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Dyslexia

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Dyslexia
SynonymsReadin ail
Dyslexia involves difficulties in processin letters an wirds.
Pronunciation
SpecialtyNeurology, pediatrics
SymptomsTrouble readin
Uisual onsetSchuil age
TeepsSurface dyslexia
CausesGenetic an environmental factors
Risk factorsFaimily history, attention deficit hyperactivity ail
Diagnostic methodSeries memory, spellin, veesion, an readin test
Seemilar condeetionsHearin or veesion problems, insufficient teachin
TreatmentAdjustin teachin methods
Frequency3–7%

Dyslexia, forby kent as wird blindness, is a learnin disabeelity that affecks either readin or writin.[1][2] Different fowk are affeckit tae different degrees.[3] Problems mey include difficulties in spellin wirds, readin quickly, writin wirds, "soondin oot" wirds in the heid, pronouncin wirds whan readin alood an unnerstaundin whit ane reads.[3][4] Aften thir difficulties are furst noticed at schuil.[5] The difficulties are involuntary, an fowk wi this ail hae a normal desire tae learn.[3] Fowk wi dyslexia hae heicher rates o attention deficit hyperactivity ail (ADHA), developmental leid ails, an difficulties wi nummers.[5]

Dyslexia is believed tae be caused bi the interaction o genetic an environmental factors.[5] Some cases rin in faimilies.[3] Dyslexia that develops owin tae a traumatic harn injury, stroke, or dementia is whiles cried "acquired dyslexia"[1] or alexia.[3] The unnerlyin mechanisms o dyslexia result frae differences athin the harn's leid processin.[3] Dyslexia is diagnosed throu a series o tests o memory, veesion, spellin, an readin skeels.[6] Dyslexia is separate frae readin difficulties caused bi hearin or veesion problems or bi insufficient teachin or opportunity tae learn.[5]

Treatment involves adjustin teachin methods tae meet the person's needs.[1] Whiles nae curin the unnerlyin problem, it mey decrease the degree or impact o symptoms.[7] Treatments targetin veesion are nae effective. Dyslexia is the maist common learnin disabeelity an occurs in aw areas o the warld.[8] It affecks 3–7% o the population;[5][9] houiver, up tae 20% o the general population mey hae some degree o symptoms.[10] Whiles dyslexia is mair aften diagnosed in lads, this is pairtly exponed bi a sel-fulfillin referral bias amang teachers an professionals.[5][11] It haes even been suggestit that the condeetion affecks men an wummen equally.[8] Some believe that dyslexia is best considered as a different wey o learnin, wit baith benefits an dounsides.[12][13]

Clessification

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Dyslexia is dividit intae developmental an acquired forms. Acquired dyslexia occurs subsequent tae neurological insult, sic as traumatic harn injury or stroke. Fowk wi acquired dyslexia exhibit some o the signs or symptoms o the developmental ail, bit require different assessment strategies an treatment approaches.[14] Pure alexia, forby kent as agnosic alexia or pure wird blindness, is ane form o alexia that maks up "the peripheral dyslexia" group.

Signs an symptoms

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In early bairnheid, symptoms that correlate wi a later diagnosis o dyslexia include delayed onset o speech an a lack o phonological awareness. A common meeth closely associates dyslexia wi mirror writin an readin letters or wirds backwards.[15] Thir behaviours are seen in mony bairn as thay learn tae read an write, an are nae considered tae be definin chairactereestics o dyslexia.

Schuil-age bairn wi dyslexia mey exhibit signs o difficulty in identifyin or generatin rhymin wirds, or coontin the nummer o seellables in wirds—baith o that depend on phonological awareness. Thay mey forby shaw difficulty in segmentin wirds intae individual soonds (sic as soondin oot the three soonds o k, a, an t in cat) or mey struggle tae blend soonds, indicatin reduced phonemic awareness.[16]

Difficulties wi wird retrieval or namin things is associatit wi dyslexia an aa.[17] Fowk wi dyslexia are commonly puir spellers, a featur whiles cried dysorthographia or dysgraphia, that depends on the skeel o orthographic codin.

Problems persist intae adolescence an adultheid an mey include difficulties wi summarising stories, memorisation, readin alood, or learnin foreign leids. Adults wi dyslexia can aften read wi guid comprehension, thou thay tend tae read mair slawly nor ithers wioot a learnin difficulty an perform worse in spellin tests or whan readin nonsense wirds—a measure o phonological awareness.[18]

Associatit condeetions

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Dyslexia aften co-occurs wi ither learnin ails, bit the raisons fur this comorbidity hae nae been clearly identifee'd. Thir associatit disabeelities include:

Dysgraphia
A ail involvin difficulties wi writin or typin, whiles owin tae problems wi ee–haund coordination; it can impede direction- or sequence-orientit processes an aa, sic as tyin knots or carryin oot repetitive tasks. In dyslexia, dysgraphia is aften multifactorial, owin tae impaired letter-writin automaticity, organisational an elaborative difficulties, an impaired veesual wird formin, that maks it mair difficult tae retrieve the veesual pictur o wirds required fur spellin.
Attention deficit hyperactivity ail
A ail chairacterised bi problems sustainin attention, hyperactivity, or actin impulsively. Dyslexia an ADHA commonly occur thegither.[9][19] Approximately 15% or 12–24% o fowk wi dyslexia hae ADHA;[20] an up tae 35% o fowk wi ADHA hae dyslexia.
Auditory processin ail
A listenin ail that affecks the abeelity tae process auditory information.[21] This can lead tae problems wi auditory memory an auditory sequencin. Mony fowk wi dyslexia hae auditory processin problems, an mey develop thair awn logographic cues tae compensate fur this teep o deficit. Some resairch suggests that auditory processin skeels coud be the primary shortfaw in dyslexia.[22][23]
Developmental coordination ail
A neurological condeetion chairacterised bi difficulty in carryin oot routine tasks involvin balance, fine-motor control an kinesthetic coordination; difficulty in the uise o speech soonds; an problems wi short-term memory an organisation.[24]

Causes

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Inferior parietal lobule – superior view animation

Resairchers hae been tryin tae find the neurobiological basis o dyslexia syne the condeetion wis furst identifee'd in 1881.[25][26] Fur ensaumple, some hae tree'd tae associate the common problem amang fowk wi dyslexia o nae bein able tae see letters clearly tae abnormal development o thair veesual nerve cells.[27]

Neuroanatomy

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Neuroeemagin techniques, sic as functional magnetic resonance eemagin (fMRI) an positron emission tomography (PET), hae shawn a correlation atween baith functional an structural differences in the harns o bairn wi readin difficulties.[28] Some fowk wi dyslexia shaw less activation in pairts o the left hemisphere o the harn involvit wi readin, sic as the inferior frontal gyrus, inferior parietal lobule, an the middle an ventral temporal cortex.[22] Meta-analyses o fMRI studies hae foond unner-activation whaur the temporal an occipital lobes meet in the left hemisphere in dyslexic subjecks (includin the veesual wird form area).[29] Ower the past decade, harn activation studies uisin PET tae study leid hae produced a breakthrou in the unnerstaundin o the neural basis o leid. Neural bases fur the veesual lexicon an fur auditory verbal short-term memory components hae been proponed,[30] wi some implication that the observed neural manifestation o developmental dyslexia is task-speceefic (i.e., functional raither nor structural). fMRIs o fowk wi dyslexia indicate an interactive role o the cerebellum an cerebral cortex as weel as ither harn structurs in readin.[31][32]

The cerebellar theory o dyslexia propones that impairment o cerebellum-controlled muscle muivement affecks the formation o wirds bi the tongue and facial muscles, resultin in the fluency problems that some fowk wi dyslexia experience. The cerebellum is involvit in the automatisation o some tasks an aa, sic as readin.[33] The fact that some bairn wi dyslexia hae motor task an balance impairments coud be conseestent wi a cerebellar role in thair readin difficulties. Houiver, the cerebellar theory haes nae been supportit bi controlled resairch studies.[34]

Genetics

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Resairch intae potential genetic causes o dyslexia haes its ruits in post-autopsy examination o the harns o fowk wi dyslexia.[27] Observed anatomical differences in the leid centres o sic harns include microscopic cortical malformations kent as ectopias, an mair rarely, vascular micro-malformations, an microgyrus—a smawer nor uisual size fur the gyrus.[35] The previously citit studies an ithers suggest that abnormal cortical development, presumed tae occur afore or durin the saxt month o fetal harn development, mey have caused the abnormalities. Abnormal cell formations in fowk wi dyslexia hae forby been reportit in non-leid cerebral an subcortical harn structurs.[36] Mony genes hae been associatit wi dyslexia, includin DCDC2[37] an KIAA0319[38] on chromosome 6, an DYX1C1[39] on chromosome 15.

Gene–environment interaction

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The contreibution o gene–environment interaction tae readin (dis)abeelity, that estimates the proportion o variance (the differences in readin abeelity across individuals) attributable tae environmental an genetic factors, haes been studied extensively bi comparin sets o identical twins an fraternal twins. Sic twin studies shaw that baith environmental an genetic influences contreibute tae readin development, wi thir twa influences' kin impact varyin bi contex. Fur ensaumple, parental eddication haes been foond tae moderate genetic influences on readin (dis)abeelity,[40] an teacher quality can moderate genetic effecks on early readin abeelity.[41] Mairower, in mair supportive environments, genetic risk factors accoont fur a lairger proportion o the variation in dyslexia.[42] This occurs acause reducin environmental risks—throu heich-quality instruction an supportive caregiein—lowers environmental differences, makin genetic effecks easier tae detect. If environmental risk factors are reduced wi guid teachin an a supportin caregier environment, genetic risk factors mey pley a muckler role in exponin why some fowk hae dyslexia[42] acause the genetic effeck is easier tae detect gien that muckle environmental noise is bracketed-oot.

As environment pleys a lairge role in learnin an memory, it is likly that epigenetic modifications pley an important role in readin abeelity. Measures o gene expression, histone modifications, an methylation in the bodie periphery are uised tae study epigenetic processes; houiver, aw o thir hae leemitations in the extrapolation o results fur application tae the bodie harn.[43]

The orthographic complexity o a leid directly affecks hou difficult it is tae learn tae read it.[44] Inglis an French hae comparatively "deep" phonemic orthographies athin the Laitin alphabet writin seestem, wi complex structurs employin spellin patterns on mony levels: letter-soond correspondence, seellables, an morphemes.[45] Leids sic as Spainish, Italian an Finnish primarily employ letter-soond correspondence—sae-cried "shallae" orthographies—that maks thaim easier tae learn fur fowk wi dyslexia.[44] Logographic writin seestems, sic as Cheenese chairacters, hae extensive seembol uise, an thir pose problems fur dyslexic learners an aa.[46]

Pathophysiology

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Corpus callosum view, front pairt at tap o eemage

Fur maist fowk wha are richt-haund dominant, the left hemisphere o thair harn is mair specialised fur leid processin. Wi regard tae the mechanism o dyslexia, fMRI studies suggest that this specialisation is less pronounced or absent in fowk wi dyslexia. In ither studies, dyslexia is correlatit wi anatomical differences in the corpus callosum, the bundle o nerve fibers that connects the left an richt hemispheres.[47]

Data via diffusion tensor MRI indicate chynges in connectivity or in gray maiter density in areas relatit tae readin an leid. Finally, the left inferior frontal gyrus haes shawn differences in phonological processin in fowk wi dyslexia.[47] Neurophysiological an eemagin procedures are bein uised tae ascertain phenotypic chairactereestics in fowk wi dyslexia, thus identifyin the effecks o dyslexia-relatit genes.[48]

Dual route theory

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The dual-route theory o readin alood wis furst descrieved in the early 1970s. This theory suggests that twa separate mental mechanisms, or cognitive routes, are involvit in readin alood.[49] Ane mechanism is the lexical route, that is the process whaurbi skeelt readers can recognise kent wirds bi sicht alane, throu a "dictionary" leukup procedure.[50] The ither mechanism is the nonlexical or sublexical route, that is the process whaurbi the reader can "soond oot" a written wird.[50][51] This is duin bi identifyin the wird's constituent pairts (letters, phonemes, graphemes) an applyin knawledge o hou thir pairts are associatit wi ilka ither — fur ensaumple, hou a string o neebourin letters soond thegither. The dual-route seestem coud expone the different rates o dyslexia occurrence atween different leids (e.g., the consistency o phonological rules in the Spainish leid coud accoont fur the fact that Spainish-speakin bairn shaw a heicher level o performance in non-wird readin, whan compared tae Inglis-speakers).[44][52]

Diagnosis

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Dyslexia is a heterogeneous, dimensional learnin ail that impairs accurate an fluent wird readin an spellin. Teepical—but nae universal—featurs include difficulties wi phonological awareness, inefficient an aften inaccurate processin o soonds in oral leid (phonological processin), an verbal wirkin memory deficits.

Dyslexia is a neurodevelopmental ail, subcategorisit in diagnostic guides as a learnin ail wi impairment in readin (ICD-11 prefixes "developmental" tae "learnin ail"; DSM-5 uises "speceefic").[53][54][55] Dyslexia is nae a problem wi intelligence. Emotional problems aften arise seicontary tae learnin difficulties.[56] The National Institute of Neurological Disorders and Stroke descrieves dyslexia as "difficulty wi phonological processin (the manipulation o soonds), spellin, an/or rapid veesual-verbal respondin".[1]

The Breetish Dyslexia Association defines dyslexia as "a learnin difficulty that maistly affecks the skeels involvit in accurate an fluent wird readin an spellin" an is chairacterised bi "difficulties in phonological awareness, verbal memory an verbal processin speed".[57] Phonological awareness enables ane tae identify, discriminate, mynd (wirkin memory), an mentally manipulate the soond structurs o leid—phonemes, onsteid-rime segments, seellables, an wirds.

Assessment

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The follaein can be duin tae assess fur dyslexia:

Apply a multidisciplinary team approach involvin the bairn's parent(s) an teacher(s), schuil psychologist, pediatrician, an, as appropriate, speech an leid pathologist (speech therapist), an occupational therapist.

Gain faimiliarity wi teepical ages bairn reach mony general developmental milestanes, an domain-speceefic milestanes, sic as phonological awareness (recognisin rhymin wirds; identifyin the initial soonds in wirds).

Dinna rely on tests exclusively. Carefu observation o the bairn in the schuil an hame environments, an sensitive, comprehensive parental interviews are juist as important as tests.

Leuk at the empirically supportit repone tae intervention (RTI) approach, that "... involves monitorin the progress o a group o bairn throu a programme o intervention raither nor unnertakin a static assessment o thair current skeels. Bairn wi the maist need are thaim wha fail tae respond tae effective teachin, an thay are readily identifee'd uisin this approach."[58]

Assessment tests

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Thare is a wide range o tests that are uised in clinical an eddicational settins tae evaluate the possibility o dyslexia.[59] If initial testin suggests that a person micht hae dyslexia, sic tests are aften follaed up wi a fou diagnostic assessment tae determine the extent an naitur o the ail.[60] Some tests can be admeenistered bi a teacher or computer; ithers require specialised trainin an are gien bi psychologists.[61] Some test results indicate hou tae carry oot teachin strategies.[61][62] Acause a variety o different cognitive, behavioural, emotional, an environmental factors aw coud contreibute tae difficulty learnin tae read, a comprehensive evaluation shoud consider thir different possibilities. Thir tests an observations can include:[63]

  • General meisurs o cognitive abeelity, sic as the Wechsler Intelligence Scale fur Bairn, Woodcock-Johnson Tests o Cognitive Abeelities, or Stanford-Binet Intelligence Scales. Low general cognitive abeelity wad mak readin mair difficult. Cognitive abeelity meisurs aften try tae meisur different cognitive processes an aa, sic as verbal abeelity, nonverbal an spatial raisonin, wirkin memory, an processin speed. Thare are different versions o thir tests fur different age groups. Awmaist aw o thir require addeetional trainin tae gie an score correctly, an are duin bi psychologists. Accordin tae Mather an Schneider (2015), a confirmatory profile an/or pattern o scores on cognitive tests confirmin or rulin-oot readin ail haes nae yit been identifee'd.[64]
  • Screenin or evaluation fur mental heal condeetions: Parents an teachers can complete ratin scales or behaviour checkleets tae gaither information aboot emotional an behavioural functionin fur yunger fowk. Mony checkleets hae seemilar versions fur parents, teachers, an yunger fowk auld eneuch tae read raisonably weel (aften 11 years an aulder) tae complete. Ensaumples include the Behavioural Assessment Seestem fur Bairn, an the Strenths an Difficulties Questionnaire. Aw o thir hae naitionally representative norms, makin it possible tae compare the level o symptoms tae whit wad be teepical fur the yunger person's age an biological sex. Ither checkleets link mair speceefically tae psychiatric diagnoses, sic as the Vanderbilt ADHD Ratin Scales or the Screen fur Bairn Anxiety Relatit Emotional Ail (SBAREA). Screenin uises brief tuils that are designed tae catch cases wi a ail, but thay aften get false positive scores fur fowk wha dae nae hae the ail. Screeners shoud be follaed up bi a mair accurate test or diagnostic interview as a result. Depressive ails an anxiety ails are two-three times heicher in fowk wi dyslexia, an attention-deficit/hyperactivity ail is mair common, as weel.[65][66]
  • Review o academic achievement an skeels: Average spellin/readin abeelity fur a dyslexic is a percentage rankin <16, weel belaw normal. In addeetion tae reviewin grades an teacher notes, staundardised test results are helpfu in evaluatin progress. Thir include group admeenistered tests, sic as the Iowa Tests o Eddicational Development, that a teacher mey gie tae a group or hale clessruim o yunger fowk at the same time. Thay coud include individually admeenistered tests o achievement an aa, sic as the Wide Range Achievement Test, or the Woodcock-Johnson (that includes a set o achievement tests an aa). The individually admeenistered tests again require mair specialised trainin.[67][68]

Screenin

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Screenin procedures seek tae identify bairn wha shaw signs o possible dyslexia. In the preschuil years, a faimily history o dyslexia, pairticulairly in biological parents an siblins, predicts an eventual dyslexia diagnosis better nor ony test. In primary schuil (ages 5–7), the ideal screenin procedure consists o trainin primary schuil teachers tae carefully observe an record thair pupils' progress throu the phonics curriculum, an tharebi identify bairn progressin slawly. Whan teachers identify sic students thay can supplement thair observations wi screenin tests sic as the Phonics screenin check[69] uised bi Unitit Kinrick schuils durin Year 1.

In the medical settin, bairn an adolescent psychiatrist M. S. Thambirajah emphasises that "[g]ien the heich prevalence o developmental ails in schuil-aged bairn, aw bairn seen in clinics shoud be seestematically screened fur developmental ails irrespective o the presentin problem/s." Thambirajah recommends screenin fur developmental ails, includin dyslexia, bi conductin a brief developmental history, a preliminary psychosocial developmental examination, an obtainin a schuil report regardin academic an social functionin.

Management

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Throu the uise o compensation strategies, therapy an eddicational support, individuals wi dyslexia can learn tae read an write.[70] Thare are techniques an technical aids that help tae manage or conceal symptoms o the ail.[71] Reducin stress an anxiety can whiles impruive written comprehension.[72] Fur dyslexia intervention wi alphabet-writin seestems, the fundamental aim is tae increase a bairn's awareness o correspondences atween graphemes (letters) an phonemes (soonds), an tae relate thir tae readin an spellin bi teaching hou soonds blend intae wirds. Reinforced collateral trainin focused on readin an spellin mey yield langer-lastin gains nor oral phonological trainin alane.[73] Early intervention can be successfu in reducin readin failur.

Resairch daes nae suggest that specially-tailored fonts (sic as Dyslexie an OpenDyslexic) help wi readin. In experiments, a mair signeeficant difference in readin performance wis driven bi interline spacin, an the difference wis nae signeeficant ance variables sic as interline spacin an x-hicht wis normalised atween the candidate fonts.[74] Bairn wi dyslexia read tex set in a regular font sic as Times New Roman an Arial juist as quickly, an thay shaw a preference fur regular fonts ower specially-tailored fonts.[74] Some resairch haes pyntit tae increased letter-spacin bein beneficial.[74]

Thare is currently nae evidence shawin that muisic eddication signeeficantly impruives the readin skeels o adolescents wi dyslexia.

Prognosis

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Dyslexic bairn require special instruction fur wird analysis an spellin frae an early age. The prognosis, generally speakin, is positive fur individuals wha are identifee'd in bairnheid an receive support frae freends an faimily.[1] The New York eddicational seestem (NYED) indicates "a daily uninterruptit 90-meenit block o instruction in readin" an "instruction in phonemic awareness, phonics, vocabulary development, readin fluency" sae as tae impruive the individual's readin abeelity.[75]

Epidemiology

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The prevalence o dyslexia is unkent, but it haes been estimatit tae be as low as 5% an as heich as 17% o the population.[76] Dyslexia is diagnosed mair aften in males.[5]

Thare are different defineetions o dyslexia uised throuoot the warld. Further, differences in writin seestems mey affeck development o written leid abeelity owin tae the interpley atween auditory an written representations o phonemes.[77] Dyslexia is nae limitit tae difficulty in convertin letters tae soonds, an Cheenese fowk wi dyslexia mey hae difficulty convertin Cheenese chairacters intae thair meanins.[78][79] The Cheenese vocabulary uises logographic, monographic, non-alphabet writin whaur ane chairacter can represent an individual phoneme.[80]

The phonological-processin hypothesis attempts tae expone why dyslexia occurs in a wide variety o leids. Furthermair, the relationship atween phonological capacity an readin appears tae be influenced bi orthography.[81]

History

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Dyslexia wis clinically descrieved bi Oswald Berkhan in 1881, but the term dyslexia wis coined in 1883 bi Rudolf Berlin, an ophthalmologist in Stuttgart. He uised the term tae refer tae the case o a yung lad wha haed severe difficulty learnin tae read an write, in maugre o shawin teepical intelligence an pheesical abeelities in aw ither respects. In 1896, W. Pringle Morgan, a Breetish physeecian frae Seaford, East Sussex, published a description o a readin-speceefic learnin ail in a report tae the British Medical Journal titled "Congenital Word Blindness".[82] The distinction atween phonological versus surface teeps o dyslexia is anly descriptive, an wioot ony etiological assumption as tae the unnerlyin harn mechanisms. Houiver, studies hae alludit tae potential differences owin tae variation in performance.[83] Ower time, the consensus haes chynged frae an intelligence-based model tae an age-based model fur dyslexia.[84][62]

Society an cultur

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As is the case wi ony ail, society aften maks an assessment based on incomplete information. Afore the 1980s, dyslexia wis thoucht tae be a consequence o eddication, raither nor a neurological disabeelity. As a result, society aften misjudges thaim wi the ail.[72] Thare is whiles a wirkplace stigma an negative attitude towards thir wi dyslexia an aa.[85] If the instructors o a person wi dyslexia lack the necessary trainin tae support a bairn wi the condeetion, thare is aften a negative effeck on the student's learnin pairteecipation.[86]

Syne at least the 1960s in the UK, the bairn diagnosed wi developmental dyslexia hae consistently been frae privileged faimilies.[87] Awthou hauf o preesoners in the UK hae signeeficant readin difficulties, gey few hae iver been evaluatit fur dyslexia.[87] Access tae some special eddicational resoorces an fundin is contingent upon haein a diagnosis o dyslexia.[87] As a result, whan Staffordshire an Warwickshire proponed in 2018 tae teach readin tae aw bairn wi readin difficulties, uisin techniques proven tae be successfu fur maist bairn wi a diagnosis o dyslexia, wioot furst requirin the faimilies tae obteen an offeecial diagnosis, dyslexia advocates an parents o bairn wi dyslexia wur fearfu that thay wur losin a privileged status.[87]

Stigma an success

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Owin tae the mony cognitive processes that dyslexia affecks an the owerwhelmin societal stigma athort the disabeelity, individuals wi dyslexia aften employ behaviours o sel-stigma an perfectionistic sel-presentation in order tae cope wi thair disabeelity.[88] The perfectionist sel-presentation is whan an individual attempts tae present thaimsels as the perfect ideal eemage an hides ony imperfections.[88] This behaviour presents serious risk as it aften results in mental heal issues an refusal tae seek help fur thair disabeelity.[88]

Resairch

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Writin seestems

Maist dyslexia resairch relates tae alphabetic writin seestems, an inspecially tae European leids.[89] Houiver, substantial resairch is forby available regardin fowk wi dyslexia wha spik Arabic, Cheenese, Hebrew, or ither leids.[90] The ootward expression o individuals wi readin disabeelity, an regular peer readers, is the same in sum respects.

See an aw

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References

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