INTERVENTION OF LEARNING DISABILITY

KUNNAMPALLIL GEJO JOHN SPEECH LANGUAGE PATHOLOGIST

KUNNAMPALLIL GEJO JOHN

A) Phonological Awareness Training

Based on the principle that phonological awareness is impaired in the dyslexic child. Phonological awareness: the ability to reflect on and manipulate the structure of an utterance (e.g. into words, syllables, or sounds) as distinct from its meaning (Stackhouse, 1997).
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Program includes 3 levels: Level I. Increasing word awareness: dividing sentences into words. Level II. Increasing syllable awareness: dividing words into syllables. Level III. Increasing sound awareness: dividing syllables into sounds.
Each level consists of 2 types of activities: Listening activities. Activities for deliberate manipulation of words, syllables and phonemes.

1. 2.

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B) Phonics Instruction
3 approaches to Teaching Phonics:

SYNTHETIC Phonics Instruction

ANALYTIC Phonics Instruction

MULTISENSORY Phonics Instruction

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1)

Synthetic Phonic Instruction:

Individual letter-sound correspondence taught after mastery

Phoneme then used in syllables and words

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2) Analytic Phonics Instruction: Whole words introduced first

Letter-sound correspondence to be deduced from the word

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3)

Multisensory Phonics Instruction:

A variation of synthetic phonics instruction that incorporates multisensory teaching techniques. Why is mutisensory approach advocated in intervention of LD? GATES (1927): help children attend to details within letters and words. ORTON (1960): kinesthetic involvement enhances learning of letter sound correspondence. SLINGELAND (1971): helps to retrieve words from long term memory.
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C)

Improving Reading Comprehension:

1.

Developing Whole Word Recognition: Irregular words are taught as sight words. Bryant et al. (1982): suggested a MASTERY LEARNING APPROACH to teach irregular words words are presented in gps of 4 or 5, child has to discriminate the words from other words similar in appearance. In multisensory programs, irregular words are taught as whole using activities such as tracing, copying, and sky-writing, while saying the individual letter names.
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COMPUTER-ASSISTED INSTRUCTION (CAI) to improve whole-word recognition: Jones et al. 1987: Learning disabled students made significant gains in their speed and accuracy with a list of monosyllabic phonetically regular words given practice with the computer.

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2.

Developing Reading Fluency:

Techniques include: Student reads words/phrases from a chalkboard before encountering the same words in stories.

Repeated reading - student reads short passages several times until a satisfactory level of fluency and accuracy has been reached. Use of audio support student reads silently while liestening to a tape recording of the passage.
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Student records number of words read each minute on a graph. Paired reading student reads alternatively in pairs. Imitative reading teacher first reads passage while student follows silently. The student then reads the material aloud following the teachers intonationand phrasing (henk et al, 1986)
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D) Increasing Word-Finding Abilities:

How is naming impaired in LD? Catts (1993): deficits in phonological awareness and rapid naming lie near the core of specific reading disabilities in young children. Swank (1994): specific phonological coding impairment construct word cannot be accessed from lexicon since: a. Child is unable to process and impose a phonetic identity on rapidly paced human speech b. Phonological info is not stored long enough to complete the naming task
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Hence, therapy techniques include:

1. Strengthen the STORAGE

Initial voc: common words, meaningful to patient

new words to be taught in orderly manner (reflect categorical and associative

relationships)

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WIIG & BECKER CAPLAN (1984): storage problems can be due to delays in concept formation and semantic hierarchical classification OR when word substitutions reflect reduced semantic complexity or compounding. Suggestions for intervention: Identify and elaborate meaning features in words (e.g. function, perceptual attributes...). Encourage word categorization by semantic class. Finally identify likenesses and differences between related words,
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2. Strengthen the RETRIEVAL

1.

Increase retrieval strength: use phonological segmentation activities use imagery activities Increase self-cueing strategies: talking and reading about words, analyzing how context affects the meaning of words, and using words frequently in various situations to enhance retrieval

2.

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3.

Increase naming speed: GERMAN, 1992 and NIPPOLD, 1992 rapid naming may improve retrieval strength (especially at advanced stage of therapy).
Profiles and Consistency: German (1992): source of the students word finding problem (storage or retrieval) and a profile of the students target word substitution should be used as basis for selecting which techniques and strategies to implement.
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4.

E) Learning About Patterns in Print:

Aim: to make transition into print easier.
1)

Making word lessons: Select a specific letter sound pattern to be worked upon. Make list of short and long words with the target.

2) J & J Language Readers: a comprehensive series of books incorporating vocabulary, oral language expansion, written expression, spelling, comprehension, and higher level thinking skills
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3) Project Read (Greene & Enfield 1991): a system of learning that is used as a strategy by the student utilizing a visual, auditory, tactile approach.
4) The Brody Reading Method (Brody,1991): decoding, comprehension, spelling and writing are integrated through extensive multisensory practice that leads students from one syllable word reading to longer words in challenging text.

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Techniques to improve Reading Comprehension, Reading Rate and Fluency:

Introduce the passage or book. Maintaining interactive ease (the adults alerts the child about new features that will be covered). Increasing accessibility (adults anticipates which words/concepts might create confusion). Prompting active reconstruction (linking to a personal knowledge e.g. ask what do you expect will happen? Use study guides (or Study Buddies) ANDERSON, 1994. These can be developed to assist with reading, writing, spelling.
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Tape recording: Record students first reading of a passage

Replay it and discuss about it

Rereading and retaping assists in developing fluent and flexible reading rate.
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Use think aloud strategies and ask questions. Identifying the main ideas and details in students own words.

Here story retelling strategies may be used e.g. Setting Who, what when, where? Problem What is the problem to be solved? Order of action What happened to solve the problem? (Correct/logical order) Tail end What happened in the end)?

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F) COMPUTER APPLICATION FOR READING NSTRUCTION

HYPERMEDIA

Reading text is presented along with the option of finding additional information about the text. (MacArthur & Haynes, 1995). Possible in the computer environment, but not possible in a traditional textbook.

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Several hypermedia software packages have been developed for students with learning disabilities. e.g. Students Assistant for Learning from Text (SALT) - MacArthur and Haynes (1995) Hypermedia!! NOW - Boone, Higgins, Falba & Langley (1993)

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Scaffolded Instructions for LD: Vygotsky, 1978: suggested that learning must be scaffolded, structured and supported by a person more competent in the skill under study.

Hence, the MENTOR had to structure learning tasks especially in the learning disabled who demonstrates a lackof organization skills in reading (e.g using a semantic map made up of a series of organizational steps).
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E) Improving Basic Writing Skills

LD: letter formation problems, spacing problems, inappropriate pacement of letters.

Improve cursive writing (Bender,1996): Student has to sbmit a written assignment. He is then asked to review the first two lines, middle two lines and last two lines regarding specific aspects such as: Are all of the short and tall letters consistent in height? Is the slant of each letter the same? Are the spaces between the words the same? Suggestions are then given about same.
1.
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Letter fading technique: student traces certain letters several times daily, until able to write the letter on his own. 2. Cognitive strategies : Use of self-monitoring (e.g. using a self instructional card). Cognitive instructions also used for spelling (these approaches involve the child to think about the spelling of a word instead of simply copying it e.g. some techniques involve visual imagery of the word)

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Improving Advanced Writing Skills

1.

Sentence and paragraph writing: use of story starters - pictures that depict an event about which students are assigned to write. Cyberpals writing: Use of e-mail to establish cyberpals in order to reach sentence and paragraph writing skills.
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2.

3.

Phases in the Writing Process:

Pre-writing:

Flowers & Hayes (1980): the ability to adapt the content, vocabulary and style of writing to an audience separates the skilled form the unskilled writer. Involves development of an organizational framework: linguistic or pictorial frameworks.
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Writing:

student builds upon the planning that has already been done and begins the actual writing. Encourage the student with LD to break the writing assignment into various stages - this will decrease the writers fear of the assignment. Strategy (De La Paz & Graham (1997) ): DARE (develop a topic sentence, add supporting detail; reject possible arguments, and end with a conclusion).
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Post-writing:

involves skills such as editing and revision of the written text. Strategy: COPS (Schmaker, Nolan & Deshler 1985) C = Check Capitalization O = Appropriate Organization of Narrative P = Check of punctuation S = Check for spelling

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H) DISABILITY-RELATED ADAPTIVE AIDS

assist individuals with learning disabilities to: (a) compensate for the processing deficits (b) easily learn to use these resource tools. Voice input: permits the user to enter text or commands through speech. E.g. Dragon dictate Spell checkers: point out the words in a document that the program does not recognize. Suggestions about the correct word may then be offered.
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1.

2.

3. Grammar checkers:

Software that can review a document for common grammatical errors. helps students learn to proofread their own work and avoid common error future.

4. Word prediction: use of artificial intelligence to offer several choices of a word after typing first few letters.
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5. Macros: Word/phrase/computer command that can be automatically typed into document by the program once the user presses a certain key. helpful in inserting frequently used phrases or words that are difficult to spell. 6. Abbreviation expansion: when the present Abbreviation is entered the program automatically expands that abbreviation the users present words or phrase (similar to macros but using abbreviations).
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7. Screen enlargers and alternate screen displays: enlarge the size of the text displayed on screen. user can block out all the text that is of no importance to them. 8. Voice synthesizers: an assistive aid in reading of text on the computer screen for students with auditory learning strengths. 9. The Franklin speller and typing tutors: electronic spelling aid which looks almost like a pocket calculator. helpful in completing essay exams and written homework assignments.
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I)

A social skills program for adolescents (HAZEL et al,

1981)

Developed to teach the social skills needed by adolescents to interact effectively with peers and adults. Teaching procedures are:

Face the person Keep eye contact Keep a neutral facial expression Use a normal voice tone Keep a straight posture Listen closely to the instruction so that you will know what to do and remember to give feedback with head nods Acknowledge the instruction
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Ask for more information if you dont understand the instruction (But I dont understand) Say that you will follow the instruction (Ill do it) Follow the instruction Throughout, give polite, pleasant responses Do not argue with the person about the instruction; go ahead and follow it and you can talk to the person later about problems.

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J)

Specific Techniques Used for Learning Disability:

1.

CLOZE PROCEDURE:
aims at expanding vocabulary in content areas for greater independence in reading.

Procedure: A passage of relevant material is selected. Eliminate every nth word from the passage (e.g. every 5th or 6th word, every verb, every adjective ). Be sure that the space indicating a missing word is of uniform size so that the reader has no clue as to the word from spacing. Direct the reader to review the passage and fill in the blanks with an appropriate word. When the reader is finished, analyze the completed word for any patterns of error, from which future lessons may emerge.
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2. MAZE TECHNIQUE:
Used for students with intact basic reading skills. Procedure: select a sentence/passage of appropriate material. at every nth word, provide 3 choices for completion:

semantically correct but syntactically wrong syntactically correct but semantically wrong both semantically and syntactically correct.

the choices should be tiered at the point of selection. Result should look like this: chair The ghost passed through the delicious door. locked reader uses a pencil and underlines as he/she reads, making a choice at each selection point by underlining the correct word. in reviewing, the teacher should note any pattern of error, such as all syntax selection problems or semantic difficulties. This targets areas for remediation or instruction.
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3. DIRECTED READING ACTIVITY (DRA):

Used to: develop ease with reading materials that were previously too difficult. Procedure: Teacher should be Familiar with the text Decide which vocabulary needs special introduction Decide what passage/phrase may need clarification
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Steps are: i. Preparation: teacher clarifies any new/unfamiliar vocabulary, concept, theme or idea.
ii.

Guided silent reading: teacher establishes the purpose for reading the selection by saying read to find out why/how . Comprehension/vocabulary development: comprehension is demonstrated at all levels vocabulary is taught with synonyms/antonyms, games, context cueing. Rereading: silent/oral (method for finding or defending answers in cases of disagreement among students).

iii.

iv.

v.

Follow up: additional activities may be added for enrichment or remediation.

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4. EXPLORE, VOCABULARY, ORAL READING, KEY IDEAS, EVALUATE, RECAPITULATION (EVOKER):

Used to develop study skills

Procedure: i. Explore: silent reading to get overall feeling of the text. ii. Vocabulary: clear up any unfamiliar words, expressions, spellings or usage. iii. Oral reading: read the selection aloud. iv. Key ideas: locate and list key ideas, characters and themes. v. Evaluate: assess the key ideas in light of their contribution to the main idea. vi. Recapitulation: reread the selection.

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5. FERNALD TECHNIQUE:

Used for students whose disabilities in reading are severe and require a multisensory approach.

Stage I: student selects a word that he/she wants to learn

word is written for the student in plain, large script

student then traces the word with his/her finger, pronouncing each sound as it is traced
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process is repeated until the student can reproduce the word without looking at the copy.

Stage II: Student is now able to smoothly copy the words and read his own copy. Words become longer. Stage III: students learn directly from the printed word by this stage without vocalizing Books introduced. Stage IV: Student can now recognize new words from known words.

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6. ORTON-GILLINGHAM TECHNIQUE:

Used for students with good auditory processing but weak visual modality Includes Visual drill Auditory drill Kinesthetic drill Build-up of decoding and encoding skills Learning of rules and patterns Reinforcement via kinesthetic pathway Repetition (to establishes learned words)

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7. SURVEY, QUESTION, READ, RECITE, REVIEW (SQ3R):

Used for development of study skills Steps: 1. Survey: preview of text prior to reading 2. Question: formulation of questions for comprehension 3. Read: student reads to answer the questions 4. Recite: rehearsal (to help transfer of info from STM to LTM) 5. Review: verification of answers to questions formulated

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8. SURVEY, QUESTION, READ, QUESTION, COMPUTE, QUESTION (SQRQCQ):

Used for mathematical problems Survey: student reads the problem rapidly to get the general nature of the problem. Question: student asks himself what is being asked for in this problem? Read: student rereads the problem slowly

i.

ii.

iii.

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iv.

v.

vi.

Question: student asks him or herself what operations are called for in this problem? Compute: student performs the computations which answer the questions in the previous step. Question: student asks him or herself whether the answer and the process used to get the answer was correct.

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9. WHOLE LANGUAGE:

Used for integration of all language skills while reading a topic is introduced language is generated from the students interest in and experience of the topic.

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K) A Note on COUNSELLING:
Dyslexia:

Look at pictures if available (since visual processing skills are usually an area of strength). When taking tests that require reading, look at the questions first. Read out loud. Use as many senses as possible simultaneously. To improve comprehension, have the student read real stories with meaningful content. KUNNAMPALLIL GEJO JOHN

Dyscalculia:

Encourage the child to work extra hard at visualizing mathematical problems. Draw pictures to understand the problem. Take time to look at the visual information provided. Provide examples and relate problems to real-life situations. Use rhythm/music. Use talking calculators. Use color coding for maintaining columns
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Dysgraphia:

Allow more time for written tasks. Instead of the student writing a complete set of notes, provide partially completed outline so the student can fill in the details. Reduce copying aspects of work. Encourage the student to use spell checker. Use paper and writing instruments of different color. Use pencil grips.
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NON-SLP INTERVENTION FOR LEARNING DISABILITY

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MEDICAL THERAPIES:

Drugs prescribed: 1. Psychostimulants: 2. Antiaggression agents 3. Antipsychotic agents

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ORTHOMOLECULAR THERAPY:
Prescription of large doses of Niacin, Pyridoxine, Vit C and Vit E to diet. Reported for use with LD patients by Cott, 1971.

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BIOFEEDBACK:

the immediate feedback of specific bioelectrical responses to the subject for the purpose of modifying those responses in vascular,neuroelectrical, and neuromuscular disorders (BLANSHARD & YOUNG, 1974). control breathing pattern, modify hyperactive behaviour and increase attention span.

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SENSORY INTEGRATIVE THERAPY:

Aynes (1972): normalization of posture would organize the midbrain processes and vestibular stimulation would improve the auditory discrimination process.

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CREATIVE ARTS THERAPY

CREATIVE ARTS THERAPY

ART THERAPY

DANCE/MOVEMENT THERAPY

MUSIC THERAPY

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The Creative Arts Therapy have been reported to reduce:

1. 2. 3.

4.

hyperactivity, distractibility, spatial and temporal distortion/disorientation and memory impairment

(in children with LD and SLI as reported).

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BEHAVIOR THERAPIES:
These are psychologically-based methods used to modify problem behaviors when associated with LD. They include: Extinction Punishment Token Economies

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