By
Breanna Smith & Nai-Cheng Kuo
Augusta University
This issue is NASET’s LD Report was written by Breanna Smith & Nai-Cheng Kuo from Augusta University. Educators need to be aware of the complexities of dyslexia to support the mental health of students with dyslexia. Due to neurological disorders, these students process information differently from their peers without dyslexia, which affects their communication, functioning, and emotions. The purposes of this article are twofold. First, we review the current literature on the relationship between dyslexia and mental health problems to highlight the importance of early identification and support systems. Second, based on those findings, we discuss actions educators can take to serve students with dyslexia and their families better. Our synthesis of research studies indicates dyslexia and mental health problems are often intertwined. Educators can contribute at least five aspects to improving the mental health of individuals with dyslexia and creating a healthy learning environment for them: 1) raising awareness, 2) identifying internalizing and externalizing problems, 3) collaborating with stakeholders, 4) advocating for dyslexia, and 5) providing direct services.
Abstract
Educators need to be aware of the complexities of dyslexia to support the mental health of students with dyslexia. Due to neurological disorders, these students process information differently from their peers without dyslexia, which affects their communication, functioning, and emotions. The purposes of this article are twofold. First, we review the current literature on the relationship between dyslexia and mental health problems to highlight the importance of early identification and support systems. Second, based on those findings, we discuss actions educators can take to serve students with dyslexia and their families better. Our synthesis of research studies indicates dyslexia and mental health problems are often intertwined. Educators can contribute at least five aspects to improving the mental health of individuals with dyslexia and creating a healthy learning environment for them: 1) raising awareness, 2) identifying internalizing and externalizing problems, 3) collaborating with stakeholders, 4) advocating for dyslexia, and 5) providing direct services.
Keywords:dyslexia, mental health, emotional and behavioral support
Supporting the Mental Health of Students with Dyslexia: What Educators Can Do?
Dyslexia affects children’s well-being, mental health, and behavior (Huang et al., 2020). Such issues have been studied since the 1960s. However, little is known about how educators can support this group of individuals. Dyslexia is a neurological disorder that can be categorized into two groups: developmental dyslexia (i.e., generic disorder) and acquired dyslexia (i.e., brain injuries caused by damage to the head from falls or accidents) (Seidenberg, 2017). Dyslexia affects one out of 10 people in America (Raymond, 2011). The International Dyslexia Association ([IDA],2002) defines dyslexia as:
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 concerning 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 the growth of vocabulary and background knowledge.
People with dyslexia have a higher chance of experiencing negative effects across emotional, social, educational, and occupational aspects (Livingston et al., 2018). Children with dyslexia often feel anxiety, anger, low self-esteem, and depression. They also experience family and social difficulties more frequently than others (Sako, 2016). It is important to note that even if some students with dyslexia may not show a high prevalence between dyslexia and psycho-emotional disorders, early identification and intervention can prevent them from unnecessary suffering and failure in later lives (Ihbour et al., 2021).
An area that is not as well versed in research is whether educators are competent in treating students with dyslexia. Research has shown a high prevalence of dyslexia and mental health concerns. Thus, educators need to be able to work with individuals who have dyslexia. The Diagnostic and Statistical Manual of Mental Disorders ([5th ed., DSM-5], 2013) listed dyslexia as a learning disability. It is primarily described by the cognitive and behavioral difficulties and not the psycho-affective consequences like low self-esteem, isolation, frustration, anxiety, and depression (Zuppardo et al., 2021). Educators need to be aware of potential mental health problems people with dyslexia can have, so they can employ the proper techniques when treating students with dyslexia. It is also crucial to identify why. What determines this relationship between dyslexia and life outcomes should be examined to promote success (Livingston et al., 2018). To determine a fitting treatment plan, educators must get to the core of the problem resulting from neurological disorders and learning differences.
It is worth mentioning the intricate effects of dyslexia on individuals. Because dyslexia is not just a reading and writing problem, attention must be given to understanding the depth of their difficulties to give them the support they need (Kjersten, 2017). Dyslexia can cause difficulties with sequencing and processing; thus, it is essential to know its impacts on communication, functioning, and emotions. For educators to work effectively with students who have dyslexia, they must develop an understanding of the complexities of dyslexia (Kjersten, 2017). To properly support a student with dyslexia, educators need to identify the signs of dyslexia and understand the different consequences of dyslexia in other developmental domains (e.g., behavioral and emotional), which will help with therapeutic planning (De Lima et al., 2020). The purposes of this article are twofold. First, we critically reviewed the existing literature on the relationship between dyslexia and mental health problems to highlight the importance of early identification and support systems. Second, based on the literature findings, we discuss actions educators can take to support students with dyslexia and their families.
Dyslexia’s Relationship with Mental Health
Emotional Problems
Emotional problems are an umbrella term that includes anxiety, depression, low self-esteem, and other mental anguish, which could lead to behavioral problems. According to De Lima et al. (2020), emotional problems in individuals with dyslexia are associated with the severity of the disorder, the complexity of their symptoms, school inclusivity, comorbidity, parent-child interactions, and how teachers handle the problems. A study by Ihbour et al. (2021) revealed a high prevalence of children/adolescents with dyslexia experiencing depressive and anxiety disorders as well as low self-esteem. Similarly, Haft et al. (2018) found children with specific learning disabilities face numerous stressors in academics and social experiences due to their disorder which can cause emotional distress.
Research shows children with dyslexia score higher on psychoticism traits, indicating they tend to be more withdrawn or troublesome. These children also scored higher on traits of neuroticism which shows they tend to feel more anxious, short-tempered, and depressed. Emotional instability can lead to a lack of concentration, anxiety, depression, conduct problems, and learning problems (Huang et al., 2020). Also, there is a higher possibility for people with dyslexia to experience psychiatric comorbidity (Ihbour et al., 2021). Since there is a vast variety of emotional problems with different symptoms and factors, each type of emotional problem is addressed in the following. In particular, we will focus on anxiety, depression, and low self-esteem.
Anxiety
The Anxiety and Depression Association of America ([ADAA], 2021) stated anxiety disorders are the most common mental illnesses in the United States; it affects 40 million adults aged 18 and older. The American Psychological Association ([APA], n.d. 1) defines anxiety as:
An emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune. The body often mobilizes itself to meet the perceived threat: Muscles become tense, breathing is faster, and the heart beats more rapidly… Anxiety is considered a future-oriented, long-acting response broadly focused on a diffuse threat, whereas fear is an appropriate, present-oriented, and short-lived response to an identifiable and specific threat.
Anxiety is another prevalent disorder that affects many. A study by Zuppardo et al. (2021) found that participants with dyslexia exhibited more frequent psycho-affective symptoms, especially anxiety and low self-esteem, in social and academic settings compared to the control group. They noticed higher anxiety levels, specifically social anxiety, within their sample of individuals with dyslexia.
Social anxiety causes difficulties in performing publicly. Humiliation and rejection are the main challenges faced by students with dyslexia (Zuppardo et al., 2021). Students with dyslexia exhibit symptoms as a response to feeling devalued or not receiving social recognition from their peers. Separation anxiety is prevalent in young children with dyslexia, while adolescents and adults tend to have mixed types of anxiety (Zuppardo et al., 2021). An exploratory study found that children with specific learning disabilities often experienced reading anxiety, a phobia, not just general anxiety (Haft et al., 2018). This discrepancy could affect how professionals might treat and assess these children.
In addition, anxiety is the most frequent emotional symptom adults with dyslexia report (Sako, 2016). An example of anxiety could be someone afraid to go to the store alone because of what might happen. If put in that situation, their bodies can react in many ways, such as an increased heart rate, sweating, stomach tightness, etc. This example alludes to what students with dyslexia may go through in school. They become fearful and avoid schoolwork because of frustration and confusion; they may anticipate failure and become anxious (Sako, 2016). For example, a teen student with dyslexia discussed his fear of reading in front of the class. If chosen, he would find a way to get out of reading by getting kicked out of class (Raymond, 2011). This concept needs to be understood to develop a robust support system for students with dyslexia; it is not because they are lazy.
One self-report study conducted by Nelson and Gregg (2012) found that college students with ADHD, dyslexia, or comorbidity of ADHD and dyslexia did not significantly differ in self-reported symptoms of depression and anxiety compared to college students without ADHD or dyslexia. Although the self-report study had limitations, such as lacking direct assessments, the finding may still be valuable. College students may be more adaptive than K-12 students because they are at the stage of pursuing a passion than passing a series of standardized exams. In addition, college students are more likely to be educated about what dyslexia is than children and know where and how to seek support, which reduces their anxiety.
The overarching research indicates that anxiety is more prevalent in individuals with dyslexia, especially in young children. Age, education, and access to support affect how individuals perceive dyslexia and handle anxiety. This is valuable information for educators.
Depression
Depression is another common emotional problem that many people face in their lifetime. According to the World Health Organization ([WHO], 2021), approximately 280 million people have depression worldwide. Depression is defined by the APA (n.d.2) as:
A negative affective state, ranging from unhappiness and discontent to an extreme feeling of sadness, pessimism, and despondency, that interferes with daily life. Various physical, cognitive, and social changes also tend to co-occur, including altered eating or sleeping habits, lack of energy or motivation, difficulty concentrating or making decisions, and withdrawal from social activities.
One study by Essia (2010) reveals that individuals with dyslexia showed higher rates of depression on the Hamilton Rating Scale for Depression (HRSD). In addition, they had more externalizing and internalizing symptoms such as withdrawal, social problems, thought problems, aggression, and delinquent behavior than those without dyslexia. Another study found similar results from students with dyslexia who expressed experiencing negative self-evaluation of performance, suicidal thoughts, guilt, fatigue, sleeping difficulties, and difficulties interacting with peers (De Lima et al. 2020). Although these students described having symptoms of depression, most of them did not meet the criteria for a diagnosis of depressive disorders.
The finding indicates that students feeling depressed does not mean that they have depression. However, if the symptoms continue going unnoticed, it can lead to more severe issues like suicidality or violence. For example, Johnathan Mooney and a teen student interviewed, both have dyslexia, talked about their suicidal intent in the sixth grade (Raymond, 2011). Therefore, it is crucial for professionals that work with people with dyslexia to assess for any signs of this. With early identification and intervention, the symptoms of depression can be reduced or prevented.
Research has reminded us that depression is common among people with dyslexia. Although most of these individuals do not have depressive disorders, they are still at high risk for intense feelings of sorrow and pain (Sako, 2016). Especially young children tend to feel more depressed than adults (Ihbour et al., 2021), combined with anxiety and low self-esteem. Because there is a higher chance for people with dyslexia to experience emotional symptoms related to depression, educators working with students who have dyslexia must be equipped with the knowledge and skills to identify and detect red flags.
Self-esteem
Psychologists define self-esteem as the attitude toward oneself (i.e., how they value or rate themselves). Self-esteem is the discrepancy between the ideal self and the self-image (Sako, 2016). The ideal self is the picture a person forms about whom they want to be influenced by society’s pressures (e.g., school, teachers, classmates, media, families). Students often judge themselves and their worth compared to others (Kress et al., 2021). Low self-esteem occurs when a person deviates far from their ideal self (Sako, 2016). Students who consistently experience failure and frustration can feel incompetent and powerless. Gradually, a negative self-image and twisted personality are formed.
Erik Erikson’s theory suggests that a child must resolve conflicts between a positive self-image and feelings of inferiority. Students with dyslexia appear to have a vulnerable self-image to frustration and anxiety (Sako, 2016). If someone does not view themselves positively, this can affect other areas of their life and further develop into an inferiority complex. An inferiority complex is a strong belief that they are not as good as others, which can be caused by physical disabilities, cognitive impairments, mental disorders, and social status (Kress et al., 2021). When students with dyslexia have negative self-evaluations and feel inadequate, they can experience issues with low self-esteem, undesirable social relationships, behavior issues, and emotional disturbance (Livingston et al., 2012). All these challenges are intertwined with self-esteem, which affects how students with dyslexia feel about themselves.
Low self-esteem is one of the most common psychological problems for individuals with dyslexia (Kjersten, 2017; Livingston et al., 2012). Multiple sources pointed out that negative self-esteem does have a higher prevalence of showing up when someone has dyslexia. Essia (2010) also found that dyslexia negatively affected individuals’ self-esteem; it caused them to feel different from others and have lower well-being. The difficulties with school achievement could lead to experiences of failure, negative self-evaluation, negative feelings, and other problems (De Lima et al., 2020). There appears to be a correlation between academic achievement and self-esteem (Sako, 2016). Many factors can influence a person’s self-esteem, which is part of the reason it can be so easy for someone’s self-esteem to falter. This is especially true for individuals with dyslexia in the school system when they do not have the support they need. Self-esteem should be evaluated when considering interventions to best support individuals with dyslexia. On-going progress monitoring is needed to see if assessments, accommodations, and interventions are working or need to be adjusted.
Behavioral Problems
Emotional problems can lead to behavioral problems. A lack of knowledge on dyslexia, frustration, and lack of support can cause an individual with dyslexia to act out in different manners. The example given above was a student with dyslexia being afraid to read in front of the class, so he would act like the class clown to get out of it (Raymond, 2011), demonstrating how emotional problems lead to behavioral problems.
The APA (n.d.3) defines problem behavior as: “a pattern of disruptive behavior that generally falls within social norms and does not seriously impair a person’s functioning.” Examples of problem behaviors include delinquent behaviors, aggression, withdrawn behaviors, rule-breaking, lying, stealing, cheating, bad temper, and threatening people (Dahle et al., 2011; Eissa, 2010). Dyslexia affects reading and writing abilities, as well as social skills. These individuals may have trouble understanding humor, finding the right words, memorizing, and picking up on social cues such as body language (Sako, 2016). Due to the impacts of dyslexia on one’s behavior, it is vital to identify the signs of dyslexia earlier to support students and provide them with early interventions.
Research shows that children with dyslexia exhibit more problem behavior, internalizing and externalizing, than those without dyslexia (Zuppardo et al., 2021). Although Dahle et al. (2011) found that individuals with dyslexia rated higher on externalizing than internalizing problems, it is crucial to be aware that internalizing problems often go unnoticed. Accumulatively, internalizing problems can lead to more severe behavioral disorders, affecting the individual mentally, physically, and socially. This highlights that paying attention to the function of problem behavior is often more important than paying attention to the form of problem behavior. When the function of one’s problem behavior is handled appropriately, all forms of the problem behavior that share the same function are likely to disappear. For example, a student cannot read and thus exhibit act-out behaviors like kicking, cursing, and fighting to avoid reading tasks. If the student learns how to read and becomes engaged in reading tasks, it will reduce different forms of problem behaviors resulting from being unable to read.
The Importance of Early Identification and Support Systems
Kjersten (2017) stated that a diagnosis for individuals with dyslexia has proved beneficial as it provides a sense of relief, a reason for their struggles, and an understanding of their experiences. Several research articles mentioned that the late diagnosis was an immense contributing factor to emotional problems in individuals with dyslexia. A research study by Morgan and Klein (2000) pointed out that adults diagnosed with dyslexia in their later lives experienced the feeling of being inadequate, frustrated, and angry in school. De Lima et al. (2020) found that possible underlying factors to late diagnosis are low social support, which could increase the risk of comorbidities and impact their development. Research suggests the earlier dyslexia is diagnosed, the earlier the individual can begin to understand what is going on, gain support, and possibly lessen emotional problems. Ihbour et al.’s (2021) study reinstated the need for early intervention of the psycho-affective difficulties (emotional problems) these individuals might face. If they do not receive help and learn coping mechanisms for dyslexia, internalizing problems can follow them into adulthood, highlighting the importance of early intervention (Livingston et al., 2017).
A late diagnosis and lack of understanding go hand in hand. Often students with dyslexia do not understand what is going on with them. They feel inferior due to bad grades, parents, teachers, or peers treating them differently. Huang et al. (2020) found that students with dyslexia typically have low academic scores and unstable emotions because parents, teachers, and others do not understand the difficulties they face. When educators understand what these students are experiencing, they will find ways to make information accessible to the students, together educating others about dyslexia. When family and peers of the students support them, it will increase their positive self-concept (i.e., the perceptions of their abilities) and higher self-esteem (Terras et al., 2009). Similarly, Huang et al. (2020) found that when students with dyslexia have positive home environments, they tend to have fewer behavioral problems. There are multiple reasons why a sound support system is essential. Students with dyslexia who have a sound support system are more likely to ask for help and push through their difficulties (Kjersten, 2017). Having someone’s support validates one’s feelings, making them feel valued and understood.
Sometimes though, students with dyslexia do not have a sound support system due to their teachers’ and peers’ stigma resulting from a lack of knowledge about dyslexia (Livingston et al., 2017). Teachers may attribute students’ bad grades as just personal laziness. In the documentary on dyslexia, Jonathan Mooney discussed his experience with his teachers and peers growing up. He would be told that he was stupid, bad, and lazy; he felt demeaned as a human being (Raymond, 2011). In the same documentary, a student with dyslexia discussed the time he was trying to share what he was experiencing in school and the difficulty he was having. His teacher said he was pretending. Teachers can sometimes make the problem worse with attitudes like that. They should try to be more proactive and helpful when noticing students struggling (Raymond, 2011). Some entrenched systems in education have put students into boxes. Not all students learn the same way. Especially for those with a learning disability such as dyslexia, education should be more fluid and allow for different techniques. There may be other factors contributing to why individuals with dyslexia have a higher prevalence of mental health issues, but these appear to be the main ones.
What Educators Can Do to Help
Fostering inclusion and awareness about dyslexia benefits all students. To achieve this, it will require educators to be competent in the complexities of dyslexia. They will need to know how to identify symptoms, assess the impacts of the symptoms on students’ lives, and support them. Based on the literature review and our clinical experience, there are five concrete actions that educators can do to improve the mental health of individuals with dyslexia and create a healthy learning environment for them: 1) Raising awareness, 2) identifying internalizing and externalizing problems, 3) collaborating with stakeholders, 4) advocating for dyslexia, and 5) providing direct services.
Raising Awareness
Students with dyslexia often experience difficulties with sequencing and processing, directly or indirectly affecting their mental health. Educators thus need to learn effective ways to serve students with dyslexia and be the source of support to them and their families (Kjersten, 2017). It is equally essential for students with dyslexia to be aware, so they can begin to understand what they have been going through.
Identifying Internalizing and Externalizing Problems
Educators need training on identifying and assisting their students with mental health problems, which includes being aware of students’ externalizing and internalizing problems associated with dyslexia (Dahle et al., 2011). Acknowledging the internal problems (e.g., stress, anxiety) can provide insight into the external problems. Once the educator has identified the internalizing problems, they can work collaboratively with the students to improve their behaviors. This approach can be efficacious in improving the student’s mental health and holistic well-being as well as promoting a better understanding of dyslexia.
Collaborating with Stakeholders
It is beneficial for the educator to work with the individual’s family and teachers. Collaborating with peers and family is essential for emotional and academic support (Zuppardo et al., 2021). According to De Lima et al. (2020), interventions for individuals with dyslexia should target cognitive, linguistic, and psychological aspects, which call for an interdisciplinary approach that involves educators across fields. Academic success and mental health are intertwined. Enhancing academic outcomes affect students’ social adjustment and emotional stability. Therefore, working collaboratively with specialists across disciplines would create an all-around supportive environment.
Advocating for Individuals with Dyslexia
Once educators have in-depth knowledge about the intricacies of dyslexia, they can better inform families, schools, and communities about the best way to support students with dyslexia. They further advocate what training and resources are needed for parents, teachers, and students with dyslexia. When educated, parents can advocate with teachers to maximize services and resources that involve academic and mental health support for children with dyslexia.
Providing Direct Services
Research has suggested possible ways that could be used to help students with dyslexia improve their mental health. One is the strengths-based approach (SBA), which focuses on the individual’s strengths to assist in recovery and empowerment (Kress et al., 2021). This technique would allow the student to see their strengths instead of just focusing on the areas they struggle with. Educators can also reframe the student’s mindset and see their disabilities positively. Livingston et al.’s (2017) findings suggest the importance of reframing personal attitudes about learning disabilities to focus on their strengths and successes to reduce negative emotional thoughts. In addition, interventions that promote positive emotions could serve as the foundation for one’s development across academic, social, and behavioral aspects (Zuppardo et al., 2021). Thus, reframing their mindset to see things in a positive light and focusing on their strengths could be an effective intervention to improve any emotional problems they are experiencing. Further, Pehrsson and McMillen (2007) reported that bibliotherapy is an approach to help students with mental health issues. In bibliotherapy, educators carefully select reading materials based on students’ interests and abilities. Students then share how the story relates to their issues. In the open, non-judgemental dialogue, educators redirect students to more positive perspectives toward the issues. In addition, a multisensory approach would be another practical approach to working with students who have dyslexia. This approach includes using visual tools (e.g., drawings), auditory tools (e.g., students hear themselves speak and the educator’s reflections), and tactile tools (e.g., role-playing) to allow students to process information in different ways and have sufficient practice opportunities (Kjersten, 2017). SBA, bibliotherapy, and multisensory approaches can be easily incorporated into the school setting to support the mental health of students with dyslexia.
Conclusion
In summary, dyslexia is associated with students’ emotional and behavioral problems. Research has illustrated underlying factors as to why dyslexia predicts depression, anxiety, and low self-esteem. Some factors include late diagnosis, lack of understanding of dyslexia, no support, and the education system, suggesting the importance of early identification and support systems. Techniques and approaches can be implemented in the school setting to improve students’ mental health and well-being. Educators can raise awareness of dyslexia among those students and the people in their lives to promote understanding. From there, they work collaboratively with all stakeholders and advocate for students with dyslexia. Through understanding dyslexia, they identify the internalizing and externalizing problems students with dyslexia are experiencing and provide services to support their development of mental health. Raising awareness, identifying internalizing and externalizing problems, collaborating with stakeholders, advocating for dyslexia, and providing direct services are concrete and practical actions educators can do to create equal opportunities and advantageous qualities in students with dyslexia.
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