They weren't diagnosed with dyslexia. But these children still need help with learning difficulties

SINGAPORE: After her elder son was diagnosed with dyslexia, Ms Elmy Sulaiha Nasre thought her daughter, who was displaying similar symptoms, also had the learning disorder. 

Instead, she found out that Nur Evren Elveera, at eight years old, had another problem which could have hindered her learning ability from an even younger age. 

At four to five years old, Evren's speech had been unclear. She had difficulties with alphabets, including flipping them around in her writing, her mother told CNA.

The 37-year-old therapy assistant hired a private tutor for Evren and sent her to be formally assessed by the Dyslexia Association of Singapore (DAS) - the main organisation here providing support for those with learning challenges.

A little over a year ago, the DAS opened its services to students without a formal diagnosis of a learning difference. 

As of April, this group of students now makes up around 5 to 6 per cent of DAS’ total enrolment, or 158 out of 3,000 students aged six to 16 across all of its programmes. 

The association said it was heartened by the steady flow of students without a diagnosis but still applying for intervention. 

It expects these numbers to eventually make up 30 per cent of total enrolment.    

Speaking to CNA, two representatives said DAS acknowledged the "good number" of students who do not meet the diagnostic criteria for dyslexia but who have similar learning challenges.

"This group is presently underserved and the DAS approach to education will also benefit these students ... These students who struggle to learn should be supported regardless of their diagnosis,"  said Ms Serena Tan Abdullah and Ms Pearllyn Kang.

Ms Abdullah is lead educational therapist and deputy director of DAS' english language and literacy division, while Ms Kang is assistant director of specific learning differences assessment services. 

WHY SOME FALL SHORT OF A DIAGNOSIS 

Dyslexia is a lifelong learning difficulty which affects skills involving accurate and fluent reading and spelling. It can be attributed predominantly to a deficit in phonological awareness, or the ability to work with speech sounds in languages. 

Principal educational psychologist at Promises Healthcare Tan Su-Lynn said dyslexia is typically identified through a combination of screenings, observations and formal assessments.

Possible signs - especially in children - include difficulties in sounding out words; slow, laboured reading; struggles with spelling; reversed letters; avoidance in reading aloud; and taking longer for written assignments, she added.

In 2021, the Education Ministry (MOE) said in a parliamentary reply that all students are screened in Primary One so that those with weak language and literacy skills receive early intervention. If their difficulties persist, then they receive further screening for dyslexia identification.

Data from 2016 to 2019 showed that about 3.5 per cent of Primary 3 students were reported as having dyslexia. In Secondary 1, about an additional 1 per cent of the cohort were reported with dyslexia.

"The proportion of students with dyslexia in Singapore is within the international prevalence of between 3 per cent and 10 per cent," said MOE then.

At DAS, dyslexia is diagnosed through a psycho-educational assessment of a student’s strengths and weaknesses. It also evaluates the common characteristics underlying dyslexia, such as phonological processing, reading and spelling skills.

The two DAS representatives stressed the importance of early and timely intervention for a child. However, attempting to detect the condition sooner comes with its own challenges. 

Literacy skill acquisition can vary from young child to child. Some might have language difficulties simply due to poor instruction or lack of exposure, Ms Abdullah and Ms Kang said.

Yet if not assessed early on, children could develop strategies that mask the condition.  

"Children are adaptable and resilient, and when they continue to struggle, they develop coping strategies to compensate for their difficulties," said Psych Connect's senior ADHD (attention-deficit hyperactivity disorder) and executive functioning coach Zainab Shaukat.

Promises Healthcare's Ms Tan said highly intelligent children, or those with strong memory skills, may memorise words or make guesses based on context, rendering their struggles less visible in the early years of schooling.

"As a result, their challenges might only surface much later, when academic demands increase such as when they are introduced to more complex tasks like comprehension or composition writing," she said, adding that such children may fall through the cracks. 

Compounding the issue is how dyslexia co-exists or overlaps with other conditions like ADHD or speech and language impairment, as all the experts CNA spoke to noted.

"There may be times when adults working with these children miss signs and attribute the literacy difficulties to other concerns," said DAS' Ms Abdullah and Ms Kang.

Dr Zainab said: "This is why a comprehensive assessment, done by an experienced professional ... is monumental in the accurate diagnosis."

In Evren's case, her assessors found that her right ear's impaired hearing from birth was the main problem hindering her ability to absorb speech and articulate, said her mother Ms Elmy. 

Because Evren only got a hearing aid at around four years old, she ended up missing out on a window period for learning. 

SUPPORT SYSTEM

Ms Tan, the psychologist, pointed to a network of special educational needs officers, teachers and learning support coordinators working together to help those who don't meet the criteria.

"Schools are increasingly adopting a needs-based approach, where support is provided based on the student’s profile and not solely on labels," she said. 

She noted how tech tools - spanning the likes of text-to-speech as well as speech-to-text software, audiobooks and reading apps with dyslexia-friendly fonts - can make reading and writing more accessible to those with learning difficulties. 

Dr Zainab said one could still receive educational therapy, even without a diagnosis.

Teaching staff in schools should be trained to identify a struggling child and to provide them with the right support, she said. 

In October last year, MOE said in a parliamentary reply that the number of special educational needs officers in mainstream schools increased from around 450 in 2017 to about 680 as of July 2024.

All teachers have also been trained to have at least a basic understanding of special educational needs and capabilities, the ministry added.

Additionally, five to ten teachers in every mainstream school have attended a 130-hour course upon which they are designated as Teachers Trained in Special Needs. These educators have "deeper expertise and can share effective pedagogical practices with other teachers to support students with more complex needs", said MOE.

As for Evren, since she was not formally diagnosed with dyslexia, she was not offered a targeted group class in her school, unlike her 10-year-old elder brother. 

Instead, her teachers sat her in front of the classroom in an attempt to help her absorb lessons better. They also check in on her to see if she's able to follow lessons. 

Outside of school, Evren has also been enrolled into DAS' IReaCH programme, which aims to help with reading, comprehension and writing.

The association, on its part, is shoring up efforts to support students with learning difficulties. 

In February, it opened its second largest learning centre at Toa Payoh, bringing the total number of centres to 12. 

DAS also received a S$300,000 donation at the same time, to be given out as bursaries to help students from low-income families - who have either been diagnosed with dyslexia or have other learning difficulties.

With all the additional support, Evren is now academically nearly on par with her peers. She no longer writes letters in reverse, her relieved mother said. 

Ms Elmy is glad that her daughter is benefitting from DAS' expanded scope, and now coping well despite a delayed start. 

"I would have acted faster if I knew the lapses she has in her studies," said Ms Elmy. "It's more on our side to make the first move."