For Medical Professionals

The definition of dyslexia, according to the International Dyslexia Association: 

“Dyslexia is a specific learning disability characterized by difficulties in word reading and/or spelling that involve accuracy, speed, or both and vary depending on the orthography. These difficulties occur along a continuum of severity and persist even with instruction that is effective for the individual’s peers. The causes of dyslexia are complex and involve combinations of genetic, neurobiological, and environmental influences that interact throughout development. Underlying difficulties with phonological and morphological processing are common but not universal, and early oral language weaknesses often foreshadow literacy challenges. Secondary consequences include reading comprehension problems and reduced reading and writing experience that can impede growth in language, knowledge, written expression, and overall academic achievement. Psychological well-being and employment opportunities also may be affected. Although identification and targeted instruction are important at any age, language and literacy support before and during the early years of education is particularly effective.” 

Dyslexia is a prevalent learning difference that is widely unidentified. About 13-14% of the school population nationwide has a learning disability in reading that qualifies them for special education. Many more people—perhaps up to 20% of the population as a whole—have symptoms of dyslexia. Even though students may not qualify for special education, they still struggle with many aspects of academic learning.

Children and adults with undiagnosed dyslexia carry a psychological burden.  You may encounter a child who is intelligent yet struggling in school. Undiagnosed dyslexia can look like ADHD and there is a high comorbidity between ADHD and dyslexia.

In some cases, insurance companies offer coverage for neuropsychological evaluations to diagnose and for remediation services.

Screening for characteristics of dyslexia is a useful way to identify students who may have a learning disorder. It’s just like screening for vision or hearing problems.

Doing an online screener can help parents determine if their child has several warning signs and should seek a neuropsychological evaluation. These screeners may be helpful to families:

International Dyslexia Association

Made By Dyslexia: Take the Dyslexic Thinking Test 

Yale Center for Dyslexia and Creativity: Signs of Dyslexia

If you notice three or more of these signs in your patient, it may be worth further evaluation with a neuropsychologist.

  1. Equip yourself with information from Up to Date (UTD) and other research bodies such as Mayo Clinic, Yale Center for Dyslexia, or University of Michigan.
  2. Choose a screening tool for your rooming staff to administer with other well-child visit tools.
  3. If identifying characteristics are present, refer the family to a neuropsychologist that specifically tests for dyslexia (not all neuropsychologists test for dyslexia).
  4. Screen for comorbidities like ADHD and anxiety and consider setting up follow– up appointments to screen for these based on the statics surrounding increased risk for mental health, substance abuse, risk taking behavior, ODD, and more. Frequency is based on the individual but often at least three times during the school year unless another medical health professional or school counselor is specifically targeting this.
  5. An undiagnosed, un-remediated learning disability is often traumatic both for the child and family. Consider arranging visits for family members including the parents to assess and support their own journeys.

Children will out grow their dyslexia/reading impairment on their own and catch up eventually.

  • Without intervention, children who are poor readers at the end of first grade almost never acquire average-level reading skills by the end of elementary school (Francis et al., 1996; Juel, 1988; Shaywitz et al., 1999; Torgesen and Burgess, 1998).

  • Even in highly transparent languages such as German, 70% of below average readers in 1st grade remain below average readers in 8th grade (Landerl & Wimmer, 2008)…early intervention is key!

Even if you screen for dyslexia and reading impairments as early as Pre-K or K, you won’t be able to intervene effectively that early anyway

  • A meta-analysis comparing intervention studies for children struggling with reading difficulties/dyslexia offering at least 100 sessions, reported larger effect sizes in kindergarten/1st grade than in 2nd and 3rd grades (Wanzek & Vaughn, 2007; Wanzek et al., 2013)

  • When “at risk” beginning readers receive intensive instruction, 56% to 92% of at-risk (for dyslexia/reading impairment) children across six studies reached the range of average reading ability (Torgesen, 2004)

  • Converging research points to the importance of early interventions for at-risk students for improving the effectiveness of remediation ( e.g.; Connor, 2009, 2013; Catts, 2015; Denton & Vaughn, 2008;Torgesen,1999; Flynn, Zheng, & Swanson, 2012; Vellutino, 1996; Morris,1997)

First Signs of dyslexia or reading impairments can only be seen after 2-3 years of reading instruction

  • Many longitudinal (following the same kids over time) studies have revealed key predictors in young children.

  • Research has shown that these key predictors of subsequent problems with learning to read include:

    • Phonological/Phonemic awareness

    • Pseudoword repetition

    • Rapid automatized naming

    • Expressive/receptive vocabulary

    • Oral listening comprehension

    • Letter (sound) knowledge

Early Screening for dyslexia/reading impairments gives students a diagnosis at age 5 before they can read

  • The purpose of early screenings is not to diagnose, but to identify children AT RISK for developing a reading impairment.

  • Dr. Gaab explains this in this article written for the BOLD blog: https://bit.ly/349VNzp :

    • “An analogy from medicine may be helpful in this context: Adults are advised to undergo screening for high cholesterol levels, which can indicate an increased risk of developing heart disease. Those diagnosed with high cholesterol don’t automatically receive a diagnosis of heart disease. They are provided with an evidence-based “response to screening,” generally a combination of prescribed exercise, dietary changes, and/or medication. This may prevent the development of the disease, or at least lessen its severity. The goal is to reduce the prevalence of heart disease, by encouraging people to take preventive action and to improve outcomes of those who will develop it by implementing lifestyle changes earlier, prior to a diagnosis.”

  • In the case of reading impairments, we need to make a similar shift from a deficit-driven to a prevention model. With the help of high-quality screening programs, we can identify AT-RISK children early, but refrain from diagnosing them while they are still in preschool/K.

  • For Gaab Lab articles on screening and prevention for dyslexia/reading impairments, please see for example: https://bit.ly/2NeKpeJ, https://bit.ly/2BO5reQ, https://osf.io/z4ryh/, and https://bit.ly/349VNzp

  • Furthermore, look at the excellent work by Hugh Catts at Florida State Unversity, e.g., this article https://bit.ly/2plrK95 and also take a look at this white paper on screening published by NCIL Literacy: https://bit.ly/31PabLG co-authored by Yaacov Petscher, Nadine Gaab, and the Texas Center for Learning Disabilities.