Struggling with words
Say the words "bad" and "dad" aloud. Can you tell them apart? Your brain has a 40 millisecond opportunity to hear and process the difference between the "d" and "b" sounds. If it misses the moment, the crucial distinction is gone. What is left is confusion. This is the problem at the heart of dyslexia.
About 375,000 schoolchildren are affected in Britain - 40 per cent are classified as severely dyslexic, the rest as mild. Increasingly though, researchers argue that this division is unhelpful: that dyslexia comprises a whole spectrum of difficulties with literacy, language, memory and attention.
SYMPTOMS AND ASSESSMENT
Even reading difficulty is not guaranteed in dyslexia, says Dr John Rack, director of research and assessment for the Dyslexia Institute. Bright children may read fluently and their disability only becomes clear through subsequent literacy failure. But in general, when a dyslexic child arrives in a classroom - there will be three on average each year - a teacher may notice problems with any or all of:
* following andor remembering instructions;
* distinguishing between sounds and repeating them;
* learning by rote;
* matching sounds to letters;
* co-ordination and balance;
* knowing what day or time it is;
* doing two things at once;
* repeating skills or performing tasks which the child seemed to have mastered the previous day.
Children starting school often struggle with these anyway, says Maggie Snowling, professor of psychology at York university. But by Christmas the difference between normal immaturity and more profound problems should emerge: "If a child, after its first term in school, has not learned any letters or letter sounds, that is very diagnostic of dyslexia."
SCREEN OR TEST?
Commercial publishers offer a plethora of early dyslexia screening tests which can be used with entire early years classes. (Details can be found on the websites of the Department for Education and Skills and the British Dyslexia Association). But, says Professor Snowling, such a blanket approach may be misguided: "Screening is costly in time and resources, the tests are only 75 per cent accurate and teachers tend not to know what to do with the information."
Instead, she and other experts suggest teachers use a battery of more detailed tests. In an ideal world, local education authority educational psychologists would test these children, says Dr Rack, because the essential factor to enable child and teacher to progress is a profile of what the child does and does not know and can and cannot do.
The Dyslexia Institute and specialist teachers registered with the association do these detailed assessments, usually at the request of parents. They cost several hundred pounds. For an adequate portrait of a child's difficulties, says Professor Snowling, classroom teachers need to use tests of single-word reading ("Dyslexic children will not be able to do much"), of letter knowledge, phonic awareness, vocabulary, spelling and writing. (The DfES website lists tests available for these.)
"Teachers should make a running record of the child reading," she says.
"Give them a book to read aloud and write down verbatim what they do and say. Use that to work out what strategies they are using: are they using visual information, are they guessing, are they sounding out?"
At least some of this assessment needs to happen during the reception year if extra sound and letter teaching are to begin in time to catch children who really need it. The Government's strategy for identifying struggling children after four terms in school is later than many experts now recommend: by then, extra teaching of sounds and letter identification should have begun, they say.
At this stage, intervention can be for small groups of up to six children and led by a teaching assistant, says Professor Snowling. A 20-week programme in North Yorkshire is being introduced in 36 schools this term after effective results in a pilot last year in which Year 1 children, who had made no reading progress in four terms' schooling, gained 11 months in their reading ages (see York university website for details).
Mildly dyslexic children can catch up with their peers and become self-propelling with this kind of early intervention, ideally starting before they are seven and a half, says Dr Rack. More severely affected children need intervention just as early and more intensively, at a slower pace, with a more individualised programme than the official literacy support and, in some cases, with one-to-one teaching. Recent American research has shown "spectacular results" with seven-year-olds given an hour a day's specialist teaching over three months, he adds.
Introducing such a programme would not only transform children, it would transform practice in schools, he says: "At present, children get some kind of support; if that doesn't work they get some other kind, and if that doesn't work they might get some assessment. What they need is early assessment and intervention before failure becomes entrenched."
CHALLENGE TO INCLUSION
Pressure on resources but also politics militate against giving dyslexic children this kind of help, experts argue. These children's brains are wired differently: they will not simply latch on to what other children pick up with more repetition and at a slower pace. They need a different kind of tailored teaching which challenges the concept of inclusion. "If a child needs one-on-one help and the school doesn't have a specialist teacher, then that means going outside the school," says BDA policy director Carol Youngs. (The Dyslexia Institute is the main provider of courses for teachers and teaching assistants.)
At secondary level, the challenge to the system is clearer, says Professor Snowling: "The state secondary schools and specialist dyslexia schools are two different worlds. I encourage people to go to state schools, but it's not possible within a mainstream school to provide the intensive support the specialist schools provide. It's an amazing gulf because the best specialist schools are getting some fantastic results."
Hence parental pursuit of statements naming specialist schools - dyslexia is one of the main issues preoccupying SEN tribunals - but also the massive expenditure around private teaching (a specialist school place can cost almost pound;15,000 a year) and on new dyslexia treatments breaking into the news with claims of astonishing efficacy almost every week.
Weighing up these claims is impossible without knowing a bit about dyslexic neurophysiology. Through a combination of psychological testing, chemistry, brain imaging and autopsy, scientists have established that dyslexia has a genetic component and have identified several possible genes. We know that dyslexic people's brains look different - although this may be because they have developed compensatory rewiring - in the areas dealing with memory, sound and speech processing.
Beyond this knowledge, however, is an area of uncertainty. Oxford university neurobiologist Professor John Stein has argued that the roots of dyslexic brain defects lie in a part of the brain called the magnocellular system, a tracking system which enables people to follow moving objects (as when scanning print on a page) or changing sound. His research, which is becoming increasingly accepted, pinpoints visual difficulties in some children as the key to their problems, and the use of coloured text overlays and glasses with coloured lenses as contributing substantially to a solution. (See website for details, including assessment and clinics. The Royal College of Ophthalmologists sells a visual screening package for schools.)
With identification of neuroprocessing problems comes all kinds of proposed solutions. Fish oils providing essential fatty acids for neural development have been claimed to boost dyslexics' performance. Neurofeedback, a brain-training system which, when attached to a headset, you can watch, manipulate and eventually learn to exercise your brain waves on a computer screen, appears to offer hope of improvement.
Most recently, the hypothesis that a primitive part of the brain called the cerebellum - linked to the magnocellular system - not only underperforms when controlling balance and movement in dyslexics, but can be trained by exercise to improve co-ordination and literacy, has come to attention through the opening of private DDAT (Dyslexia, Dyspraxia and Attention Deficit Treatment) centres.
TREATMENT OR CURE?
Almost certainly some children will improve under any of these programmes, and some will not. The difficulty is partly that any new hope is motivating, and partly that in a dyslexia spectrum some treatments will genuinely have an impact on the brain of Child X but not on the fractionally different brain of Child Y. What dyslexia researchers should be doing is engaging in a study to test the efficacy of different treatments on different children against each other. But cost and commercial considerations prohibit that. Meanwhile, "parents are so desperate they will try anything," says Carol Youngs. "But the word 'cure'
should arouse suspicion because you can't cure dyslexia. If you are born with it, you will have it until you die."
What schools can do is follow well-established treatments such as those set out in the association's programme for dyslexia-friendly schools and its soon-to-be-announced venture into Kite-marking dyslexia-friendly LEAs (see BDA website).
At primary level this means early identification, increasingly intensive and individualised teaching using a multi-sensory approach (such as Alpha to Omega) and possibly an alternative phonological system (such as Phono-Graphix), plus lots of IT-based literacy and maths skills practice.
As children move through school, they need monitoring to ensure they do not fall behind, says Professor Snowling. But the real challenge comes with secondary school, where they will need extra help with the practicalities of every lesson. "Dyslexia affects spoken as well as written language, so it's important that information is given clearly and in small bits, and instructions repeated and given in different ways," says Dr Rack. Dyslexic pupils work twice as hard as their peers to keep up. They may become very tired.
Good secondary schools will value what the child can do rather than focusing on what they can't, says Professor Snowling. That may mean working with mind-mapping software, allowing parents to spellcheck homework, accepting shorter and untidier pieces of written work, using story tapes or allowing children to submit work on tape, providing voice-recognition software or an amanuensis, making sure they use permissible aids and time allowances in public exams.
For the cost of not giving dyslexics the support they need is huge, and not only measured in society's pain - with prisons and young offender institutions full of angry undiagnosed dyslexics - but among children themselves. "Some of these children are crushed at school," says Professor Snowling, describing the 8 to 11-year-olds who attend York university's dyslexia summer school. "At the end of our course, one child wrote on our evaluation form, 'Thank you for reminding me that I am a member of the human race'."
RESOURCES AND WEBSITES
www.dyslexic.org.uk (Stein research and clinic)
www.dyslexia-teacher.com (for resources)