What is Dyslexia?
Dyslexia is one of many learning disabilities in which individuals have difficulty using the sounds and symbols of the language. It is like being tone deaf for the sounds of the language. Research by the National Institute of Health has demonstrated that most dyslexics have difficulty with a skill that has been labeled phonological awareness. They have difficulty hearing the individual sounds in words and remembering the order of their sounds. This is important because when we hear a word like the word "cup", we are hearing one complex sound wave. During kindergarten most children's brains allow them to be able to divide this complex sound and hear the individual sounds. Research has also demonstrated that it's important for children to be able to hear the individual sounds in order to connect them with their visual representation, i.e. the letter "p". Of course, this is the main task in learning phonics.
Dyslexia is a neurological condition which is inherited. Therefore, no individual or parent is responsible for the dyslexia. It is something that we are born with. However, dyslexia is not brain damage. Scientists have been able to study hundreds of brains of dyslexics and in no cases have they found a damaged or pathological brain. Dyslexics have healthy brains, but they're just built differently. In other words, the architecture in the brain is different. This appears to give dyslexics strengths in certain areas, but makes the process of learning written language difficult. It's like today's personal computer. There are PCs and Macintosh computers. Both computers are very good, but they have different advantages and disadvantages and use different software. The dyslexic brain is like a top of the line Macintosh Computer in which we have been trying to use Window's software. It works somewhat, but not nearly as well as it could if we were using the right software.
Every dyslexic is different, but most dyslexics demonstrate certain difficulties before and during school. For example, many dyslexics have difficulty learning to speak although they may develop excellent vocabularies. Furthermore, they may have trouble rhyming or playing children's word games, such as Pig Latin. They also may have great difficulty following simple directions and often times they confuse their right and left hands.
When they enter school, dyslexics usually have difficulty learning the letters and sounds. They may also reverse and transpose letters and numbers past the first grade. Dyslexics often have difficulty reading allow and great difficulty in spelling words. Their handwriting may look sloppy and very inconsistent. Memorizing their multiplication tables is often a struggle for the dyslexic. Finally, as they grow older most dyslexics have great difficulty in learning foreign languages.
The prognosis for dyslexic children and adults is excellent. If properly identified, 95 percent of all dyslexics can become good readers. However, the earlier the problems can be identified the easier it is to remediate the deficits. For example, if a child is not diagnosed until the fourth grade it takes four times as many hours to remediate as it would if it were identified in kindergarten. This and the highly significant emotional problems (see my article on The Social and Emotional Impact) are very strong arguments for early and accurate diagnosis of dyslexia. This is important because dyslexic individuals are often our most creative and innovative thinkers and are a valuable resource for our society.
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What is ADHD?
ADHD is a kind of learning disability which affects an individual's ability to focus their attention and organize themselves. ADHD consists of three general symptoms: distractibility, impulsivity and hyperactivity.
ADHD individuals are distractible in that they see and hear all aspects of their environment simultaneously and are unable to prioritize them. It's not that they can't pay attention, but they pay attention to too many things at once and cannot filter out the irrelevant stimuli. In some situations, such as on the hockey rink, this wide angle lens is very helpful and allows the individual to take in lots of information very quickly. However, in school we want children to focus on one thing at a time, the teacher, the text book or the experiment that they're doing. These individuals are aware of everything simultaneously.
Impulsivity is the process of not thinking before you act. For these individuals if a thought comes into their head, they will quickly act without thinking about the consequences. In addition to behaviorally impulsivity there are also individuals who are cognitively impulsive. They scan the environment very quickly and make decisions based on too little information. In other words they leap before they look. In identifying individuals without hyperactivity this subtle impulsivity is important to look for.
Finally, some but not all ADHD individuals demonstrate hyperactivity. Hyperactive individuals always have to be moving. In childhood this means they are always on the go. They cannot sit still. For example, they may have difficulty sitting still while they watch television or at the dinner table. As these children get older they move from being grossly hyperactive to being fidgety or wiggly. Their hand or their foot may always be moving or they may just always shift around in their seat.
Finally, I'd like to talk a little about girls with ADHD. Most of what we read and believe about ADHD is based on our experience with boys and young men with ADHD. Many of our concepts and prejudices do not apply to girls with ADHD. After 25 years of clinical experience and after reviewing the research on girls and women with ADHD, it is my firm belief that females with ADHD present a different picture. They usually have the difficulty with focusing their attention, but they are less hyperactive and less impulsive in their behavior. Unlike boys, they tend to not act out their frustration but instead turn their frustration inward and become depressed or develop eating disorders. Even in the area of distractibility their behavior may not look like the typical ADHD pattern. Many girls with these problems over-focus rather than under-focus. They get locked on to stimuli and can't shift to new stimuli. This is still a difficulty in attention but it involves instead of distractibility, not being able to easily shift one's attention from one task to another. This can be very frustrating and anxiety provoking for these individuals. It can also mask their attentional problems. Because they appear to be able to focus for long periods of time and often they can get a great deal of school work accomplished during these periods of over-focusing. The problem is that in other situations they may be very distractible and life becomes very frustrating and anxiety provoking because they can't shift from one activity to another.
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What is a Nonverbal Learning Disability?
A nonverbal learning disability is one type of learning disability which affects the individual's to use and understand complex mathematical concepts, visual-spatial relationships and organize themselves. This kind of learning disability often present later in the child's school experience. These children have excellent short-term memories and good phonological abilities so they can be very successful in early elementary school. Their difficulties begin during middle school, when concepts in math and science demand more of an understanding of visual-spatial relationship. Although, they are able to memorize individual facts these individuals often have difficulty integrating this data into a comprehensive whole and seeing the forest for the trees. These individuals will often know a great deal information about a particular subject, but they have difficulty organizing that information into a theme or a term paper. In addition, individuals with nonverbal learning disabilities often struggle on timed, multiple-choice tests.
Although we have known about nonverbal learning disabilities for over 50 years, it is only recently we began to carefully study these problems. Therefore, our knowledge about the causes is limited. However, a great deal can be done in accommodating and developing teaching styles for these individuals once we have delineated the problem.
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How do children learn to read?
In answering this question it is helpful to briefly review the last 20 years of the major research in learning disabilities. Over 20 years ago Congress asked the National Institute of Health (the organization that studies public health problems such as the SARS epidemic) to study learning disabilities. NIH quickly recognized the most wide spread and most difficult learning disabilities were in reading. They, therefore, focused their research on reading problems. They started by organizing teams of researchers to answers specific questions in the areas of neurology, genetics, and education/psychology. Their research is some of the most powerful and comprehensive research that has ever been done, particularly in the area of education. Their studies included large numbers of subjects which they followed in careful longitudinal studies. Furthermore, they did not consider any conclusion as valid unless it had been replicated using three or four different studies. This research not only taught us a great deal about dyslexia, but how all children learn to read. They learned that all individuals go through stages in learning to read. Secondly, using studies of eye movements and brain mapping studies, they were able to demonstrate that everyone uses phonics when they read. However, for most readers this process has become so automatic they do it effortlessly and aren't aware that they are sounding words out. Although somewhat over simplified, the stages of reading can be grouped into four basic stages: phonological awareness, phonics, fluency, and comprehension. Phonological awareness develops for most children in the middle of kindergarten. It is the ability to hear individual sounds and words and remember the order of the sound. This is important because when any of us hear a word, like the word "dog" we hear one complex sound wave. However, most children by the middle of kindergarten develop the ability to pull those individual sounds apart and hear the "da", "o" "g" sounds. This is important because unless the child is able to hear the individual "g" sound, they have great difficulty associating that sound with the visual representation (i.e. the letter g). This, of course, is a major part of learning phonics. The second stage is actually learning phonics which involves learning the sound-symbols relationships, learning to blend sounds together and beginning to learn the rules that govern written language. Most children very easily learn to break this code and quickly integrate these sound-symbol relationships. Children with phonological processing problems however, get stuck and reading remains a mystery to them.
After a child has learned phonics there is a period in which they practice these skills and become fluent readers. The research has demonstrated that in addition to practice, good readers also have the ability to quickly look at a visual representation and recall information concerning that image. For fluent readers this process of seeing a picture or word and quickly retrieving the name and relevant information becomes an automatic habit so that the process of reading is effortless. This allows them to work on comprehension. Research by the National Instituted of Health has confirmed that this skill is easily measured by having individuals look at a list of pictures, colors, numbers or letters and name those items as quickly as they can. The examiner simply times their response and compares it to their peers'. This rapid automatic naming ability is highly correlated with reading fluency. This is another stage that dyslexic students can become stuck at. When this happens dyslexics may learn to code words, but reading is very time consuming and laborious for them. Furthermore, they may also demonstrate great difficulty in spelling and written language.
The final stage is developing comprehension skills. This is, of course, the heart of what we mean when we say someone can read. However, in order to comprehend easily and accurately, individuals have to master all of the previous stages and also demonstrate the ability to attend to the reading task. They must have developed an adequate vocabulary and have a good knowledge of the subject matter. Finally, they must develop good comprehension and analytic skills. Many dyslexics have trouble with comprehension. However, there are some dyslexics who struggle with decoding but, through great effort and superior intelligence, are able to comprehend information. However, it takes them much longer and it is very taxing for them. Furthermore, as they get into high school and college classes they are unable to sound out the new vocabulary and, therefore, they can not connect these new words with what they hear in the classroom.
Learning to read is one of the most complex tasks we ask human beings to master. It is possible for children or adults to get stuck at any of these stages and need help. Careful diagnostic work is necessary to identify at what stage the individual is stuck and then develop remedial strategies based on their own individual needs.
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