Learning disability: Dyslexia, the most common cause

Introduction

Children often find out ways to escape from studies and due to this reason they are often overlooked of having some underlying problem. Sometimes learning problems can be an indicator for other problems as well. One of the most common learning disability among children is dyslexia. It is often overlooked due to lack of awareness among school teachers and parents. Dyslexia (specific reading disability) causes an unexpected difficulty in reading for children and adults who otherwise possess the intelligence, motivation, and reading instruction considered necessary for accurate and fluent reading.

  1. It is the most common and most carefully studied of the learning disabilities and affects 80% of all individuals identified as learning disabled.
  2. It is persistent and chronic and does not disappear over time.

The dyslexic person possesses the normal IQ and are motivated enough to learn. There are a lot of very famous personalities for whom being affected by dyslexia could not change their dreams and they did what most of us cannot do. Some of the great men Alexander graham bell, Pierre curie, Thomas Edison, Michael faraday, Leonardo da vinci and Paul MacCready who are known as the engineer of the century. Many of the above mentioned men are Nobel laureates or those who have changed the course of their respective fields. To understand dyslexia in a better way many theories have been put forward and the most accepted among them is the phonologic theory which has been described below.

The phonologic theory

  1. The phonologic theory recognizes that speech is natural and inherent, whereas reading is acquired and must be taught. To read, the beginning reader must recognize that the letters and letter strings (the orthography) represent the sounds of spoken language.
  2. To read, a child has to develop the insight that spoken words can be pulled apart into the elemental particles of speech (phonemes) and that the letters in a written word represent these sounds.
  3. Such awareness is largely missing in dyslexic children and adults.

Clinical presentation and diagnosis

Diagnosis is made by the clinician on the basis of

  1. Thorough history
  2. Observation
  3. Psychometric assessment of:
    1. Unexpected difficulties in reading (i.e. expected for the person's age, intelligence, or level of education or professional status)
    2. Associated linguistic problems at the level of phonologic processing.
  4. Dyslexia can affect people differently. Some with dyslexia can have trouble with reading and spelling, while others struggle to write, or to tell. Some children show few signs of difficulty with early reading and writing. But later on, they may have trouble with complex language skills, such as grammar, reading comprehension and more in-depth writing.
  5. Dyslexia can also make it difficult for people to express clearly. It can be hard for them to use vocabulary and to structure their thoughts during conversation.
  6. All of these effects can have a big impact on a person's self-image. Without help, children often get frustrated with learning. The stress of dealing with school work often makes children with dyslexia lose the motivation to continue and overcome the hurdles they face.

There is no single test score that is pathognomonic of dyslexia.

In the preschool child

  1. Language delay
  2. Not attending to the sounds of words (trouble learning nursery rhymes or playing rhyming games with words, confusing words that sound alike, mispronouncing words)
  3. Trouble learning to recognize the letters of the alphabet
  4. A positive family history for dyslexia.
  5. Trouble learning and correctly using new vocabulary

In the school-aged child

  1. Presenting complaints most commonly centring about school performance (not doing well in school), and often parents (and teachers) do not appreciate that the reason is a reading difficulty.
  2. A delay in speaking
  3. Does not learn letters by kindergarten
  4. Has not begun to learn to read by first grade
  5. Has difficulty sounding out words consistently.
  6. The child progressively falls behind, with teachers and parents puzzled why such an intelligent child may have difficulty learning to read.
  7. The reading difficulty is unexpected with respect to the child's ability, age, or grade.
  8. Even after acquiring decoding skills, the child generally remains a slow reader.
  9. Thus bright dyslexic children may laboriously learn how to read words accurately, but they do not become fluent readers; that is, they do not recognize words rapidly and automatically.
  10. Dysgraphia and spelling difficulties are often present and accompanied by laborious note taking.
  11. Self-esteem is frequently affected, particularly if the disorder has gone undetected for a long period of time.
  12. It is also often noted that children affected by dyslexia have problem in following directions.
  13. Dyslexic children might perform well in maths but do have a problem with word problems.

Features of Dyslexia from Second Grade On

Problems in Speaking

  1. Mispronunciation of long or complicated words
  2. Speech that is not fluent: pausing or hesitating often
  3. Use of imprecise language

Problems in Reading

  1. Very slow progress in acquiring reading skills
  2. Lack of a strategy to read new words
  3. Trouble reading unknown (new, unfamiliar) words sounded out
  4. The inability to read small function words such as that, an, in
  5. Oral reading that is choppy and laboured
  6. Disproportionately poor performance on multiple-choice test
  7. The inability to finish tests on time
  8. Disastrous spelling
  9. Reading that is very slow and tiring
  10. Messy handwriting
  11. Extreme difficulty learning a foreign language
  12. History of reading, spelling, and foreign language problems in family members

In an accomplished adolescent or young adult

  1. Slowness in reading or choppy reading aloud that is unexpected in relation to the person's level of education or professional status (e.g., graduation from a competitive college or completion of medical school and a residency).
  2. Thus, in bright adolescents and young adults, a history of phonologically based reading difficulties, requirements for extra time on tests, and current slow and effortful reading (all signs of a lack of automaticity in reading) are the signs of dyslexia.

In summary, at all ages, a history of difficulties getting to the basic sounds of spoken language, of laborious and slow reading and writing, of poor spelling, and of requiring additional time in reading and in taking tests provide indisputable evidence of a deficiency in phonologic processing, which, in turn, serves as the basis for, and the signature of, a reading disability.

Management

The management of dyslexia demands a life-span perspective; early on, the focus is on remediation of the reading problem. As a child matures and enters the more time-demanding setting of secondary school, the emphasis shifts to also incorporate the important role of providing accommodations. Effective intervention programs provide children with systematic instruction in each of the critical components of reading and the practice aligned with that instruction. Some basic modifications in the learning techniques such as modifying the classroom environment which provides support to special children by providing extra time to complete assignments and taking notes and making a modification in assessment system by taking oral tests or viva-voce. Aids such as screen readers, voice recognition computer software and audio tape books are a great helping tool for dyslexic children. The goal is for children to develop the skills that will allow them to read and understand the meaning of both familiar and unfamiliar words they may encounter. The National Reading Panel (NRP) has reported five critical elements that are necessary to teach reading effectively:

  1. Phonemic awareness (the ability to focus on and manipulate phonemes, elemental speech sounds, in spoken syllables and words)
  2. Phonics (understanding how letters are linked to sounds to form letter-sound correspondences and spelling patterns)
  3. Fluency
  4. Vocabulary
  5. Comprehension strategies

The NRP emphasized that these elements must be taught systematically and explicitly, rather than in a casual, fragmented, or implicit manner. Such systematic phonics instruction is more effective than whole-word instruction that teaches little or no phonics or teaches phonics haphazardly.

  1. Fluency is of critical importance because it allows for the automatic, attention-free recognition of words, thus permitting these attention resources to be directed to comprehension.
  2. The most effective method to build reading fluency is a procedure referred to as repeated oral reading with feedback and guidance; that is, the teacher models reading a passage aloud, the student re-reads the passage repeatedly to the teacher, another adult, or a peer, receiving feedback until he or she is able to read the passage correctly.
  3. The evidence indicates that this process of repeated oral reading with feedback has a clear and positive impact on word recognition, fluency, and comprehension at a variety of grade levels and applies to all students-for good readers as well as those experiencing reading difficulties.
  4. The most effective methods for teaching reading comprehension involve teaching vocabulary and strategies that encourage an active interaction between reader and text.
  5. Using evidence-based methods can remediate and may even prevent reading difficulties in children in primary school.

Modifications required at schools and colleges

  1. An essential component of the management of dyslexia in students in secondary school, and especially in college and graduate school, incorporates the provision of accommodations.
  2. High school and college students with a history of childhood dyslexia often present a paradoxical picture; they may be similar to their unimpaired peers on measures of word recognition and comprehension, yet they continue to suffer from the phonologic deficit that makes reading less automatic, more effortful, and slow.
  3. For these readers with dyslexia, providing extra time is an essential accommodation; it allows them the time to decode each word and to apply their unimpaired higher-order cognitive and linguistic skills to the surrounding context to get at the meaning of words they cannot entirely or rapidly decode.

Some helping tools for dyslexic people

Providing extra time for reading is by far the most common accommodation for people with dyslexia. Other helpful aids include:

  1. Laptop computers with spelling checkers
  2. Tape recorders in the classroom
  3. Recorded books
  4. Access to syllabi and lecture notes
  5. Tutors to “talk through” and review the content of reading material
  6. Alternatives to multiple-choice tests (e.g. reports or orally administered tests)
  7. A separate, quiet room for taking tests

With such accommodations, many students with dyslexia are now successfully completing studies in a range of disciplines, including medicine.

Points to note:
  1. Dyslexia is a persistent problem and not a developmental lag.
  2. Problems in reading fluency may represent the most common problems in reading in later school years, and in adolescents and young adults, it may be the hallmark of dyslexia.
  3. In adolescents and young adults, accommodations in the form of extra time on standardized tests are critical to the student with dyslexia.

No one magical program can remediate reading difficulties; a number of programs following the guidelines provided earlier are highly effective in teaching struggling children to read, provided they are implemented by knowledgeable teachers.

References


  1. Current Pediatric Therapy, Eighteenth Edition. Fredric D. Burg, Julie R. Ingelfinger, Richard A. Polin, Anne A. Gershon. Elsevier Inc. ISBN-13: 978-0-7216-0549-4.
  2. current Diagnosis & Treatment: Pediatrics, Nineteenth Edition. William W. Hay, Jr.,Myron J. Levin, Judith M. Sondheimer,Robin R. Deterding. The McGraw-Hill Companies, Inc. ISBN 978-0-07-154433-7.
  3. Textbook of Pedodontics, Second Edition. Shobha Tandon, Paras Medical Publisher, ISBN 978-81-8191-241-1.
  4. Dentistry for the Child and Adolescent, Ninth Edition. Jeffrey A. Dean, David R. Avery, Ralph E. McDonald. Elsevier Inc. ISBN 978-0-323-05724-0
  5. Handbook of Pediatric Dentistry, Third Edition. Angus C. Cameron, Richard P. Widmer. Mosby Elsevier Limited, ISBN 978 0 7234 3452 8.
  6. Special Care in Dentistry, Handbook of Oral HealthCare. Crispian Scully CBE, Pedro Diz Dios, Navdeep Kumar. Churchill Livingstone Elsevier. ISBN 13: 978 0 443 07151 5
  7. Pediatric Secrets, Fourth Edition. Richard A. Polin, Mark F. Ditmar. Elsevier Mosby.
  8. http://www.dyslexia.com/famous.htm#ixzz3GRCzPBc7
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Dr. Sanjay Soni

MDS (Oral and Maxillofacial Surgery) | Reader (MN DAV Dental College and Hospital)

MN DAV Dental College, Solan

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