Dyslexia: What SLPs Need to Know

Dyslexia is a genetically-based, neurobiological disorder that primarily affects the phonological system of language.^2,5,9,11 It is present from birth and will typically last a lifetime. Children with dyslexia have difficulty with phonological awareness as well as learning letter-sound correspondence and word decoding skills.^4-5

Research has suggested that this neurobiological deficit makes it difficult to establish, store, and retrieve phonological representations in the mental lexicon.^5,11 Typically, children with dyslexia have normal intelligence and normal language skills, but there are a few possible early warning signs that can help you detect the disorder.

Common Misconceptions About Dyslexia

Dyslexia is a term that many people have heard, but very few people understand. As such, dyslexia is frequently under-diagnosed, even though it is one of the most prevalent learning disabilities.

Dyslexia IS NOT:

• Acquired over time. A child is born predisposed to dyslexia. There are ways to intervene early to help alleviate some of the difficulties, but a dyslexic brain will always be a dyslexic brain.
• Characterized by letter reversals. In writing, letter reversal is a normal part of development until around 2^nd grade. Children with dyslexia may or may not ever reverse letters during writing. In reading, it is not the case that individuals with dyslexia “see letters backwards”.
• A visual processing problem. Thus, dyslexia will not be “cured” by working on exercises that claim to improve visual processing (e.g., eye tracking exercises, colored or distorted lenses, etc.)

Many teachers and parents have heard one or more of these misconceptions. As such, it is important for SLPs to be able to explain why this information is untrue.

Know the Warning Signs

Speech language pathologists are often unknowingly treating young children who have dyslexia. This is because specific language impairment (SLI) and dyslexia may be comorbid developmental language disorders. Although phonologic processing deficits are often associated with dyslexia, this is not necessarily true for children with SLI alone. Therefore, these disorders are distinct, but may occur together.⁵

It is imperative to know the early warning signs in order to provide preventative treatment. Signs can include:

• Family history of reading disabilities^6,12
• Early speech sound disorders and language impairments^6,8,10
• Difficulty learning letter names and sounds for successful decoding¹²

These early warning signs can be used to inform early screenings, help monitor children at risk, or provide preventative treatment.

Understand What to Assess

When you suspect a child is dyslexic, you should assess for the following:

• Phonological awareness and processing skills. The Comprehensive Test of Phonological Processing-2^nd Edition (CTOPP-2) is an option.
• Real word and nonword reading. Nonword reading is useful because it eliminates the construct of word familiarity and requires the child to use phonemic decoding. The Woodcock Reading Mastery Test-3^rd Edition (WRMT-3) or the Test of Word Reading Efficiency-2^nd Edition (TOWRE-2) are options.
• Non-verbal intelligence. Educational psychologists can help you obtain the necessary scores to accurately diagnose dyslexia. The Reynolds Intellectual Assessment Scales (RIAS) or the Kaufmann Brief Intelligence Test (KBIT) are options.
• Spelling. This assessment is applicable when working with older children.³
• Language ability. Although language impairments are distinctly different from dyslexia, they can often co-occur.^4,7

SLPs are not likely to conduct all tests independently. This should be a team-based assessment.

Know How to Intervene

Regardless of age, phonological awareness and phonics are likely a good place to start. If a child does not have those fundamental skills, word reading will always be difficult.

The specific interventions you use will vary from child to child, and are likely best done in the context of a team approach with reading specialists and special education teachers. A few age-based guidelines include:

• Preschool and kindergarten. Work on improving letter name and sound knowledge.
• Elementary school. Build phonological awareness into letter name activities (i.e., phonics) and provide opportunities to implement the skills within grade-appropriate texts (using texts 1-2 grades lower is useful). Recommend listening to audiobooks or podcasts at home so that the child is continually exposed to complex language structures.
• Middle and high school. Incorporate writing and spelling into your activities. Using vocabulary from the curriculum is a great way to provide both repeated exposure to grade-level words and a rich engagement with those words. Continue using audiobooks or podcasts!

The SLP’s Role in Treating Children with Reading Disabilities

It is within the SLP’s scope of practice to be involved in the prevention, identification, assessment, and intervention of children with reading disabilities.¹ This will and should take a variety of forms including:

• Consultation with the general or special education teachers, parents, or literacy team
• Collaboration with reading specialists
• Training of other professionals
• Participation on literacy teams
• Direct service provision

As you can see, there are many important ways SLPs can be involved in the appropriate diagnosis and treatment of dyslexia.