For dyslexia, writing is often on the wall from birth

Writing on the wall-shutterstock_345548735-croppedSome 5 to 17 percent of all children have developmental dyslexia, or unexplained reading difficulty. When a parent has dyslexia, the odds jump to 50 percent. Typically, though, dyslexia isn’t diagnosed until the end of second grade or as late as third grade — when interventions are less effective and self-esteem has already suffered.

“It’s a diagnosis that requires failure,” says Nadine Gaab, PhD, an investigator in Boston Children’s Hospital’s Laboratories of Cognitive Neuroscience.

But a new study led by Gaab and lab members Nicolas Langer, PhD, and Barbara Peysakhovich finds that the writing is on the wall as early as infancy — if only there were a way to read it and intervene before the academic, social and emotional damage is done.

In 2012, the Gaab Lab showed that pre-readers with a family history of dyslexia (average age, 5½) have differences in the left hemisphere of their brains on magnetic resonance image (MRI). “The first day they step in a kindergarten classroom, they are already less well equipped to learn to read,” Gaab says.


Some researchers have proposed that the difference reflects being raised by a dyslexic parent — perhaps, for example, being read to less. But could the difference be innate? To get at this question, Gaab and colleagues performed advanced MRI brain imaging on 14 infants with a family history of dyslexia and 18 infants of similar age with no such family history.

Since infants need to be completely still inside the scanner, this required an elaborate protocol, developed with the help of Ellen Grant, MD, director of the Fetal-Neonatal Neuroimaging and Developmental Science Center at Boston Children’s. Parents brought their babies in for scanning before their best naptime, early enough that they wouldn’t fall asleep in the car, and settled them in a space that tried to mimic the babies’ home sleep environment. Time was built in to allow babies to get used to the sound of the MRI machine. Finally, once parents got their babies off to sleep, Gaab’s team carefully slid the infants into the scanner. This strategy works about 70 percent of the time.

The MRI scan included an advanced technique called diffusion tensor imaging (DTI). It measures the flow of water molecules along the brain’s fiber tracts, and gives a good indication of how the fibers are structured and oriented and how well information is flowing in the brain.

The arcuate fasciculus in a child with a family history of dyslexia (L) versus no family history (R)
The arcuate fasciculus in a child with a family history of dyslexia (L) versus no family history (R), as seen on DTI

Arcuate fasciculus aloneAs reported today in the journal Cerebral Cortex, the scan found alterations in a particular structure called the arcuate fasciculus, a bundle of fibers that connect the posterior cortex, which is involved in mapping sounds and word/letter recognition, with the frontal cortex, which integrates and comprehends this information.

Detailed segmentation of the images revealed that fibers in certain areas of the arcuate fasiculus, shown at right as red bands, were consistently less organized.

People who have suffered damage to the arcuate fasciculus are known to have problems with expressive and receptive language and with phonological processing — the ability to manipulate the sounds of a language, a critical part of learning to read. In infants with familial dyslexia, inherited genes may interfere with the development of the arcuate fasciculus before birth, says Gaab, impairing its structural integrity.

“The street could be full of potholes, or it could be the street is narrow or has a really crappy surface, or there might be a lot of intersections where you have to stop,” she says.

But biology isn’t necessarily destiny. Research shows that with early interventions, 50 to 90 percent of children with dyslexia can become good readers, says Gaab. There are even studies indicating that the interventions lead to normalization of white matter pathways in the brain’s left hemisphere. But although public health studies support early intervention for dyslexia, many schools shy away from screening, lacking the resources to test and intervene.

“We hope this study will help show that kids should get interventions before kindergarten,” says Gaab. “We’re not saying you should scan every kindergartener, but if you have a strong family history, you could potentially have a five-minute DTI scan to see if you are at risk.”

  • I find that a majority of these so called dyslexic kids are kids who have disengaged from learning to read in the English language because teachers do not teach letter sounds correctly. If letter sounds are taught correctly these students will learn to read as well as the rest of the kids. Teachers teach one sound of the alphabets and expect all kids to learn to read when other sounds have not been taught. This is basically why about 20% of kids fail to read. Having been taught E is for elephant these kids get confused when they are taught E as in eel/equal; E as in earn/earth/early; E as in eighty/eighteen/eighty;E as in either; E as in ewe. If the teachers tell them that all vowels and some consonants have more than one sound a majority of these so called dyslexic kids will be able to learn to read as they will not be confused when a new sound is introduced.
    Read more in my blog at:

    • Tricia McLeod

      You are very sadly oversimplifying a very serious problem. Teaching the idea that vowels have more than one sound, while necessary, is simple not adequate. Please educate yourself. This is a serious and very real issue that affects many, many children and pretending it doesn’t exist as you suggest has led to generations of children being overlooked without gaining help. Stop the madness and misinformation.

      • Michelle Moore

        Agreed. 2 children dyslexic, one learned in third grade, the other pre-K, both at with Dr. Lyman’s motor/speech movement techniques COMBINED WITH teaching phoneme and dipthong sounds. Pre-K read at the top 3 of his Kindergarten class, and is reading grade level in 2nd grade. Third grade is in 7th grade now and reads very slowly, and cannot spell.