Section A. Reading, Learning Disabilities, and Dyslexia
A. What is reading?
Reading is defined as the effort to get the meaning of something printed, written or embossed by using the eyes, or in the case of Braille, the fingertips, to interpret its characters or signs.1
In today's society, reading serves as the major foundational skill for learning. The first few years of school are dedicated to teaching the difficult process of learning to read and write. Although speaking is a natural process, reading and writing are not natural nor easy for many students.2,3,4
1. Role of oral language
Oral language is the foundation for reading. A child's vocabulary is a direct response to the amount of words that he or she hears.5 Exposure to a large number of words is necessary for high-quality oral language development, and strong oral language skills are a prerequisite for successful reading.6 The size of a child's vocabulary at the age of 3 is highly correlated to his or her spoken language ability, reading ability, and reading comprehension at the end of third grade. So, it is extremely important that parents talk to and read to their children from early infancy to develop strong language and literacy skills.
2. Phonological Model of Reading
Phonological awareness (also called auditory analysis) is the ability to hear, identify, and manipulate individual speech sounds. Phonological awareness (auditory analysis) is essential in learning to read. If children are not able to hear the individual sounds in speech, they will have difficulty rhyming words, blending sounds to make words, or segmenting words into sounds.
Individual sounds that are pronounced in a certain way by native speakers are referred to as phonemes. The phoneme is the smallest unit of speech that distinguishes one word from another.1 Each language has a unique set of phonemes. The more phonemes inherent to a language, the higher the degree of difficulty to break down or decode the written word. Different combinations of phonemes produce all words in each language. English is a phonemically complex language in which the 26 letters of the alphabet create 44 sounds or phonemes. The 44 phonemes can be spelled in 74 ways and 23 of those letter combinations can make more than one sound. So, in English the relationship between letters and sounds is inconsistent (deep orthography), whereas in some other languages, the reader can look at a word and immediately know how to pronounce it (shallow orthography).
Spoken words are formed by combining one or more phonemes (sounds). These sounds create meaning. Phonemic awareness is the ability to hear, identify, blend, and break apart the individual sounds in words and to understand how changes in these sounds signal differences in meaning. Phonemic awareness is the phonological process that is most strongly associated with early word reading. A phonemically aware child is able to recognize that the difference in the sound of a word affects the meaning of that word. Developing phonemic awareness is a learned process, because phonemes are not separated in speech; they are co-articulated – spoken together – quickly, at 8 to 10 phonemes per second. Phonological and phonemic awareness are oral skills that must be in place before learning phonics.
Writing is an artificially designed use of abstract symbols to represent language. English uses an alphabetic system in which each letter is a symbol that is an abstract building block of the phonemes.
Phonics is an instructional approach that emphasizes the understanding of the relationship between the letters and the sounds that they make. The goal of learning phonics is to enable beginning readers to decode new written words by sounding them out and use that skill in reverse to spell or encode words. Early readers use phonics to sound out words, but they must eventually become proficient in reading larger units of print such as syllables, meaningful roots, suffixes (morphemes), and whole words at a fast pace.
3. 2000 National Reading Panel recommendations for teachers7
For a long time there has been a difference of opinion among teachers and other professional groups on the best ways to teach students to read. There has been a lot of frustration for parents of children struggling to read and the lack of effective remediation available for these problems. In 1997 Congress directed the creation of a “National Reading Panel” of experts to work together and establish formal recommendations.
After 3 years of site visits, literature review, and study the panel came up with the “Report of the National Reading Panel , Teaching Children to Read: An Evidence-Based Assessment of the Scientific Research Literature on Reading and its Implications for Reading Instruction.”
The report was the first of its kind because it outlined scientifically proven, evidence-based methods for the teaching of reading that can be used by teachers and parents in the education of their children. It is considered the most comprehensive and thorough report ever to be undertaken in American education.
2000 National Reading Panel Recommendations for Teaching Reading
- Phonemic awareness
- Phonics - explicitly and systematically taught
- Fluency training- via guided oral reading
- Vocabulary building
- Reading comprehension techniques
2. Learning Disabilities
A. What are learning disabilities?
Learning disabilities are lifelong conditions affecting the way the brain processes information, usually with hereditary antecedence. This difference in information processing impairs the ability to manage incoming and outgoing information. Learning disabilities are a reflection of DNA-based brain learning patterns inherited from parents or parents’ parents and not caused by brain injury or damage.4 Learning disabilities are more than learning differences; they are true obstacles to the learning process.
People with learning disabilities may have difficulty with the way they perceive, understand, remember, and/or communicate information. They affect an individual’s ability to read, write, or calculate at a level commensurate with his or her intellectual ability, educational exposure, and cultural influences.
B. Types of learning disabilities
Dyslexia - reading disability
Dysgraphia - writing disability (frequently co-occurs with dyslexia)
Includes problems with handwriting (fine-motor), spelling, copying, and/or organizing thoughts to put on paper (cognitive difficulty)
Dyscalculia - math disability
Includes problems with learning to count, estimate, remember math facts, solve arithmetic problems, grasp higher math concepts, and tell time, as well as visuo-spatial or other difficulties.
Dyspraxia - Developmental Coordination Disability - motor skill and coordination disability
Includes difficulties with planning and coordinating muscle movements, balance and posture, understanding visuo-spatial relationships, or oromotor coordination and speech.
Specific Language Impairment - delayed or disordered language development
It is a receptive and expressive language impairment. Most of these children will develop a reading disability.
C. Magnitude of the Problem
Figures provided by schools that indicate the number of children receiving special services for severe learning disabilities provide only a crude estimate of the actual problems.
According to US Department of Education statistics, (2000) 3% of children aged 6 to 21 years of age are receiving special services for learning disabilities. This is about 2.5 million students per annum in the United States.4
A. What is dyslexia?
1. Definition of Dyslexia 8
The NICHD & The International Dyslexia Association definition of dyslexia is: “Dyslexia is characterized by difficulties with accurate and / or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”
The U.K. Rose Report on Dyslexia (2009)9 described the following: “Dyslexia is a learning difficulty that primarily affects the skills involved in accurate and fluent word reading and spelling. Characteristic features of dyslexia are difficulties in phonological awareness, verbal memory, and verbal processing speed. Dyslexia occurs across the range of intellectual abilities. It is best thought of as a continuum, not a distinct category and there are no clear cut off points. Co-occurring difficulties may be seen in aspects of language, motor coordination, mental calculation, concentration and personal organization, but these are not themselves markers of dyslexia. A good indication of the severity and persistence of dyslexia can be determined by examining how the individual responds or has responded to well-founded intervention.
a.The majority of currently available research for dyslexia relates to alphabetic writing systems, especially to European languages. However, substantial research is also available regarding dyslexia in Arabic, Chinese, and Hebrew, as well as other languages. The percentage of people is estimated to vary between countries, ranging from 1%-33% of the population, an average is between 3%-4% of the population. There are different definitions of dyslexia throughout the world, but despite these differences in writing systems, different populations suffer similarly from dyslexia. Dyslexia is not limited in converting letters to sound. Chinese dyslexics have difficulty extracting meaning from shapes and characters.4
b. Dyslexia is the most common learning disability, representing 80% of all learning disabilities.10
c. Dyslexia often runs in families; approximately 40% of siblings, children, or parents of an affected individual will have dyslexia.
d. Dyslexia is more common in children with speech and language delay or problem.
e. Dyslexia affects males slightly more than females, though schools identify boys at least twice as often as girls.11,12
f. Dyslexia occurs at all levels of intelligence. Dyslexia reflects a very specific difficulty with reading and occurs in people with low, normal, and high IQs alike. Children with dyslexia process information differently. Slow reading and poor spelling are signs of dyslexia, not of low intelligence. Children with dyslexia are not “dumb” or “lazy” and they often work harder and longer than their peers. Children with dyslexia are often very bright, analytical, creative and gifted in other areas. Many people with dyslexia have an exceptional ability to reason and understand ideas and concepts. Because dyslexia is a “language-processing problem” unrelated to intelligence, it is often unexpected and may go undetected in an otherwise bright child.
g. Dyslexia represents the lower portion of a normal distribution of reading ability.13
h. Dyslexia can vary from mild to severe.13
i. Dyslexia is a lifelong condition — students do not “outgrow” dyslexia. Untreated, a poor reader in 1st grade will almost invariably stay a poor reader. Adults with dyslexia continue to read slowly and not automatically throughout life.14
Dyslexia is a lifelong condition that is neurologic in origin. Our brains were originally designed to have the ability to speak, not read. Through experience with language, every child must adapt and rewire existing areas to develop the ability to read. But some people's brains do not reorganize in the typical pattern, creating dyslexia. Functional magnetic resonance imaging (fMRI) scans have found that this difference in "wiring" is present before these children start to read.
Recent studies involving fMRIs in adults and children have shown that dyslexia occurs as a result of poor phonological processing at the level of the left parieto-temporal region during word analysis. In non-dyslexic patients, word form processing occurs in the left occipitotemporal region. Articulation and word analysis occur in Broca’s area in the left inferior frontal gyrus. The left parieto-temporal region involves the processing of phonemes in word analysis. The left occipito- temporal region is most active for times of skilled reading and “automatic rapid responding” also referred to as rapid automated naming (RAN) or verbal processing speed. An example of RAN is naming sets of colors, letters, digits, of about 50 items, timed.
fMRI studies have also shown that in dyslexic children cortical processing in these areas is deficient (when compared to non-dyslexic children) and that dyslexic children show activity in the right inferior frontal gyrus and other areas in the right cerebral cortex, during reading. These areas of increased activity are felt to be probable compensatory processes that occur in dyslexic children.
Forming letters with the lips or tongue is a common remediation technique for dyslexic persons. It is thought to be effective because it stimulates the left anterior cortical areas that are felt be involved in phoneme awareness and articulation.4
4. Dyslexia is not a vision based-disability
Dyslexia was identified by Oswahld Berkhan in 188117 The term dyslexia was first used by an ophthalmologist from Stuttgart, Germany, Rudolph Berlin, in 1887 He used the term “dyslexia “to refer to “Particular Kind of word Blindness” in the case of a young boy who had a severe impairment in learning to read and write despite showing typical intelligence and physical abilities in all other respects. A similar scenario was published by Dr. W. Pringle Morgan in the British Medical Journal on November 7, 1896.17
It became commonplace to correlate dyslexia or “word blindness” with eye problems.
However, early on it became clear that reading and learning were a function of the brain and not the eye or the ocular motility apparatus.18 This was first and best described by an ophthalmologist of the Glasgow Eye Infirmary, Dr. James Hinshelwood. Dr. Hinshelwood published a case of “acquired alexia” in a highly educated 58-year-old man, a teacher of French and German, who suddenly woke up one morning unable to read his students’ papers. He was able to read numbers down to Jaeger 1 and had no problem with performing mathematics calculations. “There was no lowering of his visual acuity.”17 This report prompted other physicians to publish their studies including Edward Jackson of Denver, Colorado.18
It became clear that even though the problems were visual in nature, in most cases there was nothing wrong with the eyes.
Early anecdotal publications in the optometric literature in the 1950s reported a possible oculomotor deficit that disrupted the normal saccadic reading pattern. In contrast, many studies subsequently have demonstrated that ocular coordination and motility are normal in children with dyslexia.19-22
Reading does not use smooth pursuit, it uses saccadic (jumping-type) eye movements that are short-duration and high-velocity. Reading uses both forward (rightward in English) saccades (85% of saccades) and backwards or regression (leftward in English) saccades (15% of saccades). Scanning a line of text requires both right and left saccades.
The saccade length is dependent on the ability to recognize letters, the length of the word before the saccade, and how well the text was understood. Experienced readers use longer saccades of approximately 2 degrees or 8 letters of average size print text.23 Backwards saccades are used for verification and comprehension and increase with the difficulty of the text. They are also used to jump to the next line. Visual perception is suppressed during the saccade. Visual information is perceived during foveal fixations or pauses lasting approximately 200 msec, which constitute 90% of our reading time. The duration of a fixation varies with the difficulty of the text.
Both early readers and dyslexic readers use shorter forward saccades, more backwards saccades, and fixate for longer periods of time. The saccadic pattern progresses toward the adult pattern as typical readers or dyslexic readers improve their reading. Strong research has revealed that the eye movement differences found in dyslexic readers are secondary to difficulties with attention, decoding, and comprehension, not a cause of their reading problems. In summary, saccadic dysfunction is not a cause of dyslexia.
It is also critical to understand that eye movement problems are not related to dyslexia nor do they cause dyslexia. The vast majority of children who have dyslexia do not have any problem with “eye tracking” and the vast majority of patients with eye movement problems (nystagmus, Mobius Syndrome, cranial nerve palsies, or oculo-motor apraxia/saccadic initiation disorder) do not have dyslexia.
A child who skips words or lines, or who has difficulty with fluent reading may be thought to have a “tracking problem.” But “reading tracking” (fluent reading) has nothing to do with “eye tracking” (saccadic function). Children may lose their place while reading and skip words and lines because of language processing difficulties. These language processing difficulties cause them to struggle to decode a letter or word combination, have poor reading comprehension, or have difficulties with memory or attention. Difficulties with fluent reading are the result of dyslexia, not the cause of the reading problem.
People with dyslexia do not see things backwards. Difficulty maintaining proper directionality has been demonstrated to be a symptom, not a cause of reading disorders. Contrary to popular belief, the primary sign of dyslexia is not reversing letters, rather it is a difficulty sounding out words and, secondarily, having poor spelling.
Research has shown that vision problems do not cause dyslexia and vision problems are not more common in dyslexics.24 Eye and vision problems including high refractive errors, poor vision, nystagmus, abnormal pursuits or saccadic eye movements, difficulties with "crossing the midline" of the visual field, CI, AI, strabismus, amblyopia, reduced stereopsis, binocular instability, or a magnocellular deficit do not cause or increase the severity of dyslexia. No consistent relationship has been demonstrated between visual perception and academic performance or reading ability. Dyslexia is no more frequent in children with significant eye movement disorders than in the general population.25
Summary: Historically, dyslexia was thought to be a vision-based disorder. Vision problems can interfere with the process of reading; however, vision problems are not the cause of dyslexia. Although vision is important for seeing print, the brain must be able to interpret what it “sees” in order to read. Reviewing the last 50 years of scientific evidence has shown that differences in language processing in the brain are the cause of dyslexia. In conclusion, dyslexia is a neurobiologically based language problem, not a vision problem or a problem with intelligence.
5. Dyslexia is a language-based disability
Reports of “word blindness” and dyslexia continued to be published, all with a similar clinical picture, namely; healthy patients with a normal eye and neurological examination, normal cognitive reasoning skills, and average or above average intelligence.
Samuel Orton was an American neurologist (1935) who noted that these patients had a common finding, namely none of them could break words down into their phonetic subsets. He felt that this was an inherited trait that involved the temporal lobe and was not associated with any brain damage or congenital defect. He felt it was a neurological problem. However, he felt that the best people to treat this condition were teachers. These teachers were trained in multisensory remediation techniques involving all of the 5 senses to help establish phonemic awareness by teaching the children how to sound out and identify words and how to spell them accurately along with practicing reading. The teacher he enlisted to promote these methods was his associate, Anna Gillingham and the methods they developed is called the Orton-Gillingham method of education. This method and updated modifications remain as the cornerstone of educational efforts for the remediation of dyslexia.26
Dyslexia is a language processing disorder that causes difficulties with multiple language skills that leads to problems learning to read. Struggles with decoding typically result from a difficulty identifying the individual speech sounds within words, called a phonological deficit. It is often unexpected in children who otherwise possess the intelligence, motivation, and education necessary for accurate and fluent reading. The phonological deficit found in children with dyslexia makes it very difficult for them to learn and use phonics, because they have trouble associating the sound with a letter. These children typically have problems with speech perception27 and have poor verbal short-term memory.
To decode a written word, the sounds must be broken apart. The goal of learning phonics is to enable beginning readers to decode new written words by sounding them out. Without phonics, children with dyslexia cannot break the alphabetic code to decode, or sound out, words and use that skill to spell or encode words. Poor spelling occurs because people with dyslexia have trouble recalling the sounds that the letters make and consequently have difficulty forming memories for spelling words.
Trouble with sounding out words (decoding words) and inaccurate word recognition are the primary difficulties. Many children with dyslexia also have trouble with "Rapid Automatized Naming," leading to a "double deficit."
These challenges can result in problems with reading fluency, comprehension, spelling, and writing. Students with dyslexia must expend more attention, concentration, and energy on the task, which makes reading unpleasant, tiring, and difficult. Because children with dyslexia tend to read less, they often have reduced growth in their vocabulary and background knowledge. Another predictor of dyslexia is poor vocabulary.
Children with dyslexia often have trouble with reading comprehension because of slow and inaccurate decoding. Most have average comprehension when listening. But, comprehension is not a marker of dyslexia, as it is currently defined. Approximately 10% of children with reading disabilities show decreased comprehension in the absence of decoding or word recognition problems.
6. Associated disabilities and problems
There are a number of associated conditions that may occur with dyslexia. Some of these conditions include:
a. Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common mental health disorder of childhood, its incidence is nearly 10%. Children with ADHD may demonstrate inattention, distractibility, hyperactivity, impulsivity, and delayed executive functions. Similarly to dyslexia, some people have mild ADHD and others have more severe attention regulation difficulties. It is a separate condition from dyslexia, but the combination of ADHD, especially the inattentive type, and dyslexia is frequent. Approximately 20% to 40% of people with dyslexia also have ADHD and vice versa.28
ADHD is not a learning disability, but especially the inattentive type can interfere with learning and can profoundly affect academic achievement. Many children with ADHD have language problems and difficulties with word reading. Sometimes, the symptoms of ADHD are difficult to distinguish from a learning disability. Psycho-educational testing is very important in identifying the presence or absence of these two conditions. Accurate identification requires proper history, testing, and knowledgeable analysis.29,30
Children with ADHD have impaired executive functioning. Executive functions consist of several mental skills that help the brain organize and act on information. These skills enable people to plan, organize, remember things, prioritize, pay attention and get started on tasks. They also help people use information and experiences from the past to solve current problems. Children with imperfect executive functioning have difficulty with any task that requires planning, organization, memory, time management, and flexible thinking. Children with learning disabilities typically have problems with one or more executive skill.30
Treatment of ADHD includes medications, behavioral modification, or a combination of the two. Enhanced attention may contribute to improvement in the child’s reading and overall performance in school.30
b. Auditory processing disorder - Auditory processing disorder is an oral language disorder. It is a condition that affects the brain’s ability to process auditory information. It is considered a “listening disability.”
Below are important terms concerning auditory processing:
Auditory processing refers to how the brain perceives and interprets sound information.
Auditory Analysis (also called phonological awareness) - the ability to identify, blend, separate, and manipulate sounds in words. This skill is vital for reading.
Auditory Sequencing - the ability to remember the order of sounds and words
Auditory Memory - the ability to remember and retain auditory information
Auditory Comprehension - the ability to follow directions, understand conversation and stories.
There is research that suggests that auditory processing deficiency could be the primary deficiency in dyslexia.27 Reading may be affected by auditory processing difficulties, because these difficulties undermine the development of phonological and phonemic awareness required for decoding. Reading is a language skill that requires accurate phonemic awareness (to be able to break down words into individual sounds) and then phonics (to recognize the sounds in print). In addition to weak phonological awareness skills and decoding difficulties, these children may have impaired auditory, and secondarily, reading comprehension. These children may also struggle with articulation, vocabulary, grammar, and syntax, further impairing reading ability.30
A child who has auditory processing difficulties may have difficulty listening in class, causing a struggle to maintain attention. These symptoms may cause these children to be diagnosed with inattentive ADHD. Therefore, it is important to include psychoeducational evaluation, to detect auditory processing problems, in the evaluation of children with suspected attention problems.30,31
c. Specific Language Impairment (SLI) is delayed or disordered oral language development that is not due to an underlying condition (such as hearing loss). Spoken language may be immature and receptive language ability may also be impaired. A high percentage of these children will have problems learning to read.
d. Dysgraphia or writing disability is the learning disability most frequently associated with dyslexia. Many of these children have poor fine motor skills. Children with dysgraphia may experience difficulties with handwriting, drawing, or copying. The Helveston Dyslexia Screen emphasizes the relationship between fine motor skills and dyslexia by having children copy letters and draw a bike.32
But dysgraphia is more than poor handwriting. Many of these children have problems encoding language leading to difficulties with spelling, organizing sentences and paragraphs, and putting their thoughts on paper.
e. Dyscalculia or math disability is the disability associated with difficulties learning to count, estimate, remember math facts, solve arithmetic problems, grasp higher math concepts, and tell time, as well as visuo-spatial difficulties or other issues. Some children with dyslexia also have dyscalculia.26
But other children with dyslexia have good math computational skills yet may experience difficulties with math word problems because of the language component associated with math word problems.
f. Dyspraxia or Developmental Coordination Disorder (DCD) is the disability associated difficulties with planning and coordinating gross or fine muscle movements, understanding visuo-spatial relationships, or oromotor coordination. These children may have trouble planning, completing, or automatizing motor skills. This may make balance, posture, sports, handwriting, or speech difficult.
g. Right-Left confusion - This is a common finding in dyslexic persons and it continues throughout life. Using memory schemes or strict protocol applications involving laterality may be helpful.26
h. Psychological and emotional problems - Untreated or poorly treated dyslexia may lead to frustration, low self-confidence, and poor self-esteem. This substantially increases the risk of developing psychological and emotional problems such as anxiety, depression, or aggression. Dyslexia may also be associated with Oppositional Defiant Disorder (ODD) and Obsessive-Compulsive Disorder (OCD).
Parents should be sympathetic to the stress that their child is experiencing and should provide encouragement and emotional support. Additionally, parents and teachers should be aware that dyslexic children might be teased or bullied by others, further ostracizing them and exacerbating these issues. If any of these problems are suspected it is important to seek evaluation and treatment from your pediatrician, family physician, or mental health professional. Counseling, cognitive therapy, and/or medications may be very helpful.
7. Risk Factors for Dyslexia30
- Family history of dyslexia
- Fetal exposure to drugs or alcohol
- Birth problems, premature birth, or low birth weight
- Neurologic problems
- Hearing or speech problems
- Exposure to toxins (lead)
- Severe head injuries
- Other chronic health problems
If there is a family history of reading disability, a child’s early language development and performance in pre-school and elementary school should be carefully monitored and problems addressed. While signs of dyslexia are typically more noticeable once a child begins school, there are some early indicators that parents and teachers might observe even in pre-school.
8. Signs of Possible Dyslexia30
- Developmental delays
- Hearing, language or speech problems
- Difficulty learning the names of colors, shapes, letters, and numbers
- Difficulty with rhymes
- Mispronouncing or mixing up words
- Searching for words
- Difficulty with memory
- Difficulty learning right from left
Early Elementary School Students:
- Difficulty learning the names of the letters
- Trouble connecting letters to their sounds
- Confusing or substituting words
- Difficulty decoding (sounding out) single words
- Making consistent errors
- Using the pictures in the book to “read”
- Not reading at the expected grade level
- Slow reading
- Dislike of reading
- Reversals of letters or words after 2nd grade
- Trouble with reading comprehension
- Trouble copying
- Poor or erratic spelling
- Frustration with schoolwork and homework
- Schoolwork and homework takes a much longer time than expected
- Reluctance to go to school
- Problems with attention
- Reading below grade level
- Slow reading
- Numerous reading errors
- Avoidance of reading – especially out loud
- Persistent difficulty decoding/sounding out new words
- Persistent difficulty with sight word recognition
- Difficulty understanding prefixes, suffixes, and root words
- Difficulty with non-literal language (jokes, idioms, poetry, proverbs, slang)
- Trouble with reading comprehension
- Poor or erratic spelling
- Difficulty learning a foreign language
- Poor recall of facts
- Trouble with math, especially word problems
- Difficulty with writing
- Difficulty with planning, organizing and time management
- Difficulty telling time
It is important to note that these signs and symptoms are indicators and not proof of dyslexia. The only way to diagnose dyslexia is through appropriate comprehensive testing.
Physicians, teachers, and parents, need to learn the signs and symptoms of possible dyslexia. Surprisingly, educators may have many of the same misconceptions about dyslexia as the general public. Importantly, many teachers do not know that dyslexia is a learning disability that affects language, and that phonemic awareness is impaired more than any other ability. Many teachers incorrectly look for letter and word reversals to identify dyslexia when they should be looking for problems sounding out words and spelling.
9. Early detection of dyslexia30
Dyslexia is most often identified in the primary grades, but in some children it may not be identified until middle or high school, when more complex reading and writing skills are required. In early elementary school, some of these children can compensate by using other strengths until the educational demands increase, making the reading disability more evident. Many of these children have tried to hide their reading difficulties and have relied on their very strong memory, background knowledge, and other strengths. Unfortunately, these “late emerging” reading disabilities often go undetected by schools.
Teachers are in a position to identify reading problems before they worsen significantly. School and state policies that delay identification and intervention are a financially “penny-wise but dollar-foolish” approach for schools and devastating for the students.
Reading screening tests should be performed on all students in the early elementary grades. These tests are used to locate poorly performing students who may be “at risk” for reading difficulties, before they turn into reading failures. In the elementary grades, screening assessments should ideally be performed early in the school year, repeated mid-year and at the end of the school year. These assessments can predict many of those who will have difficulty learning to read. Children who are found to be “at risk” for reading difficulties can be given extra assistance in an intervention program, which can lead to improved reading performance.
Reading Screening Assessment Components30
Pre-kindergarten and Kindergarten Assessments:
- Names of the letters and numbers
- Sounds associated with the letters
- Rapid naming of objects
Kindergarten and 1st Grade add:
- Reading of one-syllable words
2nd grade and beyond add:
- Decoding of new words
- Reading fluency
10. Evaluation for Dyslexia30
Dyslexia is a clinical diagnosis that requires formal testing. The Individuals with Disabilities Education Act allows parents to request evaluation for "Specific Learning Disability" at their local public school (even if their child attends private school); alternatively the testing can be conducted privately outside of school.
Testing should be used to make the correct diagnosis of the specific type of learning disability and comorbid conditions in order to prescribe the proper therapeutic regimen. Comprehensive evaluation of the causes of a child’s reading difficulty can be performed by clinical or educational psychologists, neuropsychologists or developmental pediatricians, with familiarity with dyslexia and its evaluation and assessment. These clinicians can also determine whether there are comorbid conditions, such as ADHD or other psychological issues, which might also interfere with a child's reading. Assessment limited to answering the question of whether the child has dyslexia can be performed by many reading/dyslexia specialists, educational therapists, or speech-language pathologists, again assuming they are properly trained in dyslexia and its assessment.
Family history and personal history are important components in the evaluation. There is no single standardized test to identify dyslexia. The group of tests that are selected by the evaluator will vary according to the age of the individual and the presenting problems.
Most children with dyslexia demonstrate evidence of a phonologic deficit and may also show problems with rapid naming, or other deficits.
Once testing is performed, a learning profile will be developed by the psychologist. This will give the parents and the teachers an objective description of the child’s learning strengths and weaknesses. A formal Individual Educational Plan (IEP) can be developed by the school system.
11. Early Intervention30
The importance of early intervention cannot be stressed enough. Like amblyopia treatment, the earlier treatment begins the better the chance for a successful long-term outcome. Teachers are in a position to identify reading problems before they worsen significantly. So, it is extremely important that teachers understand dyslexia and its early signs.
Students whose dyslexia is identified and addressed in kindergarten and 1st grade have approximately a 90% chance of improving to grade level. At-risk kindergarten students can often be helped with 30 minutes of intervention a day, while intervention takes much longer for older students. Children identified after 3rd grade have only a 26% likelihood of improving to grade level. It is important to identify and treat children before they leave 3rd grade to have the best chance at academic success, however, it is never too late.
12. Education and the U.S. Law30
Important federal laws protect students’ rights and provide for special instruction and services. The Individuals with Disabilities Education Act (IDEA), the Individuals with Disabilities Education Improvement Act (IDEIA), Section 504 of the Rehabilitation Act, the Americans with Disabilities Act (ADA) and the Americans with Disabilities Act Amendments Act (ADAAA) define Specific Learning Disabilities and the rights of students with them. (If you would like more information on this topic see A Parent's Guide to Dyslexia by AAPOS - available at www.AAPOS.org.)
13. Treatment of dyslexia30
In educational terms dyslexia is a "disability," in medical terms it is a "disorder," but it is really not a disease, it is a condition. Dyslexia is a condition which can be treated and improved but it cannot be cured.
Knowledgeable and skilled teachers are essential for the instruction of children with dyslexia. Until recently, most college programs that train elementary education teachers have given minimal courses in language structure, reading theory, reading development, signs of dyslexia, and methods of teaching students with dyslexia. In 2010 the International Dyslexia Association developed a guide for colleges to prepare and certify the professional development of those who teach reading called "The Knowledge and Practice Standards for Teachers of Reading."
Some college programs for elementary education teachers are now beginning to incorporate this training. Teachers who understand reading development, and the signs of dyslexia, can assist in early identification. Educational therapists or educators who have been specially trained in reading disabilities can develop and implement intervention plans for children with dyslexia.
Since dyslexia is a language-based disorder, th e educational treatment should target language development. Children with dyslexia need language explained in patterns that are logical, explicit, systematic, and multisensory. Remediation needs to be tailored to address individual student skill deficits that were detected on the educational evaluation.
Programs for children with dyslexia should be individualized, structured, intensive multi-sensory instruction with daily practice with a specially trained reading teacher or an educational therapist. These programs must continue long enough to have a lasting positive effect. Multisensory learning involves the use of visual, auditory, kinesthetic, and tactile pathways simultaneously, in order to enhance memory and learning of written language.
Children with dyslexia require more intensive instruction. They should have the full 90 minutes of language instruction in the regular classroom plus 60 minutes of extra instruction. These programs must continue long enough to have a lasting positive effect, a minimum of 2 years.
These children need to start with explicit training in phonemic awareness and then instruction in the direct connection between sounds and letters (phonics). The International Dyslexia Association calls programs that include explicit, systematic, multi-sensory, and evidence-based instruction in the reading skills and the structure of language the "Structured Literacy Approach."
Training in the Reading Skills:
- Phonemic awareness
- Fluency Training (including daily practice reading aloud)
- Vocabulary Building
Plus: Writing and Spelling
Instruction in the Structure of Language:
- Morphology (analysis of word parts)
- Syntax (grammar)
- Semantics (analysis of meaning)
- Pragmatics (interpretation of language in social contexts).
For early elementary school children with dyslexia, remediations are very important, while accommodations become increasingly important for students in middle school and beyond. Because people with dyslexia continue to read more slowly than others throughout life, accommodations can allow access to higher-level thinking and reasoning skills for learning and testing.
Accommodations change the manner or setting in which information is presented or the manner in which students respond. Accommodations may be instructional in nature, or adaptations to the testing process or environment.
Important Accommodations Include:
- Extra time
- Computers or other technology
- Recorded books
- Text-reading software
- Testing alternatives (eg, verbal testing)
- Special quiet room for testing
- Preferential seating
Modifications actually change the curriculum by changing or reducing instruction or testing. They generally decrease learning expectations. Parents need to understand that if modifications are below grade level standards, the child may be at risk for not meeting graduation requirements, and may interfere with obtaining a high school diploma.