Overcoming Dyslexia and Poor Working Memory: A Live Case Study

Sophia is an 8-year-old girl who attends Year 4 in a British school. At the age of 6 years and 5 months Sophia was identified as being dyslexic, having maths learning difficulties and very poor working memory.

Despite doing book-based and online programs at home, and the school being very supportive, the gap between Sophia and her classmates has continued to increase. At this stage she is most likely at least 2.5 years behind in her reading and writing, Sophia’s mum Lindsay told Edublox. “There is a bright little girl with ever decreasing self-esteem who views herself as ‘stupid’ and ‘useless’ because she cannot do what others find so easy despite the intensive support she receives in school and at home.” 

“She is embarrassed having to pick ‘baby’ books when others can read chapter books but the reality is she can only read simple words and cannot blend sounds to decode more complicated ones. She uses pictures to guess at words rather than attempting to read. She is ashamed of her writing and terrified to try to work by herself because of her inability to spell. No matter how many times I, or her teacher, tell her to spell it as she thinks it sounds and that mistakes don’t matter, she will not do it. She is becoming crippled by fear of failure.”

We have been touched by Sophia’s story and have chosen her to be a live case study. Sophia will be following a customised program, doing five one-hour lessons per week. Starting in November 2018, we will be  posting biweekly to triweekly updates of her progress.


Sophia’s journey…


Sophia’s story, as told by her mum Lindsay

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Sophia is in Year 4 and is aged 8. She will be 9 in January. It was clear to me before Sophia finished Nursery that she was not able to learn as easily as other children. She did not learn her colours, or learn to count past 2. (She still confuses colours such as red and green despite testing negative for colour blindness 3 times.) At age 2 she was diagnosed with epilepsy and put on medication to control her seziures. I hoped the learning problems she had were a side effect of medication and they would lessen in time, but they did not. She also has a speech disorder which affects her pronunciation, and speech aphasia, so she often forgets words: for example she can look at a picture of a boat, but only tell you ‘it’s for going on water’ – she cannot remember what it is.

As a little girl, Sophia was unable to remember nursery rhymes no matter how many hundreds of times she heard them. She still struggles to remember the names of class mates, teachers, the name of her grandmother’s dog and even, at times, her cousins’ names. In Reception she made very slow progress and could not remember her alphabet or identify her letters going into Year 1. By the end of the first term of Year 1 her teacher and I were both considering dyslexia as a probable diagnosis. She had intensive support in class over the year and continued making painfully slow progress. Words were read by sounding out individual letters – blending was impossible – but at least by the end of the year she seemed to know about 2/3 of the alphabet even if she still seemed unable to read at all.

At the end of Year 1 Sophia was assessed privately by an educational psychologist. She was just 6 years and 5 month old which is young for a formal assessment and I worried her problems would be simply put down to her age and within normal limits. I was certain it was more and was so relieved when the diagnosis came back and Sophia was identified as being dyslexic, having maths learning difficulties, and a very poor working memory. I thought a diagnosis and personalized strategies would mean she’d soon begin to make progress. I did not yet realise how severe her dyslexia was.

Since then Sophia has continued to have great 1:1 support from her school, being withdrawn for individual work on literacy and in a small group for maths. I know we are very fortunate in having such a good level of support. Sophia’s lack of progress is certainly not due to lack of effort by her teachers who have all worked incredibly hard to help her. Sophia enjoys school a great deal but is very aware of the very significant gap between herself and other children her age. This makes her hugely upset at times. Independence in the classroom is a massive challenge as she cannot read worksheets or books or spell anything more than a simple CVC word. Due to speech difficulties read-write technology is not much use. She wants – and needs – to be independent and to be able to produce work that can reflect her ideas and knowledge but this is impossible: the most she can write by herself are simple sentences like “the fox get a box”. Her self-esteem due to this is very low. She is also desperate to read at home and pick books from the book shop to read to herself like her big sister does. So much is closed off to her due to her almost non-existent literacy. In my worst moments I fear that she is never, ever going to be functionally literate.

We’ve tried book-based and online programs at home, including ones recommended by the educational psychologist, but progress seems hard to achieve and sustain. She continues to make frequent confusion between /b/ and /d/, /m/ and /n/ etc, cannot blend words with any great level of success and is very stressed out by reading and writing – we have many tears at home or angry, frustrated outbursts where she says she will never read and she is ‘just too stupid’. Hearing these things breaks my heart. When I try to reassure her she tells me that I have to say nice things as I am her mummy, but she knows she is stupid. I hate to think how much worse her self-confidence will be if she cannot start learning to read.

She is most likely at least 2.5 years behind in her reading and writing. The gap continues to get bigger. I have many despairing moments wondering whether she will gain literacy skills and what her future will be like if she doesn’t. Every year the gap between where she is and where she should be just increases. There is a bright little girl with ever decreasing self-esteem who views herself as ‘stupid’ and ‘useless’ because she cannot do what others find so easy despite the intensive support she receives in school and at home. She is embarrassed having to pick ‘baby’ books when others can read chapter books, but the reality is she can only read simple words and cannot blend sounds to decode more complicated ones. She uses pictures to guess at words rather than attempting to read. She is ashamed of her writing and terrified to try to work by herself because of her inability to spell. No matter how many times I, or her teacher, tell her to spell it as she thinks it sounds and that mistakes don’t matter, she will not do it. She is becoming crippled by fear of failure.

Sophia finds sequencing hard and struggles to remember days of the week or months of the year. She doesn’t seem to fully understand time and needs the number of ‘sleeps’ to an event rather than being told ‘in 3 days’ or ‘after the weekend’. She finds identifying rhymes very hard. Games like ‘I spy’ are very challenging when she may say ‘something beginning with T’ and then tell you the answer is Road. Luckily she also has a strong sense of humour when these errors happen within the security of the family.

She is an amazingly creative dancer despite difficulties due to problems with her muscle tone. She is determined, funny, sassy and the most hard working child you can meet. She needs so much to learn to read. Having seen the success Edublox has had with children with similar profiles to Sophia, I am feeling hopeful that we can finally unlock her mind an open up the world of books to her.

Writing and reading:

It has been hugely difficult to get Sophia to do the requested writing task as she is so lacking in confidence to show anyone what she can do. Below are three lines about ‘my mummy’ that Sophia wrote almost independently — she only asked for help to spell ‘always’.

And below is a video of Sophia reading unprepared from a book: 

 


Sophia’s assessment results

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The testing was done in July 2016, when Sophia was 6 years and 5 months old.

To evaluate Sophia’s intellectual capacity, she was administered the Wechsler Intelligence Scale for Children (WISC 4).

The Verbal Comprehension Index (VCI) measures verbal concept formation. It assesses children’s ability to listen to a question, draw upon learned information from both formal and informal education, reason through an answer, and express their thoughts aloud. It can tap preferences for verbal information, a difficulty with novel and unexpected situations, or a desire for more time to process information rather than decide “on the spot.” Sophia scored 99, which falls in the average range.

The Perceptual Reasoning Index (PRI) measures non-verbal and fluid reasoning. It assesses children’s ability to examine a problem, draw upon visual-motor and visual-spatial skills, organise their thoughts, create solutions, and then test them. It can also tap preferences for visual information, comfort with novel and unexpected situations, or a preference to learn by doing. Sophia scored 79, which is considered to be low.

The Working Memory Index (WMI) measures working memory. It assesses children’s ability to memorise new information, hold it in short-term memory, concentrate, and manipulate that information to produce some result or reasoning processes. It is important in higher-order thinking, learning, and achievement. It can tap concentration, planning ability, cognitive flexibility, and sequencing skill, but is sensitive to anxiety too. It is an important component of learning and achievement, and ability to work effectively with ideas as they are presented in classroom situations. Sophia scored 68, which is considered to be very low.

The Processing Speed Index (PSI) measures speed of information processing. It assesses children’s abilities to focus attention and quickly scan, discriminate between, and sequentially order visual information. It requires persistence and planning ability, but is sensitive to motivation, difficulty working under a time pressure, and motor co-ordination too. Sophia scored 99, which falls in the average range. Sophia scored 91, which falls in the average range.

The Wechsler Individual Achievement Test Second Edition (WIAT 2) assesses the academic achievement of children, adolescents, college students and adults, aged 4 through 85. The test enables the assessment of a broad range of academics skills: Reading, Maths, Writing, and Oral Language.

Phonological awareness involves being able to tell the difference between sounds, and being able to identify and remember the sounds that make up words. It is an important component in literacy development, especially in spelling and reading. The Comprehensive Test of Phonological Processing Second Edition (CTOPP-2) includes the following sub-tests that measure aspects of phonological awareness:

  • ‘Elision’ measures the candidate’s ability to say a word, then say what is left of that word when a designated sound is taken out.
  • ‘Blending Words’ measures the candidate’s ability to combine audiorecorded sounds to make a whole word.
  • ‘Sound Matching’ measures the candidate’s ability to identify to match words with beginning and ending sounds.
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Sophia’s dyslexia can be seen clearly in her phonological processing, spelling, reading and written expression. She also shows maths learning difficulties:\\She also showed maths learning difficulties

The Beery-Buktenica Tests of Visual Motor Integration (VMI) were used to assess Sophia’s hand-eye co-ordination. She scored comfortably in the average range here. The two Beery-Buktenica sub-tests were then administered in order to assess the separate impact of visual perception and motor co-ordination in Sophia’s visual motor integration. In the visual perception sub-test, Sophia scored at the higher end of the average range; her motor co-ordination score was at the bottom of the average range. 



Progress updates, as provided by Lindsay

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Week 2:

Sophia covering her eyes to listen to the audio task.

Two weeks into Edublox and I feel I am learning as much as Sophia. She loves doing the b/d/p/q and up/down/left/right activities. She also enjoys both the online and flash-word activities. She is learning how to learn, and learning the importance of keeping a positive mindset. I am learning more about her strengths and weaknesses, and a lack of organization and planning in her problem solving abilities that I previously did not know existed. This is hugely helpful as it is showing us things we can now work to improve which will help her enormously at school too.

I’ve always known Sophia is very determined and resilient. We have lots of tears over her inability to read and write, but she always picks herself up and keeps going. Over the last 2 weeks I’ve seen that incredible resilience and determination many times. But I’ve also seen how much her learning disabilities have impacted her self-esteem. She becomes so easily frustrated and turned off when about to do something she feels she may fail at. Reading a word wrongly that she had read ok before immediately puts a sad look on her face and demotivates her. The appearance of the automatic timer on some of the online activities increases her stress as she assumes she will fail. Because she is a loud, talkative and quite extrovert personality she can seem very confident – but it is a mask and underneath she has little confidence and a big fear of being shown to be a ‘failure’. Making a mistake leads to her saying how much she hates the activity or how stupid she is. It is a constant battle to remotivate her and bring her back to a positive mindset. Our new catch phrase has become ‘Working hard with a positive attitude’ – a reminder to her that we are learning and making mistakes is part of that, and we must be positive if we are going to move forward. Of course I would love for her not to get stressed or anxious but we cannot run away from these activities because they are going to help her in the long term. So in the short term we deal with the stress and anxiety, remember our new catch phrase and move on. With each task success I hope we embed more positive self-esteem and confidence. She loves the positive messages the activities speak to her (‘You make learning look easy’ and – her absolute favourite – ‘That deserves an ice cream!’) and these successes will ‘vaccinate’ her for the times when it is harder and motivate her to keep going.

I’ve learned from watching Sophia that her problem solving ability is inconsistent. Faced with logical thinking tasks (to complete a pattern) it was quickly apparent to me that if the pattern went beyond a simple repetition, she had no idea how to apply logical reasoning to solve it. Likewise, with grid patterns it became clear that she has a very disorganized methodology. Interestingly, when it comes to the activities which build more and more blocks in a line she noticed long before I did that the beginning stayed the same and it was just adding new colours onto the established sequence. I only realized this when I questioned why she was working backwards – from right to left – and she informed me that it was so she could work quickly and didn’t forget the most recently added colours. Because Edublox always allows her to ‘correct her mistake’ and see where she erred I’ve been able to teach her ways of identifying what the logic games are asking her and, slowly, her logical thinking skills are becoming better: she is at least now looking for a reason behind a pattern rather than randomly selecting colours or just giving up when the answer wasn’t immediately obvious to her. In other activities she has struggled with naming the colours to herself to help remember what is appearing/disappearing before the timer begins. She is not colour blind but easily misnames and confuses green and blue/red and green, and her speech aphasia makes this ever worse. A week ago, if she stumbled with remembering the names of the colours she would become frustrated and say she wanted to stop. However, she is becoming more positive and beginning to plan and strategise ways to build success. For example, she has now started telling herself stories (yellow and black side by side are a bumble bee, blue is the sky, red a flower and so on) to remember sequences of blocks. By progressing the story each time a new colour appears she helps herself remember. She did this yesterday and today, after getting something wrong, and instead of her normal frustration she immediately began the story telling strategy and correctly solved the next few rounds of the game. This was a big moment for us, as not only did she not get frustrated and angry and start being horribly critical of herself, but she took a strategy from the day before and used it without being told to. She is learning to learn.

It’s early days but the signs are so positive. Her mindset is becoming less negative and she is beginning to understand that she can learn to do more and do better than she previously thought. It’s onwards and upwards – learning with a positive attitude!