Dyslexia, Ages 3 to 6

What is dyslexia?

Although the term has fallen out of favor among some child psychologists, dyslexia is popularly used to mean a disability in processing language. There are three types: visual (trouble recognizing printed letters or words); auditory (trouble distinguishing certain sounds or connecting sounds to letters), and "expressive writing" (trouble drawing or writing legibly or trouble proceeding from thinking a word to writing it). Your child may have any or all of these types.

How common is dyslexia?

Among children in U.S. public schools, three in 20 receive special education for reading problems; 3 to 5 percent of those kids most likely have dyslexia. Boys are diagnosed with dyslexia more often than girls, though some research indicates that this may be at least partially due to bias on the part of some medical professionals. Some experts believe that dyslexia is the most common learning disability, affecting 5 percent or more of all elementary age children.

What causes dyslexia?

Nobody knows for sure, but most experts agree that some type of neurological dysfunction is involved. In a 1998 study at the Yale University School of Medicine, researchers mapped the brain activity of 29 dyslexic readers and 32 normal readers. For dyslexics, the images showed reduced activity in the part of the brain that processes language and increased activity in the area involved in the spoken word. Researchers called this "a glitch in the circuitry for reading" that makes it difficult to link printed letters and words with the sounds they represent.

Dyslexia runs in some families, which points to a genetic factor. More than a third of people diagnosed with dyslexia have a relative, often a father or an uncle, who is dyslexic.

Some healthcare professionals believe visual dyslexics have poor central vision -- that their eyes approach the printed word at an angle, or off center. But most experts say there's no sound basis for this theory. Eye exercises don't alleviate dyslexia, though many dyslexics find it helpful to use a special "marker" card, a finger, or a pencil when they're reading to keep their eyes in the right place. Vision aside, this approach may work by providing another sensory link to what's seen.

How can I tell if my child is dyslexic?

When your child is this young, it's not easy. Learning disorders such as dyslexia are usually diagnosed by measuring the gap between a child's intelligence (IQ) and his achievements in school. But that's difficult to do in the years before formal achievement testing begins, generally in first or second grade.

Developmental issues also make dyslexia hard to spot. For instance, your child may still be developing the fine motor skills required to hold a pencil. Also, preschoolers commonly reverse letters ("mirror-write"); this generally tapers off by age 7, as a child develops perceptual-motor skills (the ability to link what he does to what he sees). For these reasons, psychologists may hesitate to diagnose dyslexia before a child has reached the first or second grade.

You'll still want to watch your child closely to make sure he's building a secure foundation for writing and reading. Don't jump to conclusions, though: In this age range, what's normal in neurological development ranges widely.

Warning signs of dyslexia include:

• He dislikes books and drawing. A child with dyslexia may show little interest in reading and drawing, no matter how much you encourage him. This suggests he's having trouble recognizing words, understanding concepts, or recalling shapes. By the age of 4, your child should be able to recognize several simple colors; by 5, he should be able to name the colors and draw simple pictures; by 6, he should be able to sort objects by color or shape and name most letters and numerals.
• He's slow to acquire new words and speak in sentences. At least a third of children with dyslexia have trouble progressing beyond simple phrases ("Go store"). A youngster's vocabulary normally should expand from a few hundred words at age 2 to about 2,000 words by age 5, at which point he should be able to ask simple questions ("Can we go to the store now?"). By the age of 6, he should be able to recall a story from a picture book.
• He can't get a grip on time or sequence. Typically, visual dyslexics can't remember the order of the alphabet, months of the year, days of the week, or the month-day-year sequence of a birth date. Test your child to see what he knows: By the age of 3 or 4, he should be aware of past and present; when he's 5, he should be able to talk about last week, today, and tomorrow; at 6, he should be able to anticipate upcoming events, such as a holiday or birthday two weeks ahead.
• He doesn't recognize or respond to rhymes. Auditory dyslexics often can't hear differences between similar vowel sounds. They also have trouble telling similar words apart (big and beg) unless they're used in context. By the age of 5, your child should be able to pick up on rhymes and even make them up as he prattles or sings.

When should I seek help?

If you're anxious about the possibility of dyslexia, it's important to realize that plenty of children in this age range would rather have someone read to them than read on their own. And even those who want to read by themselves will learn at their own pace, which may seem slow. Learning to read is a complicated process for every child, and you may not realize that your child is making progress until he surprises you by pointing to something he wants on a menu or declaring that you skipped a word in his bedtime story.

Still, severe dyslexia generally starts to surface at an early age. Make an appointment with your pediatrician if you notice that your child has trouble learning new words and using them in phrases and sentences, and avoids or shows no interest in storytelling and reading.

How will the diagnosis be made?

Your pediatrician will probably first give your child a physical examination to rule out troubles with hearing or vision and other sources of developmental delay. Your pediatrician may then refer you to a child psychologist, a speech pathologist, or a reading specialist for an evaluation of your child's intelligence and ability to process language.

If your pediatrician finds no signs of a learning problem yet you still feel anxious, trust your guts -- go to a child or school psychologist for an evaluation, anyway. If it turns out you're wrong, you can relax. If you correctly sensed a problem, your child can benefit greatly from the early diagnosis, with special teaching techniques as he starts elementary school as well as the right kinds of guidance from you.

Even if your child hasn't begun formal schooling, under federal law he may be eligible for an evaluation by a psychologist at your local elementary school. Contact your school district for information.

The child or school psychologist may use an intelligence test such as the Wechsler Intelligence Scale for Children or the Stanford Binet Intelligence Scale, or a more specialized test available for very young children. Your child should also be given specialized tests to assess visual processing (for example, does he see the difference between the letters p and q?), auditory processing (does bam sound different from bram?), memory, and integration of information.

Does dyslexia mean my child isn't intelligent?

No. In fact, he may be very bright. A number of famous writers, artists, scientists, and other leaders, including Albert Einstein and Thomas Edison, had dyslexia. Former vice president Nelson Rockefeller wrote memorably about his early years as one of the "puzzle children" and credited dyslexia with forcing him to develop the powers of concentration he needed to become a four-time governor of New York. Mutual fund tycoon Charles Schwab has said that a blank piece of paper "was the most traumatic thing that had ever faced me in life," but he persevered, using personal computers and dictation to get his ideas across. So while dyslexia is a challenge, overcoming it can bring considerable rewards.

Does dyslexia mean my child won't be able to read?

Not at all, though he may always read more slowly than you do, or he may need a pencil to keep track of where he is. But he can learn strategies to ease the process and retain more of what he reads.

Will my child outgrow dyslexia?

Dyslexia is a lifelong condition, but many adults with dyslexia have so thoroughly absorbed the coping strategies that it no longer constitutes a disability. Once your child learns to read and write, his dyslexia will not continue to pose such serious obstacles.

What are the treatment options?

Three basic approaches can smooth the way for children with dyslexia: special teaching techniques in the classroom; behavioral therapy to teach good study habits, including time management; and intensive instruction, if necessary, from a therapist who specializes in reading disorders.

Most daycare directors and preschool teachers aren't formally trained in managing dyslexia, but they can apply techniques to guide your child without disrupting his participation in group activities. Meet with his teacher as well as the school's special education administrators to discuss the best ways to meet his needs. Here are some classroom strategies that work well:

• Create more structure. Ask your child's teacher to be especially clear about routines, rules, and expectations. She might use a chalkboard to write down some simple words -- lunch or nap -- so your child gets a visual cue along with oral instructions.
• Keep the setting calm. Noise is inevitable when children are gathered together, but if your child needs quiet in order to focus, you may want to talk with his teacher about ways to provide that. Or, if possible, you may want find an especially small daycare group or class for him.
• Adopt a multisensory approach. Simply concentrating on printed letters isn't enough for young children with dyslexia; they need to speak, write, read, and feel their way into language. Wooden alphabet blocks, flash cards, phonics games, and other learning aids can help your child get a grip on reading.
• Teach to the strength. Although some learning experts advocate drilling dyslexic kids on their weaker sense, most recommend letting kids learn through the sense that already serves them well. Thus a child whose auditory processing is the main problem may respond well to charts that use animal pictures, colored shapes, or other interesting markers.
• Ease the pressure. Your child will need more time to follow directions, draw a picture, or page through a picture book than other kids do. Explain to your child's teacher that she may need to give him fewer tasks or more time to complete them. Whether your child will need to be placed in a special program for kids with learning disabilities depends on how severe his dyslexia is. You'll make this decision with the help of your pediatrician, any other specialists you've consulted, and -- if your child is in school -- his teacher and the school's psychologist.

What can I do?

• Inform yourself. Loads of resources are available to parents of children with dyslexia. Start with organizations such as the International Dyslexia Association and the National Center for Learning Disabilities, which offer informational materials, support networks, and links to other resources. Two good books for parents are The Misunderstood Child, by Larry B. Silver, M.D., and Learning to Learn, by Carolyn Olivier and Rosemary F. Bowler.
• Keep reading to your child. Sharing stories can be as much fun as it ever was, but you may need to select simpler books, or stop periodically and ask him to summarize, to see if he's following the story.
• Keep your home orderly and your routine as structured as possible. You can write family rules (put your toys away, brush your teeth before bed) on colorful poster boards and tack them up where your child will see them. Set up a chalkboard in your child's room so he can practice drawing or tracing letters; get colored chalk to make it fun.
• Help your child with time sequencing. Hang up simple charts, clocks, and calendars, so your child can see what time of day it is, when his birthday is, what season it is, and how many days are left till Christmas.
• Don't discipline when dyslexia's to blame. There may be times when your child's dyslexia affects his behavior -- perhaps when he has trouble reading, his frustration makes him crabby. In such instances, discipline is not warranted. But neither is a learning disability an excuse for misbehavior. Establish rules, and discipline him gently if he doesn't follow them, as you would any child.

What should I tell my child?

Being careful not to scare or confuse him, explain that he has a problem that makes it difficult for him to make out letters or sounds. Young children won't understand dyslexia or reading disorder, so focus on things your child knows he has trouble doing, like learning the alphabet or remembering the name of his street. Encourage your child by explaining that he may need more time to do certain things, like draw a picture or know his phone number by heart, but that he's perfectly smart and his abilities will improve.

You might explain dyslexia as an individual difficulty that he can overcome. You can say, "You know how it's taken Joey longer than you to learn to ride a bike? Well, you are going to take longer learning letters and numbers. You're just different kids with different skills."

Tell him that you'll work with his teacher to make school interesting and fun. Finally, let him know that you love him and will help him to overcome his dyslexia, just as you would help him with any other challenge.

References

Shaywitz SE, et al. Functional disruption in the organization of the brain for reading in dyslexia. Proc Natl Acad Sci U S A Mar 3;95(5):2636-41

Sally E. Shaywitz, M.D., and Bennett A. Shaywitz, M.D. The Neurobiology of Reading and Dyslexia. http://www.ncsall.net/?id=278

National Institute of Neurological Disorders and Stroke, National Institutes of Health. Learning Disabilities. http://www.ninds.nih.gov/disorders/learningdisabilities/learningdisabilities.htm

Mayo Clinic. Dyslexia. http://www.mayoclinic.com/health/dyslexia/DS00224