My daughter is eight years old and is in third grade. She is a very bright girl. In school, she is very enthusiastic about things like science and math, but has consistently been behind at reading. At present, she is reading about a grade level behind. She spells phonetically. She is able to express herself verbally, but has trouble with writing. When reading out loud, she seems to be trying so hard, but the words just don't seem to flow naturally for her. Based on this, and various other reasons, I suspect my daughter may be dyslexic. I mentioned this during parent/teacher conferences and, although the teacher seemed to agree with my concerns, she did not seem to know much about the topic.

We were referred to the school's resource teacher, who stated there was no test for them to administer for dyslexia, but did agree to test her for a general learning disability/special education. She obviously did not qualify for special education services based on her test scores. At a meeting to discuss these test results, it was apparent to me that my concern about dyslexia was being dismissed. Instead, the resource teacher made several references to her attention span and activity level. The school social worker suggested look into an ADHD diagnosis. I do not believe that to be the issue. I have asked at our pediatrician's office about how I might be able to have her tested for dyslexia, but they pointed me in the direction of the school. I feel like I owe it to my daughter to get her the help she needs, but I don't know where to start. Could you please point me in the direction of someone who might be able to help?

Dr. Pierson's Response: 
I'm surprised that your daughter's pediatrician didn't have any other recommendations for you than the schools. I would be sure he/she knows about DyslexiaHelp to at least refer parents to the website. It is my experience that it is not unusual that the educators in the schools do not know about dyslexia. The schools in Michigan do not diagnose dyslexia. A student can receive an evaluation for a specific learning disability (SLD), under which dyslexia falls. But as you have experienced, many times these smart kids with dyslexia do not meet the criteria for SLD despite struggling in school greatly - very frustrating to say the least. And, this is not the first time that I've heard the ADHD fallback on the part of the schools. It is true that dyslexia (or a reading disorder) can occur with ADHD (or ADD), but many times a student’s behavior when she knows she can’t read the text in front of her can be misinterpreted as an attention problem.

It appears that you are going to need to go outside the school to get a good comprehensive assessment of your daughter’s strengths and weaknesses in order to determine whether she is indeed dyslexic. I typically refer people to this provider list for their state from the International Dyslexia Association. Here is Michigan’s. Not everyone on this list diagnoses so you will need to ask. Here's information on what a comprehensive assessment entails. More specific information available here.

If your daughter is dyslexic, then a good assessment will pinpoint her areas of weakness (as well as strengths) and a good diagnostician will write the report in a way that makes it clear how she would qualify for services in the public schools and what the intervention needs to look like (albeit it is still up to the school to interpret and use those data). I recently assessed a 4th grade girl who does have an IEP and whose parents were afraid that she was going to lose her services because she is doing so well in her classes. Well, the reason she is doing so well is that she's been getting intensive intervention- services at school AND after school. My testing did find scores below the 9th percentile, which is in the range considered clinically disordered, on six subtests. The jury is still out as to how the school will use these data.

And then, it is still another issue as to whether the school personnel have the expertise to treat dyslexia. Unfortunately, many teachers, including those in special education, have not had that training. Another story-- I evaluated a 5th grader who also had an IEP who is severely dyslexic, and who after four years of intervention at school was still reading at a 1st grade level. I attended the IEP with my evaluation report and the school developed a plan to meet every six weeks to review the program and bring data to the table relative to progress. Largely because the school is now doing the intervention that this student needs and being held accountable, we have seen two years growth in two months. Importantly, part of my work with this student is to help him advocate for himself -- to know his strengths and weaknesses and how smart he is -- and he's holding the school accountable for his learning.

So why am I telling you these stories? You are going to have to advocate for your daughter (as you are by having worked with the school and then sent this email). The squeaky, knowledgeable wheel gets the grease. I'd recommend reading Sally Shaywitz's book, Overcoming Dyslexia. Despite a 2003 publication date, it remains current as to what these kids need. The more you know, the better you'll be able to advocate for her. Please don’t hesitate if I can answer any other questions.