General Question about Dyslexia—SandyKC? Anybody?

[Heathermomster]

Please don’t quote.  I will likely delete later...Thank-you.

How does one approach teaching a severe dyslexic with gifted working memory and processing speed but average verbal comp and perceptual reasoning?  There is a diagnosis of dysgraphia and the child will require speech.

When are Lindamood-Bell materials recommended?  When is something like Hearbuilder recommended?  And how would one discover which therapy is best?

SandyKC, can you hear me?

 

 

[PeterPan]

Was the verbal score from the IQ or SLP testing? And is the SLP working on articulation or language issues?

Your gut is right that they want to figure out why the dc has such severe phonological processing disorders and whether there's something more global going on. You'd want to eliminate APD and ASD. 

It really depends on what the SLP does and whether she's hitting language. You're going to tutor or the parent? 

I'm digging on the language thing, because at that age my ds' language scores didn't necessarily look so terribly discrepant. "Average" is a pretty broad range. So with a gifted IQ, you can even be like 28th percentile on language, which renders one effectively unable to do what one's IQ is trying to do, and yet the score is still average, about 1SD from the mean. Now there is a strand of thought from ASHA that SLPs and schools need to use published cutoff data specific to the test rather than arbitrary numbers (1.5 standard deviations, etc) to determine eligibility for services. ASHA seems to be saying that for many tests a much higher cutoff is better for catching kids with SLI (specific language impairment).

In other words, without knowing what the language issues are, you don't know what he needs. You can work on the phonological processing in isolation, yes, just like any other kid. You can get him decoding and not have comprehension, depending on the degree of SLI. That's what happened with my ds. Fwiw we now have language scores that are so crazy bad the probably even the ps will finally qualify us, sigh.

So it's really about basics. Need phonological processing, just like anyone else. Need language, just like anyone else. The LMB LIPS stuff is good, obviously. The newer FIS program is open and go and will be fine assuming no clinical level speech stuff you're teaching through. For my ds, LIPS was where it was at. But yeah, just in general, it's just your normal routine.

For the language stuff, how adventurous is the worker? Your other LMB products don't really make sense for this. Verbalizing and Visualizing is good, but maybe it's not time? GPP (Grammar Processing Program) was super super helpful for my ds. I got it through Super Duper Inc. Really just depends on what the language issues are. With language, more is more better. What is underlying the comprehension? It takes testing to isolate that. A lot of times they just run the CELF. I've decided Pearson is the McDonald's of testing, drive-thru testing. The GARS, the CELF, all these tests are just drive-through. GARS instead of an ADOS by someone who is trained. The CELF includes multiple choice. Someone suggested the CELF Metalinguistics for my ds, and I'm like REALLY?? Half of it is multiple choice, sometimes with 2 of the 4 answers being correct. How are you supposed to show issues with that? Oh in theory they claim to, but I'm just saying even language testing is a bit of a scam. Fastfood testing. Beware. Cynical I grow, the farther I go.

Figure out what's going on. Yes, language will hold him back and working on it can unleash reading. Just depends on what is going on. Ask more questions and we'll give more answers. :)

I've probably said this on the boards, but my ds with comprehension issues needed continued picture supports, even once he could decode. We worked through a bunch of readers labeled by Fountas & Pinnell levels that I got at the local cc teacher's lab. As a learn to read method, f&p are crap. Not decoding, blah blah. But for what I was using them for brilliant. We were literally able to back up to a level where we would have 1-2 words to a page with an illustration on every page. For real. And we'd have 10-20 books (cute, short, witty) to choose from at that level! And it just slowly worked up. Super good for his confidence. 

So there can be a balancing act, depending on what is going on and what holds him back. If he's having articulation issues, that can hold back his phonological processing. So just see what's going on. Work through it, one layer at a time. It doesn't have to be perfect to be worthwhile and it doesn't have to be fast.

[Heathermomster]

SLP is for articulation.  This is an extremely bright, precocious child who wants to please.  No sensitivity present for noise, food, or hyperactivity.  

Does APD have to be ruled out by a sound booth or would the SLP be able to test or make a recommendation for further testing?

The student tested gifted for both wm and processing speed on the WISC.  I haven’t seen the numbers.  

High wm and processing speed with average verbal processing and perceptual reasoning numbers are the complete opposite of DS.  The tester stated she had only seen numbers like this twice.  ETA:  Meaning, wm and processing numbers are the ones that are usually low.

[Lecka]

As far as reading remediation, I don’t know if this information points to anything.

I think information about what issues are being seen, phonemic awareness, phonological awareness, will be more helpful.

The speech therapist hopefully can share information about phonological and phonemic awareness and whether or not those are areas to address.

In my opinion there is a way to learn to read that follows a certain path and help is needed at certain places on the path.  

There might be other things to address too,  but they might not be directly related to reading remediation.  Hopefully they can have an OT consult or therapy (or whatever was recommended with the evaluation) also.  

Edit:  as far as lindamood bell, there is lips which can be needed sometimes — for phonological processing.  My son did this level of intervention with speech therapy and I would not have been able to do it with him at home.  He had a lot of speech errors and he was not able to imitate several of his speech sounds, so he really benefited from speech therapy.  For my son this looked like trouble with letter sounds and trouble learning letter sounds.  

Then there is Seeing Stars, on their website they say it is for kids who do well phonetically but have trouble going on to automatic word recognition.  

[kbutton]

APD cannot be diagnosed without a booth test, but the SCAN III can be run without a booth. It's just not as definitive. For my son with APD, a non-booth test run by an ed psych caught a very broad set of issues early on, and then we had more definitive testing later. If there is a local option for this child to do an inexpensive booth test, go for it. If not, then maybe look into options for getting the SCAN III through a psych or something.

What is the gifted designation based on if most things were average? Were there specific subtests that came out great?

With both verbal and some perceptual things both "average," I wonder if there are both language and visual-spatial things going on with this child.

[Heathermomster]

14 minutes ago, kbutton said:

APD cannot be diagnosed without a booth test, but the SCAN III can be run without a booth. It's just not as definitive. For my son with APD, a non-booth test run by an ed psych caught a very broad set of issues early on, and then we had more definitive testing later. If there is a local option for this child to do an inexpensive booth test, go for it. If not, then maybe look into options for getting the SCAN III through a psych or something.

What is the gifted designation based on if most things were average? Were there specific subtests that came out great?

With both verbal and some perceptual things both "average," I wonder if there are both language and visual-spatial things going on with this child.

WM and processing speeds measured gifted high, hence the gifted designation?  Our convo was brief this morning.  I cannot put my finger on it, but I feel like there are two issues going.

I already mentioned the motor eval and provided the name of my favorite ped PT.  I’ll go ahead a mention the SCAN III and possible APD screening.  

 

[Heathermomster]

Thank-you sweet, sweet Ladies for the info.

[kbutton]

6 minutes ago, Heathermomster said:

WM and processing speeds measured gifted high, hence the gifted designation?  Our convo was brief this morning.  I cannot put my finger on it, but I feel like there are two issues going.

I already mentioned the motor eval and provided the name of my favorite ped PT.  I’ll go ahead a mention the SCAN III and possible APD screening.  

 

It is unusual to base a gifted designation on WM and processing speed for several reasons, part of which has to do with theories of intelligence and test design. Not that this child couldn't be 2e anyway, but it seems odd to me. http://www.nagc.org/sites/default/files/Position Statement/Use of the WISC-IV for Gifted Education.pdf Note the bolded statement below from this article.

Quote

It is recommended practice to derive the General Ability Index (GAI) when there are large disparities among the Composite/Index scores (Flanagan & Kaufman, 2004; Weiss, Saklofske, Prifitera & Holdnack, 2006). Flanagan and Kaufman (2004), in Essentials of WISC-IV Assessment, deem the FSIQ “not interpretable” if Composite scores vary by 23 points (1.5 standard deviations) or more. The GAI utilizes only scores from the Verbal Comprehension and Perceptual Reasoning Composites, not Working Memory and Processing Speed. If the Verbal Comprehension and Perceptual Reasoning Composite scores vary by less than 23 points, “the GAI may be calculated and interpreted as a reliable and valid estimate of a child’s global intellectual ability” (p. 128). Use of the GAI takes on special significance with the gifted. Verbal Comprehension and Perceptual Reasoning tasks are heavily loaded on abstract reasoning ability and are better indicators of giftedness than Working Memory (auditory memory that is manipulated) and Processing Speed (speed on paper-and-pencil tasks). Harcourt Assessments, publishers of the WISC-IV, provides GAI tables on its website in support of similar use of the GAI when the variance between Composite scores is both significant and unusual (see Technical Report #4).

 

[Heathermomster]

1 hour ago, kbutton said:

It is unusual to base a gifted designation on WM and processing speed for several reasons, part of which has to do with theories of intelligence and test design. Not that this child couldn't be 2e anyway, but it seems odd to me. http://www.nagc.org/sites/default/files/Position Statement/Use of the WISC-IV for Gifted Education.pdf Note the bolded statement below from this article.

 

I think the tester stressed the scores to make the mom feel a little better.  Like the strengths were helping the student compensate and were high.  

[Baile]

My first thought is that although we usually think of strengths as helping to compensate for weaknesses, in some cases those strengths can actually contribute to students falling further behind in their areas of weakness. A kid who memorizes easily and processes information quickly can skip over fine details, such as those necessary for reading and writing. If he can memorize entire words, he's likely to skip over decoding much of the time especially if decoding is hard for him in the first place. 

Before recommending an intervention plan, I would need to know more about the deficits that led to the dyslexia and dysgraphia diagnoses. How low are his phonological processing scores? Which specific skills does he struggle with? Can he decode nonsense words at all? How quickly? Has he memorized irregular words? How quickly can he read them? Etc. 

[PeterPan]

Is there a spread between the verbal and non-verbal? Any behavioral issues that affected the IQ testing?

[Lecka]

I just got an email forward thing last night about this, but as far as auditory processing, keep in mind there are some free and simple things that can be done.

It will depend on different kids what will be helpful.

But in general, things like gaining attention before speaking, being closer when speaking, facing them when speaking, having a quiet environment for learning, avoiding way too much auditory stuff over the day (for kids who get overwhelmed and tired with trying to hear everything, and will get tired over the day, listen less, tune things out), not being too fast to jump in and talk if they look like they are thinking/processing even if there is a lag in time, using teaching methods that are less wordy and may do more with things like pointing to information instead of verbalizing it when possible.  

You can find lists with ideas like that and people may be able to be more specific with things they see with kids.  

These are all supports, not remediation; and then there are more supports that might be discovered with testing and things.  But this kind of thing is good, too.  

[Lecka]

Then here are some subtle things my older son did when he was little, that showed he sometimes had trouble understanding what people said.

Being the kid who doesn’t hear the teacher/parent immediately when they call to a group of kids.  Either he would notice other kids and then do what they did, or he might be the kid who needed his own instruction (everyone blah blah, then say names of the one or two kids who didn’t react).

Having a lot of trouble following directions from a distance, with no sense of trying to avoid it, and easily able to understand when the speaker was nearby. 

Sometimes/often misunderstanding what people said by being off a word here and there.

Frustration with long, wordy explanations when he did want to know something but would get frustrated with a long, wordy answer.  He would prefer to be shown something with a little explanation than to have all verbal.  An attitude like “please just show me.”  

So for him he had speech therapy that helped his phonological processing, it turned out it was all from auditory discrimination (hearing letters like they might be other letters with certain sets of letters), and then all of these subtle things went away after he made progress in speech therapy.  

I think with more significant auditory processing, a speech therapist will be able to tell.  But if it is the kind of thing that won’t happen in the quiet, calm, peaceful atmosphere of speech therapy, then I think there are things that they might not automatically be seeing.  But I think this is why they will talk to parents too and say things like “do you see this at home, do you see that at home,” because they are wanting to know if some issues that they wouldn’t see in the office are going on in other places.  

A big difference with my son too was he got more involved in groups of kids playing, he was much less on the sidelines and more able to quickly throw in some comment or suggestion.  It was noticeable and had been something where he had a big difference in how he acted with 1-2 kids than with a group of kids.  

[Heathermomster]

8 hours ago, PeterPan said:

Is there a spread between the verbal and non-verbal? Any behavioral issues that affected the IQ testing?

I don’t know about the verbal/nonverbal spread The tester indicated that the dyslexia was severe, and she recommended retesting every 18 months to ensure the student was making improvements.  Behavior issues did not affect the testing.

[PeterPan]

How severe were the articulation issues? Are we talking just a few remaining sounds (r, th) or a lot? Apraxia?  My ds' issues are significant, because of his apraxia, and the processing and the articulation were linked. We've only started getting th/TH in the last year, so we did all of our Barton working SKIPPING anything with th. For real. But sometimes it can also be the reverse, that working on the phonological processing improves the speech. Maybe that's why his WM was so high? Maybe the way they've been working on his speech in therapy he has to hold syllables and sounds in his head? Dunno. 

The other thing is, they may have used the WISC 5. I'm hearing funky things about it backchannel, nothing official or from a psych. We had it done and the results on verbal were really funky. For my ds though, I've assumed the issue was his language issues. At age 6, when we first did the WISC, his SLP-tested language scores were sorta in the reasonable range depending on whether you were looking at expressive or receptive, vocab or comprehension. (28th-99th percentile, nothing that created a core score with 1.5 SD of discrepancy) His language tests (SLP) have now dropped to where we have multiple tests showing 1.5 or much much more SD of discrepancy, and in that time his verbal IQ dropped 30 points.

So yeah, it's possible the dc actually has a language issue and that's why the verbal WISC score is unexpectedly low. Neuropsychs often run the CELF on dyslexic kids, so that's why I was asking if he's had language testing. What's his age? Age would should you how significant the articulation issues are and what SLP tests might be indicated. My ds is kind of funny, because just to work with him informally you don't totally anticipate the crazy low scores you get when you run a standardized tool. 

Dyslexics don't typically have comprehension issues beyond the low vocab due to less language exposure from not reading and getting inputs the same rate as their peers. But if he's 6 and getting a lot of audiobooks, that shouldn't be as much of an issue. So think about the differences there. If he's 10 and still doesn't have all his sounds and is having funky scores, it's really different from 6, kwim? 

I'm agreeing with you there could be more going on. It takes more testing to sleuth it out, and where to put the money for that testing depends on the age and what they're seeing. If he's actually having issues with auditory processing, like he has trouble hearing with background noise, puts his hands over his ears, complains sounds are too loud, etc., yes, they should be getting him tested. I took my ds just because it was a reasonable thing to exclude. If they can find a univ that can do the basic hearing eval and screening on the cheap, absolutely get it done. If insurance is covering a private SLP, I would push for language testing to find out what else is going on. If that IQ verbal score was unexpected, like if the parents are gifted and the kid functions like he's gifted and they think there's a gap between what he's thinking and what he's getting out or any other indication, sure push for language testing. I'm weary beyond weary of the fast food CELF. Not a screening but some nice in-depth tools that can dig in on what could be going on there. I'm not saying there is something could on, just that that's how you would go about sorting it out if you thought there was. 

[PeterPan]

Just for your total trivia, when I was digging into genetics stuff I found a study in China that looked at 12 genes associated with dyslexia. So I think the idea was the more genes you had, the more severe your dyslexia would be. And the genes were in categories of what they affected, so there was a gene that affected phonological processing, a gene that affected rapid naming, etc. 

So in theory they could run genetics, see what else they find out along the way, and then look at that list and see which ones he has to target their intervention. Here's the link. If you scroll down, there's a table. The RS numbers are the SNPs or precise alleles they looked at. If you use 23andme, you'll be able to search for those SNPs using the RS numbers. https://behavioralandbrainfunctions.biomedcentral.com/articles/10.1186/1744-9081-10-23

[PeterPan]

30 minutes ago, Heathermomster said:

 Behavior issues did not affect the testing.

That's really interesting, btw. There's such a strong overlap with ADHD and dyslexia that we just always assume it will be there. Maybe that's why the dc has high WM and processing speed? Maybe he doesn't have dyslexia? If there were no behaviors and the psych didn't diagnose ADHD, that could explain it. And if so, that's really exciting. That's a strength to work with, absolutely. That good WM and processing speed is going to make him so much easier to work with and help him so much with his intervention. It will be able to hold the sounds and blend them together, hold sounds while he's motor planning to write/type, etc. It's a really exciting thing.

I'm with you though that you wonder whether that low verbal IQ is reflecting other verbal issues that need to be tested. If they're observant, I think they can just go with their gut.

[Heathermomster]

The child is 7 yo and only had NP testing.  I think they used the WISC-IV and performed some achievement testing.

 I wish there was some one size fits all type testing. It’s hard explain to people who are new to the game that they’re going to need to get more testing done.   The mom is looking for an SLP and OT from the same clinic. I’m assuming the SLP is going to be used for articulation but perhaps I’m wrong and the student will get more language testing.  I’ll have more information later.   I’m trying to be efficient when advising my friend. "

[PeterPan]

That's a really good age to be doing this. That's interesting that they got a referral for OT too. For the writing issues? They should test for retained reflexes themselves, because OTs often are not trained in it. Of course you know that, lol. 

Things will just evolve and unfold. Beginning SLP, OT, and OG tutoring is a lot. After he begins reading, they may say ok we're seeing comprehension issues, and that will drive further testing. It doesn't have to all unfold at once. 

I still like audiology as a cover your butt, sure. To me it's like vision or dentist.

Fwiw, we've been doing OT at a clinic like that that has a bunch of people under one roof. (8 or 10 SLPs, lots of OTs etc.). It's actually been really good. The OT brought a lot of fresh energy and enthusiasm and got my ds writing things comfortably. Not sheets and reams, but he'll take the marker from my hand and write his spelling words for himself. That's really helpful, because we were having to skip that in Barton. 

OTs just really vary, and we happened to end up with one who really enjoyed handwriting and working on the deficits (VM, etc.) underlying why they weren't writing. Who knows, maybe he'll make some beautiful progress by beginning so many services. It could happen. And if the first OT is not so helpful, they can try another. It's a journey. There's this idea of capabilities and that good therapy steps in and says you're right on the cusp of something, lets unleash this. It can change a whole dynamic, even if his situation seems really discouraging right now. They're building a good team. It sounds like good stuff. He'll probably begin to make progress! :)

[PeterPan]

In other words, PEOPLE breaking things down into small steps that he's really ready for and changing the dynamic to a positive, successful, forward-moving one, are going to be more important than particular programs. Programs can't repair a broken soul.

[Heathermomster]

The np stressed to my friend that remediation would need to be gentle so that the student didn’t shut down and/or develop negative self-worth.  

Ok, so I think OT is for the dysgraphia.  My friend has walked beside me while raising both my children.  She has heard all of my cries and fears.  I have ranted a ton about good therapists and bad therapists.  I expect she will be careful with her therapist choices, and I’ve given her the name of our ped PT who is awesome.

 

[PeterPan]

Do you have any good dyslexia schools she could consider? Around here, we have a dyslexia school that is astonishingly good. People move here to attend it or commute and rent an apartment during the week. I can tell you that in their classroom they use Zones of Reg, social thinking materials, etc. So what you might in theory wish you could bang out with a tutor, an hour a day, boom, they'll spread over 3 hours with lots of breaks. The teachers are ALL TRAINED in Zones. It's honestly the most amazing thing. So if that teacher sees you're going yellow zone, she's gonna walk up, show you your zones book, offer the cart with strategies. They can work in alternate spaces, like not even in the classroom but out in the family/living room style all. It's really what you're psych there is describing as gentle. 

So that's something for her to consider, the pacing. That's what it could look like. She might want to get trained in Zones or get the book and bone up quickly. See if the OT is trained in Zones and have the do Zones. Not everyone who uses Zones is on the spectrum. Sometimes it's just that life is so wicked, unfairly hard that people are constantly maxed out and need that extra support.

That school also does a lot with positives and strengths. Everybody, every single class, gets art every week. And I'm talking art with an artist, not just little paper crafts, kwim? Something not connected with their disability, something to let them express, something that goes well. So I don't know your friend's placement (school, homeschool), but encourage her to advocate for compassionate, supportive approaches like that. I see it now with my ds. We've peeled back some of the layers of his more obvious behavior stuff, and now what we're seeing is that academics like spelling are just really HARD and he needs those Zones strategies, that extra support.

Definitely have her do her paperwork with the ped to get registered with National Library Service/BARD. Greatest thing ever. Well that and a kindle. Love our kindle. But we also use the reader device from the NLS pretty regularly. I know that sounds silly, with so much tech in the house, but we really do. It's durable, portable, can fill a room with sound, FREE. I download books and throw them on a usb to plug into the machine, boom. For the price (free) it's really stupendous. It gets over the minor detail that he can't, hello, read comfortable the non-image-based display in the BARD app. The kindle audiobooks will all be with images, which are easy for my ds to navigate. All text, not so easy. I haven't tried the BARD app in ages though, so maybe they've improved it? For a non-reader, you want accessibility and empowerment. The kindle, ipad, anything with dictation, hook him up. 

[PeterPan]

I know, that's the hard part. So the psych says "gentle" and you're like ok, good, I'll be gentle. But what does that LOOK like? Even if they can't move to attend a dyslexia school, go drive and visit one. Seriously. It blew my mind, and I've kinda been around the block a lot. Their commitment to psychological wholeness and support to keeping kids whole was STRONG. It was this confidence that if we plow on, if we work diligently, we're gonna get there. It might not LOOK like we're gonna get there, but we will. 

And maybe that doesn't work out for every single single kid. I've heard those stories too. But when a parent gets the new diagnosis they're just like let's fix this, WHAM, buy a program. It really takes some restraint to hide your fear, PRETEND YOU ARE CONFIDENT, and say we're gonna pace it this way, we're gonna ramp up supports, we'll get there with baby steps.

Does this dc do a sport? At the dyslexia school they have a rock climbing wall. If the parent is homeschooling and has no PE, adding some kind of once a week sport or something might be good. Something that crosses the midline and builds confidence.

[Heathermomster]

The student is on a swim team and loves it.  I provided the BARD and BookShare info with links last week.  Yes, we have a local dyslexia school, and the area is crawling with OG certified tutors that we know personally.  There are lots of resources in the area.  It is very common to meet homeschoolers that homeschool in order to get their students therapies that they need. The local public system is not very good,  and the community that we live is filled with scientist and engineers.   

 

[kbutton]

15 hours ago, Heathermomster said:

I think the tester stressed the scores to make the mom feel a little better.  Like the strengths were helping the student compensate and were high.  

They are big strengths in their own way. I hope they make this child's path a lot smoother!

My kids are stinky and stinkier in the WM and processing category, lol! Some days it doesn't matter, and other days, those weaknesses are like slogging through molasses.