Coping with Dyslexia, Dysgraphia and ADHD: A Global Perspective [1 ed.] 1138069663, 9781138069664

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“Finally, someone has written a book that is readable for parents, teachers, and the public, that honestly addresses dyslexia (and dysgraphia and ADHD) comprehensively, including differences and commonalities across cultures, languages, and scripts! McBride brings together research, her own wealth of experience in many countries and cultures, and the voices of those who work with or live with dyslexia on a daily basis, to provide information about these conditions and helpful suggestions and resources. This is a book that should sit not only on academic shelves but also on teachers’ and principals’ desks and family coffee tables!” Peggy McCardle, Ph.D., MPH, PM Consulting, LLC & Haskins Laboratories “The author is one of the most well informed experts in the areas covered in this book. Widening the perspective to take into account non-English speaking environments especially when illustrating language-related developmental problems is highly welcome and is made in this book in a laudable way… A most important benefit to readers is the provision of helpful advice which can be applied in real-life situations in helping children.” Heikki Lyytinen, UNESCO Chairholder/professor on Inclusive Literacy Learning for All (2015–19), Dept. of Psychology & Agora Center, University of Jyväskylä, Finland “This is a truly amazing book! McBride uses her in-depth knowledge as a reading researcher who has lived in two cultures with very different writing systems to bring together knowledge about dyslexia as a global difficulty and what can be done about it. Students, parents, and teachers who want to learn about dyslexia across cultures should read this book to find out from McBride and her interviewees not only what causes it but what it feels like and ‘what helps’.” Professor Maggie Snowling CBE, President of St. John’s College, Oxford “McBride embarks on a sensitive and compelling journey of learning… Through stories and research that is multicultural, Cammie makes the book rich and powerful in its narrative and global in its appeal and relevance. She discusses the importance and value of careful assessment and subsequent remediation, be it dyslexia, dysgraphia or ADHD, using sound research evidence, thus making this book an invaluable resource at home, in school, and in the research laboratory.” Nandini Chatterjee Singh, Professor, National Brain Research Centre, India

COPING WITH DYSLEXIA, DYSGRAPHIA AND ADHD

Coping with Dyslexia, Dysgraphia and ADHD: A Global Perspective uniquely incorporates dyslexia, dysgraphia, and ADHD into one volume, offering practical advice on how to manage each of these disorders. McBride combines a solid research base with interviews with specialists in learning disabilities, as well as parents, teachers, and students with personal knowledge of each difficulty from six continents. The innovative cross-cultural focus of the book is emphasized in the introduction, which is followed by one chapter each on the basics of each of these learning difficulties and another three chapters on their remediation. The book goes on to cover topics such as comorbidities across learning or other difficulties, learning of multiple languages, facilitating self-esteem, and enhancing reading comprehension and writing composition in the face of dyslexia, dysgraphia, and ADHD. Appendices with short, practical tips on learning, multi-media resources, and ways to test and train cognitive-linguistic skills are included as an additional resource. Coping with Dyslexia, Dysgraphia and ADHD: A Global Perspective is intended for practitioners, teachers, parents, and those with any or all of these learning difficulties. University or postgraduate students who wish to understand more about dyslexia, dysgraphia, and/or ADHD will also benefit from the clear analysis. With this book, the reader will not only come to understand the fundamental nature of these learning difficulties, but will also get to know the people whose lives are so deeply affected by them. Catherine McBride is Professor of Developmental Psychology at The Chinese University of Hong Kong. She has served as President of both the international Society for the Scientific Study of Reading and the Association for Reading and Writing in Asia. She is an expert on reading development and impairment across languages, scripts, and cultures.

COPING WITH DYSLEXIA, DYSGRAPHIA AND ADHD A Global Perspective

Catherine McBride

First published 2019 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 52 Vanderbilt Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2019 Catherine McBride The right of Catherine McBride to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Names: McBride, Catherine, author. Title: Coping with dyslexia, dysgraphia and ADHD : a global perspective / Catherine McBride. Description: Abingdon, Oxon ; New York, NY : Routledge, 2019. | Includes bibliographical references and index. Identifiers: LCCN 2018040167 (print) | LCCN 2018052120 (ebook) | ISBN 9781138069664 (hardback) | ISBN 9781138069671 (pbk) | ISBN 9781315115566 (ebk) Subjects: LCSH: Dyslexic children—Education. | Attention-deficitdisordered children—Education. | Learning disabled children— Education | Literacy—Study and teaching. | Reading. Classification: LCC LC4708 (ebook) | LCC LC4708. M45 2019 (print) | DDC 371.9—dc23 LC record available at https://lccn.loc.gov/2018040167 ISBN: 978-1-138-06966-4 (hbk) ISBN: 978-1-138-06967-1 (pbk) ISBN: 978-1-315-11556-6 (ebk) Typeset in Bembo by Apex CoVantage, LLC

This book is dedicated to my husband, Helmuth, who shaped my experience of the writing of this book, and, indeed, the living of my life, to be progressively more global, buoyant, and einfach wunderbar.

CONTENTS

Introduction

1

  1 Understanding learning disabilities around the world

6

  2 Understanding dyslexia

25

  3 What is dysgraphia?

53

  4 Basics of attention deficit hyperactivity disorder (ADHD)

65

  5 Comorbidity: having more than one learning or mental health difficulty

78

  6 What is the impact of having to learn multiple languages or orthographies on literacy learning?

90

  7 Best practices in remediating dyslexia around the world

104

  8 Suggestions on how to help those with dysgraphia difficulties

118

  9 Helping children with ADHD

126

10 Reading and writing to learn: suggestions for helping children with reading comprehension and writing composition143

x Contents

11 Self-esteem and learning disabilities

154

12 Where do you go from here?

178

Afterword187 Appendix A: Questionnaire respondents 189 191 Appendix B: International organizations on dyslexia Appendix C: International organizations on dysgraphia 194 Appendix D: International organizations on ADHD 196 Appendix E: Practical tips to help in daily struggles with dyslexia-related learning 198 Appendix F: List of computer games and apps available free of charge online to aid in reading development, 201 separately by language Appendix G: Movies and other video clips on the subject of dyslexia and related learning disabilities 208 Appendix H: Phonological awareness and morphological 214 awareness exercises References217 Index235

INTRODUCTION

As Janet Jackson once said in a catchy one-liner 30+ years ago, what have you done for me lately? This is also a fair question for the general public to ask of researchers focused on dyslexia. It is the one I started with when I began this book. I have been engaged in research on reading development and dyslexia for almost as long as this song has been in existence, working together with colleagues from all over the world. Consistently, whenever I talk to those most concerned with dyslexia on a personal level, namely parents, teachers, clinicians, and those with dyslexia themselves, they want the answer. This book is an attempt to give you one. There is a lot that research can contribute to helping individuals, families, teachers, schools, and practitioners with understanding and remediation of dyslexia. “Theory into practice” is a mantra of many caring professionals.Yet too often, there is a gaping divide between those of us who do research for a living and those who need to apply the information to a particular individual or situation. Our methods are different, our needs are different, and even our questions are different. In this book, I wanted to integrate research on what we know about dyslexia around the world with individual voices from those who understand dyslexia and associated learning difficulties best. This book is intended both for the general public and for students and colleagues interested in dyslexia and other learning difficulties. With this goal in mind, I have brought together research on dyslexia, dysgraphia, and attention deficit disorders with interviews and quotes from those who deal with these difficulties in their daily lives. Interviews came from those who focus on one or more of these learning difficulties either because they themselves have one or more of these, because they are parents or other supporters of those who do, or because they work in this area as a practitioner (e.g., teacher, speech therapist, clinical psychologist, educational psychologist, pediatrician). What is largely lacking in the research with learning difficulties is a nuanced understanding of the practical daily aspects of these.With this book, I hope to highlight both research and practice

2 Introduction

from those who, on a daily basis, live with dyslexia and/or associated difficulties. These voices are 32 individuals who come from 20 different territories and countries and represent very different perspectives on dyslexia, dysgraphia, and attention deficit difficulties. I am extremely grateful to each individual who agreed to be interviewed in person or to complete my questionnaire. A brief list of these individuals, either by real name or by a pseudonym, as they desired, is listed in Appendix A. These individuals span six of the seven continents of the world. This book takes a more global perspective on dyslexia than most, in part because I have lived it. I am an American, educated in the United States, who has lived and worked in Hong Kong for 22 years. My research has always been on reading development and impairment across languages, scripts, and cultures. I am writing this book from Freiburg-im-Breisgau, Germany, on a sabbatical leave in Europe sponsored by the European Union (Institute for Advanced Studies). I have also given talks about reading development and impairment in several different additional countries (including India, Japan, Taiwan, Mainland China, Switzerland, Korea, Canada, and Singapore). These experiences have sensitized me to the fact that dyslexia is a problem for children and adults around the world. Many, if not most, books on dyslexia tend to focus on dyslexia as a problem of reading in English. Moreover, the research on dyslexia coming from English-speaking countries tends to be of high quality and critical for our understanding of the disorder. Yet this perspective can be limiting. With this book, I attempt to integrate multiple perspectives on dyslexia, highlighting the fact that cultures, languages, and scripts are all important for understanding learning difficulties. Indeed, the perspectives of people from Africa, Asia, Europe, and the Middle East, as well as North and South America, on dyslexia can help to underscore what is the same and what is different about dyslexia in different contexts. Still, one of the things that surprised me to the greatest extent in my interviews was that many of the most salient aspects of the experience of dyslexia are common across cultures, languages, and scripts. The interviewees included in the book attest to this and illustrate both the frustration and the hope that come with dealing with dyslexia.When I first set out to interview people with direct knowledge of dyslexia and its accompanying difficulties, I had not anticipated finding so many commonalities across cultures. What work on this book has accentuated for me, perhaps more than anything else, is the psychosocial toll that a learning difficulty takes on the individual child and even on the larger family unit. There is much more work to be done, for example, on issues of self-esteem and building grit in children with learning difficulties. We have enough research showing that those with dyslexia or other learning difficulties often suffer lower self-esteem and other feelings of doubt because of their constant frustrations in school, the focal point of their everyday lives for years, in addition to the experiences of their frustrated parents and grandparents. What is sorely needed, however, is more information on how parents and teachers can help students with dyslexia and related learning difficulties to stay motivated and excited about learning despite the obstacles they face. I hope that this book offers a small window into one way forward on this front.

Introduction  3

The book is divided into 12 chapters. I first wanted to give an introduction to the global landscape of learning difficulties across cultures. Thus, in Chapter 1, I overview learning difficulties around the world. This chapter provides a broad framework for understanding these difficulties, taking into account individual characteristics of children, environmental aspects of learning to read and to write, including language and script, and a very basic introduction to the neuroscience of dyslexia and accompanying difficulties. Chapter 2 gives a basic definition of dyslexia and focuses particularly on cognitive correlates of this word reading difficulty. Highlighting these cognitive skills can be critical in understanding how to diagnose and treat dyslexia. The aim of Chapter 3 is to provide a basic definition of dysgraphia, a word writing disorder with several facets. Defining dysgraphia is important because it often overlaps with dyslexia, but it is not the same thing. Moreover, there are those who suffer from dysgraphia but not dyslexia, and their difficulties are no less important for school success and failure. In Chapter 4, I turn to the challenge of attention deficit hyperactivity disorder (ADHD). This is an additional learning difficulty that co-occurs with dyslexia fairly often. In fact, in some countries, having attentional difficulties is virtually a part of the definition of dyslexia. Although I think this idea is very much misplaced, there is enough overlap between the two that attentional difficulties warrant some exploration. This brings us naturally to Chapter 5, which focuses on comorbidity, or overlap, across learning difficulties. Having more than one learning or psychosocial difficulty together brings with it a unique perspective and lifestyle. Some people have to contend with several specific disorders at the same time, and their experience is particularly important to highlight. It is critical to understand how these difficulties interact and how to deal with more than one of them at a time. In Chapter 6, we review what it is like to have dyslexia and to have to learn more than one language in school. For most of the world’s population, this is an important issue, and for some children, this even implies learning two different scripts as well as the languages mapped on to them. How great an obstacle is this for a person with dyslexia or dysgraphia? We will examine debates on this issue. Chapters 7, 8, and 9 consider from a practical perspective how best to help those with dyslexia, dysgraphia, and attention deficit hyperactivity disorder (ADHD), respectively. As a researcher, I am often asked what practical suggestions I can give to children who have these difficulties and their adult supporters (parents, teachers, various professionals); these chapters are my answers. Chapter 7 gives me an opportunity to put forward some advice on remediating and also simply dealing with dyslexia. Chapter 8 focuses on the same issues for dysgraphia specifically. Finally, in Chapter 9, I present some advice on how to wrestle with ADHD, including the difficult question of whether and how to use medication, an issue that is to date not ever considered for specific reading or writing difficulties but that is routinely acknowledged as potentially helpful in cases of ADHD. In Chapter 10, we talk about some basics of reading comprehension and writing composition. Although the primary focus of this book is on word reading and writing difficulties, extending the discussion to higher levels of reading comprehension and writing composition is done

4 Introduction

in this chapter in order to make the book more comprehensive in offering simple advice for general learning in school beyond word reading and writing. Chapter 11 covers issues of self-esteem with learning difficulties. This is probably one of the most important and most challenging issues of this book. Children with learning difficulties face assaults on their self-esteem every day of their school lives. How do we as professionals, parents, and teachers, keep them optimistic, hopeful, learning? Finally, the last chapter, Chapter 12, considers what to do next after reading this book. What is the way forward? What should researchers, teachers, and parents do next given the information presented? What concrete resources and ideas can you take on for yourself, your family, your classroom? In addition to the afterword at the end of this book, please take a few minutes to go through the appendices. These were compiled as labors of love and are intended to make the issue of dyslexia more accessible worldwide. Appendix A lists the names, roles/professions, and countries of all 32 of my interviewees representing 20 countries or territories and six continents. Quotes from these individuals are interspersed throughout the book, and you can refer to this Appendix at any time for additional information on each person.The youngest interviewee was 17 years old. These interviews were conducted either via emailed questionnaire or in person with individuals I either met (some randomly; some at conferences specifically devoted to dyslexia) or had previously known during the writing of this book, or via referrals from others. These interviews clearly do not represent an unbiased random sample. However, what is particularly important to me about each and every interview is that the focus was on learning difficulties from his or her own unique perspective, and the perspectives represent a variety of different viewpoints and places all around the world. Appendix B lists organizations around the world (by country or territory) that provide practical information on dyslexia. Appendix C lists similar organizations that are dedicated to understanding and remediating dysgraphia. In Appendix D, you will find information listed worldwide for those who are interested in accessing additional information about ADHD. Appendix E is a compilation of learning tips for those with dyslexia, dysgraphia, and general learning struggles. These are typically not more than 3 lines long and provide guidelines on what has worked for one or more individuals with this learning struggle. These came from the interviewees and also from the references consulted as I wrote the book; they are intended as helpful suggestions to try with the hope and perspective that some of them might work for you and yours. Appendix F lists free online games in various languages/ scripts that can help to reinforce reading skills.We highlight only those that are free, reasoning that for games that you can pay for, there will be more opportunities to search. Because computer games are very helpful as reinforced practice for struggling readers, we wanted to show some that are available now in different languages. Appendix G is a list of some resources in the forms of films or online clips that are dedicated to explaining, dramatizing, or illustrating certain ideas about dyslexia and related learning difficulties. They are intended as resources for bringing more understanding of this learning difficulty to the general public. Finally, Appendix H

Introduction  5

is an easy way to access some of the information detailed in Chapter 2 quickly. It shows some ways to measure phonological awareness and morphological awareness, two important reading-related skills, in English, so that you can take these ideas and make use of them either in English or by making some analogies to your targeted language and script. Depending upon your interests, you may want to skip one or more of the chapters geared towards theory. The chapters can be read out of order. Practitioners might be particularly interested in the specific chapters on dyslexia, dysgraphia, and attention deficit hyperactivity disorder (ADHD), individually. In addition, if you have further questions you can write me on my website cammiemcbride.com. This has been a fun book to write and research. I have thoroughly enjoyed the interviews, the research papers and books, and the websites that are summarized here. Whatever your perspective, I hope you get something useful from this integration, which is diverse, complicated, and emotional. What have I done for you lately? I tried to integrate diverse ideas from around the world in this book.

1 UNDERSTANDING LEARNING DISABILITIES AROUND THE WORLD

Dyslexia, one of the main learning disabilities recognized worldwide, can wreak havoc on one’s school performance, self-esteem, and work life and attainment. For example, Moody et al. (2000) and Wilkinson (2015) estimate that between 50% and 80% of those who are in prison may have dyslexia. Other learning disabilities which are sometimes associated with dyslexia, particularly attention deficit hyperactivity disorder (ADHD) and dysgraphia, a specific problem with writing and spelling, can be similarly debilitating. Because so much of who one is as a child revolves around school, learning difficulties can have serious and often life-long ramifications. For example, in a survey by the U.S. National Center for Learning Disabilities (2014), 55% of those Americans with learning difficulties had had some experience with the U.S. criminal justice system within eight years following the end of secondary school. Those with learning difficulties also have more struggles in completing secondary school, getting postsecondary educational qualifications, and, consequently, landing satisfying jobs. With learning struggles often come frustration and sometimes despair. These can spill over into many aspects of life. To illustrate this point, consider the personal narrative of one of my interviewees, Danna, a nurse and practitioner, with an additional Master’s degree in musicology. Danna is now the mother of three lovable and smart children and has a warm and supportive husband.Yet her story illustrates the heavy toll that learning difficulties such as dyslexia can have on a person over many years: My earliest realization of my condition or weakness came around about high school. I remember the notion that the teachers respected my efforts and willingness to study, but could not explain my very average performance in school, especially in tests. Earlier than that, in elementary school, we had little awareness of the situation. I do remember that neither my teacher nor my mother thought I could be accepted to the town’s best high school.

Learning disabilities around the world  7

I somehow made it in, but remained very average since. There was always a major discrepancy between what I thought I knew, and learned for, and how I performed in school. My mother did not believe that I could go on to higher studies. I do remember a couple of incidents where, while I was older (in my twenties), I was one time dating a lawyer, and when my mother heard about it, she commented, “why don’t they introduce you to someone at your level?” Another time, when I willingly broke up with another person I dated (a neurosurgeon), my mother told me she thought I would never marry. My mother was very focused on studies, and when she realized I was going to be average, she destined me for average and did not consider any ability to aim higher. Neither did she consider to strengthen other talents I had like dancing, playing instruments, or acting (everything I was later known to be very good at, and developed on my own, either academically or professionally). My experience throughout childhood and adolescence was being “not smart,” and unable. No one knew or spoke of dyslexia at that age (30 years ago). Danna’s words reflect a general sadness about her condition, largely unexplained and undiagnosed for many years. She and her husband, Joe, are now very high achievers in their respective professions, models of success in many ways.Yet clearly the childhood dyslexia Danna experienced colored her entire growing up period in some aspects, extending even to ideas from her mother about dating and marriage. Apart from the general pain of enduring a focus on weaknesses and a dismissal of strengths in her youth, Danna also had more specific episodes of recognizing her difficulties but not knowing how to get help with them. As she continues, There was another incident when I got a very low grade, and demanded I see the exam (which required a fee). I realized that I made several mistakes (double entries and skipping lines, which were both obvious and excruciatingly painful). I was then referred to a therapist for evaluation of a learning disability, but it did not go the right direction, but focused on therapy rather than the learning disability. I never followed through (having other issues with my mother, growing up without a father, among other challenges). While everyone with a learning disability has a different and very personal story, Danna’s narrative here echoes a nearly universal theme: Despite having particular talents and skills and being competent in various areas, those with learning difficulties often feel bewildered about their learning, and their early difficulties impact their self-esteem and developmental trajectories. In this chapter, we focus on various factors that influence how, when, and where learning disabilities manifest themselves.

Defining learning difficulties around the world How can we understand what a learning difficulty is? When I ask colleagues around the world how dyslexia is defined in their home country, their answers vary widely.

8  Learning disabilities around the world

For example, in places like the Philippines and Zambia, the perception is sometimes that dyslexia represents a broader learning disability that usually includes some attentional difficulties in learning. In other places, such as Taiwan, there is a broad definition of dyslexia, including an explicit requirement about the child’s IQ (general intelligence quotient, or general reasoning); interestingly, each region of Taiwan is given the choice as to how to diagnose each child there with a variety of different tests that are often self-selected. In Israel, dyslexia is only defined at a relatively late age (grades 4 or 5, around the ages of 10 or older). In Vienna, Austria, one colleague told me that the concept of dyslexia has been influenced strongly by just a few charismatic individuals who implicate spatial skills in a way that is not part of the global mainstream idea of dyslexia.These examples illustrate the fact that the ways in which we conceptualize a learning disability must be considered from a global perspective so as to sort out what is universally at the core of dyslexia and other learning difficulties, what might be specific to a given language or script, and even what ideas are problematic, indeed wrong, for teachers, parents, students, and clinicians devoted to ameliorating learning problems. In order to understand learning disabilities worldwide, we begin by highlighting three different influences on a child’s experience of learning difficulties. We start with aspects of language and script. These are front and center for the problems of dyslexia and dysgraphia. It is important to acknowledge that the requirements for learning to read and to write words in different languages and scripts are somewhat different, as detailed below. More broadly, we consider basic culture. Sometimes, it seems as if culture affects almost every aspect of the learner’s experience of learning disabilities. Children in Iceland, Venezuela, and Malaysia are all learning to read and to write, but their experiences of literacy and school more broadly differ widely. Culture includes general attitudes about learning and schooling and resources related to schooling. A final broad influence on learning difficulties is children’s individual approaches to learning. These include general perceptual and cognitive abilities, as well as the neurobiological aspects of learning and learning difficulties.

Culture as language and script Whether you are reading this book as a parent, teacher, clinician, education specialist, or someone with a learning disability yourself, some of the answers on how a particular learning disability is conceptualized and treated have to do with culture and surrounding environment. John Dewey, an American philosopher, once said “A problem well put is half solved.” Here, the problem is defining precisely learning disabilities – what are they? Around the world, those focused on helping people with learning disabilities attempt to define a specific learning disability are first faced with the task of understanding the precise nature of the learning disability. In relation to problems of reading and writing words, one of the most important aspects of this has to do with the language and script of the school and society. We consider languages and scripts first in our focus on culture, since dyslexia and

Learning disabilities around the world  9

dysgraphia are fundamentally problems of language and script. Which languages and scripts are taught, where, and why are central questions around the world. For example, in Zambia, in Africa, there are seven official native languages and English which are collectively used to teach early literacy; the country estimates that there are 72 languages or dialects spoken throughout the country. In the Philippines, there are two official languages (English, Filipino), and nineteen auxiliary languages (currently) as recognized by the government. These auxiliary languages are important because literacy can be taught using these in kindergarten through third grade, after which, typically, classes in school are often taught using English or Filipino. It has been estimated that in the Philippines overall, approximately 175 languages and dialects are spoken. These two situations clearly highlight the complexity that many children (e.g., Zambia with a total population of almost 17 million and the Philippines, with a total population of over 100 million) face when going to school. Although they might be learning to read in their native tongue, chances are that these children are either simultaneously learning to read not only in a language that they know but also in one that is unfamiliar to them (either English or another official language of their country). Moreover, their teachers may or may not speak the same native language as they do. When teachers and pupils have different native languages, this can lead to additional confusions. These demands are quite different from the experiences of many children in the U.S., Italy, or Spain, where children are typically learning to read only in their native tongue, shared with their teachers, at the beginning of their schooling. In both the Zambian and Philippines examples, children are taught to read in each of the languages of instruction using the Roman alphabet only, but the sounds that are made by the same letters in different languages obviously can differ somewhat. For example, the letter J is pronounced differently in the English word jar from the German word ja (meaning yes) or from the French word je (meaning I) or from the Pinyin (phonological coding system used as an aid to learning to read Chinese) word jia (meaning family, 家). Equally, the CH letter dyad in the French word bouche (meaning mouth) is pronounced differently from the same configuration in the Chinese Pinyin word chī (meaning eat, 吃) or the German word dich (meaning you) or the English word lunch. Confusions over letters and the sounds they make in each language are inevitable in the beginning stages of reading and writing. Sometimes, when we use the same script, we have to “unlearn” ideas in one language to read the other one correctly. For example, in English, the IE letter dyad is pronounced as (English pronunciation) I as in pie or die and the EI dyad is pronounced as A as in eight or E as in weird. In German, these pronunciations are different. As a general rule, in German, the IE dyad is pronounced as E as in Liebe (love) or Sie (she) and as I in Arbeit (work) or Ein (one). Thus, when English speakers see the name of my sabbatical university written down as Freiburg, they often pronounce the name as if it were printed as Freeburg following the convention of EI sounding like E (English pronunciation) as in weird in English.Those who know German always pronounce it more like (in English) Fryburg, however, and this is the correct pronunciation. These confusions illustrate the problem of conflict and

10  Learning disabilities around the world

learning and unlearning conventions. This happens when two languages share the same script and is a potentially important issue for those learning two or more languages making use of the Roman alphabet. At the same time, one could also argue that learning to read and to write in two completely different scripts is possibly even more demanding. In my attempts at learning to read and to write Chinese characters, for example, I found the visualspatial and memory demands of learning new strokes and radical configurations to be overwhelming at times. In India, a country with approximately 1.3 billion people, there are about 122 major languages and 1,599 other languages that are used. Beyond these staggering numbers are at least 25 different scripts, or writing systems, that must be mapped onto these languages. In this case, you are learning a completely different system, rather than building on some aspects of what you already know. For example, although there are some conflicts in sounds across languages making use of the Roman alphabet, some of the learning may also be mutually reinforcing. Although the initial L sound in Italian (e.g., limone (lemon)), German (Licht (light)), Chinese Pinyin (laˇn (lazy, 懶)), and English (learn) likely varies a bit by language, the /l/ sound is in many ways the same across all. In contrasting Hindi with Hebrew or Chinese, one finds one’s self having to learn an absolutely separate system. Below, we consider language and script on specific dimensions to highlight the different issues that may be important to consider for those with dyslexia and dysgraphia.This next section may seem a bit technical, but it is important for considering the specifics of dyslexia and dysgraphia from a global perspective.

Dimensions of reading difficulties vis-à-vis language and script Because dyslexia and dysgraphia, are, to some extent at least, strongly related to aspects of linguistics, it is important to note that spoken and written language are conceptualized in different ways that are relevant for understanding these difficulties. Linguistic complexity at the level of spoken language has been variously conceptualized on several dimensions (for a review, see Kortmann & Szmrecsanyi, 2012). One of these is phonological complexity, including speech-sound distinctions of the language at an individual level (e.g., a single phone distinction, such as cat vs. bat) and across the word (involving stress, lexical tone, or others). A second relates to morphological distinctions, and a third involves lexical/semantic distinctions. These are relevant to reading because readers need to understand morphemes, the smallest units of meaning, in order to be able to identify them as such. For example, in English, es or s at the end of a noun often indicates that it is plural (as in one cat and two cats or one dish and two dishes). One aspect of lexical/semantic distinctions involves sensitivity to homophones, another feature of reading and writing. When words sound the same but are written differently, it is important that we be able to distinguish them. Syntactic and pragmatic complexity are additional components of linguistic complexity overall. These final

Learning disabilities around the world  11

two are probably more critical for text reading than for word reading, but they are important to mention here as well. All of these concepts have practical value for teaching those with dyslexia. The first three are highlighted in Chapter 2 on dyslexia and the latter two are considered briefly in Chapter 10, which is focused on reading and writing of text. Language and script are also related in complicated ways. There are several dimensions that impact how difficult it is to learn to read and to write that might have direct consequences for children who are dyslexic (Daniels & Share, 2018; Share & Daniels, 2015). Share and Daniels in particular have highlighted these, and the dimensions mentioned below come from these globally thinking researchers. These particular dimensions are extremely useful for understanding dyslexia around the world. The first is linguistic distance, which is the distance between the language spoken and read by a given child. For example, although written German is relatively easy to read because letter sounds are usually pronounced consistently from one word to the next, there are many dialects of German. Some of these, including Swiss German, are substantially different in aspects of vocabulary, grammar, and even a few speech sounds used, than what appears in written form (which is high/standard German). This is a situation called diglossia, and it is common in many areas of the world, including much of the Chinese- and Arabic-speaking population. In the United States, African American English also differs substantially from standard written English as well. I have estimated, based on publications and interviews from several experts worldwide, that over 50% of the world’s children learn to read first in a language that is not their mother tongue (McBride, 2016). Having some distance between one’s spoken and written language simply makes learning to read more difficult. For example, such a mismatch may tax one’s memory (e.g., Daniels & Share, 2018), an over-arching difficulty for those with dyslexia already. A second important aspect of dyslexia around the world is spatial arrangement and nonlinearity (Daniels & Share, 2018). This refers to how the text is presented. English readers, for example, might be used to the linear arrangements of letters in a word, sequentially from left to right, with space between the words. In many scripts, graphemes are not strictly linear but, rather, symbols in the writing system can be in various positions. In some of the scripts in India, for instance, some markings occur above or below, left or right, of the symbols. The importance of spatial arrangements for writing and reading has not been fully explored yet (e.g., Nag, Snowling, Quinlan, & Hulme, 2014), but it is likely that visual-spatial skills might be at least somewhat important for learning to read in some scripts. It is certainly the case that some scripts take longer to read and to write partly because of all of the visual-spatial features to be learned. For example, determining where a word begins and ends is not as easy in Thai or Chinese as it is in English because there are no spatial indicators (e.g., McBride-Chang, Chen, et al., 2012). Daniels and Share (2018) also mention ligaturing, or joining of letters, as particularly difficult to learn for those with dyslexia in scripts where this is done, including Arabic and Indic scripts. Although this is partly associated with the broader issue of spatial

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arrangements, admittedly ligaturing might also be related to other issues such as omission of certain phonological information as described later on. Somewhat related to the issue of spatial arrangement is the dimension that Daniels and Share (2018) call visual uniformity and complexity. Some of this relates to the density of writing, and some relates to how many different visual aspects of writing are required to be integrated to be a fluent reader. For example, Chinese characters all take up the same size on the page, whether they are comprised of many or few strokes or radicals. Some characters look very simple visually and some look very visually dense. Nag (2011) noted that for some akshara scripts emerging from India, there could be approximately 400 different symbols to learn, many more than for English, though less than for Chinese, for which different individual characters number in the thousands. Daniels and Share (2018) mention this issue of set size (whether 400 in some Indian scripts or approximately 1,000 different components making up the thousands of Chinese characters, or the 26 letters of the Roman alphabet). This visual information aspect of reading has not been thoroughly explored previously, but it becomes increasingly important to do so when we think about dyslexia around the world (e.g., Chang, Chen, & Perfetti, 2018). Another universal of potential difficulties for all children but especially those with dyslexia has to do with correspondences between the written and spoken representations of words or parts of words. For historical reasons, some languages and scripts retain the old spellings of words, spellings which, given the current pronunciations of these words, are fairly illogical. For examples, we must memorize spellings for the words know, mosquito, and fight; one could not determine the pronunciations of any of them based solely on the logic of English letter and phonics knowledge. Daniels and Share (2018) highlight French, English, Thai, and Tibetan all as retaining old spellings of words that are pronounced differently than they had been centuries ago, and writing some words in these languages and scripts is certainly a challenge. The authors mention the phenomenon of homophones, or words that sound the same but are written differently, such as to, too, and two, and words that are spelled the same and pronounced differently under this category. In this latter category, they offer the example of the rhyme of ough in words such as bough, cough, dough, through, and tough (p. 106). At some point in history, all of these words rhymed, and now that they do not, the challenge of remembering how to write them all is great. For those with dyslexia, whose memory for written words is relatively limited, this can pose a huge difficulty. Although Daniels and Share (2018) do not mention Chinese in particular under this category, it is worth noting here that for every spoken syllable in Chinese, there are often at least 5–10 characters that are homophones. Thus, spoken presentations must be mapped to multiple written ones in this system. Daniels and Share (2018) mention as a separate category of difficulty for reading “spelling constancy despite . . . alternation” (p. 107). How do we learn to spell when different sounds are written the same, when the whole look of a word changes though the spelling is consistent, or when the same meaning or sound units are written differently? Let us consider morphological changes in this category. Their

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example in English is that native speakers pronounce the s in house differently than the first s in houses (which suddenly sounds more like /z/). This is certainly an issue that complicates the process of learning to read and to spell. At the same time, here, I am grouping the concept of required spelling constancy in the face of changes with the broader topic of correspondence between the written and the spoken representation. Here, I would also include allography, noted elsewhere by Daniels and Share (2018), which is defined roughly as variability in graphemes. For example, in English, B and b represent the same sound. In Arabic, there may be several variations on a single letter depiction. In Chinese, full forms of characters can be reduced as radicals in compound characters. Overall, font changes might also be a part of the confusion. There are additionally some instances in which letters or other graphemes may indicate different uses. For example, the letter h by itself indicates a particular sound, but when it is paired with other letters, it has a different sound and use (as in sh, ch, th, wh) (Daniels & Share, 2018). Overall, this issue of orthographic consistency/inconsistency in writing is perhaps among the greatest challenges for those with dyslexia. A final dimension highlighted by Daniels and Share (2018) is what they term “omission of phonological elements” (p. 108). For example, Hebrew and Arabic text usually omits most vowels.This can cause particular confusion because without these vowels represented, there are more instances of written words that look the same but might be pronounced differently. Here, I might even classify under this heading the issue of word boundaries. It is difficult to distinguish the beginnings and endings of words in scripts such as Chinese and Thai. This is not a big problem in English, where words are distinguished based on the space between one word and the other, but it can be, for instance, in Thai. For struggling readers, knowing where the boundaries are may facilitate reading in some languages (for a review, see McBride-Chang, Chen, et al., 2012). Another clear example of this across the word is the idea of suprasegmental information that is evident in spoken but not specified in written forms. For example, if you see the word refuse, you do not know if it is pronounced with the stress on the first or the second syllable unless you read it in context and you are a good reader. There are two words that are spelled that way, and they have different meanings (one, a noun, with the stress on the first syllable, means trash; the other, a verb, with the stress on the second syllable, means, basically, to say no to something). Stress is not marked in English or German; yet in other languages such as Spanish, it is more explicitly marked. In Chinese and in Tibetan, lexical tone is not marked in text. Across all of these instances, information that could make the pronunciation more explicit in print is omitted, and this can lead to confusions. For those with dyslexia in particular, giving as much information as to the pronunciation as possible explicitly is helpful. These phonological omissions likely lead to even more difficulties for those with reading difficulties. To summarize, the languages and the scripts we learn to read and to write may be more or less difficult depending upon their characteristics. Share and Daniels (2015; Daniels & Share, 2018) have highlighted some major dimensions upon which reading and writing of a script can differ. These are all worth considering

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when thinking about the challenges of learning to read and to write for any given person with dyslexia somewhere in the world.

Culture Several aspects of the broader environment are also important for understanding dyslexia. Among these are the government, education system, school, and family unit in which children grow up. We have analyzed reading difficulties in younger (Chiu, McBride-Chang, & Lin, 2012) and older (Chiu & McBride-Chang, 2006, 2010) children across scores of different countries worldwide, with some studies including almost 200,000 participants. In our large-scale studies, what emerged as most strongly associated with reading performance were country-level variables. Some countries place a greater premium on education than do others. For example, there is an association between the amount of money per individual child that a country spends on literacy teaching and how easily and well children in that country learn to read (e.g., Chiu & McBride-Chang, 2006, 2010; Chiu et al., 2012). Early childhood education has a myriad of benefits for literacy outcomes (e.g.,Wang, 2017). Some countries encourage early childhood education and others cannot yet afford to do so. There is also a cultural element to how dyslexia is conceptualized and understood. English-speaking countries in particular have a long history of understanding and remediating it. There is a special acceptance of learning disabilities in Canada, the U.S., and the U.K. that is potentially at least somewhat helpful for families and children with this disorder. Some European countries also appear to have a very good and relatively sympathetic understanding of dyslexia. For example, in the Netherlands, there have even been some complaints of an overrepresentation of children reporting themselves to be dyslexic. In the Netherlands, those with dyslexia are given more time to complete exams and even sometimes can have questions read to them. This may have led to an over-reporting of reading difficulties. There seems to be much less stigma about dyslexia in this country than in some others (“Bureaus have an interest in labelling children dyslexic”: Minister, 2017). However, in much of the world, the idea of dyslexia is vague, and accommodations or interventions for it are few or non-existent. Mainland China and India are two highly populated countries where the idea of dyslexia is not yet mainstream: There, children with dyslexia are just as likely to be viewed as lazy or stupid as they are to be considered to have a particular learning problem. At another level apart from country, school environments vary widely (e.g., McBride, 2016), and these also matter for the treatment of dyslexia and other learning difficulties. Teachers, infrastructure, and classmates all influence how children learn in big and small ways. Not all of them affect the phenomenon of dyslexia or dysgraphia equally, however. One point on the issue of teachers that emerged from some of the interviews I conducted was the relative importance of teachers for understanding, defining, and accommodating and remediating dyslexia. As far as infrastructure of schools goes, this point is likely to be clear to everyone. When

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schools are designed with attention to the learning needs of students, students tend to learn better (e.g., Győrfi & Smythe, 2010). The issue of HOW to accommodate children with dyslexia varies dramatically. In many places, rules and even laws exist in relation to whether students with dyslexia should be included in regular classes or educated separately and in what proportion. Moreover, many favor assigning dyslexics less homework and giving them more time to read and to write. However, the devil is in the details. For example, when teachers do not understand or even “believe” in dyslexia as a concept or, another common theme, have an idea of dyslexia that the given student in question does not conform to, the teacher is sometimes simply unwilling to work with the student and her family to consider what sensitivity and accommodations are necessary. For instance, Austrian Educational Psychologist Erika BarkerBenfield gives the example of a child making fewer and fewer errors in spelling on exams over the year through a lot of hard work and determination. Yet the child’s teacher failed this child repeatedly because the number of errors made by the student was still within her criterion for failure. Technically, this was within her right. At the same time, this action discouraged the student greatly and did not indicate any sympathy with the plight of the dyslexic child. Barkley (2017b), an expert on attention deficit hyperactivity disorder (ADHD), also notes that there is some segment of the American population that says they do not “believe” in ADHD as well. This latter case is in the United States, where a focus on learning difficulties has been fairly clear for decades.Thus, it is important to consider both the rules or laws on helping those with a learning difficulty and also how these rules and laws are carried out. In some countries, such difficulties have a relatively low priority amidst a myriad of other educational challenges (e.g., Nag & Snowling, 2012). In others, even when there are rules in place, these rules may not be executed appropriately. Families, teachers, and clinicians working with those with learning difficulties must, therefore, stay focused on advocacy for learning disabled students.

Economic resources and school performance One of the most important cultural factors determining school performance is access to economic resources. Access to such resources comes at the country, school, and family levels, among others (Chiu & McBride-Chang, 2006). In one study (Chiu & McBride-Chang, 2006), the variable of gross domestic product per capita accounted for 63% of the differences in reading achievement across countries. In that same study of 43 countries, economic resources at the country, school, and family levels accounted for 30% of the total variability in reading achievement across nearly 200,000 students. Similar findings underscoring the importance of economic resources at the country level were found in another study of reading achievement in 38 countries (Chiu et al., 2012). Apart from country-level wealth, the economic resources of a school are also important worldwide for understanding literacy skills (Blanchett, Klingner, & Harry, 2009; Chiu & McBride-Chang, 2006; Chiu et al., 2012). School environments are

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complicated and sometimes several factors come together to influence both attitudes and attainment within a given school. As summarized by Blanchett et al. (2009), in their powerful article focusing on American schools entitled, “The Intersection of Race, Culture, Language, and Disability: Implications for Urban Education” “the resources and overall education afforded students who attend high-poverty schools are vastly different from what is available in schools that serve students who are White and middle class” (p. 390). The effects of poverty can be seen very early and are cumulative (Blanchett et al., 2009; Herbers et al., 2012; Ransdell, 2012). As Ransdell (p. 921) noted, “The single best predictor of standardized reading comprehension in all grades is the percentage of children in a school who live in poverty.” In the United States, the rate of learning disabilities in the general population is approximately 1.5% for those above the poverty line and 2.6% for those in poverty (National Center for Learning Disabilities, 2014). These figures come from the United States, but there are similar patterns worldwide (McBride, 2016). Practically speaking, the school a child attends can have a great deal to do with how that child experiences his or her learning difficulty. In general, schools with more resources, including both material resources and better education levels for its teachers and principal, are more likely to serve those children with learning difficulties and their families better. For example, the National Center for Learning Disabilities (2014) found that, in the American public, 55% of parents and 40% of teachers think that learning disabilities are caused by the home environment of the child, and 51% view learning disabilities as the result of laziness. Much of the rest of the world likely places blame for learning disabilities similarly on parents or lack of hard work in children as well; in reality, neither parents’ home environments nor hard work by children explains learning difficulties. However, an accommodating, understanding school environment can greatly improve the lives of those with learning difficulties (e.g., Reid, 2016). A school that acknowledges and plays to a child’s strengths, that allows for accommodations for a learning difficulty (such as use of computers or extra time for assignments), that focuses on reasonable and targeted interventions for the difficulties, that basically understands the nature of learning difficulties, is an ideal school for a child with a learning disability (Győrfi & Smythe, 2010; Reid, 2016). Yet for schools, accommodating to learning difficulties is expensive such that children with learning disabilities are disadvantaged, in the United States (e.g., Capital & Main, 2016) as elsewhere. There are relatively few data on poorer countries vis-à-vis school interventions. In poorer schools in some of these countries, rates of reading difficulties are very high, and teaching methodologies and ratios of teachers to students are quite variable (Nag & Snowling, 2012). Most such schools cannot consider the issue of learning disabilities because they lack resources for even some of the basics for education. Thus, around the world, poverty specifically affects literacy skills in a myriad of ways. In general, poverty represents a confluence of factors that conspire against each struggling student. Farah and colleagues (2006), in their important work on poverty and brain development, conceptualized poverty as a public health issue, “as

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more than mere educational and economic opportunity, extending to the physical integrity of children” (p. 170). In their study of African American children of low and middle SES matched by gender and age (ranging from 10–13 years old), the researchers found that students who lived in poverty showed particular difficulties on tasks related to language, memory, and cognitive control.They argued that living in poverty appears to shape brain development in these areas in particular. These are all important for school performance, including the development of dyslexia, dysgraphia, or ADHD. Hanson et al. (2015) additionally showed that childhood poverty is associated with slower brain growth and less gray matter, an important substance in the brain associated with learning, overall in early childhood. Evans and Schamberg (2009) further demonstrated that childhood poverty is associated with working memory difficulties even in young adulthood. Why is poverty linked to difficulties with literacy and attention difficulties, among other problems? No one has dared to claim that they can fully articulate the many risk factors that living in poverty entails. Some of the problems that poverty brings with it may include prenatal risks such as exposure to second hand smoke or other in utero difficulties, vulnerability to toxins including lead, poor nutrition in childhood, greater overall stress, greater likelihood of parental absence, depression, or strain, housing and food insecurity, violence, less cognitive and linguistic stimulation, and more crowded and noisy living conditions (Blanchett et al., 2009; Evans, 2004; Hanson et al., 2015). Evans (2004) particularly focused on how all of these difficulties can build upon one another. Their effects can be multiplicative, rather than merely additive. Think about it: We can all handle a few daily hassles and one or two bigger problems at a time. Life is like that for everyone. However, for those living in poverty, the number of daily hassles increases dramatically, and some of these hassles can quickly loom large. For example, a parent finding herself unable to pay the rent at the end of the month might, as a consequence, be away from home more, be more depressed when she is home, provide less nutritious food, talk less to her child, and have to move to another home, all of which can be very stressful for the child, and all at once.Thus, Evans (2004) summarizes, “The accumulation of multiple environmental risks rather than singular risk exposure may be an especially pathogenic aspect of childhood poverty” (p. 77). It is especially important to mention poverty in relation to learning difficulties because of the complicated relationship between them. Learning difficulties occur across the population, but they are more prevalent among those living in poverty (Blanchett et al., 2009; National Center for Learning Disabilities, 2014; Winzer & Mazurek, 2015). The complex interaction between our genes and our environment (e.g., Farah et al., 2006) means that those predisposed toward any kind of learning difficulty will have even more struggles with it when growing up in a poor household. Winzer and Mazurek (2015) argue that “The evidence points to causal links from poverty to disability and from disability to poverty” (p. 158) around the world. For poorer countries, problems of poverty and learning disabilities may be even greater than they are in richer ones (e.g., Nag & Snowling, 2012; Winzer & Mazurek, 2015). Yet around the world, what may be most important

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when considering learning disabilities is that ideal learning situations are ones in which parents and educators are aware of the difficulties students have in learning and focus on how best to help children learn regardless of label. In the past, there was often an attitude of “wait to fail,” the idea that students would not receive extra help at school until they persisted in showing a poor performance in learning situations for some extended period of time and, in the act of persistent failing, could finally be diagnosed as needing extra help by virtue of their learning disability. The problem with waiting is that such students tend to fall further and further behind, sometimes to the point that they feel, psychologically, as if they can never catch up. And indeed after a significant period of failure, they do take a long time to catch up; some never do (Adams, 1990). In contrast, many teachers, researchers, and educators now recommend a response to treatment intervention (RTI) approach in which children who need help are immediately identified and receive the help that they need in three tiers, classroom, small group, or individual. This RTI approach is widely discussed both in academic articles and on the internet (e.g., www.dyslexia-reading-well.com/response-to-intervention.html). This is an improvement from the old philosophy about learning difficulties of waitto-fail for two reasons. First, students get help for their learning difficulties more quickly, and the earlier in development that children receive interventions, the better they perform subsequently (Fox, Carta, Strain, Dunlap, & Hemmeter, 2010; Ramey & Ramey, 1998). Second, there are fewer arguments about the precise nature of the learning difficulty and its causes. The idea is that children with learning difficulties need immediate help; there are fewer questions related to the causes of this learning difficulty. To summarize, while there are many important aspects of culture related to learning difficulties, poverty and all the demographic correlates that come with it (e.g., issues of home security, minority status, language usage, educational access, and many others) is a central one to consider worldwide. As Nag and Snowling (2012) pointed out, there is a lack of instruments to assess learning difficulties and relatively little attention paid to learning difficulties in many of the world’s developing countries (see also Winzer & Mazurek, 2015). In this book, I highlight some of the basic principles that may be helpful across cultures in understanding and remediating learning difficulties. Yet the influence of individual cultural ideologies for understanding learning difficulties is admittedly enormous. With this acknowledgement, we now move on to some general underlying biological aspects of dyslexia.

Perception, cognition, and neurobiology What causes a learning difficulty? Broadly speaking, researchers have tried to understand learning difficulties in relation to perception, cognition, and neurobiological aspects. These are described more specifically in Chapters 2, 3, and 4, on dyslexia, dysgraphia, and ADHD, respectively. Here, I simply wish to point out that researchers have found some evidence that all of these aspects are at least somewhat important for understanding learning difficulties.

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We begin with perception. Perceptual abilities that are most relevant for reading and writing include vision and hearing, primarily, and perhaps some of the other senses as well. For example, those who are profoundly blind will additionally make use of their sense of touch to read. It is important to acknowledge vision, hearing, and other senses because they are central to how we understand the world. Perception is integral to learning, but perceptual problems are not typically implicated as strong causes of learning difficulties by themselves. By definition, learning disabilities are typically understood to occur in the absence of hearing and/or visual difficulties. For example, a child is thought to be dyslexic if he or she has specific word reading difficulties despite normal hearing and visual acuity. At the same time, it is sometimes the case that early perceptual difficulties such as childhood/infant hearing loss can affect subsequent language skills and, thus, indirectly, be associated with learning difficulties developmentally. There are also some studies that suggest that speech perception and visual perception may be subtly linked to dyslexia (for a review, see McBride, 2016). Thus, while we cannot predict subsequent learning difficulties with an early vision or hearing test, perception is the first way in which we know the world. In addition, sometimes it is difficult to disentangle perception from cognition. Cognition is easier to implicate as a causal factor in learning difficulties. Broad cognitive abilities that are generally applicable to learning and learning difficulties include memory, speed of processing, and attention. One of the hallmarks of dyslexia is difficulty with remembering certain things. Memory difficulties can take different forms, but a good example is spelling. Across cultures, those with dyslexia tend to be poor spellers. In fact, this is the one characteristic that often continues into adulthood, even for those with dyslexia who appear to have overcome all reading difficulties (Bruck, 1990).This is less obvious these days than it was a generation ago because spellcheck is a helpful aid for all of us. But if you give even an adult with a childhood diagnosis of dyslexia a spontaneous dictation test, chances are that he or she will appear to have specific difficulties on this. Memory difficulties are obvious in childhood. Sometimes children asked to synthesize sounds, like the /k/ sound made by C in cat and the following two sounds made, respectively, by a and t, will forget what the whole word is as they are putting the sounds together because the process is laborious. Ku-aaaah-teee. What is that?! If you look at the spelling of someone who is dyslexic, it is often inconsistent. For example, in an essay written by an 8-year-old in Hong Kong on “My Favorite Teacher,” the child wrote tech, teach, teche, teachir, techir, and techur, all intended to be derivations of the word teach, all in the same paragraph. She could not remember the consistent spelling of teach or the ending of er from one word to the next. Even earlier, children at-risk for dyslexia often have difficulties remembering how the letters are written as well as how they sound. For all young children, the letters of p, b, d, and q are sometimes confusable. All involve a loop and a line; the question is simply where and how. For those with dyslexia, it takes much longer than usual to master these. Reinforcements to aid memory are helpful at the levels of visual, auditory, and kinesthetic (involving touch) senses. For example, a child might learn

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to distinguish b and d by picturing the word bed as an actual bed with posts on both the left and the right side. We all have some confusions growing up. For example, I personally had trouble telling my left from my right hand. I did not seem to have a natural sense of this. What helped me finally was when a teacher pointed out that when I put both hands on my desk, palms down, the thumb and pointer fingers together formed an L for left. I was not dyslexic, and so I found this simple mnemonic helpful. For those with dyslexia, rules, tricks, and aids to memory are essential, because one fundamental difficulty is with memory, whether visual or auditory. There are particular tests of memory that can capture memory difficulties in those with dyslexia, but even if a particular test battery to diagnose dyslexia does not have an explicit memory task in it, memory skills are fundamental. It is, in fact, difficult to find a cognitive-linguistic task that does not make substantial use of memory skills.Thus, tasks of phonological sensitivity, morphological awareness, and visual-orthographic skills, important components of word reading that are discussed in Chapter 2, all involve the fundamental process of memory in some capacity. Along with memory, speed of processing is another fundamental skill that is required for most tasks of reading and writing. Slow and laborious letter-sound sensitivity is associated with slow word recognition. Slow word recognition, in turn, limits reading comprehension. Writing difficulties are also associated with slow and effortful processing. It is difficult to disentangle memory from speed of processing. Most tasks of literacy make use of both: If you are not processing the letter sounds quickly enough when you sound them out, you forget what you are reading. Consider how a young child sounds out the word caterpillar using knowledge of letter sounds. As a 6-year-old, you might forget having made the /k/ sound initially (representing the first letter of c), followed by a short a sound and then the /t/ sound (representing the letter t), and all the sounds that follow. When you get to the final /r/ sound in caterpillar, you can easily have forgotten all the letter sounds you enunciated just before. Or try reading this nonsense word phonetically: Remesthilania. I just made this up. But sounding it out might take you a couple of tries in order to integrate the various letter sounds together.You might have to try saying the whole thing slowly, syllable by syllable, then say the whole thing more smoothly and quickly, and then repeat, first syllable by syllable and then as a whole word. Here, you will be trying to remember all the syllables while simultaneously attempting to get faster and more fluent in order to say the whole word smoothly. This process involves the integration of memory and speed. We talk more about speed, or fluency, in the following chapter under more specific cognitive-linguistic skills primarily because there is one relatively famous diagnostic task for dyslexia called rapid automatized naming (RAN) that is important for identifying those atrisk for dyslexia very early.Yet, like memory, speed of processing is pervasive across all literacy-related processes. Finally, it is important to mention general attention. Clearly, attention difficulties are, by definition, a part of ADHD, as discussed in Chapter 4. But general attention can be associated not only with ADHD as a learning difficulty but with all learning difficulties. Here, I am focusing on attention as a general capacity. We all struggle

Learning disabilities around the world  21

with deployment of attentional resources and also with inhibiting our attention in certain situations. In daily life, and particularly when studying in school, we should pay attention to certain phenomena and ignore others. Both aspects are incredibly important for learning in school. Probably the first idea is more obvious than the second because we have all had the experience of teachers telling us or our classmates to “pay attention.” This means we should focus on a particular lesson or idea. In addition, we must constantly be vigilant in ensuring that our attention is not deployed to the wrong thing. The wrong thing is defined differently for different people, but it is usually something else that is happening in our immediate environment that is distracting. I remember my classmate in second grade being extremely interested in the fly buzzing around our classroom, rather than the mathematics lesson being delivered in the front of the class by our frustrated teacher, for example. Some people find music playing in the background when they are trying to study distracting as well. People coughing in the library, light that is too bright or penetrating, a sound from outside . . . all of these can cause a shift in attention. One of the biggest challenges to our attention is our own thoughts. For example, while you are reading this book, you may suddenly remember an appointment you have tomorrow involving something you have to prepare, buy, or search on the internet.You may start to think about how to do this, and as you do so, you are no longer focused on the book. Researchers have spent a couple of decades establishing that those who are bilingual are often better in certain cognitive tasks beyond language ability. A central explanation for this skill is the fact that these bilinguals are constantly having to suppress information related to one language they know while they process information in the other language they know (e.g., Bialystok, 2015). If you know several languages, such as French, German, and Chinese, for example, when someone asks you about the car in French, you must suppress the German (das Auto) and Chinese (qì chē) names for it and focus on la voiture. Correspondingly, a discussion of the heart in Chinese (xīn) will require one to ignore the French (coeur) and German (Herz) words for this. (Another strange one for me living in Asia is that in the Pinyin, or alphabetic representation of Chinese, women, written in the Roman alphabet, means we or us. The spelling is identical to the plural of woman in English.) It is important to mention this general phenomenon of attention deployment here because it is fundamental to recognize its importance for those with dyslexia. A person with dyslexia will not necessarily have particular difficulties with ADHD, a specific learning difficulty discussed in subsequent chapters, but we all struggle with maintaining our attention when we are involved in effortful and boring tasks. And let’s face it: Learning to read is sometimes boring. Moreover, for a dyslexic child, it is pretty much always effortful. Thus, being aware of one’s own attention and how best to maintain it is essential for all. It is worth noting here that any technique that works for maintaining attention to the task at hand is potentially useful for those with dyslexia. For example, for some, blocking out irrelevant text so as to focus on the text of interest, highlighting text with a colored filter, or enlarging the text are all potential ways to magnify and maintain attention.

22  Learning disabilities around the world

Finally, learning disabilities must also inevitably be linked to their origins, which are often neurobiological. Although most researchers agree that there is relatively high heritability for specific learning disabilities and also that there are at least some identifiable differences in the brains of those with and without learning difficulties, many of these characteristics are subtle and hard to pinpoint. Some biological origins may also differ at least slightly across cultures or groups. For example, certain particular genes (e.g., DCDC2) are relatively infrequent, or rare, in some groups (e.g., Caucasian children) as compared to some others (e.g., Hong Kong Chinese children), and have been thought to have been associated with dyslexia more often in English, perhaps as a result (Scerri et al., 2017). There are similar controversies about genes for ADHD. For all learning difficulties, there appear to be some strong genetic associations given that they often run in families. Some areas of the brain also tend to differ in predictable ways, as mentioned in subsequent chapters, between those with and without learning difficulties. The specifics of these are beyond the scope of this book, but it is important to mention that learning difficulties in general tend to have genetic and brain-related causes. Gender is also associated with learning difficulties. In general, boys tend to score somewhat more poorly in reading comprehension, and this difficulty may be exacerbated somewhat with development (Chiu & McBride-Chang, 2006; Kingdon, Serbin, & Stack, 2017; Washington, Branum-Martin, Sun, & Lee-James, 2018). Indeed, spelling (Moll, Kunze, Neuhoff, Bruder, & Schulte-Körne, 2014), reading difficulties, and attention deficit hyperactivity disorder (ADHD) all tend to have a higher prevalence in boys as compared to girls (e.g.,Yoshimasu et al. (2010), though Moll et al. (2014) did not find a gender difference in reading difficulties). It is worth noting that different cultures sometimes define learning difficulties differently, and ways of identification of learning difficulties can affect gender prevalence. For example, girls with ADHD might be somewhat less disruptive in a classroom than boys with ADHD in general given that girls tend to be somewhat less rambunctious in a classroom setting overall (e.g., Quinn & Madhoo, 2014). Yet in most studies (e.g., Abu-Hamour & Al-Hmouz, 2016; Ashraf & Najam, 2017), there tend to be more boys than girls who are identified with learning difficulties. The National Center for Learning Disabilities (2014) in the U.S., for example, estimates that 66% of those with a learning disability are male. The extent to which gender differences in learning disabilities are attributable to environmental or genetic factors or a combination of these is still up for debate, however. Understanding the neurobiological origins of learning difficulties is useful for defining and recognizing them. Such understanding is, however, often less useful in suggesting effective ways to remediate the problems. That is, for most learning difficulties, with the exception of ADHD, there are no genetic or drug-related interventions that can help. What has been most effective thus far in remediating learning difficulties more generally have been various behavioral interventions. Behavioral interventions targeting the learning difficulties via innovative teaching or extra practice are the best work-through strategies. By work-through, I mean that students with these difficulties try to work on them by working harder on the skills they need to improve. For example, those with dysgraphia might practice

Learning disabilities around the world  23

holding a pencil and tracing lines in fun ways and more often than children who do not have dysgraphia. Other behavioral interventions are so-called work-around strategies. These are strategies that students can use to compensate for their learning difficulties so that they are able to keep up with their class work despite their difficulties. An example of a work-around strategy would be allowing children with dyslexia to present a report orally rather than in written form by recording, instead of writing, it. Moreover, it is important to recognize that, no matter what our personal experience with learning disabilities is, i.e., whether we ourselves have a learning disability, whether we are a parent or sibling of someone who has a learning disability, whether we are a clinical or educational psychologist working with those with learning disabilities, whether we are teachers or pediatricians or psychiatrists, or whether we are researchers, we all have an “angle.” This angle is different for each of us. For example, an educational psychologist and a researcher have in common that our “data” on a particular learning disability are likely broad-based. Conclusions we draw might be based on having seen patterns among several hundred individuals who all have the same diagnosis of having dyslexia or ADHD. However, whereas researchers generalize, often based on quantitative data across many cases, about what specific characteristics generally hold true for those with the diagnosis of dyslexia or dysgraphia, our abilities to understand what holds true for a given individual remain limited. Practically speaking, this means that we should be flexible with different techniques that may be useful to the person with dyslexia. Such techniques may or may not work.

Conclusion We have now covered some important aspects of the manifestation of learning disabilities from a cross-cultural perspective. In subsequent chapters, we will focus more particularly on specific characteristics of dyslexia, dysgraphia, and attention deficit difficulties and how to help people who struggle with any or all of these. At the end of this general introduction to learning difficulties, I wanted to return to the case of Danna, introduced at the beginning of the chapter, whose undiagnosed dyslexia contributed to a difficult childhood. As a successful practitioner, musician, and mother, she was willing to offer her story in part because one of her sons, Jonny, has attention difficulties as well as mild dyslexia himself. She and her husband, Joe, struggle to find the best ways to help Jonny. At the same time, it is important to recognize that Danna triumphed over her learning difficulty and thrives. I hope that her success story and the words of wisdom from all of our 32 interviewees serve to encourage anyone struggling with a learning difficulty. Success often comes as a result of hard work and devoted teachers. As Danna says in reflecting on how her life steadily improved following a difficult adolescence struggling with dyslexia, it was during academic studies that one of my teachers realized a major discrepancy between (my) knowledge and performance (very high clinical scores vs. average academic ones at nursing school). She first noticed, during

24  Learning disabilities around the world

an oral exam, that “you think faster than you talk.” She guided me towards slower processing and articulation, and I succeeded. Another aspect of success in many who have struggled with learning difficulties is an awareness and honing of particular strengths. Apart from becoming an accomplished nurse, for Danna, this meant pursuing her musical talents. As she notes, Later in life I signed up for a musicology BA degree in a leading local university, and leveraging my musical skills, to compensate for the disability, I excelled. I went on to do an MA (in musicology) with great pride. At the same time, for those with a learning disability, success does not mean the end of the learning difficulty. Rather, success means that one works through or works around the difficulty; the learning difficulty is part of who an individual is and is incorporated into a broader overall sense of self. As Danna states, I still realize my weaknesses every now and then, especially when processing large amounts of information, and textual memory. I often mix digits in phone numbers, letters or otherwise, and need to concentrate very hard to read a book. I still do not perform as well in written tests, although much better than before. I have developed various compensating skills among which are very strong communication skills, musical memory, and self-esteem. This self-esteem was much lacking when I was growing up. Finally, along with hard work, devoted teachers, a recognition and development of one’s strengths, and an acceptance of one’s weaknesses, a person with a learning disability also benefits enormously from the support of friends and family. Everyone who struggles needs support to make it through the tough times; advocates are key. As Danna poignantly ends the interview, A big part of my growth is attributed also to my husband and his family, who believed in me and supported me throughout my academic career and elsewhere. They have never shared the (pessimistic) perspective my mother had on me, and never will [concluded while crying]. This chapter has been a broad overview of learning disabilities in general, touching on environment, as well as genetics and neurobiology. Learning difficulties are sometimes messy and emotionally difficult for individuals who have them, for families, for teachers, for schools, and for society. With basic understanding of these, we get closer to remediation, acceptance, and integration. In the next chapter, we turn to a more specific focus on dyslexia. Here, we highlight specific characteristics related to this important learning disability. It is critical to target such specific characteristics of dyslexia in order to pinpoint best practices for identification and remediation of it.

2 UNDERSTANDING DYSLEXIA

The first time I encountered dyslexia face-to-face, I was a 20-year-old university student doing a 1-month internship in a classroom for children with special needs. I remember being assigned to a sociable second grade boy, 8 years old, Jim, who had a great sense of humor; he needed some help with homework. He loved sports and seemed popular in the classroom. I was struck by how smart he was and how he liked to talk about different animals and sports heroes I did not know.Yet when he settled down to schoolwork, his reading was hesitant, slow, nervous . . . I had some trouble reconciling this attractive, confident second grader, who seemed like a born leader, with the tongue-tied boy whose head was bowed low over a page that he could not decipher. At 20, I was most struck by the contrast between this bright, animated persona and Jim’s complete inability to decode even the simplest word. More recently, I got to know WA, a Swedish young-adult woman in art school. All her life, WA remembers being slow in word recognition and having to concentrate very hard to write words. Her aunt and her grandfather were dyslexic, and her father has some reading difficulties as well. In the early years, she remembers herself, along with each classmate, having the same course book in class to read. She recalls turning each page when the classmates did during reading time, not because she had read each page – she could not at that time – but only because everyone else did, so she did too, on cue. She frankly admits that she hates to read, eschewing books whenever possible, and says that, for learning, “YouTube has been my best friend.” WA has felt conflicted even by the word “dyslexia,” which, in Swedish, is directly understood as “word blindness.” In Swedish slang, students sometimes use the term “dysse,” which comes from “dyslexia,” to refer to classmates. She says “ ‘Dysse’ is a negative word. It can be bullying. It is a ‘reason’ for something. Oh, that’s why. He or she is ‘dysse.’ It makes me feel that I am not smart enough. Being ‘dysse’ means ‘bad in school.’ ” WA is very driven and successful in her art career. But the frustration of dyslexia has been a great challenge to her for her whole life.

26  Understanding dyslexia

Jim and WA were among millions of children worldwide who suffer from dyslexia. But what is it, exactly? In order to try to understand dyslexia, we should first attempt to define it. This might seem straightforward, but it is far from easy for reasons elaborated below. Perhaps the best definition for the purpose of this discussion has been offered by the International Dyslexia Association: Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge. (International Dyslexia Association, https://dyslexiaida.org/ definition-of-dyslexia/) I appreciate this definition because it focuses on the basics of dyslexia, which are difficulties in word reading and word spelling.This is the clearest and easiest definition across cultures, languages, and scripts. Beyond this, there is also the suggestion that phonological difficulties are a causal aspect of dyslexia. There is good evidence for this across languages and scripts. Phonological, or speech sound, manifestations are discussed later on. In addition, factors related to morphological awareness, orthographic processing, and fluency are considered as prominent correlates of dyslexia. These are the common core cognitive attributes. Yet there is also a persistent popular public perception or misconception that those with dyslexia experience words as “swimming on the page.” Some people talk about the problem of visual stress, which encompasses symptoms such as fatigue, eye strain, and feelings that the print is distorted in some way, when reading (for a review, see Singleton & Trotter, 2005). The experience of visual stress is important and may somehow be exaggerated in some individuals with dyslexia who find the whole process of word recognition exhausting anyway. This experience is important psychologically, and steps should be taken to deal with it immediately in a practical sense. At the same time, there is little evidence that specific visual difficulties cause dyslexia. The visual difficulties experienced by those with dyslexia seem so far to be either consequences of inexperience with print or a manifestation of anxiety because reading is so difficult. There is more research to be explored, but pure visual difficulties do not appear to be a primary cause of dyslexia. In fact, visual stress is not more common in those with dyslexia as compared to those without dyslexia (Saksida et al., 2016). At the same time, however, accommodations for those with dyslexia that include visual manipulations can sometimes help. For example, while evidence for special difficulties with visual stress among those with dyslexia is sparse (e.g., Henderson,

Understanding dyslexia  27

Tsogka, & Snowling, 2013), there is also evidence that letter spacing can sometimes help dyslexics to read better (Zorzi et al., 2012). Just keep in mind that visual problems are not the main issue vis-à-vis dyslexia.The assumption that people with dyslexia experience, as a primary symptom, reversal of letters, has persisted for decades, despite general agreement that letter reversals are likely more of an effect of dyslexia than a cause.That is, because those with dyslexia typically engage in less exposure to printed text than nondyslexics, they are likely to have letter reversal difficulties for longer. Anyone, child or adult, learning to read in a new script will confuse some graphemes, such as letters, given inexperience. Still, some researchers continue to perpetuate the idea that visual problems might cause dyslexia (e.g., Le Floch & Ropars, 2017). At present, most researchers, however, focus on word reading difficulties that are associated with phonological, meaning-related (morphological and semantic), or orthographic difficulties, along with fluency in word recognition, as the core components to focus on in order to understand dyslexia. In this book, we integrate what we know about dyslexia across cultures. Since most research on dyslexia has been done on Indo-European languages and scripts, there is still a lot we do not understand about reading difficulties around the world. While a language- or cognitive-linguistic-based difficulty, broadly defined, is the most commonly agreed upon causal factor in dyslexia, it is perfectly reasonable to think that other difficulties, including some sort of visual-orthographic tracking or visual-motor skills, could additionally contribute. Given that different countries and territories have quite different views on dyslexia (for some practical overview of dyslexia in your area of the world, please see Appendix B), I am often surprised to see researchers give statistics on how many children suffer from this disorder. I have seen statistics that say as few as 5% or as many as 20% of a given population has dyslexia. However, these statistics are only as good as the given definition of the disorder. Many countries have extremely varied definitions of dyslexia. These can involve attention to a cognitive skills profile, inclusion of timed or untimed reading or spelling, inclusion or exclusion of IQ, or general intelligence, and other aspects (e.g., whether ADHD is present or absent), among others. Differences in definitions can even vary across cities within a given country. Moreover, different ways to test for dyslexia sometimes lead to different conclusions, as do absolute cut-offs on test batteries (i.e., should we consider only the lowest 1% on the test as having a problem? The lowest 5 or 10%?). Sometimes these cut-offs depend, as well, on resources available. A government might like to help everyone who is struggling with reading but may have only enough financial resources to help the bottom 1 or 5% of the city or country. Both research findings and practical considerations such as financial resources available may, thus, influence definitions of dyslexia and other learning difficulties. These definitional differences make a comparison of dyslexia across cultures challenging under the best of circumstances. Indeed, there is even a book entitled The Dyslexia Debate (Elliott & Grigorenko, 2014) that argues that there is no such thing as dyslexia.The authors note that there are many problems with considering dyslexia to be a particular syndrome because

28  Understanding dyslexia

the manifestations of reading and/or writing difficulties may differ, the cognitive skills associated with the literacy difficulties (e.g., phonological vs. visual) may differ, and consequently the means of assessing dyslexia will also differ. These are all clear and well-documented “truths” of the educational world. Moreover, although that book focused mostly on definitions within the English-speaking world, this is even more obvious if we extend the issue of how to understand dyslexia to other cultures, languages, and scripts. The most realistic definition of dyslexia, then, is one which takes into account the fact that some children have particular difficulties in learning to read and to write words. These children are part of a normal population, where some people read words extremely well, some read extremely poorly, and most are in the middle. The implications of having extreme difficulties in reading are profound, and those who suffer from these particular reading problems are, by definition, within the boundaries of normal intelligence (sometimes highly intelligent, as discussed later), with adequate hearing and vision, and with access to adequate literacy instruction. Despite all of this, however, they struggle with simple literacy activities, and they struggle for a very long time. Thus, my preferred definition of dyslexia takes into account the fact that at some point, we have to define some percentage of the population as dyslexic somewhat arbitrarily. This description, clearly self-aware in its deliberate vagueness, is as good as any: Dyslexia represents the lower end of a normal distribution of word reading ability; as such, diagnosing someone with dyslexia requires setting a somewhat arbitrary cutoff on a continuous variable. A typical cutoff of −1.5 standard deviations below the mean for age on a single word decoding test identifies approximately 7% of the population as having dyslexia. (Boada,Willcutt, & Pennington, 2012, p. 266) Indeed, some vagueness is part of the basic definition of dyslexia considered across cultures: Seidenberg (2017), summarizing a very complicated and great number of studies on the subject of dyslexia, made the following four crucial points about the disorder (p. 167): •

Dyslexia does not have a single cause. Numerous underlying anomalies – at genetic, neurodevelopmental, and cognitive levels – can interfere with complex skills such as reading. • Underlying deficits vary in severity; in the behaviors they affect and to what degree, and in their malleability or persistence. • Impaired reading can result from the co-occurrence of several relatively mild deficits that would not be debilitating in isolation. The effects of such deficits can be modulated by strength in other areas (protective factors). • The manifestations of these deficits change over time as children develop.

Understanding dyslexia  29

Researchers highlight not only children’s own capacities based on genetic and neurological factors (e.g., Ozernov-Palchik, Yu, Wang, & Gaab, 2016), but also their literacy environment at home (e.g., van Bergen, de Jong, Maassen, & van der Leij, 2014), to explain how dyslexia develops.

What causes dyslexia? In trying to understand the nature of dyslexia, researchers have particularly focused on its genetic and neurobiological correlates (e.g.,Verhoeven, Perfetti, & Pugh, 2018). Clearly there is a genetic link between parents and their children for dyslexia (e.g., Torppa, Eklund, Bergen, & Lyytinen, 2011; van Bergen, de Jong, Plakas, Maassen, & van der Leij, 2012). The risks of having dyslexia with one parent who has dyslexia are 4–60%, and this risk increases further when both parents have the disorder (e.g., Schumacher, Hoffmann, Schmäl, Schulte-Körne, & Nöthen., 2007). When one sibling has dyslexia, the chances of the other sibling having it increase by three to ten times (for a review, see Schumacher et al., 2007). Attempts to link certain genes to dyslexia have revealed a variety of individual genes that have been associated with reading difficulties. I have even been an author on some of these papers on Chinese samples. However, this area is very complicated, and firm conclusions on individual genes in relation to dyslexia are rare. Rather, multiple genetic and environmental interactions are causally associated with dyslexia (e.g., Gabrieli, 2009). Neurological signs of the potential for dyslexia have been demonstrated in newborns whose parents had some reading difficulties (e.g., Leppanen et al., 2010; Molfese, 2000); these signs could distinguish the children’s reading performances years later. The brains of those infants who, years later, ended up having reading difficulties, tended to show abnormal processing of speech sounds as compared to those who turned out not to be dyslexic. Studies of those with dyslexia, including both adults (Baldeweg, Richardson, Watkins, Foale, & Gruzelier, 1999; Maurer, Bucher, Brem, & Brandeis, 2003) and children (e.g., Meng et al., 2005; SchulteKörne, Deimel, Bartling, & Remschmidt, 1998) indicate that they show fewer clear distinctions in processing acoustic information than do those without dyslexia. These perceptual difficulties are extremely subtle, however, in that most children with dyslexia do not manifest obvious perceptual difficulties. At the same time, given the studies of newborns’ development (Leppanen et al., 2010; Molfese, 2000), such difficulties may be causal. In addition, there is a clear overlap between language difficulties and reading difficulties (e.g., Aram & Hall, 1989; Bishop & Adams, 1990; Butler, Marsh, Sheppard, & Sheppard, 1985; Escarce, 1998; Fowler & Scarborough, 1999; Hagtvet, 1998; Lei et al., 2011; Magnusson & Nauclér, 1990; McBride-Chang, Lam et al., 2008, 2011; Nash, Hulme, Gooch, & Snowling, 2013; Scarborough, 1989; Snowling, Gallagher, & Frith 2003; Zhou, McBride-Chang, Fong, Wong, & Cheung, 2014; Ziegler & Goswami, 2005). There are many young children who, at one point or another, manifest certain language difficulties, although these are relatively unstable in the early years (e.g.,Tomblin, Zhang, Buckwalter, & O’Brien, 2003).With recent

30  Understanding dyslexia

findings, researchers are converging on the idea that only those with language difficulties that persist into the beginning of formal schooling tend to have particular risks for dyslexia (Snowling, Duff, Nash, & Hulme, 2016). Early language impairment by itself is typically not associated with dyslexia, but in conjunction with other difficulties such as phonological processing problems, familial risk for dyslexia within the family, and certain environmental risks, dyslexia is more likely (Snowling & Melby-Lervåg, 2016). Other studies of children with dyslexia indicate that visual word processing can also be impaired in children who are dyslexic. For example, such children appear to be slower to adapt to print as a specialized skill (e.g., Maurer et al., 2007). As we are exposed more to reading, we become better able to identify the symbols of our script and to distinguish these from other symbols that are not in our script or from pictures. Children with dyslexia seem less able to do this quickly (e.g., Meng, Tian, Jian, & Zhou., 2007). The causal mechanism behind this difficulty that those with dyslexia show is not yet clear. However, it is interesting to consider that both phonological and orthographic processes are somewhat impaired in those with dyslexia given that word reading typically involves an integration of these together in the brain. Several studies have also examined dyslexia vis-à-vis the structure of the brain. Integration of information for word reading typically comes from the frontal, temporoparietal, and occipitotemporal regions (e.g., Gabrieli, 2009; Paulesu, Danelli, & Berlingeri, 2014) in the left temporal lobe. Sometimes, less brain activity is manifested in these regions for those with dyslexia as compared to children who do not have dyslexia (e.g., Hu et al., 2010; Shaywitz et al., 2002). Other studies find that those with dyslexia have noticeable structural differences in the brain. For example, they may have a rightward asymmetry or a symmetrical planum temporale, while those without dyslexia typically have a leftward asymmetry in this region (for a review, see Caylak, 2009). Interestingly, other studies have demonstrated that those with dyslexia have either reduced gray matter density or volume in some locations in the left temporal region of the brain (e.g., Hoeft et al., 2007; Ramus, Altarelli, Jednoróg, Zhao, & di Covella, 2018), possibly indicating fewer neurons for less active processing (Caylak, 2009). From this short summary, I hope I have communicated the fact that there are likely multiple causal aspects at the genetic and brain levels for understanding dyslexia. Yet the current reality is that although scientists understand a lot about differences between the brains and, to a lesser extent, genes, of those with and without dyslexia, there is so much we still do not know. Noting a difference between groups of those with and without dyslexia is not the same as understanding a causal mechanism. The important point here is that dyslexia has a neurobiological origin. This can be both frightening and comforting. It can be frightening because the fact that dyslexia is biological and genetic means that there is nothing a parent or anyone else can do to prevent it. Perhaps we can try early training so that the effects of it are milder, but we cannot stop it. It can be comforting for the same reason: There is nothing a parent or teacher could have done to have prevented the manifestation

Understanding dyslexia  31

of dyslexia. This means that any parental or self-guilt (I should have tried harder?! I could have studied more?! I should have XXX, where XXX could be any silly idea a person with a guilt complex can imagine – eaten more salmon when pregnant? Eaten less chocolate when pregnant? Taken certain herbs or not taken them? Exercised more? Engaged in superstitious humming? Listened to more Mozart and less rock?) has no basis in reality. What is important is to accept, understand, and work through (and around) the problem of dyslexia.

What is dyslexia to you? The complexity of the concept of dyslexia is not just theoretically, but also practically, challenging. In the words of Mr. Cheung, a Hong Kong Chinese man who studies learning disabilities and who, himself, has dysgraphia Most policy makers, teachers, and parents get the impression that those with dyslexia represent a homogeneous group. . . . A general impression of dyslexia for laymen is a difficulty with reading, writing, handwriting, memory, processing speed, organization abilities, self-discipline, and so on. Basically, most (people) think that children with dyslexia should have the characteristics that every single research study has ever found. When children’s behaviors or responses do not comply with one of the millions of characteristics of dyslexia, teachers and parents are extremely confused and frustrated. . . . Usually it triggers one of two responses: Either teachers and parents will be doubtful of the information on dyslexia and lose confidence in handling children with dyslexia or they will doubt if the child is really suffering from such difficulties. This quote beautifully summarizes why coming up with a single definition of dyslexia plagues researchers and clinicians. Mr. Cheung’s impression is shared by many, and he offers this practical advice: One of the most important things is to be aware of the heterogeneity of dyslexia, actively try different methods, and don’t develop helplessness when certain methods do not work. (Such failure) is likely due to the poor fit between the method and the child’s situation. Observe the abilities of your child and do not have a fixed perception of your child’s capabilities solely based on his or her diagnosis. Many of the abilities that require monitoring in a person with dyslexia are cognitive-linguistic. As Mr. Toyota, a Japanese speech therapist notes, specifically about Japanese, “Teachers or therapists should know about the cognitive strengths and weaknesses of each child, and they should make educational plans for how the student can get academic knowledge with effective support, such as using assistive technology, adding hiragana letters to teach difficult kanji characters, or adjusting the volume and quality of the homework.” (In Japan, the hiragana system of

32  Understanding dyslexia

writing relies a lot on sound-symbol combinations, whereas kanjis (essentially the same as Chinese characters) in the script are apparently particularly daunting to learn because they sometimes seem to be arbitrary symbols, and there are so many of them.) This suggestion is useful because it emphasizes how hiragana can serve as an aid for learning more difficult kanjis, something that has been established in research in Japanese (e.g., Bowers & Michita, 1998). A clinical psychologist from Sweden, Dr. Emma Lindeblad, also suggests a focus on skills not only for remediation but for capitalization on aptitudes: “Unfortunately, there is a huge focus on what problems the child has, and not so much on actual skills and strengths.” One of the best ways in which to have a clear profile of the child’s difficulties and strengths is to start by understanding the cognitive-linguistic skills underlying dyslexia.

Cognitive-linguistic skills for understanding dyslexia As a parent, teacher, professional, or person with dyslexia, you should get to know the cognitive skills that are particularly important for learning to read. In any given culture and in any given child, the importance of these cognitive skills for reading may differ. Different scripts have characteristics that make them relatively easy or difficult to read in certain aspects. For example, Chinese characters, Japanese Kanji, and Kannada, an Indian script, all of which contain literally hundreds or even thousands of different visual symbols, make more demands on children’s visual awareness than do English or Spanish, which are written with only 26/27 letters and a few diacritics (such as accent marks). Moreover, children with dyslexia, like all of us, will have abilities that are relatively strong or weak.We each bring with us a pattern of abilities. If you know yourself or your child well, perhaps you can identify some of these right away. It is important to understand an individual’s strong and weak skills in order to adapt well to the tasks of daily life. Understanding strengths and weaknesses is useful for best managing one’s self. A profile of strengths and weaknesses may suggest work through (i.e., skills we need to work on in order to improve) and work around (i.e., procedures we implement in order to accomplish a goal using stronger rather than weaker abilities for maximal efficiency) strategies. For example, I am a relatively fast (fluent) reader and writer, but my visual-spatial skills are far below average. Thus, it takes me less time than most people to write an email or a report but much longer than normal to read a map and determine, definitively, the best route to pursue to get from one place to another. These broad reading and writing and map skills likely evolved from simpler cognitive and linguistic skills that developed over my lifetime. These days, I try to make good use of my stronger skills (by doing things like trying to write this book!); this is easy to understand – we all like to play to our strengths. But I also have to manage my poor visual-spatial skills. How to do this is less easy and a lot less fun. One thing I can do is over-practice these skills. It is not the case that I absolutely cannot read a map. Rather, I read it slowly and with a lot of effort. With more practice, I get better. I do not like to do this because it is laborious and frustrating. I would avoid doing this if I could. Sometimes I have no choice, though, and then I have to spend the

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time and practice to improve. Another common strategy is for me to work around the map reading difficulty by using my stronger skills. For example, I can type into a search engine such as Google a request to find out how to get from Address A to Address B. Google, for example, will then display on the screen a map of how to get there, which is relatively slow and effortful for me to comprehend, but also verbal instructions (e.g., turn right at the corner of Berliner Allee, a street I was on today in Freiburg, Germany). I can follow verbal commands far better than I can strategize based on a picture. Thus, I often rely on my verbal skills to compensate for my problematic visual-spatial ones. This example highlights why all of us interested in understanding dyslexia in a given language and script should take the time to understand the cognitivelinguistic skills underlying the disorder. Once you understand the basic cognitivelinguistic skills that are important for learning to read, you can also think about a given individual’s profile of strengths and weaknesses vis-à-vis this set. A person with dyslexia should capitalize on his or her strengths to build up confidence and success and work-through weaknesses, perhaps by practicing these skills far longer than most people have to in order to master them. In addition, a person with dyslexia, like all of us, can use his or her strengths to work around the weaknesses that are problematic for learning. By using his or her strengths, a child can accomplish more with greater efficiency. Thus, there are at least three main reasons that cognitive abilities are so important for thinking about dyslexia. First, once these are identified for a given script and language, they can be used to assess children’s degree of and/or risk for dyslexia. That is, some of these skills, or at least precursors to these skills, can be tested relatively early in development, before a child learns to read. As noted by many researchers (e.g., Adams, 1990) and some of our interviewees as well (e.g., Pediatrician Theresia Stoeckl-Drax), one of the best things we can do with children who have dyslexia is to identify them early, before they start to read. Early remediation is very effective in helping children so that their reading difficulties become less severe. Thus, a focus on some of these skills can help to screen young children to get the help that they need. Second, since these abilities are typically the strongest links to dyslexia, training them can often help children to learn to read better as well. Playing games that reinforce these particular skills can promote reading in children. Making these skills into games can reduce, at least a bit, the suffering related to exercising them, so please think about how you might get children to use these skills using a game. Be creative! Third, understanding a child’s strengths can be helpful in facilitating him or her in work-around strategies to try to accomplish the tasks of daily life, particularly in school, as some compensation for the difficulties that the child experiences with other skills. For example, it is possible that some of the cognitive skills we talk about below are relatively easy for a particular child with dyslexia, and others are difficult. It is important to see which are which for each individual child. While both identification and training of those with (or at risk for) dyslexia often take place at the group level, please think about cognitive tasks on the individual

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level as well. A given child might be relatively skilled in visual analysis and weak in phonological comparisons, for example. Remember to weigh the importance of each cognitive skill differently depending upon the script and child of interest for you. Cognitive skills can also be influenced by motivation and particular life circumstances. Much of the variance in so-called subtypes in dyslexia (e.g., Chen, Zheng, & Ho, 2018; Hanley, 2017; Peterson, Pennington, Olson, & Wadsworth, 2014) might be attributable to patterns of strengths and weaknesses in cognitivelinguistic skills. Ms. WA, quoted at the beginning of this chapter, is a poignant example of this. As with most individuals with dyslexia, it was not that she could not learn to read but that it took her (and still takes her) much longer to read than it did other students. Her biological mother died of tongue cancer when WA was about 8 years old. At that time, WA also had a brother who was 4 years old. Because of the nature of tongue cancer, WA’s mother could not physically speak toward the end of her life, so the mother had to resort to writing notes in order to communicate with her children.This left it up to WA to teach her young brother to read the short messages written by their mother. This young girl with dyslexia mastered the messages written on post-it notes from her mother not only for her sake but for the sake of her brother. This act of necessity and bravery is amazing in many respects. One small aspect of this situation is that WA had to draw upon her stronger skills in order to make up for the weaker ones with respect to word recognition. In the following, I highlight the cognitive skills that are central for learning to read. The broad categories of cognitive-linguistic tasks include phonological sensitivity, morphological awareness, visual-orthographic skills, and fluency. Because some languages/scripts are easier to read than others, these skills and how they are measured can vary in importance in relation to dyslexia. These skills can be identified and practiced in any given language, but for each language and script, some adaptations are required. In addition, the number of practice hours required to become a skilled reader likely differs from one script to the next. This section is a little bit heavy on linguistics. Yet it is important especially for those who would like to design games or skills to practice for children with dyslexia. For remediation purposes, understanding what these cognitive-linguistic skills are is key. The first three are clearly and directly related to word-level reading.The fourth is also related as a kind of broader capacity for efficient word recognition. These are reviewed in detail below.

The fab four: cognitive constructs for word reading At the base of word recognition is phonological ability. Broadly speaking, this refers to speech sounds. When you hear someone speaking in Bemba (one of seven official languages of Zambia), Hebrew, or Russian, even if you do not know this language, you can perceive the sounds that comprise it. Comedians have stereotypes about these sounds. For example, German is sometimes stereotyped as sounding more punctuated or guttural than nasal American English or melodic Mandarin.

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We are all sensitive to phonological aspects of various languages, at least in a broad sense. Although we might not appreciate the finer distinctions of the speech sounds of a language we do not know (e.g., some of the lexical tones in Chinese or the /g/ vs. /k/ sound in English), we hear broad differences across languages. What we cannot deduce until we begin to learn a language, however, is the meaning assigned to speech sounds and speech sound changes. Meaning is reflected in the following by morphological awareness. Morphological awareness encompasses only a small aspect of semantics, or meaning, in general. In relation to word reading, the focus on morphological awareness is at the word level (whereas semantics is broader, relating to any type of text, including phrase, sentence, or paragraph levels). If you understand that, in English, REfuse is a noun referring to garbage and reFUSE is a verb referring to absolutely not agreeing to do something, that is part of your understanding of meaning. Morphemes are the smallest units of meaning, including inflections, derivations, and prefixes and suffixes. Some of these morphemes are easy (e.g., s indicates plural in many nouns in English) and some of them are more tricky (e.g., hydro means water and can be found in words such as hydroplane, hydroelectric, and more – knowing the meaning of hydro can help one to determine the meaning of words containing it). The orthographic aspect of print refers to how words are written in a given script. Sounds and meaning are communicated in the writing. For example, no and know are pronounced the same in English but have very different meanings and very different orthographic representations. In Chinese, Chinese characters are formed according to certain orthographic rules related to character components. In other writing, such as in Vietnamese, German, or French, diacritics, or marks indicating a change in pronunciation of a given word, are part of orthographic processing of text as well. Even English makes use of these occasionally because of borrowed words, as in soufflé or naïve. These marks can appear in different places in different scripts, including above, below, or even in the middle of a printed grapheme. Beyond phonological, morphological, and orthographic awareness as cognitive constructs integral for learning to read, a fourth skill will also be highlighted in this chapter. This is fluency, the ability to read and to write (or, indeed, in a broader sense, to accomplish any given task) quickly and easily. For those with dyslexia, attaining such fluency is among the greatest challenges of all. The way in which we measure at least one aspect of fluency is typically through a task called rapid automatized naming (RAN), and not everyone agrees on precisely what RAN is. At the very least, it likely involves some elements of fluency and some elements of phonological sensitivity.Yet RAN is a powerful correlate and predictor of word reading across languages and scripts. Below, I highlight these four skills, with some attention as to how to measure them in English. I am sorry I cannot do this in multiple scripts and languages, but my hope is that you can take what you know about English and apply it to another language and script you know well. All four of these skills are in some way or other important for reading and spelling, at least at some point in literacy development, in every language. We begin with phonological sensitivity.

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Phonological sensitivity The sounds of language strongly affect meaning. I was reminded of this again when I took up sailing in Hong Kong a couple of years ago. Hong Kong has a very busy harbor, and the Hong Kong government requires those who are operating a boat in these waters to obtain a Certificate of Competency in Radiotelephony. As I was studying for this exam, I realized that many years ago, as mariners became aware of the possibilities for mispronunciation and miscommunication from one boat to another across crews from different countries, they devised a system to distinguish numbers and letters based on extra phonological information. To this day, sailors use special and long names for numbers and letters. For example, the number 2 is referred to as Bisso-Two on the high seas, and the number 3 is Terra-Three. All letters also have a two-syllable name, such as Victor for V and Whiskey for W. This system makes it much easier to communicate numerical and letter information because such labels are rarely confused. These long phonological labels were put in place to identify ships and to organize ship traffic. This solution illustrates how important phonological information is for communication. It can be just as important for word reading. A focus on phonological skills is particularly helpful for scripts that rely on alphabets, as well as other scripts that have some alphabetic elements to them (like Hangul in Korean), because learning to read an alphabet fundamentally requires attention to symbols that communicate sound information in a relatively straightforward way. In English, P makes the /p/ sound most of the time in print. This is not always true, as my friends in philosophy and psychology might note, but it is usually the case.Thus, learning that P sounds like /p/ is important and helpful. In order to be able to map this sound with this symbol, a child must be able to isolate and manipulate the /p/ sound. This ability to isolate and manipulate the sound allows a child to be able to synthesize this sound with others to make words in reading in English and many other languages (e.g., p-i-t spells pit). Other scripts such as Chinese do not use an alphabetic script. Nevertheless, even for those who read in nonalphabetic scripts, at some level, sound is still important. Most of the time in Chinese, for example, a given character in print consistently sounds the same when pronounced in context. For example, the character for country (guó) is consistently pronounced as guó across words that contain it, such as France (faˇ guó), Germany (dé guó), America (měi guó), or China (zhōng guó 中國). In this case, the sound-related, or phonological, element is at the syllable level. Syllable-level information is particularly important here. In other cases, in different writing systems, rather than focusing on the importance of single phonemes or holistic syllables as in Chinese characters for learning to read, we can expand to focus on a rime unit. (The unit that makes word endings sound the same, or rhyme, is referred to as a rime. This is not a misprint.) For example, in German, zwei (two), drei (three), and frei (free) all share the rime of ei; if you learn how to pronounce this rime of ei in one word and then see another one containing it, that helps in generalizing the pronunciation. Similarly, fight, sight,

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and light all rely on the same rime (ight) for their pronunciations. The whole idea at every level of the word is that when we learn to isolate sounds at some unit level (e.g., phoneme, rime, syllable) and then apply our knowledge of the sound and its printed representation to reading, it is very helpful for facilitating more efficient literacy skills. Beyond these skills of isolating speech sounds, often termed segmental phonological awareness, another important skill is focusing on speech sounds across an entire word. This skill in focusing on speech sounds across a word has been termed suprasegmental ability.We are probably most aware of this ability when we hear foreigners attempt to speak our native language or when we listen to children trying to read words on a page that they do not know, at least in certain languages. In both cases, we may run into the situation in which the emphasis placed in pronouncing the word is incorrect, so that a word is pronounced as poCKET instead of POcket, for example. As another illustration, those listening to foreigners pronounce Chinese or other languages that make use of lexical tones will often hear mistakes being made in the tonal pronunciation. It turns out that skill in knowing where and what stress or tones are present in various words is also additionally helpful for learning to read and to spell. We tend to spell syllables that are stressed better than we spell those that are unstressed (e.g., Treiman, Berch, & Weatherston, 1993), and those with difficulties in identifying the correct stress patterns (e.g., Wade-Woolley & Heggie, 2015; Wang & Arciuli, 2015) or lexical tone usage (Cheung et al., 2009; Liu, Shu, & Yang, 2009; Zhang et al., 2012) in their native language are at greater risk for dyslexia. Therefore, as we think about how to test for risk of reading and spelling problems in young children, a focus on phonological processing is key (e.g.,Verhoeven et al., 2018). Yet how you test it or the games you play with it will likely differ from one language to another. See if you can take some of the examples from English and apply them to your native language. In English, many of the tests of phonological awareness make use of phonological deletions or substitutions or combinations with different units. For example, some can use phonemes, but others could use rimes or syllables. Below, I simply give a few illustrations, which you could perhaps adapt for your own purposes. More examples are presented in Appendix H. Phonological awareness can be tested using real words or nonsense words, but nonsense words are more difficult than real words. My examples below are all using real words, because it is easier to understand how to manipulate speech sounds when the answer is also a word you recognize. This makes it easier to explain as well. For all of these exercises in phonological sensitivity, children should be tested or trained with oral examples. It is important to train children on phonological sensitivity by talking to them and asking them to think about these items orally but not by reading them.You can make up your own additional examples fairly easily if you understand the basic principle of testing of phonological sensitivity. The principle focuses on highlighting individual speech sounds or phonological units. The easiest

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type of activity with these units focuses on the syllable level. The very easiest of these occurs for compound words, where the syllable to be manipulated is also a word. For example, you might ask a child to say snowman without saying the man part.That would be snow. For each item below, you will request that the child make the same manipulation, in this form: “Please say snowman without the man (part of the word)” (Answer: snow). Here are a few more examples where you can substitute the words and answers (if you really are working with an individual on this, do not forget to request it in the form above – say XY without the X): Sunshine without the shine is sun. Meatball without the meat is ball. Lightbulb without the bulb is light. Doorknob without the door is knob. An exercise that is a little more difficult at the syllable level is to remove a syllable that is not, on its own, a word. For example, funny without the “yee” sound is fun. Here are a few more: Pillar without the “er” is pill. Contact without the “con” is tact. Spider without the “der” is spy. Window without the “win” is dough. (Remember you are asking these questions orally and not in print. I have written these as they sound when they are presented in conversation, just by talking.) Apart from these items focused on syllables, you can also test children on their abilities to manipulate phonemes, or individual speech sounds. These follow the same style as mentioned above, i.e., asking the child to say a word with a sound removed from it. Make sure, however, that for these items (below), you refer to the individual sounds and not letter names. Thus, I might ask a child to tell me what the new word is when she takes away the first sound in the word lap (Answer: app). Or I could ask her to “say lap without the /l/ sound.” Here, I do not mention the letter name (which might be spelled something like el) but the letter sound (which is pronounced something like llll). That is why, in the examples, below, I have written the sounds as sounds, rather than as letters. For example, in the word cow, the first sound is /k/, not C.The /k/ sound is pronounced something like kuh by native Midwestern speakers of English.You get the idea! You can ask children or adults to delete sounds at any level from a word. Here are some more: Seat without the /s/ sound is eat. Paw without the /p/ sound is awe. Fan without the /f/ sound is an. Cup without the /k/ sound is up.

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We can do this not only with the beginning phonemes, or individual speech sounds, of a word but also with those in the end. For example, beat without the /t/ sound is be. Here are some more: Bone without the /n/ sound is beau. Feel without the /l/ sound is fee. House without the /s/ sound is how. Soak without the /k/ sound is so. If we want to make the task even more challenging at the phoneme level in English, we can manipulate sounds within consonant clusters. In many languages, such as Chinese, Bemba (a language spoken in Zambia), or Korean, consonant clusters are not very common. English is difficult in its phonological awareness requirements partly because it contains a fair number of such clusters, which typically include 2–3 consonants together. Here are some examples of these: Speak without the /s/ is peak. Sling without the /l/ is sing. Crow without the /k/ sound is row. Scream without the /r/ sound is scheme. Others involving such clusters fall at the end of words. Here are some of those: Fast without the /s/ sound is fat. Fern without the /n/ sound is fur. Act without the /k/ sound is at. Pieced without the /t/ sound is piece. What about testing suprasegmental awareness? In English, the ways to test this always have to do with which part of the word is stressed. One way you can do this is simply to ask children to select the correct pronunciation of the word in a 2- or 3-syllable word, offering two different versions. For example, is the word CAmel or caMEL (where the capital letters are intended to indicate the stressed syllable). Some others might include: ANgry vs. anGRY PARcel vs. parCEL SOfa vs. soFA SUNbathe vs. sunBATHE FORget vs. forGET PERhaps vs. perHAPS REnew vs. reNEW UNless vs. unLESS

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(For the first four of these, the first option is correct, whereas for the second four options, the second option is correct.) It is possible to try different versions with longer words as well, so here are four examples of words comprised of three or four syllables: BEAUtiful vs. beauTIful iDENtify vs. identiFY HOSpital vs. hospiTAL afterNOON vs. AFternoon (For all of these above, the first option is the correct one.) There are other ways to tap suprasegmental awareness, and some of these vary by language. For example, in Chinese, one can change the lexical tone of a single syllable of a word with two or more syllables, and this will change the meaning. Comparing the correct version of the word with a word that contains an incorrect lexical tone and asking the child which is the correct answer is another useful way to tap this skill. The point here overall is that phonological sensitivity is helpful for learning to read in every language. It is the foundation for reading because we map meaning and orthographic characteristics onto sound representations. Even in Chinese, which is notoriously unreliable (e.g., Shu, Chen, Anderson, Wu, & Xuan, 2003), phonology is important. At the syllable level, which, in Chinese, is usually the morpheme level as well, the pronunciation of a particular written syllable is almost always the same from one instance to another. Practicing any games involving sounds is likely to be helpful for children to learn to focus on speech sounds, manipulate them, and blend them. In English, we have the game of Pig Latin, in which you change a given word by taking off the first sound of the word, putting it on the end of the word, and attaching a vowel of ay to the end.Thus, rat become at-ray, spot becomes ot-spay, and make becomes ake-may. Is there any silly speech-sound game in your language? Do not be afraid to play such a game to promote your child’s sensitivity to sounds.This is potentially helpful to everyone, including those with dyslexia who often have a particularly difficult time with these sounds. Again, these and other items related to phonological sensitivity are listed in full, for easy reference, in Appendix H in the back of this book. We now turn to the second cognitive-linguistic skill that appears to be, in some form or other, universally important for reading development and, thus, also reading and spelling impairment.

Morphological awareness Morphological awareness is the second cognitive-linguistic skill that is important to incorporate into any informal or formal assessment of dyslexia across cultures. Morphological awareness is relatively easy to measure, but its manifestation can differ considerably from one language to the other.

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This meaning aspect is often referred to as the semantics of language. Morphological skills are a subset of semantics. Morphological aspects here refer to how morphemes fit together in a given language. Morphemes are the smallest meaning units in a language. For example, in the word birds, there are two morphemes, the base word bird and the s, indicating that the word is plural.Thus, spoken phonological units map onto the meaning of the word in the form of semantics/morphological units. Why is morphological awareness important for learning to read? The answers might actually differ partly by script and language, but across all scripts and languages, mapping meaning onto print is important. It is not always the case that, for both word reading and for word spelling, the word can be produced only based on phonology. To illustrate this point, we can again turn to English, where this is relatively obvious. A classic example is the ed morpheme, indicating past tense of a given verb. For example, the past tense of cook is cooked, of walk is walked, and of mop is mopped. There are other examples with this classic ed one could invoke as well. For example, the past tense of bloom is bloomed, of plan is planned, and of manage is managed. In the first three examples, the pronunciation of ed ends with a /t/ sound, whereas in the second three examples, the pronunciation of ed ends with a /d/ sound. Why not write these examples according to sound only, then? The answer relates to morphology. The ed morpheme is important in indicating meaning and not sound. It indicates to readers that the word is a past tense form. This cues readers in to the broader meanings of text. In a comprehensive way, understanding the morphology of words in a language can help us to read and to spell (for an example in French, see Pacton, Foulin, Casalis, & Treiman, 2013). A child who understands, basically, that the word shriek is a verb and that to make a verb past tense in English, one often appends ed to the end of it is more likely to be able to recognize, pronounce, and spell shrieked correctly. Related to this, distinguishing the meanings of homophones is also important. For example, only if a child knows the meanings of loan and lone, both of which are pronounced identically, will she recognize that loaned is correct but loned is not; lonely is correct, but loanly is not. Homophones are particularly important in Chinese where it is not unusual for a single pronunciation of a character/word to have 15 or more meanings. For example, in Mandarin, the syllable shū can be written using more than 25 different characters. If children do not understand the differences across characters pronounced identically as shu1, they might not know that shū bāo, written in Chinese as 書 包, is correct but shū fú, written as 書服, is not. The first character of the second example should be written as 舒 and not as 書. The correct way to write shū fú is 舒服 instead. Thus, the identically sounding shū syllable has many different forms. Morphological awareness has been linked to dyslexia in several studies of Chinese children; homophone awareness is part of this broader aspect of morphological awareness (e.g., McBride-Chang, Shu, Zhou, Wat, & Wagner, 2003; Shu, McBrideChang, Wu, & Liu, 2006). Another reason that morphological awareness is important for reading more generally is because those with good morphological awareness tend to have better

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vocabulary knowledge and vice versa; vocabulary knowledge and morphological awareness tend to be mutually reinforcing of one another with development. Vocabulary knowledge itself is, of course, a cornerstone of reading development. Early in the first years of school for typically developing children, there is a switch from learning to read to reading to learn. A broad vocabulary base is a cornerstone of mature learning via reading comprehension (e.g., Hoover & Gough, 1990; Lervåg & Aukrust, 2010; Kieffer & Lesaux, 2012;Tong, Deacon, Kirby, Cain, & Parrila, 2011). In various studies we have done in Chinese, Korean (McBride-Chang, Tardif et al., 2008), and English (McBride-Chang, Wagner, Muse, Chow, & Shu, 2005), morphological awareness is predictive of vocabulary knowledge and vice versa. In general, children who have difficulties with morphological awareness may have more difficulties in learning to read. Happily, morphological awareness is relatively easy to test and to teach. One can construct a lot of fun games using some basic principles of one’s native language. We have some of these on our own website designed for early Chinese learners: http://ww9.psy.cuhk.edu.hk/chineseearlyliteracy/. Those included here are targeted to two aspects of Chinese (and English) morphological awareness that are particularly important, namely, homophone awareness (i.e., can you distinguish the meanings of to, two, and too, when all of them are pronounced identically?) and lexical compounding. Lexical compounding basically involves putting morphemes, the smallest units of meaning in a language, together to form new words or meanings. Lexical compounding is making compound words. There are many examples of compounding. The easiest in English have to do with two simple words combined to form a new word, e.g., snowflake, cowboy, or endgame. The French have some compounds as well, often making use of a hyphen, such as savoir-faire (knowhow), couvre-lit (bedspread), and oiseau-mouche (hummingbird). Some of the masters of compounding are the Chinese and the Germans, both of whom have many, many compound words. Chinese has many of the ones that occur in English (e.g., seahorse, soybean, fingernail) and many others (e.g., computer=electric+brain). Examples in German include an Armbanduhr which is a watch (arm+band+clock), a Handschuhe, which is a glove (hand+ shoe), and a Staubsauger, which is a vacuum cleaner (dust+sucker). One particularly famous example came from a shipping country in Austria; it mainly focused on shipping on the Blue Danube, referred to as the Donau in German. The company had the auspicious name of the Donaudampfschiffahrtgesellschaft (Danube+steam+ship+drive+ company). It was later shortened to DDSG Blue Danube, which made it much easier to pronounce. The running joke was a question: What do you call a DDSG captain’s hat (in German, there is a single word for the captain’s hat, namely, Kapitaensmuetze)? The answer, of course, is a very long word, namely, Donaudampfschiffahrtsgesellschaftkapitaensmuetze. (Donau+steam+ship+drive+company+captain+hat) Note that compounding can involve both simple words but also grammatical derivations. For example, a sucker is one (a person or thing) who/that sucks. To expand on this point, er in both English and in German, for example, can indicate a person who does a thing. For example, in English, a teacher is someone who teaches,

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a mourner is someone who mourns, and a complainer is someone who complains. In German, an Arbeiter is someone who works (arbeitet) a Taxifahrer is someone who drives (fährt) a taxi, and a Bäcker is someone who bakes (bäckt). In different languages, there are various grammatical changes one can make to words to change their category, to make them plural, to mark case (as in French, with feminine or masculine or German, with feminine, masculine, or neuter), to mark polite vs. informal forms (e.g., sie vs. du in German or vous vs. tu in French), to mark by classifier (as in Chinese, which often labels nouns with a classifier for that type of noun, such as flat things, heavy things, slices, etc.), and to change their structure in many other ways (e.g., noun, adjective, adverb, etc., or grammatical structure of nominative, genitive, accusative, dative, and others), depending upon the language. Urban Dictionary offers some amusing examples of English “evolving” to incorporate new words, many of which involve lexical compounding of one type or another. Some of these involve compounding in creative ways. For example, a fauxpology is an insincere (false) apology, a pregret is doing something despite the fact that you already know before you do it that you will regret it, and the adjective typeractive refers to a person who writes too much on email or texts. Here again, you can see how compounding morphemes to form words or concepts appears to be quite a popular thing to do. I am not a linguist, and my examples are very limited by the little I know about French, German, and Mandarin Chinese, in addition to my native English. However, I wanted to mention these ideas broadly because they are important at a basic level for understanding how to test morphological awareness in your home language. The basic point is this: To test morphological awareness, think about the structure of your language and how words are formed. Focus on these basic principles for testing or making up games to facilitate morphological awareness. Below, I list some ideas from English, but please draw upon your own language to make up language games that are helpful to make those with dyslexia more aware of the structure of words. This will broadly help them to become better readers. Some of these items are taken from our previous work in English (McBride-Chang et al., 2005). Any items you create should focus on new concepts, making up new words, essentially. These usually require a brief explanation. Please ensure that anything you use here is not a vocabulary word already in your native language. If you use real words, you are focusing on vocabulary, rather than morphological skills. This is also useful, but it is a different aspect of language. Some examples of forming traditional compound words are the following (answers in boldface): When the sun goes down at night, we call that a sunset. What would we call it if the moon went down at night? Answer: Moonset An apple tree is a tree that grows apples on it. What would we call a tree that grows coats on it? Answer: Coat tree Horseshoes are metal shoes that we put on horses. What would we call metal shoes that we put on pigs? Answer: Pig shoes

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Basketball is a game where you throw a ball into a basket. What would we call a game in which we throw a ball into a scarf? Answer: Scarf ball A box we use to store mail in is called a mailbox. What would we call it if we used a trunk to store mail in? Answer: Mail trunk Some further examples of grammatical compounding are these (with thanks to Berko, 1958): Today, John is stotting. Yesterday, he did the same thing. What did John do yesterday? Yesterday, he . . . stotted (Answer). Here is a thin, oily toy called a fron. I have two of them. I have two . . . frons (Answer). I like to gamp. It is really fun! Every morning I am . . . gamping (Answer). A farmer farms. A cleaner cleans. This person pasks. What would you call a person who pasks? A person who pasks is a . . . pasker (Answer). I have a pet called a wex. My friend also has a wex. Together, we have two . . . wexes (Answer). Just as for phonological sensitivity, morphological awareness is an important ability to be able to test and to train. Games involving morphological awareness can also be encouraged. One that Chinese speakers often play requires that the speaker takes the first morpheme from a two (or more) morpheme word and make it the first morpheme of a new word and continue to make chains of words that way. Here are a couple of examples of word chains in English: Start with the word doghouse: Houseboat-boatyard-yardstick-stickball-ballgamegameboy-boyfriend-friendship-shipshape-shapeup-uptake-takeover-overblown Here is another example starting with the word cupcake: Cakewalk-walkwaywaypoint-pointwork-workhorse-horseshoe-shoehorn-hornpipe-pipecleaner Playing games involving a focus on morphemes can also help to promote literacy skills in children. This can be a fun way to get children to see patterns in language and in print, a skill that is essential for those with dyslexia. Of course, being playful with morphemes can also promote vocabulary growth (e.g., Zhou, McBrideChang, Fong, Wong, & Cheung, 2012). Vocabulary growth is also important for reading, both directly and indirectly. One potential drawback of some of the games related to morphological awareness, particularly using items I listed above in boldface involving concepts that are not real, is that that they are not real! Some parents and teachers hate this and worry that they might be teaching their children something incorrect. While I understand the concern, I hope to get parents and teachers not to worry too much about this. If we want to emphasize morphological awareness, we need to focus on morphemes but not on real vocabulary words.

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If we highlight real vocabulary words too much, we are simply teaching vocabulary knowledge. Obviously, vocabulary knowledge itself is very valuable, but knowledge of morphemes and how they can be aggregated to form logical, legal new concepts in one’s native language is a somewhat different skill. This skill itself is worth teaching for reasons discussed above. Children respond well when they are told that we are making up “silly words” or the equivalent, and there do not seem to be residual problems with a focus on these novel constructions. If novel constructions bother you very much, however, another way to focus on morphological awareness is to focus on patterns of morphemes in words.The word chains above are one example. Another aspect of this is to highlight homophones. Try to do this orally and not in print, because if children are looking at how the two words are spelled differently, it will help them to get the right answer but also potentially distract them from thinking about the morphemes enough. It is better to do this as a game where you are both just talking. For example, you can ask a child which is the same word as the sun in Sunday? The sun in sunny or the sun in grandson? Answer: Sunny contains the same sun as in Sunday. Some others: Which is the waste in wastebasket? Waistband or wasteful? (Answer: Wasteful) Which is the one in one-off? Hard-won or one day? (Answer: One day) (Note, in English, many compound words or concepts are written using spaces or hyphens between the morphemes.) Which is the bear in unbearable? Childbearing or barefoot? (Answer: Childbearing) Which is the sea in sea creature? Seafaring or foresee? (Answer: Seafaring) Which is the pain in painful? Stomach pain or windowpane? (Answer: Stomach pain) See if these kinds of games are also possible in your language. Again, anything that focuses children on morphemes, what we could probably “get away” with calling smaller words or parts of words making up whole words, can be helpful for promoting literacy. This can help dyslexics to see patterns, and seeing patterns is critical for literacy learning. Memorizing some ideas about morphemes (e.g., ed at the end of a verb often indicates past tense and is consistently spelled this way) is one good approach to trying to help children learn to read or to spell more efficiently. These and other items related to morphological awareness are listed for easy reference in Appendix H at the back of the book.

Orthographic knowledge The third cognitive-linguistic skill to be highlighted across languages is orthographic knowledge. Orthographic knowledge is knowledge that has built up over time, often either consciously or unconsciously, about how a given script is written. Most of the time, we test orthographic knowledge in those who have spent some time already learning to read. It is not something that is easy to test in young

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children, for example. Sometimes when I think about this construct, I think it is a bit confusing because if you knew how to read every word in your language perfectly, presumably, your score on a measure of orthographic knowledge and your score on a measure of word reading would be basically the same thing. However, we usually measure orthographic knowledge in children, or those who are developing readers, learning to read fluently but not yet there. The way in which orthographic knowledge is tested is basically by showing children correctly and incorrectly spelled words and asking them to distinguish what is correct vs. incorrect. In an alphabetic script such as English, one can change the spelling of the word using any changes that are of interest. For example, you might be shown these words and asked whether they are real words or not: Septrm ssot trhn joaen spot plan rear toys hib stime jook crint In the first four items, there is a basic principle that is violated. In the first one, the end of the word contains four consonants. This pattern of four consonants is quite rare, and it is likely impossible for an English word to end in four consonants if the final consonant is not an S. The second word contains two Ss at the beginning of the word. This pattern of two Ss at the beginning of the word is again impossible in English (though a pattern of two Ss at the end of the word is acceptable). In the third word, there is no vowel at all contained in the word, another impossibility. In the fourth word, there is a pattern of three vowels together, which is also rarely seen in English.The four words following these are all real. Finally, the last four words are not real, but their spellings are acceptable in English. That is, these spelling patterns are possible in English. These are some examples I made up for English, but every language (in the Roman alphabet or in other completely different scripts) and every script have their own peculiarities in writing. It is important to reflect on what is possible and impossible in your home script and to highlight what important features you think might be useful to point out to children with dyslexia. Depending upon the child’s level, it may or may not be useful to directly highlight the fact that every word in English needs a vowel, that most words begin and end with one or two consonants and three consonants are rarer still, or that certain letter combinations (e.g., tr, pl) occur at the very beginning of words but not at the very end, and others occur only at the end (e.g., ss, lp) and not at the beginning. There is a lot of unconscious or tacit knowledge we have about our home script that might potentially be useful to highlight for children. For example, young children appear to write using orthographic patterns that are appropriate for their language relatively early (e.g., Treiman, Kessler, Boland, Clocksin, & Chen, 2017;Yin & McBride, 2018).We simply do not know how much of this will be helpful and at what literacy levels. Orthographic knowledge is worth exploring on its own. In some particularly visually complicated scripts, such as those found in India or China, teachers and parents might additionally want to highlight visual-motor or visual matching skills for children. There is some evidence, for example, that copying ability, which involves

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visual-motor and visual matching attention to detail skills, is additionally associated with writing words (e.g., Wang, McBride-Chang, & Chan, 2013). Overall, though, orthographic knowledge itself tends to be the focus of psychologists interested in identifying those with some particularly tendencies toward dyslexia. It may be useful to be cautious when deciding whether to test or to train this particular skill. If you expose children to incorrect spellings in print, they may have a harder time letting go of these spellings and ensuring that they use the correct spellings only. I never worry about playing silly sound or language (e.g., morphological awareness) games with children vis-à-vis reading because those with dyslexia and dysgraphia usually have language skills within normal variability by the time they are diagnosed as dyslexic. Playing these games helps children to isolate units of speech and manipulate them. However, looking at words that are misspelled in print can potentially confuse those who, by definition, have difficulties in learning to read and to write words consistently, already. It is important to understand orthographic awareness and to know how to check for it. And teaching patterns in print (e.g., in English, words can end with but cannot begin with ss) as rules is potentially helpful. However, try to avoid exposing children to too many incorrectly spelled words as part of this. What is really problematic in this respect is to offer two different plausible spellings for the same word, one of which is correct and the other incorrect, and ask the child to choose the correct one (e.g., embarrass vs. embarass). The first one is correct, but seeing choices on such words, which are easily confusable, can in some cases heighten one’s confusion! One more cognitive construct under general orthographic processing that bears mentioning here is copying skill. There have not been enough studies carried out on this particular measure to warrant unique status as a separate cognitive-linguistic skill. However, I would be remiss if I did not mention it here, given several independent published studies that have demonstrated some aspects of copying that have been linked to word reading (e.g., Kalindi et al., 2015; McBride-Chang, Chung, & Tong, 2011) and to word writing (e.g., Lam & McBride, 2018; Mo, McBride, & Yip, 2018; Wang et al., 2013; Wang,Yin, & McBride, 2015) in Chinese. Some of the impetus for studying copying has come from the observation that writing is complex and focused in Chinese in a way that it is not for some alphabetic orthographies (e.g., Tan, Spinks, Eden, Perfetti, & Siok, 2005). I also attended a conference on dyslexia in India in 2016 that piqued my curiosity on this topic. The conference was primarily for teachers of children with dyslexia. After one of the keynote speeches which focused on the importance of phonological awareness for literacy skills cross-culturally, one of the teachers asked about copying. In her experience, the best way to focus children on literacy skills was to give them various copying exercises, with both lines and shapes that were not related to the script (i.e., abstract figures, tracing lines) and also then with copying of the script itself. Chinese and some Indian scripts are more visually complicated than are alphabetic writings (e.g., Nag, 2007, 2011). Unlike the other primary cognitive-linguistic skills listed above, evidence for copying skills is sparse and in some cases negative. For example, there were no

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differences in copying of unfamiliar print between disabled and nondisabled readers of English in one famous study (e.g., Vellutino, Steger, Kaman, & De Setto, 1975). At the same time, one must keep in mind that the approach to literacy that research has taken has largely followed the parameters of English word reading and word writing, and even relative to other alphabetic orthographies, English learning has some peculiarities (e.g., Seymour, Aro, & Erskine, 2003), indeed, eccentricities (Share, 2008). With scripts such as Chinese or some of the Indian scripts, many more visual patterns must be recognized than in an alphabetic writing system. This is a distinction between hundreds or thousands of visual patterns as compared to 20–30 different graphemes in an alphabetic system.With relatively little research on correlates of literacy in Chinese or Indian scripts, researchers are not yet sure of the importance of copying for learning to read and to write in these. However, there are good reasons to think of copying as a potentially important cognitive-linguistic skill in its own right. It can be tested. If it is a child’s weakness, it can be practiced further to improve literacy, including helping the child to acquire some motor memory for certain words. If it is a child’s strength, careful visual-orthographic attention in the form of writing might be used to make up for other weaknesses in the literacy acquisition process. Like the Indian teacher I mentioned above, one can always design ad hoc copying tasks for children. Indeed, many of us were asked to trace dotted lines and duplicate figures, including simple geometric patterns, when we ourselves were young and learning to read and to write. Creating such patterns for those with dyslexia to trace and eventually copy might be useful. What is even more useful for older children is to copy words a few times to improve the learning of them. If such copying is done mindlessly, it is unlikely to improve performance. However, copying with attention to orthographic patterns might be helpful in facilitating recognition of the patterns. For example, perhaps a child with dyslexia could be asked to copy a few words that all contain a given orthographic pattern that is consistently pronounced the same. One example might be for words that contain the pattern ation, as in preparation, narration, vacation, salvation, altercation, or examination. A simpler one might be simply the ay as in bay, may, play, stay, and ray. Presumably, a focus on the same pattern can facilitate memory for it and scaffold learning of a group of words vis-à-vis orthographic similarities. Copying is an old technique for learning, and it can backfire in those who are asked to do too much of it or who do it mindlessly. However, it is also quite useful for solidifying orthographic information because it integrates understanding of orthographic patterns with visual-motor abilities (e.g., Ehri, 2014).

Fluency The final skill I want to identify here for all to be aware of is fluency, or automaticity. Essentially, this skill taps children’s abilities to be quick and efficient in carrying out all tasks associated with literacy (and non-literacy ones as well). When you are learning a new skill, if you are like most people, at first, you are slow.You will have

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to remind yourself of each step, and you will execute each one with stiffness and deliberateness. Remember learning to tie your shoes? Or learning to play a musical instrument? Or learning a dance step? Each of these skills requires a sequence of movements, one after the other, executed with precision. Execution of each step in the sequence cannot occur if we forget the sequence itself. In the same way, memory is integrally related to fluency. When we remember the sequence without hesitation, we can carry out an action more and more quickly. This is the case with learning to read as well. In most cases, we are putting sounds together to make larger words. This is perhaps clearest in English or other alphabetic orthographies where we synthesize the sounds of /k/-/ae/-/t/ to spell cat, but it is even true in Chinese to a certain extent, with individual character recognition leading to subsequent recognition of larger words comprised of two or more characters (e.g., 愛國 says patriotism (ài /love 愛 + guó /country 國)). One of the ways in which researchers have attempted to capture fluency in reading research and in clinical diagnoses of those with dyslexia is by using a task called rapid automatized naming (RAN). In this task, children are asked to look at a sheet or screen full of a few variables that should be easy for them to recognize. These symbols are repeated a few times over in random orders. Symbols could be pictures (e.g., of animals or other common objects), color blocks (red, blue, black, etc.), or graphemes such as Arabic numbers (e.g., 1, 9, 6, 5, 2), letters (e.g., H, J, L, M, B), or simple Chinese characters (e.g., 一, 九, 六, 五, 二). Tasks of RAN are among the best predictors of reading difficulty across all languages and scripts (e.g., BarKochva & Breznitz, 2014; Georgiou, Papadopoulos, & Kaizer, 2014; Ibrahim, 2015). RAN seems to capture some phonological information, but also some abilities in serial processing and articulation (Georgiou, Aro, Liao, & Parrila, 2015). RAN is particularly important for reading fluency (or lack thereof) (Georgiou et al., 2015), a hallmark of dyslexia around the world. Nicholson and Fawcett (e.g., Nicolson & Fawcett, 2011; Nicolson, Fawcett, & Dean, 2001) have further demonstrated that children with dyslexia tend to be slower than their peers on many tasks, including those of motor skills. They highlight the importance of the cerebellum for automatizing many processes, including simple motor processes. Indeed, Nicolson (2014), summarizing a variety of difficulties that those with dyslexia have vis-à-vis speed of processing, asserted that there is a fairly standard formula for estimating time on task: He calls it the “square root rule,” which dictates that “The extra time needed for a dyslexic child to master a task is proportional to the square root of the time a non-dyslexic child takes.” For example, if a task typically takes 16 trials to master for someone without dyslexia, it will take a person with dyslexia 64 trials to get it. This is the square root of 16 (which is 4) multiplied by 16. Similarly, if it typically takes approximately 100 trials to master another skill, a dyslexic child should be expected to take approximately 1000 trials to master. The extent to which this rule is literally true across all learning situations is not clear. However, this rule of thumb is helpful in demonstrating concretely the importance and urgency of fluency skills development for those with dyslexia.

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How can you train fluency in those with dyslexia? It turns out that lots of researchers are interested in this idea and have even tried it, but with mixed results. One of the best known programs that has focused on fluency is called RAVE-O (for retrieval, automaticity, vocabulary elaboration, orthography) (Wolf et al., 2009; Wolf, Miller, & Donnelly, 2000). Researchers have demonstrated that targeting several skills together certainly helps children to read better. Getting children to read over and over again, with an emphasis on speed of reading, can sometimes work and is worth exploring (Meyer & Felton, 1999). There are not a lot of studies focused solely on repeated and faster reading, but this is probably because tasks of repeated identification of stimuli, including RAN stimuli, individual words, or actual connected text, likely involve multiple processes. Indeed, the purpose of this review of the “fab four” cognitive skills has been largely to highlight each of these individually, and they are all integrated as we read words. The simplest way I can recommend to train fluency is to start wherever the child is and appeal to his or her inner sense of competition with the self. Certainly, a child with dyslexia has felt discouraged at times when comparing his or her oral reading with others.This is almost a definition of dyslexia by itself. However, we all like to improve ourselves. When we try to beat our own times and succeed, this is satisfying.When I say start wherever the child is, I mean that, depending upon the child with dyslexia, the child may be dysfluent in letter name or letter-sound identification, a relatively low level for the reading process, or, at an older age, generally very slow but correct in word recognition. If the child cannot read words, ask the child to focus on reading to you a subset of random letters (e.g., b, n, l, j, k, t) or a few Chinese characters or Korean Hangul symbols (i.e., whatever script he is learning in school) as quickly as he can. Time him with your phone or another timer. Show him how long it took for him to read these things aloud to you on the timer and then ask him to do it again but this time more quickly.The basic idea is to compare the later reading with the earlier one, hoping that he can get faster.You can do this at any level, from letters to words to entire sentences. The goal is simply to show the child that he can get faster when repeating the written material a few times. It doesn’t matter what script you are using or what units you use. This is relatively simple. Just take what you think will not be frustratingly difficult for the child and get him to read it aloud a few times. We have done this with primary school children in Hong Kong, and the teachers were impressed by how simple yet effective this was. For one thing, it was motivating for the children because they all wanted to “beat” their previous times.

Wrap up In summary, all of these skills, namely, phonological sensitivity, morphological awareness, orthographic skill, and fluency are essential for reading in all languages and scripts. What can differ from one language and script to the next, however, is the relative importance of each for reading development and impairment. Why is this? Thinking about a few different languages and writing systems might illustrate

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the difficulty. In comparison studies across written languages making use of the Roman alphabet (e.g., Seymour et al., 2003), researchers have clearly identified English as particularly difficult to learn to read and to write because of the inconsistency between how words are pronounced and how they are written, the speechspelling correspondence. A couple of those languages that are relatively easy to read (note: I said read, not to speak – grammar, vocabulary, all things oral in a language are in a different category – here, I refer only to pronouncing printed words on a page) are German and Italian, ones with relatively consistent spelling to sound correspondences.These languages depend upon good phonological skills to read. Once one has mastered the sounds of the letters, one can combine them and recognize words in new combinations of these letters relatively quickly if one has a good ability to manipulate speech sounds. In other scripts, other skills may matter as much or even more than the phonological aspects. For example, in Chinese, every given spoken unit, or individual syllable, typically can be mapped onto several meanings, or morphemes, represented by different characters. Chinese likely has the most homophones and homographs in the world. With so many possible ways to write a given morpheme or word, the importance of phonological skills may be diminished for Chinese in comparison to languages such as English or German which have relatively long and phonemically complicated words. Likewise, in many scripts of the world, including Arabic, some akshara orthographies such as Kannada (e.g., Nag et al., 2014), and Chinese, visualorthographic pattern recognition is much more complicated than it is in languages written using the Roman alphabet. In such cases, extensive orthographic knowledge is required early and at a relatively high level. Apart from this script level of relative importance for each, it is also the case that some individuals have relatively stronger or weaker abilities vis-à-vis phonological, morphological, orthographic, or speed-related skills. What I hope you have gotten out of this chapter, then, is some understanding of how and why phonological sensitivity, morphological awareness, orthographic skill, and fluency are all important for learning to read in every language and script. I also hope that you use your own judgment on which skills may be stronger and less strong in any given individual with dyslexia. Once you know something about what these skills are and how to test or train them, you can figure out which ones to focus on for a given individual, and how.Those with dyslexia in childhood often learn to read relatively well in adulthood if they persist, but the effort it takes them to do so is considerable and often fraught with frustrations. Given this extensive background in cognitive-linguistic skills in relation to dyslexia, here, we return to the case of WA, the successful art student who has struggled with dyslexia all her life. She is studying to become a graphic artist. Graphic arts focus a lot on typography, relating to the style of printed matter.WA told a wonderful story of her approach to a project in graphic arts given her dyslexia as follows: The assignment was for students individually to make an original bookplate, also referred to as ex libris, and to put the bookplate in a book they really liked in order

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to label it as their own. WA decided to use the font called Times New Roman for this bookplate, explaining, “I hated it. I used that font because I had a really bad relationship to that font. I wanted this to be something active, not just to look at.” WA had had to use this font for many difficult homework assignments throughout high school. Therefore, in her artwork, she took a sentence labeling the book written in Times New Roman and made it into a slide puzzle, blurring at times the words in different ways. The patterns made a very interesting ex libris, one that immediately stood out to her teachers. Moreover, as she explains “I hate books, but finally, I thought:This is me. So I put the ex libris in Crime and Punishment, a famous book that I don’t like.”When WA explained this approach and thinking behind her assignment, the teachers were intrigued and delighted, immediately responding to the creativity, honesty, and irony. As WA explains, “You can use your dyslexia in a good way, see it in a good way. The teachers really liked this.” WA’s accomplishment of integrating dyslexia into her work life in a positive way is very recent. It has been neither easy nor pleasant, but it is a part of who she is. The struggle of learning difficulties is clear. There is lots of frustration and sometimes hope. Having reviewed some basics of dyslexia, we turn next to dysgraphia, an equally challenging learning difficulty.

3 WHAT IS DYSGRAPHIA?

About four years ago, a young man at my university in Hong Kong contacted me about carrying out an undergraduate thesis under my supervision. He explained that he is a person with dysgraphia and that one of his primary motivations for having become a psychology major in the first place was to understand more about the condition. I did ultimately supervise him on his work, and he then went on to become my research assistant after graduating. It is he who single-handedly taught me the most about this condition of dysgraphia, both through his thorough research review and through his personal story: He persistently suffered writing difficulties in childhood, but he could always read adequately. He is Chinese and grew up in Hong Kong which, for historical reasons, emphasizes literacy learning in both Chinese and English. This meant that he had to learn to read and write in both Chinese and in English from the age of four. Ultimately, he found English easier to write than Chinese, perhaps because Chinese characters require that much more visual information be recalled than in English; yet writing in both scripts was a challenge from the very beginning. Some of his teachers were overly harsh and contributed to his early miseries. For example, one primary school teacher, frustrated by his very poor writing, publicly humiliated him by bringing him from classroom to classroom across the school and making him stand in the front while the teacher told each class of how poor his work was. How did this boy go from constant scolding about being “stupid” to being currently enrolled as a Ph.D. student in a very prestigious university? One answer is the teacher who invited him for extra tutorials after class in third grade and showed interest in his work, gradually helping him to start to see himself as a student with good potential. A further turning point for him was receiving a fountain pen from his mother; the feel of the pen in his hand when writing encouraged him to practice writing more and more. He additionally learned guitar, and the fine motor movements needed to do this seemed to have increased his awareness of his hand

54  What is dysgraphia?

movements in writing. His interest in both psychology and in English, not always a popular subject in Hong Kong, also helped over time. He tried reading self-help books, first in Chinese, and then in English as he got older, in order to figure out how he could do better and feel better. These further encouraged him to focus on overcoming his writing difficulties. This young man ultimately wrote an excellent piece on dysgraphia for my course and in doing so taught me a great deal about dysgraphia. He has spoken to many primary school teachers in Hong Kong about his experiences and moved some of them to tears with his success story. Before I met him, I had never known someone with very severe writing problems who could actually read well. I had somehow thought that dysgraphia was a part of dyslexia but not separable from it. In this chapter, I focus particularly on research and experiences specifically related to dysgraphia across cultures. Dysgraphia is basically “impaired hand-writing” (International Dyslexia Association, https://dyslexiaida.org/). Some children suffer from dysgraphia for reasons of motor control difficulties, but others might have visual-spatial confusions that lead to writing problems. For other children, there is strong overlap between those with dyslexia and those with dysgraphia. Much less is known about dysgraphia than about dyslexia, but the concept is gaining in attention. Estimates are that among children with dyslexia, almost 30% additionally manifest difficulties with handwriting (e.g., Arfé et al., in press; for a review, see Montgomery, 2008).

Distinguishing word reading from word writing Why should we consider dysgraphia apart from dyslexia? To begin with, word reading and word writing sometimes involve somewhat different processes. For example, Mr. Cheung, one of my interviewees and the man profiled above, reflected that as compared to those with dyslexia, For children with only writing difficulties, like myself, the (learning situation) is easier. We can use reading as independent learning like other normal developing children do; the only difference is that we lack practice using writing. Most agree that reading a word is easier than writing one.There are several reasons for this, and it is worth reflecting on some of the differences between word reading as compared to word writing before we review the different processes involved in word writing that might be impaired in a person with dysgraphia. An overview of the several reasons for which word writing is more demanding than word reading was given by Winkes (2014) as summarized by Döhla and Heim (2016). One idea mentioned is what they refer to as full vs. partial cues. It is true that a child can often read a word with access to only some cues. For example, in this sentence, I misspelled a word but you can still probalby “read” it anyway (the incorrectly written word is probably). Children might be able to read words without fully taking into

What is dysgraphia?  55

account every cue of the word. It is not difficult, as an adult, to read the words embarrassed or handkerchief despite some letters in each of these that are easy to overlook when spelling them. In contrast, a single omission of a letter in spelling these words makes the spelling incorrect. This fact is echoed in their second point (Döhla & Heim, 2016), which is that recognition of a word is consistently easier than recall of it. This is a truism of cognitive processes in general. Would you prefer an exam that tests you using the multiple choice vs. the essay format? Multiple choice involves recognition only. In word reading, similarly, we can recognize the word, but we need not produce it. In word writing, we must produce it from memory. If our memories for the word are incomplete, the word will be incorrectly written. Winkes (2014) and Döhla and Heim (2016) also note the importance of context. When we read a word within a sentence, we can sometimes make use of context to guess at its meaning. Although this reliance on context is not always helpful given that poor readers can guess incorrectly, it is a strategy that is often used by readers that can sometimes help, both at the word (e.g., Bu Rabia & Siegel, 1995) and even at the Chinese character (e.g., Wang & McBride, 2016) levels. One cannot use context to write words, however. Context does not allow us to determine anything about the spelling of subsequent words as we write. Winkes (2014, cited in Döhla & Heim, 2016) further highlights the effects of training over time, pointing out that the amount of time we spend reading vs. writing is quite disproportional. This point is echoed by Montgomery (2008) who noted that, historically, teachers have spent much more time in class focused on reading as opposed to writing, and this has been a problem for ensuring that students’ writing is “up to speed,” so to speak. From the beginning, children have more experience with reading, and, thus, reading becomes easier and even automatic for many people over time, whereas writing may remain extremely effortful. A last point made by these authors (Döhla & Heim, 2016; Winkes, 2014) has to do with different scripts and their characteristics. The idea applies particularly to alphabetic scripts. Overall, the writing in most languages tends to be more difficult than reading because of the correspondences between phonological segments and graphemes. Often, when a reader sees a letter, there is only a single way to pronounce it based on cues within the word. For example, in English, in general, C sounds like /k/ when followed by the vowel A, O, or U but /s/ when followed by the vowel E or I. In more transparent orthographies such as Italian or German, there is often only one way to pronounce a given letter in print. However, going the other way, from sound to print, or phoneme to grapheme, there may be additional, complicated possibilities. For example, if I asked you to write, in English, a nonsense word (this is difficult because ideally you should only hear it and not see my version of it!) like “seeply,” (pronounced SEE-plee) one can imagine that several versions of how to spell it might be possible.You could write it as seaplie or ceiplee, for example (with acknowledgement that sea and see are homophones, and words like birdie, auntie, and scrunchie end with ie for the former, and the fact that ceiling begins with cei, and that jubilee and parolee end in lee); the possibilities for English spellings via analogy are much wider than they are for reading.

56  What is dysgraphia?

With these basic differences between word reading and word writing in mind, we come back to the issue of dysgraphia specifically. From the review above, we can see that learning to write words involves somewhat different processes from learning to read them. At the same time, as discussed in Chapter 2 on the nature of dyslexia, there are likely multiple interacting abilities that contribute to writing difficulties. Some of these are relatively broad, and some are more specific, directly related to the act of writing a word itself. As summarized by McCloskey and Rapp (2017) on the issue of developmental dysgraphia, “Almost certainly there are multiple proximal and distal causes that can lead to developmental writing deficits, and our goal should be to characterize the full constellation of these proximal and distal causes” (pp. 75–76). Identifying the mechanisms underlying dysgraphia should be helpful in at least two distinct ways. First, if we understand how dysgraphia develops, we might be able to test for some of the skills that contribute to the very early development of writing in young children in order to identify those at-risk for dysgraphia. Identifying such children early can help us as clinicians and teachers to focus on early, effective interventions to pre-empt the subsequent development of dysgraphia. Second, identifying these mechanisms suggests which skills could be a focus for training. Interventions typically highlight what skills should be developed, through either play or direct teaching, in order to help to alleviate the dysgraphia that is already present or even to prevent dysgraphia from emerging in those young children who are at-risk for the difficulty. The subject of dysgraphia remains under-researched, despite estimates that between 7% and 15% of children in primary school manifest some type of writing difficulty (Döhla & Heim, 2016; McCloskey & Rapp, 2017). Across cultures, it is particularly important to consider cognitive-linguistic, perceptual, and motoric demands of writing in your given script. There are likely to be some script-specific abilities that should be highlighted for children learning to write in different languages. Research on this is sparse, but it is possible that writing from left to right or from right to left affords different challenges, for example. For instance, it is already clear in Chinese that a focus on stroke order, the ordering of each mark on the page comprising a given Chinese character, is important for Chinese word writing (Lam & McBride, 2018; Law, Ki, Chung, Ko, & Lam, 1998). There is arguably less need for doing such a study on writing in languages that make use of the Roman alphabet such as Italian, Spanish, or French, because the order of marks we make when writing the Roman alphabet letters may be relatively uncomplicated. I therefore particularly appreciate the spirit of the comments from McCloskey and Rapp (2017) on the goals of research on dysgraphia as follows (p. 76): We cannot conduct research by selecting a group of developmental dysgraphics according to some diagnostic criteria, and then studying them as a group (e.g., averaging results across participants, looking for significant group effects). This research method assumes the group to be homogeneous in relevant respects, and in particular assumes that all have the same form of impairment. Rather, we must study participants individually, allowing commonalities and differences across individuals to emerge from the conclusions of detailed single-case investigations, rather than being assumed a priori.

What is dysgraphia?  57

What I like about this vis-à-vis this book is the juxtaposition of research for the group with individual characteristics. Researchers do rely on group research because we can see some common trends within a group, and this helps us to pinpoint basic characteristics of phenomena such as dyslexia, dysgraphia, or attention difficulties. However, we cannot stop there, particularly in service to parents, teachers, clinicians, and those manifesting particular learning difficulties. We need to understand individual needs and characteristics in order to understand and then help each individual who has dysgraphia (or any other learning disability).

Dysgraphia: basic processes Dysgraphia represents a basic difficulty in writing words. Why is word writing difficult for children? McCloskey and Rapp (2017) presented two models of processes related to writing that are relevant here given the importance of individual cognitive-linguistic, perceptual, and motoric markers of writing. One process focuses on spelling-to-dictation and the other focuses on the process of writing a word given the activation from one’s knowledge of the nature of the word on paper. The models both specify a sequenced ordering of skills. However, I am less interested in this order as I am the various skills involved in dictation as contained in these two models. This is because such models enable us to consider each of the abilities we might want to evaluate in considering how dysgraphia develops and what skills to target to ameliorate this condition. Once we know what the skills are, we can then consider the order in which the skills occur. In the spelling-to-dictation model (McCloskey & Rapp, 2017), memory is emphasized. Long-term phonological and orthographic memory are both highlighted in particular. In alphabetic scripts, aksharas, and alphasyllabaries, which are, collectively, most of the writing systems of the world, phonological long-term memory is key. The writing system relies on correspondences between phonological units (such as letters) and their corresponding graphemes. We first hear or think of a word, and, based on its speech-sound attributes, we conceptualize what it is. This then involves mapping the phonological representation of the word to its meaning, which the authors refer to as lexical semantics. As an extreme example, we need to understand what the word means precisely before we can write it in the case of homophones. We will want to understand the context of the word before we write by, buy, or bye, for example, or peek, peak, or pique. This then leads us to consider our own long-term orthographic representation of the word. Do we remember how it looks? This requires us to make use of an orthographic long-term memory. Once we remember how to write a given word, we then rely on our orthographic working memory. This working memory is important in order to go from an orthographic image, however incomplete, in our head to writing it on paper. Presumably, this involves considering the components of the word, whether this involves letters, diacritics, radicals, or other aspects of writing, and planning how to write these.

58  What is dysgraphia?

In the model focusing on writing the word, the focus begins with considering the individual aspects of the word. Although the authors highlight the process using the word cat in English, one can imagine that the parts of the word could also include diacritics or other representations, such as semantic or phonetic radicals in Chinese. The writer must then also determine what allographs to use to write. An allograph has multiple definitions, but for our purposes, we will consider it to be a variant of a grapheme. For example, the letter B can also be written as b. In Chinese, many of the characters are written in either the simplified or traditional script, which look quite different. In Arabic, vowels are omitted in the mature form of writing but not in the children’s style. Moreover, all of these forms can also change depending upon one’s style. Fonts may differ in styles that are used. For example, the letter T can appear as t or as t. Cursive and printed forms might also be considered allographs. Indeed, one reason that you are sometimes asked to retype weird-looking codes of letters and numbers on websites for security purposes is because allographs vary widely and are quite difficult to program on a computer. In this model, a child then makes graphic motor plans that are independent of the actual writing process. These plans involve issues such as where to begin on the page and the direction and sequencing of the movements of the pen; one might actually imagine writing the word. Finally, a child’s developed motor plan enables him or her to actually write an image of the word. The writing may not look exactly as we picture it, but it has followed from our independent graphic motor plans. These models are complicated but suggest that several skills can be targeted as we understand writing. These are somewhat in parallel to the skills we discussed previously for dyslexia, but they focus primarily on memory. In order to write, we must have a phonological memory, a lexical-semantic memory (focused on word meaning), and an orthographic memory. In addition to these, we must have some memory for allographs, or depictions of the graphemes we wish to write, and some motor memory. Memory for allographs may be particularly linked to visual-spatial skills. This has to do with the style of grapheme production and likely involves awareness of component parts of words. For example, in the letter b, how long should the line of the letter be, how wide should the circle be, and what is the proportion of one to the other? Motor memory focuses on how our fingers and hand work together, using a pencil or pen, to create written output. These skills have been identified in several studies of writing (e.g., Berninger et al., 2006; Berninger et al., 2002; Cheng-Lai, Li-Tsang, Chan, & Lo, 2013; Lam & McBride, 2018). To summarize, dysgraphia involves three central constructs discussed previously in relation to dyslexia, namely, phonological, meaning-related (variously involving morphological and lexical-semantic skills), and orthographic processing. When these are disrupted, they can interfere with writing as well as reading at the word level. However, dysgraphia additionally includes two other processes not involved in word reading but central to word writing. These are allographic skills, which clearly involve visual-spatial sensitivity, and motor memory, which involves the sequencing of hand movements for the production of writing.

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Categorizing dysgraphia One important point about dysgraphia is that it is only rarely formally diagnosed around the world by itself. Indeed, it is often included under a very general description of dyslexia instead (e.g., McCloskey & Rapp, 2017). Dysgraphia is recognized as a learning difficulty, but unlike dyslexia, there are relatively few standardized tests for it. Once we recognize that allographic skills, involving visual-spatial sensitivity, and motor memory are unique to dysgraphia, we can start to consider dysgraphia apart from dyslexia. A hallmark of dysgraphia is very bad penmanship or writing. Some people with dysgraphia have handwriting that looks very cramped, with unusual uses of space, such as varying sizes of letters or characters, going outside of the lines or box, and confusing marks with many erasures or cross outs. It is possible to be dysgraphic without being dyslexic. As mentioned at the beginning of this chapter, one of the interviewees for this book, Mr. Cheung from Hong Kong, is dysgraphic but not dyslexic. His reading is, and always has been, fine, but he has a lot of difficulties with handwriting. It is also relatively common to exhibit dysgraphia along with dyslexia. Along this line, it is important to note that poor spelling by itself does not constitute dysgraphia. For example, there are those who can spell well orally but fail to write words on paper correctly. Rather, dysgraphia focuses on a failure to produce graphemes, or the symbols used in print, legibly and clearly. Some researchers believe that it important to identify at least three different types of dysgraphia, because each has a somewhat different cause and, thus, presumably a different solution (e.g., Deuel, 1995). That is, even when the output looks the same – which, in this case, involves terrible penmanship or writing – the underlying causal mechanism can be quite different. Indeed, previous research on children with dyslexia and their handwriting (e.g., Sumner, Connelly, & Barnett, 2013, 2014), as well as previous research on those with developmental coordination disorders (meaning that they have some motor difficulties) and their handwriting (e.g., Prunty, Barnett, Wilmut, & Plum, 2013, 2014) both demonstrate similar phenomena in relation to children’s output: In both cases, those with a given impairment (dyslexia; motor problems) tend to pause more when writing as compared to their typically developing peers. At the same time, there are also often some fine motor difficulties manifested by those with dyslexia (e.g., Haslum & Miles, 2007). A recent study of children with dyslexia as well as additional handwriting difficulties in Italian, a relatively simple, transparent language/system to read and to spell, suggests that handwriting difficulties are more likely to be associated with difficulties with spelling than with motoric problems (Arfé et al., in press). A focus on spatial difficulties in relation to handwriting troubles is relatively rarely mentioned apart from those who have acquired brain lesions, but it is still occasionally documented in work on handwriting difficulties (e.g., Smits-Engelsman & Van Galen, 1997). Given this background, Deuel’s (1995) classification of developmental dysgraphia is especially useful and widely used. In this system, three types of dysgraphia can be distinguished. These are dyslexic dysgraphia, motor dysgraphia, and spatial

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dysgraphia. Those with any of the three types of dysgraphia write relatively illegibly, especially if they have to produce text spontaneously. A hallmark of dysgraphia is that the writing is poor especially when the text to be written is done in a spontaneous context, i.e., on demand. However, these three types are distinguished when four other tasks are included. Those with dyslexic dysgraphia are unable to carry out oral spelling adequately. When asked to spell a word aloud, those with dyslexic dysgraphia will fall short. They are poor spellers whether they are writing or orally spelling. In contrast, those with motor or spatial dysgraphia can carry out oral spelling adequately. Another test to distinguish different types of dysgraphia is that of copying written text. Here, those with dyslexic dysgraphia can perform the task with relatively little trouble, but those with the other two types of dysgraphia cannot. It is important to understand that the motor and spatial forms of dysgraphia really have most to do with the act of writing itself and are relatively dissociated from reading difficulties. Dyslexic dysgraphia seems to result from the sheer frustration of not being able to spell, not from eye-hand movements of any kind. Two other tasks are used to distinguish motor and spatial dysgraphia from one another. These are drawing and finger tapping, tasks on which those with dyslexic dysgraphia perform normally. On drawing tasks, children with motor dysgraphia should theoretically perform relatively poorly, but those with spatial dysgraphia should be worse. Presumably, those with spatial dysgraphia have the biggest problems with visual-spatial perception and placement. Finally, some researchers administer to children suspected of having dysgraphia a test of finger tapping speed. In this test, participants are asked to tap one finger on the table in front of them or on keyboard keys in order to observe motor skills. Children with motor dysgraphia tend to perform poorly on this, whereas those with dyslexic dysgraphia or spatial dysgraphia perform normally on this task. Another way to test for motor difficulties in those with dysgraphia is to use a finger succession task, where children sequentially touch each finger to the thumb, usually only for the dominant (so presumably the hand used to write) hand (e.g., Berninger et al., 2006). Given the lack of information on dysgraphia in any script, it should not be surprising that research on dysgraphia in Chinese is relatively sparse. I mention Chinese here partly because I have done research on Chinese in particular but also because most people can see intuitively from looking at the Chinese script how complicated it is to write. Of all the scripts in the world, it is indeed the most complex in terms of writing (e.g., Chang, Chen, & Perfetti, 2018). I personally have been interested in this issue recently given my own experiences and those of my children in learning to write Chinese. For a student of Chinese, there is relatively universal agreement that the way to learn characters from primary school onwards is by copying each character multiple times (e.g., Wu, Li, & Anderson, 1999). Although we alphabetic learners have surely done our share of copying in learning to write words, the importance of copying in Chinese seems far greater. Learning of Chinese characters also relies relatively less on any phonological connections than does alphabetic learning. These facts combined intrigued me and have led us to begin looking at the prevalence of dysgraphia in Chinese societies.

What is dysgraphia?  61

We still have no firm conclusions. However, a few researchers (e.g., Chang & Yu, 2005; Lee, 2004; Poon, Li-Tsang, Weiss, & Rosenblum, 2010; Tseng, 1993) have attempted to characterize dysgraphia in Chinese. Their conclusions seem to be in line with those from western studies on the importance of distinguishing motor difficulties, visual-spatial problems, and/or dyslexia as correlates of dysgraphia in any child who manifests the disorder. Across all children with dysgraphia, memory seems to be a particularly salient focus.

Beyond dysgraphia: long-term consequences of word writing difficulties Memory is an important focus for those with dysgraphia because the cognitive resources required to write with this difficulty are often overwhelmed from the beginning of the process. Those with dysgraphia might be misdiagnosed as having very poor writing skills at the higher levels, including idea generation or complexity, or the ability to tell a story or to organize an expository piece of writing, because of finite memory capacity. We have all encountered difficulties related to memory capacity as we have learned new ideas or skills. For example, in learning a musical instrument, one must focus on a few skills at once: If you are learning to play the violin, you cannot process all information related to how to read music, what fingers on the strings of a violin correspond to what notes, and how to move the bow to make nice sounds all at the same time. Similarly, if you are learning to sail for the first time, you cannot learn all the vocabulary that sailors use (jib, mainsail, sheets, bow, port, starboard), how to judge where the wind is coming from, and how to optimally trim the sails for maximum speed and safety all at once. Information overload is always an issue when trying to learn something new. For those with dysgraphia, the physical act of writing words is so taxing that there are very few cognitive resources left for the rest of the thinking that is required for writing any kind of an essay or longer piece.This is a problem particularly because it often gives teachers and parents the impression that the child is a poor writer overall. However, for this kind of difficulty, it is absolutely essential that everyone supporting the child understand that writing can be divided into different sub-processes. Word writing is only the beginning. What is more important as an ultimate goal is text writing. One of my favorite models of text writing came from Hayes and Flower (1980). These researchers essentially divided writing into at least three processes. These are 1) planning what to write, 2) writing out the ideas, and 3) editing the writing. Subsequent researchers have refined and elaborated upon this model substantially (e.g., Hayes, 1996; see also Reading Rockets description online for POWER – www. readingrockets.org/article/dysgraphia-students-perspective-writing), but I prefer to keep this simple perspective. Considering writing in these three aspects is helpful particularly because it breaks down the writing process into clearly distinguishable parts. The first part, planning, is a skill that could actually be carried out entirely in one’s mind. It involves creativity, imagination, logic. This is basically the process

62  What is dysgraphia?

of deciding what you will write about: What is your “story”? The second part, namely, writing out the ideas, is probably the most involved step. I think of this as brainstorming on paper. Here, the writer should write without censoring himself or herself. In this step, it is particularly important for the writer not to be limited by worries about poor spelling, grammar, or punctuation, because constantly correcting these can discourage or even block creativity or flow of ideas. The third aspect of writing is editing. This part involves meticulous corrections. It is more tedious than the other two. Here, the writer must be extremely careful and strict about whatever has been written at this point. Here, the emphasis is on ensuring that the final form is correct, in logic, in grammar, in punctuation, and in spelling.

Planning-writing-editing One aspect of this model (Hayes, 1996; Hayes & Flower, 1980) that I particularly appreciate is the fact that all three of these processes are absolutely essential for writing, but a writer could be good at all, some, or none of them. Moreover, improving any of these processes might depend upon different skills. Planning probably depends on having good ideas, based on creativity or good understanding of the parameters of a project. For example, it is not possible simply to write an essay on “World War II.” This is unmanageable; it is way too general to be possible. Rather, a person must refine the topic of “World War II” substantially in order to make it a manageable and interesting topic on which to write an essay. Writing out the ideas probably depends on having good background knowledge, vocabulary, ability to research new information required for the piece, and many other skills. In planning a good essay, a good writer should have in mind a “thesis.” Here, a “thesis” basically refers to a conclusion, or statement, to be established with the piece of writing. Editing depends upon having good spelling, punctuation, and grammar knowledge or at least being able to detect and double check anything that seems unclear or wrong. Clearly, someone with dysgraphia will have difficulties with editing in some respects, by definition.This difficulty with presentation of a written product is the hallmark of dysgraphia. On the other hand, there is no particular reason to expect that someone with dysgraphia will be limited in any way in either planning or writing the idea in principle. No doubt, most people reading this will agree that planning should be unimpaired in those with dysgraphia. Planning is all about ideas. Indeed, those with dysgraphia may at some points be forced to seek multiple methods to learn, and their ideas based on their experiences could even be particularly exciting. But what about writing out the ideas? This is more complicated and clearly debatable.Yet as you can see from all definitions of dysgraphia (dyslexic, motor, or spatial), there is nothing in the nature of dysgraphia that highlights language difficulties in children. This is why some parents and teachers are so adamant about the importance of children being allowed to present their ideas in alternative project formats. When these children are allowed to create projects that make use of multimedia, for example, they can often excel, because the focus is no longer on producing a product that must be created using only written expression, the dysgraphic child’s shortcoming.

What is dysgraphia?  63

When a child with dysgraphia is, for example, allowed to dictate (speech-to-text) her or his essay, story, or report orally, the quality of higher-order factors, such as vocabulary knowledge, complexity of ideas, and logic, is typically much higher than it is when the child must write these ideas.Thus, there is nothing inevitable about a child with dysgraphia having difficulties with the ideas expression part of the Hayes and Flower (1980) model. Many, if not most, teachers and parents around the world view written assignments as primary. Often, they additionally do not necessarily believe that alternative assignments, such as multi-media presentations, should be included in classrooms. However, for those with dysgraphia, such an accommodation is key.The great practicality of this Hayes and Flower (1980) model is that it breaks up the skills necessary to write a piece into at least three. This model is a great, easy-to-understand, initial description of how we go about writing a piece. A logical extension of this model is that grading should be done based on the model as well. In this way, a child with problematic spelling, grammar, or overall legibility can be penalized for these flaws by getting a poorer grade on this aspect. However, he or she should additionally be graded separately on the idea generation and general logic and linguistic expression of the piece, and these could be done in alternative ways other than writing. Austrian professional school psychologist Barker-Benfield felt that some attitudes in various school systems were perhaps more damaging to those with dysgraphia than anything else. She mentioned a particular principal who told a student, “I can tell you right now, you’re not going to pass (this assignment). It doesn’t matter how nicely you write the story.” Barker-Benfield noted that in some schools, there is a rule similar to that suggested above, namely, that stories be graded in four aspects, i.e., spelling, grammar, creativity of the story, and vocabulary used, with each constituting 25% of the grade.This seems relatively appealing and fair for all, particularly those with dysgraphia. “But,” she continued, “in some schools, there is another rule. They could just grade you on spelling only.” This example from Austria helps to illustrate a problem overall for those with dysgraphia. On the one hand, with technology as developed as it is nowadays, it is more possible than ever for those with dysgraphia to work around their specific writing difficulty and perform wonderfully well in complex jobs. For example, Mr. Cheung, of Hong Kong, is now getting a Ph.D. in psychology; Ms. Amy, of the U.S., another interviewee with dysgraphia (among other learning difficulties) profiled in Chapter 5, is a translator in a multinational company.Yet the ways in which teachers and schools handle dysgraphia differs very much from school to school and around the world. To summarize so far, we know that dysgraphia is an error in writing at the word level, caused by motor, visual-spatial, or reading-related problems. Those with dysgraphia have characteristically illegible handwriting. In some ways, this seems like a relatively minor problem. As an isolated difficulty, dysgraphia implies that the child has difficulties writing but not in reading. There are a variety of accommodations possible with this particular problem. At the same time, schools tend to focus a great deal on handwritten assignments. This is natural across cultures, and there are good reasons to continue to see

64  What is dysgraphia?

benefits in children learning to write words by hand first (e.g., Alves et al., 2016; Bara, Morin, Alamargot, & Bosse, 2016). However, for those with particular difficulties in writing, while some energy can be devoted to practicing writing, the writing difficulty should not be a barrier to advanced compositions. Work-around strategies such as typing or even oral presentations that are converted to written ones via computer are possible and preferable in such cases. Because so much of a child’s school life has to do with completing written assignments, a person with dysgraphia can get very discouraged by teachers and parents because his or her assignments are consistently found to be lacking. Yet actually the problem is relatively small on the level of “mechanics” of writing. Many people with dysgraphia are creative and logical and have a lot of information to share. They simply have difficulties doing this in written form. In Chapter 8, we consider practical steps that can be taken to help those with dysgraphia. In the next chapter, we turn to a difficulty that, like dysgraphia, is also often comorbid with dyslexia, namely, attention deficit/hyperactivity disorder (ADHD).

4 BASICS OF ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

The concept of attention deficits is a fundamental one in education. In fact, in some countries, there is not a strong distinction between dyslexia and attention difficulties; both are considered to constitute a broad learning disability. Indeed, attentional deficit hyperactivity disorder (ADHD) often overlaps with, or is comorbid with, dyslexia. Most estimates on the comorbidity between the two fall between 25% and 40% (for a review, see Boada et al., 2012). Importantly, those children who have both together tend to show a relatively strong genetic component to both disorders and also manifest more cognitive and social problems than do those who have either dyslexia or attention difficulties alone (for a review, see Boada et al., 2012). In this chapter, we consider the fundamentals of ADHD itself. We start with a description of 14-year-old Jonny, who, as reported by Joe, his father, is lovable, very smart, and uniquely talented in mathematics. He also has distinct difficulties in paying attention. Joe says this about Jonny: We noticed this (attention problems) from a very young age. From ever since we remember him, he was easily distracted, he has had a hard time following instructions (including simple ones), and is generally known in the family as an “Astronaut” – detached from mother Earth . . . I can give numerous . . . examples, which especially show lack of organization and planning skills, forgetfulness, and the like. For example, every morning I prepare sandwiches for Jonny, and a bottle of water to take to school. One time I found not 2, not 3, not 4, but 5 (!) drinking bottles inside his school bag – a reminder of how carefully he organizes his stuff for school. Additionally, he is very unlikely to know if his siblings are at home or not, as they come in or go out without him ever noticing. Often, children with attention difficulties appear to be disrespectful or rude to parents or teachers.They are not listening, and they may be perceived as willfully disobeying. At first, some parents might also argue that their children could not have

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specific or special attention difficulties because they sing very well or spend hours playing computer games. However, some researchers (Barkley, 2014c) characterize attention difficulties as being more of a lack of regulation than inattention overall. Actually, some children, such as Jonny above, may pay too little attention to some activities but even too much to others (such as interesting computer games). The basic problem is one of dysregulation of attention rather than lack of it. ADHD may actually be a misleading label. A better way to characterize the disorder, as detailed by Barkley (e.g., 2017b), is as a self-regulation disorder. Given this misunderstanding, one emphasis for this chapter will be that schoolwork is often effortful and boring, and this is where those with and without attention difficulties are most easily distinguishable. Those with attention difficulties have inordinate difficulties in concentrating in school and in staying on task. Children with the hyperactive component of this difficulty are often disruptive in class, unable to sit still or to stop talking. Those who have attention deficit without hyperactivity can be more easily overlooked. They seem merely “spaced out” at times. All children with ADHD are frustrating for teachers and parents because teaching them sometimes requires extreme patience. All have either the characteristics of either inattention or impulsivity-hyperactivity – and sometimes both. As Sally, a mother of an inattentive ADHD boy said, “This is a neurological difference. It LOOKS EXACTLY like willful disobedience, but it is not. Punishment DOES NOT fix the behavior problems. STRATEGIES do.” Below, I overview the fundamental characteristics of ADHD.

Defining ADHD The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a worldwide reference for clinicians and scientists devoted to defining precisely the nature of attention deficit difficulties. In 2013, this manual (American Psychiatric Association, 2013) defined Attention Deficit/Hyperactivity Disorder (ADHD) as a neurodevelopmental disorder that might include symptoms of inattention, hyperactivity-impulsivity, or both. The categories of inattention and hyperactivity-impulsivity are different. They can overlap, but there are those with attentional problems without manifesting any aspects of hyperactive behavior. A clinician diagnosing ADHD would follow the DSM-V and identify the disorder in those below the age of 17 as having at least 6 and those ages 17 and above as having at least 5 of the following symptoms under these two categories of inattention and hyperactivity-impulsivity (e.g., Rabiner, 2013):

Inattention • • • •

Inattention to details or relatively many careless mistakes Problems in paying attention May appear not to be listening even when directly addressed Difficulties in following through on chores or homework to complete the tasks

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• Difficulties in organizing tasks to be carried out • Avoidance of tasks that are effortful or complex • Losing things excessively • Easily distractible because of extraneous events, thoughts, other stimuli • Forgetful

Hyperactive-impulsive • Fidgeting/squirming • Leaving one’s seat at school or the office excessively • Restlessness sometimes in the form of climbing or running • Problems with quiet leisure activities • Great difficulties being still, seeming to be always on the move • Unrestrained chatter • Talking out of turn • Difficulties in waiting (in a line, for one’s turn) • Interrupting or intruding upon others The DSM-V now recognizes three types of ADHD. These are inattentive, which focuses on the distractibility as listed above, but without the aspect of impulsivity, hyperactive/impulsive, which has characteristics of the second header but not those under the first, and combined. A key here is that a person can be diagnosed with ADHD only if these symptoms have lasted for a relatively long time, defined here as at least 6 months, and are not in keeping with normal standards based on developmental level, which basically means a person’s age. Thus, for example, a typically developing 7-year-old is likely to be more fidgety, impulsive, forgetful, and inattentive than a 10-year old simply because as we age, we mature. Such symptoms are only a problem if the 7-year-old is acting much more immature, fidgety, disruptive, or inattentive than his 7-year-old peers.These symptoms should also occur in more than one setting.That is, in order for someone to be diagnosed as ADHD, such symptoms should occur not just in the classroom but also in other places such as at home or when playing with friends. The idea here is that it might be theoretically possible for a child to react in a given single environment in these ways for reasons of that environment, but if he or she reacts similarly not just in the stressful environment of school but the relatively relaxed environment of home as well, this suggests that such actions are part of the child’s basic characteristics. Finally, these symptoms should have been present before the age of 12 years old for them to qualify as ADHD. Jergen (2004) elaborates on the rationale behind this particular and specific definition of ADHD, saying that: going to school often extenuates the problems that children with ADHD have regarding their hyperactivity, impulsivity, and inattention. In fact, in

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many cases, it isn’t until school starts that symptoms of ADHD become readily apparent or severe enough to draw concern. (p. 23) He goes on to say, It should be noted that if a child goes to school, is fine, and then starts exhibiting symptoms later on in life, she or he probably doesn’t actually have ADHD . . . people do not ‘develop’ or ‘get’ ADHD. Their symptoms might worsen or lessen depending upon their environment, but they don’t just suddenly become hyperactive, inattentive, or impulsive overnight. (pp. 23–24) With similar criteria, Polanczyk and colleagues (2007), analyzing research studies from around the world, estimated that, on average, about 5.3% of children and adolescents have ADHD. Jergen’s (2004) observation that the beginning of school can make ADHD particularly salient within a family is attributable to the fact that, at the beginning of school and indeed with every higher grade level progression, the requirement that a child concentrate on tedious and effortful learning increases. Homework and stress correspondingly increase. In contrast, at home and in play when children with diagnosed ADHD are engaged in activities that they enjoy, the attention difficulties are much less evident. Still, some ADHD-related symptoms are often evident; parents just become more aware of them following the stresses of school entry. ADHD is often a life-long struggle. Indeed, there are many adults who remain ADHD. Barkley and colleagues (2008, cited in Roberts, Milich, & Barkley, 2014, p. 57) compiled a list of nine diagnostic criteria for adult ADHD that includes distractibility, impulsivity, difficulty in stopping an activity when it is time to do so, beginning a new project without taking the time to understand it via reading or listening to directions first, failing to follow up on commitments made to others, difficulties in carrying out tasks in sequence, problems with staying attentive on activities related to either work or play, and difficulties with organization. They also point out that many adults with ADHD can have the tendency to speed excessively when driving and also some difficulties in taking part in leisure or other fun activities quietly. Interestingly, Barkley (2016) notes that, with development, the hyperactivity characteristics tend to diminish much more clearly than do the inattention characteristics. Across the lifespan, males with this difficulty outnumber females, but the sex ratio tends to be most unbalanced (with estimates of 3 or 4 boys to 1 girl) in childhood. Barkley (2012, 2014a) is one of the most influential thinkers on ADHD of the modern era. Having published many research studies on the topic, he was well poised to write a number of books and produce several talks and other videos that are highly informative and accessible to parents, teachers, and all of us interested in ADHD in its entirety. I recommend particularly his 2012 YouTube talk on 30 essential ideas for parents and his website (www.russellbarkley.org) for many helpful

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resources for those who want more details on the topic. One of the most poignant aspects of his work was that his own brother had ADHD and probably died in part as a function of the disorder at the age of 56 (Barkley, 2017a). This brother apparently had some tendency to take risks, including speeding in a car and not wearing a seat belt. It has undoubtedly been a struggle for Barkley to know so much about this disability and still for it not to have been enough to have been able to prevent his brother’s early death. He has written some about this incident in a frank and touching way that illustrates the importance of both research and individual perspectives and stories on this pervasive learning difficulty.

ADHD and self-regulation Barkley and others (e.g., Weyandt & Gudmundsdottir, 2014) make a very important case for the primary essence of ADHD not being attention only but, rather, a broader array of skills related to executive functioning and, ultimately, self-regulation. Executive functioning is related to controlling one’s behaviors, and the skills that comprise this control aspect are related to attention, speed, memory, planning, and inhibition. This broader conceptualization of executive functioning can be practically important. Many people who are relatively unfamiliar with ADHD, including me, have thought that this difficulty really implies that children cannot attend well. However, if you have ever spent time with those with ADHD, you know that this is only sometimes true. It may be more accurate to say that those with ADHD have special difficulties in deploying and controlling their attention. They actually have the ability to attend very well under certain circumstances but lack some of the resources to control their attention sufficiently. As Apecu98, a 24-year-old Swiss man with ADHD said in reference to his childhood, “I did not have attention problems while reading a book, watching a movie, or playing a video game.” Deploying one’s attention adequately requires multiple cognitive abilities. Perhaps even broader than the understanding of these cognitive abilities comprising attentional control, however, is the understanding that ADHD is most fundamentally a problem of self-regulation (Barkley, 2014a). With development, our executive functioning matures to allow us to engage in various self-regulation activities.These include curbing or stopping most of the difficulties previously mentioned as symptoms of ADHD, such as acting impulsively, failing to attend to what is going on around one, and making excessive movements including kicking the seat in front or wiggling around to the point that it is annoying to others. More broadly, Barkley (2014c) defines self-regulation as (p. 87) “1) any action one directs at oneself 2) in order to change subsequent behavior 3) so as to alter a distant or delayed consequence and thereby maximize those consequences.” This simple analysis describes the fundamental requirements of mastering schoolwork as well as fulfilling many other daily goals. Such self-regulation is incredibly difficult for the child with ADHD. Perhaps one of the best books on the subject of ADHD for parents and teachers who seek insights into how people with ADHD think is The Little Monster by

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Robert Jergen (2004), previously quoted above. The description of Jergen’s life makes for very important reading for those of us wishing to gain better understanding of the experience of ADHD. Jergen earned a Ph.D. in educational psychology and then later wrote this book about himself growing up with ADHD. In the book, he can evaluate the feelings and thoughts he had as a child with some distance, now through the lens of an adult with expertise on ADHD as an educational psychologist. At the same time, ADHD was and is a big part of his life, and he is good at communicating to the reader how it feels to be someone with this difficulty. Jergen did not appear to have difficulties such as dyslexia beyond ADHD, but, as is typical for every child with ADHD, his ADHD affected how his work in school progressed. For example, he notes on p. 50 of the book how having ADHD impacts his reading at times, even now, as an adult, saying, People with ADHD also have difficulty regulating their attention. For instance, there are times when I can’t read. I can say the words on the page, but I simply cannot put them all together so that they make sense. It isn’t that I am unmotivated. My level of motivation doesn’t matter.You could offer me a million dollars to read a paragraph and the same results would occur. I simply cannot focus on the words so that they make sense to me. He continues, Reading out loud in school was particularly frustrating for me. I could say the words, but I sounded as if I were retarded, had a speech impairment, or was from a non-English-speaking country. I would read as if there were a period after each word or as if the words were completely foreign. This reading difficulty seems to be a consequence of an immediate lack of selfregulation of some sort. We all feel unmotivated or unable to change our behaviors at some points, but with ADHD, this lack of self-regulation often looms very large. Indeed, it is often a hallmark of the learning difficulty.

ADHD and motivation: emotional control is key As highlighted thus far, manifestations of ADHD for those with the disorder are no doubt diverse in particulars, but one of the main commonalities for many with this difficulty is the on-going challenge of self-regulation. With regular challenges of self-regulation come special challenges of motivation. Barkley (2014c) laments the fact that, although there has been recognition that those with ADHD often lack motivation (for a review, see Luman, Oosterlaan, & Sergeant, 2005), this aspect of ADHD is rarely a focus of current diagnosis or exploration of the disorder. Why is there apparently some lack of motivation in children with ADHD? According to Barkley, this has everything to do with self-regulation related to the event, response, and outcome in a child’s life. For example, many children want to study hard (event)

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in order to ensure that they perform well on a particular exam in school (response) so as to evoke a particular more long-term consequence (outcome), such as getting an A on a report card. This sequence is not a common one in those with ADHD. Long-term consequence recognition is often not on their radar. Thus, motivation is in some senses impaired. An integral aspect of motivation is emotional control. In his chapter entitled “Emotion dysregulation is a core component of ADHD,” Barkley (2014c) makes a strong case for another primary aspect of ADHD being that of emotional impulsivity. He argues that (p. 88), “Those with ADHD will be as impulsive with their primary emotions as they are with their motor or behavioral responses because they are essentially a single unitary event: Action and emotion are united in the response.” Children with ADHD have been observed at times to be quick to frustration and anger.This is partly attributable to their difficulties in regulating the self. They have difficulties in soothing themselves. Sometimes these children also have particular trouble in reacting flexibly. For example, when a child with ADHD is expecting one situation, such as a playdate, and it is canceled because circumstances have changed, this child will sometimes react more strongly and negatively than children without ADHD. It often takes more effort to bring the self out of frustration with a series of self-calming steps for the child with ADHD than for others. This is often important because we need to deal with our negative emotions in order to accomplish future goals. However, those with ADHD operate most of their lives in the here and now and not in the future; they are notoriously bad with time and time management (Barkley, 2014a). This core difficulty in managing emotions is important to consider for both motivation and peer relations. If one can manage one’s emotions, this helps to strive toward future goals. In contrast, the inability to manage core emotions interferes with goal achievement. Those who work with ADHD children often observe them acting in ways that demonstrate very little emphasis on future strivings, and this ultimately explains the apparent lack of achievement in some with ADHD. In addition, another hallmark of ADHD in young children is difficulty in getting along with peers (Hoza, 2007). Hoza (2007) reviewed studies of primary school children and found that between 52% and 80% of those with ADHD experienced peer rejection, and some of this peer rejection was strong and long-lasting. Barkley (2014c), in reviewing several research studies, concludes that such peer rejection is typically a direct result of ADHD-related difficulties, including impulsivity, lack of cooperation, and negative emotionality in some of these children. Indeed, ADHD children seem not to differ from non-ADHD children on positive interactions, but they differ markedly from such children on negative ones. Barkley (2014c) further points out that difficulties in managing of emotions, which are relatively typical for ADHD children, are to be distinguished from mood disorders, which are not typical of children with ADHD. As he describes it, Emotions are of short duration, are provoked, and often are situation-specific to the setting of the provocation.They are also largely rational, which is to say

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understandable, to others given that typical people would have had the same subjective reaction to the provocation. (p. 106) He goes on to say, however, that most children when confronted with the same situation-specific problem typically self-soothe or find other ways to calm themselves down relatively quickly, with the benefit of more mature self-regulation techniques, ensuring that the frustration or other negative emotion is not overblown. For the child with ADHD, in contrast, the emotion appears to the outsider to be rather extreme because the self-regulation techniques are limited so that the emotional hijacking of the situation is not well contained. To summarize, the hallmarks of ADHD in children are inattention, hyperactivity, and impulsivity. Not all children diagnosed with ADHD will have all of these, but they will typically show at least inattention, or a combination of hyperactivity and impulsivity, or both. These characteristics must interfere with overall performance and are typically characterized as developmentally inappropriate in order for a person to be diagnosed with ADHD. This is a critical point, because the behaviors expected of a 5-, 7-, 9-, or 13-year-old will be different, given the great importance of maturation over time. Barkley (2012) gives his audiences a rough estimate of developmental delay in those with ADHD of approximately 30%. Thus, a parent or teacher of an ADHD child should assume that the child will act significantly younger than his or her chronological age by about 30% of the child’s current age. For example, a 7-year-old is likely to behave more similarly to a typically developing 5-year-old in various behaviors related to self-regulation. One of the best ways to understand ADHD as a general concept is probably the idea of self-regulation (Barkley, 2014a), a concept that involves many facets, such as planning, ordering, and accomplishing goals, as well as managing one’s self in a changing environment.Those with ADHD tend to have difficulties in self-regulating at the cognitive, behavioral, and emotional levels.

ADHD in adolescence and adulthood What happens when those with ADHD mature into adulthood? As with other learning and/or mental difficulties, ADHD can be more or less severe in different people. By definition, too, with development comes maturation of the brain. Thus, children with ADHD typically progress to become better and better at self-regulation as a function of brain development. At the same time, however, adults with ADHD still often have difficulties with many self-regulation tasks. One estimate is that between 30% and 60% of those who were diagnosed as having ADHD as children continue to have ADHD-linked difficulties into adulthood (ADHD, By the Number, 2018). Adolescents with ADHD as compared to their peers without ADHD tend to exhibit more risky behaviors overall. Adolescence is often a time for some experimentation and seeking a bit of distance from one’s parents in order to make one’s

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own way. For teenagers with ADHD, this experimentation may be particularly worrisome because it is, by definition, harder for them to control their impulses, their desires, and the peer pressure they experience. Substance abuse, whether it is alcohol or drugs, is one area of risky behaviors in which those with ADHD tend to have more difficulties than do those without ADHD (Patino, n.d.). On a related note, those with ADHD are about twice as likely to smoke than are their nonADHD peers (Four Things People with ADHD Should Know About Smoking, 2015). Unfortunately, nicotine in cigarettes has an immediate effect on the brain to reduce anxiety and promote feelings of calm and control. Because those with ADHD can often feel more anxious than those without ADHD both because of the genetics of ADHD in relation to emotions and moods and also because ADHD itself causes learning and social difficulties that promote stress, this is understandable. Other substances, such as alcohol and various recreational drugs, also serve to promote good feelings in the brain. Unfortunately, these are temporary and create additional difficulties long term. Thus, anyone with ADHD should be particularly careful to avoid or limit all of these substances for longer term health, especially because those with ADHD have more difficulties with addiction and have particular difficulties in trying to quit (Sherman, 2018). A second feature of adolescents with ADHD is some propensity for risky sexual behavior. Compared to those without the learning difficulty, those with ADHD are more likely to report having had more partners as well as more casual sexual partners, to have used a condom less frequently, to have contracted a sexually transmitted disease, and to have experienced an unplanned pregnancy (e.g., Flory, Molina, Pelham, Gnagy, & Smith, 2007). Such risky sexual behavior is again a result of difficulties in self-regulation. Protection for one’s self during sexual activity requires planning and forethought, skills that adolescents with ADHD have specific difficulties in (e.g., Isaksson, Stickley, Koposov, & Ruchkin, 2018). A third risky behavior that often arises in adolescents with ADHD is risky driving. Driving is an important area to mention on its own because it is so linked to safety concerns. Attitude, a website devoted to helping everyone to understand ADHD (ADHD, By the Numbers, 2018: www.additudemag.com/the-statistics-ofadhd/), notes that compared to those without ADHD, those with ADHD are five times more likely to engage in speeding and are more likely to experience a serious car crash and even to die early. This has been something that has been particularly personally meaningful to Professor Russell Barkley, whose own brother died in a car crash; the brother’s ADHD contributed to this death since he was prone to speeding and also to not wearing a seat belt (Barkley, 2017a). In fact, this death occurred in a 56-year-old man, and Barkley notes that older age can also contribute to automobile crashes in adults. Yet adolescence is the time when driving begins and when inexperience can also contribute. Indeed, adolescents are generally more prone to risky driving than older adults (e.g., Bina, Graziano, & Bonino, 2006), and adolescents with ADHD are among the riskiest drivers overall. Many of these risky behaviors tend to cluster together. For example, alcohol or drugs tend to impair any individual’s judgment. Thus, someone who has taken

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drugs or had too much to drink may be at increased risk for unprotected sex or risky driving anyway. Having ADHD simply adds another layer to that situation. Adolescence is a critical time for onset of these particular behaviors given the availability of access to mind-altering substances, sexual partners, and vehicles at that period in development.Yet these risky behaviors can continue through adulthood. Among the most prominent general ADHD-related difficulties in adulthood are time management, organization, and concentration difficulties. Frustration and anger management are also relatively common. Those with ADHD are additionally more at-risk for anxiety or depression (ADHD, By the Numbers, 2018). Apart from these general difficulties, adults with ADHD generally have more disadvantages than do those without ADHD as well. For example, they tend to have had more difficulties in school, including having been held back a grade level because of poor grades, having attained poorer grades, and having been less likely to have graduated from high school or university (Barkley, 2014a). Even if they have not been diagnosed with dyslexia, adults with ADHD also tend to have more difficulties with the classics of reading, writing (i.e., spelling), and arithmetic (for a review, see Barkley, 2014b). There are other difficulties that adults with ADHD experience as well. Because ADHD implies relatively broad-ranging self-regulation difficulties, the range of potential difficulties that such adults experience is relatively wide. For example, compared to those without this disorder, those with ADHD are more likely to be fired or to quit their jobs, to report relationship difficulties with their romantic partners (Barkley, 2014b), and to experience financial problems such as failing to save for retirement, having a poor credit rating, or declaring bankruptcy (Barkley, Murphy, & Fischer, 2008). It is clear from the review above that ADHD is a serious difficulty that requires commitment and optimism for its management. In Chapter 9, we talk more concretely about the many ways in which teachers, parents, and other caregivers can help those with ADHD, as well as how those with ADHD can help themselves. Before we focus on suggested interventions and practical hints, though, we need to know something about what causes this difficulty in the first place.

What causes ADHD? Like dyslexia, there seems to be a substantial genetic component to this difficulty. For example, a parent with ADHD had a 57% chance of having an offspring with the disorder in one study (Biederamn et al., 1995). Twin studies find that the heritability of ADHD is between 70% and 80% (Faraone et al., 2015) As with dyslexia, there are a number of so-called “candidate genes,” related to ADHD. Recall that candidate genes are those which researchers think have a particular link to the condition or most prominent characteristics of ADHD. In general, it seems as though ADHD is likely to be the result of several genes working in concert (Faraone et al., 2015), and there is still debate about which genes are most important for ADHD and indeed even how important certain genetic characteristics are across different

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ethnicities for ADHD (e.g., Leung et al., 2017). Yet one thing is particularly clear from the extensive research establishing a strong genetic component to ADHD: The genetics of the disorder are strong and indisputable. Such a conclusion should be welcome news for parents who so often worry about their parenting skills vis-à-vis ADHD. In fact, based on the extensive research on genetic correlates of ADHD, researchers have determined that only about 5% or fewer of the characteristics of those with ADHD are attributable to any environmental aspects of the family. This is particularly important because parents often feel guilty about what they have done or what they could have done to have a child with ADHD. The truth is that parents have almost no influence on the manifestation of this disorder. For example, the correlation between adoptive parents and their children vis-à-vis ADHD is 0. There is apparently no effect at all of the ­adoptive parents on their children’s behaviors. Researchers and the general public did, in the past, tend to blame parents sometimes for some of the problematic behaviors exhibited by ADHD children. Subsequent studies have determined that parenting is not a cause of ADHD (Barkley, 2012; Barkley, 2014a). It should be noted, however (as elaborated in Chapter 9), that although parents’ behaviors do not cause ADHD, their adherence to behavioral interventions for ADHD children can be very helpful in making life happier and more pleasant for parents, teachers, and children with ADHD. Moreover, some caregivers’ reactions to having a child with ADHD can conceivably exacerbate problematic behaviors on the part of the child with ADHD. Thus, exploring behavioral interventions by families for ADHD children is consistently advocated as one avenue for parents to explore (Barkley, 2014a; Faraone et al., 2015). Although many of the causal explanations for ADHD center on genetics, there are also some environmental correlates of this difficulty. Some of them focus on the in utero environments of the children. For example, children with low birth weights appear to have some increased risk for ADHD later in development. In addition, maternal drinking of alcohol and smoking have both been linked to an increased incidence of ADHD in children. In early childhood, those children who experience streptococcal infections (yes, strep throat!) or traumatic brain injury also are at higher risk for ADHD in later childhood.There is much less evidence for any other environmental causes to date. In particular, despite strong attention to television and video games as possible causal mechanisms for ADHD, there is no strong evidence for this association. Rather, it is perhaps more likely that those with ADHD are particularly drawn to television and video games, perhaps because they find these especially rewarding (Barkley, 2014a). Thus, although societies are increasingly worried about media exposure for their children, and rightly so given the negative effects of television, video games, and internet exposure for overall health and academic achievement (Impact of media use on children and youth, 2003), there is no clear evidence that ADHD is caused by media exposure. Indeed, there is no clear evidence that any environmental intervention, such as parenting, media exposure, or diet, has much to do with the development of ADHD. This appears to be a disorder that

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is strongly linked to neurodevelopmental factors with relatively minimal environmental impact. Barkley (2016) further notes that ADHD can be caused by an interaction of genes and environmental risk factors. For example, a woman with a few genes for ADHD who also smokes during pregnancy will be more likely to have a baby with ADHD than would one who either has the same genes and does not smoke or who does not have the genes but smokes. Barkley’s estimate is that this combination makes the manifestation of ADHD in the child about 2 to 3 times more likely. Ultimately, he calculates that approximately 60–70% of ADHD is caused by genetic factors, 20–25% from environmental factors that occur in utero (i.e., during the mother’s pregnancy), and 5–20% from brain injuries after birth.

ADHD and the brain With these explanations for ADHD that highlight the primary importance of genetics, and given some understanding of the additional risk of prenatal environmental factors, we turn now to another ostensible cause of ADHD, which is brain development itself. This is of interest for many reasons, not the least of which is the fact that ADHD is identified by professionals most of the time based on children’s executive functioning difficulties, and all of these are primary cognitive abilities.Verbal and visual memory, speed, and attention, as well as an integration among these, constitute most of the executive functioning abilities. The global aspects of brain functioning that stand out as most prominent vis-à-vis ADHD are total gray and white matter, the cerebral cortex, and the prefrontal cortex in particular. For reviews of these in more detail, please refer to Barkley (2014a) and Faraone et al. (2015). One important finding focuses on overall total brain size, which is slightly (by 3–5%) smaller in those with ADHD (Castellanos et al., 2002; Durston et al., 2004). Such findings have been linked to executive functioning and motor planning aspects of functioning (Barkley, 2014a). Also related to such abilities are the prefrontal areas of the cortex. Shaw et al. (2007) showed that those with ADHD (maximum cortical thickness achieved around age 10.5) tend to be on average about 3 years behind in cortical maturation as compared to those without ADHD (maximum cortical thickness achieved around age 7.5). Moreover, even into adulthood, those with ADHD tend to have some abnormalities related to cortical thickness (for a review, see Faraone et al., 2015). Barkley (2014d) also notes that most research identifies the frontal-striatal-cerebellar areas of the brain as crucial in affecting ADHD. Areas of the prefrontal cortex, including the dorsolateral, ventromedial, and medial prefrontal cortex, among other areas, have been linked to ADHD, and these areas are associated with working memory, decision-making, planning, and overall executive functioning. The frontal cortex, which is associated with promoting alertness and planning, is also implicated in ADHD. Neurological testing has indicated abnormal activation in some of these regions, particularly under-activation.

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Admittedly, this is a short summary of a complicated and large set of studies. Self-regulation involves a broad array of individual abilities, as well as the coordination of such abilities. The research on ADHD and the brain reflects this complexity. Indeed, researchers (e.g., Makris, Biederman, Monuteaux, & Seidman, 2009) focused on the neuroanatomy of ADHD have identified at least four different aspects of ADHD that are controlled by different parts of the brain. One accounts for some of the hyperactivity of ADHD, another is related to attention and planning, a third relates to inhibition, and a fourth focuses on emotional regulation (Barkley, 2014c). The effects of stimulants, one group of medications used to help to promote activity in those areas of the brain that are underactive in children with ADHD, are to help to “normalize” the brains of these children. That is, over time, brain development among children with ADHD who take stimulants tends to look more similar to children without ADHD than to those who have ADHD and are on no medications. Barkley (2014a) notes that these results have been demonstrated across at least 29 different studies, and underscores that this result has been robust and should be very heartening for families who worry about the effects of medication long term on those with ADHD. These results have particularly been noted for the common class of ADHD drugs known as stimulants. Although drugs that are not stimulants have not been studied in the same way vis-à-vis ADHD, given their somewhat similar effects on brain regions, they may have similar effects on the brain; future research will examine this further. Faraone et al. (2015) reviewed various medications and showed that they are typically helpful long term for those with ADHD and their families. In Chapter 9, we consider the ambivalence of caregivers vis-à-vis ADHD medications again.This is a tough issue for families. Clearly, those with ADHD should work closely together with professionals to ensure that the medicine they use fits them well in terms of possible side effects. Moreover, few responsible professionals would ever advocate administering medicine for those with ADHD in the absence of other behavioral interventions. My reading of the current research is that there are a lot of ideas to try in an effort to help those with ADHD. Interventions can begin early, and early interventions often promise better outcomes. As researchers and practitioners work together to understand ADHD better, there is more hope for those touched by ADHD around the world. Given this brief review of what ADHD is, we now turn to another important aspect of living with learning disabilities, namely, the co-occurrence of more than one.

5 COMORBIDITY Having more than one learning or mental health difficulty

Comorbidity, or co-occurrence, across learning difficulties is relatively common. As mentioned in Chapter 4, at least 25% of those with ADHD have dyslexia as well, and of those with dyslexia, 25–40% also have ADHD. About 25% of those with dyslexia also have dyscalculia, a specific mathematics difficulty (e.g., Saltz, 2017). Recent investigations have consistently demonstrated substantial overlap in different cultural contexts (e.g., Landerl & Moll, 2010; Moll et al., 2014). The more learning difficulties one suffers, the harder a time in school one has. This issue of comorbidity is important because learning does not take place in a vacuum. The whole person has a variety of strengths and weaknesses, in areas including cognitive abilities, emotional vulnerabilities and skills, physical challenges and abilities, and motivational approaches to life. I focused the book on dyslexia in addition to dysgraphia and ADHD because such learning difficulties often go together. Other challenges even beyond learning to the mental health realm can also be present in those with learning difficulties as well. What is it like to have dyslexia, ADHD, and dysgraphia, either two in combination or all three together? What about additional challenges such as anxiety or depression, difficulties that may be magnified by family or school experiences focused on learning failures? This is an important issue for caregivers and those with learning difficulties to confront, keeping the whole person in mind.

The importance of understanding comorbidity The comorbidity of difficulties is a crucial topic to consider given the high stakes of such conditions. Children with more than one learning difficulty appear to be at more risk for being held back at school, for general academic problems, for some social difficulties, for problems at work, and even for being arrested (Willcutt, Pennington, Olson, & DeFries, 2007). It is also important to acknowledge that there

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are additional types of comorbidity that are beyond the scope of this book but that must be understood. For example, the learning difficulties of ADHD or dyslexia do sometimes co-occur with difficulties such as autism, anxiety, depression, or others (e.g., Saltz, 2017). Indeed, as summarized by Saltz (2017), “we are becoming increasingly aware that brain differences and the symptoms associated with them are not discrete. Many, if not all, of us fall into multiple categories of brain differences” (p. 10). Minor brain differences are not of particular note in relation to learning difficulties. However, multiple differences in learning that create even greater struggles for the child who attends school anywhere in the world should be clearly acknowledged. Researchers agree that it is important to recognize comorbidity for at least four reasons (Pennington, Willcutt, & Rhee, 2005). First, for those with more than one learning difficulty, different treatments might be suggested than for those with only a single difficulty. For example, for a person with dyslexia alone, the treatment will likely focus on optimal practices for fluent and accurate word recognition. However, for a person with both dyslexia and ADHD, the treatment will focus not only on fluent and accurate word recognition training but also general strategies for staying on track during study time. It is additionally possible that such an individual would consider medication to help with attention difficulties in certain cases (for a consideration of this, pro and con, please see Chapter 9). If ADHD is comorbid with a severe case of depression or anxiety and medication is considered for the ADHD, the issue of medication for the depression or anxiety should also be taken into account in light of the ADHD medication. I do not want to say too much about different types of medication since this is not a central focus of this book, but one can easily understand how having several difficulties at once, either learning- or mood/emotion-related or both, is a different experience than having a single difficulty. Pennington et al. (2005) also highlight the fact that in cases in which the comorbidity of different difficulties is ignored, one might attribute one characteristic of the individual’s performance to a particular disorder and not understand that it is in fact associated with the other disorder instead. For example, being easily distractible and sometimes interrupting others is common among those with ADHD; it has nothing to do with dyslexia. It would be a mistake to consider distractibility to be a characteristic of dyslexia. Likewise, it is possible to have dysgraphia but not to be dyslexic. Many people confuse these two difficulties, but they are distinct. From informal discussions of researchers who grew up in Jamaica, the Philippines, and Zambia, I have the impression that sometimes teachers and parents make similar mistakes in attribution or understanding. In these and other locations, there is sometimes the idea that those who have dyslexia also have ADHD; these particular children with both difficulties are easily recognized in the classroom because they are disruptive. At the same time, children with reading difficulties only are less likely to be noticed as having any special difficulties. Here, a lack of understanding of comorbidity probably results in many of those with dyslexia not being recognized, because they are attentive but perform poorly in word recognition only.

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A third, related reason that Pennington et al. (2005) give for focusing on comorbidity is that “comorbidity is a threat to the validity of diagnostic constructs” (p. 265). Again, a comparison between ADHD and dyslexia is applicable here.There are many who have ADHD who read at or above grade level. If a child is distractible to the point that ADHD is considered but also appears to be extremely slow, labored, and frustrated when reading words, this characteristic of slow reading should be analyzed separately from ADHD. Labored word reading is not a characteristic of ADHD. It is important to distinguish ADHD from dyslexia, although the two syndromes do overlap in a large minority of cases. Distinguishing the different learning difficulties allows parents, teachers, and scientists to understand the characteristics of each separately. Once we understand these individually, we can consider various methods for remediation, focusing on the central aspects of each. Thus, the fourth reason given by Pennington et al. (2005) for acknowledging and understanding comorbidity is that once each learning difficulty is clearly distinguished and understood on its own, it then becomes possible to examine the development of each one individually. Looking at such development and underlying causes and correlates (e.g., genetic or neuro (brain pattern) associations) may help all of us to understand how better to identify early and treat each one.

A case study of comorbidity: Ms. Amy Now that we understand what comorbidity is and why it is essential to recognize and acknowledge it, we turn to the case of Ms. Amy, a 30-year-old American who earned a Master’s degree in French and now works in a large international company as a translator. Ms. Amy’s case is inspiring on many levels, but we highlight her here because she suffers from several distinct learning difficulties. She has dyslexia, ADHD, and dysgraphia. She additionally has dyscalculia, a severe mathematics learning disability, which is also relatively common among those with dyslexia and is mentioned later in the chapter. Finally, Ms. Amy has had bouts of anxiety at different periods in her life. Overall, Ms. Amy has faced many challenges related to learning difficulties. In addition, she grew up in a low-income family and experienced housing and food insecurity for much of her childhood. I was so impressed talking with this very bright, composed young woman, and I asked her how she managed, with both a disadvantaged home background and all of these learning difficulties together, to go all the way through university and earn a Master’s degree in French. She said, coming from a low-income family in a poor school district, in the U.S., “You’re told that the only way to not be low income is to get into college.” Her desires to climb out of poverty seemed to have overwhelmed everything else, and college admission became her aim early. Before that, a somewhat chance occurrence at age 16 dictated her subsequent major in university: Having been bullied in the lower income public school she attended and knowing that she would be placed in a specific program for students with learning disabilities as she continued after primary school, Ms. Amy sought out a new (charter) school for high school, and in this school, she befriended some exchange

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students from Europe.These students referred her to a program they were in where she discovered she could also apply to live and go to school in France for a year. She applied, was rejected, applied again, was wait-listed, and finally got the opportunity to go. When she arrived, she ultimately spent time with three different host families. The third was a family that spoke no English, and Ms. Amy finally had to apply herself to learning the language in order to get basic ideas across such as “I am full. Please stop feeding me.” Her strategy was to write down her basic requests and commands in English, ask students at the French school she attended for a translation, and memorize the translations. Her hard work paid off and she ultimately mastered the language. Ms. Amy describes herself as very high in grit, defined by Duckworth, Peterson, Matthews, and Kelly (2007) as “perseverance and passion for long-term goals.” She displayed this trait again and again at school and continues in this spirit today. She notes that in graduate school, she was told that they would never admit anyone with a learning disability, because it was assumed that a person with a learning disability could not complete the program. She decided they were wrong and did so despite this and many previous years of negativity from others. How did she do it? With a myriad of research to help her understand herself and her learning. Her advice to others with learning disabilities is the following: “Don’t keep doing what you’re doing if it’s not working. If you just keep looking, you’ll find something that helps you.” She sourced many materials for information on how to deal with her learning difficulties and other accompanying problems such as frustration and sadness. For example, she invested in software that helped her to read materials online by orally pronouncing any unknown words. She experimented with lighting and materials such as colored paper to figure out what facilitated her reading. Some things worked, and some things did not. For example, she is careful to brightly light her keyboard and keep the lights in the rest of the room relatively dim so as to keep herself focused on her work. However, the colored paper did not help her to read better, so she discarded it. She made alterations to her diet, especially avoidance of foods with high sugar, food dyes, or casein (a protein in milk), that made her feel better. She sought out a counselor twice per week during university to help her manage her difficult emotions. Basically, she experimented with many methods to figure out what worked best for her in the learning process and gradually her performance improved. After graduate school and a brief stint in teaching, she landed a good job in translation where her main duty is to translate from French to English. Grateful for her life now, she says that she is “still slightly terrified because I write for a living.” Interestingly, she does not worry about being potentially “discovered” as ADHD when people joke about anyone in the office being slightly ADHD. She thinks that this label is quite common in various circles now and can come with positive as well as negative connotations (like getting things done quickly or multitasking). However, the dyslexia and the dysgraphia components she perceives as completely negative. She still constantly fears being “out-ed” as dyslexic, which she envisages as making an entirely negative impression on her colleagues. Her

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concerns that colleagues will perceive dyslexia negatively are unfortunately well founded. A review of the research on work participation in adults with dyslexia (de Beer, Engels, Heerkens, & van der Klink, 2014) found that those with developmental dyslexia and their employers tended to view dyslexia relatively negatively in the work place; many adults with dyslexia worry about acquiring or keeping their jobs given their difficulties. How, then, does Amy cope? The first thing to note is that she acknowledges that her life with learning difficulties is still not easy.While the ADHD appears to be less troublesome vis-à-vis her work, she admits “It’s tough. It can still cause troubles in my marriage.” She sometimes appears not to be paying attention during serious talks with her spouse, and this can be frustrating, for both of them. At work, her biggest fear is writing. She refuses to write anything in front of people. She brings a computer to all meetings (no hand-written note-taking ever) and when she needs to review notes with others, she always brings a typed copy. It is simply too nerve-wracking to write in front of others. She also has, on occasion, made cards for herself with difficult to read or write words that she hides in her pockets and refers to at work when needed. For words that are particularly difficult to spell/type, she practices them over and over again on the keyboard using what she calls “muscle memory.” She writes them not by referring to her image of an orthographic pattern or by making use of phonological skills, but by knowing how it feels in her fingers to type them.Yet she clearly excels in her job, receiving praise from others particularly for how excellent her second language skills are. Indeed, she exercises them often, perhaps even compared to other translators.This is because she is reluctant to email others unless she has to. She prefers to seek out her colleagues in person and talk through difficulties rather than to communicate in writing. What comes through in her situation is both her incredibly well-honed, professional skills and tenacity and, at the same time, her continuing fear of being discovered as a “fraud.” She once made an error in a translation, writing one homophone when she meant another (e.g., similar to confusing sight for site) and felt “devastated” by the mistake for six months. Her concerns that colleagues will perceive her dyslexia negatively seem a bit out of proportion given her many successes, but they clearly occupy a lot of thoughts to this day. I have taken pains to paint a picture of Ms. Amy because she is both a wonderful example of a person excelling in life despite having several co-occurring learning difficulties and a real-life example of some of the daily struggles that having multiple learning difficulties pose. Not surprisingly, Ms. Amy has further suffered from anxiety for some of her life. Galuschka and Schulte-Körne (2016) estimate that for those with reading and spelling disabilities, the rate of those with an anxiety disorder as compared to the general population of children is quadrupled at 20%, the rate of depression is at 14.5%, the chances of having dyscalculia are between 20% and 40%, and the rate of some sort of social phobia is sixfold over children with no learning difficulties. Neil Alexander-Passe (2015) actually wrote a book entitled Dyslexia and Mental Health to sort through some of the emotional turmoil that those with reading and writing disabilities face and how to cope better with psychological pain. Such difficulties are likely to be a complex combination

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of risk factors and the often-tortured situation of school for those with learning difficulties. Although we cannot talk about all difficulties that can co-occur with dyslexia, I have decided to highlight three that are notable for their frequency in a minority of those with dyslexia. One is a common learning difficulty and two are psychological difficulties that can be debilitating in their own rights for children, adolescents, and adults. Facing any of these along with dyslexia represents a distinct challenge. Below, I discuss the nature of dyscalculia briefly and then mention anxiety and depression, two psychological difficulties that are not uncommon in those with learning difficulties.

Dyscalculia Dyscalculia is a particular difficulty with mathematical concepts and operations. Research on this disorder has had a comparatively short history, and, on the surface, this learning difficulty appears to be quite separate from those of dyslexia and dysgraphia. However, a relatively large minority of children with dyslexia also have somewhat extreme difficulties with mathematics. What seems particularly striking about children with dyscalculia is that even their most fundamental concepts about mathematics appear to be impaired. For example, they have difficulty counting from 1 to 10 or 1 to 20 long after it is developmentally normative to have mastered this. Also, they seem to have trouble looking at even small quantities presented visually (e.g., a picture of five buttons or seven cookies) and saying how many items there are. It is often easy for us to look at something and agree that there are three peaches or four spinning tops, for example, but for these children, this very simple type of numerical connection is effortful and sometimes error-prone. One of the central abilities that seems to be problematic in those with dyscalculia, then, is working memory. It is difficult for these children to make good use of their memory capacity. Menon (2016) makes a strong case for a particular impairment in visuospatial memory as a causal factor for children’s dyscalculia. Geary (2013) highlights the importance of three cognitive abilities for early mathematics that might be somewhat impaired in those with dyscalculia. These are approximate number sense, ability to map arbitrary symbols (e.g., the word seven or the symbol 7) onto the understanding of what this represents (in this case, a concrete understanding of what 7 pieces of something would look like), and the ability to make use of logic to build understandings of the associations among numbers. For example, can a child understand that 2 x 7 means that you have two sets of seven items, for a total of 14 (or, conversely, seven sets of two items)? Geary highlights the importance of attentional control for the ability to manage these associations. Wong, Ho, and Tang (2017) found that children who were diagnosed with dyscalculia in Hong Kong had particularly poor number sense compared to other children, including a group of more broadly low-achieving children. Thus, the nature of dyscalculia and the particularly striking lack of early number sense appear similar cross-culturally.

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An editorial in Trends in Neuroscience and Education (Szűcs & Goswami, 2013) highlights the fact that there is at least a moderate genetic component to dyscalculia, so that when one twin has the disorder, the other is likely to have it as well. However, there is very little research in this area. Some environmental factors, such as family or school environment may play a role as well. Moreover, there is no standard definition of dyscalculia as of yet. Because this area is so new, there are also relatively few interventions that have been used to help children’s learning, though a few computer-based and regular board games have been found to facilitate mathematics learning, both with typically developing children and with children with dyscalculia (for a review, see Wong et al., 2017). As with dyslexia and dysgraphia, there is no medicine or quick and easy treatment that will help to ameliorate the problems of dyscalculia. Rather, the keys to managing this disorder involve using a combination of work-through and work-around strategies. Work-through strategies focus on improving those skills that are most impaired in the person with dyscalculia. For example, a child who cannot easily learn to associate the symbol of 5 with five different objects will need help in reinforcing the correspondence between the label and its meaning over and over again. This is boring for a parent, teacher, or tutor to do, and there are several computer games that can help to target fundamental mathematical skills and to reward children for focusing on them via their various game formats. A key to dyscalculia is practicing the skill over and over again.Whatever way in which this can be accomplished such that the child will stick with it is the ideal choice. Work-around strategies focus on how to get the child to participate in meaningful mathematical endeavors with the help of some aids. Probably the best example of such an aid is the calculator. Experts recommend allowing children with dyscalculia to use the calculator in all of their higher-level mathematics work. In addition, whatever else will help the child with mathematics processing, including multimedia (e.g., text-to-speech) aids can also be useful. Those with dysgraphia sometimes confuse symbols or align them incorrectly, and such simple mistakes will cause endless heartache. For higher-level problems, such as those involving, for example, story problems involving algebra, a focus on the conceptual aspects of the problem should be made with the calculations being less of a focus. As is the case for those with dyslexia, children with dyscalculia are all individuals with varying needs, strengths, and weaknesses. What works for one of these children may not work the same for another, so one key is to explore a variety of aids and techniques and see what works. One helpful website with advice to parents and those with dyscalculia is www.dyscalculia.org/dyscalculia. Given that this is currently a “hot topic” in research, there should be a variety of services and ideas that are available to children with this disorder, and for their parents and teachers, in the coming years. For now, a rule of thumb should be that parents, teachers, and students themselves agree to spend time working on the difficulties themselves via homework at an appropriate level in addition to games and also to find ways for the students to continue with their work in concepts of mathematics with aids to help them along the way.

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Anxiety disorders Apart from dyscalculia, ADHD, and dysgraphia, children with dyslexia often additionally have anxiety disorders. One blog, www.beatingdyslexia.com/, attributes anxiety specifically to having to read in front of the class as someone with dyslexia. The over-arching characteristic of anxiety disorders is excessive worry. Although all of us worry, when worrying becomes all-consuming and interferes with the child’s normal daily activities, this may be considered an anxiety disorder depending upon how long it lasts. Children who seem unable to relax or concentrate and seem to be perfectionistic or to focus excessively on feeling unsafe might be experiencing an anxiety disorder. Some of the physical symptoms of this include trouble sleeping, tiredness, and sweating or heart palpitations (e.g., Anxiety disorders Symptoms & Causes, n.d.). Many children with anxiety disorders seek to avoid school, and those with dyslexia are likely to have particularly strong desires to do so. For them, school often represents a place to be “tortured” (Alexander-Passe, 2015) and constantly embarrassed because of the difficulties they have with seemingly easy tasks such as in-class reading. Hurley (2018) recommends several techniques parents can encourage their children to make use of for social anxiety, and presumably these should work with a variety of anxiety disorders. She breaks them down into relaxation techniques, help in changing thought patterns via cognitive reframing, guidance in working through problems, and practicing friendship skills. All of these methods are different ways to give the child some tools to use to combat anxiety. Moderate anxiety is part of life, and it is important not to focus on helping children to avoid anxiety completely by avoiding tough situations, but rather to focus on helping children to work through their anxiety with tools that they learn. We first consider relaxation and cognitive reframing. Relaxation techniques might involve slow, focused breathing or meditation. Such techniques can be practiced and perfected and are good for everyone. These are simple to learn via many online resources. Cognitive reframing is a second tool that parents can help to teach. Changing one’s thought patterns is an important goal of cognitive behavioral therapy (CBT), which is frequently used by clinical psychologists as well. The idea here is that people sometimes get overwhelmed by their own thoughts which are just that – thoughts. They are often distortions of reality and sometimes involve extreme negative thinking. In the case of a person with dyslexia, negative thinking might center around themes of “never” being able to learn to read or write or being “stupid” or disliked for one’s difficulties. The more we have these thoughts, the worse we perform because the thoughts themselves can interfere further with our clear and directed mastery of tasks. CBT techniques teach children to challenge their thinking and help them not to be extreme in this thinking. For example, after performing poorly on a dictation task, instead of jumping all the way to thinking she is stupid, a girl with dyslexia might learn, with help from parents, to tell herself that she has done well in terms of effort in preparing the test but that this task of dictation is the most difficult one for those with dyslexia to master. She might

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also remind herself that there are several things she is good at, including telling stories, singing, and swimming. These talents are additional evidence that she is not “stupid,” and she should abandon this thought about stupidity as a global, allencompassing negative self-evaluation. Furthermore, perhaps her chosen method of preparation for this test did not work well. This implies that she should search for another, better alternative way to study next time. The other two techniques focus on problem-solving and learning of new skills. Problem-solving is about how to make life easier. In the case of a child with dyslexia, many of these problems will be associated with anxiety about school learning, either alone or with peers. For example, Ms. Amy, described earlier in this chapter, fears that her peers will see how poorly she writes and spells and think badly of her as a result. To deal with this anxiety, Ms. Amy uses a computer to write. This computer can help with spellcheck and also enables her not to have to worry about poor handwriting. And remember, she is already an adult in her 30s! For young children with dyslexia, some problems might be overcome by using special paper with larger lines or margins or by having access to any number of tools to refer to for help with writing. A child with dyslexia who is asked to write an in-class essay, for example, may feel more secure if he is given a list of words he wishes to use in the essay ahead of time so he can copy these and ensure that his spelling of them is more precise than it would be if he had to produce these spellings in the absence of the model correct spelling. Finally, for some with anxiety disorders, a special type of problem-solving involves how to get along well with friends. Although there is no reason to believe that friendship skills are lacking in any way for those with dyslexia, it is true that some children with ADHD can have specific difficulties that interfere with friendship building, and there is some overlap between dyslexia and ADHD. Friendship skills will focus on abilities such as turn-taking and initiating a social interaction.

Depression Depression is another well-known difficulty associated with dyslexia. It is not as easy or common to talk about the concept of depression in children as for adolescents or adults, but it is recognized as a phenomenon that affects a minority of those with dyslexia (e.g., Galuschka & Schulte-Körne, 2016). Depression involves prolonged feelings of sadness, irritability, or hopelessness. Although it is normal and healthy to experience sadness from time to time, depression is marked by a long period of time, somewhat arbitrarily defined by professionals as two weeks or more, with this feeling. Children with depression often express negative feelings about themselves and about their future, unable to imagine happier times ahead. Other symptoms of depression can include a loss of interest in activities that previously were considered to be fun, inability to concentrate, difficulties in sleeping or eating, loss of energy, being generally clingy or crying excessively, psychosomatic complaints (e.g., headache or stomach ache with no clear physical reason), and problems with making even very simple decisions (Shiel, 2017). The American

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Psychiatric Association (What Is Depression? 2017) attributes the causes of depression to an interaction among the four characteristics of biochemistry in the brain, genetics (depression runs in families), personality of the individual, and environment. One can imagine that with the difficulties that dyslexia brings with it, a person who is already relatively pessimistic or easily stressed out could be more susceptible to depression in the same environment as compared to someone who is relatively optimistic and focused.Twenge (2015) noted that symptoms of depression and feeling overwhelmed have increased in everyone over the past few decades, and it is likely that aspects of modern society, including an emphasis on schoolwork, competition, and getting ahead, may contribute to this (e.g., Schrobsdorff, 2016). Treatments for depression can be similar in the use of cognitive behavioral therapy to those for anxiety disorders, especially in mild cases. It is also critical that the child with depression feel supported socially by family and friends. Support groups or therapies that focus on the child being able to share his or her feelings with others can help. In addition and in more severe cases, many doctors recommend using some sort of an antidepressant medication. Some worry about the adverse effects of medications on children and adolescents who are depressed, but it should also be noted that a consideration of drugs to treat this condition only occurs when a child or adolescent has clearly already suffered substantially from it. Thus, parents, doctors, children themselves, and other supporters must weigh the potential negative side effects of such medicine against the potential benefits. One clear review of this can be found on the Mayo Clinic website (Antidepressants for children and teens, 2016). It is true that in many cases, an antidepressant can be helpful for those suffering from depression. Most experts agree, however, that particularly for children and adolescents who suffer depression, drugs alone are not sufficient for treatment. Rather, medication in combination with some types of therapy or other behavioral interventions are most important for optimal outcomes for those suffering from depression, particularly young people. Because depression is likely a combination of the biology of the individual and the environment, this is imperative. Specifically, when we consider children with dyslexia and the potentially soul-crushing difficulties of school when teachers or peers do not seem to understand them, we can well imagine how depression might develop as a complex interaction between the children and their environment. To solve this difficulty, the whole child perspective is important. Therapy making use of social support, including family and peers, and perhaps also focusing on promoting problem-solving, optimistic thinking and getting rid of pessimistic thinking is most important. One personal account of life with dyslexia and depression published in the popular magazine Psychology Today by Carlton Davis (2011), who has dyslexia, makes clear how fundamental the interaction between the person, including his or her biochemistry and personality, which are heavily dependent upon genetics, and environment are. In this article, entitled “Crazy making dyslexia,” Davis, an artist, architect, writer, and public speaker, describes an incident he had as an undergraduate at Yale University, in which he repeatedly mistyped the word the as hte on a typewriter, in the days before computers, for a paper that was due imminently. As he

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attempted to correct each further mistake with more and more whiteout (a glue-y substance used to paint over mistakes for those of you too young to remember), the page and the typewriter itself became gooey messes. His frustration grew, and ultimately, he threw the typewriter out of his window, five stories above the ground. The problem of dyslexia is made slightly easier in the present day as opposed to the college days for Davis because of spell checks on his computer. Importantly, Davis suffers from depression, specifically bipolar depression, and he has written a book on this topic. His own personal take on how dyslexia and depression are related is unique, but it is worth considering this quote on the issue given our topic of comorbidity for those with dyslexia. He says, in part: A person can have mental illness without dyslexia, but I would be surprised to see if there were persons with dyslexia who didn’t show some aspect of mental illness. Although I hate that word illness because I don’t see mental conditions through a medical model, it is the term used until we find a better way of describing depression, bipolar disorder and schizophrenia. Dyslexia may breed mental illness when the frustration of the disability becomes so great that another biochemical reaction takes place creating mental illness. My dyslexia must have some relationship to my bipolar disorder because dyslexia drives me crazy. After a particularly frustrating session of typing on my computer where the cursor flies all over the place because I hit a key I didn’t want and I do it again and again, my brain melts down. I have to exert every capacity for self control not to hurl the damned machine out my window. Even though I don’t do it, I think about killing myself. I think I am a stupid and inadequate person.Who would want to live with this terrible but hidden disability? (Davis, 2011) There is no evidence whatsoever for the idea that dyslexia “causes” mental illness, but it is clear how frustrations related to the difficulty can chip away at an individual’s feelings of self-worth and amplify negative emotions. Davis’ feelings about dyslexia are raw and strong, long into adulthood. His words are powerful in highlighting how the co-occurrence of dyslexia with other difficulties, in this case depression, make the struggle of dyslexia sometimes more difficult and the frustration even more palpable.

Conclusion As we conclude this chapter on comorbidity of difficulties, it is important to acknowledge the great struggle of those with more than one learning or mental health difficulty. These hurdles of learning and sometimes of other aspects of mental processing are enormous and take tremendous time and effort to work through. With each difficulty comes more risk for some kind of negative psychosocial adjustment in life. Parents, teachers, and other professionals should consider

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these additional risks and the challenges they pose and ponder additional accommodations to help such individuals. Those who have multiple learning or other difficulties related to mental processing should also be aware of their increased challenges and be patient and kind toward themselves with this perspective in mind. At the same time, a central purpose of this book is to both acknowledge the difficulties and also to highlight the possibilities for hope and optimal development. There are many role models to look up to, people who have had dyslexia and other problems and who, nevertheless, persist and succeed. For example, Paul Orfalea, founder of Kinko’s Copying businesses, had both ADHD and dyslexia (25 Famous People with Learning Disorders, n.d.), as did Robert Toth (GreatSchools Staff, 2018), an artist whose works appear around the world in museums. A gold medalist in the Olympics, Jim Shea Jr., had both dyslexia and depression as well (GreatSchools Staff, 2018). Moreover, our own interviewee, Ms. Amy, with dyslexia, dysgraphia, ADHD, and anxiety, is currently a successful translator in a large business. These are just a documented few; there are many, many more. Again, this heralding of success is not to take away from the enormous struggles it takes to have more than one difficulty but simply to share the fact that no one is alone in this struggle. Chapters 7, 8, 9, and 11, as well as Appendices B through F are all intended to provide various ideas on how to cope with learning difficulties as well as frustration and low self-esteem. For every individual, there should be a selfdeveloped separate and important toolkit of resources from which to draw to make life easier. Abandon what does not work and keep seeking out new ideas on what does. It is possible to follow one’s own path to the fulfillment of some life goals in relation to one’s own difficulties and strengths. At the same time, it is far from easy. In Chapter 6, we turn to another challenge for those with learning difficulties, that of learning multiple languages.

6 WHAT IS THE IMPACT OF HAVING TO LEARN MULTIPLE LANGUAGES OR ORTHOGRAPHIES ON LITERACY LEARNING?

The majority of the world’s children have no choice but to learn to speak, read, and write in two or more languages. Given the popularity of English worldwide, this phenomenon also additionally requires many children (starting with everyone in China and India, the countries with the largest populations worldwide) to read in at least two scripts as well. (A script is a particular writing system, such as the Roman alphabet or Chinese characters or Arabic writing.) What does the research say about this phenomenon for those with dyslexia? This is a controversial area, with some researchers arguing that those with dyslexia should be exempt from reading a foreign language because of their troubles in reading in the native language. Sally Shaywitz, author of Overcoming Dyslexia (2003), is one of those who make the case that those with dyslexia should not be required to engage in foreign language learning if they wish to avoid it. Indeed, her Yale Group is perhaps extreme in advocating that most people with dyslexia should not be required to learn a foreign language (Landau, 2011). This position may be a relatively America-centered view in the sense that in much of the world, there is an expectation and indeed a requirement for school and for work that a child acquire at least two languages, and often more. As an American, I can attest to the fact that foreign language learning was undervalued when I was growing up and is probably less valued there than in many other countries even today. With all the struggles that those with dyslexia experience, does it make sense, then, to limit exposure to foreign language learning courses for dyslexics when possible? Occasionally, others find and argue (e.g., Miller-Guron & Lundberg, 2000) that those with dyslexia are average in or even excel in learning new languages. Recall the case of Ms. Amy in Chapter 5. She is a successful translator (from French to English) for a major company. She strongly disagrees with the idea that foreign language learning, as compared to other subjects, should be particularly difficult for those with dyslexia. She notes that dyslexia involves problems of reading and writing,

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whereas foreign language learning involves verbal communication. “They’re not even related,” she says. I have met several people in Hong Kong who feel the same way. I recall a Mr. T, whom I met at a party, who, upon learning about my research interests, disclosed that he is dyslexic. For him, one of his proudest accomplishments was being fluent in Chinese and English, as well as French. Originally from Canada, he explained his oral language (oral pronunciations paired with pictures) strategies for learning Chinese. He felt that his difficulties in learning to read were quite different than those of acquiring a foreign language. Peer and Reid (2016) have edited an entire book that is loosely devoted to this issue, entitled Multilingualism, Literacy, and Dyslexia: Breaking Down Barriers for Educators. The 20 chapters of this book represent a wide range of practitioners and researchers. The British Dyslexia Association and the International Dyslexia Association also have blogs or advice devoted particularly to this issue. There is clearly room for debate here. Overall, learning to read and to write depends on a variety of factors, both social/cultural and cognitive. Researchers do not fully understand the nature of dyslexia or dysgraphia in multiple languages, but it is important to know that dyslexia in one’s native language and orthography does not in and of itself guarantee difficulties in another language. Still, it is clearly a risk for some.

Differing contexts in learning a foreign language One of the main issues to contend with on this topic is what exactly it takes to learn a foreign language. In the book devoted to multilingualism and dyslexia (Peer & Reid, 2016) mentioned above, for example, the majority of chapters were written by those coming from a predominantly English-speaking country. With notable Canadian exceptions, the U.S., Australia, and the U.K. have not focused as much on facilitating foreign language learning as have other regions where English is not a primary language of communication. In many places in the world, English is a language of education, privilege, or of commerce; learning English often is associated with climbing a given social ladder. Thus, it may be that Canada, the U.K., Australia, and the U.S. are not necessarily the best places to study multilingualism and dyslexia. Other regions in the world where English is required in school but not the main language used in daily communication may represent quite different circumstances. Here, there is a focus on learning a language that is often used for instruction or some formal activities because it is prestigious, in addition to one’s home language. This includes large portions of Europe, Asia, and Africa. Nevertheless, the most research on this topic comes from English-speaking countries, primarily because these have had to contend with the difficult task of integrating children from many different linguistic backgrounds into their schools which use English as the medium of instruction. In some of the studies from Canada or the U.K., for example, children speaking a diversity of different languages, with 20 or more languages represented as a first language in a given classroom, including Chinese, Persian, Arabic, and others, might be included. This is a different issue as compared to, say, how one country helps all children to learn its own

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language and then one or two others, usually including English as one. This might apply to, say, China, Japan, or Sweden. There are other situations, as in Hong Kong or the German part of Switzerland, respectively, where children speak a particular dialect that is different from the language of instruction (Cantonese or Swiss German, respectively, for example, in these cases). Children must then learn to read, write, and sometimes speak in the dominant school language (Mandarin or high German, respectively for example). They are also expected to learn English and sometimes other languages. For example, in the German-speaking part of Switzerland, at least one other language apart from English is required (usually French or Italian). The current situation, particularly in Europe, into which many individuals from many backgrounds are immigrating, may add other dimensions. There are unique situations in other locations that add other dimensions of complication. For example, Zambia features seven official languages and also English. There, because of education policies and immigration, children sometimes have to learn to read in a language that is not their mother tongue, and eventually, they have to learn to read, write, and reason in English, which is ultimately the language of instruction for many of their school subjects by the end of primary school. India may be more complicated still, because so many different languages are spoken in it. Moreover, there are many scripts that are mapped onto these languages. Researchers are beginning to explore the extent to which learning different languages making use of several different scripts (e.g., Hindi, Urdu, and English), as opposed to several languages using the same script (e.g., German, French, and English) are more or less difficult.

How do we learn a foreign language? What does it take to learn a foreign language? Researchers continue to debate the best way to teach a foreign language. All teachers will emphasize that it is important to acquire vocabulary knowledge, phonological abilities to pronounce words so that you will be understood, grammatical understanding, and eventually some reading skills. Often, foreign-language teaching and learning depend upon print, particularly when the subject is taught at older ages. Yet this is not necessary for learning. We all learned our mother tongue orally first before learning to read it. Thus, a central question is that of how a second or foreign language is taught in the first place. Indeed, there are debates even about what terms to use for foreign language learning. Often these debates center primarily on how the language is used. For example, in Hong Kong where I live, Chinese children typically learn English as a school subject from the age of 3.5 years in kindergarten. English is a compulsory and formal school subject all the way through secondary school. Children are particularly graded on written assignments throughout their schooling. Many of them view English as a chore; it is a language to be learned because it is a big part of the school curriculum (e.g., Lin, Wong, & McBride-Chang, 2012). However, there are other Chinese children in Hong Kong whose parents employ helpers, or maids, from the Philippines to help at home with cooking, cleaning, and child care. By law,

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these Filipinas live with the families, and they usually speak English.Those Chinese children whose families have Filipina domestic helpers tend to perform better in English in school than those without English-speaking helpers, even years later (e.g., Dulay, Tong, & McBride, 2017) and even when the two groups are equivalent in socio-economic status (Chan & McBride-Chang, 2005). Why? One group of Chinese children has to learn English as a school subject but does not make use of it to communicate on a daily basis.The other group uses English not only formally in school but as an actual method for communication. This example of how a foreign language is learned is important for a consideration of whether and how learning multiple languages is related to dyslexia or dysgraphia. One learning model from evolutionary psychology may be particularly relevant here. Those in the area of evolutionary psychology distinguish the idea of evolutionarily primary and secondary abilities for learning (Geary, 2002). These come from the concept of evolution. The idea is that we human beings have evolved from our ancestors. With evolution, certain skills came about naturally. In terms of learning, some of these skills are referred to as evolutionarily primary and some others are referred to as evolutionarily secondary. Those that are evolutionarily primary come naturally. An evolutionarily primary ability is learning to speak one’s native language. There is no formal training required for this. Most individuals learn to speak with no special intervention. All that is required is that a child spends time around adults who use language. Language skills then develop naturally. An evolutionarily secondary ability is one such as learning to read (learning formal mathematics would be another). This is effortful and requires a lot of hours of focused and explicit practice. It is extremely rare that a child learns to read for the first time without some explicit teaching from someone else. These ideas about evolutionarily primary and secondary abilities have been quite popular overall in research on learning (Geary, 2002). They again highlight the fact that some learning is much more natural and therefore easy than others. However, no one has a clear handle on whether foreign or second language learning makes use of evolutionarily primary or secondary abilities. An argument for primary abilities could be made if and when students are taught for the purpose of learning to speak, to communicate. There probably are such programs where talking to one another is important, more important than reading and writing. When children are forced to use the language for some communication purpose, this may be the case. This situation applies to children in Hong Kong who speak to their caregivers (e.g., helpers or maids) in English in addition to learning it formally in school. However, in other cases, the focus is primarily on learning from reading and writing. This is the more typical situation in Hong Kong where children receive formal, written homework in English beginning in kindergarten but do not use English outside of their English-learning classrooms. I have been told informally that this is the case in Spain as well. English is taught in school, but no one sees a need to use it for much. For example, all textbooks are in Spanish, and people do not use English for day-to-day communication in any area. Even the American films shown in the movie theaters are dubbed for distribution to the

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global Spanish-speaking countries and communities.Thus, there is not much motivation or requirement to learn English for any particular purpose. This distinction in how a second language is taught and learned is crucial for understanding the interaction of dyslexia and multilingualism. If reading is a difficulty in one language, it may be a difficulty in a second language. At the same time, many dyslexics do not manifest a strong difficulty in speaking. Therefore, if learning a second language is done in a way that is similar to the way in which learning the first language was done, it is not clear whether those with dyslexia would have a pronounced disadvantage. Recall Ms. Amy, the translator who began to learn French in France once she was in a situation in which she had to use the language in order to meet her daily needs. Basically, she was forced to learn the language or risk having her needs go unmet. This is the best way for any of us to learn a new language: We learn because we are forced to, of necessity. With this background, one answer to the question posed at the beginning of this chapter as to what the impact is of having to learn another language in addition to one’s mother tongue on dyslexia is this: It depends on how the additional language is taught. If the context of language learning is primarily a focus on oral skills and practical usage, it is likely that the child or adult with dyslexia will perform similarly to those without dyslexia in this task. Conversation and listening should be similar for those with and without dyslexia. After all, many, if not most non-dyslexics worldwide are not necessarily all that talented in learning new languages ourselves. You will find wide variations in foreign language learning among all individuals, and those with dyslexia are likely to follow a similar pattern of variability. If the additional language is taught primarily via reading and writing, however, it is possible that a person with dyslexia might have more trouble with language learning than a nondyslexic. There are indeed some skills related to phonological, morphological, or orthographic processing that transfer from one language to another (e.g., Cárdenas-Hagan, Carlson, & Pollard-Durodola, 2007; Durgunoğlu, Nagy, & Hancin-Bhatt, 1993; Li, McBride-Chang, Wong, & Shu, 2012;Verhoeven, 1994). In particular, phonological skills tend to be highly emphasized in explaining foreign language learning difficulties (e.g., Sparks et al., 1997). Whatever the skills are that cause the person with dyslexia to have difficulty in reading and writing in the first place are likely to be troublesome in learning a second language as well. Ms. WA, a young woman with dyslexia growing up in Sweden, says this: For me, if I am going to read, I read it in Swedish. I hate to read. It must be in Swedish first. I need to think more and concentrate more. But I don’t think that you should learn fewer languages because of that. If you can learn in one language, you can learn another language. I have a hard time with all languages. Note that a primary take-away message from this is the same one that was emphasized in the chapters on the natures, respectively, of dyslexia and dysgraphia: That is, these are not primary language difficulties per se. They involve difficulties

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with specialized abilities related to analyzing speech in a metalinguistic way but not so much with the basics of learning to talk. Most of us who are dyslexics or who parent, teach, counsel, or are friends with dyslexics find no particular difficulties in such individuals vis-à-vis oral language communication skills by the time they are learning to read. Rather, the reading and/or writing problems are narrowly focused on problems with written expression. In some ways, this is very good news. It may be a (relatively) good time in history to be dyslexic or dysgraphic because there are so many tools one can use nowadays to accommodate to early reading and writing difficulties. However, most of those who need such tools in the world do not yet have access to these and/or are not allowed to use them.

Advice on foreign language learning for those with dyslexia Advice from experts on dyslexia and multilingualism sometimes seems similar to the advice given vis-à-vis helping those with dyslexia more generally (e.g., Martin, 2016; Nadler-Nir & Pascoe, 2016). For example, there should be attention to accuracy of vocabulary learning but also fluency in using new vocabulary words. Hutchings and Mortimore (2016) describe a training program on multilingualism and dyslexia from the U.K. in which they focused on several skills that are important for both literacy learning and learning a new language, including verbal memory skills, phonological sensitivity, fluency, comprehension abilities, morphological skills, and oral language abilities. These skills are generally important for all children and are also, not coincidentally, the best ones to target for foreign-language learning. A list of suggested activities for children learning an additional language from Guise and colleagues (2016) resonated with me, given my current struggles in German classes at the University of Freiburg in the Black Forest of Germany. I am not dyslexic, but I do know the pain of learning a foreign language. (As I write these words, I am worrying about an exam on akkusative and dative qualifiers next week in my A2 level Deutschkurs!) These researchers began by noting that children with dyslexia who are learning a foreign language need to have time to consolidate their own learning and also should be given the opportunity to try to use the language in a relaxed and fun manner sometimes. Of course, this is true generally of foreignlanguage learners at every level, child or adult. They recommended a variety of activities that can facilitate language use without the pressure of reading and writing. One concept they mentioned was “exploratory talk” and group discussion (p. 69). Much of this is what a creative foreign-language teacher would probably typically consider in his or her “bag of (language-learning) tricks.” They suggested, for example, extensive use of pictures in order to get students to use language for description or narration of the picture, or, at a more advanced level, anticipation of events that likely happened before or after the picture. At a more advanced level still, one’s students can be asked to tell a whole story with reference to the picture. These researchers also recommended the use of other enjoyable language-learning

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activities such as enacting plays or other short skits or dramas, making oral reports, or interviewing one another orally. Games are also popular and can target either speaking, listening, or both. For example, teachers can ask the children to guess at what an object is by asking questions about it or by playing listening bingo. Perhaps a more targeted approach to children with dyslexia might also include additional support.The authors (Guise, Reid, Lannen, & Lannen, 2016) stressed the importance of support from both teachers and peers for these students. Students should be very clear on the activities that are to be carried out, perhaps being supported in this endeavor by receiving a list of activities written on their own piece of paper (rather than having to copy from the front of the classroom, as is often done), by getting help from a classmate in noting the assignment, or by being asked to repeat the task before it is carried out to ensure that the nature and parameters of the task are perfectly understood. Importantly, teachers must focus as much as possible at keeping their directions clear and manageable. That is, directions should be simple, clear, and concise. Beyond these general and very helpful suggestions for promoting language learning in an enjoyable way, Palti (2016) highlighted the difficulties that are likely to be most challenging for those with dyslexia in learning an additional language. This article focused on dyslexics learning English in particular. Palti (2016) viewed phonological sensitivity, unstressed morphemes (e.g., those that are more difficult to hear such as the s indicating possessive or plural or the ed indicating past tense), and word order in English as relatively challenging. She also emphasized the importance of vocabulary learning, highlighting the importance of both vocabulary knowledge and relative speed in retrieving vocabulary words. She additionally recommended engaging in an explicit comparison of similarities and differences in rules across languages as well as a consideration of the grammatical rules of both. I have had occasion to do something similar with primary school English teachers in Hong Kong. We have discussed similarities between Chinese and English, including word order similarities in basic statement sentences and the fact that both languages make use of compound words and build them in some similar ways. There are many differences as well, including the use of stress (rather than lexical tone) to distinguish words with more than a single syllable in English and the fact that questions in Chinese are formed merely by putting “Why” before a statement, whereas questions in English require changes in word order (e.g., Chinese: Why you are here; English: Why are you here). I appreciate the suggested explicit focus on differences between languages. I think it helps the learner to see clearly how rules in the two languages differ and, consequently, to be more aware of how to use these. Simon (2000) has good advice on language learning and is herself dyslexic. A self-described “speech-language professional with dyslexia,” she wrote this paper with reference to her struggles to learn French. Her article is a great mixture of research on the topic and an analysis of her foreign language learning struggles and triumphs both as subject and from a professional perspective. She highlights her specific characteristics as a learner and reviews research suggesting that many people with dyslexia have particular difficulties in learning another language.Yet ultimately

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she concludes that foreign language learning is “worth it” for students with dyslexia and that doing so can even enhance strategy awareness and use. She offers both tips for those with dyslexia and tips for those teaching students with dyslexia. Tips for those with dyslexia specifically focused on foreign language learning include “Balance hard work and good health,” prepare carefully, make the foreign language meaningful to you personally, drill yourself in order to apply what you have learned (computer programs and the internet are great for this), and review regularly instead of preparing last minute. She also recommends finding an instructor who can show you visually what you need to remember and who is willing occasionally to use your native language to explain the concepts instead of sticking with the foreign language all the time. She argues that this will make it a bit less stressful. She also focuses particularly on grammar given its importance overall. She advocates not complaining or worrying about the rules of grammar or how difficult they are but just accepting them. (This resonated with me in my recent frustrations with German). In addition, she suggests that the learner get a book that explicitly explains the rules of grammar in a clear way so that these rules can be easily reviewed. As for teachers of students with dyslexia, her tips are also very practical. She suggests that teachers get ideas from among all students on best methods for learning. What works for one student will not necessarily work for another, and getting many suggestions is likely to bring about ideas for at least something that will work well for a couple of students at a time. She also highlights the importance of multisensory learning, including teaching of songs, having students correct their work with different colors of ink, and the use of charts or blocks to mark sentences. She also suggests that teachers give students authentic experiences talking to classmates (with situations created to encourage their learning, such as how to buy food at the supermarket), provide experiences in gaining in fluency with good models of sentence structures, and help students to make use of different strategies, including getting extra credit for extra work. This will encourage those with dyslexia to persist and to succeed in the face of particular frustration. At least this will help them with the idea that if they work hard, they can accomplish their goal of learning the language and passing the course.

Foreign language learning: a blessing or a curse? There is also some question as to the extent to which those with a difficulty in their first language always have difficulties in reading in a second language. Siegel (2016) has an interesting chapter summarizing her recent findings on children learning English as an Additional Language (EAL) in Canada.These children in her research had varied first language backgrounds, including Portuguese, Arabic, and Chinese. She looked at their skills in reading and in spelling in English, the target foreign language for all participants, and, across several studies, found that, compared to monolingual English-speaking Canadians with dyslexia, the EALs with dyslexia consistently performed as well and usually better. Because this phenomenon appeared over several studies and also longitudinally, it is particularly striking.

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Some might have expected that the native speakers of English would have outperformed the non-native speakers in reading and writing, but this was not the case. In attempting to explain her consistent findings, she notes that English is relatively opaque in terms of letter-sound correspondences compared to other alphabetic writing. She views children with dyslexia as having a tendency toward greater phonological skills and fewer visual-orthographic ones, relatively speaking. She actually argues for a “bilingual advantage” for those with dyslexia. She describes the process of learning a completely different language as potentially helpful to the brain in sorting out different aspects of language such as syntax or phonology: “It is as if exposure to a first language different from English helps dyslexic children develop advanced language skills” (in English) (p. 145). Perhaps Siegel’s most controversial conclusion is as follows: Although it is assumed that English is a difficult language to learn to read because of the complexity and unpredictable nature of the relation between the sounds of the language and the graphemes that represent these sounds, I believe that this characteristic of English actually provides an advantage for dyslexics. (p. 145) Similarly, Lallier, Thierry, Barr, Carreiras, and Tainturier (2018) actually demonstrated that adults with dyslexia who were monolingual speakers of English performed less well overall than did Welsh-English bilinguals for reasons related to this argument. Welsh is a more transparent orthography and seems to have made it somewhat easier for readers to make use of phonological mechanisms for reading and perhaps also spelling. I found these ideas and results both surprising and delightful, because such findings are also in line with conclusions I have been coming to in a roundabout way for the past several years in my work with Chinese children with reading difficulties. In a series of studies (e.g., Kalindi et al., 2015), our group found that only a subset of children who have difficulties in reading of Chinese also have difficulties in reading of English. Moreover, we also looked to see which children had reading difficulties in English only. Naturally, there was a group of students who had difficulties in reading of both Chinese and English. In fact, 32% of those with reading difficulties in Chinese also had reading difficulties in English in Hong Kong (and the corresponding overlap for those with reading difficulties in both Chinese and in English was 40% in Beijing) (McBride-Chang, Liu, et al., 2012). We had the opportunities to compare those with difficulties in only Chinese, only English, or in both Chinese and in English. Given previous arguments (e.g., Shaywitz, 2003) that those with dyslexia should not have to learn an additional language in school, I was quite surprised that we could isolate all three types of disabled readers and that they were not always the same people. Siegel’s (2016) argument about how reading of English requires multiple strategies, and being forced to make use of different strategies in reading is useful for reading in another language (see also Lallier & Carreiras, 2018) resonates with our own results.

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Indeed, I started to undertake these studies because of feedback I had received from parents and teachers about reading of Chinese and of English in their children. Some parents even told me that they were considering switching their children from a school in which the teachers taught in Chinese, the children’s mother tongue, to teaching in English, a foreign language.Why attend classes in a second, or foreign language, when most experts, including developmental psychologists, will almost unanimously recommend that children be taught in their native language? Having come from the United States, I was not prepared for the assertion that “Chinese is too hard.” What the parents meant is that learning to read and to write fluently in Chinese is extremely effortful, much more effortful than is learning to read and to write in English, another language that we know many people around the world also find difficult (Seymour et al., 2003). I began to realize that children (and adult learners) require somewhat different strategies for learning to read and write in Chinese as opposed to English. For example, phonological sensitivity appears to be particularly important in English as compared to Chinese (e.g., Tong, X., Tong, X., & McBride-Chang, 2015), whereas copying skill appears to be particularly important for Chinese as compared to English (e.g., Kalindi et al., 2015). Importantly, this distinction between how the scripts are read stands out in those who read both. Our findings support Siegel’s assertions that somewhat different strategies may be required for reading of different scripts and languages. In other studies contrasting scripts conducted by Singh and colleagues (2016), this research group demonstrated something similar. They found that the processing, based on neuroimaging studies of the brain, of Hindi, a relatively transparent alphabetic script, appeared to be different than the processing of English, a relatively opaque alphabetic script, in the same children. In particular, reading of Hindi could be accomplished primarily via phonological processes involving graphemephoneme conversions alone. In contrast, reading of English required both phonological and orthographic strategies. Singh and colleagues highlight how features of the script influence the developing brain in learning to read in different languages and scripts. They conclude by calling for separate assessments in each script that the child is required to read in, noting that “In India, this is particularly true, and urgently needed” (p. 212). There are not as of yet available good tools for screening children for reading difficulties in all of the languages and scripts widely used in India. These researchers then conclude by highlighting the need for evaluations of at least two important skills (here, with specific reference to Hindi and English, but presumably this could apply to other scripts as well) that are cultivated in reading of different scripts, saying, “Only when systematic evaluations of both phonological and orthographic skills are carried out in both languages will we begin to truly understand dyslexia in biliterate populations” (p. 212). I had initially been skeptical of the idea that there might be differences in reading skills for those who are learning two alphabetic scripts. It made more sense to me that strategy differences might occur at the extremes of scripts, such as the ChineseEnglish contrast. Yet at a recent meeting on literacy, I met parents and researchers who told of their own experiences with children learning to read in more than one

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alphabetic orthography, such as German, Finnish, or Icelandic, along with English; sometimes, the children had more difficulties with the native script than with English. Now, one would not want to take this too far. Surely, the demands of English as an additional language were somewhat lessened as compared to the demands of the first language. Our first language studies tend to be more advanced vis-à-vis reading and writing. In addition, these were individual case studies and not group findings. Yet these ideas reinforce the concept that dyslexia in one language does not necessarily imply similar difficulties in a second language. To be clear, such difficulties certainly exist, but they are by no means inevitable in every child. One article made this point as early as 2000. Miller-Guron and Lundberg (2000) wrote a very interesting piece on this phenomenon for Swedish children with dyslexia in the journal called Reading and Writing.They came to their research based on a single-case study of a Swedish child who was clearly dyslexic in Swedish but who seemingly thrived in English learning. The piece is very readable and informative. The team tested three groups – Swedish young adults (around age 20) without dyslexia, Swedish young adults with dyslexia but who claimed to prefer reading in English, and Swedish young adults with dyslexia who also disliked reading in English. The researchers found marked differences particularly between the two groups of those with dyslexia. Those who much preferred reading in English to reading in Swedish had different reasons for this, including the fact that they found it easier based on strategy usage, the idea that there were cultural aspects or other motivating parameters of learning English that gave them some meaning in continuing to read in English (e.g., the need to read instructions in order to accomplish modelbuilding because the instructions were only written in English or Japanese), and the fact that reading in English had, in a sense, “leveled the playing field” with other students. To elaborate on the last point, there was the feeling that all students had come to English class with no initial knowledge of it, so the person with dyslexia felt that there was more of a chance to do well or at least not to be perceived as very low in this skill compared to classmates. Miller-Guron and Lundberg concluded (pp. 59–60) by saying the following: The common assumption that native language deficits will almost certainly result in failure to read a foreign language can lead to negligence in L2 reading instruction or even an active and deliberate reduction in L2 teaching resources for dyslexic pupils. The above findings suggest a refutation of assumptions of universality regarding the component processes underlying L1 and L2 potential in dyslexics. Echoing this sentiment is Mr. Robin Hull, Chairman of the Swiss Dyslexia Association and Principal of Hull’s School in Zürich, Switzerland. He reports the following: I run a UK style sixth form college in Zürich, Switzerland with a fouryear programme for youngsters aged 15–19 covering IGCSEs and A-levels. Most of the 300 teenage students are first language speakers of German, and

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roughly ten percent have dyslexia. Though English is supposed to be unusually challenging for non-native speakers with dyslexia, we find that they do considerably better once they are taught all subjects in English by Englishspeaking teachers. As there has been very little research into this, I can only guess what the reasons may be. I suspect that the love of English plays a major part, coupled with the fact that UK education has been dyslexia friendly for many decades. English-speaking teachers are sensitized to learners with dyslexia, and multisensory teaching is very much the norm. In addition, English schools are proactive in offering learning support and granting students with dyslexia access arrangements. Moreover, in examinations, linguistic accuracy does not account for more than 15% of the overall grade. German-speaking teenagers with dyslexia in Switzerland consistently tell me that they became much more successful once they were allowed to continue their studies in English, and many say that this saved their lives. One main point made by many of the authors included in the comprehensive book edited by Peer and Reid (2016) is that it is indeed difficult to consider learning disabilities not only in the first language and writing system but also in the new language to be learned among those learning in an additional language at school. There are standardized tests that can be used to diagnose reading and writing difficulties only in a very small number of countries worldwide. These tests are typically normed for children who are natives of that country. For many of those children learning additional languages, there are few if any standardized tests, as in India (Singh et al., 2016). There has been no attention to testing children in a foreign language, a concept that may be a useful one for the future given that so many children are taught in a language that is not their native tongue. Practically speaking, it is not always clear whether a child is having difficulties because she is struggling as a foreign-language learner or as someone with dyslexia or dysgraphia or both. Parents, teachers, and clinicians need to be sensitive to the fact that both challenges in language learning of a foreign language and in literacy learning can manifest themselves via children’s school-related difficulties. Without clear testing, it is also difficult to disentangle these difficulties. Disentangling them is potentially helpful because it may suggest different strategies that are optimal in solving difficulties for each.

Poverty and second language learning One additional point that is worth raising in this context is the fact that reading difficulties tend to be more pronounced in poorer children (Blanchett et al., 2009; Cheung, Yang, Dulay, & McBride, 2018; Dulay, Cheung, & McBride, 2018; Nag & Snowling, 2012; National Center for Learning Disabilities, 2014; Winzer & Mazurek, 2015). Growing up poor brings with it a host of difficulties such that it is, among many other things, harder to catch up in literacy learning. To date, those tools that can help children with literacy learning, such as books, games, online

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programs, private tutors and the like, are mainly available to families with some money to spare. Many children are learning additional languages because their parents have immigrated, and some of them are relatively poor. I was struck, in some of the descriptions from the very important book edited by Peer and Reid (2016) on the topic of multilingualism and dyslexia, by the fact that many or most of the programs or websites cited here that are available for promoting literacy are not free and openly available. These are often colorful, attractive packages that must be paid for to use. As Dr. Sylvia Kalindi mentioned in our interview, there are difficulties in many countries, including Zambia, such that not only are there no assessments available for children, but there are no school psychologists. In some ways, though posing a serious threat to learning, dyslexia and dysgraphia are remediated primarily in those who have more financial resources to deal with them. Those who are poor have only very limited access to help. I have tried to list a few open access websites for help with literacy in Appendix F, but it would be very helpful if more companies opened their services to lower income families. For additional examples of some websites, including ones that require payment, please consult the appendices from the book by Peer and Reid (2016). The story from the previous chapter of Ms. Amy, an American woman who grew up in poverty, with dyslexia, dysgraphia, and ADHD, and who finally found the motivation to learn French so well that ultimately she became a successful translator is an inspiration in this respect. Worldwide, the odds are clearly stacked against those who learn additional languages, are dyslexic, and are poor for optimal language-learning outcomes. At the same time, such language learning is possible provided that children see good reasons to study and to learn. Motivation for such learning is key. In addition, those who have caring and supportive teachers and parents tend to do well, provided that everyone, child, teacher, parent, remains committed to helping the child to learn. For example, as observed by Dr. Kalindi in Zambia, While the Learning Support Teacher can be patient and celebrate the slow progress that the children make, I found that other subject teachers just did not appreciate the slow progress and so expected very little or nothing from such children. The parents also seemed to want quick progress (reading short letter words fluently) which was not always guaranteed. . . . Sadly, some parents also learned not to expect much from their children. For those who learned to celebrate every little bit of progress, however slow, they appeared less stressed and more engaged with the child’s learning.

Conclusion Thus, ultimately, multilingualism is simply a part of who the child is, and how he or she learns an additional language is guided very much as all learning is, by the child’s motivation and support, as well as by hard work. I am often struck by the fact

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that, in situations around the world, language teaching could be simpler than it is. There is an implicit feeling among many teachers that if the children are having a lot of fun, they are not learning.Yet games and funny exchanges may be one of the most important activities in facilitating language learning. These fun-with-a-purpose communication activities increase motivation and demonstrate some concrete rationale for learning the additional language. For a child with dyslexia, workaround methods such as allowing tapings of the lessons or transcription devices for help with written assignments, should be considered. As with native language reading and writing, additional language reading and writing requires effortful attention to print, but such print skills are only a tool to communication. When children have specific difficulties in print skills, they should be allowed to manage these with other supports. Facilitating good communication in the additional language, rather than testing in reading and writing skills per se, should be the ultimate goal of a multilingual education.

7 BEST PRACTICES IN REMEDIATING DYSLEXIA AROUND THE WORLD

Having outlined some of the basic issues related to dyslexia and accompanying learning difficulties, I turn to the practical issue of how to help. Now that we know what these difficulties are and what causes them, what can we, as parents, teachers, practitioners, and those with each difficulty, actually do to help others or ourselves to learn better? An important point about remediation of learning difficulties for individuals is that what works for one person may not work for another. Researchers conduct research studies in order to observe trends, to determine which treatment seems to work better than another treatment for a group. There are many commonalities among certain students who have dyslexia or other students who have attention deficit hyperactivity disorders. At the same time, however, it is clear that all children also differ somewhat in their strengths and weaknesses, as well as in their interests. No two brains are exactly alike. This is a fundamental issue for this book and for anyone trying to bridge the gap between research and practice. I have spent most of my adult life conducting research, pouring over data. The data analyses show me trends and allow both researchers and practitioners to determine, in a general way, what abilities are most associated with dyslexia for the purpose of identification of those at-risk for reading difficulties and also for the purpose of designing effective treatment programs to help children to improve their reading. Patterns derived from research are reliable and extremely important for progressing in how we help children with learning disabilities. At the same time, however, a given technique that works for one student with dyslexia or dysgraphia will not necessarily help another one.This point is very important for the purpose of helping a given individual. I have had many teachers and parents tell me that a specific technique did not help their child, and I have often been hard-pressed to explain why.The reason is likely complicated and has to do with the child’s specific perceptual, motor, cognitive, and other abilities, as well as his likes and dislikes.

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What does this mean, this occasional conflict between overall trends in research and individual variability such that what works for one child might not work for another? Most of all, it means that parents, teachers, clinicians, and especially those with learning difficulties themselves have to be very persistent and try various methods until they find what works best for the individual with dyslexia. Keep trying suggested techniques until you find the right one. In this book, I have tried to highlight current research on dyslexia, dysgraphia, and ADHD. I have also tried to quote or summarize various techniques that have been recommended by individual interviewees along the way. These are scattered in the text and are briefly summarized in Appendix E in the back of the book. More ideas can be gleaned from the websites devoted to helping those with dyslexia in many different countries as listed in Appendix B. In these appendices, as well as various other self-help books and tools, you will find that a quirky set of work-through and work-around strategies will work for your child, and it is your job to figure out, like a detective, which are the best ones for him or her or you. Work-through strategies refer to those that focus on enhancing the learner’s abilities in his or her weak areas, which, in relation to dyslexia, are focused on literacy skills. For example, such strategies might include exercises intended to improve phonological sensitivity or to increase the child’s speed, or fluency, in a given area of reading (such as sight word recognition). Work-around strategies refer to those techniques that are used to get around the manifested difficulties in order to achieve a given goal. For example, a person with dyslexia might opt to learn material for a science test by using software that converts the text from written to spoken form and then listening to, rather than reading, the text. In the following, we will elaborate on general and specific ideas for how to teach children with dyslexia more effectively. There are many strategies that can be adapted to fit the needs of children learning to read in different languages and scripts. Games and other strategies are rewarding and helpful in reinforcing connections in reading that otherwise seem effortful and dull. There might be exercises or strategies that can benefit individuals with dyslexia in other ways as well. Next, we explore some of these. Work-through strategies are highlighted first. Work-around strategies are then considered. I also thought it was important to note some of the strategies that some marketers try to sell to those seeking help for dyslexia. Many of these are not actively harmful but simply qualify as a waste of money. Others might actually cause harm, and it is important to distinguish these.

Work through with games One of the most important points from parents and teachers about helping children with dyslexia focuses on the importance of games. The strategies that need to be reinforced for those with dyslexia are relatively narrow and require hours of practice. How is it possible to get through these without driving the child (and yourself) to even greater distraction or frustration? Mr. Joe, from Israel, said, “I think

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gamification of assignments could go a long way into motivating kids.” Dr. Garrito, a Vice Principal and former teacher agreed: In my previous role I led a special education class. I realized . . . (that) children with learning disabilities were quite bored and disinterested in participating in paper and pencil type activities. . . . The majority of students in the class had dyslexia. Teaching children spelling patterns through a traditional teaching model was not engaging. As a teacher, I learned that it was necessary to engage students in learning via games. I established a fun environment where the game became the vehicle for teaching specific spelling patterns to improve students’ decoding skills. Computer programs are an excellent source of practice.As Ms. C.Azzopardi, a Learning Support Assistant in Malta says, “interactive educational computer games motivate children to learn independently and in an enjoyable way.” Some of these games are available in many languages (or are in the process of being adapted for them). For example, Graphogame, created by a team of Finnish psychologists, is a computer game that can be played either on a computer or on a phone, and children who play it have shown success in learning to read. It is ideal for younger children. There are YouTube videos and various write ups on the internet that give some basics on how it works. This game is particularly impressive because there are so many published studies on its success (Ojanen et al., 2015; Saine, Lerkkanen, Ahonen, Tolvanen, & Lyytinen, 2011; Kyle, Kujala, Richardson, Lyytinen, & Goswami, 2013). Graphogame, which is sometimes now referred to as GraphoLearn, is based primarily on the idea of teaching individual phonemes linked with letters and also larger letter units (e.g., igh is a single unit pronounced as I as in the rime part of words such as hi or why or of course high or thigh). The game website is not always easy to access, but if you search for it on the internet, you will find contacts who can help you to access it at no cost for various languages and scripts. There are some versions available in English, French, Portuguese, Greek, Norwegian, Swedish, Mandarin (for Pinyin, one alphabetic teaching mechanism in Chinese), Dutch, Finnish, Kiswahili, Nyanja, and Afrikaans. Some of these have their own websites, but a good place to start is to go to the website of GraphoLearn, namely, www.grapholearn.com. Another very important initiative is that of the EkStep Foundation. This group has an open source selection of online resources for promoting reading at various levels, including phonological awareness, fluency, vocabulary knowledge, reading comprehension, and even written expression. People work together, adding to the resources, and there are plenty of games available for English. In addition, there are lessons in Assamese, Bengali, Gujarati, Hindi, Ho, Juang, Kannada, Maithili, Marathi, Munda, Odia, Sanskrit, Santali,Tamil,Telugu, and Urdu.These are some of the main languages and scripts across India. An overview of some of these can be accessed at https://community.ekstep.in/resources/domain-model. Of course, there are many other computer games that can help as well. Such games often target different skills such as sight word reading, morphological

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awareness, letter names and sounds, and other skills. A cursory look through the internet with keywords related to computer games and literacy or computer games and dyslexia yields many hits. As long as you know what the skills are that are important for reading, you should be able to search for appropriate games to help your target child build skills. For most scripts, some skills in phonological awareness are essential for reading, and mapping speech sounds onto print is the key for word recognition (Verhoeven et al., 2018). Thus, games that reinforce connections between graphemes (i.e., letters or characters – small units of print) and their corresponding sounds are of primary interest for many children with dyslexia. Games that emphasize orthographic contrasts (e.g., distinguishing know from no, being able to tell whether a word is correctly spelled) are also helpful. In addition, games that encourage children to get faster as they play are desirable, given the importance of speed, or fluidity, for reading (Wolf et al., 2009). Other games that are ideal for reinforcing literacy skills for children with dyslexia will facilitate morphological skills or vocabulary knowledge. For example, the Electric Company has a free online game called Scrapyard Slice that gets children to identify compound words as compared to noncompound words and divide the compounds into their separate morphemes. It can be found at http://pbskids.org/electriccompany/games/scrapyardslice. For vocabulary knowledge, I appreciate freerice.com online, a game sponsored by the United Nations (it has the additional benefit of donating 10 grains of rice to the World Food Programme for each correct answer), though it is likely too advanced for younger children with dyslexia. This way of testing skills can be quite reinforcing, however. I advocate use of computer games to help to reinforce literacy-related skills for at least three reasons. First, exercising skills in the form of a game sometimes motivates us more than flashcards or other exercises. Even something as simple as getting faster in skill use is motivating, for adults and for children. When parents ask me what computer games are the best on the market, I simply advise them to find the one(s) that are fun for the child. The best game is one that highlights literacy skills and that a child finds interesting enough to willingly play. Second, often computer games focus on targeted skills. Practicing such skills, such as phonemic awareness or morphological awareness, can sometimes help us to become more aware of the skills needed for literacy learning. Third, computer games are readily available and do not lose patience. While skilled teachers, parents, and other helpful volunteers should always be welcome in helping the child to learn to read, computer games provide consistent reinforcement over a longer period of time. Again, there are a variety of interesting computer games to promote literacy on the market.This book is not the place for marketing, but do look online for interesting and instructional games. At the same time, however, I think it is worth highlighting a few free online games and apps, since at this point around the world, most people have access either to computers or mobile phones and can therefore, theoretically, use some of the free games. Looking for free online games on the internet can be overwhelming. Most games appear to try to draw you in and then offer more advanced versions of the

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game for a fee. For most people and schools, money is tight, so see if you can find some free games that are appealing for the child. If you find a game that looks very attractive for a child and also appears to be tapping any of the skills reviewed in Chapter 2, it is a good idea to try. What should be avoided, however, are games that are expensive and promise anything resembling a magic cure for dyslexia. Dyslexia is a life-long condition, and there will not be a single solution. One program, offered by Fast ForWord and originally designed by Paula Tallal (Tallal et al., 1996), is relatively expensive. A review of studies on the efficacy of Fast ForWord (Strong, Torgerson, C., Torgerson, D., & Hulme, 2011) did not find that it was particularly effective for those with dyslexia. My advice to anyone looking for suitable games is to understand the skills that are involved in reading (from Chapter 2), look for games that exercise one or more of these skills, and ensure that the game is interesting so that it will motivate the child who needs extra work in a given literacy skill to play it. Alternatively, design games of your own. This can be done via apps like www.memrise.com. This app allows you to design your own games based on a concept you need to learn (or to teach). One hallmark of dyslexia is that skills in literacy that typically developing children can learn in a short period of time will take those with dyslexia much longer to learn. Nicolson and Fawcett (2010) make the point that those with dyslexia simply cannot automatize their skills the way those without dyslexia can, sometimes taking up to ten or more times the number of trials to master a skill at the same level as a typically developing child. This implies that one of the main strategies for helping to remediate those with dyslexia is to practice, practice, practice. Please see Appendix F for references to apps and computer games in a variety of languages that might be helpful for facilitating extra practice in reading skills. This list is not exhaustive but represents a relatively comprehensive search across languages. Do not forget to check apps in your language; these are constantly being updated.

Text presentation I mentioned briefly in Chapter 2 that some advocates for those with dyslexia have emphasized the problem of visual stress.Visual stress is the feeling of exhaustion or discomfort when reading a text, often accompanied by the feeling that the words are changing, swimming, or fading in and out. Although research does not support the idea that those with dyslexia have this difficulty more than those without dyslexia, it is also the case that manipulating the text presentation can be helpful for a particular individual. It is important to distinguish causes of dyslexia from strategies to remediate dyslexia, or even just to make the process of literacy learning a bit more comfortable. Thus, although researchers do not think visual processing or visual problems are a primary cause of dyslexia, clearly, text manipulation can help to make reading easier for some individuals with dyslexia. For those with difficulties with keeping focused on text, there are some simple spacing techniques one can use. The British Dyslexia Association offers a variety of helpful suggestions online, many of which are applicable across languages and

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scripts. Working with your dyslexic reader, you could try a few at a time to see if any of them will help. These include reducing the glare of the paper, so that sometimes the color of the paper that the text is printed on can be changed to help, selecting a font that is easy to read, or ensuring that the text is not justified on both sides (because right-justified spacing tends to change the spacing of the words too much (British Dyslexia Association, n.d.)). One company devoted to design compiled other helpful suggestions based on several websites devoted to those with dyslexia (Anthony, 2011). They additionally recommend that sentences end with only punctuation and a single space before the next sentence. This is important because those of us who are old enough to remember typewriters learned to type with two spaces following a period at the end of the sentence; this is problematic for the spacing of a line. In addition, it is helpful for those with dyslexia to read shorter paragraphs because the density of a long paragraph can be overwhelming. Beyond these suggestions, sometimes children need to structure themselves so that they do not lose their place on a page. Many young readers read by pointing from word to word within a text. While this will slow the reader down, it might be one strategy to help keep track of the text in the initial phases of reading. Some students also like to use a ruler or anything else that is straight-edged and can help the reader to stay on track. A simple device that is largely opaque but with a small see-through window for one to a few words at a time might also be useful for children with dyslexia. I learned this from Ms. Monica, a person with dyslexia from Hong Kong, who perfected this technique with some young children with reading challenges.

Assistive technologies In almost every interview I conducted (with everyone listed in Appendix A), responders highlighted the need for assistive technologies for those with dyslexia. Mr. Lars Sanders, a senior Training Developer and father of two dyslexic boys, says, “It is important that teachers are able to separate learning (acquiring knowledge) from reading, and separate presentation from writing. All books and papers should be accessible via text-to-speak programs, and presentations should not be limited to written presentations.” Swedish Clinical Psychologist Emma Lindeblad similarly notes that reading impaired children in her research studies “have reported being helped by applications in iPads that read the text aloud (text-to-speech, TTS).” Mr. Cheung, a research student in the area of learning disabilities and one who suffers from dysgraphia himself, notes that “Technology allows us to provide more advanced adaptation for children with learning difficulties. Currently, many audiobooks are available for adults. . . . Similar conversion for children’s materials have not been made for children with learning difficulties.” He has ideas about how to improve the current situation for all students with learning difficulties, as follows: Teachers and/or book publishers can provide an audio version of the teaching materials. Homework designed using computers can have read-aloud questions and record children’s verbal responses. We are not utilizing our technology to

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provide the fewest obstacles for children with learning difficulties to learn. . . . We need systematic, convenient, and high-quality multimedia learning materials that are coherent with the syllabus. Most (existing) multimedia learning materials are chaotic; producers have made the materials for some of the topics but not all, and they might omit content that is in the written materials or they might add something more. It is not possible to use multimedia materials as an alternative learning tool right now. Moreover, students usually do not have access to such materials. These are usually withheld by teachers, and there are no ways that students can use those materials for revising. We need to produce learning materials that can be used as an alternative to the written materials. Ms. Maria Rufina Pearson, an Educational Psychologist from Argentina, agrees, saying, Nowadays, technology is the best partner. Children with learning disabilities (and those with no disability as well) learn better through videos, tech presentations, and also through significant situations where they have to be included such as debates or putting their bodies into the learning situation. Teachers should promote active learning, start with students’ previous knowledge, give them visual clues, and ask them to associate the new theme with other well-grasped concepts. And Ms. C. Azzopardi, a Maltese Learning Support Assistant, additionally notes that “In today’s technological world, the use of the interactive whiteboard, tablets, mobile devices, and word processors aids learners’ access to knowledge and also allows learners to express their knowledge. For example, presentation of video clips may help learners by accessing knowledge visually, and the use of a word processor may help learners to present their writing without spelling errors.”

Giving children extra time WA, a young woman with dyslexia, is adamant about the importance of time for doing good work. When asked what can be done to support those with learning disabilities, she says, It’s a lot about time.What you have here (pointing to her brain), it’s not about time. Examinations do not need to be timed. Time should not be a problem. Maybe give everyone time for examinations. The most difficult task is to put everything on paper. When you have dyslexia, you get some more time, but it is so difficult. Why should time constrain what you have here? Time is not your knowledge. Most parents and children focused on dyslexia believe it is essential that students with the disorder be given extra time to complete their assignments relative to those without

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dyslexia.Yet there is also a worry among some teachers that giving extra time to those with dyslexia is somehow “unfair.” There is a strong desire on the part of educators to be fair to all students, despite general agreement that being dyslexic is a continuing challenge in the life of a student, i.e., unfair to begin with. Research on this issue has not always been straightforward, with two meta-analyses, involving analyses of the results across many different journal articles focused on different research studies together, yielding relatively equivocal results (Gregg & Nelson, 2012; Sireci, Scarpati, & Li, 2005). Some studies have shown that those with learning disabilities broadly defined (e.g., Runyan, 1991) or with specific reading difficulties (e.g., Lesaux Lipka, & Siegel, 2006) tended to benefit more from extra time than did those without such difficulties; this was supported by one of the meta-analyses (Sireci et al., 2005). However, virtually all of the studies on this subject were conducted on secondary school or university students, and many of them included those with learning disabilities broadly defined. Most professionals agree that giving those with dyslexia extra time to complete their assignments is important and fair.The International Dyslexia Association (2017) recommends extra time as a crucial accommodation that teachers of those with dyslexia should readily allow. As far as general homework goes, a very good suggestion is to have in mind how much time a child should spend in homework and to agree on this with every child, including those with dyslexia. If this means that a child with dyslexia completes fewer assignments than someone without dyslexia, that is o.k. because with this general understanding, the child’s self-esteem and motivation will hopefully be sustained in a way that is less likely if the child is constantly being asked to work longer hours with more frustration than those who do not have a learning disability. This helps to avoid the not uncommon situation in which children with dyslexia spend their entire childhoods (an exaggeration but in some cases not much of one) doing homework in an effort to improve their reading and writing; when life is only focused on the drudgery of frustrating homework, it is difficult to remain optimistic and hopeful about the future or, equally, to get to know one’s whole self.Thus, it seems essential for parents, teachers, and students to discuss how much homework per night is reasonable to expect, and to stick to that amount of time as a general rule.

Adult support and encouragement Various experts often emphasize parent and teacher strategies for helping those with dyslexia. One aspect of this is cognitive support and practice, as discussed above.The other is the psychosocial aspect that allows children to find meaning and hope in school. We consider this aspect of reinforcement and encouragement here. As far as broad encouragement goes, there are a number of things parents can do. One is to have confidence that a child can succeed somewhere. One clinical psychologist, Dr. MC from Macau, notes that this encompasses sometimes a leap of faith about these children’s potential that goes beyond academics: For example, I have a mother who truly admires her daughter’s creativity in writing despite her poor spelling. I have another girl with dyslexia who wants

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to be a writer one day. These parents did not focus on the children’s weaknesses; instead they have faith in their strengths to rise above the weaknesses. Dr. MC also highlights the fact that there are role models who can give both parents and their children hope about the future of their own children. Some famous people with dyslexia include First Prime Minister of Singapore Lee Kuan Yew, actor Tom Cruise, entrepreneur Richard Branson, and actress and singer Cher. Ms. K, a mother of two dyslexic boys from India, also highlights the need for faith and hope in the face of challenges. Her sons have grown up to be successful entrepreneurs, and she notes, “My son always said, ‘Mom, everyone thinks I can’t do it, but I know I can.’ I often have to tell a parent that he or she is the only person in the world their child can depend on to believe this.” Several therapists also emphasized the importance of working with the children as a team. When children feel that they have someone who is an additional advocate for them, who is on their side, they are encouraged and hopefully persist longer. From Japan to Austria to Denmark to Hong Kong, therapists of various sorts emphasized the idea of helping students to advocate for themselves and work together with parents for a total approach to work on the reading difficulty. One of my favorite examples was from Educational Psychologist Erika Barker-Benfield, whom I met in a lively, traditional coffee house in Austria. I had arranged the meeting via recommendation from a colleague and so we were meeting for the first time. She arrived with a gorgeous large Dalmatian dog who stayed with us during the entire meeting and was very quietly beautiful and friendly, the object of much admiration around the coffee house. Ms. Barker-Benfield explained that her dog, Amy, comes with her to work every day and that her clients, the children with learning difficulties, come to see the Dalmatian as part of the whole educational process. One of the techniques this therapist uses is to first ask each child to select a stone from a box from her desk and then to put it under the belly of the Dalmatian in order to harness “Dalmatian energy.” The children are asked to keep the stone during their times of need but ultimately to return it for the next child. She tells them, “Amy, the Dalmatian, knows everything.” Before the test, she takes the stone from the child, which, along with Dalmatian energy, she also infuses with her wisdom from working with so many learning disabled children. She tells the children also that “If the energy is gone, give it to your Mom, and she can do the same.” She says this helps the children to stay calm, focused, and optimistic. Maintaining optimism, hope, and the will to learn is perhaps the most important function of a supportive adult for the dyslexic child. Any techniques or rituals that can be used to foster this should be considered. Another aspect of this support includes teacher education. From my interviews, I learned that teacher education is on the minds of many who are concerned with the well-being of dyslexic students. For example, Mr. Toyota, speech therapist, says, “In Japan, some teachers still don’t understand the notion of LD or other developmental problems, and they tend to continue in their own teaching style; they don’t accept requests from parents or other teachers.” Ms. Barker-Benfield, from Austria,

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also noted that teacher training is needed because some teachers seem not to have much understanding of the phenomenon of dyslexia at all, so when children improve (e.g., from making 40 mistakes in spelling to making only 20), the teachers still see only failure. Ms. Azzopardi, a Learning Support Assistant from Malta, also argues that, “Teaching training is crucial as, more often than not, teachers have the good will to support pupils with learning difficulties but are overwhelmed and lack confidence in catering to mixed abilities in mainstream classes.” Dr. Emma Lindeblad, a clinical psychologist in Sweden, also noted that teachers and parents need support and education on the topic of dyslexia. She explains When I meet a teacher who doesn’t believe in dyslexia (and yeah, I have met them), I ask them if they have glasses, for instance, and to remove them and continue as normal. They may experience that it is difficult, and then I explain it is what they ask of a child with learning difficulties. In tough cases, I ask teachers if they would require a 100 meter run from a child in a wheelchair. . . . And then I explain that is what they are doing to a reading impaired child, for instance, when they ask them to read at the same pace as a non-impaired classmate. Prejudice and non-acceptance are core values that need to be met at many levels, in the very situation as well as at an abstract level. Some people have difficulty connecting abstractions to a specific situation and then they need help. Everyone agrees that being an advocate for the person with dyslexia is a must. The child with a learning disability almost by definition cannot initially handle all difficulties associated with the condition alone. Along with the frustration and failure come low self-esteem and sometimes loss of hope.Thus, apart from strategies designed to help the child to improve in word reading performance, including both accuracy and speed, one of the most important roles of an advocate it to help the person with dyslexia find ways to maintain hope and optimism.

Things that do not work for those with dyslexia Apart from these main categories of helping tools that are important for those with dyslexia to improve literacy performance, there are some strategies that do not work. In this section, I focus on ideas from researchers that have been attempted for helping those with dyslexia but for which evidence is ultimately lacking. It is important to keep in mind the distinction between group results and individual preferences. Because the nature of dyslexia can differ substantially from one child in one cultural context to another child in a different cultural context, we must carefully balance important research findings from studies which typically attempt to have relatively representative samples and strong methodologies, with the fact that some strategies may indeed work for an individual child or adult struggling with dyslexia. The purpose of this section is simply to inform the reader of what seems not to work for the group. Without research support, most clinicians and

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educational psychologists will not endorse a particular training technique or other alternative approach. I want to highlight the fact that these particular treatment approaches have been tried and have not worked in an attempt to save interested individuals time and money. A more thorough review of these and how and why they do not work can be found in Elliott and Grigorenko’s (2014) book, The Dyslexia Debate. One intervention for which there is little convincing evidence is that of visual support. One of the traditional exclusion criteria for dyslexia is adequate sight. As mentioned in Chapter 2 on understanding dyslexia, there are students who complain of visual stress or print seemingly “swimming on the page” when they try to read. Such complaints prompted various attempts at intervention based on visual manipulations. For example, some researchers have encouraged eye exercises among those with dyslexia. None of these treatments have been effective in remediating dyslexia in well-controlled studies (e.g., Elliott & Grigorenko, 2014; Handler & Fierson, 2011). Apart from the visual focus, other researchers have targeted an auditory focus in relation to remediation of dyslexia. Some research has demonstrated that children with language impairments benefitted from listening to slowed speech that was gradually speeded up for easier perception (Merzenich et al., 1996; Tallal et al., 1996). Tallal and colleagues later used these results to establish a program, Fast ForWord, that has been widely used to try to help those with dyslexia. One problem with the justification for use of this product, which consists of various computer programs focused on speech of different speeds, is that the researchers never themselves demonstrated its efficacy for those with dyslexia. Nevertheless, the program was launched with commercial success. A meta-analysis of studies that have made use of this program with children with dyslexia, however, has shown no effect of it (Strong et al., 2011). It does not appear to be beneficial for children with dyslexia, nor do other auditory-based programs (for a review, see Elliott & Grigorenko, 2014). In addition to these visual and auditory interventions, ones based on theories about reading as a combined visual-auditory event, there have been additional alternative interventions that have been tried as well, with no clear successes. One of these is a perceptual-motor training program. This program is based on the idea that perhaps at the heart of dyslexia is a delay of cerebellar functioning resulting in general slowness, and sometimes clumsiness, among those with dyslexia. Indeed, there is evidence that those with dyslexia, compared to those who are matched to those without dyslexia in some meaningful way, manifest difficulties on tasks that are wide-ranging; some of these abilities focus on those making use of motor control (e.g., Ramus, 2003; Savage, 2004). It is not uncommon for those with dyslexia to be perceived as somewhat slow, lacking in automaticity in carrying out a variety of motor activities (e.g., Nicolson et al., 2001). Given this idea of a lack of automaticity for a variety of tasks among those with dyslexia, researchers have carried out several studies targeting physical exercises for those with dyslexia in an attempt to somehow retrain the brain. These attempts have not been particularly successful,

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however (for a review, see Elliott & Grigorenko, 2014). Other programs that go further afield from theory in understanding dyslexia have included the use of biofeedback and dietary alterations (especially the use of fatty acid supplements); there is no good evidence that any of these have helped those with dyslexia in measurable ways (for a review, see Elliott & Grigorenko, 2014). This section is important because it highlights interesting, or occasionally somewhat far afield ideas that have arisen and been tested to help those with dyslexia. There is no great danger for an individual in trying some or any of them, but one should be relatively circumspect in putting resources into treatments for which there is no research evidence of improvement. Because we all typically learn and improve over time, one must additionally keep in mind the fact that those in a treatment group should always be compared to a similar group of people who are not in that treatment group. Both groups’ performances should be compared before and after treatment. Because of the importance of the placebo effect, the idea that one’s belief/hope in a treatment might itself help one to improve, those not in the targeted treatment group should also receive some sort of treatment. For example, an exercise program group, the targeted treatment, might be compared to a group that is given some other sort of training, such as mindfulness. If the exercise group does not improve more than the other training group, even if both groups improve somewhat in reading over time, a general expectation of children in school, whether dyslexic or not, then this targeted group has not been demonstrated to work vis-à-vis reading improvement. A rule of thumb for any individual seeking new treatments for dyslexia should, therefore, be that treatments for which researchers have demonstrated success should be considered before untested treatments. If treatments are not harmful in terms of health risks or time or money lost, one can also try untested treatments as suggestions, keeping in mind that one should be objective about them. For individuals, sometimes even the optimism that comes with a new treatment might be helpful because it is motivating. However, the bottom line from research thus far is that the best way to learn to read better is to exercise reading-related skills.

Returning to the roots: reading-related skills to help those with dyslexia As detailed in Chapter 1, the most important skills that researchers have pinpointed for understanding dyslexia are phonological sensitivity, morphological awareness, orthographic processing, and fluency. Testing children on these skills can highlight their strengths and weaknesses. A focus on strengthening such skills often promotes better reading. Patient teachers and parents can help facilitate these skills once they understand what they are and how they are useful. Games that facilitate phonological sensitivity highlight stress or tone patterns in a word, phrase, or sentence, or highlight speech sounds in a word. Reading poems that rhyme or making up silly rhymes, playing sound games such as “Pig Latin,” or focusing on the first sound of a word (e.g., how many words can you think of that

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start with the ch sound? . . . chocolate, chips, chinchilla, chilly, churn, chunk, chipmunk, Charlie) are all good ways to scaffold children to become more sensitive to phonological sensitivity. Games or activities that are helpful for stimulating morphological awareness involve either identifying individual morphemes within words or putting morphemes together to create words. For example, a child might be asked to identify the common morpheme across the words walked, framed, and melted (Answer: ed, making each in past tense). A child might also be asked to think of all the words that make use of the morpheme, re, meaning “to do it again.” Some answers include rethink, replace, redo, recopy, or recarpet. It should be noted that some words that begin with re are not using it as a morpheme with this meaning but it is instead part of the spelling of a longer word (e.g., real, retina, or recipe). Appendix H lists phonological and morphological questions to be adapted as you consider games to create and play to facilitate phonological and morphological sensitivity. Ways to focus children’s attention on orthographic processing are those that best highlight exact spellings. One way to do this in some scripts is via crossword puzzles. Another is to focus children on palindromes, i.e., words that are spelled the same backwards and forwards such as mom, wow, Bob, radar, civic, or racecar. These are often intriguing to children and focus them on orthographic patterns. Another type of activity to use to try to highlight orthographic patterns is to show how words can mean very different things with a small change in how they are written, sometimes referred to as anagrams. For example, a single addition or subtraction of a stroke in a Chinese character might change the character’s meaning substantially. In English, a few pairs illustrate this phenomenon. These are some examples of socalled anagrams: causal-casual, tea-ate-eat, nights-things, sacred-scared. For more palindromes and anagrams, it is easy to search the internet. For example, this website is helpful: www.theislandenglishtutor.com/anagrams-palindromes-and-anadromesheteropalindromes.html. Finally, for fluency games, consider encouraging children to engage in speeded tasks of any type. I must emphasize that when I recommend games of speed for those with reading difficulties, I am focused only on games that a child can play to race or compete with himself or herself. Games that involve competition among different children are almost always a bad idea for children with dyslexia who are used to feeling routinely humiliated by their reading difficulties. However, most children do tend to enjoy racing themselves, seeing if they can get a better or faster time than they did the last time. For any racing game, you just need to use a simple activity and a timer. What are simple activities? For those with severe reading difficulties, you could focus on letter naming. With a sheet of paper or on the computer, make a list of the letters, e.g., L T G B F Q, and ask the child to say them as quickly as possible.Time him.Write down the time. Ask him to do it again, but this time faster. Time him again and see if the time improved. You can do this for the whole alphabet or for a subset. (Keep the number of letters relatively small for those with severe difficulties and include the whole list for those who have mastered

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all letters.) You can try variations on this, e.g., requiring the child to say the letter sounds instead of the names as quickly as possible. For Chinese, try it with just a few very simple characters, e.g., the numbers 1–10 written in Chinese. For any script, come up with variations related to simplicity. If letters are too easy, go to very simple words, either sight words or others that have a given characteristic. Ask the child to read the words aloud quickly. Time her. Repeat for a faster time in the second instance. Once single easy words are mastered, try this with more words or phrases. You can expand more and more, to whole sentences and even paragraphs. The main point is simply that the child should challenge herself by focusing on improving, getting faster, becoming more fluent on reading-related skills. For the topic of dyslexia around the world, there are many specifics of reading that may be particularly relevant to your orthography, language, or script. Maybe, as in Vietnamese or Thai, there are many diacritics that require attention. Perhaps, as in Farsi, Hebrew, or Arabic, children have to go from pointed to unpointed forms; vowels are not explicitly indicated in the unpointed form. It could be that you are struggling with the challenges of phonetic and semantic radicals and their positions, as in Chinese. I have neither the expertise nor the space to consider particulars of reading instruction in each language and script. However, it is also clear that by practicing grapheme (e.g., letters of an alphabet; Chinese characters; given symbols in a particular script) recognition in your script with a child with dyslexia, fluency can be improved. To summarize, for the child with dyslexia, a focus on the four basic cognitive skills of word reading, namely, phonological sensitivity (speech sounds), morphological awareness (units of meaning in language and in print), orthographic processing (print configurations that are correct), and fluency (speed of recognition), is one main key for success.Try to reinforce these skills in whatever ways are available, including games, parent or teacher training or tutoring, or reading activities.

8 SUGGESTIONS ON HOW TO HELP THOSE WITH DYSGRAPHIA DIFFICULTIES

This chapter highlights the different approaches teachers and parents can take to remediating dysgraphia difficulties depending upon the origin of the problem. As with dyslexia, there are two broad sets of strategies that should be highlighted for remediating dysgraphia. One set of these strategies has to do with attempting to overcome or at least remediate the actual writing problem; we refer to these as work-through strategies. Such strategies will obviously depend upon what the cause of the problem is. If the problem is primarily the result of dyslexia, so that spelling itself, whether written or oral, is poor, there will be different strategies that should be implemented as compared to, say, when the problem is a direct visual-spatial or motor difficulty. The other set of strategies focuses on how to circumvent the problem. Children who spend many, many extra hours in practicing writing and see progress only very slowly need to be reminded of what they are good at. Often, they have many other talents, including communicating in various ways such as telling a story or making a film or even drawing a picture (for those whose writing difficulties are not of a visuomotor origin). Although schools typically require that most of students’ work be written work, this is not, or should not be, “carved in stone.” Thus, another set of strategies that must be discussed and which most parents (though fewer teachers) endorse is one of work-around strategies, or achieving greater goals by circumventing the writing part of the assignment when possible.

Remediation: working through the writing difficulties for those with specific types of dysgraphia We begin with a discussion of ways to remediate dysgraphia. It is important to focus on remediation no matter what. As Richards (2018) stated so well on the LD Online website, It is critical that students do not totally avoid the process of writing, no matter how severe their dysgraphia. Writing is an important life skill necessary

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for signing documents, filling out forms, writing checks, taking telephone messages or writing a grocery list. Therefore, students need to be able to write, even if they cannot maintain writing for long periods of time. How to work through these writing difficulties will depend partly on the types of difficulties the child does and does not experience. Recall from Chapter 3 that Deuel (1995) distinguished at least three different types of dysgraphia, namely, dyslexic dysgraphia, motor dysgraphia, and spatial dysgraphia. By monitoring children’s ability to spell orally (when this is possible – it is difficult to imagine doing this in Chinese, for example), children’s actual copying of written text, children’s drawing skill, and children’s finger tapping or finger succession, it should be possible to determine what skills to focus on for those with dysgraphia. It is especially important to observe children’s spontaneous writing as well for any observations this might bring. For example, what does the pencil grip look like? Is the child obviously overly stressed and frustrated? Is it clear why? All of the advice provided below is meant to help stimulate thinking on a particular child but will be incomplete. A lot of the hardest work on this issue focuses on individual observation of a child and trying different techniques to see which ones work the best for her or him. General advice for those with dyslexic dysgraphia centers on remediating reading difficulties as a primary focus and helping to alleviate writing anxiety and stress, which is sometimes even manifested in holding a pencil or pen, as a side undertaking. That is, for those with dyslexic dysgraphia, the focus should be on learning of letter names and letter sounds, or other graphemes in a given script, as well as spelling/grapheme patterns. It is important to make sure that these children write normally and do not have any difficulties with pencil grip or other motor problems. However, the main focus should be on how reading skills and writing skills develop and reinforce one another. Many of the activities recommended for remediating of dyslexia in Chapter 7 are applicable to this group. In addition, focus these children on writing as much as possible, whether the words are perfectly written or not, to ensure that writing is practiced enough. The idea for these children should be that, as reading improves, better writing will also emerge, as long as writing is routinely a focus as it is for all other children. In contrast, by definition, those with motor or spatial dysgraphia alone are adequate oral spellers. As reviewed in Chapter 3, for both groups, there is something about eye-hand coordination that is causing a difficulty. Both will likely have trouble with copying of text and with drawing, though those with spatial dysgraphia will be the poorest in drawing. A person with motor dysgraphia will clearly have difficulties with motor activities such as finger tapping or finger succession. For these children who have difficulties with writing but not reading, a focus on motor skills (for those with motor dysgraphia) and visual-motor skills (for both those with motor and with spatial dysgraphia) is potentially most useful. Exercises with fingers, hand strength, or tracing can be very helpful for children with motor dysgraphia. Although this distinction among the three types of dysgraphia – dyslexic, motor, and spatial – can be useful for thinking carefully about the precise nature of a given writing difficulty, in practice, it is likely that children with dysgraphia, especially

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those who are lucky enough to be diagnosed relatively early in development before the problems become particularly severe and in some cases intractable, will benefit from a variety of approaches to remediating the problem. Exercises in squeezing a ball or drawing or tracing are likely helpful for many children who are learning to write fluently, whether they have a specific motor difficulty or not, for example. Thus, having reviewed Deuel’s (1995) three categories of dysgraphia, I now offer more general advice on helping those with dysgraphia work through writing difficulties. Much of this advice comes from various websites that offer helpful hints on helping those with dysgraphia. Hopefully these websites will be accessible for years to come, but keep in mind that many of the organizations listed in Appendix C, specifically on organizations providing specific information on dysgraphia, and indeed sometimes in Appendix B, which focuses on organizations devoted to helping those with dyslexia (given that dysgraphia is often still discussed as a condition that is associated with dyslexia), are primary sources of practical advice for these children. My goal in including these appendices was to identify some excellent organizations from which further updated information can be gleaned later, apart from the summary below. The following summary highlights the most important approaches to dysgraphia remediation overall for motor and spatial forms of dysgraphia.

Make graphemes using different forms and mediums For children who have difficulties with both reading and writing, more practice with letter or other relevant print patterns and an emphasis on visuo-orthographic configurations is particularly useful. Children who begin to hate writing need to unlearn that negative emotion. How do you begin? One suggestion is that children make use of different mediums to experience how basic graphemes feel (Rosen, n.d.). There are variations on this exercise to try depending upon the interests and age of the child, including working with clay to model these, sand to trace them, or chalk, soap, or finger paint to write them on an appropriate surface. Another way to focus attention on the kinesthetic aspects of writing is to write with a finger on the child’s hand or back and have him or her guess what has been written. The child cannot see the outcome of the writing but must judge this based on feel alone.

Practice fine motor coordination and strengthen hands Another group of suggestions for those with dysgraphia centers on fine motor coordination exercises and hand strengthening. Rosen (n.d.) recommends using “pinching” tools for the child to try to pick up objects. These ideas remind me of the classic children’s game called “Operation,” where players would have to use play tweezers to remove objects from inside the game; any time the tweezers touched the side of the game, the game would make a sound and the player would lose points. Rosen suggests asking children to pick up small objects with tweezers, tongs, or anything else that requires good finger dexterity. Rippel (n.d.) highlights the

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importance of fine motor skills as well. Some tasks that involve fine motor skills that might be appropriate for younger children to practice include stringing beads, locking and unlocking a lock with a key, putting together the puzzle pieces in a puzzle, or lacing one’s shoe. Hand strengthening can also be helpful and can be attempted in various forms, such as squeezing a ball, manipulating clay or dough, squeezing material out of a bottle in some way in order to accomplish a goal such as making patterns with glue or icing or glitter straight out of their containers, or buttoning and snapping.

Focus on bilateral integration Many websites (e.g., Dodge, 2003) also recommend that children with dysgraphia get some training in how the right and left hands work together and interact in accomplishing tasks, also known as bilateral integration. If you think about the writing process, a lot of physical writing, either with a pencil or pen or by typing, involves using both hands. When we write by hand, although we use one hand to make marks on the page, we also use the other hand to guide the paper. When we type, we do so most efficiently using both hands at once. Thus, an important focus for those with dysgraphia is making maximal use of both hands in a coordinated way. Reinforcing this skill in a fun way might help to improve coordination for writing. There are many suggestions on how to do this, including gross motor movements such as moving on the monkey bars or moving on hands and feet together (either dog or crab style), throwing a very large ball that requires two hands to manipulate, using scissors to write, playing with drums or a tambourine, pulling a rope hand over hand, using a fishing pole to reel in fish (either real fish or targets to pick up some other way in a game), and doing jumping jacks or touching toes (left foot with right hand; right foot with left hand). If children are motivated enough to play a musical instrument such as guitar, piano, violin, or trombone, this is very good training as well. It is worth noting here that researchers have some ideas about handedness development vis-à-vis writing that those focused on dysgraphia may want to consider. Handedness preferences for writing tend to develop around the age of 3–5 years in many cultures (e.g., Dodge, 2003; Forrester, 2016). While we tend to think of ourselves as either right or left handed, this is more of a tendency and not an absolute. For example, children may prefer one hand for using a spoon and another for brushing teeth. Yet for most of us, there is a clear preference, and all of these activities focused on motor skills may help to stimulate development of handedness. In general, having a preference for one hand over the other for routine activities such as writing is often preferable, though about 3–4% of the population of typically developing children does not show dominance of one hand over the other. Dominance of one hand over the other indicates that the brain has begun to specialize in use of one cerebral hemisphere over the other. Interestingly, for those with developmental difficulties such as autism spectrum disorder, the rate of nondominant hand preference is higher (17–47%) (Forrester, 2016). Hand dominance is

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associated early with more efficient abilities in accomplishing a task such as writing (Hand Dominance, n.d.). Thus, it is important that the child have a preferred hand for writing at least by the ages of 5–6.Those who appear to be more ambidextrous, either naturally or because of training to do so, have run into more difficulties than have those who have a dominant hand preference (Dvorsky, 2013). If this hand preference is/was not the case for a given child with dysgraphia, it would be useful to get him or her some help with this issue from a specialist. In addition, because about 90% of the population worldwide tends to be right handed, those who are left handed in various cultures have over the years sometimes suffered from parents and teachers insisting on them using their non-dominant hand to write. This is clearly problematic for the child. A website devoted entirely to left-handed people in the U.K. lists a myriad of potential problems associated with this (Dvorsky, 2013). Many of these difficulties have to do with writing, spelling, and reading. Remember: Handedness indicates not just hand preference but cerebral hemisphere dominance in the brain, and this specialization helps us to use spoken and written language more efficiently.

Copying practice Apart from these various activities listed above that are designed to help stimulate visual-motor and basic motor control without actually writing, children with dysgraphia also need help in honing in on copying and writing skills. By definition, those with dysgraphia have a difficult time with copying tasks. Practicing copying apart from writing itself may at times be useful for such children, particularly when oral spelling is additionally frustrating for the child. I spoke with some teachers of primary school children learning Hindi and other Indian scripts in India, and they said they routinely ask children with dyslexia to practice tracing dotted line paths created specially by the teachers on paper. They said that this seemed to help. Other recommendations are to trace or draw geometric figures or to try games involving mazes if they are of interest to the child. Anything that helps the child to be more accurate with a pen or pencil in making marks on paper is potentially useful for this group. Later on, copying of actual graphemes, including letters, Chinese characters, or any other script elements, is generally practiced in every culture. Those with dysgraphia simply require more practice. It may be particularly helpful for such children when the graphemes are enlarged so that they can clearly see every mark with enough space to make the shapes and markings very clear. In Chinese, it is very clear that those with writing difficulties tend to exhibit more variability in stroke order than do those without writing difficulties (Chang & Yu, 2013). Chinese is the most extreme case in which routinizing the writing of graphemes is likely to be important. The more routine, or automatic, writing of every grapheme is, the more that frees up mental space in the learner for thinking about other aspects of the activity.Yet it is likely that for every child in every script, automatizing writing will make it easier. This implies that children with dysgraphia should be not only taught and encouraged to write each grapheme in a routine order but also be habitually monitored in class to ensure that they maintain this order. For example, it is possible to write a

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lower case b in at least 2 ways (circle first, line second OR line first, circle second). One can imagine a child getting confused about how to write these, particularly in trying to distinguish b from d. I am suggesting that for every child with difficulties writing, the child explicitly adopt an order of steps in writing this. For example, for b, make a line from top to bottom first, then attach the circle away from your body or to the right. In Chinese, stroke order is a very important part of writing, with characters comprised of up to 20 or more strokes being written beginning with stroke 1 in order up to the final stroke. Research on aksharas in India also indicates that children who have not established a set order for writing of graphemes have more difficulties in writing overall (Nag, Treiman, & Snowling, 2010). Individual letters are less complex in composition of different marks, but making these automatic in a given order is equally important. Thus, no matter what the script, make sure that children are writing the graphemes in a set order – no deviation allowed.

Writing practice Finally, children with dysgraphia must find new ways to write in a comfortable way. Many children actually complain about the pain and tension involved in writing. How can this process be made easier? Jennifer Dodge (2003) is a pediatric occupational therapist whose website is devoted to suggestions for those with dysgraphia on many areas related to dysgraphia, including writing itself. I learned a lot from her website, and you might want to look more closely at it as well. In one section of her website, she mentions some of the activities that she personally found worked well for her clients. Many of these simply involve being innovative and finding what types of writing implements and paper work for a given child with dysgraphia. For example, she suggests trying raised-line paper so that children will feel a bump when they cross it in writing (which presumably helps children stay within the lines more effectively). Other types of paper with enlarged spaces, darkened lines for clearer reference, or graph paper might help. Experiment with types of paper to see if children perform better with one or another type of paper available. For all children, running out of space on a page creates problems. Thus, it is essential that children be given enough space to write. In addition, different types of pens or markers or pencils may be preferable. Mr. Cheung, profiled in Chapter 4, really felt that a specific fountain pen felt good enough in his hand that he wanted to write more.There are many colored markers of different thicknesses, pencils that are thicker and thinner, even scented pens. . . . It is most important to experiment with these and see what helps to encourage children to write more. With the writing implement, it is particularly important to determine which ones feel good in terms of grip. This may facilitate more writing in the long run.

Work-around strategies Having just discussed various ways to help children with dysgraphia to improve their writing and various aspects of this process (e.g., developed fine motor skills, hand dominance, a relaxed grip), we turn now to strategies that are useful in

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improving children’s school performance overall. To begin with, children might be able to write better if given alternative ways to write. Some professionals suggest that cursive writing may be easier to write than is print because cursive writing involves fewer stops and starts and is a smoother process (10 Tips to Help Children with Dysgraphia, n.d.). Some argue that the spacing and also the placement of the pencil for the beginnings of words is easier for cursive as well (Marianne, 2018). Finally, reversals of letters with cursive might be fewer (Hanning, 2016). Learning to type can also be a huge time saver for those with dysgraphia, so consider teaching your child to type very early (10 Tips to Help Children with Dysgraphia, n.d.). Typing one’s assignments allows children to go back and correct their errors without having to erase or cross out mistakes, and this leads to a far better looking final product (Cicerchia, 2016). In addition, sometimes children can learn to write using muscle memory, an additional aid for spelling. Ms. Amy, the translator introduced in Chapter 5, uses this technique often, first practicing several times the feel of the word beneath her fingers as she types. When a child can type without looking at her or his fingers constantly, this frees up cognitive resources for thinking more carefully about the ideas she or he is expressing. Technology is improving all the time, and this is excellent news for those with dysgraphia. Perhaps one of the most effective tools they can use for additional support is in the area of speech to text. A variety of programs are available to convert written text to oral presentation as well as oral output to written text. Consider investing in one of these programs to help your child reach his maximum potential in reasoning without the frustration of difficulty in writing. Overall, given the available technologies these days, it should be relatively easy to allow children to present their work using an alternative medium to handwriting. Remember that, for all young children but particularly those with dysgraphia, so many cognitive resources are required for writing individual words that very few are left for developing higher-order skills such as organizing the overall arguments in an essay.Those with dysgraphia should not show particular difficulties with logical or well-reasoned arguments if these can be presented in formats that are alternative ones to writing. Some children with extreme difficulties may wish to tape their classes so that they can have an oral record of what they have learned. Some children might also ask other adults or children to help them with note-taking in class when paying attention to what is being said is so important. Find out if the teacher could also provide organized notes to the child as additional support. As with all children, those with dysgraphia may benefit from some general presentation tips as well. For example, the use of graphic organizers, which help remind children of every step of a particular piece of writing, such as the topic sentence, the main points, supporting points, conclusion, etc., may be helpful (Osen-Foss, n.d.). There are a variety of online resources devoted to helping children to organize their writing these days. It is important to consider some of these for children with dysgraphia. In addition to these, it is important to keep in mind how many different ways there are to learn and to demonstrate learning. Different websites list these

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alternatives. Some of them include creating games, writing plays or basic dialogues, doing a short film, creating a radio show or other narrative, and showing knowledge using charts or figures. In addition, overall, teachers should consider doing some of their testing using an oral rather than written medium. It is possible that this will take more time and effort initially, but over time, this may prove to be equally interesting and helpful as compared to written answers. Perhaps one of the most important messages for those with dysgraphia is that it is essential to talk with teachers about how they grade their students. While the value of an orderly, neat-looking paper with correctly written/spelled words is important, the content of an assignment in terms of organization and ideas is also important. Often, teachers fail to distinguish the appearance of the assignment from the ideas communicated in it. A common complaint among my interviewees was the failure of teachers or principals to distinguish the content of an assignment from the form it took. While some points are typically given for a neat assignment in which the words are correctly written, this should be distinguished from the content. Teachers who are clear in how they grade for these different aspects of the assignment are particularly helpful to those with dysgraphia. To conclude, there are a variety of tools one can use in an attempt to remediate dysgraphia. How you work with a child to help remediate dysgraphia will depend in part upon the type of dysgraphia the child has, so try to be an observant detective to pinpoint the difficulties. In particular, try to figure out if the dysgraphia is or is not occurring as a result of dyslexia, and proceed from there. Both work through and work-around strategies can help a lot in focusing a child with dysgraphia on what is important in terms of writing and communication methods. In addition, teachers should be willing to grade assignments only partly based on the neatness and correct writing/spelling of words and partly based on other aspects that those with dysgraphia are likely to be unimpaired in, such as organization, creativity, and synthesis of material. Having covered some basic techniques for dysgraphia remediation, we now turn to the remediation of ADHD in Chapter 9.

9 HELPING CHILDREN WITH ADHD

In this chapter, I discuss some of the tested methods to help children with attention difficulties perform better in school. Although it is true that some of the more severe cases of ADHD are sometimes prescribed drugs to help children concentrate, a lot of the best approaches involve behavioral techniques to encourage children to stay on task. Some researchers also assert that drug therapy for attentional difficulties is more common in North America than it is in Europe and Asia. Luckily, behavioral modification techniques are fairly universal for helping children in going to school and doing homework. Excerpts from interviews with some of the teachers, parents, and children on best practices for keeping those with attentional problems on track are included to give maximal practical ideas on what might work for helping these particular children to learn best. We first consider some behavioral techniques and then go over the pros and cons of drugs for remediation of ADHD. For many children who have been diagnosed with ADHD, both behavioral techniques and medicine for the difficulty have helped at different times and in different situations. First, let us recall what having an attentional difficulty is like or implies for most people. Children who have these difficulties are still developing and lack the selfawareness of adults.Thus, it is not easy to get a comprehensive idea of what it is like to have an attentional difficulty. However, Jergen (2004), an adult who specializes in learning difficulties and who wrote about his life growing up with ADHD, gives a clear description of how attentional difficulties feel. He says, For people with ADHD, being able to concentrate is a very transitory event. It is like the weather. One minute it is bright and sunny and I can focus my attention with remarkable clarity. The next moment, clouds are rolling in and my head is filled with a fog. Consequently, I take great care to utilize the times when I can think and I do my best not to let them slip away. That is why I do not tolerate interruptions and try to minimize them as much as possible. (pp. 108–109)

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With a complementary perspective, Barkley’s (2014a) edited handbook on ADHD makes the case that this difficulty is fundamentally one of self-regulation, manifesting itself differently in different people. How can we best help those with ADHD to stay on task?

Work together with a plan One broad-based suggestion from several individuals I interviewed was that for any child with learning difficulties, there should be a collective effort on the part of his or her advocates and mentors to come up with a comprehensive plan for the individual child. In some ways, this is against what is the central school mandate, which is to provide an equal education for all. However, for those with specific learning needs, there is an entire profile of strengths and difficulties that must be integrated to maximize their performances. As Mr. OM, a German school teacher, summarizes, We should set up an individual strategy for each student. This will cost time and money, but it is the only professional way to work on one’s specific learning difficulty. The main problem is that in schools, we show good will and organize extra-curricular courses for these students. But mostly, its organization is focused on the whole group and not on the individual. Sally, a parent of a child with ADHD, says something similar: Learning comes in all shapes and sizes. Don’t force kids with disabilities to learn in ways that don’t work for them. On the whole, it’s good to learn different ways of doing things, but these kids face special challenges and the same rules just don’t apply. For example, the latest trend in education is to do lots of group/team work. This is very difficult for my son and makes the whole team miserable. Forcing him to do this is not teaching him to be a better team player, because he simply doesn’t function well in group settings. Continually forcing this makes everyone unhappy. A key to this focus on collective efforts is that advocacy is sometimes required. Families have to advocate for their children, because sometimes they find themselves in a position in which they are the only ones who have the genuine understanding of what will help. Mrs. Mayo, from Spain, said this very eloquently. Having first expressed tremendous admiration for teachers and their sometimes seemingly impossible tasks and expectations, she continues, Nevertheless, I cannot understand that there are still sectors in the Spanish education system that deny learning disorders. In Spain, there are still teachers who say they do not ‘believe’ in dyslexia, ADHD, or dysgraphia, as if it were a question of faith like the existence of God. I cannot understand why, when

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you, as a parent, have the first meeting with the teacher and bring the medical documents that state that your child has LD, the teacher is allowed to tell you, ‘I do not believe in this diagnosis, these are not real disorders, your child has no problems at all.’ And these teachers are allowed to continue with their jobs and are not punished! And it is the children who have to attend their classes, the ones who are punished because they cannot keep up with the rhythm, can be punished with extra homework, can be punished with extra low marks.

Impose structure Another theme from the interviews was the fact that children with attentional difficulties sometimes require externally imposed structure longer than do other students. This is not easy, because all parents struggle with raising their children to be more autonomous over time. It is not easy to balance children’s needs and capabilities for autonomy against the fact that one of the main struggles for those with attention difficulties is to stay on task. Ms. Ellen’s advice to those with children with learning difficulties is, thus, Bring structure to their lives, because it is very difficult for them to do so by themselves. As a parent, one simply has to accept that kids with ADHD need someone to bring routine into their lives. For example, until he was around the age of ten, my son regularly needed to be reminded to go to the restroom. I knew by the way he was moving around that it was time for him to go to the toilet. He wouldn’t go of his own accord. He was simply thinking too much about other things, too absorbed in a game or a movie on TV. Ms. Sally similarly focuses on helping her son with ADHD to structure his daily routines with the following strategies: Written reminders. Calm, matter-of-fact repeated instructions. Structured rules such as: you can’t play on the computer in the morning until AFTER you brush your teeth. And when they forget, calmly remind them. . . . Yelling or loss of privileges will not improve their ability to remember to do it next time. Similar to Ms. Ellen’s son, Ms. Sally’s son also requires many more reminders than other boys his age:“My son is almost 11 and must be reminded to brush his teeth 90% of the time. He takes an hour or two to finish homework that he could easily do in 15 minutes if he would focus.” Hong Kong psychologist Dr T succinctly notes that ADHD kids require “consistency, structure, repetition, and reinforcement.”

Give children some control over their own success and failure At the same time, it is important to give control to students over their learning whenever possible. Mr.Toyota, a Japanese speech therapist, says, “I try to help children

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acquire ways to get information by themselves, like checking dictionaries, using textspeech functions, or typing.” Both clinical psychologist Dr. MC from Macau and school psychologist from the United States, Dr. RJ, also emphasize the importance of scaffolding students so that they can learn from their mistakes. Dr. RJ notes that Failing is part of the learning process that is not often honestly or openly discussed. Winning is highly prized and promoted. Making the attempt, failing, learning from what went wrong, then trying again is seen as cumbersome and made to be a painfully embarrassing experience.Yet, it is an integral part of the learning process. It needs to be openly addressed with these kids, or they will cave too quickly. Three teachers from Australia who agreed to be interviewed agree: It is very important to explicitly teach the skills that make a person independent, and, in time, ensure that parents don’t do everything for their children. They have to make mistakes and learn from these, but this takes time, patience, and trust. They went on to note the importance of having appropriate expectations to then “provide them with the freedom to have a go.” Apecu89, a Swiss man with ADHD, in answer to my question as to what his best advice is for overcoming a learning difficulty said simply,“Failing. Making new strategies. Failing again. Improve the strategies. Win. Fail Again. Improve them again. The child has to understand: I have a learning difficulty and that is why I need to find a solution.” At another point in the interview, he also emphasized how important the balance between child and parent is for structuring homework, saying, I was forced to (do my homework). Don’t force – It will not work in the long term. Of course the child shouldn’t always be allowed to do whatever he or she wants, but it’s best if the child does it independently. Give the child one month. Tell the child: ‘I will support you, but you are on your own to study. If you want boundaries, I give you boundaries.’ Tell the child what is going to happen if he or she doesn’t pass the exams. The consequences have to be written down and (VERY IMPORTANT) carried out, once the child has failed. He or she will fail, but that is not a problem because he or she can try again the next month and will know: Mum/Dad are serious with the consequences. Explain to the child what grades he or she needs to have to pass to the next school year. NO PRESSURE, but he/she needs to understand and again to sign (a contract with the parents), (to show) that she/he understands what he or she is dealing with. Such ideas about allowing students to control their own destinies are important. Barkley (2014c) would probably also say that these must be thoughtfully carried out with careful consideration of the child’s age and maturation level. Those with

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ADHD must experience both success and failure, but parents and teachers should help to scaffold children in this process. Part of this will be sensitive teachers, parents, and clinicians helping children to understand what strategies work best for them in managing their study habits and, more broadly, their lives in general.

Techniques that may help to focus the person with ADHD Robert Jergen (2004) devoted three chapters of his autobiography to discussing techniques that work for him in facilitating his learning given his ADHD characteristics. One striking feature of his description is how specific his ideas are. We all have various peculiarities, like what shirt feels the best, our favorite music for working, when and how we sleep. I urge you to take a look at his final chapters on how he learns best. He talks about the fact that light is an issue. Lights that are either too bright or too soft are both problematic. In addition, the auditory environment is very important. He is particularly bothered by non-constant noise, e.g., a library or test situation when people are mostly silent but in which, every once in a while, the silence is punctured by a cough, sneeze, an announcement, a machine noise. The recent perfecting of various (noise-cancelling) headphones might be an additional modern consideration for many. Some headphones can help to cancel out all background noise but allow for listening of direct and focused auditory stimulation as well. I could relate to many of his observations, and I think it is important to underscore that for anyone trying to improve the way they learn, the individual should keep trying different techniques (different lighting; no music, some music, other sound stimuli) until he or she finds what works for him or her. This may be different than what will work for the next person. More of these suggestions appear in Appendix D. The most important suggestions for those with attention difficulties all appear to center on how to create a suitable working environment and how to ensure that work continues uninterrupted for as long as possible. Apecu98 advocated for a special designated study area, such as the basement, one’s own bedroom, the kitchen, the study, the grandmother’s house, even a special angle at a big table used only for studying. Ms. Amy, an American with ADHD and other learning difficulties, focused on how important it is for her to light up the keyboard and console area of the study and to keep everything else in the room reasonably dark so that the attention is always naturally drawn to the computer. How can a student best fight distraction when it encroaches on his or her study time? A consistent theme is that individuals must plan for distraction time. This is very important. It is unrealistic for anyone, particularly those with attention difficulties, to plan simply to continue studying for as long as possible. Without an end in sight on tedious tasks, we might all despair. Both Ms. Amy and Apecu89 have devised their own strategies for helping themselves to work through as they make headway on assignments or other tasks. Ms. Amy advises planning break times. The amount of time allocated between breaks to study will be individually determined by the child, and the idea is to lengthen the time between breaks

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as one gets older and also to allocate a reasonable amount of time for the break. Apecu89 says it this way: SHORT LEARNING: 20min – break – 20min – break. But these 20 minutes have to be (focused) fully on the paper. As an adult I always study 20 minutes and then get a water/snack or smoke a cigarette to congratulate myself: Hey, I studied 20 minutes without having a concentration break. In addition, Ms. Amy notes that the break time should be fixed and relatively short. This should also be determined based on the age and capabilities of the individual. The key is to stick to these principles and enforce them as a good way to structure productive time. One additional suggestion that Ms. Amy made that might be useful for some students is making use of a distraction list. This one resonated with me given the constant distractions of the world both externally (e.g., in an office or at home, a person comes to chat with you, you receive a text or a call, your computer indicates an incoming email) and internally (e.g., you remember that . . . you forgot to feed the dog, you need to arrange to have your friend come over, you are worried about something, you wonder if a particular actress is dating a particular singer, etc.). Ms. Amy advocates keeping a distraction list and writing down anything that is distracting in order to follow up on it later. This idea is similar to the worry list that is recommended by sleep experts to help you sleep better and not be overwhelmed to the point of insomnia by worries (Holmes, 2017). These ideas are all helpful in ensuring that the child does not get overcome by distraction.We now turn to some ideas on how best to help the child to accomplish a given assignment.

Barkley’s (2012) approaches to staying focused and organized In his YouTube talk entitled “30 Essential Ideas for Parents,” Russell Barkley (2012) presented five basic concepts that are the cornerstones of helping those with ADHD to stay focused and organized.These are all based on the premise that, because those with ADHD have more difficulties in self-regulation, including keeping ideas in short-term memory, being able to inhibit responses so as not to get distracted, and keeping good control over their attentional resources, a basic principle of teaching those with ADHD is to keep ideas external. That is, whereas those without ADHD may be able to keep many of their ideas and plans in mind, those with ADHD often have to keep these somewhere concrete and visible to remain on track. Barkley recommends that parents and teachers focus on these basics and develop them in whatever way makes the most sense for a given child. First, those with ADHD must ensure that they have externalized their memories. This means that they need to keep a physical list of things that must be done or considered. This could be in the form of signs or posters, stickers or some other symbolic representation, notebooks or pieces of paper, but the list must be out and

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it must be accessible to the person with ADHD to consult, to add to, and to serve as a continuous reminder. Second, Barkley (2012) notes that those with ADHD are notoriously poor with time management. Children with ADHD need to be reminded as to when things begin and end. They cannot be relied upon to monitor the time completely on their own. In order to help those with ADHD to keep track of time, consider making use of timers, counters, clocks, phones, or other devices. Some clocks and timers may set off an alarm that one can hear, whereas others may simply vibrate. The style and number of different devices one needs will vary depending on the person with ADHD and his or her support system. For example, it may be better for a teenager to use a vibrating timer to avoid having classmates be aware that he needs to time himself. Ms. Monica additionally suggests asking children to get into the habit of estimating the time it takes them to complete tasks and building that into their schedules. Many children have no idea how long any activity takes, so it might be helpful to help them to time themselves doing it once and then use that time for making up their schedules each day. This focus clearly gives children a better sense of how long daily chores and activities will take and how each day will evolve. A third fundamental practical point from Barkley is that all big tasks must be broken up into smaller ones. Like all of his tips, this is likely useful for everyone whether they have ADHD or not. But this one is critical for those with ADHD. For a fourth grader with ADHD to be asked to write a book report, for example, just as a holistic endeavor, is pretty nearly impossible. The task sounds too huge for some children to even know where to start. Therefore, those with ADHD must themselves or with other supporters divide the task into manageable smaller tasks. For example, a book report will involve selecting a book, hopefully for a compelling reason (that is, if the child is so bored by the book that he or she stops reading it, the rest of the process suffers), reading the book (perhaps chapter by chapter or page by page, depending on the child and the book), forming/expressing an overall opinion about the book and being able to back up those reasons with examples, including quotes, outside information, and one’s own reasoning, and writing the book report. Depending upon the length and the style of the book report, writing it will itself demand a series of steps. Different children and families could divide writing the book report into tasks that are different from the ones described above, of course. This is simply an off-handed example. The main point here is that homework-related tasks tend to be easier to accomplish when they are divided into smaller tasks, or what Barkley refers to as “baby steps.” These should also be close to one another, sequential, and without a lot of time in between the accomplishment of each individual step. Barkley argues that steps are easiest to process as a series of event-response-outcome occasions. For example, a child must select the book to be reviewed for the report (event) and do so in a timely manner (response) so that a variety of outcomes occur, such as happy parents, a stress-free evening without struggling over homework, or time to play. This example leads to Barkley’s fourth point.

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His fourth idea to help children with ADHD to succeed is that motivations for success must be external. Many of us have at least some vague motivations for succeeding. Thus, even if a given assignment is boring or frustrating, we can power through it because we want to do well in order to succeed. Success means different things to different people, but that might mean to be the best in a particular school subject or to fulfill our distant dreams of becoming a high school or college graduate or simply to show that we can do it. For those with ADHD, there might also be distant goals, but these often are completely “off the radar” most of the time. Without any goals for success, there is no motivation for continuing to work on a difficult task. Therefore, Barkley says that supporters of children with ADHD must help to create an artificial system of immediate rewards. This is why a token system or any other system of rewards (e.g., if you finish this spelling paper, you can play on the computer for 15 minutes) that suits your school or family structure is crucial for these children. What is particularly important about this for me is the fact that he acknowledges how parents and teachers agonize over how materialistic children might become when they are accomplishing tasks only in order to gain rewards. We as parents, teachers, or other professionals, do not want to encourage such materialistic attitudes. Barkley says, though, that this should not be a concern for a child with ADHD. Basically, such a child has no built-in mechanism for intrinsic or long-term motivation, so such external motivation must be continued as a way to scaffold those with ADHD for quite a long time as the child slowly matures. This lack of built-in reward mechanisms, in addition to the need for change and activity expressed by some with ADHD, make some educational programs more desirable than others. Austria, Germany, and Switzerland offer high-quality apprenticeships that may be particularly well-suited to those with ADHD. These educational systems are demanding and require studying. However, students typically study one to two days per week and spend the other days learning whatever trade they have chosen in a very hands-on fashion. Whereas universities are very theoretical and abstract, apprenticeships, which typically begin in these countries in mid-adolescence, are more practical and hands on. They also offer a variety of changes in the environment, keeping students interested and on task. I often think that these types of apprenticeships would work well worldwide because they offer opportunities to learn skilled trades in an enriching environment. The final basic principle laid out by Barkley (2012) in his YouTube video is the importance of helping children with ADHD with so-called mental play. He says that the difficulties of ADHD are all centered on regulating the self in terms of thoughts and plans. Those without ADHD will likely be able to think more abstractly and more into the future than will those with ADHD during childhood. The practical implication of this is that problem-solving must be rendered a process of the here and now, of the manual and the physical. Thus, for understanding mathematics, children should be encouraged to use their hands or concrete objects. Again, all children benefit from doing this initially but Barkley thinks that this is particularly important for those with ADHD. He also gives an example of how to write a story with cards, saying that one technique involves externalizing thoughts

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so that they can all literally be placed in front of the child. He recommends asking the child to come up with an idea, writing it on a card, and then coming up with another idea, and writing it on another card, and on and on, until several ideas have been generated. At that point, the child has a number of cards in front of her or him and can use all of these, which are concretely there to be examined, to work with in order to generate a story.

Maintaining emotional flexibility Barkley (2016), in his book for teachers entitled Managing ADHD in School, additionally advises that apart from helping children to structure their lives in order to perform better at school and be more organized at home, such children often become mentally and emotionally exhausted from the efforts they make in selfregulation. Indeed, it is difficult for all of us to soldier through effortful tasks. They require concentration and special efforts. For a person with self-regulation difficulties, such efforts sometimes seem all the more herculean. Barkley (2016) talks about all the efforts involved in executive functioning as “depleting the available pool of effort” (p. 21). The issue, then, is how best “to more rapidly replenish the resource pool.” Basically, this means that ADHD students, like all of us, but more so, need to take a mental break. Often. Furthermore, like the rest of us, ADHD students become more “depleted” when they have to engage in demanding tasks under difficult conditions, such as those that are particularly stressful, or when they are feeling ill or under the influence of any mind-altering substances such as alcohol or drugs. What is the best way in which to replenish a mentally and emotionally exhausted student with ADHD? Barkley lists several suggestions, including physical exercise, one of the tried and true favorites, and relaxation and meditation. Some studies (e.g., Van der Oord, Bögels, & Peijnenburg, 2012; Zylowska et al., 2008) have suggested that mindfulness mediation can be helpful to those with ADHD. These might be ones to consider, although these and other studies do not always show clear objective benefits as compared to a control group. More research is needed, but clearly if your own child enjoys or seemingly benefits from meditation or mindfulness training, this is worth considering. Barkley also suggests that children be encouraged to try to help themselves feel more positive about their abilities with what he calls “self-affirming statements” (p. 22). Canadian vice principal and special needs teacher Anna Garito gave a few examples of these in her interview, such as “I will try my best, I will do this to the best of my ability and if I can’t do it I will try again and not give up.”These can be good reminders. Finally, when work is particularly taxing, frequent breaks of a specific time limit (Barkley himself recommends 10 minutes) are essential.Within this time period, children should be allowed to do whatever they prefer within the limits of the given situation. Barkley also recommends tapping into the rewards concepts of the children, including picturing future rewards as they work as well as obtaining such rewards periodically. Again, what these rewards will be depends upon the preferences of the child. However, it is crucial to keep up a rewards system systematically to help

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children with ADHD power through because of what Barkley refers to as a “motivational deficiency” (p. 20) in these children. One thing that is very rewarding for some of those with ADHD is video games. Some of these games, focused on wars or racing are extremely appealing, particularly for those with ADHD (Maucieri, 2016). Indeed, some with ADHD even have a “hyperfocus” on video games. They are very attentive to the games, to the exclusion of almost everything else. Video games offer a reward system that is immediate and fun. These may indeed be helpful for students with ADHD, as long as the amount of time these games are played is limited. I once knew a teenage boy named Arnaldo, a young adult with ADHD whose native language was Italian, a language I cannot speak. I saw him as part of a larger group often over the period of a couple of years in Switzerland, and each time I just smiled and nodded. I knew that he had not learned English in school because his ADHD was rather severe, and so I did not talk with him. One day, I made a remark to others about him within earshot (I said he was handsome), and I thought I observed that he had understood what I said based on his reaction. Later that evening, I found him alone and asked him, tentatively, slowly, in English if he spoke English. He answered this and my follow up questions in full sentences in English! Astonished, I finally asked him how he had learned if not in school. His answer was “Grand Theft Auto.”This popular computer game was so rewarding to him and to others like him that it has even had the impressive effect of teaching him good English skills. Perhaps one’s mantra vis-à-vis ADHD and computer games should, therefore, be that limiting, but not disallowing, computer game play is likely of key importance in rewarding those with ADHD. Finally, Barkley suggests “generating positive emotions” (p. 22) and also having the children drink something that is rich in glucose while doing their work can help to replenish emotional and cognitive resources. Some people wonder about the second suggestion given that it has been relatively popular to focus on diet vis-à-vis ADHD (e.g., Stevens, 2018). Indeed, you need only type into the internet ADHD and sugar and you will find a huge number of arguments about the associations between the two. Barkley’s (2014c) argument is that the brain requires glucose to carry out complex calculations of every sort, and if children with ADHD sip drinks with some glucose such as sports drinks or juices, this may help. It may be a good idea to experiment with very moderate amounts of such drinks to see if this is useful for your child. As for promoting positive feelings, this is always a good idea and parents and teachers who know the child well will presumably do their best to carry this out in whichever way makes the most sense for him or her. Having reviewed these various behavioral techniques for helping those with ADHD to perform optimally in school, we now turn to the other aspect of ADHD management that is often considered for such children, namely, medication.

Medication One of the main difficulties parents of children with ADHD face is the issue of whether to encourage or allow them to take medication to help with their attention

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difficulties. Medication is not something that can be used to treat reading or writing difficulties per se, or at least there is no strong evidence that it is broadly helpful for those with such difficulties so far, but there is solid research to highlight the fact that medicine often works for helping children with ADHD to concentrate (see, e.g., Faraone et al., 2015). Indeed, Barkley (2014b) is a relatively strong believer in medicine for most children and some adults with ADHD. He makes the case that, for those with ADHD, “daily medication use could result in a near-normalization of functioning” (p. 368) and goes on to say, “Undoubtedly, this is one of the most extraordinary findings from neuroimaging studies of the past 15 years” (p. 386). Barkley (2014d) also acknowledges that the media and general public often worry about the potential problems of such medications for the brain. Although there is not much evidence of adverse effects of ADHD medication on the brain long term (e.g., Faraone et al., 2015), it is also true that the decision to use such medications is not typically an easy one for families. Indeed, there is great ambivalence across communities on whether using drug therapy to help children with their learning comes at too much of a cost to health, personality, or the core of the child. A good example of this ambivalence comes from Sally in the United States In answer to my question as to whether children with attention difficulties should take medication, Sally, mother of a boy with ADHD, says this: SHOULD they take medication? I don’t believe we should be giving someone whose brain is still developing ANYTHING that has the potential to disrupt their natural development. My husband and I were so torn on this subject. I didn’t want to give a developing brain any chemicals that weren’t absolutely necessary. But my son’s school was pressuring us to medicate him or homeschool him (when he was about 7).This was all done without actually coming out and saying it, of course. ‘I’m afraid we’ll keep having these behavioural problems and keep having to send him home 1 or 2 days a week when we can’t handle him. And then we’ll eventually have to suspend or expel him.’ Sally continues, I absolutely understand and don’t blame them.With mainstreaming, every teacher has 2–4 problem kids that just suck up the teachers’ energy and attention. We were in California at the time, and they didn’t/don’t have the resources to handle kids with behaviour problems at many schools. It’s just an awful and unwinnable situation. . . . So in the end, we decided it was absolutely necessary, and we gave him the minimum dose he could get by on, and only on school days. Most people I interviewed on this topic reflected a similar feeling that this is a very complicated and individual choice. Mr. OM, a German school teacher, noted, We have students who show a turn to their best concerning behaviour (when using medication). But they seem to be slowed down; some even say ‘I am not

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at ease with myself.’ Others report that their medication helps them to organize their little world. In my opinion, pharmacological therapy should always be a part of multimodal therapy. There must always be something else (e.g., behaviour therapy; Gestalt therapy, etc.). A simple medication changes nothing. Austrian Educational Psychologist Erika Barker-Benfield was initially opposed to medicine for attention difficulties for all, but her view has changed over the years after getting to know several clients who really benefited from the medication. She told me that there are two reasons to use medication. The first has to do with educational problems, our main focus in this book. The second is related to social problems: They have no friends and it’s very difficult not to be impulsive. ADHD is a spectrum. If it’s just a little bit, you can try with therapy. If it’s really a big problem, then they may need medication.When a 6- or 7-year-old child says he doesn’t want to live anymore, because nobody likes him, he has no friends, can’t stand school, the teacher hates him, you have to do something. She concludes with the compromise that many people advocate, particularly given parental worries: “After I have diagnosed a child, I always say we will try everything else first. If there are no changes, we may try medication.” Severity of symptoms can, of course, also affect approaches to ADHD a lot. As Dr. MC, a clinical psychologist from Macau, notes, It depends on the severity of the child’s attention difficulties and their impact on functioning. I typically don’t recommend meds to parents, as I believe behavioral approaches, exercise, or even brain breaks and improved sleep can make a huge difference in attention.When everything fails, I will then strongly recommend medication to curb the downward spiral of disengagement, learned helplessness, and depression. The cost is too high in these severe cases. When considering whether to use medication to help to curb the effects of ADHD, several factors must be considered. First, the nature of the attention difficulty, particularly severity of symptoms as discussed above, should be fully understood. In particular, it is important to know whether the attention difficulties come with or without hyperactivity (e.g., DSM-5). Second, the family environment of the child is important. This involves multiple aspects. Researchers and clinicians note that issues anywhere from financial difficulties to parental discord to the presence of fire arms in the home might matter (Faraone et al., 2015). This last issue of fire arms in the home underscores the importance of considering a third factor, namely cultural aspects, of each child. It is fairly safe to say that the U.S. is probably the only country in the world where clinicians think about firearms vis-à-vis ADHD medication. However, it is also true that there may be more basic differences in cultural beliefs to consider as well. For example, in their review, Faraone

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et al. (2015) note some differences between Americans and Europeans in acceptance of medication for ADHD, with Americans being more willing to consider medication early on in treatment and Europeans being willing to consider drug treatment only after exhausting other possibilities (e.g., Atkinson & Hollis, 2010). Different cultural attitudes, often based on little or no research, influence ideas about medicine for ADHD in general. For example, there is anecdotal evidence that some European countries are more prone to accept homeopathic cures as real medications as compared with Americans. Traditional Chinese medicine has also been popular in some groups as a solution to ADHD. There are some individuals who appeal to religion or various cult-like groups such as the Scientologists to try to either cure or deny the existence of ADHD as well. None of these approaches are backed by science; they do not work. Clinicians and physicians, when considering medication, should also focus on the age of the child and the severity of his or her symptoms. Most agree that medication should be used as sparsely as possible given lack of knowledge about longterm consequences of its use. Those who advocate using it typically prefer to see it used only for those in primary school or above (e.g., Atkinson & Hollis, 2010) and would often like to phase it out over time.

How to optimize use of ADHD medications Thus, although it is clear that medications often work well for those with ADHD, it is important to acknowledge that these medications can also bring with them some side effects. With the ambivalence expressed by most people who understand medications and ADHD, it is therefore important to consider opinions on how best to use these medications. Thus, what follows is a consideration from different perspectives around the world about what the best approaches to medication might be and other considerations for the good of each child with ADHD. Theresia Stoeckl-Drax, a pediatrician in Germany, though preferring personalized neurofeedback methods, recognizes the benefits of medication with clear parameters, asserting, Medication can be beneficial, because it starts immediately to act. From my own experience, however, the doses required are often much smaller than suggested by the pharma industry. For example, children and young adults may greatly benefit from small doses of extended release MPH (methylphenidate hydrochloride) like 10 mg per day with almost no adverse effects. Therefore, my recommendation for medication is as little as possible and only as much as necessary. As for MPH, there is no physical dependency which means it can also only be taken on school days. A Dutch mother and son, interviewed separately, seem to share more or less the same opinion about medication for ADHD, which is that it might be useful for

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younger children to take while they learn to learn and can be stopped as the child matures. In answer to my question about whether medication should be given to children with attention difficulties, Peter, age 17, who has ADHD, said, ‘Yes’ during schooldays and ‘no’ during weekends, so that a child learns what ADHD actually is and what it does to his mind. When the child grows older, he will be able to notice the impulses that he gets from ADHD from this, and will try to prevent it from happening, and ultimately just grow out of it. Ms. Ellen, his mother, said this about the experience of medication and ADHD: At a young age, kids are not always capable of understanding problems related to ADHD. Medication could provide a more peaceful state of mind. My child, from the age of 6 or 7, actually told me he felt people surrounding him accepted him better with, instead of without, his medication. He, of course, didn’t really understand why, but he did feel the benefits of taking the medication. After the age of 15, he proposed to stop taking it (and two years later, he did not take the pills any longer). By then, it seemed he was more capable of understanding what ADHD meant and how to deal with it by himself. He started to learn and accept other methods to deal with his lack of concentration and his restlessness. Sports became more and more important as a way to help him cope with ADHD. Type of medication also depends on the child’s profile. For example, stimulants are not typically offered to those with ADHD who also have substance use problems. For these students, there is fear that they might overuse the stimulants or share them with others (e.g.,Wilens et al., 2008). At the same time, however, several studies have shown either a protective effect of stimulant medication for ADHD against substance abuse such as smoking (e.g., Schoenfelder, Faraone, & Kollins, 2014) or no effect of stimulants on substance use disorders (e.g., Biederman et al., 2008). In addition, if the child has comorbid symptoms, these must be taken into account. For example, for a child with anxiety or depression, atomoxetine seems to work in some children (e.g., Kratochvil et al., 2005). Mrs. Mayo, mother to a daughter with dyslexia, noted this specifically. She says, Medication has helped our daughter to cope with her difficulties as much as other resources such as educational supports and cognitive and behavioural therapy. . . .The most difficult aspect for us has been to deal with her extreme anxiety when in school; we have had to learn to recognize symptoms (both physical and psychological) and how to cope with crises. In our case, medication has also been a good help. With the help of her psychiatrist, we decided to use Atomoxetine instead of Methylphenidate, and this was a good choice for her anxiety symptoms.

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Indeed, Atomoxetine is recognized as effective for ADHD among researchers (e.g., Barkley, 2014d). Atomoxetine may also be somewhat helpful for children who have both ADHD and dyslexia (Shaywitz, Williams, Fox, & Wietecha, 2014; Shaywitz et al., 2017). Overall, if one medication does not work for your child for whatever reason, it is possible to consider a few alternatives, with the help of expert advice.

More candid views on medication for ADHD When medication is used for ADHD, what have been the outcomes experienced by my interviewees? This depends partly on one’s individual experiences and partly on one’s role. I wanted to conclude this chapter by highlighting some individual opinions on use of medication. Although from my own readings, I have become more convinced that medication for ADHD is overall a very good idea for children who are really struggling with this difficulty in school, I also understand concerns from educators and parents. Some side effects are real, and advocates should work with the child to ensure that, if and when medication is used, the medication, dosage, and overall holistic approach to the child are optimized. Thus, comments from interviewees may be important to be aware of here. For example, Dr. L is a pediatrician in Hong Kong who often sees patients with dyslexia and ADHD. She has seen many patients in her practice. She views the use of medication for those with ADHD as relatively quick and effective, with relatively manageable side effects in many cases. Sally, the American mother of a son with ADHD, says this: PRO:  The

drugs helped A LOT with his focus and behavior in school. And just this year, we were finally able to send him to school without drugs (he is now age 10 and started at age 7). CON:  He would come down off his stimulants in the afternoon at home and would be cranky, defiant, and unreasonable. He wasn’t hungry during the day because of the stimulant effect, but if he didn’t eat, he’d be cranky and belligerent because his blood sugar was out-of-whack. So we made him eat and drink something small in the mornings on school days even though he didn’t want to. And we asked his teacher to do the same at lunch time. I worry that this will create unhealthy attitudes toward food. (We didn’t medicate him on the weekends and never “made” him eat on the weekends. But he usually had a good appetite on the weekends, because he wasn’t medicated.) Ms. Aiyada found the same thing. Although her daughter, who has ADD, could sit still better and learn better, the family ultimately gave up the medication because she could not sleep well and had bad dreams and no appetite. “Daddy, I don’t like what these pills do to me,” her daughter said.

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Mr. Joe, father of Jonny, notes the following about Jonny: He started taking Ritalin from a very young age, with tremendous improvement. However, as he grew older, he refused to take it anymore because of side effects. Especially interesting is his own experience of feeling like a ‘zombie’ when taking it – we’re still not sure what it means (perhaps because we have not taken Ritalin ourselves) but we think it has to do with his interactions with his friends, or lack of emotion or liveliness while playing – a feeling you cannot easily dismiss. Ms. AG, an Educational Psychologist from Hong Kong, profiled three of her clients who took medication for ADHD as follows: A second grade boy with ADHD showed significant improvement in his attention, learning, behaviour, emotion, and self-confidence after taking medication. He shared that the “smart medicine” really helped him a lot, and he was very happy about this. A grade 9 girl with ADHD revealed that she had never achieved so well in the Uniform Test after taking medication for several weeks. Her study effectiveness improved, and she made fewer careless mistakes. However, her mother was concerned about the side effects of medication and would not let her the girl take the medicine during non-school days. Finally, a grade 10 boy with ADHD could not bear the side effects of medication (lack of appetite, dizziness). He revealed that the medication only made him perform worse because of the side effects. Hence, he decided not to use it. He tried some other methods to help him deal with his forgetfulness and carelessness instead. Mr. Toyota, a speech therapist in Japan, notes, After taking medicine, children can focus on the tasks more efficiently, and some children recover their confidence with high praise from teachers or parents. On the other hand, they may worry that they are not perfect unless they take medicine. This connection between self-confidence and ADHD was an interesting angle on this issue. Ms. Leah, a Canadian primary school teacher, notes, I have seen dramatic changes for children so many times that allow them not only to learn but for their self-esteems to soar. Since one can ‘try it out’ for a relatively short period of time without worrying about side effects, I do wish that more parents would be more open to trying it, knowing that it doesn’t have to be permanent, but to see how it impacts their child.

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The struggle to understand ADHD and medication will likely continue for a long time. Much of this struggle has to do with the fact that every child is very different in so many aspects of her or her experience with learning difficulties. When students are clearly very disadvantaged by ADHD, medicine should definitely be considered. The team of parents, children themselves, teachers, and professionals should all work together, however, to monitor the type and dosage of medicine to avoid as much as possible side effects. All of us will respond differently to such medications, and we have to weigh the positive effects of a given medication with any downsides to come up with the best treatment. In addition, when medications are used, they should be only part of the various behavioral and optimal learning strategies that are implemented consistently by the whole team advocating for the child with ADHD so that the child’s learning is effectively scaffolded from all angles.

Conclusion In this chapter, I have tried to summarize some excellent advice, both from research experts and from those who either have ADHD themselves or have children with ADHD on how to manage this learning difficulty. Some of the behavioral interventions center on how to prevent or at least minimize distractions.That is, how do we keep those with ADHD from not getting “lost” mentally? Some of the behavioral interventions focused more on what should be done to accomplish relevant tasks, particularly Barkley’s (2012) notion of keeping ideas externalized to allow easy access to them. We then considered the importance of medication for managing ADHD. Although this is an emotionally fraught question, there is ample evidence that many people with ADHD benefit a lot from use of the appropriate medications. Nevertheless, everyone focused on the given child with ADHD should carefully consider type of medication, dosage, use of the medicine (all the time or only on school days?), and any side effects. With full knowledge of all of these issues, advocates for those with ADHD are maximally empowered to make decisions that will optimize such children’s learning outcomes. In the next chapter, we turn to a very different topic, namely, how children with learning difficulties, and indeed all children, can maximize their reading comprehension and writing composition.

10 READING AND WRITING TO LEARN Suggestions for helping children with reading comprehension and writing composition

This book so far has been on topics of dyslexia and dysgraphia, difficulties confined to literacy at the word level, by definition. Researchers have been clear on distinguishing those with word reading problems from those with so-called higher-order difficulties related to reading comprehension and writing composition. This book is not about those who have comprehension difficulties or difficulties in expressing themselves. Reading comprehension and writing composition likely involve almost every skill involved in thinking more generally. For example, reading comprehension involves everything from eye movements and speech perception to language processing and memory skills to synthesizing and hypothesizing about ideas. This is far beyond the scope of a book on dyslexia and accompanying difficulties. At the same time, there are some basic tips for promoting reading comprehension or attaining better writing that all children will benefit from and that are not always explicitly taught. My goal here is, thus, to give you a few tips on promoting reading comprehension. In general, anything we can do to boost children’s higher-order comprehension and production of text should be welcome because these facilitate the progression of literacy learning overall.

Language Let’s start with language. One important aspect of both reading comprehension and writing composition is being able to process and produce language. Printed text is in many ways simply language in written form. This may sound ridiculous! Of course, you are thinking, writing is spoken words written down. Yet there are also many exceptions to this idea. For example, it is rare to hear a person speaking in the same way that a prize-winning novel is written. Similarly, instruction booklets or technical scientific articles may be unique to the written form.When individuals are speaking, even about very complicated, technical issues,

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they communicate differently than when they write about the same issues. Speaking involves more repetition, more pausing, more “ah,” “um,” or other filler words than does writing.This idea of formal vs. informal is one of many reasons why reading comprehension and writing composition can and should be considered at many levels. I myself still remember being a child and watching my parents watch the news in the evenings. The news was on television, and it was important for them to watch the day’s top stories. This was spoken language in my native tongue that I was hearing; it was not written.Yet I distinctly remember that the way of speaking adopted by the newscasters was often beyond my reach at age 7 or 8. I was speaking the same native language of English that they were, but the vocabulary, syntax, and background for understanding what was going on was often beyond me.You might experience something similar as an adult if you attempt to understand a relatively sophisticated empirical research article written in a field about which you have limited or even no formal knowledge.When I have attempted to read an article on the history of religious studies, for example, I find myself confronted with complexities that are sometimes beyond me. At the same time, we do make use of some of the same comprehension techniques in reading that we do when listening. We must remember what has been said or written, we summarize the ideas communicated to ourselves, we sometimes check our own understanding, most often at clause boundaries, and we make use of background knowledge to try to understand what is being communicated. Therefore, one general thing you can do for your children is to make sure that they have lots of experiences in processing language generally. A great approach to reading stories with children is periodically to quiz them on what is going on in the story.What will happen next? How does the character feel? Would you do the same thing in this situation? Why or why not? An interesting parallel to this might be to encourage children to actually make up stories on their own or as a game with others. This forms a foundation for subsequent writing composition. For example, sitting in a circle, each child might be asked to offer one or two words or sentences that follow from the last person’s contributions in order to create a coherent story. This game often results in ridiculous or very funny situations or stories. It is a nice way to facilitate language production and comprehension. Having regular extended conversations with children also helps. Children learn new vocabulary words and are exposed to complicated sentence structures in conversations with adults. They acquire valuable new information this way. Having such conversations, which, by definition, involves an exchange of information, makes it particularly easy for children to learn new things because it allows them to ask questions to clarify aspects of the discussion that they do not understand.This is not possible when watching a narrative on YouTube, movies, or television or when reading a text independently. The importance of language comprehension and composition overall outweighs the relatively narrow skills of word recognition and word spelling. This is the way human beings communicate. Many, if not most, people with dyslexia and dysgraphia are fine communicators who can come up with attractive productions and

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evaluations of what they learn; they just cannot do this optimally in written form. When the difference between a child’s word recognition or production in print and the child’s language competencies are too large, it is important for parents and teachers to accommodate the child somewhat by allowing reading comprehension or writing composition activities to take place orally. This is not ideal. But it helps the child to continue to develop in his or her linguistic skills at an age-appropriate level and to treat the dyslexia or dysgraphia as an isolated component difficulty to be dealt with separately. Having talked broadly about language skills for reading and writing, we turn now to an analysis of those component skills that are most important for reading comprehension. This is useful because once we identify the skills that make up reading comprehension, we can consider which skills are relatively strong or weak in any given child or adult. We can be grateful for the strong ones and capitalize on them when trying to learn more, and we can equally recognize and try to work on the weak skills.

Snow’s model of reading comprehension: the nature of the text Snow (2002) has a model of reading comprehension that is a helpful springboard from which to tackle some common struggles with reading comprehension and what to do about them. She says that for every individual, there are three overarching aspects that should be considered. These interact with one another. For example, we cannot say that an essay is inherently difficult or easy. A particular passage might be easy for an adult and difficult for a second grader, for example. The first is the nature of the text. The second is the nature of the reading activity. The third is the child’s characteristics.

The text The first one, on text, offers some very practical factors that should be considered when a child begins to read a given passage. Snow (2002), highlights five aspects of the text that can affect a child’s reading of it, as detailed below. All five are worth considering because they are cornerstones of literacy learning and can be researched in order to ensure that an appropriate text is selected for each child. These five aspects can also be trained independently in a reader to facilitate a clearer reading of a text. These five aspects of the text are vocabulary knowledge, syntax, the mental model, pragmatic context, and the discourse structure. Once we understand how and why these are important, we might try to highlight these for struggling readers. To begin with, vocabulary is a critical factor in reading. Many experts counsel that ensuring that a text contains at least 95% words that are familiar to the child is crucial for comprehension. This keeps the text manageable and motivating for the reader. This is a good rule of thumb for those with dyslexia as well. Whether

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the text is read or listened to (in case a child with dyslexia opts for text to speech aids), comprehension is optimal at this level.Thus, for parents and teachers, one rule for selecting an appropriate text for a child to read is that the vocabulary words be 95% recognizable. A second aspect of the text that is important for comprehension is syntax. Syntax refers to the grammatical ordering of the sentence. We have all seen text that is either simply structured or written in a somewhat convoluted or confusing (and usually long) form. A parent or teacher who is helping a child to select a text should take a random sampling of a few sentences in it to ensure that the syntactic structure is “palatable” for the child. A third aspect of the text that should be considered for optimal reading comprehension in children is the mental model presented in the text and whether this model is shared by the child. Here, mental model basically implies a schema, or an idea of how concepts presented are organized and are interrelated. Thus, it is difficult to fully understand a text on cell division in biology if one knows nothing at all about what cells do and how they work. Matching a text to a child’s level of understanding, thus, requires that the child either have acquired a basic level of understanding of the topic under discussion to follow the text initially or be given some ideas about the topic before he or she begins reading. Aspects of the text certainly interact in multiple ways with characteristics of the reader. In this case, the mental model required for the text relates directly to a child’s own background knowledge. Children read about novel events or new ideas all the time. However, to boost a child’s chance for success in reading comprehension, teachers or parents can help to prime a reader by giving a very brief overview of the topic before the reading begins. The fourth aspect of the text highlighted by Snow (2002) is pragmatic context. Continuing with our allusion to cells in biology and how they divide, there are likely multiple publications on this issue. Some are at a highly technical level and others have been written to suit the needs of 8- or 10-year-olds learning about science. Pragmatic context refers to the fact that the same ideas can be presented at different levels for different audiences. The coverage of the topic will depend upon this pragmatic context. Teachers and parents (and book stores, online resources, and librarians) tend to be relatively concerned about the pragmatic context of the text and to select accordingly. A final aspect of the text is the discourse structure. This is the style of the piece, i.e., how the text is presented. For example, a text could be a first person narrative, a fictional account, or an exposé. Boys often tend (on international tests such as the PISA or the PIRLS, for example) to perform slightly better on expository rather than fictional texts. They may prefer expository texts a bit more than fictional ones on average. However, this tells us nothing about the individual child and what kinds of texts she or he will prefer. Motivation is likely a very strong component of the overall reading process. These five aspects of the text are common ones that are referred to fairly typically when teachers or parents are working with children who are learning to read.

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Basic advice in this aspect is to review the text to make sure it is suitable for a particular child in terms of his or her strengths and weaknesses, as well as interests. For some of these categories, it is possible to facilitate reading by focusing on what the child needs to know to read it better. In particular, one can explicitly teach some vocabulary terms if they are unknown and also provide children with explanations about the pragmatic context by talking generally about the theme of the writing (e.g., sharing what you know about the theme of “going to the hospital” or “a fun day in the park”) so that the child starts to generate some idea about what to expect based on what she already knows). One could also coach the child on discourse structure to highlight how different styles or genres present ideas differently and have different focuses. An explicit overview of any of these aspects will potentially be quite useful for developing readers.

Snow’s model of reading comprehension: the purpose of the text The other aspect of reading from Snow’s model which is perhaps not discussed enough is the purpose of the text when reading. What should the child accomplish in reading it? In seminars with teachers, I have found that even when I focus strongly on this point, very few teachers prepare their students by explaining ahead of time the purpose of reading the text.This seems to me to make children’s tasks in reading needlessly more difficult. After all, as adults, we almost always know why we are reading a given text before we read it. Sometimes we are reading voluntarily, to learn about the news from the (online) newspaper, to enjoy poetry or a new bestseller, or even to put together a piece of furniture or to prepare a new dish using a recipe. However, younger readers in particular are often not given the reason for reading what they are about to read, and this is a mistake because we tend to read differently depending upon what we are reading. Under the header of “reading activity,” Snow distinguishes three basic concepts. The first reading activity is the purpose of reading. Why is the child being asked to read this? There can be many different reasons across different subjects in school. Sometimes children are asked to memorize a poem or lines in a play. Sometimes children are asked to analyze the story or compare and contrast two themes. There might be a quiz or an exam on certain topics. And occasionally, children may be asked to read a passage simply in order to answer a specific question. All of these are very different. Knowing what the purpose of the reading is before it begins helps us to regulate our reading. Adults have enough self-understanding, experience, and flexibility to know what the purpose of their reading is ahead of time. For example, we might need to assemble a table, so we need to read a manual carefully in order to put the parts together in the right order. We might want to know what the latest news is, and so we might decide to skim the internet or paper newspaper in order to find out. We might need to understand what specific information is required for a given form, so we may need to approach a list of instructions with the intent to find a specific answer. Or perhaps we feel like reading a novel for pleasure.

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In this case, we will often read at a moderate speed, not searching for any particular point but simply enjoying the process. All of these responses to the purpose of reading illustrate the second reading activity according to Snow. The second reading activity is the type of reading required. For example, sometimes, we must read in great depth, slowly, and with care. Typically, this type of reading is done because the topic is of extreme importance to us for one reason or another. Perhaps there will be an exam on it. Perhaps we need to know all of the information in order to fix an appliance. Recalling all of the text for the purpose of passing an exam would be an example of the type of careful reading activity sometimes required. Skimming in order to get the gist of the text would be another. The third reading activity mentioned by Snow is the level of reading. We can all process text in different ways depending upon the level of reading to be carried out. For example, memorizing a poem requires one type of reading, and analyzing text for the purpose of critiquing it is another type of reading. These different reading activities interact and overlap, but the main point is that all reading is not the same. This issue that we need to consider as to what we are reading and why is an important one for everyone, perhaps most of all those who have reading difficulties. One characteristic of dyslexia is that it is a time sink. People with dyslexia (and often their caregivers) simply take longer to perform the same written work as those who do not have dyslexia. This is one reason it is important to note some effective approaches to reading comprehension here. The more targeted one’s approach to assignments and learning can be, the more effective the learning.

Snow’s model of reading comprehension: the characteristics of the reader Snow’s (2002) model of reading comprehension focuses on reader characteristics as the last piece of the puzzle in understanding how readers comprehend text. These are cognitive or linguistic (or both) in nature. Just as I said in Chapter 2 in relation to the basic cognitive-linguistic abilities (phonological sensitivity, morphological awareness, orthographic skills, and fluency) for word reading, the five skills mentioned by Snow (2002) are important to consider both for facilitating the identification of those who might need extra help in reading comprehension and also for training such skills for better reading comprehension. The skills that Snow identifies are fluency, working memory, inference-making, background knowledge, and metacognition. The first one, fluency, we already highlighted in Chapter 2 on dyslexia per se. One commonality among those with a variety of learning difficulties is that they tend to be relatively slow in accomplishing a given learning task. Those who have troubles in comprehending text are often slow readers. This is not universally true. There are indeed readers called hyperlexics who read words faster than normal readers do but seem to do so at a surface level.Their word reading at a phonological,

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or pronunciation, level is excellent, but they are unable to derive meaning in the process. This is problematic in its own way. However, the majority of those with reading comprehension difficulties tend to be relatively slow in reading (e.g., Kim, Petscher, & Foorman, 2015; Tong, McBride, Shu, & Ho, 2018). Working memory is integrally associated with fluency.Those who score higher on short-term memory measures tend to perform better on reading comprehension tasks in general. The efficiency of memory and speed together help readers to keep track of a complicated story line or of all the facts involved in a given expose so as to understand clearly the main theme of the text. Working memory here is defined as how many pieces of information a child can keep in mind at any given time. For example, if I give you a string of twelve random words, how many would you be able to remember? The better an individual’s memory, the more information he or she can hold on to and process in reading a text. Inference-making has to do with children’s abilities to understand relationships among variables. Variables could be people, things, places, or a combination. Children with particular reading comprehension difficulties sometimes have a lot of trouble understanding such relationships. Some inference-making makes use of background knowledge which is discussed below. For example, it is easier to know and conceptualize how a rudder, a keel, and a jib look and jointly work together to help a sailboat to move if you know what these objects are in the first place. Thus, background knowledge might be part of inference-making in general. However, inference-making also demands the ability to understand associations and try to figure out what these are based on clues from the text.This may be facilitated when parents and teachers ask questions that get a reader thinking about such associations. For example, after reading a passage with some dialogue among classmates, one could ask the child which of those children is the best friend of the main character. Presumably, based on the dialogue of some children being friendlier than the dialogue of some other children, this could be determined. Parents and teachers can also ask more literal question to stimulate inference-making. For example, “To whom does the label of ‘she’ refer in a given sentence?” As highlighted above, advanced readers also need to make use of background knowledge as much as possible. We are constantly building on the knowledge we already have. For example, if you are reading a book about a girl’s daily struggles to grow up in modern day China, you may be helped by having some understanding of what China is like. If you understand the nature of the economy (e.g., rapid growth), how the government operates (a focus on control and a renewed effort against corruption), the former prevalence of the one-child policy and new efforts to allow families to have more than one child, a tradition of favoring boys over girls historically, and a booming creative technology, this will help to contextualize the story. You can help your child to have the background knowledge she needs to understand what she reads in a couple of ways. First, take an interest in your child’s reading. Listen to what the child is learning through print and try to provide additional details on topics of interest from your knowledge of the world. Sharing in the

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reading process will help the child to learn about many things. In addition, for all children but particularly struggling readers, try to help match the interests of the child or children to the readings they are doing. Motivation is key for promoting reading comprehension, and children will be much more willing to read when topics are of interest to them. Second, help children to get the kinds of information they seek. Children who can get help in researching for their own interest areas and get excited about research topics are at an advantage. It is not enough to suggest that children use the internet on their own to find such information. The internet is quite a confusing and potentially dangerous place. The tremendous resources offered by the internet make high demands on parents and teachers who should try as much as possible to evaluate the helpfulness and veracity of websites before recommending them to children. Metacognition refers to the ability to reflect on one’s own cognition, one’s own thought.When we talk about metacognition about reading, we are referring to ways in which children can reflect on how they are reading. For example, have you ever had the experience of “spacing out” as you read? You suddenly find yourself three pages further than you were the last time you checked. However, you have absolutely no clue as to what you have read. Clearly, you got through all the words smoothly. You may have said them to yourself in your head as you read. But there is no sense of comprehension at all. You blanked out! If you noticed that you did not understand anything that you just read, that is, in fact, good.That means you are metacognitively aware of your reading. Please note that everyone “spaces out” and loses track of thoughts or text sometimes. The important point is that some people notice that they have done so and figure out what to do about that, whereas others simply do not notice. Not noticing is a problem because it means that no steps are taken to correct the problem of not having processed the text. It is important to help children to become metacognitively aware. First of all, it may be helpful to teach children some metacognitive “tricks,” or rules of thumb. For example, the main idea of a paragraph in English is usually summarized in the first or last sentence of the paragraph. If a child is having trouble getting all of the details of what she is reading, it may help her to know that the main ideas are outlined in topic sentences. Once we know the main idea, filling in the details becomes easier. In terms of reading stories, it may help to be familiar with the basic plot outline of a story. For example, an introduction usually comes first. A problem generally presents itself in the middle third to half of the text.The rest of the story often centers on resolving this problem. If children know what to look for in terms of story structure, they may come to understand the plot better. Try to teach more advanced readers to check their comprehension as mentioned above as well. As we read, we should pause every few paragraphs or pages to make sure we know what is happening or what we have learned so far. Children should come to do this automatically. Most of all, when they “space out,” as everyone does sometimes, they should realize that they have done it and take the trouble to go back and read again what they did not comprehend the first time.

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Another easy metacognitive aid is to teach children to access word meanings that they come to and do not understand early. Online dictionaries are so easy these days, so this should be relatively straightforward (either in written or oral form). It is better to find out a word’s meaning relatively directly if possible. Context helps a lot (guessing at it given the context of the story), but looking it up online can be a helpful confirmation of the meaning.

The art of writing composition The art of writing composition involves combining together many different skills, just as is required for reading comprehension. Researchers (Hayes, 1996; Hayes & Flower, 1980) have put forward a number of models focused on the writing process. These are very important models which help to break down the process of writing quite well. Sometimes these processes assume a process of editing twice, including editing and revising one last time; they are very detailed. Here, I want to highlight the original (Hayes & Flower, 1980) model which focuses on writing composition as occurring in three stages. This was one point of Chapter 3 and is expanded here as a practical exercise in promoting writing for all. In the first stage, the writer comes up with an idea. This stage is referred to as planning (Hayes & Flower, 1980). Note that in this stage, there is no writing taking place. No document is created. It is merely a time for planning what to write. In the second stage, the writer writes. I think of this as brainstorming on paper. This stage should encompass pure writing with no thought for editing, no worrying about whether something is spelled correctly or not, just a first pass on getting all of the ideas out. In contrast, the third stage is all about editing. Whereas stage two focused the writer on writing freely, stage three requires that the writer become a strict editor, checking carefully for punctuation, syntax, and spelling mistakes. This is a very simple perspective on writing, but it is instructive. One thing to note is that an individual could be good or poor in each of these three stages. In the first step, one could have fantastic ideas or not-so-good ones. Some children are creative in their story writing. Others struggle. In the second step, some people find it easy to write on and on, and many struggle a great deal to come up with any text at all. Almost universally, children are constrained in their writing projects by the words they know how to write or spell (e.g., Berninger et al., 2002). If a child has a good idea but she does not know how to spell the words associated with the idea, then the idea is discarded. Part of the reason for this is that she is combining more than one of these three steps of writing together. Step 3, involving strict editing, is admittedly a rather specialized skill that is much less interesting than the first two steps. It requires discipline and great attention to small details. However, there are indeed some children who are quite good at spelling, punctuation, and grammar. These skills can be learned over time with effortful practice. Admittedly, those with dysgraphia and/or dyslexia may have particular trouble with this step. I view this as an eminently practical model. Implicitly, many of those who help people with dyslexia do as well. Several of the people I interviewed urged that the

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task of spelling words correctly be separated from the task of writing interesting, logical, and/or creative prose. That is a logical appeal to separate stages two and three from one another. There are a number of ways to do this, some of which have been described in previous chapters. A basic approach to consider is to isolate these three steps and to exercise each one individually. Spend some time with your student or students with dyslexia or dysgraphia simply thinking up ideas. Brainstorm about a report that you could do or a plot to a story or a play. Some children have impressive imaginations and clear ideas about how a story could evolve. Allow them to exercise this and this alone at some points, perhaps by taping the interaction and grading the children on oral participation and ideas. In a second step of forming a coherent assignment or paper, have each child come up with a product. Most children will probably want to write down their assignment, either by hand or via typing. However, those with dyslexia or dysgraphia should be allowed to use other mechanisms for doing this. For example, they can orally dictate their ideas into a machine that transcribes their oral narrations. Consider other ways as well, such as by using interviews, pictures, or film. Finally, the third step will involve editing. As a teacher or a parent, you need to figure out how broadly or narrowly you define the concept of editing. Editing a film vs. a story are both equally essential but may require somewhat different skills. Still, it is important to consider this aspect separately from the first two. In this way, it becomes possible for a dyslexic child to recognize herself as very competent in certain aspects, such as idea generation or presentation of a project, and less competent in others, such as editing. This division of skills, in general practice and also in grading practice, can help both teachers and students to understand that generating an original assignment makes use of multiple skills, some of which may be better developed than others, for all students.

Summary In this chapter, I have highlighted some basics of reading comprehension and writing composition that I think are practically important for all of us to consider. First, please stimulate your child’s language skills by communicating often and in a variety of ways. Exposure to new ideas are key for facilitating language skills, the foundations of reading comprehension and writing composition. Second, remember that reading comprehension is an interaction between the characteristics of what we are reading, the purpose of reading it, and the individual cognitive and motivational characteristics of the child. These are combined in a given reading experience. Helping children with reading comprehension may, thus, involve varying the types of texts selected, explaining clearly the purpose of reading to the child so as to allow the child to adjust his focus and approach to reading, and working with children’s interests and cognitive strengths and weaknesses for optimal reading. Finally, there are at least three distinct steps to writing a text. The first is generating an interesting idea, the second is writing without censoring or editing anything, and the third is actually editing the writing.When these steps are treated as distinct,

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that can lead to less “writer’s block” and more confidence in the writing process. Children may begin to think of themselves and their skills in all three steps, finding that they are good at one or more of them but also need to work on others. When teachers grade according to these three aspects of writing, that can further promote the idea of writing as a process consisting of several steps.This is a particular advantage for those who are dyslexic or dysgraphic and thus, by definition, likely suffer in the final stage of editing. Hopefully, this conceptualization helps children, parents, and teachers to understand specifically strengths and weaknesses of the children and to keep these in perspective. Many with dyslexia are very good writers because they have great ideas and language skills. Their editing requires work, and so they struggle on this aspect; yet their broader writing skills can be excellent. Such an attitude is helpful in promoting a realistic sense of the whole self and in ensuring that one’s self-esteem is realistic, rather than painfully low. Additional ideas related to maintaining a healthy self-esteem are presented in the next chapter.

11 SELF-ESTEEM AND LEARNING DISABILITIES

For those with learning disabilities, low self-esteem is often pervasive and exacerbates even further the actual initial cognitive or attentional difficulties. There is sometimes a repeated pattern of school failure, feeling stupid and unworthy, and then more school failure, and on and on. In cultures where academic achievement is most highly prized, these self-esteem issues may be particularly acute, but they are hard on all children with learning disabilities. How to help children manage their negative emotions on top of their learning challenges is a real puzzle and probably depends at least in part on the personality of the given child as well. This chapter explores both broad and specific ways to ensure that children with learning disabilities have multiple sources for their sense of self. All too often, school becomes the over-arching focus of self-understanding for these children, and this narrow focus is too often negative. Ms. WA, a young adult with dyslexia, says the following in reference to dyslexia: “In one way, I don’t know if it’s good to be diagnosed. You are more than that. If someone tells you you have dyslexia, then will you ‘be’ dyslexia?” She has had difficulties with both teachers and friends who have equated her learning disability with stupidity from time to time. This has caused some lasting pain. Dr. Anna Garito, a Vice Principal and former teacher of students with different learning needs, describes some of the typical difficulties for students with learning disabilities this way: I’ve learned through my intense work with students that many will do what is necessary to not draw attention to themselves within a regular class setting. This means that while in an inclusive classroom the student wants to do the same type of work as the rest of the class and not do any type of work that looks remotely different from their same age peers. Also, teenagers do not want to leave the classroom for extra help because of fear of ridicule. What

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does this mean? It means students experience friends calling them names such as dumb, stupid, slow or the spec ed kid. As such, it is very difficult to cope with these types of emotions, and students will risk their learning just to save face and fit in with peers. In essence, a vicious cycle takes place because students struggle to learn yet feel unaccepted because of the negative comments. . . . At the root of all (behavior problems) is truly a student who does not know how to cope given their own embarrassing thoughts of their learning capabilities. We all know the child who acts out or becomes the class clown to distract from his or her own underlying learning difficulties. In the following, I will focus first on building self-esteem in students with learning difficulties and then on stimulating motivation in such children. It is essential to include some consideration of the problems of anxiety and depression and how to prevent students from making use of unhealthy coping mechanisms, particularly using substances as a way to selfsoothe as well. Of course, an important aspect of helping children with learning difficulties to maintain a positive attitude is to ensure that their parents find good support themselves; I offer a few ideas on this here. I conclude this chapter with some advice for teachers in promoting a positive attitude in the classroom for learning disabled children.

Promoting self-esteem in children with learning difficulties We begin with advice to parents, professionals, and teachers on how to help children maintain or build their self-esteem. What can adult role models offer to children that is constructive for all? There is a variety of advice out there on how to help children maintain or build self-esteem, particularly in the face of learning difficulties such as dyslexia. What seems critical is to get varied suggestions on how to facilitate children’s positive feelings about the self and to try whatever seems to make sense to see what works. I looked at a lot of advice in books and online, and I particularly appreciated these general ideas from one website (www.understood. org) that offered the following general tips:

“Be a self-esteem role model” This basically entails modeling for children your own positive thinking. Have you ever seen a parent get frustrated with himself or herself and “become unhinged” or “have a meltdown,” essentially acting in a chaotic and unhelpful manner? I have seen parents who were late or who got the time wrong for an appointment get very upset, criticizing themselves as stupid or bad. This is never helpful. When you, as a parent, make a mistake, focus on how to fix the problem. Be specific on the issue and the solution. For example, if you have forgotten an appointment (playdate for your child, parents’ night at school, etc.), instead of criticizing yourself (“I am so

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stupid!” “I can’t do anything right!”) or blaming others, after expressing frustration, try to calm down and talk about how you can try to contain the current problem and to ensure that this does not happen in the future.

Talk about (famous) role models to help foster self-esteem It is easy to look up information on the internet about famous people who have dyslexia, ADHD, dysgraphia or other learning struggles (or historical figures who are presumed to have had one or more of these). It might be useful to think about your child’s strengths in particular and to mention one or more such figures as those to identify with. Many famous business people, scientists, artists, musicians, actors, writers, and politicians could be identified. A basic discussion of how struggling is part of life and growth can add to the feeling that although dyslexia (or another learning difficulty) often makes life challenging, many of the most famous and successful role models in life have struggled actively with a particular barrier. Please note that finding famous people who have learning difficulties, while interesting, is just one approach. It is not the case that because someone has a learning difficulty, she or he will be famous. I also do not view dyslexia or other learning difficulties as a “gift.” Learning difficulties make life harder. But a person with a learning difficulty is first and foremost a person, and the basic idea here is that there are many successful people who do very well in life despite their difficulties. Role models need not be famous either. Some of the most important role models may be “regular” people in the community, including parents or friends. The main message is that learning difficulties, though challenging, do not define a person; they are only a part of the whole delightful individual.

 ncourage participation in extra-curricular activities, E so children can find their strengths Virtually everyone I interviewed for this book emphasized the importance of this one, as mentioned above. Masten (2014), in her book entitled Ordinary Magic, which focuses on fostering resilience in at-risk children, highlights extra-curricular activities at school as a major source of opportunities. Such different experiences can promote motivation, engagement in school, and competence. Zarrett and Lerner (2008) go even further, asserting that extracurriculars of all types, including youth development clubs, musical activities, religious groups, sports, focused intellectual games (such as chess or debating), and others help to promote several competencies in adolescents. Collectively, they view these as promoting what they call “positive youth development,” which includes the five, or even six, Cs for success in this aspect. Optimally, adolescents should have all of these: Competence, confidence, connection, character, caring, and contribution.These are discussed in more depth in our section on avoiding the bad, promoting the good. It is also important to think flexibly about what is and is not a strength. In some cultures, for example, it is clear that academic abilities are valued over others. It is

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great to encourage children to try new things, but be open to new things that are not necessarily what you yourself value most. For example, being a good organizer of people or things, showing talent in making friends, demonstrating finesse in computer games, being an excellent comics artist . . . All can be strengths. Look beyond school.

“Be clear, not critical” This goes along with Barkley’s (2016) suggestions to teachers as well that instructions be framed positively, with a stronger focus on what a child should than what he or she should not do, and focused. Clarity can be enhanced when children are told directly and succinctly what is expected of them. An important principle in all behavioral management, particularly of young children, is that directions should be short. In addition, directions should be given only when the child is paying attention and free of distractions. To facilitate this further, ask the child to repeat your instructions to ensure understanding. Parents have to do a lot of anticipation of children’s needs, with an empathetic focus on their strengths and weaknesses. When parents strive to be clear in their expectations and follow through with consequences when their expectations are not met in an even-handed and unemotional way, the overall parent-child relationship is improved. Positive, focused communication can help children to know what their parents’ expectations are and what the consequences of these are. When criticism is offered, it should be of the action (i.e., “This handwriting is illegible, so this part needs to be rewritten” rather than of the person (i.e., “You are lazy/sloppy/ reckless”)).

 eframe negativity to help children view R the current situation from different angles Share some favorite quotes on failure and success. These are a few of mine. From Michael Jordan, one of the best (American) basketball players of all time, I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed. (Jordan, n.d.) Jack Ma, Chinese founder of Alibaba, failed to get into university twice, failed to get a job at Kentucky Fried Chicken in China, failed in various endeavors in his life, but he likes to focus on failure as opportunity, saying “if you don’t give up, you still have a chance.” (Stibel, 2016). And J. K. Rowling, best-selling British author of the Harry Potter series, began writing that series when she was exceedingly poor and depressed, and subsequently experienced rejection of her books multiple times, before she finally enjoyed fame. As she says, “some failure in life is inevitable. It is

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impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all – in which case, you fail by default.” (Rowling, 2008). This quote leads to the sixth suggestion from Understood:

 elp children to realize that making mistakes H is normal and fosters learning One of my interviewees, Sally, an American with a son who has attention deficit difficulties had a wonderful philosophy of discovery through mistakes, saying the following: My approach is to celebrate mistakes: ‘Awesome! You just learned a way that doesn’t work.’ ‘We learn best and deepest when we make mistakes.’ ‘If you’re not making mistakes, you’re not learning.You’re memorizing.’ ‘Making mistakes is part of the scientific method. Finding out what doesn’t work is just as important as finding out what does.’ These aren’t aphorisms. I truly believe this. I am a software designer, and great software is developed by testing with users over and over to discover what doesn’t work and then fixing it and testing some more. As builders, makers, and inventors, we should EXPECT and PLAN to fail. It’s all part of the process. I also tell my son that I don’t care about his grades, but about his effort and progress. Success eventually comes if you try long enough and hard enough. But if you don’t TRY it will NEVER come. . . . Anything worth doing is hard. Hard things challenge us. Challenges are FUN. I am inspired by these ideas and would like to see all mentors and parents follow them closely. We all make mistakes. Those with learning difficulties have to face more of these mistakes at school, and they can grow very sensitive about them without an important adult who tells them it is o.k., keep going, keep learning, find new ways to learn. A child who sees making mistakes as just another part of life will keep trying, and this is the key to eventual success. These leads us naturally to Understood’s seventh suggestion for promoting self-esteem as follows:

 raise efforts made (rather than outcomes or P “natural” ability) Some of the best work in this area comes from Professor Carol Dweck (2006) who wrote the book entitled Mindset. Dweck argues that a fundamental element of success in the higher achieving performers in every area is the belief, or mindset, that intelligence can be changed.Those who think that they can improve in an area tend to try harder, stick with a problem longer, and stay motivated and interested, even after having experienced failure. Those who have the mindset that intelligence is

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fixed and therefore not changeable simply do not do as well overall.This distinction is fundamental for children who have learning difficulties. Those who believe they are naturally talented or stupid or smart run into more difficulties than do those who believe that they can improve with hard work. Parents want to praise their children, and children love praise. Dweck says that the most important attribute worthy of praise in children is the efforts that they make. She advises parents to praise them as much as we want for the growth-oriented process – what they accomplished through practice, study, persistence, and good strategies. And we can ask them about their work in a way that admires and appreciates their efforts and choices. (p. 177) Importantly, she particularly highlights the fact that that those with learning difficulties may also need specific advice, noting that “for them, it is not sheer effort that works but finding the right strategy” (p. 178). Some advice for those with learning difficulties that she endorses are the following: I like the effort you put in, but let’s work together some more and figure out what it is you don’t understand. We all have different learning curves. It may take more time for you to catch on to this and be comfortable with this material, but if you keep at it like this you will. Everyone learns in a different way. Let’s keep trying to find the way that works for you. (p. 178) Along with these seven tips from the Understood website, I would include an eighth, which is that we should strive to show empathy. Some of these learning difficulties can be very frustrating, not just for the child but for the parent and even the teacher.When a mentor tries to teach a strategy or skill and the child simply cannot master it after much persistence and patience on the part of the mentor, this is hard for both of them. Barkley (2014b) and other educators also repeatedly emphasize the importance of empathy for the learner. In individual interviews, everyone agreed that compassion and empathy are essential for children to thrive. Ms. Aiyada, a mother of a daughter with ADHD from Thailand, said, “Give and forgive. Must have a lot of patience . . . understanding with compassion. . . . Real stories of success from parents who have endured the struggle will be encouraging.” Kate, an Indian mother of boys with dyslexia agrees. Building and maintaining an empathetic bond is crucial, especially in the early years. I found that talking about my own childhood experiences, feelings, and fears that might mirror theirs was an especially helpful way to encourage them to talk about what they might be going through.

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Kate’s case should also be of comfort to those with children with learning disabilities. Her story is this: My younger son was repeatedly told he ‘could not do Mathematics,’ and was even advised not to attempt the subject at the (O Level equivalent) Board examinations. Through sheer perseverance and the support of a committed teacher, he passed the exams with flying colors and studied Commerce and Economics at the University level.Today he runs his own logistics and equipment hiring company.

Respecting areas of strength Probably one of the more under-researched focuses related to children with learning difficulties is how to motivate them. Children who have learning difficulties have often experienced repeated failures at school, and they have little energy left for undertaking schoolwork after a while. I asked some of my interviewees what they thought would help in motivating such children. Several of them offered some general advice focused on appreciating differences in learning. This philosophy is essential for both teachers and parents, as well as students, to appreciate. For example, Monica, who is a Hong Kong young person with dyslexia, says, First of all, we need to bear in mind that learning is not only limited to reading print or getting good grades in exams. Second, we need to have faith in our children that they are born to learn; everyone can learn in his or her own ways. We need to consider children’s learning style and their interests when trying to get back their long-lost motivation to learn. Two mothers of children with learning challenges from different countries echo this sentiment: It’s a step by step process. All children can learn, regardless of their challenges. Our job is to provide them with the basics (reading; writing), and they will find the rest. We watch them, cheer them on, giving them a slow and steady process of learning building blocks along the way. This was advice from Ms. Aiyada, from Thailand, a mother of a daughter with ADHD. Kate, the mother of two dyslexic boys from India also advised, Teach them the skills necessary to tackle the tasks they find difficult. Allow them to spend time doing the things they really enjoy and are proficient in. Children’s learning is not just a matter of remediating learning difficulties but of building on strengths. All too often, those with dyslexia, dysgraphia, or attention deficit struggles

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are encouraged to spend all of their time “fixing” their difficulties.The children have to complete a lot of remedial work, spend extra time with tutors or others supporting their learning, work on revising their errors seemingly endlessly.Yet spending time correcting one’s errors is effortful and often joyless. Over time, students come to associate schoolwork with hardship. Perhaps even more important is that children get the opportunity to experience success by using their talents. Virtually everyone has strengths to draw upon, whether they are good at art, sports, making friends, playing games, music, or others. It is important for children to experience joy and success on the way to adulthood; this may be in an area other than academics. Some clinicians echoed similar sentiments, focusing on highlighting both children’s challenges but also their strengths. For example, as suggested by American former School Psychologist and person with an attention deficit himself, Mr. R., we should try to know as much as we can about the performance strengths and weaknesses of the individual, then build the intervention program or approach in a way that avoids overwhelming the weaknesses, maintains the strengths, and entices the individual toward activities likely to provide successes as they challenge their known weaknesses. . . . If they can understand what is happening with them that contributes to performance frustration and anxiety, and some degree of why, I have found they often maintain motivation longer as they persist at challenging learning tasks. Hong Kong psychologist Dr. T similarly says, Teachers and parents sometimes focus too much on what children with SpLD (specific learning difficulties) cannot do and overlook what they can do. Children with SpLD often feel ashamed. . . . It is important to help children bring awareness of their strengths and potential. . . . Identify the child’s strengths and weaknesses in order to realize where the child’s true potential lies . . . In order to build motivation, the child needs to experience success. We need to build success by taking small steps in learning. Danish Speech Therapist Ms. HO agrees, noting that, I use an area of interest and provide motivators, which will vary according to the student’s age, environment, and family context. Contracts should be drawn up with the student regarding what the aims of the therapeutic intervention might be and how it would impact their learning. In my experience, the most effective intervention usually is as a result of a strong team (i.e., therapist, teacher, parents) focused on supporting the student in a positive way with achievable goals. It has to be FUN! Our group of classroom teachers from Australia made equally clear that they try to support every student in his or her strengths. As they said, “Every student has some

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strength, and if we can provide opportunities (for students) to demonstrate this expertise to their peers, this is beneficial for their self esteem. Peers acknowledge true competencies.”They gave an example of a fourth year student (around age 10) who has “low progress in literacy but is good at powering his lego models and operating them remotely.” They encouraged him to make a phone video illustrating his project for the class.

What motivates? While some of the interviewees focused on a basic philosophy and approach to helping children stay motivated and maintaining basic self-esteem, others were much more concrete in their practical suggestions for success. The suggestions focused on rewards, making use of support tools for help, and tapping into children’s individual interests. Peter, a 17-year-old Dutch boy with ADHD, suggested, “At a younger age, give them rewards for the good things they do, even though this will create problems if you don’t give them rewards for learning.” Peter has basically and succinctly captured a lot of the arguments that Russell Barkley makes about rewards in general for ADHD students. Barkley (2012) has several ideas for how best to motivate children with ADHD extrinsically, arguing that those with ADHD in particular are impaired in their ability to think into the future and use the concept of future success for current motivation. He argues that these children need immediate, frequent, and relatively high magnitude consequences of their actions. Rewards can be in the form of praise, hugs, or concrete events, opportunities (e.g., play outside; play a computer game), or things (e.g., snacks; toys; stickers). However, the frequency with which these are needed and the risks that a steady diet of similar rewards will be boring and hurt motivation when it goes on too long make a system of points or tokens particularly important over the long term, especially with younger children. A token system is a method by which a child can earn points or tokens toward a desirable goal. Using chips or coins is common. Barkley (2016) recommends keeping a focus on positive behaviors rather than negative ones overall. Thus, for example, encouraging children to write five spelling words in the allotted time for a single token is more motivating than deducting points for bad behavior. Once children have earned enough points, they are allowed, within this system, to trade them for something desirable such as more time on the computer, more time spent in drawing, or having first choice of sports equipment at recess. What is motivating here is in the eye of the child. This is true as much for extrinsic rewards as it is for intrinsic ones. How, then, can we motivate learning overall? How does a learning disabled child maintain some interest in school learning given the obstacles that he or she often faces? Leah, a Canadian primary school teacher, suggested a focus on alternative ways to learn: There are so many ways to learn, especially in our day and age: Yes, reading opens up a whole world to us, but so does viewing, deep discussions,

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listening to stories, developing number sense not through drills, but through investigation and play and challenges that allow brains to try to make sense of numeracy in many ways. Another more general suggestion came from Mr. Cheung, a 20-something Hong Kong person with dysgraphia: I think you really need to give children the incentive to learn. . . . For example, in my case, social media uses is a huge motivation for me to learn more about typing. And by typing, I am much more familiar with (Chinese) characters. . . . Social motivation has always been and always will be one of the largest sources of human motivation. Therefore, I would suggest that parents be more lenient on the use of social media. Instant messaging, blogging, communicating in a forum – all can help children to write more. An educational psychologist in Hong Kong, Ms. G, agrees: “Learning via games or multimedia with immediate feedback is the most attractive to children.” Another interesting suggestion from Mr. Cheung had to do with school placement. The extent to which a family might have any control over where their child attends school is not clear across cultures. However, from his perspective, this mattered, luckily to his benefit in this case: I was placed in a lower ranking secondary school. Contrary to many people’s beliefs, it was one of the most important things that helped me. Because in perceiving a lower difference between peers’ academic performance and my own academic performance, I could have some hope; I no longer lived in a state of learned helplessness. Motivation to work hard has always been the key to overcoming any difficulties, and a less competitive environment provided me with the environment to build such motivation. Therefore, I would say it isn’t always a bad thing to get into a lower ranking secondary school. All of the above suggestions highlight general approaches to motivating children to learn school-related skills. They focus on minimizing pain and difficulty in the face of the challenge of a learning disability. They are general and relate to ways in which children’s responsibilities at school can be made a bit easier given the circumstances. A somewhat different question relates specifically to how to get children to become independently interested in something in particular. For many children, a small spark of interest can snowball into better reading or writing or even a life-long interest or talent. In the book Grit, Angela Duckworth (2016) focuses on “the power of passion and perseverance.” I was especially interested in her take on how to foster a passion, because linking learning to interests is potentially crucial for those with learning difficulties to succeed. We work harder and longer when we find something intrinsically interesting. I appreciate her declaration that “Nobody is interested in

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everything, and everyone is interested in something” (p. 99). This seems to me to be a fundamental truism that may provide the starting point for all of us, especially those struggling to stay positive in school given struggles with a particular learning difficulty. In exploring the importance of passion for one’s career and life goals, Duckworth (2016) argues that “passion for your work is a little bit of discovery, followed by a lot of development, and then a lifetime of deepening” (p. 103; emphasis hers). She says that childhood is usually not the time when a child’s interests are solidified; this typically happens much later. In addition, children typically only get interested in things through their interactions with the world over time. It seems almost accidental how all of us keep returning to certain themes that end up being our subsequent interests. Parents, teachers, and other supporters of children help to ensure that certain interests develop over time by creating situations in which ideas or activities are perceived as interesting. A lot of this is happenstance over time, and a lot of it is seemingly quite accidental. Duckworth’s message to parents and other mentors who seek to foster motivation and interest in children is the following: “Before those who’ve yet to fix on a passion are ready to spend hours a day diligently honing skills, they must goof around, triggering and retriggering interest” (p. 106). Children require warm nurturing and the chance to experience new ideas and new potential interests for an extended period of time. This is important for all children and may even be more important for those with learning difficulties, for whom many of the actual or at least theoretical pleasures of school subjects may be virtually unreachable.Tapping a learning disabled child’s motivation for learning is perhaps one of the most difficult aspects of the process, but a couple of our interviewees had very good examples of what motivated them to keep learning or even to start learning. Mr. Cheung, who has dysgraphia, said this: I got a fountain pen. It turned writing into quite an interesting thing for me. Making writing interesting for children with writing difficulties is not an easy thing to do; yet it is quite important. Through that pen, I overcame my writing-phobia for a bit, which lead to the beginning of my self-initiated handwriting practice. I think for each child, the way to make writing interesting is different . . . But the take home message is to add some fun to it. Monica, a Chinese woman who has dyslexia, hated learning English in school, but was motivated through cooking. She reports, My grandmother was a very good cook, and to some extent I have inherited her love of cooking. It is difficult for a newbie to cook without a recipe, but it is more difficult for me to read.When it suddenly came to a point that I really wanted to learn how to cook dishes I had no idea how to make, I decided to battle against English reading with my Filipina helper, Jenni, when I was 7. Jenni photocopied and enlarged recipes. We prepared the ingredients

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from the supermarket together, read and followed the cooking steps one by one, and practiced over and over again. Eventually, I learned more English vocabulary on food, cooking utensils, and cooking procedures, and started to memorize the ‘shapes’ of these words in print, and later on, I could spell these words and learned blending of sounds through these words. Monica continues: My ADD brother who often fell asleep in history class and had no interest in studying history suddenly grabbed a thick Chinese history book from the school library and finished the 500-page book in one night. He later confessed that the new video games he was playing had a Chinese history background, and he got fascinated by the storyboard, so he wanted to know more about it. For Apercu89, a Swiss man with ADHD, it was also history: I started to love history when I found out that I can watch very good YouTube videos, in which the information is told by a teacher/expert in a funny way or combined with a story. Certain school books kill the motivation to study. It is also important to understand that a child sometimes simply is not in the mood for studying (because the brain has 100 other things on its mind) and it is impossible then for him or her to study. Parents and teachers who are on a mission to connect learning with the child’s interests have happier children and, ultimately, children who have stronger connections to life around them. Monica’s final advice is this: Try to find something that the child likes and use that as a way to motivate him or her to learn, even for something that doesn’t seem to be useful in daily life, e.g., playing yoyo or making models. Still, the child can learn something from these experiences and get some satisfaction. It is very important for the child to realize that he or she can actually manage to complete something with his or her efforts. Children need successful experiences to build their confidence in learning again.

Avoiding the bad, promoting the good: no to drugs and alcohol and yes to positive youth development Learning difficulties create struggles that can exacerbate daily hassles of growing up. Several studies have documented the fact that those with some learning difficulties have an increased chance of suffering from substance addictions. For example, those with ADHD tend to be at much greater risk for cigarette or alcohol addiction

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(Barkley, 2017b), both in adolescence and adulthood. Jergen (2004), who himself has ADHD, describes in some detail in his book his enjoyment of and ultimate reliance on alcohol for dealing with the anxiety that came with his daily experiences of rejection caused by his ADHD symptoms. Barkley (2017b) suggests that the appeal of alcohol for those with ADHD is in temporarily reducing anxiety and perhaps helping them to forget their problems. The nicotine in cigarettes actually acts as a stimulant to partially reduce symptoms of ADHD, so the phenomenon of smoking is especially understandable, indeed logical, in those with ADHD. Use of recreational drugs can also help those with learning difficulties to stop focusing on current frustrations and difficulties. We all know that they ultimately cause many additional problems, but they provide immediate relief. Partnership for Drug-Free Kids lists eight main reasons why adolescents use ­alcohol and drugs (The Partnership, 2017). Of these, four are directly associated with one or more types of learning difficulties. These include escape, boredom, rebellion, and lack of confidence. While it is true that these four rationales likely apply to all teenagers at some point or another, for those with learning difficulties, these needs and attributes are all the more salient. The desire to escape is clear for all children with learning difficulties. The pressures of school are relentless, and the frustrations are great. Who would not want to escape under such circumstances? Boredom is a particular hallmark of some students with ADHD. A characteristic of many of these individuals is that they consistently seek to try new things and have trouble staying focused on any given task. Rebellion is a predictable consequence of feeling “less than” at school. Students with learning difficulties often feel that they are much less than the unattainable ideal of perfect, too often judged by teachers, parents, and even peers. Rebelling from such judgments out of anger or frustration seems reasonable given the pressures they sometimes feel. Finally, lower self-esteem as a consequence of learning problems is relatively typical, partly because those who are diagnosed have often suffered failures at school for a prolonged period of time without understanding why (Lyons, 2012). Given the potential appeal of alcohol or drugs as an easy “out” for a frustrated student, it is important for caregivers to be extra vigilant with students with learning difficulties. The best approach to avoiding problems of substance abuse is to come at this from a place of honesty. Talking openly about drugs and alcohol with preteens and teenagers can be very helpful in ensuring that they understand the risks that substance use brings with it. Experts often emphasize a few additional key elements of parenting at this age that can help. First, parents should try as hard as they can to be psychologically available to their children often, particularly to eat dinner with their children several evenings per week (Zarrett & Lerner, 2008); such availability reduces depression symptoms in teens. Family dinners are also, correspondingly, inversely associated with substance abuse in teenagers (Fulkerson et al., 2006). Second, parents should ensure that their adolescents are actively pursuing something of interest outside of their school subjects. Any extra-curricular activity may be helpful, and having more than one extra-curricular activity might even be better

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than having just one (up to a limit of, say, four) (Zarrett & Lerner, 2008). Feldman and Matjasko’s (2005) review of this area showed that those with extra-curricular activity involvement tended as a rule to be less likely to experiment with drugs and alcohol. One caveat to this general rule is that peers have a strong influence over a child’s willingness to try alcohol or drugs. Therefore, parents should also get to know their children’s friends and partners in extra-curricular pursuits, and encourage their children’s peer relationships with those who do not use illicit substances and who are developing outside passions and interests themselves. Parents’ own behaviors, particularly their own modeling of a healthy lifestyle free from alcohol or other substance abuse, also play a key role in their children’s decisions not to get involved with these substances. Around the world, a strong deterrent against substance abuse and other problematic behaviors in teens is their respect for their parents and their desire to make parents proud. In addition to modeling healthy behaviors, parents should be firm in their “house rules” for their adolescents. Teenagers do best when families have agreed upon rules that all must follow both at home and outside the home. Parents who are both very warm and also firm in their rules and enforcements of those rules tend to have children who cope particularly well with the pressures from peers related to substance use and abuse. Zarrett and Lerner (2008) have a general prescription for what they term “positive youth development” which may be helpful to outline here. It is not enough to ensure that our children stay away from illicit substances. What is most important of all is that children thrive and maintain optimism and engagement about themselves and in relation to their communities. In Zarrett and Lerner’s conceptualization, the goals of an optimal adolescent life involve the six Cs mentioned above. The first is competence. An individual has a range of competences that he or she strives for. Academic competence is the one that learning disabled individuals may struggle with since so much of this has to do with grades in school. But there are several others. For example, health competence involves staying well-rested, getting enough exercise, managing stress positively, eating right, and avoiding substance abuse. Cognitive competence implies that one can generally reason well about issues that come up in daily life. Social competence involves getting along well with others and showing maturity in relation to various interpersonal relationships. The authors also stress the importance of vocational competence, involving career interests and capabilities. This idea of a multi-faceted competence in adolescence is appealing because it highlights the fact that the person with a learning disability is a whole person with many dimensions. I find this a useful way to think of each individual. The other facets of positive youth development from Zarrett and Lerner (2008) are also important to consider and to foster. One is confidence, which is the feeling of being capable and important. This is central to healthy development among all adolescents and perhaps even more so in those with learning difficulties who run the risk of feeling uncertain about themselves given how much time they must spend in school where the difficulties may be magnified. Another C is for

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connection, which is feeling some sense of bonding or kinship with people in one’s own family, with one’s friends, with one’s school and greater community. Teachers and parents working together as advocates for the child with a learning disability help to solidify this connection. The final three Cs are character, caring, and contribution. These three reflect how the child interacts with her or his community. Character reflects some sense of morality and responsibility to others. Caring reflects the extent to which one feels compassion or empathy for others. Ultimately, contribution is an investment in others, including one’s family and the greater community. How can the youth give back to others in some way? These Cs of positive development are clearly important goals worldwide. Årdal, Holsen, Diseth, and Larsen (2017) showed that one of the stronger predictors of these was perception of an empowering school environment. Zarrett and Lerner (2008) also highlight extracurriculars in giving children the tools to explore themselves such that they develop a sense of some of these competencies apart from school. Finally, the importance of the immediate family, including parents and other caregivers, as well as of teachers, for positive development is difficult to overstate.Yet parents and teachers also need support and advice. Thus, in the following sections, we consider what parents and teachers need to know not only for the children but for themselves.

Parents need support too Jergen (2004) noted that ADHD doesn’t just affect the person who has it. It affects how their classmates learn. It affects how their parents see themselves and how they are viewed by the community. It affects the self-esteem of their lovers and partners. (p. 83) In this section, I seek to highlight the difficulties that parents of those with learning difficulties have and also to explore how parents can help themselves and in doing so also help their children. In my interviews with individuals listed in Appendix A, there was quite a lot of emphasis on how parents can approach their children with learning difficulties, whether it is dyslexia, dysgraphia, ADHD, or others. One major emphasis was on compassion, compassion not only for their children, as discussed above, but also for these parents themselves, who, very naturally, find it difficult and frustrating to work with their children with learning difficulties sometimes. Here, I focus on advice to parents themselves, as parents, first. One of the most important things that parents of those with learning disabilities can do is to acknowledge some feeling of disappointment or frustration in themselves. Parents all around the world have many expectations of their children and of how they will parent these children.This often begins before birth, when parents have definite hopes and expectations even about

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the gender of their child. Boys are often preferred over girls in certain cultures such as India or China, but individual families still have their own individual preferences. A gender preference (or not) is just the beginning of what is often a long road of adjustment for all parents. Parents wish their children were more “something,” and here “something” could be any number of characteristics, including taller, shorter, more attractive, thinner, fatter, more outgoing, more gender typical, quieter, more polite, less fearful, smarter, better in sports, and on and on. A child having a learning disability is one of those things parents were often not expecting. Certainly this causes some angst in many parents. Mrs. Mayo, the parent of a daughter with dyslexia in Spain, reflected this dilemma beautifully when she said, Concerning parents, it is difficult to accept that the girl who was born a beautiful baby, the third daughter in the family, when she starts school, does not follow in the footsteps of her older sisters or her own parents. Why does she fail once and again? Why is all the schoolwork returned with red marks all over? Why does she start saying she does not want to go to school? This is a process both your daughter and you have to walk together. You have to learn that school is just a part of her life, that there are other aspects of her life where life is shiny and beautiful. You have to understand that life has nothing to do with reading or maths, that she may fail at school but that she might be as capable as anyone else in the other aspects of her life. She has to understand that her sisters have better marks than she will ever have, but that she has other virtues or skills that they will never achieve. Several clinicians I interviewed recognize the difficulties parents themselves face when their children have learning difficulties.There are very few resources devoted to parents’ coping strategies, but there should be more. For example, Hong Kong Educational Psychologist Ms. AG advises, “Show empathy for parents because this will never be easy to accept.” She further advises on how to help families together: Use metaphors to illustrate the fact that unrealistic expectations can only damage the self-esteem of children and reduce their learning motivation. Adjusting their expectations, setting optimally challenging sub-goals with adequate support, would eventually help their children to achieve better in a stepwise manner. Learning Support Assistant Ms. C. Azzopardi from Malta additionally notes that “Parents also need training and support to be able to help their children cope with their learning difficulties.” Dr. MC, a clinician from Macau, seems to understand these worries at a deep level: I think teachers are more open to accepting children with learning difficulties than parents are. After all, they don’t need to worry about the child’s future, whether he can hold a job, have a meaningful life, or even have a family.These

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are the questions and worries that parents are often struggling with as they don’t see the future or have a point of reference for a reality check, she notes. Ms. HO, a Danish Speech Therapist, highlights her explicit plan for parents as follows: In my practice, I insist on working closely with parents from the outset where they attend the assessment sessions and are part of describing and defining the strengths and challenges (of their child) observed. This builds on understanding, acceptance, and usually a reduction in anxiety; with knowledge comes a possibility for developing support systems and parent empowerment, which then gives a good baseline for student advocacy. I often feel that when parents initially come to see me they are fearful and anxious and, hence, their perspective is out of balance. Professor Pae, a Korean expert on speech and language pathology, and Dr. Lindeblad, a Swedish Clinical Psychologist, echo this sentiment as well. They independently highlighted the fact that one of the most important needs of children with dyslexia is for families to get support from professionals and from one another. Despite wonderful successes in those with learning difficulties, it is important to acknowledge again that feelings of disappointment are natural at some point.There are struggles, and they should be acknowledged. Two of my interviewees made this point rather poignantly; both have struggled with sons with attention difficulties. Ms. Sally, an American, highlights one particular family struggle that attentional difficulties have caused: How do I explain to family members that ADD is a neurological difference that causes behavior that LOOKS like willful disobedience, but isn’t? How do I explain to my parents that punishing my child for behaviors they see as inappropriate DOES NOT work? Friends are too polite to say judgmental things about your children’s behavior to you and will butt out. But parents think they know better than you and that you’re just being too soft, or aren’t disciplining your child effectively.This has caused literally YEARS of conflict with our parents. It took a medical diagnosis to convince them that we are doing things the way they needed to be done. My mom eventually apologized to me for not understanding before. This conflict nearly destroyed our family. I moved across the country to get away from my mother’s judgment and harping about how I should be disciplining my son. Robert Jergen, author of The Little Monster (2004), said this nearly fifteen years ago: I know several couples who are no longer speaking to their own parents because the grandparents feel the grandchild with ADHD is ‘out of control.’

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The grandparents say that the parents are ‘too lenient’ and need to discipline their kids more often. (Jergen, 2004, p. 12) Ms. Ellen, from The Netherlands, expresses similar emotions and has also had her share of misplaced advice on raising her son with ADHD. She says, Dealing with a child with ADHD has made me realize that raising a child can be extremely difficult and challenging.Very often you can’t find the answers to a certain problem. This can be frustrating, but something you have to accept.Yet, raising a child with ADHD has somehow made me more patient and inventive, at the same time. And that’s good. She continues, “Follow your heart. Always. You know your child best. If you honestly feel someone (a doctor or a teacher or another parent) gives you the wrong advice, don’t follow it up.” Both mothers have had to learn new parenting techniques in the face of a challenging learning difficulty. They have both seen great progress with their sons, but the journey has been far from easy. Ms. Sally’s struggle may be especially helpful for readers to know about because she is upfront about her ambivalence and what parents should and should not expect from themselves: My son is very difficult in so many ways. It makes it difficult to love him. Both my husband and I feel terrible guilt over this and we hope it gets better with age. After A LOT of research and reading, we’ve learned this is common, but no one ever really talks about it. It would be helpful if there was more information about this. I would like other parents to know that if they feel like they are doing the best they can, then they ARE doing the best they can.We only have so much to give, and we need to learn to forgive ourselves when we can’t give more. She continues: This is my greatest regret and challenge in life. I don’t enjoy my son’s company 95% of the time. I work very hard to spend as much time as I am able with him. Playing, talking, watching TV together. I know it is not enough, but it is all that I am capable of without making myself miserable. The guilt I feel is immeasurable; but it’s not enough to make me spend more time with him. My husband feels similarly, and does the best he can to spend time with him in different ways; but he also feels terrible that he doesn’t enjoy spending time with his own son. Research on this topic is still relatively sparse. Most of the work that is out there is on helping parents to help their children in the learning process. Few consider

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the complex issues facing parents when their children have learning difficulties. A report from the U.K. (Marjoribanks, 2017) sponsored by several organizations demonstrated that compared to parents with a child without a learning disability, those with one or more children with learning difficulties were more likely to feel lonely, anxious, and unhappy in their relationships. These relationships included not only those with spouses but also with their own parents, as noted by Ms. Sally above. The most important conclusion from this and other research on the topic is that having a child with a learning disability somewhat increases, on average, feelings of anxiety or depression in parents. Other work highlights the effects of the ADHD child on the relationship between parents. For example, those who have children with ADHD are far more likely to separate or divorce compared to those with children who do not have ADHD (Johnston & Chronis-Tuscano, 2014; Kvist, Nielsen, & Simonsen, 2013). The disruption in the marital relationship appears to be primarily a function of the child’s behavior and less to do with the parents. For example, in a study of adult identical twins, those with a child with ADHD were more likely to report interparental conflicts and/or divorce than the other twin (Schermerhorn, Cummings, DeCarlo, & Davies, 2007). Both mothers and fathers of children with ADHD are also at risk for depression, with at least 50% of mothers of such children having had an episode of clinical depression at one point in their lives (for a review, see Johnston & Chronis-Tuscano, 2014). These parents often experience both more negative and fewer positive interactions with their children and with others in relation to their children. In addition, mothers with children with ADHD compared to mothers without such children may have fewer occasions to enjoy time away from their children either for work or for leisure social activities; such activities are often important for protecting against depression.

Helping parents get the support they need So given this problem, what should one do about it? One website that might help to provide some support and some concrete suggestions to parents is this: www. understood.org/en, which can be found in both English or Spanish. Another for parents of children with attention difficulties is this one: www.additudemag.com/ youre-not-alone/ or this one: www.chadd.org/NRC.aspx, which is an Americanbased comprehensive resource. Whether these websites will be accessible in the years to come when you are reading this book is hard to predict. However, one of the easiest things a parent can do anywhere is to go online and look for resources or online chat groups devoted to supporting one another as parents. Some of the groups listed in Appendices B through D, offering information on dyslexia, dysgraphia, or ADHD, in different countries, can also help. It is fundamentally important for parents to recognize their own stress levels and to take some time to manage these. Social support is one essential ingredient of stress management. It is also worth exploring what methods of stress management are helpful to you as a parent. This website for all parents on stress management may be useful: https://

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childdevelopmentinfo.com/ but there are many available that can remind parents of basic techniques to reduce stress. Apart from social support, these highlight health care (get enough sleep, eat properly, limit bad habits such as excessive alcohol use or smoking, exercise regularly), time management (allow enough time to get to appointments, go through homework, prepare meals early so that you are not overwhelmed by last minute and unexpected chores that emotionally “flood” you), keep lists (of things you need to do so you do not forget, of things you are grateful for so you remember the positive, of worries if you are overwhelmed with negative thoughts so you can think them through later), and schedule breaks (to do nothing, listen to music you enjoy, stretch, breathe deeply). Above all, it is important for all parents, but particularly those supporting a child with special struggles such as one or more learning difficulties, to practice some form of self-care. A parent who is too stressed out herself or himself cannot effectively parent the child who needs her or him. This focus on parental needs and feelings is crucial, and I have not seen enough materials available to highlight how critical it is to keep families healthy, not only physically but mentally.With studies suggesting that over half the population suffers some sort of mental disorder or illness (i.e., a DSM-defined mental disorder, e.g., anxiety, depression, substance dependence) across the lifetime (Moffitt, Caspi et al., 2010) and parents of children with dyslexia showing more distress related to this difficulty (Bonifacci, Montuschi, Lami, & Snowling, 2014), there is a real need to acknowledge the importance of social support for parents of those with learning difficulties. Compounding such needs is the fact that often parents of those with dyslexia may also struggle somewhat with learning problems themselves (Bonifacci et al., 2014), making the job of supporting their frustrated children with dyslexia potentially even harder.

Teachers’ roles Apart from parents, other professionals who work with children with learning difficulties may also need some support and advice.What ideas are important for them to consider? Across interviewees, I asked for advice on what teachers could do to help. Most interviewees were profoundly sympathetic to the plight of teachers and grateful to them. Teachers are heroes and heroines. For example, Mrs. Mayo, from Spain, said, I must say that I admire teachers, really. I believe this is one of the most important professions; the future of our society is in their hands. They have a very difficult task before them; they have to ‘cope’ with 25 children, each one of them with his own needs and difficulties. It is difficult, when you have some goals to fulfill (such as educational plans, school curriculum, etc.) to take into account the different rhythms and learning styles of all the pupils. I understand it is difficult for teachers to accept a student who has another rhythm and does not keep up with the class. I advocate for a school system that gives teachers the tools to cope with this.

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At the same time, most of those interviewed wanted to make sure that teachers understand the importance of supporting students even when they have difficulties in school. One aspect of this is further education for teachers. Many do not know enough about learning difficulties to be fully supportive, and this differs strongly by culture. For a large number of those with learning difficulties, there have been painful moments in school when teachers were cruel. Ms. Amy, an American with dyslexia, still remembers her eighth grade teacher yelling at her in front of the class in eighth grade, because she had trouble paying attention. She notes, “What people don’t realize is that you can always learn stuff later. Rebuilding somebody’s self esteem? That’s a lot harder.” Mr. Cheung, a Hong Kong researcher and person with dysgraphia agrees, and has this advice for teachers: I think the most important thing for teachers to do is to stop explicitly comparing students’ abilities or mentioning (special educational needs) students’ difficulties. No matter whether the intention is good or bad, either to help students to understand more or to humiliate the poor performing students, picking students out is likely to make them a target of bullying or to lower their social status among students. From my personal experience, children’s peer social status is largely based on teachers’ comments and attitudes. If children perceive that a certain child is considered to be academically weak, the social status of that child will also be very low.

General advice for teachers So what can teachers do beyond having this understanding and treating all students with respect, a cornerstone of the teaching profession? Brooks (2016) highlights several ideas for classroom management by teachers in order to maintain all students’ self-esteem. One that resonated strongly with me was that all children (indeed, everyone at every stage of life) need to have a sense of control over their lives. When they have that, they can think through strategies of how to improve on their own performances, how to manage their time, and how they themselves would like to facilitate their own learning. As Brooks points out, having some sense of control ensures that these students feel some sense of ownership over their own learning; feeling such ownership is one key to maintaining learning motivation. His own work with students and teachers led him to offer advice for classroom teachers, and one can well imagine that some of this advice would apply in certain situations at home or elsewhere as well: First, it is useful to highlight the obvious theme that children are different and learn differently. Some are faster or slower runners, better or not-so-good at music, more or less proficient in reading, and quicker or slower to understand mathematics concepts. Brains and abilities are simply different (e.g., Saltz, 2017).With these differences acknowledged, the teacher or facilitator can introduce the idea that work in and out of the classroom might differ

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in quantity and/or quality depending upon the needs of the student. I found this to be an important yet controversial point, one that I have discussed a few times with Hong Kong teachers in several forums. Their general attitude seems to be similar to what Brooks (2016) perceives is that of American teachers: Children might see differences in homework as unfair. As someone with experience with those with dyslexia, you will immediately note that the condition of dyslexia itself is unfair, and that is why accommodations should be different for those with dyslexia or any other learning difficulty. However, teachers fear reactions from students and parents on this nebulous issue of fairness. The advice that Brooks (2016) offers about this issue is that teachers should openly discuss the idea of learning differences, work differences, and fairness before any assignments are ever given. Teachers can then be direct with their pupils about issues of fairness and how students should discuss these with the teacher if any concerns arise. In his experience, if this issue is directly considered at the beginning of the course, there are usually few or no concerns that ever arise. One innovative example of this came from Canadian Vice Principal Dr. Anna Garito. She recommends the following: As a special education teacher I took the initiative to teach students what it means to be a student with a learning disability through presentations with older students from high school with LD and video presentations. Presentations given by older students are very powerful because they are able to share some of the strategies they use to help them cope. Also, I’ve learned that by the time the students get to high school they’ve accepted their learning challenges and can empathize with young teens. As such, teaching students early on how to compensate for their learning difficulties is truly a life strategy and an approach to help students realize that they are capable of learning. The concept of showing early awareness of differences and fostering empathy in fellow students seems essential and works well in practice. Even if teachers are not allowed to acknowledge learning difficulties explicitly, they can still focus on general principles associated with learning differences. Brooks (2016) offers additional recommendations for accommodations to learning differences as well. These include giving extra time for exams to some students, ensuring that students understand the maximum amount of time they are to devote to homework, making sure that students are clear about their assignment each day, and allowing students to use the computer to complete assignments when needed. The first suggestion is a standard one offered by schools and universities that are attuned to learning difficulties all over the world. It was discussed as a good practice for those with dyslexia in Chapter 7 and should be upheld whenever possible as a basic accommodation to those struggling with learning difficulties. The second, focused on giving children a set maximum amount of time to complete their homework every day, is mentioned less frequently. It is a very good way to ensure that students and their parents have some gauge of what is

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developmentally appropriate for children of each age and grade level. In China, for example, primary school children spend about three hours per night on homework, twice the international average (Liu, 2015).Those with learning difficulties in Chinese societies often have to spend even more time because parents are convinced that their children need to work harder to succeed. The suggestion that there be an established stopping point for homework is a potential lifesaver for some frustrated students and parents. Currently, there is often the expectation that no matter what the child has done or is capable of doing, he or she should keep doing homework until it is finished. This sometimes has the consequence that a child has no time for anything in life except homework and likely colors the child’s outlook on life as a joyless, continuous exercise in school and homework with nothing else. Every child needs a balanced life for healthy development. Balance includes enough time for exercise, time with the family, sleep, and fun. Self-development cannot occur when one has no time for it. The third idea, that students must be clear about their assignments each day, is commonly acknowledged among teachers, though it is not always obvious how to ensure this. Teachers often write assignments for the day somewhere at the front of the classroom. Those with learning difficulties may be too slow, too distracted, or not efficient enough in writing to be clear on the assignment in time.Teachers who can ensure that this information is clearly communicated to all children are doing them a great service. This might be possible by sending assignments to all children and their parents electronically (if this is feasible in your area; in many locations worldwide it is, of course, not yet possible to do this), having the teachers hand out the assignments in some form so that the children do not have to copy them from another place, having a clear syllabus with a plan for each day from the beginning, or pairing the child with a learning difficulty with another child without such a difficulty as a “buddy” to make sure the assignments are clear. The fourth suggestion from Brooks (2016) is a familiar theme of this book: Allow children to use computers to communicate their ideas if needed. A focus on handwritten work can be counterproductive for those with dyslexia or dysgraphia. Allowing computers to be used for writing assignments ensures that students’ difficulties in writing at the word level can be somewhat minimized because writing is made easier with spell checks, uniform neatness of the print, and even choices in font. Of course, when students are self-conscious that they are standing out because they are receiving different or special treatment, this can also be problematic. Dr. Anna Garito presents a solution used at her school in Canada for this one as well: When students are in class and self-conscious of looking different I’ve set up a meeting with the student to discuss the possibility of a cueing system. The purpose of a cueing system is to use a non-verbal approach to ask for assistance and/or leave the class (e.g. index finger raised while hands are placed on the desk, private note asking for a time to meet, student asks to go to the library or bathroom but then goes to the special education teacher to

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get extra help). In fact, some students will not even use assistive technology while in class. In these cases the student has been able to use the program in an alternative class setting. . . . Importantly the student and teacher relationship has to be established before any measure can take place. Students need to feel a sense of safety and trust with the educator. Unfortunately, without a solidified relationship it will be too difficult for the student to believe the teacher has his/her best interest at heart. Perhaps a final suggestion for teachers to keep in mind, though a bit trite, is how much they matter. As noted by Masten (2014) and many others, almost without exception, every child who demonstrates resilience does so because he or she has been supported by a caring adult. Many of these mentors were their own parents, but for many others, the crucial role model is a teacher. Teachers who maintain the view that all children can learn, albeit in different ways, help children with learning difficulties to persist in the face of difficulties. Such teachers tend to demonstrate support, enable children to participate and try out new ideas, and maintain high expectations for student performance (e.g., Benard, 2003). Most of us are lucky enough to remember at least a couple of teachers who influenced our career or life development in a profoundly positive way. For those with learning difficulties, perhaps one of the most important benefits of a teacher beyond day-to-day tutoring is the ability to see the whole child. Teachers who can see the child’s potential and strengths help her or him to become her or his best self. And so, in the end, it is up to all mentors, including parents, teachers, and other professionals, to focus on facilitating trust in the relationship as much as possible. Research on children who are resilient, defined as having adapted positively in life despite adversity, shows that they consistently have benefited from a caring mentor. This mentor might have been a parent, older sibling, teacher, or other caring adult. The role of mentor is extremely important for all children. Yet for those with a learning disability, it becomes even more powerful, because these children face almost relentless learning struggles. Mentors’ flexibility, understanding, and the search for and appreciation of strengths, in addition to being willing to help those with learning difficulties to work through their weaknesses, are keys to success for every such child.

12 WHERE DO YOU GO FROM HERE?

Difficulties with literacy learning and attention deficits are pervasive in schools worldwide. Some countries have few, if any, resources with which to deal with these learning difficulties. In other countries, there is good sensitivity and available resources for helping such students. This book is intended to provide parents and teachers with some of the groundwork needed to understand the challenges faced by those with literacy and/or attention difficulties no matter where in the world you live. If the fundamental difficulties are recognized, parents and teachers can help these children to identify specific strengths and weaknesses and to practice skills that are weak but necessary for the reading and writing process to take place. In many countries, there is at least one organization dedicated to helping those with learning disabilities to excel. Readers of this book should reach out to others through such organizations when possible (either in person or on the internet). The difficulties discussed in this text cannot, for the most part, be remediated through drug therapy, at least exclusively. Rather, these difficulties require attention to best behavioral learning processes. One place to turn for help and support will be internet sites that might customize learning activities for your language, script, and culture. This book can serve as a base from which to plan ideas for helping children with dyslexia, dysgraphia, and ADHD in different aspects.Your way forward should begin with a scan of the appendices provided in order to get support (Appendices B–D), hints on learning strategies that might work (E), some websites to consider for actual practice games to reinforce word learning (F), suggested movies and online materials that can be inspiring in their accounts of what it is like to live with a learning difficulty in different cultures (G), and exercises for cognitive skills related to reading that can be adapted to your language or script (H). I hope the chapters and the appendices together provide a solid platform for planning a holistic treatment for children with dyslexia, dysgraphia, and ADHD.

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Learning struggles I have the luxury of writing this book in middle age at a time when I have had a lot of exposure to work on literacy across cultures but also when I personally have thought a lot about the nature of learning because of my own recent experiences. With encouragement from my husband, I started to learn something about sailing about four years ago. I was lucky enough to get a sabbatical to work on this book in Germany in 2017–2018; in preparation and while in Germany, I spent some time each week learning German, a language I began learning casually and spottily in October of 2016. These two novel learning experiences have been excellent for reminding me of how difficult it is to learn new things on a system-wide level. Sailing requires knowledge of a whole vocabulary I was unaware of, including homographs (one example: luff, meaning either the forward edge of a sail or to sail close to the wind or to flap when losing wind – why are there all these multiple meanings of this one word I never knew before this?!). I now know words like portside and starboardside, jib, tack, jibe, lifeline, boom, and lots of others that I can recognize but not produce. But learning to sail also makes use of completely new skills I never exercised in the past. For example, I had to learn how to tell where the wind was coming from, something that took me a very long time to figure out. I had to learn literally how to row a boat.This was also not intuitive for me. I bring up these examples because these are not skills we all had to use in childhood (well, not for me, growing up in Indiana, U.S.A., which has relatively few bodies of water!). Actually, some of these skills were completely new. It turns out that I am not naturally good at them.Yet I love to sail. It is beautiful and opens up new worlds and angles on life. It is motivating for the final goal. I think of this so often when I think of dyslexia. Most children with dyslexia are readers as adults.They use reading for one or more outcomes that are useful and desirable, like selecting the right ingredients in the grocery store, scanning the internet for what entertains them, communicating with others via text or email, and of course often for work. But this particular skill of reading words has come later and with more difficulty than for others. In case you think I am exaggerating my analogies here, I offer a personal story of some humiliation but also of redemption. I participated in a sailing course with four other students in Hong Kong. All of us were in our 40s and 50s.The three men had more experience than we two women. All of us were quite motivated to learn the basics of sailing. We worked hard to learn these over the week. We had to pass a few different skills tests in order to get our certificates. One of the tests was for rowing a dinghy, a small boat. This is important for obvious reasons. If the engine of a small dinghy fails, one must be able to row to safety. I was the last of the five of us to attempt to row. I was by far the worst at this. I had never spent any time in a dinghy rowing. But more than that, I have some difficulties (always have) in understanding directionality and my own body. It is hard for me to anticipate what is left and right and how my actions move us in those directions. To make matters worse, all of you who know how to row a boat know that you are essentially rowing backwards.The boat goes where you guide it from behind. As I tried to row in front

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of all the other students, I felt myself screwing up and failing continuously. Those who perform something they are not good at in front of a crowd tend to perform it even worse than they would alone, by themselves. I felt my performance going from bad to worse. Our instructor was simply dumb struck. He had not seen me as in any way talented in sailing, but he had not seen me thus far as completely incompetent either. How was this possible? The more I rowed, the further from my goal and the more out of control I became. Also, I felt completely humiliated. In middle age, many of us have determined what we are good at and enjoy and do that more and what we are bad at, we avoid. We certainly avoid doing things we have trouble with in front of others! What was I doing? I wanted to give up completely. So I did. I told my instructor that there was no way I could pass the test on that day. This was quite unusual, virtually unheard of. He did not quite know what to do. With the negative emotions and confusion I was experiencing, though, I could not imagine passing this test. Ultimately, I was given six weeks to practice in private and then send him a video of me rowing, the last part of a test to allow me to get my certificate. I practiced several times, and when I was not in the water, at odd times during the day or at night, I would rehearse to myself the steps I should take in order to go from point A to B in a row boat. Eventually, I succeeded. I sent in my video and got the certificate. But this took a lot of time, energy, and ego management. I do not generally think of myself as a stupid person, but this skill was something I had special trouble acquiring. Maybe you cannot imagine having trouble with something as easy as rowing a boat? All you have to do is row! But it involves awareness of space and directionality that I was never at ease with. Indeed, in childhood, I could never “feel” intuitively what was my left side as compared to my right side. Ironically, I only managed to figure these out because I happened to be a good reader. Someone explained to me that if you put your palms down on the table with the thumbs spread away from the fingers, one of them makes an L. That L stands for left.This is how I internalized left as opposed to right. Most of the time, I am able to ignore this slowness and awkwardness in thinking about visual-spatial aspects of my own body in relation to accomplishing novel tasks such as moving a boat.Yet this was one situation in which I could not avoid or “fake” my way out of displaying my ineptitude. Luckily for me, most of the time, such situations are relatively infrequent occurrences. Why have I brought up my rowing woes? To a certain extent, I wonder if those with dyslexia or dysgraphia have the same sorts of feelings but over a much longer period of time. One cannot pause and explain to one’s classmates that he or she is actually capable in many areas such as computer games, drawing, organization, music, and only failing at the activity the class is currently engaged in.You feel the humiliation of failure, and there is nothing to do to get out of it. All you can do is work harder over an extended period of time. But such incidences are also seared into the mind as occasions when your group might see you as a complete incompetent. This is not easy to handle when it arises often, as in a school setting. Some may see this book as less sympathetic or clear on the parameters of learning difficulties than is appropriate. The truth is that, for some, learning difficulties

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bring with them despair.This despair can last for years and years. In particular, conversations with several parents of those with ADHD brought up feelings of complete desperation. As their children went from childhood to adolescence to young adulthood (early 20s), these parents often experienced prolonged disappointment in the children’s abilities to manage a range of experiences that come up during this time, including relationships, money, alcohol, cigarettes, or other drugs, or school or employment. It is important to be realistic but also to find room for hope. In this period through adolescence in particular, life can be frustrating and full of challenges, exhausting. It would be a mistake to interpret anything I have said here as lacking in understanding of the emotional and mental challenges of learning difficulties for those who have them and their families. As Ms. Ellen says, living with ADHD (as my son, Peter, does) + living with someone who has ADHD (as I do as a parent) is such an incredible struggle and worry, causing so much pain, sadness and stress without any end in sight. For you, whomever and wherever you are, the most important point I can make here, having acknowledged this pain, then, is that no one is alone in this. Students, families, teachers, and practitioners all over the world share the same frustrations and occasional despair as learning difficulties are incorporated into the realities of modern life.

Soldiering on with a growth mindset and grit Thus, this rowing incident from my own life might actually be quite a bad analogy for those who have dyslexia or dysgraphia.Yet it is the one that is closest to me at this time in my life because I just lived it. After failing my public rowing test, I felt embarrassed and alone. I went off by myself and cried bitterly out of extreme frustration. In the following weeks, I had to work hard just to pass. But this is where an analogy to learning difficulties ends. I worked hard, but only for a few weeks. And then I passed and it was over. For many people living with dyslexia, this is a life-long struggle. It can come up repeatedly at work, and it comes up again if and when a person with dyslexia has children who are also required to learn to read and to write as part of standard schooling. One cannot take medicine to improve reading and writing. There is no quick or easy solution. The only way forward is a hard slog of extra work, extra practice, and mindfulness, knowing one’s self, so that each person can come up with the way in which learning to read and to write, at whatever pace, is easiest (meaning not impossible, never meaning easy) for him or her. Dweck (2006) and Duckworth (2016) remind us that the “growth mindset” and some “grit,” respectively, are what are needed, for overcoming dyslexia or other difficulties, and for blossoming into skilled individuals. I am a firm believer in these philosophies. This does not make them easier. The focus of this book has been primarily on what we know about dyslexia and associated learning difficulties around the world. What parents and teachers are

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usually most interested in is how to “fix” it. I hope that this book has made you feel less alone, no matter what your relationship to dyslexia is. If you have dyslexia, if you are a parent of someone with dyslexia, or if you are a teacher, tutor or aid, clinician, pediatrician, researcher, or other for those with dyslexia, I hope you have found some insights into how dyslexia might be at least partly remediated. Ideally, some of the tips provided in the book and in the appendices can help in a concrete way. At the same time, it is equally, or perhaps more important, to note that dyslexia is a way of thinking differently. As such, dyslexia and other learning difficulties cannot be completely overcome but must be integrated into the whole person’s identity. Gail Saltz (2017), a professor of psychiatry and author of the book entitled The Power of Different:The Connection between Disorder and Genius, presents many hopeful stories about those with dyslexia and other learning or thinking difficulties. I think that most people view dyslexia primarily as a difficulty and an impairment because it interferes with conventional school learning, and no matter where you live in the world, success in school learning is important for a brighter future. However, I do appreciate the argument put forward by Saltz (2017) and also by Sally and Bennett Shaywitz (e.g., www.dyslexia.yale.edu), medical researchers who have established a center focused on creativity and other strengths of those with dyslexia, that the differences in thinking of those who have dyslexia should be very much appreciated. There are clearly many in various fields, including governing (e.g., legendary leader of Singapore Lee Kuan Yew), business (e.g., IKEA founder Ingvar Kamprad, of Sweden), science (e.g., American Nobel Prize-winning microbiologist Carol Greider), and performing (e.g., legendary singer and actress Cher), who have worked with or beyond their dyslexia to achieve extraordinary success. Having dyslexia in no way guarantees extraordinary success in other domains. It is, after all, a learning difficulty. However, it is also important to recognize that those with dyslexia, as well as dysgraphia and ADHD, are capable of ground-breaking accomplishments, perhaps in part as a result of their way of thinking as influenced by having a learning difficulty.To put it in an optimistic light, it undoubtedly teaches them to be less afraid of failure and, hopefully, more willing to try new methods. Duckworth (2016) specifically underscores the idea of hard work as a key to success, as Dweck (2006) had done with other ideas ten years earlier, with two direct examples in the area of literacy. In one of her early studies, Duckworth examined the children participating in the (American) National Spelling Bee held each year in Washington, D.C. She tried to look at the students’ overall skills ahead of the competition and compared them to who performed better in the final contest. Results were simply that children who spent more time studying how words were spelled performed better, and this “time on task” is what Duckworth refers to as grit. The more one practices, the better one becomes, in any skill. This is frankly amazing considering the fact that those in this National Spelling Bee are all top spellers and usually top students in general. I had not expected much variability in student performances. It is somehow comforting to know that even in this elite group, the harder workers ultimately seemed to perform better.

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Her second example is perhaps more inspiring still. In several of the interviews I conducted with those listed in Appendix A, I learned of parents who hoped their children with dyslexia would become writers. A real-life example of a famous writer who was severely dyslexic as a child is John Irving, American author of The World According to Garp and many other novels, as highlighted by Duckworth (2016). Irving, describing his early school years, is quoted in the book as saying “If my classmates could read our history assignment in an hour, I allowed myself two or three.” (p. 45). As an adult, he still reads occasionally by using his finger to highlight words and very slowly.Yet he views his dyslexia ultimately as having been his good fortune. He notes that the requirement that he read and write slowly, laboriously, has given him confidence in writing over time. His “stamina” in writing is described as an “advantage” (p. 45). The message is clear: Had he not had to work so hard and focus so carefully on crafting his writing, he might never have become as skilled or even as prolific as he is today.

Focusing on the whole child What is the way forward for best helping the child with dyslexia, dysgraphia, or ADHD? What I appreciate most about Saltz’s (2017) book is that she considers the whole person in understanding difficulties. In her final chapter, entitled “The future of thinking differently,” She makes five recommendations to parents on how to help their children who face particular difficulties related to thinking or learning. These are quite general, but they are worth mentioning here because at least some of them are applicable for parents around the world. Saltz’s (2017) first recommendation is that the child receive an evaluation and diagnosis.You may be reading this book because your child already has the diagnosis of dyslexia, dysgraphia, and/or ADHD, or because you suspect he or she has it but you are not sure. In many countries, there are paths to getting such a diagnosis relatively cheaply or free.We have listed some places that can help online in Appendix B, and if you do not find your country, you can also refer to the worldwide International Dyslexia Association. It is important to try to get a professional’s help in diagnosing the child to ensure that you are clear on what the problem is and is not. At a broad level, this might mean that the evaluation shows that the child has dysgraphia and ADHD but not dyslexia, or vice versa, meaning dyslexia but not handwriting or attention difficulties, for example. The evaluation helps to define the whole problem so that there are no longer questions about areas of difficulty. Often, an evaluation is comprehensive enough that you can learn not just about the child’s greatest areas of difficulties but also about what the child appears to be capable of at an average or above level. These skills the child has are so important to understand in order to consider alternative approaches to learning. For example, if the child is weak in phonological skills but average in visual skills, you might consider focusing a bit more on visual approaches to symbol learning. I am mindful of the fact that it is sometimes impossible to get an evaluation for a given child, however. In many places in the world, professionals with knowledge

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of dyslexia or dysgraphia, such as clinical or educational psychologists, are few, non-existent, or unaffordable for many families. This is why I took a lot of space in Chapter 2 to describe the cognitive-linguistic skills most associated with learning to read and to write across scripts. If you think about these and integrate these skills into what you know about your own language or script, you may also have some sense of the child’s strengths and weaknesses. Moreover, classroom teachers typically work with many students over the years, and they can be a good source of knowledge of performance of your child in some aspects. Again, you should focus not only on the child’s major difficulties but also on his or her relative strengths in the classroom. The second and third recommendations from Saltz (2017) further highlight this theme. Here, she advocates leading with the child’s strengths and ensuring that learning takes place in an 80–20 ratio. That is, 80% of the time should be devoted to the child making use of strengths in learning, and only 20% of the time should be devoted to the child working on her or his learning weaknesses to improve them. This sounds somewhat radical and in some places unrealistic given the relative inflexibility of conventional schools. However, in an ideal world, this should be possible. In particular, as many parents stressed in our interviews, dyslexia implies particular difficulties in word decoding, which involves symbol processing. Those with dyslexia can have clear strengths in broader projects involving designing, creating, and carrying out any and all (e.g., research; art; communication such as a play) assignments.This suggested 80–20 ratio is interesting and provocative. Although this ratio is not always realistic in many of today’s settings, it is important to consider it here, because the way things typically go for most children with dyslexia is probably at least a reversal of this (80% working on weaknesses and at best 20% playing to the child’s strengths).While working to improve one’s weaknesses is important, a continuous focus on what one is poor in is discouraging at best and kills all desire to learn at worst. Saltz’s (2017) fourth recommendation is to allow children more opportunities for play. In today’s world of continuous competitiveness at school, this is a refreshing reminder. One of my friends who works professionally with children with dyslexia in Hong Kong once told me a very sad story of a 7-year-old boy with severe dyslexia. His parents are wealthy enough to hire tutors to try to help to remediate his learning difficulties. The parents had hired tutors to help him to improve on his school subjects, especially Chinese, English, and mathematics, but also hired teachers to try to get him to be good in other culturally admired abilities such as piano playing, which the boy also did not like and did not excel in. The boy was so overscheduled that he ended up setting his alarm clock for 7 a.m. on Sunday mornings knowing that that was the only time in the entire week when his parents would still be asleep and he would have an hour of time all to himself to play with his beloved legos. Remember: this boy was only 7 years old and had to sacrifice sleep in order to gain an hour of play in a week. The idea from parents that play is not as important as academic training is by no means a universal. In some European countries such as Finland and Sweden, for

Where do you go from here?  185

example, formal literacy instruction does not even begin until age 7, and young children are encouraged to play most of the time before this and a substantial amount of time afterward; homework is not all-encompassing in primary school and beyond. Sadly, however, in other countries, parents routinely belittle children’s play, demanding that they try to improve their formal learning, particularly if they appear to have a learning difficulty. Indeed, two popular movies depicted this exact theme of a learning disabled boy failing repeatedly at school and finally being recognized for his talents in art by a dedicated teacher despite frustration, anger, and despair from the boy’s caring but helpless parents. One of these was “I Not Stupid,” which came out in 2002 in Singapore; a sequel (“I Not Stupid Too”) came out in 2006 because of the huge popularity of the first film.The other was “Taare Zameen Par” (English title: “Like Stars on Earth”) which came out in 2008 in India. (These are both listed, along with other useful online materials that may help you and others interested in learning difficulties to empathize more fully with those with learning difficulties as you see some life stories of what such children go through, in Appendix G.) Both films won awards and were commercially extremely popular, perhaps, in part, because so many could relate to the theme: A happy life involves not only struggle but also joy, and those with learning disabilities should be allowed to make use of their talents and not just focus on improving their weaknesses.Thus, the idea that children should be allowed to play more should be heeded around the world. Ms. Leah, a Canadian school teacher, echoes this idea: I think it would be helpful for parents to see how valuable down-time/playtime/outside time is, that homework or more schooling is not the answer, and that their kids are perfect exactly where they are at. The idea that everyone should be at a certain level by a certain age is archaic, yet we still embrace it in the way we teach and in the way society goes along with it. I hope schools and eventually the greater public starts to understand this and shifts education accordingly. Later in the interview, she further mentioned a side point that some parents push children to go to school too early. There are places where kids are just too young to be in the grade they are in. If we are still using a grading system, it’s just not fair to expect a child who is nearly a year younger than another child to be working at the same level, regardless of any learning challenges. Don’t be in a rush to put your child in school! This idea may be additionally helpful for some parents to consider in relation to learning difficulties. If these are suspected early, parents might additionally consider placing children in school a year later. Finally, Saltz (2017) advises that families get help from educators to improve the plight of the child with a learning difficulty. Advocacy on the part of the person

186  Where do you go from here?

with dyslexia is a continuing struggle. Some teachers understand dyslexia and are eager to help students to work around it, and others simply do not “believe” in it. Families who know a lot about the difficulty can help children to get the best treatment possible in the classroom. Vigilance over the learning environment is often essential because different teachers and different situations may bring about different situations for the child with dyslexia. Over time, the student with dyslexia will have to educate and advocate for herself or himself about the disorder. German pediatrician Theresa Stoeckl-Drax focuses on some advice that both teachers and parents could benefit from as a basic philosophy in advocacy for those with dyslexia: As for every developmental process, some children are quicker and more at ease than others. For learning to walk, some children walk within 9 months, and others within 18 months; both are normal, and this does not even tell us about their sportiness in later life. This applies to reading, writing, and math as well. Children can be developmentally slower in some aspects – call it dyslexia or just a developmental delay in learning to read or write correctly. It is usually not the inability to acquire this skill. But as with walking, we still carry a child who does not walk; yet even when her best friend already is on his own, we encourage little steps and get excited about them. The same should apply to slow or late readers and writers, small steps, a lot of encouragement and excitement about their steps and reading to them as long as they need it.

Conclusion Thank you for reading across many themes in the area of learning difficulties across cultures. We have considered both cognitive and socio-emotional aspects of learning disabilities, and in every individual, these must be integrated. Learning facilitates interests and motivation, and interests and motivation inspire learning. I hope that, with the examples from individuals across six continents given here, you realize that, wherever you are in the world, you are not alone in this focus on optimizing the lives of those with dyslexia, dysgraphia, and ADHD. I wish you every success in your journey.

AFTERWORD

I am grateful to many people and institutions for allowing my dream of this book to become a reality. For administrative and collegial support, I am very appreciative of Nikolaus Binder, Petra Fischer, Bernd Kortmann, Britta Küst, and Roland Muntschick. I could not have written this book without these wonderful people, who represent the best of the Freiburg Institute for Advanced Study (FRIAS) at the University of Freiburg in Freiburg, Germany. The research leading to these results and to this book has received funding from the People Programme (Marie Curie Actions) of the European Union’s Seventh Framework Programme (FP7/2007– 2013) under REA grant agreement number 609400. Many thanks to the EURIAS (European Institute for Advanced Studies) program and particularly to FRIAS for sponsoring the fellowship that allowed me to write this book. This was a truly wonderful year in so many ways. In addition, for various editing and appendix contributions, ideas, and suggestions, I am extremely thankful to Leo Cheang, Edmond Cheung, Kay Dulay, Christina Lee, Judy Leung, Tiffany Tsoi, and Natalie Wong. Special thanks to Jonalyn for keeping everything together at home. Collectively, these are part of my core Hong Kong crew. I am additionally appreciative of the support I have had throughout the years from The Chinese University of Hong Kong. I am also particularly grateful to my interviewees for this book, all of whom are listed in Appendix A. Some of them agreed to be identified by their real names and some by pseudonyms; all were incredibly gracious, helpful, and straightforward in their answers. I was occasionally moved to tears by their answers, and I learned a great deal from each and every perspective. I hope that I have done a reasonable job of integrating their quotes and characterizing their ideas. I apologize for any mistakes along the way. I was eager to make this a book that is globally relevant. At the same time, this is not an easy task. There are so many differences across cultures, languages, and scripts. Clearly, research on this work is

188 Afterword

ongoing and is not yet well represented in some places. We tried our best to highlight relevant websites and resources in a reasonable number of different countries and areas, but some errors are almost inevitable. I am entirely responsible for these errors. I particularly want to thank my friends and family for supporting me in writing this. This is my emotional core. Special thanks to Dr. Anna Garito, Irma Hoskens, Kate McEvoy, and Mona Visnius for being who they are. I am especially grateful to my parents, Bill and Angela, to my sister, Kara, to my Aunt Cecilia, and to my children, Leeren and Claire.This year was a really good one for spending time with the Swiss family side as well, especially Rochelle, Pascal, and Raphael.Vielen Dank! Finally, I am profoundly thankful to my husband, Helmuth, without whom this book would not have come to be. It takes a (global) village!

APPENDIX A Questionnaire respondents

Place of Origin

Name/Alias

Role

Argentina

Ms. Maria Rufina Pearson

Australia

Ms. N (+two associates)

Austria Canada

Ms. Erika Barker-Benfield Dr. Anna Garito

Denmark

Ms. HO

Denmark

Mr. Lars Sanders

Germany Germany Hong Kong

Mr. OM Dr. med. Theresia StoecklDrax Mr. Cheung

Hong Kong Hong Kong Hong Kong

Ms. G Dr. L Ms. Monica

Hong Kong India

Dr. T Ms. Kate

Educational Psychologist; Author of the book Dyslexia: Una Forma Diferente de Leer; Director of a Center for Learning Disabilities Teacher, with special education qualifications – three teachers together wrote up this interview Educational Psychologist Vice Principal and Former Special Education Teacher Speech and Language Pathologist and Audiologist Father of two dyslexic children; Senior Training Developer for an educational software company High school teacher/school consultant Pediatrician, mother of three children with some dyslexia and ADHD Person w/dysgraphia; Ph.D. student in the area of learning disabilities Educational Psychologist Developmental Pediatrician (female) Person w/ dyslexia; student in the area of disabilities Educational Psychologist (male) Mother of two boys with dyslexia (Continued)

Place of Origin

Name/Alias

Role

Israel

Ms. Danna

Israel

Mr. Joe

Mother of a boy with ADHD, has dyslexia herself; Nurse/Therapist Father of a boy with ADHD, husband of Danna; business executive Speech Therapist Speech Language Therapist, Professor (female) Clinical Psychologist (female) Learning Support Assistant at a primary school (female) Mother of person with ADHD Person with ADHD (young adult); son of Ms. Ellen Mother of daughter with dyslexia; Member of Catalan Dyslexia Association Clinical Psychologist; researcher in the area of learning disabilities Person with dyslexia; art student (young adult) Person with ADHD (young adult) Principal of a secondary school and President of the Swiss Dyslexia Association Mother of child with ADHD Former School Psychologist; person with ADHD and father of child with ADHD Person with dyslexia, dysgraphia, and ADHD; Translator Person with ADHD; mother of son with ADHD Former teacher of children with learning difficulties; researcher in the area of literacy in children

Japan Mr. Toyota Korea (South) Dr. Pae Macau Malta

Dr. MC Ms. C. Azzopardi

Netherlands Netherlands

Ms. Ellen Mr. Peter

Spain

Mrs. Mayo

Sweden

Dr. Emma Lindeblad

Sweden

Ms. WA

Switzerland Switzerland

Mr. Apercu89 Mr. Robin Hull

Thailand United States

Ms. Aiyada Dr. RJ

United States

Ms. Amy

United States

Ms. Sally

Zambia

Dr. Sylvia Kalindi

APPENDIX B International organizations on dyslexia

Countries/Regions

Organization

Website

Africa

The Southern African Association for Learning and Educational Differences Australian Dyslexia Association Australian Federation of SPELD Associations Dyslexic Advantage Learning Difficulties Australia The Dyslexia-SPELD Foundation Berufsverband Akademischer Legasthenie-DyskalkulieTherapeutinnen Dyslexia International Brazilian Dyslexia Association Dyslexia International The Reading Well Fundacion Costarricense de Dislexia Czech Dyslexia Association Fana Association for Individuals with Learning Difficulties 

www.saaled.org.za/

Australia

Austria

Belgium Brazil Brussels Canada Costa Rica Czech Republic Ethiopia

http://dyslexiaassociation.org.au http://auspeld.org.au/ www.dyslexicadvantage.org/ www.ldaustralia.org https://dsf.net.au/ www.lrs-therapeuten.org/

www.dyslexia-international.org/ www.dislexia.org.br/ www.dyslexia-international.org/ www.dyslexia-reading-well.com/ http://dyslexiacenterofcostarica. org/ www.czechdyslexia.cz/index.html http://fanaethio.org/

(Continued)

Countries/Regions

Organization

Website

Europe

European Dyslexia Association The Egyptian Society of Developing Skills of Children with Special Needs Niilo Mäki Instituutti Dyslexia International Bundesverband Legasthenie & Dyskalkulie e.V. Dyslexia Association of Hong Kong Heep Hong Society Hong Kong Association for Specific Learning Disabilities Dr. Anjali Morris Education and Health Foundation Maharashtra Dyslexia Association Dyslexia Association of Ireland Kol Koreh The Organization for Unlocking the Potential of Dyslexic Learners Associazione Italiana Dislessia Dyslexia Association of Sarawak The Netherlands Dynaread

http://eda-info.eu

Egypt

Finland France Germany

Hong Kong

India

Ireland

Israel

Italy Malaysia Netherlands

Japan

Kenya Kuwait

Latvia Philippines

Japan Dyslexia Research Association Japan Dyslexia Society Dyslexia Organization, Kenya Kuwait Dyslexia Association The Centre for Child Evaluation  & Teaching Pro Futuro, Latvia Philippine Dyslexia Foundation

www.advance-society.org/

www.nmi.fi/en www.dyslexia-international.org/ www.bvl-legasthenie.de/

www.dyslexia.org.hk/ www.heephong.org/ https://asld.org.hk/

http://morrisfoundation.in/ www.mdamumbai.com/ www.dyslexia.ie/ www.kolkoreh.org/ www.dyslexia-abilities.org/

www.aiditalia.org/ www.dyslexia-swk.com/ www.dynaread.com/Netherlandsdyslexia-tests-programs-groups http://square.umin.ac.jp/dyslexia/ www.npo-edge.jp/ www.dyslexiakenya.org/ http://q8da.com/ www.ccetkuwait.org/ www.disleksija.lv/ www.facebook.com/pages/ Wordlab-Philippine-DyslexiaFoundation/117553354994622

Countries/Regions

Organization

Website

Portugal

Associação Portuguesa de Dislexia Dyslexia Association of Singapore Madrid con la Dislexia Project Difference Verband Dyslexie Schweiz Turkey Dyslexia Foundation British Dyslexia Association Dyslexia Assist Dyslexia Association of London Dyslexia Foundation Dyslexia Research Trust The Reading Well Academy of OrtonGillingham Practitioners and Educators American Dyslexia Association Bright Solutions for Dyslexia Davis Dyslexia Association International Decoding Dyslexia Dyslexia Society of Connecticut Eye to Eye Headstrong Nation LD Online Learning Ally Learning Disabilities Association of America Lexercise

www.dislex.co.pt/

Singapore Spain Switzerland Turkey U.K.

United States

Worldwide

Reading Rockets The Dyslexia Foundation The Reading Well The Yale Center for Dyslexia & Creativity Understood University of California San Francisco Dyslexia Center Beating Dyslexia International Dyslexia Association

www.das.org.sg/ www.madridconladislexia.org/ http://projectdifference.org/en/ https://www.verband-dyslexie.ch www.turkiyedisleksivakfi.org/ www.bdadyslexia.org.uk http://dyslexia-assist.org.uk/ http://dyslexialondon.org/ www.dyslexiafoundation.co.uk/ www.dyslexic.org.uk/ www.dyslexia-reading-well.com/ www.ortonacademy.org/

www.american-dyslexiaassociation.com/ www.dys-add.com/ www.dyslexia.com/ www.decodingdyslexia.net/ www.dyslexiasocietyct.org/ http://eyetoeyenational.org/ http://headstrongnation.org/ www.ldonline.org/ www.learningally.org/ https://ldaamerica.org/ www.lexercise.com/onlinedyslexia-treatment http://readingrockets.org/ http://dyslexiafoundation.org/ www.dyslexia-reading-well.com/ http://dyslexia.yale.edu/ www.understood.org/en http://dyslexia.ucsf.edu/

www.beatingdyslexia.com/ https://dyslexiaida.org

APPENDIX C International organizations on dysgraphia

Countries/Regions

Organization

Website

Australia

Australian Dyslexia Association Kid Sense Child Development The Dyslexia-SPELD Foundation Learning Disabilities Association of Red Deer Learning Disabilities Association of Ontario Dyspraxie France DYS-POSITIF Tous à l’école

http://dyslexiaassociation.org.au

Canada

France

Hong Kong

Amaze Learning Solutions

Italy

Italian Association Disgrafie GraphicMente Association Venturelli method

Portugal

CADin

https://childdevelopment.com. au/ https://dsf.net.au/ http://ldreddeer.ca/ www.ldao.ca/ www.dyspraxies.fr/ www.dys-positif.fr/dysgraphie/ www.tousalecole.fr/content/ dysgraphies www.amazelearning.com/en/ index.html www.associazioneitaliana disgrafie.it/ www.associazionegrafic amente.it/associazione/ www.disgrafiaevolutivaventu relligrafologia.it/ www.cadin.net/saber-maisdislexia-2/166-o-que-e-adisgrafia

Countries/Regions

Organization

Website

U.K.

Dysgraphia Help The Institute for NeuroPhysiological Psychology Ascend Learning Brain Balance Achievement Centers Hands On Learning Solutions Handwriting Problem Solutions LD Online Learning Disabilities Association of America National Institute of Neurological Disorders and Stroke Reading Rockets Smart Kids with Learning Disabilities The Reading Well

www.dysgraphiahelp.co.uk/ www.inpp.org.uk/

United States

Worldwide

Understood International Dyslexia Association

www.ascendlearningcenter.com/ www.brainbalancecenters.com/ www.hol-solutions.com/ www.handwriting-solutions.com/ www.ldonline.org/ https://ldaamerica.org/types-oflearning-disabilities/dysgraphia/ www.ninds.nih.gov/Disorders/ All-Disorders/DysgraphiaInformation-Page http://readingrockets.org/ www.smartkidswithld.org/ www.dyslexia-reading-well.com/ dysgraphia.html www.understood.org/en https://dyslexiaida.org/ understanding-dysgraphia/

APPENDIX D International organizations on ADHD

Countries/Regions

Organization

Website

Australia

Australian National Health and Medical Research Council TDAH Belgique Associação Brasileira do Déficit de Atenção Canadian ADHD Resource Alliance Centre for ADHD Awareness, Canada China ADHD Alliance ADHD Europe European Network on Adult ADHD TDAH France Zentrales adhs-netz Heep Hong Society – Hong Kong

www.nhmrc.gov.au/

Belgium Brazil Canada

China Europe

France Germany Hong Kong

India New Zealand

Hong Kong Association for ADHD ADHD India ADHD Association, New Zealand

www.tdah.be/tdah/ http://tdah.org.br/ www.caddra.ca http://caddac.ca/adhd/ www.adhd-china.org/en-index www.adhdeurope.eu www.eunetworkadultadhd.com www.tdah-france.fr/ www.zentrales-adhs-netz.de www.heephong.org/webprod/cht/ child-development-and-training/ ADHD www.adhd.org.hk/information.aspx www.adhdindia.com www.adhd.org.nz/

Countries/Regions

Organization

Website

Singapore

Institute of Mental Health

www.imh.com.sg/clinical/page. aspx?id=249 www.singaporepsychiatrists.com/ attention-deficit-hyperactivitydisorder-adhd/ www.tc-adhd.com/?page_id=97

Taiwan U.K. United States

Worldwide

Nobel Psychological Wellness – ADHD in Singapore Caring Association for ADHD in Taiwan UK Adult ADHD Network ADHD in Adults American Academy of Pediatrics ADHD Toolkit American Professional Society for ADHD and Related Disorders Centers of Disease Control and Prevention (ADHD) Children and Adults with ADHD US NIMH ADHD World Federation Attention Deficit Disorder Association International Collaboration on ADHD and Substance Abuse

www.ukaan.org www.adhdinadults.com www.aap.org/en-us/pubserv/ adhd2/Pages/default.aspx? www.apsard.org

www.cdc.gov/ncbddd/adhd/data. html www.chadd.org www.nimh.nih.gov www.adhd-federation.org https://add.org/ www.adhdandsubstanceabuse.org

APPENDIX E Practical tips to help in daily struggles with dyslexia-related learning

For reading:

• Teach phonics • Teach orthographic strategies • Help children to identify small words within more complex words (e.g., be and come in become) • Provide children with a list of sight words (those that cannot be sounded out phonetically (e.g., was, the, is)) • Use guided reading – reading at one’s own level, not necessarily the age- or grade-appropriate level • Tap difficult words into syllables • Breathe frequently while reading (to show punctuation, before long words, etc.) • Practice reading in pairs – each one reads five words and alternates the turn • Explore the text before reading, giving a quick overview to find long, unknown, or difficult-to-pronounce words. Then read these in advance. • Use individual cards or sticky notes to remember the word • Put the word in the context of a sentence; write your own sentence using the word in your own way • Repeat words out loud to remember them • Use colors to highlight difficult words • Stop after each paragraph to think about whether the child understands. This helps to monitor comprehension. • Make use of various software programs to help. One expensive but very useful one is called “What You Need Now (WYNN).” It can take any file and allow a person to highlight any word or sentence on a computer screen and pronounce the word over and over again as needed.

For writing:

For general learning/attention difficulties:

• “Fake it ‘til you make it.” When it is impossible to read all of the material, read some of it. Selectively read when time is not on your side. Recognize that 100% is sometimes not possible. • Use pre-writing to organize the theme and final product • Make sure you learn to type well and automatically (some require instruction and practice) • Consider using muscle memory to learn certain words (e.g., where are your fingers when they are typing the word “hamster”?) • Teach how to use text-to-speech functions • Use the look, say, write, cover, check strategy to learn to spell • Help children to identify small words within more complex words (e.g., for and get in forget) • Separate the mechanics of writing (spelling, punctuation) from the creativity (e.g., telling a story, making a report – these can be done orally) • Grade children separately on mechanics vs. creativity in a writing assignment • Take them for a walk or a run • Explain things slowly • Make a deal/compromise (“If you X, then you get Y”) • Give teachers and parents access to online, evidence-based practical strategies, step-by-step • Maintain a positive attitude • Emphasize the importance of persistence and effort • Give individual support (group work sometimes does not work well) • Use a token system • Seat children in the front of the classroom • Allow children to fidget with something small (like a rubber band or a tiny bag of sand) • Allow children to think differently • Be patient and forgiving to them and to yourself • Break down tasks into smaller steps • Create visual schedules with words and pictures • Create quiet work areas with fewer distractions • Put a desk lamp on the keyboard so it is well lit and leave the rest of the room relatively dark. This will refocus where your eyes should be. • Ensure consistency (same information across situations, no mixed messages) • Provide structure (rules, guidelines, boundaries) • Repeat instructions • Give reinforcement (praise, punishment) • Provide written reminders • Set an amount of time to work and then take a break. Increase the time before the break as the days and weeks progress. • Consider diet modification such as avoiding food dyes, heavy sugars, and casein (a protein in milk) (Continued)

• Make a distraction list. When you experience obtrusive thoughts, e.g., you want to google something or text a friend RIGHT NOW, write it down. Plan to do everything on this list once your study time is over and you have a break. • Teach children how to use positive self-talk. Example: I will try my best, I will do this to the best of my ability and if I can’t do it I will try again and not give up. • Teach organization skills as early as possible. Break down each step on how to help a student become better organized until some level of independency is achieved. For example: a daily time schedule for at home use (e.g. 4:00 to 4:30 watch t.v./youtube; 4:30 to 5:00 do spelling; 5:00 to 5:30 have dinner; 5:30 to 6:00 complete math) • Use smartphone. Set timer; give reminders for assignments or upcoming tests • Keep the smartphone away – it is too distracting • Go to the library or somewhere where it is boring and not distracting • Use a monthly calendar and write in important dates; color co-ordinate according to subject • Give student a choice on how to use his or her time and when to take breaks. In doing so, this will become more meaningful. • Teach self-advocacy skills. Teach students to ask for what they need to assist with organization and management of learning, e.g. Hello Ms. Jones. I have two tests on Tuesday. Can I ask for an extension of the test because I’m feeling overwhelmed? • As children initially use strategies it will be important to monitor the effective use of any type of strategy used. If it is too difficult for the student to use, then try another approach.

APPENDIX F List of computer games and apps available free of charge online to aid in reading development, separately by language

Chinese

Bengali

Assamese

The GraphoGame mobile learning game teaches players the basics of reading in Afrikaans Write the Arabic alphabet with audio

Afrikaans Arabic

Incorporates a series of games and assessments to teach children letter and sound recognition, decoding letter and word combinations, vocabulary and oral fluency Helps kids to develop letter and sound recognition, decoding (letters, letter combinations, and words) and vocabulary knowledge in Arabic “Antura wa al Huruf ” (Antura and the Letters) uses the properties of play to achieve its pedagogical and psychosocial goals, featuring principles such as stealth learning, flow and player psychological modeling. The narrative context tasks the player with helping an old keeper watch over the living letters – wild little creatures. With the help of the keeper’s dog, Antura, the player embarks on a journey through multiple mini games, which correspond to content from Syrian elementary school curriculum” “Feed the Monster is an innovative smartphone puzzle game that helps children learn Arabic. The game is designed in a way that does not require any prior knowledge. It guides the player through learning the Arabic alphabet to vowels, words, and then reading short paragraphs drawn from the Syrian Arabic language arts curriculum” “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” Kids can learn Bengali basic character and then Bengali grammar; words are divided into different categories “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” Presents tips for parents and teachers to help make early literacy acquisition in Chinese easier

Description

Language

Direct descriptions of content from websites in “quotes.”

http://ww9.psy.cuhk.edu.hk/chineseearlyliteracy/

https://play.google.com/store/apps/details?id=com. altergyan.learnbengaliquicklyfree https://ekstep.in/

https://ekstep.in/

https://allchildrenreading.org/winners/appsfactory/

https://allchildrenreading.org/winners/colognegame-lab/

www.grapholearn.com https://itunes.apple.com/hk/app/muslim-kidsseries-hijaiya-arabic-alphabet/id445298616?mt=8 https://allchildrenreading.org/winners/colognegame-lab/ http://vgwb.org/projects/antura/

Website

English

Dutch

Help build kids’ phonemic awareness skills and improve child’s phonological processing ability Teach kids to read phonics

Learn to recognize rhyming words, and sort them by sound

GraphoGame mobile learning game teaches players in Pinyin, which is an alphabetic approach to coding Chinese Goal is to pop the bubbles before they float off the screen. Each time you tap on a bubble, you hear it spoken by a native speaker and try to read the word Three categories available only for free version; can test kids’ listening and reading skills There is a picture for many scenes, and the pronunciation and spelling of that vocabulary is shown. Includes other languages as well The GraphoGame mobile learning game was designed to teach basic aspects of reading in Dutch “Which letter is the boss?” recording in each game session asking the kids to choose the first letter of the last word in the sentence. Look at the image and listen to the recording and type the word

Nice games for kids to learn Chinese, such as deciding whether a word is the suitable one in the sentence or phase Kids can learn simplified Chinese by watching a video presenting the pronunciation, the formation process, and the way to write that word Kids can learn the structure, pronunciation and meaning of Chinese vocabulary

(Continued)

www.education.com/game/alphabet-hide-andseek-reading-comprehension/ www.gamestolearnenglish.com/spelling-beeenglish/ https://itunes.apple.com/us/app/phonics-rhymingbee-free-short/id492740258?mt=8 https://itunes.apple.com/us/app/abc-magicreading-short-vowel/id416896853?mt=8 www.starfall.com/

www.grapholearn.com

www.loecsen.com/nl/cursussen-nederlands

https://play.google.com/store/apps/details?id=com. overpass.dutchbubblebathlite www.teachkidslanguages.com/dutch/app/

https://itunes.apple.com/hk/app/%E5%BF%AB %E6%A8%82%E4%B8%AD%E6%96%87-funchinese-%E5%85%92%E7%AB%A5%E6%BC%A 2%E8%AA%9E%E5%AD%B8%E7%BF%92%E9 %81%8A%E6%88%B2/id547571511?l=zh&mt=8 www.grapholearn.com

http://sz.gongfubb.com/

http://ebook.huayuworld.org/lang/chineselearn/

German

French

Finnish

Language

Trains children on spelling of German words

http://pbskids.org/electriccompany/games/ scrapyardslice

Words will fly on the screen and kids need to cut through words that could be separated into two words (these are compound words); pronunciations are also provided Kids need to select the vocabulary word that has the same meaning as a given word; the website will donate 10 gains of rice to help end hunger whenever participants get a correct answer Kids need to choose the correct wordings spoken in the video, and the meaning of that word will be provided “GraphoGame mobile learning game teaches players the basics of reading in English” “EkStep Foundation group has an open source selection of online resources for promoting reading at various levels, including phonological awareness, fluency, vocabulary knowledge, reading comprehension, and even written expression. People work together, adding to the resources, and there are plenty of games available for English” Kids can learn Finnish in this app by association memory and connection between words “GraphoGame mobile learning game teaches players the basics of reading in Finnish” Unique games designed to help memorize words, practice verb conjugation, and learn word gender. Native speaker audio clips available Attractive design, people can choose the correct picture of the meaning of an English vocab, and the pronunciation and spelling of French will be provided (highly recommended). Includes lessons for other languages “GraphoGame mobile learning game teaches players the basics of reading in French” Kids can learn German vocabulary words with this game

www.grapholearn.com https://itunes.apple.com/us/app/learn-german-bymindsnacks/id473825665?mt=8 https://play.google.com/store/apps/details?id=com. learninglabs.wordup.german

https://itunes.apple.com/hk/app/learn-finnish/ id528924632?l=zh&mt=8 www.grapholearn.com https://itunes.apple.com/us/app/learn-french-bymindsnacks/id409947305?mt=8 www.duolingo.com/welcome

www.grapholearn.com https://community.ekstep.in/resources/domainmodel.

www.memrise.com/home/

http://freerice.com/#/english-vocabulary/1592

Website

Description

Hindi

“EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary”

Juang

Kannada

Kids can access the meaning and the pronunciation of each word by clicking on a picture Kids can learn how to write Javanese letters

Kids can learn Italian through examples of letters and words with pictures and pronunciations Kids need to type the pronunciation of 50 Japanese sounds; timed Kids can learn how to write 50 Japanese words in the correct sequence

“EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” Kids can learn how to speak and read Italian

Javanese

Japanese

Italian

Ho

Kids can learn Hindi using associative memory – good for word learning

Hebrew

Kids can learn Hindi letters and words

“GraphoGame mobile learning game teaches players the basics of reading in Greek” “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” Kids can learn Hebrew letters and some words

Greek Gujarati

https://ekstep.in/ (Continued)

https://play.google.com/store/apps/details?id=com. aksara.hanacaraka&hl=zh_HK https://ekstep.in/

https://itunes.apple.com/us/app/learn-italian-bymindsnacks/id433199718?mt=8 https://play.google.com/store/apps/details?id=net. goldensoft.italianaphabet https://kids.dragons.jp/kplay/games/typing.html https://itunes.apple.com/hk/app/%E8%81%BD% E5%AF%AB%E4%BA%94%E5%8D%81%E9%9 F%B3/id588653318?l=zh&mt=8 http://languageapps.org/javanese_vocabulary.php

https://ekstep.in/

http://freehebrewgames.com/games/index. php?mode=memorymatch https://itunes.apple.com/us/app/learn-hindi/ id463142943?mt=8 https://play.google.com/store/apps/details?id=in. promentors.LearnHindi https://ekstep.in/

www.grapholearn.com https://ekstep.in/

Spanish

Santali

Sanskrit

Portuguese

Nyanja Odia

Norwegian

Munda

Marathi

Maithili

“EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” “The GraphoGame mobile learning game teaches players the basics of reading in Norwegian” “The GraphoGame mobile learning game teaches players the basics of reading in Nyanja” “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” Word spelling in Portuguese “The GraphoGame mobile learning game teaches players the basics of reading in Portuguese” “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” Need $0.99 USD to unlock the 150 levels after one free session of word learning

https://itunes.apple.com/us/app/learn-spanishwith-lingo-arcade/id592986630?mt=8

https://ekstep.in/

https://ekstep.in/

www.digitaldialects.com/Portuguese.htm www.grapholearn.com

www.grapholearn.com https://ekstep.in/

www.grapholearn.com

https://ekstep.in/

https://ekstep.in/

www.grapholearn.com www.digitaldialects.com/Korean/Vocabulary_ audio.htm www.masteranylanguage.com/c/q/o/Korean/ Alphabet/pmg1/1#htop https://play.google.com/store/apps/details?id=com. nakashimajohn.hangeul&hl=en https://ekstep.in/

“The GraphoGame mobile learning game teaches players the basics of reading in Kiswahili” Kids need to choose the correct object in the correct order for word learning 

Kiswahili Korean

Helps kids to learn Hangul

Website

Description

Language

“EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” Introduction to numbers, the alphabet, other words. Some basic Urdu teaching

Basic word game

Vietnamese

Kids can learn how to write and read Turkish words

Kids can learn some basic Turkish words

Digital Dialects is an online platform for people to learn Tamil vocabularies. Games are used to teach Tamil here “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” Master Any Language in Tamil provides online lessons on learning the language in different forms, including numbers, the alphabet, and spelling “EkStep Foundation provides stories and worksheets on literacy concepts, e.g., comprehension, decoding and fluency, phonological awareness and vocabulary” Teaches Thai numbers

Kids have to create a word of 1 to 5 letters from Tamil letters

“The GraphoGame mobile learning game teaches players the basics of reading in Swedish” Kids can learn Tamil basic words

Urdu

Turkish

Thai

Telugu

Swedish Tamil

Explore new words and phrases and learn how to read. Other languages are also available on this app for learning. It is fun, but it won’t let you continue learning unless you pay more Trains word recognition

www.masteranylanguage.com/c/p/o/Urdu https://play.google.com/store/apps/details?id=com. urdu.qaida.game.user.play.project https://play.google.com/store/apps/details?id=com. tss21.talk.vie.google

https://itunes.apple.com/us/app/learn-thainumbers-fast!-for/id645905468?mt=8 https://itunes.apple.com/us/app/babbel-learnturkish/id578223038?mt=8 https://itunes.apple.com/us/app/wordpower-learnturkish-vocabulary/id297437799?mt=8 https://ekstep.in/

https://ekstep.in/

www.masteranylanguage.com/c/p/o/Tamil

https://ekstep.in/

https://play.google.com/store/apps/details?id=com. learninglabs.wordup.spanish www.grapholearn.com https://play.google.com/store/apps/details?id=com. altergyan.learntamilquickly https://play.google.com/store/apps/details?id=com. renganath.tamilword www.digitaldialects.com/Tamil.htm

https://itunes.apple.com/us/app/memriselanguage-learning/id635966718?mt=8

APPENDIX G Movies and other video clips on the subject of dyslexia and related learning disabilities

Name

2007

2002

Like Stars on Earth (Taare Zameen Par)

I Not Stupid (小孩不笨)

Singapore

2010

(Continued)

“This adaptation of Rick Riordan’s remarkably popular fantasy book series tells the tale of accidentprone teenager Percy, a 16-year-old boy who appears to his peers to be dyslexic. One day, he discovers that he is actually a demigod, the son of Poseidon, and he is needed when Zeus’ lightning is stolen. Percy must master his newfound skills in order to prevent a war between the gods that could devastate the entire world.” (Description retrieved from: www.allmovie.com/movie/v473930) “Ishaan Awasthi is an eight-year-old dyslexic boy who dedicates more time to dreaming up wondrous worlds of animals and kites than he does to finishing up his schoolwork. When Ishaan gets in trouble at school and his parents decided that the best thing for everyone is to send the boy away to a school where he can be properly disciplined. Upon arriving at his new school, Ishaan is disheartened to find that things there are much the same as they were back home; he is still a misfit, but now he does not even have his parents to talk to. Later, newly-arrived art teacher Ram Shankar Nikumbh arrives at Ishaan’s boarding school looking to liven things up by getting his students to think outside the box. Not surprisingly, the vast majority of students respond to their free-thinking new teacher with great enthusiasm – all except for Ishaan, that is. When Ram notices just how unhappy his most imaginative young student really is, he vows to break through to Ishaan and unlock the promising young student’s full potential.” (Description retrieved from: www.allmovie.com/movie/taare-zameen-par-v422978) “Jack Neo has chosen to use the simple yet hilarious story of three young children and their families from different social backgrounds to create a social satire touching on issues of education streaming, the importance of the Chinese language and the focus on academic excellence. While the three children, Kok Pin, Boon Hock and Terry, suffer from the pressure of school, their parents have another set of problems. Following the story of theirs, we see the different issues faced by Singapore families in a light hearted sometimes almost silly situation.” (Description retrieved from: https://web.archive.org/web/20110909081302/www.inotstupid.com.sg/ inotstupid1/ch/index.htm)

Release Description Year

India

Movies (in alphabetical order) Canada, United States Percy Jackson & the Olympians:The Lightning Thief

Countries/Regions

2006

2007

2012

A Mind of Her Own

bAd

Dislecksia:The Movie

U.K.

United States

United States

“Inspired by a true story, A Mind of Her Own tells the poignant and moving story of Sophie, a determined young girl whose ambition to become a doctor is obstructed by the fact that she is severely dyslexic. But Sophie, encouraged by her closest friend, Becky, has never been one to give up and, despite being advised by parents and school teachers to be realistic and pursue something less academic, she puts herself through college and university, in the process achieving a first class degree in biomedical science and a PhD conducting research into post trauma regeneration of the spinal column which ultimately leads to her achieving worldwide recognition for her work and helping to develop a cure for paralysis.” (Description retrieved from: www.imdb.com/title/tt0461813/) “A fifth grade student, John Read, struggles to find a means of working around his oft-misunderstood learning disorder. He is having trouble in the classroom; his teacher thinks that he’s just too lazy to study, and the local bully takes every opportunity to humiliate him. When John’s mother decides to get to the source of her son’s problems once and for all, she is shocked to learn that he suffers from dyslexia. Now, as mother and son slowly begin to understand what it means to be dyslexic, they work together to get his education back on track, and prove to everyone that his disorder is a very real problem that can have devastating effects on people of all ages.” (Description retrieved from: www.allmovie.com/movie/v426827) “Hubbell V and his crew explore the unique nature of how each of us learns. Join Hubbell, dyslexic superstars Billy Bob Thornton and Joe Pantoliano, world-renowned brain scientists and researchers, students and advocates as they join a movement to revolutionize education. Find out what it’s like to have your brain scanned inside an fMRI and visit with a group of dyslexic researchers in the jungles of Costa Rica, all the while following Hubbell through his days of growing up dyslexic before many had even heard of the word. Through the non-linear brain of Hubbell, his lens captures the otherwise complex issues of learning differences in a manner that allows the audience to recognize the differences and honor the gifts in all of us. This is social awareness with a heart.” (Description retrieved from: www.dislecksiathemovie.com/)

Release Description Year

Name

Countries/Regions

1998

2016

2015

The Mighty

United States

Video Clips (in alphabetic order) Hong Kong In Blossom (生如夏花)

Hong Kong

A Wall-less World Series V: Invisible Disability (沒有牆的世界 5: 看 不到的障礙)

How Difficult Can This 1989 Be? The F.A.T. City Workshop

United States

(Continued)

www.youtube.com/watch?v=fW8BYxDQUts “Yu-Cheung is a primary student who has dyslexia and his Chinese academic result is way below standard. He has not finished his Chinese writing exercise with the title ‘I Am Special’ and makes card games instead. His teacher complains him and warns that he may be asked to quit this school if his ‘poor behavior’ continues. This makes Yu-Cheung’s mum panic. In the night of finishing the Chinese writing exercise, the tangles between academic performance and self-value thus exposed. Childhood is the best period of time to learn. However, In Yu-Cheung’s case, who is supporting him in his academic paths or blocking his way?” (Description retrieved from: www.youtube.com/watch?v=fW8BYxDQUts) www.youtube.com/watch?v=_GyTk573b28 “Tsz-chun is a grade 6 student. He feels that his parents spoil his brother, Tsz-hin who suffers from dyslexia. One day, he decides to leave home and lives with his uncle. During the stay with his uncle, he experiences challenges faced by individuals with dyslexia and realizes that people are born with different strengths.” (Description translated from: www.youtube.com/watch?v=_GyTk573b28)

“This unique program allows viewers to experience the same frustration, anxiety and tension that children with learning disabilities face in their daily lives. Teachers, social workers, psychologists, parents and friends who have participated in Richard Lavoie’s workshop reflect upon their experience and the way it changed their approach to children with learning disabilities.” (Description retrieved from: www.ricklavoie.com/videos.html) “The movie is adapted from the Rodman Philbrick’s popular young-adult novel Freak the Mighty which is about two young boys, both social outcasts in their small town, form an unlikely friendship. Although burly, slow-paced eight-grader Maxwell Kane is learning disabled, he nevertheless has a poetic soul, as evidenced when he meets the bright and brainy Kevin Dillon, crippled by a birth defect.The physically deformed Kevin, who wears leg braces and uses crutches, suffers from Morquio’s Syndrome, which causes physical growth to stop after the age of six. Illiterate Max gets Kevin as a reading tutor, and the two misfits soon become friends, sharing a vision of life as a contemporary Camelot.” (Description retrieved from: www.allmovie.com/movie/v158888)

Dyslexi

Dyslexia and Me | Katie Willsey | TEDxLake TravisHigh

Dyslexia: The World the Way I See It

Dyslexic Learners in 2014 the EFL Classroom: Parts 1–4

Sweden

United States

United States

United States

2010

2017

2017

2012

Dyslexia

Malaysia

www.youtube.com/watch?v=SaQfuxODpog A short film, made for Dyslexia Association of Singapore, tells struggling of a dyslexic child Joe and his father, Bryan. An artist’s depiction of how dyslexia feels in Swedish (about two minutes long) https://vimeo. com/217372078 www.youtube.com/watch?v=Vtb_S4Y5mLY “Katie Willsey offers a touching account of how she, as a dyslexic person, experiences her world. Kaite Willsey moved to Lakeway, Texas two and a half years ago and became very involved in school spirit days, the school’s musical production, volunteering, and competitive swimming. In the 9th-grade, Katie was diagnosed with a serious concussion setting her back in both her education and her swimming. As a result, Katie decided to move her passion to participating in the Speech and Debate Team and the TED-Ed Club, giving her the opportunity to work on her presentation and speech writing skills.” (Description retrieved from: www.youtube.com/watch?v=Vtb_S4Y5mLY) www.youtube.com/watch?v=rhygmurIgG0 “This three-time award winning documentary about dyslexia explains the challenges and as well as the gifts that are attributed to this learning disability.” (Description retrieved from: www.youtube.com/watch?v=rhygmurIgG0) In this four-episode online course, educational experts respectively introduce a variety of ways to facilitate dyslexic students in classroom to acquire English. (Description retrieved from: Part 1: www.youtube.com/watch?v=A-nrMvocyk8 Part 2: www.youtube.com/watch?v=icZlWT3bwgo Part 3: www.youtube.com/watch?v=8QamfQl9B_U Part 4: www.youtube.com/watch?v=ofDMOmuG4GQ)

Release Description Year

Name

Countries/Regions

2013

United States

www.youtube.com/watch?v=DWOvnPZ9e7Y “An award winning short documentary about one family’s struggle with the public school system to provide their dyslexic son the necessary tools needed for him to learn.” (Description retrieved from: www.youtube.com/watch?v=DWOvnPZ9e7Y) www.youtube.com/watch?v=ugFIHHom1NU “Piper Otterbein is a senior at Cape Elizabeth High School. When she was in first grade, she was diagnosed with a learning disability. While she struggled throughout elementary school, it was not until 7th grade that this disability was identified as dyslexia. When Piper entered high school, she had a revelation; rather than focusing all of her energy on the challenges in her life, she decided to alter her outlook and focus instead on her strengths.” (Description retrieved from: https://amara.org/he/videos/HVdzD1TZ1FH6/en/187394/)

(Note: All descriptions are quoted directly from their website description)

Overcoming Dyslexia, Finding Passion | Piper Otterbein | TEDxYouth@ CEHS

Overcoming Dyslexia 2017

United States

APPENDIX H Phonological awareness and morphological awareness exercises

These are games as mentioned in Chapter 2. When children can do well on such oral language games (here in English but adaptable to other languages), they tend to read better.

Phonological Awareness Compound words Question 1 Say snowman without saying the man part 2 Say sunshine without saying the shine part 3 Say meatball without the meat part 4 Say lightbulb without the bulb part 5 Say doorknob without the door part 6 Say airplane without the air part 7 Say herself without the self part 8 Say pancake without the pan part 9 Say popcorn without the corn part 10 Say crosswalk without the cross part

Answer Snow Sun Ball Light Knob Plane Her Cake Pop Walk

Removing a syllable that is not on its own Question 1 Say funny without the “yee” sound 2 Say pillar without the “er” sound 3 Say contact without the “con” sound 4 Say spider without the “der” sound 5 Say window without the “win” sound 6 Say trumpet without the “trum” sound 7 Say cutie without the “tee” sound 8 Say pumpkin without the “pump” sound 9 Say today without the “too” sound 10 Say until without the “un” sound

Answer Fun Pill Tact Spy Dough Pit Cue Kin Day Till

First phoneme Question 1 Say cup without the /k/ sound 2 Say seat without the /s/ sound 3 Say paw without the /p/ sound 4 Say fan without the /f/ sound 5 Say speak without the /s/ sound 6 Say bring without the /b/ sound 7 Say crow without the /k/ sound 8 Say brass without the /r/ sound 9 Say train without the /t/ sound 10 Say blown without the /b/ sound

Answer Up Eat Awe An Peak Ring Row Bass Rain Loan

Final phoneme Question 1 Say bone without the /n/ sound 2 Say feel without the /l/ sound 3 Say house without the /s/ sound 4 Say soak without the /k/ sound 5 Say hurl without the /l/ sound 6 Say meant without the /t/ sound 7 Say wimp without the /p/ sound 8 Say gasp without the /p/ sound 9 Say mask without the /k/ sound 10 Say newt without the /t/ sound

Answer Beau Fee How So Her Men Whim Gas Mass New

Stress on the syllable: Question 1 Which is the correct pronunciation, CAmel or caMEL? 2 Which is the correct pronunciation, ANgry or anGRY? 3 Which is the correct pronunciation, PARcel or parCEL? 4 Which is the correct pronunciation, SOfa or soFA? 5 Which is the correct pronunciation, SUNbathe or sunBATHE? 6 Which is the correct pronunciation, FORget or forGET? 7 Which is the correct pronunciation, PERhaps or perHAPS? 8 Which is the correct pronunciation, REnew or reNEW? 9 Which is the correct pronunciation, UNless or unLESS? 10 Which is the correct pronunciation, BEAUtiful or beauTIful? 11 Which is the correct pronunciation, iDENtify or identiFY? 12 Which is the correct pronunciation, HOSpital or hospiTAL? 13 Which is the correct pronunciation, afterNOON or AFternoon? (Note: Capital letters are intended to indicate the stressed syllable)

Answer CAmel ANgry PARcel SOfa SUNbathe forGET perHAPS reNEW unLESS BEAUtiful iDENtify HOSpital afterNOON

Morphological Awareness Examples of novel lexical compounds for practice Question 1 When the sun goes down at night, we call that a sunset. What would we call it if the moon went down at night? 2 An apple tree is a tree that grows apples on it. What would we call a tree that grows coats on it? 3 Horseshoes are metal shoes that we put on horses. What would we call metal shoes that we put on pigs? 4 Basketball is a game where you throw a ball into a basket. What would we call a game in which we throw a ball into a scarf? 5 A box we use to store mail in is called a mailbox. What would we call it if we used a trunk to store mail in? 6 Horseback is the back of a horse. What would we call the back of a cat? 7 A washroom is a room in which you can wash. What would we call a room where you can snorkel? 8 A blackboard is a board that is black in color. What do we call a board that is pink in color? 9 The case that holds books is called a bookcase. What do we call the case that holds beans? 10 A cloth we use to clean dishes is called a dishcloth. What do we call a cloth that cleans chairs?

Answer Moonset Coat tree Pig shoes Scarf ball Mail trunk Cat back Snorkel room Pink board Bean case Chair cloth

Examples of novel grammatical manipulations demonstrating morphological awareness for practice Question 11 Today, John is stotting.Yesterday, he did the same thing. What did John do yesterday? Yesterday, he ______? 12 Here is a thin, oily toy called a fron. I have two of them. I have two ______? 13 I like to gamp. It is really fun! Every morning I am ______? 14 A farmer farms. A cleaner cleans. This person pasks. What would you call a person who pasks? A person who pasks is a ______? 15 I have a pet called a wex. My friend also has a wex. Together, we have two ______? 16 Cherry is fast. She won the race by being fast. She is the fastest. Mary is tosk. She won the race by being tosk. She is the ______. 17 This is a hess. Now there is another hess. There are two of them. There are two ______? 18 Peter knows how to yick. Peter yicks every day. Ken and Sean also know how to yick. They do that every day too. What do Ken and Sean do every day? Every day, they are ______? 19 This is a boy who knows how to huck. He has done the same thing just now. What has he done? He has just _____?

Answer Stotted Frons Gamping Pasker Wexes Toskest Hesses Yicking

Hucked

REFERENCES

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INDEX

Page numbers in bold indicate tables. adolescents: ADHD in 72 – 74; positive youth development 167 – 168 adulthood, ADHD in 72 – 74 Africa 2, 9, 91; dyslexia organizations 191 alcohol and drug use 73, 173, 181; addictions 73, 165; ADHD and 73 – 74, 75, 134; self-esteem and 165 – 167 Alexander-Passe, Neil 82 American Psychiatric Association 86 – 87 anxiety disorders 26, 73 – 74, 79; alcohol and drugs for 166; comorbidity with dyslexia 85 – 86; coping 155; depression and/or 74, 78, 83, 139, 155, 172; Mr. R. 161; Ms. HO 170; Ms. Amy 80, 82 – 83, 89; in parents 172, 173; treatment 87, 139 apps, reading aids by language 202 – 207 Argentina 110; questionnaire respondents 189 atomoxetine 139 – 140 attention: attention deficit disorders 1; learning disabilities 20 – 21; practical tips for daily learning struggles 199 – 200 attention deficit hyperactivity disorder (ADHD) 3, 6; in adolescence and adulthood 72 – 74; alcohol and drugs with 165 – 166; belief in 15; brain and 76 – 77; causes of 74 – 76; comorbidity with dyslexia 65; defining 66; drugs for 77, 126, 136, 138, 140; emotional control for motivation 70 – 72; gender and 22; genetics 74 – 75; hyperactiveimpulsive 67 – 69; inattention 66 – 67;

international organizations on 196 – 197; school performance 17; self-regulation and 69 – 70, 77; three types of 67; see also helping children with ADHD auditory focus, dyslexia and 114 Australia 91, 129, 161: ADHD organizations 196; dysgraphia organizations 194; dyslexia organizations 191; questionnaire respondents 189 Austria 8, 15, 42, 63, 112, 133, 137: dyslexia organizations 191; questionnaire respondents 189 Azzopardi, Ms. C. 106, 110, 113, 169, 190 Barker-Benfield, Erika 15, 112, 137, 189 Barkley, Russell 131 – 133, 134, 162 Belgium: ADHD organizations 196; dyslexia organizations 191 bilingual advantage 98 brain: ADHD and 76 – 77; dyslexia and structure of 30; medication for ADHD 136; neuroimaging of 99 Branson, Richard 112 Brazil: ADHD organizations 196; dyslexia organizations 191 British Dyslexia Association 91, 108 Brussels, dyslexia organizations 191 Canada 2, 14, 91, 97, 176: ADHD organizations 196; dysgraphia

236 Index

organizations 194; dyslexia organizations 191; questionnaire respondents 189 Cher 112, 182 children with ADHD see helping children with ADHD China 1, 14, 46, 90, 92, 149, 157, 169, 176; ADHD organizations 196 Chinese: compounding 42; homophones 41; phonological awareness 40; reading English and 98 – 99 Chinese characters 12, 13, 90; cognitive skills 32; context of 55; copying practice 122 – 123; fluency training 50; morphemes 51; morphological awareness 41, 42; orthographic awareness of 35, 46, 48, 116; phonological sensitivity 36 cognition, learning and 19 – 20 cognitive behavioral therapy (CBT) 85, 87 cognitive-linguistic skills: graphic arts and dyslexia 51 – 52; understanding dyslexia 32 – 34 comorbidity 78, 88 – 89; ADHD and dyslexia 65; case study of 80 – 83; dyscalculia 83 – 84; importance of understanding 78 – 80 competence, positive youth development 167 – 168 compounding, words 42 – 44 computer games: for dyslexia remediation 106 – 108; Grand Theft Auto 135; identifying motivation 162; reading aids by language 202 – 207 copying: learning technique 48; practice for dysgraphia 122 – 123 Costa Rica 191, 210 Cruise, Tom 112 culture: dyslexia and 14 – 15; as language and script 8 – 10 Czech Republic, dyslexia organizations 191 Davis, Carlton 87 – 88 Denmark 112; questionnaire respondents 189 depression 17; ADHD and 137, 139, 166, 172; anxiety and/or 74, 78, 83, 139, 155, 172; comorbidity with dyslexia 86 – 88; Jim Shea, Jr. and 89; parents and 172, 173; rate of 82; teens 166 Dewey, John 8 Diagnostic and Statistical Manual of Mental Disorders (DSM) 66 Dodge, Jennifer 123 Dr. L 140, 189 Dr. MC 111 – 112, 129, 137, 169, 190

Dr. Pae 170, 190 Dr. RJ 129, 190 Dr. T 128, 161, 189 driving, ADHD and 73 drugs: for ADHD 77, 126, 136, 138, 140; for depression 87; self-esteem and 165 – 167; see also alcohol and drug use Duckworth, Angela 163 – 164 Dweck, Carol 158 – 159 dyscalculia 78, 85; comorbidity with 83 – 84; Ms. Amy and 80, 82 – 83; work-around strategies 84; work-through strategies 84 dysgraphia 1; basic processes of 57 – 58; categorizing 59 – 61; defining 3; developmental 56; impaired handwriting 54; international organizations on 194 – 195; long-term consequences of 61 – 62; planning-writing-editing 62 – 64; spelling-to-dictation model 57; types of 119 – 120; under-researched subject of 56; writing the word model 57, 58; see also remediation for dysgraphia dyslexia 1; advice on foreign language learning for 95 – 97; causes of 29 – 31; cognitive-linguistic skills for understanding 32 – 34; comorbid with anxiety disorders 85 – 86; comorbid with depression 86 – 88; concept of 8, 31 – 32; correspondences between written and spoken representations of words 12 – 13; cultural element of 14 – 15; definition of 3, 26, 28; dimensions of 10 – 14; dyscalculia and 83 – 84; global perspective of 2; international organizations on 191 – 193; interviewee Danna on 6 – 7, 23 – 24; linguistic distance 11; movies and video clips on 209 – 213; omission of phonological elements 13; practical tips for daily learning struggles 198 – 200; reading-related skills for helping those with 115 – 117; spatial arrangement and nonlinearity 11 – 12; understanding comorbidity with 78 – 80; visual stress and 26 – 27; visual uniformity and complexity 12; word origin 25; working through with games 105 – 108; see also remediation for dyslexia Dyslexia: Una Forma Diferente de Leer (Rufina) 189 Dyslexia and Mental Health (AlexanderPasse) 82 Dyslexia Debate,The (Elliott & Grigorenko) 27, 114 dyslexic dysgraphia 59 – 60, 119

Index  237

economic resources, school performance and 15 – 18 Egypt, dyslexia organizations 192 EkStep Foundation 106 Electric Company 107 emotional control, ADHD and motivation 70 – 72 emotional dysregulation, ADHD 71 emotional flexibility, ADHD and maintaining 134 – 135 English: compounding words 42 – 44; language of learning 91; learning as additional language 97 – 98; morphological awareness 42, 43; phonological awareness 38 – 39; phonological sensitivity 37 – 40; pronunciation marks 35; reading Chinese and 98 – 99; spelling of words 46; word spacing 13; writing and reading 55 English as an Additional Language (EAL) 97 – 98 Ethiopia, dyslexia organizations 191 Europe 2, 81, 91 – 92, 126; ADHD organizations 196; dyslexia organizations 192 extra-curricular activities, self-esteem and participation in 156 – 157, 166 – 167 Fast ForWord program 108, 114 fine motor coordination, dysgraphia remediation 120 – 121 Finland 184, 192 fluency: reading comprehension 148 – 149; reading-related skills for dyslexia 115, 116 – 117; word reading 35, 48 – 50 foreign language: blessing or curse of learning 97 – 101; differing contexts in learning 91 – 92; dyslexia in learning 90 – 91; how to learn second or 92 – 95; learning advice for those with dyslexia 95 – 97; poverty and second language learning 101 – 102 France 36, 81, 94; ADHD organizations 196; dysgraphia organizations 194; dyslexia organizations 192 French: morphological awareness 41; pronunciation marks 35 games: computer, for dyslexia remediation 106 – 108; for dysgraphia 125; identifying motivation 162, 163, 165; play and learning 184 – 185; reading-related skills for dyslexics 114 – 115; working through dyslexia using 105 – 108

Garito, Anna 134, 154, 175, 176, 189 gender, learning disabilities and 22 general intelligence 8, 27 genetics: in ADHD 74 – 75; dyslexia 29 German: compounding 42 – 43; morphological awareness 42 – 43; pronunciation marks 35; reading ease 11, 51; writing and reading 55 Germany 2, 33, 36, 95, 133, 138, 179, 187: ADHD organizations 196; dyslexia organizations 192; questionnaire respondents 189 Google 33, 202 – 207 Grand Theft Auto 135 graphemes: copying practice 122 – 123; language learning 98 – 99; remediating dyslexia 107, 117; scripts 27, 35, 48 – 49, 55; spatial arrangement 11; using forms and mediums 120; variability 13; writing 57 – 59 Graphogame 106 GraphoLearn 106 Greider, Carol 182 grit, growth mindset and 181 – 183 Grit (Duckworth) 163 growth mindset 181 – 183 hand dominance 121 – 122 handedness development 121 – 122 hand strengthening, dysgraphia remediation 120 – 121 handwriting difficulty, dysgraphia 54, 59 – 60 Harry Potter series (Rowling) 157 helping children with ADHD 126 – 127; Barkley’s approaches to focus and organization 131 – 134; focusing on whole child 183; giving control over own success and failure 128 – 130; identifying motivation 162 – 165; imposing structure 128; maintaining emotional flexibility 134 – 135; medication 135 – 138; mentors 177; optimizing use of ADHD medications 138 – 140; promoting self-esteem 155 – 160; supporting parents for 168 – 172; techniques to aid focus of 130 – 131; views on ADHD medication 140 – 142; working together on plan 127 – 128; see also attention deficit hyperactivity disorder (ADHD) homophones 10, 12, 41, 42, 45, 51, 55, 57 Hong Kong 2, 19, 22, 187; ADHD 128, 140 – 141; ADHD organizations 196;

238 Index

dyscalculia 83; dysgraphia 53 – 54, 59, 63; dysgraphia organizations 194; dyslexia 31, 36, 50; dyslexia organizations 192; learning struggles 179, 184; multiple languages 91 – 93, 96, 98; questionnaire respondents 189; remediating dyslexia 109, 112; self-esteem 160 – 161, 163, 169, 174 – 175 Hull, Robin 100, 190 India 2, 10 – 12, 14, 46, 47, 90, 92, 99, 101, 112, 160, 169, 185; ADHD organizations 196; dyslexia organizations 192; questionnaire respondents 189 Indian scripts: 12, 90, 106; cognitive skills 32; orthographic knowledge 46, 48; copying practice 122 – 123 inference-making: reading comprehension 149 International Dyslexia Association 26, 91, 111, 183 international organizations: ADHD 196 – 197; dysgraphia 194 – 195; dyslexia 191 – 193 interviewees 4, 189 – 190 IQ (intelligence quotient) 8, 27 Ireland, dyslexia organizations 192 Irving, John 183 Israel 8, 105; dyslexia organizations 192; questionnaire respondents 190 Italy 9; dysgraphia organizations 194; dyslexia organizations 192; language reading ease 51; language writing and reading 55 Jackson, Janet 1, 5 Jamaica 79 Japan 2, 31 – 32, 92, 112, 141: dyslexia organizations 192; questionnaire respondents 190 Jergen, Robert 70, 130, 170 – 171 Jordan, Michael 157 Kalindi, Sylvia 102, 190 Kamprad, Ingvar 182 Kenya, dyslexia organizations 192 Korea (South) 2; Korean language 36, 39, 42, 50, 170, 206; questionnaire respondents 190; symbols and fluency training 50 Kuwait, dyslexia organizations 192 language: art of writing composition 151 – 152; computer games and apps

for reading development by 202 – 207; conversations for learning 144; dimensions of reading difficulties 10 – 14; reading comprehension 143, 145 – 152; relation of language and script 11; writing composition 143 – 145; see also reading comprehension language learning: dyslexia with 90 – 91; multilingualism and 102 – 103; poverty and 101 – 102; reading difficulties 29 – 30; see also foreign language Latvia, dyslexia organizations 192 learning difficulties 179 – 181; case study (Ms. Amy) 80 – 83; comorbidity and 78; defining around the world 7 – 8; focusing on whole child 183 – 186; global landscape of 3; poverty and 16 – 18; practical tips for daily learning struggles 198 – 200; promoting self-esteem in children with 155 – 160; research and individual variability for remediation of 104 – 105; sailing and rowing 179 – 180; self-esteem and 154 – 155; supporting parents of children with 168 – 172; see also self-esteem learning disabilities 6 – 7; attention and 20 – 21; cognition and 19 – 20; culture as language and script 8 – 10; gender and 22; memory and 19 – 20; movies and video clips on 209 – 213; neurobiological origins of 22 – 23; perception and 19; rate in general population in United States 16; self-esteem in those with 154 – 155; see also self-esteem Lee Kuan Yew 112, 182 Lindeblad, Emma 32, 109, 113, 170, 190 literacy 143, 178 Little Monster,The (Jergen) 69 – 70, 170 Ma, Jack 157 Macau 111, 129, 137, 169; questionnaire respondents 190 Malaysia 8, 192, 212 Malta 106, 113, 169; questionnaire respondents 190 Managing ADHD in School (Barkley) 134 mathematics, dyscalculia 83 – 84 Mayo Clinic 87 medications: candid views of 140 – 142; children with ADHD 135 – 138; MPH (methylphenidate hydrochloride) 138; optimizing use of ADHD 138 – 140; Ritalin 141; traditional Chinese medicine 138

Index  239

memory: allographs 58; dysgraphia and 61; learning and 19 – 20; spelling-to-dictation model 57 mental model 145, 146 mental play, ADHD and 133 – 134 metacognition, reading comprehension 150 – 151 methylphenidate 139 methylphenidate hydrochloride 138 Mindset (Dweck) 158 morphemes 10; Chinese characters 51; compounding 43; dividing compounds 107; games 44, 116; language learning 96; lexical compounding 42; meaning aspect 35, 41; vocabulary growth and 44 – 45 morphological awareness: compounding of words 42; exercises 216; reading-related skills for dyslexia 115, 116, 117; word reading 35, 40 – 45 motivation: ADHD and success 133; emotional control in ADHD 70 – 72; identifying, for children 162 – 165; respecting areas of strength 160 – 162 motor dysgraphia 59, 60, 119 movies and video clips, dyslexia 209 – 213 Mr. Apercu89 165, 190 Mr. Cheung 31, 54, 59, 63, 109, 123, 163, 164, 174, 189 Mr. Joe 105, 141, 190 Mr. OM 127, 136, 189 Mr. Peter 139, 162, 181, 190 Mr. Toyota 31, 112, 128, 141, 190 Mrs. Mayo 127, 139, 169, 173, 190 Ms. Aiyada 140, 159, 160, 190 Ms. Amy 80, 82 – 83, 89, 190 Ms. Danna 6 – 7, 23 – 24, 190 Ms. Ellen 128, 139, 171, 181, 190 Ms. G 163, 189 Ms. HO 161, 170, 189 Ms. Kate 159, 160, 189 Ms. Monica 109, 132, 189 Ms. N 189 Ms. Sally 66, 90, 127 – 128, 136, 140, 158, 170 – 172, 190 Ms. WA 34, 94, 154, 190 multilingualism: interaction of dyslexia and 94; language learning and 102 – 103 Multilingualism, Literacy, and Dyslexia (Peer and Reid) 91 National Center for Learning Disabilities 16, 22 National Spelling Bee 182

Netherlands 14, 171; dyslexia organizations 192; questionnaire respondents 190 neurobiological origin: dyslexia 30 – 31; learning disabilities 22 – 23 New Zealand, ADHD organizations 196 Operation (game) 120 Ordinary Magic (Masten) 156 Orfalea, Paul 89 orthographic knowledge: reading-related skills for dyslexia 115, 116, 117; word recognition 35, 45 – 48 Overcoming Dyslexia (Shaywitz) 90 parents: help in acquiring necessary support 172 – 173; needing support 168 – 172; play and formal training 184 – 185 Partnership for Drug-Free Kids 166 Pearson see Rufina Pearson, Maria Philippines 8, 9, 79, 92; dyslexia organizations 192 phonological awareness: exercises 214 – 215; principle of testing of 37 – 38; readingrelated skills for dyslexia 115 – 116, 117; word reading 34 – 35, 36 – 40 Pig Latin 40, 115 placebo effect 115 planning-writing-editing, dysgraphia and 62 – 64 Portugal: dysgraphia organizations 194; dyslexia organizations 193 poverty: learning disabilities and 16 – 18; second language learning and 101 – 102 Power of Different,The (Saltz) 182 pragmatic context 146 – 147 Psychology Today (magazine) 87 questionnaire respondents 4, 189 – 190 rapid automatized naming (RAN) 20, 35, 49, 50 RAVE-O (retrieval, automaticity, vocabulary elaboration, orthography) 50 Reading and Writing (journal) 100 reading comprehension: background knowledge 149 – 150; characteristics of reader 148 – 151; discourse structure 146; fluency 148; inference-making 149; language 143 – 145; level of reading 148; mental model 146; metacognition 150 – 151; practical tips for daily learning struggles 198 – 199; pragmatic context 146; purpose of reading 147; purpose of text 147 – 148; Snow’s model of 145 – 151;

240 Index

syntax 146; text 145 – 147; type of reading required 148; vocabulary 145 – 146; working memory 149 reading development, computer games and apps by language 202 – 207 reading difficulties: dimensions of vis-a-vis language and script 10 – 14; helping those with dyslexia 115 – 117; language and 29 – 30 remediation for dysgraphia: copying practice 122 – 123; focusing on bilateral integration 121 – 122; focusing on whole child 183 – 184; hand strengthening 120 – 121; learning to type 124; making graphemes using different forms and mediums 120; practicing motor coordination 120 – 121; work-around strategies 118, 123 – 125; working through writing difficulties 118 – 120; work-through strategies 118 – 120; writing practice 123 remediation for dyslexia: adult support and encouragement for 111 – 113; assistive technologies for 109 – 110; focusing on whole child 183 – 186; giving children extra time 110 – 111; individual variability 104 – 105; interventions that do not work for 113 – 115; text presentation for 108 – 109; working through with games 105 – 108 response to treatment intervention (RTI), identifying children needing help 18 rewards, identifying motivation 162 Ritalin 141 Rowling, J. K. 157 Rufina Pearson, Maria 110, 189 Saltz, Gail 182 Sanders, Lars 109, 189 school performance, economic resources and 15 – 18 Scrapyard Slice 107 second language see foreign language segmental phonological awareness 37 self-esteem: advice for teachers 174 – 177; avoiding bad and promoting good 165 – 168; clarity without criticism 157; learning through mistakes 158; participation in extra-curricular activities 156 – 157, 166 – 167; positive youth development 156 – 157, 167 – 168; praising efforts 158 – 160; promoting in children with learning difficulties 155 – 160; reframing negativity 157 – 158; respecting

areas of strength 160 – 162; role models 155 – 156; teachers’ roles in students’ 173 – 174 self-regulation, ADHD and 69 – 70, 77 semantics of language 41 sexual behavior, ADHD and risky 73 Shaywitz, Bennett 182 Shaywitz, Sally 90, 182 Shea, Jim, Jr. 89 Singapore 2, 112, 182, 185, 209; ADHD organizations 197; dyslexia organizations 193 Spain 9, 93, 127, 169, 173; dyslexia organizations 193; questionnaire respondents 190 spatial dysgraphia 59 – 60, 119 spelling-to-dictation model, dysgraphia 57 square root rule 49 Stoeckl-Drax, Theresia 138, 186, 189 substance addictions, self-esteem and 165 – 166 Sweden 32, 92, 94, 113, 182, 184; questionnaire respondents 190 Swiss Dyslexia Association 100 Switzerland 2, 92, 100 – 101, 133, 135; questionnaire respondents 190 syntax 146 Taiwan 2, 8; ADHD organizations 197 Tallal, Paula 108 tasks, ADHD and breaking down 132 teachers: advice for 174 – 177; roles in children’s self-esteem 173 – 174 technology, dysgraphia and 124, 176 television 75, 144 Thailand 159, 160; questionnaire respondents 190 time: ADHD and, management 132; extra, for children with dyslexia 110 – 111; homework completion recommendations 175 – 176 Toth, Robert 89 Trends in Neuroscience and Education (journal) 84 Turkey, dyslexia organizations 193 United Kingdom (U.K.) 14, 91, 95, 122, 172, 210; ADHD organizations 197; dysgraphia organizations 195; dyslexia organizations 193 United States 2, 11, 15, 99, 129, 136: ADHD organizations 197; dysgraphia organizations 195; dyslexia organizations 193; movies 209 – 213; National Center

Index  241

for Learning Disabilities 6; questionnaire respondents 190; rate of learning disabilities in general population of 16 University of Freiburg 95 Urban Dictionary 43 video games 69, 75; ADHD and 135, 165 visual stress, experience of 26 – 27 visual support, dyslexia and 114 vocabulary, reading comprehension 145 – 146 vocabulary knowledge, morphological awareness and 41 – 42 word reading: distinguishing from word writing 54 – 57; see also word recognition word recognition: cognitive constructs for 34 – 35; fluency 35, 48 – 50; morphological awareness 35, 40 – 45; orthographic knowledge 35, 45 – 48; phonological sensitivity 34 – 35, 36 – 40 word writing, distinguishing word reading from 54 – 57

working memory, reading comprehension 149 World According to Garp,The (Irving) 183 World Food Programme 107 worldwide: ADHD organizations 197; dysgraphia organizations 195; dyslexia organizations 193 writing composition: art of 151 – 152; language 143 – 145; practical tips for daily learning struggles 199; practice and dysgraphia 123 writing the word model, dysgraphia 57, 58 www.beatingdyslexia.com (blog) 85 Yale University 87 youth development: positive 156 – 157, 167 – 168 YouTube 25, 68, 106, 131, 133, 144, 200, 211 – 213

Zambia 8, 9, 34, 39, 79, 92, 102; questionnaire respondents 190