We are very suspicious that our bright 3rd grade son has dyslexia. Although he reads very well, he struggles immensely with writing, his spelling omits syllables or has the right letters in the wrong order, he omits small words or repeats phrases during oral reading, does not have a strategy for decoding new or bigger words despite phonics instruction the first two years of school, and he still reverses b/d. We have a full private psychoeducational assessment scheduled to evaluate for dyslexia and dysgraphia. However, it cannot be completed until early March - 3 months from now. School will not assess because his grades are As and Bs, so going that route is not an option. Our sweet, thoughtful, and creative son is struggling mentally and emotionally at school this year. He no longer likes school. Homework is miserable for all of us. He refused to go to school one day recently because he felt so overwhelmed. We would like to support him as much as we can while awaiting testing, so we are considering starting OG tutoring while we wait. However, after reading another question’s answer in which you state that tutoring can affect a child’s CTOPP score, thus making the diagnosis a bit less clear, I am wondering if we should wait on the tutoring. We already are concerned that his “brightness” and high reading ability may obscure the diagnosis - the school is skeptical that his problems are due to anything aside from his lack of motivation. “We have no data that would support a deficiency of any kind,” we were told. But we know that *something* is going on. Will two months of OG tutoring alter his testing significantly? Should we wait, or proceed?

Dr. Pierson's Response: 

I am so sorry that your little guy is struggling and no longer likes school. Sigh. Let me start by saying this - “We have no data that would support a deficiency of any kind,” we were told - intimates to me they do not understand dyslexia.

Your son is now at the age when the curriculum shifts from learning to read to using one's reading to learn. Many times it is at this critical juncture when kids start to struggle. In part, they can no longer rely on their strong spoken language skills to learn and teachers are doing less teaching via the oral mode. Both reading and writing become much more demanding and this only continues as they move through the grades. Letter reversals beyond 2nd grade are a red flag for dyslexia.

Generally, we want students to get an assessment before beginning intervention because 1) a good assessment will lay the groundwork for intervention and 2) intervention works, as you noted. I can sometimes see students whom I know are dyslexic, but who do not meet the clinical markers to receive a diagnosis, and I end up giving a diagnosis of "subclinical dyslexia." This can happen even with kids who have not received intervention.

That said, I doubt starting intervention now will greatly impact his scores on the CTOPP-2 in March. It could, depending how intensive it is, but typically it takes longer than 2 months to make great changes in the students with dyslexia with whom I work. And, a good diagnostician will take that intervention piece into account when making a diagnosis. I also think you need to consider his self-esteem as a learner. All the while that he is not able to demonstrate his potential in school, as you noted, is taking a hit on his self-esteem and emotional well-being. The school is going to need to come on board in regard to giving him accommodations to help bolster him because while the tutoring will help him learn to read and spell-- he may still be slow at it and need additional time, need to dictate his thoughts, need text read to him -- all kinds of accommodations to help him reach his potential. Every student I see for a diagnostic assessment needs some kind of accommodation -- typically, a number of them. Here is a piece that I wrote as to why kids don't qualify for services in the schools despite being dyslexic.

So, the challenge for the examiner will be to demonstrate your son’s need for additional services at school despite scoring As and Bs. Here is what a comprehensive assessment entails: http://dyslexiahelp.umich.edu/parents/learn-about-dyslexia/dyslexia-testing/comprehensive-dyslexia-evaluation. His spoken word retrieval skills need to be assessed to hone in on what piece of the writing is challenging for him -- is it because he can't find the word he wants and then when he does has forgotten what he wants to write? Is it spelling, is it working memory, is it thought formulation, grammar? There is a LOT that goes into writing and determining where the breakdown is.

I recommend getting a copy of Sally Shaywitz's book Overcoming Dyslexia. Despite the 2003 publication date, it remains current as to what dyslexia is, how to assess/diagnose, and, importantly, to answer your question, how to treat it, with the exception that Dr. Shaywitz does not use the term "structured literacy" when talking about intervention. That is because the term was not coined until 2014 by the International Dyslexia Association -- but that is the intervention approach she describes. She wrote the book for parents, so it is very reader-friendly.

Last, I suspect you are going to have to hone your advocacy skills so that he gets the help he needs.