Q: Why should dyslexia be included in the ADA?

A. If you break your arm and your arm is in a cast, there is visible evidence of a disability.  If a person is in a wheelchair it is apparent that she is disabled. In contrast, dyslexia is a hidden disability, there’s no external sign on you saying you are dyslexic. New scientific findings have shown that there is a biologic difference between dyslexic and typical readers; however, until functional imaging, these differences remained hidden from view.  In addition, dyslexia is a paradox—that is, in dyslexia a person can be very bright, possess a strong intellect with outstanding reasoning and analytic abilities and yet read slowly, at times, speak with mispronunciations and hesitations (not be glib) and spell poorly. It’s easy to dismiss the fact that such a dyslexic person has a problem; easy, but also wrong.

	Critical is to keep the definition in mind: Dyslexia is an unexpected difficulty in reading, a disparity between intelligence and reading ability, particularly reading fluency.

Critical is to keep the definition in mind: Dyslexia is an unexpected difficulty in reading, a disparity between intelligence and reading ability, particularly reading fluency. We have now learned that in typical readers reading achievement and intelligence are linked across development, an increase in one produces an increase in the other; reading influences intelligence and vice versa. They go hand in hand such that one predicts the other. Dyslexia is different; here, reading and intelligence are not linked over time; instead, each goes its separate way. In the case of dyslexia, intelligence can be quite high while reading is average or less. Furthermore, as an individual matures, it is not only the comparison between reading and intelligence, but between a person’s reading and his or her educational level or professional status that form the definition of dyslexia.

Modern science has alerted us to the importance of reading fluency. We used to think reading was about reading words accurately and comprehending what was read. Now, it is understood that if reading accuracy and comprehension are the pillars of the arch of reading, fluency is the keystone. Reading fluency is the ability to read, not only accurately, but rapidly and automatically, really effortlessly. Educators have learned how to help children and young adults to read more accurately and even dyslexic children can and do improve their accuracy as they mature. However, no one has figured out how to overcome lack of fluency.  As a consequence, for dyslexic children and adults, instead of it being rapid and automatic, reading remains slow and effortful. Dyslexics have to work harder at reading, it’s more tiring, and it takes longer. At the same time, research has shown, the dyslexic person who is the slow reader can also be the high-level comprehender—providing, and only if, s/he has been allowed extra time to slowly read the words on the page. The dyslexic reader has the comprehension skills to understand and reason at a very high level but –only if s/he is permitted the additional time necessary for him/her to slowly decode the words. Essentially, dyslexia robs a person of time; receiving additional time returns it. The additional time acts as a bridge allowing the dyslexic person to access his higher-level strengths. Furthermore, contrary to the popular myth that every one would benefit from extra time, the evidence clearly indicates that it is only the dyslexic person—and not the typical reader—who benefits significantly from additional time. It is the dyslexic young man or woman who has a neurobiologic need for extra time (see below).

"Now, because bright but dyslexic students have earned good grades, when they request accommodations on high-stakes standardized tests like the SAT or GMAT or LSAT or MCAT, the request is rejected. The student is often told, “your grades are too good, you’re not disabled.”

Young people who have gone through school and have been identified as dyslexic have received accommodations over the years, such as extra time on exams and a separate room in which to take tests. A quiet room is required because their lack of automaticity in reading results in a need for intense focus during reading such that any noise will break their concentration.  So, here we have a situation where students have the ability to comprehend at high levels, and if such dyslexic students received reading help and the accommodation of extra time, they will have performed well in school and received good grades. They have been allowed to access their higher-level thinking abilities.

Now, because bright but dyslexic students have earned good grades, when they request accommodations on high-stakes standardized tests like the SAT or GMAT or LSAT or MCAT, the request is rejected. The student is often told, “your grades are too good, you’re not disabled.” It’s like telling a person who has a motor impairment but is able to cross a street with the aid of a wheelchair or cane, “you couldn’t be disabled because you got across the street,” forgetting that the reason he got across the street was because he had the accommodation of the wheelchair or cane.

It’s like telling a person who has a motor impairment but is able to cross a street with the aid of a wheelchair or cane, “you couldn’t be disabled because you got across the street,” forgetting that the reason he got across the street was because he had the accommodation of the wheelchair or cane.

In light of all this, the Supreme Court ruled in recent years on several cases addressing so-called mitigating measures. In determining whether a person who has benefited from mitigating measures under the ADA (that is, a physical or mental impairment that substantially limits a major life activity) the effects of the person’s mitigating measure must be considered.

As a consequence, if you are benefiting from mitigating measures, you are no longer considered disabled and entitled to ADA protection. For example, if you are diabetic but your blood glucose is controlled by diet and medication, you are no longer disabled according to recent interpretations of the ADA. In the same way, if you are a dyslexic who demonstrates an extraordinary work ethic, frequently giving up any semblance of a social life at college; reads effortfully for long hours into the night due a persistent lack of fluency, and who through the ameliorative effect of testing accommodations earns a high grade point average, you are considered not to be disabled. This issue of mitigating measures was a major issue that had to be corrected. This is not what Congress intended but, nevertheless,  it is how the Supreme Court ruled in denying ADA coverage to many, including those who were clearly dyslexic and unable to read fluently (rapidly).

Another area of serious concern with the manner the ADA has been interpreted is the issue of the average person. Testing agencies have interpreted the law to mean that if you are reading at the level of an average person, then you are not disabled. While such an approach might work for physical disabilities where the definition of the particular disability and resulting comparison is to the so-called average person, such a comparison is not appropriate for dyslexia. Why? It violates the very foundation and basis of dyslexia whose definition resides in a comparison between a person’s reading (accuracy or fluency) and his intelligence, level of education or professional status. Thus, dyslexia at its core and in its definition is a disparity within the person, not comparing one person to another.

In diagnosing dyslexia, you are comparing that person’s reading ability to his cognitive ability, educational level, or professional stature.  If you’re a second-year medical student with an IQ of 140 and you are reading at 100, that for you is a huge disparity—one not characterizing your fellow medical students who may have a similar IQ of 140, but who are also reading at about that level.  However, dyslexia is different, for here the person with the high IQ (or who has had the cognitive ability and perseverance to read college, graduate school, or professional school materials) while at the same time having a neurobiological disruption in the neural systems for rapid reading suffers the result of extremely slow and effortful reading. This means that your cognitive ability is such that you have the ability to master complex and very difficult conceptual material within a college and graduate or professional school curriculum, despite having such impaired reading fluency. The average person with the same reading difficulties would not be able to master the curriculum of medical school. Dyslexia is conceptualized as an encapsulated weakness resulting in slow reading surrounded by a sea of strengths. It is the sea of strengths in thinking and reasoning that together with the accommodations of extra time allow a slow-reading but good-thinking dyslexic to succeed. The accommodation of extra time on tests levels the playing the field, allowing the hardworking dyslexic to access his strengths and demonstrate his knowledge.

The failure to grant accommodations to deserving dyslexics has become a seemingly impassable hurdle to those dyslexics who, up to the present, by hard work and accommodations have been able to overcome each barrier they have encountered.

The failure to grant accommodations to deserving dyslexics has become a seemingly impassable hurdle to those dyslexics who, up to the present, by hard work and accommodations have been able to overcome each barrier they have encountered. People are being punished because they can only read at an average level. They are being denied accommodations, because they are too smart. Such interpretations of the ADA by the courts appear to be placing a ceiling on the achievement level of people who are dyslexic which, of course, is contrary to the congressional intentions of the ADA.

A young man I know attends medical school. Diagnosed with dyslexia in the early grades, he received good instruction, worked very hard and received accommodations through high school, college and now medical school. He also requested and was granted extra time for his SATs. Now, in the third year of medical school, he is required to take a very high stakes examination, the United States Medical Licensing Exam (USMLE), in order to continue on in medicine. As for his previous tests, he requested accommodations, but in this instance was denied, seemingly based on his good performance in college (where he received testing accommodations).  Recognizing that he cannot demonstrate his knowledge and pass the test if he does not have enough time to simply read the questions, his family sought the assistance of the court to enforce the application of the ADA. Here, based on older interpretations of the ADA, the judge said to the effect of, “you can read menus, road signs, you can read as well as the average person,” ruling that the student was not disabled and denied him accommodations. This ruling totally disregarded the medical student’s neurobiologically based inability to read rapidly and his consequent requirement for extra time if he was to demonstrate his knowledge. Ironically, his medical school has allowed him additional time on tests in each of his courses and, with the provision of such time, the student ranks in the top quarter of his class. Without such extra time, he would no doubt fail his courses and will most likely fail the USMLE. Here, sadly, not only would the student have to leave medical school but society would be deprived of what it currently needs most: a compassionate, caring and knowledgeable physician who knows what it is like to struggle and to experience hardship. Such unfortunate situations involving bright, dyslexic students who want to go forward in their education but are being turned down and stopped in their tracks are now happening all over the country.