Dyslexia is a neurological condition that is understood to be genetic in origin. It is extremely common: estimates vary depending on the research you look at, but it’s estimated that up to 20 percent of the U.S. population has dyslexia.
To talk through the details of diagnosis, the different intervention approaches, and how to approach dyslexia if your child has other co-occurring diagnoses, we reached out to Elizabeth Bloom, Education Advocate and Regional Leader–Los Angeles of Decoding Dyslexia CA; Allyson Flynn, PhD, School Psychologist and Special Education consultant; and Dr. Jordan Wright, Chief Clinical Officer of Parallel Learning.
What is the definition of dyslexia, and what are the signs and symptoms of dyslexia?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists dyslexia as a specific learning disorder (SLD). You can read much more about SLDs in our article Specific Learning Disabilities 101.
People with dyslexia have difficulties with word recognition, spelling, and decoding; as a result, they typically struggle with learning how to read and write. As the DSM-5 puts it, “a person who is dyslexic must read with great effort and not in the same manner as those who are typical readers.”
Flynn describes a few of the common dyslexia symptoms that tend to show up when kids are still really young, even as early as preschool: “One of the first signs of dyslexia is a struggle with matching letters and sounds or decoding words — part of building vocabulary and reading,” she says. Children at risk for reading failure can be reliably identified even before kindergarten. In fact, deficits in phonological awareness, rapid automatized naming, verbal working memory, and letter knowledge have been proven to be strong precursors of dyslexia in children as young as age three.
Signs of dyslexia vary from person to person and evolve over a person’s life. Some of the most common include:
- Delayed speech development or articulation issues
- Difficulty following directions, especially directions with more than two steps
- Difficulty reciting the alphabet (e.g., saying “lelomenopee” instead of l, m, n, o, and p)
- Difficulty with rhyming
- Tendency to mix up names of familiar people, places, and objects
- Difficulty pronouncing words with three or more syllables
- Difficulty remembering the days of the week or sequences of numbers
- Difficulty recognizing words that begin with the same sounds
- Difficulty clapping to match a beat
- Tendency to switch the hand used for writing, drawing, or coloring
- Difficulty learning to write
- Difficulty with directionality
- Difficulty learning to tie shoelaces
And remember that dyslexia isn’t limited to reading text! Flynn says, “While dyslexia is most often associated with reading challenges, it can also affect math comprehension and skills development.” After all, math can also involve reading multistep directions, decoding unfamiliar words, sequencing information, and comprehending instructions.
When and how is a student assessed for dyslexia?
Children can be screened for learning disabilities, including difficulties with reading, as early as preschool. Research has found that evidence of an “achievement gap” between typical readers and dyslexic readers is clear even by first grade and continues into adulthood. The earlier reading intervention begins, the better the outcome. In fact, according to the International Dyslexia Association, “Research has shown that brain plasticity decreases through childhood. It takes four times as long to intervene in fourth grade as it does in late kindergarten because of brain development and because of the increase in content for students to learn as they grow older.”
While some states employ universal reading screenings for students in grades K–2, an alarming number don’t have a comprehensive policy to identify and support struggling readers. (You can see how your state is doing in this chart.) Screenings are used to identify struggling readers and pinpoint who needs reading intervention, or response to intervention (RTI). Bloom cautions that “RTI is multi-tiered and can be complicated to roll out, especially with limited staff, limited trainings, and limited budgets for tiered literacy curriculum. Furthermore, RTI may not include structured literacy, which targets dyslexia.” It’s also important to note that progress monitoring is an essential component of any intervention strategy — without it, students who aren’t making adequate progress will need a different level of instruction.
According to this Dyslexia Assessment Fact Sheet, “a clinical evaluation is necessary to determine a diagnosis of dyslexia if the student continues to struggle with literacy skills, despite high-quality instruction using an RTI approach. Areas to be assessed, in depth, by a team of individuals include the following: phonological awareness, phonological or language-based memory, rapid automatic naming, receptive vocabulary, phonics skills, decoding/encoding real and pseudo-words, oral reading fluency, and writing at the sentence and paragraph level.”
Wright points out that assessment is key not only because it helps us pinpoint the need for intervention, but it can show what intervention will be best for a student. “If we only know that a student is falling behind in reading,” he says, “we have no idea where in the reading process to intervene. However, if we assess the student carefully, we can see where in the process of reading they’re having difficulty, and this points a provider toward interventions and supports that are most likely to benefit that specific student.”
This is backed up by the current approach to diagnosing specific learning disabilities. As Rosemary Tannock points out on the International Dyslexia Association website, by not having to focus on explaining an achievement gap, an assessor should be able to “shift from ‘assessment for diagnosis’ to ‘assessment for intervention’ and have more time to provide psychoeducation and consultation with parents and teachers.”
Anyone (parent, teacher, therapist) connected to a student who feels the child is not responding as expected to their curriculum and/or academic interventions can ask the school to evaluate them for learning disabilities. A specific learning disability is one of thirteen categories that makes a child eligible for an Individualized Education Plan. (You can find out how children are assessed in our article What Is an IEP?)
Who can diagnose dyslexia?
According to the California Association of School Psychologists (CASP), any licensed educational psychologist (including those working in school districts) can make a diagnosis “if they have the training and knowledge in that area.” This may differ depending on what state you live in. School-based assessments, while comprehensive, are designed to find out whether a student meets the criteria for a disability that would impact learning. Depending on the qualifications of the assessor, a school-based assessment may not be thorough enough to diagnose dyslexia.
Parents who feel their child was not assessed accurately or thoroughly have the right to request additional assessments, including an Independent Educational Evaluation (IEE), at public expense. An IEE is typically done by a clinical psychologist or a neuropsychologist who is not associated with the school district. This can be especially important if a child has more than one diagnosis.
Bloom says that, if the district does not agree to provide an IEE, an alternative option is to check with private health insurance to learn if a psycho-educational assessment can be covered medically. (You’ll want to check with your insurance company to see if that’s true for your family — IEEs are not cheap; costs vary, but generally run upwards of $3,000.) Another option is to have your child evaluated by a speech-language pathologist, pediatrician, or literacy specialist who is trained to evaluate whether dyslexia is impacting a child’s learning. However, as Flynn points out, the school is only required to “consider” information that comes from a privately funded evaluation.
What are common co-occurring diagnoses with dyslexia?
The most common diagnoses that occur alongside dyslexia are ADHD, dysgraphia, dyspraxia, oppositional defiant disorder (ODD), and anxiety. When it comes to ADHD, this recent study finds greater evidence linking attention disorders and dyslexia, suggesting that some ADHD medications may help support a student’s ability to benefit from reading interventions.
However, just because other co-occurring diagnoses aren’t common doesn’t mean they can’t be present — including intellectual disability. Here’s how Wright puts it: the presence of intellectual disability “does suggest that there will be academic struggles related to that particular diagnosis. This does not mean, though, that a student cannot actually have both an intellectual disability and learning differences.” However, “IEP teams typically will not test for dyslexia because it will be too difficult to tease out, and it is unlikely to change the educational accommodations and interventions recommended. Private providers may test for dyslexia, but many times they will not be able to make a definitive diagnosis when intellectual disability is present, so families may be disappointed in the outcome.”
To read more about making sure your child receives the supports they need, check out our article on specific learning disabilities.
What interventions are available for dyslexia?
Bloom suggests that families find out what specialized literacy instruction their school offers by asking these questions:
- Are the reading interventionists and special education teachers using a structured literacy curriculum? If so, which program are they trained in? How long was the training? (Some districts provide brief trainings while others invest in longer trainings.)
- How long has the school or teacher(s) been implementing these structured literacy programs?
- Will structured literacy instruction be offered to this student individually, and how will the progress be charted?
- If a student isn’t showing progress, can another curriculum be considered? Are staff members trained in more than one structured literacy curriculum?
Is it important to specify dyslexia in the IEP?
While it's not necessary to receive a dyslexia diagnosis to qualify for a specific learning disability, Bloom says it’s a good idea to make sure the school knows if the student has a dyslexia diagnosis so that the reading remediation program they use appropriately targets a student’s underlying skill deficits.
“In all cases,” she says, “parents should ask which reading remediation curriculum will be used to support their struggling reader, AND whether this curriculum targets the weak skill areas identified on the assessments.” She quotes the International Dyslexia Association, which says that “students who have a specific learning disability in reading (dyslexia) need a specialized approach to reading instruction to make progress. It is crucial that this specialized instruction begin at the student’s current level of reading skill development, rather than at the student’s grade level.”
Though it’s often not done in a student’s IEP, Wright feels it’s important to distinguish dyslexia from a specific learning disability because dyslexia requires specific interventions and supports that are different from other learning disabilities. He explains, “For example, a student who has an SLD with impairment in reading may have difficulty with reading comprehension, in which case they would need specific supports around better understanding text. This is very different from a kid with dyslexia, who needs extremely specific supports around phonemic proficiency and automaticity. We have some evidence-based curricula for dyslexia, and we want to make sure students have access to those specific curricula.”
This article presents some other compelling reasons why it’s important to use the word dyslexia in school and beyond.
What are some supports and accommodations for dyslexia?
“Students with dyslexia and other reading disabilities and learning differences struggle in an ongoing way, even when they are receiving supports and intervention,” Wright says. “Because they are actively working on improving their reading, we don’t want them to continue to fall behind substantively in their academics.” It’s important to give them access to digital tools and accommodations to keep them engaged.
Some common accommodations in IEPs or 504 plans for kids with dyslexia include:
- access to technology for dictation
- access to test questions and answer choices read aloud
- use of mnemonic devices
- access to text to speech (TTS) and speech to text (STT) apps
- masking (blocking or whiting out) unnecessary content (such as navigational buttons, menu, additional questions, etc.) so students can focus on tests, classwork, and homework one step at a time
- front-of-the-room seating
- brain breaks
- reading chunked into smaller sections
- materials provided in larger print
- access to teacher notes
- alternate testing environments
- extended time on tests
- utilization of a reader and/or a scribe
- being allowed to take photos of the classroom board and/or homework requirements
- colored overlays
- dyslexia line reader
Bloom also recommends looking into adding plug-ins for Chrome and Microsoft, checking out the Livescribe Smartpen, which uses speech-to-text technology to help learners take and review their notes, and using dyslexia-friendly fonts such as Dyslexie. (Note that while some people with dyslexia prefer dyslexia-friendly fonts, research has not found that they’re actually all that useful.) You can find a comprehensive list of assistive technology tools here.
Wright adds that “parents can also collaborate with teachers to think about high-interest books and reading material that is lower in demand than grade level to keep kids interested and practicing their reading basics.” It’s equally important to encourage kids to listen to audiobooks at their grade level and beyond. Undivided Navigator and education specialist Kelly Hatfield says, “Strong auditory comprehension seems to be somewhat common in kids with dyslexia. You don’t want to only focus on decoding, which is typically approached through below-grade-level texts — you also want to make sure dyslexic kids are listening to books at and above their grade level to build higher-level comprehension and vocabulary.”
Reading with dyslexia
According to the Yale Center for Dyslexia & Creativity, “Most children and adults with dyslexia can learn to read — but with more effort than their peers. The typical child can learn to read ‘fluently,’ meaning that reading is automatic, fast and pleasurable. By contrast, many dyslexic children remain ‘manual’ readers who read slowly and with great effort.”
But challenges with reading and writing don’t necessarily translate to less academic success. There’s recent research to back this up. According to a 2020 study from the Journal of Pediatric Neuropsychology that focused on the post-graduate experiences of Yale alumni with and without dyslexia, dyslexic college graduates did not have different outcomes than their non-dyslexic peers in the workplace or in social settings.
As Bloom says, “I do not look at dyslexia as a condition. I understand dyslexia as a way of thinking that involves so many more skills and strengths than just learning to decode written language.” It also involves ingenuity and compromise. Thanks to the proliferation of audiobooks, podcasts, text-to-speech and read-aloud apps, and more, kids can become proficient readers in whatever way makes the most sense for them. It’s access to successful interventions and technology that really matter.
How to support kids with dyslexia at home
Wright says there a few things he always recommends to parents whose kids are getting reading supports:
- Encourage family reading as much as possible — read books to and with your child and try to make it fun and low-stress.
- Don’t worry about their struggles — praise their efforts.
- Collaborate with providers who may have specific suggestions for how to support your child’s reading and sustain any gains from their interventions.
Hatfield has a few additional tips for parents:
- Teach your child about their unique dyslexic brain and some of the benefits of having dyslexia.
- Celebrate your child’s successes.
- Make sure teachers are aware of your child’s accommodations (you can start by creating a one-page introductory “All About Me” to share).
- Make sure your child knows about their accommodations since they’ll likely need to remind teachers about them.
- Make sure your child is making progress in the remediation program their school is using, and if progress isn’t being made, ask for a new program.
- Advocate for your district to adopt an effective dyslexia remediation program.
- If the school is not helping your child improve, consider finding an educational therapist for additional support.
How could better laws support kids with dyslexia?
There have been several recent lawsuits intended to establish that all students have a “right to read,” which should be supported by early detection and evidence-based reading interventions in schools. (Check out the awesome efforts of Decoding Dyslexia in Maryland, which paid off in 2019.)
Currently, California is one of ten states that doesn’t require universal screening for reading difficulties, including dyslexia, in elementary schools. While Governor Newsom’s 2022 budget supports dyslexia research as well as a pilot program to improve reading intervention services and support in schools, a bill requiring universal screening (SB-237) did not make it past the CA State Assembly Education Committee. If you want to take action, contact members of the Education Committee and urge them to support universal screening and all students’ right to read.