1. Tim Conway, PhD * The Morris Center *! Ocala and Gainesville, FL Neuro-development of Words – NOW! * International The Einstein School * (a free, public charter school for children with dyslexia) University of Florida * Dept. of Clinical and Health Psychology Dept. of Speech, Language and Hearing Sciences Is it Ever Too Late? – Library Literacy Services for Adults with Reading Difficulties or Dyslexia

2. Human Neuroscience & Neuropsychology Complex challenges Post-Stroke Phonological Alexia (poor reading skills) Remediation of Genetic, Developmental Dyslexia Prevention of Genetic, Developmental Dyslexia Research Research-based versus Evidence-based Components of Effective Reading Instruction Case Studies Library-based Adult Literacy Services in Alachua County, Florida Conclusions and Future Directions

3. Can we make changes in neural synapses or networks? At what age do human’s neurons lose the ability to make new connections (synapses) with other neurons? Does each person’s brain work differently? Does each person learn differently? HOW does the human brain learn? 1. Sensory input, then…. 2. Integration of sensory input “fire together wire together” 3. Processing skills/cognition 4. Behaviors

4. Neuroplasticity or LEARNING is promoted by: 1.Intensity - # of hours per day 2.Frequency - # of days per week 3.Specificity – explicit instructions/methods 4.Neurodevelopmental Hierarchy – training basic skills before advanced skills 5.Duration – # of weeks of treatment

5. Research-based methods/instruction Based on research related to the program being used, e.g. Orton-Gillingham is based on studies that phonics instruction is important to learning Evidence-based methods/instruction A specific, scientific method study or studies of a program (instructional approach) have been conducted and reported in professional, peer-reviewed publications. Scientific Method Theory Hypotheses Research Design Results & Analyses Conclusions

6. noun a method of procedure that has characterized natural science since the 17th century, consisting in systematic observation, measurement, and experiment, and the formulation, testing, and modification of hypotheses.

7. Penicillin Does it work in FLORIDA Does it work in Michigan Does it work in Europe Does it work…….

8. STG (bilateral) acoustic-phonetic speech codes pMTG (left) sound-meaning interface Area Spt (left) auditory-motor interface pIFG/dPM (left) articulatory-based speech codes Hickok & Poeppel (2000), Trends in Cognitive Sciences Hickok & Poeppel (2004), Cognition STS phoneme representations

9. UNIQUE AND OVERLAPPING NETWORKS SENTENCE/SYNTACTIC, SEMANTIC, PHONOLOGICAL (Vigneau, et al., 2006)

10. Developmental “Language Building Blocks” building a solid foundation for reading C O M P R E H E N S I O N (MEANING) (FORM) READING WRITING SPELLING METALINGUISTICS SOUND OUT WORDS (phonology/decoding) SIGHT WORDS (Visual Memory) SIGHT WORDS (visual memory) VOCABULARY (Semantic Knowledge) VOCABULARY (semantic knowledge) SYNTAX R E A D I N G F L U E N C Y

11. MORPHO- SYNTACTIC Typical READING Development PHONICS RULES SYNTACTIC SEMANTIC/ LEXICAL EXECUTIVE FUNCTION / INTENTION WORKING MEMORY (HOLD / MANIPULATE) ORTHOGRAPHICARTICULATORYPHONOLOGIC PROSODIC ATTENTION / AROUSAL (Alexander & Slinger, 2004)

12. EXECUTIVE FUNCTION / INTENTION WORKING MEMORY (HOLD / MANIPULATE) ACOUSTIC VISUAL ORAL MOTORSOMATOSENSORY ATTENTION / AROUSAL PHONEMICREPRESENTATION PROSODIC (WORD LEVEL) (Alexander & Slinger, 2004) PHONOLOGY (PERCEPTION & PRODUCTION)

13. 18 MONTHS 5 YEARS 9 YEARS 1 MONTH 9 MONTHS Developmental Building Blocks for Language Developmental Building Blocks for Language (Alexander & Heilman, 2006; adapted) Receptive Language Expressive Language

14. Dyslexia => Dys = difficulty & lexia = words Poor skills in Reading Neurological in origin Adult learners’ difficulty may be environmental or due to injury or due to ….. Lifelong, but environment may alter course Core deficit = “phonological language skills” Accompanying Challenges (~50%) ADHD Sensorimotor Behavior problems = More challenging to remediate

15. .. is NOT A VISUAL PROBLEM.. is NOT A LACK OF INTELLIGENCE.. is NOT DUE TO LACK OF EFFORT.. is NOT IMPROVED BY STANDARD READING INSTRUCTION.. is NOT UNCOMMON: 5–17.5 % OF POPULATION.. is NOT A DEVELOPMENTAL LAG

16. MORPHO- SYNTACTIC Atypical READING - Dyslexia PHONICS RULES SYNTACTIC SEMANTIC/ LEXICAL EXECUTIVE FUNCTION / INTENTION WORKING MEMORY (HOLD / MANIPULATE) ORTHOGRAPHICARTICULATORYPHONOLOGIC PROSODIC ATTENTION / AROUSAL

17. Biology (RAMUS, 2004) Behavior Cognition

18. “OUT OF LINE NEURONS” (ECTOPIAS) FRONT BACK

19. X www.thebrain.mcgill.ca NEURONAL MIGRATION and “OUT of LINE NEURONS”

20. (Ramus, 2004)

21. Disciplines: Neuropsychology Psychiatry Clinical Psychology Occupational Therapy Speech-Language Pathology Education

22. DEVELOPMENTAL DYSLEXIA: A MOTOR- ARTICULATORY FEEDBACK HYPOTHESIS (HEILMAN, VOELLER, ALEXANDER, 1996 Annals of Neurology) “The inability to associate the position of their articulators with speech sounds may impair the development of phonological awareness and the ability to convert graphemes to phonemes. Unawareness of their articulators may be related to programming [sensory integration] or feedback [sensory perception] deficits.”

23. Alexander, Anderson, Heilman, Voeller, Torgesen (1991). Phonological Awareness Training and Remediation of Analytic Decoding Deficits in a Group of Severe Dyslexics. Annals of Dyslexia, 41, 193-206.

27. T. Conway a,b,c, D. Szeles a,b, F. Bowden b, S. Uhazie b,c, J. Gilbert a, C. Hamm a, P. Prilutsky a, B. Crosson a,b, & L. Gonzalez-Rothi a,b,c,d a VA RR&D Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida b University of Florida, Department Clinical and Health Psychology, Gainesville, Florida c University of Florida, Department of Speech, Language and Hearing Sciences, Gainesville, Florida d University of Florida, Department of Neurology, Gainesville, Florida Acknowledged support: VA RR&D Center of Excellence (#B3149-C), Career Development (C2743V & B6699W), and Career Scientist awards (B5083L & B6364L).

28. Preventing Reading Failure in Young Children with Phonological Processing Disabilities: Group and Individual Responses to Instruction Joseph K. Torgesen Richard K. Wagner Carol Rashotte Elaine Rose Patricia Lindamood Tim Conway Cyndi Garvan (1999). Journal of Educational Psychology 91, 579-593. *NICHD, National Center for Learning Disabilities, Donald D. Hammill Foundation

29. Dyslexia Prevention Study - using a “BOTTOM- UP” approach NTC RCS EP NOW! Foundations 0 5 10 15 20 25 30 35 40 45 Percent retained in K or 1st (Torgesen, et al, 1999) Percent Percent Retained Group (control & treatments)

30. A SOLUTION TO THE READING FLUENCY GAP: PREVENTION 10th 10th 70 80 90 100 STANDARD SCORE Accuracy Rate 4 th GRADE 2 nd GRADE 30 th % ile BEGINNING % ile TREATMENT AGE5-6 (Torgesen et al, 2003) WORD READING

31. “…the PASP [NOW! Foundations®] treatment, as delivered in this study, was relatively ineffective in normalizing the phonetic reading skills of approximately [only] 2.4% of children in the total population [180] from which our treatment sample (the bottom 10%) [of ~1,854 children] was selected.” (Torgesen, Wagner & Rashotte, 1997; Torgesen, et al., 1999)

32. Intensive Remedial Instruction for Children with Severe Reading Disabilities: Immediate and Long-term Outcomes from Two Instructional Approaches Joseph K. Torgesen Ann W. Alexander Richard K. Wagner Carol Rashotte Kytja Voeller Tim Conway (2001). Journal of Learning Disabilities, 34, 33-68. Supported by NICHD, NCLD, DDHF

33. Immediate and Long Lasting Improvement (Decoding + Comprehension) Standard Score 75 80 85 90 95 Initial Test Pre- Treatment Test Post-treatment test results 1 Year After Treatment 2 years Normal Range of Performance 9-Week Intensive NOW! Foundations Torgesen, et al., 2001 16 Mos. Special Ed Class

34. GROWTH IN PHONEMIC DECODING DURING INTERVENTION & FOLLOW-UP 60 70 80 100 Pretest Posttest1 year2 years Standard Score 90 NOW! Foundations Torgesen, et al., in A.J. Fawcett (Ed), 2001

37. STRONG ACTIVITY PATTERN weak activity pattern BRAIN ACTIVITY DURING READING “SIGNATURE” DYSLEXIC BRAIN Simos, et al 2002

38. Effective Treatment Changes Brain Activity/Networks - in Developmental Dyslexia (Simos, et al., 2002) left left rightright Decreased activity in right hemisphere Treatment = Increased activity in left hemisphere Pre-Treatment S-3 Pre-Treatment S-4 After Treatment S-3 After Treatment S-4

39. Altering Cortical Connectivity – Remediation Induced Changes in the white matter for poor readers.

41. www.emschool.org

42. 0 50 100 150 200 250 300 350 4th5th6th7th8th GRADE DEVELOPMENTAL SCALE SCORE FLORIDA STATE AVERAGE ALACHUA COUNTY AVERAGE EINSTEIN MONTESSORI Einstein School’s FCAT results from 2005 AVERAGE CHANGE IN READING DEVELOPMENT (IMPROVEMENT FROM 2004 TO 2005)

43. Disciplines: Neuropsychology Psychiatry Clinical Psychology Occupational Therapy Speech-Language Pathology Education

45. Jon

47. IQ = 98 76 115 70 7676 79 103 94 112 97 94

48. Phonics Transfer Index Decoding Skills Test Normal cutoff 0.74 0.93 0.72

49. 65 8179 92 58 97 75 100 IQ = 98

53. Alachua County Library Adult Literacy Services: # tutors trained in NOW! Foundations for Speech, Language, Reading and Spelling® program - 24 # learners being served with NOW! - 20 Total # learners served in program (ESOL and Literacy) – 59 Anecdotal Feedback and Report – NOT the Scientific Method.

54. Implementing NOW! in a volunteer-driven program can be challenging, but worthwhile things aren’t always easy to figure out at first glance…if it were super easy, everyone would be doing it. But that’s why I’m committed to the journey—to working out the kinks, going through the hiccups to get it all smooth enough to share with other similar programs. The training commitment for tutors is substantial, but it helps them self-weed…you may train fewer, but those who commit usually stay with the program and with their learners because they have invested. And with the small group approach, you can actually serve more learners in a dynamic way. And, at first glance, some programs may think it’s expensive… But when you compare the cost to the consumable materials purchased over one year, it’s not. It’s comparable, and may even save money once the kits are purchased. And, you cannot argue with science. I’m confident in our new direction and all the positive challenges it may include.

55. D., the star student tutor in July's training group, works with a learner who was a true zero-level, female, age 63. Never went to school...ever. Guessed at all the sight words and CVC words on the READ intake. Not one right. Learner waited 4 months for a tutor. Just before I matched her with Diana she told me if this doesn't work out for her and she never gets to learn to read, she was going to "take herself off this earth“, so she wouldn't be a burden to her adult kids, and because her husband "stopped caring about me long ago“, so it wouldn't really matter anyway.

56. D. reported this right after starting to meet: After my first lesson with S., I realized her phonological awareness was *VERY* limited. Just after FOUR actual tutoring sessions, about 7 hours, she expertly knows the three vowel sounds...she has markedly improved, and last class even SHE was saying how much she'd improved and that she thinks the program is working for her! And reported this for September: S. knows almost all the consonant pairs. She's pretty good at recognizing/segmenting/spelling with two-sound words. We're working on three-sound words now. She's always improving.

57. This from a tutor who went through the first training and continues: “J. continues to make great strides in her reading. She uses the NOW! Foundations® material [method] to sound out words in her work in other books. She really notices differences in words and asks many questions in order to understand how language works. (This learner is in her 60s, compensated greatly through her life for her reading challenges, is the secretary for her church but always declines participating and reading unless it's part of her rote, memorized duties.)

58. From a tutor in the July group who was matched with a learner recently: J. has mastered 4 consonant pairs. She can classify vowels into the smile, open or round and is beginning to discriminate between them sufficiently to place a few on the steps. (This learner is 54 years old and only went to 6th grade, and was in "special classes.") Her biggest challenge is building confidence. Each time we practice reading and spelling J. is quicker and more sure of herself. I love that students can master small chunks at a time with NOW! Foundations® and feel successful very early on.

59. “In my experience in volunteer based adult literacy programs, no matter the training, there is ALWAYS attrition. With Laubach, we would fill the room with 35 volunteers, they would be bored stiff and only half of them would actually want to be matched with a learner. If it were a two-part training, many never came back. I did that myself with a Laubach training many, many years ago—I left at the lunch break! So no volunteer- driven program is perfect. Until the government allocates funds for adult reading programs where we can pay more than just the coordinator, it will always be like this.”

60. www.TheMorrisCenter.com www.NOWprograms.com www.einsteinschool.us email: info@MorrisCenters.com info@NOWprograms.com