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Article on comorbidity of dyslexia and DLD

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This is very interesting. I have always felt somewhat intuitively that dyslexia made more sense when it was accompanied by noticeable speech or language difficulties. And,  I know people told us to look for speech articulation problems or vocabulary problems in our young kids if we were concerned about dyslexia. In our case, none of that was present, which made the dyslexia so confounding. All three of my kids spoke well, in complex sentences and with great vocabulary from a young age. They all love listening to audio books and have good listening comprehension. They just have difficulty with reading text/spelling/ writing. 

To be honest, the medical and diagnostic terminology seems to be changing so fast, in an environment where the research is also growing, that it's hard to keep up with the meaning of terms.  In this case, dyslexic becomes a broad, work in progress, category. 

 

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I don't know if they have stats yet on how often DLD is co-morbid. The tools the schools typically use for deciding whether to intervene on language are under-sensitive, like the CELF, so I think there's this sense in which the SLPs now doing intervention are finding narrative and other language issues just super common in the community. But I get what you're saying that it's kind of weird to look at EVERYONE with dyslexia and imply they ALL have DLD. 

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Yeah, despite being a reading specialist in my former life, it honestly never occurred to me that Cat was dyslexic, because she spoke precociously early, in complex sentences, with a very advanced vocabulary, and learned her letters/ sounds very early (like 18 months early) and had solid skills at rhyming/ blending/ segmenting.  She had lots of red flags, but literally none of them were for dyslexia.  

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I liked the article. It presents a lot to think about, but it also clearly acknowledges that some can have phonological dsylexia without other language impairments. This describes DD13. When she had her neuropsych evaluation, the NP described her dyslexia as a "word level" reading problem. I found it interesting at the time that he described it that way, and I think it was deliberate on his part to indicate that she did not have other language based issues (whereas others with dyslexia might.)

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I listened to a great podcast yesterday about other reasons why (besides dyslexia) kids struggle to read. It was really interesting.  I actually sat and took notes to send to my colleagues.

Dr. Robin McEvoy, Developmental neuropsychologist, Denver, CO
 
---------------
Intro

- 1 in 5 children struggle with reading

- Dyslexia is not the only cause
- Since 20% of the population struggles to read, then we should view it as normal. We can't classify 20% of our population as disabled.
 
Dyslexia
- Phonological processing problem
- If you have trouble remember or associating a sound with a letter, you will struggle to read correctly
- Vowel sounds are very subtle, and if the brain is not attuned to these differences, it makes it hard to read
- Saying words incorrectly is a sign - "revenant" for "relevant," "Little Prairie on the House" vs. "Little House on the Prairie."
- Neurological in origin
- Also genetic. If a parent has dyslexia, 50/50 chance a child will, too.
- NOT visual. B and D reversals, for example - it's not that they can't see the difference, they just can't remember which sound goes with which letter
 
Language Processing Weakness
Receptive - trouble making sense of language
Expressive - trouble expressing thoughts through language (writing, speaking)
 
Speech vs. language disorder
- Speech only: Examples, Stuttering, trouble physically pronouncing sounds
 (12:00 minute mark)
- Researchers expected speech disorders to be more closely linked with reading disorders than the research has actually shown
- Kids with speech disorders often don't have the expected problems learning to read
-  If speech/language is the source of the problem, remediation is best done with speech and language therapist who is familiar with reading (build language skills and reading at the same time)
 
Auditory Processing Disorder
- Kids do not process sounds correctly
- "The red box" may sound like "thread box"
- Some kids with APD may be misdiagnosed as having ADHD
- OR some ADHD kids may also have some degree of APD
- If a kid has APD, "paying attention" won't help because they still misunderstand things
- Kids with APD may stop trying to pay attention, and then teachers think the child is distracted
- Can sometimes happen when there are frequent ear infections/ fluid in the ears when they are very young (can cause permanent mis-wiring for sounds)
- If kids cannot discriminate sounds, (e.g., "ma" and "pa"), need to remediate with multi-sensory reading program (such as LiPS)
 
Executive Functioning Weaknesses
- Causes problems with organizing, which can impact reading 
- Phonics patterns are initially hard to detect
- E.g., cat, mat, sat - kids with EF weaknesses (organizing) may not notice the similarities between these words, thus have to laboriously sound out each time
- OR, seeing "cat" in two different sentences, won't recognize that it's the same word the second time, leading kids to sound out yet again
- Kids don't nail down these skills before the class moves on, so they are perpetually behind and have to guess at sounds
- Reading is very complicated, e.g., "a" can make up to 5 different sounds, putting an 'h' with a 'c', 
 
- Non-dyslexic problems can remediate reading faster than 
- EF weaknesses can impact comprehension in addition to decoding
- May appear at first to be dyslexia, but once reading improves, weaknesses are still there
 
Visual processing problems
- Convergence (eyes focusing, team, work together)
- Scanning issues
- Discriminating sizes and shapes
- Can spot these problems, sometimes, by how kids move when they read (leaning back, twisting around, etc)
- Need to see a developmental optometrist for diagnosis
- Sometimes special glasses help, or OT (vestibular system is linked to visual system)
- Vision therapy
 
ADHD
- Can be hard to learn to read because it's boring!!
- ADHD kids need novelty
- Go through early reading quickly, and get to interesting material as soon as possible
 
Other
- Concussions can exacerbate issues, or mimic issues, for several months
- Gaps in knowledge
- Strange things like celiac disease, other physical causes
 
Best programs:
- Multi-sensory reading programs
- Examples: Barton, Wilson, Lindamood-Bell
- Using visual and motor cues in addition to just looking at paper
- These programs also benefit non-dyslexic struggling readers
- Use caution if programs are phonics-based, but NOT multi-sensory - NEED BOTH!
 
Important:
- If parents aren't taking time to read, they aren't showing their child that they value the skill of reading
 
 
 
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13 hours ago, Terabith said:

Yeah, despite being a reading specialist in my former life, it honestly never occurred to me that Cat was dyslexic, because she spoke precociously early, in complex sentences, with a very advanced vocabulary, and learned her letters/ sounds very early (like 18 months early) and had solid skills at rhyming/ blending/ segmenting.  She had lots of red flags, but literally none of them were for dyslexia.  

In the podcast, the neuropsychologist says that many psychs diagnose all reading difficulties as dyslexia, despite there being more reasons. 

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9 hours ago, Mainer said:

In the podcast, the neuropsychologist says that many psychs diagnose all reading difficulties as dyslexia, despite there being more reasons. 

Thanks for posting that. I'll have to take time and listen. I think I'd rather see more, rather than fewer, diagnoses of dyslexia, simply because there doesn't yet seem to be consensus on its definition. The most workable definition right now seems to be an "unexpected" difficulty in reading (which I suppose would mean a difficulty that is not explained by one of these other factors). I see in the posted outline that dyslexia is covered under the category of phonological processing primarily. This is the definition people like Sally Shaywitz seemed to be advocating. What seems to be missing from this outline is the double-deficit understanding of dyslexia that includes difficulties with speed (rapid naming) as also a form of dyslexia. I think it's Wolf that makes the argument that dyslexia can be either a phonological deficit or a rapid naming deficit or both. 

All three of my dyslexic kiddos were super slow in the processing speed/rapid naming categories, and that seems to be a different sort of brain organization - probably heritable as well. 

Edited by hepatica
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18 hours ago, hepatica said:

What seems to be missing from this outline is the double-deficit understanding of dyslexia that includes difficulties with speed (rapid naming) as also a form of dyslexia. I think it's Wolf that makes the argument that dyslexia can be either a phonological deficit or a rapid naming deficit or both. 

This was just one psychologist, so I'm sure other people's categories are different. I wonder if this particular psych would categorize your kids' reading difficulties as dyslexia (phonological), compounded by a rapid naming deficit. 

How are things going, with reading/writing by the way?

Edited by Mainer

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The thing that always gets me with classifying dyslexia is the sense that it is both specific  and not specific at the same time. So many of the other things that are included in DLD or other reading difficulties, such as auditory processing, receptive or expressive language, visual processing, are much more hard wired in the brain than reading. The human brain has evolved for speech for more than a million years (also for certain types of visual processing). So it seems it is much easier to say that children with a speech articulation problem, for example, have a certain deficit or disability in the part of the brain that processes speech. Reading on the other hand has only been around for a few thousand years, and available to the mass of the public for only a few hundred, so there isn't a set way that the brain processes reading. The brain borrows circuits evolved to do other things (like facial recognition) and combines them with other circuits to complete the complex task of reading. There seem to be more or less efficient ways to process written language, but it is not done the same way by all brains. So, when it comes to dyslexia, it is not clear that there is a disability involved, but rather the brain is utilizing different, less efficient perhaps, circuits to accomplish a task for which it does not have a dedicated circuit. So I am always frustrated when dyslexia gets cast as one among a series of other disabilities or processing deficits because there is no clear "correct" or "non-disabled" standard to compare dyslexic functioning to (not sure if that makes sense, but it is a thing that has been bothering me as I have learned more and more about reading).

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7 hours ago, hepatica said:

So, when it comes to dyslexia, it is not clear that there is a disability involved, but rather the brain is utilizing different, less efficient perhaps, circuits to accomplish a task for which it does not have a dedicated circuit. So I am always frustrated when dyslexia gets cast as one among a series of other disabilities or processing deficits because there is no clear "correct" or "non-disabled" standard to compare dyslexic functioning to (not sure if that makes sense, but it is a thing that has been bothering me as I have learned more and more about reading).

Nicely put 🙂

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