Reading disorder Health Article

Diagnosis

Evaluation of children's reading ability must be done on an individual basis in order to make a diagnosisof reading disorder and distinguish it from slow learning or low intelligence. The examiner must take into account the child's age, intelligence, educational opportunities, and such cultural factors as whether the language spoken at home is different from the language taught and used at school. Reading disorder is diagnosed when a child's reading achievement is substantially below what would be expected after taking these factors into account.

In addition, the reading problems must interfere in significant ways with the person's schoolwork or daily life. If a physical condition is present (for example, mental retardation, poor eyesight, or hearing loss), the reading deficit must be in excess of what one would normally associate with the physical handicap.

Diagnosis is complicated by the fact that 20%–55% of children with reading disorder have attention-deficit/hyperactivity disorder(ADHD), a behavioral disorder that aggravates learning difficulties. In addition, about one-quarter of children with reading disorder have conduct disorder. Oppositional defiant disorderand depression also occur in higher-than-average rates in children with reading disorder. Almost all people with reading disorder have difficulties spelling, and about 80% of them have other language problems.

Anyone who is suspected of having reading disorder or any other learning disability should have a comprehensive evaluation, including hearing, vision, and intelligence testing. The test should include all areas of learning and learning processes, not just reading. In school-age children, this evaluation often involves a team of educators, educational psychologists, and child psychiatrists.

Demographics

Estimates by the National Institutes of Health of the number of people with learning disorders range from 5%–15% of the general population. About 80% of people with a learning disorder have reading disorder. Other studies suggest that about 4% of school-age children have reading disorder. People with reading disorder are more likely to have a parent or sibling with the disorder.

Between 60% and 80% of children diagnosed with reading disorder are boys. For various reasons often related to behavior, boys tend to be referred more frequently to special education classes, which suggests that girls with reading disorder may be underdiagnosed. Some experts think that this disparity comes about because boys are more often disruptive in class.

Treatments

Reading disorder, like other learning disorders, falls under the federal Individuals with Disabilities Education Act (IDEA). Definitions of learning disabilities vary among the states, and some school districts are more willing than others to recognize specific learning disabilities. Any child, however, who has a diagnosed learning disability, including reading disorder or dyslexia, should be eligible for an Individual Education Program (IEP) that provides customized instruction at school designed to address the disability.

Treatment approaches vary from visual stimulation to special dietsto enhanced reading instruction. However, it is generally agreed that customized education is the only successful remedy. The American Academy of Ophthalmology, the American Academy of Pediatrics, and the American Association for Pediatric Ophthalmology and Strabismus have issued a policy statement warning against visual treatments and recommending a cross-disciplinary educational approach.

The first researcher to identify and study dyslexia, Samuel Torrey Orton, developed the core principles of such an approach in the 1920s. The work of three of his followers—teachers Bessie Stillman, Anna Gillingham, and Beth Slingerland—underlies many of the programs in use today, including Project READ, the Wilson Reading System, and programs based on the Herman method. There are many successful programs to address individual reading needs. In general, all good programs are:

• Sound/symbol (phonics)-based. They break words down into their smallest visual components: letters and the sounds associated with them.
• Multisensory. Good programs attempt to form and strengthen mental associations among visual, auditory, and kinesthetic channels of stimulation. The student simultaneously sees, feels, and says the sound-symbol association. For example, a student may trace the letter or letter combination with his or her finger while pronouncing a word out loud.
• Highly structured. Remediation begins at the level of the single letter-sound; works up to digraphs (a pair of letters representing a single speech sound); then syllables; then into words and sentences in a systematic fashion. Repetitive drill and practice serve to form necessary associations between sounds and written symbols.