Diseases and Conditions » Dyslexia

Dyslexia is a specific learning disability that manifests primarily as a difficulty with written language, particularly with reading and spelling. It is separate and distinct from reading difficulties resulting from other causes, such as deficiencies in intelligence, a non-neurological deficiency with vision or hearing, or from poor or inadequate reading instruction. Dyslexia does not affect speech as a rule.

Evidence suggests that dyslexia results from differences in how the brain processes written and/or verbal language. Although dyslexia is the result of a neurological difference, it is not an intellectual disability. Dyslexia occurs at all levels of intelligence, average, above average, and highly gifted.

The word dyslexia comes from the Greek words δυσ- dys- ("impaired") and λέξις lexis ("word"). People with dyslexia are called dyslexic or dyslectic.

·         Overview

·         History

·         Subtypes of dyslexia

·         Variations and related conditions

·         Scientific research

o    Theories of developmental dyslexia

§  The evolutionary hypothesis

§  The phonological hypothesis

§  The rapid auditory processing theory

§  The visual theory

§  The cerebellar theory

§  The magnocellular theory

§  Perceptual visual-noise exclusion hypothesis

o    Research also indicates

§  Genetic factors

§  Physiology

§  Effect of language orthography

·         Characteristics

o    General

o    Speech, hearing and listening

o    Reading and spelling

o    Writing and motor skills

o    Mathematical abilities

·         Remedial programs and technologies

·         Facts and statistics

·         Legal and educational support issues

·         Controversy

·         See also

·         References

·         External links

o    Historical

o    Research papers, articles and media

o    Regional associations and organizations

o    Support groups and organizations

o    Dyslexia Video

·        Overview

Dyslexia is most commonly characterized by difficulties with learning how to decode at the word level, to spell, and to read accurately and fluently. Dyslexic individuals often have difficulty "breaking the code" of sound-letter association (the alphabetic principle), and they may also reverse or transpose letters when writing or confuse letters such as b, d, p, q, especially in childhood. However, dyslexia is not a visual problem that involves reading letters or words backwards or upside down, nor is such reversals a defining characteristic of dyslexia.

Many individuals with dyslexic symptoms involving reading, writing, and spelling also exhibit symptoms in other domains such as poor short-term memory skills, poor personal organizational skills, problems processing spoken language, left-right confusion, difficulties with numeracy or arithmetic, and issues with balance and co-ordination. These symptoms may coexist with or overlap with characteristics of attention-deficit hyperactivity disorder, auditory processing disorder, developmental dyspraxia, dyscalculia, and/or dysgraphia. However, dyslexia and attention deficit/hyperactivity disorder are not correlated developmental problems.

Evidence that dyslexia is of neurological origin is substantial. Research also suggests an association with biochemical and genetic markers. However, experts disagree over the precise definition and criteria for diagnosis, and some advocate that the term dyslexia be dropped altogether and replaced with the term reading disorder or reading disability (RD). Because reading skills occur on a continuum with no clear distinction between typical readers and dyslexic readers, some experts assert that the term dyslexia should be reserved for the two to five percent with the most severe reading deficits.

Dyslexia is a lifelong condition for which there is no cure, but appropriate remedial instruction and compensatory strategies can help the dyslexic individual mitigate or overcome their difficulties with written language. A large body of evidence shows which types of instruction dyslexics need to be successful. Many dyslexics overcome early problems with literacy and go on to earn advanced degrees and pursue successful careers; a high level of motivation coupled with strong encouragement and mentorship has been identified as factors leading to their success.

·        History

The term 'dyslexia' was coined in 1887 by Rudolf Berlin, an ophthalmologist practicing in Stuttgart, Germany. He used the term to refer to a case of a young boy who had a severe impairment in learning to read and write in spite of showing typical intellectual and physical abilities in all other respects.

In 1896, W. Pringle Morgan, a British physician, from Seaford, East Sussex, England published a description of a reading-specific learning disorder in a report to the British Medical Journal titled "Congenital Word Blindness". This described the case of a 14-year-old boy who had not yet learned to read, yet showed normal intelligence and was generally adept at other activities typical of children of that age.

During the 1890s and early 1900s, James Hinshelwood, a Scottish ophthalmologist, published a series of articles in medical journals describing similar cases of congenital word blindness, which he defined as "a congenital defect occurring in children with otherwise normal and undamaged brains characterised by a difficulty in learning to read." In his 1917 book Congenital Word Blindness, Hinshelwood asserted that the primary disability was in visual memory for words and letters, and described symptoms including letter reversals, and difficulties with spelling and reading comprehension.

A key early researcher in dyslexia was Samuel T. Orton, a neurologist who worked primarily with stroke victims. In 1925 Orton met a boy who could not read and who exhibited symptoms similar to stroke victims who had lost the ability to read. Orton began studying reading difficulties and determined that there was a syndrome unrelated to brain damage that made learning to read difficult. Orton called the condition strephosymbolia (meaning 'twisted signs') to describe his theory that individuals with dyslexia had difficulty associating the visual forms of words with their spoken forms. Orton observed that reading deficits in dyslexia did not seem to stem from strictly visual deficits. He believed the condition was caused by the failure to establish hemispheric dominance in the brain. He also observed that the children he worked with were disproportionately left- or mixed-handed, although this finding has been difficult to replicate. Orton's hypothesis concerning hemispheric specialization was borne out by postmortem studies in the 1980s and 1990s establishing that the left planum temporale, a brain area associated with language processing, is physically larger than the corresponding right area in the brains of non-dyslexic subjects, but that these brain areas are symmetrical or slightly larger on the right for dyslexic subjects. FMRI imaging studies of children and young adults reported in 2003 provide further support, demonstrating that increases in age and reading level are associated with a suppression of right hemispheric activity.

Influenced by the kinesthetic work of Helen Keller and Grace Fernald, and looking for a way to teach reading using both left and right brain functions, Orton later worked with psychologist and educator Anna Gillingham to develop an educational intervention that pioneered the use of simultaneous multisensory instruction. The Orton-Gillingham approach to remedial reading instruction is still widely used and forms the basis of many reading intervention programs.

In the 1970s, a new hypothesis, based in part on Orton's theories, emerged that dyslexia stems from a deficit in phonological processing or difficulty in recognizing that spoken words are formed by discrete phonemes (for example, that the word CAT comes from the sounds [k], [æ], and [t]). As a result, affected individuals have difficulty associating these sounds with the visual letters that make up written words. Key studies of the phonological deficit hypothesis include the finding that the strongest predictor of reading success in school age children is phonological awareness, and that phonological awareness instruction can improve decoding skills for children with reading difficulties.

The advent of neuroimaging techniques to study brain structure and function enhanced the research in the 1980s and 1990s. Since then, interest in the neurologically based causes has persisted. Current models of the relation between the brain and dyslexia generally focus on some form of defective or delayed brain maturation. More recently, genetic research has provided increasing evidence supporting a genetic origin of dyslexia.

Researchers are currently searching a link between the neurological and genetic findings, and the reading disorder. There are many previous and current theories of dyslexia, but the one that has the most support from research is that, whatever the biological cause, dyslexia is a matter of reduced phonogical awareness, the ability to analyze and link the units of spoken and written language.

·        Subtypes of dyslexia

In addition to varying definitions of dyslexia, educators and clinicians have also developed varying subtypes or classifications of dyslexia based on differing patterns of underlying symptoms. Such categories are useful in choosing among remediation strategies, and also for purposes of defining population groups for purposes of research. Large-scale data from comparative studies of reading patterns in dyslexic and normal readers supports a finding of at least two prevalent and distinct varieties of developmental dyslexia. One common approach has been to differentiate a speech discrimination deficit from visual perception impairment. Distinct patterns of neuropsychological organization have been reported in the following three varieties of dyslexia.

§  Dysphonetic or Auditory Dyslexia

The most predominant form of dyslexia identified by researchers is the dysphonetic or auditory subtype, which is associated with difficulty connecting sounds to symbols, and attendant difficulty with sounding out words. The American physician Elena Boder, who developed the Boder Test of Reading-Spelling Patterns (1973), reported this pattern among approximately 60% of the children she surveyed.

§  Dyseidetic or visual dyslexia

The dyseidetic (visual or surface) subtype is associated with inability to develop a sight word vocabulary, slow and laborious reading as familiar words must be repeatedly deciphered, and unconventional but highly phonetic spelling. Boder reported that approximately 10% of her subjects exhibited this pattern, with an additional 22% showing a "mixed" type with elements of both the dyseidetic and dysphonetic forms.

§  Rapid automatic naming or Double Deficit

Other researchers have identified a deficit related to "naming speed", which relates to the ability of students to rapidly verbalize the names of symbols such as letters and numbers when tested. A deficit in "rapid automatic naming" is seen as related to an impaired mental timing system. When such difficulties exist in conjunction with a phonological deficit, it is characterized as double deficit dyslexia.

·        Variations and related conditions

Dyslexia is a learning disability. It has many underlying causes that are believed to be a brain-based condition that influences the ability to read written language. It is identified in individuals who fail to learn to read in the absence of a verbal or nonverbal intellectual impairment, sensory deficit (e.g., a visual deficit or hearing loss), pervasive developmental deficit or a frank neurological impairment.

The following conditions may also be contributory or overlapping factors or underlying cause of the dyslexic symptoms as they can lead to difficulty reading:

o    Auditory processing disorder is a condition that affects the ability to encode auditory information. It can lead to problems with auditory working memory and auditory sequencing. Many dyslexics have auditory processing problems including history of auditory reversals. Auditory processing disorder is recognized as one of the major causes of dyslexia.

o    Cluttering is a speech fluency disorder involving both the rate and rhythm of speech, and resulting in impaired speech intelligibility. Speech is erratic and dysrhythmic, consisting of rapid and jerky spurts that usually involve faulty phrasing. The personality of the clutterer bears striking resemblance to the personalities of those with learning disabilities.

o    Dyspraxia is a neurological condition characterized by a marked difficulty in carrying out routine tasks involving balance, fine-motor control, and kinesthetic coordination. Problems with short term memory and organization are typical of dyspraxics. This is most common in dyslexics who also have attention deficit disorder.

o    Verbal dyspraxia is a neurological condition characterized by marked difficulty in the use of speech sounds, which is the result of an immaturity in the speech production area of the brain.

o    Dysgraphia is a disorder which expresses itself primarily during writing or typing, although in some cases it may also affect eye-hand coordination in such direction or sequence oriented processes as tieing knots or carrying out a repetitive task. Dysgraphia is distinct from Dyspraxia in that the person may have the word to be written or the proper order of steps in mind clearly, but carries the sequence out in the wrong order.

o    Dyscalculia is a neurological condition characterized by a problem with learning fundamentals and one or more of the basic numerical skills. Often people with this condition can understand very complex mathematical concepts and principles but have difficulty processing formulas and even basic addition and subtraction.

o    Scotopic sensitivity syndrome, also known as Irlen Syndrome, is a term used to describe sensitivity to certain wavelengths of light which interfere with proper visual processing. See also Orthoscopics and asfedia.

·        Scientific research

§  Theories of developmental dyslexia

The following theories should not be viewed as competing, but viewed as theories trying to explain the underlying causes of a similar set of symptoms from a variety of research perspectives and backgrounds:

o    The evolutionary hypothesis

This theory posits that reading is an unnatural act, and carried out by humans for an exceedingly brief period in our evolutionary history (Dalby, 1986). It has been less than a hundred years that most western societies promoted reading by the mass population and therefore the forces that shape our behavior have been weak. Many areas of the world still do not have access to reading for the majority of the population. There is no evidence that "pathology" underlies dyslexia but much evidence for cerebral variation or differences. It is these essential differences that are taxed with the artificial task of reading.

o    The phonological hypothesis

The phonological hypothesis postulates that dyslexics have a specific impairment in the representation, storage and/or retrieval of speech sounds. It explains dyslexics' reading impairment on the basis that learning to read an alphabetic system requires learning the grapheme/phoneme correspondence, i.e. the correspondence between letters and constituent sounds of speech. If these sounds are poorly represented, stored or retrieved, the learning of grapheme/phoneme correspondences, the foundation of reading by phonic methods for alphabetic systems, will be affected accordingly.

o    The rapid auditory processing theory

The rapid auditory processing theory is an alternative to the phonological deficit theory, which specifies that the primary deficit lies in the perception of short or rapidly varying sounds. Support for this theory arises from evidence that dyslexics show poor performance on a number of auditory tasks, including frequency discrimination and temporal order judgment. Backward masking tasks, in particular, demonstrate a 100-fold (40 dB) difference in sensitivity between normals and dyslexics. Abnormal neurophysiological responses to various auditory stimuli have also been demonstrated. The failure to correctly represent short sounds and fast transitions would cause further difficulties in particular when such acoustic events are the cues to phonemic contrasts, as in /ba/ versus /da/. There is also evidence that dyslexics may have poorer categorical perception of certain contrasts.

o    The visual theory

The visual theory (Lovegrove et al., 1980; Livingstone et al., 1991; Stein and Walsh, 1997) reflects another longstanding tradition in the study of dyslexia, that of considering it as a visual impairment giving rise to difficulties with the processing of letters and words on a page of text. This may take the form of unstable binocular fixations, poor vergence, or increased visual crowding. The visual theory does not exclude a phonological deficit, but emphasizes a visual contribution to reading problems, at least in some dyslexic individuals. At the biological level, the proposed aetiology of the visual dysfunction is based on the division of the visual system into two distinct pathways that have different roles and properties: the magnocellular and parvocellular pathways. The theory postulates that the magnocellular pathway is selectively disrupted in certain dyslexic individuals, leading to deficiencies in visual processing, and, via the posterior parietal cortex, to abnormal binocular control and visuospatial attention. Evidence for magnocellular dysfunction comes from anatomical studies showing abnormalities of the magnocellular layers of the lateral geniculate nucleus (Livingstone et al., 1991), psychophysical studies showing decreased sensitivity in the magnocellular range, i.e. low spatial frequencies and high temporal frequencies in dyslexics, and brain imaging studies.

o    The cerebellar theory

Yet another view is represented by the automaticity/ cerebellar theory of dyslexia. Here the biological claim is that the dyslexic's cerebellum is mildly dysfunctional and that a number of cognitive difficulties ensue. First, the cerebellum plays a role in motor control and therefore in speech articulation. It is postulated that retarded or dysfunctional articulation would lead to deficient phonological representations. Secondly, the cerebellum plays a role in the automatization of overlearned tasks, such as driving, typing and reading. A weak capacity to automatize would affect, among other things, the learning of grapheme±phoneme correspondences. Support for the cerebellar theory comes from evidence of poor performance of dyslexics in a large number of motor tasks, in dual tasks demonstrating impaired automatization of balance, and in time estimation, a non-motor cerebellar task. Brain imaging studies have also shown anatomical, metabolic and activation differences in the cerebellum of dyslexics.

o    The magnocellular theory

There is a unifying theory that attempts to integrate all the findings mentioned above. A generalization of the visual theory, the magnocellular theory postulates that the magnocellular dysfunction is not restricted to the visual pathways but is generalized to all modalities (visual and auditory as well as tactile). Furthermore, as the cerebellum receives massive input from various magnocellular systems in the brain, it is also predicted to be affected by the general magnocellular defect (Stein et al., 2001). Through a single biological cause, this theory therefore manages to account for all known manifestations of dyslexia: visual, auditory, tactile, motor and, consequently, phonological. Beyond the evidence pertaining to each of the theories described previously, evidence specifically relevant to the magnocellular theory includes magnocellular abnormalities in the medial as well as the lateral geniculate nucleus of dyslexics' brains, poor performance of dyslexics in the tactile domain, and the co-occurrence of visual and auditory problems in certain dyslexics.

o    Perceptual visual-noise exclusion hypothesis

The concept of a perceptual noise exclusion (Visual-Noise) deficit is an emerging hypothesis, supported by research showing that dyslexic subjects experience difficulty in performing visual tasks such as motion detection in the presence of perceptual distractions, but do not show the same impairment when the distracting factors are removed in an experimental setting. The researchers have analogized their findings concerning visual discrimination tasks to findings in other research related to auditory discrimination tasks. They assert that dyslexic symptoms arise because of an impaired ability to filter out both visual and auditory distractions, and to categorize information so as to distinguish the important sensory data from the irrelevant.

§  Research also indicates

o    Genetic factors

Developmental dyslexia also appears to have a genetic component, such that it can tend to occur in multiple members of the same family. Reading difficulties in dyslexia can vary in their severity. The condition is not restricted to childhood, and can persist through adulthood. In addition, while early reports suggested dyslexia is more prevalent in boys, more recent studies have indicated it is not sex-linked, and occurs both in boys and girls with equal frequency.

Studies have linked several forms of dyslexia to genetic markers. One major genetic study identified a region on chromosome 6, DCDC2, as possibly linked to dyslexia.

As of 2007, genetic research in families with dyslexia has identified nine chromosome regions that may be associated with susceptibility to dyslexia. However, several of the major studies have not been replicated.

o    Physiology

Modern neuroimaging techniques such as functional Magnetic Resonance Imaging (fMRI) and Positron Emission Tomography (PET) have produced clear evidence of structural differences in the brains of children with reading difficulties. It has been found that people with dyslexia have a deficit in parts of the left hemisphere of the brain involved in reading, which includes the inferior frontal gyrus, inferior parietal lobule, and middle and ventral temporal cortex.

Scientific studies of brains donated to medical research have revealed that there are anatomical differences in two parts of the dyslexic brain: the cerebral cortex and the thalamus. In 1979 Albert Galaburda of Harvard Medical School noticed anatomical differences in the language center in a dyslexic brain, showing microscopic differences known as ectopias and microgyria. Both affect the typical six-layer structure of the cortex. An ectopia is a collection of neurons that have pushed up from the lower layers of the cortex into the outermost one. A microgyrus is an area of cortex that includes only four layers instead of six. These differences affect connectivity and functionality of the cortex in critical areas related to auditory processing and visual processing, which seems consistent with the hypothesis that dyslexia stems from a phonological awareness deficit.

Studies of both autopsied brains and living brains using neuroimaging techniques have shown that the brains of dyslexic children are symmetrical, unlike the asymmetrical brains of non-dyslexic readers who had larger left hemispheres.

Scientists do not claim that all people with dyslexia have these structural brain differences. However, the studies are evidence that some children's reading problems are brain based. The challenge for researchers is to determine how these structural differences affect reading acquisition.

o    Effect of language orthography

Some studies have concluded that speakers of languages whose orthography has a highly consistent correspondence between letter and sound (e.g., Italian) suffer less from the effects of dyslexia than speakers of languages where the letter-sound correspondence is less consistent (e.g. English and French).

In one of these studies, reported in Seymour et al., the word-reading accuracy of first-grade children of different European languages was measured. English children had an accuracy of just 40%, whereas among children of most other European languages accuracy was about 95%, with French and Danish children somewhere in the middle at about 75%; Danish and French are known to have an irregular pronunciation.

However, this does not mean that dyslexia is caused by orthography: instead, Ziegler et al. claim that the dyslexia suffered by German or Italian dyslectics is of the same kind as the one suffered by the English ones, supporting the theory that the origin of dyslexia is biological. However, dyslexia has more pronounced effects on orthographically difficult languages.

·        Characteristics

Formal diagnosis of dyslexia is made by a qualified professional, such as a neurologist or an educational psychologist. Evaluation generally includes testing of reading ability together with measures of underlying skills such as tests of rapid naming, to evaluate short term memory and sequencing skills, and nonword reading to evaluate phonological coding skills. Evaluation will usually also include an IQ test to establish a profile of learning strengths and weaknesses. However, the use of a "discrepancy" between full scale IQ and reading level as a factor in diagnosis has been discredited by recent research. It often includes interdisciplinary testing to exclude other possible causes for reading difficulties, such as a more generalized cognitive impairment or physical causes such as problems with vision or hearing.

Recent advances in neuroimaging and genetics provide evidence that could potentially help identify children with dyslexia before they learn to read in the future. However, such tests have not yet been developed and more research is needed before such testing could be considered reliable.

§  General

Individuals with dyslexia:

o    May be bright, intelligent and articulate, however their reading, writing and spelling level is below their average age group.

o    Have the same intelligence range as people without dyslexia.

o    May have poor academic achievement due to their problems with reading and writing.

o    May have good oral language abilities but will perform much more poorly on similar written-language tests.

o    Because dyslexia primarily affects reading while sparing other intellectual abilities, affected individuals might be categorised as not "behind enough" or "bad enough" to receive additional help in a school setting.

o    Might feel unintelligent and have poor self-esteem, and might be easily frustrated and emotional about school reading or testing.

o    Might try to hide their reading weaknesses with ingenious compensatory "strategies".

o    Might learn best through hands-on experience, demonstrations, experimentation, observation, and visual aids.

o    Can show talents in other areas such as art, drama, music, sports, mechanics, story-telling, sales, business, designing, building, or engineering.

o    Have related problems with attention in a school setting; for instance they might seem to "zone out" or daydream often; get lost easily or lose track of time; and have difficulty sustaining attention.

§  Speech, hearing and listening

Speech delays may be an early warning sign of dyslexia. Many dyslexics may have problems processing and decoding auditory input prior to reproducing their own version of speech. Early stuttering or cluttering can also be warning signs of dyslexia.

Many dyslexics also can have problems with speaking clearly. They can mix up sounds in multi-syllabic words (ex: aminal for animal, bisghetti for spaghetti, hekalopter for helicopter, hangaberg for hamburger, mazageen for magazine, etc.) They also can have problems speaking in full sentences. They can have trouble correctly articulating R's and L's as well as M's and N's. They often have "immature" speech. They may still be saying "wed and gween" instead of "red and green" in second or third grade. Many dyslexics might have speech therapy in special education. They may have fast speech, cluttered speech, or hesitant speech.

Reading requires the sounding out of words. Therefore,it makes sense that children with speech problems can end up having reading problems later. Many have problems with speech due to problems with auditory processing disorder issues.

Many dyslexics have problems with phonemic awareness. Phonemes are the smallest units in spoken language. The Auditory related underlying causes of dyslexia may be partially remediated by auditory therapy or speech therapy, which help with phonemic awareness. This may help to make sense of phonics which may help with phonological awareness, which is needed to sound out words.

Many acquire auditory processing disorder as an underlying cause of dyslexia from glue ear, Otitis Media.

Some shared symptoms of the speech/hearing deficits and dyslexia:

1.    Confusion with before/after, right/left, and so on

2.    Difficulty learning the alphabet

3.    Difficulty with word retrieval or naming problems

4.    Difficulty identifying or generating rhyming words, or counting syllables in words (phonological awareness)

5.    Difficulty with hearing and manipulating sounds in words (phonemic awareness)

6.    Difficulty distinguishing different sounds in words (auditory discrimination)

7.    Difficulty in learning the sounds of letters

8.    Difficulty associating individual words with their correct meanings

9.    Confusion with combinations of words

10. Due to fear of speaking incorrectly, some children become withdrawn and shy or become bullies out of their inability to understand the social cues in their environment

§  Reading and spelling

o    Spelling errors — Because of difficulty learning letter-sound correspondences, individuals with dyslexia might tend to misspell words, or leave vowels out of words (e.g., spelling "magic" as mjc).

o    Letter order - Dyslexics may also reverse the order of two letters especially when the final, incorrect, word looks similar to the intended word (e.g., spelling "dose" instead of "does").

o    Highly phoneticized spelling - Dyslexics also commonly spell words inconsistently, but in a highly phonetic form such as writing "shud" for "should". Dyslexic individuals also typically have difficulty distinguishing among homophones such as "their" and "there".

o    Reading — Due to dyslexics' excellent long term memory, young students tend to memorize beginning readers, but are unable to read individual words or phrases.

o    Vocabulary - Having a small written vocabulary, even if they have a large spoken vocabulary.

§  Writing and motor skills

Because of literacy problems, an individual with dyslexia may have difficulty with handwriting. This can involve slower writing speed than average or poor handwriting characterised by irregularly formed letters. They may use inappropriate words when writing.

Some studies have also reported gross motor difficulties in dyslexia, including motor skills disorder. This difficulty is indicated by clumsiness and poor coordination. The relationship between motor skills and reading difficulties is poorly understood but could be linked to the role of the cerebellum and inner ear in the development of reading and motor abilities.

§  Mathematical abilities

Dyslexia should not be confused with dyscalculia, a learning disability marked by severe difficulties with mathematics. Individuals with dyslexia can be gifted in mathematics while having poor reading skills. However, in spite of this they might have difficulty with word problems (i.e., descriptive mathematics, engineering, or physics problems that rely on written text rather than numbers or formulas). Individuals with dyslexia may also have difficulty remembering mathematical facts, such as multiplication tables, learning the sequence of steps when performing calculations, such as long division, and other mathematics which involve remembering the order in which numbers appear. This may be exhibited by having a slow response in mathematical drills and difficulty with word problems.

·        Remedial programs and technologies

There is no cure for dyslexia, but dyslexic individuals can learn to read and write with appropriate education or therapy. There is wide research evidence indicating that specialized phonics instruction can help remediate the reading deficits. The fundamental aim is to make children aware of correspondences between graphemes and phonemes, and to relate these to reading and spelling. It has been found that training, that is also focused towards visual language and orthographic issues, yields longer-lasting gains than mere oral phonological training.

Effective training is given by teachers at school or kindergarten. Meta-analysis evaluating the effects of phonological awareness instruction has shown that word reading skills of all children, those with a risk for reading problems as well as those developing typically, improved their reading in systematic phonics instruction, a method that encourages a word to be recognised through the building of its constituent sounds. Basic phonemic awareness instruction did not, however, improve spelling in disabled readers. None of the studies included measures of reading fluency.

The core deficit of dyslexia is in learning to read at the word level, and individuals with dyslexia require more practice to master skills in their areas of deficit. In the circumstances where typically developing children need 30 to 60 hours training, the number of hours that has resulted in optimistic conclusions concerning the treatability of dyslexia is between 80 and 100 hours, or less if the intervention is started sufficiently early. Only approximately 20% of adults with early reading difficulties have acquired fluent reading skills in adulthood.

Functional MRI (fMRI) studies have shown changes in the brains of dyslexic children and adults with phonics tutoring, along with improved performance on tests of phonemic awareness and text decoding. Functional MRI studies have also shown changes in the brain and spelling improvement of dyslexic children taught spelling phonetically in an orthographic manner.

There are also many different therapeutic approaches which focus on providing treatment for underlying cognitive, neurological, auditory, or visual impairments thought to underlie dyslexia, although many of these approaches are controversial. Such approaches include Davis Dyslexia Correction, which is a comprehensive, counseling-based approach combining mental techniques to overcome disorientation associated with dyslexia with the use of clay modeling to learn the alphabet, words and concepts; Fast Forward; the Dore Program (previously known as DDAT), a system of balance and coordination exercises designed to increase cerebellar function; Auditory integration training; Neurofeedback, dietary treatments and many others.

In the seventies and eighties interest grew in how ocular or visual impairments may account for dyslexia with a corresponding growth in "visual training" programs. These programs were controversial and research has shown mixed results.

·        Facts and statistics

In the United States, researchers estimate the prevalence of dyslexia to range from five to nine percent of school-aged children, though some have put the figure as high as 17 percent.

Dyslexia's main manifestation is a difficulty in developing word-level reading skills in elementary school children. Those difficulties result from reduced ability to associate visual symbols with verbal sounds. While motivational factors must also be reviewed in assessing poor performance, dyslexia is considered to be developmental. Most scientific criteria for dyslexia exclude cases that can be explained as arising from environmental factors such as lack of education or total sensory deficits.

Dyslexia can be substantially compensated for with proper therapy, training, and assistive technology. Many coping strategies are developed subconsciously by the individual dyslexic.

The Dyslexic syndrome of symptoms can have a range of underlying causes such as Auditory Processing Disorder the corresponding Visual Processing Disorder, Attention Deficit Disorders (ADD or ADHD).

Dyslexia has many variations dependent on the cultural choice of visual notation of speech. So the nature of the notation used in different cultures creates different types of problems for their groups of dyslexics. The differences between the English text and Chinese characters are a good example.

·        Legal and educational support issues

In the United States, Canada, New Zealand and in the United Kingdom, some people say that there is a lack of adequate support and a general lack of interest in the learning disabilities of children in public schools. This has recently led to legal action by private parties against public schools in the United States and state schools in the United Kingdom. In English law, the recent case of Skipper v Calderdale Metropolitan Borough School (2006) EWCA Civ 238 the Court of Appeal applied Phelps v London Borough of Hillingdon (2001) 2 AC 619 as the landmark case on the failure to diagnose dyslexia (see duty of care in English law), and to hold that the appellant could pursue her claim against her school for humiliation, lost confidence, and lost self-esteem, and for loss of earnings following its failing to diagnose and treat her dyslexia despite the fact that, as Latham LJ. says at para 29:

"The extent to which her dyslexia could have been ameliorated or provided for will always remain uncertain, as will the extent to which that would have affected her performance in public examinations; the evidence that we have includes material to suggest that she, not surprisingly, reacted adversely to the break-up of her parents marriage when she was 15, in other words at a critical time in her education. Whether any improvement in her examination results would have led to her life taking a significantly different course will also be a matter for some speculation."

Some charitable organizations like the Scottish Rite Foundation have undertaken the task of testing for dyslexia and making training classes and materials available, often without cost, for teachers and students.

In England and Wales, the failure of schools to diagnose and provide remedial help for dyslexia following the House of Lords decision in the case of Pamela Phelps has created an entitlement for students with dyslexia in Higher Education to receive support funded via the Disabled Students Allowance. Support can take the form of IT equipment (software and hardware) as well as personal assistance, also known as non-medical helper support. Dyslexic students will also be entitled to special provision in examinations such as additional time to allow them to read and comprehend exam questions.

The British Disability Discrimination Act also covers dyslexia.

"In some cases, people have 'coping strategies' which cease to work in certain circumstances (for example, where someone who stutters or has dyslexia is placed under stress). If it is possible that a person's ability to manage the effects of the impairment will break down so that these effects will sometimes occur, this possibility must be taken into account when assessing the effects of the impairment." — Paragraph A8, Guidance to the Definitions of Disability

·        Controversy

Some disagreement exists as to whether dyslexia does indeed exist as a condition, or whether it simply reflects individual differences among different readers.

"The Dyslexia Myth" is a documentary that appeared as part of the Dispatches series produced by British broadcaster Channel 4. First aired in September 2005, it claims to expose myths and misconceptions that surround dyslexia. It argues that the common understanding of dyslexia is not only false but makes it more difficult to provide the reading help that hundreds of thousands of children desperately need. Drawing on years of intensive academic research on both sides of the Atlantic, it challenged the existence of dyslexia as a separate condition, and highlighted the many different forms of reading style.

The documentary only focused on the reading difficulties that dyslexics encounter. As discussed in previous headings, dyslexia is more than a mere reading disability, and commonly includes symptoms that extend beyond reading difficulties. However, these symptoms are not included in the DSM-IV list of symptoms by which "Reading Disorder" is diagnosed (USA).

Julian Elliott, a psychologist at Durham University in the UK, disputes the characterization of dyslexia as a medical condition, and believes it should be treated simply as a reading difficulty. According to Elliot, "(parents} don’t want their child to be considered lazy, thick or stupid. If they get called this medically diagnosed term, dyslexic, then it is a signal to all that it’s not to do with intelligence.” Elliot believes that children of all levels of intelligence may struggle with learning to read, and that all can be helped by educational strategies appropriate to their needs. He feels that resources are wasted on diagnosis and testing, and favors early intervention programs for all struggling readers.

However, John Everatt of the University of Surrey, also in the UK, has demonstrated that dyslexic students can be distinguished from other children with low reading achievement by testing geared to assessing their strengths as well as weaknesses. Dyslexic children tend to score significantly better than other children, including non-impaired children, on tests of creativity, spatial memory, and spatial reasoning. Dyslexic children also perform better than other reading-impaired children on tests of vocabulary and listening comprehension. Everatt suggests that dyslexic children may be better served by educational intervention which includes strategies geared to their unique strengths in addition to skill remediation, and thus recommends more comprehensive evaluation and targeted interventions