By Mary Ann Carmack, M.D., Ph.D., PAMF Pediatrics

Reading is something many of us take for granted, but learning to read is a formidable task for children with dyslexia. Dyslexia is a common learning disability affecting one in five children that can impact a child's entire educational experience. While children with dyslexia are often above average in intelligence, their inability to read fluently can make other areas of learning more challenging.

Reading is a complex cognitive process. Children learn to read by translating the sounds within words (phonemes) into words. For example, the word "bat" has three phonemes—the "b," "a" and "t" sounds—and combining these sounds creates the word. As a child begins to recognize familiar words, he or she learns to read.

Children with dyslexia can't learn to read and spell in this fashion because they have trouble translating the phonemes. They may not be able to recall phonemes and words from memory, which makes reading slow and inaccurate. Children with dyslexia often have trouble speaking and writing words as well as reading them. They may also have problems with handwriting, planning and organizational skills, and math.

No one knows what causes dyslexia, but most agree there is a genetic component since it tends to run in families. Some studies suggest abnormalities in the functioning of the areas of the brain responsible for language, visual processing, attention and organizing.

There are several common misconceptions about dyslexia. Dyslexia is not caused by poor vision, and people with dyslexia do not "see" backward. Dyslexia is a learning disorder—it is not caused by a lack of motivation to learn to read. Rather, it is best thought of as an "unexpected difficulty in learning to read."

Signs of dyslexia in preschool children include:

• Beginning to talk later than expected
  
• Being slow to learn or add new words
  
• Difficulty rhyming
  
• Difficulty learning alphabet letters

After a child begins school, the signs of dyslexia include:

• Difficulty reading single words, such as a word on a flashcard
  
• Difficulty learning the connection between letters and sounds
  
• Confusing small words, such as "at" and "to"
  
• Choppy, slow oral reading; inability to read fluently
  
• Inability to sound out words; a tendency to take wild guesses at words

If your child has one of these signs, that doesn't mean he or she has dyslexia. However, if your child exhibits several of these signs or you have a family history of the learning disability, you should probably have him or her evaluated by a pediatrician. Your doctor will review the child's history, discuss the child's teachers' and your observations and concerns, ask the child questions, and administer reading tests and other types of assessments.

Treatment for dyslexia involves providing educational tools for your child. Federal law requires that schools develop an Individualized Education Program (IEP) for children with dyslexia, which provides intense, personalized education to retrain the way the mind processes sounds within words. You and your child's pediatrician, teachers and other health professionals have input into the plan developed for your child. The plan is updated annually.

An excellent book on dyslexia, written especially for parents and teachers, is Overcoming Dyslexia, by Sally Shaywitz, M.D., a neuroscientist and professor of pediatrics at Yale University.

There is no cure for dyslexia, and there are no medications to make it go away. However, through early identification of the problem and early intervention, difficulties can be minimized and overcome.

Dr. Carmack is a board-certified ophthalmologist and head of pediatrics at PAMF's Palo Alto Center. She sees patients at both the Palo Alto Center and the Fremont Center.