Episode Transcript
[00:00:05] Kate Winn: Hello to all you travelers out there on the road to evidence based literacy instruction. I'm Kate Winn, classroom teacher and host of IDA Ontario's podcast reading Road Trip. Welcome to episode seven of season three.
Before we get started, we would like to acknowledge that we are recording this podcast from the traditional land of the Mississauga Anishinaabe. We are grateful to live here and thank the generations of First Nations people for their care for and teachings about the earth. We also recognize the contributions of Métis, Inuit, and other Indigenous peoples in shaping our community and country.
Along with this acknowledgement, and in the spirit of truth and reconciliation, we'd like to amplify the work of an Indigenous artist. And this week we are sharing the book Autumn Peltier, Water Warrior, written by Carol Lindstrom, illustrated by Bridget George. From New York Times bestselling author Carol Lindstrom and illustrator Bridget George comes a must-read companion to the powerful, award winning picture book We Are Water Protectors, telling the story of real-life water protectors. Autumn Peltier, Water Warrior celebrates Autumn Peltier and her great aunt Josephine Mandaughman, two Indigenous rights activists inspiring a tidal wave of change.
The 7th generation is creating a sea of change. It was a soft voice at first, like a ripple, but with practice it grew louder. Indigenous women have long cared for the land and water, which in turn sustains all life on earth, honouring their ancestors and providing for generations to come. Yet there was a time when their voices and teachings were nearly drowned out, leaving entire communities and environments in danger and without clean water. But then came Anishinaabe elder grandma Josephine, and her great niece, Autumn Peltier. Featuring a foreword from water advocate and indigenous rights activist Autumn Peltier herself, this stunning picture book encourages young readers to walk in the footsteps of the water warriors before them. Add this book to your home or classroom library today in each episode.
This season, we're also sharing a review for reading road trip from the Apple podcasts app. And this week we want to thank Jen K. Who kindly posted the following I love and appreciate so many things about this podcast, the guests, the host, the fact that it's Canadian, but most of all, the learning I take away from each show. Thank you and keep up the great work. Thank you, Jen K. And while I can tell you all that fully one quarter of our school staff is named Jen, there's not a Jen K. So I don't believe I work with this particular Jen. But thank you Jen. And thank you everyone who leaves us a rating and or a review. Every single one is very appreciated. And now on with the show.
I am so pleased to introduce our guest here this week on reading Road trip. Dr Mark Joanisse is a professor at the University of Western Ontario in the Department of Psychology and the Western Institute for Neuroscience. He received his PhD from the University of Southern California in 2000 under the supervision of Dr Mark Seidenberg. His research examines the cognitive and brain basis of reading dyslexia and developmental language disability in children, as well as typical reading and language and development. His research team at the Western Language Reading and Cognitive Neuroscience Lab uses a multimodal approach, including eye tracking, EEG and MRI. His research in dyslexia focuses on better understanding the links between poor reading and spoken language and phonology, and the comorbidities of dyslexia with other kinds of learning disorders like DLD and ADHD. Welcome to the show, Doctor Mark Joanisse.
[00:03:53] Dr. Marc Joanisse: Thanks very much. I'm so happy to be here.
[00:03:55] Kate Winn: We are going to be talking about dyslexia a lot in this episode. So could we start by confirming the definition of dyslexia that you use?
[00:04:04] Dr. Marc Joanisse: Sure. You're going to get different definitions of dyslexia depending on who you ask, unfortunately. But I tend to take a view that's as inclusive as possible, where there's a really short answer, which is dyslexia is the difficulty learning to read words.
But there's also a really long answer, which is why I think a simple, broad definition is important. That is, you get lots of definitions that use words like unexpected, which implies that there might be something about children's learning and cognitive abilities needing to be normal. Where I think there is some truth in that, in the sense that we wouldn't call reading difficulties in a child who's deaf or blind has having dyslexia. On the other hand, unexpectedness has muddied the waters a bit when it comes to the fact that a lot of kids with reading problems have other difficulties as well that go along with it. And I don't think it makes sense to exclude those kids from our definition of dyslexia. And that's why I don't tend to use the word unexpected very liberally. There's evidence that shows that these kids who have dyslexia and as part of a bigger set of exceptionalities, will benefit just as much as any other child would from reading remediation, and that we wouldn't want to think about kids as having a pure versus a complex form of dyslexia as being somehow in having any kind of different status.
[00:05:23] Kate Winn: Okay, I think most people would agree, I hope they would agree that students with dyslexia or reading difficulties can benefit from remediation. And you've done some interesting brain research in this area. Could you tell us about that?
[00:05:36] Dr. Marc Joanisse: Sure. Maybe I can talk about the kind of neuroimaging work that we do in my lab. And that work generally focuses on what's different in good versus poor readers. That is, children with dyslexia versus children who don't have dyslexia prior to remediation. To the point about there not being, well, the first thing I should say is, one thing we find is that there aren't really clear biomarkers or absolute differences between good and poor readers. Instead, what we find is support for the idea that dyslexia is this dimensional disorder rather than an absolute either or disorder.
And so there's not really going to be a biomarker or a litmus test where we can detect the presence or absence of dyslexia. That's always been true in the behavioral literature, where we have cutoff scores for whose reading scores show them to be impaired or not.
Those cutoffs tend to be pretty arbitrary, because reading is a continuum, and a child is going to be somewhere along that continuum. And where they are on that continuum tells us, rather about the severity of their disorder, rather about its absence or its presence. And we find that with brain data as well, where we see differences in brain activity for kids who are poorer readers versus better readers.
When you see these very impressive pictures of brain images for a child who has dyslexia versus a child who doesn't, what you have to understand is the experiment is kind of set up to show that contrast, where the contrast is not categorical, it's not the presence or absence of brain activity in a certain region or an EEG marker that's there or is not there. Rather, these are going to be graded differences where types of brain activity closely track ability or severity, of reading problems.
And so we do find that kids who are poor readers will show brain markers on a whole range of difficulties that are related to reading. We don't just look at single word reading, but also things like decoding and also language comprehension or reading comprehension, and also this thing called rapid naming, or RAN, which is the ability to very quickly name familiar objects one after the other, including letters, but also things like chips of colour and so on. And our neuroimaging data has identified different neural correlates for each of these different kinds of difficulties, where there's apparently different aspects of the brain's reading network that are all engaged, or in this case, disengaged in those different sub types of reading abilities.
If we hop over to remediation, though, the story gets a little bit more interesting, which is that over the last 20 years, it seems like the key marker for effective remediation in children is a kind of normalization of brain activity, where as kids reading improves, we see that there's an emergence of brain activation patterns that look more and more like those of typically developing kids. That's work done by people like Fumiko Hoeft at the University of Connecticut, amongst many other researchers.
And so, for my own part, one thing that's nagged a lot of researchers and parents and educators is that not all kids show the same response to intervention. And so some kids are what you might call treatment resistant, and these kids need a much bigger, what you might call dose of treatment compared to other kids. So some kids might need a lot of remediation, many hours, one on one, whereas other kids seem to pick up more quickly and figure it out much more quickly. And what's interesting is, prior to remediation, it's very difficult to anticipate which child's going to need that bigger dose and which isn't. So I'm particularly excited right now with work I'm doing with the team at Haskins Laboratories at Yale University, where we're looking at how the brain reorganizes itself during remediation and using a bunch of different kinds of brain imaging technologies. We're looking at both before and after with things like functional MRI. But we're also looking at how intensive tutoring as it's happening might also change brain organization, not really in real-time, but week to week. So we're using portable technologies like EEG and functional infrared spectroscopy, called FNIRs, which gives us brain images every couple of weeks as the child is progressing through a reading remediation program. And what's really promising there is the ability to detect those effects of learning as they're happening, rather than waiting a certain amount of time and then scanning a child a second time.
The other thing that's really promising here is the possibility that there might be able, there might be an ability to look ahead of time using brain imaging at which children might be more treatment resistant and which might be more treatment responsive. And if we can do that, then we might be able to better prepare the kind of dose that a child needs before we actually get going with intervention. So that, you know, ahead of time, this child might need 20 hours. This child might need 120 hours rather than waiting for that response to intervention to actually happen.
[00:10:30] Kate Winn: That is fascinating stuff. Very cool. Thank you. What are some of the comorbidities that are often seen alongside dyslexia?
[00:10:39] Dr. Marc Joanisse: Yeah, so this has been another big focus of my research for the past 25 years. Is this interest in how children with dyslexia have other comorbidities or other problems that hop along with it. And those key ones that I was initially interested in was developmental language disability, which was earlier known as specific language impairment, or SLI. We call it DLD now for a few different reasons, but it's an oral language problem that affects comprehension in areas like syntax and morphology, oral language comprehension abilities in these kids, and it also will affect comprehension, but maybe a little less prevalently.
It's a silent disability in the sense that it tends to go undiagnosed because there's such poor awareness of it. We're pushing really hard to get better visibility, but including encouraging educators and parents and clinicians to be more aware of its existence, because it tends to co occur a lot with dyslexia, something in the range of 30% to 50%. So it's really quite prevalent. And I guess that's not a big surprise in the sense that if we think about reading as building on a child's oral language skills, it shouldn't be that surprising that a child who has problems with oral language development will also go on later on as they enter those school years to also develop reading problems. That doesn't mean all children with dyslexia will have DLD, but it certainly is something to be on the lookout for and also can guide the way that we approach those kids in terms of the kinds of assistance that they might need when they reach the classroom.
Another one is dyscalculia, and dyscalculia is a problem with math and numeracy. It also co occurs with reading difficulty at a fairly high and unexpected rate, more than we would expect it by chance alone. Kids with dyscalculia have problems with learning math, especially as it relates to learning how numbers map onto quantities, for instance, knowing that the number two would map onto there being two little dots on the screen, also in learning calculations, because of the need to understand how numerical quantities work when you do things like addition, subtraction, multiplication, and so on.
And the other big one, of course, is ADHD, which again, co occurs with reading disability at a fairly unexpectedly high rate, especially since we don't think about ADHD as have anything at all to do with reading. It's problems with attention, it's problem with the ability to focus, and also with issues like hyperactivity, the inability to stay still and remain still during a lesson and so on.
[00:13:09] Kate Winn: You mentioned ADHD, and I know as a classroom teacher, that is something that is quite commonly diagnosed in children. What are some of the misconceptions out there about ADHD itself, do you think?
[00:13:20] Dr. Marc Joanisse: Yeah, there's so many of them, right? The old ones are that these are kids who are lazy or who just need to learn to behave. That's really the big one. It's also the idea that this might be a misdiagnosis, that it's become a catch all for other kinds of problems, like depression, anxiety, or autism, or a sleep disorder. And there I think we need to think about the cause and effect that kids with ADHD do show those other kinds of problems. For instance, interrupted sleep is very common in ADHD, although it may have more to do with the difficulty with calming their mind and difficulty with settling as part of a hyperactivity problem, and also issues with depression, anxiety, also autistic traits. Where, again, are we really understanding what the relationship is there? And it could be that as we start to address those kids problems with attention and hyperactivity, that we might see that those other traits start to fade into the background as a result of it. So again, the idea that there's another problem with these kids, well, let's start to address ADHD first and see what happens. The other one is that it's maybe over diagnosed due to things like social media pushing this idea on kids. So we see, you know, people who are so called influencers talking about their ADHD, and this might be influencing kids to say, well, maybe I have ADHD, too. My reaction to that has actually been kind of the opposite, which is that our current willingness to talk more and more about ADHD as being a real problem has been a bit of a breath of fresh air for people that so many adults with ADHD who grew up with ADHD traits early on in life, at a time when people weren't talking about it. Those folks are talking to me about how different the world is now compared to when they were kids, that we're having real conversations now about ADHD as a genuine disorder, that we were really weren't having 20 to 30 years ago. And being able to put a name to face to these difficulties, is something that they wish they had earlier in their lives. And so our ability to address it earlier, to pursue diagnoses early on to think about how we can address these problems, that's been absolutely striking, and it changes the way that people think about themselves, and it could be a net positive. ADHD is a dimensional disorder, just like dyslexia is, in the sense that it's not a thing that you may have in an absolute sense. There's no litmus test to it. Again, it's more just how many of these traits you might actually endorse in yourself or that your educator sees in you leads to a diagnosis or not. And the willingness to address this as something where there may be borderline cases, weak cases versus strong cases, or even the idea that there's different subtypes of ADHD is increasing gow many people we think have ADHD, and also how we address it in the general population. And so, for instance, some people might have ADHD where there's not a hyperactive presentation of it. Rather, it's just the presentation of inattentive subtype of ADHD. And those kids or adults who have the inattentive subtype are not going to show those hyperactive traits and may therefore fly beneath the radar and not show all of the different spectrum that people might expect. We see this especially when we're looking at gender differences, that girls, for instance, tend to look different from boys when they have ADHD. At least in many cases, they may not show the same hyperactive subtypes that we see in more prevalently in boys. And also boys who don't have the hyperactive traits as well will also be maybe under the radar. They may be seen as a little bit flaky, as inattentive and not paying attention, but that's seen as a behavioral problem rather than possibly ADHD compared to somebody next to them who's showing all the usual wiggling around and difficulty needing to stand up and so on, and be more disruptive in the classroom. So being able to admit those broader spectrums of ADHD subtypes is changing the way that we think about the disorder and probably changing its prevalence as well. But that doesn't make it over diagnosed, of course. That just means that we're thinking about it differently and maybe addressing the different traits that we see in one child to the next.
[00:17:28] Kate Winn: Great points. Thank you. I'm curious to know if you have a professional opinion on ADHD medication for students. As a teacher, of course, I'm not at all qualified to diagnose or prescribe or anything else. I have a professional opinion of my own, but I'd like to hear yours.
[00:17:46] Dr. Marc Joanisse: Yeah, and I'm in the same boat. As a researcher, I'm not a clinician. I don't even do the diagnosing of these problems. But what I can tell you is that when a parent pursues diagnosis, it's generally with a clinical psychologist or a psychotherapist. And with that diagnosis in hand, which is done behaviorally, really it's done by looking at the different kinds of behavioral traits we see in a child, as well as a more general psychoeducational workup that might also look at other learning exceptionalities to try to rule out other problems. Then the family goes to the family doctor or a pediatrician or even a psychiatrist and says, well, what do we do about this? And one of the courses of action, but not the only, is medication, but that's often done by a different person who does the diagnosing. And that person may bring their own baggage with them in terms of how they see the role of medication versus other interventions in this. And certainly medication is going to be part of that conversation.
Only a physician can do the prescribing. And of course, if they're not the ones who do the diagnosis, they may have views about what role ADHD medications play.
A misconception that goes around, though, is that there may be dramatic differences among different kinds of stimulant medications that are used to treat ADHD. And in fact, really, there's really one line of medications that are stimulant medications. They come by different names, Ritalin, Concerta, Vyvanse. These are all closely related chemically to one another. So there's really only two stimulant classes, and they work in the exact same way. And what we'll see is generally very similar effects from one drug to the next. People might get misconceptions. Well, this one worked, that one didn't work. It may have to boil down more to either the dosage, or it may boil down to this idea of one being more time released than the other, so it works more rapidly than the other, but in fact, the effects are very, very similar. And the changes that a doctor will make to that will have to do with those two things, the time release nature or the dosage, trying one versus the other. But most people will respond in roughly the same ways. It's a little frustrating because for many people, those, those stimulant medications may not work very well. There are non stimulant medications, things like NSRI's, that may also be effective against any ADHD, although they tend to be more subtle in their effects. On the other hand, they don't have the other, the other side effects that people report, which have to do with difficulty sleeping, an alarming drop in appetite and personality changes that we see, and also making anxiety traits worse. So it's not magic. It is a situation, though, where the nice thing about the stimulant medications, that the effects wear off quickly, which means that some strategies that parents and kids can use, which is to not necessarily take those drugs each day and to think about when they take it relative to when they actually need its effects to be strongest. That may not be every single day of the week, every single week of the year and so on. For instance, some kids will go off it in the summer when they're not going to school as a way of making sure that they're nothing exposed to those side effects any more than they actually need to.
[00:20:55] Kate Winn: I feel like we talked about misconceptions about ADHD, and I think there's a misconception if they're about teachers and that we want to drug all the kids just to keep them all compliant and quiet and make our lives easier. And I think for me, I kind of. I find it interesting when I first heard somebody say, you know, if your child were diagnosed with diabetes and the doctor wanted them to have insulin, would you say, I don't believe in medicating kids. Right. Whereas this is another example, of course, again, if your doctor is recommending this to you. But I feel like I've got good classroom management and I love a range of activity levels and energy in my students. That's all good. I mean, obviously, sometimes an individual's behaviours can impact other students in the class, but anytime I'm supporting a parent and a child to get a diagnosis or to go down that path, it's not to make my life easier or I want my classroom quieter, or I just want, you know, peace in the room. I have seen some examples where I would say it's been a miracle when a student has gotten their diagnosis and has gone on medication. And it's not just about, oh, they're quieter. The learning, the difference in learning, I've seen, and one really interesting story was it was a grade four student, and I was talking to the mum at an evening event at school, and I said, let's call him Adam. And I said, you know, I just can't believe how Adam's really turned a corner these last few weeks. Like, he's really focused. He's completing his work without reminders. He's staying at his desk. He seems to be getting the math and she said, oh, we were wondering if you'd notice he went on ADHD medication a few weeks ago. Right. And so I thought, okay, kind of funny you didn't want to tell me that first, but, oh, yes, I noticed and there have been several others. So, I mean, people think of me as a kindergarten teacher now. I don't see this often in kindergarten, but it was more when I was in grade 2, 3, 4, 5 that I, I would see such a huge difference and just be so thrilled that that child was going to be able to learn and be successful academically because of that. So that's just another kind of misconception, I think, out there about why teachers are wanting this for their own convenience. And so I thought I'd throw that in while we were speaking about this.
[00:23:05] Dr. Marc Joanisse: Absolutely. I also think, though, that parents think about classroom management very differently from how teachers are thinking about it now as well. They remember back when they were students where every desk was lined up in a row and everybody sat still for an hour and a half and was, you know, quietly taking notes on what the teacher was saying. And when I've looked into classrooms more recently, what I'm seeing is things like learning pods and different kids doing different activities at the same time and also a lot more flexibility of, hey, you know, that guy needs to walk around every 20 minutes and maybe needs to go sit in that reading nook over there for a little while and cool off. And, you know, other kids who may do strategies, like, for instance, take noise canceling headphones to school not because they're necessarily listening to music, but only because they need to maybe block out the distractions that are happening. There are lots of different creative ways in which teachers are understanding that, you know, with all these different ways in which kids are going to come into the classroom, that being able to expect those kids to accommodate you is much less realistic. And so I do definitely think that's part of the story as well. And that, you know, these kids really do want to be able to attend and want to be able to learn and are frustrated with their inability to either sit still or maintain their attention without it drifting off and are sometimes frustrated that, you know, things that are minor distractions to other kids, like a noise in the background, become a major distraction for them. And they don't understand why everybody else is able to power through those occasional distractions, whereas, you know, the least bit of distraction while they're taking a test throws them off completely. And so often those medications are a real game changer for them in terms of the confidence that they bring to it.
I do worry about making things like anxiety worse for some kids, and that's where the frustration comes, that with those stimulant class of medications, in some cases, kids bring with them other kinds of difficulties, and those stimulant medications really are not indicated. And so that's where I think there's probably physicians need to be more creative with where they look at dosage, and also that there's also second line medications like those NSRI's that are not going to work in the same way. So something you need to take for several weeks before they start to work, where their effectiveness is going to be much less salient to kids. The kids may even swear that they're not working at all until parents say, well, in fact, it's working extremely well. And that's something that maybe physicians are less willing to take up because it's a little bit more work and it's going to require more visits to get it exactly right compared to something like those stimulant medications where you're tweaking the dose, or even the child can tweak the dose themselves, ten milligrams this day, 20 the next, and so on. And so I think there's probably more work to be done on that, and I'm hopeful that we'll see more progress in that regard, especially for those kids who are maybe more drug resistant or who show maybe difficulties with tolerating those stimulant medications.
[00:26:00] Kate Winn: You've said that decoding and word recognition difficulties are often seen alongside ADHD. What about the language comprehension side, and then how that leads to the ultimate goal of reading comprehension? Is that connected to ADHD, too?
[00:26:14] Dr. Marc Joanisse: I think that what we see the most in kids with ADHD is decoding difficulties. They look the most like the kids with dyslexia when they have comorbid dyslexia, and I should be clear on that. There's a whole cohort of kids that we've seen who have absolutely no reading problems at all. And then there's kids with ADHD who have, I should be clear, many kids with ADHD who have no reading problems at all. But the kids with RADHD plus dyslexia seem to have the same kinds of decoding problems as a whole that we see in dyslexia alone. And so there we also see comprehension problems. But that's. I think that's because comprehension problems follow these decoding problems like night and today, we see if they have problems decoding the individual words on a page, then assembling those words into a sentence and into a discourse is going to be very difficult for them. Like any other child with a reading problem, what we don't see is an unusual prevalence of problems with oral language comprehension and ADHD, unless those kids also have a DLD diagnosis. We do see that a lot of kids with ADHD are also susceptible to DLD, which is that oral language problem we've seen before, and we should be sensitive to identifying those problems in those kids as well. The idea that some kids have ADHD plus DLD seems to be the case that we see a lot of kids with both disorders, much more than we'd expect by chance alone. And that's where we need to be sensitive to this and that. If those kids have, you know, ADHD and a language, an oral language problem, then we should be on the lookout for a reading problem as well. And that that's the kind of constellation that have difficulties that we shouldn't be surprised to see and something that we should be on the lookout out for when we're looking at these kids.
[00:27:56] Kate Winn: I know that sometimes students can be screened out of intensive intervention programs because of attention difficulties. Talking about reading intervention here because their issues could also impact the rest of the group is sort of the argument. Right. What are your thoughts on this, and does the approach to reading intervention for kids who have both dyslexia and ADHD need to be different?
[00:28:19] Dr. Marc Joanisse: Absolutely. This is something that's really been bugging me, and I think it goes back to our definition of dyslexia that I talked about before. The reason why I encourage people to use such a permissive view of dyslexia as dyslexia is a reading disorder full stop is that people are tempted to define dyslexia differently from what you might call reading disability or a reading impairment, that somehow, because it's got a fancy sounding name, dyslexia is special from other kinds of reading problems. And I think that's absolutely wrongheaded, that this may be controversial, but we shouldn't think about reading disability and dyslexia as anything other than the same thing. Dyslexia is a reading disability, and that children with reading problems should have their reading problems assessed by thinking about using the term. Dyslexia has shifted around in the years I've been avoiding using it a lot in the literature when I'm publishing, because I don't want people to think that I'm somehow envisioning dyslexia as only the subtype of kids with reading problems who have a phonological reading problem, and I don't want parents and educators and scholars to be talking past each other. But in fact, any child with a reading problem should have the nature of their reading problem assessed at face value. We shouldn't carry with us into that the expectation that only dyslexia involves a phonological problem, and that only kids who have problems with phonological decoding have dyslexia, and that the reading remediation programs that we've developed for addressing dyslexia should only be about decoding. We should be talking about a comprehensive view that really is addressing the kinds of things that go wrong in those kids.
Another way to think about that is there are in fact, subtypes of reading problems or dyslexia, some of which are emphasizing less on the side of decoding and more on the side, for instance, of rapid automatized naming. Thinking about work, for instance, by Pat Bowers and Marianne Wolf in the two thousands where they promoted this model, in which some kids have difficulty with rapid naming and that that's at least partially dissociable from their decoding problems, and that we may need to address those problems slightly differently, not by making them, for instance, faster at naming and emphasizing fluency, but by emphasizing the other things that might go wrong. For instance, there are whole word naming problems. Some kids have problems with these idiosyncratic spellings of words like pint and have, where a word like have, for instance, competes with words like gave and save and rave. And when we're teaching that ave pattern how the a, the a in a word like rave and save is making a certain sound, because the e at the end of a word, well, have goes against that. But that's a sight word that we should also be working with kids, at least to some extent on, and that some kids with what you might call surface dyslexia have problems with those sorts of words. And we should be emphasizing research reading programs that address those in kids who really do have those difficulties as well. What I find heartening is that a lot of more modern reading remediation programs, like empower, for instance, do emphasize that there's more than one thing going on. It's not just single letter decoding. It's also understanding things like word bodies. It's also things like morphological awareness, where you understand that the ed or the ing at the end of words is part of a bigger puzzle that you're trying to unlock about spelling patterns. And also that there are these words like pint and have that you also need to know. And incorporating things like sight words into the program is really an essential part of that.
[00:31:45] Kate Winn: I'd like to ask you about a case study. So this is shifting gears from ADHD, as this is not suspected in this student. But because I have you here and have your expertise, I'd like to throw this one out at you.
[00:31:54] Dr. Marc Joanisse: Sure.
[00:31:54] Kate Winn: So I'm wondering about your thoughts on a kindergarten student with strong phonological awareness. So when I say strong, I mean above benchmark for first sound fluency, above benchmark for phoneme segmentation fluency, but still really, really struggling with the print piece, like right back at the level of letter-sound correspondences. And I know, you know, sometimes if it's not a phonological issue, I know there's the whole RAN. You were mentioning ran a few minutes ago. And I, like earlier, you mentioned something about with RAN how it has to be familiar letters or objects or whatever that they're naming. We tried to do a ran assessment with this child, but the child was not familiar with the letters or the numbers that were part of those two pieces, so we couldn't get a full piece of that assessment.
Does that student, if they have a strong phonological awareness, phonemic awareness profile, do you think we can trust those scores and think that it's something different? What would be your thoughts on how to approach things with the student?
[00:32:50] Dr. Marc Joanisse: There's two things. One is I see a lot of kindergarten instructors now are really emphasizing phonological awareness to the point where we get kids who are super phonological awarenessers, right, they're doing things like phoneme elision or phoneme deletion or rhyming or syllable and phoneme counting really, really well because they've had this drilled into them. But phonological awareness is not necessarily the skill for learning to read. It's a way of measuring phonological processing. Just because it's a measure of phonological processing doesn't mean that if you make a child better on the measure means that you've fixed the thing that's underlyingly impaired in that child. You might just make them really, really good at doing those tests where those tests are really just being used as one way of measuring what's underlyingly going on in their head as they're processing phonological information.
Phonological processing is as much an implicit ability as anything else, and phonological awareness is an explicit ability. You can train the explicit ability without actually fixing the implicit ability. And so it's very possible that we need to think about better ways to address phonological processing than simple phonological awareness training. That's why people have been moving away from phonological awareness training as the thing that we should be doing with kindergarteners. And, you know, not to say that it's completely a waste of time, but more than a few lessons becomes more an activity that kids will get better at, whereas it's not giving us a lot of insight into whether they're actually going to use that phonological knowledge to actually learn, learn to read. I think emphasizing things like understanding how the letter names and the letter sounds link up with the visual form on a page, that's where it starts to become more like reading instruction, and that's where we should be moving with kids. So that's one piece of it.
The other piece, though, is, yeah, there's a lot of kids with dyslexia who may not be decoding based. They may have other things wrong with them. And I mentioned this thing called surface dyslexia, where some kids have problems not with decoding, but with spelling patterns. And I wonder if that's where the problem is with certain children who have pretty good decoding. So lots of kids will have problems with both. They'll be bad at the spelling patterns and with the irregular spelling that we see in words as well as decoding. But other kids may be specifically impaired on that other side of reading, which is recognizing whole words, and where those may be. The few kids who actually benefit from more instruction on understanding how idiosyncratic spelling patterns in some cases do map onto the words on a page. And that's something that educators should be mindful of as they teach decoding, that they're teaching decoding, but they're also mindful that some kids may be excellent decoders, but that reading is built up of two things. It's built up of both the decoding side of it, where you're mapping the individual letters to the individual sounds in your head, but also this other side of things, which is mapping entire spelling patterns to the meaning and to the sounds that go with it.
And those two, what you might call roots or mechanisms, are both going to work in parallel to different extents. It's a trading relation between those two abilities. That's something that people worked on a lot in the nineties, but it's a message that I think got lost as we had this revolution and how we thought about teaching kids to read, which was very heavily decoding-based. That whole language and so called blended approaches really did push too hard on that whole word knowledge. But that's not to say that whole word knowledge is completely irrelevant. And we should not be teaching kids at all on how to understand spelling patterns. That doesn't mean we should be teaching, you know, purely visual approaches and, you know, teaching kids how to think about what the word, what the letters themselves look like, or whole word shapes and things like that were very big and the whole word emphasis, or even overemphasizing fluency, but rather to think about how we're teaching different granularities of spelling patterns from the individual letters. For instance, this letter usually makes this sound all the way up to this is an irregular word, like the word colonel or yacht, which has a funny, weird spelling pattern. And that is still something you're going to need to see because in some cases, these are very high-frequency words, and often these very high-frequency words are the ones that have the most irregular spelling pattern.
[00:37:02] Kate Winn: So if I understand you correctly, thinking about, you know, this student, or any student that perhaps on the universal screener, which we know is good, we want to do these to see where they are. But just because they aren't looking to be at risk on phonemic awareness tasks is no guarantee that there may not still be a reading issue.
[00:37:21] Dr. Marc Joanisse: That's right, and you mentioned a universal screener. But I mean, what is that universal screener based on? Is that assuming a universality of decoding as the only indicator of reading success? And if it is, then I don't think that screener is very universal. Then I think we need to rethink what we're doing to screen our kids. Some boards, for instance, have rolled out a phonological awareness or decoding based screener for kindergarteners and first graders. And that's been very powerful in identifying kids who are at risk of reading disability. But some kids will still pass that with flying colors because it's only measuring one aspect of this reading ability. But we know that reading is this multi componential thing. We also know that both behaviorally and for neuroimaging, that kids with reading exceptionalities, kids who are poor readers, for instance, may show problems on things that are not related to decoding, like things like ran, and that that involves different kinds of reading pathways that could also go wrong for different reasons. Reasons most kids are, you know, fortunately for a universal screener standpoint, going to show problems with decoding, even if that's not their primary difficulty. But let's not be misled to think that decoding is the only thing there's other things going on in a lot of those kids, and we should be probably taking a broader view of this to also look at the other kinds of exceptionalities that they may have.
[00:38:42] Kate Winn: Thank you. We talked earlier about ADHD misunderstandings, misconceptions. But is there anything else in terms of misunderstandings, about anything else we've talked about today? Remediation, dyslexic comorbidities? Anything else at all that you want to clarify or share with listeners?
[00:38:58] Dr. Marc Joanisse: Sure thing. I mean, I'm somebody who studies both behavioural and neural correlates of reading disability. And obviously, the thing that gets people the most wowed is when they show them brain pictures. I show them a photo of a child's brain. I say, this is a child with dyslexia, and look at how the activation pattern in this child is different than in the child who doesn't have dyslexia. And that carries a lot of weight with people because they want to know that reading disabilities like dyslexia are neurobiological in their origin. On the other hand, I think we can very easily get led down the garden path on that. That is, we get wowed by guys like me showing brain pictures and forget that the whole point to reading is that reading is a behaviour. It's an ability. It's not just a that's happening in the brain.
You know, I just happen to be curious about how to measure reading disability in the brain. But is knowing that dyslexia has a brain origin really going to change the way that we approach a child having dyslexia? I mean, I hope not, because we're trying to think about these children in terms of their abilities and disabilities and whether or not we have an image of their brain or not. Let's think about what this child can and can't do and approach them on those terms. It's a bit of a thought experiment. I mean, what else did we expect, right? If learning happens in the brain, then, of course, children with learning problems will show different brain activity. And so let's not get too wowed by the brain data, and let's make sure that we're understanding that with or without the brain data, we should be thinking about what's going wrong in kids, what our general model of reading ability and disability is, and how we're going to tackle that child's constellation of exceptionality.
The contribution that my own brain imaging approaches has made, I hope, is the idea that we're not just measuring one aspect of a child's brain when we're actually doing things like comparing their brain images to their abilities and disabilities, but that what we're finding is that there are different reading pathways supporting different sub aspects of reading ability and disability, and that those are different kinds of things that might need to be addressed through a comprehensive remediation package that we're presenting to that child. So it's not just going to be phonological awareness, not just going to be RAN, not just going to be spelling training. It's going to be a constellation of things that addresses the exact weaknesses that we've identified in those kids.
[00:41:11] Kate Winn: That's great. And before I let you go, could you share with listeners what's next for you and your work and where they can find you?
[00:41:17] Dr. Marc Joanisse: Sure thing. Just in the past few weeks, we've started to launch a new project that's going to use EEG, which is electroencephalography, which is actually a very old technology, over 100 years old.
And we're using EEG to measure children's brains as they track speech in real time. The big hypothesis about dyslexia is these kids have difficulty processing the spoken form of language, and that those difficulties are often very, very subtle, that we can't just detect it the way we can detect other kinds of difficulties in these kids, and that we can use EEG and machine learning techniques to actually measure how children are actually tracking speech in real-time. So kids listen to familiar stories like podcasts, and we measure their brain responses to those speech sounds in real-time with EEG, and then we're able to actually track what's going on in those kids and how they're organizing sounds in their brains. One of the exciting promises of this is that it doesn't really require the child to do anything at all, including reading, which means we can get to a young age, as young as three years old or even earlier. And so we're going to be recruiting kids from ages three to eight years old, which is much before we're really seeing, in some cases, reading difficulties actually start to emerge in these kids and actually measure what's going on as the brain starts to organize itself around understanding spoken language and using their EEG measure to actually look at how this develops up to about the age of eight years old.
So we're pretty excited by that in terms of reaching, for instance, families that want to keep track of how we're doing on the these kinds of things, or who might be interested in participating themselves in our studies. We're actually using Facebook for the most part, and I can give you a link for how to find us on Facebook. I know that not everybody uses Facebook anymore. In this case, it's one way that we found very easy to get to parents of kids who are affected. And I know there are a lot of very interesting discussion groups. People have used Facebook less and less to, for instance, post photos of things, but they're more and more interested in these bigger discussion groups. And that's where I find it's easy to engage with parents and educators as well in some of the discussion groups that have emerged. For instance, the IDA Ontario adjacent discussion groups have been really educational for me, and we've got our own, our own page where we're posting, for instance, things like interesting talks, interesting videos, and also, occasionally, also opportunities for people who are around us to get involved in the kind of research. And so one thing I'm interested in breaking out into is things like TikTok and Instagram. That's a little more challenging for a guy like me. But something that I'm super interested in as well as we move forward, is, you know, how we might be able to meet people where they are on things like these shorter reels, these easier to get to posts, these little snippets where, for instance, we might show people what it's like to be in a study and to visit our lab and so on.
[00:44:03] Kate Winn: That's awesome. This has been such a fascinating conversation. Dr Marc Joanisse. Thank you so much for being here with us for this episode of Reading Road Trip.
[00:44:11] Dr. Marc Joanisse: Thanks very much. This has been a lot of fun.
[00:44:19] Kate Winn: Show notes for this episode with all the links and information you need can be found at podcast.idaontario.com. and you have been listening to season three, episode seven with Doctor Mark Jonas. And now it's time for that typical end-of-the-podcast call to action. If you enjoyed this episode of Reading Road Trip, we'd love it if you could rate and or review it in your podcast app as this is extremely helpful for a podcast and your review might make it onto an episode. Of course we welcome any social media love you feel inspired to spread as well. Feel free to tag IDA Ontario and me. My handle is thismomloves on Twitter and Facebook and katethismomloves on Instagram. Make sure you're following the Reading Road Trip podcast in your app and watch for new episodes continuing every Monday throughout the summer. We couldn't bring reading road trip to you without behind the scenes support from Katelyn Hanna, Brittany Haynes and Melinda Jones at IDA Ontario.
I'm Kate Winn and along with my co producer Dr Una Malcolm. We hope this episode of Reading Road Trip has made your path to evidence based literacy instruction just a little bit clearer and a lot more fun. Join us next time when we bring another fabulous guest along for the ride on Reading Road Trip.
