The Misunderstanding
of Dyslexia
by Sally Shaywitz,
M.D.
Recently I heard that
a friend’s brother—a
graduate of a competitive college with an MBA working for a
business firm—was demoted once he told his superiors
he was dyslexic. As unbelievable as this may seem in the 21st
Century, such lack of understanding of dyslexia and the unfounded
stigma associated with it remain. Such misunderstanding of
dyslexia is particularly painful and unnecessary in an era
when science has taught us so much about dyslexia, including
how to recognize it early and accurately, how to treat it effectively,
and perhaps most importantly, we now understand how it is that
so many people can be both smart and dyslexic.
Concerned
that there was such a gap between the growing knowledge about
dyslexia and the everyday school and societal practices affecting
children and adults who are dyslexic, I spent five years
writing a book, Overcoming Dyslexia published by Alfred
A. Knopf in 2003. Based on the premise that “knowledge is power,” I
wanted to empower parents and teachers and those who are
dyslexic to understand the nature of dyslexia and the implications
of this knowledge for the improving the well being of those
who are dyslexic.
The new scientific discoveries have profound and
positive implications for identifying children (and adults),
for providing evidence-based, effective reading instruction
and reading interventions, and for understanding the neurobiological
basis for the absolute need for the accommodation of extra
time for those who are dyslexic.
Why do the lines and
squiggles on a page have any meaning at all? There is now
a strong consensus among investigators in the field that
reading reflects language and that the central problem in
struggling readers reflects a deficit within the language
system. This evidence begins with the recognition that spoken
language is instinctive, built into our genes and hard-wired
in our brains. In order to read, the abstract lines and circles
on the page that we call letters, must link to something
that already has inherent meaning—the sounds
of spoken language. In contrast to spoken language, which is
natural, written language is acquired and must be taught.
As a physician, I practice
evidence-based medicine that is; in choosing a treatment
for a patient I am guided by the scientific evidence of which
treatment is proven to be most effective. Today, for the
first time, we have the knowledge to be in an era of evidence-based
education where, for example, reading programs are selected
on the basis of scientific evidence of their efficacy and
not on the basis of opinion or philosophy. Converging scientific
evidence, including the rigorous analysis by the National
Reading Panel, indicates that effective reading instruction
is comprised of five essential elements: phonemic awareness,
phonics, fluency, vocabulary and comprehension. Furthermore,
how reading is taught matters; effective programs teach reading
systematically and explicitly. For example, phonics is taught
in a preplanned way where vowels and all the letter-sound
combinations are systematically taught; this is in contrast
to more casual, “by the way” approaches. Effective
programs are aligned so that reading practice reflects the
letter-sound linkages taught. We know that the brain learns
by practice and such practice is especially important as a
foundation for the development of fluency.
Within the last decade
or so, the dream of scientists, educators and struggling
readers has come true. It is now possible to “see” the brain at work. Functional brain imaging,
primarily functional magnetic resonance imaging (fMRI), uses
the same scanner employed in MRI studies commonly obtained
for assessing headaches or knee ligament injuries, but with
the addition of more sophisticated soft and hardware that make
it possible to “see” which brain systems are activated
as a child performs reading or reading-related tasks.
Using functional brain imaging, scientists have
discovered the brain basis of reading and a glitch in the neural
circuitry for reading in children and adults who struggle to
read. Such evidence of a disruption in the reading pathways
provides a neurobiological target for reading interventions.
A study we published in 2004 demonstrated that provision of
an evidence-based, phonologically mediated reading intervention,
both improved reading accuracy and fluency and was associated
with the development of the fast-paced word form systems serving
skilled reading.
Our data indicate that teaching matters and that
use of an evidence-based reading intervention can facilitate
the development of the fast-paced neural systems that underlie
skilled reading. Thus, there is now a new level of evidence,
based on functional imaging studies of the brain at work, that
supports the findings of a systematic review of the scientific
literature on reading conducted by the National Reading Panel.
Finally many dyslexic adolescents and young adults
have not enjoyed the benefit of evidence-based reading instruction.
They remain slow readers and require extra time in order to
demonstrate their knowledge on tests. Their requests for extra
time are supported by new brain imaging data that provide incontrovertible
evidence of the need for extra time. As I write in Overcoming
Dyslexia, “dyslexia
robs a person of time, accommodations return it”; a dyslexic
has as much of a physiologic need for extra time as a diabetic
has for insulin.” In dyslexia, there is an observable
disruption in the fast-paced neural systems for rapid, automatic
reading; over time other systems compensate, permitting more
accurate, but not fluent reading. There should no longer be
any doubt about the dyslexics’ absolute need for extra
time.
Never has there been a more hopeful or optimistic
time for those who are dyslexic. We have the knowledge; I hope
we have the will to use it.#
Sally E. Shaywitz, M.D. is Professor of Pediatrics
and Co-Director, Yale Center for the Study of Learning and
Attention, New Haven, CT.
