MATURATIONAL READINESS 5 9

Teachers of Reading. Cambridge, Harvard Graduate School of Education, 1961.

20 . . . . . . . . . . . . . . . : The First R: The Harvard Report on Reading in Elemen- tary Schools. New York, The Macmillan Company, 1963.

21. White, Sheldon H.: "Evidence for a Hierarchical Arrangement of Learning Processes," in Lipsit, Lewis and Spiker, Advances in Child Development and Behavior, Vol. 2:187-220. N.Y., Academic Press, 1965.

22. Almy, M., Chittendon, E. and Miller, P.: Young Children's Thinking: Studies in Some Aspects of Piaget's Theory. N.Y., Teachers' College Press, 1966.

23. Flavell, John H.: The Developmental Psychology of Piaget. Princeton, N.J., D. Van Nostrand and Co., 1963.

24. Inhelder, B. and Piaget, J.: The Growth of Logical Thinking from Childhood to Adolescence. N.Y., Basic Books, 1958.

25. Piaget, Jean: The Origins of Intelligence in Children. New York, International Universities Press, 1952.

26. Koffka, Kurt: The Growth of the Mind. London, Kegan Paul, 1928. 27. Hebb, Donald O.: Organization of Behavior. New York, Wiley and Sons, 1949. 28. Schilder, Paul: Contributions to Developmental Neuropsychiatry. New York,

International Universities Press, 1964. 29. Orton, J. L., ed.: "Word-Blindness" in School Children and Other Papers on

Strephosymbolia (Specific Language Disability~Dyslexia)--1925-1946~by Samuel Torrey Orton, M.D., Pomfret, Conn., The Orton Society, 1966.

30. Hunt, J. McV.: "Introduction" to George, Anne E., trans., The Montessori Method. N.Y., Schocken Books, 1964.

31. Slingerland, Beth H.: Screening Tests [or Identifying Children with Specific Language Disability. Cambridge, Mass., Educators Publishing Service, 1962.

SPECIFIC READING DISABILITY INFORMATION FOR PARENTS AND TEACHERS

RICHARD S. EUSTIS, M.D.

Originally published in the Independent School Bulletin. Series of ' 4 7 - ' 4 8 , No. 4, April, 1948. Revised by the author, July, 1954, and reproduced for use in The Adolescents' Unit of the Children's Hospital Medical Center, Boston, Mass. Reprinted by permission of author and publisher.

It is common knowledge that many children in our schools fail to learn to read, write, and spell as well as they should. Educators them- selves estimate that about one-third of the pupils in the early grades have some difficulty in mastering these skills, and list the following as the usual causes: low intelligence, physical illness, poor eyesight, partial deafness, malnutrition, fatigue, immaturity, lack of interest, emotional blocking, and poor teaching.

No one doubts that these often cause reading failure. What many of us do not realize, however, is that much of the poor reading comes from an entirely different cause. Lost in the mass of poor readers lies an unrecognized, sizable minority of children who are held back by what we call a specific reading disability.

6 0 B U L L E T I N OF T H E OR'I-ON SOCIETY

Through no fault of their own they are unable to compete success- fully with their schoolmates in reading, writing, and spelling. They try hard, fail, and become discouraged. Some take to daydreaming and are accused of being lazy. Others become thoroughly obnoxious "behavior problems." Eventually, even without special tutoring, almost all of them learn to read after a fashion, but so slowly and inaccurately that many occupations and professions are closed to them. With a special kind of teaching, however, those of normal or better intelligence are able to graduate from high school and college and to lead successful lives in the business or profession of their choice.

What is Specific Reading Disability? Admittedly the name is not a perfect one, but it is better than the

popular terms mirror reader or left-handed reader, which over-emphasize one aspect of the condition; and is also better than specific dyslexia or strephosymbolia, which suggest, quite wrongly, to parents and teachers that its victims suffer from a disease. We should not allow the name to disturb us. It is nothing more than a descriptive term, used in place of an adjective to describe a certain kind of normal person.

What the term means is this: the inability, in an otherwise normal, healthy, and intelligent child, to master reading, writing, and spelling as quickly and easily as he masters other subjects. He usually under- stands arithmetic well, although he is more likely than the others to produce a wrong answer on paper by reversing the order of the digits. (He knows that 3 x 4 is 12, but his fingers put down 21!)

Specific reading disability may occur, of course, in people of any degree of intelligence from moron to genius, but is excessively hard to treat intensively in children below the normal range. The word inability in the definition should be taken literally. The child's failure is not because he doesn't pay attention or concentrate on his work. Those symptoms come later, after he has learned that no amount of effort on his part is of any use. He is simply unable to learn rapidly enough by the prevalent whole-word or look-and-say method of teaching children to read.

One aspect of this disability seems to be a confusion between right and left, or, more rarely, between up and down. We call this spatial confusion, and expect to find it in some children at the start of the first grade. Such pupils try to work backward at first, but most of them soon establish the correct left-to-right sequence without special help. Those with the specific disability tend to remain confused far longer, and so have great difficulty in learning to read.

These children also find it very hard to remember the shapes of the different words on the printed page, or even to associate correctly the shapes of the letters with their sounds. It is well-known that some people have great trouble in remembering names and faces. Apparently these pupils run into the same sort of difficulty when they try to asso- ciate the sounds of the letters, syllables, and words with their printed or written symbols.

SPECIFIC READING DISABILITY 6 ]

The specific disability is far commoner in boys than in girls, and often involves speech as well as reading. Many of the group were late in learning to talk, often find it hard to express themselves orally, and frequently lisp or stutter. Ambidexterity and left-handedness seem un- usually common among them. As small children many, but not all, were slow and clumsy in learning to feed and dress themselves, to run, to hop on one foot, or to ride a bicycle. As older children their coordination may still be poor, and many remain below average for life in athletics, and in dancing. Some of them show only one of these traits; a few, all! and most of them two or more in any combination.

When the members of the family, including cousins, are well-known for several generations, we usually find among them a number of similarly affected individuals, most of whom are males.

Specific reading disability, therefore, seems to be merely a part, although the most serious one, of a family tendency toward confusion between right and left, ambidexterity, comparative clumsiness, and rela- tive weakness in the use of language. What Causes This Family Tendency?

Scientists do not know with certainty. The different aspects appear in any combination, and so are probably not causes of each other. Most likely there is a common underlying cause from which any or all of the symptoms may develop.

This cause may be a lag in the development of certain parts of the nervous system. Obviously the picture we have described is a thoroughly normal one in infancy. An infant is clumsy, has no preferred hand, is confused between right and left, either cannot talk or uses baby talk, often stutters when excited, and cannot read. These conditions attract attention only when they persist into later childhood, instead of being outgrown at the proper age. There is some medical evidence that the slowness of these special children in getting good control of certain groups of muscles results from a corresponding delay in the development of some of the motor and association nerves.

How Common Is It? We have no really accurate statistics on this. Our schools miss

entirely many of the milder cases, particularly those of high intelligence, and suspect a wrong cause for many of the more severe ones. We have seen that teachers report that nearly a third of the pupils in the early grades have some difficulty with reading. Most of these fail for one or more of the reasons mentioned in the introductory paragraph, but about a third of the failures, or about a tenth of the school population, are victims to a greater or lesser extent of specific reading disability. Many of the milder cases eventually learn to read satisfactorily without special help. About a sixth of the failures, however, or about one in twenty of the school population never do so unless special methods are used.

Why Does It Seem To Be Commoner Now Than Formerly? One reason is that more teachers and doctors have been trained to

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recognize it. In the past invariably, and in too many schools even today, children with the specific disability were regarded as stupid, lazy, in- attentive, or lacking in concentration.

A more important reason, however, is the literal inability of children with specific reading disability to master reading when it is presented to them by the whole-word method. This method may work well in the majority, although all too often it produces abominable spellers, but it fails lamentably in children with the specific form of reading difficulty. It stresses speed and clues from pictures rather than an accurate reading of the words themselves. It overemphasizes learning by looking, and ignores to a great extent the common knowledge of mankind that we learn also by hearing, saying, and doing.

Learning to read is a complicated process which requires correct association between the marks on paper and spoken words already known and used. In these special children the visual images of the words they have seen are so uncertain that they need a great deal of help from what we now call auditory and kinesthetic re-enforcement. In simple language, they need to look many times at a letter or word, say it aloud, and write it down. This process calls more nerve cells into action and seems to aid in recollection. Whatever the reason, we know that the child with specific reading disability does better with this older approach to reading and spelling. Effect on the Child

These children are failing, and failure always results in unhappiness and loss of self-confidence. Some try to assert their individuality by withdrawing from the group into solitude; some by showing off, lying, stealing, or vandalism; others, subconsciously, by such symptoms as bed-wetting, headaches, indigestion or even obesity from simply overeating. Even those pupils who are apparently not bothered by their failure go through several years of concealed worry and discouragement which may leave their mark on them for life.

Inability to learn quickly and easily from books, or to express one- self well on paper, also affects a young man's choice of a career. A poten- tial lawyer, scientist, or author may end up as a misfit and unhappy mechanic, farmer, or clerk, not drawn to these occupations by aptitude or interest, but because of his slow and uncertain reading.

It also seems fair to conclude that at least some of our "problem ch i ld ren" - - and even our "problem adul t s" - - s ta r ted down the wrong road in an attempt to compensate for their failure in school.

What Can Be Done For It? First and most important, the schools must learn how to identify

these children as early as possible. When a pupil fails behind his class in reading, his school should study him promptly. He should be given one of the standard individual intelligence tests, because the group tests of intelligence assume that the children have at least average reading ability. His work should be checked for reversals, which are errors such

SPECIFIC READING DISABILITY 63

as the following: reading or writing b for d, p for q, letters which are mirror images of each other; or, in short words, was for saw, on for no; in longer words, form for from, astrep for repast.

If he is found to be of normal vision and hearing, and is doing reasonably well in arithmetic, but is failing in reading and s p e l l i n g - particularly if he makes many reversals - - w e should class him as a child with specific reading disability.

The simplest and cheapest treatment for him might at first glance seem to be to postpone reading instruction until a later grade when reading readiness has been firmly established, with better coordination, more firmly established left-to-right gaze and perhaps stronger visual memory. A few schools have tried this and report that children who had been merely immature have caught up quickly with the others after a delayed start. However, this is not to be counted upon, especially when there is a marked language disability. The better course seems to be in the direction of early identification and specific help in areas of weakness.

Moreover, postponement is seldom practical. When children fail to learn to read, most schools merely redouble their efforts without sufficient change of method; what these pupils really need is an entirely different approach.

There seem to be two chief underlying reasons why these children are in trouble. The first is their poor visual memory for symbols, which makes it extremely hard for them to recognize the shapes of individual letters or of words. The second is their tendency, at unpredictable inter- vals, to reverse momentarily the direction in which their eyes are moving and to try to read from right to left. A letter or word read correctly on one line may be read backward in whole or in part on the next line, the resulting errors making utter nonsense of the material. The difficulty here is not with the eyes themselves. Instead it seems to result from the per- sistence into later childhood of the confusion between right and left that is normal in early childhood, but in the majority is overcome by the beginning of the first grade.

Thus our basic aim in teaching children of this type to read is to establish early and firmly, in their minds, eyes, and fingers, the correct left-to-right sequence, the shapes and sounds of the letters, and the ability to blend these sounds into words. This takes time and much practice, even when aided by the methods of auditory and kinesthetic reinforcement already mentioned. Some of these pupils can be taught successfully in small, homogeneous groups, but others vary so in their needs that they require, for a time at least, skilled individual tutoring before they are ready to join a group.

Whether the tutoring is given singly or to small groups, the teacher must place the emphasis on accuracy and understanding rather than on speed. That may or may not come later, according to the interests, apti- tudes, and opportunities of the children. UsuaUy the poor concentration,

64 B U L L E T I N OF T H E O R T O N SOCIETY

the refusal to try, and the behavior problems all tend to disappear as the pupil gains confidence in his ability to learn by this method. Practical Difficulties

Once we have decided that a child has the specific kind of reading disability and have explained the situation to the parents and teachers, we would like to hand the actual teaching back to the school, where it belongs. Unfortunately at present, this is advisable only for the milder cases attend- ing schools with good teachers of the appropriate kind of remedial reading. Although it is true that most schools now recognize reading disability and many have remedial reading classes, very few distinguish children with specific disability from those who are reading poorly from other causes, and fewer still are able to supply the individual tutoring so often needed.

Usually their classes in remedial reading are overcrowded, the teachers overworked, and often there is pressure on them to return the pupils to the regular classes before they are ready. Insufficient remedial training produces students who cannot read fast and accurately enough to do good work in high school and college. Those with a severe disability, and even some with a milder disability, find that many of the courses offered require so much reading that they are unable to take them, and so are unable to develop their minds to their full capacity. The public schools tend to place these pupils in "special," or "opportunity" classes, where they obviously do not belong, or to assign them almost exclusively to shop work or home economics, which however valuable, do not supply enough intellectual challenge. Those in some of the private schools may be no better off, and frequently shift from school to school in constant hope that a miracle will occur.

These are the reasons that so often force a physician to advise indi- vidual tutoring, and in many instances, where he feels able to do so, to insist most reluctantly that it be done under his supervision. If he does not do the latter, some schools will fail to select the methods best suited for the pupil, and others will try to push him ahead too fast. Also, when the physician maintains contact with the work, he frequently is able to make helpful suggestions to the tutor and to the parents.

The tutoring should be intensive at first, for at least one school period a day and for five days a week. It is impossible to prophesy in the beginning how long this must continue. Occasionally it will be needed for a few months only, usually for about a year, and sometimes for several years. When the pupil's reading skill approaches that of his grade, the frequency of the tutoring may be cut to once or twice a week, but usually should not be stopped abruptly.

This method of teaching reading is very different from that in use in most schools. We therefore strongly recommend that the pupil be excused temporarily, so far as possible, from his class work in reading. If this is not done, he becomes confused and progresses more slowly.

The length and intensity of the tutoring depend on the intelligence of the child, the severity of his disability, the amount of emotional dis-

SPECIFIC READING DISABILITY 65

turbance, and, somewhat on his age. In general, younger children respond more quickly than older ones, in whom years of failure have produced well-justified discouragement and emotional tensions, and who have further to go to catch up. Isn't All This Expensive?

It certainly is. Nevertheless, when the family can afford it, a few hundred dollars spent on skilled tutoring in the early grades may make all the difference between success and failure in high school, college, and later life. When the family cannot afford the additional expense, the problem is left with the public school authorities, whose inadequate budgets in most communities do not give them the means to supply the necessary amount of tutoring. How Can The Cost Be Lessened?

The only way to diminish the cost to the individual family and to the community is to identify the children with specific reading disability early in the first grade. We now know enough to do this successfully in most cases. The school should then teach them by methods they can understand and utilize. Many will respond to group teaching, others will require the intensive individual tutoring we have described. The money now spent in the upper grades on "remedial reading" will bring far better results if spent in the first grade on finding these children, and then on teaching them by methods that they themselves say, "Make sense."

When the correct methods are used, these children gradually learn to read, write, and spell wall enough to compete successfully with their classmates. There is nothing mysterious in the technique used in teaching them. It is more time-consuming and expensive, because these pupils have to proceed for a while more slowly than the others and may need indi- vidual attention.

The wealthy can easily afford the tutoring; others, only at a sacrifice; and the majority, not at all. The present situation, which allows intelli- gent children with a specific disability in reading to fail year after year with consequent frustration and problem behavior, is intolerable in com- munities which boast of supplying free education for all.

The solution lies in the hands of the parents and teachers of the children who are suffering. Little will be done until they demand relief; for there are still too many teachers and school psychologists who do not separate the specific form of reading disability from reading failure due to other causes, and who do not realize that specific reading disability re- quires a special sort of teaching.

SEMANTICS 1969: What to Call the Teacher? Dr. Eustis uses "tutor", as do many other people. Anna Gillingham

objected vigorously to this usage because in common speech a "tutor" refers to one who helps a student catch up with his class if he has been absent or is just not a very able learner. The tutor, in this sense, uses an individual-but-more-of-the-same approach.