Is it dyslexia or a vision issue?

Dyslexia is a brain-based learning difference. It is a language processing disorder and not a vision or eye problem. In contrast to dyslexia specialists and most pediatricians, some optometrists may try to convince you that your child’s reading difficulties are due to vision problems and may recommend vision therapy or glasses. Some well-intentioned (but misinformed) therapists or teachers may even suggest colored overlays to “fix” the problem.

Are Our Readers Really Reading?

Dyslexia is often referred to as a hidden disability because it can go undetected for so long. On the surface, everything looks fine. It has been my experience that dyslexic students are good at coping, they know how to play school. They work hard, they are highly verbal, love to answer questions in class, they are curious, can make the most amazing connections, and at an early age – when texts are predictable, repetitive, and have strong picture support – these students can look like readers. It’s not until you dig deeper and begin to analyze their phonemic awareness skills or their ability to rhyme and manipulate sounds that you may realize there is a hiccup.

“But, he’s so smart, he can’t be dyslexic!”

When I begin to suspect that a child may be dyslexic, one of the sure-fire things to tip me off is observing a really bright student struggle with reading a simple text.

When discussing my concerns with teachers, they often say, “But, he’s so smart, he can’t be dyslexic!”

Dyslexia does not have any correlation to a person’s intelligence and in fact, people with dyslexia often have above average IQ’s. We assume that if a person is smart that they are a strong reader. Dyslexia defies this assumption.

How Do You Determine which Accommodations are Best?

Once you have intervention in place to be sure your child is closing any skill gaps:

How do you get the right supports from the school?

Talking with your child's school team is of paramount importance. You want to be sure that while your child is getting the help they need privately or through school-based intervention, that they are not continuing to fall further behind in the classroom.

If necessary, I find it helpful to limit the number of requests to your top two in each domain to be more likely to have consistent follow-through from the school. While they are doing their best to accommodate every student, the reality is that less can be more in some instances.

How Much Therapy is Enough?

So now that you know you need academic therapy...how long will it take to finish?

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This is a great question, but it can be difficult to answer. The length of time needed in an academic therapy program really depends on your child's academic profile, needs, and retention of the information.

Typically we can help predict the length of time in a program based on standardized testing results (psychoeducational testing results, not necessarily state standardized assessments). While at Children's Hospital Colorado our team researched the length of time it would take to see consistent growth in reading ability. There were many factors at play but overall we found that student's could expect to see around 10 Standard Score points of growth in a 6-month period with therapy occurring once to twice per week. There was not a statistical difference between students being seen once to twice per week.

You can check out the research poster here and the overview of the findings here!

Of course, every child is different but typically we are able to give strong predictions of length of time in a program. For reading remediation typically students remain on our caseload for 12-18 months depending on the concerns. Some students need less time and some need more.

For math students, it generally depends on how large the skill gap is - often students progress through our math program in 6-12 months (some need longer depending on the level of severity and cause of the deficit).

Our executive functioning program generally takes 10-12 weeks of once per week sessions to complete the skills workbook. Some students need longer with more individualized practice to really hold onto the skills introduced in the program.

What can you do to help your child make progress quicker?

  • Make sure to remain in communication with your child's therapist about the skills they are working on during our sessions.
  • The more practice and support you can offer your child outside of their sessions - the quicker the progress will be. Complete all of the home practice activities you are provided!
  • Consider inviting us to attend an IEP meeting so we can make sure your child is getting the most they can out of supports provided at the school.
  • Be consistent with your appointments! We know life gets in the way, especially when you have such a long-term commitment with academic therapy. But missing sessions significantly impacts the length of time it takes to complete the program.

Why Orton-Gillingham (OG) Reading Instruction?

So many parents are very curious about Orton-Gillingham instruction as it is largely tauted the "Gold Standard" in reading intervention. So, often the question is:

What is so different about OG instruction?

Well, as we mentioned in a previous post, a major benefit is that it meets the student where they are as opposed to assuming they indirectly picked up a rule/strategy without being given the explicit rule or pattern to follow. But equally as important OG is different than reading instruction they may have received previously because it teaches the "why" of our language.

By exploring the "science/engineering" and "history" of our language we are able to teach students how to systematically decode words using explicit rules following a very organized pattern. For example the science/engineering of our language - includes the six syllable types that predict all of our vowel sounds, our Hard and Soft C/G rule (sometimes known as Gentle Cindy) teaches us how and when c says /s/ versus /k/ and when g can say /j/. Many parents are floored by all of the amazing rules of our English language they never learned as a child.

The history of our language helps us identify word origin which impacts spelling and pronunciation of words and explains why some words make no sense (generally anglo-saxon words because these people were largely uneducated). Using predictable sound patterns, we are able to build/engineer words in a very structured way which speaks to a different area of the brain that dyslexic students often excel in.

In explaining this to students we talk about using building blocks, Legos, that will click together, stack and build on eachother to give us the knowledge we need to read and spell unfamiliar words. These Lego pieces are entirely different than what most students will learn at school and therefore by the end of their time in an OG program they will have this huge amount of knowledge about the science, history, engineering of our langauge!!! Very empowering if we do say so ourselves!

Signs to Watch For if You are Concerned about Dyslexia

According to the Yale Center for Dyslexia and Creativity, indicators of dyslexia can be noticed early on, before school-age. It's important to catch these signs early because early identification and intervention can be key to preventing several difficulties children who struggle with dyslexia may encounter.

Preschool Early Signs of Dyslexia

  • Trouble learning common nursery rhymes, such as “Jack and Jill”
  • Difficulty learning (and remembering) the names of letters in the alphabet
  • Seems to be unable to recognize letters in his/her own name
  • Mispronounces familiar words; persistent “baby talk”
  • Doesn't recognize rhyming patterns like cat, bat, rat
  • A family history of reading and/or spelling difficulties

Kindergarten and 1st Grade

Kids in school learn symbol/sound correlation (e.g., what does B say?), they learn to decode (sound out) words, remember sight words, and spell words. If your child is struggling, indicators of dyslexia are:

  • Reading errors that show no connection to the sounds of the letters on the page. Your child may say “puppy” instead of the written word “dog” on an illustrated page with a dog shown.
  • A lack of understanding that words come apart
  • Complains about how hard reading is or “disappearing” when it is time to read
  • A history of reading problems in parents or siblings
  • Difficulty sounding out even simple words like cat, map, nap
  • Does not associate letters with sounds, such as the letter b with the /b/ sound

2nd Grade and Above

When kids reach second grade and above, the reading and spelling struggles begin to appear more obviously. There is a larger gap between their cognitive capabilities and their academic performance. People with dyslexia tend to have an average or above average IQ, so many learn to compensate on their own and therefore “fly under the radar” in the classroom. Kids may struggle with basic reading concepts along with some noticeable speech issues. Some indicators to watch for are:

  • Slow in acquiring reading skills. Reading is slow, awkward, and laborious
  • Trouble reading unfamiliar words, often making wild guesses because he/she cannot sound out the word
  • Lack of a strategy for reading new words
  • Avoidance of reading out loud
  • Searching for a specific word and ends up using vague language, such as “stuff” or “thing” a lot, without naming the object?
  • Pauses, hesitates, and/or uses lots of “umm’s” when speaking
  • Confuses words that sound alike, such as saying “tornado” for “volcano,” substituting “lotion” for “ocean”
  • Mispronunciation of long, unfamiliar, or complicated words
  • Seems to need extra time to respond to questions.

Do I Need an Evaluation?

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While there may be some cases in which it is good to wait, generally the answer to this question is - YES! While you absolutely do not need an evaluation to get started with remediation, it can help guide treatment and answer many questions for you, as parents as well as for the clinicians working with your child.

School-Based Evaluations

Evaluations can be provided through the school as part of an Individual Education Program (IEP) eligibility process. The trick here is that you want to ask for IEP eligibility testing NOT learning disability testing.

School-based evaluations are the most cost-effective route and they guarantee school buy-in, but they can take months to complete, and depending on the school, may not provide a lot of specific recommendations.

Private Learning Disability Evaluations

Educational diagnosticians, psychologists, and neuropsychologists can also provide evaluations. These evaluations often require parents to pay out of pocket. In some cases, insurance may cover part or all of the evaluation but this is not common. Typically if your insurance is willing to cover part of the cost you will be required to submit for reimbursement through your insurance.

Private evaluations can be costly but often provide more comprehensive recommendations for your child and can often be scheduled earlier than school-based evaluations in order to speed up the process in getting your child the specific help he or she needs.

Is it worth it?

The bottom line is, children who demonstrate academic struggles early on, will continue to struggle throughout their academic career if they do not receive instruction that meets their specific learning style and needs.

The “wait and see” approach is never a good option to take; any amount of additional academic support will never hurt a child but the lack of necessary additional support can absolutely have lifelong impacts. Whether you choose to have your child evaluated through the school or through a private evaluator is completely personal and may be dependent upon on your child’s needs and your family's situation.

The value of knowledge and data about your child’s academic strengths and challenges will prove to be an extremely worthwile investment.

How is Learning Therapy Different From Tutoring?

Often by the time a student is suspected of having a learning disability, parents or caregivers have already gone to great lengths to support their child. Many have hired tutors or had teachers spend extra time with their child over the summer to no avail. So often families ask us how academic therapy or dyslexia therapy is different from what they have tried in the past. This is a wonderful and necessary question.

Learning Therapy

  • The key difference is that learning therapy aims to identify the underlying causes of the learning difficulty in order to target those skills with structured tasks and curriculum design in order to support foundational learning elements.
  • Because therapy aims to target the underlying causes of the learning difficulty, a specific intervention plan is provided for the student. This means that the interventionist is not necessarily supporting homework completion with the school-based curriculum, but rather, that a program and materials are being developed to help fix the cause of the difficulty in the classroom.
  • Learning therapy uses past educational testing (from an IEP or initial screening) to determine how to create a curriculum specific to the student's needs.
  • Learning therapists or interventionists typically provide the curriculum for the student during the session, the student does not bring work from the classroom. Sometimes as therapy progresses, therapists will work with a child on generalizing the skills they have learned to the classroom assignments.
  • Learning therapy typically has a finite beginning and end (that varies on the learning pace of the student) that follows a systematic order of instructional topics.
  • Because learning therapy is so individualized, targeted, and designed around a student's need, the intervention generally costs more than a traditional tutor.

Tutoring

  • Generally tutors aim to support the "symptoms" of a specific learning disability. Their job is usually to support the student through the curriculum assigned by the school or teacher.
  • Tutors require the student to bring work that they are struggling with in the classroom in order to provide alternative ways or additional one-on-one instruction in order to support specific academic gaps.
  • The target of the instruction can vary from week to week depending on the needs of the student.
  • Because tutors can rely more on worksheets and work brought from the classroom, there is less need for planning ahead of the session and therefore typically traditional tutor rates are lower than that of a learning therapist's rates.

It is important to recognize that there is immense value in both learning therapy and tutoring. Making the decision on what is right for your child depends on his or her specific needs. Often standardized assessment or consultation with a learning therapist can help to determine which option is the best fit for your child.

Discovering a Learning Disability

The best place to begin is to identify indicators of a potential learning problem. Think about it this way; if you have a student who has average to superior intelligence, has intact sensory perception (e.g., ability to see words on the paper and hear words) and has been instructed in reading and writing by a competent teacher for months or years, but is demonstrating a significant discrepancy between their IQ and their academic achievement, it is time for an evaluation.

For example, if a student has an IQ standard score of 120 but their reading and spelling achievement standard scores are reported as 80 and 76 respectively, they are demonstrating at least a 40 point discrepancy between their overall cognition and their academic achievement. (Generally, a 15 point difference is reported to be statistically significant.) Another way this discrepancy might come to your attention (without having standardized assessment scores) is in daily interactions with a child. A child might demonstrate strong verbal skills and strong problem-solving skills, but their reading/writing/spelling output do not seem to match their verbal output.

An evaluation is important, not only to identify the underlying deficit, but to also identify an appropriate instructional approach, goals for remediation, and the potential need for further assessment by a specialist. School systems have moved away from using the "discrepancy model" in order to identify learning disabilities, but the fact is, if you have an intelligent student and their work output does not match their intelligence (meaning they are significantly under-performing), then there is most likely a learning deficit. The good news is, remediation is generally successful with students who possess average intelligence levels.

There are other indicators and behaviors to look for that may or may not be obvious. These behaviors will most likely be demonstrated in the classroom and in the home. It is important to note that all children exhibit one or more of these behaviors from time to time. IF a child is consistently demonstrating a group of these behaviors it may be time to seek out an evaluation by a qualified individual.

Difficulty with Attention and Concentration

  • Daydreaming
  • Showing distractibility
  • Trouble completing tasks
  • Restless behaviors

Difficulty with Memory

  • Learning the alphabet
  • Identifying letters
  • Spelling
  • Remembering names

Difficulty with Spoken or Written Language

  • Pronouncing words
  • Learning new vocabulary
  • Following directions
  • Discriminating among sounds (hearing the difference between /m/ and /n/ for example)
  • Reversing or omitting letters, words or phrases (very common with smaller words or word parts, such as suffixes, while reading)
  • Reading comprehension
  • Writing stories and essays

Difficulty with Organization

  • Time management
  • Assignment completion
  • Sequencing information (letters in the alphabet, days of the week, months of the year, numbers)
  • Thinking (relating a specific detail or idea to a unifying concept)

Difficulty with Physical Coordination

  • Drawing
  • Manipulating small objects

Difficulty with Appropriate Social Behavior

  • Tolerating frustration (outbursts)
  • Interpreting nonverbal skills (body language)
  • Accepting changes in routine

Homework Strategies for Students with Learning Difficulties

Homework Strategies

Set a timer!

Having a concrete ending point can help children maintain attention. Make sure to monitor their attention to task during this time. Each time your child/student appears to be "zoning out" or not attentive to their work, stop the timer until they are ready to refocus. 30/30 is an amazing app meant for adults or older students (click on the image below), but I like the simple user interface and it can help younger students transition to independent time management as an adolescent/young adult. I recommend setting a time for each subject of no longer than 10-15 minutes depending on the needs of the child. After 10-15 minutes finish the problem/question you are and switch to a new subject or take a quick brain break.

Display manageable chunks

For particularly difficult subjects (especially writing or reading for a child with dyslexia or math for a child with dyscalculia) display only manageable chunks. I love this idea from Teach 123 of cutting a file folder in order to display only one question or problem at a time so that students are not overwhelmed by all that needs to be accomplished.

Give only one step of large multi-step projects

If a long term project is to be completed, only give one step at a time along with a due date. This will help the student not jump ahead and also keep them organized and on track. Utilizing apps can help older students manage multiple class loads at a time.

Provide a hands-on visual organizer for procedural tasks

This is a great strategy for tasks which are repeated frequently that are generally procedural in nature (or follow a systematic process). Math is a great example of structured tasks that can be organized in this way. Review of written work is another (e.g., Check for Capitals, Check for Organization, Check for Punctuation, Check for Spelling). I chose to type this example but you could also hand-write on pre-laminated sheets with a dry erase marker for easier swaps of material.

The goal of providing a visual like this is to allow a student that usually needs step by step instruction of tasks to work more independently. You can teach a child to become more autonomous by removing steps and asking what was left out, or incorrectly ordering steps and asking for the student to correct them before beginning.

Teach organization skills with use of a planner

Often times managing a planner is not a skill that comes easily to children with executive function challenges (especially those with ADHD). This skill needs to be explicitly taught. Working with your child or student on how to use a planner and determining the best type of planner at the very beginning of the year is very important. I like to use planners because you can color-code subjects and make sure that all the steps are completed. By placing a planner in the front of a homework binder or placed in a paper protector stapled onto the front of a homework folder teachers can know to check for homework that may have been completed but not handed in.