SOME people have a
learning disability that leads to difficulty in learning and using certain
skills. The skills that are usually affected are reading, writing, listening,
speaking, reasoning, and doing mathematics.
The terms used for
these disabilities are dyslexia, which refers to difficulties in reading and
spelling; dysgraphia, which refers to difficulties in writing; and dyscalculia,
which refer to difficulties in doing mathematics.
This article is
about dyslexia, which is derived from the Greek works, dys (difficulty), and
lexia (use of words). The symptoms range from the very mild to the very severe.
People with dyslexia have difficulties with phonemic awareness, verbal memory
and verbal memory speed.
Phonemic (or
phonological) awareness is the ability to learn how speech sounds make up
words, connecting the sounds to alphabet letters, and learning how to blend the
sounds into words. Changes in the sounds lead to different words with different
meaning. This ability is believed to be crucial in early reading and spelling
development.
Verbal memory is the
ability to remember a sequence of verbal information for a short time.
Verbal processing
speed is the time taken to recognise and process familiar verbal information,
e.g. this speed is the time taken to recognise the letters, A, S, E, A and N,
process it, and then realise that it refers to the Association of South East
Asian Nations.
Although dyslexia is
considered a learning disorder, there is no relationship between dyslexia and
intelligence. Dyslexia has been defined well by Shaywitz, who stated that,
“Dyslexia is a reading difficulty in a child or adult who otherwise has good
intelligence, strong motivation and adequate schooling ... Dyslexia reflects a
problem within the language system in the brain.”
Dyslexia is reported
to affect about 10% of schoolchildren, with about 4% having severe difficulties
that affect their learning ability in school. The incidence in males is
estimated to be 1.5 to three times more than that in females. It affects all
ethnic groups.
Roots of dyslexia
Dyslexia is a
genetic condition. However, there are various theories about the causes.
It occurs in certain
families. It is estimated that a child of a dyslexic has a 40% to 60% chance of
developing the condition. If an identical twin has the condition, it is very
likely that the other twin would also have the condition.
Scientists have
detected genes that may lead to dyslexia, but their effects on the brain have
yet to be elucidated.
The phonological processing
impairment theory is believed by many to explain how dyslexia affects reading
and writing. The ability to understand spoken language is an innate capacity of
the brain, which recognises a word as a whole and does not register it by the
units of sound that constitute a word (phonemes).
However, reading and
writing requires the ability to recognise the letters in a word, identify from
the letters the phonemes, and then bring them together to form a word. This
process, which is termed phonological processing, is believed to be impaired in
dyslexics.
There is evidence
from magnetic resonance imaging (MRI) that the part of the brain (left
hemisphere) involved in producing, analysing and identifying written words
demonstrate less activity in dyslexics when they read. This may impact upon
phonological processing.
MRI has also shown
that the activity in the cerebellum of dyslexics is different from those
without the condition. The cerebellum, which is found at the lower back of the
brain, is believed to be crucial to the processing of language, coordination
and assessment of time. This may explain why dyslexics have difficulties with
coordination and time management.
Distinctive features
There is individual
variation in the features of dyslexia. Each affected person would have
distinctive features.
The features in a
pre-school child include delayed speech development when compared to children
of the same age; speech problems, like an inability to pronounce long words;
problems expressing spoken language, like an inability to remember the right
word to use; lack of understanding or appreciation of words that rhyme; or lack
of interest in learning the letters of the alphabet.
It is not always
possible to detect dyslexia in a pre-school child.
The features in the
early school years include problems learning the names and sounds of letters,
erratic spelling, problems copying written language, and poor phonological
awareness, i.e. the ability to recognise that words are comprised of smaller
sound units (phonemes) and new words can be created by altering the phonemes.
The child may also
have difficulty in making sense of unfamiliar words by considering smaller
words or collection of letters.
The features in the
later primary school years include problems with spelling, problems
understanding and recognising new words, and slow reading speed.
The features in
secondary school include problems with reading fluency, slow writing speed, and
problems expressing knowledge in writing.
Some dyslexics reach
adulthood without the diagnosis ever being made. Their features include
avoidance of reading and writing and hiding these difficulties from others,
reliance on memory and verbal skills instead of reading and writing, poor
spelling, and poor time management.
Dyslexia is associated
with poor numerical skills, poor short term memory, poor concentration, poor
time and organisational management as well as problems with physical
co-ordination.
The earlier dyslexia
is diagnosed, the more likely its management will be effective.
If a child has
difficulties with reading and writing, a discussion with the teaching staff and
a consultation with the family doctor would be helpful. The latter would
exclude health problems which affect the child’s ability to read and write,
e.g. vision problems, poor hearing, and other conditions like attention deficit
hyperactivity disorder. The former would help in a review of the teaching
methodology and provide alternative
approaches and support, which is helpful
for many children, including those with mild or moderate dyslexia.
If the problem
persists despite the above, an assessment by an educational psychologist would
be advisable. The latter is a specialist who assists children with problems in
their educational progress because of emotional, psychological, cognitive
(learning), or behavioural factors. This can be challenging as there are not
many educational psychologists available in the country.
Alternatively,
assistance can be sought from the Dyslexia Association of Malaysia, which has
centres in Peninsular Malaysia. Its contact details are 6, Persiaran Kuantan,
Off Jalan Setapak, 53200 Kuala Lumpur (Tel: 03-4025-5109).
The assessment
includes an evaluation of the child’s reading and writing abilities as well as
other skills like vocabulary, memory, reasoning, language development,
processing speed of visual and sound information, organisational skills, and
approaches to learning.
A diagnosis of
dyslexia is made if the child’s reading and writing skills are poor despite
appropriate teaching methodology and the child’s logic and verbal skills are
unaffected.
Adults can also have
similar assessments done.
Treating dyslexia
There is currently
no cure for dyslexia. However, there are many interventions that can assist
dyslexics. The degree and type of intervention is determined by the severity of
the problems.
Interventions before
a child goes to school are effective in achieving long term improvements in the
condition. There is evidence that interventions which improve the ability to
identify and process sounds (phonological skills) are effective.
These interventions,
which are called phonics, concentrate on recognition and identification of
sounds in spoken words (phonemic awareness) and instruction on phonics,
spelling, writing, vocabulary, comprehension, and fluency.
There is evidence
that effective methods of teaching phonics to dyslexics have certain features:
● Teaching is
structured, with gradual increase based on what has been learnt previously.
● Use of different
senses.
● Reinforcement with
regular practice.
● Development of
other useful skills.
● Recognition that
there are different learning methods and approaches and then selecting the
appropriate one for different situations.
● Breaking down the
dyslexic’s emotional barriers, like anxiety and frustration, with empathy,
encouragement, and promotion of the dyslexic’s self-esteem.
Many older children
find the use of educational software applications useful rather than text or
exercise books.Similar approaches
are useful in adult dyslexics.
In a nutshell
It is useful to
remember that about 95% of dyslexic children respond well to educational
interventions, with reasonable to good progress in reading and writing. About
5% continue to experience difficulties and would need more rigorous and
long-term support.
It must be
emphasised that although dyslexic children encounter daily challenges, even
those with severe dyslexia can go on to have full and productive lives.
(Written by Dr Milton Lum who is a member of the board of Medical Defence Malaysia).
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