“Adult persons with Dyslexia.
University and work place. Same
problems? Different
possibilities?”
Enrico Ghidoni, MD
Associazione Italiana Dislessia
Ghidoni.enrico@alice.it
Adult dyslexics in Italy
• Estimated prevalence of Dyslexia in Italy is
3 %.
• But in 2 out of 3 cases Dyslexia isn’t
recognized at school.
• So there are a lot of unrecognized adult
dyslexics (in universities, at work, in social
life…).
• Dyslexia may be compensated but the
neurobiological substrate is still present.
Questions about adult dyslexia 1
• What are the cognitive and psychological
characteristics of adult dyslexics?
• Is the adult dyslexia profile different from that in
the developmental age?
• What are the parameters for diagnosis (reading
time, speed, accuracy…)?
• How many parameters must be abnormal to
diagnose dyslexia?
• What tools to measure these parameters?
Questions about adult dyslexia 2
• Can Compensation make the disorder
undetectable using any tool?
• How can we define diagnostic
subcategories such as mild, moderate and
severe dyslexia or phonological,
superficial dyslexia……
• What are the residual patterns of each
SLD?
Questions about adult dyslexia 3
• Are there adult dysfunctional patterns due to
SLD which are unclassifiable according to
common categories?
• Is there a specific history pattern for every SLD?
• What kind of aid and support for adult SLD?
• What compensatory tools are really effective?
• To what extent is research on English-speaking
dyslexics transferable to our context?
Questions about adult dyslexia 4
• What is the natural history of dyslexia?
• Is there any advantage for those who have
received a diagnosis and support?
• Are there predictive factors for the evolution
of dyslexia in adult age?
Adult dyslexics – the facts
• Persistent phonological dysfunction
• Variable effect on life activities (study and
work)
• Psychological fall-out
• Personal coping
D. Pollak: Four types of
dyslexic student:
• The ‘patient’
• The ‘student’
• The ‘hemispherist’
• The ‘campaigner’
Pollak
• Those I called ‘patients’ had internalised a medical
view of dyslexia; they saw themselves as suffering
from a condition which made them defective.
• The next group, I called ‘students’; they focused on
the discrepancy between their IQ and their scholastic
attainments, and regarded dyslexia as something
which affected them only in an educational context.
• The ‘hemispherist’ group were good at
metacognition, i.e. analysing the ways in which they
learned; they were aware of their own strengths, for
example in visualisation and holistic thinking.
• The fourth group, I called ‘campaigners’; they viewed
dyslexia as a political issue, and were determined to
fight for their right to be taught and assessed in
dyslexia-friendly ways.
McLoughlin et al’s four types of
dyslexic adult:
•
•
•
•
unaware that they are dyslexic, and
thus have no strategies for success
aware that they are dyslexic, but still
have no strategies
aware that they are dyslexic, and have
unconscious strategies
aware that they are dyslexic, and
make conscious use of good strategies.
Critical issues for adult
diagnosis in Italy
• Adults (>18 ) are not treated by health services
for childhood and adolescence
• There are hardly any standardized tests for
subjects over 18.
• There is little interest in neuropsychology
laboratories for adult neurological diseases
• The examination batteries for adult acquired
dyslexia were conceived to evaluate disorders
which are very different from developmental
dyslexia.
Diagnostic demand
• University and College students who want to
take advantage of accommodations now
available in many universities;
• Students who have to take exams (state exams,
public selections, driving license);
• Adults who wish to go back to school to obtain
secondary school qualifications;
• Parents of DYS children who want to understand
their own difficulties
Screening in adults
• Adult Dyslexia Check List, Vinegrad
(ADCL) 1994
• Adult Reading History Questionnaire, Lefly
& Pennington, 2000
• Lucid Adult Dyslexia Screener (LADS)
Singleton, 2002
• On-line Questionnaires, Kasler e Fawcett,
2009
Project
Adult Dyslexia Diagnosis
• Associazione Italiana
Dislessia
• University of Modena and
Reggio E.
• Arcispedale S. Maria
Nuova, U.O. Neurology
Unit, Neuropsychology Lab
Project phases
1
Standardization study
regarding controls
2
Identification of
sensitive tests
(controls/dyslexics
comparison)
3
Clinical study on adults,
students or other
1. Standardization study
• Control group: N = 80 (AVIS volunteers,
students, hospital staff)
• Mean values and standard deviation
(percentiles for error scores)
• Four age groups: 18-24; 25-34; 3544; 45-54
• Cut-off: - 2 standard deviations;
• 95° percentile for error scores
Test sensitivity
(% positive results )
• ADCL 93%
• Text Reading:
•
time 56%
•
errors 38%
•
speed 48%
• Word lists: time 52%
•
errors
40%
•
speed
31%
• Non words time 69%
•
errors
37%
•
speed
52%
• Allographs time40% • Non word writing 29%
Test sensitivity
(% positive results )
•
•
•
•
RAN:
Digits time
31%
Letters time
29%
Colours time 35%
• Word Span
13%
• Visual search
matrices
27%
•
•
•
•
•
•
•
•
N&D 1 time 29%
N&D 2 time 21%
N&D 2 time 23%
N&D 3 time 33%
N&D 3 errors 40%
Backward counting:
time 27%
errors 44%
3. Clinical study:
Examination procedure
•
•
•
•
Clinical interview
Family history
Personal history (medical and educational)
Neuropsychological history (previous and
current trouble)
• Preliminary tests (ADCL, Raven PM38,
Oldfield, Beck DI, Hamilton Anxiety)
DD Adult Basic Battery
•
•
•
•
•
•
•
Text, word list, non word reading
Allograph Comparison
Text comprehension
Non word writing
RAN (digits, letters, colours)
Night & Day attention test
Counting backwards
Additional Investigation
• Questionnaire /partially structured
interview about self narrative
• Central Auditory Processing Disorder
Checklist
• Psychological tools to evaluate affective
relational aspects (BDI, Hamilton )
Single case in depth study
• Calculation (dyscalculia battery)
• Short term memory(digit span, Corsi’s cubes,
word span; dual task)
• Long term Memory (verbal, visuo-spatial…)
• Language (fluency, naming, metaphors
comprehension , verbal judgements, etc)
• Writing (Luzzatti test)
• Attention (Visual Matrices, Stroop, Trail making)
• Intelligence (WAIS-R)
• Visuo-spatial functions (Benton line orientation,
Rey’s figure)
University Students (N 37)
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•
•
•
•
•
•
•
•
•
•
Primary Education
Engineering
Architecture
Economics
Communications
Law
Arts
Medicine; Veterinary
Psychology
Sociology
Nursing studies; Physical Education
7
5
3
3
3
3
3
3
3
2
2
Dyslexia at University
• An increasing number of DYS students
• Dynamics of Relationship with peers,
teachers, administration
• Support measures and tools
• Tutoring, Negotiation, Mediation
(Singleton, 2009)
In Italy :estimated prevalence amongst university students 1%
Results in our sample
• Dyslexics are present in all degree
courses.
• There is a high rate of “new” diagnoses
(over 60% of cases)
• Academic and psychological problems
are more evident if dyslexia is
associated with dyscalculia
In the workplace
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•
•
•
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Compensations and strategies
A misunderstood style of work
“I need more time!”
Silly mistakes and managerial ability
Negative stigmatization
Choosing an occupation
Disclosure and acceptance
The world of adult dyslexics
• A wide variety of ways of experiencing and
understanding one’s own dyslexia (Fulgeri,
2010; Cardano, 2010)
• Discovery or creation of the niche
• Finding the right social and professional
niche improves functional and
psychological compensation
Personal experience
• Self narratives as a tool for reconstructing
one‘s own identity
• To what extent is identity building
conditioned by dyslexia?
• Diagnosis may be a turning point in life, a
biographical transition.
Dyslexic identities
The social reality of dyslexia
• Cultural evolution
• Awareness of neurobiological ontology
• Protection and support require the
recognition of the difference (labelling)
• Anti-label positions
• Labelling and stigma: which comes first?
• Ideology and stereotypes
Reggio Emilia, Italy