Video Link: https://vimeo.com/599294309

What does the word dyslexia mean?

When a word begins with 'dys' it means something is not working so well or is difficult.

So, the dys in dyslexia means something is difficult.

There is a story behind the 'lexia' part of the word...

The word dyslexia was first used, or coined, in the late 1800s by a German eye doctor. The lexia bit is from the Greek word 'lexis'. Lexis is from the older Greek word 'legein'. Both mean 'to speak'. It is thought there may have been some confusion between the Greek word 'legein' (to speak) and the Latin word 'legere' meaning 'to read', and the wrong one was picked. Remember, this is long before we had the internet to easily check these things. So, the word we commonly identify with reading difficulties, dyslexia, might be the wrong word. We often have an image with translations to explain the origin of a word, but have not used one here, because translating dyslexia to 'difficulty speaking' is confusing.

So, the person who coined the phrase to explain difficulty with words, evidently had difficulty with the word meaning 'word' and picked the wrong one. How ironic!

What is dyslexia?

Dyslexia is about difficulties with reading. Where the difficulty is related to writing this may be a condition called dysgraphia, which we will explain in this lesson, along with another condition called alexia, where a person is unable to read.

Reading and writing come under the umbrella term literacy.

Dyslexia is a complicated label, partly because there are many different causes of dyslexia, but also because not everything that causes reading difficulties is classified as dyslexia.

Reading Difficulties for Children with Learning Difficulties
To be given the diagnosis of dyslexia a child needs to be an otherwise typical learner with average language skills. If the child has known learning difficulties, regardless of what the cause of those difficulties is, even if the cause is unknown, they would not have dyslexia according to the diagnostic criteria, because their reading difficulties would be due to their learning difficulties, even though their reading difficulties might be the cause of their learning difficulties!

Phonetic Dyslexia
There are different types of dyslexia. Phonetic dyslexia causes difficulties reading related to phonetic difficulties. Phonetic is all about the sounds of words, and the person's abilities to sound out a word, and to imagine such sounds. The clip below is taken from the video tutorial above.

Example of sounding out words phonetically.Video Link: https://vimeo.com/648526173

It is thought that the cause of reading difficulties for children with phonetic dyslexia relates to difficulties sounding out words, either out loud or in one's head. Phonetic dyslexia only applies if the child has otherwise typical language skills. If the child has a language delay, then the reading issues would not be due to phonetic dyslexia according to current diagnostic criteria, because the difficulties could then be attributed to their language difficulties, and in many, their learning delays as a result.

For children who have difficulties building up sounds from letters, learning to recognise words, by instead picturing the written word as a whole, can help. Adult readers do this, in essence meaning that memorising the shape of the word by whole word recognition, simply misses out on the phonetic step of learning. This is explained in more detail under Learning to Read below.

Picturing whole words is also a helpful strategy for children who have dorsal stream dysfunction (level 9) causing them to see and process only one part, or a small amount at a time.

For both groups, having to join multiple letters to form a complete word which they can't see as a whole, can pose enormous difficulties with reading. Yet visually learning each word as a singular entity skips the phonetic reading stage.

In nations that use symbols as words (e.g. China), phonetic dyslexia rarely interferes with the language learning process.

Neurological Dyslexia
Think about the words you are looking at and reading right now.

They are images.

As with everything you see, looking is a mental process. With words, the process involves:

• 1. Your eyes taking in the information of what you are looking at, and sending the visual information to the brain's occipital lobes to create the picture of the word / words you can see, right now. That's your occipital lobes (lesson 1b) in action.
• 2. The picture of that word is processed and taken to the correct memory file where there is a matching remembered word. The memory files of letters and words are typically in the left temporal lobe (lesson 1e) because individual letters are singular symbols, like numeric symbols (representing numbers, lesson 12a). Words are a bit more complicated. Words are not just connected with reading a word, but also hearing the word, speaking the word, writing the word, thinking the word and all the experiences associated with that word. Research has shown that the locations of memory files of words are scattered all over the brain. So, finding the correct match is not a case of everything going to roughly the same area in the brain, as is the case with facial recognition for example, where for most people their memories of faces are in a very specific location (the fusiform gyrus in the right temporal lobe, lesson 10a).
• 3. The word you are looking at and the remembered word, once matched send that 'intelligence' to the front of your brain where you have conscious visual attention (lesson 1f) and so know the meaning of the word. Just think, for every word you read in this lesson, your brain went through that process, and continues to do so as you read these words, but there's more...
• 4. Other than road signs, words are rarely singular, and we typically read them in groups, as sentences. The words in a sentence, including this one, are all sewn together as you read them, to create understanding of more complex messages. Now think about all the different places words are stored in your mind. To enable reading, your brain finds and employs the correct pathways for each successive word, in a way that is synchronised to get the information relayed in good order, the order in which the words are presented.

Your brain is very busy when you are reading, and most of the processing goes on in unconscious parts of the brain, sort of 'behind the scenes'.

This is the visual process behind reading, and where it is not working typically it can lead to reading difficulties which may be neurological dyslexia, but not always.

If the words can't be seen clearly due to eyesight issues, making reading difficult, this is not neurological dyslexia as it is due to an eye or optical disorder causing lack of clarity.

If the words can't be seen clearly because of reduced visual acuity (lesson 5b) or because there is insufficient contrast (lesson 5c), or a visual field impairment (Level 6), this is not typically thought of as neurological dyslexia. Again the reading difficulties are explained in terms of the visual impairment, even though it can be brain based.

If the word can be seen clearly, but there is an issue with correctly recognising the word, and this is not caused by phonetic difficulties (explained above), or broader learning difficulties, then this is likely to be neurological dyslexia.

As words are stored all over the brain, it means that any issue affecting the brain pretty much anywhere can impact reading. This can be mild, when occasional words are missed, or severe, meaning reading is extremely difficult in an otherwise able child. It can arise from birth, or be acquired due to a brain injury or event, at any time in life.

If a child has an issue affecting the left temporal lobe specifically, or as is more commonly the case with children, both temporal lobes, (lesson 10b Integrative Agnosia), then the memory processes involving individual letters being learnt and joined together to form words may be difficult. This is a form of neurological dyslexia, and is caused by cerebral visual impairment, where a part of the visual process required to capture and interpret text is not working typically.

Alexia
Alexia is the most severe form of dyslexia, where a person with a typical learning ability, is unable to read at all. It is most commonly caused as the result of an acquired brain injury, for example a stroke. Some people who are affected, can retain the ability to write yet lose the ability to read, meaning they can't read what they have written. This is because reading and writing are two different processes, as we explained in the video tutorial. It is also possible to lose the ability to read some letters, but not others. This is called literal alexia.

Literal Alexia

An approach that can be effective for alexia is to access the shape of the letters by enlarging the text and running a forefinger over each letter, as if writing it. The shape of the letter is then picked up by the nature of the hand movement, giving an alternative way of accessing each letter and building up each word. Another similar reported technique is to emulate the shape of each letter by moving the tongue on the palate as a copy of each letter.

Dysgraphia and Agraphia
Dysgraphia relates to difficulties writing, which can be words, or numbers, but does not necessarily always affect drawing and pictures. The cause is likely related to the part of the brain where the mental images of the letters and numbers are stored, not working properly. Agraphia is an inability to write for the same reasons.

CVI & Literacy

Reading and writing use symbols to represent language.

They cannot be separated from language, and language comes first.

Without language a child can't learn to read, write or even talk, and such a child is likely to be profoundly learning disabled.

CVI affects literacy for many different reasons, and they do not necessarily fit with different diagnostic criteria for dyslexia or dysgraphia.

To explain how CVI affects literacy, we are going to leave the labels behind, because it quickly gets very confusing.

Let's just look at the child with CVI and see if we can understand the possible causes of their difficulties.

Below are several reasons why children with CVI (including the majority for whom it has yet to be diagnosed) may struggle with both reading and writing.

CVI, Language & Literacy
Reading and writing use symbols to represent language.

CVI can affect the development of language, in some severely, meaning that words are not learnt at all.

The words in your mind, the words you 'know' are called 'receptive language' or your receptive vocabulary.

The child needs to develop receptive language for all the words they are trying to learn to read and write.

Before looking at causes of reading and writing difficulties, check first the child's language abilities.

Do they understand every word you are using?

You need to know the answer to this question before you expect the child to learn to read. You need to know that they have the vocabulary needed.

CVI, Language & Literacy Example: Learning to read the word 'rainbow'.
Let us imagine the word rainbow is a new word in a story.

Does the child with CVI know what a rainbow is?

Some children with CVI only see one thing at a time, so when you can see the sea and sky and clouds and rainbow (left image, above), the child may only be seeing one thing, and if they are not sure what they are looking for, from many descriptions, it may well be the thing in the visual scene that stands out the most that attracts their visual attention, here, possibly the brightest thing, which is the cloud that has been illuminated by the light. Other children may find their vision darts about the image, looking for something that might match the new word 'rainbow'. This type of CVI is called simultanagnostic vision, lesson 7c, and is common in children with CVI.

Few people check that words have been learnt correctly by being correctly matched to what they describe. So these little mistakes, rather than being corrected, get added to more little mistakes, and this adds up to a lot of mistakes. Such incorrect understanding of language can contribute to learning difficulties.

One can imagine that several further times when rainbows have been pointed out, the child sees other bright clouds, and so the word rainbow is reinforced, as having the meaning of cloud.

Today the child is learning to read the word rainbow for the first time, but no one has checked they know what the word means.

This is what the child has been shown, but it might not be what the child sees...

Our child with simultanagnosia who is learning the word rainbow, has been shown a picture of a rainbow, but they may see the picture differently, and what they do see may be nothing like what they thought a rainbow was from their previous experiences.

These images are our interpretations to explain these types of difficulty from multiple accounts from children with CVI.

Imagine the confusion and difficulties.

The way to check is to ask open questions, like 'have you ever heard of the word rainbow' and if the child tells you yes, go on to ask them to describe what they have seen and what it means to them.

Teaching reading and writing to children who do not understand the words correctly is going to inevitably lead to reading and writing difficulties and further along the line, learning difficulties.

So here, whilst the effect may be reading and writing difficulties, the cause is something else. Language.

It may be that the child would not have any reading or writing difficulties, and the cause of the problem lies with how language has been taught and learned.

To learn to read a word, that word needs to be known and understood, and what the written word looks like needs to connect with the existing memory files relating to that word, including what it sounds like when spoken and whether the meaning has been correctly learned. These abilities all fit neatly together. That is how learning works, layer by layer, with memories and understanding become more detailed. Rainbows for most of us, combine visual experiences, emotional experiences, the sound of the word, and everything else that relates to rainbows, like rainbow socks, or a rainbow pencil case, as well as what the word looks like to read and the coordination and muscle skills needed to write the word. These joined up memories link all the child's 'rainbow' experiences, but these don't work so well if the word has been learnt and so remembered, incorrectly. Level 2 explains this process.

This specific example might seem rare or extreme, but miss-learning is very common, with each person with CVI being affected in their own unique ways.

Reading & Writing Skills
Please can you take a piece of paper and write the word rainbow on it.

Think of the skills needed. You probably knew the word in your mind so did not need to copy it, but a child learning to write would be copying the word. You also have gained the tiny movements required by your hand to create the unique shape of the word 'rainbow'. Those hand skills have memories. They are muscle memories formed during your 'learning to write' journey, and over years became better and better - you can probably write the word rainbow without even looking, just by using your muscle memories. These are all different forms of memory. In Level 2 we explain how CVI can affect how memories are formed.

Writing is something going from your brain through your hand to the pen you are holding, onto the piece of paper.

Reading is something going in, from the piece of paper through your eyes and visual systems into your brain.

They are closely connected, as both relate to the way language is symbolised but they are two different processes. Many children can have difficulties with both, but they need to be understood separately, because each may require different support strategies.

Reading & Writing
We are going to explain reading and writing in relation to these three areas:

• 1. Seeing the words clearly
• 2. Learning to read
• 3. Writing

1. Seeing the Words Clearly

All children need to have their sight tested.

For many children the font, and the spacing between words and lines are more important than the text size. This means that selecting the correct font size for a child with CVI requires a full understanding of the child's unique visual needs. When the text size is too big, it can make reading more difficult for some children with CVI (see Fonts, below).

As we have explained throughout these lessons, many children with CVI struggle in a complex and cluttered environment, so their surroundings have an impact on what they can see on the page because peripheral clutter commonly diminishes central attention. Also, if there is a lot of clutter on the page, like lots of pictures, this can create similar difficulties.

As the child's reading develops, it is likely that the type of books they read will change.

Books written for older children have much smaller print size with greater crowding than for younger children. Printed material for children becomes smaller with increasing age, but this may become too small, and too crowded for some children with CVI.

As the child's vision is developing, the ability to comfortably read smaller text sizes progressively evolves, and takes time. Their reading abilities may be ahead of their visual abilities, but the smaller (more crowded) text can make reading difficult because it can't be seen clearly. For this reason we know some children who have stopped enjoying reading, having previously enjoyed it.

Our reading tool LOOK is designed for children who have CVI causing dorsal stream dysfunction, both to help them learn to read and to help with reading. Below is a quick demonstration video.

Demonstration of our free reading tool called LOOK.Video Link: https://vimeo.com/605611126

Sentences and Paragraphs
As children learn more words, they will need to learn to read sentences. Children with CVI can have difficulties because there are too many words. Try:

• Using LOOK, starting with one word at a time, at the child's pace, add a word, so they are reading two words, and when comfortable, three, up to full sentences.
• Ensuring there is good spacing between the lines and paragraphs. If text in a book is small and crowded, it may need to be reproduced in large print or to make it accessible for the child to read.
• A typoscope is a piece of (usually black) plastic or card with a hole in it, for children to place over their text so they only see one or two lines, meaning they don't get lost. Some children find this useful; others find it a distraction. Another device is called a bar magnifier, where a line of text is made bigger to see, which magnifies both horizontally and vertically, search on-line for examples. These devices can be purchased from low vision suppliers. The child could also learn to use their finger as a guide on the text, or a ruler.

The images in the picture above were taken in good light, but could they be made easier to see?

Adding brightness, for example from a reading lamp, can help increase the contrast between the text and the paper making it easier to read. Make sure the light source does not create a distraction, but simply improving the lighting conditions can help with reading.

2. Learning to Read

Children in countries where alphabets are used (as opposed to symbols, for example in Chinese writing) are typically taught to read using a phonetic approach, where they learn the individual letters, and put them together to sound out words. It is the same approach which we explain above in relation to phonetic dyslexia.

For children with CVI, the phonetic approach to teaching reading can be difficult for a number of reasons, but particularly relating to the need for learning to be a 'one thing at a time' process. Even a small word like 'sun' has three letters, plus an understanding of what the sun is, and the sound of the word sun. That can be too many things for many children with CVI.

If a child whom you think may be affected by CVI is struggling to learn to read, you could try teaching them reading by a 'whole word recognition' approach, but remember, one thing at a time, so not like this:

What is wrong with the image above?

Looking back at what we have already explained:

• 1. Have you checked the child knows the correct meaning of the word sun? The real sun doesn't look like the sun in the picture. The child may recognise the sun in the picture but not have connected it with the real sun that rises and sets in the sky. With CVI you have to check these things.
• 2. One thing at a time, so not a picture and a word, that's two things. And in the picture, there is also a face and sunglasses. It may seem simple and fun to you, but it is adding complexity, and so making it more difficult.

Once you are sure the child understands what the word sun represents, then next you need to make it clear that what they are going to see is the word 'sun', and all they need to do is look at it, and then show them the word:

Picturing the Word
One word, not to spell out as separate letters, but a picture to remember as a whole word.

And repeat.

With repeated experience, the word can be remembered, and over time, can be recognised correctly just by looking at it. That is whole word recognition. This is how children learn to read in countries like China where each symbol represents a whole word.

The phonetic approach starts with the spelling. For children with CVI, the whole word approach may make a lot more sense to them. One child we know (see Case Study: Katherine, below) was an intelligent and articulate eleven year old with CVI, who had never been able to learn to read. She tried reading by whole word recognition and immediately not only started to learn to read but loved it. Learning phonetically did not make any sense to her.

You do not necessarily need to start with short words. Longer words have more to recognise them by, and for some, can be easier to learn.

3. Writing

For all the reasons above, if reading is difficult, it will follow that writing is likely to be difficult too, because to write a word, what that word looks like first needs to be known, and that needs a visual memory file which may be limited.

Learning to write can also be difficult for the child who learns one thing at a time. Learning to hold a pencil, moving it to create the written word, and watching it as it moves involves many thoughts at once. One suggestion involves letting the child learn the shapes of the letters needed to make the words using their fingers, for example in sand - that is forming a memory of the feeling of what is needed to form the letters and words, because the act of writing is tactile - using touch - and involves very precisely organised muscle memories. Build the skill one step at a time

Many children with CVI have inaccurate visual guidance of reach (lesson 7b).

For a little exercise, get a plain piece of paper and somewhere in the centre mark a dot with a pencil or pen.

Now look at the dot, and with the same pen, try to put another dot on top of the first dot, as accurately as you can.

This is something you could ask the child with CVI to do. If they miss, or find it difficult, it may be because the location of the dot and where their mind has placed the dot (lesson 7b Optic Ataxia) are slightly different. So when the child tries to put a dot on top of the dot, they miss. Now imagine what writing must be like if things are even only very slightly misaligned - what might their writing look like if every time their pen touches the paper, where they want it to move to, is not quite where it ends up.

Like this maybe?

Spelling
Many people have a word or two they repeatedly spell incorrectly, do you?

For our team the words 'embarrass' and 'guarantee' came up. We had no problem reading these words, but difficulties spelling them were admitted to.

Reading and spelling are different.

For some people learning to spell is easy, for others, less so. With CVI this may mean needing more repetitions to learn, so learning takes longer. A learning rich environment, so somewhere clear, calm, quiet and clutter free, will help. There are also lots of rhymes to help remember the rules of spelling like

Grammar & Punctuation
The rules of grammar and punctuation are complex. As with spelling described above. There are fun aids to learn ways to remember the rules of grammar. Some are very colourful posters and guides, and these will not be particularly helpful for many children with CVI. The information can be used but it needs to be reformatted it in ways the child can learn. This may be in text they are comfortable with, or may involve discussing the rules with them, and using more talking and listening to support their learning or writing.

Also, encourage reading. Books with enjoyable content need to be comfortable to read in terms of text and layout. Reading for fun, even if the content might not be academic or on the school curriculum, exposes the child to new vocabulary. It provides new and different ways to articulate knowledge and ideas. It provides challenges, new spellings, and different sentence structures and grammar. If a word or phrase or use of punctuation comes up that the child does not understand, be sure to explain it to them.

Keep it fun! We know many families who have reached the point when literacy difficulties become literacy learning. This is when the child starts to enjoy themself.

Teaching Checklist

In lesson 12a we explained this checklist around ensuring what is being taught is accessible for the child to learn from. All of these points also apply to learning to read and write. Make sure the way the child is being taught is learnable for them, if it isn't they will struggle to learn.

Visual Behaviours

Difficulty with reading and writing for many different reasons, can show as:

• Not reading at a level considered typical for the child's age.
• Inconsistencies, where sometimes the child can read well and sometimes not so well
• Missing sections of reading
• Easily losing their place reading, and struggling to find it again
• The words seeming to 'move about'
• Taking a long time to read
• Mixing words up
• Handwriting overlapping, straying from lines
• Unreadable handwriting

Targeted Support

Throughout this lesson we have made many suggestions, and the further reading below has more.

Briefly:

• Check language is known, and talk - talking improves vocabulary and learning.
• Consider teaching to read using whole word recognition
• Ensure the font is the correct size, with optimal spacing to be seen clearly.
• Use our e-reader LOOK or other e-readers if needed.
• Encourage reading for fun
• Talk about grammar, punctuation, spelling and other 'rules' around literacy.
• Try guides to help follow lines of text on a page, like a typoscope , a bar magnifier (which magnifies horizontally as well as vertically), or a ruler (covering the text above, as this is clutter that has just been read).
• Use writing guides and thick lined writing paper.
• Learn to touch type
• Use other forms to supplement reading, for example audio.
• Keep the environment clear, quiet, and known.

Self-referencing

An issue with literacy difficulties for children with CVI is there may be a number of different causes. Many of these may not seem directly related to literacy, but can have an effect on learning.

We know there may seem a vast range of causes, but each is quite simple to check, with a little time.

Reading is widely taught phonetically and this we know can be an issue for many children with CVI.

Allow time, be patient, and really encourage the child. You may have found learning to read and write easy, but the child with CVI likely has multiple invisible challenges to try to navigate.

Checklist

Please ensure you have understood the following:

• What the word dyslexia means, and why there is some confusion about its origin.
• That dyslexia relates specifically to reading, and not the broader areas of literacy including writing, although a child can have difficulties with both.
• What phonetic means in relation to learning words.
• What phonetic dyslexia means.
• Why a child with a learning difficulties or a language delay may not qualify for a dyslexia diagnosis.
• The areas of visual impairment from the brain that can cause reading difficulties but do not qualify as neurological dyslexia.
• The difficulties that do qualify as neurological dyslexia.
• What 'whole word recognition' means and why it is an alternative way to learn to read for some children with CVI.
• What alexia means.
• What dysgraphia and agraphia mean.
• Why CVI can affect learning to read and write, aside from dyslexia as a cause.
• The role of language in reading.
• Why writing can be difficult and untidy or illegible.
• The importance of reading for fun.
• Ways of learning spelling, grammar and punctuation.
• The importance of checking the teaching checklist, to ensure what is being taught is learnable.

Further Reading is not necessary, but if supporting a child who is learning to read and write, or struggling with literacy, we strongly recommend the following:

Developmental Dyslexia Paper - Explaining more about the different types of dyslexia and where CVI fits in.

LOOK - Pages explaining our CVI e-reader and a link to use LOOK.

Newsletter 18 CVI & Literacy, including multiple further links.

Reading Using Whole Word Recognition - explaining the process and reasons why it can be helpful for children with CVI.

Fonts - Guide to ensuring text is suitable for the child with CVI you support.

Katherine Case Study - How a girl with CVI started learning to read as a young teenager and loved it.

Reading to your Child - the incredible value of reading to your child, reading with your child and supporting your child reading, just for fun.

John's Writing Storyboard - explaining one of the causes of difficulties with handwriting for children with CVI.

Video showing how easy it is for a child to learn words incorrectly, here thinking an apple is a banana.Video Link: https://vimeo.com/504348192

Level 12 Full Checklist

You should understand...

• What calculia means
• Different devices used for counting
• The difference between counting and the modern numeric symbol system of teaching and understanding mathematics
• Why CVI can cause difficulties learning numbers and mathematics
• The CVI teacher checklist
• The different difficulties with CVI and learning mathematics, and dyscalculia
• The part of the brain responsible for dyscalculia
• That dyscalculia can be from birth or acquired
• That dyscalculia can be mild or severe
• The most severe form of dyscalculia is called acalculia
• What the word dyslexia means, and why there is some confusion about its origin.
• That dyslexia relates specifically to reading, and not the broader areas of literacy including writing, although a child can have difficulties with both.
• What phonetic means in relation to learning words.
• What phonetic dyslexia means.
• Why a child with a learning difficulties or a language delay may not qualify for a dyslexia diagnosis.
• The areas of visual impairment from the brain that can cause reading difficulties but do not qualify as neurological dyslexia.
• The difficulties that do qualify as neurological dyslexia.
• What 'whole word recognition' means and why it is an alternative way to learn to read for some children with CVI.
• What alexia means.
• What dysgraphia and agraphia mean.
• Why CVI can affect learning to read and write, aside from dyslexia as a cause.
• The role of language in reading.
• Why writing can be difficult and untidy or illegible.
• The importance of reading for fun.
• Ways of learning spelling, grammar and punctuation.
• The importance of checking the teaching checklist, to ensure what is being taught is learnable.

Congratulations on completing CVI Scotland's Lessons.

From our community, thank you for taking the time to learn.