Story by BBC News (abridged)
A medical student in the UK with dyslexia claims multiple choice exams discriminate against people with the condition and is taking legal action to prevent their use.

But why do children who struggle with reading find multiple choice difficult? Dyslexia is known to cause problems with the way the brain processes words and sequences, and students with the condition are generally granted 25% extra time in exams.

But Naomi Gadian, a second year medical student, is calling for the General Medical Council to scrap multiple choice questions as part of doctors' training. She says although essays and practicals have not been a problem, multiple choice questions discriminate against people with dyslexia. "They don't let me express my knowledge. In normal day life, you don't get given multiple choice questions to sit. Your patients aren't going to ask you 'here's an option and four answers. Which one is right?'" she says.

THE ANSWER
A lot of information in one question can be difficult to remember. So are multiple choice questions particularly difficult for people with dyslexia? Dr John Rack, head of psychology at Dyslexia Action, says people with the condition can find multiple choice questions difficult because of the large amount of information which they have to deal with, all at once. "Dyslexics often have problems with their 'working memory'," he says, "which is the space where we hold on to information. If there are too many options, it is hard to keep track of them and by the last option, they have forgotten the first."He says everyone can find this problematic, but those with dyslexia find it harder - especially as they tend to read more slowly.

Reasonable adjustments
But Dr Rack does not think multiple choice is the worst exam format for those who have dyslexia - and says it is unusual for people to have a particular problem with them. He says case studies and essays can put pressure on the speed of writing and fluent writing skills such as spelling, structuring and sequencing.

"So long as multiple choice questions are well structured and short, they should be fairly accessible," he says.

Story from BBC NEWS
It is interesting that test skills and learning skills overlap. Gemm Learning's programs aimed at resolving learning issues also work in the test prep format.

Spotting and treating learning difficulties early is vital for children's mental well being, a UK government report has found. The report from Foresight, the government think tank on the future, said learning difficulties were a problem that affected up to 10% of children.

"Yet too often they remain unidentified, or are treated only when advanced. The result can be under-achievement in school and disengagement by the child, sometimes leading to a long-term cycle of anti-social behavior, exclusion and even criminality," it said.

"Improvements in early detection combined with focused interventions could prevent problems developing and create broad and lasting benefits for the child and society."

The report found that dyslexia and dyscalculia (math learning problems) can both substantially reduce lifetime earnings and academic achievement, with dyscalculia potentially as common as dyslexia but frequently undetected.

"We need to empower professionals at schools to better address the needs of individual children, and to improve learning and development trajectories.

Parents also need to be vigilant. Know the signs of language and learning issues under 5 years of age, and the signs of reading difficulties 4-7 years of age. Here's one article that we wrote for Parent Guide called Looking for Clues.

Even small gains from interventions at elementary school or earlier will have out-sized benefits over a lifetime, in and out of school, due to the power of compounding.

This story of a 28 year old dyslexic just came in:

Annemarie, 28, has had dyslexia her entire life. Her self confidence and overall school performance caused her to give up on her dreams of college. Upon leaving high school she has worked in retail without expecting to advance.

Before coming to Gemm Learning, Annemarie was having difficulties at work. She needed to listen to voice mail messages several times to hear the phone number or understand the person's name. Her spelling was atrocious and her co-workers could not read or understand the messages.

Three weeks into her Fast ForWord program with Gemm Learning Annemarie reported that she was no longer having trouble writing phone messages. In addition, she was better able to recognize her spelling errors.

When recently discussing her progress, Annemarie told us, “I feel like I am finally out of the dark.” She now feels when she has her own children she will be able to help them learn to read.
Annemarie is now an avid reader, her reading comprehension is much improved. She has more confidence and is thinking about college. She hopes to work in the education field, either as a teacher or as an advocate for children with special needs.

EdisonLearning, formerly Edison Schools, has a division that is developing proto-type schools based on best practices and using the very best of current science. They just announced a decision to impelement Fast ForWord at a school in Baltimore. Here's the press release:

EdisonLearning Selects Fast ForWord Family of Products to Improve At-Risk Students' Reading Skills
OAKLAND, Calif.--(BUSINESS WIRE)-- Scientific Learning today announces that Edison Learning, the nation’s largest partner to public school districts and communities, has chosen the Fast ForWord to provide a research-based reading intervention program for Furman L. Templeton Elementary in Baltimore. Fast ForWord is a family of educational software products that help for dyslexia and accelerate learning by developing the student brain to process more efficiently.

Furman L. Templeton Elementary, a preK-5 public school in the Baltimore City Public School System (BCPSS), is an EdisonLearning and BCPSS Partnership school. This fall, the school plans to implement the Fast ForWord reading intervention software to strengthen the brain processing and literacy skills of at-risk students in grades three, four and five. In addition, students who require additional assistance are expected to use the Fast ForWord products after school.

“EdisonLearning’s goal in all of our partnership schools is to advance achievement and help students reach the highest levels of reading proficiency,” said Dr. Marlaina Palmeri, senior vice president and regional education officer for EdisonLearning. “The Fast ForWord program enhances our ability to achieve this mission by incorporating proven methodologies that help students develop their cognitive and reading skills while also building their confidence and self-esteem. I n addition, the Fast ForWord program fits easily into our academic day without compromising critical time for core instruction, and is adaptable for our after school program at Furman L. Templeton.”

The Fast ForWord family of products consists of scientifically proven intervention programs that apply neuroscience principles to build the fundamental cognitive skills required to read and learn. The products work by improving the brain’s processing efficiency — how the brain functions to support learning and intellectual activity, including memory, attention, processing rate, and sequencing — with intensive exercises that adapt to each student’s level.

Dr. Joseph Wise, chief education officer for EdisonLearning noted, “Too many students are being taught in classes very much like the ones their parents and even grandparents attended, not benefiting fully from new research, technology and advances in education. As public educators, we can accelerate the learning curve for all children and connect them in new and engaging ways with their teachers.”

About EdisonLearning
EdisonLearning is the nation’s largest partner to public school districts and communities, and during the 2008/09 school year, has a network of more than 100 schools serving 350,000 students in 23 states. EdisonLearning works with school leaders and communities to provide solutions that inspire students to think, learn, and succeed. The organization partners with public educators to create or support improvement in schools that help students achieve lasting gains in performance and prepare them to meet their full potential and the expectations of the 21st century workplace. For more information, visit www.edisonlearning.com.

About Scientific Learning Corp.
Scientific Learning creates educational software that accelerates learning by improving the processing efficiency of the brain. Based on more than 30 years of neuroscience and cognitive research, the Fast ForWord® family of products provides struggling readers with computer-delivered exercises that build the cognitive skills required to read and learn effectively. Scientific Learning Reading Assistant™ combines advanced speech recognition technology with scientifically-based courseware to help students strengthen fluency, vocabulary and comprehension to become proficient, life-long readers. The efficacy of the products has been established by more than 550 research studies and publications. For more information, visit www.scientificlearning.com or call toll-free 888-452-7323.

by Martha S. Burns Phd
Why is it that one child within a family of normal readers needs reading help when it comes easily to other children? Find out about brain studies which point to biological explanations for dyslexia.

For decades, ever since dyslexia was described as a disorder in learning to read, scientists, educators, and parents have wondered about the causes. Why is it that one child within a family of normal readers has so much trouble learning to sound out new words, can't learn to read effortlessly with good comprehension, or needs a great deal of special tutoring to learn what comes easily to other children?

Over forty years ago, reading specialists speculated that there might be some defect in the brain that could account for dyslexia. Some experts even used the term "minimal brain damage" or "minimal brain dysfunction" to account for the struggle some children experienced in learning to read. But, after years of research with EEG and anatomic scans like CAT or MRI images, no structural differences could be found to account for reading problems.

In the 1980's, Normal Geshwind and Albert Galaburda of Harvard Medical School proposed a theory to account for neurological changes that would not be visible to the naked eye or on brain scans but could cause dyslexia. They hypothesized that the causes of dyslexia might be microscopic changes in brain physiology due to differences in the development of the brain. Brain cells form before a child is born by dividing from base cells and travelling, or migrating, to form functional parts of the human cerebrum. Geshwind and Galaburda argued that there might be factors which occur while the brain is forming that could cause neuronal cells to migrate incorrectly. Neurons that migrate incorrectly never mature and are called ectopic cells. Under a microscope, ectopias look like small warts on the top of the brain, but they cannot be seen on conventional CAT scans or MRI's.

Galaburda conducted several microscopic studies of the brain cells of adults with dyslexia after they died of natural causes. He identified ectopic cells in regions of their brains that were known to be important for learning language. He also found anatomical differences in the medial geniculate (auditory) nucleus of the thalamus, namely an overall reduction in the cell size. The large, magnocellular, cells of the thalamus are the fast processing neural pathways that connect the sensory organs (eyes and ears) to the cerebrum via the thalamus. The questions raised by his findings were:

What are the causes of the ectopias?How are they related to the differences in the magnocellular pathways?How do such small cellular abnormalities cause such severe dyslexia?What can be done to remediate the problems that result?How Ectopias Form In The Brain
Animal research has recently clarified how ectopias form in the brain. In humans, around four to five months gestation, cells migrate to form the cerebral cortex. As the cells are migrating, they are guided by radial glial cells. These guiding cells act like ropes that the cortical cells can climb to reach their end position. At the end of the climb, a membrane acts like a ceiling so the cells remain where they belong. If there is a breach in the membrane, the cells migrate through the breach. Although researchers originally believed that a mother's immune system might play a part in the development of ectopias, it is now generally agreed that a genetic component is a factor in the development of ectopias. At this time, at least two or three genes have been identified that result in the formation of ectopias. A second form of minor neocortical malformation, microgyria, has also been linked to processing disturbances in animals. Like ectopias, microgyria, are microscopic malformations that can be induced in animals while the brain is forming.

A question still remains, however, as to how minor cortical malformations might lead to dyslexia. Animal research has begun to clarify the relationship. When very small malformations are induced in the brains of rats, for example, researchers have found that these will cause a major restructuring all over the brain. Because the brain is so plastic, small abnormalities in a developing brain can produce profound consequences. One region that this restructuring can affect is the magnocellular cell system in the lateral (vision) and medial (hearing) geniculate nuclei of the thalamus. It appears that when neurons migrate incorrectly and form ectopias, these may lead to abnormalities in the magnocellular system neurons that conduct auditory and visual impulses to the cortex. As many as 80% of children who have defects in the fast, magnocellular, auditory sensory systems go on to be diagnosed as dyslexic. However, the impact of these magnocellular abnormalities has been poorly understood until recently.

Connections to Reading Researchers from several different perspectives have begun to clarify the relationship between reduced magnocellular function and reading. For over twenty years, researchers in child language have known that children with developmental language problems have problems recognizing and sequencing tones that occur too close together in time. Dr. Paula Tallal, who first recognized this phenomenon in language impaired children, theorized that a problem detecting tones occurring within rapid succession impaired perception of the phonemic contrasts needed to learn language and later learn to read.

Recently, this same phenomenon has been observed in male rats with induced cortical malformations. In one study, male rats with induced malformations could not detect two tones if they occurred in rapid succession, less than one quarter of a second apart. In a separate study, male rats, unable to detect a second tone when presented within 72 milliseconds of a first tone, were shown to have a greater number of small and no large cells in their medial geniculate nucleus. Taken together, these studies point to the interrelationship between microscopic developmental malformations in the brain (ectopias and microgyria) and problems with rapid processing (large, magnocellular) systems in the thalamus.

Several new studies of reading skill and dyslexia add the final link for understanding the relationship between rapid processing systems and reading skill. One study conducted by Talcott and his colleagues at Oxford University showed that phonological reading decoding skills were correlated with ability to process fast moving auditory stimuli, while the ability to recognize words with irregular (non-phonemic) combinations of letters was correlated with ability to process fast moving visual information. David Heeger and his colleagues at Stanford University have reported findings from a functional imaging study comparing normal and dyslexic readers while performing tasks that require fast visual processing. They found less activity in the magnocellular pathways of people with dyslexia than in the normal readers. In a third study, John Gabrieli, Torkel Klingberg and their associates at Standford University have found, using a new imaging technique called "diffusion tensor imaging", that adults with dyslexia have less well organized white matter in regions of the cortex responsible for integrating auditory and visual information. They have speculated that these white matter differences represent differences in processing speed.

In an intervention study, Habib and his colleagues at the Cognitive Neurology Laboratory in Marseille, France found evidence that modifying speech signals to slow the rapid speech transitions significantly helps children with dyslexia. In a study of twelve ten- to twelve-year old children with phonological dyslexia who underwent intensive phonological awareness exercises (45 minutes a day over a five week period), those for whom the short transitional speech elements were slowed and made louder made significantly greater gains than the children who received normal speech for their training.

Taken together, these results suggest that a key to learning to read is the ability to process rapidly occurring sounds and visual signals. It appears, from Talcott's research, that there is a continuum of skill in this domain, with better readers also showing greater processing speed. Processing speed, in turn, seems to be linked to magnocellular processing pathways that conduct information from the thalamus to the cerebral cortex. Finally, magnocellular systems are affected by early minor alterations in the microscopic development of the cerebral cortex that seem to be guided, at least in part, by genetic influences.

Although researchers are beginning to understand the biological foundations of reading and reading disorders, it is important to recognize that there is a great deal that remains unclear. Although there may be a genetic predisposition to factors that contribute to reading disorders, clearly there is not a one-to-one correspondence. Talcott's finding that reading skill, in general, is related to both visual and auditory processing speed, suggests that reading skill occurs on a continuum and involves at least two processing systems. Animal research further suggests that processing speed is related to cellular systems in the thalamus that process rapidly changing stimuli. However, there may be gender differences in these influences, and the biology appears to be plastic, that is, able to be altered by intensive instruction or other environmental factors. We all await the research that will further clarify these latter considerations, as it will help educators to tailor their methods to the specific needs of each child.

Dr. Martha S. Burns is a certified speech-language therapist on staff at Evanston-Northwestern University Hospital and on faculty at Northwestern University department of communication sciences and disorders. She runs the private practice support team at Scientific Learning Inc. She has published widely on neurological foundations of language and reading disorders.
References:
Azar, Beth. 2000 What's the link between speed and reading in children with dyslexia? Monitor on Pscyhology. March: 36-39.
Habib, M.; Expesser, R.; Rey, V.; Giraud, K.;Bruas,P; Gres, C. 1999. Training Dyslexics with Acoustically Modified Speech: Evidence of Improved Phonological Performance. Brain and Cognition. 40:143-146.
Murray, Bridget. 2000. From Brain Scan to Lesson Plan. Monitor on Psychology. March: 22-28.
Talcott, Joel; Witton, Caroline; McLean, Maggie; Hansen, Peter; Rees, Adrian; and Green, Gary. 2000 Dynamic sensory sensititvity and children's word decoding skills. Proceedings of the National Academy of Sciences.