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Medical Contribution to the Management of Dyslexia Arch Dis Child: first published as 10.1136/adc.59.6.588 on 1 June 1984. Downloaded from Archives of Disease in Childhood, 1984, 59, 588-590 Current topic Medical contribution to the management of dyslexia N GORDON, I McKINLAY, AND L ROSENBLOOM Booth Hall Children's Hospital, Manchester and Alder Hey Children's Hospital, Liverpool One child in 6 has a special educational need' and remedial reading classes or special examination dyslexia, defined as a lower literacy ability than arrangements. would be expected from the child's age and general In discussions on dyslexia between representa- level of intelligence, is one of several learning tives of the medical and educational professions in disabilities. Individual children may have more than the United Kingdom, statements have been made one learning disability, for example a perceptual which may easily be misunderstood: 'Dyslexia is not motor or calculating problem as well as a literacy due to intellectual inadequacy or faulty teaching, problem (dyslexia). It would be inappropriate, nor is it associated with emotional or anatomical however, to attribute the range of their learning defects'. The first part of this statement may be true disabilities to 'being dyslexic', which is a confusing if of specific reading retardation, but the validity of common practice. the second part must be questioned. Emotional Delay in the development of reading skills is disorders may not be a primary cause of dyslexia but common among children. In Rutter's study2 over they are often a secondary effect. Acquired dyslexia three per cent of junior school children on the Isle of is caused by a cerebral lesion, often a disconnection Wight had a reading age 28 months less than their of one part of the brain from another. Developmen- chronological age and 10 would have suggested, and tal dyslexia may sometimes be caused by a failure in in another study3 11% of children in one Inner the establishment of neural pathways, a non- London Education Authority were in this category. connection syndrome; and immaturity of neural http://adc.bmj.com/ It is believed that in some inner city schools the mechanisms or focal heterotopias of the cerebral reading age of a third of junior school children may cortex may also contribute to dyslexia in some be two years less than their chronological age. In children. these days when educational resources are limited it is unlikely that a child whose performance falls Role of the doctor within the low average range, despite a higher 10, will generate much concern among education Often when parents are concerned about their authorities whose reluctance to designate certain child's progress they consult their family doctor who on September 29, 2021 by guest. Protected copyright. children as 'special' within the large population with may refer the child to a paediatrician for a further reading problems is understandable. opinion. This request for help should not be If a child is failing to reach expectations, there- ignored. Although the doctor has no expertise in fore, or is competent in oral work but cannot keep educational matters, with the present scarcity of up with the class in written work (reading, writing, services he can contribute to the management of and arithmetic) he may be suffering frustrations children with learning difficulties in the following which present in a number of ways. This situation ways: may be exacerbated if a child has more than one (a) Examination of the child, if possible in the problem; perhaps he is clumsy or has family as well presence of the parent, may show developmental as literacy difficulties.4 The problems these children immaturity in other areas such as coordination. have with literacy and coordination may extend into (b) Vision and hearing can be checked and, if everyday and leisure activities. They may be un- necessary, more detailed testing arranged through popular and lonely or have difficulty planning a community health services. future after school. The predicament has more than (c) Emotional disorders and the ensuing stresses educational implications which may not be resulting from learning difficulties may present in a adequately resolved by excessive emphasis on number of ways. The child may be obviously 58E Arch Dis Child: first published as 10.1136/adc.59.6.588 on 1 June 1984. Downloaded from Medical contribution to the management of dyslexia 589 anxious or depressed in addition to manifesting a the effects of remedial teaching or interceding on variety of symptoms, including headache, abdomi- the child's behalf if for example his behaviour at nal pain, or enuresis. These conditions need medical home has deteriorated after the withdrawal of a interpretation and may sometimes respond to speci- remedial teacher at school. He should include fic treatment. Abnormal behaviour may often result parents in all stages of assessment procedures and if a child's learning disability is not managed with the communication of results to them is of the sensitivity, but both the disability and the behaviour utmost importance.5 He has a significant role to play may be symptoms of a failure of cerebral integra- in interpreting the opinions of experts, particularly tion. Such abnormal behaviour is amenable to those relating to the causes of the learning disabili- treatment by a team approach involving psychol- ties, and he may also be the coordinator of medical ogist, family doctor, teacher, and parents. If the and paramedical services for the child, cooperating child's learning difficulties persist it is easy for the closely with those responsible for educational whole family to be affected and for parents to provision. become increasingly distressed. The opportunity for the parents to talk to someone not directly con- The doctor in the school nected with the provision of education is often beneficial. Discussion with them may indicate how In the United Kingdom clinical medical officers and much of the problem is educational and how much family doctors who act as school doctors should behavioural (both in and out of school) and to what regard the medical assessment of children with extent the child's condition is presented at this time learning and behaviour problems as a specific area because other family tensions are leading to intoler- of expertise and should be identifiable as effective ance or excessive anxiety. Counselling may help the team members within the school.' Much time is family to accept the child with a learning problem, spent screening children for liability to learning rather than emphasise what is 'wrong'. The child is problems without monitoring its effectiveness. as he is; he needs to be accepted as different, but Short, standardised tests with local norms for normal and requiring appropriate teaching. abilities such as the level of coordination, are (d) The doctor can also encourage parents to needed to aid in the assessment of children with discuss the child's progress at school with the head difficulties.6 teacher to work out a joint approach. In the United Kingdom parents do have certain rights relating to Research their child's assessment at school and these have been strengthened in the provisions of the 1981 The doctor can contribute to research on the causes http://adc.bmj.com/ Education Act. and evolution of learning disorders, both genetic (e) The doctor can arrange referral to the and acquired, with a view to prevention. Further appropriate specialist for children who, for example, epidemiological studies are needed and more must have handwriting that is sufficiently bad to raise the be learned about the management, the prognosis, possibility of a neurological disease, or who need a and the role of drugs in children with these scarce resource, such as occupational therapy, which disorders. is only available at specific centres, or who need on September 29, 2021 by guest. Protected copyright. psychiatric help if the emotional aspects of dyslexia Conclusion are severe (such cases are exceptional). There is no clear cut division between the edu- (f) The doctor can encourage parents to seek and cational and medical aspects of developmental or promote enjoyable and fulfilling activities for the learning disorders. The doctor has particular skills child, some of which they may be able to share, and to offer, especially to the child aged under 5 years, to limit their involvement with the child's problems and must be an active member of the team helping to sensible times rather than, for example, before these children. Teams already exist in many parts of bedtime. the United Kingdom and, with few exceptions, they (g) Educational advice from doctors is generally should be community based. inappropriate; and although attention can be drawn A number of different medical disciplines will be to the presence of learning difficulties, there is no working together; paediatricians, paediatric neur- place for 'certifying' dyslexia. The psychologist and ologists, family doctors, clinical medical officers, teacher should be the ones to advise education and child psychiatrists. The medical component of boards on the special needs of these children. The learning difficulties among preschool children is doctor may, however, be asked to act as the child's likely to be particularly important and an initial advocate to the education system, enquiring about referral to the appropriate medical specialist may be Arch Dis Child: first published as 10.1136/adc.59.6.588 on 1 June 1984. Downloaded from 590 Gordon, McKinlay, and Rosenbloom necessary. If learning difficulties first become mani- home environments. It is necessary to view this fest during school years, referral will often be to the situation as a whole rather than to concentrate solely educational psychologist by the teacher or clinical on any particular aspect of it. The doctor is medical officer at the school.
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