Pediatrician’s Guide to the Early Identification of Children at Risk for Dyslexia

By Christine Johnson, MA/CCC-SLP

Christine Johnson, M.A./CCC-SLP is a speech/language pathologist and OG trained therapist at Nationwide Children’s Hospital specializing in the areas of evaluation and treatment of dyslexia.  She is the mother of five children, two of whom are dyslexic, and has a personal and professional passion in the area of dyslexia.  Christine presented at the American Speech-Language-Hearing Association (ASHA)’s national conference regarding the Speech/Language Pathologist’s Role in the Evaluation and Treatment of Dyslexia, and will be presenting this spring on Dyslexia Comorbidities: ADHD and Affective Disorders.  She has over 30 years of experience working in a variety of settings including schools, private practice and in the clinical setting. In addition, she earned her LD/BD (Learning Disability/Behavior Disorder) certification from The Ohio State University.  She is currently serving her second term on the International Dyslexia Association Central Ohio Branch.

Failure to detect the early signs of dyslexia can be devastating to a child, yet pediatricians can play a vital role in making proper early referrals by identifying risk factors and characteristics of dyslexia. Children with dyslexia face educational challenges throughout their academic lifetime, including the efficient acquisition of reading, writing and spelling skills. Students who struggle to read and write are in a state of academic and emotional vulnerability. Prevalence rates of dyslexia are as many as one in five children (IDA, 2010) or as few as one in ten (Shaywitz, 1998). Additionally, there are many internalizing disorders and symptoms that often co-occur with dyslexia. Children with dyslexia carry a significant risk of comorbid psychiatric disorders that appear in early childhood and can persist into adulthood.  Research indicates that between 25-40% of people with dyslexia have ADHD and affective disorders including anxiety, depression, low self-esteem, and suicidal ideation (Wilcutt & Pennington, 2000a, 2000b). ADHD is the psychiatric disorder most frequently associated with dyslexia; ADHD symptoms have been associated with an increased risk of suicidality (Balazs, 2014).

Considering the high stakes associated with early identification, it is important to understand the disorder and identify the early signs and risk factors associated with dyslexia. Many children with dyslexia have a history of speech/language delays.  Dyslexia is a language based learning disability resulting from deficit in phonological awareness, rapid automatic naming, working memory, and processing speed. Phonological processing is the single most important predictor of dyslexia. If a child is showing difficulties in phonics (letter/sound correspondence); and the ability to identify sounds (e.g. “What sound do you hear at the beginning, ending, or middle of a word?”), blend sounds, segment sounds, or manipulate sounds (rhyming), they may be at risk for dyslexia. Dyslexia is the most common cause of difficulties with reading but other difficulties such as spelling, speech, and memorization may occur.  Many children with handwriting difficulties also demonstrate difficulties in the orthographic structure of language. Letter reversals may or may not occur in children with dyslexia, but do not reflect a visual deficit. There may be children with dyslexia that demonstrate letter reversals (b/d) or word reversals (was/saw), that persist past their peers, but it is important to note that these are not the one and only symptom of dyslexia (Vellutino, 2004; Lachmann, 2003). Another important risk factor is familial history. The incidence of reading disability in a child’s immediate family puts a child at increased risk for dyslexia as it is hereditary. Between 23-65 percent of children who have a parent with dyslexia will also have the disability, and a rate among siblings is 40 percent (Scarborough, 1998).

“Although dyslexia is life-long, individuals with dyslexia frequently respond successfully to timely and appropriate intervention” (IDA). Evidenced-based intervention for children with dyslexia by a trained and experienced teacher, tutor, or therapist is recommended. Independent, scientific, replicated research supports the use of a reading program that provides direct, multisensory, systematic, explicit, and intense instruction. This instruction is recommended over a longer period of time to achieve automaticity in word recognition. Research from the NICHD at the NIH has demonstrated that the only effective form of evidenced-based reading instruction for remediating deficits in the phonological structure of language is a multi-sensory structured language (MSL) approach such as the Orton-Gillingham (OG) method or an Orton-Gillingham based program (e.g. Lindamood-Bell LIPS; Wilson Fundations, Just Words & Wilson Reading System; Alphabetic Phonics; Stevenson; and Slingerland, etc.).

Children with dyslexia are often not identified before third grade in the schools, but at this age it is more difficult to remediate. Dyslexia can (and should) be diagnosed well before the third grade. Ideally, all children should be screened in Kindergarten.  Children progress faster through intervention and treatment when identified earlier as compared to older children which minimizes educational delay and preserves self-confidence. Referrals should not be postponed as reading problems cannot be outgrown; they are persistent. Pediatricians can refer at risk children to local schools, private psychologists or speech/language pathologists for additional testing. As in other areas, early diagnosis and treatment is critical for the successful academic and emotional development of our children. Pediatricians can play an important role in the identification of dyslexia as early as preschool age using the following suggested screening questions:

  • Is there a family history of dyslexia or reading, writing, or spelling difficulties?
  • Is there a history of speech/language delay?
  • Is there a history of ADHD or other affective disorders such as anxiety or depression?

In Pre-School:

  • Does your child have difficulty learning common nursery rhymes?
  • Does your child have difficulties with learning the alphabet or phonics (letter/sound correspondence)?
  • Can your child rhyme words? (Give me a word that rhymes with “mop”)
  • Does your child know the letters in his/her own name?

In Kindergarten:

  • Does your child have difficulties identifying sounds in words (eg. “What sound do you hear at the beginning of ‘map’?” or “What sound do you hear at the end of ‘dog’?”)
  • Can your child put sounds together to create a word? (m-o-p=mop)
  • Can your child tell what sounds he hears in words? (What sounds do you hear in “bat”?=/b/, /a/, /t/)
  • Does your child have difficulties with handwriting?
  • Does your child have difficulty memorizing?
  • Does your child have difficulties pronouncing words? (pacific/specific, renember/remember, pasgetti/spaghetti)
  • Does your child avoid reading or complain about how difficult reading is?
  • Does your child have difficulty reading simple one syllable (CVC) words such as (map, hat, big, etc.)


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