DSM-IV-TR criteria

• A. Reading achievement, as measured by individually administered standardized tests of reading accuracy or comprehension, is substantially below that expected given the person’s chronological age, measured intelligence, and age-appropriate education.
• B. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living that require reading skills.
• C. If a sensory deficit is present, the reading difficulties are in excess of those usually associated with it.

Coding Note: If a general medical (e.g., neurological) condition or sensory deficit is present, the condition code on Axis III.

Associated Features

A reading disability is a learning disability that involves significant impairment of reading accuracy, speed, to the extent that the impairment interferes with academic achievement or activities of daily life. People with reading disabilities perform reading tasks well below the level one would expect based on their general intelligence, educational opportunities, and physical health.

Reading involves several steps, including: pronunciation, phonics, silent letters, word recognition, and so forth. People with reading deficiencies can exhibit difficulties in one or more of these areas. For people who experience a reading deficiency, there is a considerable gap between the actual level of achievement and the expected level of performance. People with reading disabilities might experience the following: slow reading speed, poor comprehension, omission of words, reversal of words or letters, difficulty decoding syllables or single words and associating them with specific sounds (phonics), and limited sight word vocabulary.

Children who experience a reading disability tend to experience more negative emotions than children who have typical reading skills. Some negative emotions that have been associated with reading disabilities are: shame, low self-esteem, and lack of motivation. Consequently, this may have a negative effect on their academic work and achievement level, even if they are of average or normal intelligence. The deficiency can also negatively impact a person’s motivation to advance in their reading abilities, which in turn leads to a lower self-esteem. Oftentimes, peers make fun of a child’s reading ability, or lack thereof, because he/she often reads slowly and often needs help pronouncing what other children view as simple words, which leads to a child’s feelings of shame.

Teachers can usually identify children with this disorder when doing “popcorn reading,” or reading aloud. Children with reading disabilities greatly benefit from a learning environment, in which a teacher has adjusted her curriculum and teaching style to meet their specific needs. Some techniques that teachers can use to help children are: individual reading time, clapping to the rythm of the different phonemes, tutoring, reading shorter passages, pairing with skilled readers on topic tasks, and picture and physical action association. It is very important for parents and teachers to maintain a positive attitude towards the child. Continued reassurance, maintaining frustration levels low, providing flexibility, and providing realistic expectations are critical to reduce negative emotions and provide positive methods for children to cope with their disability. Children who receive early diagnosis and treatment for their reading disorders experience less negative emotions and negative life impacts, such as school drop out, as opposed to children who do not receive early intervention. This rate of improvement is at an astonishingly 90 to 95%.

Child vs. Adult Presentation

About 4% of school-age children in the United States are diagnosed with reading disability. Children are usually presented with a reading disability when they start kindergarten or first grade, when reading skills are first developed. Since learning disabilities, are life-long, they persist into adulthood. If a person receives adequate intervention and treatment for their disability while in school, they will usually have learned coping skills by the time they enter adulthood. In contrast, if coping skills are not learned, they could continue to struggle as adults and fall into socially unacceptable lifestyles, such as substance abuse or other crimes.

Gender and Cultural Differences in Presentation

Sixty to 80% of children who are diagnosed with reading disabilities are male. The prevalence in females with the disability may be underestimated, since males tend to be more disruptive in class and referred to special education classes more often. Females, on the other hand, tend to quietly disassociate or daydream in expression of their disability. For the purpose of ruling out cultural differences, a random sample of the population is tested in addition to any individualized testing is performed as a diagnostic tool.

Twin Studies

• Dyslexia was found in 80% or higher of monozygotic twins. The reason the concordance is so high is because monozygotic twins have the same genotype, as opposed to dizygotic twins. In other words, monozygotic twins share the same environment and, therefore, share heritability.
• Depending on how strict the criteria is in a given country, the incidence and prevalence figures for Reading Disorder may vary from place to place.

Epidemiology

It is approximated that between five and fifteen percent of the general population has a learning disorder and about eighty percent has a reading disorder. Studies also suggest that about four percent of school-age children have a reading disorder.

Symptoms of difficulty in reading can be seen as early as Kindergarten, but they are seldom diagnosed before the end of Kindergarten or the beginning of first grade, because formal reading instruction does not begin until that time. A reading disorder may go unnoticed for a while for children with a high IQ, because those children might function at or near their appropriate grade level in early grades. Their disorder could become more apparent, however, in fourth grade or later when the mass amount of new information makes it nearly impossible for them to hide their disorder any longer. For cases with early intervention, the prognosis is positive although the reading disorder may persist throughout their adult life.

Etiology

Reading is an intricate task, that requires eye muscle coordination, spatial orientation, visual memory, sequencing ability, an understanding of sentence structure and grammar, and the skill to categorize and analyze individual letters and a combination of letters. The brain must also be able to incorporate visual cues with memory and associate them with specific sounds. These sounds are then associated with specific meanings which must be retained while a sentence or passage is being read. When any of these processes are disrupted, a reading disorder can occur. Therefore, the cause of reading disorder is difficult to pinpoint. However, research has found that this disorder may be partially inherited. Therefore, reading disorders are more common in children that have a first-degree biological relative with a learning disability. By evaluating the reading and writing abilities of about 80 family members across four generations,researchers were able to isolate mutations in specific genes that were associated with reading and writing short comes (Davidson). Other theories suggest that problems in certain locations of the brain may cause a reading disorder. Studies have shown that the left-hemisphere posterior brain system does not respond correctly when people with the disorder are reading. Also two different systems function to develop a reading ability; an initial system that recognizes phonetics located in the parieto-temporal region and a decoding system used by more skilled readers in the occipito-temporal region that recognizes sight vocabulary. People with a reading disorder demonstrate a low activation of both these areas and an increased activation of the frontal gyrus which causes letter to sound decoding. There may also be a visual or auditory processing deficit, such as having problems moving the eyes to follow text and moving the eyes back and forth across a line. This would not be a problem in seeing, but in processing information from the eyes and in using the eyes to get information.

Reading Disorders aggregate familiarly and is more prevalent among first-degree biological relatives of individuals with Learning Disorders.

Empirically supported treatments

Early intervention is essential to the individuals well being. Customized education plans that has a cross-disciplinary educational approach is a treatment option. Many of the successful programs all use systems that are sound or symbol based, which breaks down the words into letters and sounds. Also, they attempt to build and reinforce mental associations using visual, auditory, and kinesthetic channels of stimulation. They simultaneously see, feel, and say the sound-symbol association by tracing the letters with their finger while pronouncing a word out loud for example. The programs are also highly structured, beginning with the sound of a single letter, working up to a pair of letters, then syllables, and then into words and sentences. By doing repetitive drill and practice, they will be able to form essential associations between sounds and symbols which may help them overcome their reading disorder (Davidson). Also, graphic organizers have a beneficial effect and are more beneficial when created by the student. These graphic organizers are visual methods of highlighting important information. They link what the student already knows with what they are trying to learn. For those with dyslexia, reading with an index card with a window cut in it is also helpful, as is reading with special colored filters.