Dyslexia, Dysorthography and Dysgraphia

Nature of specific disorders in the acquisition of written language commonly called “dyslexia”, “dysorthography” and “Dysgraphia.

Written language disorders cover learning difficulties in children, which may concern:

• reading (dyslexia);
• spelling and written expression (dysorthography);
• writing (dysgraphia).

This is a specific and significant impairment in reading (dyslexia) and / or in writing and spelling (dysorthography).
These disorders appear from the first moments of learning in the form of difficulty in mastering the so-called alphabetic stage of learning to read.

In the next stage, the disorder manifests as an inability to memorize the visual form of words and to recognize them globally (orthographic stage). This results in a reading that is generally hesitant, slowed down, peppered with errors, which nevertheless required a great deal of effort. Spelling, which normally develops as global word recognition becomes automated, is affected.

The impairment associated with dyslexia is variable in intensity among individuals. It may be accompanied by problems with calculus, motor coordination (and in particular graphics) or disturbances in attention, with or without hyperactivity.
Their association is an aggravating factor.

What is dyslexia

Dyslexia is generally a disorder that involves learning to read. It can take many forms. The dyslexic child confuses certain letters, has difficulty deciphering words, or has a memory that cannot store words in their entirety for flash reading. This process takes place naturally in the later stages of learning to read. Dyslexia affects boys much more often than girls (factor of 3-4 to 1).

Events (appearance)

• Difficulty identifying words.
• Difficulty reading without error and fluently.
• Difficulty breaking up words in a sentence.
• Exaggerated slowness in reading.
• Difficulty in understanding the texts.
• Slow and difficult writing, sometimes illegible (dysgraphia).
• Numerous spelling mistakes, some phonetically plausible, some aberrant.
• Significant fatigue related to reading and writing activity.

Repercussions (aftereffect)

• Poor keeping of school notebooks. Are often incomplete, illegible and incomprehensible, causing difficulty in studying lessons and doing homework.
• Reading and writing difficulties preventing natural access to information.
• Lack of taste for reading and writing.
• Learning difficulties in many subjects: literary subjects are the most affected, science subjects too can be affected by the difficulties
understanding of the statements.
• Problems understanding written exam papers, producing a readable and correctly spelled copy, and time spent writing.
• Academic results not commensurate with the efforts made.
• More difficult schooling with the risk of repeating a year, interruption of schooling or orientation towards less ambitious training than his intellectual capacities would be entitled to authorize.
• Difficulty managing situations where it is necessary to read or write (CV, classified ads, job tests, etc.)
• Psychological weakening.
• Decreased self-esteem.

Dyslexia and dysorthography: what are they?

Dyslexia and dysorthography are learning disorders (DYS) that affect children and do not affect the point of intelligence, nor that of psychological balance. They are manifested by difficulties in reading and writing. They must be distinguished from temporary delay in acquisition, because dyslexia and dysorthography are lasting disorders. Once the diagnosis has been made, it is unfortunately not possible to cure dysorthography or dyslexia. In order to mitigate the consequences of the disorder, the child is followed by a speech therapist.

What is dysorthography

As the name suggests, dysorthography is a writing disorder. It manifests itself by letter inversions, numerous spelling, grammar and conjugation errors, incorrect splitting of words, concerns about distinguishing homophonies (court / court), etc. Dysorthography is in the majority of cases the consequence of dyslexia, although there are rather rare cases of children with dysorthography and who do not have reading problems.

Difference between dyslexia and dysorthography

In conclusion, dyslexia is a reading disorder while dysorthography is a writing disorder. In a dyslexic child, dysorthography is almost always manifested, more or less severe depending on the case. The diagnosis is made via a speech therapy assessment. The child must be followed in order to mitigate the impact of these DYS disorders.

Why?

Several explanatory hypotheses have been evoked with multiple scientific researches, currently the two hypotheses most often retained are:

– the phonological hypothesis, recognized by the entire scientific community, according to which dyslexic and / or dysorthographic children have phonological and metalinguistic skills significantly lower than those who read normally. These capacities (phonological awareness, verbal fluency, rapid naming, verbal memory, metaphonological tests, etc.) are predictive of the level of learning of written language.
– the visuo-attentional hypothesis evokes the presence of difficulties in perceiving movements and rapid information, visual disturbances of contrasts, saccades and anarchic eye fixations. In addition, attention in reading must be focused selectively and successively on each word to enable identification procedures. A visual-attentional dysfunction would be responsible for a poor distribution of attention on the sequence of words to be identified.

What symptoms and what consequences?

Dyslexias are always associated with transcription difficulties (dysorthographies). For the clarity of our presentation we will describe separately the different types of errors, first in reading and then in spelling. It is necessary to carry out a precise classification of errors and to compare the child’s performances with age and / or class standards, thanks to standardized assessments.

1) Clinical description of dyslexia:

a) Dyslexic disorders in decoding
– hearing errors: confusion between close sounds (t / d, k / g, f / v …), omissions (table -> tabe), additions in consonantal associations (gate -> geta)…
– visual errors: visual confusion between identical graphemes but oriented differently in space (b / d, p / q, u / n …), visual confusion relating to the number or height of jambs (m / n, h / n …), confusion between graphemes having common visual features (f / t, ℓ / h, E / F, C / G …), poor overall word recognition with visually similar word substitutions (apple tree / firefighter), omissions or substitutions of tool words (determinants, prepositions …)
– sequential errors relating to the order of succession of graphemes: at the level of indirect (ohme -> home) or complex syllables (by -> yb), at the level of words (sleep -> splee, sad -> das)
– visual-attentional errors: visually close substitutions of words (sit down -> try) or morphological ones (flew away -> fly away), omissions, additions, substitutions of words and tool words, line breaks
– errors due to non-compliance with the contextual rules managing variations in pronunciation of certain graphemes: “g”, “c”, “s”, “y”, “er”
b) Reading comprehension problems
In certain forms of dyslexia, accuracy may be respected but there are difficulties in accessing the meaning of the written message.

2) Reading procedures:

The classification of dyslexia is based on Coltheart’s dual path model which postulates the existence of two written word recognition procedures:
– the phonological procedure (analytical, indirect way or way of assembly) which consists in the conversion of a sequence of letters into a sequence of sounds, followed by an operation of phonemic fusion allowing the reading of the word. This channel allows the reading of words encountered for the first time and of non-words;
– the lexical procedure (orthographic, direct route or addressing route) allows visual recognition of a word and its matching with its orthographic form stored in our “internal” lexicon. This route can therefore only deal with words already encountered, called “familiar” words, the representations of which have been memorized beforehand.

3) Clinical forms:

* phonological dyslexia: the impairment is located at the level of the phonological pathway. The mastery of the grapheme-phoneme conversion rules is deficient with type errors: substitutions, scheduling errors, lexicalizations of non-words (“chein” read “dog”). In contrast, the reading of familiar regular and irregular words is relatively preserved.
* surface dyslexia: by involvement of the lexical way. Global visual recognition of words is deficient and reading is mainly based on phonology: each word is laboriously deciphered, resulting in significant slowness. We find regularization errors for irregular words, eg “tool” read “tool”; on the other hand, the reading of regular words and non-words is relatively preserved.
However, the majority of children do not present such pure patterns and have impairment of both reading pathways corresponding to mixed dyslexia.
* Visuo-attentional dyslexia: the impairment is located at the level of the visual analysis or recognition system leading to visual-attentional errors, as well as word and line skipping, poor eye scanning, backtracking and deterioration during reading.

Dysorthographies are associated with developmental dyslexia with essentially two profiles parallel to the dyslexia profiles:
– Phonological dysorthography with difficulties in using phonological mediation (difficulties in dictating non-words while the performances for known words are relatively preserved – relative acquisition of the usual spelling – numerous grammatical errors)
– Surface dysorthography with a very low usage spelling

4) Clinical description of dysorthographies:

Transcription errors can be classified into 4 categories:
a) Phonological transcription disorders testifying to difficulties of conversion between the heard phoneme and the transcribed grapheme: auditory errors by substitutions between close sounds (deaf / sound confusions: grumbling -> rumbgling…), by assimilations (knowing -> kowning…) or by word substitutions (path -> path, the -> the …); visual errors (path -> paht…); inversions (seven -> svene…); errors in the phonological code due to non-compliance with combinatorial rules or by ignorance of complex spellings (ill, gn, oi …); annunciation errors: “Four Egos” “Before He Goes.
b) Problems at the level of semantic control: homophone error (level > levle).
c) Disorders at the level of morphosyntactic skills: confusion between grammatical categories (to feed them -> to feed tehm…); difficulties in the use of syntactic markers, whether at the nominal level (gender, number), at the verbal level (suffixation, pronominal, temporal, modal).
d) Problems relating to the spelling lexicon with poor memorization of the spelling used even for familiar and frequent words.

Diagnostic

The diagnosis is based on the speech therapy or phoniatric assessment but in many cases it requires a multidisciplinary assessment (neuropediatric, neuropsychological, psychological, psychomotor …) in order to confirm the specificity of the disorders and possibly to carry out a differential diagnosis: delay in reading and spelling falling within the framework of a global delay, primary psychological disorders … all difficulties which must also be taken into account.
The speech therapy assessment consists of an anamnesis and an assessment using standardized tools allowing clinical diagnosis and classification.

The assessment will focus on oral language skills, reading prerequisites (phonological awareness tests, visuo-attentional tests, etc.), reading and spelling assessments as well as memory and attention skills.
Additional explorations: audiogram, orthoptic or occupational therapy assessment, etc. may also be carried out depending on the symptoms found.

Faced with the persistence of severe difficulties, recourse to the Reference Centers for Learning Disorders allows, through multidisciplinary evaluations, to refine the diagnosis, to specify the severity, the specificity of the disorders, to look for any associated deficits and to guide the modalities of rehabilitation and school care.

Processing

The care almost systematically involves speech therapy in a private practice, in a hospital or in a specialized establishment… This must be as early and regular as possible, on average two weekly sessions, in individual care.
Speech therapy techniques are specific and adapted to the clinical type aimed at strengthening the preserved capacities and developing the deficient capacities.
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When to pay attention?

Early detection of these disorders is fundamental involving both health professionals (PMI doctor, school doctor, pediatrician, etc.) and the teaching staff.
For this, health professionals can use screening tools: EVAL MATER (Assessment in kindergarten – 3-4 years) and BSEDS (Health Assessment Assessment of Development for Education), ERTLA6 (Identification test for language disorders and Learning at 6 years old), BREV (Rapid Cognitive Function Assessment Battery) ODEDYS (Dyslexia Screening Tool).

The warning signs in kindergarten:

– persistent oral language disorders (phonological disorders, lexical and syntactic poverty, speech and / or language delay, etc.)
– difficulties in sound analysis, handling, rhyming judgments …
– psychomotor disorders (poor spatio-temporal orientation, awkward graphics, mirror writing, psychomotor instability …)
– attentional and / or memory disorders.

The call signs in primary and later:
– no automation of reading after 6 months of CP
– persistence of confusions, inversions, omissions … Sometimes non-recognition of letters
– difficulties in copying, spelling
– reading comprehension problems
– child in school failure, better at oral and maths, slow, tiring …
– gap or mismatch between the child’s thinking skills and what he expresses in writing

How to improve the school life of dyslexic and dysorthographic children?

School facilities:
Treat for dyslexic children in the same way as for any disabled child:
– ensure the pupil, as often as possible, regular schooling as close as possible to his home;
– closely involve parents in their child’s orientation decision and at all stages of the definition of their personalized schooling plan (P.P.S.);
– guarantee the continuity of a school path, adapted to the skills and needs of the pupil;
– guarantee equal opportunities between disabled candidates and other candidates by providing a legal basis for the adjustment of examination conditions.

Dyslexic children may benefit from school arrangements both in their daily schooling and for the passing of controls and exams (additional third time for the Brevet des colleges, the Baccalaureate, etc.).

Two types of measures maybe requested by families from the school:

– the Personalized Schooling Project (PPS): it is aimed at pupils recognized as disabled by the CDA (Commission of Rights and Autonomy) coming under the MDPH (Departmental House of Handicapped Persons). It allows the implementation of schooling arrangements (support during school time), educational arrangements (school relief, photocopies of courses), the allocation of suitable equipment (computer …) and the obtaining third-party overtime …
– the Individualized Reception Project (PAI): internal system of the establishment allowing school arrangements (re-educational support during school time, educational arrangements possible with the agreement of the educational team, etc.).

Some examples of the aid maybe offered:

– read the statements and / or rephrase them to ensure that the instructions are understood;
– promote oral assessments as soon as possible (mainly for foreign languages ​​which remain difficult to learn for dyslexics);
– do not penalize for spelling
– provide a personalized assessment, no notes for dictations but a scoring system allowing him to judge his progress.
– use hole exercises, multiple choice questions …
– provide photocopied, ventilated, highlighted courses, with emphasis on the essentials
– promote listening and mobilization of attention on the content of the course in class
– reduce the number of exercises during checks and for homework
– teach him to organize his work, to plan …

We must recognize the child’s difficulties, give him time, value her/him, put him in confidence…

What is Dysgraphia?

Dysgraphia is a set of difficulties commonly seen in school. The child coordinates his gestures poorly, he is embarrassed in graphic exercises: he has difficulty writing his first name, has slow or illegible handwriting, is reluctant to draw, color and is not attracted to manual work. His work gives a neglected impression, because he organizes his page badly, his writing lacks fluidity. Disturbances in tone are also often associated with dysgraphia.

Classification

There are three known subtypes of dysgraphia: dyslexic dysgraphia, motor dysgraphia, and spatial dysgraphia. In general, little information is available on these different types of dysgraphia. Some children might associate more than one of these subtypes.

Dysgraphia is often accompanied by other learning disabilities such as dyslexia or attention deficit disorder.

There are several types of dysgraphia:

• clumsy dysgraphias;
• crisp dysgraphias, if the writing is stiff and the line tense;
• soft dysgraphias, if the writing lacks hold, especially with irregular letters;
  impulsive dysgraphias, if the child writes quickly to the detriment of the shape of the letters which lose all structure;
• slow and precise dysgraphias, in which, unlike impulsive dysgraphia, the patient manages to write correctly by providing very important efforts which are exhausting; the writing is then excessively applied and precise.

Dysgraphia can also have several origins:

• poor gesture when holding pencil during childhood, sometimes due to dyspraxia;
• general motor difficulties (poor perception of body pattern), laterality problems or poor posture;
• difficulties in reproducing letters, which is observed in particular in the event of visual disturbances (difficulties in positioning oneself in space);
• visual impairment (in children it is mainly disorders of oculomotor coordination);
• the writer’s cramp;
• pathologies such as Dupuytren’s or Parkinson’s disease;
• psychological immaturity (lack of self-confidence, family problems, etc.) with the establishment of a vicious circle that slows down or even prevents learning to write;
• sometimes dyslexia which is generally associated with dysorthography (especially if the child is trying to speed up the pace of his writing);
• a trauma.

Diagnose

To diagnose the disorder, it is necessary to carry out an assessment in a speech therapist. Generally, additional examinations are also carried out with various specialists: pediatrician, neurologist, psychomotor therapist, occupational therapist…

Treatment

The care is indeed multidisciplinary. It notably involves a speech therapist, a psychomotor therapist and an occupational therapist who work together to treat the dysgraphia. The essence of the treatment consists in allowing the patient to relax in order to achieve control of his actions. For this, we offer: graphic exercises and / or adapted games.

It is also a question of working on the other weak points of the dysgraphic:

his posture;
fine motor skills;
the writer’s outfit (pen, pencil);
the formation of letters.
The emphasis is on the quality of the writing more than on its quantity, in order to enhance the child and thus motivate him.

Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.

Sources: PinterPandai, National Center for Biotechnology Information, Understood, Lexercise, Barnsley College