OCCUPATIONAL THERAPY FOR CHILDREN WITH DYSLEXIA
Occupational Therapy for Primary School-Age Children with Dyslexia
Primary school-age children lead demanding and challenging lives. During these “middle years” of childhood, the foundation for adult roles in work, recreation, and social interaction is laid. Great development strides are made during these years when children develop competencies in physical, cognitive, and psychosocial skills.
The developmental changes between ages 6 and 18 are diverse and span all areas of growth and development. Physical, psychosocial, cognitive, and moral skills are developed, expended, refined, and synchronized so that the individual may become an accepted and productive member of the society. The environment in which the individual develops skills also expands and diversifies. Instead of the boundaries of family and close friends, the environment may now include the school, community, and the church. Because of expectations for development, increasing skill and knowledge base, and environmental expansion, the individual experiences new difficulties and dilemmas.
The school or educational experience expands the child’s world and is a transition from a life of relatively free play to a life of structured play, learning, and work. The school and home influence growth and development, requiring adjustment by the parents and the child.
Cognitive changes provide the school-age child with the ability to think in a logical manner about the here and now and to understand the relationship between things and ideas ( & , 2004). The thoughts of school–age children are no longer dominated by their perceptions, and thus their ability to understand the world greatly expands.
However, in some instances this development does not follow the normal way. Learning disabilities or disorders related to language occur in some children. A specific learning disability is a disorder of the processes involved in understanding and using language, including listening, thinking, speaking, reading, writing, and doing mathematical calculations. Children with learning disabilities often display major discrepancies between their intellectual abilities and academic achievements, which cannot be explained by sensory-motor or cognitive disorders. Frequently, this discrepancy causes difficulty in oral or written expression, reading or listening comprehension, and social skills (, 2006).
Dyslexia is an example of a learning disability related to reading which occurs in children. Dyslexia is the most common and perhaps least understood reading disability. It is a condition in which an individual with normal vision is unable to interpret written language and therefore is unable to read. Dyslexic children are usually of normal or better intelligence. Their inability to read is inconsistent with their achievement in other school subjects, such as arithmetic. Spelling ability may or may not be impaired. Sensory deficits and neurological impairment are absent. Confusion in orientation of letters is the prime characteristic. This is manifested by reading from right to left, failure to see (and sometimes to hear) similarities or differences in letters or words, or inability to work out the pronunciation of unfamiliar words. A better-than-normal facility at mirror-reading or -writing is common. Symptoms of frustration are inevitable. The reading disability and its effects on learning and school performance of the child may lead to behavioral problems, delinquency, aggression, withdrawal, and alienation from other children, parents, and teachers.
Most studies of reading disability in children have focused on language processing tasks, as opposed to visual-perceptual processing. Children with dyslexia have difficulties processing the phonological level of language. In other words, their difficulty lies primarily in processing at the level of speech sounds as opposed to, for instance, semantics. Individuals with dyslexia are slower and less accurate than typical readers at phonological coding--that is, computing the pronunciation of a visual letter string. They also show reduced phonological awareness; that is, they are slower and less accurate at analyzing or blending the component sounds of words (, 2004)
Depending on the degree or condition of the dyslexia, there are differing modes of intervention that are commonly used to restore, improve, or maintain levels of occupational performance for the given scenario. On a basic level, any method that helps children to concentrate on a reading task and excludes distractions should be helpful. Specifically, programs that help children to form sharper perceptual categories for sounds and letters could supplement existing dyslexia interventions (, 2005).
Compensation on a functional level involves the occupational therapist helping the child to develop cognitive strategies to bypass the effects of the deficit or to enhance functioning by using areas of strength to make up for cognitive limitations. Compensation on a psychological level refers to helping the child manage the stigma and feelings related to experiencing difficulty and failure with learning that negatively affect self-esteem. Development of the personality or sense of self is largely influenced by how well the child is able to function in areas affected by the disorder. Chronic functional difficulties appear to result in low self-esteem, which is the most common psychological problem for persons with dyslexia (, 2003).
Significant and effective attention to functional concerns by occupational therapists and other caregivers appears to promote adaptation, positive self-esteem, and positive self-narratives, resulting in success in areas of difficulty and acceptance of the learning disability (, 2001). Insufficient attention to functional concerns can result in poor adaptation, low self-esteem, and negative self-narratives. Under those circumstances, an individual is ostensibly more likely to deny or even disavow the learning disability. Persons with learning disabilities may employ either or both of these defense mechanisms to protect self-esteem due to the experience of failure and to fears of being identified as or feeling "lazy," "stupid," "crazy," or even "mentally retarded."
The role of caregivers, such as parents, occupational therapists and other professionals, is to help persons with dyslexia function, adapt, and compensate and to encourage positive self-esteem and self-narratives. When occupational therapists work with children, they should consider the developmental abilities of the child and the condition that is present in the child. If possible, a parent or a guardian of the child should be around during therapy sessions.
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