Allison Brooks

Treatment of Handwriting Problems in Beginning Writers: Transfer from Handwriting to Composition.

Almost 700 children were screened to identify 144 1st graders at risk for handwriting problems who were randomly assigned to 1 of 6 treatment conditions. Treatment was delivered to groups of 3 that met twice a week in 20-min sessions until they completed 24 lessons. Five groups received 10 min of different kinds of handwriting instruction. The contact control group received 10 min of phonological awareness training. All 6 groups composed and shared their writing for 10 min. Converging evidence across multiple measures showed that combining numbered arrows and memory retrieval was the most effective treatment for improving both handwriting and compositional fluency (composing with time limits). Thus instruction aimed at improving transcription transfers to improved text generation in beginning writers.

Magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders

BACKGROUND Magnetic resonance (MR) technology offers noninvasive methods for in vivo assessment of neuroabnormalities. METHODS A comprehensive neuropsychological/psychiatric battery, coupled with MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessments, were administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The 4 study groups included: (i) fetal alcohol syndrome (FAS)/partial FAS (PFAS); (ii) static encephalopathy/alcohol exposed (SE/AE); (iii) neurobehavioral disorder/alcohol exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and (iv) healthy peers with no prenatal alcohol exposure. Presented here are the MRI assessments that were used to compare the sizes of brain regions between the 4 groups. The neuropsychological/behavioral, MRS, and fMRI outcomes are reported separately. RESULTS Progressing across the 4 study groups from Controls to ND/AE to SE/AE to FAS/PFAS, the mean absolute size of the total brain, frontal lobe, caudate, putamen, hippocampus, cerebellar vermis, and corpus callosum length decreased incrementally and significantly. The FAS/PFAS group (the only group with the 4-Digit FAS facial phenotype) had disproportionately smaller frontal lobes relative to all other groups. The FAS/PFAS and SE/AE groups [the 2 groups with the most severe central nervous system (CNS) dysfunction] had disproportionately smaller caudate regions relative to the ND/AE and Control groups. The prevalence of subjects in the FAS/PFAS, SE/AE, and ND/AE groups that had 1 or more brain regions, 2 or more SDs below the mean size observed in the Control group was 78, 58, and 43%, respectively. Significant correlations were observed between size of brain regions and level of prenatal alcohol exposure, magnitude of FAS facial phenotype, and level of CNS dysfunction. CONCLUSIONS Magnetic resonance imaging provided further validation that ND/AE, SE/AE, and FAS/PFAS as defined by the FASD 4-Digit Code are 3 clinically distinct and increasingly more affected diagnostic subclassifications under the umbrella of FASD. Neurostructural abnormalities are present across the spectrum. MRI could importantly augment diagnosis of conditions under the umbrella of FASD, once population-based norms for structural development of the human brain are established.

Early intervention for spelling problems: Teaching functional spelling units of varying size with a multiple-connections framework.

Poor spellers in 2nd grade (n = 128) participated in 24 20-min sessions that included (a) direct instruction in the alphabet principle (most frequent phoneme-spelling connections); (b) modeling of different approaches, singly and in combination, for developing connections between spoken and written words for 48 words ordered by sound-spelling predictability; and (c) practice in composing. Results of this multilayered intervention showed that (a) more than 1 way of developing sound-spelling connections is effective in teaching spelling but that after training in the alphabet principle, combining whole word and onset-rime training is most effective in achieving transfer of the alphabet principle across word contexts; (b) functional spelling units of not only a single letter but also 2 or more letters are important in beginning spelling; and (c) training in spelling transfers to composition and word recognition.

Teaching Spelling to Children with Specific Learning Disabilities: The Mind's Ear and Eye Beat the Computer or Pencil.

Children with only spelling (n=24) or handwriting and spelling disabilities (n=24) were randomly assigned to a pencil or computer response mode. They were taught 48 words of varying orders of sound-spelling predictability using a method that emphasized hearing the word in the minds ear and seeing the word in the minds eye and making connections between the phonological and orthographic representations at the whole word and subword levels. Although no main effects were found for response mode, at posttest the pencil was superior to the computer for easy orders (single-letter spelling units with high sound-spelling predictability), but the computer was superior to the pencil for moderate and difficult orders (multiletter spelling units with intermediate or low sound-spelling predictability). Prior to and in response to treatment, children with handwriting and spelling problems spelled less well than children with only spelling problems. Multiletter spelling units of moderate or difficult orders of sound-spelling predictability explained unique increments of variance in spelling achievement, whereas single-letter spelling units of easy order of sound-spelling predictability did not. Based on these findings, instructional recommendations are to provide explicit instruction in the correspondence between sound and multiletter spelling units.

Magnetic resonance spectroscopy outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders

Magnetic resonance (MR) technology offers noninvasive methods for in vivo assessment of neuroabnormalities. A comprehensive neuropsychological/behavioral, MR imaging (MRI), MR spectroscopy (MRS) and functional MRI (fMRI) assessment was administered to children with fetal alcohol spectrum disorders (FASD) to determine whether global and/or focal abnormalities could be identified and to distinguish diagnostic subclassifications across the spectrum. The four study groups included (1) FAS/partial FAS; (2) static encephalopathy/alcohol exposed (SE/AE); (3) neurobehavioral disorder/alcohol exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and (4) healthy peers with no prenatal alcohol exposure. Results are presented in four separate reports: MRS (reported here) and neuropsychological/behavioral, MRI and fMRI outcomes (reported separately). MRS was used to compare neurometabolite concentrations [choline (Cho), n-acetyl-aspartate (NAA) and creatine (Cre)] in a white matter region and a hippocampal region between the four study groups. Choline concentration in the frontal/parietal white matter region, lateral to the midsection of the corpus callosum, was significantly lower in FAS/PFAS relative to all other study groups. Choline decreased significantly with decreasing frontal white matter volume and corpus callosum length. These outcomes suggest low choline concentrations may reflect white matter deficits among FAS/PFAS. Choline also decreased significantly with increasing severity of the 4-Digit FAS facial phenotype, increasing impairment in psychological performance and increasing alcohol exposure. NAA and Cre concentrations did not vary significantly. This study provides further evidence of the vulnerability of the cholinergic system in FASD.

Functional magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders

A comprehensive neuropsychological/psychiatric, MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessment was administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The four study groups included: 1. FAS/Partial FAS; 2. Static Encephalopathy/Alcohol Exposed (SE/AE); 3. Neurobehavioral Disorder/Alcohol Exposed (ND/AE); and 4. healthy peers with no prenatal alcohol exposure. fMRI outcomes are reported here. The neuropsychological/psychiatric, MRI, and MRS outcomes are reported separately. fMRI was used to assess activation in seven brain regions during performance of N-back working memory tasks. Children across the full spectrum of FASD exhibited significant working memory deficits and altered activation patterns in brain regions that are known to be involved in working memory. These results demonstrate the potential research and diagnostic value of this non-invasive MR tool in the field of FASD.

Language-based spelling instruction: Teaching children to make multiple connections between spoken and written words

Two studies addressed issues related to multiple instructional components in early intervention for at-risk spellers learning to spell polysyllabic words. The first study was a follow-up to a prior second-grade intervention. The fast responders in that study, who were monitored at the beginning and end of third grade (n=61), maintained their earlier gains during third grade when treatment was withdrawn. Thirty-two of the slower responders received continuing tutoring (12 individual tutorials over 6 to 8 weeks in late fall of third grade), which showed that children who received only alphabet principle training did as well as those who received combined alphabet principle and syllable awareness training (syllable types in English), but that these children required 24 practice trials for short-term mastery of spelling specific words. The second study with a new sample of 48 third graders also evaluated the effectiveness of alphabet principle training only versus combined alphabet principle and syllable awareness training. In these 24 individual tutorials over a 4-month period beginning in the fifth month of third grade, the combined treatment was more effective for (a) spelling untrained transfer words, (b) spelling taught polysyllabic words with a final, silent e syllable, and (c) transfer to phonological awareness. A two-tier model for early intervention to prevent spelling disabilities is proposed. In the first tier alphabet principle is taught (along with other sound-spelling connections for words including syllable awareness) and applied to practice in spelling words singly and in text (teacher-directed dictation and child-generated composition). In the second tier children are monitored in the year following early intervention and continuing tutoring is provided if necessary.

Tutorial Interventions for Writing Disabilities: Comparison of Transcription and Text Generation Processes

Seventeen fourth and fifth graders with severe writing disabilities participated in a weekly, one-hour individual tutorial for over eight months on the average. The tutorial was equally directed to transcription (handwriting and spelling) and composition skills. Students showed reliable improvement in composition and handwriting automaticity but not in spelling. Although writing-related fine-motor, orthographic, orthographic-motor integration, and phonological segmentation skills were not directly trained, they improved. However, phonological memory skills did not improve and may be a major constraint in the development of spelling skills in students with severe learning disabilities involving written language. Remediation may need to focus on development of phonological memory and not just on teaching rules and strategies. Word recognition skills also seemed to limit response to spelling instruction, and remedial spelling instruction may need to focus on words students can already read. In addition, students with spelling disabilities may benefit from a connectionist approach that models sound-spelling connections without teaching rules and may need more repeated practice with specific words than was provided. This exploratory study generated hypotheses that require further instructional research to test.

Letter Naming and Letter Writing Reversals in Children With Dyslexia: Momentary Inefficiency in the Phonological and Orthographic Loops of Working Memory

Given mounting evidence for working memory impairments in dyslexia, letter reversals during rapid automatic letter naming (phonological loop) or rapid automatic letter writing (orthographic loop) may reflect momentary inefficiency of working memory. Few of the children, with or without dyslexia, in a multi-generational family genetics study, produced reversals, but those with dyslexia produced more than those without dyslexia. Working-memory component predictors (word storing and processing units, phonological and orthographic loops, and executive functions) in regressions differentiated children with dyslexia (average age 11) who did and did not make reversals, predicted the number of reversals on specific letter naming or letter writing tasks, and explained unique variance in reading and writing outcomes. Although reversals are not a hallmark defining feature of dyslexia, children who produce reversals may benefit from instruction designed to develop specific working memory components and their efficient coordination in time.