Dyslexia: An invisible disability or different ability

Abstract

Background:

With a global dyslexia prevalence of at least 10%, significant numbers of students with dyslexia go undiagnosed and their symptoms unaddressed, but with timely intervention, 90% of dyslexic children can be educated in regular inclusive classrooms.

Aim:

This study aimed to estimate the prevalence of dyslexia among primary schoolchildren in government and private schools.

Material and Methods:

A cross-sectional study on 128 primary schoolchildren attending selected government and private schools in Western Maharashtra was conducted and evaluated using the Search tool, which is a standardized study tool for screening dyslexia. Microsoft Excel and MedCalc version 3.1 were used for data entry and analysis. The prevalence of dyslexia was estimated, and differences between groups were evaluated using appropriate tests.

Results:

Of the total sample size of 128 children, findings showed 10.9% of students as dyslexic, 9.3% as vulnerable, and the remaining 79.8% as non-dyslexic. Of 14 dyslexic children, 10 were found to be from government schools and the remaining four were from private schools.

Conclusion:

The high prevalence of dyslexia even in a small study sample size is a matter of concern and emphasizes the need for extensive research and initiatives, including awareness campaigns among teachers, parents, and school authorities, and the importance of detection of undiagnosed dyslexic children as early as possible and providing them with appropriate interventions.

Dyslexia is a learning disability that affects the ability to read, write, spell, and even speak. According to the International Dyslexia Association, dyslexia has a prevalence of about 10%. The dyslexic child's limitations restrict him or her from accomplishing academic expectations, leaving him or her overwhelmed and insignificant. This frequently elicits feelings of anger or distress, which leads to low self-worth, isolation from peers, and uncertainty about the child's capabilities if dyslexia remains under the radar.[1,2] Several studies[3,4,5,6] from various parts of the world highlight on the high prevalence of dyslexia among children ranging from 3.9% to 27%. According to the Dyslexia Association of India,[7] research showed that 10–15% of Indian children are dyslexic. Other studies[8,9,10] conducted in India also show similar findings, with prevalence ranging from 6% to 13.67%. Numerous educational strategies can be accessed that can be helpful for dyslexic learners. Kindergarten is an ideal time to identify children who may have reading issues and offer intervention initiatives. Children identified as at-risk for reading issues in kindergarten benefited from classroom-based intervention programs that focused on phonological awareness, vocabulary, and reading skills.[11] Although dyslexia is a significant educational issue and a hidden disability, there is very little research concerning it in India. In addition, the coronavirus disease 2019 (COVID-19) pandemic has adversely affected the education sector, including school enclosure and online classes, which might have aggravated the situation even more. Hence, we found our study to be the need of the hour to evaluate the dyslexia situation during the post-COVID-19 period and thereby emphasize the importance of detecting undiagnosed dyslexic schoolchildren as early as possible and providing them with needed assistance.

MATERIAL AND METHODS

This cross-sectional study was conducted in selected schools of Western Maharashtra from November 2022 to April 2023. Besides attaining prior approval from the Institutional Ethical Committee (I.E.S.C/147/2022 dated 12/11/2022) before the start of the study, verbal consent from the students, along with written informed consent from the respective school authorities, was also obtained as a part of the study.

The sample size was calculated using WINPEPI VI 1.65 software, with a prevalence of 13.67%[8] and an acceptable difference of 6% within 95% confidence interval (CI), and the minimum sample was calculated to be 126. We enrolled 128 children for this study. Stratified random sampling was performed—initially, the field area will be divided into a list of equal numbers of government and private schools, followed by random selection of an equal proportion of students from classes III and IV. The sample selection process is described in the following flow chart [Figure 1].

Figure 1.

Sample selection process

A total of 128 schoolchildren belonging to classes III and IV in the selected private and government schools were included in the study. Exclusion criteria included students who are suffering from illnesses, noncooperative students, and absentees.

A semi-structured questionnaire covering sociodemographic details—age and sex of the students—was used. The standard study tool used was the Search tool,[6] scanning instrument for identifying potential learning disabilities. The present composition was defined to include 10 components. The evaluation was based on total Search tool scores.

Statistical analysis

All data are presented in the form of numbers and percentages. Data were entered in Microsoft Excel and analyzed using MedCalc software (version 3.l). Frequency and percentage were calculated for the nominal variables, and descriptive statistics were calculated for the quantitative variables.

RESULTS

The study was conducted among 128 schoolchildren attending government and private schools in Western Maharashtra. The sociodemographic variables included the age and gender of the schoolchildren. The mean age of the children is 8.58 years with a standard deviation (SD) of 0.508. The minimum age is 8 years, and the maximum age is 10 years. Of 128 students, 10.9% of students are dyslexic, 9.3% are vulnerable and non-dyslexic (at risk), and the remaining 79.8% are non-dyslexic and non-vulnerable [Table 1]. Of the total, 39.1% were females and 60.9% were males, while among 14 dyslexic children, 71.4% were males and 28.6% were females [Table 2]. Fisher's test was used to determine any association between dyslexia and gender. There was no statistically significant association between them (P = 0.56; >0.05). 9.3% of government schoolchildren are dyslexic, while only 1.5% of private schoolchildren are found to be dyslexic among 128 children [Table 3]. Of the 14 dyslexics, the majority were students at government schools (85.7%), leaving a minority of dyslexic students in private schools (14.3%). Using Fisher's test, it was found that there was a statistically significant association between dyslexia and government schoolchildren (P = 0.008; <0.05).

Table 1.

Distribution of dyslexia among the study population

Category (n=128)	n (%)	95% CI
Dyslexia	14 (10.9)	6.11-17.67
Non-dyslexic Vulnerable (at risk)	12 (9.3)	4.94-15.80
Non-dyslexic Non-vulnerable	102 (79.8)	71.67-86.28

Table 2.

Distribution of gender among the study population

Category (n=128)	Female	Male	Total	P-value
Dyslexia	4	10	14 (10.9%)	P=0.56; >0.05
Non-dyslexic	46	68	114 (89.1%)
	50 (39.1%)	78 (60.9%)	128

Table 3.

Distribution of dyslexia among government and private schoolchildren

Category (n=128)	Government school	Private school	Total	P-value
Dyslexia	12	2	14 (10.9%)	P=0.008, <0.05
Non-dyslexic	52	62	114 (89.1%)
	64 (50.0%)	64 (50.0%)	128

DISCUSSION

The 4-year-old child who battles to learn their letters evolves into a 4-year-old child who struggles to associate letters with sounds. By the time, she is 11 years old, and she is the child who prefers to lurk in the school restroom than reading text in class. At age 18, her severely poor reading makes it practically hard to accomplish major examinations in the given timeframe, jeopardizing her chances of getting an education and finding her full potential. This predicament is preventable if the dyslexic child gets diagnosed early and receives appropriate intervention.[2]

The finding of a 10.9% prevalence of dyslexia among schoolchildren in Western Maharashtra in this study is in agreement with a few earlier studies. Using a mix of search phrases linked to developmental dyslexia (DD) and prevalence, in studies from the 1950s to June 2021 a meta-analysis was performed. The pooled prevalence of DD was 7.10 percent (95% CI: 6.27—7.97%).[3] As per the studies conducted at NILD University, USA, using the Search tool, approximately 27% of the entire kindergarten grades of their standardization sample are vulnerable to learning failure.[6] An Asian study[12] reported that the prevalence of dyslexia and probable dyslexia was 6.3% and 12.6%, respectively.

Few Indian studies conducted on dyslexia also highlight the higher prevalence of dyslexia. The prevalence of dyslexia and probable dyslexia among 400 schoolchildren in Mysore was 13.67%.[8] The prevalence and pattern of learning disabilities in schoolchildren study showed that the prevalence of dyslexia was 21.62%,[13] while a previous study showed a prevalence of 5–15%.[14] The prevalence rate varies throughout research, which may be due to the use of various cutoff points on the spectrum of dyslexia in different studies and because of the heterogeneous nature of samples of poor readers.

This study shows no gender correlation with dyslexia (P > 0.05). This finding was also noticed by an earlier study, which concluded that when gender is considered there is no difference in the prevalence of learning disorder.[13] This was a variation observed in comparison with other studies the reason being the limited sample size. A cross-sectional study conducted in China on the estimate and associated risk factors of dyslexic students showed the gender ratio (boys to girls) as nearly 3:1 (P < 0.01).[4] A similar study conducted in Thailand reported the male-to-female ratio of dyslexia as 3.4:1.[12] Kumar J et al.[10] also reported that the prevalence of dyslexia is higher among children, especially among male children. Similar findings were also reported from a study conducted in Chandigarh.[15] This finding may be explained by the greater variance in males' reading performance.

Another statistically significant finding in our study was the higher prevalence of dyslexia among government schoolchildren compared with private schoolchildren. A similar study on dyslexia among early adolescents in government and private schools of Kathmandu showed that, compared to private schools, government schoolchildren had a higher proportion of dyslexia.[16] These findings might point out the lack of teaching facilities, early stimulation teaching, trained psychological counselors, or even the genetic background, which requires further research.

From the observations made during the study and considering the results and discussions of the present study, the following few recommendations are advised:[17] There is a need for compulsory screening measures at the school level specific to Indian conditions. Teachers must have the competence to recognize students with dyslexia and provide them with the appropriate support by fostering an inclusive learning environment. Health education to parents regarding this condition and the need to provide them with emotional and educational support are necessary. Educational psychologists should be credentialed and educated to identify dyslexia and use various strategies for the successful management of dyslexic children. Legislative action must be taken, and awareness campaigns must be run.

Limitations

This is a short-term study with a small sample size from one geographical location. In addition, the degree of disability was not taken into account.

CONCLUSION

It is evident from the study that there is an increasing prevalence of dyslexia among children and the key to supporting those with dyslexia in prospering academically and throughout life is early detection and effective intervention. Therefore, the need of the hour is to create awareness about dyslexia among teachers, parents, and school authorities, with future developments emphasizing various aspects including classroom diagnosis, inclusive education, individualized education program, multidisciplinary approach, and home–school partnerships.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.