Dyslexia

Most parents have, at one time or another, observed their young child interchanging letters as they read or reversing a number or a letter as they learn to write.  You may have even asked yourself, “Does my child have dyslexia?”  Fortunately, for most parents this isolated behavior, especially in young children, is not sufficient evidence of dyslexia.  Dyslexia is a brain-based disorder in which an individual has unexpected difficulty reading words accurately.  In other words, children with dyslexia have difficulty matching letters and groups of letters (graphemes) with their corresponding sounds (phonemes). For example, a child with dyslexia may read a word like “bake” and say “back,” or may spell the word “baked” as “bakd.”  Grapheme/phoneme correspondence that is unexpected for a child’s age and grade is at the root of dyslexia, and can translate to more complex problems with reading, including slow and/or labored reading, trouble understanding longer passages, and poor spelling.  So while letter reversals can show up in dyslexia, it is actually a much more complex topic than many would think.

Dyslexia is a developmental, neurobiological disorder.  In other words, scientists have discovered subtle differences in the brain’s architecture between children with dyslexia and those without it.  The good news is that children with dyslexia usually respond well to structured, intensive remediation, and the brain responds to intervention by following suit.  When a child learns to read well, the brain actually develops stronger connections to the parts of the brain responsible for visualizing words, saying words silently in one’s head, and thinking about their meaning.

Although dyslexia is found in children with or without other developmental disorders, and among children of varied intellectual abilities, there are some disorders with which dyslexia is most commonly found.  It is common for children with early speech and articulation issues to struggle with reading.  In fact, the same systems in the brain that work together to produce language also work together when a child reads.  Dyslexia is also commonly found in children with Attention-Deficit Hyperactivity Disorder (ADHD).  If you think about it, it makes sense.  Children who have difficulty with concentration have a harder time focusing on reading sentences and longer passages.  They find reading frustrating and have less practice reading in the long run in comparison to their peers without ADHD. 

Assessment

If your child is having difficulty sounding out words, reading slowly, spelling, or is having trouble answering questions about stories they have just read, they may benefit from an educational assessment.   You may want to discuss these issues with your child’s teacher and/or resource specialist who may suggest monitoring your child’s progress with brief, periodic testing.  The standard of care involves using tests with information about your child’s placement according to their age and grade to monitor their progress.  If, despite appropriate instruction, your child continues to struggle and fall behind in reading, a school psychologist may recommend an Individualized Educational Program (IEP), where specific targets for intervention are identified. 

In some instances, an assessment with a broader scope by a community practitioner is appropriate.  If a child does not have reading abilities that differ significantly from their overall cognitive abilities, children may be denied more intensive reading intervention in the school setting.  In some instances, children and adolescents who are very bright have worked very hard to learn how to decode new words, but may still read slowly or have a hard time with comprehension.  When a school-based assessment leaves unanswered questions, an Independent Educational Evaluation (IEE) conducted by a community-based provider may be appropriate.  Additionally, if you are concerned that your child may have another disorder that is not assessed in a typical educational setting, such as ADHD, or if you are concerned that your child has a medical history that could be contributing to their overall brain functioning, a neuropsychological evaluation by a licensed clinical psychologist with specialty training in pediatric neuropsychology is recommended. 

I routinely screen for dyslexia in my own pediatric neuropsychology practice, as I believe it is one of the most important skills a child can have.  After about the 4th grade, reading is the window to learning about history and science and many of the other interests that can enrich a child’s life.  Without strong reading skills, children can fall behind in other subjects as well and their confidence and self-esteem suffers.  If you suspect your child may have dyslexia, I recommend not delaying an appropriate assessment. 

Intervention

There are some strategies that parents can utilize at home to help strengthen their child’s reading skills. One of the most important things is to help build a child’s phonological awareness (i.e., strengthen a child’s ability to sound out groups of letters).  Explicit instruction in phonics is critical, as whole-word or naturalistic approaches are not as effective for struggling readers.  In order to improve reading fluency, the ability to read words quickly and efficiently, I suggest using flash-card techniques that improve “sight word” reading.  In other words, as long as the child understands the rules for sounding out certain words, the focus can shift to improving your child’s ability to recognize words quickly without having to sound them out.  I typically recommend that parents provide their children with a variety of high-interest books at or below their reading level.  The idea is to make reading fun and increase a child’s exposure to texts.  Allow plenty of time for leisurely reading without the stress of intervention.

Teaching reading skills can, and often does, create tension between a well-meaning parent and a frustrated child.  In those instances, it may be beneficial to have an educational therapist provide additional instruction in the home and/or help with homework completion.  For additional instruction outside of the school setting, I often recommend contacting a local Lindamood-Bell (http://lindamoodbell.com/) center or locating a practitioner or educator certified in the Orton-Gillingham approach (http://www.ortonacademy.org/for-parents/find-a-teacher-tutor/).  Recommendations for reading intervention are usually tailored for each child or adolescent based on their reading ability and learning style.  No one approach fits all.  I recommend working with a qualified professional to create a treatment plan that fits your child’s needs. 

Author:

Dr. Vindia G. Fernandez is a licensed clinical psychologist with specialty training in pediatric neuropsychology, serious mental illness, and social-skills training.  She is a faculty member in the Division of Child and Adolescent Psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior, where she is an attending clinician in the UCLA PEERS Clinic. Dr. Fernandez obtained her undergraduate degree at Yale University and her Ph.D. in clinical psychology from the University of Houston, where she conducted dyslexia research and clinical work in neuropsychology at Baylor College of Medicine and Texas Children's Hospital. She completed her internship and postdoctoral training at the UCLA Semel Institute. As a recipient of the Ruth L. Kirschstein National Research Service Award from the National Institute of Health, Dr. Fernandez studied language and neurocognitive functioning in young adults with schizophrenia.

Dr. Fernandez can be reached at:

(424) 255 6388
center@pediatricneuropsych.com
www.pediatricneuropsych.com