What is Dyslexia?
Dyslexia is a language-based learning difference that impacts a child’s reading skills. In many cases, a child’s basic reading skills do not develop automatically, and reading can be quite effortful for them. Children with Dyslexia often struggle with phonological awareness. Phonological awareness is a neuropsychological process that allows us to understand the foundational sound structure of language and to manipulate that sound structure to decode, blend, and spell words. At its core, it is the ability to associate a sound with certain letters or letter combinations, which is then used to sound out, read, and write words. Other cognitive skills that Dyslexic children can struggle with include reading letters and words at a typical pace for their age, verbal memory, vocabulary knowledge, and processing speed.
When talking about Dyslexia, you might see two different terms – Specific Learning Disorder with impairment in reading and Dyslexia. There are some nuances to both of the terms, but they are generally used interchangeably. Dyslexia just happens to be the term that more people are familiar with.
What are the signs of Dyslexia?
Dyslexia is a language-based learning difference that impacts a child’s reading skills. In many cases, a child’s basic reading skills do not develop automatically, and reading can be quite effortful for them. Children with Dyslexia often struggle with phonological awareness. Phonological awareness is a neuropsychological process that allows us to understand the foundational sound structure of language and to manipulate that sound structure to decode, blend, and spell words. At its core, it is the ability to associate a sound with certain letters or letter combinations, which is then used to sound out, read, and write words. Other cognitive skills that Dyslexic children can struggle with include reading letters and words at a typical pace for their age, verbal memory, vocabulary knowledge, and processing speed.
When talking about Dyslexia, you might see two different terms – Specific Learning Disorder with impairment in reading and Dyslexia. There are some nuances to both of the terms, but they are generally used interchangeably. Dyslexia just happens to be the term that more people are familiar with.
What are the signs of Dyslexia?
As Dyslexia is a language-based learning disorder, one of the potential early signs of Dyslexia is a language delay. This does not mean that a child with a language delay will have Dyslexia, but that sometimes we can see differences in language development that early on. It is also notable that some children who develop Dyslexia had intact or even strong early language skills. However, when they learn to read at a later age, the level at which they can read is much lower than the level at which they can speak.
In young kids, early signs of Dyslexia may include difficulty remembering classmates’ names, playing rhyming games, remembering lyrics to songs or nursery rhymes, and identifying sounds that are similar (e.g., saying words that begin with the same sound).
In early elementary school, signs of Dyslexia include difficulty reading sight words, decoding real words or nonsense words, and spelling, as well as slow, effortful, or error prone reading. In later elementary school, signs of Dyslexia may include difficulty with reading fluency and reading comprehension.
How is Dyslexia diagnosed?
For all diagnoses, we look for consistency between the child’s history, behavioral observations (e.g., what other people are noticing or reporting and what the child is reporting) and test results. Dyslexia can be diagnosed by an educational psychologist or a clinical psychologist. When testing for Dyslexia, your child will typically complete a battery of tests, potentially including the following:
Qualitative data is also important when considering a Dyslexia diagnosis. Paying attention to the types of errors a child makes when reading is important to consider in combination with their overall test scores. Moreover, paying attention to how the child feels about reading, and how effortful and stressful reading is for them, is important as part of the evaluation process.
Many parents expect that learning differences will be identified by the school system, which is not always the case. While classroom teachers, special education teachers, and school psychologists can identify reading difficulties and discrepancies, they are not qualified to make a clinical diagnosis of a Specific Learning Disorder, or Dyslexia. This can be confusing for families, in part because special education plans (e.g., IEPs) use a category called “specific learning disability” when identifying children with learning challenges. However, the use of this category is different from a formal clinical diagnosis. Similarly, a child can receive a clinical diagnosis of Dyslexia, but not meet the criteria for a “specific learning disability” within the school setting. This typically happens when the Dyslexia case is on the milder side, and the child is either compensating for his deficits at school, or, at times, the school assessments are not sufficiently comprehensive to pick up on the disorder. As you might expect, discrepancies between how schools and outside professionals view and diagnose/identify Dyslexia tend to be confusing and frustrating for parents.
Do I need a clinical diagnosis?
The short answer is … it depends. If your child is struggling in reading, it is possible to get them in-school academic supports and/or private tutoring, using systematic phonics-based instruction. However, because Dyslexia commonly occurs with other diagnoses (including Dysgraphia and ADHD), having your child participate in a comprehensive evaluation assessing a range of academic, attentional, and executive functioning skills can be immensely helpful. Moreover, a clinical diagnosis can open up access to additional services and supports.
What are the accommodations and interventions recommended for students with Dyslexia?
Again, Dyslexia is a language-based learning disorder, so it is not uncommon for students with Dyslexia to struggle with other language-based tasks in the school setting (e.g., foreign languages, math word problems, math facts). As reading and language-based tasks are common in the school setting, students with Dyslexia need appropriate accommodations in order to optimize their access to their learning. Additionally, students with Dyslexia work quite hard at school and need to expend an exceptional amount of energy to keep up. Accommodations help keep the school day manageable for them, which helps preserve their identity as a capable learner. Examples of common accommodations may include, but are not limited to:
The most common intervention for Dyslexia is explicit, systematic, phonics-based instruction using an evidence-based system. Examples of evidence-based systems include Wilson Reading System and Orton-Gillingham. More and more schools provide this type of instruction, though some families seek out private tutoring to provide or augment these services. As children get older, intervention may shift away from phonics-based work to an emphasis on vocabulary and reading comprehension strategies (though phonics instruction can still be helpful for a wide range of ages).
What if I am concerned about my child’s reading?
If you are concerned about your child’s reading, you have a few options.
1. You can put in a formal request in writing to have your child evaluated for special education services by the school;
2. You can seek out a licensed psychologist or neuropsychologist who can conduct a comprehensive evaluation, potentially resulting in a formal clinical diagnosis;
3. You can seek outside tutoring, which will generally come with its own form of assessment and progress monitoring, though not a formal diagnosis.
In young kids, early signs of Dyslexia may include difficulty remembering classmates’ names, playing rhyming games, remembering lyrics to songs or nursery rhymes, and identifying sounds that are similar (e.g., saying words that begin with the same sound).
In early elementary school, signs of Dyslexia include difficulty reading sight words, decoding real words or nonsense words, and spelling, as well as slow, effortful, or error prone reading. In later elementary school, signs of Dyslexia may include difficulty with reading fluency and reading comprehension.
How is Dyslexia diagnosed?
For all diagnoses, we look for consistency between the child’s history, behavioral observations (e.g., what other people are noticing or reporting and what the child is reporting) and test results. Dyslexia can be diagnosed by an educational psychologist or a clinical psychologist. When testing for Dyslexia, your child will typically complete a battery of tests, potentially including the following:
- Cognitive assessment
- Academic assessments in reading, writing, and math
- Timed and untimed tests of reading fluency, which can include reading out loud and silent reading
- Tests of phonological awareness
- Rapid letter and word naming tests
- Nonsense word reading
Qualitative data is also important when considering a Dyslexia diagnosis. Paying attention to the types of errors a child makes when reading is important to consider in combination with their overall test scores. Moreover, paying attention to how the child feels about reading, and how effortful and stressful reading is for them, is important as part of the evaluation process.
Many parents expect that learning differences will be identified by the school system, which is not always the case. While classroom teachers, special education teachers, and school psychologists can identify reading difficulties and discrepancies, they are not qualified to make a clinical diagnosis of a Specific Learning Disorder, or Dyslexia. This can be confusing for families, in part because special education plans (e.g., IEPs) use a category called “specific learning disability” when identifying children with learning challenges. However, the use of this category is different from a formal clinical diagnosis. Similarly, a child can receive a clinical diagnosis of Dyslexia, but not meet the criteria for a “specific learning disability” within the school setting. This typically happens when the Dyslexia case is on the milder side, and the child is either compensating for his deficits at school, or, at times, the school assessments are not sufficiently comprehensive to pick up on the disorder. As you might expect, discrepancies between how schools and outside professionals view and diagnose/identify Dyslexia tend to be confusing and frustrating for parents.
Do I need a clinical diagnosis?
The short answer is … it depends. If your child is struggling in reading, it is possible to get them in-school academic supports and/or private tutoring, using systematic phonics-based instruction. However, because Dyslexia commonly occurs with other diagnoses (including Dysgraphia and ADHD), having your child participate in a comprehensive evaluation assessing a range of academic, attentional, and executive functioning skills can be immensely helpful. Moreover, a clinical diagnosis can open up access to additional services and supports.
What are the accommodations and interventions recommended for students with Dyslexia?
Again, Dyslexia is a language-based learning disorder, so it is not uncommon for students with Dyslexia to struggle with other language-based tasks in the school setting (e.g., foreign languages, math word problems, math facts). As reading and language-based tasks are common in the school setting, students with Dyslexia need appropriate accommodations in order to optimize their access to their learning. Additionally, students with Dyslexia work quite hard at school and need to expend an exceptional amount of energy to keep up. Accommodations help keep the school day manageable for them, which helps preserve their identity as a capable learner. Examples of common accommodations may include, but are not limited to:
- Use of assistive technology, including speech-to-text, text-to-speech, and access to audiobooks
- Extra time for tests and assignments
- Material presented in multiple modalities (e.g., verbally, visually, and in written form)
- Spelling errors should not be counted when assessing overall academic and creative writing quality for students with Dyslexia
- Students with Dyslexia may have the option to give responses verbally instead of in writing, and to have math story problems or longer directions read aloud to them
- Allow for modified assignments if appropriate
- Provide a waiver from foreign language requirements
- Support with reading comprehension strategies
The most common intervention for Dyslexia is explicit, systematic, phonics-based instruction using an evidence-based system. Examples of evidence-based systems include Wilson Reading System and Orton-Gillingham. More and more schools provide this type of instruction, though some families seek out private tutoring to provide or augment these services. As children get older, intervention may shift away from phonics-based work to an emphasis on vocabulary and reading comprehension strategies (though phonics instruction can still be helpful for a wide range of ages).
What if I am concerned about my child’s reading?
If you are concerned about your child’s reading, you have a few options.
1. You can put in a formal request in writing to have your child evaluated for special education services by the school;
- Pros: It’s free
- Cons: It can take a long time; it does not result in a formal diagnosis; it does not always result in intervention or support
2. You can seek out a licensed psychologist or neuropsychologist who can conduct a comprehensive evaluation, potentially resulting in a formal clinical diagnosis;
- Pros: A clinical diagnosis can help open up access to services (including special education) and inform treatment planning; a comprehensive evaluation can also look at other factors potentially affecting reading skills (e.g., attention, anxiety); you will receive additional recommendations that may be helpful
- Cons: It can be expensive and many insurance companies do not cover it; it can result in a formal label and some families worry about the stigma of this
3. You can seek outside tutoring, which will generally come with its own form of assessment and progress monitoring, though not a formal diagnosis.
- Pros: It can address the concern without a formal label, which some families feel is less stigmatizing; it can generally happen quickly
- Cons: Some tutors work well with schools to support educational plans, while others do not have as much involvement in school support plans.
Author
Dr. Danielle Mohr is a licensed psychologist at Wolff Child Psychology. She specializes in comprehensive evaluations for children, teens, and young adults, and she conducts regular individual and family sessions.
Learning About Dyslexia