Does dyslexia exist?
This post heavily references the work of Hugo Kerr in his excellent free e-book, The Cognitive Psychology of Literacy Teaching: Reading, Writing, Spelling, Dyslexia
Schools are packed to the gunnels (whatever they are) with students diagnosed with dyslexia. And, of the hundreds of dyslexic students I’ve taught, many have languished helplessly in the doldrums of illiteracy while some seem suddenly to make rapid and remarkable progress. This year, two students who were presented to me as dyslexic have experienced very different trajectories.
One, let’s call him Ben, had spent Years 7 and 8 being taught English in very small groups of students identified as having ‘specific learning difficulties’. In Year 9 such students are put back into mainstream classes with the expectation that the work they’ve done in the previous 2 years will have equipped them to cope. Ben arrived in my class very worried about whether he was going to ‘look thick’ and with a very low estimation of his ability. He’s a quiet, hard-working chap, however, and wants to do well. I spent a fair bit of time working with Ben at the beginning of the year and, frankly, failed to see what the problem was: his reading was a little hesitant and his writing was inaccurate but full of good ideas and definitely showed signs of conscious crafting. One lesson, I was talking to him about his work and suggested some ways he could improve his spelling. The despondency of his response was heartbreaking; “I can’t spell, sir. I’m dyslexic.”
“Ben,” I told him. “That’s nonsense! Of course you can.” We spent some time going over doubling consonants, ‘i before e’ and a few other easy to implement gems and before we knew it, his spelling had improved! We also did some work on various reading strategies like skimming and scanning and, guess what? His reading comprehension showed similar improvements. His confidence has grown massively and he’s now consistently producing C grade work. We’re now talking about what he needs to do to get an A in Year 11. If he carries on the way he has this year, he’s a shoe in.
Then there’s Carrie. She has terrible attendance, her behaviour is awful and she produces little or no work. When I met her parents at parents’ evening, they told me that none of this was Carrie’s fault; she was dyslexic you see. I didn’t see. I pointed out that even though she might find English difficult that was no excuse for not trying. At that point we reached a bit of an impasse.
Things have got a little better because, frankly, I’m not prepared to accept the bare minimum of work that Carrie feels it’s acceptable to produce. Critique protocols have made quite an impact on her; when she knows her work will be displayed publicly and will receive feedback, she shows just what she’s capable of. And it’s not bad. Although she doesn’t work anyway near as hard as Ben, her reading and writing have improved and she’s making what we might describe as ‘steady’ progress. But her attendance is slipping, she’s regularly excluded and there’s been talk of her having a ‘fresh start’. Through it all, her parents maintain that her dyslexia isn’t being catered for. I worry that she may not make it.
But, whether the label is of benefit to children’s sense of self, it certainly gets you on to a school’s radar and often qualifies you for additional funding. This funding would be of benefit to any child who suffered with poor decoding skills. It stands to reason that educated, middle-class parents will have both the cultural capital and the cash to ensure their child receives a dyslexia diagnosis and that children who come form a more deprived background will not. How can it be fair that our system further privileges the privileged?
Professor Julian Elliott, at Durham University, struggles to find a difference between a child labelled ‘dyslexic’ and a child labelled ‘a poor reader’. In other words, there may not be a special group of kids with a different intelligence who need special intervention to help them overcome their reading problem. Maybe there are simply too many ‘dyslexic ‘children to make the term meaningful: once you get such a high number of kids labelled with a condition such as dyslexia (that’s around 375,000 in the UK), you’ve simply got to question whether there’s any real basis to the label.
But in a world where there seems to be an unquestioning acceptance of dyslexia’s existence this is not a popular view. The problem is caused, in part, by the casual, unthinking way in which we use the term. More often than not it’s used to describe any inexplicable deficit with reading/writing/spelling in an otherwise able student. We pass off the cause as something unknowable and neurological. As such, it’s no one’s fault, and teachers, and students, can shrug and pass the buck.So do dyslexics have problems not suffered by other poor readers? All sorts of symptoms have been put forward to justify the hypothesis but it has never been proven. There doesn’t appear to be any scientific evidence that the syndrome exists. And if “dyslexia” doesn’t refer to reading problems – as the dyslexia establishment maintains – then it certainly doesn’t refer to anything which has been scientifically established.
So do dyslexics have problems not suffered by other poor readers? All sorts of symptoms have been put forward to justify the hypothesis but it has never been proven. Dyslexia is an emotionally loaded term; life tends to be worse for children who find reading difficult: compared with normal readers, they are more likely to have other problems (clumsiness, hyperactivity and poor short-term memory, for example) and having one such problem makes it more likely you’ll have another. Yet, there is no evidence that these problems actually cause reading difficulties. Maybe we’re putting the cart before the horse. Maybe the reading difficulties cause the problems?
Poor short-term memory is a case in point. It’s the symptom most often quoted as distinguishing dyslexics from other poor readers, and those who have difficulty reading are more likely to suffer from it. Yet, however disabling poor short-term memory may be, evidence suggests it neither causes reading difficulties nor predicts the outcome of intervention. A study conducted by Torgesen in 2006, showed that out of 60 children with severe reading difficulties, only eight had poor short-term memories, while almost as many – seven – had very good short-term memories. And, crucially, the children with poor short-term memories benefited from help with their reading as much as the others.
But is there any compelling evidence for Dyslexia’s existence? And do dyslexics have problems not suffered by other poor readers? Well, it’s worth noting that diagnosing and treating dyslexia is big business, and where this kind of commercial vested interest exists it’s always worth having a careful look at who’s saying what, and why. Perhaps surprisingly there’s almost as many theories on the causes and treatment of dyslexia as there are researchers, and the only constant appears to be the sometimes staggering inconsistencies which abound.
A quick dip into the literature on dyslexia illustrates the muddle:
The construct of learning disabilities has historically been difficult to define. (Fletcher 2003)
… the history of dyslexia is littered with theories that were once widely supported but now lie abandoned on the scrap heap … it is vital that we should continue to treat everything as questionable and to regard nothing as beyond dispute. Certainty is for tele-evangelists, not scientific researchers or teachers. (Ellis et al 1997 pp. 13-14) (their emphasis)
Definitions of dyslexia are notoriously varied and no single definition of dyslexia has succeeded in gaining a scientific acceptance which even approaches unanimity… Each researcher or clinician becomes attached to his or her own definition in a manner which is reminiscent of Humpty Dumpty in Lewis Carroll’s Through The Looking Glass – ‘When I use a word … it means just what I choose it to mean.’ Definitions … soon become muddied when the researcher or clinician is confronted with a variety of adult cases exhibiting highly heterogeneous profiles. (Beaton et al 1997 p.2)
The diversity of theories concerning the biological underpinnings of dyslexia is impressive… It is clear there is some way to go before any consensus is reached regarding the biological basis of dyslexia … (ibid. pp. 4 – 5)
Students had individual clusters of the cognitive weaknesses usually associated with dyslexia, alongside clear strengths in some cases…They were also accompanied by widely varying individual configurations of literacy and other difficulties, so much so that the students themselves wondered if they were experiencing the same syndrome. The identification of dyslexia could not by itself predict the individual configurations, and the question of whether or not there was one distinctive syndrome became less important than the issue of learning to describe one’s particular situation to a world largely ignorant of these matters, eg “I am dyslexic and for me this means that I literally cannot write my own name, but I can read quite well and I am now using a word processor.” (Herrington 1995 pp. 6 – 7)
…the research literature provides no support for the notion that we need a scientific concept of dyslexia separate from other, more neutral, theoretical terms such as reading disabled, poor reader, less-skilled, etc. Yes, there is such a thing as dyslexia if by dyslexia we mean poor reading. But if this is what we mean, it appears that the term dyslexia no longer does the conceptual work that we thought it did. Indeed, whatever conceptual work the term is doing appears to be misleading. (Stanovich 1994 p. 588)
Over a decade ago … there was little evidence that poor readers of high and low IQ differed importantly in the primary processing mechanisms that were the cause of their reading failure. A further decade’s worth of empirical work on this issue has still failed to produce such evidence. (Stanovich & Stanovich 1997 p.3)
One of the fascinations of dyslexia for researchers is that, whatever one’s interest in human behaviour and performance, children with dyslexia will obligingly show interesting abnormalities in precisely that behaviour. (Nicolson & Fawcett 1999 p. 156)
This collection of syndromes masquerading under the umbrella of dyslexia has something of an unscientific scope; whatever symptoms or deficits researchers find are claimed as evidence of dyslexia. Everything is subsumed. The quote from Nicolson & Fawcett above says it call. Try substituting ‘dyslexia’ with ‘spina bifida’, or any other recognisable medical condition. If it were possible to say such a thing about spina bifida it would be clear that it was either a collection of syndromes which we were unable to distinguish from each other, or not a syndrome at all. No syndrome, however obliging, is going to show every symptom we look. for. Although I’m no scientist, I think you’ll agree that this kind of thinking is very far from scientific. And if “dyslexia” doesn’t refer to reading problems, either – as the dyslexia establishment maintains – then it doesn’t refer to anything which has been scientifically established.
So what is it?
Dys [Greek] means difficult, abnormal, impaired, and lexikos [also Greek] means pertaining to words. So quite literally, dyslexia means difficulty with words. But despite this, definitions are many and various; some are so broad as to be almost meaningless, some are confused and imprecise, and some say next to nothing. There is little consensus.
One of the most widely accepted definitions, and the one used by the World Health Organisation is this:
Dyslexia is a disorder manifested by difficulty in learning to read despite conventional instruction, adequate intelligence and sociocultural opportunity. It is dependent upon fundamental cognitive disabilities which are frequently of constitutional origin.
But a little bit of unpicking reveals how little this actually says:
Dyslexia is a difficulty with reading which may only be diagnosed if there are no other obvious causes to hand (such as poor schooling, poor parenting, low IQ or social disadvantage). It might sometimes be caused by there being something wrong with the brain.
You see? This uncertainty simply defines dyslexia as an odd difficulty with reading, given an otherwise apparently normal educational and social history. This would make it impossible for a child from a socially deprived background to be ‘dyslexic’ at all.
The Dyslexia Institute (2013) defines dyslexia as:
…a specific type of learning difficulty that primarily affects the skills involved in accurate and fluent word reading and spelling. Characteristics of dyslexia include difficulties in areas such as phonological awareness, verbal memory and verbal processing speed.
They also say that dyslexia is “biological in origin” which runs counter to most of the research which admits that only “a very small percentage of impaired readers may well be afflicted by basic cognitive deficits of biological origin” (Valentino 2004).
The British Dyslexia Association (BDA Management Board 2007) says:
Dyslexia is a specific learning difficulty that mainly affects the development of literacy and language related skills. It is likely to be present at birth and to be life-long in its effects. It is characterised by difficulties with phonological processing, rapid naming, working memory, processing speed, and the automatic development of skills that may not match up to an individual’s other cognitive abilities. It tends to be resistant to conventional teaching methods, but its effect can be mitigated by appropriately specific intervention, including the application of information technology and supportive counseling.
While this definition restricts itself to “literacy and language related skills”, it relates the difficulties to satisfying scientific sounding ‘processing’ problems. But what, exactly is being processed? What do our brains use as ‘information’, and just exactly what they are doing when they ‘process’ it? ‘Processing’ is too vague a concept to be of much use, and, as far as I can work out, cognitive science is in no position to assess it in a neurologically meaningful way. Basically, all this actually says is that the condition is potentially made up of a hodge-podge of characteristics, some, or all of which may, or may not, be present and repeats the comforting thought that the difficulties with literacy do not align with a sufferer’s intelligence. Which is fair enough: we’re all better than our limitations.
Elliott says the problem is that there is no uniform test for dyslexia:
Some tests look at memory, some at sounds and words, some at visual processing. The traditional route was to identify a child whose IQ was high, but whose reading level was low: that test is still being used in some places, although you could ask why look at a child’s IQ when deciding if they need special reading help? But the bottom line is that experts can’t agree precisely what set of problems make up the condition they call dyslexia: and if you can’t agree on what a condition is, how on earth can you test for it?
Maybe the problem is that diagnosis is really about trying to make students with poor literacy (and their parents) feel better about it. It’s much more convenient and comforting to blame the victim’s central nervous system. Occasionally even the internationally recognised expert lets this one out of the bag:
…the term dyslexia assists parents and the child to make sense of occurrences they know to exist. They know the child has difficulty with reading and spelling; they need explanations which remove the sense of self-blame. (Pumfrey & Reason 1991 p. 69)
This is remarkably similar to the ‘it’s my hormones’ explanation of obesity. It may absolves us from responsibility, but this explanation entirely fails to understand, or make any attempt to solve, the real problem which, as we all strongly suspect, has nothing to do with hormones.
And then sometimes researchers let another out of the bag as when Cooke says (2001 p. 49):
Miles (1995) has questioned whether there can be a single definition of dyslexia; she suggests instead that different people, and different groups, will want a definition to suit their own requirements. This is clearly correct …
This is shameless! If it’s OK to just pick our own, personal, definition to suit our own particular agenda, then we may as well give up. The condition we call ‘dyslexia’ has been researched for over a century, and it’s astonishing that such confusion still exists and such woolly remarks are accepted in apparently serious, peer-reviewed, scientific journals.
The fact is that no one seems to have a satisfying, meaningful definition of dyslexia that everyone else accepts. But the label continues to be slapped on to anyone with any kind of literacy problem. I’d argue that this is unhelpful, and, ultimately, fraudulent.
But really, why all the fuss? As long as students get help for their unspecified ‘specific learning difficulty’ who cares what we call it?
Well, the dyslexia diagnosis industry has its casualties. For some students, being labelled as dyslexic does them more harm than good. Often, in my experience, it can be an excuse for not trying. Teachers may start to have lower expectations. We concentrate on the mechanics of reading and writing rather than purpose and flair, rules rather than writing. This is inevitable once we’ve attributed a student’s problems to a single, conceptually simple, innate and unalterable cause; classic soil in which to grow learned helplessness – and not just in students. Once a diagnosis is made, other, simpler (but less lucrative) potential causes for poor performance are ignored. And what about those who don’t get diagnosed? Does that mean they’re simply stupid?
There are, I contend, two types of dyslexia, acquired and developmental.
Acquired dyslexia is the result of trauma to the brain occurring after literacy has been acquired. Some accident results in damage to the part of the brain which had learned literacy skills. Depending on the degree of damage, the skills will be correspondingly lost. The same applies to speech, of course. Many stroke victims have their speech centres damaged and show varying degrees of loss of the power of speech. This is horrible but makes perfect cognitive sense – if you damage the part of the brain which has learned to be responsible for a particular skill then that skill will be correspondingly damaged. How could it be otherwise?
Developmental dyslexia is, in contrast, an utterly different animal. Here, there is assumed to be a congenital neurological deficit of some kind. This may be genetic but may also be the result of damage to the foetus during gestation. At any rate, developmental dyslexia is presumed to be an affliction of those parts of the brain which will one day be expected to learn the skills of literacy. It’s an innate defect which is innately pre-wired to learn literacy only in a particular location or locations. Valentino acknowledges that “a very small percentage of impaired readers may well be afflicted by basic cognitive deficits of biological origin, especially phonological deficits that lie at the root of their difﬁculties in learning to read.” (2004 p30) But that’s it: a very small number. The rest are victims of, by and large, inadequate instruction.
Just cos I’m not happy with this idea of developmental dyslexia doesn’t mean that I fail to recognise that lots of people have literacy difficulties and that these difficulties can be ‘cured’. But diagnosing dyslexia disempowers and both students and teachers alike. To accept otherwise is to descend into the damp and foetid cellars of educational pessimism where learned helplessness grows like a fungus.
Right, I hear you cry, if it’s not dyslexia, what the hell is it? Well, there are so many other, more likely explanations for peculiar difficulty with literacy, each more likely than a highly selective mis-wiring of the brain. Basically though, I think most difficulties with language come down to the fact that “Reading and writing are not just cognitive activities – feelings run through them.” (Barton 1994 p. 48) and Valentino reports the following:
Results from recent intervention studies suggest that explanations of reading difficulties in most children must incorporate experiential and instructional deficits as possible causes of such difficulties, rather than focus exclusively on the types of cognitive and biological deficits that have predominated theory and research in this area of inquiry throughout the previous century. (2004 p3)
These points lead us, inexorably, to the Matthew effect.
The Matthew effect
For unto every one that hath shall be given, and he shall have abundance; but from him that hath not shall be taken away even that which he hath.
As I’ve written before, the Matthew effect is a huge factor in students’ literacy difficulties. Stanovich says that “… a strong bootstrapping mechanism that causes major individual differences in the development of reading skill is the volume of reading experience”. Daniel Rigney tells us that, “While good readers gain new skills very rapidly, and quickly move from learning to read to reading to learn, poor readers become increasingly frustrated with the act of reading, and try to avoid reading where possible.” The good reader may read several millions of words a year, whereas the poor reader reads only a few thousand (and probably hates every one) – as Robert MacFarlane says, “Every hour spent reading is an hour spent learning to write”, and we all know what practise makes! This is the Matthew effect; the rich get richer while the poor get poorer. The simple fact that less literate people read a great deal less than more literate people makes it more difficult for them to progress. Hirsch tells us that those “who possess intellectual capital when they first arrive at school have the mental scaffolding and Velcro to catch hold of what is going on, and they can turn the new knowledge into still more Velcro to gain still more knowledge”. It’s small wonder that this early advantage can never be overtaken.
Many of the symptoms that are said to identify dyslexics are now believed to be the consequence of reading difficulties, not their cause. Compared with children who read a lot, those who read little suffer educational and intellectual damage: their writing and spelling are poorer and they have less ability to organise themselves. And all poor readers are likely to suffer such problems whether they have been diagnosed as dyslexic or not. For instance, most poor readers suffer with sound awareness problems but beyond this, their conditions are so wide-ranging that it is impossible to identify any sub-group who, on the basis of their literacy difficulties, could usefully be called ‘dyslexic’.
Sadly, though, the more problems a students suffers, the more difficult it may be for them to resolve their literacy problems. Worse, the longer these problems remain unresolved, the further they will fall behind and the worse their plight becomes. For many, even if their reading improves, it can be next to impossible for them to catch up. Despite this there are cases of apparently odd difficulty in acquiring and using literacy but they almost always include some or all of the following steps:
- Relatively little (sometimes no) literacy activity in the home
- Very early failure in school, leading to general anxiety
- Literacy is experienced as impossibly difficult and humiliating.
- Students become highly risk-averse, further draining motivation and the ability to learn or perform.
- Students are diagnosed as ‘special needs’ and decide they are ‘thick’
What should we do?
Elliott says, “I can understand parents wanting to get this label, because there’s a human need for labels. But what parents believe is that the label will lead to an intervention, in much the same way that a diagnosis of a broken arm leads to effective treatment. And what I’d argue is that the intervention they receive when their child is labelled dyslexic isn’t effective – and furthermore, it’s very expensive and time-consuming, and it diverts resources away from what could be being done better to help all children with reading problems. “In fact, reading isn’t something that requires a high level of intelligence. Amongst children who struggle to read, you find some with a high IQ, some in the middle and some with a low IQ.” And interestingly, researchers at York University have found that low ability students can be helped just as much with reading problems as able students, providing the right reading programme is implemented in the right way. If resources are thrown at a particular group of students suffering from a particular syndrome, what happens to students who haven’t paid the £300 quid or so needed to receive this label?
Maybe we should agree that either every child with poor reading ability is dyslexic, or none of them is.
Teachers are routinely faced with students with officially sanctioned diagnoses of dyslexia. What do you do, if you think, as I do, that’s it’s a load of old pony? You have three choices: you can challenge the diagnosis, reinforce it or ignore it. Even though I’m unconvinced, I can’t say with absolute certainty that dyslexia doesn’t exist. We all remain too ignorant as yet for dogmatism. For this reason, and also because the diagnosis may be helpful to the student (it’s certainly better than being regarded as unintelligent), I wouldn’t recommend a direct challenge to the diagnosis. Neither, though, do I recommend it be accepted – this will reinforce the disability fantasy and will lead to learned helplessness. So then, the third way; the ‘Mmmm…’ approach. When told a student is ‘dyslexic’ I say “Mmmm…” and then teach as if the diagnosis had never been made; I treat the student as completely ‘normal’. I dismiss dyslexia from my own mind and, hopefully, the student will feel it fade from theirs too. It is at this point that progress can be made.
I could be very wrong about this. Certainly lots of well-intentioned, knowledgeable people think so. But wrong or not, the best approached to dyslexia that I’ve come up with is not indulge sufferers in the belief that they are doomed, cursed or otherwise blighted by a condition over which they have no control. We all have ‘specific learning difficulties’ of one form or another and they’re never an excuse for not trying. We should always encourage students to overcome their difficulties and provide them with the tools to cope the curve balls their brains throw at them. For some having a label may be helpful, for others it’s most definitely not. My own experience suggests that patience, compassion and high expectations are the very best that a teacher can offer any student. And this seems to work, more often than not.
If you’re interested, there’s a fascinating Channel 4 documentary called The Dyslexia Myth to watch as well.
And here is a fascinating unpicking of some recent research from Yale on the likelihood of children having a genetic form of dyslexia.
Update – the very latest neuroscientific research seems to suggest that my suspicion that most dyslexia doesn’t have a biological cause may be correct. See this post from Daniel Willingham.
Specific reading disability (dyslexia): what have we learned in the past four decades? by Vellutino, Fletcher, Snowling and Scanlon
Julian Elliott also has a very good chapter on dyslexia in Bad Education: Debunking Myths in Education