Dyslexia

The essential guide to identifying and managing your child’s learning difficulty.

Many children spend their school lives struggling with their work. This can result in feelings of frustration, demoralisation and isolation. This authoritative guide addresses these sensitive issues and offers comprehensive checklists, perceptive advice and practical tools to help you to:

Dr Valerie Muter and Dr Helen Likierman are practising psychologists with extensive knowledge and experience of children’s learning difficulties.

Dr Valerie Muter is a consultant clinical psychologist at Great Ormond Street Hospital for Children where she specialises in working with children with both developmental and neurologically based learning disorders. She holds an honorary research fellowship at the Centre for Reading and Language, University of York, and has carried out extensive collaborative research into reading development and dyslexia with Professor Margaret Snowling, the UK’s leading authority on dyslexia. She was a consultant psychologist at the Dyslexia Institute (Dyslexia Action) for 20 years.

Dr Helen Likierman is a consultant clinical psychologist working with families and children (from pre-schoolers to older adolescents) where there are emotional, social, behavioural or learning concerns. After her psychology degree, she trained and worked as a teacher of young primary school children before moving on to clinical training and a PhD on pre-schoolers’ friendships and peer relationships. She worked for many years as a practising clinical psychologist in the NHS and was a consultant psychologist at the Dyslexia Institute (Dyslexia Action) for three years. In addition to her current consultant work, she is the school counsellor at a large co-educational school. She is the mother of two teenage children, one of whom has specific learning difficulties.

Around the age of seven, your child should have settled comfortably into school and be coping with the work. But some children – many children – are already starting to have difficulties that seem surprising. If you are worried or concerned that your child is failing to progress in a way you instinctively feel is right, then this book is for you.

Children struggle at school for many reasons. Sometimes teachers and parents will say about a child who is struggling, ‘If only we could find the key to unlock his difficulties, then he’d be away.’ But searching for an elusive key can be successful only when all the facts are known. This is often a long and difficult process, but it doesn’t need to be. If you ask the right questions and do the right kinds of observations and assessments, you will find the causes of your child’s problems – and therefore the solutions as well.

A parent’s desire to find out what their child’s particular learning problems are is clearly a sensible ambition, but there can be obstacles. Sometimes it seems there is too much information ‘out there’ on learning difficulties – dyslexia, dyspraxia, dyscalculia, language and attention problems – and this information can seem conflicting or unclear. This is not altogether surprising as even professionals disagree about the definitions, causes and treatment of learning difficulties. The controversies may be picked up by the media, but without clearly defining the issues or even being accurate. The result is often more worry for parents who feel that they may not be doing the right thing by their child or do not know in which direction to go.

In this book we separate fact from fiction. We will take you through the major learning disorders or difficulties (we prefer ‘difficulties’ though you will hear the two words used interchangeably) so that you can understand them. We will help you spot your child’s learning difficulties; and we will show you what more you need to find out, how to approach your child’s school and how to get professional help. Finally, we will give you guidelines, based on our own clinical experience and practice, to what you can do to help your child at home.

Our book is based on the most up-to-date research and practice, on facts and evidence rather than ‘old wives’ tales’ and myths. We draw on research and our own extensive clinical experience (which between us spans around 60 years and thousands of children) to suggest the most effective strategies. The book is for parents of children aged between 7 and 14. These are the most important years for catching problems and helping children overcome them, but obviously the earlier the better.

Step One is to find out whether your child has dyslexia or another learning difficulty – or whether there’s nothing too much to worry about. We ask you to start by looking in detail at the problems he or she seems to be having now, and then to look back at your child’s early development. We have devised a series of ‘checks’ for you to try out with your child to test out your hypothesis (belief, feeling, hunch) that he or she could have a learning difficulty.

Step Two gives you lots of ideas about how to approach professionals and to understand how they can help your child. Chapter 7 explains the steps you need to take to get help from school. The education support system is complicated, but it will help you to know the details so you can make sure your child gets the best help possible. Chapter 8 covers what you need to know about making contact with other professionals. In particular, we take you in detail through the psychological assessment as this is so helpful for the understanding of an individual child’s difficulties and needs.

Step Three will guide you through all the things you can do at home to help your child. Chapter 10 shows you how you can help a child with dyslexia (improve reading, spelling and written work), with dyspraxia (improve handwriting), with dyscalculia (improve maths) and with SLI (improve language). Chapter 11 gives you strategies for dealing with attention, homework, revising for exams, getting organised and staying motivated.

Throughout the book we draw on our own experience with a number of case histories. We start with an example. Nicholas (not his real name) is a child who came to us for assessment because he was ‘struggling with reading at school’. Have you ever said the same about your child? This is his story as told by his mother.

When I look back, Nicholas was such a bright and happy little boy. His dad and I could never have imagined before he started school that he would go on to have so many problems. Nicholas went to our local nursery school at age three – he was so keen to go. He loved it. He liked his teachers, he enjoyed playing with the other children and he found the games and puzzles great fun. His teachers said that he settled in well – they all loved him. And they said that he was so bright, that he’d do well when he started school. And he seemed to get off to a good start. He loved story time, ‘show and tell’ and learning about numbers. I suppose we first became a little worried when Nicholas seemed a bit slow at learning his letters. But his teacher said not to worry, that some children did get off to a slow start but usually caught up by the end of Reception. The problem was that he didn’t catch up by the end of Reception. I said to his teacher, ‘Nicholas knows only five letters of the alphabet, yet I can see that his classmates know many more.’ ‘Let’s see how he gets on in Year 1,’ she said.

Well, Year 1 came, and Nicholas enjoyed school, liked being with his friends and seemed to be doing fine with his maths. But he hated reading – he wouldn’t look at books at home. He’d say, ‘Reading is rubbish,’ though he still liked being read to. I had a chat with his class teacher and she said, ‘Yes, he is a bit slow getting going with his reading. I’ll get our classroom assistant to do some extra work with him on his letters and send some books home for him to read with you – I’m sure that will help.’ Only it didn’t! Nicholas refused to read even the simple story books his teacher sent home. If I pressed him he’d throw them on the floor and have a temper tantrum. I couldn’t believe how my lovely, easy-going little pre-schooler was turning into a rather miserable child with an awful temper. And I was shocked to realise that, at the end of Year 1, Nicholas still knew only five letters of the alphabet, while all the other children in his class knew them all. His class teacher was getting worried too – she promised that in Year 2 the special needs co-ordinator would start giving him extra reading lessons.

It’s amazing how quickly your child’s primary school years speed by. And it’s frightening when you have a child like Nicholas who just doesn’t ‘get’ reading at all. Over the next three years, he continued to make very slow progress. He still seemed bright, his maths was good (when he could actually read the question), he liked sports and spending time with his friends. Actually, it was hard to keep close tabs on how Nicholas was getting on with his reading because he flatly refused to read at home. And he usually ‘forgot’ to bring home his spelling lists. When he did remember, and I was able to bribe him to try and learn the spellings, he could sometimes struggle through the Friday test (getting about half of them right), but he’d have forgotten them all by the next week. I’d talk to his teachers from time to time, but I felt that I was being labelled a ‘bit of a nuisance’ and a ‘neurotic mother’. His teacher would say, ‘Don’t worry – he’s having extra help. He’ll be fine – he should catch up in the end.’

By the time Nicholas was 10 years old and in Year 5, I wondered how on earth he was going to cope when he moved to his secondary school. He still couldn’t read and made mistakes even when spelling three-letter words. His moods and his refusal to do any homework were driving me mad. His teachers also started to complain that his difficult behaviour was disrupting the class, and they felt he could do the work if he tried harder and concentrated more because they considered him to be a bright boy.

Then a friend of mine suggested that I get Nicholas assessed by a psychologist. I thought this could be a step in the right direction. The psychologist saw Nicholas and then talked to me. ‘Did you know that Nicholas has dyslexia?’ she said. I didn’t, but it felt such a relief to hear that he had a problem I could at last put a name to. She showed me a piece of his writing, and between the two of us we had real difficulty following it because his spelling was so odd.

The psychologist said, ‘I’ll talk to his teachers, write a report and make some suggestions about how best to teach him.’ So the teachers started to give him more help and put him on a special reading programme. The psychologist put me in touch with the local dyslexia association and I was able to get a lot of advice and support from them.

Nicholas himself is happy to know that his difficulties are not his fault, and that many others share his problems. I just wish I had been able to recognise the problems earlier on. We could have done much more – and Nicholas wouldn’t be so far behind and so frustrated and moody. But I’m feeling more positive now, and so is Nicholas. We still have a long way to go – but Nicholas, his dad and me, and his teachers have made a start. And we have the very real feeling that at last we know where we’re going.

Nicholas’s – and his parents’ – problems are not unusual. But we want to make sure that difficulties like his are spotted early, so that effective action can be taken. That’s what this book is all about.

So now it’s time to deal with your own child’s experiences and sort out any concerns you might have. We ask you to think about your concerns now, and then to think about those early days when, perhaps, you might have started to feel just a bit worried. Even if you believe your child has difficulties in only one area, it’s worth checking the others too – very many children have more than one problem, and additional problems can easily be missed.

TO EXPLAIN WHAT dyslexia actually is has proved to be quite a challenge, as there are so many different views about how it should be defined. What everyone agrees is that children with dyslexia have much greater difficulty learning to read and spell than would be expected. (This is exactly the difficulty Nicholas had, see here.)

Research has shown that almost all children with dyslexia have difficulty with what they hear, not with what they see. Dyslexia is not a form of word blindness. What can be said with certainty is that children with dyslexia have a problem with an aspect of spoken language known as phonological processing.

Having phonological processing difficulties means that children find it hard to make sense of the speech sounds in words; for example, they cannot easily break a spoken word like ‘stop’ into its separate sounds ‘s’ – ‘t’ – ‘o’ – ‘p’. Nor can they easily put sounds together (known as blending) – if they hear s-t-o-p, they cannot tell that it makes the spoken word ‘stop’. Children need these phonological skills to be able to learn the relationship between sounds and lettters and then to read and spell.

The part played by intelligence (IQ) has been a cause of confusion because dyslexia can affect children of almost any ability level. It’s a myth that only children with high intelligence have dyslexia. On a practical level it is helpful to recognise that children with dyslexia have literacy levels that are out of keeping with their ability level (or IQ) – and possibly also out of keeping with other skills and attainments, such as maths, music or art. For this reason, dyslexia is sometimes referred to as a specific learning difficulty (you might also come across specific reading or specific spelling difficulty).

Children with below-average intelligence would not be expected to read at a level in keeping with their age. However, there are some lower-ability children who have more difficulty with learning to read than they have in the learning of other skills. Such children should equally be described as having dyslexia (though it needs to be recognised that their low IQ might make many aspects of learning a struggle for them).

Of course, not all literacy problems are due to a specific (or even a general) learning difficulty. Some children may progress poorly in reading because they have problems with their schooling – whether as a result of absence due to illness, poor teaching, lack of interest in learning (poor motivation), behaviour problems or attention difficulties. However, in this chapter we are looking at children whose literacy difficulties are a result of the specific learning problem that is dyslexia.

Dyslexia should not be seen as something one either has or doesn’t have, but rather a difficulty somewhere along a continuum from mild through to severe. Children with mild dyslexia may escape major reading problems, but have difficulties with spelling and expressing themselves fluently in writing. Children with severe dyslexia will have reading, spelling and writing difficulties that are likely to continue into their adult years.

Find out how much you already know – or think you know – about dyslexia in general. Read each statement and circle TRUE or FALSE then look below for the answers and more information.

Dyslexia is more common among boys than girls. TRUE or FALSE
Many children who develop dyslexia have had early (pre-school) speech and language problems. TRUE or FALSE
You can tell children have dyslexia from the type of spelling errors they make. TRUE or FALSE
Dyslexia is more common among left-handed than right-handed children. TRUE or FALSE
All children with dyslexia have exceptional talents. TRUE or FALSE
Children with dyslexia are usually clumsy. TRUE or FALSE
A child with no reading problems cannot have dyslexia. TRUE or FALSE
Many children with dyslexia may overcome their reading difficulties by their early teenage years. TRUE or FALSE
Playing games like ‘I Spy’ with letter sounds can help young children with dyslexia. TRUE or FALSE

2. Many children who develop dyslexia have had early (pre-school) speech and language problems. TRUE

3. You can tell children have dyslexia from the type of spelling errors they make. FALSE

4. Dyslexia is more common among left-handed than right-handed children. FALSE

8. Many children with dyslexia may overcome their reading difficulties by their early teenage years. TRUE

9. Playing games like ‘I Spy’ with letter sounds can help young children with dyslexia. TRUE

If you got between 7 and 9 of the quiz items correct, well done – you are aware of many of the important facts. However, it wouldn’t be surprising if you didn’t score as highly as this, given all the controversy surrounding the subject. By the end of this chapter you should have a clear understanding of what dyslexia is and whether it might be your child’s problem.

There is a common myth that children with dyslexia have an exceptional talent or gift, such as in art, design, music or maths. Alas, there is almost no scientific evidence for this. However, having dyslexia does not mean that an individual may not be talented and successful. There are many prominent people with dyslexia. These include Sir Richard Branson (entrepreneur, businessman and adventurer), Ruby Wax (television personality), Lord Richard Rogers (architect), A.A. Gill (journalist), Susan Hampshire (actress) and Sir Steve Redgrave (sportsman). Every child has strengths as well as weaknesses – and this is as true for the child with dyslexia as any other. In all cases, it is important for teachers and parents to look for and foster a child’s emerging strengths, talents and interests. This is necessary not just for helping with learning in the classroom but also for promoting confidence and self-esteem.

Studies of very large numbers of children can tell us how common learning difficulties are. Different studies do tend to come up with slightly different estimates – it depends on how the learning difficulty is measured and how severe the problem has to be to count as a difficulty. A working figure for severe dyslexia is around 5 per cent, and around 10 per cent if mild difficulties are included. Therefore, far from being rare, dyslexia is indeed a common learning problem. Boys are much more likely to have dyslexia than girls – three boys to every one girl.

Dyslexia is a learning difficulty that is largely inherited but in quite a complex way as several genes are involved. Family members often have sets of genes in common and therefore there is a strong risk that dyslexia will pass down through families. Parents (or other close family members) who had difficulty with reading, spelling and writing and struggled in school could well have had dyslexia even if, sadly, their difficulties went unrecognised.

Professor Margaret Snowling, a leading authority on dyslexia, studied children born into families where one parent had dyslexia, and followed them from the age of 3 to 13 years. The aim was to find out more about what causes dyslexia and what puts children at risk for reading difficulties. One of the findings was that the risk of dyslexia is very strong in families with a history of reading problems. By the time these at-risk children reached the age of 13 years, an extremely high number – nearly 50 per cent – were experiencing literacy difficulties. So, if you or your partner (or even your or your partner’s parents or brothers or sisters) had, or still have, difficulties with literacy then your children are certainly at risk. Of course, it does not mean that your children will definitely have dyslexia, but the probability of them having dyslexia is much higher than for other children.

If your child is at risk of an inherited learning difficulty, it would be a very good idea to check it out. Knowing your child is at risk may help you understand where your child’s problems are coming from so you can take positive action. In Professor Snowling’s study, many parents realised that slowness in learning the alphabet would make learning to read harder, so they spent more time teaching their children letters and their sounds.

The explanation of dyslexia we gave earlier points to children with dyslexia having phonological problems. Why is this awareness of speech sounds in words, and being able to remember them easily, so important for learning to read? It is because the ability to break up words into their component sounds and to remember the sequence (or order) of sounds are both needed for children to work out what a printed word says. This process is known as decoding – and is what phonics is all about. Being able to decode is essential for learning to read and spell. Children with dyslexia are poor at decoding and so are going to find reading and spelling very hard.

Pre-schoolers who understand sounds in words show this by playing games like clapping the syllables or ‘beats’ in a word; for instance, two claps for dustbin (dust – bin), three claps for umbrella (um – bre – lla). They have fun with nursery rhymes and even make up little rhymes of their own – even if it’s only like ‘I’ve been to the loo – poo, poo, poo!’ They join in games like ‘I Spy’. Parents of children with dyslexia may well recall that their child, when young, had difficulty with these sorts of language games.

Quite a lot of children who go on to have dyslexia have also been late to start talking and may well have had unclear speech. In the research described above, children from families with dyslexia were found to be behind on several aspects of language when they were age three to four (they had less good vocabulary and were more likely to make grammatical errors when they talked). So, both early difficulties with speech and language and difficulties with awareness of speech sounds should be seen as warning signs of possible dyslexia.

As children get a little older – at around the ages of four and five – their understanding of sounds in words becomes greater. Now they are able to think of and say back to you lots of words that begin with the same sound, such as sun, sandwich and sock. They may even be able to ‘take away’ sounds from words, such as ‘sat’ without the ‘ss’ sound says ‘at’. They also begin to learn and to remember the sounds or names of the letters of the alphabet. Children with dyslexia find all of these skills very difficult.

Because children with dyslexia have difficulties with speech sounds and with learning alphabet letters from a very early age, it follows that it is possible to ‘screen’ children for dyslexia as they start school. Indeed, there are tests used by psychologists and teachers that use speech sound and letter games to assess if children aged five are at risk for dyslexia. This is why it is not necessary to wait until the age of seven, when children would normally be reading, to recognise them as certainly having dyslexia. Another type of test used to identify children with dyslexia is a test of nonsense word reading. Nonsense words like ‘frod’ and ‘preet’ can only be read by decoding or ‘sounding the letters out’. Real words can be recognised, and so read, more easily because they may be familiar or easier to pick up in the context of a story. Children with dyslexia who have very poor decoding skills find it especially hard to read nonsense words.

Children with dyslexia usually have even more difficulty with spelling than they do with reading. Even if they overcome their reading problems (and many do by the time they are at secondary school) they are left with continuing and sometimes severe spelling problems. Interestingly, it’s not possible to tell if a child has dyslexia by the types of spelling errors seen in their written work. Their spelling mistakes look exactly like those made by younger children rather than being of a different kind.

Are children with decoding or reading accuracy problems also poor at reading comprehension (that is, understanding and remembering what they read)? This is a really important issue because the goal of reading is to understand and take on board what has been read. Children who read the words and sentences without understanding are sometimes described by teachers as ‘barking at print’. Children’s ability to understand what they read will depend on the number of words they can recognise. So a child with severe dyslexia who is able to read only very few words is likely to have problems with reading comprehension. The child with mild dyslexia who has a bigger reading vocabulary would be expected to have less of a problem with comprehension. Indeed, some children with mild dyslexia understand well what they read. These children usually have an above-average IQ and, most importantly, good spoken-language skills. They are therefore able to use their good vocabulary and the clues given by the context of the words in the story to help them make even better sense of what they read. If children have reading comprehension problems, it is important not just to assess how accurate their reading is, but also to look at their language skills. Children who find it hard to understand spoken language and who have a limited spoken vocabulary will also have problems understanding what they read.

Some people believe that dyslexia is caused by being left-handed or crossed- or mixed-lateral (for example, being right-handed but left-eyed). There is no evidence for these conditions being related to dyslexia. Nor is there any evidence that being forced to change handedness (a naturally left-handed child being made to write with the right hand) will cause that child to develop dyslexia. It might, however, lead to handwriting problems and lack of confidence or even emotional distress.

Problems with another skill – short-term memory for speech sounds – also affect many children with dyslexia. Children who have been late to talk are especially likely to have problems with short-term verbal memory. You may have noted how difficult it is for your child to remember instructions even when he or she seems to be paying attention and listening carefully. Your child’s short-term verbal memory can be assessed by psychologists or teachers by getting him or her to repeat sequences of words or sentences or strings of numbers.

This is another area where there is much disagreement. The most usual view is that there is only one type of dyslexia: phonological processing and decoding problems are the cause of reading difficulties. The underlying cause is the same for all children with dyslexia – it’s just that some have more severe difficulties than others.

A rather different view of dyslexia is that there are two subtypes – phonological dyslexia and surface dyslexia. Children with phonological dyslexia have severe reading and spelling problems that are caused by their phonological processing and decoding difficulties. Children with surface dyslexia have fewer phonological processing and decoding problems; but they are likely to have other difficulties, for instance with short-term verbal memory. Children with surface dyslexia usually catch up in their reading accuracy after a slow start, but they often continue to have reading speed and spelling problems.

What these views have in common is that they describe dyslexia as due to an underlying spoken language difficulty. If phonological and surface dyslexia were really found to be two completely separate learning problems, then in theory no one child could move from one subtype to the other. In practice, however, a child can go from showing the profile of phonological dyslexia to resembling a child with surface dyslexia, if over time they receive good tuition in phonological processing and decoding. More evidence is needed to decide for sure which of these views – one type or two subtypes – best describes dyslexia.

There is also the issue of visual- versus sound-based dyslexia. Most research suggests that visual skills play only a small part in learning to read and spell. It is only very occasionally that a child with literacy problems is found to have visual processing difficulties of one kind or another, but without having any phonological and decoding difficulties.

A high number of children with dyslexia have other significant learning difficulties too. This is known as co-occurrence or co-morbidity. These other learning difficulties are persistent language problems; motor and nonverbal difficulties, including clumsiness; maths problems; and attention problems.

The at risk study showed that around 70 per cent of children with dyslexia had one or more of these other learning problems as well. Many children with dyslexia have problems with maths because dyslexia affects the verbal aspects of number processing. They find it hard to learn the number names so they count slowly and make mistakes when doing calculations. They also find it hard to recall maths facts like multiplication tables. There are also many children with dyslexia (at least 35 per cent) who have attention problems.

There is growing evidence that dyslexia is not quite the very specific or selective difficulty that it was once thought to be. This is not just because there may be different subtypes of dyslexia, but also because other (co-occurring) learning difficulties have such a marked effect on how the dyslexia shows itself. It is, therefore, vital to recognise all the difficulties shown by a child with dyslexia so that these can be dealt with alongside help given for the literacy problems. How to recognise these other problems will be described in Chapters 2, 3, 4 and 5.

Not all children with dyslexia fail to read – but dyslexia affects educational progress

Many children with dyslexia will indeed have reading problems, either mild or severe. Small numbers of children with dyslexia escape reading difficulties but still have problems with learning to spell and to write. Many issues affect how well children with dyslexia are likely to manage by the time they leave school: