OVERVIEW OF DYSLEXIA ANN W ALEXANDER, M.D. MORRIS

OVERVIEW OF DYSLEXIA ANN W ALEXANDER, M.D. MORRIS

OVERVIEW OF DYSLEXIA ANN W ALEXANDER, M.D. MORRIS CENTER GAINESVILLE, FL TIM CONWAY, PhD UNIVERSITY OF FLORIDA GAINESVILLE, FL JANE WELLINGTON LAWYER, MEd WELLINGTON ALEXANDER CENTER SCOTTSDALE, AZ I IDA 2006 KEY TO DYSLEXIA THE PICTURE OF DYSLEXIA THE WHO WHAT WHEN

WHERE WHY & WHAT IT LOOKS LIKE WHAT TO DO WHAT IT ISNT DYSLEXIA IS NOT A VISUAL PROBLEM NOT A LACK OF INTELLIGENCE NOT DUE TO LACK OF EFFORT NOT A DEVELOPMENTAL LAG. NOT UNCOMMON 5 17.5 % OF POPULATION NOT RESPONSIVE TO STANDARD READING INSTRUCTION

WHAT IT IS DYS = TROUBLE LEXIA = WORDS TROUBLE WITH WORDS NEUROLOGIC IN ORIGIN - GENETIC LIFELONG ENVIRONMENT MAY ALTER COURSE CORE DEFICIT IN PHONOLOGICAL COMPONENT OF LANGUAGE READING COMPREHENSION > WORD READING ACCOMPANYING CHALLENGES ( 50% ) ADHD SENSORY MOTOR DIFFICULTY BEHAVIORAL PROBLEMS MORE CHALLENGING TO REMEDIATE WHY OUT OF LINE NEURONS ( ECTOPIAS ) FRONT

LAYERS OF BRAIN CORTEX www.thebrain.mcgill.ca/flash/d/d_02/d_02_cl/d_02_cl_vis/d_02_cl_vis.html#3 NEURAL MIGRATION GENETICALLY PROGRAMMED ww.thebrain.mcgill.ca/flash/a/a_09/a_09_cl/a_09_cl_dev/a_09_cl_dev.htm NEURAL MIGRATION GONE AWRY IN DEVELOPMENTAL DYSLEXIA ww.thebrain.mcgill.ca/flash/a/a_09/a_09_cl/a_09_cl_dev/a_09_cl_dev.htm X

ECTOPIC CELLS Ramus, 2004 NEURONAL CONNECTIONS OUT OF LINE NEURONS ( ECTOPIAS ) FRONT TYPICAL LANGUAGE ACTIVATION AREAS VISUAL-LANGUAGE ASSOCIATION AREA VISUAL / VERBAL AREA SPEECH PRODUCTION

AREA AUDITORY PROCESSING AREA LEFT HEMISPHERE TYPICAL READING ACTIVATION AREAS WORD ANALYSIS WORD ANALYSIS AUTOMATIC (SIGHT WORD) LEFT HEMISPHERE B A C K

O F R I G H T B R A I N BRAIN ACTIVATION WITH READING Strong activation pattern BACK OF LEFT BRAIN Weak activation

pattern SIGNATURE BRAIN, Shaywitz, 2005 Simos, Fletcher, Bergman, et al 2002 PHONOLOGICAL AWARENESS THE CORE DEFICIT WHAT IS PHONOLOGICAL PHONOLOGICAL AWARENESS THE UNDERSTANDING THAT WORDS ARE MADE UP OF SMALL BITS OF SOUND PHONOLOGICAL SENSITIVITY Do the words cat and fat sound the same at the end? What is the first sound in the word man? INNATE IN A TYPICAL BRAIN RECEIVING APPROPRIATE LANGUAGE INPUT Torgesen, www.fcrr.org

PHONEMIC AWARENESS THE ABILITY TO IDENTIFY, THINK ABOUT, AND MANIPULATE THE INDIVIDUAL SOUNDS (PHONEMES) IN WORDS THE IMPLICATION OF A GROWING ABILITY TO IDENTIFY INDIVIDUAL SOUNDS IN WORDS. Torgesen, www.fcrr.org EARLY LANGUAGE DEVELOPMENT BRAIN IS TUNED TO PARENTS LANGUAGE NEWBORN: INTEGRATES: ORAL-FACIAL MOVEMENTS SPEECH SOUNDS PHONOLOGY SOCIAL EMOTIONAL (NON VERBAL TONES & GESTURES) - PRAGMATICS LANGUAGE DEVELOPMENT

(BUILDING BLOCKS) 9 YEARS ___ METALINGUISTIC WRITING SPELLING READING 5 YEARS ___ SYNTAX (FORM) 18 MONTHS ___ SEMANTICS 9 MONTHS ___ 1 MONTH ___ (MEANING)

PHONOLOGY PRAGMATICS (FORM) (FUNCTION) PRINCIPLES OF LEARNING WHAT FIRES TOGETHER, WIRES TOGETHER MULTIPLE SENSES STRENGTHEN PATHWAYS OPTIMAL ATTENTION CONSISTENT INPUT INTENSITY SALIENT FREQUENT REPETITION, REPETITION, REPETITION Alexander, 2003 PHONOLOGY

(PERCEPTION / PRODUCTION) EXECUTIVE FUNCTION / INTENTION WORKING MEMORY HOLD / MANIPULATE PHONEMIC MOTOR ARTICULATORY STIMULUS SOMATOSENSORY ARTICULATORY STIMULUS PROSODIC REPRESENTATION (WORD LEVEL) REPRESENTATION ACOUSTIC

VISUAL STIMULUS STIMULUS ATTENTION / AROUSAL THE EFFECTS OF WEAKNESSES IN ORAL LANGUAGE ON READING GROWTH (Hirsch, 1996) 16 High Oral Language in Kindergarten 15 14

5.2 years difference Reading Age Level 13 12 11 Low Oral Language in Kindergarten 10 9 8 7 6 5 5

6 7 8 9 10 11 12 13 14 15 16 Chronological Age Torgesen, www.fcrr.org EARLY READING DEVELOPMENT BREAKING THE CODE RECIPE FOR READING DECODING

(MECHANICS) + LANGUAGE COMPREHENSION READING COMPREHENSION WHAT IS PHONICS? ITS A LEARNED SKILL PRONOUNCE THESE WORDS blit frachet IT MUST BE TAUGHT NEED PA (SOUNDS) TO HOOK TO ABSTRACT WRITTEN SYMBOLS (LETTERS)

GROWTH IN PHONICS ABILITY OF CHILDREN WHO BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME AWARENESS AND LETTER KNOWLEDGE (Torgesen & Mathes, READING GRADE LEVEL 2000) 6 5 4 3 5.9 Average Low PA Low Ave. PA 2.3 2

1 K 1 2 3 4 5 GRADE LEVEL CORRESPONDING TO AGE GROWTH IN WORD READING ABILITY OF CHILDREN WHO BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME AWARENESS AND LETTER KNOWLEDGE (Torgesen & Mathes, 2000) READING GRADE LEVEL

6 5.7 Low PA Average 5 Low PA Ave. 4 3.5 3 2 1

K 1 Torgesen, www.fcrr.org 2 3 4 GRADE LEVEL CORRESPONDING TO AGE 5 GROWTH IN READING COMPREHENSION OF CHILDREN WHO BEGIN FIRST GRADE IN THE BOTTOM 20% IN PHONEME AWARENESS AND LETTER KNOWLEDGE (Torgesen & Mathes, 2000) 6.9 READING GRADE LEVEL

6 5 Average Low 4 3.4 3 2 SAME VERBAL ABILITY VERY DIFFERENT READING Low PA COMPREHENSION 1

Ave. PA K 1 Torgesen, www.fcrr.org 2 3 4 5 GRADE LEVEL CORRESPONDING TO AGE 3 LEGGED STOOL COMPREHENSION

FLUENCY AUDITORY / VISUAL / SOUNDING OUT SIGHT WORDS LANGUAGE / VOCABULARY GRAMMAR NORMAL READER 3 LEGGED STOOL COMPREHENSION FLUENCY

AUDITORY AUDITORY AUDITORY AUDITOR AUDITOR / AUDITOR /YY /Y/// SOUNDING VISUAL / SIGHT WORDS SOUNDING SOUNDIN SOUNDI OUT SOUNDIN OUT G

NG OUT OUT G OUT LANGUAGE / VOCABULARY GRAMMAR DYSLEXIA WHERE ANYWHERE SIGNATURE BRAIN IMAGES ARE THE SAME DIFFERENT LANGUAGES AFFECT THE PICTURE ITALIAN VS ENGLISH WHO ANYONE

ALL AGES ALL WALKS OF LIFE PREPONDERANCE IN : ARCHITECTS ENGINEERS SURGEONS ENTREPRENEURS SCHOOL DROPOUTS PRISON INMATES WHEN AS EARLY AS THE NEWBORN PERIOD IDENTIFICATION OF A PHONOLOGIC GLITCH THE WEAKER THE PHONOLOGY, THE EARLIER THE STRUGGLE THE PICTURE OF DYSLEXIA WHAT DOES IT LOOK LIKE?

THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ORAL LANGUAGE CHALLENGES LISTENING Poor PHONOLOGICAL AWARENESS Memory for word sequence (phone numbers, directions) Foreign Language SPEAKING Word Finding Multisyllables Sequencing

Ideas Foreign Language THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) WRITTEN LANGUAGE CHALLENGES READING Mechanics SPELLING/WRITING Comprehension Mechanics Speed Speed Expressing

Ideas THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ACCOMPANYING CHALLENGES (SENSORIMOTOR) Messy Eating Writing/knots Words Swim Oral Motor Fingers Lose Place

Eyes Tired Left/Right Up/Down Spatial Awareness THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ACCOMPANYING CHALLENGES (BEHAVIORAL) Attention / Executive Function Anxiety Brain / Behavior Disorders OCD

Oppositional Behavior Depression Parents with similar challenges DEVELOPMENTAL DIFFERENCES PRESCHOOL: SENSORIMOTOR ORAL LANGUAGE ATTENTION EARLY ELEMENTARY: PRINT RECOGNITION LETTER SOUND KNOWLEDGE MECHANICS OF READING HANDWRITING ATTENTION

DEVELOPMENTAL DIFFERENCES MID ELEMENTARY / MIDDLE SCHOOL: COMPREHENSION WRITTEN EXPRESSION ATTENTION HIGH SCHOOL / ADULT: READING EFFICIENCY COMPREHENSION FOREIGN LANGUAGE ATTENTION WHAT TO DO ASSESSMENT OF STRENGTHS AND WEAKNESSES NEUROCOGNITIVE PSYCHOSOCIAL ASSESSMENT DRIVES TREATMENT

BELL SHAPED CURVE NORMAL POPULATION DISTRIBUTION PROFILE GRAPH BRAIN TEAM SEVERE AT RISK AVERAGE SUPERIOR RANGE WEAKNESS GIFTED STRENGTH

Standard Scores 65 70 75 80 85 90 95 100 105 110

115 120 125 130 135 Percentiles 1st 2nd 5th 9th

16th 25th 37th 50th 63rd 75th 84th 91st 95th 98th 99th

ATTENTION/ INTENTION Visual Auditory INTELLIGENCE/COGNITION Fluid Reasoning Executive Processes Processing Speed ORAL LANGUAGE Phonological Awareness (Morpho)Syntactic Awareness Receptive (Listening) Expressive (Speaking) Word Retrieval (Naming) MEMORY Aud. Working Memory Vis. Working Memory SENSORIMOTOR Visual Processing Visuo/Motor Ability

PROFILE GRAPH BRAIN TEAM RESULTS SEVERE AT RISK AVERAGE WEAKNESS SUPERIOR RANGE GIFTED STRENGTH Standard Scores 65

70 75 80 85 90 95 100 105 110 115

120 125 130 135 Percentiles 1st 2nd 5th 9th 16th 25th

37th 50th 63rd 75th 84th 91st 95th 98th 99th WRITTEN LANGUAGE Word Reading (Real)

Word Reading (Rate) Word Reading (Nonsense) Word Reading (Rate) Passage Comprehension Passage Fluency Writing/Written Expression Writing Fluency Spelling ARITHMETIC Concepts Operations Applications Fluency PRESCHOOL PREDICTORS OF FUTURE READING SUCCESS PHONOLOGICAL AWARENESS LETTER NAME KNOWLEDGE RAPID NAMING of OBJECTS, COLORS

ALL OF THESE PREDICTORS ARE DEPENDENT ON A STRONG PHONOLOGICAL SYSTEM NOT IQ !!! Torgesen, www.fcrr.org TREATMENT EARLY IDENTIFICATION PREVENTION OF READING DIFFICULTIES LATER IDENTIFICATION INTERVENTION FOR READING DIFFICULTIES PREVENTION STUDY MID KG END 2ND GRADE SCREENING - BOTTOM 10TH %ILE FREQUENCY 20 MINUTES / 4 DAYS / WEEK INTENSITY 1:1, 67 HRS. TEACHERS & AIDES 4 METHODS PASP (MULTISENSORY, BOTTOM UP- LiPS)

EP (TRADITIONAL RDG INSTRUCTION WITH EXPLICIT PHONICS) RCS (SUPPORT OF CLASSROOM TEACHING) NTC (NO TREATMENT CONTROL) NICHD Torgesen et al, 1999 PREVENTION STUDY OUTCOME ONLY PASP YIELDED SIGNIFICANT PHONOLOGICAL AWARENESS AND WORD READING GAINS END OF 2ND GRADE: 50TH %ILE WORD READING SKILLS (ACCURACY AND FLUENCY). OTHERS NO BETTER THAN NO TREATMENT CONTROL BEST PREDICTORS OF GROWTH IN READING: ATTENTION/BEHAVIOR, HOME BACKGROUND, AND P/A. A SOLUTION TO THE PROBLEM OF THE FLUENCY GAP: PREVENTIVE INTERVENTIONS

100 2nd 4th GRADE GRADE STANDARD SCORE 30th % ile 90 WORD READING 80 Accuracy Rate

70 BEGINNING % ile TREATMENT AGE 10th 10th 5-6 Torgesen et al, 2003 5-6 DYSLEXIA PREVENTION STUDY BOTTOM-UP VS TOP-DOWN PASP (LiPS) USES A MORE EXPLICIT, CONCRETE, MULTISENSORY (BOTTOM UP) APPROACH TO DEVELOP PHONOLOGICAL AWARENESS

45 40 35 30 25 NTC Percent retained in K or 1 RCS EP 20 15 10 5 0

Torgesen et al, 1999 LiPS GROWTH IN WORD READING ABILITY 75th NATIONAL PERCENTILE 70th 50th 30th 25th OCTOBER Torgesen, www.fcrr.org MAY

JANUARY AT RISK READER Left KINDERGARTEN BEFORE INTERVENTION FIRST GRADE AFTER INTERVENTION Simos et al, 2005 Right REMEDIATION STUDY OLDER CHILDREN (8 10 YRS) SEVERE DYSLEXIA 2nd %ILE FOR WORD READING

35th %ILE IQ 2 TREATMENTS BOTH EXPLICIT PHONICS RX A BOTTOM UP (LiPS) VS A TOP DOWN (EP) EQUAL TIME AND INTENSITY 1:1 100 MINS DAILY 8-9 WEEKS TOTAL 67.5 HRS RESEARCH DEMONSTRATES BOTH IMMEDIATE & LONG LASTING RESULTS IN BROAD READING (DECODING+COMPREHENSION) Standard Score 95 90 Normal Range of Performance 9-Week Intensive

Program 85 80 16 Mos. Special Ed Class 75 Initial Test PostTreatment Test PreTreatment Test 1 Year After Treatment

2 years Torgesen, Alexander, Wagner et al, 2001 TWO YEAR FOLLOW UP READING RESULTS STANDARD SCORE 100 90 WRMT-R 30th percentile 93 91

* 80 * 81 82 * 70 69 WORD ATTACK Torgesen, Alexander, Wagner et al, 2001 68 WORD ID

PASSAGE COMP. N = 50 * p= <.05 TWO YEAR FOLLOW UP READING RESULTS GORT-R 100 STANDARD SCORE 96 90 91

91 * * 80 * 83 72 74 70 71 68

N = 50 * p= <.05 30th percentile WORD ATTACK WRMT-R TEXT READING ACCURACY READING COMP. TEXT READING RATE

SPOKEN LANGUAGE GAINS ROWTH IN SPOKEN LANGUAGE DURING INTERVENTION FOLLOW-UP Standard Score 100 LIPS 90 CELF-R-RLS CELF-R-ELS 80 EP CELF-R-RLS 70 CELF-R-ELS

60 Pretest Post Test 1 year Torgesen, Alexander, Wagner et al, 2001 2 years EFFECT SIZE OF TREATMENT ON LANGUAGE COMPREHENSION LIPS EP PRE - POST PRE - 2 YRS

PRE - POST PRE - 2 YRS RLS 1.05 0.97 0.49 1.05 OD 0.75 0.61 0.61 0.62 0.75 0.44

0.93 0.58 0.31 0.46 0.84 0.43 0.38 0.85 0.60 0.24 0.75 0.71 0.70 0.54 0.49 WC

SR LP ELS FS RC SA ES of 5 7 moderate; 8+ large 0.50 0.37 0.03 0.70 0.44 0.20 0.76 0.67 0.60 0.16

0.78 P<= 0.05 TREATMENTS EFFECTS ON BRAIN ACTIVITY Decreased activity in right hemisphere Increased activity in left hemisphere Simos et al 2002 EXCITING RESULTS! HOWEVER.. LATE VS EARLY INTERVENTION (PREVENTION) WORD READING ACCURACY AND RATE Accuracy 100 4th

grade Rate 2nd grade STANDARD SCORE 30th % ile 90 80 70 BEGINNING % ile TREATMENT AGE 2nd

8-11 10th 8-11 10th 5-6 10th 5-6 PROJECTED GROWTH IN SIGHT VOCABULARY OF NORMAL READERS AND DISABLED CHILDREN BEFORE AND AFTER REMEDIATION Torgesen Size of sight vocabulary 2nd Year followup

Normal Dyslexi c Intervention 1 2 3 4 5 6 7 Torgesen, www.fcrr.org

Grade in School Later intervention does not close fluency gap early intervention does EARLY INTERVENTION IS URGENT! 10TH %ILE 5TH GRADE READER 50,000 WORDS A YEAR 50TH %ILE 5TH GRADE READER 600,000 WORDS A YEAR AVERAGE STUDENTS RECEIVE ABOUT 10 TIMES AS MUCH PRACTICE IN A YEAR (Anderson, Wilson, & Fielding, 1988) RESPONSE TO INTERVENTION MODEL APPLICATION OF EVIDENCE-BASED TREATMENT TO SCHOOLS

A TIERED APPROACH TIER 1: CLASSROOM TIER 2: PULL OUT SUPPORT TIER 3 :TOTAL PULL OUT TIER TWO LITCHFIELD SCHOOL DISTRICT PHOENIX, ARIZONA ID BY CLASSROOM TEACHER SPALDING INSTRUCTION IN CLASSROOM READING / PA ASSESSMENT BELOW GRADE LEVEL OR, AT GRADE LEVEL, BUT STRUGGLING NOT QUALIFIED FOR SLD EXPLICIT, MULTISENSORY PROGRAM (LiPS) 40 MINS DAILY, 120 DAYS, 80-100 HRS GROUPS : 6-8:1 (YOUNGER) 8-12:1 (OLDER) LSD RESULTS 1st GRADE 113

110 * 100 101 STANDARD SCORE 96 * 90 80 *

85 83 70 30th percentile 72 WORD ATTACK WORD ID PASSAGE COMP. N = 63 * p= <.05

LSD RESULTS 2nd GRADE 110 108 100 * 96 STANDARD SCORE 101 90 * 98 95

30th percentile 93 80 70 WORD ATTACK WORD ID PASSAGE COMP. N = 64 * p= <.05 LSD RESULTS 3rd 5th GRADES 100

STANDARD SCORE * 90 101 100 91 96 * * 95 30th percentile

91 80 70 WORD ATTACK WORD ID PASSAGE COMP. N = 126 * p= <.05 TIER THREE EINSTEIN MONTESSORI CHARTER SCHOOL FLORIDA

www.einsteinmontessori.com EINSTEIN MONTESSORI SCHOOL, INC (EMS) CHARTER SCHOOL (1999) REMEDIATE LITERACY SKILLS LANGUAGE-BASED LEARNING DIFFICULTIES 2ND - 8TH GRADE LITERACY SKILLS FOUR CLASS PERIODS/DAY 1. PHONOLOGICAL AWARENESS (LIPS) 2. READING 3. READING 4. WRITING

TEACHER TRAINING ACROSS ALL CLASSES EMS GAINS 2004-2005 (GRADES 3-5) SIGNIFICANT IMPROVEMENT (P <0.001) WORD ATTACK PASSAGE COMPREHENSION PHONOLOGICAL PROCESSING WORD & NONWORD READING EFFICIENCY STATE ACHIEVEMENT TESTING NON-SIGNIFICANT IMPROVEMENT WORD IDENTIFICATION EINTSTEIN MONTESSORI RESULTS HOWEVER.MANY MEASURES, WHILE SIGNIFICANT, DID NOT REACH 30TH%ILE BENCHMARK THEREFORE.INSTITUTING AN INTENSIVE FOUNDATIONAL INTERVENTION (LiPS) 3 HOURS/DAY X 6 WEEKS

SMALL GROUP FCAT 2005 AVERAGE CHANGE IN READING DEVELOPMENT (IMPROVEMENT FROM 2004 TO 2005) DEVELOPMENTAL SCALE SCORE 350 300 EINSTEIN MONTESSORI 250 200 ALACHUA COUNTY AVERAGE 150 FLORIDA STATE

AVERAGE 100 50 0 4th 5th 6th 7th 8th GRADE TIER FOUR 1:1 FOR THE TREATMENT RESISTERS THE RESEARCH MODEL THOROUGH BRAIN TEAM ASSESSMENT TREAT OTHER FACTORS THAT MAY BE OBSTACLES ATTENTION BEHAVIOR SENSORIMOTOR RESEARCH RESULTS 3rd 5th GRADES

STANDARD SCORE 100 90 30th percentile 93 91 * 80 * 81

82 * 70 69 WORD ATTACK 68 WORD ID PASSAGE COMP. N = 50 * p= <.05 CONCLUSION TREATMENT IS MOST EFFECTIVE IF: YOUNGER AGE

INTENSIVE EXPLICIT PHONOLOGICAL/PHONICS ATTENTION IS OPTIMAL BOTTOM-UP MORE EXPLICIT PHONICS APPROACH: PREVENTION MILD TO SEVERE DYSLEXIA AUDITORY WORKING MEMORY WEAKNESS TOP-DOWN PHONICS APPROACH: AFTER 3RD GRADE MILD TO MODERATE DYSLEXIA PRINCIPLES OF LEARNING WHAT FIRES TOGETHER, WIRES TOGETHER MULTIPLE SENSES STRENGTHEN PATHWAYS OPTIMAL ATTENTION CONSISTENT INPUT INTENSITY SALIENT FREQUENT REPETITION, REPETITION, REPETITION Alexander, 2003

THE WONDERS OF DYSLEXIA THE PICTURE OF DYSLEXIA (All Symptoms Do Not Occur With Everyone) STRENGTHS LEADERSHIP SKILLS THINKING OUT OF THE BOX TED TURNER PAT T ON CHURCHILL JFK

POLITICAL & MILITARY TH (PH OMA ON S E OG DIS RA O N PH ) ENTREPRENEURS SCIENTISTS & INVENTORS THE PICTURE OF DYSLEXIA (All Symptoms Do Not Occur With Everyone)

STRENGTHS CREATIVITY WRITERS HANS CHRISTIAN ANDERSEN ARTISTS LEONARDO Da VINCI MUSICIANS MOZART ACTORS / DIRECTORS HARRISON FORD & STEVEN SPEILBERG

THE PICTURE OF DYSLEXIA (All Symptoms Do Not Occur With Everyone) STRENGTHS VISUOSPATIAL / MOTOR SKILLS SURGEONS NEUROSURGERY ATHLETES MOHAMMAD ALI NOLAN RYAN Acknowledgments National Institute of Child Health and Human Development Joe Torgesen Carol Rashotte Rick Wagner

Pat Lindamood Tim Conway Jane Lawyer Sally Shaywitz THANK YOU EMS RESULTS 3rd 5th GRADES 100 * STANDARD SCORE * 90 93

91 86 30th percentile * 88 85 80 85 70 WORD ATTACK

WORD ID PASSAGE COMP. N = 61 * p= <.05

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