By Dr. Dineshani Hettiarachchi Sirisena    Dyslexia is one of the most common language-based learning disabilities the world over. However, its exact numbers are elusive and its prevalence is difficult to determine precisely. As symptoms could range from mild to severe, the majority of dyslexics may not be identified and might never receive the necessary treatment to overcome their impediments. However, many who had dyslexia have gone on to accomplish great things in life.  Among the many success stories are those of Thomas Edison, Stephen Spielberg, F. Scott Fitzgerald, and Charles Schwab to name a few. We spoke to Colombo South Teaching Hospital Consultant Child and Adolescent Psychiatrist and University of Sri Jayewardenepura Department of Psychiatry Senior Lecturer Dr. Yasodha Rohanachandra to understand the basis and shed light on the available interventions for early diagnosis and treatment of dyslexia.  It is important to note that dyslexia is not a disease. It is a specific learning disability that one is born with. Sometimes it runs in families.   According to the International Dyslexia Association, “dyslexia is a specific learning disability that is neurobiological in origin. It is characterised 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. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge”.  Research has also shown that in those with dyslexia, the brain processes information differently. Dyslexia has no relationship with their intelligence. Their intelligence quotient (IQ) is normal and even above average in certain instances. However, their ability to process information seems to differ. Brain imaging has shown that when they read, they use different parts of the brain compared to people without dyslexia. There is a widely held misconception that dyslexia is purely a reading disorder. In actuality, dyslexia can also affect writing, spelling, and speaking abilities. They also exhibit difficulties in processing and manipulating the sounds in a spoken language, and as a result, can have trouble with spelling. While this certainly makes reading more difficult, with the right support, almost all individuals with dyslexia can learn to read. Since there is no cure for this condition, individuals who overcome the associated learning disability usually adopt certain coping strategies.  Early educators must be aware of how to identify dyslexia in order to take corrective steps. With the correct knowledge, they can help those who are suffering from the condition tremendously. In preschool and elementary school kids, some signs of dyslexia include difficulty with the following:  

• Learning to talk
• Pronouncing long words
• Rhyming
• Learning the alphabet sequence, days of the week, colours, shapes, and numbers
• Learning letter names and sounds
• Learning to read and write his or her name
• Learning to identify syllables (cow–boy in cowboy) and speech sounds (phonemes like b-a-t in bat) in words
• Sounding out simple words
• Reading and spelling words with the correct letter sequence ("top" rather than "pot")
• Handwriting and fine-motor co-ordination

Older kids, teenagers, and adults might have these same signs of dyslexia and will probably also exhibit the following signs:

• Read and spell far below grade level
• Avoid reading and writing
• Work slowly on reading and writing assignments and tests
• Struggle with learning a foreign language

  Impact of dyslexia    The impact it has on an individual has great variability and differs from person to person, as the symptoms can range from mild to severe with core difficulties with word recognition and reading fluency, spelling, and writing. Some may also experience difficulties with spoken language and as a result, may find it difficult to express themselves clearly, or to fully comprehend what others mean when they speak. As such, these subtle communication problems are often difficult to recognise, but can have a lasting impact. Dyslexia can also affect a person’s self-image and self-esteem. They may feel inadequate and may even feel discouraged to continue school.   Arriving at a diagnosis    Even though salient features might be apparent during elementary school, they can only be formally diagnosed through a comprehensive evaluation by a child and adolescent psychiatrist or a psychologist. Hence, detecting early can guide families to get proper help.    Overcoming dyslexia    Since dyslexia is a lifelong condition, getting proper help is the first step. Most children with this condition need help from a teacher, tutor, or therapist specially trained in using a multisensory, structured language approach. The main strategy is to use a systematic and explicit method that involves several senses (hearing, seeing, touching) at the same time, stated Dr. Rohanachandra. They may also need personalised help on a one-on-one basis tailored to their own pace. Schools can also help these students by giving them extra time to complete a task and by modifying assignments according to their individual capabilities and even incorporating different assessment methods. Proper counselling by a mental healthcare provider can help overcome some of the struggles associated with dyslexia in order to prevent these children from developing any long-term psychological issues.   Facilities available in Sri Lanka    If a child is suspected to have dyslexia, the child should be brought for assessment as soon as possible. Such assessments are available at child and adolescent mental health services at teaching hospitals. Assessments for dyslexia may also be carried out by psychologists in the private sector.  Children with dyslexia are managed within mainstream classrooms. However, they need extra support in reading and writing. Some schools have resource centres where such extra support is provided. Unfortunately, not many schools have this facility and this gap needs to be bridged in order to provide optimum support for these children.  Children with dyslexia can have special provisions at examinations. This may include having extra time at examinations, having an invigilator to read out the exam paper, making provisions to answer questions orally rather than in writing, or allowing the child to use a computer to answer questions. Special provisions should be requested from the Department of Examinations at the time of application and should be recommended by a psychiatrist or psychologist.    Take home message    Dr. Rohanachandra emphasised that children with dyslexia are not “stupid” or “lazy” and  punishing these children for their learning difficulties does not help in any way. Rather, it would make the child dislike education and suffer from low self-esteem. These children need an individualised educational plan that is in keeping with their abilities. They do not do well in settings with many children as such settings do not provide such one-to-one attention. That is why contrary to the popular belief, children with dyslexia find tuition classes with many children unhelpful. Children with dyslexia may thrive in other areas of life, such as sports, music, art, etc. It is important to identify and focus on the child’s strengths and what they can do rather than their weaknesses and what they can't do. This strengths-based approach will help the child achieve the best outcome.