What is dyslexia?

Causes and Symptoms

The term dyslexia was first introduced by the German
ophthalmologist Rudolf Berlin in the nineteenth century. Berlin defined it as
designating all those individuals who possessed average or above-average
intelligence quotients (IQs) but who could not read adequately because of their
inability to process language symbols.

The problem involved in dyslexia has been defined and redefined many times since
its introduction. The modern definition of the disorder, which is close to
Berlin’s definition, is based on long-term, extensive studies of children with
dyslexia. These studies have identified dyslexia as a complex syndrome
characterized by a variety of difficulties associated with reading, spelling,
writing, listening, and processing information due to neuroanatomical
abnormalities, particularly deficits in areas of the brain involved in language.
These problems include visual letter and word reversal, difficulties
understanding spoken words and following complex instructions, difficulties
spelling, the inability to sound out new and unfamiliar words, and the inability
to distinguish between important elements of the spoken language. Associated
behavioral problems can arise due to these problems in processing information,
including distractibility, frustration, and loss of motivation in school.

Identifying dyslexia early in order to correct this reading disability is crucial.
To learn to read well, an individual must acquire many basic cognitive and
linguistic skills. First, it is necessary to pay close attention, to concentrate,
to follow directions, and to understand the language spoken in daily life. Next,
one must develop an auditory and visual memory, strong sequencing ability, solid
word decoding skills, the ability to carry out structural-contextual language
analysis, the capability to interpret written language, a solid vocabulary that
expands as needed, and speed in scanning and interpreting written language. These
skills are taught in good developmental reading programs, but some or all are
found to be deficient in individuals with dyslexia. Early educational
interventions that are tailored to the child with dyslexia can focus on building
these deficient skills by teaching phonemes and strategies to better comprehend
written material. Tutoring sessions with a reading specialist or an individual
education plan can help to reinforce these skills.

Many physicians propose that dyslexia is caused by heritable structural
abnormalities in the brain. In-depth studies into the causes of dyslexia have been
made by the use of electroencephalograms (EEGs), computed tomography (CT) scans,
and positron emission tomography (PET) scans.

Another interesting point of view, expressed by some experts, is the idea that
dyslexia may be the fault of the written languages of the Western world. For
example, Rudolph F. Wagner argues that Japanese children exhibit a lower incidence
of dyslexia. The explanation for this, say Wagner and others, is that unlike
Japanese, Western languages require both reading from left to right and phonetic
word attack. These characteristics—absent in Japanese—may make the Western
languages either much harder to learn or much less suitable for learning.
Evolutionary biologists argue that reading and writing are relatively new skills
when considered against the entire time line of human evolutionary history.

A number of experts propose three types of dyslexia. The most common type and the
one most often identified as dyslexia is called visual dyslexia, the lack of
ability to translate the observed written or printed language into meaningful
terms. The major difficulty is that afflicted people see certain words or letters
backward or upside down. The resultant problem is that to the person with visual
dyslexia, any written sentence is a jumble of many letters whose accurate
translation may require five or more times as much effort as is needed by an
unafflicted person. Special fonts have been developed to overcome the problems
posed by visual dyslexia; these fonts are designed to make similar-looking
letters, such as p, b, q, and d, more visually distinct from one another. The
other two problems viewed as dyslexia are auditory dyslexia and dysgraphia.
Auditory dyslexia is the inability to perceive individual sounds of spoken
language. Despite the absence of hearing problems, individuals with auditory
dyslexia have difficulty hearing the differences between certain vowel or
consonant sounds, and what they cannot hear they cannot write. Dysgraphia is the
inability to write legibly. The basis for this problem is a lack of the hand-eye
coordination that is required to write clearly.

Many children with visual dyslexia also exhibit elements of auditory dyslexia.
This complicates the issue of teaching many students with dyslexia because only
one type of dyslexic symptom can be treated at a time.

Treatment and Therapy

The early diagnosis and treatment of dyslexia is essential to its eventual
correction. The preliminary identification of dyslexia can be made from symptoms
that include poor written schoolwork, easy distractibility, poor coordination,
poor spatial orientation, confused writing and spelling, and poor left-right
orientation. Because numerous children who do not have dyslexia also show many of
these symptoms, a second step is required for such identification: the use of
written tests designed to identify dyslexics. These tests include the Peabody
Individual Achievement Test and the Halstead-Reitan Neuropsychological Test
Battery.

EEGs and CT scans may be often performed in the hope of pinning down concrete
brain abnormalities in patients with dyslexia. There is considerable disagreement,
however, regarding the value of these techniques, beyond finding evidence of
tumors or severe brain damage—both of which may indicate that the condition
observed is not dyslexia.

Once conclusive identification of dyslexia has been made, it becomes possible to
begin corrective treatment. Such treatment is usually the preserve of
individualized
education plans. These plans are carried out by the special
education teacher in school resource rooms and provide specially tailored
supplemental education to address the specific problems posed by dyslexia or other
learning difficulties. Many schools also involve special classes limited to
children with reading disabilities and schools that specialize in treating
learning
disabilities. Private or group tutoring sessions with a
reading specialist can also teach strategies to a child with dyslexia to help them
overcome specific difficulties with reading comprehension, writing skills, and
spelling.

An often-cited method used is that of Grace Fernald, which utilizes kinesthetic
imprinting, based on combined language experience and tactile stimulation. In this
popular method or adaptations of it, a child with dyslexia learns to read in the
following way. First, the child tells a spontaneous story to the teacher, who
transcribes it. Next, each word that is unrecognizable to the child is written
down by the teacher, and the child traces its letters repeatedly until he or she
can write the word without using the model. Each word learned becomes part of the
child’s word file. A large number of stories are handled this way.

A second common teaching technique used by special educators is the
Orton-Gillingham-Stillman method, which was developed in a collaboration between
two teachers and a pediatric neurologist, Samuel T. Orton. The method evolved from
Orton’s conceptualization of language as developing from a sequence of processes
in the nervous system that ends in its unilateral control by the left cerebral
hemisphere. He proposed that dyslexia arises from conflicts between this cerebral
hemisphere and the right cerebral hemisphere, which is usually involved in the
handling of nonverbal, pictorial, and spatial stimuli.

Consequently, the corrective method that is used is a multisensory and kinesthetic
approach, like that of Fernald. It begins, however, with the teaching of
individual letters and phonemes. Then, it progresses to
dealing with syllables, words, and sentences. Children taught by this method are
drilled systematically, to imprint them with a mastery of phonics and
the sounding out of unknown written words. They are encouraged to learn how the
elements of written language look, how they sound, how it feels to pronounce them,
and how it feels to write them down. Although the Orton-Gillingham-Stillman method
is as laborious as that of Fernald, it is widely used and appears to be
successful.

An important aspect of dyslexia treatment is parental support. Such emotional
support helps children with dyslexia cope with associated problems of frustration,
lack of motivation, and lowered self-esteem. Useful aspects of this support
include a positive attitude toward the child, appropriate home help that
complements efforts at school, encouragement and praise for achievements, lack of
recrimination when repeated mistakes are made, and positive interaction with
special education teachers.

Perspective and Prospects

The identification of dyslexia by German physician Rudolf Berlin and England’s W.
A. Morgan began the efforts to solve this unfortunate disorder. In 1917, Scottish
eye surgeon James Hinshelwood published a book on dyslexia, which he viewed as
being a hereditary problem, and the phenomenon became much better known to many
physicians. Attempts at educating individuals with dyslexia were highly
individualized until the endeavors of Orton and his coworkers and of Fernald led
to more standardized and widely used methods. These procedures, their adaptations,
and several others had become the standard treatments for dyslexia by the late
twentieth century.

Many famous people—including Hans Christian Andersen, Winston Churchill, Albert
Einstein, George Patton, and Woodrow Wilson—had symptoms of dyslexia, which they
subsequently overcame. This was fortunate for them, because untreated dyslexia
often puts individuals at a great disadvantage.

With the development of a more complete understanding of the brain and its many
functions, better counseling facilities, and the conceptualization and
actualization of both parent-child and parent-counselor interactions, the
probability of success in overcoming the challenges posed by dyslexia has improved
greatly. Moreover, while environmental and socioeconomic factors contribute
relatively little to the occurrence of dyslexia, they strongly affect the outcome
of its treatment.

The endeavors of special education have so far made the greatest inroads in the
treatment of dyslexia. It is hoped that many more advances in the area will be
made as the science of the mind grows and diversifies and the contributions of
psychologists, physicians, physiologists, and special educators mesh even more
effectively.

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