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The American Experience: Towards a 21st Century Definition of Dyslexia

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Title: The American Experience: Towards a 21st Century Definition of Dyslexia
Language: English
Authors: Shaywitz, Bennett A., Shaywitz, Sally E.
Source: Oxford Review of Education. 2020 46(4):454-471.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 18
Publication Date: 2020
Document Type: Journal Articles
Reports - Evaluative
Education Level: Early Childhood Education
Elementary Education
Kindergarten
Primary Education
Grade 1
Descriptors: Definitions, Dyslexia, Laws, Policy Formation, Evidence Based Practice, State Legislation, Federal Legislation, Reading Difficulties, Learning Disabilities, Screening Tests, Minimal Brain Dysfunction, Intelligence Quotient, Professional Development, Response to Intervention, Special Schools, Kindergarten, Grade 1, Young Children
DOI: 10.1080/03054985.2020.1793545
ISSN: 0305-4985
Abstract: We review the evolution of the conceptualisation of dyslexia and along with it the current, 21st century definition of dyslexia. Our starting point is the seminal report by Pringle Morgan in 1896, followed by early 20th century reports by Hinshelwood, and continuing with concepts of brain injury and minimal brain dysfunctions then to the emergence of 'learning disability' in the mid-20th century. Within this historical framework we note the emergence and scientific validation of an 'unexpected' model culminating in the first definition of dyslexia in U.S. federal law in late 2018 and in recent U.S. federal civil rights law. We next address the issue of whether dyslexia is 'real' by showing how advances in non-invasive functional brain imaging have led to a replicated, robust neural signature for dyslexia. We close by illustrating how science has informed policy, emphasising the focus on evidence-based practices beginning with the report of the National Reading Panel and including the creation of the What Works Clearinghouse. Early screening for dyslexia represents another important policy accomplishment with dyslexia laws now passed in over 30 states. Evidence-based effective interventions for dyslexia, including free, public charter schools specialised for dyslexic children exemplify the most recent policy initiative.
Abstractor: As Provided
Entry Date: 2020
Accession Number: EJ1265161
Database: ERIC
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  Value: <anid>AN0145134200;oxr01aug.20;2020Aug17.04:10;v2.2.500</anid> <title id="AN0145134200-1">The American experience: towards a 21st century definition of dyslexia </title> <p>We review the evolution of the conceptualisation of dyslexia and along with it the current, 21st century definition of dyslexia. Our starting point is the seminal report by Pringle Morgan in 1896, followed by early 20th century reports by Hinshelwood, and continuing with concepts of brain injury and minimal brain dysfunctions then to the emergence of 'learning disability' in the mid-20th century. Within this historical framework we note the emergence and scientific validation of an 'unexpected' model culminating in the first definition of dyslexia in U.S. federal law in late 2018 and in recent U.S. federal civil rights law. We next address the issue of whether dyslexia is 'real' by showing how advances in non-invasive functional brain imaging have led to a replicated, robust neural signature for dyslexia. We close by illustrating how science has informed policy, emphasising the focus on evidence-based practices beginning with the report of the National Reading Panel and including the creation of the What Works Clearinghouse. Early screening for dyslexia represents another important policy accomplishment with dyslexia laws now passed in over 30 states. Evidence-based effective interventions for dyslexia, including free, public charter schools specialised for dyslexic children exemplify the most recent policy initiative.</p> <p>Keywords: Dyslexia; reading disability; learning disability; unexpected; U.S.</p> <hd id="AN0145134200-2">Evolution of dyslexia as an unexpected difficulty in relation to intelligence early history:...</hd> <p>The observation that seemingly otherwise healthy men and women could lose the ability to read had been made as early as the 1600s (Schmidt, [<reflink idref="bib60" id="ref1">60</reflink>], as cited in Benton & Joynt, [<reflink idref="bib6" id="ref2">6</reflink>]) and by the 1800s descriptions of educated adults who suddenly found themselves unable to read began to appear, a condition referred to as 'acquired alexia.' The most prominent of these cases were described in the early 1890s by the French neurologist Jules Dejerine (Dejerine, [<reflink idref="bib11" id="ref3">11</reflink>], [<reflink idref="bib12" id="ref4">12</reflink>]), who showed that acquired alexia was the result of a stroke involving posterior brain systems in the parieto-temporal and occipito-temporal regions. Following the report by Scottish ophthalmologist James Hinshelwood ([<reflink idref="bib26" id="ref5">26</reflink>]) of an adult with acquired alexia, British physician Dr. W. Pringle Morgan (Pringle Morgan, [<reflink idref="bib39" id="ref6">39</reflink>]) published the first report of developmental dyslexia, describing 14-year-old Percy F.: '... He has always been a bright and intelligent boy, quick at games, and in no way inferior to others his age. His great difficulty has been – and is now – his inability to read.' Following Hinshelwood's diagnosis of word blindness in adults, Morgan labelled this condition congenital word blindness, emphasising that the young boy, Percy, had good vision and was intelligent, commenting that 'The school-master who has taught him for some years says that he would be the smartest lad in the school if the instruction were entirely oral.' Hinshelwood ([<reflink idref="bib27" id="ref7">27</reflink>]) went on to describe a number of other children with dyslexia and also emphasised the unexpected nature of the reading difficulty; it was not due to a generalised deficit in intelligence, but to a 'localized' problem affecting reading so that affected children also manifest strengths as well as the weakness in reading. He also observed that the disorder, like most other physiological entities, occurred in gradations rather than as an all or none phenomenon, a finding that more recent research has validated (S. E. Shaywitz et al., [<reflink idref="bib65" id="ref8">65</reflink>]).</p> <p>By the mid-1900s American physician Samuel Torrey Orton ([<reflink idref="bib43" id="ref9">43</reflink>]) noted a number of clinical findings in dyslexia that we have come to know 80 years later, including lack of reading fluency, poor spelling, and trouble learning a foreign language at adolescence. Of particular relevance, Orton emphasised that although their reading could often appear normal for their age, it was below what was expected for their intelligence. As we review below, the unexpected nature of the reading problem was also the hallmark of what came to be known as learning disabilities (LD).</p> <hd id="AN0145134200-3">Brain damage, minimal brain dysfunctions and learning disability</hd> <p>By the mid-1900s descriptions of the brain-injured child (Strauss & Lehtinen, [<reflink idref="bib74" id="ref10">74</reflink>]; Strauss & Werner, [<reflink idref="bib75" id="ref11">75</reflink>]), and then the child with minimal brain dysfunctions (MBD) (Clements & Peters, [<reflink idref="bib10" id="ref12">10</reflink>]) began to appear. Symptoms of MBD included specific learning deficits, especially failure to read and making dyslexic errors along with poor spelling. At the same time Kirk and Bateman ([<reflink idref="bib31" id="ref13">31</reflink>]) first used the term 'learning disability,' and illustrated the evaluation of a learning disability with the steps in diagnosing a reading disability. The concept of a discrepancy between the child's ability and his/her actual academic achievement represented the hallmark of 'learning disability': 'discrepancy between the capacity for reading and actual achievement in reading ... ' (Kirk & Bateman, [<reflink idref="bib31" id="ref14">31</reflink>], p. 73) and as a discrepancy between potential and actual success in learning resulting in significant underachievement (Myklebust, [<reflink idref="bib40" id="ref15">40</reflink>]).</p> <p>By the 1980s LD had become one of the most frequently diagnosed conditions in children referred for problems learning in school. At the time, many physicians noticed that parents of children with mild mental retardation (what today is classified as intellectual disability) not surprisingly preferred to refer to their children as LD. Perhaps in order to differentiate these intellectually disabled children from the majority of children designated as LD, Kavale and Forness ([<reflink idref="bib30" id="ref16">30</reflink>]) emphasised that the IQ-achievement discrepancy is essential to the diagnosis of LD and can be reliably determined, and the presence of an ability-achievement discrepancy, came to be recognised as the most consistent element in defining LD (Hammill, [<reflink idref="bib21" id="ref17">21</reflink>]). These studies emphasise that for over 100 years in the case of dyslexia and over 50 years in the case of LD, the most consistent and enduring core of the definition is unexpected underachievement (B. A. Shaywitz et al., [<reflink idref="bib62" id="ref18">62</reflink>]).</p> <hd id="AN0145134200-4">The Connecticut Longitudinal Study</hd> <p>There are now empirical data confirming the unexpected nature of dyslexia. These data come from the Connecticut Longitudinal Study, a project involving a sample survey of 445 (98% of those invited) Connecticut schoolchildren representative of those children entering public kindergarten in Connecticut in 1983. All subjects were children whose primary language was English. This cohort, assembled from a two-stage probability-sample survey, has been followed longitudinally beginning in kindergarten. Each was given an individualised test of intelligence (WISC-R) (Wechsler, [<reflink idref="bib83" id="ref19">83</reflink>]) in alternate years and reading and mathematics achievement annually up through 12th grade using the Woodcock-Johnson Achievement battery (Woodcock & Johnson, [<reflink idref="bib84" id="ref20">84</reflink>]). Upon entry into the study in kindergarten parents completed the Yale Children's Inventory (S. E. Shaywitz et al., [<reflink idref="bib67" id="ref21">67</reflink>]) incorporating the child's early development and family history. Each year children completed a measure of self-esteem (Harter, [<reflink idref="bib23" id="ref22">23</reflink>]) and at the end of each school year teachers completed the Multigrade Inventory for Teachers (MIT) (Agronin et al., [<reflink idref="bib2" id="ref23">2</reflink>]). This measure incorporated the teacher's assessment of academic, language, dexterity, attention, and activity, as well as global impressions of learning and behaviour, mastery of reading decoding, reading comprehension, arithmetic, written expression, handwriting and extent of parental involvement in school. We also obtained information on the frequency of latenesses, absences, and whether the child received special education services. We have maintained ongoing seamless contact along with periodic assessments of the participants which continues through adulthood, with the participants now in their fifth decade. We continue to follow 375 participants (84% of the original cohort). The racial and ethnic composition of this sample from Connecticut was similar to that of the nation at the time of the study (<emph>Statistical Abstract of the United States: 1986</emph>, [<reflink idref="bib80" id="ref24">80</reflink>]). Data from this study have been instrumental in demonstrating a range of information about dyslexia, including finding dyslexia occurs equally in girls and boys (S. Shaywitz et al., [<reflink idref="bib63" id="ref25">63</reflink>]). That dyslexia occurs approximately equally in boys and girls is supported by a number of studies (Harlaar et al., [<reflink idref="bib22" id="ref26">22</reflink>]; Hawke et al., [<reflink idref="bib24" id="ref27">24</reflink>], [<reflink idref="bib25" id="ref28">25</reflink>]; Stevenson, [<reflink idref="bib73" id="ref29">73</reflink>]) though one study (Rutter et al., [<reflink idref="bib58" id="ref30">58</reflink>]) finds male predominance. In our study, teachers completed the MIT as noted above, an inventory incorporating a series of behavioural and academic scales and, in addition, were asked to indicate the likelihood that the child had a range of conditions, including dyslexia. We observed that teachers identified more boys than girls as dyslexic, primarily on the basis of the more active, disruptive behaviour of boys. In contrast, when we tested each of these children individually, our individualised testing demonstrated equal numbers of dyslexic boys and girls. As a result of the studies demonstrating that dyslexia is an equal opportunity disability, girls are being identified and now there are equal numbers of boys and girls enrolled in many specialised schools for dyslexia (Russell, [<reflink idref="bib57" id="ref31">57</reflink>]).</p> <p>Most recently (Estrada et al., [<reflink idref="bib13" id="ref32">13</reflink>]) the data have been used to develop methods for identifying whether the increase in reading proficiency displayed by an <emph>individual</emph> student from one year to the next is adequate for his/her age, or indicates the student is falling behind. Currently we are testing reading in this unique sample who are now 41 years of age, using remote testing via ipads and cell phones.</p> <hd id="AN0145134200-5">Dyslexia defined as 'unexpected'</hd> <p>Figure 1 (Ferrer et al., [<reflink idref="bib16" id="ref33">16</reflink>]; S. Shaywitz & J. Shaywitz, [<reflink idref="bib64" id="ref34">64</reflink>]) shows that in typical readers, development of reading and IQ are dynamically linked over time, that is if the child is intelligent, he or she will typically be a good reader, and if he or she is a good reader, the child most often is intelligent. In dyslexic readers, however, IQ and reading diverge, so that reading achievement is significantly below what would be expected given the individual's IQ. These data provide empiric validation of the unexpected nature of dyslexia. Thus, in dyslexia, a highly intelligent person may read at a below average or even average level but below that expected, based on his/her intelligence, education, or professional status.</p> <p>PHOTO (COLOR): Figure 1. In typical readers (left panel) IQ and reading are dynamically linked over time. In dyslexic readers (right panel) IQ and reading diverge indicating that in dyslexia a person can have a very high IQ yet read at a much lower level so that the poor reading is unexpected.</p> <p>The definition of dyslexia as unexpected is now (as of 2018) codified in U.S. federal law (U.S. Public Law 115-391): 'The term "dyslexia" means an unexpected difficulty in reading for an individual who has the intelligence to be a much better reader, most commonly caused by a difficulty in the phonological processing (the appreciation of the individual sounds of spoken language), which affects the ability of an individual to speak, read, and spell.' Furthermore, the implications of this definition mean that there is no reading level below which an individual, student or adult must score to be diagnosed as dyslexic. Rather, the central point is how the individual reads, the effort and work that must go into the reading process for him or her to decipher the word accurately and fluently. Recognition of the effort and work dyslexic students must expend in reading is recognised in U.S. disability law (ADA Amendments Act, [<reflink idref="bib1" id="ref35">1</reflink>]) and the U.S. Department of Justice regulations relating to this law (U.S. Department of Justice, [<reflink idref="bib81" id="ref36">81</reflink>]). These regulations recognise another important characteristic of dyslexia – it is persistent (see Figure 3 below, and S. E. Shaywitz et al., [<reflink idref="bib66" id="ref37">66</reflink>]; Snowling et al., [<reflink idref="bib72" id="ref38">72</reflink>]). The U.S. Department of Justice regulations ensure that once a student has received accommodations for dyslexia (most commonly, extra time for examinations), the student should be able to receive those accommodations on any subsequent test. Please see Overcoming Dyslexia, 2nd edition (S. Shaywitz & J. Shaywitz, [<reflink idref="bib64" id="ref39">64</reflink>]) for a more detailed discussion of these issues.</p> <hd id="AN0145134200-6">Why not use DSM-5?</hd> <p>DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) has become very controversial and fallen from favour in the US. For example, on the advice of American academics, U.S. legislators did not consider using the definition and criteria described in DSM-5 (American Psychiatric Association, [<reflink idref="bib3" id="ref40">3</reflink>]). Most recognise that DSM has become a political, rather than a scientific document, providing diagnostic codes that are helpful to practitioners for billing purposes but offering little else, according to Allen Frances, a highly knowledgeable individual who actually chaired the prior iteration of DSM, DSM-IV (Frances, [<reflink idref="bib18" id="ref41">18</reflink>]). It is particularly problematic in dyslexia because rather than defining dyslexia, DSM-5 places dyslexia within the category of 'Specific Learning Disability ... <bold>315.00 (F81.0) with impairment in reading</bold> Word reading accuracy; Reading rate or fluency; Reading comprehension.'</p> <p>This is problematic for a number of reasons – as noted previously in the historical section, a diagnosis of learning disability has not proven to be useful. Another significant problem is that one of the exclusionary criteria for a diagnosis in this category includes 'psychosocial adversity', a serious problem that seems to reflect an inherent bias against identifying disabled minority students. This bias is found not only in DSM-5 but also in the U.S. Individuals with Disabilities Education Act (IDEA) (Individuals With Disabilities Education Act, [<reflink idref="bib28" id="ref42">28</reflink>]). Both DSM-5 and the IDEA harbour still another bias: confounding dyslexia with problems in comprehension. Strong evidence considers problems in reading comprehension as distinct from dyslexia (Nation & Snowling, [<reflink idref="bib41" id="ref43">41</reflink>]). Furthermore, in IDEA, learning disabilities 'refer, in part, to such symptoms as "imperfect ability ... to think"' which not only do not at all apply to dyslexia but could even be harmful to those who are dyslexic. 'Dyslexics have a reading impairment, not a thinking impairment' (S. Shaywitz & Shaywitz, [<reflink idref="bib64" id="ref44">64</reflink>], pp. 93–94).'</p> <hd id="AN0145134200-7">Is dyslexia real? Making a hidden disability visible: neurobiological evidence</hd> <p>In the early descriptions of dyslexia, there was serious concern over whether there was evidence of 'brain dysfunction.' Converging evidence from many laboratories around the world using functional brain imaging, first positron emission tomography (PET) in the 1980s and then functional magnetic resonance imaging (fMRI) in the 1990s, for the first time has made visible what previously was a hidden disability. In one of the first studies of fMRI in dyslexia, we (B. A. Shaywitz et al., [<reflink idref="bib61" id="ref45">61</reflink>]) studied 144 children, approximately half of whom had dyslexia and half of whom were typical readers. Results indicated significantly greater activation in posterior reading systems in typical readers than in readers with dyslexia during a task tapping phonologic analysis. These data from fMRI studies in groups of children with dyslexia have been replicated in reports from many investigators (Richlan et al., [<reflink idref="bib52" id="ref46">52</reflink>], [<reflink idref="bib53" id="ref47">53</reflink>]) and show a failure of left-hemisphere posterior brain systems to function properly during reading, particularly the systems in the left-hemisphere occipitotemporal regions. Price and Devlin ([<reflink idref="bib45" id="ref48">45</reflink>]) have emphasised the critical nature of this region for reading, hypothesising and providing strong arguments that the left hemisphere occipitotemporal region acts as an interactive node for reading, assimilating the orthography (the way the word looks), the phonology (the way the word sounds) and the semantics (what the word means).</p> <p>When does the neural signature for dyslexia develop? Do these changes in brain function and organisation predate the poor reading, or are they the result of poor reading itself? Functional brain imaging in prereading children with a family history of dyslexia (compared to prereading children without a family history of dyslexia) demonstrated reduced activation in posterior reading systems (Raschle et al., [<reflink idref="bib48" id="ref49">48</reflink>]). This study, along with other studies in prereaders of structural brain images (Raschle et al., [<reflink idref="bib47" id="ref50">47</reflink>]) and white matter integrity (Saygin et al., [<reflink idref="bib59" id="ref51">59</reflink>]) add additional evidence that the differences in brain function and structure are present even before the children learn to read.</p> <p>These functional brain imaging findings are universal, occurring in languages using alphabetic and logographic orthographies. For example, using PET, Paulesu and his associates (Paulesu et al., [<reflink idref="bib44" id="ref52">44</reflink>]) reported inefficient functioning in these posterior brain regions regardless of the native language spoken by these English, French or Italian dyslexic college students. More recent studies demonstrate similar findings in German (Kronbichler et al., [<reflink idref="bib33" id="ref53">33</reflink>]) and Italian (Brambati et al., [<reflink idref="bib8" id="ref54">8</reflink>]) readers with dyslexia. Some studies in Chinese readers with dyslexia show brain dysfunction in left occipitotemporal and anterior frontal regions (Siok et al., [<reflink idref="bib69" id="ref55">69</reflink>], [<reflink idref="bib70" id="ref56">70</reflink>], [<reflink idref="bib71" id="ref57">71</reflink>]) similar to those found in dyslexia in alphabetic orthographies. Another study of Chinese dyslexics (Liu et al., [<reflink idref="bib37" id="ref58">37</reflink>]) demonstrated reduced activation consonant with a language-specific role of right visual cortex in Chinese reading.</p> <p>Connectivity analyses of fMRI data represent the most recent evolution in characterising brain networks in dyslexia. Measures of functional connectivity are designed to detect differences in brain regions with similar magnitudes of activation but whose activity is differentially synchronised with other brain systems across subject groups and/or types of stimuli. In a study from Switzerland (Van der Mark et al., [<reflink idref="bib82" id="ref59">82</reflink>]), in typical readers the posterior reading systems were functionally connected to relatively distant regions including frontal regions. In contrast, in dyslexic readers functional connectivity was disrupted between posterior reading systems and more distant regions with the functional connectivity limited to regions adjacent to the posterior reading systems. More recently, using functional connectivity analyses involving the whole brain, we (Finn et al., [<reflink idref="bib17" id="ref60">17</reflink>]) found that compared to typical readers, in dyslexic readers, connectivity was disrupted to the word-form area (critical to reading fluency), and between posterior reading systems and attention systems in frontal regions. Please see Overcoming Dyslexia, 2nd edition (S. Shaywitz & J. Shaywitz, [<reflink idref="bib64" id="ref61">64</reflink>]), for a more detailed discussion of the functional neuroimaging studies of dyslexia.</p> <hd id="AN0145134200-8">Implications of brain imaging studies</hd> <p>The brain imaging studies reviewed above provide neurobiological evidence that illuminates and clarifies current understanding of the nature of dyslexia and its treatment. For example, brain imaging has taken dyslexia from what had previously been considered a hidden disability to one that is visible; the findings of inefficient functioning in posterior reading systems are often referred to as a 'neural signature for dyslexia' (Figure 2).</p> <p>PHOTO (COLOR): Figure 2. Non-impaired readers (left) activate three important language areas on the left side of the brain, one anterior (Broca's area) and two posterior (parietotemporal, above, and occipitotemporal, below). These two posterior regions are significantly less activated and function inefficiently in dyslexic readers (right).</p> <p>These findings should eliminate any thoughts of whether dyslexia is real or a 'valid' diagnosis; even more so, these cutting-edge converging functional brain imaging data from imaging laboratories worldwide should encourage the use of the word 'dyslexia,' for it has meaning and relevance at levels reaching to the basic functional neural architecture in reading and its inefficient functioning in struggling readers.</p> <p>A final caveat: While functional brain imaging has produced very consistent and replicated studies in dyslexic compared to typical readers (Richlan et al., [<reflink idref="bib52" id="ref62">52</reflink>], [<reflink idref="bib53" id="ref63">53</reflink>]), anatomic brain imaging has not produced as clear a picture (Ramus et al., [<reflink idref="bib46" id="ref64">46</reflink>]).</p> <hd id="AN0145134200-9">Consequences of failing to identify dyslexic students</hd> <p>Dyslexia has profound long-term impacts on educational, income, and health outcomes, all of which are significantly worse for dyslexics than for their typically reading peers. Children and adults with dyslexia: experience high-school drop-out rates that are three to four times as large as for typical readers (Blackorby & Wagner, [<reflink idref="bib7" id="ref65">7</reflink>]); are more likely to be below or near national poverty levels (Bynner & Parsons, [<reflink idref="bib9" id="ref66">9</reflink>]; Kirsch et al., [<reflink idref="bib32" id="ref67">32</reflink>]; Kruidenier et al., [<reflink idref="bib34" id="ref68">34</reflink>]; Kutner et al., [<reflink idref="bib35" id="ref69">35</reflink>]; Reder & Vogel, [<reflink idref="bib49" id="ref70">49</reflink>]; Rudd et al., [<reflink idref="bib54" id="ref71">54</reflink>], [<reflink idref="bib55" id="ref72">55</reflink>]; Sum et al., [<reflink idref="bib76" id="ref73">76</reflink>]; Tamassia et al., [<reflink idref="bib77" id="ref74">77</reflink>]); have difficulty accessing or understanding health-related information, are hospitalised more often, and do not manage chronic diseases as well (Kutner et al., [<reflink idref="bib36" id="ref75">36</reflink>]; Rudd et al., [<reflink idref="bib54" id="ref76">54</reflink>], [<reflink idref="bib55" id="ref77">55</reflink>]); and experience poor health and a shortened life span (Baker et al., [<reflink idref="bib4" id="ref78">4</reflink>]; Kutner et al., [<reflink idref="bib36" id="ref79">36</reflink>]; Marcus, [<reflink idref="bib38" id="ref80">38</reflink>]; Rudd et al., [<reflink idref="bib56" id="ref81">56</reflink>]). Our longitudinal data show that dyslexic young adults are half as likely to go to college as their typically reading peers. Compared to their typically reading peers dyslexic young adults have significantly higher unemployment and significantly lower lifetime earnings (S. Shaywitz & J. Shaywitz, [<reflink idref="bib64" id="ref82">64</reflink>], p. 409).</p> <hd id="AN0145134200-10">How science has informed dyslexia policy</hd> <p></p> <hd id="AN0145134200-11">Funding</hd> <p>In contrast to many countries where funding for public education comes from the central government, in the U.S. less than 10% of kindergarten through high school (grade 12) funds come from federal sources, primarily directed to the poorest school districts in the country. The remaining 90% of school revenues are shared approximately equally between state (50 states in the U.S.) and local sources (Institute for Education Science, [<reflink idref="bib29" id="ref83">29</reflink>]).</p> <hd id="AN0145134200-12">Development of evidence-based practices</hd> <p>Over two decades ago, the U.S. Congress, concerned about the mounting evidence that large numbers of American school children were not able to read at even the most basic levels, established The National Reading Panel to examine this serious national crisis. One of us (SES) was proud to serve on The National Reading Panel and presented The Report of the National Reading Panel (National Reading Panel, [<reflink idref="bib42" id="ref84">42</reflink>]) to Congress in 2000. Subtitled 'An Evidence-Based Assessment of the Scientific Research Literature on Reading and Its Implications for Reading Instruction', the report was the first mention of evidence-based research, in contrast to research-based, an important advance in considering screening, identification and intervention in the education of dyslexic readers. By 2002 the Institute of Education Science of the U.S. Department of Education had established the What Works Clearinghouse tasked with reviewing 'the existing research on different programs, products, practices, and policies in education ... to provide educators with the information they need to make evidence-based decisions.' The major U.S. federal legislation affecting students in elementary school through high school is The Elementary and Secondary Education Act, and its most recent iteration, Every Student Succeeds Act (ESSA) (Every Student Succeeds Act, [<reflink idref="bib14" id="ref85">14</reflink>]) encouraging 'state educational agencies (SEAs), local educational agencies (LEAs), and schools to prioritize and include evidence-based interventions, strategies, or approaches.' Schools are not mandated to use these and so adoption of evidence-based practices has been slow. In fact, many schools, districts and states often seem ignorant of evidence-based practices and continue to use programmes where evidence has clearly demonstrated their ineffectiveness.</p> <hd id="AN0145134200-13">Problems with teacher professional development programmes</hd> <p>Many school districts continue to use a teacher professional development programme thinking it is effective in improving student reading achievement. These school districts seem unaware of the findings from the What Works Clearinghouse of The Impact of Two Professional Development Interventions on Early Reading Instruction and Achievement. The study (Garet et al., [<reflink idref="bib19" id="ref86">19</reflink>]) found: 'Although there were positive impacts on teacher's knowledge of scientifically based reading instruction and on one of the three instructional practices promoted by the study PD [professional development program], neither PD intervention resulted in significantly higher student test scores at the end of the one-year treatment ... There were no statistically significant impacts on measured teacher or student outcomes in the year following the treatment.'</p> <hd id="AN0145134200-14">Problems with response to intervention (RTI)</hd> <p>Multi-Tiered Systems of Support (MTSS), embodied in Response to Intervention (RTI) represents the instructional framework used in most U.S. schools. RTI provides a range of assessment, instruction, and interventions within a tiered system offering different reading interventions depending on the child's level of reading difficulty (S. Shaywitz & J. Shaywitz, [<reflink idref="bib64" id="ref87">64</reflink>]). Tier 1 refers to reading instruction provided to all students in a class. Tier 2 interventions involve supplemental, small group reading instruction focused on foundational reading skills. Tier 3 interventions are provided to students who do not progress after a reasonable amount of time with the Tier 2 intervention and require more intensive assistance, for example, one-to-one tutoring (Gersten et al., [<reflink idref="bib20" id="ref88">20</reflink>]).</p> <p>Concerns about RTI were raised over a decade ago (Reynolds & Shaywitz, [<reflink idref="bib50" id="ref89">50</reflink>], [<reflink idref="bib51" id="ref90">51</reflink>]) and these concerns have now been validated in the findings from a very large study commissioned by the U.S. Department of Education (Balu et al., [<reflink idref="bib5" id="ref91">5</reflink>]). In this large federal study, 'Assignment to Tier 2 or Tier 3 intervention services ... had a negative effect on performance on a comprehensive reading measure for first-graders ... a negative effect of this magnitude is equivalent to approximately one-tenth of a year less learning than what they would have achieved had they not been assigned to intervention. The estimated effects on reading outcomes in Grades 2 and 3 are not statistically significant.' Despite the evidence of its ineffectiveness, many schools and school districts seem to remain blithely unaware of this evidence and the majority of schools in the U.S. continue to use RTI as the primary intervention method in educating children with dyslexia. The difficulty, of course, is that effective interventions for dyslexic children are expensive and often not available in schools, so that RTI continues to be used despite its documented shortcomings.</p> <hd id="AN0145134200-15">Current directions</hd> <p></p> <hd id="AN0145134200-16">Early screening for dyslexia</hd> <p>For decades parents have been told by schools that dyslexia cannot be identified before third grade. Good evidence now indicates that the achievement gap between dyslexic and typical readers is evident as early as first grade, and persists (Ferrer et al., [<reflink idref="bib15" id="ref92">15</reflink>]) (Figure 3).</p> <p>PHOTO (COLOR): Figure 3. The arrow shows the gap in reading between typical readers (upper curve) and dyslexic readers (lower curve) occurring at first grade. Both groups show gains in reading over time but the gap between typical and dyslexic readers persists.</p> <p>These findings, from our Connecticut Longitudinal Study, demonstrate two important points: first, the achievement gap between typical readers and dyslexic readers is evident as early as first grade; in addition, there is a steep slope in reading acquisition in the early grades which begins to plateau as children go on to higher grades (Figure 3) Such information, together with over three decades of reading research, demonstrates that the earlier dyslexia is identified and the earlier children receive effective intervention, the better the outcome (Torgesen, [<reflink idref="bib79" id="ref93">79</reflink>]). This provides strong evidence and impetus for early screening and identification of, along with early intervention for, young children at risk for dyslexia. Good evidence indicates that screening is most useful when the child has already begun school (Thompson et al., [<reflink idref="bib78" id="ref94">78</reflink>]), further supporting screening for dyslexia by the end of kindergarten or first grade. The same recent U.S. federal law (PL 115-391) defining dyslexia also codified criteria for a dyslexia screener: '(A) evidence-based with proven psychometrics for validity; (B) efficient and low-cost; and (C) readily available.' Over 30 of our 50 states now have state laws recognising dyslexia, with many mandating early screening for dyslexia. One source of potentially powerful and highly accessible screening information is the teacher's judgement about the child's reading and reading-related skills and the Shaywitz DyslexiaScreen<sups>TM</sups> (Pearson) was developed just for this purpose, to find children most at risk for dyslexia and target them for extra help as early as possible. The screener is brief, efficient and inexpensive, completed by the child's teacher who knows the child best and is ideal for universal screening; it is evidence-based and has strong psychometrics with AUC of.81 (Kindergarten) and.89 (First Grade) indicating that the screener is very strong and accurate in separating children at risk for dyslexia from those not at risk.</p> <p>Not surprisingly, many school districts are reluctant to screen for dyslexia, worried that the identification and interventions to help children with dyslexia will increase costs to the schools system. As noted above, the long-term costs of failing to screen for and diagnose dyslexia are very high. A dyslexic child who is not identified does not receive evidence-based instruction, continues to struggle in school and sees him or herself as a failure and not smart. He or she has no knowledge of what his/her difficulty is, that it has a name – dyslexia, and has no self-awareness of why he or she cannot do what his or her peers can do. The dyslexic child is frequently bullied and teased. He or she would rather be sent to the Principal's office than read aloud in class. Over time, the child sees him or herself as not meant for school, and all too often drops out. Early screening for dyslexia may be an important factor in reversing these serious consequences of failing to identify dyslexia in children. As distinguished economist (and dyslexic) Diane Swonk noted: 'Recognizing and understanding dyslexia may be a solution to income inequalities and a solution to the lost human capital' (S. Shaywitz & J. Shaywitz, [<reflink idref="bib64" id="ref95">64</reflink>], p. 508).</p> <hd id="AN0145134200-17">Effective interventions for dyslexic children</hd> <p>Reading interventions for children with dyslexia remain a contentious issue for the affected children, their parents and their educators. As noted above, early screening has the potential to identify children at risk for dyslexia as early as kindergarten and first grade, when intervention approaches are most successful, when the learning curve for reading acquisition accelerates most rapidly. For most dyslexic students, schools in the U.S. typically adopt a multi-tiered system of supports, which, as noted above, has serious problems. Placement of the dyslexic child in special education classrooms within the general education environment has not proven effective (S. E. Shaywitz & J. Shaywitz, [<reflink idref="bib68" id="ref96">68</reflink>], p. 316).</p> <hd id="AN0145134200-18">Specialised schools for dyslexia</hd> <p>Independent, specialised schools focused on dyslexic students have proven very successful in educating dyslexic children. Such schools provide a positive climate in which there is understanding of dyslexia and its impact on children and their families by all members of the school team, including not only teachers, but coaches and others extending to the person who sits at the front desk as you enter the school. There is welcome and not denial or shame that greets the students. Since the school is specialised for dyslexic children, there is always time to focus on students' needs, academic and others, rather than what is too often the case in other settings where the attitude concerning dyslexia is 'Oh, I'll teach this if there is time left over and I can get to it.' which rarely happens. Valuable too, is meeting and getting to know other boys and girls who are dyslexic and see how bright they are, a feeling of not being isolated and alone but one of the group, not fearing to read aloud in front of the class or fearing to go out for recess and being teased for your reading mistakes.</p> <p>Specialised schools focus on an intensive intervention program over a period of four or more years and then graduate the dyslexic children to public or independent high schools. These schools are quite expensive and while many of these schools offer some scholarship financial aid, for the most part their tuitions are out of the reach of most parents of dyslexic children. Within the last few years we have seen the creation of a new model, public charter schools specialised for dyslexia. The unique feature of these schools is that, as public schools, they are free for all students. The first such school, the Louisiana Key Academy in Baton Rouge, Louisiana, was started eight years ago and now houses grades first through eighth. Other school districts and municipalities are considering opening public schools specialised for educating dyslexic children. We discuss this in more detail in Overcoming Dyslexia, pp. 313–355 (S. Shaywitz & J. Shaywitz, [<reflink idref="bib64" id="ref97">64</reflink>]).</p> <p>Here's an example of how life-changing attending a specialised public charter school can be for a dyslexic as described in Overcoming Dyslexia 2nd edition. 'One little child in particular came in who couldn't read. Today he is a remarkable, profoundly changed child. He was smart and incredibly creative but wasn't able to communicate well, which he can now do with both his teachers and his peers. And he is able to read. So the hope of his parents is now dramatically increased, as is the child's self-esteem. Basically, he is no longer isolated. He's able to socially interact and have friends, which he was not able to do before. What encourages me the most is that we've changed this child's life just about 180 degrees. What concerns me is there are many more like him who remain unidentified and don't learn to read, and whose self-esteem is under constant attack.' (S. Shaywitz & Shaywitz, [<reflink idref="bib64" id="ref98">64</reflink>], p. 352).</p> <hd id="AN0145134200-19">Conclusion</hd> <p>Since its initial description by the British physician W. Pringle Morgan over a century ago, dyslexia has always been conceptualised as an unexpected difficulty in reading, a definition now codified in U.S. law (PL 115-391) as 'an unexpected difficulty in reading for an individual who has the intelligence to be a much better reader ... ' Validation of the unexpected nature of dyslexia comes from data demonstrating that in typical readers IQ and reading are dynamically linked, while in dyslexic readers, IQ and reading diverge. Functional brain imaging studies from laboratories around the world have demonstrated a neural signature of dyslexia, specifically an inefficient functioning of those posterior neural systems for skilled reading. Significantly, these brain imaging studies have for the first time made visible what had previously been a hidden disability, confirming what over a century of clinical reports have always shown – dyslexia is real. Recent evidence that the achievement gap between typical and dyslexic readers occurs as early as first grade and persists mandates early, evidence-based screening for dyslexia. U.S. federal law defines criteria for an effective screener and evidence-based screening carried out by the child's teacher in kindergarten and first grade offers the possibility of early universal screening for dyslexia. The development of public charter schools specialised for educating children with dyslexia now offers help for many dyslexic children previously only available to the few dyslexic children fortunate enough to attend independent schools specialised for dyslexia. Finally, we want to leave readers with the thought that while many of these scientific advances have informed educational policy, most important is the need to incorporate evidence into educational practices. No matter how good an intervention sounds, always ask: show me the evidence that it works.</p> <hd id="AN0145134200-20">Disclosure statement</hd> <p>No potential conflict of interest was reported by the authors.</p> <ref id="AN0145134200-21"> <title> References </title> <blist> <bibl id="bib1" idref="ref35" type="bt">1</bibl> <bibtext> ADA Amendments Act. (2008). Pub. L. No. 110–325. 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Woodcock-Johnson psycho-educational battery-revised (WJR). Developmental Learning Materials.</bibtext> </blist> </ref> <aug> <p>By Bennett A. Shaywitz and Sally E. Shaywitz</p> <p>Reported by Author; Author</p> <p></p> <p>Bennett A. Shaywitz , M.D., the Charles and Helen Schwab Professor in Dyslexia and Learning Development at Yale University and Co-Founder and Co-Director of the Yale Center for Dyslexia & Creativity, is an elected member of the National Academy of Medicine within the National Academies. He and Dr. Sally Shaywitz have been honoured with the Liberty Science Center 2019 Genius Award 'in recognition of your inspiring accomplishments and your pioneering work in advancing our understanding of dyslexia,' in 2018 profiled in the Scientists at Work section of the New York Times, and spoken about dyslexia at the World Economic Forum in Davos, Switzerland. His collaborative research with Dr. Sally Shaywitz' Connecticut Longitudinal Study (CLS) reveal both the neurobiological and cognitive underpinnings and economic and personal impact of dyslexia. A study in progress compares early cognitive and academic performance when the CLS subjects were age 5 years to measures in these very same individuals' who are now adults in their early 40s, offering a unique opportunity for unravelling which specific predictors relate to specific outcomes. Dr. Shaywitz stepped down as Chief of Child Neurology at Yale in 2015 to focus on increasing public awareness of 21st century scientific knowledge of dyslexia.</p> <p>Sally E. Shaywitz , M.D. is the Audrey G. Ratner Professor in Learning Development at Yale University and Co-Founder and Co-Director of the Yale Center for Dyslexia & Creativity. She is the author of over 350 scientific articles and chapters, as well as the award-winning, best-selling book Overcoming Dyslexia, 2nd edition, (Alfred A. Knopf, New York, 2020). Dr. Shaywitz is an elected member of the National Academy of Medicine within the National Academies and is annually selected as one of the Best Doctors in America. She has been honoured with the Liberty Science Center 2019 Genius Award 'in recognition of your inspiring accomplishments and your pioneering work in advancing our understanding of dyslexia,' and in 2018 profiled in the Scientists at Work section of the New York Times. She has served on the Congressionally-mandated National Reading Panel and Committee to Prevent Reading Difficulties in Young Children of the National Research Council and, by Presidential appointment on the National Board of the Institute for Education Sciences of the U.S. Department of Education. She has also spoken at the World Economic Forum in Davos, Switzerland. She served as Co-Chair, National Research Council Committee on Gender Differences in the Careers of Science, Engineering and Mathematics Faculty.</p> </aug> <nolink nlid="nl1" bibid="bib60" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib12" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib26" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib39" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib27" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib65" firstref="ref8"></nolink> <nolink nlid="nl8" bibid="bib43" firstref="ref9"></nolink> <nolink nlid="nl9" bibid="bib74" firstref="ref10"></nolink> <nolink nlid="nl10" bibid="bib75" firstref="ref11"></nolink> <nolink nlid="nl11" bibid="bib10" firstref="ref12"></nolink> <nolink nlid="nl12" bibid="bib31" firstref="ref13"></nolink> <nolink nlid="nl13" bibid="bib40" firstref="ref15"></nolink> <nolink nlid="nl14" bibid="bib30" firstref="ref16"></nolink> <nolink nlid="nl15" bibid="bib21" firstref="ref17"></nolink> <nolink nlid="nl16" bibid="bib62" firstref="ref18"></nolink> <nolink nlid="nl17" bibid="bib83" firstref="ref19"></nolink> <nolink nlid="nl18" bibid="bib84" firstref="ref20"></nolink> <nolink nlid="nl19" bibid="bib67" firstref="ref21"></nolink> <nolink nlid="nl20" bibid="bib23" firstref="ref22"></nolink> <nolink nlid="nl21" bibid="bib80" firstref="ref24"></nolink> <nolink nlid="nl22" bibid="bib63" firstref="ref25"></nolink> <nolink nlid="nl23" bibid="bib22" firstref="ref26"></nolink> <nolink nlid="nl24" bibid="bib24" firstref="ref27"></nolink> <nolink nlid="nl25" bibid="bib25" firstref="ref28"></nolink> <nolink nlid="nl26" bibid="bib73" firstref="ref29"></nolink> <nolink nlid="nl27" bibid="bib58" firstref="ref30"></nolink> <nolink nlid="nl28" bibid="bib57" firstref="ref31"></nolink> <nolink nlid="nl29" bibid="bib13" firstref="ref32"></nolink> <nolink nlid="nl30" bibid="bib16" firstref="ref33"></nolink> <nolink nlid="nl31" bibid="bib64" firstref="ref34"></nolink> <nolink nlid="nl32" bibid="bib81" firstref="ref36"></nolink> <nolink nlid="nl33" bibid="bib66" firstref="ref37"></nolink> <nolink nlid="nl34" bibid="bib72" firstref="ref38"></nolink> <nolink nlid="nl35" bibid="bib18" firstref="ref41"></nolink> <nolink nlid="nl36" bibid="bib28" firstref="ref42"></nolink> <nolink nlid="nl37" bibid="bib41" firstref="ref43"></nolink> <nolink nlid="nl38" bibid="bib61" firstref="ref45"></nolink> <nolink nlid="nl39" bibid="bib52" firstref="ref46"></nolink> <nolink nlid="nl40" bibid="bib53" firstref="ref47"></nolink> <nolink nlid="nl41" bibid="bib45" firstref="ref48"></nolink> <nolink nlid="nl42" bibid="bib48" firstref="ref49"></nolink> <nolink nlid="nl43" bibid="bib47" firstref="ref50"></nolink> <nolink nlid="nl44" bibid="bib59" firstref="ref51"></nolink> <nolink nlid="nl45" bibid="bib44" firstref="ref52"></nolink> <nolink nlid="nl46" bibid="bib33" firstref="ref53"></nolink> <nolink nlid="nl47" bibid="bib69" firstref="ref55"></nolink> <nolink nlid="nl48" bibid="bib70" firstref="ref56"></nolink> <nolink nlid="nl49" bibid="bib71" firstref="ref57"></nolink> <nolink nlid="nl50" bibid="bib37" firstref="ref58"></nolink> <nolink nlid="nl51" bibid="bib82" firstref="ref59"></nolink> <nolink nlid="nl52" bibid="bib17" firstref="ref60"></nolink> <nolink nlid="nl53" bibid="bib46" firstref="ref64"></nolink> <nolink nlid="nl54" bibid="bib32" firstref="ref67"></nolink> <nolink nlid="nl55" bibid="bib34" firstref="ref68"></nolink> <nolink nlid="nl56" bibid="bib35" firstref="ref69"></nolink> <nolink nlid="nl57" bibid="bib49" firstref="ref70"></nolink> <nolink nlid="nl58" bibid="bib54" firstref="ref71"></nolink> <nolink nlid="nl59" bibid="bib55" firstref="ref72"></nolink> <nolink nlid="nl60" bibid="bib76" firstref="ref73"></nolink> <nolink nlid="nl61" bibid="bib77" firstref="ref74"></nolink> <nolink nlid="nl62" bibid="bib36" firstref="ref75"></nolink> <nolink nlid="nl63" bibid="bib38" firstref="ref80"></nolink> <nolink nlid="nl64" bibid="bib56" firstref="ref81"></nolink> <nolink nlid="nl65" bibid="bib29" firstref="ref83"></nolink> <nolink nlid="nl66" bibid="bib42" firstref="ref84"></nolink> <nolink nlid="nl67" bibid="bib14" firstref="ref85"></nolink> <nolink nlid="nl68" bibid="bib19" firstref="ref86"></nolink> <nolink nlid="nl69" bibid="bib20" firstref="ref88"></nolink> <nolink nlid="nl70" bibid="bib50" firstref="ref89"></nolink> <nolink nlid="nl71" bibid="bib51" firstref="ref90"></nolink> <nolink nlid="nl72" bibid="bib15" firstref="ref92"></nolink> <nolink nlid="nl73" bibid="bib79" firstref="ref93"></nolink> <nolink nlid="nl74" bibid="bib78" firstref="ref94"></nolink> <nolink nlid="nl75" bibid="bib68" firstref="ref96"></nolink>
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  Data: The American Experience: Towards a 21st Century Definition of Dyslexia
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: 18
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  Data: Journal Articles<br />Reports - Evaluative
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  Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="EL" term="%22Elementary+Education%22">Elementary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Kindergarten%22">Kindergarten</searchLink><br /><searchLink fieldCode="EL" term="%22Primary+Education%22">Primary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Grade+1%22">Grade 1</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Definitions%22">Definitions</searchLink><br /><searchLink fieldCode="DE" term="%22Dyslexia%22">Dyslexia</searchLink><br /><searchLink fieldCode="DE" term="%22Laws%22">Laws</searchLink><br /><searchLink fieldCode="DE" term="%22Policy+Formation%22">Policy Formation</searchLink><br /><searchLink fieldCode="DE" term="%22Evidence+Based+Practice%22">Evidence Based Practice</searchLink><br /><searchLink fieldCode="DE" term="%22State+Legislation%22">State Legislation</searchLink><br /><searchLink fieldCode="DE" term="%22Federal+Legislation%22">Federal Legislation</searchLink><br /><searchLink fieldCode="DE" term="%22Reading+Difficulties%22">Reading Difficulties</searchLink><br /><searchLink fieldCode="DE" term="%22Learning+Disabilities%22">Learning Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Screening+Tests%22">Screening Tests</searchLink><br /><searchLink fieldCode="DE" term="%22Minimal+Brain+Dysfunction%22">Minimal Brain Dysfunction</searchLink><br /><searchLink fieldCode="DE" term="%22Intelligence+Quotient%22">Intelligence Quotient</searchLink><br /><searchLink fieldCode="DE" term="%22Professional+Development%22">Professional Development</searchLink><br /><searchLink fieldCode="DE" term="%22Response+to+Intervention%22">Response to Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Schools%22">Special Schools</searchLink><br /><searchLink fieldCode="DE" term="%22Kindergarten%22">Kindergarten</searchLink><br /><searchLink fieldCode="DE" term="%22Grade+1%22">Grade 1</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink>
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  Data: We review the evolution of the conceptualisation of dyslexia and along with it the current, 21st century definition of dyslexia. Our starting point is the seminal report by Pringle Morgan in 1896, followed by early 20th century reports by Hinshelwood, and continuing with concepts of brain injury and minimal brain dysfunctions then to the emergence of 'learning disability' in the mid-20th century. Within this historical framework we note the emergence and scientific validation of an 'unexpected' model culminating in the first definition of dyslexia in U.S. federal law in late 2018 and in recent U.S. federal civil rights law. We next address the issue of whether dyslexia is 'real' by showing how advances in non-invasive functional brain imaging have led to a replicated, robust neural signature for dyslexia. We close by illustrating how science has informed policy, emphasising the focus on evidence-based practices beginning with the report of the National Reading Panel and including the creation of the What Works Clearinghouse. Early screening for dyslexia represents another important policy accomplishment with dyslexia laws now passed in over 30 states. Evidence-based effective interventions for dyslexia, including free, public charter schools specialised for dyslexic children exemplify the most recent policy initiative.
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        Value: 10.1080/03054985.2020.1793545
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 18
        StartPage: 454
    Subjects:
      – SubjectFull: Definitions
        Type: general
      – SubjectFull: Dyslexia
        Type: general
      – SubjectFull: Laws
        Type: general
      – SubjectFull: Policy Formation
        Type: general
      – SubjectFull: Evidence Based Practice
        Type: general
      – SubjectFull: State Legislation
        Type: general
      – SubjectFull: Federal Legislation
        Type: general
      – SubjectFull: Reading Difficulties
        Type: general
      – SubjectFull: Learning Disabilities
        Type: general
      – SubjectFull: Screening Tests
        Type: general
      – SubjectFull: Minimal Brain Dysfunction
        Type: general
      – SubjectFull: Intelligence Quotient
        Type: general
      – SubjectFull: Professional Development
        Type: general
      – SubjectFull: Response to Intervention
        Type: general
      – SubjectFull: Special Schools
        Type: general
      – SubjectFull: Kindergarten
        Type: general
      – SubjectFull: Grade 1
        Type: general
      – SubjectFull: Young Children
        Type: general
    Titles:
      – TitleFull: The American Experience: Towards a 21st Century Definition of Dyslexia
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          Numbering:
            – Type: volume
              Value: 46
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Oxford Review of Education
              Type: main
ResultId 1