Dyslexia, Ages 6 to 12

What is dyslexia?

Although the term has fallen out of favor among child psychologists and other experts, 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, 2.6 million have learning disabilities and a majority of those with disabilities receive special education for reading problems. Of those kids with reading trouble, dyslexia is the most common cause. 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.

What causes dyslexia?

Nobody knows for sure, but most experts agree that some type of neurological dysfunction is involved. In a 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. Some healthcare professionals believe visual dyslexics have poor central vision -- that their eyes approach the printed word at an angle, or off center. But 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 to keep their eyes in the right place as they read. Vision aside, this approach may work by providing them with another sensory link to what they see.

How can I tell if my child is dyslexic?

Be aware of the early warning signs. These include:

• An inability to learn the entire alphabet or to write it in the correct order.
• Difficulty in copying words or sentences. Your child may reverse letters or words (writing d instead of b, for example); this is common among preschoolers but normally disappears by age 7.
• Confusion over identifying similar-looking letters and words. Your child may have trouble telling p from q, may read words backward (saw instead of was ), and may fail to distinguish uppercase letters from lowercase letters.
• Confusion over similar-sounding words. When you say "could," your child may hear it as "good." He may also hear extra sounds that aren't there ("blizzared" instead of "blizzard").
• Trouble retaining concepts after reading or hearing them. Your child may be unable to summarize or explain something he's just read, he may have a hard time following oral instructions, or he may constantly ask you to repeat what you say.
• Confusion about direction when reading or writing. One of the developmental milestones that kindergarten teachers watch for is the practice of navigating a page of text from top to bottom and left to right. Kids need some time to pick this up, but you should probably be concerned if your child is still struggling with it in second or third grade.
• Difficulty following instructions. You may sometimes think that your child is deliberately disobeying you, but what's probably happening is that he's losing track as you explain what you want him to do.
• A dislike of reading, writing, or drawing. Your child may show little interest in these activities, or he may actively avoid situations in which he'd have to do them.
• Trouble expressing thoughts. Not only is writing difficult for children with dyslexia, but so is talking. If your child had a tough time acquiring language skills, including vocabulary and grammar, in early childhood, he may now struggle to express himself clearly with you or others.
• Tested for but not eligible for special education.
• Problems with school such as hating it or dropping grades.
• History of speech language problems.

When should I seek help?

If your child is having trouble learning the alphabet, recognizing words, copying letters or numbers in the correct sequence, or communicating (whether orally or in writing), make an appointment with the psychologist at his school. Under federal law, your local public school must provide an evaluation and, if the psychologist diagnoses a learning disability, a treatment plan that may include special classes. This won't cost you anything. Furthermore, if you disagree with the psychologist's conclusions, you also have the right to request an outside evaluation (at the school district's expense) by a qualified professional of your choice.

You might also want to have your pediatrician examine your child to make sure there's no physical problem interfering with his ability to learn.

How will the diagnosis be made?

Dyslexia is diagnosed when a child has poor verbal skills and no other developmental, emotional, or physical disorder that could be causing the problem. The diagnosis also calls for measuring the gap between the child's intelligence and his achievements in school.

A child or school psychologist will give your child a battery of tests, probably including an intelligence test such as the Iowa Tests of Basic Skills or the Stanford Achievement Test. In checking for a learning disability, perceptual processing tests are used to assess visual, auditory, and motor (producing thoughts in writing) skills. Your child's reading level will also be appraised.

Your pediatrician could give your child a physical exam to rule out factors such as poor hearing or vision. She might also check when your child achieved certain developmental milestones, for example, starting to crawl, walk, and talk. If you're dubious about the diagnosis made by the psychologist at your child's school, you can ask your pediatrician for a referral to a child psychologist, a speech pathologist, or an educational diagnostician.

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 brings rewards, not least of which are good study habits and an ability to work hard.

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 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.

Many teachers aren't formally trained in managing dyslexia but can apply techniques to guide your child without disrupting the class. Furthermore, all public schools have psychologists and special education teachers -- and they can advise your child's teacher. To make sure this happens, set up a meeting with your child's teacher and the school psychologist or special ed people. Effective classroom strategies include:

Phonologic Awareness. One of the best strategies in the treatment of dyslexia, according to guidelines published in the American Family Physician, is to build an awareness of the sound structure of the spoken word, also called phonologic awareness. As children acquire language skills, it is critically important for them to be able to decode syllables and smaller sounds within syllables. Some methods of building phonologic awareness include clapping out the syllables in words, singing songs, and playing rhyming games. According to experts, the earlier dyslexic children acquire phonologic awareness skills, the better the outcome for them over the long run.

• Teaching the alphabet in sequence. Most children learn a letter here, a letter there, eventually putting the set together in its customary order. But dyslexic kids need a more structured approach. Your child can master this critical first step by tracing the alphabet in sequence on a chalkboard. The next steps are to write the letters himself using the teacher's model, then to write the alphabet by himself from memory.
• Using a multisensory approach. Learning experts generally advocate teaching to a dyslexic child's strength -- for example, using visual tools if your child's main difficulty is with auditory processing. And your child may benefit from being able to touch his subject matter, so his teacher might provide wooden letters or flash cards that he can feel and move around.
• Writing out instructions. Dyslexic children often do well when a visual aid backs up what they hear. Your child's teacher might try putting homework assignments on the board or using a poster to chart the day's activities.
• Easing the pressure. If timed tests or drills rattle your child and rote exercises leave him exhausted, discuss other ways his teacher could develop his skills and measure his performance. Could he have more time on tests or not be timed at all? Instead of 20 addition problems, could he do 10? Such minor adjustments can make it much easier for your youngster to keep up.
• Maintaining a placid classroom. Dyslexic children often have trouble tuning out noise and other distractions. His teacher may be able to help just by having him sit near her in the front row. If your child's dyslexia is severe, it might be that he would do best in a special class for kids with learning disabilities. Your child's teacher and pediatrician, as well as the specialists who were involved in his diagnosis, can aid you in making this decision.

What can I do?

• Contact organizations such as the International Dyslexia Association and the National Center for Learning Disabilities for up-to-date information and referrals to support groups and other resources.
• Read up on dyslexia, both on your own and with your child. The Misunderstood Child, by Larry B. Silver, MD, and Learning to Learn, by Carolyn Olivier and Rosemary F. Bowler, are good starting points for parents. The Survival Guide for Kids with LD (Learning Differences) , by Gary Fisher and Rhoda Cummings, is a great book to read with your child; it has an upbeat perspective and offers lots of confidence-building tactics.
• Have your child talk to a therapist. If he's endured even a year or two of struggling in school without knowing why he had so much more trouble than other kids, his self-esteem may be low. He may have suffered from suspecting that his teachers and classmates thought him stupid or lazy. Your reassurance is healing but may not be enough. A professional can work with him on developing respect and compassion for himself.
• Keep reading to your child. You may need to read slowly or stop periodically to talk about what he understands and doesn't understand, but reading together will stimulate his interest in books -- and is a pleasure neither of you should miss.
• Have your child read aloud to you. This is a good way to figure out the kinds of mistakes he tends to make. Correct him gently, and stop if he becomes tired or upset.
• Keep your home orderly and your routine as structured as possible. You can write rules (when to feed the dog, what to pack in a knapsack for school) on colorful poster boards and tack them up where your child will see them. Get a chalkboard and some colored chalk for your child's room, so he can practice his letters in an enjoyable, low-key way. Hang up easy-to-read charts, clocks, and calendars: Your child should be able to see what time of day it is, when his birthday is, what season it is, and how many days are left till Christmas. These time markers will help him to comprehend order and sequence.
• Resist the impulse to discipline your child in situations where his dyslexia may be to blame (when he forgets to bring a book home from school, for example). But don't let his learning disability be an excuse for misbehavior, either; make sure he understands your rules and enforce them appropriately.

What should I tell my child?

After a visit to the doctor, your child may feel uneasy, so first reassure him that he's perfectly healthy. Then explain that he has a problem that makes it difficult for him to make out letters or sounds. You may want to say that his brain works differently when he reads than most people's brains, but nobody knows exactly why or how. If he's been mixing up his letters, point it out as an example of what happens with dyslexia.

Tell him, too, how much you love and value him, and reassure him that your feelings could never be affected by how long he takes to read a chapter or add up some numbers. Self-esteem is critical to overcoming dyslexia, and your child may already be anxious or depressed about doing poorly in school. Remind him of his talents, and point out that his friends all have different strong and weak suits.

Finally, talk to your child about what's ahead. Discuss your expectations and hopes -- and his. Make sure he knows that he can excel so long as he works hard. Be candid about the moments of frustration and disappointment that he'll endure: Homework may take more time, tests may be more difficult, and doing his chores may take more commitment and concentration. What he might find especially tough is having less time to play -- seeing siblings and friends romping in the yard while he's still inside with his books. But tell him that he'll have the full support of everyone who loves him and that you'll do everything you can to help him reach his goals.

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. August 2009. http://www.mayoclinic.com/health/dyslexia/DS00224

Paracchini S, Steer CD, Buckingham L, et al. Association of the KIAA0319 dyslexia susceptibility gene with reading skills in the general population. American Journal of Psychiatry.

Hamilton S et al. Evaluation of Children with Reading Difficulties. American Family Physician. Volume 74, Number 12. http://www.aafp.org/afp/20061215/2079.html

American Academy of Pediatrics. AAP Policy: Vision Problems Do Not Cause Dyslexia. http://www.aap.org/advocacy/releases/july2709vision.htm

US Department of Education. Teach Phonological Awareness. http://dww.ed.gov/practice/?T_ID=15&P_ID=30