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January 21, 2000
Diagnosing Dyslexia
Are you paying attention to your child's learning differences?

photo: J. Kevin Shushtari

Like most children, my daughter Katie loved having stories read to her from a very early age. Many times, as I was falling asleep reading her yet another bedtime story, she would nudge me, saying, "Daddy, read it again!" On a recent family vacation, we entertained ourselves in the car with a Greek mythology cassette collection. It was much too complicated for me; I couldn't keep track of the lives of Helen and Paris, or of the history of Troy. But to Katie, it was an exciting story, and she listened intently throughout the trip.

It came as a surprise several years ago when my wife, Julie, told me she suspected Katie wasn't mastering basic reading. We never doubted she was bright, and although she was frequently anxious at drop-off time, she seemed to love the nurturing private school she attended.

I suppose it should have been obvious from the first grade. We knew Katie had problems with schoolwork, so we sought help from her school. We wanted to believe she was just a "late bloomer" -- apparently, so did her teachers. Katie's homeroom teacher denied that Katie had trouble. The teacher had been fooled into thinking Katie could read because she carried books like The Boxcar Children under her arm and knew the stories well. What the teacher didn't realize was that Julie had read these books to Katie so many times that Katie had memorized the words.

Julie and I became frustrated as Katie grew older. By third grade, she still wasn't getting better, and we still didn't know what was wrong. She had developed compensatory skills that helped cover some of her difficulties at school. She was passing, but she had to put in a lot more studying time than her peers. Lacking any other avenue, Julie insisted that Katie undergo intelligence testing, which confirmed our suspicion -- Katie had superior intelligence but was reading at far below her grade level.

Julie began studying up on dyslexia. We both feared that diagnosing Katie with such a learning difficulty would brand her through school, if not her entire life. Nevertheless, since the private school had no special-needs programs, we decided to send Katie to public school for fourth grade, so she could attend a Special Education class. Her engaging personality and the skills she used to compensate for her learning problems were rewarded with encouragement from her teachers, but it was a difficult time for her. Acutely socially aware, Katie feared that others viewed her as "slow."

Katie's Special Ed teacher was unable to determine her exact learning disability and could not confirm dyslexia. Katie was now 10 years old. Julie and I knew we could not let her progress any further in school without finding out for sure what was going on. If we waited even another year, it might be too late for Katie to learn the skills she needed to catch up with her classmates.

Julie drove Katie to Yale-New Haven Hospital, in New Haven, Connecticut, to be evaluated by experts. The doctors there reviewed her school record, gave her a battery of tests, and interviewed her and Julie. We were told, definitively, that Katie did indeed have dyslexia. Further, they said she would never be a great reader and advised that she go to a special school for dyslexics to learn basic reading skills.

Dyslexia alters the way the brain processes written information. It is a chronic condition that affects an estimated 10 million Americans. The effects of the disorder vary from person to person; the only common trait among dyslexics is that they read at levels significantly lower than others of the same age and intelligence.

Experts agree that people with dyslexia seem to be "wired" differently. They tend to be visually oriented and are often highly creative. Understandably, they excel at hands-on learning. Like Katie, most dyslexics are acutely aware of their environment and are good at practical tasks.

There are several common traits of dyslexics, but in my opinion there is no such thing as a typical case. Because each dyslexic child is unique, it can be difficult to immediately recognize dyslexia. In Katie's case, both the public school and the private school she attended were completely unprepared to diagnose or even fully recognize her difficulties. Often it is almost entirely up to the parents to advocate for their child at school. Parents need to seek out experts who will offer suggestions on how best to serve the needs of their dyslexic child.

Katie is now a happy fifth grader at a special private school for dyslexic children in Austin, Texas. She is mastering some basic academic skills and preparing to be "mainstreamed" back into a public-school setting. One thing Katie's teachers tell her is that she has a "learning difference," not a "learning disability." She understands that and has a good attitude about her unique abilities.

Katie is definitely an individual with a bright future. The other day I told her that Leonardo da Vinci, Albert Einstein, Thomas Edison, Charles Schwab, Whoopi Goldberg, and Tom Cruise were dyslexic. When I mentioned that these people may have become successful because of, not in spite of, their dyslexia, Katie said, "Like, duh, Dad, welcome to reality." Somewhere along the way, this child has become confident and secure about who she is. And as parents, we could not hope for more.

How to Tell if It's Dyslexia

The following is a checklist from the International Dyslexia Association, a nonprofit organization dedicated to the study and treatment of dyslexia.

Characteristics that may accompany dyslexia

  • Lack of awareness of sounds in words -- sound order, rhymes, or sequence of syllables
  • Difficulty with word identification
  • Difficulty spelling
  • Difficulty learning and remembering printed words
  • Errors in naming letters
  • Poor sequencing of numbers and letters either when read or written (e.g., confusing b and d, sign and sing, left and felt, soiled and solid, or 12 and 21)
  • Problems with reading comprehension
  • Difficulty expressing thoughts in written form
  • Delayed spoken language
  • Imprecise or incomplete interpretation of language that is heard
  • Difficulty expressing thoughts orally, such as in finding the "right word"
  • Confusion about directions in space or time (right and left, up and down, early and late, yesterday and tomorrow, months and days)
  • Uncertainty about right or left handedness
  • Cramped or illegible handwriting, or a slow rate of writing
  • Difficulty in mathematics -- often related to the sequencing of steps or directionality or to the language of mathematics

If you think your child is dyslexic:

1. See the child's pediatrician to eliminate any physical explanation.

2. Discuss your concerns with your child's teacher, and request a screening for dyslexia.

3. If the screening is positive, a program of remedial instruction should be implemented based on the following concepts:

  • A simultaneous, direct, multisensory approach that uses visual, auditory, and kinesthetic/tactile methods
  • A high level of structure in all activities
  • A phonetically based program of reading and spelling that teaches the complete sound structure of the language
  • A great deal of repetition and drill in both individual and group instruction

4. Acknowledge your child's difficulty.

5. Accept your child for who he or she is, not for who you feel he or she should be.

6. Encourage your child's sense of self-worth.

7. Accentuate your child's abilities, not his or her disabilities.

8. Provide some structure at home.

9. Help your child with schoolwork.

10. Support and enhance school efforts to help your child.

11. Involve yourself in the local network for families with dyslexic children.

More Information

For a full description of ways to help your child, and to find information on your local dyslexia support groups, email the International Dyslexia Association International Office (, visit their website ( ), call their toll-free number (1-800-222-3123), or write to them at the following address: Chester Building, Suite 382, 8600 LaSalle Road, Baltimore, Maryland 21286-2044.

 J. Kevin Shushtari, M.D., is's Chief Medical Officer and a co-founder of the company. He is also a board-certified internist with a medical degree from Dartmouth College. In Dr. Kevin's Column he will share his own experiences as a physician, a family member, and a patient.