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Dyslexia – Definitions & Characteristics and how can be treated?

Last updated date: 13-Dec-2021

CloudHospital

12 mins read

Dyslexia – Definitions and Characteristics

Reading is a human-only ability that is essential for survival in today's society. Reading is one of the first subjects taught in elementary school. Children are frequently assigned to long-term educational achievement tiers depending on their ability to learn to read.

 

Dyslexia definition 

Dyslexia (developmental dyslexia) occurs when youngsters struggle to learn to decipher words. When reading aloud, decoding is the accuracy or fluency that one acquires. These kids have difficulty sounding out words and identifying "sight words."

They have low reading fluency and struggle with spelling. These youngsters generally do not have difficulties with their speech or nonverbal talents. It is crucial to emphasize that a reading difficulty cannot be explained by a lack of educational options or a lack of intellectual potential.

Over the last 25 years, scientific understanding of dyslexia and other learning disorders has advanced rapidly in areas such as description and categorization, neuropsychological correlates, neurobiological variables, and treatments.

 

Dyslexia meaning

Dyslexia is now often characterized as "difficulties with accurate and/or fluent word recognition, as well as poor spelling and decoding ability," according to a definition from the International Dyslexia Association (IDA). These challenges are generally caused by a deficiency in the phonological component of language, which is frequently unanticipated in connection to other cognitive talents and the provision of successful classroom education."

Dyslexia is a lifetime condition that can offer problems on a daily basis, but treatment is available to enhance reading and writing abilities and help individuals with the problem be successful at school and employment.

 

Etiology

Dyslexia is inherited; nevertheless, household literacy and education quality have a significant influence on a child's reading ability. Reading problems are strongly heritable, according to twin studies, and new genetic investigations have discovered numerous minor genes that influence reading development. These genes have an impact on neuron migration, cortical morphogenesis, neurite outgrowth, and the structure and function of cilia.

 

Risk factors for dyslexia

  • Family history
  • Early speech delay
  • Prematurity
  • Very low birth weight (<1500 g)

Although it is often held that males are considerably more likely than women to be dyslexic, new study has found that this supposed sex imbalance is not supported. There are somewhat more males than women with dyslexia, but the difference is not statistically significant.

Dyslexia obviously has a neurological foundation. A number of postmortem investigations have revealed anomalies in dyslexic people's brains. The lack of the normal asymmetry in the planum temporale is the general finding. There may also be anatomical abnormalities in the corpus callosum, which governs communication between the two hemispheres of the brain, between dyslexics and nondyslexics.

 

Epidemiology

Reading ability varies greatly throughout the population and is highly dependent on education level. It is believed that up to one in every ten persons in the UK suffers with dyslexia. Dyslexia affects around 7% of the population, and there is no racial or gender difference.

 

Pathophysiology

During the early phases of learning, the cerebellum is extremely active. Differences in the cerebellum of people with dyslexia have been discovered using structural and functional MRI. These people were found to have less grey matter in the right lobule of the VI. When individuals with dyslexia were asked to name things quickly, this lobule was shown to have abnormal activity.

It is essential to highlight that the cerebellar abnormalities seen in dyslexia differ from those seen in autism spectrum disorder and attention deficit hyperactivity disorder (ADHD), suggesting that distinct circuits cause different symptoms.

Postmortem imaging revealed decreased asymmetry of the planum temporale's left and right sides, as well as left perisylvian architectonic dysplasias and neuronal ectopias. For in-vivo investigations, magnetic resonance imaging (MRI) scanning is employed.

Several electrophysiological investigations have revealed differences between dyslexics and nondyslexics. Event-related potentials can be used to evaluate the timing and brain regions engaged during print and language cognitive processing. A number of investigations, for example, have revealed that dyslexics' event-related potentials, in contrast to nondyslexics', failed to display what is known as mismatched negativity, which is a negative deflection in the wave in response to a change in the stimulus.

Functional magnetic resonance imaging has revealed structural variations between dyslexic and nondyslexic brains. The precise nature of these differences differs depending on the investigation. In general, variations in the planum temporale have been discovered, resulting in significant asymmetries in the nondyslexic, and the orientation may even be reversed in the dyslexic.

Functional MRI (fMRI) is now being utilized to investigate the brain regions involved in certain tasks. Dyslexics exhibit abnormal activations in the left temporoparietal areas, as well as bilaterally in the frontal and occipital regions, according to fMRI testing.

 

Dyslexia symptoms

Depending on their age, children with reading challenges manifest in a variety of ways. Early intervention is critical to improve their result since most children who have reading problems in third grade continue to struggle throughout their formal schooling. Typically, a diagnosis is not made until formal reading education has been undertaken, which is generally in the first grade.

Dyslexia generally manifests itself when a child enters school and begins to focus more on learning to read and write.


Pre-school children

In some cases, it's possible to detect symptoms of dyslexia before a child starts school. Symptoms can include:

  • delayed speech development compared with other children of the same age 
  • speech problems, such as not being able to pronounce long words properly and "jumbling" up phrases 
  • difficulties expressing themselves through spoken language, such as being unable to recall the exact phrase to use or wrongly putting sentences together
  • Rhyming words, such as "the cat sat on the mat," and nursery rhymes are not well understood or appreciated.
  • difficulty with, or little interest in, learning letters of the alphabet

 

Schoolchildren

When children enter school and begin to focus more on learning how to read and write, symptoms of dyslexia generally become more visible.

Symptoms of dyslexia in children aged 5 to 12 include:

  • problems learning the names and sounds of letters
  • spelling that's unpredictable and inconsistent
  • putting letters and figures the wrong way round (such as writing "6" instead of "9", or "b" instead of "d")
  • confusing the order of letters in words
  • answering questions well orally, but having difficulty writing the answer down
  • reading slowly or making errors when reading aloud
  • visual disturbances when reading 
  • struggling to learn sequences, such as days of the week or the alphabet
  • poor phonological awareness and word attack skills
  • difficulty carrying out a sequence of directions
  • slow writing speed and poor handwriting
  • problems copying written language and taking longer than normal to complete written work

 

Phonological awareness

Phonological awareness is the capacity to recognize that words are made up of smaller units of sound (phonemes) and that altering and manipulating phonemes can result in new words and meanings.

A kid with inadequate phonological awareness may be unable to answer the following questions correctly:

  • What sounds do you think make up the word "hot", and are these different from the sounds that make up the word "hat"?
  • What word would you have if you changed the "p" sound in "pot" to an "h" sound?
  • How many words can you think of that rhyme with the word "cat"?


Word attack skills

Young children with dyslexia may struggle with word attack abilities.

This is the capacity to understand novel words by seeking for smaller words or groups of letters that a kid has already learned.

For example, a kid with strong word attack skills may read the word "sunbathing" for the first time and obtain an understanding of its meaning by breaking it down into "sun," "bath," and "ing."

 

Dyslexia in adults

Dyslexia in adults

In addition to the issues listed above, signs of dyslexia in older children and adults might include:

  • Poorly organised written work that lacks expression 
  • Difficulty planning and writing essays, letters or reports
  • Struggling to meet deadlines
  • Poor spelling
  • Difficulty taking notes or copying
  • Difficulties revising for examinations
  • Trying to avoid reading and writing whenever possible
  • Struggling to remember things such as a PIN or telephone number

 

Children with reading problems will avoid reading, exposing them to fewer words and worsening their reading deficiency. Patients with dyslexia should have a standard physical exam that looks for evidence of other neurological, medical, or genetic reasons of their disability.

 

Diagnosis

Any anyone suspected of having a reading difficulty should be evaluated. This examination is offered in schools and higher education organizations. The evaluation should include a thorough evaluation of reading, spelling, and arithmetic skills.

Early intervention is feasible because dyslexia can be diagnosed as early as preschool. According to one research, if there is a family risk but the kid acquires the early capacity to letter-name, the chance of having dyslexia lowers substantially.

 

Children who have weak letter-naming abilities at the age of 4.5 to 5.5 but have high phonological awareness are less likely to suffer dyslexia. Dyslexia is a complex condition caused by a variety of causes. Those who have language challenges at the end of preschool are at a higher risk, and screening is most effective at this age.

One of the most serious issues is the lack of a particular blood test or brain imaging result that can offer a diagnosis. Fundamentally, the problem is that reading is assessed on a scale, and there is no cutoff score on a reading test that clearly distinguishes between dyslexic and nondyslexic persons. The difference between dyslexia and normal reading is arbitrary, and the cutoff point changes per study.

These youngsters should be tested for hearing and visual impairments first. Unless there are additional variables affecting this choice that were discovered in their history and physical examination, laboratory or imaging testing is usually not required for these youngsters. fMRI is utilized for research rather than diagnosis.

 

Dyslexia test

  • Dyslexia test for kids

Children suspected of having dyslexia should be sent to the school system for examination. Their reading comprehension, executive function, and intelligence quotient (IQ) will be assessed. In the United States, this testing is usually free and necessary before services may be given.

A test of pseudoword reading is an essential diagnostic tool for dyslexia (eg, the Woodcock Word Attack test). This exam consists of reading pronounceable letter combinations that do not represent English words but can be articulated using English pronunciation standards. Items such as 'bab,"shum,' 'cigbet,' and 'bafmotbem' are examples. This is a simple decoding skill test. These decoding abilities are especially crucial while learning to read and determining the pronunciation of new words that have never been heard before.

Although reading comprehension is essential and the primary goal of reading, dyslexia is best identified by problems at the word level. Word decoding is essential for improving comprehension abilities. Reading comprehension is often assessed by having the subject read a piece and then answer questions about it.

Timed reading comprehension exams are common. Some people, even if they can comprehend words, struggle with reading comprehension because they lack the inferential abilities to make sense of what they read or because they read slowly. They may lack the necessary prior knowledge to comprehend the material or the questions.

 

Management

As a physician, it is critical to collaborate with parents, schools, and caregivers to detect dyslexic patients early. However, the majority of therapy is given in school and at home. Early intervention will concentrate on vocabulary, understanding, and essential skills like phonics.

Direct and systematic instruction of letters and their associated sounds (ie, phonological abilities) is a useful method to aid dyslexics in some instances.

As children continue through their schooling, the intervention will shift to increase knowledge of word meanings, comprehension, more difficult reading, and excel methods.

 

Support for people with dyslexia

people with dyslexia

If your kid has dyslexia, they will most likely require additional educational help from their school.

There is typically no reason why your child cannot attend a mainstream school with adequate assistance, however a small percentage of children may benefit from attending a specialised school.

 

Techniques and support that may help your child include:

  • 1-to-1 teaching or lessons in a small group with a specialist teacher
  • Phonics (a special learning technique that focuses on improving the ability to identify and process the smaller sounds that make up words)
  • Technology like computers and speech recognition software that may make it easier for your child to read and write when they're a bit older

Universities also offer specialized personnel that can help students with dyslexia succeed in higher education.

Adults can benefit from technology such as word processors and electronic organizers.

Employers must make reasonable changes to the workplace to accommodate persons with dyslexia, such as giving extra time for particular activities.

 

Differential Diagnosis

Dyslexia is commonly associated with other disorders such as an arithmetic learning disability, attention deficit disorder, attention deficit hyperactivity disorder, obsessive-compulsive disorder, and Tourette's syndrome. Reading and language impairments may be connected with behavioral challenges, although in many situations, the behavioral difficulties are likely to be a result of the reading difficulty rather than a cause of it. It is especially critical that doctors should not dismiss the potential of dyslexia when other developmental problems are present.

Differential diagnosis can include:

  • Hearing impairment
  • Vision impairment
  • Educational deficits
  • Decreased exposure
  • Increased absences
  • Poor instruction
  • Cognitive impairment
  • Learning disabilities
  • Toxin exposure (lead poisoning)
  • Familial dysfunction
  • Emotional illness

 

Prognosis

Those who overcome reading difficulties in early childhood generally achieve average reading skills. Children who have a persistent reading impairment may learn to read words in their area of interest. A longitudinal research revealed that while reading impairments improve with age, there may still be a difference when compared to their peers.

 

Prevention 

Children at risk of having reading difficulties can be detected in kindergarten (at the age of five), and intervention programs can be offered. One research discovered that children identified as at-risk for reading issues in kindergarten, regardless of whether English was their first language, benefited from classroom-based intervention programs emphasizing phonological awareness, vocabulary, and reading skills.

 

Complications

  • Poor school performance
  • Dislike of school
  • Somatic dysfunction
  • Social maladaptation
  • Psychiatric illness (anxiety, depression)

 

Conclusion

Dyslexia is a widespread learning disability that can lead to difficulties with reading, writing, and spelling. Reading tests are used to diagnose dyslexia, however because reading skill is on a continuum, any cutoff point is arbitrary. The IQ score has no bearing on the diagnosis of dyslexia.

Dyslexics struggle with speech perception, identifying and manipulating the basic sounds of a language, language memory, and learning the sounds of letters. Dyslexia is a neurological disorder that has a hereditary foundation. Dylexic people have anomalies in their brains.

It is critical to understand that behavioral issues at school might be a symptom of dyslexia. Any indication of difficulty learning to read, especially if it appears early in a child's school experience, should be taken seriously and explored. In most situations, the conventional notion that the kid would grow out of the issue is incorrect.

We know that early detection and intervention can avoid or at least lessen the severity of most significant reading problems. Any academic or behavioral issues should be examined right once. School anxiety and/or somatic symptoms on school days may indicate a learning impairment.

Physicians are especially essential in identifying children who are at risk for dyslexia and assisting their parents in obtaining the appropriate testing.

It is critical to collaborate with schools and local resources to ensure that the required services are provided. It is also critical to emphasize to parents the significance of getting early intervention and sticking with treatment. Educate parents and guardians that early intervention can help their kid narrow the reading gap with their classmates.

Students with high IQs and high levels of achievement may be neglected early in their school careers. They may still have dyslexia but compensate in other ways, resulting in a missed opportunity for early help. As reading gets more difficult, this can have a significant influence on their attitude toward school and have a long-term impact on their capacity to learn.]

Diagnosis and management of dyslexia can be challenging for medical experts. An interprofessional team comprised of primary physicians, optometrists, audiologists, and nurses will produce the greatest results.

As part of the team, developmental and behavioral pediatricians, child neurologists, psychologists, and/or neuropsychologists may be required. Furthermore, parents, instructors, and school officials have an important role in improving results in dyslexic patients.

Referrals may be required if the family is dissatisfied with the school's intervention or if the clinician is concerned about the outcomes. Patients who see developmental and behavioral pediatricians, child neurologists, psychologists, and/or neuropsychologists may benefit. It is crucial to remember that certain experts may not be covered by the patient's insurance.

There is evidence that there are a high number of dyslexics among runaway homeless street adolescents, teenage suicide victims, and juvenile criminals. It is critical that we identify these issues early and work to remove or decrease their severity.

Physicians play an especially significant role in identifying a kid who is at risk for dyslexia and assisting parents in obtaining the appropriate testing.

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