Key Points Covered in This Talk:

• What is dyslexia? The BDA provides the following definition of dyslexia: "Dyslexia is a
specific learning difficulty which mainly affects the development of literacy and language
related skills. It is likely to be present at birth and to be lifelong in its effects. It is
characterized by difficulties with phonological processing, rapid naming, working
memory, processing speed, and the automatic development of skills that may not match
up to an individual's other cognitive abilities. It tends to be resistant to conventional
teaching methods, but its effects can be mitigated by appropriately specific intervention,
including the application of information technology and supportive counseling." (BDA
Website). There have been many definitions of dyslexia over the years and the BDA's
definition is a very good starting poing for beginning to understand what dyslexia is.
• The causes of dyslexia: It is not a disease that you can catch. It is a condition that seems
to be inherited. We are at the early stages of understanding all this because although it is a
genetic condition we don't know for certain which genes are inolved.
• Why are there more male than female dyslexics? This is not very well understood. Boys
are more susceptible to developmental problems in early language development. There
have been various theories as to why this might be but nobody has got to a definitive
answer. Nevertheless many more boys than girls have dyslexia and quite often when girls
are dyslexic they don't seem to be as severely dyslexic as boys can be.
• The dyslexic brain: People have done autopsies on dyslexic brains and found that the two
hemispheres tend to be the same size, whereas in most brains the left hemisphere is larger
than the right. There also seems to be something strange that happens with the neurons in
the brain as the brain is developing in the womb. It is definitely not a question of brain
damage but a question of brain difference.
• The effects of being dyslexic: The main element is that dyslexia effects the way that a
person analyses sounds and words around them. Dyslexia used to be known as "word
blindness". The core definition is more related to being ear blind. Dyslexics therefore
struggle to perceive the sounds that make up words.
• Signs of dyslexia to look out for: When children are at nursery school the dyslexic child
could be late to start speaking and the ones with auditory memory difficulties might
actually find it difficult to learn nursery rhymes. Dyslexics can have a language delay and
evidence of memory difficulties for following instructions. Dyslexia is a syndrome and
therefore there would be many signs for a diagnosis. Not easily learning nursery rhymes
does not necessarily mean a child is dyslexic. However, a child not picking up early
speech and language (like nursery rhymes or the alphabet) is a key sign that a child might
be dyslexic.
• Are there different types of dyslexia? Scientists do not always agree. There is
phonological dyslexia (which is more related to speech perception of sounds) but there
are many children who also have visual memory and processing issues. Some children
have a combination of both auditory memory and visual memory difficulties. These
children tend to have a more severe form of dyslexia.
• Assessment: If some of these problems are being noticed then, in a pre-school child, it
would probably be very wise to see a speech and language therapist because they might
just have a developmental delay. Many children are highly articulate before they go to
 school and the parents are full of confidence that they are not going to have any
problems, even if there is dyslexia in the family. They are the sort of children who may
not learn to read easily if they have got a visual memory problem because they do not
recognise words they have seen many times. Children who are late to speak or have
trouble using language before they go to school are in the "at risk" category but it doesn't
necessarily mean they are going to be dyslexic. Seeing a speech and language therapist
would still be a good idea as most educational psychologists prefer not to see children to
diagnose dyslexia before they are around seven years old. It can be very worrying when
you have a five or six year old child at school, so if the signs seem obvious even when
they are five or six it's good to go and have a preliminary assessment with an educational
psychologist.
• Helping dyslexics with reading and spelling: There has been a debate over whether "look
and say" or a phonic approach is most effective. The safest and best way is to help
children develop both skills. Children may be very good at phonically decoding words
that are regular but struggle with irregular words. Or you can get children who can learn
words wholistically but then they can't sound them out or work out what the sounds are
within them and that begins to effect spelling. There are many children with dyslexia who
struggle spelling phonetically so a lot of training to help them learn to perceive sounds is
required, using individual letters then practicing putting them together. For children who
have a poor visual memory it's a question of repetition and not introducing too many
irregular words too quickly. It helps to learn words in a multi-sensory way (using as many
senses as you can) so you might get a child to say the word, hear the word, paint the word
(perhaps in the air), bake the word with dough. Touch-typing is another way of seeing the
word. Putting words in context can also be extremely helpful. This can be achieved by
using carefully selected reading books where children can get the gist from a picture or
from the story and from predicting what might happen and getting to know the
characters. Therefore they do not have to work hard on every singly word which can be
very tiring for those who struggle with reading.
• What parents should be doing: Children who have good oral language skills often get off
to a good start. Therefore reading to your child from an early age gives a rich sense of
grammar and vocabulary as well as helping to learn irregular verbs. Many dyslexics carry
on saying "the man runned" for many years because they don't remember the irregular
word "ran". Therefore reading to your child, playing games with sounds (such as I Spy)
and being increasingly complex with these games is helpful. Labeling things around the
house or having a blackboard with very common words can be effective.
• Dyslexia and maths: Dyslexia can effect maths. Working memory is required to calculate
or count things and the memory issues can therefore effect maths.
Dyslexia need not be a disaster: If you are concerned early intervention will be effective and
it's good to start giving extra help early. If your child turns out not to be dyslexic then it
can only help to get them off to a good start so you can't lose either way. Many young
dyslexics go on to make a great success of their lives and do well at school and university so
Reading and the Brain: the
dyslexia certainly need not be a disaster.
causes and symptoms of Dyslexia
By Professor Rod Nicolson | Published: 18/09/2008
Professor Nicolson works in the Department of Psychology at the University of Sheffield and is
a leading authority on dyslexia and developmental learning disabilities. In this article (based on a
talk given in 1999) he looks into the causes and symptoms of dyslexia.

The main aim of the talk is to demonstrate how 'pure' scientific analysis and techniques can make
a real contribution to the understanding of developmental dyslexia, the most common of the
developmental disorders, and one that affects millions of children and adults in the UK.
Developmental dyslexia is normally identified by unexpected problems in learning to read for
children of average or above average intelligence —“a disorder in children who, despite
conventional classroom experience, fail to attain the language skills of reading, writing and
spelling commensurate with their intellectual abilities” (from the definition by the World
Federation of Neurology, 1968, p26). A typical estimate of the prevalence of dyslexia in Western
school populations is 4%, with roughly four times as many boys as girls being diagnosed. It has
major financial and social repercussions at school and at work both for those with dyslexia and
those working with them.

A major problem with developmental dyslexia is that it is diagnosed by means of reading

difficulties, and so a child needs to fail to learn to read for two years or so before a diagnosis is
considered valid. It is of course a very destructive process for a child to have the crucial early
years at infant school blighted by failure to acquire one of the fundamental skills. For the later
school years there is also the danger of a vicious circle with poor reading leading to poor
motivation, avoidance of text-based school work, emotional trauma, and adoption of maladaptive
strategies such as clowning around, disruption or truancy. Even in adulthood, many dyslexic
people still feel intensely angry about the way they were treated at school. It is important to note,
however, that dyslexia is defined in terms of a discrepancy between actual reading and the
reading performance that would be expected on the basis of the child's intelligence. Many
dyslexic children turn out to be creative and successful, and it has been suggested that many of
our most creative artists and scientists were dyslexic.

The main aim of dyslexia researchers has been to find the underlying cause of dyslexia. If the
underlying cause can be established, then it should be possible to diagnose dyslexia pre-school,
thereby giving the opportunity to provide initial reading support better tuned to the way that
dyslexic children learn best. This 'stitch in time' support should then lead to much improved
reading, allowing the child to keep up with the rest of the class, and so avoid all the traumas
caused by failing to learn to read - allowing the dyslexic child to enjoy his/her strengths without
suffering from the core reading problem. There is very great interest internationally in dyslexia,
and, in particular, in a long-standing core programme the US National Institute for Health has
invested over $200M since 1984 in research aimed at discovering the underlying cause(s).

One of the most promising approaches to finding the underlying cause derives from findings in
the early 1980s that dyslexic children had particular difficulty in hearing the individual sounds in
words. For instance, at the age of 5 years, children who would later turn out to be dyslexic had
considerable difficulty in hearing that, say, 'cat', 'mat' and 'bat' rhyme. In general, they seem to
have limited 'phonological awareness' (sensitivity to the sound structure in words). This
'phonological deficit' leads to difficulties in learning to read and spell because one of the early
stages in learning to spell is to split a word into its component sound chunks, each of which then
has to be spelled in order. The phonological deficit account was for many years the dominant
hypothesis for dyslexia research, but the key question is why dyslexic children have this
problem.

In the talk, I shall describe the research undertaken over the past 12 years by my colleague Dr.
Angela Fawcett and me, in our attempt to discover the underlying cause. The trail has led us
from cognitive psychology to cognitive neuroscience to developmental science, but we believe
that we now have a coherent account of the major symptoms, the underlying cause and the way
the reading problems develop. Whether our account proves to be a complete explanation, or
whether there are other important contributory causes, remain topics for further research, but at
present, as I shall describe in the talk, there appear to be remarkably few loose ends.

In our original research, published 10 years ago, we argued that, unlike language, reading is not a
'special' skill for humans. We are not evolutionarily adapted to read, since after all, few people
could read at all until the last two or three hundred years. Consequently, an analysis of the
learning processes should cast some light on why dyslexic children fail to learn to read. One of
the critical aspects of learning a skill fluently is to make it automatic, so that one can do it
without thinking about it. A clear adult example of the importance of automatisation is in
learning to drive. The beginner can either steer, or change gear, but not both at the same time,
because of the need to consciously attend to each procedure. An expert driver changes gear and
steers 'automatically', thus leaving more 'capacity' for watching the traffic, planning a
manoeuvre, or holding a conversation. Of course, automatisation is a key requirement for
reading, and there is extensive evidence that dyslexic children, even when reading well, are less
fluent, requiring more time and effort to read than would a non-dyslexic child of the same
reading age. Automatisation of the processes in reading is no different from the general processes
of automatising any other complex skill, and so we started by putting forward the bold
hypothesis that dyslexic children would have difficulty in automatising any skill (cognitive or
motor). Rather to our surprise, this hypothesis was clearly supported by a set of experiments in
which we asked dyslexic children to do two things at once. If a skill is automatic, then one ought
to be able to do something else at the same time (assuming it does not directly interfere with the
first skill) with little or no loss of performance. Our most startling finding was for balance - a
highly automatic skill with no language component. We found that although a group of dyslexic
adolescents were normally able to balance as well as 'controls' (non-dyslexic children matched
for age and IQ), their balance deteriorated very significantly when they had to do something else
at the same time, whereas the controls' balance was not affected at all. We tried a range of
secondary tasks, including counting or pressing a button on hearing a tone (and also we tried
blindfolding them to prevent the children consciously attending to visual cues when trying to
balance) and got the same pattern. We concluded therefore that our hypothesis was indeed
supported, and that dyslexic children were not automatic even at the fundamental skill of
balance. For some reason, dyslexic children had difficulty automatising skills, and had therefore
to concentrate harder to achieve normal levels of performance. We have used the analogy of
driving in a foreign country - one can do it, but it requires continual effort and is stressful and
tiring over long periods. On our account, life for a dyslexic child is like always living in a foreign
country.

It should be stressed that automatisation is not a conscious process - by dint of practice under
reasonably consistent conditions most humans just 'pick up' skills without having to think at all.
Our account gave an intuitively satisfying account not only of the reading problems but also of
the phonological difficulties (because phonological awareness is a skill that is picked up initially
just by listening to one's own language). Furthermore, it explained why it is that everything
needs to be made explicit in teaching a dyslexic child, whereas for non-dyslexic children one can
often get away with just demonstrating the skill. Perhaps most satisfying, many dyslexic people
and dyslexia practitioners came to us to say that our account seemed exactly right to them - they
did have to concentrate on even the simplest skills. On the other hand, what was not clear was
why dyslexic children have problems in skill automatisation, and until this puzzle has been
solved, it was difficult to see how we would be able to test for dyslexia before school.

Interestingly, dyslexia has an established genetic basis - a male child with dyslexic parent or
sibling has a 50% chance of being dyslexic. There should therefore be some underlying
abnormality of the brain reflecting this genetic inheritance. Researchers have investigated the
language area of the cerebral cortex, together with the relative size of corresponding regions of
the right and left cerebral hemispheres (most right handed people have the temporal lobe of the
left hemisphere specialised for language processing). However, promising early leads seemed to
peter out on further investigation. There have also been recent investigations of the
magnocellular pathways - sensory pathways from the eye and ear that carry information rapidly
to the brain, but it is not clear why sensory input difficulties might cause problems, say, in
spelling. It had long been known that the cerebellum (the 'hind brain' - a primitive but very
complex brain structure at the back of the brain) is involved in acquisition and execution of
motor skills such as walking and reaching. Interestingly, however, when brain imaging
techniques such as PET scanning were introduced in the early 1990s, it became clear that the
cerebellum was highly active in a range of skills - when imagining a tennis stroke, when
speaking, or even when trying to keep a list of words in memory. These findings tallied with an
emerging view that the cerebellum was a key brain structure for the acquisition and use of a
range of cognitive skills, including 'language dexterity'. Putting together the 'cognitive
neuroscience' results on the role of the cerebellum in skill automatisation, balance and language
dexterity with our own findings with dyslexic children, it became clear that the cerebellar
abnormality was a prime candidate for the cause of the difficulties suffered by dyslexic children.

Over the past five years we have completed a series of stringent tests of our cerebellar deficit
hypothesis. First we undertook clinical tests of cerebellar dysfunction - both dysmetria (difficulty
in precisely measured movements) and dystonia (low muscle tone) - on our panel of dyslexic and
control children. We established that the dyslexic children showed marked deficits on almost all
of these clinical tests, and we then replicated these findings on further populations of dyslexic
and control children, establishing that around 80% of our sample of dyslexic children showed
clear 'cerebellar' symptoms. These findings were completely unexpected from the literature and
were not predicted from any other theory of dyslexia, and consequently they provided strong
support for the hypothesis. Nonetheless, it could still be argued that it was not the cerebellum
itself, but perhaps some input to, or output from, the cerebellum that was causing the problems.
This is by no means an unlikely hypothesis because the cerebellum has two way connections
with almost all parts of the brain, including the language areas. Consequently, in collaboration
with colleagues in other laboratories, we carried out two direct tests of the cerebellar deficit
hypothesis. Particularly striking results were obtained from a PET (brain imaging) study
involving learning a sequence of finger presses, known to result in considerable activation in the
cerebellum with non-dyslexic adults. We established that our dyslexic adults showed only 10%
of the normal cerebellar activation both when executing a previously overlearned (automatic)
sequence and when learning a new sequence. This suggests strongly that, unlike non-dyslexic
adults, dyslexic adults do not activate the cerebellum in these learning and automatic tasks -
presumably because it does not help them in the normal way. Finally, there is a collection of
dyslexic and non-dyslexic brains in the Beth Israel / International Dyslexia Association Brain
Bank (Boston, USA) and our PhD student, Andrew Finch, was given permission to undertake
neuroanatomical investigation of the cerebellar regions of these specimens. He established
significant abnormality, characterised by greater cell size, in both the cerebellum and in the
inferior olive (a nucleus in the brain stem that sends input to the cerebellum).

Consequently, at least for the dyslexic children in our panel, we have found both behavioural and
neurological evidence of cerebellar abnormality, thereby providing strong support for our
cerebellar deficit hypothesis. Of course there is a great deal of research still to do, and indeed the
hypothesis suggests a range of fascinating further studies, but those are for the future. This
converging multidisciplinary evidence of cerebellar abnormality led us to develop an
'ontogenetic causal chain' analysis in which we propose that cerebellar abnormality from birth
leads to slight speech output dysfluency, then receptive speech problems (i.e., difficulties in
hearing the speech sounds) and thence deficiencies in phonological awareness. Taken together
with the problems in skill automatisation and coordination associated with the cerebellar
impairment, this analysis provides not only a good account of the pattern of difficulties suffered
by dyslexic children, but also how they arise developmentally. This causal chain analysis still
awaits confirmation via studies of pre-school 'dyslexic' children, but if supported by further
research, it provides a very significant analysis. It demonstrates how abnormality in a brain
structure (the cerebellum) can lead, via difficulties in cognitive processes such as automatisation
and phonology, to deficits in arguably the pinnacle of cognitive skill, namely reading.

Finally, let us return to one of our initial motivations, that of identifying dyslexia pre-school and
providing support proactively so that a dyslexic child can learn to read relatively normally.
Several years ago we were able to put together our findings on balance and motor skill
difficulties with 9 further tests known to be difficult for dyslexic children (including,
phonological, memory, speed, copying and pre-literacy tasks) into a 30 minute screening test that
could be administered by a teacher in a child's reception year at infant school. This 'Dyslexia
Early Screening Test' has now been taken up by over 3000 schools in the UK, and can form the
first stage in a screening-support system. We feel strongly that the development of this important
applied educational test could not have been achieved if it had not been for our careful scientific
analysis and investigation of the underlying causes of dyslexia.
Causes and Risk Factors of Dyslexia
Developmental dyslexia is a specific learning disability characterized by difficulty in learning
to read. Some dyslexics also have difficulty learning to write, to spell and, sometimes, to
speak, or to work with numbers.

We do not know what causes dyslexia, but we do know that it affects children who are
physically and emotionally healthy, academically capable, and who come from good home
environments. In fact, many dyslexics have the advantages of good schools, high mental
ability, and parents who are well-educated and value learning.
School children are subject to a broad range of reading problems and researchers have
discovered the cause of many of these problems. Today, most teachers accept these
research findings and use them in planning their instruction, but there remains a small
group of children who have difficulty in learning to read for no apparent reason. These
children are called dyslexic. Although estimates of the prevalence of dyslexia are hard to
find, it is estimated that as many as 15 percent of American students may be classified as
dyslexic.
Dyslexia tends to run in families.

Symptoms of Dyslexia
Children with dyslexia are not all alike. The only trait they share is that they read at levels
significantly lower than is typical for children of their age and intelligence. This reading lag is
described in terms of grade level. Dyslexics commonly have one or more of the following
problems:

• Difficulty learning and remembering printed words

• Letter reversal (b for d, p for q), number reversals (6 for 9), and changed order of
letters in words (tar for rat, quite for quiet) or numbers (12 for 21)
• Leaving out or inserting words while reading
• Confusing vowel sounds or substituting one consonant for another
• Persistent spelling errors
• Difficulty writing
Other characteristics sometimes include:
• Delayed or inadequate speech
• Trouble picking the right word to fit the meaning desired when speaking
• Problems with direction (up and down) and time (before and after, yesterday and
tomorrow)
• Clumsiness

Diagnosis of Dyslexia
A physician will obtain a medical history and perform a physical exam in order to rule out
other causes of reading difficulty, including vision problems. Testing by a psychologist is
often recommended.

Treatment of Dyslexia
Educators and psychologists generally agree that the remedial focus should be on the
specific learning problems of dyslexics. Therefore, the usual treatment approach is to modify
teaching methods and the educational environment.

Children suspected of being dyslexic should be tested by a psychologist. By using a variety

of tests, it is possible to identify the types of mistakes that are most commonly made. The
examiner then can make specific recommendations for treatment such as tutoring, summer
school, speech therapy, or placement in special classes.
Treatment programs for dyslexic children fall into three general categories: developmental,
corrective, and remedial. Some programs combine elements from more than one category.
The developmental approach involves the use of methods that have previously been
used in the belief that these methods are sound and that the child needs extra time
and attention.
The corrective approach uses small groups in tutorial sessions, but it emphasizes a
child's assets and interests. Those who use this method hope to encourage children
to rely on their own special abilities to overcome their difficulties.
Proponents of the remedial approach try to resolve the specific educational and
psychological problems that interfere with learning.
Definition of Dyslexia
Dyslexia is an impairment of the ability to read, as a result of a variety of pathologic
conditions, some of which are associated with the central nervous system.

Description of Dyslexia
Dyslexic persons often reverse letters and words, cannot adequately distinguish the letter
sequences in written words, and have difficulty in understanding left from right.

Some reading experts doubt that dyslexia is a pathologic disorder and believe the condition
represents a combination of reading problems, each of which should be isolated by specific
tests. The problems cited by these authorities are poor vision, impaired hearing, emotional
immaturity, lack of physical development, psychic stress, and inadequate reading
instruction.
Over the years, the term dyslexia has been given a variety of definitions, and for this
reason, some teachers have resisted using the term at all. Instead, they have used such
terms as "reading disability" or "learning disability" to describe conditions more correctly
designated as dyslexia.
Although there is no universally recognized definition of dyslexia, the one presented by the
World Federation of Neurology has won broad respect: "A disorder manifested by difficulty
in learning to read despite conventional instruction, adequate intelligence, and sociocultural
opportunity."

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