Dyslexia and Arrowsmith Program

Dyslexia and Arrowsmith Program: A Language-Based Disability That Can Require More Than Just Phonological Awareness Training and/or Phonics Remediation

There is no question that early phonological awareness training is critical for children who are learning to read. There is a substantial bank of research available now that shows how important it is to give children this early training in the sound structures of spoken words. The International Dyslexia Association highlights this point, stating that “If children who are dyslexic get effective phonological training in Kindergarten and 1st grade, they will have significantly fewer problems in learning to read at grade level than do children who are not identified or helped until 3rd grade. 74% of the children who are poor readers in 3rd grade remain poor readers in the 9th grade.”

In 1972, I was diagnosed with Severe Developmental Dyslexia. I was in Grade 2. I was not reading. My teachers had tried to use the “whole word” method of teaching reading. They would hold up index cards with words printed on them and then ask the class to look at the word and say it. I would sit at the back of the classroom, looking at the word, waiting for the other children to pronounce it so that I could follow them with my pronunciation milliseconds later. When it was my turn to read on my own I would turn red in the face with embarrassment and look down at the floor. The teacher would move on to the next child.

The child psychiatrist who diagnosed my Dyslexia informed my parents that I should receive an intensive phonics program called Orton-Gillingham. My parents quickly hired a tutor and, over a period of five years, I slowly began to learn to read, although my spelling remained inconsistent for some time. There was no doubt that the Orton-Gillingham program gave me the ability to decode the English language. It was not easy, but I eventually mastered the skill of word decoding. Despite my gains in this area, however, I struggled with spelling, fluency and comprehension for years.

My problems with Dyslexia did not just affect my reading skills. I also had difficulty with auditory memory for phrases of information and instructions. I struggled to acquire a second language as a result of my continued auditory discrimination difficulties. My word findings abilities were weak; thus, my expressive language was weak. As a result, I was quiet and shy as a child and adolescent. The phonics program that I received did not provide the necessary cognitive remediation to improve my weaknesses with language processing, memory and retrieval. I did learn to read – this was critical; however, if there were a way to improve these other language weaknesses that are so often apparent in children with Dyslexia, would one not want to consider this path?

The International Dyslexia Association provides a definition of Dyslexia. It is important to review this definition and to consider the type of intervention that could most directly affect each of the symptoms of Dyslexia highlighted. The association states:

Dyslexia is a language-based learning disability. Dyslexia refers to a cluster of symptoms, which result in people having difficulties with specific language skills, particularly reading. Students with dyslexia usually experience difficulties with other language skills such as spelling, writing, and pronouncing words. Dyslexia affects individuals throughout their lives; however, its impact can change at different stages in a person’s life. It is referred to as a learning disability because dyslexia can make it very difficult for a student to succeed academically in the typical instructional environment, and in its more severe forms, will qualify a student for special education, special accommodations, or extra support services.

The description of Dyslexia continues:

Some dyslexics manage to learn early reading and spelling tasks, especially with excellent instruction, but later experience their most debilitating problems when more complex language skills are required, such as grammar, understanding textbook material, and writing essays.

People with dyslexia can also have problems with spoken language, even after they have been exposed to good language models in their homes and good language instruction in school. They may find it difficult to express themselves clearly, or to fully comprehend what others mean when they speak. Such language problems are often difficult to recognize, but they can lead to major problems in school, in the workplace, and in relating to other people. The effects of dyslexia reach well beyond the classroom.

It is clear that learning problems related to Dyslexia can go far beyond reading and spelling difficulties. Intervention programs for Dyslexia often focus on reading and spelling. The other neurological weaknesses connected with Dyslexia, such as problems with spoken language and the understanding of more complex language, are often not addressed. The child with Dyslexia therefore learns to read and improve spelling ability through the use of a phonics program, but still struggles with reading comprehension, finds it difficult to memorize auditory information and instructions, and has limited expressive language ability.

Researchers now consider Developmental Dyslexia and Specific Language Impairment to actually be the same problem, differing only in severity and developmental stage. A Specific Language Impairment is a developmental disorder than can impact expressive and receptive language. Researchers are discovering that children with Developmental Dyslexia often have the same problems as children with Specific Language Impairments (SLI). Those studying this association have stated that Dyslexia researchers seem to over-emphasize weak phonological processing as the cause of reading difficulties.

In the field of dyslexia, there has been an overwhelming emphasis on poor phonological processing as a cause of reading difficulties. However, study of children with oral language problems indicates that difficulties with semantics, syntax, and discourse will also affect literacy acquisition; in some children (so-called poor comprehenders) these difficulties may occur without any phonological impairment. In more classic cases of SLI, there can be both phonological and nonphonological language impairments that affect learning to read.

As noted previously, oral language problems impact not only literacy, but classroom functioning as well. If a child with Dyslexia struggles with receptive language, he or she may experience significant problems following classroom instructions and understanding general information. If this child has expressive language difficulties he or she may not speak up in class, self-advocate, or share knowledge with peers.

It is also important to note that Dyslexia may be caused by additional neurological deficits not addressed through phonological training. Reading and spelling requires not just sound discrimination processing, but also the ability of the child’s brain to process, memorize and retrieve the orthographic patterns (letter patterns) of words. Researchers have used the term Visual Dyslexia, or Orthographic Dyslexia, to describe children who struggle with this area of neurological functioning. Nathlie Badian in an article entitled: Does a Visual-Orthographic Deficit Contribute to Reading Disability (2005) stated:

In spite of the significant roles of phonological awareness and naming speed in reading development, these two variables leave a considerable proportion of the variance in reading unexplained, which leads to the logical hypothesis that other, unspecified, variables are contributing additional variance to reading. Basic visual-orthographic skills such as the accurate recognition of letter orientation may be among those variables.

Badian continues:

This study indicates that there are some children whose reading development continues to be hampered by a problem in orthographic memory for the orientation of letters (and numerals) long after most children have easily mastered this task. The problems of such children require special attention, but may be overlooked, especially if, as is frequently the case, they also have naming speed and/or phonological awareness deficits.

The cause and symptoms of Dyslexia are quite varied, and depend on the specific neurological strengths and weaknesses of each child. It is important to recognize that phonological awareness training is not the only intervention for students with Dyslexia, and that it does not address all causes and symptoms of Dyslexia. However, as noted at the beginning of this article it is a very important intervention and should be implemented at the early stages of reading instruction. Additionally, phonic-based reading remediation programs are also valuable and provide a critical component of an intervention program.

The problem for children with Dyslexia today is that these intervention programs do not provide all of the necessary cognitive training required to improve language impairments and possible visual-orthographic weakness. In addition, in some cases of severe Dyslexia, the number of neurological deficits may be so significant that a phonics-based reading program may not be immediately helpful for that child. Cognitive training to strengthen these neurological capacities is required prior to the effective utilization of a phonics-based reading program.

The Arrowsmith Program is a unique cognitive training opportunity available to children with Dyslexia and other learning disabilities. The program focuses on the many symptoms of Dyslexia, including the specific language impairments often observed (namely receptive and expressive language problems). The Arrowsmith Program also recognizes the different subtypes of Dyslexia that can exists – auditory, visual, or combined auditory/visual neurological deficits. The primary goal of the program is to improve the underlying neurological dysfunctions that are causing Dyslexia. For example, if a child with Dyslexia struggles with receptive language (i.e. difficulty processing speech sounds, and difficulty processing and memorizing general information and instructions), or expressive language, specific cognitive exercises are implemented to improve that particular neurological capacity.

Many areas of the brain are responsible for success, or difficulty, with reading and spelling ability. Arrowsmith Program assessments first identify which of these neurological functions are weak. The student then works on cognitive activities in order to strengthen these areas. For example, when analyzing the activity of reading, four brain regions are considered including Symbol Recognition (orthographic), Brocas (speech sounds), Lexical Memory (memory for words) and Motor-Symbol Sequencing (visual scanning and tracking of symbols). It has been observed in Arrowsmith Program research that a higher number of neurological weaknesses is correlated with more severe reading disorders. (Please see: http://www.arrowsmithschool.org/images/Arrowsmith_study_11_20_05.pdf.) Additionally, as these neurological weaknesses improve and move to an average range of function, the child begins to develop reading and spelling abilities. Phonics-based programs can then be introduced and the child can further develop reading and spelling skills. The Arrowsmith Program recognizes the importance of teaching the sound/symbol structure of the English language once these neurological deficits are improved. Some children working on the Arrowsmith Program had previously received years of phonics training with little success. The same children, after months of cognitive training, begin to develop reading skills; thus, an increase in neurological capacity was required prior to achieving success with reading.

In summary, the Arrowsmith Program does not focus on one particular reason why children with Dyslexia struggle to read and process language. Rather, the program looks at the neurological functions required for these abilities, and generates a cognitive training program specific to each child’s profile. Recognizing the relationship that exists between strengthening cognitive capacities and the acquisition of skills related to academics is an important step in ensuring that each child’s educational plan is designed for success.

http://www.interdys.org/FAQLearnToRead.htm
http://www.interdys.org/FAQ.htm
http://www.interdys.org/FAQ.htm
Bishop, D., & Snowling, M. (2004) Developmental Dyslexia and Specific Language Impairment: Same or Different? Psychological Bulletin, 130, 6, 858-886.
Bishop, D., & Snowling, M (2004) p. 858
http://findarticles.com/p/articles/mi_qa3809/is_200506/ai_n13644137/
Baden, N. (2005) Does a Visual-Orthographic Deficit Contribute to Reading Disability? Annals of Dyslexia, June 2005.
Baden, N. (2005) Does a Visual-Orthographic Deficit Contribute to Reading Disability? Annals of Dyslexia, June 2005

Attention Disorders and Arrowsmith Program

What is the underlying cause of attention disorders? The National Institute of Mental Health states that “scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.”

At this point in scientific research there is no definitive answer to this question. Indeed, many parents try a variety of solutions to improve their child’s attention capabilities from the control of diet, to increase in exercise, to neurobiofeedback therapy, to the intake of natural supplements, or to the use of stimulant medication. I have seen positive results from my clients using one or the majority of these intervention methods. As well, I have seen limited results, depending on the client. There is no question that each brain and the environment it lives in is so diverse that it is difficult to imagine a study that can generate one definitive result that proves why a child struggles to attend to information. Parents often attempt to try solutions based on the information they receive and observe their child’s response to that treatment.

The American Academy of Pediatrics published the Clinical Practice Guideline: Treatment of School-Aged Child With Attention-Deficit/Hyperactivity Disorder . They noted that 4% to 12% of school-age children show ADHD behaviours. The guideline stipulated the need for pediatricians to work with other service providers to consider the best treatment plan, management of behaviours and monitoring of outcomes:Primary care clinicians cannot work alone in the treatment of school-aged children with ADHD. Ongoing communication with parents, teachers, and other school-based professionals is necessary to monitor the progress and effectiveness of specific interventions. Parents are key partners in the management plan as sources of information and as the child’s primary caregiver. Integration of services with psychologists, child psychiatrists, neurologists, educational specialists, developmental-behavioral pediatricians, and other mental health professionals may be appropriate for children with ADHD who have coexisting conditions and may continue to have problems in functioning despite treatment. Attention to the child’s social development in community settings other than school requires clinical knowledge of a variety of activities and services in the community.

Researchers also realize that medication is not always the answer for their clients. Dr. David Rabiner noted in a research review study that, “Although medication treatment is effective for many children with ADHD, there remains an important need to explore and develop interventions that can complement or even substitute for medication.” He goes on to state that not all individuals benefit from medication. Some individuals experience adverse affects to medication. Medication benefits do not continue once it is discontinued. Dr. Rabiner notes that, “Because of these limitations, some researchers have pursued cognitive training as an alternative method of treatment. The basic idea behind cognitive training is that important cognitive skills such as attention and working memory can – like any other skill – be strengthened and enhanced with intensive and focused practice. Furthermore, when an individual builds these skills the benefits may endure beyond the time when the actual training is provided.”

The Arrowsmith Program provides one such cognitive intervention service. Over the last 30 years the Arrowsmith Program has successfully improved the executive control abilities of children diagnosed with ADHD. The Arrowsmith Program, founded on neuroscientific research, involves intensive and graduated mental exercises that are designed to strengthen the source of the attention disorders – underlying weak cognitive capacities. Over 30 years of experience the Arrowsmith Program has demonstrated that these affected brain areas can be improved through mental exercises, resulting in increased mental capacities and strengthened learning abilities. Weaker areas of the brain are treated like weak muscles and are intensely stimulated through mental exercises in order to produce strengthened learning capacities. Research at Arrowsmith School has also shown that when the deficient area is improved, the individual’s ability to plan, organize and actively engage in academic work requires less effort.

A significant number of children previously on stimulant medication for ADHD can successfully end this treatment through the Arrowsmith Program. That is, the Arrowsmith Program has found that a portion of children with ADHD actually have multiple cognitive dysfunctions that impact their ability to sustain active engagement in a classroom setting. The ADHD diagnosis is not a primary disorder, but rather secondary to the multiple cognitive weaknesses impacting processing, memorizing or conceptualizing information. David was one such student.

David was given a full psycho-educational assessment for a possible learning disability. He was struggling at school. His mother would have to get him to sit down to do his homework. When she went over his assignment it appeared to her that her son was not listening in class. This was frustrating and resulted in conflicts at home. Yelling, arguing, debating were common social interactions between her and David on a daily basis. She really felt that David was to blame.—if only he could pay attention and work harder. The psycho-educational assessment identified specific learning disabilities. The primary problem appeared to be written expression. The ADHD checklists highlighted ADHD-Inattentive Type as another area of concern. He showed at least six of the nine behaviours often associated with the Inattentive subtype. This included not listening to instructions, difficulty following through on homework or school related activities, forgetting assignments, inability to sustain attention and being easily distracted in class.

David’s mother heard about the Arrowsmith Program through a friend. Through discussion with Arrowsmith staff, it was determined that David had at least 7 specific learning dysfunctions that would impact classroom management. David was then assessed to determine the severity level of his learning dysfunctions and to determine his Arrowsmith cognitive remediation program. Several of the cognitive weaknesses would certainly impact attention control, including weak memory for information and instructions, weak visual-motor integration for printing and copying and a weakness with determining the main idea, also known as saliency determination. After three years of intensive cognitive remediation (brain exercises) David was able to move these learning dysfunctions from a severe level of disability to average ability. He was then capable of listening to instructions, sustaining active engagement on school-related tasks, following through on homework and assignments and was not easily distracted in class. These neurological improvements took hours and hours of cognitive training. Brain change requires active engagement and repetitive brain exercises that require increasing complexity. By improving neurological weaknesses through cognitive intervention training he no longer demonstrated ADHD-like behaviours.

In summary, it is important for those diagnosing and managing children with ADHD to consider cognitive intervention training. The Arrowsmith Program is one such method available in Vancouver, B.C. Results from a 2007 study on the Arrowsmith Program highlighted positive gains in ADHD-like behaviours. The study was completed with the cooperation of the Toronto Catholic School Board, which has used the Arrowsmith Program for the last 12 years (since 1997). The study showed that the students that had completed the Arrowsmith Program and were now fully immersed in regular education classes show significant improvements in following instructions, organization skills and willingness to complete homework. All of the teachers identified a noticeable to extremely noticeable change in the Arrowsmith students’ ability to follow and understand instructions (for those students for whom this was a concern). In regards to willingness to attempt and complete homework, 80% of teachers recognized a noticeable to extremely noticeable change. Only 7 % of teachers noticed no change (for 13% of students this was not a concern). Finally, in regards to organizational skills, 85% of teachers recognized a noticeable to extremely noticeable change. Only 4 % of teachers noticed no change (for 11% of students this was not a concern). Medication for ADHD can certainly provided immediate results, but long-lasting changes in brain functioning can occur through cognitive training methods.

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/4/1033
http://www.sharpbrains.com/blog/2008/06/12/promising-cognitive-training-studies-for-adhd/
http://www.arrowsmithschool.org/research.htm