Reading, Writing & Frustration

She read haltingly, stumbling over the simplest words. She surprised and baffled us by doing well on spelling tests, until we realized she was once again memorizing. Gradually, it dawned on Sarah, too, that there was a problem.

"Why can the other kids read better than me?" she asked us. We didn't know what to say. How do you reassure a child that her brain works fine -- especially when you yourself don't know what the problem is? When Sarah was again placed in the lowest-level reading group in third grade, we decided to follow a friend's recommendation and, swallowing hard, shelled out $1,500 for a full battery of tests from an educational testing service.

SARAH TURNED OUT TO BE A CLASSIC DYSLEXIC -- among the 5 to 15 percent of schoolchildren with normal or above-average intelligence who perform significantly below their potential when handed a book or a pencil. One measure of dyslexia is a 15-point difference between IQ and reading achievement. Sarah had a 23-point gap.

To most people, a dyslexic is someone who reverses letters when he reads or writes. But dyslexia is not a deficit in the visual system. Dyslexics see words correctly. It is a deficit in the brain's language system -- in the neurons that are used to process the distinctive sound elements that constitute language.

Dyslexics have a flawed ability to develop phonemic awareness -- that is, the ability to divide the written word into its underlying segments, called phonemes. Phonemes are the smallest discernible segment of speech (for example, the word "cat" consists of three phonemes: kuh, aah, tuh) and the bedrock of reading. When learning to read, children naturally break apart each word into its phonemes and then rapidly reassemble it into a coherent word. Eventually, they learn to pay attention to the word's meaning rather than its sounds, and they read text rapidly, smoothly and effortlessly.

By contrast, dyslexics struggle to blend letter sounds to create whole words. For them, reading and spelling is like trying to crack an impossible code, and the effort can take a toll. Studies have shown that dyslexic students have significantly more academic and behavioral problems than children without learning disabilities. One 1996 study found that 2 percent of those with learning disabilities go on to a four-year college. Studies have also found that adult dyslexics have a lower satisfaction with health and friends, and exhibit more psychiatric problems than non-dyslexics. Fewer are employed and, even if employed, hold jobs that are part-time, minimum wage and unskilled. We spent Sarah's childhood in almost constant anxiety that our daughter, too, would spend her life as a frustrated underachiever.

But with the advent in the 1990s of functional brain imaging, technology began providing answers. To find the physical basis of "word blindness," researchers at four learning disability centers nationwide, among them the Center for the Study of Learning at Georgetown University, are using magnetic resonance imaging to map the neural pathways used in reading. By watching the brain as subjects read, researchers can track words and symbols as they bounce from the eyes to the visual cortex and through the circuitry of the brain.

In just the past few years, scans have revealed stunning details of what goes right -- and wrong -- when humans read. Scans have found that normal readers activate three interconnected neural systems in the brain's left hemisphere. Commonly seen words are directly processed in an area behind the left ear (the occipitotemporal cortex). The more complex work of picking apart words appears to be rooted in another area, above and slightly forward from there (the inferior parietal area).

A third area, just behind the left temple (called the inferior frontal gyrus), is responsible for analyzing word meaning and for the articulation of a word.

In dyslexics, the areas in the back, where words are formed and analyzed, aren't as engaged, while other areas, such as the front and the right side of the brain (used mostly for visual processing), become more active, perhaps as dyslexics struggle to compensate for the failure of their rear brain neural systems.

By taking thousands of images as dyslexic and normal readers identify letters flashing above them inside the glowing tunnel of the MRI, the Georgetown center and the other labs expect to soon determine whether intensive reading therapy can "rewire" the dyslexic brain. Eventually, they expect the research to lead to better diagnoses and treatment of dyslexia, perhaps before a child shows any signs of problems. In the meantime, there have been dramatic advancements in technologies that assist dyslexics in bridging the gap between their potential and their performance.

During Sarah's elementary school years, such tools were helpful but rudimentary. After her diagnosis, she started using an electronic speller and a portable word-processing device so she could type her in-class assignments rather than handwrite them.