DYSLEXSIA
Dyslexia
PREFACE
• Dyslexia is defined in this chapter as an unexpected
difficulty in reading, that is, unexpected in relation to
intelligence, chronological age/grade level, education, or professional
status. In typical readers, development of reading and IQ are
dyslexic readers
dynamically linked over time, but in
there is a developmental uncoupling
between reading and IQ
ETIOLOGY
• Dyslexia is both familial and heritable.
• Dyslexia is observed in 50% of children who have a parent with
dyslexia; 50% of the siblings of dyslexic persons; and 50% of the
parents of dyslexics.
EPIDEMIOLOGY
• Dyslexia is the most common and most comprehensively studied of
the learning disabilities, affecting 80% of children identified as
learning disabled.
• Dyslexia may be the most common neurobehavioral disorder affecting
children, with prevalence rates ranging from 5-10% in clinic- and
school-identified samples to 17.5% in unselected populationbased
samples in the United States and other countries.
• more boys than girls are identified by schools as dyslexic, but in
others study there are no significant gender differences in dyslexia
PATHOGENESIS
reflects deficits
• Evidence from a number of lines of investigation indicates that dyslexia
within the language system, and more specifically, within the
phonologic component of the language system engaged in
processing the sounds of speech.
• Dyslexic individuals have difficulty developing an awareness that spoken words can be segmented into
smaller elemental units of sound (phonemes), an essential ability given that reading requires that the
reader map or link printed symbols to sound. Increasing evidence indicates that disruption of attentional
mechanisms may also play an important role in reading difficulties.
• Functional brain imaging in both children with dyslexia and adult dyslexic readers demonstrates an
inefficient functioning of left hemisphere posterior brain systems, a pattern referred to as the neural
signature of dyslexia.
• Although functional MRI consistently demonstrates differences between groups of dyslexic compared to
typical readers, brain imaging is not able to differentiate an individual case of dyslexic reader from a typical
reader and so brain imaging is not useful in diagnosing dyslexia.
CLINICAL MANIFESTATION
• Reflecting the underlying phonologic weakness, children and adults with
dyslexia manifest problems in both spoken and written language.
• Spoken language difficulties are typically manifest by mispronunciations, lack
of glibness, speech that lacks fluency with many pauses or hesitations and
“ums,” word-finding difficulties with the need for time to summon an oral
response and the inability to come up with a verbal response quickly when
questioned; these reflect sound-based, and not semantic or knowledge-based
difficulties.
• The cardinal signs of dyslexia observed in school-age children and adults are a
labored, effortful approach to reading involving decoding, word recognition,
and text reading.
CLINICAL MANIFESTATION
• Listening comprehension is typically robust. Older children improve reading
accuracy over time, albeit without commensurate gains in reading fluency; they
remain slow readers. Difficulties in spelling typically reflect the phonologically based
difficulties observed in oral reading.
• Handwriting is often affected as well.
• History often reveals early subtle language difficulties in dyslexic children.
• During the preschool and kindergarten years, at-risk children display difficulties
playing rhyming games and learning the names for letters and numbers.
Kindergarten assessments of these language skills can help identify children at risk
for dyslexia.
• Although a dyslexic child enjoys and benefits from being read to, the child might
avoid reading aloud to the parent or reading independently.
CLINICAL MANIFESTATION
• Dyslexia may co-occur with attention-deficit/hyperactivity disorder
this comorbidity has been documented in both referred samples (40%
comorbidity) and nonreferred samples (15% comorbidity).
DIAGNOSIS
• clinical manifestation and history, observation, and psychometric
assessment, if there are unexpected difficulties in reading (based on the
person’s intelligence, chronological/grade, level of education or
professional status) and associated linguistic problems at the level of
phonologic processing.
• Family history, teacher and classroom observation, and tests of language
(particularly phonology), reading including fluency, and spelling represent
a core assessment for the diagnosis of dyslexia in children;
• additional tests of intellectual ability, attention, memory, general
language skills, and mathematics may be administered as part of a more
comprehensive evaluation of cognitive, linguistic, and academic function.
MANAGEMENT
• intervention programs provide systematic instruction in 5 key areas:
phonemic awareness, phonics, fluency, vocabulary, and
comprehension strategies.
• Programs such as Kurzweil, WYNN, Learning Ally, and Bookshare are
available, as are programs such as Dragon Dictate that provide voice-
to-text conversion.
PHONIC AWARNESS
• Taking each component of the reading process in turn, effective interventions improve phonemic
awareness: the ability to focus on and manipulate phonemes (speech sounds) in spoken syllables
and words.
• The elements found to be most effective in enhancing phonemic awareness, reading, and spelling
skills include teaching children to manipulate phonemes with letters; focusing the instruction on 1 or
2 types of phoneme manipulations rather than multiple types; and teaching children in small groups.
• Providing instruction in phonemic awareness is necessary but not sufficient to teach children to
read.
• Effective intervention programs include teaching phonics, or making sure that the beginning reader
understands how letters are linked to sounds (phonemes) to form letter-sound correspondences and
spelling patterns.
• The instruction should be explicit and systematic; phonics instruction enhances children’s success in
learning to read, and systematic phonics instruction is more effective than instruction that teaches
little or no phonics or teaches phonics casually or haphazardly.
FLUENCY
• Fluency is of critical importance because it allows the automatic, rapid
recognition of words and while it is generally recognized that fluency
is an important component of skilled reading, it has proven difficult to
teach.
VOCABULARY AND
COMPREHENSION STRATEGY
• Interventions for vocabulary development and reading
comprehension are not as well established. The most effective
methods to teach reading comprehension involve teaching vocabulary
and strategies that encourage active interaction between the reader
and the text.
• Emerging science indicates that it is not only teacher content
knowledge but the teacher’s skill in engaging the student and
focusing the student’s attention on the reading task at hand that is
required for effective instruction.
