Individuals who struggle with reading problems such as Dyslexia usually struggle with word decoding or comprehension.  Frequent complaints include having to read and re-read text multiple times, forgetting what one has read, reading very slowly or substituting/guessing words based on context.  To become an effective reader an individual must have intact phonological processes, orthographic processes, and phonological fluency.

In over 80% of Dyslexia cases the individual has difficulty with phonological processing, that is difficulties with auditory processing or making sense of the individual sounds in words and sound-symbol relationships which represents the ability to understand individual sounds and the letters used to symbolize those sounds. These individuals may, in many cases, have a history of ear infections and required placement of myringotomy tubes.  Language delays or difficulties may also have been present (e.g., problems with articulation, language comprehension or expression). Intact phonological awareness is critical for word decoding (sounding out the words/reading).  Individuals with impaired phonological awareness may compensate by memorizing sight words, guessing at words based on their configuration or the context in which they are located.  This can lead to decreased comprehension of written material, particularly in higher grades.

Further, fluent reading refers to reading that is smooth, rapid, and automatic.  Individuals with fluency deficits can often decode words adequately, but they do it in a more laborious manner and frequently make many errors when spelling.  Typically, a person will struggle to connect the visual symbols they see on a page with their verbal (sound) labels (known as rapid naming or the speed of visual-verbal associations). These individuals often struggle with holding information in mind and working with it for short periods (short term memory/working memory and processing speed) and report that they quickly forget what they have just read.  These types of difficulties are often associated with conditions affecting attention and executive processes and are frequently found in individuals with inattentive subtype of ADHD.

Although controversy currently exists in the scientific literature, some believe that a very small minority of individual may have difficulties with orthographic processes.  These individuals can decode words that make phonemic sense (are spelled as they sound like “to”) but have trouble with irregular words like “two” (may pronounce as “twah”).  Often their reading is slow and laborious.  This type of reading disorder sometimes has a perceptual component in which letters are misidentified (e.g., confuse b, d, p, q, s & z) or transposed (i.e., letters within a word are switched), or letters in the middle of the words are missing during reading.  At the same time, many researchers now believe that such deficits are also attributable to subtle deficits in phonological processing (see work by Sally Shaywitz), more specifically at the level of analysis and synthesis.

There are several reasons why people may experience difficulties with reading comprehension. In some cases, the difficulties are due to challenges with language processes such as comprehension, but in other cases, the difficulties may be a result from working memory/attention or executive processes.

When conducting a neuropsychological evaluation, the aim is to determine why the individual is struggling with reading, examining which aspects of the reading and cognitive process are not operating properly, and then recommending scientifically based accommodations and rehabilitation strategies.