Dyslexia

DEFINITION: A learning disorder associated with difficulties identifying speech sounds that affects one's ability to read, spell, and write

ANATOMY OR SYSTEM AFFECTED: Brain, nervous system, psychic-emotional system

CAUSES: Unknown; possibly neurological disorder associated with heritability; dormant, immature, or undeveloped learning centers in the brain

SYMPTOMS: Poor written schoolwork, late language development, easy distractibility, poor coordination, poor spatial orientation, confused writing and/or spelling, reading below grade level, poor left-right orientation, difficulty processing directions, difficulty sounding out new words

DURATION: Chronic

TREATMENTS: Tutoring sessions to teach specific reading skills and practice repeated language drills (imprinting)

Causes and Symptoms

The term dyslexia was first introduced by the German ophthalmologist Rudolf Berlin in the nineteenth century. Berlin defined it as designating all those individuals who possessed average or above-average intelligence quotients (IQs) but who could not read adequately because of their inability to process language symbols.

The problem involved in dyslexia has been defined and redefined many times since its introduction. The modern definition of the disorder, which is close to Berlin’s definition, is based on long-term, extensive studies of children with dyslexia. These studies have identified dyslexia as a complex syndrome characterized by a variety of difficulties associated with reading, spelling, writing, listening, and processing information due to neuroanatomical abnormalities, particularly deficits in areas of the brain involved in language, with a possible genetic component. These problems include visual letter and word reversal, difficulties understanding spoken words and following complex instructions, difficulties spelling, the inability to sound out new and unfamiliar words, and the inability to distinguish between important elements of the spoken language. Associated behavioral problems can arise due to these problems in processing information, including distractibility, frustration, and loss of motivation in school.

Identifying dyslexia early in order to correct this reading disability is crucial. To learn to read well, an individual must acquire many basic cognitive and linguistic skills. First, it is necessary to pay close attention, to concentrate, to follow directions, and to understand the language spoken in daily life. Next, one must develop an auditory and visual memory, strong sequencing ability, solid word decoding skills, the ability to carry out structural-contextual language analysis, the capability to interpret written language, a solid vocabulary that expands as needed, and speed in scanning and interpreting written language. These skills are taught in good developmental reading programs, but some or all are found to be deficient in individuals with dyslexia. Early educational interventions that are tailored to the child with dyslexia can focus on building these deficient skills by teaching phonemes and strategies to better comprehend written material. Tutoring sessions with a reading specialist or an individual education plan can help to reinforce these skills.

Many physicians propose that dyslexia is caused by heritable structural abnormalities in the brain. In-depth studies into the causes of dyslexia have been made by the use of electroencephalograms (EEGs), computed tomography (CT) scans, and positron emission tomography (PET) scans.

Another interesting point of view, expressed by some experts, is the idea that dyslexia may be the fault of the written languages of the Western world. For example, Rudolph F. Wagner argues that Japanese children exhibit a lower incidence of dyslexia. The explanation for this, say Wagner and others, is that unlike Japanese, Western languages require both reading from left to right and phonetic word attack. These characteristics—absent in Japanese—may make the Western languages either much harder to learn or much less suitable for learning. Evolutionary biologists argue that reading and writing are relatively new skills when considered against the entire timeline of human evolutionary history.

A number of experts propose three types of dyslexia. The most common type and the one most often identified as dyslexia is called visual dyslexia, the lack of ability to translate the observed written or printed language into meaningful terms. The major difficulty is that afflicted people see certain words or letters backward or upside down. The resultant problem is that to the person with visual dyslexia, any written sentence is a jumble of many letters whose accurate translation may require five or more times as much effort as is needed by an unafflicted person. Special fonts have been developed to overcome the problems posed by visual dyslexia; these fonts are designed to make similar-looking letters, such as p, b, q, and d, more visually distinct from one another.

The other two problems viewed as dyslexia are auditory dyslexia and dysgraphia. Auditory dyslexia is the inability to perceive individual sounds of spoken language. Despite the absence of hearing problems, individuals with auditory dyslexia have difficulty hearing the differences between certain vowel or consonant sounds, and what they cannot hear they cannot write. Dysgraphia is the inability to write legibly. The basis for this problem is a lack of the hand-eye coordination that is required to write clearly.

Many children with visual dyslexia also exhibit elements of auditory dyslexia. This complicates the issue of teaching many students with dyslexia because only one type of dyslexic symptom can be treated at a time. A similar learning disorder, dyscalculia, involves struggling with understanding and using numbers rather than letters.

Treatment and Therapy

The early diagnosis and treatment of dyslexia is essential to its eventual correction. The preliminary identification of dyslexia can be made from symptoms that include poor written schoolwork, easy distractibility, poor coordination, poor spatial orientation, confused writing and spelling, and poor left-right orientation. Because numerous children who do not have dyslexia also show many of these symptoms, a second step is required for such identification: the use of written tests designed to identify dyslexia. These tests include the Peabody Individual Achievement Test and the Halstead-Reitan Neuropsychological Test Battery.

EEGs and CT scans may be often performed in the hope of pinning down concrete brain abnormalities in patients with dyslexia. There is considerable disagreement, however, regarding the value of these techniques beyond finding evidence of tumors or severe brain damage—both of which may indicate that the condition observed is not dyslexia.

Once conclusive identification of dyslexia has been made, it becomes possible to begin corrective treatment. Such treatment is usually the preserve of individualized education plans. These plans are carried out by the special education teacher in school resource rooms and provide specially tailored supplemental education to address the specific problems posed by dyslexia or other learning difficulties. Many schools also involve special classes limited to children with reading disabilities and schools that specialize in treating learning disabilities. Private or group tutoring sessions with a reading specialist can also teach strategies to a child with dyslexia to help them overcome specific difficulties with reading comprehension, writing skills, and spelling.

An often-cited method used is that of Grace Fernald, which utilizes kinesthetic imprinting, based on combined language experience and tactile stimulation. In this popular method or adaptations of it, a child with dyslexia learns to read in the following way. First, the child tells a spontaneous story to the teacher, who transcribes it. Next, each word that is unrecognizable to the child is written down by the teacher, and the child traces its letters repeatedly until they can write the word without using the model. Each word learned becomes part of the child’s word file. A large number of stories are handled this way.

A second common teaching technique used by special educators is the Orton-Gillingham-Stillman method, which was developed in a collaboration between two teachers and a pediatric neurologist, Samuel T. Orton. The method evolved from Orton’s conceptualization of language as developing from a sequence of processes in the nervous system that ends in its unilateral control by the left cerebral hemisphere. He proposed that dyslexia arises from conflicts between this cerebral hemisphere and the right cerebral hemisphere, which is usually involved in the handling of nonverbal, pictorial, and spatial stimuli.

Consequently, the corrective method that is used is a multisensory and kinesthetic approach, like that of Fernald. It begins, however, with the teaching of individual letters and phonemes. Then, it progresses to dealing with syllables, words, and sentences. Children taught by this method are drilled systematically, to imprint them with a mastery of phonics and the sounding out of unknown written words. They are encouraged to learn how the elements of written language look, how they sound, how it feels to pronounce them, and how it feels to write them down. Although the Orton-Gillingham-Stillman method is as laborious as that of Fernald, it is widely used and appears to be successful.

An important aspect of dyslexia treatment is parental support. Such emotional support helps children with dyslexia cope with associated problems of frustration, lack of motivation, and lowered self-esteem. Useful aspects of this support include a positive attitude toward the child, appropriate home help that complements efforts at school, encouragement and praise for achievements, lack of recrimination when repeated mistakes are made, and positive interaction with special education teachers.

Perspective and Prospects

The identification of dyslexia by German physician Rudolf Berlin and England’s W. A. Morgan began the efforts to solve this disorder. In 1917 Scottish eye surgeon James Hinshelwood published a book on dyslexia, which he viewed as being a hereditary problem, and the phenomenon became much better known to many physicians. Attempts at educating individuals with dyslexia were highly individualized until the endeavors of Orton and his coworkers and of Fernald led to more standardized and widely used methods. These procedures, their adaptations, and several others had become the standard treatments for dyslexia by the late twentieth century.

Many famous people—including Hans Christian Andersen, Winston Churchill, Albert Einstein, George S. Patton, and Woodrow Wilson—had symptoms of dyslexia, which they subsequently overcame. This was fortunate for them, because untreated dyslexia often puts individuals at a great disadvantage.

With the development of a more complete understanding of the brain and its many functions, better counseling facilities, and the conceptualization and actualization of both parent-child and parent-counselor interactions, the probability of success in overcoming the challenges posed by dyslexia has improved greatly. Moreover, while environmental and socioeconomic factors contribute relatively little to the occurrence of dyslexia, they strongly affect the outcome of its treatment.

The endeavors of special education have so far made the greatest inroads in the treatment of dyslexia. It is hoped that many more advances in the area will be made as the science of the mind grows and diversifies and the contributions of psychologists, physicians, physiologists, and special educators mesh even more effectively.

Bibliography

"Dyslexia." Mayo Clinic, 6 Aug. 2022, www.mayoclinic.org/diseases-conditions/dyslexia/symptoms-causes/syc-20353552. Accessed 16 Oct. 2024.

"Dyslexia." National Institute of Neurological Disorder and Stroke, 11 Apr. 2023, www.ninds.nih.gov/health-information/disorders/dyslexia. Accessed 31 Mar. 2024.

Eide, Brock L., and Fernette F. Eide. The Dyslexic Advantage: Unlocking the Hidden Potential of the Dyslexic Brain. New York: Plume, 2011. Print.

Farquharson, Kelly, et al. "Phonological and Lexical Influences on Phonological Awareness in Children with Specific Language Impairment and Dyslexia." Frontiers in Psychology 5 (2014): 838. Web. 12 Dec. 2014.

Foss, Ben. The Dyslexia Empowerment Plan: A Blueprint for Renewing Your Child's Confidence and Love of Learning. New York: Ballantine, 2013. Print.

Huston, Anne Marshall. Understanding Dyslexia: A Practical Approach for Parents and Teachers. Rev. ed. Lanham: Madison, 1992. Print.

Jordan, Dale R. Overcoming Dyslexia in Children, Adolescents, and Adults. 3rd ed. Austin: Pro-Ed, 2002. Print.

Levinson, Harold N. Smart But Feeling Dumb: The Challenging New Research on Dyslexia—And How It May Help You. Rev. ed. New York: Warner, 2003. Print.

"NINDS Dyslexia Information Page." National Institute of Neurological Disorders and Stroke. Natl. Institutes of Health, 11 Sept. 2015. Web. 27 Apr. 2016.

Reid, Gavin, and Jane Kirk. Dyslexia in Adults: Education and Employment. New York: Wiley, 2001. Print.

Shaywitz, Sally. Overcoming Dyslexia: A New and Complete Science-Based Program for Reading Problems at Any Level. New York: Vintage, 2005. Print.

Snowling, Margaret. Dyslexia: A Cognitive Developmental Perspective. 2nd ed. Malden: Blackwell, 2002. Print.

Wolf, Maryanne, et al. "Towards a Dynamic, Comprehensive, Conceptualization of Dyslexia." Annals of Dyslexia, 13 Jan. 2024, doi.org/10.1007/s11881-023-00297-1. Accessed 31 Mar. 2024.

Wolraich, Mark L., ed. Disorders of Development and Learning: A Practical Guide to Assessment and Management. 3rd ed. Hamilton: Decker, 2003. Print.