dyslexia child case study

Case Study: Ten year old child with severe dyslexia

This study discusses a ten year old Elementary School student with significant levels of dyslexia. Reading through this case study will help you recognize typical concerns, and possibly identify approaches and techniques to help you with your student. You will notice the weighing of factors and the considerations discussed. Every child is unique. No single overall approach applies to each and every child.

Student Profile

18 March 2014 Eric (M) 10 (Grade 2) Student ID ER3445752M Dyslexia Test https://www.dynaread.com/index.php?cid=testresults&pmp_id=ER3445752M646464

Input by Elaine Benton MA, with additional comments by Hans J.A. Dekkers. Both Dynaread Team members.

INPUT BASED ON PROVIDED BACKGROUND INFORMATION

School-provided information in italics.

Eric has been with us since kindergarten. Already then, he expressed difficulty learning letters and sounds, so when he moved to grade 1 we hoped with extra one-on-one help he would thrive. He didn't. At parent request and with school approval, he repeated.

ELAINE: From our perspective, looks like this was a very good decision.

His second time through was more successful, but when he hit grade 2 and had to start reading more, identifying more sight words, and writing sentences and short paragraphs, it was obvious that he didn't have the skills yet.

ELAINE: How poor is his writing? We tend to forget manual writing as we concentrate on reading but it can be such a painful, and not unrelated, issue that needs kind but concerted and steady attention.

ELAINE adds...: [Topic: About composition work with the limitations of low reading and handwriting removed]. The child tells/dictates an experience story (it could be a phrase, sentence or even a whole short story that they want to share) to the adult who writes it down and then uses the material that has been created as a text to be read. It ensures that the reading text only uses language that the child already knows and it's an excellent approach as long as the child is not able to parrot the story back from memory. If this is the case, the tutor should let the story go stale in memory until the child can't 'read' it entirely from memory. This is called the Language Experience Approach (LEA) and it is used with very, very basic readers. Reading teachers should really know or learn how to use this approach. It's hard to write as fast as they talk but its' worth it because this is a reading instruction technique that also helps them to begin to develop and order their thoughts cogently before they would otherwise be able to do so. It is, effectively, composition work with the limitations of low reading and handwriting removed.

HANS: Eric's test demonstrates extremely marginal literacy (near illiterate). In language development, a child progresses from listening to speaking, to reading, to writing, to complex authoring.

It is unreasonable to expect a near illiterate dyslexic to write. Copying, as part of a multi-modal, multi-sensory approach in learning to read: Yes. But writing originally composed short paragraphs or even short sentences on his own: No. This is simply out of reach and ability (based on his demonstrated reading skills in our test).

So he started Orton-Gillingham for a minimum of two hours per week, which continued daily until he began with the Dynaread program.

ELAINE (Certified Orton-Gillingham Remediator): [HANS: To be effective, in the perfect world...] Orton-Gillingham should really be done for a minimum of three one-hour long lessons per week ... with practice in between. Also, see below for recommendations regarding the type of OG program that is most beneficial.

He has no other learning disabilites, is not ESL, and is a very strong oral learner. Like many other dyslexics, if he could get through life orally, no one would probably realize how much he struggles with reading and writing.

I've been working with him this school year now that he's in grade 3. I see a bright boy who is willing to try anything I suggest. We've been focusing on Orton-Gillingham yet, hoping to hammer those skills in more and more. Last year, his retention of new information had about a 50% carry-over to regular seat work. This year, it's about 70%.

But while the rest of his class has moved on at grade level, many of them reading books at the 3-3.5 level, he is beginning to realize that his books at 1.8 level are "too easy" for the others. He's becoming less brave in reading out loud in class or volunteering information.

I think this is the year that he's either going to start feeling successful or start shutting down and turn into an attitude case. I believe that's also the reason he was so keen to try a new program like Dynaread, because he wants to keep up.

ELAINE: I understand where you're coming from but I've just had so many students who've had severe reading problems but have never shut down or had attitude problems. It's just essential that they, and we, find and emphasize other things that they're good at. For some kids it's the arts, or sports and for some its things we wouldn't normally think of ... like class pets, other games or just the fact that they have a good friend and/or the ability to make a lot of friends or become a leader ... so many possibilities and all it takes is one.

Please talk to the teacher about the reading out loud. Is it being done in larger groups? If so ..., no go. Reading pairs ... ok. Triads ... ok. Many more ... not so much.

HANS: Though I fully agree with the power of identifying and help internalizing one (or more) skills that Eric may excel in, researched statistics overwhelmingly evidence the grave risks of emotional shut down. Part of the solution is what Elaine shared, but part of it is also helping Eric understand that Dyslexia is not a curse, not something to be ashamed of, and something that actually comes with many benefits (if managed well, by him and those who raise him, and educate him). It may be a very good idea for his parents to buy the following book, and read it together with Eric. Not instead of identifying and endorsing his unique talent area(s), but alongside it.

The Dyslexic Advantage: Unlocking the Hidden Potential of the Dyslexic Brain by Brock L. Eide M.D. M.A. Permalink: http://www.amazon.ca/dp/0452297923

His teacher is very aware of his strengths and limitations and teaches to them. But all the interventions now lie on my plate, and I'm hoping to help him achieve some more success. Since all our students bus in (he's on the bus about 40 minutes), before/after school programs are not an option. Generally, we focus on math and reading/writing as crucial life skills, and if needed we minimize the time spent on social/science to help them keep up with math and reading. We try not take them out of music and art, because there's lots of research to suggest that those subjects also help out academically.

ELAINE: 40 minutes on a bus is really unfortunate ... I guess it has to be social time, a good time for kid books on tape or music, learning apps or, if it isn't embarrassing, easier books that he can read alone or with a friend.

HANS: Public libraries often have offerings of audio books in their collection. I myself use Audible.com by Amazon, which offers a high quality audio experience. Some people demonstrate the ability to listen with comprehension at faster rates, and Audible.com allows this. They offer a three month trial subscription for little money. It may be a way for him to progress in academics and overall development, through listening on the bus.

ELAINE: I totally agree with the effort to keep music and art ... unless he hates them. Personally, I don't think there's much extra benefit if the child isn't interested. On the other hand, how about something physical? Sport or building/making things? Would he be interested? It's just as beneficial ... or more so.

HANS: I am also familiar with the research on the benefits of music and art to overall academic development. We are not linear-thinking creatures. Music and arts help us to broaden our perspectives. And with a current lack of reading skills, this may help compensate. And if he happens to be good at it, will also boost his sense of self-worth.

He would not be retained any more in elementary, regardless of what grade level he achieves this year or in years to come.

ELAINE: I'm really curious about why this is the case. Is there room for negotiation here?

ELAINE adds...: Regarding repeating more than one school year in elementary school, do check in with the Ministry of Education to see if such a rule can actually be imposed by a school. I don't know the rules here but I do know that, in Ontario, this would rule would never stand.

HANS: When I read that statement, I concluded that you were primarily stating it as a fact. But fact or not, retention in a Grade when peers move on is very tough on a child, especially if the child -- like Eric -- seems very very eager to stay at par with his friends.

Rather than retaining, my preference would go out to assistive technologies, like Text to Speech and Audio Books, plus selecting an academic path for him which suits his talents and abilities. But... most certainly continuing to help him to Learn to Read, with Dynaread and possible continued augmentation of OG Phonics. I categorically do not see assistive technologies as replacement for learning to read. AT's are merely a means, and most certainly not an end. You may want to watch this video (possibly even together with Eric), in which I talk about the role of AT and the balances in handling Dyslexia: http://youtu.be/0wOLl3ZRcw4

YOUR TOP THREE OF WHAT YOU HOPE TO RECEIVE FROM OUR TEAM

1. how to boost his reading performance.

ELAINE shares... I would recommend the following to help boost Eric's reading performance.

(1) Dynaread. It is really quite obvious that Eric needs to increase his sight word reading vocabulary and improve his reading speed for the words that he knows. Dynaread will help him to do this as well or better than other programs. Truthfully, no bias. Full stop.

(2) Make sure that Eric is getting the kind of Orton-Gillingham program that he needs. In my experience, OG fails when children are taught phonic information but are not given enough opportunity to use it i.e. to recode (read and spell) a good number and a wide variety of words with target phonemes in the initial, final and middle positions. (in that order if you can). Application is a skill that has to be taught explicitly (for accuracy) and drilled (for speed) with individual words, phrases, sentences and short paragraphs. Systematic, explicit phonics instruction has to go hand in hand with systematic, explicit 'application instruction'.

(3) It would be excellent if Dynaread words could be included among the words used to teach application. Doing this would, effectively, cement and 'back up' already acquired sight words and make application easier at the same time.

(4) This is going to sound obvious but ... find something that he really wants to read. Try out everything. Let him choose and let him stay with what he loves for as long as he wants. Fiction, non-fiction, many authors, many topics, many formats, graphic/cartoons, colorful characters ... anything and, if he wants to read something that is too hard, simplify sections of it and, together, do it anyway. I can't do enough to stress how important this is. It's not rocket science but it can make all the difference in the world. When they find the right things, they just take off and you wonder what on earth just happened.

ELAINE adds... : Teachers/tutors can 'level' a text by summarizing, paraphrasing and shortening it ... with simpler words that they can definitely use with the child. It's effortful on the part of a tutor. They have to be good at paraphrasing and summarizing ... but it is a pretty common and effective technique. The child still reads and learns the content that interested him but he isn't asked to read beyond his own level.

The analogy between physical and reading disabilities isn't always appropriate. I have one severely dyslexic child who wanted to run. He was only interested in, and would only try to read, books about animals. The books he wanted were way above his level but, initially, at least, he only wanted the pictures and the facts ... so we/I ended up cherry picking facts from quite difficult books. We used the pictures and captions to learn the facts together. Initially, I did almost all of the reading but then we would pull out the simpler words to work on and learn together. The level of learning kept him motivated but the level of reading instruction stayed very low. I credit this technique, however, for his remarkable improvements. He is extremely motivated to increase his knowledge on his own, read those hard 'fact' words and those books on his own and he is now (9 months later) reading vocabulary that is way above his grade level. Easy texts just always bored and de-motivated him. Now he's excited. (the principles of CLAD clear language and design can be of great assistance here ex. line breaking).

I think the main thing, is to remember that the child is not expected to do these things on their own. It's about essential teacher/student 'scaffolding'; a gradual shift/transfer of responsibility and skill from teacher to student.

HANS: Personally, I would like to add a little balance here as well. We all know the paradigm from which she is reasoning: Inner drive and motivation can do so much more than any 'external' force. Though this may be true, it never brought my friend Matthijs with his quadriplegic condition to walking. Eric did not demonstrate mild dyslexia (rather: severe dyslexia). The risk of toying with reading materials whilst not really being able to read is that they contextually guess their way through the text. In that process, the orthography of one word gets coupled with the semantics and pronunciation of another, which effectively results in polluting their reading system with inaccurate information. If a child is making progress and starts to be able to read, then I can follow Elaine's argument, but personally -- based on Eric's demonstrated abilities in his Dyslexia Test -- I would judge this too early.

ELAINE continues...

(5) Separate reading and reading comprehension as much as possible. Concentrate on one of these at a time. Unless a child is extremely motivated and willing to do a lot of start-stop-recap and rerun ... try to do word decoding before or after you've read the text. Learn problematic words in advance ... read them for the student as you go along ... or read them with the student if you can do it fluently together. Motivation goes asunder when decoding effort is painful.

2. HOW TO HELP HIM SUCCEED WITH INCREASINGLY COMPLEX READING MATERIALS AS WE PREPARE HIM FOR END-OF-YEAR GOVERNMENT PROVINCIAL ACHIEVEMENT TESTING AND BEYOND

ELAINE shares...

With increasingly complex reading materials ... remember that there are two kinds of texts; ones that a child can read on their own and those that they can only attempt with help. You have to use both. Learning comes from 'the new' while mastery and pride comes with the independent practice. So, it's ok if they want to read easier texts if, together, you are also reading things that are more difficult. Harder things move into the 'easy' category and we leap frog along in that fashion.

Also, don't forget that reading depends on basic language and listening skills. And reading is not the only way to improve and expand them. The richer the child's language, knowledge and story-telling environment the better.

HANS: This point of Elaine I cannot stress enough. There is significant research demonstrating that children who have been read to lots when young, and who grow up in a verbally rich environment enjoy a language development advantage. As shared earlier, reading is merely a stage in overall language development. But it is crucially important to recognize two things here:

1. Initial reading merely couples the orthography of words to the already present verbal vocabulary of the child. This is where the rich verbal environment and the being-read-to comes in as an advantage. Audio books, likewise, can help here as well.

2. ... and the following is something I would like to do more structured research in one day... When you study the works of Chomsky and other linguists, you come to realize the role of reading in our ability to grow intellectually as well. We can only 'merge' ideas and concepts if we know them. We cannot combine e.g. flour, salt, and water to come up with bread if we have never heard of flour. Reading plays a significant role in expanding our overall know-how and understanding, resulting in enriching our access to individual ideas and concepts, which we can subsequently 'merge' into original new thinking and ideas. This point is obviously a bit out of Eric's direct-needs context, but it does argue for two things: (a) It is of great value to him, if we succeed in becoming a functional reader, and (b) exposure to audio books and other non-reading materials can help make up for what he misses out in reading. And my preference would go out to audio-books over e.g. videos, because books cover subjects in so much more detail and a video.

ELAINE continues... I really wouldn't worry, at all, about preparing Eric for the PAT test (or any other standardized test until he reaches the final years of high school). Teachers are often encouraged to 'teach to the test' for these events but, especially in Eric's case, this would be counterproductive. These tests are more about evaluating schools and school systems than they are about testing individuals. Eric will, of course, have to take the test with everyone else but it won't yield any specific knowledge that will be of much use to you. Keep him on his usual program.

HANS: I could not agree more with Elaine. If at all possible and/or permissible, I would not have him involved. At this point in Eric's life it would be the equivalent of asking Matthijs to participate in the Athletics test on running a quarter mile. It only pains him, and does not yield any advantage for Eric.

3. HOW TO OPTIMIZE OUTCOME AND POTENTIAL FOR A STUDENT LIKE ERIC, EVEN UTILIZING ASSISTIVE TECHNOLOGIES IF NEEDED

Get him onto Dynaread and ensure that his Orton-Gillingham program is systematic and explicit and stresses phonics application in spelling as well as reading. Do and try anything and everything to (1) find material that really motivates him (even if it wouldn't be your choice for him) and (2) other activities and friends that make his life meaningful and fun at school and at home. More than this? I don't think you can do too much more than this. Don't forget to appreciate, congratulate and reward yourself for all of your efforts. Eric is lucky to have you.

HANS: Building on what Elaine closed her paragraph with, your school displays remarkable commitment and ability. Keep it up!

Regarding assistive technologies, well that's a thorny issue. When should we start using them? I recommend that you keep them on a backburner for a while. Voice recognition programs are becoming more and more popular but there is still room for them to improve. There are pens and other scanners that will read text aloud for you; tools that I'd suggest to any adolescent or adult. And one can ask for extra time for tests and assignments that are graded; something that's really important as soon as poor reading skills begin to mask displays of subject knowledge and other practical skill development. These are all good tools but, I have a lot of experience teaching adults as well as children so I'm acutely aware of the fact that the early years are the best learning years. Unfortunately, it rarely gets easier than it is now. It would be a terrible thing to miss any of the potential of these years by moving into adaptive technologies too quickly.

HANS: I point back to my video again. I do believe there is good use for AT, though, but... NEVER at the expense of full throttle efforts to help Eric learn to read. These AT are often rolled out as RT's (my coined term: Replacement Technologies). AT's should remain assistive and never replace the effort to learn to read.

Lastly, allow me to refer you to a white paper by the International Dyslexia Association, on Accomodating Students with Dyslexia in All Classroom Settings. https://www.dynaread.com/accommodating-students-with-dyslexia

End of Case Study

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The following are some case studies of dyslexics with whom we have worked over the past years. In each story, we provide background information, the course of therapy that integrates the individual's strengths and interests, and the outcomes—all of which are positive.

Case Studies for using strengths and interests

Case Study One:

Grace has a diagnosis of dyslexia. She has trouble with visual scanning, processing, and working memory. She also has difficulties with spelling and sequencing for problem solving. She has strong verbal skills and is artistic abilities. She learns well with color and when her hands are occupied.

Grace struggled with note taking because of her difficulties with spelling and visual scanning (looking from the board to her paper). Furthermore, she could not keep up and got "lost" in the lecture (particularly for subjects that were already difficult for her). Grace’s teachers thought that she was not putting forth the effort, because they often saw her daydreaming in class. When the therapist asked Grace about this, she admitted that sometimes she would daydream because she did not know where they were in the lecture. She also desperately wanted to blend in with her peers, so she looked to them to see what she was supposed to be doing. However, when she was permitted to follow along with a book that she could highlight in and make her own doodles and notes in the margins during the lecture, she was able to focus her energy on the teacher and have notes that she could refer back to later with all of the main points highlighted. Using Grace's kinesthetic learning style and preference for color, she was able to participate with her peers, decrease her anxiety in class, and develop a skill that will help her to learn better across the curriculum.

Due to her difficulties with sequencing, working memory, and reading, Grace struggled with numerical operations and story problems in math. Her problem solving skills were good when she could leverage her strengths: connecting abstract ideas and thinking at the macro level. Hence, when she could connect a concept to a real life problem, she could inevitably come up with a creative solution and grasp the concept; however, her poor numerical operations skills were still holding her back. The therapist remembered Grace's interest in color and tactile learning style and introduced her to a number of "hands-on" ways of solving the problem: calculating probability with colored marbles, using her fingers for multiplication, and solving equations with objects to represent the variables. In this manner, Grace not only grasped the concept that was presented at the macro-level, but using her love of color and keeping her hands moving she could reliably solve for the answer. Employing colored pencils for numbering steps or placing hash marks in multi-step directions helped Grace stay on point and not skip steps in complex problems. These strategies were incorporated into her 504 Plan and were communicated to her math teacher.

Case Study Two:

Amy has a diagnosis of dyslexia. She enjoys creative writing, fashion, and art. She is extremely bright and has a strong memory. She benefits from rule-based instruction. If you tell her a rule once, she will be able to recite it to you the next time you see her. She delights in being able to be the teacher and teach the rules herself or correct others’ errors.

Amy’s stories often jumped around without any cohesion or plot. The clinician suggested that Amy work on her stories on a daily basis. Amy drafted her stories about glamorous people and enjoyed illustrating their wardrobes. Her clinician helped her to expand and revise her story using a multi-sensory tool to teach her the parts of story grammar. She was able to revise her own story, by adding the components of a good plot (characters, setting, initiating event, internal response, plan, and resolution). With several revisions, she produced a well-developed story and colorful illustration that was framed and displayed. The combination of using Amy’s interests, learning style, and a powerful reinforcement (framing and displaying the finished product) lead Amy to become proficient in telling stories and in revising her own work.

Case Study Three:

Ryan has a diagnosis of PDD-NOS that affects his language, social, and literacy skills. He also struggles with anxiety. He has a number of interests including: pirates and treasure, cooking, watching his favorite TV shows, and drama. Ryan has a strong memory and conveys a great deal of social knowledge when he is acting or drawing.

Due to Ryan’s anxiety associated with reading and writing, he often protested and completely shut down when presented with something to read or write. Ryan watched a number of shows that taught lessons about friendship or had a “moral to the story.” He was able to take some of those themes and stories and modify them, inserting kids from his school as the characters, and adding himself as a character and narrator. Given his interest in drawing, he illustrated his story, and made it into a short book.

The clinician wanted to incorporate his interest in writing and illustrating stories to improve his social skills. The therapist suggested that Ryan make his story into a play, and that he could be the director. Through a series of role-plays, Ryan was able to overcome his social anxiety and invite a peer to act in his play. Numerous social skills were targeted: greetings, turn-taking, active listening, problem solving, and flexibility for handling unforeseen circumstances. Ryan has now directed four plays, and has written countless others. To date, five of his peers have come and acted in his plays. (It has become a “cool” thing to do in Ryan’s social circle). He has gained a great deal of confidence in relating to his peers and in his strength of writing and directing plays.

In addition to social skills, Ryan has struggled with reading and following directions, asking for clarification, and comprehending and using abstract vocabulary. These areas were addressed using his interests in cooking and treasure hunts. Ryan participated in a number of baking projects that required him to locate the directions on the package, sequence and follow each step in a sequence, and determine the meaning of new vocabulary. Since this was in a context that he enjoyed, his attention was high and his anxiety was non-existent. Furthermore, Ryan had the opportunity to learn a new recipe and build on his strength for baking. Since his learning was in context, he was able to remember the meanings of abstract vocabulary. Ryan’s social skills were targeted when he went to the various offices in the building and offered his baked treats. He inevitably received positive social feedback.

Another motivating context for boosting Ryan’s reading for directions and vocabulary skills was participating in scavenger hunts around the building. He enjoyed the challenge of complex directions because there was an element of surprise and adventure. There was a notable consequence if he incorrectly followed the directions. This created the opportunity for Ryan to ask for directions or seek clarification. Since his learning was in context (i.e., he was looking at a fire extinguisher when he was reading the word for the first time), it was memorable. Many conjunctions (but, therefore, so, if) and sequence words (when, at the same time, before, after, next) were targeted multiple times, which led to mastery. This multi-sensory activity was enjoyable for both Ryan and the clinician. For Ryan, it resulted in greater participation, gains, and retention than traditional teaching approaches.

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Dyslexia: A Student Case Study

When a child is diagnosed with dyslexia, parents often want to know what the road to reading and spelling success will look like.  While this road varies from child to child, there are certain landmarks that characterize the journey.  These include initial success with word attack which leads to improvement in automatic word recognition and eventually improvement in spelling.  The following case study describes one child and her experience.**

Karen’s mother Anna came to Commonwealth Learning Center when Karen was in the middle of second grade.  Karen’s speech was remarkable for phoneme reversals – She said the word  breakfast  as  bress-ket , the word  animal  as  aminal , and the word  especially  as  peshasly . Karen had not made expected progress in reading during her first grade year and her parents were growing restless with the Response to Intervention Model at the school. They decided to seek a private evaluation, and during the debrief following the evaluation, the neuropsychologist suggested that they seek private tutoring. Anna and I met and talked about Karen’s likes and dislikes and how she felt about possibly starting tutoring soon. This information is just as important as testing as it helps ensure a good teacher match and a smooth start to tutoring. I asked permission to speak with the neuropsychologist given the absence of a written evaluation. (The report was forthcoming but Karen’s parents did not want to wait.) The neuropsychologist described Karen as a lovely and bright child with severely compromised phonological awareness and rapid naming, hallmarks of dyslexia. Not surprisingly, her word attack skills, word identification, and single-word spelling were also below the 16th percentile. Her spelling was not phonetic; in other words, she did not represent each sound of the word with a letter. She wrote  luc  for  lunch ,  bet  for  best , and  sak  for  snack .

Karen began her twice weekly Orton-Gillingham tutorials the following week.  She enjoyed the one-to-one time with her teacher and relished the opportunity to play games that incorporated her interests – word cards with kitten stickers on the back and sentences written with purple marker. She wrote in sand and on shaving cream and in big letters in the air. Her ability to read words and eventually books grew alongside her confidence. After six months, Karen had some benchmark testing. Her phonological awareness was in the 42nd percentile and her word attack skills were now in the 34th percentile, but her word identification and spelling were below the 25th. This is common. Word attack is measured by giving the child phonetically regular words (words that can be “sounded out”); many of them are single-syllable words. This is just what she had been working on in tutoring. Word identification and spelling on most assessments is measured by giving a child a mix of phonetically regular and irregular words.

Karen continued with tutoring, learning syllable types, spelling generalizations, and syllable division strategies.  Karen had another set of benchmark testing a year later, one and a half years into tutoring, at the start of her fourth grade year. At that time, Karen was reading grade level text according to the Qualitative Reading Inventory. She had solidly average word attack and word identification skills (both hovering around the 50th percentile). Karen had made gains in spelling; her mistakes were so much better! She represented each sound she heard in words, but she had a terribly hard time knowing whether to spell  compete  as  compeet ,  compete , or  compeat …They all sounded right! The good news was that since Karen’s spelling mistakes were better, most of her errors were the type that could be corrected through spellcheck software. The other area that lagged behind was Karen’s reading fluency – While her accuracy was fantastic (98% or more of the words read correctly), her rate was below expectations for grade level. It is fairly common for students with dyslexia to read more slowly than their peers, and, for this reason, many access audiobooks when the reading load becomes too heavy to carry without support. While Karen does not yet need this support as a fourth grader, it is likely that she will as she progresses through the grades.

Karen no longer attends tutoring during the school year, but she plans to return during the summers to ensure that she maintains and improves upon the skills that she has worked so hard to obtain.  Oh, and she wants to talk to her tutor about her new favorite book series:  The Chronicles of Narnia !

Submitted by Shadi Tayarani, M.Ed Director of Commonwealth Learning Center, Danvers

** Names have been changed to protect the family’s privacy.

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The Case for Early Dyslexia Screening

• Posted October 19, 2023
• By Jill Anderson
• Cognitive Development
• Early Education
• Families and Community
• Language and Literacy Development
• Learning Differences and Accessibility

Associate Professor Nadine Gaab wants to see the whole system surrounding children and reading development change — starting in utero. Earlier intervention can be the ultimate game-changer when it comes to identifying children with dyslexia or other learning differences. 

“When it comes to learning differences such as dyslexia, we are largely focused on a reactive deficit-driven wait to fail model instead of the development of preventative approaches,” she says. Gaab is a neuroscientist who researches the development of typical and atypical language and literacy skills in the pediatric brain, and pre-markers of learning disabilities. 

"What we could show is that some of these brain alterations are already there in infancy, and toddlerhood, and preschool. So what we can conclude from this is that some children step into their first day of kindergarten with a less optimal brain for learning to read. So you want to find them right then, right? And that has tremendous implications for policy," she says. "You don't want to wait and let them fail if you already can determine who will struggle most likely and who will not."

While there have been some efforts to mandate universal dyslexia screening, it is only one small part of what needs to be done to take steps toward addressing the needs of children, something that Gaab envisions an entire community — beyond just the school walls — being a part of, from pediatricians to bus drivers to librarians.

In this episode of the EdCast, Gaab discusses what we know and don’t know about dyslexia and literacy development, and why the need for intervention — as early as preschool — could be the most impactful thing that happens. 

JILL ANDERSON: I'm Jill Anderson. This is the Harvard EdCast. 

Nadine Gaab knows early dyslexia screening and intervention could change outcomes for millions of children. She's a Harvard neuroscientist whose research focuses on language-based learning disabilities and typical and atypical reading development. An estimated 5% to 10% of Americans have dyslexia, but screening and diagnosis can be complicated and take time.

Many states have begun mandating universal dyslexia screening at an early grade, but it's only a small piece of what has to be done to move toward what she calls a prevention model. I wanted to know the potential impact of early screening and what's keeping it from happening. First, I asked Nadine to tell me what is dyslexia.

NADINE GAAB: This is actually a very complicated question. And I think if you would ask 50 people to define, it you would maybe get 50 different responses. So the field itself is not really sure how to define it. The way we define it is it's a specific learning disability with a neurobiological origin. So there is a brain correlate to it. And it's usually characterized by difficulties with accurate and/or fluent word reading.

And we want to put the emphasis here on word reading because it's the mechanics of learning to read that usually is the core symptom of developmental dyslexia. So we have poor decoding abilities. You could have poor spelling abilities. And so it's that deciphering of single words, the decoding of single words, that's the core symptom of dyslexia.

Subsequently, it can lead to problems with reading fluently and comprehending what you read. But I think it's really important that we define it at the word level in these children.

JILL ANDERSON: Is that partly why it is so hard for children to be identified as dyslexic?

NADINE GAAB: I think the reason why it's so hard is more a systems level problem than it is the definition of what it is.

JILL ANDERSON: Right.

NADINE GAAB: Often, we get hung up on the definitions. Or does the child have dyslexia? Or is it another reading disability? Maybe this child is only struggling because of environmental reasons or they were late talkers. There's all these different factors.

What's really important is that we find kids who struggle with reading early and help them early regardless of what the underlying cause is. And whatever diagnosis we give the child should be the one that helps them most within the systems they're living in.

JILL ANDERSON: We're going to talk a bit more about early screening and early intervention, but is there some sort of paradox between what we know in brain science about dyslexia and intervention versus what's actually happening on the ground in schools?

NADINE GAAB: Yes. The biggest problem right now is that, when it comes to learning differences such as dyslexia, we are largely focused on a reactive deficit-driven wait to fail model instead of the development of preventative approaches. So let me explain it a little bit more.

So as a society, we embrace preventative medicine, right? So we love vaccines and checkups. And we get mammograms. We all do this so that we don't get sick.

NADINE GAAB: So we are trying to do this preventative angle. We don't do that as much in education, where we more or less have the kids start school. Then we kind of observe who is struggling. And we observe a little bit more and observe a little bit more. And there may a bit of response to intervention, et cetera, et cetera. But overall, it's more a wait to fail model than it is a preventative model.

What we knew since probably the last 25 years is that the brains of children who are struggling with reading, including dyslexia, show some alterations. So their brain development is different from children who don't struggle with learning to read. What we didn't know for the longest time is whether this is a result of struggling on a daily basis since kindergarten.

So is it that they all kind of start the first day of kindergarten with a clean slate when it comes to brain development, and then the brain changes because they're struggling on a daily basis? Or do these brain alterations predate the onset of formal reading instruction? And what we could show is that some of these brain alterations are already there in infancy, and toddlerhood, and preschool.

So what we can conclude from this is that some children step into their first day of kindergarten with a less optimal brain for learning to read. So you want to find them right then, right? And that has tremendous implications for policy. You don't want to wait and let them fail if you already can determine who will struggle most likely and who will not.

JILL ANDERSON: When you hear that, the obvious question becomes, why has it been so hard to implement some form of earlier screening if we already know that many children can get early intervention and change the outcomes?

NADINE GAAB: Yeah. It's really a problem on the systems level, right? I want to just emphasize that we can't use brain imaging on the individual basis to determine this child will develop dyslexia and this child will not. And I don't think that's where we want to go, but we behaviorally know. In 3 and 4-year-olds, we can reliably identify based on a series of prereading tasks and milestones who will most likely struggle with learning to read.

But the educational system is not really a preventative system as we have in medicine. And I think it just takes a shift in mindset in order to move from that wait to fail model to a more preventative lens. And we need to make sure that we look into prekindergarten and other preschool educational settings. We need to train teachers in order to understand these milestones and being able to recognize, being able to intervene early.

So there's a lot of different levels related to policy, related to how we currently operate in terms of literacy development, and how early literacy development starts. So most people still think it starts maybe late preschool or midpreschool. But in my lab, we know that literacy development starts in utero because the fundamental milestones for learning to read are sound and language processing. And they start as early as in utero.

JILL ANDERSON: Wow. I mean, hearing all of this makes me think this is a huge issue. And there's so many layers to it. So we're seeing movement on one end in that many more states have begun to mandate universal dyslexia screening in children between kindergarten and second grade.

NADINE GAAB: Yes.

JILL ANDERSON: And that's a big step forward, but it sounds like that's still not necessarily going to be enough to respond and help these kids.

NADINE GAAB: Yeah. So there's many, many more layers to this. It's definitely a really good first step that we now have, that early screening legislation in most states in the United States. But often, educators don't know what kind of screeners to use. They don't know how to interpret the screening results. 

So there's the lack of data literacy in many educational settings is a problem. But also, often pre-K, kindergarten, first grade teachers are not trained to intervene and remediate some of these early signs that these screeners pick up. And so that's where higher education needs to come in where we need to have teachers learn these kinds of things in their teacher training.

Another set of issues is related to having assessments that are working well for multilingual learners, for dialect speakers, that are really culturally responsive and inclusive. And so there's many different layers to follow now. We can't just lean back and say, now we have legislation and everything. We'll automatically move to a more preventative model in education.

JILL ANDERSON: If you could snap your fingers and just change everything instantly, what do you think it would look like to have that preventative model in place? It would start in utero it sounds like.

NADINE GAAB: Yeah. So I think it's really important that we shift our mindset and say that reading development starts in utero, right? So if we think about this, then after the child is born the next steps of successful reading development are all within the framework of oral language, right?

So the child learns to distinguish which sounds belong to her or his or their native language versus other languages. We learn the meaning of the words and the rules of our language. And then years later, we learn to map the sounds of our language or languages onto the graphemes and start putting those together and start decoding. The ultimate goal is to read paragraphs and comprehending what you read. So if you see reading development as a very complex skill that starts in utero and develops all the way into late adolescence or adulthood and that we recognize that it needs a lot of explicit instruction and practice, I think that will bring us a long way. Because what that means is that, if we place reading development as starting in utero, then the first four, four and a half years of reading development are actually oral language development.

So if we think about early identification, if you think about how can we prepare children for successful reading acquisition, we want to focus as much on the oral language component, listening, comprehension, vocabulary, as much as on the mechanics of learning to read. So learning the letters, the sounds of the letters, and decoding, morphology, et cetera.

JILL ANDERSON: And we know-- one of the things I know from hosting the EdCast is just how we teach reading is such a hotly debated subject in America. I mean, it comes up regularly in episodes. Anything that has to do with literacy, it seems to come up. Because that's just something that not everyone seems to agree on. And not that I want to take us down a path of talking about the reading wars today.

NADINE GAAB: Thank you.

JILL ANDERSON: But it seems like that kind of plays into this.

NADINE GAAB: Yeah. I'm a little bit more optimistic. I think we have the science of reading. And I think we need to understand what the science of reading is and what it's not, right? So what it's not is it's not some ideology or philosophy. And it's not a political agenda, or a certain program of instruction, or a single specific component of instruction such as phonics. What it really is is the interdisciplinary body of all the scientifically-based research that many, many people around the globe have done over 50 years. And now, what we do is we are taking that body of knowledge and applying it into the school systems. And so the translational component is difficult as we know from many other disciplines.

And so I think we should see similar to climate, right? So we didn't know as much about climate changes. But now, we do. And there is a vast interdisciplinary body. And now, we have to implement it into policy changes and systems level changes. And we have to do that in reading as well.

So I see it very optimistic. We just need to start fighting and working together and bringing the different strands together, which includes the oral language piece and background knowledge as well as the mechanics of reading. So I think if we just manage to put it all together, it will be a really good addition to the field and will eventually, hopefully, move these reading scores up.

JILL ANDERSON: When I think about that data of approximately 65% of all fourth graders are not reading at grade level, I try to imagine what would that look like if we had some early intervention in place to actually identify challenges kids may have or learning disabilities that kids may have.

NADINE GAAB: Yeah. I mean, 65% of fourth graders are not reading at grade level. But I think it's important to mention that not 65% of these fourth graders have dyslexia, right? There's many—

NADINE GAAB: --different factors that contribute to atypical reading development. So you have genetics. You have brain development. You have perception and cognition. And you have the environment, right? 

Many years ago, I think the field thought, if you just find this one cause of dyslexia, we can just work on it. And then all children will miraculously read well. But I think the field has long moved away from this and now sees the multifactorial aspects and how these factors interact with each other.

I think what we need to do is really work on all of these components, so environmental factors such as neighborhood factors and stress related to maybe chronic illness of the parent, immigration status, socioeconomic status, trauma, et cetera, et cetera. We've had many good policies put in place. So we had the National Reading Panel, and No Child Left Behind, and the Individuals with Disabilities Education Act, and Decoding Dyslexia, and other aspects.

But that really has not moved the needle much if you look at the National Center for Education Statistics. So it's not that these 65% are suddenly showing up and we were reading fine 20 years ago or before COVID, right? No. It's been low all the way back to the '90s.

And so I think we need to really think, based on the science we now know, what are some of the things we are missing. And so I think moving to a preventative model and seeing reading development similar to math, or executive functioning, or social emotional learning happening much, much earlier than we currently think they are. And so with that lens into infancy and early childhood and thinking about early identification and who is teaching these children early and how much are they appreciated in the educational system and their training and compensation will really move the needle in my opinion. It's not going to be the only thing, but I think it will be a really important piece.

JILL ANDERSON: In the meantime, we have parents, caregivers. They often seem to be the folks who are really working on this at least within their schools. They're trying to get services that they need for their kids. And it seems like in a lot of ways, even with a lot of the mandated screening, the parents and advocates are the people who are pushing this forward in a lot of ways. What is your advice to them as they wait for either more legislation or wait for some more change to take place?

NADINE GAAB: I think parents have done or caregivers have done an incredible job in the last 10 plus years when it comes to reading disabilities, including dyslexia. My advice would be to know your rights, work with your educators, take an active role in your child's reading development, know what the milestones are, know how important home literacy is, but also work in a community setting. So we do a lot of work with pediatricians, and social workers, and libraries, and other stakeholders in the process.

And we think that, in order to optimize how we care for children who struggle with reading or have a learning disability is to really improve that working together on the systems level. That includes the general educator talking to the pediatrician, or it includes the advocacy of people in the community like after school teachers, and bus drivers, and maybe officials in churches and libraries to know more about learning disabilities and optimize care for children who are struggling and do this as early as possible.

And I think we often say, well, the educators don't give us access to screening, or they don't know. I think we have to give a lot of credit to educators who really want children to do well, but often they haven't been trained on prevention and early identification. That's not part of teacher training preservice. 

It's not often a big topic in higher education. And also, the quality of evidence-based professional development and how it's delivered is often suboptimal. So I feel like the whole system needs to change for us to embrace more of a preventative model.

And then I think what's also really important-- and I want to make sure we mention this-- is that we still don't know whether there are language-specific risk factors. We know now that we can screen multilinguals and dialect speakers and that they need to be included in the screening process, but that development of equitable screening tools and assessments and eliminating biases and reading curricula and screening early identification even in the intervention process or the support systems and awareness is really, really important.

So it really takes a whole village. And I know every child has the right to learn to read well. So we all have to work together in order to maximize the joy of learning to read.

JILL ANDERSON: Nadine, well, thank you so much. This was really eye-opening and informative.

NADINE GAAB: Thank you so much for having me today.

JILL ANDERSON: Nadine Gaab is an associate professor at the Harvard Graduate School of Education. She leads the Gaab Lab, which focuses on typical and atypical learning trajectories from infancy to adulthood with a special focus on language and reading development.

I'm Jill Anderson. This is the Harvard EdCast produced by the Harvard Graduate School of Education. Thanks for listening. 

Correction: The audio version of this podcast references an inaccurate statistic. The correct percentage of Americans with dyslexia is 5% to 10%.

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Case Study – How Morningside Elementary School Helps Dyslexic Students Succeed

Teacher Training and a Well-Stocked Toolbox Help Dyslexic Students Succeed at One Atlanta Public School

Peek into a first grade classroom at Morningside Elementary School in Atlanta and there’s a good chance you’ll see students tapping out the sounds that comprise a word with their fingers or tossing bean bags in the air as they work to learn new words. In another classroom a group of third graders is decoding nonsense words while others sit in small groups engrossed in a discussion about a book they’re reading.

This is what reading instruction looks like at Morningside—and Audrey Sofianos, the school’s principal, couldn’t be prouder. “We provide a level of training that teachers never have. It just blows my mind. This is not what normal teachers are taught to do.”

Sofianos has good reason to boast. In September 2016 Morningside was named a National Blue Ribbon School by the U.S. Department of Education, in large part for an innovative literacy curriculum that includes an intensive focus on helping dyslexic students learn to read.

One sentence from Morningside’s application for the National Blue Ribbon designation neatly sums up this commitment: “We believe this cadre of teachers has the skills and tools needed to teach anyone to read no matter the challenge, and that is a powerful resource and component of our culture.”

Morningside, which has 889 students in grades K–5, is not a typical urban school. It has high student test scores and strong parental involvement, including a parent foundation that provides much of the funding for its extensive teacher training and innovative reading program. But the Morningside model demonstrates what is possible in a public school setting when administrators and teachers are determined to help all students, including those with dyslexia, reach their full potential.

Morningside’s literacy approach boils down to three key elements:

• A commitment to training teachers
• A well-stocked toolbox of options to meet the needs of every student
• A consistent approach to monitoring student progress

Teacher Training

Every teacher and administrator at Morningside is required to take a 70–hour training course called the Complete Reading Series (CRS), which covers early literacy, phonics, word roots and learning disabilities, including one component specifically on dyslexia. Because the course is broken down into a series of components, CRS can be learned by teachers over a few years without disrupting their classroom schedules.

CRS is designed to “empower teachers to possess, understand and master the content and instructional practices necessary to teach reading, spelling and comprehension to the gifted student, the general education student and to the student in need of remediation,” says Brenda Fitzgerald, executive director of the Georgia Educational Training Agency and creator of the program. In part, Fitzgerald based the course on research by the National Reading Panel, The Florida Center for Reading Research, the National Institute for Literacy and the work of Drs. Sally and Bennett Shaywitz of the Yale Center for Dyslexia & Creativity.

CRS was originally brought to Morningside during the 2011–12 school year by then-principal Rebecca Pruitt, who felt more needed to be done to keep students with dyslexia and other learning disabilities from leaving the school to receive more specialized instruction at private schools in the area, particularly The Schenck School, which specializes in educating dyslexic children. “When I moved to Morningside as their principal, I distinctly remember a family telling me they were leaving the school to go to Schenck, and I thought, ‘I want [my school] to have what they have. Why are people leaving? Who is going to take care of the kids who can’t afford that tuition? What is it that schools like Schenck have, and why can’t we do it here?’”

Pruitt made CRS a cornerstone of her efforts to retain such students. “CRS helps you start to peel back the layers of the onion” to reveal where students need extra help, says Pruitt. “Then it moves to programming for reading and for writing, and standardizing vocabulary, and looking at really understanding what work is needed to support our children.”

Today, 53 current Morningside teachers and administrators have completed or are in the process of completing CRS, which includes a day-long course on dyslexia given to the entire staff. Of those, 28 also have taken an intensive two-week training course in the Orton-Gillingham (OG) method, which uses visual, auditory and kinesthetic approaches to teaching reading and can be highly effective for dyslexic readers. Another 18 teachers and staff are scheduled to receive OG training over the next two summers.

“We consider this type of reading training and dyslexia-focused work a huge hallmark of our school,” said Sofianos, adding that the goal is for 100 percent of teachers and staff, including herself, to receive the OG training. “Our teachers have a lot of knowledge in how reading is taught and developmentally what should be happening along the way. That makes it much easier to identify whether a student is dyslexic or not.”

A Well-stocked Toolbox

Teachers at Morningside never rely on just one program or textbook. “We have multiple tools in our toolbox, so if one method isn’t working for a student we can always try a different approach until we get it right,” said Laurie Luckmann, a first grade teacher.

In addition to CRS and OG, those tools include Wilson Fundations Phonics, a research-based program that incorporates OG methods for teaching phonics and spelling in grades K–3. Each Fundations lesson focuses on carefully sequenced skills, including alphabet awareness, phonological awareness, phonemic awareness, decoding, vocabulary, fluency and spelling. It is designed to help teachers quickly identify and address reading, spelling and writing challenges.

Another critical tool in the toolbox is a reading manual created by the school to ensure all teachers understand and adopt Morningside’s balanced literacy approach, which progresses from phonemic awareness to phonics; decoding and fluency to reading comprehension; and vocabulary building through word study.

With this wide range of tools at their disposal, teachers have the flexibility to adapt quickly to students’ individual needs. For instance, Luckmann says that when her students are learning to read a non-phonetic word like “said,” some will “just know it after it’s repeated five or six times while others may need to write it 15 or 20 times in shaving cream before they get it” or toss a bean bag as they say the word.

These strategies are common at schools for students with learning disabilities, but extremely rare in mainstream public schools. “We use a very sensory approach for some kids such as tapping and clapping to help them sound out words and make the connection physically,” says Amelia Morel, an Early Intervention Program reading teacher for third and fourth graders.

Morel knows firsthand how unusual it is for public school teachers to understand and embrace such techniques. She spotted red flags in her own son’s reading that eventually led to a dyslexia diagnosis even though teachers at his school insisted he was “doing just fine.”  Morel doesn’t blame the teachers but notes that they “simply don’t have the training” to recognize such problems.

Because all Morningside teachers receive the same training and tools, they also can more readily help each other when they aren’t sure what approach to take for a student. “I run things by Laurie (Luckmann) a lot to see if what I’m doing makes sense,” says Morel.

Monitoring Progress

Consistent training and use of the reading manual and Fundations means all teachers know what normal progress looks like and can immediately spot problems when a student is struggling to read. Three kids in Luckmann’s class of 20 students have been diagnosed with dyslexia, and 20 percent of students in grades three, four and five are receiving remedial reading services, most of whom are likely dyslexic, according to Morel. (As in many states, Georgia law prohibits schools from specifically identifying kids as having dyslexia.)

These students are monitored every week to check their progress. For instance, Morel’s third and fourth graders receive weekly nonsense-word fluency tests that align with whatever phonics they’re working on. To show mastery in a particular area, such as closed-syllable words with a vowel-consonant-consonant-vowel pattern, the students need to be able to read 10 nonsense words that follow that pattern in a minute or less. “Many couldn’t do it initially, but by the end of the unit all were getting at least eight to ten words right. This shows us that they have mastered that phonics piece” and are progressing toward greater fluency, says Morel.

Part of the strength of Morningside’s approach is that it benefits all students, not just those who are dyslexic. “I know every kid who goes through the first grade program is rock solid with this stuff and comes out with incredible phonics skills. It’s what all kids need,” says Luckmann.

Since adopting the program, student achievement overall has increased significantly at Morningside. Scores on Georgia’s Criterion-Referenced Competency Tests (CRCT) rose from 77 percent of the students exceeding in reading in 2012 to 90 percent in 2014. (This is the latest data available; the test used by the state changed in 2015.)

Morningside’s successful literacy program stems from a deep commitment by its leaders, starting with former principal Pruitt and continuing now with Sofianos. But it also helps significantly that the school has the financial resources to match that commitment. Funding for the program, including the training courses and Fundations, comes solely from the school’s parent foundation. And none of it is cheap. The 10-day OG training, for instance, costs $1,100 per teacher, and the 12-day CRS course, typically taken over a two-year period, is $980 a head.

Sofianos readily admits that the school could not pay for any of this without parent support. “The funds we get from the district to develop teachers are the same funds we get to buy paper, scissors and pens,” she says, adding that the parents are “very proud to have well-trained teachers and happy to support the program.”

For schools without such support, adopting similar programs may seem prohibitive. For its part, Atlanta Public Schools is working to replicate elements of the Morningside approach district-wide, including recently purchasing Fundations for schools throughout the district.

Morningside teachers believe the type of training they’ve been lucky enough to receive should be standard practice in every school. Says Luckmann, “What makes me feel so good about coming to work every day is that I know what I’m doing for dyslexic kids will help all my kids. There is no doubt in my mind.”

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The 100 Top-Cited Studies on Dyslexia Research: A Bibliometric Analysis

Shijie zhang.

1 Department of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China

Yonggang Zhang

2 Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China

3 Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China

Associated Data

The original contributions presented in the study are included in the article/ Supplementary Material , further inquiries can be directed to the corresponding author/s.

Background: Citation analysis is a type of quantitative and bibliometric analytic method designed to rank papers based on their citation counts. Over the last few decades, the research on dyslexia has made some progress which helps us to assess this disease, but a citation analysis on dyslexia that reflects these advances is lacking.

Methods: A retrospective bibliometric analysis was performed using the Web of Science Core Collection database. The 100 top-cited studies on dyslexia were retrieved after reviewing abstracts or full-texts to May 20th, 2021. Data from the 100 top-cited studies were subsequently extracted and analyzed.

Results: The 100 top-cited studies on dyslexia were cited between 245 to 1,456 times, with a median citation count of 345. These studies were published in 50 different journals, with the “Proceedings of the National Academy of Sciences of the United States of America” having published the most ( n = 10). The studies were published between 1973 and 2012 and the most prolific year in terms of number of publications was 2000. Eleven countries contributed to the 100 top-cited studies, and nearly 75% articles were either from the USA ( n = 53) or United Kingdom ( n = 21). Eighteen researchers published at least two different studies of the 100 top-cited list as the first author. Furthermore, 71 studies were published as an original research article, 28 studies were review articles, and one study was published as an editorial material. Finally, “Psychology” was the most frequent study category.

Conclusions: This analysis provides a better understanding on dyslexia and may help doctors, researchers, and stakeholders to achieve a more comprehensive understanding of classic studies, new discoveries, and trends regarding this research field, thus promoting ideas for future investigation.

Introduction

Dyslexia is a common learning disorder that affects between 4 and 8% of children ( 1 – 3 ), and often persists into adulthood ( 4 , 5 ). This neurodevelopmental disorder is characterized by reading and spelling impairments that develop in a context of normal intelligence, educational opportunities, and perceptual abilities ( 4 , 6 ). Reading and spelling abilities can be affected together or separately. The learning abilities of children with dyslexia are significantly lower than those of their unaffected pairs of the same age. Generally, difficulties begin to show during the early school years. Dyslexia is a complex multifactorial disorder whose etiology has not been fully elucidated, and it has caused great social and economic burdens. Over the last few decades, the research on dyslexia has made some progress. For example, some studies have shown that dyslexia has a strong genetic background that can affect brain anatomy ( 7 , 8 ) and function ( 9 , 10 ). But a citation analysis on dyslexia that reflects these advances is lacking.

The publication of study results in scientific journals is the most effective strategy to disseminate new research findings. A high number of citations can indicate the potential of a paper to influence the research community and to generate meaningful changes in clinical practice ( 11 ). Citation analysis is a type of quantitative and bibliometric analytic method designed to rank papers based on their citation counts. The latest and up-to-date research findings on dyslexia are well-reflected in recent scientific papers ( 12 ), particularly in the most cited ones ( 13 , 14 ). By analyzing the most cited studies, especially the 100 top-cited studies, we can gain better insight into the most significant advances made in the field of dyslexia research over the course of the past several decades ( 15 ). This retrospective bibliometric approach has been used for many other diseases, such as diabetes ( 16 ), endodontics ( 17 ), cancer ( 18 ). However, to date, no bibliometric analyses have been conducted in the field of dyslexia. Therefore, the aim of the present study was to analyze the 100 top-cited studies in the field of dyslexia.

Materials and Methods

Search method and inclusion criteria.

This retrospective bibliometric analysis was conducted using the Web of Science Core Collection database. The Web of Science Core Collection is a multidisciplinary database with searchable authors and abstracts covering a vast science journal literature ( 19 ). It indexes the major journals of more than 170 subject categories, providing access to retrospective data between 1945 and the present ( 20 ). On May 20th, 2021, we conducted an exhaustive literature retrieval, regardless of the country of origin, publication year, and language. The only search term used was “dyslexia” and the search results were sorted by the number of citations.

Article Selection

Two authors independently screened the abstracts or full-texts to identify the 100 top-cited articles about dyslexia. Disagreements were resolved through discussion. Only studies that focused on dyslexia were included in subsequent analyses. Studies that only mentioned dyslexia in passing were excluded.

Data Extraction

The final list of the 100 top-cited studies on dyslexia was determined by total article citation counts. We extracted the following data for each article: title, authors, journal, language, total citation count, publication year, country, journal impact factor, type of article, and Web of Science subject category. If the reprint author had two or more affiliations from different countries, we used the first affiliation as the country of origin. If one article was listed in more than one subject category, the first category was selected. If one article had more than one author, we selected the first-ranked author as the first author and the last-ranked author as the last-author.

Data Analysis

SPSS 11.0 (Chicago, IL, USA) was used to count the frequency. We analyzed the following data: citation count, year of publication, country, the first author, journal, language, type of study, and Web of Science subject category.

Citation Analysis

The 100 top-cited studies on dyslexia based on total citations are listed in Table 1 . The total citation count for these 100 articles combined was 42,222. The total citation count of per study ranged from 245 to 1,456 times, with a median citation count of 345. Only 3 studies were cited more than 1,000 times, and the rest of the studies were cited between 100 and 1,000 times. The title of the top-cited study, which also had the largest mean citation per year count ( n = 91), was “Reading acquisition, developmental dyslexia, and skilled reading across languages: a psycholinguistic grain size theory,” which was published by Ziegler et al. in Psychological Bulletin in 2005 ( 21 ). The second top-cited study, which also had the second-highest mean citation per year count ( n = 80), was published by Vellutino et al. ( 22 ). In addition, we also identified the 100 top-cited studies on dyslexia based on mean citation per year, whose results were shown in Supplementary Table 1 .

The 100 top-cited studies on dyslexia based on total citations.

USA, the United States of America; UK, the United Kingdom.

The different journals of the 100 top-cited studies on dyslexia and their associated impact factors are listed in Table 2 . The 100 top-cited studies on dyslexia were published in 50 different journals, with the top three in frequency being “Proceedings of the National Academy of Sciences of the United States of America” ( n = 10), “Brain” ( n = 6), and “Journal of Educational Psychology” ( n = 6).

Journals of the 100 top-cited studies on dyslexia.

The journal with the highest total citation count was “Proceedings of the National Academy of Sciences of the United States of America.” However, the highest average citation count per study belonged to the journal “Psychological Bulletin.” The journal impact factors of the 100 top-cited studies on dyslexia ranged from 1.315 to 74.699. Of the 100 top-cited studies, 29 were published in a journal with an impact factor greater than 10. The standard “CNS” journals, with the exception of “Cell,” “Nature,” and “Science” published 2 and 3 studies, respectively. Regarding the top four medical journals, while the “New England Journal of Medicine” and “Lancet” published 2 studies each, no top-cited study was published by the “Journal of the American Medical Association” or the “British Medical Journal.”

Language and Year of Publication

The 100 top-cited studies on dyslexia were all published in English and were published between 1973 [by Boder et al. ( 23 )] and 2012 [by Norton et al. ( 24 ) and Peterson et al. ( 25 )] ( Table 3 ). The most productive years were 2000, 2001 and 2003, with 9, 8 and 8 published articles, respectively. The year of 2003 had the most total citations with a total count of 3,788 and an average citation count per study of 474.

Publication year of the 100 top-cited studies on dyslexia.

Countries and Authors

Eleven countries contributed articles to the 100 top-cited studies on dyslexia ( Table 4 ). Most of the articles were from the USA ( n = 53), United Kingdom ( n = 21), Canada ( n = 7), and France ( n = 6). In addition, the USA had the highest total citation count (23,129), and Italy had the highest average citation count per study (665).

Countries of the 100 top-cited studies on dyslexia.

As shown in Table 5 , there were 18 first-authors and 13 last-authors who published more than one of the 100 top-cited studies on dyslexia. Among them, Shaywitz SE published the most top 100 articles ( n = 7) on dyslexia as the first author, followed by Galaburda AM ( n = 3) and Pugh KR ( n = 3). And for the last author, 8 studies of the 100 top-cited studies on dyslexia research were published by Shaywitz BA who was the most productive.

Authors with at least two first-author or last-author publications in the 100 top-cited studies on dyslexia.

Publication Type and Web of Science Subject Categories

As shown in Table 6 , there were 71 studies in the form of an original research article, 28 studies in the form of a review article, and one study in the form of an editorial material publication. The total citation counts for each publication type were 27,812, 13,899, and 511, respectively. Although the type of original research article had the highest total citation count, it had the lowest average citation count per study. In addition, a total of 12 Web of Science subject categories were extracted. Among them, “Psychology” was the most frequent category associated with studies [35], followed by “Clinical Neurology” [15], and “Multidisciplinary Sciences” [15], “Neurosciences” [12], and “Education” [6]. Consistent with the number of studies, the subject categories of “Psychology” and “Clinical Neurology” also had the highest total citation counts (15,683 and 6,427, respectively). The “Behavioral Sciences” subject category had the highest average citation count.

Type of study and subject categories for the 100 top-cited studies on dyslexia.

Although retrospective bibliometric approach has been conducted in many other diseases, to our knowledge, no citation analyses have examined publications on dyslexia. Therefore, this study is the first comprehensive analysis summarizing several features of the most influential studies on dyslexia. It has been suggested that a highly cited study can be considered as a milestone study in a related field and has the potential to generate meaningful changes in clinical practice ( 26 ). We believe that the present analysis of the 100 top-cited studies on dyslexia may be beneficial to the research community for the following reasons. First, the present study not only provides a historical projection of the scientific progress with regards to dyslexia research, but it also shows associated research trends and gaps in the field ( 27 ). Second, our findings provide critical quantitative information about how both the classic studies and recent advancements in the field have improved our understanding of dyslexia ( 28 ). Third, the present analysis may help journal editors, funding agencies, and reviewers critically evaluate studies and funding applications ( 28 ).

Our analysis discovered that the 100 top-cited studies on dyslexia were published in 50 different journals. This may reflect the fact that the 100 top-cited studies on dyslexia were very multidisciplinary in nature, unlike the top studies of other fields (e.g., psoriatic arthritis) where there is a more inherent researcher bias for journal selection ( 29 ). Of the 100 top-cited studies, 29 were published in a journal with an impact factor >10, and 62 studies were published in journal with an impact factor >5. However, there were only five studies published in the standard “CNS” journals and only four published in the top four medical journals, which suggests that most dyslexia researchers are more inclined to choose the most influential journals in their respective professional fields when submitting articles ( 30 ). This is in marked contrast with some other fields (e.g. vaccines), where the majority of top-cited articles are published in either the standard “CNS” journals or in the top four medical journals ( 15 ). Several other factors, such as the review turnaround time, likelihood of manuscript acceptance, publication costs, journal publication frequency, will all invariably also affect a researcher's journal selection ( 13 , 20 ).

According to the results of our analysis, nearly 80% of the 100 top-cited studies on dyslexia were published between 1990 and 2005, and the years of 2000 was found to have the most publications. The increase of landmark publications between 1990 and 2005 might reflect an increase in the interest in dyslexia research or that researchers had made some important scientific breakthroughs during this time period. All the top-cited studies on dyslexia were published in English, likely because English is the most commonly used language for knowledge dissemination in the world.

The top countries with regards to total citation count and number of papers in the top 100 list were the USA ( n = 53) and United Kingdom ( n = 21), which accounted for ~75% of the 100 top-cited studies. The USA published the most studies from the list, and this is probably because some of the world's top research centers are located in the USA and likely also the USA receives more research funding ( 31 ). Furthermore, the most prolific first-author (Shaywitz SE) and last-author (Shaywitz BA) were also from the USA. It is also worth mentioning that China had two studies on the top 100 list, which attests to the improvement of our national scientific research community with regards to knowledge dissemination.

In the present study, there were more original research articles ( n = 71) than review articles ( n = 28), but the latter had higher average citation counts per study. These results indicate that even though researchers pay significant attention to new findings on dyslexia, they regularly use information from review articles to convey relevant points in their own papers. We found that “Psychology” was the most frequent subject category associated with the top 100 articles, which indicates that researchers have been working to find effective treatments for people with dyslexia and that research in this field will continue to progress.

Like with other bibliometric analyses, there are some study limitations that should be highlighted. First, the 100 top-cited studies were extracted from the Web of Science Core Collection, which might have excluded some top-cited studies from other databases, such as Scopus and Google Scholar. Second, there was no citation data for recently published studies. Third, self-citations might have substantially influenced the results of the citation analysis. Moreover, this was a cross-sectional study, which implies that the identified 100 top-cited studies could change in the future. Despite these limitations, this descriptive bibliometric study could contribute new information about the scientific interest in dyslexia.

In conclusion, the present analysis is the first analysis to recognize the 100 top-cited studies in the field of dyslexia. This analysis provides a better understanding on dyslexia and may help doctors, researchers, and stakeholders to achieve a more comprehensive understanding of classic studies, new discoveries, and trends regarding this research field. As new data continue to emerge, this bibliometric analysis will become an important quantitative instrument to ascertain the overall direction of a given field, thus promoting ideas for future investigation.

Data Availability Statement

Author contributions.

YZ and HF designed the study. SZ and YZ acquired the data and performed statistical analyses. SZ, YZ, and HF drafted the manuscript. All authors critically revised the article and approved the final version of the manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding. This study was partly supported by National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (Z2018B016).

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2021.714627/full#supplementary-material

Case Study: 3 siblings with severe dyslexia

Jan 31, 2014 | DM Case Studies , DM News Blog , Parent Reviews | 0 comments

The Problem

The story of Doresa and her three children’s struggles with learning to read began three years ago, when Javon was in Kindergarten and the twins Jordan and Makaila were in a private preschool.

Doresa and her husband were a little worried about Javon’s reading because he just seemed so inconsistent whenever he tried to decode words with them at home. As such they approached his teacher, who was frankly shocked by their suggestion that he had problems learning to read. Far from behind, she told them how Javon was actually the best reader in the class!

So why the problems with reading books at home? Well, fairly soon Doresa realised that the reason for the apparent contrast between her son’s baseline ability with individual words and his aptitude for devouring entire books at school, was that he was a highly gifted sight reader.  His intelligence was in no doubt, having been tested as being in the 99.8th percentile for intelligence. For that reason, he had discovered that there was no need to read using the phonetic structure; he could simply sight-memorize the text, and did this so effectively that the teachers never caught on.  At home meanwhile, where Javon didn’t have his throng of well-memorized books to hand, he could be seen making mistakes on even the simplest of words. Any given page was peppered with surprising mistakes.

Having made this discovery, Doresa took her Javon to see a psychologist who worked with gifted children. They confirmed not just a reading issue, but one of the most severe cases of dyslexia they had ever encountered. It was exactly because of his exceptionally high IQ that he still appeared to be reading above grade level.

Frankly, Doresa was unsure of what she should do next. It was a very strange position to be in, especially given that the school flat-out refused to give credence to her suggestions that he was unable to decode, even after they had the report from the psychologist.

Finally she made the decision to quit her job and homeschool Javon. That way she could ensure that he received the proper reading foundation he needed to be able to really progress. Doresa’s hope was that this was the start of a new and exciting change in the way Javon understood and processed written language…but unfortunately this could not have been further from the truth.

They had Javon tested again after twelve months and the results showed that despite Doresa’s very best personal efforts, he was reading only five additional words out of context compared with a year ago. A skilled sight reader he may be, but there was now no hiding from the fact that Javon was on a reading plateau. Doresa also decided to have the twins tested. They too were profoundly gifted (99.7th and 98th percentile), and also showing signs of dyslexia.

So, in an effort to pinpoint the issue, all three children had their eyes tested. The testing revealed them as having some tracking and convergence issues and so they subsequently underwent a year of vision therapy. However, while the vision issues improved, the reading did not. Feeling a bit deflated yet determined, Doresa’s quest to help her children continued.

From then on, the list of tried and tested interventions started to get ludicrously extensive! Reading Horizons, StarFall, Bob Books, All About Spelling, and lots of Scholastic worksheets… Javon would do the work without complaint, but aside from photographically memorizing pages at a time and therefore appearing to digest the material well, in her heart Doresa knew that he just wasn’t moving forward.

The Solution

When Doresa first stumbled across Easyread she instantly knew it would be perfect for one of her children in particular, Jordan, who was the least confident academically of all the kids. He was intensely frustrated and confused by all the different reading platforms they were trying to work through. For that reason, the idea of a game based system was something she thought would suit him very well indeed. The fact that the system had a focus on eye-tracking, and that the sessions were so short, were also excellent incentives for signing up her youngest son.

What’s more, while the cost of the program seemed high initially, compared to the $150 an hour Doresa was paying to have a certified reading tutor (who had been in place for quite some time and was yet to yield any positive change) this approach was ultimately much more reasonable. After watching her twin on the program on his first day, Makaila asked if she could start it too. Two days after that, Javon wanted to join his younger siblings, and so before they knew it they were all on board!

Everything about Easyread suited Doresa’s three very different but similarly bright children: the gentle approach,  the fun yet challenging games, David’s gentle words coaxing the children to stop for the day and try again tomorrow when they get stuck in was especially for Jordan, the least confident of the children. The fact that not all of the words are “easy” in the lessons was hugely beneficial too. Javon, Jordan and Makaila could easily fake their way through words like “hat, sat, bat, mat”, which had tended to be the focus of other programs they had tried. However they couldn’t do that when being confronted by words that were new to them.  The continued assessments allowed them to all clearly track their progress too, which was very useful. Doresa by this point had spent so much time and money on programs that appeared to be working because the kids were chomping through the material, but without some kind of formal assessment it was close to impossible to know for sure. Where Easyread was concerned, she was able to clearly map her children’s decoding ability as it flourished. And flourish it certainly did…

The Results

Mikaila, Jordan and Javon’s desire to read and confidence has experienced a drastic leap. Indeed Javon, the eldest, will now read to his younger siblings. Mikaila meanwhile has discovered that she loves reading books and writing stories. The biggest change for Javon is that he now not only enjoys decoding words, but has also started to write as well! This is a child that would never, ever write without being prodded to in the past. And yet now he will just pick up a pen and piece of paper and go for it.

Happily the three children have consulted one another and decided on what they would like their reward to be for finishing Easyread…space camp! They fully understand that this is a high pressure reading environment where every child is assigned a “job”, and that reading will be a part of every job. They will have to read publicly so that all team members can complete various phases of the mission.  Aside from all being great space enthusiasts, it seemed to be a great fit with the “Agent” theme of Easyread and as such Doresa gladly agreed to this prize.

And guess what – even with the cost of Easyread and Space Camp – it is still cheaper than what the family would have spent hiring a private tutor to work with each child weekly! They are all reading and writing so much better than before they started, and the twins are working at decoding even the most challenging of words. They no longer shy away from reading challenges, but embrace them as they know every success they have in reading gets them closer to the ultimate Space Camp goal.

These three children defy the stereotype that dyslexia is a learning disability, since it is their very intelligence that led them to sight-read words in the first place. So with that in mind, where to next? Well 8 year old Javon is currently reading chapter books that are written for young teens, and meanwhile the twins are growing in confidence and ability every day that they are on the Easyread course. For these three little astronauts, the sky really is the limit!

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