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AN OVERVIEW ON DYSLEXIA: DEVELOPMENTAL READING DISORDER

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About Author:
Snigdha Mishra
Department of Pharmacology, Sunder Deep Pharmacy College,
NH-24 Dasna, Sunder Deep Nagar Ghaziabad,
U.P., India-201001
snigdha2112@gmail.com

Abstract
Dyslexia is a neurological condition manifesting in children, who typically are average in intelligence, struggling academically. This tends to be confounding for parents who, based on their child's aptitude and general abilities in regard to problem solving, and should be able to read without too much difficulty but, nonetheless, they tend to struggle. Unfortunately, sometimes these children are labeled as "lazy" when, in fact, they tend to be working more diligently than other children to "keep up." Here we are having a brief about cause, symptoms, classification, positive aspects and management strategy to cope up with the children bearing this disorder.

REFERENCE ID: PHARMATUTOR-ART-1936

Introduction
Dyslexia is the most recognized of brain-based type of learning disability reading disorders. It is characterized by difficulty with learning to read fluently and with accurate comprehension despite normal intelligence.1, 2 These individuals typically read at levels significantly lower than expected despite having normal intelligence. Although the disorder varies from person to person, common characteristics among people with dyslexia is difficulty with phonological processing (the manipulation of sounds), spelling, and/or rapid visual-verbal responding. In individuals with adult onset of dyslexia, it usually occurs as a result of brain injury or in the context of dementia; this contrasts with individuals with dyslexia who simply were never identified as children or adolescents.  Dyslexia can be inherited in some families, and recent studies have identified a number of genes that may predispose an individual to developing dyslexia.

Dyslexia was identified by Oswald Berkhan in1881.3But the term Dyslexia was coined in 1887 by Rudolf Berlin, who was an Ophthalmologist in Stuttgart.4 Dyslexia, is a neurological condition manifesting in children, who typically are average in intelligence, struggling academically. This tends to be confounding for parents who, based on their child's aptitude and general abilities in regard to problem solving, should be able to read without too much difficulty but, nonetheless, they tend to struggle. Unfortunately, sometimes these children are labeled as "lazy" when, in fact, they tend to be working more diligently than other children to "keep up." Students who are evaluated by the School Psychologist may demonstrate a "discrepancy" between ability and achievement in that, typically they are, as described above, average or near-average in intelligence but performing well below grade level. However, often the ‘discrepancy’ is not significant enough to meet criteria for special education until at least third grade. These children may struggle with spelling in regard to "phonic" spelling errors (spelling words the way they sound) as well as difficulties with visual tracking. They tend to write letters and number backwards and have confusion over left/right differentiation. Spelling errors are also a common manifestation and they may demonstrate "jumbled" spellings in which all of the correct letters are present but in the wrong order. Children with dyslexia tend to rely on visual memory but, unfortunately, struggle in that regard relative to spelling and reading capacity.

Classification of Dyslexia
There are three proposed cognitive subtypes of dyslexia (auditory, visual and attentional), although individual cases of dyslexia are better explained by specific underlying neuropsychological deficits and co-occurring learning disabilities e.g.attention-deficit/hyperactivity disorder, math disability, etc.5-8

Castles and Coltheart describe phonological and surface types of developmental dyslexia by analogy to classical subtypes ofalexia (acquired dyslexia) which are classified according to the rate of errors in reading non-words.9,10 However, the distinction between surface and phonological dyslexia has not replaced the old empirical terminology of dysphonetic versus dyseidetic types of dyslexia.11 The dysphonetic/dyseidetic distinction refers to two different mechanisms; one that relates to a speech discrimination deficit, and another that relates to a visual perception impairment.

Sign and symptoms

  • Delays in speech12
  • Letter reversal or mirror writing(soiled/solid, left/felt)13, 14
  • Being easily distracted by background noise15
  • Difficulty identifying or generating rhyming words, or counting syllables in words (phonological awareness),16
  • A difficulty segmenting words into individual sounds, or blending sounds to make words17
  • Commonly very poor spelling (Orthographic coding)18
  • Trouble with summarizing a story, memorizing, reading aloud, and learning a foreign language19
  • A common misconception about dyslexia is that dyslexic readers write words backwards or move letters around when reading – this only occurs in a very small population of dyslexic readers20
  • Avoids reading aloud
  • Trouble with word problems
  • Difficulty with handwriting
  • Awkward, fist-like, or tight pencil grip
  • Slow or poor recall of facts
  • Difficulty making friends
  • Delay in learning tasks such as tying shoes & telling time
  • Inattentiveness; distractibility
  • Inability to follow directions
  • Left-right confusion
  • Difficulty learning the alphabet, times tables, words of songs or rhymes
  • Poor playground skills
  • Difficulty learning to read
  • Mixing the order of letters or numbers while reading or writing


Why Dyslexia is gift?
Dyslexia people are highly creative, intuitive and excel at three dimensional problem solving and hands on learning. Their visual and holistic learning style means that they learn best through the creative processes, with methods that focus on mastery of meanings of words and symbols. The true gift of dyslexia is the gift of mastery. When they use learning methods that fit their thinking style, they can excel in academics and read and write efficiently. Children with dyslexia may struggle with reading but, by the same token, they have numerous strengths including being quite creative, physically athletic, and empathetic, given their plight. They may excel in various vocations including in the creative arts, personnel service, customer advice, as well as sports management and training.

Some famous Dyslexic’s personalities

Albert Einstein(Genius) was a German theoretical physicist, author and one of the most influential scientists.

Steve Jobs was the best known cofounder and the CEO of Apple, a computer and telecommunication company.

Alexander Flaudy became the youngest undergraduate at Cambridge in over 200years at the age of 15yrs.

Tom Cruise is an American actor who has many leading roles in popular films throughout the two decades.

Leonardo Da Vinci an Italian inventor is truly one of the original Renaissance man.

Thomas Edison a great scientist who invented light bulb.


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Etiology
Dyslexia tends to be inherited in that, almost invariably, if a child has dyslexia, a parent or relative does as well. Interestingly, there is often left-handedness somewhere in the family of children who have dyslexia though such is not a causative factor. There is also evidence of "ectopic" cells that failed to move to the brain's surface at the time when the brain was developing, that may have some correlation with dyslexia. Moreover, there is evidence that the brain of children with dyslexia is working inefficiently in regard to understanding language in that, for example, using the right side of the brain to a greater extent than non-dyslexic children for the use of language skills. There is also evidence of conductive hearing loss that may contribute to dyslexia.

Genetic research into dyslexia has its roots in the examination of post autopsy brains of people with dyslexia21, 22 When they observed anatomical differences in the languages center in dyslexic brain, they showed microscopic cortical malformations known as ectopias and more rarely vascular micro malformations, and in some instances these cortical malformation appeared as a microgyrus. These study suggested abnormal cortical development which was presumed to occur before or during the sixth month of fetal brain development.23

In the area of neurological research into dyslexia, modern neuro imaging techniques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have produced clear evidence of structural differences in the brains of children with reading difficulties. It has been found that people with dyslexia have a deficit in parts of the left hemisphere of the brain involved in reading, which includes the inferior frontal gyrus, inferior parietal lobule, and middle and ventral temporal cortex.24 Diverse ?ndings appear incompatible with the theory suggesting that abnormal embryonic cell formations within the linguistic cerebral cortex have a primary role in causing dyslexia.25,26


Fig. Differences between normal and dyslexic brain

Several learning disabilities often occur with dyslexia, but it is unclear whether these learning disabilities share underlying neurological causes with dyslexia.27

These disabilities include:
Dysgraphia
a disorder which expresses itself primarily through writing or typing, although in some cases it may also affect eye–hand coordinationdirection- or sequence-oriented processes such as tying knots or carrying out a repetitive task. In dyslexia, dysgraphia is often multifactorial, due to impaired letter writing automaticity, finger motor sequencing challenges, organizational and elaborative difficulties, and impaired visual word form which makes it more difficult to retrieve the visual picture of words required for spelling. Dysgraphia is distinct from dyspraxia in that dyspraxia is simply related to motor sequence impairment.

Attention deficit disordera high degree of co-morbidity has been reported between ADD/ADHD and dyslexia/reading disorders28 it occurs in between 12% and 24% of those with dyslexia.29, 30

Auditory processing disorderA condition that affects the ability to process auditory information, is major cause of dyslexia31

Developmental coordination disorder  A neurological condition characterized by a marked difficulty in carrying out routine tasks involving balance, fine-motor control, kinesthetic coordination, difficulty in the use of speech sounds, problems with short-term memory and organization are typical of dyspraxics.

Experience of speech acquisition delays and speech and language problems can be due to problems processing and decoding auditory input prior to reproducing their own version of speech,32, 33 and may be observed as stuttering, cluttering or hesitant speech.34

Management
There is no cure for dyslexia, but dyslexic individuals can learn to read and write with educational support.35 There are techniques and technical aids that can manage or even conceal symptoms of the disorder.36 Removing stress and anxiety alone can improve written comprehension.37For dyslexia interventions 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. It has been found that training focused towards visual language and orthographic issues yields longer-lasting gains than mere oral phonological training.38

There is some evidence that the use of specially tailored fonts may provide some measure of assistance for those suffering from dyslexia.39 Intervention early on while language areas in the brain are still developing is most successful in reducing long-term impacts of dyslexia.40

Learning strategy
Children with dyslexia tend to have, as a foundational deficit, difficulties with phonemic awareness. In that regard, they have difficulty understanding the connection between letters and the sounds they make. Fortunately, there are a number of strategies to enhance phonemic awareness including games and activities. It is vital to review, and promote mastery of, the 26-letters of the alphabet and their accompanying phonemes. Reading activities are particularly helpful as well, including using the "Golden Rule" that involves telling the child the words they do not know without having them struggle during the reading activity. This promotes both enjoyments in the child's reading, as well as subsequent learning, given the repetition of the activity. Children with dyslexia often struggle with a lack of self-confidence given the academic difficulties they face essentially on a daily basis. Consequently, it is vital to emphasize their strengths that typically include coordination, creativity, and empathy with others. Cognitive therapy can also be utilized to help them "re-think" how they view themselves in a more realistic and accurate manner, focusing on their strengths as opposed to weaknesses. By increasing the child's confidence, motivational levels can also be enhanced, which further the child's academic functioning.41

Teaching strategy
A multisensory approach is optimal in working with children with dyslexia. In that regard, children with dyslexia tend to be at a disadvantage when being provided with instruction based solely in the visual or the auditory. Children with dyslexia tend to benefit from the aforementioned multi-sensory approach utilizing sight, hearing, touch, and movement. This can be accomplished by teaching children in a traditional manner, utilizing the visual and auditory senses and, additionally, utilizing a tactile approach by letting the child draw the letter, using their finger, on the carpet or using sand paper in a similar manner. Visual imagery can also be helpful by, for example, recalling the word "bed" and visualizing the direction of the "b and d" letters (and a person sleeping between the two letters, as if on a bed). A number of routine-oriented strategies can be helpful in the classroom setting including providing an outline prior to the lesson being taught; printing keywords in upper case letters; using colored chalk to distinguish activities; and leaving writing on the blackboard long enough to ensure the child does not have to rush. Even better, would be to provide a photocopy of the assignment sheet to the dyslexic child. It also helps to be provided off-white colored paper and larger font (14 or above) in Arial. It is also vital to avoid using overhead transparencies. Tasks need to be broken-down into small easily remembered pieces of information. It also helps to use a highlighter to emphasize keywords, main ideas, as well as important names and vocabulary. It is important to not ask a dyslexic child to read aloud in class. Cursive joined writing is most helpful to children with dyslexic problems, given that they can use their visual memory in helping to recall the sequence of the letters. Voice dictation software can be helpful and learning to type.

Children who struggle with Dysgraphia will benefit from typing their work or using voice-recognition software.41

· Focus on strengths

· Provide a clear subject overview

· Link key concepts and constantly revisit previously covered areas

· Provide clear and concise visual handouts using diagrams, mind maps and pictures.

· Use large text on colored paper

·  Teach organizational skills (files with color-coded subject areas…)

· Use visual diagrams and graphs as opposed to ‘wordy’ paragraph.

· Allow for use of typing rather than writing

· Ignore spelling errors in text

· Use oral testing

· Untimed tests

· Dictated responses

· Short answer and multiple choice

· Provide model answers

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There are various courses and workshops available to manage these symptoms. The Dyslexia Association of India conducts not for profit courses and workshops that are tailor made to suit the requirements of teachers and parents. They encourage attending these workshops and helping those children’s who cope with learning differences. Using ‘rehabilitation of dyslexia’ or ‘intervention in dyslexia’ did some change in that figure.

Conclusion
Children with dyslexia tend to need extra support and attention. With the help of various courses, strategy and workshops available to manage these symptoms, one can overcome with these disorders.

References
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