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. People with dyslexia have higher rates of attention deficit hyperactivity disorder, developmental language disorders, and difficulties with numbers.
Dyslexia is believed to be caused by the interaction of genetic and environmental factors. Some cases run in families. Dyslexia that develops due to a traumatic brain injury, stroke, or dementia is called "acquired dyslexia". The underlying mechanisms of dyslexia are problems within the brain's language processing. Dyslexia is diagnosed through a series of tests of memory, vision, spelling, and reading skills. Dyslexia is separate from reading difficulties caused by hearing or vision problems or by insufficient teaching or opportunity to learn.
Treatment involves adjusting teaching methods to meet the person's needs. While not curing the underlying problem, it may decrease the degree or impact 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% of the general population 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 divided into developmental and acquired forms. This article is primarily about developmental dyslexia, i.e., dyslexia that begins in early childhood. Acquired dyslexia occurs subsequent to neurological insult, such as traumatic brain injury or stroke. People with acquired dyslexia exhibit some of the signs or symptoms of the developmental disorder, but requiring different assessment strategies and treatment approaches.

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. 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. 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 include 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.

Associated conditions

Dyslexia often co-occurs with other learning disorders, but the reasons for this comorbidity have not been clearly identified. These associated disabilities include:
Researchers have been trying to find the neurobiological basis of dyslexia since the condition was first identified in 1881. For example, some have tried to associate the common problem among people with dyslexia of not being able to see letters clearly to abnormal development of their visual nerve cells.

Neuroanatomy

techniques, such as functional magnetic resonance imaging and positron emission tomography, have shown a correlation between both functional and structural differences in the brains of children with reading difficulties. Some people with dyslexia show less electrical activation in parts of the left hemisphere of the brain involved with reading, such as the inferior frontal gyrus, inferior parietal lobule, and the middle and ventral temporal cortex. Over the past decade, brain activation studies using PET to study language have produced a breakthrough in the understanding of the neural basis of language. Neural bases for the visual lexicon and for auditory verbal short-term memory components have been proposed, with some implication that the observed neural manifestation of developmental dyslexia is task-specific. fMRIs of people with dyslexia indicate an interactive role of the cerebellum and cerebral cortex as well as other brain structures in reading.
The cerebellar theory of dyslexia proposes that impairment of cerebellum-controlled muscle movement affects the formation of words by the tongue and facial muscles, resulting in the fluency problems that some people with dyslexia experience. The cerebellum is also involved in the automatization of some tasks, such as reading. The fact that some children with dyslexia have motor task and balance impairments could be consistent with a cerebellar role in their reading difficulties. However, the cerebellar theory has not been supported by controlled research studies.

Genetics

Research into potential genetic causes of dyslexia has its roots in post-autopsy examination of the brains of people with dyslexia. Observed anatomical differences in the language centers of such brains include microscopic cortical malformations known as, and more rarely, vascular micro-malformations, and microgyrus—a smaller than usual size for the gyrus. The previously cited studies and others suggest that abnormal cortical development, presumed to occur before or during the sixth month of fetal brain development, may have caused the abnormalities. Abnormal cell formations in people with dyslexia have also been reported in non-language cerebral and subcortical brain structures. Several genes have been associated with dyslexia, including DCDC2 and KIAA0319 on chromosome 6, and DYX1C1 on chromosome 15.

Gene–environment interaction

The contribution of gene–environment interaction to reading disability has been intensely studied using twin studies, which estimate the proportion of variance associated with a person's environment and the proportion associated with their genes. Both environmental and genetic factors appear to contribute to reading development. Studies examining the influence of environmental factors such as parental education and teaching quality have determined that genetics have greater influence in supportive, rather than less optimal, environments. However, more optimal conditions may just allow those genetic risk factors to account for more of the variance in outcome because the environmental risk factors have been minimized.
As environment plays a large role in learning and memory, it is likely that epigenetic modifications play an important role in reading ability. Measures of gene expression, histone modifications, and methylation in the human periphery are used to study epigenetic processes; however, all of these have limitations in the extrapolation of results for application to the human brain.

Language

The orthographic complexity of a language directly affects how difficult it is to learn to read it. English and French have comparatively "deep" phonemic orthographies within the Latin alphabet writing system, with complex structures employing spelling patterns on several levels: letter-sound correspondence, syllables, and morphemes. Languages such as Spanish, Italian and Finnish have mostly alphabetic orthographies, which primarily employ letter-sound correspondence—so-called "shallow" orthographies—which makes them easier to learn for people with dyslexia. Logographic writing systems, such as Chinese characters, have extensive symbol use; and these also pose problems for dyslexic learners.

Pathophysiology

Most people who are right-hand dominant have the left hemisphere of their brain specialize more in language processing. In terms of the mechanism of dyslexia, fMRI studies suggest that this specialization may be less pronounced or even absent in cases with dyslexia. Additionally, anatomical differences in the corpus callosum, the bundle of nerve fibers that connects the left and right hemispheres, have been linked to dyslexia via different studies.
Data via diffusion tensor MRI indicate changes in connectivity or in gray matter density in areas related to reading/language. Finally, the left inferior frontal gyrus has shown differences in phonological processing in people with dyslexia. Neurophysiological and imaging procedures are being used to ascertain phenotypic characteristics in people with dyslexia thus identifying the effects of certain genes.

Dual route theory

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 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.

Diagnosis

Dyslexia is a heterogeneous, dimensional learning disorder that impairs accurate and fluent word reading and spelling. Typical—but not universal—features include difficulties with phonological awareness; inefficient and often inaccurate processing of sounds in oral language ; and verbal working memory deficits.
Dyslexia is a neurodevelopmental disorder, subcategorized in diagnostic guides as a learning disorder with impairment in reading. Dyslexia is not a problem with intelligence. Emotional problems often arise secondary to learning difficulties. The National Institute of Neurological Disorders and Stroke describes dyslexia as "difficulty with phonological processing, spelling, and/or rapid visual-verbal responding".
The British Dyslexia Association defines 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". Phonological awareness enables one to identify, discriminate, remember, and mentally manipulate the sound structures of language—phonemes, onsite-rime segments, syllables, and words.

Assessment

There is a wide range of tests that are used in clinical and educational settings to evaluate the possibility that a person might have dyslexia. If initial testing suggests that a person might have dyslexia, such tests are often followed up with a full diagnostic assessment to determine the extent and nature of the disorder. Some tests can be administered by a teacher or computer; others require specialized training and are given by psychologists. Some test results indicate how to carry out teaching strategies. Because a variety of different cognitive, behavioral, emotional, and environmental factors all could contribute to difficultly learning to read, a comprehensive evaluation should consider these different possibilities. These tests and observations can include:
Screening procedures seek to identify children who show signs of possible dyslexia. In the preschool years, a family history of dyslexia, particularly in biological parents and siblings, predicts an eventual dyslexia diagnosis better than any test. In primary school, the ideal screening procedure consist of training primary school teachers to carefully observe and record their pupils' progress through the phonics curriculum, and thereby identify children progressing slowly. When teachers identify such students they can supplement their observations with screening tests such as the Phonics screening check used by United Kingdom schools during.
In the medical setting, child and adolescent psychiatrist M. S. Thambirajah emphasizes that "iven the high prevalence of developmental disorders in school-aged children, all children seen in clinics should be systematically screened for developmental disorders irrespective of the presenting problem/s." Thambirajah recommends screening for developmental disorders, including dyslexia, by conducting a brief developmental history, a preliminary psychosocial developmental examination, and obtaining a school report regarding academic and social functioning.

Management

Through the use of compensation strategies, therapy and educational support, individuals with dyslexia can learn to read and write. There are techniques and technical aids that help to manage or conceal symptoms of the disorder. Reducing stress and anxiety 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 and phonemes, and to relate these to reading and spelling by teaching how sounds blend into words. Reinforced collateral training focused on reading and spelling may yield longer-lasting gains than oral phonological training alone. Early intervention can be successful in reducing reading failure.
Research does not suggest that specially-tailored fonts help with reading. Children with dyslexia read text set in a regular font such as Times New Roman and Arial just as quickly, and they show a preference for regular fonts over specially-tailored fonts. Some research has pointed to increased letter-spacing being beneficial.
There is currently no evidence showing that music education significantly improves the reading skills of adolescents with dyslexia.

Prognosis

Dyslexic children require special instruction for word analysis and spelling from an early age. The prognosis, generally speaking, is positive for individuals who are identified in childhood and receive support from friends and family. The New York educational system indicates "a daily uninterrupted 90 minute block of instruction in reading", furthermore "instruction in phonemic awareness, phonics, vocabulary development, reading fluency" so as to improve the individual's reading ability.

Epidemiology

The percentage of people with dyslexia is unknown, but it has been estimated to be as low as 5% and as high as 17% of the population. While it is diagnosed more often in males, some believe that it affects males and females equally.
There are different definitions of dyslexia used throughout the world, but despite significant differences in writing systems, dyslexia occurs in different populations. Dyslexia is not limited to difficulty in converting letters to sounds, and Chinese people with dyslexia may have difficulty converting Chinese characters into their meanings. The Chinese vocabulary uses logographic, monographic, non-alphabet writing where one character can represent an individual phoneme.
The phonological-processing hypothesis attempts to explain why dyslexia occurs in a wide variety of languages. Furthermore, the relationship between phonological capacity and reading appears to be influenced by orthography.

History

Dyslexia was clinically described by Oswald Berkhan in 1881, but the term dyslexia was coined in 1883 by Rudolf Berlin, an ophthalmologist in Stuttgart. He used the term to refer to the case of a young boy who had severe difficulty learning to read and write, despite showing typical intelligence and physical abilities in all other respects. In 1896, W. Pringle Morgan, a British physician from Seaford, East Sussex, published a description of a reading-specific learning disorder in a report to the British Medical Journal titled "Congenital Word Blindness". The distinction between phonological versus surface types of dyslexia is only descriptive, and without any etiological assumption as to the underlying brain mechanisms. However, studies have alluded to potential differences due to variation in performance.

Society and culture

As is the case with any disorder, society often makes an assessment based on incomplete information. Before the 1980s, dyslexia was thought to be a consequence of education, rather than a neurological disability. As a result, society often misjudges those with the disorder. There is also sometimes a workplace stigma and negative attitude towards those with dyslexia. If the instructors of a person with dyslexia lack the necessary training to support a child with the condition, there is often a negative effect on the student's learning participation.

Research

Most dyslexia research relates to alphabetic writing systems, and especially to European languages. However, substantial research is also available regarding people with dyslexia who speak Arabic, Chinese, Hebrew, or other languages. The outward expression of individuals with reading disability and regular poor readers is the same in some respects.