Dyslexia and Reading Disorder

This disorder of phonologic processing and decoding of words is the most common developmental language disorder. It is estimated that as many as 30% of the American urban population has reading problems. Dyslexia frequently is familial, occurring more often in sons (35% to 40% risk of occurrence) than in daughters (17% to 18% risk). The underlying deficit is impaired recognition and processing of phonemes– the most discrete elements of sound in language. Those who have dyslexia do not appreciate that speech is composed of sounds that join together to form segments, syllables, morphemes, and words. The processing of language in the course of reading or writing is constantly compromised by the struggle to decode or encode words. Preschool children who have dyslexia manifest delays in acquisition of speech, poor articulation, difficulty with learning the names of letters and colors, and persistent missequencing of syllables (eg, “aminals” for “animals”). These children experience difficulty following multistep directions. They are unable to express frustration by “using their words” and, therefore, are prone to develop secondary behaviors such as hitting, kicking, or throwing tantrums.Dyslexia can be diagnosed confidently by the end of the second grade. Children will be slow and halting in their oral reading and have difficulty in reading comprehension. They have poor word retrieval and frequently use more fillers (”um,” “like,” “you know”) in their narratives. They experience markedly increased difficulties in the fourth grade when there is a shift from “learning to read” to “reading to learn.” Children must be taught to break down, or segment, syllables into phonemes. Some children whose overall cognitive abilities are high may compensate for their dyslexia and not be identified by the schools because they can maintain average grades. However, they will have persistent difficulties with spelling and written language into adulthood.

Abnormal development of the left hemisphere (planum temporale) has been postulated to have taken place in adults who have dyslexia. This theory is supported by autopsy studies of five adults who had dyslexia in which multiple areas of microdysgenesis or “brain warts” were present in the left perisylvian cortex, as well as by recent neuroimaging studies

TREATMENT

Attempted therapies for dyslexia include educational remediation, medications, and psychosocial interventions. It appears that the most effective therapy is remedial education involving direct instruction in reading. Such remediation should include instruction and practice with letter-sound associations (phonics), word recognition tasks, and reading comprehension. That treatment approach is considered effective whether used in settings such as Head Start programs, pull-out programs or resource rooms, small classroom settings, or individual tutoring.

Various types of cognitive-perceptual skills training (for example, sensory integration training, perceptual-motor training, occupational therapy, auditory memory training, vestibular stimulation, hemispheric stimulation, optometric training) have been used with reading disabled children. The effectiveness of those methods in improving dyslexia and reading disorder in the majority of children has not been convincingly demonstrated.

Medical approaches to treating dyslexia include stimulant medications, antianxiety medications, motion sickness medication, vitamins, and special diets. The most promising are stimulants and piracetam. Both methylphenidate (Ritalin) and piracetam have been studied in double-blind trials. Although methylphenidate does not appear specifically beneficial to reading skills, there is some indication that piracetam may facilitate reading performance.

Psychosocial approaches to dyslexia include supportive psychotherapy, parent guidance and training, social skills training, relaxation training, and behavioral modification approaches. The effectiveness of such approaches for dyslexia has not been proved, although they are likely to be helpful for associated behavioral and emotional problems. Similarly, the benefits of speech or language therapy for reading are not known, although it may prove helpful for associated speech and language deficits.

An overall treatment program should include attention to associated disorders such as language disorders or psychiatric disorders. In addition, it is likely that individual characteristics of the child–motivation, learning style, attentional abilities, and responses to instructional strategies or to curriculum materials–may be significant to treatment selection and outcome.

Rate this:

2.5

The nicest compliment that you can give me is to to subscribe to the Dental Blogging Newsletter. Thanks for visiting!