Sheryl M. Handler, M.D.
Reading is the ability to decode and comprehend written symbols. While speaking is a natural process reading and writing are not natural or easy for many students, especially for those with dyslexia. For most children the very complex process of learning to read requires years of active teaching. Learning to read is a sequential process; each new skill builds on mastering the previously learned skills. The sequence consists of gaining decoding skills, fluency, comprehension and the final step is storing the information in memory.
Initial difficulty in learning to read occurs in nearly 40% of students in the U.S. Reading difficulties are the most common cause of underachievement and academic failure. Difficulties in early reading may have a number of different causes including deficits in spoken language skills, lack of background knowledge, inadequate instruction, insufficient reading practice, or a true reading disability or reading disorder called dyslexia.
Many parents become concerned when they notice that their child is struggling to remember letters, words, or how to read and spell. Parents often experience additional frustration because schools may not identify the problem early or provide extra help to improve it. This article is designed to provide a general understanding of reading disability, the terminology, basic strategies, resources and support to help parents of children with dyslexia.
A learning disability is a life-long disorder affecting the way the brain processes information. It results from a difference in the way a person's brain is "wired." People with learning disabilities may have difficulty with the way they receive, understand, remember and communicate information. Millions of children struggle in school because of inborn differences in learning and are often misunderstood by the adult world.
The term learning disability is a generic term that includes dyslexia (reading disability), dysgraphia (writing disability), and dyscalculia (math disability). Dyslexia and dysgraphia frequently co-exist. Dyscalculia is an under-recognized condition and recent research on the topic has been increasing.
Dyslexia - reading disability
Dyslexia is one type of learning disability. Dyslexia is often an unexpected reading difficulty in a child or adult who otherwise has adequate intelligence, motivation, and schooling. Dyslexia refers to a cluster of difficulties with language skills resulting in problems with decoding, word recognition, reading fluency, pronouncing words, spelling and writing. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.
In order to obtain services at school it is important to use the terminology "dyslexia," "reading disability" or "learning disability" rather than “learning differences” or other terminology.
Dyslexia - background
Dyslexia is the most common learning disability. As many as 1 out every 5 people or 20% of children in the U.S. have dyslexia. Dyslexia can vary from mild to severe. It occurs in boys slightly more than in girls. But boys are diagnosed significantly more often than girls, perhaps because they tend to “act out” when they are unable to do a task properly while girls tend to try to become "invisible" in the classroom.
It often runs in families. Approximately 40% of siblings, children, or parents of an affected individual will have dyslexia. 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. Because it is a language processing problem unrelated to intelligence, it is often unexpected in an otherwise bright child. Dyslexia does not represent a transient developmental lag; it is a life-long condition. Some dyslexics will learn to read words accurately but often continue to have problems with reading fluency or comprehending as efficiently as unimpaired readers throughout life.
Dyslexia is NOT caused by a vision problem
Although vision is important for reading, the brain must be able to interpret what it sees in order to read. It may seem easy to blame dyslexia on the eyes, but dyslexia is caused by the brain, not the eyes. Currently, the scientific evidence does not show that subtle eye or visual problems (abnormal focusing, jerky eye movements, misaligned or crossed eyes) cause or increase the severity of dyslexia. Furthermore, no consistent relationship between visual function and academic performance or reading ability has been shown. Children with learning disabilities do not have more visual problems than children without learning disabilities. Visual problems may co-exist with dyslexia but appear to be present with the same incidence as in the general population.
When a teacher notices that a student has problems with writing or fluent oral reading the teacher may believe that the child has a vision problem. However, dyslexia is not due to a visual disorder. Problems with reading fluency are not based on problems with "eye tracking." Children with dyslexia often lose their place while reading because they struggle to decode a letter or word combination, lack comprehension, or have difficulties with memory or attention. The apparent “tracking abnormality” is the result rather than the cause of the reading problem. That is why vision therapy does not work for this population; the eyes are not the problem!
Dyslexia is caused by difficulties in language processing
Dyslexia is a language-based learning disability, not a vision-based disorder. The brain learns to read the same way it learns to talk, one sound at a time. Contrary to popular belief, the primary sign of dyslexia is not reversing letters; rather it is a difficulty interpreting the sound components of our language.
Scientists have found that distinguishing and separating the sounds in spoken words is fundamental to learning to read. Some important terminology on this topic: phonological awareness is the ability to hear individual sounds, manipulate them and remember the order of the sound, phonemes are the smallest units of sound in words that signal differences in meaning ("bat vs. "cat"), phonemic awareness is the understanding that speech can be segmented or broken into individual sounds that signal differences in meaning, whereas phonics is the understanding that segmented units of speech can be represented by printed forms.
Phonological awareness is important in learning to read because unless children are able to hear the individual sounds, they have difficulty rhyming words, blending sounds to make words, or segmenting words into sounds. A person with dyslexia typically has trouble understanding written words because of a problem processing the sound structure in spoken speech, a phonological deficit. Young children may show the first signs of this deficit when they are learning to speak. Developing phonemic awareness is not automatic, because phonemes are not separated in speech. To decode a written word, the sounds must be broken apart.
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 phonemes. Children with dyslexia encounter great difficulty learning phonics because they have trouble associating the sound with a letter, their phonological deficit makes it very difficult to learn and use phonics. 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. Adding to the challenge, the relationship between letters and sounds is inconsistent in the English language. All of these problems can make reading a mystery to children with dyslexia.
Recent brain scan research has provided strong scientific evidence demonstrating that the brain of a person with dyslexia is "wired" differently even before they start to read. As compared with typical readers, children with dyslexia use a different area of the brain for processing written words. This alternative pathway has trouble retrieving the sounds in spoken words making it difficult to read.
The primary problem for most children with dyslexia is that the phonological deficit causes weak decoding skills and secondary difficulties with spelling. Spelling problems, like reading problems, originate with language learning weaknesses and not visually-based problems. Poor spellers have trouble remembering the letters in words because they have trouble noticing, remembering, and recalling the features of language that those letters represent. That is also why reversals are common.
Dyslexics may also have difficulty identifying and naming letters or objects rapidly. They have difficulty with rapid word retrieval and memorization. Their sight word recognition may be impaired and may never become automatic. Attention or memory problems can further interfere with sight word memorization and automatic fluent reading. All of these difficulties cause slow decoding speed, decreased decoding accuracy and insufficient sight word vocabulary, which in turn leads to difficulty reading with enough fluency to comprehend sentences.
Dyslexia often coexists with other developmental difficulties and disabilities. Children who are found to have problems in one area of academic achievement often have problems in other areas.
Children with dyslexia may experience difficulties with language skills such as pronouncing words, spelling and writing. Children with poor spoken language skills in kindergarten often become poor readers. Although children with spoken language difficulties show an increased likelihood of dyslexia, most dyslexic children have good spoken language skills and vocabularies. Unfortunately, because children with dyslexia tend to read less, their vocabularies may not increase as much over time as typical readers.
Dysgraphia (writing disability) is the learning disability most frequently associated with dyslexia. Children with dysgraphia may experience difficulties with handwriting, spelling, or organizing and putting their thoughts on paper.
Children with dyslexia may also encounter difficulties with math when they are presented math problems as a "word problem."
Children with dyslexia frequently struggle when learning a foreign language.
Some children with dyslexia may also have associated difficulties with motor coordination (dyspraxia) or fine motor skills which often makes handwriting difficult.
Problems with attention, concentration, executive function, and memory (especially verbal working memory) greatly impact dyslexia. Many people with dyslexia have difficulties with executive functioning, which governs your ability to plan, organize and manage time and details. The combination of attention deficit disorder (ADD/ADHD) and dyslexia is frequent. ADD/ADHD is a separate condition from dyslexia, but, approximately 20-40% of people with dyslexia also have ADD/ADHD and vice versa.
The extra amount of work expended by dyslexic readers combined with the frustrations of failing to achieve meaningful comprehension makes reading unpleasant, tiring, and unrewarding. Students who cannot read well tend to read less and this negatively impacts their reading fluency, vocabulary, comprehension and concept knowledge. Dyslexic children may also be teased or bullied by others. Dyslexia can damage a child’s self-image development and cause emotional problems such as withdrawal, anxiety, depression or aggression. Dyslexia can also be associated with and complicated by oppositional defiant disorder (ODD), obsessive compulsive disorder (OCD), anxiety, or depression. If any of these associated problems are suspected, early evaluation and management is recommended.
Myths about dyslexia
Oversimplifications and misconceptions pop up often, despite ongoing efforts by many dyslexia associations to dispel dyslexia’s myths.
Myth # 1: Dyslexia does not exist.
Fact: Dyslexia is a specific neurological learning disability. It is one of the most researched and documented conditions that impacts children. fMRI brain scans have made dyslexia a "visible" disability.
Myth #2: Dyslexia is rare.
Fact: Dyslexia impacts 1 out of 5 people or 20% of the population in the United States. It is the most common reason that a child will struggle with spelling, reading and writing. Dyslexia can vary from mild to severe. Regrettably, many students with milder dyslexia will never officially be diagnosed or be given appropriate help. Severe dyslexia will qualify a student for special education, special accommodations and/or extra support services at school. But, only a small group of people with dyslexia will have it severe enough to be eligible for an Individualized Education Program (IEP) while most of the people with dyslexia will not qualify and may "fall through the cracks."
Myth #3: Individuals with dyslexia "see" letters upside down or backwards and that dyslexia is a result of a visual error that causes letter or word reversals.
Fact: People with dyslexia do not see things backwards. They actually view text the same way you and I do. Many early readers and writers exhibit reversals of letters or words and mirror writing. Children with dyslexia are not more prone to reversals at this early learning stage, but the problem may persist in children with dyslexia beyond the time at which it usually clears in children with unimpaired reading. Reversals may be related to insufficient memorization of similar or mirror-image shapes like b and d or p and q and the difficulties recalling the features of language that those letters represent. Letter and word reversals and skipping words have been demonstrated to be a symptom, not a cause, of reading disorders. They have been shown to result from linguistic deficiencies rather than visual or perceptual disorders.
Myth #4: Smart people cannot be dyslexic.
Fact: Dyslexia reflects a very specific difficulty with reading and occurs in people with low, normal and high IQs alike. Children with dyslexia are not "dumb" or "lazy," their brains just process information differently. They are often very bright, analytic, creative and gifted in other areas. Many people with dyslexia have a very high ability to reason and understand ideas and concepts.
Myth #5: Dyslexia can be outgrown.
Fact: Dyslexia is a lifelong issue. Due to the false hope that early difficulties will be outgrown, parents often wait a year or more after they first notice that their child is experiencing learning difficulties before they request assistance. Unfortunately, waiting is the worst thing to do since during the delay a child will often fall further behind making treatment more difficult. Early intervention and support can really make a difference for your child. Many dyslexics can develop greatly improved reading skills with early, effective and scientifically-based reading interventions.
Risk factors for dyslexia:
Family history of dyslexia
Birth problems, premature birth, or low birth weight
Fetal exposure to drugs or alcohol
Infections of the central nervous system
Exposure to toxins (lead)
Severe head injuries
Other neurological problems
Early signs and symptoms of possible dyslexia in pre-school children:
Hearing, language or speech problems
Difficulties with rhymes
Mispronouncing or mixing-up words
Searching for words
Difficulty learning the names of colors and shapes
Difficulty learning the names of letters and numbers
Signs and symptoms of possible dyslexia in early elementary students:
Difficulty learning letters
Trouble connecting letters to their sounds
Difficulty decoding/sounding out single words
Making consistent errors
Not learning to read as expected
Using the pictures in the book to "read"
Dislike of reading
Reversals of letters or words after 2nd grade
Trouble with reading comprehension
Frustration with schoolwork and homework
Not wanting to go to school
Problems with attention
Signs and symptoms of possible dyslexia in older students:
Reading below grade level
Many reading errors
Avoidance of reading - especially out loud
Difficulty decoding/sounding out new words
Difficulty with sight word recognition
Difficulty understanding prefixes, suffixes, & root words
Difficulty with non-literal language (jokes, idioms, proverbs, slang)
Trouble with reading comprehension
Poor recall of facts
Trouble with math word problems
Difficulty with writing
Difficulty with planning, organizing and time management
*It is important to note that these signs and symptoms are indicators and not proof of dyslexia. The only way to properly diagnose dyslexia is through comprehensive testing.
Teacher knowledge and preparation
Educators have many of the same misperceptions and lack of awareness of dyslexia as the general public. The majority of teachers incorrectly look for letter and word reversals to identify dyslexia. 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. Teachers, as well as parents, need to learn the signs and symptoms of possible dyslexia and that the severity of dyslexia can vary greatly. Teachers also need to understand that children who are smart can also have dyslexia.
This lack of knowledge exists because a "research-to-practice gap" is found in many areas of teacher training. Many teachers receive only a cursory introduction to reading instruction and often have not been exposed to the latest research. Currently, the majority of teachers have not been sufficiently prepared to prevent reading problems and they are not aware of the signs of dyslexia, which leads to delays in assessments and interventions. Additionally, general education teachers as well as many special education teachers may not be adequately prepared to instruct students with dyslexia and related reading problems.
Skilled teaching is the key to success for students with dyslexia. Teacher preparation programs in colleges and continuing education programs should include information on language structure, reading theory, reading development, reading problems, the early signs of possible dyslexia and reading assessment. Currently, teachers are often licensed without acquiring this knowledge.
In many states the teachers who have been trained in science-based reading intervention programs are improving reading scores. But, more work needs to be done in educating professionals who work with elementary age students who have dyslexia. In 2010 the International Dyslexia Association (IDA) created a Knowledge and Practice Standards to serve as a guide for educators.
The role of schools in preventing reading problems
Scientific progress in education and reading research needs to be translated into useful educational policy. Strong educational research has demonstrated how to revise the language curricula to teach early readers. Providing explicit and systematic reading instruction is the key to teaching all early readers and lessening the impact of reading disabilities. Explicit instruction means that children are not expected to infer key skills or knowledge Struggling dyslexic students are more likely to be successful when teachers demonstrate and clearly explain what they need to learn. If early confusions are not addressed and foundational skills are not mastered, it is likely that students will fall further behind. With appropriate reading and writing instruction in the early grades, all but the most severe reading disabilities can be prevented or greatly reduced and students can be placed on track toward success.
For beginning readers in pre-school and kindergarten, explicit instruction in phonemic awareness is the best educational prevention for reading and writing problems for all children. Unfortunately, most schools do not teach explicit phonemic awareness and phonics despite years of educational research.
It would be wise if states allocated incentives and resources for effective preschools. School resources should be allocated for smaller class size in the early elementary grades. In-service training needs to be provided for teachers to be educated in language structure, language and reading development, teaching using research-based reading programs, and for early identification and intervention of reading problems. Schools need to appreciate that early intervention is a cost-effective solution to improving reading skills. Delaying identification and intervention is "penny-wise but dollar-foolish" financially for schools.
Children enter kindergarten with tremendous individual differences and diverse learning needs. Entering students have large differences in spoken language skills, reading skills, background knowledge, the way they learn, the amount of repetition that they need, and the speed at which they learn. Students who enter kindergarten knowing how to read need to have their educational needs met also and start at a higher level. It is not wise to let these children become bored while the others catch up. Appropriate curricula and effective teachers recognize that every student learns differently so both the content and methods of the teaching needs to adapt to this. The curriculum should have a versatile design to attend to these variables rather than attempting to teach uniformly. Schools and teachers need to embrace these individual differences to benefit all children.
The role of parents in preventing reading problems
Your involvement in your children's education is very important to their academic success. You are your child's first teacher. It is extremely important for you to talk a lot to your child even before they can speak to you as good spoken language development is a prerequisite for successful reading. Children's vocabulary is a direct response to the amount of words that they hear. The size of their vocabulary at age 3 is strongly correlated to their spoken language ability, reading ability and reading comprehension at the end of Grade 3. Children who enter school with good vocabularies are years ahead of those with smaller vocabularies.
As parents, you can help to prevent many reading difficulties by actively participating in your child's learning process. You can have fun reading books with rhymes to your children starting when they are young. When reading to young children it is very helpful to exaggerate the sound of the rhyming words to develop your child's important awareness that words can rhyme. You can pull apart the sounds in the words, exaggerate them and blend them back together, such as "bbb-aaaa-tt" for "bat." You can also help by pulling apart words into their syllables and putting them back together, such as "tea/cher." Later you can work with your children to learn the names of the letters, recognize and print the letters, and then learn the sounds of the letters. Children whose parents read and worked with them enter kindergarten educationally ahead of those whose parents didn't work with them.
You should also let your kids know that school is important and continue to be their "teacher." Children should read to you as soon as they are able to help them practice this important skill. School and teachers do not provide a child's complete education, so it is essential that you continue to be actively involved with your child's reading and learning even after school starts.
Early identification and early treatment
You may be the first one to realize that your child is having trouble. It is important for you to be aware of the risk factors and common early signs of dyslexia so that you can identify potential reading problems as early as preschool or kindergarten
If dyslexia is in your family, if your child was premature, had birth problems, has neurologic problems, or developmental delays his language and reading development should be monitored carefully. The earliest actual clues to dyslexia may involve delayed spoken language. Once your child begins to speak, look for difficulties with pronunciation or rhyming.
A child who is not performing at his or her level in spite of proper instruction may be dyslexic or have other problems interfering with learning. If your child struggles repeatedly in school or is frustrated with learning or homework over a period of time, the possibility of dyslexia should be considered.
Children who are identified early can be treated early and early intervention can be very powerful! At-risk kindergarten students can often be helped with 30 minutes of intervention a day while intervention takes much longer for older students. Students whose dyslexia is identified and addressed in kindergarten and 1st grade have approximately a 90% chance of improving to grade level. Prevention and early phonemic awareness intervention programs in kindergarten through 2nd grade can increase reading skills in most poor readers to average reading levels. It is important to identify and treat children before they leave 3rd grade to have the best chance at academic success, but it’s never too late. Students with dyslexia who are identified later may learn to read accurately, but, they continue to read slowly with less fluency and comprehension throughout life.
So, don't wait if your child is struggling! Be proactive! The sooner you address your child’s struggles, the sooner you can take steps to seek an evaluation from a school or an outside specialist. If your child is struggling you should keep careful records, talk to your child's teacher, find out how the process works at your school, find out what your school can do or is doing for your child, know your rights, and ask in writing for an evaluation. After your child is evaluated, help support can be provided before he or she fails.
Involve your pediatrician or primary care physician
Your pediatrician or primary care physician can serve a number of important functions for children with dyslexia and their families. The pediatric well-child exam gives your pediatrician an opportunity to assess your whole child. Early developmental screenings may identify early language or learning concerns. If your child has suspected learning difficulties, your pediatrician or family physician can determine whether there is a history of prematurity or birth problems, a family history of speech and language problems or dyslexia, and then assess for medical problems that could affect your child’s ability to learn. The evaluation will include vision screening, hearing screening, growth charting, determination if your child has chronic medical problems that may have caused school absences, evaluation for ADD/ADHD, autism spectrum disorder, anxiety, depression or other problems.
Your pediatrician or primary care physician will refer your child, if necessary, for further medical, psychological or educational evaluations. A formal learning evaluation can be performed by school psychologists or outside specialists. Your physician may be able to give you a resource list of informational websites and books or local specialists to assist you. Your pediatrician may also be able to serve as an advocate within the school system, ensuring that your child gets the appropriate services to which he/she is entitled.
If your child does not pass vision screening, if anyone suspects that your child has a possible visual problem or if your child has any visual complaints he or she should be referred to a pediatric ophthalmologist for further evaluation.
Screening to find at-risk students
You or your preschool teacher can use screening tools such as the Get Ready to Read Screening Tool for pre-kindergarteners to determine whether they have the early literacy skills they need to become readers. This can be found at www.getreadytoread.org/screening-tools/grtr-screening-tool.
In the school system, appropriate recognition and treatment of dyslexia is the responsibility of teachers and all educators. School screening tests should be performed to locate students "at risk" for reading disorders before they turn into reading failures. In the elementary grades, screening assessments should ideally be performed early in the school year and repeated during the year. These assessments can predict many of those who will have difficulty learning to read.
Screening assessments in pre-kindergarten and kindergarten should look for difficulties learning the names of the letters and numbers, the sounds associated with the letters and rapid naming of objects. Assessing the ability to write the letters of the alphabet in kindergarten can predict many of the children who will have trouble writing. In kindergarten and 1st grade your child’s ability to read common one-syllable words and spelling should be measured. In 2nd grade and beyond difficulties with fluent reading and decoding new words should be evaluated.
Dyslexia is most often identified in the primary grades, but in some children, it may not be diagnosed until later during 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. Late emerging reading disabilities often go undetected by schools.
Many schools wait until a student is showing persistently poor academic achievement ("wait-to-fail approach") before being referred for a formal educational evaluation. Unfortunately waiting for failure decreases the chances of interventional success.
Response to Intervention - RTI
In some states, your child may be placed directly into an educational intervention program, "Response to Intervention" (RTI), when he or she first experiences academic difficulties. In RTI, struggling learners are provided with high quality instruction, interventions tiered at increasing levels of intensity to accelerate their rate of learning, along with ongoing assessments. If your child does not respond well to supplementary instruction, your child will undergo an evaluation for learning disabilities. But, you may request a formal evaluation in writing anytime during the RTI process.
Ideally, this approach will allow earlier and more effective identification and treatment than the traditional method in which your child must show persistently poor academic achievement for a few years before referral, assessment, and remediation. But, there is only a small amount of evidence currently supporting RTI and many researchers have concerns. Some of these reservations include unclear guidelines of entrance into RTI, how to treat children with multiple problems, how to choose the intervention without an evaluation, how to determine whether programs are effective and what to do for instruction after a child fails to respond. In contrast to the “wait to fail approach” RTI may "watch a child fail."
Important federal laws concerning learning disabilities
The Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act, and the Americans with Disabilities Act (ADA) define the rights of students with specific learning disabilities. Federal law requires public schools to evaluate any child who is thought to have a learning disability and to provide treatment and special services if the child qualifies based on the degree of deficit present. IDEA allows parents to request a formal educational evaluation by the school district to determine eligibility for special education and related services. Either you or your child’s school can request such an evaluation, but it can only be conducted with your written consent.
IDEA guarantees each student a free appropriate public education tailored to his or her individual needs. IDEA also provides funding for special education services. Special education is instruction that is specially-designed to meet the unique needs of a child with a disability. It is provided to you at no cost. In each case, the individual educational needs of the child should be addressed in the least restrictive environment possible. In the least restrictive environment, students have the opportunity to stay with their peers, create bonds and maintain friendships.
Under IDEA, a “child with a disability” is one who is eligible for special education and related services. Eligibility for special education is determined by the Individualized Education Program (IEP) team. If your child is eligible, then an IEP plan will be written. The IEP document must list specific learning goals. The IEP plan should identify the different instructional methods or other treatments that are expected to be most beneficial as well as the nature and intensity of services to be provided. In addition to remedial education, accommodations and modifications in academic requirements may be written into the IEP contract.
The IEP team will meet with you to discuss the testing and provide you a written report. After there is agreement the IEP contract must be signed by the school professionals and you before it can be implemented. The IEP will be reviewed on an annual basis and, if necessary, revised for the next school year. Addendum IEPs can be held if issues in the initial IEP need to changed or modified during the school year. Every 3 years, your child will undergo comprehensive reevaluation.
Generally, only students with severe dyslexia will qualify for an IEP. It is important to know that many struggling students with a learning disability will not show severe enough difficulties on evaluation to receive a diagnosis of a "disability" as defined by IDEA and will not be eligible for special education and related services. Even if your child does not qualify for an IEP, the information uncovered during the evaluation may be used to make changes that may help your child. So, it’s still important for you to continue to work with the school psychologist and his or her teacher to ensure that the evaluation findings are used to implement changes.
In this case your child will continue with the instruction given in the regular classroom. But if he/she still needs targeted reading or other assistance to be able to participate fully in school your child may be a candidate for a 504 plan. A 504 plan is used to provide a child equal access to education. A 504 plan can be written that describes the areas of difficulty and lists the accommodations that will be provided in the regular classroom. Also, your child's teacher may provide reading assistance or accommodations in the classroom even without a 504 plan.
Academic accommodations and modifications can be implemented to help students with dyslexia succeed. Accommodations change the manner or setting in which information is presented or the manner in which students respond. Because people with dyslexia have a persistent problem and continue to read slowly throughout their life, it often becomes necessary to adapt the learning environment. Accommodations make it possible for students with dyslexia to show what they know without being impeded by their disability and allow access to higher-level thinking and reasoning strengths. Dyslexia robs a person of time and the accommodation of extra-time returns it. Examples of accommodations include using a computer or other technology, text reading software, recorded books, note-takers, spell-checkers, grammar-checkers, extended time for test taking, special quiet room for testing, testing alternatives, preferential seating, or special services such as after-school tutoring.
IDEA includes the National Instruction Material Accessibility Standard (NIMAS). NIMAS stipulates that all textbooks must be available not only in regular print but also as a digital "source file" that can be transformed into other formats such as: digital talking books, audio books, large print books and others. These formats and other assistive technologies are often very helpful for children with dyslexia. Learning Ally (www.learningally.org) formerly called Recording for the Blind and Dyslexic provides downloadable audio-books. Learning Ally currently has a collection of more than 70,000 digitally recorded textbooks and literature titles that are downloadable and accessible on mainstream as well as specialized assistive technology devices. Bookshare (www.bookshare.org) is an accessible online library for people with dyslexia and other disabilities. Over 160,000 titles are available, and membership is free for students with qualifying disabilities.
Unfortunately, the reality for students and their families may be different than the ideal. Without an IEP students with mild to moderate dyslexia often do not receive enough remediation at school to alleviate their difficulties. Even if a child has a 504 plan, busy teachers may not be able to fully implement the recommended remediations and accommodations. So, in some circumstances you may need to continually advocate for your child so that accommodations are maintained in school. In some cases you may want to consider seeking educational interventions outside school.
In addition, there are variations between federal and state laws. In some states, these variations leave room for some local school districts to not recognize dyslexia as a specific learning disability and allows a gap in services and resources needed by students with dyslexia.
Evaluation for dyslexia
Many different professionals can conduct an evaluation for reading disability. The testing can be conducted by trained school or outside specialist. The professional should be experienced and have knowledge in the clinical assessment of cognitive and learning disorders. The evaluator should possess expertise in reading theory, reading problems, and be able to make recommendations for reading interventions.
Family history and personal history are important components in the evaluation. The three basic steps of the evaluation include: establishing the existence of a reading problem according to age and education, gathering evidence of its “unexpectedness” compared with learning capability, and demonstrating evidence of a phonologic weakness.
Individuals may be tested for dyslexia at any age. The group of tests that are selected will vary according to the age of the individual and the presenting problems. Dyslexia is not diagnosed solely by IQ testing. Testing will include critical underlying language skills that are closely linked to dyslexia. These include receptive listening skills; receptive written language skills, expressive language skills; expressive written language skills, phonologic skills, including phonemic awareness; alphabet knowledge and rapid naming of letters and names; vocabulary; reading accuracy; fluency; and comprehension. A student’s ability to read lists of words in isolation, as well as words in context, should also be assessed. Evaluation of memory, attention, intellectual ability, information processing, executive skills, linguistic processing and academic achievement are also included.
A psychoeducational evaluation is a series of tests performed to gain a better understanding of your child's strengths and weaknesses, severity of the problem, recommend specific interventions for your child and to determine your child's eligibility for special education and support programs
A more comprehensive evaluation by a behavioral pediatrician or neuropsychologist can be considered if your child has not been making progress after a previous psychoeducational evaluation, diagnosis and interventions or has other medical or neurological problems. A neuropsychological assessment addresses many issues outside of the range of a school psychoeducational exam. It focuses on educational issues as well as on a broader assessment of brain function. The evaluation goes beyond the "numbers" to assess a child's approach to the task. It is an in-depth look at how a person thinks and learns in order to identify the underlying causes of the disorder and to make diagnoses.
Behavioral pediatricians and neuropsychologists can determine whether your child's learning problems may be related to other disorders such as attention deficit hyperactivity disorder (ADD/ADHD), affective disorders (anxiety, depression), central auditory processing dysfunction, pervasive developmental disorders, or physical or sensory impairments. This testing can also distinguish whether attentional or emotional issues contributes to or results from the learning difficulties.
After the testing is completed the evaluator should discuss the testing with you and provide you a written report. The discussion and evaluation report should include a description of your child’s unique combination of strengths and weaknesses and specific recommendations for treatment. The evaluation will provide a road map on which evidence-based interventions and accommodations are based.
If you obtain an independent educational evaluation on your own and it meets the school’s criteria, those results and recommendations must be considered by the school's IEP team. But, the IEP team would need to determine whether the disability and its severity qualify your child to obtain special education and related services in school.
Treatment of dyslexia
Dyslexia makes it very difficult for a student to succeed academically in the typical instructional environment. Because dyslexia is a language-based disorder, the educational treatment should be directed at this problem. Children with dyslexia require teaching beyond the conventional methods.
Children with dyslexia learn best in small groups of 2 - 5 students who are at the same level. Programs for children with dyslexia should be individualized, structured, intensive instruction with daily practice with a specifically trained skilled teacher or an educational therapist. Children with dyslexia should have 90 minutes of language instruction in the regular classroom plus 60 minutes of extra instruction. These programs must continue long enough to have a positive effect that will endure.
Speech therapists can evaluate and treat underlying oral language difficulties that are often associated with dyslexia. Most successful programs for individuals with weak phonological processing focus on strengthening the brain's ability to analyze the sounds that make up words through a structured, sequential, explicit and multi-sensory interventional program. Teaching should be carefully sequenced so that easier skills are taught before more difficult skills. Multisensory learning involves the use of visual, auditory and kinesthetic-tactile pathways simultaneously to enhance memory and learning of written language.
There are many reading programs based on similar multi-sensory language principles of instruction. The International Dyslexia Association website lists many programs. Although some programs have a higher success rate than others, there is not a single program that works for all students with dyslexia. That is because learning disabilities vary significantly in severity and in pattern and because each child has his unique combination of strengths and weaknesses.
Children with dyslexia can benefit most from individualized instruction teaching the 5 reading skills of phonemic awareness, phonics, fluency, vocabulary and comprehension plus writing and spelling.
Importantly, the spoken code needs to be understood before children can progress to the written code. Children should be taught awareness of rhymes and how to identify phonemes in words. In kindergarten both phonologic and phonemic awareness should be taught before alphabet and phonics instruction begins, otherwise, the phonics instruction will not make sense to the dyslexic child. Phonics is the understanding that segmented units of speech can be represented by printed symbols. The sound-symbol association must be taught and mastered in two directions: auditory to visual and visual to auditory. Children need be taught to break apart words and to blend sounds into words. Students need to be specifically taught what to do when they get to a hard word. These programs also emphasize the writing system (orthography), the architecture of words and word parts (morphology), sentence structure (syntax), word or phrase meaning (semantics), and grammar.
Fluency is the ability to read quickly and accurately with good comprehension and proper expression. Fluency training can be performed at school and at home. Practice in oral reading, not silent reading, improves reading fluency. Oral reading provides greater direct feedback to the child and an opportunity for the child to receive guidance and corrections. Corrections will allow the reader to not make the same mistakes repetitively. In the classroom, reading can be practiced with the teacher and extra training can be gained using peer tutoring routines. Practicing reading aloud is essential because the brain learns best by practice, and practice is the key to learning to read. Repetition is an important element in developing decoding skills and a large number of sight words.
Most elementary schools recommend that children read aloud 20 minutes daily to their parents. Struggling readers tend to avoid this practice but they actually need to practice much more. You can assist your child with learning to sound out words and decode, spell and with reading practice. You can help to build reading fluency by having your child read out loud daily using books that are easy and fun to read. You should help your child find books on topics that they want to know about. Older children may want to read newspapers or magazines.
You can actively participate with your child in guided oral reading by using paired reading and repeated reading techniques. In guided oral reading you should help your child develop decoding skills and make corrections as necessary. In paired reading, you read a passage to your child, followed by you and your child reading the same passage together a few times, and then your child reads the passage a few times to you. In repeated reading, your child reads and re-reads passages until they become competent with the material. When you read together you can talk about it together.
You can also help your child work on memorizing sight words on flash cards. Large vocabularies help children become strong readers. On average a child's vocabulary grows by 3000 words a year. You can aid vocabulary development by emphasizing new words, discussing the word's meaning and relevance and by encouraging your child to use the new word.
Children need to read fluently to be able to gain comprehension. Children with dyslexia can become frustrated by the fact that they can understand what they hear but not what they read. You can also help with comprehension by encouraging your child to ask questions and become an active listener then an active reader. Listening comprehension generally develops faster than reading comprehension because reading comprehension is a more complicated process that depends on understanding oral language, decoding the printed word, reading fluently, vocabulary, background knowledge and using active reading comprehension strategies simultaneously. Techniques enhancing active reading comprehension include prediction, summarization, visualization, critical thinking, making inferences, and drawing conclusions.
Children also need to undergo instruction in spelling, handwriting and written expression.
Students with dyslexia must get the intensive instruction, academic modifications and classroom accommodations that they need so they can have access to a better future. These have been discussed previously.
Students with severe dyslexia will qualify for an IEP and be eligible for specialized intensive intervention by a reading specialist outside of the regular classroom but at least part of your child's program may include being mainstreamed in the regular classroom. Also, most children with mild to moderate dyslexia will be ineligible for special education services and will be dependent on the information given to the teacher and the instruction given in the regular classroom. Unfortunately, many general education teachers may not have the training or experience to assist students with dyslexia but they are expected to provide interventions or make modifications so the student has access to curriculum and meets the standards.
If you believe your child needs an intensive specialized program outside of school, specialized reading clinics that focus on reading disabilities are preferable to a commercial learning center. Programs designed for the struggling non-dyslexic reader may not benefit the dyslexic student.
Part of the long-term solution may be hiring an outside educational therapist or experienced specially-trained tutor. A regular tutor generally does not have the training necessary to provide the remediation that a child with a learning disability requires. An educational therapist or specially-trained tutor can utilize the information obtained from your child's psychoeducational or neuropsychological evaluation to work on individualized interventions designed to remediate learning problems, use your child's strengths to overcome or compensate for areas of weakness, develop alternative strategies for problem solving, teach strategies for organization and time management, and may reduce or eliminate homework-related tensions.
To find educational therapists or specialized tutors you can ask your school, teacher, friends or pediatrician for a recommendation. You can also go to the websites of major learning disability organizations including the International Dyslexia Association at www.interdys.org. To find an educational therapist you can go to the website of the Association of Educational Therapists at www.aetonline.org. It is important to examine the background, special training, certification and experience of the professional, and whether they use a multi-sensory approach to teach reading. It is also important to determine how the tutor interacts with your child, works with your child's teachers and the school system, and whether your child's teacher is willing to work with the tutor. If you are unable to find a tutor or educational therapist near your home you may want to evaluate one-on-one tutoring on-line. One example of this is Lexercise that provides on-line reading and writing help using Orton-Gillingham methods at www.lexercise.com.
It is recommended that new specialized tutors trained in any of the multi-sensory language approaches have 100 hours or more in a supervised practicum. You can go to the website of the International Multisensory Structured Language Education Council website at www.imslec.org that accredits training programs or to the Academy of Orton-Gillingham Practioners and Educators at www.ortonacademy.org that accredits training programs and certifies individuals in the Orton-Gillingham approach.
The International Dyslexia Association cautions parents who are looking for instructors, clinicians, schools and programs to be very thorough in their review of programs and services that claim to treat dyslexia or "cure" dyslexia. It is important to be a wise consumer because in this era of internet advertising, claims are frequently made about therapies and treatment programs that have little or no scientific merit. Claims about the effectiveness of some widely advertised programs and/or their components may be unsubstantiated by objective independent research, and the practitioners of those programs and methods may not have met customary standards for training in the field.
Technology is also very important for the child with dyslexia. Everyday new applications and technologies are developed. These applications and technologies have expanded options for individuals with dyslexia and learning disabilities. Some of these options include: computers, text reading software, recorded books, e-books and e-textbooks, digital talking books, audio books, large print books, note-takers, spell-checkers, grammar-checkers, and voice recognition software.
Medications or counseling can be used to improve concentration problems and other conditions such as anxiety or depression. Improved attention may contribute to improvement in your child's reading and overall performance in school.
Vision therapy and colored lenses and filters are NOT helpful for dyslexia
Unfortunately, unproven, ineffective interventions and other treatments are widely available and directly marketed to the public. Vision therapy is based on the belief that reading problems can be benefited by eye exercises. However, there is no evidence to support the effectiveness of this therapy for dyslexia. Because visual problems do not underlie dyslexia, approaches designed to improve visual function by training are headed in the wrong direction. There is no evidence that the use of training glasses, eye exercises, behavioral/perceptual vision therapy, or colored lenses and filters improves the long-term educational performance in children with dyslexia. There is no valid evidence that children participating in vision therapy are more responsive to educational instruction than children who do not participate in it or that Irlen, Wilkins or ChromaGen lenses are helpful in the treatment of dyslexia. In fact, there is scientific evidence against the usefulness of eye tracking/binocular vision exercises, vision therapy and colored lenses or filters in dyslexia. The use of vision therapy and tinted lenses contradicts all of the evidence that demonstrates that reading skills depend on language-based processes, such as phonological awareness.
Using ineffective, controversial methods of treatment may give parents and teachers a false sense of security that a child’s reading difficulties are being addressed. They also waste family and/or school time and resources, and may delay proper instruction or remediation.
Should I get my child's eyes evaluated if he/she is having difficulty in school?
It is appropriate for a child with reading difficulties to have a thorough eye examination by a pediatric ophthalmologist to ensure that there are no eye or vision disorders. Visual problems occur in 5 - 10% of early elementary students and up to 25% of high school students. Some struggling children may have a visual problem that masquerades as a learning problem or they may have a treatable visual problem along with their primary learning problem. Treatable ocular conditions include misaligned or crossed eyes, amblyopia or "lazy eye", convergence insufficiency or abnormal focusing, and a nearsightedness or farsightedness. A need for glasses may make it difficult to see the board or to read. Many of these conditions can be treated with glasses and generally will show benefit very quickly. Convergence exercises should be considered in children with symptomatic convergence insufficiency. Most of the children treated with exercises will improve in a few weeks to a few months.
Parents may experience many frustrations
Knowing your child is smart but not be able to read or remember seemingly simple things
Difficulty understanding the laws and navigating through the process at schools
Schools are not identifying all struggling students.
Some schools do not diagnose "dyslexia"
The student's difficulties are not severe enough to qualify for evaluation and/or for extra help
Inadequately prepared teachers
Large class size overwhelms teachers so that they are unable to help struggling students
Parental inability to help their child
Difficulty finding appropriate outside specialists
Hardship paying for outside specialists
Slow progress for some students
Parents can do a lot!
Talk to your infant and child
Have books at home
Read to your child daily - help your child develop a love for reading
Determine whether your child has any risk factors for learning disabilities
Determine whether there is a family history of learning difficulties or disabilities
Monitor early language development
Watch for signs and symptoms of learning disabilities
Help your child learn to sound out words, learn sight words, spelling, and vocabulary development
Have your child practice reading out loud daily
Participate with your child with paired reading and repeated reading and learning sight words
Gather and organize information about your child's academic development and progress
Go to the websites listed below to learn about learning disabilities
If your child is experiencing academic difficulties do not wait and see
Ask for an educational evaluation
Involve your pediatrician for a physical exam
Understand the laws and available services
Work with and communicate with your child's school and teachers
Learn about evidence-based reading instruction
If your child is diagnosed with dyslexia
Monitor that he/she is placed in an intensive reading program
If your school's program falls short consider additional outside educational therapy or tutoring
Be proactive - become your child's advocate
Insist on accommodations such as extra time
Reassure and encourage your child
Provide emotional support to help your child stay positive about school
Help your child develop positive problem solving and coping skills to avoid stress
Provide activities where your child can excel because there's more to life than school
Help your child be a self-advocate
Your involvement is crucial for your child's academic success. You can help your child with learning disabilities achieve success by encouraging his or her strengths, knowing his or her weaknesses, understanding the educational system, working with teachers and other professionals, learning about and using alternative strategies for dealing with specific difficulties and spending time working on all aspects of reading.
The gift of dyslexia - dyslexic thinking
Dyslexia is viewed as a gift by some. It certainly does a child with dyslexia a disservice to only view him or her only from the perspective of having a disability. Dyslexia is not an intelligence disability. Differences in brain organization not only give rise to slow reading, they also generate a "new ability" sometimes called "out-of-the-box thinking." People with dyslexia are often very bright, analytic, creative and gifted in other areas. Many people with dyslexia have a very high ability to reason, understand ideas and concepts and are often excellent at solving problems in a novel fashion. Dyslexics tend to learn by understanding the big picture or the overall idea or meaning first, and then fill in the specific details. Dyslexia tends to be a weakness in language decoding surrounded by higher level cognitive strengths such as reasoning, spatial reasoning, analytical critical thinking, problem solving, general knowledge and even vocabulary. Dyslexics are often high achievers because they have learned to persevere through adversity.
Scott Adams - creator of "Dilbert"
Orlando Bloom - actor
Richard Branson - founder of Virgin Records & Virgin Airways
John Chambers - CEO of Cisco
Cher - actress
Tom Cruise -actor
Walt Disney - founder of Disney
Whoopi Goldberg - actress
Bill Hewlett - co-founder of HP
Bruce Jenner - Olympic gold medalist
Steve Jobs - co-founder of Apple
Magic Johnson - basketball player
Keira Knightley - actress
Jay Leno - host of the Tonight Show
Paul Orfalea - founder of Kinko's
Charles Schwab - creator of Schwab Brokerage
Steven Spielberg - film director, screenwriter, producer
Ted Turner - founder Turner Broadcasting Systems
Vince Vaughn - actor
Henry Winkler (The Fonz) - actor, director, and writer of children's books for dyslexic children
And many others
Did they or didn't they have dyslexia? They probably did.
Alexander Graham Bell
Leonardo da Vinci
Interesting insights on dyslexia:
People with dyslexia are found in every profession, including law, medicine, science, design and the arts. Dyslexics also run many successful businesses where they can play on their strengths and get around their weaknesses in reading and writing. Dyslexics may be drawn to start their own businesses since the corporate world doesn't always value their strengths.
Betsy Morris, the author of a 2002 Fortune Magazine article on Overcoming Dyslexia, stated that "If you could survive childhood, dyslexia was a pretty good business boot camp. Having dyslexia fostered risk taking, problem solving, and resilience. School was a chess game that required tactical brilliance."
In the same article the president of Maker's Mark said, "Many times in business, different is better. We dyslexics do different without blinking an eye."
Dyslexia is a language-based reading disability. There is no “cure” for dyslexia. It is life-long. Children with dyslexia can be taught strategies to work with their learning disability. With early detection, the right help and hard work children with dyslexia can and do learn successfully. There is no quick and easy solution for helping you negotiate the complex challenges that comprise the lives of children with learning disabilities. Similarly, there is no single preferred approach when it comes to meeting the educational and behavioral needs of children with dyslexia. Working together, parents, in partnership with members of the medical and educational communities, can formulate and oversee a prescription for success.
Skilled teaching in the early grades can prevent or limit the severity of reading and writing problems. Early identification and proper intensive treatment are the keys to successful intervention. Students with dyslexia must get the intensive instruction, support, and interventions they need so they can have access to a better future. Because many students with learning disabilities receive most of their instruction in general education class, teachers should be trained on the instructional strategies essential to success for these students. Children with dyslexia benefit most from individualized instruction in reading, including decoding, fluency training, vocabulary and comprehension; daily practice reading aloud; and classroom accommodations. Accommodations are critical to allow access to higher-level thinking and reasoning strengths.
Early identification, treatment and support of individuals with dyslexia will allow them the potential to experience success and high achievement in life. It is important to look at your whole child rather than focus on isolated weaknesses. Your child has many abilities and strengths and it is important to look for them, encourage and expand them because we all succeed on our strengths!
For more Information:
International Dyslexia Association www.interdys.org
Learning Disabilities On Line www.ldonline.org
National Center for Learning Disabilities www.ncld.com
Great Schools (Schwab Learning) www. greatschools.org
Learning Disabilities Association of America www.ldaamerica.org
Council for Learning Disabilities www.cldinternational.org
The Yale Center for Dyslexia & Creativity www.dyslexia.yale.edu
Dyslexia Help - University of Michigan www.dyslexiahelp.umich.edu
Dyslexic Advantage www.dyslexicadvantage.com
All Kinds of Minds www.allkindsofminds.org
Reading Rockets www.readingrockets.org
Get Ready to Read www.getreadytoread.org
American Speech-Language-Hearing Association www.asha.org
Study Dog www.studydog.com
Barton Reading & Spelling System www.BartonReading.com
Association of Educational Therapists www.aetonline.org
Intl Multisensory Structured Lang Ed Council www.imslec.org
Orton Academy www.ortonacademy.org
Learning Ally www.learningally.org
U.S. Department of Education www.ed.gov
What Works www.whatworks.ed.gov
Quackwatch (eye related quackery) www.quackwatch.com
1. Overcoming Dyslexia: A New and Complete Science-Based Program for Overcoming Reading Problems at Any Level - Sally Shaywitz, M.D., New York, NY, Knopf; 2003.
2. A Mind at a Time - Mel Levine, M.D., New York, NY, Simon and Schuster; 2002
3. The Misunderstood Child - Understanding and Coping with Your Child’s L.D. - (4th Ed) - Larry Silver, M.D., New York, NY, Three Rivers Press; 2006
4. Beyond the Label: A Guide to Unlocking a Child’s Educational Potential - Karen Schiltz, Ph.D., Amy Schonfeld, Ph.D., Tara Niendam Ph.D., New York, NY, Oxford University Press; 2012
Dyslexia Toolkit - National Center for Learning Disabilities available at: http://www.ncld.org/images/content/files/Dyslexia_101_E-Book.pdf
The International Dyslexia Association has a recommended reading list for parents at:
The National Center for Learning Disabilities has a recommended reading list for parents at:
The International Dyslexia Association has a recommended reading list for children and teens at: http://www.interdys.org/ewebeditpro5/upload/RecommendedReadingforChildrenandTeens.pdf
The National Center for Learning Disabilities has a recommended reading list for parents at:
Learning Disabilities, Dyslexia, and Vision -2009 Policy Statement
Joint policy statement of the American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, & American Association of Certified Orthoptists
Learning Disabilities, Dyslexia, and Vision 2011 Technical Report
Joint report of the American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, & American Association of Certified Orthoptists Pediatrics 2011;127:e818–e856
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