I was recently asked, "What's the best way to teach a child with PDD and dyslexia to read?"
First, some definitions:
PDD = Pervasive Developmental Delay (or Disorder). According to the National Institutes of Neurological Disorders and Stroke, all autism disorders fall under the heading of PDD, but not all children with PDD have a diagnosis of autism. And yes, it is confusing, even to experts. The difficulties are:
- At present, there are no biological markers for any of the conditions, only behavioral indicators, which are measured by various assessment instruments, which are to a certain extent subjective.
- There are no clear dividing lines between various labels within the PDD umbrella; and
- There are differential social factors among the various diagnostic lables. For example, in one school district, a child with a PDD or autism diagnosis may be eligible for more supports and services than a child with an Asperger's diagnosis, without consideration of the child's actual needs for supports and services.
A confounding feature: relative cognitive or intellectual strengths and/or weaknesses. Some people with autism have global cognitive or intellectual strengths; others have areas of strengths and weaknesses, and so on. Yet another degree of difficulty: (a) many tests of cognitive abilities presume that the subject's expressive language is congruent with the subject's level of cognitive functioning (which may not be accurate for people with autism and (b) many tests of cognitive abilities are based on social conventions that may not be currently accurate (one simple example: asking a respondent to identify a the function of an image of a pay phone with a rotary dial....pay phones have almost disappeared, and rotary dials have been gone for decades)
Before I discuss the behavioral features of PDD, I also want to define writing, reading and dyslexia.
The very most oversimplified definition: writing is the act of transcribing a stream of speech using an agreed-upon set of symbols. Reading is the act of converting those symbols back into a stream of speech.
Dyslexia: It isn't listed in the Fourth Edition of the Diagnostic and Statistical Manual (DSM-4TR) by that name.
- DSM-IV 315.00 Specific Learning Disabilities
- Reading Disorder; DSM-IV 315.01:
According to the DSM-IV, the diagnostic criteria for specific learning disability--reading disorder are:
A. Reading achievement, as measured by individually administered standardized tests of reading accuracy or comprehension, is substantially below that expected given the person's chronological age, measured intelligence, and age-appropriate education.
B. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living that require reading skills.
C. If a sensory deficit is present [ie, hearing or vision impairments], the reading difficulties are in excess of those usually associated with it..
Of course, dyslexia is used more commonly. A more narrative description from the International Dyslexia Association is:
Dyslexia is a specific learning disability that is neurological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede the growth of vocabulary and background knowledge.
Now let's look at the charateristics of PDD that specifically have to do with language. The following is a paraphrase from a number of different sources (there are more PDD characteristics, but we are focusing on language here):
- Difficulty with language
- Clarity of speech (pronunciation), separate from expressive language issues
- Receptive (incoming) language
- understanding speech the individual hears
- responding appropriately to speech the individual hears
- Expressive language: producing words, phrases, and sentences that
- serve to meet the child's needs
- respond appropriately to interactions with others
- Difficulty with non-verbal communication, such as gestures and facial expressions.
- Changing response to sound. (The child may be very sensitive to some noises and seem to not hear others.)
So (grossly speaking) PDD is a difficulty with understanding and using language, and dyslexia is a difficulty with a specific application of language.
Stand by. There's another wrinkle. Some children with PDD also have an early and unusual ability to decode (render as speech what is written), without some (or any) comprehension. This is called hyperlexia. There don't appear to be good online resources at this time, but to summarize: children with hyperlexia can accurately read aloud discrete words and/or connected text without formal reading instruction, but often have little comprehension of what they are reading. This appears to be a splinter or savant skill.
So, let's summarize: people with autism have a more-or-less global difficulty in communication. People with dyslexia have various difficulties that make the acquisition of reading difficult.
Here is what we know about teaching reading with people with dyslexia alone:
The National Reading Panel Report (National Institute of Child Health and Human Development [NICHD], 2000) summarized several decades of scientific research that clearly shows effective reading instruction addresses five critical areas:
- Phonemic awareness
- Phonics
- Fluency
- Vocabulary
- Comprehension
Relative to phonics and phonemic awareness: students with dyslexia or other language issues need more explicit and direct instruction, and more opportunities for error-free practice.
- Direct, Explicit Instruction: People with dyslexia may not make make intuitive leaps, or generalize from one set to another. Many people with dyslexia often need to be taught the most common rules of decoding (spelling) to mastery, and then move on to the exceptions. Students should be taught one rule at a time (again to mastery) until it is mastered in receptive language (reading, hearing) and then in expressive language (spelling and writing).
- Direct and Explicit Instruction in Synthetic and Analytic Phonics and Word Analysis: Some people intuitively grasp that words are made up of a string of sounds, and can be likewise decomposed into individual sounds represented by letters. People with dyslexia lack this intuitive ability. Peole with dyslexia must be taught both how to take the individual letters or sounds and put them together to form a word (synthetic phonics), as well as how to look at a long word and break it into smaller pieces (analytic phonics). Teachers of students with dyslexia must expect to teach and reteach synthetic and analytic phonics and word analysis as the student progresses.
- Simultaneous Multisensory Instruction: People with language issues may need to use all of their senses when they learn (visual, auditory, tactile, and kinesthetic) to have better storage and retrieval of information. Example: a begining reader might be shown the letter B, and while producing the |b| sound, lay her fingers over her mouth to experience the muscle movement involved in producing the sound |b|, and then be prompted to trace the letter forms while producing the most common letter sound.
- Intense Instruction with Ample Practice: Many students with language issues need much more intense instruction (more detail) and many more practice opportunities, spread over time (distributed practice) than those who seem to "get" reading "on the fly".
- Systematic and Cumulative: Students with dyslexia need a solid foundation in the rules of the English language. Sometimes students become confused, or cannot recall previously-mastered rules.
- Diagnostic Teaching: the teacher must continuously assess their student's understanding of, and ability to apply, previously rules. The teacher must ensure the student isn't simply recognizing a pattern and blindly applying it. And when confusion of a previously-taught rule is discovered, it must be retaught.
I will write more about the specific issues relative to teaching struggling readers with pervasive developmental disabilities (PDD) in Part Two.
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