Development of the Understanding of Dyslexia

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19th Sep 2017 Health And Social Care Reference this

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Introduction

The following three chapters offer not only an introduction, but an in depth analysis of the current state of the study of Dyslexia today. Much of the information evaluated for this study was based on the preeminent minds in the study of learning disabilities today. It is the responsibility of a curious society to determine the causal and symptomological relationships for a particular disorder prior to its diagnosis. Dyslexia presents a unique challenge to this social responsibility because of a uniquely manifested heterogeneity which is pervasive in many forms. Further research is decidedly required in order to isolate the underlying cause of such an affliction, yet with current medical data and a limited number of scientific studies, this feat remains next to impossible, even one hundred years after its initial recognition.

Chapter One

When his trembling hand gripped tightly to the pencil and the words began to flow freely, their meaning rushed through his mind; minute synaptic reactions converted thought into impulse and further into written word. When read, however, by a stupefied instructor, it was the letter reversal, in addition to poor, untrained handwriting which brought cause for alarm. Visits with a Neurologist, discussions with a Psychiatrist, all led towards an unfortunate diagnosis: Dyslexia.

Introduction

The following chapter is designed to offer an in depth history and background for one of the most misunderstood and misdiagnosed affectations in history: Dyslexia. It is only through thorough comprehension of this disorder and the potential affects on youth and adults alike that proper diagnosis and treatment will be initiated.

Defining a Theory

When theory becomes practice and eventually is predominately a diagnosis, it stands to reason that a clear and effective definition of that theory would aid in discussion with patients and training for educators. However, when a disability necessitates the scientific consensus of hundreds of doctors dealing with similar, yet uniquely defined cases, the theory will flounder, pinned in a net of conflicting case studies and rhetoric. Webster’s Dictionary defines Dyslexia as “a variable often familial learning disability involving difficulties in acquiring and processing language that is typically manifested by a lack of proficiency in reading, spelling, and writing.”[1] This definition is not particularly enlightening, nor does it further our comprehension of what symptoms or solutions may be present for such a disorder.

Pop culture would have us believe that all dyslexics read words backwards, are inwardly frustrated individuals, and are oftentimes lazy in study while uniquely talented in another aspect of life. Yet, with the ambiguous definitions which have punctuated the study of this disorder, it can easily be seen how education in this area is lacking, particularly in terms of diagnosis. “The term dyslexia comes from the Greek root “dys” (trouble) and “lexia” (word).[2] It is easily seen how such a generic definition can lead to great scientific debate, not only in study, but in treatment as well. There is no singular treatment for dyslexia, in fact, this is a lifetime disability where teaching awareness in addition to atypical forms of learning becomes paramount in the normal functionability of the patient.

Most common in modern definitions of Dyslexia is that it is a phonological disorder predicated by neurological dysfunction contributing to poor reading, writing, and oftentimes learning abilities. This theory, however, becomes problematic as a variety of scientific studies seek to minimize the extent that cerebral malfunction influences phonological impairment. Through simplification of the diagnosis procedure, tests such as IQ testing become the benchmark for identification dyslexics as opposed to poor readers. It is important to note that dyslexics do not have an intelligence deficiency. Their disorder is directly linked to improper phonological interpretation, and oftentimes, unique strengths arise from within this impairment. The following sections will further explore the preeminent theories behind dyslexia, in addition to extrapolating linked generic theories into cohesive formats by which further understanding of dyslexia will be simplified.

Dyslexia: Historical perspective

The first case study which endeavored to define dyslexia was recorded in 1872 by a physician, R. Berlin of Stuttgart, Germany. The initial cases of dyslexia were predominately adults who had lost the ability to read, write, or comprehend language in some cases due to severe trauma or head wounds. Early definitions of this disorder invoked use of a more common term aphasic, or a loss of the ability to use or comprehend words. In 1877, A. Kussmaul suggested the theory of “word blindness” to describe a patient who similar to earlier cases, had lost his ability to read. In 1887, the term alexia was first defined as an inability to comprehend written words by Charcot. All of these predecessors led to the modern term, dyslexia which we use fluidly today. This term was first defined by Bateman in 1890 who had determined a form of verbal amnesia in which a patient had lost his memory of the conventional meaning of language.

In 1896, Morgan formulated a revised definition called congenital word blindness, citing a 14-year-old boy who although he functioned on a similar intellectual level with his peers, had a specific difficulty in learning to read. Further comprehension of this disorder surfaced with James Hinshelwood, a surgeon at the Glasgow Eye Infirmary who published a series of articles in the journal “The Lancet.” These articles dealt more specifically with acquired word blindness than Morgan’s congenital word blindness and after his first experiences with congenital cases in early 1900, Hinshelwood eventually published a book on both forms of word blindness which further defined theories behind the disorders. “This taxonomic classification system was based upon the performance of the patients when attempting to read. In this regard, Hinshelwood’s formulations and methodology resemble those of contemporary neuropsychology.[3] Hinshelwood’s research led him to create reading guidelines, including a three stage model of learning in which educators could focus their efforts on training students to read proficiently. Part of Hinshelwood’s congenital word blindness related to what he had previously witnessed in adults which were a major trauma or head injury which led to the apparent disorder. His believe was that during the birthing process or at some point during infancy, extreme head trauma or a birth defect had caused the lapse in language abilities, creating the word blindness.

Study in the area of reading difficulty continued. In 1925, an American Neurologist named Samuel Orton proposed a theory regarding the specific formation of these disorders. “According to Orton, reading reversals (e.g. b for d and saw for was) were caused by problems with cerebral dominance in the early stages of reading.”[4] This mirror-image theory was one of the most misconstrued and misunderstood theories of the early twentieth century. By the early seventies, however, the mirror-image theory had been discredited on the basis that while dyslexia affects language functions, it does not seem to affect other visual tasks such as forms of recognition.

During the 60’s and 70’s, visual perception and correction of this problem in relation to dyslexia became a debatable theory. “Marianne Frostig developed a test for visual perception and a remedial training program involving tracing, and copying shapes and patterns.[5]” This test was unsuccessful when paired with dyslexic students and was inappropriately utilized without positive result for some time. In 1962, Herbert Birch proposed the intersensory deficit hypothesis which proposes that because reading utilizes both auditory and visual senses, that there is an innate inability to perform the dual tasks. His theory was also discredited as testing lacked in control mechanisms and an inability to replicate results with consistent reliability plagued Birch and his associates.[6]

From these bases of research on dyslexia came a flurry of tests, examinations, theories, discredited scientists, and the debate still continues. Current theories tend to focus on areas of the brain which are abnormally affected by the disorder, but more importantly, research into the techniques required in order to appropriately educate affected individuals has increased. This research, in addition to testing, continues to allow for uniquely afflicted individuals to lead remarkable yet uncured lives.

Phonology—From Record to record

When dyslexia moves from theory to diagnosis, phonological deficits become measurable symptoms of the disorder. Phonology, or the study and description of the sound changes in a language, can help educators pinpoint and explore specific regions of sound including word pairings and splits. Additionally, it is one of the most affected areas of comprehension relative to dyslexia. “The amazing discovery is that people systematically ignore certain properties of sounds. They perceive two different sounds as the same sound. We call the stored versions of speech sounds phonemes. Thus phonemes are the phonetic alphabet of the mind. That is, phonemes are how we mentally represent speech; how we store the sounds of words in our memory.” Dyslexia, however, as previously defined, is a disorder in accessing the proper linguistic characteristics as related to reading and writing. Therefore, in extrapolating disability from inability, it is essential to determine whether the child is phonetically challenged, they have an inability to attach proper synaptic responses to linguistic characteristic, or in a non-dyslexic case, that the problem could be directly related to visual acumen.

If there is a possibility that the child has a visual impairment which while serious and requiring further diagnosis and study, it does not decidedly group them into a dyslexic category. “Overall, studies have shown perceptual deficits: in vision related to impaired motion detection and in phonology related to impaired coding. This impairment is related to symmetry, reversed asymmetry, and lower numbers of neurons in, predominantly, the temporal lobes and visual motion areas of the occipital lobe. Also, the auditory deficits may be closely related to temporal abnormalities that impede speed and accuracy for speech-sound relationships in reading of the planum temporale region, as well as the thalamus near the corpus callosum.”[7] It is this potential brain abnormality which makes this disorder so difficult to define and identifying specifically which deficits contribute directly to the dyslexic tendencies of a child is a most difficult and sometimes impossible process.

Additionally, the multitude of theories and definitions of learning disabilities makes the educator’s task of proper identification much more difficult. “It has been shown that explicit training in phonological awareness can lead to improved word reading; evidence of a reciprocal causal relationship between phonological awareness and reading has also been found.”[8] In assessing potential dyslexics, it is widely held that phonological deficit is one of the most reliable assessors when comparing results from a controlled variety of children. Evaluations of this deficit oftentimes take the place of speed tests, word recognition studies, and testing of verbal fluency. As debate continues about the underlying causal factors of phonological deficit, one powerful theory is that “cerebellar deficit is the only single explanation of problems in balance, phonology, and speed, and is also one explanation of ‘pure’ phonology/speed problems.”[9] This localized brain failure directly relates many of the predominant symptoms of dyslexia, including combining many different areas of testing and relating them to one overall failure, as opposed to a variety of causes for a multitude of symptoms.

Symptoms

In order to diagnose and treat such a heterogeneous disorder such as dyslexia, symptomology, or breaking down specific traits and behaviors into repeatable offenses, must be at the forefront of the educator’s investigation. But, when every child’s individual response to the disorder is different, where does one begin to define those unique traits which enable grouping, and therefore, repeatable treatment and disability management? As will be defined in future sections, it is essential to the educator that they are able to differentiate between the textbook dyslexic and the garden variety poor reader. Oftentimes, IQ testing is performed on children to initiate a benchmark for further evaluation of variance from this basis point. Children who exhibit reading variances below the average IQ of the test group cannot be immediately defined as dyslexic. Further investigation involving a variety of controlled examinations must be performed in order to discover the unique symptoms associated with the particular child’s disability.

It must be noted that oftentimes dyslexia is a hidden disorder, primarily because of social pressures placed on children to perform in school. Fear of labeling, coupled with parental disappointment can be a powerful motivator in masking or hiding of dyslexic symptoms. Initial determination of this disorder must be made through observation and recognition of potential warning signs. “Parents are often aware that their children have some problems with language before they start school. Youngsters with language processing disabilities may be slow in learning to speak, and may use shorter sentences, smaller vocabularies, and poorer grammar than their brothers and sisters did at similar ages.”[10]

As symptoms are not easily identified due to lack of visual corroboration, there are a variety of discrepancy principles which are most often utilized for more accurate prognosis. IQ testing will be discussed in detail in further sections, yet, the ability to establish a connection between variances in observed and expected achievement make this form of testing one of the most consistent, yet debated, techniques for initial identification of dyslexic symptoms. Similarly, reading and listening comprehension are often studied in an attempt to determine obvious strengths in one category over the other.[11] Determining that a patient’s reading comprehension is far inferior to his listening does not, however, decidedly diagnose them as dyslexic. This approach must identify the innate deficiency in word identification and contrast those results with alternate discrepancy evaluations.

Additionally, the definition of phonological deficiency pervades this model, as dyslexic children can have problems with written and spoken words alike. As dyslexia is clearly a heterogeneous disorder, a variety of symptoms requires varying evaluations, and in both of these discrepancy tests, the symptomology alone does not dictate dyslexia. A third area of discrepancy evaluation relates chronological age to reading age. Yet, historic evaluations of schooling and environmental factors (home environment, access to reading materials, etc) become paramount in determination whether or not the reading proficiency directly correlates to the social environment of the child. Again, it is the predicated evaluation of all apparent and collaborative symptoms which enables accurate diagnosis and appropriate educational tactics.

Causality

Often confused with symptomology, causality is the identification of the underlying failures contributing directly to the disorder. For dyslexic evaluations, an simplified approach to causality is to determine that a phonological impairment has contributed to an inability to read and write at the same level as their peers. Therefore, treatment tactics will include direct reading training, word recognition instruction, symbolic representation, and intensified reading emphasis. In the next chapter, RTI (responsiveness to intervention) will be discussed as a replacement for the “wait to fail” approach, which when utilized properly, determines their responsiveness to the training and potentially prevent misdiagnosis. Could the child respond to the phonological training? If there were dramatic improvement through basic teaching tactics which were more localized to poor readers, then perhaps the entire diagnosis of dyslexia could be removed, and focus on reading abilities and further instruction would become a priority. However, dyslexia, as previously stated, is a lifetime disability which mandates many changes in lifestyle and learning approach. The underlying causes are irreversible, and proper diagnosis is paramount in determining the best tactics toward normalization.

“The World Federation of Neurology defines dyslexia as a disorder manifested by difficulty in learning to read despite conventional instruction, adequate intelligence, and sociocultural opportunity. It is dependent upon fundamental cognitive disabilities which are frequently of constitutional origin.”[12] Directly related to the phonological impairment is a cerebral malfunction or failure in which not only reading and writing abilities are impaired, motor skills including balance can also be affected. In addition to cerebral malfunctions, it is a well known fact that both sides of the brain process and perform different functions as related to thinking: the left side predominantly controls speech, reading, writing, and numeric processing ability; the ride side controls creativity, musical ability, and imagination. “Mixed hemispheric dominance” is attributed to the cause of improper phoneme reproduction is due to the brain’s hemispheric responses to stimuli.[13] Therefore, the functions normally controlled by the left half of the brain are delegated in part to the right side, an area not typically charged with these particular functions. Dyslexics are often characterized as picture thinkers, or students who tend to think and speak in very imaginative capacities, often formulating speech as though they were painting a picture. In this scenario, the causality of photo-dictation is directly related to a confused hemispheric dominance. It is important, however, to note that assumption of causal relation to dyslexic symptoms can only be validated through intense scientific research and neurological study. Causes of this impairment are readily defined, but oftentimes troublesome in clinical corroboration.

Mythological Muddle or Modern Mystery

It is the duty and underlying objective of the scientist to investigate all causes and symptoms of a particular disorder in order to determine without a doubt the symbiotic relationship between the two and repeatability of testing procedures with future patients. Therefore, it would stand to reason that as time passes and frequency of variance within investigation techniques subsides, that scientific data would affirm one theory of dyslexia above all others. Unfortunately, the heterogeneity of this disorder has left a lifetime of neurologists without a solid foothold from which to hoist concrete scientific evidence as to the causes and treatments for dyslexia. The most problematic area of the body has proven to be the brain, and for obvious reasons, interpreting its responses to educational stimuli is a difficult and painstaking task.

Study aside, cultural mores supply myths which often muddle educated theories regarding dyslexia. One myth as qualified by an ignorant teacher of a dyslexic student was “well, I mean, it’s one of those things that has been conjured up by pushy parents for their thick or lazy children, quite often both.”[14] These myths affect cultural perception as well as tactics educators explore in relation to future education of clinically diagnosed dyslexics. It is essential to the support and appropriate treatment of dyslexia that the dispelling of common myths becomes a priority. The following represents some of the most prevalent, but certainly not all myths associated with this disorder.

Myths:

All dyslexics read backwards

As previously stated, dyslexia is not simply a “backwards reading disorder.” While letter and word manipulation is a result of the disorder, not all dyslexics view words backwards. Oftentimes mirrored writing is an effect, yet proper teaching and techniques enable dyslexics to read and write over time as well as non-impaired individuals.

Dyslexia only affects reading

Discussion of symptomology of this disorder clearly shows that writing, listening, even motor skills are often affected by dyslexia. Phonological impairment does not limit dyslexic symptoms to poor reading alone. The inability to appropriately process and utilize language, words, and letters affects all areas related to these categories.

Dyslexics have a poor sense of direction

Dyslexics are often grouped into a category of individuals with poor sense of direction, and ones who are often clumsy or inept. While dyslexia can oftentimes cause a directional confusion, it is a trait which is dictated by the unique affectation of a heterogeneous affliction.

Dyslexia can be cured

Scientific advancements have challenged the confines of the human mind, yet manipulation of the brain, moreover, repair of major cerebral impairments, is as of date an impossibility with relation to dyslexia. Many dyslexics will learn to live normally with their impairment; many have already gone on to become great historical figures, yet curing this disorder is simply a task charged to the neurologists of the future.

My parents can read so I am not dyslexic

The genetic link between relatives and dyslexia is apparent and proven. The misconception however lies within the idea that genetic correlation is linked directly to the parents. Heredity and dyslexia form a bond within a family’s genetic makeup, enabling the link to come from oftentimes removed relatives, Uncle, Aunt, Grandfather. Dyslexia is a hereditary disorder and further research into a family tree reveals the path of its emergence.[15]

Dyslexia, a mystery to scientists and educators for over one hundred years, presents children with challenges unlike other afflictions. The inability to localize the gene or regional affectation which causes dyslexia presents an almost hopeless image of what, in other scenarios, might be considered a gift. It is the unique modifications made by the mind which enable dyslexics to processes other areas of learning more quickly than other students, and this compensation oftentimes more than outweighs the debilitation of a decrease in language comprehension.

Personal Affectation—Why Me?

Scientific study aside, the human factor relative to living with dyslexia is prevalent and worthy of discussion. A child in an educationally pervasive society with expectations and standards thrust on him on a regular basis would find his inability to read common words not only frustrating but frightening. From a psychological standpoint, abnormality in a very standardized environment causes great confusion among children. Their inability to fully comprehend the situation will often lead to masking tactics in addition to rebellious behavior which carries the potential for misdiagnosis.

The perspective of a potential dyslexic is that they will be ridiculed in school settings for their differences and perhaps even placed in remedial classes in order to help them have a full and prosperous education. It is the responsibility of the educator as well as the parents to address this particular affliction, not as an illness but as a gift. Reminding students that a very impressive list of famous and successful dyslexics exists today and that more are added to it yearly allows for a comfort factor which can offset some of the fear. Creating an educational blueprint which navigates the student through the symptoms and adaptations of dyslexia and assists them to define a life of normalcy is a priority. The upcoming chapter will discuss the specific processes which can assist a student in a prosperous and diverse lifestyle in addition to addressing and identifying the unique factors of their disorder which may eventually help neurologists pinpoint the cause of dyslexia.

Chapter Two

Sitting before his teacher, hands clenched tightly in front of him on the desk, the student waited with anticipation as the cards were raised one at a time. The pictures were familiar, the writing seemed like something he had seen once before but it didn’t make sense. The instructor slowly prompted the wary student, the sounds forming behind tight lips. His first steps towards living with dyslexia had begun.

Introduction

The following chapter will not only evaluate dyslexia based upon specific traits and the modern techniques utilized to explore and define the disorder, it will explore the potential benefits of choosing each uniquely suited tactic in the attempt to properly diagnose and treat with accuracy.

Necessity or Misdiagnosis

“Congratulations, you have dyslexia.” This is not exactly a reasonable statement for a neurologist to make to a grade school child who is afflicted with the malady. Nor can he treat the diagnosis as though he has spelled the end of a normal lifestyle for this frightened adolescent. It is important for educators to note that the process which is undertaken in order to get to this step, the ultimate diagnosis of the disorder, must be recognized, internalized, and practiced on a regular basis in order to avoid unfortunate misdiagnosis.

The student who stands on his desk and yells mild obscenities at the top of his lungs will not only gain laughs from his classmates, but will most likely enjoy a trip to the school counselor. Should he appear restless and frustrated as his problems are probed, the counselor will suggest further examination. Eventually, ADD, Attention Deficit Disorder could become the prognosis, and Ritalin the drug of choice for overcoming this unfortunate scenario. And perhaps Ritalin does not work and the school performance continues to falter, then another trip to the physician and another diagnosis, yet a complete absence of alternate thinking regarding the disability is present at this time. The poor spelling and scribbled essays are completely forgotten in exchange for a reprise from destructive and irascible behavior. It is the failure of the teacher to note the extreme inability to read aloud in front of the class and realize that the reaction to his embarrassment is the disruptive nature for which they are medicating.

An ability to recognize, diagnose with accuracy, and utilize trained teaching abilities to inspire change and growth are qualities that are lacking in many of today’s teachers. It’s not a failure of their intelligence by any means, nor is it the training they have received; it is that there are simply too many variables from which to accurately diagnose learning disabilities in children.

Experience, coupled with comprehension of relevant learning categories is essential to proper dyslexic diagnosis.

  1. Family and heredity, as stated before, is essential to understanding the child’s genetic makeup. If there is a history of dyslexia within the family, closer attention can be paid to specific traits which are associated with the disorder than if there were not such congruence.
  2. Language skills are additionally a priority, as these abilities are essentially the area in question when formulating a diagnosis. Evaluation of comprehension, word identification, pronunciation and word retrieval are only a few of the basic categories from which to test a child.
  3. Reading, aloud and silently should also be tested. Listening to the child and analyzing particular word confusion, in addition to pronunciation issues will allow for important data to be drawn. Additionally, querying the child regarding reading comprehension can give insight into how the child processes the information they are taking in.
  4. Spelling and writing are essential as well. Looking for obviously inverted spelling in addition to word mirroring can be essential to the appropriate diagnosis.
  5. Handwriting as well becomes a necessary category from which to draw conclusions. Letter formation, balance of lines, spaces, paper alignment, all are paramount to proper evaluation.
  6. Memory becomes a category for study, as all time frames should be probed, from long to short term, in addition to visual memory.

It is through the mastery of evaluation of these categories, as well as experience with the basic psychology relevant to children of this age and proclivity, that will enable the educator or evaluator to appropriately diagnose and if all else fails, point the student towards the correct diagnosis and treatment center.

Phonological Instruction

The previously discussed phonological failure contributing to dyslexia warrants a structured approach to therapy and instruction. Nearly unanimously, researchers agree that proper phonological instruction is a priority for all school children, and even more necessitated with children diagnosed with dyslexia. “The general findings suggest that early and direct teaching of sound-symbol relationships produces better decoding skills than later and less explicit phonics instruction (Clark, 83).”[16]

Synthetic Phonics Instruction

In this approach to phonological instruction, a specific phoneme is separated and taught to the child prior to blending or inclusion in syllables or entire words. ie. /ph/ is inscribed on cue cards where the student learns to recognize an image of a phone through sight in addition to phoneme. Once this process has been appropriately completed and the student exhibits repeatable comprehension of the relationship, the phoneme is synthesized within words with letters that are already known so that the child may read them. Synthetic relationships are in this way established between objects, letters, and phoneme.

Intrinsic Phonics Instruction

As suggested by its title, this form of phonetic instruction utilizes complete words, beginning with those that are most often already known to the children. The patients are then encouraged to draw relationships between the letters, practicing phoneme and letter relationship at one time rather than learning segments and then grouping them to create words.

One program which has successfully adopted the Synthetic Phonetic approach to dyslexic instruction was initiated by the wife and co-scientist of Samuel Orton in collaboration with her partner Anna Gillingham in 1960. The approach was summarized through the following distinguishing features:

  1. It is a direct approach to the study of phonics, presenting

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