To whom should I refer a child with dyslexia concerns?

Referral for Children with Dyslexia Concerns

Children with dyslexia concerns should be referred to a multidisciplinary team led by a speech-language pathologist, along with educational psychologists and developmental pediatricians for comprehensive evaluation and intervention.

Understanding Dyslexia

Dyslexia is a common learning disorder affecting approximately 5% of children, characterized by severe impairment in learning to read and spell 1. It is strongly heritable, occurring in up to 70% of identical twins and 50% of individuals who have a parent or sibling with dyslexia 2. Early identification is crucial as dyslexia is persistent - children who struggle with reading in early grades often continue to have difficulties throughout their education 3.

Primary Referral Pathway

1. Speech-Language Pathologist (SLP)

   • Primary professional for evaluation of reading and language disorders
   • Conducts comprehensive assessment of phonological awareness, decoding skills, and language abilities
   • Develops targeted intervention plans for reading and spelling difficulties

2. Educational Psychologist

   • Evaluates cognitive functioning and academic achievement
   • Administers standardized reading and spelling tests
   • Assesses for co-occurring conditions (40-60% of dyslexic children have psychological manifestations including anxiety, depression, and attention deficit) 1

3. Developmental Pediatrician

   • Evaluates for medical conditions that may impact learning
   • Coordinates care between specialists
   • Monitors developmental progress

Additional Specialists Based on Presentation

• Pediatric Neurologist: If neurological concerns are present
• Occupational Therapist: For assessment of motor impairments or sensory processing issues that may contribute to learning difficulties 4
• Audiologist: If hearing concerns exist, as approximately 30% of children with hearing deficits have intellectual/developmental disorders 4
• Ophthalmologist/Pediatric Ophthalmologist: To rule out vision problems that may interfere with reading process (though vision problems do not cause dyslexia) 5

Early Intervention Approach

The American Academy of Pediatrics recommends initiating Early Intervention Program services for children 0-3 years with speech delay, even while diagnostic workup is ongoing 6. This maximizes linguistic competence and literacy development, preventing children from falling behind in communication, cognition, reading, and social-emotional development.

Red Flags Requiring Immediate Referral

• No meaningful single words by 16 months
• No two-word phrases by 24 months
• Any loss of previously acquired language skills
• Limited interest in other children
• Lack of pretend play by 18 months
• Poor eye contact and joint attention 6

School-Based Services

For school-aged children, referral for educational evaluation through the school system is essential to establish:

1. Individualized Education Program (IEP): Legally mandated document outlining special education services and accommodations 4
2. Learning Media Assessment: To determine whether print or alternative learning methods are most appropriate 4

Important Considerations

• Early identification before school entry is ideal, during a period of heightened brain plasticity when interventions are more effective 3
• Treatment should be directed at the language-based etiology of dyslexia 5
• Effective programs include specific instruction in decoding, fluency training, vocabulary, and comprehension 5
• Most effective interventions include daily intensive individualized instruction that explicitly teaches phonemic awareness and phonics 5

Follow-Up and Monitoring

• Regular developmental monitoring at 6-month intervals using norm-referenced assessment tools 6
• Scheduled reassessments at key developmental transitions (12-24 months after initial evaluation, 3-5 years of age, and 11-12 years of age) 6
• Coordination between specialists to monitor progress and adjust interventions as needed

By following this referral pathway, children with dyslexia can receive timely, evidence-based interventions to improve reading outcomes and prevent secondary psychological complications.