Shaywitz Et Al 2008 The Education of Dislexic Children PDF

ANRV331-PS59-17 ARI 1 December 2007 16:42
The Education of Dyslexic

Children from Childhood
to Young Adulthood
Annu. Rev. Psychol. 2008.59:451-475. Downloaded from arjournals.annualreviews.org
Sally E. Shaywitz,1 Robin Morris,2

by University of Minnesota- Law Library on 03/10/08. For personal use only.
and Bennett A. Shaywitz3

1
Department of Pediatrics, Yale University School of Medicine, New Haven,
Connecticut 06510; email: sally.shaywitz@yale.edu
2
Department of Psychology, Georgia State University, Atlanta, Georgia 30302;
email: robinmorris@gsu.edu
3
Departments of Pediatrics and Neurology, Yale University School of Medicine,
New Haven, Connecticut 06510; email: bennett.shaywitz@yale.edu
Annu. Rev. Psychol. 2008. 59:45175 Key Words

The Annual Review of Psychology is online at accommodations, classication, learning disabilities, neuroimaging,
http://psych.annualreviews.org
specic reading disability, reading remediation, reading
This articles doi: intervention, dyslexia
10.1146/annurev.psych.59.103006.093633
Copyright c 2008 by Annual Reviews. Abstract

All rights reserved
The past two decades have witnessed an explosion in our understand-
0066-4308/08/0203-0451$20.00 ing of dyslexia (or specic reading disability), the most common and
most carefully studied of the learning disabilities. We rst review
the core concepts of dyslexia: its denition, prevalence, and devel-
opmental course. Next we examine the cognitive model of dyslexia,
especially the phonological theory, and review empiric data suggest-
ing genetic and neurobiological inuences on the development of
dyslexia. With the scientic underpinnings of dyslexia serving as a
foundation, we turn our attention to evidence-based approaches to
diagnosis and treatment, including interventions and accommoda-
tions. Teaching reading represents a major focus. We rst review
those reading interventions effective in early grades, and then re-
view interventions for older students. To date the preponderance of
intervention studies have focused on word-level reading; newer stud-
ies are beginning to examine reading interventions that have gone
beyond word reading to affect reading uency and reading compre-
hension. The article concludes with a discussion of the critical role
of accommodations for dyslexic students and the recent neurobio-
logical evidence supporting the need for such accommodations.
451
to decipher the code. Just how many are af-

Contents fected, the basis of the difculty, and most im-
portantly, the most effective, evidence-based
BACKGROUND AND
approaches to educating dyslexic children and
DEFINITION . . . . . . . . . . . . . . . . . . . 452
young adults were questions that had to wait
Historical Roots . . . . . . . . . . . . . . . . . . 452
until quite recently for resolution. We begin
Denition: Core Constancy
by reviewing the core concepts of dyslexia,
Amid Renements . . . . . . . . . . . . . 453
including its denition, epidemiology, cog-
EPIDEMIOLOGY OF
nitive model, and etiology, especially neuro-
DYSLEXIA . . . . . . . . . . . . . . . . . . . . . . 455
biological inuences. We next consider spe-
Prevalence . . . . . . . . . . . . . . . . . . . . . . . 455
cic evidence-based reading interventions for
Developmental Course . . . . . . . . . . . 455
word-reading accuracy, uency, and compre-
Sex Differences in Dyslexia . . . . . . . 456

hension and then the exciting neurobiolog-
COGNITIVE MODEL OF
ical ndings that together have given rise

DYSLEXIA AND ITS
to and must inform contemporary, evidence-
IMPLICATIONS . . . . . . . . . . . . . . . . 456
based approaches to the education of dyslexic
Phonological Theory . . . . . . . . . . . . . 456
children. We conclude with a discussion
Dyslexia in Different
of the critical role of accommodations for
Orthographies . . . . . . . . . . . . . . . . 457
dyslexic students and the new neurobiolog-
ETIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . 458
ical evidence supporting the need for such
Genetic Inuences . . . . . . . . . . . . . . . 458
accommodations.
Neurobiological Inuences . . . . . . . 458
DIAGNOSIS AND
TREATMENT . . . . . . . . . . . . . . . . . . 461 Historical Roots
Diagnosis of Dyslexia . . . . . . . . . . . . . 461
Dyslexia has been described in virtually ev-
Teaching Reading to Dyslexic
ery ethnic group, language, and geographic
Students . . . . . . . . . . . . . . . . . . . . . . 462
region. The original report, published as A
Early Intervention . . . . . . . . . . . . . . . . 462
Case of Congenital Wordblindness on November
Interventions for Older Students . . 463
7, 1896, was prompted by the experience of
Beyond Word Accuracy . . . . . . . . . . . 463
a British physician, W. Pringle Morgan, with
Treatment Resisters . . . . . . . . . . . . . . 465
his patient Percy F., age 14, for whom he pro-
Response to Intervention . . . . . . . . . 465
vided the following description:
Summary of Interventions . . . . . . . . 466
Accommodations . . . . . . . . . . . . . . . . . 466 . . . He has always been a bright and intel-
ligent boy, quick at games, and in no way
inferior to others his age. His great dif-
culty has beenand is nowhis inability to
BACKGROUND AND read. He has been at school or under tutors
DEFINITION since he was 7 years old, and the greatest ef-
forts have been made to teach him to read,
For good readers, gaining meaning from print
but, in spite of this laborious and persistent
quickly and effortlessly, like breathing and
training, he can only with difculty spell out
speaking, is a natural part of life. For these
words of one syllable . . . .
men and women, it is almost unimaginable
Fluency: the ability how something that seems to come so nat- . . . I might add that the boy is bright and
to read words urally could be difcult for others. Without of average intelligence in conversation. His
accurately, rapidly, doubt, since ancient times when man learned eyes are normal . . . and his eyesight is good.
and with good
to use printed symbols to convey words and The schoolmaster who has taught him for
intonation
ideas, there have been those who struggled some years says that he would be the smartest
452 Shaywitz Morris Shaywitz

lad in the school if the instruction were en- speaking, reading, writing, and mathematics.
tirely in oral . . . (Morgan 1896, p. 1378). In contrast to this undifferentiated construct,
the current denition explicitly categorizes
What is so striking is the similarity of Accommodations:
dyslexia as a specic learning disability. New adaptations within
Percy F. to the children we continue to see to to the current denition over the previous the classroom, use of
this day. Such clinical descriptions from ev- one is reference to dyslexias neurobiologi- assistive technology,
ery corner of the globe attest to the invari- cal origin, reecting the signicant advances or provision of extra
ance of dyslexia over both time and place. In in neuroscience, particularly the brain imag-
time allowing
his clinical vignette, Dr. Morgan captures the learning-disabled
ing of reading and dyslexia that is discussed in students to
essence of dyslexia: an unexpected difculty in detail below. demonstrate their
reading. New, too, is the incorporation of, and em- full knowledge
phasis on, the importance of uent reading: Decoding:
the ability to read text not only accurately, determining the

Definition: Core Constancy Amid
but also rapidly and with proper expression pronunciation of a

Refinements word by analyzing
(Rep. Natl. Reading Panel 2000). Thus, the
Current definition. The basic notion of the vowels and
previous reference to single word decoding consonant
dyslexia as an unexpected difculty in read- is now supplanted by reference to difcul- combinations within
ing has remained constant across denitions ties with accurate and/or uent word recogni- the word
of dyslexia (Critchley 1970, Lyon 1995) as tion, acknowledging converging data point-
evidenced by the most current denition ing to the critical lack of the development of
provided by a working group meeting in uent reading as a hallmark of dyslexia that
Washington, D.C., in 2002: persists into adolescence and then adulthood,
Dyslexia is a specic learning disability that
even when accuracy improves. The lack of u-
is neurobiological in origin. It is character-
ent reading is observed clinically by reading
ized by difculties with accurate and/or u-
that is effortful and slow; it is often consid-
ent word recognition and poor spelling and
ered the sine qua non of dyslexia, especially in
decoding abilities. These difculties typi-
young adult and adult readers (Bruck 1998,
cally result from a decit in the phonological
Ley & Pennington 1991, Shaywitz 2003).
component of language that is often unex-
This renewed appreciation of the importance
pected in relation to other cognitive abili-
of uency should encourage its measurement;
ties and the provision of effective classroom
otherwise, many dyslexic children who can
instruction . . . (Lyon et al. 2003, p. 2).
read accurately, but not uently, will continue
to go unnoticed (and untreated) within the
Refinements from prior definitions. classroom (Katzir et al. 2006).
Dyslexia (also referred to as specic reading As in the prior denition (Lyon 1995),
disability) is a member of the family of emphasis is on the phonological weakness
learning disabilities; in fact, reading disability giving rise to the reading (and speaking)
is by far the most common learning disability, difculties characterizing dyslexia. A range
affecting over 80% of those identied as of studies has indicated phonological dif-
learning disabled (Lerner 1989). Although culties as the most robust (Fletcher et al.
the recognition of dyslexia as a discrete entity 1994, Shaywitz et al. 1999, Stanovich & Siegel
dates back over a century, the concept of a 1994) and specic nding (Morris et al. 1998)
learning disability is relatively new. in dyslexic children and adolescents, sup-
The term learning disabilities, as ini- porting the phonological-core variable differ-
tially proposed by Samuel Kirk (Kirk 1963) ences model proposed earlier by Stanovich
and later operationalized in the Federal (1988). Critical to the notion of a phonolog-
Register (U.S. Ofce Educ. 1977), refers to a ical weakness as causal in the development of
broad group of difculties involving listening, the concatenation of difculties observed in
www.annualreviews.org Education of Dyslexic Children 453

dyslexia has been the repeated demonstration ing discrepant to simply low-achieving poor
that remediation of the phonological weak- readers (dened on the basis of a reading
ness leads to the amelioration of the decod- score below a certain cut point, e.g., below
ing and word-reading weaknesses in dyslexia a standard score of 90) nd overlap between
(Bradley & Bryant 1983; Byrne & Fielding- the two groups on reading-related constructs
Barnsley 1995; Byrne et al. 2000; Foorman but not on IQ-related measures (Stuebing
et al. 1998; Hatcher et al. 1994; Schneider et al. 2002). In addition, both low-achieving
et al. 1997; Torgesen et al. 1999, 2001). and discrepant readers demonstrate compa-
rable growth rates in word reading during
Core definitional concept: an unexpected the school years (Francis et al. 1996). Knowl-
difficulty in reading. Perhaps the most con- edge of long-term adult outcome may shed
sistent and enduring core of any denition of light on possible differences between the two
dyslexia is the concept of dyslexia as an un- groups not captured by studies during child-
expected difculty in reading. Unexpected hood; such efforts are now under way us-
refers to the presence of a reading difculty ing data from the Connecticut Longitudinal
in a child (or adult) who appears to have all of Study (Ferrer et al. 2007, Shaywitz et al. 2003).
the factors (intelligence, motivation, exposure Not only do poor readers identied by either
to reasonable reading instruction) present to discrepancy or low-achievement criteria re-
be a good reader but who continues to strug- semble one another on measures of reading
gle (Shaywitz 1998). More challenging has and growth rates of reading, but each group
been the question of how to operationalize also differs along multiple dimensions from
the unexpected nature of dyslexia. Thus, us- groups of typically achieving boys and girls
ing differing methods and criteria, denitions (Fletcher et al. 1999, Lyon et al. 2001).
have attempted to capture the unexpected These ndings have strong educational
nature of dyslexia by requiring a discrepancy implications: It is not valid to assume that dis-
of a certain degree between a childs measured crepant children require instructional strate-
IQ and his reading achievement. For example, gies that differ from those for low-achieving
schools have typically relied on criteria based readers. It also is not valid to deny the ed-
on an absolute discrepancy, most commonly ucation services available for disabled or at-
one or one-and-one-half standard deviations risk readers to low-achieving, nondiscrepant
between standard scores on IQ and reading children. On the other hand, the observed
tests; others, including many researchers, pre- similarity of the discrepant and low-achieving
fer regression-based methods adjusting for groups in reading-related constructs argues
the correlation of IQ and reading achievement for identication approaches that include
(Reynolds 1984, Stuebing et al. 2002). both low-achieving children and those strug-
We want to emphasize that the difculty gling readers who are discrepant but who do
has been not with the notion of a discrep- not satisfy an arbitrary cut point for designa-
ancy, but rather with the real-life practical tion as low achieving. Seventy-ve percent of
effect of implementing this model in a pri- children identied by discrepancy criteria also
mary school setting. For example, children meet low-achievement criteria in reading; the
who were clearly struggling as early as kinder- remaining 25% who meet only discrepancy
garten or rst grade had to wait, often until criteria may fail to be identied and yet still
third grade or later, until their failure in read- be struggling to read (Shaywitz et al. 1992a).
ing was of such a magnitude that they met A recognition of these difculties com-
discrepancy requirements. And so it is under- bined with accumulating data indicating
standable why this approach has often been the importance of early intervention (Lyon
referred to as a wait-to-fail model. Attempts to et al. 2001; Torgesen et al. 1999, 2001) has
clarify the criteria by meta-analyses compar- prompted researchers and educators to search

for alternative approaches that would pro- Thus, like hypertension and obesity, dyslexia
mote earlier intervention or prevention for occurs in degrees of severity. A dimensional
at-risk readers. One such approach focuses on model also argues that although cut points
RTI: response to
a more dynamic assessment, particularly ap- are placed to help dene groups, these are ar- intervention
plicable to early grades, where the ongoing bitrary and may have no biological validity;
Evidence-based
development of uency in component read- those on one or the other side of such a cut reading instruction:
ing skills (e.g., letter recognition, word read- point will differ from one another by degree, programs and
ing) is measured frequently and is compared but not kind. Clinically, for school identica- methods for which
with expected norms (Kameenui et al. 2000). tion of children for special services, this means there is reliable and
valid evidence
Another approach, termed response to inter- that children who do not meet these arbitrar-
published in a
vention (RTI; Fuchs & Fuchs 2006), has gen- ily imposed criteria may still require and prot peer-reviewed
erated considerable interest. Here, all chil- from special help in reading (Shaywitz et al. journal of
dren are rst provided with evidence-based 1992b, p. 149). effectiveness in

reading instruction and their progress is fre- teaching children to

read
quently monitored; those who are not making
progress are selected to receive additional sup- EPIDEMIOLOGY OF DYSLEXIA
port (see below for fuller discussion of RTI).
Prevalence
Definitional framework of dyslexia: cate- Reading difculties are highly prevalent; the
gorical or dimensional. How best to more specic prevalence rate will reect the par-
broadly conceptualize dyslexia has long been ticular denition and cut points established as
of theoretical interest to investigators and of criteria for identication. For example, results
more practical import to educators who must of the 2005 National Assessment of Educa-
set policies to identify struggling readers in tional Progress indicate 27% of high school
need of support. Earlier views, mainly stem- seniors are reading below the most basic lev-
ming from the inuential Isle of Wight study els (minimum level at which a student can
(Rutter & Yule 1975, Yule & Rutter 1985), demonstrate an understanding of what she
posited a categorical view of dyslexia envision- or he has read) (Grigg et al. 2007). Even
ing reading ability as bimodally distributed, more primary grade students36% of fourth
with children with specic reading retarda- grade childrenare reading below basic lev-
tion (dyslexia) forming a so-called hump at els (Perie et al. 2005). In our epidemiolog-
the lower tail of the distribution (Rutter & ical Connecticut Longitudinal Study sample
Yule 1975, Yule & Rutter 1985). In con- in which each participant was individually as-
trast, more recent data from an epidemio- sessed, we found that 17.5% of students were
logic sample, the Connecticut Longitudinal reading below age or ability levels (Shaywitz
Study, suggests that reading difculties, in- et al. 1994).
cluding dyslexia, occur as part of a continuum
that includes nonimpaired as well as disabled
readers (Shaywitz et al. 1992b). Other investi- Developmental Course
gators, too, have pointed out methodological Converging data indicate that reading dif-
aws in the British study (van der Wissel & culties are persistent and do not remit with
Zegers 1985) or failed to replicate its ndings age or time (Francis et al. 1994, Shaywitz et al.
( Jorm et al. 1986, Rodgers 1983, Silva et al. 1995) (Figure 1).
1985, Stevenson 1988). The importance of the This should put an end to the unsupported,
Connecticut data is that these ndings place but unfortunately, too widely held notion that
dyslexia within the same dimensional frame- reading problems are outgrown or somehow
work as other important disorders that affect represent a developmental lag. The implica-
the health and welfare of children and adults. tion is that reading problems expressed early

must be addressed or they will persist with COGNITIVE MODEL OF

time. Here, also, it is important to keep in DYSLEXIA AND ITS
Phonemes:
mind that the expression of the difculty may IMPLICATIONS
elemental particles of change, so that difculties with reading ac-
speech; the smallest curacy, especially in very bright children, of- Phonological Theory
unit of speech ten evolve into relatively accurate, but not Print emerged from the language system, and
distinguishing one uent, reading. Given the knowledge of the the relationship between print and spoken
spoken word from
unremitting course of dyslexia, early interven- language is perhaps best captured by the state-
another
tion takes on a new urgency; particularly since ment, Writing is not language, but merely a
the data strongly indicate a much more pos- way of recording [spoken] language by visi-
itive response to interventions that are pro- ble marks (Bloomeld 1933, p. 21). Of the
vided in the very rst few years of school com- several theories suggested, an explanation re-
pared with those delivered in the later years ecting what is known about the relation-
of primary school (Torgesen et al. 2006). ship between spoken and written language,
the phonological model, has received the most
support (Hulme et al. 2005, Ramus et al. 2003,
Sex Differences in Dyslexia
Rayner et al. 2001, Shaywitz 2003, Snowling
The belief that reading difculties affect 2000).
predominantly or exclusively males reects Most contemporary approaches to diagno-
the overwhelmingly larger number of boys sis and to teaching dyslexic children to read
compared with girls identied by schools derive from a phonological model of how
as having a reading problem. However, a children gain access to print. In particular,
series of epidemiological studies, including knowledge of this model enables the reader
ones that compare school-identied disabled to understand the basis and logic of current
readers with objective, individually assessed, evidence-based reading instruction. Here we
criterion-identied disabled readers, in- discuss the nature and educational implica-
dicate that a referral bias favors boys in tions of this model; in a later section, spe-
school-identication procedures reecting cic evidence-based approaches to reading in-
boys disruptive classroom behavior (Shay- tervention are presented. To understand why
witz et al. 1990). Since boys are generally print has meaning and why reading presents a
more active and impulsive, they are more challenge, we rst consider the language sys-
likely to be identied through traditional tem and then discuss why reading is more dif-
school-identication procedures, whereas cult than speaking.
girlswho are generally quiet and who may
struggle to readoften go unnoticed. A range The language system. The language sys-
of data now indicate that although there are tem is conceptualized as a hierarchy of com-
somewhat more boys, signicant numbers of ponent modules (Fodor 1983); at the lowest
girls struggle to read (Flynn & Rahbar 1994, level is the phonological module, dedicated
Shaywitz et al. 1990). Awareness of a students to processing the elemental units of language,
reading difculties should not be dependent phonemes. Language is generative; different
on overt signs of a behavioral difculty; the combinations of just 44 phonemes in the En-
increased reliance on ongoing monitoring of glish language produce tens of thousands of
reading uency (for example, use of dynamic words (Abler 1989). The phonological mod-
indicators of basic early literacy skills, or ule assembles the phonemes into words for the
DIBELS; Kameenui et al. 2000) should help speaker and disassembles the words back into
to ensure that all children who are failing to phonemes for the listener. Reecting a pro-
make progress will be identied and receive cess referred to as coarticulation, spoken lan-
appropriate interventions. guage appears seamless to the listener, with

no clues to its segmental nature (Liberman Hatcher et al. 1994; Torgesen et al. 1999,
et al. 1967). Thus, the word bat is com- 2001). Acquisition of phonological awareness
posed of three phonemes, b, aaaa, and t, follows a systematic, hierarchical model of
Orthography: the
but the listener hears this as the holistic word word structure, progressing from larger to specic writing
bat and not as three separate sounds. It is the smaller phonological units (Anthony et al. system of a language
seamless nature of spoken language, giving no 2003). Accordingly, children rst develop a Morphemes: the
clue to its underlying segmental nature, that sensitivity to, or awareness of, spoken whole smallest meaningful
presents a challenge to the would-be reader. words, then syllables, then phoneme-level linguistic units, for
Spoken language is innate, observed in all units of language. The latter is referred to example, prexes,
sufxes
societies on earth, and has been with us for as phonemic awareness. Good evidence sup-
tens of thousands of years. Exposing a baby ports the belief that reading itself is critical for
to a natural speaking environment results in the development of PA. Thus, PA is primarily
the development of spoken language; spoken developed following introduction to reading

language is spontaneous and does not need instruction, independent of age (Goswami
to be taught. In contrast, print is articial; & Bryant 1990), and not surprisingly, (il-
many societies still rely primarily on spoken literate) adults who have never received
language. From an evolutionary perspective, reading instruction lack phonemic awareness
print is rather new, only several thousand years (Morais et al. 1979). The importance of
old (Lawler 2001). Consequently, as opposed reading instruction to the development of
to spoken language, written language is ac- the critical skill of phonemic awareness
quired and must be taught. Converging data was demonstrated in a study of four-, ve-,
suggest that the prime challenge for begin- and six-year-old children (Liberman et al.
ning readers is to map the orthography (let- 1974) in which none of the four-year-olds,
ters) onto the elemental sounds of spoken lan- 17% of the ve-year-olds, and 70% of the
guage (phonemes), and this serves as the major six-year-olds (following a year of schooling
focus of early reading instruction. However, and presumed reading instruction) performed
reecting the seamless nature of spoken lan- well on a test of phonemic awareness. A major
guage, perhaps as many as 30% of the pop- advance has been the availability of stan-
ulation has difculty noticing the phonemes dardized tests of phonological abilities (e.g.,
within words, resulting in difculty learning the Comprehensive Test of Phonological
to associate the letters with specic sounds Processing; Wagner et al. 1999) that can be
within each word (Liberman et al. 1974). administered as early as age ve.
Phonological awareness. Phonological

awareness (PA), referring to the ability to Dyslexia in Different Orthographies
recognize, identify, and manipulate syllables Dyslexia has been described in all writing sys-
and phonemes within spoken language, tems, including alphabetic and logographic
is at the core of reading and reading dif- orthographies (Stevenson et al. 1982). Alpha-
culties (Snow et al. 1998, Torgesen & betic orthographies use letters and letter clus-
Mathes 2000, Wagner & Torgesen 1987). ters to represent phonemes, whereas logo-
PA predicts reading acquisition (Bradley & graphic ones (Chinese, Korean, and Japanese
Bryant 1983, Hatcher et al. 1994, Hoien Kanji) use characters to represent monosyl-
et al. 1995) and differentiates good and poor labic morphemes of spoken language. Within
readers (Goswami & Bryant 1990, Wagner alphabetic writing systems, dyslexia occurs in
& Torgesen 1987), and instruction aimed languages with highly predictable relations
at improving PA improves reading (Bradley between letters and sounds (e.g., Finnish,
& Bryant 1983; Byrne & Fielding-Barnsley German, and Italian) and those described
1995; Byrne et al. 2000; Foorman et al. 1998; as dense orthographies with a more erratic

relationship between letters and sounds ETIOLOGY

(e.g., especially English, but also Danish,
Portuguese, and French) (Caravolas 2005, Genetic Influences
Functional
magnetic Goulandris 2003, Ziegler & Goswami 2005). Dyslexia is both familial and heritable: The
resonance imaging Although dyslexia occurs in all languages, disorder is found in 23% to 65% of the chil-
(fMRI): using the variations in the consistency of the mapping dren of parents who are dyslexic, and 40%
magnetic properties of the orthography to the phonology will in- of the siblings of a dyslexic child are also af-
of blood to measure
uence reading acquisition and strategies, re- fected (Pennington & Gilger 1996). Interest-
blood ow and
localize brain sulting in differences in reading development ingly, a higher heritability for dyslexia has
processes while among languages (Ziegler & Goswami 2005). been reported in children with higher IQs
subjects perform a Of importance from an educational perspec- (Olson et al. 1999, Wadsworth et al. 2000).
cognitive task tive is that the more consistent the letter- Genetic transmission is complex, with both
sound mappings are, the easier it is for chil- recessive and dominant transmission observed
dren to learn to read words accurately. Thus, in different cases, with at least 50% or more
the initial steps of literacy acquisition oc- of the variance explained by genetic factors
cur earlier and with more ease in languages and the remainder attributed to environmen-
such as Finnish and Italian, where there is tal inuences (Olson & Byrne 2005). Link-
greater predictability of sound-symbol linkage studies have implicated genes on four
ages. Variations in consistency, in turn, will chromosomes2, 6, 15, and 18in dyslexia
inuence the expression of dyslexia across dif- (Fisher & DeFries 2002). At least nine loci
ferent languages. For example, in orthogra- have been reported to be associated with the
phies that are more consistent, learning to disorder. Much attention has recently cen-
read words accurately generally occurs read- tered on DCDC2, located on the short arm
ily in dyslexic as well as in good readers. As (p) of chromosome 6 in band 22 (6p22), and
a result, in these readers, dyslexia may not its association with dyslexia has been inde-
present itself until later on in school, perhaps pendently reported by two different investiga-
after fourth grade or so, and may be expressed tive groups (Meng et al. 2005, Schumacher
only as a problem in reading uency, with et al. 2006). These ndings of a strong ge-
reading accuracy relatively intact (Ziegler & netic inuence have educational implications:
Goswami 2005). The inconsistencies between If a child has a parent or sibling who is dyslexic,
the sounds and their spellings, not surpris- that child should be considered at risk and ob-
ingly, also affect dyslexic children and cause served carefully for signs of a reading dif-
difculties in spelling. Ziegler & Goswami culty. It is also important to emphasize that a
(2005) posit that these variations will affect genetic etiology does not constrain a positive
how well dyslexic children develop phonemic response to reading intervention (Torgesen &
awareness once literacy instruction begins. Mathes 2000; Wise et al. 1999, 2000); once
They argue that consistent phonemic-letter identied, dyslexic children deserve and will
linkages tend to be held and kept in memory benet from evidence-based interventions.
more easily so that they are better instanti-
ated in response to reading instruction; as a
result, dyslexic children demonstrate phono- Neurobiological Influences
logical decits only very early on in these lan- Within the past two decades, the development
guages. In contrast, in languages such as En- of neuroimaging, particularly functional mag-
glish, with more unpredictable letter-sounds netic resonance imaging (fMRI), has provided
mappings, decits in phonemic awareness are investigators and clinicians with the oppor-
noted early on in school and persist through tunity to examine and treat learning disabili-
adolescence (Shaywitz et al. 1999) and into ties at a previously dreamed of, but unattain-
adulthood (Bruck & Treiman 1992). able, level of understanding (Anderson &

Gore 1997, Frackowiak et al. 2004, Jezzard are malleable and whether the disruption in
et al. 2001). Using this technology, neurosci- these systems in struggling readers can be in-
entists have been able to identify and local- uenced by a reading intervention. Specic
ize several interrelated left hemisphere neural interventions are discussed below; here, we
networks in reading: an anterior network in focus on brain imaging as a tool to inter-
the inferior frontal gyrus (Brocas area), long rogate the plasticity of these systems and to
associated with articulation that also serves examine the inuence of reading instruction
an important function in silent reading and on the development or reorganization (repair)
naming (Fiez & Peterson 1998, Frackowiak of these neural systems. For example, in a
et al. 2004), and two in left hemisphere pos- study of second- and third-grade dyslexic and
terior brain regions, one around the parieto- nonimpaired readers, compared with dyslexic
temporal region serving word analysis, the readers who received other types of interven-
other in the left occipito-temporal region, tion, children who received an experimental
the word form area, critical for skilled, u- evidence-based phonological intervention not
ent reading. A number of functional brain only improved their reading but also demon-
imaging studies in disabled readers converge strated increased activation both in left an-
to indicate a failure of left hemisphere poste- terior (inferior frontal gyrus) and left poste-
rior brain systems to function properly dur- rior (middle temporal gyrus) brain regions
ing reading (Brunswick et al. 1999; Helenius (Shaywitz et al. 2004). These ndings in-
et al. 1999; Horwitz et al. 1998; Paulesu et al. dicate that teaching matters and that how
2001; Rumsey et al. 1992, 1997; Salmelin children are taught can foster the develop-
et al. 1996; Shaywitz et al. 1998) (Figure 2). ment of those automatic neural systems that
This neurobiological evidence of dysfunction serve skilled reading. Other investigators, too,
in left hemisphere posterior reading circuits have found that reading interventions inu-
is already present in reading-disabled chil- ence neural systems in brain. For example,
dren and cannot be ascribed simply to a life- one study in adults demonstrated greater acti-
time of poor reading (Seki et al. 2001, Shay- vation in the left prefrontal cortex after train-
witz et al. 2002, Simos et al. 2000, Temple ing compared with before training (Temple
et al. 2000). Anterior systems, especially in- et al. 2000). Other studies in children have
volving regions around the inferior frontal reported intervention-associated changes in-
gyrus, have also been implicated in disabled cluding fMRI changes in left inferior frontal
readers in reports of individuals with brain and posterior areas as well as in right hemi-
lesions (Benson 1994) as well as in func- sphere and cingulate cortex (Temple et al.
tional brain imaging studies (Brunswick et al. 2003); changes in lactate concentration dur-
1999, Corina et al. 2001, Georgiewa et al. ing magnetic resonance spectroscopy in the
2002, Paulesu et al. 1996, Rumsey et al. 1997, left frontal regions (Richards et al. 2000);
Shaywitz et al. 1998). Although dyslexic read- fMRI changes in left frontal and left posterior
ers exhibit a dysfunction in posterior reading regions (Aylward et al. 2003); changes in mag-
systems, they appear to develop compensatory netoencephalography in the left superior tem-
systems involving areas around the inferior poral gyrus (Simos et al. 2002); and changes
frontal gyrus in both hemispheres as well as in fMRI in dyslexic adults in posterior reading
the right hemisphere homologue of the left systems (Eden et al. 2004). Still to be deter-
occipito-temporal word form area (Shaywitz mined is the precise relationship among the
et al. 2002). type of intervention, changes in brain activa-
tion, and clinical improvement in reading.
Malleability of neural systems for read-
ing. A number of investigators have focused fMRI and mechanisms of reading. fMRI
on whether the neural systems for reading has also been very useful in understanding

the mechanisms of reading, knowledge that to that seen in nonimpaired readers, occurred
offers the possibility of providing more indi- during reading Kana. In contrast, LPMOT
vidualized interventions to dyslexic children activation, comparable to that observed in
LPMOT: left
posterior and medial and adults. Neurobiological evidence is be- dyslexic readers, was noted during reading
occipito-temporal ginning to emerge to support behavioral data of Kanji script (Nakamura et al. 2005), sug-
region indicating that many dyslexics are not able to gesting that the LPMOT region functions
LALOT: left make good use of sound-symbol linkages as as part of a memory-based system. Together,
anterior and lateral they mature, and instead, they come to rely these behavioral and recent neurobiological
occipito-temporal on memorized words. Behavioral studies in- ndings lead us to suppose that as dyslexic
region
dicate phonologic decits continue to charac- children mature, this posterior medial system
terize struggling readers, even as they enter supports memorization rather than the pro-
adolescence and adult life (Bruck & Treiman gressive sound-symbol linkages observed in
1992, Shaywitz et al. 1999). In addition, per- nonimpaired readers.

sistently poor adult readers appear to read

words by memorization so that they are able to Implications of brain imaging studies.
read familiar words but have difculty reading The brain imaging studies reviewed above
unfamiliar words. Brain imaging now reveals provide neurobiological evidence that illu-
that such readers demonstrate an aberrant minates and claries current understanding
neural connectivity pattern. Thus, in nonim- of the nature of dyslexia and its treatment.
paired readers, functional connections were For example, brain imaging has taken dyslexia
observed between the left occipito-temporal from what had previously been considered a
word form area and other components of the hidden disability to one that is visiblethe
left hemisphere reading system. In contrast, in ndings of a disruption in posterior reading
persistently poor readers, functional connec- systems are often referred to as a neural sig-
tions were observed between the left occipito- nature for dyslexia.
temporal word form area and right frontal Important, too, is the demonstration of a
neural systems regions associated with mem- disruption in the occipito-temporal or word
ory (Shaywitz et al. 2003). form system, a system that converging brain
A more recent fMRI study (Shaywitz et al. imaging studies now show is linked to u-
2007) also demonstrates the importance of ent (automatic, rapid) reading. Disruption in
memory systems in dyslexic readers. This this system for skilled reading has very im-
study found that brain regions developing portant practical implications for the dyslexic
with age in dyslexic readers differ from those readerit provides the neurobiological evi-
in nonimpaired readers, primarily in being dence for the biologic necessity for additional
localized to a more left posterior and me- time on high stakes tests (see Accommoda-
dial (LPMOT), rather than a more left ante- tions section below).
rior and lateral (LALOT) occipito-temporal Studies demonstrating the effects of a
region. This difference in activation pat- reading intervention on neural systems for
terns between dyslexic and nonimpaired read- reading have important implications for pub-
ers has parallels to reported brain activation lic policy regarding teaching children to read:
differences observed during reading of two The provision of an evidence-based reading
Japanese writing systems, Kana and Kanji. intervention at an early age improves read-
Kana script employs symbols that are linked ing uency and facilitates the development
to the sound or phoneme (comparable to En- of those neural systems that underlie skilled
glish and other alphabetic scripts); Kanji script reading (see section on interventions). fMRI
uses ideographs where each character must studies focusing on the mechanisms of read-
be memorized. In the imaging study of these ing indicate that poor readers rely on mem-
writing systems, LALOT activation, similar ory rather than understanding how letters link

to sounds. Furthermore, these studies under- retrieve phonological elements has an impor-
score the importance of uency; many bright tant function in speakingfor example, in re-
but struggling readers memorize words and trieving phonemes from the internal lexicon
Phonological
can read them relatively accurately but not au- and serially ordering them to utter the spo- processing: a
tomatically, and so they read slowly and with ken word. Thus, it should not be surpris- category of oral
great effort. ing that problems with spoken language, al- language processing
Thus, evidence is beginning to emerge to beit more subtle than those in reading, are involved with
accessing the specic
indicate that many dyslexics compensate for often observed. These include late speaking,
sounds making up
their poor reading by memorizing words. The mispronunciations, difculties with word re- spoken words
problem, of course, for poor readers, is that trieval, needing time to summon an oral re-
memory has a limited capacity. For exam- sponse, and confusing words that sound alike,
ple, by third or fourth grade, a reader comes for example, saying recession when the in-
across perhaps 3000 or more new words a year. dividual meant to say reception. A range
Many of these words are difcult to memo- of problems are noted in reading (especially
rize because they are long, complicated, new, small function words and unfamiliar words,
or rare words. Those typical readers who have slow reading); difculties in spelling; ability to
learned about the sound-symbol organization master a foreign language; handwriting; and
of written language are able to analyze words attention (Shaywitz 2003). The lack of reading
based on the letter-sound linkages and have uency brings with it a need to read manu-
a distinct advantage over the dyslexic reader. ally (a process consuming great effort) rather
The reliance on memory systems in these than automatically; the cost of such reading is
populations of older disabled readers may a tremendous drain on attentional resources.
have implications for treatment of dyslexia. This is often observed in the classroom when
For example, it suggests that more pragmatic struggling readers, asked to read quietly, de-
interventions focusing on sight words (such plete their attentional resources as they strug-
as those occurring in assigned reading mate- gle with the print, and consequently appear
rials) and provision of accommodations such to be daydreaming or not attending to the as-
as aural presentation of literature (e.g., books signed reading. Some have posited that the
on tape; see Accommodations section be- need to call upon exceptional attentional re-
low) might take on a more signicant role sources during reading leads to the clinical ap-
in these older dyslexic individuals than would pearance of attentional difculties, in this in-
an approach used in younger students that stance, secondary to the reading difculty and
is based primarily on teaching sound-symbol not primary (Pennington et al. 1993). That
associations. is, it is to be viewed as distinct from a pri-
mary attentional problem. In addition, it has
long been known that there is also a high
DIAGNOSIS AND TREATMENT comorbidity between dyslexia and attention
decit/hyperactivity disorder, ranging from
Diagnosis of Dyslexia 15% to 50% (Biederman et al. 1996, Shaywitz
Dyslexia is more than simply a score on a et al. 1994). Therefore, both primary and sec-
reading test. Reecting the core phonolog- ondary attentional difculties are often noted
ical decit, a range of downstream effects in individuals who are dyslexic.
is observed in spoken as well as in written In contrast to these difculties, other cog-
language. Phonological processing is critical nitive abilities, including thinking, reasoning,
to both spoken and written language. Al- vocabulary, and listening comprehension, are
though most attention has centered on the usually intact. Intact higher-level abilities of-
print difculties (and they are the most se- fer an explanation of why reading comprehen-
vere), the ability to notice, manipulate, and sion is often appreciably above single-word

reading accuracy and uency in dyslexia (re- in a Report to Congress. The panel worked
viewed in Shaywitz 2003). for two years reviewing the extant data on
Dyslexia is a clinical diagnosis, best made teaching children to read published in peer-
National Reading
Panel: by an experienced clinician who has taken a reviewed journals, performing meta-analyses
Congressionally careful history, observed the child or young where the data allowed, and reporting to
mandated in 1998 to adult reading, and administered a battery of Congress on its ndings in April 2000. As a re-
review research tests that assess the childs cognitive abil- sult of its exhaustive review, the panel found
literature on
ity, academic skills including reading accu- that ve essential elements should be incor-
teaching reading,
and in 2000 reported racy, uency, and comprehension, spelling, porated into effective reading instruction
on the most effective and mathematics (an area in which skills phonemic awareness, phonics, uency, vocab-
methods and are often high), and language skills, partic- ulary, and comprehension (Rep. Natl. Read-
approaches ularly phonological processing (Marzola & ing Panel 2000)and that these are optimally
Phonics: an Shepherd 2005, Shaywitz 2003). The uneven taught systemically and explicitly. These em-
approach to early peaks and valleys of both cognitive and aca- pirically rooted ndings converge with what
reading instruction
demic functioning contribute to the clinical we know about why print has meaning. As
emphasizing
letter-sound linkages picture of dyslexia: a weakness in phonolog- noted above, a core decit in phonological
ically based skills in the context of often- processing is observed in a majority of chil-
stronger cognitive and academic skills in dren and adults with developmental dyslexia
nonreading-related areas. (Liberman & Shankweiler 1991). Thus, it is
As children mature, compensation often not surprising that a majority of the many re-
occurs that results in relatively accurate, but cent well-controlled research studies have fo-
not uent, reading. Awareness of this devel- cused on preventing or remediating these core
opmental pattern is critically important for phonological decits.
the diagnosis in older children, young adults,
and beyond. The consequence is that such
dyslexic older children may appear to perform Early Intervention
reasonably well on a test of word reading or Probably the most hopeful research has been
decoding; on these tests, credit is given irre- early intervention studies of children at-
spective of how long it takes the individual risk for dyslexia based on their problems
to respond or if initial errors in reading are with phonological processing or initial word-
later corrected. Accordingly, tests of reading identication skills (Lonigan 2003) in kinder-
uencyhow quickly and accurately individ- garten or the rst grade. Both classroom-
ual words and passages are readand tests as- level interventions (Adams & Carnine 2003,
sessing reading rate are keystones of an as- Foorman et al. 1998, Fuchs & Fuchs 2005)
sessment for, and an accurate diagnosis of, and pullout remedial approaches (Blachman
dyslexia. 1997, DAgostino & Murphy 2004, Torgesen
et al. 1999, Vellutino et al. 2006) and
combinations of classroom and pullout ap-
Teaching Reading to Dyslexic proaches (OConnor 2000, Simmons et al.
Students 2003, Vaughn et al. 2003) have reported pos-
Within the past decade, an evidence-based itive results. Although denitions of reading-
approach to teaching children (including disabled or dyslexic subjects in these studies
dyslexic children) to read has emerged. Much varied, on average, large effects sizes (>0.70)
of the evidence base was synthesized by the were reported. Together, these studies sug-
National Reading Panel established by the gest that prevention programs that explicitly
U.S. Congress in 1998 with a mandate to focus on phonemic awareness, phonics, and
review existing research on teaching chil- meaning of text in the earliest grades of read-
dren to read and then to present the data ing instruction reduce the base rates of at-risk

students to below 5%. Although one can- ties below the fth percentile. The investiga-
not explicitly dene such children as having tors showed that these explicit programs re-
dyslexia because they are typically just learn- sulted in signicant improvements in reading
ing to read, and it is difcult to dene a on standardized reading measures following
word-reading decit at this level of reading the interventions, and many of the students
development, it appears that these systematic tested in the average range on word identi-
programs can signicantly improve core read- cation measures (but not uency measures).
ing skills in the weakest readers at these ages. More importantly, the gains made in word
identication lasted for more than two years
post intervention.
Interventions for Older Students These and many other studies (for more
For older students the remedial research lit- comprehensive reviews, see Fletcher et al.
erature includes a range of intervention pro- 2007; Shaywitz 2003; Swanson et al. 1999,
grams, including those described as direct in- 2003) have provided the evidence that phono-
struction and those that are more strategy logically based decoding and word recog-
based (Swanson et al. 1999). Here, the ev- nition skills are teachable aspects of read-
idence is less encouraging than for younger ing for most children (Moats & Foorman
children. Investigations using remedial inter- 1997, p. 188). This corpus of evidence in-
ventions that begin after the second grade indicates that focused, intense, systematic, and
dicate it is more challenging to bring chil- explicit interventions can positively impact
dren or adults up to expected grade levels word-reading development, with some ex-
once they fall behind, although signicant pected transfer impacting comprehension, in
improvements in reading can still occur (ef- even the most severely disabled dyslexic read-
fect sizes >0.60). As an example, Lovett et al. ers and that many different types of remedia-
(2000) combined a program referred to as an tion programs can be effective. This is an im-
explicit, scripted direct-instruction approach portant nding, for there is often a tendency
(based on Reading Mastery; Engelmann & to search for the one (magical) program that
Bruner 1988) that focused on phonologi- will address all struggling readers difculties.
cal analysis and blending of phonemes with Current knowledge supports several types of
a strategy-based program (an expanded and intervention programs as effective. Evidence
adapted version of the Benchmark program; is not yet available that would allow the selec-
Gaskins et al. 1986) that focused on teaching tion of one specic program over others or to
children metacognitive strategies to assist in support the choice of an individual program
word identication. This combined program, that would be specically more benecial to
and adaptations of it for different grade levels, particular groups of dyslexic readers.
have been evaluated with severe dyslexic stu-
dents in both elementary and middle school
in randomized experimental designs with con- Beyond Word Accuracy
trol groups. Results of implementation of such Fluency. The consistent improvement in
combination programs indicated that this ap- phonologically based word attack and de-
proach resulted in signicantly better stan- coding skills has not always generalized to
dardized reading measure outcomes than the accurate, uent text reading or adequate
individual components alone or other contrast reading comprehension, the ultimate goal of
programs (Lovett et al. 2003). all reading interventions (Lovett et al. 1989,
In an intensive eight-week evaluation of Torgesen et al. 1997). Moats & Foorman
two different phonologically based programs, (1997) review this problem and state, gener-
Torgesen et al. (2001) focused on older el- alization and transfer of decoding prociency
ementary students with word-reading abili- to uent word recognition and better reading

comprehension was not automatic . . . effect sizes 0.350.50). This nding suggests
(p. 188), a conclusion that has continued to that its the amount of reading that is criti-
be echoed by other studies and reviews (Lyon cal in supporting the development of uent
Scaffolding: a
teaching strategy & Moats 1997, Rayner et al. 2001, Rep. Natl. and automatic reading. Chard and associates
where the teacher Reading Panel 2000, Snow 2002, Torgesen (2002) review of studies specic to students
provides scaffolds et al. 1997). with dyslexia found slightly higher average ef-
(supports) that These results and questions have more re- fect sizes (0.500.70) for a range of interven-
facilitate the childs
cently raised signicant interest in whether tion approaches focused on uency.
ability. For example,
the teacher reads a uency decits can be treated in reading-
passage slightly more disabled and dyslexic subjects and whether Reading comprehension. Although chil-
difcult than the such interventions (see Kuhn & Stahl 2003, dren and adults with dyslexia are dened by
child is able to read Rep. Natl. Reading Panel 2000 for more their word identication and decoding prob-
by him/herself. The
comprehensive reviews) should be focused lems, some may also have reading compre-
child then reads the
same passage on connected-text or word-level strategies. hension difculties that are not due to an un-
repeatedly and Meyer & Felton (1999) found that most u- derlying oral language disorder. Because of
gradually learns to ency programs use repeated reading of con- this, some researchers have focused on inter-
read this previously nected text, although some newer programs vention programs aimed at reading compre-
difcult section with
focus on broader developmental models of hension abilities. Most remedial approaches
facility
uency encompassing both building semantic have developed comprehension-related strat-
knowledge and orthographic pattern aware- egy instruction or specic comprehension-
ness (Wolf et al. 2000). related skill instructional types of programs.
As examples of the repeated reading Strategy-related programs have focused on
approaches, Stahl & Heuback (2005) and developing critical thinking skills related to
Young and associates (1996) reported signif- understanding of text and constructing its
icant gains in their poor readers text read- meaning based on the readers prior knowl-
ing uency using connected text methods, edge, prediction of text, monitoring of text
whereas Levy and associates (1997) and Tan structure, and question asking, as examples.
& Nicholson (1997) focused their interven- Skill-related programs focus more on nding
tions at the word level and showed similar but ideas and facts, developing multiple meaning
less robust gains in connected text uency. A of words and increasing vocabulary, and sum-
key aspect of most uency-focused interven- marizing text.
tion programs with dyslexic students is that Several reviews ( Jenkins & OConnor
they require signicant reading of connected 2003, Swanson et al. 1999, Vaughn &
text with scaffolding support by either peers Klingner 2004) suggest that various types of
or teachers. The conceptual framework be- comprehension-focused intervention studies
hind these approaches is that as word identi- in reading-disabled children and adults, par-
cation becomes more automatic, due to in- ticularly those using explicit, strategy-focused
creasing orthographic awareness via practice, approaches, were effective. Unfortunately,
an improving reader requires less strategic at- because of the wide range of methodologies
tention on the act of reading as it becomes used in these studies and the variety of pro-
automatic and can direct more cognitive en- grammatic approaches, the resulting range of
ergy and focus on comprehension of mean- effect sizes seen in comprehension-focused
ing. Kuhn & Stahls (2003) review of uency- intervention studies of dyslexic students is
oriented instructional approaches found that typically broad (0.200.70). It appears that
repeated reading of text with scaffolding typi- many of these studies support the efcacy of
cally produces gains in uency and reading- the comprehension-focused remediation pro-
related skills similar to reading the equiva- grams ability to teach their specic strate-
lent amounts of nonrepetitive text (average gies, but the ability of students to apply those

strategies in new text reading and comprehen- still have not mastered reading due to their
sion situations is less consistent. underlying individual core phonological and
linguistic decits. In addition, some students
have experienced both factors. Such problems
Treatment Resisters are not easily addressed via one-time evalua-
In their focus on treatment resisters, Torgesen tions or interventions without some develop-
& Mathes (2000) highlighted a key set of nd- mental perspective and sequential evaluations
ings across all intervention studies: A number over time.
of children and adults do not respond to pro- The thrust of RTI frameworks (Fuchs &
grams that are shown to be effective in their Fuchs 2006) is to address these traditional
peers. Such results highlight the heterogene- limitations in the treatment of persons with
ity of the dyslexia population, but also sug- dyslexia by focusing on change over time. A
gest that no one explicit remedial instructional typical model would screen all students on
program, whether focused at the level of word core academic abilitiesin this case reading
identication, uency, or comprehension, or and identify those at risk using somewhat
any combination of these processes, will be liberal criteria (resulting in more false posi-
able to successfully address the needs of all tives). These students are then followed us-
such readers. The kinds of issues raised by ing frequently repeated reading-focused eval-
such consistent ndings of treatment-resisters uation probes during an academic year (or
across different interventions focus on con- years) while they are receiving systematic
textual or procedural factors rather than con- reading instruction. Those students who do
tent itself. Questions include how best to un- not make adequate progress compared with
derstand the role of (a) instructional intensity their typically developing peers (comparing
(length of intervention, hours of instruction, the amount of change over a given time pe-
optimal ratios of teachers to students, read- riod) are then provided with increasingly in-
ing time, etc.); (b) program integrity/delity; tense and, as needed, alternative approaches
(c) teacher ability/experience; (d ) program to reading interventions and continue to be
focus/explicitness/multidimensionality; and monitored over time. Students who receive
(e) individual student prior instructional ex- the best available quality instruction and who
periences/exposure and reading abilities. The do not respond to these increasingly explicit,
ways in which these factors, individually and intense, and alternative approaches over time
together, affect treatment outcomes is just would then be classied as dyslexic or learn-
beginning to be addressed, particularly for ing disabled (Presid. Commiss. Excell. Spec.
treatment resisters. The answers to these Educ. 2002). Clearly, such multitiered models
unresolved questions will provide critical still depend on measures sensitive to change,
information to better understand the ways in denitions of adequate change, validated in-
which effective instructional programs may terventions of increasing intensity, instruc-
affect any specic student with dyslexia. tional integrity, and a systematic approach
at the school/teacher level to ensure that
all students are monitored. McMaster and
Response to Intervention colleagues (2005) have provided one of the
It has become increasingly apparent that sev- better examples of this approach to children
eral causes exist for students deciencies in across 33 classrooms. Less than 5% of those
reading. Such students may be instructional children who, via the ongoing weekly mon-
casualties resulting from poor, inappropriate, itoring of reading, received increasingly in-
or noneffective reading instruction. On the tense and ultimately one-on-one instruction
other hand, some reading-decient students were still considered not to have made ad-
have received quality reading instruction but equate progress in reading, compared with

nearly 15% of the control classrooms using Accommodations

standard reading instruction and practices.
A complete education for a dyslexic student
The use of RTI models is expected to be a
includes evidence-based reading interven-
rapidly growing trend in the school identi-
tions and accommodations. As noted above,
cation of reading difculties.
intervention data, although promising, have
yet to indicate that the gap has been closed in
Summary of Interventions the ability of dyslexic students to read words
Explicit, intense, systematic, and develop- uently beyond the rst few grades. Accord-
mentally appropriate interventions are effec- ingly, although dyslexic children will improve
tive and provide an evidence-based approach their accuracy, decient uency continues to
in treating dyslexia. Interventions focused at be a concern at all grade levels, and increas-
ingly so as children move up into middle
word decoding and single-word identication

levels have had the most consistent evidence and high school and then into postsecondary
and have been shown to be the most effective, education.

particularly in prevention and early childhood Accommodations are of three general
studies. Fluency- and comprehension-focused types: (a) those that by-pass the reading dif-
interventions have had less investigation but culty by providing information through an
have still shown signicant, albeit more vari- auditory mode, (b) those that provide compen-
able, effects on reading outcomes in these satory assistive technologies, and (c) those that
students. Programs that systematically inte- provide additional time so that the dysuent
grate multiple-focused interventions are con- reader can demonstrate his/her knowledge.
sidered the most effective, although their spe- First, beginning quite early in their school-
cic sequencing, degree of overlap, and level ing, dyslexic readers require alternative modes
of focus on each component during each phase of acquiring information so that their vocab-
are still open to critical investigation. At this ulary and fund of knowledge better reect
point, determining which instructional pro- their intellectual level than does their im-
gram works best is not necessarily important, paired reading ability. Access to recorded ma-
but rather determining what program works terials, whether they are based on the school
best for what kind of dyslexic student with curriculum or reect what peers are reading
what kind of characteristics in what kind of for pleasure, are a necessity for such children if
implementation. they are to keep up with their classmates and
Overall, signicant progress has been with their own intellectual curiosity and in-
made in understanding the cognitive basis of terests. Next, assistive technology, computers,
dyslexia and in using this knowledge to in- and both print-to-speech as well as speech-to-
form instructional practices. At the same time, print software provide further compensation
it must be kept in mind that we are only for oft-noted difculties with handwriting,
in the early stages of discovering and devel- spelling, and lack of uency. A major ad-
oping specic reading interventions that will vance has been the convergence of behavioral
consistently improve all components of read- and neuroimaging data providing evidence for
ing, including accuracy, uency, and compre- the critical need for extra time on examina-
hension. Broad-stroke gains have been made tions for dyslexic students, particularly as they
in developing an overall template for pro- progress toward high school graduation and
viding reading interventions to dyslexic stu- beyond. Behavioral data indicating the per-
dents; however, we await evidence to guide sistence of dysuent reading are now sup-
the more ne-grained selection of specic in- ported by neurobiological data demonstrating
terventions for individual struggling readers that the left anterior lateral occipito-temporal
at all ages and at all levels of reading ability. (word-form) region responsible for uent,

rapid reading is disrupted in dyslexic children sures of word identication fail to capture dif-
and adults (Dehaene et al. 2005; Shaywitz et al. culties in uent reading and so are often mis-
1998, 2003). As the neurobiological data indi- leading. In addition, since such nonautomatic
cate, dyslexic readers develop compensatory readers must call upon attentional resources
neural pathways, and these systems support during reading, these students are highly sus-
increased accuracy over time. However, the ceptible to noise and other distractions. Study
word-form region does not develop (Shaywitz and test taking in quiet, separate rooms al-
et al. 2007), and compensatory pathways do low these dysuent readers to concentrate and
not provide uent or automatic reading. Ac- make maximum use of their often strained at-
cordingly, if such students are to demonstrate tentional resources.
the full range of their knowledge, provision In summary, given that dyslexia represents
of additional time on examinations is a neces- a disparity between an individuals reading
sity to compensate for the lack of availability and intellectual abilities; accommodations are
of the efcient word-form area. Currently, no critical to assure fairness and equity. Con-
quantitative data are available to serve as a re- temporary management of dyslexia provides
liable metric for gauging the specic amount evidence-based accommodations; these in-
of extra time needed by a student, and this clude access to recorded materials; computers
determination is best guided by the students and print-to-speech software; and additional
own experience over the years. Because the time on examinations, with the amount of
persistence of the reading difculty is indi- time determined by the students experience
cated by both behavioral and imaging longi- (Shaywitz 2003). Such accommodations are
tudinal data, requiring that students in post- provided based on a students history, observa-
secondary settings be tested every three or ve tions of his/her reading aloud, and test results.
years is not consistent with scientic knowl- With the provision of such accommodations,
edge. Furthermore, it is extremely expensive dyslexic students are entering and succeeding
and even problematic. As students progress in a range of professions, including journal-
through school to higher grades and compen- ism, literary writing, science, medicine, law,
sate in reading accuracy, simple reading mea- and education (Shaywitz 2003).
SUMMARY POINTS
1. The core concept of dyslexia as an unexpected difculty in reading has remained
invariant over the century since its rst description; dyslexia is found in all languages
including both alphabetic and logographic scripts.
2. A decit in phonological processing, accessing the individual sounds of spoken words,
represents the core weakness in dyslexia, and its remediation is the focus of early
intervention programs for at-risk and struggling readers.
3. Dyslexia is a chronic, persistent difculty and is neither a developmental lag nor
outgrown; the implication is that reading problems must be recognized and addressed
early.
4. Evidence-based interventions are now available and have positive effects on reading.
The most consistent and largest effect sizes are associated with provision of prevention
programs explicitly focused on phonological awareness, phonics, and meaning of text.
5. Intervention programs for children beyond second grade, though effective, are chal-
lenging and have produced less-consistent results. Such evidence-based programs
focus on systematic, phonologically based instruction and teaching metacognitive

strategies to assist in word identication. No single program is the most effective;

many types of remediation programs can be effective.
6. Fluency decits have proven much more difcult to remediate than word accuracy
problems. Many children who respond to programs aimed at improving word iden-
tication skills remain dysuent, slow readers. Approaches that focus on repeated
oral reading with feedback and guidance have shown the most consistent positive re-
sults. For readers who are not uent and cannot read individual words automatically,
reading remains effortful and slow.
7. Neurobiological studies have revealed differences in the neural circuitry for read-
ing between nonimpaired and dyslexic readers and identied a neural signature for
dyslexia. Brain imaging has also indicated a target (the left occipito-temporal word
form area) for intervention for skilled or uent reading and that these systems are
malleable and respond to effective reading interventions. Such ndings demonstrate
the importance and powerful impact of effective reading instruction.
8. Interventions, while promising, have yet to close the gap in the ability of dyslexic
children to read uently; dyslexic children often remain accurate but slow readers.
Neurobiological evidence indicates that the failure of the word form area to function
properly in dyslexic children and young adults is responsible for their characteristic
inefcient, slow reading. Accommodations, particularly the provision of extra time,
are essential for dyslexic students to fully demonstrate their knowledge.
FUTURE ISSUES
1. To identify which specic instructional components/programs work best for which
specic types of dyslexic students and under what kinds of implementation practices.
2. To identify which specic instructional elements in which specic combination im-
prove uency and reading comprehension, particularly in older students.
3. To identify the role of attentional difculties in dyslexic readers.
4. To determine effective methods of identifying at-risk children earlier and more accu-
rately.
5. To determine mechanisms by which the phonology and orthography are integrated
in the word form region and how this process could be facilitated.
ACKNOWLEDGMENTS
The work described in this article was supported by grants from the National Institute of Child
Health and Human Development (P50 HD25802, RO1 HD046171, and R01 HD057655) to
Sally Shaywitz and Bennett Shaywitz.
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reading. J. Exp. Child Psychol. 77:197235
Wolf M, Miller L, Donnelly K. 2000. Retrieval, automaticity, vocabulary elaboration, orthog-
raphy (RAVE-O): a comprehensive, uency-based reading intervention program. J. Learn.
Disabil. 33:37586
Woodcock R, Johnson M. 1989. Woodcock-Johnson Psycho-Educational Battery-Revised (WJ-R).
Allen, TX: Dev. Learn. Mater.
Young A, Bowers P, MacKinnon G. 1996. Effects of prosodic modeling and repeated reading
on poor readers uency and comprehension. Appl. Psycholing. 17:5984
Yule W, Rutter M. 1985. Reading and Other Learning Difculties. Oxford, UK: Blackwell Sci.
Ziegler J, Goswami U. 2005. Reading acquisition, developmental dyslexia, and skilled reading
across languages: a psycholinguistic grain size theory. Psychol. Bull. 131:329

Shaywitz.qxd 11/06/2007 01:55 PM Page C-1
Figure 1
Trajectory of reading skills over time in nonimpaired and dyslexic readers. Ordinate is Rasch scores
(W scores) from the Woodcock-Johnson reading test (Woodcock & Johnson 1989) and abscissa is age
in years. Both dyslexic and nonimpaired readers improve their reading scores as they get older, but the
gap between the dyslexic and nonimpaired readers remains. Thus, dyslexia is a deficit and not a devel-
opmental lag. (Figure derived from data in Francis et al. 1996 and reprinted from Shaywitz 2003 with
permission.)
www.annualreviews.org Education of Dyslexic Children C-1

Shaywitz.qxd 11/06/2007 01:55 PM Page C-2
Figure 2
Neural signature for dyslexia. Schematic view of left hemisphere brain systems for reading observed
during fMRI in nonimpaired (left) and dyslexic (right) readers. In nonimpaired readers, three systems
are evident: one anterior in the area of the inferior frontal gyrus and two posterior, the top system
around the parieto-temporal region and the bottom system around the occipito-temporal region. In
dyslexic readers, the anterior system is slightly overactivated compared with systems of nonimpaired
readers; in contrast, the two posterior systems are underactivated. This pattern of underactivation in
left posterior reading systems is referred to as the neural signature for dyslexia. Figure reprinted from
(Shaywitz 2003) with permission.
C-2 Shaywitz Morris Shaywitz

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Prefatory
The Evolution of a Cognitive Psychologist: A Journey from Simple

Behaviors to Complex Mental Acts

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ANRV331-PS59-17 ARI 1 December 2007 16:42

The Education of Dyslexic

Sally E. Shaywitz,1 Robin Morris,2

and Bennett A. Shaywitz3

Annu. Rev. Psychol. 2008. 59:45175 Key Words

Copyright c 2008 by Annual Reviews. Abstract

to decipher the code. Just how many are af-

Sex Differences in Dyslexia . . . . . . . 456

ical ndings that together have given rise

452 Shaywitz Morris Shaywitz

the ability to read text not only accurately, determining the

but also rapidly and with proper expression pronunciation of a

www.annualreviews.org Education of Dyslexic Children 453

454 Shaywitz Morris Shaywitz

dren are rst provided with evidence-based 1992b, p. 149). effectiveness in

reading instruction and their progress is fre- teaching children to

www.annualreviews.org Education of Dyslexic Children 455

must be addressed or they will persist with COGNITIVE MODEL OF

456 Shaywitz Morris Shaywitz

the development of spoken language; spoken developed following introduction to reading

Phonological awareness. Phonological

www.annualreviews.org Education of Dyslexic Children 457

relationship between letters and sounds ETIOLOGY

458 Shaywitz Morris Shaywitz

www.annualreviews.org Education of Dyslexic Children 459

1992, Shaywitz et al. 1999). In addition, per- nonimpaired readers.

sistently poor adult readers appear to read

460 Shaywitz Morris Shaywitz

www.annualreviews.org Education of Dyslexic Children 461

462 Shaywitz Morris Shaywitz

www.annualreviews.org Education of Dyslexic Children 463

464 Shaywitz Morris Shaywitz

www.annualreviews.org Education of Dyslexic Children 465

nearly 15% of the control classrooms using Accommodations

word decoding and single-word identication

and have been shown to be the most effective, education.

466 Shaywitz Morris Shaywitz

www.annualreviews.org Education of Dyslexic Children 467

strategies to assist in word identication. No single program is the most effective;

468 Shaywitz Morris Shaywitz

Adams G, Carnine D. 2003. Direct instruction. In Handbook of Learning Disabilities, ed. H

study. J. Am. Acad. Child Adolesc. Psychiatry 35:34351

www.annualreviews.org Education of Dyslexic Children 469

Ferrer E, McArdle J, Shaywitz B, Holahan J, Marchione K, Shaywitz S. 2007. Longitudinal

reading disability: comparisons of discrepancy and low achievement denitions. J. Educ.

470 Shaywitz Morris Shaywitz

www.annualreviews.org Education of Dyslexic Children 471

Lyon G, Shaywitz S, Shaywitz B. 2003. A denition of dyslexia. Ann. Dyslexia 53:114

Morais J, Cary L, Alegria J, Bertelson P. 1979. Does awareness of speech as a sequence of

phones arise spontaneously? Cognition 7:32331

472 Shaywitz Morris Shaywitz

www.annualreviews.org Education of Dyslexic Children 473

Neurosci. Lett. 290:6165

474 Shaywitz Morris Shaywitz

Torgesen J, Alexander A, Wagner R, Rashotte C, Voeller K, Conway T. 2001. Intensive re-

to instruction. J. Educ. Psychol. 81:57993

www.annualreviews.org Education of Dyslexic Children 475

www.annualreviews.org Education of Dyslexic Children C-1

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Volume 59, 2008

The Evolution of a Cognitive Psychologist: A Journey from Simple

Behaviors to Complex Mental Acts

Pharmacology and Behavior