Cognitive aspects of language Reading disability

Two years ago a boy of 9 years studying in the fourth class of an English medium school was brought to me for correction of his scholastic backwardness and behavioural abnormalities such as disobedience, temper tantrums and reluctance to go to school. Previously he was diagnosed by a clinician as ‘childhood schizophrenia’ and given a psychotropic drug. The condition did not improve even after six months’ medication. On examination he was found to be suffering from reading disability (dyslexia) and associated emotional problems.

Treatment for dyslexia consists of using educational tools to enhance the ability to read. Medicines and counseling are usually not used to treat dyslexia. An important part of treatment is educating the child and the family about the condition.  

Reading disability or dyslexia is the most common form of learning disability. Dyslexia is a Specific Learning Disability [SLD]. A child with dyslexia cannot read correctly and comprehend accurately what is read. Dyslexia is different from reading difficulties resulting from other causes such as deficiency with vision or hearing, or from poor or inadequate reading instruction. National Institute of Neurological Disorders and Stroke [NINDS]  under National Institute of Health, USA defines dyslexia as follows: “Dyslexia is brain-based type of disability that specifically impairs person’s ability to read. These individuals typically read at levels significantly lower than expected despite having normal intelligence.”

The features of disorder varies from person to person but the common characteristics among people with dyslexia are difficulty with sound processing, spelling, and/or rapid visual-verbal responding. In children these deficiencies are expressed as scholastic backwardness and behavioural abnormalities.

When the onset of dyslexia is in adulthood, it usually occurs as a result of brain injury or with the onset of dementia. Dyslexia can be inherited in some families, and recent studies have identified a number of genes that may predispose an individual to develop dyslexia

Dyslexia is not an intellectual disability. Cognition of an individual develops independently. Therefore Intelligence Quotient (IQ) and dyslexia are not interrelated.

Characteristics of dyslexia

I. Symptoms in Preschool-aged children

It is difficult to identify dyslexia before the child begins school. Parents who keenly observe their children may notice the following symptoms:

1.    Delays in speech

2.    Slow learning of new words

3.    Difficulty in rhyming words as in nursery rhymes

4.    Knowledge of letters does not improve

5.    Letter reversal or mirror writing. Example: "Я" instead of “R”

II. Symptoms in early primary school children

1.    Slow in learning the alphabet

2.    Inability to associate sounds with the letters that represent them. In other words sound-symbol correspondence is difficult

3.    Difficult to identify rhyming words or lack of phonological awareness

4.    Inability to segment words into phonemes or sound blocks (lack of phonemic awareness)

5.    Naming-speed deficit: naming-speed refers to how quickly an individual can tell the names of a set of familiar objects. For example a student may be shown 50 patches of different colours and asked to name the colours quickly. Individuals with dyslexia find it difficult to name even the familiar colours.

6.    Inability to distinguish between similar sounds in words and mixing up sounds in polysyllabic words. Examples: “aminal” for animal, “cutbis” for biscuit

III Symptoms in older primary school children

1.    Slow or inaccurate reading

2.    Very poor spelling which is called dysorthographia.

3.    Very slow in reading out loud, reading words in the wrong order, skipping words and sometimes saying a word similar to another word.

4.    Difficult to associate individual words with their correct meanings

5.    Difficult to keep time when doing certain task

6.    Children with dyslexia fails to see similarities and differences in letters and words, and may be unable to sound out pronunciation of an unfamiliar word

7.    Tendency to omit or add letters or words when writing and reading.

IV Symptoms in secondary school children and adults

Some people with dyslexia are able to disguise their weaknesses, even from themselves. Many students reach higher education before they encounter the threshold at which they are no longer able to compensate for their leaning disability. At this stage dyslexic people are identified by writing that does not seem to match their level of intelligence. Dyslexic people often substitute similar-looking, but unrelated, words in place of the ones intended. Examples: what/want, say/saw, help/held, fell/fall, to/too, who/how etc.

Associated disabilities and disorders

Many other learning disabilities often occur in association with dyslexia, but it is not clear whether these learning disabilities share the same neurological causes with dyslexia. These disabilities include:

Dysgraphia: This disorder expresses itself primarily through writing or typing. Dysgraphia is often multifactorial. It may be due to impaired letter-writing automaticity and impaired visual word form which makes it more difficult to retrieve the visual picture of words from long term memory, required for spelling.

Dyscalculia: It is a neurological condition characterized by a problem with basic sense of number and quantity. People with this disorder often can understand very complex mathematical concepts and principles but have inability to memorize basic mathematical facts involving addition and subtraction.

Attention deficit disorder: Dyslexia is often associated with ADD and ADHD. These are dealt with separately.

Cluttering: This is a disorder of speech fluency. Both rate and rhythm of speech are defective resulting in erratic, non-rhythmic, rapid and jerky spurts of words that usually contain faulty phrasing.

Causes of dyslexia

Researchers have and are evolving many theories on the causes of the dyslexia. These theories are not mutually contradictory but enlightening on the different causative factors of this disorder.

Effect of language orthography

The complexity of a language’s orthography can be a significant contributing factor to the difficulties experienced by dyslexic readers. Orthography is the writing system of a language. There are deep orthographies and shallow orthographies. Arabic and English are examples of deep orthographies that do not have a one-to-one correspondence between sound blocks (phonemes) and the letters that represent them. Shallow orthographies have a one-to-one relationship between graphemes (meaningful letter blocks) and phonemes and the spelling of words is very consistent. This type of writing is called phonetic orthography. Most of the East European languages like Albanian, Bosnian, Bulgarian etc. and many Asian languages are phonographic. Most of the Indian languages including Malayalam have phonemic orthographies.  Deep orthographies contribute more to the difficulties of a dyslexic reader. Logographic writing systems like Japanese and Chinese characters have graphemes that are not directly linked to their pronunciation pose different types of dyslexic difficulty.

From a neurological perspective, different types of writing system, for example alphabetic as compared to logographic writing systems, require different neurological pathways in order to read, write and spell. Because different writing systems require different parts of the brain to process the visual notation of speech, children with reading problems in one language might not have a reading problem in a language with a different orthography. The neurological skills required performing the tasks of reading, writing, and spelling can vary between different writing systems and as a result different neurological deficits can cause dyslexic problems in relation to different orthographies.

Incidentally, the boy who was brought to me two years back is having not much reading problem with his native language Malayalam.

Aggravating conditions

Dyslexia is attributed to neurological factors that influence the individual's ability to read, write, and spell written language.The following conditions may be contributory or overlapping factors, as they can lead to reading disability:

1. Aphasia - neurologically based speech disorders, which can cause alexia (acquired dyslexia).
2. Attention deficit hyperactivity disorder - A disorder that occurs in between 12% and 24% of those with dyslexia.
3. Auditory processing disorder - A condition that affects the ability to process auditory information. Auditory processing disorder is a listening disability. Some children can acquire auditory processing disorder as a result of experiencing otitis media, a condition characterized by bacterial infection with fowl smelling discharge.
4. Developmental dyspraxia - A neurological condition characterized by a marked difficulty in carrying out routine tasks involving balance, fine-motor-control, difficulty in the use of speech sounds, problems with short term memory and organization are typical of dyspraxics.
5. Specific language impairment (SLI) - A developmental language disorder that can affect both reading and writing. SLI is defined as “pure” language impairment, meaning that is not related to or caused by other developmental disorders, hearing loss or acquired brain injury.

Management

There is no cure for dyslexia. But dyslexic individuals can learn to read and write with appropriate educational support. Early intervention is very helpful. Stress and anxiety contribute to the difficulties of dyslexic. So stress management and alleviation of anxiety are essential.  

A cognitive technique for undergraduates is reading the first and the last sentences of each paragraph first, comprehending them and then reading the whole paragraph. This technique enhances the comprehension of the entire paragraph. It has been found that training focused towards visual language and orthographic issues yields longer-lasting gains than mere oral phonological training.

Cognitive aspects of language Disorder of written expression

Disorder of written expression is a learning disability in which a person's ability to communicate in writing is substantially below the level normally expected based on the individual's age, intelligence, life experiences and educational background. This disability affects both the physical reproduction of letters and words and the organization of thoughts and ideas in written compositions.

Steven Pinker

People are not born to read or write. These skills have to be acquired by learning. Taking the computer analogy, Canadian cognitive-neuroscientist Steven Arthur Pinker said: “Children are wired for sound, but print is an optional accessory that must be painstakingly bolted on.”

 The Graphomotor skills are combination of complex mental and physical skills which enable a person to write. A child with Graphomotor problems will find writing difficult because there is detachment between their thoughts and their ability to express them through writing.  Reading and writing are intricately linked with oral language skills, and with each other. Writing is also strongly linked to skeleton-muscular motor system. In child development reading and writing represent the last and most complex language-related skills to develop, and are the most vulnerable to insult, injury, and adverse genetic influences.  In human evolution the history of reading and writing proceed in parallel.

How to identify disorder of written expression?

Following are the signs that suggest disorder of written expression:

1. Poor or illegible handwriting
2. Poorly formed letters or numbers
3. Excessive spelling errors
4. Excessive punctuation errors
5. Excessive grammar errors
6. Sentences that lack logical cohesion
7. Paragraphs and stories that are missing elements and that do not make sense or lack logical transitions
8. Deficient writing skills that significantly impact academic achievement or daily life.

These symptoms must be evaluated in light of the person's age, intelligence, educational experience, and cultural or life experience. Written expression must be substantially below the level of samples produced by others of the same age, intelligence, and background. Normally, several of the symptoms are present simultaneously.

 Diagnosis

There are no specific tests to diagnose disorder of written expression. This disorder is not normally diagnosed before age eight because of the variability with which children acquire writing skills. It is most commonly diagnosed in the fourth or fifth grade. Requests for testing usually originate with a teacher or parent who notes multiple symptoms of the disorder in a child's writing.

Several standardized tests accurately reflect spelling abilities, but do not assess other writing skills with the same reliability. Tests that might be helpful in diagnosing disorder of written expression include the Diagnostic Evaluation of Writing Skills (DEWS), the Test of Early Written Language (TEWL) and the Test of Adolescent Language. However, assessment using standardized tests is not enough to make a diagnosis of disorder of written expression. In addition, a qualified evaluator should compare multiple samples of the student's written work with the written work normally expected from students of comparable backgrounds. The person being evaluated may also be asked to perform tasks such as writing from dictation or copying written material as part of diagnostic testing.

Students with Graphomotor problems are frequently called "lazy", "unmotivated" and/or "oppositional" because they are reluctant to produce written work. Many times, these are the children who dislike school the most. Because they are sometimes able to write legibly if they write slowly enough, they are accused of writing neatly "when they want to". This statement has moral implications and is untrue; for children with Graphomotor problems, neat handwriting at a reasonable pace is often not a choice.

Treatment

There is no medicine for this disorder. Emerging evidence indicates that a preventive approach of providing instruction in handwriting, spelling, and composition in kindergarten and primary grades, for children already at risk of reading delay is effective in improving these children’s subsequent spelling and reading abilities. This is because handwriting is not just a motor process or penmanship. Rather, handwriting draws on letter knowledge and in turn may reinforce orthographic representations of letters and spellings, so that practicing a word’s spelling appears to reinforce phonetic awareness and facilitate word reading. Also, since transcription skills (spelling, handwriting) uniquely predict compositional fluency throughout elementary grades, it is not surprising that writing instruction in kindergarten facilitates the development of both content and fluency of written expression in later grades. Both the parents and the teachers can participate in instructional exercises.