Dyslexia

I
INTRODUCTION
Dyslexia, the inability to learn to read fluently. No single definition of dyslexia is accepted by all reading specialists. In the United States, federal law governing special education classifies dyslexia as a “specific learning disability” or as a “specific reading disability.” The World Health Organization labels dyslexia a “specific reading disorder,” and other sources label it a “specific language disorder.” However, a central feature of all definitions is an unexpected and substantial difficulty in learning to read. The lack of a commonly accepted definition of dyslexia has caused some educators, physicians, and researchers to avoid using the term altogether.
Because there is no clear and widely held definition of the problem, estimates of the number of persons with dyslexia vary widely. Most researchers have suggested that dyslexia is rare, occurring in 1 to 2 percent of the world’s population. However, others contend that 10 to 20 percent of the population have dyslexia or display dyslexic characteristics. Those arguing for the higher incidence levels also suggest that dyslexia can appear in differing levels of intensity, affecting the reading achievement of some individuals more than others. Dyslexia is usually identified during childhood, but it continues to affect individuals throughout their lives.
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CHARACTERISTICS
Before about 1970 most explanations of dyslexia held that the root of the problem lay in visual difficulties. For example, many experts believed that dyslexic children saw letters backward or in reverse order. Since then, however, much research has shown that children with dyslexia are no more prone to reverse letters while reading and writing than are other children.
Most dyslexia research now focuses on problems distinguishing the various sounds, or phonemes, that make up speech. Available evidence suggests that dyslexics have substantial difficulty decoding the phonological system of words—that is, they have problems breaking words into their various constituent sounds. For example, dyslexics may have difficulty breaking the spoken word hit into the three phonemes that correspond to the letters h, i, and t. Because they cannot segment hit into these three sounds, dyslexics often do not associate those sounds with the corresponding letters that would enable them to read the word. About 20 percent of all children experience some difficulty in distinguishing the individual sounds of spoken words. However, most of those children benefit from specialized instruction to treat reading problems early. Only 1 to 2 percent of children exhibit continuing reading difficulties after they receive such instruction.
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INCIDENCE
Evidence suggests that dyslexia is more common in some families than others. Because of this, some researchers claim that there may be a genetic basis for dyslexia, but this has not been conclusively proved. Most studies have also reported that dyslexia affects significantly more boys than girls. However, a recent large-scale study reported that although schools identified more boys with reading problems than girls, test results showed severe reading difficulties in roughly equivalent numbers of both sexes.
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DIAGNOSIS
Common methods of diagnosing dyslexia vary widely, although most experts rule out other common sources of learning difficulty—such as lack of intelligence, absence from school, hearing or vision problems, and behavior disorders—before making a diagnosis of dyslexia. Many researchers have called for a shift in methods to identify dyslexia. Some argue that a diagnosis of dyslexia should be made only in children who continue to struggle with reading, even after having received high-quality, intensive tutorial instruction. This diagnostic method consists of two steps. First, experts assess the intensity and appropriateness of the instruction the child has received. If they find no evidence of an appropriate, intensive educational intervention to correct reading problems, then a diagnosis of dyslexia is premature. Second, experts assess the child’s ability to distinguish phonemes. Once again, a diagnosis of dyslexia would be premature if examiners identified difficulties in this area but found that the child had received no intervention to develop phonological processing skills.
Experts diagnose dyslexia only when reliable evidence shows that a child’s reading difficulties do not seem correctable through intensive, appropriate instruction. A child may not respond well in group instructional settings and may fall behind classmates in both reading acquisition and phonological processing skills. But these deficits alone would not warrant a diagnosis of dyslexia. Such a diagnosis is appropriate only if the deficits remain after the child receives intensive tutorial instruction to correct them.
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LIVING WITH DYSLEXIA
Many children experience some difficulties learning to read, write, and spell. With access to appropriate teaching, however, most of these children can and do become good readers. Effective instruction for dyslexics provides significant opportunity to read books of appropriate difficulty, meaningful writing activity, and guidance in developing useful strategies for decoding words and in establishing self-monitoring skills. However, few students with reading difficulties receive such instruction. Intensive tutorials often require one-to-one instruction, which most schools find too expensive to provide. A small number of private schools in the United States have well-researched and successful instructional programs for children with reading difficulties, but these serve relatively few students.
Even after receiving high-quality instruction, a small percentage of children fail to develop fluent reading abilities. Although these children are identified by most experts as dyslexic, even they can learn to read. Their reading often remains slower than their peers and the effort required for reading remains substantially greater. Nonetheless, many dyslexics not only graduate from high school and college but go on to excel in a wide variety of occupations.

Dyslexics get stuck at the starting gate because they can’t make the connection between the symbol and the sound.

D...........Disability to learn

Y...........Hundred years on {Understanding dyslexia}

S...........Spelling Disorder {Phonetics}

L..........Low school performance

E……… Early language impairment

X……….Genes on “x” chromosomes

I………..IQ above normal

A……….Attention deficit disorder

Phobia

Phobia, intense and persistent fear of a specific object, situation, or activity. Because of this intense and persistent fear, the phobic person often leads a constricted life. The anxiety is typically out of proportion to the real situation, and the victim is fully aware that the fear is irrational.
Phobic anxiety is distinguishable from other forms of anxiety only in that it occurs specifically in relation to a certain object or situation. This anxiety is characterized by physiological symptoms such as a rapid, pounding heartbeat, stomach disorders, nausea, diarrhea, frequent urination, choking feelings, flushing of the face, perspiration, tremulousness, and faintness. Some phobic people are able to confront their fears. More commonly, however, they avoid the situation or object that causes the fear—an avoidance that impairs the sufferer's freedom.
Psychiatrists recognize three major types of phobias. Simple phobias are fears of specific objects or situations such as animals, closed spaces, and heights. The second type, agoraphobia, is fear of open, public places and situations (such as public vehicles and crowded shopping centers) from which escape is difficult; agoraphobics tend increasingly to avoid more situations until eventually they become housebound. Social phobias, the third type, are fears of appearing stupid or shameful in social situations. The simple phobias, especially the fear of animals, may begin in childhood and persist into adulthood. Agoraphobia characteristically begins in late adolescence or early adulthood, and social phobia is also associated with adolescence.
Although agoraphobia is more often seen in treatment than the other types of phobia, it is not believed to be as common as simple phobia. Taken together, the phobias are believed to afflict 5 to 10 persons in 100. Agoraphobia and simple phobia are more commonly diagnosed in women than in men; the distribution for social phobia is not known. Agoraphobias, social phobias, and animal phobias tend to run in families.
Behavioral techniques have proved successful in treating phobias, especially simple and social phobias. One technique, systematic desensitization, involves gradually confronting the phobic person with situations or objects that are increasingly close to the feared ones. Exposure therapy, another behavioral method, has recently been shown more effective. In this technique, phobics are repeatedly exposed to the feared situation or object so that they can see that no harm befalls them; the fear gradually fades. Antianxiety drugs have also been used as palliatives. Antidepressant drugs have also proved successful in treating some phobias.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder, mental illness in which a person experiences recurrent, intrusive thoughts (obsessions) and feels compelled to perform certain behaviors (compulsions) again and again. Most people have experienced bizarre or inappropriate thoughts and have engaged in repetitive behaviors at times. However, people with obsessive-compulsive disorder find that their disturbing thoughts and behaviors consume large amounts of time, cause them anxiety and distress, and interfere with their ability to function at work and in social activities. Most people with this disorder recognize that their obsessions and compulsions are irrational but cannot suppress them.
Obsessive-compulsive disorder usually begins in adolescence or early adulthood. It affects from 1.5 to 2 percent of people in the United States. The disorder affects slightly more women than men.
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SYMPTOMS
Obsessions can include a variety of thoughts, images, and impulses. Common obsessions include fears of contamination from germs, doubts about whether doors are locked or appliances are turned off, nonsensical impulses such as shouting in public, sexual thoughts that are disturbing to the individual, and thoughts of accidentally and unknowingly harming someone. People with obsessions may avoid shaking hands with other people because they fear contamination, or they may avoid driving because they fear they will injure someone in a traffic accident.
People usually perform compulsions to relieve the anxiety produced by their obsessions, although not all people with obsessions perform compulsions. The most common compulsions involve cleaning rituals and checking rituals. For example, people with obsessions about germs may wash their hands dozens of times each day until their skin becomes raw. People with obsessions about neatness and symmetry may constantly rearrange or straighten objects on their desk. People with checking compulsions must repeatedly check to make sure they locked doors and windows or turned off water faucets. Other compulsions include counting objects, hoarding vast amounts of useless materials, and repeating words or prayers internally.
Obsessive-compulsive disorder can have disabling effects on people’s lives. People with severe cases of this disorder may need hospitalization to help treat the compulsions. In less extreme instances, individuals with compulsions often must allow a great deal of extra time to complete seemingly routine tasks, such as preparing to leave the house in the morning. Individuals may avoid going to certain places or engaging in certain activities because they feel embarrassed about their behavior.
In addition, family members of someone with this disorder may feel angry at the person because the compulsive behaviors intrude on their time together or interfere with the family’s functioning. For instance, some individuals hoard things, such as newspapers or magazines, because they believe they may someday need certain pieces of information. The piles of newspapers may cover the living areas and make other family members feel embarrassed to have guests in the home.
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CAUSES
Like many mental illnesses, obsessive-compulsive disorder appears to result from a combination of biological and psychological influences. Some people may have a biological predisposition to experience anxiety. Research also suggests that abnormal levels of the neurotransmitter serotonin may play a role in obsessive-compulsive disorder. Brain scans of people with obsessive-compulsive disorder have revealed abnormalities in the activity level of the orbital cortex, cingulate cortex, and caudate nucleus, a brain circuit that helps control movements of the limbs.
The disorder may develop when these biological influences combine with a psychological vulnerability to anxiety. Some people may develop a psychological vulnerability to anxiety in childhood. They may come to believe that the world is a potentially dangerous place over which one has little control. People seem to develop obsessive-compulsive disorder specifically when they learn that some thoughts are dangerous or unacceptable and, while attempting to suppress these thoughts, develop anxiety about the recurrence of the thoughts and about the perceived dangerousness and intrusiveness of the thoughts.
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TREATMENT
Treatment for obsessive-compulsive disorder includes psychotherapy, psychoactive drugs, or both. Mental health professionals consider exposure and response prevention, a type of cognitive-behavioral therapy, to be the most effective form of psychotherapy for this disorder. In this technique, the therapist exposes the patient to feared thoughts or situations and prevents the patient from acting on his or her compulsion. For example, a therapist might have patients with cleaning compulsions touch something dirty and then prevent them from washing their hands. This technique helps 60 to 70 percent of people with obsessive-compulsive disorder.
Medications to treat obsessive-compulsive disorder include selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) and fluvoxamine (Luvox). A tricyclic antidepressant, clomipramine (Anafranil), also helps relieve symptoms of the disorder. About 80 percent of people with the disorder show some improvement with a combined treatment of medication and behavioral therapy. However, many patients relapse when they stop taking the medication.