Introduction

The concept of dyslexia can be confusing to clinicians who encounter children with severe reading difficulties within their day-to-day practice, given the problems of definition. Usually, such reading difficulties are accompanied by emotional and/or behavioural adjustment problems, or more widespread problems at school, hence the child's referral into child mental health services. Understanding the nature of the reading difficulty offers the prospect of prioritising treatment alternatives. For instance, if a child has a specific reading difficulty that has resulted in much teasing at school, and high levels of parental disapproval, he/she may then manifest symptoms of anxiety that will in turn further hamper the acquisition of reading skills. Remedial teaching, albeit accompanied by work with parents to foster an understanding of their child's difficulties, becomes an urgent priority. Alternatively, it is possible to envisage a situation in which an emotionally abused child is too distressed to acquire reading skills commensurate with their cognitive potential. With the latter child, the underlying causes of their presenting reading difficulty are emotional in origin rather than reflecting a core difficulty or abnormality in their cognitive processing. Although remedial reading may well be necessary at some stage, the clinician should first concentrate on alleviating the abuse. These are, of course, extreme examples and children rarely present in such a clear-cut way. Nonetheless, it is important for the clinician to know whether there is a group of children with meaningfully divergent reading difficulties, such that they can be characterised as having a specific reading retardation. If there are such children, how would they be identified and distinguished from those readers regarded simply as generally poor readers; what is the prognosis for such children; and what remediation would be appropriate and helpful?