Discover the signs, assessment, and resources for dyslexia. Find support and strategies to help individuals with dyslexia on Meri Sehat.

Dyslexia

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Syed Intisar Hussain

Overview

Dyslexia is a specific learning disorder that affects a person&#39;s ability to read, write, and spell despite having normal intelligence and adequate educational opportunities. 
&nbsp;

According to the International Dyslexia Association, dyslexia is &quot;a language-based learning disability.&rdquo; It is a neurological condition caused by a different wiring of the brain that impacts the way information is processed, particularly language-related information. This difference in brain function can make it difficult for individuals with dyslexia to decode and recognize words, leading to difficulties in reading fluency, accuracy, and comprehension<a href="#accordion">[1]</a>. 
&nbsp;

The incidence and prevalence of dyslexia vary depending on the population studied and the criteria used to define the disorder. However, it affects approximately 9-12% of the population worldwide<a href="#accordion">[20]</a>. 
&nbsp;

According to a study, the prevalence of dyslexia among school-aged children is around 5-17%, with some studies reporting even higher rates<a href="#accordion">[21]</a>. In terms of incidence, a longitudinal study found that the risk of dyslexia increases with a family history of the disorder, with children of dyslexic parents having a 40-60% chance of developing dyslexia themselves<a href="#accordion">[5]</a>. 
&nbsp;

While some studies provide some indication of the prevalence of dyslexia in Pakistan, it is important to note that they were conducted on relatively small samples and may not be representative of the broader population. Further research is needed to better understand the prevalence of dyslexia in Pakistan. 
&nbsp;

Dyslexia is a complicated disorder that can present itself in many different ways<a href="#accordion">[22]</a>.

It is broadly categorized into: 
&nbsp;

Developmental:&nbsp;This type of dyslexia presents at birth. It includes:

<ol>
	<li>Primary Dyslexia &ndash; This is caused due to a genetic mutation. Also, primary dyslexia usually affects the left side of the brain so the individual cannot process language.</li>
	<li>Secondary Dyslexia &ndash; This is caused due to a neurological developmental process in the womb. 
	&nbsp;</li>
</ol>

Acquired:&nbsp;This is also known as trauma dyslexia. It occurs due to an illness or injury, like <a href="https://merisehat.pk/disease/stroke">stroke </a>or <a href="https://merisehat.pk/disease/dementia">dementia</a>.

The developmental and acquired dyslexia can be further divided into:

<ol>
	<li>Phonological Dyslexia: The most prevalent kind of dyslexia, phonological dyslexia, is characterized by issues with phonemic awareness and interpretation. That is, the person will have trouble breaking down words into their sounds.</li>
	<li>Surface Dyslexia: Surface dyslexia is characterized by issues with spelling and reading words, both new or already learned, on the page and matching them to their sounds. This eventually renders them unable to memorize or remember words.</li>
	<li>Rapid Naming Dyslexia: Task difficulties are a hallmark of rapid naming dyslexia. People with this kind of dyslexia struggle to name known objects, numbers, or colors, which affects their ability to read fluently.</li>
	<li>Double Deficit Dyslexia: A person with double deficit dyslexia has trouble in two different areas of reading, like phonological awareness and rapid naming.</li>
	<li>Visual Dyslexia: Visual dyslexia is defined by problems with visual processing. For instance, they have issues with forming letters, such as &quot;b&quot; and &quot;d&quot; or &quot;was&quot; and &quot;saw.&rdquo;. They may have issues with spelling and other aspects of writing, which also makes it difficult to remember what they had just read. 
	&nbsp;</li>
</ol>
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Signs and Symptoms

Dyslexia is a complex disorder that can manifest in a variety of ways. Some of the most commonly observed signs and symptoms of dyslexia include: 
&nbsp;

<h5>Infants And Preschool Children</h5>

<ul>
	<li>Developmental delays, like taking longer to speak and write than their peers, due to poor language skills</li>
	<li>Difficulty recognizing, learning, and recalling letters (e.g., &ldquo;t&rdquo; is mistaken for &ldquo;d&rdquo;)</li>
	<li>Baby talk </li>
	<li>Mispronouncing familiar words 
	&nbsp;</li>
</ul>

<h5>Elementary Grade </h5>

<ul>
	<li>Reading slowly compared to peers</li>
	<li>Trouble sounding out and understanding words they read</li>
	<li>Trouble connecting letters to the sounds they make, like &ldquo;buh&rdquo; for &ldquo;b&rdquo;</li>
	<li>Trouble differentiating between certain words or letters</li>
	<li>Write slowly, usually accompanied by misspelled words</li>
	<li>Writing numbers or letters backward, like &ldquo;d&rdquo; instead of &ldquo;b&rdquo; 
	&nbsp;</li>
</ul>

<h5>Middle School</h5>

<ul>
	<li>Social withdrawal since greater demands only make communication harder</li>
	<li>Handwriting is messy and there are errors in spelling, punctuation, and grammar</li>
	<li>Speak slowly so may avoid reading out loud</li>
	<li>Difficulty finishing tasks, like tests or homework, on time</li>
	<li>Increased use of filler words (e.g., um or uh) to allow time to recall proper words</li>
	<li>Using wrong words, like &ldquo;ocean&rdquo; substitutes for &ldquo;lotion&rdquo; 
	&nbsp;</li>
</ul>

<h5>Adults</h5>

<ul>
	<li>Difficulty reading or reading at a good pace; also, find it difficult to attempt activities that involve reading </li>
	<li>Difficulty copying or taking notes</li>
	<li>Difficulty staying organized or meeting deadlines</li>
	<li>Difficulty understanding common sayings or jokes with underlying meaning</li>
	<li>Difficulty doing math (e.g., remembering pin codes) and learning a different language 
	&nbsp;</li>
</ul>

NOTE: Not everyone with dyslexia will have all of these symptoms and each person&#39;s level of symptom severity will differ significantly. It&#39;s important to get a thorough evaluation from a trained expert to determine whether you or someone you know may have dyslexia. 
&nbsp;

Causes

Although the precise origins of dyslexia are not yet fully known, it is believed that the condition is caused by genetic, neurodevelopmental, and environmental elements among others. 
&nbsp;

1. Genetics: According to numerous studies, there is a strong possibility that dyslexia is passed down from one generation to the next. Dyslexia has been linked to certain genes, especially those that affect how language processing and reading-related brain regions develop and operate. 
&nbsp;

2. Brain Development: Dyslexic people often differ from people without the disorder in terms of the structure and operation of their brains. Several studies in particular have discovered variations in the size and connection of brain areas involved in language processing, like the left hemisphere. 
&nbsp;

3. Environmental Factors: Premature delivery or low birth weight, exposure to chemicals or illnesses during pregnancy, and inadequate nutrition throughout crucial stages of brain development are all environmental factors that may contribute to dyslexia. 
&nbsp;

4. Phonological Processing Deficits: According to research, dyslexia can be caused due to deficiencies in phonological processing, or the capacity to identify and control the sounds that make up words. 
&nbsp;

5. Visual Processing Deficits: Dyslexia may also be impacted by deficiencies in visual processing. 
&nbsp;

NOTE: Dyslexia can be caused by several interrelated circumstances, and each person likely has a different cause. 
&nbsp;
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Dyslexia screening tests help identify people that are at risk for the condition and can offer valuable data for diagnosis and therapy planning. Below are a few regularly used dyslexia screening tests: 
&nbsp;

1. The Phonological Awareness Screening Test (PAST): The PAST is a brief and simple exam that evaluates a person&#39;s phonological awareness.

2. The Dyslexia Early Screening Test (DEST): The DEST measures phonological processing abilities and awareness of letter sounds in early years.

3. The Rapid Automatized Naming (RAN) Test: The RAN test measures a person&#39;s capacity to recall a string of common items, colors, or letters, consequently having trouble reading fluently due to issues with the quick processing of visual data.

4. The Test Of Word Reading Efficiency (TOWRE): The TOWRE evaluates a person&#39;s capacity to read a list of words fast and accurately.

5. The Comprehensive Test Of Phonological Processing (CTOPP): This exam can offer a thorough evaluation of a person&#39;s phonological processing skills, such as phonological awareness, phonological memory, and quick naming, which are essential for improving reading and writing ability. 
&nbsp;

It is crucial to remember that screening tests are not diagnostic instruments, and if the doctor suspects dyslexia, then they should be followed by a thorough evaluation by a trained specialist. 
&nbsp;
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Diagnosis

Some of the commonly used diagnostic tests for dyslexia include: 
&nbsp;

<ul>
	<li>Intelligence Tests: A person&#39;s cognitive ability can be revealed via intelligence tests, which can also help rule out other potential contributors to reading difficulty.</li>
	<li>Achievement Tests: Achievement exams gauge a person&#39;s academic proficiency in subjects like reading, writing, and math.</li>
	<li>Cognitive Processing Tests: A person&#39;s cognitive ability in areas like phonological processing, memory, and attention is evaluated using cognitive processing tests. Certain cognitive processing abnormalities that may be causing reading difficulties can be found using these tests.</li>
	<li>Reading Tests: Reading tests evaluate a person&#39;s accuracy, fluency, and comprehension in reading.</li>
	<li>Writing Tests: Writing tests evaluate a person&#39;s writing abilities, including composition, grammar, and spelling.</li>
	<li>Vision Tests: Vision exams evaluate a person&#39;s visual acuity and visual processing skills and can assist in excluding vision issues that could be causing reading difficulty.</li>
	<li>Audiological Tests: Hearing exams evaluate a person&#39;s hearing capabilities and can help rule out hearing issues that could be causing reading difficulty. 
	&nbsp;</li>
</ul>

It is crucial to keep in mind that a thorough assessment for dyslexia should be carried out by a licensed expert, such as a neuropsychologist or educational psychologist. 
&nbsp;

Treatment

Dyslexia is a lifelong condition, but it can be managed effectively with appropriate interventions. Here are some common treatments for dyslexia: 
&nbsp;

<ol>
	<li>Phonics-Based Reading Instruction: Phonics-based reading instruction has proved to be very effective for dyslexics. It involves teaching reading through the systematic instruction of sound-letter correspondences 
	&nbsp;</li>
	<li>Multisensory Instruction: Multiple senses, such as visual, aural, and kinesthetic, are included in the learning process. Dyslexic people have been demonstrated to benefit from this strategy since it improves their ability to process information. 
	&nbsp;</li>
	<li>Assistive Technology: Dyslexics may find it easier to access written information with the aid of assistive technology, such as text-to-speech software. 
	&nbsp;</li>
	<li>Accommodations In The Classroom: Those with dyslexia benefit from accommodations in the classroom, such as additional time for exams and homework. 
	&nbsp;</li>
	<li>Cognitive Training: It&rsquo;s possible to improve cognitive abilities, such as working memory and attention, with the use of training programs like Cogmed Working Memory Training. 
	&nbsp;</li>
	<li>Counseling: Dyslexics who seek counseling can learn coping mechanisms and deal with any psychological or emotional problems that may be connected to their condition. 
	&nbsp;</li>
</ol>

Effective dyslexia management depends on early intervention. Also, the effectiveness of interventions for dyslexia can vary from person to person and may require a combination of interventions. 
&nbsp;

Many consequences are possible with dyslexia, especially if it is undetected or left untreated: 
&nbsp;

<ol>
	<li>Mental Health Problems: In particular, if they have not gotten sufficient help for their learning difficulties, adults with dyslexia may have mental health issues such as anxiety, depression, and substance addiction. 
	&nbsp;</li>
	<li>Emotional And Behavioral Problems: Frustration, low self-esteem, anxiety, and depression in children with dyslexia can result in behavioral issues and social challenges. 
	&nbsp;</li>
	<li>Learning Disabilities: Other learning disorders like attention-deficit/hyperactivity disorder (ADHD), dyscalculia (difficulty with math), and dysgraphia (difficulty with writing) are frequently linked to dyslexia. 
	&nbsp;</li>
	<li>Employment Difficulties: People with dyslexia may have trouble reading and writing at work, which can restrict their possibilities for careers and their earning potential. 
	&nbsp;</li>
</ol>

Dyslexic people must receive the right support and therapies to avoid these complications. 
 
&nbsp;

There are several risk factors associated with dyslexia. Here are some common risk factors:

<ol>
	<li>Family History: Dyslexia tends to run in families, and individuals with a family history of dyslexia are at a higher risk of developing the condition themselves. 
	&nbsp;</li>
	<li>Genetic Factors: There is evidence to suggest that dyslexia may have a genetic component as certain genes are associated with the condition. 
	&nbsp;</li>
	<li>Premature Birth Or Low Birth Weight: Individuals who are born prematurely or with a low birth weight are at a higher risk of developing dyslexia. 
	&nbsp;</li>
	<li>Exposure To Toxins During Pregnancy: Exposure to toxins during pregnancy, such as lead or mercury, has been linked to an increased risk of dyslexia. 
	&nbsp;</li>
	<li>Brain Abnormalities: Structural and functional abnormalities in the brain have been found in individuals with dyslexia, and these abnormalities may increase the risk of developing the condition. 
	&nbsp;</li>
	<li>Poverty And Lack Of Access To Early Education: Children from low-income families and those who do not have access to early education may be at a higher risk of developing dyslexia, as they may not have the same opportunities to develop reading skills as their peers. 
	&nbsp;</li>
</ol>

It is crucial to remember that a person does not automatically get dyslexia just because they have one or more risk factors. However, early risk factor recognition and management might lessen the likelihood of the illness occurring. 
&nbsp;

There is no known way to prevent dyslexia as it is a neurobiological condition, which is caused by both genetic and environmental factors. However, several factors may help reduce the risk of dyslexia or mitigate its effects. Some examples include: 
&nbsp;

<ol>
	<li>Early Intervention: Dyslexia can be kept from getting worse by early detection and assistance with reading issues. Targeted reading treatments can help kindergarten or first-graders who are classified as struggling readers improve their phonological awareness and other reading-related abilities. 
	&nbsp;</li>
	<li>Access To High-Quality Early Education: Children who have access to high-quality early learning opportunities, such as preschool programs that prioritize language and literacy development, may be better prepared to acquire good reading skills and may be at a decreased risk of having dyslexia. 
	&nbsp;</li>
	<li>Multisensory Learning: A multimodal method of reading that involves several senses (such as visual, auditory, and kinesthetic) can support children who have dyslexia or are at risk of developing the condition. A solid foundation in phonological awareness, letter-sound correspondences, and other reading-related skills can be created with this method. 
	&nbsp;</li>
	<li>Physical Activity: Reading performance in particular has been linked to regular physical activity. Promoting physical activity in kids may help lower the chance of dyslexia or lessen its symptoms. 
	&nbsp;</li>
	<li>Rich Language Environment: Youngsters who are exposed to both spoken and written language frequently as they are growing up may be better prepared to master reading. Access to books, reading aloud to children, and having interactions with them can all assist language development. 
	&nbsp;</li>
</ol>

It&#39;s crucial to remember that these factors might not always work to prevent dyslexia, and some people might still have the condition despite these precautions. Nonetheless, these methods can help lessen its negative effects. 
&nbsp;
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Key Points

<ul>
	<li>Dyslexia is a specific learning disorder that affects a person&#39;s ability to read, write, and spell despite having normal intelligence and adequate educational opportunities.</li>
	<li>This difference in brain function can make it difficult for dyslexics to decode and recognize words, leading to difficulties in reading fluency, accuracy, and comprehension</li>
	<li>Genetics, premature delivery or low birth weight, exposure to chemicals or illnesses during pregnancy, and inadequate nutrition throughout crucial stages of brain development are all environmental factors that may contribute to dyslexia</li>
	<li>People with dyslexia may find it easier to access written information with the aid of assistive technology, such as text-to-speech software.</li>
	<li>Dyslexics who seek counseling can learn coping mechanisms and deal with any psychological or emotional problems that may be connected to their condition.</li>
	<li>A multimodal method of reading that involves several senses (such as visual, auditory, and kinesthetic) can support children who have dyslexia or are at risk of developing the condition. 
	&nbsp;</li>
</ul>
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[1] International Dyslexia Association. (n.d.). Dyslexia basics

[2] Shaywitz, S. E., Morris, R., & Shaywitz, B. A. (2008). The education of dyslexic children from childhood to young adulthood. Annual review of psychology, 59, 451-475.

[3] Kumar, R., Singh, J., & Hussain, M. (2017). Prevalence and associated risk factors of dyslexia among primary school children in a North Indian City. Journal of Child Neurology, 32(5), 467-475.

[4] Gupta, R., Kar, B. R., & Srinivasan, N. (2012). Developmental dyslexia in a multilingual country. Journal of child neurology, 27(7), 898-908.

[5] Snowling, M. J., & Melby‐Lervåg, M. (2016). Oral language deficits in familial dyslexia: A meta‐analysis and review. Psychological bulletin, 142(5), 498-545.

[6] Shahid, F., Khan, M. M., & Khan, A. R. (2016). Prevalence of dyslexia in school-aged Pakistani children. Journal of the Pakistan Medical Association, 66(9), 1104-1107.

[7] Siddiqui, S., Sultana, S., & Tahir, S. (2020). Prevalence of dyslexia among university students in Lahore, Pakistan. Journal of Pakistan Medical Students, 10(1), 72-76.

[8] Ferrer, E., & Shaywitz, B. A. (2014). Chapter 9 - Dyslexia. In Handbook of Clinical Neurology (Vol. 120, pp. 139-153).

[9] Gabrieli, J. D., Norton, E. S., & Wood, T. (2015). Dyslexia. Annual review of clinical psychology, 11, 283-307.

[10]  Peterson, R. L., & Pennington, B. F. (2015). Developmental dyslexia. The Lancet, 386(10009), 742-751.

[11] Lyon, G. R., Shaywitz, S. E., & Shaywitz, B. A. (2003). A definition of dyslexia. Annals of dyslexia, 53(1), 1-14.

[12] Wagner, R. K., Torgesen, J. K., & Rashotte, C. A. (1999). Comprehensive test of phonological processing. PRO-ED.

[13] Fletcher, J. M., Lyon, G. R., Fuchs, L. S., & Barnes, M. A. (2007). Learning disabilities: From identification to intervention. Guilford Press.

[14] National Institute of Child Health and Human Development. (2000). Report of the National Reading Panel. Washington, DC: US Government Printing Office.

[15] Daley, A. J. (2009). Can exercise prevent cognitive decline? A review of the evidence. Preventive medicine, 48(3), 193-198.

[16] Fernald, A., Marchman, V. A., & Weisleder, A. (2013). SES differences in language processing skill and vocabulary are evident at 18 months. Developmental science, 16(2), 234-248.

[17] Furnham, A., & Batey, M. (2010). The relationship between learning disabilities, depression, and anxiety. Journal of learning disabilities and offender rehabilitation, 1(2), 9-14.

[18] Smythe, I., & Everatt, J. (2008). Dyslexia: the role of the pediatrician. Pediatrics in review, 29(7), e35-e41.

[19]  Nalipay, M. J., & Mendoza, M. (2018). The efficacy of assistive technology in enhancing reading comprehension for individuals with dyslexia: A meta-analysis. Dyslexia, 24(3), 190-210.