by Maude Leroux | Oct 16, 2018 | Reading
I have been so very busy with different trainings these past months that I know my blogs have been slow in coming! But I hope to be back on track now as we speak. We already discussed the impact of the different sensory systems on reading as well as the influence of praxis, timing and bilateral integration for interhemispheric organization. All of these would majorly impact on decoding skill, though also on our comprehension of what we read. Learning to decode occurs for a certain period in early school years and has to become an automatic skill. Comprehension skill continues to develop throughout our adult lives.
The integration model of Kintsch and Rawson (2005) state that when we read, we create a personal representation of its meaning, a mental model of sorts. This mental model is derived from information from text and our general knowledge of the words and topic. Once again this takes us back to development. In order to create this mental model, we have to be able to visualize, which calls on abstract formation, the ability to see what is not concretely in front of us. This skill develops through play as we imagine and play out stories and everyday scenarios. So many children today are over exposed to visual media taking away the responsibility of the mind to need to visualize for itself. Many children can use the visual media to store information in long term memory and then retrieve their story line, sequence and all through long term memory. Teachers and parents may think this is a wonderful accomplishment and it certainly is good for sustaining long term memory. But it fails in the integration work that occurs when we create stories ourselves, from our own mind with our sequence, timing, characters and visualization of different plots.
It is the development of working memory that enables the mind to bring the story to life so that as we decode the letters, the words are shaped into meaning and at the same time we can reflect and recall past information of concepts already known to us, all done simultaneously as we also sequence and prioritize the information at the same time. Our ability to use working memory is tested by neuropsychologists (educational psychologists) through assessments that incorporate the visual and verbal stream of information. It is the ability to integrate what we see and what we hear at the same time in the cortex that provides the adequacy of our working memory capacity. If there is a delay in either stream of information, a “mismatch” of information occurs in the cortex. It is almost akin to watching a badly dubbed movie where we see the mouth move in a certain way, but the words we hear do not match. This causes the student to sometimes need to forfeit one stream of information for the other, which shortens the availability of working memory and it becomes too much hard work to read.
Of course, comprehension also depends on the ability to use and understand language and vocabulary is one of the largest predictors of later reading proficiency. My colleagues in Speech Language Pathology can speak far more eloquently than I on the topic of language, as this certainly is an important consideration for reading comprehension. On the linguistic level individual words and the meaning of the words are considered. There is also the construct of “Microstructure”, wherein we recognize and process larger chunks of text. Finally, we also consider “Macrostructure”, wherein we recognize and process themes, topics and genre information. Different aspects of language in reading include phonology (sounds of words) and semantics (meaning of words). Grammar would be the structure of words and sentences, which could lead to struggles understanding complex sentences and working out “who” did “what” to “whom”, as well as experiencing difficulties structuring sentences. Pragmatics, which contains the social use of language, is included. Finally, there is also the aspect of figurative language, which occurs when we take language at face value and attribute multiple meanings, not only a literal meaning. Students who struggle in this area find jokes, sarcasm and wordplay confusing.
Reading comprehension is a developmental skill and requires processing speed and working memory along with imaginative thinking and creativity derived from the ability to visualize a mental representation of what we read, while we also have to understand the language we are encountering. It is complex, but if we target the different components through a multidisciplinary approach, there is no reason why children with adequate intelligence could not learn to read and do it well. I hope you enjoyed this series with me. Next time it will be on to a different topic for us to peruse and ponder.
by Maude Leroux | Sep 10, 2018 | Reading
In the previous blogs we covered the influence of the senses (auditory and visual), as well as timing on the development of reading. There is one more component to consider in order for us to decode the sound / symbol adequately and efficiently. Timing is one component of praxis (motor planning), though yet another component would be bilateral integration. Bilateral integration would be best described as the ability of the body to use the left and right side of the body in different functions at the same time. A good example would be the ability to hold the paper in one hand, turning it, as the other hand cuts the same paper. But there is more to consider.
At the most primitive level, the baby requires the assistance of the Asymmetrical Tonic Neck Reflex (ATNR) in order to move the body in a reflexive way. This reflex is developed in utero and assists in the birth process as the baby pushes head first to gain access to a world of light, sound, and movement. This reflex causes the baby to extend the upper and lower limb to the side the head was facing, while the opposite side of the body flexes. Turn the baby’s head and the opposite happens. This is the beginning of understanding laterality in the body. The development of the Symmetrical Tonic Neck Reflex (STNR) is also important as it assists the baby to move reflexively with upper and lower body. Essentially it is like a cat drinking milk. When the head goes down, the bottom goes up and when the bottom goes down, the head comes up. This is more evident during the baby’s first attempts to crawl and as the baby steadily gains control over crawling, this reflex would then become integrated.
When the baby starts rolling over from supine to prone position or from prone to supine position, they would require the upper body to be able to turn with clear segmentation through the trunk, separating the upper body from the lower body in a “turn” position. This would be the beginnings of integrating both the ATNR and STNR reflexes and also coincides with the baby’s ability to reach with his arms across midline of the body to grab hold of something.
The crawling action refines the integration of the ATNR and STNR and, over time, it steadily builds the ability to use effective bilateral integration. At first we see the same side upper and lower body complete similar actions, after which the body would then develop where upper and lower body in all 4 limbs could be acting in opposition of each other with fluidity and efficiency.
As bilateral integration ability in praxis grows in becoming more adept, the developing child starts developing an internal sense of left and right and we gain the earliest beginnings of establishing different dominance areas. Research does not support the specificity of a specific hand or foot dominance, but this innate sense of laterality becomes an important marker for school readiness in general. As the body develops this feature of laterality, it also supports the development of directionality. Directionality would be the ability to use the sense of laterality in space, such as planning ahead which direction to go or following multi-step directions to get from our office to a new store. As someone provides the directions our mind is able to follow the directions with the correct orientations of left and right in an automatic way.
It is at this level where we can really start using our eyes and hand easily from left to right and not be confused with this action during reading or writing. It is also here where developing efficiency in interhemispheric organization with specialization of reading occur in the left-brain. When we see reversals in both reading and writing, it is this interhemispheric organization that is not quite efficient as yet. And this specific organization is arranged in different systems, such as vision, auditory and the body and they all integrate together at this stage in order to create an efficient reader.
Haabib (2000) noted that there is a great overlap in cases of dyspraxia with dyslexia. The development described in this writing would be the essential overlap between these systems and it makes much sense when one considers the different components of development together with the different components of reading. In order to truly remediate decoding, it is never going to be sufficient to target one system at a time, or think that the student simply “needs more practice at a slower pace”. This type of intervention will only reinforce the difficulties that the student is already facing.
In our final blog on reading (for now), we will discuss the reading process and the impact of working memory (not long-term memory) for the act of reading.
by Maude Leroux | May 25, 2018 | Reading
Photo by sean Kong on Unsplash
In the last blog we discussed the impact of the visual system on the reading process, more specifically, decoding. There is always much talk about phonics when it comes to reading decoding and it is likely the most talked about feature discussed in current literature. Sally Shaywitz wrote in her seminal book: “Overcoming Dyslexia” that the pathway of phonics is really good for the novice reader who are learning to read, but in order to accomplish reading efficiency, we would need the high speed pathway from the occipital lobe (vision), through the temporal (auditory and timing) and to the pre-frontal cortex for meaning. It is a confluence of developmental skill that creates a proficient reader.
The first aspect to consider in the auditory contribution is if she (or he) is actually registering the sound in the inner ear. Sound occurs through a variety of frequencies and is also embedded in the under and overtones within the speaker’s voice. The listener would need to discriminate the actual sound to be repeated and create an imprint of this particular sound in the auditory cortex. When the listener encounters the same sound again, it could then be anticipated by memory. Coinciding with having difficulty with phonics, parents and clients will frequently also describe additional features of difficulty with sound. One example would be that family members could note that the struggling reader would be called 3 times by name before responding to their call. She would need to “shut down” the auditory system in order to focus on a task. On such occasions family members may schedule a hearing test, which many times result in hearing being “normal”. Hearing is frequently not the issue in phonics (unless there is a medical condition), but it is more likely the registration and processing of the auditory stimulus that can cause trouble. The pathway to the auditory cortex might be disturbed in it’s processing and the actual sound may not make it to the cortex for analysis.
For a client with difficulty in this area, it would be difficult to know if the sound she hears is the same sound that the speaker produced.
Audiologists who specialize in auditory processing disorder (APD) would have much more to say about this area of function. Fact remains: the child needs to register each specific sound with it’s own frequency and intensity on the basilar membrane of the inner ear (Organ of Corti) to create a tonotopic map, which is repeated in the cochlear nucleus of the subconscious brain, and then finally again in the cortex, where the identification between the sound and symbol can be analyzed for the first time. For a client with difficulty in this area, it would be difficult to know if the sound she hears is the same sound that the speaker produced. When she sounds out a different sound than expected, the teacher would repeat the sound, which would be confusing to her. She knows something is wrong by the words of the teacher (that can be understood in context), but isolating the sound she can only reproduce what she is “hearing”.
Another factor to consider is that the efficient reading pathway is mostly located on the left side of the brain, as is most of language. Since sensory information from the right side of the body travels mostly to the left side of the body and vice versa, it makes sense that the right ear would have to be the leading ear in this process. It would be quicker and far more efficient. In fact, our right ear is supposed to be the leading ear in listening and language, as our left ear is always scanning the environment in order to gain information from around us. In most clients tested for reading difficulties at our center, we would find that they use their left ear as the leading ear, causing a processing speed delay as the information has to first travel to the right brain and then back to the left brain. In most of these cases, we also find a coinciding auditory sensitivity, either in the past or present, as for some reasons (perhaps developmental delay?) the client had to maintain high vigilance to the environment in order to gain control over stimuli. Literature have yet to uncover more about auditory sensitivity, but it is a real issue for many family members as they observe hands over ears, especially when younger and later simply avoiding loud and boisterous social engagements. This is not to say that every client with a decoding issue has this difficulty, but it certainly coincides in a high percentage of cases.
When the teacher reads a story, the child can tune a listening ear to create context from the teacher’s language, using cognitive skill to compensate. But the same child can have great difficulty decoding “nonsense” words and even when decoding appears to be good, spelling may be a difficult, as the same sound to a different visual symbol does not make sense. Homonyms are especially difficult in spelling and it would behoove the family to seek more thorough evaluation particular to the auditory system.
Families can have this difficulty tested from the ages of 6-7 by an audiologist specializing in this area of APD. Bear in mind that accommodative strategies would be different from remediation therapy. Fast Forward has shown some success in remediating reading proficiency and would be a valuable therapy to consider. I found the most success in using Tomatis Sound Therapy (www.tomatis.com) as it also combines the vestibular process as well. Our auditory and vestibular systems share the same cranial nerve in the brain (CN8) and the added bone conduction in Tomatis support the faster processing speed. Using the Forbrain is also an additional tool that we use in conjunction with Tomatis Sound Therapy. (www.atotalapproach.com)
by Maude Leroux | Apr 13, 2018 | Reading
For the next 4-5 blogs we will focus on different aspects of acquiring reading skill. Reading is an acquired skill in the brain and not something that we are born with. It comprises of the ability to decode symbols of information as well as comprehending the words with meaning to make sense of what we are reading. Decoding is the “technical” part of reading and is comprised of the following aspects:
- The ability to see a string of letters from left to right in a sequential order requiring visual skill.
- The ability of the auditory system to be able to sound out what the eyes are seeing (phonics).
- The ability of the visual and auditory system to time together in split second second timing to gain automaticity, speed and reading fluency.
All three components are developed in the brain during early development, first requiring each system’s separate development and then ultimately the systems have to integrate together. Decoding can impact on reading efficiency in different ways:
- Some persons clearly struggle with decoding and it is an obvious difficulty that is witnessed by the observer.
- Other persons would appear to decode fine, especially when reading story books of their interest, but struggle greatly when it comes to factual text books, finding themselves reading the same text over and over.
- Others would be able to decode sufficiently, supporting the process with their intelligence, but would never be seen to pick up a book to read for pleasure.
Many families will note to us that their child can decode very well, but cannot comprehend what they are reading. If their listening comprehension is intact and they have sufficient command over language in other contexts, it does not make sense that it would only be in reading that they could not comprehend. We have to consider more closely what the different components of decoding skill are and assess each separate function in order to determine why reading has such an impact on a person’s learning ability, especially when intelligence is intact. For this writing let us briefly focus on the different visual skills involved in the reading decoding process.
In order for the eyes to see the letters it is supposed to decode, we require acuity and ocular motor skill. Acuity is tested through an optometrist, though ocular motor skills frequently are not. There are ciliar muscles around the eyes that have to be synchronized in order to create this efficiency. The eyes have to work together to see exactly at the same point on the page (binocular fusion). Both eyes have to be able to rapidly move from one point to another very quickly (saccades). And both eyes have to be able to fixate together at the end of a saccadic eye movement in order to give the auditory system time to sound out what was seen.
Decoding also requires a very precise synchrony between the visual and vestibular system in order to gain efficiency. The development of the Vestibulo-Occular Reflex (VOR) is an important piece of development in this instance. We have to be able to intricately coordinate the visual pathway of stable vision with peripheral vision in order to affect the momentum of the eyes. Some persons with reading difficulties will note that for them it feels like the words are moving and they need to “catch up” to the individual words. The eyes also need to develop visual perceptual skills such as:
- Form Constancy – no matter the font, it will be recognized for the letter it is. Visual discrimination will assist in seeing the differences in each letter to be able to read it.
- Visual Figure ground is an ability to pay attention to the foreground (letters in black) against the background (the white page). For some persons it feels like they are seeing white “rivers” instead of focusing on the black print. When a reader is fluent in decoding they also employ Visual Closure. This is seen in the ability of the brain to “close” the letters we are scanning through on a written page. Fluent readers do not look at each letter anymore.
- Visual memory is required to remember different letters, words, and patterns to form Word Attack skills.
Another skill would be Visual Sequential Memory that recognizes the different sequences in words in a certain order. Some persons are observed to reverse letters, sounds and words and have to “de-reverse” in order to make sense of a word. We will discuss this more under laterality later.
Each of these skills need to be assessed on it’s own in order to determine efficiency. These areas can be influenced by therapy and need to be considered when confronted by a struggling reader. There is no reason anyone, no matter the age, can learn to read as it is an acquired developmental skill, not a specific brain injury. Decoding training requires skill and expertise and is not going to be changed if we are simply taking someone in a separate room to read “at their own pace”. In the next blog we will discuss the involvement of the auditory system.
by Maude Leroux | Apr 25, 2016 | Reading
Suzie was sitting next to her favorite teacher reading some passages of a story together. More often than not, her teacher interrupted her process requesting of her to reread a word. Suzie was becoming anxious. She knew that this was not without reason, something about what she sounded out was “wrong”. She really wanted to please her teacher, but she saw what she saw and heard what she heard in her mind’s ear. To help herself in the situation, she looked at the word again and took a guess she hoped was going to be the right one.
So many children and adults struggle to overcome the reading process. Reading is about the ability to use your senses in a coordinated manner to make use of symbols you see on paper. The technique for acquiring reading skill that is still mostly used in school systems is repetition at your own pace. If you repeat the same patterns long enough, you will only achieve the compensation your brain has to make in order to cope with the reading and not necessarily gain the ease of decoding that will lead to fluency.
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In order to read a symbol, we have to first be able to see it. Suzie might be having difficulty with ocular scanning, or she might have difficulty appreciating the black and white contrast on the page (a form of visual hypersensitivity), or she might be seeing distorted images that are not stable to her and same symbols never quite look the same to her, to name a few. We do not know how Suzie uses her eyes in order to perceive the symbol. And she does not know to tell us because she assumes our vision would be the same as hers and we are seeing what she sees. The teacher does not know that no amount of repeating is going to change what Suzie sees unless she could find a way to use rote memory which will never gain reading fluency, not attract Suzie ever to pick up a book to read for pleasure.
When we insist on repetition of broken patterns of reading, we are only reinforcing what is not there, causing the very compensations we do not want to see.
It might be that Suzie can see the symbols quite well, but she has difficulty sounding out the word. The world of phonics is a large one and teachers do spend a great amount of time in early grades on phonics, which is truly a great work. The trouble is that you can only speak what you can hear. If Suzie is having difficulty assimilating sound in her inner ear, she might not be hearing the same sound that the teacher is pronouncing. Think of when we are trying to communicate in a foreign country and we are trying to pronounce the foreign language, but we simply cannot get the sound out. I think you get the idea, but this is what the world sounds like every day for a kid like Suzie. And once again, she has no idea that she is not listening in the same way to the same sound and therefore it is very hard to commit to memory and to use fluently. No amount of phonics repetition can replace that the auditory system does not perceive sound the same way as the sound projected.
But let’s say that Suzie can see and hear adequately. Keith Raynor’s research stated that good readers see about 11 to 18 character letters at a time and the phonics kicks in between 5 to 20 milliseconds later. We are talking split second timing now. If the visual and auditory system is not timed together, there is no way of gaining the fluency you need for reading.
Reading is complex, but it is also developmental. If we ignore the developmental aspect, we have to make too many assumptions that may simply not be true. When we insist on repetition of broken patterns of reading, we are only reinforcing what is not there, causing the very compensations we do not want to see.
by Maude Leroux | Mar 20, 2016 | Autism Spectrum Disorder, Executive Functioning Skills, Parenting, Praxis, Programs, Reading, Social Skills
For many years now I wanted to create a space for parents, therapists, teachers and psychologists to come together and discuss functional difficulties in the light of development. In our world today, the focus has shifted to more and more productivity and though I also believe being productive is a good goal, I really want to support the process to get to that goal. What does this mean? Simply that if a child understands the sequence of how to accomplish something and can execute it, the product will always be there.
Too much emphasis is being placed on behavior, when in reality the child’s behavior is a communication to us. We have to try to understand why a child chooses a specific behavior in a certain circumstance. At my trainings, I usually repeat the following statement a number of times: “If a child could, he/she would”. Once any one of us feels successful at something, we wish to repeat it again because it feels so good. The only reason we avoid certain activities is because that “feeling good” is absent or elusive and we have to find a way out of the situation.
Too much emphasis is being placed on behavior, when in reality the child’s behavior is a communication to us.
In this blog, we can cover a multitude of discussions on a variety of different topics. We can discuss modalities such as DIR/Floortime or Sound Therapy, but we are also going to be practical and discuss different behaviors and what to do about them. We can discuss the brain and what does a child need in order to achieve academically. How do we read and write? How do I get my great ideas out on written expression? How do we pace ourselves through an activity and know how much we can accomplish in a certain time? How do we mobilize a child to the next level of functioning? I will welcome case discussions and discuss sensory processing development alongside emotional processing development. Diagnosis is necessary, but not considered the most important aspect of every child. We can discuss kids on the autism spectrum; though also discuss children with Down syndrome, Cerebral Palsy, and yet other categories such as reading and learning disorders. What I do not know, we can research together, but the importance would lie in that we tie in theory with practice and be helpful in providing everyone ideas to collaborate upon.
I travel a lot to train others; so do not despair if sometimes I do not respond immediately. I will be there most of the time quite quickly, unless travel causes a delay in my response time. I would also like to make this blog about you. Your questions, your suggestions are going to spearhead the next pieces of information, so please comment, ask your questions. Together we can create a forum that would support all of us as a collective group.
So welcome again and let the games begin!
Maude
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