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Dyslexia and reading and writing difficulties

In this edition of the ”Researcher’s Corner” we meet with affiliated GNC researcher Jakob Åsberg Johnels. Jakob did his post-doc at GNC and is also involved in several GNC research projects. He is a lecturer at the unit for speech and language pathology at the Institute of Neuroscience and Physiology and clinically active at the Child Neuropsychiatric Clinic (CNC), Queen Silvia's Children Hospital in Gothenburg. Over the past two years Jakob, along with six other researchers, has been involved in a report that evaluates tests and interventions given to children with reading and writing difficulties. According to the report, produced by the Swedish Council on Health Technology Assessment (SBU), most of the pedagogic methods used by schools to help children and young people with dyslexia lack scientific support. Among the several hundred studies evaluated in the report only one scientifically proven intervention was found. The method, called phonics, involves structured training of the correspondence between phonemes (sounds) and letters. This, however, is a relatively uncommon method in Sweden.

What was the study aim and purpose of the SBU project?

- The SBU project really consists of several parts: the examination of psychometric performance in the most commonly used tests is one part. Our aim was primarily to assess the performance in the instruments used in Sweden. When this proved impossible, as there was no research that had focused on this question, we chose to look specifically at a number of tests most commonly used in research internationally. Our selection of tests was chosen based on recommendations by a group of international experts within the field. Another part deals with dyslexia treatment. We also looked at whether, based on assessment of various abilities in preschool age, it is possible to predict which children will develop dyslexia later on. To some degree, this seems to be possible; poorly developed letter knowledge, phonological awareness and rapid automatised naming – so called RAN – were identified as risk factors.

There is reason to believe that dyslexia may represent the lower tail of a normal distribution of reading and writing ability in the population. Hence, to determine the prevalence of dyslexia is somewhat difficult, but it is commonly reported that about 5-8% of all Swedes have dyslexia. There are currently no national guidelines assisting schools in how to help students with dyslexia. The SBU report underlines the need for further research regarding how to identify dyslexia in children as well as regarding how to best provide the right support to these children.

What, if anything, is the difference between the concepts of dyslexia and reading and writing difficulties?

- That is a very important question and one that I personally think was not sufficiently reflected on in the SBU report. Is there a difference between dyslexia and reading difficulties? Which additional criteria must be fulfilled for us to talk in terms of dyslexia, and why are these to be used? An important discussion about this has been reignited through a book published earlier this year by two world leading researchers within the field – The Dyslexia Debate by Elliott and Grigorenko. And our research is also relevant to this discussion. I am leading an on-going study that is relevant for this discussion. The study concerns reading and writing in a relatively large group of adults with more pervasive disabilities, such as intellectual disability and autism, and who have access to daily activities through The Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (LSS). Unsurprisingly we find that these adults read and spell poorly for their age. But can we say that they have dyslexia? Historically, the answer has been no per definition. A common way of operationalising this distinction has been through the so-called discrepancy definition stating that the term dyslexia can only come into question if there is a discrepancy between the general cognitive ability (relatively high) and the level of reading (relatively low). This idea has however increasingly been abandoned in research and clinically, mainly because it makes a random distinction between poor readers, creating a subgroup of people who risk not getting attention and support for their difficulties. This, in spite of virtually all research indicating that both ”subgroups” would benefit from the same kind of support.

How has the approach to the concept of dyslexia developed over time and what is its current standing?

- Today it is more common to think that ”real” dyslexia, unlike ”non-dyslexic reading difficulties”, is caused by a primary deficiency in the phonological system, i.e. the ability to recognise and manipulate phonemes. From this perspective many would expect poor readers with other types of neuropsychiatric/neurodevelopmental disabilities – for instance our group of adults with intellectual/cognitive disabilities – not to display phonological core deficits. Instead the reading difficulties of these individuals would be expected to be more ”secondary”. But when, for the first time, we really examine this in a systematic way, we find that the poor readers in the daily activities do in fact display a classic dyslexia profile, with underlying phonological difficulties, which are also unexpectedly severe if compared to younger typically developing readers at the same level of word reading, and which predict their word decoding and spelling.

What are the clinical implications of these results?

- I believe these to be positive results since they support the thought that all poor word readers and spellers can initially be approached using the same concept. Then it is of course important to look at each individual to map out his or her unique profile.

- The whole idea of on shaky ground dividing reading difficulties into ”real” dyslexia and ”other reading difficulties” is very questionable. If we relate it to Christopher Gillberg’s ESSENCE concept we can expect ”comorbidity” as the rule rather than the exception, partly because of the etiology of different conditions overlapping. We have long known that reading difficulties have a strong genetic component, which also partly overlap with other difficulties, for example attention deficits and low cognitive processing speed. At the same time, it is of course important to attend to individuals with high intellectual capacity and relatively specific reading difficulties, who risk being misunderstood in school and end up in negative spirals of resignation and low expectations on their academic ability. It is however premature to assume that the underlying problems in reading and writing difficulties would be qualitatively different depending on factors like cognitive and intellectual ability or the prevalence of other disabilities.

What approach to dyslexia and reading and writing difficulties would you recommend in order to be able to provide the right support for everyone in need of it?

- I think that if in research and clinics we should continue to use the term dyslexia, this should be made synonymous with reading and writing difficulties, and potentially include all individuals with difficulties reading single words and with spelling. I see far too many poor readers who would have benefited from getting understanding and support for their difficulties, but who, according to some more or less arbitrary distinction, have not been classified as ”real dyslexics” and therefore do not get this extra attention.

By Nanna Gillberg






Page Manager: Anna Spyrou|Last update: 11/3/2014

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