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The Misunderstanding of Dyslexia
by Sally Shaywitz, M.D.

Recently I heard that a friend’s brother—a graduate of a competitive college with an MBA working for a business firm—was demoted once he told his superiors he was dyslexic. As unbelievable as this may seem in the 21st Century, such lack of understanding of dyslexia and the unfounded stigma associated with it remain. Such misunderstanding of dyslexia is particularly painful and unnecessary in an era when science has taught us so much about dyslexia, including how to recognize it early and accurately, how to treat it effectively, and perhaps most importantly, we now understand how it is that so many people can be both smart and dyslexic.

Concerned that there was such a gap between the growing knowledge about dyslexia and the everyday school and societal practices affecting children and adults who are dyslexic, I spent five years writing a book, Overcoming Dyslexia published by Alfred A. Knopf in 2003. Based on the premise that “knowledge is power,” I wanted to empower parents and teachers and those who are dyslexic to understand the nature of dyslexia and the implications of this knowledge for the improving the well being of those who are dyslexic.

The new scientific discoveries have profound and positive implications for identifying children (and adults), for providing evidence-based, effective reading instruction and reading interventions, and for understanding the neurobiological basis for the absolute need for the accommodation of extra time for those who are dyslexic.

Why do the lines and squiggles on a page have any meaning at all? There is now a strong consensus among investigators in the field that reading reflects language and that the central problem in struggling readers reflects a deficit within the language system. This evidence begins with the recognition that spoken language is instinctive, built into our genes and hard-wired in our brains. In order to read, the abstract lines and circles on the page that we call letters, must link to something that already has inherent meaning—the sounds of spoken language. In contrast to spoken language, which is natural, written language is acquired and must be taught.

As a physician, I practice evidence-based medicine that is; in choosing a treatment for a patient I am guided by the scientific evidence of which treatment is proven to be most effective. Today, for the first time, we have the knowledge to be in an era of evidence-based education where, for example, reading programs are selected on the basis of scientific evidence of their efficacy and not on the basis of opinion or philosophy. Converging scientific evidence, including the rigorous analysis by the National Reading Panel, indicates that effective reading instruction is comprised of five essential elements: phonemic awareness, phonics, fluency, vocabulary and comprehension. Furthermore, how reading is taught matters; effective programs teach reading systematically and explicitly. For example, phonics is taught in a preplanned way where vowels and all the letter-sound combinations are systematically taught; this is in contrast to more casual, “by the way” approaches. Effective programs are aligned so that reading practice reflects the letter-sound linkages taught. We know that the brain learns by practice and such practice is especially important as a foundation for the development of fluency.

Within the last decade or so, the dream of scientists, educators and struggling readers has come true. It is now possible to “see” the brain at work. Functional brain imaging, primarily functional magnetic resonance imaging (fMRI), uses the same scanner employed in MRI studies commonly obtained for assessing headaches or knee ligament injuries, but with the addition of more sophisticated soft and hardware that make it possible to “see” which brain systems are activated as a child performs reading or reading-related tasks.

Using functional brain imaging, scientists have discovered the brain basis of reading and a glitch in the neural circuitry for reading in children and adults who struggle to read. Such evidence of a disruption in the reading pathways provides a neurobiological target for reading interventions. A study we published in 2004 demonstrated that provision of an evidence-based, phonologically mediated reading intervention, both improved reading accuracy and fluency and was associated with the development of the fast-paced word form systems serving skilled reading.

Our data indicate that teaching matters and that use of an evidence-based reading intervention can facilitate the development of the fast-paced neural systems that underlie skilled reading. Thus, there is now a new level of evidence, based on functional imaging studies of the brain at work, that supports the findings of a systematic review of the scientific literature on reading conducted by the National Reading Panel.

Finally many dyslexic adolescents and young adults have not enjoyed the benefit of evidence-based reading instruction. They remain slow readers and require extra time in order to demonstrate their knowledge on tests. Their requests for extra time are supported by new brain imaging data that provide incontrovertible evidence of the need for extra time. As I write in Overcoming Dyslexia, “dyslexia robs a person of time, accommodations return it”; a dyslexic has as much of a physiologic need for extra time as a diabetic has for insulin.” In dyslexia, there is an observable disruption in the fast-paced neural systems for rapid, automatic reading; over time other systems compensate, permitting more accurate, but not fluent reading. There should no longer be any doubt about the dyslexics’ absolute need for extra time.

Never has there been a more hopeful or optimistic time for those who are dyslexic. We have the knowledge; I hope we have the will to use it.#

Sally E. Shaywitz, M.D. is Professor of Pediatrics and Co-Director, Yale Center for the Study of Learning and Attention, New Haven, CT.



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