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Dyslexia's hidden contours

Yale Medicine Magazine, 2004 - Summer


Sally Shaywitz scores a hit with a scientific guide to diagnosing and treating reading disorders.

At least one child in five has dyslexia, a congenital “wiring glitch” in the brain that makes it hard to master what neuroscientist and behavioral pediatrician Sally E. Shaywitz, M.D., calls “the most elegant and complex of human abilities—learning to read.”

Dyslexia is an inherited problem that cuts across class, race and language, says Shaywitz, professor of pediatrics. Yet “significantly less than half” of American children with dyslexia are even identified. Shaywitz finds this frustrating because researchers have developed reliable diagnostic procedures and evidence-based instruction that, in young students, may even rewire the brain. “A huge gap, almost an abyss, separates what we know and what happens to people with reading problems,” she says.

Shaywitz has helped close that gap through her own research and clinical work and by writing about the science of reading and dyslexia. Her goal, she says, is “making a complex disorder understandable and treatable.” Five years in the writing, Overcoming Dyslexia: A New and Complete Science-Based Program for Reading Problems at Any Level (Alfred A. Knopf) has brought Shaywitz sustained national attention since its publication in spring 2003. Soon after, Time ran a cover story on the topic that featured Shaywitz prominently. A year later the book, a national bestseller that Publishers Weekly called “groundbreaking,” was in its 10th printing; it is also available on tape and CD.

Shaywitz became interested in reading disorders during her pediatrics residency at Albert Einstein College of Medicine in the late 1960s, when she first heard mothers despair because their seemingly bright children were foundering at school. Reading ability is falsely taken as a “proxy for intelligence,” says Shaywitz, and so children with dyslexia often feel stupid or ashamed. Shaywitz has heard many dyslexic adults recount “horrible memories of being asked to read aloud in class.”

And yet, paradoxically, Shaywitz finds that among people who are smart and creative, the “crème de la crème,” a seemingly disproportionate number have dyslexia—medical school professors among them. “I can tell you, a significant proportion of them have been in my office, with the door closed, telling me, ‘I must be the only one,’” says Shaywitz.

Graeme L. Hammond, M.D., professor of surgery (cardiothoracic), who has grappled with dyslexia since childhood, says he was gratified to see that the disorder was finally getting the attention of scientists and the public when he watched Shaywitz discussing dyslexia on The NewsHour with Jim Lehrer in 1998. In the epilogue of her book, Hammond joins well-known dyslexics, including novelist John Irving and financier Charles Schwab, in describing the toll it took. Hammond describes how dyslexia, like many other handicaps, helps develop different, perhaps latent, pathways such as perseverance and innovation to accomplish goals.

In her book, Shaywitz describes dyslexia as a phonological weakness. That is, readers with dyslexia have trouble translating letters on a page into sounds they represent. Although people with dyslexia do learn to read more accurately over time, they do not read rapidly or automatically. “What remains for people with dyslexia is how hard they have to work, how much effort they have to put in,” Shaywitz says.

The book also corrects several misconceptions. Writing letters backwards or transposing them is common among novice writers and doesn’t suggest dyslexia. And although schools identify three boys with dyslexia for every girl, researchers find no significant difference in the prevalence of reading disabilities in girls and boys. But boys get more attention—they tend to be more rambunctious—while many struggling girls go unnoticed and unidentified. The book includes checklists of signs of dyslexia and suggests which tests are effective for diagnosis. Tests for accuracy may miss dyslexia, especially in teenagers and adults; testing fluency is essential.

Shaywitz says educators have remained largely ignorant of the huge advances in understanding dyslexia. “The whole notion that there’s science or evidence hasn’t been part of the culture, so teachers haven’t been provided with the tools.” Furthermore, schools often provide only unproven, sporadic remediation for a chronic problem.

The book draws on a decade of laboratory research at Yale on differences in brain function between skillful and struggling readers. Shaywitz conducted those studies in partnership with her husband, Bennett A. Shaywitz, M.D., professor of pediatrics and neurology. (Both Shaywitzes are also on the Child Study Center faculty.) World-renowned leaders in the use of imaging to study reading, the Shaywitzes have discovered what they call “functional lesions” in the left occipitotemporal and parietotemporal regions (behind the left ear). These lesions correspond exactly with physical lesions in people who have lost the ability to read because of a stroke or brain tumor. They discovered this correspondence using functional magnetic resonance imaging, studying metabolism in the brain to show which parts of the brain readers use as they decode texts. YM

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