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INTRODUCTION

Learning to read is one of the key outcomes for early education and children who have reading difficulties often enter a downward spiral of low educational attainment and poor employment prospects with negative consequences for adult well-being. When we consider problems in learning to read, it is important to make a clear distinction between decoding (the accuracy or fluency of reading aloud) and comprehension (the adequacy of understanding text). Problems in learning to decode (developmental dyslexia) and problems in learning to comprehend text (reading comprehension impairment) are distinct forms of difficulty, both of which appear to depend principally upon impairments of oral language development. As we will outline below, Dyslexia is related to early problems in oral language development, with persisting problems in the development of speech-sound (phonological) skills being a particularly important obstacle to learning to decode print. In contrast, reading comprehension impairment depends critically upon broader oral language difficulties; particularly problems with understanding word meanings, and problems with grammatical skills.

DYSLEXIA

Definition and prevalence

Developmental dyslexia is the most widely used term for children who experience severe difficulties in learning to decode print. Children with dyslexia find it hard to recognize printed words, have great difficulties 'sounding out' unfamiliar words, and often also read slowly. In European languages, which have more regular writing systems than English, the main symptoms of dyslexia are poor reading fluency and spelling but the predictors of reading (and dyslexia) are the same, namely letter knowledge, phoneme awareness and rapid naming (RAN) skills [ 1].

It is important to emphasize that reading skills, like many other human characteristics (e.g., weight, blood pressure) show a continuous distribution in the population. As such, the criteria used for diagnosis are to some extent arbitrary (just as for obesity or hypertension). A common criterion for diagnosing dyslexia is reading accuracy more than 1.5 SD below the mean, which results in roughly 7% of the population being identified as dyslexic [ 2]. Dyslexia is more common in males, and is frequently comorbid with other developmental disorders such as specific language impairment (SLI), attention deficit hyperactivity disorder, or developmental coordination disorder [ 3].

Risk factors for dyslexia

Dyslexia runs in families and twin studies have established that difficulties with reading and related skills are highly heritable. More recently, molecular genetic analyses have identified many potential candidate genes of small effect associated with individual differences in reading [ 4]. Notwithstanding the importance of genetic factors, the home literacy environment [ 5] and the quality of teaching are likely additional influences on reading development.

Furthermore, genes act through the environment and both passive and active gene-environment correlations can be expected to affect literacy outcomes. Parents with dyslexia not only share genes with their offspring, but also plausibly may provide a different home literacy environment to that found in homes where parents do not experience literacy difficulties. Similarly, children who are poor readers are less likely to seek out opportunities for reading than good readers and hence will have less exposure to print. Low levels of print exposure and reading practice will, in turn, compromise reading development.

For many years, studies of the likely cognitive causes of dyslexia were dominated by case-control studies of highly selected clinical groups. Such studies are subject to referral bias and often children with comorbid conditions are excluded from study samples. Arguably a more robust approach is offered by prospective longitudinal studies, which follow the development of children at high risk of dyslexia from the preschool years, to examine the characteristics of those who go on to be dyslexic to identify causal risk factors.

Studies of children at family risk of dyslexia by virtue of having a first degree affected relative have highlighted the crucial importance of language to literacy development. Several studies of children at family risk of dyslexia have been completed and others are ongoing [ 6▪▪]. These studies show a heightened prevalence of dyslexia in the offspring of affected parents, with some 44% developing dyslexia. These studies also show that dyslexia is not 'all or none'. Rather, among children at family risk of dyslexia, literacy outcomes are distributed continuously with some children, while not qualifying for the label of dyslexia, nonetheless showing dyslexic symptoms, including relatively poor reading fluency and spelling.

The findings of family risk studies also show that single deficit accounts of dyslexia are inadequate. Although such studies confirm that poor phonological skills (e.g., poor nonword repetition in the preschool and poor phoneme awareness in the school years) are primary risk factors for poor reading, dyslexia is more likely to be 'diagnosed' when broader language impairments (including difficulties with grammar and poor vocabulary) persist into the school years. Such findings add to a growing body of evidence that a phonological deficit is one of a number of risk factors for dyslexia that accumulate towards a threshold [ 7].

RELATIONSHIP BETWEEN DYSLEXIA AND LANGUAGE IMPAIRMENT

Preschool profiles

It is well established that children with speech and language difficulties are at risk of literacy problems and there are likely to be shared endophenotypes between SLI, speech sound disorder, and dyslexia [ 8]. Bishop and Snowling [ 9] suggested that dyslexia and language impairment are both characterized by poor phonology (a shared risk factor for poor decoding) but differ in the extent to which broader language difficulties (vocabulary and comprehension) are implicated. However, few studies have made direct comparisons between the disorders as SLI tends to be diagnosed in the preschool years, whereas dyslexia is typically diagnosed much later (after a child has been in school for some years but failed to make adequate progress in learning to read).

Nash et al. [ 10], Hulme et al. [ 11▪▪], and Snowling et al. [ 12▪] followed the development of children at family risk of dyslexia and children with preschool language impairment in the Wellcome Language and Reading Project - a 5-year longitudinal study from age 3.5 to 8 years. Three groups of preschool children were recruited to the study: children at family risk of dyslexia, children considered to be language impaired, and children at low risk of dyslexia (controls). Following parental assessment of literacy skills, children were initially classified as either at family risk or not at risk. Next, following a language assessment, the children were grouped according to whether they fulfilled criteria for language impairment, defined as at least 1 SD below the mean on measures of receptive and expressive language skills. This procedure yielded four groups of children: typically developing, children with SLI, children at family risk of dyslexia (FR), and children at family risk of dyslexia with SLI. It is noteworthy that about a third of the children at family risk of dyslexia also had a preschool language impairment. These children did not differ from the SLI-only group on any phonological or language measure, whereas the FR-only group had difficulties only on phonological tasks that tapped speech production, namely articulation and word and nonword repetition. They also showed subtle and short-lived difficulties with grammar (problems with marking the past tense - ed, and third person singular - s) and in repeating sentences accurately. Gooch et al. [ 13] went on to show that the children in the SLI groups were more likely to have difficulties with attention and motor development than children at family risk without language impairment.

Predictors of individual differences in reading

Hulme et al.[ 11▪▪] tracked the progress of the children from the three risk groups and controls at ages 3.5, 4.5, 5.5, and 8 years and used the data in a path model to investigate the causal relationships between language and literacy skills. At 3.5 years, a single language factor could be defined by performance on tests of vocabulary, grammar, conceptual understanding, repetition, and articulation (with repetition and articulation loading least well on this factor, possibly because they also tap speech processes). Language at 3.5 years predicted the foundations for decoding: namely letter knowledge, RAN, and phoneme awareness with the relationship between language and phoneme awareness being particularly strong. In turn, letter knowledge and phoneme awareness measured at 4.5 years predicted decoding skills at 5.5 years. Reading comprehension at 8 years of age was predicted by decoding at 5.5 together with language at 3.5 years.

These findings underline the importance of oral language development for reading development. The impact of language development at 3.5 years on decoding was fully mediated by phoneme awareness and letter knowledge, and there was a direct long range effect of language skills at 3.5 years on reading comprehension measured some 5 years later at age 8 years. A clear implication is that children with poor language skills in the preschool years are at high risk of developing both dyslexia and reading comprehension impairment. However, there is a complication. It is not uncommon for children who show delayed language development in the preschool years to 'catch up' and for speech difficulties to resolve. In this light, Bishop and Adams [ 14] proposed a 'critical age hypothesis' - only when children have problems with language (or speech) development that persist to the point of school entry will they succumb to reading problems.

Trajectories of language development

To investigate language development in the Wellcome Language and Reading Project, and more specifically, to differentiate children with persistent versus resolving language impairments, Snowling et al. [ 12▪] examined the progress of individual children at three time points: preschool (3.5 years), school entry (5.5 years), and the middle of primary school (8 years). By assessing each child on tests tapping receptive and expressive grammar and vocabulary, it was possible to determine whether or not they fulfilled criteria for SLI at the different time points. In total, 66% of the children in the sample had normal language at all three times. Among the others, it was possible to discern three trajectories of development: 16% had language impairments that resolved, whereas 56% had persisting language impairments. In addition, some 28% showed late emerging language impairments; these children performed well within the normal range on language tasks at 3.5 years, yet scored as poorly as the persisting group at age 8 years. It is noteworthy that this 'late emerging' trajectory was strongly associated with familial dyslexia. In line with the critical age hypothesis, children with early language difficulties, which resolved by the start of formal literacy instruction tended to have good literacy outcomes, but children with both persisting and later emerging difficulties tended to have reading difficulties with more than 40% of each group affected.

Screening and assessment

Given that dyslexia has its precursors in preschool, it may be possible to identify children early with a view to providing early intervention. However, screening is not straightforward because risk and protective factors interact during learning to read. Using data from a Finnish longitudinal study, Puolakanaho et al.[ 15] showed that being at family risk of dyslexia increases the probability of reading disability. However, if letter-naming skills develop early, the risk is considerably decreased. Similarly, for a child with poor letter-naming skills at 4.5 and 5.5 years, the probability of dyslexia is lower if he or she has good phonological awareness or efficient RAN.

In a similar vein, data from the Wellcome Language and Reading Project confirmed a changing pattern of prediction of dyslexia at different ages [ 16]. Although family-risk status was a stronger predictor of dyslexia from preschool than language difficulties were, at the time of school entry, poor language skill was a significant risk factor. Additional predictors in the preschool years included letter knowledge, phonological awareness, RAN, and executive skills and, at the time of school entry, motor skills slightly increased the prediction probability. These findings underline the fact that dyslexia is the outcome of multiple risk factors and confirm that children with language difficulties at school entry are at high risk. However, screening for dyslexia does not reach an acceptable clinical level until close to school entry when letter knowledge, phonological awareness, and RAN, rather than family risk, together provide good sensitivity and specificity as a screening battery.

INTERVENTIONS FOR CHILDREN'S READING AND LANGUAGE DIFFICULTIES

We began by arguing that there are two types of reading disorder and we showed that the predictors of decoding (and hence dyslexia) differ from the predictors of reading comprehension. It follows that different forms of intervention are required for children with dyslexia compared with 'poor comprehenders'. The evidence reviewed so far suggests that early interventions to strengthen the language foundations for reading will be important. There is growing evidence from randomized trials that educational interventions for reading and related learning disorders are effective when delivered by trained practitioners [ 17]. In general terms, interventions to promote decoding (and hence remediate dyslexia) comprise training in phoneme awareness linked to letter knowledge, together with systematic phonic instruction in the context of book reading. In contrast, interventions to promote reading comprehension involve work to improve oral language skills (including work on vocabulary and narrative skills) and emphasis on the use of inferences and metacognitive strategies to ensure coherent understanding of text [ 18].

Fricke et al. [ 19] evaluated an oral language programme aimed at improving vocabulary, grammar, narrative and active listening skills, and also assessed its impact on reading. Children receiving the intervention made greater gains in oral language and narrative skills than a waiting-list control group who received 'business as usual' and their phoneme awareness and letter knowledge also improved. Although the programme contained no activities directed towards reading, and no gains were made in decoding skills, an important outcome was that the intervention group showed significant gains in reading comprehension 6 months after the intervention had ended. Moreover, these gains were fully mediated by gains in oral language.

CONCLUSION

Dyslexia represents the lower end of a continuous distribution of reading skills in the population. The oral language weaknesses that are the precursors of dyslexia can be observed in the preschool period. Being at family risk of dyslexia is an important risk factor and a major proximal cause is in speech processing (phonological) difficulties. Although dyslexia is primarily a decoding difficulty, many children also experience reading comprehension problems associated with co-occurring language difficulties. We believe that screening for language difficulties should be conducted at school entry to identify children who are at risk of difficulties in learning to read. There is good evidence from randomized trials that language interventions can ameliorate language weaknesses detected in the early school years. Similarly, specialist teaching methods are effective in ameliorating the problems in learning to decode print that are seen in children with dyslexia.

REFERENCES AND RECOMMENDED READING

Papers of particular interest, published within the annual period of review, have been highlighted as:

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Learning to read is one of the key outcomes for early education and children who have reading difficulties often enter a downward spiral of low educational attainment and poor employment prospects with negative consequences for adult well-being.

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Developmental dyslexia and how it relates to brain function are complicated topics that researchers have been studying since dyslexia was first described over a hundred years ago.

W. Pringle Morgan (cited in Shaywitz, 1996), a doctor in Sussex, England, described the puzzling case of a boy in the British Medical Journal: "Percy ... aged 14 ... has always been a bright and intelligent boy, quick at games, and in no way inferior to others of his age. His great difficulty has been - and is now - his inability to read" (p. 98).

Almost every teacher in the United States has at least one student who could fit the same description written so many years ago. This situation leads many school personnel to wonder why their articulate, clearly bright student has so many problems with what appears to be a simple task - reading a text that everyone else seems to easily comprehend.

Having information about the likely explanation for and potential cause of the student's difficulties often relieves teachers' fears and uncertainties about how to teach the student and how to think about providing instruction that is relevant and effective. Current research on dyslexia and the brain provide the most up-to-date information available about the problems faced by over 2.8 million school-aged children.

When talking with teachers about their students who struggle with reading, we have encountered similar types of questions from teachers. They often wonder, What is dyslexia? What does brain research tell us about reading problems and what does this information mean for classroom instruction?

The purpose of this article is to explain the answers to these questions and provide foundational knowledge that will lead to a firmer understanding of the underlying characteristics of students with dyslexia. A greater understanding of the current brain research and how it relates to students with dyslexia is important in education and will help teachers understand and evaluate possible instructional interventions to help their students succeed in the classroom.

What is dyslexia?

Dyslexia is an often-misunderstood, confusing term for reading problems. The word dyslexia is made up of two different parts: dys meaning not or difficult, and lexia meaning words, reading, or language. So quite literally, dyslexia means difficulty with words (Catts & Kamhi, 2005).

Despite the many confusions and misunderstandings, the term dyslexia is commonly used by medical personnel, researchers, and clinicians. One of the most common misunderstandings about this condition is that dyslexia is a problem of letter or word reversals ( b/ d, was/ saw) or of letters, words, or sentences "dancing around" on the page (Rayner, Foorman, Perfetti, Pesetsky, & Seidenberg, 2001).

In fact, writing and reading letters and words backwards are common in the early stages of learning to read and write among average and dyslexic children alike, and the presence of reversals may or may not indicate an underlying reading problem. See Table 1 for explanations of this and other common misunderstandings.

One of the most complete definitions of dyslexia comes from over 20 years of research:

Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. (Lyon, Shaywitz, & Shaywitz, 2003, p. 2)

Dyslexia is a specific learning disability in reading that often affects spelling as well. In fact, reading disability is the most widely known and most carefully studied of the learning disabilities, affecting 80% of all those designated as learning disabled. Because of this, we will use the terms dyslexia and reading disabilities (RD) interchangeably in this article to describe the students of interest.

It is neurobiological in origin, meaning that the problem is located physically in the brain. Dyslexia is not caused by poverty, developmental delay, speech or hearing impairments, or learning a second language, although those conditions may put a child more at risk for developing a reading disability (Snow, Burns, & Griffin, 1998).

Children with dyslexia will often show two obvious difficulties when asked to read text at their grade level. First, they will not be able to read as many of the words in a text by sight as average readers. There will be many words on which they stumble, guess at, or attempt to "sound out." This is the problem with "fluent word recognition" identified in the previous definition.

Second, they will often show decoding difficulties, meaning that their attempts to identify words they do not know will produce many errors. They will not be very accurate in using letter-sound relationships in combination with context to identify unknown words.

These problems in word recognition are due to an underlying deficit in the sound component of language that makes it very difficult for readers to connect letters and sounds in order to decode. People with dyslexia often have trouble comprehending what they read because of the great difficulty they experience in accessing the printed words.

What areas of the brain relate to language and reading?

The human brain is a complex organ that has many different functions. It controls the body and receives, analyzes, and stores information.

The brain can be divided down the middle lengthwise into a right and a left hemisphere. Most of the areas responsible for speech, language processing, and reading are in the left hemisphere, and for this reason we will focus all of our descriptions and figures on the left side of the brain. Within each hemisphere, we find the following four brain lobes (see Figure 1).

The frontal lobe is the largest and responsible for controlling speech, reasoning, planning, regulating emotions, and consciousness.
In the 19th century, Paul Broca was exploring areas of the brain used for language and noticed a particular part of the brain that was impaired in a man whose speech became limited after a stroke. This area received more and more attention, and today we know that Broca's area, located here in the frontal lobe, is important for the organization, production, and manipulation of language and speech (Joseph, Noble, & Eden, 2001). Areas of the frontal lobe are also important for silent reading proficiency (Shaywitz et al., 2002).

The parietal lobe is located farther back in the brain and controls sensory perceptions as well as linking spoken and written language to memory to give it meaning so we can understand what we hear and read.

The occipital lobe, found at the back of the head, is where the primary visual cortex is located. Among other types of visual perception, the visual cortex is important in the identification of letters.

The temporal lobe is located in the lower part of the brain, parallel with the ears, and is involved in verbal memory.
Wernicke's area, long known to be important in understanding language (Joseph et al., 2001), is located here. This region, identified by Carl Wernicke at about the same time and using the same methods as Broca, is critical in language processing and reading.

In addition, converging evidence suggests that two other systems, which process language within and between lobes, are important for reading (see Figure 2).

The first is the left parietotemporal system (Area A in Figure 2) that appears to be involved in word analysis - the conscious, effortful decoding of words (Shaywitz et al., 2002). This region is critical in the process of mapping letters and written words onto their sound correspondences - letter sounds and spoken words (Heim & Keil, 2004). This area is also important for comprehending written and spoken language (Joseph et al., 2001).

The second system that is important for reading is the left occipitotemporal area (Area B in Figure 2). This system seems to be involved in automatic, rapid access to whole words and is a critical area for skilled, fluent reading (Shaywitz et al., 2002, 2004).

What does brain imaging research tell us about dyslexia?

Structural brain differences

Studies of structural differences in the brains of people of all ages show differences between people with and without reading disabilities.

The brain is chiefly made up of two types of material: gray matter and white matter. Gray matter is what we see when we look at a brain and is mostly composed of nerve cells. Its primary function is processing information.

White matter is found within the deeper parts of the brain, and is composed of connective fibers covered in myelin, the coating designed to facilitate communication between nerves. White matter is primarily responsible for information transfer around the brain.

Booth and Burman (2001) found that people with dyslexia have less gray matter in the left parietotemporal area (Area A in Figure 2) than nondyslexic individuals. Having less gray matter in this region of the brain could lead to problems processing the sound structure of language (phonological awareness).

Many people with dyslexia also have less white matter in this same area than average readers, which is important because more white matter is correlated with increased reading skill (Deutsch, Dougherty, Bammer, Siok, Gabrieli, & Wandell, 2005). Having less white matter could lessen the ability or efficiency of the regions of the brain to communicate with one another.

Other structural analyses of the brains of people with and without RD have found differences in hemispherical asymmetry. Specifically, most brains of right-handed, nondyslexic people are asymmetrical with the left hemisphere being larger than the same area on the right.

In contrast, Heim and Keil (2004) found that right-handed people with dyslexia show a pattern of symmetry (right equals left) or asymmetry in the other direction (right larger than left). The exact cause of these size differences is the subject of ongoing research, but they seem to be implicated in the reading and spelling problems of people with dyslexia.

Functional brain differences

We lack space here for a detailed explanation of imaging techniques. For excellent descriptions of several techniques, readers are directed to Papanicolaou, Pugh, Simos, and Mencl (2004) and Richards (2001).

One commonly used method for imaging brain function is functional magnetic resonance imaging (fMRI), a noninvasive, relatively new method that measures physiological signs of neural activation using a strong magnet to pinpoint blood flow. This technique is called "functional" because participants perform tasks while in (or under) the magnet, allowing measurement of the functioning brain rather than the activity of the brain at rest.

Several studies using functional imaging techniques that compared the brain activation patterns of readers with and without dyslexia show potentially important patterns of differences. We might expect that readers with RD would show underactivation in areas where they are weaker and overactivation in other areas in order to compensate, and that is exactly what many researchers have found (e.g., Shaywitz et al., 1998).

This type of functional imaging research has just begun to be used with children. This is in part because of the challenges involved in imaging children, including the absolute need for the participant's head to remain motionless during the scanning.

We will present the largest, best-specified study as an example of these new findings with children. Shaywitz et al. (2002) studied 144 righthanded children with and without RD on a variety of in- and out-of-magnet tasks. They compared brain activation between the two groups of children on tasks designed to tap several component processes of reading:

identifying the names or sounds of letters

sounding out nonsense words

sounding out and comparing meanings of real words

The nonimpaired readers had more activation in all of the areas known to be important for reading than the children with dyslexia.

Shaywitz et al. (2002) also found that the children who were good decoders had more activation in the areas important for reading in the left hemisphere and less in the right hemisphere than the children with RD.

They suggested that for children with RD, disruption in the rear reading systems in the left hemisphere that are critical for skilled, fluent reading (Area B in Figure 2) leads the children to try and compensate by using other, less efficient systems (Area A in Figure 2 and systems in the right hemisphere).

This finding could explain the common experience in school that even as children with dyslexia develop into accurate readers, their reading in grade-level text is often still slow and labored without any fluency (e.g., Torgesen, Rashotte, & Alexander, 2001).

In summary, the brain of a person with dyslexia has a different distribution of metabolic activation than the brain of a person without reading problems when accomplishing the same language task. There is a failure of the left hemisphere rear brain systems to function properly during reading.

Furthermore, many people with dyslexia often show greater activation in the lower frontal areas of the brain. This leads to the conclusion that neural systems in frontal regions may compensate for the disruption in the posterior area (Shaywitz et al., 2003). This information often leads educators to wonder whether brain imaging can be used as a diagnostic tool to identify children with reading disabilities in school.

Can we screen everyone who has reading difficulties?

Not yet. It is an appealing vision of putting a child we are concerned about in an fMRI machine to quickly and accurately identify his or her problem, but research has not taken us that far.

There are several reasons why a clinical or school-based use of imaging techniques to identify children with dyslexia is not currently feasible. One is the enormous cost of fMRI machines, the computers, and the software needed to run them. Another part of the cost is the staff that is needed to run and interpret the results.

Also, in order for this technology to be used for diagnosis, it needs to be accurate for individuals. Currently, results are reliable and reported for groups of participants, but not necessarily for individuals within each group (Richards, 2001; Shaywitz et al., 2002).

The number of children who would be identified as being average when they really have a problem (false negatives) or as having a problem when they are average (false positives) would need to be significantly lower for imaging techniques to be used for diagnosis of individual children.

Can dyslexia be cured?

In a word, no. Dyslexia is a lifelong condition that affects people into old age. However, that does not mean that instruction cannot remediate some of the difficulties people with dyslexia have with written language. A large body of evidence shows what types of instruction struggling readers need to be successful (e.g., National Institute of Child Health and Human Development, 2000; Snow et al., 1998; Torgesen, 2000).

Now researchers can also "look" inside the brains of children before and after an intensive intervention and see for the first time the effects of the intervention on the brain activity of children with RD. The following are two such studies.

Aylward et al. (2003) imaged 10 children with dyslexia and 11 average readers before and after a 28-hour intervention that only the students with dyslexia received. They compared the two groups of students on out-of-magnet reading tests as well as the level of activation during tasks of identifying letter sounds.

They found that while the control children showed no differences between the two imagings, the students who received the treatment showed a significant increase in activation in the areas important for reading and language during the phonological task. Before the intervention, the children with RD showed significant underactivation in these areas as compared to the control children, and after the treatment their profiles were very similar.

These results must be viewed with caution because of several limitations. One limitation is the lack of specificity about the intervention that was provided, another is the small sample size, and the last is the lack of an experimental control group (i.e., a group of children with RD who did not receive the treatment). Without an experimental control group, we cannot be certain that the intervention caused the changes found in the brain activation because of so many other possible explanations.

Shaywitz et al. (2004) addressed these limitations in their investigation of brain activation changes before and after an intervention. They studied 78 second and third graders with reading disabilities who were randomly assigned to three groups:

the experimental intervention

school-based remedial programs

control

A summary of the instructional intervention is provided in Table 2 and a full and detailed description of the intervention and out-of-magnet reading assessments can be found in Blachman et al. (2004).

Before the intervention, all groups looked similar in their brain activity, but immediately after the intervention the experimental and control groups had increased activation in the left hemispheric regions important for reading.

One year after intervention, the experimental group showed increased activity in the occipito-temporal region important for automatic, fluent reading (Area B in Figure 2), while at both time points the level of compensatory activation in the right hemisphere decreased.

Shaywitz et al. (2002) concluded, "These findings indicate that ... the use of an evidence-based phonologic reading intervention facilitates the development of those fast-paced neural systems that underlie skilled reading" (p. 931).

Important considerations to keep in mind about the brain research

While research advances have allowed us to look more closely within the brain for the first time and revealed important information about how and where we think during reading, there are important considerations that must be remembered.

One is that with the exception of the research by B.E. Shaywitz, S. Shaywitz, and their colleagues, the sample sizes in each study are very small. The evidence from these small studies is converging into results that are reliable, but the results may change as more and more participants are included in the research base. This is especially true with children where both the number of studies and the sample sizes are quite small.

Second, we must consider the type of task being used in the magnet. Because of the requirement that the person's head not move during the imaging, researchers are not able to study people actually reading aloud. Instead, they give tasks that require the person to read silently and then make a decision that he or she indicates with a push button (e.g., Do the letters t and v rhyme? Do leat and jete rhyme?).

Because the researchers have worked carefully on these tasks and have specified the particular process that is being measured, we can trust their conclusions about what the activation levels mean; however, the tasks are quite removed from natural classroom reading and should not be interpreted as if they were the same. The area of brain research is developing rapidly; technological advances are being made that will address these issues as time goes on.

Recommendations for teachers

What does all of this information mean for school personnel and their students? Once teachers understand the underlying processes and causes of reading disabilities, they can use this information as they work with students and their families. The following are specific recommendations based on the neurological research:

Adequate assessment of language processing is important in determining why students struggle to learn to read.
Dyslexia, or reading disability, is a disorder of the language processing systems in the brain. Specific information about exactly what sorts of weaknesses are present is needed in order to determine the appropriate instruction to meet each student's needs.

Imaging research confirms that simple tasks can more reliably be interpreted as "red flags" suggesting that a young child may be at risk for dyslexia.

It is vital to begin using screening and progress monitoring procedures early on to measure children's understanding of sounds in speech, letter sounds in words, and fluent word recognition. Using such assessment in an ongoing way throughout a child's school career can help teachers know what skills to teach and whether a child is developing these skills.

Explicit, intense, systematic instruction in the sound structure of language (phonemic awareness) and in how sounds relate to letters (phonics) is needed for readers with dyslexia.

Imaging research confirmed that instruction in the alphabetic principle caused distinct differences in brain activation patterns in the students with RD (Shaywitz et al., 2004). Keep in mind that the intervention was explicit, intense, long term, and specifically focused on phonological processing, phonics, and fluency.

The roles of motivation and fear of failing are important when discussing reading problems.

Students do not struggle simply because they are not trying hard enough. They may have a brain difference that requires them to be taught in a more intense fashion than their peers. Without intense intervention, low motivation may develop as students try to avoid a difficult and painful task.

School personnel can use their knowledge of the neurological characteristics and basis of dyslexia to help their students understand their strengths and weaknesses around reading and language.

Understanding a possible reason why they find something difficult that no one else seems to struggle with may help relieve some of the mystery and negative feelings that many people with a disability feel. Sharing our knowledge of brain research may demystify dyslexia and help students and their parents realize that language processing is only one of many talents that they have and that they are not "stupid," they simply process language differently than their peers.

Recommendations for parents

The identification of a child with dyslexia is a difficult time for parents and teachers. We suggest that teachers can help parents learn more about their child's difficulty in the following ways:

Teachers can share information about the student's specific areas of weakness and strength and help parents realize the underlying causes of their child's difficulty.
This conversation can also include information about how to help their child use areas of strength to support areas of weakness.

It is critical to help parents get clear about what dyslexia is and is not.

Sharing the common misconceptions and the correct information found in Table 1 with parents may help clear up any confusion that may exist.

Early intervention with intense, explicit instruction is critical for helping students avoid the lifelong consequences of poor reading.

Engaging parents early in the process of identifying what programs and services are best for their child will ensure greater levels of success and cooperation between home and school.

There are many organizations devoted to supporting individuals with RD and their families.

Accessing the knowledge, support, and advocacy of these organizations is critical for many families. A list of several large organizations to share with parents can be found in Table 3.

Finally, teachers can often best help families by simply listening to the parents and their concerns for their children.

Understanding a disability label and what that means for the future of their child is a very emotional process for parents and many times teachers can help by providing a sympathetic ear as well as information.

Imaging research has demonstrated that the brains of people with dyslexia show different, less efficient, patterns of processing (including under and over activation) during tasks involving sounds in speech and letter sounds in words. Understanding this has the potential to increase the confidence teachers feel when designing and carrying out instruction for their students with dyslexia.

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Dyslexia and the Brain: What Does Current Research Tell Us?

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The identification of a child with dyslexia is a difficult process, but there are ways that parents and teachers can learn more about the reading difficulty and support the child's learning.

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"It's frustrating that you can't read the simplest word in the world."

Thomas Lester grabs a book and opens to a random page. He points to a word: galloping.

"Goll-. G-. Gaa-. Gaa-. G-. " He keeps trying. It is as if the rest of the word is in him somewhere, but he can't sound it out.

"I don't ... I quit." He tosses the book and it skids along the table.

Despite stumbling over the simplest words, Thomas - a fourth-grader - is a bright kid. In fact, that's an often-misunderstood part of dyslexia: It's not about lacking comprehension, having a low IQ or being deprived of a good education.

It's about having a really hard time reading.

Dyslexia is the most common learning disability in the United States. It touches the lives of millions of people, including me and Thomas. Just like Thomas, I spent much of my childhood sitting in a little chair across from a reading tutor.

Today, Thomas is working with his tutor in an office building in northwest Washington, D.C. The suite they're in is an oasis of white couches and overstuffed pillows. In the waiting area, a kid is curled up sucking her thumb, and a mom reads a magazine quietly.

In the back of the suite - a Lindamood Bell Reading Center - Thomas fidgets with everything in arm's reach.

"All right, I am going to give you some air-writing words," the tutor says to Thomas, speaking rapidly as if daring Thomas to keep pace. She spells the first one out loud: "C-O-R-T."

With his index finger, Thomas writes the letters sloppily in the air.

Then his tutor asks a question: What sound do the two middle letters make? "Eer? Aar?"

Thomas squints at whatever visual memory he can retain from the letters he has just scribbled in the air. Then, with a burst of enthusiasm, he stumbles on the answer: "Or!"

"Good job!" his tutor replies, with what seems like genuine excitement, before moving on to her next question about the letters.

I also have a question for Thomas: What's it like to have dyslexia?

Thomas stops his fidgeting. "It's hard," he pauses. "Like, really hard."

Thomas, 9, has trouble reading, but he likes books. Just give him the audio version, he says, and he'll "listen to the book on Audible like 10,000 times."

"His comprehension is that of a 13-year-old," says Geva Lester, Thomas' mom. "He can understand Harry Potter, but he can't read it."

Before they started coming to this Lindamood Bell Reading Center, Lester says, she'd watch with alarmed confusion as her son struggled with the most basic text: "See Spot run."

She remembers trying to read with him. "On one page he would figure out the word: 'There.' And on the second page, he would see it and he would have no idea what it said."

Sitting there with Thomas and his mom, I remember doing that myself - and in some ways, I still do.

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As a child, my dyslexia was a closely guarded secret. In kindergarten, I'd leave class to work in a tiny closet, with a space heater and a reading specialist. Walking there, down the locker-lined hallways, I'd avoid eye contact, hoping nobody would notice me.

In middle school, I struggled to read even picture books. In class, I'd pretend. Then, at home, I'd listen to my books on cassette tapes - at double speed. And during the summer, I'd go to Lindamood Bell, just like Thomas. (The reading centers, which offer tutoring and reading programs around the world, also provide financial support for NPR.)

Over the years, I survived by memorizing words. It started with boxes and boxes of index cards. I'd practice each night, looking at a word and saying its sound as quickly as I could. I memorized hundreds and hundreds - maybe a few thousand - words this way.

I've never been able to sound out unfamiliar words. And I still can't.

When I come across a word I don't know, I freeze. It's often a last name or a street name that never made it onto those index cards. It takes a great deal of focus for me to clump the letters into groups, link those groups with sounds and, finally, string those sounds together.

Since dyslexia is not something you outgrow, I have learned to work with it, and work around it. It's always there, but it is rarely the focus of my thoughts. That was true through college and graduate school, but when I became an education reporter, it changed.

As I returned to elementary school classrooms and interviewed parents and teachers, dyslexia kept popping up in places I didn't expect. I saw teachers who were mystified by their students' struggles and parents whose stamina and empathy were tested.

Dyslexia is so widespread that it forces schools and parents to take action. And yet, it is deeply misunderstood. Even basic questions don't have easy answers.

Exactly how many people around the world have dyslexia? Well, it's complicated. Estimates vary greatly, partly because it depends on what country or language you are talking about (English speakers may be more likely to have it than, say, Italian speakers) and partly because many people who have dyslexia never get a formal diagnosis. However, most estimates in the United States put it at somewhere between 5 and 17 percent of the population.

Many people think that dyslexia is seeing letters in the wrong order, or getting b and d mixed up. Not true. Researchers, experts and people with dyslexia dismiss these as common misconceptions.

So, if dyslexia isn't any of those things people think it is, then what is it?

"It's basically like looking at a foreign word," says Jonathan Gohrband. He's a videographer in Chicago and, at 31, he says dyslexia is still part of his daily life.

When reading, Gohrband says, his eyes often lurch to a stop in front of a word that looks utterly unfamiliar. His best solution, he says, is to turn to his girlfriend, asking a now familiar question: "What's this word?" And as she answers, he almost always has the same response: "Of course that's what it is!"

Here's the thing: There's nothing wrong with Jonathan Gohrband's vocabulary. Or 9-year-old Thomas Lester's vocabulary. They know what "galloping" means. And they can use the word in spoken English 20 different ways. They just can't read the word.

That's why dyslexia used to be called "word blindness." People with dyslexia don't naturally process the written word. They don't easily break it into smaller units that can be turned into sounds and stitched together.

This makes reading a laborious - even exhausting - process. Writing, too. Gohrband remembers when his former boss pulled him aside after she'd received emails littered with spelling mistakes.

" 'Hey, I know it's the weekend, but don't email when you're drunk,' " he recalls her saying. He was, of course, perfectly sober - just dyslexic. Now, he can spend hours scouring emails he's drafted, looking for typos. "It's very time-consuming and very exhausting."

Consuming. Exhausting. There's an emotional dimension, too. Gohrband recalls that when he was a child he would fantasize about not "being broken." He would avoid telling people about it: "If they know that you're dyslexic, they'll think you're dumb."

Yet, he says, there came a turning point when the shame faded. For him, it was when he found videography. There he discovered a "language" that came easily, and suddenly his talents were visible to others.

"I felt so much more confident," he says.

And with time, Gohrband says, he has found benefits hidden inside his struggles. He thinks that being pushed outside his comfort zone by dyslexia has made him more creative and less judgmental.

I've felt that myself, and as I've talked with many others, I heard one thing again and again: When things don't come easy, you learn to try new things and work hard at them.

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Millions Have Dyslexia, Few Understand It

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"It's frustrating that you can't read the simplest word in the world." Thomas Lester grabs a book and opens to a random page. He points to a word: galloping. "Goll-. G-. Gaa-. Gaa-. G-. " He keeps trying. It is as if the rest ­­of the word is in him somewhere, but he can't sound it out.

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A new , sheds some light on the most common learning disability in America that is still a mystery to most. Gabrielle Emanuel, nprEd writer and correspondent, is dyslexic herself. In her series she goes through explaining the difficulties of dyslexia, the science behind it and the necessary steps to overcome it. This is part 2 of our 2 part review. NPR radio series, "Unlocking Dyslexia" Click here to read part 1.

The effects of dyslexia "extend[ ] far beyond the classroom, causing stress, tension and confusion for families with a dyslexic child". Emanuel receives some testimonials from parents of dyslexic children:

"There would be days that she could not get on the bus... Just the look of fear in her huge eyes - Mommy, I can't do this; I can't do this; don't make me do this." - Megan Lordos

"You could feel the cloud hover over the kitchen. It was just - it was a nightmare every night" - Lance Pressl

"He would get off the bus, and he would say to me, Mom, I'm stupid" - Geva Lester

This happens more often than not. "Schools are supposed to help children with dyslexia, but many don't have the resources to do so." As a result, Many parents and their children find themselves in this emotional and destructive spiral without knowing what the problem is or how to fix it. One mother recounts the "'school didn't seem worried'...they kept telling her: 'Well, let's wait six more months, and we'll see what happens'". dyslexia is often denied and intervention for it is delayed. "The research suggests early and intensive reading help is most effective". Some intervention can be costly. As one family puts it "'...we use their college fund to pay for it. We invest in the child that we have now. You know, college won't be an option if they continue to hate school and reject everything that has to do with reading'" (Emanuel, "Raising A Child).

The radio series highlights one dyslexia program, Lindamood-Bell, a NPR financial supporter. Emanuel received intervention at a Lindamood-Bell center as a child herself. However she explains that "I've never been able to sound out unfamiliar words. And I still can't" ("Millions Have Dyslexia"). Learning how to pronounce unfamiliar words should be a focus of treatment, a cornerstone of Lexercise therapy. Furthermore, Lindamood-Bell is very expensive, often only available in metro areas and disrupts a child's schooling by requiring intensive, 4-6-hours-a-day instruction for 6 weeks.

If your experience sounds like the testimonials above, get your child immediate help. Lexercise Structured Literacy can be done in the comfort of your own home, works around your schedule, and most importantly guarantees a grade level increase in 8 weeks of therapy. Call us at 1-919-747-4557 with any questions or to get paired with your expert therapist.
Works Cited: Emanuel, Gabrielle. "Raising A Child With Dyslexia: 3 Things Parents Can Do." All Things Considered. NPR. 29 Nov. 2016. Radio.
Emanuel, Gabrielle. "Millions Have Dyslexia, Few Understand It." All Things Considered. NPR. 28 Nov. 2016. Radio.

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Dyslexia Series on NPR News: Part 2 - Lexercise

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A new , sheds some light on the most common learning disability in America that is still a mystery to most. Gabrielle Emanuel, nprEd writer and correspondent, is dyslexic herself. In her series she goes through explaining the difficulties of dyslexia, the science behind it and the necessary steps to overcome it.

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Part 3 of our series " Unlocking Dyslexia."

A mother who spent years coaching and encouraging her dyslexic son recalls his childhood with one pervasive feeling: "It was really scary."

One father told me his home life was ruined. Trying to do homework with his struggling daughter, he says, felt like "a nightmare every night." Optimism and determination would inevitably descend into tears and anxiety. The culprit: dyslexia.

Yet another mom - whose son and daughter both have dyslexia - suggests changing the definition of dyslexia: "It's no longer a reading problem. It's a life crisis."

As the most common learning disability, dyslexia affects somewhere between 5 and 17 percent of the U.S. population. Its reach extends far beyond the classroom, causing stress, tension and confusion for families with a dyslexic child.

But experts and parents say there are three key things that can help.
1. The sooner you intervene, the better
When Megan Lordos' daughter was a toddler, there were hints.

Canela Jayne loved books, but hated letters. Halfway through reading a story, Lordos would often try to sneak in a quick lesson about which letter makes which sound. But Canela Jayne would have none of it. She'd jump off her mom's lap, effectively ending story time.

There were other hints, too: Canela Jayne hated wearing shirts with words on them. She didn't want to be that close to letters. Rhyming felt like an impossible task for her. And as she entered and progressed in school, she sat in frustration while her classmates sped ahead with their reading.

When Lordos worried, friends assured her that each child matures at a different pace.

But soon, her daughter began to dread going to school. "There were days when she could not get on the bus," says Lordos.

Sitting at the kitchen table in their Virginia home, Lordos recalls how Canela Jayne would refuse to get out of bed, then refuse to get dressed and, eventually, she'd refuse to get out of the car at school.

Lordos remembers looking at her daughter and seeing "this look of fear in her huge eyes." Then, she says, Canela Jayne would plead: "Mommy, I can't do this. I can't do this. Don't make me do this."

Canela Jayne's school didn't seem worried. Lordos says they kept telling her: "Well, let's wait six more months, and we'll see what happens."

When Canela Jayne was eventually diagnosed with dyslexia, it felt to Lordos like valuable time had slipped away. Experts worry that this happens a lot. The research suggests early and intensive reading help is most effective. And many say starting specific reading programs at a young age has been successful.

2. Find something else your child is really good at

With lime green walls and craft projects on every visible surface, Canela Jayne Lordos' bedroom is an artistic 10-year-old's dream.

As light spills in from the backyard, she picks up a little wax figurine she made. This one is a monkey, one of dozens of intricate animals she sculpted using only the red wax that wraps the cheese her parents buy at the grocery store.

"I take one half to make the body," she says, explaining the process carefully. Then, she turns to another favorite activity - embroidery. Here, her explanation is about her motivation: She likes embroidery because it lets her write with pictures - a mode far easier for Canela Jayne than writing with letters.

Besides her bedroom, she tells me, her other favorite room is the kitchen. She loves standing on her stool at the counter, cooking. Scones. Biscotti. Banana bread. She is even willing to read the recipe, if that's necessary.

Although Canela Jayne now spends much of her summer days with tutors at reading centers, her mother has carved out time each year for her daughter to trade books for a spatula and cooking camp. Canela Jayne looks forward to it all year.

For other kids, it's sports, computers, music - anything that takes skill and builds confidence and pride.

Experts say that children with dyslexia are at a higher risk for depression. And having another passion - where there's a more direct link between effort and success - is helpful.
3. Make a financial plan
Schools are supposed to help children with dyslexia, but many don't have the resources to do so. That means parents who can afford it often bear the cost of outside testing, specialized tutors, reading centers and, of course, private schools.

Some families estimate that they spend upwards of tens of thousands - if not hundreds of thousands - of dollars helping their kids learn to read before high school graduation.

Lordos and her husband say they were faced with what felt like an impossibly hard trade-off: college tuition or reading tutors. Eventually, they decided to "invest in the child that we have now."

"You know," she adds, "college won't be an option if they continue to hate school and reject everything that has to do with reading."

After more than 400 hours of intensive tutoring, Canela Jayne is doing much better. She no longer complains about going to school in the mornings. And, while she's still in the process of learning to read, she's making strides.

The biggest change, Lordos says, it's that her daughter is "much, much happier."

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Raising A Child With Dyslexia: 3 Things Parents Can Do

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Part 3 of our series " Unlocking Dyslexia." A mother who spent years coaching and encouraging her dyslexic son recalls his childhood with one pervasive feeling: "It was really scary." One father told me his home life was ruined. Trying to do homework with his struggling daughter, he says, felt like "a nightmare every night."

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Dyslexia is the most common learning disability in the United States. It's not about lacking comprehension, having a low IQ or being deprived of a good education. It's about having a really hard time reading.

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Dyslexia is the most common learning disability, affecting tens of millions of people in the United States. But getting help for children who have it in public school can be a nightmare.

"They wouldn't acknowledge that he had a problem," says Christine Beattie about her son Neil. "They wouldn't say the word 'dyslexia.' "

Other parents, she says, in the Upper Arlington, Ohio, schools were having the same problem. The district in a suburb of Columbus wasn't identifying their children's dyslexia or giving them appropriate help.

So, in 2011, the parents pooled their resources and hired a lawyer.

"I was not surprised there was a group of students with dyslexia who were not getting the kind of instruction that they really needed," says Kerry Agins, an Ohio special education attorney who represented the Upper Arlington parents. She says the issue of public schools failing to address the needs of students with dyslexia is widespread, in Ohio and across the country.

Agins advised the parents to file a group complaint against the district.

Parents typically fight special education cases alone, seeking remedies one by one. But a group complaint, Agins told them, could force the school system to make broader change.

Nineteen people signed the complaint, including parents, students and graduates of the Upper Arlington public schools.

In August 2011, the Ohio Department of Education found the Upper Arlington Schools in violation of the law when it came to promptly and properly identifying students with learning disabilities and finding them eligible for special education services.

"We felt vindicated," Christine Beattie recalls. "Like, we aren't crazy. We know what we're talking about."

In its decision, the state ordered the Upper Arlington Schools to train teachers and staff on how to identify and evaluate students with learning disabilities.

But the parents said this was more than a special ed problem. They say it was a problem with the way kids were being taught to read.
How kids learn to read
The Upper Arlington Schools were using what's referred to as a "whole language" approach to reading instruction. It's an approach that became popular in the 1980s and continues to guide reading instruction in many public schools today.

Whole language holds that learning to read is a natural process. Children don't need much direct instruction. Instead, surround them with books, and they will become readers.

But decades of research shows that reading is not a natural skill. Unlike speaking, which humans learn automatically by being surrounded with speech, we have to be taught to read.

People with dyslexia have an especially hard time learning to read because their brains are wired in a way that makes understanding the relationship between sounds and letters difficult.

Research shows that they learn to read better when they are explicitly taught the ways that sounds and letters correspond. And research shows that even students without dyslexia learn better this way.

Upper Arlington had to retrain its teachers, who had, for the most part, learned whole language-based methods in their teacher-preparation programs.

Now, students in Upper Arlington are taught to read using a phonics-based approach that explicitly and systematically teaches them how letters represent sounds to form words on the page.

"O Octopus ah!" the kids yell in a first- and second-grade classroom at Barrington Elementary School in Upper Arlington.

Their teacher, Ashley Stechschulte, is holding up a series of cards with words on them, and the children repeat after her as she sounds out the first letter sound.

Then they move to more complex letter-sound combinations. They discuss the word "sock." Stechshulte asks what the letter combination "ck" is called.

"A digraph," answers a student. A digraph is one sound created when two letters appear together.

Stechshulte then asks the class to consider the difference between the digraph "ck" and the digraph "wh," as in the word "whistle."

"Who can tell me what's the big difference between these two digraphs?" Stechshulte asks.

A little hand shoots up. It's a boy named Jacob.

"The 'ck' can only go at the end (of a word) and the 'wh' can only go at the beginning," says Jacob.

The teacher was using "Fundations," a program based on the Wilson Reading System, a structured, phonics-based approach. Fundations is typically used with children who are struggling to learn to read but it can also be used for whole class instruction.

For students in Upper Arlington who show signs of dyslexia on a screening test, there is more intensive, one-on-one tutoring available.

Brett Tingley, one of the Upper Arlington parents who signed the group complaint, says if all kids get effective reading instruction, fewer children should need special ed services.

"I have started to call it not dyslexia but 'dysteachia,'" Tingley says. "It's the teachers who are not giving the right kind of instruction."
Emily Hanford is senior education correspondent for APM Reports.

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Rethinking How Students With Dyslexia Are Taught To Read

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Dyslexia is the most common learning disability, affecting tens of millions of people in the United States. But getting help for children who have it in public school can be a nightmare. "They wouldn't acknowledge that he had a problem," says Christine Beattie about her son Neil. "They wouldn't say the word 'dyslexia.'

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Dyslexia can impact people in a variety of ways. When we read, the brain recognizes and processes words almost simultaneously. Generally, dyslexic people struggle to analyze words as they see them.