Let s Start from the Beginning

Specialized Reading Instruction for Students At Risk for Dyslexia Martha S. Burns, Ph.D. NYCASE Keynote July, 2017 Let s Start from the Beginning Other New Research on Multi-Deficit Approach to Dyslexia Let s start with: Peterson. Robert & Pennington, Bruce (2012) Seminar: Developmental Dyslexia Lancet. May 26; 379(9830): 1997 2007 Like all other behaviorally-defined disorders, the etiology of dyslexia is multifactorial, involving multiple genes and environmental risk factors There is a relatively small but significant male predominance (1.5-3:1) Boys with dyslexia come to clinical attention more often than girls, apparently because they have higher rates of comorbid externalizing disorders, including Attention-Deficit/Hyperactivity Disorder (ADHD) For many years, a single-deficit phonological theory of dyslexia reigned. BUT this is likely not necessary and sufficient to cause the disorder. So, Although more research is needed to fully understand the phonological problem in dyslexia and related language disorders, such as SSD and LI, focusing only on phonemes is clearly a mistake 3 1

Update - Review of Newer Research on the Neurobiology of Dyslexia August 2016, Pages 45 58 Neuroscience of education Lessons to be learned: how a comprehensive neurobiological framework of atypical reading development can inform educational practice. Ola Ozernov-Palchik, Xi YuYingying Wang and Nadine Gaab Multi-Deficit View to Dyslexia Now considered the most accurate way to understand causation and also understand other related learning disabilities Ozernov-Palchik, O., Wang XY., and Gaab, N., 2016 1. Perceptual Cognitive Level 2

The Relationship between Auditory Processing and Reading Christmann, C A.; Lachmann, T. & Steinbrink, C (2015) Evidence for a General Auditory Processing Deficit in Developmental Dyslexia From a Discrimination Paradigm Using Speech Versus Nonspeech Sounds Matched in Complexity. Journal of Speech, Language and Hearing Research. Feb. 2015, VOL 58, 107-121 7 Summary: Christmann, C A.; Lachmann, T. & Steinbrink, C (2015) Auditory Processing Deficits were found prior to school entry Results support the existence of a general auditory processing impairment in developmental dyslexia that might be the cause of the phonological problems at least in a large subset of persons with dyslexia. This pattern of results was, however, not evident in every individual. In fact, four participants with dyslexia did not show any auditory processing deficits at all. 8 Categorical speech representation in human superior temporal gyrus Edward F Chang, Jochem W Rieger, Keith Johnson, Mitchel S Berger, Nicholas M Barbaro & Robert T Knight Nature Neuroscience VOLUME 13 NUMBER 11 NOVEMBER 2010 3

Categorical Perception 4

Updated research N Mesgarani et al. Science 2014;343:1006-1010 Fig. 1 Human STG cortical selectivity to speech sounds.(a) Magnetic resonance image surface reconstruction of one participant s cerebrum. N Mesgarani et al. Science 2014;343:1006-1010 Published by AAAS Fig. S6. Spatial organization of responses in STG (A) Location of electrodes in one subject color coded by cluster membership in Fig. 2C shows a dispersed pattern (B) Correlation values of electrode PSIs plotted against their distance shows a small but significant relation between similarity of PSIs with distance between electrodes. 5

JSHR Research 2017 Franscisco, A. et al A General Audiovisual Temporal Processing Deficit in Adult Readers With Dyslexia The results suggest an audiovisual temporal deficit in dyslexia that is not specific to speechrelated events. 16 Brain Level Reading depends on integrity of brain infrastructure? When a child s brain is mature and ready for school it is like an efficient intercontinental transportation system Nodes are like city buildings built through subject area content Use of content builds the circuits that connect the nodes- rapid and efficient transportation systems 6

Neuroscience Updates as of January 2017 Brains build like companies do: they reorganize as they expand Brain areas we used to consider emotional, such as the regions of the limbic system, are now known to be major hubs for general communication throughout the brain so managing motivation and reinforcement is essential that s what drives the hubs to form 19 Hubs, nodes, edges, nodules - the full view Rich clubs form for highest traffic patterns VandenHeuvelandSporns Structural-Functional Networks in Human 20 Cortex J.Neurosci.,September4,2013 33(36):14489 14500 Nodes, edges and modules closeup Grammatical encoding Houses with families temporal processing Suburbs verb tenses Rapid access Slow effortful access OHare, ATL,SFO INTERSTATE HWYS LOCAL ROADS Haartsen, R., Jones, E. & Johnson, M. (2016) Human brain development over the early years. Current Opinion in Behavioral Sciences 2016, 10:149 154. Brain networks. Nodes (orange dots) are connected by short and long range edges (light blue lines) within modules (in green dotted circle). Connections between nodes, for Human brain example development node a and over node the b, early can years Rianne have a Haartsen, short path Emily length JH Jones (solid yellow and Mark arrow) H Johnson or a long length (dotted yellow arrow). Rich club nodes (red glowing dots) are connected across modules with strong (solid dark blue lines) and weak (dotted dark blue lines) longrange edges. Adapted from [8,21,29,30]. 21 7

An Analogy we all understand complex travel We are learning how information travels in the brain Microscale edges and nodes Macroscale - connectome Language and the Brain Michael Artur Skeide, Max Planck Institute for Human Cognitive and Brain Sciences The ontogeny of the cortical language network. Nature Reviews Neuroscience April 2016 8

The development of Syntax Skeide, The ontogeny of the cortical language network. Nature Reviews Neuroscience April 2016 Development of Language in the Brain Skeide, The ontogeny of the cortical language network. Nature Reviews Neuroscience 2016 April Vandermosten, 2016 The most consistent findings across studies are differences in left TP brain regions between at-risk pre-readers and controls. Because left TP is associated with phonological processing, this provides substantial support for the phonological deficit theory. Differences in left ventral OT regions are also observed prior to reading onset, though less consistently. Finally, some evidence is also provided for an early deficit in perceptual regions, especially in the auditory domain [15,17 ]. It is important to highlight that several studies indicate early connectivity differences in at-risk pre-readers [3,16,18 ]. 9

Brain Level Differences in Dyslexia Genetics Dyslexia risk gene relates to representation of sound in the auditory brainstem Previous studies associate poor reading with unstable speech-evoked brainstem responses. DCDC2 and KIAA0319 risk alleles form a strong genetic link with developmental dyslexia. Genetic burden with KIAA0319 risk is related to unstable speech-evoked brainstem responses. Genetic burden with DCDC2 risk is related to intact speechevoked brainstem responses. Revealed brain-gene relationships may inform the multifactorial pathophysiology of dyslexia. Neef, et al. Developmental Cognitive Neuroscience 24 (2017) 63 71 10

Do children with dyslexia also have other disabilities? It is estimated that approximately 40% of all persons with dyslexia will also have ADD or ADHD Arnett et al (2017) Explaining the sex difference in dyslexia. J Child Psychol Psychiatry, online Feb. 9, 2017 Find that the sex difference in dyslexia is also real The cognitive differences identified to account for a portion of the sex difference in dyslexia in this research were processing speed (PS) and inhibition (INH) males showed better verbal reasoning. No difference in female vs. male verbal skills (interesting). 32 Arnett et al (2017): Conclusions Processing speed, which is slower and more variable in males, mediates the sex difference in both dyslexia and attention deficit/hyperactivity disorder. This research clearly supports the content and science that underlies of the FFWD exercises with emphasis on building Working Memory, Rapid Auditory Processing and in some cases Processing Speed more closely akin to that term used by neuropsychologists, and Inhibition in the form of vigilance tasks like Moon Ranch and Flying Fish 33 11

Estimated Cumulative Words Addressed to Child (In Millions) 6/8/2017 Environmental Factors Prenatal factors such as maternal stress, smoking, and alcohol consumption, can affect cortical development and neural migration The development of brain regions that support language, reading, and executive functions are particularly affected by socioeconomic factors At the onset of schooling, ineffective instructional practices, negative social perception, limited instructional resources, and other adverse academic factors may further exacerbate poor reading development in children Moreover, lack of parental awareness may result in negative parent child interactions and poor psychological outcomes for the child Language Experiences Language Experiences by Group Professional 45 Million Words Working-class 26 Million Words Welfare 13 Million Words 12 24 36 48 (Age Child in Months) Meaningful Differences in the Everyday Experience of Young American Children by Betty Hart & Todd R. Risley. Paul H. Brookes Publishing Co. (1995). 12

What we now know about the importance of language and brain maturation http://www.nature.com/nature/videoarchive/brain-dictionary/index.html Huth, A., DeHeer, W., Griffiths, T., Theunissen, F. & Gallant, J. (2016)Natural speech reveals the semantic maps that tile human cerebral cortex. Nature 532, 453 458 (28 April 2016) As far as the brain is concerned - Language is everywhere How does Poverty affect Brain maturation Family Poverty Affects the Rate of Human Infant Brain Growth * Poverty Affects Cognitive Functions * Jamie L. Hanson et al., in PLOS One, Vol. 8, No. 12, Article No. e80954; December 11, 2013 Educational achievement depends on integrity of brain infrastructure? When a child s brain is mature and ready for school it is like an efficient intercontinental transportation system Nodes are like city buildings built through subject area content Use of content builds the circuits that connect the nodes- rapid and efficient transportation systems 13

Scientific American Mind May 2016 Effects on Brain Development The neural circuits for dealing with stress are particularly malleable (or plastic ) during the fetal and early childhood periods the regions of the brain involved in fear, anxiety, and impulsive responses may overproduce neural connections those regions dedicated to reasoning, planning, and behavioral control may produce fewer neural connections Damage to health and well-being This wear and tear increases the risk of stress-related physical and mental illness later in life Extreme exposure to toxic stress changes the stress response system Responds at lower thresholds to events that might not be stressful to others, Activates more frequently and for longer periods than is necessary, like revving a car engine for hours every day. 14

(1) the sympatheticadrenomedullar y (SAM) system, which produces adrenaline in the central part of the adrenal gland Biology (2) the hypothalamicpituitaryadrenocortical (HPA) system, which produces cortisol in the outer shell of the adrenal gland Both adrenaline and cortisol are produced under normal circumstances and help prepare the body for coping with stressors. Adverse Childhood Experiences (ACES) (n =1007) [Jimenez et al, 2016) Variable % (No.) Child maltreatment Psychological 16 (162) Neglect 13 (132) Physical 15 (154) Sexual 0.6 (6) Household dysfunction Maternal depression 12 (121) Substance use 15 (149) Incarceration 18 (181) Violence toward mother 11 (111) Total ACEs 0 45 (451) 1 27 (275) 2 16 (158) 3 8 (84) 4 3 (25) 5 1 (11) 6 0.3 (3) Jimenez et al. Adverse Experiences in Early Childhood (ACES) and Kindergarten Outcomes PEDIATRICS Volume 137, number 2, February 2016 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Table 3 Teacher Ratings of Below Average Academic Skills percentages (Jimenez et al, 2016) Lang and Literacy Science & Social Studies Math 0 Aces 1 Aces 2 Aces 3 or more Aces 15

What's Behind The Push In Scientific Research To Identify Dyslexia Early? Interview with Dr. Nadine Gaab May 30, 2017 http://www.wbur.org/c ommonhealth/2017/05 /30/identifyingdyslexia-early Auditory Processing as a Dyslexia Predictor - Dr Nina Kraus The Washington Post New research suggests it may be possible to predict Preschoolers who will struggle to read in later years. It has to do with how the brain perceives The Auditory Neuroscience Lab, Northwestern University, shows scalp electrodes to pick up how children s brains react to sounds such as speech in a noisy background. Northwestern University researchers analyzed brain waves of children as young as 3 speech when it s noisy. 47 Kraus, et al. 2015 Fig 2. (A) In Year 1 (Experiment 1) each child s score on the phonological processing test is plotted against the model s predicted scores (n = 37). The two are highly correlated (r = 0.826, p <.001; when a correction is applied for the unreliability of the psychoeducational test, r = 0.870, p <.001). (B) A histogram of the error of estimation (the difference between a preschooler s actual and predicted scores). For a majority of children, the model predicts scores within 2 points on the test. 48 16

Interventions Zone of Proximal Development New concepts are maximally learnable because they are just difficult enough to engage the child yet easy enough to maintain high spirits What can be done when the brain is not mature and ready to learn? Exercise and Build Cognitive Infrastructure Supports learning and assures content maintained Sustains Focus on Content Supports Fluency and Learning Efficiency Solutions: Neuroscience Moving from Why to What and How Positive experiences after infancy have been shown to compensate to some degree for the negative behavioral consequences Being exposed to an environment rich in opportunities for exploration and social play, Caring and positive relationships with adults Computer activities designed to target the skills that are impacted can turn around some effects of poverty Fast ForWord exercises, because of their specific emphasis on language, attention and memory are particularly effective and offer a cost effective valuable solution 17

The Role of Neuroscience Technology Well designed neuroscience-based technology builds the underlying capacities that are reduced in some children of poverty or with learning issues Executive Function + Cognitive Skills 52 To Enable Fast and Enduring Changes in Achievement Cognitive Infrastructure Exercises must also be INTENSIVE DOES THE CONTENT OF THE INTERVENTION MATTER? Interventions and training programs involving phonological and auditory tasks have repeatedly gained remedial effects in Dyslexia, Specific Language Impairment, and Language Learning Impairments (Ylinen and Kujala, 2015) 54 18

LANGUAGE AND READING AREAS ARE ACTIVATED AFTER SIX WEEKS OF COGNITIVE/LANGUAGE TRAINING Typically reading children Reading Impaired Children Reading Impaired Children before remediation after remediation Gabrieli, 2009 Left anterior inferior Angular frontal gyrus IFG Gyrus AG Left Medial Temporal Gyrus Visual Word Form Area Do children with dyslexia have difficulty in other subject areas? Reading is integral to every subject, so children with dyslexia often have trouble in other areas. For instance, a student may be gifted in math, yet be unable to complete word problems. Science and social studies also require larger amounts of reading. Additionally, social difficulties can arise from lack of confidence and self-esteem directly related to the disability. Successful Reading Intervention May Help other Subject Areas 19

Fig. 2 Learning to read strengthens cortico-subcortical functional connectivity Skeide, et al., 2017 Learning to read alters corticosubcortical cross-talk in the visual system of illiterates. Science Volume 3(5):e16026 12 May 24, 2017 What resources may help parents support their student with dyslexia at home? Proust and the Squid by Maryanne Wolf is a great book; Useful Web sites include LD Online at www.ldonline.org and the National Center for Learning Disabilities at www.ncld.org. Questions? 60 20