Diagnosis and management of reading dysfunction for the primary care optometrist

A model for the identification/diagnosis and management of reading dysfunction for the primary care optometrist is presented. The model is based upon clinical experiences in both private and academic practice and an extensive review of the literature. The model, illustrated in a series of flow charts and a table, incorporates the major perceptual dysfunctions typically encountered by patients who present with reading problems. The first part of the model, labeled fundamental, demonstrates the minimum diagnostic and management techniques for those children who appear to have reading dysfunction. The second part of the model, labeled complex, provides a more extensive diagnostic and management approach. The validity of the approach is further illustrated in a series of 13 arbitrarily selected cases of reading dysfunction which are statistically analyzed. Robust correlations are found among different tests of visual-motor skills (Bender, Test of Visual Analysis Skills), a test of short-term memory (Getman-Henderson-Marcus Test of Visual Recall), and reading decoding. Modest correlation is also found between a test of auditory perception, The Test of Auditory Analysis Skills (TAAS) and reading decoding. Direct testing for dyslexia using the Dyslexia Determination Test illustrates that not all those with reading dysfunction are dyslexic.