Dyslexia Is Not Always Permanent, Depending On The Underlying Cause
When a learning evaluation turns up dyslexia, many people stop. They recognize the dyslexia label. That is their headline. However, these evaluations often include other issues. Some of these are symptoms, but among them may be the underlying source of the dyslexia, the clue to future treatment options.
The question is, which one?
In medicine, using x-rays, virus tests, etc., most diagnoses can be made with accuracy. There is no need to diagnose using circumstantial evidence, symptoms.
Learning evaluations are different. Almost all educational evaluations are symptoms-based. This is true of autism, it is true of ADD and it is true for dyslexia.
And so, many clinical evaluations tend to list detected behaviors. Some are superficial symptoms, others are deep-seated issues more likely to be the source of difficulty. Also, many of these behaviors listed will have the same cause. For instance, children with auditory processing disorder may well end up being diagnosed with dyslexia, dysgraphia (writing), spelling, math, attention and/or language problems.
It’s like a doctor evaluating your child who has a broken ankle, and saying he has a broken ankle, an inability to run, an inability to jump, an inability to climb stairs, an inability to hop, etc. A number of symptoms, but just one source of difficulty, the broken ankle. Heal the broken ankle and these our abilities will take care of themselves.
This same opportunity for clarity can exist in learning evaluations if you ask your clinician the right question. Namely:
Which of these issues is the likely source issue and which are just symptoms? In other words, which learning issue is the “broken ankle?”
In our earlier example, auditory processing disorder (APD) is the broken ankle. All the other difficulties, including the dyslexia, are downstream learning and reading difficulties that stem from the APD.
Separating Symptoms From Root Causes
We all know reading is a challenging skill. It’s one of life’s little miracles. It requires all aspects of learning — working memory, attention, processing, sequencing, eye tracking, vocabulary, etc. — to work almost perfectly. The brain needs to be able connect text symbols to stored language memory and then extract meaning, both automatically and at lightning speed.
It’s an amazing skill. Even the slightest glitch in any of the many cognitive skills used will impair the development of reading. If your child has any kind of diagnosed learning difficulty, a reading problem is almost a certainty.
The Dyslexia Scenario
Quite often, the first hint of an issue surfaces only when a child either starts learning to read (sounding out is hard) or when reading comprehension does not progress as expected. In these cases, the underlying learning delays are noticed because the challenge involved in learning to read exposed them. These learning delays are only mildly impacting other learning or language skills and so they are not diagnosed in their own right.
This is the scenario where, if reading difficulties are severe, the dyslexia label is perfect. It is an unexpected reading difficulty or perhaps even more accurate, an unexplained reading difficulty. It is the circumstance dyslexia was intended to describe, as defined by Dr. Sally Shaywitz of Yale University.
Of course, once reading has surfaced as a serious issue, everyone is more vigilant in observing other behaviors. Quite often are issues are then identified, including language-based and/or attention issues, which become part and parcel of the dyslexia diagnosis.
Dyslexia, The Symptom
However, where the learning delay is more serious, and there are already visible symptoms outside reading, this is a different matter. In these cases, given how hard reading is anyway, the child is at the very least an at risk reader. The reading difficulty is not unexpected or unexplained — it is expected and the diagnosed learning delay is the likely root cause.
For instance, children with auditory processing disorder (APD) who struggle with listening and maybe even speech early on and then develop reading difficulties are often described as having dyslexia also. However, APD impacts phonological awareness required for sounding out while reading. Most children with auditory processing disorder will go on to have reading difficulties also. The appropriate diagnosis that should be the focus for treatment though is APD, not APD and dyslexia.
Similarly, children with ADHD who tend to struggle with reading are often labeled as dyslexic. However, if your child has ADHD, chances are they will also struggle with reading because of their inability to consistently focus on the task of learning to read. It is the ADHD that is the source issue.
Why It Matters to Separate Dyslexia From Expected Reading Difficulties
The use of dyslexia to describe only unexpected or unexplained reading difficulty is losing currency. Today, the dyslexia label has become a catchall phrase for severe reading difficulties, unexpected or expected.
This creates the perception that dyslexia is a condition in its own right, whereas the reality is that in most cases, as we have described earlier, where other learning issues are identified, reading difficulties (dyslexia) is a symptom of the deeper learning issue or delay.
We see three consequences of this liberal use of the dyslexia label when there are other learning issues present.
First, it’s a scary (and maybe unnecessary, given the likelihood of reading issues?) label to put onto a struggling child, who may already has multiple diagnoses to deal with.
Second, it creates a perception for parents that their child has multiple problems — for instance, APD and dyslexia — and that they need to act on multiple fronts. In reality, in most cases there really is just one issue, the underlying learning issue, in our example the APD, that needs to be addressed.
Third, correctly identifying dyslexia as a symptom, not a separate problem, will help parents more clearly see their remediation choices or at least help parents see more clearly understand what to expect from any interventions or support they might provide for their child.
For instance, if your child has a diagnosed learning issue that impacts reading (this is a long list including delays in auditory processing, working memory, sensory integration, attention, and others), anything you do to help the underlying condition will almost always help the reading also. And not only will it help reading, but because you are going after the underlying source of difficulty, if you are successful, you will most likely be able to resolve any reading difficulties permanently.
On the other hand, if parents decide to treat the dyslexia as a separate issue, to the extent they are able to help reading, but the underlying delay is left unresolved, the reading gains may only be temporary. Understanding which are symptoms and which are causal can help parents in setting expectations for the various tools they use to help their children.
A Question To Ask When Treating Dyslexia
First of all, just because your child has been diagnosed or suspected to have dyslexia, you should not lose hope. The treatment options are the same as those applied to struggling readers. The only question you should ask, is if your child has been diagnosed with dyslexia, what clues do I have about a possible cause.
While your child may not have sensory integration issues severe enough to lead to an ADHD diagnosis or language processing issues severe enough to rise to an auditory processing disorder diagnosis, it is still worth asking your clinician if any of the cognitive or learning issues known to cause reading problems are present in your child.
This is at least would give you a starting point for treating the dyslexia.