The term dyslexia has existed for many years. It is used primarily by medical specialists to identify a group of children who suffer from severe reading disabilities. The reading disability is often accompanied by visual perception problems, such as:
1. Reversals: was for saie, on for no, b for d.
2. Inversions: u for n, p for d.
3. Mirror image.
The suspected cause of the reading disorder is neurologic dysfunction.
The word dyslexia has become a "catchall" term and is being used in a variety of ways by different authors. Some of these diverse definitions include the following:
1. A loss of competency due to brain injury or degeneration.
2. A basic disturbed pattern of neurologic organization.
3. Minimal brain damage syndrome.
4. Maturational or developmental lag syndrome.
5. Delayed and irregular neurologic development.
6. Failure to learn to read through conventional classroom methods.
Several authors have indicated that dyslexia has a strong tendency to run in families, indicating a genetic or inherited cause of the reading problem rather than an environmental cause.
Educational specialists have a view of dyslexia that is different from that of medically oriented specialists. The former see dyslexia as a reading disability, meaning simply that dyslexies are children who are having difficulty learning to read. These children have an average or aboveaverage intelligence and are free frorn mental or gross neurologic defects.
A review of the literature on dyslexia leads to no conclusive evidence for or against the theories of either discipline. As Lerner has said, "Researchers and scholars must and should study the reading problem of children in terms of their own training, experience, and framework."1
Today, with learning-disabled children, reading specialists are not concerned with the cause of the malady or the medical terminology attached to the problem. If the child has a neurologic dysfunction, it is of no assistance when designing a remedial program to know that his brain damage was the result of injuries at birth or to know that the child has been labeled dyslexic. Ultimately, educators must deal with the reality of teaching the reading-disabled child and focus on his learning disability instead of on the etiology or terminology of the disorder.
The term learning disability shows the influence that educators have had in this field. It is a relatively new field that has grown at a phenomenal rate. Each concerned profession began contributing its own terminology and ideas. To channel these diverse opinions and attitudes, the National Advisory Committee on Handicapped Children of the Office of Education proposed a definition that was used in the Congressional bill entitled "The Learning Disabilities Act of 1969." This definition states:
Children with special learning disabilities exhibit a disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language. These may be manifested in disorders of listening, thinking, talking, reading, writing, spelling or arithmetic. They include conditions which have been referred to as perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia, developmental aphasia, etc. They do not include learning problems which are due primarily to visual, hearing or motor handicaps, to mental retardation, emotional disturbance or to environmental disadvantage.
Bateman's definition of learningdisabled children stresses the discrepancy between achievement and potentiality. She defines learning-disabled children as those who
manifest an educationally significant discrepancy between their estimated intellectual potential and actual level of performance related to basic disorders in the learning processes, which may or may not be accompanied by demonstrable central nervous system dysfunction, and which are not secondary to generalized mental retardation, educational or cultural deprivation, severe emotional disturbance, or sensory loss.2
When a child, diagnosed as dyslexic, comes to the Child Resource Center, a diagnostic and prescriptive teaching clinic, we begin a diagnostic procedure that leads to a program of remediation. The purpose of the tests is to discover the diagnostic hypothesis that will lead to a prescriptive teaching program. This prescription is individually designed to focus on the child's unique learning patterns as well as his developmental and academic strengths and concerns.
Generally, there are five basic stages in the diagnostic process. These may be best illustrated when applied to a specific child. Ricky, an eight-year-old boy in the second half of the second grade, was referred to the Child Resource Center. Ricky's mother was concerned about his reading achievement. Ricky was not working up to "grade level" and was very unhappy with his school experience.
The first step taken at the clinic was to determine whether the learning program was general, spurious, or specific. To achieve this end, the Wechsler Intelligence Scale for Children (Revised) was administered. This is an individually administered test of general intelligence for children between the ages of six and 16. The WISC-R is composed of 12 possible subtests that can be classified as testing for either verbal ability or performance ability. The test results indicated that Ricky had above-average intelligence.
The second step was to analyze Ricky's academic behavior patterns. Therefore, a series of academic tests were administered. We needed to know in greater detail what he could or could not do in the reading process - what his errors and his faulty habits were, how he attacked new words, whether he had an adequate sight vocabulary, what words confused him, and how fast he could read. Most important, what were his instructional, frustration, and independent reading levels?
We also needed to know if his learning problems were spreading into other areas, such as mathematics. A "KeyMath Diagnostic Arithmetic Test" was administered. The KeyMath is designed to provide four levels of diagnostic information. The results of the test help to identify a child's specific strengths and weaknesses so that an appropriate instructional program can be established.
The clinician analyzing the problem now had the following information:
Chronologic age: 8 years 5 months
Mental age: 9 years 4 months
Arithmetic level: 3.0
Instructional reading level: 1.0
The results showed a discrepancy between his chronologic age, mental age, and arithmetic level, on the one hand, and his reading achievement, on the other. A problem did exist and was specifically related to reading.
In the third step, we try to discover the factors relating to the functional behavior of the child. Three correlates referred to are the physical, environmental, and psychologic. Why did Ricky fail to learn to read? A thorough investigation of his school attendance, home background, and physical health showed that they were not contributing factors to his reading problem. Results of visual and auditory examinations were reported as normal. During the diagnostic testing at the Child Resource Center, Ricky indicated no need for psychologic or neurologic examinations. In Ricky's case the emotional, environmental, and physical correlates had been ruled out.
The fourth step taken at the clinic was to find a diagnostic hypothesis based on the correlate data and test results. The hypothesis is very important. It entails specifying the interrelationship of symptoms and the correlates that have contributed to Ricky's inability to read. The development of the hypothesis requires the expertise of a clinician who can use the diagnostic tools, select relevant facts, and assemble all the pieces of the puzzle into an organized form that will explain the child's inability to learn. It is from the hypothesis that the remedial program is developed.
The final stage in the diagnostic procedure at the Child Resource Center is organizing a systematic prescriptive teaching program based on the diagnostic hypothesis. The remedial program is developed around the child's strengths and concerns discovered by the clinician in step four. For Ricky, a prescriptive teaching program was developed around the 17 concerns the child exhibited during the testing procedure, as well as his 23 areas of strengths.
A major development in the field of learning disabilities is the earlyidentification movement. This is a recent concern in special education. It is a movement to identify preschool children who may be potential learning-disabled candidates. In the past, learning-disabled children were identified primarily at elementarvschool age. By identifying these children when thev are preschoolers, it may be possible to diagnose their disabilities and begin remediation before learning problems occur.
The early identification of learning-disabled children has received much support from both state and national levels of government. At the national level, the Bureau of Education for the Handicapped of the Office of Education has given priority to early childhood programs. Many states have passed legislation to assure that public schools develop identification programs for potential school failures and provide preventive services to children as early as age three.
Pediatricians are a good source for the early recognition of children with learning disabilities. They should be trained to detect the behavior symptoms that may indicate the possibility of learning disability. A parent may report to the pediatrician such symptoms as:
1. Overactivity or constant motion.
2. Low tolerance of frustration.
3. Disorganization in working and thinking.
4. Variations in mood from day to day or hour to hour.
5. Poor relations with peers.
6. Poor performance in school.
7. Overreaction to everything.
8. Silliness at inappropriate times.
9. Inability to foresee consequences of own actions.
11. Problems with reading or understanding numbers and arithmetic concepts.
12. Frequent bumping into objects, clumsiness.
Pediatricians are becoming increasingly alert to learning disabilities. They are often guest speakers at educational conferences. They are serving on advisory boards and committees of the Association for Children with Learning Disabilities. Pediatricians are members of interdisciplinary diagnostic teams in various clinical settings in which learningdisabled children are encountered.
Most important, when a cluster of symptoms are suggestive of a learning disorder, pediatricians are making referrals to educational diagnostic and remediation clinics. This is an important milestone - a linking of two very important professions as they relate to one another about the problems of learning-disabled children.
1 Lerner. J W. Children with Learning Disabilities, Second Editon Boston Houghton Mifflin. 1976
2 Bateman, B. An educator's view of a diagnostic approach to learning disorders. In Hellmuth, J (ed.). Learning Disorders, Volume 1. Seattle: Special Child Publications. 1965. pp 219-236
Gearheart. B R., and Weishahn. M. W The Handicapped Child in the Regular Classroom. St Louis: The C. V. Mosby Company, 1976.
Hammill, D. D., and Bartel, N. R Teaching Children with Learning and Behavior Problems. Boston: Allyn and Bacon, 1975.
Harris. A. J How to Increase Reading Ability, Fourth Edition New York: David McKay Company, 1961.
Kirk, S. A. Educating Exceptional Children, Second Edition Boston Houghton Mifflin Company, 1972.