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Who Helps Kids With Dyslexia Gain Reading Fluency?

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When Martha Youman was starting out as a second-grade teacher, every Friday she would stay late after school to make what she called “seat work” for her 30 students— packets to help differentiate instruction for the three levels of learners in her classroom.

“My high-level [students] would get lots of reading passages with reading comprehension questions,” she said. “My medium level would get the same thing, but shorter. And my students at the low level would get things like coloring pages, connect the dots — just things to keep them busy so they wouldn’t act out.”

She said that some students at the lowest learning level couldn’t even write the alphabet yet, so she’d even put kindergarten-style trace-the-letter pages into their seat work.

While the “seat work” kept behavior in check, it was failing as a teaching strategy. Youman, who had been a New York City Teaching Fellow, said she knew that some of these kids were struggling to read, but also knew from class interactions that they were smart. “I kept them busy. Truly, there were interventions they needed, I just didn’t know how to help them,” she said. “I had a master's in teaching, and didn’t know how to deal with these students.”

Youman now understands that some of her struggling second-graders were most likely dyslexic, with neurobiologically different brains that often fail to read words and sentences without direct, specific intervention.


“I received zero dyslexia training in grad school,” she said. “I received one class in how to teach reading, one in how to teach language arts, how to teach science, how to teach math. But these classes focused more on lesson planning and strategies at a class level. We did not talk at all about kids who can’t catch up, ever. The word dyslexia was never even mentioned.”

After a few years in what felt like “the front lines of a war zone,” she went back to school to pursue a Ph.D. in school psychology, figuring she’d become the expert the struggling kids needed to intervene on their behalf.

It was only after she took a doctorate-level class called “High-Incidence Disabilities” with Dr. Nancy Mather at the University of Arizona did the lightbulb switch on. She learned that reading disabilities affect anywhere from 5 percent to 20 percent of students. Youman recalled discussing dyslexia in the class and feeling perplexed. “I stopped and said, 'Wait, this happens a lot? Then why don’t we know about it?' ”

The 7- and 8-year-olds who couldn’t even write the alphabet, she discovered, might have been helped if someone had stepped in to find out why—was it a deficiency with roots in the child’s environment, or lack of phoneme awareness? Or a comprehension deficiency, or some combination of any or all of them? Youman quickly decided that this is where she could be useful -- to go inside schools and help find the kids who were struggling, figure out what was happening and try to intervene.

Armed with a Ph.D. in school psychology and currently diagnosing disabilities at a middle school in the Jefferson Elementary School District in Daly City (near San Francisco), Youman now understands more clearly why she didn’t know then how to help her struggling students: First, she was never trained how to specifically help students become better readers; and second, there are multiple bureaucratic barriers standing in the way of students getting help. For example, until very recently, California law provided 13 disability categories that could qualify students for services through an Individualized Education Program (IEP), but dyslexia wasn’t one of them.*

“When I’m testing a child to decide if they need special education services, I have to say that they have a Specified Learning Disorder, or SLD,” she said, noting that dyslexia is one of the categories buried under the umbrella term SLD. “But that can be confusing for parents if psychologists in one state say your kid has dyslexia. If they were to move to another state and say, 'We were told our child has dyslexia,' their new school might say, ‘Dyslexia isn’t a thing here.’”

That’s recently changed, aided in part by advocacy work Youman herself has done to get a new bill passed that addresses dyslexia in schools directly. On October 8, the California state legislature enacted Assembly Bill 1369, which will require schools to assess young readers for dyslexia specifically. The new law, which will make allowances for school psychologists to diagnose a “phonological processing deficit” also known as dyslexia, may seem like a small change, but Youman said its impact on how children can get intervention will be huge.

“With this change, we can actually tell parents and teachers that a child being evaluated has dyslexia,” said Youman. “And we can recommend specific interventions that help at home and in the classroom. Hooray! This change seems very minor, but it is really huge.” Although Youman said that no direct changes have come to schools yet, at least they are on their way. And she’s hoping that just being able to say the word dyslexia will open the doors to more and better changes, including more sophisticated in-school tutoring and teacher training on how to recognize and teach to dyslexics.

Assembly Bill 1369 has helped to clarify the overall SLD category, which Youman described as “messy." Much of the time, she is forced to rely on her clinical judgement to decide who gets an IEP.

In addition, Youman said that whether or not IEPs actually help depends upon the individual school’s resources, because teachers and paraprofessionals need to be trained on what exercises to do to help students diagnosed with dyslexia, and the best results come from individual instruction. She admitted that in many cases, IEPs don’t really work and many families must rely on private tutors.

Youman wishes that dyslexia intervention had the outcomes of speech and language therapy, a school-rendered intervention she said actually works. “For speech and language therapy, the student sees a trained person. What they do is targeted, one-on-one or two-on-one, and they do a really good job targeting the specific areas of weakness.” But with dyslexia (or SLD), at her school, students are pulled out in groups of 10 to get help with their homework, and that’s the whole of the intervention. And Youman, now an expert in dyslexia, said it’s not enough.

Where is the Training?

In a recent New York Times op-ed titled “Teachers Aren’t Dumb,” cognitive psychologist Daniel T. Willingham at the University of Virginia wrote that many teachers don’t know the basic concepts of reading -- ones agreed upon by the National Reading Panel. He cited one study of undergraduates preparing to be teachers, “fresh from their coursework in reading instruction,” in which 42 percent couldn’t correctly define the term “phonological awareness,” the first of the five pillars of reading. In Willingham's estimation, American schools of education are dropping the ball when it comes to preparing teachers how to teach.

Laurie Cutting, professor of special education and faculty director of the Vanderbilt Kennedy Center Reading Clinic, called the lack of American teacher training in reading “a disgrace,” considering she has yet to meet a teacher who doesn’t want to do right by her students. Yet misinformation abounds. She said teachers who don't know how to teach reading make a logical, if flawed, observation about it, based on classroom experience: 50 percent of any group of kids are going to “magically” learn how to read. Teachers then may assume that the second half will also magically learn how to read, given enough time.

Cutting said that’s not the case. That second half will struggle and need some direct instruction; within that group, a portion will need a whole lot of direct instruction (perhaps even intervention). The half (maybe a little more in affluent schools) that learns to read as if it were natural can subtly influence how teachers think of reading -- which may lead teachers to lean on more holistic views of language, focusing more on enriching vocabularies and exposure to literature instead of phonics.

But the 50 percent who need direct instruction need first to learn how to decode, or be able to match the sounds of letters to print letters in order to form words. Teaching the whole class the basics of decoding will not damage the students who are already reading (Cutting said some research suggests that it might actually make their reading stronger). But direct instruction on exactly how to teach phonemic awareness and decoding to that other 50 percent may be getting short shrift in education schools (think of Martha Youman, with her master's in teaching, but no idea how to help struggling readers). Dr. Louisa Moats, vice president of the International Dyslexia Association, has called this gap between what the scientific community knows about reading and what teachers learn the “Knowledge Gulf.”  She travels widely, offering whole-school interventions in reading training.

“It really is a disgrace,” Cutting said, “because we know how to do it [teach decoding]. We have these tools, and we know how to teach this part of reading. The other parts are not as easily addressed, like fluency, but we know how to teach kids how to decode.”

Cutting said approximately 1-2 percent of kids will always struggle, but that leaves 48 percent -- nearly all of that second half of the classroom -- who would be greatly helped with direct instruction correctly administered.

Enriching students and exposing them to literature is a necessary part of learning to read, but only one leg of the triangle model of reading. Cutting explained that in order for reading fluency to happen, students must have strong connections in all three pieces: a semantic representation, or knowing what the word means; an orthographic representation, knowing what the word looks like; and a phonological representation, knowing what the word sounds like.

For many dyslexics, at least one piece of this triangle isn’t represented, sometimes two. But, as Maryanne Wolf wrote in "Proust in the Squid," the most common deficit among children who can't read is phoneme awareness: the ability to see letters and sound them out efficiently to form words.

What Individualized Instruction Looks Like

Since each human brain must learn to read on its own, Cutting, along with Brooke Soden, associate director at the Vanderbilt Kennedy Center Reading Clinic, understand that deficiencies and weaknesses are individual, and often must be addressed on a case-by-case basis.

That’s how the clinic tackles reading disabilities: one child at a time. Soden coordinates and manages the clinic, overseeing one-on-one tutoring as well as providing community training to teachers on how to teach reading. Often children arriving at the clinic are the hardest ones to work with, after their parents and teachers have tried everything else, so Soden assesses students to tease out what’s really going on and where their weaknesses are, then works with tutors on individual plans of action for each child. In most cases, the tutoring involves systematic, direct instruction, much of which is a version of the Orton-Gillingham method created to teach dyslexics to read nearly 100 years ago.

Developmental pediatrician Sheryl Rimrodt, who works with Cutting and Soden in helping to diagnose children with both behavioral and reading disabilities, said that since dyslexia doesn’t have any biomarkers to distinguish it, diagnoses are made up of descriptions of what they see happening, blended with the child’s history.

Often, reading problems go hand-in-hand with attention and impulsivity issues like ADHD (Cutting suggested that current research may find a link between the two, having to do with executive function), which creates yet another challenge: Is the child acting out because they can’t read? Or, is it the other way around?

If sorting out the diagnosis and treatment of dyslexia weren’t complicated enough, the Vanderbilt researchers mention the most crucial piece for schools and clinics alike: deciding who is going to get special intervention services. The Reading Clinic costs money, even though scholarships are available to the financially needy. And IEPs in schools also cost money; it costs money to train teachers and bring on extra staff to do the crucial one-on-one work necessary to improve dyslexia.

“You have a finite amount of money, and a bunch of kids. The kids who are going to get the services are most likely the ones who are the most severe, or have the most advocates,” Cutting said. “It’s sort of a fundamental fact of life. It’s too bad that we are not able to capture kids early enough to do some remediation so that they don’t have as many word-level problems. It’s too bad that teachers many times aren’t trained in a way that allows those kids to work through their weaknesses, to sound out their words. Because that would benefit all of the kids.”


*Note: An earlier version of this post misidentified "Individualized Education Program" as "Individualized Education Plan." It also misidentified Youman's school district as the San Francisco Unified School District. We regret these errors. 

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