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This month's focus: A Note From the Chair Voice Production and Pathology Improving Patients' Quality of Life Dean's Musings Around the College Bookbeat Grants CLASnotes |
Overcoming Reading Disabilities
More than 30% of school-age children read below grade level (which could be the result of a variety of social and cultural factors), but only a small percentage of these kids have the kind of dyslexia mentioned above, a neurobiological weakness that renders common remediation strategies ineffective. "These are not individuals who have had a lack of exposure to reading, have depressed intelligence, or lack the motivation to read. They have reading and spelling difficulties because they possess a different brain processing capacity for integrating sounds and letters," explains Communication Sciences and Disorders professor Linda Lombardino, who specializes in diagnosing and treating the disorder. "Developmental dyslexia is a specific learning disability caused by a problem in the brain system which affects phonological processing (processing sounds and mapping them onto corresponding letters)," she says. Although reading can be terribly difficult for children "Patients come to the clinic to be evaluated, to receive treatment or both," she explains. "Evaluations take four to five hours. We examine all aspects of reading, spelling and writing, and based on the results, we recommend treatment if appropriate." Since developmental dyslexia runs in families, when a sibling or parent has similar problems, it helps practitioners identify the disorder. "I can only think of two or three cases I've worked with in the past four years where there wasn't a clear family history," Lombardino recalls. Once the condition is identified, there are several types of reading programs available to help persons with dyslexia, but the most effective, says Lombardino, are multi-sensory strategies, meaning that children learn sound-letter associations through utilizing every possible modality: listening to sounds, repeating sounds, tracing letters associated with the sounds, reading aloud, and writing and pronouncing words simultaneously. In addition, multi-sensory programs teach patients the specific rules of language that most people are able to pick up implicitly. "For example, there are four basic syllable types, and once you know them you can sound out and spell words much better," says Lombardino. Most of us understand these rules intuitively, without consciously committing them to memory; in fact, we don't even necessarily know the rules exist. Teaching these kinds of rules to people with developmental dyslexia helps them break down language into its essential parts, bridging a neurological gap and allowing them to grasp explicitly what the rest of us take for granted. "While phonological processing problems make this type of learning and remembering slow and difficult, persons with developmental dyslexia can be helped to read, spell, and write more effectively," Lombardino stresses. In fact, many of the patients she treats are gifted students, who thrive when taught through the multi-sensory approach. Developmental dyslexia, like all learning disabilities, is brain-based and can't be "cured," but Lombardino points out that scientists and health practitioners are beginning to realize that the brain is far more adaptable than was once thought. Lombardino and fellow researcher Christiana Leonard, Department of Neuroscience, hope to prove that certain kinds of intervention may help the dyslexic brain forge new connections, diminishing language problems (not just compensating for them) in the long run. "While I doubt that we can alter biology to the extent that the reading disability can be completely reversed, we are hoping that we can increase the efficiency of the neural processing of print in persons with dyslexia by stimulating areas of the brain that are typically most active during reading." And if multi-sensory intervention can enhance the brain's With Leonard, Lombardino received NIH funding five years ago to study brain-behavior patterns in children as they acquire language. They used MRI technology to compare the size and shape of brain structures associated with language processing in children with normal language and compared them to MRIs from children with specific language impairments but no other learning difficulties. They found definite differences between the two groups, supporting their hypothesis that language impairment is a consequence of an underlying neurobiological defect. They now plan to extend their research to use functional magnetic imagining (fMRI) to examine the effects of reading intervention on the brain activity of children who have developmental dyslexia. This interest was spawned by a recent Yale study that used fMRI to record images of the brains of adults with dyslexia and controls without dyslexia, taken while these subjects were performing certain reading tasks. They found that adults with dyslexia had less brain activation, due to decreased cerebral blood flow in the posterior areas of the brain, where reading is understood to be primarily processed. "That was the first real evidence that there are truly functional brain differences with dyslexics," she explains. "We're hoping to use the same type of scanning protocols on children with dyslexia. We'll do a fMRI of their brains while they're doing a reading task before we treat them, we'll treat them intensively with multi-sensory program and then do a follow up fMRI to see if we've increased brain activity in posterior brain areas. Continued research in this area will help them to document the efficacy of their intervention treatments--such as the aforementioned multisensory approach--and to record associated neurobiological changes. This type of research may also eventually lead to the development of imaging procedures that can help identify children who are at risk for reading disorders as early as three or four years old. Though a great deal of their time is spent working with children, Lombardino and her CSD colleague Henriette Le Grand also treat adults in the UF Speech and Hearing Clinic. These adults are often college students who, "bright and in spite of their problems, made it here and hit brick wall when they had to take a foreign language or fast paced courseÐboth exceedingly difficult for dyslexics," she notes. "At the adult level we often recommend accommodation rather than treatment, since the person has usually developed sophisticated coping strategies." For example, instructors are asked to assist dyslexic students by providing extra time for exams (or giving untimed exams), substituting oral tests for written ones, overlooking spelling problems, and/or waiving language requirements. "We try to give the University the information it needs to best serve each student, but we've found that certain fields, such as journalism, are not wise for these students to go into," she adds, "so sometimes we advise students to redirect their talents." Lombardino's teaching reflects her research and clinical work. She offers mainly graduate courses focused on preparing students to become speech language pathologists, concentrating on language learning disabilities, both oral and written. Through all aspects of her work, Lombardino's goal remains the same: "to help persons with developmental dyslexia finds ways to conquer roadblocks that stand in the way of achieving their life goals." |
Imagine staring at a page of text written in plain English and not being able to recognize words that you know you have seen before. The letters make familiar shapes spaced evenly across the page, but you can't recall the sounds associated with them. This sensation--kind of like trying to decode a foreign language--is common for persons who suffer from a learning disability called developmental dyslexia.
who suffer with the disorder, specialized intervention--part of what Lombardino does in the UF Speech and Language Clinic--can make a big difference.
ability to make stronger memories for sound-letter associations and letter sequences (to increase the rate and accuracy of word recognition), then persons with dyslexia should be able to enjoy the permanent ability to read more efficiently and with greater speed.