Dyslexia

Many children with learning problems in school have trouble with reading and/or writing. If the trouble is severe enough, it may be diagnosed as a “specific learning disorder in reading” or a “specific learning disorder in writing.” These terms do not reveal the kind of difficulty a child may be having, and parents whose children have trouble with reading or writing often wish to know whether their child has dyslexia. Developmental dyslexia is one kind of a reading and writing disorder. In other words, children can struggle with reading for a variety of reasons, but only some of them have developmental dyslexia. It is called “developmental” because it is caused by some difference in normal brain development and damage to the brain.

The hallmark of developmental dyslexia is inaccurate or halting word reading and spelling, despite otherwise competent oral (spoken) language. Children with dyslexia have trouble with comprehension because they cannot read the text accurately or fluently. Thus, they can typically comprehend a grade level text that is read to them even though they cannot read it themselves. The deficits in reading and spelling words in children dyslexia often stem from a deficit in the phonological component of language, that is, a child’s awareness of and ability to manipulate the sounds in words. However, challenges with learning letters can be seen in young children and with processing orthography (the visual representation of the word) in older children. These also interfere with the development of basic reading skills. Although some children with dyslexia reverse letters (such as confusing b and d in their reading or writing), letter reversals do not necessarily mean that a child has dyslexia.

Dyslexia is diagnosed by a detailed assessment of the child’s reading, language and cognitive skills. In the Learning Disabilities Program, your child will be seen by a team that includes a written language specialist, who is qualified to determine, in collaboration with the neurologist and neuropsychologist, whether the child has dyslexia.

Researchers sometimes use brain scans to learn more about the neurological basis for dyslexia, and children with dyslexia can be very helpful in advancing science by participating in these studies. However, brain scans are not used to diagnose dyslexia or other reading disorders, nor are they pertinent to treatment. Accordingly, insurance does not cover them for this purpose.

Dyslexia is typically treated by special education intervention provided in school. There are scientifically based programs for teaching reading skills to children with dyslexia. The specialists in the Learning Disabilities Program will make personalized recommendations for the types of interventions that are likely to be helpful. Most children with dyslexia are provided with an individualized education plan (IEP) in school. For a child with dyslexia, these plans should include intensive, daily direct reading instruction guided by one of these programs.

With appropriate and intensive intervention, most children with dyslexia make good progress. They may, however, continue to read slowly or have persistent problems with spelling. Nevertheless, teenagers and adults with dyslexia generally learn strategies to get around these problems.

There are several ongoing research programs that focus on dyslexia at Boston Children’s Hospital. Dr. Aparna Raghuram researches the role of vision in dyslexia (aparna.raghuram@childrens.harvard.edu).