I have been working with my son since he was 4 on his reading and writing skills, which have always been a struggle for him. He now tests in the average range for reading fluency, and above average in comprehension on the Gray Oral Reading Test (GORT). He has a high score for phonological processing on the comprehensive Test of Phonological Processing (CTOPP). He seems to have visual processing difficulties though (his visual acuity tested at 20/20 and it seems his eyes are tracking together) where he loses his place, adds/omits words, and scrambles phrases as he reads. It gets worse after he reads more than a paragraph. He complains that his eyes are tired, and often outright refuses to read aloud or to himself. He loves audio books and will read along books where the words are highlighted. His writing looks like a first grader’s with poor spacing and words “falling off the lines”. So, I’m wondering about the possibility of Irlen Syndrome. Do you have any suggestions about diagnostic questions we should be asking and/or professionals we should consult. If you know of a good research article about this, that would also be welcome.

Dr. Pierson's Response: 

First and foremost, as I think you know, dyslexia [1] is not a visual problem, but results from weaknesses in phonological processing.

It is true that our students with dyslexia are exerting so much effort to read and spell and write, that they become quickly fatigued. Here are two pieces that Dr. Lauren Katz and I wrote about vision problems [2] and dyslexia [3].

I cannot find much research on Irlen Syndrome, which is indicative. Here is a structured literacy intervention.

When you say he has a high score on the CTOPP -- I'm assuming you mean high scores across all 3 areas. The challenge with the CTOPP-2 is that response time is not accounted for on any of the phonological awareness tasks. The examinee can take as long as he needs to get to the correct answer. Evidence has suggested that struggles with speed of accessing phonological information can impact reading and spelling skills (Kilpatrick, 2015). We need to be mindful that your son has been receiving reading intervention since he was four. Intervention is known to have positive outcomes on phonological awareness skills. I have been known to have to clarify “average” CTOPP-2 phonological awareness scores in the student who has had intervention.

As a diagnostician, I’d want to know whether attention may be playing a role in your son’s reading challenges. I would also take him to a reputable ophthalmologist, in Ann Arbor we have Kellogg Eye Center. They understand the role of vision in reading and will not recommend vision therapy with the false promise of helping his reading. There are those who will not follow the protocol, claiming that vision therapy will 'cure' the reading problem. This thinking is detrimental to the child with dyslexia. Structured literacy is the intervention for the student with dyslexia.