2/3/2021

Understanding Dyslexia Today: An Interview with Dr. Suzanne Carreker and Lee-Ann Tolfree Mertzlufft

Dyslexia, the most common learning disability, affects as much as 15% to 20% of the population. What exactly is this learning difference? How can educators better understand dyslexia? And how can we best meet the needs of students with dyslexia today? In an interview with Tina Davey of Lexia Talks, Dr. Suzanne Carreker, Principal Education Content Lead at Lexia, and Lee-Ann Tolfree Mertzlufft, Director of Options With Learning, discuss the state of dyslexia today and how affected students are coping with the shift to remote-hybrid learning.

This interview has been edited for clarity and brevity.

Tina Davey, Lexia Talks: Welcome, Suzanne and Lee-Ann. Great to have you guys here today. Suzanne, let's begin with you. Just a general question: What exactly is dyslexia and what is it not? Further, I'm curious to learn how the understanding of it has changed over the last 30 years.

Suzanne Carreker, Lexia: Well, Tina, if we think about the goal of reading, it's comprehension. The simple view of reading is a model of reading that proposes that proficient comprehension is the product of decoding and listening comprehension. Both of these components are necessary in efficiency, and one or both components can lead to non-proficient reading comprehension. You can think of this simple view of reading like a multiplication equation: anything times zero is zero. We know that dyslexia is a learning disability that involves a difficulty in learning to read that's associated with that decoding component. And as you mentioned, it may impact 15% to 20% of the population. Students with dyslexia have difficulty translating printed words on a page into their spoken equivalents, and this is in spite of having adequate listening comprehension skills. So their inadequate decoding makes their reading very slow and laborious. The students’ cognitive resources are so focused on figuring out how to read the words, they can't focus on the meaning of what they're reading. Dyslexia is neurobiological in origin. It is present at birth, and it's not related to intelligence. Students with dyslexia have difficulties processing, storing, and retrieving or producing information. The difficulties that students have with reading are often unexpected in relation to other cognitive abilities. For example, many times students with dyslexia may demonstrate strong verbal or visual spatial abilities, or they may have notable math or mechanical abilities. Because of these strengths, students with dyslexia are often admonished to try harder. It seems like a motivation issue. If you have these strengths, why are you not reading better? But we know that these students are usually trying really hard. When I was teaching students with dyslexia 30-plus years ago and would mention to someone that I taught students with dyslexia, a very common response was “Oh, yeah, dyslexia: that’s seeing letters or words backwards, like ‘B’ for ‘D’ or reading ‘was’ for ‘saw,’” but dyslexia is not about seeing letters or reading words backwards.

A shifting perception

Suzanne Carreker: I'm happy to say this perception of dyslexia is not as prevalent today as it was 30 years ago, but it still exists. What we know today is that the difficulty with this decoding that students with dyslexia have is the result in a deficit of the phonological component of language. So this deficit will affect their decoding as well as their spelling. These are students that may have difficulty detecting or discriminating sounds in spoken words, so they misread words. Oftentimes, they’ll mispronounce words. When they're spelling and sounding out a word, they may have difficulty in temporarily storing all the sounds in the word long enough to spell it on paper. So what you will see on paper with a word like “split”, it may end up as “spit” or “slit” or even “silt.” These students may also have difficulty quickly naming letters or quickly associating sounds with letters, and of course that will interfere with decoding. With the insight that the phonological component of language is a deficit, tasks such as generating rhyming words, counting the number of syllables in words, identifying the first sound of a word, or segmenting a word into its sounds are an essential part of interventions for students with dyslexia.

With the release of the National Reading Panel report in the year 2000, which stated that phonological and phonemic awareness are important for all students who are learning to read, we're seeing more emphasis on these tasks in the general classroom, particularly in kindergarten and first grade. This focus, we hope, will prevent or ameliorate reading problems. So it's important to know, Tina, that students with dyslexia won't outgrow their dyslexia. This is not a wait-and-see situation. Early intervention and the right instruction is critical for the students. Instruction must teach all the structures of language. For example: the sounds in English, the letters, the sentence structure, the text structure, the skills and concepts that are important to reading need to be taught explicitly, or directly. They need to be taught in a very logical sequence that moves from simple to complex. And that instruction needs to be cumulative, which means that new learning is building on prior learning. And this ensures that students really are building a firm foundation and understanding all the skills they need to become better decoders.

In addition to there being better understanding of dyslexia, there's really more awareness of dyslexia today than there was 30 years ago. Thirty years ago, only a very small handful of states had dyslexia laws. Today, the opposite is true; only a small handful of states do not have dyslexia laws. So the awareness and understanding of dyslexia has definitely and positively changed over the past 30 years.

Tina Davey: Which is a good thing. Now, you mentioned coding. Do you want to tell me a little bit about coding? That’s an interesting thing.

Suzanne Carreker: Well, the decoding aspect of reading is being able to look at a word and associate a sound to each letter or letter pattern in a word. If students learn the patterns and they practice those patterns, those patterns are built in memory. So you, as a skilled reader, can read words without having to look at letters and sounds because those words are built in memory. But for students with dyslexia, they need that explicit instruction of how the letters and sounds go together. They need that practice, practice, practice to build those patterns in memory, so eventually they can read words that are really regular for reading—meaning you can sound them out, but also they'll be better able to hold in memory those words that are irregular words. Think about a word like “enough”—you can't really sound it out, you just have to know it. So that decoding aspect is, how do you get to the meaning? You have to be able to translate those words into their spoken equivalence so you can get to the meaning of what you're reading.

Tina Davey: Lee-Ann, I know that you have personal experience with dyslexia. How does that impact the way that you teach?

Lee-Ann Mertzlufft, Options With Learning: Having dyslexia myself and not being identified as such until my freshman year of college, when I go to a lesson and I meet a child for the first time, I can honestly say I understand the fear, the shame, and the embarrassment of not knowing or not being able to read or know how to read. And with all that, there comes anxiety—you freeze. And I know what it’s like to sit there and to say, “Oh my goodness, I just have no idea how I'm going to do this, and everybody's going to know this secret about me.” When I look at that, and I meet that child, the first thing I realize is they need to trust me, because when I'm going to go in to teach them, they're going to reveal their secret that they have no idea how to tackle these words. And I have a personal insight into how the dyslexic brain works.

Tina Davey: And how wonderful is that for the student that you're teaching? For them to know, “Hey, this person has been through exactly what I'm going through. They understand me completely.”

Lee-Ann Mertzlufft: It took a long time for me to feel comfortable to reveal that. It's something that you go along with because even as an adult, there are individuals in the professional world and in life that, you know... you're not a pedigree if you have a learning disability. So disclosure, for me, it could put you in a very vulnerable situation as an adult. So I have chosen to do it when I have felt the time is right to do it.
 

Following best practices and keeping expectations high

Tina Davey: What are the best practices, would you say, for teaching students with dyslexia? And why should these practices be universal, do you think?

Lee-Ann Mertzlufft: Well, I'm going to get to that. But one thing I would like to share with all the teachers who are listening and the parents who may be listening is that when you teach, teach with compassion for that student, teach with empathy for that student, and teach with expectations. Have high expectations. And when you go into that teaching, make sure that you remove all the shame and the embarrassment from your lessons. Don't be apologetic for having to teach closed-syllable or short-vowel sounds or words that only have two sounds in them from the beginning because that is where they need to begin. And then, as a teacher, have expectations for yourself and for your students.

Tina Davey: Have high expectations.

Lee-Ann Mertzlufft: High expectations, that’s right. And when you walk into that room, you need to believe that your student can learn to read and that you as a teacher have that ability to teach them to read. Because if you don't believe in that student, if you are looking at that standard score of word attack that's in the 70s or you are a high school teacher and you're getting a kid in your class and on their individual educational plan, they're still reading at the second-grade level and you think, “I'm never going to be able to teach this kid to read, they're never going to learn to read,” then you've already failed before you’ve walked in there. So you need to believe that at any point where they're ready to come to that lesson, that you have the ability and that they have the ability to learn to read.

Tina Davey: And that confidence, I think, will inspire success in both teacher and student.

Lee-Ann Mertzlufft: Yes, absolutely. But you do need to use the right tools. And there are programs out there that are research-based that you do need to use. You have to vet your program and make sure, as Suzanne said, that the programs are explicit in teaching the student why in the word “at,” the letter “a” says “ae”; in the word “ate”, “a” says “ay”; why in the word “ago,” “a” says “ah”; why in the word “watch”, “a” will say “aw.” And the English language is not necessarily an opaque language. So having all that understanding—and once you give that child that understanding and you teach, as Suzanne said, with the mythology and then the phonology and syllable division, syntax, semantics, and you have a clear, strong scope and sequence—then you need to look at, as a teacher, your frequency, your duration, and your participation. These are key, because I can be the best teacher in the world but if I don't have enough time to teach my lesson, that kid's never going to go anywhere. If you think about it, a child without an organic learning disability gets reading every day. And then often, we walk into these rooms for CSE [Committee on Special Education] meetings and then we barter about how frequently we're going to teach reading to the dyslexic brain. So, frequency is key, duration is key, and having that child actively participate in the skill level where they need to be is also key.

Tina Davey: These are some of the best practices, I would imagine. Is that what we're hearing now? Do you want to tell us why these practices should be universal?

Lee-Ann Mertzlufft: When I get a child who is showing signs of dyslexia, and they may have not been through the evaluation process to determine whether they have dyslexia or not, to me as a teacher, it doesn't matter, honestly, because I'm going to start at the same spot where I would start that dyslexic child. But the difference is, they're going to move a lot quicker, they're going to internalize the why, the explicit instruction—whereas with that child with dyslexia, I may need to present that same concept, that same pattern, hundreds if not thousands of times before they internalize that concept rapidly and automatically. You definitely want to move the child as quickly as possible once they show mastery. You also want to use authentic children’s and young adult books in addition to your teaching. They need to interact with not just controlled text, but also authentic, non-controlled text as well.

Learning on the go

Suzanne Carreker: Lee-Ann, I'm interested in knowing: When you were learning the Wilson program, how did you feel as an individual with dyslexia, knowing that this is instruction that you didn't have as a child with dyslexia?

Lee-Ann Mertzlufft:  In a lot of ways, I think about my first student who I taught the Wilson program to. And you know, I always worry about, like, “Are you the first person that doctor operated on?” And I am very grateful to that student, but in a lot of ways I learned with my student. I think I got by in college by recording for the blind and dyslexic at that point, and having great attendance and going to class and tape-recording my classes and listening to them again. And I had like a sight vocabulary, but I probably didn't learn to read until I started to teach my students to read, I would say. And then I started to go to professional development; so I would say I really taught myself to read.

Tina Davey: So as you were a teacher, you still were struggling with reading yourself?

Lee-Ann Mertzlufft: I was. I went through my whole four years of my undergrad struggling with reading, and then I went on to get my master's in Special Education and I definitely struggled with reading, and I did have one reading class in my master's that talked about decoding, but it was like decoding on steroids. And then I would have to go to disclose in front of all these professors who would either believe me or think I was lying and making this up because I wanted an easy avenue to my education. I remember at my master's level, I went to this one teacher who was very well-known in the academic arena for special education, and she says, “You're just not trying hard enough.” She goes, “You really don't have this.” She debated me, and I remember going home, and I still have this mentor and a friend I met in undergraduate—Betsy—and I called her up and I was crying. She's like, “Lee-Ann, why are you doing this to yourself?” She just kind of kicked me in the pants, like she always did. So I understand why it is still quiet, and people decide whether they're going to disclose or not disclose. It took me into my 50s, but I did it.

Suzanne Carreker: Tina, I think something that Lee-Ann and I can attest to is that teachers are not provided information about the teaching that is important to all students, but in particular those students with dyslexia, in their preparation programs. I had none when I was in college, and I was a Special Education major. I was taught this idea that it's a perceptual issue, so you work on visual perception and auditory perception. Never was it ever talked about as a difficulty with language. I remember in my first year of teaching, I attended a workshop and I learned the syllable division patterns, which I had never known as a child. I didn't learn those in college as part of my preparation program, and there are four different patterns that we can teach students to help them perceive how to divide longer words. I was so excited that I went into my classroom the next day and taught all four patterns in one day, which is not the way you're supposed to do it. But it's such an eye-opener—it really empowers you as a teacher to help all students learn to read, and particularly those students with dyslexia who need that very explicit and systematic instruction.
 

Finding the right tools

Tina Davey: Suzanne, let me ask you this: Why do you think it's so important to use tools or programs that are accurate and research-proven, like Lexia? What risks could arise otherwise?

Suzanne Carreker: Well, we do expect for students who are typically developing students to gain at least one year's growth in one year's time—that's what we call typical growth. But when students are behind or below grade-level, as students with dyslexia often are, we're looking at a different kind of growth. We're looking at catch-up growth. If a student is one year behind, one year's growth in one year's time isn't enough growth. They will remain behind, and they may even fall further behind. So it's critical, for example, for a program to be research-proven to accelerate learning so that students really can gain more than one year's growth in one year's time. So that's a really important piece so we can do that catch-up growth and get them where they need to be. And we know that that catch-up growth is possible through personalized learning. That's the idea of monitoring progress, which helps you identify why students are struggling. And then once you know why students are struggling, what's important is responsive instruction that really addresses why the student is struggling. So that's important for educators to look for when they're thinking about a program.

We know the accuracy of data is important. The accuracy of the instructional content is also important. Lee-Ann mentioned the closed syllable, and I just happened to be looking at a curriculum not long ago where the curriculum stated that a syllable that ends in a consonant is a closed syllable and the vowel is short. The examples they gave were “cat” and “car.” So, both words do end in a consonant—however, although “cat” has a short vowel, “car” does not. And what are students going to do with a word like “sweet” that ends in a consonant, but the vowel sound is not short? Imprecise descriptions of patterns of language may cause more confusion than clarity for students, so it is really important to look at tools from that focus: Is it research proven? If there is data, is it accurate? Is the content accurate?
 

Language barriers

Tina Davey: I know English is a difficult language—very difficult, as [shown in] the examples you've given here. Does dyslexia exist in other languages as prevalent as in English?

Suzanne Carreker: That's a very good question. English has the most complex, complicated orthography of all languages. When they have done studies looking at students learning to read in different orthographies, those orthographies that are transparent or shallow, they're often called—Finnish has an almost perfect one-to-one match between letters and sounds, so the prevalence of dyslexia is less than 6%. That's a big difference. And students learning to read in Finnish will learn to read in less than half a year. Usually, they'll learn it in the fall semester. When we look at English, even students who are typically developing readers—they don't have any difficulties—will take two-and-a-half years to gain the same accuracy and fluency as students in Finnish can do in half a year. So definitely the orthography of English is another challenge to students with dyslexia.

Tina Davey: I'll just say, I remember an “I Love Lucy” episode from years ago—she was teaching Ricky Ricardo how to read. You remember that episode, with “bough”? It's a great skit, and I wonder if you might use that in your training.

Suzanne Carreker: It is a great skit because it shows that complexity, and part of that complexity is due to the fact that English is a very friendly language. We're always bringing in words from other languages and words from other languages will have different letter-sound correspondences. And in the example of “I Love Lucy,” for many of those words, the pronunciations have evolved over the years. So at one time the pronunciation and the spelling might have matched, but the pronunciations were difficult so they evolved, but the spelling sort of stayed put.

Dyslexia in the age of remote-hybrid learning

Tina Davey: Let's have a final question here for both of you: How has remote-hybrid learning affected students with dyslexia? And are there special concerns, challenges, or opportunities for this population of students in a remote environment? Lee-Ann, why don't I start with you?

Lee-Ann Mertzlufft: There are probably two sides to that answer, and I'll answer the first from my assistive technology role. Probably the best thing that happened with the pandemic and the infusion of technology on steroids for all students is the universal design for learning. There's no more “I can't use this, I look different” or “This accommodation has to be only used in this environment, not in that environment.” Everybody can use voice dictation right now for writing. If you can speak, you can write now, so you don't need to worry about the spelling, the organization, and all the parts that take place for writing. You can speak, you can write. Ebooks are for everybody right now. There are many screen readers that are available for anybody right now too, so our students are spending an incredible amount of time on the screen—which isn’t, in my opinion, the best thing—but they can also use a screen reader. And then there is immersion reading, where they can follow along with those texts as well and it doesn't cost anything. It's right there. It's a Google extension to have. So the best thing that has happened is probably the universal design for learning when it comes to technology.

Probably the worst thing that has happened is that video has trumped print. Even those students who are not dyslexic, they see, but they don't read—they click. Then we're not really processing print; everything is expected to be done quickly, and that's not really a positive thing. So the academic endurance that you need and the patience you need to read and to have sustained attention is also being lost in this video world. And there are some kids who are thriving with remote instruction, and then there are some kids who are drowning with remote instruction. It is a very individual situation—those who are doing well and those who are doing poorly.
 

Support from Lexia

Tina Davey: Suzanne, what about you? What do you feel like the concerns, challenges, and opportunities for this population of students are in a remote learning environment?

Suzanne Carreker: Well, of course, a grave concern with remote or hybrid learning has been equitable access to technology and reliable internet connections for all students—in particular, those students with dyslexia. With so many disruptions in moving to a remote learning environment, a concern specific to students with dyslexia is the continuation or the preservation of the interventions. We don't want it to be seen as just one thing you can put aside; they're very important to include and continue. Remote learning does lack proximity to the teacher, so engagement can be a challenge for some students. What we have found with our Lexia programs that use adaptive blended learning, there is adaptive learning online, so as students are learning a new skill and they're struggling, the computer will provide additional instruction. There is accurate and ongoing data for the teachers to monitor progress, so they can see when students are really struggling and they need to stop and deliver a teacher-led lesson that will provide targeted instruction for that student. And what we've seen in the pandemic is that educators are seeing that student usage has gone up, and the teachers really are accessing the available data more closely—they're logging in to look at it. So I think that increased usage by students and increased progress monitoring by the teachers is definitely a support for students with dyslexia, because they can get instruction and practice with Lexia as well as whatever is part of their intervention.

Tina Davey: Do you want to say a little bit about Lexia, in particular?

Suzanne Carreker: Lexia provides online learning for students. We have Core5, which is our program for students in pre-K through grade five. We do think about our programs as being programs that accelerate learning for all students. PowerUp is our program for students who are struggling to learn to read in grades six through 12. So again, we want to accelerate their learning by finding their strengths and capitalizing on those, so they may place at a higher level in grammar than they do in decoding, because that's an area of strength and we want to keep growing that strength. But if they have lower ability in decoding, we want to make sure that we're providing that explicit instruction that will help them with that decoding piece, which is so important to comprehension. 

So, Lee-Ann, can I ask you what you're seeing in terms of classroom instruction? Are you seeing more of what we call structured literacy? Structured literacy is instruction that is informed by what we call the “science of reading.” The science of reading is all of the evidence that has been accumulated through gold-standard methodologies, and structured literacy is really the application of that evidence. So do you see that going on, Lee-Ann, in classrooms?

Lee-Ann Mertzlufft: Yes, I see structured literacy, and I see Lexia as a valuable tool—I always have—in working with my population of students with dyslexia, or whatever you want to call it, a reading disability, or who are behind in reading. It is taking artificial intelligence and it is adapting that so a child can respond quickly to whether you're chaining a word or dividing the word. It gives them the practice that they need; they need that practice to advance, and it does have the ability to integrate authentic literature. PowerUp does a great job in doing that in the comprehension section, so they're still working on their word study and they can also work on comprehension; and grammar has been resurrected as an important part of our studies. So if they participate, and if the lessons are taught with fidelity and the teacher believes in that student and the student believes that they can learn, success will be had.

Suzanne Carreker: We do think that this blended model that includes the online learning, the data monitoring, and the teacher-led lessons is really the equation that leads to equity for all students.

Tina Davey: Yeah, perfect recipe.

Lee-Ann Mertzlufft: It is. There should be no reason why any child is left behind in literacy in this day and age.

Tina Davey: Absolutely. Well, thank you guys so much for joining us today.

Lee-Ann Mertzlufft: Thank you for this opportunity to participate and to spread the word.

Suzanne Carreker: Absolutely.