Dyslexia

Dyslexia
Kristen Pammer, University of Newcastle, Newcastle-upon-Tyne, UK
Dyslexia is a disorder characterized by difficulty in learning to read that cannot be attributed to secondary organic, mechanical or social circumstances.

Introductory article
Article Contents
. Introduction . Assessment . Incidences of Dyslexia . Developmental Dyslexia and Acquired Dyslexia

Introduction
No sensible educator, academic, or medical professional would deny that there is an identiable group of children who, despite apparent ability and opportunity, simply fail to learn to read. The labels under which this diculty has manifested itself are many and varied, and include specic learning diculty, specic reading disability, strephosymbolia and dyslexia. The following caveats notwithstanding, the term dyslexia is the one adopted in this article. The reason for this is that in the authors experience the term dyslexia generates at least some sort of understanding in the listener most people have some notion about what dyslexia is, i.e., that it is a problem with reading and/or spelling. Other terms, which have historically fallen in and out of favour, generally fail to produce the same degree of basic awareness. An individual with dyslexia demonstrates normal academic and social achievement in all other respects, but has inordinate diculty learning to read. The most frequently used formal denition for dyslexia is that of the World Federation of Neurology: a disorder manifested by a diculty in learning to read despite conventional instruction, adequate intelligence, and socio-cultural opportunity. It is dependent upon fundamental cognitive disabilities which are frequently of constitutional origin.

. Symptomatology . Aetiology

underlying diculty. Other adults maintain a reading diculty, but the symptomatology changes. Scientists cannot explain why the persistence of the disorder into adulthood should be so idiosyncratic. Nevertheless, although the discussion in this article focuses on children, much the same still applies to adults.

Incidences of Dyslexia
A commonly used criterion for dyslexia is a reading lag of 2 years or more behind an aged-matched cohort. Research usually quotes between 5% and 15% of the population as suering from dyslexia, but clearly these numbers are highly dependent upon the cut-o we adopt. If we specify that children with a reading lag of 1 year are dyslexic, then the incidence of dyslexia will be substantially higher than if we use the criterion of a 2-year reading lag. There is no simple answer to this issue. However, if dyslexia was just poor reading (i.e. a child who for maturational reasons simply develops dierent scholastic abilities at dierent rates), then we would expect reading ability to fall into a reasonably normal distribution. We know that reading does not fall into such a neat distribution; there is a hump at the poor end of the reading distribution. What this means is that the number of individuals in the population who have poor reading skills is greater than would be predicted if reading skills followed a normal continuum like height or weight.

Assessment
Typically, a child would be diagnosed with dyslexia by a health professional such as a psychologist, who would administer a number of appropriately standardized reading and general literacy tests. These tests would be administered in conjunction with a developmental IQ test and other language and performance tests. If a child presents with other developmental diculties, then a diagnosis of dyslexia should only be made in conjunction with the other diagnosis. An example of this might be a diagnosis of attention decit disorder, with dyslexia. The persistence of a reading diculty from childhood to adulthood is not straightforward. Some adults demonstrate the same severity and symptomatology into adulthood, others appear to grow out of it, others are considered to be compensated, which means that the individual can read, even though there may still be some

Developmental Dyslexia and Acquired Dyslexia

One nal distinction is the one between developmental dyslexia and acquired dyslexia. Acquired dyslexia is an inability to read because of some sort of neurological trauma. The individual who suers from acquired dyslexia is typically an adult who has always demonstrated reading skills consistent with their age and development, but who has experienced brain damage as a result of a stroke or accident. As a consequence of this damage, they lose the
1

ENCYCLOPEDIA OF LIFE SCIENCES / & 2002 Macmillan Publishers Ltd, Nature Publishing Group / www.els.net

Dyslexia

reading skills they once had. These individuals are of enormous neuropsychological interest for the information they provide regarding such issues as cerebral localization of reading and language function, the relationship between dierent reading strategies, and the relationship to other cognitive functions. However, this article is concerned almost exclusively with developmental dyslexia, that is, children and adults who for some reason have never developed reading skills. While the symptoms of acquired and developmental dyslexia share many similarities, they cannot be considered to arise from a common aetiology one is reactive, with a clearly identiable cause, the other is developmental, the cause of which is currently unknown.

dyslexia with SLI may in fact constitute an entirely separate dyslexia subtype.

Memory difficulties
Some researchers have suggested that phonological decits in dyslexia are a manifestation of memory diculties. In order to solve many of the above phonological problems, one must be able to hold and manipulate a substantial amount of information in short-term memory. While dyslexic children demonstrate normal visual memory, research consistently shows a decit in verbal memory skills. Verbal short-term memory is speech based; in other words, it is somewhat akin to talking mentally to yourself. We know this, for example, because the number of items we can remember over a short period of time is dependent on how long it takes to articulate them. Dyslexic children tend to be able to remember fewer items for a short period of time. Similarly, some researchers have demonstrated that reading disabled children tend not to be as confused as normal readers when given similar items to remember. For example, it is typically harder to remember a string of similar letters such as B, D, E, G, D, E, C than it is to remember the items H, M, B, Q, K, L, A. Evidence that dyslexic readers tend to be able to remember each set of items equally demonstrates that they may not be adequately utilizing a phonological code in short-term memory.

Symptomatology
Phonological processing
Almost all academics and educators would agree that dyslexia is foremost a diculty in phonological processing. Phonics refers to the sounds letters and words make, i.e. the physical reality that the letter A constitutes the sound /a:/, and the word CAT constitutes the sounds /c/ // /t/. Phonological awareness is the psychological recognition of the relationship between letters and words, and how they sound, as well as an ability to manipulate the sounds. Examples of phonological awareness include the recognition that if one takes the /c/ away from CAT, it sounds like AT, or an awareness that the last sound of the word HOSPITAL is /l/, or being able to make a reasonable attempt at an unfamiliar word like APTERYX. Many dyslexic readers have extraordinary diculties in understanding and manipulating the sounds of words. A number of ways in which dyslexic children have diculties with phonological representations have been identied. For example, dyslexic children have more diculty producing a uent rhyming sequence, segmenting words into their constituent sounds, and solving phonological games, such as identifying the odd word out in a rhyming sequence (e.g. cat, bat, pop, sat), making new words by changing or removing a constituent letter (e.g. what word do you get when you take the c from the word cat ?), and spoonerisms (swapping the initial sounds of words, e.g. bat attery for at battery). In addition to this, dyslexic children have diculties in producing rapid, uent verbal labels for common pictures, as well as general speech production particularly with unfamiliar and non-words. This raises the question of general language diculties in dyslexia. The research in this area is equivocal. Dyslexic children can clearly communicate satisfactorily; however, there is evidence of subtle diculties in both expressive and receptive language. Indeed some researchers have suggested that the distinction between specic language impairment (SLI) and dyslexia has been blurred, and
2

Subtle hearing difficulties

Of course good phonological awareness requires good hearing skills; understanding phonology requires being able to understand speech. The sounds that make up speech change very quickly over time particularly changes in frequency (the highs and lows) and amplitude (loudness). Dyslexic children typically have no obvious hearing diculties. However, they do demonstrate more subtle hearing diculties, although research in this eld is somewhat ambiguous. Some studies have demonstrated that dyslexic children have diculties organizing sound over time, such as determining the correct order of two or more quickly presented tones. However, the physiological basis for this diculty is still unclear. It has certainly been demonstrated that dyslexic readers are less sensitive than normal readers to quick changes in sound signals. When a sound signal is varied in terms of frequency or amplitude very quickly, say 30 or 40 times a second (called modulating a signal), then dyslexic children require signicantly larger frequency changes (frequency modulations) in a signal in order to discriminate it from an unmodulated (pure) tone. Moreover, this ability is strongly correlated with phonological ability, such that individuals who are poor at detecting frequency modulations are also poor at phonological discriminations. Researchers in this

ENCYCLOPEDIA OF LIFE SCIENCES / & 2002 Macmillan Publishers Ltd, Nature Publishing Group / www.els.net

Dyslexia

eld have suggested that such hearing diculties may be an auditory correlate of the visual diculties that dyslexic readers frequently demonstrate, as discussed below.

Dyslexic subtypes
Although the majority of dyslexic readers have diculties in phonological awareness, there are some children who can condently sound out a word, and are aware of phonological relationships, yet still present with a reading pattern that is slow, laborious and painstaking. What then is going on? The answer to this question lies in a basic understanding of some of the theories regarding how we read.

How do we read?
Coltheart and colleagues have formulated a cognitive approach to reading which, in its most basic form, suggests the following: we have at least two cognitive routes that we use to read. One route the phonological route is the process we are adopting when we sound words out. As experienced readers, it is the strategy we adopt when we encounter a word we are unfamiliar with, such as EXTEMPORANEOUS, or a non-word we have never encountered before, such as PERPLISTERONK. Young readers adopt this strategy almost exclusively because almost all words they encounter are unfamiliar. However, as an experienced reader, one does not phonologically recode, or sound out every word encountered; most words we read have some sort of mental representation, called a lexicon, that we are able to access directly, without sounding out. For example, we might need to sound out EXTEMPORANEOUS, but are unlikely to need to sound out the word HOUSE in order to recognize it. It is the transition from reading by sounding out, to reading by direct access (also sometimes referred to as the lexical route) that signies the transition to a condent, experienced reader.

reader is called a surface dyslexic, and may be characterized by regularization errors, in which they try to regularize or sound out an irregular word. Some examples of irregular words include YACHT, and MERINGUE. Irregular words can only be recognized by direct access one cannot access the word by sounding it out. A typical regularization error that a surface dyslexic might engage in is to read YATCHET, and MER-IN-GOO. Similarly, phonological dyslexics have extraordinary diculties reading simple non-words, such as KOPT. This distinction between surface and phonological dyslexia is not new, and has been recognized by a number of researchers. Boder, in 1973, identied dysphonetic (phonological diculties) and dyseidetic (limited sight vocabulary) readers to characterize a similar distinction. While many dyslexic readers display characteristics of phonological dyslexia, the majority of dyslexic readers display various qualities of both surface and phonological dyslexia and are considered to be of mixed type.

Dyslexia versus visual stress

A common misconception with dyslexia is the distinction between visual discomfort or visual stress, and dyslexia. Some individuals, when reading, describe symptoms such as the words moving, shimmering or disappearing, words looking like they were carved into the page, lines or rivers through the text, and preferring to read under very low light levels. Such individuals are almost certainly describing visual discomfort or stress, and this should not be confused with dyslexia. Individuals who suer from visual stress typically have a reading diculty as a consequence of a physical aversion to reading; i.e. it is usually physically painful or uncomfortable to read, and the child or adult avoiding reading typically falls behind, giving the impression of being dyslexic. Moreover, there is scientic evidence that coloured glasses or lenses may be helpful in alleviating the symptoms of visual discomfort, whereas such a relationship has yet to be demonstrated for dyslexia. Individuals who suer from visual stress are believed to be oversensitive to the visual patterns that constitute text, i.e. close-set black and white lines on a page. Individuals will generally demonstrate similar responses to other visual patterns that are not text. This is not the case for individuals who have dyslexia. Dyslexic readers tend to be unconcerned about patterns that produce discomfort in suerers of visual stress. Individuals who suer from visual stress rarely show the same cognitive reading diculties such as problems in phonological awareness already discussed above.

Phonological and visual dyslexia

Many dyslexic children suer from a diculty in using the phonological route when reading. This means that they will have diculties in sounding words out and making phonological manipulations. Conversely, they are likely to over-rely on the lexical route. This would result in errors such as reading CARROT for CARPET where they jump to a word they are mentally familiar with (i.e. have an established lexicon for), or read CARROT for CABBAGE where they are over-relying on context to recognize the word. Such dyslexic readers are called phonological dyslexics. Conversely, some dyslexic readers have relatively little problem using the phonological route, but have diculties using the lexical route, and consequently rely almost exclusively on sounding words out. This type of

Reading and spelling

One of the most consistent ndings in the dyslexia literature is the evidence that dyslexic readers are almost
3

ENCYCLOPEDIA OF LIFE SCIENCES / & 2002 Macmillan Publishers Ltd, Nature Publishing Group / www.els.net

Dyslexia

invariably also poor spellers. The type of spelling diculties displayed by dyslexic readers tends to be consistent with the type of reading diculty displayed. Readers who have phonological diculties tend to have diculties spelling phonetically, producing spelling errors that are visual attempts of words existing in their lexicon. Such attempts can be quite bizarre, for example attempting BETLOON for between. However, the interesting thing about such errors is that they are not completely unrelated to the target word. This is frequently the case the attempt tends to maintain the rst letter, and/or word shape. This indicates some degree of visual awareness that there is some, albeit partial, lexical entry for the word. Conversely, readers who tend to over-rely on the phonological route will frequently make phonological errors, for example GARUNTEE for guarantee. However, as with the reading diculty, it is commonly the case that a mixed type of spelling diculty is manifested.

Aetiology
We do not know for sure what causes dyslexia. However, there are a number of plausible theories. The majority of these theories revolve around the common theme that the brain and sensory systems of the dyslexic individual are constructed or perform in a way that is subtly dierent from the normal reader, which makes it dicult for them to learn to read.

Difficulties in visual processing

One sensory decit theory is the magnocellular decit theory of dyslexia. In order to appreciate this theory, one has to understand that there are at least two primary pathways that convey visual information from the eye to the brain. One pathway, called the parvocellular (or parvo) pathway, is responsible for transmitting visual information such as colour and ne detail. The other pathway is the magnocellular (or magno) pathway, which is responsible for transmitting visual qualities such as contrast, motion and spatial qualities of a visual image. Many studies have demonstrated that a large proportion of dyslexic readers perform more poorly than normal readers on visual tasks that are carefully designed to maximally stimulate magno functioning. In eect, what this means is that for many dyslexic readers, their visual system is constructed such that a component of their visual pathway works dierently from that of normal readers. This dierence in processing makes it dicult for the dyslexic brain to integrate information from both visual pathways, resulting in diculties in those tasks requiring subtle and complex visual interactions, i.e. reading. However, reading is not just a visual task, it generally requires a sensitivity to auditory processing as well. I have already described how
4

dyslexic readers frequently have subtle auditory processing diculties, and it has been demonstrated that visual and auditory processing diculties are strongly correlated. In an attempt to integrate evidence from the visual and auditory domain, it has been suggested that dyslexia may be the consequence of a single underlying cause that manifests in dierent sensory modalities. The basic tenet of this argument is that the reading disabled individual may suer from a subtle change or dierence in neural timing that results in visual and/or auditory neural signals being slightly out of synchrony making it dicult for the brain to integrate the neural signals both between and within modalities. One might be tempted to ask, if reading skills are so exquisitely sensitive to adequate visual and auditory processing, then how do deaf or blind readers learn to read? The answer to this lies in the fact that deaf readers and blind readers almost certainly adopt dierent sensory and cognitive processes when reading. In other words, what a deaf person does when reading is likely to be quite dierent to what a hearing person does, and it is only when the normal process is subtly out of synchrony that problems arise. Exactly how a visual and/or auditory processing diculty contributes to a reading diculty is still unknown. Suggestions include the possibility that visual temporal (timing) jitter compromises our sensitivity to spatial location within words. Another similar argument postulates that an abnormally functioning magno system is unable to spatially orient on the page, resulting in insucient feedback to the parvo system necessary to recognize words, and provide sucient visual navigation across text. Similarly, subtle auditory diculties will make it dicult for the dyslexic reader to make the correct associations between squiggles on a page (letters) and the sounds they are associated with. One way or another, it is likely to be understood in terms of a compromise in the interactions between the visual pathways and auditory processing.

Cerebellar dysfunction
Other theories similarly involve an awareness of brain pathologies and include, among others, theories of cerebral dominance, and theories of cerebellar dysfunction. Targeting the role of the cerebellum in dyslexia is an attempt to integrate the observation that dyslexic children seem to have subtle decits in a number of domains, including reading, writing, spelling, vision, balance, memory, speed and hearing. Research in this area has typically focused on the ability of the dyslexic child to engage in tasks dominated by cerebellar functioning. The cerebellum sits at the base of the brain. It is involved in the control of rapid skilled movements, and the automation of motor and cognitive skills. Recent research has directly implicated the

ENCYCLOPEDIA OF LIFE SCIENCES / & 2002 Macmillan Publishers Ltd, Nature Publishing Group / www.els.net

Dyslexia

role of the cerebellum in reading and language acquisition. It is therefore not surprising that dyslexic children seem to be poorer than normal readers at tasks requiring cerebellar input. Such tasks typically require the child to perform some simple, repetitive motor activity, such as toe tapping, and similar repetitive hand movements, as well as measures of postural stability and arm displacement. Furthermore, brain imaging studies have demonstrated that dyslexic readers demonstrate less activation in the cerebellum when performing an automated task, and the cerebellum of dyslexic adults shows abnormal metabolic uptake. Again, it is important to note that any apparent cerebellar dysfunction is likely to be subtle. Dyslexic children, as a whole, tend not to display gross signs of cerebellar dysfunction, such as dystonia (problems with muscle tone), and dystaxia (disturbances in posture, gait or limb movements). Theories regarding cerebellar input to dyslexia are not unrelated to the magnocellular hypothesis, as the cerebellum receives a substantial amount of general magnocellular input, and itself contains magno cells. Therefore, it is very possible that these two theories are simply part of a larger explanation.

Genetics
Finally, it has been observed that children with dyslexia frequently live in a family in which one or more members are similarly dyslexic. This, however, does not automatically conrm a genetic link in dyslexia. Family members also generally share environmental experiences, so it may not be clear whether a child is dyslexic because their father is also dyslexic, or because there is little reading material in the house, and the child is simply not exposed to reading experiences. Research conducted in Boulder, Colorado, on dizygotic and monozygotic twins has demonstrated that dyslexia is approximately 50% heritable. With monozygotic twins, who share all their genes, it is almost 70% likely that if one twin suers from dyslexia the other will too; dizygotic twins have a concordance rate of almost 40%. Determining the heritability, and ultimately a genetic locus for dyslexia, is exacerbated by variability of denition and manifestation of dyslexia, genetic complexity, and the equivocal relationship between a reading diculty and the underlying genetic architecture. However, research conducted in collaboration with Oxford University in England has identied a number of possible chromosomal candidates, such as the short arm of chromosome 6, as well as sites on chromosomes 1, 2, 3 and 15.

resonance imagery (fMRI), positron emission tomography (PET) and magnetoencephalography (MEG). These techniques allow us to determine when and where in the brain responses to dierent activities occur. For example, if we show an individual a very visual display while measuring their brain activity, we would expect those areas of the brain that are responsible for processing visual information to become activated. Already we know that the location and pattern of cortical activity in the brains of dyslexic readers is dierent from those of normal readers for specic tasks. Such tasks include phonological stimuli, non-word-like acoustic stimuli, and visual stimuli mediated by the magnocellular system. In general, the reports are consistent with the hypotheses and ndings discussed above. Thankfully, as a society, we no longer believe that dyslexia is due to laziness or stupidity. We have come to understand that dyslexia is a real disorder with identiable symptoms, and in most cases, a denitive cause. We have come to appreciate the complexities of the disorder, for the individual who suers from a reading diculty, for the researcher, the teacher, and all the other associated medical support units. We have come to recognize that dyslexia is characterized by a wide range of symptoms, the most striking of which is a diculty in understanding and manipulating phonological information. The aim for the future is to understand the underlying causes of dyslexia and learn how to identify and help children who are at risk of the disorder, before they learn to read, thereby assisting in the childs normal transition into our literate society.

Further Reading
Boder E (1973) Developmental dyslexia: A diagnostic screening procedure based on three characteristic patterns of reading and spelling. In: Bateman B (ed.) Learning Disorders. Seattle: Special Child Publications. Castles A and Coltheart M (1993) Varieties of developmental dyslexia. Cognition 47 (2): 149180. Critchley M (1970) The Dyslexic Child. London: William Heinemann Medical Books, pp. 11. DeFries JC and Gillis JJ (1993) Genetics of reading disability. In: Plomin R and McClearn G (eds) Nature, Nurture and Psychology. Washington DC: APA Press. Lovegrove W (1993) Weakness in the transient visual system. Annals of the New York Academy of Sciences 682: 5769. Nicolson RI and Fawcett AJ (1999) Developmental dyslexia: the role of the cerebellum. Dyslexia: An International Journal of Research and Practice 5: 155177. Snowling M (2000) Dyslexia. Oxford: Blackwell. Stein JF and Talcott JB (1999) The magnocellular theory of dyslexia. Dyslexia 5: 5978. Wilkins A (1995) Visual Stress. Oxford: Oxford University Press.

Neuroimaging
The future will lie in the application of neuroimaging techniques. Such techniques include functional magnetic

ENCYCLOPEDIA OF LIFE SCIENCES / & 2002 Macmillan Publishers Ltd, Nature Publishing Group / www.els.net