CASE STUDY ON KATY
INTRODUCTION/BACKGROUND
Katy was referred as a result of academic and behavioural changes noticed by her teachers. Katy’s Mother thinks she has inherited dyslexia from her husband who was diagnosed at University.
Katy: 6 years old. Attends local state school. Father is dyslexic. She went from being a young bubbly and cheerful girl that enjoys stories to one that hates books and rejects bedtime stories. Good parental relationship with the mother as Katy effectively explains the problem to her. School issues as she suffers bullying and teasing from her classmates. Teachers may be mean towards her as she fears they get angry when she forgets what she has been taught. Parents most likely still together so no apparent issues at home.
BRIEF DESCRIPTION OF THE PRESENTING PROBLEM/WORKING HYPOTHESIS.
Katy lacks confidence in self, she is too withdrawn and extremely sensitive. Inability to remember, bad comprehension and reading skills. Recently developed bad writing skills, misspell words. Significantly low cognitive ability.
Katy is suffering from dyslexia with traces of dysgraphia. It could be an executive function issue since executive function involves skills that enable various cognitive tasks including self-control, mental flexibility and management of the working memory. The area of the brain that carries out executive function is the frontal lobe. In Katy’s case, it is possible that just the working memory is majorly affected. Her teachers seem to exercise on the fact that she forgets to carry out give task/assignment. Katy herself thinks this is what annoys the teacher, her ‘forgetfulness’. It could also be a sensory issue which is either hyposensitive or hypersensitive. Her failure to do tasks assigned to her may be due to hearing impairment. Katy’s inability to read could also be as a result of sight impairment. It will be helpful to access Katy’s medical records or consult a medical doctor to conduct a medical check on Katy regarding her eyesight and hearing. There could be an existing co-morbidity with Katy showing signs of dysgraphia as well. Katy is at a pre-operational stage (usually occurs around 2 to 7 years of age), a stage where children are ‘egocentric’ (Piaget, 1951). The egocentrism is not in the literal sense but the child’s cognitive inability to see things from the point of view different from their own (Mitchell & Ziegler, 2013). Even though Katy’s teacher think they are trying to help her by scolding her, she perceives it differently as an act of anger. Katy could also be dealing with a specific learning disorder which could have been facilitated by either biological or environmental factors. This would disrupt the learning style which is different from her peers; it would be effective to discover the proposed learning style that would fit Katy (Diagnostic and statistical manual of mental disorders , 2013). Dysgraphia is an impairment that affects the written expression of an individual. It is not associated with laziness; rather it is addressed cognitive or physical impairment (Jones, 2017). Children struggling with dysgraphia find it difficult to either hold a pen or write neatly. Letters appear unorganised or discombobulated win the dysgraphic individual. Although writing may prove difficult, dysgraphic people also find it hard to express their ideas in written form (Jones, 2017). Dysgraphia is the term used by professionals to describe writing disorder, although some other professionals may choose to use a different term to address the disorder. However dysgraphia is defined, it is quite important for the parents or teacher to understand that the child is not to be blamed for their bad handwriting as it has nothing to do with laziness (Jones, 2017). Children with dysgraphia struggle with language processing and fine motor skills and both skills are required for effective writing. Experts haven’t discovered the exact cause of dysgraphia; usually, information is stored by the brain to retrieve for later use. Retrieval from either the short-term memory or the long-term memory is important to begin the writing process as it allows organise writing from previously stored information. Someone with dysgraphia would struggle with the process of organising and retrieving information and this would affect how the information is written (Jones, 2017). The would result in an abstract or vague piece of writing with spelling errors making it difficult to read. The working memory or short-term memory is affected in a dysgraphic child. Orthographic coding is impaired in a dysgraphic child as he/she may struggle with storing words that are not familiar.
Dysgraphia can be categorised into six different symptoms and they are:
i. Fine motor
ii. Grammar
iii. Language organisation
iv. Visual-spatial
v. Language processing
Vi. Handwriting/Spelling
It is important to properly assess a child that misdealing with dysgraphia since this could hinder the mental growth of the child. The child may struggle academically as it takes more effort to write, note taking would prove difficult. This could be discouraging for the child and may hinder their academic work.
If the motor skills are affected, children will struggle with basic skills such as tying their shoelace, knotting their tie which could result to bullying from their peers. This could hinder their self-esteem.
These common challenges dysgraphic children face may affect them in long-term as dysgraphia can easily be misinterpreted as laziness, it can create serious esteem issues that can hinder the social life of the child.
RATIONALE FOR THIS HYPOTHESIS (MODELS, EXPLANATORY MECHANISMS)
Dyslexia was originally defined as the inability to read or learn despite being provided with effective learning exercises (Woolfson, 2011). Over the years there have been different definitions of dyslexia that emphasises on the fact that it has nothing to do with general intelligence neither does it affect an individual’s ability to perform exceptionally. (Hulme & Snowling, 2011) stated that a person is classified as dyslexic if their reading ability is significantly low compared to their chronological age and measured intelligence. Woolfson states two reading models that suggest children use either visual/lexical technique which involves sight vocabulary. The other model is the non-lexical which normally requires the reading of words that are unfamiliar using phonological rules.
There are a few theories that explain dyslexia according to (Woolfson, 2011), these theories are :
i. The Magnocellular hypothesis- This theory states that dyslexia is as a result of complications in the visual magnocellular pathway (Woolfson, 2011)). It has to do with the visual aspect of reading. In this case, dyslexics view the words to be in motion. The words appear to be crossing and moving around each other.
ii. Cerebellar deficit hypothesis- This states that children with dyslexia struggle to read without making a conscious effort. They lack the skills required for automatisation which is caused by an abnormality in the cerebellar.
iii. Working Memory Deficit- Short-term memory difficulties is one of the present issues in dyslexics (Woolfson, 2011).
Different factors affect literacy in the classroom, for example, the amount of time a teacher spends on the student and its effectiveness is an important factor that determines a level of literacy. According to (Woolfson, 2011), higher reading scores were found in a situation where teachers showed good organisation in the classroom. A well-organised classroom allows every student to be carried along while performing reading tasks. Learning difficulties/deficit can sometimes be as a result of the educational system and may not lie within the child that requires special educational needs (Beaver, 2011). It is important to focus on both Katy and the educational system to examine how it can fit or improve her learning ability. Co-morbidity in learning deficits occur more than it is anticipated, in Katy’s case dysgraphia could be present hence her bad writing skills. Regarding learning, spelling can be difficult than reading as it requires memorisation of a complete word while reading only needs recognition (Mather & Wendling , 2012). Reading and spelling in English are difficult compared to other languages; this is due to the low consistency of the writing system and the phonological complexity (Goswami, 2005). For healthy reading development through different stages, Katy’s teacher needed to do a great deal of work to help the pupil improve as her age increases.
There are five different causative areas of reading disability, they include emotional, educational, environmental, constitutional and intellectual (Mather & Wendling , 2012).
OUTLINE OF ASSESSMENT PROCESS
Diagnostics test is important to determine the various processes that may be detrimental to learning spelling and reading skills. A multiple deficit approach will be considered as we are hypothetically dealing with dyslexia. An IQ test would be conducted to prove Katy is not intellectually disabled. The Progressive Achievement Test in Mathematics (PAT Maths) would be used to assess Katy’s mathematical skills to ensure she is not struggling with calculations as well. There are various correlates of dyslexia, phonological awareness, for example, is different from phonics, phonological awareness is to do with sound distinction to make different words. Phonological awareness development is different with different age groups. For example, from age 3 to 4 rhyme is produced spontaneously, age 4 to 5 the child can identify some syllables by either tapping or clapping and can use syllables to create a word (Mather & Wendling , 2012). At age 6 and above the child should be able to produce rhyme, identify sounds and easily blend two units of sound to create a word and at a high level, they could perform tasks that involve phonemic awareness (Mather & Wendling , 2012). One of the tests that would be effective in Katy’s assessment would be The Comprehensive Test of Phonological Processing (CTPP) since it can be used to measure phonological awareness concerning phonological memory and repetition of non-words. Dyslexics usually repeat nonsense words; this is a simple way to assess their ability in that sense. In this case, it would be preferable to use the Kaufman Test of Educational Achievement (KTEA-II) as Katy falls under the age category of 4-6years. This also would provide Katy’s an accurate assessment of Katy’s phonological awareness. Another test to be considered is the Rapid Automatized Naming (RAN), in this test Katy will be asked to randomly name objects that could be familiar as quickly as she can. This test is associated with comprehension and reading accuracy in general. RAN extends beyond phonological awareness, as it offers unique result in regards to reading prediction in (Mather & Wendling , 2012). Memory is an important factor to consider when reading. To understand and remember what is understood memory is essential. The ability to store and retrieve information is facilitated by the limbic system. The working memory is made up of different components including the central, executive phonological loop and visuospatial sketch in terms of verbal speech processing and visual input. Phonological awareness can affect the performance of the phonological loop. Working memory test that would prove effective in Katy’s case would be the Differential Ability Scales (DAS-II) for children age 2-6yrs (Mather & Wendling , 2012).
RESULTS
Following the observation and assessment of Katy using the Wechsler Intelligence Scale for Pre-school and Primary Scale of Intelligence (WPPSI), she scored average and has proven that her IQ is normal and has nothing to do with intellectual disability. Katy proves to be able to verbally express herself and examine situation around her in an intellectual manner. Although some flaws may suggest she is intellectually disabled, the results have shown to prove otherwise. Results from the Progressive Achievement Test in Mathematics (PAT Maths) proved Katy is good with solving arithmetic problems generally but she struggled with word problems, which could have been from her misinterpretation of the questions due to bad comprehension. Apart from issues with word problems Katy’s numeracy skills were reasonably good. Results from the Comprehensive Test of Phonological Processing (CTPP) showed that Katy performed poorly, this means there is a deficit in Katy’s phonological awareness in terms of phonological memory and she also performed defectively in repetition of non-words. From this result, it can be proved that Katy is dyslexic but further tests were carried to ensure correlation in the results. To further assess the accuracy of the previous results, Kaufman Test of Educational Achievement (KTEA-II) was used to measure repetition of non-words. The results had a strong correlation with previous result gathered. Katy had performed as poorly as she did in the previous test. This confirms our hypothesis that Katy has a deficit in her phonological awareness. Results from the Rapid Automatized Naming (RAN) proved that Katy struggles with reading comprehension and accuracy as she performed poorly in the naming task. The final test carried out was the working memory test, this was assessed using the Differential Ability Scales (DAS-II). Results from the working memory test proved Katy has a poor working memory which explains why she struggles with retrieval of information and forgetfulness. Poor working memory would also increase chances of dysgraphia since writing requires organisation of information to be transcribed into written form. Katy proved not to have any major sensory issues, her sight and hearing were not impaired according to test results.
DETAILED INTERVENTION PLAN
Teachers should be extra careful when correcting Katy. Peers should be more encouraging towards her and refrain from teasing Katy since she is extremely sensitive. Katy needs constant reassurance in her intellectual abilities and teachers should refrain from labelling her. This gives the other children the opportunity to tease Katy which has had a major effect on her self-confidence in her intellectual ability. It is important for teachers to consider the approach they use when dealing with Katy. It is proven that dyslexia can occur as a result of environmental influence (Frederickson, Miller, & Cline, 2008). Katy needs more intensive teaching to overcome dyslexia or improve reading and spelling skills. Two effective methods used in treating dyslexia are Auditory Discrimination in Depth and Embedded phonic (Frederickson, Miller, & Cline, 2008). Both interventions are intense and time-consuming as they require roughly 68 hours of one to one teaching within eight weeks. These methods affect mainly reading accuracy and not reading fluency (Frederickson, Miller, & Cline, 2008).. Katy’s parents should play a significant role to help improve her reading and spelling skills. The role of parents in children’s learning should not be undermined. Parents level of education is reflected in their children (Woolfson, 2011), if Katy’s father graduated with a good degree, there is a high chance she can achieve similar or even better results with the right intervention. Reading to Katy is not sufficient enough to provide an improved reading ability, rather Katy should be more involved in the reading. Dyslexia can be facilitated by poor teaching methods according to past research. Phonics should be taught at an early age in an intense and structured way. Phonological based intervention should be implored when dealing with Katy as it improves cognitive process and reading skills (Cline, Guildford, & Birch, 2015).
There are no exact cures for dysgraphia but there are different intervention strategies that can help improve the impairment. Dysgraphia based on physical deficits could be treated by occupational therapists (Jones, 2017).
Writing impairment could be improved using classroom accommodation method that involves the dysgraphic individual answering classroom questions orally rather than writing (Jones, 2017).
Technology can be used to improve dysgraphia as there are a few apps and games that can be recommended. Teachers should consider dysgraphic students when giving out assignments. Teachers should implement different writing skills other than traditional ones; they can do this effectively using the software Handwriting without tears (Jones, 2017). The written work volume should be considered when dealing with dysgraphic; teachers should make written work less for the dysgraphic individuals. Written works such as tests and assignment should be answered orally, or give the pupils options to answer openly, either by drawing their answer or using phrases (Jones, 2017). Teachers should effectively show the dysgraphic students how writing can be broken down into different stages and grade every stage differently. The students should, first of all, think about what they want to write(brainstorm) then draft and edit whatever has been written before finally moving on to proofread to ensure the written work is of standard (Jones, 2017). Teachers should be lenient when marking the work of the dysgraphic, criteria such as spellings and syntax should be overlooked. Negative feedback can leave the dysgraphic broken rather they should be encouraged to do better and put in more work.
Conclusion
In conclusion, Katy is suffering from dyslexia co-morbid with dysgraphia. Katy’s specific learning difficulty is influenced by environmental and biological factors. Environmental factors most likely have to do with her teachers and their teaching method, Katy needs to be observed closely as she is being left behind. Teachers should pay attention to her and cater to her needs since this may have facilitated Katy’s dyslexia. With quality teaching and intervention, Katy will improve over time. Katy’s father did not find out he was dyslexic until he was at University level of education, her early diagnosis would see Katy excel even at a higher level than her father. It is important to be positive around Katy concerning her educational abilities because labelling her would severely affect her self-esteem and give a chance to inadequate academic performance.
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