Case Study Report:
Intervention Category: Cognitive Development and Dyslexia
Level: Primary
Cissie
7 years, 8 months
1st grade

What was the reason for referral?

Dr. Wheelock was contacted by Cissie’s school district for a diagnosis because Cissie was not making reading progress and a learning disability was suspect.

What background information did the parents report?

Cissie lives with her parents, who are in their late forties and are both college educated. The father is a corporate executive, and the mother is a commercial artist. English is the only language used in the home. Cissie is the youngest of four children and she is the only girl. Her brothers are 13, 15 and 19, have not had any academic difficulties and excel in sports. The family has lived in the same Midwestern metropolitan community for 15 years. Her maternal grandmother lives across the street and hosts Cissie after school.

The mother reported that Cissie had a premature birth by 2 months, with complications resulting in intensive care intervention for several days. The mother also reported that Cissie has had some developmental delays in walking and speech of several months to a year behind those of her brothers. Cissie currently is 20 percent below the normal ranges of height and weight for her age.

Her vision is normal.

Cissie is sensitive and difficult to control at home, according to the mother. White a loving child, she has fairly frequent temper tantrums and feels very particular about her clothes. Although she picks out her clothes herself, she complains that they itch, do not fit and that they “don’t feel right.” She is upset and frequently cries when confronted with challenges and new situations.

Cissie showed great reluctance in starting kindergarten and first grade, voicing concern that she could do the work. She enjoys gym and art, and the parents and older brothers read to her every day. Cissie likes to make up stories and builds upon the story themes that are read to her. She creates elaborate games and imaginative plays, and likes to construct forts and castles. The parents and brothers help her use the computer for creative games and play. She has friends from school with whom she plays and has sleep-overs on a regular basis.

What background information did the classroom teacher report?

Cissie’s school reported that her classroom teacher worked with her after school for one day a week for the first semester of the year. Due to her lack of progress in literacy, she also is enrolled with the Reading teacher and Special Education teacher several times a week for the past four months. However, she has made little to no progress.

What were diagnostic outcomes?

Dr. Wheelock administered a series of diagnostic tests and procedures with Cissie. His observations were that Cissie was somewhat shy but that rapport was easily established. Cissie was verbal and well oriented to time and place. During the testing proper, she worked well and with sustained interest. At times of transition, however, she had occasional moments of silent weeping and asked for her mother.

For the purposes of this case study, Dr. Wheelock presents the following outcomes of the Classroom Reading Inventory and a synopsis of relative data from other measures..

Cissie’s Case Study
Part I: Word Lists
Form A: Pretest Inventory Record
Classroom Reading Inventory, 11th edition

From the CRI word lists, Cissie made the following types of word substitutions:

from – “for”
over – “of”
no – “on”
find – “five”
head – “hat”
think – “thick”
want – “went”
pass – “pace”
eight – “that”
kind – “keened”

Beyond recognition of some basic sight words, and knowledge of regular consonants, Cissie had little else in the way of phonetic and structural analysis skills.

Cissie’s Case Study
Part II: Graded Paragraphs
Form A: Pretest Inventory Record
Classroom Reading Inventory, 11th edition

Dr. Wheelock positioned Cissie to begin reading the graded paragraphs at the Pre-Primer level in the Classroom Reading Inventory, 11th edition. He chose the Pre-Primer level because it was the lowest level at which Cissie could read 85 percent of the words on the word lists.

Cissie’s oral reading in context at sight was characterized by tendency to read word-by-word with numerous word substitution errors and words not recognized. She frustrated at the Primer level. Dr. Wheelock continued the assessment of her listening capacity by reading the next grade levels of stories to her and asking her the comprehension questions. Listening capacity is the ability to understand material when it is read to the student and it helps establish the student’s capacity for understanding concepts taught and discussed orally in the classroom. Cissie showed a listening capacity at the third grade. Her comprehension of the material she read, and the material read to her, was very good through a third grade-level. Her word recognition errors were consistent with those kinds of errors demonstrated on the word lists.

Summary of diagnostic data from other measures:

• On the Wechsler Intelligence Scale for Children – III®, Cissie had a Full Scale IQ classified as average according to the Wechsler norms for her age group. Her individual verbal and performance scales were both rated as average. There was unevenness of functioning throughout the subtests, with Scaled Scores ranging from a low of 6 (Information) to a high of 14 (Similarities). The overall clinical impression was of a youngster with at least average intellectual capacity.
• On the Bender Visual-Motor Gestalt Test, the protocol is suggestive of uneven perceptual development – most likely developmental in nature.
• On the Wepman Auditory Discrimination Test and the Betts Visual Discrimination Test, there were no indications of difficulty in these areas.
• The results of the Harris Test of Lateral Dominance indicate a right-side dominant pattern. However, there are indications of a left-right orientation of direction problem.
• On the Wheelock Informal Spelling Test, Cissie recognized 40 percent of basic sight words. Cissie seems unable to associate spoken sounds (phonemes) with the printed symbols (graphemes) that represent them; e.g., wrote ciat for eight, and uppod for upon. The results of the Draw-A-Person Test and post-drawing interrogation tend to indicate a youngster who is anxious about her self concept and general functioning. Such anxiety dampens intellectual and motor performance. There is a tendency to become easily depressed.

Conclusions:
Dr. Wheelock found that Cissie was a youngster of at least average intellectual capacity who exhibits a disorder manifested by difficulty in learning to read despite conventional instruction, adequate intelligence and socio-cultural opportunity. It is dependent upon fundamental cognitive disabilities that are frequently of constitutional origin – specific developmental dyslexia (mild).

Recommended Interventions:
Dr. Wheelock met with Cissie’s parents and school representatives and discussed each diagnostic test with them and his recommendations:

1. Report of testing: Dr. Wheelock helped Cissie’s parents and the school educators to understand the specific diagnostic outcomes as well as the patterns between and among the test results. He provided them and school representatives a report of testing.
2. Person-centered planning: Dr. Wheelock recommended that the parents share the outcomes of the evaluation with Cissie in a person-centered planning process. The family will identify where Cissie is academically, how she views her learning priorities, what she needs to achieve to reach her goals, and how they can work together to achieve a family and school plan of support for her.
3. School meeting: Dr. Wheelock met with Cissie’s parents, classroom teacher, the Reading teacher in the school, the Special Education director and the principal to review the report of testing. Dr. Wheelock reviewed and explained the diagnostic outcomes from which the school personnel determine an Individual Educational Plan for Cissie and interventions through special reading services.
4. Therapeutic approach: Dr. Wheelock confirmed that Cissie needs a great deal of individual remedial reading therapy with a certified reading teacher. He noted that in cases like Cissie’s specific developmental dyslexia, there is a tendency to try different approaches in an attempt to teach a youngster her basic decoding skills. It would be best in Cissie’s case to adopt, and stick with, a multi-sensory approach. That it, use an approach that employs all of the sense modalities – visual, auditory, kinesthetic and tactile.
5. Long period of remediation: It is important not to become discouraged if this method does not seem to work all at once. One of the things that characterize children like Cissie is long periods of no gain.
6. Decoding skills: In teaching the basic decoding skills, Dr. Wheelock recommended using a model of minimum skills and to stick to the basics like long, short and irregular vowel combinations.
7. Sight words: For the basic sight words, Dr. Wheelock recommended teaching these through a look-say approach with a great deal of repetition and review. Focus on teaching Cissie tricks to differentiate between highly similar words such as them-then, there-three.
8. Spelling: Cissie’s spelling should be consistent with words she is learning to decode and basic sight words. The instructor should try always to use words that fit a consistent pattern she is learning; e.g., when teaching the gr blend, have lots of gr blend words on her spelling test. Review often!
9. High interest readers: In addition to basal reader, high-interest easy reading books and some language experience stories should be used.
10. Independent reading: Once Cissie begins to better associate spoken words with the printed symbols that represent them, she should be started on a program of independent reading. She should use high interest-easy reading material in which she will have a reasonable chance of completing the stories or books she begins. Discussing her independent reading with her is a way to motivate and reward her persistence.
11. Listening-speaking approaches: It is important that Cissie’s teachers bear in mind that Cissie is learning disabled, as, as such, expectations for her work in class must not be the same as they are for non-disabled students. Much of what she is expected to do should be on a listening-speaking basis. Homework assignments should be modified so that Cissie has every chance of completing them in a relatively short period of time. Remember – Cissie is disabled. Failure to realize this only impedes her progress and has negative results as far as her mental health is concerned.
12. Long-term expectations: Dr. Wheelock cautions not to lose patience with Cissie. Remember – long periods of no gain. The learning increments will be slow to come and far between. With time, patience and sticking to a multi-sensory approach, Cissie will learn to read.

Discussion with experts:

Drs. Wheelock and Campbell answer questions below about Allen’s case study. If you have a question, please Ask the CRI Experts or check the FAQ.

FAQ’s related to Cissie’s case study:

1. If a student with learning disabilities is showing signs of having a highly sensitive nervous system, how does this issue affect reading remediation?
2. What does it mean when students are diagnosed with directional confusion and how can they be helped?
3. How can an artistically inclined student with specific learning disabilities like dyslexia build reading skills and comprehension creatively?
4. How can basic sight words be promoted and reinforced effectively in the home?
5. If a dyslexic student goes for a long period in a reading remediation program without showing gains, how do the teachers and parents know that the child is making progress?