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Education Course – SPED/530: Introduction To Learners With Special Needs
The Need for Special Education & Common Characteristics Support Chart
As part of your professional development, your principal has asked you to further develop your knowledge of exceptional learners and their characteristics, as well as how to best support these students in the classroom.? Refer to the information you gathered in the Collaborative Discussion Activity: Who Are Exceptional Learners???? Complete Parts 1 and 2 below.???
Reflect on the readings and discussions from Week 1.?? Create a 1-page visual or infographic that addresses the following questions:
What is the need for special education?
How are the needs of exceptional learners different from the needs of non-exceptional learners?
How does your school support best practices for students within special education and those struggling students being supported through your referral processes?
How are skills necessary for personal and academic success in school, as well as adulthood, developed?
Part 2 ?
Complete the Common Characteristics and Supports Chart. (1st Attachment)
Differentiate among types of specific learning disabilities, effective interventions, and strategies supporting student success.
Describe the following aspects of ADHD: prevalence, types, learner characteristics, impact on student learning, and social/emotional development in school and transition to adulthood.
Identify characteristics of behavioral and emotional disorders, and strategies proven effective for strengthening academic and personal skills necessary for individual growth and progress.
Analyze giftedness, twice exceptionality, and the impact of learner characteristics on academic, emotional, and social supports.
Read and use the following articles and links synthesize to base the answers on:
“From Frazzled to Focused: Supporting Students With Executive Function Deficits”
“The Neurobiology of Dyslexia”
“ADHD Remission, Inclusive Special Education, and Socioeconomic Disparities”
“Supporting Students With Emotional or Behavioral Disorders: State of the Field”
“Classroom Management With Exceptional Learners”
“Learners Who Are Exceptional”
SPED/530 v2 Common Characteristics and Supports Chart Instructions Complete the 4 charts below by listing at least 5 common characteristics of learners in the following categories: learners with a learning disability, learners with ADHD (either type), learners with a behavior disorder, and gifted and talented learners. Include academic and/or behavior supports for the specific learner characteristics identified in the first column. Be sure to include characteristics which will impact the student’s academic, social, and emotional development necessary for successful transition to adulthood. Include APA formatted in-text citations and a list of references used to develop the chart. Note: An example has been provided for you below. Learners With a Learning Disability Common Learner Characteristics Example: SLD Reading. Learner reads 3 years below grade level. Academic and/or Behavior Supports for Common Learner Characteristics Example: Software program highlights and reads aloud text on the screen at an individualized rate. Learners With Attention Deficit Hyperactive Disorder Common Learner Characteristics Academic and/or Behavior Supports for Common Learner Characteristics Copyright 2019 by University of Phoenix. All rights reserved. Common Characteristics and Supports Chart SPED/530 v2 Page 2 of 2 Learners With Behavior Disorders Common Learner Characteristics Academic and/or Behavior Supports for Common Learner Characteristics Gifted and Talented Learners Common Learner Characteristics Academic and/or Behavior Supports for Common Learner Characteristics References (Include APA-formatted citations.) Copyright 2019 by University of Phoenix. All rights reserved. TEACHING Exceptional Children, Vol. 51, No. 5, pp. 372–381. Copyright 2019 The Author(s). DOI: 10.1177/0040059919836990 Executive Function From Frazzled to Focused Supporting Students With Executive Function Deficits Corinne Gist 372 Council for Exceptional Children Ms. Miller is an experienced special education teacher at Huntley Middle School. This year, she has several students on her caseload demonstrating difficulties that she did not notice during her first year of teaching. Students are losing assignments, turning in homework late, missing scheduled practices, and continuing to exhibit ineffective problem-solving strategies, even after receiving feedback. Verbal reminders and loss of points on late assignments have not been effective. Ms. Miller is at a loss for how to help these students. The struggles these students are experiencing are not unique to Ms. Miller’s classroom. Special and general education teachers experience similar challenges on a daily basis. As any teacher will tell you, reminders and lectures to stay focused or to apply oneself are not enough for many children who have deficits in their executive functioning skills. Executive functions are often referred to as the chief operating system of the brain. Currently, there is no one agreed-upon definition for the term executive functions, but it is most often used as an umbrella term for a set of processes or subskills needed for higher-level cognitive functioning (Suchy, 2009). Executive function subskills include task initiation, sustained attention, working memory, and inhibition. These skills are often referred to as selfdiscipline or self-control by the general public. Additionally, executive functions are related to subskills necessary for higher-order thinking skills, such as planning, organizing, goal setting, and problem solving. All of these skills develop most rapidly during the preschool years but continue to develop during adolescence and beyond (Zelazo & Carlson, 2012). Students with diagnoses of autism spectrum disorder (ASD), emotional and behavioral disorders, specific learning disabilities (LD), and attention deficit hyperactivity disorder (ADHD) commonly demonstrate deficits in executive function skills (Cole, Usher, & Cargo, 1993; Martinussen & Tannock, 2006; Mattison & Mayes, 2012). In fact, Barkley (2012), a leading expert on ADHD, states that, at its base, ADHD is an executive functioning disorder. Deficits in executive functions can lead to many difficulties for students with disabilities. Research has shown a strong correlation between deficits in executive functions and deficits in academic performance and socialemotional functioning (e.g., Best, Miller, & Naglieri, 2011; Clark, Prior, & Kinsella, 2002). In addition, results of a longitudinal study reported that a self-control assessment given to children 3 to 11 years old predicted physical health, substance dependence, socioeconomic status, and the likelihood of a criminal conviction by age 32, even after controlling for social class of origin and IQ score (Moffitt et al., 2011). Deficits in self-control were correlated with poorer outcomes later in life. Difficulty with impulsivity, problem solving, and planning also affect an individual’s ability to make and maintain friendships (Diamantopoulou, Rydell, Thorell, & Bohlin, 2007). With executive function skills affecting so student’s individualized education program. Data can be collected in the same manner as data are collected on academic goals. If students are able to plan, organize, stay on task, and problem solve, they may not need additional interventions that would otherwise be required. Ms. Miller attended a teacher preparation program that was known for its strong application of applied behavior analysis and prides herself on her ability to apply behavioral principles in her classroom. She runs a well-structured classroom that includes clear behavioral expectations, classwide and individual reinforcement systems, and individual supports for challenging behaviors. Despite the structure Ms. Miller provides for her students, she is frustrated by her inability to help students with executive function deficits to stay organized, manage their time, and problem solve in their daily lives. For example, one of Ms. Miller’s students, Samantha, has difficulty bringing the correct materials to math Improving executive function skills also increases students’ abilities to perform academic, social, and daily living tasks and decreases off-task and challenging behaviors. many aspects of a student’s life, it is important for teachers to find ways to mediate these deficits in the classroom. With state testing requirements, response to intervention (RTI), and positive behavior interventions and supports (PBIS), teachers have more responsibilities than ever before. Adding one more skill set for teachers to address may seem overwhelming; however, deficits in executive function skills are often related to academic and behavior problems that lead to referrals to the RTI or PBIS team. Improving executive function skills also increases students’ abilities to perform academic, social, and daily living tasks and decreases off-task and challenging behaviors (Best et al., 2011; Clark et al., 2002). Executive function skills can also be addressed on a class. She will often show up to class without her calculator, protractor, or graph paper. Samantha always appears embarrassed and apologizes for forgetting her materials, but her behavior has not changed. Ms. Miller allows Samantha to retrieve her items from her locker, but, in turn, Samantha misses the first 5 minutes of instruction. After speaking with Samantha’s other teachers, Ms. Miller learns that this a common problem for Samantha. She is also forgetting to bring her textbook, homework, and materials to her English, social studies, and physical education (PE) classes. Samantha’s grades are suffering due to her difficulty with staying organized. She is failing PE because she often forgets her gym clothes at home or leaves them in her locker. TEACHING Exceptional Children | May/June 2019 373 Fortunately for Ms. Miller, she already has the tools needed to help Samantha and her other students struggling with similar difficulties. The behavioral principles she uses to prevent and address challenging behavior can also be applied to assist students with executive function deficits. Figure 1. Task analysis for Samantha Task: Samantha will bring her materials to class. 1. Go to locker after each period. 2. Take out checklist of needed materials for your next class (hung on locker door with magnetic clip). 3. Check off each item on checklist as you put them into your book bag. 4. Put checklist back on top shelf of locker and close locker. How Do I Teach Executive Functioning Skills Using Behavioral Principles? From the behavioral perspective, executive function skills involve selecting, monitoring, and revising behavioral strategies. These strategies are then used to develop (and revise) an appropriate plan (Borkowski & Muthukrishna, 1992, as cited in Hayes, Gifford, & Ruckstuhl, 1996). Executive function skills allow students to (a) set goals and engage in behaviors that lead to achieving those goals, (b) engage in behaviors that are consistent with the chosen goals and avoid behaviors that are not, and (c) self-evaluate behavior and change course if the plan is not leading to the desired outcome. All of these behaviors are observable and measurable and can be taught using behavioral strategies. Step 1: Define the Behavior Before beginning the process of teaching new skills, teachers must first determine what it is they want to teach—they must define the target behavior. Defining the target behavior simply means stating what the student should do and describing the behavior in observable and measurable terms. For example, stating that Samantha needs to be more organized is not an observable or measurable statement. What does it mean to be organized? How can her teacher measure it? What is meant by more? Instead of saying, “Be more organized,” Samantha’s teacher could state, “Samantha will bring all her materials to class.” Her teacher can create a list of the materials needed and observe and measure how often Samantha brings those materials to class. 374 Council for Exceptional Children 5. Walk directly to class with bookbag and materials. Step 2: Provide Reinforcement One of the most important steps in teaching a new behavior is providing reinforcement. Reinforcement involves adding or subtracting something from the environment immediately after a behavior that increases future frequency of the behavior under similar circumstances (Cooper, Heron, & Heward, 2007). Therefore, if the reinforcer does not increase the student’s behavior, it is not a reinforcer for that student. It is crucial that reinforcers are individualized for each student—what is reinforcing for one student may not be for another. For example, Amber’s behavior may be reinforced by social praise, whereas Russell’s behavior may be reinforced by extra opportunities to play on the computer. In addition, reinforcers may change over time, especially for younger students and students with short attention spans. It is important to collect data on each student’s behavior and adjust the reinforcers as needed. Ms. Miller and Samantha discuss reinforcer options and decide that Samantha will earn buckeye bucks to spend at the school store. Samantha will have the opportunity to shop at the school store on Fridays. Ms. Miller knows that for some students, it may be best to make the exchange period (when the students can spend their money) indiscriminable. In other words, students do not know which day of the week they will get to visit the school store. This approach is best for students who may engage in the desired behaviors only toward the end of the week or right before they are able to cash in for the terminal reinforcer. Samantha is able to wait until Friday to shop at the store. In addition, her behavior is also reinforced by the positive praise she receives when she earns the buckeye bucks. Step 3: Create a Task Analysis After the target behavior is defined, the teacher can begin teaching the new behavior. The first step is to analyze the behavior by creating a task analysis. A task analysis involves breaking down complex or multistep skills into smaller, easier-to-learn subtasks (Heward, Alber-Morgan, & Konrad, 2017). The number of steps required will be determined by each student’s individual needs and skill set. Task analysis can be used to teach a variety of skills, from cleaning tables (R. Smith, Collins, Schuster, & Kleinert, 1999) to training teachers to teach literature (Browder, Trela, & Jimenez, 2007). For example, Bryan and Gast (2000) taught students with highfunctioning autism on-task and on-schedule behaviors using a task analysis and picture schedule system. Figure 1 provides an example of a task analysis that could be used to teach Samantha to bring her materials to class. This task analysis was designed specifically for Samantha and may need to change if used with another student. For example, a teacher may add additional steps, combine steps, or exclude steps that are not needed. Step 4: Create a Chaining Plan Once the task analysis is complete, chaining can be used to teach the new Figure 2. Forward, backward, and total task chaining set of behaviors. Chaining involves individually teaching each step of the task analysis to create a chain or set of behaviors and has been used to teach functional and academic skills to individuals of all ages (Purrazzella & Mechling, 2013; Rao & Kane, 2009; Test, Spooner, Keul, & Grossi, 1990). Most, if not all, higher-order thinking skills involve multiple steps and, therefore, will probably be taught using a chaining procedure. Chaining can be useful for students who do not know how to complete some steps, miss or skip steps, or complete some steps incorrectly. There are three types of chaining procedures that are commonly used: (a) forward chaining, (b) backward chaining, and (c) total task chaining (Cooper et al., 2007). In forward chaining, the student is required to complete only the first step in the chain before earning a reinforcer (e.g., prize, reward, praise). Once the first step is mastered, the student is required to complete the first and second steps in order to earn the reinforcer. This pattern continues until the student has completed the entire chain. Backward chaining follows a similar process; however, the teacher begins with having the student complete only the last step in the chain in order to earn the reinforcer. Once the student has mastered the last step, he or she is required to complete the last two steps in the chain to earn the reinforcer, and so on. Last, total task chaining involves working on the entire chain from the start—the student receives training on each behavior in the chain during each session. There are a few points for teachers to consider when deciding which chaining method is best for their student (see Slocum & Tiger, 2011, for an experimental comparison of forward and backward chaining). First, if the student can already complete the first couple steps in the chain, the teacher may want to begin with forward chaining. For instance, if a student completes the first few steps of the classroom morning routine (e.g., hang up coat, take lunch out of book bag, hang up book bag) but consistently forgets to take homework out of the book bag and turn it in, the teacher may want to begin with forward chaining. However, if the last step must be completed, for example, in Samantha’s case (she must bring all her materials to class), the teacher may want to use backward chaining (Najdowski, 2017). The student is responsible for independently completing only the last step, and the teacher can prompt or assist the student through the beginning of the chain. Last, total task chaining is best for students who have the skills needed to complete the entire behavior chain but require additional motivation to do so. For example, total task chaining may be used with a high school student who has the ability to fill out a planner every day but needs some extra motivation (or reinforcement) to do so. Total chaining is not the best option for students who are easily frustrated with long tasks (Najdowski, 2017). See Figure 2 for a summary of chaining options. Ms. Miller sits down with her team to create a plan to assist Samantha with bringing her materials to class. The plan includes the use of chaining, prompting, reinforcement, fading prompts, and self-management strategies. The first component involves teaching Samantha the behavior chain described in the task analysis in Figure 1. Ms. Miller’s teaching assistant, Ms. Gebhardt, will walk Samantha through Steps A, B, C, and D. In order to earn the reinforcer, Samantha is responsible only for independently walking to class TEACHING Exceptional Children | May/June 2019 375 Figure 3. Example of prompts that may be used when teaching a new skill Target: Complete morning routine. 1. Hang up backpack. 2. Put lunch in bin. 3. Take out bell work, notebook, and pencil. Prompt Type Definition Examples Verbal Involves spoken or written words for hints, cues, reminders “Sheri, please take out your morning routine checklist. Remember, your first step is to hang up your book bag.” Visual Visual cue or reminder of desired behavior Sheri has a checklist on her desk that contains words and/or pictures that represent each step in the chain. Gestural Pointing or moving eye gaze towards the item The teacher points to the checklist to show Sheri which step is next. Modeling Demonstrating the behavior for the student The teacher hangs up Sheri’s book bag and then has Sheri hang up the book bag herself. Additional Auditory/ Tactile Prompts Devices that can prompt the start of a behavior or shorten/lengthen the duration of a behavior The teacher sets a timer and vibrating device (e.g., MotivAider®) and has Sheri complete all the steps before the timer goes off. with her materials (Step D). After she reaches some set criteria for independently completing Step D (e.g., independently walks to class with materials for 3 consecutive days), she will be required to put her checklist away (Step C) and walk to class with her materials (Step D) to earn the reinforcer. Step 5: Select Prompts Once the task analysis is complete and the chaining procedure has been selected, the teacher must determine what types of prompts the student will need in order to engage in the behavior. Prompting involves providing some type of assistance in order to evoke a target behavior. For instance, if the teacher asks the entire class to line up and one student does not do so, the additional verbal direction or gesture given to that student is a prompt. As with the other steps, the number and types of prompts required will be individualized for each student. Using prompts in the classroom is a successful strategy for assisting students with LD, autism, and other disabilities (Garfinkle, & Schwartz, 2002; Moore, Anderson, Glassenbury, Lang, & Didden, 2013; Rouse, AlberMorgan, Cullen, & Sawyer, 2014). 376 Council for Exceptional Children Figure 3 provides examples of prompts for a target behavior. Ms. Miller has decided that Ms. Gebhardt will use verbal and visual prompts to assist Samantha in learning to bring her materials to class. Ms. Miller and Samantha will create a list of the steps Samantha must follow to assure she brings her materials to class (i.e., task analysis). Additionally, they will create lists of the materials she needs for each class. These lists will be posted in her locker. Last, Ms. Gebhardt will meet Samantha at her locker and provide verbal prompts as she learns each step in the behavioral chain. Ms. Gebhardt’s assistance will be faded as Samantha becomes more independent. Step 6: Create a System for Data Collection In addition to consistently providing reinforcement, data must be collected when teaching a new skill. Collecting and analyzing data is the only way to determine if the student is learning the new skill. Data also help in making decisions regarding when to add or fade prompts, change the teaching method (e.g., forward chaining vs. total task chaining), or begin teaching a new skill. Including the student in the data collection and analysis can add extra motivation for the student. Most students enjoy seeing their progress in graph form. The task analysis created for Samantha will also serve as the data collection form (see Figure 4) Ms. Gebhardt will use to collect data on Samantha’s progress. Ms. Gebhardt will circle the type of prompt needed for each step in the chain. For example, if Samantha forgets to walk to her locker after class and needs a verbal prompt to do so, Ms. Gebhardt will circle the V for verbal prompt. If Samantha requires only a gestural prompt for the next step, Ms. Gebhardt will circle the G. Last, if Samantha is able to complete a step without any prompts, Ms. Gebhardt will circle the I to indicate Samantha completed the step independently. Once Samantha has independently completed the determined step(s) for 3 consecutive days, the next step will be added to the chain. Step 7: Prevent Prompt Dependency (Fading and Self-Management) The ultimate goal of teaching any skill, whether it be academic, social, or related to executive functions, is to Figure 4. Data sheet for Samantha Week of: Step Day: Monday Tuesday Wednesday Thursday Friday Go to locker after class. I G V I G V I G V I G V I G V Take out checklist of materials for your next class. I G V I G V I G V I G V I G V Check off each item on checklist as you put them into your book bag. I G V I G V I G V I G V I G V Hang checklist back on door and close locker. I G V I G V I G V I G V I G V Walk directly to class. I G V I G V I G V I G V I G V I_____ G____ V____ I_____ G____ V____ I_____ G____ V____ I_____ G____ V____ I_____ G____ V____ Total Prompt Key: I: Independent have the student be able to complete the task independently. Many times, the steps are put into place, but teachers forget to slowly fade the prompts and thin the schedule of reinforcement. Fading prompts involves decreasing the number of prompts given for a particular step or set of steps. If prompts are withdrawn too quickly, the student may regress in his or her progress; however, if prompts are not faded at all, the student may become prompt dependent and demonstrate the target behaviors only when prompted. Thinning the reinforcement schedule means increasing the requirements for receiving reinforcement. For example, initially Samantha may earn a buckeye buck for every class period she brings her needed materials. The teacher could thin her reinforcement schedule by requiring her to bring her materials to all of her classes in order to earn the buckeye buck. The decision to fade prompts and thin reinforcement should be made based on the student’s data. As prompts are faded, teachers should work with the student to create a self-management plan. Selfmanagement is defined as “the personal application of behavior change tactics that produces a desired G: Gesture Notes V: Verbal change in behavior” (Cooper et al., 2007, p. 578). Self-management is often used as a blanket term to cover a group of behaviors including self-monitoring (self-recording), self-evaluation, and self-delivered reinforcement (Cooper et al., 2007). Self-management interventions can improve an individual’s awareness of his or her behavior, minimize the need for external supports, and increase maintenance and generalization of behavior change (Cooper et al., 2007). It is important to transfer the responsibility of prompting and reinforcing the behavior to the student, as the student is the only one who is always present when the behavior is exhibited. In addition, learning self-management skills will increase independence and reduce reliance on the teacher. A recent meta-analysis (Lee, Simpson, & Shogren, 2007) found that self-management interventions for individuals with ASD successfully increased appropriate behaviors across several domains (e.g., problem behavior, academic performance, daily living skills). Additional research has found similar results for students with ADHD, LD, and emotional and behavioral difficulties (Alsalamah, 2017; for a review, see Briesch, & Briesch, 2016). For easy-to-use self-management strategies, see Joseph and Konrad (2009). Once Samantha independently completes the entire behavior chain, the verbal prompts from her teacher will be faded. Samantha will keep the list of materials for each class in her locker and independently use them when needed. Additionally, Samantha will need to bring all of her needed materials to class in order to earn her buckeye buck. As Samantha increases her independence, the number of consecutive days she is required to bring her materials in order to earn the buckeye buck will gradually increase. Ms. Miller has helped Samantha and her other students strengthen their executive functioning skills by applying behavioral procedures. She is confident her students have learned the skills needed to successfully transition into high school. Ms. Miller’s students will use their self-management plans to stay organized, set goals, and problem solve for years to come. Putting It All Together The steps for teaching executive function skills are versatile—they can be used to teach of range of skills to a range of students. Here is an example TEACHING Exceptional Children | May/June 2019 377 Figure 5. Checklist for Nathan Directions: Complete the checklist at the end of each school day. Mark yes if the step is complete; mark no if the step is not complete or if Nathan needs prompts to complete the step. Total the yes and no responses at the bottom of the checklist. Task Yes No 1. Each academic subject is listed for today and tomorrow 2. Each subject has an assignment listed and includes the following information a. The name of the assignment b. The due date of the assignment c. The estimated amount of time needed to spend on the assignment each night 3. Completed assignments are crossed off 4. After-school activities are listed and include the following information a. The time of the activity b. The location of the activity c. Supplies and equipment needed Total of how to put all the steps together. This scenario follows Nathan, a student who is struggling with staying organized and managing his time, as he works with his guidance counselor to develop a plan. Nathan is an 11th grader who is involved in many activities at school. He is on the soccer team and hopes to receive a scholarship to play soccer in college. Nathan’s school counselor advised him to become involved in other school activities to increase his chances of receiving a college scholarship. This school year, Nathan has joined the yearbook club, is active in the gaming club, and volunteers at the local food bank. In addition to these activities, he receives academic tutoring three times a week. Over the past semester, Nathan has started missing practices, meetings, and assignments. Nathan and his teachers agree that he needs to create a plan to assist him in managing all of his responsibilities. 1. Define the target behavior. Nathan will complete his planner checklist at the end of each school day. Although Nathan may have more to work on than just writing in his 378 Council for Exceptional Children planner, this skill is currently the top priority. Nathan admits that he cannot remember when his assignments are due, the dates of his club meetings, or what time he has practice. Completing his planner each day will allow him to keep track of all of his responsibilities. Once he has mastered this skill, the team can create a plan to work on related skills. 2. Determine reinforcement plan. Mr. James, Nathan’s guidance counselor, will provide verbal praise when Nathan independently completes steps on his checklist. Additionally, Nathan will receive naturally occurring social reinforcement from his coaches and teachers when he decreases the number of missing assignments and practices. Additional tangible reinforcement (e.g., snacks, school store bucks, gift cards) can be added if needed. 3. Create a task analysis (planner checklist). Nathan and Mr. James create a planner checklist for Nathan to complete each day (see Figure 5). Mr. James knows that if Nathan writes down his meetings, practices, and assignments, he will be more likely to remember them and, in turn, attend and complete them. Nathan is responsible for deciding which details he needs to record for each activity (e.g., time of event, materials needed, length of activity). 4. Decide on a chaining plan. Mr. James determines that total task chaining will be used to assist Nathan with completing this checklist. Nathan has the skills to complete each step but requires additional prompts to write in his planner each day. 5. Select a prompting procedure. When the plan is first implemented, Mr. James will sit with Nathan at the end of each school day to complete his checklist. Mr. James will provide verbal prompts only for the steps that Nathan does not complete on his own. Verbal prompts may include information on the activity (e.g., due date, practice start time) or reminding him where to look for certain information. For example, if Nathan does not have any after-school activities listed, Mr. James may tell Nathan to check his e-mail for his volunteer schedule or to check his Figure 6. Additional resources Topic Reinforcement Selfmanagement Teaching Executive Functions Resource Description Perle, J. G. (2016). Teacher-provided positive attending to improve student behavior. TEACHING Exceptional Children, 48, 250-257. A practitioner paper with practical strategies for implementing positive attending in the classroom Smith, K. (2016, December 2). Positive reinforcement in the classroom: Tips for teachers. Retrieved from https:// cehdvision2020.umn.edu/blog/positive-reinforcementteacher-tips/ A teacher tip sheet for implementing positive reinforcement in the classroom National Center on Intensive Intervention (February, 2016). Reinforcement strategies. Washington, DC: U.S. Department of Education, Office of Special Education Programs, National Center on Intensive Intervention. Retrieved from https://intensiveintervention.org/sites/default/files/ Reinforcement_Strategies_508.pdf A tip sheet describing positive reinforcement strategies Joseph, L. M., & Konrad, M. (2009). Have students selfmanage their academic performance. Intervention in Schools and Clinic, 44, 246-249. A practitioner paper with 10 easy to use self-management tools Schulze, M.A. (2016). Self-management strategies to support students with ASD. TEACHING Exceptional Children, 48, 225-231. A practitioner paper with strategies for implementing self-management with students with ASD. Najdowski, (2017) A. C. Flexible and focused: Teaching Executive Function Skills to Individuals With Autism And Attention Disorders A manual that includes ready-toimplement lessons for executive functioning skills Dawson, P., & Guare, R. (2009) Smart But Scattered: The Revolutionary “Executive Skills” Approach to Helping Kids Reach Their Potential A book that provides information on identifying, assessing and teaching executive function skills to children soccer team’s web site for his practice and game schedule. 6. Collect data. Data will be collected using the task analysis/checklist in Figure 5. Each day, Mr. James and Nathan will count the number of responses of yes and no and graph the totals. If either total stays stagnant or moves opposite of the desired direction, additional interventions (e.g., additional prompts or reinforcement) will be introduced. 7. Fade prompts and develop selfmanagement plan. When Nathan has completed all the steps on the checklist, without prompts, for 3 consecutive days, Mr. James and Nathan will decrease their meetings from 5 to 4 days each week. The number of meetings a week will continue to decrease until Nathan is able to independently complete the checklist. When Nathan becomes independent with the checklist, the team may want to create a new plan to assist Nathan in managing his time. This plan could include creating a daily schedule that specifically indicates the time of day and duration of time Nathan will spend on each activity. For additional information on teaching time management skills, see the resources listed for Teaching Executive Functions in Figure 6. Conclusion When students struggle with executive function skills in the classroom, it affects all aspects of their learning. Fortunately, teachers can use behavioral principles to teach their students the skills they need to be successful. When target behaviors are clearly defined, a task analysis is created, appropriate reinforcers are selected and delivered, a chaining plan and prompt procedures are put in place, data are collected, and responsibility for implementing the plan is slowly transferred to the student, independence can be achieved. By following the steps outlined in this article, teachers can teach their students to independently organize, plan, and TEACHING Exceptional Children | May/June 2019 379 manage their time. Mastering these skills will allow students to succeed in school and life. References Alsalamah, A. (2017). Use of the selfmonitoring strategy among students with attention deficit hyperactivity disorder: A systematic review. Journal of Education and Practice, 8, 118–125. Barkley, R. A. (2012). Executive functions: What they are, how they work, and why they evolved. New York, NY: Guilford Press. Best, J. R., Miller, P. H., & Naglieri, J. A. (2011). Relations between executive function and academic achievement from ages 5 to 17 in a large, representative national sample. Learning and Individual Differences, 21, 327–336. doi:10.1016/j.lindif.2011.01.007 Briesch, A. M., & Briesch, J. M. (2016). Meta-analysis of behavioral selfmanagement interventions in single-case research. 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D., & Carlson, S. M. (2012). Hot and cool executive function in childhood and adolescence: Development and plasticity. Child Development Perspectives, 6, 354–360. doi:10.1111/ j.1750-8606.2012.00246.x Corinne Gist, doctoral candidate, Department of Special Education, The Ohio State University, Columbus. TEACHING Exceptional Children, Vol. 51, No. 5, pp. 372–381. Copyright 2019 The Author(s). Address correspondence concerning this article to Corinne Gist, The Ohio State University, 305 Annie and John Glen Ave, Columbus, OH 43201 (e-mail: email@example.com). We are delighted to announce the launch of a streaming video program at SAGE! SAGE Video online collections are developed in partnership with leading academics, societies and practitioners, including many of SAGE’s own authors and academic partners, to deliver cutting-edge pedagogical collections mapped to curricular needs. Available alongside our book and reference collections on the SAGE Knowledge platform, content is delivered with critical online functionality designed to support scholarly use. SAGE Video combines originally commissioned and produced material with licensed videos to provide a complete resource for students, faculty, and researchers. NEW IN 2015! • Counseling and Psychotherapy • Education • Media and Communication sagepub.com/video #sagevideo TEACHING Exceptional Children | May/June 2019 381 Copyright of Teaching Exceptional Children is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. TEACHING Exceptional Children, Vol. 51, No. 3, pp. 175–188. Copyright 2018 The Author(s). DOI: 10.1177/0040059918820051 Dyslexia The Neurobiology of Dyslexia Devin M. Kearns , Roeland Hancock, Fumiko Hoeft, Kenneth R. Pugh, and Stephen J. Frost Advances in neurobiological research have created new opportunities for understanding and exploring dyslexia. The purpose of this article is to (a) provide a straightforward, although not overly simplified, overview of neurological research on dyslexia and (b) make connections between neurological research and classroom interventions for students with dyslexia. Key ideas are that neuroscience confirms the importance of systematic phonics instruction, neuroimaging has led to new ideas about how dyslexia might be treated, and specific brain regions and pathways are involved in reading. Educational neuroscience remains in early stages, but the immediate relevance for the classroom is emerging. The term dyslexia refers to difficulty in reading, a type of specific learning disability, sometimes called a reading disability or disorder. Dyslexia is complex, and varied definitions exist across educational, medical, and governmental organizations (Table 1). Despite the many differences, most definitions include one common characteristic—difficulty recognizing words. That is, students with dyslexia will encounter difficulty identifying or pronouncing familiar and unfamiliar words accurately and fluently (Hancock, Gabrieli, & Hoeft, 2016; Hulme & Snowling, 2017; Mabchek & Nelson, 2007; Tanaka et al., 2011). Individuals with dyslexia often have unknown words by decoding them. In alphabetic languages such as English, readers link the graphemes (written units that represent sounds; e.g., c or ck) to the phonemes (sounds of a language; e.g., /k/). This happens in two ways (see Figure 1). One way involves attention to letters and letter patterns—readers link graphemes to phonemes and assemble the phonemes to say a word, as in the top path for cat. Mapping letters and letter patterns to phonemes is decoding, also called phonics or sounding out. The other way that readers connect letters to the sounds in a word is through whole-word or sight recognition. Sight recognition occurs only when a reader has previously encountered a word and memorized the pronunciation of the printed word, as in the bottom path, where the letters are linked directly to the pronunciation. Most developing readers will partly rely on sight memory and partly on decoding for words that they have seen (they may remember some letters but not others). Neuroimaging allows researchers to understand how readers with dyslexia use decoding and sight recognition to read words and how the reading behavior of students with dyslexia differs from that of students with typical reading development. Why Study Neurobiology? In special education, many researchers and practitioners focus on students’ Neuroimaging allows researchers to understand how readers with dyslexia use decoding and sight recognition to read words and how the reading behavior of students with dyslexia differs from that of students with typical reading development. other difficulties, as some definitions in Table 1 address (e.g., reading comprehension challenges). However, this is often the result of word-reading difficulty rather than a core aspect of dyslexia. Word reading is the ability to pronounce real words quickly and accurately and the ability to read 176 Council for Exceptional Children observed difficulties when reading, rather than the possible internal processes that cause dyslexia. For example, researchers will examine the effects of specific approaches to wordreading instruction on students’ wordreading ability (Reschly, 2005). Examining the relation between specific approaches to reading instruction and changes in the reading ability of students with reading disabilities and those at risk for reading failure has resulted in a strong body of knowledge related to effective reading instruction for students with dyslexia (e.g., Wanzek et al., 2013). Therefore, the benefits of understanding the neuroscience of reading (i.e., the internal processes associated with reading behavior) may not be apparent. Some special educators are also wary of neuroscience because they associate it (understandably but not correctly) with the “brain based” education of the 1960s and 1970s. At that time, the promoters of the “Doman-Delacato treatment of neurologically handicapped children” (Doman, Spitz, Zucman, Delacato, & Doman, 1960) said that reading difficulties were caused by brain damage that could be reversed with activities such as crawling, breathing through masks, and doing somersaults. Others recommended cognitive interventions based on students’ cognitive profiles identified by the Illinois Test of Psycholinguistic Abilities. These “brain based” interventions became very popular, but studies showed that they did not improve students’ reading (American Academy of Pediatrics, 1982; Hammill & Larsen, 1974). There are more “brain based” or “cognitively focused” interventions available today, but most do not have supporting evidence (see Burns et al., 2016; Kearns & Fuchs, 2013). Despite the misuse of the concept of “brain based” approaches, an understanding of the neurobiology of dyslexia can be beneficial to special educators for several reasons. First, examining the brain at a fine-grained level can provide insights about how students are performing in ways that performance (i.e., evaluations of external behaviors) on tests cannot. For example, researchers have shown that data from brain scans can demonstrate whether students will respond to reading instruction even before it begins (Hoeft et al., 2007; Hoeft et al., 2011). In theory, these kinds of data could be used to decide the intensity of intervention needed to help a TEACHING Exceptional Children | January/February 2019 177 Decoding, fluency, reading comprehension, recall, spelling, writing. Possible related skills: speech Not addressed. Skills in broader category (specific learning disability): reading, spelling, speaking, writing “A specific learning disability that affects reading and related language-based processing skills. The severity can differ in each individual but can affect reading fluency, decoding, reading comprehension, recall, writing, spelling, and sometimes speech and can exist along with other related disorders. Dyslexia is sometimes referred to as a Language-Based Learning Disability.” None—given as a type of specific learning disability “Dyslexia is a primary reading disorder and results from a written word processing abnormality in the brain. It is characterized by difficulties with accurate and/or fluent sight word recognition and by poor spelling and decoding abilities. These difficulties are unexpected in relation to the child’s other cognitive skills” (p. 838). Learning Disabilities Association of America (n.d.) Individuals with Disabilities Education Act (2004) American Academy of Pediatrics Section on Ophthalmology et al.a (2009) Phonological processing. Also in some individuals: rapid visual-verbal processing, working memory, attention Learning disabilities Note. DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; ICD-10-CM = International Classification of Diseases, Tenth Revision, Clinical Modification, maintained by the World Health Organization; NCLD = National Council for Learning Disabilities; NINDS = National Institute of Neurological Disorders and Stroke. aJoint statement from the American Academy of Pediatrics Section on Ophthalmology, Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Academy of Certified Orthopedists (2009). Most definitions also implicitly or explicit proscribe the inclusion of students with intellectual disabilities from the category of dyslexia. Word reading, fluency, spelling Specific reading disorder Not addressed Reading achievement. Skills in broader category (specific reading disorder): reading comprehension, spelling, word recognition, writing “Developmental dyslexia is marked by reading achievement that falls substantially below that expected given the individual’s chronological age, measured intelligence, and age-appropriate education.” ICD-10-CM Diagnosis Code F81.0 Specific learning disability Specific learning disorder Not addressed Decoding, fluency, spelling. Skills in broader category (specific learning disorder): reading comprehension, spelling, writing, word reading None—given as a type of “specific learning disorder” American Psychiatric Association (2013), DSM-5 Language processing Learning disability Not addressed Fluency, word reading. Possible related skills: reading comprehension, spelling, writing “A specific learning disability in reading. Kids with dyslexia have trouble reading accurately and fluently. They may also have trouble with reading comprehension, spelling and writing.” Understood Team of NCLD (n.d.) Learning disability None given “Phonological component of language” Decoding, spelling, word reading. Possible related skills: background knowledge, reading comprehension, vocabulary “Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/ or fluent word recognition and by poor spelling and decoding abilities.” International Dyslexia Association Board of Directors (2012) Language processing None given Superordinate category Phonological processing. Rapid visual-verbal processing Identified cognitive processes Decoding, fluency, reading comprehension, spelling Included skills “Dyslexia is a brain-based type of learning disability that specifically impairs a person’s ability to read.” Definition NINDS of the National Institutes of Health (n.d.) Source Table 1. Different Definitions of Dyslexia Figure 1. Two ways a reader might pronounce the printed word cat to provide a straightforward picture of the state of the art in the neuroscience of dyslexia to provide an understanding of what neuroscience can and cannot presently demonstrate about reading and dyslexia. Neurobiology and Reading struggling reader. Although researchers have yet to make instructional decisions for individual students on this basis, the fact that neuroimaging data can provide information that tests cannot is alone one reason for educators to understand what neuroscientists have learned about how the brain works when students read. Another benefit of knowing what parts of the brain are activated during reading is that this location-based information is now being used to develop new reading interventions that target the specific brain regions implicated in dyslexia. For example, some researchers found that stimulating certain reading-related regions of the brain with a tiny electrical current (safely and nonsurgically) in adults (Turkeltaub et al., 2012) and school-age students (Costanzo et al., 2016; Costanzo et al., 2018; Costanzo, Menghini, Caltagirone, Oliveri, & Vicari, 2013) during reading leads to more improvement in reading as compared with nonstimulated reading conditions. This promising, albeit unique, technology can work because researchers know what part of the brain to stimulate. Neuroscientific reading research makes that possible. Finally, a benefit of showing how the brain operates during reading is that it provides an objective understanding of how reading works. If it is known what brain regions are strongly activated during reading and what their general functions are, it is possible to understand how the brain 178 Council for Exceptional Children operates when a student tries to read a word. Neuroscience now provides such information. Without neuroimaging data, it might be easy to argue about the processes that readers use to Neurobiology is a way of describing the organization of the brain and the uses of its various parts. The brain has four main lobes—the frontal, parietal, temporal, and occipital lobes in each hemisphere—as well as the cerebellum, subcortical nuclei, and brainstem that underlie these. Although humans constantly use all of these systems, researchers have long known that different regions within these lobes are more active during some tasks than others. The systems of the brain Neurobiology is a way of describing the organization of the brain and the uses of its various parts. recognize words and the instruction that will help them best—as was the case in the past (e.g., Adams, 1990). With neurological data, however, researchers and educators can know how the brain processes word information with little room for debate. It may not end disagreements about how reading works or what kind of instruction is best, but neuroscience provides an objective biological starting point that can offer some clarity. For these reasons, we think that it is worthwhile for educators to understand the neurobiology of reading among students with and without dyslexia. It is also important to acknowledge the limitations of the neuroscientific research on dyslexia. Neuroscience has improved our understanding of reading, dyslexia, and the effects of reading intervention, but it has not yet resulted in direct changes to instructional approaches for students with dyslexia (Bowers, 2016; Gabrieli, 2016). There are other limitations and many things still to learn. One goal of this article is support many basic human functions, such as movement and communication. However, reading is unique because it is not an innate human ability. Humans invented reading more than 5,000 years ago (Daniels, 2001) primarily to allow efficient, direct communication with others without being in the same place (Seidenberg, 2017). What makes reading remarkable is that humans can learn to do it with such great automaticity despite the fact that our brains are not specifically organized to do this (Dehaene, 2009). It is also remarkable that—across many people and cultures—readers use the same parts of the brain to accomplish the task of reading. Researchers are still debating whether reading “takes over” a part of the brain (Dehaene & Cohen, 2011) or whether the reading parts still have other functions. For example, researchers are not sure if the part of the brain that recognizes letters also performs other visual processing tasks (Price & Devlin, 2003). Research is clear on one point, though: Reading does not happen in just one region of the brain. During the reading process, regions from all four lobes work together. Neurobiological research has revealed patterns of coordination among these regions in good readers, demonstrated how the brain scans of students with dyslexia differ, and indicated how reading intervention can change the brain activation patterns of students with dyslexia. Researchers have studied the neurobiology of reading for more than a century. Early studies examined individuals who had acquired wordreading problems as a result of a lesion (e.g., tissue damage as a result of an injury) on the brain (Hinshelwood, 1900). In these studies, individuals with lesions in different areas of the brain demonstrated different kinds of difficulties with word reading. Some had great difficulty reading nondecodable words, such as eye and who, but could still perform decoding tasks. Some had the opposite problem: They could not decode but could remember words that they had read before. Researchers then began to theorize what these patterns revealed about how humans use the brain when they read. Researchers have now developed special techniques to better understand how the parts are being used in people who may not have brain damage—and without surgery. Today, one of the most common technologies used to analyze the reading brain is functional magnetic resonance imaging (fMRI). fMRI allows researchers to see what is happening in the brain using information about how much blood flows to different parts of the brain during the reading process (i.e., while a person is actively decoding). The circulatory system provides oxygen to all parts of the brain at all times, but additional oxygenated blood is provided to some parts of the brain when they are particularly active and have depleted the oxygen. The fMRI machine can detect when there is more oxygenated blood in a part of the brain—the more oxygenated blood, the greater the activation. When individuals participate in neuroimaging research with fMRI, the “functional” part refers to the fact that they perform tasks in the scanner that involve some kind of reading-related processing. For example, words may flash on the screen in rapid succession (Malins et al., 2016). Because it is virtually impossible not to read a word if one knows how, participants will read the words as they are flashed on the screen. Performance on the word-reading tasks can be compared with nonreading performance tasks, such as looking at a picture, so that researchers can identify differences in location and activation levels during reading and nonreading tasks. The Reading Brain in Typical Readers As a result of many fMRI studies, researchers have identified what is now considered the “classical” pattern of activation in the reading brain. Specifically, three regions across the four lobes are involved in decoding or sight recognition reading: the left inferior frontal gyrus in the frontal lobe, the left temporoparietal cortex, and the left occipitotemporal region. fMRI studies of good readers have shown that these regions are more active than other parts of the brain during reading (Price, 2012; Turkeltaub, Eden, Jones, & Zeffiro, 2002). However, the story of the reading brain is a little more complex because researchers have identified areas within these three regions that have a role in reading (Figure 2). Table 2 provides an overview of the regions of the brain and their functions. The Inferior Frontal Gyrus in the Frontal Lobe The inferior frontal gyrus (IFG, in particular the posterior IFG), which overlaps with what some call Broca’s area, has several language-related functions. In reading, the IFG stores information about the sounds that words contain, and it links this information to other representations of the word in the brain and motor regions, even during silent reading (Richlan, Kronbichler, & Wimmer, 2011). The IFG also has a more general role in sequencing information, and researchers think that this may help readers put the sounds in the correct order when they are ready to say a word aloud. The IFG is used regardless of whether the reader decodes the word or recognizes it by sight. Temporoparietal Region The primary areas of focus within the temporoparietal region are the superior temporal gyrus (which overlaps with what some call Wernicke’s area), supramarginal gyrus, and angular gyrus. The superior temporal gyrus is the main speech-processing region and helps extract phonemes from the speech that we hear. The supramarginal gyrus serves as a link between phonemes and graphemes. The angular gyrus may be involved in processing word meanings (Seghier, Fagan, & Price, 2010). The temporoparietal region serves as the decoding center of the reading brain. Occipitotemporal Region The occipitotemporal region includes the fusiform gyrus and the inferior temporal gyrus. This region is very close to the parts of the brain that process visual information. Researchers believe that this region is used to process familiar visual information, such as letters and words (Kronbichler et al., 2004; Schlaggar & McCandliss, 2007). A portion of the fusiform gyrus is sometimes called the visual word form area (McCandliss, Cohen, & Dehaene, 2003). However, not all researchers use this term, because it implies that the region is specialized for words. To the contrary, researchers have shown activation in this area when readers process other types of familiar visual information (e.g., images of objects; Devlin, Jamison, Gonnerman, & Matthews, 2006). The Reading Network The IFG, temporoparietal, and occipitotemporal regions interact to link printed words to sound and meaning. The dorsal pathway uses systems on the top half of the brain (the parts linked by the red line in Figure 2) and is used by TEACHING Exceptional Children | January/February 2019 179 Figure 2. Regions of the reading brain good readers to decode unknown words. Researchers think that readers use the systems in the parietal lobe to link letters to sounds and activate their pronunciations in the IFG. The ventral pathway (shown by the green lines in Figure 2) is used by good readers to read familiar words, likely because known words are recognized in the fusiform gyrus and linked to pronunciation in the IFG (Levy et al., 2009). Finally, the brain has a subcortical system that lies underneath the four regions and above the cerebellum. Its components, the striatum (a region including the caudate nucleus, putamen, and basal ganglia) and the thalamus are thought to have a role in reading as well. However, their contributions are less well understood. The Reading Brain in Readers With Dyslexia The primary difference between developing readers with dyslexia and their peers with typical reading skills is that those with dyslexia show less increase in brain activation in the temporoparietal regions and the occipitotemporal regions during 180 Council for Exceptional Children reading and rhyming tasks (Martin, Schurz, Kronbichler, & Richlan, 2015). Some studies showed that readers with dyslexia even have less gray matter (brain tissue) in the temporoparietal regions that involve decoding and the occipitotemporal regions involved in sight word reading (Richlan, Kronbichler, & Wimmer, 2013). The lower activation and smaller amount of gray matter in these areas align with the fact that students with reading difficulty have weaker decoding skills and more difficulty recognizing words by sight than do their peers with typical reading skills. However, a few studies found that students with dyslexia show some areas of greater activation as compared with their peers with typical achievement. The left precentral gyrus—a region involved in articulation (i.e., the production of speech sounds)—shows more activation in children and adults with dyslexia than that of their typical peers (Richlan et al., 2011). Currently, researchers have hypothesized that readers use articulation to compensate for their weakness in the temporoparietal system that involves decoding (Hancock, Richlan, & Hoeft, 2017). For example, a reader might try to pronounce an unknown word using the visual information without trying to link letters to sounds. This could explain why some readers with dyslexia appear to be guessing when they read—it may be an adaptation that the brain makes due to difficulties in the decoding system. Finally, there is evidence that students with dyslexia activate The primary difference between developing readers with dyslexia and their peers with typical reading skills is that those with dyslexia show less increase in brain activation in the temporoparietal regions and the occipitotemporal regions during reading and rhyming tasks. Table 2. Left Hemisphere Regions of the Cerebral Cortex Involved In Reading Region Posterior inferior frontal gyrus Involved Areas Pars opercularis Pars triangularis (Near) Synonyms Broca’s area Precentral gyrus Temporo-parietal region Parietal • Supramarginal gyrus • Perisylvian regions Angular gyrus Function Pathway Storing and sequencing speech Dorsal and ventral Controlling articulation of speech sounds Dorsala Linking letters and speech sounds Dorsal Processing meaning Dorsal Processes speech Dorsal Processing sight words and meanings Ventral Letter and word recognition Ventral Temporal • Occipito-temporal cortex uperior temporal S gyrus Wernicke’s area Temporal • Middle temporal • gyrus Occipital • Fusiform gyrus • Inferior temporal gyrus Visual word form areab Extrastriate cortex Note. The dorsal pathway is often called the decoding pathway. The ventral pathway is the often called the sight recognition pathway. aActivation in the precentral gyrus is particularly associated with a potentially compensatory mechanism for students with dyslexia. bThis refers to the fusiform gyrus specifically. Many researchers prefer not to use the term visual word form area because activation in this area is not exclusive to words. subcortical regions (parts of the brain covered by gray and white matter), including the striatum and thalamus, more than their typical peers do (Richlan et al., 2011). These regions interact with many other parts of the brain and are involved in motor control (Alexander & Crutcher, 1990), learning (Packard & Knowlton, 2003), and cognitive control (Aron et al., 2007). Parts of the thalamus are involved in attention. The diverse functions of these regions make it difficult to make inferences about their role in dyslexia. Some researchers have suggested that the striatum and thalamus may be important in developing the ability to learn without being taught directly (Ullman, 2004), which is impaired in some individuals with dyslexia (Lum, Ullman, & Conti-Ramsden, 2013) and thought to be important for learning phoneme-grapheme correspondences (Deacon, Conrad, & Pacton, 2008). Others have suggested that these circuits have a direct role in phonological processing (Booth, Wood, Lu, Houk, & Bitan, 2007; Crosson et al., 2013). It is not simple to derive an overall finding from these results, but these areas of overactivation indicate that readers with dyslexia are using other systems to read words rather than relying on the process of mapping graphemes to phonemes as other readers do. In terms of the reading network, poor readers do not always use the pathways in the same way as good readers. For example, they may activate the ventral pathway even when reading nonwords. This is one possible reason why readers with dyslexia try to read nonsense words as real words (Yeatman, Dougherty, Ben-Shachar, & Wandell, 2012). Taken together, these data suggest that readers with dyslexia activate different regions and use different pathways when reading as compared with peers with typical reading. The Reading Brain and Reading Intervention Although neurobiological research has yielded a clearer picture of the reading brain in typical readers and individuals with dyslexia, one of the most promising outcomes relates to findings associated with neurocognitive flexibility. That is, researchers have demonstrated that students’ patterns of brain activation can change as a result of reading intervention (for a review, see Barquero, Davis, & Cutting, 2014). In an increasing number of studies, researchers have placed students with dyslexia in reading interventions designed to improve their wordreading skills—namely, interventions that focus on building their decoding skills. As a result of these interventions, students read words more accurately and fluently. These studies demonstrated that (internal) neurological change was evident as were changes in (external) reading behaviors. The ways in which the brain changes are not completely understood, in part because of the few studies that involve reading intervention and neuroimaging. For this article, we reviewed recent TEACHING Exceptional Children | January/February 2019 181 studies of the effect of intervention on neurobiological processing and Barquero and colleagues’ (2014) analysis of earlier studies. Unfortunately, there are still not enough studies to draw specific conclusions about exactly how intervention changes brain activity. However, the studies almost all included approaches that will not surprise; they are the same kinds of word feature–focused strategies contained in many programs designed for students with dyslexia. Changes in Activation: Implications for Intervention Changes in Activation: Different From Typical Readers The data on these unique patterns among students with dyslexia have led to questions about whether students should learn compensatory strategies—that is, strategies that focus on using the parts of the brain that students with dyslexia appear to use after intervention anyway (e.g., meaning-focused approaches). However, the data are not yet conclusive about the efficacy of targeting compensatory areas only. There are, though, evidence-based approaches that align with a focus on meaning and articulation—areas of higher activation among readers with dyslexia. Neuroimaging data now appear to indicate something that typical intervention studies have not. Successful intervention changes the patterns of activation of students with Meaning-Based Approaches. In terms of meaning, it is possible that students with dyslexia might receive benefits from learning about the meaning parts within words—that is, Researchers have demonstrated that students’ patterns of brain activation can change as a result of reading intervention. dyslexia, but the patterns are still different from those of students with typical achievement (Peck, Leong, Zekelman, & Hoeft, 2018). One important finding is that readers who respond to intervention increase their activation in the precentral gyrus, the region that activates the articulation (physical formation) of sounds in the mouth (Hancock et al., 2017). Students who benefit from reading intervention also appear to rely more on meaning than do their peers with typical achievement. The subcortical systems play a role in processing meaning (Yeatman et al., 2012), so students who respond may be using meaning information to support their reading. Finally, increased activation in the left thalamus in the subcortical region could also indicate improvement involving language and memory; increased right IFG could indicate improvement related to attention; and middle occipital gyrus could indicate a role for visual processing. 182 Council for Exceptional Children morphemes such as re-, -ment, and -s in replacements. Given the possibility that readers with dyslexia are using some meaning information, it may be beneficial to teach students how morphemes affect meaning and how they are used to change the part of speech of base words, as suggested by Ullman and Pullman (2015). Morpheme units are also valuable even within the typical reading system because they are recognizable units that might be processed similarly to familiar words in the occipitotemporal region, and data suggest that students benefit from instruction on morphemes—regardless of the neurobiological data. See Kearns and Whaley (2019; this issue) for further details on how to teach morphological units. Articulation-Based Approaches. For the data showing that readers use information about speech sound formation, one way to help students compensate might be to teach them about how sounds are produced. At least one program, the LindamoodBell Phoneme Sequencing Program (Lindamood & Lindamood, 1998), includes instruction on how sounds are formed in the mouth, including the parts of the mouth that are used (e.g., lips, teeth, tongue), whether the sound is a stop sound (e.g., /p/) or a continuous sound (e.g., /f/), and whether the sound is produced with or without activating the voice. Figure 3 provides a dialogue that a teacher might use to teach a student with dyslexia about the pronunciation of the /p/ and /b/ sounds for the letters p and b. Even though it is not yet clear whether increased activation in the precentral gyrus indicates compensation, the Lindamood-Bell Phoneme Sequencing Program has evidence of increasing reading achievement (e.g., Kennedy & Backman, 1993). As a result, teaching about speech sound formation may help readers even if research has not empirically demonstrated that this approach reflects compensation. It is important to be clear that the word-reading strategies described in Figures 4 and 5 are still essential, even if there are potential benefits of morphological and speech-production instruction. In addition, some researchers have found that instruction does produce a more typical pattern of activation, similar to students without difficulty (Peterson & Pennington, 2015). In short, teachers should use evidence-based phonological strategies for word-reading instruction, but they might consider some supplemental instruction on morphemes or speech production for some students. The phrase “for some students” is important. Students with dyslexia begin intervention with unique patterns of brain activity during reading, so they will not all respond exactly the same way to instruction. Phonological word-reading strategies should be used for teaching all students (National Institutes of Child Health and Human Development, 2000; Stuebing, Barth, Cirino, Francis, & Fletcher, 2008), but educators can Figure 3. A dialogue between a teacher (wider boxes) and student designed to teach the production of the speech sounds /p/ and /b/ associated with the letters p and b optimize instruction by considering additional strategies when students do not respond. Complexities Associated With Neurobiological Reading Research At the outset of this article, we described that students are typically identified with dyslexia because they have poor word-reading skills. The problem for reading researchers and educators is that there are many reasons why students might exhibit poor reading skills (see Table 3). Difficulty linking letters to speech characterizes most cases of dyslexia, but there are other factors related to reading difficulty that could result in a diagnosis of dyslexia. Some students have difficulty in all academic areas, not just reading. Others may have attention, emotional, or behavioral difficulties that make it hard for them to stay focused during reading instruction. Another group may struggle due to an inadequate amount of evidence-based wordreading instruction. In the early elementary grades, students require extensive instruction and practice to help them learn grapheme-phoneme connections and recognize many words by sight. Some kinds of instruction—especially explicit, systematic phonics instruction—are especially effective in helping students acquire word-reading skills. In its absence, some students will not develop good word-reading skills. In short, there are many possible reasons why students may experience difficulty learning to read. It is tempting to think that the effects of attention, inadequate instruction, and inherent problems processing graphemes and phonemes can be separated by analyzing fMRI data, but they cannot. It can be hard to separate students with dyslexia from those with attention difficulty because children often have both problems and it is difficult to separate issues of attention from those related to dyslexia. In terms of inadequate instruction, individuals with reading problems often have patterns of activation similar to those of students with dyslexia before they receive instruction (Dehaene et al., 2010). Thus, researchers cannot identify the source of reading problems, even using advanced neuroimaging techniques. Therefore, although neurobiological research has yielded new insights about the reading brain of students with dyslexia in general, the research TEACHING Exceptional Children | January/February 2019 183 Figure 4. Words and sound-spelling units that students with dyslexia need to learn article reflect studies where performance has been combined across many students. This body of research has resulted in a deeper understanding of components and related areas of the reading brain, but fMRI data cannot yet be used to diagnose and identify interventions for individual students. Conclusion has not resulted in the identification of unique groups of students to target instruction. We are also still unable to scan students, determine their patterns of activation during reading, and 184 Council for Exceptional Children decide on appropriate instruction. However, researchers think that this may be possible, and they have made some progress in this direction (Hoeft et al., 2011). The data presented in this As we have made clear, researchers have a strong understanding of how readers use their brains to read and how the patterns of activation differ between students with and without dyslexia. In addition, researchers’ understanding of the relation between intervention and neurobiological change continues to improve— although there is much more work to do in this area. Overall, there are several key findings about the neurobiology of reading among students with dyslexia. First, individuals with good and poor reading differ in their patterns of activation, in terms of the degree to which they activate parts of the brain associated with reading, such as recognizing familiar print (the occipitotemporal region), linking letters and sounds (the temporoparietal area), and processing phonemes (the inferior frontal gyrus). Importantly, readers with dyslexia are not just showing less activation overall; they show a different pattern of activation. In other words, their brains are not working more slowly— they are working differently. The second important finding is that when students with dyslexia successfully participate in reading interventions, their patterns of brain activation do not always end up the same as those of students with typical reading achievement. These differences occur even when students with dyslexia participate in phonicsfocused, word-reading interventions. This means that a foundational word-reading intervention will help students with dyslexia, but there are still differences in the brain. The data showing differences may also suggest that students with dyslexia might benefit from different kinds of instruction—but the data on this are not conclusive. Third, neuroimaging data appear to provide support for using the wordrecognition programs upon which many educators have long relied. Although this is obvious, we think that it is important given the continued debate about the value of foundational word-recognition instruction. There are decades of data demonstrating the efficacy of these programs (Scammacca, Roberts, Vaughn, & Stuebing, 2015; Stuebing et al., 2008). We think that it is helpful to illustrate the same effect via a very different approach—differences in patterns of neurological activation before and after instruction of this kind. A fourth point is that educators should continue to stay tuned. Researchers are working on new ways to do intervention based on some of these preliminary neuroimaging data and to continue refining understanding of the activation patterns associated with response to intervention. We also expect that revolutionary approaches such as the one by Costanzo and colleagues (2018) and Turkeltaub and colleagues (2012) will continue to emerge as more is learned about the reading brain. Compared with 10 years ago, there is much more known about the impact of intervention on the way that readers use their brains, and we expect that there will be much more to say in the next few years. Finally, in this article, we present current scientific understandings of the neurobiology of reading and dyslexia. There are many unfounded claims about the “brain science.” Therefore, separating fact from fiction is important. We are aware that educators, advocates for students with dyslexia, and students with dyslexia themselves have turned to neuroscience to understand this serious difficulty. All of us are likely to hear more frequent discussions of the neurobiology of dyslexia in the next few years, and we think that this article may facilitate engagement in Figure 5. Activities to practice decoding skills these conversations. We also hope that the educators reading this article consider researchers like ourselves as partners in the future of this work. Some of the authors are education researchers and others are neuroscientists, and we are—like many whose work bridges education TEACHING Exceptional Children | January/February 2019 185 Table 3. Possible Causes of Reading Difficulty and Their Relationships With Dyslexia Cause Description Relationship with dyslexia Phonological deficit A core deficit associated with dyslexia In neuroimaging, students with reading difficulty always show this difficulty. This type of difficulty is at the core of the cognitive and neurobiological understanding of dyslexia. General difficulty A level of cognitive functioning that is below average for all academic areas, not just reading Many students have difficulty in multiple academic areas. If dyslexia is a deficit related to reading specifically, it is unclear whether this fits into the definition of dyslexia. Attention, behavioral, or emotional difficulty Challenges that affect a student’s ability to focus on reading instruction, even if one does not have dyslexia If students have not paid attention to reading instruction, their brain activity will look the same as the activity of a student with only a phonological deficit. In this case, the neurobiological origin of the problem is very different than it is for those with a phonological deficit. Limited evidence-based word-reading instruction A school-based reason why a student may not have developed good word-reading skills, including (a) limited word-reading instruction altogether or (b) word-reading instruction that does not include evidencebased practices Some students start to improve their word reading as soon as they receive evidence-based instruction. 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F., BenShachar, M., & Wandell, B. A. (2012). Development of white matter and reading skills. Proceedings of the National Academy of Sciences, 109, e3045–e3053. doi:10.1073/ pnas.1206792109 Devin M. Kearns, Assistant Professor, and Roeland Hancock, Assistant Research Professor, Department of Psychological Sciences, University of Connecticut, Storrs; Fumiko Hoeft, Professor and Director of Laboratory for Learning and Engineering and Neural Systems, Department of Psychiatry, University of California, San Francisco, and Professor and Director of Brain Imaging Research Center, Department of Psychological Sciences, University of Connecticut, Storrs; Kenneth R. Pugh, Professor, Department of Psychological Sciences, University of Connecticut, Storrs, and President and Director of Research, Haskins Laboratory, New Haven, Connecticut; and Stephen J. Frost, Senior Scientist, Haskins Laboratory, New Haven, Connecticut, USA. Address correspondence concerning this article to Devin Kearns, Department of Educational Psychology, University of Connecticut, 249 Glenbrook Road, Unit 3064, Storrs, CT 06269, USA (e-mail: devin. firstname.lastname@example.org). TEACHING Exceptional Children, Vol. 51, No. 3, pp. 175–188. Copyright 2019 The Author(s). Copyright of Teaching Exceptional Children is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. SSM – Population Health 8 (2019) 100420 Contents lists available at ScienceDirect SSM – Population Health journal homepage: www.elsevier.com/locate/ssmph Article ADHD remission, inclusiv…