I have a son that I think may have dyslexia. My son has always struggled with reading but was never "bad enough" to qualify for reading help at the school. At his annual well-visit 2 years ago, the doctor said something about his eyes not working together. We took him to see the optometrist and she said he needed glasses (he is very good about wearing his glasses every day). On your "Clues to Dyslexia" page, there were multiple boxes that I checked as things that my son struggles with. We sent him to a reading tutor when he was younger; but with the 4th-grade work getting harder and more complex (and with learning happening virtually due to the pandemic), we're noticing him struggling a lot more. He starts next week with an online tutor, but I think he needs an official diagnosis for school. Please let me know if you can help him get an assessment, official diagnosis, or any next steps.
Dr. Pierson's Response: 
First, let me address the vision issue. Indeed, a student's eyes need to be working properly. But, reading disorder is not caused by a vision problem. My colleague at my clinical practice Dr. Lauren Katz and I have written two pieces addressing this misconception. Dyslexia is a language-based learning disorder with the core weakness being in phonological processing. Second, this is not the first time that I’ve heard of a student who is struggling with reading not being “bad enough” to warrant further investigation by the school. You are on the right track in thinking that he should be assessed. Here is a piece that I wrote about that. You are also right to be concerned about his ability to be able to access the 4th grade curriculum. This is when the curriculum has shifted from learning to read in the early grade to using one's reading to learn. By 4th grade, text has become more demanding. It is estimated that 60-80% of the vocabulary is now morphologically complex (e.g., adaptation, atmosphere, herbivore, metamorphic), and students need to have the skills to decode those words in order to learn from text. Our students with reading disorder are at even greater risk for developing vocabulary in line with their peers. The “4th grade slump” in which students’ strong vocabulary skills take a dive is well documented in the literature. As you noted, the first step is a good comprehensive assessment. A good assessment lays the groundwork for intervention. It will flesh out his pattern of strengths and weaknesses. It appears, given that the school staff does not recognize his challenges, that you will have to get an outside evaluation. I typically refer people to the International Dyslexia Association’s (IDA) provider list for their state. You could also search for the Decoding Dyslexia chapter for your state on Facebook. Decoding Dyslexia was started by parents to advocate for students with dyslexia. Someone in your area may be able to refer you to a good diagnostician. My guess is the tutor your son had when he was younger got him reading well enough to succeed at the lower level. But, reading is progressive and it only gets tougher and so we need to continue the intervention, termed structured literacy by the IDA. At his age, your son will need direct instruction in Latin and Greek roots, prefixes, and suffixes; spelling rules; strategies to decode multisyllabic words; strategies for reading comprehension, to name a few. I find that when you, as the parent, have a well-written report that highlights your child’s strengths and weaknesses and bring that to the school, most school personnel are open to using that information to help them determine eligibility for services at the school. Dyslexia is a specific learning disability. It will also be important to ascertain that someone is trained in structured literacy intervention. You do not want your son pulled out of important class time and miss content if the intervention is not what he needs.