Learning Disabilities, ADD/ADHD, and

Dyslexia

Development of Young Children with Disabilities#872.514 (61)

Carol Ann Heath

What are Learning Disabilities?

Learning disabilities are disorders that affect the ability to understand or use spoken or written language, do mathematical calculations, coordinate movements, or direct attention. Although learning disabilities occur in very young children, the disorders are usually not recognized until the child reaches school age.

The term "learning disability" was apparently first used and defined by Dr. Samuel Kirk (1962, cited in Streissguth, Bookstein, Sampson, & Barr, 1993, p.144). The term referred to a discrepancy between a child’s apparent capacity to learn and his or her level of achievement. A review of the LD classifications for 49 of 50 states revealed that 28 of the states included IQ/Achievement discrepancy criteria in their LD guidelines (Ibid., citing Frankenberger & Harper, 1987).

However, the National Joint Committee for Learning Disabilities (NJCLD) (1981; 1985) preferred a slightly different definition: is a generic term that refers to a heterogeneous group of

disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning abilities. These disorders are intrinsic to the individual and presumed to be due to Central Nervous System Dysfunction. Even though a learning disability may occur concomitantly with other handicapping conditions (e.g. sensory impairment, mental retardation, social, and emotional disturbance) or environmental influences (e.g. cultural differences, insufficient/inappropriate instruction, psychogenic factors) it is not the direct result of those conditions or influences.

The Individuals with Disabilities Education Act (United States) defines a learning disability this way: . . .[a] disorder in one or more of the basic psychological

processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations. . . .Learning disabilities include such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.

The Learning Disabilities Association of Ontario (Canada) defines LDs this way: “Learning Disabilities” refers to a variety of disorders that affect

the acquisition, retention, understanding, organization or use of verbal and/or non-verbal information. These disorders result from impairments in one or more psychological processes related to learning (a), in combination with otherwise average abilities essential for thinking and reasoning. Learning disabilities are specific not global impairments and as such are distinct from intellectual disabilities.

Learning disabilities range in severity and invariably interfere with the acquisition and use of one or more of the following important skills: oral language (e.g., listening, speaking, understanding), reading (e.g., decoding, comprehension), written language (e.g., spelling, written expression), mathematics (e.g., computation, problem solving). Learning disabilities may also cause difficulties with organizational skills, social perception and social interaction.

Continued

The impairments are generally life-long. However, their effects may be expressed differently over time, depending on the match between the demands of the environment and the individual’s characteristics. Some impairments may be noted during the pre-school years, while others may not become evident until much later. During the school years, learning disabilities are suggested by unexpectedly low academic achievement or achievement that is sustainable only by extremely high levels of effort and support.

Learning disabilities are due to genetic, other congenital and/or acquired neuro-biological factors. They are not caused by factors such as cultural or language differences, inadequate or inappropriate instruction, socio-economic status or lack of motivation, although any one of these and other factors may compound the impact of learning disabilities. Frequently learning disabilities co-exist with other conditions, including attentional, behavioral and emotional disorders, sensory impairments or other medical conditions.

A person with a learning disability has difficulty in collecting, organizing, or acting on verbal and nonverbal information. Most commonly, the person has trouble understanding or using written or spoken language. The difficulty is due to a neurological difference in brain structure or functioning.

The disparity between the child’s intelligence and the child’s school performance highlights the learning difficulties.

People with learning disabilities do not have low intelligence; in fact, they have average or above average intelligence. However, their academic performance, as measured by standardized tests, is below what one would expect of someone of their intelligence, age, and grade level.

A person with a learning disability may score poorly on tests, but the low scores are due to a problem with learning, not to low intelligence.

Problems occur in one or more of these areas:

language development and language skills (listening, speaking, reading, writing, and spelling)

social studies mathematics social skills motor skills (fine motor skills, as well as coordination) cognitive development and memory attention and organization test-taking

What are the types of learning disabilities?

Speech and language disorders Academic disorders Fine motor skills problems (dyspraxia) Nonverbal Learning Disorder

Speech and language disorders

Difficulty producing speech sounds (developmental articulation disorder). The person might mispronounce certain letters or letter combinations.

Difficulty using spoken language to communicate (developmental expressive language disorder). The person has difficulty with verbal expression.

Difficulty understanding what other people say (developmental receptive language disorder). The person hears the words, but doesn’t process the words correctly.

Academic skills disorders

Reading problems (developmental reading disorder, or dyslexia). The person cannot identify different word sounds.

Writing problems (developmental writing disorder, or dysgraphia). The person has problems with handwriting or with creating sentences that make sense to others.

Arithmetic skills problems (developmental arithmetic disorder, or dyscalculia). The person has problems with calculations or with abstract mathematical concepts.

What are the signs of LD?

average or above average intelligence (as measured by the IQ score)

significant delay in academic achievement severe information processing deficits uneven pattern of cognitive development throughout

life a disparity between measured intellectual potential

(IQ score) and actual academic achievement the learning disability persists despite instruction in

standard classroom situations

Discrepancy Model

The discrepancy model has dominated the school system for many years, there has been substantial criticism of this approach (e.g., Aaron, 1995, Flanagan and Mascolo, 2005) among researchers.

Does not predict the effectiveness of treatment. Low academic achievers who do not have a

discrepancy with IQ (i.e. their IQ scores are also low) appear to benefit from treatment just as much as low academic achievers who do have a discrepancy with IQ.

Responsiveness to Intervention Children who are having difficulties in school are identified early -

in their first or second year after starting school. They receive additional assistance such as participating in a

reading remediation program. The response to this intervention determines whether they are

designated as having a learning disability. Sternberg (1999) has argued that early remediation can greatly

reduce the number of children meeting diagnostic criteria for learning disabilities. He suggested that the focus on learning disabilities and the provision of accommodations in school fails to acknowledge that people have a range of strengths and weaknesses and places undue emphasis on academics by insisting that people should be propped up in this arena and not in music or sports.

What can help? The most common intervention for learning disabilities is special

education. Trained educators may perform a diagnostic educational

evaluation assessing the child's academic and intellectual potential and level of academic performance.

Basic approach is to teach learning skills by building on the child's abilities and strengths while correcting and compensating for disabilities and weaknesses.

Other professionals such as speech and language therapists also may be involved.

Some medications may be effective in helping the child learn by enhancing attention and concentration.

Psychological therapies may also be used.

What is the prognosis?

Learning disabilities can be lifelong conditions.

In some people, several overlapping learning problems may be diagnosed.

Other people may have a single, isolated learning problem that has little impact on their lives.

What causes a learning disability?

Abnormal brain structure or function causes learning disabilities. However, poor performance in school can be due to other factors. For example: If no one at home talks to a child and helps the child to

learn how to interact with the world, the child will be delayed in social or intellectual development.

If parents or teachers have a personal style at odds with the child’s style (such as a highly structured, visually organized adult and an energetic, kinesthetic child who learns by doing, not by seeing), the mismatch may appear to be a learning disability in the child.

What brings about the different brain structure or function?

Neurological abnormalities in the brain can result from: genetics factors before birth or during delivery factors in early childhood brain trauma or tumors

Genetics

A person can inherit abnormal brain structure

or function. Although a person may have inherited a learning disability, the environment can still make a difference.

Factors before birth or during delivery

The uterine environment is very important for healthy brain development in the fetus. Negative influences on brain development in utero and at birth are: the mother’s drug-use, alcohol-use, or smoking during

pregnancy physical problems during pregnancy or delivery (e.g.,

measles, oxygen deprivation) very low birth weight; extremely low birth weight premature birth birth trauma or distress the mother’s poor nutrition

Factors in early childhood

Several factors in early childhood can contribute : neonatal seizures a poor learning environment due to a parent’s own learning

disability developmental trauma ( such as abuse, isolation or neglect

in infancy) toxins in the environment (such as cadmium, lead, or

mercury) chemotherapy treatment for childhood cancer central nervous system infections chronic illnesses such as diabetes or asthma poor nutrition

Terminology and classification

Some of them are as follows (codes provided are ICD-10 and DSM-IV, respectively.)

(F80.0-F80.2/315.31) Dysphasia/aphasia - Speech and language disorders difficulty producing speech sounds (articulation disorder) difficulty putting ideas into spoken form (expressive

disorder) difficulty perceiving or understanding what other people

say (receptive disorder)

(F81.0/315.02) Dyslexia - the general term for a disability in the area of reading. difficulty in phonetic mapping, where sufferers have difficulty

with matching various orthographic representations to specific sounds

Some claim that dyslexia involves a difficulty with spatial orientation, which is stereotyped in the confusion of the letters b and d, as well as other pairs. In its most severe form, b, d, p and q, all distinguished primarily by orientation in handwriting, look identical to the dyslexic. However, there is no scientific evidence that dyslexia, or other learning difficulties, are related to vision or can be alleviated with visual exercises or colored glasses.[1]

Some claim that dyslexia involves a difficulty with sequential ordering, such that a person can see a combination of letters but not perceive them in the correct order. However, as with spatial orientation, there is no scientific evidence that dyslexia involves a visual problem.[1]

(F81.1/315.2) Dysgraphia - the general term for a disability in the area of physical writing. It is usually linked to problems with visual-motor integration or fine motor skills.

(F81.2-3/315.1) Dyscalculia - the general term for a disability in the area of math.

Dyspraxia - the general term for a disability with co-ordination and movement.

Accommodations involve multi-modal and appropriately tailored teaching and compensatory strategies/tools such as:

special seating assignments alternative or modified assignments modified testing procedures electronic spellers and dictionaries word processors talking calculators audio books Text-to-Speech (TTS) Software note-takers readers proofreader

What else can look like a learning disability? ADHD sensory integration dysfunction (DSI, or SI) (see below) hearing deficits vision problems attachment disruption emotional trauma anxiety depression a home environment that is not conducive to learning a mismatch between a child’s personal learning style and the

expectations of the child’s parents and/or teachers

How is sensory integration dysfunction (DSI or SI) related to learning disabilities?

Sensory integration dysfunction (DSI or SI) can look like a learning disability, but it isn’t. DSI is a neurologically based disorder, like ADHD and learning disabilities. A child with DSI has an inability to organize sensory input for use in daily living, which includes school, play, and family life. The child has either a hyposensitivity or a hypersensitivity to sensory input, such as an overreaction to the feel of clothing or to the texture of food. DSI is similar to ADHD in that it impacts learning, but is not a learning disability. DSI overlaps with ADHD in symptoms of inattention and restlessness.

Is ADHD a learning disability?

This question is an important, but confusing, one because many individuals with ADHD also have one or more learning disabilities, and individuals with learning disabilities sometimes also have ADHD. Each condition has a separate diagnosis and treatment.

An individual with ADHD may struggle with learning, but he or she can often learn adequately once successfully treated for the ADHD. A person can have ADHD but not learning disabilities or have learning disabilities without having ADHD. The conditions can co-occur known as co-morbidity.

Someone with a learning disability is affected in only one or a few areas. However, people with ADHD are often affected in all areas.

What is ADD/ADHD

ADD = Attention Deficit Disorder ADHD = Attention Deficit Hyperactivity

Disorder Predominantly Inattentive type Predominantly Hyperactive and Impulsive type Combined type

Attention Deficit Hyperactivity Disorder (ADHD)

Condition that becomes apparent in some children in the preschool and early school years. It is hard for these children to control their behavior and/or pay attention.

It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States.

This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD.

ADHD was first described by Dr. Heinrich Hoffman in 1845.

"The Story of Fidgety Philip" was an accurate description of a little boy who had attention deficit hyperactivity disorder.

It was not until 1902 that Sir George F. Still published a series of lectures to the Royal College of Physicians in England in which he described a group of impulsive children with significant behavioral problems, caused by a genetic dysfunction and not by poor child rearing—children who today would be easily recognized as having ADHD.1

Symptoms of ADHD Appear over the course of many months, often with the

symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more.

Different symptoms may appear in different settings, depending on the demands the situation may pose for the child's self-control. A child who "can't sit still" or is otherwise disruptive will be noticeable in school, but the inattentive daydreamer may be overlooked. The impulsive child who acts before thinking may be considered just a "discipline problem," while the child who is passive or sluggish may be viewed as merely unmotivated. Yet both may have different types of ADHD.

Diagnostic and Statistical Manual of Mental Disorders2 (DSM-IV-TR),

Three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive far more than others of their age.

May show all three types of behavior. This means that there are three subtypes of ADHD recognized by professionals. predominantly hyperactive-impulsive type (that does not

show significant inattention); predominantly inattentive type (that does not show significant

hyperactive-impulsive behavior) sometimes called ADD—an outdated term for this entire disorder;

combined type (that displays both inattentive and hyperactive-impulsive symptoms).

Hyperactive children

Seem to be "on the go" or constantly in motion. They dash around touching or playing with whatever is in sight, or talk incessantly. Sitting still at dinner or during a school lesson or story can be a difficult task. They squirm and fidget in their seats or roam around the room. Or they may wiggle their feet, touch everything, or noisily tap their pencil.

Hyperactive teenagers or adults may feel internally restless. They often report needing to stay busy and may try to do several things at once.

Impulsive children Unable to curb their immediate reactions or think

before they act. They will often blurt out inappropriate comments, display their emotions without restraint, and act without regard for the later consequences of their conduct. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they're upset.

As teenagers or adults, they may impulsively choose to do things that have an immediate but small payoff rather than engage in activities that may take more effort yet provide much greater but delayed rewards.

Signs of hyperactivity-impulsivity are:

Feeling restless, often fidgeting with hands or feet, or squirming while seated

Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected

Blurting out answers before hearing the whole question

Having difficulty waiting in line or taking turns.

Inattention Children who are inattentive have a hard time keeping their

minds on any one thing and may get bored with a task after only a few minutes. If they are doing something they really enjoy, they have no trouble paying attention. But focusing deliberate, conscious attention to organizing and completing a task or learning something new is difficult.

Homework is particularly hard for these children. They will forget to write down an assignment, or leave it at school. They will forget to bring a book home, or bring the wrong one. The homework, if finally finished, is full of errors and erasures. Homework is often accompanied by frustration for both parent and child.

DSM-IV-TR gives these signs of inattention:

Often becoming easily distracted by irrelevant sights and sounds

Often failing to pay attention to details and making careless mistakes

Rarely following instructions carefully and completely losing or forgetting things like toys, or pencils, books, and tools needed for a task

Often skipping from one uncompleted activity to another.

Causes of ADHD-like behavior are the following:

A sudden change in the child's life—the death of a parent or grandparent; parents' divorce; a parent's job loss

Undetected seizures, such as in petit mal or temporal lobe seizures

A middle ear infection that causes intermittent hearing problems

Medical disorders that may affect brain functioning Underachievement caused by learning disability Anxiety or depression.

Environmental Agents

Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the offspring of that pregnancy. As a precaution, it is best during pregnancy to refrain from both cigarette and alcohol use.

Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead in the bodies of young preschool children. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels is not as prevalent as it once was. Children who live in old buildings in which lead still exists in the plumbing or in lead paint that has been painted over may be at risk.

Brain Injury

One early theory was that attention disorders were caused by brain injury.

Some children who have suffered accidents leading to brain injury may show some signs of behavior similar to that of ADHD, but only a small percentage of children with ADHD have been found to have suffered a traumatic brain injury.

Food Additives and Sugar It has been suggested that attention disorders are caused by refined

sugar or food additives, or that symptoms of ADHD are exacerbated by sugar or food additives.

In 1982, the National Institutes of Health held a scientific consensus conference to discuss this issue. It was found that diet restrictions helped about 5 percent of children with ADHD, mostly young children who had food allergies.3

A more recent study on the effect of sugar on children, using sugar one day and a sugar substitute on alternate days, without parents, staff, or children knowing which substance was being used, showed no significant effects of the sugar on behavior or learning.4

In another study, children whose mothers felt they were sugar-sensitive were given aspartame as a substitute for sugar. Half the mothers were told their children were given sugar, half that their children were given aspartame. The mothers who thought their children had received sugar rated them as more hyperactive than the other children and were more critical of their behavior.5

Genetics Attention disorders often run in families, so there are likely to be

genetic influences. Studies indicate that 25 percent of the close relatives in the families of ADHD children also have ADHD, whereas the rate is about 5 percent in the general population.6 Many studies of twins now show that a strong genetic influence exists in the disorder.7

Researchers continue to study the genetic contribution to ADHD and to identify the genes that cause a person to be susceptible to ADHD. Since its inception in 1999, the Attention-Deficit Hyperactivity Disorder Molecular Genetics Network has served as a way for researchers to share findings regarding possible genetic influences on ADHD.8

Disorders that Sometimes Accompany ADHD

Learning Disabilities Tourette Syndrome Oppositional Defiant Disorder Conduct Disorder Anxiety and Depression Bipolar Disorder

Facts to Remember About Medication for ADHD

Medications for ADHD help many children focus and be more successful at school, home, and play. Avoiding negative experiences now may actually help prevent addictions and other emotional problems later.

About 80 percent of children who need medication for ADHD still need it as teenagers. Over 50 percent need medication as adults.

Intervention Approaches

Psychotherapy Behavioral therapy (BT) Social skills training Support groups Parenting skills training

Behavioral Interventions

Children with ADHD may need help in organizing. Schedule. Have the same routine every day, from wake-up time to bedtime. The schedule should include homework time and playtime (including outdoor recreation and indoor activities such as computer games). Have the schedule on the refrigerator or a bulletin board in the kitchen. If a schedule change must be made, make it as far in advance as possible. Organize needed everyday items. Have a place for everything and keep everything in its place. This includes clothing, backpacks, and school supplies. Use homework and notebook organizers. Stress the importance of writing down assignments and bringing home needed books.

Dyslexia

The word "dyslexia" comes from the Greek words δυς- dys- ("impaired") and λέξις lexis ("word"). People are often identified as dyslexic or dyslectic when their reading or writing problems cannot be explained by a lack of intellectual ability, inadequate instruction, or sensory problems such as poor eyesight.

The term 'dyslexia' was coined in 1887 by Rudolf Berlin.[7] He used the term to refer to a case of a young boy who had a severe impairment in learning to read and write in spite of showing typical intellectual and physical abilities in all other respects.

Several years later, W. Pringle Morgan, a British physician, from Seaford, East Sussex, England published a description of a reading-specific learning disorder in a letter to the British Medical Journal. His letter described the case of a boy named Percy who, at age 14, had not yet learned to read, yet he showed normal intelligence and was generally adept at other activities typical of children of that age. Wikepedia

A key early researcher in dyslexia was Samuel T. Orton. Orton coined the term strephosymbolia (meaning 'twisted signs') to describe his theory that individuals with dyslexia had difficulty associating the visual forms of words with their spoken forms.[8] Orton observed that reading deficits in dyslexia did not seem to stem from strictly visual deficits.[9] He also believed that dyslexics were disproportionately left-handed, although this finding has been difficult to replicate.[10]

In the 1970s, a new hypothesis, based in part on Orton's theories, emerged that dyslexia stems from a deficit in phonological processing or difficulty in recognizing that spoken words are formed by discrete phonemes (for example, that the word CAT comes from the sounds [k], [æ], and [t]). As a result, affected individuals have difficulty associating these sounds with the visual letters that make up written words. Key studies of the phonological deficit hypothesis include the finding that the strongest predictor of reading success in school age children is phonological awareness,[11] and that phonological awareness instruction can improve reading scores in children with reading difficulties.[12]

Thomas G. West, towards the end of the 20th century, suggested that many dyslexics are visual spatial thinkers who are wired for the big picture — designed to process information in pictures rather than words. West believed that our education system is inadvertently biased against the "Einstein gene", and thereby all our most original and gifted thinkers. To support this view he has examined the difficult early educational experiences of five Nobel prize winners or near-winners: Einstein, Edison, Marconi, Churchill and Faraday.

West's theory is echoed in the work of Ronald Dell Davis, author of The Gift of Dyslexia, who describes dyslexia as the outgrowth of a primarily picture-thinking mind. Davis posits that the symptoms associated with dyslexia arise from disorientation that results from confusion over language symbols. This view has also been supported indirectly by the research of Linda Silverman, author of Upside Down Brilliance -- the title reflects the counter-intuitive experiences of those who find the easy tasks difficult and hard tasks easy. Echoes of this theory can be traced to the emerging discipline of Neuro-linguistic Programming.

The World Health Organization (WHO)

"A disorder manifested by difficulty learning to read, despite conventional instruction, adequate intelligence and sociocultural opportunity. It is dependent upon fundamental cognitive disabilities which are frequently of constitutional origin". ICD-10, The International Statistical Classification of Diseases and Related Health Problems, tenth revision ICIDH-2, The International Classification of Impairments, Activities, and Participation

US National Institute of Child Health and Human Development (NICHD) / International Dyslexia Association

Dyslexia is a specific learning disability of neurological origin. Characterized with difficulties with accurate and/or fluent word recognition, spelling and decoding abilities.

Canadian Government

The Government of Canada’s Health Portal links its description to the BC HealthGuide web site using their definition. Dyslexia is defined here having a difficulty with the alphabet, reading, writing, and spelling in spite of normal to above average intelligence, conventional teaching, and adequate sociocultural opportunity. Dyslexia is thought to be both genetic and hereditary. Dyslexia is not caused by poor vision. Dyslexia is identified following psychological and educational tests that determine language and other academic abilities, IQ and problem-solving skills, and is only identified if the reading disability is not a result of another condition.

Developmental Dyslexia The result of differences in affected individuals'

neural organization for language and reading. Appears to have a genetic component, such that it

can tend to occur in multiple members of the same family.

Reading difficulties in dyslexia can vary in their severity.

Not restricted to childhood, and can persist through adulthood.

Early reports suggested dyslexia is more prevalent in boys, more recent studies have indicated it is not sex-linked, and occurs both in boys and girls with equal frequency.

Diagnosis Made by a qualified professional, such as a neurologist or an

educational psychologist. Evaluation generally includes testing of reading ability together

with measures of underlying skills such as tests of rapid naming, to evaluate short term memory and sequencing skills, and nonword reading to evaluate phonological coding skills. Evaluation will usually also include an IQ test to establish a profile of learning strengths and weaknesses.

Use of a "discrepancy" between full scale IQ and reading level as a factor in diagnosis has been discredited by recent research. It often includes interdisciplinary testing to exclude other possible causes for reading difficulties, such as a more generalized cognitive impairment or physical causes such as problems with vision or hearing.

Recent advances in neuroimaging and genetics provide evidence that could help identify children at risk of dyslexia before they learn to read in the future.

May appear bright, intelligent and articulate, however their reading, writing and spelling level is below their average age group.

Have average or above average intelligence, yet may have poor academic achievement.

May have good oral language abilities but will perform much more poorly on similar written-language tests.

Might be labeled lazy, dumb, careless, immature, "not trying hard enough," or as having a "behavior problem."

Because dyslexia primarily affects reading while sparing other intellectual abilities, affected individuals might be categorized as not "behind enough" or "bad enough" to receive additional help in a school setting.

Might feel dumb and have poor self-esteem, and might be easily frustrated and emotional about school reading or testing.

Might try to hide their reading weaknesses with ingenious compensatory "strategies".

Might learn best through hands-on experience, demonstrations, experimentation, observation, and visual aids.

Can show talents in other areas such as art, drama, music, sports, mechanics, story-telling, sales, business, designing, building, or engineering.

Have related problems with attention in a school setting; for instance they might seem to "zone out" or daydream often; get lost easily or lose track of time; and have difficulty sustaining attention.

Speech/hearing symptoms of dyslexia Difficulty with oral language Late in learning to talk Difficulty pronouncing words Difficulty acquiring vocabulary or using age-appropriate grammar Difficulty following directions Confusion with before/after, right/left, and so on Difficulty learning the alphabet, nursery rhymes, or songs Difficulty understanding concepts and relationships Difficulty with word retrieval or naming problems Difficulty identifying or generating rhyming words, or counting syllables

in words (phonological awareness) Difficulty with hearing and manipulating sounds in words (phonemic

awareness) Difficulty distinguishing different sounds in words (auditory

discrimination) Difficulty in learning the sounds of letters

Vision, Reading, and Spelling

Contrary to how it has been portrayed in the popular press, individuals with dyslexia do not perceive words backwards or upside down. In fact, visual problems are typically ruled out before a diagnosis of dyslexia can be made. Early studies of dyslexia did focus on the possibility that dyslexia is caused by visual difficulties, however very little evidence was found to support this theory. Likewise, there is little evidence that visual training provides effective treatment.[23]

A popular theory in the 1970s suggested dyslexics may have Meares-Irlen Syndrome, a visual deficit in which the glare of the white page against black letters causes the words to shake, shiver, spin, etc. after a few minutes of reading. The proposed treatment was the use of colored plastic overlays that were thought help anchor the words to the page. This treatment has fallen out of favor as scientific studies have failed to support these claims.

Spelling errors — Because of difficulty learning letter-sound correspondences, individuals with dyslexia might tend to misspell words, or leave vowels out of words (e.g., spelling "magic" as mjc).

Letter order - Dyslexics may also reverse the order of two letters especially when the final, incorrect, word looks similar to the intended word (e.g., spelling "dose" instead of "does").

Highly phoneticized spelling - Dyslexics also commonly spell words inconsistently, but in a highly phonetic form such as writing "shud" for "should". Dyslexic individuals also typically have difficulty distinguishing among homophones such as "their" and "there".

Reading — Due to dyslexics' excellent long term memory, young students tend to memorize beginning readers, but are unable to read individual words or phrases.

Treatment for Dyslexia

Orton-Gillingham, which provides systematic, multisensory teaching geared to building phonetic decoding skills.

Phonological awareness training Lindamood-Bell Learning Processes Alternative multisensory approach

Evidence that dyslexia is a neurological or brain-based condition is substantial. Research also suggests an association with biochemical and genetic markers.[3][4][5] Some question whether the term dyslexia is so fraught with popular misconceptions that it should be dropped altogether and replaced with the term Reading Disorder or Reading Disability (RD).

Because difficulty in "breaking the code" of sound-letter association (reading acquisition) can be seen as being on a continuum, some believe the term dyslexia should be reserved for the two to five percent most severely affected with RD. Moreover, dyslexia is not always the culprit in a child's not learning to read. Poor teaching methods can leave non-dyslexic children with poor reading skills.[6]

Co-Existing Conditions Attention Deficit Disorder (with or without Hyperactivity)

Attention Deficit Disorder is a completely separate condition than dyslexia. However, research has shown that at least 40% of people with dyslexia also have AD/HD.

Light Sensitivity (Scotopic Sensitivity)A small percentage (3% to 8%) of people with dyslexia also have light sensitivity (sometimes called scotopic sensitivity). These people have a hard time seeing small black print on white paper. The print seems to shimmer or move; some see the rivers of white more strongly than the black words. These people tend to dislike florescent lighting, and often "shade" the page with their hand or head when they read.

Resources and References

http://www.ninds.nih.gov/disorders/learningdisabilities/learningdisabilities.htm

http://www.helpguide.org/mental/learning_disabilities.htm

http://en.wikipedia.org/wiki/Learning_disability

http://en.wikipedia.org/wiki/Dyslexia

Slide References ^ a b Learning Disabilities, Dyslexia, and Vision: A Subject Review A

report from American Academy Of Pediatrics reporting the complete lack of evidence for a link between visual problems and learning difficulties.

^ Astley, S.J. (2004). Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code. Seattle: University of Washington. Can be downloaded at http://depts.washington.edu/fasdpn

Flanagan, D.P., & Mascolo, J.T. (2005). Psychoeducational Assessment and Learning Disability Diagnosis. In D.P. Flanagan & P.L. Harrison (Eds). Contemporary Intellectual Assessment: Theories, Tests, and Issues. New York: The Guildford Press.

Aaron, P.G., (1995) Differential diagnosis of reading disabilities. School Psychology Review 24(3), 345-360.

Sternberg, R. J., & Grigorenko, E. L. (1999). Our labeled children: What every parent and teacher needs to know about learning disabilities. Reading, MA: Perseus Publishing Group

^ Stanovich, KE. (1988) Explaining the differences between the dyslexic and the garden-variety poor reader: the phonological-core variable-difference model. Journal of Learning Disabilities, 21(10):590-604.

^ Murphy, Martin F (2004). Dyslexia, An Explanation. Flyleaf Press. ISBN.  ^ Cope, N; Harold D, Hill G, Moskvina V, Stevenson J, Holmans P, Owen MJ, O'Donovan MC, Williams J (April 2005).

"Strong evidence that KIAA0319 on chromosome 6p is a susceptibility gene for developmental dyslexia". American Journal of Human Genetics 76 (4): 581-91. PMID. 

^ Meng, H; Smith SD, Hager K, Held M, Liu J, Olson RK, Pennington BF, DeFries JC, Gelernter J, O'Reilly-Pol T, Somlo S, Skudlarski P, Shaywitz SE, Shaywitz BA, Marchione K, Wang Y, Paramasivam M, LoTurco JJ, Page GP, Gruen JR (Nov 22 2005). "DCDC2 is associated with reading disability and modulates neuronal development in the brain". Proceedings of the National Academy of Sciences 102 (47): 17053-8. PMID. 

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^ Dalby, J. T. "An ultimate view of reading ability"International Journal of Neuroscience, 1986, 30, 227-230. ^ Haslam, R, Dalby, J.T., Johns, RD and Rademaker,A.W. (1981). "Cerebral asymmetry in developmental dyslexia".

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^ Miles,Tim: Music and Dyslexia: Opening New Doors, Whirr Publishers, London UK 2001 ^ Shaywitz, Sally E.; Bennett A. Shaywitz (August 2001). "The Neurobiology of Reading and Dyslexia". Focus on Basics 5

(A).  ^ Learning Disabilities: Multidisciplinary Research Centers, NIH Guide, Volume 23, Number 37, October 21, 1994,

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attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 1990; 29(4): 526-533. 7Faraone SV, Biederman J. Neurobiology of attention-deficit hyperactivity disorder. Biological Psychiatry, 1998; 44; 951-

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disorder molecular genetics network. American Journal of Medical Genetics, 2002, 114:272-277. 9Castellanos FX, Lee PP, Sharp W, Jeffries NO, Greenstein DK, Clasen LS, Blumenthal JD, James RS, Ebens CI, Walter

JM, Zijdenbos A, Evans AC, Giedd JN, Rapoport JL. Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Medical Association, 2002, 288:14:1740-1748.

10Wender PH. ADHD: Attention-Deficit Hyperactivity Disorder in Children and Adults. Oxford University Press, 2002, p. 9. 11Geller B, Williams M, Zimerman B, Frazier J, Beringer L, Warner KL. Prepubertal and early adolescent bipolarity

differentiate from ADHD by manic symptoms, grandiose delusions, ultra-rapid or ultradian cycling. Journal of Affective Disorders, 1998, 51:81-91.

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14Barkley RA. Taking Charge of ADHD. New York: The Guilford Press, 2000, p. 21. 15U.S. Department of Transportation, National Highway Traffic Safety Administration. State Legislative Fact Sheet, April 2002. 16Silver LB. Attention-deficit hyperactivity disorder in adult life. Child and Adolescent Psychiatric Clinics of North America, 2000:9:3: 411-523. 17Wender PH. Pharmacotherapy of attention-deficit/hyperactivity in adults. Journal of Clinical Psychiatry, 1998; 59 (supplement 7):76-79. 18Wilens TE, Biederman J, Spencer TJ. Attention deficit/hyperactivity disorder across the lifespan. Annual Review of Medicine, 2002:53:113-131. 19Attention Deficit Disorder in Adults. Harvard Mental Health Letter, 2002:19;5:3-6. Resource Books The following books were helpful resources in the writing of this document. Many other informative books can be found at any good bookstore, on a

website that offers books for sale, or from the ADD Warehouse catalog (see next page). Taking Charge of ADHD, by Russell A. Barkley, PhD. New York: The Guilford Press, 2000. ADHD: Attention-Deficit Hyperactivity Disorder in Children and Adults, by Paul H. Wender, MD. Oxford University Press, 2002. Straight Talk about Psychiatric Medications for Kids, by Timothy E. Wilens, MD. New York: The Guilford Press, 1999. This is a revision of Attention Deficit Hyperactivity Disorder, a brochure first printed in 1994 and reprinted in 1996. The revision is by Margaret Strock,

staff member in the Public Information and Communications Branch, National Institute of Mental Health (NIMH). Scientific review was provided by Russell A. Barkley, Ph.D., Medical University of South Carolina; Peter A. Jensen, M.D., Columbia University; Edgardo Menvielle, M.D., and Benedetto Vitiello, M.D., staff members, NIMH. Editorial assistance was provided by Lisa Alberts and Constance Burr, Public Information and Communications Branch, NIMH.

NIH Publication No. 3572 NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health

(NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated. However, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines:

NIMH does not endorse or recommend any commercial products, processes, or services, and publications may not be used for advertising or endorsement purposes.

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NIMH requests that non-Federal organizations not alter publications in a way that will jeopardize the integrity and "brand" when using publications. Addition of Non-Federal Government logos and website links may not have the appearance of NIMH endorsement of any specific commercial products

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nimhinfo@nih.gov.

Rief, S. (1997). The ADD/ADHD checklist. NJ: Prentice Hall.

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