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Poster P3

Friday stream 1-4 Session 16.10 - 17.25 Length 25 minutes

A non-reader who achieved a degree: a case-study of a student with severe dyslexia

Ann Cooke

Dyslexia Unit, University of Wales, Bangor e.a.cooke@bangor.ac.uk

Abstract

The poster presents a case study of J, a mature-age student with severe dyslexia. It describes the nature of her disability, the support and teaching programme set up for her, and the outcome of her three years' degree course in Psychology. J had very limited literacy skills when she entered university; she also had great difficulty with handwriting and with numbers. She was heavily dependent on a word-processor/computer. Her problems were essentially those of the surface, that is, the words and numbers on the paper. Whenever she could break through this barrier she became free to understand and work with the information. Difficulties with phonology and with working memory and for phonological information presented almost insuperable problems. When tuition was provided, progress came in bursts followed by long periods of consolidation. J. developed efficient study methods and was very well organised - but her coping-strategies were constantly challenged by her difficulties with basic skills and despondency about continuing obstacles. This case study highlights a number of issues concerning severely dyslexic students in Higher Education: the arrangements needed to access course content and examinations; provision of study-support; the funding of that support; students' entitlement under disabilities and equal opportunities legislation, and subsequently in seeking employment. It also questions assumptions about the skills that are needed to pursue a degree and that are presumed to be essential for successful graduation. These merge into the wider issue of where the boundaries of 'literacy' should be drawn now that communications and information technology can perform the mechanical tasks of reading and writing.

Background

Personal and family:

J is the younger sibling - by 10 minutes - of identical (monozygotic) twins. Birth was eight weeks premature: birth weight low (2.1 and 2.2 lbs. respectively))
J: had some difficulties of vision - 'lazy eye' and astigmatism. Hse was prescribed glasses at 7 years of age.
Both sisters had speech therapy between ages 5 and 7 years. (They had used a 'private language'.)
Her sister - also dyslexic but less severely - has a hearing problem. Brother is dyslexic. Mother reads very little (J suspects that this is due to reading difficulties).

Educational:

Referred for remedial help at primary and secondary school but without success.
Aged 16: took a care course.
Aged 18 - 21: took a course in psychiatric nursing. Developed strategies of visualisation and imaging to remember verbal information Managed to conceal the extent of her difficulties.
Depended on: verbal presentations, dictation of work on to audiotape, which was sent to a professional typist.
Left nursing course 3 months before final examinations.
1996 ACCESS course: dictated essays to a professional typist; tutors arranged for books to be audio-taped; completed course successfully.
1996: Entry to University of Wales, Bangor. Ticked YES to dyslexia on UCAS form.

Assessment on entry to UWB

Psychological Assessment

Assessed as of 'at least average' intellectual ability - Wechsler Adult Intelligence Scale (WAIS 111)

Profile : Verbal sub-tests: scores ranged from 12 to 14
Performance sub-tests: scores ranged from 9 to 17
On items dependent on working memory and speed of processing scores were between 2 and 7
Scores on single word reading (WORD Reading Dimension - Wechsler) and spelling tests (WAIS) in 7;00 - 7;6 years band. Handwriting noted as 'very poor'; used both hands though preferred the left hand; writing speed 5 words per minute.
Bangor Dyslexia Test: 9 'positive' signs. Seemed to have few strategies for coping with certain short-term memory tasks.
Greatest strength: listening using visualisation strategy and 'network-building'. Preferred learning mode - auditory and visual.
Excellent memory for information.
Some difficulties reported with print distortion and sensitivity to bright light. Occasional use of orange filter.

Study Needs Assessment recommended:

• a range of IT equipment (computer, printer, scanner, voice-recognition software)
• help with note-taking in lectures provision of extra time
• a reader/amanuensis in examinations and modular assessments
• tutorial support for coursework, essay writing and proof-reading
• tuition for literacy and numeracy difficulties.

Funding: Disabled Student's Allowance (DSA)

Delivery: UW Bangor Student Services/Student Welfare (note-takers) School of Psychology (handouts, overhead notes/lecture notes printed-out or on email)
Dyslexia Unit - tuition, advice, study-support help with form-filling, applications etc.

Tuition for literacy skills.

Early sessions:

Year 1 Term 2. Assessment of difficulties and J's coping strategies No tests were given in order to avoid putting J under undue pressure. Informal observations in first three sessions showed that J's difficulties were profound.

Reading:

• minimal word recognition:
• no strategy for visual word-matching by remembering a sequence of letters
• incomplete knowledge of grapheme-phoneme correspondence especially for lower-case letters or digraphs (phoneme-grapheme correspondence was more secure)
• poor phonemic/phonological skills: decoding, or blending, words from known/recognised letters; blending words from syllables and phonemes spoken for her; segmentation of e.g. initial/final phoneme appreciation of vowel phonemes recognition of, and production of, rhyming words
• some recognition of initial phonemes in words spoken to her. Correct responses to oral/auditory segmentation and blending tasks were slow and seemed to involve two distinct processes:
  i) mentally formulating the sound or word
  ii) producing it in speech While lack of confidence was a factor, it seemed that J had to process the motor organisation needed for the response. (This process could take up to 5 seconds.)
  Strategies: none. Depended on word-processor, audiotapes or a scanner when available.

Writing and spelling:

• incomplete knowledge of phoneme-grapheme correspondence, particularly for lower case letters
• no knowledge of consonant digraphs
• no knowledge of spelling conventions; memory for few whole words.

Strategies:

• phonemic segmentation: each word was transcribed letter by letter, being pronounced repeatedly until it was done. Many letters were incorrect, incorrectly placed or omitted (particularly vowels). She could read it back to herself for a limited time after writing but would not have recognised the same word in its correct spelling. It was difficult to read her uncorrected writing, but not impossible.
  (See sample below)
• computer keyboard: helped phoneme-grapheme correspondence (also when handwriting)
• spellchecker: extensively used, each attempt altered until it was 'recognised'
• screen text-reader: used to monitor and edit her writing; also used to access a predictive spellchecker, identifying the correct word from the choices offered.

Example of uncorrected spelling:

Mentl helf esae. frm as far bak as rekuds ar kept mentil ilnes has ben defned xplrud ad dokumntd in teh letretre its cuzs haf ben atrebud to a mlutetde (lots of) of resens rangng from posesten demens bad sprtes and krses.

Mental health essay. From as far back as records are kept, mental illness has been defined, explored and documented in the literature, Its causes have been attributed to a multitude of reasons ranging from possession by demons, bad spirits and curses.

Observations: some letters incorrect because of articulation difficulties; absence of punctuation; use of chosen words despite spelling difficulties; reading is facilitated by pronouncing words aloud.

Written expression and grammar:

J had little formal knowledge of grammar. Her oral/verbal expression was usually good, but her first drafts of written assignments lacked clarity and her arguments could be difficult to follow. Each assignment was checked repeatedly with the screen text-reader until she thought they were clear. Text produced in this way took many hours to produce. A 2000 word assignment could take between 75 and 100 hours. She submitted very little of her work for proof-reading and correction before handing it in.

Handwriting:

J was also limited by her poor handwriting skills. Among the difficulties noted were:

• poor motor-memory for letter formation - preventing any response
• letters often formed from the bottom;
• some letters were incorrectly orientated or inverted o absence of joining lines
• a persistent tendency to start at the right margin
• a tendency to write first the letters she knew, starting at the end of words and working backwards or filling in gaps
• preference for her left hand but she was apt to change to the right after a time a 'fist-grip' pen-hold with the hand hooked in some respects she found it easier to write 'upside-down'. Physical tiredness was a problem. Nevertheless J wrote a great deal for her personal satisfaction. She was able to draw freely and liked drawing.

Visual difficulties:

J found orange-tinted prescription glasses and an orange filter helpful for reading and writing.

Teaching programme

J agreed that a programme of teaching would start with:

• basic letter-sound work
• build on word-writing as this was her greater skill
• link this to word reading concentrate on reading, with spelling arising from the basic word-building work
• use IT as much as possible
• use multisensory strategies for learning
• develop her phonemic and phonological skills
• include exercises and drills to
  i) achieve automatic response
  ii) consolidate learning
  iii) promote decoding
  iv) promote word recognition
• require practice between sessions
• work on handwriting only when she decided to tackle it.

The work was treated at an academic level by putting it into a linguistic framework. (She later commented that previous tuition had either attempted to teach her 'phonics' through spelling rules, or by presenting her with 'adult' reading matter that was too difficult, and not addressing her basic difficulties.)

We decided also that it would be kept separate from course work. For that she would depend on IT, and on other systems of support - note-takers, readers and so on. We agreed to meet weekly for one hour.

The first year's work was disrupted by health problems, then by examinations and the summer vacation.

Phonological training: techniques and approaches

Programme: a phonic progression was followed starting with single letters, consonant digraphs, consonant blends in initial and final position, all in one-syllable words with regular short vowel spelling before moving on to two-syllable words, long vowel sounds and vowel digraphs.

Routines for teaching alphabetic skills, phoneme-grapheme/grapheme-phoneme responses and simple word-building included:

• illustrated letter cards, separate plastic letters, tracing procedures,
• writing with the computer
• attention to th/f/v articulation difficulties; work on distinguishing between short vowels
• multisensory approaches to build up memory for grapheme-phoneme correspondences, and to enhance phonemic awareness;
• auditory/oral/visual modalities and motor-memory for letter-sequences on the computer were stressed.

Materials and resources for regular practice included:

• Phonological Awareness Training (PAT) worksheets (Goswami 1993) were introduced at an early stage, in an attempt to structure J's practice and give her practice in building and recognising words by analogy. These had limited success because J was unable reliably to copy the letter strings in correct order, re-blend the onset-rime into words without help, and to check on whether the words made were real words
• Toe by Toe. (Cowling 1995) Early pages used for systematic practice of grapheme-phoneme response. J added small picture cues to help learning and later recall. The onset-rime pages were more suitable than PAT worksheets in requiring reading only. The disadvantage was that its pages included too much variety of pattern. Simpler versions were constructed which gave the slower progression that she needed.

Year 2 (Autumn 1997)

Number of sessions was increased to 3 per week for about 7 weeks. J began to master whole word pronunciation but her response was still slow and a lot of blending was still going on - though now silently. Problem: working memory difficulties.

J could not process one word-part then hold it in memory while she worked on another, then blend both into a whole word. Onset+vowel and coda (nu+t) was marginally easier than onset + rime.

• Word building was re-introduced on the computer, making much use of look - say - listen - write for one part before tackling the other
• Practice of grapheme-phoneme correspondence was continued, aiming at automatic response
• To discourage blending, flashcards were tried but she found the demand for quick response stressful
• Tracking exercises were used extensively at this time (and were much disliked!) to improve recognition of sounds and words:
  i) for th, ch and sh, as separate digraphs and within words. Articulation of th needed work. This helped recognition and writing of the (She is still apt to write teh).
  ii) Letter strings - upper case, 3, 4 then 5 letters to be tracked. We discussed strategies for searching and increasing the scanning rate: she was encouraged to memorise the letters without referring back to the target; to memorise the letter names by auditory rehearsal; to use silly sentences and picture mnemonics.
  iii) consonant blends. These were introduced with the Alpha to Omega card pack.
  iv) whole word (e.g. the, and) and sentence tracking.

Mid-November: J was able to read simple sentences e.g. 'The pet cat is with the duck in the big pen' She worked out most words by saying the rime first. At this stage, she was encouraged to re-read each sentence, try to hold it in memory and repeat it, then re-read the sentence more quickly, trying to capture whole words. This helped to build word-recognition skills.

Moving on

• Long vowel sounds. J knew the vowel names but now had to meet them as sounds. She found this very confusing. For distinguishing long and short vowel sounds a card pack was made. The different vowels were identified with diacritical marks and cue pictures. (acorn, apple etc) J practised in short sessions (5 - 10 minutes) sometimes 2 or 3 times daily.
• Open syllables and closed syllables. These were taught next as spelling patterns for long and short vowels. A card model showing an open/closed door helped the learning of correct vowel responses in contrasting words e.g. we/wet, no/not, hi/him etc. Single syllables were practised - aiming for fast response.
• 2-syllable words were now introduced, first with two closed syllables, then with unequal syllables. Exercises on syllable division (on computer) gave word-reading practice. Another blending/working memory difficulty now emerged: each syllable had to be blended separately, held in memory and then re-blended for the word.

Putting word-recognition skills into context:

• Pam and Tom Books ( Pat Heaton. Barnsley College of FE.) This series was introduced in J's 3rd term of lessons. The word attack practice was transferred into the books and her word-recognition began to improve. At the introduction of 2-syllable words ( Book 5) J became discouraged and needed a lot of confidence boosting to take the next step. Separate skills-training was still needed.
• Single-letter practice continued - responding to given sounds and letter-names with cards or by indicating on the computer keyboard. (This was still acting as a mnemonic.)
• Irregular words or words with variable segmentations were difficult (e.g. Polish/polish; robin/ robot). She lacked any strategy for dealing with these. She was encouraged to use context and guess from limited cues. Increasing confidence helped her to adopt this approach and it paid off.
• Blending sounds or syllables in words of more than 2 syllables was still a major problem. Word-attack strategies such as shortening words by cutting off suffixes, looking for the root, and so on, were difficult for her.
• Suffixes were taught as units but she had great difficulty holding them in memory and continued for some time to process the letters separately
• Suffixing rules were explained and reading of separate syllables practised - tion, ture, al, ly etc. Explicit spelling work was needed to strengthen her awareness of these syllables. 'Looking for little words' was not effective as her word-recognition was not good enough.
• Long vowels spelled with silent -e: J at first found difficulty looking to the end of the word to determine the vowel sound, and it slowed the processing, but then the problem seemed to disappear.
• Long vowels: ee and oo. J needed to have an explanation for why vowels were combined - either for different spellings of one sound or to represent new sounds.
• Other frequent digraphs were pointed out when they appeared in context; after that she made many of the connections for herself and became able to read words with different vowel digraphs.
• Word-recognition. A difficulty here has been the difference between the correct spelling of a word and how J would expect a word to be spelled; she does not recognise the word because it does not look as her own written version would look. J compares it to reading in an unknown language: the word you see is not the word you know. It might be expected that use of voice-recognition software would enable her to build a new sight vocabulary, but she does not routinely read back from the screen as her preferred mode of working is through listening. The period spent 'training' the software was the most helpful in this respect: the 'own-voice' repetition and repeated appearance of an irregular word on-screen.

Reading material:

The Pam and Tom series was a key to the improvement in J's whole-word recognition: the simple, much-repeated vocabulary (fish, chips, pub, flat, job, bus, run, rush, get, him, her mad, etc) the repetitive features and episodes of the story and the short sentences, all enabled practice at the right level - though tedious! (This was before her voice-recognition software was finally set up in her 5th term.)

• Some of the standard readers for older students (Chillers and Spirals - Hodder) were tried but there was too much variety, and too many irregular words.
• Newspapers and magazines: the variety of words and style prevented steady, continuous reading. She continued with Pam and Tom for independent practice and we used the other books for instruction.

Year 2 Term 3, Year 3 and later

By the end of her second year she took on the challenges of some children's fiction:

• The Magic Finger (R. Dahl) Charlie and the Chocolate Factory, and Charlotte's Web.

In September '98 she had the confidence to send me an uncorrected email: 'carly adn teh koklete faktore is misng you. mafs is a pane in teh bum. prjkte is gowhg wel, btu tyernngi'. (Charlie and the Chocolate Factory is missing you. Maths is a pain in the bum. Project is going well, but tiring.) Some of the misspellings may now be mis-typings rather than real errors.

Adult fiction has been difficult because of sentence length and style in the books she wants to read (1984, Catcher in the Rye, Pride and Prejudice). Several Penguin Adult Readers adaptations were tried but she found these unsatisfying.

After graduating she has read some Barrington Stoke young adult titles and three Harry Potter books (The names have been difficult.) She re-read the Barrington Stoke books with the scanner and wrote reviews. Reading for pleasure is still accessed through her scanner.

Outcomes. Summer/Autumn 2000

Dyslexia Adult Screening Test (DAST) Psychological Corporation 1997)

Selected items were given to check J's phonological skills.

• Phonemic Segmentation: J responded correctly to 1 syllable item out of 3, 8 of the 9 phoneme items and the 3 Spoonerism items. However many of the responses took more than 5 seconds. The Spoonerisms were achieved only after much experimentation.
• Nonsense passage reading: the real text was read without hesitation but J had problems with the phonic blending process needed to read the non- words. Two were correct, several were wrong by one phoneme and in two others she read the syllables correctly but could not blend then into a word. The passage was abandoned after 7 mistakes, just over halfway through. Time taken: 225 seconds.
• Backwards digit span: both items correct at 3-digits. 1 digit misplaced at 4-digits.
• Semantic Fluency: 23 items (animals) named in 1 minute.
• Verbal fluency: 10 words beginning with s named in 1 minute. The phonemic segmentation and nonsense reading items could not have been attempted three years earlier but the results show that J's phonemic/phonological skills are still undeveloped.

Reading comprehension:

J can now read simple text but her comprehension is poor.

• While most 1-syllable and many 2-syllable words can be read at sight, simple word-recognition is still not totally automatic
• Longer word decoding requires direct attention
• Both of the above slow the pace and disrupt the fluency
• Attention-resources are not available for processing meaning
• Memory of the whole sentence is not built up
• Different parts of the text are not integrated - first over a single paragraph, and then over succeeding paragraphs.
• Interaction with the text is limited. On a second reading, J can recall some details if asked questions, but she does not yet make use of this technique independently. Reading comprehension is therefore a major problem and is holding up further progress. Next stages in reading work will use
• general reading matter - short newspaper reports, short paragraphs from leaflets and other social-work material
• cloze passages in simple text o exercises in which short (and increasing length) paragraphs are followed by several questions, requiring intuitive and inferential understanding as well as simple information from the passage.
• regular, explicit review of what has been read.
• renewed skills training to promote word-recognition: syllable reading and word-attack - if she is willing to go along with it!

Listening comprehension:

The disparity between her reading and listening comprehension can by seen in her responses to the comprehension passages in the WORD (Wechsler Reading Dimension) test administered in October 2000. J was able to read the first passage only, and was unable to answer the comprehension question. Yet when the most advanced passage was read to her she was able to answer complex questions about it without hesitation.

Summary: J's use of IT.

• word-processor: essential for all course-work
• spell-checker: limited value - it would not cope with her 'phonics'
• voice recognition software: she did not have full use of her own system until over half-way through her course. pros: cut hours of work from the process of writing cons: lengthy initial training;
• screen text reader: essential for checking clarity of written expression.
• scanner: available throughout. pros: reading not possible without it cons: not all text would scan e.g. badly printed handouts/papers - reduced access to course material and reading scanning of books took a lot of time; difficult if page numbers read incorrectly.
• email: enabled written communication within the School and the University;
  pros: could be spell-checked; (now used through voice-recognition system)
  cons: must be transferred into Word for sound-card to read them.
  General: good technical support is essential for training, seeing to breakdowns and advising on and installing system up-grades.

General summary

J graduated with a BA (lower second class) in Psychology in July 1999 and is now following an MA Diploma in Social Work. Her academic success has been achieved in spite of a set of specific difficulties:

• limitations in phoneme-awareness, phonology, and working memory.
• difficulties with symbols - letters, numbers - and mathematical notation
• motor-coordination difficulties - including handwriting and speech difficulties
• visual difficulties: short-sightedness and distortion of print These are counterbalanced by strengths in other areas:
• intellect - enabling her to understand and learn new concepts
• memory for factual information presented in auditory or (non-literary) visual mode
• ability to integrate and remember facts and ideas at one hearing
• verbal language skills - organisation and expression of facts and ideas
• general organisational skills
• good IT skills
• personal qualities of courage determination and stamina

The foregoing account deals with only a small part of the support that was available to her - and that part was not directly related to her course. She drew on many other resources and sources of help - some of which were more consistently available than others. Among these were:

• lecture notes sent on email, handouts, copies from overhead projector sheets etc (School of Psychology)
• note-takers (Student Services) o tutorial help for coursework and project preparation (Dyslexia Unit tutor)
• photocopying of papers and books e.g. of texts on restricted loan (friends)
• keeping track of lecture and exam timetables (Dyslexia Unit, friends)
• technical support for IT (School of Psychology, Student Services)
• reader and amanuensis in modular tests and examinations (School)
• special arrangements for examinations (University examinations officer and School)
• personal support (Dyslexia Unit personnel, friends)
• her LEA gave consistent support through DSA funding

Conclusions

J's case is rare - but not unique - and it raises major points of concern.

• Failure to become literate does not mean lack of 'intelligence'. Individuals with limited literacy who wish to study at Higher Education level should not be denied the opportunity now that Communications and Information Technology can by-pass the surface difficulties of reading and writing. Admission to HE has to be based on other ways of determining the level of ability needed to follow a course.
• Every institution must comply with Disability and Equal Opportunities legislation that prevents discrimination against people with disabilities. Similar legislation applies to the employment sphere. Here even more radical shifts of perception are needed for people with discrepant skills to be accepted as suitable for 'good' posts.
• Provision/funding for students (or employees) with disfunctional literacy. Extra resources and a high level of support are needed. The systems for providing that support are costly for an individual institution (or employer) and should be adequately funded by central government.
• Grant-application by individuals is a cumbersome and lengthy process. A way of speeding up the provision of personal CIT equipment needs to be found, so that students have time to master its use early in their course.
• Centrally available resources are not an adequate substitute for CIT provision to individuals.
• What defines 'literacy'. Traditionally it has meant 'having the ability to read and write'. J, and others like her, demonstrate that CIT can enable access to literacy at a high level. They have the ability to make use of written language even though the conventional means are not available to them.

J's experience demonstrates that lack of functional literacy can be overcome but this it at considerable cost in personal and financial terms. As yet, technology should not be thought an easy alternative