When parents express concern that their child is struggling with language and reading skills, pediatricians can be a valuable source of information and guidance. Here are 5 steps to assist pediatric care providers with the assessment of dyslexia in children and referral of these patients to the appropriate specialists.
1. Early signs.
A common misconception about dyslexia is that it cannot be diagnosed or remediated until a child is in the third grade. Researchers now believe that early identification and intervention is critical for children with dyslexia to be successful in school. Students learn to read in kindergarten to third grade, and read to learn in fourth grade and beyond. Students will often begin to struggle with reading beginning in the fourth grade or later because a reading problem such as dyslexia was overlooked in the primary grades.
It is typical for a child in early childhood/primary grades to have some but not all of the following problems because of individual differences and access to early remediation:
· Difficulty with rhyming, blending sounds, learning the alphabet, linking letters with sounds.
· Difficulty learning rules for spelling; eg, spell words the way they sound (“bik” for bike); use the letter name to code a sound (“lafunt” for elephant).
· Difficulty remembering “little” words (want, said, of) that cannot be “sounded out.”
· Listening comprehension is usually better than reading comprehension; eg, the child may understand a story when read to him/her but struggles when reading the story independently.
There also may be reports of reading/spelling difficulties across generations in the family and delays or difficulties acquiring speech and language skills.
2. Identification and intervention.
For students with dyslexia, putting the emphasis on preventive or early intervention is necessary. There is no benefit to the child if special instruction is delayed for months while waiting for an involved testing process to occur. Additional direct instruction provided appropriately, beginning in kindergarten through third grade, can help students catch up to grade-level literacy skills and close the gap for many poor readers. Early assessment is the first step in identifying these students to make sure they receive the effective instruction they need to succeed.
By January or February of first grade, tests of early word reading, decoding, and spelling begin to be useful in providing information about what the student has learned and what gaps in knowledge exist. This information may be used to plan instruction and guide ongoing assessment.
Before second grade, it is more important to focus an evaluation on the precursors of reading development. Measures of language skills, phonological awareness, memory, and rapid naming are more suggestive of being at-risk for dyslexia among young children than are measures of word reading, decoding, and spelling.
When a student is having difficulties with reading and spelling, an evaluation is important for 3 reasons: diagnosis, intervention planning, and documentation:
· Diagnosis—An effective evaluation identifies the likely source of the problem. It rules out other common causes of reading difficulties and determines if the student profile of strengths and weaknesses fits the definition of dyslexia.
· Intervention planning—An effective evaluation develops a focused remedial program. It is crucial that this specialized instruction begins at the student’s grade level.
· Documentation—An effective evaluation documents the history of a student’s learning disability. The purpose of this documentation is to determine eligibility for special services and obtaining accommodations in school.
Most children with dyslexia need help from a teacher, tutor, or therapist specially trained in using a Multisensory Structured Language approach. It is important for these individuals to be taught by a systematic and explicit method that involves several senses (visual, auditory, tactile/kinesthetic) at the same time. Many individuals with dyslexia need individual help so that they can move forward at their own pace. In addition, students with dyslexia often need a great deal of structured practice and immediate corrective feedback to develop automatic word recognition skills.
5. Referral to dyslexia specialists.
Many parents are unable to find effective instruction to meet the educational needs of their children. This is especially true for reading instruction. Most public school teachers are not trained in the scientifically based approaches that are effective for a child with dyslexia. When looking for an outside provider, determine if the instructor is trained and experienced in the use of a Multisensory Structured Language program such as Orton-Gillingham (www.orton-gillingham.com), Wilson Language Training (www.wilsonlanguage.com), or other programs consistent with the IDA’s Knowledge and Practice Standards for Teachers of Reading (dyslexiaida.org/knowledge-and-practices/).
The Academic Language Therapy Association (ALTA; www.altaread.org/) certifies academic language therapists. Certified Academic Language Therapists (CALT) are specialists trained to work with students with dyslexia or reading disability. They have completed extensive accredited training in Multisensory Structured Language teaching. These specialists have knowledge of the logic and structure of English language systems: phonology, phonics, orthography, morphology-etymology, semantics, and syntax. They also know how to deliver structured language instruction using simultaneous multisensory teaching strategies.