Identify Dyslexia Using TILLS

Identify Dyslexia Using TILLS

Nickola Wolf Nelson, Ph.D., CCC-SLP, BCSCLWestern Michigan University

Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D., Nancy Helm-Estabrooks, Sc.D., and Gillian Hotz, Ph.D. Copyright © 2016 by Paul H. Brookes Publishing Co. All rights reserved.

Acknowledgement/Disclosure

• Nelson, N. W., Plante, E., Helm-Estabrooks, N.,& Hotz, G. (2016). Test of Integrated Language and Literacy Skills (TILLS). Baltimore, MD: Paul H. Brookes Publishing, Inc.

• Drs. Michele A. Anderson & E. Brookes Applegate, collaborating on Grant R324A100354 from the U.S. Department of Education, Institute of Education Sciences to Western Michigan University. Note that opinions in this presentation are those of the authors and not the U.S. government.

• Nelson, N. W., & Wiig, E. (in press). How SLD manifests in oral expression and listening comprehension. In D. P. Flanagan & V. C. Alfonso (Eds.), Essentials of specific learning disability Identification (2nd ed.). Hoboken, NJ: John Wiley & Sons.


Course Objectives – After completing this Webinar, participants will be able to:

• Describe patterns of phonological and nonphonological language skills that constitute a pattern of dyslexia.

• Discuss how dyslexia, specific language impairment, and specific comprehension deficit overlap, along with features that distinguish them.

N. W. Nelson, Western Michigan U., 2016Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D.,

Nancy Helm-Estabrooks, Sc.D., and Gillian Hotz, Ph.D. Copyright © 2016 by Paul H. Brookes Publishing Co. All rights reserved.

Language Disorders

DyslexiaReading Disorders


Language Disorders

Dyslexia

Reading Disorders


Learning Disabilities

Language Disorders

DyslexiaOral Language

Disorders


Recognizing DyslexiaControversies and Policies


• Elliott and Grigorenko(2014) created a furor inThe Dyslexia Debate, bysuggesting that:

• “…the term ‘dyslexia’ hassurely outgrown itsconceptual and diagnosticusefulness” (p. 177).


Meanwhile…

“as of December of 2015, 28 states had statewide dyslexia laws, 6 states had initiatives or resolutions related to dyslexia, and 14 states had handbooks or resource guides to inform parents and educators about proper procedures for students in public and private educational settings” (Youman & Mather, 2015, p. 10).

Youman, M., & Mather, N. (2015). Dyslexia Laws in the USA: An Update. Perspectives on Language and Literacy, Newsletter of The International Dyslexia Association (December, 2015), 10-18.


FIVE reasons why the construct of dyslexia is worth keeping

1. Identifiable profile2. Distinguishable from other disorders3. Tends to run in families4. Implications for what to do next5. Public recognition

Three cautions1. Boundaries are often fuzzy2. Other profiles also justify special help3. Same labels can mean different thingsExcerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D.,


Scenario 1• Identified in

preschool with orallanguage impairment

• Appears to beprimarily expressive

• Later, sounds okaywhen talking

• Problems withreading decoding

• Later, problems withreading fluency andcomprehension (alsolistening comp,written expression,and formal oral exp.)

From Nelson, N. W., & Wiig, E. (in press). How SLD manifests in oral expression and listening comprehension. In D. P. Flanagan & V. C. Alfonso (Eds.), Essentials of specific learning disability Identification (2nd ed.). Hoboken, NJ: Wiley.

Scenario 3• Identified in middle

primary years• Average or above in

reading decoding• Problems in listening

comprehension aswell as readingcomprehension

• Academic problemsmay be attributed toother problems (nottrying, ADHD)

3 Scenarios


Take a Vote• Which scenario best fits a classical profile of

dyslexia?1 Preschool oral language problems; problems with reading decoding and comprehension in school-age years2 No preschool concerns; problems with phonological processing, reading decoding, fluency, spelling, listening comprehension better than reading comprehension early; reading comprehension improves3 No preschool or early elementary concerns; good surface reader; comprehension problems apparent later (but may be blamed on inattention, laziness, or processing concerns)


Poll Question #1


International Dyslexia Association

• Dyslexia is a language-based learning disability.• Dyslexia refers to a cluster of symptoms, which

result in people having difficulties with specificlanguage skills, particularly reading.

• Students with dyslexia usually experiencedifficulties with other language skills such asspelling, writing, and pronouncing words.

• Dyslexia affects individuals throughout their lives;however, its impact can change at different stagesin a person’s life.


DSM-5 definition of dyslexia

• “Dyslexia is an alternative term used to refer to a pattern of learning difficulties characterized by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities” (p. 67).


Definition of SLD in IDEA

• The term ‘specific learning disability’ means adisorder in one or more of the basicpsychological processes involved inunderstanding or in using language, spoken orwritten that may manifest itself in theimperfect ability to listen, think, speak, read,spell, or do mathematical calculations. (IDEA2004, §602.30, Definition)

Note: IDEA = Individuals with Disabilities Education Improvement Act (2004)


Rethinking “Processes”

Cognitive Processes

Language Processes (Oral and Written)

Academic Performance

NOT “achievement”


Two Pathways to Identification as SLD

RtI Tier 1 RtI Tier 2 RtI Tier 3 /Assessment/Identification

IEP for SLD

Screening orReferral

Assessment of PSW Identification IEP for SLD

Note: PSW = Pattern of Strengths and Weaknesses; IEP = Individualized Education Program; SLD = Specific Learning Disability

Assessment of PSW - Identification

SLS + TILLS


The purpose of this letter is to clarify that there is nothing in the IDEA that would prohibit the use of the terms dyslexia, dyscalculia, and dysgraphia in IDEA evaluation, eligibility determinations, or IEP documents. …However, regardless of whether a child has dyslexia or any other condition explicitly included in this definition of “specific learning disability,” or has a condition such as dyscalculia or dysgraphia not listed expressly in the definition, the LEA must conduct an evaluation in accordance with 34 CFR §§300.304-300.311 to determine whether that child meets the criteria for specific learning disability or any of the other disabilities listed in 34 CFR §300.8, which implements IDEA’s definition of “child with a disability.”


N. W. Nelson, Western Michigan U., 2016

OSERS reminds SEAs and LEAs about previous guidance regarding the use of MTSS, including RTI, and timely evaluations,1 specifically that a parent may request an initial evaluation at any time to determine if a child is a child with a disability under IDEA (34 CFR §300.301(b)), and the use of MTSS, such as RTI, may not be used to delay or deny a full and individual evaluation under 34 CFR §§300.304-300.311 of a child suspected of having a disability.



In determining whether a child has a disability under the IDEA, including a specific learning disability, and is eligible to receive special education and related services because of that disability, the LEA must conduct a comprehensive evaluation under §300.304, which requires the use of a variety of assessment tools and strategies to gather relevant functional, developmental, and academic information about the child. This information, which includes information provided by the parent, may assist in determining: 1) whether the child is a child with a disability; and 2) the content of the child’s IEP to enable the child to be involved in, and make progress in, the general education curriculum. 34 CFR §300.304(b)(1).


DyslexiaLearning Profile

• First signs in Kdg or 1st

grade—naming letters and associating sounds

• No preschool history of problems in oral language milestones or primary oral language disability

• Impaired accuracy and/or rate in– word decoding (pseudowords)– word reading (real words)– word spelling

Phenotype Profile

• Impaired phonological coding• Impaired orthographic coding• Impaired phonological loop for

integrating letters and phonological codes for oral naming

• Impaired orthographic loop for integrating orthographic codes with finger movements for letter and word production

From: Silliman, E. R., & Berninger, V. W. (2011). Cross-disciplinary dialogue about the nature of oral and written language problems in the context of developmental, academic, and phenotypic profiles. Topics in Language Disorders, 31(1), 6-23.Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D.,


Oral and Written LLDDevelopmental

Profile• Preschool history of oral

language struggles or delay

• Persisting oral and written language problems in school years

• All developmental domains in normal range

• Specific language impairment (SLI) or language learning disability (LLD) occurs in which one or more but not all language skills are impaired

Learning Profile• Impaired reading

comprehension—at word level (vocabulary), sentence level (sentence comprehension), and/or text level (factual and inferential questions)

• Impaired syntax or other language affect written composition

• Same impairments as dyslexia

PHENOTYPE PROFILE

Impaired morphological coding

Impaired syntax coding Impaired word retrieval Impaired listening Impaired memory Same impairments as for

dyslexia


Using the Quadrant Model

for Differential Diagnosis


Language Levels (NOT receptive/expressive)


Language comprehension & Formulation• Construct

ideas/message• Formulate or

analyze vocabulary, sentences, & discourse

Word recognition & Production • Decode/encode

words using phonology & morphology

• Recognize/pro-nounce/ spell/write words

Expressive

Receptive

Sound/ word level


“Simple View of Reading”

• Reading decoding– Sound/word level knowledge

• Vocabulary knowledge• Graphophonemic & orthographic knowledge

– Focus on form• Reading comprehension

– Sentence/discourse level knowledge• Syntactic knowledge• Discourse and macrostructure knowledge• Includes vocabulary knowledge as well

– Focus on making sense– Relies on accurate decoding

Gough, P. B., & Tunmer, W. (1986). Decoding, reading, and reading disability. Remedial and Special Education, 7, 6-10.

Word recognition (WR) X Oral language comprehension (LC) = Reading comprehension (RC)


DWord

Recognition

COral Language

Comprehension

RReading

Comprehension

Pattern of DyslexiaListening comprehension > Reading comprehension

(Badian, 1999; Stanovich, 1994)

VocabularyPart of C

Simple View of Reading (SVR; Gough & Tunmer, 1986)Simple View of Reading Redux (Tunmer & Chapman, 2012)



Word Spelling + Transcription

Sentence Formulation Message

VocabularyPart of C

Spelling in Context as the Reciprocal of Reading DecodingRepresents vocabulary selected to fit into sentence and

discourse contexts to communicate meaning


Berninger, et al. (2002). Teaching Spelling and Composition Alone and Together: Implications for the Simple View of Writing. Journal of Educational Psychology, 94, 291–304. Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D.,


Relationships of Disorders of Oral & Written Language

• Two dimensions may explain dyslexia and specific language impairment (SLI)– Phonological skills

(sound/word level)– Nonphonological skills

(sentence/discourse level)

(Bishop & Snowling, 2004; Catts, Adlof, Hogan, & Weismer, 2005)Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D.,


Quadrant Model

Good listening comp + sentence formulation

when talkingLow reading decoding +

fluency + spelling + word inflection when

writing

Average in both

Low Reading + Low Oral Language

High sound/word skills and surface reading

Good Reading Decoding + Poor Comprehension

Sentence/Discourse Ability

Sound/Word Ability

Dyslexia(Spoken > Written)

Specific Comprehension Deficit(Written > Spoken)

Spoken + Written Disorder

Normal Language(Written = Spoken)

(Bishop & Snowling, 2004; Catts, Adlof, Hogan, & Weismer, 2005; Catts, Adlof, & Weismer, 2006; Ramus, Marshall, Rosen, & van der Lely, 2013)Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D., Nancy Helm-Estabrooks, Sc.D., and Gillian Hotz, Ph.D. Copyright © 2016 by Paul H. Brookes Publishing Co. All rights reserved.

Using the SLS to Screen for Dyslexiaand TILLS to Diagnose It

and other language/literacy disorders


(Nelson, Plante, Helm-Estabrooks, & Hotz, 2016)

TILLS – Student Language Scale (SLS)(Nelson, Anderson, & Howes, 2017)


Consider teacher, parent, and student input on the SLSMultiple sourcesCo-norming Student Rating Scale

Correlation between Items 3-4 and Sound/Word Composite:Teachers = .671** Parents = .595**


Teacher’s ratings on the first 8 items--

• Are 2 or more ratings <5? High sensitivity90% of 68 students with LLD identified accurately as having problems

• Are all (but 1) ratings >5? High specificity90% of 203 students with NL identified accurately as nothaving problems

Sensitivity Specificity

Teacher 61/68 = .90** 182/203 = .90**

Parent 203/239 = .85* 1065/1290 = .83*

Student 66/90 = .73 257/419 = .61

Correlation between Items 1-8 and total TILLS for Teachers = .752** Parents = .613**


Nelson, N. W., Plante, E., Helm-Estabrooks, N., & Hotz, G. (2015). Test of Integrated Language and Literacy SkillsTM (TILLS™). Brookes Publishing Co., Inc.

Language Levels X Modalities Model


Interpret TILLS results for 3 validated purposes

• Identify language/literacy disorder• Profile patterns of strengths and weaknesses• Track change over time (6 mos. +)


Purpose 1.

Identify language/literacy disorder


Identification Core Subtests and Sensitivity/Specificity

• Core subtests– Vocab

Aware– NW Spell– NW Read– WE-

Discourse• Sensitivity 88%• Specificity 85%

6-7 year olds 8-11 year olds

• Core subtests– Phoneme Aw– NW Spell– Rdg Comp– Reading

Fluency– WE-Word

• Sensitivity 86%• Specificity 90%

• Core subtests– Vocab

Aware– Phoneme

Aw– NW Rep

• Sensitivity 84%• Specificity 84%

12-18 year olds


Purpose 2.

Profile strengths and weaknesses

Profile of Dyslexia- Lower sound/word - LC > RC


Purpose 3.

Track change over time


Practice Identifying Profilesfor Differential Diagnosis


7;9 Grade 1 BoyHistory of articulation difficultiesWorking on /l/Getting RtI Tier 2 help for reading delays


7 year 9 month old boy



Core subtests Vocab Aware Phoneme Aw NW Rep

Sound/word 48

Sentence/discourse 73

Consistent with diagnosis of dyslexia?Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D.,


Poll Question #2


7 year 9 mo old boy

Good listening comp & sentence formulationLow reading

decoding & fluency & spelling

High in both?

Low in both?

High sound/word skills and surface

reading?Low comprehension

in listening and reading?


Sound/Word Ability

School Classification: SLI-speech Only

Should there be more?

Dyslexia Dx is appropriate


7;10 Grade 2 GirlNo preschool servicesPositive family history of reading problemsHas an IEP with reading decoding and fluency goalsLD as primary eligibility (Reading)No S/LI as secondary eligibility – Should there be?


Teacher and Parent SLS for 7;10, Grade 2

Parent SLSGen Ed Teacher SLS


Grade 2 girl (age 7;10)


7;10 Grade 2 Girl

Sound/word 50


Core subtests Vocab Aware Phoneme Aw NW Rep

Consistent with diagnosis of dyslexia?


Poll Question #3


7;10 Grade 2, Girl



High in both?

Low in both?





Sound/Word Ability

LD as primary eligibility (rdg).Also gets help in class (co-taught by special edteacher and other assignments read to her).

Reading decoding and fluency goals on IEP.

Should there be goals related to oral language?Written expression and spelling?


8;9 Grade 3 BoyNo IEP In our Language Literacy Risk (LLR) group:

RtI services for Reading Fluency 30 min, 1X/day, 5 days/week21st %ile on Star Reading77 SS, 6th %ile on WRMT Word Attack

Should he be tested/identified?Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D.,


8;9 Grade 3 BoyParent SLSTeacher SLS


Student SLS


Grade 3 boy (age 8;9)


Written Expression Story

Discourse: 4/20 = 20%Sentence: 4/4 = 1.00Word: 18/23 = 78%


8;9 Grade 3 Boy

Core subtests Vocab Aware NW Spell NW Read WE-Discourse

Sound/word 53




Poll Question #4


8;9 Grade 3 Boy



High in both?

Low in both?





Sound/Word Ability

Example of isolated focus on Reading Fluency

It was fine but there were many other problems

Not classic dyslexia

Could say:Dyslexia + Language Dis:

Vocab Delayed Story RetellSocial Comm


10;5 Grade 5 BoyIdentified as having a learning disabilityReading goals on IEPADHDNo history of spoken language problemsIs there evidence of any?



Core subtests Vocab Aware NW Spell NW Read WE-Discourse

Sound/word 91




Poll Question #5


10;5 Grade 5 boy

Good listening comp & sentence

formulation?Low reading

decoding & fluency & spelling?

High in both?

Low in both





Sound/Word Ability

School Classification: LLD-Reading Impairment Only + ADHD

NOT best fit for dyslexia, but words in context are low

Needs:Listening compReading compVocabulary

(semantic relations)

Social comm*Stories may be

relative strength Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D.,


10;7 Grade 5 BoyFamily history of reading problemsMother asked for him not to be pulled out for special reading since Grade 2504 plan (no IEP)


Gen Ed Teacher SLS Parent SLS

10;7 Grade 5 boy


10;7, Grade 5 boyStudent SLS


10;7 Grade 5 boy


Written Expression Story (10;7 boy)

Discourse Score: 18/20 content units = 90% SS 16Sentence Score: 18 content/7 T-units=2.57 SS 15Word Score: 74/88 wdswithout error = 84% SS 6Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D.,


Nonword Spelling (10;7 boy)

gid

stenders

vilding

tep

dabe

tarbing

skeep

disvagle

glapped

untigament

Scroil

droof

1


Core subtests 8-11 Vocab Aware NW Spell NW Read WE-Discourse

Sound/word 87


10;7, Grade 5 boy



Poll Question #6


10;7 Grade 5 boy



High in both?

Low in both?





Sound/Word Ability

Section 504 plan Longer test taking timeLonger time for in-class assignmentsCan dictate writing to momMom can read to him

Placed in advanced language arts because of high comp – “twice exceptional”

Classic dyslexia –Could benefit from word structure study

Reading fluencySpelling in context


13;7 Grade 7 BoyIdentified with Reading Impairment + ADHD No IEP


13;7 Grade 7 boy


13;7 Grade 7 BoyParent SLS


Written Expression (13;7 boy)


13 year 7 month old Grade 7 boy

Core subtests 12-18 Phonemic Aware NW Spell Reading Comp Reading Fluency Wr Exp – Word

Sound/word 90




Poll Question #7




High in both?

Low in both?





Sound/Word Ability

NOT classical dyslexia

StrengthsPhonemic AwarenessNonword RepetitionReading FluencyWritten Expression (Discourse + Sentence)

WeaknessesStory Retell--answering comp QsListening ComprehensionReading ComprehensionSocial CommunicationVocabulary AwarenessALSONonword ReadingWritten Expression-Word

13;7 Grade 7 Boy


No current IEP S/LI + reading in younger gradesSee parent SLS re listening to story

17;5 Grade 11 Girl


17;5 Grade 11 GirlParent SLS


17;5 Grade 11 Girl

Core subtests 12-18 Phonemic Aware NW Spell Reading Comp Reading Fluency Wr Exp – Word

Sound/word 104




Poll Question #8


Pattern observed?

Good listening comp & sentence

formulation?Low reading

decoding & fluency & spelling?

High in both?

Low in both





Sound/Word Ability

No IEPNeeds 504 plan

PA low

NOT dyslexia

Example of student with spoken language but not written problems?

Digit span tasks were WNLSocial comm good

Story Retell lowDelayed lowerHx of concussion?Excerpted with adaptations from the Test of Integrated Language and Literacy Skills™ (TILLS™) by Nickola Wolf Nelson, Ph.D., Elena Plante, Ph.D.,


Conclusions


A Cautionary Note about Using the Quadrant Model to Differentiate Dyslexia and SLI

“A problem with all such taxonomies is that they leave some children unclassified and find few pure subtypes. Our view is that individual differences in reading and language disorders are better conceptualized in terms of a multidimensional model, in which there is continuous variation in component language and literacy skills, rather than discrete categories.” (Bishop & Snowling, 2004, p. 862)


Take-home points• Comprehensive assessment provides insights not

available otherwise• Students with dyslexia have a unique profile• Others may demonstrate problems similar to dyslexia but

show problems in other areas too• Debatable whether listening comprehension problems should be an

exclusion criterion for dyslexia• Debatable whether specific comprehension deficits should be viewed

as SLI-only (Catts et al., 2005; Ramus et al., 2014); regardless, they probably involve problems of expressive formulation as well.

• Dyslexia + SLI = Oral Written Language Learning Disabilities (OWL-LD) (Berninger favors this term)

• Individual differences more important for planning than a specific label…even dyslexia (we use language/literacy disorder)


ReferencesBadian, N. A. (1999). Reading disability defined as a discrepancy between listening and reading comprehension: A longitudinal study

of stability, gender differences, and prevalence. Journal of Learning Disabilities, 32, 138-148.

Berninger, V. W., Vaughan, K. Abbott, R. D., Begay, K., Coleman, K. B., Curtin, G., Hawkins, J.. M., & Graham, S. (2002). Teaching Spelling and Composition Alone and Together: Implications for the Simple View of Writing. Journal of Educational Psychology 2002, Vol. 94, No. 2, 291–304

Bishop, D. V. M., & Snowling, M. J. (2004). Developmental dyslexia and specific language impairment: Same or different?Psychological Bulletin, 130(6), 858-886.

Catts, H. W., Adlof, S. M., Hogan, T. P., & Ellis Weismer, S. (2005). Are specific language impairment and dyslexia distinct disorders?Journal of Speech, Language, and Hearing Research, 48(6), 1378-1396.

Gough, P. B., & Tunmer, W. E. (1986). Decoding and reading disability. Remedial and Special Education, 7, 6-10.

Hoover, W. A. & Gough, P. B. (1990). The simple view of reading. Reading and Writing, 2, 127-160.

Nation , K., Clarke, P., Marshall, C. M., & Durand, M. (2004). Hidden language impairments in children: Parallels between poor reading comprehension and specific language impairment? J. of Speech, Language, and hearing Research, 47(1), 199-211.

Nelson, N. W., Plante, E., Helm-Estabrooks, N., & Hotz, G., (2016). Test of Integrated Language and Literacy Skills (TILLS). Baltimore, MD: Paul H. Brookes Publishing Co.

Ramus, F., Marshall, C. R., Rosen, S., & van der Lely, H. K. J. (2013). Phonological deficits in specific language impairment and developmental dyslexia: Towards a multidimensional model. Brain, 136, 630–645.

Scarborough, H. (2001). Connecting early language and literacy to later reading (dis)abilities: Evidence, theory, and practice. In S.B. Newman & D.D. Dickinson (Eds.), Handbook of early literacy research (pp. 97–110). New York: Guilford Press.

Silliman, E. R., & Berninger, V. W. (2011). Cross-disciplinary dialogue about the nature of oral and written language problems in the context of developmental, academic, and phenotypic profiles. Topics in Language Disorders, 31(1), 6-23.

Stanovich, K. E. (1994). Annotation: Does dyslexia exist? The Journal of Child Psychology and Psychiatry and Allied Disciplines, 35(4), 579-595.

Tunmer, W. E., & Chapman, J. W. (2007). Language-related differences between discrepancy-defined and non-discrepancy-defined poor readers: A longitudinal study of dyslexia in New Zealand. Dyslexia, 13(1), 42-66.

Tunmer, W. E., & Chapman, J. W. (2012). The simple view of reading redux: Vocabulary knowledge and the independent components hypothesis. Journal of Learning Disabilities, 45, 453-466.


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