Archive | December, 2015

Recognizing Reading Difficulties 

6 Dec

Lucy was five and moved to Lynchburg, Virginia. She entered kindergarten for the first time and didn’t remember anything remarkable about that first school experience. She changed schools in the first grade and she remembered having trouble with what she called “some pronunciations.” By the time she was in the third grade and reading Dick, Jane and Sally, she realized that anything “that started in a /wh/, I had no idea. I couldn’t do a what, when, why, or where” Her father could not figure it out, in his words, “Honey, what the hell is wrong with you?” Her mother, oddly enough, was a kindergarten teacher,  and she saw that her daughter was having some trouble reading. She encouraged her to read. Sadly, Lucy didn’t like it. Reading was a chore. The outcome of these efforts was poor decoding and essentially no comprehension. Lucy’s mother desperately looked for help and for some reason decided Lucy needed piano lessons. Lucy’s response was “like I could read those notes and I couldn’t read Dick, Jane and Sally? What I remember particularly about learning to play the piano was that if you would play it for me, I could pick out the notes with my fingers. If I could hear it I could learn it. And taking piano lessons was the first time I realized if you would read it to me I could get it.”

My years of working as a reading specialist have been filled with conversations with parents in which they report they have been told that their daughter’s reading delay was due to nothing more than a developmental lag. They are told to give it some time and their daughter will eventually catch up. When a kindergartener confuses letters, associates the wrong sound with a letter, or cannot distinguish a rhyme, it usually has nothing to do with social maturity. Please do not accept the developmental lag excuse. If your intuition tells you something is not right, do not wait to seek help. 
The National Institutes of Health state that ninety-five percent of poor readers can be brought up to grade level if they receive appropriate early intervention. Of course it is still possible to help an older child with reading, but children beyond third grade require much more frequent and intensive help. The longer you wait to get help for a child with reading difficulties, the harder it will be for the child to catch up. Seventy-five percent of children receiving intervention at age nine or later continue to struggle throughout their school careers. Waiting until fourth grade, rather than taking action in kindergarten, will only make the task of remediation more complex and time intensive. It will take four times as long to obtain equivalent results. Awareness of the red flags of reading disability is the first step to an early and accurate diagnosis.

The Red Flag List

Pre K/Kindergarten Grades (Kaufman and Hook, 1998)

  •  Delay in Talking
  • Difficulty recognizing and producing rhymes
  • Difficulty remembering rote information, such as letter names
  • Difficulty remembering or following directions

Grades 1-3

  • Difficulty with sound/symbol correspondence (/a/, as in apple)
  • Confusion with letters that look alike ( b/d/p, w/m, h/n, f/t)
  • Confusion with letters that have similar sounds ( d/t, b/p, f/v)
  • Difficulty remembering common sight words (was, the, and, she)
  • Problems segmenting words into sounds (cat – /k/ /a/ /t/)
  • Difficulty blending individual sounds to make words
  • Reading and spelling errors that indicate difficulty sequencing sounds ( blast -> blats)
  • Omission of grammatical endings when reading and writing ( -s, -ed, -ing)
  • Difficulty remembering spelling of words over time
  • Slow rate of letter, object and number naming

Grades 4-8 

  • Significant difficulty reading and spelling multisyllabic/longer words (Ex. Omits whole syllables)
  • Reduced awareness of word structure (prefix, roots, and suffixes)
  • Frequent misreading of common sight words
  • Difficulty learning new information from text because of word reading errors
  • Difficulty understanding text because of underlying oral language problems with vocabulary and/or grammar
  • Significant difficulty writing, due to spelling and organization problems
  • Slow rate of reading

Grades 9-12 and adult

  • Continued difficulty with word recognition that significantly affects acquisition of knowledge and ability to analyze written material
  • Slow rate of reading
  • Continued difficulty with spelling and written composition
  • Difficulty taking notes in class
  • Trouble learning a foreign language

The awareness of these red flags makes it imperative for schools to implement systematic screening plans. The best plan is to begin screening children in early-kindergarten and continue screening at least three times a year until the end of third grade. The rationale is that it is better to slightly over-identify the number of children who may be “at risk” of reading difficulty than to miss some who may need help. The worst outcome of over-identification is that a child who would eventually have caught on receives some additional help. 

Baddeley, Allen (2003). Working Memory: Looking Back and Looking Forward, volume 4. Retreived from

Carlisle, Joanne F. & Rice, Melinda S. (2002). Improving Reading Comprehension: Research-Based Principles and Practices. Timonium, Maryland: York Press, Inc.

Hurst, E.B. (2013). Why Can’t My Daughter Read? Waco, Texas: Prufrock Press.h

National Research Council (1998). Preventing Reading Difficulties in Young Children. Washington, D.C.: National Academy Press.

Pugh, K. & McCardle, P. (2009). How Children Learn to Read: Current Issues and New Directions in the Integration of Cognition, Neurobiology and Genetics of Reading and Dyslexia Research and Practice. New York, NY: Psychological Press.


Vision Therapy Smoke and Mirrors

5 Dec​
Reprinted from above link

I had just returned from the International Dyslexia Association (IDA) annual conference, which was excellent. One of the talks I attended was on the topic of the use of Vision Therapy (VT) as a treatment for dyslexia. That same day I had a question from a parent on VT pop into my DyslexiaHelp 

To cut to the chase—there is absolutely no evidence to support VT as a therapy option for the treatment of dyslexia. None. Zero. Zilch. I could end this piece right there, but let me highlight some of the evidence (or lack thereof). In 2011, the IDA published a piece in Perspectives on Language by Drs. Jack Fletcher and Debra Currie titled “Vision Efficiency Interventions and Reading Disability” that concluded, “Referral for color overlays, tinted lenses, eye tracking, and visual information processing interventions are not supported by research.” Now, that seems pretty clear, but these therapies are still being pushed at parents as a treatment for dyslexia. They are expensive and time-consuming.

In their excellent talk on October 30, 2015, “Dyslexia: The Eyes Don’t have it,” pediatric ophthalmologists Drs. Sheryl Handler, Walter Fierson, and Melinda Rainey laid out the evidence relative to reading, dyslexia, and vision therapies. They included controversial topics such as Magnocellular Deficit Theory and Behavioral Optometric Theories, as well as therapies such as colored lenses and vision therapy. They cited, among many other sources, two joint statements (2009, 2011) from the American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; and the American Association of Certified Orthoptists, and here is what they concluded in the 2011 report:
“Visual problems do not cause dyslexia. Scientific evidence does not support the efficacy of eye exercises, behavioral/perceptual vision therapy, training glasses, or special tinted filters or lenses in improving the long-term educational performance in these complex pediatric neurocognitive conditions.” Again, quite clear (no pun intended).
During the talk, a parent asked, “What about my daughter complaining that the text moves around when she reads?” A developmental ophthalmologist in the audience who has a dyslexic daughter responded that the movement, fuzziness, etc. experienced by the child is “a symptom of the effort that’s involved in reading,” not the cause. In other words, because reading is so challenging, laborious, and fatiguing, the child experiences or perceives the print to be moving or jumping. But, no amount of VT is going to teach her to decode and read fluently. (Of course, the presenters acknowledge the importance of visual exams to determine visual acuity.) Instead, she needs systematic and explicit instruction in the skills that are directly related to reading.
What are those skills and what does intervention look like for dyslexia? The research is clear. Intervention should be research-based, multisensory, individualized, systematic, direct, and explicit. It should incorporate all aspects of spoken and written language—listening, speaking, reading, and writing. Therapy should target phonology (i.e., the sound system of our language), sound-symbol (letter) correspondences, orthographic knowledge and awareness, syllable instruction, morphology (e.g., base words, inflectional endings (past tense, third person, and plural suffixes), Greek and Latin roots, prefixes, and suffixes), semantics (i.e., word meanings), and syntax (i.e., word order). And, it should be cumulative—it should build on underlying skills over time.
So, what to do as a parent? To quote Drs. Handler, Fierson, and Rainey, “become a wise consumer.” I have posted a lot of information about intervention of the DyslexiaHelp site. Know that there is no quick fix for dyslexia. Carefully evaluate the claims that are being made with a treatment approach. Be wary of “testimonials” because you’ve no guarantee who wrote them. Ensure that the intervention is targeted at those skills I listed above that underlie learning to read, spell, and write. The practitioner should provide data that shows how your child is improving in reading, spelling, and writing. Invest your precious dollars and time into what works—for dyslexia that means research-based language/literacy intervention.
In addition to providing the leadership to DyslexiaHelp, Dr. Pierson is a founding partner in the Literacy, Language, and Learning Institute (3LI)