Dyslexia: Reading Between the Lines

0:04 Good evening, and welcome. Thank you so much for joining us for tonight’s webinar, Dyslexia. Reading Between the Lines, presented by doctor Eric Di Blair. 0:14 My name is Katie Delaney. I’m the Family Medical Outreach co-ordinator for the New Jersey Center for Tourette Syndrome and Associated Disorders. 0:22 I will be your facilitator for this evening. 0:24 Before I introduce our presenter, I wanted to go over some housekeeping notes. 0:29 The audience is muted if you were attending the live webinar, any questions you have can be submitted in the questions box located at the bottom of your screen. Throughout this presentation, if you have a question, please type it in the questions box and hit submit. 0:42 During the live Q and A the audience will gain access to unmute themselves. 0:46 Because of this, we will stop recording right before we start Q&A. 0:54 Hmm, We’ll start with the submitted questions, and then open the floor for any verbal questions. 0:59 To ask a verbal question that the Reactor button at the bottom of your screen, I will say your name. And then, you may ask a question. Ginger, everyone gets a time. Please only ask one question. To the right of the React button, you will see an arrow. When you click the arrow, you will see a few emoji’s appear, such as heart, thumbs up, et cetera. Throughout the webinar, feel free to use this feature to let the presenter now how they are doing. 1:22 So, how are you guys feeling about this? Just to make sure that you know what we’re talking about, can you give me a thumbs up or heart to make sure you know it? 1:32 Sam? Anybody else? 1:36 OK, great, so, for those viewing the webinar recording, you will not have access to these features. However, you will still be able to submit your questions for the presentation for the presenter to answer. 1:51 Your questions box is located to the left of your screen. Questions Submitted will be posted to our webinar blog for the presenter to answer. 1:59 This blog can be found on our website and … dot org, under the Programs tab. 2:04 Under the Programs tab, this problem blog will be monitored until Wednesday, February seven. Please note any personal information will not be included in the pounds. 2:14 New Jersey Center for Tourette Syndrome and Associated Disorders, its directors and employees assume no responsibility for the accuracy, completeness, objectivity, or usefulness of information presented on our site. 2:25 We do not endorse any recommendations or opinion made by any member or a physician, nor do we advocate and new treatment. 2:32 You are responsible for your own medical decision. 2:36 Now it is my pleasure to introduce our speaker for this evening, doctor Erik tagline. Doctor … 2:42 holds a master’s degree in school and school psychology, and a doctorate in clinical psychology. 2:48 He has worked in a variety of settings serving children with mental health needs. Doctor … is the director of … is the director of Psycho Educational Services. For his wife’s practice, the Center for Emotional Health of Greater Philadelphia. 3:03 He specializes in clinical diagnostic work and therapeutic services for children with severe mental illness, and with that, I’m going to hand it over to you, doctor …. 3:16 Thank you very much, Katie, and I’m really glad to be here and presenting this topic. 3:22 As, as, Katie said, that, the school psychologists and clinical psychologist, I’ve actually been in the field since 19 89, which is when I started my master’s degree, so, I guess that’s 35 years. 3:36 And one thing that has been a constant topic all the way through is dyslexia or reading disorders, and this is what we’re going to be talking about tonight. 3:48 This talk is actually a version of a talk that I gave 20, maybe 22 years ago, and at the Temple University Grand Rounds for psychiatrists. 4:04 And, uh, I was looking at it, and I thought, how much of this is usable for this talk? 4:09 I talk about this a lot, but I don’t normally use slides, so, how much of this is useful and I was surprised, going through it. 4:16 Almost all of it is still applicable. Now, the definition of what Dyslexia is, has changed somewhat and in wording. 4:24 The information about about what Dyslexia is and where it is in the brain and all that stuff is very much the same with a few refinements. 4:34 So what I decided to do was keep this old presentation and this is why why it looks the way that it does it is old. And I kinda found that charming that it’s this old PowerPoint format. And I updated the information that was relevant and I removed the slides that, you know, that you wouldn’t need unless you’re a psychiatrist and I added some new things. 4:56 But what was really nice to see looking back at this, is what has changed a lot in the last 20 years. 5:04 Now, the information here, then, I’ll be talking about some of the, this is, like I said the same, but what is different is the information that schools have. 5:15 When I gave this talk, then schools did not have almost any of this information. 5:21 What is different now is that schools really are at least the schools in on the East Coast. I think most of you are probably in New Jersey. The schools have caught up to this information. At one point. This was new and sometimes alarming to them to hear these kinds of things, and they weren’t sure what they should do. 5:39 But now, they are really on top of this. And if you look at the materials provided by New Jersey, and we’re going to recommend that you do that, we’re gonna make something available to you. It’s the New Jersey Dyslexia Handbook, It’s something provided by the State Department of Education, you’re gonna find a lot of this stuff echoed in there. This is now what they’re presenting, to their teachers. 6:00 So, it’s very gratifying to see that the people who really need this, are now caught up with this. 6:07 and are now essentially, the leaders in this, this is a wonderful, wonderful change. 6:14 So, we’re going to talks at, first, about some basics, of what reading actually is, and this is you’re gonna hear this from a clinical perspective. You know, I’m a clinician, and this is the way that I chose to present this Other people might show in a somewhat different way, But we’re gonna go through these topics very quickly. 6:33 Humans are hard wired for verbal language. 6:35 Spoken language is a genuinely, generally continuous auditory stream. Written Language is an abstracted, non continuous code that uses symbols to represent the sounds of speech and to be able to read one has to understand how the written code represents the spoken language. 6:51 Now we’re gonna break that down a little bit. But this is basically what’s going on. Like what is happening in reading. 6:57 Humans are hard wired for Verbal Language. 6:59 Now, if any of you were ever familiar with Noam Chomsky, and his idea of I believe he called it language acquisition device, which he said was a theoretical part in your brain that was built for language. And it had innate grammar, we were born to have grammar. It would arise naturally. 7:19 And that started a lot of people thinking that was back in the 19 sixties. Now, they’ve never been able to show this. 7:23 It doesn’t really seem to exist that way, But what they’ve been able to show is that we are built to learn verbal language, or sign language if, if you are not able to hear. 7:36 But, we are built to pick this up without direct instruction. 7:41 Kids, babies will learn to speak, like the people around them, whether you tell them how to do it or not. They’ll make mistakes. They’ll need to have it refined, they will need to have direct instructions on the finer points of it, but they will learn to speak simply by being exposed. So, we may not have a language acquisition device like Chomsky said. But we’re we definitely have the mechanics in there somewhere to do this. 8:07 Now, this spoken language that we hear, it is, I use the term here a continued, generally, continuous auditory street. 8:15 And, I used this because this kind of terminology is, is what you use with dictation, like software dictation. It listens to a continuous stream. 8:25 We hear spoken language as an uninterrupted stream, except for when we take pauses like that. 8:31 I don’t put spaces in between my words, you just know where they are. 8:35 We talk, without break, unless it’s for two, and a sentence, or for emphasis, but we don’t put in spaces between words, and this is one of the reasons that sometimes when you hear somebody speaking a language or you’re not familiar with, it sounds like they’re speaking very quickly, because you don’t know where the words, and you just hear the sound. When computers listen to our, our speech, this is what they’re listening to. Patterns in a continuous stream. You’ve probably found this. If, you know, if you dictate into your phone, if you speak slower and put the spaces in between the words, it can understand you as well, because it doesn’t match regular speech any. 9:11 Now, how is this different from written language? 9:14 Written language is not that. It’s not a continuous stream. It’s not heard, it’s not hurt at all. It’s what it is, is code, a set of codes that uses symbols to represent the sounds that we hear. 9:30 So the difference in this is we’re not hard wired for written language. We have to learn. We need direct instruction in the rules. We need to be taught what the symbols are, how they go together, how words work, all of this stuff. 9:44 So kids will learn how to speak by hearing people, but they need to be taught how to read. 9:50 And the whole idea is you need to learn how this written code matches the sounds that you hear. 9:57 And as we’ll talk about it, more fully in a few minutes, you need to be able to do it very quickly in order to be able to read well at all. 10:09 So, how many codes Now, this, I’m going to, I’m going to ask if people, wouldn’t mind typing this in, how many different codes do you see in this example? And this is not my handwriting. This is actually taken from an online resource about what handwriting is. 10:25 If you look at this, how many different codes do you see? 10:28 And I’ll give you, I’ll take a look here at sea, what people are guessing. 10:36 How many different written language codes do you see? 10:46 I can’t actually, I’ll ask you, Katie, I can’t tell if people are typing right now. 10:51 I believe that people can only ask questions, they can cannella. 10:57 Aye, But I see, too. 11:00 Although, as people see to input a thumbs up, the people see more than two or less than two thumbs down using the React button. 11:11 OK, OK, we have is a great way to do it. That was good thinking. 11:16 We have 50, they’re pretty divided, I would say half his thumbs, up, half of them as thumbs down. 11:23 Thank you. 11:24 Thank you, that was great. 11:26 So for this, you look at it and say like well once cursive and one is your regular block printing or whatever you want to call it. 11:35 But there’s four codes at least. 11:37 So this is what we often don’t think about. If you’re a good reader, you don’t think about these things. 11:43 When like the regular printed word is one set of symbols, cursive is another set of symbols. They’re not the same. They’re similar, but you have to learn how they match up. So you have to be fluent with both. 11:57 But each set of symbols also has capital letters. Every letter has a capital letter, which is another set of codes. So just writing these two sentences, you have to be able to automatically recognize for different codes and the sounds that they represent. 12:14 So this is with all writing, and you should think about things like different fonts and all that they’re going to be, they’re going to differ. You have to be able to recognize these differences and you may have to learn multiple codes for this. This is why some people are not teaching cursive anymore, because a lot of people don’t know, they’re not using it. They’re using keyboards. They don’t learn the symbol. So you will find kids who are good readers. They haven’t maybe not been taught cursive. They can’t read it because it is a different set. If you are a good reader with ease, you don’t even think of that. And I like to use that as an example, because it has to be that automatic. 12:48 It has to be instantaneous. 12:51 If you’re going to read efficiently, you can’t think about it. You just have to know it, and that takes a lot of practice. 13:00 So how does reading work? What’s going on? 13:03 Now, like a special education teacher or reading specialist, would probably have a lot more to say about it, but we can break it down into at least two basic components. There’s a set of decoding components and the comprehension component. 13:16 So decoding is this, you have to learn that the sounds of the words that you hear can be broken down into basic elements And the most basic element of speech is called a phoney. 13:30 So, you know that you need to learn to think about words like, Well. 13:35 I can break these down into a bunch of individual sapped Then you have to learn that those sounds can be represented by symbols and those are letters and other languages. They might be characters or other things but it still works out to the same process that words can be represented by symbols in our language and most languages that use alphabets that they can be, the symbols can be combined to form different words. 14:01 You call this, all this process is phonological or phonemic awareness and phonetic or orthographic decoding orthographic means like rapid learning term to recognize the shape of the word as a, as a single unit. 14:15 Instead of reading each word and saying, Oh, it’s these letters, you begin to recognize that, Andy is the word, and you don’t have to sounded out, look at each one. So you have to have all of that decoding, which we think about it, Explain it this way. 14:27 It’s fairly complicated. There’s a lot going on, and you have to have them all at the ready to do instantaneously. 14:34 Once you’ve decoded what the words are, then you have to to determine what it is, what it meets what you’re talking about. So the meaning has to be brought from memory. It’s re-assembled into a sentence, into something that you can understand what they’re talking about. And all this stuff happens at the same time. 14:53 So, these are important because of what we are going to talk about in terms of breeding dysfunction. 15:00 So these two main areas can each be impacts of decoding and comprehension. 15:06 Now, this has been refined somewhat over the years, so we don’t have to, you don’t have to pay too much attention to these, these parts of the brain. But the idea is this: I have them all written down the basic areas that they know they’re involved in reading. 15:18 The most important thing, is if you look at this diagram, you can see that there are portions like, this isn’t a brain looking this way, although this is stuff mostly localized on the left side. 15:30 So, you have parts in front of the brain, parts middle of the brain, parts of the back of the brain. 15:35 There’s just the idea that you have many different areas that have to work together. 15:41 So, there are, there are visual areas for recognizing There’s language areas, that’s processing the stuff through there. There’s memory areas. All of these things have to be co-ordinated, and they all have to work together. 15:54 And if you have a disruption in their anywhere, you have reading this that is affected, that slow down. That’s inefficient. 16:02 one thing that we know is, well, actually, I’m going to show you this, this is a little bit better. 16:07 Let me skip ahead to this. 16:14 I want to show you this. Now. This make a little more sense later. 16:19 There are better images these days, but they’re all very similar. This is a composite functional magnetic Resonance imaging. 16:29 Diagram that shows some of the areas that are active while reading. 16:33 The one on the left is a typical reader, a non impaired reader. 16:39 And newer images will show more things that are involved. 16:43 But in this, if you look at the back of the brain, you can see that that’s where like a lot of visual stuff is being processed. 16:51 You don’t see the same areas that are lit on the right. 16:56 So, these are people that are pulling up meaning, they’re pulling up words or recognizing them. On the right, you can see that those areas in the back are less active. 17:05 They’re not lighting up on this areas toward the front ARR, the areas that are on here are the areas that are more associated with speech and not just speech, but, like physical speech moving the lips the, the moving the tongue, things like this So what is actually going on here is people who are non impaired readers. 17:32 Are just looking at the words, getting the meaning and reading on Dyslexic readers more of what’s happening is they’re using the speech centers. 17:44 They’re using the, the sets, the, the parts of the brain that control the mouth and the tongue to sound out the words, they’re reading to themselves, as they read. 17:58 They’re sounding the words out, they might actually even be physically moving them out, there, saying this, they’re using that. That’s a way that you can get by. 18:08 If you don’t have an efficient reading system, you can use this, and it’ll work, but it’s slow. 18:14 And it’s inefficient. 18:15 So, people with dyslexia are using these kind of ancillary systems, too. 18:23 Be able to get through it. 18:24 But you can’t do that as fast as somebody who doesn’t need to do that, and this is something that surprises a lot of people, they’re like, Well, doesn’t. 18:31 everybody kind of sounded out in their heads? No, they don’t. Really good reader. A really fast reader, won’t even be thinking of the sounds, they’re going straight for the meeting. She can’t do that unless it’s all automatic. 18:44 So people with dyslexia read much slower and they’re using other things to try and compensate for it. 18:50 Can, now we’ll go back to it. 18:54 This, So what is Dyslexia? What’s the definition? 18:58 Now this is from the International Dyslexia Association, and this is their definition, that they codified in 2002, I believe. And this is now in the New Jersey Handbook for Dyslexia, the one by this, the the Department of Education. They put this in here and they say we’re adopting this too. 19:17 So I’m going to read through this once, but I’m going to go through some points for the two. But Dyslexia is a specific learning disability that is neurobiological in origin, is characterized by difficulties with accurate and or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede the growth of vocabulary and background knowledge. 19:51 Now that’s kind of debt, but let’s go through some of these things. So the first part, they’re saying, this is neurobiological in origin. It’s something that happens in the brain. 20:01 And what it is characterized by the difficulties it’s characterized by are recognizing words quickly by poor spelling and poor abilities to decode. 20:12 That’s what dyslexia. It’s, those three things, to varying degrees, which we’ll talk about in a moment. 20:18 So, problems, pulling up the words quickly, problems, spelling them, problems, decoding them, then they go on to say these difficulties are phonological. They don’t want that. So, when we talked about before, if, trouble understanding how the sounds of speech can be broken down and then represented as a code. 20:38 And that this eliminates them to go on to the next part of the unexpected unexpected in relation to other cognitive abilities. So, it has nothing to do with their intellectual ability. 20:48 This is below their intellectual ability, that’s, that’s what they mean by an unexpected trouble and unexpected difficulty, is that you think they would do better based on their ability to do other things. 21:00 And that is the provision of effective classroom. 21:03 instruction means that they’ve had instruction, that they’ve had a typical schooling, but they haven’t made the progress that you expect. 21:10 So this is what they’re trying to say. 21:12 These sorts of problems and their problems that you can’t explain. In other ways, they seem to have higher ability level. They have been taught how to read, but they’re having more difficulty than you would expect. 21:27 There’s still, even with all this stuff, and all the, the progress that people have made, there are still a number of very persistent misconceptions about Dyslexia. 21:39 So one of them is dyslexia is a visual problem. 21:43 Dyslexia is not a visual problem, they do not see letters backwards. They don’t see words backwards. 21:49 This, sometimes people will report this. 21:52 They’ll say like well, you know the words the letter’s seem to swim around and it really seems to come down to this that if you don’t know what the letter’s mean. 22:02 And this is my favorite example of it. 22:03 If you look at a P A B, acu, a D, they’re all the same shape and different orientation and if you don’t know what they mean automatically, you can really very easily confuse the mie. you can make mistakes. 22:18 So things look like they’re jumbled if you, if they don’t mean much to you. Sometimes you see kids make more reversals. A lot of kids make reversals when they’re just learning how to read them. You know, like the Putting the D Backwards and a backwards or things like that. Kids with Dyslexia may do it more, but it’s not a visual thing. It’s just, this doesn’t mean the same thing to them. They’re not clear of the meeting. It looks the same either way as far as they’re concerned. 22:43 We also hear, dyslexia is a developmental lag that most individuals outgrow. 22:48 You don’t outgrow. 22:49 You, people with dyslexia have problems with reading. Almost all of them throughout their lives. That gets better. It can, you can, you can make progress with these things but it doesn’t go away. 23:02 Sometimes, Dyslexia can be fixed through special education or intensive remediation. You can bring people up to grade level, but that’s not the same thing as fixing it. It can really, you can make tremendous progress with it. 23:13 You can, you don’t necessarily just stopped, like, Well, now they’re a grade level, and now we can stop. And sometimes schools do this. 23:20 They said, well, they do, you no longer qualify for special education. So, we don’t have to worry about this anymore. And then they tend to just have problems further down the line. You can bring them up to the level that you expect with the right kind of remediation, but they will still need help. 23:36 Another one, Dyslexia, that’s much more common in males, it is not, it’s identified more e-mails because males tend to have more behavioral problems when they’re having difficulty. 23:45 So what you end up having is that a lot of females that are under diagnosed, it is not more common myths, But it is more frequently undiagnosed and female. 23:57 And we still hear this when dyslexia doesn’t really exist, where people will say, I don’t believe it, and it’s just, they’re just wrong. That there’s not much to say about that. We have 100 years of research on this, it is absolutely a real thing. 24:10 But there are people who still believe it. 24:12 I can throw out some other ones too, because I know sometimes these make people angry. 24:16 So I’ll give you a couple other ones that, that might be upsetting to some people. 24:19 just so you know, Sugar does not increase hyperactivity. Vaccines do not cause Autism. 24:27 And there’s no such thing as being a left brain and right brain thinker. 24:31 That is the, That’s just not a real thing at all. There’s no such thing as learning styles when people say, I’m a visual learner, I’m an auditory learner, That’s based on a concept from about 50 years ago it was debunked then it is still debunked. Now, none of those things are. 24:44 Just so, you know, so, but what is real is Dyslexia, and it’s very common, it is one of the most common things that kids have to deal with. 24:55 You’ll get different estimates and how common it is. 24:58 But, fit between five and 17% of school age kids are what typically comes up in US samples. At least 10% seems to be a pretty safe number. So, you see this in every classroom at every age, you’re going to see this in adults too, but they don’t study it as much in adults. 25:17 So it’s harder to say what the prevalence, it is the most common of all learning disorders. 25:24 So, when we talk about learning disorders, 80% of the time, we’re talking about dyslexia and a lot of other learning disorders, things like problems in math and written language, are really just manifestations of a reading disorder. So, you can tell if somebody cannot read. They have a lot of trouble with doing math as well. Because they, they might mistake the symbols of operation. They have trouble with word problems. Written language stands to reason, they’re going to have difficulty with this. So, sometimes they can look like they have difficulty in all academic areas. 25:56 But really, reading is involved in all academic areas, and they really have a reading problem. 26:02 It is possible to have a disorder in mathematics alone and disorder in written language alone, and they do happen, but they’re much, much less common. 26:13 So, what causes it? 26:16 We don’t know exactly what causes it, but we know that there’s a lot of evidence to say that it’s familial, inheritor, which means it runs in families, and that there’s a genetic component to it. 26:28 So the more closely you are related to somebody that has Dyslexia, the more likely you are to have it, as well, so many times when we have kids that are being evaluated. 26:39 They have learning problems. 26:40 They’ll say, Well, you know, my mother has a learning problem. My father has a learning problem, my uncle, this is. This is very, very common. 26:48 And there’s some stuff about chromosomes. It’s not really important what that is right now, but we know that we can localize it to some extent, so there’s some genetic component to it. 26:59 Now, this is like this, there was a lot of people off. They’re like, Well, is it Dyslexia, or is it a reading disability? Is it a reading disorder? 27:09 And the thing is, from our perspective, as clinicians, that these words are kind of interchangeable. So, most of the time, when you’re talking about a reading problem, you are talking about Dyslexia. 27:19 But this is a nice helpful chart that’s pulled from that handbook that shows the subtypes of Reading Disability, The Disability as an Educational Term. We will get to that. 27:29 So, what you see here, there’s a Language Comprehension Deficit. 27:34 That’s about 10 to 15% of reading problems. 27:37 There’s a phonological deficit, and that’s what we’ve already talked about. That. 27:41 70 to 80% of reading problems. And there’s a fluency and naming speed deficit, which is 10 or 15%. And that’s why people that, it just takes them too long to remember what the word is or what the sound is. 27:55 There’s those two ones at the bottom of the chart. A phonological deficit or a fluency speed, a name, deficit. 28:03 Those are dyslexia. 28:05 So if you’re not talking, if you have a reading problem and it isn’t dyslexia. It’s a pure language comprehension. 28:12 Comprehension deficit, but that’s relatively uncommon. 28:14 So, what does this ends up looking like, is if you have a phonological deficit, you may have a problem with language comprehension. Because it takes you too long to figure out what you’re reading. It takes you too long to understand what’s going on too much effort, goes into decoding the words. 28:31 And then reading them is, is, they understanding them, there’s just less effort available for that. 28:40 But that’s what we, that’s what we see, very frequently, people will make mistakes with phonological stuff. 28:46 The fluency, naming speed deficit, why this one’s important, is that these: people still have dyslexia, but they don’t seem to be making the same mistakes, it’s not as obvious. So you can have a fluency and naming deficit. 29:02 That is, that doesn’t have the phonological deficit, where if you ask them what a word is, they can give you the right answer. They don’t seem to make those things, But they read far too slow. So the same thing happens where language comprehension is impaired. 29:18 When you have them both together that’s called the double deficit model. 29:20 And that’s actually by far the most common one Most people with Dyslexia have both of these things. 29:27 Phonological deficits and speeded naming deficits. So they are not sure what the sounds are. That takes them a long time to remember what it is. 29:36 So this is when people say like, Well, is it dyslexia, or is it a reading disorder? It’s like, they’re all reading disorders. And most reading disorders are dyslexia. There’s just different presentations in it. 29:48 You do find people who have language comprehension deficits alone. 29:51 But, that’s a very small number of people, and that, the approach that is a little bit different, you have to work more on comprehension. 29:58 They’re not making reading errors, but they don’t know what they’re reading, so that that can be difficult as well, we already did this. 30:07 So what does it look like, and what do you see at different ages? 30:11 So when kids are young, the the youngest um, the strongest indicators in young kids are difficulties identifying the phonemes in speech. 30:25 So, this is even before they can read, but you ask things like, which EW might show a picture of a series of pictures and say, Which one of these starts with the same sound as that you might have ball, Capt, plane, animals? Something like that? 30:46 And they have trouble finding that same sound in the picture, even if they don’t know what it is, they may know what all those things are called. But, when you give them that first sound, they can’t find it. 30:57 So this can be seen in kids before they’re able to read. 31:01 And that’s the strongest indicator. 31:06 And suddenly you see an older kids really once they’ve started to read is they can’t decode nonsense words very well. 31:14 That’s the strongest indicator overall at any age, but they have to be able they have to have had a lot of reading instruction first before you can do this. 31:21 And sometimes the the assessment measures we use will give them nonsense words and they’ll have to try and read it an unusually slow reading rate. 31:30 And that can be difficult to see unless you’re timing it. Unless you are looking for it. 31:34 So they might read they might sound like they’re reading correctly, especially these people who only have speed, the only have the speed of naming deficit. But they’re reading much slower than everybody else. 31:46 And if they’re reading and usually we have them do this outloud an unusually high number of errors. And, again, that’s only compared to other people. 31:55 And, um, considerable difficulty with spelling. So we see all of these, these things by the time kids are in school, and have had direct instruction. When we do diagnosis from a clinical perspective of reading disorder, they have to have been in school for at least six months. 32:14 So we can’t diagnose a learning disability before. People have been in school and had at least six months of direct instruction, but at that point, you might be able to start picking it up. 32:25 These are the things that everybody’s going to be looking for. 32:29 So now I wanted to do a little demonstration here of what is Dyslexia really like, and I’ve seen all kinds of exercises of, you know, to try to give people a feeling of what it’s like. 32:44 But I think this is this kind of thing works a little bit better, and Katie volunteered to do this for us. So, Katie, can you turn on your microphone? 32:53 Some roddy, OK, so what I’m going to do here, this is going to be a little bit like you’re in school. Because you’re going to be reading it aloud in front of a bunch of people, which is what kids have to do. 33:03 They have to read in front of their peers. 33:05 So when I say, I’m going to give you a text sample. 33:12 And what I would like you to do is I would like you to read the passage. 33:16 When I tell you start, read the passage out loud at a comfortable pace, OK, Are you ready? 33:23 Yes, OK. So please read this passage. 33:27 The ancient Egyptians built pyramids as tunes for their parents. They believe that the pyramids would protect them and the accurately this text has 38 words and uses vocabulary and concepts that are appropriate for sixth grade level. 33:41 Very nice. That was NaN. 33:43 You made zero errors so I cheated a little bit. I’m 38, is the number 38, I counted as word. This is 38 words all together. 33:55 And sixth grade is what is generally felt to be functional reading, to read news articles and things like that. So I’m going to ask you a couple of questions here. What was that text about? 34:12 Egypt? 34:15 Yeah, Injection Pharaoh’s. 34:22 Sure. 34:25 I remember 30 words. 34:28 Yes, 38, I honestly don’t remember what it was about. I was just reading it, I was not paying attention. 34:35 So that’s a different thing, but we can talk about it. It’s interesting. So but this is the kind of thing that kids would be asked about. This was about why the Egyptians built pyramids. 34:48 And the example of sixth grade texts. 34:54 Now, I’m going to ask you to read another passage. 34:59 Same thing, when I, when I show it to you, I would just like you to read it outloud at a comfortable pace. 35:08 When I say go, are you ready? 35:10 Yes. 35:14 Ingredients: Water, EIU, sodium, Laurel, sulfate, sodium, Laurel, sulfate. 35:22 Can you do … Attain? 35:27 like whoa, just stare, read the whole thing? 35:31 Yes, just steer a dime messy cone: sodium citrate, …, miah, Sodium, Eggs, exile, and sold, honey fragrance Parfum, citric Acid Sodium, Benzie, Wholey Quad, Turning 70, sodium chloride, Tetra, Sodium, EDTA, pantanal, Cantonal. 35:59 Useful answer: Messe: oh, goodness. 36:06 Messa Lore. 36:11 Met, I met dial chlor route, is to buyers, all known mm method, is only known. 36:29 Very nice. What is this passage about? 36:33 Ingredients. 36:36 Yeah. 36:38 Ingredients ingredients that are in something, but I have no idea what any of it is besides, like, water. 36:44 Right? I know it was difficult, because three of the words were French. 36:47 Yeah. 36:52 So but this was English. 36:55 Not only gave you one code, right? They’re all They’re all capital letters. 36:58 Yeah. So what is these ingredients for? 37:05 What are they for? 37:07 Yes. 37:09 I’m guessing. 37:12 Like either makeup or something that’s not food. 37:17 And if it is food, I’m very worried. You actually did a really excellent job in it, but it took you a minute and NaN to read you made at least nine years. 37:30 This is This is a shampoo lipp. 37:36 This now, you can tell from the first one that you’re a very good reader. 37:42 But what did it feel like when you got to words that you didn’t know? 37:48 It was, It was really difficult, because I had a sounded owl, and I knew that like it, not only was I sounding it out, but as I was sounding it out, I kept having to start over because I was, I’m struggling, even just with sounding out those Jane … words. 38:06 Like it. 38:07 just took so much more mental capacity to be able to read each word, that’s dyslexia. 38:16 This is the best example, this is my favorite kind of example. The first set, They were words that you knew. 38:23 You didn’t have to think about it, and you were able to read them very quickly without errors, if you had difficulty understanding it. It was just because you’re not paying attention to it. You didn’t have any difficulty comprehending what was going on. 38:35 It didn’t require effort. 38:38 But when you got to these other words, that, I knew, at least some of them, and you didn’t really really well with it, but it’s like it was some of them you wouldn’t know, because unless you are a chemist, you’re not gonna come across those words. We are used to knowing the words that we see. If we’re good readers, If we’re not impaired, readers, were used to knowing them, and only occasionally come across something that we don’t know. 39:02 If you have dyslexia, this second thing Oh no, it’s a little dramatic. I know, but this the second thing, is a lot more calm. 39:08 Where they look at a word and they’re not sure what it is, and the only thing they can do is sound it out. 39:14 So this took you five times as long to read, and that’s not too far off from a lot of people with dyslexia. 39:22 So here’s what I want everybody to think about with this. 39:26 Reading these things, if you have a child with Dyslexia, the classroom, They’re behind everybody else, everybody is reading further, their further, They’ve read more material than maybe, you know, maybe they have notes. They’re looking at their, it’s their way behind in that Many pages behind often. They’re trying to sound out the words. They don’t know what the words are. They don’t know if they got them right? Because they don’t recognize it. So maybe they read the wrong word for that, and they just go on. So now they’re trying to understand what it means. 39:58 When you are putting this much effort into it. 40:02 You don’t have a lot left over to just get the information, because you’re struggling through it. 40:07 So, when I talk about, you know, some people who are watching, this might have seen me talking about ADHD. And I say ADHD is much more complicated than people realize that dyslexia is much simpler than people realize. 40:20 It’s, it’s this, it is, It just isn’t automatic. 40:25 And if it’s not automatic, you can’t do it well. 40:29 But we take it for granted. 40:30 If we’re good readers, people with dyslexia, Most of them can read. There are people with very severe dyslexia. Maybe they can’t, but almost all people with dyslexia can read, they can’t read well enough to to meet the needs they have for this. And the older you get, the more information is presented to you. 40:48 Through written language and they’re not trying to teach you to read anymore or they’re trying to get the information across. But if you are. 40:56 If you are having trouble reading it, you’re not getting as much information. So it affects everything. 41:02 So does or does a person with dyslexia. Could you, could you have a social studies disorder? No, there isn’t that. But if you have dyslexia, you might have trouble understanding social studies, because it takes too much effort to read. 41:17 And I wanted to point out, one thing you did, which is actually very typical of kids with reading difficulties. 41:23 Once you started, when it started getting difficult, you said, Do I have to read this whole thing? 41:28 And this is another thing that we see as a big indicator. 41:31 They’ll be like, can I stop this? Can I avoid this? 41:36 Many people with reading problems will say, Well, I just don’t like to read or I hate reading, right onto a lot of times, they do this, because it’s difficult, and they’re trying to avoid. So we have this on top of everything else, they’re having difficulty doing it and they don’t wanna do it, because it feels bad. 41:50 And especially with, with other kids, they’re looking and they see that everybody else is ahead of them, Everybody else is getting the question, right. 41:59 So what did they think? 42:00 Now they don’t know our definition that we already showed, that saying like it has nothing to do with their cognitive ability, unfortunately, because if their cognitive ability is fine. They’re really pretty aware that they’re having difficulty but they think it is that they think that it is their ability. 42:14 I can’t read because I’m not smart and that’s not with Dyslexia, it, it can happen it kind of cognitive ability from very gifted to average, to significantly below average. It’s the idea is that if not, where you expect it’s lower than you would expect based on that. So a lot of times, kids are aware they have these problems, but they think it’s them. They think it’s their ability. 42:38 So, what happens with adults that have gone through all this? 42:45 With practice, I won’t read this exactly. 42:47 But like with practice, people with dyslexia can become good at reading things, they have to work harder. They have to, they over practice to be able to be normally function, and they’re always better with the material that they know the best, when they’re getting something new, they have difficulty. But, of course. now we just did with that example with you, Katie. 43:07 We did a more dramatic one, like everybody has trouble with things they’ve never seen before. It’s just a better reader. You are the less often that happens. But people with dyslexia, maybe they’re great, They have to read the same stuff all the time, they know what they’re looking for, Something new, my throat, they read slower, they have more difficulty, but these difficulties with phonological issues and slow reading rates tend to continue throughout their entire lives. 43:33 You can be functional, you can learn to do this, but it’s not like it goes away. 43:38 So how do we address dyslexia? And this is something that I’m sure everybody wants to know, and I will say this from everything that I’ve seen over all these years, your first and your best resource is typically the public school system. 43:50 Because they have the resources to do it, They have the the the funding, the education, and the background for it. 43:58 So, there are things that look at everything from special education to things that are before that, which, if we have time, we’ll talk about that as well, Things that hopefully happen before you get to special education, where they can address these things. 44:11 And, what they do is evidence based instructional methods these days, and that is the only way to go, not some novel approach. Not some, you know, oh, there’s this new thing. 44:22 There has to be evidence that it works. And there are methods that are out there. I am a big fan of using reading specialists. Special education teachers are fantastic but reading specialists are trained specifically in helping people learn how to read. 44:37 And you can access that kind of professional Whether you have a disability or not Reading specialists often will use something like one of these evidenced based methods. The ones will come across the most or the Orton Gillingham method and the Wilson method. 44:53 But that’s something you should definitely ask. Like is this, you know, do you use an evidenced based approach? The answer should be yes. If it’s a school You will be. Yes. 45:02 one thing to know about, and I think this part is important, the difference between a disorder and a disability, a disorder is a clinical term. 45:12 Uh, it means that we, like, it’s very close to the definition of dyslexia we had before, although they use the word disability, And a disorder means that it is, it is, like for this reading, that is below the level that you would expect. 45:28 And that it has to be measured, and that, that you need some kind of supports in order to function. 45:34 Disability is what the schools use. 45:37 Disability is a legal definition. 45:40 And there’s a world of difference between a disorder and a disability. 45:44 So when they say that is a learning disability, it means that the person’s difficulty is significant enough. 45:51 They don’t have a free and appropriate, they don’t have access, equal access to a free and appropriate public education, which is the language that we use in the law, saying that if they don’t have these, these supports, if they’re not afforded additional support, they are disabled and unable to benefit the way that they need to from school. 46:15 So that’s where special education comes in. 46:18 That’s where these extra resources come. So, here’s where the difficulty can be. 46:24 A disorder is not necessarily equal to a disability. 46:28 So you can have a reading disorder, but not be disabled. 46:32 And that can be very frustrating for people. 46:35 A lot of the times, they will be the same. 46:37 Somebody with a disorder will qualify for a disability and will be eligible for special education. 46:43 But just because you have Dyslexia doesn’t mean that you automatically can be considered disabled. 46:50 I mean, you don’t you don’t want to be disabled, so like, that’s you, But you hope that, it’s my older than that. But there are resources. If you’re if you do have a disability, but you could still have a disorder. 47:01 You still need help, but as long as you are able to function at an appropriate level, at a grade, appropriate level, the school will not consider you to say, but you may need help. 47:11 Now, this is one of the things that has changed over time. 47:15 Schools now have have resources to help people, hopefully, stay out of the special get special education system by addressing these things through targeted, evidence based instruction as soon as they see it. 47:30 And then all referring to special education if those efforts are not successful, and that’s why we’ll say intervention needs to be as early as possible, and as intense as appropriate. 47:42 So, if you can catch these things in first grade, you have a better chance of being on grade level throughout the, the rest of the time that you’re in school. 47:52 If you wait until age nine, then about 75% of people are going to be below grade level in reading. 48:00 For the rest of the time, they’re there in school. 48:02 The problem with special education is you don’t get special education, until you’re failing essentially, or that you can’t do the work. 48:09 So, if you’re just relying on special education to catch it, you may miss this. That’s what’s great. You know, I absolutely encourage you to read that New Jersey handbook and see the things that they can do to try and address these things without special education as soon as they see it, and then if it doesn’t work, you go to special education. 48:28 So, the actual solution is, Is not, no, it’s not incredibly dramatic or anything like that, but it isn’t the actual solution, is finding the actual deficits, and then working directly on those deficits, targeted kinds of instruction, and just over practice. 48:52 Is it going to be harder for them? It is going to be harder for them. Will they have to learn? 48:57 Will they have to spend more time learning how to read? 49:00 They will, but if you do it, they can. 49:04 There’ll be over practiced, but they will be able to hopefully, participated grade level and beyond. 49:13 So there is no other way around it, because you need this instruction, you need extra instruction. You need these kinds of services and resources that schools have. Reading Specialists are also available privately. But like this, they need that practices early as possible, and hopefully just say on special education and special education will be there for them if they need it. 49:32 And one thing I want to say, you’ll see a lot of different alternative treatments that are not this, not direct instruction, and they all have one thing in common, and they don’t work. 49:41 Nothing else works except for this. 49:43 And if people say, oh, colored lens thing, know, these things don’t work. 49:48 Anything other than these kinds of direct instructional tasks, doesn’t have the track record to show that they are effective. 49:59 So I’m sorry, I’m sorry. I don’t mean to interject, we have around 10 minutes before it, eight o’clock, so I just wanted to give you a time-stamp. 50:08 OK, this is good, we don’t even, I mean, I wanted people to take a look at this. 50:13 This is also available in that handbook. 50:15 This is the last thing that’s really worth talking about right now, but this is the flowchart that they use in New Jersey to say like, no screening for dyslexia. 50:25 So this is what schools are looking at, and I think this is worth just NaN, so, universal screening and data review. So they have things that are, that are done at different ages and different grades, screening measures and screening methods, they’re looking for. 50:39 So depending on where that puts in, you can see like is the person at or above benchmark, and they’re making good progress then. They say you continue instruction, and that’s up to the left, everything is fine. 50:51 Are they, app are above benchmark, but they’re performing poorly in the classroom? 50:58 Hmm, hmm, hmm. Then you go onto delivered structured literacy intervention. 51:04 Are they having difficulty still consider screening for Dyslexia? 51:09 Are they below the benchmark to the right that they get through the same thing, but then you are to screen for Dyslexia, then you’ll look like at that point. 51:19 Do they are they progressing? If they’re progressing, you continue with the interventions if they are not progressing. 51:27 If you’ve done the interventions, they’re below benchmark and they’re not progressing, then you referred to special education. When I started doing this, there was only whether they did it in the classroom, or whether they went to special education. 51:39 This is what always needed to happen. 51:42 They needed to measure along the way. can we fix this? 51:46 Are we monitoring it? 51:47 If we can’t fix it, then we have evidence to go to special education. We’ve tried this, we’ve tried this, we’ve tried this. They’re not making it. This is a much better system. So I wanted to end with that. Schools have largely caught up. Schools have this information and they’re looking at it. And if you don’t happen to live in New Jersey, most states have something very similar based on the same stuff from the, from the federal department of education. 52:12 So, ask your school if you don’t have it. So let’s stop there, and then we will, we will do questions. 52:21 OK, thank you so much, doctor Dahlberg, so we do have a few questions. 52:27 Alan. 52:30 That’s me. 52:34 OK, so before we start Q and A Since the audience will gain access to unmute themselves, we will be stopping the reporting in a minute for those that are watching the recorded version of this webinar. I thank you so much for attending Dyslexia Reading between the lines presented by doctor Eric …. When this webinar ends, there’ll be an exit survey, which we appreciate you completing. 52:55 An archive recording of this webinar will be posted to our website, … dot org, under the Programs tab. 53:01 All questions submitted during the recording will be posted to the block and the presenter to answer this blog will be open and monitored until Wednesday, February seven. 53:10 Any personal information will not be included, and then posting. Our next presentation will be on hand as pediatric autoimmune neuropsychiatric disorders associated with strep. 53:20 Presented by doctor …, it’s scheduled for Wednesday, February 21st at 7 0 PM Eastern Standard Time. 53:26 But the recording the following day, Thursday, February second at 2 0 PM Eastern Standard Time, we offer Professional Development certificates for school professionals and school nurses that attend the live recording of the webinar. 53:39 To register for either time, please visit … dot org slash webinars. 53:43 And with that, I’m going to stop the recording. Have a great, I have a great afternoon.