What is the recommended approach to managing dyslexia?

Approach to Dyslexia

Dyslexia should be treated with intensive, structured phonological intervention focusing on phonemic awareness, decoding, and fluency training, delivered daily in individualized sessions, as this directly addresses the underlying language-based deficit that causes the disorder. 1, 2

Understanding Dyslexia

Dyslexia is a receptive language-based learning disability characterized by difficulties with decoding, fluent word recognition, rapid automatic naming, and reading comprehension that result from deficits in the phonological component of language. 1 The disorder affects approximately 5% of children and is multifactorial, reflecting genetic influences and dysfunction of brain systems. 2

A critical pitfall is misattributing dyslexia to visual problems—children with dyslexia have the same visual function and ocular health as children without the condition. 1

Diagnostic Assessment

The diagnostic evaluation must include:

• Standardized reading and spelling tests administered as a battery to quantify the severity of impairment 2
• Psychological evaluation to identify comorbid conditions, as 40-60% of dyslexic children have anxiety, depression, or attention deficit 2
• Information from parents and teachers to understand functional impact across settings 2
• Multiaxial classification system to establish the formal diagnosis 2

Evidence-Based Treatment Approach

Primary Intervention: Phonological Training

The core treatment must be intensive, individualized phonological intervention that explicitly teaches:

• Phonemic awareness (the ability to manipulate sounds in words) 1, 2
• Decoding skills using systematic phonics instruction 1
• Fluency training through repeated reading practice 1
• Vocabulary development 1
• Reading comprehension strategies 1

Delivery specifications: Daily intensive individualized instruction is required, with sessions explicitly teaching phonemic awareness and the application of phonics. 1

Adjunctive Interventions

Visual-attentional training may be added as a supplementary intervention, as recent evidence shows dyslexia is multifactorial with many children having deficits in multiple domains beyond phonology. 3, 4

• Dynamic computerized visuo-attentional interventions improve reading fluency and comprehension, with effects equal to or greater than phonological strategies alone 4
• Action video games have shown benefits for reading rate and fluency 4
• Visually-based reading acceleration programs improve reading accuracy and rate 4

The multimodal approach should tailor interventions to the individual's cognitive profile, addressing phonological, visual-attentional, and cross-modal integration deficits as identified through assessment. 3

Compensatory Reading Strategy

For children with identified visual processing contributions to their reading disorder:

• Teach compensatory reading strategies that address inadequate fixation, excessively large saccadic amplitudes, reduced ability to simultaneously recognize letter sequences, and prolonged fixation/speech onset latency 5
• This compensatory approach produces immediate improvement when the identified causes are addressed (effect size Hedges' G = 1.72) 5

Treatment of Comorbid Psychological Disturbances

Psychotherapy must be provided for any coexisting psychological disturbance, as these conditions significantly impact treatment outcomes and quality of life. 2 Address anxiety, depression, and attention deficits through appropriate psychological interventions concurrent with reading remediation. 2

Prevention Strategies

For at-risk children in kindergarten:

• Implement evaluated prevention programs that promote phonological awareness and early literacy skills 2
• These programs can be delivered in kindergarten and at home to facilitate reading and spelling acquisition before formal reading instruction begins 2

What NOT to Do

Avoid vision-based treatments that lack scientific support:

• Visual training, muscle exercises, ocular pursuit-and-tracking exercises, behavioral/perceptual vision therapy, "training" glasses, prisms, and colored lenses/filters are NOT effective treatments for dyslexia 1
• There is no valid evidence that children participating in vision therapy are more responsive to educational instruction 1
• These approaches are scientifically unsupported despite being widely marketed to families 1

Treatment Duration and Follow-up

Intensive interventions should last at least 2 months per modality (phonological, visual-attentional, cross-modal), with effects maintained for at least 2 months post-intervention. 3, 4 Regular reassessment of reading comprehension, spelling performance, and functional impact is necessary to guide ongoing treatment. 3