Dyslexia and Early Intervention #23 | Liz's Early Learning Spot

Podcast: Play in new window | Download

Today’s interview is with dyslexia and early intervention specialist Dr Tim Conway. If you’re looking for ways to ensure young children are given the best early intervention, or just to take the most effective approach towards setting up a solid foundation for reading in the future, this interview is for you! You can listen to this episode above, listen to it on iTunes or Stitcher, or read the transcript below. Learn all about dyslexia and early intervention in this interview with Dr Tim Conway. Lots of practical tips!

Dr Tim Conway

Dr Conway works in the area of neuropsychology, which means understanding how our knowledge, our behaviours and emotions relate to our brain function. He’s done extensive research on dyslexia, since it runs in his family, as well as research on how to use early intervention to successfully help kids, and adults, overcome their learning challenges. You can find out more about Dr Conway’s work and his online tutoring programs by going to The Morris Center or NOW! Programs. Or find him on Facebook at Now! Programs or The Morris Center. Just so you know, this podcast has not been compensated in any way to promote Dr Conway’s programs. Nor can I personally vouch for them, but if dyslexia is of personal or professional interest to you his programs are a resource you may like to investigate. Dr Conway, welcome to the Early Childhood Research podcast. Thank you so much, Liz. It is my pleasure.

What is dyslexia?

Today we’re talking about dyslexia. And so my first question is, what exactly is dyslexia? Dyslexia really falls under a large category called Specific Learning Disorders.

It’s a Specific Learning Disorder

There are three types of Specific Learning Disorders.

There’s reading and spelling.
There’s a written expression one,
and there’s mathematics.

Clearly dyslexia is the one that falls under the reading and spelling learning disorders.

Diagnosis

That diagnosis can be given to children, whether their reading problem is:

a reading accuracy problem, which means they misread words, they make mistakes, they start to add, repeat, shift, change words.
a reading fluency problem where they’re reading too slowly and they don’t catch up with their peers and they’re always far behind in their reading speed
a reading comprehension problem where they’re reading along, but they’re not understanding what they’re reading,
and of course there could be any combination of those three altogether

That diagnosis of a specific learning disorder is identical or synonymous with the term dyslexia.

Etymology

DIS means trouble, LEX means words. Dyslexia means trouble with words, but our most common focus is on the reading problems of it.

Misconceptions of dyslexia

What are the misconceptions of what dyslexia is?

Seeing words backwards

Probably the most common ones that the newspapers and cartoonists love to play with, is that they make the children or adults with dyslexia see words backwards. They reversed words, they reversed letters and they used to think this might possibly be one of the causes of what was happening. Kids would look at the word “pot” and they might say “top” or they look at “was” and they’d say “saw”, and we thought, oh, they’re seeing the words backwards. But then what no one really asked back then was, how come they don’t look at “the” and say “eht”? Because if they saw words backwards, they should read all the words backwards, not just the ones that can be flipped back and forth, and regardless of whether you go right – left, or left – right, it’s identical. They’re both real words. So that’s been disproven to show, no, they actually don’t see words backwards. They do have some directional difficulties. They might have trouble with left hand and right hand and might have trouble with remembering which way do we go when we read a book, do we go left to right or right to left?

It’s a visual processing problem

That could be other co-occurring issues and that kind of confounds the misunderstandings of it, but the number one myth is it’s a visual processing problem and they see things backwards or even they think that words move. That could be a secondary symptom to the stress of the reading. When they’re struggling, the primary pieces, they just purely have trouble sounding out words and they’re not very accurate in their reading.

It’s not that common

It affects one out of five children. I find that really astonishing. I have a question about that. You have the one in five statistic about dyslexia, but I’m wondering, are there variations? Is it on a spectrum like other things are, so that some kids are more obviously dyslexic and others only have a touch of it? Yes. With the brain, you’re always talking about a continuum, mild, moderate or severe, and so if you include all variations of it from mild to moderate to severe, that’s where you get the higher percentage ratings. It was one out of five kids. If you’re looking at just severe ones, it looks more like about 5%, so it’s going to be a little bit lower ranking than the 20%. So in other words, we’re missing a lot of kids that are on the lower end of the spectrum, I suppose. Yeah, true. They get pushed on or the parents are told, let’s wait and see, maybe they’ll catch up.

It’s more common in boys than girls

Or are they’re given myths like, well, you know, boys read later than girls, things that we thought were true until people really tested and found out, no, actually, those aren’t true. Those are just myths and we used to think it was four boys for every girl would have dyslexia. So like a four to one ratio. And then they actually did a large scale study and found, no, it’s actually about 1.2 or 1.3 boys for every girl that has dyslexia. The difference was the boys would act up and get in trouble when they weren’t reading because they couldn’t read well and be upset and they’d back out and girls would tend to withdraw and not want to be noticed, not want to be identified and not want to be seen as different. And so the girls just weren’t getting identified where the boys were getting identified because they were causing behaviour problems in class and being sent to the office and then found to not be able to read well. I feel like it’s a bit like that with ADHD as well. Yeah. And that was even harder because we’ve got great standardised measures for predicting reading problems. We can predict it as young as age four and five. We can even predict it based on family genetics and say if there’s family history, you’re automatically high risk. If you have a father or mother or brother or uncle or grandparent who had reading problems, you’re a high risk, but we don’t have that kind of easily quantifiable, easily measured, easily predicted kind of data that goes along with ADHD and it gets confounded by poor parenting or other problem behaviours that can cause and have symptoms that look like ADHD are secondary to some other problem.

Dyslexic brains work differently

There’s a myth that the brains of children with dyslexia work differently. Well, Liz, I’m a neuroscientist and a neuropsychologist and there’s no evidence that the brains are physically working differently. They’re working less efficiently and we can change that with the right practice and the right experience. So the hope is to get that knowledge out there and to get educators to embrace science and scientists who want to help them have more effective methods.

How to recognise dyslexia in young children

DOWNLOAD A FREE PDF OF THIS GRAPHIC HERE! Often dyslexia doesn’t seem to be diagnosed until children are in early or even later primary school, but you are a great proponent of early intervention which means parents and teachers of very young children need to be able to spot the warning signs. At what age can we start recognising that one of our children might be at risk and what exactly are we looking for?

Let’s not ‘wait and see’

Those are great questions because in any aspect of a diagnosis or a difficulty, whether it’s a medical or educational, early intervention always gives better outcomes. There’s going to be less struggle, there’s going to be less difficulty. It’s going to have less of a negative impact on the child. Decades ago, we didn’t really know what the number one predictors were. We didn’t really know what was causing dyslexia, and so there was a lot of guessing. Many times schools will take the wait and see approach. Well maybe this child is going to catch up later or maybe you know, they’re making progress and so let’s just wait and see. So wait and see has been one of the most common misapplied terms or misapplied approaches to dyslexia because now today we have very large, very reliable, very accurate predictive studies that say if you’re aged four and five and you struggle with holding onto a word and being able to manipulate its sounds then you’re going to face challenges.

Speech processing and speech perception

These are not visual tasks, they’re not a reading task. It’s actually a speech processing task or speech perception task. And then you’re going to struggle to learn how to read. How the researchers did that was they gave children a word verbally, They’d say cat, and they would ask the child, say cat back to me, and then they’d tell the child, now say cat, but don’t say the “c” sound. Well to do that task, you have to hold the word in auditory memory. You have to find where the “c” sound is, you have to take the “c” sound away. You have to figure out how to put those two sounds back together that are left and say the word “at” back to the researcher.

Phonological awareness

Kids who have what is called strong phonological awareness, and that just means your awareness of the speech sounds in words that you heard. Kids who can hold on to them and manipulate them, they have been shown to become really strong, accurate, fluent readers. Kids who are poor at holding on to these sounds, being able to manipulate them, being able to judge different changes, they’ve been shown to be kids who are more likely to struggle to learn to read and certainly are not going to be reading at their true potential or their true IQ. That’s interesting because we don’t really know that it’s going to manifest until we realise they have trouble reading. So you’re saying it’s not to do with that? It’s before they get to reading and writing.

Speaking comes before reading

Absolutely, and here’s the way to think about it. The brain is very systematic and very organised in how it develops skills. So when I ask parents, OK, which skills did you learn first? Did you read and spell first or did you speak first? They are all like, well, of course we spoke first. So speaking is the earliest developing form of language. You speak and you listen, and you speak and you listen.

The alphabet is abstract – children start with the concrete

Then later we bring in alphabet letters. One question I think really helps parents to understand the complexity of this reading or spelling task. I’ll ask parents to think about the letter K. Why does a K say “K”? How come a K doesn’t say “j” or how come a K doesn’t say “ey”, or how come a K doesn’t say “yu”? Why does a K makes the sound it makes? What’s the logic behind the shape of alphabet letters? And parents look at me dumbfounded like I didn’t learn that at university, and then I have to explain to them, sorry, it’s a trick question. There is no real logic, these are just purely abstract letters. They’re abstract shapes. There is no reason why the letters have the shapes they have. We learned decades ago from a developmental psychologist named Piaget that children learn from concrete sensory experiences first and they develop abstract thinking skills later on. So letters are an abstract concept. They are more difficult to learn, especially if we don’t have strong phonological awareness processing skills.

Identifying dyslexia amidst multiple issues

Children with dyslexia can be dealing with other challenges such as ADHD, behaviour problems and sensory motor issues. For those young children, are we more likely to focus on their behaviour and perhaps miss, or consider not as important, the difficulty that they’re having with words? How can we look at a child and ensure that we’re seeing that child in their entirety? Understanding how behaviour can be secondary to a difficulty helps us pinpoint the primary difficulty.

Problem behaviours?

Is it problem behaviours first lead to poor attendance in school or poor engagement in school and that’s why they’re reading because they just hadn’t gotten enough educational interest to read? Or is it that the reading problems lead to frustrations, which lead to the problem behaviours? If we improved the reading problems, then we might improve the actual problem behaviours. So we always want to look at the child, look up the standardized testing, look at the home environment, the school environment, understand the whole picture of what makes up a child’s ability to function and perform academically in school.

Sensory motor issues

Then we have the best chance of figuring out what are the primary issues and what are secondary issues. But your question also mentions sensory motor issues and this goes back to that phonological awareness again. Many people initially thought phonological awareness was just acoustic, it’s just hearing sounds until somebody studied it.

The importance of visual input for speech

When they studied it, what we found was that babies as young as six months of age are staring at your mouth. They’re watching it move, watching how your tongue is working and they’re using their visual input. S o hearing and vision together begins to build these early phonological processing skills. But that’s not enough to help them really fully build that phonological system. So if you think of it this way, if I say (ffff, th) acoustically, those sound almost sound the same to the ear and when you can’t see the speaker’s face, your ears are going to have a harder time figuring it out, was that the same sound or two different sounds? But if your eyes come in and you can see the person’s mouth, you’d see when they say ‘ffff’ the top teeth bite the bottom lip, like the letter F making, an F sound. When they say ‘th’, the top of the tongue is sticking out between the teeth and the teeth are biting down to the tongue and the air’s coming out and that’s a th sound. So then the eyes can actually help the ear categorize the sounds, but then here’s a problem with that – visual and acoustics are not enough sensory input to figure out all sounds because the child, the adult or the teenager, they can’t see their own mouth. So how can they tell if they’re making a ‘ffff’ or a ‘th,’ because they can’t use vision?

What’s my mouth doing?

So then we have a third sensory system that comes into play which is touch movement in the mouth. Scientifically we call it tactile kinaesthetic. So it’s the touching and the moving. If you feel your teeth make the shape, or feel your top teeth bite down on your bottom lip and feel you to have your mouth in the proper shape to make the f sound, then you know you’ve got that shape. Then your brain’s using three sensory inputs, vision, hearing, and touch movement of the mouth. Now, some people say, well, how can the child not know what their mouth was doing or not know how it moves? Think of it this way. If you walked into the lunch room of five year olds, you’ll see some five year olds who are wearing half their lunch on their face, there’s ketchup smeared all over their face. You know, there’s jell-o shoved up their nose and they have no idea that they have all this food on their face. So that tells you right there, that neurological sign, this child has decreased sensory awareness on their mouth because they’re not feeling this mess they have all over their face. Now, in large groups, when I speak, some wives will say, well, my husband still does that today. He still has food on his face and doesn’t know. Well, just because you got older, it doesn’t guarantee the brain actually built these skills, either.

Experience, not age, improves brain wiring

Age doesn’t re-improve the wiring of the brain. It’s experiential. So your question about sensory motor issues is very pertinent because many kids who have dyslexia will have sensory motor processing difficulties as well. The part of the brain that controls sensory feedback around the mouth and the fingers is just above the part of the brain that does our phonological processing. So those two areas of the brain are literally neighbours.

Fine motor skills

So if there’s problems in phonological awareness, there’s a high likelihood they’re going to have more trouble holding on to a pencil and not pushing too hard and breaking the lead, or have trouble forming their letters because that’s that finger control, and that part of the brain is just neighbour to the part of the brain that does the phonological awareness. That’s really interesting. So I assume that means, kids with dyslexia, it’s not just all one cause. So some kids are affected in different ways by it. So I assume that means that when we’re trying to help kids with dyslexia there is no one fixed solution?

One intervention method or many?

One study that my group did, we screened 1,500 five year olds. We screened which kids in that group of 1,500 five year olds could say catch without the “c” sound or say flame without the “l” or say baseball without saying base and just say ball. And we picked out the kids in the bottom 10% of that group.

It’s genetic

So we picked out 160 kids who had the worst of those skills and therefore most likely to become dyslexic. And by that I mean, of course dyslexia, let me clarify, it’s genetic. It runs in families. So it’s not like we’re trying to figure out if they have the gene or not. They’ve got it. We’re trying to see evidence of more severe impairment like we talked about before, or was it a more mild or moderate impairment? And so by understanding that, then we know who’s highest risk because they’ve got the gene and it started to show up and their behaviours and their brains are struggling with that phonological skill. So from those 1500 kids down to the 160 kids, we randomly assigned kids to four groups and then there’s four different interventions

One group of 40 kids got no help for two and a half grade levels and we just followed them to see how they progressed over time.
One group got equal time and attention, 20 minutes a day, four days a week for two and a half grades, just doing whatever method their teacher was using for literacy instruction. But now they got a little bit extra one on one because maybe the method didn’t matter. Maybe what mattered is that you’re going to get a little extra one on one time and that’s going to help the brain build these skills.
The third group got in an explicit phonics program because lots of research says phonics is important. It’s a part of reading. Because let’s be frank, English is a horrible language, just horrible. So inconsistent, so many variations, very few consistent rules. You can drive you crazy how sometimes E the end of the word says nothing. Sometimes there isn’t the E at the end of the word. There’s all these inconsistencies that make the language very difficult to learn, but phonics is part of it. So those kids got a real explicit phonics program, 20 minutes a day, four days a week, one on one for two and a half grades.
The fourth group got a neurodevelopmental approach, which says, we know that speech processing develops before letters and reading. Let’s go back and focus on those sensory inputs of what it sounds and looks like with the eye. What do you hear for sounds? What do you feel with your mouth from the sounds and help build that sensory basis to speech processing first and then later go to the literacy with the letters and whatnot.

That study showed that if the kids got no treatment or extra one on one help or phonics, 25-40% of them did not pass kindergarten or first grade, they were held back. But if those same skill level kids got the 20 minutes a day, four days a week of the neurodevelopmental, building those sensory processing from the ground up, addressing speech processing first and then into literacy, we had 91% of the kids who passed kindergarten and first grade. That wasn’t 25-40% that were held back, it was only nine. So it was a huge difference. Now in studies like that, you’re also looking at the dosage of what you’re doing because maybe that one method would be even more successful if they actually had gotten it five days a week instead of four, or if it was 30 minutes a day instead of 20. Those are the questions we don’t know because of the study didn’t ask those questions.

Prevention is best

So when people say no one method helps all kids, well prevention-wise, that’s really not true. Prevention-wise, we have solid data that says certain approaches like this neurodevelopmental approach are far more successful than a phonics approach than an equal extra time approach or than the do nothing and wait and see.

Language and sensory skills

If we’re going back to early intervention, the issue of focusing on spoken language is something critical we can do with young children because they’re all learning to speak and to make sounds. They’re not up to reading and writing, so therefore it makes sense that if that’s the early intervention we can do, that’s going to have a really positive effect. Absolutely, and that’s why they’re always advocating for reading to kids at young ages, discussing things with them, talking with them, engage them in their world, but there’s also just equal importance on the sensory motor system. It’s not just the literacy skills or the language skills that need to develop, we need the language skills to develop along with the sensory motor skills, along with the emotional awareness of mood and feelings and you know how that might feel to somebody else – all those things holistically together.

Don’t start reading and writing too early

I guess a good way to explain it is right now I’m in the country of Trinidad and Tobago. Here they’ve gotten to the focus now of actually teaching the written alphabet at around age two and three. In the States, we typically are not teaching the written alphabet until about the age of four and five. In the Netherlands, they do not teach it until the age of seven. Well, that’s a whopping difference. It’s like five years difference, two and seven. And yet when we look at the studies with adults literacy, adults in the Netherlands, are just as literate as adults in the US, as adults in Trinidad and Tobago. So in some ways, early instruction is not always developmentally appropriate, so you try to find what’s the developmentally appropriate early instruction.

Focus on spoken language first – it comes before reading

Now some folks have started to focus on that. There’s word meanings and so there’s morphology of words and words have small parts like “un” changes the meaning of a word or “re” will change the meaning of a word like redo or return. And they now have gotten focused on teaching kids the meaning of chunks of words as if that’s the first system to develop, and that’s what’s going to improve their literacy. But when you look at language from a developmental, cognitive model, you find no, we actually speak and perceive sounds versus phonology that comes on board first. That meaning system, that morphology system, that comes on board later. So all the research right now says do the phonological interventions first, certainly morphology training later on can be helpful, but it’s not the initial or first step of training.

What do brain scans tell us?

When we look at brain scans, we can see that dyslexic children are not using those specific parts of their brains as efficiently as non dyslexics. So as educators, is it our job to expose our children to activities that specifically stimulate those areas? If so, what kinds of activities including play should we be focusing on and if not, I ask the same question, what kinds of activities should we be sure to incorporate into our preschool day or our kinder day or our homeschool day? Yeah, that’s another really popular piece of science. In fact, I’m an FMRI brain imaging scientist myself and I have done FMRI brain imaging studies, published those studies and in that field, we call FMRI or brain scans the sexy science because it sells really well.

Just general information

It does really well in publications. People love the colorful pictures and it’s easy to understand. Oh look, this part’s working, that part’s not, but what most people don’t know about brain imaging is it’s a very young science. It’s not really well standardized, meaning different labs, even within one university. Three different brain imaging labs might actually measure and analyze and collect the data in different ways. It’s not like the standardized tests of vision. Pretty much any doctor anywhere is going to use the same vision chart, measure the same way – that doesn’t exist in the brain sciences or brain scans. So one thing we have to keep in mind is that this is a young science.

It’s an early stage science

In the states, brain imaging is only approved for one clinical purpose, that clinical purpose is figuring out if a person has more of the left side of their brain controlling speech, reading and spelling, or more of the right side of the brain, because the doctor needs to go in and take away part of the brain tissue because they have seizures that can’t be stopped with medication. And so they want to be sure that when they take away part of the brain tissue, it’s not also going to severely damage their language skills. So that’s really the only clinically approved use of brain imaging. The rest, purely exploratory. Purely just kind of trying to look and figure things out.

Phonological training leads to improved brain activity patterns

So keeping that in mind, the imaging studies show that children have decreased activity in certain parts of the brain, increased activity in other parts of the brain. But the most important finding from imaging research with dyslexia is that after those children who have been through effective phonological awareness training, their brain activity pattern looks identical to a child who does not have reading problems. There was one very popular paper that came out from a group of researchers in Houston and they took a very controversial title. They called it, and sometimes researchers do this because they like free PR, so they called the study Normalization of Brain Activity in Children with Dyslexia. That word normalization really sets people off sometimes because you’re assuming the others are abnormal. No one likes that characterization, but what they’re trying to point out is, look, once these kids had the effective phonological awareness training that went back to the speech processing first and built up to literacy second, it didn’t go straight to letters.

There are different types of phonological awareness training

Most people don’t understand that when you say phonological awareness, there can be a hundred different ways you do phonological awareness training. So we’re not always using that word to mean the same thing. But when these kids got phonological awareness training, it went from the speech processing and then into literacy, they had brain activity patterns and reading skills that were identical to kids their own age who didn’t have reading problems. So we showed that that brain activity difference is not essentially a hardwire difference. They weren’t born with an inability to use the brain properly. It was more of an efficiency. They were less efficient in using the typical areas, so other areas of the brain were trying to help out.

Scans showing dyslexia

So in general, you’d say when you look at these brain scans, you’d see in a child with dyslexia the left side is less active and the right side’s more active. And then after intervention you see the reverse, now they have more activity in the left side and less activity in the right side, and that’s the same pattern of activity as a child who’s a good reader.

Children need lots of experiences

So the key thing that you mentioned in your question, too, is experience. What are the activities or experience? The brain’s wiring is under a very key principle called experience based plasticity. That means new wiring doesn’t form unless you give the brain the right experiences, the right activities.

Reading and playing with words

And so that’s why we know lots of reading to kids is very important. Lots of early wordplay teaching your kid pig Latin, as silly as that sounds, trying to teach a kid how to say those words and move them around and say, (uh-at-way, r-ay-u-yay-u-in-day) and like, what?

Songs and rhymes and silliness

Just play with it because that makes new phonological activities, nursery rhymes, songs that go along with nursery rhymes as well. Rhyming books like Dr Seuss books – these are all books that are exploring and exposing the sound structure of our language and giving kids more and more experience with it. That wiring that might have been inefficient at birth due to the genetics is going to get enough practice and enough experience and it will wire itself more efficiently. Then the child then won’t struggle and won’t fall behind and won’t get diagnosed with dyslexia.

Make it fun

And I’m assuming that if we’re doing lots of word play and we’re doing that in a way that’s really fun and enjoyable for the child, that gives a much better long-term outlook. Absolutely, because engagement, motivation, attention, they all come hand in hand and one way to think about that is from a cognitive brain processing perspective, we say attention precedes thinking.

Attention precedes thinking

If you’re not attending to what the teacher is saying, you’re attending to, or focusing on, what you see some kid next to you doing, your brain’s thinking about what the kid’s doing, not thinking about what the instructor is saying. And so you’re going to learn about the kid next to you, you’re not going to learn the content of the day. So that attention piece really drives the actual rewire of the brain, too, because where you’re attending is where the brain’s getting the activity and where that process is going to be building.

The importance of focus

It’s why attention issues are such a critical factor for kids is because say for example, in a classroom, let’s say most kids will have a reading class once a day, five days a week. Maybe it’s a 60 minute class. If one child tunes out for 10 minutes of every class Monday, Tuesday, Wednesday, Thursday, Friday, that child’s basically lost about an hour of instruction for that week and if they’re going to be in school for 30 weeks or 40 weeks, then that’s going to be 30 or 40 hours instruction they’ve gotten less than the other kids in their group just because of their focus issues, and I say focus very explicitly because ADHD is really a poorly named disorder. These kids don’t have attention problems. They have lots of attention. The problem is where do they focus it. His parents will tell you, my kid can’t have ADHD. He plays those video games for hours if I don’t stop them, so they have plenty of attention. The challenge is can they keep it where it’s supposed to be as opposed to where it was more engaging, or more fun or more interesting to keep it.

Boring lessons?

In education, there’s been a lot of issues raised about trying to force kids to learn too early, such as, like what used to be grade one is now kindergarten and so that if it’s not done in a fun way and if it’s putting pressure on the teacher and on the child, I’m assuming that when it comes to the wiring of the brain, that’s actually not going to be as effective as it should be. Absolutely, and that’s why some of the reading programs that have been written over the years are downright painful for the child and painful to the teacher because they’re dry scripted. Teacher says this, child’s supposed to say that, it’s very dry. It’s not engaging. It’s not exploratory. It’s not motivating in learning and discovery. It’s just rote memorisation, rote memorisation, rote memorisation and that is painful. And so if we don’t get the motivation to get the engagement, what also may be a problem is you may not build the independence and the skill either and then maybe the child is now dependent on the teacher.

Teach them how, not what

He would always ask these certain questions because the child hasn’t been taught how to figure it out themselves. It’s the old biblical parable of, are you giving him a fish or teaching him how to fish? True literacy instruction should be teach them how to fish, teach them how to sound out words, teach them how to memorize the words, teach them how to figure out the meaning from the pictures to the story. All these are critical skills that should be building together and that gives us the best well-rounded educational piece, and it gives the child the best chance to be able to independently build these skills and will continue to do these activities when they’re not in the class.

More engagement = more practice

So when they’re driving down the road with mom and dad, they’re trying to read street signs or in the restaurant, they’re trying to read the menu and they’re trying to engage this activity more and more because again, that’s back to that experience-based plasticity. If you do it more per day, you’re giving the brain a chance to build wiring more efficiently, more quickly because the brain is getting more practice. An analogy I use with parents again is I’ll say, okay, let’s say that mom’s going to learn German and she’s going to get a free German lesson every Monday for three hours, but dad’s going to learn German, but dad, we’re going to send them away to a German family to live with them for eight weeks. Oh, and by the way, they speak no English and he’s going to come back in eight weeks. Now what if we giving Mama a year’s head start and then let me send Dad away for eight weeks. Who do you think’s going to be better at German? Well, odds are it’s probably going to be Dad because of the intensity, the explicitness, and it’s just the total immersion in that learning experience, that brain built that worry at a higher level with more efficiency and more automaticity. Those are the kind of the key elements of how the brain builds new skills.

More wiring = more independence

Then we’re going to get to a point where the child’s wiring is automatic and it’s more independent and they don’t need the instructor or the teacher helping them along. And then the last one is do we help them generalize it from the teaching classroom to their other life classrooms, like to math class, to history class, to science class so that they’re using these skills across all the classes because then, they’re most likely to continue to use this skill on their own without much direct instruction or guidance because we’ve built a higher degree of independence, Right, because it’s not just about what’s happening immediately with the child, but the long-term effect. Exactly. You’re trying to build life’s learning skills they can use all throughout life and keep getting stronger and stronger.

How to inform parents?

In your experience, what’s the best approach for an educator to take when wanting to let a parent know that their child is potentially at risk? Because while we’re keen on early intervention, it’s a very touchy subject and many people do want to take that wait and see approach and going on from there, what kind of advice or suggestions or recommendations should we be making?

Early screening

It’s interesting because there is, like in Australia and the UK, there’s a big push for what they call the phonics check. We want to get kids screened early, and early screening is a great idea. And if we’re doing it with everyone, then we’re really not trying to label anyone, we’re trying to actually get and identify as soon as possible who might be struggling, to get them intervention before they would get labelled, before they have fallen so far behind that they meet the diagnostic criteria of a learning disability. So most of the time, if it’s a standard part of a curriculum and an educational system that is not such a big deal, the parents want to know early.

Parents want to know

In fact, the biggest complaint of a parent is ‘I knew, I knew, I knew and they wouldn’t listen to me’, or whether they’re the teacher or the paediatrician or it’s someone else who’s involved in the child’s health and well-being, the parent is frustrated because they had that gut sense or does that experiential sense of this child is number three in my family and number one and two didn’t struggle like that. Now, sure we’re not supposed to compare kids too much, but some things are okay to compare like are they building reading skills? Are they learning to speak? Are they able to ride their bike? We want to see those developmental milestones happening at appropriate times.

Depends on your educational culture

So it really comes back to the culture of the educational system. If the culture is we want to help promote and reinforce kid’s skills as well as possible, then the early screening is not seen as a negative thing. If the culture is look, I don’t know anything about dyslexia. It’s not my area. I’m not trained in that, which is what many teachers unfortunately had the experience of being put in the position of and that’s very frankly, we’re just going to lay it right out there and say that’s the fault of the educational system for teachers.

Teacher education needs to improve

That’s the fault of the colleges of education, not making sure all teachers really understand how language skills develop, how the brain develops these skills, because it’s critical for all teachers to know how the brain works because essentially what they’re trying to do in school is change the brain’s wiring and build new content knowledge. If you don’t how their brain works, you’re going to be at a disadvantage of how to best do instruction. So when the culture there is different, and the culture is it’s not my job, that’s Special Ed, or that’s someone else, that does give the family stigma and that does make it harder to hear that my child is struggling in some way and you don’t know what to do about it and because the parents are like, well, what am I supposed to do about it? You’re the teacher, you’re the professional, so it can be really frustratingly difficult, but if we do a better job of educating the educators and they get more of this brain research knowledge in part of their university system, then it will be much easier for them to understand what’s happening and much easier for our system to take a more proactive approach and make sure that we’re working efficiently to effectively intervene before the skills become so far behind that they would meet the diagnostic criteria.

How early is too early?

For a lot of very young children, if you’re talking about children who are, say, three or four and they’re in preschool, so they’re not even necessarily having to start reading yet. If I’m teaching say a three, four year old class and I recognise issues, they can’t rhyme or things like that, that’s before they’re even in formal schooling. How do you approach parents when they’re that young? Is that alarmist?

Intervention: as early as possible

No, I think there’s rarely going to be any harm by early intervening and giving the kid extra practice. It’s going to be more harmful by not doing anything and waiting to see if the skill falls further behind. It’s kind of like saying if you have a cut and you’re not sure it’s infected, it’s looking a little red and swollen, well, why not just go ahead and put some antibiotic on it, the ointment to make sure it doesn’t become worse as opposed to wait to see if it starts to ooze, because by then you’ve had let it become worse. There’s no benefit to that.

Intervention should be evidence based

We require educational systems to use what we call evidence-based methods. There’s two characteristics of this, evidence-based and highly effective. Evidence based means a methodology has been tested, proven and shown to be effective, but when you compare three different methods, it all had studies, all had research, all shown to be effective, one might be more effective than the others.

Intervention should have to be proved effective

So we want to use those highly effective that’s also evidence-based because right now, there’s a recent article by a professor in the Graduate School of Education at an Ivy League college and this professor raised the question that says, do we need an FDA, which in the US is our government body that approve medications so the physicians can’t use a medication unless it has gone through this review process. It’s stringent, it’s very critical of making sure we don’t give them medications that are going to harm people. They’ve really been vetted to make sure they’re going to be effective and they do what they say they’re going to do, but we have nothing like that for education.

Kids need to strengthen ALL learning styles

Right now, education is still left to say every child learns differently. Every child has different learning styles. That’s been disproven. That’s not true. They might have strengths or weaknesses, but every child needs all their styles to be as strong as possible. Every child’s going to do better if they have strong visual learning skills, strong auditory learning skills, strong tactile learning skills. If you can give them strengths and all of those areas which the brain can do, then we give the child the greatest chance for long-term success in learning as opposed to saying, well, gee, Johnny’s better with visual learning, Suzie’s better with auditory learning, so let’s teach auditory to Suzie and visual to Johnny. That’s a horrible idea because then Johnny is going to become more impaired in auditory because you’re giving him no practice. He’s getting no experience with it. Suzie’s going to become more impaired in visual compared to her classmates because they’re going to be getting their visual system stronger and stronger because we stopped giving her visual instruction and focused on auditory. She’s going to fall further and further behind. That’s not helpful to her. That doesn’t help her be ready to compete in the typical world, at the college level or at the business level or the university level. Wherever she goes and tries to progress, the more strengths each child can have, the better they can adapt to their environment, to the learning challenges they’re faced with or to whatever occupation they choose to progress into as well.

Schools need evidence based programs

So our goal should be, look at all the skills we want the child to have, but really push the schools to only buy programs that are evidence-based. Publishers don’t really want us to do that. Publishers make millions of dollars because they sell schools basically the same method with a new logo, a new package, a few new words, a different person, some different PhD’s name on it. About every three to five years they can sell the school as a whole new curriculum, and so it’s an endless money-making machine for the publishers. Now that doesn’t mean that the publishers are malicious and are purposely trying to sell bad stuff. It just means if we made publishers adhere to the same science we make drug companies adhere to and prove that what they’re selling works, then schools will have a much better chance of making purchases that give us an educational methodology that has more likely much higher success rate for a larger number of kids.

Publishers should provide independent, peer-reviewed proof that their materials are effective

That’s a really good idea. We should push for that. It’s what we call a paradigm shift. That would be a huge paradigm shift in education to recognise that:

Scientific method actually has something to do with education. It could be helpful, and
For educational systems, whether it’s a school or a district or a state or a country to say we’re not buying stuff from you unless you have evidence that’s independent peer-reviewed science and it’s not only has to be published, but has to be published and shown to be highly effective because then we have the best chance of buying the programs to give our kids the best chance for early growth in skills and less likelihood to fall behind.

And I think too, you’re more likely to help lower income children. If the proper information is in the schools, then all children can have access. I feel like often in education, if you’re from a wealthier family, they can go and search and find more and more and more options, but that’s not an option for a low income family.

Exactly. They’re just going to get whatever the school has, and it can put the child at a disadvantage because they may not be getting the most effective, most efficient learning approach and many of those kids, too, who live in poverty or have poor family life or don’t have a stable home environment, they’re dealing with other stressors as well that work against education. Poor nutrition or emotional trauma or even just poor sleep hygiene or potential abuse, all those things can also affect the child’s learning and their ability to actually benefit from the instructional environment of the school. One of the approaches that one of my companies takes is we built the program. We did all this research on it. We first studied the good readers who don’t struggle. How do they do it? What did the brain build? What skills came on board when? How did it build these phonological skills and how did that build these reading skills?

For the whole class: for prevention AND enrichment

Then we designed the treatment method that replicates that and we’d give it to a classroom. If we gave it to a whole classroom, remarkably you could be doing prevention and enrichment simultaneously because the kids who are not at risk, those kids are just going to get stronger and their okay skills are maybe going to become great skills. The kids who are at risk, who are in the lower 10% of the class, we know they desperately need this instruction. Well, we’re already giving it and we’re giving it early on in class. That’s going to help them be getting early intervention before they fall behind. Sure, a few kids still might need to be pulled out and they still might need to get more explicit instruction because they’re just too far behind, but it gives us a greater chance that it will be fewer of the children because we’re getting an earlier start with an evidence-based and highly effective program.

What can we do in our classrooms today?

Early educators are always promoting the idea of reading to kids from a very young age and there are many different approaches we can take during that reading time. If we’re concerned that a child is showing red flags such as mispronunciation or trouble with rhyming or not being able to re-tell a story in chronological order, do you have some tips for us for reading time since that’s an everyday activity for us? Should we choose specific types of books? Should we instigate specific types of conversations while reading? Should we talk about words? What kind of response should we be encouraging from our child, if any?

Let them see your mouth

This is going to sound odd, but our number one recommendation is make sure that when you’re saying the word to the child that they’re looking at your mouth. Make sure that the child is looking at your mouth, because if you’re saying, look, Johnny, a ball! Johnny says “bah”. No honey, it’s a ball, he says “bah”, you can try shouting it louder in his ear. Maybe he didn’t hear what you said, but research tells us no, it probably wasn’t a hearing problem. He wasn’t perceiving all the sounds you are making so we can actually let them see your mouth. Your tongue lifts up at the end when you say “ba-ll” and that ‘l’ sound comes out. Then he’s like, oh, and then he’s more likely to get his tongue to lift up and then he’s going to be producing the proper sounds.

Visual cues are important for speech

I mentioned earlier about how we know that children by six months of age start looking at the mum and dad’s mouth to learn the sounds of their language. That’s not all kids. It’s only about 70%, so 20-30% actually are not looking at mom and dad’s mouth. So we think actually, not getting all the sensory systems build at an early age and they’re just trying to learn language only by acoustics and that’s not going to be as efficient and it’s going to give a harder time for the brain to tell sounds apart because say for example like a B and a D, well, “buh” and “duh” acoustically sound a lot alike, there’s not much difference. But physically and watching the mouth. When you say “buh”, your lips come together and pop, when you say “duh”, the lips stay apart, your tongue, lifts up and hits the top of your mouth, comes back down so there’s a huge difference in the visual piece and the tactile kinaesthetic, when you are aware of how your mouth is moving. How it feels in your mouth is also hugely different as well. But if we don’t help bring that awareness to the child, they’re not going to be as likely to perceive that sensory input and perception precedes cognition so their brain’s not going to be building that network of, “buh” makes my lips pop and my lips come together and it sounds like this and it looks like this and I can see your lips pop.

McGurk Effect

Visual cues override audio clues

I encourage parents to go online and Google a thing called the McGurk effect. He was a famous psychologist who did a crazy study. He did this study where he took a person’s face and they’re moving their mouth and just saying a few sounds, like maybe they’re saying “lag-uh-lag-uh” and they’re not sure what their mouth is saying, but then they’ve played an audio track and the audio track actually does not match how their mouth was moving. So in the, the most famous version of that, the mouth is looking like it’s saying a D sound or a G sound like a “duh ” or a “guh”, but the music they played is the letter B sound, “buh”, and so the ear is hearing “buh” the whole time, but whenever the person looks at the person’s mouth on the screen and they see the lips don’t come together, they will tell you that person is saying “duh” or “guh.” And they’ll be asked to look away, they’ll say, oh no, wait, no, they’re actually saying “buh”. What we learned from that McGurk effect is visual overrides acoustic almost every time. So what you see somebody’s mouth do will override what you actually hear coming out of their mouth, but that’s only for about 70% of kids. 20-30% aren’t building that visual acoustic wiring together very efficiently.

Mispronunciation = different mouth movements

We really do want you to see how our mouth moves. It’s part of really how speech works. Rhyming also has an auditory acoustic piece. The pronunciation, if you slow down the mouth movements and show them how to move the mouth when kids mispronounce, it means their mouth is moving in a different way than yours did. That’s where the mispronunciation came from, because they’ve made a different movement of the mouth and the more overt you can make it, the more clear you can make it, the better the kid can start to learn how to wire what I see, what I hear, what I feel I am doing to enable the wiring to come together.

Read engaging, fascinating books

In terms of specific types of books, the comment you made earlier, it really was key, which is books that they’re engaged in, books that they find fascinating, books that they love the content of. There’s some great early books that are touchy-feely zipper books, fabric books, texture books, so we get more sensory motor things on board as well.

Focus on sensory experiences and explorations

In the Netherlands and some parts of the UK, they do great exploratory. They read a book and then they go outside and explore what they just read about. So it’s experiential in multiple domains of the brain and how it works together. Really just getting the child engaged in language, engaged in literacy, engaged in learning and engaged in these key sensory motor features of the phonological system are really some of our most important thing to do early and do frequently. I really liked your tip about the mouth moving because when we’re focused on reading with kids generally, we might have them in our lap and we’re always focusing on the book. So you actually need to make a decision, OK, I’m going to have that child look at me, we’re going to look at each other, which is also really great for bonding. But for most people when we read with kids that’s not instinctual. So I think that our listeners will really find that quite helpful. Great.

Retaining kids is usually pointless

Going back to kids getting retained, sometimes they’re held back in Kinder or Grade one because they’re “not progressing”, and the conventional wisdom is that an extra year will give the child the chance to mature. What does research say about holding kids back a grade because they’re not keeping up? Most of the research on retention or kids being held back says it’s not going to make a big difference.

Retention doesn’t fix the problem

It doesn’t really “fix the problem”, and here’s what that means from a brain scientist’s perspective, because I’m a neuropsychologist and my expertise is how the brain works. If I want to teach you how to ride a bike and I gave you a hundred bike riding lessons, but every time I’d give you the lesson, let’s say I do it a daily activity, a daily bike riding lesson. I’m trying to teach Suzie how to ride her little bike and it’s going to be for 30 minutes every day, five days a week. We’re going to do it until we hit 100 sessions, but every time I did it, I only say ride it, ride it, ride it, ride it. Okay, well the directions are not very explicit to me and they don’t give her all the information of what she needs to do. If I say, well, she didn’t learn it yet, so I’m going to give her another year of that. Again, you’ll probably get the same results because the brain’s based on experience, the experiences you give the brain to build the wiring.

These kids need different experiences if its not working

If I give you the same experiences and next year that I gave you last year, I’d probably get the same results because if what I did last year didn’t work, it’s probably not going to work next year too. Now the fallacy in this thing that if we hold them back, they’re going to mature is a fallacy of thinking that age actually changes the functional communication or the functional skills of the brain. That’s not always a guarantee.

Age doesn’t change a brain, experience does

That’d be like saying every man, age 50 is perfectly mature because by 50 you’ve matured. Now that doesn’t happen. Chronology doesn’t rewire the brain to better efficiency, better function, so the extra year, this concept of he hasn’t matured yet. What maturity means in the educational setting is the teachers don’t know why, but he doesn’t have the skills yet, so maybe next year he will.

The foundation of language skills needs to be solid

Scientists like myself have really broken down what the skills are and how can you explicitly train these skills. Then we can say, Okay, let’s not hold them back. Let’s give them an intervention to change the skills, change them right away because the instruction that they’ve been getting in the classroom, it’s kind of like saying, if you’re building a house, there’s key hierarchy to how lower level parts of the house building effect the upper level half of the house. So the most important piece is the foundation. If the foundation of the house is concrete, but it’s not level or it’s cracked or it’s got a wave in it or something that’s going to affect every floor of the house from that point forward because every part of that builds on top of it. The brain is very similar. If these lower level systems are not being addressed by the instructional curriculum, it’s kind of like saying you’re trying to build the brain house from the second story up. You’re hoping the foundation’s level, you’re hoping the foundation was even poured and you’re just going to keep doing your instructional method, but then you’re giving the instruction a level higher than what the brain actually needs. It’s not going down to the lower levels where the weaker skills are, so then you’re actually not going to change the weaker skills quite as much.

Top-down learning is not as effective or efficient

It doesn’t mean you can’t do what they call top-down learning. I can say I’m going to teach you morphology, about word meetings and from that I’m going to get to the phonological awareness. By exposing you to more words, you’re hearing sounds too. But that’s not going to be as efficient and as effective and it hasn’t been shown in research to be more effective, so then why would we do that? How about a more direct approach that gives the best chance to building the skills from the bottom. So retention rarely is the right answer. Early identification, before the gap gets there and evidence-based and highly effective interventions give us the best chance to build the skills.

Outcomes from early intervention

My last question is, what is the prognosis for children with dyslexia with the help of early intervention? It’s going to depend on the intervention they get. If you give kids a phonics program only, and that’s our early intervention, and it’s always letters first, letters first, well okay, we’re now building the house from the second story up because you don’t learn a language by letters, you learn a language by speech processing. So we have a higher risk of those kids might improve their literacy skills. They might learn some of the phonics rules, but they’re probably not going to be as efficient as a child who got this speech processing early intervention first before they got into the written letter, literacy intervention second.

Neurodevelopmental plans are effective

In our studies when we compare kids like that who got a phonics program versus a neurodevelopmental program, we found the kids who got the neurodevelopmental program have larger gains, more long lasting gains, and many of them never actually fall behind enough to get identified, so you actually can intervene so well that kids who are high risk for being diagnosed with dyslexia, which means the reading problems. We’re not changing the genetics. Some parents get really upset when the see me post something online about what if we could prevent dyslexia. Like that’s genetic, you can’t do that! Okay, dyslexia by definition is a word reading problem, so I’m not talking about genetics, I’m talking about reading problems, okay?

Early intervention avoids the development of reading problems

If we can early intervene and prevent them from having the reading problems, that’s a number one best outcome. Studies show that when kids get these evidence-based, highly effective interventions first, then they could be typical readers on grade level and many of them actually don’t need Special Ed or IEPs or remedial instructions.

Effective intervention means kids can leave Special Ed

In fact, we did one study with older kids, eight to 10 year olds. These kids were already in remedial. They’re already in Special Ed. They’ve already been diagnosed with dyslexia and we did a five year study to see, could we change their skills enough that they would actually be on grade level with reading and maybe even leave Special Ed? And in that study, again it was not a measure of the effectiveness of a program as a measure of this dosage. They got two hours a week, five days a week, so basically 10 hours of instruction a week for eight weeks. So no more than 80 sessions. An outcome from that study Liz, was that 40% of the kids no longer stayed in Special Ed within one year of those eight weeks. And in the US, we know that if you get in Special Ed and you get remedial and you get as much as IEP, 95% of kids never leave Special Ed. That tells you that whatever they’re doing really isn’t addressing the cause of the problem. They’re kind of putting plasters on the symptoms or they’re putting a band-aid on the symptoms and it’s not really addressing the causal factors. It’s quite heartbreaking, isn’t it? Yes, and there’s a new push now among children and adults with dyslexia to say, there’s nothing wrong with me, I don’t have a disease, I don’t need your treatment. And it’s like, well, but you know, what if we could make reading stronger, why would we not do that?

Dyslexia does not mean kids are good visual spacial learners

So whether you liked the diagnosis or not is irrelevant to me. I want you to have the strongest skills as possible and strongest reading skills, strongest spelling skills.

There’s also a big myth going around that says dyslexic kids are better visual spacial learners. They’re better out of the box thinkers more of them become CEOs. That’s really just not true. There is no large-scale research studies that show that.

And why would we want to even focus on that if we actually know how to get the majority of kids reading on grade level before the age eight? Other studies have shown you can systematically get a large percentage of kids on grade level before age eight, so that maybe only about 3% of them are not reading on grade level, not 20% of them or even 5, 7 or 10%.

One of the research studies showed that we could actually get it down to about 2.6% of kids will be falling behind if we did this intervention in a whole classroom setting and so that’s really a much better outcome than the 5-20% we have right now.

I can hear the frustration of having to deal with all the myths and misconceptions.

It’s coming through?

Yes, it’s coming through.

I’m a dad of two kids. Dyslexia runs in my family. When I was 5 years old my 7 year old brother had trouble learning how to read. Fortunately for us, my aunt was world famous for her work with dyslexia, so my brother got early intervention from my mum who trained with my aunt. I then got prevention, so I got worked with at age five. Fast forward to me being an adult, both of my kids had dyslexia. My kids both got early intervention, they’ve never struggled. It breaks my heart to think that all kids aren’t getting that opportunity because we have such powerful interventions. We should be getting them out there to all kids, training teachers, training the systems to put them in place.

Apps for mums and dads

So my focus right now is electronic delivery, I’m actually building apps. I’ll get apps out to mum and dad because mum and dad always pick this up first. They know before most of the teachers do. Most parents, right away at ages two, three and four, know something’s not developing quite the same with language or motor skills. So if we get them some apps that give them some very directed, explicit scientific practice, you have a better chance that we can even help mum and dad have a more powerful effect on their kids’ literacy and language skill development. That to me would be a huge boon for us because we’re not going to change crime, drug abuse or violence until we change better educational outcomes. That’s really the key element.

Well, that is an amazing project.

Thank you so much for chatting with me today. It’s been a really helpful discussion and I appreciate it very much.

My pleasure. Thanks so much for having me on the show and we hope your parents are optimistic and understand that these issues of developmental difficulties or these neurodevelopmental disorders can be greatly improved with evidence-based, highly effective interventions, and we’re getting better and better and we hope we would continue to improve with that success rates.

Great. Thank you.

You’re welcome.

Please leave a rating on iTunes!

That’s it for today’s episode. If you enjoyed it please go to iTunes to leave a rating and review, it helps others find the podcast.

The Education Podcast Network

This podcast is part of The Education Podcast Network. Podcasts by educators. Podcasts for educators. Thanks for joining me to learn more about early childhood research and I wish you happy teaching and learning.

Previous Episodes

photo http---signaturesmylivesignaturecom-54492-188-68756A9A76D8FC4C238F390489D07295_zps633c4098.png