Phonics-based instruction improves reading skills

By Jason Mosheim

With about 112 hours of phonics-based instruction, adults with dyslexia can improve their reading skills, according to a collaborative study by researchers at Wake Forest University Medical Center, in Winston-Salem, NC, and Georgetown University in Washington DC.

Dyslexia is a neurologically-based learning disorder characterized by a combination of inaccurate and dysfluent word recognition, with accompanying spelling and decoding disabilities. Reading comprehension also is affected, leaving little room for reading experience and vocabulary growth.¹ The approximately 10 percent of children identified as having dyslexia do not outgrow it.

In the new study, which was funded by the National Institute of Child Health and Human Development, researchers used functional magnetic resonance imaging (fMRI) to detect the differential brain activity of adults with dyslexia. They also took note of brain behavior as the subjects received instruction. The researchers noticed that more blood flows to the parts of the brain that experience more activity, just as it does to muscles in the body during physical exercise.²

"We're detecting where blood flow increases in response to brain activity underlying reading-related skills," Lynn Flowers, PhD, a neurophysiologist at Wake Forest University School of Medicine, told ADVANCE.

In a previous study, children received similar phonics-based instruction. The researchers wanted to see if the same method would change the reading skills of adults with dyslexia, a population they have studied for 15 years. They also were interested in any corresponding changes in brain activity, particularly in the areas that manage and process language functions.

"This technology shows us that brain patterns, just like behavioral patterns, are very similar in adults and children," Dr. Flowers said. "Therefore, we thought it would be appropriate to apply the same kind of reading instruction to adults that has been successful in children."

The researchers first compared people with dyslexia to typical readers to show that their brains looked a lot like those of other people with dyslexia. They then divided the group and compared people with dyslexia who received tutoring to those who did not.

As a result of the phonics-based instruction, several changes occurred in different areas of the brain. The functions of the left side of the brain, where language function seems to be mediated the most, experienced significant changes.

"Some right-hemisphere areas were also more active after remediation than before, which hadn't been observed in similar studies with children learning to read," Dr. Flowers reported. "We interpret this to show that there are two mechanisms in adults that are at work."

One mechanism is a normalizing of activity in the left hemisphere, and the other is compensatory behavior in the right hemisphere.

"The areas in the right hemisphere are more commonly active in young children who are just learning to read," she explained. "The adult brains look different from the brains of the children in that the adults increase the activity in their right hemisphere, whereas children tend to rely increasingly more on their left hemisphere."

The researchers also found improvements in phonemic awareness, but the biggest change was in the area of decoding.

"The subjects could figure out what a word sounded like even if they hadn't seen it before," said Dr. Flowers. "We tested that using simulated words to avoid the possibility of having them recognize something familiar."

Another discovery was that when people with dyslexia read a paragraph, they were able to do so with greater accuracy, she said, noting, "Not just in single words, but in reading words in a specific context."

However, the tutoring did not change the speed of reading or the amount of information extracted from the material.

"The tutoring really was on phonemics and decoding," Dr. Flowers stated. "We achieved what we wanted with these skills, which in children most accurately predict later reading skills."

She said, "We believe that if we kept tutoring the adults with severe dyslexia, they would have continued to increase their brain activity, although we haven't tested this yet."

Based on developmental studies, researchers know that children who do not receive remediation continue to have trouble throughout school, Dr. Flowers reported. "Identifying and testing adults who were diagnosed as dyslexic in childhood allows us to see that they still have many of the same problems, although they may have compensated to some degree."

Dyslexia, which is believed to be genetic in nature, may share similarities to other kinds of behaviors in that several genes on different chromosomes probably contribute to its occurrence.

"If we take a group of people with dyslexia and look at the familial relationships through their genetic material, we can compare their phonetic skills to their fluency skills," she said. "This way, we can see how they might load heavier on one chromosome or another."

Children with dyslexia sometimes have so much trouble in school that they don't want to go. They are easily distracted and are mistaken for having attention deficit disorder (ADD), when, in fact, they are unable to do the work.

People with dyslexia often don't reach their full vocational potential and have emotional issues such as a lack of self-esteem. They have a higher rate of drug abuse and suicidal ideation than their typical peers, according to another study in which Dr. Flowers was involved.

"We tend to see that the gap between the capabilities of dyslexics and the capabilities of their peers widens as they get older," she said. "That gap doesn't close unless they receive tutoring."

Adults with dyslexia should be evaluated by someone who has expertise in assessing reading disabilities, such as a neurophysiologist.

Finding a phonics-based program that uses structured, sequential instruction is crucial, Dr. Flowers said. "If someone decides to invest money and time for tutoring purposes, make sure the program has some scientific background. It should be backed by independent research conducted by someone other than the company providing it."

Even though it's easier to teach children more readily than adults, it is never too late to get help for dyslexia, she said. However, "remediation at the earliest possible stage is preferable. Clinicians should try to identify the condition as soon as possible instead of waiting until a child fails."

The recent study shows that a 40- or 50 year-old adult who has had a lifetime of difficulty reading can make a change, she noted. "You might be able to learn better if you start earlier, but you can still learn as an adult."

The researchers plan to investigate more dyslexia-related issues. Proposals include studying people who read exceptionally well but have poor comprehension, comparing English as an alphabetic system to a non-alphabetic system, and studying children who learn to read in Chinese compared to those who learn an alphabet system.

"We'd also like to look at skilled learning in adults," Dr. Flowers said. "We think of reading as another skill that a person can learn. In some ways, reading isn't a natural function but a skill that can be acquired."

One thing future studies will look at is how the brain functions when adults learn to associate an abstract symbol, such as a letter, with a sound. To explore the possibilities, researchers will have to develop and teach an artificial alphabet system.

Reference

1. International Dyslexia Association. (2002). Dyslexia FAQ. Accessed online via www.interdys.org.

2. Flowers, L., Eden, G., Jones, K., et al. (2004). Neural changes following remediation in adult developmental dyslexia. Neuron, 44 (3): 411-22.

For More Information

Lynn Flowers, PhD, 336-769-1661, e-mail: lflowers@wfubmc.edu