Dr. Jack Fletcher on Dyslexia

Dr. Jack Fletcher

Excerpts from our conversation with Dr. Jack Fletcher, a psychologist who specializes in learning disorders at the University of Houston.

NIHNiH: How do we learn how to read?

Reading is not natural. To develop reading skills, your brain has to reorganize itself. It takes brain areas that are built for language and for visual attention and repurposes them for reading. For a lot of kids, that’s very dependent on instruction. Until you make some active effort to teach a child appropriately, you can’t say that the person has dyslexia.

A lot of kids develop dyslexia because they haven’t received the instruction that their brain needs to learn reading. Dyslexia is not something that you’re born with. You’re born with risk factors: genetic factors and environmental factors. These put your brain at risk, but we can lessen that risk with instruction on reading and on how language works and other approaches.

The goal for people at risk for dyslexia should be to identify it early. We should be screening all kids in kindergarten, first grade, and second grade. Early screening is actually being mandated by legislation in over 40 states now.

We have a lot of evidence that early intervention is effective. Unfortunately, dyslexia is typically identified when the child hits third grade and is struggling in school. They get a diagnostic evaluation, and it finds that they’re reading far below the expected level. At that point, people usually struggle to develop adequate reading skills. If you’ve gone into third grade, and nobody’s identified the problem, it takes a long time and a lot of intensity to remediate the problem. If we do it early, we can really reduce the number of kids who are going to be in that situation.

NIHNiH: What signs can you look for that a child may have dyslexia?

Fletcher: Parents should know their family history and if there’s at least a risk for dyslexia. A lot of kids with dyslexia have early language problems. They don’t develop concepts like rhyming at age 3 or 4.

In kindergarten, having trouble with letter names and sounds is very predictive. There’s a pivotal skill called phonological awareness. This is the understanding that words have internal structures made of phonemes that you manipulate in spoken language. That understanding can be assessed in very young kids and in first grade.

By second grade, the most effective way to screen is simply asking the child to read words. After they’ve been exposed to instruction for a year, they should be able to read. If they can’t read at expected levels, that’s an indication of risk. The first thing that you should do with an at-risk child is to get them in an intervention. Then you monitor the child to see what their progress is and intensify the intervention if they’re not making adequate progress.

NIHNiH: What interventions does a child with dyslexia need?

First of all, reading instruction needs to be explicit and teacher led. There needs to be a significant component that involves phonics. It has to occur in the context of a more comprehensive program. So a good program teaches the child about what we call the alphabetic principle. The idea that the letters on the page represent the sounds of language. That’s something kids absolutely have to learn.

There’s a brain system that’s specifically geared towards that type of learning. It has to be engaged and has to develop in order to support reading. But then kids also need to be able to read efficiently and automatically. That takes exposure to a lot of text and reading. Comprehension is always the goal. So, a good curriculum teaches phonics and works towards reading becoming automatic through practice, and then also has a comprehension component. We call those comprehensive curriculums.

But for kids at risk of dyslexia, the instruction needs to be personalized. You need to look at the individual child, the concepts that they know and that they don't know, and then organize the program to address those weaknesses. That’s usually done by forming groups in the classroom. You’ll typically have groups of kids who are at about the same level. The key is to organize kids into relatively similar groups so that you can really target their individual needs.