pediatrics
Dyslexia
Diagnosis of Dyslexia
Reading evaluation Speech, language, and auditory evaluations Psychologic evaluations (See also Diagnosis .) Most children with dyslexia are not identified until kindergarten or 1st grade, when they encounter symbolic learning. Children with a history of delayed language acquisition or use, who are not accelerating in word learning by the end of 1st grade, or who are not reading at the level expected for their verbal or intellectual abilities at any grade level should be evaluated. Often, the best diagnostic indicator is the child’s inability to respond to traditional or typical reading approaches during 1st grade, although wide variation in reading skills can still be seen at this level. Demonstration of phonologic processing problems is essential for diagnosis. Children suspected of having dyslexia should undergo reading, speech and language, auditory, cognitive, and psychologic evaluations to identify their functional strengths and weaknesses and their preferred learning styles. Such evaluations can be requested of school staff by the child’s teacher or family based on theIndividuals with Disabilities Education Act (IDEA), the primary US special education law. Evaluation findings then guide the most effective instructional approach. Comprehensive reading evaluations test word recognition and analysis, fluency, reading or listening comprehension, and level of understanding of vocabulary and the reading process. Speech, language, and auditory evaluations assess spoken language and deficits in processing phonemes (sound elements) of spoken language. Receptive and expressive language functions are also assessed. Cognitive abilities (eg, attention, memory, reasoning) are tested. Psychologic evaluations address emotional concerns that can exacerbate a reading disability. A complete family history of mental disorders and emotional problems is obtained. Physicians should ensure that children have normal vision and hearing, either through office-based screening or referral for formal audiologic or vision testing. Neurologic evaluations may help detect secondary features (eg, neurodevelopmental immaturity or minor neurologic abnormalities) and rule out other disorders (eg, seizures). 