that the way i think

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Thats the Way I Think

Many people with dyspraxia and dyslexia also have ADHD. Thisfully revised edition of David Grants thought-provoking, insightfulbook develops our understanding of specific learning differences andconsiders the further challenges presented by these overlappingconditions.

New sections explore mental imagery (visualisation) andsynaesthesia, enabling the reader to gain a fuller understanding ofthe sensory experiences and thoughts of individuals with specificlearning differences.

As well as providing information defining dyslexia, dyspraxia andADHD, Thats the Way I Think addresses topics including:

colours and reading becoming creative sports, genes and evolution invisible girls and women.

The accessible style of this book, which includes numerousanecdotes and personal insights, will immediately strike a chord withanyone who has first- or second-hand experience of these specificlearning differences.

Essential and enlightening reading for people with specificlearning differences as well as their parents and/or partner, thisbook also provides an invaluable insight for teachers, teachingassistants and SENCos.

David Grant is a chartered psychologist specialising in theidentification of specific learning differences in adults. He is aregular speaker at conferences, and has over thirty years experienceof working in higher education.

Thats the Way I Think

Dyslexia, dyspraxia andADHD explained

Second edition

David GrantWith illustrations by Hannah Evelyn French

First edition published 2005by David Fulton Publishers

This edition published 2010by Routledge2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN

Simultaneously published in the USA and Canadaby Routledge270 Madison Avenue, New York, NY 10016

Routledge is an imprint of the Taylor & Francis Group, an informa business

2007, 2010 David Grant

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

British Library Cataloguing in Publication DataA catalogue record for this book is available from the British Library

Library of Congress Cataloging-in-Publication DataGrant, David.

Thats the way I think: dyslexia, dyspraxia and ADHD explained/David Grant. 2nd ed.

p. cm.1. Dyslexia. 2. Apraxia. 3. Attention-deficit hyperactivity disorder. I. Title.RC394.W6G73 2010616.8553 dc22 2009034219

ISBN10: 0415564654 (hbk)ISBN10: 0415564646 (pbk)ISBN10: 0203857968 (ebk)

ISBN13: 9780415564656 (hbk)ISBN13: 9780415564649 (pbk)ISBN13: 9780203857960 (ebk)

This edition published in the Taylor & Francis e-Library, 2010.

To purchase your own copy of this or any of Taylor & Francis or Routledges collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.

ISBN 0-203-85796-8 Master e-book ISBN

Contents

Preface viiForeword ixAcknowledgements xiii

Introduction 1

1 Dyslexia, dyspraxia and ADHD: the common ground 7

2 What is dyslexia? 28

3 What is dyspraxia? 50

4 What is ADHD? 65

5 Visualisation and synaesthesia 82

6 Colours and reading 99

7 Becoming creative 105

8 Sports, genes and evolution 121

9 Invisible girls and women 140

10 Sleep 148

11 Neurodiversity and concluding remarks 156

Appendix: Suppliers of assistive software 161

vi Contents

Preface

There is nothing unusual about being dyslexic, dyspraxicor an individual with ADHD. About one in 20 peopleare dyslexic. About one in 20 are dyspraxic. About one in twenty have ADHD. However, in spite of thesenumbers, relatively few books have been written foradult dyslexics and dyspraxics that explore and explainin everyday language their lived experiences.

This book provides a non-academic explanation ofwhy the everyday experiences of dyslexics, dyspraxicsand individuals with ADHD are different from those ofother people in a number of crucial ways. It was writtenfor more than just adults and those in their late teenswith a specific learning difference. As so many havepointed out to me, they also want members of their own family and close friends to gain a better insightinto why they do certain things, and why they think in different ways.

Many also pointed out to me that they want peoplethey work with and work for, whether that be colleagues,employers, teachers or lecturers, to also understand them.All too frequently dyslexics, dyspraxics and individualswith ADHD are misunderstood, and have been for far

too long. This book is about dispelling myths andbreaking down barriers of misunderstanding. It is writtenfor non-professionals and professionals who want a clearinsight into understanding the everyday livedexperiences of being dyslexic, or being dyspraxic, orbeing someone with ADHD. This understanding is thekey to unleashing talent and hidden potential.

viii Preface

Foreword

How many times in my teaching career spanning twenty-five years did I come across a child who was strugglingwith spelling, writing, reading or numeracy? An individualwho did not appear to be making the same progress astheir classmates, or worse, was not making progress at all.My natural teaching instinct told me to change the way Iwas teaching, provide an alternative stimulus, differentiatethe work I was giving the individual child but most of all to try to discover what the underlying differencewas between this one child and their peers. What wasoften very obvious was that each individual had abilitiesas well as weaknesses and again the instinct was to build on the strengths and the abilities whilst trying tosupport the weaknesses.

Often, I was able to make a difference, but inhindsight, especially in the early days of my career, itwas probably only transitory the bigger issue was notbeing addressed. I cant remember any children beinglabelled dyslexic, dyspraxic or as having ADHD. Instead,they were slow learners, poor readers, clumsy, lazy ornaughty. There were probably many other adjectivesthat were used by teachers and pupils alike that would

have had very negative connotations and may havecaused severe distress to those young peopleencountering these difficulties. On reflection many of these children would today have been assessed andbeen given the label of dyslexia, dyspraxia and/orADHD.

Would having that label have made any difference tomy teaching? Probably not, because what I lacked wasknowledge about these specific learning differences andthe underlying meanings and emotions that becomewhat David defines as a lifestyle. Why did I lack theknowledge? Mainly because the research, assessment andprolific writing that we now have on specific learningdifferences was not available, and as a primary teacher Iused my knowledge of child development, differentteaching and learning styles and trial and error to try toensure that each individual in my classroom would beable to reach their full potential. Looking back, I nowknow that not all of those individuals would havereached their full potential because I was not addressingtheir underlying needs. Davids book would without adoubt have helped me all those years ago to have amuch deeper understanding of the needs of individualswith these differences.

The book is written in an informal manner that isaccessible to everyone. There is much material aboutdyslexia, but it is very academic in its nature, both interms of its content and its use of terminology and assuch is very dyslexia-unfriendly.

This book is different, it is written in an accessiblestyle that makes it very easy to read. The case studies

x Foreword

and references to the many individuals that David hasworked with give you a sense of dj vu, because everyteacher or parent will be able to recognise the scenariosplayed out within the book and be able to name ayoung person they have known who will have encountereda similar difficulty.

The book is written for a multitude of audiences.First, those who are dyslexic, dyspraxic or who haveADHD who can empathise with the case studies drawnupon by David. Second, the parents and siblings ofthose with specific learning differences who want tounderstand their different way of thinking and be ableto support them in everyday situations. Finally, it iswritten for professionals working with those with specificlearning differences to support them in being able toprovide the necessary teaching and learningopportunities that will meet their needs.

David has not only asked lots of questions; he hasattempted to bring answers together and draw inferencesfrom all of the personal histories that he has collected.When I was reading the book I began to question my knowledge and tried to address some of thoseunderlying conceptions or misconceptions that I mayhave built up over the years in education. I hope thatthis book will make you reflect on your practice in the same way.

We have read much in the media about dyslexia andrelated specific learning differences. Much of thereporting would lead you to believe that there is onestrategy, one piece of technology, one drug, one cure.This book illustrates that one size does not fit all and

Foreword xi

that each individual has very personal requirements which,with help, support and intervention, can be managedand equip them with life-skills that will lead to a happyand fulfilling future.

Lorraine Petersen OBECEO of NASEN

xii Foreword

Acknowledgements

This book could not have been written without over2,000 dyslexics, dyspraxics and individuals with ADHDsharing with me their thoughts and experiences. Toeveryone, a big thank you. I am also grateful, andhumbled, by the emails, letters and phone calls I havereceived from individuals and families who have, for thefirst time, achieved an understanding of themselves, orchild or partner, when reading the first edition of Thatsthe Way I Think.

My family has also made a major contribution. Mywife, Cathy, has helped me make my writing moresuccinct, questioned me on sections she did notunderstand, and improved my grammar. It is a betterwritten book because of her input. My sons have alsoplayed a part. My eldest son, Matthew, played a key rolein helping me establish a database. As a genetics studenthe cast a critical eye over my earlier observations andtracked down key papers. He also carried out a surveyinto the sleeping patterns of undergraduates. Myyoungest son, Daniel, is dyslexic and was the Middlesex800m county champion in his age group for threesuccessive years. Hence my particular interest in the

links between sporting ability and dyslexia. As a sportsand exercise science undergraduate (now a postgraduateMSc student) he helped in the gathering of data on theincidence of visualisation in undergraduates. I am verygrateful for their inputs.

Hannah Evelyn French, an illustrator, graduated from Kingston University in 2003. I have always beenimpressed by how well, even as an undergraduate, shecaptured a range of dyslexic experiences in her work. As a dyslexic herself she could immediately understandwhat I was looking for whenever I asked her for anillustration. I am very pleased that Hannah has provideda new illustration on visualisation to accompany herprevious ones.

Thanks are due to Tanya Watkins, fashion designer,for permission to use an illustration taken from herundergraduate portfolio. Tanya graduated in fashion from Kingston University with a first-class degree. I amalso delighted that this second edition includes twoillustrations by Kerry, a Ravensbourne College animationstudent. Kerry (a pseudonym) graduated in the summerof 2009. She is dyspraxic, has ADHD and is asynaesthete.

I am also grateful for the feedback from manyuniversity and college staff who encouraged me in mybelief that there is still much of importance to be saidabout dyslexia, dyspraxia and ADHD.

xiv Acknowledgements

Introduction

Dyslexia is far more than just a label it is a life style.As a label it is associated with many different meaningsand emotions. For some people, being told they aredyslexic is a moment of liberation: I was so anxious youwere going to tell me I was thick. Knowing Im dyslexicis the best day of my life. For others, being told theyare dyslexic is a surprise: I thought dyslexia was allabout writing letters backwards. I dont do that so Ithought I couldnt be dyslexic.

This book is about both liberation and surprises. It isabout liberation in the sense that even many peoplewho know they are dyslexic dont fully understand whatbeing a dyslexic is. It sets out to help develop anddeepen personal understanding. This book is also aboutsurprises, for there are many myths and misconceptionsabout dyslexia, and these are explored.

Issues of dyspraxia and ADHD (Attention DeficitHyperactivity Disorder) as well as dyslexia are alsodiscussed. Although they may at first sight appear quitedifferent conditions, they have many features incommon, and their overlap is much more extensive thanmany people realise. In addition, it is quite common to

find they co-exist. For example, the combination ofADHD and dyspraxia is quite a frequent one.

This book is also about the individuality of peoplewho are dyslexic, dyspraxic or have ADHD. The labelsdyslexia, dyspraxia and ADHD are misleading for theysuggest that everyone who is dyslexic, dyspraxic or hasADHD is exactly the same as another individual withthe same specific learning difference. I prefer the termsdyslexias and dyspraxias because they help to breakaway from this misleading stereotyping. It is also usefulto realise that ADHD can and does take different forms.

I also propose that being dyslexic or dyspraxic or anindividual with ADHD should be considered as a lifestyle dyslexia is not just about difficulties with readingand spelling, dyspraxia is not just about clumsiness ordifficulties with pronunciation, ADHD is not just aboutattentional difficulties. The presence of a specificlearning difference means that your everyday life isinfluenced and shaped in a variety of different ways.This book explores those everyday experiences.

This book is purposely written in an informal style.The reason for this is simple I have read too manybooks about dyslexia which are dyslexia-unfriendlybecause they are too academic. I wanted to writesomething that most dyslexic, dyspraxic and ADHDstudents would feel reasonably comfortable with. Second,many of the individuals I have met find it difficult toexplain to others what being dyslexic, dyspraxic or anindividual with ADHD is like since they are themselvesunsure which of their experiences are due to theirdifferent way of thinking and which are not. I therefore

2 Introduction

wanted to write a book that their parents, partners andsiblings could also read and learn from. I have chosen toillustrate the ideas and concepts by using the actualwords of dyslexics, dyspraxics and individuals withADHD I have met, for it is they who are living theexperience.

In order to learn you have to listen. Many years agoEwan McColl, a great songwriter, explained how helearnt from listening. He pointed out that when peopleare first asked questions about their lives, they spend thefirst twenty minutes telling you what they think youwant to know. After that they tell you about themselves.By listening, it became very evident to me that beingdyslexic or being dyspraxic or being an individual withADHD is a lived experience that influences so manyaspects of everyday life.

Over the past nine years I have listened toapproximately 2,000 individuals with specific learningdifferences discussing their personal histories and everydayexperiences. Mainly students in higher education, theyranged in age from 16 to 68. In spite of this collectivewealth of experience, and very impressive levels ofintellectual ability, the thing that struck me most washow little is still known and understood about dyslexia,dyspraxia or ADHD.

When you ask questions about dyslexia most peopleimmediately think of some kind of difficulties withreading. It is not obvious that going into a room tocollect something, only to find you have forgotten whatyou went for, might also be related to being dyslexic. Itis even less obvious that using the time before drifting

Introduction 3

off to sleep to sort through the days events and plan forthe following day is also a frequent experience ofindividuals with dyslexia, as well as dyspraxia andADHD. By creating space to listen, so much can belearnt.

Through listening carefully to detailed personalhistories, I have gradually developed a much wider rangeof questions to draw upon when assessing whether aspecific learning difference is present. This has taken meinto unexplored areas. For example, the first edition ofthis book contained nothing on mental imagery. Sincethen I have realised just how important this sensoryexperience is and now routinely determine whethervisualisation (including synaesthesia) is present, and ifso, to what extent, when carrying out a diagnosticassessment. In that respect I am going back to thenineteenth-century tradition of psychology being thestudy of the mind.

I have also realised just how little I knew aboutADHD when writing the first edition. As it was notuntil the autumn of 2008 that the National Institute forClinical Excellence (NICE) advised the UK governmentthat ADHD was a valid diagnosis, and that adults aswell as children could have ADHD, I was not alone inmy lack of understanding. However, I have sinceaddressed this lack of knowledge and now routinely lookfor ADHD whenever I carry out an assessment. While Istill have a great deal to learn, my diagnostic questioninghas already revealed an intriguing association betweenADHD and synaesthesia, an association explored in thisnew edition.

4 Introduction

However, it is one thing to ask questions, but anothermatter to bring the answers together and draw inferences.The definition of a scientist as being someone who seesthe same things as others but thinks about themdifferently is one that appeals to me. In one sense,virtually all the observations I have made could havebeen made 50 years ago. However, it does help to have an electronic database. The thinking differently is another matter. In writing this book I wanted to move beyond pure descriptions to also come up withpossible explanations. This, at times, inevitably requiresspeculative thinking. Unlike most psychologists whostudy and research dyslexia, dyspraxia or ADHD, I hadthe advantage of not being wedded to one specific theoryor hypothesis about underlying causes.

I could stand back. I also know from having taughtabout creativity and innovation for some years that newideas often emerge from finding solutions to questionsoutside of the immediate field being studied. Standingback provides that space to think outside of the box.Consequently, the research literature I have consulted is unusually wide taking in genetics, synaesthesia, the life histories of creative achievers, and cognitiveneuropsychology.

Most of this research is published in academic journalsand is written in a very complex and dense style, as it isaimed at researchers rather than the lay public. While Ihave drawn upon this research to inform my ideas andobservations, I have avoided citing endless names anddates when writing each chapter. As it was my intentionto keep the style of writing as informal as possible I

Introduction 5

have not included copious citations. My thinking hasbeen informed by many different researchers and writers,but I would like to think it has also been inspired andshaped by the agent provocateur spirit of such greatpsychologists as Norman Geschwind.

Thinking outside of the box is an exciting adventure.You may not always be right but sometimes you canpoint ideas in a different direction. I sense that mostresearch into dyslexia and dyspraxia, unlike a number ofbooks I have read about ADHD, has somehow missedthe person who is experiencing it. This second edition,like the first one, for me, is an attempt to get back tothe person. I hope it is for you as well.

6 Introduction

Dyslexia, dyspraxia andADHDThe common ground

Most books about dyslexia start by focusing on readingand spelling. Most books about dyspraxia begin bydiscussing problems with coordination. Most books about ADHD (Attention Deficit Hyperactivity Disorder) commence with an account of problems withconcentration. These are important issues. They are not, however, the only issues. There are more commonlinks between dyslexia and dyspraxia than distinguishingfeatures. There are also many shared features withADHD. That is why this book breaks with tradition by initially describing and discussing similarities ratherthan differences. This chapter focuses on those sharedexperiences the common ground as it were. For manydyslexics, dyspraxics and individuals with ADHD, it isthese experiences that most colour and shape theireveryday lives. They are also often the most noticeablefeatures.

Many of the students I see tell me how disorganisedthey are. In addition, they very often describethemselves as having a poor memory and poorconcentration. Consequently they are likely to misplacethings, forget what they were going to say halfway

Chapter 1

through a sentence, miss appointments, and make use ofpost-it notes and lists. They are also easily distracted,and experience difficulties when copying notes from anoverhead projector as they find it hard to remembermore than three or four words at a time.

All of these experiences, as well as many others, arethe result of a weak working memory. This statementneeds to be explained, for there are different types ofmemory, two of which are short-term memories: workingmemory and visuospatial memory. I am using the termworking memory to refer very specifically to a short-term memory for verbal information. For example,imagine you are new to a college or university and youask someone how to get to the students union fromwhere you are. When you are told, Go straight to theend of the corridor, turn left, and its the third door onthe right, you have to use your working memory toretain this information while you walk towards thestudents union. (If you can then retain a visual memoryof this route once you have walked it then this is anexample of a long-term visual memory.)

Working memory refers to a memory store thatenables you to actively organise and think about verbalinformation for a short time. The term working memoryis a better one than short-term memory for it capturesthe manner in which we think consciously about things.A key feature about working memory is that it is oflimited capacity. Some people have a greater capacitythan others.

In general, working memory capacity is linked to levelof verbal reasoning. A high verbal reasoning ability is

8 Dyslexia, dyspraxia and ADHD

accompanied by an above-average working memorycapacity. A low level of verbal reasoning ability isusually accompanied by a smaller working memorycapacity. This harmony of linkage is not observed inmost instances of dyslexia, dyspraxia or ADHD. As afairly broad generalisation, the working memory spacethat is available for many individuals with a specificlearning difference is less than they need for their levelof ability. In many cases it is much less. In addition,working memory also appears to be more fragile,especially when ADHD is present.

The impact of limited workingmemory capacity

A lack of working memory capacity affects bothacademic life and everyday social and working life. For example, to take good notes in a lecture requiresdoing a number of different things at the same time.First, you need to be able to follow the theme of thelecture in order to understand the points that are beingmade. Second, you have to be able to identify what isimportant so you can make a note of the main points.That is, you have to know how to be selective. Third, you also need to be able to write down what is important. All these activities require the use ofworking memory space. On top of all this you have tobe able to write quickly, spell well and maintainconcentration.

Taking good notes can be difficult even for someonewho does not have a specific learning difference. For a

Dyslexia, dyspraxia and ADHD 9

dyslexic, dyspraxic or individual with ADHD, note-taking is even more difficult because working memoryspace becomes overwhelmed very quickly, so someelements get squeezed out. As a consequence, doingmore than one thing at a time becomes almostimpossible when working memory is weak. For example,in a lecture some students just listen to make sure theyhave understood what is being said. Others try to takenotes without really understanding what is being said.This is why being allowed to make a recording of alecture is so important. It is also very helpful if alecturer provides good-quality lecture notes, preferably inadvance. A weak working memory also affects thecopying of information. Most lecturers make use ofeither a PowerPoint presentation or an overheadprojector. Poor reading skills obviously slow down therate at which information can be read. However, a weakworking memory also slows down the rate at whichinformation can be copied.

If you have an efficient working memory, you canprobably read through the following sentence andremember all of it while you write it down: Sperry wasawarded the Nobel prize for his pioneering work in the1930s on neuronal regeneration. Being dyslexic,dyspraxic or an individual with ADHD will probablyresult in you remembering only a small part of thesentence while you are writing it down. Consequently,you have to spend more time looking from the text toyour notes and back again when copying informationdown. You also have to scan to find your place againeach time you go back to the text. Copying information


down therefore takes considerably longer. If you alsohave to stop and think, How do I spell pioneering? Howdo I spell neuronal? it can feel as if it is taking for everto copy the information. While you are concentratingon remembering what it is you have to copy, there is nospare capacity to take in what the lecturer is saying. Ifyou are an individual with ADHD even the act ofmaintaining concentration may well feel almostimpossible.

Hannahs illustration (see Illustration 1.1) captures herown experience of being in a lecture. It is as if she isbeing so swamped by the words of the lecturer that sheis no longer able to take in what is being said.

It is not surprising that most children and teenagerswith specific learning differences find so many schoollessons so frustrating. If a teacher starts off the lesson bysaying, I want you do this, and then this, and when youhave finished these make a start on this page of thisexercise, by the time the teacher has reached the end ofthe list of things to do you will have forgotten what thefirst task was. You might then ask your friend what youhave to do and this may be misinterpreted by theteacher as you not paying attention or being disruptive.In one or two subjects, such as maths, the difficulty withremembering more than a few things at a time makes itparticularly hard to remember all the steps of a sequencethat is being worked through.

A weak working memory does not necessarily meanyou will be poor at maths. I have seen some brilliantmathematicians and physicists who have dyslexia,dyspraxia or ADHD. One captured the impact of his



Illustration 1.1

weak working memory quite succinctly: I find the easymaths difficult, and the difficult maths easy. By easymaths he was referring to learning the times tables anddoing mental arithmetic. By difficult maths he wasreferring to concepts such as matrices and calculus.Because a weak working memory often results in verynoticeable difficulties with the learning of basicarithmetical processes such as multiplication anddivision, there is a danger that these difficulties willresult in the suggestion that dyscalculia (a specificdifficulty with numbers) is present. In my experiencedyscalculia, which in its pure form is a fundamentaldifficulty with the concepts of greater than and lessthan, is very rare.

A weak working memory also affects the writing ofessays. Many students tell me that they find starting towrite an essay the worse part. This is not surprising.Writing an essay or report is like creating a complexstory with lots of characters. As the writer, you have todecide what the story line is and the order of appearanceof the characters. To plan and tell the story well requireslots of working memory capacity.

Limited working memory capacity makes it impossibleto think about all aspects of the story at once because itimposes a limit on the number of ideas that can beactively considered at the same time. This results in therealisation that its not going to work and anotherattempt is made to think of how to organise all theideas. And then another, and another, until frustrationsets in and you go off to make a cup of tea or coffeeinstead. One student spoke for many when he referred


to his difficulties with starting an essay as being thewhite sheet syndrome. For many students, trying towork out how to start writing an essay is akin to lookingat their ideas through a kaleidoscope. Each time theythink about what to do the picture changes. Theproblem is that a limited working memory means thatonly part of the picture can be thought of at any onetime, rather than the whole picture. It is therefore notsurprising that the writing of an essay gets repeatedly put off until the last possible minute, even when anindividual has started the preliminary research longbefore others.

Fortunately, there are ways of getting around thesememory limitations. For a number of students with aspecific learning difference, but not all, visual memory ismuch better than working memory. This means thatmind-maps and spider-diagrams can be very useful. Ifthese are drawn by hand they can get quite messy andthis is why a software program such as Inspiration canbe so important. (See Appendix for details of where topurchase specialist software.) By being able to drag ideasaround on the screen and change text, the visualscheme of ideas can be kept very clean. The use ofcolour-coding and icons also makes it possible to groupideas together so links can be seen easily.

The difficulty with arranging ideas to arrive at anessay that has a good internal logic and structure meansthat many dyslexics and dyspraxics often have to rewritean essay a number of times. It is not uncommon to betold, it takes me three times as long as anyone else.Even making notes from books at the research stage for


an essay can be problematic. Making notes requires anability to select what is important. This involves beingable to think about a number of ideas simultaneously sothat only the most appropriate elements are selected.

A weak working memory also affects the structuring of sentences. Many dyslexics and dyspraxics have atendency to write very long sentences that ramble.When memory is limited the whole of that workingspace might be taken up with just one phase, whichthen sparks the next idea, and then the next, and so on.Consequently, punctuation and internal logic suffer.Also, the completed sentence will contain too manyideas, and will often go off at a tangent. Sometimes, thewriting of a sentence will come to a complete halt dueto stopping to think about a spelling. Because sortingthis out can occupy all of the working memory capacity,it results in the original idea that was in the process ofbeing written down being forgotten. Students tell methat when this happens they have to reread what theyhave just written in order to work out what they weregoing to say next. It is not surprising that so manystudents say they find it very hard to express their ideasin writing: I know it in my head but I cant get it downon paper.

A weak working memory doesnt just have an impacton taking notes and writing essays, it affects everydaylife as well. A high proportion of dyslexic, dyspraxic andADHD students describe themselves as being disorganised,a bit dippy. They give as examples forgettingappointments, misplacing and losing items, not returningbooks on time, and going to a room to fetch something


only to find they have forgotten what they went for.Because forgetfulness is such a general problem, differentpeople develop different coping strategies.

Some people have everything strewn around theirroom. Although this may appear to be disorganised,sometimes and I stress the sometimes it can be adeliberate way of arranging things because everything ison display and visual memory can be used to rememberwhere particular items are. Some students use theirmobile phones as personal organisers and also textthemselves messages of things they need to remember.Others use post-it notes and diaries. It is not unusual forsomeone with a weak working memory to writethemselves a note on the back of their hand. Somestudents pack everything they need for the next morningthe night before, to ensure things dont get forgottenwhen they leave the house the following morning.Others develop a routine of patting themselves, Have Igot my wallet/watch/mobile/keys?, before going out ofthe house or leaving a pub.

A weak working memory is, in my experience,observed in most students with a specific learningdifference. However, in a minority, more so in instancesof dyspraxia and ADHD than dyslexia, working memorycapacity is fine. As always, it is misleading to take abroad generalisation and apply it in all cases.

The fragility of working memory

Many students have told me how, during a conversation,ideas often occur to them suddenly and they go off at a


tangent. On other occasions, they will be about to saysomething, only to realise they have forgotten what theywanted to say. Most students tell me how easily theycan lose concentration, My mind wanders very easily,and how they were told off at school for daydreaming.These are all examples of the fragility of workingmemory. In one sense working memory has to be fragilein that new information is constantly replacing currentinformation. However, the manner in which informationis replaced appears to be much more of a randomprocess for those with dyslexia, dyspraxia or ADHD thanfor individuals with no specific learning difference. Isuspect that two factors may be responsible for thisfragility: limited memory capacity and an inefficientexecutive function.

Limited memory capacity implies an imbalancebetween working memory capacity and verbal reasoningabilities. When a full psychological assessment is carriedout using what is commonly known as the WAIS(Wechsler Adult Intelligent Scales) or WISC (WechslerIntelligence Scales for Children), both working memoryand verbal reasoning are measured. Ideally, these abilitiesshould be in equilibrium. If, however, working memorycapacity is much lower than the level required to be inbalance with verbal reasoning, then a working memorydeficit is formally recorded. It is important to note thatworking memory capacity does not have to be belowaverage for a weak working memory to be recorded. Ihave seen a number of bright students who have scoredhigher on working memory than the average person.However, for these students there is still a significant


gap between their scores for working memory and verbalreasoning.

When this imbalance occurs it is as if the brain isgenerating more ideas than can be accommodatedwithin the available working memory space. This resultsin a logjam of ideas building up outside of workingmemory. Consequently, it is as if these ideas jostlecompetitively to gain access to the working memoryspace. Access to working memory is controlled by whatpsychologists call the executive function. This does anumber of things, such as prioritising what informationgains entry to working memory space, and controllingthe direction of attention. Without such a mechanismour conscious experience of working memory would beone of total chaos. It also coordinates and integratesauditory and visual/spatial memories.

An analogy to illustrate this is to think of theexecutive function as being a bouncer outside a selectnightclub the more limited the working memory, themore select the nightclub. There is therefore greatcompetition to gain entrance to this nightclub. Whenthe nightclub is full the only way someone can gainentry is when someone else leaves. The greater thecrowd outside, the more difficulties the bouncer willhave, and the more chance there is of someonegatecrashing and getting past the bouncer withoutpermission.

In the case of someone with a weak working memorythe executive function is not particularly effective, withthe consequence that ideas occur suddenly withoutwarning. As they burst into working memory they create


space by pushing an existing idea out of consciousthought. One student described this experience asfeeling as if her ideas were being pushed over the edge.Because ideas can come and go without warning theconscious thought experience of many individuals withdyslexia, dyspraxia or ADHD is characterised by a senseof chaos and transience of ideas (see Illustration 1.2).

This experience was summed up well by one dyslexicstudent of radio broadcasting. He described to me how,one evening in the student union bar, an idea suddenlyoccurred to him, an idea he thought was brilliant.Quick, he said to his friend, write this idea down andphone me in the morning to tell me what it is. He waswell aware that if he didnt capture his creative idea


Illustration 1.2

there and then he would very quickly forget what it was.Sometimes thoughts can appear and disappear so rapidlythey are like shooting stars, flashing across the consciousspace of the mind. No sooner has an idea occurred thanit vanishes.

I sometimes describe this experience, of ideas comingout of nowhere and then disappearing just as quickly, asbeing a kind of Richard Branson phenomenon. RichardBranson is dyslexic and his Virgin company is verydifferent from other commercial organisations. Mostcompanies have a core business, such as making aspecific kind of product, or selling a specific service. Incontrast, the Virgin organisation is essentially a brandname, a very well known one that encompasses adiversity of activities, from music to financial services todrinks and travel. It is as if random ideas crash intoRichard Bransons mind and grab his attention. He is, ofcourse, skilled enough to discard ideas that wont work.

This fragility of thought appears to apply mainly toverbal thought. Visual thought seems to be more stable.For example, many dyslexic and dyspraxic students findthey are very easily distracted when engaged in activitiessuch as reading or writing. Although it could be arguedthat this is because they are not very interested in theseactivities, the same distractibility and unpredictabilitycan also occur in conversation as well. One student toldme: When an idea pops into my mind I have to say itstraight away otherwise I will forget it. Many studentsdescribe going off at tangents during a conversation.However, if engaged in a visual activity such as videoediting, painting or drawing, or one with a high visual


content such as playing hockey, football or sailing, thenconcentration can be intense and sustained, often forhours at a time. A key reason for this is that visualmemory and thought take over and, in most cases, thevisual memory capacity is considerably greater, particularlyfor dyslexics and individuals with ADHD. An exceptionto this is dyspraxia, for in about 50 per cent short-termvisual memory is noticeably below expectation.

Many students have told me they have a very goodmemory for faces but are very poor at rememberingnames. Several art students have described how they tryto overcome their poor memory for names by makingsketches of the other students in their year and thenwriting the name of each student alongside the relevantsketch. Most people, whether dyslexic or not, are betterat remembering faces than names. It is just that whenworking memory is poor the difficulty with rememberingnames becomes much more obvious.

Whilst the imbalance between a high level of verbalability and a low working memory capacity results inmemory retention being more fragile than it should be,in my experience ADHD dramatically speeds up the rateat which ideas enter and leave both verbal and visualconscious thought. When an idea enters workingmemory, it is as if it needs a small piece of Velcro toenable it to be held in conscious thought for a shorttime. In the case of ADHD, whenever an idea occurs it is as if the executive function coats it in soap instead of Velcro, making it slippery rather than sticky.Consequently, individuals with ADHD find it very hardto hold ideas in conscious thought, as they slide in and


slip out rapidly and with an element of randomness.This slipperiness factor means that even when workingmemory capacity is good, forgetfulness is still very muchan everyday experience and gives rise to what onestudent described as his disorganised mind.

Processing speed

At the beginning of this chapter it was mentioned thata common link between dyslexia, dyspraxia and ADHDis a weak working memory. A second aspect they havein common is a slow speed of processing. Once again,this does not apply in all cases. However, it occurs withsufficient frequency to be recognised as an importantfeature.

In carrying out a psychological assessment using theWAIS, four general sets of abilities are assessed andtheir levels calculated. Two of these have already beenmentioned Working Memory and Verbal Reasoning(usually called Verbal Comprehension). The other twosets of abilities are Processing Speed and PerceptualOrganisation (visual reasoning). Processing Speed isassessed by how well an individual does on two tasks,both of which are visual in nature and require an abilityto take in and search for simple visual symbols veryquickly. Although these two tasks involve a lower levelof thinking than the three visual reasoning tasks thatare used to determine a Perceptual Organisation score,they are important because they provide an indication ofthe speed at which simple or routine visual informationcan be processed and learnt without errors being made.


Ideally, the levels of Processing Speed and PerceptualOrganisation should be in balance. For many dyslexics,dyspraxics and individuals with ADHD this is not thecase: Processing Speed is often well below the levelrecorded for Perceptual Organisation. This difference willaffect a wide range of activities, including speed ofreading, writing and drawing, ability to proof-read well,and the types of sports and computer games that arepreferred. Figure 1.1 for Alice, who is dyspraxic, istypical of the spiky WAIS profile recorded for manydyslexic, dyspraxic and ADHD individuals.

This characteristic profile reveals very clearly thatscores for verbal and visual reasoning are much higherthan scores for working memory and processing speed.(Note. If there was no specific learning difference, such as dyslexia, dyspraxia or ADHD, the WAIS profilewould look fairly flat. That is, all four columns would be approximately the same height.) This characteristicdouble-spike profile occurs independently of age.


Figure 1.1 Alices Reading and Spelling scores, plus 4 WAIS-IIIIndex scores expressed as percentile scores

When dyslexia, dyspraxia or ADHD is present it doesnot matter whether someone is 8, 18 or 68 the sameprofile is observed in about 80 per cent of instances ofdyslexia, and probably about 60 to 70 per cent whendyspraxia or ADHD is present. You do not grow out ofbeing dyslexic or dyspraxic even when special teachingimproves reading skills or physiotherapy results in animprovement in motor coordination.

One way of interpreting this spiky profile is to thinkof the brain as a computer. Verbal Comprehension isakin to being the word processing software, whilstWorking Memory is RAM memory. PerceptualOrganisation can be thought of as the graphics card, and Processing Speed is the processing chip. For manydyslexics and dyspraxics, it is as if they have a good-quality word processing package and graphics card, butlimited memory and a slow processing chip. However, itis not possible to go to the nearest computing store andbuy additional memory and a faster chip. Instead, it is aquestion of learning how to get around the limitationsso that full potential is achieved.

When processing speed is slow a number of activitiesare affected. For example, many students have told methat when they are writing they often feel as if their brainis thinking faster than their hand can move. Because ofthis, it is as if, at times, their hand jumps to keep up soparts of words or even whole words may be left out.When proof-reading, it is, as one student put it, As ifmy brain is ten words ahead of my eyes. This is one keyreason why proof-reading is so difficult. In fact, it can beso challenging that a number of students give up on it.


TextHELP is a software package that can read aloudtext displayed on a computer screen. This can be a greathelp in proof-reading for you can listen to what youhave written and check that it sounds right. DragonNaturally Speaking is a software package that convertsspeech to text, taking away the slowness of writing byhand and difficulties with spelling. The software canlearn to recognise most voices but not all within tenminutes (although it takes the user much longer to learnthe commands).

A slow speed of processing will also affect reading.Reading requires doing many things simultaneously you have to scan lines of visual symbols anddiscriminate very quickly between shapes, be able tounderstand what you are reading, as well as rememberwhat you have just read. Whereas many dyslexics anddyspraxics are good at the verbal thinking requirements,if the processing is slow and working memory weak, theability to understand and think about what has just beenread will be disrupted. When there is an imbalancebetween speed of processing and speed of thought, it isnot surprising that words get misread. It is as if part ofthe brain wants to go faster than it is receivinginformation, and it starts to make guesses at what aword might be.

A slow speed of processing also affects activities thatrequire fast responses, such as some sports and computergames. One student who had reached the semi-professional level in football was puzzled why, eventhough he practised each day for hours at a time, he wasalways a fraction of a second off the pace. However,


because of his excellent visual reasoning abilities, hecould read a game very well and was particularly goodat defending. Once he had viewed his profile heimmediately understood his strengths and weaknesses.Very few people reach a semi-professional level in sports.Many more people play computer games. In many cases,people with a much higher visual reasoning ability thanprocessing speed prefer to play games of strategy ratherthan ones that depend purely on speed of response. Thisslowness of response can also be seen when scrollingthrough text on a computer monitor. If speed ofprocessing is slow, rapid scrolling is very difficult evenwhy reading skills are good.

Even activities such as crossing a busy road on foot,driving in traffic, or walking along a crowded pavement,can become slightly more difficult if processing speed isslow. When a slow processing speed is also accompaniedby a weak short-term visual memory (this combinationoccurs in 50 per cent of dyspraxics), these types ofeveryday activities become even more challenging. Aslow processing speed may also influence styles ofdrawing. This particular aspect is discussed in Chapter 7.

A slow speed of processing, in combination with aweak working memory, results in many dyslexics anddyspraxics disliking being asked to work under pressure.A number of students have told me that, provided they are left to work by themselves, they can achieve a high standard. But this has to be without pressure.Paradoxically, individuals with ADHD often work bestunder pressure. This, however, is a reflection of stressresulting in an increase in the production of those


chemicals needed to improve the efficiency of howneurons in the brain talk to each other.

To summarise what has been covered so far, a weak working memory and a slow speed of processingare typical aspects of being dyslexic, dyspraxic or anindividual with ADHD. They are not, however, causesof any of these specific learning differences. Each factorinfluences a surprisingly wide variety of everydayexperiences at home, work and college or university.Because of this it is appropriate to think of beingdyslexic, dyspraxic or having ADHD as a particular kind of life style.

The next three chapters focus on the need to thinkabout the different forms that the dyslexias, dyspraxiasand ADHD can take.


What is dyslexia?

Most definitions of dyslexia are too narrow for theyfocus on unexpected difficulties with learning to read. In reality dyslexia is extremely complex. This chapter begins with the simplistic view and goes on to describe and discuss the complexity that the dyslexias are.

Central to most definitions of dyslexia is therequirement that reading ability is unexpectedly poor,and that there is no adequate explanation to account for this other than dyslexia. As will be explained later,this is a narrow view of what dyslexia in reality is.However, in practice, this requirement has to be satisfied to arrive at a diagnosis of dyslexia, and this isthe starting point for considering its complexity.

The only satisfactory way to determine whetherreading skills are unexpectedly poor is to measure andcompare an individuals level of intellectual ability withtheir level of reading performance. (Spelling ability isusually assessed at the same time as well.) A personalhistory is also required for if a difference is recorded thepersonal history will then help determine whether thedifference is genuinely an unexpected one.

Chapter 2

The question of which intellectual abilities to measureis crucial, since not all measures are suitable. In my viewit is important to compare like with like. For this reasonI place the greatest importance on the comparison of reading (and spelling) skills with verbal reasoningskills. Most diagnostic tests of verbal reasoning abilityare carried out orally and measure knowledge andunderstanding of language through asking questionsabout the meaning of words and relationships betweenwords.

Questions about the meanings of words typically takethe form of Can you explain the meaning of the wordadolescent? Relationships between words are exploredby asking questions such as In what ways are drizzleand monsoon similar to each other? These questionsare explored orally so that there are no reading orwriting requirements. The questions are presented insequence, going from quite simple questions to very hardones. For example, most people can explain what amountain is. It is much harder to explain the meaningof the word paradigm. As you would expect, somepeople are better at these kinds of tasks than others, butthat is not important. What is important is how thescore for an individual compares with that persons ownscores for reading and spelling.

In general, the relationship between measures ofverbal reasoning and reading and spelling abilities is anapproximate one. That is, while there is a strongtendency for them to be roughly equal, some variation isto be expected. Nevertheless, for some people, theextent of the variation can be surprisingly great.

What is dyslexia? 29

Jane is typical of many dyslexic students I see (seeFigure 2.1). While her verbal reasoning performanceplaces her in the top 20 per cent of the population, her word reading accuracy score puts her in the bottom10 per cent. This is an unexpected difference givenJanes much higher level of verbal reasoning. If dyslexiawere not present, her skills of reading and spellingwould be at least average, and probably above.

There will probably always be debate about how bigthe gap has to be between levels of reading skills andverbal comprehension before dyslexia can be said to bepresent, but virtually all diagnoses of dyslexia aredependent on demonstrating an unexpected difference.Usually, if reading skills are weak, spelling is also weak.However, some people have very good reading skills butare very weak at spelling. Although it is a term notoften used in the UK, the word dysorthographiadescribes a person who has an unexpected weaknesspurely in spelling.

30 What is dyslexia?

Figure 2.1 Janes Reading and Spelling scores, plus 4 WAIS-IIIIndex scores expressed as percentile scores

In order to demonstrate that a discrepancy betweenreading (and spelling) and verbal reasoning is anunexpected one, it is necessary to know key detailsabout a persons life. For example one student, Shona,had been brought up in a country where even primaryschool children had to pay to be educated. Her familywas very poor and her primary and secondary educationtotalled just eighteen months. Not unexpectedly, herskills of reading and spelling were below average, but byonly a little. Shonas verbal reasoning skills were a littleabove average. Given the circumstances, her skills ofreading and spelling were very much better than mighthave been expected. Shona was not dyslexic. Her historyalso demonstrated how quickly some people can learn toread and spell.

When comparing reading and spelling abilities withintellectual abilities I have stressed the need to useverbal reasoning skills as the basis for comparison. Illexplain why that is important. The most commonly usedmeasure of intellectual ability in a diagnostic setting isthe Wechsler Scales of Intellectual Abilities. There is aversion for children and young teenagers (WISC), and a version for adults (WAIS). Each version consists of aseries of subtests which are used to measure performanceon a range of different skills including knowledge ofvocabulary, mental arithmetic, three-dimensionalthinking and speed of copying symbols. When all thescores are combined IQ can be calculated.

For someone who is dyslexic it is unwise to use an IQ figure as a point of comparison with reading and spelling. This is because, in virtually all cases of


dyslexia, an IQ measure would hide very importantvariations such as just how good or poor someone isat certain kinds of activities. In most cases a typicaldyslexic Wechsler profile reveals higher scores for verbaland visual reasoning than for short-term memory andspeed of visual processing. When no specific learningdifficulties are present the Wechsler profile will be fairlyflat, not spiky.

Janes spiky profile (see Figure 2.1) is typical of adyslexic student in that she scored above average onverbal and visual reasoning skills and below average on working memory and processing speed. Whereas her Verbal Comprehension (verbal reasoning) andPerceptual Organisation (visual reasoning) scores put her in the top 20 per cent and top 23 per cent of thepopulation respectively, her scores for Working Memoryand Processing Speed put her in the bottom 9 per centand 32 per cent respectively.

This type of variation is important as it helps toexplain a number of everyday experiences (see Chapter 1).However, once these scores are combined, the variationis lost and a false picture emerges. If Janes verbal IQ is calculated by combining her verbal reasoning andworking memory scores, her verbal IQ score places herin the bottom 45 per cent of the population. This is abig drop from being in the top 20 per cent for verbal reasoning.

The same kind of thing happens if scores from thesubtests of visual reasoning and processing speed arecombined to calculate Janes performance IQ. WhereasJanes score for visual reasoning places her in the top


23 per cent of the population, her performance IQpushes her down to the top 37 per cent. Finally, whenverbal IQ and performance IQ are together used tocalculate a general IQ score, Janes IQ of 101 places herjust above the midpoint of 100 for the population. Asshe is actually of high average ability on tests of verbaland visual reasoning, her IQ score is not a fair reflectionof her real abilities, nor does it reveal the barriers thatprevent her from achieving her full potential.

Whereas Janes level of verbal reasoning places her inthe top 20 per cent of the population, her levels ofreading and spelling put her in the bottom 10 per centand 8 per cent respectively, differences of 70 and 72 percentile points. These are major discrepancies.However, if you just compare her reading with her IQthe discrepancy will be much smaller, just 40 percentilepoints.

It is important to note that it is the extent of thediscrepancy between the scores for reading and verbalreasoning that is the key to arriving at a diagnosis ofdyslexia, not the level of reading by itself. That is, it is not necessary to be really poor at reading to bediagnosed as being dyslexic. While I have met severalstudents whose reading skills are so poor that they findtravelling difficult because they cannot read the namesof stations or roads, most students I see can read.Probably about 10 per cent choose to read for pleasure.

It is not true that dyslexics cannot read. Most can,but their reading ability is well below expectation. Forexample, I frequently see students whose performance onthe assessment of verbal reasoning places them in the


top 1 per cent of the population. However, their readingputs them in the bottom 30 per cent or 40 per cent of the population. While it is the case that thesestudents can read some types of books and newspaperswith a fair degree of accuracy and fluency, their realreading difficulties become apparent only when readingacademic books and research papers.

One student described how, when reading a novel,she just flowed with the story and skipped over wordsshe didnt recognise. However, when reading anacademic text, she had to read every word andconcentrate on remembering what she had just read.Reading is not just a question of reading words withaccuracy. It is also being able to retain the informationand not be distracted while reading, both of which arewell known dyslexic features. Hannahs illustration of herself reading but not taking in what she is reading captures this typical dyslexic challenge (seeIllustration 2.1). On top of this, visual stress may also be present (see Chapter 6). It is important to rememberthat reading is a multi-skilled process.

Because the profile of abilities for dyslexics is anuneven one, some definitions of dyslexia state that, inaddition to an unexpected weakness in reading andspelling, dyslexia is characterised by one or morecognitive weaknesses as well. (Note. The wordcognitive just means a mental process carried out bythe brain, such as remembering.) This type of definition,with its emphasis on information-processing, is the typeI favour, as it helps to focus attention on the complexnature of dyslexia. Another general advantage of



Illustration 2.1

information-processing definitions is that they do notusually specify which cognitive weakness, or weaknesses,have to be present. This is important, for the reality of dyslexia is that there are a variety of dyslexias, not just one.

One of the most important books on dyslexia waswritten over sixty years ago, by the English educationalpsychologist Fred Schonell (1945). Schonell did not usethe term dyslexia as it was not in common use at thattime, but instead referred to backward readers andspellers. In his 1945 book he describes three differentpatterns of reading difficulties. He points out that somechildren, whom he called auditorily weak, have verygood visual recognition skills but poor phonologicalskills. Others have the reverse profile. That is, visuallyweak children have good phonological skills but are poor at visual recognition. Yet others are poor at bothphonological processing and visual recognition.

Such differentiation is important in that goodphonological and visual skills are necessary to read wellin English. This is because English contains manyirregular words that are not spelt as they sound and sodo not follow the general phonetic spelling rules. Whenwords are regular they are easy to read and to pronouncecorrectly, even if you have never encountered thembefore.

For example, if you have good phonological skills youwill be able to read the sentence Zog norded novMungent with some fluency and accuracy. However,when a word is irregular, it has to be recognised from its shape. For example, the sentence The reigning


sovereign campaigned from her yacht contains fourirregular words. Those dyslexics with good visualrecognition skills but poor phonological ones would beable to read The reigning sovereign campaigned fromher yacht with little difficulty, but would really strugglewith Zog norded nov Mungent.

Unlike English, a number of languages such as Italianand Spanish (but not Hispanic Spanish that is,Spanish spoken in Latin America) are phoneticallyregular. A visually weak dyslexic Italian or Spanishperson would not necessarily encounter major difficultieswith learning to read or write in their own language.However, it is highly likely that the process of learningwill be slow, for the other facets of dyslexia would stillapply such as finding it hard to remember what theyhave just read, and daydreaming at school when theyshould be reading or listening to the teacher at school.

Maria is a classic example of a visually weak Spanishdyslexic. Her teachers and parents could neverunderstand why she always performed badly in examsand homework at school when she had a very goodvocabulary and her verbal skills were excellent. Readingin Spanish was not a problem for Maria and, when shelived at home, she read three to four books a month forpleasure. Maria had to learn English at school butbecause she found it so difficult her parents paid for herto visit the UK to practise. When Maria was 14 she hadstill not learnt all the times tables and her parents paidfor her to have private maths tuition. She also had torepeat a year at high school. Her mother alwayscomplained about how disorganised Maria was.


Maria eventually enrolled, as a mature student, at anart college in the UK, which provided the opportunityfor her to be assessed. This assessment revealed anexcellent level of verbal comprehension but a very weakworking memory. In addition, her short-term visualmemory is also poor. (This means that when she looksat something and then looks away, her visual memoryfades away much faster than would be expected.) Maria can read regularly spelt English words withvirtually no problems. However, her error rate forirregular English words is nine times greater than forregular ones. That is, her memory for the shape of words is very poor.

If we define dyslexia as being an unexpected difficultywith acquiring reading skills, Maria is dyslexic whenassessed on her reading in English but not dyslexic whenassessed on her Spanish reading skills. However, hercognitive profile remains the same whether she is livingin Spain or the UK, and her everyday experiences andbehaviours are typical of dyslexia. By knowing about thedifferent forms that dyslexia can take, it is possible tounderstand why this is so. This is why it is so importantto realise that dyslexia is more than just an unexpecteddifficulty with reading. The underlying cognitivelandscape differs from dyslexic to dyslexic.

This individual complexity is captured within thecurrent British Dyslexia Association definition:

Accompanying weaknesses may be identified inareas of speed of processing, short-term memory,organisation, sequencing, spoken language and


motor skills. There may be difficulties with auditoryand/or visual perception.

(Tresman, 2006, page 7)

It is more than sixty years since Schonell firstdescribed three different subtypes of dyslexia. Since thenthere have been several more attempts to identifydiffering forms of dyslexia. For example, Elena Boder(1971) in the USA and Andrew Ellis (1984) in the UKeach advanced the case for there being three types ofdyslexia, but with little general success. Interestingly, thematch between the subtypes proposed by Schonell, Ellis and Boder is a very close one, and some researchers(e.g. Ben-Yehudah et al., 2001), still take care to makeuse of these three general categories of dyslexia

Probably the reason why Schonell, Ellis and Boderenjoyed little practical recognition when they subdivideddyslexia into three subtypes is that, in practice, it is notalways clear cut as to which category of dyslexia aperson should be assigned to, and sometimes no categoryappears to be appropriate. This does not mean that weshould therefore think of dyslexia as being a unitaryconcept. It is far more helpful to recognise that dyslexiais a combination of strengths and weaknesses, and that dyslexic profiles can often be quite different fromeach other in a number of ways, without having toworry about how many types of dyslexia there are.Nevertheless, it would be a major step forward if wespoke of the dyslexias, as this would at least drawattention to the need to think about the particularrange of characteristics each individual has.


The advantage of using the Wechsler Scales ofIntelligence as part of a diagnostic assessment is that, byplotting the four Index scores of Verbal Comprehension,Working Memory, Perceptual Organisation andProcessing Speed, different profiles are revealed.Although Janes double-spike profile is the one mostcommonly found in assessments, there are significantvariations from this. For example, Figure 2.2 reveals thatJuliettes performance on Perceptual Organisation (ameasure of visual reasoning ability), as well as herProcessing Speed score, are well above her VerbalComprehension performance (a measure of verbalreasoning ability), while her score for Working Memoryis particularly low.

Whereas her Processing Speed score (her highestscore) places her in the top 10 per cent of thepopulation, her Working Memory score puts her in thebottom 10 per cent.

Jasons profile (see Figure 2.3) is almost a mirrorimage of Juliettes. His Working Memory score is aboveaverage, and on a par with his Verbal Comprehensionscore. However, his Processing Speed score places him inthe bottom 14 per cent. Interestingly, Jasons readingprofile revealed he made five times as many errors whenreading irregular words than regular ones, and his speed of reading was almost half that expected of anundergraduate. In many ways he is typical of the readerthat Schonell identified as having poor visual wordrecognition skills but good phonological skills.

Jane, Juliette and Jason are all dyslexic in that allthree have unexpected difficulties with reading and


spelling. They all have one or more cognitiveweaknesses as well as strengths. However, their cognitiveprofiles are significantly different, and these differenceswill be reflected in their everyday experiences. Forexample, Juliette is inclined to be impulsive and veryforgetful, while Jason dislikes having to work underpressure and prefers to think carefully about his


Figure 2.2 Juliettes Reading and Spelling scores, plus 4 WAIS-IIIIndex scores expressed as percentile scores

Figure 2.3 Jasons Reading and Spelling scores, plus 4 WAIS-IIIIndex scores expressed as percentile scores

responses before answering questions. Because the factorsunderlying dyslexic cognitive profiles influence andcolour such a wide range of everyday behaviours andexperiences, it is more helpful to think of dyslexia asbeing a lifestyle but a style that is for life.

Although the profile of a dyslexic person frequentlyreveals cognitive strengths and weaknesses, it isimportant to realise that these weaknesses are part ofbeing dyslexic, but do not cause the dyslexia. Thetypical double spike observed for many dyslexics is oftenfound in instances of dyspraxia and ADHD as well (seeChapters 3 and 4), even when reading and spelling aregood. Very occasionally, this double-spike profile isobserved when a person is neither dyslexic nor dyspraxicand does not have ADHD. In order to understand whatdyslexia is, it is necessary to understand what liesbeneath the profiles.

There has been no shortage of attempts to explain thebasis of dyslexia. Currently there are four popular majortheories. Rather than asking which one is right, Ibelieve it is more helpful to think of them as providingdifferent perspectives on what is a very complexneurological picture.

The word dyslexia literally means difficulties withlanguage, and was first coined about 130 years ago.There has always been debate about whether dyslexia isjust a difficulty with language, or a mixture of verbaland visual components. Probably for the past twentyyears the most popular theoretical explanation has beenthat dyslexia is the result of phonological processingdifficulties.


The first name that comes to mind when this theoryis mentioned is likely to be that of Professor MargaretSnowling. She claims: Dyslexia is a specific form oflanguage impairment that affects the way the brainencodes the phonological features of spoken words. The core deficit is in phonological processing . . .(Snowling, 2000, page 213). Phonological processingrefers to the brains ability to break down a stream ofsounds into very small parts when listening to someonetalk, and then recombine the units to make sense ofwhat is being said. If there is a weakness in phonologicalprocessing, this will have an impact on a range ofexperiences.

For example, some dyslexics find it hard to follow aconversation in a noisy environment even though othershave no such difficulty. Some confuse similar soundingwords, such as specific and Pacific, and divert anddiverse. This phonological weakness also affects theability to match the right letters to sounds whenspelling. For example, an attempt to spell quarrel mightresult in corral. It will also affect the ability to learnhow to break words down into their component soundswhen learning to read, as well as the ability toremember verbal information for a short period of time.It is as if the brain is trying to remember and recallauditory information that is not very clear or welldefined. This is why it can be difficult to holdinformation in working memory.

It may affect long-term memory as well forinformation has to be both stored and retrieved withprecision. If the auditory sounds are slightly fuzzy it will


take slightly longer to retrieve the information. Oftensomeone will say that they know they know the answerto a question, but cant quite arrive at it on demand.This is sometimes called the tip-of-tongue phenomenon.

A few psychologists have gone so far as to recommendthat dyslexia be defined just as a weakness in phonologicalprocessing. They point out that by adopting thisapproach there is no longer a need to assess intellectualabilities. However, most psychologists and educationalistsare wary of going down this path. Janes profile showsthat there are two key cognitive weaknesses associatedwith dyslexia, not one. In my experience, this double-spike profile is observed in about 80 per cent ofdyslexics I have seen.

Jason is one of the 20 per cent of dyslexics without adouble-spike profile. His profile is important because itreveals that there are some dyslexic people who do nothave a weak working memory. This poses a problem forthose who argue that phonological processing is thedefining feature of dyslexia.

Another problem for the phonologists, as will berevealed in the next chapter, is that some dyspraxicshave excellent reading and spelling skills but still have aweak working memory. If a difficulty with phonologicalprocessing results in problems with learning to read and spell, as well as with working memory, how cansomeone be good at reading but poor at rememberingthings for a short period of time? These questionsremain unanswered.

While the work of Margaret Snowling is important,and has been very influential, the phonological deficit


hypothesis is just one of several attempts to provide acausal explanation of the nature of dyslexia. Currentlythere are at least three other major theories offered asalternatives. The double deficit hypothesis proposed byMaryanne Wolf states that in addition to a phonologicaldeficit, there is also a speed of processing deficit. Thisdouble deficit concept sits well with the double spikeseen in most Wechsler profiles. However, as Juliettesprofile reveals, not all dyslexics experience a problemwith speed of timing. Once again, there are problemswith trying to generalise about dyslexia.

Professor John Stein has developed quite a differenttheory the magnocellular theory to account fordyslexia. Central to this is the proposition that thebrains of dyslexics have fewer magnocellular cells thanthose of non-dyslexics, especially in the pathway thatconveys visual information from the eyes to the back ofthe brain and the specialised visual fields. The availableevidence to date (e.g. Ramus et al., 2003) suggests thatwhile this is probably true for some dyslexics, it does nothold true in all cases.

The fourth major hypothesis, often referred to as thecerebellum hypothesis, has been developed by RodNicolson and Angela Fawcett. In essence, they believethat the cerebellum which plays a crucial role inintegrating different streams of information as well as inrelaying this information to the rest of the brain maybe underperforming in dyslexics. Because of this,learning takes longer. They also believe it accounts forpoor balance in dyslexics. Once again, this theory is notwithout its critics (e.g. Ramus et al., 2003). There is


evidence that some dyslexics have an underperformingcerebellum, but not all do. I am far from convinced thatthe cerebellum hypothesis applies universally to alldyslexics, since the proportion of dyslexics who excel atsports is relatively high (see Chapter 8).

Having met dyslexics who are national champions atice-skating, cycling and gymnastics all sports thatrequire excellent balance a difficulty with balance isnot a universal dyslexic trait. I believe, however, that itis possible to reconcile these very different approaches.Fundamental to all of them is some form of weakness ininformation processing. It is possible that this occurs ata very basic level.

For information processing to take place, incomingstreams of information have to be broken down intosmall bits of information, which are then reassembled togive them meaning. For example, when listening tosomeone talking, it is as if the brain breaks thecontinuous stream of information down into smallchunks of information every 130 milliseconds. However,there is some evidence that in cases of dyslexia thechunks are larger perhaps about 210 milliseconds inlength (Helenius et al., 1999). There may also be asimilar type of difference in visual processing. It hasbeen shown that, at the first memory stage of visualinformation processing, the time it takes for an image to decay and disappear, which is usually justmilliseconds, is shorter for dyslexics (Ben-Yehudah et al., 2001). As the very brief visual images decay faster than expected, this results in the brainexperiencing some difficulties with comparing the


last image with the current one. Its as if the picture isslightly cloudy.

Although these four major theories about dyslexiaappear at first sight to be quite different from eachother, there is one theory which can unite all of them the asynchrony hypothesis of Michel Habib (2000). Asignificant feature of Habibs way of thinking aboutdyslexia is that it encompasses dyspraxia as well. Hisideas about the underlying basis of dyslexia areimportant, for he has proposed that the tempo ofinformation processing may be different in dyslexics.

If we assume that the brain works best when allneuronal systems are in synchrony with each other,difficulties will arise if one system is running very fast orvery slow compared with the others. There are manydifferent systems in the brain, including the major onesof vision, language and movement. If the time-coding ofinformation processing is impaired between these threesystems, then both dyslexia and dyspraxia are likely.

If just one system is affected it might give rise to avisual or verbal form of dyslexia. In principle, it ispossible to see how slow timing in one system gives riseto difficulties when integration between systems isrequired. If the auditory timing is slow, then thematching of sounds with images will be problematic andwill result in slowness with some forms of learning.

The concept of processing systems needing to run atthe right pace, as it were, also applies to the creationof memories. For memories to become permanent it isnecessary for the nerve cells of the brain to fire at theright tempo and in the right sequence (Fields, 2005).


If visual or auditory processing systems are not operatingat the same rate that is, they are asynchronous thisis likely to have a knock-on effect in that long-termmemory is also affected.

It appears to me that Habibs approach not onlyencompasses all four of the current major theories ofdyslexia, but also goes beyond them since it embracesdyspraxia as well as dyslexia. What most theoristsoverlook is that dyslexia and dyspraxia are not separateconditions. I have found that about 25 per cent of thestudents I see are dyslexic and dyspraxic to differingdegrees. Many experts on dyspraxia claim that theoverlap is even higher. Because there is such an overlap,I suggest that we can only claim to understand whatdyslexia is when that explanation encompasses dyspraxiaas well.

Bibliography

Ben-Yehudah, G., Sackett, E., Malchi-Ginzberg, L. & Ahissar, M. (2001) Impaired temporal contrast sensitivityin dyslexics is specific to retain-and-compare paradigms,Brain, 124, 13811395.

Boder, E. (1971) Developmental dyslexia: A diagnosticscreening procedure based on three characteristic patternsof reading and spelling. In Bateman, B. (ed.) LearningDisorders, 4, Special Children Publications, Seattle.

Ellis, A.W. (1984) Reading, Writing and Dyslexia: A CognitiveAnalysis, Lawrence Erlbaum Associates, NJ.

Fawcett, A.J. & Nicolson, R. (2004) Dyslexia: the role of the cerebellum. In Reid, G. & Fawcett, A. (eds) Dyslexiain Context: Research, Policy and Practice, Whurr Publishers,London.


Fields, R.D. (2005) Making memories stick, ScientificAmerican, 292, 2, 5965.

Habib, M. (2000) The neurological basis of developmentaldyslexia: An overview and working hypothesis, Brain, 123,23732399.

Helenius, P., Uutela, K. & Hari, R. (1999) Auditory streamsegregation in dyslexic adults, Brain, 122, 907913.

Ramus, F., Rosen, S., Dakin, S.C., Day, B.L., Castellote, J.M.,White, S. & Frith, U. (2003) Theories of developmentaldyslexia: insights from a multiple case study of dyslexicadults, Brain, 126, 841865.

Schonell, F.J. (1945) Backwardness in the Basic Subjects, 2ndedition, Oliver & Boyd Ltd., Edinburgh and London.

Snowling, M.J. (2000) Dyslexia, 2nd edition, BlackwellPublishers, Oxford.

Stein, J., Talcott, J. & Witton, C. (2001) The sensorimotorbasis of developmental dyslexia. In Fawcett, A. (ed.)Dyslexia: Theory and Good Practice, Whurr Publishing,London.

Tresman, S. (2006) What is dyslexia? In Tresman, S. &Cooke, A. (eds) The Dyslexia Handbook, British DyslexiaAssociation, Reading.

Wolf, M. & OBrien, B. (2001) On issues of time, fluency,and intervention. In Fawcett, A. (ed.) Dyslexia: Theory andGood Practice, Whurr Publishing, London.

Further reading

Moody, S. (2007) Dyslexia: Surviving and Succeeding at College,Routledge, Oxford.


What is dyspraxia?

When carrying out a diagnostic assessment I always askthe question: Were you well coordinated or clumsy as achild? In a surprisingly high number of cases the replyis: I was clumsy still am. Clumsiness and difficultieswith motor coordination are classic soft signs of thepresence of dyspraxia. When these difficulties are severeenough to result in a clumsy child being diagnosed asbeing dyspraxic, a physiotherapist or occupationaltherapist will then work with that child to bring aboutimprovements in motor coordination. In some casesspeech therapy is required as well. However, it is amistake to assume that improvements in motor controland speech result in a cure for dyspraxia. Theunderlying cognitive characteristics, a big part of beingdyspraxic, are still very much the same and are oftenignored. In addition, many people are never diagnosed asbeing dyspraxic in the first place. For example, Laura haslived with being clumsy throughout her life but has justaccepted this as being part of her: I have learnt to livewith who I am.

Dyspraxia is similar to an iceberg in two ways. First,there is a small visible part with a very considerable

Chapter 3

hidden portion. The visible part in the case of dyspraxiais the element of clumsiness and associated difficultieswith motor coordination. The hidden aspect is theunderlying difficulties with attention, memory and sometasks requiring perceptual skills. The second similarity isthat, over time, the visible part becomes smaller and lessnoticeable. This gradual melting away analogy refers tothe observation that coordination skills improve overtime and people also learn to become more careful.Consequently, as a child grows into a teenager and thenan adult, the visible aspects of being dyspraxic oftenbecome quite muted. However, and crucially, theunderlying cognitive picture changes very little.

The most obvious aspect of being dyspraxic isclumsiness, and this is summed up in the phrase clumsychild syndrome. Clumsiness can take different forms,such as bumping into things, knocking things over,spilling things, and tripping over your own feet. As it isdemeaning, as well as age-inappropriate, to refer to ateenager or adult who is clumsy as having clumsy childsyndrome, the term dyspraxic is much more frequentlyused.

Within recent years there has been a move to renamedyspraxia as Developmental Coordination Disorder (e.g. Drew, 2005). I have considerable difficulties withaccepting this change as one for the better because the defining criteria are taken from the Diagnosis andStatistical Manual of Mental Disorders, 4th edition (DSM-IV), of the American Psychiatric Association, and they make no reference to the cognitive profile ofdyspraxia. DCD (Developmental Coordination Disorder)

What is dyspraxia? 51

is defined in terms of a marked impairment in motorcoordination. In addition, I am uneasy with dyspraxiabeing defined by psychiatrists. Dyspraxia is not a mentaldisorder.

As a consequence of my unhappiness with theattempt to rename dyspraxia as DevelopmentalCoordination Disorder I have developed, with help fromothers, a new definition of dyspraxia. The short versionis given below. The fuller version is given at the end ofthis chapter.

Dyspraxia is present when a motor coordinationweakness, frequently expressed as clumsiness, incombination with significant variations inneurocognitive function, impact in a noticeableway on everyday life. Dyspraxia is thus an umbrellaterm for it varies in form and severity. Motorcoordination weaknesses may be primarily of finemotor control, gross motor control, or both.Significant variations in neurocognitive functiontypically include weaknesses in visual processingspeed, short-term visual memory, implicit memoryprocessing, and short-term auditory memory (i.e.working memory). In many instances, but not all,verbal conceptual understanding and verbalknowledge are noticeably better than visual reasoningand spatial abilities. In a minority of instancesmathematical skills are exceptionally strong.

As with dyslexia, I believe it is more helpful to talkabout the dyspraxias than dyspraxia because it can take

52 What is dyspraxia?

different forms. However, rather than worry about howmany labels there should be, I believe it is much moreimportant to focus on the profile of an individualsstrengths and weaknesses. In my view, the use of theWechsler Intelligence Scales is essential to drawing upthat profile. This battery of tests can bring into full viewmany of the hidden aspects of dyspraxia.

This point can be illustrated by describing twostudents I have seen. John was first diagnosed as beingdyspraxic when he was 7. Amanda was not diagnosed asbeing dyspraxic until she was in her early twenties.Johns birth was a very difficult one, and he was a floppybaby (rather like a rag doll his legs and arms floppedabout). He had not stood up by the time he was 18months old and was provided with physiotherapy to helphim learn to walk. He was also a very messy eater.Although he was walking by the time he started schoolhe could not climb steps and was consequently providedwith further physiotherapy. It was not until he was 7that a consultant finally diagnosed him as beingdyspraxic. What is striking about Johns case is how longit took for his parents to be given a diagnosis. As thiscan take so long even when motor coordinationdifficulties are evident from so early on, it is easy tounderstand why children with more subtle forms ofcoordination difficulties are not identified at all.

When I met John he was studying English literatureat a highly respected university. His assessment (seeFigure 3.1) revealed a very high level of verbalreasoning ability top 0.1 per cent of the population.His visual reasoning abilities, although high average,

What is dyspraxia? 53

are well below his exceptionally high verbal reasoningperformance. Of the three visual reasoning subtests hetook, his lowest score was on the Block Design subtest,a test of being able to think three-dimensionally. A dipin performance on this subtest is a typical dyspraxicfeature. There is a working memory weakness and Johnsspeed of visual processing is exceptionally low bottom5 per cent of the population.

Although Johns visual reasoning performance iscomfortably above average, his sense of place and spaceis nevertheless very poor. It takes him very much longerthan most people to learn how to find his way around abuilding or area, and he still gets lost in places he hasknown for some time. John is prone to lapses inconcentration and his writing style is typically dyslexic,in that he finds it hard to structure essays and writessentences that are very long and complex, with poorpunctuation. This is in spite of his having excellentskills of spelling and word reading accuracy. His reading

54 What is dyspraxia?

Figure 3.1 Johns Reading and Spelling scores, plus 4 WAIS-IIIIndex score

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