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Dyslexia in the Context of Social Work: Screening and Early Intervention

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Abstract

Dyslexia, the most common learning disability, is associated with poor academic, economic, vocational, and health outcomes. Disproportionately, dyslexia is undiagnosed and untreated in children who are Black, Indigenous, and people of color (BIPOC) or who live in poverty. Early identification of and subsequent interventions for children at risk for dyslexia can effectively mitigate poor outcomes. While screening and interventions largely occur in schools, social workers across practice contexts have responsibilities to address dyslexia: identifying, referring, educating, and advocating. Social workers should address dyslexia to promote equity and improve quality of life and various outcomes across the life course. This paper describes dyslexia, early screening, and interventions; dyslexia as a social justice issue; and social workers’ roles in addressing dyslexia.
Dyslexia in the Context of Social Work: Screening and Early Intervention
Lisa Schelbe, Ph.D., MSW, Florida State University College of Social Work
(lschelbe@fsu.edu)
Jessica Pryce, Ph.D., MSW, Florida State University College of Social Work
(jpryce@fsu.edu)
Yaacov Petscher, Ph.D., Florida State University College of Social Work and Florida
Center for Reading Research (ypetscher@fsu.edu)
Hank Fien, Ph.D., University of Oregon (ffien@uoregon.edu)
Christopher Stanley, Ph.D, Florida State University (cstanley2@fsu.edu)
Brian Gearin, Ph.D., University of Oregon (bgearin@uoregon.edu)
Nadine Gaab, Ph.D, Harvard Graduate School of Education
(Nadine_gaab@gse.harvard.edu)
DYSLEXIA AND SOCIAL WORK 2
Abstract
Dyslexia, the most common learning disability, is associated with poor academic, economic,
vocational, and health outcomes. Disproportionately, dyslexia is undiagnosed and untreated in
children who are Black, Indigenous, and people of color (BIPOC) or who live in poverty. Early
identification of and subsequent interventions for children at risk for dyslexia can effectively
mitigate poor outcomes. While screening and interventions largely occur in schools, social
workers across practice contexts have responsibilities to address dyslexia: identifying, referring,
educating, and advocating. Social workers should address dyslexia to promote equity and
improve quality of life and various outcomes across the life course. This paper describes
dyslexia, early screening, and interventions; dyslexia as a social justice issue; and social workers’
roles in addressing dyslexia.
DYSLEXIA AND SOCIAL WORK 3
Dyslexia is the most common learning disability and is commonly understood as a brain-
based learning disability that specifically impairs a person's ability to decode single words or to
spell words in isolation (Peterson & Pennington, 2015). Dyslexia historically is reported as
affecting 5-17% of children (Cortiella & Horowitz, 2014; Shaywitz, 1998). Children with
dyslexia not only may struggle as they are learning to read, but also may experience additional
issues such as persistent poor educational outcomes and other challenges (Mugnaini et al., 2009).
The impact of these poor outcomes and challenges are often compounded for vulnerable and
underrepresented communities (Robinson, 2013; Rojas, 2018). Early identification through
screening for dyslexia has been repeatedly supported in the literature as part of best practices to
provide remediation and support to children who struggle learning to read (Petscher et al., 2019).
Screening for dyslexia is important because without early intervention, cumulative life-long
problems can occur (Miciak & Fletcher, 2020). Well implemented early screening approaches,
strategies for early identification/diagnoses, and evidence-based intervention techniques can lead
to positive outcomes and typical reading development in children at-risk for dyslexia (Wanzek et
al., 2015).
In the United States 48 states have adopted dyslexia legislation, and most require or
recommend screening for dyslexia. These legislative efforts are based on research that indicates
that through early screening for risk for dyslexia and interventions, it is possible to effectively
treat or mitigate the negative consequences associated with subsequent formal diagnoses of
dyslexia (Fien et al., 2021). Evidence exists that this early intervention and prevention
framework is effective across groups of children, including BIPOC children (Robinson, 2013;
Rojas, 2018). This evidence is particularly robust in early grades (Burns et al., 2020).
DYSLEXIA AND SOCIAL WORK 4
Unfortunately, in spite of recent state legislation requiring or recommending that all
children benefit from early screening and intervention for dyslexia, schools have not
implemented these practices at scale (Fien et al., 2021; Sedienberg et al., 2020; Solari et al.,
2020). This inordinately adversely affects BIPOC children (Rojas, 2018; Robinson, 2013) and
children living in poverty (Peterson & Pennington, 2015). Not providing screening and early
interventions to these populations contributes to the disproportionate under-identification of
these children and the widening of reading gaps. Professionals outside the field of education who
work with children and families, can help to ensure these children gain access to screening and
early intervention services. Pediatricians play an important role as they work with young children
and already are concerned with child development and well-being and can screen for risk for
dyslexia (Sanfilippo et al., 2020). Similarly, social workers are uniquely positioned to aid in
efforts in addressing dyslexia due to their work with children and families in diverse settings.
Social work has not traditionally focused on dyslexia, yet social workers across practice
settings play an important role in addressing it. This paper argues that dyslexia is a social justice
issue and should be a priority for social workers. After describing dyslexia, including the
inequity in identification, the paper argues that dyslexia is a social justice issue. Thereafter, it
presents the importance of screening for dyslexia risk and details about the need of subsequent
interventions. The paper highlights social workers’ roles in addressing dyslexia: identification,
referrals, education, and advocacy. It concludes with implications for social work practice.
This paper focuses specifically on dyslexia, rather than looking at reading problems and
learning disabilities broadly. This is not to indicate that social workers should not be concerned
with literacy and learning; rather, the focus on dyslexia is to simplify the presentation of
DYSLEXIA AND SOCIAL WORK 5
information. Early intervention is the best way to prevent early problems from becoming more
severe over time (Connor et al., 2014). Much of the information within this paper is applicable to
other reading problems and literacy. Similarly, this paper emphasizes universal screening in
schools during kindergarten through third grade, as research has found early interventions most
effective with this developmental period of children as they are learning to read (e.g., Wanzek et
al, 2018). This is not to negate the importance of screening and interventions for dyslexia for
children of all ages as children; however, if evidence based universal screening was properly
conducted later screening would likely not be as necessary. Screening and interventions remains
important considering there may be circumstances where children are not be screened in
kindergarten through third grade (e.g., children missing testing; families moving and criteria
changing in the school district or state; children being homeschooled until later grades).
What is Dyslexia?
Although there is debate about the precise definition of dyslexia (Peterson & Pennington,
2015), states increasingly use aspects of the International Dyslexia Association definition of
dyslexia (Gearin et al., 2021), which is:
Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized
by difficulties with accurate and/or fluent word recognition and by poor spelling and
decoding abilities. These difficulties typically result from a deficit in the phonological
component of language that is often unexpected in relation to other cognitive abilities and
the provision of effective classroom instruction. Secondary consequences may include
problems in reading comprehension and reduced reading experience that can impede
growth of vocabulary and background knowledge (Lyon et al., 2003. p. 2.)
DYSLEXIA AND SOCIAL WORK 6
It is worth highlighting that this definition recognizes the role of the brain in acquiring reading
skills (i.e., neurological) as well as dyslexia’s primary symptoms being reflected by poor
performance in spelling and accurate and/or fluent word reading. In this manner, the neurological
and biological etiology of dyslexia often manifests in its symptomology through cognitive
processes of reading such as phonological awareness (the ability to manipulate the sounds
language such as rhyming or deleting/adding sounds in a word) and word reading. It is important
to note; however, that poor phonological awareness and word reading may not fully explain
dyslexia as there are behavioral (e.g., anxiety), environmental (e.g. poverty), and other cognitive
processes (e.g., language) that correlate with the etiology and symptomology of dyslexia. Not all
children with phonological awareness problems have dyslexia, and not all children with dyslexia
exhibit phonological awareness problems.
The confluence of these factors are frequently represented in risk and resilience factors
models (e.g., Catts & Petscher, 2020; Ozernov-Palchik et al., 2016). Risk factors include
phonological deficits, language impairments, attentional deficits, visual problems, and
trauma/stress. Resilience factors may include classroom instruction, growth mindset, task-
focused behavior, adaptive coping strategies, and family and peer support. Dyslexia cannot be
explained by poor vision or hearing or lack of motivation or educational opportunities. In
addition to its proximal impact upon reading skills, dyslexia has been linked with decreases in
self-esteem and amount of time reading outside of school contexts, which may contribute to
widening of gaps in reading ability, vocabulary, and background knowledge (Cunningham &
Stanovich, 1998; Undheim, 2003).
DYSLEXIA AND SOCIAL WORK 7
Children may be at risk for not attaining full literacy skills for a variety of reasons. For
example, children may be at risk because they are learning literacy skills in two languages
simultaneously (Gersten & Brengelman, 1996). Alternatively, children may be at risk due to lack
of exposure to print (e.g., a child may live in a “literature-poor” environment where books are
not present). Of course, single-cause explanations rarely capture the complexity behind a child’s
struggle to develop strong literacy skills (Maughan & Carroll, 2006; Snowling & Hulme, 2012).
Multiple risk factors may be interacting to make literacy problems more pronounced than if only
one risk factor was present (Muter & Snowling, 2009).
Dyslexia is a Social Justice and Social Work Issue
Dyslexia is a social justice issue that social workers should be concerned with for a
multitude of reasons. First and foremost, literacy is a human right. The United Nations
Educational, Scientific and Cultural Organization (UNESCO; 2019) has identified literacy as a
human right and argues literacy required for sustainable development across the world. It is well-
documented that literacy is correlated to standard of living and has many economic benefits to a
country (Cameron & Cameron, 2006). The benefits of literacy and education broadly can be seen
within individuals as well. Level of education is highly correlated to a person’s earning potential
(e.g., Carnevale et al., 2011). Duration of education is a strong predictor of a person’s health and
longevity (Johnston, 2019).
Dyslexia may also be viewed as a social justice issue given that although dyslexia can
impact a person across their life and as such cannot be considered merely a “childhood concern,”
the disorder can typically be remediated effectively when identified early in childhood as
children are learning to read. Children in the United States are to be given equal educational
DYSLEXIA AND SOCIAL WORK 8
opportunity; federal law requires schools to identify children with disabilities and provide the
appropriate education (Individuals with Disabilities Act, 2018). When children do not receive the
education they need, they are excluded from employment opportunities and have a lower earning
potential later in life (e.g., Carnevale et al., 2011). Not intervening with dyslexia creates
exclusion; it eliminates opportunities for people with dyslexia. As children are reliant upon
adults, they may be considered in a vulnerable developmental period.
The argument for addressing dyslexia as a social justice issue extends beyond a
developmental argument and children’s vulnerability. Dyslexia is disproportionately undiagnosed
in children of color (Rojas, 2018; Robinson, 2013) and children in poverty (Peterson &
Pennington, 2015). Several policies explicitly identify that poverty rules out dyslexia in
screening (U.S. Department of Education, 2007). For example, the Individuals with Disabilities
Education Act (IDEA) states that “Specific learning disability does not include learning problems
that are primarily the result of visual, hearing, or motor disabilities, of intellectual disability, of
emotional disturbance, or of environmental, cultural, or economic disadvantage.” (emphasis
added, IDEA, 2018, Sec. 300.8 (c) (10)). One argument offered to support this dubious practice
is that treatment for dyslexia is resource intensive and resources would not be available for the
children. This is problematic, especially considering that educational difficulties children with
dyslexia may face may contribute to not graduating high school and attending college and
education has been heralded as a solution to ending poverty.
There are also disparities in receiving treatments/interventions for some children.
Nationally, the children in public schools who receive educational services for a developmental
and learning disability are disproportionately Black at 21% (NBCDI, 2018), though usually these
DYSLEXIA AND SOCIAL WORK 9
labels are broadly applied without specificity on individual disabilities like dyslexia. Research
has also highlighted the presence of bias as a factor in that disproportionality (Harry & Klinger,
2014). A child who is already experiencing intersections of social inequity is more likely to
become labeled with a learning disability, and research is inconclusive on if special education
within schools improves outcomes for these children (Shifrer, 2018). The importance of early,
accurate, and comprehensive (inclusive of external factors which may be contributing)
identification for BIPOC children cannot be overstated (Robinson, 2013). The achievement gap
between black and white youth has been an outstanding and seemingly intractable problem
(Paschall, et al., 2018); which creates an even more compelling reason for the field of social
work to become leaders in advocating for early screening of dyslexia.
Children in families who are wealthy may be able to access resources due to their parents’
resources and power (e.g., Elsen-Rooney, 2020). These parents may hire educational lawyers to
enforce IEP goals or to receive out of district placements in private schools specializing in
educating children with dyslexia. When dyslexia is not identified early, children continue to
struggle to read and miss out on important instructional and intervention and remediation. These
teaching casualties can also lead to additional learning issues such as, memory problems,
organization problems, attention problems, motivation problems (Chapman & Tunmer, 2019)
and missed economic opportunities throughout life (UNSECO, 2019).
Research consistently demonstrates that dyslexia does not occur in isolation.
Approximately half of children diagnosed with dyslexia have a language disorder (Adlof &
Hogan, 2018). Children with dyslexia may be at risk for poor mental health outcomes (Grills-
Taquechel et al., 2012; Hendren et al., 2018) such as depression (Mammarella et al., 2016;
DYSLEXIA AND SOCIAL WORK 10
Mugnaigi et al., 2009) and anxiety (Mammarella et al, 2016; Nelson & Harwood, 2011).
Dyslexia has been found to be associated with conduct disorders and oppositional defiant
disorders (Burke et al., 2002). Twenty to 40% of children diagnosed with ADHD have dyslexia
(Germano et al., 2010). Children diagnosed with autism spectrum disorder have a higher rate of
dyslexia than their peers (Asberg et al., 2010). Similarly, children diagnosed with dyspraxia, a
developmental coordination disorder, have increased risk for dyslexia with up to 85% of children
with dyspraxia also having dyslexia (Pauc, 2005). Together, dyslexia and associated conditions
include a variety of symptoms and challenges for the individual.
There is some evidence that dyslexia may be associated with adverse childhood
experiences. Fuller-Thomson and Hooper (2015) reported the odds ratio for dyslexia was seven
times higher among adults who reported being physically abused as a child (i.e., 35% compared
to 7%). Socioeconomic status is shown to be correlated with reading ability, such that children
from families in lower socioeconomic status having poorer reading skills; however, these same
children are under-diagnosed as having dyslexia when compared to their peers in families of
higher socioeconomic statuses (Peterson & Pennington, 2015).
As addressing dyslexia is a social justice issue impacting many of the children, families,
and communities served by social workers, social workers must be equipped to be part of an
equitable solution. Social work has long been recognized as a profession which can play an
important role in addressing dyslexia (Danenhower, 1966). They should join educators,
physicians, and other professionals in early identification and intervention efforts. Scientists in
literacy research advocate for earlier identification of dyslexia (Ozernov-Palchik & Gaab, 2016),
stronger preventative frameworks for screening and intervention (Catts & Hogan, 2020), and
DYSLEXIA AND SOCIAL WORK 11
contextualized screening and instructional supports in existing preventative frameworks in
schools (Miciak & Fletcher, 2020). Social workers should increase their advocacy for early and
accurate screening for dyslexia risk and interventions to profoundly impact the educational
outcomes for children. Advocacy requires an understanding of current screening practices and
intervention strategies.
Universal Screening for Dyslexia
The purpose of a dyslexia screening is to identify children at risk for dyslexia. The
purpose of universal screening for risk for dyslexia is different than the purpose of diagnosing
dyslexia. Screening determines the level of risk for reading problems in general and the potential
risk of having or developing dyslexia. Universal screening is a process that helps to identify
students who are at-risk for having dyslexia, often measured as performing below a particular
threshold of standardized measure of reading (e.g., <10th percentile of word reading). Core
literacy skills, depending on grade level, are typically assessed at the beginning of the academic
school year. Screening results are then used to determine which students are at-risk and the types
and amount of support needed. Screening for risk of dyslexia should not be deficit oriented;
rather it should prioritize identifying children’s needs and making sure they get the appropriate
education. The point of screening is to provide early intervention prior to a formal diagnosis.
A diagnosis is a process whereby qualified professionals use valid and reliable tools to
measure skills typically associated with dyslexia. It is often used with individuals who
demonstrated elevated levels of risk from a screening assessment, have not responded adequately
to early interventions, or a combination of the two. School psychologists or clinical
psychologists typically conduct the assessments using assessment tools and criteria outlined in
DYSLEXIA AND SOCIAL WORK 12
the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric
Association, 2013). Differences exist in the diagnosis processes, and psychologists may
sometimes diagnose children with “specific learning disorder” without diagnosing dyslexia. It
should also be noted that there is not a single agreed upon assessment for dyslexia; variation
exists among the assessments. A formal diagnosis of dyslexia can lead to supports, services, and
accommodations. Some schools may not provide adequate interventions without a diagnosis of
dyslexia. It is not appropriate to use screening results to diagnose if a person has dyslexia.
Screening data are used to make decisions about the level of instructional support children need.
Characteristics of Universal Screening
A universal screening system for dyslexia in schools is typically administered to all
children in kindergarten through third grade at least once per year as early as possible in the
school year so that the information can be acted on immediately. Although screening this early
may be useful as a baseline to capture children early, it is critical to note that as children are
developing in their skills, many kindergarten screening assessments present with floor effects
(e.g., Catts et al., 2008) resulting in very high false positive rates. Dyslexia screening should
directly measure children’ proficiency on essential reading content or essential pre-literacy
measures (depending on the child’s grade level/skill level).
The recommendation to administer dyslexia screenings in schools before third grade is
based on three empirical findings. First, reading problems can be prevented, and early problems
remediated, through early evidence-based interventions (e.g., Adams, 1990; Wanzek et al, 2018).
Early screening assessments allow interventions to be implemented effectively as soon as
possible. Second, patterns of reading development are established early once school begins and
DYSLEXIA AND SOCIAL WORK 13
are stable over time unless interventions are implemented to increase child progress (Good,
Karminski, et al., 2001; Juel, 1988; Shaywitz et al., 1992; Torgesen, 2000; Torgesen et al., 2001).
Third, without intense interventions, struggling readers do not eventually “catch up” to their
average performing peers—in fact, the gap between strong and weak readers increases over time
(Torgesen, 2000; Torgesen et al., 2001). Reading interventions that begin in third grade and
beyond are likely to be less successful and less cost-effective than interventions that begin in the
earlier grades. The later interventions begin, the longer they take to work, the longer they need to
be implemented each day, and the less likely they are to produce desired effects (Adams, 1990;
Good, Simmons et al., 2001; Torgesen, 2000; Torgesen et al., 2001; Wanzek et al., 2018).
Benefits of Early Screening for Dyslexia Risk
The benefit of universal screening for dyslexia risk is that early intervention in early
elementary school clearly reduces the risk for a reading problem in general, and specifically
word-level reading problems epitomized by dyslexia (e.g., Conner et al., 2014). It is paramount
that states, districts, and schools take action to improve services for children with dyslexia,
which begins with efforts at early screening and preventative intervention.
Screening and intervention can focus on early literacy skills that can hinder the
development of reading, writing, language processing, and comprehension. Schools should
determine the areas of risk or literacy skills to measure and then choose technically adequate
screening measures. Screening makes it possible to provide intervention to children with any
undiagnosed literacy-related disabilities, including dyslexia, as well as those children who are
experiencing literacy-related difficulties for other underlying reasons (Shaywitz, 2014). Whether
the literacy-related difficulty is caused by dyslexia or a disability other than dyslexia, another
DYSLEXIA AND SOCIAL WORK 14
factors (e.g., low oral language skills), or a combination of factors, early and intense intervention
to address the difficulties is the best way to prevent early problems from becoming more severe
over time (Connor et al., 2014).
Considerations for Best Practices in Universal Screening
There is broad agreement that schools should implement early screening and intervention
programs; however, there are converging and diverging viewpoints on how this implementation
should occur. Although universal screening for dyslexia risk could potentially help many
children struggling with reading, it also poses risks and challenges for school systems and the
children within them. Implementing an effective universal screening system to understand
children’ risk for reading disabilities, including dyslexia, is not a simple matter of selecting and
administering a one-time test to select children. Rather, all children in all grades should be
screened multiple times a year and appropriate interventions provided. The most important issue
is the reliability and validity of decisions made by professionals and families based on the
screening method. Developing an effective screening system for dyslexia requires an inherent
trade-off between positive and negative decisions, and more importantly, the risks associated
with falsely identifying a child not at risk (false positive error) and the costs of missing a child
who is at risk (false negative error; Petscher et al., 2018). The issue with false positives is
resource driven; if the screener generates too many false positive errors, it can potentially
become a waste of resources to provide intervention and/or additional assessment to children
who did not need the extra support or further assessments. However, the consequences of a false
negative could mean lack of access to early reading intervention, which is more serious because
of the need for children to receive interventions as early as possible as they are learning to read.
DYSLEXIA AND SOCIAL WORK 15
Accounting for the reliability and validity of scores from assessments, with special attention to
the types of errors that are made in screening systems is critical. Scores from a screener may be
unreliable because of poor psychometric properties or lack validity because the methods are not
sensitive to the risk characteristics associated with dyslexia, resulting in decisions about children
that may be uninformative or misinformative. Alternatively, a screener may have good
psychometric properties, but be used by educators or families in ways that are not supported by
research. There is basic agreement about how to gauge the technical adequacy of screeners. The
National Center on Intensive Intervention (NCII; 2018) conducts independent, standardized
reviews of screening measures to help schools select an appropriate screening tool. More
specifically, the NCII tools chart allows users to examine classification accuracy, technical
standards (i.e., reliability, validity) and usability (e.g., administration format, scoring time).
Viewpoints related to screening tend to diverge when it comes to the many specific
decisions that schools must make when implementing universal screening in an MTSS. Most
aspects of the implementation process have been subject to debate over the past few decades,
from the selection of screeners, to the best use of screening scores (e.g., Breaux et al., 2017;
Gillis, 2017; VanDerHeyden & Burns, 2017). Effectively implementing universal screening is
not a simple matter of selecting and administering a test. School administrators and educators
must consider when the screener will be administered, to whom, and how the scores will be used.
Because each one of these decisions must be evaluated against the local context, and because
school systems differ in terms of their child populations, financial resources, technical
infrastructure, and schedules, what is best practice for one school might not be for another.
Intervention
DYSLEXIA AND SOCIAL WORK 16
For a child at found to be at risk for dyslexia through universal screening, effective
interventions are available in the school as well as home and community settings. State policies
and expert opinion generally favor schools’ use of a multi-tiered system of support (MTSS;
Miciak & Fletcher, 2020). Within MTSS, children are screened early and at multiple timepoints
to assess risk for dyslexia and reading disabilities in general. Scores that assess risk of dyslexia
are then used to make instructional decisions, such as the delivery of intensive intervention
specially designed to address individual child needs. Schools should provide at least three levels
of instructional support. First, there should be core classroom instruction for children reading at
or above grade level (i.e., low risk for dyslexia). Second, moderate additional support for
children reading somewhat below grade level expectations (moderate risk for dyslexia) should be
provided. These children benefit from small group interventions that include phonemic
awareness and phonics instruction tailored to their needs. Third, schools should provide intense
additional support for children reading well below grade level expectations (at high risk for
dyslexia) as these children are well below reading proficiency expectations. These children
benefit from small group intensive interventions that include phonemic awareness and phonics
instruction. A meta-analysis has found that in the early grade levels (kindergarten through third
grade), MTSS can be effective and feasibly implemented (Wanzek et al., 2015). Children in
second and third grade with severe reading deficits who received reading interventions grew at a
rate equal the growth rate of students without reading deficits and had growth rates significantly
higher than students receiving special education services for reading (Burns et al., 2020).
Within the home and community setting various interventions exist to reinforce and
augment the school interventions. University reading clinics and community-based tutoring may
DYSLEXIA AND SOCIAL WORK 17
assist children. There are also apps and programs that can be used in the home to help children
with reading. There are no standardized interventions that occur outside of schools. Additionally,
home and community interventions may not be offered in all communities and the costs
associated with them may be prohibitive for some families. There is a glaring need for additional
accessible evidence-based interventions for dyslexia outside the school setting.
Social Workers’ Role in Addressing Dyslexia
The roles social workers play in addressing dyslexia fall into the categories of identifying
risk, referring, educating, and advocating. Identification of dyslexia can be incorporated into
social worker practice in several ways. Because early warning signs of risk for dyslexia (e.g.,
problems with letter name or letter sound recognition) may be present in children before they
begin school, social workers working with young children play an important role in identifying
children who at risk for dyslexia. This can be done through assessments of children and families
they serve. When completing a biopsychosocial intake and doing ongoing assessments, social
workers can incorporate questions related to reading proficiency and dyslexia. Checklists of risk
factors for learning disabilities for children of different ages developed by the National Center on
Improving Literacy (2018) can be completed with parents. Due to dyslexia’s heritability, asking
parents about any family history of problems with reading can help to determine risk.
Additionally, validated instruments such as the Adult Reading History Questionnaire (ARHQ;
Lefly & Pennington, 2000) can be administered quickly to parents to determine the presence of
problems with reading. This can help to identify familial risk which helps to provide a global
assessment of a child’s risk (Sanfilippo et al., 2020). One benefit of social workers conducting
these assessments and working with families is to help recognize and document early concerns,
DYSLEXIA AND SOCIAL WORK 18
and to generate awareness of resources and options. Social workers can prepare parents for the
conversations with teachers and school administrators about their children’s risk for dyslexia.
When social workers identify risk for dyslexia, they should make referrals for early
interventions and further assessment. Many of the referrals for school aged children are to the
schools where most of the interventions and assessments occur. There may be intervention
programs offered in the community, such as university reading clinics or tutoring. Social workers
may also refer to apps and materials for children to use at home that reinforce the school
interventions. For diagnostic testing, social workers may refer to psychologists, as at this time
social workers are not recognized as having the authority to diagnosis for dyslexia.
Social workers’ responsibilities related to educating about dyslexia start with children,
families, and communities about the importance of literacy. Raising awareness about dyslexia
and the availability of effective interventions should be a priority of social workers. As there is
stigma and myths around dyslexia and other learning disabilities, social workers should work to
provide the most current accurate information about dyslexia that can combat the negative views
and misinformation about it. Specifically, social workers’ educational efforts should include
information that dyslexia is not related to low intelligence. Education about dyslexia should be
strength-based rather than deficit-oriented. Social workers should make sure to work to reduce
stigma and are appropriate for cultural contexts.
The advocacy related to addressing social work pertains to: 1) the availability and
provision of universal screening and early intervention for dyslexia, and 2) the specific needs of
those who have been identified as at risk for dyslexia. Social workers must promote universal
screening in schools in kindergarten through third grade. Social workers should increase their
DYSLEXIA AND SOCIAL WORK 19
advocacy for early and accurate screening for dyslexia risk and interventions to profoundly
impact the educational outcomes for BIPOC children. There is a need to ensure that regardless of
the school setting, children who may be at risk of dyslexia or who have been diagnosed with
dyslexia have access to appropriate interventions. Social workers should advocate for reducing
the disparities in education; schools in neighborhoods considered having a lower socio-economic
level should have the same resources for reading instruction as those in wealthier neighborhoods.
They should lobby their elected officials at the local, state, and federal levels. Social workers
also play a critical role in working with children who have been identified at risk for or
diagnosed with dyslexia and helping the children and their parents navigate the schools to ensure
they are provided the appropriate interventions. When an adult is diagnosed with dyslexia, social
workers may also assist in advocating to ensure that their rights are protected in accordance with
the Americans with Disabilities Act.
Implications for Social Work Practice
All social workers should have basic training about dyslexia which highlights the
importance of screening and information on how to make referrals for assessment and
intervention. There are some specific practice settings where social workers should actively
address dyslexia. Perhaps most obvious would be the schools. School social workers are in
positions to directly advocate for screening of children and appropriate testing follow ups as
necessary. This is especially important in elementary schools but screening later can still be
helpful to identify dyslexia and help the children. Social workers in early childhood intervention
programs already are part of interdisciplinary teams who seek to address developmental delays,
including those related to language acquisition. While the programs target children under the age
DYSLEXIA AND SOCIAL WORK 20
of three, which is below the age of the typical screening for dyslexia, there may be warning signs
and caregivers can be educated about the need for screening when their child enters kindergarten.
As children who have dyslexia are experiencing rates of physical abuse higher than their
peers without dyslexia (Fuller-Thomson & Hooper, 2015), child welfare is an area of practice
where social workers should be incredibly concerned about dyslexia. Social workers in child
welfare are already aware that children with disabilities are a group at risk for maltreatment (e.g.,
Child Welfare Information Gateway, 2018). Identifying learning disabilities may assist child
welfare professionals in assessments and identifying risk. Child welfare professionals need
accurate information; when it is unknown if a child has dyslexia, helpful information is missing.
As children under the age of three are at greater risk for maltreatment, and are younger than
universal screening, child welfare professionals may be able to help detect dyslexia before the
screening occurs in the school settings. For children of all ages who enter foster care screening
for dyslexia could be conducted as part of the health exam for children. As children who enter
the foster care system are at risk for poor educational outcomes, dyslexia screening should be at
the forefront of the minds of the child welfare professionals.
Social workers who provide mental health services to people at all ages, should be
concerned about dyslexia. First and foremost, because of the comorbidity with other conditions,
social workers who are mental health providers should seek to become aware of reading
problems of the people they serve. During intake, social workers can ask about learning
disabilities, and specifically dyslexia and make referrals for screening should there be incomplete
information. Larger mental health agencies may wish to conduct screening onsite and incorporate
it in ongoing assessments and working with children. As there is an intergenerational component,
DYSLEXIA AND SOCIAL WORK 21
mental health professionals should screen should ask parents about dyslexia. Although it must be
understood that a person could have dyslexia and not have been diagnosed. Social workers must
be able to address the mental health concerns that stem from dyslexia including depression and
anxiety.
Awareness about dyslexia is already in the medical community. As part of the larger push
for literacy, there has been a call for pediatricians to screen for dyslexia since they interact with
children prior to school age and early signs of problems with literacy including dyslexia may be
present (Sanfilippo et al., 2020). Social workers who work within health settings should be aware
of this practice and work with pediatricians.
All social workers have a role in various aspects of dyslexia, including promoting
screening and early intervention. Those who directly provide services to children and families
have the responsibility to encourage screening and advocate for the people they serve so that
children receive appropriate further assessment and interventions. Social workers in
administration and management should consider how the agencies and programs that they work
within can address dyslexia. They can prioritize training for staff about dyslexia that outlines the
importance of the issue, warning signs, and appropriate referrals. For social workers in advocacy
and community organizing, connections to dyslexia may be easy to make as it connects with
literacy and education and disproportionately impacts children of color and children in poverty.
This is not to say that dyslexia should not become the sole focus of advocacy and organizing
efforts, yet there may be opportunities to integrate the issue within efforts. For example,
organizing around education could include a call for improving literacy through having universal
screening for dyslexia in kindergarten through third grade and making interventions accessible to
DYSLEXIA AND SOCIAL WORK 22
children. Some of the greatest impact that social workers can make in addressing dyslexia is
through policy. Social workers who work within policy and planning can work to ensure federal,
state, and local policies are enacted that promote universal screening as well as interventions for
children diagnosed with diagnosis.
Social work educators and researchers have a role in addressing dyslexia in ensuring that
the next generations of social workers are appropriately trained and that quality research on
dyslexia is conducted. Scholars have asserted that the connection between race and dyslexia
needs more research (Blanchett, 2010); social work academics could contribute to enhanced
recommendations about outcomes within certain subgroups. Content about dyslexia could be
integrated into the Human Behavior in the Social Environment courses as well as courses about
working with children. Additionally, training for continuing education of social workers can
focus on dyslexia and the role of social work. Researchers must work with practitioners and
policymakers to ensure that their research can help answer the questions around addressing
dyslexia that will directly help children, families, and communities.
Conclusion
There is little debate as to whether the screening of children is a useful mechanism by
which children who are at-risk for dyslexia can be routed to appropriate early interventions. By
providing children with the appropriate evidence based early interventions, remediation can be
effective and later problems may be reduced. Dyslexia is a social justice issue as it is connected
to the human right of literacy and disproportionately impacts BIPOC children and children in
poverty. In the diverse settings and roles in which they work, social workers play an important
role in addressing dyslexia and ensuring that children are screened and receive early intervention.
DYSLEXIA AND SOCIAL WORK 23
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