**8. Firm classification of child H's learning difficulties based on response to intervention**

Based on the evidence of Child H's response to a number of different treatment interventions which indicated continuing difficulties with reading, writing and spelling as well as continuing difficulties with phonics, Child H was classified for both medical aid and concession purposes as having dyslexia (Note 22). The classification

#### *Multivariate Treatment of Dyslexia, Dysgraphia and Dyscalculia DOI: http://dx.doi.org/10.5772/intechopen.110287*

provided was based on the use of ICD10 indicators linked to the presence of a number of continuing areas of difficulty affecting a number of areas of scholastic functioning.

Motivation was then made for reading, spelling and rate of work concessions based on the dyslexic classification. In addition, the evidence from Child H's Grade 6 response to intervention assessment was linked to the need for ongoing intervention in a number of areas and the continuing implementation of a multivariate treatment programme.

Labelling Child H as dyslexic was at this stage based on both quantitative and qualitative data using multimethod, data and time triangulation [73, 132]. The diagnosis was firm, and based on incremental data from cross-sectional concurrent assessment as well as longitudinal evidence of Child H's response to specific types of intervention. This then formed the basis for concessions, as well as planning of the interventions necessary to support Child H's transition from primary school to high school.

#### **9. Planning for the transition from primary to high school**

After using the dyslexic diagnosis to motivate for concessions, the next step in planning for Child H's transition to high school was to work with the evidence from his Grade 6 assessment in replanning his programme. This was done using the indicators of cognitive strengths and weakness from the recent IQ, combined with scholastic test and working memory indicators.

Both the Phonic Inventories and the Durrell indicated that Child H had made substantial progress in applying phonic rules in the reading and spelling of individual words, while the working memory indicators in the Durrell indicated progress in phonic spelling but continuing difficulties with the development of higher level phonic associations, visual memory for words and rate or work. There were also continuing difficulties with reading fluency as well as writing and spelling fluency, indicating needs for interventions involving:


Based on this, Child H's programme was replanned with continuing focus on the development of reading fluency and comprehension, accurate spelling of both individual words and sequences of words and activities designed to increase ability to process written work rapidly. This included use of a stop watch to work on reading, writing and spelling activities against pressure of time, as well as rapid reading and working memory activities based on use of an electronic tachistocope.

#### **10. Increased emphasis on work on visual memory and rapid naming**

Work was thus continued on programmes previously used for phonological referencing, phonic analysis and visual memory development, as well as work on rapid naming using registers of words that were familiar to Child H. This was linked to activities to develop accurate and rapid memory for individual words and words in sequence. Tachistoscopic work was also introduced [118], working repetitively with words of increasing length drawn from an electronic dictionary. In addition, Child H was asked to create custom lists of words in which more than one letter was used to represent the vowel sounds. The target words were drawn from graded paragraphs previously used for targeted revisualisation, as well as from Child H's school books.

In introducing activities using the electronic tachistocope, length of words, time exposure of the presentation of each word and the time between the exposure of each word were conceptualised as treatment variables for rapid naming, as in the model presented in **Figure 10** below.

#### **10.1 Methods for treating rapid naming difficulties here**

Other variables could also be included in the model by varying the ways in which words were presented, read, revisualised and written down, by varying the exposure as well as the length of words presented electronically. The aim was to link the tachistocopic methods used for developing Child H's ability to rapidly recognise and remember words to the methods being used in other areas of the programme for training fluency in reading, writing and spelling. This was done through use of thematically based vocabulary presented tachistoscopically in activities designed to link rapid naming of words [133, 134] with written activities aimed at developing usage of the words in context. This was combined with use of computer-based speech to print technologies in which words used in context orally could be linked to words printed and read.

**Figure 10.** *Methods for treating rapid naming difficulties.*

#### **10.2 Progress evaluation (September 2020)**

Over his Grade 6 year at primary school, Child H continued to work on the different areas of his programme diligently with the help of his parents. He found both the revisualisation-based activities and the tachistoscopic work particularly helpful, and reported that these were assisting his reading, writing and spelling as well as his rate of work in the classroom (Note 23).

As the aim was to achieve a level of literacy (Note 24) before the end of primary school, the Durrell Analysis of Reading Difficulty was redone in October 2020, to see whether there had been change in Child H's levels of reading, writing and spelling prior to his final Grade 7 year.

The profile of Child H's age scores on the Durrell at this point is presented in **Figure 11** below.

#### **10.3 Child H—profile of Durrell age scores (October 2020) here**

It was evident from comparing the 2019 and 2020 Durrell profiles that there had been improvements in a number of different areas of reading as well as in visual memory for words. The improvements in visual memory were particularly marked. Child H attributed these improvements both to continued focus on activities involving use of sequential memory for words and use of the tachistoscope for rapid processing and recall of individual words (Note 25).

At this point it was evident that Child H's transition to high school was likely to be accompanied by continuing difficulties with reading, spelling and rate of work. External assessment was thus conducted to confirm the classification of Child H's learning difficulties as linked to dyslexia, for which continuing concessions at high school would be necessary.

The results of this assessment are reported in the next section.

**Figure 11.** *Child H – profile of Durrell age scores (October 2020).*
