Introduction to Dyslexia

Given the prevalence of dyslexia co-occurring with ADHD, I thought parents would like to know more about dyslexia. While some researchers say 30-40% of individuals with dyslexia may have ADHD, other researchers say it is likely much higher. Furthermore, many students with learning differences are struggling during online schooling related to COVID-19. Both student and parent are experiencing increased frustration as these students may struggle with independent learning. I have therefore asked a licensed psychologist, Dr. Cynthia Johnson, if she could answer a few questions to help parents understand dyslexia and what to do if they are concerned that their child may be struggling with reading.

What is Dyslexia? 

Dyslexia is a brain-based language disorder. It affects brain areas associated with the detection and processing of speech sounds and their corresponding letters. 

The picture below illustrates the brain activity of typical adult readers (red) and adults with dyslexia (blue). Typical readers use areas of the brain associated with language and speech. The connections between these areas become very efficient over time. It can be thought of as using “superhighways” for reading. Readers with dyslexia, on the other hand, use different parts of the brain. The connections form a more distributed network that is slower and less efficient; it can be thought of as using “country roads” for reading.

Individuals with dyslexia have a weakness in phonological processing (detecting and discriminating differences in speech sounds), spelling, and/or rapid naming (quickly retrieving speech sounds and correct letter order patterns that they see). Weakness in these areas can be exhibited in a number of ways. As dyslexia is a language-based disorder, these individuals may have struggled to learn speech sounds when younger. They may struggle with early language games, such as learning to rhyme. This phonological weakness leads to difficulties in decoding or sounding out letters and blended sounds. Sight words may be difficult to recognize and sound out. Recognizing a word in different contexts may be difficult. For example, if individuals can successfully sound out a word, they may struggle to comprehend it (run vs. runner). Complex words (in + stru + ment à instrument) may understandably be very challenging to decode. These difficulties combine to make slow, inaccurate and labored oral reading.

Individuals may also have spelling difficulties. They may be inefficient when writing letters from memory. They typically need increased time to spell words, and they may make an increased number of errors. Individuals with dyslexia may also struggle to name items quickly. For instance, they may have difficulty quickly naming familiar objects, letters, numbers, colors that they see. These difficulties affect reading fluency and comprehension, spelling, and writing.

Dyslexia may affect academic areas other than reading. Mathematics may be challenging when students attempt to memorize number facts or correctly do math operations. Additionally, learning a foreign language can be particularly frustrating for individuals with dyslexia.

Individuals experiencing academic difficulty may also experience emotional difficulties, such as anxious feelings. Work avoidance or other behavioral problems may be an attempt by some children to conceal academic difficulties.

There seems to be a lot of misinformation related to dyslexia. Could you speak about that?

Yes, you are correct, there are a lot of myths related to dyslexia. I’ve included many of them below:

Myth: Dyslexia is a visual problem
Fact: Dyslexia is a language-based problem (processing language sounds), not a visual problem. While some people may have heard that vision therapy can help dyslexia, studies have shown that is not true. Vision therapy helps with vision problems such as convergence insufficiency when eyes do not work together correctly. It does not help with dyslexia since dyslexia is a language-based learning difference.

Myth: Reading and writing letters backward is the main sign of dyslexia.
Fact: Young children, those with and without dyslexia, commonly reverse letters as they are learning to read and write, especially letters such as b/d, and p/q.

Myth: Those with dyslexia cannot learn to read.
Fact: Individuals with dyslexia can learn to read with explicit instructional support. However, depending on the level of severity, it may be a long-term struggle.

Myth: Dyslexia is related to below-average intellect.
Fact: Dyslexia is found in individuals with average and above-average intelligence. Individuals with below-average intellect have different challenges. I tell many of my students that, “you have to be pretty smart to have dyslexia.”

Myth: Dyslexia doesn’t show up until elementary school, and it can’t be diagnosed before a child reads.
Fact: Dyslexia can be seen in preschool, or even earlier when essential language skills are developing.

Myth: Kids just need to try harder to read.
Fact: Most students are trying very hard to read. Outcomes from intervention are more tied to instructional type than effort. Individuals with dyslexia need explicit, structured, multi-sensory instruction.

Myth: “She will outgrow dyslexia.”
Fact: Dyslexia is a life-long challenge in terms of language milestones, schooling, employment, and self-esteem.

What kind of intervention is most helpful?

Individuals with dyslexia typically respond best to explicit instruction, where what is being taught is directly stated and not implied. Instruction can be either individual or in small groups.

Structured literacy that explicitly teaches systematic word identification and decoding strategies are helpful for all students and vital for those with dyslexia. This approach emphasizes phonology (the sound structure of spoken words), including phonemic awareness (ability to distinguish, segment, manipulate and blend speech sounds), sound-symbol association (mapping sounds to their corresponding letters), syllables, morphology (the meaningful part of words), semantics (word meaning and the relationship among words), syntax (the structure of sentences), and orthography (the writing system).

Multisensory instruction, where students use all their senses to learn, is also necessary for students with dyslexia. The use of several senses helps students understand, store, and retrieve information because more parts of the brain are activated than if just using one sense. Students are, therefore, more likely to remember concepts. That being said, typical learners have to come across information approximately 25 times before it is stored in long-term memory. Individuals with learning differences may have to interact with information 250-300 times before it is stored in long-term memory, hence the need for significant repetition. Structured, multisensory reading programs include Orton Gillingham, Wilson, Lindamood-Bell, and Susan Barton.

In terms of the timing of intervention, the earlier, the better. Before the intervention, many students experience significant frustration in their attempts to read. Early intervention efforts can help reduce that frustration.

 Many states are starting to screen kindergarteners for dyslexia. What is included in the screening? What if a child is identified as being ‘at-risk’ for dyslexia?

Research indicates that screening measures for kindergarteners are most successful when they include assessment of phoneme (sound) segmentation, blending, onset and rime (initial and ending sounds), letter naming fluency, letter-sound association, and pseudo-word repetition (Catts, et al. 2015; Jenkins & Johnson, 2008). Pseudo-word repetition, where students both repeat words with atypical spellings they hear (i.e., lirst, strite) and attempt to read pseudo-words that they see, helps determine if they truly understand the sounds of a specific letter or letters in combination.

If a student is identified as struggling with phonological concepts, their school will likely emphasize these concepts explicitly through Response to Intervention (RTI). RTI is a multi-tier approach to the early identification and support of students with learning needs. The RTI process begins with a universal screening of all children in the general education classroom, and progress is monitored over a period of time. If students do not make adequate progress, or they are identified as struggling through screening mechanisms, they receive 2nd tier small group support. If their progress is still limited, they receive 3rd tier high-intensity one-on-one or small group interventions. That said, the RTI process takes time, usually several months, to proceed through the tiers if a student continues to struggle. Parents may, therefore, choose to pay to have their child formally evaluated privately.

According to the International Dyslexia Association’s Dyslexia Assessment Fact Sheet (Lowell, Felton, & Hooks, 2014), a formal clinical evaluation is necessary to determine a diagnosis of dyslexia if the student continues to struggle with literacy skills, despite high-quality instruction using a Response to Intervention approach in the schools. Areas to be assessed include cognitive abilities, phonological awareness, phonological or language-based memory, rapid automatic naming, receptive vocabulary, phonics skills, decoding/encoding real and pseudo-words, oral reading fluency, and writing at the sentence and paragraph level. Evaluations are completed by trained specialists (e.g., psychologists and neuropsychologists, or educational specialists who have advanced degrees in assessment or education.)

In trying to determine whether a child needs formal evaluation outside of the school system, Dr. Johnson stated that it depends on several factors such as the severity of difficulties the child is experiencing and family history. For example, if she had a four-year-old child with a family history of dyslexia, who was struggling with early language milestones, she would have him or her evaluated at that time. Remember, the earlier the intervention, the better for the child’s love of learning, academic success, and sense of self-esteem.

I know you said that dyslexia is a lifelong challenge. What does that look like for an individual entering the workforce?

The fact that someone learns differently does not mean that he or she cannot be successful in the workplace. Individuals with dyslexia have a broad range of abilities, varied strengths, talents, and interests. Just as children with learning differences need specialized, explicit instruction tailored to their needs, adults with learning differences should look for careers that maximize their strengths and minimize their weaknesses.

Understood.org, a website for individuals with learning differences, describe many very successful individuals with dyslexia. Entrepreneurs such as Richard Branson, Barbara Corcoran, and Charles Schwab have such learning differences.

Cindy adds: I remember when I went to the Understood annual dinner, Daymond Johnson from Shark Tank was being honored.  He said that of the six Sharks on Shark Tank, four of them (including him) had Dyslexia! Coincidence?  I don’t think so! 

Many entrepreneurs say that learning and thinking differently helped them thrive in business. Others say it made them more creative and social. Entertainers such as Walt Disney, Tom Cruise, along with journalist Anderson Cooper experience these learning differences. These individuals have likely had appropriate intervention and/or have developed successful coping strategies. Many successful individuals with dyslexia say the most important thing is to not let school struggles or grades define you.

What if a parent is seeing how much their child is struggling with reading during online schooling?

Some students have strong enough verbal abilities that they can compensate somewhat for their reading difficulties. They may be doing “well enough” in school that they have not yet been targeted for reading intervention. Yet parents can see them struggling during more independent learning such as online schooling. These students will struggle even more as their learning becomes more complex and abstract in later years. It is essential to get these students evaluated over the summer. Schools are going to be more frenzied than usual when they start up again, and testing needs to be completed before then.

Cynthia Johnson, Ph.D., NCSP, is a licensed Clinical Psychologist and a Nationally Certified School Psychologist who specializes in diagnosing and treating children and adolescents with learning disabilities, gifted/2e, complex ADHD, intellectual disability, and related emotional, social and behavioral difficulties. She is the owner of StepStone Psychological Assessment and Therapeutic Services, and works extensively with families and schools to support students, and offers therapeutic services to help students utilize their strengths and successfully negotiate any areas of difficulty. She can be reached at: info@stepstoneassessment.com  And her website is www.stepstoneassessment.com.