New Clue to Cause of Dyslexia Seen in Mishearing of Fast Sounds
Researchers Find Gene That May Link Dyslexia With Immune Disorders
Genetic Determinants of Dyslexia.
The 90 Minute Dysgraphia Evaluation
News and Research on dyslexia.
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What is dyslexia?
When a person has difficulties with reading, writing, spelling and maybe even speaking, no matter how hard he or she tries, the
problem could be a learning disability
known as dyslexia.
Dyslexia is a life-long language processing that hinders the development of oral
and written language skills. Children and
adults with dyslexia can be highly intelligent, however they
have a neurological disorder that causes the brain to process and interpret information differently.
Since so much of what happens in a classroom is based on reading and writing, it’s important to identify dyslexia as early as possible and devise strategies to help a child succeed academically.
Dyslexia has been defined as...
"A disorder in children who, despite conventional classroom experience, fail to attain the language skills of reading, writing and spelling, commensurate with their intellectual abilities." (World Federation of Neurology 1968)
More recently, this definition has been expanded and described as...
"A complex neurological condition which is constitutional in origin. The symptoms may affect various areas of learning and function and may be described as a specific difficulty in reading, spelling and written language. One or more of
these areas may be affected: numeracy, notational skills (music), motor function and organizational skills. However, it is particularly related to mastering written language, although oral language may be affected to some degree."
(British Dyslexia Association 1968)
Research into Dyslexia has been ongoing since the symptoms of "word blindness" and problems of visual memory were first identified by an Opthalmologist Dr James Hinshelwood in the 1890’s. The last 30 years of research have converged on
4 main areas of difficulty, of which one or several may be present:
Difficulties with automatic balance
Immature motor skills
Auditory processing problems
Abnormal processing of visual information
In 1996, researchers at the University of Sheffield concluded that, "children with dyslexia have deficits in phonological skill, speed of processing and motor skill. These deficits are characterized as problems in skill atomization
which are normally masked by the process of conscious compensation." (Fawcett, Nicolson and Dean 1996)
When 2 or more of these symptoms are present, Neuro-Developmental Delay can be one of the underlying factors.
All academic learning is connected in some way to the functioning of the motor system. Reading is not a purely cognitive task, it requires eye movements to be precise and well controlled; writing involves hand-eye co-ordination with
the automatic support of the postural system. Posture develops as a child gains control over balance and balance is dependent upon a mature reflex system. Immaturity in the development of primitive and postural reflexes can therefore
have a direct impact upon motor dependent skills and academic learning that is linked to motor performance.
"Whilst it cannot be said that all children who have been diagnosed as having Dyslexia have Neuro-Developmental Delay, Neuro-Developmental Delay is sometimes an underlying factor in children who fail to respond to normal remedial
intervention" (Goddard Blythe 2001).
What are the effects of dyslexia?
Dyslexia can have different effects on different people, depending on the severity of the learning disability and the success of efforts to develop alternate learning methods. Traditionally dyslexia causes problems with reading,
writing and spelling and those problems manifest themselves differently in each person. In fact, some children with dyslexia show few signs of difficulty with early reading and writing, but have more trouble with later complex language
skills, such as grammar, reading comprehension, and more in-depth writing.
Dyslexia can also make it difficult for people to express themselves clearly. It can be challenging for them to use vocabulary and to structure their thoughts during conversation. Others struggle to understand when people speak to
them, not because they don’t hear, but because of their difficulty processing verbal information. This is particularly true with abstract thoughts and non-literal language, such as idiomatic expressions, jokes and proverbs.
Perhaps most importantly, all of these effects can have a disastrous impact on a person’s self-image. Without help, children often get frustrated with learning. The stress of dealing with schoolwork often makes children with dyslexia
lose the motivation to continue on and overcome the hurdles they face.
Is dyslexia common?
According to the National Institute of Health, up to 15% of
• the US population has significant difficulty learning to read.
• Dyslexia occurs among people of all economic and ethnic backgrounds.
• People are born with dyslexia. Often other members of the family also have dyslexia.
What are the warning signs?
The following are common signs of dyslexia in people of all ages, but that does not mean that a person displaying these signs necessarily has a learning disability. If a person continues to display difficulty over time in the areas
outlined below, testing for dyslexia
should be considered.
• Understanding that words are made up of sounds (known as phonological awareness)
• Assigning correct sounds to letters-alone and when combined to form words
• Pronouncing words properly-blending sounds into speech
• Spelling words
• Learning the alphabet, numbers, days of the week-basic sequential
information
• Reading with age-appropriate speed and accuracy
• Reading comprehension
• Learning numbers facts
• Answering open-ended questions, such as math or word problems
• Organizing thoughts, time or a sequence of tasks
• Learning a foreign language
How is dyslexia identified?
Identifying dyslexia must be done through a formal evaluation by trained professionals. The evaluation investigates a person’s ability to understand and use spoken and written language and looks at specific areas of strength and
weakness in the skills that are needed for reading. Family history, intellectual ability, educational background, social environment and other factors that can affect learning are also taken into account.
Treating dyslexia
Recognizing dyslexia early in life is a key factor in how much the learning disability will affect a person’s development. Unfortunately, adults with unidentified dyslexia often work in jobs below their intellectual capacity. But with
help from a tutor, teacher or other trained professionals, almost all people with dyslexia can become good readers and writers. Incorporating the following strategies into the learning process can help overcome the difficulties of
dyslexia:
• Early exposure to oral reading, writing, drawing and practice to encourage development of print knowledge, basic letter formation and recognition skills and linguistic awareness the relationship between sound and meaning) Practice
reading different kinds of texts (i.e., books, magazines, advertisements, comics)
• Multi-sensory, structured language instruction and practice using sight, sound and touch when introducing new ideas
• Modifying classroom procedures to allow for extra time to complete assignments, help with note-taking, oral testing and other means of assessment
• Using books-on-tape and assistive technology such as screen readers and voice recognition computer software
• Help with the emotional issues that arise from struggling to overcome academic difficulties.
•Reading and writing are fundamental skills for daily living, however it is important to emphasize other aspects of learning and expression. Like all people, those with dyslexia enjoy activities that tap into their strengths and
interests. As multi-dimensional thinkers, visual fields such as design, art, architecture, engineering and surgery, which do not emphasize language skills, may appeal to them.
Using alternate learning methods, people with dyslexia can learn how to achieve success.
Signs of dyslexia at different ages:
Young Children
Difficulty recognizing letters, matching letters to sounds and blending sounds into speech
Confusion when pronouncing words, i.e. "mawn lower" instead of "lawn mower"
Slow to learn and use new vocabulary words correctly
Trouble learning the alphabet, numbers, days of the week or similar common word sequences
Difficulty with rhyming
School Age Children
Difficulty mastering the rules of spelling
Trouble remembering facts and numbers
Poor handwriting, awkward pencil grip
Slow to learn and understand new skills - relies heavily on memorization
Frequent reading and spelling errors such as reversing letters (d,b) or moving letters around (left, felt)
Difficulty following a sequence of directions
Trouble with word problems in math
Teenagers & Adults
Reading below expected level
Difficulty understanding non-literal language, i.e. idioms, jokes, proverbs
Difficulty organizing and managing
Trouble summarizing a story
Poor memory skills
Avoid reading aloud
Reprinted from the Dyslexia Institute
Dyslexia is a language disability, not a reading disability, so not only does it affect the ability to learn to read, write, and spell by conventional methods, it affects the ability to communicate in more subtle ways. Dyslexics have
processing, perceptual, and attention/concentration problems. Dyslexic people think primarily in pictures, not words, and have difficulty learning to work with symbols such as letters or numerals. When they are confused or frustrated
as children, they begin to experience distorted perceptions, such as reversals of letters, and develop life-long learning blocks that hamper their progress.
I. Perception
___1. Impaired directionality or poor right/left discrimination.
___2. Poor performance on visual-motor gestalt test for age and intelligence.
___3. Field dependent perception.
___4. Impaired auditory discrimination.
___5. Poor spatial orientation.
___6. Impaired temporal orientation.
___7. Impaired coordination or gross motor skills.
___8. Impaired fine motor skills.
___10. Impaired reproduction of rhythmic patterns.
___11. Speech irregularities.
II. Processing
___12. Impaired concentration ability.
___13. Short attention span for age.
___14. Slow in finishing work.
___15. Poor ability to organize work.
___16. Variability in performance.
___17. Impaired inhibitory patterns or preservative behaviors.
___18. Low tolerance to frustration.
___19. Impaired activity levels.
___20. Concrete thought patterns.
___21. Possible secondary emotional overlay.
III. Intelligence
___22. Spotty performance on intelligence test, achievement high in some areas while low in others, high on some types of tests while low on others. Depression in intelligence scores.
___23. Mental age on Draw-A-Man test below mental age on individual intelligence tests.
IV. Academic
___24. Reading disabilities. (Oral reading and/or comprehension)
___25. Spelling disabilities.
___26. Writing disabilities. (Dysgraphia)
___27. Expressive problems. (Dysphasia)
___28. Mathematical and/or calculation disabilities. (Dyscalculia)
___29. Poor performance on group tests that require reading and writing.
___30. Frequent perceptual reversals in reading or writing beyond age and instructional level.
___31. Phonological awareness problems.
___32. Poor retention of learned information.
V. Medical and Family Background -- Genetic
___33. More susceptible to allergies and addictions.
___34. Family or personal history of allergies, diabetes, alcoholism, arthritis, migraines, learning problems, thyroid disorders.
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New Clue to Cause of Dyslexia Seen in Mishearing of Fast Sounds
By SANDRA BLAKESLEE
Published: August 16, 1994
RESEARCHERS say they have pinpointed a fundamental brain flaw that may be a major factor in the development of some forms of dyslexia, a learning disability that affects millions of Americans, schoolchildren and adults.
The new finding, published yesterday in the Proceedings of the National Academy of Sciences, suggests that dyslexia is at root not a visual or ordinary hearing problem, as many have thought, but a flaw in a specific brain circuit that
handles rapidly flowing auditory information. Although brain researchers familiar with the study praise it highly, most dyslexia experts have not had time to assess the new claims.
The study found that the left brain hemispheres of dyslexic children usually contain few cells of the kind that specialize in comprehending rapid sounds and that this comprehension problem is a major factor in their later difficulty in
learning to read. The researchers say the effects of dyslexia begin in infancy, when such children are unable to hear many components of ordinary language.
Dyslexia, or difficulty in reading, is a serious educational problem that affects many children and adults. Methods of treating it have generally had uneven success. The new research is important because, if confirmed by others, it
suggests a new understanding of the problem, which could suggest new treatment approaches.
"This is a medical problem with a neurological basis," said Dr. Paula Tallal, a leader in the new research. "It's not the fault of the child, the parents or the schools." Dr. Tallal is co-director of the Center for Molecular and
Behavioral Neuroscience at Rutgers University's Newark campus.
Dr. Tallal and her colleagues have just completed a pilot study of ways to help children with this form of dyslexia compensate for the brain defect. While results have not yet been analyzed, Dr. Tallal said, "we are very encouraged by
what we saw." In March, the Charles A. Dana Foundation in New York awarded a three-year grant of $2.3 million to Dr. Tallal and four other scientists who are spearheading the revised view of dyslexia.
The new research is "really exciting," said Will Baker, executive director of the National Dyslexia Research Foundation in Boca Grande, Fla. Schools may have to reconsider the way they approach dyslexia, he said.
Dr. Tallal, who heads the group effort, began working on dyslexia in the early 1970's. Back then, educators put nearly all their emphasis on the analysis of reading, she said. Speech pathologists and vision specialists paid close
attention to the eyes and ears, devising exercises to help children recognize sounds and written words.
"I wanted to ask what is going on in the brain that would lead to problems in language and reading," Dr. Tallal said. "This put me on the fringe."
Dr. Tallal's early research described how language-impaired children sometimes had trouble integrating sensory events. "I really had an 'Aha!' phenomenon," she said in a recent interview. "I thought maybe it's that they have difficulty
in processing fast speech sounds.
"I looked at the acoustics of speech," she said. "What are the critical cues that differentiate one speech sound from another? The speech stream is very complicated. When you put sounds together, everything starts moving fast. You need
to analyze individual sounds, put them in the right order and keep up with the meaning."
Some speech sounds, such as pure vowels like "aaaaahh," occur in a steady flow that continues for more than 100 milliseconds (a tenth of a second), Dr. Tallal said.
But other sounds are characterized by rapid changes. The so-called stop-consonant syllables -- ba, da, ga, pa, ta and ka -- have a transitional period in which the initial consonant frequency changes very rapidly to the frequency of
the vowel.
The initial "b" vibration in the sound "ba" lasts for only 40 milliseconds before switching to the "ah." The brain has to distinguish these fast transitions to discriminate stop-consonant syllables, Dr. Tallal said.
But other sounds, such as "ma," do not depend on a fast transition, she said. The "m" typically lasts a hundred or more milliseconds before the "ah." Hints From the 70's
Dr. Tallal said listening experiments done in the 1970's had also led her to think about auditory timing in the brain. In such experiments, a different word is introduced simultaneously into each ear of a human subject. Most people
tend to pick up the word that is introduced into the right ear, she said, presumably because it goes to the left side of the brain, which is specialized for language.
But in further tests, Dr. Tallal found that only words with stop consonants and the fast-timing requirement yield this so-called right ear advantage. If sounds like "ba" are artificially stretched out -- turning the 40-millisecond
transition into a 100-millisecond transition -- the right ear advantage is less pronounced.
In other experiments, Dr. Tallal presented brain-damaged adults with nonverbal tones arriving 10 milliseconds apart. Those with right-brain damage could hear both tones just fine, she said, but those with left-brain damage could not.
That led to a second idea, Dr. Tallal said. "Maybe the reason we have left specialization for language," she theorized, "is not for speech alone, but for rapid temporal processing." These ideas remained unprovable, she said, until
scientists could probe the brain with new imaging and anatomical techniques.
Dr. Albert Galaburda, a neuroscientist at Harvard Medical School and a world authority on brain anatomy, has found microscopic anomalies in the cerebral cortex and asymmetries in left- and right-brain regions of people who suffered
from dyslexia. Dyslexia appears to be a problem stemming from mistakes that occur during brain development, he said. But how these abnormalities could lead to reading problems has not been clear.
The finding reported yesterday helps clear up the mystery. In autopsies on five dyslexic and seven normal brains, Dr. Galaburda examined an area called the medial geniculation nuclei, a relay station in the auditory circuit essential
for comprehending sounds. In the normal brains, he found a mixture of large and small nerve cells in the medial geniculation of both hemispheres. Neuroscientists theorize that large cells are specialized for fast information
processing, Dr. Galaburda said. They would detect the transition from "b" to "ah" or "p" to "ah" and never confuse the two.
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Researchers Find Gene That May Link Dyslexia With Immune Disorders
By SANDRA BLAKESLEE
Published: October 18, 1994
BY comparing the reading test scores and genetic codes of hundreds of children, researchers have found the approximate location of a gene that seems to be associated with dyslexia, a complex disorder that prevents millions of people
from ever learning to read well.
The site of the gene is on chromosome six and lies within a huge stretch of DNA that gives rise to the human immune system. The finding, reported in the current issue of Science magazine, fits with the observation that many dyslexics
have asthma, hay fever and other immune disorders, suggesting that the problems may be linked.
If the finding holds up, it might one day be used to develop early genetic screening tests for some types of dyslexia, said Dr. Reid Lyon, a director of research on learning disabilities at the National Institute of Child Health and
Human Development in Bethesda, Md. Some treatments for dyslexia are effective, he said, and the younger the child begins them, the better the results.
But the study's authors expressed caution about their finding. "This gene could affect autoimmune disease and dyslexia, but we could be wrong," said Dr. Lon Cardon, a quantitative geneticist at Sequana Therapeutics in La Jolla, Calif.,
and the lead author of the paper. A decade ago, experts declared there was a gene for dyslexia on chromosome 15 but, Dr. Cardon said, like many studies involving complex traits, as more families were added to the study, the finding did
not hold up.
Nevertheless, most experts are convinced that dyslexia has a strong genetic basis. If a parent is dyslexic, a child's risk of developing the disorder is 30 to 40 percent higher than that of a child without a family history, said Dr.
Bruce Pennington, a neurophysiologist at the University of Denver who studies dyslexic families.
Other studies show a link with autoimmune disorders, Dr. Pennington said. For example, one survey found that 10 percent of dyslexics had autoimmune illnesses like rheumatoid arthritis or ulcerative colitis, whereas only 1.5 percent of
their nondyslexic relatives had similar disorders. Thirty percent of dyslexics had hay fever, as compared with 12 percent of those without the reading problem.
But such increased risks do not show up in all studies of dyslexics, Dr. Pennington said, which suggests that the sort associated with immunity may be a subtype.
To explore this link, the new study used a simple method. Researchers recruited 114 severely dyslexic children and their siblings, measured their reading scores and extracted DNA from their blood. Then they mapped the locations of a
series of so-called DNA markers -- short lengths of DNA that show great variation among individuals.
If siblings shared a marker and both had severe reading problems, it meant the marker might be near a gene that contributed to the reading problem, Dr. Cardon said. To verify the results, researchers applied the same method to 50 pairs
of fraternal twins, one with a reading problem and one without. No associations were found when the markers and reading scores were different.
So far, only one gene locus on chromosome six has shown a strong correlation with reading difficulties, Dr. Cardon said. Nothing unusual has shown up on chromosome 15 or 12, he said, but the search is continuing on other chromosomes.
This is the first gene locus that appears to have a big effect on susceptibility for dyslexia, said Dr. Shelley Smith, a medical geneticist at the Boys Town National Research Hospital in Omaha, Neb. But there are probably other genes
that are also important.
The next step is to try to isolate the gene and figure out its function, Dr. Smith said. Recent research suggests that dyslexia may be caused by subtle defects in brain wiring and that the gene may be somehow involved in this problem,
she said.
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Genetic Determinants of Dyslexia.
With an incidence as high as 5-10 percent in school age children, dyslexia is primarily genetically determined. Recently, several genes have been independently identified as causative for the disorder. One of these, located in the DYX5
locus on chromosome 3, has been shown by Dr. Kere and colleagues from Karolinska Institute,
Sweden to be the axon guidance receptor gene ROBO1. Another haplotype, on chromosome 6p22, has been shown by Dr. Silvia Paracchini, University of Oxford, to be associated with a biological mechanism for the development of dyslexia.
Drs. Haiying Meng and Jeff Gruen, Yale University, also will describe a reading disability locus on chromosome 6p22, located within the DCDC2 gene, which is preferentially expressed in brain regions known to participate in the reading
process. Drs. Bruce Pennington, University of Denver, and Dr. Anthony Monaco, Well come Trust, Oxford, will present information on dyslexia and the genetics of language and reading disorders, respectively.
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What is Dysgraphia?
The term dysgraphia has customarily been used to refer to a disorder of written language expression in childhood as opposed to a disorder of written language acquired in adulthood. Written language disorders have also been referred to
as "developmental output failures."
Difficulties in writing have an adverse impact on academic achievement in school and subsequently on business and industry. It is currently estimated that dysgraphia costs American industry and business $30 billion per year.
Written language is the graphomotor execution of sequential symbols to convey thoughts and information. Since writing represents the last and most complex skill to develop, it is the most vulnerable to insult, injury and adverse
genetic influences (Deuel, 1994).
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Multiple Brain Mechanisms
Writing represents a highly complex neurodevelopmental process, which involves multiple brain mechanisms. It requires the simultaneous and sequential integration of attention, multiple information sources, memory, motor skill,
language, and higher cognition. Gross and fine-motor coordination, motor memory, and "kinetic melody", a term coined by Luria, requires balancing, flexing, and contracting movements as well as simultaneously stimulating some muscle
groups while inhibiting other muscle groups.
In order to self-monitor writing output, visual, proprio-kinesthetic, automatic motor memory, and revisualization feedback mechanisms must be engaged.
Visual feedback mechanisms include eye-hand coordination and visual-fine motor integration.
Proprio-kinesthetic feedback mechanisms include awareness of the movement and location of the fingers in space, internal monitoring of rhythm and rate, and pencil grip.
Motor memory feedback mechanisms include motor plans or engrams, visual-fine motor coordination to produce symbols, sequentialization, speed, and accuracy.
Revisualization feedback mechanisms include visual memory for symbols, whole word memory, visual attention to detail, and spelling.
All of these skills require developmental readiness and can be improved with practice.
Requirements for Written Language
The primary requirements for written language include:
An intact central nervous system
Intact cognitive ability
Intact language skills (both receptive and expressive)
Motivation
Skill development
Practice, and
Emotional stability.
Secondary written language requirements include:
Concepts of organization and flow
Writing skill
Spelling skill
Syntax and grammar knowledge
Mechanics, productivity, & accuracy
Visual spatial organization
Simultaneous processing
Revisualization, and
Automatization.
Dysgraphia Classification Systems
Dysgraphia is often classified as either specific or non-specific (Deuel, 1994). Specific dysgraphia results from spelling disabilities, motor coordination problems, and language disabilities such as aphasia. The components of motor
dysgraphia are sometimes related to anatomical problems, executive dysfunction, motor planning deficits, and visual-spatial perception problems.
Non-specific dysgraphia may result from mental retardation, psychosocial deprivation, or poor school attendance. Some children do not develop adequate handwriting skills because they have not received enough direct instruction in
written language.
Deuel (1994) has divided dysgraphia into three subtypes:
Dyslexic dysgraphia
Dysgraphia due to motor clumsiness
Dysgraphia due to a defect in the understanding of space
In dyslexic dysgraphia, spontaneously written text is poorly legible and spelling is severely abnormal. Copying of written text is relatively preserved, however, and finger-tapping speed on a neuropsychological battery is generally
normal.
Dysgraphia due to motor clumsiness is associated with poorly legible spontaneously written text, preserved spelling, and poorly legible copying of written text. Finger tapping speed in such cases is generally abnormal.
Dysgraphia due to a defect in understanding of space is associated with poorly legible spontaneously written text, preserved spelling, poorly legible copying of written text, and normal finger tapping speed.
Assessment Issues
There are a variety of assessment issues, which must be addressed in evaluating disorders of written language. These include the various characteristics of the dysgraphic writer, such as fine-motor/writing speed, attention and
concentration, writing organization, spelling, knowledge and use of vocabulary, language expression, and perception of details.
Assessment instruments, which may be useful in diagnosing written language disorders include:
Processing Speed Index scores from the WISC-IV
Developmental Test of Visual-Motor Integration
Bender-Gestalt
Jordan Left-Right Reversal Test
Trails tests from the Halstead-Reitan Neuropsychological battery
In addition, a variety of written language achievement measures include:
Test of Written Language-Third Edition
Woodcock-Johnson Psycho-Educational Battery-III standard and supplemental achievement tests
Wechsler Individual Achievement Test-Second Edition
In addition to characteristics of the writer, the school psychologist must assess the type of instruction that has been provided to the learner and the student's response to the writing curriculum. Various characteristics of
instruction, which should be incorporated into the background knowledge and included in the history taking of the student, include:
Penmanship instruction
Instruction on how to organize and arrange thoughts
Instruction on written language rules including capitalization, punctuation, grammar, spelling and sentence structure.
The psychologist should determine whether direct instruction has been provided and whether note-taking methods have been taught and practiced.
In many classrooms relatively little time is allocated to the cognitively complex business of writing (Graves, 1983). It may well be the case that many of the difficulties so many students experience with writing are due to the
inopportune combination of difficult content to be learned and very little time allocated to learning it (Stein, Dixon & Isaacason, 1994).
Some current writing mechanics trends advocate teaching mechanics only as the student's interests dictate in the course of a planned composition instruction (DuCharme, Earl & Poplin, 1989). Advocates of such trends suggest that
mechanical writing skills, such as spelling, should not be taught formally. Rather, students should be encouraged to invent spellings. Others are wary of this type of approach for several reasons:
First, descriptive research (Graham, 1990) indicates that spelling and handwriting difficulties experienced by many students with learning disabilities hamper their effective participation in composition instruction.
Second, such an approach virtually preempts the possibility that many diverse learners will learn mechanics in such a way that their knowledge will transfer. Knowledge transference depends upon the careful selection of instruction
examples (Gick & Holyoak, 1987).
Third, a concerned shift away from teaching writing mechanics represents a swing in the educational pendulum that can produce deficits in knowledge of these important components of writing (Stein, et. al., 1994).
Finally, there is little research support for the notion that writing mechanics will take care of themselves more or less automatically in the course of well-designed composition instruction (Isaacson, 1989; Stein, et al., 1994). Good
writers have knowledge of all aspects of writing mechanics and composition alike.
Intervention for Written Language Disorders
Intervention for written language disorders depends upon an accurate localization and assessment of the student's specific deficiencies. When difficulties are related to the child's age or grade, age-specific remediation of deficit
skills is recommended. When specific deficiencies are present, bypass strategies may be useful. When dysgraphia is the result of multiple deficiencies, remediation and bypass of the problem become more difficult.
Remediation strategies for early elementary age children with written language problems include writing readiness exercises, instruction and practice using appropriate pencil grip, formation of symbol skills, practice to increase
fluency, and direct instruction to improve writing organization.
Writing studies indicate that students with learning disabilities benefit most from instruction that emphasizes writing as a process (Graham & Harris, 1989; Morrocco & Newman, 1986). This instructional model emphasizes the
communicative purpose of writing by creating a social context in which students write for real audiences with real purposes. Secondly, it is based on the view of composing as a problem solving process involving planning, drafting,
revision, and editing.
At the upper elementary level it is often important to begin introducing bypass strategies for the dysgraphic student. Examples include shortening assignments, increasing performance time, grading first on the content of the work and
then on the quality, avoiding negative reinforcement, using oral exams and allowing oral presentations from the student, and giving tests in untimed conditions.
Bypass strategies utilizing computers and other assistive devices are also helpful for students with written language disorders.
Prior to teaching the use of word processing software, keyboarding skills should be mastered. Keyboarding can be taught by any teacher who can type (Majsterk, 1990). An excellent program to teach keyboarding skills is Keyboarding
Skills for All the Grades (1987) by Diana Hanbury-King. Keyboarding skills are best taught on a manual typewriter which requires force to push down the keys. This helps to lock in muscle memory for the position of the keys.
Summary
Written language is the ultimate, most complex method of expression. It involves infinitely complex multiple brain mechanisms, highly synchronized processing and has multiple sources and locations for disruption of activity.
There is a need for accurate diagnosis of written language problems, realistic remedial strategies and realistic expectations for the learner. A combination of accurate diagnosis, remediation using direct instruction techniques, and
the use of bypass strategies and assistive technology can be useful in supporting the needs of the learner with written language deficits.
On-Line Resources
Disorders of Written Language
Alpha Smart
Assistive Technology
Handwriting without Tears
Handwriting Repair
Suggested Readings
Cavey, D.W. (2000) Dysgraphia: Why Johnny Can't Write: A handbook for Teachers and Parents.
Levine, M. (1994) Educational Care: A System for Understanding and Helping Children with Learning Problems at Home and in School. Cambridge, MA: Educators Publishing Services.
Richards, R.G. (1998). The Writing Dilemma: Understanding Dysgraphia. RET Center Press.
Richards, R.G. (1999) The Source for Dyslexia and Dysgraphia. LinguiSystems, Inc.
Silver, L. (1998) The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities. Times Books.
Vail, P. L. (1987) Smart Kids with School Problems: Things to Know and Ways to Help. New York: E.P. Dutton.
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The 90 Minute Dysgraphia Evaluation
Neuropsychology of Dysgraphia
Steven G. Feifer, Ed.S, NCSP
Philip A. Defina, Ph.D., ABPdN
November 2002
(The examiner would use one test from the different categories.)
1 - INTELLIGENCE MEASURES:
Wechsler Intelligence Scales for Children
Cognitive Assessment System
Differential Ability Scales
Woodcock-Johnson III
2 - CONSTRUCTIONAL DYSGRAPHIA:
Beery Visual-Motor Integration Test
Bender Gestalt
NEPSY (Design Copying)
Process Assessment of the Learner (Copying)
Wide range Assessment of Visual Motor Abilities
Rey Complex Figure Test
3 - WORKING MEMORY:
Test of Memory and Learning (Digits and Letter Backwards)
Trailmaking Test (Halstead-Reitan)
Planned Connections (Cognitive Assessment System)
Children's Memory Scale (Dot Locations and Sequences)
Woodcock-Johnson III (Auditory Working Memory)
WISC PI (Spatial span, Arithmetic & Sentence Arrangement)
Wechsler Memory Scale(Visual reproduction & Paired Associate)
Paced Auditory Serial Addition Test (PASAT)
Wide Range Assessment of Memory and Learning (Finger Windows)
4 - EXECUTIVE FUNCTIONS:
Wisconsin Card Sort Test
Stroop Test
BRIEF (Behavior Rating Inventory of Executive Functions)
Brown ADD Scales for children (3-12)
Woodcock-Johnson III (Planning)
Cognitive Assessment System (Planned Connections)
Delis-Kaplan Executive Function Scale
NEPSY (Tower)
WISC PI (Elithorn Mazes)
Booklet Category Test for Children
5 - WRITING AND SPELLING SKILLS:
Wechsler Individual Achievement Test - 2nd Edition
Woodcock-Johnson III
Test of Written Language - 3rd Edition (TOWL-3)
Test of Written Spelling - 4th Edition
Test of Early Written Language - 2nd Edition (TEWL-2)
Test of Written Expression (TOWE)
OWLS Written Expression Scale
Informal Writing Assessment
6 - PHONOLOGICAL AWARENESS TESTS:
Comprehensive Test of Phonological Processing (C-TOPP)
Process Assessment of the Learner (Phonemes & Pseudo-word Decoding)
Woodcock-Johnson III (Word Attack)
Phonological Awareness Test
NEPSY (Phonological Processing)
Test of Word Reading Efficiency (TOWRE)
7 - RETRIEVAL FLUENCY MEASURES:
Woodcock-Johnson III (Retrieval Fluency & Rapid Picture Naming)
NEPSY (Verbal Fluency & Speeded Coding)
Process Assessment of the Learner (Expressive Coding & Sentence Sense)
Controlled Oral Word Association Test (COWAT)
8 - FAMILY HISTORY:
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