Dyslexia

Overview

What is dyslexia?

Dyslexia is a learning problem that makes it hard to read, write, and spell. It occurs because the brain jumbles or mixes up letters and words. Children with dyslexia often have a poor memory of spoken and written words.

Having dyslexia does not mean that your or your child's ability to learn is below average. In fact, many people with dyslexia are very bright. But not being able to read well can make many areas of learning a problem.

Dyslexia is also called specific reading disability, reading disorder, and reading disability.

What causes dyslexia?

Experts don't know for sure what causes dyslexia. But it often runs in families. So it may be passed from parents to children (genetic disorder). Also, some studies have found problems with how the brain links letters and words with the sounds they make.

Dyslexia is not caused by poor vision, and people with dyslexia do not see letters and words backward.

What are the symptoms?

Signs of dyslexia in children who are too young for school include:

• Talking later than expected.
• Being slow to learn new words.
• Problems rhyming.
• Problems following directions that have many steps.

After a child begins school, the signs of dyslexia include:

• Problems reading single words, such as a word on a flash card.
• Problems linking letters with sounds.
• Confusing small words, such as "at" and "to."
• Reversing the shapes of written letters such as "d" for "b." For example, the child may write "dat" instead of "bat."
• Writing words backward, such as "tip" for "pit."

If your child has one of these signs, it does not mean that he or she has dyslexia. Many children reverse letters before age 7. But if your child has several signs and reading problems, or if you have a family history of dyslexia, you may want to have your child checked for the problem.

How is dyslexia diagnosed?

To find out if your child has dyslexia, your doctor will ask about your child's past health. The doctor will also ask you what signs of dyslexia you and your child's teachers have seen. He or she will ask your child questions too. Your doctor may order reading and skill tests. Tests may include those that look at your child's personality and how he or she learns, solves problems, and uses words. Your child may also have an IQ test.

These tests will help your doctor find out if your child has dyslexia or another learning problem.

How is it treated?

Treatment uses a number of teaching methods to help your child read better. These methods include:

• Teaching how letters are linked to sounds to make words.
• Having the child read aloud with a teacher's help.
• Teaching the child to listen to and repeat instructions.

United States law requires schools to set up a learning plan to meet the needs of a child with dyslexia. This plan is called an Individualized Education Program (IEP). You, your child's teachers, and other school personnel will have a say in designing the plan. You can also ask your child's doctor to attend. The plan is updated each year based on how well your child is doing and what your child's needs are.

Medicines and counseling usually are not a part of treatment for dyslexia.

Dyslexia is a lifelong problem, but early treatment during childhood can help. Support from family, teachers, and friends is also important.

Frequently Asked Questions

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Cause

The cause of dyslexia is not clear, although it is probably an inherited (genetic) disorder because it runs in families.¹

Some studies have shown that people with dyslexia have abnormalities in the functioning of the areas of the brain involved in reading and language.²

Symptoms

Signs of dyslexia vary depending on age. If your child has one or two of the signs, it does not mean that he or she has dyslexia, but having several of the signs listed below may mean that your child should be tested.

A preschool-age child may:

• Talk later than most children.
• Have more difficulty than other children pronouncing words. For example, the child may read aloud "mawn lower" instead of "lawn mower."
• Be slow to add new vocabulary words and unable to recall the right word.
• Have trouble learning the alphabet, numbers, days of the week, colors, shapes, how to spell and write his or her name.
• Have difficulty reciting common nursery rhymes or rhyming words. For example, the child may not be able to think of words that rhyme with the word "boy," such as "joy" or "toy."
• Be slow to develop fine motor skills. For example, your child may take longer than others of the same age to learn how to hold a pencil in the writing position, use buttons and zippers, and brush his or her teeth.
• Have difficulty separating sounds in words and blending sounds to make words.

A child in kindergarten through fourth grade may:

• Have difficulty reading single words that are not surrounded by other words.
• Be slow to learn the connection between letters and sounds.
• Confuse small words such as "at" and "to," or "does" and "goes."
• Make consistent reading and spelling errors, including:
  • Letter reversals such as "d" for "b."
  • Word reversals such as "tip" for "pit."
  • Inversions such as "m" and "w" and "u" and "n."
  • Transpositions such as "felt" and "left."
  • Substitutions such as "house" and "home."

A child in fifth through eighth grade may:

• Read at a lower level than expected.
• Reverse letter sequence such as "soiled" for "solid," "left" for "felt."
• Be slow to recognize and learn prefixes, suffixes, root words, and other reading and spelling strategies.
• Have difficulty spelling, and he or she may spell the same word differently on the same page.
• Avoid reading aloud.
• Have trouble with word problems in math.
• Write with difficulty or have illegible handwriting. His or her pencil grip may be awkward, fistlike, or tight.
• Avoid writing.
• Have slow or poor recall of facts.

Students in high school and college may:

• Read very slowly with many inaccuracies.
• Continue to spell incorrectly or frequently spell the same word differently in a single piece of writing.
• Avoid tests that require reading and writing, and procrastinate on reading and writing tasks.
• Have trouble preparing summaries and outlines for classes.
• Work intensely on reading and writing tasks.
• Have poor memory skills and complete assigned work more slowly than expected.
• Have an inadequate vocabulary and be unable to store much information from reading.

Adults with dyslexia may:

• Hide reading problems.
• Spell poorly or rely on others to spell for them.
• Avoid writing or not be able to write at all.
• Be very competent in oral language.
• Rely on memory rather than on reading information.
• Have good "people" skills and be very good at "reading" people (intuitive).
• Have spatial thinking skills. Examples of professionals who need spatial thinking abilities include engineers, architects, designers, artists and craftspeople, mathematicians, physicists, physicians (especially orthopedists, surgeons), and dentists.
• Often work in a job that is well below their intellectual capacities.
• Have difficulty with planning and organization.
• Be entrepreneurs, although lowered reading skills may result in difficulty maintaining a successful business.

What Increases Your Risk

The only known risk factor for dyslexia is having a parent or sibling with this condition.¹

Studies suggest that dyslexia may occur about equally in boys and girls.

When to Call the Doctor

If your child struggles with language, reading, and sounding out words, you may want to have your child evaluated for dyslexia. You can also speak with your child's pediatrician, teacher, or school counselor if you believe your child's reading or other language skills are not advancing or your child seems motivated but is performing below his or her potential.

If you have dyslexia and are concerned that your child may have some of the signs of dyslexia, you may want to talk to your doctor or to school personnel because your child is at increased risk for having the condition.

Exams and Tests

Doctors do not diagnose dyslexia with a single test. Rather, your doctor looks at your child's medical history, reviews your observations and those of teachers, and asks your child questions. Reading tests and other types of assessments may also be done to help your doctor find out more about your child's skills. For example, tests may include those that focus on your child's personality traits, learning style, language and problem-solving skills, and intelligence quotient (IQ).

Dyslexia is diagnosed only after it is clear that your child does not have another problem that could cause him or her to struggle with reading, such as a condition that affects cognitive development.

Dyslexia is only diagnosed when:

• There is evidence of a severe reading problem.
• The problem is not due to low intelligence, a visual or hearing deficit or other physical conditions, or a lack of educational opportunity.

Your child's doctor will assess your child's general health and cognitive development. The doctor and your child's educators will assess academic skills and abilities. A complete medical, behavioral, educational, and social history will be taken to rule out other conditions (such as a brain injury) that can also interfere with the ability to read or memorize words.

The most critical tests are those that are timed. A few tests that can help doctors and educational professionals diagnose dyslexia include:

• The Wechsler Intelligence Scale for Children (WISC), an intelligence test that is mostly verbal and does not require reading or spelling.
• The Woodcock-Johnson Psychoeducational Battery-Revised, which measures cognitive or thinking ability.
• The Kaufman Assessment Battery for Children (K-ABC), which measures intelligence and reading skills.

Depending on the severity of your child's dyslexia, you may want to have a teacher's aide or tutor available to help your child with schoolwork. To qualify for special education assistance, federal law requires that a child be tested in the following seven academic areas: oral expression, listening comprehension, written expression, basic reading skills, reading comprehension, math calculation, and math reasoning. These tests help check a child's language and math abilities.

Treatment Overview

Treatment for dyslexia consists of using educational tools to enhance the ability to read. Medicines and counseling are not used to treat dyslexia. An important part of treatment is educating yourself about the condition. The earlier dyslexia is recognized and addressed, the better. Starting treatment when a child is young can improve reading and may even prevent reading problems in the first years of school.³ But reading will likely not ever be easy for a person with dyslexia.

When a child age 3 years and older has been diagnosed with dyslexia, federal law requires that public school personnel create an Individualized Education Program (IEP) that's tailored to the child's needs. The first step in developing the IEP is talking with your child's school to create a treatment team made up of you, the teacher, and other school personnel, including school counselors and special education teachers. You can also ask your child's doctor to attend.

Your child's personalized IEP will detail specific disabilities, appropriate teaching methods, and goals and objectives for the academic year. It is evaluated at least once a year, with changes made based on your child's progress. Parents have the right to appeal if they do not agree with their child's IEP. Preparing children for further education, employment, and independent living is also required by law. This should start no later than age 16.

According to a comprehensive U.S. government study on how children learn to read, a combination of educational methods is the most effective way to teach children to read. These methods include teaching phonics-making sure that the beginning reader understands how letters are linked to sounds (phonemes) to form words. Guided oral reading, in which the student reads aloud with guidance and feedback, is also important for developing reading fluency. The child must clearly understand the instructions being given, and the instructions must be repeatable or systematic in order to improve the child's reading abilities.⁴

Previously, it was thought that covering one eye helped children with dyslexia read better. But the American Academy of Pediatrics and the American Academy of Ophthalmology found this type of treatment is ineffective because dyslexia is caused by altered brain function and not by altered visual function.⁵

It is important to know dyslexia is a lifelong condition. Even though early treatment during childhood can help, your child will likely always have to make an extra effort to read.

Ongoing Concerns

Each child with dyslexia has a different set of abilities and disabilities, which can range from mild to severe. A child's academic future lies in a combination of several things: the severity of dyslexia, his or her intelligence, support of family and school professionals, family resources, motivation to learn, and any associated disability, such as attention deficit hyperactivity disorder (ADHD).

Up to half of children with specific learning disabilities have other impairments that interfere with their schooling.⁶ Disabilities often associated with dyslexia include ADHD, behavioral or memory problems, or difficulty using problem-solving skills to achieve a goal.

Studies that have followed children with dyslexia from kindergarten through high school indicate that most learn to read accurately, although they usually read at a slow rate and are not completely fluent readers. Thus, many teens with dyslexia may need some special assistance in the classroom.

Extra time to finish classroom assignments or tests is often needed by all children with dyslexia. Children with dyslexia also may need help managing their schedules, organizing work, and completing multiple assignments and long-term projects, especially when they reach middle school. It's also helpful to let them:

• Tape classroom lectures.
• Use books on tape to access texts and other required readings.
• Take tests aloud or as short essays rather than as multiple choice.
• Use a laptop computer with a spelling checker.
• Take tests in a separate, quiet room.

Parents can effectively support their child if they understand dyslexia and how to deal with their child's special needs. Having dyslexia can lead to poor self-esteem, depression, or behavioral problems in some children which can hinder their reading progress. If you think your child has self-esteem problems related to dyslexia, counseling may help.

Growth and development: Helping your child build self-esteem

Will my child learn to read and succeed at school?

Typically children with dyslexia are very bright, although reading will probably continue to be a challenge throughout life. The earlier dyslexia is recognized and addressed, the greater the chance that your child will learn to read at his or her highest possible level.³

Encouraging and supporting your child while staying involved in his or her education are other key factors. Helping children with coping strategies as they advance in school will also help. Although extra effort and dedication are required, often children with dyslexia are able to contend with this disability and succeed in academics and other areas.

Helping Your Child

Parents can make a big difference in improving the reading skills of a child diagnosed with dyslexia. Because you are most aware of your child's strengths and weaknesses, you can focus on learning strategies that will work best for him or her. With young children, playing alphabet games and reading rhyming books, for example, while offering support and encouragement, might greatly improve reading skills. Staying involved with your child's education throughout the school years will be a key part of your child's success.

You can be a positive force in your child's education. Following is a list of ways parents can help their young children with dyslexia develop reading skills and feel good about themselves.

• Read to your child. Starting when your child is 6 months old, find time to read to your child every day. Point to the words as you read. Draw attention to words that you run across in daily life, such as traffic signs, billboards, notices, and labels.
• Be a good reading role model. Show your child how important reading is to daily life. Make books, magazines, and other reading materials available for your child to explore and enjoy independently.
• Focus on phonemes. Play rhyming games, sing songs that emphasize rhyme and alliteration, play word games, sound out letters, and point out similarities in words.
• Work on spelling. Point out new words, play spelling games, and encourage your child to write.
• Help with time and planning. Hang up simple charts, clocks, and calendars, so your child can visualize time and plan for the future.
• Share in the joy of reading. Find books that your child can read but that you will also enjoy. Sit together, take turns reading, and encourage discussion. Revisiting words that cause trouble for your child and rereading stories are powerful tools to reinforce learning.
• Read, read, read. Read to and with your child. This can help make a positive difference in learning basic reading skills.

Children with dyslexia may need emotional support for the many challenges they face. Following is a list of ways parents can offer encouragement.

• Learn about dyslexia. Information about dyslexia can help you better understand and assist your child.
• Teach through your child's areas of strength. For example, if your child understands more when listening, let him or her learn new information by listening to a book on tape or watching a video. If possible, follow up with the same story in written form.
• Respect and challenge your child's natural intelligence. Most children with dyslexia have average or above-average intelligence that can be challenged by parents who encourage their intellectual growth. Be honest with your child about his or her disability. Explain it in understandable and age-appropriate examples and terms while offering unconditional love and support.
• Teach your child to persevere. You can model, through good-humored acceptance of your own mistakes, that mistakes can help you find solutions.
• Recognize your child's limitations. There may be some things your child will always struggle with. Help your child understand that this does not mean he or she is a failure.
• Don't become a homework tyrant. Expecting perfection and squabbling with your child over homework will create an unhealthy relationship and emphasize your child's failures.

Other Treatments

Some advertised reading programs that promise success in teaching phonics and reading for children with dyslexia should be viewed with caution. Before you invest in these programs, request research that documents their claims, and talk to school personnel and doctors.

Treatments that block vision, call for special or colored lenses, or advocate eye or balance exercises have not been proved effective.

Previously, it was thought that covering one eye helped children with dyslexia read better. But the American Academy of Pediatrics and the American Academy of Ophthalmology state these treatments are not effective because dyslexia is caused by altered brain function and not by altered visual function.⁵

Other Places To Get Help

Organizations

Related Information

• Attention Deficit Hyperactivity Disorder (ADHD)
• Growth and Development, Ages 2 to 5 Years
• Growth and Development, Ages 6 to 10 Years
• Speech and Language Development

References

Citations

1. Alsobrook JP, et al. (2002). Specific reading disability section of Genetic influences on child psychiatric conditions. In M Lewis, ed., Child and Adolescent Psychiatry, 3rd ed., pp. 421-423. Philadelphia: Lippincott Williams and Wilkins.

2. Nass R, et al. (2002). Specific syndromes of cognitive disorders. In CD Rudolph et al., eds., Rudolph's Pediatrics, 21st ed., pp. 2203-2207. New York: McGraw-Hill.

3. Shaywitz SE, et al. (2006). Dyslexia (specific reading disability). In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1244-1247. Philadelphia: Saunders Elsevier.

4. National Institute of Child Health and Human Development (2000). Report of the National Reading Panel. Teaching Children to Read: An Evidence-Based Assessment of the Scientific Research Literature on Reading and Its Implications for Reading Instruction. Available online: http://www.nichd.nih.gov/publications/nrp/smallbook.htm.

5. Olitsky SE, Nelson LB (2003). Reading disorders in children. Pediatric Clinics of North America, 50: 213-224.

6. Shapiro B, et al. (2007). Specific learning disabilities. In ML Batshaw et al., eds., Children with Disabilities, 6th ed., chap. 25, pp. 367-385. Baltimore: Paul H. Brookes Publishing.

Other Works Consulted

• Grigorenko EL (2007). Learning disabilities. In A Martine, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 410-418. Philadelphia: Wolters Kluwer, Lippincott Williams and Wilkins.

• Lyon GR, et al. (2007). Dyslexia section of Specific language and learning disabilities. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 150-152. Philadelphia: Saunders Elsevier.

• Noble KG, McCandliss BD (2005). Reading development and impairment: Behavioral, social, and neurobiological factors. Journal of Developmental and Behavioral Pediatrics, 26(5): 370-378.

• Shaywitz SE, Shaywitz BA (2003). Dyslexia (specific reading disability). Pediatrics in Review, 24(5): 147-152.

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