A possible reason for this is that until the s dyslexia was thought to be caused by educational methods. However, the results of basic research conducted in the last 30 years show that dyslexia has neurobiological correlates and that genetic factors affect reading and spelling ability e1 — e4. This selective literature review is based on the guidelines of the German Society of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy.
Reading disorder is characterized by very significantly reduced reading speed.
Children with reading disorder often require two to three times as much time as other children, or more, to read text. Slower reading leads to great difficulty understanding what has been read, particularly when reading longer sentences. Associating individual letters with their corresponding sounds is very slow, and mistakes are often made. In place of words which are difficult to read, children with reading disorder tend to read other words with similar letters.
Some children manage to deduce the content of a sentence on the basis of the other words it contains even when individual words are read incorrectly e. It is therefore very important that diagnosis take into account not only reading comprehension but also the speed with which individual words are read aloud. Limited reading speed is also the main symptom of reading disorder in adults 4. This occurs in particular with complex, polysyllabic, and rare words. In stressful situations, e. Reading disorder also manifests itself in counting e. Spelling disorder is characterized by a significantly increased number of spelling errors.
In free writing, words are avoided when children suspect that they cannot spell them correctly. This is often perceived as limited vocabulary or a lack of linguistic ability. However, it is usually a compensation strategy to avoid spelling errors, which are still often corrected in red pen, with negative comments from teachers. The development of the ability to spell comes in stages.
First of all, children begin to spell phonetically, e. It usually takes a year to learn all sound-letter associations. Children with spelling disorder often take two years. The next stage of spelling development is orthographically correct writing. This includes issues such as correct use of capital and lower-case letters, suffixes asked , not askt and correct spelling of word roots happen , not hapen , because the first vowel is short.
The basics of correct spelling have usually been acquired before the end of the fourth year of school in Germany age 10 years. Children with spelling disorder have great difficulties spelling words correctly, even in adulthood. An example from German standardized spelling tests in the first years of spelling practice. It is impossible to define subgroups of dyslexia according to etiology.
Nor are there any spelling errors which are typical of dyslexia, but rather errors which can be assigned to individual stages of development. Children with dyslexia experience more negative thoughts, depression, gloomy moods, and school-related anxiety as early as primary school. They often feel excluded, disapproved of by teachers, and rejected. The rate of world-weary thoughts and suicide attempts in adolescents with dyslexia is three times as high as that of adolescents of the same age without dyslexia 5 , 6.
The rate of depressive disorders in adolescents with dyslexia is twice as high, and anxiety disorders are as much as three times as common 7. ICD classifies dyscalculia as combined disorders involving abilities learned in school F For many years it was thought that those with significant problems reading and spelling must be good with numbers.
This idea was not borne out by empirical research. Although ICD and DSM-IV are based on a clinical picture characterized by impaired development of reading and spelling, current research shows that there are three separate disorders 8 :. It appears that different neurocognitive deficits underlie each of these disorders. However, as yet there are no valid research results on this 8. Studies involving large epidemiological samples have shown repeatedly that dyslexia is two to three times as common in boys as in girls. When differentiating between reading disorder and spelling disorder, it was shown that boys exhibit spelling problems more frequently but are affected by reading disorder in similar numbers to girls 8 , 9.
World-weary thoughts and suicide attempts in adolescents with dyslexia are three times as common as in others of the same age. The rate of depressive disorders is twice as high, and anxiety disorders are as much as three times as common. These functional areas are represented for classification in the multiaxial classification system for mental disorders MAS, 10 and its six axes. Developmental disorders are represented on axis II, psychiatric illnesses on axis I, intelligence on axis III, physical diseases on axis IV, psychosocial factors on axis V, and psychosocial functional level on axis VI.
Diagnosis of reading ability should cover speed, accuracy and comprehension when reading. There are currently standardized tests available for this for German school years 1 through 6 table 1. A combination of various tests is needed to test word reading and reading comprehension. This involves individual testing of a child by an examiner. There are often standards for particular months, which means that tests should only be used during these limited time periods.
Tests which were standardized more than ten years ago should not be used. There are currently standardized tests for all school years to examine spelling ability table 2. In these tests, children write down dictated words in sentences with gaps figure 1. Depending on age and grade, children are required to write down more than 20 words. There is no time limit for the test. These tests are also standardized for limited periods of time. This means that spelling tests should only be used when there are standards for the time period during which testing can be conducted.
There are currently standardized tests available for this for German school years 1 to 6. To describe the cognitive ability of a schoolchild with dyslexia, a test with as broad a scope as possible should be selected. In addition to linguistic abilities, this test includes logical thought, processing speed, and memory. The results profile it provides allows for differential diagnosis of reading and spelling weaknesses due to lower intelligence and dyslexia with cognitive abilities of at least average level.
It is often necessary to divide the extensive testing into two periods. In addition to developmental history, school history is also very important. It is helpful to obtain information on development in reading, spelling, counting, and other school subjects from teachers. In addition to examination, questionnaires and clinical interviews can be used to assess emotional development, anxieties, and depression Scales to measure motivation for learning and performance 14 are a valid, reliable method for assessing motivation in school, use of avoidance strategies, and attainment of targets.
In practice, this means that reading and spelling performance as measured in individual tests is compared to intelligence quotient IQ. As there is a medium-high correlation between reading, spelling and IQ, the use of a divergence criterion in children with low or high intelligence does not yield meaningful diagnostic results.
In children with high intelligence e. Because of this, in practice a regression criterion must be used This criterion, which is more appropriate methodologically, means that for the given example spelling test performance must be less than percentage ranking 14 i.
Table 3 shows critical divergences for both criteria columns 1 and 2 for a divergence of 1. However, diagnosis must not be based on reading and spelling test scores alone. In adolescents with dyslexia or children who have received treatment, the critical borderline value may be narrowly missed, but this does not mean that the disorder has been cured. Treatment consists initially of defining the disorder, advising parents, and possibly also advising teachers Subsequent treatment depends on the severity of dyslexia and psychological symptoms or concurrent disorders.
Drug treatment is not beneficial for dyslexia. Only if a dyslexia sufferer also has attention deficit hyperactivity disorder ADHD can drug treatment for ADHD also improve learning abilities inside and outside school. Defining the disorder, its causes, and treatment options is usually a great relief to parents. Diagnosis often takes months to years, during which time parents, usually the mother, have tried to support their child via daily practice at home.
In addition, parents often receive reports from teachers to the effect that their child might benefit from more practice at home. If parents are then told in advice sessions that they have not failed, that their child finds it significantly harder than other children to learn to read and spell because of neurobiological deficits, this comes as a great relief to parents. Children themselves must also have the disorder explained to them and thereby have their stress relieved.
The dyslexia diagnosis must also be reported. In some German federal regions dyslexia is recognized by educational law, which has consequences for inschool support and awarded grades. Dyslexia treatment has two components: treatment of core problems with reading and spelling, and treatment of any concurrent psychological disorders Child and adolescent psychotherapy is available to treat psychological disorders.
To the great bewilderment of all parents, dyslexia treatment is not covered by statutory health insurance in Germany. As a result, parents must seek specialist help on the free market. The term BVL-certified dyslexia therapist, which is granted to graduates of the corresponding training institutes, is associated with extensive theoretical and practical training. All other titles, such as dyslexia therapist, are unprotected and do not necessarily guarantee suitable qualification.
Refubium - Reading Preparation - The Development of Lexical Representations in Pre- Literates
In some German federal states dyslexia is recognized by educational law, which has consequences for inschool support and awarded grades. On the basis of detailed analysis of developmental status in reading, reading support should be provided regularly, at least once a week for at least a year. In addition to this therapy, establishing a reading-friendly family environment with frequent reading sessions and reading together can also substantially boost reading development. Only a few types of reading support have been empirically investigated. Spelling support must be given separately from reading support.
As with reading support, individual developmental status must be determined at the outset. Support is then designed around this. Beginning with support in phonics spelling individual sounds , children learn regular trends in spelling. For example, in English the diphthong is usually spelled using the digraph ou it is occasionally spelled ow , as in fowl , but more often ou , as in found. There are similar examples for double consonants, which in English words only follow short vowels filling with -ll- , but filing with -l-. Children also learn how to use this knowledge.
For spelling support, too, there are almost no evaluation data available, with only a few exceptions. As yet there are no analyses of the level of evidence of symptom-specific intervention.
Analysis of this is expected to become available in late However, despite regular, intensive support most children with dyslexia achieve only slight improvement in their reading and spelling. The reasons for this are not well understood. Attempts are now being made to better understand the processes which are disrupted in these children by recording neurobiological correlates during treatment.
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An essential part of treatment is therefore psychotherapy. Children suffering from anxiety and depression can be significantly helped by such treatment. If a sufferer also has ADHD, drug treatment is also indicated when the disorder is severe, in addition to psychotherapy.
Because of the often chronic progression of the disorder, together with substantial psychosocial limitations and psychological stress, preventing reading and spelling difficulties is very important. As primary prevention, schemes which build on preschool support for linguistic abilities have been developed.
It is used with small groups of children a half-year before they start school, led by a kindergarten teacher The focus is on language games, rhyme recognition, clapping syllables, and sound recognition. This early support also reduces the risk for children who are at risk of dyslexia e9 — e However, it is only effective when kindergarten teachers are well trained in how to use the method and correspondingly well motivated. The significance of families in supporting language skills in preschoolers has long been known.
In the last half-year before children start school, one parent carries out 15 minutes of activities with the child every day. With the help of three activity books and extensive materials figure 3 , there are games and tasks involving rhyme recognition and creation, syllables, knowledge of words and sentences, recognition of the beginnings of words and syllables, letter-sound associations, and the ends of words and syllables. These activities are great fun for children, and the scheme also prepares them for school, as they are faced with specific tasks.
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What concurrent disorders are often present in children with dyslexia? What should be examined as part of diagnosis when reading disorder is suspected? What causes particular difficulties for children with spelling disorder? What percentage of children with dyslexia also has mental problems? For what part of dyslexia treatment are there studies with level of evidence 1b? What diagnostic test for reading disorder should be used in the last two months of years 1 to 6 of the German school system?
What diagnostic test for spelling disorder has separate standards for high schools and grammar schools, and also has age standards for those aged 14 to 60? What is the prevalence of dyslexia among children and adolescents? Conflict of interest statement.
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