Wednesday, July 18, 2007

MRI Screening for Dyslexia

I recently read an article where a researcher concluded that by using both reading skill tests and fMRI tests together that the identification of dyslexics would be improved. This seemed to be greeted with the usual enthusiasm from the public that is looking for the magic bullet that is going to be able to finally identify dyslexics so that appropriate help can be arranged. It seems to be reasoned that as the identification of dyslexics has already been mandated by law in many states that the states will pay for any method that works.

I don't think that even the MRI researchers themselves believe that there will ever be routine MRI scanning procedures to identify potential dyslexics in the general population. Who would pay for it ? Genetic testing suffers from the same problems. First of all, both are medical procedures, and under existing conditions that means that either the insurance companies would have to include that as a benefit ( not likely ) or the individual would have to pay. Neither are cost effective methods for the identification of dyslexics.

Consider this. If the 5-10% of the population that is dyslexic could be identified by a test, then the effective cost of identifying 1 dyslexic will be 10 to 20 times the cost of the test. If an MRI evaluation costs $2000 then the identification of 1 dyslexic would be $20,000 -40,000.

The reason the researcher in the article said that a combination of MRI and a reading skills test together would increase the ability to identify a dyslexic is that MRI tests alone can not identify individual dyslexics at this time. Only differences between groups of dyslexics and non dyslexics are reported with so much overlap that individuals can not be put into either group with certainty. It does seem to be almost a cheat if ( as far as MRI goes ) to find that someone has good reading skills and so can be removed from the group with dyslexic looking scans and put into the group of non dyslexics or moving someone into the group of dyslexics from the non dyslexic looking scans because of poor results on a reading skills test.

I can understand the frustrations of going into a study with the preconceived idea that a particular part of the brain is going to be able to identify whether a person is dyslexic or not and having the results only be able to tell the difference between groups of dyslexics and non dyslexics. What I really can not understand is the continued fixation with only focusing on one part of the brain for each study.

Common knowledge is that different dyslexics have different dyslexic symptoms. Some dyslexics seem to have auditory problems where they have difficulty hearing the difference between sounds. fMRI studies have determined that this occurs in one part of the brain and when studied the standard results of being able to determine differences between groups of dyslexics and non dyslexics but not individually dyslexic or non dyslexic is found. Some dyslexics seem to have problems making words from letters. This word forming part of the brain has been studied by fMRI studies with the same standard result......................I get tired of writing it all out.................................different groups...............................not able to identify individuals. Some dyslexics have visual processing problems. Again the visual center is identified with the same result............................groups ....................not individuals. Some dyslexics have problems with the meanings of words. Word processing area of the brain identified same fMRI results ...........................groups ....................................not individuals.

Now I suspect that some of you know where I am going with this but I am going to spell it out anyway. Some dyslexics may have problems in all the above areas to different degrees but most function adequately in some areas. Not all dyslexics have auditory problems and so for those dyslexics their results of being in a fMRI study focused on the auditory area of the brain would likely result in a similar analysis as non dyslexics. There are dyslexics without word processing problems that can't be identified by looking at only the word processing area. Dyslexics without visual problems that can't be identified by looking at only the visual processing area of the brain by fMRI.

Now as far as overlap going the other way I am going to use an analogy. Many dyslexics are poor spellers. There must be a spelling part of the brain. Some very good readers are also poor spellers. Any fMRI study that only had a focus on the spelling part of the brain to identify dyslexics would expect to see the same standard results....................groups ...................not individuals.

I am not saying that fMRI research into dyslexia is worthless. The useful information that is being developed by looking at specific areas of the brain is just not ever going to develop into a identification screening procedure for dyslexia by looking at one brain site. I predict that at some point fMRI may be used to determine what specific areas are problem areas for a particular already diagnosed dyslexic so that an intervention may be developed that most effectively addresses his or her dyslexic problem/s.

The economics of fMRI evaluation for the best intervention selection for a diagnosed dyslexic could turn out to be very favorable for the people that can afford $20,000-30,000 a year for dyslexia intervention. Spending $2,000-4,000 to custom design the intervention based on fMRI results could be cost effective.

A more reasonable future screening process for dyslexia from the general population would include some skill tests and include a family's IQ and educational history along with a questionnaire about their reading habits and other questions that might be found to be helpful such as how well oral directions are followed. The goal should be to identify not only dyslexics but all who are likely to need extra help developing reading skills. Some screening tests already exist and are possibly something that could find funding from educational budgets.

My niche in dyslexia is for the minority of dyslexics that describe visual problems such as jumping or missing letters that make reading difficult for them. I sell dyslexia glasses that remove described visual problems at . I follow most mainstream dyslexia research and am amazed at the hype that is generated as if dyslexia is caused by a single factor and that the answer has been found. I am also concerned that the % of poor readers is so much higher than any estimate of dyslexics and conclude that the educational system is failing many when it comes to teaching the skills needed to read.

MRI studies have their place in generating information about dyslexia but are not ever going to be used for evaluation on a widespread scale because the cost of testing all the non dyslexics would also need to be absorbed.

Thursday, February 15, 2007

Dyslexia and High Intelligence a Common Belief

I have posted on a couple of sites lately that there is no scientific data that indicates that dyslexics have normal to above average intelligence . Diagnosed dyslexics do have average or above average intelligence not because dyslexics have average or above average intelligence in general but because lower intelligent dyslexics are harder to identify and so never enter the group of diagnosed dyslexics that is used for all comparisons to non dyslexics.

While below average dyslexics may be harder to identify that does not mean they could not be helped by proper intervention. The result of this false belief is that dyslexics that could be helped are never identified.

After searching the Internet , I have found why this is such a common belief.

Everybody says so -

A review of many pages of dyslexia web sites indicates that almost all say dyslexics have normal or above normal intelligence. ( This seems to be enough for some people but I usually require at least anecdotal evidence )

By Definition -

Dyslexia is considered a learning disability in the Federal Register under Public Law 94-142. As with other learning disabilities covered under this law, dyslexia involves what is called an exclusionary diagnosis. That is, instead of describing characteristics directly, the definition describes all the conditions that must be ruled out (e.g., low IQ, physical handicaps, environmental factors, etc.) before making a diagnosis. ( This carries more weight than everybody says so. This is a case of I say so and I make the rules. The agenda here seems to be to limit who will be able to get added money from school resources.)

There are other definitions for dyslexia and learning disabilities. I tend to think this next source's agenda is more directly related to scientific reality.

The term "learning disability" was apparently first used and defined by Kirk (1962, cited in Streissguth, Bookstein, Sampson, & Barr, 1993, p.144). The term referred to a discrepancy between a child’s apparent capacity to learn and his or her level of achievement. A review of the LD classifications for 49 of 50 states revealed that 28 of the states included IQ/Achievement discrepancy criteria in their LD guidelines (Ibid., citing Frankenberger & Harper, 1987). However, the National Joint Committee for Learning Disabilities (NJCLD) (1981; 1985) preferred a slightly different definition: "Learning Disability" is a generic term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning or mathematical abilities. These disorders are intrinsic to the individual and presumed to be due to Central Nervous System Dysfunction. Even though a learning disability may occur concomitantly with other handicapping conditions (e.g. sensory impairment, mental retardation, social and emotional disturbance) or environmental influences (e.g. cultural differences, insufficient/inappropriate instruction, psychogenic factors) it is not the direct result of those conditions or influences.

Another reason for believing dyslexics are above average is not that they are but only that they are easier to detect.

Current National Institutes of Health (NIH) studies estimate the prevalence of this disorder (dyslexia) at 20% of school age children. This means that one in five children have the fears and emotions expressed above. It is by far the most common form of learning disability. In addition, dyslexia affects all socio-economic classes and all races equally (2) (2). It affects as many boys as girls (3). However, boys are usually spotted more quickly because they tend to exhibit externalizing behaviors such as acting out when doing poorly in school. Consequently the teacher is more likely to look for a problem in a child who is acting out in class rather than one who is quiet. Thus, boys who tend to act out more will be noticed more by the teacher.
As described above, children with the disorder often feel stupid as a result of their constant struggle in school. However, there is no correlation between intelligence and dyslexia. Furthermore it is important to note that phonological abilities do not depend on IQ - the genetic risk can affect learning to read in children of high and of low IQ equally though the problem is easier to detect in those of higher ability who do not show other learning problems. This does not mean however, that it will be easy to differentiate at school entry
between children with dyslexia and children at risk of failure because they come to school from socio-economically or linguistically disadvantaged backgrounds.

Has anyone actually looked to see if low IQ children would benefit from reading intervention compared to higher IQ children?

There's now evidence from research at York University that shows - contrary to what you might have expected - that children with a low IQ can be helped just as much with reading problems as children with a high IQ, providing it's the right reading programme and providing it's implemented in the right way. What you might have expected is that children with a low IQ wouldn't progress as quickly as children with a high IQ: but what these studies in York have found, he says, is that they do.

This isn't a complete review of the subject and I should add that some researchers have looked at dyslexics V's non dyslexics and indeed concluded that dyslexics are of average or above average intelligence. The flaw I see is in those comparisons is that the group of dyslexics does not actually represent all dyslexics but rather diagnosed dyslexics. As the NIH says, the higher intelligent dyslexics are easier to identify and therefore I believe they are over represented in the groups of dyslexics that are compared. If you consider the fact that there also does not seem to be any real difference between the prevalence of dyslexia in boys and girls but more boys are identified as having dyslexia because they seem to act out their frustration more often, then the resulting ,everybody says so , that dyslexia occurs more often in boys than girls starts to be explained in a similar manner.

My little niche in the field of dyslexia involves visual dyslexia. I would like to give one anecdotal example of a undiagnosed visual dyslexic who was considered mildly mentally retarded. It is about the saddest waste of potential I have ever experienced.

Briefly, I accidentally discovered filters that seemed to remove visual problems for a dyslexic back in 1992. After reading all the literature and seeing how badly everyone thought about tinted lenses as a solution I really didn't want to get involved.

My girlfriend's son seemed to meet the description of reading below his intelligence level for being dyslexic as he was a 20 years old special ed student and had never written or read a word in his life except his name and still did not know his alphabet. He was classified as being mildly retarded, had cerebral palsy affecting his left side and had some hearing loss.

Being bored one day, I thought to see if the filters that later became the See Right Dyslexia Glasses might help Chris. It wasn't readily apparent how to go about that but eventually I tried writing out the alphabet once in order and below that I scrambled the letters. I asked him to match A-A and B-B etc. He could only match 13 of the letters. That did seem to help explain why he never learned his alphabet or to read.

After putting on the See Right Dyslexia Glasses he could match all 26 letters and in 3 days he could read the alphabet from flash cards. He wrote his first note to his mother after a week. Since then I have been looking for the research that has been done to conclude that dyslexics are only from the group of average to above average intelligence and I still do not believe it has ever been done.

My experience with how Chris responded to the dyslexia glasses motivated me to investigate several subjects. The first was to identify who the See Right Dyslexia Glasses might help and why. The second was to identify why dyslexics were thought to be from the group of people who have average to above average intelligence.

15 years later I have the answers to both questions. The See Right Dyslexia Glasses remove any described visual problem that makes reading difficult for visual dyslexics and so benefit any dyslexic that can describe a visual problem that makes it difficult to read. The myth of why dyslexics are considered to have average or above intelligence is the result of several factors described in this post but does not seem to have any valid support and is a self fulfilling prophecy.

Monday, February 12, 2007

An Example of Sampling Bias in Dyslexia Reporting

Pre selecting has a long history in dyslexia research. " dyslexics are of average or above average intelligence." is a self fulfilling prophecy because if you look for dyslexics from the group of people having average to above average intelligence to the exclusion of below average intelligence then that is what you find. This technique produces what is called a sampling bias.

The following is from an article that suggests that schools need to do a better job teaching dyslexics how to read. That is certainly true. I just do not believe that the example below supports what is inferred from the rest of the article.

"Robert Broudo, the Landmark School's headmaster, said the school selects students with strong intellectual ability, even if they have serious reading deficits.
It then gives them concentrated help with their reading difficulties, he said, including one-on-one tutoring each day and grouping students by reading ability in each of their classes.
The results? About 90 percent of Landmark's graduates go on to college, and all of them passed Massachusetts' state graduation exam last year, compared with 65 percent of special education students elsewhere in the state. "

Let me take the above information and look at it differently to see why I suggest the results might not be what it suggests. I will use a group size of 100 as an example.

1) Normally 65 special ed students pass the Massachusetts' state graduation exam out of a group of 100.

2) Normally 35 special education students do not pass the Massachusetts' state graduation exam college out of a group of 100.

3) If you look at the top 50 of the group as indicated by intellectual ability you would expect a higher % to pass the Massachusetts' state graduation exam .

4) If you look at the bottom 50 of the group as indicated by intellectual ability you would expect a smaller % to pass the Massachusetts' state graduation exam.

5) All 50 passed the Massachusetts' state graduation exam from the top group after intervention.

6) If 15 out of 50 passed the Massachusetts' state graduation exam from the bottom group ,a 30% average, then the total would be the same.

Is it reasonable to suspect that the rate of passing the Massachusetts' state graduation exam is 100% from the top half and 30% from the bottom half for special education students when the average for the whole group 65% without the intervention? I believe it is.

For the intervention to not be indicated as any success by the standard of passing the Massachusetts' state graduation exam , the only thing that would have to be true is that the 35 special education students who did not pass the Massachusetts' state graduation exam all were from the bottom half of the students.

I think it is reasonable to suspect that the 35 students who were not going to pass the Massachusetts' state graduation exam were indeed from the bottom half of the group along with 15 students who were going to pass the Massachusetts' state graduation exam.

Do I think the intervention was of no value? NO ! Was any information given that would support the value of the intervention? NO !

How reading is taught needs to be improved, examples are everywhere in the statistics.That is why I will not say that the intervention had no value. This sloppy example does nothing to give any indication of what type of intervention works or does not work. The standard used, that the selected students did better than average as indicated by passing the Massachusetts' state graduation exam, could have also resulted from the sampling bias of selecting the better students and then comparing the selected group to the average.

Dyslexia is a syndrome

A minority of dyslexics have predominantly visual problems and most of these dyslexics surprise their parents and teachers with their difficulty learning to read because they have normal verbal development. When these ( a minority of dyslexics ) describe symptoms such as not being able to read because the letters are moving around to much or there is an amount of time before the next word comes into focus, it is easy to see their problem isn't phonological.

The prejudice against visual problems being involved with dyslexia partly is generated by the public response to those overselling the concept that there is a single color for a particular dyslexic that will help their dyslexia. When the evaluation is actually the product being sold there is no recourse when there is failure and no financial reason to limit those tested as the profits are the same for both success or failure.

This failure of high priced evaluations to determine a particular color for a particular dyslexic should not result in the conclusion that dyslexics have no visual problems. All the failure does is to make it a financially risky action to try those high priced evaluations.

Why then are we reading lately that fMRI studies have now proven that dyslexia is caused by phonological processing areas of the brain? Simply because that is the latest study reported and almost all fMRI studies conclude that they have found the cause.

My opinion is that there just doesn't seem to be any glory in concluding that a factor in dyslexia has been found. In fact every part of the brain that involves reading ,when studied by fMRI , shows the same type of results when a group of dyslexics is compared to a group of non dyslexics. The results show differences between groups but have so much overlap that individuals can not be identified as being dyslexic or not.

Now, I do not question any of the brain imaging results. I do note the fact that the differences observed ( when looking at any single brain location ) only show up when comparing groups and not individuals.

I suggest that the dyslexics in those studies whose results overlap non dyslexics actually have their dyslexia caused by different factors than what is being studied. I suspect that 1 group that skews the results have visual processing problems. This also works in reverse when studying the visual centers by the phonologically impaired.

Having a group of dyslexics made from dyslexics that actually have different factors causing their dyslexia would produce the fMRI results that are reported. I think that dyslexia having more than one cause the more reasonable conclusion rather than there is one cause which can not identify a individual as being dyslexic.

To consider dyslexia a syndrome and not be constrained by the single cause theory is much more likely to result in arriving at being able to identify a dyslexic by the fMRI method. This would require that several areas of the brain are evaluated for signs of dyslexia and at least might identify those individuals whose cause of dyslexia is able to be evaluated by fMRI data.

Friday, February 2, 2007

The Visual Dyslexia Solution

I have a web site where I sell See Right Dyslexia Glasses that claim to remove any described visual problem that makes reading difficult for dyslexics. I used to blog on Jumbled Letters which was for dyslexics but they are no longer in existence.

The address for the site is .