Up to one in five individuals has dyslexia. This disability cannot be detected until a child starts reading — and thereafter, it can still take several years to arrive at a diagnosis. Here’s how to recognize the symptoms, navigate the diagnostic process, and be the best possible advocate for your child.
Many people have heard of dyslexia — or what is now officially known as a "Specific Learning Disorder with impairment to reading or writing" in the DSM-V. Read on to learn more about the disability, its diagnosis, and interventions.
There is no single, unifying definition of dyslexia agreed upon by all experts, but the definition provided by the National Institute of Child Health and Human Development captures the range of criteria used to diagnose the disorder:
Dyslexia is a brain-based type of learning disability that specifically impairs a person's ability to read. Individuals with dyslexia typically read at levels significantly lower than expected despite having normal intelligence. Although the disorder varies from person to person, common characteristics among people with dyslexia are difficulty with phonological processing (the manipulation of sounds), spelling, and/or rapid visual-verbal responding. Dyslexia can be inherited in some families, and recent studies have identified a number of genes that may predispose an individual to developing dyslexia.
Dyslexia is a heterogeneous disorder — meaning that it has multiple symptoms, not all of which need to be present to receive a diagnosis. The principal symptoms of dyslexia are difficulty with reading and writing.
Reading challenges may manifest in any of the following ways:
- Relatively low fluency, which is an assessment of how quickly and accurately a person reads, as well as how expressive the person is when reading
- Limited comprehension of written texts
Writing challenges may appear as:
- Difficulty with spelling
- Diminished writing fluency, meaning that the speed of writing is slower than is common for non-dyslexic peers
- Difficulty with writing structure, such as not knowing the parts of a paragraph or how to craft a story
- Difficulty with decoding (sounding out) words
Children with dyslexia can have difficulty in at least one of the following areas (and since these skills are interrelated, many students have multiple symptoms):
Fluency - Reading aloud in a monotone - Reading at a rate that is too slow for comprehension (since slow reading requires more memory, as words must be retained from the beginning of a sentence or paragraph) - Re-starting, repeating, or skipping words or sentences frequently (this also requires more memory and manipulation than fluent reading)
Decoding - Substituting one sound or word for another, such as “cat” for “car” - Appearing to guess words; mistakes can be phonological — based on the first sound, as in the “cat”/”car” example — or semantic, as in guessing “floor” for the word “story” - Reading of “non-words” (e.g.,“blork”)
Reading Comprehension - Homing in on a detail of the text, or getting only the gist of a passage without understanding its nuances - Recalling literal details or events, but not making inferential connections between parts of a text, or between one text and others - Making illogical predictions
Encoding (Spelling) - Omitting letters or words in written work - Having difficulty generalizing spelling-pattern rules
Writing Structure - Having limited written output — significantly less in quantity and complexity than a child’s spoken ideas
For a complete list of dyslexia signs in children and adults, visit the Yale Center for Dyslexia and Creativity.
If you recognize some of these dyslexia characteristics in your child, here are factors to consider as you seek out a diagnosis.
Diagnostician and Testing
Dyslexia can be diagnosed by a psychologist (clinical, school, or educational) or a neuropsychologist. An evaluation of dyslexia will include information about family history, developmental milestones, and academic history, as well as tests of intelligence and academic achievement, decoding, reading fluency and comprehension, encoding, and writing structure (length, complexity, and mechanics). A psychologist is also likely to look at previous school work and speak with teachers or other relevant professionals — such as tutors or speech-language pathologists — who may have worked with the child.
In addition to identifying discrete areas that are challenging for the child, the evaluator will want to figure out which skills or needs are interrelated. For example, if a student has difficulty with decoding, it will be difficult for her to understand what she reads. The psychologist may then read a passage aloud to isolate the child’s comprehension ability from any decoding or fluency issues.
See Noodle's guide to learning disabilities in children for a more detailed description of the diagnostic process.
Age of Diagnosis
The American Psychiatric Association’s DSM-V states that Specific Learning Disorders — such as dyslexia — can be diagnosed once a child reaches school age. If, however, parents or day care providers notice that a child is struggling to learn letters, has difficulty with rapid automatic naming (such as quickly labeling shapes in succession) or with articulation and phonology (saying sounds or words), it would be beneficial to begin early reading and writing supports — even before receiving a formal diagnosis or entering school.
Data from one study cited in the journal Paediatrics & Child Health suggest that the prevalence of dyslexia in the general population is between five and 10 percent, while others have estimated the rate to be as high as 17 percent. Because dyslexia lacks a single, standard definition that all professionals follow, it is difficult to draw accurate conclusions about its prevalence. Since dyslexia is just one type of learning disability, moreover, some statistics simply report the total percentage of individuals with “learning disabilities,” but do not provide statistics on the sub-group of dyslexia.
The Brain and Dyslexia
Researchers have conducted multiple studies to determine the neurological causes of dyslexia. Brain scans of people diagnosed with dyslexia have revealed bilateral over-activation in the frontal gyri — areas of the brain involved with attention and inhibition — and less activation in posterior regions that are responsible for processing sound and language, converting written letters and words into sounds, and processing visual information (which is essential for reading). Additional studies are being funded by the National Institutes of Health, which has a searchable database of all the research it has funded. Other institutions that are at the forefront of dyslexia-related research include the Florida Center for Reading Research, the Yale Center for Dyslexia and Creativity, and the Center for Reading and Language Research at Tufts University.
Recognition of the Positives
Dyslexia brings with it many strengths, which we often don’t realize are a direct result of the disorder. Here are several you may have noticed in people with dyslexia:
- Advanced visual comparison, visual processing, and visual manipulation
- Interconnected thinking — the ability to see the “big picture”
- Narrative reasoning — the ability to learn and accurately recall facts gained through experience
- Dynamic reasoning — the ability to deal with novel situations and make predictions based on these experiences
- Greater empathy toward others with learning disabilities, as well as towards non-disabled individuals
Interestingly, dyslexia is comparatively common among successful entrepreneurs: Whether it’s the problem-solving, the interconnected thinking, or some combination, there is research showing that a disproportionately high number of entrepreuneurs have dyslexia, as compared to the general population and other corporate managers.
Along with strengths, though, there are challenges. Various interventions have been shown to help students with dyslexia overcome challenges associated with this disability.
Orton Gillingham (or other multisensory reading instruction)
Multisensory reading instruction is research-validated and hierarchical, meaning that every lesson builds on knowledge gained from previous ones. By definition, it relies on more than one modality — such as speaking and writing and listening — to integrate literacy skills in students with dyslexia.
Assistive Technology (AT)
Sally Shaywitz, a prominent dyslexia researcher, has long recommended using available assistive technologies to support the learning needs of dyslexic students. As these capabilities have improved since she began writing about the topic in 2003, the range and sophistication of tools that students, teachers, and families can utilize have grown enormously. Several of the most promising technologies are:
- Dragon Dictation, a free speech-to-text application for iPad devices
- LiveScribe, a “smart pen” that records audio as someone writes
- Notability and Evernote, both excellent brainstorming and note-taking tools that also enable audio recording, photography, and drawing
- Learning Ally and LibriVox, both websites for free audiobooks
- Texthelp, a multifeature suite of apps that help with reading fluency through text-to-speech, a visual dictionary, and other literacy tools
Some parents may feel concerned about allowing their dyslexic children to use technology in place of traditional reading and writing practices — but there is a large body of research that demonstrates “increased literacy capabilities” among those who integrate AT tools into their learning processes.
Multiple Strategy Instruction
To aid reading comprehension, there is strong evidence in support of multiple strategy instruction, an approach that includes several of the following:
- Activating Prior Knowledge/Predicting — relying on known facts
- Questioning — asking questions
- Visualizing — picturing the text
- Monitoring — checking comprehension
- Clarifying — unpacking difficult concepts
- Fixing Up — catching and fixing problems as they arise
- Drawing Inferences — making connections among ideas based on facts given
- Summarizing/Retelling — providing a synopsis of a section after reading it
Noodle’s range of articles on dyslexia, including:
- Dyslexia Mythbusters
- Dyslexia is Not an Effort Problem
- Graphic Organizers for Students with Dyslexia
- Find Community Through These Expert-Approved Dyslexia Reources
- Apple Products for Students with Dyslexia
- Evaluating Dyslexia-Friendly Schools
- More generally, this article about strengths of people with learning disabilities
- Great Apps for Dyslexia, with additional apps listed here
The following outside resources are well-established authorities in the field of dyslexia. You will find in-depth coverage here:
- Overcoming Dyslexia by Sally Shaywitz
- Thinking Differently by David Flink
- Understanding Dyslexia, a series by The National Center for Learning Disabilities
- The Yale Center for Dyslexia and Creativity
IDA and the Dyslexic Advantage Question. (2014, May 21). Retrieved March 10, 2015, from Dyslexia Help.
Improving Reading Comprehension in Kindergarten Through 3rd Grade. (2010, September 1). Retrieved March 15, 2015, from Institute of Education Sciences.
Kidder, K. (2002, January 1). Who Can Diagnose LD and/or ADHD. Retrieved March 12, 2015, from LD Online.
Logan, J. (2009, January 1). Dyslexic Entrepreneurs: The Incidence; Their Coping Strategies and Their Business Skills. Retrieved March 12, 2015, from Cass Knowledge.
(n.d.). Retrieved March 18, 2015, from Differentiate Reading.
Riddick, B. (2003). Experiences of Teachers and Trainee Teachers Who Are Dyslexic. International Journal of Inclusive Education, 7 (4), 389-402.
Shaywitz, S., & Shaywitz, B., et al (1998). Functional disruption in the organization of the brain for reading in dyslexia. Proceedings of the National Academy of Sciences of the United States of America PNAS, Proceedings of the National Academy of Sciences, 95(5), 2636-2641.
Siegel, L. (2006). Perspectives on dyslexia. Paediatrics & Child Health, 11(9), 581-587.
Signs of Dyslexia. (n.d.). Retrieved March 25, 2015, from The Yale Center for Dyslexia & Creativity.
Tannock, Ph.D., R. (2014, January 1). DSM-5 Changes in Diagnostic Criteria for Specific Learning Disabilities (SLD) 1: What are the Implications? Retrieved March 13, 2015, from University of Michigan.
Technology Integration for Students With Dyslexia. (n.d.). Retrieved March 18, 2015, from Region 10.
What Are Reading Disorders? (2014, April 2). Retrieved March 11, 2015, from National Institute of Child Health and Human Development.
What Is Dyslexia? (n.d.). Retrieved March 10, 2015, from Michigan Dyslexia Institute, Inc..
Venton, D. (2011, September 20). Q&A: The Unappreciated Benefits of Dyslexia | WIRED. Retrieved March 13, 2015, from Wired.