Hearing the diagnosis of dyslexia is often a frightening and disheartening experience for a parent. Visions of years, perhaps a lifetime of struggles with literacy are often in the minds of parents when they are told that their child is dyslexic. While many dyslexics continue to suffer with this condition throughout their lives, there are remediations available, both formal programs offered through schools, like the Wilson Reading System and others, as well as private, reading interventions offered by individual,licensed literacy professionals.
Here in the New York area, the New York Branch of the International Dyslexia Association is a 501(C)(3) non-profit, scientific and educational organization dedicated to the study and treatment of the learning disability, dyslexia. The Branch was formed to increase public awareness of dyslexia in New York State, excluding Buffalo and Suffolk County. This branch of the association has been serving individuals with diagnosed dyslexia, their families and professionals in the field of reading disability in this area for nearly three decades. Easily accessible through an online search by name, the association, is located at 71 West 23rd Street, and the phone number is 212-691-1930. Contact email is [email protected] The Association is extremely helpful in guiding parents, and in answering questions in a thoughtful, supportive manner.
But just what is dyslexia? And if your child is suffering with difficulties in reading, is it possible that there are other issues at play, and what else might they be? Let’s take a look at the issues surrounding reading difficulty.
Watching your child learn to read is one of those childhood events that all parents look forward to- with both excitement, but also, often, some anxiety. For some, the process is smooth and occurs early, during the years before Kindergarten even begins. But for others, the proverbial “lightbulb” does not turn on easily, or at all, even as little ones begin the journey into elementary school. Unfortunately, approximately 20% of children 6 and above struggle to learn how to read. So how are parents to know exactly what the problem might be, and how best to navigate the possible roads to finding the appropriate remediation for your slow-reader, or non-reader, once he has entered school?
The first and most important issue is to obtain a correct diagnosis for what is behind your child’s difficulty with reading. A thorough screening by an ophthalmologist to rule out any organic eye issues would be the first step. Attention to possible vision difficulties, which can be addressed by a visit to an optometrist, who will measure your child’s vision, and prescribe corrective lenses, and then an optician who will make the actual glasses would be the next stop. Young children rarely realize that their vision is not clear, and often parents do not either.
Another consideration when reading difficulties arise, involves a child’s visual skills, or the actual ability for the eyes to work effectively in the reading process. Should your child’s ophthalmologist and regular optometrist give you a perfect evaluation, the next consultation might be a special type of optometrist, called a Developmental Optometrist. This professional is trained to diagnose and provide vision therapy for children who are found to be suffering from a variety of other possible difficulties in their visual skills. These might include Eye Teaming Problems, also known as convergence insufficiency, where the ability to aim the eyes breaks down, and eyes point slightly different places on a page, resulting in blurred, scrambled or double print. Tracking problems, or the inability to control the fine eye movements required to follow a line of print, are sometimes present, and result in a child’s losing his place, skipping, or transposing words, and is a problem with the central and peripheral visual systems. These are kids who cannot control their eye movements at close ranges. Focusing, or Accommodation is other potential areas of deficiency when a child has difficulty with reading, and involves the child’s ability to maintain sharp, clear images for an extended time, as well as the ability to quickly change focus when looking from near to far (these children will often complain of headaches).
Difficulties with vision perception, or the ability to interpret, analyze and give meaning to what is seen, may be the problem for your child. Vision perception includes Discrimination (ability to attend to the characteristics of similar forms), Memory (the ability for immediate recall of material’s characteristics), Sequential Memory (the ability to remember characters in correct order), Spatial Relations (the ability to distinguish differences among similar forms), Spatial Orientation (the ability to process from left to right in English, or directionality, and up-down movement as well), Form Constancy (the ability to manipulate forms and visualize the resulting outcomes), Closure (the ability to visualize a complete whole when only given a partial picture), and Figure Ground (the ability to identify and locate a form on a busy background without becoming confused by the other images).
Finally, another visual skill which may be weak in a child with reading difficulty may involve visual motor- integration issues, or eye-body or eye-hand coordination. These problems would include difficulty with the ability to monitor and adjust placement of their bodies, allowing for good balance and coordination (gross-motor skills), or with the ability to coordinate visual input into the body’s fine motor system (fine-motor skills).
So what happens when barring any medical eye conditions, simple need for corrective lenses, or visual skill deficiencies, your child still has difficulty with reading?
The next step would be to consider an evaluation with a reading specialist (most schools have these trained professionals on staff), who is trained to administer tests of early phonological awareness. These tests assess your child’s ability to distinguish the phonemes, or individual sounds in words. One common test that you may have heard of that assesses a child’s ability to hear the sounds in words is a DIBELS (Dynamic Indicators of Basic Early Literacy Skills), created by Dr. Ronald Good and Dr. Ruth Kaminski, of the Dynamic Measurement Group, an internationally recognized research organization. The DIBELS will reveal difficulty in the area of phoneme recognition, in hearing, for example, the p-a-k-t sounds within the word “pact.” Difficulty or inability with a DIBELS task is a strong indicator of possible future reading disability. Another informal task that a parent can monitor is a child’s ability to identify and produce simple rhymes. Can your child hear that “house” rhymes with “mouse?” Can he tell you a rhyme for the word “cat?” The inability to attend accurately to this simple skill is very significant red flags.
In slightly older children, say grade two and up, informal reading tests are available in schools that measure a child’s reading fluency and comprehension. (These tests are actually available at the Kindergarten Level, but are generally not accepted to be as accurate as those administered after the age of about 8, in terms of providing data that might support future reading disability). The tests are simple, and the child is asked to read a passage, or a short book, and then to answer simple questions about the text. The child’s performance is then be compared to benchmark, or expected levels for children of the same age, and scores are interpreted, and a reading level is assigned to the child. Two common tests that are used with students to determine reading levels are a QRI (Qualitative Reading Inventory) and a DRA (Developmental Reading Assessment). Most schools prescribe to one of these tests to measure reading ability, but there are others.
When a child’s reading level is determined to be below benchmark, a closer investigation into potential problems is called for. Scores measure both decoding ability (fluency) as well as comprehension. If comprehension causes a lower reading score than would be expected, but reading fluency is average, the suggestion is that the child may need support in the area of comprehension. This would likely eliminate a possible diagnosis of dyslexia. But for those for whom fluency, or smooth, accurate reading (decoding) is weak, the next step would be a closer investigation into the reasons why. Could the problem be dyslexia? Not always. But since early difficulty with reading will very often be an indicator of future difficulty as the elementary years kick in, it is very important that a parent watch, and see how the process unfolds.
Just as in all areas of development, it is known that the ability to read is achieved over a period of time, and that the normal time frame is recognized to be fairly wide. There are precocious pre-schoolers that can identify letters and sounds and simple words at 3, and there are those for whom the ability to read fluently kicks in in first grade. Some children are late bloomers, and others are naturally slow readers (so are some adults, yet they are not dyslexic).
So just when should a parent be concerned that a child’s difficulty with reading may be more than simple developmental delay? For late bloomers, the observation is that although they may be slow to initially grasp the letter/sound correspondence, and to be able to accurately blend sounds into short, simple words, they do finally do so, and with consistency. They begin to recognize common, high-frequency English words (called sight words), and read them with accuracy. Significantly, these children move forward, albeit slowly, but always learning and improving, and most significantly, they do not experience the unexpected difficulties that are common to dyslexics.
When a child does not move forward with his reading ability, who simply “cannot get it,” for whom letters and their sounds never “gel,” parents and educators need to take a much closer look. Children who cannot seem to blend individual letter sounds, and despite much individual effort by teacher and parent, still cannot read the simplest words, and for whom spelling is a particularly difficult task, the possibility of dyslexia may be a real one.
Let’s look for a moment at exactly what the word “dyslexia” means. Generally, “dyslexia” refers to unexplained difficulties with sight-word recognition and or phonological processing. The word itself actually means “Difficulty with Words/Language.” The skills that are affected in dyslexia are performed by neurological centers at the back, left portion of the brain. Essentially, a diagnosis of dyslexia refers to the inability of the brain’s verbal language or auditory processing centers to accurately decode print or phonetically make the connection between the word’s written symbols and their appropriate sounds. In summary, it is a lack of marriage between the grapheme (written symbol) and phoneme (sound).
There are actually three types of dyslexia:
Dyseidetic Dyslexia, which is indicated when a child can’t read (decode) and/or spell (encode) because he is unable to remember whole, irregular sight words.
Dysphonetic Dyslexia, which is indicated when a child can’t read (decode) and/or spell (encode) because he is unable to break phonetically regular words down into its sound parts.
If a child can’t read (decode) and spell (encode) words either eidetically or phonetically, this is known as Mixed Dyslexia or Dysphoneidetic Dyslexia. This is the severest form of dyslexia because it involves both types of coding functions.
There is strong evidence that at least one type of dyslexia, “Dyseidetic Dyslexia,” is genetic, and that it is present equally in male and female children. In cases where a child may be having difficulty and either mother or father has diagnosed dyslexia, parents might choose to seek help at an earlier age. Dysphonetic Dyslexia is believed to be polygenic, meaning that it is not generally believed to be genetic. Some evidence indicates that this type of dyslexia may be associated with chronic otitis media (ear infections) before the age of 2; logically children who suffered from these infections as infants and are exhibiting reading weakness later on should be taken to a professional at a younger age.
Parents need to be very cautious when they are told that their child’s early reading struggles are just due to a developmental delay. Roughly 90% of children that struggle early on with reading will continue to struggle as they grow older, so close monitoring of the progress of these children is very important. Many of them will, in fact, eventually be labeled as dyslexic. It is important to remember that any of the visual skills problems we outlined earlier are NOT evidence of dyslexia by themselves- these issues are completely independent of such a diagnosis, and may co-exist with such a diagnosis. But dyslexia is a neurological deficiency in the language processing portion of the brain, not in the visual centers.
Some of the common symptoms that could (remember- only a licensed psychologist can make the diagnosis of dyslexia) indicate the likelihood of dyslexia would include:
1. unable to hear and/or produce rhymes
2. demonstrates confusion by letters and complex verbal explanations
3. reads with little comprehension, but has good listening comprehension
4. unable to spell correctly with consistency
5. demonstrates difficulty putting thoughts into words
6. mispronounces multi-syllabic words, and is unable to identify sight words
7. “thinks in images and feelings”, not words (missing inner monologue)
8. had frequent ear infections as an infant
9. cannot identify the individual phonemes (sounds) in words, or does so inconsistently
10. demonstrates little progress in reading, making errors, or the same mistakes over and over
11. demonstrates reading ability that is inconsistent with formally measured or observed intelligence
Remember, a diagnosis of dyslexia is not the end of your child’s success academically and otherwise. Early intervention is key, and our schools here in New York, and elsewhere are generally well-prepared to handle this type of disability. The New York Branch of the International Dyslexia Association (full information is above) is staffed with sensitive helpful professionals who will guide you to finding the support that you need. And throughout this process, when reading may become a sensitive topic in your home, and your struggling reader may become a reluctant one, con’t forget to try to keep them, as we reading people say “keeping their eyes on print.” Read to them frequently, enjoy that storybook hour before bedtime, (every night if you can), and don’t allow a diagnosis of dyslexia keep the pages from turning in your home.