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Case Study: Ten year old child with severe dyslexia

This study discusses a ten year old Elementary School student with significant levels of dyslexia. Reading through this case study will help you recognize typical concerns, and possibly identify approaches and techniques to help you with your student. You will notice the weighing of factors and the considerations discussed. Every child is unique. No single overall approach applies to each and every child.

Student Profile

18 March 2014 Eric (M) 10 (Grade 2) Student ID ER3445752M Dyslexia Test https://www.dynaread.com/index.php?cid=testresults&pmp_id=ER3445752M646464

Input by Elaine Benton MA, with additional comments by Hans J.A. Dekkers. Both Dynaread Team members.

INPUT BASED ON PROVIDED BACKGROUND INFORMATION

School-provided information in italics.

Eric has been with us since kindergarten. Already then, he expressed difficulty learning letters and sounds, so when he moved to grade 1 we hoped with extra one-on-one help he would thrive. He didn't. At parent request and with school approval, he repeated.

ELAINE: From our perspective, looks like this was a very good decision.

His second time through was more successful, but when he hit grade 2 and had to start reading more, identifying more sight words, and writing sentences and short paragraphs, it was obvious that he didn't have the skills yet.

ELAINE: How poor is his writing? We tend to forget manual writing as we concentrate on reading but it can be such a painful, and not unrelated, issue that needs kind but concerted and steady attention.

ELAINE adds...: [Topic: About composition work with the limitations of low reading and handwriting removed]. The child tells/dictates an experience story (it could be a phrase, sentence or even a whole short story that they want to share) to the adult who writes it down and then uses the material that has been created as a text to be read. It ensures that the reading text only uses language that the child already knows and it's an excellent approach as long as the child is not able to parrot the story back from memory. If this is the case, the tutor should let the story go stale in memory until the child can't 'read' it entirely from memory. This is called the Language Experience Approach (LEA) and it is used with very, very basic readers. Reading teachers should really know or learn how to use this approach. It's hard to write as fast as they talk but its' worth it because this is a reading instruction technique that also helps them to begin to develop and order their thoughts cogently before they would otherwise be able to do so. It is, effectively, composition work with the limitations of low reading and handwriting removed.

HANS: Eric's test demonstrates extremely marginal literacy (near illiterate). In language development, a child progresses from listening to speaking, to reading, to writing, to complex authoring.

diagram of language development

It is unreasonable to expect a near illiterate dyslexic to write. Copying, as part of a multi-modal, multi-sensory approach in learning to read: Yes. But writing originally composed short paragraphs or even short sentences on his own: No. This is simply out of reach and ability (based on his demonstrated reading skills in our test).

So he started Orton-Gillingham for a minimum of two hours per week, which continued daily until he began with the Dynaread program.

ELAINE (Certified Orton-Gillingham Remediator): [HANS: To be effective, in the perfect world...] Orton-Gillingham should really be done for a minimum of three one-hour long lessons per week ... with practice in between. Also, see below for recommendations regarding the type of OG program that is most beneficial.

He has no other learning disabilites, is not ESL, and is a very strong oral learner. Like many other dyslexics, if he could get through life orally, no one would probably realize how much he struggles with reading and writing.

I've been working with him this school year now that he's in grade 3. I see a bright boy who is willing to try anything I suggest. We've been focusing on Orton-Gillingham yet, hoping to hammer those skills in more and more. Last year, his retention of new information had about a 50% carry-over to regular seat work. This year, it's about 70%.

But while the rest of his class has moved on at grade level, many of them reading books at the 3-3.5 level, he is beginning to realize that his books at 1.8 level are "too easy" for the others. He's becoming less brave in reading out loud in class or volunteering information.

I think this is the year that he's either going to start feeling successful or start shutting down and turn into an attitude case. I believe that's also the reason he was so keen to try a new program like Dynaread, because he wants to keep up.

ELAINE: I understand where you're coming from but I've just had so many students who've had severe reading problems but have never shut down or had attitude problems. It's just essential that they, and we, find and emphasize other things that they're good at. For some kids it's the arts, or sports and for some its things we wouldn't normally think of ... like class pets, other games or just the fact that they have a good friend and/or the ability to make a lot of friends or become a leader ... so many possibilities and all it takes is one.

Please talk to the teacher about the reading out loud. Is it being done in larger groups? If so ..., no go. Reading pairs ... ok. Triads ... ok. Many more ... not so much.

HANS: Though I fully agree with the power of identifying and help internalizing one (or more) skills that Eric may excel in, researched statistics overwhelmingly evidence the grave risks of emotional shut down. Part of the solution is what Elaine shared, but part of it is also helping Eric understand that Dyslexia is not a curse, not something to be ashamed of, and something that actually comes with many benefits (if managed well, by him and those who raise him, and educate him). It may be a very good idea for his parents to buy the following book, and read it together with Eric. Not instead of identifying and endorsing his unique talent area(s), but alongside it.

The Dyslexic Advantage: Unlocking the Hidden Potential of the Dyslexic Brain by Brock L. Eide M.D. M.A. Permalink: http://www.amazon.ca/dp/0452297923

His teacher is very aware of his strengths and limitations and teaches to them. But all the interventions now lie on my plate, and I'm hoping to help him achieve some more success. Since all our students bus in (he's on the bus about 40 minutes), before/after school programs are not an option. Generally, we focus on math and reading/writing as crucial life skills, and if needed we minimize the time spent on social/science to help them keep up with math and reading. We try not take them out of music and art, because there's lots of research to suggest that those subjects also help out academically.

ELAINE: 40 minutes on a bus is really unfortunate ... I guess it has to be social time, a good time for kid books on tape or music, learning apps or, if it isn't embarrassing, easier books that he can read alone or with a friend.

HANS: Public libraries often have offerings of audio books in their collection. I myself use Audible.com by Amazon, which offers a high quality audio experience. Some people demonstrate the ability to listen with comprehension at faster rates, and Audible.com allows this. They offer a three month trial subscription for little money. It may be a way for him to progress in academics and overall development, through listening on the bus.

ELAINE: I totally agree with the effort to keep music and art ... unless he hates them. Personally, I don't think there's much extra benefit if the child isn't interested. On the other hand, how about something physical? Sport or building/making things? Would he be interested? It's just as beneficial ... or more so.

HANS: I am also familiar with the research on the benefits of music and art to overall academic development. We are not linear-thinking creatures. Music and arts help us to broaden our perspectives. And with a current lack of reading skills, this may help compensate. And if he happens to be good at it, will also boost his sense of self-worth.

He would not be retained any more in elementary, regardless of what grade level he achieves this year or in years to come.

ELAINE: I'm really curious about why this is the case. Is there room for negotiation here?

ELAINE adds...: Regarding repeating more than one school year in elementary school, do check in with the Ministry of Education to see if such a rule can actually be imposed by a school. I don't know the rules here but I do know that, in Ontario, this would rule would never stand.

HANS: When I read that statement, I concluded that you were primarily stating it as a fact. But fact or not, retention in a Grade when peers move on is very tough on a child, especially if the child -- like Eric -- seems very very eager to stay at par with his friends.

Rather than retaining, my preference would go out to assistive technologies, like Text to Speech and Audio Books, plus selecting an academic path for him which suits his talents and abilities. But... most certainly continuing to help him to Learn to Read, with Dynaread and possible continued augmentation of OG Phonics. I categorically do not see assistive technologies as replacement for learning to read. AT's are merely a means, and most certainly not an end. You may want to watch this video (possibly even together with Eric), in which I talk about the role of AT and the balances in handling Dyslexia: http://youtu.be/0wOLl3ZRcw4

YOUR TOP THREE OF WHAT YOU HOPE TO RECEIVE FROM OUR TEAM

1. how to boost his reading performance.

ELAINE shares... I would recommend the following to help boost Eric's reading performance.

(1) Dynaread. It is really quite obvious that Eric needs to increase his sight word reading vocabulary and improve his reading speed for the words that he knows. Dynaread will help him to do this as well or better than other programs. Truthfully, no bias. Full stop.

(2) Make sure that Eric is getting the kind of Orton-Gillingham program that he needs. In my experience, OG fails when children are taught phonic information but are not given enough opportunity to use it i.e. to recode (read and spell) a good number and a wide variety of words with target phonemes in the initial, final and middle positions. (in that order if you can). Application is a skill that has to be taught explicitly (for accuracy) and drilled (for speed) with individual words, phrases, sentences and short paragraphs. Systematic, explicit phonics instruction has to go hand in hand with systematic, explicit 'application instruction'.

(3) It would be excellent if Dynaread words could be included among the words used to teach application. Doing this would, effectively, cement and 'back up' already acquired sight words and make application easier at the same time.

(4) This is going to sound obvious but ... find something that he really wants to read. Try out everything. Let him choose and let him stay with what he loves for as long as he wants. Fiction, non-fiction, many authors, many topics, many formats, graphic/cartoons, colorful characters ... anything and, if he wants to read something that is too hard, simplify sections of it and, together, do it anyway. I can't do enough to stress how important this is. It's not rocket science but it can make all the difference in the world. When they find the right things, they just take off and you wonder what on earth just happened.

ELAINE adds... : Teachers/tutors can 'level' a text by summarizing, paraphrasing and shortening it ... with simpler words that they can definitely use with the child. It's effortful on the part of a tutor. They have to be good at paraphrasing and summarizing ... but it is a pretty common and effective technique. The child still reads and learns the content that interested him but he isn't asked to read beyond his own level.

The analogy between physical and reading disabilities isn't always appropriate. I have one severely dyslexic child who wanted to run. He was only interested in, and would only try to read, books about animals. The books he wanted were way above his level but, initially, at least, he only wanted the pictures and the facts ... so we/I ended up cherry picking facts from quite difficult books. We used the pictures and captions to learn the facts together. Initially, I did almost all of the reading but then we would pull out the simpler words to work on and learn together. The level of learning kept him motivated but the level of reading instruction stayed very low. I credit this technique, however, for his remarkable improvements. He is extremely motivated to increase his knowledge on his own, read those hard 'fact' words and those books on his own and he is now (9 months later) reading vocabulary that is way above his grade level. Easy texts just always bored and de-motivated him. Now he's excited. (the principles of CLAD clear language and design can be of great assistance here ex. line breaking).

I think the main thing, is to remember that the child is not expected to do these things on their own. It's about essential teacher/student 'scaffolding'; a gradual shift/transfer of responsibility and skill from teacher to student.

HANS: Personally, I would like to add a little balance here as well. We all know the paradigm from which she is reasoning: Inner drive and motivation can do so much more than any 'external' force. Though this may be true, it never brought my friend Matthijs with his quadriplegic condition to walking. Eric did not demonstrate mild dyslexia (rather: severe dyslexia). The risk of toying with reading materials whilst not really being able to read is that they contextually guess their way through the text. In that process, the orthography of one word gets coupled with the semantics and pronunciation of another, which effectively results in polluting their reading system with inaccurate information. If a child is making progress and starts to be able to read, then I can follow Elaine's argument, but personally -- based on Eric's demonstrated abilities in his Dyslexia Test -- I would judge this too early.

ELAINE continues...

(5) Separate reading and reading comprehension as much as possible. Concentrate on one of these at a time. Unless a child is extremely motivated and willing to do a lot of start-stop-recap and rerun ... try to do word decoding before or after you've read the text. Learn problematic words in advance ... read them for the student as you go along ... or read them with the student if you can do it fluently together. Motivation goes asunder when decoding effort is painful.

2. HOW TO HELP HIM SUCCEED WITH INCREASINGLY COMPLEX READING MATERIALS AS WE PREPARE HIM FOR END-OF-YEAR GOVERNMENT PROVINCIAL ACHIEVEMENT TESTING AND BEYOND

ELAINE shares...

With increasingly complex reading materials ... remember that there are two kinds of texts; ones that a child can read on their own and those that they can only attempt with help. You have to use both. Learning comes from 'the new' while mastery and pride comes with the independent practice. So, it's ok if they want to read easier texts if, together, you are also reading things that are more difficult. Harder things move into the 'easy' category and we leap frog along in that fashion.

Also, don't forget that reading depends on basic language and listening skills. And reading is not the only way to improve and expand them. The richer the child's language, knowledge and story-telling environment the better.

HANS: This point of Elaine I cannot stress enough. There is significant research demonstrating that children who have been read to lots when young, and who grow up in a verbally rich environment enjoy a language development advantage. As shared earlier, reading is merely a stage in overall language development. But it is crucially important to recognize two things here:

1. Initial reading merely couples the orthography of words to the already present verbal vocabulary of the child. This is where the rich verbal environment and the being-read-to comes in as an advantage. Audio books, likewise, can help here as well.

2. ... and the following is something I would like to do more structured research in one day... When you study the works of Chomsky and other linguists, you come to realize the role of reading in our ability to grow intellectually as well. We can only 'merge' ideas and concepts if we know them. We cannot combine e.g. flour, salt, and water to come up with bread if we have never heard of flour. Reading plays a significant role in expanding our overall know-how and understanding, resulting in enriching our access to individual ideas and concepts, which we can subsequently 'merge' into original new thinking and ideas. This point is obviously a bit out of Eric's direct-needs context, but it does argue for two things: (a) It is of great value to him, if we succeed in becoming a functional reader, and (b) exposure to audio books and other non-reading materials can help make up for what he misses out in reading. And my preference would go out to audio-books over e.g. videos, because books cover subjects in so much more detail and a video.

ELAINE continues... I really wouldn't worry, at all, about preparing Eric for the PAT test (or any other standardized test until he reaches the final years of high school). Teachers are often encouraged to 'teach to the test' for these events but, especially in Eric's case, this would be counterproductive. These tests are more about evaluating schools and school systems than they are about testing individuals. Eric will, of course, have to take the test with everyone else but it won't yield any specific knowledge that will be of much use to you. Keep him on his usual program.

HANS: I could not agree more with Elaine. If at all possible and/or permissible, I would not have him involved. At this point in Eric's life it would be the equivalent of asking Matthijs to participate in the Athletics test on running a quarter mile. It only pains him, and does not yield any advantage for Eric.

3. HOW TO OPTIMIZE OUTCOME AND POTENTIAL FOR A STUDENT LIKE ERIC, EVEN UTILIZING ASSISTIVE TECHNOLOGIES IF NEEDED

Get him onto Dynaread and ensure that his Orton-Gillingham program is systematic and explicit and stresses phonics application in spelling as well as reading. Do and try anything and everything to (1) find material that really motivates him (even if it wouldn't be your choice for him) and (2) other activities and friends that make his life meaningful and fun at school and at home. More than this? I don't think you can do too much more than this. Don't forget to appreciate, congratulate and reward yourself for all of your efforts. Eric is lucky to have you.

HANS: Building on what Elaine closed her paragraph with, your school displays remarkable commitment and ability. Keep it up!

Regarding assistive technologies, well that's a thorny issue. When should we start using them? I recommend that you keep them on a backburner for a while. Voice recognition programs are becoming more and more popular but there is still room for them to improve. There are pens and other scanners that will read text aloud for you; tools that I'd suggest to any adolescent or adult. And one can ask for extra time for tests and assignments that are graded; something that's really important as soon as poor reading skills begin to mask displays of subject knowledge and other practical skill development. These are all good tools but, I have a lot of experience teaching adults as well as children so I'm acutely aware of the fact that the early years are the best learning years. Unfortunately, it rarely gets easier than it is now. It would be a terrible thing to miss any of the potential of these years by moving into adaptive technologies too quickly.

HANS: I point back to my video again. I do believe there is good use for AT, though, but... NEVER at the expense of full throttle efforts to help Eric learn to read. These AT are often rolled out as RT's (my coined term: Replacement Technologies). AT's should remain assistive and never replace the effort to learn to read.

Lastly, allow me to refer you to a white paper by the International Dyslexia Association, on Accomodating Students with Dyslexia in All Classroom Settings. https://www.dynaread.com/accommodating-students-with-dyslexia

End of Case Study

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example case study of child with dyslexia

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The following are some case studies of dyslexics with whom we have worked over the past years. In each story, we provide background information, the course of therapy that integrates the individual's strengths and interests, and the outcomes—all of which are positive.

Case Studies for using strengths and interests

Case Study One:

Grace has a diagnosis of dyslexia. She has trouble with visual scanning, processing, and working memory. She also has difficulties with spelling and sequencing for problem solving. She has strong verbal skills and is artistic abilities. She learns well with color and when her hands are occupied.

Grace struggled with note taking because of her difficulties with spelling and visual scanning (looking from the board to her paper). Furthermore, she could not keep up and got "lost" in the lecture (particularly for subjects that were already difficult for her). Grace’s teachers thought that she was not putting forth the effort, because they often saw her daydreaming in class. When the therapist asked Grace about this, she admitted that sometimes she would daydream because she did not know where they were in the lecture. She also desperately wanted to blend in with her peers, so she looked to them to see what she was supposed to be doing. However, when she was permitted to follow along with a book that she could highlight in and make her own doodles and notes in the margins during the lecture, she was able to focus her energy on the teacher and have notes that she could refer back to later with all of the main points highlighted. Using Grace's kinesthetic learning style and preference for color, she was able to participate with her peers, decrease her anxiety in class, and develop a skill that will help her to learn better across the curriculum.

Due to her difficulties with sequencing, working memory, and reading, Grace struggled with numerical operations and story problems in math. Her problem solving skills were good when she could leverage her strengths: connecting abstract ideas and thinking at the macro level. Hence, when she could connect a concept to a real life problem, she could inevitably come up with a creative solution and grasp the concept; however, her poor numerical operations skills were still holding her back. The therapist remembered Grace's interest in color and tactile learning style and introduced her to a number of "hands-on" ways of solving the problem: calculating probability with colored marbles, using her fingers for multiplication, and solving equations with objects to represent the variables. In this manner, Grace not only grasped the concept that was presented at the macro-level, but using her love of color and keeping her hands moving she could reliably solve for the answer. Employing colored pencils for numbering steps or placing hash marks in multi-step directions helped Grace stay on point and not skip steps in complex problems. These strategies were incorporated into her 504 Plan and were communicated to her math teacher.

Case Study Two:

Amy has a diagnosis of dyslexia. She enjoys creative writing, fashion, and art. She is extremely bright and has a strong memory. She benefits from rule-based instruction. If you tell her a rule once, she will be able to recite it to you the next time you see her. She delights in being able to be the teacher and teach the rules herself or correct others’ errors.

Amy’s stories often jumped around without any cohesion or plot. The clinician suggested that Amy work on her stories on a daily basis. Amy drafted her stories about glamorous people and enjoyed illustrating their wardrobes. Her clinician helped her to expand and revise her story using a multi-sensory tool to teach her the parts of story grammar. She was able to revise her own story, by adding the components of a good plot (characters, setting, initiating event, internal response, plan, and resolution). With several revisions, she produced a well-developed story and colorful illustration that was framed and displayed. The combination of using Amy’s interests, learning style, and a powerful reinforcement (framing and displaying the finished product) lead Amy to become proficient in telling stories and in revising her own work.

Case Study Three:

Ryan has a diagnosis of PDD-NOS that affects his language, social, and literacy skills. He also struggles with anxiety. He has a number of interests including: pirates and treasure, cooking, watching his favorite TV shows, and drama. Ryan has a strong memory and conveys a great deal of social knowledge when he is acting or drawing.

Due to Ryan’s anxiety associated with reading and writing, he often protested and completely shut down when presented with something to read or write. Ryan watched a number of shows that taught lessons about friendship or had a “moral to the story.” He was able to take some of those themes and stories and modify them, inserting kids from his school as the characters, and adding himself as a character and narrator. Given his interest in drawing, he illustrated his story, and made it into a short book.

The clinician wanted to incorporate his interest in writing and illustrating stories to improve his social skills. The therapist suggested that Ryan make his story into a play, and that he could be the director. Through a series of role-plays, Ryan was able to overcome his social anxiety and invite a peer to act in his play. Numerous social skills were targeted: greetings, turn-taking, active listening, problem solving, and flexibility for handling unforeseen circumstances. Ryan has now directed four plays, and has written countless others. To date, five of his peers have come and acted in his plays. (It has become a “cool” thing to do in Ryan’s social circle). He has gained a great deal of confidence in relating to his peers and in his strength of writing and directing plays.

In addition to social skills, Ryan has struggled with reading and following directions, asking for clarification, and comprehending and using abstract vocabulary. These areas were addressed using his interests in cooking and treasure hunts. Ryan participated in a number of baking projects that required him to locate the directions on the package, sequence and follow each step in a sequence, and determine the meaning of new vocabulary. Since this was in a context that he enjoyed, his attention was high and his anxiety was non-existent. Furthermore, Ryan had the opportunity to learn a new recipe and build on his strength for baking. Since his learning was in context, he was able to remember the meanings of abstract vocabulary. Ryan’s social skills were targeted when he went to the various offices in the building and offered his baked treats. He inevitably received positive social feedback.

Another motivating context for boosting Ryan’s reading for directions and vocabulary skills was participating in scavenger hunts around the building. He enjoyed the challenge of complex directions because there was an element of surprise and adventure. There was a notable consequence if he incorrectly followed the directions. This created the opportunity for Ryan to ask for directions or seek clarification. Since his learning was in context (i.e., he was looking at a fire extinguisher when he was reading the word for the first time), it was memorable. Many conjunctions (but, therefore, so, if) and sequence words (when, at the same time, before, after, next) were targeted multiple times, which led to mastery. This multi-sensory activity was enjoyable for both Ryan and the clinician. For Ryan, it resulted in greater participation, gains, and retention than traditional teaching approaches.

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Dyslexia: A Student Case Study

example case study of child with dyslexia

When a child is diagnosed with dyslexia, parents often want to know what the road to reading and spelling success will look like.  While this road varies from child to child, there are certain landmarks that characterize the journey.  These include initial success with word attack which leads to improvement in automatic word recognition and eventually improvement in spelling.  The following case study describes one child and her experience.**

Karen’s mother Anna came to Commonwealth Learning Center when Karen was in the middle of second grade.  Karen’s speech was remarkable for phoneme reversals – She said the word  breakfast  as  bress-ket , the word  animal  as  aminal , and the word  especially  as  peshasly . Karen had not made expected progress in reading during her first grade year and her parents were growing restless with the Response to Intervention Model at the school. They decided to seek a private evaluation, and during the debrief following the evaluation, the neuropsychologist suggested that they seek private tutoring. Anna and I met and talked about Karen’s likes and dislikes and how she felt about possibly starting tutoring soon. This information is just as important as testing as it helps ensure a good teacher match and a smooth start to tutoring. I asked permission to speak with the neuropsychologist given the absence of a written evaluation. (The report was forthcoming but Karen’s parents did not want to wait.) The neuropsychologist described Karen as a lovely and bright child with severely compromised phonological awareness and rapid naming, hallmarks of dyslexia. Not surprisingly, her word attack skills, word identification, and single-word spelling were also below the 16th percentile. Her spelling was not phonetic; in other words, she did not represent each sound of the word with a letter. She wrote  luc  for  lunch ,  bet  for  best , and  sak  for  snack .

Karen began her twice weekly Orton-Gillingham tutorials the following week.  She enjoyed the one-to-one time with her teacher and relished the opportunity to play games that incorporated her interests – word cards with kitten stickers on the back and sentences written with purple marker. She wrote in sand and on shaving cream and in big letters in the air. Her ability to read words and eventually books grew alongside her confidence. After six months, Karen had some benchmark testing. Her phonological awareness was in the 42nd percentile and her word attack skills were now in the 34th percentile, but her word identification and spelling were below the 25th. This is common. Word attack is measured by giving the child phonetically regular words (words that can be “sounded out”); many of them are single-syllable words. This is just what she had been working on in tutoring. Word identification and spelling on most assessments is measured by giving a child a mix of phonetically regular and irregular words.

Karen continued with tutoring, learning syllable types, spelling generalizations, and syllable division strategies.  Karen had another set of benchmark testing a year later, one and a half years into tutoring, at the start of her fourth grade year. At that time, Karen was reading grade level text according to the Qualitative Reading Inventory. She had solidly average word attack and word identification skills (both hovering around the 50th percentile). Karen had made gains in spelling; her mistakes were so much better! She represented each sound she heard in words, but she had a terribly hard time knowing whether to spell  compete  as  compeet ,  compete , or  compeat …They all sounded right! The good news was that since Karen’s spelling mistakes were better, most of her errors were the type that could be corrected through spellcheck software. The other area that lagged behind was Karen’s reading fluency – While her accuracy was fantastic (98% or more of the words read correctly), her rate was below expectations for grade level. It is fairly common for students with dyslexia to read more slowly than their peers, and, for this reason, many access audiobooks when the reading load becomes too heavy to carry without support. While Karen does not yet need this support as a fourth grader, it is likely that she will as she progresses through the grades.

Karen no longer attends tutoring during the school year, but she plans to return during the summers to ensure that she maintains and improves upon the skills that she has worked so hard to obtain.  Oh, and she wants to talk to her tutor about her new favorite book series:  The Chronicles of Narnia !

Submitted by Shadi Tayarani, M.Ed Director of Commonwealth Learning Center, Danvers

** Names have been changed to protect the family’s privacy.

example case study of child with dyslexia

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Dyslexia sample case study

Case Study � �Katie� by Ashley Rutledge, NAU student The words just zoomed right by. They were taken in, processed, and filed away. Now on to the next sentence. And the next and the next and the next, never really pausing. Reading was something that came naturally, something that I�d been doing almost automatically since age 6. But for some people it wasn�t and isn�t so easy. Dyslexia and other severe reading disabilities are something very real, something 17 percent to 20 percent of children experience (National Center for Learning Disabilities, 1999).

Enter �Katie,� a 19-year old young woman who has been living with the effects of dyslexia since age 5, even though she was not formally diagnosed until age 17. Katie is from Tempe, Arizona where she has lived with her mother, father, and younger brother for her entire life. Both of her parents are teachers; her father teaches music at various grade levels and her mother is a librarian at a local high school. Katie�s younger brother is 14 and in the 8th grade. Katie graduated high school in the top of her class and is now an honors student at the college she attends.

Obviously then, Katie�s family places a large emphasis on education. However, she describes her family as being torn on the issue of grades and learning. �My dad was the one who cared about learning. He also has symptoms of dyslexia, even though he has never formally been diagnosed. So I think that�s where his emphasis on learning came from; he could understand. But my mom cared about the grades. I could have been held back a couple of times because I really wasn�t learning anything, I was just memorizing answers to get by, but she didn�t want me to because of the stigma of being held back.� Katie also described the extreme intelligence of her younger brother as being somewhat of an obstacle. She remembers being embarrassed about having to ask him how to spell words, even though he is 6 years younger. Fortunately though, her parents never compared the two children in terms of their academics. �I would have lost,� Katie says.

Looking back on her early education, Katie cringes. She has memories as early as preschool of not being able to understand the alphabet. �I just didn�t understand the concept of letters,� she says. �The order, the sounds, recognizing them on paper, the whole thing just confused me.� As a result, she cried frequently. And the older she got, the more frustrated she became. She says that she was �pretty much okay with the progress of things until [she] realized that [she] was way far behind everyone else. They all understood.� And she didn�t, and her self-worth plunged. Katie recollects that she just felt so stupid.

When asked about specific memories from her educational experience, Katie is quick to recall. �Second grade is a time that particularly stands out. My teacher, Mrs. Cates, had divided us into reading groups according to our current reading level. There was the smart group, the mediocre group, and the dumb group. I was obviously in the dumb group but by the end of the first week Mrs. Cates had kicked me out. She didn�t even bother to ask me why I was struggling or offer me any extra help. She just made me sit outside while everyone else read. It was like she didn�t even care. She had no patience, and looking back, she almost made it a point to ignore me and be negative towards me. She had the opportunity to diagnose me because of my obvious struggles but she didn�t. And I missed out.�

Regardless of such constant negative experiences, Katie looks back at her education with a smile. She has become a stronger person because of what she has faced, and ultimately, Katie feels that is so much more important than the people she had to deal with are. Indirectly, they taught her not to feel sorry for her self and to persevere. �But the good teachers were the ones who cared about me as a person first, and then worried about my disorder. They made me think, not just memorize facts so that I could move on at the end of the year.�

According to the International Dyslexia Association, individuals diagnosed with dyslexia are in need of a structured language program. They �require multi-sensory delivery of language content. Instruction that is multi-sensory employs all pathways of learning � at the same time, seeing, hearing, touching writing, and speaking.� In Katie�s case, seeing and hearing were the only two methods applied, which was not sufficient for her.

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E-mail J'Anne Ellsworth at [email protected]

example case study of child with dyslexia

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TOD Case Example: Using the Tests of Dyslexia-Early to Identify Dyslexia

The Tests of Dyslexia-Early (TOD™-E) easel and record form

by Rebecca Stanborough

The summary below is based on an actual case example from the TOD authors Nancy Mather, PhD, Sherry Bell, PhD, Steve McCallum, PhD, and Barbara Wendling, MA . We’ve changed the personally identifiable information to protect the privacy of the student and his family.  

Background  

Ryan Garcia is six years old. He’s curious, funny, active, and social. He’s had abundant exposure to all sorts of activities and experiences: summer camps, Sunday s chool, parks & rec reation programs, and library story hours. He’s also had ample explicit instruction in phonemic awareness and phonics in preschool programs he’s attended since the age of two . That ’s why his parents referred him for dyslexia evaluatio n: D espite good instruction and a love of stories read aloud to him , Ryan struggles to read and write. Whether he’s reading in class or at home, he fatigues and becomes frustrated easily. What he writes is hard to understand.  

Our Testing Strategy

Based on his background and TOD-Screener results, we administered these assessments in two separate sessions, each one lasting around an hour.  

  • Tests of Dyslexia-Early (TOD-E)
  • TOD Parent/Caregiver and Teacher Rating Scales
  • Written Language and Math tests from the Woodcock Johnson IV Tests of Achievement (WJ IV ACH)  

We chose this approach because we wanted a clear picture of his linguistic abilities and his reading and writing skills, in addition to his dyslexia risk. We also wanted to be able to compare them to his abilities in other areas.  

Ryan’s Index Scores

In the TOD-E, all tests except Picture Vocabulary contribute to the Early Dyslexia Diagnostic Index (EDDI) . When we analyzed Ryan’s performance, we saw significant differences in scores from test to test. For example, Ryan had an Average score on segmentation and rhyming tests but had a Well Below Average score on the rapid naming test. Because of the discrepancy, we took extra care with interpreting his performance. Overall, Ryan’s EDDI score was 75, which is in the Well Below Average range, telling us that he has a Very High Probability of dyslexia.  

When we reviewed Ryan’s scores on the five tests that make up the Early Reading and Spelling Index (ERSI) , we noted a total score of 74, in the Well Below Average range. Again, we saw some variability in how he performed from one test to another within that index.

Ryan’s scores on the three tests included in the Early Linguistic Processing Index (ELPI) were in the Below Average range. He had higher scores in rhyming and early segmenting (Average) and lower scores on early rapid number and letter naming (Well Below Average).

When we compare Ryan’s scores on the tests most sensitive to dyslexia (EDDI) to his results on the Picture Vocabulary test, which measures his receptive vocabulary, we were struck by the difference. It clearly indicated dyslexia.   

Ryan’s Composite Scores

The TOD-E gave us insights into four sets of skills and abilities: Early Sight Word Acquisition , Early Phonics , Early Basic Reading Skills , and Early Phonological Awareness . On tests that involved Early Sight Word Acquisition, his combined score of 67 indicated he was Significantly Below Average on both tests.  The combined score for two Early Phonics Knowledge tests was 86—that’s considered Below Average—but scores differed between the two tests.

On the two tests that measure Early Basic Reading Skills, Ryan’s standard score was 79, in the Well Below Average range. Once again, there was a notable difference between his ability to recognize sight words and his knowledge of letters and sounds. Finally, on the two tests that track Early Phonological Awareness, Ryan’s total score was 92, in the Average range. His rhyming and early segmenting abilities were about equally developed.   

Ryan’s Written Language and Math Abilities

To get a different perspective on Ryan’s writing and spelling skills, we used the WJ IV ACH spelling and writing samples. His standard score on this measure was 89 —Below Average. On two math measures, Calculation and Applied Problems, however, his scores were Above Average. He understood ba sic math facts and could solve problems—even though he sometimes reversed or transposed numbers.

TOD-E Teacher and Parent/Caregiver Rating Scales

Ms. Eston, Ryan’s teacher, reported that his oral language and reasoning were more advanced than many of his classmates. She considered his rhyming, blending, and segmenting abilities typical for a first grader. And she pointed out that he has a hard time telling the difference between some look-alike letters, as well as difficulty with spelling some high-frequency words.

Her other observation was that Ryan never chooses to read on his own, even though he likes listening to other people read stories. Taken together, her responses gave a T -score of 71—which correlates to a Very High Risk of dyslexia.

Ryan’s parents reported that his father had trouble with reading. They also said Ryan had speech and language services when he was in pre-K and kindergarten. They see his current oral language and reasoning abilities as more advanced than his peers’. Even so, they said, he has trouble with spelling and with learning the names of letters. He sometimes mixes up look-alike letters. Like Ryan’s teacher, the Garcias noticed that Ryan avoids reading and writing. In fact, he has to work extra hard to carry out the fine motor aspects of writing, tracing, and cutting.  

The Garcias’ rating scale responses produced a T -score of 77, which is characterized as a Very High Risk of dyslexia.  

Recommended Interventions

Based on his background, his TOD and WJ IV ACH assessment response patterns, and what our team has observed, our diagnostic impression is that Ryan has a specific learning disability in reading (dyslexia) and in written language (dysgraphia).  

Using the TOD Interventions companion guide and our clinical experience, we recommend the following interventions:  

At School    

  • His school team should consider Ryan’s eligibility for SLD services, especially systematic interventions to address his difficulty with reading and spelling. 
  • While his reading and writing skills are improving, Ryan’s teachers will need to adjust the level of difficulty in his classwork and homework. 
  • We recommend allowing Ryan to use the digital program Read, Write, and Type as an alternative to regular homework. Learning opportunities such as oral reports and project-based learning are a preferable way for Ryan to show what he knows. It’s also a good idea to build on areas where he’s already strong, such as vocabulary and math learning opportunities.  

At Home  

  • To grow, Ryan needs specialized instruction from a teacher trained to work with attention and reading difficulties. One option might be intensive private tutoring, especially during the summer. We’d recommend one hour, three times a week.   
  • To minimize frustration, Ryan’s homework time should be broken into short periods of around 10-15 minutes, followed by a rewarding activity break. For homework periods that last longer, periodic tokens or rewards will help him stay motivated.  
  • Keep reading books to Ryan—especially on topics he loves. That will grow his vocabulary and his interest in reading.  

First Steps    

  • Ryan needs an intensive synthetic phonics program to teach him letter-sound relationships. He needs immediate instruction to build his recognition of common letter patterns and spelling rules, as well as his ability to break words into syllables.   
  • To develop his early literacy skill, try a program such as Road to the Code .  
  • Ryan also needs a systematic spelling program. We’ve used Scholastic Success with Spelling (Grade 1) with success.   
  • One-minute speed drills will help Ryan get faster and more accurate pronouncing sight words and irregular words. It’s important to use the drills and track his performance daily.  
  • Decodable texts will help develop Ryan’s phonics skills.   
  • Don’t penalize Ryan when he reverses or transposes numbers in math. Remind him to check larger numbers using place value.   

The TOD-S and TOD-E gave us the information we needed to identify the probability that Ryan has dyslexia. The indexes and composites were useful as diagnostic indicators, but perhaps just as important, they showed us where to focus our instruction and intervention recommendations.   

The rating scales provided us with much needed context and helped us identify risk factors in Ryan’s background. Using the interventions guide, we were able to provide specific guidance to his teachers and family. Later in the school year, we’ll be able to work with his teachers to monitor progress with growth scores.   

This case example provides information based on the Tests of Dyslexia (TOD), published by WPS. The original case example appears in Chapter 3 of the TOD Manual .

Related to this TOD Case Example: 

  • The WPS Guide to Dyslexia Assessment  
  • TOD FAQs  
  • Dyslexia Assessment Tool Kit  
  • How Schools Can Use the TOD to Transform Dyslexia Education  
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example case study of child with dyslexia

example case study of child with dyslexia

Defeating Dyslexia and Dysgraphia: A Trial Case Study

  • Dysgraphia and Writing Problems
  • Susan du Plessis
  • November 4, 2020

example case study of child with dyslexia

Ten-year-old Dalton has been diagnosed with dyslexia and developmental coordination disorder (dyspraxia) at Texas Scottish Rite Hospital for Children and with dyslexia and dysgraphia by a multidisciplinary team at his school. Despite occupational therapy, speech therapy, physical therapy, and putting three Orton-Gillingham-based programs to the test, he continued to struggle.

Dalton becomes an edublox student.

Like all pharmaceuticals, Edublox intervention programs get tested before they get implemented. Dalton became a trial student to help develop our live online tutoring programs for dyslexia and dysgraphia. Edublox’s Live Tutor consists of two components: (1.) cognitive development through Development Tutor and (2.) live online tutoring.

Dalton’s progress summarized

Dalton began the recommended Edublox program on October 31, 2018. After taking time off in December, he did his final free live tutoring session on March 10, 2019.

His mom summarized the progress made after the first month:

example case study of child with dyslexia

His mom summarized the progress made after the three months trial:

Dalton has also improved in his reading, so much so that he has gained confidence to read in front of his friends. He has never had the confidence – or ability – to do this before. Before Edublox, I tried multiple Orton-Gillingham programs with Dalton. The programs base their teaching on phonemic awareness and learning phonics. It did not matter how hard we worked, how many tears fell, he would get halfway through learning a section and he would immediately forget what he had learned. I drilled him; we repeated everything over and over again, but nothing stuck. Edublox is completely different. Dalton now retains what he has learned, because the Edublox program has improved his memory. As he progresses to higher levels on the cognitive exercises, he is motivated to work even harder. He is also finally starting to see the patterns in the logic exercise, which has been a real challenge before. Edublox has also helped for his auditory processing disorder and other processing problems. He is less stressed and can work for longer periods. For Dalton, Edublox is life-changing!

A comprehensive version of Dalton’s journey

Dalton’s story, as told by his mom.

  • Dalton’s assessment results (he was assessed twice)
  • Progress updates .

. Dalton started public school in preschool and remained there until the middle of second grade. He struggled from the very beginning, but his struggles were clearly visible once he entered kindergarten. He couldn’t remember letters, sounds, numbers, write his own name, and wasn’t learning sight words like he should. We also started noticing severe anxiety issues and he hated going to school. He started telling us he was stupid and dumb.

In April of his kindergarten year we got a call from the school and we found out Dalton’s teacher was calling him and other kids in the class ‘stupid’. A fellow teacher reported her behavior, and according to the counselor his anxiety was caused by this teacher’s actions. Even with all that happening, the school wanted to retain him, but I refused. I had already learned from past experience with Dalton’s older sister that retention does not help solve a learning disability or dyslexia.

Dalton continued to struggle in first grade with reading, writing, and math, so I requested to have him tested for dyslexia and other learning disorders at Texas Scottish Rite Hospital. They diagnosed him with a speech-sound (articulation) disorder, dyslexia, at risk for dyscalculia, and developmental coordination disorder (his fine motor development was severely delayed); and told us that he needed occupational therapy for core strength issues. He immediately started occupational therapy, speech therapy, and with a tutor using an Orton-Gillingham-based program. Dalton, however, continued to struggle with basic sight words, letter reversals, handwriting, sounding out CVC words, and had no fluency.

In first grade Dalton had a wonderful teacher who tried to help fight to get services for him through the school. However, since he wasn’t in second grade they refused to start dyslexia services or any other interventions, other than what was being offered in the classroom.

In March of his first-grade year Dalton was assessed again, this time by a multidisciplinary team at his school. They confirmed the diagnoses of dyslexia (specific learning disability in basic reading skills and reading fluency) and speech impairment (articulation delays), and also diagnosed him with dysgraphia (specific learning disability in written expression).

We moved before Dalton started second grade. The school district we moved to refused to start dyslexia services or any other services until after the first semester, so I pulled him out to homeschool him. I thought he would be like my daughter and we could continue an Orton-Gillingham-based program and see real improvement. I found a well-known program that I could teach at home. Since he had improved a little bit before while being tutored only once a week, I figured that he would improve quickly if we would work on it daily. Well, after a year, I realized this program was not helping but frustrating him. We tried another OG-based curriculum with the same result. The only real improvement we saw was with his math skills and with his anxiety, which was getting less.

Dalton continued to struggle in third, and now in fourth grade, and is falling further and further behind in reading and writing. He only has about 10 sight words and those are not consistently. He struggles daily with remembering the days of the week and months of the year, and confuses morning and evening. He even struggles to remember when he should go to gymnastics, where he trains a total of 4 hours a day, 5 days a week. He is frustrated and wants to read so badly, and he is scared that he is never going to learn how.

I found Edublox in a desperate search for other options, and after reading Maddie’s story I was in tears. This was the first time I felt like I had real hope to help my son. Dalton and Maddie have so much in common with their reading, writing, and math issues. I showed Dalton the video of Maddie reading before starting Edublox, and he said, “mom she reads just like me.” When I showed him her video after only three weeks of Edublox he started to cry, and said he wanted to learn to read like she did. As we get ready to start Edublox this is the first time Dalton and I both have real hope.

Stephanie Dalton’s mom

***********

Dalton attempting to read the ten sight words known to him: ., . stephanie also submitted examples of dalton’s writings: ., . below he had to “write 3 sentences about sharks”: ..

example case study of child with dyslexia

The glow-in-the-dark shark lives deep in the ocean. The whale shark has a lot of teeth. All sharks are made of cartilage.

. Dalton writing the ten digits: .

Dalton’s assessment results .

. Dalton was assessed twice: first at Texas Scottish Rite Hospital for Children at the beginning of 1st grade, and again at his school by a multidisciplinary team in March of 2016.

Texas Scottish Rite Hospital for Children

The report from the hospital confirmed that Dalton “was delayed in achieving early developmental milestones in oral language. He participated in speech therapy, occupational therapy and physical therapy through a private facility from 2 to 4 years of age with emphasis on oral development and fine motor skills. Dalton has been receiving reading intervention through the school since kindergarten. He currently receives additional reading support four times per week. He also receives support from his classroom teacher as needed.

“The ANSER System School Questionnaire was used to obtain educator perceptions of Dalton’s strengths and weaknesses in the academic environment. The questionnaire was completed on December 13, 2015 by his first grade teacher. Dalton is experiencing difficulties with reading, writing, spelling and math reasoning. He displays strengths in attitude, compassion and effort. He performs significantly below the level expected for age in decoding skills, sight word recognition, oral reading accuracy, reading fluency, reading comprehension, handwriting, copying skills, spelling and written expression. In the area of math, delays are noted in his ability to learn math symbols, learn math facts, learn new procedures, perform computations, solve word problems, acquire math vocabulary, and understand explanations about math. Dalton demonstrates the ability to understand verbal directions and stories read to him but displays difficulty with following multistep instructions, remembering skills over time, learning new vocabulary, pronouncing new words, speaking intelligibly, constructing good spoken sentences, explaining, summarizing and elaborating on his thoughts verbally. He does not always apply effective strategies for problem-solving. At this time, the teacher is primarily concerned about his reading skills. He does not display complicating factors related to behavior and attention. The teacher is requesting more information about how to support him in the areas of phonemic awareness, reading and math.”

A battery of tests was administered; the results of the most important are below. To understand the results one needs to know the meaning of “standard scores”. Standard scores are used to compare the child’s performance to children of the same age. Generally, standard scores that fall between 90 and 109 represent the “average” range. Approximately 50% of the children will have scores within the “average” range.

> 130: Very Superior 120-129: Superior 110-119: High Average 90-109: Average 80-89: Low Average 70-79: Borderline 69 and below: Extremely Low

Wechsler Abbreviated Scale of Intelligence – Second edition (WASI-II) Standard Score

Verbal Comprehension Index: 101 (Average)

Perceptual Reasoning Index: 97 (Average)

Full Scale IQ: 99 (Average)

Wechsler Individual Achievement Test – Third edition (WIAT-3)

Word Reading : 70 (Borderline)

Spelling: 82 (Low Average)

Numerical Operations: 91 (Average)

Math Problem Solving: 86 (Low Average)

Comprehensive Test of Phonological Processing (CTOPP-2)

Phonological Awareness Composite: 77 (Borderline)

Rapid Symbolic Naming Composite: 88 (Low Average)

Phonological Awareness Test 2 (PAT-2)

Decoding: 87 (Low Average)

Woodcock-Johnson IV

Writing samples: 80 (Low Average)

Beery Buktenica Development Test of Visual-Motor Integration

Visual-Motor Integration: 96 (Average)

Visual Perception: 93 (Average)

Motor Coordination: 55 (Extremely Low)

Dalton was diagnosed with

  • Speech Sound (articulation) Disorder
  • Oral Language Disorder, tentative, pending diagnostic evaluation
  • At Risk, Mathematics Disorder
  • Developmental Coordination Disorder .

School assessment

A multidisciplinary team at Dalton’s school confirmed the diagnoses of dyslexia (specific learning disability in basic reading skills and reading fluency) and speech impairment (articulation delays), and diagnosed him with dysgraphia (specific learning disability in written expression), contrary to the diagnosis of developmental coordination disorder (dyspraxia) that he received at  Texas Scottish Rite Hospital . Dyspraxia generally impacts both gross and fine motor skills, and dysgraphia only fine motor skills. We believe the many hours of gymnastics practice has erased any gross motor problems Dalton might have had, as the team considered gross motor skills to be a strength (see below). We have thus accepted the school’s diagnosis of dysgraphia, rather than dyspraxia: .

example case study of child with dyslexia

Progress updates

. november 30, 2018. dalton’s tutor wrote:.

I began tutoring Dalton on October 31, 2018 – a friendly young boy, one who is willing to learn but one who clearly struggles to do so. I have tutored many students with dyslexia over the last three decades. At the start of tutoring, most of them can sound out CVC words and read CVC words after sounding them out. Dalton was unable to sound out CVC words — even “cat” and “dog.” He struggled with auditory processing, frequently reversed letters and words, and his memory — both short- and long-term — was extremely poor.

Lesson 3 was a great session. When we ended, Dalton was able to read 18 words, which seemed promising and already an improvement over him reading on the video recorded only a few days before.

As more words were added, Dalton’s ability to process new words slowed down, and I started drilling the basic sounds using 3- and 4-letter words. By the end of November, I was able to introduce spelling patterns, for example, if you can spell “nest” you can also spell “west,” “best,” “test,” “vest,” and “rest.”

After Lesson 3, Stephanie sent this message via Facebook: .

example case study of child with dyslexia

. On the same day, she also had some sad news: .

example case study of child with dyslexia

. Dalton had a ton of ear infections growing up, Stephanie explained, and was fitted with ear tubes (grommets) several times. A few doctors told Dalton’s parents that he needed hearing aids, but a pediatric audiologist said his hearing wasn’t poor enough for hearing aids. The assessment that was done by his school in March 2016 also indicated that his hearing skills were adequate.

The multiple ear infections explain Dalton’s auditory processing challenges, as well as his articulation problems.

Dalton will receive hearing aids in 2019.

As mentioned, Dalton reversed letters: not only the typical b-d and p-q, but also g, j, and n. During Lesson 3, Dalton had to write “jump” and “dog”: .

example case study of child with dyslexia

. Both “mug” and “gum” are part of his reading pile, which he continually reversed for the first three weeks. By the end of November, however, there were hardly any reversals in his reading and spelling. The images below are from Lessons 17 and 18: .

example case study of child with dyslexia

. Progress in reading and spelling hinges on improved cognitive skills. Below is Dalton’s Development Tutor progress bar by the end of November: .

example case study of child with dyslexia

. On November 30 (after Lesson 23), I asked Stephanie if she was seeing progress on her side, and she replied: .

. A video of Dalton doing gymnastics: .

. February 1, 2019. Dalton’s mom wrote:

We took some time off in December because Dalton was sick and our Edublox tutor on vacation, but on January 2 we were back on schedule.

Since starting Edublox Online Tutor and live tutoring with in November, Dalton is now trying to read or having me read to him multiple times a day. Before he didn’t even want me to read to him because he had problems remembering what I had read, and zoned out while I was reading, so books were boring and not fun or interesting. Right now, we are reading The 39 Clues series together and he is able to keep up with the adventures and clues better than I am.

Dalton also decided that he wanted to practice some sight words that he couldn’t do before to surprise his tutor with how much he has learned. We had spent countless hours on these same sight words for years with little progress. After practicing them over 5 days he only missed 4 of the 58 sight words! In math, he is now able to do addition and subtraction, and even multiplication problems quickly. I am amazed at how far he has come in such a short time.

Dalton and I recently started having text conversations. He has never even tried to read the text before. For the most part I use words that he can sound out or already read, but there are always a few where he has to use context clues to figure them out.

I finally got everything cleared from my schedule, so that I can spend more time working with Dalton. Last semester I had night classes 5 days a week, but now I have only 2 so we plan to put in an extra 45 minutes or so every day and hope to see even faster progress than we have seen so far.

Dalton will also have his hearing aids either this week or next week, and I know from experience that he is going to have a whole new world of sound opening up to him. .

. Dalton’s Development Tutor progress bar after 67 sessions: .

example case study of child with dyslexia

. March 10, 2019. Dalton’s mom wrote:

Dalton is starting to adjust to his new hearing aids. I have been told my family, friends, and coaches how much of a difference they have seen in his personality. He is more talkative and outgoing, and is also answering questions in detail, not just giving one- or two-word responses.

Dalton has also improved in his reading, so much so that he has gained confidence to read in front of his friends. He has never had the confidence – or ability – to do this before.

Before Edublox, I tried multiple Orton-Gillingham programs with Dalton. The programs base their teaching on phonemic awareness and learning phonics. It did not matter how hard we worked, how many tears fell, he would get halfway through learning a section and he would immediately forget what he had learned. I drilled him; we repeated everything over and over again, but nothing stuck.

Edublox is completely different. Dalton now retains what he has learned, because the Edublox program has improved his memory. As he progresses to higher levels on the cognitive exercises, he is motivated to work even harder. He is also finally starting to see the patterns in the logic exercise, which has been a real challenge before. Edublox has also helped for his auditory processing disorder and other processing problems. He is less stressed and can work for longer periods. For Dalton, Edublox is life-changing! .

. Dalton’s Development Tutor progress bar: .

example case study of child with dyslexia

Edublox offers live online tutoring to students with dyslexia and dysgraphia. Our students are in the United States, Canada, Australia, and elsewhere.  Book a free consultation  to discuss your child’s learning needs.

example case study of child with dyslexia

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Understanding Mental Health in Developmental Dyslexia: A Scoping Review

Adrienne wilmot.

1 Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Perth, WA 6845, Australia

Penelope Hasking

2 Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, WA 6845, Australia

Suze Leitão

3 Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA 6845, Australia

Elizabeth Hill

Associated data.

The article is a scoping review and no data were collected.

Children with dyslexia are at elevated risk of internalising and externalising mental health concerns. Our aim was to scope the extent and nature of the literature investigating factors which may influence this association. We systematically searched the peer-reviewed and grey literature with no restrictions on the date. We included both qualitative and quantitative studies. Inclusion criteria included: (1) a focus on childhood (≤18 years) reading/learning difficulties; (2) internalising and/or externalising symptoms; and (3) a potentially modifiable third factor (e.g., self-esteem). Ninety-eight studies met the inclusion criteria. We organised the studies according to individual, family, and community-level third factors. Whilst a range of third factors were identified, relatively few researchers tested associations between the third factor and mental health in the context of dyslexia. Furthermore, there was a focus on primary rather than secondary school experience and a reliance, in many cases, on teacher/parent perspectives on children’s mental health. Future researchers are encouraged to explore links between socio-emotional skills, coping strategies, school connectedness, and mental health in the context of dyslexia. Research of this nature is important to assist with the identification of children who are more (or less) at risk of mental health concerns and to inform tailored mental health programs for children with dyslexia.

1. Introduction

Dyslexia is characterised by difficulties with accurate and fluent word reading and poor spelling and decoding abilities that do not progress as expected with the provision of well-intentioned and targeted intervention [ 1 ]. Importantly, dyslexia is not related to more generalised cognitive difficulties or sensory deficits, rather, the difficulties are thought to stem from neuro-cognitive differences in the way speech sounds are processed [ 2 , 3 ]. Consistent with this account, oral language difficulties in early childhood are a frequent precursor to dyslexia [ 4 ] and difficulties in both the oral and written (reading, spelling, writing) domains of language often co-occur across the lifespan [ 5 , 6 , 7 ]. Furthermore, dyslexia is frequently associated with other learning and attentional difficulties that are believed to share genetic risk factors and/or underlying cognitive differences [ 8 , 9 ].

The Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5); Ref. [ 10 ] has a category for dyslexia within the Specific Learning Disorders (SLD); a category which also includes dyspraxia (difficulties with writing) and dyscalculia (difficulties with mathematics). It is difficult to estimate prevalence rates for dyslexia as many children remain unidentified. Nevertheless, it is generally believed that 5–10% of children experience severe and persistent word reading difficulties consistent with dyslexia; a figure which equates to approximately 2–4 children in an average-sized classroom [ 3 , 11 ].

1.1. Academic and Psychosocial Correlates to Dyslexia

Dyslexia can negatively affect children’s motivation to read [ 12 ], vocabulary acquisition and reading comprehension. These skills are important for higher level learning and more complex academic content as the school years progress. Qualitative accounts suggest that children with dyslexia are often aware of the extra effort they need to put into their studies to achieve at comparable levels to their peers [ 13 , 14 ]. Similarly, longitudinal evidence suggests that many, but not all, experience relatively poor educational and occupational outcomes [ 15 , 16 ]. Furthermore, those who live and work with children with dyslexia frequently report concern for children’s mental health [ 11 , 14 , 17 ]. Indeed, there is considerable evidence to suggest that dyslexia is associated with a range of psychosocial difficulties in childhood including: reduced academic self-concept [ 18 ], poor reading self-efficacy [ 19 ], and elevated levels of internalising (e.g., anxiety) and externalising (e.g., aggression) symptoms indicative of poor mental health [ 20 , 21 , 22 ]. Taken together, these findings suggest that the mental health concerns of children with dyslexia can extend beyond the classroom into their everyday lives and may persist into adulthood. Understanding why children with reading difficulties, such as dyslexia, are at elevated risk of mental health concerns is now a stated research imperative [ 22 , 23 ].

1.2. The Current Review

The aim of the current review was to scope the extent and nature of the literature investigating factors which may influence the association between childhood dyslexia and internalising and externalising mental health concerns. In so doing, we aimed to identify gaps in the literature and use the findings of the review to inform decisions about directions for future research. Such research is needed to: (1) identify children who may be more (or less) at risk of mental health concerns, and (2) inform tailored mental health programs. Given this aim, a scoping rather than a systematic review was indicated. (For the purpose of this review, mental health concerns are defined according to an internalising/externalising dichotomy [ 24 , 25 ]. which is widely used in the child development literature and clinical settings. Internalising refers to expressions of emotional distress which are inwardly focused (e.g., withdrawal) whilst externalising refers to expressions of emotional distress which are outwardly focused (e.g., aggression).

A preliminary search for existing reviews and meta-analyses on this topic was conducted in April 2021 using the following databases: Prospero, Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, Campbell Collaboration, and the Open Science Framework. We were unable to find any planned or existing reviews with the same focus as ours. Previous reviews have focused on investigating the strength and direction of the relationship between learning/reading difficulties and internalising symptoms [ 21 , 22 , 26 ] or learning difficulties and both internalising/externalising symptoms [ 27 ]. Another review by Haft and colleagues [ 28 ] offered an excellent preliminary discussion of protective factors for socio-emotional resilience in the context of developmental dyslexia but did not comprehensively search the literature of the time. Our review therefore offers an extension to the existing field.

We came to an a priori decision to present our findings using the three-tiered framework of (1) individual, (2) family, and (3) community-level factors developed by Haft and colleagues [ 28 ] and applied previously in research on dyslexia and child mental health [ 29 ]. This framework acknowledges that children’s mental health is influenced by a range of factors that relate to the child themselves (the individual), their family, and the communities in which they participate.

2. Materials and Methods

Our review was informed by the Joanna Briggs Institute (JBI) guidelines [ 30 ] and the PRISMA extension for scoping review checklist [ 31 ] which build on Arksey and O’Malley’s [ 32 ] foundational work on scoping review methodology. A protocol for the review was registered on the Open Science Framework on 04.05.2021 and is available to view at 10.17605/OSF.IO/GZ98X. Changes to the protocol that were applied during the review process are described in Appendix A .

2.1. Inclusion/Exclusion Criteria

Types of studies. Peer-reviewed primary research studies as well as theses/dissertations were considered for inclusion. When the same research was reported in a dissertation and journal article then the dissertation was excluded. No limits by date were set. Books, book chapters, study protocols, theoretical/opinion pieces, and previous reviews were excluded.

Population. Sources that included children (≤18 years) or adult perspectives (e.g., teachers, parents, or adult retrospective studies) on children’s mental health were considered so long as the child participants spoke an alphabetic language and were not being tested in a language other than their primary language.

Concept 1: Reading difficulties. Sources were included if they investigated internalising and/or externalising symptoms among children with recognised learning difficulties and/or word reading difficulties consistent with dyslexia. In keeping with DSM-5 diagnostic criteria, when the learning difficulties could be better explained by medical (e.g., hearing loss), neurodevelopmental (e.g., autism, intellectual disability), or socio-cultural factors (e.g., child poverty, second language learners, lack of educational opportunity) sources were excluded [ 10 ].

Concept 2: Mental health. Mental health concerns were defined as consisting of both/either internalising or externalising symptoms. Sources which used global measures of psychosocial functioning with sub-scales to measure internalising/externalising symptoms (e.g., Strengths and Difficulties Questionnaire (SDQ); Goodman, 1997 [ 33 ]), as well as those which measure a particular aspect of internalising/externalising symptoms (e.g., anxiety) were included. For qualitative research, self/parent/other description of emotional difficulties or mental health concerns were sufficient for inclusion.

Concept 3: Third factor. Sources were only included if they investigated a modifiable “third factor” in association with mental health concerns among children with learning/reading difficulties. By modifiable we are referring to a skill/attitude/behaviour (e.g., emotion regulation) which could become an intervention target for mental health programs designed for school-aged children with reading difficulties and/or their families and communities. For this reason, sources which solely investigated factors which are intractable (e.g., a child’s age); factors which cannot be modified once a child has reached primary school age (e.g., exposure to environmental toxins in-utero); or cognitive differences that may be difficult to modify (e.g., working memory, attention) were not included.

Context. Sources were not excluded based on geographical factors, the educational context of the children (e.g., mainstream, or specialised school), or whether children were receiving educational support or socio-emotional or reading intervention.

2.2. Search Strategy

An initial set of search terms were developed by the research team based on their current understanding of the literature. A 3-step search strategy was then followed as recommended by the JBI [ 30 ] (p. 418). At the first stage, the first author conducted a preliminary search of two databases (Scopus and ProQuest) on 10.06.2021. Based on the subject headings and keywords from relevant sources found in this preliminary search, an additional 4 keywords were added to the search terms ( Appendix B ).

The first author then conducted the second stage of the search on 11.07.2021 with an update on 17.05.2022. This included a search by subject heading and keyword of the OVID platform databases: Embase, PsychInfo, and OVID Medline, and a search by keyword on Scopus, ProQuest and CINHAL. Limits were set for English language and to peer-reviewed journals (where possible). The first author then conducted a search for dissertations/theses using the same keywords via the ProQuest Dissertation and Thesis database. See Table S2 for an example of a complete search of one database, PsychInfo. For the third and final stage of the selection process, the first author reviewed the reference lists of key sources and relevant reviews. An additional 8 sources were located at this stage.

2.3. Source Selection

A total of 10,810 sources (10,155 articles and 655 theses) were downloaded into Endnote [ 34 ] and duplicates removed by the Endnote de-duplication process and by hand. This resulted in a total of 7389 sources (6840 articles and 549 theses) being considered by title or title/abstract from the database search (a further 8 sources were added at a later stage from the third stage of the search). At this stage, a source selection tool (see Table S1 ) was developed and piloted by each member of the review team on a random selection of 25 sources. No one reviewer achieved less than 88% agreement with the first author and 4 members of the review team of 6 achieved 100% agreement with the first author. After this pilot, no changes to the subject headings or keywords of the search were considered necessary. However, the source selection tool was adjusted through team discussion to add further explanation and examples to aid the selection process. Throughout the source selection process, we further refined the inclusion/exclusion criteria as outlined in Appendix A .

Following this, a random sample of approximately 20% of sources was independently reviewed by two members of the review team (the first author and one other) by title and/or title/abstract. An inter-rater agreement of 88.6% was achieved. This was considered a satisfactory level of adherence to the selection criteria by the first author who then proceeded to select sources for consideration from the remaining 80% of total sources. Disagreement between reviewers was resolved by consensus by two members of the review team.

A similar process was followed for the next stage of the selection process; selection for inclusion/exclusion based on full text review. Approximately 20% of sources were independently screened by two members of the review team (the first author and one other) (inter-rater agreement of 82%) and the remainder was reviewed by the first author alone. Disagreements between authors, and/or any uncertainty by the first author, were resolved by group consensus. A record of the number of sources included/excluded at each stage of the source selection process and the reasons for exclusion are included below in Figure 1 .

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PRISMA flow diagram http://prisma-statement.org/ (accessed on 28 January 2021) and adapted for this scoping review.

2.4. Data Extraction

A data extraction form for this review was adapted from models presented by the JBI manual and other authors [ 30 , 32 ] and developed with input from 3 members of the research team. The first author extracted the relevant data from each source and the fourth author (EH) checked the data extraction of 20% of sources. Based on EH’s review, one source was excluded and the participant details of another were corrected.

A total of 98 studies (12 theses and 86 peer-reviewed journal articles) met the inclusion criteria. Geographically, the scope of the studies was widespread. A total of 20 countries were represented; the largest numbers of studies originated from the USA (32), Italy (11), United Kingdom (10), and Israel (7). One study was a cross-cultural analysis of children’s mental health and coping strategies and included participants from Germany and Indonesia [ 35 ]. In terms of design, nine studies were qualitative, 10 incorporated a mixed methods approach, and the remainder were quantitative by design, incorporating either a longitudinal (21 studies) or cross-sectional (58 studies) approach. One of the longitudinal studies was a secondary analysis of four longitudinal studies from English-speaking countries [ 36 ].

3.1. Sampling Characteristics

Approximately one quarter of the included studies (27 studies; 27.5%) were not dyslexia specific, that is the researchers conducted their investigations using samples of children/adolescents with learning difficulties without specifying sub-type (reading, writing, mathematics difficulties) or specified that the children all had a diagnosis of SLD mixed-type (difficulties in at least two domains of reading, writing, and/or mathematics), see for example [ 37 ]. Researchers of the remaining 71 studies focused on developmental dyslexia or word reading difficulties consistent with a dyslexia diagnosis. A wide range of methods were used to determine group status, ranging from self-identification of reading difficulties, see for example [ 38 ], to extensive diagnostic and validation measures, see for example [ 39 ]. Furthermore, the severity of dyslexia (when reported) ranged from mild [ 40 ] to severe [ 41 ].

Sample sizes ranged from one (a case study) [ 42 ] to a study incorporating findings from four databases totaling 23,799 children [ 36 ]. In terms of the age and the stage of development of participants, the researchers of 46 studies focused exclusively on primary school-aged children (≤12 years; 46 studies); 17 on adolescents (≥12 years); and 27 included samples of young people whose ages ranged across these developmental periods (childhood–adolescence). Of the remainder, there were four longitudinal studies in which children were tracked from their primary to secondary school years [ 43 , 44 , 45 , 46 ]; three studies in which adults were interviewed about their childhood experiences with dyslexia, see for example [ 47 ]; and one study in which educators of children with dyslexia aged 5–18 years were interviewed [ 11 ]. In many of the longitudinal studies the researchers stopped assessing children in the primary school years, see for example [ 36 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ].

3.2. Study Aims and Mental Health

There was great variety with regard to the aims of the included studies. For example, some researchers primarily aimed to investigate the relative contribution of SLD or attentional difficulties (e.g., co-morbid ADHD) in explaining internalising/externalising symptoms, see for example [ 59 ]. Many researchers had the primary aim of investigating the direction of effects between learning/reading difficulties and a range of psychosocial (e.g., self-esteem, social skills) variables, see for example [ 36 , 50 , 54 , 55 , 56 , 60 , 61 ]. In other studies, mental health was not included as an outcome variable. Rather, the relative influence of learning difficulties and/or behaviour/mental health on children’s social skills [ 62 ] or academic outcomes was investigated (e.g., grades, reading comprehension, secondary school completion), see for example [ 43 , 57 , 63 , 64 ]. However, in our estimation, the aim of 39 (40%) of the included studies aligned to that of this review; that is, the researchers aimed to better understand mental health in the context of childhood learning/reading difficulties. Not all researchers found dyslexia-related group differences in mental health concerns, see for example [ 65 ]. However, when differences were found, the balance of evidence suggests that reading difficulties precede internalising symptoms [ 36 , 46 , 48 , 50 , 52 , 54 ] whereas the direction of effects between dyslexia and externalising symptoms was less certain. Specifically, there is evidence that externalising symptoms are associated with attentional difficulties which may be present before school entrance but can worsen in response to school demands [ 46 , 66 , 67 ].

In the qualitative studies (and one mixed method study), mental health was investigated among children with reading difficulties broadly. Among the studies incorporating a quantitative approach, the researchers of 25 studies focused on internalising symptoms only and those of one study focused on externalising symptoms only [ 59 ]. Most researchers in this review (62; 63.3%) investigated both internalising and externalising symptoms. Many conducted their investigations of internalising/externalising symptoms with well-validated measures of global psychosocial functioning such as the Strengths and Difficulties Questionnaire (SDQ) (10 studies) and the Child Behaviour Checklist (CBCL); Achenbach (various versions, for example, [ 24 ]) (27 studies). Of the total sample of the included studies (qualitative and quantitative), the researchers of 39 studies combined perspectives (e.g., child and/or teacher and/or parent and/or both parents) on children’s mental health. However, in nearly half of the included studies (45; 45.9%, excluding the adult retrospective studies where adults reflected on their own childhood experiences) children’s perspectives on their mental health were not considered. Furthermore, a wide variety of child-reported measures of anxiety (11 measures) and depression (10 measures) were included in this review.

3.3. Third Factors

The research team formed 26 third factors categories (see Table 1 below) on the basis of common tools or measures and definitions provided in the publication. Each category was allocated to individual, family, and community-level factors. Many studies investigated factors on more than one of these levels. Where constructs are included in parathesis, they were deemed to be related to the primary third factor. Studies have been placed in a column depending on whether they primarily dealt with the third factor using qualitative, quantitative or both approaches. When a quantitative approach was taken, we have provided an indication of whether a statistical association between the third factor and the mental health concern in the context of learning difficulties was found, not found, or was not tested. Table S3 presents the summary of findings from all 98 studies included in this review including information regarding the direction of association between the variables.

“Third factors” and associations with internalising/externalising mental health (MH) concerns among children with reading/learning difficulties.

* Check Supplementary Materials for direction of association. † This category includes many domains of self-esteem (or related constructs), such as social self-esteem, scholastic self-esteem etc. Check Supplementary Materials for specific domain of self-esteem explored in the study.

4. Discussion

The aim of the current review was to scope the extent and the nature of the literature investigating factors which may influence the association between childhood dyslexia and internalising and externalising mental health concerns. In so doing, we aimed to identify gaps in the literature and use the findings of the review to inform decisions about directions for future research. Such research is needed to (1) identify children who may be more (or less) at risk of mental health concerns and (2) inform tailored mental health programs. To this end, our review identified a total of 98 sources (86 peer-reviewed journal articles and 12 theses) for inclusion dating from 1968. Twenty different countries were represented highlighting a global concern for the mental health of children who struggle to read. Our review includes: 70 studies in which individual-level factors (e.g., self-esteem) were explored; 39 in which family-level factors (e.g., the parent-child relationship) were explored; and 54 in which community-level factors (e.g., the teacher-child relationship) were explored. Most researchers investigated both internalising and externalising symptoms but those of 25 studies focused exclusively on internalising symptoms. One explanation is that internalising symptoms, specifically anxiety, have been highlighted as a particular mental health concern among children with dyslexia, see for example [ 21 , 22 ].

4.1. Social Experiences

The social skills (20 studies) and the social problems (29 studies) of children with word reading/learning difficulties were amongst the most studied “third factors” in this review. However, social difficulties were most often studied as correlates of learning difficulties, see for example [ 48 , 50 , 110 ], or poor academic performance [ 62 ] or attentional difficulties [ 59 , 129 ] that may co-occur, rather than as possible risk/protective factors for mental health. Furthermore, there was a focus on investigating children’s challenges (e.g., peer difficulties) from the parent and/or the teacher perspectives rather than their strengths. Children’s subjective feelings of loneliness were also under-studied, a finding consistent with Kwan and colleagues’ (2020) recent review [ 130 ]. Nevertheless, our review highlighted consistent links between bullying involvement and mental health concerns [ 29 , 58 , 124 , 125 ] and the protective function of friendship, see for example [ 77 , 117 ], in the context of childhood dyslexia. Differences between child, parent, and teacher reports of social difficulties were reported by some researchers, see for example [ 41 , 61 ], highlighting the importance of examining the context of social difficulties (e.g., school or home) in addition to gauging children’s own perspectives on their social strengths and challenges in future research.

4.2. Self-Esteem

Other individual-level third factors which have been widely studied in this field are self-esteem (and related constructs, e.g., self-concept/self-efficacy) (30 studies) and stress, coping and resilience (18 studies). A secondary analysis of four different longitudinal studies by McArthur and colleagues (2022) found a link between early reading difficulties and later anxiety, depression, and poor reading self-concept (beliefs about oneself as a reader) [ 36 ], suggesting that poor reading self-concept may be a risk factor for anxiety and depression. Consistent with this, Terras and colleagues (2009) found an association between low scholastic self-esteem (beliefs about oneself as a learner) and parent/child reported internalising symptoms [ 73 ] and Giovagnoli and colleagues (2020) found that adolescents with dyslexia who reported low levels of self-efficacy (belief in one’s ability) with regard to school tasks experienced more somatic (headaches, stomach aches) symptoms [ 39 ]. However, there were some mixed results across the field regarding both the domain of mental health (anxiety, depression, externalising) and the domain of self-esteem/self-efficacy (e.g., scholastic self-esteem, social self-esteem) involved. Furthermore, most studies which examined the associations between self-esteem and internalising/externalising symptoms were cross-sectional by design meaning that the direction of effects could not be determined. Disentangling the strength and direction of these associations, and factors that support children’s self-esteem in the context of dyslexia, would allow for the provision of timely and targeted support for children at risk of mental health concerns.

4.3. Coping and Resilience

Although over a decade old, Singer’s (2005, 2007) foundational work suggests that the strategies that children with dyslexia use to cope with school-related difficulties (such as teasing and poor grades) are instrumental in supporting their self-esteem (or not) [ 68 , 69 ]. For example, the children she interviewed used self-talk to either support or hinder their self-esteem. Consistent with this, Hossein and colleagues (2022) found that children with reading disorder who had more “grit” (i.e., perseverance) and “resilience” were less likely to experience anxiety (reported by teachers) and depression (reported by parents) [ 91 ]. Similarly, Giovagnoli and colleagues (2020) found that internalising symptoms among adolescents with dyslexia were associated with a tendency to react to school-related problems with hypervigilance, defined as an “excessive sense of alertness” [ 39 ] (p. 461). However, two other groups of researchers in this review did not find any group differences in coping related to learning/reading difficulties although higher levels of internalising symptoms were observed [ 35 , 94 ]. As such, we believe that an investigation of coping strategies, especially with regard to the school context, in relation to children’s mental health warrants further exploration.

4.4. Emotion Regulation and Academic Factors

Emotion regulation (the ability to understand and manage one’s emotions) is one aspect of coping which appears to be relatively under-studied in this field. Several studies in this review included an examination of factors related to emotion regulation, such as emotional intelligence, see for example [ 99 , 106 ]; focused on one aspect of emotion regulation, namely rumination [ 97 ]; or measured emotion regulation with a single item on a parent survey [ 29 ]. As a result, we believe that emotion regulation in the context of dyslexia has not been comprehensively explored. This represents a gap in the literature given that emotion regulation is strongly associated with mental health across the lifespan [ 131 , 132 , 133 ] and may be hindered in children who experience language/literacy difficulties in early childhood and beyond [ 134 , 135 , 136 ]. Certainly, there is evidence from experimental research that children with dyslexia, relative to controls, have more difficulty with recognising emotions in others (from facial and vocal cues) [ 137 , 138 ]. This may suggest difficulty with understanding their own emotions, a basic building block to emotion regulation [ 139 ]. Furthermore, many children with reading difficulties report experiencing heightened negative emotions (e.g., frustration, anger, sadness) in the school context [ 14 , 55 ] suggesting that effective emotion regulation may be a particularly salient intervention target for their mental health. Longitudinal studies using well-validated (child and parent/teacher versions) measures of specific socio-emotional competencies (e.g., emotion regulation, spoken language skills) are needed to test these associations over time and to build upon the existing work described in this review. Relatedly, children’s attitude to their learning and whether they succeed in their studies despite their learning challenges has been linked to their mental health, see for example [ 57 , 65 , 108 , 109 ], and warrants replication.

4.5. Family Factors

In terms of family factors, the association between children’s mental health and parental psychological variables (e.g., parental stress, anxiety, self-esteem, coping, emotion regulation); the quality of the child-parent relationship; family functioning/support; and parenting values/practices is well researched. A strength of this field is the widespread use of well-validated measures such as the Parenting Stress Index (PSI) and its short form [ 140 ] enabling a comparison of the findings across the field. Importantly, the PSI-SF has been validated for use with parents of children with a wide variety of mental, emotional, and behavioural difficulties [ 141 ]. However, much of the research in this section of the review has employed samples of children with a wide range of learning and attentional difficulties without specifying the sub-type, see for example [ 98 ]. This is a limitation given that parents of children with dyslexia may have unique strengths and challenges, see for example [ 83 , 113 ]. Furthermore, the perspectives of fathers and siblings were often absent and there are mixed results which require further exploration. Nevertheless, future researchers are encouraged to investigate the value of whole-family support within mental health promotion programs for children with dyslexia and other learning difficulties.

4.6. School and Community Factors

Certainly, the importance of having parents who understand dyslexia and provide both emotional and academic support was highlighted by many studies in our review, see for example [ 14 , 73 , 117 ]. However, when interviewed, people with lived experience of dyslexia (especially parents/teachers and older adolescents/young adults) also raised school/community-level concerns such as: teachers’ misunderstanding of dyslexia; a lack of accommodation and support for reading-related challenges; and experiences of stigma, shame, and discrimination in learning environments, see for example [ 11 , 14 , 42 , 47 , 121 ]. Findings such as these suggest that children with dyslexia and other learning difficulties may be vulnerable to low levels of “school connectedness”, a concept that describes perceptions of being understood, supported, and treated fairly at school (by peers and by teachers alike) [ 142 , 143 ]. Consistent with this, two sets of researchers in this review found evidence to suggest that school connectedness may be a particularly salient protective factor for the socio-emotional wellbeing of children with learning difficulties [ 107 , 126 ]. Similarly, Chiappedi and Baschenis [ 122 ] found that children with SLD who believed that their teacher understood and supported their learning disability reported significantly lower levels of anxiety. Future researchers are encouraged to replicate the aims of these studies using well-validated measures of school connectedness and dyslexia-specific samples. There is evidence from our review that children with dyslexia experience a different trajectory of socio-emotional difficulties during the school years than those with other special educational needs, see for example [ 50 ], and therefore need to be differentiated in future research.

4.7. Methodological Considerations

A strength of the field is the widespread use of well-validated measures of children’s psychosocial functioning such as the Strengths and Difficulties Questionnaire (SDQ)and the Child Behaviour Checklist (CBCL).This aids cross-cultural comparisons and the generalisability of each study’s findings. However, many studies included in this review examined group differences (e.g., children with and without reading difficulties) with regard to the third factor rather than testing associations between the third factor and mental health concerns. This limits our understanding of risk and protective factors for mental health. Furthermore, in many cases, researchers relied on parent/teacher, rather than child, perspectives on internalising symptoms, see for example [ 49 , 126 ]. Internalising symptoms may be difficult for an outsider to accurately assess; therefore, future research which gauges children’s own perspectives is encouraged. Furthermore, to advance understanding of risk/protective factors for specific (e.g., depression) mental health concerns then the use of well-validated measures which align to DSM criteria (such as the Revised Children’s Anxiety and Depression Scale (RCADS; Chorpita et al., 2000) [ 144 ] and include parent/child versions, rather than (or in addition to) broad-band measures of psychosocial functioning such as the SDQ, are needed.

Additionally, our review highlighted a bias in the field towards investigating the psychosocial wellbeing of children rather than adolescents. Indeed, several researchers of longitudinal studies included in this review stopped tracking children’s socio-emotional functioning by the time they reached the upper primary school years, see for example [ 48 , 50 , 55 ]. This presents a significant gap in the literature. Adolescence is a risk period for the onset of several mental health concerns [ 145 ] which may exacerbate for children with dyslexia due to concerns about the changes in the secondary school environment such as the increased difficulty of reading and workload, see for example [ 39 ]. To complement the field, future researchers are encouraged to track children with and without dyslexia as they transition from primary to secondary school and beyond. Current research suggests that this school transition may be a risk period for both school connectedness and mental health concerns among children broadly [ 146 , 147 ] and may have specific relevance for children with reading difficulties [ 46 ].

4.8. Limitations and Future Research

The current review is limited by our exclusion of studies in which reading ability was measured as a continuous variable. We are aware of studies of this kind which would have addressed our research aim, see for example [ 148 ]. The decision to exclude these studies was influenced by the feasibility of the review process and the readability of a review with 100+ sources. Additionally, a quality assessment of studies in this field is warranted given the range of methodological limitations which has been briefly discussed. Nevertheless, we identified a variety of individual, family, and community-level factors which may influence mental health in the context of developmental dyslexia, located gaps in the literature, and offered suggestions for future research. Future research which examines associations between aspects of children’s socio-emotional competencies (e.g., emotion regulation), domains of self-esteem, coping strategies, school connectedness, and sub-types of mental health (e.g., depression) in the context of childhood dyslexia is encouraged. This will improve understanding about risk and protective factors for the mental health of children with dyslexia. In terms of methodological factors, our review highlighted a need for more longitudinal work (especially over the transition to secondary school and beyond), which includes dyslexia-specific samples alongside typically developing comparison groups and includes child as well as parent/teacher perspectives wherever possible.

5. Conclusions

The current review highlighted a broad range of individual, family, and community-level factors which may influence mental health in the context of developmental dyslexia but relatively few studies which tested associations between third factors and mental health. We identified several gaps in the literature regarding both the content (e.g., school connectedness) and methods (e.g., child perspectives on mental health) of current research and proposed recommendations for future research. Such research is needed to help to identify children who are more (or less) at risk of mental health concerns and to inform tailored mental health promotion programs for children with dyslexia.

Acknowledgments

With thanks to Sophie Haywood and Lachlan Toms for their assistance with the source selection process and the Health Sciences Librarians atCurtin University, for ongoing support throughout the review process.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/ijerph20021653/s1 , Table S1: Source selection tool, Table S2: An example of a database search, Table S3: Summary of findings from studies included in the review.

Appendix A. Changes to the Protocol and Inclusion/Exclusion Criteria

  • Changes to title and objective/aim of the review : We removed the reference to “risk and protective factors” in the wording of the title and the objective/aim of the review to better reflect the broad range of studies included.
  • Changes to the inclusion/exclusion criteria : We decided to exclude studies which measured reading as a continuous variable for feasibility reasons. The focus of our review is children with developmental dyslexia rather than other types of reading difficulty (e.g., difficulty with reading comprehension). For this reason, we specified dyslexia or word reading difficulties in our inclusion criteria. Further refinement to the inclusion/exclusion process occurred by group consensus during the source selection process. Specifically, we decided to exclude studies which measured mental health specifically within the context of the COVID-19 pandemic, as well as past reviews, intervention studies, and all “cognitive” third factors such as a child’s Theory of Mind ability and their executive functioning.
  • Changes to the source selection process: Due to feasibility reasons, approximately 20% of sources selected for full text review and 20% of data extraction was independently screened by a second author. We used Excel spreadsheets in addition to Endnote to manage the source selection process, as this method facilitated better sharing of sources between the review team.
  • Changes to the data extraction form: We applied some changes to the data extraction form by group consensus during the source selection/data extraction process. Specifically, we removed reference to the strengths and the limitations of each study and suggestions for future research and added a column to describe the context of the study and the “third factor” included in the study.

Appendix B. Keyword Search Terms

  • The keywords in bold were added after the first stage of the search.
  • Child* or teen* or adolescen* or youth or young AND dyslexi* or “poor reader*” or “reading abilit*” or “reading skill*” or “reading achievement” or “reading difficult*” or “reading disorder*” or “reading impair*” or “reading delay” or “reading defici* ” or “reading disabilit*” or “literacy difficult*” or “learning disorder” or “struggl* adj3 read*” AND internali?ing or “somatic complaint*” or anxious or anxiety or depression or depressed or “emotion* difficult*” or “emotion* problem*” or psycho?social or socio?emotion* or withdrawn or “mental health” or hyperactiv* or impulsiv* or externali?ing or “conduct problem*” or “behaviour* problem*” or “behavior* problem*” or aggress*

Funding Statement

Adrienne Wilmot is supported by an Australian Government Research Training Program scholarship. Mark Boyes is supported by the National Health and Medical Research Council, Australia (Investigator Grant 1173043).

Author Contributions

Conceptualisation and methodology, A.W., P.H., S.L. and M.B. Data curation and writing—original draft preparation, A.W. Writing—review and editing, A.W., P.H., S.L., E.H. and M.B. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

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Dyslexia is a learning disorder that involves difficulty reading due to problems identifying speech sounds and learning how they relate to letters and words (decoding). Also called a reading disability, dyslexia is a result of individual differences in areas of the brain that process language.

Dyslexia is not due to problems with intelligence, hearing or vision. Most children with dyslexia can succeed in school with tutoring or a specialized education program. Emotional support also plays an important role.

Though there's no cure for dyslexia, early assessment and intervention result in the best outcome. Sometimes dyslexia goes undiagnosed for years and isn't recognized until adulthood, but it's never too late to seek help.

Signs of dyslexia can be difficult to recognize before your child enters school, but some early clues may indicate a problem. Once your child reaches school age, your child's teacher may be the first to notice a problem. Severity varies, but the condition often becomes apparent as a child starts learning to read.

Before school

Signs that a young child may be at risk of dyslexia include:

  • Late talking
  • Learning new words slowly
  • Problems forming words correctly, such as reversing sounds in words or confusing words that sound alike
  • Problems remembering or naming letters, numbers and colors
  • Difficulty learning nursery rhymes or playing rhyming games

Once your child is in school, dyslexia symptoms may become more apparent, including:

  • Reading well below the expected level for age
  • Problems processing and understanding what is heard
  • Difficulty finding the right word or forming answers to questions
  • Problems remembering the sequence of things
  • Difficulty seeing (and occasionally hearing) similarities and differences in letters and words
  • Inability to sound out the pronunciation of an unfamiliar word
  • Difficulty spelling
  • Spending an unusually long time completing tasks that involve reading or writing
  • Avoiding activities that involve reading

Teens and adults

Dyslexia signs in teens and adults are a lot like those in children. Some common dyslexia symptoms in teens and adults include:

  • Difficulty reading, including reading aloud
  • Slow and labor-intensive reading and writing
  • Problems spelling
  • Mispronouncing names or words, or problems retrieving words
  • Difficulty summarizing a story
  • Trouble learning a foreign language
  • Difficulty doing math word problems

When to see a doctor

Though most children are ready to learn reading by kindergarten or first grade, children with dyslexia often have trouble learning to read by that time. Talk with your health care provider if your child's reading level is below what's expected for your child's age or if you notice other signs of dyslexia.

When dyslexia goes undiagnosed and untreated, childhood reading difficulties continue into adulthood.

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Dyslexia results from individual differences in the parts of the brain that enable reading. It tends to run in families. Dyslexia appears to be linked to certain genes that affect how the brain processes reading and language.

Risk factors

A family history of dyslexia or other reading or learning disabilities increases the risk of having dyslexia.

Complications

Dyslexia can lead to several problems, including:

  • Trouble learning. Because reading is a skill basic to most other school subjects, a child with dyslexia is at a disadvantage in most classes and may have trouble keeping up with peers.
  • Social problems. Left untreated, dyslexia may lead to low self-esteem, behavior problems, anxiety, aggression, and withdrawal from friends, parents and teachers.
  • Problems as adults. The inability to read and comprehend can prevent children from reaching their potential as they grow up. This can have negative long-term educational, social and economic impacts.

Children who have dyslexia are at increased risk of having attention-deficit/hyperactivity disorder (ADHD), and vice versa. ADHD can cause difficulty keeping attention. It can also cause hyperactivity and impulsive behavior, which can make dyslexia harder to treat.

  • Dyslexia. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pediatrics/learning-and-developmental-disorders/dyslexia. Accessed April 6, 2022.
  • Sutton Hamilton S. Reading difficulty in children: Clinical features and evaluation. https://www.uptodate.com/contents/search. Accessed April 6, 2022.
  • Sutton Hamilton S. Reading difficulty in children: Interventions. https://www.uptodate.com/contents/search. Accessed April 6, 2022.
  • Sanfilippo J, et al. Reintroducing dyslexia: Early identification and implications for pediatric practice. Pediatrics. 2020; doi:10.1542/peds.2019-3046.
  • Hall C, et al. Current research informing the conceptualization, identification, and treatment of dyslexia across orthographies: An introduction to the special series. Learning Disability Quarterly. 2021; doi:10.1177/073194872092901.
  • Specific learning disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. http://dsm.psychiatryonline.org. Accessed April 6, 2022.
  • Dyslexia information page. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Dyslexia-Information-Page#disorders-r1. Accessed April 6, 2022.
  • Information and resources for adolescents and adults with dyslexia ⸺ It's never too late. International Dyslexia Association. https://dyslexiaida.org/adolescents-and-adults-with-dyslexia/. Accessed April 6, 2022.
  • Support: New to learning disabilities. Learning Disabilities Association of America. https://ldaamerica.org/support/new-to-ld/. Accessed April 6, 2022.
  • Heubner AR (expert opinion). Mayo Clinic. June 6, 2022.
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IMAGES

  1. Case Study Child Dyslexia

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  2. Case Study Child Dyslexia : Dyslexia: Symptoms, Causes and Treatment

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  6. Case Study Child Dyslexia : Dyslexia: Symptoms, Causes and Treatment

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  1. Spotlight on Specialist Tutoring Webinar

COMMENTS

  1. Case Study: Ten year old child with severe dyslexia

    Case Study: Ten year old child with severe dyslexia This study discusses a ten year old Elementary School student with significant levels of dyslexia. Reading through this case study will help you recognize typical concerns, and possibly identify approaches and techniques to help you with your student.

  2. Case Studies

    Case Study One: Grace has a diagnosis of dyslexia. She has trouble with visual scanning, processing, and working memory. She also has difficulties with spelling and sequencing for problem solving. She has strong verbal skills and is artistic abilities. She learns well with color and when her hands are occupied.

  3. Dyslexia: A Student Case Study

    Dyslexia: A Student Case Study When a child is diagnosed with dyslexia, parents often want to know what the road to reading and spelling success will look like. While this road varies from child to child, there are certain landmarks that characterize the journey.

  4. Dyslexia of 8-Year-Old Boy Case Study

    Case Study 8-year-Old With Dyslexia. Second Grade 8-year-old Dyslexic Child. Brief History of Child. Jefferey (8) a student in the second grade was recognized by his classroom teacher in the first grade as having some operational difficulties with reading and writing tasks in general despite having greater than average intelligence on testing ...

  5. Dyslexia sample case study

    "My dad was the one who cared about learning. He also has symptoms of dyslexia, even though he has never formally been diagnosed. So I think that's where his emphasis on learning came from; he could understand. But my mom cared about the grades.

  6. PDF Using Case Studies to Understand Dyslexia

    Key features of dyslexia (cont.) • Difficulties in dyslexia can range from mild to severe • Most research suggests that children with dyslexia do not require a qualitatively different approach to intervention than do other poor decoders • However, they may need significantly more intensity of instruction (e.g., Torgesen, 2004) -e.g. more

  7. Identifying Dyslexia Using TOD-Comprehensive: A Case Study

    The summary below is based on an actual case example from the TOD authors Nancy Mather, PhD, Sherry Bell, PhD, Steve McCallum, PhD, and Barbara Wendling, MA. We've changed the personally identifiable information to protect the privacy of the student and his family. Background Jayden Carter is new to Brentfield Elementary.

  8. The cognitive basis of dyslexia in school‐aged children: A multiple

    Abstract This study focuses on the role of numerous cognitive skills such as phonological awareness (PA), rapid automatized naming (RAN), visual and selective attention, auditory skills, and implicit learning in developmental dyslexia.

  9. Why Children With Dyslexia Struggle With Writing and How to Help Them

    Conclusions Many students with dyslexia experience writing difficulty in multiple areas. However, their writing (and even reading) skills can improve with the instructional strategies identified in this article. We describe instructional procedures and provide links to resources throughout the article.

  10. Identifying Dyslexia Using TOD-Early: A Case Study

    TOD Case Example: Using the Tests of Dyslexia-Early to Identify Dyslexia. The summary below is based on an actual case example from the TOD authors Nancy Mather, PhD, Sherry Bell, PhD, Steve McCallum, PhD, and Barbara Wendling, MA. We've changed the personally identifiable information to protect the privacy of the student and his family.

  11. (PDF) A Case-based Study of Dyslexia in Learning English ...

    A general estimation of the case was carried out by first, an evaluation of the social and academic status of the girl's family, and second, using dyslexia screeners with some of the reading...

  12. Defining and understanding dyslexia: past, present and future

    The role of sensorimotor impairments in dyslexia: A multiple case study of dyslexic children. Developmental Science, 9 (3), 237-255. 10.1111/j.1467-7687.2006.00483.x [Google Scholar] Whyte, W. (2020). Class and Classification: The London Word Blind Centre for Dyslexic Children, 1962-1972.

  13. The social impact of schooling on students with dyslexia: A systematic

    For example, Livingston Siegel and Ribary's (2018) review of literature on the emotional impact of dyslexia points to long term effects associated with school failure, including depression, an increased risk of suicide, as well as 'delinquency and reoffending' (p. 3).

  14. PDF What works in dyslexia / SpLD friendly practice in the secondary school

    Background to the study These case studies were researched and produced by a team from the Faculty of Education at Manchester Metropolitan University (MMU), in partnership with the British Dyslexia Association (BDA). They are part of the second year of a major Department for Education (DfE) funded project, aiming to develop the quality

  15. PDF Pacific University CommonKnowledge

    Dyslexia: A case study . Abstract . Dyslexia is a diagnosis commonly used to categorize many of the learning disabilities a child may have. Tests including the Wechsler Adult Intelligent Scale-Revised (WAIS-R), Woodcock-Johnson Psychoeducational Battery-Revised (the WJ-R), Dyslexia Determination Test and the Dyslexia Screener are

  16. Johan, a Case Study of a Swedish Adolescent with Dyslexia

    Students with reading difficulties/dyslexia: A longitudinal Swedish example December 2010 · International Journal of Inclusive Education Eva Heimdahl Mattson

  17. Defeating Dyslexia and Dysgraphia: A Trial Case Study

    Like all pharmaceuticals, Edublox intervention programs get tested before they get implemented. Dalton became a trial student to help develop our live online tutoring programs for dyslexia and dysgraphia. Edublox's Live Tutor consists of two components: (1.) cognitive development through Development Tutor and (2.) live online tutoring.

  18. The 100 Top-Cited Studies on Dyslexia Research: A Bibliometric Analysis

    Introduction. Dyslexia is a common learning disorder that affects between 4 and 8% of children (1-3), and often persists into adulthood (4, 5).This neurodevelopmental disorder is characterized by reading and spelling impairments that develop in a context of normal intelligence, educational opportunities, and perceptual abilities (4, 6).Reading and spelling abilities can be affected together ...

  19. PDF A Case Study with Dyslexic Children

    A Case Study with Dyslexic Children Weam Gaoud Alghabban1,2 · Robert Hendley2 Received: 14 September 2021 / Accepted: 6 April 2022 / Published online: 23 April 2022 ... For example, dyslexia in Arabic is dierent from dyslexia in English [27]. Two types of languages exist: transparent and non-transpar - ent orthographic languages. Readers in ...

  20. PDF Good Practice Pack

    (mild dyslexia) Case Study 2 - Liam (mild dyspraxia with ADD) Case Study 3 - Andrew (high functioning, classic dyslexic) Case Study 4 - Rebecca ... Try to be explicit with concrete examples of how you might work with the student both developmentally and practically. 4. What wider philosophies underpin your teaching to e nable this students learning

  21. Understanding Mental Health in Developmental Dyslexia: A Scoping Review

    Sample sizes ranged from one (a case study) to a study incorporating findings from four databases totaling 23,799 children . In terms of the age and the stage of development of participants, the researchers of 46 studies focused exclusively on primary school-aged children (≤12 years; 46 studies); 17 on adolescents (≥12 years); and 27 ...

  22. PDF A Case Study of A Child With Special Need/Learning Difficulty

    1. To find out the real and factual problem faced by both the student/child and the teachers teaching the child/student. 2. To collect the factual data/information about the child' s behaviour and back ground. 3. To reach at some reliable conclusion. 4. Plan future strategy to solve this problem based on the conclusion. IV.

  23. Dyslexia

    Some common dyslexia symptoms in teens and adults include: Difficulty reading, including reading aloud. Slow and labor-intensive reading and writing. Avoiding activities that involve reading. Mispronouncing names or words, or problems retrieving words. Spending an unusually long time completing tasks that involve reading or writing.