Speech Pathology, Literacy and High School Students: The Current State of the

Literature & Clinical Practice

Dr. Julie MarinacLecturer in Speech Pathology,SHRS, UQ.j.marinac@uq.edu.au

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 2

Dyslexia through the ages

• 1877, 1897 Word blindness (Kerr; Kussmaul)• 1896, 1917 Congenital word blindness (Morgan;

Hinshelwood)

• 1925 Strephosymbolia (Orton)• 1947 Specific reading disability (Eustis)• 1962, 2005 Reading disability (Kirk & Bateman; Cantone &

Brady)

• 1972, 2003 Unexpected reading failure (Symmes & Rapoport; Shaywitz et al.)

• 1975 Specific reading retardation (Berger, Yule & Rutter)

• 1985 Poor reading (Olson, Kliegl, Davidson & Foltz)

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 3

Dyslexia, defined and redefined

• “Disorder in children who, despite conventional classroom experience, fail to attain the language skills of reading, writing and spelling commensurate with their intelligence abilities

(World Federation of Neurology, 1968).

• “A specific language based disorder of constitutional origin, characterised by difficulties in single word decoding, usually reflecting insufficient phonological processing abilities (Orton, 1995).

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 4

DSMIV-TR (2000) and Dyslexia

• Describes 2 correlates for dyslexia – but not ‘dyslexia’ per se.

• 1) Reading disorder (315.00) – unexpected failure to attain age appropriate skills in reading and decoding single words and text

• 2) Disorder of Written Expression (315.2) – difficulties demonstrated in spelling and/or written language skills

• Both of these can co-occur or appear in isolation

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 5

Sub-types of Dyslexia• Visual or visual-perception (Warnke, 1999)

– Probably only 5-10% of those with dyslexia

• Surface (Castles and Coltheart, 1993)– Primarily affects reading and spelling of

irregular words

• Deep (Stanovich, Siegel & Gottardo, 1997)

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 6

Phonological dyslexia

• May be called ‘Developmental Phonological Dyslexia’– Reflects expectation the difficulties will emerge during

period when reading, spelling and writing are being learned.

– May not be applicable to students who have moved beyond the literacy learning period (i.e., secondary school students)

• Phonological Core DyslexiaPhonological Core Dyslexia – Phonological dyslexia that impedes the acquisition of

age appropriate literacy skills beyond primary beyond primary schoolschool age

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 7

Phonological Core Dyslexia

• May originate in a deficit in phonological processing skills

• Demonstrated by written language skill deficits even in those who have learned to read

• May include those who are not diagnosed until secondary school, the ‘compensated adolescents and adults’ (as per Birch & Chase, 2004; Wilson & Lesaux, 2001)

• Compensatory strategies and/or the educational environment (e.g., total reliance on sight word knowledge, and/or learning in a sight-word environment)

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 8

Recent Findings in the Literature: Prevalence

• No specific figures for secondary school students

• 20% of the school population (Glezerman, 1983, in Grigorenko, 2001);

• 3-10% of the population (Snowling, 2000). • 5-17% of school-aged children in the United States • 30% of Yr 8 students and 25% of Yr 12 read at a

level below expected (USA Department of Education, 1998).

• Based on reading disability only – primary factor acknowledged as phonological processing deficits.

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 9

Recent Findings in the Literature: Causality

• Wide-spread agreement for a neurological basis (Warnke, 1999).

• Very little definitive, empirical agreement as to the precise area of the brain affected (Temple, 2002).

• WHO- “developmental associated with abnormal neurobiological development related to brain structure and brain function” (ICD-10).

• Activity deficits in connective tissue between posterior and frontal regions (Temple, 2002), or

• In interhemispheric connective tissue (corpus callosum) (Shillcock & McDonald, 2005).

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 10

Recent Findings in the Literature: Causality• Defined by multiple genes/loci (Grigorenko, 2001)• May be autosomal dominant and additive

(Pennington et al., 1991). • Positive family history increases risk 5.7 times

general population (Pennington and Lefly, 2001).

• 61% of high-risk familial history 8:0yr. children had reading difficulties in comparison with 13.8% of those without the familial risk (Snowling, Gallagher, & Frith, 2003).

Genetic factors may determine Genetic factors may determine structural/physiological differences in the brain structural/physiological differences in the brain then environmental factors ameliorate those then environmental factors ameliorate those differences by cognitive ‘usagedifferences by cognitive ‘usage’ .

(Grigorenko, 2001; Vellutino et al., 2004).

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 11

Recent Findings in the Literature:

• Universal but language structure plays major role in type/level of difficulties with English being particularly problematical (Grigorenko, 2001).

• Attention/conduct disorders secondary to dyslexia more frequent than normal and LD controls, but not depression until 18 years of age.

• Criminality and unemployment risk is 24-25% (non-dyslexic is 4%; German data) (Esser & Schmidt, 1994)

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 12

Evidence from the Clinic•Screening – 17.66% of 386 Yr 8 students – PA/PP deficits

•Skills deficits –Phonological Awareness (discrimination, segmentation and blending)–Vowel knowledge and discrimination–Metalinguistic and metalanguage–Auditory memory and organisation–Written language planning and production

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 13

Evidence from the Students

• Complete reliance on sight word reading/spelling• Instant recognition of consonants but not vowels• Lack of awareness of vowel spelling variations • Word-by-word reading (scanning issues)• Matthew effectsMatthew effects• Lack of need for punctuation• Expressive language not translated into graphemic

form• Rejection of academic potentials and ideals

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 14

BSHS / UQSHRS Experience3 Tiered Collaborative Service Delivery

Teacher observation (reactive)Whole school screening (Teaching staff; PATHS CII; proactive)In-depth assessment by Sp Path (diagnostic decisions)

Within class intervention (PATHS-PA & Spelling Classroom Program)

Learning Support (PATHS Support Program in small groups)Speech Pathology (PATHS Support Program and individual

therapy)

Teaching staff (academic and curricular responsibility)Learning support staff (on-site assistance and management)Speech Pathologist (diagnostic and management

responsibility)

Dr. Julie Marinac Speech Pathology Australia Sydney 2007 15

Where to from here?• Accept responsibility for assessment and treatment

of PCD in secondary school students

• Accept need for, and utility of, collaborative approach

• Ensure professional development in secondary schools includes literacy learning failure and PCD

• Research, research and more research– Identification, assessment, prevalence, incidence,

outcomes, intervention, efficacy, awareness, evidence for practice, etc. – everything that has been done in the primary school sector needs to be replicated in the secondary school sector!!!!