Dyslexia/Reading Disability

(part of a series on Specific Learning Disability types)

This post will explore the basics of Dyslexia, also known in some contexts as Reading Disability. I'll cover some basic descriptions of the condition, its roots and treatment, and an example of a (fictional but based in reality) child with Dyslexia and how she was treated.

Definitions and Root Causes

The Diagnostic Statistical Manual Fifth edition, which is used by psychologists and other mental health professionals worldwide, defines these as the core criteria for Dyslexia

• “Inaccurate or slow word reading” and/or “difficulty understanding meaning of what is read” which persists more than 6 months.

• Being “substantially and quantifiably” below expectations based on age.

• These difficulties may go undetected until the students abilities are overtaxed by new academic demands.

• The difficulties aren’t better explained by other variables (eg, vision acuity, lack of language proficiency, inadequate teaching etc)

The core of this disorder seems to be impaired metalinguistic awareness, which is to say the intuitive ability to analyze and decompose words and sentences. This impairment is often primarily phonological, meaning it relates to the distinguishing the individual sounds in a word (eg, the sounds /s/, /t/, /i/ and /p/ in the word “steep”), although it often entails deficits in morphological (relating to meaningful affixes of words), syntactic and semantic deficits as well. Often, if the primary difficulty is phonological, a child will attempt to compensate by relying more on the syntactic and semantic domains as a tool for word identification.

What it looks like

Some major signs of dyslexia include slow and stumbling reading, misidentifying words (especially replacing words with contextually appropriate but unrelated words), misspelling words with similar sounds (eg “dag” for “dog”).

In addition to formal tests like the Woodcock Reading Mastery Test, dyslexia can be informally evaluated by having the child read and/or spell a set of nonsense words. Because these words cannot be memorized in advance, they put extra pressure on the phonological component of reading - that is, the ability to sound out unfamiliar words. Nonsense words given in a syntactic context, where students are asked to conjugate or pluralize the nonsense word, (eg the classic test “This is a wug. Now there are two of them. There are two ____” from Jean Berko Gleeson) may be used to assess a student’s facility with morphological awareness.

Working with Layla

Layla is an 8 year old child (a fictional composite of many students I've worked with) from a well educated affluent family. She is the youngest of 3 and attends her local elementary. Her parents are concerned that she is lagging behind her peers, and where her siblings were at the same age. I was brought in to informally assess and create a plan for remediation.

Layla had a sunny friendly disposition, showing excellent determination in working through what was clearly difficult subject. I asked her to read some graded sample passages, about a paragraph long, and compared her fluency and error rate to the mean and median for kids her age. I also asked some comprehension questions, and checked her ability to spell and read pseudowords of various complexity (from “op” to “blump”). Her performance on these suggested to me she has some deficits in phonological awareness, not extreme but roughly in the 30th percentile for her age, and probably lower relative to her privileged peer group.

I recommended she receive 40-60 hours of direct instruction in learning sound letter correspondences, vowel rules, with some visual working memory exercises, influenced by methods the Lindamood-Bell LiPS program, in which possible auditory processing deficits are circumvented by using tactile feedback and oral motor skills.

One of the concerns with students who struggle with reading is that their difficulties in this domain will spread to others, as increasingly students read for instruction in math, science and social studies. To help mitigate this I would encourage the teacher to offer the accommodation that assessment and instruction in text should be read aloud for the student to ensure accessibility.