Dyslexia is one of the more common conditions to affect school age children. It is estimated that between 5 and 10% of children between the ages of 5 and 20 meet criteria for the disorder. The definition of dyslexia is an inability to read; however, while this is a disorder that is very easy to define, it can be difficult to diagnose and treat. Reading is an intimate and essential skill in our school systems. Children are taught to read in first and second grade; but by grade three they are expected to acquire new information from what they read and children who have difficulties in reading will begin to suffer in all subjects if left untreated.
Dyslexia and The Brain
There has been a wealth of information published on this disorder since first conceptualized nearly a hundred years ago. What researchers have essentially concluded is that we don’t have a formal reading center in our brain. Rather, we utilize language and speech areas to make sense of written words. Thus, any disorder that affects language systems can impact reading. In fact, in adult stroke patients, there is an unusual condition called alexia (can’t read) without agraphia (can’t write), which means that a person could write a sentence but be unable to read what they had just written. Through the advent of neuroimaging, we have been able to trace the pathways that lead from the visual perception of written text to the decoding of that text for meaning and have a pretty good understanding of how children with dyslexia read (or don’t read) differently than normal children. We have not been as successful in figuring out the cause of this disorder.
The current thinking is that our visual system is built to recognize objects from a variety of different angles because we are creatures that move in the world. For instance, if I turn a chair on its side, it won’t take you longer to figure out it is still a chair. However, letters and words need to be identified in the same orientation and in the same order if they are to have meaning. The visual system, therefore, “cheats” by funneling letters and words over to the language centers for processing instead of in typical object recognition centers. If this process occurs correctly, most children will be able to read as early as five years of age. If they don’t funnel this information correctly to the left side, they will continue to treat letters and words just like objects in the environment. For instance, a child might see the word “choir” but say the word “chair” since they are visually so similar in appearance. However, their meaning is quite different and clearly comprehension is going to be affected if many of those errors occur.
Signs of Dyslexia in Children
Some of the common signs of dyslexia in younger children can be the omission of connecting words (i.e., in, an, the, to, etc.), taking the first letter or two of the word and guessing, or converting words that they have never seen into words that they already know, even when the meaning is quite different. I hear often that parents become worried because their child reverses letters and, while this does occur in children with dyslexia, it is also a fairly common phenomenon with children who are learning to read, particularly with letters that look similar (i.e., b and d). Thus, it often does take a trained professional to differentiate children who are poor readers or who are developing slowly or in a patch-like fashion from children who actually have dyslexia.
Dyslexia in School
One of the challenges with this condition is that many of the schools have gone to an RTI Model (Response To Intervention) for reading. This means that they wait to see how a child responds to a normal classroom and if they fail, they move them to additional services, and if that fails, they move them to further intense services. Failing that, an evaluation is ordered. In real life, this means that many children are not evaluated properly for several years and by that time there are major gaps in their learning and acquisition. We do know of several methods for remediating dyslexia, although they often involve multiple hours a week of tutoring on a one-on-one basis and some school systems are simply ill-equipped to provide those types of services for children.
Most children that we see here at the clinic with dyslexia are bright and capable children who become increasingly frustrated with school because they are unable to bring their intellect to bear on many of the activities they are asked to perform in the school system. Even subjects in which they find much enjoyment are limited in terms of their ability to access the material because so much of it is done through written form. They often look poor on standardized reading and math testing; but because they are bright they can usually “muddle along” just enough to escape attention until they have fallen several years behind by middle school.
Treatment for Dyslexia
Fortunately, several treatment methods have been developed over the years that lead to a “normalization” of the reading system within the brain on imaging studies and to a dramatic increase in reading scores on educational tests. Only a trained professional can determine if your child has a developmental delay, dyslexia, or some other condition that is impacting their reading; but these are often critical evaluations to get done early since the remediation process can take 12 to 24 months.
I have evaluated hundreds of children for this condition and seen rather dramatic improvements when these children are placed in evidence-based programs for even a short amount of time. I urge all families who have children who struggle with reading to at least get a consultation with a trained professional to determine an accurate diagnosis and appropriate treatment planning.