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The Eyes, the Brain, and Reading

April 6, 2011

This morning I was trying to read the paper with a two-year-old clinging to my leg, begging for juice. It made me think about how hard reading can be and how many things can go wrong with it. The squiggly lines on the page come in through the eyes and travel to the visual centers in the brain, where they are recognized as letters and words. The info is then sent to the brain’s language centers where we make sense of the material based on all of the background knowledge stored in our memory systems. And for the whole thing to work, there needs to be an undercurrent of focused attention and energy.

It’s like a neurological chain reaction that turns a series of lines on the page into meaning. We need to figure out how to set this chain reaction off in our kid’s brains, because if we don’t they are going to be in a lot of trouble at school (and in life).

The problem is that a pretty large group of kids don’t experience this chain reaction as they start school. These struggling readers are at high risk not only for academic problems, but also for emotional and behavioral problems if they don’t get help on time.

The good news is that we know a lot about helping these kids. The bad news is that there are a lot of obstacles in our way, which brings me to two interesting studies.

The first is a paper put out by the American Academy of Pediatrics, the American Academy of Opthamology, and the American Association of Certified Orthoptists called “Learning Disabilities, Dyslexia, and Vision”. This addresses the question of which link in the chain tends to be broken when a child isn’t reading. It is a review of the research which concludes that the evidence supports the view of dyslexia as a language problem, not a vision problem…and that vision therapies for dyslexia are not scientifically supported. This is critical…the problem for kids with dyslexia is that they are not processing oral language in a way that allows them to make the leap to written language. The treatments that work for them are language based treatments.

There is a long history of claims that dyslexia is a visual problem. At one point, people thought that it had to do with letter and word reversals (and many parents of kindergarteners still worry about dyslexia when their kids write a letter backwards). Today, there is a large industry around vision therapy. Sometimes called “behavioral optometry”, these treatments focus on skills such as eye tracking. They compete with the research-based language therapies, confusing parents and teachers and making it difficult to decide which path to follow in helping a struggling reader. This can have the effect of delaying the start of good intervention, which brings me to the second study.

Published in the Journal of Special Education by Rolanda O’Connor and colleagues, this study was called “Responsiveness of Students with Language Difficulties to Early Intervention in Reading”. It looked at kindergarten students with language vulnerabilities and randomly┬áseparated┬áthem into two different groups. Both groups received good language-based treatment, but one group started in September and the other waited until February. Both groups benefited…but the students in the September group were twice as likely as the other students to turn into average readers in time for the 1st grade.

So what’s the take home here? Reading problems are language problems, and it’s incredibly important to treat these problems early! To do that, we need to do two things. First, we need to be really clear about what works and what does not, just like the AAP and their collaborators. Second, we can’t wait for these kids to fall behind in reading before we help them (which is exactly the way that the special education system too often works). We need to look for the early language deficits that predict reading disability and treat early. After all, knowing that 5 months can make such a big difference for kindergarteners helps us to understand why most readers who come into the 3rd grade lagging behind, stay behind.