Reading Disabilities

Types of reading difficulty

Diagnosis

Treatment

BIBLIOGRAPHY

The failure of some children to learn to read as easily or in the same manner as their peers has been a persistent educational problem that has caused much heartache to the children themselves, attracted much attention from research workers, and provoked much controversy in educational circles.

Estimates of the number of children who have severe difficulty in learning to read vary from country to country and from investigator to investigator, depending largely upon the way that disability is defined. In general, such estimates run from 5 to 20 per cent. Boys outnumber girls three to one. Although fewer difficulties are reported in countries where the language is phonetic than in countries where the language is less regular, even in such countries there persists a small hard core of children with difficulties. Accurate estimates of incidence are often clouded by inadequate diagnosis; children who have reading difficulty may be considered merely unintelligent or careless workers.

It is customary in a discussion of reading difficulty to exclude those children who are genuinely mentally retarded, who are partially sighted, hard of hearing, have gross neurological impairment, or are psychotic. Obviously, differences in these areas are of degree, and distinctions are difficult to make. Valuable insights for the teaching of less-handicapped children have come from work with the severely handicapped.

Types of reading difficulty

It is possible to identify a number of different types of reading difficulty, although there is much overlap among the types.

“Simple” reading difficulty

First, there is what may be called the simple type. This appears in a child who is of normal intelligence, who has no serious physical or emotional problems, whose home background is reasonably stable, and whose background experiences enable him to comprehend the ideas presented in school but who may have slight difficulty in one or more of these areas and who may have received instruction that was inadequate or interrupted by illness or by changes of schools, teachers, or methods of teaching. If, for example, a child has only low average ability, or has a minor visual problem, or although not seriously disturbed is timid and feels incompetent, or comes from a home that, although stable, does not value education, or has had only minimal experiences that help him understand his reading, or has any other slight but significant handicap, he may encounter trouble unless he has had superior instruction in reading from the beginning. It is almost as if he can carry a reasonable burden of stress until there comes “the straw that breaks the camel’s back.” To call this type of difficulty simple is perhaps misleading; with its intricately interwoven threads it is highly complex. But it is possible to unravel the threads with relative ease.

Experiential inadequacies

A second type of difficulty, which may be called experiential, has its roots in the differences between school and home. When a child comes from a home that in its values or its patterns of language and behavior is markedly different from the school, he is likely to have difficulty in school in general and in reading in particular.

Language differences

Many children do not speak the language spoken at the school they enter. They may speak a truly different language, a foreign or a tribal language, or they may speak a vernacular or dialectal form of the school language. Their ears may not be tuned to the speech patterns of the teacher; they may not be able to identify the sounds used for the letters. They may not, for example, be able to discriminate between the English sounds “th” and “d.” If many of the children face the same problem and if the teacher takes time to lay a foundation in the spoken language before moving to a formal reading program all may be well. But if the child, who does not even realize his problem, is left to flounder he may fall farther and farther behind. Slow reading even at the college level may spring from a persistent unfamiliarity with the language patterns [seeLanguage, article onspeech pathology; Perception, article onspeech perception].

Lack of preparation for reading tasks

In addition to his problem with the language of the school the child may face tasks and ideas for which his experience has not prepared him. He may have had few stories told or read to him and may not have skill in following a plot. He may have lived a very restricted and isolated life and not know through experience what, for example, a city, or lake, a mountain, or a clown is like. True, he will ultimately use books to expand his horizons, but in the beginning stages of reading he needs to know concretely the referents for which words stand. This lack of a foundation of concrete experiences on which to build the ideas met in reading handicaps many learners. This handicap, too, may persist for many years and contribute to the poor comprehension of many high school students.

Lack of familiarity with school values

Unfamiliarity with the values of the school may contribute to reading difficulty. Sitting still, carrying tasks through to completion, talking about events and one’s reactions, listening to others—all are skills the child from certain kinds of homes may not have. Certainly he will be handicapped.

Emotional pressures

A third type of difficulty springs from the emotional pressures under which the child may be living. If he has fears that he will fail, that he is no good, that he will lose his parents, that his siblings are more competent, or that fate is unjust, his energies will be unavailable for learning. Sometimes reading may represent one area in which a youngster may be master; no one can make him be a successful reader. These and other disturbing feelings may be the major contributing factor to the difficulties of certain children.

Neurological dysfunction

Still another type of reading difficulty can be identified—one that has as its source neurological dysfunction. This type of difficulty has been called dyslexia, word-blindness, and primary reading difficulty. Often children suffering from this type of difficulty are divided into two categories: those whose history and neurological examination show brain injury, however minimal the impairment; and those whose history and examination are essentially negative but whose generalized language problems presuppose some kind of neurological dysfunction. In general, children in both categories may test in the normal or even superior range on an intelligence test but may show marked discrepancies between subtest scores. They have particular difficulty with perceptual-motor tasks, such as copying geometric figures, and with concepts of time, space, and distance.

The academic performance of these youngsters is often highly erratic; their work may be excellent in mathematics and poor in spelling and reading. They may have been late talkers or have some history of speech difficulty. They may have poor auditory discrimination. Their handwriting is often slow, labored, and inferior. They may be awkward, poorly coordinated, and lack manual dexterity. Sometimes, although not always, they have trouble with direction, confusing right and left. They are frequently hyperactive, impulsive, and distractible. Perseveration may mark their performance. The children in the second category show fewer of the above difficulties than do those where the damage is identifiable. Indeed, their difficulties may be restricted to the language areas with, possibly, some directional difficulty. All children do not show all the above characteristics.

Effects of types of difficulties

The reading performance of the child reflects the type and source of the difficulty, whether poor instruction, experiential inadequacy for reading, emotional tension, or neurological dysfunction. The reading of the child with a “simple” reading difficulty may reveal the gaps in his instruction, such as having missed many days of school in the first grade. He may, for example, know a good deal about syllabication but not know the sounds of the initial consonants; or his reading errors may show no specific pattern but his general performance be like that of a younger child.

The reader whose major difficulty comes from lack of experience or from a discrepancy between the values of home and school is likely to have particular difficulty with comprehension, although he will probably have difficulty with new words as well and may appear uninterested in books and stories. His general academic achievement in other subjects, too, is likely to be poor.

Emotional tensions reveal themselves in many ways: in inability to concentrate; erratic test performance; discrepancy between test performance and school achievement; slow, inflexible, overly precise approach to all reading tasks; blocking at certain words; and in an apathetic, bored tone or an anxious, tense one. Any of these difficulties may, of course, have causes other than emotional tension.

The child whose difficulty is of neurological origin may show a variety of reading characteristics. He may reverse words or letters in reading and spelling, writing lithg for light or reading on for no. He often guesses at words on the basis of first letter. He can discriminate between two similar words if both are in front of him, but he cannot retain a visual image of a word. Vowels and the blending of letter sounds often give him difficulty. Most frustrating to his teacher is his tendency to know a word on one line and miss it on the next. Surely he is just careless! The sloppy nature of his written work adds to this picture. “He could do it if he tried,” claims the parent or teacher who does not understand his problem.

Diagnosis

It is easier to identify in theory the sources of difficulty and to differentiate between the types of behavior and performance shown than it is to make a differential diagnosis in practice. There is much overlap among types, and the diagnostic tools are crude. An adequate developmental history is of the greatest importance. School reports and records and tests of vision, hearing, and intelligence are useful. Tests to identify perceptual-motor difficulties or memory defects are not readily available or highly refined. Often the clinician must rely on subjective impressions and on informal appraisals. Much improvement in these measuring devices can be expected in the next few years.

Diagnosis of reading difficulty involves a survey of the child’s general level of reading skill and of his specific strengths and weaknesses in reading. The diagnostician wants to know how much and what kind of reading he does, whether he knows the phonetic elements of the language, whether he can and does use this knowledge to decipher unknown words. It is important to know, too, his reading speed and his competence in such comprehension skills as skimming, getting the main idea, or picking out the important details. An analysis of the errors he makes often reveals gaps in his knowledge and sheds light on his mode of attack. Among older children, a comparison of performance on timed and untimed tests will reveal the painfully slow but accurate reader and the one who cannot understand the material no matter how much time he has. Observation and examination of the child’s errors are as important as test scores in appraising performance.

Treatment

When the nature of the child’s difficulties and their probable sources have been determined, the method of treatment then needs to be considered. Too frequently some one remedial technique has been advocated almost as a “magic” cure-all. This search for a panacea may be touching in its naivete, but it has been fruitless and even dangerous. There is no one form of treatment that will help all children with difficulty. Too often children have had years of remedial help with few or no positive results. This is not because of the child’s inability to learn; even seriously handicapped children can make slow but steady progress. Too often it is because the techniques and materials have been chosen with little regard for the child’s needs as revealed by his performance and behavior.

Since most children with reading difficulty have met much failure and since the acquisition of reading skill is an important developmental task of childhood, one of the most important elements in treatment is success. The task must be broken down into such small steps and the child given so many clues to follow that he can hardly fail to respond correctly. False praise does not help him; real success does. All the teacher knows about human learning and about pedagogy will be of service in a remedial program.

Specific approaches

Beyond the application of general techniques of teaching, certain specific approaches seem effective with certain types of difficulty. For the child whose difficulty springs from poor or inadequate instruction, careful pinpointing of his gaps in knowledge, followed by systematic instruction with interesting material, is usually sufficient. For the child whose experiences are limited and whose motivation for learning is insufficient, it is often necessary to provide evidence that reading skill is useful. Helping him to read material that will enable him to do something he wants to do, for example, make a model plane or a batch of cookies, may spark his interest. It is wise to avoid abstract, dull practice material that savors too much of school, in which he has failed and the value of which he often does not see. Allowing him to dictate stories of his own experiences and using these as the basis of instruction has also been found useful. Practice in all forms of language usage—listening and talking as well as reading and writing—is essential.

Psychotherapy

For the child whose difficulty springs from emotional tension a variety of techniques have been tried. Some form of psychotherapy, preceding or concurrent with special reading instruction, is often effective. Too often, however, psychotherapists have urged remedial teaching for a child before he is emotionally ready to profit from it. Such unwise haste often adds another failure to the child’s already crushing burden. Conversely, some psychotherapists have acted as if the child would be able to read as soon as he felt better about himself and others. Sometimes “magic” does seem to happen, but more often psychotherapy only makes it possible for the child to use his energies in learning—he must still be taught.

Treatment of the dyslexic

Of all types of difficulty, those springing from neurological dysfunction require the most carefully planned treatment. For the dyslexic child, especially, remedial treatment that does not work is harmful, leading to confusion and distraction. It is fortunate that many of the methods needed to work with the dyslexic youngster are also useful with the child whose problems stem from emotional pressure. The latter child will need some supplementary enrichment of the remedial program and can better tolerate violations of the general principles of learning.

In treatment of the dyslexic it is essential to keep in mind the nature of his difficulties. He has difficulty with perception; he therefore needs instruction that will focus on the specific perceptual task. He needs to have his attention drawn to the details of the word. He needs much practice in noting the differences between words; for example, in differentiating between get and got. Since he may have difficulty with auditory discrimination as well as with visual perception it is often helpful to use a multisensory approach, having him write or trace the word as well as say it. Such practice also focuses on details.

The dyslexic tends to repeat his mistakes; it is important for the teacher to set up situations in which he does not make mistakes. This is done, in part, by dividing the task into very small elements and presenting these so gradually that it is difficult to make a mistake. It is also done by providing a word for him as soon as he hesitates. The dyslexic child needs to be able to use his phonic skills rapidly and automatically. Slow, laborious sounding out defeats its purpose.

Since the dyslexic child is easily distracted and confused, materials should be simple, uncluttered, and based on skills he already has. Encouraging the dyslexic child to jump into materials that are much too difficult for him is disastrous. He does not swim; he sinks. He seems to lose even skills he previously had. In addition to his difficulty in reading, the dyslexic also often has trouble with spelling and handwriting. Too many written exercises based on his reading may be discouraging.

Treatment programs

Instruction tailored to the child’s type of difficulty and specific needs can be provided under several organizational patterns. One fruitful practice involves the early identification of children who may have trouble and the planning for them of a preventive program. This has been done for the experientially deprived and for the potentially dyslexic. Such a program has the obvious advantage of eliminating the depressing failure so often experienced by these children. Individual instruction, perhaps over a period of years, is the most effective pattern of help for dyslexics. This can be done within the regular school setting or outside the school in a clinic or by a private practitioner. At the beginning stages these children rarely function well in a group; hence, even in a classroom teaching must be individualized.

The most widespread pattern of treatment for all children with reading difficulty has been the small remedial group, meeting three to four times a week in school but outside the regular classroom. For children with gaps in their past instruction and for those of deprived cultural background, and for some emotionally troubled children, such groups have been effective if the group was small enough, the instruction intensive, coordinated with classroom work, and continued for a long enough period of time, and the teacher sensitive and flexible. When these conditions have not been met, and when dyslexics and seriously disturbed children have been included, the remedial group has been minimally effective. A good program of treatment provides for both individual and group help as each seems appropriate. Besides remedial treatment provided in schools, a number of social agencies, courts, and individuals offer supplementary services.

Materials used in treatment

Materials used in the treatment of reading difficulty are many and varied, ranging from teacher-made games and exercises to rather elaborate instruments providing tachistoscopic training. The materials themselves are of less importance than the way they are used. There is no magic in one kind of exercise, one type of vocabulary control, one organization of skills. The secret of successful use of materials lies in selecting those appropriate to a certain child with a certain type of difficulty. The colorful, delightfully illustrated, amusing book that catches the attention of the culturally deprived ten-year-old may only confuse, distract, and overwhelm the child with slight neurological damage. The phonic exercise book may provide structure for a disorganized child but bore or defeat one who dislikes school. Machines that compel the reader to proceed more rapidly than usual may goad one college student on to more rapid reading and frustrate and annoy another. Appropriateness is the key to successful selection of materials.

A technical society cannot afford to have a group of unemployable, inadequate readers. As the pressure for trained manpower increases, increased effort must be made to provide treatment for all children who have difficulty in learning to read.

Anne McKillop

[Other relevant material may be found inDevelopmental psychology; Intelligence and intelligence testing; Language, article onlanguage development; Learning, article onneurophysiological aspects; Mental retardation.]

BIBLIOGRAPHY

Bond, Guy L.; and Tinker, Miles A. 1957 Reading Difficulties: Their Diagnosis and Correction. New York: Appleton.

Bryant, N. Dale 1962 Reading Disability: Part of a Syndrome of Neurological Dysfunctioning. Pages 139-143 in International Reading Association, Conference Proceedings Volume 7: Challenge and Experiment in Reading. Edited by J. Allen Figurel. New York: Scholastic Magazine Press.

DeHirsch, Katrina 1961 Reading and Total Language Disability. Pages 211-214 in International Reading Association, Conference Proceedings Volume 6: Changing Concepts of Reading Instruction. Edited by J. Allen Figurel. New York: Scholastic Magazine Press.

Ephron, Beulah 1953 Emotional Difficulties in Reading. New York: Julian Press.

Gibson, Eleanor J. 1965 Learning to Read. Science 148:1066–1072.

Harris, Albert J. (1940) 1961 How to Increase Reading Ability. 4th ed. New York: McKay.

Harris, Irving D. 1961 Emotional Blocks to Learning. New York: Free Press.

Johns Hopkins Conference on Research Needs and Prospects 1962 Reading Disability: Progress and Research Needs in Dyslexia. Baltimore: Johns Hopkins Press.

Kawi, Ali A.; and Pasamanick, Benjamin 1959 Prenatal and Paranatal Factors in the Development of Childhood Reading Disorders. Monographs of the Society for Research in Child Development, Vol. 24. Lafayette, Ind.: Child Development Publications.

Pearson, Gerald 1954 Psychoanalysis and the Education of the Child. Part 2: Ego Psychology and the Education of the Child. New York: Norton.

Rabinovitch, Ralph L. 1959 Reading and Learning Disabilities. Volume 1, pages 857-869 in Silvano Arieti (editor), American Handbook of Psychiatry. New York: Basic Books.

Riessman, Frank 1962 The Culturally Deprived Child. New York: Harper.

Roswell, Florence; and Natchez, Gladys 1964 Reading Disability: Diagnosis and Treatment. New York: Basic Books.