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A Neuroplasticity Perspective on Dyslexia:

The Imagery-Language Connection

From Theory To Practice

Angelica Benson, Ed.M.

Director of Development and Outreach

Lindamood-Bell Learning Processes

San Luis Obispo, California (USA)

European Dyslexia Association Summer Seminars

1 July 2023

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Agenda

  • Research Questions/Background

  • A Model for Remediation: How/What? (Practice)

  • The Imagery-Language Connection in Dyslexia (Theory)

  • Current Findings: Neuroplasticity in Dyslexia

  • Future Directions

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Lindamood-Bell Co-Founders, Authors, Researchers

Patricia Lindamood and Nanci Bell

1986

2023

Instructional Experience to Scientific Research

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We believe, passionately, that children

and adults can be taught to read

and comprehend to their potential, including

those individuals previously diagnosed with

dyslexia, hyperlexia, and/or autism spectrum disorder.

~ Nanci Bell

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Crisis to Solve

Learning to read and comprehend serves as a foundation for all educational pursuits and indeed for economic success in life, yet millions of students struggle to learn.

Yet, 15% of the school population in America, more than 7.2 million students, have a condition qualifying them for special education.

85% of those students have a primary learning disability in reading and/or processing language.

The most common type of learning disability is dyslexia.

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Our goal is to help every individual

reach his or her potential to learn.

Our global efforts include

Lindamood-Bell Learning Centres,

Seasonal Learning Camps,

School Partnerships,

Professional Development Workshops,

and neurological and behavioural research.

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Research Collaborators

McGovern Institute for Brain Research and Department of Brain and Cognitive Sciences

Department of Teaching,

Learning and Culture

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Our instructional journey began in a clinical environment.

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We questioned, we instructed, and we researched.

Why could some children learn to read from an

early age, yet others could not?

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What was the primary cause of dyslexia?

Could the cause be identified and remediated so dyslexia would not need to be a lifelong struggle?

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    • Phoneme Awareness (PA) is the ability to perceive the identity, number, and sequence of sounds within words.

    • Symbol Imagery (SI) is the ability to create mental imagery for sounds and letters within words.

    • Concept Imagery (CI) is the ability to create an imaged gestalt (whole) for oral and written language.

3 Sensory-Cognitive Functions

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Sensory input of imagery is a primary sensory-cognitive function.

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Two Types of ImageryParts and Wholes

Symbol Imagery is imagery for sounds and letters within words.

Concept Imagery is an imaged whole for oral/written language. 

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Comprehension

Language

Auditory

Contextual Reading

Visual

Word Recognition

Word Attack

A Paradigm for Reading

Sensory-cognitive functions underlie

the component parts of reading.

Fluency

Bell, Nanci. Visualizing and Verbalizing for Language Comprehension and Thinking, Gander Publishing, 1986, rev. 1991, 2007.

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Dual Coding Theory:

A Theoretical Model For Literacy

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Buzz

CA: 12-5 Grade: 7.0

Peabody Picture Vocabulary Test 75th Percentile

Comprehension 37th Percentile

Woodcock Word Attack 95th Percentile

Wide Range Achievement Test

Word Recognition 37th Percentile

Gray Oral Reading Test-3

Rate 10th Percentile

Accuracy 25th Percentile

Fluency 16th Percentile

At end of 6th grade, Buzz hated reading. Despite improved phonological processing, he still couldn’t read text accurately and easily. His teacher said, “He can sound out words better but he still can’t read.”

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Symptoms of Weak Symbol Imagery

Weakness in:

  • Phonological awareness
  • Orthographic awareness
  • Word reading skills: word attack and word recognition
  • Memorizing sight words
  • Fast, accurate decoding (single and/or multi syllable words)
  • Fast, accurate self-correcting in reading and spelling
  • Orthographic spelling (spelling almost phonetically accurate)
  • Contextual reading (guessing rather than rapid, accurate decoding)

*Student may or may not be diagnosed with dyslexia

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Concept Imagery and Comprehension/Thinking

imaged whole

Higher Order Thinking

• main idea

• conclusion

• inference

• predict and extend

• evaluate

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Natalie

CA: 11-10 Grade: 7.0

Comprehension _______________________

Peabody Picture Vocabulary Test___________86th Percentile

Woodcock Word Attack__________________86th Percentile

Wide Range Achievement Test

Word Recognition____________________87th Percentile

Gray Oral Reading Test-3

Rate_______________________________84th Percentile

Accuracy ___________________________95th Percentile

Fluency_____________________________91st Percentile

2nd Percentile

Though Natalie had easily learned to read words in her early grades, by 4th grade she was sick before going to school and moving her to the front of the classroom didn’t help her performance.

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Symptoms of Weak Concept Imagery

Weakness in:

    • Written language comprehension
    • Oral language comprehension
    • Critical and logical thinking, and problem solving
    • Following directions
    • Expressing language orally
    • Expressing language in writing
    • Interpreting social situations
    • Understanding cause and effect

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“Cognition is proportional to the extent that the coding mechanisms of mental representations (imagery) and language are integrated.”

Paivio’s Dual Coding Theory (DCT)

“Performance is mediated by the joint activity of verbal and nonverbal systems…cognition is always an interplay between the verbal and nonverbal systems.”

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“…DCT is among the strongest current candidates for developing a unified, scientifically-based theory of literacy.

…DCT principles apply to grapheme-phoneme correspondences, vocabulary, grammar, the construction of mental models of text episodes, and imaginative responses to text including the social construction of self and others in literacy encounters.”

The DCT model addresses decoding as well as oral and written language comprehension and memory.

DCT Offers a Unified Theory of Literacy

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Dual Coding and the�Cognitive Science of Learning

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Science of Reading/Cognitive Science of Learning

Science of Reading

  • Simple View of Reading (SVoR) is a model of the “Science of Reading.”

  • One Code – Language

Cognitive Science of Learning

  • Dual Coding Theory (DCT) is applying sensory-cognitive functions to all learning.

  • Two Codes – Language and Mental Representations

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“There are individual differences

in the ability to create mental representations and thus

there are individual differences in the ability to dual code

imagery and language for cognition.”

~ Nanci Bell

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Imagery and Language Processing

Comprehension

Word

Attack

Word

Recog

Paragraph

Reading

Decoding

Weak Comprehension

weak or dyslexia

Weak or hyperlexia, autism

Symbol Imagery

Concept Imagery

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Behavioral Results

(2008-2022)

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Lindamood-Bell Learning Center�Decoding and Comprehension Deficits

Based on students who received over 40 hours of instruction at Learning Centers

January 2008 through December 2022.

n=27,064

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Symbol Imagery

Phonological and orthographic imagery �for reading and spelling words—orthographic memory.

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Decoding Only Students

*Statistically significant (p < .0001)

Based on students who received over 40 hours of Seeing Stars (symbol imagery/orthographic and phonological processing) only instruction at Learning Centers, January 2008 through September 2022.

Average Hours of Instruction: 111.4

n = 10,145 Average Age: 9.2

Pre- and Posttest Percentiles

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Decoding Only Students

Medium (3.0–4.5)

Large (> 4.5)

Small (< 3.0)

Based on students who received over 40 hours of Seeing Stars (symbol imagery/orthographic and phonological processing) only instruction at Learning Centers, January 2008 through September 2022.

Magnitude of Change

Average Hours of Instruction: 111.4

n = 10,145 Average Age: 9.2

Average Standard Score Changes

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Dyslexia Students With Previous Diagnosis

Average Hours of Instruction: 123.4

n = 2,764 Average Age: 9.7

*Statistically significant (p  < .0001)

Based on students with third-party diagnoses of Dyslexia who received over 40 hours of  Seeing only instruction at Lindamood-Bell Learning Centers, January 2008 through December 2022.

Pre- and Posttest Percentiles

Sym

Imag*

Phon

Awar*

Word

Att*

Word

Rec*

Acc*

Flu*

Reading Comp*

Vocab*

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Dyslexia Students With Previous Diagnosis

Average Hours of Instruction: 123.4

n = 2,764 Average Age: 9.7

Based on students with third-party diagnoses of Dyslexia who received over 40 hours of  Seeing only instruction at Lindamood-Bell Learning Centers, January 2008 through December 2022.

Medium (3.0–4.5)

Large (> 4.5)

Small (< 3.0)

Average Standard Score Changes

Magnitude of Change

Sym

Imag*

Phon

Awar*

Word

Att*

Word

Rec*

Acc*

Flu*

Reading Comp*

Vocab*

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Our Take Aways

If we measure sensory-cognitive processing, differentiate the diagnosis, and provide instruction to develop the sensory input of imagery to interplay with language, individuals can become independent in language and literacy skills.

These findings suggest a counter view to the belief that a reading disability, such as dyslexia, is a lifelong challenge that cannot be changed.

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A Neuroplasticity Perspective On Dyslexia:

Highlights From 3 Research Studies

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What is Neuroplasticity?

Neuroplasticity can be defined as the ability of the nervous system

to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections.

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Gray Matter Changes Following Reading Intervention

in Dyslexic Children(Krafnick, Flowers, Napoliello, & Eden, 2011)

Krafnick, A. J., Flowers, D. L., Napoliello, E. M., & Eden, G. F. (2011). Gray matter volume changes following reading intervention in dyslexic children. Neuroimage, 57, 733-741. doi:10.1016/j.neuroimage.2010.10.062

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Research Design

Intervention: Symbol Imagery Instruction (provided by Lindamood-Bell Learning Processes, administered one-to-one, 5 days per week, for 8 weeks, 2-4 hours per day)

Pre-Intervention:

(1) neuropsychological assessment in reading and, (2) neuroimaging measures

Post-Intervention:

(1) neuropsychological assessment in reading and, (2) neuroimaging measures

 

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Overview

  • Eleven children, identified as dyslexic, received explicit instruction in symbol imagery as it applied to reading.
  • After 8 weeks of reading intervention, the children in the study showed marked improvement in several reading and reading-related skills.
      • Significant at p < .001: LAC, SI, Word Recognition
      • Significant at p < .01: Rapid Naming
      • Significant at p < .05: Word Attack
      • Significant at p < .05: Passage Comprehension
  • Improvements in reading ability were accompanied by changes in brain structure.

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Significant Neurological Findings�

Four areas of brain structure showed increased gray matter volume (GMV) at the end of the intervention.

These areas included those involved in memory and mental imagery. In the left hemisphere, this included the anterior fusiform/hippocampus and precuneus.

The precuneus is involved with episodic memory, visuospatial processing, and aspects of consciousness.

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All Brain Structure Changes Were Maintained Following Instruction

T1 is before instruction, T2 after their remediation, and T3 (null period) is 8 weeks later.

*Statistically significant ( p ≤ .05)

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Conclusion

    • Training-induced changes in GMV can be observed in a pediatric sample for the first time.
    • Reading improvements resulting from intervention are accompanied by GMV changes.
    • Both reading improvement and GMV changes are maintained after the training period.

Krafnick, A. J., Flowers, D. L., Napoliello, E. M., & Eden, G. F. (2011). Gray matter volume changes following reading intervention in dyslexic children. Neuroimage, 57, 733-741. doi:10.1016/j.neuroimage.2010.10.062

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Rapid and Widespread White Matter Plasticity During an Intensive Reading Intervention

(Huber, Donnelly, Rokem & Yeatman, 2018)

Huber, E., Donnelly, P. M., Rokem, A., & Yeatman, J. D. (2018). Rapid and widespread white matter plasticity during an intensive reading intervention. Nature Communications, 9, 2260. doi:10.1038/s41467-018-04627-5

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Research Design

Intervention- Experimental Group: Symbol Imagery Instruction (provided by Lindamood-Bell Learning Processes, administered one-to-one, 5 days per week, for 8 weeks, 2-4 hours per day)

Pre-Intervention::

(1) neuropsychological assessment in reading and, (2) neuroimaging measures

At Regular Intervals and Post-Intervention:

(1) neuropsychological assessment in reading and, (2) neuroimaging measures

 

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Overview

This study “used a longitudinal intervention design to examine experience-dependent growth in reading skills and white matter in grade school-aged, struggling readers. Diffusion MRI data were collected at regular intervals during an 8-week, intensive reading intervention. These measurements reveal large-scale changes throughout a collection of white matter tracts, in concert with growth in reading skill.”

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Significant Neurological Findings�

Brain connectivity effects were observed within the arcuate fasciculus, where language and sounds are processed, within the left inferior longitudinal fasciculus where visual inputs, such as letters on a page are transmitted through the brain, and the posterior callosal connections which link the two hemispheres of the brain.

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Conclusion

Reading skills improved by an average of one full grade level for students who took part in the eight week intervention to develop symbol imagery for phonological and orthographic processing.

Diffusion MRI data collected during instruction indicates that there were large-scale changes in white matter conductivity correlating with the gains in reading. Subjects in the control group showed no changes.

Intervention to stimulate and develop symbol imagery led to increased brain structure conductivity and improved reading for children with reading difficulties including dyslexia.

Huber, E., Donnelly, P. M., Rokem, A., & Yeatman, J. D. (2018). Rapid and widespread white matter plasticity during an intensive reading intervention. Nature Communications, 9, 2260. doi:10.1038/s41467-018-04627-5

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Intensive Summer Intervention Drives Linear Growth of Reading Skill in Struggling Readers �(Donnelly, Huber, & Yeatman, 2019)

“The goal of this study was to analyze reading growth curves during an intensive summer intervention program. A cohort of 31 children (6–12 years) with reading difficulties (N = 21 with dyslexia diagnosis) were enrolled in 160 hours of intervention occurring over 8 weeks of summer vacation. We collected behavioral measures over 4 sessions assessing decoding, oral reading fluency, and comprehension. Mixed-effects modeling of longitudinal measurements revealed a linear dose-response relationship between hours of intervention and improvement in reading ability; there was significant linear growth on every measure of reading skill and none of the measures showed non-linear growth trajectories.”

Fig. 2. (A) Mean growth of composite reading skills. Growth curves are plotted using the intercept and slope estimates from a linear mixed-effects model with session as a categorical variable. The dashed lines represent measurements during the baseline period. Results show growth across reading measures during the intervention period, and no change (or a decline) in scores during the baseline period.ASD-EXP group. Note: Figure used with permission.

Donnelly, P. M., Huber, E., & Yeatman, J. D. (2019). Intensive summer intervention drives linear growth of reading skill in struggling readers. Frontiers in Psychology, 10, 1900. doi:10.3389/fpsyg.2019.01900

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Overview

The goal of this study was to analyze reading growth curves during an intensive summer intervention program.

The research team collected behavioral measures over 4 sessions assessing decoding, oral reading fluency, and comprehension.

These results highlight the opportunity to improve reading skills over an intensive, short-term summer intervention program, and the linear dose-response relationship between duration and gains.

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Conclusion

Changes in white matter and dosage amounts correlate to changes in reading behavior.

These findings show the intervention’s positive efficacy in developing dyslexic readers’ sensory-cognitive functions, phonemic awareness and orthographic processing as related to measures of decoding.

Findings add validity to the tenets of Dual Coding Theory (DCT) and suggest the universality of phonemic and orthographic awareness/processing with dyslexic profiles.

Donnelly, P. M., Huber, E., & Yeatman, J. D. (2019). Intensive summer intervention drives linear growth of reading skill in struggling readers. Frontiers in Psychology, 10, 1900. doi:10.3389/fpsyg.2019.01900

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Dyslexia Research Findings Summary�University of Washington

Institute for Learning and Brain Sciences [I-LABS]

  • Evidence was established purporting a dose-response relationship between hours of intervention and improvement in reading using the Seeing Stars program.
  • Large-scale changes in the brains’ white-matter tracts resulted from the Seeing Stars intervention, with corresponding growth in reading skills.
  • *In concert with white-matter diffusion improvements, coupled with corresponding changes in reading, the magnitude and time-course plasticity does not depend on the subjects’ age. (Suggesting there is not a fixed window for neuroplasticity changes in dyslexia)

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While many parents and teachers might worry that dyslexia is permanent, reflecting intrinsic deficits in the brain, these findings demonstrate that targeted, intensive reading programs not only lead to substantial improvements in reading skills, but also change the underlying wiring of the brain’s reading circuitry.

- Jason Yeatman, Ph.D.

Director

Brain Development & Education Lab

Stanford University

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In Conclusion

  • Symbol imagery can be developed and applied to language and literacy skills.
  • Imagery-language instruction results in significant improvement in core deficits in reading for students with dyslexia.

  • Dual-Coding Theory gives us a viable model for understanding a primary cause of weakness in language and literacy skills.

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In Conclusion

  • Innovative evidence-based interventions show that individuals can learn to read and comprehend to their potential, including those qualifying for special education (United States) and/or diagnosed with dyslexia. 
  • Behavioural and neurological research validates the imagery-language connection resulting in changes in brain structure for children identified as dyslexic.

  • These neuroscientific and behavioral results provide further evidence of the phenomenon of neuroplasticity in the dyslexic brain and suggest that a diagnosis of dyslexia need not be one of a permanent nature. 

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Current/Future Directions

  • To compare behavioural and neurological findings of students with dyslexia who receive live, in-person instruction vs. those who receive live, online instruction (Principal Investigator: Dr. Jason Yeatman, Stanford University, Brain, Development and Education Lab, Palo Alto, California)

  • To apply this evidence-based instruction to school settings (primary-secondary) with the goal of early identification and remediation for students with dyslexia as well as at-risk struggling readers, creating a sustainable school-led model that meets best practice standards (Jamaica: local/regional non-profit partners and Ministry of Education; United States: variety of school/district/state level implementations)

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Thank You EDA.

Contact: angelica.benson@lindamoodbell.com

Research Abstracts:

www.lindamoodbell.com/research