ladies and gentlemen thank you for standing by and welcome to the neuro psychology of reading disorders a framework of effective interventions webinar during the presentation all participants will be in a listen-only mode if you would like to ask a question during the presentation please use the chat feature located in the lower left corner of your screen if you need to reach an operator at any time please press the star followed by the zero as a reminder this conference is being recorded Tuesday May 14th 2013 I would now like to turn the conference over to Andrea Moss please go ahead thanks so much and thanks everyone thank you so much for joining us if you've attended the cause and effect sessions in the past you know this series is all about why is my students struggling and what can I do to intervene and for first-time attendees just wanted to let you know that we do post the archives of these sessions so you'll have that resource to refer back to and it's also great to share with your colleagues who may have missed the session note on today's handouts they were emailed via a reminder email yesterday so if you did not receive those please use the chat box to send me your email and I'll get those out to you as quickly as possible and with that I'm very pleased to introduce our speaker for today dr. Stephen Pfeifer is a nationally renowned speaker and author in the field of learning disabilities and has authored six books on learning and emotional disorders and children he has 19 years of experience as a school psychologist and currently works as a professor and research scientist at George Washington University in Washington DC he is also a clinical supervisor in the ABS and peace school neuropsychology training program and maintains a part-time private practice at the Monocacy neurodevelopmental center in Frederick Maryland dr. faux dr. Pfeiffer was voted the Maryland School Psychologists of the year in 2008 and awarded the 2009 National School Psychologists of the Year in 2011 he was honored as a distinguished alumnae scholar of the Year by the Indiana University Pennsylvania College of Education dr. Pfeiffer were so glad to have you with us again and please begin once you're ready thank you very much Andrea and hello everyone welcome again to our cause and effect webinar series this is installment number number four over this past year in terms of looking at learning and emotional disorders and children and today's topic is the neural psychology of reading disorders a framework for effective interventions for those of you who were with me in the fall when we kicked off our cause-and-effect series we also did a a webinar on reading disorders and the overarching framework of that webinar was more on looking at decoding and phonemic awareness we looked at fluency expression automaticity a lot of what you see in the blue and the yellow of those building blocks are reading on our first slide today's emphasis will be a very very brief review but we're going to spend 95% of our time looking at that pinnacle of reading today's focus will clearly be on reading comprehension you see my email address on the very first line and that is the best way to reach me with with perhaps any further questions that we were unable to answer during the course of this webinar many goals we want to address during our presentation today we're going to start out again a beautiful review we talked about this last time for those who weren't with us in the fall we will quickly review our four basic subtypes of reading disorders and again from a brain behavioral perspective but what we want to really focus our discussion today is with subtype number four and that is going to be reading comprehension skills that's going to be the focus of most of our discussion and interventions we will talk about neural pathways we'll talk about specific brain regions as so see aided with reading comprehension skills and perhaps most importantly we're going to talk about the fundamental neurocognitive constructs needed to best derive meaning from print and those constructs are going to lead us to the frontal lobes we're going to talk about executive functioning we're going to talk about working memory and we're going to talk about the interplay between executive functioning and working memory and how that helps us again derive meaning from print we will also get into language development skills because while language development is not housed in the frontal lobe that's more of a temporal lobe a type of thing in terms of vocabulary language skills is the frontal lobes that help us self organized language for the purpose of to facilitate later recall so we'll look at how all of these constructs the interplay of all of these constructs assist us in reading comprehension as you know with most of my webinars I like to pride myself to go where no psychologist has gone before in the areas of interventions that I mean talk real meaningful interventions we will certainly be talking about a combination of classroom strategies to use for children who struggle with comprehension skills but in addition we'll talk about some of the prepackaged programs that you can use for children with disabilities specifically reading disabilities and reading comprehension skills so peppered throughout the webinar we are definitely going to sink our teeth into interventions and we're not going to save that until the end it'll be embedded without our discussion today okay that is the main focus of our talk as always much of the information we're going to talk about today as much of the information throughout the year with our cause and effect webinar series has come from our trio books integrating RTI with cognitive neuropsychology a scientific approach to much of our talk today will be based on information in that book we also did a webinar on mathematics earlier in a year as well as a webinar on written language for those interested in further information ww school nurse I press comm WWF press comm and they are offering a deal for the three books so I just wanted to call that to your attention I believe it's three four ninety nine is what they are offering okay with that said let us dive into our content and I thought we'd start out with a few case studies let's start out talking about before we get into the brain and before we get into constructs how about we talk about kids kids that you see every day how about Billy is Billy someone you see every day Billy is a twelve year old student Billy has an attention deficit disorder now Billy needs accommodations in school because of difficulties with planning and with organization skills he struggles to take notes in class Billy Billy also has a difficulty comprehending information from text and frequently turns in assignments late so this is Billy Belize has an attention deficit disorder Billy struggles with reading comprehension how about Sam do you work with Sam as well see Sam's nine years old Sam is a student with Asperger syndrome and his academic skills are pretty good pretty strong but he struggles to comprehend more abstract types of text drawing inferences from print literal questions such as what color is Billy shirt well he can find his way back into the text Sam can answer a question like that but questions such as make a prediction about what might happen next more informations Sam will struggle with Sam also has difficulties in the social arena he doesn't have a lot of friends seem socially awkward maybe a bit immature in his social-emotional skills and make up a lot of problems reading social cues from others this Sam sounds fairly familiar maybe so once again Sam is an example of student who may have reading comprehension tests deficits what about Jo anybody worked with Jo hijos in high school jo is 16 years old jo is busting loose with an IQ of 135 okay by anybody's standards Jo would meet the criteria for a gifted and talented program the only problem is while Joe's IQ was so strong his academic performance is that weak he's performing poorly in most of his classes Jo does not put forth a lot of effort in fact rarely terms and assignments try never turns in assignments during class Jo does not disrupt anybody he just prefers to pull out a book actually multiple books and read them under his desk during most instruction Joe struggles with comprehension on information that he has no interest in ever run across Jo in any of your schools well one more for you how about Martin I think most people have seen Martin before see Martin's in 11th grade Martin is great Martin is 11 years old and just made the transition from 5th to 6th grade as we talked about before I think one of the biggest transitions in fact the biggest social emotional transition you will make in school is the elementary to middle school jump going from 5th to 6th grade and Martin has a lot of difficulty in the area of controlling and managing his emotional impulses you see Martin's been suspended from school in numerous times for fighting for using inappropriate language Martin's non-compliant his grades are poor a lot of interventions with Martin a lot of behavior interventions a lot of behavior plans still not having a lot of effect changing behavior and as most behavior plans go really don't focus on changing the underlying emotion among Martin's difficulty in school Martin struggles with reading comprehension sustaining his attention and curbing his emotional impulses long enough to derive meaning from text for children for cases four types of disabilities the fact of the matter is whether you have a disability or not research has shown that up to 10% of all school-age kids not just kids in special ed I mean all school-age kids struggle with reading comprehension in spite of having adequate decoding skills adequate fluency skills they struggle with reading comprehension we're talking about ADHD kids like Billy kids who are hyper lexa like Martin know Martin wasn't my hyper lesyk Sam I'm sorry Sam was our hyper electric student you don't hyperlexia hyperlexia pretty much can decode anything in print but you struggle to derive meaning from print students who are second language learners how about Joe high IQ kids very poor executive functioning how is that possible will show how that's possible shortly kids with social emotional disorder struggle with reading comprehension kids with lower verbal IQs and minimal vocabulary development struggle with reading comprehension and the one processing skill this seems to permeate any learning disability whether it's reading whether it's writing whether it's mathematics tends to be poor working memory skills one of the points of showing this discussion and beginning our discussion with with these various cases is that when we think of reading comprehension we think it kids with learning disabilities and as you look at the pie chart with learning disabilities look most children find their way into special education 42% because of the specific learning disability and among those 42% the big blue pie chart here among those kids 80% are there because of a language based learning disability that means they struggle with reading or writing or in most cases both now my point is it's not just kids with learning disabilities that struggle with reading comprehension kids with speech and language impairments limited vocabulary skills struggle with reading comprehension the other health impairment domain and we know primarily who constitutes that domain ADHD kids they struggle with reading comprehension skills kids with intellectual disabilities struggle with reading comprehension skills kids with emotional disorders struggle with reading comprehension skills kids with autism hyperlexia Asperger's syndrome something in the autism spectrum disorder struggle drawing inferences and meaning especially as texts become more abstract the point is all children it's a I'll back up most children with disabilities no matter what the disability it tends to affect the area of reading comprehension and all of the children that I talked about in terms of our case studies none of them were learning disabled but they had other disabilities and one of the things I want to explore is how does those other disabilities affect the area of reading comprehension well the only way to truly tease that out and to really pull out and provide us with a framework an overarching framework to me to understand how we derive meaning from print it's really to understand learning in general is I've always taken a school neuropsychological approach looking at learning from a brain behavioral perspective for me has always taken much of the mystery outside some of behavioral phenomenon I see with kids trying to learn information a neuropsychological approach to assessment simply tries to identify what's the core underlying process responsible for learning as opposed to boxing kids in the diagnostic categories and talked about this a lot with my current students you know simply saying as a child has Asperger's syndrome or a child has autism or a child as a learning disability that is not the endpoint for an assessment that's a label it's time to go the next step beyond the label what are the core underlying processes getting in the way of this child learning you see a report that is based more on a school neuropsychological framework it's really based upon a brain behavioral paradigm that attempts to describe how a child processes information the goal is not to get into fancy math and determine what this kids full scale IQ is the goal is determined why the child has not been successful in school what neuropsych assessment tries to do is examine the cognitive and emotional strengths and weaknesses of the child said this before I'll say it again evidence-based assessments is the key to key to leading us to evidence-based interventions and specificity with assessments to determine the underlying reason why this child is struggling that will promote and lead to targeted interventions and oh yes an actual IEP you know with a capital I not the G EPS running around you know generic education plans you have read one you've read them all but to truly individualize an education plan to format learning for a particular child we have to know a little bit about you know how they learn and what their strengths and weaknesses are to develop specific educational strategies and the framework in which I do that is with neuropsychological assessment and that's what we want to share here today that's the paradigm now whether you agree that that's the way to go where you're thinking now that's overkill who needs to do all this testing my gosh you can just do an observation and figure it out or I still just want to give an IQ test and I'm good with that or oh we're an RTI district we don't do a lot of testing no matter what your feeling is on a neuropsychological approach keep in mind what a neuropsychological approach is trying to do is serve a higher cognitive functioning and determining the fundamental underlying processes in learning and trying to determine what's a strength and what's a weakness it's a collection of information I have always struggled why would anybody be against trying to collect more information about a child if if you could do it in a manner that would help us better understand the child and promote interventions well no matter where do you feel about the need to assess and the need to collect so much information let me tell you what's embedded within the law right now now a quick story about two years ago I was invited to go out to just a town just outside of Oregon Forest Grove School District and for all I know we have some psychologists and folks with us today from Forest Grove welcome went out there as part of a group that was called the meeting of the minds some a lot of folks perhaps you've heard of in specialist field myself George McCluskey Don Flanagan Dan Miller I believe Nancy Mather was out there can't remember Brad he'll join us for that or not but we had a number of folks and we were doing individual workshops but collectively we were conducted a panel discussion and talked about the nature the true nature of what a learning disability is and why Forest Grove why were we out there because something pretty important happened in Forest Grove that I think people need to know about and it goes something like this a child a child a student I believe the high school level had been struggling in school for many years and eventually was referred for an assessment in high school now I was not privy to what the assessment constituted and what the specific tests were but the more questions I asked the more it sounded like it was a you know one of those quick and dirty school psych assessments that were well for all I know you know all of us it could it they could have you know it could be any one of us who form this battery of perhaps just an IQ test you know a bender a basque and let's call it a day okay quick and dirty school psych assessment and this student did not qualify for special education services the parents were at the meeting apparently there was no real discrepancy you've heard my thoughts on discrepancies before there was no discrepancy between ability and achievement and you know parents find off and said okay you know whatever and you know how those meetings ago they can be rather intimidating and you kind of comply but after the meeting the parents started to think and it still didn't add up it still didn't make sense nobody explained why their son was struggling in school so focus that the meeting was only does he qualify for special ed or not and what's the IQ sound familiar but no one explained why the student was really struggling so the parents thought an independent evaluation and this was an independent neuropsychological evaluation and a lot of areas were surveyed that were not hit upon in the initial school psych evaluation the executive functioning skills memory skills subtypes of attention and I'm not talking about just attention checklist but cognitive subtypes selective attention sustained attention divided attention shifting attention a lot of things were looked at in the neuro psych eval came back and said we've got some issues with this child and there were some attention issues there were some learning issues there are executive functioning issues they found the child had an educational disability well the parents then I went back to the school and said aha you see told you obviously they lost some trust with the school and pulled their child and sent set the student to a private school that was rather expensive they went back to the school district and said you're gonna pay for it and the school district said no we're not and hence the battle ensued eventually a due process hearing officer was called in and the due process hearing officer concluded that the school district failed to provide a free and appropriate education and yeah the school district was liable for private school services for a kid who never spent that day in special ed in this school they're saying you're now liable well school district said that's we don't agree and went back and forth and why am I telling you about this case because it went all the way up to the United States Supreme Court right here where I'm broadcasting from just outside of Washington DC I'm here in Frederick Maryland the United States Supreme Court Justice John Paul Stevens one of his last rulings on the bench before retiring in 2009 looked at this case says you know what the parents and the due process hearing officer are correct Justice John Paul Stevens of the United States Supreme Court ruled the school had overlooked a disability by not completing a more comprehensive evaluation in all areas other suspected disability whether you agree or disagree law of the land we need to survey all areas comprehensive evaluations serving all areas of a suspected disability that means it would help us to really know what areas we're talking about when there are reading issues or writing issues or math issues and that's what a lot of our cause and effect webinar series has been about so what we're going to talk about today is what those areas are with respect to reading but more importantly reading comprehension skills well a quick review from our fall webinar one of the things that we talked about in the fall where that reading and in fact the essence of the entire webinar is that when you look at reading from a brain behavioral standpoint a one of the things that helps me is that I reading is about various subtypes and let's assess for to our our brain here and to describe each of the subtypes we'll do a very quick review but the one that's the most popular I should say common if you work at an elementary school I mean you get this subtype as well as ADHD is probably your two most common referrals something called dis phonetic dyslexia and dyskinetic dyslexia is that third or fourth grade student reading on about a first grade level simply because they lack decoding skills that's probably that subtype number one okay it's the most common type of referral kids who don't master that decoding phonological process aspect of reading so what do we have and we looked at see if my marker will work this sort of hierarchy of the brain right here we're in the area of the left hemisphere the left hemisphere is the dominant hemisphere for learning and just above our left ear is the temporal lobe and the temporal lobe is a real marquee player in the area of reading now while reading cannot be isolated or localized in any one area of the brain there are multiple circuits that contribute this area called Heschl's gyrus will speech or language therapists have a different name for that they refer to this as auditory discrimination skills this is basically hearing sounds and boundaries within sounds and in the English language we have 44 of these sounds they're called phonemes and the ability to hear whether two sounds are the same or they're different or if they rhyme I mean this is something that really should be mastered by age five this is what we call phonemic awareness Heschl's gyrus as we get pretty good on those sounds we learn as we go up and to the back up and to the back the superior temporal gyrus is more of a cross modal association area the superior temporal gyrus allows us to take those sounds we're pretty good at distinguishing and link them up to a symbol the alphabetic code to understand that this sound goes with this symbol so there is a visual component to the superior temporal gyrus and it allows us to modulate okay those 44 phonemes because now we can isolate and identify a beginning sound or an ending sound or something like that very important in the reading process but the highest level of phonological development sits all the way back here let's go up again and to the back up into the back this super marginal gyrus that represents the interface of the parietal and temporal lobes the parietal lobes facial orientation and where that temporal lobes are sound the super marginal gyrus is a big-time player in the spatial appreciation of sound and as any good reading teacher knows when you say calf is at it's not aa or a kata in other words it's one thing to do the sound but this allows us to spatially manipulate and order the sounds that's the highest level a phonological processing and now we know in subtype number one kids with dyskinetic dyslexia something's gone awry on that whole sound structure that decoding piece that goes from phonemic awareness to phonological processing and we talked about interventions for that subtype number 2 our second subtype with something called surface dyslexia so if we go back one we have surface dyslexia now the difference between subtype 2 and subside one is on subtype 2 these kids have sounds it's not a problem kids and subscibe basket number one they're the ones who don't have the sound these kids have the sounds what they lack is speed these kids have difficulty with a rapid and automatic recognition of words in print they over rely on sounds these kids are letter-by-letter readers sound by sound the kid in basket one who has no ability to sound out a word if you show them the word cats are gonna go couch they look at the first letter totally guessed totally let one fly here because they have no idea how to sound something out so they look at the first letter and over rely on maybe visual cues and just guess but the kids in basket too it's the opposite they over rely on sound cues so they see the work cat Top Cat Cat Cat Cat thank you ok good we're getting somewhere they have the sounds what they don't have is speed and the reason they don't have speed more often than not is they have poor orthographic processing skills orthography the visual sort of the spatial contour of shapes of letters and the contour of the letters allow us to sort of use some visual cueing to automatically recognize words because the fact of the matter is in the English language one out of every four words is a phonologically or regular word you know whose bright idea was it to put the letter C and yacht I don't hear it so sometimes because of the spatial configuration of words we need to rely on that so identify words kids with surface dyslexia have the sounds but they over rely on them they don't put the whole word together and there's an area of the brain way back here angular gyrus doesn't really look like this but it kind of angles up the end of the posterior part of the temporal lobes that pulls in visual occipital lobe spatial parietal lobe appreciation of sound the visual spatial appreciation of sound back here and this is what really helps us with orthography we also talked about mixed dyslexia and that's the mote that's the most severe subtype of dyslexia and that's where you lack both phonology and orthography so again the kid in basket one with dis phonetic that particular subtype they're going to really struggle to decode words the kid in basket number two they can decode they're just really slow and doing so they lack speed and fluency and automaticity and one of the keys you see is they make a lot of errors on phonologically inconsistent words of which one in four of our words are phonologically or regular but they can't in basket three then mix up type that's the most severe because they lack both they lack both phonology and orthography they have no usable key to unlock the reading code and pattern this is the kid in six seventh and eighth grade reading on a first or second grade level those were the big three we talked about last time what we're going to talk about this time is not so much what happens with difficulty recognize in words back at the brain allows us to mechanically recognize the words but I'm going to take you up front today there we go and let's talk about deriving meaning from print and when you talk about deriving meaning from print we're out of the back of the brain and we're into the world of the prefrontal cortex now as we begin our discussion of some of the main attributes of reading comprehension skills these are the attributes I really want to explore quite a bit today the four main attributes to help us with subtype for which is reading comprehension well we're going to talk about today is one very an emotional attribute content affinity to frontal lobe attributes working memory and executive functioning and then just having the core language foundational skills to derive meaning from print what's the hardest thing about taking a course let's say in in high school whether it's chemistry or physics or biology or my goodness baby psychology that terminology can be overwhelming you have to add the language skills to support what you're reading so if we take these one by one the only thing that I'm going to mention about content affinity is that it matters to make an emotional connection with the information in print know I've said this example before but it's worth saying again you've heard me say I'm just outside of Washington DC and I am a huge Washington Redskins football fan I realize we're have folks here from all over the country who now are just turning their head to the side making a very very ugly expression on their face when I acknowledge I'm a Redskins fan I realize that but it's the passion of the Redskins that I can read you know that they find a third string tied in from Brigham Young University I'll remember the guys name and is his 40-yard dash time I remember everything about this trivial detail simply because that the passion and interest I have in my Washington Redskins but you know what if I'm reading about something oh let's say I won't be mean and say the Dallas Cowboys let's say we're reading about geology and igneous rocks well that doesn't really capture the same emotional interest from me it's very important it does matter the amount of passion and emotional connectivity a student can have with the text in order to facilitate comprehension skills the limbic system in our brain that is really and we talk about the limbic system in previous webinars and when we did emotional disorders that's gonna have really helped to enhance our ability to connect with the information to begin to self-organize that information in a meaningful and useful way it's when we're connected with the print that's what we mean by content affinity that's why every kid to me needs to be reading 20 minutes a day minimum on a topical subject that they enjoy to be able to make an emotional connection to the print well let's talk about the second construct that's involved with reading comprehension emotional connectivity second is going to be working memory and the fact of the matter is working memory is intimately tied in just about any aspect of learning in fact working memory I think is most common processing depths that you see with all kids with learning disabilities why because it affects all the academic domains probably more so in the area of written language than anything else because in written language I answer simultaneously plan my thoughts organized my thoughts remember spelling rules and boundaries recall grammar rules concentrate on penmanship capitalize the first word of the sentence think about my word choice always think about my penmanship hold and ideal in mind when proofreading there's just tons of stuff to remember simultaneously to keep in conscious awareness when engaged in the writing process many of our ADHD friends notoriously have difficulty with working memory and many of our ADHD friends struggle in the writing process more than any other academic task planning and organizing really hard to do when you cannot conjure and hold onto information in working memory working memory affects mathematics we talked about this in an earlier webinar as well maybe not in the beginning years kindergarten for a second-grade we're learning single-digit addition single digit subtraction single digit multiplication that can be memorized but working memory really affects us when we get into longer math equations decision two and three digit multiplication working with fractions decimals when there's a map algorithm involved in there's three four five steps needed to problem solve it goes beyond just rote memorization to know a single fact that's more it's not so much working memory working memory they have to perform some mental gymnastics with the information so in mathematics it kind of affects us when we're actually in the act of problem solving that requires three four or five steps often a problem that will require paper and pencil and something we call it impact math algorithms but for our suggestion today working memory primarily impacts the reading area by way of comprehension to be effective in passage comprehension we have to simultaneously take in the new information while linking it up with previously read information and linking that up to our past background knowledge and experience again that's where that emotional connectivity piece comes in but working memory keeps all that in mind it's a holding tank it stores all of that and there's many components of working memory in the brain you see the phonological working memory loop is located more and that's the brain on you see on the left side of your screen and that's going to affect more the language centers and acoustical centers of the brain yes if I get my marker working here there we go back in here more that temporal lobe area there is a working memory that's a component was called the visuospatial sketchpad that's more on the right posterior part of the brain back in the parietal lobe that helps us with more spatial information but the fact is both loops both the phonological loop and visuospatial sketchpad work together to help us keep information whether it's auditory and acoustical information or information that we've seen digital spatial information wherever it helps us keep it in the mind's eye by way of the central executive system located bilateral that means on the left and the right frontal lobes all the way up front the frontal lobes dominate in terms of working memory and we know that there's a couple of things that foul up we're at the central executive systems ability to do its job and to coordinate the working memory process by working with the phonological loop in the visuospatial sketchpad command and control of working memory is in the frontal lobes and what fouls left the prefrontal cortexes responsibilities with respect to working memory anxiety and emotional distress nervous about taking a test I have an emotional condition like Martin that was one of the first students we talked about how does edie affect reading comprehension distress emotional distress anxiety emotional conditions in that cognition by way of working memory that's how an impact and we've all been there we've all been so nervous to try to you know take a high-stakes test we barely remember our first name let alone the content that the information the same thing with reading comprehension maybe you can automatically read the page have you ever been so preoccupied and worried that you're sitting there and you're trying to read a book maybe to take your mind off of things and you might read an entire page of text get to the end and realize I have no idea what I just read let's try that one again see the automatic pilot aspect of reading sure we can pull that off but to derive meaning from print that's frontal lobes that's conscious awareness and that starts with working memory anxiety and emotional distress impacts cognition by way of working memory so working memory is kind of a learning facilitator it's going to keep information in mind while executive functioning as we will see next is the strategies we use to self organize that information to facilitate later recall however you're not going to be able to self organize what ain't there and working memory allows us to keep the information fresh active and alive most ADHD kids and LD kids have limitations with working memory and one thing that we need to stress for those with people out there though with four is not a comprehensive measure of working memory so what I'm saying is if you're giving a whisk and say look it's got working memory I can talk about working memory I think only in the most superficial ways in other words what is the whisk for working memory yet what digits Pam but digits forward that's not working memory Johnny six five three four say it back to me that's immediate memory everyone's going to remember you know digits within a two second occult race anything beyond two seconds of space then we assume someone used a working memory strategy to maintain the information and keep it active and alive but the first two seconds it's echoing memory its immediate memory what about digits backwards seven three four six say it in reverse order now that's a working memory task because you have to do something with the information perform some mental gymnastics with the information work with the information so I like digit span halfway because I like the digits backwards but but the whisk floor has something called letter number sequencing that's the second hat that's the other sub test to allow us a working memory score hey Billy come over here a minute Billy sit down you know what Billy I'm gonna say some numbers I'm gonna say some letters no no matter what numbers I you know what I say always repeat back the numbers first in the letters and when you repeat back the numbers put them from lowest to highest and when you repeat back the letters always an alphabetical order you got that Billy geez you know what I'm saying the working memory you need to understand the directions is a mouthful but but you need to do a couple of practice ones Billy's kind of got the hang of it somebody out there want to explain to me how come Billy can get it wrong and it's still right on the protocol alright we'll get back to that what I'm trying to say is that to me the risk for working memory is a screener at best my preference is to supplement that with working memory measures particularly I like the wisp for integrated I think the wisp or integrated with the visual digit span and the spatial spam and the letter span I like to use the integrated it allows you to different immediate initial registration which is immediate memory versus the ability to manipulate the information and I like making that distinction one is more tied in with attention deficits when you have deficits with immediate memory or the initial registration of an of information but if it's more the manipulation of information that's more working memory I do like the whisk for it integrated I also like very much the panel to working a verbal working memory sub test so those are some other choices you could try also the ramble to just the last couple of you all have to do the whole ramble I mean it's a pretty comprehensive memory test but the last few soft tests on there you can you can also look at at working memory as again there's an inverse relationship between anxiety and working memory skills generally the more anxious and uncomfortable we are the poor our working memory is let's move in and talk about our third construct we've talked about emotional connectivity to print we've talked about the importance of working memory to the comprehension process how about executive functions please tune in later this week to hear my good friend George McCluskey talk about executive functions and reading but let's uh let's give a brief overview on executive functions and reading as George will talk about they are direct executive functions or directive capacities of the month there are multiple executive functions is not a single entity executive functions simply cue other regions of the brain of what to do in executive functions are routed through the frontal lobe so again both working memory and executive functions frontal lobe measures executive function is not i q-- it's pretty important so if we look at our brain okay it's not a perfect distinction here because an IQ test is a sloppy test it's sloppy because it's a little bit of reasoning a little bit of processing a little bit of academic achievement and a little bit of executive functioning all rolled up in one that we call IQ we feel that IQ is primarily located back here if I can get my marker to work hang on let's try let's try Pig whoops bear with me here all right right well actually write it back in here somewhere if you see that that's called the inferior parietal lobule that means the underneath side of the parietal lobes where they interface with the occipital and temporal lobe that's what Larry would call the highest area or tertiary area of reasoning we think I Q is tapping more posterior parietal functioning okay take it to the bank executive functioning is up here IQ back to the brain executive functioning up front primarily in an area called the dorsal lateral prefrontal cortex now when you look at the brain the central sulcus is the dividing line right down here between the back of the brain parietal temporal and occipital lobe versus the front of the brain about a third of our neocortex is the frontal lobe but we got a big chunk of that frontal cortex called the dorsal lateral prefrontal cortex and that's pretty much what we refer to when we talk about cost into the executive functions planning organization allocating time sustaining attention cognitive executive functions more dorsal lateral prefrontal cortex now the point that I want to make is that when you if you're like me and the only place you can test is the janitor's closet in the elementary school and Here I am dragging little Murray into the janitor's closet don't make any jokes we sit down we pull out the whisk and we start our test think during that hour and a half period I am little Maria's prefrontal cortex I tell little Marie what to do win I allocate how much time to do it when she's off task I get her back on task if she's struggling I maintain motivational persistence Marie you're doing great I'm so proud of you keep up the good work all of those things you are that kids forget prefrontal cortex during testing and it's especially during testing when you give examples of how to do a particular task you're showing the kid the strategy for pete's sake you have pretty much overtaken someones prefrontal cortex as a tester I don't know I don't know how much quote-unquote intelligence you need to be successful in school to maintain to push through a curriculum and to get through it you have to be in ninety can you get through school at it as an 80 how about a 78 but the fact of the matter is raw intelligence rote intelligence what we think we're measuring more back at the brain but the most important aspect to me is up front and how you use your executive functions to channel that rote level intelligence in the purse towards the pursuit of a goal directed tasks quick story here remember back to the one of the initial examples I gave of Joe 135 IQ 16 years old failing grades do you know who Joe is Joe is my older brother yes and that's about what his IQ is because has this day he could drag me into any conversation he wanted and grind me up and chew me up like a stone but this is true story when Joe was 16 years old Joe was in the 11th grade do you know what Joe set out to do just thought it would be a really good idea and it takes it takes a brain of this magnitude to do this that in his five core academic classes what he wanted for the year was an a a b a c a d NF you got it an a b a c at the NF that was what he's tried to get hum and he got about halfway into the year and his french teacher pulled him aside and said hey Joe what what are you doing here I mean I I think you have the aptitude to do just fine and French but you're really struggling now I'd be more than happy to meet you halfway come after school come in the morning we'll work together but I I truly think you can pass my my class so the end of year comes and I he was so incredibly mad and upset he was livid because report cards came out he had a full years of work tied into this and he ended up getting an a a b a c and two DS his french teacher passed him now he wasn't nearly as livid as my parents when they figured out what was going on but i love my brother but you don't want a classroom with Jose you need a minimum threshold of IQ I'll give you that to be successful in school but beyond that it's about executive functioning it's about channeling that smarts towards a goal directed task to try your best every day to be organized to plan out what you're going to do to allocate your time appropriately to sustain your attention to task even when distracted to persevere and not make the same mistake over and over again but to try to be resourceful these are all dorsal lateral prefrontal cortex cognitive executive functions and let's look at how they affect the reading process cognitive executive functions are helpful in planning you want to read with a specific question or purpose and mine when seeking specific information other words plan of strategy that's how you comprehend you have to plan a strategy organization is a dorsal lateral prefrontal cortex attribute stitching together text in a cohesive manner and slotting information appropriately slotting information is huge okay then kids with good comprehension skills naturally slot Bob and Jim we're walking to the bakery on a Sunday morning when Bob smelled some bread fresh bread baking in the oven okay okay Bob again slot those characters Sunday morning a time of day bakery is the setting kids with good comprehension skills had the organizational capacity to slot on the fly and I'm going to show you in a few minutes how you can determine who can slot and who cannot in just a couple of minutes I like that slot II working memory we've talked about concept formation the depth of understanding of the text executive functioning and reading comprehension involves response inhibition concentration refraining from jumping ahead when reading text and missing more salient aspects of the passage how about our friend Martin who had emotional impulsivity he also struggle with response inhibition this is how it affects comprehension how about our first our first student that we talked about today what was his name I know his name was Billy ADHD sustained attention the ability to stay focused on the text for prolonged periods of time and resisting distractions how about cognitive flexibility that's something that most of our has burgers and autistic friends are not real strong on and we talked about the Sam as our nine-year-old example earlier shifting patters of thought processes to the organizational parameters of the text being read and that per separating on the same material and thoughts over and over again self-monitoring staying aware and engaged once you're reading while you're actually reading the information these are executive functioning attributes now hopefully by looking at reading from this process side of working memory and executive functioning you start seeing that it's not just isolated to kids with learning disabilities ADHD kids kissable language skills kids with poor executive functioning kids who struggle with working memory there are a lot of other disabilities that are going to struggle with reading comprehension so this these suggestions in terms of what we're going to do about it now is not just linked for kids with LD this can be applied to anyone and feel free to copy and paste and add this to your reports if you feel this is helpful number one what are we going to do about stop and start technique I love it for ADHD kids have them read for two minutes since they stop every 30 and ask them questions about what they just read when they can consistently answer questions you increase the interval by 30 seconds help kids it helps kids self monitor what they're doing while they're doing it for prolonged periods of time directional questions why do we put the questions at the end of the text why not put them in the beginning of the text especially if I'm reading about something that well I'm reading about perhaps geology I don't know what's salient what's not salient directional questions okay help me plan and organize what I need to kind of pay attention to and information perhaps I can discard might sound silly but reading out loud facilitates working memory hearing your own voice linger longer allows you to apply a specific strategy to help you self organize that information we comprehend better reading out loud than reading silently story maps look if I've got an executive dysfunction I can plan and organize and slot do it before you read pre reading activities use graphic organizers to outline and organize the information I remember for many years my son's bedtime story was Harry Potter and and we got up to oh I don't know for you Harry Potter guys out there wasn't the fourth book I think was that Goblet of Fire yeah we got to about the fourth book and wow it was getting a little hard to comprehend and my son one day made a story now about Harry Potter he must have wrote down 40 different names with little arrows okay similar to what you see on the screen here's the book Harry Potter here's the setting the plot and in the character space he subdivided the character bubble there and lifted them out and arrows like connecting this person with that person Sirius Black is related to Bellatrix Lestrange and all that kind of stuff but by laying that out in advance we were able to get through Goblet of Fire because there were dozens and dozens and dozens of characters we were struggling to keep straight story maps can be very helpful planning out the text narrative reading have the child retell a story after reading it out loud to begin the organization and synthesis process multiple exposures one of the things we try to encourage students to do is to skim before reading particularly looking at chapter headings and also topic sentences active participation encouraging children to not be passive readers have them take notes put asterisks next to information use multiple colors for highlighting be careful with our ADHD friends because highlighting turns to page painting very quick yellow yellow here let me put a little yellow there and you fall into that trap but sometimes highlighting characters with a yellow and or I should say the protagonist with a yellow and the antagonist with the green but color coding highlighting can also help self organize the information clearly reducing anxiety will maximize working memory one way to reduce anxiety a lot of kids don't want to want to read out loud in class that's a huge source of anxiety make reading out loud be optional a lot of kids get real self-conscious about that real quick comprehension will be gone you can say when all else fails what about medication management well you know that can be helpful for ADHD kids that little white pill will allow you to focus it does nothing to help you strategically self organize the information it can be you know a facilitator but I think we need a lot more than medication pulling out terminology and practicing it prior to reading the text is huge we'll get into that talking about vocabulary in a minute classroom discussion and every time you introduce a new topic a needed capturing a students interest providing them with background knowledge what classrooms discussions actually do is allow students to engage or have a chance to develop an emotional connectivity with the text and that was the first bullet point we talked about emotional connectivity working memory executive functioning and then we're going to get the language in a minute clearly fluency will help as well the more fluent you are as a reader the more automatic you are as a reader that will free up cognitive resources in the frontal lobes to do with the frontal lobes need to be doing and then it's to derive meaning from print we showed this in our last webinar that learning disabled kids use too much of their frontal lobes to help decode the information that's got to be automatic it's got to be back at the brain stuff because it's got to free up the frontal lobes to do what they need to do and that's to reflect keep information and conscious awareness and help us plan organize and store information in a meaningful way to facilitate retrieval at a later date you know what's hard you know what's really hard what's really hard is measuring executive functions and as a profession were struggling there's no question I think for many years let's look at we've had generic measures the brief started at all the behavior rating inventory of executive functioning if you've never administered the brief it's really quite easy you write the student's name and the protocol you tiptoe into the main office of a school slip it in a teacher's box and run away now you've just administered the brief it's actually it's actually not too bad it takes about ten or fifteen minutes to complete but it's a very generic sort of executive functioning you might want to consider Jack nag Larry and Sam Goldstein scaled assessee clinical help me out clinical executive functioning inventory I might have I might have misspoke on that acronym but it is this Fe and it is the newest executive functioning rating scale on the market and there's some other ones with my Russell Berkeley is got a new one on the market as well in our neuro psych training program we teach a test called the decaf the devil's Kathlyn executive functioning scale there is the Wisconsin card sort test test of executive control I believe power puts that one out then fc2 has executive functioning sub tests these are what I call generic measures let me tell you what I think is missing in our profession academic measures of executive function second function is a big term too big concept I encourage you to listen to dr. McCarthy later and a week discuss it further how we best capture to me I think we need more academic executive functioning tests there's no one on the market but let me tell you what I like and what I tend to use the California verbal learning test and if you haven't seen Pearson's Q interactive system you need to contact Pearson about Q interactive and they have California verbal learning test on the Q interactive and it's pretty cool they're still the paper and pencil version which you know most of us use but it's neat that it's been computerized California verbal learning test is I'm going to read you a list of words and you're going to be going to the store and here's your shopping list and I'm going to read you 15 words so maybe the first time you repeat it back to me you get five or six we do it five times now by the system by the fifth time you ought to be telling me back you know as 12 13 out of the 15 words because it's the same list over and over then there's a few other tasks and distracting tasks and so forth but what the beauty of the California is is that kids who can slot and have real good executive functioning skills they recognize that all the words you say all of them are either a piece of fruit an article of clothing or a type of furniture and you see it's a whole lot easier to remember three categories then 15 isolated words that you can't see any connection between and this is a computer score test and in about ten minutes I know who can slot and who cannot I give the California to everyone I see I really do because a good semantic recall or that's what it calls it semantic recall are can slot effectively on the other hand if you can't recognize the categories the slot the serial recall or tries to help me back the information in the exact order that they hear it and oh that's difficult and good luck trying to read a text and then remembering the information exactly word per word you know 2,000 words later on what you just read it's not an effective way to recall information so I like to California test like the cost and test of educational achievement at least allows you to make a distinction between kids better comprehending literal information versus more inferential information I do like the PAL - again with the PAL - that's more kindergarten through sixth grade that's Virginia burnishers test that is put out by Pearson some of the morphological and syntactic coding it consists of a few different sub tests it's are they related does it fit sentence structure are they related would be simply you read two words from the response booklet and kids have to see if there's a connection in between them okay so these tests kind of get a little bit into language relationships language organization I also a big fan of the court I've always been a gore person so I might compare comprehension let's say Gork five which is more read out loud versus comprehension on let's say a why is three so making that which is more silent and seeing if there's distinctions between the two but you can see it's real tough we don't really have a pure academic measure of executive functioning with reading we have to infer it from the measures on the market probably best practice is to do one generic and one specific now if you're looking for more programs to help children with reading comprehension let's talk about a few I've very much like the Nancy Belle's Lindemann visualization of verbalization program this is a real effective program great research supporting it for kids with autism hyperlexia kids that you know we talked earlier about today one of our cases was Sam who had Asperger's English language learners are lower verbal abilities basically this is a way to use pictures and imaging whether it's word imaging sentence imaging for multiple sentence sentence imaging eventually paragraph imaging but it's allowing you to use your strengths which is thinking in pictures help us self-organize and remember verbal information the Elizabeth visualization and verbalization program we use this one quite effectively at the elementary level soar to success so actually teaches four key strategies and primarily for later elementary school and that the kids don't need to be on grade level but if they're within shouting distance that's pretty you know that's good enough it teaches kids how to summarize clarify question and make predictions it teaches you the executive functioning component of how to slop and how to self organize there's five key aspects the kids will start out by rereading the story from before with a partner a lot of story mapping and graphic organizers which is another way to externalize executive functioning if I can't do it intrinsically with my dorsal lateral prefrontal cortex I've got to externalize it on a piece of paper beforehand story mapping graphic organizers rehearsing allows me to preview the text and begin learning how to make predictions what cues and strategies do I use to make predictions about what's going to be read that day there's reading exercising and then the lesson concludes with reflection and in a verbal discussion of the story sort of success nice program to help kids with comprehension go through a couple of these quickly you could certainly make the case that building fluency will increase comprehension as well the left my prefrontal cortex has to think about the mechanical aspect of reading the more it's freed up to do what it's supposed to do and that's derive meaning from print my favorite fluency building program is probably read naturally and we did talk about read naturally last time very affordable you don't have to be a highly trained reading specialist or go to lots of conferences to figure out how to use it you can just order it and dive into it the program is each part level the program is 24 nonfiction stories and it's about putting the headphones on and and and reading while listening to a reader read it with you you graph your time and performance the one thing I do want to mention about read naturally it has comprehension responsibilities but it doesn't teach actual comprehension skills in other words that is trying to allow you to be fluent and and and and working on that but before you can go to the next passage you have to answer five comprehension questions to show that you're retaining comprehension and not just reading with blind speed and ignoring comprehension so you have comprehension responsibilities but nowhere in the program is it aimed at teaching comprehension strategies but still a nice nice program to help with fluency you see I think one of the biggest issues and problems we have is just because kids are reading fluent we assume they can comprehend we assume that they can do it and my point is sometimes you just have to be shown and taught the actual strategies read 180 we've talked about before that's probably our best balanced literacy program on the market more for older students ninety minutes a day it hits all aspects of of reading and decoding what I like about it is the computerized station builds into learning vocabulary words with the reading zone and the success zone is the actual implementation and teaching of comprehension strategies we've talked about this before read 180 is a phenomenal program to help kids in all aspects of reading biggest problem with read 180 you got it $30,000 yep very expensive well we've talked we've talked about emotional connectivity to the text is important for comprehension and ways to enhance that through discussions and pulling out background knowledge and so forth we've talked about working memory we've spent a lot of time talking about executive functioning and dr. McAfee will talk more about executive functioning and reading in his next webinar but the last aspect of executive reading comprehension you should probably discuss this vocabulary development you have to have the language skills in place to derive meaning from print well looking at language from a brain behavioral standpoint here's a quick fact you can impress perhaps some of your friends with at Birth the human brain only weighs 25% of its adult weight that's it chimpanzees brain okay 46% and for you dog and cat lovers out there you're at seventy seventy five percent what you see is what you get but the human brain leaves a lot of room for growth a lot of room to be shaped by the environment by stimulation and you know what that human brain that just weighs 25 percent of its adult weight at birth it weighs 95 percent of its adult weight at age five before that child even enters your building and what is really really vital and critical to helping that brain grow and to grow a academic brain a learning brain our reading brain during those pivotal important first five years is exposure to the most linguistically enriched environment that we can we can offer that is so critical to allow kids to prepare and to be ready for school so a lot of people think of neuropsychology as I would so wrote it's so about the brain and neurons and you are what you would now if you study Lauria you recognize that sure the brain shapes the environment but the environment shapes the praying it's not either nature or nurture as a combination it's a dance that's really what it is how do we shape a reading brain early enrichment linguistic enrichment here's some studies done by Joseph Ferguson how'd you like to be the bean-counter who participated in this he said the average number of words spoken in a professional household is about 15 to 25 hundred per day or these kids have been exposed they don't know but they've been exposed to three and a half million words by age three the average number of words spoken in a middle-class household about 1000 to 1500 these kids have been exposed they don't know but they've been exposed to 2 million words by age 3 average number of words spoken by a welfare mom five to eight hundred one million words by age three now they're this is maybe not the most politically correct example but what torque isn't was trying to show and I think really try to lobby for is the need for early intervention especially for kids who might be at risk and this is one reason for to really help with more linguistic development this is a study done by Sally Shaywitz it comes from her book overcoming dyslexia and see if I can punch up my tool here on the bottom it says this is the time spent reading each day now if you're a kid and you read less than a minute per day how do you do that don't you look at the Burger King sign out the window on the way home from social look at something all right let's say you read a minute or less per day after school you will be exposed to 8,000 8,000 words a year now if you have as a teacher the audacity to assign four-and-a-half minutes of silent reading homework every night four and a half minutes that child will be exposed to 282 thousand words per year but if you're a kid who reads 20 minutes a day after school look at this it goes up to almost two million words per year we need all kids to be reading 20 minutes per day that's the key to building to getting better at reading it's going to be the key to building the vocabulary development is absolutely critical I'm not saying what they can read content completely up to them they want to read about professional wrestling or whatever hunting fishing that's fine 20 minutes a day look at the potential for vocabulary development keeping in mind the typical child enters school with a receptive vocabulary of 13 thousand words but according to Lisa Elliot and expresses vocabulary from 5,000 vocabularies enhanced by both reading and talking to kids conversing maybe turning the television set off during dinner and having a conversation it is very important we practice terminology before reading tags especially in the more challenging subjects when we get into middle and high school more the science and technological subjects the vocabulary will just bury you enhance depth through experienced role learning and field trips to really develop rather than memorize a term but really develop an in-depth understanding of concepts help differentiate between students who struggle with inferences versus details a reading comprehension test like the kauffman test of educational achievement Katie ei2 will help us with that and always use classroom discussions to put words in a context the brain love context doesn't like rote memorization but notice context well final point to make of course we you know we talked about the importance of fluency and comprehension let's just pause for a few go ahead and read this could anybody read this anybody I'll give you a few seconds to read that I'll take a sip of water pretty amazing huh you see as an adult reader we average about 250 words per minute that's four words a second one word every 250 milliseconds we are so automatic and fluent we don't even have to put the words there we don't even have to spell the words correctly or even put the letters in the correct order our frontal lobes are so freed up because reading is automatic that we're in a position to decipher meaning from print even when we look at a passage and nothing is spelled correctly and that's what approach we need to take with our kids not only get reading and put them in a position where reading is automatic but also teach this course strategies to help them self organize verbal information quick example quick little case here and our remaining I think we have about six or seven minutes one of the reasons our cause and effect webinars I think has been relatively popular as folks have recognized some of the limitations of looking at learning simply through the lens of an IQ test only and if we look at learning through the lens of an IQ test only we tend to look at as look at kids as being nothing more than numbers here's the IQ here's their achievement that they qualify what do you think look at Bobby what do you think you know most people would look at that profile and say full scale IQ is eighty-seven reading eighty-six math ninety-six writing ninety-two what's the problem what's the problem his achievement is right where his full scale IQ is and if that's our interpretation we're being fooled we're being misled it's time to turn the page the United States is Precourt even recognize this now that to truly understand learning we have to widened the Glens IQ scores have too many blind spots and how do you widen the lens you can test the processing and you get tests the processing related to the reading process we're not going to survey every higher cortical functions go over the survey the ones that are important to reading and now we're looking at Bobby more like holy cow you know his his phonics skills look a little little a little rough there now we look at Bobby and we look at some of the executive functioning and verbal working memory components related to reading by way of the pal to looks a little rough there and if you backed up when we back up one slide and you look at the IQ performance look this is the hot spot for reading I don't care what the full scale q is I said there's a lot a million times they have is below 75 sure I'm interested above 120 yeah I'm interested but most kids score that morass of mediocrity this factor scores and what are the factor scores that are really important in reading verbal IQ and working memory look at the weakness on Bobby verbal IQ working memory and if I don't want to take a bed after our last discussion he's going to have some reading comprehension problems verbal IQ working memory now what we've done that has layered some of the executive functioning components by trying to tease that out by way with the pal verbal working memory let me get my marker here we've given the court five and we've noticed some comprehension issues in court five we've already established verbal working memory he's very very limited his weakest area was working memory on the Wisc anyway he gave a test like the California verbal learning test no semantic recall he doesn't slot at all we got the executive functioning issues in general shown with the brief but then we were specific with the California it's also related specifically the reading he doesn't slot we got the double whammy here guys what combination that we have we got a kid with poor executive functioning we got a kid with working memory limitations we got a kid with some language issues and yeah his reading fluency in exactly top of the charts either it's a little slow Bobby needs help you want to call it special ed not special ed doesn't matter to me kid needs help Bobby probably needs a more highly structured type of reading program we talked about some of these programs last time but what we're adding to it is not just to help them with phonology but to play into some of the strengths which seems to be the visual spatial component horizons fast-track is actually a visual phonics program but teaching and strategies to comprehend sort of success you know how to do a story map a graphic organizer how to make predictions great leaps is a nice quick to help with the fluency end because the more fluent he can become the more that can free up the frontal lobes to do with the frontal lobes do best and that is the self organize the information for the purpose of later retrieval you can always pull in curriculum based measurement to monitor and track progress so just a quick quick case to kind of begin to exit us out of this webinar there's one last thing that I would like to mention our remaining a minute and a half for those of you who have continued to join us throughout the year with our cause and effect webinar series and for those of you who really appreciate the this file in which we take this from using principles of neuropsychology and processing to help tease out learning in children and hopefully what my emphasis has been has been to link that to interventions that can be targeted and individualize I do want to mention that if you are interested in doing further training in neuropsychology as aundrea said in the in the introduction I am a clinical supervisor in the school nurse psychology postgraduate certificate program that is a one-year training program for school psychologists whether you are trained at the Masters EDF or doctorate level it does not matter you need to be a certified school psychologist if you are interested in how you can use elements of processing executive functioning working memory and so forth to tease out reading writing math emotional disorders to go further in your assessments and to go further in your interventions but you want to remain in your schools you want to work with kids it's not a program that's you're gonna you're going to go into if you want to work in a hospital or rehab center but you're it's a school nurse like training program I would encourage all of you to go to this website WWF comm that is WW school Neurosci comm you'll also find dr. Miller's email address is the program coordinator ww school neuropsych comm if you are interested and perhaps I might be your supervisor for this upcoming year in the area of school neuropsychology and with that said I hope this webinar was very helpful in your important important work with children I wish you all a good day thank you for joining us