Dyslexia

 

Dyslexia, also known as reading disorder, is characterized by trouble with reading despite normal intelligence. Different people are affected to varying degrees. Problems may include difficulties in spelling words, reading quickly, writing words, “sounding out” words in the head, pronouncing words when reading aloud and understanding what one reads. Often these difficulties are first noticed at school. When someone who previously could read loses their ability, it is known as alexia. The difficulties are involuntary and people with this disorder have a normal desire to learn.

Dyslexia is believed to be caused by both genetic and environmental factors. Some cases run in families. It often occurs in people with attention deficit hyperactivity disorder (ADHD) and is associated with similar difficulties with numbers. It may begin in adulthood as the result of a traumatic brain injury, stroke, or dementia. The underlying mechanisms of dyslexia are problems within the brain’s language processing. Dyslexia is diagnosed through a series of tests of memory, spelling, vision, and reading skills. Dyslexia is separate from reading difficulties caused by hearing or vision problems or by insufficient teaching.

Treatment involves adjusting teaching methods to meet the person’s needs. While not curing the underlying problem, it may decrease the degree of symptoms. Treatments targeting vision are not effective. Dyslexia is the most common learning disability and occurs in all areas of the world. It affects 3–7% of the population, however, up to 20% may have some degree of symptoms. While dyslexia is more often diagnosed in men, it has been suggested that it affects men and women equally. Some believe that dyslexia should be best considered as a different way of learning, with both benefits and downsides.

Classification
Dyslexia is thought to have two types of cause, one related to language processing and another to visual processing. It is considered a cognitive disorder, not a problem with intelligence. However, emotional problems often arise because of it. Some published definitions are purely descriptive, whereas others propose causes. The latter usually cover a variety of reading skills and deficits, and difficulties with distinct causes rather than a single condition. The National Institute of Neurological Disorders and Stroke definition describes dyslexia as “difficulty with phonological processing (the manipulation of sounds), spelling, and/or rapid visual-verbal responding”. The British Dyslexia Association definition describes dyslexia as “a learning difficulty that primarily affects the skills involved in accurate and fluent word reading and spelling” and is characterized by “difficulties in phonological awareness, verbal memory and verbal processing speed”.
Acquired dyslexia or alexia may be caused by brain damage due to stroke or atrophy. Forms of alexia include pure alexia, surface dyslexia, semantic dyslexia, phonological dyslexia, and deep dyslexia.

Definition
There is some variability in the definition of dyslexia. Some sources, such as the U.S. National Institutes of Health, define it specifically as a learning disorder. Other sources, however, define it simply as an inability to read in the context of normal intelligence, and distinguish between developmental dyslexia (a learning disorder) and acquired dyslexia (loss of the ability to read caused by brain damage). ICD 10, the manual of medical diagnosis used in much of the world, includes separate diagnoses for “developmental dyslexia” (81.0) and for “dyslexia and alexia” (48.0). DSM 5, the manual of psychiatric diagnosis used in the United States, does not specifically define dyslexia, justifying this decision by stating that “the many definitions of dyslexia and dyscalculia meant those terms would not be useful as disorder names or in the diagnostic criteria”. Instead it includes dyslexia in a category called specific learning disorders.

Signs and symptoms
In early childhood, symptoms that correlate with a later diagnosis of dyslexia include delayed onset of speech and a lack of phonological awareness, as well as being easily distracted by background noise. A common myth closely associates dyslexia with mirror writing and reading letters or words backwards. These behaviors are seen in many children as they learn to read and write, and are not considered to be defining characteristics of dyslexia.

School-age children with dyslexia may exhibit signs of difficulty in identifying or generating rhyming words, or counting the number of syllables in words – both of which depend on phonological awareness. They may also show difficulty in segmenting words into individual sounds or may blend sounds when producing words, indicating reduced phonemic awareness. Difficulties with word retrieval or naming things is also associated with dyslexia.:647 People with dyslexia are commonly poor spellers, a feature sometimes called dysorthographia or dysgraphia, which depends on orthographic coding.

Problems persist into adolescence and adulthood and may accompany difficulties with summarizing stories, memorization, reading aloud, or learning foreign languages. Adults with dyslexia can often read with good comprehension, though they tend to read more slowly than others without a learning difficulty and perform worse in spelling tests or when reading nonsense words – a measure of phonological awareness.

Mechanisms
The dual-route theory of reading aloud was first described in the early 1970s. This theory suggests that two separate mental mechanisms, or cognitive routes, are involved in reading aloud. One mechanism is the lexical route, which is the process whereby skilled readers can recognize known words by sight alone, through a “dictionary” lookup procedure. The other mechanism is the nonlexical or sublexical route, which is the process whereby the reader can “sound out” a written word. This is done by identifying the word’s constituent parts (letters, phonemes, graphemes) and applying knowledge of how these parts are associated with each other, for example, how a string of neighboring letters sound together. The dual-route system could explain the different rates of dyslexia occurrence between different languages (e.g. the Spanish language dependence on phonological rules accounts for the fact that Spanish-speaking children show a higher level of performance in non-word reading, when compared to English-speakers).

Dyslexia disorder is not caused by mutation in one gene; in fact, it appears to involve the combined effects of several genes. Studying the cognitive problems associated with other disorders helps to better understand the genotype-phenotype link of dyslexia. Neurophysiological and imaging procedures are being used to ascertain phenotypic characteristics in dyslexics, thus identifying the effects of certain genes.

Diagnosis
There are tests that can indicate with high probability whether a person is a dyslexic. If diagnostic testing indicates that a person may be dyslexic, such tests are often followed up with a full diagnostic assessment to determine the extent and nature of the disorder. Tests can be administered by a teacher or computer. Some test results indicate how to carry out teaching strategies.

Central dyslexias
Central dyslexias include surface dyslexia, semantic dyslexia, phonological dyslexia, and deep dyslexia. ICD-10 reclassified the previous distinction between dyslexia (315.02 in ICD-9) and alexia (315.01 in ICD-9) into a single classification as R48.0. The terms are applied to developmental dyslexia and inherited dyslexia along with developmental aphasia and inherited alexia, which are considered synonymous.

Surface dyslexia
In surface dyslexia, words with regular pronunciations (highly consistent with their spelling, e.g. mint) are read more accurately than words with irregular pronunciation, such as colonel. Difficulty distinguishing homophones is a diagnostic used for some forms of surface dyslexia. This disorder is usually accompanied by surface agraphia and fluent aphasia. Acquired surface dyslexia arises when a previously literate person experiences brain damage, which results in pronunciation errors that indicate impairment of the lexical route.

Management
Through the use of compensation strategies, therapy and educational support, dyslexic individuals can learn to read and write. There are techniques and technical aids which help to manage or conceal symptoms of the disorder. Removing stress and anxiety alone can sometimes improve written comprehension. For dyslexia intervention with alphabet-writing systems, the fundamental aim is to increase a child’s awareness of correspondences between graphemes (letters) and phonemes (sounds), and to relate these to reading and spelling by teaching how sounds blend into words. It has been found that reinforced collateral training focused on reading and spelling yields longer-lasting gains than oral phonological training alone. Early intervention that is done for children at a young age can be successful in reducing reading failure.

There is some evidence that the use of specially-tailored fonts may help with dyslexia. These fonts, which include Dyslexie, OpenDyslexic, and Lexie Readable, were created based on the idea that many of the letters of the Latin alphabet are visually similar and may, therefore, confuse people with dyslexia. Dyslexie and OpenDyslexic both put emphasis on making each letter more distinctive in order to be more easily identified. The benefits, however, might simply be due to the added spacing between words.

There have been many studies conducted regarding intervention in dyslexia. Among these studies one meta-analysis found that there was functional activation as a result.

There is no evidence demonstrating that the use of music education is effective in improving dyslexic adolescents’ reading skills.

Prognosis
Dyslexic children require special instruction for word analysis and spelling from an early age. While there are fonts that may help people with dyslexia better understand writing, this might simply be due to the added spacing between words. The prognosis, generally speaking, is positive for individuals who are identified in childhood and receive support from friends and family.

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