spelling pseudowords, whereas orthographic treatment resulted in better improvement in rate of reading pseudowords. In Study 2 (4th to 6th grade sample), students were randomly assigned to explicit language treatment (phonological working memory + phonological-orthographic spelling + science report writing training) or nonverbal problem solving treatment (virtual reality-based computer simulation, drawing maps, and building clay models). Both treatments used science content material and resulted in significant improvement in spelling and reading pseudowords (accuracy and rate). The surprising finding was that hands-on, engaging science problem solving led to more improvement in phonological working memory than did specialized phonological instruction. Only when spelling instruction emphasized orthography or morphology (Study 1) did real word spelling improve. Preparation of this chapter was supported by Grant Nos. HD25858 and P50 33812 from the National Institute of Child Health and Human Development (NICHD). In Study 1 teaching assistants included Sylvia Abbott, Marci Anderson-Youngstrom, Belle Chennault, Kate Eschen, Noelia Garcia, Sandra Hiramatsu, Lynn Junell, Julia Kim, Stephanie King, Shin-Ju (Cindy) Lin, Rebecca Metzger, Heather Murphy, Jennifer Norton, Sue Palewicz, Rebecca Pirie, and Suzanna West. Also on the assessment team were Sylvia Abbott, Belle Chenault, Kate Eschen, and Rebecca Pirie. Certified teachers Diana Hoffer and Christina Johnson implemented the composition lessons written by the first author. In Study 2, teaching assistants included Nicole Alston-Abel, Leah Altemeier, Wade Altom, Marci Anderson-Youngstrom, Annie Boyd, Nicole Garcia, Laura Gould, Marta Holsinger, Yen-Ling Lee, Shin-Ju (Cindy) Lin, Laurie McCarthy, Heather Murphy, Hema O’Shea, Michelle Proux, Kristine Tardiff, and Kari Terjeson. Janine Jones supervised the assessment team. Margaret McShane and Doug Stock served as administrative assistants.     

Differences between good and poor child writers on fMRI contrasts for writing newly taught and highly practiced letter forms

During fMRI imaging, 12 good and 8 poor writers aged 11 wrote a newly taught pseudoletter and a highly practiced letter. Both letters were formed from the same components, but the pseudoletter had a novel configuration not corresponding to a written English letter form. On the first fMRI contrast between the newly taught pseudoletter and highly practiced letter, based on a group map, good and poor writers significantly activated many common regions; but the poor writers showed spatially more extensive brain activation than did the good writers. The additional regions of significant activation may reflect inefficiency in learning a new letter form. For the second contrast between the highly practiced and newly taught letters, individual brain activation analyses, based on exact clusters, showed that good and poor writers differed significantly in activation only in left fusiform. This individual fusiform activation correlated significantly with behavioral measures of automatic letter writing and expressive orthographic coding. Multiple regression in which both individual fusiform activation and individual orthographic coding were entered explained significant variance in written composition. Results are discussed in reference to the role of the orthographic loop, from internal letter form to external letter writing by hand, in writing letters and composing. The overall results are consistent with prior brain and behavioral studies of writing.     

Letter names and sounds: their implications for the phonetisation process

Our aim was to analyse the impact of the characteristics of words used in spelling programmes and the nature of instructional guidelines on the evolution from grapho-perceptive writing to phonetic writing in preschool children. The participants were 50 5-year-old children, divided in five equivalent groups in intelligence, phonological skills and spelling. All the children knew the vowels and the consonants B, D, P, R, T, V, F, M and C, but didn’t use them on spelling. Their spelling was evaluated in a pre and post-test with 36 words beginning with the consonants known. In-between they underwent a writing programme designed to lead them to use the letters P and T to represent the initial phonemes of words. The groups differed on the kind of words used on training (words whose initial syllable matches the name of the initial letter—Exp. G1 and Exp. G2—versus words whose initial syllable is similar to the sound of the initial letter—Exp. G3 and Exp. G4). They also differed on the instruction used in order to lead them to think about the relations between the initial phoneme of words and the initial consonant (instructions designed to make the children think about letter names—Exp. G1 and Exp. G3—versus instructions designed to make the children think about letter sounds—Exp. G2 and Exp. G4). The 5th was a control group. All the children evolved to syllabic phonetisations spellings. There are no differences between groups at the number of total phonetisations but we found some differences between groups at the quality of the phonetisations.