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Dyslexia and Reading Disorder

This disorder of phonologic processing and decoding of words is the most common developmental language disorder. It is estimated that as many as 30% of the American urban population has reading problems. Dyslexia frequently is familial, occurring more often in sons (35% to 40% risk of occurrence) than in daughters (17% to 18% risk). The underlying deficit is impaired recognition and processing of phonemes-- the most discrete elements of sound in language. Those who have dyslexia do not appreciate that speech is composed of sounds that join together to form segments, syllables, morphemes.

Dyslexia can be diagnosed confidently by the end of the second grade. Children will be slow and halting in their oral reading and have difficulty in reading comprehension. They have poor word retrieval and frequently use more fillers ("um," "like," "you know") in their narratives. They experience markedly increased difficulties in the fourth grade when there is a shift from "learning to read" to "reading to learn." Children must be taught to break down, or segment, syllables into phonemes. Some children whose overall cognitive abilities.

Abnormal development of the left hemisphere (planum temporale) has been postulated to have taken place in adults who have dyslexia. This theory is supported by autopsy studies of five adults who had dyslexia in which multiple areas of microdysgenesis or "brain warts" were present in the left perisylvian cortex, as well as by recent neuroimaging studies.

TREATMENT

Attempted therapies for dyslexia include educational remediation, medications, and psychosocial interventions. It appears that the most effective therapy is remedial education involving direct instruction in reading. Such remediation should include instruction.

Various types of cognitive-perceptual skills training (for example, sensory integration training, perceptual-motor training, occupational therapy, auditory memory training, vestibular stimulation, hemispheric stimulation, optometric training).

Medical approaches to treating dyslexia include stimulant medications, antianxiety medications, motion sickness medication, vitamins, and special diets. The most promising are stimulants and piracetam. Both methylphenidate (Ritalin) and piracetam have been studied in double-blind trials. Although methylphenidate does not appear specifically beneficial to reading skills, there is some indication that piracetam may

Psychosocial approaches to dyslexia include supportive psychotherapy, parent guidance.

An overall treatment program should include attention to associated disorders such as language disorders or psychiatric disorders.

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