Student Case Study Formats On Dyslexia
By Shadi Tayarani
When a child is diagnosed with dyslexia, parents often want to know what the road to reading and spelling success will look like. While this road varies from child to child, there are certain landmarks that characterize the journey. These include initial success with word attack which leads to improvement in automatic word recognition and eventually improvement in spelling. The following case study describes one child and her experience.**
Karen’s mother Anna came to Commonwealth Learning Center when Karen was in the middle of second grade. Karen’s speech was remarkable for phoneme reversals – She said the word breakfast as bress-ket, the word animal as aminal, and the word especially as peshasly. Karen had not made expected progress in reading during her first grade year and her parents were growing restless with the Response to Intervention Model at the school. They decided to seek a private evaluation, and during the debrief following the evaluation, the neuropsychologist suggested that they seek private tutoring. Anna and I met and talked about Karen’s likes and dislikes and how she felt about possibly starting tutoring soon. This information is just as important as testing as it helps ensure a good teacher match and a smooth start to tutoring. I asked permission to speak with the neuropsychologist given the absence of a written evaluation. (The report was forthcoming but Karen’s parents did not want to wait.) The neuropsychologist described Karen as a lovely and bright child with severely compromised phonological awareness and rapid naming, hallmarks of dyslexia. Not surprisingly, her word attack skills, word identification, and single-word spelling were also below the 16th percentile. Her spelling was not phonetic; in other words, she did not represent each sound of the word with a letter. She wrote luc for lunch, bet for best, and sak for snack.
Karen began her twice weekly Orton-Gillingham tutorials the following week. She enjoyed the one-to-one time with her teacher and relished the opportunity to play games that incorporated her interests – word cards with kitten stickers on the back and sentences written with purple marker. She wrote in sand and on shaving cream and in big letters in the air. Her ability to read words and eventually books grew alongside her confidence. After six months, Karen had some benchmark testing. Her phonological awareness was in the 42nd percentile and her word attack skills were now in the 34th percentile, but her word identification and spelling were below the 25th. This is common. Word attack is measured by giving the child phonetically regular words (words that can be “sounded out”); many of them are single-syllable words. This is just what she had been working on in tutoring. Word identification and spelling on most assessments is measured by giving a child a mix of phonetically regular and irregular words.
Karen continued with tutoring, learning syllable types, spelling generalizations, and syllable division strategies. Karen had another set of benchmark testing a year later, one and a half years into tutoring, at the start of her fourth grade year. At that time, Karen was reading grade level text according to the Qualitative Reading Inventory. She had solidly average word attack and word identification skills (both hovering around the 50th percentile). Karen had made gains in spelling; her mistakes were so much better! She represented each sound she heard in words, but she had a terribly hard time knowing whether to spell compete as compeet, compete, or compeat…They all sounded right! The good news was that since Karen’s spelling mistakes were better, most of her errors were the type that could be corrected through spellcheck software. The other area that lagged behind was Karen’s reading fluency – While her accuracy was fantastic (98% or more of the words read correctly), her rate was below expectations for grade level. It is fairly common for students with dyslexia to read more slowly than their peers, and, for this reason, many access audiobooks when the reading load becomes too heavy to carry without support. While Karen does not yet need this support as a fourth grader, it is likely that she will as she progresses through the grades.
Karen no longer attends tutoring during the school year, but she plans to return during the summers to ensure that she maintains and improves upon the skills that she has worked so hard to obtain. Oh, and she wants to talk to her tutor about her new favorite book series: The Chronicles of Narnia!
Submitted by Shadi Tayarani, M.Ed
Director of Commonwealth Learning Center, Danvers
** Names have been changed to protect the family’s privacy.
Case Study: Ten year old child with severe dyslexia
This study discusses a ten year old Elementary School student with significant levels of dyslexia. Reading through this case study will help you recognize typical concerns, and possibly identify approaches and techniques to help you with your student. You will notice the weighing of factors and the considerations discussed. Every child is unique. No single overall approach applies to each and every child.
18 March 2014
Eric (M) 10 (Grade 2)
Student ID ER3445752M
Dyslexia Test https://www.dynaread.com/index.php?cid=testresults&pmp_id=ER3445752M646464
Input by Elaine Benton MA, with additional comments by Hans J.A. Dekkers. Both Dynaread Team members.
INPUT BASED ON PROVIDED BACKGROUND INFORMATION
School-provided information in italics.
Eric has been with us since kindergarten. Already then, he expressed difficulty learning letters and sounds, so when he moved to grade 1 we hoped with extra one-on-one help he would thrive. He didn't. At parent request and with school approval, he repeated.
ELAINE: From our perspective, looks like this was a very good decision.
His second time through was more successful, but when he hit grade 2 and had to start reading more, identifying more sight words, and writing sentences and short paragraphs, it was obvious that he didn't have the skills yet.
ELAINE: How poor is his writing? We tend to forget manual writing as we concentrate on reading but it can be such a painful, and not unrelated, issue that needs kind but concerted and steady attention.
ELAINE adds...: [Topic: About composition work with the limitations of low reading and handwriting removed]. The child tells/dictates an experience story (it could be a phrase, sentence or even a whole short story that they want to share) to the adult who writes it down and then uses the material that has been created as a text to be read. It ensures that the reading text only uses language that the child already knows and it's an excellent approach as long as the child is not able to parrot the story back from memory. If this is the case, the tutor should let the story go stale in memory until the child can't 'read' it entirely from memory. This is called the Language Experience Approach (LEA) and it is used with very, very basic readers. Reading teachers should really know or learn how to use this approach. It's hard to write as fast as they talk but its' worth it because this is a reading instruction technique that also helps them to begin to develop and order their thoughts cogently before they would otherwise be able to do so. It is, effectively, composition work with the limitations of low reading and handwriting removed.
HANS: Eric's test demonstrates extremely marginal literacy (near illiterate). In language development, a child progresses from listening to speaking, to reading, to writing, to complex authoring.
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It is unreasonable to expect a near illiterate dyslexic to write. Copying, as part of a multi-modal, multi-sensory approach in learning to read: Yes. But writing originally composed short paragraphs or even short sentences on his own: No. This is simply out of reach and ability (based on his demonstrated reading skills in our test).
So he started Orton-Gillingham for a minimum of two hours per week, which continued daily until he began with the Dynaread program.
ELAINE (Certified Orton-Gillingham Remediator): [HANS: To be effective, in the perfect world...] Orton-Gillingham should really be done for a minimum of three one-hour long lessons per week ... with practice in between. Also, see below for recommendations regarding the type of OG program that is most beneficial.
He has no other learning disabilites, is not ESL, and is a very strong oral learner. Like many other dyslexics, if he could get through life orally, no one would probably realize how much he struggles with reading and writing.
I've been working with him this school year now that he's in grade 3. I see a bright boy who is willing to try anything I suggest. We've been focusing on Orton-Gillingham yet, hoping to hammer those skills in more and more. Last year, his retention of new information had about a 50% carry-over to regular seat work. This year, it's about 70%.
But while the rest of his class has moved on at grade level, many of them reading books at the 3-3.5 level, he is beginning to realize that his books at 1.8 level are "too easy" for the others. He's becoming less brave in reading out loud in class or volunteering information.
I think this is the year that he's either going to start feeling successful or start shutting down and turn into an attitude case. I believe that's also the reason he was so keen to try a new program like Dynaread, because he wants to keep up.
ELAINE: I understand where you're coming from but I've just had so many students who've had severe reading problems but have never shut down or had attitude problems. It's just essential that they, and we, find and emphasize other things that they're good at. For some kids it's the arts, or sports and for some its things we wouldn't normally think of ... like class pets, other games or just the fact that they have a good friend and/or the ability to make a lot of friends or become a leader ... so many possibilities and all it takes is one.
Please talk to the teacher about the reading out loud. Is it being done in larger groups? If so ..., no go. Reading pairs ... ok. Triads ... ok. Many more ... not so much.
HANS: Though I fully agree with the power of identifying and help internalizing one (or more) skills that Eric may excel in, researched statistics overwhelmingly evidence the grave risks of emotional shut down. Part of the solution is what Elaine shared, but part of it is also helping Eric understand that Dyslexia is not a curse, not something to be ashamed of, and something that actually comes with many benefits (if managed well, by him and those who raise him, and educate him). It may be a very good idea for his parents to buy the following book, and read it together with Eric. Not instead of identifying and endorsing his unique talent area(s), but alongside it.
The Dyslexic Advantage: Unlocking the Hidden Potential of the Dyslexic Brain by Brock L. Eide M.D. M.A. Permalink: http://www.amazon.ca/dp/0452297923
His teacher is very aware of his strengths and limitations and teaches to them. But all the interventions now lie on my plate, and I'm hoping to help him achieve some more success. Since all our students bus in (he's on the bus about 40 minutes), before/after school programs are not an option. Generally, we focus on math and reading/writing as crucial life skills, and if needed we minimize the time spent on social/science to help them keep up with math and reading. We try not take them out of music and art, because there's lots of research to suggest that those subjects also help out academically.
ELAINE: 40 minutes on a bus is really unfortunate ... I guess it has to be social time, a good time for kid books on tape or music, learning apps or, if it isn't embarrassing, easier books that he can read alone or with a friend.
HANS: Public libraries often have offerings of audio books in their collection. I myself use Audible.com by Amazon, which offers a high quality audio experience. Some people demonstrate the ability to listen with comprehension at faster rates, and Audible.com allows this. They offer a three month trial subscription for little money. It may be a way for him to progress in academics and overall development, through listening on the bus.
ELAINE: I totally agree with the effort to keep music and art ... unless he hates them. Personally, I don't think there's much extra benefit if the child isn't interested. On the other hand, how about something physical? Sport or building/making things? Would he be interested? It's just as beneficial ... or more so.
HANS: I am also familiar with the research on the benefits of music and art to overall academic development. We are not linear-thinking creatures. Music and arts help us to broaden our perspectives. And with a current lack of reading skills, this may help compensate. And if he happens to be good at it, will also boost his sense of self-worth.
He would not be retained any more in elementary, regardless of what grade level he achieves this year or in years to come.
ELAINE: I'm really curious about why this is the case. Is there room for negotiation here?
ELAINE adds...: Regarding repeating more than one school year in elementary school, do check in with the Ministry of Education to see if such a rule can actually be imposed by a school. I don't know the rules here but I do know that, in Ontario, this would rule would never stand.
HANS: When I read that statement, I concluded that you were primarily stating it as a fact. But fact or not, retention in a Grade when peers move on is very tough on a child, especially if the child -- like Eric -- seems very very eager to stay at par with his friends.
Rather than retaining, my preference would go out to assistive technologies, like Text to Speech and Audio Books, plus selecting an academic path for him which suits his talents and abilities. But... most certainly continuing to help him to Learn to Read, with Dynaread and possible continued augmentation of OG Phonics. I categorically do not see assistive technologies as replacement for learning to read. AT's are merely a means, and most certainly not an end. You may want to watch this video (possibly even together with Eric), in which I talk about the role of AT and the balances in handling Dyslexia: http://youtu.be/0wOLl3ZRcw4
YOUR TOP THREE OF WHAT YOU HOPE TO RECEIVE FROM OUR TEAM
1. HOW TO BOOST HIS READING PERFORMANCE
ELAINE shares... I would recommend the following to help boost Eric's reading performance.
(1) Dynaread. It is really quite obvious that Eric needs to increase his sight word reading vocabulary and improve his reading speed for the words that he knows. Dynaread will help him to do this as well or better than other programs. Truthfully, no bias. Full stop.
(2) Make sure that Eric is getting the kind of Orton-Gillingham program that he needs. In my experience, OG fails when children are taught phonic information but are not given enough opportunity to use it i.e. to recode (read and spell) a good number and a wide variety of words with target phonemes in the initial, final and middle positions. (in that order if you can). Application is a skill that has to be taught explicitly (for accuracy) and drilled (for speed) with individual words, phrases, sentences and short paragraphs. Systematic, explicit phonics instruction has to go hand in hand with systematic, explicit 'application instruction'.
(3) It would be excellent if Dynaread words could be included among the words used to teach application. Doing this would, effectively, cement and 'back up' already acquired sight words and make application easier at the same time.
(4) This is going to sound obvious but ... find something that he really wants to read. Try out everything. Let him choose and let him stay with what he loves for as long as he wants. Fiction, non-fiction, many authors, many topics, many formats, graphic/cartoons, colorful characters ... anything and, if he wants to read something that is too hard, simplify sections of it and, together, do it anyway. I can't do enough to stress how important this is. It's not rocket science but it can make all the difference in the world. When they find the right things, they just take off and you wonder what on earth just happened.
ELAINE adds... : Teachers/tutors can 'level' a text by summarizing, paraphrasing and shortening it ... with simpler words that they can definitely use with the child. It's effortful on the part of a tutor. They have to be good at paraphrasing and summarizing ... but it is a pretty common and effective technique. The child still reads and learns the content that interested him but he isn't asked to read beyond his own level.
The analogy between physical and reading disabilities isn't always appropriate. I have one severely dyslexic child who wanted to run. He was only interested in, and would only try to read, books about animals. The books he wanted were way above his level but, initially, at least, he only wanted the pictures and the facts ... so we/I ended up cherry picking facts from quite difficult books. We used the pictures and captions to learn the facts together. Initially, I did almost all of the reading but then we would pull out the simpler words to work on and learn together. The level of learning kept him motivated but the level of reading instruction stayed very low. I credit this technique, however, for his remarkable improvements. He is extremely motivated to increase his knowledge on his own, read those hard 'fact' words and those books on his own and he is now (9 months later) reading vocabulary that is way above his grade level. Easy texts just always bored and de-motivated him. Now he's excited. (the principles of CLAD clear language and design can be of great assistance here ex. line breaking).
I think the main thing, is to remember that the child is not expected to do these things on their own. It's about essential teacher/student 'scaffolding'; a gradual shift/transfer of responsibility and skill from teacher to student.
HANS: Personally, I would like to add a little balance here as well. We all know the paradigm from which she is reasoning: Inner drive and motivation can do so much more than any 'external' force. Though this may be true, it never brought my friend Matthijs with his quadriplegic condition to walking. Eric did not demonstrate mild dyslexia (rather: severe dyslexia). The risk of toying with reading materials whilst not really being able to read is that they contextually guess their way through the text. In that process, the orthography of one word gets coupled with the semantics and pronunciation of another, which effectively results in polluting their reading system with inaccurate information. If a child is making progress and starts to be able to read, then I can follow Elaine's argument, but personally -- based on Eric's demonstrated abilities in his Dyslexia Test -- I would judge this too early.
(5) Separate reading and reading comprehension as much as possible. Concentrate on one of these at a time. Unless a child is extremely motivated and willing to do a lot of start-stop-recap and rerun ... try to do word decoding before or after you've read the text. Learn problematic words in advance ... read them for the student as you go along ... or read them with the student if you can do it fluently together. Motivation goes asunder when decoding effort is painful.
2. HOW TO HELP HIM SUCCEED WITH INCREASINGLY COMPLEX READING MATERIALS AS WE PREPARE HIM FOR END-OF-YEAR GOVERNMENT PROVINCIAL ACHIEVEMENT TESTING AND BEYOND
With increasingly complex reading materials ... remember that there are two kinds of texts; ones that a child can read on their own and those that they can only attempt with help. You have to use both. Learning comes from 'the new' while mastery and pride comes with the independent practice. So, it's ok if they want to read easier texts if, together, you are also reading things that are more difficult. Harder things move into the 'easy' category and we leap frog along in that fashion.
Also, don't forget that reading depends on basic language and listening skills. And reading is not the only way to improve and expand them. The richer the child's language, knowledge and story-telling environment the better.
HANS: This point of Elaine I cannot stress enough. There is significant research demonstrating that children who have been read to lots when young, and who grow up in a verbally rich environment enjoy a language development advantage. As shared earlier, reading is merely a stage in overall language development. But it is crucially important to recognize two things here:
1. Initial reading merely couples the orthography of words to the already present verbal vocabulary of the child. This is where the rich verbal environment and the being-read-to comes in as an advantage. Audio books, likewise, can help here as well.
2. ... and the following is something I would like to do more structured research in one day... When you study the works of Chomsky and other linguists, you come to realize the role of reading in our ability to grow intellectually as well. We can only 'merge' ideas and concepts if we know them. We cannot combine e.g. flour, salt, and water to come up with bread if we have never heard of flour. Reading plays a significant role in expanding our overall know-how and understanding, resulting in enriching our access to individual ideas and concepts, which we can subsequently 'merge' into original new thinking and ideas. This point is obviously a bit out of Eric's direct-needs context, but it does argue for two things: (a) It is of great value to him, if we succeed in becoming a functional reader, and (b) exposure to audio books and other non-reading materials can help make up for what he misses out in reading. And my preference would go out to audio-books over e.g. videos, because books cover subjects in so much more detail and a video.
ELAINE continues... I really wouldn't worry, at all, about preparing Eric for the PAT test (or any other standardized test until he reaches the final years of high school). Teachers are often encouraged to 'teach to the test' for these events but, especially in Eric's case, this would be counterproductive. These tests are more about evaluating schools and school systems than they are about testing individuals. Eric will, of course, have to take the test with everyone else but it won't yield any specific knowledge that will be of much use to you. Keep him on his usual program.
HANS: I could not agree more with Elaine. If at all possible and/or permissible, I would not have him involved. At this point in Eric's life it would be the equivalent of asking Matthijs to participate in the Athletics test on running a quarter mile. It only pains him, and does not yield any advantage for Eric.
3. HOW TO OPTIMIZE OUTCOME AND POTENTIAL FOR A STUDENT LIKE ERIC, EVEN UTILIZING ASSISTIVE TECHNOLOGIES IF NEEDED
Get him onto Dynaread and ensure that his Orton-Gillingham program is systematic and explicit and stresses phonics application in spelling as well as reading. Do and try anything and everything to (1) find material that really motivates him (even if it wouldn't be your choice for him) and (2) other activities and friends that make his life meaningful and fun at school and at home. More than this? I don't think you can do too much more than this. Don't forget to appreciate, congratulate and reward yourself for all of your efforts. Eric is lucky to have you.
HANS: Building on what Elaine closed her paragraph with, your school displays remarkable commitment and ability. Keep it up!
Regarding assistive technologies, well that's a thorny issue. When should we start using them? I recommend that you keep them on a backburner for a while. Voice recognition programs are becoming more and more popular but there is still room for them to improve. There are pens and other scanners that will read text aloud for you; tools that I'd suggest to any adolescent or adult. And one can ask for extra time for tests and assignments that are graded; something that's really important as soon as poor reading skills begin to mask displays of subject knowledge and other practical skill development. These are all good tools but, I have a lot of experience teaching adults as well as children so I'm acutely aware of the fact that the early years are the best learning years. Unfortunately, it rarely gets easier than it is now. It would be a terrible thing to miss any of the potential of these years by moving into adaptive technologies too quickly.
HANS: I point back to my video again. I do believe there is good use for AT, though, but... NEVER at the expense of full throttle efforts to help Eric learn to read. These AT are often rolled out as RT's (my coined term: Replacement Technologies). AT's should remain assistive and never replace the effort to learn to read.
Lastly, allow me to refer you to a white paper by the International Dyslexia Association, on Accomodating Students with Dyslexia in All Classroom Settings. https://www.dynaread.com/accommodating-students-with-dyslexia
End of Case Study
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What is Dyslexia
Watch a 10 min video explaining very clearly what Dyslexia is, and how it affects your child.
We are very pleased with the progress our son has made in reading over the last six months. The time we were spending with our son, at home, trying to practice reading schoolbooks, only frustrated him. Since starting the program he has become more confident and he enjoys reading. He no longer sees reading fluently as something out of his reach. I would recommend Dynaread to any child struggling with reading.
British Columbia, Canada