Health: A wobble now means less work later: Dyslexia often goes undiagnosed in children until they are nine or ten. A new test could enable them to get help earlier, says Nigel Howard

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Ellie Nicolson, aged nearly five, bites her lip in concentration as she stands blindfolded, one foot in front of the other, her arms outstretched. She balances for 30 seconds in front of a video camera which records the number and size of her wobbles.

It may look odd but Ellie's future, and that of thousands of other children, could be at stake. For this, exercise, in conjunction with several other simple tasks, can reveal whether a child is dyslexic and will need special help in the early years at school.

The balancing act was developed by a team of research psychologists, Angela Fawcett, Paul Dean, and Ellie's father Rod Nicolson, senior lecturer and head of the department at Sheffield University. It is part of a 30-minute test for children starting school, which the Sheffield team plans to have available for use this September. Initially a number of schools will be involved as part of a programme funded by the Medical Research Council.

Dyslexia affects one child in 20 and is defined by the World Federation of Neurologists as 'a disorder in children who, despite conventional classroom experience, fail to attain the language skills of reading, writing and spelling commensurate with their intellectual ability.'

Britain's two million dyslexics often endure years of difficulty at school, are frequently branded as slow learners and occasionally as handicapped. Most are not diagnosed as dyslexic until they reach the age of seven or eight without having learnt to read.

Dr Fawcett decided to test the balance of dyslexic children after researchers in the United States put forward a new, still controversial, theory about the region of the brain known as the cerebellum.

The cerebellum - located behind the brain stem - is concerned with posture, balance and co-ordination. The American theory argues that the cerebellum is involved in thinking and language processing as well as in the co-ordination of muscle activity and the maintenance of muscle tone and balance.

Dr Fawcett started working with children from Mark College, a school for the dyslexic in Somerset, and compared them with a group of 'normal' children. She found that, while balancing ability was similar without a blindfold, the performance of the dyslexic youngsters was far worse than the 'normals' once all visual help was removed.

She then tried using tests on muscle tone which are normally used to check for cerebellum problems after people have suffered head injuries. Here, too, the dyslexic children performed poorly. The results were so impressive that the MRC awarded Dr Fawcett a grant to develop the tests for use in schools.

She says: 'Dyslexia is not just about reading difficulties. It seems reading and spelling problems are the tip of the iceberg. Our work shows that dyslexic children have to try harder and concentrate more to perform basic skills as well as non-dyslexics. For instance, they rely heavily on visual clues to help them balance. That is why they have so much difficulty when blindfolded.'

Scientists have long been puzzled by the cerebellum's large size in humans, compared with other animals. But a growing number of researchers in the US believe they have an answer.

New brain-scanning techiques have revealed that, even in the absence of any motor activity, parts of the cerebellum are used when we think and speak. They speculate that the development of a big cerebellum may have been necessary before human language could evolve.

Dr Dean says: 'The cerebellum could be described as an extremely complex auto-pilot system. As we learn new skills this system gradually becomes programmed so that when we need that skill again, the cerebellum takes over and the activity is performed automatically.

'If there is a problem and the cerebellum cannot be programmed, you have difficulties learning new skills. Then, even if you do learn to do it, you may still have to think about what you are doing each time. The US research and our own work certainly seem to suggest that this could be happening in dyslexia.'

The research shows that as well as balance and literacy, most dyslexic children also have problems with memory, speed of reactions and in distinguishing between sounds. The Sheffield test therefore includes balancing, word rhyming, repeating a nonsense word, pressing a button on hearing a tone and naming objects pictured on cards. The results are recorded on a computer which then calculates the risk of dyslexia.

Dr Fawcett says: 'We are modifying the balance test so that a video camera is not needed. The test can be done in a child's first term at school by a school nurse or a teacher, and should take about 30 minutes. Children identified as 'at risk' by our test can then be sent for IQ testing and psychological assessment.

'At present a child is sent to school and we wait until he or she is not learning. But this could be for all sorts of reasons. Children learn at different rates. Some start slowly and catch up and so the tendency is to wait and see.

'But dyslexia gets worse if you don't intervene. The gap in learning gets wider, the dyslexic child gets more and more frustrated and the issue becomes fraught with emotional difficulties which make learning even harder.

'Remediation does work. You can't cure dyslexia but you can prevent children suffering for it. If you can identify these children early on and give them six months' concentrated help they can catch up and keep up and you can save the three or four years' extra help that will be needed if the problem is not discovered until the age of nine or 10.'

Dr Fawcett maintains that, with early help, dyslexics can learn to read as well as anyone else, although perhaps not as quickly. They will probably always have trouble with spelling, however.

She says: 'Dyslexic students at university perform well, they just take longer to write their assignments. There is no reason why, once over the 'reading hump', dyslexic children cannot fulfill their intellectual potential.'

(Photograph omitted)

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