The Mindful SLP: Dyslexia - Keeping an Open Mind - Ep. 015
Have you ever wondered what the occupational therapists’s role is in treating dyslexia? Today we talk about the role visual perceptual, motor, and memory skills play in dyslexia, and how those skills integrate with phonological awareness skills. We also talk about the importance of working on executive functioning.
-----Links-----
Dyslexia Perspectives with Michael, Robin, and Sarah Sullivan
Tracking Phonological Awareness
Music: Simple Gifts performed by Ted Yoder, used with permission
Transcript
Dan: Welcome to The Mindful SLP, the podcast for SLPs looking for simple tools and optimal outcomes. Your host is Denise, experienced speech therapist specializing in all things pediatric and Dan, business manager for her private clinic.
Welcome back to The Mindful SLP. This week, we're going to continue our discussion on dyslexia, kind of wrap up a few things here and talk about some things that you need to keep your mind open to around dyslexia. It's a vast topic that we really learned a lot about as we went through this. And there's some more things that we want to make sure you're aware of. Denise, why don't you get us started off here, talk a little bit about a story you told me about your sister.
Denise: My sister has a son who had a learning disability when he was younger. We were talking about it one time and she told me that he has the same issue that her husband does. And that's that the letters move on him. And when she told me this, she was a little bit hesitant and sounded almost like she didn't think I would believe her.
And I thought, oh, she's heard this: Well, that's not dyslexia. Well, that doesn't happen. Well, why would letters move? Well, I did believe her because that's the same thing that happens to you, Dan, and also to our son. But that's not phonological awareness that we've been talking about over and over and over again, which is part of dyslexia. But what is that? So that's what we're going to talk about today, but the thing is we need to not discount people's experiences and say, oh, well, that's outside of my experience. So that's not dyslexia, you don't know what you're talking about!
Dan: When we talked to Sullivan's a couple of podcasts ago, that was one thing that was fascinating to me because, you know, they, they had said that their daughter had dyslexia, but when she described her version of dyslexia, my initial reaction was that's not dyslexia, that's not what I experienced. And, and yet when you dig into it, it is a very multifaceted beast, if you will. And there's a lot to it.
Denise: Yeah, she describes phonological awareness, uh, as a huge part of her dyslexia. And I just want to be clear that Dan, you probably would never receive or have received the diagnosis of dyslexia because that's a reading disorder. You didn't have the reading disorder. I like to say you got all the gifts that come with the creativeness that comes with dyslexia without any of the problems.
Uh, so mild of a dyslexia that I have. It's not even, yeah, I agree. It's not really worth it. In fact, no one ever picked up on it until...
Well, let's back up and describe what are we talking about when you're saying, that you have letters move on you.
Dan: So for me, uh, there's a few letters that spin around when I look at them, like, especially. Uh, letters that are the same both directions, D will spin around because the corners are on one side, but this rounded on the other. So it'll spin along the vertical axis.
X obviously spins for me all the time, but that doesn't matter because it's the same both ways. Uh, but when you get into things like R, R is one of those that does that to me, uh, M and W if someone writes a W I just found this out this, this week, it just hit me. If somebody writes a W with the two outside lines straight up and down, so it looks like an M, an inverted M, That just goes nuts on me. I go, I read something this week where somebody had written their W that way, and I read it four times before I realized it was a W cause it looked like an M to me, and it just kept spinning around on me. So, you know, there's a few letters that do that, and it didn't really bother me that much, cause I just got used to it when I was...
Denise: And I must say you have an excellent auditory memory. I mean, your auditory memory is so, so, so good. I think it would compensate for any weakness on that visual perceptual side.
Dan: Sometime we'll have to discuss whether that has to do with all the musician side.
Denise: Oh yes, I think so. Um, so Dr. Kilpatrick, that we did our last podcast about he defined dyslexia as a reading disorder without complications, and a reading disorder when the language disorder was also present, he would call that a mixed reading disorder. So he had dyslexia and mixed reading disorder. And that's how he was talking about this reading disorder, but we know we've got this visual organization piece.
Dan: So he doesn't cover that?
Denise: Oh, so what Dr. Kilpatrick does, he does mention we need more research in this area. So I really love that he left the door open. He didn't say, well, that's not part of it.
Dan: Isn't that wonderful, to have somebody who's really smart that says, I don't know everything?
Denise: It is. Um, but I I've always wondered about this because no one had really validated that thing about letters moving, other than a book we read years ago called The Gift of Dyslexia.
But Dr. Kilpatrick really doesn't cover the visual side of it.
Yes, but there's someone who does and her name is Dr. Penny Stack. I took a course presented by her and you're going to love this name. It's called Building New Neural Pathways to Master Visual and Auditory Memory, Visual Perceptual Skills, Visual Motor Skill Development, and More.
Dan: Ding ding ding, we have a winner for the longest name ever.
Denise: Okay. And that was through an organization called PESI I'll link that in the show notes, but she is an OT, occupational therapist with dyslexia.
Dan: So she has it herself.
Denise: And her daughter has it, but she addresses this whole side that speech therapists might not see a whole lot of, about the visual perceptual, I mean, I see the phonological awareness problems all day long. And sometimes I see a mixed disorder where the child has the visual perceptual and the phonological awareness.
Dan: If you have a severe visual problem without the auditory problems, nobody's going to really pick up on that probably.
Denise: Yeah I know, if they're not aware of it...
Dan: And so that's why speech surface would never see it.
Denise: This is real important. We've got to consider that there are types of dyslexia that have this visual organization component so that we can fully remediate all areas that need to be remediated. And also, I really love what Dr. Stack says about executive cognitive function, how to work on it. And Dr. Kilpatrick talks about how to work on it without actually saying you're working on this executive function. I love how she pulls it out and says, okay, you are working on executive function.
Dan: So it's real important to make sure that as you see clients come in with the auditory problems to expand your horizon just a bit and make sure that there isn't something going on with the visual as well.
Denise: Yes. And that you need an OT to be part of your team, or need to know what to look for and say to the parents, go check this out with an OT.
Dan: Well, what did you learn from Dr. Stack about the skills that are needed to read and why order is important?
Denise: One of the most valuable things that Dr. Stack talked about was the sequence of development. She's figured this out, that you can't do everything at once with a child with a learning disability. We probably have figured that out, but you might have an IEP where everyone has put their piece in and it looks like, oh, we're working on everything at once,. And she has found that it takes kids longer to succeed if you don't do things in the right sequence, in the right order of development. That makes sense. So motor first and a speech therapist to us, that means oral motor. If I'm working with a child whose oral motor skills are very poor, I found it's not productive to work on auditory memory yet. I'm not talking about a child who doesn't have the later developing sounds because I do work on auditory memory with preschool through early elementary ages all the time.
I'm talking about a child whose oral motor skills are far below what is expected at their age level. You've really got to get the motor skills down. And for Penny Stack, as an OT, she's talking about the other motor things too, but motor first, then visual memory, then auditory memory. This is how children develop, this is how typical children develop. Then phonological awareness, and then reading. So you see if we come in at phonological awareness, right there, there's three things that are missing, three things above it, the possibly missing, you might run into what Dr. Kilpatrick calls treatment resistant clients. Cause he put some of those kids who really struggle who have that mixed dyslexia problem, okay, these clients are going to take longer. They're a little bit resistant to treatment. Well, it's some of these things going on besides the language disorder or part of the language disorder, you've got these things going on. So address things in the right sequence of development and you will have faster progress.
Dan: Tell us about Dr. Stacks list of skills for reading.
Denise: This is her list of the skills you need to read, which is going to match Dr. Kilpatrick's a lot. Phonological awareness, phonological memory, auditory sequential, memory opportunity, and we've covered those pretty thoroughly. But then she says we also need visual sequential memory, visual perceptual skills, visual motor skills, and fine motor coordination.
So why am I so passionate about this visual part? Because of my relatives who have experienced this letters moving thing, or that very few people seem to understand that this could be part of dyslexia. You get a lot of disbelief sometimes. Our son struggled in school. He struggled a little bit with learning to read. The writing was such a huge struggle for him and just completing homework took hours yet he didn't have any of the signs of a speech-language disorder.
Dan: Of course being a speech therapist,, you were looking for those.
Denise: And I was just confounded. I didn't know what to do. What do we do? What's going on? Well, his was largely in the visual perceptual area, his problems, and whether he had some phonological awareness things going on, I don't know that they've been resolved now, so I couldn't tell.
Dan: But we knew that it was a miserable experience for all of us to try and get him through his homework every day. And we just felt so sorry for the kid, because he was just a basket case.
Denise: And you can't have a child spending hours and hours and hours on homework. The teacher says, well, this should take no more than 30 minutes or whatever, so, but if they don't complete it in thirty minutes, what do you do? What if it takes them hours to complete it?
Dan: I remember going to a teacher's conference and saying, well, this is taking us four hours a night and she was shocked and she didn't know what to do either, but she was shocked that it was taking four hours a night for Jonathan, who she considered to be a pretty bright kid.
Denise: Sometimes they just hide so well at school. So my sister told me about her son. Well, the teacher told my sister that he did so well in school and he was just well-behaved and she couldn't see any problem. Then my sister was like, you do not understand, he is holding it all in for you. He is trying to be so good and so on task for you. And when he comes home, I have to patch him up. And that's what I felt like, we were kind of patching up our son every day to send him back to school the next day. Enough about that. But it's a lived experience. One of the things that Dr. Stack says that I love is you need to respect the person's lived experience of dyslexia. I mean, this is my experience. This is what happened. So let's look at it. Let's believe it. Let's figure out what to do about it.
Dan: Tell me more about these visual perceptual skills.
Denise: Okay. So let's just describe what they are. So you, a speech therapist, if you see something like this going on, you'll know, okay. I need to pull the OT in. So we've got this list. The first one is discerning like items from a wide variety. So you're looking at a lot of things. It could be letters and seeing things that are alike. I'm seeing things that are alike,
Dan: I'm sure you do a lot of things like that. One of these things is not like the other.
Denise: And the other one is figure ground, which is finding a specific item among items that are similar.
So think of, oh yeah, Where's Waldo. Okay. You need these skills to be able to read.
Dan: I hate Waldo, by the way,
Denise: Um, a visual memory. So recall something when you no longer see it.
Dan: Yeah. This is one I excel in, you know, cause I love Sherlock Holmes. He could have, you know, perfect recall on anything that he saw once.
Denise: He had a great visual memory. Spatial awareness, you can visually manipulate shapes and colors. Going back to the phonological awareness. You are auditorily manipulating sounds within words, right? Okay. Here you're visually in your mind being able to manipulate shapes and colors.
Dan: Okay, tell me about visual closure.
Denise: Identifying a shape when it is partially completed. So you see a half a circle, can you identify it?
Dan: Okay. That's that's another one I really do well in. Form constancy.
Denise: Recognizing objects when viewed from a different angle. And this is probably what's going on when letters flip on you.
Dan: Interesting. Cause yeah, I, like I said, a previous time, one of the things that I can do is I can look at something and I can see all sides of it at once, you know, and I can flip that thing around in my mind, even if I never haven't seen the other side, I can still figure out what it's going to look like on the other side.
Denise: And so that totally works for objects that are not letters and numbers. Right? Most of our things are 3d, but letters and numbers are not. And so someone who has the gift as you might call it of being able to see in 3d and both you and our son are very, very artistic. In fact, our son can sculpt amazing things, right. But letters are flat and they don't like to be flipped.
Dan: My letters aren't flat. I live in a different world. What is executive cognitive function?
Denise: Executive cognitive function is a set of mental skills that include working memory, flexible thinking and self control. Dr. Stack talks about building neural pathways or this executive function and not just providing accommodations.
Dan: So an accommodation is just allowing...
Denise: Maybe giving someone more time to do something, to complete something. So I've, I've got an example for this, Dr. Kilpatrick talks about how the sight word vocabulary needs to be instantaneous. Right. If someone is really slow sounding out, even if they're very accurate, that's going to interfere with their ability to read because they don't have that instant recall library. So building that ability to be instantaneous is working on the executive cognitive function. And so I have a client right now when I give her a phonological awareness assessment, she is very accurate, even accurate above what is expected at her grade level, but extremely slow. Very slow. I gave her Dr. Kilpatrick's assessment. He invented the PAST, so I told her about, this huge discrepancy between her accuracy and her speed. And she was like, that makes so much sense to me. She says, they're telling me at the school, she understands, she understands you understands because she's getting it, but they're not including the timed element.
And she says she can look at a word like was, and every time she looks at it, it's like a new word. She has to figure it out over again. And so she was so happy to hear that it was something we could work on, something we can improve. We've just got to improve her speed. So don't give her the accommodations of more time, that's not going to help her
Dan: You need to give her a pathway to actually improve the problem.
Denise: That's building a neural pathway and not just providing an accommodation. Memory strategies, like I described in my simple tools video, Simple Poem, Six Ways, I describe how to work on auditory memory and sequential memory.
That's huge. I've seen that make a difference in a lot of clients. I describe a lot of memory strategies, auditory memory strategies in my phonological awareness tracking form, by the way, which I did a podcast on. And we'll link that in the show notes. There's one additional area Dr. Stack talked about, even though it's not really in our areas, speech therapists, but she talks about handwriting and how improperly formed letters will slow them down.
So sometimes we might think, okay, what's the big deal with handwriting? They're writing it. I can read it, let's move on. But no doubt you've seen how some kids form the letters a little bit strangely and it takes them extra time to do it, in the long run that is going to slow them down, they won't keep up and it will be a problem.
So that's just something to be aware of something to know that, oh yes, handwriting is important. And I like to make an analogy to articulation therapy. Sometimes the way a child says a sound, sounds okay, but it's going to slow them down and interfere further down the road. So suppose you have a child who rolls their lips in, anytime they say 'up' sound. Oh, you can't see me, but one of my client's parents called it the granny lips, cause that's how her daughter was saying like a word like banana, her lips are totally tucked in. Well, you tuck your lip in and it shoots your lower jaw out, all sorts of things happen. So yeah, she's saying the sound okay. But it's how she's saying it is going to slow her down is going to interfere with sounds further down the road. So it's the same idea with handwriting. It needs to be formed correctly.
Dan: Make sure your foundation is very secure because it will always come back later on.
Denise: Yeah. Shaky foundation is going to hurt you further down the road.
Dan: It's important to give people the accommodation of time to fix things, but it's more important to actually teach them how to improve and how they can problem solve. What about inner drive? How's that come into it?
Denise: That self-control, this, that part of that executive function. So Dr. Stack calls that grit. Okay. And she actually put that in capital letters. This is the other thing you need to overcome dyslexia, but Dr. Stack calls grit, I tend to call self-regulation, building mindfulness and attention.
So I've got a couple examples here. I've got an example of grit and non grit. So a young man with a cognitive delay came to my clinic. His grandma brought him in for a consult because she felt that even with his cognitive impairment, he had potential to do more than he could. I was having him do some task, I can't remember quite what it was, but he looked at it and he said, okay, let me figure this out. And I was like, wow, that's the grit. That's the self-regulation. He didn't get overwhelmed by having a problem that he knew he had to pay some attention to, to figure out what an awesome client to have.
Dan: He had already figured out what did he need to do to figure out a problem that ability to problem solve.
Denise: Or to step back, yeah. And, and that's the first part of solving a problem by stepping back and saying, okay, I've got to follow a sequence to work this out. And an example of non grit. I have a little preschool client who often will dissolve into a puddle on the floor the minute I ask him to do something, he just doesn't have that ability to not be totally overwhelmed by something that seems a little bit hard to him. And then there's me. Anytime I write a podcast, I have to use a lot of executive function. My initial scribbled ideas are just a mess. And thinking about organizing them into a cohesive narrative is enough to make me just want to go eat ice cream instead. Which is what we're going to do when this is over, we're going to go get ice cream wraps.
Dan: Some people just have grit. Some people know how to solve problems. Is this something we can teach, or we can help?
Denise: Oh, I do it all day long. I do it through mindfulness. I did a whole podcast. I think our very first podcast was on mindfulness.
Dan: You're always watching. You're always seeing how they're reacting to things. It's not just necessarily can they do ABC or not, but it's more about how are they doing A B and C. And is there anything that you can nurture and bring out to help them learn how to do it as much as what they're doing?
Denise: Well, I break things into the smallest possible steps and help them realize they can take the next step. And they do have to have a little bit of that internal drive to go beyond what they're really comfortable with. Just be very supportive. You can help build grit. Yes you can. Like my little preschooler, he's already doing better. We have our days, but it's getting a little bit better and it will continue to get better.
Dan: And it's just one more thing that you worked on with him.
Denise: It's a sort of an overlying theme you have to consider with each client in your therapy situation.
Dan: What's our takeaway here from this podcast?
Involve an OT in the assessment. If you're in a school setting, that's easy to do. If you're in a private setting like me, I tried to make contacts with other OTs and I asked parents detailed questions about these visual skills I watch for them so I can refer out since I don't have an OT in house. The thing is you can't do it all by yourself. You need a team approach. Perhaps if your client only has the phonological awareness piece as a problem, then you could fix it all yourself, but you still want that classroom teacher involved. You want the parents involved, but Dr. Stack brings out the music teacher, the art teacher, all of these build visual and auditory memory, she says, and of course he's talking to SLPs that are in the school, but bring in the art teacher, bring in the music teacher, bring in everyone. Interesting. In fact, it's really interesting. She found with some of her clients had better motor skills who lived on the ranches, um, cause she's out lives out in Oklahoma where there's some rural areas and there's some inner city kids, just because of their environment and the things they do and sitting on tractors and all that kind of stuff. She's like, they've got better motor skills than the inner city kids. Of course. Yeah. Interesting. So just little things like that, that the parents could incorporate things like that. Yeah. No, the PE teacher can, the music teacher can, you mentioned your music ability helping you probably with auditory memory and she did bring that up. Yeah. Music can be a huge benefit.
Okay, great. Well, that's our topic for today. Just keep a real open mind as you see anybody who might have dyslexia, that it could be more than just an auditory problem. Thanks for joining us today. We hope you enjoyed this podcast. Please, if you like what you're hearing, give us a thumbs up or a five-star rating on any of the iTunes or other podcast ratings platforms. We really appreciate everything that you do to take time and listen to us. And we hope to talk with you next week, being right around the holidays. We have a little bit of an extra treat, kind of a more relaxing topic, but I think you're going to enjoy it. We'll talk to you next time. Thanks for joining us.
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