Views on Vision - by Dr. Charles A. Boulet

(Page 6)

What Is A Reading Disability?


What is a reading disability? Is this an imaginary thing? It seems with each passing year, school resources are stretched ever further to accommodate and treat children with reading problems. Likewise for post-secondary institutions.
While there is a difference between a 'learning disability' and a 'reading disability', reading today IS learning. That is, for the most part, instruction (teaching) is based on transmission of knowledge and understanding through printed text (paper, electronic, or in any other form). Furthermore, for the most part, learning (student understanding and retention of knowledge) is assessed through primarily text-based means such as written exams, essays, and so forth. So it follows that any block to reading is an impediment to learning in the traditional classroom.
In clinic, we distinguish between a reading 'impediment' and a reading 'disability'. Both can be defined as factors that impact negatively upon reading (learning). The difference, however, is that impediments can be overcome given the right circumstances. A disability, on the other hand, is permanent and intractable.
There are many definitions of 'reading disability', but the primary reference for most physicians in this area, (the DSM-IV-TR) defines 'Reading Disorder' as requiring three criteria (paraphrased):
A.    Reading achievement is substantially below that expected on standardized tests, given the person's age, measured intelligence and age-appropriate education.
B.    The disturbance in 'A' significantly interferes with academic achievement or activities of daily living that require reading skills.
C.    If there is some other physical/medical problem present, the reading difficulties are in excess of what is usually associated with it.
Put another way, we might say dyslexia is a severe delay in reading in an otherwise normal child - in spite of the efforts of parents, teachers and doctors. (We'll focus on school children for the time being, though adults are equally impacted by reading difficulties.)
When it comes to dyslexia, there are more questions than answers. Even the definition itself is constantly evolving and in perpetual dispute. However, we do know some things. For starters, not all children with a 'severe delay in reading' have dyslexia, even though they may have been diagnosed (labeled) with dyslexia.
Some estimates suggest between 5% and 10% of the population is affected by dyslexia, but this figure depends on how dyslexia is defined, how it is tested, and who is doing the assessments (motive and training are important factors for anyone assessing dyslexia). These estimates are high, I feel, and reflect more accurately the number of people who have trouble learning to read AND those with dyslexia, as opposed to those with pure dyslexia alone. Dyslexia, true dyslexia, is exceedingly rare. But regardless of the accuracy of the diagnosis, virtually all children with a dyslexia diagnosis receive ongoing remedial training in and out of school at great expense to taxpayers and parents, and potentially great costs to the child's self-esteem.
Frequently, assessments of reading ability and acquisition are fairly narrowly focused on the act itself - is this child having trouble reading? If the answer is 'yes', then we can simplify our lives as parents and healthcare professionals by applying a diagnostic label (dyslexia) and put our faith in science to come up with a solution. (Indeed, some researchers have suggested that different medications might solve things in a tidy and easy-to-administer solution for parents, teachers, doctors and school administrators). In focusing our attention this way, we tend to view reading disability as the problem (or the 'disease', to take a western medical viewpoint) and not an artifact or 'symptom' of other intruding factors or disease. Furthermore, by ignoring the elephant in the room (the possibility that dysfunctional reading is not dyslexia), we miss out on the opportunity to solve the immediate problem - the fact that the child is having trouble learning to read due to some modifiable reason.
If you treat it and it disappears, was it really there to begin with? There are many reasons why a child might have trouble learning to read. If you eliminate these factors and the child can now keep up with their peers, then the dyslexia diagnosis is obviated - except, perhaps, as a means to permit the continuation of remedial therapeutic care.
In the next article in this series, I will look at a number of reasons why children have difficulty learning to read, including dyslexia.


Dr. Boulet is an optometrist and owner-operator of Diamond Valley Vision Care in Black Diamond (403-933-5552 or info@dvvc.ca.) He is also a former high school teacher and continues to work with children who have trouble learning.