3/27/2011

The Neuropsychology of Reading and Written

Language Disorders:
A Framework for Effective Interventions

Steven G. Feifer, D.Ed., NCSP, ABSNP

Wake County, North Carolina
Feifer@comcast.net

PRESENTATION OF GOALS

1. Discuss the role of school neuropsychology, within an RtI

framework, as a more viable means to both assess and
remediate learning disorders in children.
2. Explore the neuropsychological underpinnings of
reading and written language disorders by examining the
underlying neural circuitry involved in processing
this type of academic information.
3. Introduce a brain-based educational model of diagnosing
reading and written language disorders by classifying
each into four subtypes, with specific remediation
strategies linked to each subtype.

4. Introduce the 90 minute LD evaluation as a more

comprehensive means to assess eight core cognitive
constructs associated with learning disorders in children.

BASIC LITERACY FACTS

(National Literacy Council, 2008)

 Currently, approximately 6.7 million children receive

special education services under IDEA, which
corresponds to approximately 9 percent of all children
aged 3-21 in public education.
 Approximately 40 percent of those children receiving
services are classified as being “learning disabled”
due primarily to reading and/or written language
deficiencies.
 Clearly, literacy is the single most important educational
attribute paving the road for not only school success,
but perhaps for successful life endeavors as well.
 Kavale and Forness (2000) revealed nearly 50% of students
classified as having a learning disability do not
demonstrate a significant discrepancy between
aptitude and achievement due in part to the statistical
impreciseness of this method.
3

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Traditional Problems with Special

Education Service Delivery Model
 A deliberate separation of regular education
from special education.
 Undocumented benefit of special education for
children with high incidence disabilities.
 A disconnect between testing for eligibility
purposes versus testing for what
interventions work best.
 A reactive model not geared toward early
intervention services.
 IEP’s that rarely emphasize the “I”.
 Inconsistent qualification decisions since there
is no universal agreement on what
constitutes a significant discrepancy.

MAIN PITFALLS OF DISCREPANCY

MODEL

1. There is no universal agreement on what the

discrepancy should be, or developmental guidelines
for discrepancy expectations.

2. It remains unclear as to which IQ score should be

used to establish a discrepancy.

3. A discrepancy model of learning disabilities precludes

early identification and creates a “wait and fail” policy.

4. A discrepancy model of reading assumes that IQ is the

best predictor of successful reading.

 What is the relationship between IQ and reading?

 Discrepancies only represent unexpected

underachievement!! 5

3-Headed Monster of Reading

DECODING FLUENCY COMPREHENSION

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IDEA REAUTHORIZATION

IDEA REATHORIZATION - signed into law by President

Bush in December, 2004.

 States may opt out of using the discrepancy model

to identify learning disabilities, and replace with
RTI.

 Gives school districts flexibility to craft policy

whereby students who do not respond to
scientifically based reading program can be
eligible for SPED.

 Requires districts with disproportionate number of

minorities in SPED to consider eliminating the use
of IQ tests.

Six Components of an Effective RTI Model

(1) Universal Screening - for all students a

minimum of three times per year.
(2) Baseline Data - using curriculum-based
measurement as primary data gathering means.
(3) Measurable Terms - define problem areas
numerically.
(4) Accountability Plan – monitor fidelity of
selected intervention.
(5) Progress Monitoring – how, where, and when
intervention results will be measured and
recorded.
(6) Data Based Decision Making – ongoing analysis
of data to drive future intervention decisions.

RESPONSE TO INTERVENTION MODEL

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Curriculum-Based Measurement

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RtI Strengths and Limitations

RtI strengths:  allows for earlier intervention.
 non-categorical.
 excellent for progress monitoring.
 utilizes data to make decisions.
 systemic deployment of interventions.

RtI weaknesses: is not sufficient to identify a learning disability

(National Joint Commission on Learning Disabilities, June 2005)

 RtI is incapable of differential diagnosis and offers

little in identifying other emotional conditions or attention
factors hindering learning (Reynolds, 2008).
 Run the risk of delaying assessment and denying a
student eligibility for services (OSEP memo, 2010).
 RtI models often promote standard protocol
interventions and assume a “one size fits all” approach to
remediation (Feifer & Della Toffalo, 2007).

 Evidence based interventions require evidence based

assessments!! 11

School Neuropsychological Assessment

 Reports based upon a brain-behavioral
paradigm which attempts to describe how a
child learns and processes information.

 Focus on why the child has not been

successful in school as opposed to IQ
scores.

 Less emphasis on whether or not the

student qualifies for special education
services.
 Examine the cognitive and emotional
strengths and weaknesses of the child and
link to specific educational strategies and
interventions. 12

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Supreme Court and School Neuropsychology

 Forest Grove School District case reached the Supreme
Court in June, 2009. The local school psychologist
evaluated a child and concluded there was no
disability present.

 The parents sought a private assessment that was more

comprehensive and examined multiple cognitive
constructs. There was evidence of a disability. The Due
Process Hearing Officer concluded that the school
district failed to provide FAPE and that the school district
is liable for private school services.

 Supreme court justice John Paul Stevens agreed with the

Due Process Hearing Officer because the school had
overlooked a disability because they had not completed
a comprehensive evaluation in all areas of the suspected
disability. Cost of tuition…$5200 per month.

 Do you agree?
13

Competing Neuropsychological Models

1. Cattell-Horn-Carroll (CHC) model emphasizes
cross battery assessment examining broad and
narrow abilities (Dawn Flanagan).
2. Discrepancy/consistency approach utilizing the
PASS model of information processing
(Jack Naglieri).
3. Cognitive Hypothesis Testing (CHT) model links
assessment to intervention using a demands
analysis (Brad Hale & Cathy Fiorello).
4. School Neuropsychological Conceptual model
of information processing (Dan Miller).
5. 90 Minute Learning Disorders model teasing
out subtypes of each disorder (Steven Feifer).
*Let us begin our discussion on how reading
14
is represented in our brain.

Four Universal Truths of Reading

1. In all word languages studied to date, children with
developmental reading disorders (dyslexia) primarily
have difficulties in both recognizing and manipulating
phonological units at all linguistic levels (Goswami,
2007).

2. English speaking children tend to develop phonemic

processing more slowly than children in more
phonologically consistent languages such as Spanish
or Italian (Goswami, 2007). Still, children in all
languages initially become aware of larger acoustical
units within the words themselves such as syllable,
onset, and rhyme.
Superior
Temporal Gyrus

Angular Gyrus
Heschl’s Gyrus
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How Complex is English????

 The English language includes over 1,100 ways of
representing 44 sounds (phonemes) using a series of
different letter combinations (Uhry & Clark, 2005). By
contrast, in Italian there is no such ambiguity as just 33
graphemes are sufficient to represent the 25 phonemes.

 Therefore, 25% of words are phonologically irregular (i.e.

“debt”, “yacht”, “onion”, etc..) or have one spelling but
multiple meanings (i.e. “tear”, “bass”, “wind”, etc..)

The six types of syllables that compose English words

must be directly taught as orthographic representations.
a) Closed syllables (just one vowel…”cat”)
b) Open syllables (ends in long vowel…”baby”)
c) Vowel-Consonant E Syllables (silent e elongates vowel...”make”)
d) Vowel-Team Syllables (two vowels make one sound…”caution”)
e) R-Controlled Syllables (vowel followed by “r”changes sound…”hurt”)
f) Consonant-le Syllables (end of word ending in “le”…..”turtle”)

16

Four Universal Truths of Reading

3. Specific neuroimaging techniques have
demonstrated that phonological processing is
a by-product of the functional integrity of the
temporal-parietal junctures in the left
hemisphere of the brain ….supramarginal
gyrus (Pugh et al., 2000, McCandliss & Noble,
2003; Shaywitz, 2004; Sandak et al., 2004).

Supramarginal
Gyrus

Superior
Temporal Gyrus
Heschl’s Gyrus

17

Four Universal Truths of Reading

4. According to the National Reading Panel(2000), the
most effective method of teaching a phonologically
challenging language such as English is through a
direct and explicit model of phonological
development.

COMPREHENSION

LANGUAGE

FLUENCY

PHONICS

PHONEMIC AWARENESS 18

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NATIONAL READING PANEL:

Conclusions K-1st grade
(1) The younger the child, the better the outcome.
(2) The “at-risk” child responds best to small group
instruction (3:1), with phonological awareness
training being combined with explicit phonics.
(3) Highly trained teachers achieve the best results.
(4) Frequency of instruction (4-5 days per week) was
more effective than sporadic instruction (2 days per
week).
(5) Gains were maintained in most children at long-term
follow up.
(6) The following characteristics were associated with
poor outcome:
a) attention or behavior concerns
b) low socioeconomic status
c) poor verbal skills
d) poor rapid naming skills 19

NATIONAL READING PANEL:

Conclusions 2nd – 6th grade
(1) Readers at this age respond to explicit phonological
instruction, though gains were not as strong as with
younger children.
(2) These readers were less responsive to explicit
phonological instruction, though did better in one-to-
one or small group instruction.
(3) More intensive work for a longer duration required.
(4) Spelling and fluency did not improve much, though
some improvement with reading comprehension.
(5) Computer instruction served as an effective aid, but
was not effective by itself.
(6) The following characteristics were associated with
poor outcome:
a) attention or behavior concerns
b) low socioeconomic status
c) poor verbal skills
d) poor rapid naming skills 20

Neural Circuitry of Reading Disorders

 Nonimpaired readers activate primarily

posterior portions of left hemisphere.
 Impaired readers under-activate posterior
regions and activate primarily frontal
areas.
21

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Our Adaptive Brain

Question: Can brain chemistry actually become altered
as a result of practice and effective interventions???
 London cab drivers showed direct correlation
between number of years on the job and hippocampal
volume (Maguire et al., 2000)
 Bilingual individuals have more gray matter in the
left angular gyrus than monolingual students, no matter
when the second language was acquired (Green et al.,
2007)
 There is a correlation between the size of Heschl’s
gyrus and the amount of time practicing an instrument
(Schneider et al., 2002)
 Dyslexic students fail to activate brain regions
associated with phonological processing and
automaticity (Shaywitz & Shaywitz, 2005). 22

Our Adaptive Brain

 Researchers (Hoeft, et al., 2010) were able to predict with 90%
accuracy which teens could improve their reading based upon
neural activation in the right inferior frontal gyrus of the brain.
This was more accurate than any standardized reading measure
including the Woodcock Reading Mastery Test.

 The strongest gains were in reading comprehension rather

than phonological awareness. The right longitudinal fasciculus,
a pathway connecting front and back speech zones, tended to
show greater activation. (Proceedings of the National Academy of Science).

23

Four Subtypes of Reading Disorders

(1) Dysphonetic Dyslexia – difficulty sounding

out words in a phonological manner.

(2) Surface Dyslexia – difficulty with the rapid

and automatic recognition of words in print.

(3) Mixed Dyslexia – multiple reading deficits

characterized by impaired phonological and orthographic
processing skills. Most severe form of dyslexia.

(4) Comprehension Deficits – mechanical

side of reading is fine but difficulty persists deriving
meaning from print.

24

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UNDERSTANDING THE NOTION OF

SUBTYPING
Inferior Frontal Gyrus Supramarginal
Gyrus

Angular
Gyrus

Heschl’s Gyrus Fusiform

Superior Temporal Gyrus
Gyrus

25

UNDERSTANDING THE NOTION OF

SUBTYPING
KEY BRAIN REGIONS IN DYSLEXIA

(1) Heschl’s Gyrus- auditory perception and

discrimination.
(2) Superior Temporal Gyrus – modulates the 44
phonemes of the English Language.
(3) Angular Gyrus – cross modal association area
mapping symbols to sounds.
(4) Supramarginal Gyrus – cross modal association
area underlying the spatial appreciation of sounds.
(5) Fusiform Gyrus – automatic word recognition center
for reading.
(6) Inferior Frontal Gyrus – key region for passage
comprehension.

* Posterior portion of the brain decodes.

* Anterior portion of the brain comprehends.
26

DYSPHONETIC DYSLEXIA
INTERVENTIONS
Over Age 12: Wilson Reading System
SRA Corrective Reading
(Top- Down) Read 180

Ages 7 - 12: Alphabetic Phonics (Orton-Gillingham)

Recipe for Reading
SRA Corrective Reading
Earobics II
SIPPS
LIPS
LEXIA
(Bottom-Up) Horizons
Read Well
DISTAR (Reading Mastery)

Under Age 7: Fast Forword (Tallal)

Earobics I
Phono-Graphix
Lindamood Phoneme Sequencing Program
Success for All
Ladders to Literacy
Fundations 27
Road to the Code

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SURFACE DYSLEXIA (FLUENCY)

INTERVENTIONS

Under Age 7: Analytic or Embedded

Reading Recovery
Early Steps

Ages 7 - 12: Great Leaps program

Read Naturally
Quick Read
RAV-O
Over Age 12: Neurological Impress
method
Wilson Reading System
Laubauch Reading Series
Read 180 28

4 REMEDIATION STRATEGIES FOR

MIXED DYSLEXIA

(1) Balanced Literacy - An eclectic and approach capitalizing

on the particular strengths of the child. Consider using a
multi-sensory type of Orton-Gillingham program, coupled
with a fluency model such as Read Naturally, and the
computerized models of Read 180.
(2) Top Down Strategies – Often atypical development
mapping individual sounds to the visual word form
association areas (Temple, 2002; Shaywitz, et al, 2003; Noble
& McCandliss, 2005).
(3) Socioeconomic Status - According to Noble and
McCandliss (2005), socioeconomic status (SES) is a very
strong predictor of reading skills due primarily to the home
literacy environment. Therefore, schools need to provide
more reading opportunities.
(4) Motivation and Confidence –Great Leaps, Read Naturally,
and Neurological Impress tend to give immediate feedback.
29

4 Reasons for Poor Comprehension

1. Content Affinity - attitude and interest toward
specific material.

2. Working Memory - the ability to temporarily

suspend information while simultaneously
learning new information. The amount of
memory needed to execute a cognitive task.

3. Executive Functioning - the ability to self-

monitor performance and organize
information on a given problem solving task.

4. Language Foundation – most children enter

kindergarten with 3000 – 5000 words, though
graduate from high school with 60,000 words
(Pinker, 1994).

30

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READING COMPREHENSION
INTERVENTIONS

 Stop and Start Technique

 Directional Questions
 Story Maps
 Narrative retelling
 Read Aloud
 Multiple Exposure
 Active Participation
 Create Questions
 Reduce Anxiety
 Medication Management
 Practice Terminology
 Classroom Discussions
 Sequencing Tasks
Increase Fluency
SOAR TO SUCCESS
31

90 Minute Dyslexia Evaluation

 Intelligence tests
 Phonemic/Phonological Awareness
 Rapid Naming
 Verbal Memory Tests
 Reading Fluency
 Orthographic Skills
 Attention
 Executive Functioning
 Family History
32

Dyslexia Assessment Instruments

Phonemic/Phonological Awareness :
NEPSY II: Phonological Processing
PAL II: Phonological Coding
WIAT III: Pseudoword Decoding, Early Reading Skills
CTOPP
KTEA II
Rapid Naming:
PAL II: RAN, NEPSY II: Speeded Naming, CTOPP, KTEA II
Verbal Memory Tests:
CVLT-C , NEPSYII: List Memory,
PAL II Verbal Working Memory
 Reading Fluency:
GORT 4, CBM, WIAT III ORF,
WIAT III Word Reading
 Orthographic Skills: PAL II Receptive Coding,
Orthographic Spelling
 Attention: NEPSY II Auditory Attn, Connors 3, TEACH
 Executive Functioning: BRIEF, NEPSY II Inhibition,
WIAT III Reading Comp (Inferential vs. literal)
DKEFS 33

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Sample Case: Bobby’s Psychological Profile

WISC IV: Full Scale IQ = 87

Verbal IQ = 83
Perceptual Reasoning = 96
Working Memory = 80
Processing Speed = 103
WJIII Achievement:
Broad Reading = 86
Broad Math = 96
Broad Writing = 92

 Most traditional school psychologists would not

qualify Bobby since there is no discrepancy
between IQ and achievement. Big mistake!!

34

Bobby’s Neuropsychological Profile

CTOPP: Phonological Awareness = 80
Phonological Memory = 73
Rapid Naming = 90

PAL II: Orthographic Coding 96

Phonological Coding 76
Pseudoword Decoding 70
RAN (letters & words) 92
Verbal Working Memory 74

CBM: 36 words per minute correct

GORT IV: Oral Reading Quotient 70

Fluency 5
Comprehension 6

NEPSY II: Auditory Attn Response Set 78

Comprehension of Instructions 74

CVLT: Poor Semantic Recall

BRIEF: Significant 35

Bobby’s Recommendations

 Bobby needs a highly structured type of

reading program focusing on teaching phonics
through visual cues and morphology, and not
acoustically based phonics programs with
numerous rules to remember (i.e. Ladders to
Literacy, Road to the Code, Fundations,
Alphabetic Phonics, etc.).
 Recommend:  Horizons Fast Track
 Soar to Success
 Great Leaps
 CBM to progress monitor!

36

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WRITTEN LANGUAGE: A Survival Skill!!

37

Measuring Written Language

The National Center for Educational Statistics
administered writing samples to 276,000 students
in grades 4, 8, and 12 (2003).

 Narrative Writing – involves the production of stories

or personal essays to capture a reader’s imagination.
Can include responses to photographs, poems, and
cartoons.
 Informative Writing – communicates information to
the reader to convey a message, instruction, or an idea.
Includes reports, reviews, and letters.
 Persuasive Writing – influence the reader to take
action to bring about change. Should include reasons,
examples, comparisons. Examples included writing to a
friend, newspaper editor, or refute an argument in a
debate.

 Scored as Basic, Proficient, or Advanced.

38

National Center for Educational

Statistics (2007): 8th Grade Scoring

8th grade proficient level:

2007 – 33% at or above proficiency
2002 – 31% at or above proficiency
39
1998 - 27% at or above proficiency

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National Center for Educational

Statistics (2007): 12th Grade Scoring

12th grade proficient level:

2007 – 24% at or above proficiency
2002 – 24% at or above proficiency
40
1998 - 22% at or above proficiency

National Center for Educational

Statistics (2007): Males vs. Females

4th Grade Proficient Level: 20% Males 36 % Females

8th Grade Proficient Levels: 21% Males 42% Females
12th grade proficient levels: 14% Males 33% Females

* 2007 data showed 8 pt increase in males (grade 12 only) ; no other

41noted.
differences

Why the disconcerting trend?

 Most students rely on writing,
either e-mail, text messages, word
processing, or other computerized
technology to communicate.

 Downward extension of our

curriculum whereby reading and
written language are skills
emphasized in kindergarten.

 Most state assessments require written language

responses, short answers, and brief constructed
responses even in subjects such as mathematics.
Therefore, most school curriculums readjusted to
emphasize state testing requirements.

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The Cost of Poor Writing Skills

 U.S. corporations spend an
estimated $3.1 billion annually
to remediate their employees’
writing skills (National Commission
on Writing, 2005).

 State governments spend approximately

$221 million annually to do the same
(National Commission on Writing, 2005).

 A 2005 ACT (American College Testing)

report indicated almost one-third of high
school students planning to attend
college do not meet the readiness
standards for college composition
courses.
43

Curriculum-Based Measurement: Writing

6 Components to Assess Writing:
(1) Fluency: measure the number of words
written and spelled correctly in a time
period.
(2) Grammar: informally assess from passage.

(3) Vocabulary: assess variety by dividing

number of different words by total numberof
words.
(4) Sentence Structure: summarize sentences
as being incomplete, simple, compound,
complex, run-on, or fragmented.
(5) Conventions: percent of words spelled
correctly, proportion of errors per 100
words, correct writing sequence.
(6) Content: develop analytic rating scale.
44

Cognitive Constructs Involved with Written

Language

 Attention
– Poor planning
– Uneven tempo
– Erratic legibility
– Inconsistent spelling
– Poor self monitoring
– Impersistence

BRAIN REGION - Anterior Cingulate

45

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Cognitive Constructs Involved with

Written Language

 Spatial Production
– Poor spatial production
– Poor visualization
– Poor margination
– Organization problems
– Uneven spacing
– Poor use of lines

BRAIN REGION - Right Parietal Lobe

46

Cognitive Constructs Involved with

Written Language

 Sequential Production
– Poor connected writing
– Letter reversals
– Organizational deficits
– Lack of cohesive ties

BRAIN REGION - Left Prefrontal Cortex

47

Cognitive Constructs Involved with

Written Language

 Memory Skills
– Poor word retrieval
– Poor spelling
– Poor recall of grammar rules
– Preference for printing
– Loss of train of thought
– Deterioration of continuous writing

BRAIN REGION - Semantic memories stored in

Temporal Lobes. Retrieved
48 by Frontal Lobes

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Cognitive Constructs Involved with

Written Language

 Language
– Poor vocabulary
– Poor written expression
– Dysphonetic spelling
– Lack of cohesive ties
– Unconventional grammar
– Simplistic sentence structure

BRAIN REGION - Left Temporal Lobe

49

Cognitive Constructs Involved with

Written Language

 Intelligence
– Concrete ideation
– Poor development of ideas
– Poor audience awareness
– Weak opinion development
– Simplistic sentence structure

BRAIN REGION - Inferior Parietal Lobes

50

Cognitive Constructs Involved with

Written Language

 Executive Functioning
– Organize and plan ideas
– Self monitor
– Task initiation
– Sustain attention to task

BRAIN REGION – Dorsolateral Prefrontal Cortex

51

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4 Subtypes of Written Language Disorders

1. Dysphonetic dysgraphia - the hallmark feature of
this disorder is an inability to spell by sound, thus
rendering an over-reliance on the visual features of
words.
2. Surface dysgraphia -this disorder is characterized
by a breakdown in the orthographic representation of
words. Miscues made primarily on phonologically
irregular words.
3. Mixed Dysgraphia - this disorder is characterized
by a combination of both phonological errors and
orthographical errors depicting faulty arrangement
of letters and words.
4. Executive Dysgraphia - an inability to master the
implicit rules for grammar which dictate how words
and phrases can be combined. Deficits in working
memory and executive functioning frontal lobe skills.
52

UNDERSTANDING THE NOTION OF

SUBTYPING
Inferior Frontal Gyrus Supramarginal
Gyrus

Angular
Gyrus

Heschl’s Gyrus Superior Temporal

Gyrus

53

5 INTERVENTION KEYS: AUTOMATICITY

(1) Motor Skills Automaticity: “Handwriting without

tears”
(2) Spelling Automaticity: “Alphabetic Phonics”

(3) Language Automaticity: “ Scaffolding to enhance

verbal fluency”
(4) Executive Functioning Automaticity: “Graphic
Organizers”
(5) Self Monitoring Automaticity: “Peer review
with COPS strategy”

54

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Research Based Interventions

(Graham & Perin, 2007)

(1) Writing Strategies (effect size .82)

(2) Summarization (effect size .82)
(3) Collaborative Writing (effect size .75)
(4) Specific Product Goals (effect size .70)
(5) Word Processing (effect size .55)
(6) Sentence Combining (effect size .50)
(7) Prewriting (effect size .32)
(8) Inquiry activities (effect size .32)
(9) Process Writing Approach (effect size .32)
(10) Study of Models (effect size .25)
(11) Writing for Content Learning (effect size .23)
55

5 Major Steps of Writing Process (Ray, 2001)

(1) Prewriting - use graphic organizers.

(2) Drafting – use model to take notes and model how
to organize in a text form using topic sentences.
(3) Revising – second draft emphasizing content, and
elaboration of ideas and making connections.
(4) Editing – re-read for capitalization and
punctuation errors.
(5) Publishing – peer assisted strategies and teaching
students to give and receive feedback .

56

90 Minute Dysgraphia Evaluation

 Intelligence Measures
 Visual-Motor Integration
 Attention
 *Working Memory*
 *Executive Functions*
 Writing and Spelling Skills
 Phonological Awareness Skills
 Retrieval Fluency Skills

57

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DYSGRAPHIA ASSESSMENT INSTRUMENTS

 Visual-Motor Integration - WIAT III Alphabet Writing
Fluency (30 sec), NEPSY II Design Copying, PAL II
Alphabet Writing, PAL II Handwriting Subtests
 Attention - NEPSY II Auditory Attn & Response Set,
NEPSY II Inhibition, Connors 3, Tea-CH, CAS-Receptive
Attention, WJIII- Auditory Attention.
 Working Memory – WISC IV Integrated Subtests, PAL II
Verbal Working Memory Subtests, SB5, CAS, WRAML-2.
 Executive Functions - WIAT III Sentence Composition,
PAL II Expository Note Taking, PAL II Narrative
Compositional Fluency, BRIEF, DKEFS, NEPSY II.
 Writing and Spelling Skills – WIAT III Spelling (error
analysis) , PAL II Orthographic Spelling, WIAT III
Essay Composition, PAL II Expository Writing
 Retrieval Fluency Skills - NEPSY II Word Generation,
NEPSY II Speeded Naming, WJIII Retrieval Fluency.
58

Proposed 4-Factor Model Defining a

Learning Disability
1) There should be data documenting that a student’s
RATE of learning is substantially slower than grade
level peers.
2) There should be data documenting that a student
has not responded to evidenced-based
interventions over a protracted period of time.

3) There should be data from standardized testing

indicating the presence of a psychological
processing deficit associated with the academic
skill in question. This may include measures of
phonological or orthographic processing skills,
language skills, working memory skills, executive
functioning skills, and rapid naming and retrieval
skills.
4) There should be data ruling out environmental,
medical, emotional, and cultural factors. 59

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