Current Status of Treatments for Dyslexia: Critical Review

Ann W. Alexander, MD; Anne-Marie Slinger-Constant, MD

Disclosures

J Child Neurol. 2004;19(10):744-758. 

In This Article

Summary

Although treatment studies have shown that the majority of children respond to evidence-based treatment interventions, there are still a significant number of children who are resistant to treatment. They are the challenges for future research and the children who require more comprehensive evaluation and individualized interventions. As described by Heilman and Alexander,[43] although appropriate language intervention is the key component in the treatment plan for the child with oral and/or written language impairments resulting from a faulty foundation in the phonologic system, other factors must be considered for optimal outcome. The child's attention, working memory, and executive functions must be assessed and treated optimally. Sensorimotor deficits, including dysgraphia, can impact skill acquisition and should also be remediated. The linguistic and social emotional environments at home and school must be evaluated and addressed with treatment if necessary. Is there evidence of an associated psychiatric disorder? (Considering the high degree of comorbidity between attention-deficit hyperactivity disorder [ADHD], mood disorders, and anxiety disorders, a careful assessment of the child's psychologic and emotional status is often extremely important. The reader is referred to the article by Sundheim and Voeller in this issue.[73]) Related to this is the child's ability to persevere in the face of frustration, which is an extremely valuable asset. Some children are born with that trait, others have to be encouraged to develop it, and some have decided that they will never learn to read and have given up. Reinforcement of the appropriate work ethic will allow the child to become successful in spite of being less dextrous with language, fine motor skill, or organizational abilities. Compensatory accommodations should be considered; does the child need more time, a quiet room for test taking, an FM amplifier, a scribe, a voice-activated word processing program, or Books on Tape from the Library for the Blind and Dyslexic?

A child's language development is a dynamic process. The clinician's challenge is optimally tracking this process, identifying deficits that can hinder optimal acquisition of critical language skills, and guiding interventions to address them. The clinician should continue to monitor progress even after intensive treatment has moved a child's performance into the average range. Behavioral and imaging studies have demonstrated that the newly strengthened language systems might continue to have subtle weaknesses that might impede acquisition of the skills called for at the next level. The same process of assessment and thoughtful evaluation of all of the factors that need to be in place for optimal development must be repeated. With the advent of more rigorous intervention research, the outlook for the child with dyslexia is much more optimistic. As the science of intervention grows, more refined and sophisticated techniques will become available, and the individual with dyslexia will be free to function even more efficiently at school, at home, and in the workplace.


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