Dyslexia: What you need to know
By being vigilant to signs of dyslexia, dispelling the myths, and helping to coordinate care, pediatricians can help children with dyslexia enjoy success in school and in daily life.
Learning to read is an extremely complex process, which has been described to be as challenging as learning rocket science.1 Therefore, it is not too surprising that, for many reasons, over 60% of children in America fail to meet standards for reading proficiency.2
Multiple issues may underlie this reading difficulty, including poor early language development, inadequate instruction, insufficient reading practice, lack of background knowledge, and intellectual disability. In some children, however, the problem is the specific learning disability called dyslexia.
Dyslexia is by far the most common learning disability and is present in some degree in up to 20% of children.3 Just as early detection and intervention are crucial in medical diseases, the same is true in learning disabilities. The consequences of untreated dyslexia are broad and can be significant, including effects on academic success and psychosocial well-being. Children with dyslexia experience intense frustration; may act aggressively or withdraw; frequently become targets of bullying and ridicule; have low self-esteem; and may even develop mental health problems, including anxiety and depression.
Pediatricians have the opportunity and responsibility to enable detection and proper treatment of dyslexia in children. This article aims to provide information and strategies that will allow clinicians to best assist and advise patients and their parents.
Dyslexia is a language-based learning disability characterized by difficulties with decoding (sounding out) words, fluent word recognition, and/or reading-comprehension skills. Children with dyslexia often develop secondary problems with comprehension, spelling, writing, and knowledge acquisition.
The difficulties found in dyslexia are usually caused by a phonological deficit (an auditory processing problem involving hearing the sounds in speech). The phonological deficit leads to difficulty connecting speech sounds to letters, which is a skill needed to decode the written word. Alternatively, dyslexia in some children results from problems with oral language skills, sight word recognition, processing speed, comprehension, attention, or verbal working memory.
Anatomical and imaging studies investigating brain development and function show a corresponding physical basis for dyslexia in language-related areas of the brain. The brains of persons with dyslexia function differently than the brains of “typical readers” before they even start to read, as dyslexics use an alternative pathway for reading. Specifically, these investigations reveal that persons with dyslexia have dysfunction in the left-hemisphere posterior reading areas with corresponding compensatory use of the bilateral inferior frontal gyri of both hemispheres and the right occipitotemporal area.3
In discussing the definition of dyslexia and its causes, it is also useful for pediatricians to be aware of the many myths and misperceptions that exist. Dyslexia is not a condition where readers see letters or words upside down or backwards. It is not related to visual or eye-tracking problems.4 In addition, dyslexia is not a developmental issue that children may be expected to outgrow; rather, it is a persistent lifelong condition.
Dyslexia also is not related to intelligence or laziness in a child. Dyslexia occurs in persons with low, normal, and high intelligence quotients (IQs) alike. The fact that dyslexia is not related to IQ, however, creates the potential for a significant learning disability to be overlooked in an otherwise bright child. Dyslexics are often perceived to be “lazy” or “not working up to their potential” when, in fact, they often work harder and longer than their peers.
In addition, there is no male predominance for dyslexia. It is found almost equally in boys and girls, but tends to be identified earlier and more often in boys, perhaps because boys tend to “act out” when they are unable to do a difficult task versus girls who are inclined to make themselves “invisible” in the classroom.
Detection and diagnosis
A diagnosis of dyslexia is established clinically based on history, observation, and a battery of age-appropriate educational tests interpreted by a knowledgeable, qualified professional. Although it is not up to pediatricians to make the diagnosis, an understanding of dyslexia can help to identify children by being attentive to risk factors and signs that are elicited in the medical and social history during well-child exams (Table 1).
Dyslexia is heritable and familial, and so the history should ascertain whether there is a family history of speech and language problems or dyslexia. Other risk factors for dyslexia include prematurity, neurological problems, and developmental or language delays.