Functional Brain Imaging: Sensory Integration, Reading and Reading Intervention Multisensory integration in the brain Paul J. Laurienti, M.D., Ph.D. Wake Forest University School of Medicine The neural substrate of the development of auditory and visual word representations James R. Booth, Ph.D. Northwestern University Intervention studies in children using a MSL approach Guinevere Eden, D.Phil. Georgetown University Medical Center

Component skills that are essential for growth of reading Phonemic Awareness Phonics Fluency Vocabulary Comprehension strategies Identifying words accurately and fluently Constructing meaning once words are identified

Remediation Approaches Phonology and other language structures are explicitly and systematically taught Large amount of practice given Mode of delivery: small group or one-one Use of enhancing techniques (multi-sensory techniques linking listening, speaking, reading, and writing)

MSL Remediation Approaches Systematic, cumulative, explicit, and sequential approaches that allow professionals to teach language structure at many levels Emphasize the importance of multi-sensory engagement of the learner using motor, visual, auditory, and kinesthetic feedback combined with extensive, controlled practice in word recognition.

Multisensory Structured Language (MSL) Programs Long history of use in the classroom and clinics – successful in teaching students to read, write and use language. Programs vary in the extent to which they have been investigated using scientifically valid research studies.

Further Information about MSL approaches IDA Matrix of Multisensory Structured Language Programs Birsh J. (2005) Multisensory Teaching of Basic Language Skills. Baltimore: Paul Brookes Florida Center for Reading Research ( Eden G. and Moats L. (2002) Nature Neuroscience Reviews

Institute of Educational Sciences US Department of Education There are a vast array of educational interventions that claim to improve educational outcomes and to be supported by evidence…...introduced with great fanfare as being able to produce dramatic gains… …yielding little in the way of positive and long lasting changes The What Works Clearinghouse:

Randomized Controlled Trials Groups Intervention (under study) Other intervention program Active control (Placebo control or sugar pill ) No intervention (passive control)

Randomized Controlled Trials Design Randomized assignment of dyslexic individuals into different groups Compare the groups after intervention Groups are equal in reading measures prior to the intervention Cross over design

Clinical Trial: Study Design 1 Randomized assignment of individuals into two groups receiving different interventions Groups are equal in reading measures prior to the intervention Compare the two groups after intervention Group1 Group 2 Pre intervention Program AProgram B Post intervention

Clinical Trial: Study Design 2 Randomized assignment into two groups receiving different interventions, followed by cross over Group1 Group 2 Pre intervention Program AProgram B Post intervention 1 Program BProgram A Post intervention 2

Institute of Educational Sciences US Department of Education Guidelines on how to evaluate whether an educational intervention is supported by rigorous evidence Randomized controlled trials + Effective in two or more settings = Strong Evidence Pre-post studies do not comprise strong or even possible evidence - often produce erroneous results

CSL – Jemicy School Study Treatment Group: Reading Intervention (Seeing Stars) Active Control Group: Math Intervention (On Cloud Nine) Developmental Control: No Intervention Interventions administered in the same five-on-one fashion.

Study Design Reading Math ReadingBreak Reading Math Assessment & Imaging Assessment & Imaging Assessment & Imaging Reading Intervention: Lindamood-Bell Seeing Stars ®: Symbol Imagery for Phonemic Awareness, Sight Words and Spelling Program. Math Intervention: Lindamood-Bell On Cloud Nine ®:

Seeing Stars: Symbol Imagery for Phonemic Awareness, Sight Words, and Spelling Goal: Develop symbol imagery (i.e. the ability to create mental representations for sounds and letters within words). refining the speed and accuracy of PA and PP establishing a visual memory base for sight words increasing fluency and rate in contextual reading improving phonetic and orthographic spelling. Program progresses from visualization for single sounds and letters through to multisyllable reading and spelling, with application to contextual reading and spelling.

Results: still being analyzed

John Agnew Kate Cappell Emily Curran Emma Cole Nicole Dietz Iain DeWitt Erin Einbinder Lynn Gareau Karen Jones Jessica Koehler Joe Maisog Martha Miranda Alison Merikangas Corinna Moore Eileen Napoliello Jenni Rosenberg Peter Turkeltaub Robert Twomey John VanMeter Thomas Zeffiro Wake Forest University Lynn Flowers Frank Wood Debi Hill Gallaudet University Carol LaSasso Kelly Crain Supported by NICHD, NIDCD, NIMH

Special Thanks to Jemicy School and Lindamood-Bell Learning Processes