{"id":2170,"date":"2014-08-14T08:51:58","date_gmt":"2014-08-14T08:51:58","guid":{"rendered":"https:\/\/www.dyslexiadaily.com\/?p=2170"},"modified":"2026-03-30T10:55:13","modified_gmt":"2026-03-30T10:55:13","slug":"what-is-dyslexia","status":"publish","type":"post","link":"https:\/\/www.dyslexiadaily.com\/blog\/what-is-dyslexia\/","title":{"rendered":"What is dyslexia?"},"content":{"rendered":"

\u2029Reference \u2029Dr.\u2029 Sally\u2029 Shaywitz,\u2029 Author\u2029 of\u2029\u2018 Overcoming\u2029 Dyslexia\u2019<\/strong><\/h3>\n

Developmental dyslexia is an unexpected difficulty in reading.\u00a0Unexpected refers to children and adults who appear to have all the\u00a0factors necessary to become good readers: intelligence, motivation,\u00a0and exposure to reasonable reading instruction – and yet struggle to\u00a0read. Here, for ease of communication. We will refer to\u00a0\u201cdevelopmental dyslexia\u201d as simply \u201cdyslexia\u201d; it is also referred to as\u00a0specific reading disability.<\/p>\n

Dyslexia<\/a>, first described over a century ago by a British physician, is the\u00a0most common and most carefully studied of the learning disabilities,\u00a0affecting 80% of all individuals identified as learning disabled.<\/p>\n

The Basic Facts About Dyslexia<\/strong><\/h3>\n

Who and how many are affected?<\/strong><\/p>\n

Similar to hypertension and obesity, dyslexia occurs in gradations. In\u00a0other words, within the population, reading ability and reading\u00a0disability occur along a continuum with dyslexia occurring in varying\u00a0degrees of severity. Dyslexia is perhaps the most common\u00a0neurobehavioral disorder affecting children, with prevalence rates\u00a0ranging from 5-20%. Support for the high prevalence of dyslexia comes\u00a0from the 2005 National Assessment of Educational Progress (NAEP)\u00a0data which indicate that only 31% of fourth graders are performing at\u00a0or above proficient reading levels. Sometimes, lower prevalence rates\u00a0are noted; these typically refer to the number of children with dyslexia\u00a0receiving services in public schools. Differences in prevalence rates\u00a0based on testing every child in a class for a reading problem\u00a0compared to data based on the number of children receiving special\u00a0education services were exemplified by the findings of the\u00a0Connecticut Longitudinal Study (CLS). The CLS, based on a population\u00a0representative of all children attending public kindergarten in\u00a0Connecticut, assessed reading and intelligence in each child in the\u00a0study and found that one in five children was dyslexic. This figure\u00a0contrasts sharply with data based solely on numbers of children\u00a0receiving special educational services, which is much smaller, about\u00a05%. Clearly, many struggling readers are not identified by their schools.<\/p>\n

Dyslexia affects just about as many girls as boys. It is used to be thought\u00a0that dyslexia affected primarily boys, and as a result, mainly boys were\u00a0identified; girls who were sitting quietly at their desks \u2013 and not reading\u00a0– tended to be overlooked. This reflects what is referred to as selection\u00a0bias. For example, in the CLS, not only was each child individually\u00a0tested, but the researchers also obtained data on which children were\u00a0identified by their schools as having a specific reading disability. While\u00a0comparable numbers of boys and girls were found to be dyslexic when\u00a0each child was tested, four to five times as many boys compared to\u00a0girls were identified by schools. Why? The data showed that teachers\u00a0tended to refer for further evaluation boys who were more active and\u00a0impulsive. In contrast, girls – who were not learning to read, but who\u00a0were perceived as behaving more \u201cproperly\u201d – were not identified by\u00a0their schools as having a reading problem. It seems teachers often\u00a0incorporate a \u201cnorm\u201d for behavior for both boys and girls that is more\u00a0typical of girls. As a result, boys who may be behaving on the higher\u00a0end of normal rambunctious behavior for boys, are considered to be\u00a0behaving poorly and referred for further evaluation.<\/p>\n

Does dyslexia ever go away?<\/strong><\/p>\n

Dyslexia does not resolve over time. Longitudinal studies indicate that\u00a0dyslexia is a persistent, chronic condition; it does not represent a\u00a0transient “developmental lag.\u201d The image below shows the trajectory\u00a0of reading skills over time in good and poor readers. The vertical axis on\u00a0the left is the reading achievement score from the Woodcock-Johnson\u00a0reading test, and the horizontal axis is the age in years. Both good\u00a0(upper curve) and poor readers (lower curve) improve their reading\u00a0scores as they get older, but the gap between the dyslexic and the \u00a0non-impaired readers remains.<\/p>\n

\"11\"<\/p>\n

The proven persistence of dyslexia is a critical finding: children who\u00a0present with reading difficulties early on must be helped immediately\u00a0rather than waiting in the belief that the reading difficulties are\u00a0temporary or that they will be outgrown. While dyslexia is not cured, it\u00a0can be helped greatly by early and effective, scientifically-based\u00a0reading interventions. (See below: Teaching Reading and Remediating\u00a0Reading Difficulties)<\/p>\n

The Cognitive Basis of Dyslexia<\/strong><\/h3>\n

Why do otherwise bright, motivated children struggle to learn to read?<\/strong><\/p>\n

Dyslexia reflects a very specific difficulty with reading and has nothing\u00a0to do with intelligence. In fact, understanding ideas and concepts are\u00a0often at a very high level in dyslexia as are other higher-level reasoning\u00a0skills. Dyslexia is a localized problem, one involving the sounds, and not\u00a0the meaning, of spoken language. Consideration of the differences\u00a0between spoken and written language provides a helpful\u00a0understanding of why some bright children struggle to read.<\/p>\n

First, let us consider spoken language. We, as humans, have beenspeaking for hundreds of thousands years; speaking is part of the\u00a0human condition. Everyone learns to speak, speaking is natural; simply\u00a0place a baby in a spoken language environment and that child will\u00a0learn to speak. No need to develop a spoken language curriculum for\u00a0babies.<\/p>\n

Reading is different, it is a relatively recent invention of man and many\u00a0societies still rely on speaking, rather than reading. In contrast to\u00a0speaking, which is natural and spontaneous, reading is artificial and\u00a0must be taught.\u00a0The question is: what must be learned in order to transform the printed\u00a0letters on the page to words that have meaning? Today, science has\u00a0provided the answer: the letters must be connected to something that\u00a0already has inherent meaning \u2013 the sounds of spoken language. And\u00a0so, in order to learn to read, children must learn how to link the printed\u00a0letters on the page to the sounds of spoken language. To do this, a\u00a0child must first develop the awareness that spoken words can be\u00a0pulled apart into their constituent parts; for example, that the word,\u00a0mat is made up of three underlying sounds \u2013 \u201cmmm,\u201d \u201caaaa,\u201d \u201ct.\u201d For\u00a0about 60-70% of children, this awareness develops readily by the age\u00a0of about six years. In contrast, another 30- 40% experience difficulty\u00a0noticing these basic sounds, called phonemes that make up all spoken\u00a0and written words.<\/p>\n

Try it yourself, for example, can you say the word \u201csteak\u201d without the\u00a0\u201ct\u201d sound? Answer: \u201csake.\u201d To do this, you had to pull apart the \u00a0Sounds-\u00a0– \u201csss\u201d \u201ct\u201d \u201caaa\u201d \u201ck\u201d — that make up \u201csteak\u201d and pull out the \u201ct\u201d sound\u00a0and then push the remaining sounds back together so that \u201csake\u201d\u00a0remains. These sounds, called phonemes (defined as the smallest unit\u00a0of speech that distinguishes one word from another) are the basic\u00a0building block of all spoken and written words. In English, there are\u00a0forty-four phonemes.\u00a0In speaking, a person utomatically goes to his\/her internal dictionary\u00a0and retrieves the appropriate phonemes that make up a word, orders\u00a0them correctly, and then utters the word. For most people, the\u00a0phonemes are clear and crisp, but for reasons yet unknown, in people\u00a0with dyslexia, the phonemes are less clear; they are fuzzy and less\u00a0distinct. And this has important implications for both speaking and\u00a0reading. In speaking, people with dyslexia sometimes retrieve a\u00a0phoneme that sounds similar to the one they intended; the result is that\u00a0a dyslexic sometimes intends to say one word but ends up saying a\u00a0word that sounds similar. For example, a child who is dyslexic was at a\u00a0ballgame where she became thirsty and asked her mother to take her\u00a0to the \u201cconfession\u201d stand. Of course, she meant, \u201cconcession\u201d stand\u00a0but pulled out — not the exact sound — but one that was very similar to\u00a0the sound she intended.<\/p>\n

This difficulty in spoken language is common in dyslexia; its practical\u00a0significance is that it provides a clue that a child may be at-risk for\u00a0dyslexia, even before she is expected to read. Such word confusions\u00a0are important clues for parents and teachers to be aware of, and to\u00a0recognize that they are sound-based and not meaning-based\u00a0mistakes. The person who is dyslexic knows the word s\/he wants to say,\u00a0but just has trouble pulling the correct sound out of his\/her internal\u00a0dictionary. Even in adults, such sound-based or phonological\u00a0confusions (derived from the Greek word \u201cphone\u201d meaning sound) are\u00a0often a clue that a person may be dyslexic.<\/p>\n

In reading, the importance of being able to pull apart the sounds of\u00a0spoken words and isolate individual sounds is that the individual sounds\u00a0of spoken words represent the links, the Velcro, on which to connect\u00a0the letters in words. If a child (or adult) cannot isolate the individual\u00a0sounds, he does not have anything with which to link the letters in a\u00a0word. And so, the fundamental steps in learning to read are:<\/p>\n

\u2022 Developing the awareness that a spoken word can be pulled\u00a0apart into smaller units or phonemes, technically, this is referredto as phonemic awareness. Keep in mind that this basic first step\u00a0in learning to read involves spoken language.<\/p>\n

\u2022 Linking each letter in a word to the individual sound it represents.\u00a0This is referred to as phonics<\/p>\n

Once children appreciate that the printed word has the same number\u00a0and sequence of sounds as the spoken word, they have mastered the\u00a0alphabetic principle and are ready to read. It is important to\u00a0remember that all children, the very best readers, the poorest readers,\u00a0and all those in-between, must take the very same steps to becoming\u00a0a reader. The difference, of course, is in the time and effort that it\u00a0takes.<\/p>\n

In summary, in order to read, a child has to develop the insight that\u00a0spoken words can be pulled apart into the elemental particles of\u00a0speech (phonemes) and that the letters in a written word represent\u00a0these sounds. Accumulating evidence indicates that this difficulty with\u00a0the sounds of spoken language is largely missing in dyslexic children\u00a0and presents a persisting difficulty in adults who are dyslexic. A quote\u00a0that captures this relationship between spoken and written language\u00a0comes from Bloomfield, who wrote, \u201cWriting is not language, but\u00a0merely a way of recording [spoken] language by visible marks.\u201d<\/p>\n

Making a Hidden Disability Visible<\/strong><\/h3>\n

Imaging reading and dyslexia<\/strong><\/p>\n

Dyslexia is a hidden disability; people who have it are often bright and\u00a0have no outward signs of a problem. If a person has a broken arm, it is\u00a0visible to all. If a person is dyslexic, how can you look within his or her\u00a0brain to see the root of the problem? For many, many years, this\u00a0presented a significant problem for those who are dyslexic. Because\u00a0their reading difficulty is by definition, unexpected, and they seemed\u00a0to have all the cognitive equipment necessary to be good readers,\u00a0dyslexic children were often undiagnosed, misdiagnosed, or worse,\u00a0accused of not trying hard enough or of being not motivated or of\u00a0being \u201cstupid.\u201d Since people who are dyslexic have no outward visible\u00a0signs of their difficulty, many even questioned the very existence of dyslexia.<\/p>\n

\"12\"<\/a>
\n
\n<\/a><\/p>\n

In the 21st century, with the advent of functional brain imaging, this has\u00a0all changed. In our laboratory, one of the very first to image dyslexia,\u00a0we have now imaged several thousand children and adults as they\u00a0read or attempt to read. Functional magnetic resonance imaging\u00a0(fMRI) is similar to MRI; if you have ever had an MRI for a headache or\u00a0knee injury, fMRI and MRI use a similar scanner. fMRI, shown in the\u00a0image above, uses somewhat more sophisticated hardware and\u00a0software that allow it to capture brain changes (mainly blood flow) as\u00a0a person performs a specific cognitive task, for example, reading.<\/p>\n

Data using fMRI from laboratories around the world indicate three\u00a0neural systems for reading shown in the image below. These are all\u00a0located in the left side of the brain: one in the front of the brain (shown\u00a0in green, in the region of the inferior frontal gyrus [Broca\u2019s area]) and\u00a0two in the back of the brain (one in the parieto-temporal region, shown\u00a0in red, and a second in the occipito-temporal region, shown in yellow).<\/p>\n

\"13\"The latter system (found behind the ear in the area where children\u00a0often have swollen glands) is of particular importance for skilled, fluent\u00a0reading and is termed the visual word-form area (VWFA).\u00a0Neural systems in dyslexia<\/p>\n

In dyslexic readers, converging evidence from many laboratories\u00a0around the world has demonstrated \u201ca neural signature for dyslexia,\u201d\u00a0that is, a disruption of the two neural systems in the back of the brain\u00a0observed during reading (shown in the image below).<\/p>\n

In nonimpaired readers, three systems are evident, one anterior in the\u00a0area of the inferior frontal gyrus (shown in green) and two posterior, the\u00a0top system around the parieto-temporal region (shown in red) and the\u00a0bottom system around the occipito-temporal region (shown in yellow).<\/p>\n

In dyslexic readers, the anterior system is slightly overactivated\u00a0compared to non-impaired readers; in contrast, the two posterior\u00a0systems are underactivated. This pattern of underactivation in left\u00a0posterior reading systems is referred to as the neural signature for\u00a0dyslexia. Brain imaging now provides visible evidence of the reality of\u00a0dyslexia; dyslexia is no longer a hidden disability.<\/p>\n

\"14\"<\/p>\n

Imaging also reveals compensatory overactivation in other parts of the\u00a0reading system. The compensatory neural systems allow a dyslexic\u00a0person to read more accurately. However, the critical visual word-form\u00a0area remains disrupted and difficulties with rapid, fluent, automatic\u00a0reading persist. The dyslexic continues to read slowly.<\/p>\n

Neurobiological evidence is beginning to emerge indicating that many\u00a0dyslexics are not able to make good use of sound-symbol linkages as\u00a0they mature, and instead, they come to rely on memorized words. A\u00a0recent fMRI study also demonstrates the importance of memory\u00a0systems in dyslexic readers. Together, these recent neurobiological\u00a0findings suggest that as dyslexic children mature, neural systems\u00a0supporting word memorization develop, rather than the systems\u00a0supporting sound-symbol linkages and automatic reading that are\u00a0observed in typical readers.<\/p>\n

Functional imaging has been helpful in demonstrating that the neural\u00a0systems for reading are malleable, and that the disruption in these\u00a0systems in young struggling readers can be modified by an effective\u00a0reading intervention (see below: Teaching Reading and Remediating\u00a0Reading Difficulties). Compared to struggling readers who received\u00a0other types of intervention, children who received an experimental\u00a0intervention (which focused on evidence-based application of the\u00a0alphabetic principle) not only improved their reading but, compared\u00a0to pre-intervention brain imaging, demonstrated increased activation\u00a0in the neural systems for reading. These data have important\u00a0implications for public policy regarding teaching children to read: the\u00a0provision of an evidence-based reading intervention at an early age\u00a0improves reading and facilitates the development of those neural\u00a0systems necessary for reading.<\/p>\n

Translating Research into Practice<\/strong><\/h3>\n

Clues to a Diagnosis of Dyslexia<\/strong><\/p>\n

Dyslexia is more than simply a score on a reading test. Reflecting the\u00a0core sound-based phonological deficit, a range of downstream effects\u00a0is observed in spoken as well as in written language. Phonological\u00a0processing is critical to both spoken and written language. While most attention has centered on the print difficulties, spoken language is also\u00a0affected. The ability to notice, manipulate, and retrieve individual\u00a0sounds (phonemes) has an important function in speaking, for\u00a0example, a person must retrieve phonemes from his\/her internal\u00a0dictionary lexicon and serial order them correctly in order to utter the\u00a0spoken word. Thus, it should not be surprising that problems with spoken\u00a0language, albeit more subtle than those in reading, are often\u00a0observed.<\/p>\n

Clues to spoken language difficulties in dyslexia: (source \u00a9 Overcoming\u00a0Dyslexia, S.Shaywitz, Knopf, 2003, pp.122- 123;
\nhttp:\/\/www.amazon.com\/Overcoming-Dyslexia-Complete-Science-Based-Problems\/dp\/0679781595)<\/p>\n

\u2022 late speaking<\/p>\n

\u2022 mispronunciations<\/p>\n

\u2022 difficulties with word retrieval<\/p>\n

\u2022 needing time to summon an oral response<\/p>\n

\u2022 confusing words that sound alike, for example, saying\u00a0\u201crecession\u201d when the individual meant to say, \u201creception\u201d<\/p>\n

\u2022 pausing or hesitating often when speaking<\/p>\n

\u2022 using lots of \u201cum\u2019s\u201d during speaking, lack of glibness<\/p>\n

\u2022 using imprecise language, for example, \u201cstuff,\u201d \u201cthings,\u201d instead\u00a0of the proper name of an object<\/p>\n

\u2022 underestimation of knowledge, if based solely on (glibness) of\u00a0oral response<\/p>\n

As reflected in the spoken language difficulties in dyslexia noted\u00a0above, it is apparent that dyslexics are not glib, particularly when put\u00a0on the spot for a quick response. Keep in mind: this is not a matter of\u00a0knowing the answer. Rather, the problem – when the person knows the\u00a0answer – is in pulling the word out and saying it, that is, in retrieving the\u00a0spoken word instantly. Glibness should not be taken as a measure of\u00a0understanding, especially in a person who is dyslexic.<\/p>\n

A range of difficulties is noted in reading at all ages. Awareness of\u00a0these signs is important and may lead to earlier and more accurate\u00a0diagnosis of dyslexia in children and adults. Specific clues to dyslexia\u00a0noted in reading are listed below.<\/p>\n

Clues to Reading Difficulties in Dyslexia: (source \u00a9 Overcoming\u00a0Dyslexia, S.Shaywitz, Knopf, 2003, pp.123- 124;
\nhttp:\/\/www.amazon.com\/Overcoming-Dyslexia-Complete-Science-Based-Problems\/dp\/0679781595)<\/p>\n

\u2022 Slow progress in acquiring reading skills<\/p>\n

\u2022 Lack a strategy to read new, unknown words \u2013 trouble sounding\u00a0out unfamiliar words<\/p>\n

\u2022 Inability to read small, so-called function words such as \u201cthat,\u201d\u00a0\u201can,\u201d \u201cin\u201d<\/p>\n

\u2022 Terrific fear of reading aloud; avoidance of oral reading<\/p>\n

\u2022 Oral reading filled with mispronunciations, omissions, substitutions<\/p>\n

\u2022 Oral reading that is choppy and sounds like reading a foreign\u00a0language<\/p>\n

\u2022 Reliance on context to discern the meaning of what is read<\/p>\n

\u2022 Disproportionate poor performance on multiple choice tests<\/p>\n

\u2022 Slow reading<\/p>\n

\u2022 Reading is tiring<\/p>\n

\u2022 Inability to finish tests on time \u2013 doesn\u2019t finish or rushes and makes\u00a0careless errors; final test grade does not reflect person\u2019s\u00a0knowledge of the topic<\/p>\n

\u2022 Disastrous spelling<\/p>\n

\u2022 Homework that never seems to end; parents recruited as reader<\/p>\n

\u2022 Messy handwriting despite what may be an excellent facility at\u00a0word processing<\/p>\n

\u2022 Extreme difficulty learning a foreign language<\/p>\n

\u2022 Avoidance of reading for pleasure which seems too exhausting<\/p>\n

\u2022 Reading effortful, demands extra attention and concentration to\u00a0read<\/p>\n

\u2022 Requires quiet environment to concentrate on reading<\/p>\n

\u2022 Reading accuracy improves over time, though it continues to\u00a0lack fluency and remains laborious and slow<\/p>\n

\u2022 Lowered self-esteem with pain that is not always visible to others<\/p>\n

\u2022 Development of anxiety, especially in test-taking situations<\/p>\n

\u2022 History of problems in reading, spelling, foreign language\u00a0learning in family members<\/p>\n

The lack of reading fluency brings with it a need to read \u201cmanually\u201d (a\u00a0process consuming great effort and time), rather than \u00a0automatically;\u00a0the cost of such reading, in addition to reading slowly, is a tremendous\u00a0drain on attentional resources. This is often observed in the classroom\u00a0when struggling readers are asked to read quietly, deplete their\u00a0attentional resources as they struggle with the print, and, as a\u00a0consequence, appear to be daydreaming or not attending to the\u00a0assigned reading. An additional cost to the person is that non-fluent or\u00a0\u201cmanual\u201d reading is very tiring to the person.<\/p>\n

Sea of Strengths Model of Dyslexia<\/strong><\/p>\n

\"15\"In contrast to the spoken language and reading difficulties in dyslexia,\u00a0other abilities, particularly higher level cognitive abilities including\u00a0thinking, reasoning, vocabulary, and problem solving are usually intact.\u00a0This conceptual model of dyslexia has been referred to as a Sea of\u00a0Strengths Model of Dyslexia (shown in image above). This model\u00a0considers dyslexia to be an encapsulated or circumscribed weakness\u00a0in decoding surrounded by a range of higher level cognitive strength.\u00a0In diagnosing dyslexia, the goal is to identify both the strengths and the\u00a0weakness and in managing dyslexia, the weakness is remediated and\u00a0the strengths are acknowledged and facilitated. A critical component\u00a0of managing dyslexia, as discussed below, is to ensure that people who\u00a0are dyslexic are able to access their strengths and this is most\u00a0commonly achieved through the provision of accommodations such\u00a0as extra time on examinations.<\/p>\n

How dyslexics think<\/strong><\/p>\n

As noted above, dyslexia is more than a score on a reading test. In\u00a0fact, dyslexia is more than just a reading difficulty, it is a way of thinking\u00a0and of being. Differences in brain organization not only give rise to slow\u00a0reading, they also generate a different way of thinking. Intact higher\u00a0level abilities offer an explanation of why reading comprehension is\u00a0often appreciably above single word reading accuracy and fluency in\u00a0dyslexia. Often strong vocabularies and strong conceptual skills enable\u00a0a dyslexic to figure out a word or the gist of a paragraph even when\u00a0that person cannot decipher the specific word on the page.<\/p>\n

Dyslexics tend to be top-down rather than bottom-up thinkers; that is,\u00a0they learn from getting the big picture or the overall idea or leaning\u00a0first, and then fill in the specific details. People who are dyslexic learn\u00a0best through meaning, by understanding the overall concept or main\u00a0idea rather than through rote memorization of isolated facts.<\/p>\n

Strong visualization skills are also an asset to those who are dyslexic.<\/p>\n

Making a diagnosis of dyslexia<\/strong><\/p>\n

Dyslexia is a clinical diagnosis, best made by an experienced clinician\u00a0who knows the individual, has taken a careful history, observed the\u00a0child or young adult reading, and administered a battery of tests that\u00a0assess the child\u2019s intelligence, academic skills including reading\u00a0accuracy, fluency and comprehension, spelling, mathematics (which is often high), and language skills, particularly phonological processing\u00a0(getting to the sounds of spoken language). The uneven peaks and\u00a0valleys of cognitive and academic functioning both contribute to the\u00a0clinical picture of dyslexia: a weakness in phonologically-based skills in\u00a0the context of stronger cognitive and academic skills in non-reading\u00a0related areas.<\/p>\n

The critical element is the unexpected nature of the reading difficulty,\u00a0that is, it is unexpected in relation to a person\u2019s age, intelligence,\u00a0education, and professional status. And so, if a person has an IQ in the\u00a0superior range or is a physician or an engineer and has a reading\u00a0accuracy score in the so-called \u201caverage\u201d range, there is a disparity\u00a0between that individual\u2019s ability, education or training, and his\/her\u00a0reading achievement \u2013 that person is dyslexic. Just recently, in our\u00a0laboratory, using longitudinal data from the CLS, our research team has\u00a0been able to demonstrate that in good readers, intelligence and\u00a0reading are linked and mutually influence one another over time.<\/p>\n

However, and critically, in the case of dyslexia, intelligence and\u00a0reading go their separate ways, are not linked, and do not influence\u00a0one another. This finding provides important empirical evidence to\u00a0support the definition of dyslexia as an unexpected difficulty in reading.<\/p>\n

This dissociation in dyslexia between intelligence and reading also\u00a0provides strong evidence for the findings of low reading \u00a0achievement\u00a0in the presence of strong intellectual abilities in people who are\u00a0dyslexia.<\/p>\n

As children mature compensation often occurs, resulting in relatively\u00a0accurate, but not fluent, reading. Awareness of this \u00a0developmental\u00a0pattern is critically important for the diagnosis in older children, young\u00a0adults, and beyond. The consequence is that such dyslexic older\u00a0children may appear to perform reasonably well on a test of word\u00a0reading or decoding accuracy; on these tests credit is given\u00a0irrespective of how long it takes for the individual to respond or if there\u00a0are initial errors in reading that are then corrected. Accordingly, tests of\u00a0reading fluency \u2013 how quickly and accurately — individual words and\u00a0passages are read aloud and tests assessing reading rate are\u00a0keystones of an assessment for, and an accurate diagnosis of, dyslexia.<\/p>\n

What do you do if you suspect a reading problem in your\u00a0child?<\/strong><\/p>\n

Do not wait!! We now know that reading difficulties are persistent.\u00a0Teachers and parents, too, often rationalize: it\u2019s just a developmental\u00a0lag; she\u2019ll outgrow it; he\u2019s a boy. Early on, in preschool or kindergarten,\u00a0a child – who has difficulty learning the names of the letters and then\u00a0the sounds associated with each letter or letter group, and doesn\u2019t\u00a0seem to be able to learn how to sound out words – should be\u00a0considered at-risk and assessed for a possible reading problem. At this\u00a0early stage, often a speech and language pathologist is extremely\u00a0helpful in assessing the spoken language skills that represent the\u00a0foundation for learning to read. As a child matures and seems to be\u00a0struggling with reading and exhibiting the difficulties in spoken and\/or\u00a0written language noted above, that child should receive a full\u00a0evaluation for the possibility of dyslexia. Children learn about three\u00a0thousand new words a year; in the US, children tend to be identified as\u00a0dyslexic in third grade or often, much later. This means that these\u00a0struggling readers are already behind in learning ten thousand or so\u00a0words; a terrible burden to place on a child \u2013 especially when there\u00a0are highly effective reading interventions now available.<\/p>\n

Other considerations in making a diagnosis of dyslexia:\u00a0<\/strong><\/p>\n

As in other important medical conditions, the history is critical and\u00a0should be given prominence in the diagnostic formulation. Observing\u00a0the person read and administering tests are ancillary and helpful. Since\u00a0vision and hearing are critical for reading, children and adults who are\u00a0experiencing difficulty in reading should have their hearing and vision\u00a0checked. There are no laboratory tests other than cognitive, language,\u00a0and reading that are necessary to make a diagnosis of dyslexia. While\u00a0brain imaging is a very helpful research tool, it is not yet reliable\u00a0enough when used on individuals (rather than with groups) to be used\u00a0as a diagnostic tool. Similarly, while there is research exploring possible\u00a0genetic links to dyslexia, this is still in its early stages and there are\u00a0currently no reliable genetic tests for dyslexia. Most likely, there are\u00a0several genes governing the reading process and much more work to\u00a0be done. An additional consideration in making the diagnosis is the\u00a0role of attention. Attention is critical for learning to read as part of the\u00a0reading process itself. Struggling readers require large amounts of\u00a0attention, sometimes more than they can provide. In addition, there is\u00a0a significant overlap or high \u201cco-morbidity\u201d between the occurrence\u00a0of dyslexia and attention-deficit\/hyperactivity disorder (ADHD). Both\u00a0frequently occur in the same individual. Consequently, a consideration\u00a0of the possibility of an accompanying ADHD should also be considered\u00a0in those diagnosed with dyslexia; similarly, dyslexia should be\u00a0considered as a possible additional diagnosis in those diagnosed as\u00a0ADHD.<\/p>\n

Essentials of Dyslexia Management:<\/strong><\/h3>\n

I. Teaching Reading and Remediating Reading Difficulties<\/strong><\/p>\n

All children must take the same steps in learning to read. Accordingly,\u00a0the basic components of reading that must be mastered are shared by\u00a0all readers: good readers and struggling ones. What and how to most\u00a0effectively teach reading now has a scientific basis. In 1998, Congress,\u00a0concerned about what seemed to be a growing epidemic of reading\u00a0difficulties in children, mandated that a National Reading Panel (NRP)\u00a0be appointed to carefully review and assess the scientific data on\u00a0teaching children to read. One of us (SS) was honored to serve on the\u00a0NRP and in April, 2000, presented the Report of the NRP to the US\u00a0Congress. Basically, the Panel found that the most effective, evidence-\u00a0based approach to teaching reading must include five critical\u00a0components:<\/p>\n

1. Phonemic awareness<\/strong>: the ability to be aware of,\u00a0notice, or manipulate the sounds of spoken language<\/p>\n

2. Phonics<\/strong>: learning to link letters to the sounds they\u00a0represent<\/p>\n

3. Fluency<\/strong>: the ability to read both accurately and\u00a0rapidly, and with good intonation<\/p>\n

4. Vocabulary<\/strong>: to understand the meaning of words read<\/p>\n

5. Comprehension<\/strong>: to understand and discern the\u00a0meaning of connected text<\/p>\n

Furthermore, these components are most effectively taught in an\u00a0explicit, systematic approach. For struggling readers, it is critical that, in\u00a0addition to an evidence-based approach:<\/p>\n

\u2022 Instruction is intense<\/strong>, that is, in small groups not greater than 4-5\u00a0students;<\/p>\n

\u2022 Sufficient time<\/strong> is devoted to teaching reading and language-related skills, for example, sixty to ninety minutes, optimally, each\u00a0day;<\/p>\n

\u2022 Support services<\/strong> are provided to children until they become not\u00a0only accurate, but also fluent for most words at their grade level;<\/p>\n

\u2022 Accommodations<\/strong> are provided to permit dyslexic students to\u00a0demonstrate their knowledge<\/p>\n

Just as for other important conditions that affect the health and\u00a0welfare of children where we expect physicians to prescribe the most\u00a0effective, proven treatments, today, in education, science has progressed so that it is now possible, and indeed, mandatory, that\u00a0children be taught reading by evidence-based, proven methods. Such\u00a0evidence-based approaches have been found to be highly effective\u00a0for improving reading in children who are dyslexic. Interventions\u00a0focused at word decoding and single word identification levels have\u00a0had the most consistent evidence and have been shown to be the\u00a0most effective, particularly in prevention and early childhood studies.\u00a0Fluency and comprehension focused interventions have had less\u00a0investigation, but have still shown some, albeit more variable, effects\u00a0on reading outcomes in these students. Programs that systematically\u00a0integrate multiple-focused interventions are considered to be the most\u00a0effective, although their specific sequencing, degree of overlap, and\u00a0level of focus on each component during each phase are still open to\u00a0critical investigation. There is no single program that is head and\u00a0shoulders above other evidence-based programs. Up-dates on the\u00a0most recent evidence evaluating the efficacy of reading programs are\u00a0found on the What Works Clearing House Web site\u00a0(www.whatworks.ed.gov) of the Institute for Educational Sciences of\u00a0the US Department of Education.<\/p>\n

II. Providing Accommodations<\/strong><\/p>\n

Accommodations that Help Level the Playing Field<\/strong><\/p>\n

A complete education for a dyslexic student includes evidence-based\u00a0reading interventions and accommodations. As noted above,\u00a0intervention data, while promising, have yet to indicate closing the\u00a0gap in the ability to read words fluently in children beyond the first few\u00a0grades. Accordingly, although dyslexic children will improve their\u00a0accuracy, lack of fluency (slow, effortful reading) continues to be a\u00a0concern at all grade levels, increasingly so as children move up into\u00a0middle and high school and then into postsecondary education.<\/p>\n

Accommodations are of three general types:<\/strong><\/p>\n

1) Those that by-pass the reading difficulty by providing information\u00a0through an auditory mode;<\/p>\n

2) Those that provide compensatory assistive technologies; and,<\/p>\n

3) Those that provide additional time so that the dysfluent reader can\u00a0demonstrate his\/her knowledge.<\/p>\n

First, beginning quite early in their schooling, dyslexic readers require\u00a0alternative modes of acquiring information so that their vocabulary\u00a0and fund of knowledge more closely reflect their intellectual level than\u00a0their impaired reading ability. Access to recorded materials, for\u00a0example, from Recordings for the Blind & Dyslexic (www.rfbd.org),\u00a0whether they are based on the school curriculum or reflect what peers\u00a0are reading for pleasure, are a necessity for such children if they are to\u00a0keep up with their classmates and with their own intellectual curiosity\u00a0and interests. Next, assistive technology, computers with both print-to-\u00a0speech as well as speech-to-print software, provide further\u00a0compensation for oft-noted difficulties with handwriting, spelling, and\u00a0lack of fluency.<\/p>\n

The Scientific Basis for the Necessity for Accommodations for\u00a0Dyslexia<\/strong><\/p>\n

\"16\"<\/p>\n

A major advance has been the convergence of behavioral and\u00a0neuro-imaging data providing evidence for the critical need for extra-time on examinations for dyslexic students, particularly as they progress\u00a0towards high school graduation and beyond. Thus, ehavioral data\u00a0indicating the persistence of dysfluent reading are now supported by\u00a0neurobiological data. The image above shows cut-away views of the\u00a0brain in non-impaired readers (left) and dyslexic readers (right). As\u00a0noted earlier when describing the neural signature of dyslexia, in\u00a0dyslexic readers the posterior reading systems, especially the left\u00a0occipto-temporal (word-form) region responsible for fluent, rapid\u00a0reading, is disrupted in dyslexic children and adults. Other\u00a0compensatory systems, in the frontal regions on both left and right\u00a0hemispheres (shown in green), and the right hemisphere homologue of\u00a0the word form area develop, and these systems support increased\u00a0accuracy over time. However, the word-form region does not develop\u00a0and compensatory pathways do not provide fluent or automatic\u00a0reading. Accordingly, if such students are to demonstrate the full range\u00a0of their knowledge, providing additional time on examinations is a\u00a0necessity to compensate for the lack of availability of the efficient\u00a0word-form area and to level the playing field.<\/p>\n

How much extra time is best determined by the student\u2019s own\u00a0experience of trial and error over the years. Currently, there are no\u00a0quantitative data available to serve as a reliable metric for gauging\u00a0the specific amount of time needed by a student. Since longitudinal\u00a0data, both behavioral and imaging, indicate persistence of the\u00a0reading difficulty, requiring that students in postsecondary settings be\u00a0tested every three or five years is not consistent with scientific\u00a0knowledge. Furthermore, it is extremely expensive and even\u00a0problematic.<\/p>\n

As students progress through school to higher grades, and compensate\u00a0in reading accuracy, simple reading measures of word identification\u00a0fail to capture difficulties in fluent reading and so are often misleading.\u00a0In addition, since such non-automatic readers must call upon\u00a0attentional resources during reading, they are highly susceptible to\u00a0noise and distractions. Study and test-taking in quiet, separate rooms\u00a0allow these dysfluent readers to concentrate and make maximum use\u00a0of their often strained attentional resources.<\/p>\n

People who are dyslexic are entitled to protection from discrimination\u00a0under the Americans with Disabilities Act (ADA). Here are some helpful\u00a0things to know about accommodations:<\/p>\n

\u2022 In making assessments of an individual who is dyslexic for\u00a0purposes of providing accommodations under the ADA, that\u00a0person\u2019s reading must be compared with others of comparable\u00a0education, intelligence, and professional status.<\/p>\n

\u2022 Studies have shown that providing accommodations provides no\u00a0special advantage to dyslexic individuals, it just levels the playing\u00a0field. It is important to know that non-dyslexic readers do not\u00a0show a significant increase in test scores with extra time, while\u00a0people who are dyslexic show a highly significant increase in\u00a0scores. (Image 6; link to ADA Congressional testimony).<\/p>\n

\u2022 A Blue Ribbon Panel convened to determine the necessity for\u00a0\u201cflagging\u201d tests taken with accommodations determined that\u00a0such flagging was not appropriate. (See link to www.dra.org for\u00a0full report of the Panel).<\/p>\n

\u2022 Dyslexia is life-long; there is no necessity and it is, in fact,\u00a0inappropriate to require repeated testing after a person is\u00a0diagnosed as dyslexic.<\/p>\n

In summary, given that dyslexia represents a disparity between an\u00a0individual\u2019s reading and intellectual abilities; accommodations are\u00a0critical to assure fairness and equity. Contemporary management of\u00a0dyslexia provides evidence-based accommodations; these include:\u00a0access to recorded materials; computers and print-to-speech\u00a0software; additional time on examinations, with amount of time\u00a0determined by the student\u2019s experience. Tests are often inadequate\u00a0proxies; the reality of life experience in dyslexia provides the most valid\u00a0evidence for a person\u2019s need for accommodations. In addition, it is\u00a0inappropriate to assess a dyslexic person\u2019s knowledge based on his\/her\u00a0performance on an oral examination in which that individual is under\u00a0pressure to provide a quick or glib response.<\/p>\n

Accommodations are\u00a0provided based on a student\u2019s history, observations of his\/her reading\u00a0aloud, and test results; once a student is diagnosed as dyslexic, the\u00a0evidence indicates this is a persistent, life-long difficulty. With provision\u00a0of such accommodations, dyslexic students are entering and\u00a0succeeding in a range of professions including journalism, literary\u00a0writing, science, medicine, law, and education.<\/p>\n

Adult Outcome of Dyslexia<\/strong><\/p>\n

Over time, reading accuracy improves so that dyslexic readers are\u00a0able to read, albeit slowly and with great effort. In contrast, dyslexic\u00a0readers continue to lack fluency. The basic phonologic difficulty\u00a0persists; spoken language difficulties remain.<\/p>\n

Problems in speaking in adult dyslexics: (source \u00a9S. Shaywitz,\u00a0Overcoming Dyslexia, Knopf, 2003, pp.125- 126;
\nhttp:\/\/www.amazon.com\/Overcoming-Dyslexia-Complete-Science-Based-Problems\/dp\/0679781595)<\/p>\n

\u2022 Mispronunciation of names of people and places<\/p>\n

\u2022 Difficulty remembering names of people and places<\/p>\n

\u2022 Confusion of names that sounds alike<\/p>\n

\u2022 Struggle to retrieve words, \u201cIt was on the tip of my tongue\u201d<\/p>\n

\u2022 Lack of glibness, especially if put on the spot<\/p>\n

\u2022 Spoken vocabulary smaller than listening vocabulary<\/p>\n

\u2022 Hesitation to say aloud words that may be mispronounced<\/p>\n

Problems in reading in adult dyslexics: (source \u00a9S. Shaywitz,\u00a0Overcoming Dyslexia, Knopf, 2003, pp.125- 126;\u00a0http:\/\/www.amazon.com\/Overcoming-Dyslexia-Complete-Science-Based-Problems\/dp\/0679781595)<\/p>\n

\u2022 Childhood history of reading and spelling difficulties<\/p>\n

\u2022 Word reading more accurate, but still effortful<\/p>\n

\u2022 Lack of fluency<\/p>\n

\u2022 Embarrassment caused by oral reading: avoidance of Bible\u00a0study group, reading at Passover seders, or delivering a written\u00a0speech<\/p>\n

\u2022 Trouble reading and mispronouncing uncommon or strange\u00a0words such as people\u2019s names, names of streets or locations,\u00a0food dishes on the menu\u00a0\u2022 Substitution of made-up words, during reading, for words that\u00a0cannot be pronounced, for example, metropolitan becomes\u00a0mitan<\/p>\n

\u2022 Extreme fatigue from reading<\/p>\n

\u2022 Slow reading of most material: books, manuals, subtitles to\u00a0foreign films<\/p>\n

\u2022 Penalized by multiple choice tests<\/p>\n

\u2022 Unusually long hours spent reading school or work materials<\/p>\n

\u2022 Frequent sacrifice of social life for studying<\/p>\n

\u2022 Preference for books with figures, charts, or graphics<\/p>\n

\u2022 Preference for books with fewer words per page or with lots of\u00a0white showing on the page<\/p>\n

\u2022 Disinclination to read for pleasure<\/p>\n

\u2022 Spelling remains disastrous; in written work, preference for less\u00a0complicated words that are easier to spell<\/p>\n

\u2022 Particularly poor performance on rote, clerical tasks\u00a0Strengths in higher level thinking processes<\/p>\n

\u2022 High learning capability<\/p>\n

\u2022 Noticeable improvement when given additional time on multiple\u00a0choice tests<\/p>\n

\u2022 Noticeable excellence when focused on a highly specialized\u00a0area such as medicine, law, public policy, finance, architecture,\u00a0basic science<\/p>\n

\u2022 Excellence at writing if content and not spelling is important<\/p>\n

\u2022 Noticeable articulateness in expression of ideas and feelings<\/p>\n

\u2022 Exceptional empathy and warmth and feeling for others<\/p>\n

\u2022 Success in areas not dependent on rote memory<\/p>\n

\u2022 Talent for high level conceptualization<\/p>\n

\u2022 Ability to come up with original insights<\/p>\n

\u2022 Big picture thinkers<\/p>\n

\u2022 Inclination to think out-of-the-box<\/p>\n

\u2022 Noticeable resilience and ability to adapt<\/p>\n

Reflecting these strengths, dyslexics are often high level\u00a0conceptualizers who manifest \u201cout-of-the-box thinking\u201d and are\u00a0frequently the ones who provide new insights. As a person who is\u00a0dyslexic progresses and is able to specialize in an area, s\/he may\u00a0become relatively automatic in reading the vocabulary recurring in\u00a0that area. Dyslexics are often represented at the higher levels of a\u00a0range of professions and are frequently found as leaders in such\u00a0diverse areas as science, medicine, law, business, writing\/literature,\u00a0poetry.<\/p>\n

Dyslexic writers and playwrights:<\/strong><\/p>\n

John Irving<\/p>\n

Stephen J. Cannell<\/p>\n

Wendy Wasserstein<\/p>\n

Dyslexic financiers or entrepreneurs:<\/strong><\/p>\n

Charles Schwab,<\/p>\n

Sir Richard Branson,<\/p>\n

John Chambers (Cisco Systems),<\/p>\n

William Hewlett,<\/p>\n

Paul Orfalea (Kinko\u2019s),<\/p>\n

Ingvar Kamrad (IKEA),<\/p>\n

Ted Turner<\/p>\n

As Charles Schwab recalls,<\/p>\n

\u201cEven though I couldn\u2019t read quickly, I could imagine things much\u00a0faster than some other people who were stuck thinking sequentially.\u00a0That helped me in solving complex business problems. I could visualize\u00a0how things would look at the end of the tunnel.\u201d<\/p>\n

\u00a9 Overcoming Dyslexia, S. Shaywitz, 2003, p. 357.<\/p>\n

Dyslexic scientists:<\/strong><\/p>\n

Nobel laureates: Albert Einstein, Nils Bohr, Barry Benacerraf;<\/p>\n

Dyslexic physicians:<\/strong><\/p>\n

Harvey Cushing \u2013 father of neurosurgery<\/p>\n

Dr. Helen Taussig \u2013 helped develop Blalock-Taussig operation for \u201cblue\u00a0babies;\u201d<\/p>\n

Dr. Jack Barchas – leading psychiatrist<\/p>\n

Dr. Delos Cosgrove – led the Department of Cardio-Thoracic Surgery at\u00a0the Cleveland Clinic to International prominence and has at least 20\u00a0patents for advances in valvular surgery. Dr. Cosgrove is now CEO of\u00a0the Cleveland Clinic.<\/p>\n

Looking to the Future<\/strong><\/p>\n

There is now evidence of both the weakness and the strengths\u00a0associated with dyslexia. The weaknesses have been well elaborated\u00a0and described; the strengths are often overlooked. To illuminate and\u00a0focus attention on the strengths associated with dyslexia and to inform\u00a0society about the newest knowledge of dyslexia, the Yale Center for\u00a0Dyslexia and Creativity (with the tag-line: slow reader, out-of-the-box\u00a0thinker) has now been established at Yale University (Website:\u00a0www.dyslexia.yale.edu). The mission of the Center is to use the power\u00a0and authority of modern science to transform dyslexia from a liability to\u00a0a strength, so that his or her strengths rather than weaknesses come to\u00a0define a dyslexic person\u2019s life. The Center is actively involved in large\u00a0scale dissemination and education initiatives – to produce a paradigm\u00a0shift and advance societal attitudes about dyslexia. These efforts are\u00a0targeting K- 12 as well as higher education, medicine, business, law,\u00a0policy, the media, and other innovative, scholarly initiatives to better\u00a0identify dyslexia and to define the link between dyslexia and creativity.<\/p>\n

Websites:<\/strong><\/p>\n

http:\/\/www.amazon.com\/Overcoming-Dyslexia-Complete-Science-<\/p>\n

Based-Problems\/dp\/0679781595<\/p>\n

www.dyslexia.yale.edu<\/p>\n

www.professorgarfield.org<\/p>\n

www.sparktop.org<\/p>\n

www.whatworks.ed.gov<\/p>\n

www.dralegal.org<\/p>\n

www.rfbd.org<\/p>\n

www.audible.com<\/p>\n

www.bookshare.org<\/p>\n

www.asha.org<\/p>\n

Books about Dyslexia<\/strong><\/h3>\n

Shaywitz, S. (2003). Overcoming Dyslexia:<\/strong> A new and complete\u00a0science-based program for reading problems at any level. New York,\u00a0NY: Alfred A. Knopf.<\/p>\n

Report of the National Reading Panel. (2000).<\/strong> Teaching Children to\u00a0Read: An Evidence Based Assessment of the Scientific Research\u00a0Literature on Reading and its Implications for Reading Instruction (Vol.\u00a0NIH Pub. No. 00-4754): U.S. Department of Health and Human Services,\u00a0Public Health Service, National Institutes of Health, National Institute of\u00a0Child Health and Human Development.<\/p>\n

References<\/strong><\/p>\n

1. Shaywitz, S., Morris, R., & Shaywitz, B. (2008). The education of dyslexic\u00a0children from childhood to young adulthood. Annual Review of\u00a0Psychology, 59, 451-475.<\/p>\n

2. Shaywitz, S. E. (1996). Dyslexia. Scientific American, 275(5), 98- 104.<\/p>\n

3. Shaywitz S, Shaywitz B. Dyslexia (speci\ufb01c reading disability). Biol\u00a0Psychiatry 2005;57: 1301\u20139.<\/p>\n

4. Dehaene, S., Cohen, L., Sigman, M., & Vinckier, F. (2005). The neural\u00a0code for written words: a proposal. Trends in cognitive sciences, 9(7),\u00a0335-341.<\/p>\n

5. Shaywitz, B., Skudlarski, P., Holahan, J., Marchione, K., Constable, R.,\u00a0Fulbright, R., et al. (2007). Age-related changes in reading systems of\u00a0dyslexic children. Annals of Neurology, 61, 363-370.<\/p>\n

6. Paulesu E, Demonet J-F, Fazio F, McCrory E, Chanoine V, et al. 2001.\u00a0Dyslexia-cultural diversity and biological unity. Science 291:2165–67<\/p>\n

7. Marzola E, Shepherd M. 2005. Assessment of Reading Difficulties. In\u00a0Multisensory Teaching of Basic Language Skills, J.R. Birsh, Editor, Paul H\u00a0Brookes, Baltimore, MD: pp. 171- 185.<\/p>\n

8. Reynolds, C.R. (2008). RTI, Neuroscience, and Sense: Chaos in the\u00a0Diagnosis and Treatment of Learning Disabilities, in Neuropsychological\u00a0Perspectives on Learning Disabilities in the Era of RTI: Recommendations\u00a0for Diagnosis and Intervention, E. Fletcher-Janzen and C.R. Reynolds\u00a0(Eds.), John Wiley & Sons,\u00a0Hoboken,\u2029NJ.<\/p>\n\n","protected":false},"excerpt":{"rendered":"

\u2029Reference \u2029Dr.\u2029 Sally\u2029 Shaywitz,\u2029 Author\u2029 of\u2029\u2018 Overcoming\u2029 Dyslexia\u2019 Developmental dyslexia is an unexpected difficulty in reading.\u00a0Unexpected refers to children and adults who appear to have all the\u00a0factors necessary to become good readers: intelligence, motivation,\u00a0and exposure to reasonable reading instruction – and yet struggle to\u00a0read. Here, for ease of communication. We...
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