Dyslexia: A Challenge That Can Be Overcome with Allison Poore, CCC-SLP

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

When you read, your brain connects letters to sounds to form words and sentences that allow you to understand the text. This decoding of the written word is something most of us don't even think about. It just happens. But that's not the case if you have dyslexia. This common learning disability disrupts how your brain processes the written language, which can lead to issues in understanding what you read or communicating ideas. It's a significant issue for many, many people, but it can be overcome.

Today, we're joined by speech-language pathologist, Allison Poore, to take a closer look at dyslexia and get some tips on taming it. She's one of the many experts at Cleveland Clinic who visit our weekly podcast to chat about issues that are familiar to so many families. So, with that, let's learn more about dyslexia, a condition that's estimated to affect up to one in five people, and maybe even someone close to you.

Welcome to the podcast, Allison. Thanks for stopping by to help us broaden our understanding of dyslexia.

Allison Poore:

Thank you very much for having me. It's a really important topic, and it's getting a lot of buzz lately, so it's very important that we discuss and learn as much as we can about it. So, thank you.

John Horton:

Allison Poore:

John Horton:

Allison Poore:

John Horton:

Allison Poore:

Yeah, you're right. About 20% of the US population have it and they don't know they have it. They usually just, adults usually, assume that, "I just had a really hard time in school," or, "I'm a terrible speller." Now, that doesn't mean that you have dyslexia, but those are certainly characteristics and traits.

About one in five children in the American classroom have a diagnosis of dyslexia, so when you're dealing with 30 kids in a classroom, there's going to be about six children who can actually have a diagnosis of dyslexia. In addition to that, there's another three to four children who will just have a reading impairment and just a very hard time picking up on the sounds and symbol correlations and how they go together.

John Horton:

Allison Poore:

Yeah, there's been a lot of buzz about dyslexia lately just because we're getting statistics back in from our fourth-graders all over America. And the statistics are quite low as to how many fourth-graders are literate, and it's staggering. So, a lot of the states are individually bringing together new laws that are requiring educational staff to be retaught on how we teach our students Read-All. It's also happening in Ohio here. So, there has been a lot of a buzz and a lot of information going around about dyslexia, and so I think that has really created an environment for conversation and discussion. And as a result, parents are also looking inward at themselves and saying, "Hey, could this have been used in school as well?"

John Horton:

Allison Poore:

Yeah, there actually is. As I discussed before, it's brain-based. So, when we read, unlike speech and learning how to talk, typically, now there are exceptions, but typically a child will learn to talk just based on listening to the people in his or her environment. The mom will say, "Hi, Daddy." And the baby will imitate that eventually. That's very innate in that the child can just pick up on that.

With Read-All, it's very, very different. We are not born to read. We have to be taught. And the interesting thing about Read-All is that it connects several different parts of the brain. So, you have your language area of your brain, you have your sound system in your brain, you have the vision system, what you see on paper, and then you also have how you formulate, so a motor portion in your brain. All four of those areas have to coordinate with each other and send messages.

I like to refer to our brain parts communicating with each other like a highway. They send information from one part to the next. And in some disorders, just like dyslexia, you can imagine a tree. There's a tree down in the highway, and so the message can't get there. So, what we have to do is teach your brain how to go around that tree and how to still get the message to that area of the brain. It's really fascinating and we definitely take it for granted that it's a very finite process and everything has to go just right in the communication between these areas.

John Horton:

So, like you said, this is just something that's there, so is it a genetic sort of thing you're just born with that there's just this difference or disruption in your brain that influences your ability to do this?

Allison Poore:

Yeah, genetics play a huge role in this. So, if a child has parents or even grandparents or aunts and uncles or cousins, genetics is being studied currently. We don't know the percentage of how genetic this is, but it is highly, highly genetic. It's very common to have multiple people within a family have dyslexia.

The indicators other than being genetic, there are also high percentages of children who have language delays, so their speech is very late to develop, and those children too who have speech sound disorders. Because like I said, in the brain there's that speech sound center, and if they're having difficulty beginning to say their sounds or their sounds are disorganized and confused, that will lead into the potential of having some issues when we go to read as well.

So, those are some indicators for really young children in addition to the genetics, and then as time goes on, you can look at as a child starts their educational life when they have difficulty with rhyming, writing letters. It takes an extreme amount of effort to write. Following directions can be something that is also a precursor to it because memory does play a big role in that brain communication as well. So, remembering things, remembering bits of information, remembering three-step directions where the child will begin to start a direction and not be able to finish it.

And also what I have seen too is in the speech center, you will get some children who even their speech is a little bit disorganized. So, caterpillar might come out claderpillar, and you twist your head and think, well, that was a different way of saying it. But it's something that can happen over and over and over again with usually bigger words. So, that's that disorganization in the sound system that we hear.

John Horton:

Allison Poore:

It can be diagnosed as early as five and a half years of age. Most people will like to see that the child has had some sort of formal curriculum given to them to just make sure that it's not just attentional or a lack of curriculum, but it does happen right at that beginning stages.

Now, they may do very well in the beginning and you may start to see more and more problems as the complexity of what they're doing increases. So, as things get harder, we might start to see more and more things. It's always trying to play catch up, so just because they start out well or are hanging by a thread in first grade, when they get to third grade and have to write reports and read reports and understand what they're reading, that is definitely indicators that something more should be done.

And it's important to say, too, that dyslexia is, we call it a spectrum disorder. What that means, and you've heard that with other disorders as well, is that it ranges from very severe to very minimal. I can honestly say with all the kids that I've assessed here, I have never seen two children that are exactly alike. Once again, you think of all those parts of the brain working together. One person's miscommunication between the brain parts will look completely different to another person.

John Horton:

Allison Poore:

Yeah, that's right. They definitely learn to strategize. And I think that as they're younger, they may be coming up with strategies. It also could depend on the educators that they're working with or the curriculum that they're receiving. They may be getting more support at the earlier levels, and then as they grow even into sixth, seventh, eighth grade, they're becoming very singular. They're working on their own. They're expected to work on their own, and if there hasn't been a diagnosis, there are not accommodations in place. So, accommodations are there just like strategies, to make sure that the child is protected and that if they need extra time or if they need to dictate instead of write, that that's there for them. And so if there's a diagnosis there, we can see some of those accommodations used, but if there isn't and the child or family is unaware, they can definitely struggle greatly.

John Horton:

Allison Poore:

I would say that, as with anything, I would say how often are difficulties occurring? First and foremost, you may have received some information from your child's school. We are doing more and more testing now for dyslexia with those new laws that are coming into effect, so you may be getting a paper coming home saying your child is at risk for dyslexia. That would be one indicator.

Also, is it just not matching what you would think? In terms of the amount of work they're doing and the input that they're putting into it, a first-grader, are they spending three hours trying to complete their homework? Are they having meltdowns? Are they having tantrums? Is it just this dreaded thing that comes up every day? I would gauge, is this appropriate? Would I expect a first-grader to have three hours of homework and be crying through this? And then I would say, is it not matching your child's ability? If you know that your child has a great vocabulary language, they love school, and then all of a sudden you're seeing worst grades. You're seeing more marks on their paper and just an overall not liking school, stomachaches. They start to call themselves stupid or, "Oh, I'm so dumb. I don't get this. I'm not like the other kids." If you start to see self-esteem decrease as well, that's definitely something that you should pay attention to and act on.

John Horton:

Allison Poore:

Yeah. I have seen the effects of that. And anxiety is another big link. And I obviously don't diagnose that, but I do send children, when I see aspects of that, I will send them to the correct professional because I do see kids that are very hard on themselves blame themselves, and I think that sets them up for problems as they're growing. And it's good to get that under control. And how you get that under control is you advocate, you find the right resources, and you also get them help for that self-esteem as well.

John Horton:

Allison Poore:

It is. Here at the Cleveland Clinic, we have a group of evaluators who are specially trained to evaluate. As also around the United States, there are psychologists, speech-language pathologists, neurologists, there's a lot of different people that can test for this. And testing can last a very long time. It can go on for a couple of days, depending on what you're looking at. It can go on for several hours with breaks.

But what we take a look at is, if you recall those areas of the brain that I talked about before, we need to look at each of those areas, and we assess those using standardized tests, which means just back and forth asking and answering questions with the child. So, we'll assess language skills, how they produce their language verbally. Are their sentences making sense? Do they use good vocabulary? We assess receptive language or how they're understanding what's being said to them. We also look at memory, not the memory in terms of they remember their friend's name, but more academic memory. So, can they keep this information in their head for three minutes and manipulate it within a sentence and then reuse it? We also look at cognition at times, so their IQ. Even though it's not linked to dyslexia, that can be helpful to see if anything else is going on and deciding what the diagnosis is.

John Horton:

Allison Poore:

Correct, yeah.

John Horton:

Allison Poore:

I would say the first thing is open communication with the child's school. We have to remember that a child's job is school. That's their job. That's where they spend eight hours a day, so we need to have open communication with them. Let the teachers and educational staff know what's going on at home. Let them know that there's meltdowns. Let them know that it's taking three hours. Let them know that there's low self-esteem, and ask questions. Don't be afraid to ask them, "What are you seeing? How are they responding? Have you tested them lately? What are the scores like?"

So, first of all, that would be number one, is open communication. Secondly, I think just with all the different areas of the brain, they all have to work together, so we all have to strengthen those areas. So, from very young age, increasing their language and understanding of language. So, how do you do that? You begin to talk to the child and explain things. Have the child cook with you and explain what you're doing and why you're doing it. And those all make little connections in that language center, and it all hooks the language and the vocabulary words together. When the child's older, read with your child. Look at the vocabulary words. Explain what country that might be talking about. Give some information about what you know about that country. So, increasing the language skills is great.

And also, another thing to work on is reading together. Kids learn a lot with listening to their caregiver read. So, when a child listens to an adult read, they're picking up on the emotion in the story. They're picking up on when you pause. When do you raise your voice for a question? When do you show excitement with an exclamation point? And it also teaches them a lot about literature, the problem, the solution, and bringing it to their life. When have you experienced this? Tell me about a time when this happened to you. This is all creating a love of literature and learning. With that, hopefully then with the open communication, you can get on the right track and really independent discussions about what exactly will help your child in terms of phonetics and spelling will then come about, and you can work on that too.

John Horton:

Allison Poore:

Yep, that's exactly right. We're continuing to strengthen those areas of the brain and we're maybe soliciting another part of the brain to pick up the slack in that information highway where that tree might be down. Learning is constant. And children, and even adults, we learn. Every time we take in information, there's more connections that are going on in the brain.

John Horton:

Allison Poore:

Yeah, definitely, especially with older children when they have a lot of memorization. Mnemonic devices are really important. Those are special ways that you can remember facts because, like we know with dyslexic individuals, their memory, their working memory might be off a little bit. So, reviewing, constantly reviewing, using those devices, those special ways of memorizing, and a lot of visuals. I would say try and incorporate all your senses and encourage your child to incorporate all their senses when they're learning. How does the word look? How do the sounds feel in our mouth where we make them? And then it links to that vocabulary piece. Where have you seen this word? So, using all your senses and reviewing, use those visuals.

Also, decodable readers are really good for even older children, matching where your child is at. And there are great books out there that do focus on high interest but are still low complexity or easy for the older kids. So, even going to the library and try to get some of those books, those are all things that parents can do.

John Horton:

Allison Poore:

Good question. Decodable readers are books that follow the general learning sequence of how we teach phonics. So, there's been so much research done on the ways that we teach phonics, and it's been shown that there's a certain somewhat sequence that works based on how words appear in our language. There's no need to teach a very complex word to a very young child because it's only 3% of our language. So, it keeps the phonics all in one unit and it goes from one to the next. It's mastered before the next level is introduced. So, as not to confuse or overwhelm the brain or the child with too many spelling concepts or too many phonics concepts, it keeps it simple and it keeps it uniform.

John Horton:

Allison Poore:

Yeah, I think that is definitely something that you should do. And don't be afraid to say the word dyslexia. We need to normalize it and we need to allow the child to know that that's just part of who they are and that's how their brain works, and there's nothing wrong with that. So, I think finding whatever motivates your child is going to be the key. Children will not work for things that they're usually not motivated about or interested in. So, if your child is interested in electronics, go try and find a book at the library or even you can read a book about that to the child, just to let them know that literature is exciting. Perhaps you can read five or six books, you get a star, and then you get to pick out your own book. It's okay to celebrate those little victories and to let them know that it could be a little bit of an uphill battle, but you'll be okay and we're going to celebrate along the way.

John Horton:

Allison Poore:

Yes. There are certain programs that studies have indicated, just like I was saying before, that go along with how phonics are taught in the natural sequence, our language, how often the patterns are seen in our language. So, structured literacy is that methodology or that scope of where people will look to find help, and there's lots of different programs. So, that's the overall arching theme is structured literacy. But under that, you'll find different types of programs that are out there. One is not better than the other. They're just different. So, I always recommend that people look towards those programs. I also recommend reading those decodable readers. Finding information on the International Dyslexia Association website is going to be the most reputable and the most up-to-date information. Florida Center for Reading Research has great information for parents and children. And also, Reading Rockets actually is really good, something that I'll let parents know. It just helps parents, breaks everything down, and there's also some really specific things that the kids can do as well, some activities.

John Horton:

Allison Poore:

Yeah, I think pediatricians are a great start to bring your concerns up front. We're getting the word out, as I'm sure most places who are doing the testing to the pediatricians of, "Hey, this is a place where we can help." A lot of times, there's testing available, but there's not intervention available. There are some hospitals that do have certain centers, so if you contact your local children's hospital, they may be able to direct you to within their hospital or have psychologists or outside team members that are out in the community that will definitely be able to assist you.

John Horton:

Allison Poore:

Yes, absolutely. We need to meet the children where they're at. And we can't compare one child to another. I know it's hard, I'm a parent as well, but we have to set the child on their own path, meet where they're at. If they're at this lower level but yet they're in an older grade, we're going to celebrate all those achievements along the way. There is nothing with dyslexia that can inhibit a person from meeting their goals. It's important to learn those strategies, those strategies like dictating into the computer instead, or using a reading pad to read the text for you. There's so many different strategies, and if we encourage them to use those throughout their life, no matter whether they're in the workplace, college, high school, elementary school, they will do just fine as long as they know where to find those strategies and they can use them.

John Horton:

Allison Poore:

Right. There are quite a list of famous people. The big ones that I think of are Picasso, Einstein, Da Vinci, and then there's even well and JFK. And there's even some that the children will be more apt to connect with now, Ed Sheeran, Keira Knightley is an actress, and Jennifer Aniston is also dyslexic. And it seems like there's more and more people who are now coming out and saying, "Hey, you know what? I had dyslexia too, and I did just fine."

John Horton:

Allison Poore:

Thank you very much for having me. I'm very excited that you brought some light to the issue. Seeing that it is one in five people, it does affect one in five people, so thanks so much for bringing it to the surface.

John Horton:

Dyslexia creates definite learning challenges for those who have it, but it's not an impossible obstacle standing between anyone and their goals. If you suspect that you or someone close to you has dyslexia, know that help is available to get you past it. If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.