Dyslexia (Learning Disorders: Reading)

  • Medical Author: Neelkamal S Soares, MD, MBBS, FAAP
  • Medical Editor: Elizabeth A Finley-Belgrad, MD
  • Medical Editor: Mary L Windle, PharmD
  • Medical Editor: Melissa Conrad Stöppler, MD

Reading Skills Facts

  • Reading is a complicated process, involving recognition of symbols of language in a printed form. It is not an innate skill, but rather must be learned. Written words bear no meaning until the reader constructs meaning by making inferences and interpretations.
  • Acquisition of reading skills is closely tied to development of language in children. The ability to break down words into individual sounds or phonemes, is the core skill that needs to be mastered in order to be a fluent reader.
  • This is called "phonemic awareness." For example, in reading the word "CAT," one must be aware of its component graphemes, and then break it down into the phonemes C/Ah/T. Then, one must blend the phonemes back into the spoken word "CAT" which is then produced.
  • This process is called "decoding." It sounds complicated, and it is. Yet most children with access to instruction and in the absence of sensory or other neurological deficits master this skill easily.
  • But some children, this basic process is impaired often leading to lifelong struggles with reading. These are individuals with the learning disability called "Reading Disorder." It is also popularly known as dyslexia.

Learning Disability Facts

  • Learning disabilities, or LDs, is an "umbrella" term given to a group of different conditions which include difficulties in performing certain academic-related tasks despite having the intelligence, opportunity, motivation and schooling to do so. They affect life in educational, job related, or social arenas.
  • Although dyslexia (reading disorder) is the most common and most widely known learning disability, there are several others including math disability, disability with written expression (writing), disability with oral expression (speaking), disorder of verbal comprehension (understanding), and disorder of pragmatic/non-verbal skill (socialization).
  • We do not know exactly how often these other disorders occur, however some evidence estimates they occur in around five to six percent of the population as well. There is considerable overlap with people with dyslexia and these other disorders.

Dyslexia (Reading Disorder) Overview

Dyslexia (reading disorder) is the most common of all learning disabilities and is the best understood. It is more easily identified by the public and has received a lot of attention in research and the media. Failure to read (or read accurately and with speed) is very noticeable and somewhat stigmatizing in today's society.

Although it was traditionally thought that many more boys than girls had dyslexia, studies have shown that this is not true and that both boys and girls are equally likely to have the condition. Further, although it is not understood which genes are responsible and how it is passed down through families, there is strong evidence to suggest that dyslexia is a genetic condition. It is present from birth and commonly runs in families. It is not predominantly something acquired because of lack of adequate early education due to poverty or lack of access to education.

Dyslexia Symptoms and Signs

In preschool group:

  • Difficulty recognizing alphabet letters
  • Language delays
  • Trouble with rhyming
  • Difficulty with sounds of letters
  • A history of someone in family with dyslexia or another learning disability is sometimes seen in these youngsters

In early elementary grades:

  • Difficulty reading single words (especially without visual cues or context)
  • Difficulty with "nonsense" or pseudowords
  • Slow speed of reading
  • Poor spelling
  • Numerous substitutions of letters
  • Generally good number math concepts

In later elementary and middle school grades:

  • As math involves more language, greater math difficulties
  • Difficulties with completing assignments involving reading large passages of text
  • Trouble with comprehension of reading passages

Dyslexia Comorbidity

Children with dyslexia can have simultaneous (often called "comorbid") disorders that interfere with learning.

Comorbid conditions:

  1. Attention Deficit/Hyperactivity Disorder (ADHD): This neurological disorder. It mainly affects attention and organization, and may be accompanied by hyperactivity and impulsivity. This can seriously impact the learning of a child already impacted by dyslexia.
  2. Affective Disorders (Anxiety, Depression): Children with dyslexia may have low self-esteem related to their struggles in academics and are prone to depressive and anxiety disorders. These are usually identified by change in a child's usual pattern of behavior and deterioration in academics accompanied by withdrawal from activities, greater irritability, mood swings, avoidance of school, change in alertness, eating, sleeping, and play habits.
  3. Conduct Disorders (ODD, CD): Some children may demonstrate negative behaviors, defiance of authority, and aggressive behaviors in class, and engage in avoiding class work. Oppositional Defiant Disorder (ODD) further interferes with learning and peer relations in a classroom setting.

Dyslexia Diagnosis

The diagnosis of dyslexia is not a simple one and often needs input from several different professionals. While it is indeed a disorder affecting learning and considered predominantly part of the educational realm, there are neurological and medical issues at play as well, and so a cooperative effort between the school, physician, and other health care professionals is critical to serve the child and family.

The centerpiece of a diagnosis of "learning disability" in schools is the demonstration of a difference or "discrepancy" between the child's IQ and his academic performance or "achievement." This discrepancy criterion has been widely debated between the research community and the educational community, however, at the present, it remains an important consideration. This was done so that children who are exceptionally gifted may still be learning disabled, and struggle with reading and spelling, but perform on those subjects at the level of their grade peers, and be thus overlooked if one only bases the diagnosis on performance below one's classmates.

Many children with dyslexia get missed or overlooked until they are in higher elementary or middle school, when there is a noticeable decline in academic performance. They often do not "fall two grades behind their grade level," which in many systems is the cut-off for providing remedial services, and so continue to struggle without intervention.

Furthermore, there is a confounding factor in using typical school-based criteria for discrepancy in that many IQ tests rely on strong language skills which are inherently weaker in many children with dyslexia, thus narrowing the "discrepancy" and thus negating a conclusive diagnosis of dyslexia.

There is also the ongoing argument between medical and educational professionals regarding terminology around reading disorder. Many educators do not believe that "dyslexia" is a valid term; many physicians believe the term "learning disabilities" is applied too broadly to indicate the specific deficits a child has.

A community specialist like a developmental-behavioral pediatrician or neurologist might use screening tools like Wide Range Achievement Test (WRAT) or Peabody Individual Achievement Test (PIAT). These can identify domains of concern, but should not be construed as final diagnostic tests. The latter can only be done by educational specialists or psychologists skilled in administering IQ and achievement tests.

Typical IQ tests in schools include Wechsler WISC-IV test, and achievement is measured by a battery of academic tests included in the Woodcock-Johnson test or Wechsler Achievement test (WIAT) or similar tests. The choice of tests may vary depending on the school district's preference. Usually, behavioral data and speech-language testing may also be done depending on the determination of the school system's committee on special education.

Role of the Healthcare Professional in Dyslexia

Because dyslexia is a complex neurological disorder, there is a role for the physician in the care of children with dyslexia, even though treatments are primarily educational.

The physician may perform a physical exam and order screening tests, such as vision and hearing testing, to rul out any contributing deficits.

The physician also serves an important function in identifying neurological conditions like attention deficit hyperactivity disorder (ADHD), either by screening or by referral to subspecialists such as psychiatrists, neurologists, or developmental pediatricians. If ADHD is diagnosed, the physician plays a vital role in prescribing medication to help manage the symptoms of ADHD, and thus contributes to the overall on-task behavior of the child at school.

Several pediatricians are involved in the national Reach Out and Read© program, by which literacy-promoting books are available to children attending their well-child visits.

It must be remembered that there is no blood test or brain scan test for dyslexia.

Dyslexia Intervention

Although dyslexia is a life-long neurological disorder that cannot be "outgrown", there are many different strategies that can be used, especially early in academic life to help these individuals.

The early focus (before fifth and sixth grades) is on "remediation." This means that strategies are employed to assist the child in learning to improve deficits in the particular area of disability, for example reading decoding, reading comprehension, or speed of reading. A child needs to be instructed in how to recognize the sounds of letters, how to identify the letters, and correlate with the sound. Then, focus builds on decoding with abilities to blend sounds into words and break down words into component sounds.

Gradually, a child is taught to focus on the content of the reading material, not merely focusing on individual words, but how to seek out sections which convey meaning for comprehension. The strategy of "guided oral reading" provides feedback to a child so as to identify areas of errors, and teach alternative ways of tackling the task at hand.

A popular and well-researched strategy is "multi-sensory learning." This comprises using auditory, visual, and sometimes tactile strategies to assist a child in recognizing and retaining written material to convey meaning. Material is organized to follow a sequential, logical pattern of learning, building on previously acquired skills or "scaffolding." This is often accomplished by direct instruction from a trained special education professional, individualized to the child's needs.

Some examples of this are the Orton-Gillingham method; and its variations including the Slingerland Method, Spalding Method, Herman Method, Wilson reading program, and several others. These strategies are well understood and used by special education teachers and several regular education teachers as well. There is no perfect strategy, and each must be adapted to fit an individual child's needs. There are no direct comparisons which indicate that one method is preferred over the other.

The advantage of early detection and remediation is that it provides individuals with dyslexia to be able to compensate for deficits and learn appropriate strategies to apply to learning. This helps reduce frustration and other emotional problems. Children need to be monitored even after appropriate interventions are put in place to ensure that they continue to make gains in their learning. This should be done periodically by the teacher and family, but also by a formal review by the school special education team at least annually. This would help to determine if the strategies employed are enabling the child to function more appropriately in the learning environment. If not, additional techniques or exploration of other possible causes of the problem need to be addressed.

Phonics vs Whole-Word Teaching with Dyslexia

The phonics approach teaches word recognition through systematic learning of letter-sound correlations. The whole word approach teaches whole words in word families, or similar spelling patterns. The student is not directly taught the relationship between letters and sounds, but learns them through minimal word differences. As the child progresses, words that have irregular spellings are introduced as sight words.

Proponents of each teaching system maintain that their particular approach is the key to engaging children in reading. There have been no overwhelming guidelines from evidence-based research that demonstrate a clear advantage of one approach over the other. Nowadays, many teachers are looking for a user-friendly combination of both strategies; to use phonics as part of whole language instruction and thus complementing each approach.

A reasonable approach would be to familiarize oneself with the philosophy of the school district regarding interventions for children with a dyslexia, inquire whether adaptations individualized to the child are encouraged, and attempt to use strategies from both approaches in a systematic format. Then, review of the results after a predetermined period would reveal if improvement has been achieved.

Accommodations for Dyslexia

Later in school life, and in adulthood, the focus is on "accommodations." This means that reasonable attempts must be made to adapt the curriculum and method of instruction to allow the individual with dyslexia to use alternative strategies for a given task.

These accommodations are usually requested under the Individualized Education Plan (IEP); however in some instances they can be applied under a section 504 plan under American with Disabilities Act without the procedural safeguards of an IEP.

Some types of accommodations include:

  • instructional,
  • environmental,
  • testing,
  • assignment/homework, and/or
  • assistive technology

There are excellent resources online and in print regarding details of the above, but a few examples are provided here:


  • Adjust reading level
  • Allow student to tape lectures
  • Allow typewritten or word-processed assignments
  • Provide a written outline

Classroom Environment

  • Seat student near teacher
  • Provide a structured routine in written form
  • Provide organizational strategies such as charts, timelines, binders for materials etc.


  • Allow open book tests
  • Give multiple choice instead of short answer questions
  • Allow use of dictionary or calculator during test
  • Provide extra time to finish
  • Allow testing in a distraction-free environment


  • Allow student to work on homework while at school
  • Give frequent reminders about due dates
  • Give short assignments
  • Develop reward system for homework completed

Assistive Technology (AT)

Assistive technology is any piece of equipment or product used to increase, maintain, or improve functional capabilities of individuals with disabilities. It serves to augment an individual's strengths, and to provide an alternative mode of performing a task.

Examples of technological solutions include:

  • Timepieces, computer organizers to help with organization
  • Books on tape
  • Tape recorders help students review class materials
  • Voice recognition software for transcribing dictated reports
  • An optical character recognition system to enter text or printed material into a computer by use of a scanner.
  • Software programs like Spell Check to correct spelling and syntactical errors
  • Word processors for composing written text

Assistive technology options need to be explored through the school special education committee, usually with an assisted technology evaluation of the child to determine the "best fit" for the child's needs. Options for utilizing the assisted technology equipment at home needs to be explored to ensure generalization of skills in different settings.

Parental Support for Dyslexia

In the home:

  • Provide access to books either in the home or at the public library.
  • Spend time everyday in reading for FUN!
  • Choose reading materials based on the child's interest.
  • Read to children often, and give them time to read both alone and in conjunction with the adult.
  • Play word games, rhyming, naming, etc.
  • Try tape-recording a child reading to provide feedback.
  • Spend small amounts of time with frequent breaks during reading assignments to avoid frustration .
  • Use plenty of praise, limit criticism.

In School:

  • Be involved in the preparation of the child's Individualized Education Plan (IEP)
  • Request frequent updates regarding the child's progress
  • Be familiar with strategies to be implemented at school
  • Request duplicates of child's assignments to practice at home
  • Communicate with school personnel
  • Communicate information between child's treating medical professional and school

Dyslexia Outlook

In conclusion, dyslexia is prevalent in our society, though not well recognized or understood. It is a life-long condition, which affect both children in school and adults in their vocational and social environments. Adults with dyslexia do exist and often are not recognized since they appear to function well in society and tend to mask their disability or gravitate toward occupations that do not emphasize their disability. Families and physicians must be aware of resources that exist in their communities and on the Internet for adults with dyslexia and allow access of these resources to enable them to best compensate for their disability.

There continues to be further research into the nature of dyslexia, the deficits that need to be overcome, and strategies that can be employed to achieve this goal. Individuals with dyslexia can learn to read, and with the right guidance, assistance and resources, can do so with a sense of accomplishment, skill and confidence.

Famous People with Learning Disabilities

  • Entertainers: Jay Leno, Whoopi Goldberg, Tom Cruise
  • Presidents: Woodrow Wilson, John F. Kennedy, George Washington
  • Businessmen: Ted Turner, Charles Schwab, Walt Disney
  • Scientists: Thomas Edison, Albert Einstein
  • Authors: Agatha Christie, Hans Christian Andersen
  • Athletes: Magic Johnson, Muhammad Ali, Nolan Ryan
Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

"Reading difficulty in children: Clinical features and evaluation"