“Adult persons with Dyslexia. University and work place. Same

problems? Different possibilities?”

Enrico Ghidoni, MDAssociazione Italiana Dislessia

Ghidoni.enrico@alice.it

Adult dyslexics in Italy

• Estimated prevalence of Dyslexia in Italy is 3 %.

• But in 2 out of 3 cases Dyslexia isn’t recognized at school.

• So there are a lot of unrecognized adult dyslexics (in universities, at work, in social life…).

• Dyslexia may be compensated but the neurobiological substrate is still present.

Questions about adult dyslexia 1

• What are the cognitive and psychological characteristics of adult dyslexics?

• Is the adult dyslexia profile different from that in the developmental age?

• What are the parameters for diagnosis (reading time, speed, accuracy…)?

• How many parameters must be abnormal to diagnose dyslexia?

• What tools to measure these parameters?

Questions about adult dyslexia 2

• Can Compensation make the disorder undetectable using any tool?

• How can we define diagnostic subcategories such as mild, moderate and severe dyslexia or phonological, superficial dyslexia……

• What are the residual patterns of each SLD?

Questions about adult dyslexia 3

• Are there adult dysfunctional patterns due to SLD which are unclassifiable according to common categories?

• Is there a specific history pattern for every SLD?• What kind of aid and support for adult SLD?• What compensatory tools are really effective?• To what extent is research on English-speaking

dyslexics transferable to our context?

Questions about adult dyslexia 4

• What is the natural history of dyslexia?• Is there any advantage for those who have

received a diagnosis and support?• Are there predictive factors for the evolution

of dyslexia in adult age?

Adult dyslexics – the facts

• Persistent phonological dysfunction

• Variable effect on life activities (study and work)

• Psychological fall-out

• Personal coping

D. Pollak: Four types of dyslexic student:

•The ‘patient’•The ‘student’•The ‘hemispherist’•The ‘campaigner’

Pollak• Those I called ‘patients’ had internalised a medical

view of dyslexia; they saw themselves as suffering from a condition which made them defective.

• The next group, I called ‘students’; they focused on the discrepancy between their IQ and their scholastic attainments, and regarded dyslexia as something which affected them only in an educational context.

• The ‘hemispherist’ group were good at metacognition, i.e. analysing the ways in which they learned; they were aware of their own strengths, for example in visualisation and holistic thinking.

• The fourth group, I called ‘campaigners’; they viewed dyslexia as a political issue, and were determined to fight for their right to be taught and assessed in dyslexia-friendly ways.

McLoughlin et al’s four types of dyslexic adult:

• unaware that they are dyslexic, and thus have no strategies for success

• aware that they are dyslexic, but still have no strategies

• aware that they are dyslexic, and have unconscious strategies

• aware that they are dyslexic, and make conscious use of good strategies.

Critical issues for adult diagnosis in Italy

• Adults (>18 ) are not treated by health services for childhood and adolescence

• There are hardly any standardized tests for subjects over 18.

• There is little interest in neuropsychology laboratories for adult neurological diseases

• The examination batteries for adult acquired dyslexia were conceived to evaluate disorders which are very different from developmental dyslexia.

Diagnostic demand

• University and College students who want to take advantage of accommodations now available in many universities;

• Students who have to take exams (state exams, public selections, driving license);

• Adults who wish to go back to school to obtain secondary school qualifications;

• Parents of DYS children who want to understand their own difficulties

Screening in adults

• Adult Dyslexia Check List, Vinegrad (ADCL) 1994

• Adult Reading History Questionnaire, Lefly & Pennington, 2000

• Lucid Adult Dyslexia Screener (LADS) Singleton, 2002

• On-line Questionnaires, Kasler e Fawcett, 2009

Project Adult Dyslexia Diagnosis

• Associazione Italiana Dislessia

• University of Modena and Reggio E.

• Arcispedale S. Maria Nuova, U.O. Neurology Unit, Neuropsychology Lab

Standardization study regarding controls

Identification of sensitive tests

(controls/dyslexics comparison)

Clinical study on adults, students or other

Project phases1

2

3

1. Standardization study

• Control group: N = 80 (AVIS volunteers, students, hospital staff)

• Mean values and standard deviation (percentiles for error scores)

• Four age groups: 18-24; 25-34; 35-44; 45-54

• Cut-off: - 2 standard deviations;

• 95° percentile for error scores

Test sensitivity (% positive results )

• Word lists: time 52%

• errors 40%

• speed 31%

• Non words time 69%

• errors 37%

• speed 52%

• Non word writing 29%

• ADCL 93%

• Text Reading:

• time 56%

• errors 38%

• speed 48%

• Allographs time40%

Test sensitivity (% positive results )

• N&D 1 time 29%• N&D 2 time 21%• N&D 2 time 23%• N&D 3 time 33%• N&D 3 errors 40%• Backward counting:• time 27%• errors 44%

• RAN:• Digits time 31%• Letters time 29%• Colours time 35%

• Word Span 13%• Visual search matrices

27%

3. Clinical study: Examination procedure

• Clinical interview

• Family history

• Personal history (medical and educational)

• Neuropsychological history (previous and current trouble)

• Preliminary tests (ADCL, Raven PM38, Oldfield, Beck DI, Hamilton Anxiety)

• Text, word list, non word reading

• Allograph Comparison

• Text comprehension

• Non word writing

• RAN (digits, letters, colours)

• Night & Day attention test

• Counting backwards

DD Adult Basic Battery

Additional Investigation

• Questionnaire /partially structured interview about self narrative

• Central Auditory Processing Disorder Checklist

• Psychological tools to evaluate affective relational aspects (BDI, Hamilton )

Single case in depth study

• Calculation (dyscalculia battery)

• Short term memory(digit span, Corsi’s cubes, word span; dual task)

• Long term Memory (verbal, visuo-spatial…)

• Language (fluency, naming, metaphors comprehension , verbal judgements, etc)

• Writing (Luzzatti test)

• Attention (Visual Matrices, Stroop, Trail making)

• Intelligence (WAIS-R)

• Visuo-spatial functions (Benton line orientation, Rey’s figure)

University Students (N 37)

• Primary Education 7• Engineering 5• Architecture 3• Economics 3• Communications 3• Law 3• Arts 3• Medicine; Veterinary 3• Psychology 3• Sociology 2• Nursing studies; Physical Education 2

Dyslexia at University

• An increasing number of DYS students

• Dynamics of Relationship with peers, teachers, administration

• Support measures and tools

• Tutoring, Negotiation, Mediation

In Italy :estimated prevalence amongst university students 1%

(Singleton, 2009)

Results in our sample

• Dyslexics are present in all degree courses.

• There is a high rate of “new” diagnoses (over 60% of cases)

• Academic and psychological problems are more evident if dyslexia is associated with dyscalculia

In the workplace

• Compensations and strategies

• A misunderstood style of work

• “I need more time!”

• Silly mistakes and managerial ability

• Negative stigmatization

• Choosing an occupation

• Disclosure and acceptance

The world of adult dyslexics

• A wide variety of ways of experiencing and understanding one’s own dyslexia (Fulgeri, 2010; Cardano, 2010)

• Discovery or creation of the niche

• Finding the right social and professional niche improves functional and psychological compensation

Personal experience

• Self narratives as a tool for reconstructing one‘s own identity

• To what extent is identity building conditioned by dyslexia?

• Diagnosis may be a turning point in life, a biographical transition.

Dyslexic identities

The social reality of dyslexia

• Cultural evolution

• Awareness of neurobiological ontology

• Protection and support require the recognition of the difference (labelling)

• Anti-label positions

• Labelling and stigma: which comes first?

• Ideology and stereotypes

Reggio Emilia, Italy