Dyslexia

Dyslexia is a disorder with many myths attached. People tend to think that dyslexia is merely a matter of reading, writing or saying words backwards. Although this sometimes happens as a result of the disorder, there are complex reasons for why this does occur. It is not a matter of a visual deficiency or a speech impediment, but of an auditory processing problem that has far-reaching consequences.

Dyslexia and its indicators

In Australia, dyslexia is frequently referred to as a ‘specific learning difficulty’ with an emphasis on language problems. Dyslexia is not, as many people mistakenly believe, a matter of visual dysfunction. Dyslexic people do not see whole words reversed and the condition does not necessarily manifest in writing letters backwards. The condition is best explained as a language-based disorder. People who have dyslexia often experience difficulties in the areas of reading, spelling, writing, and mathematics.

It is important to know that people who have dyslexia do not make random mistakes. Rather, they will have very consistent problems with certain sets of letters and this will be apparent in reading, writing and spelling of relevant words.

The types of mistakes made with letters comprise three main categories:

Reversal: reading the back-to-front mirror image of the letter – pairs include d/b and q/p – the individual may mistake ‘bad’ for ‘dad’

Inversion: reading the upside-down mirror image of the letter – pairs include w/m – the individual may mistake ‘wake’ for ‘make’

Transposition: swapping two adjacent letters in a word – the individual may mistake ‘far’ for ‘fra’, or ‘sits’ for ‘stis’

Sound is made up of many frequencies (high and low pitch tones). The auditory processing problems associated with dyslexia most often involve a difficulty in perceiving certain frequencies of sounds. The implications for communication are considerable. Some of the most common of these sounds are the high frequency sounds like ‘t’, ‘f’ ‘s’, ‘k’, ‘p’ and the blended sounds of ‘th’ and ‘sh’. Children with dyslexia may have perceptual difficulties with some of these sounds, meaning that words that contain these sounds, may be misheard and subsequently mispronounced, leading to compromised communication. Many of these symptoms are more obvious when in a busy environment and the individual may be experiencing sensory overload. On the other hand, some sounds may also be processed at different speeds leading to confusion when a spoken message is received.

Causes of dyslexia

Most cases of dyslexia are hereditary, but it is possible for the condition to occur after birth. Young children who suffer glue ear – blockage of the ear through infection – may have interrupted development of the auditory system and auditory processing. With this occurring at such a critical stage of development, sound reception and phonological awareness may be compromised, which may lead to acquired dyslexia.8 In the case of hereditary dyslexia, the inherited chromosome causes neurological (brain) differences in people with dyslexia; however not all children of dyslexic people will be born with the condition themselves.8 The gene is not always inherited directly from the parent – sometimes the parent will have a sibling or immediate relative with the disorder.

Much research has been conducted to show that people consistently use the same part of their brain when they read. Dyslexic people, however, do not show the same uniformity. The usual part of the brain is not activated, but there doesn’t seem to be an alternative part of the brain consistently activated either. This seems to suggest a degree of neural disorganization, which means that people with dyslexia are not accessing the most useful part of their brain when required to read.

Different types of dyslexia

As with any disorder, no two people will present with identical symptoms of dyslexia. The degree of the condition will vary, but in addition to this it is possible to differentiate between some broad categories of problems. Two of the recognised subtypes of dyslexia are:

Dysphonetic – problems with letter–sound integration (auditory-linguistic)

Dyseidetic – problems with perceiving words as a whole (visual-spatial).

The majority of people with dyslexia fall into the first category only (over 60%), with the next highest percentage of sufferers possessing both subtypes of problems (over 20%). This causes the most difficulties for people. It is rare then that dyseidetic dyslexia exists on its own, though it is certainly possible (under 10%). There are always a few cases that remain unclassified.

The physiology of dyslexia

In addition to experiencing problems in academic domains, difficulties with task-sequencing, memory, time-concepts, spatial organization and directionality are also commonly observed. It may appear unusual that a language disorder could have an effect on these seemingly unrelated areas, but when assessing the source of dyslexia, the ensuing difficulties make more sense. Studies suggest that although dyslexia presents as verbal learning disability, these are only the symptoms of a complex neurological issue – that is, a problem with how the brain processes information.

This is evident in terms of the auditory processing problems experienced by dyslexic individuals. For a polysyllabic word such as ‘elephant’, the various sounds in the word may not be processed in the sequence they were delivered. Some sounds may be processed more quickly than others which may lead to the individual’s perception of the word as ‘ephelant’. The reversal, inversion or transposition problems experienced in reading are also reflective of a poorly developed vestibular system. The vestibular system in the inner ear is not only concerned with balance and co-ordination, but with the very fine movement of the eye and its visual tracking capability. It is less surprising then that a visual tracking deficit may exist concurrently with a weak or underdeveloped auditory system.

Recent research has uncovered an interesting theory that dyslexia originates in the cerebellum, the part of the brain concerned with movement. Although the cerebellum is mainly discussed for its effect on physical movements, it is also central to the act of learning and automating not only physical movements but also mental processes such as reading. In fact, many of the skills that dyslexic people struggle with (sequencing, recall, rote learning) have their basis in the cerebellum which is highly impacted by the workings of the inner ear. The inner ear comprises two organs – the cochlea (responsible for sound reception) and the vestibule (responsible for body coordination and balance). It follows then that unless these organs are operating at their optimum level and their connections to the cerebellum are strong, two distinct problems will arise.

Problems in the cerebellum have been traced back to infancy. Children emerge from the womb with primitive reflexes designed to enable them to respond automatically to their environment. As the child matures, these primitive reflexes are overtaken by postural reflexes which allow the child to make more deliberate and conscious movements. Children with dyslexia, however, appear to partially retain some of their primitive reflexes. It is suggested that this causes slower development of the central nervous system, and which may partially explain as to why the cerebellum may not be operating as normally expected.

Dyslexic people will inevitably develop their own compensatory techniques to disguise or alleviate the effects of their condition. These have important adaptive value, but should not be relied on as an exclusive means of coping. There are interventions available that provide more practical and helpful ways of addressing the problems particular to the individual and while the disorder cannot be cured, there are ways of making its effects less intense. Findings suggest that the key to managing dyslexia is intensive work on phonemic awareness.

Phonemic and phonological awareness

Phonemes are the most basic units of sound. The English language contains 44 phonemes, which are used in combination to form spoken words. Phonemic awareness – knowledge of these sounds – has been shown to play a pivotal role in determining how well children develop language skills. Without the ability to discriminate between and remember these sounds, individually and in combination, individuals will have great trouble acquiring new vocabulary. Most children can figure out new words by piecing the sounds together – clearly this cannot be done unless the sounds are already known.

Phonological awareness is one step up from phonemic awareness. It describes the ability to integrate these spoken sounds with their written symbols. Most people acquire this recognition over time and this leads to speech, reading and writing development. It is this ability that children rely on, to understand concepts of rhyming, word patterns, and distinguishing between similar sounds (e.g.. ‘pear’ and ‘bear’) and different sound emphasis (e.g.. ‘accent’ and ‘ascent’).

Individuals may appear to have phonological awareness because they are able to look at a fairly complex word on a page and know what it sounds like. People without phonemic awareness, however, will be unable to explain the individual sounds within the word – they will only know how the word sounds because they have memorized what it looks like as a whole. This is a common disguise for people with dyslexia or language delay. Take the word ‘wonderful’ for example – a person with no phonemic awareness would not know what sound would be left if ‘wonder’ was covered up and ‘ful” remained. The individual may not be able to say ‘ful’.

It makes sense then that dyslexia and associated developmental disorders can be understood with regard to sound reception. It seems logical for phonemic awareness not to exist independently of appropriate auditory processing.

Social consequences for people with dyslexia

As well as the salient aspects of the disorder, dyslexia can have a considerable effect on how sufferers perceive their world. Therapists and family members have described how relating to a child with dyslexia can often be confusing and disorienting. Paul Madaule describes this process as the dyslexic child ‘dyslexifying’ the relationships and world around him or her. It is vital that dyslexia is diagnosed as such so that the sufferer is not mislabelled as lazy or incompetent, which often leads to further deterioration of self-esteem and confidence.

A significant problem for dyslexic people is that their poor verbal ability makes it extraordinarily hard for them to convey their difficulties to teachers or parents. Paul Madaule, a dyslexic himself until the age of, describes this feeling as akin to being in a foreign country and being unable to speak anything beyond the basics of the language. The process of communication is heavily compromised, with the intended message being only partially received or expressed, leading to frustration on the part of both the listener and the speaker. The social consequences of this unfulfilled interaction are predictably discouraging, and are often reflected in the relationships between people with dyslexia and those around them.

If the condition is left untreated, many dyslexic adults experience emotional troubles, occasionally becoming depressed. One suggestion for why this occurs is that people with dyslexia have developed auditory filters that make received sounds unpleasant, thereby transforming verbal communication into a negative experience where it should be enriching and nurturing. As previously mentioned, this sound reception problem is not a matter of deafness, but of distorted auditory perception. It is for this reason that intervention to assist people with dyslexia must not exclusively concentrate on written language, but must focus on integrating written language into a framework of understanding how words sound.

How the Auditory Training Program can assist individuals with dyslexia

Rather than teaching specific skills for overcoming the language problems of dyslexia, the Auditory Training Program attempts to strengthen neural connections and auditory pathways through intense auditory stimulation program. This program aims to stimulate, challenge and it is a “Bottom-Up Therapy Program” which is stimulus-driven and intended to improve encoding of the signal through adaptive stimulation – via technology to simulate the processes of a normal ear and auditory pathways. The program needs to be conducted for an extended period of time and frequent. Strengthening the auditory system enables listening to improve.

The Auditory Training Program aims to train important aspects of listening:

Sound localisation (identifying the origin of a sound)

Sound sequencing (knowing the order in which individual sounds combine to form words, following ordered directions, recalling the correct sequence of auditory information)

Sound discrimination (e.g.. ‘pa’ versus ‘ba’)

Attending to particular sounds in a noisy or busy environment

Auditory processing (speed and appropriateness of responses, interpretation of information, accuracy of comprehension)

Auditory memory (recalling the content of auditory information, giving undivided and sustained attention to a task, adapting to changes in information)

Auditory blending (combining sounds to form words).

Research has demonstrated that intervention programs that focus on training the brain to connect letters with their corresponding sounds are the most effective in assisting people with dyslexia. If problems with reading and writing are indicative of a more fundamental issue within the auditory system, it makes sense that effective intervention needs to focus on the foundations of dyslexia by targeting the auditory system. Studies have shown that it is not helpful for people with dyslexia to be given whole words to deal with. On the contrary, it is far more effective to return to the basics of sound recognition (phonemic awareness) and ensure the foundations are secure before progressing to whole words.

The key to receiving any instruction is the skill of good listening. Training in sound and letter integration may be helpful to people with dyslexia, just as reading intervention programs have been shown to improve performance. However, unless the person with dyslexia is listening effectively enough to comprehend the given instructions and suggested strategies, the time spent on these programs may not be as effective.10 This makes the Auditory Training Program a logical first step in treating the disorder.

Combining the Auditory Training Program with Developmental Movement Exercises (DME)

Developmental Movement Exercises (DME) addresses the problems of coordination and motor control commonly experienced by individuals with dyslexia. The systems targeted in Developmental Movement Exercises (DME) are those involved in learning through motion. Motion, or movement, is detected by the tactile system, the auditory system, the visual system, the vestibular system (balance) and the propioceptive system (body position). DME usually involves following a sequence of sensorimotor activities centered on these sensory systems.

Most commonly the sequence involves tactile stimulation, vestibular and auditory activity, propioceptive stimulation, and which is followed by fine and gross motor activity. Developmental Movement Exercises can be thought of as a movement program that guides the individual through the earliest stages of developmental reflexes. It is, in a sense, the reliving of the experience of sensory development so that the primitive reflexes are revisited and overtaken as they ideally would have been during the child’s infancy.

Developmental Movement Exercises is often undertaken in conjunction with the Auditory Training Program. The combination of the therapies aims to strengthen auditory pathways, balance, coordination and sequencing, through the combined use of sound stimulation, audio-vocal training and sensorimotor exercises. Close monitoring has shown that as the sensory system is normalized, children tend to communicate better with those around them, feel more comfortable in their bodies and demonstrate greater overall wellbeing.

Other programs

It is possible that one of the centre's other programs are more suitable including Cellfield, Fast Forword or Neurofeedback.

Assessment

In order to recommend the most appropriate intervention it is necessary to attend an assessment at the centre.

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