Developmental reading disorder

Alternative names 
Dyslexia

Definition
Developmental reading disorder, also called dyslexia, is a reading disability resulting from the inability to process graphic symbols.

Causes, incidence, and risk factors

Between 2 and 8% of elementary-age children have some degree of reading disability. Developmental reading disorder (DRD) is not caused by vision problems, but rather is a problem involving higher cortical (brain) processing of symbols. Children with DRD may have trouble rhyming and separating the sounds in spoken words. These abilities appear to be critical in the process of learning to read.

A child’s initial reading skills are based on word recognition, which involves being able to separate out the sounds in words and associate them with letters and groups of letters. More developed reading skills require the linking of words into a coherent sentence. Because DRD children have difficulty connecting the sounds of language to the letters of words, they may consequently have difficulty understanding sentences.

Most children with DRD have normal intelligence, and many have above-average intelligence. The disorder is a specific information processing problem that is not connected with the ability to think or comprehend complex ideas.

DRD may appear in combination with developmental writing disorder and developmental arithmetic disorder. All of these processes involve the manipulation of symbols to convey information. These conditions may appear singly or in any combination.

Other causes of learning disability and, in particular, reading disability, must be ruled out before a diagnosis of DRD can be made. Cultural and educational shortfalls, emotional problems, mental retardation, and diseases of the brain (for example AIDS) can all cause learning disabilities.

Symptoms

     
  • Possible family history of learning disorder  
  • Difficulty learning to recognize written words  
  • Difficulty rhyming  
  • Difficulty determining the meaning (idea content) of a simple sentence  
  • May occur in combination with writing or arithmetic learning problems

Signs and tests
The first step is to perform a complete medical, developmental, social, and school performance history. Physical and neurologic examinations are also necessary, followed by psychoeducational testing and psychological assessment. Other causes of learning disabilities will need to be ruled out before the diagnosis of DRD can be confirmed.

Treatment
Special education services may include specialist help, individualized tutoring, or special day classes. Every individual has different requirements and an Individual Education Plan should be created for each child. Positive reinforcement is important as many students with learning disabilities have poor self-esteem. Psychological counseling may be helpful.

Expectations (prognosis)
Marked improvement in reading and understanding can be achieved with remedial instruction. However, difficulties with reading may persist throughout adulthood.

Complications

     
  • Problems in school, including behavior problems (an indirect result, such as a reaction to teasing by other children) and loss of self esteem  
  • Problems with reading in adulthood, which may result in occupational problems in certain careers, particularly if the problem was not addressed early

Calling your health care provider
Call your health care provider if your child appears to be having trouble learning to read.

Prevention

Learning disorders tend to run in families. DRD is one kind of learning disorder. Affected families should make every effort to recognize existing problems early.

For families without a previous history of learning disabilities, an intervention can begin as early as preschool or kindergarten if teachers detect early signs. Early intervention will provide the best possible outcome.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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