A Conversation with Sally Shaywitz, M.D.
Q: What is dyslexia?
A: Dyslexia refers to a difficulty in learning to read in a person who has good intelligence, strong motivation, and who has received appropriate teaching. Logic says such a child or adult should have learned to read and yet he or she has not. And so dyslexia represents a paradox, particularly in our society where reading ability is often taken as a proxy for intelligence and it is assumed that if you are a good reader you are also highly intelligent and if you struggle to read you must not be so smart. Dyslexia violates that assumption because people who are dyslexic are both highly intelligent and struggle to read. It is exciting is that scientists now understand exactly why otherwise smart children and adults can have trouble reading and know how to help them. There are now highly effective methods for diagnosing and treating children and adults with dyslexia at all levels and all ages.
Q: How many Americans are affected by dyslexia?
A: There are no obvious or visible physical signs of dyslexia, and as a result it often goes undetected and its true prevalence is often underestimated. In our studies where we tested every child in a randomly selected population, we discovered that dyslexia is a very common problem, affecting at least one child in five. In addition to the 20% of children and adults identified with reading problems, another large number (perhaps an additional 20%) experience reading difficulties which are not severe enough to be readily identified but can still cause problems.
Q: Does your research in Overcoming Dyslexia have implications for the entire population (i.e. people who have trouble reading but might not be diagnosed as dyslexic)?
A: Absolutely. That is one of the main reasons I wrote the book. There are so many people who can be helped if they only recognized the nature of their reading difficulty. Many people struggle and don’t realize that they have a reading problem. In Overcoming Dyslexia I provide a concise list of both the problems and unique strengths characterizing people who are dyslexic and describe how to recognize dyslexia in young children, in school-aged boys and girls, and in older children and adults. From experience with my patients I know what a relief it is to finally understand what has been troubling you for so many years. And the best part is that there are now highly effective, scientifically-proven methods and programs for teaching reading.
Q: What are the most common misconceptions about people who are dyslexic?
A: Perhaps the most common myth about dyslexia is that people who are dyslexic see words backward (“dog” as “god” or “was” as “saw”). This assumption is wrong. Another myth is that children outgrow reading problems. They don’t. This means that it is imperative that dyslexia be detected early and treated seriously. A third myth is that dyslexia affects only (or mostly) boys. In a study published in 1990 in the Journal of the American Medical Association, we demonstrated that dyslexia affects comparable numbers of boys and girls. A fourth myth holds that people who struggle to read are not very smart. On the contrary, some of the very brightest boys and girls struggle to read. Dyslexia occurs at all levels of intelligence, average, above average, and highly gifted. The writer John Irving and the financier Charles Schwab are both dyslexic and I have included their stories in Overcoming Dyslexia not only because they dispel myths about dyslexia but also because they provide wonderful examples of how boys and girls who struggle can become highly successful men and women. A fifth myth is that dyslexia only occurs in languages that use the alphabet and so it does not occur in countries like China and Japan whose languages are logographic (based on characters or pictures). Studies have shown that reading problems are as prevalent in these countries as they are in the United States and that struggling readers in China and Japan tend to make the same types of phonologic or sound-based errors as do their counterparts speaking English or other alphabetic languages.
Q: At what age can signs of dyslexia first be detected? What are the early warning signs?
A: Today, most children who struggle to read are not recognized until third grade, though some are identified earlier. Many more go undetected until much later. Some are not identified until they are adults. Scientists have discovered that almost all cases of dyslexia reflect a problem in getting to the basic sounds of words. Children who are dyslexic are unable to attend to the individual sounds (called phonemes) making up all words. For example, the word “bat” has three phonemes -- b - aaaa - t. It is important for children to be able to detect the individual sounds making up a spoken word because that is how they go about solving the reading puzzle.
In Overcoming Dyslexia I review, step-by-step, how children learn to read and which signs tell a parent that a child is not on track for becoming a reader. The earliest clues can come from listening to a child’s spoken language; a mild delay in learning to talk or a difficulty learning words that rhyme are often very early indicators of a possible reading problem. A little later, difficulty learning the names of the letters of the alphabet and then the sounds of the letters may be signs of an imminent reading difficulty. But once these vulnerabilites are identified there are now scientifically proven early reading programs that bring a child up to speed and allow her to catch up to and keep pace with her classmates.
Q: What is the most important thing a parent can do to help her dyslexic child?
A: A knowledgeable and proactive parent is often the critical factor responsible for transforming an unhappy struggling reader into a happy, proficient one. A parent plays a determining role in ensuring that her child: 1.) is accurately and promptly diagnosed; 2.) is provided reading programs that are scientifically proven to work; and 3.) develops a lasting positive sense of himself. The critical factor, is the child’s sense he can succeed. I believe it is essential to find the time to develop and nurture a child’s strengths, — in athletics, drama, whatever — to view himself as a competent individual.
Q: Are the public schools adequately meeting the needs of children with dyslexia? Are these children better off in private school?
A: Public schools are not doing a very good job of teaching children with dyslexia to become skilled readers. First, many, many children who are struggling to read are going undetected for long periods of time, typically not being identified until third grade or later. This is unfortunate since we know how to identify children very early on. Second, there is growing evidence that most special education programs are not doing their job. A gap in reading exists between dyslexic children and their classmates. To be successful, a reading program must help the child to make even more progress than his classmates so that he can close the gap and keep up with his classmates who are continuing to make progress. In Overcoming Dyslexia, I guide parents on how to determine if a program is effective and provide the names of specific reading programs that have been proven to work. I also provide parents with a systematic list of questions to ask in evaluating and selecting a school for their dyslexic child.
Q: If your preschooler’s birthday is close to the cutoff to start school, should you delay sending him to school for a year to give him more time to develop?
A: Research studies have shown that delaying kindergarten entry for a year does not help a child scholastically or emotionally. The idea of a “maturation lag” is not supported by science. To the contrary, research has shown that if a child seems to be behind, it is critical that he receive help as soon as possible.
Q: What are the elements of an effective reading program?
A: In 1998, in response to urgent demands from parents and teachers, Congress mandated that a National Reading Panel comprised of the top scientists, reading researchers, educators as well as parents be appointed to evaluate the effectiveness of different methods and programs to teach children to read. I served on the Panel.
The most effective reading programs provide instruction in teaching children to notice the sounds of spoken words. The letters comprising words represent a code and the first step of teaching reading is to help children break the code; they do this by learning how to attach letters to the sounds they hear in spoken words. This approach allows a child to sound out most words. Some words can’t be sounded out (for example, “though” or “she” or “your”) and children are taught to memorize these words. Sounding out words allows a child to have a strategy to read new words, words he has never before seen. Just relying on memorization can work for a while, but once a child is in third grade or higher, his memory bank simply runs out of space and he is at a loss when he comes across new or more complicated words. It is also important that the developing reader learns to read words fluently; this means he reads a word accurately and quickly. This skill, fluency, is critical if a child is to become a really good reader, one who enjoys reading and who looks forward to reading for pleasure and for information. In my book, I say what parents can do at home in the evening with their child to develop fluency and what specific programs are most effective. Developing your child’s fluency only takes ten or twenty minutes of your and your child’s time in the evening. Building a child’s vocabulary and comprehension skills round out an effective reading program.
Q: How can you distinguish between a child who is struggling to read because of dyslexia and one who has difficulties because of some other problem (i.e., a different learning disability or an emotional problem)?
A: The hallmark of dyslexia is an unexpected reading difficulty in a child who seems to have all the equipment (intelligence, verbal skills, motivation) necessary to become a reader. In such children we expect to see difficulties getting to the sounds of words, and at the same time, strengths in other areas of language such as the ability to understand what she hears (as opposed to what she reads). The diagnosis of dyslexia is made mostly by the history as well as by observing the child read and analyzing his performance on tests of reading and language. Older children and adults who are dyslexic demonstrate a lack of fluency, that is they read slowly and with great effort. This is in contrast to others, who with the same degree of education, read not only accurately but quickly and effortlessly. And so, slow reading, requiring extra time on tests, and finding reading extremely tiring are the hallmarks of dyslexia in a bright young adult. It is exceedingly rare that an emotional problem is responsible for a reading difficulty; more likely, unidentified and untreated dyslexia gives rise to frustration and anxiety.
Q: Can you outgrow dyslexia?
A: Dyslexia is not outgrown. Children who are dyslexic grow into adults who are dyslexic. They may learn how to read words accurately, but they do not develop into skilled readers who read quickly and who enjoy reading. However, the good news is that a struggling reader can be transformed into one who reads fluently and who looks forward to reading. The key is identifying the problem, the earlier the better. As I discuss in Overcoming Dyslexia, rigorous research studies have now absolutely demonstrated that all children can be helped to become better readers.
Q: Is there help for adults with dyslexia?
A: Adults with dyslexia can become better readers. I devote an entire chapter to adults with dyslexia, presenting programs and strategies that can help the youngest or oldest adult who is dyslexic become a better reader.
Q: You note that there are actually some benefits to being dyslexic. Please explain.
A: I conceptualize dyslexia as a weakness (in getting to the sounds of language) surrounded by a sea of strengths (conceptualizing, thinking out of the box, seeing the big picture). Dyslexics think in new and original ways. As I explain in Overcoming Dyslexia, revolutionary brain imaging technology shows dyslexics use different pathways; for reading, this presents a problem, for thinking creatively, I believe, this presents an extraordinary opportunity. Some of our greatest and most talented writers are also dyslexic (John Irving, Wendy Wasserstein, Stephen J. Cannell, John Grisham, Richard Ford.) In Overcoming Dyslexia, you will read about Nobel Laureates and some of our most creative scientists and physicians who are also dyslexic.
Q: Was there a common thread to the experiences of these very accomplished people?
A: These all had two things in common: first, few would have predicted their ultimate success; second, in each instance there was someone — a parent, a teacher, a coach — who truly believed in him and who helped him to develop a passionate interest in an area in which he could find success. For writer John Irving, it was his wrestling coach; for playwright Wendy Wasserstein and novelist Stephen J. Cannell, it was a college professor who saw beyond the spelling errors and slow reading to recognize and to encourage true talent. In Chapter 22, “Protecting and Nourishing Your Child’s Soul,” I provide specific steps that a parent can take to ensure that her child’s self-image is protected.
Q: What is the role of accommodations such as extra time for a dyslexic reader?
A: I devote an entire chapter to accommodations because they are frequently misunderstood and yet are essential if a child is to be judged by his strengths and not his weakness. Timed, multiple choice standardized tests represent a major barrier to the pathway to success for highly qualified, hard-working students who are dyslexic. After reading the accommodations chapter in Overcoming Dyslexia, including what new brain imaging studies reveal about the dyslexic’s absolute physiologic need for extra time, there will no longer be any doubt about the critical need for such accommodations for young men and women who are dyslexic. As I write in the book, the dyslexic’s need for extra time is as fundamental as is the diabetic’s need for insulin.
Q: What is the most important message you want your book to send?
A: Today, in 2003, the future for each dyslexic child and adult should be filled with hope. I am exhilarated by the extraordinary progress scientists have made in understanding dyslexia. I want people to know that it is possible to identify dyslexia early and accurately, to diagnose dyslexia precisely in older students and adults, to provide highly effective treatments that lead to skilled reading. Today, we know more about dyslexia than about most other problems in medicine — we have to get that news out.